Coagulopatías por consumo en el paciente con cáncer / Consumptive Coagulopathies in the Patient with Cancer

Introducción: Los trastornos de la coagulación durante el perioperatorio de pacientes oncológicos, son eventos más frecuentes de lo que se conoce en realidad, debido a que un gran número de estos transitan de forma inadvertida. Objetivo: Describir los factores fisiopatológicos que propician la ocurrencia de las coagulopatías adquiridas por consumo durante el perioperatorio del paciente oncológico. Métodos: Se realizó una revisión narrativa, en idiomas español e inglés, se utilizaron como fuente de búsqueda las bases de datos Ebsco, SciElo, Pubmed, Cubmed, Hinary, durante el período de enero a marzo de 2022, y el referenciador Zotero versión 5.0. Resultados: Para comprender qué pasa en el paciente con cáncer en relación con las coagulopatías por consumo es necesario entender la fisiología de los mecanismos de la coagulación. En este sentido, se pueden observar tanto trastornos trombóticos como hemorrágicos, por el incremento del factor tisular que determina la formación de trombina y el fallo de los mecanismos antifibrinolíticos. También, factores como la radioterapia, la quimioterapia y la transfusión de hemocomponentes, aumentan el riesgo de padecerlas. Conclusiones: la coagulopatía por consumo en el paciente oncológico es una entidad multifactorial, compleja y dinámica, en la que se debe pensar y diagnosticar para evitar complicaciones graves en el período perioperatorio.

Introduction: Coagulation disorders during the perioperative period of cancer patients are more frequent events than is actually known, due to the fact that a large number of these go unnoticed. Objective: To describe the pathophysiological factors that favor the occurrence of consumption-acquired coagulopathies during the perioperative period of cancer patients. Methods: A narrative review was carried out, in Spanish and English, using the Ebsco, Scielo, Pubmed, Cubmed, Hinary databases as a search source, during the period from January to March 2022, and the Zotero version 5.0 referer. 96.3. Results: To understand what happens in cancer patients in relation to consumption coagulopathies, it is necessary to understand the physiology of coagulation mechanisms. In this sense, both thrombotic and hemorrhagic disorders can be observed, due to the increase in the tissue factor that determines the formation of thrombin and the failure of antifibrinolytic mechanisms. Also, factors such as radiotherapy, chemotherapy and transfusion of blood components, increase the risk of suffering from them. Conclusions: consumption coagulopathy in cancer patients is a multifactorial, complex and dynamic entity, which must be considered and diagnosed to avoid serious complications in the perioperative period.

Unusual primary central nervous system T-cell/histiocyte-rich large B-cell lymphoma: a case report.

We report the case of a 54-year-old immunocompetent woman who presented with a primary T-cell/histiocyte-rich large B-cell lymphoma (TCHRLBCL) of the central nervous system without systemic involvement, diagnosed by means of a brain biopsy. She was treated with corticosteroids and we subsequently started chemotherapy with rituximab, methotrexate, ifosfamide and intrathecal cytarabine. The patient's symptoms gradually improved over the first weeks and we followed-up with autologous haematopoietic cell transplantation. The patient has been in complete remission for a year. Primary TCHRLBCL of the central nervous system in an immunocompetent patient is an extremely rare condition that requires a multidisciplinary approach. This case highlights the importance of undergoing a sequential work-up and establishing a treatment despite the absence of evidence-based guidelines.

[Hypervitaminosis B12. Our experience and a review]. / Hipervitaminosis B12. Nuestra experiencia y una revisión.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

Hipervitaminosis B12: Nuestra experiencia y una revisión / Hypervitaminosis B12. Our experience and a review

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

Twenty years of experience in vascular reconstructions associated with resection of malignant neoplasms in a single cancer center.

OBJECTIVE: Vascular invasion is no longer considered to be an absolute contraindication to tumor removal, and complex reconstructions are part of the daily activity of vascular surgeons in specialized cancer centers. Our aim was to report a single-center experience of complex vascular reconstructions involving en bloc resection of tumors and patients' long-term survival and graft patency outcomes. To the best of our knowledge, this is the largest report of vascular reconstructions published to date, with the longest follow-up. METHODS: Between September 1997 and January 2016, there were 91 patients who underwent 92 arterial and 47 venous reconstruction procedures in this retrospective cohort study. Long-term survival and patency outcomes were analyzed for all study patients and individually assessed in different body segments (head and neck, thorax, upper limbs, abdomen, and lower limbs). RESULTS: The estimated mean and median follow-up times were 112.66 and 100 months, respectively. The 24- and 60-month survival estimates for the patients overall were 55.3% and 31.1%, respectively. Survival estimates were significantly lower in the head and neck cases compared with the other body segments. The primary arterial patency rates at 24 and 60 months were 96.7% and 84.9%, respectively, and they were similar in all body segments. The venous patency rates were 71.4% and 64.2% at 24 and 60 months, respectively. Seven cases (7.6%) of arterial vascular complications were observed. CONCLUSIONS: Vascular reconstruction performed in conjunction with oncologic resection is a feasible treatment option for tumors with vessel involvement. When surgery is performed in specialized centers, low perioperative morbidity and long-term patency rates are expected irrespective of the vascular territory undergoing intervention.

Postsurgical pyoderma gangrenosum after an autologous stem cell transplantation for multiple myeloma.

We report a man who underwent autologous stem cell transplantation (ASCT) for multiple myeloma. Two months after ASCT, he presented with necrotising cholecystitis due to gallbladder stones and was submitted to laparoscopic cholecystectomy. About a week later, he developed progressive skin ulcers at sites where trochanters had been inserted. Progressive enlargement and necrotic aspect of these ulcers took place despite debridement and large spectrum antibiotics. New ulcers developed at the site of enoxaparin injection at the right arm (pathergy phenomenon). A skin biopsy and clinical evaluation favoured the diagnosis of pyoderma gangrenosum (PG). He was treated with daily methylprednisolone and dapsone with improvement of the lesions. This is the first case in the literature of PG after ASCT. Despite the risk factors, the onset of an autoinflammatory disease right after the transplant is intriguing since PG is extremely rare in immunocompromised patients.

Sexual satisfaction in patients with cancer / Satisfacción sexual en enfermos de cáncer / Satisfação sexual em pacientes com câncer

Abstract This study aimed to compare the dimensions of sexual satisfaction in subjects with and without cancer. Independent variables were: different types of cancer, time elapsed since diagnosis, types of treatment and changes in body image. The dependent variable was level of satisfaction with sexual relations. The sample consisted of 184 participants, of whom 95 belonged to the cancer group (ages between 26 and 84 years) and 89 to the non-cancer group (ages between 19 and 67 years). The instrument used was the Sexual Satisfaction Questionnaire (QSRS, for its Portuguese acronym). The results showed significant differences between the cancer group and the non-cancer group. Individuals with a history of cancer disease had lower values (17.93 ± 9.67) at the level of sexual function compared to individuals with no history of the disease (30.19 ± 4.2). Individuals with cancer who had higher values of self-esteem were those with urological cancer (16.76 ± 2.85), followed by breast cancer (14.83 ± 3.34) and "other cancers" (14.41 ± 5.5), whereas those with digestive cancer presented the lowest values (5.68 ± 13.63). In sexual functioning, the group of "other cancers" showed the highest levels of satisfaction (23.53 ± 10.12), while people with breast cancer (19.54 ± 9.36), digestive cancer (18.50 ± 12.57), and urological cancer (29.12 ± 7.22) presented the lowest levels of satisfaction. Within the group of people with cancer, those who had less than one year and between three to five years of having been diagnosed reflected less satisfactory sexual performance values. On the other hand, radiation treatments, surgery and "other treatments" showed negative effects on sexual functioning, as well as changes in body image. All independent variables had a negative impact on sexual satisfaction and performance, with the exception of weight loss, vomiting, and hair loss.

Resumen Este estudio tuvo como objetivo comparar las dimensiones de satisfacción sexual en sujetos con y sin cáncer, específicamente al comparar los diferentes tipos de cáncer, el tiempo de diagnóstico y los tipos de tratamiento, con cambios en la imagen corporal y el nivel de satisfacción con las relaciones sexuales. La muestra estuvo compuesta por 184 participantes, de los cuales 95 pertenecieron al grupo con cáncer (edades entre los 26 y 84 años) y 89 al grupo sin cáncer (edades entre los 19 y 67 años). El instrumento utilizado fue el Questionário de Satisfação com o Relacionamento Sexual (QSRS). Los resultados mostraron diferencias significativas entre el grupo con cáncer y el grupo sin cáncer, los individuos con antecedentes de enfermedad de cáncer presentaron valores más bajos (17.93 ± 9.67) en el nivel de la función sexual en comparación con los individuos sin antecedentes de dicha enfermedad (30.19 ± 4.2). Los individuos con cáncer que presentaron valores más altos en autoestima fueron los de cáncer urológico (16.76 ± 2.85), seguidos por los de cáncer de mama (14.83 ± 3.34) y "otros tipos de cáncer" (14.41 ± 5.5); siendo los de cáncer digestivo quienes presentaron los valores más bajos (5.68 ± 13.63). En el funcionamiento sexual, el grupo de "otros tipos de cáncer" mostró niveles más altos de satisfacción (23.53 ± 10.12), mientras que las personas con cáncer de mama (19.54 ± 9.36), cáncer digestivo (18.50 ± 12.57) y cáncer urológico (29.12 ± 7.22) presentaron los niveles más bajos de satisfacción. Dentro del grupo de personas con cáncer, los que tienen menos de un año y de tres a cinco años después de haber tenido el diagnóstico reflejaron valores de funcionamiento sexual menos satisfactorios. Por otro lado, los tratamientos de radiación, cirugía y "otros tratamientos" mostraron efectos negativos en el funcionamiento sexual, así como cambios en la imagen corporal. Todas las variables independientes tuvieron un impacto negativo en la satisfacción y el desempeño sexual, con excepción de la pérdida de peso, el vómito y la pérdida de cabello. Palabras clave: Cáncer, sexualidad, funcionamiento sexual, enfermedad maligna.

Resumo O objetivo foi comparar indivíduos em função das seguintes variáveis independentes: cancro e sem cancro, diferentes tipos de cancro, tempo de diagnóstico, diferentes tipos de tratamento e mudanças na imagem corporal tendo por variável dependente o nível da satisfação da relação sexual. A amostra foi constituída por 184 participantes (95 com cancro com idades entre 26 e 84 anos; 89 sem cancro, com idades entre 19 e 67 anos). Foi utilizado o Questionário de Satisfação com o Relacionamento Sexual (QSRS). Verificaram-se efeitos significativos entre os indivíduos com historial de doença oncológica ao nível do funcionamento sexual, comparativamente com os indivíduos sem historial de doença oncológica. Indivíduos com cancro urológico apresentam valores mais elevados ao nível da autoestima (16.76 ± 2.85), seguidos pelo cancro de mama (14.83 ± 3.34) e outros tipos de cancro (14.41 ± 5.05). O cancro digestivo é o que apresenta os valores mais baixos (13.63 ± 5.68). Com relação ao funcionamento sexual, o grupo "outros tipos de cancro" apresenta maiores níveis de satisfação (23.53 ± 10.12). Seguem-se o cancro de mama (19.54 ± 9.36) e os digestivos (18.50 ± 12.57) e, por último, o cancro urológico, que apresenta os níveis mais baixos (12.29 ± 7.22). Dentro do grupo de indivíduos com cancro, o período inferior a um ano e de três a cinco anos apresenta valores menos satisfatórios na dimensão funcionamento sexual, e os tratamentos de radioterapia, cirurgia e "outros tipos de tratamento" produzem efeitos negativos ao nível do funcionamento sexual, assim como as mudanças na imagem corporal. No presente estudo, com a exceção de perda de peso, vómitos e perda de cabelos, todas as variáveis independentes têm um impacto negativo na satisfação/desempenho sexual.