RESUMO
BACKGROUND AND OBJECTIVE: The predictive Khorana's model was developed to score the thromboembolic disease risk in cancer patients on chemotherapy and to identify which patients would benefit from thromboprophylaxis. We analized the results and applied the predictive Khorana's model in patients with cancer and who were diagnosed with deep vein thrombosis. MATERIAL AND METHODS: Retrospective analysis of prognostic characteristics of Khorana's model in 122 patients based on a prospective analysis. RESULTS: Seventy-nine percent of the total were in the low and intermediate risk category and 21% had high risk according to the Khorana's predictive model. This model had a sensitivity and prognostic precision of 20.8% (95% confidence interval [95% CI]: 14.6-28.7) and a false negatives proportion of 79.2% (95% CI: 1.3-85.4). CONCLUSIONS: Application of this model in our patients would not be enough as the unique tool to identify cancer patients who should receive tromboprophylaxis. The use of both biomarkers and clinical models seems to be the best cost-effective strategy for this purpose. Future, randomized, prospective, placebo-controlled studies are needed for find better treatment strategies in cancer patients.
Assuntos
Anticoagulantes/uso terapêutico , Técnicas de Apoio para a Decisão , Neoplasias/complicações , Tromboembolia/prevenção & controle , Trombose Venosa/prevenção & controle , Humanos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade , Tromboembolia/etiologia , Trombose Venosa/etiologiaRESUMO
Fundamento y objetivo: El modelo predictivo de Khorana se desarrolló para estratificar el riesgo de enfermedad tromboembólica en pacientes con cáncer y en tratamiento con quimioterapia y, por tanto, identificar a aquellos que podrían beneficiarse de tromboprofilaxis. Analizar los resultados de la aplicación del modelo predictivo de Khorana en una cohorte de pacientes con cáncer y que fueron diagnosticados de trombosis venosa profunda (TVP). Pacientes y métodos: Análisis retrospectivo de las características pronósticas del modelo de Khorana en 122 pacientes con cáncer y TVP, basado en una recogida prospectiva de datos. Resultados: Se catalogó al 79% como pacientes de riesgo bajo e intermedio, y al 21% como de alto riesgo. La escala de Khorana tuvo una sensibilidad y exactitud pronóstica del 20,8% (intervalo de confianza del 95% [IC 95%]: 14,6-28,7) y una proporción de falsos negativos de 79,2% (IC 95%: 1,3-85,4). Conclusiones: La aplicación de este modelo en nuestros pacientes resultaría insuficiente como única herramienta para identificar a los enfermos con cáncer que deberían ser tratados con tromboprofilaxis. El uso de biomarcadores junto a modelos clínicos parece ser la mejor estrategia costo-efectivas para identificar a pacientes candidatos al tratamiento profiláctico. Estudios amplios, prospectivos, randomizados y con placebo deberían decidir si esta estrategia es la más válida (AU)
Background and objective: Khorana predictive model was developed for scoring the risk of thromboembolic disease in cancer patients on chemotherapy and to identify which patients would benefit from thromboprophylaxis . We analyze the results and apply the predictive model Khorana in patients with cancer who were diagnosed with deep vein thrombosis. Material and methods: Retrospective analysis of prognostic features Khorana model in 122 patients on the basis of a prospective analysis. Results: Seventy -nine percent of the total were in the category of low and intermediate risk and 21 % had a high risk according to the predictive model Khorana . This model had a sensitivity and prognostic accuracy of 20.8 % (95 % confidence interval [95% CI ] : 14.6 to 28.7 ) and a false negative rate of 79.2 % ( 95% CI : 1 , 3 to 85.4 ) . Conclusions: The application of this model in our patients would not be sufficient as the only tool to identify patients with cancer who should receive tromboprophylaxis . The use of both biomarkers and clinical models seems to be the best strategy for this purpose cost effective. Further studies , prospective, randomized , placebo-controlled to find better treatment strategies in cancer patients are needed (AU)
Assuntos
Humanos , Tromboembolia Venosa/complicações , Neoplasias/complicações , Anticoagulantes/uso terapêutico , Previsões/métodos , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
El cáncer de lengua es una entidad oncológica de baja incidencia; a nivel de cavidad bucal representa la segunda neoplasia más frecuente, luego del cáncer de labio. En el rabdomiosarcoma embrionario, los factores concurrentes son la predisposición genética y las alteraciones cromosómicas. El objetivo de este trabajo es presentar un paciente con un tipo histológico infrecuente en adultos como es el rabdomiosarcoma embrionario de lengua, pero de gran agresividad y capacidad de invasión local, el cual antes del año, posterior a la terapia, recidiva en el mismo sitio; a pesar de no invadir ganglios, es de alta morbilidad por el deterioro del habla y de la deglución, además del riesgo permanente de fístulas oro-traqueales.
Tongue cancer is an oncological entity of low incidence; it represents the second more frequent neoplasia in oral cavity, after lip cancer. In the embryonic rabdomyosarcome the concurrent factors are the genetic basis and the cromosomic disorders. The objective of this work is to present a patient with an uncommon histological type for adults, such as the embryonic tongue rabdomyosarcome, but very aggressive and highly capable of local invasion, which, one year post therapy, relapses in the same site in less than in spite of not invading ganglion, it is of high morbility the deterioration of speech and deglution, due to besides the permanent risk of traqueobroncheal fistulas.
Assuntos
Masculino , Adulto , Rabdomiossarcoma , Rabdomiossarcoma Embrionário , Neoplasias da Língua , Afonia , Transtornos de DeglutiçãoRESUMO
Tipo de estudio: Retrospectivo y comparativo en el hospital Dr. Juan Tanca Marengo ION SOLCA de la ciudad de Guayaquil, durante el período comprendido de enero de 1991 a diciembre del año 2000, sobre cáncer de tiroides.Objetivo: Comparar en dos grupos problema de 33 pacientes cada uno, variables referentes a sexo, edad, tipo histológico, y fundamentalmente el periodo de remisión tumoral entre dos terapéuticas que se presentaron durante estos diez años como parte del protocolo utilizado en la institución donde se llevó a cabo el estudio.Resultados: De 131 pacientes, 66 participaron en el estudio, pudiéndose constatar que es una patología con mayor incidencia en las mujeres relación mujer hombre: 2.81, que si bien el tipo histológico fue contundentemente el carcinoma papilar, se observó una proporción idéntica entre el cáncer folicular y el cáncer anaplásico, dato que no se reporta normalmente en otros países. Finalmente y los más importante fue que pacientes que fueron solamente operados recidivaron en un 61% vs. un 15% en pacientes que posteriormente de la cirugía recibieron Yodo 131, concluyéndose que esta asociación es el tratamiento de elección para pacientes con cáncer diferenciado de tiroides sin importar edad y estadio de la enfermedad.Conclusiones: Mujeres menores de 40 años y económicamente activas fueron la mayor incidencia por lo que el factor hormonal y laboral esta relacionado en la etiología; la terapia combinada debe ser instaurada de forma sistemática a pacientes con Ca diferenciado de tiroides.
Type of study: Retrospective and comparative study at the Dr. Juan Tanca Marengo Hospital ION SOLCA in the city of Guayaquil, during the period of time between January of 1991 to December of the year 2000, in a group of patients with thyroid cancer.Objective: To compare two groups of 33 patients. The variables are: sex, age, histological type, and fundamentally the period of tumor remission between two therapeutic treatments that were presented during these ten years as part of the protocol used in the institution where the study was carried out.Results: Of 131 patients, 66 participated in the study, being able to verify that it is pathology with more incidences in the women. Where the ratio between woman - man: 2.8 - . Overwhelmingly the most frequent malignancy was the Papillary Carcinoma. An identical ratio was observed between follicular and anaplastic carcinoma a finding that is not usually reported in other countries. The most important finding was that patients that were solely operated recurred in 61% vs. only 15% in patients that after surgery they received Iodine 131. We conclude that this association of surgery and treatment with Iodine 131 is the goal treatment for patients with differentiated thyroid cancer without emphasis on age and stage of the illness.Conclusions: Women less than 40 years of age and economically active had a higher incidence due to the hormonal and labor factor which is associated with the etiology. Patients with Differentiated thyroid Cancer should receive the combined treatment.
Assuntos
Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Terapia Combinada , Neoplasias da Glândula Tireoide , Adenocarcinoma Folicular , Adenocarcinoma Papilar , Carcinoma Papilar , Carcinoma Papilar, Variante FolicularRESUMO
Existen múltiples tumores vesicales que no son muy frecuentes a nivel mundial, uno de ellos es el leiomioma de vejiga (LV); es un tumor mesenquimatoso benigno que deriva del tejido muscular liso, de muy rara incidencia, representando apenas el 1 de los tumores vesicales. Reportamos 2 casos clínicos de pacientes diagnosticados con leiomioma de vejiga en nuestro instituto, cuya conducta terapéutica se resolvió por cirugía abierta debido a la magnitud de la tumoración en el primer caso, y por medio de resección transuretral (RTU) el otro caso. En ambos pacientes se presentó hematuria y síntomas de almacenamiento, principalmente disuria. Actualmente, ambos pacientes están vivos. El objetivo de este trabajo es dar a conocer a la comunidad médica y oncológica estos casos para tenerlos en cuenta en el diagnóstico diferencial de tumores vesicales.
There are multiple bladder tumors that are not very frequent around the world, one of them is bladder leiomyoma (BL); it is a benign mesenchymatous tumor derived from smooth muscular tissue, very rare in frequency, representing hardly 1 of bladder tumors. We present 2 clinical cases of patients in our institute with the diagnosis of bladder leiomyoma, solved by open surgery in account of the size of the tumor in the first case and through transurethral resection (TUR) the second one. Both patients had hematuria and storage symptoms, mainly dysuria. At present both patients are alive. The objective of this paper is to make known these cases by the medical and oncologic community for they bear them in mind in bladder tumors differential diagnosis.