RESUMEN
BACKGROUND: Communication between physicians and patients is a fundamental aspect of cancer care, yet most physicians' perceptions are often inconsistent with the patients' stated preferences while prognostic information is the most misunderstood. PATIENTS AND METHODS: Members of the Brazilian Society of Oncology Physicians (n=609) were identified and asked to complete a mailed questionnaire. Outpatients (n=150) and their family members (n=150), oncologists and fellows (n=55) from a public healthcare hospital and a tertiary cancer hospital in Sao Paulo were also personally invited to participate. RESULTS: A total of 202 physicians, 150 outpatients and 150 family members were participated. The majority of patients (92%) believe they should know about their terminal stage compared with 79.2% of physicians and 74.7% of families (P=0.0003). Cancer patients were most likely to support disclosure of diagnosis and terminality (P=0.001), to consider that this disclosure was not stressful (P<0.0001) and that this knowledge would improve their quality of life (P<0.0001). CONCLUSIONS: Cancer patients seen in these centers in Southeastern Brazil prefer to know the truth about their poor prognosis more than their physicians and families think. Further studies with larger samples of patients and physicians are necessary to show if our results are representative of all Brazilian situations.
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Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Relaciones Médico-Paciente , Revelación de la Verdad , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias , Pacientes , Médicos , Pronóstico , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Although the use of androgen deprivation therapy (ADT) has resulted in improved survival in men with advanced prostate cancer, the resulting hypogonadism is associated with profound adverse effects comparable to those found in morbid obesity, being cardiovascular risk among the most lethal. OBJECTIVES: Evaluate metabolic syndrome, metabolic abnormalities and cardiovascular risk in patients with prostate cancer under ADT, not under ADT and morbid obese men. METHODS: This is a cross-sectional study that involves 79 men presenting prostate cancer, of whom 54 under ADT and 25 not under ADT and 91 morbidly obese patients paired by sex and age. To define metabolic syndrome, we used the International Diabetes Federation (IDF) criteria. Metabolic abnormalities, metabolic markers and Framingham score to predict the ten year coronary heart disease risk were compared among patients under ADT, not under ADT and morbid obese. RESULTS: Patients under ADT presented significantly greater occurrence of diabetes and central obesity and higher levels of total cholesterol and low density lipoprotein (LDL) compared to eugonadal men. The mean cardiovascular risk was significantly higher in patients under ADT (39.97±12.53% vs. 26.09±14.80%; p=0.021). Morbidly obese subjects had increased ten year coronary heart disease risk; comparable to patients under ADT (p=0.054). CONCLUSION: This study suggests that patients under ADT show higher prevalence of metabolic abnormalities and cardiovascular risk similar to those found in morbidly obese subjects. It is possible that both processes share cardiovascular risk through metabolic syndrome.
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Adenocarcinoma/terapia , Andrógenos , Antineoplásicos Hormonales/efectos adversos , Enfermedades Cardiovasculares/etiología , Hormona Liberadora de Gonadotropina/agonistas , Síndrome Metabólico/complicaciones , Neoplasias Hormono-Dependientes/terapia , Obesidad Mórbida/complicaciones , Orquiectomía/efectos adversos , Neoplasias de la Próstata/terapia , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Anciano , Antineoplásicos Hormonales/uso terapéutico , Biomarcadores , Enfermedades Cardiovasculares/epidemiología , Terapia Combinada , Humanos , Incidencia , Masculino , Síndrome Metabólico/sangre , Síndrome Metabólico/inducido químicamente , Síndrome Metabólico/fisiopatología , Persona de Mediana Edad , Neoplasias Hormono-Dependientes/cirugía , Obesidad Mórbida/fisiopatología , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/cirugía , RiesgoRESUMEN
BACKGROUND: Drug-drug interactions (DDIs) comprise an important problem in medical oncology practice. We systematically reviewed the frequency of DDIs in oncology. METHODS: We searched PubMed for eligible articles and on-line databases for abstracts of major oncology meetings. RESULTS: Eight studies reported on the frequency of DDIs: six evaluated the frequency of potential DDIs, while two studies reported on real DDIs, i.e. interactions that had clinical consequences. Studies of potential DDIs found that approximately one-third of patients are exposed to dangerous drug doublets, with the most common ones involving warfarin and anticonvulsants. One study of real DDIs found that 2% of hospitalized cancer patients had a DDI as the cause of admission. CONCLUSIONS: Drug interactions comprise an important issue in oncology, with approximately one-third of ambulatory cancer patients being at risk of DDIs. Data are limited on the clinical consequences of drug interactions among cancer patients.
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Antineoplásicos/uso terapéutico , Interacciones Farmacológicas , Oncología Médica , Antineoplásicos/efectos adversos , HumanosRESUMEN
BACKGROUND: Recombinant granulocyte colony-stimulating factors (G-CSFs) such as Filgrastim are used to treat chemotherapy-induced neutropenia. We investigated a new G-CSF, XM02, and compared it to Neupogen after myelotoxic chemotherapy in breast cancer (BC) patients. METHODS: A total of 348 patients with BC receiving docetaxel/doxorubicin chemotherapy were randomised to treatment with daily injections (subcutaneous 5 microg/kg/day) for at least 5 days and a maximum of 14 days in each cycle of XM02 (n = 140), Neupogen (n = 136) or placebo (n = 72). The primary endpoint was the duration of severe neutropenia (DSN) in cycle 1. RESULTS: The mean DSN in cycle 1 was 1.1, 1.1, and 3.9 days in the XM02, Neupogen, and placebo group, respectively. Superiority of XM02 over placebo and equivalence of XM02 with Neupogen could be demonstrated. Toxicities were similar between XM02 and Neupogen. CONCLUSION: XM02 was superior to placebo and equivalent to Neupogen in reducing DSN after myelotoxic chemotherapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama Masculina/tratamiento farmacológico , Neoplasias de la Mama/tratamiento farmacológico , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Neutropenia/tratamiento farmacológico , Adulto , Anciano , Análisis de Varianza , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/patología , Neoplasias de la Mama Masculina/patología , Docetaxel , Método Doble Ciego , Doxorrubicina/efectos adversos , Doxorrubicina/uso terapéutico , Femenino , Filgrastim , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Factor Estimulante de Colonias de Granulocitos/farmacocinética , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neutropenia/inducido químicamente , Neutrófilos/efectos de los fármacos , Proteínas Recombinantes , Taxoides/efectos adversos , Taxoides/uso terapéutico , Resultado del TratamientoRESUMEN
Burnout syndrome is typified by three dimensions: emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PS), and is prevalent among cancer care providers. The objective is to conduct a systematic review and meta-analysis of studies that evaluated the presence of burnout syndrome in professionals dedicated to the care of cancer patients. A search was conducted of the MEDLINE, LILACS and COCHRANE databases. Articles were selected that had used the Maslach questionnaire to assess burnout syndrome prevalence, had evaluated at least 35 subjects (including physicians), had at least a 20% questionnaire response rate, and that were published in English, Spanish or Portuguese. Ten studies (2375 participants) were included in this analysis. Severe involvement by any one of the three dimensions ranged from 8% to 51%. The overall prevalence of EE was found to be 36% [95% confidence interval (CI) (31-41)], while for DP this was 34% [95% CI (30-39)] and for PS 25% [95% CI (0.16-34)], demonstrating considerable heterogeneity across studies. The prevalence of burnout syndrome is elevated among cancer professionals throughout the world but varies substantially among studies. Further research is needed to better understand and prevent this syndrome.
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Agotamiento Profesional/psicología , Atención a la Salud/normas , Despersonalización/psicología , Oncología Médica/normas , Lugar de Trabajo/psicología , Agotamiento Profesional/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Oncología Médica/estadística & datos numéricos , Prevalencia , Estrés Psicológico/psicología , Encuestas y CuestionariosRESUMEN
Alkaline phosphatase (AP) has several isoforms including bone alkaline phosphatase (BAP). We evaluated BAP and AP for screening for bone metastasis (BM) in patients with solid tumours. This is a prospective non-blinded study conducted at ABC Foundation School of Medicine Oncology clinics. A total of 40 subjects without a history of cancer and 62 patients with various solid tumours referred for a bone scan had serum drawn for BAP and AP determination. Bone alkaline phosphatase and AP levels in patients with cancer and BM, without BM and with no cancer, were 70.32 +/- 3.65 and 310.21 +/- 16.87 U/L; 41.40 +/- 2.80 and 113.23 +/- 12.95 U/L; 21.19 +/- 2.76 and 148.05 +/- 12.79 U/L respectively (P < 0.0001 for both AP and BAP). For BAP and AP sensitivity, specificity, positive and negative predictive values were 0.86 and 0.52; 0.69 and 1; 0.45 and 1; 0.94 and 0.87 respectively. ROC AUC value for BAP was 0.89 and for AP was 0.93. We conclude that BAP is more sensitive than AP, whereas AP had a remarkable specificity of 100%. In screening for BM in patients with solid tumours, obtaining initially BAP and then selecting for further investigation only patients with an abnormal AP may be a cost and resource saving strategy.
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Fosfatasa Alcalina/sangre , Neoplasias Óseas/diagnóstico , Huesos/enzimología , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Pruebas Enzimáticas Clínicas , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Dolor/etiología , Curva ROC , CintigrafíaRESUMEN
BACKGROUND: Sexual morbidity after chemotherapy and hormonal therapy for breast cancer can seriously affect patients' quality of life. Bupropion is an antidepressant that has been reported to increase libido. OBJECTIVE: To investigate the improvement of sexual function in female breast cancer patients using bupropion. PATIENTS AND METHODS: We performed an 8-week open trial using bupropion in women diagnosed with breast cancer who had received chemotherapy and were currently receiving adjunctive hormonal therapy. The Arizona Sexual Experience Scale (ASEX) was used. The ASEX scale includes five questions that evaluate sexual function in the following areas: libido, excitability and ability to reach orgasm. Women received oral Bupropion 150 mg/daily for 8 weeks and were evaluated prior to the initiation of the study and again during Weeks 4 and 8. RESULTS: Twenty patients were included in the study. At the beginning of the study, the mean ASEX score was 23.45 [21.67-25.24] 95% CI. After 4 weeks of treatment, we observed a reduction in the mean ASEX score that persisted until the end of the study, at eight weeks: 18.45 [16.59-20.31] 95% CI (P = 0.0003) and 18.95 [16.60-21.30] 95% CI (P = 0.0024), respectively. CONCLUSION: In this non-controlled open trial bupropion 150 mg/daily was associated with improved sexual function in women receiving adjuvant systemic treatment for breast cancer.
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Antidepresivos/uso terapéutico , Neoplasias de la Mama/terapia , Bupropión/uso terapéutico , Sexualidad , Neoplasias de la Mama/fisiopatología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Complementary and alternative medicine (CAM) is frequently employed by patients with cancer. An extensive survey was conducted among Brazilian cancer physicians to understand their attitude towards CAM. A questionnaire was sent to all 655 members of the Brazilian Cancer Society asking what is their opinion regarding CAM and if they would prescribe any CAM modality for their patients. They were also questioned regarding their degree of awareness of CAM self-administration by their patients. Overall, 119 questionnaires were returned to us (18%). Most oncologists knew at least one type of CAM (96.6%) and 76.7% had previously made use of at least one type of CAM for themselves. We observed that 76 (63.8%) of the oncologists used to ask their patients about CAM utilization and 37.8% described at least one reason to stimulate its use (68.8% as complementary treatment). Only 10% of the oncologists would prescribe at least one type of CAM and this attitude correlated significantly with previous physicians' use of CAM and with being a clinical oncologist as well as with having questioned patients about CAM use. Most oncologists (80.7%) would not indicate the use of CAM, mainly for lack of scientific proof of its efficacy (56.2%). Physicians knew many kinds of CAM and had frequently used some of them themselves, but only a minority of Brazilian oncologists would indicate them. As CAM use is very prevalent in our population, we believe that most of its utilization depends, probably, on patient's own and independent initiatives. However, these results should be viewed with caution because of the low response rate we observed in this study.
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Actitud del Personal de Salud , Terapias Complementarias/psicología , Oncología Médica , Neoplasias/terapia , Brasil , Terapias Complementarias/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
Although intravenous (IV) 5-fluorouracil (5-FU) and uracil/futraful (UFT) have comparable antitumour efficacy in the treatment of metastatic colorectal cancer (MCC), we wanted to assess which of these two regimens would be preferred by our patients. We randomized 20 previously untreated patients with MCC at our centre to receive oral UFT or bolus IV 5-FU both associated with leucovorin. After the first cycle patients were crossed over to the other arm. Before the third cycle we left patients to choose one of the regimens to continue their treatment until disease progression. Two patients chose 5-FU and 18 chose UFT (P < 0.001). Fewer side effects (50%) and convenience of home treatment (40%) were the main reasons for their choice for the oral regimen. UFT induced less mucositis (P = 0. 02) and diarrhoea (P = 0. 01). We conclude that convenience and lower toxicity may explain the observed preference for oral UFT.
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Antimetabolitos Antineoplásicos/administración & dosificación , Neoplasias Colorrectales/secundario , Leucovorina/administración & dosificación , Tegafur/administración & dosificación , Uracilo/administración & dosificación , Administración Oral , Anciano , Antimetabolitos Antineoplásicos/efectos adversos , Neoplasias Colorrectales/tratamiento farmacológico , Estudios Cruzados , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Inyecciones Intravenosas , Masculino , Satisfacción del Paciente , Estudios Prospectivos , Tegafur/efectos adversos , Uracilo/efectos adversosRESUMEN
BACKGROUND: The recent introduction of sensitive RT-PCR-based techniques for the detection of epithelial antigen expression, such as CK-19, in the peripheral blood and bone marrow of breast cancer patients may provide an opportunity to evaluate tumor response at the molecular level, even in the absence of measurable disease while patients are still receiving chemotherapy. METHODS: We studied serially collected blood samples of 53 patients with breast cancer before, during, and after adjuvant, neoadjuvant, and palliative chemotherapy to evaluate its effects on the expression of CK-19 measured by RT-PCR. RESULTS: The percentage of CK-19 RT-PCR positivity decreased consistently from 43% (23/53) before chemotherapy to 14.3% (7/49), and to 18.9% (7/37) after 3 and 6 cycles, respectively (chi-square for linear trend = 7.948; p = 0.0048). Furthermore, there was a significant correlation between a negative CK-19 at three months and the response to chemotherapy (p = 0.024). CONCLUSION: We conclude that RT-PCR negativity for CK-19 expression at 3 months after the beginning of chemotherapy correlates with tumor response and, as treatment progresses, there is a significant trend for the occurrence of more negative RT-PCR results. Further studies are needed to confirm if this technique can be useful to assess response to chemotherapy in patients without measurable disease and if negativation of CK-19 expression while on chemotherapy is of prognostic significance.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores de Tumor/análisis , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/inmunología , Regulación Neoplásica de la Expresión Génica , Queratinas/biosíntesis , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Adulto , Anciano , Progresión de la Enfermedad , Femenino , Humanos , Persona de Mediana Edad , Cuidados Paliativos , Valor Predictivo de las Pruebas , Resultado del TratamientoRESUMEN
BACKGROUND: In order to foster the use of the Internet by our medical students, we devised a virtual test to be taken by the whole class during the Hematology-Oncology course given in the third year. MATERIAL AND METHODS: Through a specially designed home page in the Internet students were asked questions regarding their personal characteristics, knowledge of basic Internet skills and were also given a short virtual course on line on the use of the Internet. RESULTS: We noted that only 53% of our students had used the Internet before. The use of the Internet was correlated with having more members of the household accessing the net (p < 0.001) but not with the student's sex, age or family income. CONCLUSION: Most of the students reacted favourably to this educational experience through which about half of them got acquainted with the use of the Internet for the first time.
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Educación Médica/métodos , Hematología/educación , Internet , Oncología Médica/educación , Adulto , Alfabetización Digital , Instrucción por Computador , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
OBJETIVO: Com o intuito de estimular o uso da Internet pelos nossos estudantes de medicina, criamos uma prova virtual a qual se submeteu toda a classe durante o curso de Oncologia e Hematologia ministrado no 3o ano do curso médico. MATERIAL E MÉTODO: Através de uma página na Internet especialmente criada para esta prova, avaliou-se através de perguntas específicas dados pessoais, padrões de uso e conhecimentos básicos sobre o acesso à rede. Ofereceu-se ainda, dentro desta mesma página, um pequeno curso virtual sobre como utilizar a Internet. RESULTADOS: Notamos que apenas 53 por cento dos nossos alunos tinham usado a Internet antes da prova. O uso da Internet se correlacionou com a presença de outros usuários entre os membros da família (p < 0,001) mas não com sexo, idade ou renda familiar dos alunos estudados. CONCLUSÃO: A reação dos alunos a esta experiência educacional foi positiva sendo que através dela cerca da metade deles utilizou a Internet pela primeira vez.
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Humanos , Masculino , Femenino , Adulto , Internet , Educación Médica/métodos , Hematología/educación , Oncología Médica/educación , Encuestas y CuestionariosRESUMEN
BACKGROUND: The introduction of serotonin antagonists as antiemetics for prophylaxis of chemotherapy-induced nausea and vomiting represented a major step toward better patient tolerance and adherence to this type of treatment. Several published trials compared different serotonin antagonists without demonstrating clear superiority of any one of them. Because most of these trials compared ondansetron with granisetron, the authors conducted a meta-analysis to determine if the current data available show any therapeutic difference between them. METHODS: MEDLINE and CANCERLIT databases were searched from 1990 to May 1999, and pertinent article references also were surveyed, without restriction to English language. The authors included all randomized controlled trials (RCTs) that had more than 25 patients per arm and compared ondansetron to granisetron for prophylaxis of acute (A) (< 24 hours) and delayed (D) (> 24 hours) nausea (N) and vomiting (V) induced by highly (H) or moderately (M) emetogenic chemotherapy. Only the first chemotherapy cycle was considered for studies that involved a crossover design. RESULTS: Fourteen studies with 6467 evaluable patients among the 21 studies retrieved were selected for this meta-analysis. In none of the eight scenarios studied (AHV, AHN, AMV, AMN, DHV, DHN, DMV, and DMN) could the authors detect any significant differences in the antiemetic efficacy of any of these medications. CONCLUSIONS: The authors conclude that both granisetron and ondansetron have similar antiemetic efficacy for prophylaxis of chemotherapy-induced nausea and vomiting. Because the number of comparative studies that addressed the delayed nausea and vomiting scenarios is low, further RCTs are still needed to confirm these results.
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Antieméticos/uso terapéutico , Granisetrón/uso terapéutico , Náusea/prevención & control , Ondansetrón/uso terapéutico , Antagonistas de la Serotonina/uso terapéutico , Vómitos/prevención & control , Antieméticos/farmacocinética , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Estudios Cruzados , Granisetrón/farmacocinética , Humanos , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Ondansetrón/farmacocinética , Ensayos Clínicos Controlados Aleatorios como Asunto , Antagonistas de la Serotonina/farmacocinética , Equivalencia TerapéuticaAsunto(s)
Antineoplásicos/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Enfermedad de Hodgkin/terapia , Linfoma no Hodgkin/terapia , Acondicionamiento Pretrasplante , Adolescente , Adulto , Carboplatino/administración & dosificación , Terapia Combinada , Etopósido/administración & dosificación , Humanos , Melfalán/administración & dosificación , Persona de Mediana Edad , Proyectos Piloto , RecurrenciaRESUMEN
BACKGROUND: Early detection of haematogenous dissemination of epithelial tumours afforded by the analysis of epithelial antigen expression in the peripheral blood mononuclear fraction (PBMN) and bone marrow may confer a worse prognosis to patients with carcinoma. Cytokeratin 19 is a protein normally expressed by epithelial cells including normal and malignant mammary cells. Previous studies have demonstrated that analysis of cytokeratin 19 expression by the reverse transcriptase-polymerase chain reaction (RT-PCR) can detect one epithelial cell in as many as 10(5)-10(7) haematopoetic cells. Despite its sensitivity concern has been voiced recently about the specificity of this technique owing to the detection of cytokeratin 19 expression in the PBMN of normal volunteers and the bone marrow of patients with haematological malignancies. AIMS: To assess the sensitivity and specificity of RT-PCR detection of cytokeratin 19 in PBMN of normal female blood donors. METHODS: Blood was taken from 52 normal female blood donors and PBMN separated through Fycol gradient centrifugation. Cytokeratin 19 was measured using a two step nested RT-PCR assay. RESULTS: No amplification was found in the first step for any of the samples studied, whereas in the second step amplification was observed in 10 of the 52 samples. Both steps could detect one MCF-7 cell (the cytokeratin 19 positive control) in 10(6) CEM (cytokeratin 19 negative control) cells. CONCLUSIONS: As both PCR steps are sensitive to the 10(-6) level, performing only the first amplification step may decrease the non-specificity of this method. Further studies are needed to define the specificity and sensitivity of this technique in blood and bone marrow specimens of women with breast cancer.
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Biomarcadores de Tumor/sangre , Neoplasias de la Mama/sangre , Queratinas/sangre , Reacción en Cadena de la Polimerasa/métodos , Biomarcadores de Tumor/genética , Donantes de Sangre , Femenino , Expresión Génica , Humanos , Queratinas/genética , ARN Mensajero/genética , Sensibilidad y Especificidad , Células Tumorales CultivadasRESUMEN
The use of polymerase chain reaction (PCR) for routine detection of clonal immunoglobulin heavy-chain (IgH) gene rearrangements represents an attractive alternative to Southern hybridization analysis not only because PCR protocols are quicker and simpler, but also because of the ability to analyze very small population of cells in search of minimal residual disease. This can be especially important for the detection of clonal malignant cells in locations other than bone marrow or peripheral blood. We describe a case in which central nervous system involvement, a very rare complication of chronic lymphocytic leukemia, was confirmed by PCR analysis for IgH genes rearrangement of the lymphocytes found in cerebrospinal fluid. The cerebrospinal fluid and the peripheral blood lymphocytes (obtained from archival cytospins stored at the time of diagnosis, 5 years before) presented an identical IgH gene rearrangement, as shown by sequence analysis. Thus, the use of PCR for IgH genes rearrangement can be very useful in the detection of monoclonality in samples with a small number of cells and in the confirmation of the common origin of B cells in different specimens of the same patient.
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Aracnoides/patología , Leucemia Linfocítica Crónica de Células B/líquido cefalorraquídeo , Linfocitos/citología , Reacción en Cadena de la Polimerasa/métodos , Líquido Cefalorraquídeo/citología , ADN/aislamiento & purificación , Humanos , Leucemia Linfocítica Crónica de Células B/genética , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Bacterial infection of skeletal muscle (pyomyositis) is usually followed by abscess formation. The most commonly isolated pathogen is Staphylococcus aureus. Tuberculosis rarely affects patients with acute leukemia. The authors report on 2 patients, one with acute myelogenous leukemia and the other with acute lymphoblastic leukemia whose clinical course was complicated by tuberculous skeletal muscle abscesses. In both instances, musculoskeletal pain was accompanied by evidence of muscle abscesses by imaging studies of the painful areas. Therefore, in patients with acute leukemia and evidence of muscle abscesses with initial cultures negative for bacteria and fungi, one should include tuberculosis in the differential diagnosis.
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Absceso/complicaciones , Absceso/microbiología , Leucemia Mieloide Aguda/complicaciones , Enfermedades Musculares/complicaciones , Enfermedades Musculares/microbiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Tuberculosis/complicaciones , Adulto , Anciano , Femenino , HumanosRESUMEN
To investigate whether the tumor expression of beta-2-microglobulin (beta 2-M) could serve as a marker of tumor biologic behavior, the authors studied specimens of breast carcinomas from 60 consecutive female patients. Presence of beta 2-M was analyzed by immunohistochemistry. No significant correlations were found between tumor beta 2-M expression and several histologic attributes such as type, histologic and nuclear grades, mitotic index, necrosis, vascular invasion, and lymphocytic infiltration. Likewise, beta 2-M was not associated with markers of disease extension such as TNM, (UICC, classification of malignant tumors) staging and axillary lymph node involvement or with estrogen, progesterone, and glucocorticoid receptor levels. However, there was a significantly positive association between tumor beta 2-M expression and the degree of lymphocytic infiltration in the tumor tissue. Beta 2-M serum levels were determined by an enzyme-linked immunosorbent assay in samples from 22 of the above women. Although some of the highest values had been obtained in women with larger (T4) primary tumors, the authors failed to detect any statistical relationship between beta 2-M expression in the tumor with serum levels or between serum beta 2-M and the above histologic, laboratory, and clinical factors.