RESUMO
Small-cell lung cancer (SCLC) is a highly aggressive malignancy comprising approximately 15% of lung cancers. Only one-third of patients are diagnosed at limited-stage (LS). Surgical resection can be curative in early stages, followed by platinum-etoposide adjuvant therapy, although only a minority of patients with SCLC qualify for surgery. Concurrent chemo-radiotherapy is the standard of care for LS-SCLC that is not surgically resectable, followed by prophylactic cranial irradiation (PCI) for patients without progression. For extensive-stage (ES)-SCLC, a combination of platinum and etoposide has historically been a mainstay of treatment. Recently, the efficacy of programmed death-ligand 1 inhibitors combined with chemotherapy has become the new front-line standard of care for ES-SCLC. Emerging knowledge regarding SCLC biology, including genomic characterization and molecular subtyping, and new treatment approaches will potentially lead to advances in SCLC patient care.
Assuntos
Neoplasias Pulmonares , Carcinoma de Pequenas Células do Pulmão , Humanos , Etoposídeo/uso terapêutico , Platina/uso terapêutico , Seguimentos , Carcinoma de Pequenas Células do Pulmão/terapia , Carcinoma de Pequenas Células do Pulmão/tratamento farmacológico , Neoplasias Pulmonares/terapia , Neoplasias Pulmonares/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
INTRODUCTION: This study investigated the impact of systemic cancer therapy on the quality of life, mental well-being, and life satisfaction of cancer patients. METHODS: This prospective study was promoted by the Spanish Society of Medical Oncology (SEOM) and enrolled patients with localized, resected, or unresectable advanced cancer from 15 Spanish medical oncology departments. Patients completed surveys on quality of life (EORTC-QoL-QLQ-C30), psychological distress (BSI-18) and life satisfaction (SWLS) before and after systemic cancer treatment. RESULTS: The study involved 1807 patients, 944 (52%) having resected, localized cancer, and 863 with unresectable advanced cancer. The mean age was 60 years, and 53% were female. The most common types of localized cancer were colorectal (43%) and breast (38%), while bronchopulmonary (32%), non-colorectal digestive (23%), and colorectal (15%) were the most frequent among those with advanced cancer. Before systemic treatment, patients with advanced cancer had poorer scores than those with localized cancer on physical, role, emotional, cognitive, social limitations, symptoms, psychological distress, and life satisfaction (all p < 0.001), but there were no differences in financial hardship. Patients with localized cancer had greater life satisfaction and better mental well-being than those with advanced cancer before systemic treatment (p < 0.001). After treatment, patients with localized cancer experienced worsening of all scales, symptoms, and mental well-being (p < 0.001), while patients with advanced disease had a minor decline in quality of life. The impact on quality of life was greater on all dimensions except economic hardship and was independent of age, cancer location, and performance status in participants with resected disease after adjuvant chemotherapy. CONCLUSION: In conclusion, our study highlights that systemic cancer treatment can improve quality of life in patients with advanced cancer, while adjuvant treatments for localized disease may have a negative impact on quality of life and psychological well-being. Therefore, treatment decisions should be carefully evaluated on an individual basis.
Assuntos
Neoplasias Colorretais , Qualidade de Vida , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Qualidade de Vida/psicologia , Estudos Prospectivos , Emoções , Bem-Estar Psicológico , Inquéritos e Questionários , Neoplasias Colorretais/terapiaRESUMO
Resumen INTRODUCCIÓN: El tumor de Buschke-Löwenstein se asocia con el virus del papiloma humano por lo que se considera una infección de transmisión sexual. Se caracteriza por un condiloma gigante, verrugoso, exofítico, con forma de coliflor, de crecimiento lento, pero que durante el embarazo puede crecer rápidamente y formar condilomas solitarios que afectan las estructuras vecinas. CASO CLÍNICO: Paciente de 18 años, primigesta, con 35 semanas de embarazo, sin antecedentes de importancia para el padecimiento actual. Cuatro meses previos inició con verrugas en el perineo, con aumento acelerado de su tamaño en los últimos 30 días, asociado con dolor intenso a la movilización, secreción fétida, eritema e irritación interglútea y formación de un tumor friable con tendencia al sangrado y áreas de necrosis. CONCLUSIONES: El tumor de Buschke-Löwenstein es una alteración poco frecuente causada por el virus del papiloma humano, que puede tener crecimiento acelerado por el estímulo hormonal, propio del estado gestacional. El tratamiento de primera línea es la resección quirúrgica. El seguimiento de las pacientes debe ser estrecho, debido al alto índice de recidiva.
Abstract BACKGROUND: Buschke-Löwenstein tumor is associatted with the human papillomavirus (HPV), which is considered a sexually transmitted infection, characterized by the presence of a giant wart, exophytic condyloma with the shape of a cauliflower, slow growth, but during pregnancy it can grow fast as a solitary condyloma, affecting other structures. This case provides a better understanding of an unusual pathology, which with surgical treatment was obtained aesthetic results and with adequate functionality of external genitalia. CLINICAL CASE 18-year-old female, primiparous with 35 weeks pregnant, with no significant history, 4 previous months begins with the presence of warts in the perineal region with accelerated increase in size in the last 30 days, associated with intense pain on mobilization, fetid discharge, and area oferythema and intergluteal irritation, friable tumor with a tendency to bleed with areas of necrosis. CONCLUSIONS: The Buschke-Löwenstein tumor is a rare pathology caused by HPV, which can present accelerated growth due to the hormonal stimulus of the gestational state, this tumor does not resolve spontaneously, so the surgical approach is considered top of the line. The follow-up of these patients must be close due to the high rate of recurrence.
RESUMO
BACKGROUND: Thyroid metastases are extremely rare, with an incidence of 1-3% according to different data. Colon cancer is the second most common tumor that metastasizes to this organ. CASE REPORT: We report a case of a long-standing colon cancer with an atypical metastatic pattern and the appearance of a thyroid metastases. In addition, we highlight the importance of multidisciplinary management of this pathology and the emerging need to establish next generation sequencing panels for better molecular characterization.
ANTECEDENTES: Las metástasis tiroideas son tremendamente infrecuentes, situándose su incidencia en torno al 1-3% según los diferentes datos. El cáncer de colon es el segundo tumor que con más frecuencia produce metástasis en este órgano. CASO CLÍNICO: Se expone un caso de cáncer de colon de larga evolución con patrón metastásico atípico y aparición de metástasis tiroidea. Además, se señala la importancia del manejo multidisciplinario de esta patología y la necesidad emergente de establecer paneles de secuenciación masiva para una mejor caracterización molecular.
Assuntos
Neoplasias do Colo , Neoplasias da Glândula Tireoide , HumanosRESUMO
We present a clinical case of a solitary fibrous pleural tumor (TFSP) with abnormal behavior due to its high aggressiveness and poor short-term prognosis, where an ALK translocation was identified. TFSP is an infrequent tumor, with an estimated incidence of around 8 per 100,000 inhabitants and with few cases reported in the literature. The most common is that it is a neoplasm of benign behavior, with debut as a localized mass and whose The treatment of choice is surgical resection. All the data in the literature contrast with our experience, which we report below.
Presentamos un caso clínico de un tumor fibroso solitario pleural (TFSP) de comportamiento anómalo por su alta agresividad y mal pronóstico a corto plazo, en el que se identificó una translocación de ALK. El TFSP es un tumor infrecuente, con una incidencia estimada en torno a 8 casos por 100,000 habitantes y con pocos reportes en la literatura. Lo más habitual es que se trate de una neoplasia de comportamiento benigno, con debut como una masa localizada y cuyo tratamiento de elección es la resección quirúrgica. Todos los datos de la literatura contrastan con nuestra experiencia, que presentamos a continuación.
Assuntos
Neoplasias Pleurais , Tumor Fibroso Solitário Pleural , Humanos , Neoplasias Pleurais/genética , Neoplasias Pleurais/cirurgia , Receptores Proteína Tirosina Quinases , SíndromeRESUMO
AIM: To perform a clinical and histomorphometric evaluation of a combination of allograft and xenograft for alveolar ridge preservation (ARP) procedures. METHODS: Seven consecutive cases in need of nonmolar tooth extraction and posterior implant placement were treated by ARP, using a combination of a cortico-trabecular allograft and a mineralized xenograft. All sites received a minimally traumatic tooth extraction, bone graft, collagen membrane placement, and flap closure as possible. Healing time was 4 months for the majority of cases. After tooth removal and just before implant installation, clinical measurements were taken; after the healing time, bone biopsies were taken. RESULTS: All sites healed uneventfully. Bone dimensional changes were small; a mid-buccal vertical bone gain of 1.0 mm (SD, 3.2 mm) and a horizontal bone reduction of 1.6 mm (1.6) were recorded. Histomorphometric analysis showed large variability in percentages of new bone (mean 22.3% [17.3], range: 1.8%-35.2%) and a considerable amount of residual bone graft material (mean 33.2% [13.2], range: 5.5%-45.8%). CONCLUSION: Favorable clinical results were observed after the use of the combined bone graft, although a large variability in tissue proportions was present at 4-month healing time, especially for new mature bone.
Assuntos
Aumento do Rebordo Alveolar/métodos , Transplante Ósseo/métodos , Implantação Dentária Endóssea/métodos , Implantes Dentários para Um Único Dente , Minerais/uso terapêutico , Alvéolo Dental/cirurgia , Adulto , Biópsia , Regeneração Óssea/fisiologia , Feminino , Xenoenxertos , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Extração Dentária , Resultado do Tratamento , Cicatrização/fisiologiaRESUMO
El leiomioma parauretral es una patología poco frecuente, se trata de un tumor mesenquimatoso no dependiente de uretra y que ocasiona sintomatología uroginecológica en la paciente. Su manejo es principalmente quirúrgico. No se reportan casos de malignización, recidiva, ni metástasis y su diagnóstico diferencial se debe realizar con todas las patologías de masas uretrales y para-uretrales. El presente caso describe la presencia de este tumor en una mujer post-menopaúsica de 60 años, que además de presentar incontinencia urinaria mixta, refería signos obstructivos urinarios, fue diagnosticada y manejada de manera quirúrgica: Resección de tumor y posterior ubicación de cinta suburetral.
The paraurethral leiomyoma is a rare pathology, it is a mesenchymal tumor not dependent of the urethra which causes urogynecological symptoms in the patient. Its management is mainly surgical. No cases of malignancy, recurrence or metastasis are reported and its differential diagnosis must be performed with all pathologies of urethral and para-urethral masses. The present case describes the presence of this tumor in a 60-year-old post-menopausal woman who, in addition to presenting mixed urinary incontinence, referred obstructive urinary signs, was diagnosed and managed surgically: tumor resection and subsequent placement of suburethral tape.
Assuntos
Humanos , Técnicas de Diagnóstico Obstétrico e Ginecológico , Leiomioma/diagnóstico por imagem , Incontinência Urinária/tratamento farmacológico , Espectroscopia de Ressonância MagnéticaRESUMO
La colpocleisis como técnica obliterante se va realizando desde el año 1823 y se ofrece como alternativa para tratamiento quirúrgico de prolapso tipo III y IV a pacientes sin deseo de vida sexual y con riesgos de morbilidad transquirúrgica. No existe mucha evidencia del grado de satisfacción post-quirúrgica de las pacientes Objetivo: determinar el grado de satisfacción de las pacientes sometidas a colpocleisis y los síntomas pélvicos más frecuentemente encontrados a lo largo del primer año post- quirúrgico. Método: studio transversal no experimental. Se aplicó cuestionario validado de satisfacción post-quirúrgica en pacientes sometidas a colpocleisis durante periodos 2013 a 2014, vía telefónica, dentro de su primer año post-quirúrgico. Se tabularon los datos obtenidos. Resultados: El total de pacientes encuestadas se encontraban entre satisfechas y muy satisfechas e indicaban que volverían a someterse a la cirugía. La edad promedio de las pacientes fue de 76 años. El 50% de las pacientes presentaron incontinencia urinaria de urgencia, 15% incontinencia anal, el restante 35% no presentó ninguna sintomatología. Los síntomas pélvicos se presentaron con más frecuencia en las pacientes con prolapsos tipo IV. Conclusiones: el nivel de satisfacción delas pacientes sometidas a colpocleisis es alto, se puede seguir ofreciendo como alternativa quirúrgica en mujeres sin actividad sexual, la sintomatología pélvica más frecuente fue incontinencia urinaria de urgencia e incontinencia anal, en las pacientes con mayor grado de prolapso.
The colpocleisis as obliterans technique is conducted since 1823 and is offered as an alternative to surgical treatment of prolapse type III and IV patients with no sexual desire for life and morbidity risks transsurgical. There is much evidence of the degree of post-surgical patient satisfaction Objective: to determine the degree of satisfaction of patients undergoing colpocleisis and urinary symptoms most frequently encountered throughout the first year post-surgery Methods:cross-sectional study is not experimental. validated questionnaire post-surgical satisfaction in patients undergoing colpocleisis during periods 2013-2014, by telephone, in his first post-surgical year was applied. The data obtained are tabulated Results: total patients were surveyed between satisfied and very satisfied and indicated they would undergo surgery. The average age of patients was 76 years. 50% of patients had urinary urge incontinence, anal incontinence 15%, 35% showed no symptoms. Patients who had type IV prolapses, presented some pelvic symptoms. Conclusion: The level of satisfaction delas patients undergoing colpocleisis is high, you can continue to offer as surgical alternative for women without sexual activity, the most common pelvic symptoms were urinary urge incontinence and anal incontinence in patients with higher degree of prolapse.
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Prolapso Uterino/cirurgia , Incontinência UrináriaRESUMO
OBJECTIVES: It is imperative that individual differences in the cultural contexts of adolescent mothers, whose parenting is often linked to poor child outcomes, be better understood, especially among Puerto Rican-origin mothers who experience high rates of poverty. Behaviors that mothers use to elicit compliance from their children are important to investigate, because children's ability to engage in regulated, compliant behavior has long-term consequences for their adjustment. This study tested whether mothers' orientation to both American and Latino cultures influenced the associations between such maternal behaviors and compliant and defiant child behaviors. METHOD: The sample included 123 young, Puerto Rican-origin mothers and their 24-month-old toddlers. Behaviors coded from a toy cleanup task measured maternal guidance and control and child compliance and defiance, and acculturation and enculturation were measured with a self-report questionnaire. RESULTS: Maternal guidance predicted more child compliance, with no significant variations by cultural orientation; however, mothers who were more enculturated had children who were more compliant. As predicted, mothers' more frequent use of control was related to more child defiance for mothers reporting high levels of acculturation, and not for less acculturated mothers. CONCLUSIONS: Findings support the hypothesis that individual differences in cultural orientation influence variations in associations between certain maternal and child behaviors. (PsycINFO Database Record
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Comportamento Infantil/psicologia , Mães/psicologia , Poder Familiar/etnologia , Aculturação , Adolescente , Comportamento Infantil/etnologia , Pré-Escolar , Feminino , Humanos , Masculino , Relações Mãe-Filho , Poder Familiar/psicologia , Pobreza , Porto Rico/etnologia , Inquéritos e QuestionáriosRESUMO
The Gartner's cyst is a remnant of the Wolffian duct, representing 11% of vaginal cysts and is usually small, benign and asymptomatic. We report the case of a Gartner's duct cyst whose size and localization mimicking a pelvic organ prolapse, disease is one of the differential diagnoses.
Assuntos
Cistos , Doenças dos Genitais Femininos , Adulto , Cistos/diagnóstico , Cistos/cirurgia , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Femininos/cirurgia , HumanosRESUMO
BACKGROUND: Female urinary and anal incontinence are common entities in pelvic floor dysfunction. The most frequently age affected range from 45 to 69 years. Previous studies performed in the United States report a prevalence of 24-62% for urinary incontinence and 3-60% for anal incontinence. OBJECTIVE: To determine the prevalence of these disorders in the Guadalajara metropolitan area because we do not know it. PARTICIPANTS AND METHODS: A transversal and various stage study was performed recollecting blocks first, then houses, finally interviewing women and applying a structured questionnaire with somatometric and social-demographic data and also clinical-pathological antecedents. The data obtained was registered and processed first manually then using Excel and Epi-Info software. RESULTS: The group of women interviewed (n = 352) were between 15-85 years. The majority were married, housewives, 33% with grammar school, 23% finished high school, 25% professionists and 19% did not finish school; with an average of three pregnancies and with a body mass index (BMI) positive for overweight and obesity. The prevalence for urinary incontinence was 27.8% and anal incontinence of 3.4%. These are results compatible with those reported in the United States. CONCLUSIONS: Women living in Guadalajara have the same behavior that European and American women about prevalence of urinary incontinence. We recommend the performance of this type of studies in other states of this country in order to enrich the present information.
Assuntos
Incontinência Fecal/epidemiologia , Incontinência Urinária/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , México , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , População UrbanaRESUMO
BACKGROUND: It has been estimated in English medical reports, that the frequency of vesical voiding dysfunction in urogynecological patients is around of 22-24%; however in our country it does not have any published epidemiological study about this problem. OBJECTIVE: To detect the prevalence of vesical voiding dysfunction in our urodynamic unities and describe the clinical and urodynamic findings. MATERIAL AND METHODS: This is a descriptive and retrospective study in which were revised the clinical reports of 300 female patients, that were sent to some of our urodynamic units because they were suffering of lower urinary tract symptoms. Assessment variables included: Patient clinical history, physical examination, urinalysis, urine culture, urethral calibration, Q tip test, urethrocistoscopy, uroflowmetry, multichannel cystometry, electromyography and pressure voiding study. The diagnosis criterion was based in the concept that Blaivas established for vesical voiding dysfunction in women. RESULTS: The diagnosis of vesical voiding dysfunction was established in 72 cases of the total 300 patients analyzed. The most frequent symptom was the irritative vesical type (frequency/urgency), following of weak stream. Some grade of pelvic organ prolapse was detected in 84.8% of cases. Uroflowmetry was normal in 50% of the cases; nevertheless in the morphologic aspect were observed profile signs suggestive of distal vesical obstruction in 75%, and detrusor hypoactivity in 25% of the total of the cases. CONCLUSIONS: The frequency of obstruction in our casuistic was similar to the other authors. The obtained results permit us to confirm that the vesical voiding dysfunction in the urogynecological Mexican patients is a frequent problem in the urogynecological patient; however the diagnostic is complex and require a carefully correlation as clinical as urodynamical aspects in addition to endoscopic and image studies.