RESUMO
El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.
Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.
Assuntos
Humanos , Analgesia/métodos , Analgésicos/uso terapêutico , Dor/terapia , Neoplasias/fisiopatologia , Analgesia Epidural , Adjuvantes Farmacêuticos/administração & dosagem , Adjuvantes Farmacêuticos/uso terapêutico , Analgesia/normas , Analgésicos/administração & dosagem , Analgésicos/classificação , Terapia Combinada , Gerenciamento Clínico , Vias de Administração de Medicamentos , Dor/tratamento farmacológico , Dor/etiologia , Dor/psicologia , Dor/radioterapia , Dor/cirurgia , Medicina Baseada em Evidências , Bombas de Infusão Implantáveis , Injeções Intraventriculares , Medicina Física e Reabilitação/métodos , Bloqueio Nervoso , Seleção de PacientesRESUMO
PURPOSE: Pathologic angiogenesis has been correlated with tumor growth, dissemination, metastasis, and prognosis in solid tumors including breast cancer. Angiogenesis has also been implicated in the pathophysiology of, and shown to be a therapeutic target in tumors arising in the bone marrow. The status of angiogenesis in the bone marrow of breast cancer patients is unknown. The aim of this study was to estimate the extent of bone marrow angiogenesis in this subset of patients. EXPERIMENTAL DESIGN: We studied 42 women with breast cancer in whom a bone marrow biopsy was done. Bone marrow samples were sorted according to their infiltration status by breast cancer cells. In all bone marrow sections, blood vessels were highlighted by staining endothelial cells with an antibody directed against the CD34-related antigen. A hematopathologist blind to the status of infiltration of breast cancer did the bone marrow vessel count. RESULTS: Nineteen patients (45%) had bone marrow metastasis. The bone marrow microvessel density was significantly higher in patients with bone marrow metastases compared with patients without bone marrow metastases (P < 0.0005). Median bone marrow microvessel density was 2 for the negative bone marrow group, and 15 for the positive bone marrow group. An increased microvessel density was correlated with presence of disease at last follow-up. CONCLUSIONS: This is the first study showing that bone marrow microvessel density is significantly higher in breast cancer patients with bone marrow metastases, when compared with breast cancer patients without evidence of bone marrow metastatic disease. Further research is needed to shed light into the prognostic and therapeutic relevance of this finding.
Assuntos
Medula Óssea/patologia , Neoplasias da Mama/patologia , Neovascularização Patológica , Adulto , Antígenos CD34/biossíntese , Células da Medula Óssea/citologia , Células da Medula Óssea/metabolismo , Células da Medula Óssea/patologia , Neoplasias da Mama/metabolismo , Diferenciação Celular , Proliferação de Células , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Metástase Linfática , Microcirculação , Pessoa de Meia-Idade , Metástase Neoplásica , Razão de Chances , PrognósticoRESUMO
Los síndromes paraneoplásicos neurológicos son un grupo de entidades causadas por los efectos a distancia de un tumor, y dado que pueden afectar cualquier porción del sistema nervioso, se presentan como cuadros neurológicos. Estas entidades son condiciones poco frecuentes causadas por respuestas inmunes contra antígenos tumorales que tienen una reacción cruzada con antígenos neuronales. En esta revisión se estudian los mecanismos propuestos para explicar su etiopatogenia, haciendo hincapié en la reacción autoinmune hacia antígenos onconeurales. En esta revisión se analizan las manifestaciones clínicas de los síndromes paraneoplásicos neurológicos, las neoplasias a las que se asocian así como la importancia de establecer un diagnóstico; tratamos de recalcar el valor de estudio de los mismos, pues pueden ser la primera manifestación de malignidad.