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BACKGROUND: Retrospective data suggest an association between bevacizumab efficacy and the incidence of arterial hypertension (AHT). Additionally, epigenetic mechanisms have been related to AHT. METHODS: This prospective observational study conducted by GEICAM Spanish Breast Cancer Research Group included metastatic breast (MBC) or colorectal (mCRC) cancer patients treated with bevacizumab-containing chemotherapy as first-line treatment. Blood pressure (BP) levels were measured (conventional and 24-h Holter monitoring) at baseline and up to cycle 3. Primary endpoint assessed BP levels increase as predictive factor for progression-free survival (PFS). Germline DNA methylation profile was explored in pre-treatment blood samples; principal component analysis was used to define an epigenetic predictive score for increased BP levels. RESULTS: From Oct-2012 to Jul-2016, 143 (78 MBC and 65 mCRC) patients were included. The incidence of AHT according to guidelines was neither predictive of PFS nor of best overall tumor response (BOR). No statistically significant association was observed with systolic BP nor diastolic BP increment for PFS or BOR. Grade 3 and 4 adverse events were observed in 37 and 5% of patients, respectively. We identified 27 sites which baseline methylation status was significantly associated to BP levels increase secondary to bevacizumab-containing chemotherapy. CONCLUSIONS: Neither the frequency of AHT nor the increase of BP levels were predictive of efficacy in MBC and mCRC patients treated with bevacizumab-containing chemotherapy. CLINICAL TRIAL REGISTRY: ClinicalTrials.gov Identifier: NCT01733628.
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Bevacizumab , Neoplasias da Mama , Neoplasias Colorretais , Hipertensão , Humanos , Bevacizumab/uso terapêutico , Bevacizumab/administração & dosagem , Feminino , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Pessoa de Meia-Idade , Hipertensão/induzido quimicamente , Estudos Prospectivos , Idoso , Masculino , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Idoso de 80 Anos ou mais , Intervalo Livre de Progressão , Metilação de DNARESUMO
PURPOSE: RAS (KRAS/NRAS) mutational status on a tumor biopsy is mandatory to guide the best treatment in metastatic colorectal cancer (mCRC). Determining the RAS mutational status by tumor-tissue biopsy is essential in guiding the optimal treatment decision for mCRC. RAS mutations are negative predictive factors for the use of EGFR monoclonal antibodies. Cell-free DNA (cfDNA) analysis enables minimally invasive monitoring of tumor evolution. METHODS/PATIENTS: PERSEIDA was an observational, prospective study assessing cfDNA RAS, BRAF and EGFR mutations (using Idylla™) in first-line mCRC, RAS wild-type (baseline tumor-tissue biopsy) patients (cohort 2). Plasma samples were collected before first-line treatment, after 20 ± 2 weeks, and at disease progression. RESULTS: 117 patients were included (103 received panitumumab + chemotherapy as first-line treatment). At baseline, 7 (6.8%) patients had RAS mutations, 4 (3.9%) BRAF mutations and no EGFR mutations were detected (cfDNA, panitumumab + chemotherapy subpopulation [panitumumab + Ch]). The baseline RAS mutational status concordance between tissue and liquid biopsies was 94.0% (93.2%, panitumumab + Ch). At 20 weeks, only one patient in the study (included in the panitumumab + Ch) had an emerging cfDNA RAS mutation. No emerging BRAF or EGFR mutations were reported. At disease progression, 6 patients had emergent mutations not present at baseline (RAS conversion rate: 13.3% [6/45]; 15.0% [6/40], panitumumab + Ch). CONCLUSIONS: The concordance rate between liquid and solid biopsies at baseline was very high, as previously reported, while our results suggest a considerable emergence of RAS mutations during disease progression. Thus, the dynamics of the genomic landscape in ctDNA may provide relevant information for the management of mCRC patients.
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Ácidos Nucleicos Livres , Neoplasias Colorretais , Mutação , Panitumumabe , Proteínas Proto-Oncogênicas B-raf , Humanos , Neoplasias Colorretais/genética , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/sangue , Feminino , Masculino , Estudos Prospectivos , Idoso , Pessoa de Meia-Idade , Ácidos Nucleicos Livres/genética , Ácidos Nucleicos Livres/sangue , Proteínas Proto-Oncogênicas B-raf/genética , Panitumumabe/uso terapêutico , Proteínas Proto-Oncogênicas p21(ras)/genética , Receptores ErbB/genética , Adulto , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , GTP Fosfo-Hidrolases/genética , Progressão da Doença , Proteínas de Membrana/genéticaRESUMO
PURPOSE: The optimal drug regimen and sequence are still unknown for patients with metastatic colorectal cancer (mCRC) who are candidates for third-line (3L) or subsequent treatment. The aim of this study is to know the opinion of experts on the most appropriate treatment options for mCRC in 3L and to clarify certain clinical decisions in Spain. METHODS: Using a modified Delphi method, a group of experts discussed the treatment in 3L of patients with mCRC and developed a questionnaire with 21 items divided into 5 sections. RESULTS: After 2 rounds, the 67 panelists consulted agreed on 17 items (81%). They considered that the main objective of 3L is to equally increase survival and improve patients' quality of life (QoL), but preferably the QoL. It was agreed that patients with mCRC in 3L prefer to receive active versus symptomatic treatment. Panelists considered trifluridine/tipiracil (FTD/TPI) to be the best oral treatment available to them in 3L. In patients with MSI-H or dMMR and BRAF V600E, the panelists mostly prefer targeted treatments. Panelists agreed the use of a therapeutic sequence that not only increases outcomes but also allows patients to be treated later. Finally, it was agreed that FTD/TPI has a mechanism of action that allows it to be used in patients refractory to previous treatment with 5-fluorouracil. CONCLUSION: The experts agreed with most of the proposed items on 3L treatment of mCRC, prioritizing therapeutic options that increase survival and preserve QoL, while facilitating the possibility that patients can continue to be treated later.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Colorretais , Técnica Delphi , Qualidade de Vida , Humanos , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Consenso , Pirrolidinas/uso terapêutico , Trifluridina/uso terapêutico , Timina/uso terapêutico , Inquéritos e Questionários , Metástase Neoplásica , Proteínas Proto-Oncogênicas B-raf/genética , EspanhaRESUMO
Resumen Austrocylindropuntia pachypus (K.Schum.) Backeb. es un cactus endémico de Perú, cuya distribución conocida estaba restringida a las vertientes occidentales de La Libertad, Áncash y Lima. En base a expediciones botánicas por las estribaciones andinas de Ica, en este trabajo reportamos nuevas localidades con pequeñas poblaciones, lo que amplía en más de 260 km al sur la distribución conocida de A. pachypus. Además, en base a 42 registros georreferenciados, se amplía la información sobre sus localidades, poblaciones, distribución potencial, hábitats, amenazas y estado de conservación. El modelo de distribución potencial mostró altos niveles predictivos o de idoneidad con valores de AUC = 0.96 en base a siete variables climáticas, siendo Bio17, Bio2 y Bio7 las variables con mayor contribución; mostrando a Lambayeque, La Libertad, Áncash, Lima, Ica y Huancavelica los departamentos con mayores valores de idoneidad. Las poblaciones con mayor concentración de individuos, pero que a su vez se encuentran seriamente perturbadas por actividades antropogénicas, son las de los valles del río Chillón (Santa Rosa de Quives, Canta) y Rímac (Santa Eulalia, Huarochirí) en Lima. Asimismo, se estima que cerca del 70% de las poblaciones de A. pachypus se encuentran amenazadas por derechos mineros, extracción de hidrocarburos, sobrepastoreo y expansión urbana o agrícola, incrementando la fragmentación de sus hábitats, por lo que se propone categorizar a este cactus endémico como En Peligro (EN).
Abstract Austrocylindropuntia pachypus (K.Schum.) Backeb. is an endemic cactus of Peru, whose known distribution was restricted to the western slopes of La Libertad, Áncash, and Lima. Based on botanical expeditions along the Andean foothills of Ica, this study reports new localities with small populations, thereby extending the known distribution of A. pachypus by over 260 km to the south. Additionally, based on 42 georeferenced records, information on its localities, populations, potential distribution, habitats, threats, and conservation status is expanded. The potential distribution model exhibited high predictive or suitability levels with AUC values of 0.96 based on seven climatic variables, with Bio17, Bio2, and Bio7 being the most contributory variables; Lambayeque, La Libertad, Áncash, Lima, Ica, and Huancavelica demonstrated the highest suitability values. Populations with the highest concentration of individuals, yet significantly disturbed by anthropogenic activities, are those in the valleys of the Chillón River (Santa Rosa de Quives, Canta) and Rímac River (Santa Eulalia, Huarochirí) in Lima. Furthermore, it is estimated that approximately 70% of A. pachypus populations are threatened by mining rights, hydrocarbon extraction, overgrazing, and urban or agricultural expansion, exacerbating habitat fragmentation. Hence, it is proposed to categorize this endemic cactus as Endangered (EN).
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El dolor torácico es uno de los motivos de consulta más frecuente en un servicio de urgencia. Dentro de las hipótesis diagnósticas se deben descartar las patologías de mayor gravedad: el infarto al miocardio (IM), la disección aórtica, el tromboembolismo pulmonar y el neumotórax. El escenario más frecuente es el IM debido a un accidente de placa, pero existen casos en donde la disección aórtica puede verse acompañada de un déficit de perfusión coronaria (síndrome de malaperfusión) generando un IM. Su diagnóstico es difícil, con una mayor mortalidad y complejidad quirúrgica. Presentamos el caso de un hombre de 59 años que cursó con dolor torácico y electrocardiograma con elevación del segmento ST inferior y anterior, derivado a angioplastia primaria y que en el estudio angiográfico se identifica compromiso ostial de coronarias, se sospecha una disección aórtica, confirmándose por angiotomografía computada de aorta, donde se evidencia una disección de aorta ascendente con compromiso de ambos ostium coronarios que se trató quirúrgicamente.
Chest pain is one of the most frequent reasons for consultation in the emergency department. The most severe pathologies must be quickly ruled out within the diagnostic hypotheses: myocardial infarction (MI), aortic dissection, pulmonary thromboembolism, and pneumothorax. A frequent scenario is ST elevation MI due to a plaque accident. However, there are infrequent cases of aortic dissection associated with a deficit in coronary perfusion (malperfusion syndrome) that triggers a MI. The diagnosis of a double artery is difficult, with higher mortality and surgical complexity. We present the case of a 59-year-old man who presented chest pain and an electrocardiogram with inferior and anterior ST-segment elevation who was referred for primary angioplasty. The angiographic study confirmed the presence of a coronary ostium defect and suggested aortic dissection. Computed tomography angiography confirmed the diagnosis, showing the dissection of the ascending aorta with the compromise of both coronary ostia, which was subjected to surgical treatment.
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Resumen La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.
Abstract Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.
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Patent ductus arteriosus (PDA) is frequent in preterm newborns, and its incidence is inversely associated with the degree of prematurity. The first choice of pharmacological treatment is ibuprofen. Several genes, including EPAS1, have been proposed as probable markers associated with a genetic predisposition for the development of PDA in preterm infants. EPAS 1 NG_016000.1:g.84131C>G or rs7557402 has been reported to be probably benign and associated with familial erythrocytosis by the Illumina Clinical Services Laboratory. Other variants of EPAS1 have been previously reported to be benign for familial erythrocytosis because they decrease gene function and are positive for familial erythrocytosis because the overexpression of EPAS1 is a key factor in uncontrolled erythrocyte proliferation. However, this could be inconvenient for ductal closure, since for this process to occur, cell proliferation, migration, and differentiation should take place, and a decrease in EPAS1 gene activity would negatively affect these processes. Single-nucleotide polymorphisms (SNPs) in EPAS1 and TFAP2B genes were searched with high-resolution melting and Sanger sequencing in blood samples of preterm infants with hemodynamically significant PDA treated with ibuprofen at the National Institute of Perinatology. The variant rs7557402, present in the EPAS1 gene eighth intron, was associated with a decreased response to treatment (p = 0.007, OR = 3.53). The SNP rs7557402 was associated with an increased risk of pharmacological treatment failure. A probable mechanism involved could be the decreased activity of the product of the EPAS1 gene.
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Idiopathic dilatation of the right atrium is a rare malformation characterized by disproportionate growth of the right atrium in the absence of a cause that justifies it. We present the case of a patient with idiopathic dilatation of the right atrium diagnosed since fetal life.
La dilatación idiopática de la aurícula derecha (DIAD) es una malformación poco frecuente caracterizada por un crecimiento desproporcionado de la aurícula derecha en ausencia de una causa estructural o funcional que la justifique. Presentamos el caso de una paciente con DIAD con diagnóstico desde la etapa prenatal.
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Átrios do Coração , Humanos , Dilatação , Átrios do Coração/anormalidades , Dilatação PatológicaRESUMO
The triatomic system NeI2 is studied under the consideration that the diatom is found in an excited electronic stateâ (B). The vibrational levels (v=13, , 23) are considered within two well-known theoretical procedures: quasi-classical trajectories (QCT), where the classical equations of motion for nuclei are solved on a single potential energy surface (PES), and the trajectory surface hopping (TSH) method, where the same are solved in a bunch of crossed vibrational PES (diabatic representation). The trajectory surface hopping fewest switches (TSHFS) is implemented to minimize the number of hoppings, thus allowing the calculations of hopping probability between the different PES's, and the kinetic mechanism to track the dissociation path. From these calculations, several observables such as, the lifetimes, vibrational and rotational energies (I2 ), dissociation channels, are obtained. Our results are compared with previous experimental and theoretical work.
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BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is a rare entity with severe inflammatory demyelinating events of the central nervous system with debilitating sequelae. Its global prevalence ranges between 0.5 and 4/100,000 individuals, with variations by region and ethnicity. Latin America lacks epidemiological data on the disease, and Colombian prevalence is unknown. OBJECTIVE: Prevalence of NMOSD in Colombia was estimated between 2017 and 2021 using the official Ministry of Health administrative database (SISPRO). METHODS: This is an observational, cross-sectional retrospective study, using data between January 2017 and December 2021 in the SISPRO database using the International Classification of Disease code for NMOSD G36.0. Prevalence by gender, age and geographic distribution was estimated using official government statistics for 2019. World Health Organization (WHO) standard population was used to adjust using the direct method. RESULTS: 2,650 patients were diagnosed with NMOSD; the average age was 44.9 years with an overall unadjusted prevalence of 5.3/100,000 individuals, higher for females (7.8) than for males (2.8). No significant changes (from 5.3 to 5.4) were seen after adjusting to the WHO standard. CONCLUSION: According to this study Colombia has one of the highest prevalence rates of NMOSD in Latin America, further studies are needed to elucidate the contributing factors.
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Colorectal cancer (CRC) is the second leading cause of cancer deaths in Spain. Metastatic disease is present in 15-30% of patients at diagnosis and up to 20-50% of those with initially localized disease eventually develop metastases. Recent scientific knowledge acknowledges that this is a clinically and biologically heterogeneous disease. As treatment options increase, prognosis for individuals with metastatic disease has steadily improved over recent decades. Disease management should be discussed among experienced, multidisciplinary teams to select the most appropriate systemic treatment (chemotherapy and targeted agents) and to integrate surgical or ablative procedures, when indicated. Clinical presentation, tumor sidedness, molecular profile, disease extension, comorbidities, and patient preferences are key factors when designing a customized treatment plan. These guidelines seek to provide succinct recommendations for managing metastatic CRC.
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Neoplasias do Colo , Neoplasias Retais , Humanos , Gerenciamento Clínico , Preferência do Paciente , EspanhaRESUMO
Peritoneal metastases (PM) occur when cancer cells spread inside the abdominal cavity and entail an advanced stage of colorectal cancer (CRC). Prognosis, which is poor, correlates highly with tumour burden, as measured by the peritoneal cancer index (PCI). Cytoreductive surgery (CRS) in specialized centres should be offered especially to patients with a low to moderate PCI when complete resection is expected. The presence of resectable metastatic disease in other organs is not a contraindication in well-selected patients. Although several retrospective and small prospective studies have suggested a survival benefit of adding hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS, the recently published phase III studies PRODIGE-7 in CRC patients with PM, and COLOPEC and PROPHYLOCHIP in resected CRC with high-risk of PM, failed to show any survival advantage of this strategy using oxaliplatin in a 30-min perfusion. Final results from ongoing randomized phase III trials testing CRS plus HIPEC based on mitomycin C (MMC) are awaited with interest. In this article, a group of experts selected by the Spanish Group for the Treatment of Digestive Tumours (TTD) and the Spanish Group of Peritoneal Oncologic Surgery (GECOP), which is part of the Spanish Society of Surgical Oncology (SEOQ), reviewed the role of HIPEC plus CRS in CRC patients with PM. As a result, a series of recommendations to optimize the management of these patients is proposed.
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Neoplasias Colorretais , Hipertermia Induzida , Neoplasias Peritoneais , Humanos , Neoplasias Colorretais/patologia , Neoplasias Peritoneais/secundário , Estudos Retrospectivos , Estudos Prospectivos , Terapia Combinada , Hipertermia Induzida/métodos , Taxa de SobrevidaRESUMO
Staphylococcus aureus is the main etiological agent of mastitis in small ruminants worldwide. This disease has a difficult cure and possible relapse, leading to significant economic losses in production, milk quality and livestock. This study performed comparative genomic analyses between 73 S. aureus genomes from different hosts (human, bovine, pig and others). This work isolated and sequenced 12 of these genomes from ovine. This study contributes to the knowledge of genomic specialization and the role of specific genes in establishing infection in ovine mastitis-associated S. aureus. The genomes of S. aureus isolated from sheep maintained a higher representation when grouped with clonal complexes 130 and 133. The genomes showed high genetic similarity, the species pan-genome consisting of 4200 genes (central = 2008, accessory = 1559 and unique = 634). Among these, 277 unique genes were related to the genomes isolated from sheep, with 39.6 % as hypothetical proteins, 6.4 % as phages, 6.4 % as toxins, 2.9 % as transporters, and 44.7 % as related to other proteins. Furthermore, at the pathogen level, they showed 80 genes associated with virulence factors and 19 with antibiotic resistance shared in almost all isolates. Although S. aureus isolated from ovine showed susceptibility to antimicrobials in vitro, ten genes were predicted to be associated with antibiotic inactivation and efflux pump, suggesting resistance to gentamicin and penicillin. This work may contribute to identifying genes acquired by horizontal transfer and their role in host adaptation, virulence, bacterial resistance, and characterization of strains affecting ovine.
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Mastite Bovina , Infecções Estafilocócicas , Feminino , Animais , Bovinos , Ovinos/genética , Humanos , Suínos , Fatores de Virulência/genética , Staphylococcus aureus/genética , Adaptação ao Hospedeiro , Infecções Estafilocócicas/genética , Infecções Estafilocócicas/veterinária , Infecções Estafilocócicas/microbiologia , Ruminantes/genética , Genômica , Sequências Repetitivas Dispersas , Mastite Bovina/genética , Mastite Bovina/microbiologiaRESUMO
Intrapericardial teratoma is a rare tumor composed of tissue from the three germ cell layers with a rapid growth that may cause severe hemodynamic complications due to compressive effects. We present two clinical cases: the first case had severe fetal heart failure with fatal outcome, and the second underwent surgical treatment during the immediate postnatal period with a favorable evolution. Although teratomas are histologically benign tumors, rapid growth can cause serious hemodynamic complications. The importance of prenatal diagnosis is to allow appropriate monitoring of tumor growth and establish a prompt therapeutic plan. Opportune surgical treatment can prevent death and improve the prognosis of these patients.
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Neoplasias Cardíacas , Teratoma , Gravidez , Feminino , Humanos , Pericárdio/cirurgia , Pericárdio/diagnóstico por imagem , Diagnóstico Pré-Natal , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Prognóstico , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ultrassonografia Pré-NatalRESUMO
ABSTRACT Introduction: The interest in spinal endoscopy is rising, particularly among younger spine surgeons. Formalized postgraduate training programs for endoscopic spinal surgery techniques are lacking behind. Methods: The authors performed a retrospective survey study amongst participants of the 2022 AMCICO endoscopic surgery symposium. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. In addition, surgeons were asked about their clinical experience and preferences with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, and future training requirements. SPSS (version 27) statistical software package was used for data analysis. Descriptive statistic measures were used to count responses and calculate the mean, range, standard deviation, and percentages. In addition, chi-square statistics were used to determine the strength of the association between factors. Results: The online survey was accessed by 321 surgeons, of which 92 completed it (53.4%). Demographic data showed the majority of responding surgeons being orthopedic surgeons (73.6%) and under the age of 50 (69.2%), with over half (51.1%) having less than three months of formalized training in endoscopic spinal surgery techniques. Most surgeons practiced uni-portal (58.9%) versus bi-portal (3.4%) spinal endoscopy. The transforaminal approach (65.5%) was preferred over the interlaminar method (34.4%). The bi-portal technique was indicated almost exclusively for the lumbar spine (94.8%). For endoscopically assisted spinal fusions, a uni-portal approach was preferred by 72% of surgeons over a bi-portal procedure (24.5%). 84.1% of respondents were interested in navigation, of which 30.7% preferred optical over electromagnetic technology (18.2%). Robotics was of interest to 51.1% of survey participants. Respondents' bias was estimated with course attendance assessments, with 37% of surgeons having attended all three days, 27.2% two days, and 16.3% one day. One-fifth of responding spine surgeons did not participate in any curriculum activities but completed the survey. The academic impact of the AMCICO endoscopy symposium was high, with 68.1% of respondents indicating interest in continued training and 61.1% of trainees ready to apply their newly acquired knowledge base to clinical practice. Conclusion: The interest in spinal endoscopy surgery techniques and protocols is high among AMCICO members. Many surgeons are interested in learning advanced endoscopic surgical techniques to integrate the technology into their surgical procedure portfolio to address common painful conditions of the degenerative spine beyond herniated discs and foraminal stenosis. The authors concluded that its academic impact was high based on the responses given by the participating surgeons. Level of evidence III; Retrospective study.
Resumo: Introdução: O interesse em cirurgia endoscópica da coluna tem aumentado especialmente entre os jovens cirurgiões, contudo, são poucos os centros que atualmente oferecem programas de treinamento nesta disciplina. Métodos: Foi realizada uma pesquisa retrospectiva entre os participantes do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" realizado durante o Congresso AMCICO 2022. Estatísticas descritivas e testes de correlação foram aplicados às respostas das perguntas de múltipla escolha. Os cirurgiões foram questionados sobre experiência clínica e preferências pela endoscopia espinhal, histórico de treinamento, tipos de descompressão lombar endoscópica que realizaram e requisitos futuros para um treinamento adicional. O software estatístico SPSS (versão 27) foi utilizado para a análise de dados. As medidas estatísticas descritivas foram utilizadas para quantificar as respostas e calcular a mediana, a média, o desvio padrão e as porcentagens. O qui-quadrado foi empregado para determinar a associação entre os fatores estudados. Resultados: A pesquisa on-line foi visualizada por 321 cirurgiões, dos quais 92 a completaram (53,4%). As informações demográficas mostraram que a maioria dos participantes são cirurgiões ortopédicos (73,6%) e menores de 50 anos (69,2%), com mais da metade deles (51,1%) possuindo menos de 3 meses de treinamento formal em técnicas endoscópicas. A maioria dos cirurgiões pratica abordagens uniportais (58,9%, contra 3,4% bi-portais). A abordagem transforaminal (65,5%) foi preferida em relação à abordagem interlaminar (34,4%). A abordagem biportal foi selecionada como a abordagem indicada para a região lombar (94,8%). Para a fusão endoscopia-assistida, a abordagem unilateral foi preferida por 72% dos participantes contra a abordagem biportal (24,5%). Os sistemas de navegação foram de interesse para 84,1% dos participantes, dos quais 30,7% responderam que preferiam a óptica em vez da eletromagnética (18,2%). O uso da robótica foi de interesse para 51,1% dos participantes. O viés dos participantes foi calculado com base no percentual de participação, onde 37% participaram de todos os 3 dias de conferências, 27,2% participaram de 2 dias e 16,3% participaram de apenas um dia. Um quinto dos cirurgiões não participaram das atividades do simpósio e ainda assim responderam à pesquisa. O impacto acadêmico do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" foi alto, com 68,1% dos participantes respondendo que têm interesse em treinamento adicional nestas técnicas e 61,1% respondendo que estão prontos para aplicar novos conhecimentos em sua prática médica. Conclusão: O interesse em técnicas cirúrgicas endoscópicas da coluna vertebral é alto entre os membros da AMCICO. Um grande número de cirurgiões está interessado em aprender técnicas cirúrgicas endoscópicas avançadas da coluna vertebral e integrar esta tecnologia como parte de suas ferramentas cirúrgicas para resolver problemas comuns que afetam a coluna com doença degenerativa, além de hérnias de disco e estenoses foraminais. Baseados nas respostas fornecidas pelos cirurgiões participantes, os autores concluem que o impacto acadêmico foi elevado. Nível de evidência III; Estudo retrospectivo.
resumen está disponible en el texto completo
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Humanos , Coluna VertebralRESUMO
Chest pain is one of the most frequent reasons for consultation in the emergency department. The most severe pathologies must be quickly ruled out within the diagnostic hypotheses: myocardial infarction (MI), aortic dissection, pulmonary thromboembolism, and pneumothorax. A frequent scenario is ST elevation MI due to a plaque accident. However, there are infrequent cases of aortic dissection associated with a deficit in coronary perfusion (malperfusion syndrome) that triggers a MI. The diagnosis of a double artery is difficult, with higher mortality and surgical complexity. We present the case of a 59-year-old man who presented chest pain and an electrocardiogram with inferior and anterior ST-segment elevation who was referred for primary angioplasty. The angiographic study confirmed the presence of a coronary ostium defect and suggested aortic dissection. Computed tomography angiography confirmed the diagnosis, showing the dissection of the ascending aorta with the compromise of both coronary ostia, which was subjected to surgical treatment.
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Dissecção Aórtica , Eletrocardiografia , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Angiografia Coronária , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicaçõesRESUMO
Pancreatic cancer and biliary tract cancer have a poor prognosis. In recent years, the development of new diagnostic techniques has enabled the identification of the main genetic alterations involved in the development of these tumours. Multiple studies have assessed the ability of certain biomarkers, such as BRCA in pancreatic cancer, IDH1 or FGFR2 in biliary tract cancer and microsatellite instability or NTRK fusions in an agnostic tumour fashion, to predict response to treatment.In this consensus, a group of experts selected by the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathology (SEAP) reviewed the role played by these mutations in the process of carcinogenesis and their clinical implications. As a result, this article proposes a series of recommendations to optimize the determination of these biomarkers to help standardize the diagnosis and treatment of these tumours.
Assuntos
Neoplasias do Sistema Biliar , Neoplasias Pancreáticas , Neoplasias do Sistema Biliar/diagnóstico , Neoplasias do Sistema Biliar/genética , Biomarcadores Tumorais/genética , Consenso , Humanos , Oncologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias PancreáticasRESUMO
OBJECTIVE: This study aims to investigate the relationship between the pre-operative indocyanine green (ICG) test, the chemotherapy-associated liver injury (CALI), and the development of severe post-operative complications (POC) in patients operated of colorectal liver metastases (CRLMs). MATERIALS AND METHODS: Sixty-nine patients previously treated with chemotherapy and submitted to liver resection for CRLM were retrospectively studied. Two pathologists independently reviewed the pathological specimens and assessed the presence of CALI. The correlation between ICG clearance and specific pathological features was analyzed. In addition, a logistic regression analysis was performed to seek for pre-operative factors associated with severe complications. RESULTS: After a mean of 10.6 (± 7.5) chemotherapy cycles, 44 patients (63.8%) developed CALI. ICG retention rate at 15 min (ICG-R15) was not statistically different between patients with and without CALI and it could only discriminate the presence of centrilobular fibrosis. Rate of severe complications was almost 6-fold in patients with CALI compared to patients without CALI (p = 0.024). ICG-R15 ≥ 10% was the only independent risk factor associated with severe POC at multivariable logistic regression (OR = 4.075 95% CI: 1.077-15.422, p = 0.039). CONCLUSIONS: Pre-operative ICG clearance test, although not useful to identify patients with hepatic drug toxicity, is a strong predictor for the development of severe post-hepatectomy complications.
OBJETIVO: Investigar la relación entre el test de aclaramiento del verde de indocianina (ICG) preoperatorio, las alteraciones patológicas derivadas de la quimioterapia (CALI) y el desarrollo de complicaciones posoperatorias en los pacientes sometidos a resección hepática por metástasis de cáncer colorrectal (MCCR). MATERIAL Y MÉTODOS: Sesenta y nueve pacientes previamente tratados con quimioterapia y operados de MCCR se estudiaron de manera retrospectiva. Dos patólogas revisaron independientemente el parénquima hepático no tumoral de los especímenes y determinaron la presencia de daño quimio-inducido. Se analizó la correlación entre el aclaramiento de ICG y las diferentes alteraciones anatomo-patológicas encontradas. Además, se realizó un análisis de regresión logística para identificar los factores preoperatorios asociados con las complicaciones posoperatorias. RESULTADOS: Tras una media de 10.6 (± 7.5) ciclos de quimioterapia, 44 pacientes (63.8%) desarrollaron CALI. La tasa de retención de ICG a los 15 minutos (ICG-R15) no fue estadísticamente diferente entre los pacientes con y sin CALI y solo pudo discriminar la presencia de fibrosis centrolobulillar. La tasa de complicaciones severas posoperatorias fue 6 veces superior en los pacientes con CALI, comparada con aquella de los pacientes sin CALI (p = 0.024). Un ICG-R15 ≥ 10% fue el único factor de riesgo independiente asociado a complicaciones severas (OR = 4.075 95% CI: 1.077-15.422, p = 0.039). CONCLUSIONES: La prueba preoperatoria de aclaramiento del ICG, a pesar de no identificar eficazmente los pacientes con daño por quimioterapia, es un fuerte predictor de desarrollo de complicaciones severas posoperatorias.
Assuntos
Neoplasias Colorretais , Hepatite , Neoplasias Hepáticas , Neoplasias Colorretais/complicações , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Humanos , Verde de Indocianina/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND AND AIMS: Transient global amnesia (TGA) is a clinical syndrome characterized by sudden anterograde amnesia not accompanied by other neurological symptoms. There is no consensus on the underlying pathophysiological mechanism. However, diffusion-weighted imaging (DWI) of the magnetic resonance imaging (MRI) has demonstrated hippocampal lesions in as many as 50% of cases. This paper describes a series of patients with TGA and hippocampal lesions. METHODS: This study assessed vascular risk factors in patients older than age 18 admitted to the Hospital Universitario San Ignacio, Bogota, Colombia, from May 2017 to June 2020 with a diagnosis of TGA and evidence of hippocampal ischemic lesion on 3 Tesla brain MRI. RESULTS: The authors identified 36 patients, 72.2% female, with mean age 62 years. Cardiovascular risk factors, most frequently high blood pressure, carotid disease, and dyslipidemia, were present in 75% of these patients. Hippocampal lesions were unilateral in 80% of cases, with median size 2.5 mm, most frequently located at the hippocampal body. Approximately 14% of patients also presented acute ischemic lesions in locations other than the hippocampus. CONCLUSIONS: TGA is a clinical entity previously considered to have undetermined etiology. The present study used brain MRI to identify a group of patients with hippocampal ischemic lesions, finding associated vascular risk factors in a high proportion of them.