RESUMO

BACKGROUND: Primary central nervous system germinomas of the medulla oblongata are extremely rare and usually have been found in young female Asian patients. The authors present an illustrative case of a patient who presented with severe medullary and posterior cord syndrome, the first South American case published to date, to the authors' knowledge. OBSERVATIONS: Initially, the radiological differential diagnosis did not include this entity. The lesion was located at the obex and exhibited a well-delineated contrast enhancement without hydrocephalus. An emergency decompressive partial resection following functional limits was performed. After histological confirmation, radiotherapy was indicated, with complete remission achieved at a 6-month follow-up. The patient, however, continued to have a severe proprioceptive disorder. The literature review identified 21 other such patients. The mean age for this location was 23 years, with a strong female and Asian origin predilection. All tumors exhibited contrast enhancement, and only one presented with hydrocephalus. LESSONS: In the absence of elevated tumor markers, radiological clues such as a well-delineated, contrast-enhanced lesion arising from the obex, without hydrocephalus, associated with demographic features such as young age, female sex, and Asian heritage, should evoke a high level of suspicion for this diagnosis. Gross total resection must not be attempted, because this tumor is potentially curable with high-dose radiotherapy.

RESUMO

Cigarette smoking is a known risk factor for the development of lung cancer. We investigated whether circulating microRNA expression levels and their potential diagnostic value are affected by cigarette smoking in adenocarcinoma (AD) patients and healthy (H) participants. In total, 71 female AD patients and 91 H individuals were recruited, including 42 AD never-smokers (AD/CS-), 29 AD smokers (AD/CS+), 54 H never-smokers (H/CS-), and 37 H smokers (H/CS+). PCR array (754 microRNAs) and qPCR were performed on sera from the discovery and validation cohorts, respectively. The expression levels of miR-532-5p, miR-25-3p, and miR-133a-3p were significantly higher in adenocarcinoma patients than in healthy participants, independent of their smoking status. Multivariate analysis showed that levels of miR-133a-3p were independently associated with smoking. ROC analysis showed that only miR-532-5p discriminated AD patients from H controls (AUC: 0.745). However, when making comparisons according to cigarette smoking status, miR-532-5p discriminated AD/CS- patients from H/CS- controls with a higher AUC (AUC:0.762); miR-25-3p discriminated AD/CS+ patients from H/CS+ controls (AUC: 0.779), and miR-133a discriminated AD/CS+ patients from H/CS+ controls with the highest AUC of 0.935. Cancer and lung-cancer-enriched pathways were significantly associated with the three miRNAs; in addition, nicotinate/nicotinamide metabolism, inflammation, and pulmonary hypertension were associated with miR-133a-3p. Our findings highlight how cigarette smoking affects the reliable identification of circulating miRNAs as diagnostic biomarkers in lung cancer and suggest a smoking-dependent pathogenic role of miR-133a-3p in smokers.

RESUMO

Cardiac angiosarcoma is a rare and clinically challenging pathology. It is a high-grade primary malignant tumor of the heart tissue that has many variants, of which the epithelioid variant is rarely present in the heart or the great vessels. As with many other cardiac tumors, it is mainly a diagnosis of exclusion and the initial diagnostic test is an echocardiogram followed by a biopsy with immunohistochemistry analysis to ascertain the type of tumor. The differential diagnosis of cardiac tumors is challenging due to the overlapping clinical manifestations with different cardiac tumors and systemic diseases. Cardiac angiosarcomas are often aggressive with a poor prognosis even with treatment. Herein, we present a case of the epithelioid variant of a cardiac angiosarcoma in addition to a thorough review of the recent literature on the clinical manifestation, diagnosis, and treatment of this type of tumors.

RESUMO

The availability of new scientific information about the etiology, diagnosis and treatment of carious lesions and the introduction of reliable adhesive restorative materials substantially reduced the need of extensive tooth preparations. In order to achieve a successful procedure, an adequate bonding interface between old and new composite is required. The aim of this article is to review the concepts and techniques described in the literature for the improvement of resin-resin bonding. Bonding to dentin has been quite difficult to achieve. The difficulties are that dentin's histological structure and chemical composition are very different from those of the enamel. Bonding to dentin requires, besides acid conditioning and the adhesive required for enamel, a primer or dentin bonding agent, which is a hydrophilic, able to penetrate by infiltrating the microscopic spaces of the collagen mesh. The repairing of faulty restorations is a treatment option that has proven to be quite effective and safe, since it presents excellent results over time. For this purpose, different methods for surface treatment have been develo-ped, which has a great effect on the resistance of the reparation bonding. In order to achieve successful bonding between both resins, the following steps are recommended, including: surface roughening, acid etching, silane application, and bonding agent application

Assuntos

Humanos , Colagem Dentária/métodos , Resinas Sintéticas , Resinas Compostas , Cimentos de Resina

RESUMO

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

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RESUMEN Objetivo: Estudios previos demuestran que la biopsia pleural cerrada (BPC) para diagnóstico de malignidad tiene una sensibilidad menor al 60%, por lo que recientemente ha despertado controversia su valor como prueba diagnóstica. Nuestro objetivo fue evaluar la exactitud de la BPC para diagnóstico de malignidad en pacientes con derrame pleural. Métodos: Estudio prospectivo de 8 años en individuos que se sometieron a la realización de BPC para establecer la etiología del derrame. La información de cada paciente se tomó de los registros de anatomopatología y del expediente clínico. Cuando el resultado de la BPC demostró malignidad o tuberculosis, esto se tomó como biopsia diagnóstica y quedó éste como diagnóstico definitivo. En los casos en que el resultado del estudio histopatológico de la biopsia resultó inespecífico, el diagnóstico definitivo se estableció en base a otros procedimientos diagnósticos, como toracoscopia, toracotomía, fibrobroncoscopia, estudio bioquímico y celular del líquido pleural y/o pruebas microbiológicas. Mediante una tabla de contingencia de 2 × 2 se midieron los indicadores para una prueba diagnóstica. Resultados: Se estudiaron 1034 biopsias de pacientes con derrame pleural, de las cuales se excluyeron 171 (16.54%) por muestra inadecuada o información insuficiente. El desempeño para malignidad fue: sensibilidad, 77%; especificidad, 98%; valores predictivos positivo y negativo, 99% y 66%, respectivamente; índices de probabilidad positivo y negativo, 38.5 y 0.23, respectivamente; probabilidad antes y después de la prueba, 2.13 y 82, respectivamente. Conclusión: La BPC es útil como prueba diagnóstica en la práctica clínica, debido a que produce un cambio importante de la probabilidad antes de la prueba a la probabilidad después de la prueba.

Assuntos

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biópsia/classificação , Biópsia/métodos , Derrame Pleural Maligno/patologia , Pleura/patologia , Toracoscopia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade

RESUMO

OBJECTIVE: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. METHODS: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. RESULTS: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. CONCLUSIONS: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

Assuntos

Biópsia , Derrame Pleural Maligno/patologia , Biópsia/classificação , Biópsia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pleura/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Toracoscopia

RESUMO

Large vessel vasculitis and particularly Temporal Arteritis are systemic diseases that may affect the aorta and its major branches, mainly involving extra cranial branches of the carotid artery. We report a 72-year-old man presenting with weight loss, fever and malaise. Positron emission computed tomography (PET CT) showed an extensive inflammation of the aorta and its major branches. Temporal artery biopsy confirmed the presence of vasculitis with granulomas. Treatment with a high dose of steroids had an excellent clinical response. This case underscores the utility of PET CT in the assessment of this disease.

Assuntos

Humanos , Masculino , Idoso , Aortite/patologia , Aortite/diagnóstico por imagem , Arterite de Células Gigantes/patologia , Arterite de Células Gigantes/diagnóstico por imagem , Aortite/tratamento farmacológico , Artérias Temporais/patologia , Arterite de Células Gigantes/tratamento farmacológico , Biópsia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada

RESUMO

Large vessel vasculitis and particularly Temporal Arteritis are systemic diseases that may affect the aorta and its major branches, mainly involving extra cranial branches of the carotid artery. We report a 72-year-old man presenting with weight loss, fever and malaise. Positron emission computed tomography (PET CT) showed an extensive inflammation of the aorta and its major branches. Temporal artery biopsy confirmed the presence of vasculitis with granulomas. Treatment with a high dose of steroids had an excellent clinical response. This case underscores the utility of PET CT in the assessment of this disease.

Assuntos

Aortite/diagnóstico por imagem , Aortite/patologia , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/patologia , Idoso , Aortite/tratamento farmacológico , Biópsia , Arterite de Células Gigantes/tratamento farmacológico , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Artérias Temporais/patologia

RESUMO

Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.

Assuntos

Anti-Inflamatórios não Esteroides/uso terapêutico , Infliximab/uso terapêutico , Neoplasias Peritoneais/tratamento farmacológico , Adulto , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Miofibroblastos , Recidiva Local de Neoplasia , Neoplasias Peritoneais/patologia , Tomografia Computadorizada por Raios X

RESUMO

Myofibroblastic tumor (MIT) is characterized by the infiltration of different organs, most commonly the lungs, with nodular lesions composed of myofibroblasts and inflammatory cells, which can be identified by specific patterns in the immunohistochemical studies. When it involves the peritoneum it is difficult to eradicate, tends to relapse and it has an invasive behavior, requiring its differentiation from peritoneal carcinomatosis. Treatment may be surgical excision, the use of non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids. We report a 30 years old female with an unremarkable medical history, presenting with abdominal pain and progressive abdominal distention. A CT scan revealed multiple peritoneal nodular lesions. A surgical biopsy was reported as a myofibroblast and inflammatory cell infiltrate. Immunohistochemical staining was consistent with MIT. Given the extensive involvement of the peritoneum surgical therapy was not considered appropriate and treatment with NSAID and glucocorticoids was started. No response was observed after 6 months, therefore infliximab therapy was started. After 10 months of follow-up the patient is well, returned to normal life, ascites improved and resolved and CT scan showed partial regression or stabilization of the lesions.

Assuntos

Adulto , Feminino , Humanos , Anti-Inflamatórios não Esteroides/uso terapêutico , Infliximab/uso terapêutico , Neoplasias Peritoneais/tratamento farmacológico , Biópsia , Diagnóstico Diferencial , Miofibroblastos , Recidiva Local de Neoplasia , Neoplasias Peritoneais/patologia , Tomografia Computadorizada por Raios X

RESUMO

OBJETIVE: In patients with non-small cell lung cancer (NSCLC), knowledge of the epidermal growth factor receptor (EGFR) mutation status is fundamental for selecting the treatment involving EGFR-tyrosine kinase inhibitors (EGFR-TKIs). Little information is available regarding the response and progression-free survival (PFS) in platinum-based chemotherapy (CT) versus EGFR-TKIs in the presence or absence of KRAS mutation, particularly in patients without EGFR mutation. METHODS: From 2007 to 2010, 353 patients with NSCLC were treated with first-line CT, EGFR-TKIs were used in the second or third line of treatment. Tests were performed for EGFR and KRAS mutation and the results of the mutations were obtained 3 to 4 months after the start of the treatment. We analyzed clinical characteristics, mutation profile, response and PFS to CT and EGFR-TKIs, and overall survival. The protocol is registered with ClinicalTrials.gov, number NCT01023828. RESULTS: Presence of the wild-type (WT) KRAS was independently associated with increased response rate to first-line CT when compared with KRAS mutation (41.4% vs. 14.7%; P=0.001). The EGFR mutation (57.8% vs. 11.7%; P<0.001) and WT-KRAS (39.6% vs. 3.3%; P=0.001) were associated with the EGFR-TKIs response. PFS of patients with WT-EGFR and KRAS mutation treated with EGFR-TKIs was shorter when compared with patients with WT-EGFR and WT-KRAS (P<0.001). CONCLUSIONS: KRAS mutation status is a good biomarker for response to EGFR-TKIs in patients with NSCLC. KRAS mutational status could impact the decision to give CT or EGFR-TKIs as a second line of treatment to patients with NSCLC, particularly in patients with WT-EGFR.

Assuntos

Adenocarcinoma/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Receptores ErbB/antagonistas & inibidores , Neoplasias Pulmonares/tratamento farmacológico , Inibidores de Proteínas Quinases/uso terapêutico , Proteínas Proto-Oncogênicas/genética , Proteínas ras/genética , Adenocarcinoma/genética , Adenocarcinoma/patologia , Idoso , Carboplatina/administração & dosagem , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/patologia , Cisplatino/administração & dosagem , Intervalo Livre de Doença , Receptores ErbB/genética , Feminino , Marcadores Genéticos , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mutação , Paclitaxel/administração & dosagem , Prognóstico , Proteínas Proto-Oncogênicas p21(ras) , Resultado do Tratamento , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , Vinorelbina

RESUMO

Pleural chronic inflammation (PP) and mesothelial hyperplasia (HP) may be critical to the development of malignant pleural mesothelioma (MPM). Nonetheless, studies searching for mechanistic links involving microRNA (miRNA) regulation among these interrelated processes have not been reported. Using PCR-Array, we identified the miRNAs expressed in pleural tissues diagnosed with MPM (n=5), PP (n=4) and HP (n=5), as well as in non-cancerous/non-inflammatory tissue as the normal control (n=5). We performed bioinformatics and network analysis of differentially expressed miRNAs to identify tumorigenesis-related miRNAs and their biological networks. The targets of four down-regulated miRNAs in MPM (mir-181a-5p, miR-101-3p, miR-145-5p and miR-212-3p), one in PP (mir-101-3p) and one in HP (mir-494) were significantly enriched in "pathways in cancer". Interactome networks revealed that >50% of down-regulated miRNAs in MPM targeted the signaling-activation molecule MAPK1, the transcription factor ETS1 and the mesenchymal transition-associated molecule FZDA, which have been associated with oncogenic function. Comparative analysis revealed that FZD4 was an overlapping gene target of down-regulated miRNAs that were associated with "pathways in cancer" in MPM, PP and HP. Moreover, MAPK1, ETS1 and Cox-2, a pro-inflammatory enzyme associated with over-expression in cancers, were among the 25 overlapping target genes in MPM and PP. This network analysis revealed a potential combinatory effect of deregulated miRNAs in MPM pathogenesis and indicated potential molecular links between pleural inflammation and hyperplasia with tumorigenesis mechanisms in pleura.

Assuntos

Carcinogênese/genética , Neoplasias Pulmonares/genética , Mesotelioma/genética , MicroRNAs/análise , Neoplasias Pleurais/genética , Lesões Pré-Cancerosas/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hiperplasia/genética , Hiperplasia/patologia , Inflamação/genética , Inflamação/patologia , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma/patologia , Mesotelioma Maligno , Pessoa de Meia-Idade , Neoplasias Pleurais/patologia , Transcriptoma , Adulto Jovem

RESUMO

During the influenza pandemic of 2009, the number of viral pneumonia cases showed a marked increase in comparison with seasonal influenza viruses. Mutations at amino acid 222 (D222G mutations) in the virus hemagglutinin (HA) molecule, known to alter the receptor-recognition properties of the virus, were detected in a number of the more severely-affected patients in the early phases of the pandemic. To understand the background for the emergence of the mutant amino acid D222G in human lungs, we conducted histological examinations on lung specimens of patients from Mexico who had succumbed in the pandemic. Prominent regenerative and hyperplastic changes in the alveolar type II pneumocytes, which express avian-type sialoglycan receptors in the respiratory tract of severely affected individuals, were observed in the Mexican patients. An infection model utilizing guinea pigs, which was chosen in order to best simulate the sialic acid distribution of severe pneumonia in human patients, demonstrated an increase of D222G mutants and a delay in the diminution of mutants in the lower respiratory tract in comparison to the upper respiratory tract. Our data suggests that the predominance of avian-type sialoglycan receptors in the pneumonic lungs may contribute to the emergence of viral HA mutants. This data comprehensively illustrates the mechanisms for the emergence of mutants in the clinical samples.

Assuntos

Modelos Animais de Doenças , Hemaglutininas Virais/genética , Vírus da Influenza A Subtipo H1N1/genética , Influenza Humana/virologia , Infecções por Orthomyxoviridae/virologia , Pneumonia Viral/virologia , Células Epiteliais Alveolares/virologia , Animais , Surtos de Doenças , Feminino , Genes Virais , Cobaias , Interações Hospedeiro-Patógeno , Humanos , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/patologia , Células Madin Darby de Rim Canino , Mutação , Pneumonia Viral/patologia , RNA Viral/genética , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/metabolismo , Receptores Virais/genética , Receptores Virais/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa

RESUMO

BACKGROUND: In addition to clinical aspects and pathogen characteristics, people's health-related behavior and socioeconomic conditions can affect the occurrence and severity of diseases including influenza A(H1N1)pdm09. METHODOLOGY AND PRINCIPAL FINDINGS: A face-to-face interview survey was conducted in a hospital in Mexico City at the time of follow-up consultation for hospitalized patients with pneumonia due to influenza virus infection. In all, 302 subjects were enrolled and divided into two groups based on the period of hospitalization. Among them, 211 tested positive for influenza A(H1N1)pdm09 virus by real-time reverse-transcriptase-polymerase-chain-reaction during the pandemic period (Group-pdm) and 91 tested positive for influenza A virus in the post-pandemic period (Group-post). All subjects were treated with oseltamivir. Data on the demographic characteristics, socioeconomic status, living environment, and information relating to A(H1N1)pdm09, and related clinical data were compared between subjects in Group-pdm and those in Group-post. The ability of household income to pay for utilities, food, and health care services as well as housing quality in terms of construction materials and number of rooms revealed a significant difference: Group-post had lower socioeconomic status than Group-pdm. Group-post had lower availability of information regarding H1N1 influenza than Group-pdm. These results indicate that subjects in Group-post had difficulty receiving necessary information relating to influenza and were more likely to be impoverished than those in Group-pdm. Possible factors influencing time to seeking health care were number of household rooms, having received information on the necessity of quick access to health care, and house construction materials. CONCLUSIONS: Health-care-seeking behavior, poverty level, and the distribution of information affect the occurrence and severity of pneumonia due to H1N1 virus from a socioeconomic point of view. These socioeconomic factors may explain the different patterns of morbidity and mortality for H1N1 influenza observed among different countries and regions.

Assuntos

Hospitalização/estatística & dados numéricos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/complicações , Influenza Humana/epidemiologia , Pandemias/economia , Pandemias/estatística & dados numéricos , Pneumonia/epidemiologia , Pneumonia/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Atenção à Saúde , Feminino , Saúde , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Vírus da Influenza A Subtipo H1N1/classificação , Influenza Humana/economia , Influenza Humana/virologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Pneumonia/economia , Fatores Socioeconômicos , Adulto Jovem

RESUMO

PURPOSE: This randomized phase II trial evaluated whether the combination of cisplatin and paclitaxel (PC) plus all-trans retinoic acid (ATRA) increases response rate (RR) and progression-free survival (PFS) in patients with advanced non-small-cell lung cancer (NSCLC) with an acceptable toxicity profile and its association with the expression of retinoic acid receptor beta 2 (RAR-beta2) as a response biomarker. PATIENTS AND METHODS: Patients with stages IIIB with pleural effusion and IV NSCLC were included to receive PC, and randomly assigned to receive ATRA 20 mg/m(2)/d (RA/PC) or placebo (P/PC) 1 week before treatment until two cycles were completed. RAR-beta2 expression was analyzed in tumor and adjacent lung tissue. RESULTS: One hundred seven patients were included, 55 in the P/PC group and 52 in the RA/PC group. RR for RA/PC was 55.8% (95% CI, 46.6% to 64.9%) and for P/PC, 25.4% (95% CI, 21.3 to 29.5%; P = .001). The RA/PC group had a longer median PFS (8.9 v 6.0 months; P = .008). Multivariate analysis of PFS showed significant differences for the RA/PC group (hazard ratio, 0.62; 95% CI, 0.4 to 0.95). No significant differences in toxicity grade 3/4 were found between groups, except for hypertriglyceridemia (10% v 0%) in RA/PC (P = .05). Immunohistochemistry and reverse-transcriptase polymerase chain reaction assays showed expression of RAR-beta2 in normal tissues of all tumor samples, but only 10% of samples in the tumor tissue. CONCLUSION: Adding ATRA to chemotherapy could increase RR and PFS in patients with advanced NSCLC with an acceptable toxicity profile. A phase III clinical trial is warranted to confirm these findings.

Assuntos

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Cisplatino/administração & dosagem , Método Duplo-Cego , Feminino , Humanos , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Paclitaxel/administração & dosagem , Receptores do Ácido Retinoico/análise , Tretinoína/administração & dosagem

RESUMO

In order to evaluate the synergistic effect of habitual smoking and air pollution in Mexico City on the retention of inorganic fibers, ferruginous bodies (FB) were quantified as markers of exposure to inorganic fibers in lung digests from 426 autopsy cases. FB were isolated from 426 lung digests from cases with several lung diseases. The results revealed more retention of FB in the smokers group than in non-smokers: 38 FB per gram (FB/g) versus 11.2 FB/g, respectively (p < 0.05). Male smokers living in Mexico City increased their median to 54 FB/g. This contrasts with the median of outside residents: 11.2 FB/g (p < 0.002). Housewives and manual laborers increased their medians when the smoking habit was positive: from 11 to 14 FB/g, and from 16 to 21.5 FB/g, respectively. There is an effect of tobacco smoke on the retention of more fibers identified as FB when the individuals are males and Mexico City residents.

Assuntos

Poluição do Ar/efeitos adversos , Compostos Inorgânicos , Pulmão/patologia , Fibrose Pulmonar/patologia , Fumar/patologia , Adulto , Idoso , Autopsia , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Ocupações , Caracteres Sexuais , Fumar/epidemiologia , População Urbana

RESUMO

Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and leiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal and pericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.

Assuntos

Cisto Broncogênico/patologia , Espaço Retroperitoneal/patologia , Adulto , Cisto Broncogênico/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Pancreatectomia/métodos , Espaço Retroperitoneal/cirurgia

RESUMO

Retroperitoneal cystic tumors are uncommon. More than two thirds are malignant. Benign lesions include lipomas and íeiomyomas, among others. Bronchogenic cysts are congenital anomalies that result from an abnormal budding of the primitive foregut, and are most commonly found in the mediastinum. Occasionally they can be seen in the skin, subcutaneous tissue, in the pre-sternal andpericardial areas, but those located under the diaphragm are extremely rare. We report a 24 year-old female who consulted for abdominal pain. An abdominal ultrasound disclosed a retroperitoneal cystic lesion, that was confirmed with a CAT scan. The patient was operated, finding a cyst that was adhered to the pancreas. A distal pancreatectomy and cyst excision were done. The pathological examination of the lesion showed a bronchogenic cyst. The patient was discharged ten days after surgery.

Assuntos

Adulto , Feminino , Humanos , Cisto Broncogênico/patologia , Espaço Retroperitoneal/patologia , Cisto Broncogênico/cirurgia , Diagnóstico Diferencial , Laparoscopia , Pancreatectomia/métodos , Espaço Retroperitoneal/cirurgia

RESUMO

Hombre de 71 años de edad con diabetes mellitus tipo II de 10 años de evolución, con tabaquismo intenso. Inició con derrame pleural e imagen radiológica de cavitación en lóbulo superior izquierdo.

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Male of 71 years with 10 years evolution of diabetes mellitus II, heavy smoker. The case began with pleural overflow and with X ray cavitation in the left upper lobe.