Utilización de fibroscopio con canal de biopsia bajo anestesia tópica para biopsias de lesiones laríngeas oncológicas

Treball prospectiu experimental de pacients a estudi per possible lesió tumoral en l’àrea de cap i coll. Realitzarem biòpsies de les lesions mitjançant una tècnica que anomenem Fibro-Laringo Biòpsia (FLB) sota anestesia tòpica i sedació, consistent en biopsiar-les mitjançant un fibroscopi amb canal de treball que permet visualitzar tota la regió naso-faringo-laríngia. Ho compararem amb un grup de pacients ja biopsiats durant l’any 2010 amb la tècnica de Micro-laringo biòpsia (MLB) sota anestesia general. Volem valorar si la FLB és una tècnica tan útil pel diagnòstic i /o estadiatge de tumors com ho és, actualment en el nostre servei, la MLB.

Evaluación de la efectividad del tratamiento mediante instilaciones con ácido hialurónico en el control de la hematuria asociada a cistopatía rádica

Quan la bufeta és exposada a la radiació durant el tractament de tumors pelvians, esdevenen una sèrie de canvis histopatològics amb manifestacions clíniques. A més de la síndrome miccional irritatiu caracteritzat per urgència, polaquiuria i disúria, l'aparició d'hematúria suposa una de més grans les complicacions que l'uròleg ha de manejar. L'àcid hialurònic endovesicals constitueix una de les opcions de tractament. Avaluem l'efectivitat del tractament i la idoneïtat de la seva pauta d'administració mitjançant un estudi descriptiu retrospectiu amb 20 pacients i un període de seguiment mínim de 12 mesos.

Sarcomas mandibulares: experiencia quirúrgica en los últimos diez años (2001-2010)

Els sarcomes de cap i coll són tumors relativament estranys, representant un 2% de tots els tumors de cap i coll i un 4-10% del total dels sarcomes. Per tant els localitzats a la mandíbula representen un percentatge encara menor, no recollits específicament en cap estudi. La histopatologia heterogènia i les diverses localitzacions fan d'ells una entitat difícil d'estudiar. En aquest treball de recerca es pretén descriure l'etiologia i comportament dels sarcomes de cap i coll i recolzar els resultat de la literatura que promulguen la cirurgia com arma terapèutica principal, basant-nos en l'experiència del servei de Cirurgia Oral i Maxil·lofacial de l'Hosptial Vall d'Hebron en els últims 10 anys en el maneig del sarcoma mandibular.

Factores de recidiva del carcinoma hepatocelular tras resección quirúrgica con intención curativa

El carcinoma hepatocel•lular representa del 70-80% dels tumors hepàtics primaris. És la sisena neoplàsia més freqüent i la tercera causa més freqüent per càncer. Els factors de risc més importants són l'hepatitis B i C. La resecció quirúrgica és la primera opció terapèutica. La causa de la mort dels pacients sotmesos a resecció hepàtica amb intenció curativa és la recidiva. Les taxes de recidiva global arriben al 70-100% als 5 anys. Identificar els factors de risc de recidiva és important per augmentar la supervivència, aplicant teràpies preventives o incloent en llista d'espera de trasplantament.

Eina per al desenvolupament de reflectors de conjunts òptics

Avui en dia, una bona il·luminació vial és molt important, tant per als conductors com per als vianants. Els fanals o conjunts òptics estan compostos per una font de llum que és la làmpada, el reflector i la carcassa que els protegeix. Trobar la forma exacta d’un reflector amb unes propietats òptiques en particular és de gran importància en el sector luminotècnic. En aquest projecte es vol dissenyar i desenvolupar una sistema capaç d’ajudar a obtenir el reflector adequat, un programari que permeti dissenyar un reflector a partir d’una boca qualsevol, i mitjançant una làmpada, capturar la intensitat de llum que el reflector projecta sobre al terra o una superfície del carrer. L’aplicació desenvolupada vol facilitar el procés de selecció d’un bon reflector als enginyers luminotècnics

Metastasis of renal cell carcinoma to the buccal mucosa 19 years after radical nephrectomy

Renal cell carcinoma (RCC) has high metastatic potential, which requires early diagnosis to optimize the chance of cure. Metastasis of RCC to the head and neck region is less common and metastasis to the buccal mucosa is extremely rare. This phenomenon occurs mostly in patients with generalized dissemination, especially with lung metastases. In this article we report a case of buccal mucosa metastasis from RCC in a 65-year-old man who presented 19 years after undergoing a left radical nephrectomy for clear cell RCC. Surgical excision of the buccal lesion was performed without evidence of recurrence or new metastatic lesions after 6 years of followup. To our knowledge, this is the first case of metastasis to the buccal mucosa from a RCC reported in the literature.

Caracterización de las células madre neoplásicas en el cáncer de endometrio

El carcinoma de endometrio (CE) es el tumor maligno más frecuente del tracto genital femenino en países desarrollados. Durante los últimos años, ha ganado firmeza la hipótesis de que el origen de los tumores se encuentra en la transformación de células indiferenciadas multipotenciales denominadas células madre somáticas (CMS) en células madre neoplásicas (CSC). Estudios recientes han observado la existencia de células madre en endometrios murinos y humanos; el presente proyecto pretende identificar, aislar, cultivar y caracterizar las CSC endometriales y estudiar los mecanismos moleculares responsables de su transformación. Nuestros resultados muestran que diferentes lineas celulares de cancer de endometrio expresan factores de célula indiferenciada. Un trabajo más extenso con la línea celular Ishikawa muestra la capacidad de estas células para crecer como esferas, diferenciarse a otros linajes y resistir al tratamiento radioterapéutico. Los resultados obtenidos nos permiten pensar que la línea Ishikawa es un buen modelo para el estudio de las CSC endometriales, aunque se necesitaría ampliar el estudio para ser concluyente.

Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study.

BACKGROUND In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level. METHODS Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of <10%, 10-25%, and 25% and a prescribed radiation dose of <35 Gy, 50 Gy, and 66-70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field. RESULTS A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%. CONCLUSION This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.

Osteosarcoma extraóseo en extremidad inferior

INTRODUCTION: Extraoseus osteosarcoma is a rare tumor confined in soft tissues but with histological features similar to bone osteosarcoma. CLINICAL CASE: We report the case of a young male affected extraosseous osteosarcoma. A detailed analysis of the clinical symptoms and evolution from the beginning of the process to the death of the patient, three years later, is performed. DISCUSSION: The different types of treatment and prognostic factors involving this disease are discussed CONCLUSIONS: Radical surgery followed by chemotherapy is the preferred form of treatment in extraosseus osteosarcoma.The latest advances in chemotherapy have improved the prognosis in this type of tumor

Manejo de las Lesiones Renales Menores de 4 Centímetros Mediante Ablación por Radiofrecuencia Percutánea

La nefrectomía parcial se ha constituido en el tratamiento de referencia de los tumores renales pequeños. En pacientes de alto riesgo quirúrgico se han planteado técnicas mínimamente invasivas como la ablación por radiofrecuencia como una alternativa terapéutica. En este estudio evaluamos nuestra experiencia en la aplicación de esta técnica en cuanto sus resultados oncológicos y en cuanto a su efecto sobre la función renal a los 3 y 12 meses de seguimiento. Se concluye que se trata de una técnica que no altera la función renal con resultados oncológicos prometedores que deben ser validados por estudios a largo plazo.

Oral and general health-related quality of life in patients treated for oral cancer compared to control group.

BACKGROUND Health-related quality of life (HRQoL) is gaining importance as a valuable outcome measure in oral cancer area. The aim of this study was to assess the general and oral HRQoL of oral and oropharyngeal cancer patients 6 or more months after treatment and compare them with a population free from this disease. METHODS A cross-sectional study was carried out with patients treated for oral cancer at least 6 months post-treatment and a gender and age group matched control group. HRQoL was measured with the 12-Item Short Form Health Survey (SF-12); oral HRQoL (OHRQoL) was evaluated using the Oral Health Impact Profile (OHIP-14) and the Oral Impacts on Daily Performances (OIDP). Multivariable regression models assessed the association between the outcomes (SF-12, OHIP-14 and OIDP) and the exposure (patients versus controls), adjusting for sex, age, social class, functional tooth units and presence of illness. RESULTS For patients (n = 142) and controls (n = 142), 64.1% were males. The mean age was 65.2 (standard deviation (sd): 12.9) years in patients and 67.5 (sd: 13.7) years in controls. Patients had worse SF-12 Physical Component Summary scores than controls even in fully the adjusted model [β-coefficient = -0.11 (95% CI: -5.12-(-0.16)]. The differences in SF-12 Mental Component Summary were not statistically significant. Regarding OHRQoL patients had 11.63 (95% CI: 6.77-20.01) higher odds for the OHIP-14 and 21.26 (95% CI: 11.54-39.13) higher odds for OIDP of being in a worse category of OHRQoL compared to controls in the fully adjusted model. CONCLUSION At least 6 months after treatment, oral cancer patients had worse OHRQoL, worse physical HRQoL and similar psychological HRQoL than the general population.

Evaluation of the efficacy and safety of lanreotide in combination with targeted therapies in patients with neuroendocrine tumours in clinical practice: a retrospective cross-sectional analysis.

BACKGROUND Based on the mechanism of action, combining somatostatin analogues (SSAs) with mTOR inhibitors or antiangiogenic agents may provide synergistic effects for the treatment of patients with neuroendocrine tumours (NETs). Herein, we investigate the use of these treatment combinations in clinical practice. METHODS This retrospective cross-sectional analysis of patients with NETs treated with the SSA lanreotide and targeted therapies at 35 Spanish hospitals evaluated the efficacy and safety of lanreotide treatment combinations in clinical practice. The data of 159 treatment combinations with lanreotide in 133 patients was retrospectively collected. RESULTS Of the 133 patients, with a median age of 59.4 (16-83) years, 70 (52.6 %) patients were male, 64 (48.1 %) had pancreatic NET, 23 (17.3 %) had ECOG PS ≥2, 41 (30.8 %) had functioning tumours, 63 (47.7 %) underwent surgery of the primary tumour, 45 (33.8 %) had received prior chemotherapy, and 115 (86.5 %) had received prior SSAs. 115 patients received 1 lanreotide treatment combination and 18 patients received between 2 and 5 combinations. Lanreotide was mainly administered in combination with everolimus (73 combinations) or sunitinib (61 combinations). The probability of being progression-free was 78.5 % (6 months), 68.6 % (12 months) and 57.0 % (18 months) for patients who only received everolimus plus lanreotide (n = 57) and 89.3 % (6 months), 73.0 % (12 months), and 67.4 % (18 months) for patients who only received sunitinib and lanreotide (n = 50). In patients who only received everolimus plus lanreotide the median time-to-progression from the initiation of lanreotide combination treatment was 25.8 months (95 % CI, 11.3, 40.3) and it had not yet been reached among the subgroup of patients only receiving sunitinib plus lanreotide. The safety profile of the combination treatment was comparable to that of the targeted agent alone. CONCLUSIONS The combination of lanreotide and targeted therapies, mainly everolimus and sunitinib, is widely used in clinical practice without unexpected toxicities and suggests efficacy that should be explored in randomized prospective clinical trials.

Preços mais baixos para novos clientes: consequências da percepção de injustiça de preço nos clientes atuais

No estudo relatado, analisam-se as relações consequentes da percepção de injustiça de preço desencadeada pela comparação com o preço a ser pago por um novo cliente em uma situação promocional. A pesquisa foi feita por meio de um experimento, com uma amostra composta por 200 estudantes de graduação. A análise dos dados foi realizada por meio da modelagem de equações estruturais. Os resultados do estudo indicam que a percepção de injustiça é positivamente sucedida por emoções negativas e intenções de troca imediata e futura. Além disso, a confiança aparece como negativamente afetada pela percepção de injustiça, uma vez que essa percepção pode abalar a confiança que o cliente tem na empresa. Suportando a distinção das intenções de troca imediata e futura, identificou-se no estudo que as emoções negativas e a confiança possuem impactos distintos nesses dois tipos de intenções de troca. A intenção de boca a boca negativo também foi constatada como importante consequência das emoções procedentes da percepção de injustiça, assim como da confiança, indicando que fortes emoções negativas e menores níveis de confiança se relacionam com maiores níveis de boca a boca negativo. No estudo, discutem-se as contribuições gerenciais e acadêmicas dos resultados e, também, consideram-se as implicações para estudos futuros.