ABSTRACT
Resumen: La disección coronaria espontánea ha surgido como una causa interesante y poco reconocida de síndrome coronario agudo no aterosclerótico. Ocurre más frecuentemente en mujeres jóvenes, donde de forma importante puede asociarse a anomalías arteriales no coronarias. La clave para un tratamiento oportuno es el diagnóstico precoz que impida su evolución a cuadros más severos. Se presenta el caso de una mujer de 36 años con un síndrome coronario agudo secundario a una disección coronaria espontánea bi-arterial que evolucionó de forma grave a una insuficiencia cardíaca aguda. El objetivo es informar un cuadro poco usual y proporcionar evidencia que respalde el cómo debe enfrentarse.
Abstract: Spontaneous coronary dissection is an important cause of acute non-atherosclerotic coronary syndrome. It occurs more frequently in young women, often without significantly associated coronary arterial anomalies. Early diagnosis is a key to prompt treatment, in order to prevent severe complications. We report the case of a 36-year-old woman with an acute coronary syndrome secondary to spontaneous bi-arterial coronary dissection progressing to severe acute heart failure. A discussion of the management of this condition is included.
Subject(s)
Humans , Female , Adult , Vascular Diseases/surgery , Vascular Diseases/complications , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/complications , Myocardial Infarction/etiology , Vascular Diseases/diagnostic imaging , Stents , Coronary Vessel Anomalies/diagnostic imaging , Percutaneous Coronary InterventionABSTRACT
Objetivo: Analizar datos relacionados con el programa «Colecistectomía como prevención del cáncer de vesícula biliar¼. Método: Se analizan los resultados obtenidos de la página web del DEIS del Ministerio de Salud chileno. Resultados: El año 2006, fecha de inicio del programa, fueron egresados 42.780 pacientes entre 20 y 64 años con diagnósticos correspondientes a los códigos CIE-10, K80-K83. El año 2012, el número de egresos fue de 58.818, lo que significó que desde el año 2006 fueron egresados 39.419 pacientes más que si se hubiesen mantenido los números del año 2006. Por otra parte, desde antes de la puesta en práctica del programa, se aprecia una disminución de la mortalidad ajustada por edad del cáncer de vesícula. Conclusión: Aunque desde la puesta en marcha del programa de prevención del cáncer de vesícula se observa un aumento en el número de casos intervenidos, especialmente durante los años 2011 y 2012, la caída de la tasa de mortalidad parece deberse a factores diferentes al aumento de las colecistectomías.
Goal: To evaluate published data related to the program Cholecystectomy as prevention of Gallbladder Cancer. Method: Analysis of the results obtained from the DEIS web page (Ministry of Health of Chile). Results: Since 2006, The Chile Ministry of Health began a program to reduce the number of gallbladder cancer cases in Chile. To accomplish the above, Chile Government has guarantied the execution of a cholecystectomy program under parameters of quality, opportunity and financial support between the ages of 35 and 49 years old. During 2006, 42,780 patients corresponding to the ICD 10 codes, K80-K83 between 20 and 64 years old were discharged from Chilean Hospitals. In 2012, six years after the beginning of the program, 58,818 were discharged. The program would make done possible to discharge approximately 39,419 extra patients. On the other hand, during the last ten years, a decrease in the mortality rate of gallbladder cancer has been observed in Chile. Conclusion: Although since the beginning of the program an increase in the number of patients discharged is observed, the decrease in the gallbladder cancer mortality seems not to have relation with the program.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Cholecystectomy/statistics & numerical data , Gallbladder Neoplasms/mortality , Gallbladder Neoplasms/prevention & control , Age Distribution , Chile/epidemiology , Cholelithiasis/surgery , Gallbladder Neoplasms/surgery , Patient Discharge/statistics & numerical data , Sex FactorsABSTRACT
Background: In colorectal cancer, BRAF and KRAS mutation are mutually exclusive, but both are independent prognostic factors for the disease. Aim: To determine the frequency of BRAF V600E mutation in colorectal cancer. Material and Methods: A KRAS mutation study was carried out in 100 tissue samples of primary and metastatic adenocarcinomas of colon and rectum from patients aged 61.1 ± 62 years (56 women). Negative KRAS mutation cases underwent study of BRAF V600E mutation by restriction fragment length polymorphism (RFLP) and direct sequencing. Results: Primary tumors were located in the colon and rectum in 88 and six cases respectively. Five were liver metastases and in one case, the sample location was undetermined. Forty two samples were KRAS positive (mutated). In 12 of the 58 KRAS negative (wild type) samples, the V600E mutation in codon 15 of the BRAF gene was demonstrated. No differences in the frequency and distribution of mutations, stratified by gender, age, primary tumor versus metastasis, or tumor location were observed. Conclusions: Twelve percent of KRAS negative colorectal cancer samples showed BRAF gene mutation. Considering that 42% of samples have a KRAS mutation, 54% of patients should not respond to therapies with monoclonal antibodies directed against epidermic growth factor (EGFR) pathway.
Subject(s)
Female , Humans , Male , Middle Aged , Adenocarcinoma/genetics , Colorectal Neoplasms/genetics , Mutation/genetics , Proto-Oncogene Proteins B-raf/genetics , Proto-Oncogene Proteins/genetics , ras Proteins/genetics , Genotype , Neoplasm Staging , Polymorphism, Restriction Fragment LengthABSTRACT
Background: The quality of the archival samples stored at pathology services could be a limiting factor for molecular biology studies. Aim: To determine the quality of DNA extracted from gallbladder cancer samples at different institutions. Material and Methods: One hundred ninety four samples coming from fve medical centers in Chile, were analyzed. DNA extraction was quantifed determining genomic DNA concentration. The integrity of DNA was determined by polymerase chain reaction amplification of different length fragments of a constitutive gene (β-globin products of 110, 268 and 501 base pairs). Results: The mean DNA concentration obtained in 194 gallbladder cancer samples was 48 ± 43.1 ng/µl. In 22% of samples, no amplification was achieved despite obtaining a mean DNA concentration of 58.3 ng/ul. In 81, 67 and 22% of samples, a DNA amplification of at least 110, 268 or 501 base pairs was obtained, respectively. No differences in DNA concentration according to the source of the samples were demonstrated. However, there were marked differences in DNA integrity among participating centers. Samples from public hospitals were of lower quality than those from private clinics. Conclusions: Despite some limitations, in 80% of cases, the integrity of DNA in archival samples from pathology services in our country would allow the use of molecular biology techniques.
Subject(s)
Humans , DNA, Neoplasm/isolation & purification , Gallbladder Neoplasms/genetics , Chile , Cholecystectomy , DNA, Neoplasm/standards , Gallbladder Neoplasms/pathology , Nucleic Acid Amplification Techniques/methods , Pathology Department, Hospital , Polymerase Chain Reaction/methods , Quality Control , Sample SizeABSTRACT
Background:Overexpression/amplification of the HER2 gene in advanced gastric cancer is a predictor of response to adjuvant therapy with monoclonal antibodies.Aim: To determine the frequency of HER2 gene overexpression and amplificationin advanced gastric cancer. Material and Methods: One hundred nine advancedgastric cancer biopsy specimens, from 76 men and 33 women aged 67 ± 14 and 62± 12 years respectively, were selected. Three histological patterns (diffuse, intestinaland mixed) were recognized. Automated immunohistochemistry was performedwith monoclonal c-erbB-2 (NCL-356) Novocastra. Fluorescent in situ hybridization (FISH) for HER2 was performed in positive cases. Results: In 39% of cases,immunohistochemical staining was negative. It was 1+, 2+ and 3+ positive in 15,36 and 11% of cases, respectively. It was positive in 16% and 3% of intestinal typeand mixed carcinomas, respectively. It was negative in all diffuse carcinomas. FISHwas performed in 39 (2 +) cases and in 11 (3 +) cases. The gene amplification waspositive in two (2 +) and 11 (3 +) cases (11.9%). The overall concordance betweenimmunohistochemical staining and in situ hybridization was 85%. Conclusions: Inadvanced gastric cancer, HER2 gene overexpression or amplification was observed in11% and 12% of cases, respectively.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Adenocarcinoma/genetics , Gene Amplification/genetics , /genetics , Stomach Neoplasms/genetics , Adenocarcinoma/pathology , Gene Expression , In Situ Hybridization, Fluorescence , Stomach Neoplasms/pathology , Tissue Array AnalysisABSTRACT
Background: KRAS oncogene is involved in colorectal carcinogenesis in 22 to 45% of cases. Aim: To determine the frequency, types and distribution of KRAS mutations in colorectal cancer. Material and Methods: KRAS mutations studies were carried out in primary tumors and metastases of colo-rectal cancer from 56 women aged 60 ± 14 years and 53 men aged 61 ± 11 years. Formalin fixed and paraffin embedded tissue samples were evaluated using RFLP (Restriction Fragment Length Polymorphism) and direct sequencing. Results: Primary tumors were located in the colon and rectum in 82 (75.2%) and 24 cases (20%), respectively. In three cases the extraction site of the tumor sample was unknown. In 46 cases (42.2%) KRAS mutations were demonstrated. The main point mutations were located in codon 12 (80.4%), G12D (39.1%), G12V (24.2%), G12S (6.5%), G12A (4.3%); G12C (4.3%), G12R (2.1%) and 19.6% at codon 13 (G13D). No differences were demonstrated in the frequency and distribution of mutations by gender, age, primary versus metastatic tumors or tumor location. Conclusions: In this series, 42% of colorectal cancer tissue samples had KRAS mutations. Their frequency and distribution are similar to those reported in the literature, except for G12C mutation.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Adenocarcinoma/genetics , Colonic Neoplasms/genetics , Proto-Oncogene Proteins/genetics , Rectal Neoplasms/genetics , ras Proteins/genetics , Chile , Codon , DNA Mutational Analysis , Mutation , Polymorphism, Restriction Fragment LengthABSTRACT
Cystic tumors of the pancreas are diagnosed with increasing frequency. The main problems associated with their diagnosis are to determine ifthey are benign of malingnant and to decide their surgicai excision or clinical follow up, since these tumors can be benign, potentiaiiy maiignant or malignant. Imaging techniques such as CT sean, magnetic resonance and endoscopic uitrasonography are the key procedures that must be performed before adopting a final therapeutic decision. However, 10 percent of cystic lesions are unable to be categorized even after thorough imaging evaluation. We analyze the characteristics of the more common cystic pancreatic lesions and the means to recognize them.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Adenocarcinoma, Mucinous , Adenocarcinoma, Papillary , Pancreatic Cyst , Pancreatic Neoplasms , Adenocarcinoma, Mucinous/pathology , Adenocarcinoma, Mucinous , Adenocarcinoma, Papillary/pathology , Adenocarcinoma, Papillary , Cholangiopancreatography, Endoscopic Retrograde , Cholangiopancreatography, Magnetic Resonance , Pancreatic Cyst/pathology , Pancreatic Cyst , Pancreatic Neoplasms/pathology , Pancreatic Neoplasms , Tomography, X-Ray ComputedABSTRACT
La anormalidad citogenética más común en la leucemia mieloide crónica (LMC) es el cromosoma Philadelphia, producida por la t(9;22), cuya expresión molecular es el gen de fusión BCR-ABL, que codifica proteínas con actividad tirosinquinasa. Según el punto de ruptura de los genes BCR o ABL se produce una proteína de fusión de 210-kD(p210) o 190-kD(p190). La presencia de este gen de fusión en pacientes con LMC tiene implicancia diagnóstica. Con el propósito de detectar transcriptos de fusión del gen BCR/ABL en pacientes con leucemia mieloide crónica, procedentes de la IX Región de Chile, se estudiaron 14 muestras de sangre de 11 pacientes con LMC. A 2 de ellos, se les realizó seguimiento durante su tratamiento con Gleevec. Se aplicó la técnica de reacción en cadena de la polimerasa con transcriptasa reversa (RT-PCR), usando una PCR en nido. Para la detección de los transcriptos de fusión p210 y p190 del gen BCR/ABL, se utilizaron 4 pares de iniciadores. En 9/14 muestras se detectó el transcripto de fusión p210 y en 5/14 los transcriptos de fusión p210 y p190. En los 2 pacientes en seguimiento, hubo desaparición del transcripto p190, permaneciendo el transcripto p210. Estos resultados reafirman la importancia de detectar transcriptos de fusión BCR/ABL para el diagnóstico y seguimiento durante el tratamiento de la LMC.
Subject(s)
Humans , Fusion Proteins, bcr-abl , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics , Transcription, Genetic/physiology , Philadelphia ChromosomeABSTRACT
El cáncer de la vesícula biliar presenta diseminación prerentemente de tipo local, por lo cual su tratamiento debe ser de preferencia locorregional. Con el objetivo de conocer la factibilidad de emplear quimiorradiación previo a cirugía de tipo radical, desarrollamos un protocolo prospectivo. Desde abril de 1993 hasta octubre de 1995, incluímos a 13 pacientes portadores de un cáncer de la vesícula biliar diagnosticado luego del estudio anatomopatológico de la pieza de colecistectomía. Del total de pacientes, 12 completaron el esquema de qQuimiorradiación y fueron reintervenidos. De éstos, 11 fueron resecados con expectativas de cirugía curativa. El tiempo transcurrido entre el diagnóstico y el inicio del protocolo nunca fue superior a 2 meses. El efecto secundario más común relacionado a la quimiorradiación fue la presencia de plaquetopenia, observada en 6 pacientes. Del total de pacientes, 7 permanecen vivos con un seguimiento máximo de 32 meses. Como conclusión, podemos decir que el empleo de quimiorradiación previo a cirugía representaría una forma útil de terapia sin afectar mayormente la realización de cirugía radical. En la actualidad, está en desarrollo otro protocolo prospectivo randomizado tendiente a comparar el efecto de la quimiorradiación en relación al momento de la cirugía
Subject(s)
Humans , Female , Adult , Middle Aged , Gallbladder Neoplasms/therapy , Antineoplastic Agents/administration & dosage , Cholelithiasis/pathology , Clinical Protocols , RadiotherapyABSTRACT
Con el propósito de conocer características del cáncer vesicular en jóvenes, estudiamos un grupo de pacientes menores de 40 años en relación a pacientes de mayor edad de igual patología. Desde enero de 1980 a diciembre de 1991, se diagnosticaron 286 pacientes portadores de cáncer vesicular, de los cuales 28(8,7 por ciento ) fueron menores de 40 años. Estos pacientes se compararon a un grupo de 42 pacientes mayores de 40 años. Entre los jóvenes el cáncer se detectó en estadios más precoces, lo que permitió efectuar una colecistectomía más frecuente (p<0,05). A pesar de que los jóvenes tenían enfermedad menos avanzada al momento del diagnóstico, durante las reintervenciones efectuadas fue más frecuente observado el compromiso metastásico en el grupo de pacientes jóvenes. Del mismo modo, las curvas de sobrevida de ambos grupos no variaron e incluso cuando los grupos fueron analizados de acuerdo a diferentes niveles de invasión, el grupo de pacientes jóvenes tuvo un peor comportamiento. Como conclusión del trabajo podemos resaltar la importancia de este tipo de tumor en la población menor de 40 años y su probable mayor malignidad en relación a pacientes de mayor edad
Subject(s)
Humans , Male , Female , Adult , Gallbladder Neoplasms/epidemiology , Case-Control Studies , Neoplasm Metastasis , Neoplasm Staging/statistics & numerical data , Postoperative ComplicationsSubject(s)
Adult , Middle Aged , Humans , Male , Female , Stomach Neoplasms/diagnosis , Biopsy , Chile , Endoscopy , Stomach Neoplasms/pathologySubject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Retroperitoneal Neoplasms/diagnosis , Biopsy, NeedleSubject(s)
Child, Preschool , Child , Adult , Middle Aged , Humans , Retroperitoneal Neoplasms/diagnosis , Biopsy, Needle , UltrasonographySubject(s)
Adult , Middle Aged , Humans , Male , Hemochromatosis/diagnosis , Hemosiderin , Myocardium/ultrastructure , Microscopy, ElectronABSTRACT
La enfermedad de Hodgkin en el niño presenta características diferentes a las formas del adulto. Nuestro estudio incluye 82 casos de enfermedad de Hodgkin en niños. Los hombres fueron afectados el doble que las mujeres. El promedio de edad fue de 7,4 años. Los ganglios cervicales fueron los más frecuentemente comprometidos. Los tipos histológicos fueron: Celularidad Mixta (54%), Predominio Linfocítico (35%), Esclerosis Nodular (8%), Depleción Linfocitaria (2%) e Inclasificable (1%). En 14 casos se practicó necropsia, en 10 se demostró tumor. El tipo histológico más frecuente en estos casos fue la Depleción Linfocitaria. Nuestra serie presenta marcadas diferencias con respecto a la frecuencia de los diferentes tipos histológicos reportadas por otros autores