Coagulopatías por consumo en el paciente con cáncer / Consumptive Coagulopathies in the Patient with Cancer

Introducción: Los trastornos de la coagulación durante el perioperatorio de pacientes oncológicos, son eventos más frecuentes de lo que se conoce en realidad, debido a que un gran número de estos transitan de forma inadvertida. Objetivo: Describir los factores fisiopatológicos que propician la ocurrencia de las coagulopatías adquiridas por consumo durante el perioperatorio del paciente oncológico. Métodos: Se realizó una revisión narrativa, en idiomas español e inglés, se utilizaron como fuente de búsqueda las bases de datos Ebsco, SciElo, Pubmed, Cubmed, Hinary, durante el período de enero a marzo de 2022, y el referenciador Zotero versión 5.0. Resultados: Para comprender qué pasa en el paciente con cáncer en relación con las coagulopatías por consumo es necesario entender la fisiología de los mecanismos de la coagulación. En este sentido, se pueden observar tanto trastornos trombóticos como hemorrágicos, por el incremento del factor tisular que determina la formación de trombina y el fallo de los mecanismos antifibrinolíticos. También, factores como la radioterapia, la quimioterapia y la transfusión de hemocomponentes, aumentan el riesgo de padecerlas. Conclusiones: la coagulopatía por consumo en el paciente oncológico es una entidad multifactorial, compleja y dinámica, en la que se debe pensar y diagnosticar para evitar complicaciones graves en el período perioperatorio.

Introduction: Coagulation disorders during the perioperative period of cancer patients are more frequent events than is actually known, due to the fact that a large number of these go unnoticed. Objective: To describe the pathophysiological factors that favor the occurrence of consumption-acquired coagulopathies during the perioperative period of cancer patients. Methods: A narrative review was carried out, in Spanish and English, using the Ebsco, Scielo, Pubmed, Cubmed, Hinary databases as a search source, during the period from January to March 2022, and the Zotero version 5.0 referer. 96.3. Results: To understand what happens in cancer patients in relation to consumption coagulopathies, it is necessary to understand the physiology of coagulation mechanisms. In this sense, both thrombotic and hemorrhagic disorders can be observed, due to the increase in the tissue factor that determines the formation of thrombin and the failure of antifibrinolytic mechanisms. Also, factors such as radiotherapy, chemotherapy and transfusion of blood components, increase the risk of suffering from them. Conclusions: consumption coagulopathy in cancer patients is a multifactorial, complex and dynamic entity, which must be considered and diagnosed to avoid serious complications in the perioperative period.

Research progress in the treatment of oral submucous fibrosis with traditional Chinese medicine and Western medicine / 口腔疾病防治

@#Oral submucous fibrosis is a chronic, occult and progressive potentially malignant disease that seriously affects the oral function and quality of life of patients. The oral burning sensation and limitation of mouth opening are the main reasons for patients to see a doctor. At present, the main treatment for oral submucosal fibrosis is still drug therapy. To provide ideas and references for the clinical treatment of oral submucosal fibrosis, this article reviews the mechanism, therapeutic effect and characteristics of common Chinese and Western medicine in the treatment of oral submucosal fibrosis. The results of the literature review show that salvia miltiorrhiza, aloe, lycopene, curcumin and other traditional Chinese medicine and Western medicine are effective in the treatment of oral submucosal fibrosis; in addition, Taohong Siwu Decoction combined with Western medicine and other combinations of traditional Chinese and Western medicine are effective and reduce side effects, and clinicians can choose appropriate drugs according to the patient’s main symptoms and general condition. In the future, researchers can study more combinations of traditional Chinese and Western medicine to treat oral submucosal fibrosis.

Hipervitaminosis B12: Nuestra experiencia y una revisión / Hypervitaminosis B12. Our experience and a review

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

The Comparison of Oncologic Outcomes between Open and Laparoscopic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma: A Korean Multicenter Collaborative Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We compared oncologic outcomes of patients with upper tract urothelial carcinoma (UTUC) who underwent open nephroureterectomy (ONU) or laparoscopic nephroureterectomy (LNU). MATERIALS AND METHODS: Consecutive cases of ONU and LNU between 2000 and 2012 at five participating institutions were included in this retrospective analysis. Clinical characteristics and pathologic outcomes were compared between the two surgical approaches. The influence of the type of surgical approach on intravesical recurrence-free survival (IVRFS), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using the Kaplan-Meier method and differences were assessed with the log-rank test. Predictors of IVRFS, PFS, CSS, and OS were also analyzed with a multivariable Cox regression model. RESULTS: A total of 1,521 patients with UTUC were eligible for the present study (ONU, 906; LNU, 615). The estimated 5-year IVRFS (57.8 vs. 51.0%, p=0.010), CSS (80.4 vs. 76.4%, p=0.032), and OS (75.8 vs. 71.4%, p=0.026) rates were significantly different between the two groups in favor of LNU. Moreover, in patients with locally advanced disease (pT3/pT4), the LNU group showed better 5-year IVRFS (62.9 vs. 54.1%, p=0.038), CSS (64.3 vs. 56.9%, p=0.022), and OS (60.4 vs. 53.1%, p=0.018) rates than the ONU group. Multivariable Cox regression analyses showed that type of surgical approach was independently associated with IVRFS, but was not related to PFS, CSS, and OS. CONCLUSION: Our findings indicate that LNU provided better oncologic control of IVRFS, CSS, and OS compared with ONU for the management of patients with UTUC.

Impact of Day 14 Peripheral Blood Chimerism after Allogeneic Hematopoietic Stem Cell Bone Transplantation on the Treatment Outcome of Non-Malignant Disease

BACKGROUND: The impact of early peripheral blood chimerism on the outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) is unclear. We aimed to determine whether day 14 peripheral blood chimerism after allo-HSCT predicts outcomes in patients with non-malignant diseases. METHODS: Data from 56 patients who received allo-HSCT between April 2007 and March 2016 were retrospectively analyzed. Chimerism was evaluated using short-tandem repeat polymerase chain reaction, with mixed chimerism (MC) defined as greater than 1% recipient cells which was further categorized into low-level MC (> 1% and < 15% of recipient-derived cells) and high-level MC (≥ 15% of the recipient-derived cells). RESULTS: Thirty-six patients showed complete donor chimerism (CC), 14 low-level MC, and 6 high-level MC at day 14 post-transplant. The estimated 5-year event-free survival (EFS) was higher in the CC or low-level MC groups than in the high-level MC group (86.1% vs. 71.4% vs. 33.3%; P = 0.001). In BM or peripheral blood stem cell (BM/PBSC) transplants, the 5-year EFS was higher in the CC or low-level MC group than in the high-level MC group (93.1% vs. 66.7% vs. 0%; P < 0.001). However, in cord blood transplants, the 5-year OS and EFS according to the day 14 peripheral blood chimerism did not reach statistical significance. CONCLUSION: Although CC is not always necessary after allo-HSCT for non-malignant diseases, our data suggest that day 14 peripheral blood chimerism may predict outcomes in patients with non-malignant diseases who underwent BM/PBSC transplants.

Sexual satisfaction in patients with cancer / Satisfacción sexual en enfermos de cáncer / Satisfação sexual em pacientes com câncer

Abstract This study aimed to compare the dimensions of sexual satisfaction in subjects with and without cancer. Independent variables were: different types of cancer, time elapsed since diagnosis, types of treatment and changes in body image. The dependent variable was level of satisfaction with sexual relations. The sample consisted of 184 participants, of whom 95 belonged to the cancer group (ages between 26 and 84 years) and 89 to the non-cancer group (ages between 19 and 67 years). The instrument used was the Sexual Satisfaction Questionnaire (QSRS, for its Portuguese acronym). The results showed significant differences between the cancer group and the non-cancer group. Individuals with a history of cancer disease had lower values (17.93 ± 9.67) at the level of sexual function compared to individuals with no history of the disease (30.19 ± 4.2). Individuals with cancer who had higher values of self-esteem were those with urological cancer (16.76 ± 2.85), followed by breast cancer (14.83 ± 3.34) and "other cancers" (14.41 ± 5.5), whereas those with digestive cancer presented the lowest values (5.68 ± 13.63). In sexual functioning, the group of "other cancers" showed the highest levels of satisfaction (23.53 ± 10.12), while people with breast cancer (19.54 ± 9.36), digestive cancer (18.50 ± 12.57), and urological cancer (29.12 ± 7.22) presented the lowest levels of satisfaction. Within the group of people with cancer, those who had less than one year and between three to five years of having been diagnosed reflected less satisfactory sexual performance values. On the other hand, radiation treatments, surgery and "other treatments" showed negative effects on sexual functioning, as well as changes in body image. All independent variables had a negative impact on sexual satisfaction and performance, with the exception of weight loss, vomiting, and hair loss.

Resumen Este estudio tuvo como objetivo comparar las dimensiones de satisfacción sexual en sujetos con y sin cáncer, específicamente al comparar los diferentes tipos de cáncer, el tiempo de diagnóstico y los tipos de tratamiento, con cambios en la imagen corporal y el nivel de satisfacción con las relaciones sexuales. La muestra estuvo compuesta por 184 participantes, de los cuales 95 pertenecieron al grupo con cáncer (edades entre los 26 y 84 años) y 89 al grupo sin cáncer (edades entre los 19 y 67 años). El instrumento utilizado fue el Questionário de Satisfação com o Relacionamento Sexual (QSRS). Los resultados mostraron diferencias significativas entre el grupo con cáncer y el grupo sin cáncer, los individuos con antecedentes de enfermedad de cáncer presentaron valores más bajos (17.93 ± 9.67) en el nivel de la función sexual en comparación con los individuos sin antecedentes de dicha enfermedad (30.19 ± 4.2). Los individuos con cáncer que presentaron valores más altos en autoestima fueron los de cáncer urológico (16.76 ± 2.85), seguidos por los de cáncer de mama (14.83 ± 3.34) y "otros tipos de cáncer" (14.41 ± 5.5); siendo los de cáncer digestivo quienes presentaron los valores más bajos (5.68 ± 13.63). En el funcionamiento sexual, el grupo de "otros tipos de cáncer" mostró niveles más altos de satisfacción (23.53 ± 10.12), mientras que las personas con cáncer de mama (19.54 ± 9.36), cáncer digestivo (18.50 ± 12.57) y cáncer urológico (29.12 ± 7.22) presentaron los niveles más bajos de satisfacción. Dentro del grupo de personas con cáncer, los que tienen menos de un año y de tres a cinco años después de haber tenido el diagnóstico reflejaron valores de funcionamiento sexual menos satisfactorios. Por otro lado, los tratamientos de radiación, cirugía y "otros tratamientos" mostraron efectos negativos en el funcionamiento sexual, así como cambios en la imagen corporal. Todas las variables independientes tuvieron un impacto negativo en la satisfacción y el desempeño sexual, con excepción de la pérdida de peso, el vómito y la pérdida de cabello. Palabras clave: Cáncer, sexualidad, funcionamiento sexual, enfermedad maligna.

Resumo O objetivo foi comparar indivíduos em função das seguintes variáveis independentes: cancro e sem cancro, diferentes tipos de cancro, tempo de diagnóstico, diferentes tipos de tratamento e mudanças na imagem corporal tendo por variável dependente o nível da satisfação da relação sexual. A amostra foi constituída por 184 participantes (95 com cancro com idades entre 26 e 84 anos; 89 sem cancro, com idades entre 19 e 67 anos). Foi utilizado o Questionário de Satisfação com o Relacionamento Sexual (QSRS). Verificaram-se efeitos significativos entre os indivíduos com historial de doença oncológica ao nível do funcionamento sexual, comparativamente com os indivíduos sem historial de doença oncológica. Indivíduos com cancro urológico apresentam valores mais elevados ao nível da autoestima (16.76 ± 2.85), seguidos pelo cancro de mama (14.83 ± 3.34) e outros tipos de cancro (14.41 ± 5.05). O cancro digestivo é o que apresenta os valores mais baixos (13.63 ± 5.68). Com relação ao funcionamento sexual, o grupo "outros tipos de cancro" apresenta maiores níveis de satisfação (23.53 ± 10.12). Seguem-se o cancro de mama (19.54 ± 9.36) e os digestivos (18.50 ± 12.57) e, por último, o cancro urológico, que apresenta os níveis mais baixos (12.29 ± 7.22). Dentro do grupo de indivíduos com cancro, o período inferior a um ano e de três a cinco anos apresenta valores menos satisfatórios na dimensão funcionamento sexual, e os tratamentos de radioterapia, cirurgia e "outros tipos de tratamento" produzem efeitos negativos ao nível do funcionamento sexual, assim como as mudanças na imagem corporal. No presente estudo, com a exceção de perda de peso, vómitos e perda de cabelos, todas as variáveis independentes têm um impacto negativo na satisfação/desempenho sexual.

Prevalence of extracardiac findings in the evaluation of ischemic heart disease by multidetector computed tomography / 老年心脏病学杂志（英文版）

Objective Multidector computed tomography (MDCT) is now commonly used for the evaluation of coronary artery disease. Because MDCT images include many non-cardiac organs and the patient population evaluated is highly susceptible to extracardiac diseases, this study was designed to evaluate the prevalence of extracardiac findings in the MDCT evaluation of ischemic heart disease. Methods From March 2007 to March 2008, a total of six-hundred twenty patients, who underwent 64-slice MDCT evaluations for chest pain, or dyspnea, were enrolled in this study. Cardiac and non-cardiac findings were comprehensively evaluated by a radiologist. Results Enrolled patients included 306 men (49.4%), with a mean age of 66 years. Significant coronary artery stenosis was found in 41.6%of the patients. A total of 158 extracardiac findings were observed in 110 (17.7%) patients. Commonly involved extracardiac organs were lung (36.7%), hepatobiliary system (21.5%), thyroid (19.6%), kidney (10.8%), spine (9.7%) and breast (0.6%). Of those 110 patients, 50 (45.5%) patients underwent further diagnostic investigations. Malignant disease was detected in three (2.7%) patients (lung cancer, pancreatic cancer, and thyroid cancer). Conclusions Extracardiac findings are frequently present and should be a concern in the MDCT evaluation of chest pain syndrome.

Clinical implications of chimerism after allogeneic hematopoietic stem cell transplantation in children with non-malignant diseases

BACKGROUND: The effects of chimerism on outcomes following allogeneic hematopoietic stem cell transplantation (HSCT) are unclear and may differ between diseases. We retrospectively evaluated the association between chimerism and transplant outcomes in children with nonmalignant diseases. METHODS: Chimerism was evaluated using short-tandem repeat polymerase chain reaction (STR-PCR) in 48 patients, with mixed chimerism (MC) defined as greater than 1% recipient cells. RESULTS: The only variable exerting a significant influence on patients' chimerism status was the number of infused CD34+ cells. MC was detected in 23 transplants (9 showing transient MC; 10 with sustained low levels [30%]). The degree of STR-PCR at 28 days after HSCT was significantly higher in patients with high-level MC than those with transient or low-level MC. All patients with transient or low-level MC successfully maintained engraftment and showed a clinical response to HSCT, whereas 2 of the 4 patients with high-level MC experienced graft failure. The incidences of grades II-IV acute and chronic graft-versus-host disease (GVHD) were significantly higher in patients with complete donor chimerism (CC) than MC. We observed no significant survival differences between CC and MC groups. However, the survival rate was lower in patients with high MC than those with low-level or transient MC (P=0.03). CONCLUSION: In non-malignant diseases, MC may indicate a tolerant state with a decreased incidence of GVHD. However, high-level MC may signify an increased risk of graft failure and a lower survival rate.

Primary Pulmonary Carcinoma Ex-pleomorphic Adenoma of the Salivary Gland Type / 대한흉부외과학회지

Pleomorphic adenoma is also called a mixed tumor and it most commonly occurs in the salivary gland. This neoplasm has a low grade malignant potential, but it may also show aggressive clinical behavior like recurrence or metastasis. We report here on a case of a tumor that was confirmed to be primary pulmonary carcinoma ex-pleomorphic adenoma by the pathologic examination after complete resection, and it had the characteristics of malignant neoplasms, such as multiple metastases.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Viscum Album Therapy in Malignant Pleural Effusion / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common clinical problem in neoplastic patients. With the diagnosis of a malignant pleural effusion, palliative therapy was done. One of the treatments was a chemical pleurodesis. Talc was the most commonly used a sclerosing agent, but the quality of patient's life was not improved. We was evaluated by other agents such as Viscum album for relief of malignant pleural effusion. MATERIAL AND METHOD: From November 2001 to October 2003, 17 patients who underwent to chemical pleurodesis for the malignant pleural effusion. We compared the talc (group I: 10 patients) and Viscum album (group II: 7 patients). We analysed them retrospectively in term of various factors and results. RESULT: There were no significant differences between group I and group II in the sex ratio, mean age, origin of primary cancer and site, but, group I had higher successful rate (80%:71%) than group II. Group II had better length of chest tube stay after procedure, Karnofsky performance and recurrence than group I. The failed treatement group was related to the pleural fluid pH and interval of initial chemical pleurodesis after thoracostomy. CONCLUSION: Although the chemical pleurodesis with Viscum album was slightly lower than talc in the successful rate, there was an alternative method instead of the chemical pleurodesis with talc to improve the patient's quality of life in malignant pleural effusion.

Pulmonary Epithelioid Hemangioendothelioma Mimicking Hamartoma: A case report / 대한흉부외과학회지

Epithelioid hemangioendothelioma, originating from the vascular endothelium, is a very rare and low-grade malignancy. World-wide, about 50 cases of pulmonary epithelioid hemangioendothelioma have been reported. This is more common in female and is usually shown as multiple nodules in both lung fields. A 41-year-old male, who had suffered from right pleuritic chest pain for 3 months, was initially diagnosed as adenocarcinoma under bronchofiberscopic biopsy. At that time, the stage of tumor according to the TNM staging was IIIa. He received bronchoscopic biopsy again during follow-up period and it was diagnosed as hamartoma. After surgery, the final diagnosis was pulmonary epithelioid hemangioendothelioma.

Effective Predicting Succes Factors of Retrograde Ureteral Stenting in Patients with Malignant Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: We have endeavored to find the factors predicting the success of ureteral stenting before cystoscopic retrograde ureteral catheterization in the patients with malignant ureteral obstruction. MATERIALS AND METHODS: 38 patients(51 kidneys) were analyzed, who were treated by retrograde ureteral stenting or percutaneous nephrostomy due to ureteral obstruction in non-urologic malignancy during the past 3 years. The sorts of primary tumors were cervix cancer in 14 cases(18 kidneys), stomach cancer in 12 cases(18 kidneys), colo-rectal cancer in 7 cases(9 kidneys), ovary cancer in 4 cases(5 kidneys), and endometrial cancer in 1 case(1 kidney). The cause of the ureteral obstruction was direct tumor invasion in 26 kidneys, lymphadenopathy in 23 kidneys and post radiation therapy in 2 kidneys. Retrograde ureteral stenting had failed in 22 kidneys(ureteral orifice could not be found in 14 kidneys, guide wire could not be advanced in 8 kidneys). RESULTS: Among the 51 kidneys, 29 kidneys(57%) were succeeded, and 22 kidneys(43%) were failed in retrograde ureteral catheterization. In fourteen of 22 kidneys(64%) ureteral orifice could not identified due to hemorrhage and edema of mucosa of bladder, and in 8 kidneys(36%) ureteral catheter could not be advanced to the renal pelvis. The cause of failure of the retrograde ureteral catheterization were direct tumor invasion in 10/26 kidneys(39%), and lymphnode enlargement in 4 of 23 kidneys(17%)(p=0.0007). According to the presence of ureteral obstructive symptoms, 8/29 kidneys(28%) were with the presence of ureteral obstruction symptoms, whereas 14/22 kidneys(64%) were failed with the absence of ureteral obstructive symptoms(p=0.0051). Of the obstruction site, 4/21 kidneys(19%) of upper to mid ureteral obstruction and 18/30 kidneys(79%) of lower ureteral obstruction were failed(p=0.0056). Of the degree of hydronephrosis, 18/47 kidneys(38%) of mild to moderate degree of hydronephrosis and 4/4 kidneys(100%) of severe hydronephrosis were failed(p=0.0022). CONCLUSIONS: This study shows that direct tumor invasion to the ureter, asymptomatic ureteral obstruction, lower ureteral obstruction, and high grade hydronephrosis were regarded as a high failure factors for the retrograde ureteral catheterization. Thus, we should not hesitate to choose percutaneous nephrostomy, in such condition that makes difficult for retrograde ureteral catheterization in malignant ureteral obstruction patients.