Diagnosis and prognosis of cervical lymph node metastases of squamous cell carcino-ma of unknown primary site / 中国肿瘤临床

Objective: To investigate the characteristics, diagnosis, primary detection, and prognosis of cervical lymph node metastases of squamous cell carcinoma of unknown primary site (SCCUP). Methods: This study retrospectively analyzed the clinical features and follow-up data of 262 patients with SCCUP. The Chi-square test were used to analyze the clinical performances, characteristics of pri-mary lesions, and sensitivity and specificity of examinations to identify original lesions. Factors related to the overall survival (OS) and progression-free survival (PFS) were also analyzed. Results: The 262 patients with SCCUP comprised more men, with a median age of 57 years. At the follow-up, 70 patients were diagnosed with primary lesions (26.7%), and the detection rates of primary lymph nodes in those who were male (30.1%), with a single lesion site (31%), and with levelⅣdisease (39.3%) were higher than those in patients who were female (17.4%), with multiple lesion sites (18.7%), and with levelⅡ/Ⅲdisease (20.8%). Compared with traditional imaging examinations, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) had higher sensitivity and speci-ficity in detecting the primary tumor. Survival analysis showed that distant metastasis was an independent risk factor affecting OS and PFS, and the effect of N stage on PFS was statistically significant. Conclusions: In SCCUP patients, the proportion of patients who were male, with a single lesion site, and with cervicalⅣlymph node metastasis had higher rates of detection of the primary sites. PET/CT examination is important for the diagnosis of SCCUP, as well as the detection of primary lesions. Advanced N stage and distant metasta-sis indicated poor prognosis.

To strengthen the detection of biomarkers in the synchronous metastatic axillary lymph nodes of primary breast cancer / 中华内分泌外科杂志

Postoperative adjuvant therapy for primary invasive breast cancer patients with synchronous ax-illary metastases is mainly based on the characteristics of biomarker of the primary tumor. Recently, some studies have showed the discordance and clinical significance of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status between primary breast cancer and synchronous axillary lymph node metastases. As local metastasis, the synchronous axillary metastases may represent the potentially metastatic breast cancer cells much better than the primary tumor. Hence, determination of biomarkers status should be performed in synchronous axillary metastasis, together with primary tumor, to guide therapy management and evaluate the prognosis of primary invasive breast cancer patients with synchronous axillary metastases.

Fisiopatología del trauma craneoencefalico / Physiopathology of traumatic brain injury

Introducción: El trauma craneoencefalico (TCE) es un problema de salud mundial que produce incapacidades motoras, del comportamiento o en la esfera cognitiva. Objetivo: Hacer una revisión de la fisiopatología del TCE partiendo de unas bases epidemiológicas, anatómicas y fisiológicas. Discusión y conclusiones: La revisión de la fisiopatología del evento traumático servira para tener el contexto dentro del cual se intentara describir y conceptualizar de manera general los procesos fisiopatológicos mas importantes relacionados con el TCE. No es motivo de este artículo profundizar en los conceptos aquí expuestos porque generaría capítulos extensos de discusión tematica, sino por el contrario, dar una mirada panoramica del TCE para poder comprender las principales características y la definición como enfermedad del conjunto de manifestaciones clínicas y estructurales.

Introduction: Traumatic brain injury (TBI) is a global medical problem. After TBI patients may show motor, behavioral and cognitive disabilities. Objective: The intention of this paper is to develop the patho-physiology of the head injury, beginning with epidemiological, anatomical, and physiological bases. Discussion and conclusions: The knowledge of the pathophysiology of TBI will help us to have a context with in we will try to describe and conceptualize in general way the most important patho-physiological process related to the head injury. It is not pretense of this paper get in deep of the concepts exposed here, since it would generate huge chapters of thematic discussion. The pretense is to take a panoramic review of the head injury to understand the foremost characteristics and definition, as a whole of clinical and structural manifestation of this pathology.

Uveíte e lesões primárias disseminadas na sífilis adquirida / Uveitis and primary lesions disseminated in syphilis

Introdução: a sífilis é uma doença infecto-contagiosa de transmissão sexual, ascendente epidemiologicamente na saúde pública brasileira, devendo todos os profissionais da área de saúde estarem atentos a essa patologia, incluindo as manifestações extragenitais. Objetivo: relatar um caso clínico de sífilis primária que foi diagnosticado a partir de uveíte e de lesões primárias disseminadas. Métodos: foram feitos estudos de mapeamento e fundo de olho do paciente, bem como análise clínica e exames laboratoriais (VDRL, FTA-Abs IgM e IgG, sorologia para HIV, HBsAg, anti-HBc total, anti-HBsAg, anti-HCV). Resultados: a análise clínica, associada à investigação epidemiológica, com o resultado reagente do VDRL, acompanhado de FTA-Abs IgM, em um paciente soronegativo para HIV, com boa resposta ao tratamento com penicilina benzatina, confirma a hipótese diagnóstica de sífilis primária. Conclusão: é de fundamental importância que o profissional de saúde consulte novas referências bibliográficas para o conhecimento sobre as manifestações extragenitais de sífilis para que executem um diagnóstico correto e o tratamento adequado da doença, a fim de evitar possíveis seqüelas.

Introduction: syphilis is an infectious and contagious illness caused by sexual transmission, which is ascending in the Brazilian public health scenario.Therefore all professionals of the health area must be aware of the manifestations of this illness including extragenital manifestations. Objective: analyzing a clinical case of primary syphilis that was diagnosised from ocular manifestations and disseminated primary injuries. Methods: ophthalmologic and clinical analysis of the injuries of the patient, as well as examinations in laboratories (VDRL, FTA-Abs IgM/IgG, HIV sorology, HBsAg, anti-HBc total, antiHBsAg, anti-HCV) have been conducted. Results: the association of the clinical findings and epidemiologic investigation, with the positive result of VDRL, with FTA-Abs IgM in a no-HIV patient, confirmed the diagnostic hypothesis of primary syphilis. Conclusion: it is of utmost importance for health professionals, to gather new references of the knowledge of other manifestations of syphilis, in order to be able to establish a correct diagnosis and treatment, and avoid complications.