Facoemulsificación en pacientes con glaucoma / Phacoemulsification in patients with glaucoma

La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)

Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)

Implante ExPRESS-P en el glaucoma traumático / ExPRESS-P implant for the traumatic glaucoma

Se presenta un paciente masculino, blanco, de 32 años de edad, con antecedentes de trauma contuso en el ojo izquierdo a los 8 años de edad. El examen oftalmológico del ojo izquierdo reveló agudeza visual mejor corregida 60 VAR; presión intraocular 42 mmHg con terapia hipotensora máxima; catarata corticonuclear traumática y daño glaucomatoso avanzado. Como opción de tratamiento se realizó la cirugía combinada (facoemulsificación e implante de dispositivo ExPRESS, modelo P-50), asociado al uso de mitomicina C 0,2 por ciento. Se obtuvo agudeza visual mejor corregida 97 VAR y presión intraocular 17 mmHg a los 3 meses posoperatorio. Este caso evidencia la necesidad del seguimiento de por vida luego de un trauma ocular, y fundamentalmente cuando existe un receso angular traumático, con la finalidad de diagnosticar precozmente la hipertensión ocular y prevenir la pérdida visual irreversible por glaucoma. La facoemulsificación combinada con el implante ExPRESS resulta una opción favorable para el tratamiento de casos complejos que presentan glaucoma y catarata(AU)

The report presented a 32 years-old white male patient with a history of blunt trauma in his left eye since he was 8 years-old. The ophthalmological exam revealed best corrected visual acuity of 60 VAR, intraocular pressure of 42 mmHg with maximum dose of hypotensive treatment, traumatic corticonuclear cataract and advanced glaucomatous damage. The treatment option was combined surgery (phacoemulsification and implantation of ExPRESS device, P-50 model) associated to the use of 0.2 percent mitomycin C. The best corrected visual acuity increased to 97 VAR and the intraocular pressure lowered to 17 mmHg three months after surgery. This case shows the need of lifelong follow-up after ocular trauma, particularly when there is traumatic angle recession, in order to early diagnose ocular hypertension and to prevent irreversible vision loss due to glaucoma. Phacoemulsification combined with ExPRESS implant results in favorable option for treatment of complex cases suffering glaucoma and cataract(AU)

Managing the consequences of aggressive conservative treatment for refractory retinoblastoma with vitreous seeding / Lidando com as consequências do tratamento agressivo para retinoblastoma refratário com semeadura vítrea

A 4 year-old girl with bilateral, non-familial retinoblastoma (RB) was referred to our care after primary enucleation OS and active tumor OD refractory to multiple therapies (intravenous chemotherapy, laser/cryotherapy, and I-125 plaque radiotherapy). Vitreous seeding OD, initially controlled by several sessions of Ophthalmic Artery Infusion Chemotherapy (OAIC) and periocular chemotherapy, recurred shortly thereafter. The patient underwent intravitreal (IVit) Melphalan injections achieving tumor control despite the concurrent development of keratopathy, pupillary synechiae, cataract, and necrosis of the inferior fornix and the adjacent orbital fat, all secondary to the treatments administered. Repeated amniotic membrane implants and tarsorrhaphy were performed to alleviate the symptoms. Despite being tumor free for 6 months, a poor fundus view and treatment-related complications prompted us to consider enucleation, but parents declined. Following recent negative magnetic resonance imaging (MRI), her cataract was removed. She was then found to have tumor recurrence. Her eye was enucleated 12 months ago and she recovered well from the surgery. As ocular oncology embarks in eye-preserving treatments for retinoblastoma, it is important to address the cumulative effects and associated impact of such treatments and the possibility of failure.

Uma menina de 4 anos com retinoblastoma (RB) bilateral, não-familiar foi encaminhada após enucleação OE e tumor ativo OD refratário a múltiplas terapias (quimioterapia endovenosa, laser/crioterapia e braquiterapia com I-125). Semeadura vitrea OD, inicialmente controlada por inúmeras sessões de Quimioterapia Intra-Arterial Oftálmica (QIAO) e quimioterapia periocular, recorreu em seguida. Paciente recebeu injeções intravítreas de Melphalan obtendo controle tumoral apesar do desenvolvimento concomitante de ceratopatia, sinéquias pupilares, catarata, necrose do fórnice inferior e gordura periorbitária adjacente, todos secundários aos tratamentos usados. Implantes repetidos de membrana amniótica e tarsorrafias foram realizadas para melhora sintomatológica. Apesar de estar livre de tumor por 6 meses, a baixa visibilidade do fundo e complicações terapêuticas nos levaram a considerar enucleação que foi descartada pelos pais. Após recente ressonância magnética nuclear (RMN) negativa, a catarata foi removida. Foi então detectada recorrência tumoral. O olho foi enucleado há 12 meses e ela se recuperou bem da cirurgia. Enquanto a oncologia ocular embarca em tratamentos para preservar em retinoblastoma, é importante considerar os efeitos cumulativos e impacto associado desses tratamentos, e a possibilidade de fracasso.

Injertos y colgajos en pacientes sometidos a quimio o radioterapia: son seguros?: revisión de la literatura / Is it safe do grafts or flaps in a patient being treated with chemotherapy or radiation therapy?: literature review

Es conocido que la radiación ha sido asociada a una cicatrización disminuida de las heridas, necrosis grasa y decoloración. La quimioterapia, por otra parte, se ha descrito con efectos adversos como infección, necrosis, contractura o deformación de los colgajos. Los antecedentes previos son los causantes de cierta confusión al enfrentar pacientes oncológicos que durante su evolución requieren solucionar defectos de piel y tejidos blandos: es seguro realizar injertos o colgajos en un paciente que está siendo tratado con quimio o radioterapia? Por medio de la revisión de la literatura publicada buscamos dar respuesta a esta interrogante.

It is known that the radiation has been associated with decreased wound healing, fat necrosis and bleaching. Chemotherapy, on the other hand, has been described with side effects as infection, necrosis, contraction or deformation of the flaps. The previous history are causing some confusion that may arise when facing cancer patients that during their evolution require fix skin and soft tissue defects: is it safe do grafts or flaps in a patient being treated with chemotherapy or radiation therapy? Through the review of the published literature we seek to answer this question.

Acrodermatitis due to zinc deficiency after combined vertical gastroplasty with jejunoileal bypass: case report / Acrodermatite por deficiência de zinco após associação de gastroplastia vertical com derivação jejuno-ileal: relato de caso

CONTEXT: Nutritional complications may occur after bariatric surgery, due to restriction of food intake and impaired digestion or absorption of nutrients. CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. Seven months after the bariatric surgery, she presented dermatological features compatible with acrodermatitis enteropathica, as seen from the plasma zinc levels, which were below the reference values (34.4 mg%). The skin lesions improved significantly after 1,000 mg/day of zinc sulfate supplementation for one week. CONCLUSIONS: The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment.

CONTEXTO: Complicações nutricionais podem ocorrer após cirurgia bariátrica, pela restrição no consumo de alimentos e por comprometimento do processo digestivo e absortivo. RELATO DO CASO: Após ter sido submetida a gastroplastia vertical e derivação jejuno-ileal, uma paciente apresentou acentuada perda de peso e desnutrição proteica. Sete meses após a cirurgia bariátrica, manifestou-se quadro dermatológico compatível com acrodermatite enteropática, verificado a partir dos níveis plasmáticos de zinco (34,4 mg%), que se situavam abaixo dos valores de referência. As lesões cutâneas melhoraram significativamente após 1.000 mg/dia de suplementação de sulfato de zinco, por uma semana. CONCLUSÕES: A evolução da paciente mostra que a equipe multiprofissional envolvida no tratamento cirúrgico da obesidade deve considerar as deficiências nutricionais no diagnóstico diferencial das doenças cutâneas, a fim de instituir precocemente o tratamento.

Atualização terapêutica no tratamento dos craniofaringiomas / Therapeutic update on the treatment of craniopharyngiomas

O craniofaringioma é uma neoplasia de natureza benigna, pouco frequente, responsável por 1 por cento a 3 por cento de todos os tumores intracranianos, sendo a mais frequente neoplasia intracraniana não neuroepitelial na criança. Geralmente o tumor é restrito à região selar e ao III ventrículo, mas, em decorrência da infiltração e frequente aderência ao sistema nervoso central, apresenta comportamento clínico muitas vezes desfavorável, sendo classificado pela Organização Mundial de Saúde (OMS) como grau I, caracterizado como tumor de baixo ou incerto potencial de malignização. As sequelas endocrinológicas ganham destaque devido ao importante impacto na qualidade de vida dos pacientes, na maioria das vezes crianças. O hipopituitarismo e a obesidade hipotalâmica são complicações frequentes, sendo o tratamento desse tumor um grande desafio para endocrinologistas e neurocirurgiões. A combinação da cirurgia, radioterapia e aplicação de drogas e radioisótopos intratumorais tem como objetivo maximizar as chances de cura e tentar minimizar as sequelas pós-operatórias, mas, mesmo assim, a recidiva ainda é frequente. A escolha da modalidade de tratamento mais adequado para os craniofaringiomas é uma decisão difícil e que deve sempre ser individualizada para cada paciente. Com o objetivo de explorar as múltiplas opções terapêuticas para o craniofaringioma, foi realizada revisão na literatura com ênfase nas possibilidades terapêuticas e complicações inerentes ao tratamento dessa patologia.

Craniopharyngioma is an uncommon benign neoplasm, accounting for 1 percent-3 percent of all intracranial tumors, and the most common non-neuroepithelial intracranial neoplasm in childhood. Usually, the tumor is confined to the sellar region and the third ventricle, but due to frequent infiltration and adherence to the central nervous system, it often has an unfavorable clinical behavior. Therefore, it is classified by the World Health Organization (WHO) as a tumor of low or uncertain malignant potential. Endocrine after effects, mainly hypothalamic hypopituitarism, obesity and diabetes insipidus are highlighted due to their important impact on the quality of life of patients, mostly children. Optimal treatment of this tumor is a major challenge for neurosurgeons and endocrinologists. The combination of surgery, radiation, and application of radioisotopes and intratumoral drugs, aims at maximizing the chances of cure with minimal complications. Yet, recurrence is still frequent. Choosing the best treatment modality for craniopharyngiomas is a difficult decision, and it should always be specific for each case. In order to explore the multiple therapeutic options for craniopharyngiomas, we reviewed the literature with emphasis on the therapeutic possibilities and complications inherent to the treatment of this disease.

Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe / Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer

O tratamento radioterápico/ radioquimioterápico para tumores de laringe pode ocasionar sequelas na deglutição. OBJETIVO: Avaliar características da deglutição de pacientes tratados por radioterapia/ radioquimioterapia para tumores de laringe. MATERIAL E MÉTODO: Estudo prospectivo com 20 indivíduos, idade média de 62 anos, após término do tratamento oncológico. Destes, 6 (30 por cento) foram tratados por radioterapia exclusiva e 14 (70 por cento) por radioquimioterapia. O tempo médio decorrido do tratamento médico ao momento da avaliação fonoaudiológica foi de 8,5 meses. Foi realizada avaliação videofluoroscópica da deglutição orofaríngea e analisados eventos das fases preparatória, oral e faríngea da deglutição. RESULTADOS: Todos os pacientes se alimentavam com via oral exclusiva. Apenas 25 por cento da amostra apresentavam deglutição dentro dos limites da normalidade. A videofluoroscopia da deglutição identificou os seguintes eventos alterados: formação do bolo (85 por cento), ejeção do bolo (60 por cento), estases na cavidade oral (55 por cento), alteração no início da fase faríngea (100 por cento), redução da elevação da laringe (65 por cento) e estase em hipofaringe (80 por cento). A penetração laríngea foi diagnosticada em 25 por cento dos casos e 40 por cento penetrações seguidas de aspirações traqueais. O grau de penetração/ aspiração foi considerado discreto em 60 por cento, porém em 35 por cento da amostra a aspiração foi silenciosa. Embora 75 por cento da amostra apresentassem algum grau de disfagia, apenas 25 por cento dos pacientes referiam queixa de deglutição. CONCLUSÃO: Pacientes com câncer de laringe tratados com radioterapia/ radioquimioterapia podem apresentar alterações em todas as fases da deglutição, mesmo na ausência de sintomas.

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. AIM: To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. METHODS: A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30 percent) underwent radiation therapy, and 14 patients (70 percent) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. RESULTS: All patients had only an oral diet. Normal swallowing was present in only 25 percent of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85 percent), bolus ejection (60 percent), oral cavity stasis (55 percent), changes in the onset of the pharyngeal phase (100 percent), decreased laryngeal elevation (65 percent), and hypopharyngeal stasis (80 percent). Laryngeal penetration was observed in 25 percent of the cases; 40 percent presented tracheal aspiration. The grade of penetration/aspiration was mild in 60 percent of cases. Aspiration was silent in 35 percent of patients. Although 75 percent of patients had dysphagia, only 25 percent complained of swallowing difficulties. CONCLUSION: Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

[Microscopic assessment of the effects of chemoradiotherapy on normal oral mucosa in patients with head and neck cancer]

There are only few studies about effect of chemoradiotherapy based on cellular level. The aim of this study was to evaluate the effects of such treatment on normal cells of oral mucosa. Seventy patients whose normal oral mucosa was exposed to radiation during the course of chemoradiotherapy were selected. Before starting the treatment, 2 slides from the normal oral mucosa were prepared for each patient, one from keratinized and one from non keratinized mucosa. At the end of treatment 2 other slides were taken from the same area too. After observing the slides under light microscope in blind form, the results of the observation from the first slides were compared with the results of the second one. Statistical analysis was carried out by Mc Nemar, Marginal Homogeneity and Wilcoxon tests. The results revealed changes in nucleus and cytoplasm. and N/C ratio, formation of bizar cells, cellular abnormality, nucleous and cytoplasmic vacuolization in affected cells during treatment. There was statistically significant differences between the groups [p < 0.001]. Keratinization of basal cell mucosa in cytology slide was observed after treatment [P < 0.01] and also there was an increase in number of inflammatory cells [p < 0.001]. Cellular apoptosis, numerous granular cells with large size granules, cells with multiple nucleous and clear nuclei, bacterial colony and candida were observed after treatment. chemoradiotherapy may induce formation of bizar cells, abnormal nocleous and cytoptasm, changes in N/C ratio. Cellular abnormality, and cellular vacuolization

Angiosarcoma secundario a terapia conservadora por cáncer de mama: a propósito de un caso clínico / Angiosarcoma after conservation treatment for breast cancer: a clinical case report

La angiosarcoma es una neoplasia maligna del endotelio, linfático o vascular descrito por primera vez por Caro y Stubenrauch en 1945. Representa menos del 1 por ciento de las neoplasias malignas de tejido blando y a diferencia de la mayoría de los sarcomas muestra especial predilección por la piel y tejidos blandos superficiales. Se presenta principalmente en cabeza y cuello de pacientes añosos, o aparece en áreas de infedema crónico o radiodermitis con aspectos de máculas eritematosas o purpúricas que se extienden formando nódulos que más tarde se ulceran. Es poco frecuente en niños. Presentamos el caso de una paciente con angiocarcinoma secundario a cirugía conservadora y radioterapia complementaria por carcinoma mamario.

Clinicopathologic Characteristics and Therapeutic Outcomes of Primary Gastrointestinal Non-Hodgkin's Lymphomas in Central Anatolia, in Turkey

Primary gastrointestinal lymphoma is a common presentation of non-Hodgkin's lymphoma. The main controversy arises when many aspects of its classification and management are under discussion, particularly regarding roles for surgical resection. The aim of this study was to evaluate clinicopathologic characteristics and the therapeutic outcome of primary gastrointestinal non-Hodgkin's lymphoma. We carried out a retrospective analysis of 74 patients who were presented to our center with histopathological diagnosis of primary gastro-intestinal non-Hodgkin's lymphoma between 1990 and 2001. All patients have been staged according to Lugano Staging System. For histopathological classification, International Working Formulation was applied. The treatment choice concerning the surgical or non-surgical management was decided by the initially acting physician. Treatment modalities were compared using the parameters of age, sex, histopathological results, stage, and the site of disease. Of the 74 patients, 31 were female and 43 were male, with a median age of 49 years (range 15-80). The stomach was the most common primary site and was seen in 51 of 74 patients (68.9%). The intermediate and high grade lymphomas constituted 91.9% of the all cases. In a median follow-up of 29 months (range 2-128), 20 out of 74 patients died. There was a three year overall survival rate in 65.4% of all patients. The three year overall survival rate was better in stage I and II1 patients who were treated with surgery plus chemotherapy (+/-RT) than those treated with chemotherapy alone (93.7% vs. 55.6%, p<0.05). The stage and presence of B symptoms affected the disease free survival and overall survival significantly, but the histopathologic grade only affected the overall survival. On the basis of these results, we suggest that surgical resection is necessary before chemotherapy in early stage (stage I and II1) patients with gastrointestinal non-Hodgkin's lymphomas because of the significant survival advantage it would bring to the patient.

A Case of Treatment-Related Myelodysplastic syndrome and Acute Myelogenous Leukemia Following High-Dose Chemotherapy with Autologous Stem Cell Transplantation for Non-Hodgkin's Lymphoma

Treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (t-AML) are now well established as complications of cytotoxic chemotherapy. We experienced a 28-yr-old female patient who developed t-MDS/t-AML with characteristic chromosomal abnormalities including 11q23 chromosomal rearrangement following high-dose chemotherapy with autologous stem cell transplantation (ASCT) for non-Hodgkin's lymphoma. The patient was admitted with bulky abdominal masses of B cell lineage non-Hodgkin's lymphoma. After 2 cycles of systemic chemotherapy of the Vanderbilt regimen, the patient underwent ASCT with high dose chemotherapy of the BEAC regimen. She also received radiation of 48 Gy for the residual periportal lymphadenopathy. The initial cytogenetic analysis of the infused mononuclear cells revealed a normal karyotype. Twenty two months after the ASCT, pancytopenia was noted and her bone marrow aspirate showed dysplastic hemopoiesis with myeloblasts up to 12% of nonerythroid nucleated cells. The patient was diagnosed as t-MDS (refractory anemia with an excess of blasts). Cytogenetic analysis showed complex chromosomal abnormalities including 11q23 rearrangement, which is frequently found in topoisomerase II inhibitor-related hematologic malignancies. Four months later, it was noted that the t-MDS had evolved into an overt t-AML. Cytogenetic analysis showed an evolving pattern with more complex abnormalities. The patient was treated with combination che-motherapy, but her leukemic cells were resistant to the therapy.

Effect of cancer treatment modalities on serum lipids and lipoproteins among women with carcinoma of the breast.

Serum lipids and lipoproteins were studied in 61 breast cancer patients before initiation of therapy and subsequently during and after completion of cancer therapy. Different serum lipid fractions were estimated by enzymatic method. It was observed that mean levels of serum triglycerides, total cholesterol and low density lipoprotein (LDL)-cholesterol among untreated breast cancer patients decreased significantly after treatment. On the contrary, an increasing trend in the levels of high density lipoprotein (HDL)-cholesterol was noticed in patients during the course of treatment. This study reflects the effects of cancer therapy in the alteration of levels of different serum lipid fractions in the patients with breast cancer.

Cancer related fatigue of patients receiving different modalities for cancer treatment

Fatigue is the most common symptom of illness affecting sufferers of both acute and chromnic conditions. The subjective feeling of fatigue is closely n linked to individual perceptions of illness from a nursing perspective. fatigue has been conceptualized as an "inability to continue in whatever " situations people find themselves " and described as a feeling of inability to mobilize the energy to carry on. It was reported that cancer-related fatigue is an immense problem associated with pervasive disturbances in quality of life. Despite the prevalence of fatigue in cancer patients and the extent to which it can interfere with daily activities, there is a limited research describing severity of cancer treatment related fatigue; and identifying measures that prevent or ameliorate fatigue. Prevention and treatment of fatigue must be addressed in the plan of care of cancer patient to minimize the negative impact of fatigue on the quality of life. This study was conducted to determine the severity of fatigue of cancer patients receiving different modalities for treatment [radiation and/or chemotherapy], to determine the factors that increase its severity, and to identify the measures used by the patients to relieve fatigue. Design: Descriptive survey, Setting: The present study was conducted in the oncology department in Alexandria Main University Hospital. Sample: Data were collected from cancer patient, of both sexes, who were admitted to Alexandria Main University Hospital for cancer treatment whether by, radiation and/or chemotherapy

Impacto de la infección por el virus de la inmunodeficiencia humana Tipo-1 en la población hemofílica / The impact of human immunodeficiency virus infection in haemophilic patients

En los últimos 3 años se han producido notables avances en el tratamiento de la enfermedad HIV/SIDA. En este trabajo se compara la evolución y respuesta al tratamiento con antirretrovirales en 175 pacientes hemofílicos HIV (+) evaluados entre los años 1983 y 1995 con 54 pacientes de las mismas características, pero que recibieron terapias combinadas de alta eficacia, entre los años 1996 y 1999. Se evaluaron los siguientes parámetros: influencia de la edad al momento de la infección con el tiempo de sobrevida libre de enfermedad, incidencia de complicaciones oportunistas, tipo y severidad de la hemofilia en relación con el riesgo de infección por el retrovirus, respuesta al tratamiento antirretroviral, efectos adversos relacionadas con el mismo y modificaciones acaecidas en los niveles de linfocitos T CD4 (+) y en los valores de la carga viral en plasma.

Recaídas en hanseniasis: experiencia personal / Leprosy relapses: personal experince

En un total de 451 pacientes tratados con Monoterapia con Sulfonas, se han observado 31 recaídas, 15 de ellas de forma dimorfa. El intervalo de tiempo entre inactividad y recaídas oscila entre 6 y 39 anos. En los enfermos tratados con Multiterapia se ha observado un único caso

Manejo multidisciplinario del cáncer de ano: asociación radio quimioterapia / Multidisciplinary management of anal cancer: radio-chemotherapy association

Se presentan 21 casos de cáncer anal, todos carcinomas epidermoides, tratados en forma prospectiva con asociación de quimioradioterapia desde abril de 1986 a septiembre de 1994. De ellos 17 son mujeres y 4 son hombres, con una edad promedio de 65,7 años y con un margen de 51 a 82 años. Todos se trataron con un esquema de 5FU, MyC y radioterapia externa. Se presentaron complicaciones inmediatas, durante el tratamiento correspondiendo a diarrea al 81 por ciento, náuseas y vómitos al 70 por ciento, estomatitis y radioepidermitis al 62 por ciento, y, en menores porcentajes leucopenia en 23 por ciento y deshidratación en el 9 por ciento. Las complicaciones mediatas, hasta 3 meses postratamiento fueron: incontinencia anal transitoria, leucopenia, diarrea y alopecia. El seguimiento es de 100 por ciento de los casos, con un control local de 86 por ciento. Hubo 3 fallas rescatadas por resección abdominoperineal. Actualmente el 100 por ciento vivos sin evidencia de enfermedad.

El cumplimiento del paciente tuberculoso en un centro particular y la importancia del programa de control de tuberculosis / The completion of tuberculosus patients in private center and importance of tuberculosis control program

Se describe el cumplimiento de la terapia en pacientes tuberculosos manejados en un centro privado. Noventa y siete enfermos recibieron tratamiento ambulatorio, no supervisado y financiado por el paciente. La edad promedio fue de 24 [8*68] años y la Tuberculosis de tipo pulmonar la forma de enfermedad más frecuente. Treinta y dos (33 por ciento) fueron transferidos al Programa de Control de Tuberculosis del Ministerio de Salud o del Instituto Peruano de Seguridad Social, 31 (32 por ciento) cumplieron criterios de curación, 31 (32 por ciento abandonaron la terapia, un (2 por ciento) paciente recibió tratamiento irregular y 2 (2 por ciento) seguían terapia durante la revisión de historia clínicas. Si se excluyen los casos transferidos al Programa, la tasa de abandono es 48 por ciento. Las causas de abandono fueron: falta de poder adquisitivo en 11 (35 por ciento) y alivio presentado durante las primeras semanas de terapia en 8 (26 por ciento) casos. La alta tasa de abandonos es debida a la modalidad de tratamiento, es decir sin supervisión y autofinanciado. Se recomienda transferir a los pacientes al Programa de Control de Tuberculosis una vez establecido su diagnóstico

New trends in the medical treatment of carcinoma of the stomach

Author summarizes literature data concerning the medical treatment of gastric carcinoma with cytostatic chemotherapy. From the review of the available clinical results, as well as from the personal experience with the recently introduced FAM scheme [5-.fluorouracil + adriamycin + mitomycin C] producing 44% objective response rate [complete + partial >/= 50% tumor reduction], it can be concluded that polychemotherapy-especially the more recent adriamycin containing combinations is an effective and applicable tool for palliation of advanced and metastatic gastric cancer