Filtro de Veia Cava Inferior: Características Clínicas e Prognósticas de Pacientes Oncológicos do INCA / Placement of Inferior Vena Cava Filter: Clinical and Prognostic Characteristics of Cancer Patients at INCA

Introdução: O tromboembolismo venoso é uma condição potencialmente fatal e frequente no paciente oncológico. Muitas vezes, a anticoagulação é inviável, e a colocação do filtro de veia cava (FVC) torna-se uma opção. A indicação clínica, entretanto, é controversa e gera alto custo. Objetivo: Descrever as características demográficas, clínicas e epidemiológicas dos pacientes com colocação de FVC e seu impacto na sobrevida global. Método: Estudo de coorte retrospectiva com pacientes em tratamento oncológico no INCA, que tiveram FVC implantado de janeiro/2015 até abril/2017. Na análise de sobrevida global em cinco anos, foram considerados o tempo entre o diagnóstico de câncer e o óbito por qualquer causa. Realizaram-se análise descritiva, estimativas de sobrevida (Kaplan-Meier) e regressão de Cox. Resultados: Foram incluídos 74 pacientes com média de idade 54 (+-15) anos. Em sua maioria, apresentavam tumores ginecológicos (52,7%) e digestivos (20,3%). O tempo mediano entre o diagnóstico de câncer e a colocação do FVC foi de 3,48 meses (0-203). No seguimento, foram observados 40 óbitos (54,1%) com mediana de tempo de 25 meses (IC 95%; 1,76-47,32). Na análise ajustada, verificou-se risco 5,63 vezes maior de morrer nos pacientes com colocação do FVC em até seis meses após o diagnóstico de câncer (HR=4,99; IC 95%; 2,20-11,33; p<0,001), e risco 2,47 vezes maior entre aqueles que não fizeram no pré-operatório (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusão: A colocação do FVC foi realizada com maior frequência em pacientes com tumores ginecológicos e em até seis meses após o diagnóstico de câncer foi associada a maior risco de óbito.

Introduction: Venous thromboembolism is a potentially fatal condition and frequent in oncologic patients. Quite often full anticoagulation is unfeasible, and placement of an inferior vena cava (IVC) filter becomes an option. Clinical indication, however, is controversial and expensive. Objective: To describe the demographic, clinical and epidemiological characteristics of oncologic patients submitted to IVC filter placement and their impact on global survival. Method: Retrospective cohort study with patients undergoing cancer treatment at INCA submitted to IVC filter placement from January 2015 to April 2017. Time between cancer diagnoses and death from any cause was considered for the analysis of the global 5-years survival. Descriptive analysis, survival estimates (Kaplan-Meyer) and Cox regression were performed. Results: 74 patients with a mean age of 54 (+15) years were included. Most of them had gynecological (52.7%) and digestive (20.3%) tumors. The median time between cancer diagnosis and IVC filter placement was 3.48 months (0-203). In the follow-up, 40 deaths (54.1%) were observed with a median time of 25 months (95% CI; 1.76 to 47.32). In the adjusted analysis, 5.63 times greater risk of death was verified in patients with IVC filter placement within six months after cancer diagnosis (HR=4.99; 95% CI; 2.20-11.33; p<0.001), and 2.47 times greater risk among those who did not do it at pre-operation (HR=2.47; 95% CI; 1.08-5.66; p=0.032). Conclusion: IVC filter placement was performed more frequently in patients with gynecological tumors and in until six months after cancer diagnosis was associated with increased risk of death.

Introducción: El tromboembolismo venoso es una afección potencialmente mortal y frecuente en pacientes con cáncer. La anticoagulación a menudo no es factible, y la colocación de un filtro de vena cava (FVC) se convierte en una opción. Sin embargo, las indicaciones clínicas son controvertidas y generan un alto costo. Objetivo: Describir las características demográficas, clínicas y epidemiológicas de los pacientes con colocación de CVF y su impacto en la supervivencia general. Método: Estudio de cohorte retrospectivo de pacientes sometidos a tratamiento contra el cáncer en INCA a quienes se les implantó FVC entre enero de 2015 y abril de 2017. En el análisis de la supervivencia general a cinco años, el tiempo transcurrido entre el diagnóstico de cáncer y la muerte cualquier causa Se realizó un análisis descriptivo, estimaciones de supervivencia (Kaplan-Meier) y regresión de Cox. Resultados: Se incluyeron 74 pacientes con una edad media de 54 (+-15) años. La mayoría de ellos tenían tumores ginecológicos (52,7%) y digestivos (20,3%). La mediana del tiempo entre el diagnóstico de cáncer y la colocación de FVC fue de 3,48 meses (0-203). En el período de seguimiento, se observaron 40 muertes (54,1%) con una mediana de tiempo de 25 meses (IC 95%: 1,76 a 47,32). En el análisis ajustado, se observó un riesgo de muerte 5,63 veces mayor en pacientes con colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer (HR=4,99; IC 95%: 2,20-11,33; p<0,001) y 2,47 veces mayor riesgo entre aquellos que no lo hicieron antes de la operación (HR=2,47; IC 95%; 1,08-5,66; p=0,032). Conclusión: La colocación de FVC se realizó con mayor frecuencia en pacientes con tumores ginecológicos. La colocación de FVC dentro de los seis meses posteriores al diagnóstico de cáncer se asoció con un mayor riesgo de muerte.

Protective and therapeutic effects of metformin on gynecologic cancers / 부인종양

No abstract available.

Edema maciço de ovário / Massive ovarian edema

O edema maciço de ovário é uma condição benigna rara caracterizada pelo aumento tumoral símile do ovário comprometido. As doenças ovarianas de importância cirúrgica da infância não são frequentes e podem ser divididas em lesões neoplásicas, em cistos não neoplásicos e em alterações inflamatórias. Os autores descrevem um caso de edema maciço de ovário em uma paciente de treze anos que referia dor abdominal associada a uma lesão sólido-cística do ovário direito, avaliada como neoplasia pela ultrassonografia. Ao exame macroscópico, o ovário era bocelado e estava aumentado de volume, medindo 9,5×6,0×5,0 cm e apresentando uma lesão sólida com áreas císticas à superfície de corte. O aspecto microscópico fundamental desse processo era a presença de edema acentuado e difuso do estroma, envolvendo folículos, e associado a uma camada cortical com espessamento fibroso superficial. O conhecimento dessa entidade é fundamental para auxiliar no diagnóstico durante a avaliação ultrassonográfica de tumores ovarianos e prevenir tratamentos incorretos.

Massive ovarian edema is a rare benign condition characterized by similar tumor growth of the affected ovary. The ovarian disorders of surgical importance of childhood are not frequent and can be divided into neoplastic lesions, non-neoplastic cysts, and inflammatory alterations. Here the authors describe the case of a massive ovarian edema in a 13-year-old female patient who reported abdominal pain associated with a solid-cystic lesion of the right ovary evaluated as a neoplasm by ultrasonography. The macroscopic examination showed ovary with increased volume, measuring 9.5×6.0×5.0 cm, and presenting a solid lesion with cystic areas at the cutting surface. The key microscopic feature of this process was the presence of pronounced diffuse edema of the stroma, involving follicles and associated with a cortical layer with superficial fibrous thickening. Knowledge of this entity is key in aiding the diagnosis during the ultrasonographic evaluation of ovarian tumors and preventing improper treatments.

The efficacy of ginger in prevention of postoperative nausea and vomiting after major gynecologic surgery.

OBJECTIVE: To study the efficacy of ginger in prevention of nausea and vomiting after major gynecologic surgery. STUDY DESIGN: Double blind randomized controlled trial. SETTING: Department of Obstetrics and Gynecology, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand. MATERIAL AND METHOD: From March 2005 to April 2006, 120 patients who underwent major gynecologic surgery were randomized into group A (n = 60) and group B (n = 60). The patients in group A received two capsules of ginger taken one hour before the procedure (one capsule contains 0.5 gram of ginger powder). The patients in group B received the placebo. The visual analog nausea score (VANS) and frequency of vomiting were evaluated at 0, 2, 6, 12, and 24 hours after the operation. RESULTS: The results demonstrated the statistically significant differences in nausea between group A (48.3%) and group B (66.7%). The VANS was lower in group A compared to group B at 2, 6, 12, and 24 hours. The most statistically significant differences occurred at 2 and 6 hour. The incidence and frequency of vomiting in group A were lower than group B. Side effects caused by ginger were not detected. CONCLUSION: Ginger has efficacy in prevention of nausea and vomiting after major gynecologic surgery.

Granulocyte-colony stimulating factors for secondary prevention of leucopenia in patients receiving chemotherapy.

OBJECTIVE: To evaluate the effectiveness of GCSF as a secondary preventive adjunct to chemotherapy in the gynaecologic cancer patients who previously had grade 3-4 neutropenia or leucopenia from chemotherapy. MATERIAL AND METHOD: We retrospectively reviewed the medical records of 94 chemotherapeutic cycles with GCSF as secondary prophylaxis in 29 patients with gynaecologic malignancy between January 1996 and April 2005. RESULTS: The median age of the patients was 51 years (21-75). Most of the patients had ovarian cancers (19 cases, 65.6%). From secondary GCSF, grade 4 neutropenia was developed in 12 of 94 cycles (12.8%), and grade 4 leucopenia was developed in 5 of 94 cycles (5.3%). There were no patients developing febrile neutropenia after GCSF support. CONCLUSION: Secondary GCSF prophylaxis was effective in preventing grade 4 leucopenia, grade 4 neutropenia, and febrile neutropenia.

Evaluation of safety and efficacy of transdermal therapeutic system-fentanyl in adult patients with gynecological cancer-related pain.

OBJECTIVES: To assess the analgesic safety and efficacy of Transdermal Therapeutic System (TTS)-fentanyl in the treatment of chronic gynecological cancer-related pain. BACKGROUND: TTS-fentanyl is a Transdermal Therapeutic System, which contains a rate-limiting membrane that provides constant release of fentanyl. TTS-fentanyl can be properly used to control pain. Therefore, this trial was designed to establish the analgesic efficacy and safety of TTS-fentanyl in the treatment of chronic gynecological cancer-related pain. MATERIAL AND METHOD: Thirty patients were recruited into the study. This open study was comprised of two phases. Phase 1: an oral morphine stabilization phase where eligible patients, who took other opioids and/or analgesic drugs, were entered into the stabilization phase and should be converted to oral morphine according to the conversion chart. The patients were then titrated to a stable oral morphine dose. Phase 2: an open TTS-fentanyl treatment phase where the daily dose of oral morphine was switched to TTS-fentanyl according to the conversion chart. The efficacy parameters of pain score were assessed by visual analogue scale (VAS) and global assessments. The safety was evaluated by monitoring the patient's clinical conditions and adverse events. RESULTS: TTS-fentanyl was generally well tolerated. Only one patient was dropped out from the study due to lacking enrollment in the stabilization phase. The most frequent adverse events were mild nausea or vomiting (46%) and constipation (33%). The median pain VAS during TTS-fentanyl treatment was decreased from 8 to 3 and global assessments at the end of the treatment were better than at the start of the treatment. CONCLUSION: The results suggest that TTS-fentanyl is safe and effective in managing chronic gynecological cancer-related pain.

Complicaciones rectosigmoideas en el tratamiento radiante del cáncer ginecológico / Rectosigmoid complications in radiation treatment of gynecological cancer

Antecedentes: La radioterapia mediante irradiación intracavitaria y externa solas o asociadas a cirugía o quimioterapia es considerada el tratamiento de elección del cáncer ginecológico. Las dosis radiantes efectivas que se requieren para tratar adecuadamente procesos neoplásicos es lindante con aquellas toleradas por los tejidos circundantes. Objetivos: Analizar las complicaciones rectosigmoideas relacionadas al tratamiento radiante del cáncer ginecológico. Diseño: Trabajo retrospectivo. Población: Se presentan 55 pacientes con complicaciones rectosigmoideas del tratamiento radiante por cáncer ginecológico tratados durante junio 1990 a junio 1999. Método: El tratamiento radiante se implementó en 27 pacientes (49 por ciento), 17 casos por cáncer de cuello uterino y los restantes 10 por cáncer de endometrio. A la radioterapia, en 28 casos se le asoció cirugía (Op. de Wertheim Meigs) con diagnóstico de: cáncer de cuello uterino en 9 casos, cáncer de endometrio en 17 y de ovario en 2 casos. La dosis radiante utilizada osciló entre los 4500 y 13200 cGy. Resultados: Se presentaron complicaciones tempranas en 21 casos (38,2 por ciento) y las tardías ocurrieron en 34 pacientes (68,8 por ciento). Estas fueron fistulosas en 15 casos, hemorrágicas en 7 casos, obstructivas en 10 y ulcerativas en 2 casos. Se implementó tratamiento médico en 27 casos (49 por ciento), tratamiento quirúrgico en 31 pacientes (56,4 por ciento) todos ellos con complicaciones tardías. La morbilidad quirúrgica fue de 58 por ciento y la mortalidad cercana al 40 por ciento. Conclusiones: Consideramos un llamado de atención a las indicaciones del tratamiento radiante para que se tomen todas las medidas preventivas para reducir la frecuencia de sus severas complicaciones. Es necesario un manejo artesanal de cada paciente por el radioterapeuta evitando la estandarización del proceso.

Malignant ascites in female patients: a seven-year review.

Malignant ascites is common in various types of advanced cancer. Our objective was to determine the primary site and the clinical characteristics of female patients presenting with malignant ascites as well as evaluating the outcome. The authors carried out a retrospective study of 118 cases of malignant ascites diagnosed from January 1986 to December 1992 in female patients. Of the 118 cases, the primary site of the neoplasms was gynecologic in 65 cases (cervix 4, endometrium 6, ovary 52, fallopian tube 3) = 55.1 per cent, non-gynecologic 29 cases (GI 18, lymphoma 8, breast 2, kidney 1) = 24.6 per cent, and unknown 24 cases = 20.3 per cent. The mean age of patients in the gynecologic, non-gynecologic and unknown primary site was 50.4, 45.5 and 59.3 years respectively. Surgery combined with chemotherapy was the main treatment in the gynecologic group, whereas, supportive and symptomatic management was the main treatment in the unknown primary group. Treatments in non-gynecologic group were supportive and symptomatic, surgery and chemotherapy. Survival was longer in gynecologic than in the nongynecologic and the unknown primary groups. The most common primary site of malignant ascites in females was ovarian cancer. In malignant ascites in females caused by gynecologic neoplasms, the prognosis as measured by survival was better than in the non-gynecologic and the unknown primary groups.

Tratamiento de la Cistitis Radiogéna Hemorrágica con Formalina. Reporte de 5 casos / Treatment of hemorrhagic radiogenic cystitis with formaldehyde. Report of 5 cases

Se informan los resultados del tratamiento con formalina al 5 por ciento utilizada intravesical en 5 pacientes portadores de hematuria vesical masiva por cistitis radiógena hemorrágica. Se obtuvo remisión completa en el 100 por ciento de los casos, dada por el cese inmediato del sangramiento. Como complicación se presentó espasmo vesical moderado en todos los pacientes. Se recomienda este proceder terapéutico para el sangramiento incontrolable producido por cistitis radiógena hemorrágica con riesgo para la vida

Anastomosis coloanal, operación de Parks, para el tratamiento de la rectitis actínica grave / Coloanal anastomosis coloanal, Parks surgery, in the treatment of severe radiation rectitis

Aim: To assess inmediate and late results of Prks operation in the treatment of severe radiation rectitis. Patients and methods: Retrospective review of clinical histories of 35 patients with uterine cervical cancer, 5 with endometrial cancer and 1 with vaginal cancer that received radiotherapy. Two years as a mean after radiotherapy, 14 women had rectal bleeding, 19 fistulae, 7 stenosis and 1 rectal ulceration. All were initially treated with a discharge colostomy and after a mean interval of 1.6 years, a Parks operation was performed. Results: One patient died after surgery (2.4 percent) due to peritonitis and sepsis. Early surgical complications were necrosis of descended colon in 2, intra-abdominal sbscess in 1, splenic rupture in 1 and postoperative bleeding in 1. Colostomy was closed in 37 patients 3 months after surgery. During late follow up (ranging from 3 to 64 months) rectal continence has been assessed as good in 30 patients, fair in 5 and bad in 2. Three women required a new colostomy. Conclusion: Parks operation is a viable therapeutic alternative for severe radiation rectitis

Respuesta citológica de la vagina irradiada a succinato de estriol / Cytologic response of the irradiated vagina by estriol succinato

Se estudia la repuesta vaginal al succinato de estriol en 40 pacientes oncoginecológicas, 20 de ellas irradiadas (grupo estudio) y 20 no irradiadas (grupo control) ambas con menopausia artificial instalada. Los índices clínicos y citológicos previo a la terapia estrogénica, en el grupo de pacientes irradiadas fueron significativamente mas severos, con una incidencia de atrifia vaginal postmenopausica alta, que guarda relación con el tipo y dosis de radioterapia. La respuesta al tratamiento en ambos grupos fue muy favorable, sin haber diferencias estadísticamente significativas entre ellos, esto se reflejó en un marcado cambio del frotis vaginal, indicando un intenso efecto estrogénico, con una correlación directa entre la respuesta clínica y la proliferación celular, concluyendo que la vagina de pacientes irradiadas responde de manera similar al estímulo estrogénico. La dosis de 4 mg diarios de succinato de estriol, en terapia continua, son suficientes, para el alivio de los síntomas vaginales en pacientes oncoginecológicas, irradiadas o no, traduciéndose finalmente en un mejoramiento de la calidad de vida

Actinic rectitis--the role of colostomy

From 4132 patients treated with radiation therapy due to gynecological malignancy from 1974 to 1988, 527 (12.75%) developed some grade of actinic rectitis with clinical manifestation. The authors analyzed the efficacy of colostomy in the management of 10 women with actinic rectitis grades I and II (Sherman classification) submitted to clinical treatment without response. Pelvic radiation therapy, clinical findings, proctoscopy and rectal biopsy were the basis for the diagnosis and staging of the actinic rectitis. All colostomies were made in the transverse colon and the median follow up from colostomy to last review was 53 months. Eight patients had complete remission of clinical findings after colostomy, but one had recurrence of symptoms 2 years later. One patient had incomplete remission but with clinical improvement and one patient had tumor recurrence. From 8 patients with complete clinical remission, 2 had the colostomies closed, but in 1 was restored 3 months later due to rectum-vaginal fistula

Sistema de carga diferida con radium 226 en el tratamiento de las neoplasias ginecológicas / Defered charge system with Radium 226 in the treatment og gynecological neoplasms

Se analizaron 148 casos consecutivos de pacientes con cáncer de cuello uterino en tratamiento en el Instituto Nacional de Enfermedades Neoplásicas en el año 1992 con indicación de aplicación de radio intracavitario. La mitad de las pacientes fueron tratadas con el sistema de Manchester modificado y la otra mitad con el sistema de carga diferida manual con los aplicadores de Fletcher-Suit-Delclos, realizándose en forma secuencial un número aproximado de 15 aplicaciones por semana, de los cuales la mitad correspondía a cada uno de los sistemas de aplicación. No se encontró ningún tipo de problema para realizar las aplicaciones con cuaquiera de los 2 sistemas, ambos sistemas son lo suficientemente versátiles para adaptarse a las variantes anatómicas que presentaban las pacientes( como por ejemplo amplitud de vagina, cirugía previa, histerometría, etc). Ambos sistemas son bien tolerados y requieren tan solo de analgesia leve a moderada. No se encontraron diferencias significativas en cuanto a complicaciones de tipo local. Se observó una distribución más homogénea y se pudo determinar mejor las cargas necesarias para el tratamiento en las pacientes tratadas con el sistema de carga diferida, aunque no hubo diferencia significativa en cuanto a dosis administradas con ambos sistemas. En vista de que no se observaron mayores dificultades ni complicaciones con empleo del nuevo sistema (carga diferida), se recomienda su uso en las pacientes a ser tratadas ya que sí se logra disminuir considerablemente la exposición a radiación del personal involucrado en la aplicación del mismo.

Ovarian cancer: Clinical analysis of 209 cases

Two hundred and nine ovarian cancer cases were treated between January 1974 and December 1988. The median age was 45 years. The commonest symptoms were abdominal distension, pain and uterine bleeding. The commonest histology was the common epithelial variety [79%]. Half of the cases were in stage III and IV, and 61% had histopathological grades 3 and 4. Seventy four percent women had postoperative residual tumor more than 2 cm in diameter. Radiotherapy induced total response of 38.6% in 101 cases, and chemotherapy induced total response of 58.3% in 60 cases. The five year actuarial survival was 30%, 39%, 26% for common epithelial, germ cell and sex cord tumors respectively. The most important prognostic factors were the initial stage, size of the residual tumor, and unfavorable histology

Infecciones por el virus del papiloma humano y cáncer genital

El virus del papiloma humano (VPH) ha sido inmplicado como agente etiológico del cáncer genital. Los tipos 6 y 11 se asocian con condilomas y displasias leves, mientras que los tipo 16, 18 y 35 con displasias severas y carcinomas intraepiteliales e invasores; el tipo16 es el más fecuentemente relacionado con el NIC, se ha informado que el tipo 18 es un factor de rápida transformación entre NICI y carcinomas invasores. Se describen brevemente las técnicas del Southerm Blot e hidrización in situ para tipificar los grupos del VPH. Los resultados obtenidos con este último método en nuestro laboratorio confirma lo publicado recientemente

Piometra: estudio de evaluación en 15 años en el hospital Loayza / Piometra: evaluation study in 15 years in hospital Loayza

Se revisa en forma retrospectiva nueve casos de piometra ocurridos durante un período de 15 años en el Hospital Arzobispo Loayza, Lima*Perú. El diagnóstico fue establecido clínicamente luego de la observación de material purulento que escapaba a través del orificio cervical en forma espontánea o luego de dilatación del cervix. El promedio de edad fue de 52.5 años. Siete pacientes se encontraban en edad post*menopáusica. El síntoma de flujo vaginal como descarga purulenta fétida se presentó en siete pacientes, cinco de las cuales acudieron con fiebre y compromiso del estado general. En ningún caso se encontró asociación con enfermedad maligna del cervix o útero. En seis casos se encontró útero aumentado de tamaño y, en todos los casos, este fue doloroso a la palpación. El diagnóstico preoperatorio fue hecho en cuatro casos. Los resultados bacteriológicos son limitados por no haberse hecho cultivos para anaerobios. Todas las pacientes recibieron tratamiento médico y quirúrgico, y su evolución fue favorable. Se discute los resultados basados en una revisión bibliográfica actualizada

Laparoscopía Oncológica / Oncological laparoscopy

La laparoscopia diagnóstica debe considerarse, en pacientes de alto riesgo con padecimiento oncológico avanzados, como un excelente método para precisar el diagnóstico y adecuar el tratamiento, fue realizado en 15 pacientes. La edad de 45 a 70 años. La sintomatología predominante era ascitis, com citología positiva para neoplasia maligna. Los estudios preoperatorios en límites aceptables y las funciones cardiorrespiratorias estables. El tiempo requerido para el procedimiento fue de 30 minutos. En todos los casos de tomó biópsia y se estableció el diagnóstico