The Association between Exposure to Second-Hand Smoke and Disease in the Chinese Population: A Systematic Review and Meta-Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the association between exposure to second-hand smoke (SHS) and 23 diseases, categorized into four classifications, among the Chinese population.@*METHODS@#We searched the literature up to June 30, 2021, and eligible studies were identified according to the PECOS format: Participants and Competitors (Chinese population), Exposure (SHS), Outcomes (Disease or Death), and Study design (Case-control or Cohort).@*RESULTS@#In total, 53 studies were selected. The odds ratio (OR) for all types of cancer was 1.79 (1.56-2.05), and for individual cancers was 1.92 (1.42-2.59) for lung cancer, 1.57 (1.40-1.76) for breast cancer, 1.52 (1.12-2.05) for bladder cancer, and 1.37 (1.08-1.73) for liver cancer. The OR for circulatory system diseases was 1.92 (1.29-2.85), with a value of 2.29 (1.26-4.159) for stroke. The OR of respiratory system diseases was 1.76 (1.13-2.74), with a value of 1.82 (1.07-3.11) for childhood asthma. The original ORs were also shown for other diseases. Subgroup analyses were performed for lung and breast cancer. The ORs varied according to time period and were significant during exposure in the household; For lung cancer, the OR was significant in women.@*CONCLUSION@#The effect of SHS exposure in China was similar to that in Western countries, but its definition and characterization require further clarification. Studies on the association between SHS exposure and certain diseases with high incidence rates are insufficient.

Clinical Value of Autoantibody Prognostic Markers in Tumor Immune Checkpoint Inhibitor Therapy / 中国肺癌杂志

Serum autoantibody markers have the advantages of easy specimen acquisition, simple detection technology and dynamic real-time monitoring. With the wide application of immune checkpoint inhibitors in the treatment of malignant tumors, autoantibody markers in predicting tumor immune checkpoint inhibitors efficacy and forecasting irAEs (immune related adverse events) show good prediction of potential. This review mainly focused on the progress of autoantibody markers in the prediction of therapeutic effect and the monitoring of irAE in tumor immunotherapy.
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Radiation therapy with elective lymph node irradiation for breast cancer: dosimetric study and impact on cardiovascular risk and second neoplasms

SUMMARY OBJECTIVE: The aim of this study was to perform dosimetric analysis of radiotherapy (RT) plans with or without elective nodal irradiation (ENI) and estimate whether the increase in mean doses (MDs) in the heart and lungs with ENI may lead to late side effects that may surpass the benefits of treatment. METHODS: The dosimetric analysis of 30 treatment plans was done with or without ENI. The planning and dose-volume histograms were analyzed, and the impact on the mortality of cardiovascular and lung cancer was estimated based on the correlation of the dosimetric data with data from population studies. RESULTS: RT with ENI increased the doses in the lungs and heterogeneity in the plans compared to breast-exclusive RT. When the increase in MDs is correlated with the increase of late side-effect risks, the most important effect of ENI is the increased risk of lung cancer, especially in patients who smoke (average increase in absolute risk=1.38%). The increase in the absolute risk of cardiovascular diseases was below 0.1% in the all the situations analyzed. CONCLUSIONS: ENI increases the heterogeneity and the doses at the lungs. When recommending ENI, the risks and benefits must be taken into account, considering the oncology factors and the plan of each patient. Special attention must be given to patients who smoke as ENI may lead to a significant increase in MD in the lung and the increased risk of radiation-induced lung cancer may surpass the benefits from this treatment.

Concordância e validade dos diagnósticos de cânceres associados ao asbesto no sistema de informação hospitalar do Sistema Único de Saúde / Agreement and validity of asbestos-related cancers in the hospital information system of the Brazilian Unified Health System

RESUMO: Objetivo: Estimar o grau de concordância e validade dos diagnósticos de neoplasias malignas relacionadas à exposição ao asbesto registrados no Sistema de Informação Hospitalar do Sistema Único de Saúde (SIH/SUS), em comparação aos Registros Hospitalares de Câncer do Estado de São Paulo (RHC/SP). Métodos: Óbitos com registros de neoplasias malignas associadas ao asbesto foram identificados e extraídos do SIH/SUS entre 2007 e 2014. Óbitos nos casos de câncer registrados na base do RHC/SP foram extraídos para o mesmo período. Essas bases foram unidas pelos mesmos indivíduos empregando-se o software Link Plus. Um único diagnóstico codificado pela CID-O3 ou CID-10 selecionado de cada sistema foi analisado. A proporção de concordância e a sensibilidade, especificidade e valores preditivos foram estimados. Resultados: Encontraram-se 19.458 pares com registros nas duas bases. A proporção de concordância foi elevada, variando de 92,4% para a localização primária desconhecida a 99,7% para o câncer de pleura. O índice Kappa variou de 0,05 (IC95% 0,04 - 0,07) para o câncer de pleura a 0,85 (IC95% 0,84 - 0,87) para o câncer de pulmão. A menor sensibilidade foi de 0,08 (IC95% 0,01 - 0,25), para o câncer de pleura, e a maior de 0,90 (IC95% 0,90 - 0,91), para o câncer de pulmão. Conclusão: Diagnósticos de neoplasias malignas associadas ao asbesto alcançaram maiores níveis de concordância e validade quando comuns. Os diagnósticos mais raros apresentaram baixa acurácia no SIH/SUS.

ABSTRACT: Objective: To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP). Methods: Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated. Results: 19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer. Conclusion: Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.

Uso de bleomicina en el manejo del derrame pleural recidivante maligno / Bleomycin in the management of malignant recurrent pleural effusion

Introducción: El derrame pleural recidivante maligno se reproduce en breve tiempo y requiere el diagnóstico etiológico positivo de malignidad, la etiología más frecuente es el cáncer de pulmón. La pleurodesis química es el tratamiento de elección con la aplicación intrapleural de sustancias sinfisiantes. Objetivo: Describir la respuesta clínica y radiológica de los enfermos con derrame pleural recidivante maligno con el uso de bleomicina. Método: Estudio observacional comparativo en 30 pacientes con derrame pleural recidivante maligno divididos en dos grupos, en uno se aplicó la bleomicina intrapleural y al otro yodo povidona. Resultado: El 33,3 por ciento fueron del sexo masculino, 60 por ciento perteneció al grupo de edades de 60-69 años. El grupo tratado con bleomicina presentó una respuesta clínica favorable en los síntomas, p<0,005 después de la pleurodesis. En la evaluación de la respuesta radiológica, 66,6 por ciento pacientes tratados con la bleomicina tuvieron una resolución completa. Conclusiones: Se logró una buena respuesta clínica-radiológica con la pleurodesis química similar entre ambas modalidades de tratamiento. Se obtuvieron mejores resultados y menos reacciones adversas con la bleomicina intrapleural(AU)

Introduction: The malignant recurrent pleural effusion reproduces in short time and it requires a positive etiological diagnosis of malignancy, the most frequent etiology is lung cancer. Chemical pleurodesis is the treatment of choice with the intrapleural application of symphysiating substances. Objective: To describe the clinical and radiological response of patients with malignant recurrent pleural effusion with the use of bleomycin. Method: A comparative observational study in 30 patients with recurrent malignant pleural effusion was carried out. They were divided into two groups, one used intrapleural bleomycin and the other group used povidone iodine. Result: 33.3 percent were male, 60 percent belonged to the 60-69 age group. The group treated with bleomycin presented favorable clinical response in symptoms, p <0.005 after pleurodesis. At the evaluation of the radiological response, 66.6 percent patients treated with bleomycin had a complete resolution. Conclusions: Good clinical-radiological response was achieved with similar chemical pleurodesis between both treatment modalities. Better results and fewer adverse reactions were obtained with intrapleural bleomycin(AU)

Multiple cavitary lung lesions on CT: imaging findings to differentiate between malignant and benign etiologies / Lesões escavadas pulmonares múltiplas em TC: achados de imagem para diferenciação entre etiologia maligna e benigna

ABSTRACT Objective: To determine the CT findings of multiple cavitary lung lesions that allow the differentiation between benign and malignant etiologies. Methods: We reviewed CT scans, including patients with two or more cavitary lung lesions. We evaluated the number of cavitary lesions, their location, cavity wall thickness, and additional findings, correlating the variables with the diagnosis of a benign or malignant lesion. Results: We reviewed the chest CT scans of 102 patients, 58 (56.9%) of whom were male. The average age was 50.5 ± 18.0 years. Benign and malignant lesions were diagnosed in 74 (72.6%) and 28 (27.4%) of the patients, respectively. On the CT scans, the mean number of cavities was 3, the mean wall thickness of the largest lesions was 6.0 mm, and the mean diameter of the largest lesions was 27.0 mm. The lesions were predominantly in the upper lobes, especially on the right (in 43.1%). In our comparison of the variables studied, a diagnosis of malignancy was not found to correlate significantly with the wall thickness of the largest cavity, lymph node enlargement, emphysema, consolidation, bronchiectasis, or bronchial obstruction. The presence of centrilobular nodules correlated significantly with the absence of malignant disease (p < 0.05). In contrast, a greater number of cavities correlated significantly with malignancy (p < 0.026). Conclusions: A larger number of cavitary lung lesions and the absence of centrilobular nodules may be characteristic of a malignant etiology. However, on the basis of our evaluation of the lesions in our sample, we cannot state that wall thickness is a good indicator of a benign or malignant etiology.

RESUMO Objetivo: Determinar os achados tomográficos de lesões escavadas pulmonares múltiplas que contribuem para a diferenciação entre etiologia benigna e maligna. Métodos: Foram revisados exames de TC, sendo incluídos pacientes com duas ou mais lesões pulmonares escavadas. Avaliaram-se a quantidade de lesões escavadas, sua localização, espessura parietal das lesões e achados adicionais, correlacionando as variáveis com a presença de diagnóstico de benignidade ou de malignidade. Resultados: Foram revisadas TCs de tórax de 102 pacientes, sendo 58 (56,9%) desses do sexo masculino. A média de idade foi de 50,5 ± 18,0 anos. Lesões benignas e malignas foram diagnosticadas em 74 pacientes (72,6%) e em 28 (27,4%), respectivamente. Quanto aos achados tomográficos, a média do número de cavidades foi 3, a da espessura média da parede da maior lesão foi de 6,0 mm, e a do diâmetro da maior lesão foi de 27,0 mm. Houve predomínio das lesões em lobos superiores, especialmente no direito (43,1%). Após a comparação das variáveis estudadas, a espessura parietal da maior escavação, assim como a presença de linfonodomegalia, enfisema, consolidação, bronquiectasias e obstrução brônquica, não apresentaram diferenças estatisticamente significativas para o diagnóstico de malignidade. A presença de nódulos centrolobulares correlacionou-se significativamente com a ausência de doença maligna (p < 0,05). Observou-se também que um número maior de cavidades se correlacionou significativamente com malignidade (p < 0,026). Conclusões: Um maior número de lesões pulmonares escavadas e a ausência de nódulos centrolobulares podem ser características relacionadas à etiologia maligna. Por outro lado, a espessura parietal não permitiu a diferenciação entre etiologia benigna e maligna das lesões em nossa amostra.

Tabaquismo y cáncer de pulmón / Tobacco use and lung cancer

Resumen: El tabaquismo es la principal causa de cáncer de pulmón. Participa en la etiología y, dependiendo de la intensidad y duración, influye en el tipo histológico, el estadio de la enfermedad y el efecto del tratamiento, por lo que nunca es tarde para dejar de fumar. La toxicidad del humo del tabaco es tan alta que no existe ninguna modalidad segura de tabaquismo. Los filtros, las diferentes variedades de cigarros light, los puros, pipas de agua, etc. son prohibitivamente dañinas. Inclusive los diferentes dispositivos electrónicos para la administración de nicotina, además de promocionar la adicción, tienen efectos respiratorios y cardiovasculares a corto plazo y, aunque aún es pronto para conocer sus consecuencias a largo plazo, se han identificado efectos en la proliferación celular y progresión tumoral. Por lo anterior, las campañas para el control del tabaquismo deben considerar estos productos como su principal amenaza.

Abstract: Smoking is the main cause of lung cancer. It plays a role in the etiology, and depending on the intensity and duration, it also has an influence on histology, stage and therapeutic outcome. Therefore, it is never too late to stop smoking. Tobacco smoke is so toxic, that there is no safe smoking modality. Filters, light cigarettes, pipes, water pipes, etc. are prohibitively harmful. In addition, the electronic nicotine delivery systems, besides promoting addiction, cause acute respiratory and cardiovascular effects. In addition, even though long-term consequences are yet to be known, cell proliferation and tumor progression have been identified. Tobacco control efforts should look at all these new products as its main threat.

Update on the approach to smoking in patients with respiratory diseases / Atualização na abordagem do tabagismo em pacientes com doenças respiratórias

ABSTRACT Smoking is the leading cause of respiratory disease (RD). The harmful effects of smoking on the respiratory system begin in utero and influence immune responses throughout childhood and adult life. In comparison with "healthy" smokers, smokers with RD have peculiarities that can impede smoking cessation, such as a higher level of nicotine dependence; nicotine withdrawal; higher levels of exhaled carbon monoxide; low motivation and low self-efficacy; greater concern about weight gain; and a high prevalence of anxiety and depression. In addition, they require more intensive, prolonged treatment. It is always necessary to educate such individuals about the fact that quitting smoking is the only measure that will reduce the progression of RD and improve their quality of life, regardless of the duration and severity of the disease. Physicians should always offer smoking cessation treatment. Outpatient or inpatient smoking cessation treatment should be multidisciplinary, based on behavioral interventions and pharmacotherapy. It will thus be more effective and cost-effective, doubling the chances of success.

RESUMO O tabagismo é o maior responsável pelas doenças respiratórias (DR). Os efeitos nocivos do tabaco sobre o aparelho respiratório se iniciam ainda intraútero e influenciam as respostas imunológicas ao longo da infância e vida adulta. Os tabagistas com DR possuem peculiaridades que podem dificultar a cessação tabágica, tais como maior grau de dependência e de abstinência de nicotina; níveis mais elevados de monóxido de carbono exalado; motivação e autoeficácia baixas; maior preocupação com ganho ponderal; e elevada prevalência de ansiedade e depressão. Além disso, requerem tratamento mais intensivo e prolongado. É necessário esclarecer sempre o paciente sobre o fato de que parar de fumar será a única medida que irá reduzir a progressão das DR e melhorar sua qualidade de vida, independentemente do tempo e da gravidade da doença. Os médicos devem sempre oferecer o tratamento de cessação tabágica. O tratamento ambulatorial ou hospitalar deve ser multidisciplinar, baseado em intervenções comportamentais e farmacoterapia, sendo eficaz e custo-efetivo, dobrando as chances de sucesso.

Uma proposta de criação de um sistema para monitoramento dos casos de mesotelioma maligno em Curitiba, Paraná, Brasil / A proposal for the creation of a system to monitor cases of malignant mesothelioma in Curitiba, Paraná, Brazil / Una propuesta de creación de un sistema para la supervisión de los casos de mesotelioma maligno en Curitiba, Paraná, Brasil

Este estudo objetivou propor a criação de um sistema de monitoramento dos casos de mesotelioma maligno no Município de Curitiba, Paraná, Brasil, desenvolvido com base no modelo italiano. Trata-se de uma pesquisa-ação tipo diagnóstica, que utiliza as fases exploratória e de planejamento, desenvolvida no período de julho de 2015 a maio de 2017. Utilizaram-se como ferramentas de busca os seguintes instrumentos: Integrador de Registro Hospitalar de Câncer, com as morfologias específicas para mesotelioma; Registro Hospitalar de Câncer, com os códigos C38.4 e C45, da Classificação Internacional de Doenças, 10ª revisão, e/ou registros codificados pelo CID-O, com as topografias C38 e C48; Registro de Câncer de base populacional da Secretaria Municipal de Saúde de Curitiba, com os mesmos códigos. Também foram conhecidos, analisados e adaptados para a realidade brasileira o modelo, os questionários e o software de registro de mesotelioma da Lombardia, na Itália. Observou-se que, no Integrador de Registro Hospitalar de Câncer, foram registrados 15 casos de mesotelioma. No Registro Hospitalar de Câncer do hospital universitário, foram dois. No hospital oncológico, 16. Os dados do Registro de Câncer de Base Populacional, por sua vez, indicaram 317 registros relativos ao período. Apesar de algumas informações estarem mais completas, existe a falta de dados relacionados à história laboral, impossibilitando estabelecer o nexo causal. Com o aumento do número de casos de mesotelioma previstos para as próximas décadas e o atendimento às demandas legais, a implantação de registros torna-se essencial para auxiliar no conhecimento, no acompanhamento, na determinação de nexo causal e nas fontes de contaminação específicas no país.

The study proposes the creation of a system to monitor cases of malignant mesothelioma in the municipality of Curitiba, Paraná State, Brazil, based on the Italian model. This diagnosis-type action-research project featured exploratory and planning phases conducted from July 2015 to May 2017. The following search tools were used: Hospital-Based Cancer Registries Integrator with specific morphologies for mesothelioma; Hospital-Based Cancer Registry with codes C38.4 and C45 of the International Classification of Diseases, 10th revision, and/or records coded by the ICD-O with topographies C38 and C48; Population-Based Cancer Registry of the Curitiba Municipal Health Department, with the same codes. The study also identified, analyzed, and adapted to the Brazilian reality the model, questionnaires, and registry software for mesothelioma from Lombardy, Italy. Fifteen cases of mesothelioma were recorded in the Hospital-Based Cancer Registries Integrator. Two cases were recorded in the University Hospital-Based Cancer Registry and 16 in the Cancer Hospital. There were 317 cases recorded in the Population-Based Cancer Registry during the same period. Although some information was complete, data were lacking on patients' occupational history, thereby preventing the determination of a causal nexus. Given a predicted increase in cases of mesothelioma in the coming decades and the response to court cases, the implementation of registries has become essential to facilitate knowledge and follow-up on the determination of the causal link and specific sources of asbestos exposure in the country.

El objetivo de este estudio fue proponer la creación de un sistema de monitoreo de casos de mesotelioma maligno en el municipio de Curitiba, Paraná, Brasil, desarrollado en base al modelo italiano. Se trata de una investigación-acción de tipo diagnóstica, que usa fases de carácter exploratorio y de planificación, desarrolladas durante el período de julio de 2015 a mayo de 2017. Se utilizaron como herramientas de búsqueda los siguientes instrumentos: Integrador del Registro Hospitalario de Cáncer con morfologías específicas para mesotelioma; Registro Hospitalario de Cáncer con los códigos C38.4 y C45, procedentes de la Clasificación Internacional de Enfermedades décima revisión, y/o registros codificados por el CID-O con topografías C38 y C48; Registro de Cáncer de base poblacional de la Secretaría Municipal de Salud de Curitiba con los mismos códigos. También se presentaron, analizaron y adaptaron a la realidad brasileña el modelo, los cuestionarios y el software de registro de mesotelioma de Lombardía, en Italia. Se observó que, en el Integrador de Registro Hospitalario de Cáncer, se registraron 15 casos de mesotelioma. En el Registro Hospitalario de Cáncer del hospital universitario, fueron dos. En el hospital oncológico, 16. Los datos del Registro de Cáncer de Base Poblacional, a su vez, indicaron 317 registros relacionados con este período. A pesar de que algunos datos estaban más completos, existe una falta de datos relacionados con la historia laboral, imposibilitando establecer el nexo causal. Con el aumento del número de casos de mesotelioma previstos para las próximas décadas, y la atención a las demandas legales, la implantación de los registros se convierte en esencial para apoyar el conocimiento, el seguimiento, así como la determinación del nexo causal y las fuentes de contaminación específicas en el país.

Cáncer pulmonar el peor efecto del tabaquismo / Lung cancer the worst effect of smoking

Resumen El cáncer de pulmón constituye la primera causa de muerte por cáncer en Chile. A nivel mundial da cuenta de más de 8 millones de fallecimientos anuales, de los nuevos casos de cáncer, más de 6 millones están relacionados con tabaco, constituyendo a el tabaquismo un importante factor de riesgo y causa directa de cerca del 20% de la mortalidad global asociada a cáncer. La incidencia de cáncer de pulmón está directamente relacionada el nivel de exposición a tabaquismo durante la vida, la exposición puede aumentar el riesgo de esta enfermedad hasta 30 veces. El riesgo disminuye exponen-cialmente con la cesación de esta adicción, especialmente si ocurre en etapas tempranas de la vida. En Chile el 85% de los cánceres de pulmón en hombres y el 40% en mujeres estarían explicados por tabaquismo, equivalentes a 1926 anuales, siendo la recomendación realizar consejería breve según las Guías Clínicas de Tratamiento del Tabaquismo Chile 2017 y si no es posible derivar a todos los fumadores con cáncer a terapia de cesación del tabaquismo que puede ser telefónica Salud Responde MINSAL 6003607777, el número está en los envases de cigarrillos.

Lung cancer is the first cancer death in Chile. Globally accounts for more than 8 million annual deaths, of the new cases of cancer, more than 6 million are smoking related, making smoking the most important cancer risk factor and cause of about 20% of the global cancer-related mortality. The incidence of lung cancer is directly related to smoking exposure level during life, exposure that increases the risk of this disease up to 30 times. This risk decreases exponentially with smoking cessation, especially if it occurs in early life stages. In Chile, 85% of lung cancers in men and 40% in women would be explained by smoking, equivalent to 1926 per year, being recommended to conduct brief counseling according to the Clinical Guidelines for the Treatment of Smoking in Chile 2017, and if it is not possible to refer all smokers with cancer to smoking cessation therapy that may be by telephone Salud Responde, MINSAL 6003607777, the number is in the cigarette packets.

Malformación adenomatoidea quística y riesgo de tumores malignos pulmonares / Adenomatoid lung malformation and malignant tumors

Cystic adenomatoid malformation is the most frequent congenital pulmonary malformation. The usual treatment is surgical resection. However there is controversy over management in asymptomatic patients. The possible malignization would justify surgery of cystic lesions. Relation with pleuropulmonary blastoma has been described, however it is not clear whether this is a primary tumor or cyst malignization. Cystic adenomatoid malformation also has association with adenocarcinoma and rhabdomyosarcoma. Currently available evidence suggests surgical resection, despite the natural course of congenital lung cystic lesions is uncertain

La malformación adenomatoidea quística (MAQ) es la anomalía del desarrollo pulmonar más frecuente. El tratamiento habitual es la resección quirúrgica, no obstante existe controversia sobre el manejo en pacientes asintomáticos. La posible malignización de las lesiones quísticas es uno de los argumentos que justifican la cirugía en estos pacientes. Se ha descrito relación con blastoma pleuropulmonar, sin embargo no está claro si se trataría de una lesión quística que se maligniza o es una entidad diferente. También hay asociación con adenocarcinoma y rabdomiosarcoma . Actualmente se sugiere la resección quirúrgica como el tratamiento más adecuado, sin embargo la evolución natural de las lesiones quísticas pulmonares congénitas es incierta

Small cell lung cancer associated with multiple paraneoplastic syndromes / Cáncer de pulmón de células pequeñas asociado a múltiples síndromes paraneoplásicos

Abstracts We report the case of a patient presenting with multiple severe electrolyte disturbances who was subsequently found to have small cell lung cancer. Upon further evaluation, she demonstrated three distinct paraneoplastic processes, including the syndrome of inappropriate antidiuretic hormone, Fanconi syndrome, and an inappropriate elevation in fibroblast growth factor-23 (FGF23). The patient underwent one round of chemotherapy, but she was found to have progressive disease. After 36 days of hospitalization, the patient made the decision to enter hospice care and later she expired.

Resumen Se reporta el caso de una paciente que ingresó al hospital para evaluación de múltiples trastornos electrolíticos y, posteriormente, se le hizo el diagnóstico de cáncer de pulmón de células pequeñas. Tras la evaluación médica, se detectaron tres síndromes paraneoplásicos: síndrome de secreción inadecuada de hormona antidiurética, síndrome de Fanconi y elevación inapropiada del factor 23 de crecimiento de fibroblastos. Se le administró quimioterapia sin éxito, por lo cual se decidió darle tratamiento paliativo y, un tiempo después, falleció.

Residential radon and lung cancer: a cohort study in Galicia, Spain / Radón residencial y cáncer de pulmón: un estudio de cohorte en Galicia, España / Radônio residencial e câncer de pulmão: um estudo de coorte na Galícia, Espanha

Case-control studies show an association between residential radon and lung cancer. The aim of this paper is to investigate this association through a cohort study. We designed an ambispective cohort study using the Galician radon map, Spain, with controls drawn from a previous case-control study. Subjects were recruited between 2002 and 2009. The data were cross-checked to ascertain lung cancer incidence and then analysed using a Cox regression model. A total of 2,127 subjects participated; 24 lung cancer cases were identified; 76.6% of subjects were drawn from the radon map. The adjusted hazard ratio was 1.2 (95%CI: 0.5-2.8) for the category of subjects exposed to 50Bq/m3 or more. This risk rose when subjects from the case-control study were analyzed separately. In conclusion, we did not observe any statistically significant association between residential radon exposure and lung cancer; however, it appears that with a sample of greater median age (such as participants from the case-control study), the risk of lung cancer would have been higher.

Los estudios de casos y controles muestran una asociación entre el radón residencial y el cáncer de pulmón. El objetivo del artículo fue investigar esa asociación a través de un estudio de cohorte. Proyectamos un estudio de cohorte ambispectivo, utilizando el mapa de radón de Galicia, España, con los controles obtenidos de un estudio anterior de casos y controles. Los individuos fueron reclutados entre 2002 y 2009. Los datos fueron verificados para confirmar la incidencia de cáncer de pulmón y después analizados con un modelo de regresión de Cox. Participaron un total de 2.127 individuos; se identificaron 24 casos de cáncer de pulmón; un 76,6% de los individuos fueron obtenidos a través del mapa de radón. El hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para la categoría de individuos expuestos a 50Bq/m3 o más. El riesgo aumentó cuando los individuos del estudio de casos y controles fueron analizados separadamente. En conclusión, no se observó una asociación estadísticamente significativa entre exposición al radón residencial y cáncer de pulmón; sin embargo, parece que con una muestra con una media de edad más elevada (tales como los participantes del estudio de casos y controles), el riesgo de cáncer de pulmón habría sido más alto.

Estudos de casos e controles mostram uma associação entre radônio residencial e câncer de pulmão. O artigo teve como objetivo investigar essa associação através de um estudo de coorte. Projetamos um estudo ambispectivo coorte, utilizando o mapa de radônio da Galícia, Espanha, com os controles obtidos de um estudo anterior de casos e controles. Os indivíduos foram recrutados entre 2002 e 2009. Os dados foram verificados para confirmar a incidência de câncer de pulmão e depois analisados com um modelo de regressão de Cox. Participaram um total de 2.127 indivíduos; foram identificados 24 casos de câncer de pulmão; 76,6% dos indivíduos foram obtidos através do mapa de radônio. O hazard ratio ajustado era 1,2 (IC95%: 0,5-2,8) para a categoria de indivíduos expostos a 50Bq/m3 ou mais. O risco aumentou quando os indivíduos do estudo de casos e controles foram analisados separadamente. Em conclusão, não foi observada associação estatisticamente significativa entre exposição ao radônio residencial e câncer de pulmão; entretanto, parece que com uma amostra com mediana de idade mais elevada (tais como os participantes do estudo de casos e controles), o risco de câncer de pulmão teria sido mais alto.

Predictores clínicos y funcionales del riesgo de cáncer pulmonar en el seguimiento de una cohorte de adultos fumadores / Risk factors for the development of lung cancer in a cohort of adult smokers

Background: Identifying risk factors for lung cancer in the population could improve the cost-effectiveness of early detection programs using thoracic computed tomography (CT). Aim: To examine the risk factors of lung cancer in a cohort of adult smokers. Patients and Methods: An annual clinical and respiratory functional assessment, chest computed tomography for three years and clinical follow up for five years was carried out in 270 patients aged 65 ± 9 years, 55% males, active or former smokers of 10 or more pack-years. Results: Thirty seven percent of patients were active smokers, consuming 37 ± 26 packs/year, 85% had comorbidities, especially chronic obstructive pulmonary disease (COPD) (66%), hypertension (48%), diabetes (22%) and dyslipidemia (42%). Thirteen percent of patients had family history of lung cancer. Twenty-one cases of lung cancer were detected in the five years follow up, especially squamous cell carcinoma and adenocarcinoma. In the univariate analysis, the main risk factors for lung cancer identified were an age older than 60 years, history of COPD, family history of lung cancer, active smoking, tobacco consumption more than 30 pack/year and lung hyperinflation. In multivariate analysis, the three independent risk factors for lung cancer were a family history of lung cancer, active smoking and the number of packs per year of tobacco consumption. Conclusions: The identification of risk groups probably will improve the performance of programs for early detection of lung cancer.

Les cancers broncho-pulmonaires primitifs à Ouagadougou

Le cancer bronchique primitif est la deuxieme cause de mortalite dans le monde apres les pathologies cardiovasculaires. En Afrique; l'introduction de l'endoscopie a entraine l'augmentation de son 'incidence. Pour avoir une recente idee sur cette affection; nous avons decide de mener une etude retrospective et descriptive a Ouagadougou du 1er janvier 2002 au 31 decembre 2011. Ainsi avons-nous observe une preponderance masculine et un age moyen de 58 ans. La consommation moyenne de tabac a ete evaluee a 15 paquets-annee. Il y avait une predominance de l'atteinte de l'arbre bronchique droit et du carcinome epidermoide. La place du tabagisme a encore ete confirmee comme facteur etiologique

Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies / 예방의학회지

OBJECTIVES: Approximately 10% to 15% of lung cancer cases occur in never-smokers. Hormonal factors have been suggested to lead to an elevated risk of lung cancer in women. This systematic review (SR) aimed to investigate the association between hormonal replacement therapy (HRT) and the risk of lung cancer in women using cohort studies. METHODS: We first obtained previous SR articles on this topic. Based on these studies we made a list of refereed, cited, and related articles using the PubMed and Scopus databases. All cohort studies that evaluated the relative risk of HRT exposure on lung cancer occurrence in women were selected. Estimate of summary effect size (sES) with 95% confidence intervals (CIs) were calculated. RESULTS: A total of 14 cohort studies were finally selected. A random effect model was applied due to heterogeneity (I-squared, 64.3%). The sES of the 14 articles evaluating the impact of HRT exposure on lung cancer occurrence in women indicated no statistically significant increase in lung cancer risk (sES, 0.99; 95% CI, 0.90 to 1.09). CONCLUSIONS: These results showed that HRT history had no effect on the risk of lung cancer in women, even though the sES of case-control studies described in previous SR articles indicated that HRT had a protective effect against lung cancer. It is necessary to conduct a pooled analysis of cohort studies.

Concurrent Gastric and Pulmonary Mucosa-Associated Lymphoid Tissue Lymphomas with Pre-Existing Intrinsic Chronic Inflammation: A Case Report and a Review of the Literature

Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.

Concurrent Gastric and Pulmonary Mucosa-Associated Lymphoid Tissue Lymphomas with Pre-Existing Intrinsic Chronic Inflammation: A Case Report and a Review of the Literature

Herein, we report a rare case of concurrent gastric and pulmonary mucosa-associated lymphoid tissue (MALT) lymphomas. A 65-year-old man who had been diagnosed with Helicobacter pylori-positive gastric MALT lymphoma received eradication therapy and achieved complete remission. During follow-up, he developed de novo pulmonary MALT lymphoma as a sequela of pulmonary tuberculosis, accompanied by recurrent gastric MALT lymphoma. Polymerase chain reaction (PCR) products of the CDR3 region of the immunoglobulin heavy chain gene showed an overall polyclonal pattern with bands at 400 base pairs (bp) and 200 bp predominant in the pulmonary tissue, as well as two distinctive bands in the gastric tissue at 400 bp and 200 bp. This case suggests that multiorgan lymphomas are more likely to be independent from each other when they are far apart, involve different organ systems, and have independent precipitating factors.