Contribución del panel de miositis en el estudio de pacientes con enfermedades pulmonares intersticiales y sospecha de enfermedad del tejido conectivo / Contribution of myositis panel in the study of patients with interstitial lung disease and suspicion of connective tissue disease

INTRODUCCIÓN: La manifestación extramuscular de las miopatías inflamatorias idiopáticas (MII) es la enfermedad pulmonar intersticial (EPI) y el diagnóstico se basa en autoanticuerpos séricos. Los nuevos anticuerpos específicos y asociados a MII han ayudado a identificar nuevas entidades clínicas en el espectro de MII. El objetivo de este estudio es evaluar la contribución diagnóstica de un panel de anticuerpos de miositis (PM) en una cohorte de pacientes chilenos con EPI sin una enfermedad del tejido conectivo (ETC) definitiva. MATERIALES Y MÉTODOS: A partir de enero de 2017 se realizó un panel de miositis a 111 pacientes consecutivos con EPI y sospecha de ETC, pero sin un diagnóstico definitivo a través de otra herramienta diagnóstica, en el programa de Pulmón-Reumatológico del Instituto Nacional del Tórax, Santiago, Chile. Se compararon las características basales clínicas y serológicas de los pacientes que se asociaban más frecuentemente a la probabilidad de tener un panel positivo. RESULTADOS: El PM fue positivo en 56 de 111 pacientes. El síndrome antisintetasa (SAS) fue el diagnóstico más frecuente. Los anticuerpos más frecuentes fueron Ro-52, PM / Scl-75 y Ku. Las variables más frecuentes en el grupo PM(+) fueron la presencia del Raynaud, miositis, manos de mecánico, los anticuerpos Ro y La positivos, la presencia de un patrón combinado de neumonía intersticial inespecífica y neumonía organizada en la tomografía computarizada de tórax. CONCLUSIONES: la incorporación del PM nos ha ayudado a mejorar nuestra precisión diagnóstica en pacientes con EPI / ETC. Presentamos elementos clínicos y serológicos que perfeccionan el rendimiento de la prueba.

INTRODUCTION: The most common extramuscular manifestation of the idiopathic inflammatory myopathies (IIM) is interstitial lung disease (ILD) and the diagnosis is based on serum autoantibodies. The new specific and associated antibodies to IIM have helped to identify new clinical entities in the spectrum of IIM. The objective of this study is to evaluate the diagnostic contribution of a myositis antibodies panel (MP) in a cohort of Chilean patients with ILD without a definitive connective tissue disease (CTD). MATERIALS AND METHODS: Starting on January 2017 we performed a MP to 111 consecutive patients with ILD and suspected CTD but without a definitive diagnosis through another diagnostic tools in the Lung-Rheumatological Program at the "Instituto Nacional del Tórax", Santiago, Chile. The clinical and serological baseline characteristics of the patients that were most frequently associated with the probability of having a positive panel were compared. RESULTS: The MP was positive in 56 of 111 patients. Anti synthetase syndrome (ASS) was the most prevalent diagnosis. The most frequent antibodies were Ro-52, PM/Scl-75 and Ku. The most frequent variables in the positive MP group were the presence of Raynaud's phenomenon, myositis, mechanic's hands, positive Ro and La antibodies and the presence of combined pattern of nonspecific interstitial pneumonia and organizing pneumonia in chest computed tomography scan. CONCLUSIONS: The incorporation of the MP has helped us to improve our diagnostic precision of patients with CTD/ILD. We present clinical and serological elements that refine the performance of the test.

Arteritis de células gigantes: actualización y proposición de un algoritmo de estudio

Giant cell arteritis (GCA) is a primary granulomatous systemic vasculitis involving the aorta and its main branches that affects people aged over 50 years with a genetic predisposition. Its main phenotypes are cranial and extracranial involvement, with or without symptoms of polymyalgia rheumatica. These phenotypes can overlap. The extracranial form can be oligosymptomatic and must be sought directly. The main complications of the disease are ischemia of essential territories such as the optic nerve or cerebral circulation, and aneurysmal dilations of the aorta and its large branches. Clinicians must be aware of all the presentation forms of the disease, to start a timely treatment and avoid potentially serious or fatal consequences. To date, the diagnosis of GCA is based on clinical and pathological criteria, with the temporal artery biopsy as the "gold standard" for diagnosis, although its sensitivity is variable. This can lead to an underdiagnosis in patients with negative biopsies or predominant extra-cranial symptoms. The emergence of new and valuable imaging tools substantially improved the timely diagnosis, mainly in subclinical and oligosymptomatic forms. Among them we highlight ultrasonography of the temporal and axillary arteries, Computed Tomography Angiography, Magnetic Resonance Angiography, and PET-CT. These imaging techniques are complementary, and their use is highly recommended. GCA treatment is based on steroidal therapy, often associated with a corticosteroid-sparing immunosuppressive agent. The follow-up is eminently clinical.

Evaluación reumatológica del paciente con enfermedad pulmonar intersticial / Rheumatological evaluation of the patient with interstitial lung disease

Las Enfermedades del Tejido Conectivo (ETC) comprenden un grupo heterogéneo de patologías multisistémicas de origen autoinmune. La Enfermedad pulmonar intersticial (EPI) asociada a ETC (EPI-ETC) es frecuente y empeora el pronóstico de la ETC. Las EPI-ETC representan aproximadamente 15-30% del total las EPI y se presentan con las mismas formas histopatológicas y radiológicas descritas para las EPI idiopáticas. Esto pone en evidencia la importancia de incorporar en forma rutinaria a reumatología en el comité multidisciplinario para el diagnóstico y manejo de las EPI.

Connective Tissue Diseases (CTD) comprise a heterogeneous group of multisystemic pathologies of autoimmune origin. Interstitial lung disease (ILD) associated with CTD (CTD-ILD) is common and and it worsens the prognosis of CTD. CTD-ILD represent approximately 15-30% of the universe of ILD and have the same histopathological and radiological forms described for idiopathic ILD. This highlights the importance of routinely incorporate a rheumatologist into the multidisciplinary committee for the diagnosis and management of ILD.

Enfermedad pulmonar difusa en esclerodermia: diagnóstico y tratamiento / Intetstitial lung disease in scleroderma: diagnosis and treatment

Scleroderma is among the connective tissue diseases (CTD) with more pulmonary involvement. More than half of scleroderma patients have some kind of interstitial lung disease (ILD), and this is currently the leading cause of death due to the disease itself. The main risk factor for ILD is the autoantibodie profile, and the period of greatest risk of developing ILD is among the first 3-5 years of disease. The most common histopathological form is NSIP, but the histopathological subtype has no influence on prognosis or response to treatment. Given the fact that some ILD patients will remain stable and because of the lack of a really effective and risk free treatment, immunosuppressive therapy is generally reserved for patients with extensive and / or progressive disease. The main risk factors for progressive disease are pulmonary extent and functional impairment. With currently available therapies the more realistic goal is stabilization of lung disease. The most widely used immunosuppressive induction therapy is Cyclophosphamide (CYC), but there is enough evidence to support the use of Mycophenolate Mofetil (MMF). As maintenance therapy, options are MMF and Azathioprine. Periodic clinical and functional reassessment is of vital importance, to monitor functional progression and/or the response to immunosuppressive therapy...

La esclerodermia está entre las enfermedades del tejido conectivo (ETC) que con mayor frecuencia presentan enfermedad pulmonar difusa (EPD), y se encuentra en más de la mitad de los pacientes. Actualmente la EPD representa la principal causa de muerte atribuible a la propia enfermedad. El principal factor de riesgo es el perfil de autoanticuerpos, y el período de mayor riesgo de desarrollar EPD son los primeros tres a cinco años de enfermedad. La forma histopatológica más frecuente es neumonía intersticial no específica (NINE), pero el subtipo histopatológico no tiene mayor influencia en el pronóstico ni en la respuesta al tratamiento. Dada la existencia de pacientes con EPD intrínsecamente estable y a la ausencia de una terapia realmente efectiva y exenta de riesgos, la inmunosupresión se reserva en general para pacientes con enfermedad extensa y/o progresiva. Lo parámetros que mejor se han correlacionado con el riesgo de progresión son la extensión radiológica y el compromiso de la función pulmonar. Con las terapias actualmente disponibles, el objetivo más realista es la estabilización del compromiso pulmonar. El Inmunosupresor más utilizado para la terapia de inducción es ciclofosfamida (CYC), pero existe evidencia suficiente que avala el uso de micofenolato mofetil (MMF). Como terapia de mantención las principales opciones son azatioprina y MMF. La reevaluación clínica y funcional periódica es fundamental, para monitorizar la progresión y/o la respuesta al tratamiento inmunosupresor...

Perfil clínico radiológico de 18 pacientes con síndrome antisintetasas atendidos en Policlínico de Pulmón Reumatológico, Instituto Nacional del Tórax / Clinic and radiologic profile of 18 patients with antisynthetase syndrome, treated in a Rheumatologic Lung Disease Clinic, Instituto Nacional del Torax

Connective Tissue Diseases (CTD) can manifest as Interstitial lung disease (ILD). ILD is a common manifestation of Anti-synthetase syndrome (AS). The main pattern of ILD in AS is nonspecific interstitial pneumonia (NSIP) with or without elements of organizing pneumonia (OP). Other less common forms include usual interstitial pneumonia (UIP) and nonspecific forms. Objectives: Describe radiological and clinical profile of 18 patients with ILD due to AS, evaluated in Instituto Nacional del Torax (INT) between 2013 and 2015. Highlighting the importance of Myositis Panel in patients being evaluated for ILD. Methods: Review of clinical records and lung CT of 76 patients with ILD and suspected AS, seen at INT between august 2013 and July 2015. Results: The diagnosis of AS was made in 18 of 76 patients, with female predominance and mean age of 46.5 years . In most patients the diagnosis of AS and ILD was simultaneous. The most frequent AS antibody was Jo-1, followed by PL-12. Less than half had ANA (+). The predominant radiographic pattern was NSIP / OP. Half of the patients had myositis. Conclusions: AS should be suspected in patients under study for ILD, especially NSIP / OP, and may occur without myositis and with negative ANA. It is essential to have new immunological tests such as a Myositis Panel, which will allow us to diagnose AS with subtle clinical features and negative or inconclusive serology...

Las Enfermedades del tejido conectivo (ETC) se pueden manifestar como Enfermedad Pulmonar Difusa (EPD). El Síndrome Antisintetasas (SAS) con mucha frecuencia presenta EPD. La forma de expresión más frecuente en SAS es la neumonía intersticial no específica (NSIP) con o sin elementos de neumonía en organización (OP). Otras formas menos frecuentes son la neumonía intersticial usual (UIP) y formas inespecíficas. Objetivos: Describir el perfil clínico radiológico de 18 pacientes con EPD secundaria a SAS, atendidos en el Instituto Nacional del Tórax (INT) entre los años 2013 y 2015. Destacar la importancia del Panel de Miositis en pacientes con EPD en estudio. Métodos: Revisión de ficha clínica y TAC pulmonar de 76 pacientes con EPD y sospecha de SAS, atendidos en INT entre agosto 2013 y julio 2015. Resultados: En 18 de 76 pacientes se hizo el diagnóstico de SAS, predominio femenino, edad promedio 46,5 años. En la mayoría el diagnóstico reumatológico y pulmonar fue simultáneo, el anticuerpo antisintetasa más frecuente fue Jo-1, seguido de PL 12. Menos de la mitad tuvo ANA (+). El patrón radiológico predominante fue NSIP/OP. La mitad de los pacientes no presentaron miositis. Conclusiones: El SAS debe ser sospechado en el estudio de pacientes con EPD, especialmente NSIP/OP y se puede presentar sin miositis y ANA (-). Es indispensable contar con nuevos exámenes inmunológicos como el Panel de Miositis, que permite diagnosticar SAS con clínica sutil y serología habitual negativa o no concluyente...

Diagnóstico diferencial de nódulos pulmonares cavitados: a propósito de un caso clínico / Differential diagnosis of cavitary pulmonary nodules: a propos of a clinical case

El diagnóstico diferencial de nódulos pulmonares cavitados constituye un gran desafo en el cual, la clínica, la imagenología y los exámenes de laboratorio permiten una orientación etiológica en cutro grandes grupos: infecciosa, neoplásica, reumatológica y miscelánea. Presentamos el caso de una paciente gran fumadora y portadora de una diabetes mellitus descompensada, con nódulos pulmonares cavitados, en la cual el contexto clínico obligaba a plantear ciertas etiologías como las infecciosas y neoplásicas, pero cuya biopsia fue compatible con Granulomatosis con Poliangeítis (ex Granulomatosis de Wegener), sin una clínica ni exámenes de laboratorio concordantes con dicho hallazgo.

The differential diagnosis of cavitary pulmonary nodules is a great challenge, where the clinical context in addition to the image studies and laboratory tests are part of the key tools to guide the diagnostic process through 4 major etiological groups: infectious, neoplastic, rheumatologic and miscellaneous. We describe a case of a heavy smoker and complicated diabetic patient with cavitary pulmonary nodules, with a clinical context that induces certain etiologies such as infectious and neoplastic, but whose biopsy was compatible with Granulomatosis with polyangiitis (ex Wegener 's granulomatosis), without a clinical exam nor laboratory tests suggesting this finding.

Sindromes Dolorosos Regionales, Columna, Hombro y Rodilla / Regional pain syndromes, spine, shoulder and knee

Los Síndromes Dolorosos Regionales son muy frecuentes y de etiología múltiple. e debe distinguir si son de origen músculoesquelético o se trata de dolor referido a la zona dolorosa. Las pruebas de movilidad pasiva y activa permiten diferenciar el dolor articular del periarticular. Se debe descartar compromiso neurológico y la presencia de signos de enfermedad sistémica. En dolor de columna, es importante distinguir el origen mecánico del inflamatorio, cuyo enfrentamiento es muy diferente. El dolor mecánico es el más frecuente, generalmente autolimitado y no requiere estudios complementarios. En el hombro, lo más frecuente es la patología del manguito rotador, especialmente en mayores de 40 años, y el tratamiento principal incluye analgesia y fisioterapia precoz. En la rodilla, los trastornos periarticulares incluyen bursitis y tendinitis de distintas estructuras, y hay que considerar la osteonecrosis dentro del diagnóstico diferencial del dolor de rodilla del adulto mayor.

Regional pain syndromes are common and caused by multiple etiologies. We have to distinguish whether their origin is musculoskeletal or the pain is referred to the painful area. Passive and active mobility allows differentiate extra-articular joint pain from joint pain. It should be ruled out neurological involvement and signs of systemic disease. In back pain, it is important to distinguish mechanical pain from inflammatory pain, because the causes and approach are very different. Mechanical pain is the most common, usually self-limitted and requires no additional studies. Rotator cuff tendinitis is the most common cause of shoulder pain, especially in patients over 40 years old. Treatment includes analgesia and early physiotherapy. In the knee, extra-articular disorders include bursitis and tendinitis of different structures, and osteonecrosis must be considered in the differential diagnosis of knee pain in the elderly.

Hombre joven con déficit motor y lesiones inflamatorias intracerebrales: reporte de un caso clínico de Neuro-Behcet / Young man with motor deficit and intracerebral inflammatory lesions: a Neuro-Behcet case report

La enfermedad de Behçet (EB) es una patología inflamatoria vascular, multisistémica y recurrente. El fenómeno subyacente es una perivasculitis que afecta el territorio arterial y venoso. La mayor prevalencia de la enfermedad se encuentra en el Oriente y cuenca del Mediterráneo, en la llamada “Ruta de la Seda”. La prevalencia en Chile es desconocida. Las manifestaciones clínicas más frecuentes son úlceras orales y genitales recurrentes, uveítis, artritis, compromiso de sistema nervioso y vascular. El compromiso de SNC (Neuro-Behçet) varía entre 5 por ciento y 13 por ciento, y se divide en dos tipos: Intra-axial o parenquimatoso, más frecuente, más grave, con lesiones inflamatorias en tronco del encéfalo, en unión meso-diencefálica y región pontobulbar. Puede extenderse hacia diencéfalo, bulbo y médula espinal. El compromiso hemisférico es menos frecuente. Extra-axial, que se presenta como trombosis de senos venosos, y aneurismas, estenosis y disección arterial. El tratamiento del Neuro-Behçet intra-axial se basa en esteroides en dosis altas asociados a inmunosupresores, entre ellos, y dependiendo de la severidad, Metotrexato, Azatioprina, Ciclofosfamida, Micofenolato, y Anti-TNFα en casos refractarios o severos.

The highest prevalence of the disease is found in the East and the Mediterranean basin, in the so called “Silk Road”. The prevalence in Chile is unknown. The most frequent clinical manifestations are recurrent oral and genital ulcers, uveitis, arthritis, and CNS involvement (Neuro-Behçet). Neurological disease varies between 5 percent and 13 percent, and it can be divided into two types: Intra-axial or parenchymatous: more frequent, more severe, with inflammatory lesions involving the brainstem, midbrain, diencephalon and pontobulbar regions. It may extend into the spinal cord. Involvement of the brain hemispheres is less common. Extra-axial: also called “Neurovasculo Behçet”, less common and with better prognosis. It can manifests as venous sinus thrombosis, and aneurysm, stenosis, or arterial dissection of intracerebral or extracranial arteries. Treatment of Intra-axial Neuro-Behçet is based on high-dose steroids associated with immunosuppressive agents like: Methotrexate, Azathioprine, Cyclophosphamide, Mycophenolate, and anti α-TNF in refractory or severe disease.

Concomitancia de anticuerpos antimembrana basal y ANCA en el síndrome riñón-pulmón / Concomitance of glomerular basement membrane antibodies and ANCA in pulmonary - renal syndrome

La enfermedad antimembrana basal glomerular (anti-MBG) es una condición que se manifiesta clínicamente como glomerulonefritis rápidamente progresiva y hemorragia alveolar, también llamada Síndrome Riñón- Pulmón. Se asocia a la presencia de autoanticuerpos dirigidos contra el colágeno tipo IV de la membrana basal glomerular. Las vasculitis sistémicas asociadas a ANCA también pueden manifestarse como Síndrome Riñón-Pulmón, cuadro clínico a veces indistinguible de la enfermedad anti-MBG. La concomitancia de ANCA y anticuerpos anti-MBG en el Síndrome Riñón-Pulmón es del orden de un 30 por ciento, según distintos reportes de la literatura. El perfil clínico, el pronóstico y el rol fisiopatológico de cada anticuerpo en este grupo de pacientes todavía son materia de investigación. El mecanismo patogénico inicial parece ser el daño mediado por ANCA, que puede inducir la aparición de anticuerpos anti-MBG, los que perpetúan el daño en el glomérulo.

Anti-glomerular basement membrane (anti-MBG) disease is a condition that is manifested clinically as rapidly progressive glomerulonephritis and alveolar hemorrhage, also known as Pulmonary-Renal Syndrome. It is associated with the presence of autoantibodies directed against type IV collagen of the glomerular basement membrane. Systemic vasculitis associated with ANCA may also manifest as Pulmonary-Renal Syndrome, sometimes clinically indistinguishable from the anti-MBG disease.The concomitance of ANCA and anti-MBG antibodies in the Pulmonary-Renal Syndrome is about 30 percent, according to various reports in literature. The clinical profile, prognosis and physiopathologic roles of each antibody in this group of patients is still under investigation. The pathogenic mechanism appears to be the initial damage mediated by ANCA, which may induce the appearance of anti-MBG, those who perpetuate the glomerulus damage.

Clinicopathologic features of breast disease in Jamaica: findings of the Jamaican Breast Disease Study, 2000-2002 / Características clínico-patológicas de la enfermedad de mamas en Jamaica: hallazgos del estudio jamaicano de la enfermedad de mamas, 2000-2002

OBJECTIVE: To describe the clinicopathologic profile of breast disease in Jamaica. METHODS: The Jamaican Breast Disease Study is an ongoing prospective, multidisciplinary investigation of breast disease at the University Hospital of the West Indies (UHWI). The initial phase was a prevalence survey comprising all consenting patients referred to the Surgical Outpatient Department (SOPD) UHWI, for breast disease. Demographic, clinical, radiologic and pathologic information were recorded for each patient and the data for the first three years (2000-2002) were analyzed. RESULTS: A total of 1189 patients was enrolled for the study period (28.8% of all new SOPD patients). The age range was10 to 93 years (mean/SD = 36.5 +/- 16.4 years) with a female : male ratio of 14:1. Most patients (67.8%) presented with a palpable lump and the clinical diagnosis was benign in the majority (70.4%) of patients. Fibroadenoma was the most common benign histologic result (39.4% of all biopsies) followed by non-proliferative (fibrocystic) disease (19.3% of all biopsies). Proliferative disease without atypia, complex fibroadenoma and atypical ductal hyperplasia accounted for 6.9%, 2.6% and 0.4% of biopsies respectively. Overall, 23.4% of biopsies showed malignant histology (10.8% patients); invasive ductal carcinoma accounted for the majority of these cases (69.5%). CONCLUSIONS: The majority of patients with breast disease in Jamaica are young women with clinically benign disease. There was a low prevalence of clinically significant premalignant disease. This is the first study to prospectively describe the clinicopathologic features of breast disease in Jamaica and supports the need for advocating breast cancer screening to facilitate detection of significant premalignant disease and early stages of breast cancer.

OBJETIVO: Describir el perfil clínico-patológico de la enfermedad de mamas en Jamaica. MÉTODOS: El "Estudio jamaicano de la enfermedad de mamas" - que continua realizándose en la actualidad en el Hospital Universitario de West Indies (HUWI) - consiste en una investigación prospectiva y multidisciplinaria de la enfermedad de mamas. La fase inicial fue un estudio de prevalencia que abarcó a todos los pacientes que dieron su consentimiento, y que fueron remitidos al Departamento de Cirugía Ambulatoria (DCA) de HUWI a causa de la enfermedad de mamas. Se registró información demográfica, clínica, radiológica y patológica de cada paciente, así como los datos referidos a los primeros tres años (2000-2002). RESULTADOS: Un total de 1189 pacientes fueron captados para el periodo de estudio (28.8% de todos los pacientes nuevos del DCA). El rango de edad fue de 10 a 93 años (media/SD = 36.5 + / - 16.4 años) con una proporción hembra:varón de 14:1. La mayoría de los pacientes (67.8%) presentó un nódulo palpable y el diagnóstico clínico fue benigno en la mayoría (70.4%) de los pacientes. El fibroadenoma fue el resultado histológico benigno más común (39.4% de todas las biopsias) seguido por la enfermedad (fibrocística) no proliferativa (19.3% de todas las biopsias). La enfermedad proliferativa sin atipia, el fibroadenoma complejo y la hiperplasia ductal atípica representaron el 6.9%, 2.6% y 0.4% de las biopsias respectivamente. En general, el 23.4% de las biopsias mostraron histología maligna (10.8% de los pacientes); el carcinoma ductal invasivo representó la mayoría de estos casos (69.5%). CONCLUSIONES: La mayor parte de los pacientes con la enfermedad de mamas en Jamaica son mujeres jóvenes con enfermedades clínicamente benignas. Hubo una baja prevalencia de enfermedades premalignas clínicamente significativas. Este es el primer estudio dirigido a describir prospectivamente las características clínico-patológicas de la enfermedad de mamas en Jamaica, y respalda la necesidad de abogar por el pesquisaje del cáncer de mamas, a fin de facilitar la detección de enfermedades premalignas significativas y las fases tempranas del cáncer de mamas.

Compromiso cardiovascular en el lupuseritematoso sistémico / Cardiovascular involvement in patient with systemic lupus erythematosus

Lupus erythematosus is a multisystemic disease that compromises principally women in fertile age. The principal affected organs are kidney, SNC, bone marrow and serous membranes. Cardiovascular affection includes pericardium, conduction system, myocardium, valves and coronary arteries. The most frequent valve disease is Libman-Sacks endocarditis, although valvulitis or valve dysfunction can exist as well. The mitral valve is the most affected, followed by the aortic valve. The most frequent valve abnormality is slight to moderate aortic insufficiency, while serious insufficiency or valve disruption is very rare. A physical examination has limited efficacy in the diagnosis of valve disease. A high degree of suspicion associated with echocardiography helps to establish the diagnosis. If surgery is not needed, antiplatelet therapy is recommended for asymptomatic patients, and oral anticoagulation treatment is advised for those with valve disease and evidence of thromboembolic phenomena. Recurrence of the disease has been observed in biological grafts, which makes the use of mechanical prostheses advisable when valve replacement indication exists. The following case shows the clinical evolution of a female patient with a rare but very serious lupus erythematosus complication.

Trends in incidence and histological subtypes of lung cancer, Kingston and St Andrew, Jamaica, 1968-1997 / Tendencias en la incidencia y subtipos histológicos de cáncer pulmonar en Kingston y St Andrew, Jamaica, 1968­1997

Several scientific publications have reported a progressive shift in the distribution of the histologic subtypes of lung carcinoma in the latter decades of the 20th century, with adenocarcinoma now surpassing squamous cell carcinoma as the most commonly diagnosed morphologic pattern. A 30-year review (1968-1997) of lung cancer cases registered in the Jamaica cancer registry shows a similar trend among males in Kingston and St Andrew with a progressive increase in the documented cases of adenocarcinoma relative to squamous cell carcinoma. Similar changes were not observed in females.

Varias publicaciones científicas han reportado un desplazamiento progresivo en la distribución de los subtipos histológicos del carcinoma pulmonar en las últimas décadas del siglo 20. En las mismas se evidencia que, en el presente, el adenocarcinoma supera al carcinoma celular escamoso como patrón morfológico más comúnmente diagnosticado. Una revisión de 30 años (1968–1997) de casos de cáncer pulmonar registrados en el registro de cáncer de Jamaica, muestra una tendencia similar entre los hombres en Kingston y Saint Andrew, con un aumento progresivo en los casos documentados de adenocarcinoma en relación con el carcinoma celular escamoso. No se observaron cambios similares en las mujeres.

Gynaecologic cancer incidence, Kingston and St Andrew, Jamaica, 1973-1997, and gynaecologic cancer mortality, Jamaica, 1999

The incidence of gynaecologic cancers in women from Kingston and St Andrew for the period 1973-1997 were reviewed by analyzing data previously published by the Jamaica Cancer Registry. Gynaecologic cancer-related mortality statistics for the entire island for 1999 were compiled from data obtained from the Registrar General's Department (RGD) and the Statistical Institute of Jamaica (STATIN). Data were compared to gynaecologic cancer statistics for women from the United States of America for 1973-1997. A total of 2862 gynaecologic cancers were registered for the years 1973-1997, which represents 26.8 of all female cancers from Kingston and St Andrew. Cervical cancer accounted for 62 of these gynaecologic cancers. The 268 cancer-related deaths (168 due to cervical cancer) registered in Jamaican women for 1999 represent approximately 15 of all female cancer-related deaths. The present incidence (27.9 per 100,000) and mortality rate (15.8 per 100,000) of cervical cancer are much higher than that documented for American women--both African Americans and Caucasians--and signify the limited success, to date, of efforts to decrease the incidence and mortality of cervical cancer by the implementation of cervical cancer screening programmes. For the time period reviewed, an increase was noted in the incidence of cancer of the corpus uteri while decreases were recorded for the incidence of choriocarcinoma, ovarian cancer and cancers arising from the vulva, vagina and fallopian tube

Jamaica cancer mortality statistics, 1999

A total of 2697 cancer-related deaths were documented among Jamaicans for the year 1999, accounting for 17.7 of all deaths. Males accounted for 1466 and females for 1231. The age-adjusted cancer mortality rate was 171.7 per 100,000 for males, 122.0 per 100,000 for females and 140.5 per 100,000 for the total population. Leading cancer mortality sites for males were prostate, lung and stomach and in females, breast, cervix uteri and large bowel. Most deaths were recorded in the 55-64 and 65-74 year-age groups. Despite well-established cervical cancer screening programmes, the calculated mortality rate for cancer of the cervix uteri in Jamaican females (15.8 per 100,000) is approximately two and a half times that seen in African-American females.

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1993-1997

A total of 4285 malignant neoplasms were recorded in Kingston and St. Andrew during the period 1993-1997, 2344 in females and 1941 in males. The crude incidence rate per 100,000 (CIR) for males was 121.6 and for females 129.2. Age standardized rates per 100,000 (ASR) were 156.7 and 176.7 for males and females respectively. In males, the leading sites for cancer were prostate (619 cases), bronchus (265 cases) and large bowel (144 cases) while in females the leading sites were breast (627 cases) cervix uteri (376 cases) and large bowel (204 cases). The crude and age standardized incidence rates have remained stable as compared to those for the previous five year period (1998-1992). The leading sites for both males and females have also been maintained in the same order but there was a marked increase in prostate cancer (ASR 56.4 versus 36). Invasive cervical cancer has shown no significant change in incidence (ASR 25.2 versus 26.3) but the rate for in-situ cancers has decreased (ASR 27.4 versus 43.8). The incidence of cancer of the female breast has remained relatively stable (ASR 43.2 versus 47.1). The trends exhibited by both prostate cancer and in-situ cervical cancer probably represent the influence of screening methods for prostate cancer and ablative management for low grade dysplastic lesions of the cervix uteri respectively.

Genotipo del virus C de la hepatitis en pacientes con porfiria cutanea tarda / Genotype of the hepatitis virus C in patients with porphyria cutanea tarda

En pacientes con porfiria cutánea tarda (PCT) se ha demostrado alta prevalencia del anticuerpo del virus C de la hepatitis (anti-VCH) y del propio virus. Previamente hemos informado una prevalencia de anti-VCH de 53 por ciento, y de 80 por ciento entre aquellos pacientes con PCT esporádica. La PCT se asocia frecuentemente a daño hepático crónico,desconociéndose su origen. Se ha postulado que el VCH, directa o imdirectamente, modificaría la actividad de la uroporfirinógeno decarboxilasa(URO-D) hepática, alteración carterística de la PCT, y por lo tanto la enfermedad sería adquirida y no genética. Podría esperarse que la frecuencia e intensidad de la hepatopatías en los pacientes con PCT fuera mayor en aquellos pacientes portadores del Anti-VCH

Age-specific incidence of cancer in Kingston and St Andrew, Jamaica, 1988-1992

During the period 1988 - 1992, a total of 4,030 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica. These comprised 1,829 males and 2,201 in females. Histological confirmation was obtained in 83.4 percent. The crude incidence rate for males was 128.5, and 136.2 for females. The age-standardized rates (ASR) were 179.9 for males and 166.1 for females. Age-specifics rates by site, sex and age are tabulated. Attention is drawn to increased incidence for cancers of prostate, larynx, bronchus and non-Hodgkin's lymphoma in males. There was also an increase in female breast cancer (crude rate 36.0; ASR 47.1). Invasive cervix cancer has shown no significant change in incidence. Neoplasms of the body of the uterus have increased (crude rate 7.6; ASR 9.5). The rise in cancer of breast and body of uterus suggests that the influence of exogenous oestrogens should be considered

Age-specific incidence of cancer in Kingston and St. Andrew, Jamaica. part 1: 1978-1982

A total of 3,396 malignant neoplasms were recorded in Kingston and St. Andrew, Jamaica during 1978 to 1982. There were 1,477 males and 1,919 females. Histological confirmation was achieved in 88.4%. The crude incidence rate for males for all age group was 107.8 per 100,000 per year, in females, the figure was 123.0. The age-standardized rates (world population) were 157.9 for females. Age-specific rates by site, sex, and age are tabulated.

Age-specific incidence of cancer in Kingston & St. Andrew, Jamaica

The Jamaican Cancer Registry recorded 3,652 cases of cancer in Kingston and St. Andrew during the period 1983-1987. Histological confirmation was maintained at a high level (86.3%). For males, the crude rate was 103.1 and for females, 126.5 (per 100,000 per annum). The age-standardized rates for all ages were 148.3 for males and 160.2 for females. The tables contain age-specific rates for each site by age.

30-year cancer trends in Jamaica: Kingston & St. Andrew (1958-1987)

A total of 19,225 malignant neoplasms were recorded in Kingston & St.Andrew, Jamaica over the 30-year period 1958-1987. The most prevalent cancers in males were those of prostate (12.2%), stomach (10.9%) and lung (10.7%). In females 24.1%of cancers occurred in breast and 20%were recorded for invasive carcinoma of the cervix. There is a steady improvement in the diagnosis of in situ cervical lesions, and a relative decline in the invasive lesions. Lung cancer in women remains at a low level. A significant decline in cancer of the oesophagus and stomach in both sexes was noted, while neoplasms of colon and rectum maintained a stable pattern. The 30-year trends of lymphomas and leukaemias have shown no increase, although there are changes in classification patterns.