Résumé
During thyroid tumor progression, cellular de-differentiation may occur and it is commonly accompanied by metastatic spread and loss of iodine uptake. Retinoic acid (RA) administration might increase iodine uptake in about 40 percent of patients, suggesting that RA could be a promising therapeutic option for radioiodine non-responsive thyroid carcinoma, although a prospective study with a long-term follow-up has not been reported. This was a clinical prospective study assessing the value of 13-cis-RA in patients with advanced thyroid carcinoma and its impact on major outcomes such as tumor regression and cancer-related death with a long-term follow-up of patients submitted to radioiodine (131I) therapy after RA administration. Sixteen patients with inoperable disease and no significant radioiodine uptake on post-therapy scan were selected. Patients were treated orally with 13-cis-RA at a dose of 1.0 to 1.5 mg·kg-1·day-1 for 5 weeks and then submitted to radioiodine therapy (150 mCi) after thyroxine withdrawal. A whole body scan was obtained 5 to 7 days after the radioactive iodine therapy. RECIST criteria were used to evaluate the response. An objective partial response rate was observed in 18.8 percent, a stable disease rate in 25 percent and a progression disease rate in 56.2 percent. Five patients died (62.5 percent) in the group classified as progression of disease. Progression-free survival rate (PFS) ranged from 72 to 12 months, with a median PFS of 26.5 months. RA may be an option for advanced de-differentiated thyroid cancer, due to the low rate of side effects.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Antinéoplasiques/usage thérapeutique , Radio-isotopes de l'iode/usage thérapeutique , Isotrétinoïne/usage thérapeutique , Tumeurs de la thyroïde/traitement médicamenteux , Tumeurs de la thyroïde/radiothérapie , Association thérapeutique/méthodes , Survie sans rechute , Études de suivi , Stadification tumorale , Études prospectives , Radiotolérance/effets des médicaments et des substances chimiques , Résultat thérapeutique , Tumeurs de la thyroïde/anatomopathologieRésumé
Os autores descrevem o caso de uma mulher de 51 anos, portadora de massa torácica extrapulmonar, que apresentou episódios de hipoglicemia sintomática dejejum. Esse quadro reverteu após a retirada cirúrgica de um mesotelioma pleural benigno, que pesava 1.800g. Sao discutidos os mecanismos de hipoglicemia tumoral extrapancreática em face de níveis indetectáveis de insulina, como em nosso caso.
Sujets)
Humains , Femelle , Adulte d'âge moyen , Hypoglycémie/étiologie , Mésothéliome/complications , Tumeurs du thorax/complications , Insuline/composition chimique , Mésothéliome/chirurgieRésumé
A Brazilian case of Creutzfeldt-Jakob disease in a hypopituitary patient who had received cadaver-derived human pituitary growth hormone between 1968 and 1977 is reported. The clinical diagnosis was confirmed during his lifetime by the demonstration of two abnormal 30-kDa proteins in the cerebrospinal fluid by two-dimensional gel electrophoresis. These proteins, characteristic of Creutzfeldt-Jakob disease, present isoelectric points of 5.1 and 5.2. Furthermore, both proteins migrate as doublets, each one displaying a molecular weight variant of about 29-kDa. This is one of 16 cases of the disease associated to therapy with cadaver-derived human growth hormone and one of the few examples among such cases of confirmation of the clinical diagnosis by biochemical characterization of abnormal proteins in the cerebrospinal fluid