Radioterapia en tumor de células gigantes tenosinovial (sinovitis villonodular pigmentada) / Radiation therapy in tenosynovial giant cell tumor (pigmented villonodular synovitis)

Presentar nuestra experiencia de 18 años en el tratamiento con radioterapia y evaluar cifras de control tumoral local en pacientes con diagnóstico de tumor de células gigantes tenosinovial difuso sinovitis villonodular pigmentada difusa. 33 pacientes, tratados durante el período 2000-2018. En 19 (57,6 %) se practicó sinovectomía parcial, 10 (30,3 %) fueron tratados con artroplastia y sinovectomía, 4 (12,2 %) con sinovectomía total. 32 pacientes recibieron radioterapia posoperatoria, 1 paciente preoperatoria. Técnica más empleada fue planificación 2D 51,5 % seguida de conformada con planificación 3D (RTC3D) 48,5 %. La dosis total promedio administrada 44 Gy (rango 10,5 - 50). Tiempo promedio de tratamiento radiante 28 días (8-35). Tiempo de seguimiento entre 0,7 - 240,8 meses, mediana 12 meses, promedio 52,1 meses. 26 pacientes (79 %) presentaron mejoría de la sintomatología inicial y 6 (18 %) refirieron estabilidad de los síntomas. La respuesta clínica al tratamiento en relación al tiempo de seguimiento, 12 pacientes (36,4 %) estaban asintomáticos, 10 con un seguimiento mayor a 60 meses; 14 (42,4 %) refieren respuesta clínica satisfactoria, (2 con un seguimiento mayor a 60 meses) 6 pacientes presentaban enfermedad estable, para un control local del 97 %. El 87,9 % presentaron dermatitis grado I, 1 desarrolló dermatitis grado II, 3 no presentaron efectos adversos. La radioterapia es una modalidad de tratamiento muy efectiva como adyuvante a la sinovectomía, observándose altas tasas de control local de la enfermedad con una baja morbilidad(AU)

To report our eighteen-year experience with radiation therapy in the treatment of diffuse tenosinovial giant cell tumor / diffuse pigmented villonodular synovitis and to assess local control of the disease. A review of 33 patients with treated with radiation therapy during the period 2000-2018 was done. 19 (57.6 %) partial synovectomy was performed, 10 (30.3 %) underwent arthroplasty plus synovectomy, 4 (12.2 %) total synovectomy. 32 patients received radiotherapy postoperative and 1 pre-operative. Most common technique employed was conventional (2D) in 51.5 % and 3D conformal (3DCRT) in 48.5 %. The average total dose was 44 Gy (range 10.5-50), with a mean treatment time of 28 days (8-35). Follow-up time ranged from 0.7- 240.8 months, median time and mean time of 12 and 52.1 months respectively After RT 26 (79 %) of the patients obtained improvement of the initial symptoms and 6 (18 %) were stable. 12 patients (36.4 %) were asymptomatic with follow-up time longer than 36 months (10 of 12 had follow-up time >60 months), 14 (42.4 %) had significant clinical improvement (2 of 14 had follow-up time >60 months), and 6 had stable disease, local control of 97 %. Complications were few, acute skin toxicity was grade I in 29 (87.9%) and grade II in 1 patient. There was no significant chronic toxicity. Radiation therapy is an effective adjuvant treatment modality after synovectomy in patients with high local control rates and low morbidity(AU)

Registro Nacional de infarto miocárdio agudo (RENIMA) / National record of heart attack miocßrdio acute (RENIMA)

Objetivo: Conocer la epidemiología, factores de riesgo y manejo del infarto de miocardio agudo (IMA) en el Perú.Materiales y Métodos: Se registraron los casos de IMA procedentes de 41 centros hospitalarios públicos y privados ocurridos el a±o 2006, obteniéndoseinformación acerca de antecedentes, presentación, diagnóstico, tratamiento y desenlace final. Resultados: Se incluyeron 995 casos, de los cuales 72.3 por ciento fueron varones. La mortalidad intra hospitalaria fue 7.4 por ciento(6.4 por ciento en varones y 10.0 por ciento en mujeres). La prevalencia de los principales factores de riesgo fuehipertensión arterial (60.7 por ciento), obrepeso (59.9 por ciento), dislipidemia (41.1 por ciento), tabaco (22.8 por ciento) y diabetes (20.3 por ciento). No hubo diferencias en relación a las estaciones del a±o y la mayoría de pacientes se concentraron a nivel de la costa (87 por ciento pacientes, 88 por ciento), fundamentalmente Lima (707 pacientes, 71 por ciento). Los pacientes recibieron tratamiento farmacológico en base a ßcido acetil salicílico (95.6 por ciento), estatinas (87.7 por ciento), anticoagulantes (heparinas 83.1 por ciento), clopidogrel (80.5 por ciento ), inhibidores de enzima convertidora de angiotensina (72.6 por ciento), betabloqueadores (63.8 por ciento), nitratos (30.7 por ciento). El mayor porcentaje de pacientes no tenía antecedente previo de enfermedad coronaria (65.2 por ciento), y entre los que tenían se refirió IMA previo (16.4 por ciento), angina estable (14.5 por ciento), angina inestable (9.4 por ciento) entre otros. Los IMAs con segmento ST elevado resultaron ser la mayoría (53.1 por ciento) y mßs frecuente en hombres con menor edad respecto de las mujeres, seguido del IMA sin elevación de ST con 32.6 por ciento y de IMA con BCRIHH con 4.8 por ciento Hubo dolor torßcico típico a la presentación del paciente en 84 por ciento de los casos, encontrßndose ademßs alta positividad enzimßtica con 82.7 por ciento de CKMB y 84 por ciento...

Objectives: To know about Acute Myocardial Infarction(AMI) epidemiology, risk factors, and management in Perú. Design: Register of cases reported from 41 health institutions during 2006. Their past history, clinical features, diagnosis criteria, management and ut comes were evaluated.Results: There were 995 cases, 72 per cent males. Intrahospitalary mortality was 7.4 per cent (6.4 per cent males, 10.0 per cent females). Among main risk factors were arterial hypertension (60.7 per cent), overweight (59.9 per cent), dyslipidemia(41.1 per cent), smoking (22.8 per cent) and diabetes (20.3 per cent). There were no differences about seasonal presentation, and most of the cases proceeded from the coastal region(88 per cent), mainly from Lima (71 per cent). Drug therapy received included acetylsalicylic acid (95.6 per cent), statins (87.7 per cent),anticoagulants (83.1 per cent), clopidogrel (80.5 per cent), ACE inhibitors (72.6 per cent), beta blockers (63.8 per cent), and nitrates (30.7 per cent ). Most of the patients did not refer coronary heart disease history (65.2 per cent), and some referred previous AMI (16.4 per cent), stable (14.5 per cent) and unstable angina (9.4 per cent). Elevated ST AMI were more frequent (53.1 per cent), significantly in younger men than in women, and there were 32.6 per cent with non-elevated ST AMI and 4.8 per cent with left bundle branch block. Patient presented with typical chest pain in 84 per cent, and cardiac enzymes were frequently positive: MB-CK 82.7 per cent and Troponins 84 per cent. Finally, thrombolysys was more frequent at others cities (20.5 per cent) than at Lima (11.5 per cent), where is more feasible to get primary angioplasty (16.4 per cent) than the rest of the country (0.7 per cent).Conclusions: RENIMA shows shows AMI approach data, demographical variables, and clinical pictures like others reported, but a mortality rate which should be improved.

Incidência de aflatoxinas em amostras de amendoim e paçoca comercializadas na cidade de Alfenas-MG, Brasil / Incidence of aflatoxins in samples of peanuts and paçoca marketed in the city of Alfenas-MG, Brazil

Foods are subject to contamination by chemical substances, including aflatoxins, which are potentially carcinogens. The presence of these substances in food is important risk in human population and animals. The aim of this study was to determine the occurrence of aflatoxins B1, B2, G1 and G2 in samples of peanuts and paçoca ramdomly acquired in shops and food market in the city of Alfenas-MG, Brazil, from June 2006 to February 2007. The technique used for the separation, identification and quantification of the substances was a liquid-liquid extraction with subsequent thin layer chromatography (TLC). Results showed that 38 percent of peanuts samples and 13 percent of paçoca samples were contaminated with aflatoxins and the concentrations ranged from 21 to 138 μg kg-1. All positive samples exceeded the maximum level established by Brazilian Legislation (20 μg kg-1). The results obtained in this work confirm the need for frequent monitoring of the presence of aflatoxins in food.

Os alimentos estão sujeitos à contaminação por substâncias químicas, dentre elas as aflatoxinas, as quais são potencialmente carcinogênicas. A presença de tais substâncias nos alimentos constitui importante risco para a população tanto humana quanto animal. O objetivo deste estudo foi determinar a ocorrência de aflatoxinas B1, B2, G1 e G2 em amostras de amendoim e paçoca adquiridas aleatoriamente no comércio da cidade de Alfenas- MG, Brasil, no período de junho de 2006 a fevereiro de 2007. A técnica utilizada para a separação, identificação e quantificação das substâncias foi a cromatografia em camada delgada com prévia extração, líquido-líquido, dos analitos. Os resultados demonstraram que 38 por cento das amostras de amendoim e 13 por cento das amostras de paçoca estavam contaminadas com aflatoxinas, sendo que as concentrações variaram de 21 a 138 μg kg-1. Todas as amostras positivas excederam o limite máximo permitido, preconizado pela legislação brasileira de 20 μg kg-1. Os achados do presente estudo corroboram com os relatados na literatura e confirmam a necessidade do freqüente o nitoramento da presença de aflatoxinas em alimentos.