Puesta al día: carcinoma paratiroideo / An update on parathyroid carcinoma

Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It should be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.

Compromiso de seno cavernoso como presentación de cáncer anaplásico de tiroides / Cavernous sinus involvement as presentation of anaplastic thyroid cancer

Anaplastic thyroid cancer is an uncommon malignant tumor, usually fatal, primarily affecting older adults and doesn't have effective systemic therapy. The median survival is less than 6 months from diagnosis. Brain metastases are low frequency and reach 18 percent. We present the case of a patient with papillary carcinoma of the thyroid who takes an aggressive form, becoming anaplastic carcinoma, with involvement of the central nervous system (CNS) manifested by paralysis of the cranial nerve IV, which is rare clinical condition.

Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Febrile neutropenia in the tropics: A description of clinical and microbiological findings and their impact on inappropriate therapy currently used at an oncological reference center in Colombia / Neutropenia febril en el trópico: una descripción de los hallazgos clínicos y microbiológicos y el impacto de la terapia inapropiada que utilizan en un centro de referencia oncológica en Colombia

Introduction. Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. Materials and methods. A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. Results. One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). Conclusions. The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.

Introducción. La neutropenia febril es una complicación frecuente de la quimioterapia para las neoplasias hematológicas. Se dispone de escasa información de sus complicaciones infecciosas en nuestro medio. Objetivo. Evaluar las características clínicas y microbiológicas de pacientes con neutropenia febril, así como su resultado clínico en una institución de referencia oncológica en Colombia. Materiales y métodos. Se conformó prospectivamente una serie de casos con pacientes con enfermedad oncológica confirmada, que consultaron o presentaron neutropenia febril durante la hospitalización. Se excluyeron aquellos con enfermedad hematológica benigna. Se recolectaron datos sobre variables demográficas, microbiológicas, clínicas, de tratamiento y de resultado de los pacientes. Se llevaron a cabo un análisis univariado y uno multivariado, con la mortalidad como resultado. Resultados. Se identificaron 130 episodios de neutropenia febril en 104 pacientes, con una edad media de 19 años y 53 % masculinos. El 86 % de los episodios ocurrieron en pacientes con alteraciones hematológicas. Se demostró infección en 65 % de los casos: 41 % con un foco infeccioso localizado y 27,7 % con bacteriemia. Los principales focos infecciosos se localizaron en el torrente sanguíneo, el aparato urinario, el sistema gastrointestinal, la piel y los tejidos blandos. De los aislamientos microbiológicos, 46,4 % fueron bacilos Gram negativos, 38,4 %, cocos Gram positivos, 9 %, hongos y, 7,1%, parásitos. La mortalidad global fue de 7,7 %. En el análisis multivariado la utilización de un tratamiento empírico apropiado se correlacionó con una menor mortalidad, de forma independiente (OR=0,17; IC 95% 0,034-0,9; p=0,037). Conclusiones. La tasa de mortalidad fue relativamente baja y fue comparable con lo reportado en países desarrollados. El tratamiento antimicrobiano inapropiado fue el principal factor asociado con mortalidad.

Identifying and controlling a multiresistant pseudomonas aeruginosa outbreak in a latin-american cancer centre and its associated risk factors

Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

Indicadores antropométricos, composición corporal y limitaciones funcionales en ancianos / Anthropometry, body composition and functional limitations in the elderly

Background: Functional limitations limit the independence and jeopardize the quality of life of elderly subjects. Aim: To assess the association between anthropometric measures and body composition with functional íimitations in community-living older people. Material and Methods: Cross-sectional survey of 377 people >6 5 years old (238 women), randomly selected from the SABE/Chile project. Complete anthropometric measurements were done. Handgrip muscle strength was measured using dynamometers. Body composition was determined using Dual-Energy X-Ray Absorptiometry. Functional limitations were assessed using self reported and observed activities. Results: Body mass index was strongly associated with fat mass (men r =0.87; women r =0.91) and with lean mass (men r =0.55; women r =0.62). Males had significantly greater lean mass (48.9 kg vs 34.9 kg), and bone mass than females (2.6 kg vs 1.8 kg) and women had higher fat mass than men (26.3 kg vs 22.9 kg). The prevalence of functional íimitations was high, affecting more women than men (63.7 percent vs 37.5 percent, p <0.01). Functional íimitations were associated with lower handgrip strength in both sexes. In the multiple regression models, with functional íimitations as dependent variable and anthropometric measures as contributing variables, only hand grip strength had a significant association (negative) with functional íimitation in both genders. Age was also a significant risk factor for functional íimitations among women. Conclusions: Hand grip strength was strongly and inversely associated with functional íimitations. Handgrip dynamometry is an easy, cheap and low time-consuming indicator for the assessment of functional íimitations and the evaluation of geriatric interventions aimed to improve functional ability.

Impacto de las [beta]-Lactamasas de espectro extendido en pacientes con cáncer / Extended-spectrum [beta]-lactamases in cancer care

En los últimos años ha habido un incremento del interés en las enterobacterias productoras de [beta]-lactamasas de espectro extendido (BLEE). Las cepas que expresan este fenotipo son capaces de hidrolizar un amplio grupo de antibióticos, incluyendo cefalosporinas de tercera generación y aztreonam, por lo que constituyen un reto terapéutico de difícil abordaje. Los pacientes con cáncer, especialmente aquéllos con neutropenia febril, son un grupo que se encuentra en alto riesgo paradesarrollar infecciones por este tipo de bacterias. En el artículo se revisan los distintos tipos de BLEE y su epidemiología, los esquemas de clasificación, los métodos de tamizaje y detección existentes, los factores de riesgo asociados con su aislamiento,las opciones terapéuticas disponibles en la actualidad y el impacto de estas enzimas en los pacientes con cáncer.

Extended-spectrum [beta]-lactamase (ESBL) producing enterobacteriaceae have been a topic of growing concern for the last years. When producing these enzimes, organisms become highly resistant against many classes of antibiotics (including third generation cephalosporins and aztreonam), resulting in difficult-to-treat infections. Cancer patients, especially febrile neutropenic patients, belong to a high risk group. This review covers the different ESBL types and the current epidemiology, classification schemes, laboratory detection techniques, and associated risk factors. Therapeutic options and impact on cancer patients are also discussed.

Micobacteriemia en pacientes con neoplasias de origen hematológico / Mycobasteremia in patients with haematologic malignancies

En pacientes con neutropenia y cáncer, la fiebre de origen desconocido puede tener múltiples causas, inclusive, infecciones de difícil diagnóstico. Se presnetan dos casos fatales de micobacteriemia. Al primer paciente se le diagnosticó leucemia linfoide aguda durante su hospitalización; cursó con derrames pleurales persistentes, empiema, neutr.openia febril y colitis neutropénica. En la tomografía computarizada (TC) de tórax se evidenciaron múltiples lesiones nodulares compatibles con infección micótica, por lo que fue tratado con anfotericina B, sin obtener respuesta. A los 61 dias de hospitalización se aislaron micobacterias en los hemocultivos tomados el dia 41. Se inicio tratamiento antituberculoso. El paciente falleció el dia 67. El segundo caso se trata de un paciente con diagnóstico previo de mieloma múltiple y transplante autólogo de médula ósea, quien consultó por haber presentado fiebre durante 30 dias. Durante su estancia hospitalaria, desarrolló neutropenia y pancitopenia. Se hizo el diagnóstico de síndrome mielodisplásico secundario. La TC torácica reveló adenomegalias mediastinales, de las que no se pudo obtener una biopsia por la trombocitopenia persistente. Los hemocultivos tomados en lo octavo día fueron positivos par micobacterias, a los 17 días de incubación. El paciente falleció a los neuve dia de su ingreso. La micobacteriemia es una forma unusual de presentación de la tuberculosis en pacientes con neoplasias de origen hematológico y es uan de las causas de fiebre desconocido en este grupo.