ABSTRACT
Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC (AU)
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Subject(s)
Humans , Male , Female , Consensus Development Conferences as Topic , Societies, Medical/organization & administration , Societies, Medical/standards , Thyroid Neoplasms/drug therapy , Thyroid Neoplasms/radiotherapy , Radiotherapy/methods , Iodine/radiation effects , Antineoplastic Agents/therapeutic use , Thyroid Gland , Thyroid Gland/pathology , Thyroid Gland , Fluorodeoxyglucose F18/administration & dosage , Positron-Emission TomographyABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years (AU)
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Subject(s)
Humans , Male , Female , Thyroid Carcinoma, Anaplastic/complications , Thyroid Carcinoma, Anaplastic/epidemiology , Thyroid Carcinoma, Anaplastic/genetics , Consensus , Neoplasm Metastasis/diagnosis , Neoplasm Metastasis/drug therapy , Thyroid Carcinoma, Anaplastic/radiotherapy , Adenocarcinoma, Papillary/complications , Adenocarcinoma, Papillary/drug therapy , Prognosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Quality of Life , Palliative CareABSTRACT
Anaplastic thyroid cancer (ATC) is the most aggressive solid tumor and almost uniformly lethal in humans. The Boards of the Thyroid Cancer Group of the Spanish Society of Endocrinology and Nutrition and the Grupo Español de Enfermedades Huérfanas e Infrecuentes of the Spanish Society of Oncology requested that an independent task force draft a more comprehensive consensus statement regarding ATC. All relevant literature was reviewed, including serial PubMed searches together with additional articles. This is the first, comprehensive Spanish consensus statement for ATC and includes the characteristics, diagnosis, initial evaluation, treatment goals, recommendations and modalities for locoregional and advanced disease, palliative care options, surveillance, and long-term monitoring. Newer systemic therapies are being investigated, but more effective combinations are needed to improve patient outcomes. Though more aggressive radiotherapy has reduced locoregional recurrences, median overall survival has not improved in more than 50 years.
Subject(s)
Thyroid Carcinoma, Anaplastic/therapy , Thyroid Neoplasms/therapy , Algorithms , Combined Modality Therapy , Consensus , Humans , SpainABSTRACT
Thyroid cancer is the single most prevalent endocrine malignancy; differentiated thyroid cancer (DTC) accounts for more than 90 % of all malignancies and its incidence has been rising steadily. For more patients, surgical treatment, radioactive iodine (RAI) ablation, and thyroid-stimulating hormone (TSH) suppressive therapy achieve an overall survival (OS) rate of 97.7 % at 5 years. Nevertheless, locoregional recurrence occurs in up to 20 % and distant metastases in approximately 10 % at 10 years. Two-thirds of these patients will never be cured with radioactive iodine therapy and will become RAI-refractory, with a 3-year OS rate of less than 50 %. Over the last decade, substantial progress has been made in the management of RAI-refractory DTC. Given the controversy in some areas, the Spanish Task Force for Thyroid Cancer on behalf of Spanish Society of Endocrinology Thyroid Cancer Working Group (GTSEEN) and the Spanish Rare Cancer Working Group (GETHI) have created a national joint task force to reach a consensus addressing the most challenging aspects of management in these patients. In this way, multidisciplinary management should be mandatory and nuclear medicine targeted therapy, novel molecular targeted agents, and combinations are currently changing the natural history of RAI-refractory DTC.
Subject(s)
Cell Differentiation/drug effects , Iodine Radioisotopes , Practice Guidelines as Topic/standards , Protein Kinase Inhibitors/therapeutic use , Radiation Tolerance/drug effects , Thyroid Neoplasms/drug therapy , Cell Differentiation/radiation effects , Consensus , Disease Management , Humans , Molecular Targeted TherapyABSTRACT
Background: Of all thyroid cancers,< 5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. Methods: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. Results: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. Conclusions: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression (AU)
No disponible
Subject(s)
Humans , Male , Female , Thyroid Neoplasms/diagnosis , Thyroid Neoplasms/epidemiology , Thyroid Carcinoma, Anaplastic/diagnosis , Thyroid Carcinoma, Anaplastic/epidemiology , Consensus Development Conferences as Topic , Prognosis , Societies, Medical/organization & administration , Societies, Medical/standards , Molecular Biology/instrumentation , Molecular Biology/methods , Molecular Biology/trends , Biomarkers/analysis , Biomarkers, Tumor/analysisABSTRACT
BACKGROUND: Of all thyroid cancers, <5 % are medullary (MTC). It is a well-characterized neuroendocrine tumor arising from calcitonin-secreting C cells, and RET gene plays a central role on its pathogeny. METHODS: The electronic search was conducted using MEDLINE (PubMed), EMBASE and Cochrane Central Register of Controlled Trials. Quality assessments of selected current articles, guidelines and reviews of MTC were performed. RESULTS: This consensus updates and summarizes biology, treatment and prognostic considerations of MTC. CONCLUSIONS: Multidisciplinary teams and specialized centers are recommended for the management of MTC patients. In the metastatic setting, those patients with large volume of disease are candidates to start systemic treatment mainly if they are symptomatic and the tumor has progressed in the last 12-14 months. Wait and see strategy should be offered to patients with: disseminated disease with only high levels of calcitonin and no macroscopic structural disease, low burden and absence of progression.
Subject(s)
Carcinoma, Neuroendocrine/pathology , Carcinoma, Neuroendocrine/therapy , Thyroid Neoplasms/pathology , Thyroid Neoplasms/therapy , HumansSubject(s)
Drug Eruptions/etiology , Eczema/chemically induced , Propylene Glycol/adverse effects , Female , Gels , Humans , Pregnancy , Recurrence , Ultrasonography, Prenatal , Young AdultSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Dermatitis, Photoallergic/etiology , Drug Eruptions/etiology , Ketoprofen/analogs & derivatives , Tromethamine/analogs & derivatives , Administration, Oral , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Cross Reactions , Dermatitis, Photoallergic/diagnosis , Drug Eruptions/diagnosis , Humans , Ketoprofen/administration & dosage , Ketoprofen/adverse effects , Male , Skin Tests , Tromethamine/administration & dosage , Tromethamine/adverse effects , Ultraviolet Rays/adverse effectsABSTRACT
En España, 56.000 personas mueren al año por enfermedades asociadas al hábito de fumar. Pero se ha estudiado poco la influencia de este hábito en el asma extrínseca. En estudios publicados, la prueba cutánea y las concentraciones de IgE específica en el suero verificaron una sensibilización al tabaco, pero no se han realizado estudios alergológicos completos en series amplias de pacientes. Objetivos: Investigar si una respuesta específica alérgica al tabaco puede asociarse a la aparición del asma alérgica, el asma intrínseca, la EPOC y el carcinoma broncógeno. Métodos: Seleccionamos de forma aleatoria 3 grupos de pacientes: 60 con asma polínica, 60 pacientes no atópicos con obstrucción bronquial (20 con asma intrínseca, 20 con EPOC, 20 con carcinoma broncogénico) y 60 controles. Se realizó un estudio en vivo: prick con extracto de tabaco; provocación bronquial (PB) con cigarrillo encendido, apagado y extracto de hoja fresca de tabaco; prueba epicutánea con extracto de tabaco y nicotina. Y también un estudio de laboratorio: IgE específica a tabaco por CAP y EAST, immunoblotting e inhibición de EAST). Resultados: La proporción de fumadores activos fue del 42% (índice tabáquico del 28,7%). Un 17,83% de los pacientes presentaron, frente al extracto de tabaco, respuestas positivas en prick y en la PB con una IgE específica > 0,35 kU/l, sin ninguna relación con la edad pero sí con el sexo masculino (p 0,35 kU/l) y la provocación bronquial (p < 0,001). La sensibilización al tabaco fue mayor en el grupo de asmáticos polínicos (30%) que en los grupos con EPOC y carcinoma, y negativa en asma intrínseca y en los controles. La positividad del prick y del parche no dependió del número de cigarrillos ni del número de años de hábito tabáquico, pero la respuesta bronquial se asoció significativamente al número de años de hábito (p < 0,001) y al número de cigarrillos fumados en el caso de los exfumadores (p < 0,007). La respuesta dual en la PB fue más frecuente en los pacientes con EPOC (p < 0,001). La positividad (en el prick y la IgE) al tabaco se asoció a la sensibilización al látex (p < 0,002) y a los pólenes de Artemisia vulgaris (p < 0,006) y Lolium perenne (p < 0,001), pero no a otras solanáceas ni al resto de los alérgenos probados. Se demostró reactividad cruzada entre el polen de Lolium perenne y el tabaco por inhibición de EAST y del immunoblotting. Conclusiones: Demostramos que el tabaco se puede comportar como un alérgeno capaz de provocar una respuesta inflamatoria a través de un mecanismo inmunitario mediado por IgE específica. Así como en el asma ocupacional se ha observado que el hábito de fumar se asocia a una expresión temprana de la enfermedad, es posible que también aumente la expresión clínica de otros tipos de asma extrínseca y de la EPOC. El perfil de esta sensibilización corresponde a agricultores varones de mediana edad con una media de hábito de 20 años. La sensibilización es más frecuente en los polínicos por la posible reactividad cruzada entre los alérgenos vegetales. Se observó una mayor posibilidad de sensibilidad del tipo IV en los pacientes con EPOC, lo que sugiere que una respuesta inmunitaria frente al tabaco podría haber influido en el desarrollo de su inflamación crónica bronquial (AU)
Background: Asthma and chronic obstructive pulmonary disease (COPD) are two devastating clinical problems and major causes of morbidity and mortality in worldwide. Although asthma may originate soon after birth, the natural history of the disease and the influence of tobacco habits are poorly understood. Skin test and specific IgE level have verified the existence of tobacco sensitisation. However, the very few published studies report conflicting results concerning the clinical significance of tobacco IgE. Objective: The aim of our study was to investigate if a specific allergenic response against tobacco might influence the development of different obstructive bronchial diseases: allergenic and intrinsic asthma, bronchial carcinoma and COPD. Methods: We performed an observational study on the effects of tobacco exposure in 3 groups of subjects: 60 patients suffered from grass-pollen asthma, 60 patients with non-allergy bronchial obstructive disease (20 patients diagnosed as having COPD, 20 having intrinsic asthma, 20 suffered from bronchial carcinoma) and 60 healthy controls that were randomly chosen. All these patients were tested in order to try to identify tobacco as a possible allergen that might cause clinical specific response (pricktests, specific IgE to tobacco and related allergens, bronchial challenge, patch tests with tobacco and nicotin) and immunological response: immunoblotting and EAST-inhibition. Results: The proportion of current smokers was 42% (tobacco index 28.7%). Positive prick and positive BC with specific IgE > 0.35 kU/l was demonstrated in 17.8% of the patients, significantly in men and farmers; 57% of these patients were atopic. The association among positive prick, IgE and BC were good (p < 0.001). Tobacco sensitisation was negative in intrinsic asthma and controls. Positive BC was related with the number of years of habit (p < 0.0001) and tobacco index in patients who had stopped smoking (p < 0.007). Delayed bronchial response and positive patch response were more common in patients with COPD (p < 0.002) than in patients suffering from other pathologies. Tobacco IgE level was related with sensitisation to latex (p < 0.002) and pollens from mugwort p < 0.006) and Lolium perenne (p < 0.001), but not with other vegetables that belong to the Solanaceae family. EAST-inhibition showed the existence of cross-reactivity between tobacco and Lolium perenne pollen. Conclusions: Tobacco may be responsible of a specific IgE response. Smoking time, tobacco index and male sex were all related with positive specific response to tobacco. This smoking-induced allergenic response may be associated to different obstructive bronchial diseases as COPD and bronchial carcinoma. Patients with asthma due to pollen, farmers and patients also sensitised to latex were the people with more positive responses to tobacco, possibly due to a cross-reactivity between vegetal and tobacco allergens (AU)
Subject(s)
Humans , Nicotiana/immunology , Allergens , Asthma/immunology , Carcinoma, Bronchogenic/immunology , Pulmonary Disease, Chronic Obstructive/immunology , Case-Control Studies , Immunoglobulin E/blood , Cross Reactions , Bronchial Provocation Tests , Skin TestsABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Hymenoptera/pathogenicity , Arthropod Venoms/adverse effects , Food Hypersensitivity/diagnosis , Wine/adverse effects , Sulfites/adverse effects , Wasp Venoms/adverse effectsABSTRACT
Ingestion of infant cereal formula as a cause of anaphylaxis has been exclusively described in children. We report the case of a man who experienced an anaphylactic reaction after eating his son's cereal formula. We believe that cereals constitute a rising problem and a hidden allergen that can cause severe reactions. Although these reactions are not fully understood, they may possibly be a life-long event.
Subject(s)
Anaphylaxis/etiology , Edible Grain/adverse effects , Food Hypersensitivity/etiology , Infant Food/adverse effects , Adult , Construction Materials/adverse effects , Double-Blind Method , Flour/adverse effects , Humans , Immunoglobulin E/immunology , Infant , Male , Occupational Diseases/etiology , Oryza/adverse effects , Secale/adverse effects , Skin Tests , Zea mays/adverse effectsABSTRACT
Ingestion of infant cereal formula as a cause of anaphylaxis has been exclusively described in children. We report the case of a man who experienced an anaphylactic reaction after eating his son's cereal formula. We believe that cereals constitute a rising problem and a hidden allergen that can cause severe reactions. Although these reactions are not fully understood, they may possibly be a life-long event (AU)
La anafilaxis producida por papillas a base de cereales sólo se ha descrito en niños. Presentamos un caso de reacción anafiláctica en un adulto tras ingerir la papilla de su hijo. Creemos que es importante tener en cuenta los cereales como un problema creciente y un alergeno oculto que puede producir importantes reacciones que aún no se comprenden totalmente, pero que posiblemente puedan darse a lo largo de toda la vida (AU)
Subject(s)
Adult , Infant , Male , Humans , Immunoglobulin E , Food Hypersensitivity , Double-Blind Method , Construction Materials , Anaphylaxis , Secale , Edible Grain , Infant Food , Flour , Oryza , Zea mays , Construction Materials , Skin Tests , Occupational DiseasesABSTRACT
BACKGROUND: The effects of fluctuations in pollen counts have important implications for health services. Little research on the clinical implications of the vertical distribution of pollen in allergy symptoms has been carried out. METHODS: We have investigated the allergic symptoms of a population of 17 171 patients coming from our health area (Valladolid, Spain) and living in the city and villages. We compared the prevalence of sensitization to different pollens: Graminae, trees and shrub in relation with the floor of the building where they were living. RESULTS: Relative risk of pollen sensitization (confidence index, CI 95%) was higher in patients who were living at high floors than in those patients who were living in lower floors or at street level, independently of rural or urban conditions The chi-square showed a lineal trend in this relationship in the case of sensitization to grass pollen: chi(2): 1794, P > 0.00001 CONCLUSIONS: On the basis of our local investigations, natural pollen sensitization appears to increase with height where the patient lives. This paper reports clinical results on the influence of vertical pollen distribution in pollen allergy.
Subject(s)
Hypersensitivity/etiology , Pollen/immunology , Adult , Female , Housing , Humans , Hypersensitivity/epidemiology , Male , Prevalence , Risk FactorsABSTRACT
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Subject(s)
Humans , Larva/pathogenicity , Hypersensitivity/etiology , Immunoblotting/methods , Allergens/isolation & purification , Allergens , Skin Tests/methodsABSTRACT
No disponible
Subject(s)
Adult , Aged , Female , Male , Humans , Angioedema/drug therapy , Melkersson-Rosenthal Syndrome/diagnosis , Methylprednisolone/therapeutic use , Pheniramine/therapeutic use , Diagnosis, Differential , Minocycline/therapeutic use , Skin TestsABSTRACT
OBJECTIVE: To determine the role of intrarenal Doppler ultrasound (US) in patients with renal colic and to establish the usefulness of this diagnostic method. MATERIALS AND METHODS: In 121 patients with renal colic and 70 healthy individuals, 382 kidneys were examined with color duplex US. Mean intrarenal-arterial resistive index (RI), and the difference of mean RIs (dRI) between both kidneys were determined. In 64 patients, RI and dRI were compared with urographic findings (time of delay pyelogram between both kidneys). RESULTS: In the 70 healthy individuals, RI was 0.62 +/- 0.045 and dRI 0.018 +/- 0.01. In the 121 patients with renal colic, RI (0.71 +/- 0.06) was significantly superior (P < 0.001) with respect to the opposite kidney, with a dRI of 0.09 +/- 0.055. In a correlation performed in 64 patients with urographic findings among color doppler US, with a RI > or = 0.70 and/or dRI > or = 0.06 as an indicative value of obstruction, sensitivity and specificity were 91.8% for patients with delayed pyelogram (n = 37 patients), and 48.1% for patients with nondelayed pyelogram (n = 27 patients) with a specificity of 92.8% with respect to the group of normal patients. In the group of patients with delayed pyelogram, RI was significantly superior (P < 0.05) in patients with an evolution time greater than 24 hours, in patients with proximal ureteral obstruction and in patients who had signs of pyelonephritis. There were no significant differences in the group of patients with nondelayed pyelograms. CONCLUSION: Color Doppler US is useful to fundamentally evaluate the consequences of the obstruction on renal function. Other factors such as evolution time of the symptomology, obstruction level, or existence of pyelonephritis can alter the US-Doppler values.
