[Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation]. / Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario / Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation

Objetivo: Con el fin de analizar el diagnóstico diferencial de las lesiones óseas con células gigantes en los huesos faciales, presentamos un caso con hiperparatiroidismo primario no diagnosticado previamente, que presentó múltiples tumores pardos maxilofaciales como primera manifestación clínica de la enfermedad. Caso clínico: Mujer de 70 años de edad con tumor en el arco anterior de la mandíbula de un año de evolución. Una biopsia confirmó la presencia de una lesión con células gigantes. Radiológicamente se corroboró la presencia de otras dos lesiones líticas en la región maxilofacial. Durante la evaluación bioquímica previa a la cirugía se consideró la posibilidad de hiperparatiroidismo. Por tomografía computarizada se localizó tumor de paratiroides en una posición atípica. La resección quirúrgica confirmó adenoma de paratiroides. La paciente cursó con hipocalcemia sintomática, siendo manejada con suplementos de calcio y calcitriol. Al cuarto mes de la cirugía, persistía con cifras normales de calcio sérico y el tumor mandibular se había reducido parcialmente. Conclusiones: La detección de una lesión ósea con células gigantes en la región maxilofacial es un elemento diagnóstico primordial puesto que varias entidades, entre ellas el tumor pardo del hiperparatiroidismo, pueden tener una imagen histológica similar. Sólo una evaluación clínica, radiológica y bioquímica sistemática puede permitir un diagnóstico definitivo. La presencia de múltiples tumores pardos maxilofaciales simultáneos en el hiperparatiroidismo primario es poco común, y en raras ocasiones puede ser el primer signo de la enfermedad.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

Parámetros de práctica para el manejo del dolor en cáncer: Grupo de Consenso para el Manejo del Dolor en Cáncer / Practice guidelines for cancer pain management: Task Force for Cancer Pain Management

El dolor por cáncer es un problema frecuente en nuestro medio, se presenta en 80 a 90 % de los pacientes y en aproximadamente 90 % de ellos se resuelve con medidas relativamente sencillas. No obstante, aproximadamente 40 % de los pacientes se encuentra insatisfecho con el médico o la enfermera respecto al manejo de su dolor. Por tal motivo, se convocó a un grupo de consenso con la finalidad de generar parámetros de práctica clínica fundamentados en la evidencia publicada y en la opinión de los expertos. Este grupo estuvo integrado por 31 médicos líderes de opinión es este campo, quienes con base en 599 documentos emitieron esta serie de recomendaciones, identificadas cada una según su nivel de evidencia.

Cancer pain is a frequent medical problem in our society. This syndrome affects from 80 to 90% of cancer patients and can be solved with relatively simple measures in 90% of the cases. Approximately 40% of cancer patients reported to be unsatisfied with the physician or nurse about their pain management. For these reasons, we gathered a task force in order to generate practice guidelines based on medical evidence and on the opinion of experts in this area. These guidelines were generated by a task force of 31 physicians who were leaders in this field and based on 599 papers selected by a previous literature search. This group evaluated the results of this search in three work sessions, during which a level of evidence was assigned to each recommendation.

[Lymphatic mapping and sentinel lymph node biopsies in order to avoid axilar dissection in early breast cancer]. / Mapeo linfático y linfadenectomía del ganglio centinela para evitar la disección axilar en mujeres con cáncer temprano de mama.

OBJECTIVE: To present the characteristics of women with early breast cancer and clinically negative ganglia who were submitted to LM and SLNB in order to select the positive cases for axilar dissection and to identify the negative cases. MATERIAL AND METHODS: Cases included patients who attended the Breast Tumor Service of the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute from March 1, 2002, to April 30, 2004. Women with early breast cancer and clinically negative ganglia (N0) were included, with out previous treatment and without previous biopsies. All cases were submitted to LM and SLNB with patent blue or double-blue technique and gamma probe. The lymph nodes were evaluated histopathologically and negative or positive results were considered, in order to determine whether or not to undertake the axilar dissection. No cases were excluded. RESULTS: Sixty cases were reviewed with an average age of 51 years. The average size of the ganglia was 1.9 cm, with stages EC-0: 9%, EC-I: 33%, EC-IIA: 58%. Sentinel lymph nodes were found in 100% and 95 ganglions were dissected, for an average of 1.6 per procedure. The histopathology was definitive in 19 women with metastasis (32%) and in 41 women with negative ganglia (68%). The results of transoperative histopathology were correlated with the histopathology report (one false positive and six false negative cases), sensitivity of 68.4%, specificity of 97.5%, positive predictive value 92.8% and negative predictive value 86.9%. CONCLUSIONS: LM and SLNB avoided radical axilar dissection in 68% of the cases and reduced the cost in 10% of the cases.

[Prognostic factors in oropharyngeal cancer]. / Factores pronóstico en cáncer de orofaringe.

INTRODUCTION: Oropharyngeal carcinoma (OFC) is rare in Mexico, it only represents 0.6% of all carcinomas. Treatment alternatives are radiotherapy (RT) or radiotherapy-surgery association and prognosis depends on stage and tumor location. OBJECTIVE: Our objective was to know prognostic factors in patients with OFC treated with RT. MATERIAL AND METHODS: We conducted a retrospective analysis of patients with OFC. Analyzed variables were tumor location, RT technique (with or without field reduction; TRC and TSRC), tumor stage, histologic grade, and macroscopic tumor type. Survival was estimated with Kaplan-Meier method. RESULTS: A total of 70 patients, median age of 62 years, 19 women and 51 men. Locations included 24 tonsil, 35 tongue base, eight soft palate, and three posterior lateral wall. A total of 32 tumors were excrescent and 38, ulcer infiltrating, 81% T3-T4 and 18% T1-T2. RT median dose was 5,625 rads; 51 were treated with TSRC and 19 with TRC. Local-regional control was achieved in 35 patients (50%), mortality secondary to treatment was 12.9% whit there were 5-year overall survival. Loco-regional recurrence was 44%. Most frequent morbility for treatment was dysphagia (66%). Variables with statistical survival significance were TRC (18% vs. 53% p = 0.0012), stage (T1-2 vs. T3-4; 58% vs. 21% p = 0.0025, and tonsil location (43% vs. 24% p < 0.005). OFC diagnosis is usually made in advanced stages. Survival prognostic factors are tumor location, tumor stage, and RT technique.

[Post total laryngectomy stomal recurrence. Case report and review of the literature]. / Recurrencia estomal posterior a laringectomía total. Reporte de un caso y revisión de la literatura.

Development of stomal recurrence following total laryngectomy is a devastating scenario with an extremely poor prognosis. Overall rate of stomal recurrence ranges from 1.7%-40%, with an average rate of 7.5%. Irrespective of the etiology of stomal recurrence, it invariably consists of diffuse infiltration of tumor into the soft tissues of the neck and mediastinum, thereby making control of the disease difficult. Despite aggresive surgery, radiotherapy, and chemotherapy, salvage rate is poor. Prevention of stomal recurrence is therefore of paramount importance and the only means of reducing incidence. Systematic use of preventive surgical measures together with postoperative radiotherapy to the stoma and superior mediastinum have led to decrease in appearance of stomal recurrence. Intensive follow-up should be performed for patients with laryngeal carcinoma who had subglottic involvement, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.