Diagnóstico y clínica de los carcinoides intestinales. El síndrome carcinoide / Diagnosis and characteristics of intestinal carcinoid tumors. Carcinoid syndrome

Los tumores carcinoides son tumores neuroendocrinos que derivan de células enterocromafines, capaces de producir serotonina y diversos polipéptidos. Se localizan sobre todo en el tracto gastrointestinal y los bronquios. Se pueden clasificar según su origen embrionario (intestino superior, medio y posterior), pero actualmente se clasifican en función del tamaño, las características histológicas, la invasión local y las metástasis. Los síntomas dependen de la localización del tumor primario y la secreción hormonal. El síndrome carcinoide se caracteriza por rubefacción de la cara y el tronco, diarrea, broncoespasmo y disnea. Se produce, sobre todo, en tumores localizados en el intestino delgado y en presencia de metástasis. El diagnóstico se basa en las determinaciones de ácido 5-hidroxiindolacético, serotonina y cromogranina A. Las técnicas de localización incluyen la tomografía computarizada, la resonancia magnética, la gammagrafía con análogos de somatostatina y diversas técnicas endoscópicas. El tratamiento incluye la cirugía, los análogos de somatostatina, el interferón alfa, la terapia ablativa, la quimioterapia y los radiofármacos. La presencia de metástasis reduce la supervivencia a 5 años al 40-60% (AU)

Carcinoid tumors are neuroendocrine tumors arising from enterochromaffin cells able to secrete different classes of peptides and serotonin. The most common localization is the gastrointestinal tract and the bronchia. These tumors can be classified according to their embryologic origin (foregut, midgut and hindgut), but the current classification includes size, histological features, local invasion, and metastases. Symptoms depend on primary tumor localization and hormone secretion. Carcinoid syndrome is characterized by flushing of the face and trunk, diarrhea, bronchial spasm, and dyspnea. This syndrome frequently occurs in small bowel tumors and in patients with metastases. Diagnosis is based on 5-HIAA, serotonin and chromogranin A plasma analysis. Localization techniques include computed tomography, magnetic resonance imaging, somatostatin receptor scintigraphy, and endoscopic techniques. Treatment of carcinoid tumors includes surgery, somatostatin analogs, interferonalpha, ablative therapy, chemotherapy, and radionuclides. Metastatic disease reduces 5-year survival by 40-60% (AU)

[Pulmonary tuberculosis in the outpatients clinics of the Social Security in Biscay (author's transl)]. / La tuberculosis pulmonar en la práctica ambulatoria de la Seguridad Social en Vizcaya.

The authors review the problem of active pulmonary tuberculosis in the clinics of the Social Security in Biscay. The high number of cases offers a wide panorama and the possibility of arriving at general conclusions within the Biscayan demographic structure. It is rather disturbing to discover an average of 24.37 cases per 100,000 inhabitants per year in this partial study of the situacion. The indexes for 1967 and 1974 were practically the same. Although the disease occurs with greatest frequency in persons between 30 and 60 years of age, there is a marked tendency for it to appear at increasingly lower ages. The disease is much more common in men than in women, and immigrates seem to be more susceptible than the native population. Pulmonary tuberculosis was reported as the cause of 1.12 percent of the 61,341 deaths registered in Biscay during the 8-year period under study (1967-1974). In view of this situation the authors insist on the urgent need for strategic methods to erradicate this serious menace to public health. They consider the role of tuberculosis sanatoriums in the state to be of outmost importance.