Obesity and gynecological cancers: A toxic relationship.

Despite the evidence supporting the relevance of obesity and obesity-associated disorders in the development, management, and prognosis of various cancers, obesity rates continue to increase worldwide. Growing evidence supports the involvement of obesity in the development of gynecologic malignancies. This article explores the molecular basis governing the alteration of hallmarks of cancer in the development of obesity-related gynecologic malignancies encompassing cervical, endometrial, and ovarian cancers. We highlight specific examples of how development, management, and prognosis are affected for each cancer, incorporate current knowledge on complementary approaches including lifestyle interventions to improve patient outcomes, and highlight how new technologies are helping us better understand the biology underlying this neglected pandemic.

Correlation of intratumoral lymphatic microvessel density, vascular endothelial growth factor C and cell proliferation in salivary gland tumors.

Lymphatic dissemination is one of the most important pathways for metastasis in many solid tumors, including head and neck carcinomas. The lymphatic growth of cancer has been used as a significant independent adverse prognostic factor and provides information about tumor progression. Salivary gland tumors present different prognoses and have the ability to develop metastases; however, this information regarding the lymphatic spread is scarce. This paper quantifies the lymphatic microvessel density (LMD) in benign and malignant salivary gland tumors and analyzes the relationship between LMD and tumor expression of vascular endothelial growth factors C (VEGF-C) and the proliferative index. The results show that there is no correlation between LMD, VEGF-C and the proliferative index in the majority of salivary gland tumors analyzed, apart from polymorphous low-grade carcinoma which exhibits statistical correlation between LMD and the proliferative index (p < 0.05). This correlation probably does not indicate a poor prognosis for this PLGA, since this is a low metastasizing carcinoma of the salivary glands. Different from other solid tumors, such as breast or prostatic carcinomas, there is no correlation between VEGF-C and LMD in salivary gland tumors, and so these traits are not able to estimate the metastatic risk or the prognosis of these tumors.

Anaplastic thyroid cancer: multimodal treatment results.

BACKGROUND: Anaplastic thyroid cancer is a rare and lethal disease. It accounts for 1-2% of thyroid malignancies, but specific mortality is higher than 90%. It is an aggressive locoregional disease with a high metastatic capacity. There is no agreement with regards to the best treatment. We analysed the results of treatment in a mestizo population treated in the National Cancer Institute (Mexico). METHODS: We reviewed 1,581 files of thyroid carcinomas; of these, 29 (1.83%) had anaplastic thyroid carcinoma. Demographic variables, clinical manifestations, tumour characteristics, and treatments were analysed. RESULTS: The median age was 64.5 ± 13.2 years. Females were more affected (female/male ratio: 2.6:1); 21 cases occurred in women (72.4%), and eight in males (27.6%). The most common manifestations were neck enlargement (93.10%) and hoarseness (71.31%). The median tumour size was 8 cm (range: 4-20 cm). The percentage of cases which presented in clinical stage IVA was 10.3%, with 62.1% presenting in clinical stage IVb and 27.6% presenting in clinical stage VIc. Complete resection (R0) (p = 0.05), radiation doses of higher than 33.1 Gy (p = 0.04), and multimodal therapy were associated with better survival. Surgery plus radiotherapy with or without systemic treatment (p = 0.006). The median overall survival was 119 days (IC 95%, 36.3-201.6). Six-month, one-year and two-year survival was 37.9%, 21% and 13%, respectively. CONCLUSION: Complete surgical resection is associated with better survival but is very difficult to achieve due to aggressive biological behaviour. Multimodal therapy is associated with better survival and a better quality of life. There is a need for more effective systemic treatments as extensive surgical resections have little overall benefit in highly invasive and metastatic disease.

Mortalidad por influenza y neumonía. Tendencia, estacionalidad y pronósticos. Jagüey Grande, 2002-2010 / Mortality caused by influenza and pneumonia. Tendency, seasonality and prognosis. Jagüey Grande, 2002-2010

La influenza y la neumonía constituyen una de las primeras causas de morbimortalidad en el mundo. En Cuba, son la cuarta causa de muerte; pero la magnitud de este problema de salud es mucho mayor al quedar también oculta tras otras causas de muerte y no ser registrada en las estadísticas vitales. Es importante conocer su magnitud, tendencia, características de comportamiento y pronóstico para su vigilancia e inclusión al evaluar acciones de prevención y control. Se realizó una investigación descriptiva de series temporales de la mortalidad por influenza y neumonía como causa básica, causa oculta y ambas incluidas, que se denominó “mortalidad total”. Se revisaron los certificados médicos de defunción de los 3 433 fallecidos residentes en el municipio de Jagüey Grande, en el período 2002-2010. En 1 127 de ellos, se registró la influenza y la neumonía como eventos mórbidos que intervinieron en su muerte, y en 323, se registró en las estadísticas vitales como causa básica. Se conformaron tres series de tiempo, de las que se analizaron su magnitud y tendencia. De la mortalidad total se describe su variabilidad mensual, estacionalidad y se pronostica el comportamiento esperado para el año 2011. Se utilizan técnicas recomendadas para el análisis de series temporales, incluyendo la modelación ARIMA para los pronósticos. La tendencia de mortalidad por influenza y neumonía como causa básica es descendente, mientras que la causa oculta y la causa total ascienden. No se encontró comportamiento estacional manifiesto de la serie de mortalidad total. Además, se hacen pronósticos mensuales para el año 2011.

The influenza and the pneumonia are one of the first causes of morbimortality around the world. In Cuba , they are the fourth cause of death; but the magnitude of the health problem is bigger because it is hidden behind other death causes and is not registered in the statistics. It is important to know its magnitude, tendency, behavioral characteristics and prognosis for the surveillance and inclusion when evaluating actions for prevention and control. We carried out a descriptive research of temporal mortality series for influenza and pneumonia as basic causes, hidden cause or both, called -total mortality-. We reviewed the decease medical certificates of the 3 433 deceased persons who lived in Jagüey Grande, in the period 2002-2010. In 1 127 of them, the influenza and the pneumonia are registered as morbid events that got involved in the decease, and in 323, they were registered as the main causes of death. We formed three time series, analyzing the magnitude and tendency. The total mortality is described as a monthly variability, seasonal, and we predict the behavior for 2011. We use the techniques recommended for the analysis of temporal series, including the ARIMA model for the prognoses. The mortality tendency by influenza and pneumonia as basic cause is descendent, while as hidden cause and as total cause is increasing. We did not find an open seasonal behavior of the total mortality series. We also make monthly prognoses for 2011 .

Rhinosinusitis in autologous and allogeneic bone marrow transplantation: a retrospective study on the performance of imaging studies on severity and prognostic evaluation / Rinossinusite em transplante de células-tronco hematopoéticas autólogo e alogênico: um estudo retrospectivo sobre o desempenho de estudos de imagem na avaliação de severidade e prognóstico

The objective of this work was to evaluate the diagnostic and prognostic performance of a traditional imaging staging system for rhinosinusitis in the bone marrow transplantation (BMT) scenario. A retrospective cohort study was carried out at a bone marrow transplantation referral center involving subjects who underwent allogeneic or autologous BMT from September 1st 2005 to September 31st 2007 and later evolved with rhinosinusitis during the BMT inpatient period. Patients who had a previous history of sinusal disease or otolaryngologic surgery were excluded from the study. Data concerning mortality, the treatment of rhinosinusitis and BMT outcomes were extracted from medical files. The collected parameters were compared to the Lund-Mackay tomographic staging system score which was calculated based on available tomography films of each patient. A total of 85 BMT were performed and 23 allogeneic and 14 autologous (43.5 percent) BMT patients evolved with rhinosinusitis during transplantation. A significant association with LMS was found for the absolute neutrophil count (ANC), with a higher ANC (>500/mm3) correlating with a higher LMS (Mean LMS for lower ANC 6.08 and higher ANC 9.71 points, p<0.05). Need for surgical management and post-BMT admissions, the resolution of the rhinosinusitis and overall mortality had no significant correlation with LMS. Patients with less than 500 neutrophils/mm3 are known to be prone to more severe infections, but paradoxically showed lower LMS when developing rhinosinusitis. However, there were no differences in the main outcomes between those with higher and lower LMS. This would possibly lead to an equivocal assumption of a less severe disease. Severely neutropenic patients are probably not able to mount an effective inflammatory response capable of inducing significant tomographic abnormalities. So, this imaging study would not be able to adequately evaluate the extent of sinusal involvement. We thus ...

O objetivo deste trabalho foi avaliar o desempenho diagnóstico e prognóstico de um escore de estadiamento de rinossinusite (RS) por tomografia em pacientes submetidos a transplante de medula óssea (TMO). Realizou-se um estudo de coorte retrospectivo de pacientes submetidos a transplante de medula óssea (autólogo e alogênico) de 1º de setembro de 2005 a 31 de setembro de 2007 que desenvolveram RS durante o período de internação do transplante. Pacientes com história prévia de doença sinusal ou cirurgia otorrinolaringológica foram excluídos do estudo. Dados relacionados à mortalidade, resolução da RS e desfechos do TMO foram extraídos do prontuário médico. Os parâmetros coletados foram correlacionados com o escore de estadiamento de Lund-Mackay (ELM), que foi calculado com base nas alterações tomográficas de cada paciente. Um total de 85 TMO foram realizados e 37 (23 alogênicos e 14 autólogos) destes pacientes desenvolveram RS durante o transplante. Uma correlação significativa com o ELM foi encontrada quando se considerava a contagem absoluta de neutrófilos (CAN), com uma CAN mais alta (>500/mcl) se associando com um ELM de maior valor (média de escore para CAN baixa 6,08 e CAN alta 9,71 pontos, p<0,05). A necessidade de intervenção cirúrgica e reinternações pós-TMO, resolução da RS e mortalidade geral não mostraram correlação com o ELM. Mesmo assumindo que a neutropenia severa é um fator de risco relevante para intercorrências infecciosas durante o TMO, paradoxalmente, os pacientes com menos de 500 neutrófilos/mcl mostraram um ELM de menor severidade, embora não tenham evoluído de maneira diferente daqueles com maior ELM. É provável que ELM mais alto esteja simplesmente ligado ao fato de uma CAN mais alta levar a uma maior reação inflamatória e consequente alteração tomográfica. Desta forma, o ELM não parece útil na avaliação de pacientes altamente imunossuprimidos como os do TMO. Rev. Bras. Hematol. Hemoter.

Sistema Glutation-S-Transferase como fator prognóstico no carcinoma papilífero da tireoide / GST genes expression as prognostic factor in papillary thyroid cancer

OBJETIVO: Analisar se existe relação entre os fatores moleculares dos genes GTS e a mortalidade dos pacientes com câncer de tireoide dado pelo índice AMES de prognóstico clínico. MÉTODOS: Foram coletadas amostras da tireoide de 66 pacientes com carcinoma papilífero (53 mulheres e 13 homens), de modo a permitir extração do material genético das enzimas. Foram constituídos dois grupos, segundo os fatores prognósticos clínicos de alto e baixo risco, de acordo a classificação AMES. Cada grupo foi avaliado pela presença ou não do genótipo nulo para as enzimas estudadas, correlacionando-os com os fatores prognósticos clínicos (AMES). RESULTADOS: Foram analisados os resultados de 17 doentes com alto risco (grupo A) e 49 com baixo (grupo B). Todas combinações de genótipos do GSTT1 e GSTM1 foram encontrados. O genótipo nulo dos dois genes do grupo de alto risco foi encontrado em 5,8 por cento e no de baixo risco em 6,1 por cento. CONCLUSÃO: A presença ou deleção dos genes GST (GSTT1 e GSTM1) não são bom fatores prognósticos no câncer papilífero da tireoide.

PURPOSES: Analyze the relationship between the AMES classification and molecular factors from Glutation-S-Transferase System, specifically the GSTT1 and GSTM1 in patients with well differentiated thyroid cancer. METHODS: Samples of thyroid tissue of 66 patients with papillary thyroid carcinoma were obtained (53 women and 13 men). Patients were divided in two groups (high and low risk) according to the AMES classification. In each group, presence of the null genotype of both GST enzymes system was studied. These results were compared with the AMES classification. Samples were obtained in the operating room immediately after thyroidectomy, placed in cryotubes, immersed in liquid nitrogen and stored in a freezer at -80ºC. DNA of this enzymes was extracted by the fenol-cloroformium method. RESULTS: There were 17 high risk patients and 49 low risk patients. The null genotype of the high risk group was 5.8 percent and in the other group was 6.1 percent. CONCLUSION: There was no relationship between absence of genes GSTT1 and GSTM1 and prognosis of the papillary thyroid carcinoma when compared to the AMES classifications.