Resultados del tratamiento multidisciplinario de tumores neuroendocrinos de intestino delgado / Outcomes of multidisciplinary treatment of neuroendocrine tumors of the small intestine

Resumen Objetivos: Describir los resultados del tratamiento de pacientes con tumores neuroendocrinos (TNE) del intestino delgado tratados por un grupo multidisciplinario. Métodos: Estudio tipo serie de casos en pacientes con diagnóstico histológico confirmado de tumor neuroendocrino con primario intestinal entre el 1 de mayo de 2004 y el 30 de abril de 2014. Resultados: En el periodo del estudio se atendieron en la institución 301 pacientes con diagnóstico de TNE de diferentes localizaciones, de los cuales 48 casos de primario intestinal reunieron los criterios de inclusión. La cirugía con intención curativa o paliativa fue la primera línea de tratamiento en la mayoría de pacientes (n = 35; 72,9%) y se logró remisión completa en 13 de ellos. Los análogos de somatostatina fueron la primera línea de manejo en el 14,5%. Al momento de la última valoración: 13 pacientes (27,1%) estaban libres de enfermedad; 17 pacientes (35,4%) se encontraban estables, y 7 pacientes (14,6%) con enfermedad en progresión. Más del 50% de los pacientes permanecieron vivos a los 5 años luego del diagnóstico. La mayor edad al momento del diagnóstico, la presencia de síndrome carcinoide, el compromiso metastásico, el grado histológico, y los valores elevados de marcadores bioquímicos (cromogranina A y 5-hidróxi indol ácido acético), fueron factores que se encontraron asociados a un peor pronóstico de supervivencia. Conclusiones: En el presente artículo se resumen los resultados clínicos del tratamiento de los pacientes con TNE de primario intestinal en un grupo multidisciplinario y la confrontación de dichos resultados con los datos disponibles en la literatura.

Abstract Aim: To describe the outcomes in a group of patients with neuroendocrine tumors (NETs) of the small intestine treated in a multidisciplinary group. Methods: A descriptive study based on the clinical records of patients with confirmed histological diagnosis of a neuroendocrine tumor with intestinal primary between 1 May 2004 and 30 April 2014 Results: A total of 301 patients diagnosed with NETs in different locations were treated during the study period, of which 48 cases of intestinal primary met the inclusion criteria. Surgery with curative or palliative intent was the first line of treatment in most patients (n = 35, 72.9%) and complete remission was achieved in 13 of them. Somatostatin analogues were the first line of management in 14.5%. At the time of the last assessment, 13 patients (27.1%) remained disease-free, 17 patients (35.4%) with persistent but stable disease, and 7 patients (14.6%) had progressive disease. More than 50% of the patients remained alive at 55 months after diagnosis. The higher age at diagnosis, the presence of carcinoid syndrome, the metastatic compromise, the histological grade, and elevated biochemical markers (Chromogranin A and 5-hydroxy indole acetic acid) were factors associated with a worse survival prognosis. Conclusions: A summary is presented on the clinical outcomes of the treatment of patients with NET of primary intestinal by a multidisciplinary group, as well as the comparison of these outcomes with the data available in the literature.

Consenso médico de biopsia por aspiración con aguja fina de tiroides. reporte de citología tiroidea basado en el sistema de bethesda / Medical consensus of fine-needle aspiration biopsy of the thyroid. bethesda system for reporting thyroid cytopathology

En este artículo se presenta un consenso médico basado en el sistema de Bethesda del Instituto Nacionalde Cáncer (Estados Unidos) para el uso de la biopsia por aspiración con aguja fina en el manejo de nódulos tiroideos, realizado en conjunto con patólogos, radiólogos, endocrinólogos y otras especialidades médicas de Colombia, España, Chile, Venezuela, Estados Unidos y Panamá. En este trabajo se describen las indicaciones de la biopsia por aspiración con aguja fina de tiroides, requisitos previos, entrenamiento, acreditación, técnicas, terminología diagnóstica, pruebas complementarias y opciones de tratamiento. El objetivo del actual artículo es presentar ante la comunidad médica la clasificación de los reportes citológicos, el reporte de ecografía que propone usar el sistema de datos y el reporte de imágenes tiroideas (TIRADS, del inglés The Thyroid Imaging Reporting and Data System), el uso de la medición de tiroglobulina en biopsia por aspiración con aguja fina y técnicas de citología líquida;...

This article presents a medical consensus based on the Bethesda system of the National Cancer Institute (USA) for the use of fine needle aspiration biopsy in the management of thyroid nodules. This consensus was performed in conjunction with pathologists, radiologists, endocrinologists, and other medical specialties of Colombia, Spain, Chile, Venezuela, United States, and Panama. In this work was described the indications for fine needle aspiration biopsy of thyroid, prerequisites, training, accreditation, techniques, diagnostic terminology, additional tests and treatment options. The aim of this article is present to the medical community the classification of cytological report, ultrasound report using the data system, and the thyroid imaging reporting and data system (TIRADS); as well as, the use of thyroglobulin measurement in fine needle aspiration biopsy, and liquid-based cytology techniques...

Management of neuroendocrine tumors: a meeting of experts from Latin America.

A panel of experts from Latin America convened in Brazil, in May of 2007, for consensus recommendations regarding the management of neuroendocrine tumors (NETs) of the gastrointestinal tract and pancreas. The recently introduced World Health Organization classification of NETs represents a step forward, but the former classification of carcinoids into foregut, midgut and hindgut is still likely to be useful in the near future. Macroscopic description of the tumor should be followed by light microscopic examination and immunohistochemical staining, whereas other techniques might not be widely available in Latin America. Surgery remains the mainstay of treatment for patients with potentially curable tumors, and adequate selection is paramount in order to optimize treatment results. Regarding systemic therapy, patients with well-differentiated tumors or islet-cell carcinomas may be categorized as having indolent disease, while patients with poorly differentiated, anaplastic, and small-cell carcinomas, or with atypical carcinoids, may be approached initially as having aggressive disease. Somatostatin analogues play a cytostatic role in indolent tumors, and chemotherapy may play a role against other, more aggressive NETs. Obviously, there is an urgent need for novel therapies that are effective against NETs.

Blood schizontocidal activity of methylene blue in combination with antimalarials against Plasmodium falciparum.

Methylene blue (MB) is the oldest synthetic antimalarial. It is not used anymore as antimalarial but should be reconsidered. For this purpose we have measured its impact on both chloroquine sensitive and resistant Plasmodium strains. We showed that around 5 nM of MB were able to inhibit 50% of the parasite growth in vitro and that late rings and early trophozoites were the most sensitive stages; while early rings, late trophozoites and schizonts were less sensitive. Drug interaction study following fractional inhibitory concentrations (FIC) method showed antagonism with amodiaquine, atovaquone, doxycycline, pyrimethamine; additivity with artemether, chloroquine, mefloquine, primaquine and synergy with quinine. These results confirmed the interest of MB that could be integrated in a new low cost antimalarial combination therapy.

Antimalarial activity of some Colombian medicinal plants.

Antimalarial activity of 10 vegetal extracts (9 ethanolic extracts and 1 crude alkaloid extract), obtained from eight species traditionally used in Colombia to treat malaria symptoms, was evaluated in culture using Plasmodium falciparum chloroquine resistant (FcB2) strain and in vivo on rodent malaria Plasmodium berghei. The activity on ferriprotoporphyrin biomineralization inhibition test (FBIT) was also assessed. Against Plasmodium falciparum, eight extracts displayed good activity Abuta grandifolia (Mart.) Sandwith (Menispermaceae) leaves, Acacia farnesiana (L.) Willd. (Mimosaceae) leaves, Acnistus arborescens (L.) Schltdl. (Solanaceae) aerial part, Croton leptostachyus Kunth (Euphorbiaceae) aerial part, Piper cumanense Kunth (Piperaceae) fruits and leaves, Piper holtonii C. DC. (Piperaceae) aerial part and Xylopia aromatica (Lam.) Mart. (Annonaceae) bark with IC(50) values ranging from <1 to 2.1 microg/ml, while in the in vivo model only Abuta grandifolia alkaloid crude extract exhibits activity, inhibiting 66% of the parasite growth at 250 mg/kg/day. In the FBIT model, five extracts were active (Abuta grandifolia, Croton leptostachyus, Piper cumanense fruit and leaves and Xylopia aromatica).

Simalikalactone D is responsible for the antimalarial properties of an Amazonian traditional remedy made with Quassia amara L. (Simaroubaceae).

French Guiana (North-East Amazonia) records high malaria incidence rates. The traditional antimalarial remedy most widespread there is a simple tea made out from Quassia amara L. leaves (Simaroubaceae). This herbal tea displays an excellent antimalarial activity both in vitro and in vivo. A known quassinoid, simalikalactone D (SkD), was identified as the active compound, with an IC(50) value of 10nM against FcB1 Plasmodium falciparum chloroquine resistant strain in vitro. Lastly, it inhibits 50% of Plasmodium yoelii yoelii rodent malaria parasite at 3.7 mg/kg/day in vivo by oral route. These findings confirm the traditional use of this herbal tea.