RESUMO
Objetivo: La biopsia selectiva del ganglio centinela (BSGC) como procedimiento de estadificación en el cáncer de mama múltiple es cuestión de controversia. Nuestro objetivo es evaluar la eficiencia de detección del ganglio centinela (GC) en las pacientes con cáncer multifocal o multicéntrico, y la seguridad de su aplicación clínica, tras un seguimiento prolongado. Material y métodos: Se realiza un estudio prospectivo descriptivo. Se estudian 89 pacientes con cáncer múltiple de mama sometidas a BSGC (73 procesos multifocales, 16 multicéntricos), comparándolas con las que presentaron neoplasia unifocal. En la mayor parte de las BSGC se realizó administración periareolar del radiocoloide. Se realiza la evaluación a los 67,2 meses de seguimiento medio (32-126 meses). Resultados: Las tasas de localización gammagráfica y quirúrgica del GC en las pacientes con cáncer de mama múltiple fueron respectivamente 95,5% y 92,1%, observándose mayor porcentaje de GC extraaxilares que en los procesos unifocales (11,7% frente a 5,4%) y un número de GC por paciente significativamente mayor (1,70 frente a 1,38). La tasa de localización del GC en el cáncer multicéntrico fue ligeramente inferior al multifocal (87,5% frente a 93,1%) y el hallazgo de drenajes extra-axilares más elevado (20% frente a 10%). El número promedio de GC por paciente fue significativamente superior en el cáncer multicéntrico (2,33 frente a 1,57). No se han registrado recurrencias axilares en el seguimiento de las pacientes con cáncer múltiple. Conclusiones: La BSGC mediante inyección periareolar es un procedimiento preciso y fiable de estadificación del cáncer de mama múltiple, incluso multicéntrico (AU)
Objective: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. Material and methods: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Results: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SNlocalization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. Conclusions: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes (AU)
Assuntos
Humanos , Feminino , Biópsia de Linfonodo Sentinela , Neoplasias da Mama/cirurgia , Metástase Linfática/patologia , Sensibilidade e Especificidade , Reprodutibilidade dos Testes , Estudos ProspectivosRESUMO
OBJECTIVE: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. MATERIAL AND METHODS: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). RESULTS: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. CONCLUSIONS: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes.
Assuntos
Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
OBJECTIVES: Because fibroblast growth factor (FGF) causes the intracellular accumulation of activated signal transducer and activator of transcription 3 (STAT3), we assessed whether dobesilate, a synthetic FGF inhibitor that has been reported to show antiproliferative and proapoptotic activities in glioma cell cultures, down-regulates the STAT3 signaling pathway in growing cultures of those cells. Because STAT3 signaling pathway plays pleiotropic roles in tumor proliferation, maintenance of STAT3 in its inactive state may prevent glioma growth and spreading. METHODS: Rat glioma C6 cells were treated with dobesilate and cultures were evaluated immunocytochemically for STAT3 activation and enhancement of the expression rate of cyclin D1 and bcl-XL. RESULTS: Dobesilate abrogates the accumulation of activated STAT3 in glioma cells. The decrease in the intracellular levels of activated STAT3 by the dobesilate treatment runs parallel with a significant attenuation of cyclin D1 and bcl-XL expression. CONCLUSION: Treatment with inhibitors of FGF down-regulates the STAT3 signaling pathway. These alterations could be correlated to the already observed inhibition of cell proliferation and promotion of apoptosis in glioma cell cultures by dobesilate. The reported results may open new avenues for developing new treatments against these tumors.
Assuntos
Neoplasias Encefálicas/metabolismo , Dobesilato de Cálcio/farmacologia , Ciclina D1/metabolismo , Glioma/metabolismo , Fator de Transcrição STAT3/metabolismo , Proteína bcl-X/metabolismo , Animais , Apoptose/efeitos dos fármacos , Apoptose/genética , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/genética , Divisão Celular/efeitos dos fármacos , Divisão Celular/fisiologia , Linhagem Celular Tumoral , Proliferação de Células/efeitos dos fármacos , Transformação Celular Neoplásica/efeitos dos fármacos , Transformação Celular Neoplásica/genética , Transformação Celular Neoplásica/metabolismo , Ciclina D1/efeitos dos fármacos , Ciclina D1/genética , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/genética , Fatores de Crescimento de Fibroblastos/antagonistas & inibidores , Fatores de Crescimento de Fibroblastos/metabolismo , Regulação Neoplásica da Expressão Gênica/efeitos dos fármacos , Regulação Neoplásica da Expressão Gênica/genética , Glioma/tratamento farmacológico , Glioma/genética , Inibidores do Crescimento/farmacologia , Hemostáticos/farmacologia , Ratos , Fator de Transcrição STAT3/efeitos dos fármacos , Fator de Transcrição STAT3/genética , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/genética , Ativação Transcricional/efeitos dos fármacos , Ativação Transcricional/genética , Proteína bcl-X/efeitos dos fármacos , Proteína bcl-X/genéticaRESUMO
OBJECTIVES: Dihydroxy-2,5 benzenesulphonate (dobesilate) is used as an oral agent for treatment of vascular complications of diabetic retinopathy. We previously showed that blockade of fibroblast growth factor (FGF) driving angiogenesis with dobesilate inhibited new blood vessel formation in a mouse gelatine plug assay. In the present study we assessed the effects of dobesilate in rat glioma cells. METHODS: Rat C6 cells line were grown as adherent cells in Dulbecco modified Eagle medium supplemented with 1% (v/v) fetal bovine serum and antibiotics. Calcium dobesilate was added in independent experiments at the following concentrations: 10, 25, 50, 75 and 100 microM, and cells were incubated for 24 hours. Effects of dobesilate in glioma cell proliferation and survival were assessed using crystal violet staining and TUNEL assay, respectively. RESULTS: Incubation of glioma cells with dobesilate for 24 hours concentration-dependently decreased cell proliferation with an apparent IC50 of 25 microM, and this antiproliferative effect was related to a significant increase in glioma cell apoptosis. CONCLUSIONS: The results suggest that dobesilate is a promising candidate leading to the development of a new adjuvant therapeutic strategy for gliomas.
Assuntos
Antineoplásicos/farmacologia , Apoptose/efeitos dos fármacos , Neoplasias Encefálicas/patologia , Dobesilato de Cálcio/farmacologia , Linhagem Celular Tumoral/efeitos dos fármacos , Glioma/patologia , Animais , Antineoplásicos/administração & dosagem , Dobesilato de Cálcio/administração & dosagem , Divisão Celular/efeitos dos fármacos , Relação Dose-Resposta a Droga , Ensaios de Seleção de Medicamentos Antitumorais , Concentração Inibidora 50 , RatosRESUMO
La aplicación de sistemas de gestión de calidad según la norma ISO 9001:2000 se ha considerado muy adecuada a las actividades y características de las administraciones públicas. En este artículo presentamos un proyecto de gestión de calidad en el ámbito del aprovisionamiento sanitario en atención primaria, del que no existen muchas experiencias. El proyecto del servicio de compras y suministros de la Gerencia de Atención Primaria (GAP) de Lugo es un proyecto sencillo y al mismo tiempo novedoso, en el que se ha diseñado un plan de comunicación y de trabajo en equipo. Para comenzar el proyecto se creó una estructura orgánica y funcional adecuada y dirigida a la distribución de competencias y responsabilidades en materia de calidad. El sistema de elaboración de procedimientos abierto a la participación de todo el personal implicado y con continuas reuniones de los grupos de trabajo debe garantizar la adecuación de dichos procedimientos a las necesidades de la organización. Además de los resultados prácticos, ya alcanzados antes de lograr la certificación, es muy destacable que el solo intento de planificar y empezar a desarrollar e impulsar un proyecto de estas características ha supuesto hasta la fecha unos beneficios importantes en la metodología de trabajo y en la propia realización de las actividades de nuestra organización. Estos resultados, por la mejora que suponen, deben servir de motivación a otros servicios de nuestra gerencia y de otras (AU)
