Importancia de la escala Centor en la atención a pacientes con amigdalitis aguda durante la COVID-19: Serie de casos

Fundamento: En Cuba, durante la pandemia de COVID-19, se puso a prueba la importancia de las escalas clínicas para el tratamiento de pacientes adultos con amigdalitis aguda por no contar con pruebas de detección rápida de antígenos, sin embargo, su uso sigue siendo controversial. Objetivo: Describir los resultados de la aplicación de la escala Centor en la atención a pacientes con amigdalitis aguda durante la COVID-19. Metodología: Se realizó un estudio de serie de casos y se incluyeron los pacientes con amigdalitis aguda diagnosticados en un período de dos años en la consulta externa de Otorrinolaringología del Hospital General Provincial Camilo Cienfuegos, Sancti Spíritus, Cuba. A todos se les aplicó la escala Centor. Resultados: Se incluyeron 114 pacientes. La media de edad fue de 28.9 + 18.7 años, más de la mitad de los pacientes tenían antecedentes de amigdalitis crónica y adenoiditis crónica y eran fumadores activos. Aproximadamente 2 de cada 5 pacientes tuvieron puntuaciones <3 según la escala Centor. Conclusiones: La amigdalitis aguda fue un problema de salud durante la COVID-19 y la escala Centor fue una importante herramienta para la toma de decisiones terapéuticas en pacientes con amigdalitis aguda, aun en condiciones de ausencia de pruebas confirmatorias.

Background: In Cuba, during the COVID-19 pandemic, the clinical scales for adult patients treatment with acute tonsillitis were put under test for not having rapid antigen detection tests, however, its use is still controversial. Objective: To describe the Centor scale application results in the care of patients with acute tonsillitis during COVID-19. Methodology: A case series study was conducted and it included acute tonsillitis patients diagnosed over a two year period in the Otorhinolaryngology external consultation at Camilo Cienfuegos Provincial General Hospital, Sancti Spíritus, Cuba. The Centor scale was applied to all of them. Results: It included 114 patients. The average age was 28.9 + 18.7 years, more than half of the patients had previous history of chronic tonsillitis and chronic adenoiditis and they were active smokers. Approximately 2 out of 5 patients had scores <3 according to the Centor scale. Conclusions: Acute tonsillitis was a health problem during COVID-19 and the Centor scale was an important tool for therapeutic decision in acute tonsillitis patients, even in absence of confirmatory evidence.

The C-Circle Biomarker Is Secreted by Alternative-Lengthening-of-Telomeres Positive Cancer Cells inside Exosomes and Provides a Blood-Based Diagnostic for ALT Activity.

C-Circles, self-primed telomeric C-strand templates for rolling circle amplification, are the only known alternative-lengthening-of-telomeres (ALT)-specific molecule. However, little is known about the biology of C-Circles and if they may be clinically useful. Here we show that C-Circles are secreted by ALT+ cancer cells inside exosomes, and that a blood-based C-Circle Assay (CCA) can provide an accurate diagnostic for ALT activity. Extracellular vesicles were isolated by differential centrifugation from the growth media of lung adenocarcinoma, glioblastoma, neuroblastoma, osteosarcoma, and soft tissue sarcoma cell lines, and C-Circles were detected in the exosome fraction from all eleven ALT+ cancer cell lines and not in any extracellular fraction from the eight matching telomerase positive cancer cell lines or the normal fibroblast strain. The existence of C-Circles in ALT+ exosomes was confirmed with exosomes isolated by iodixanol gradient separation and CD81-immunoprecipitation, and C-Circles in the exosomes were protected from nucleases. On average, 0.4% of the total ALT+ intracellular C-Circles were secreted in the exosomes every 24 h. Comparing the serum-based and tumor-based CCAs in 35 high risk neuroblastoma patients divided randomly into ALT+ threshold derivation and validation groups, we found the serum-based CCA to have 100% sensitivity (6/6), 70% specificity (7/10), and 81% concordance (13/16). We conclude that the secretion of C-Circles by ALT+ cancer cells in the exosomes provides a stable blood-based biomarker and a potential clinical diagnostic for ALT activity.

Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos / Juvenile nasopharyngeal angiofibroma surgical treatment in paediatric patients

Introducción y objetivos: El nasoangiofibroma juvenil es una neoplasia benigna sumamente vascularizada de tratamiento complejo, tanto en su preparación quirúrgica como en la cirugía a realizar, los riesgos y las recurrencias. El objetivo es analizar el manejo y tratamiento quirúrgico para el nasoangiofibroma juvenil. Materiales y métodos: Se revisaron las historias clínicas e imágenes de los pacientes intervenidos por la especialidad de cirugía de cabeza, cuello y maxilofacial con resultado de proceso patológico compatible con nasoangiofibroma juvenil, en el periodo comprendido entre enero de 2008 a diciembre de 2016. Resultados: Se intervinieron 61 casos, todos ellos tratados con el mismo acceso quirúrgico por medio de una osteotomía Le Fort I. La totalidad de los pacientes fue de sexo masculino, con un promedio de edad de 13,3 años. Se utilizó la clasificación de Andrew-Fish para la estadificación de los casos, obteniendo los grados ii y i la mayor cantidad de casos. Conclusiones: El abordaje descrito provee un acceso quirúrgico extenso, el cual es adecuado para los diferentes estadios de la tumoración. Requiere de experiencia para poder llevar a cabo la resección de la tumoración con el menor sangrado posible

Introduction and objectives: The juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences. The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma. Materials and methods: We reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016. Results: Sixty-one cases were treated; all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I. Conclusions: The described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding

The C-Circle Assay for alternative-lengthening-of-telomeres activity.

The C-Circle Assay has satisfied the need for a rapid, robust and quantitative ALT assay that responds quickly to changes in ALT activity. The C-Circle Assay involves (i) extraction or simple preparation (Quick C-Circle Preparation) of the cell's DNA, which includes C-Circles (ii) amplification of the self-primed C-Circles with a rolling circle amplification reaction and (iii) sequence specific detection of the amplification products by native telomeric DNA dot blot or telomeric qPCR. Here we detail the protocols and considerations required to perform the C-Circle Assay and its controls, which include exonuclease removal of linear telomeric DNA, production of the synthetic C-Circle C96 and modulation of ALT activity by γ-irradiation.

Understanding response and resistance to oestrogen deprivation in ER-positive breast cancer.

Oestrogens (E) and oestrogen receptor alpha (ERα) play fundamental roles in the development and progression of more than three-quarters of breast cancers (BC). The ability to influence the natural history of BC by hormonal manipulation is well established and endocrine therapies represent the cornerstone of systemic management for women with ERα-positive disease. Endocrine agents abrogate oestrogenic signalling through distinct and incompletely overlapping mechanisms, either impeding the transcriptional activity of ERα or diminishing E-synthesis. In post-menopausal women, E-production is chiefly attributable to the enzymatic conversion of androgens in extra-gonadal tissues by the cytochrome P-450 superfamily member aromatase. Greater understanding of steroid biosynthesis has underpinned rational drug design and pharmacological development of potent and specific aromatase inhibitors (AIs). Contemporary agents induce profound E-suppression in post-menopausal women and are first-line neo-adjuvant, adjuvant and metastatic therapies, with greater efficacy and tolerability than tamoxifen. The principal qualifier for endocrine treatment, including AIs, remains ERα expression. However, it is increasingly apparent that ERα expression is not synonymous with sensitivity to treatment and insufficient to account for the considerable heterogeneity of response. Better predictive biomarkers of de novo resistance are required to improve patient selection and identify those poor-responders who may benefit from alternative or additional systemic treatment from the outset. Among patients who do respond well initially, many relapse during their clinical course and there is also an unmet need for biomarkers of acquired resistance. The majority of women who relapse on AIs continue to express functional ERα which remains a legitimate target for second-line endocrine therapy. Understanding and overcoming acquired resistance to AIs requires a greater appreciation of ERα biology and the mechanisms though which E-dependence can be subverted. In this article, we review the impact of therapeutic E-deprivation on the natural history of ERα-positive breast cancer. Consideration is given to established and emerging biomarkers and/or determinants of response and resistance to E-deprivation. In vitro and in vivo evidence of the molecular mechanisms underpinning the transition from sensitivity to resistance are reviewed in the context of current models of ERα activity and their potential translational relevance.

Osteomielitis maxilar y mandibular en pacientes pediátricos / Pediatric maxillary and mandibular osteomyelitis

Introducción: La osteomielitis es un cuadro, de presentación ocasional, que resulta como complicación de diversas etiologías y requiere un tratamiento quirúrgico y médico inmediato. Objetivos: Evaluar los resultados de patología informados como osteomielitis a nivel de los maxilares en pacientes pediátricos, tanto de la mandíbula como del maxilar superior, los cuales requirieron tratamiento quirúrgico y cobertura antibiótica en el periodo del 2008 – 2013. Material y método: Estudio descriptivo y retrospectivo, realizado en el Instituto Nacional de Salud del Niño. Resultados: Se encontró predominio en el sexo masculino (64.7%) y mayor presentación en menores de 10 años de edad (91%), la mandíbula fue en mayor frecuencia afectada (92,1%); con predominio de osteomielitis crónica en 82,4% de los casos. La región del cuerpo y ángulo mandibular resultaron los más afectados con 75 y 62,5% respectivamente. A todos los pacientes se les realizó limpieza quirúrgica y remoción de secuestros óseos con exodoncias de las piezas comprometidas. Conclusión: La cirugía junto a la cobertura antibiótica son la base del tratamiento el cual se busca erradicar el foco infeccioso y al microorganismo patógeno. Proponemos como cobertura antibiótica clindamicina y penicilina resistente a betalactamasa durante 8 semanas, en forma parenteral por 2 semanas como mínimo y luego vía oral hasta completar el tratamiento.

Introduction: Osteomyelitis is a picture of casual presentation, resulting as a complication of various etiologies and requires immediate surgical and medical treatment. Objective: To evaluate the results of pathology-level reported as osteomyelitis of the jaws in pediatric patients , both the jaw and the upper jaw, which required surgical treatment and antibiotic coverage, for the period from 2008 to 2013. Material Methods: Study descriptive, retrospective , held at the National Institute of Child Health Results : predominance was found in males ( 64.7 %) and higher filing under 10 years of age (91%), the mandible was more frequently affected (92.1 %) with a predominance of chronic osteomyelitis in 82.4 % of cases . The region of the mandibular body and angle were the most affected with 75 and 62.5 % respectively. All patients were performed surgical cleaning and removal of sequestra with extractions of compromised parts. Conclusion: Surgery with antibiotic coverage are the mainstay of therapy , which seeks to eradicate the source of infection and the pathogen. We propose as clindamycin antibiotic coverage lactamase resistant penicillin for 8 weeks parenterally for at least 2 weeks and then orally until complete.

Challenges in identifying candidate amplification targets in human cancers: chromosome 8q21 as a case study.

Detailed genomic characterization of cancer specimens is required to identify all genes whose dysregulation contributes to tumorigenesis and/or tumor progression. These include amplification target genes, whose oncogenic functions derive from their overexpression in response to increased gene copy number, and which increasingly serve as therapeutic targets and predictive markers. We propose that identifying novel amplification target genes is becoming more challenging, and may require the comparative analysis of multiple studies mapping gene copy number changes and/or defining associations between gene copy number and expression. We therefore reviewed the array comparative genomic hybridization and single nucleotide polymorphism profiling literature to identify copy number increases that were restricted to chromosome 8q21 in human cancers, which were reported most frequently in breast cancer. We determined the minimal regions of overlap between gained regions and then examined which chromosome 8q21 genes were most frequently overexpressed, or otherwise supported, in individual studies. As these combined approaches supported the previously proposed amplification targets TCEB1, TPD52, and WWP1, the comparison of multiple genomic studies may therefore effectively predict candidate gene amplification targets, and prioritize these for further study.

Hipoplasia del seno maxilar en un paciente octogenario: presentación de un caso / Hipoplasia del seno maxilar en un paciente octogenario. Presentación de un caso

Fundamento: la hipoplasia unilateral del seno maxilar es una enfermedad rara. Se presenta con mayor frecuencia en individuos en la cuarta década de la vida. Puede aparecer por una anomalía del desarrollo o debido a la interrupción de la aireación del seno maxilar. La tomografía computarizada permite realizar el diagnóstico de certeza y es utilizada para la valoración prequirúrgica de esta afección. El caso que se presenta puede catalogarse como una curiosidad en la práctica médica pues es infrecuente el diagnóstico de la hipoplasia del seno maxilar en pacientes con edad avanzada. Presentación de caso: paciente de 84 años de edad con algia facial, rinorrea y obstrucción nasal de meses de evolución al que se le indica tomografía computarizada de senos perinasales, diagnosticándose una hipoplasia del seno maxilar derecho tipo II. Conclusiones: se le propuso al paciente el tratamiento quirúrgico de la hipoplasia del seno maxilar, pero fue aplazado por criterio individual debido a su edad(AU)

Background: the unilateral hypoplasia of the maxillary sinus is a rare desease. It is more frequent in individuals during the fourth life decade or more. It may appear as an anomaly of the development or due to the interruption of aeration of the maxillary sinus. The CT scan lets perform the certainty diagnosis and is used for presurgical assessment of the affection. The case presented may be cataloged as a curiosity in the medical practice for the diagnosis of the hypoplasia in the maxillary sinus is infrequent in patients over forty years. Case presentation: An 84 year old patient with facial algia, rinorrhea and nasal closure of several months is ordered a CT scan of the perinasal sinuses with a diagnosis of hyploplasia of the right maxillary sinus type II. Conclusion: the patient was ordered a surgical treatment for hypoplasia of the maxillary sinus, but was postponed for individual criterion due to his age(AU)

An in vitro model showing adaptation to long-term oestrogen deprivation highlights the clinical potential for targeting kinase pathways in combination with aromatase inhibition.

Aromatase inhibitors (AI) have improved the treatment of oestrogen receptor positive (ER+) breast cancer. Despite the efficacy of these agents over 40% of patients relapse with endocrine resistant disease. Here we describe an in vitro model of acquired resistance to long-term oestrogen deprivation (LTED). The LTED cells retain expression of the ER and appear hypersensitive to oestrogen as a result of altered kinase activity. Furthermore analysis of temporal changes in gene expression during the acquisition of resistance highlight growth factor receptor pathways as key mediators of this adaptive process.

Targeting the receptor tyrosine kinase RET sensitizes breast cancer cells to tamoxifen treatment and reveals a role for RET in endocrine resistance.

Endocrine therapy is the main therapeutic option for patients with estrogen receptor (ERalpha)-positive breast cancer. Resistance to this treatment is often associated with estrogen-independent activation of ERalpha. In this study, we show that in ERalpha-positive breast cancer cells, activation of the receptor tyrosine kinase RET (REarranged during Transfection) by its ligand GDNF results in increased ERalpha phosphorylation on Ser118 and Ser167 and estrogen-independent activation of ERalpha transcriptional activity. Further, we identify mTOR as a key component in this downstream signaling pathway. In tamoxifen response experiments, RET downregulation resulted in 6.2-fold increase in sensitivity of MCF7 cells to antiproliferative effects of tamoxifen, whereas GDNF stimulation had a protective effect against the drug. In tamoxifen-resistant (TAM(R)-1) MCF7 cells, targeting RET restored tamoxifen sensitivity. Finally, examination of two independent tissue microarrays of primary human breast cancers revealed that expression of RET protein was significantly associated with ERalpha-positive tumors and that in primary tumors from patients who subsequently developed invasive recurrence after adjuvant tamoxifen treatment, there was a twofold increase in the number of RET-positive tumors. Together these findings identify RET as a potentially important therapeutic target in ERalpha-positive breast cancers and in particular in tamoxifen-resistant tumors.

EGFR/HER2 inhibitor AEE788 increases ER-mediated transcription in HER2/ER-positive breast cancer cells but functions synergistically with endocrine therapy.

BACKGROUND: Cross-talk between receptor tyrosine kinases and the oestrogen receptor (ER) is implicated in resistance to endocrine therapy. We investigated whether AEE788 (a combined inhibitor of EGFR, HER2 and VEGFR) plus tamoxifen or letrozole enhanced the individual anti-tumour effects of these agents. METHODS: Breast cancer cell lines modelling endocrine-resistant and -sensitive disease were engineered to express aromatase (A) and examined using proliferation, western blotting and ER-alpha transcription assays. RESULTS: AEE788 enhanced the anti-proliferative effect of tamoxifen and letrozole in ER(+) cell lines (MCF-7 2A, ZR75.1 A3 and BT474 A3). This associated with an elevated G1 arrest and nuclear accumulation of p27. It is noteworthy that AEE788 alone or in combination with endocrine therapy increased the expression of progesterone receptor (PGR) and TFF1 in BT474 A3 cells. This may indicate a mechanism of resistance to AEE788 in ER(+)/HER2(+) breast cancers. In a ZR75.1 A3 xenograft, AEE788 alone or in combination with tamoxifen provided no further benefit compared with letrozole. However, letrozole plus AEE788 produced a significantly greater inhibition of tumour growth compared with letrozole alone. CONCLUSION: These data suggest that AEE788 plus letrozole in breast cancer overexpressing HER2 may provide superior anti-tumour activity, compared with single agents.

Conducta alimentaria e imagen corporal en una muestra de adolescentes de Sevilla / Eating behaviour and body image in a sample of adolescents from Sevilla

Objetivo: En el presente trabajo se analiza la presencia de alteraciones alimentarias y la influencia que sobre ellas puede tener el grado de insatisfacción corporal entre los adolescentes. Método: Aplicando el Eating Attitudes Test-40 (EAT-40), el Sick Control On Fat Food (SCOFF) y la subescala de insatisfacción corporal (BD) del Eating Disorders Inventory-2 (EDI-2) a 841 estudiantes, de 12 a 19 años, se analizaron las conductas alimentarias de riesgo, se estudiaron las diferencias en función del sexo y la edad y se analizó la relación de dichas conductas con el grado de insatisfacción corporal. Resultados y discusión: El 21,29% tuvo puntuaciones significativas en el SCOFF y el 7,13% en el EAT-40. Por sexos, hubo diferencias significativas (13,93% y 3,23% en SCOFF y EAT-40 para los varones, 29,38% y 10,70% para las mujeres). Con respecto a datos anteriores, se observa un descenso del riesgo en las mujeres y un incremento en los varones. Se observó una mayor insatisfacción corporal en las chicas de 12 a 17 años, si bien la diferencia entre chicas y chicos, en alteraciones alimentarias, se centra en los 14-16 años. La insatisfacción corporal correlacionó positiva y significativamente con el Índice de Masa Corporal, EAT-40 y SCOFF. Para implantar programas de prevención primaria en la población adolescente, es necesario conocer las conductas alimentarias de riesgo y el grado de insatisfacción corporal, para poder plantear específicamente las intervenciones a llevar a cabo, involucrando al profesorado como agente primario de trabajo en el contexto escolar (AU)

Objective: This study examined the presence of disordered eating behaviours and the influence that on them could have the degree of body dissatisfaction among adolescents. Method: By the Eating Attitudes Test-40 (EAT-40), the Sick Control On Fat Food (SCOFF) and the subscale of body dissatisfaction (BD) of the Eating Disorders Inventory-2 (EDI-2) a total of 841 students, aged 12-19, were studied. Eating behaviours, sex and age differences, and eating attitudes and behaviours related to the degree of body dissatisfaction were analized. Results: We found that 21,29% had significant punctuations in the SCOFF and 7,13% in the EAT-40. There were significant sex-differences (13,93% and 3,23% in SCOFF and EAT-40 for males, 29,38% and 10,70% for women). With regard to previous studies, a decrease of the risk is observed in women and an increase in males. Major body dissatisfaction was observed among the 12 to 17-year-old girls, though sex-differences in eating alterations, can be mostly found between the ages of 14 and 16. Body dissatisfaction correlated positively and significantly to Body Mass Index, EAT-40 and SCOFF. Conclusion: In order to implement primary programs in the adolescent population it is necessary to explore the eating behaviours of risky and the degree of body dissatisfaction to be able to raise specifically the interventions to be carried out, involving teachers as primary agents for the work in the school context (AU)

Angiofibroma juvenil / Juvenile angiofibroma

Se realizó una breve revisión sobre los Angiofibromas Juveniles, presentándose un caso que acude al centro y es atendido en consulta externa por presentar epistaxis de moderada intensidad y una marcada obstrucción nasal; en estudios hematológicos se encontraron parámetros dentro de límites normales, constatando en la rinoscopia posterior una masa de color violácea, de consistencia firme, y sangrado fácil. Se decidió realizar tratamiento quirúrgico para exéresis de la misma, y el resultado histólogo fue compatible con un Angiofibroma Juvenil, su evolución hasta este momento es satisfactoria (AU)

A brief review was carried out on juvenile angiofibromas,with the presentation of a case that comes to the center and is assisted in external consultation for having epistaxis of moderate intensity and a marked nasal obstruction; in haematological studies, parameters within normal limits were found, verifying in the later rhinoscopy a violaceous mass, of firm consistency and easy bleeding. It was decided to carry out a surgical treatment to remove it, and the result histological result was compatible with a juvenile angiofibroma. Its evolution until this moment is satisfactory

The anti-oestrogen ICI 182,780, but not tamoxifen, inhibits the growth of MCF-7 breast cancer cells refractory to long-term oestrogen deprivation through down-regulation of oestrogen receptor and IGF signalling.

Long-term culture of MCF-7 wild-type (wt) cells in steroid-depleted medium (LTED) results in hypersensitivity to oestradiol (E2) coinciding with elevated levels of ERalpha and enhanced growth factor signalling. In this study, we aimed to compare the effects of the pure anti-oestrogen ICI 182,780 (ICI) with the competitive anti-oestrogen tamoxifen (TAM) on oestrogen and IGF signalling in these cells. Wt MCF-7 and LTED cells were treated with a log 7 concentration range of E2, TAM or ICI. Effects on cell growth, ERalpha transactivation, expression of ERalpha, ERbeta and components of the IGF pathway were measured with and without insulin. In the presence of insulin, growth of LTED cells was refractory to TAM but inhibited by ICI and E2. In the absence of insulin, LTED cells showed persistent hypersensitivity to E2, and remained inhibited by ICI but were largely unaffected by TAM. ICI but not TAM inhibited ER-mediated gene transcription and treatment with ICI resulted in a dose-dependent reduction in ERalpha levels whilst having no effect on ERbeta expression. IGF-I receptor and insulin receptor substrate 2 levels were increased in LTED versus the Wt MCF-7 cells, and ICI but not TAM reduced their expression in a dose-dependent fashion. Thus IGF signalling as well as ERalpha expression and function are enhanced during LTED. While the resultant cells are resistant to TAM, ICI down-regulates ERalpha, reducing IGF signalling and cell growth. These results support the use of ICI in women with ER-positive breast cancer who have relapsed on an aromatase inhibitor.

Growth factor signalling and response to endocrine therapy: the Royal Marsden Experience.

De novo resistance to endocrine therapy is a near-universal feature of oestrogen receptor (ER)- negative breast cancer. Although many ER-positive breast cancers also show no response to tamoxifen or aromatase inhibitors on objective clinical grounds the large majority show reduced proliferation indicating that some oestrogen dependence is present in almost all ER-positive breast cancer. In neoadjuvant studies HER2 positivity is associated with poor response rates to tamoxifen but not aromatase inhibitors, consistent with preclinical models. Acquired resistance to tamoxifen is associated with decreases in ER positivity but most recurrent lesions remain ER-positive. A small proportion of these show increased HER2 expression and in these patients increased phospho-p38 may contribute to the tamoxifen-resistant phenotype. There is an unfortunate paucity of clinical and biological data on acquired resistance to aromatase inhibitors.

Consensus statement. Workshop on therapeutic resistance in breast cancer: impact of growth factor signalling pathways and implications for future treatment.

Anti-hormones (notably tamoxifen), chemotherapy and modern radiotherapeutic approaches are invaluable in the management of breast cancer, and collectively have contributed substantially to the improved survival in this disease. Moreover, there is promise that these successes will continue with the emergence of other endocrine agents (for example, aromatase inhibitors and pure anti-oestrogens). However, de novo and acquired resistance comprises a significant problem with all treatment approaches examined to date. This Workshop aimed to evaluate the contribution made by growth factor signalling pathways in the various resistant states, primarily focusing on resistance to anti-hormonal strategies and spanning experimental models and, where possible, clinical breast cancer data. The successes and limitations of therapeutic targeting of these pathways with various signal transduction inhibitors (STIs) were evaluated in model systems and from emerging clinical trials (including epidermal growth factor receptor inhibitors such as gefitinib). It was concluded that growth factor signalling is an important contributor in the development of endocrine resistance in breast cancer and that use of STIs provides a promising therapeutic strategy for this disease. However, the cancer cell is clearly able to harness alternative growth factor signalling pathways for growth and cell survival in the presence of STI monotherapy and, as a consequence, the efficacy of STIs is likely to be limited by the acquisition of resistance. A number of strategies were proposed from studies in model systems that appeared to enhance anti-tumour actions of existing STI monotherapy, notably including combination therapies targeting multiple pathways. With the increased availability of diverse STIs and improved drug delivery, there is much hope that the more complex therapeutic strategies proposed may ultimately be achievable in clinical practice.

Granuloma maligno medio facial / Medial facial malignant granuloma

Ingresó en el Servicio de O.R.L. del Hospital Provincial Universitario Camilo Cienfuegos una paciente femenina R.O.R. de raza negra, de 51 años de edad, por presentar lesiones en la orofaringe y síndrome general, que al examinársele la orofaringe se aprecia lesión ulcerada del pilar anterior y posterior de la amígdala derecha, úlcera que se extiende al pilar anterior y posterior de la amígdala izquierda, con fondo limpio, bordes rosados, tejido friable y fetidez intensa. Remiten las lesiones posteriores al uso de esteroides y es egresada con tomas de biopsias con células inflamatorias. Reingresa dos meses después con desaparición anatómica de la orofaringe, úvula amputada, ausencia de ambos pilares. Fallece en shock hipovolémico por epistaxis severa, diagnosticándosele días antes Granuloma maligno medio facial por L.N.H. de alto grado de malignidad(AU)

A 51 year-old black female patient (R:O:R) was admitted at the otolaringology service of the Camilo Cienfuegos University Hospital for presenting lesions in the oropharynx and general syndrome. On exam, an ulcerated lesion of the anterior and posterior pillars of the right tonsil is observed that extends to the anterior and posterior pillar of the left tonsil, with a clean bottom, rosy borders, friable tissue and intense fetidity. Steroids are prescribed to remit the posterior lesions and she is discharged with takings of biopsies with inflammatory cells. She is readmitted two months later with an anatomical disappearance of the oropharynx, amputated uvula, and absence of both pillars. She dies in hypovolemic shock from severe epistaxis, with a diagnosis being made of medial facial malignant granuloma from L.N.H. of a high degree of malignancy some days before(AU)

Afecciones agudas del oído durante el verano. 2003 Hospital Universitario "Camilo Cienfuegos" de Sancti Spíritus.

Se encontraron pocas referencias de estudios realizados sobre las urgencias otorrinolaringológicas atendidas en este hospital. Se recogieron los pacientes atendidos en el servicio de urgencias en el período comprendido desde junio hasta agosto del año 2003. Se tomaron como datos los síntomas referidos en el momento que acudieron al cuerpo de guardia: los diagnósticos cuando fueron atendidos y los tratamientos impuestos. Se atendieron un total de 2,309 de los cuales las patologías más frecuentes encontradas relacionadas con el verano fueron, la otitis externa aguda, otitis media aguda, tapón de cerumen, otomicosis y la otitis media crónica agudizada. Los síntomas más frecuentes: el dolor y el prurito. El tratamiento de elección utilizado, la medicina natural y tradicional .Se recomienda orientar desde la atención primaria: no usar inadecuadamente el cuerpo de guardia, recordando que los municipios y las diferentes áreas de salud son atendidas por un especialista en O.R.L.[AU]

A few references were found of studies carried out on the otolaryngological emergencies assisted in this hospital. The patients taken were those assisted in the emergency ward in the period from June to August of the year 2003. Taken as data were the symptoms referred in the moment that they went to the emergency ward, the diagnoses when they were assisted and the treatments prescribed. A total of 2,309 patients were assisted of which the most frequent summer-related pathologies found were, acute external otitis, acute otitis media, wax tampon, otomycosis and acute chronic otitis media. The most frequent symptoms were: pain and pruritus. The choice treatment used was natural and traditional medicine. It is recommended to guide from primary attention: not to use the emergency ward improperly, remembering that the municipalities and the different areas of health are assisted by a specialist in otolaryngolgy(AU

Comportamiento clínico epidemiológico de la muerte encefálica en el territorio Oriente Norte de Cuba durante los años 2002-2003 / Epidemiological clinical behaviour of brain deaths in the North-Eastern territory of Cuba throughout the years 2002-2003

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Afecciones agudas del oído durante el verano. 2003 Hospital Universitario Camilo Cienfuegos de Sancti Spíritus / Acute ear affections during summer. 2003 "Camilo Cienfuegos" University Hospital of Sancti Spíritus

Se encontraron pocas referencias de estudios realizados sobre las urgencias otorrinolaringológicas atendidas en este hospital. Se recogieron los pacientes atendidos en el servicio de urgencias en el período comprendido desde junio hasta agosto del año 2003. Se tomaron como datos los síntomas referidos en el momento que acudieron al cuerpo de guardia: los diagnósticos cuando fueron atendidos y los tratamientos impuestos. Se atendieron un total de 2,309 de los cuales las patologías más frecuentes encontradas relacionadas con el verano fueron, la otitis externa aguda, otitis media aguda, tapón de cerumen, otomicosis y la otitis media crónica agudizada. Los síntomas más frecuentes: el dolor y el prurito. El tratamiento de elección utilizado, la medicina natural y tradicional .Se recomienda orientar desde la atención primaria: no usar inadecuadamente el cuerpo de guardia, recordando que los municipios y las diferentes áreas de salud son atendidas por un especialista en O.R.L.[AU]