Epidermal growth factor receptor and epididymis invasion as prognostic biomarkers in clinical stage I testicular germ cell tumours.

BACKGROUND: Inguinal orchiectomy is curative in 70-80% of clinical stage I testicular germ cell tumours (CS I TGCT). The identification of patients who are at low risk of relapse is critical to avoid unnecessary treatment. The aim of this study is to explore EGFR, hMLH-1/hMSH-2 and microsatellite instability (MSI) as potential prognostic factors of recurrence in CS I TGCT. METHODS: Fifty-six CS I TGCT patients who underwent inguinal orchiectomy were included in this study. We analysed the relationship between clinicopathological and molecular factors with survival. Analysis of hMLH1, hMSH2 and EGFR expression was carried out by immunohistochemistry. Methylation status of the hMLH1 promoter was determined by pyrosequencing analysis in selected cases. EGFR exons 19, 20, 21 were analysed by PCR labeled-fragments and MSI status was determined using standard Multiplex MSI assays. RESULTS: Classical pathological factors such as lymphovascular invasion, high percentage of embryonal carcinoma, rete testis invasion or tumour size ≥4 cm showed a significant relationship with a higher risk of relapse. Additionally, it was found that an epididymis invasion proved to be a significant independent poor prognostic factor of recurrence (p = 0.001). hMLH1 or hMSH2 expression showed no significant association with risk of relapse and no MSI was found. EGFR expression was observed in 30.4% of samples and its expression was associated with higher risk of relapse (HR 3.5; 95% CI 1.3-9.8; p = 0.016). None of the cases presented EGFR kinase domain mutations. CONCLUSIONS: Epididymis invasion and EGFR expression, but not hMLH-1/hMSH-2 or MSI, could be potentially useful as new prognostic factors of recurrence for CS I TGCT.

Chemotherapy-induced nausea and vomiting: pathophysiology and therapeutic principles

Chemotherapy-induced nausea and vomiting (CINV) is a major determinant of quality of life in cancer patients. In addition, the perceptions that oncology professionals have about CINV quite often do not coincide with reality. Antineoplastic agents and their combinations can be categorised according to their emetogenic level, and this categorisation is helpful for classifying the severity of CINV and treating it. All CINV treatment guidelines emphasise the need to administer prophylaxis to patients who receive highly or moderately emetogenic chemotherapy. With the introduction of NK1 receptor antagonists, the control of acute and delayed CINV after highly or moderately emetogenic chemotherapy schedules has improved in the great majority of patients. NK1 receptor antagonists have been demonstrated to improve the control of CINV in all risk subgroups of patients (AU)

Perfil de deserciones infantiles y adolescentes del Centro Comunitario de Salud Mental de Quinta Normal, Región Metropolitana, entre los años 2006–2007 / Drop profile of children and adolescents of Community Mental Health Center Quinta Normal, in the period 2006-2007

Objetivo: Describir las deserciones (DS) de pacientes infantiles y adolescentes en un centro comunitario de salud mental. Pacientes y Método: Estudio descriptivo y retrospectivo realizado en el Centro Comunitario de Salud Mental de la Comuna de Quinta Normal (COSAM). Se revisaron un total de 816 fichas clínicas (FC entre Enero del 2006 y Diciembre del 2007, de éstas, 222 fichas corresponden a menores de 18 años, de los cuales 27,2 por ciento son niños y 13,5 por ciento adolescentes. Se registraron aspectos demográficos generales, diagnóstico y acciones realizadas, seleccionando aquellas de pacientes con DS. Resultados: De la totalidad DS, un 35,5 por ciento son infantiles y 13,9 por ciento adolescentes. La mayor cantidad de consultas se presentó en la población masculina siendo un 58 por ciento. El lugar de procedencia más frecuente correspondió a atención primaria (51,4 por ciento) y el principal motivo de consulta a los problemas conductuales con 44,8 por ciento. Se encontraron casos sin registro en el motivo de derivación en un 48 por ciento, diagnóstico de referencia en un 28,8 por ciento y en los diagnósticos por COSAM un 11 por ciento. Discusión: Es importante recalcar el alto porcentaje de pacientes que poseen un “no registrado” en el motivo de derivación, diagnóstico de referencia y diagnóstico COSAM. Además, considerando que la mayoría de los pacientes son derivados de la atención primaria, se concluye que las políticas de intervención se deben basar en un correcto manejo de ésta, primer eslabón en la atención de salud.

Objective: Describe infantile and teen patient drop outs (DS) at a community mental health center. Patients and Methods: Descriptive and retrospective study made at the Community Mental Health Center of Quinta Normal (COSAM). 816 medical records were reviewed between january, 2006 and December, 2007, 222 of these med records belonged to under age patients, 27,2 percent were children and 13,5 percent teenagers. General demographic aspects, diagnosis and therapeutic actions were registered, choosing those patients with DS. Results: 35,5 percent of DS were infants and 13,9 percent were teenagers. The male population had the major rate of consultation with a 58 percent. Primary care was the most frequent place of origin (51,4 percent) and the main reason of consultation was because of behavioral problems with 44,8 percent. Out of all the main reason of derivation 48 percent of patients had a non registered diagnosis, 28,8 percent of patients had a non registered reference diagnosis and 11 percent of patients that came from COSAM had a non registered diagnosis. Discussion: It’s important to highlight that number of patients that had a “non registered”diagnosis in their reason of referral, reference diagnosis and COSAM´s diagnose. Considering that most patients are referred from primary care, the policies of intervention must be basedon a correct management from primary care, the first link at the health’s attention.

Fractura de húmero por medición de fuerzas o gallitos: reporte de casos / Humeral fracture during arm wrestling: case reports

Humeral fracture during arm wrestling is unusual. There are not many cases described. Demographical characteristics and mechanism seems to be a common factor. Frequently, correspond to a distal third humeral shaft spiral fracture. Some cases can be associated to a radial nerve injury. We present 2 cases which shown similar fractures, one of them with radial nerve palsy. Both cases underwent to open reduction and internal fixation.

La fractura de húmero por medición de fuerzas o “gallitos”, es un evento inusual. Los reportes bibliográficos son escasos. Las características demográficas y el mecanismo parecieran ser un factor común en todos los casos. Generalmente, corresponde a una fractura de tercio distal de diáfisis humeral de rasgo espiroideo. En algunas ocasiones se puede asociar a compromiso del nervio radial. Mostramos2 casos, los cuales presentan fracturas de similares características y uno de ellos compromiso del nervio radial. La resolución de ambos casos fue quirúrgica.

Análisis de las tendencias en la prevalencia de caries dental en dos delegaciones de la ciudad de México / Trends analysis in dental caries prevalence in two delegations from Mexico city

Se examinaron 266 niños, de 7, 8 y 9 años de edad provenientes de las escuelas públicas federales de las delegaciones Tláhuac y Miguel Hidalgo. Dichas delegaciones se detectaron en 1980 como dos de las tres zonas en el distrito federal con menor prevalencia de caries. El promedio de los índice de caries en la delegación Tláhuac, son para la dentición temporal 4.64 +- 3.0 (CEO-D) y para la permanente 1.08 +- (CPO-D). En la delegación Miguel Hidalgo se determinó un índice CEO-D de 4.58 +- 3.1 y un CPO-D de 0.69 +- 1.1. El 9.4 por ciento de los niños se encontró libre de caries (6 por ciento Tláhuac y 3.4 por ciento Miguel Hidalgo). Al comparar los resultados con el estudio realizado por la Secretaría de Salud en 1980 se demostró que no hay cambios importantes en los niveles de caries para la dentición temporal, pero sí en la experiencia de caries para la dentición permanente, lo cual sugiere que las medidas preventivas utilizadas en este sector de la población, han tenido impacto en los últimos 12 años