RESUMO
Over the last 2 decades, the standard fluoropyrimidine-based chemotherapy backbone for metastatic colorectal cancer has been complemented by the addition of novel biological agents, achieving impressive increases in 5-year survival rates. Nonetheless, these new combinations have also entailed increases in toxicity, leading to evaluation of de-escalated chemotherapy regimens and "drug holiday" periods in attempts to reduce side effects and optimise quality of life without impairing efficacy. Here, we review the current and emerging evidence for maintenance schedules with chemotherapy and targeted agents, versus continuous treatment after induction treatment, in metastatic colorectal cancer patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Quimioterapia de Manutenção/métodos , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab/administração & dosagem , Camptotecina/administração & dosagem , Camptotecina/análogos & derivados , Capecitabina/administração & dosagem , Cetuximab/administração & dosagem , Ensaios Clínicos como Assunto , Neoplasias Colorretais/patologia , Progressão da Doença , Cloridrato de Erlotinib/administração & dosagem , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Quimioterapia de Indução , Irinotecano/administração & dosagem , Leucovorina/administração & dosagem , Leucovorina/efeitos adversos , Doenças do Sistema Nervoso/induzido quimicamente , Doenças do Sistema Nervoso/prevenção & controle , Compostos Organoplatínicos/administração & dosagem , Compostos Organoplatínicos/efeitos adversos , Oxaliplatina/administração & dosagem , Oxaliplatina/efeitos adversos , Oxaloacetatos/administração & dosagem , Panitumumabe/administração & dosagem , Suspensão de TratamentoRESUMO
Informamos el caso de un hombre inmunocompetente que consultó por cuadro de sangrado digestivo alto secundario a una úlcera esofágica de origen tuberculoso. El compromiso gastrointestinal por el Mycobacterium tuberculosis es raro aun en pacientes con altas prevalencias de enfermedad pulmonar y extrapulmonar; los sitios de mayor afectación son íleon terminal y el peritoneo, la enfermedad esofágica es exótica y generalmente es secundaria a la extensión proveniente de órganos vecinos infectados, como ganglios mediastinales y/o bronquios. La clínica, las imágenes endoscópicas y radiológicas de la enfermedad esofágica suele simular una neoplasia maligna. La quimioterapia antituberculosa es la base del tratamiento, rara vez se requiere manejo quirúrgico.
We report the case of an immune-competent man with symptoms of upper gastrointestinal bleeding secondary to esophageal ulcers of tubercular origin. Gastrointestinal involvement from Mycobacterium tuberculosis is rare even in patients with numerous occurrences of pulmonary and extrapulmonary diseases. The most frequently affected sites are the terminal ileum and the peritoneum. Esophageal tuberculosis is exotic and is usually secondary to extension from neighboring infected organs such as the mediastinal nodes and/or the bronchi. Clinical, endoscopic and radiological pictures of the esophageal disease often mimic malignancy. Tuberculosis treatment is the mainstay of treatment, and surgery is rarely required.
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Esôfago , Hemorragia Gastrointestinal , Tuberculose , ÚlceraRESUMO
La disfagia es síntoma común en varias enfermedades neurológicas, en afectados por eventos cerebrovasculares o como consecuencia de traumas craneoencefálicos. Otro grupo importante que desarrolla trastornos de la deglución son aquellos adultos mayores con pérdida progresiva de las funciones cognitivas como es el caso de pacientes con demencia tipo Alzheimer, en donde la enfermedad se acompaña de complicaciones respiratorias que son potencialmente evitables, si la disfagia es reconocida precozmente y se trata adecuadamente
Dysphagia is a common symptom in many neurological diseases, particularly occurring after a stroke or head trauma. Another important group of patients who develop swallowing dysfunctions are older adults with progressive loss of cognitive functions such as patients with Alzheimers disease. This type of disease is accompanied by diffi culty swallowing that has been associated with increased mortality due to respiratorycomplications that are potentially preventable if dysphagia is recognized early so that appropriate strategiesfor treatment can be used
Assuntos
Humanos , Masculino , Adulto , Feminino , Doença de Alzheimer , Deglutição , Transtornos de Deglutição , EsôfagoRESUMO
The aim of the Mexican Consensus on Portal Hypertension was to develop documented guidelines to facilitate clinical practice when dealing with key events of the patient presenting with portal hypertension and variceal bleeding. The panel of experts was made up of Mexican gastroenterologists, hepatologists, and endoscopists, all distinguished professionals. The document analyzes themes of interest in the following modules: preprimary and primary prophylaxis, acute variceal hemorrhage, and secondary prophylaxis. The management of variceal bleeding has improved considerably in recent years. Current information indicates that the general management of the cirrhotic patient presenting with variceal bleeding should be carried out by a multidisciplinary team, with such an approach playing a major role in the final outcome. The combination of drug and endoscopic therapies is recommended for initial management; vasoactive drugs should be started as soon as variceal bleeding is suspected and maintained for 5 days. After the patient is stabilized, urgent diagnostic endoscopy should be carried out by a qualified endoscopist, who then performs the corresponding endoscopic variceal treatment. Antibiotic prophylaxis should be regarded as an integral part of treatment, started upon hospital admittance and continued for 5 days. If there is treatment failure, rescue therapies should be carried out immediately, taking into account that interventional radiology therapies are very effective in controlling refractory variceal bleeding. These guidelines have been developed for the purpose of achieving greater clinical efficacy and are based on the best evidence of portal hypertension that is presently available.
Assuntos
Hipertensão Portal/diagnóstico , Hipertensão Portal/terapia , Árvores de Decisões , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , MéxicoRESUMO
La hemorragia de vías digestivas altas por várices gástricas, aunque menos frecuente que la secundaria a lasesofágicas, es una causa de alta mortalidad en los pacientes cirróticos. La ligadura es el tratamiento óptimoen las várices esofágicas, pero este tratamiento para las gástricas es todavía muy discutido.Presentamos el caso de una anciana, con antecedente de cirrosis hepática secundaria a esteatosis hepáticano alcohólica (NASH), que ingresa, con hemorragia de vías digestivas altas, evidenciándose en laesofagogastroduodenoscopia una várice fúndica subcardial con sangrado activo, para la cual se decide manejocon ligadura con banda de caucho con resultado exitoso y desaparición de la várice en control posterior
Upper digestive tract bleeding due to gastric varices, although less common than bleeding secondary toesophageal varices, is one of the causes of high mortality in cirrhotic patients. Although band ligation is theoptimal treatment for esophageal varices, its use for gastric varices is still hotly debated.We report the case of an elderly woman with a history of hepatic cirrhosis secondary to nonalcoholicsteatohepatitis (NASH) and obesity who was admitted to the hospital with upper digestive tract bleeding.An esophagogastroduodenoscopy showed an actively bleeding subcardial varice in the gastric fundus. Thedecision was made to manage the bleeding with rubber band ligation. The outcome was successful outcome,and the varice had disappeared in subsequent check-ups
Assuntos
Idoso , Varizes Esofágicas e Gástricas , Hemorragia , LigaduraRESUMO
BACKGROUND: Helicobacter pylori (Hp) is recognized as a type 1 carcinogen for gastric cancer associated with pre-neoplastic lesions (atrophy and intestinal metaplasia [IM]). Its relation with p53, which intervenes in the cell cycle, has had contradictory results. AIMS: To analyze p53 expression in gastric mucosa and its relation with Hp infection. METHODS: A 3-month prospective, observational, cross-sectional study was conducted. Patients that had no evidence of acute or clinically significant gastric pathology had biopsies taken according to the Sydney system at the Hospital Juárez de México and the histopathologic studies were done at the Hospital Español de México. RESULTS: Hp prevalence was 32.7% in 104 patients. There were no cases of atrophy or dysplasia. A total of 91% of the infected patients were positive for p53. Of the non-infected patients, 14% were positive for p53 and 60% of them had IM. Of the IM patients, 75% presented with positive p53. Of the patients without IM, 31 presented with positive p53, and Hp was positive in 85% of them. There was association between Hp and p53 and between p53 and IM (P<.0001 and P<.0006, respectively). CONCLUSIONS: Significant association was shown between Hp and p53 expression, even in patients with pre-neoplastic lesions that no longer presented with Hp. Given that the identification of pre-neoplastic lesions is important for the prevention of cancer, immunohistochemistry could benefit routine biopsy carried out during endoscopy for the detection of Hp, by identifying patients with expression of the important oncogene regulator, p53.
Assuntos
Mucosa Gástrica/metabolismo , Expressão Gênica/fisiologia , Genes p53/fisiologia , Infecções por Helicobacter/metabolismo , Helicobacter pylori , Proteína Supressora de Tumor p53/biossíntese , Adulto , Biópsia , Estudos Transversais , Feminino , Mucosa Gástrica/patologia , Expressão Gênica/genética , Genes p53/genética , Infecções por Helicobacter/genética , Infecções por Helicobacter/microbiologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Introducción: El Tarwi es una especie leguminosa cultivada ancestralmente en los andes. Es rico en proteina y grasas y como probiotico podria ser usado como complemento en los productos lacteos de la dieta en el Perú. Objetivo: establecer pruebas preliminares para la formulación y elaboración de un yogurt en base a harina de tarwi que tenga aceptabilidad por el consumidor. Material y método: Estudio de desarrollo experimental con Lupinus mutabilis Sweet para el desarrollo de una formulacion nutricia de yogurt con componente parcial de Tarwi, con evaluación nutricional, sensorial y microbiológica. Resultados: se realizaron 2 mezclas de diferentes concentraciones (YSPT1; 70 por ciento leche en polvo + 30 por ciento de leche de tarwi), (YSPT2; 80 por ciento de leche en polvo + 20 por ciento leche de tarwi). El contenido de sólidos totales presente en la mezcla se encontró entre 12 a 14 por ciento. El contenido en proteínas fue de 3,86 y 3,93 por ciento, grasa 2,88 y 3 por ciento, carbohidratos 14,04 y 14,13 por ciento con un aporte energético de 97,57 y 99,33 kcal en YSPT1 y YSPT2 respectivamente. Se establecieron pruebas de acidez expresado como porcentaje de ácido láctico, evaluados por 8 horas a temperatura de 42 a 44 ºC, los resultados indican que YSPT1 y YSPT2 presentan 0.39 y 0.41 por ciento de acidez respectivamente. Los atributos sensoriales como aroma, sabor y aceptabilidad no presentaron diferencia estadística según análisis de varianza (ANOVA), con un nivel de significancia de p<0.05. Sin embargo los promedios generales reportan una mayor preferencia por los panelistas para la proporción (YSPT2; 80 por ciento de leche en polvo + 20 por ciento leche de tarwi). Según la escala hedónica utilizada muestran un nivel de agrado moderado. Conclusiones: Estos resultados ofrecen una buena posibilidad de utilización de esta leguminosa a través de la elaboración de productos que son similares en el mercado.
Introduction: Tarwi is an ancient leguminous plant that has been grown for many centuries in the Andean region. It has rich protein and fat contents, and since it has probiotic actions it may be used as a nutritional supplement in dairy products in Peru. Objective: To establish preliminary tests for the formulation and elaboration of a yogurt product using tarwi flour, aiming at the acceptability of such a product. Material and method: An experimental development study performed with Lupinus mutabilis Sweet for the development of a nutritional yogurt formulation incorporating Tarwi flour, and with nutritional, sensorial, and microbiological assessment. Results: Two mixtures incorporating different concentrations were elaborated (YSPT1; 70 per cent powder milk + 30 per cent tarwi flour), (YSPT2; 80 per cent powder milk + 20 per cent tarwi flour). Total solid contents in the mixtures were between 12 to 14 per cent. Protein contents were 3,86 per cent and 3,93 per cent; fat contents were 2,88 per cent and 3,0 per cent; carbohydrate contents were 14,04 per cent and 14,13 per cent; and energy contents were 97,57 and 99,33 kcal, respectively. Acidity tests were performed, looking for percentages of lactic acid. Samples were assessed for 8 hours in an environment between 42 to 44ºC temperature. Results indicated that YSPT1 and YSPT2 had 0,39 per cent and 0,41 per cent acidity, respectively. Sensorial characteristics, such as odor, taste and acceptability did not show any statistically significant difference according to an analysis of variance (ANOVA), with a p<0,005 significance level. However, general average values reported that evaluators preferred YSPT2 compound (80 per cent powder milk + 20 per cent tarwi flour). According to the hedonic scale used, they experienced a moderately pleasant sensation when ingesting the product. Microbiological results for the presence of coliform bacteria, fungi and moulds showed <10 cfu/g per sample in both concentrations...
Assuntos
Técnicas Microbiológicas , Lupinus , Probióticos , IogurteRESUMO
Las fracturas de húmero proximal corresponden al 75 pro ciento de las fracturas en pacientes mayores de 40 años. Después de los 50 años y por su alta incidencia de osteoporosis, las mujeres tienen una mayor frecuencia de fracturas que los hombres. Y aunque en pacientes menores de 50 años el trauma de alto impacto es la causa principal de fractura, en pacientes que sobrepasan esa edad los mecanismos de bajo impacto son la causa más común. Las lesiones de la arteria axilar ocurren frecuentemente con dislocaciones de hombro y con fracturas de clavícula, no asociándose usualmente a fracturas del humero proximal. Presentamos el caso de una paciente con lesión de la arteria axilar asociada a una fractura conminuta de humero proximal. Usualmente el diagnóstico se sospecha por el cuadro clínico, teniendo en cuenta que durante el examen físico inicial, la circulación colateral del hombro puede demostrar pulsos normales, a pesar de que haya una lesión en la arteria axilar. Para tratar este tipo de lesiones el diagnóstico temprano es un elemento clave y para disminuir complicaciones futuras la circulación se debe restablecer en las primeras seis a ocho horas. De ahí la importancia de mantener un alto índice de sospecha cuando existen fracturas cercanas a grandes vasos y dada la anatomía vascular alrededor de la región proximal del humero, se debe descartar una lesión de la arteria axilar.
Assuntos
Humanos , Artéria Axilar/lesões , Fraturas do ÚmeroRESUMO
Se evaluó la toxicidad aguda, oral, en ratones y el efecto metabólico sobre glicemia y lipidemia del extracto metanólico de Notholaena Nivea, "Cuti-Cuti", al 10 por ciento en modelos del CYTED. El efecto sobre la glicemia fue evaluado en ratas normo e hiperglicémicas, frente a grupos controles a los cuales se les administró suero fisiológico. La hiperglicemia fue inducida con aloxano, administrados por vía intraperitoneal a la dosis de 150 mg/kg de peso. Utilizamos 60 ratas distribuidas en tres grupos (I, II y III), de 20 ratas cada uno. Todos los animales fueron sometidos a ayuno de 24 horas, previo al inicio de los experimentos. El grupo I fue subdividido en dos subgrupos de 10 animales cada uno y recibieron suero fisiológico o extracto de Cuti-Cuti, para observar su efecto sobre la glicemia normal. El segundo grupo recibió aloxano a la dosis de 150mg/kg de peso, vía intraperitoneal, para inducir hiperglicemia experimental; los valores de glicemia y lipidemia fueron determinados a la 1,2,4 y 24 horas. Al tercer grupo de ratas se les administró extracto aloxano por vía intraperitoneal a la dosis de 150 mg/kg de peso; cuando los niveles de glicemia eran superiores a 300 mg por ciento, administramos a 10 ratas suero fisiológico y a otras 10 Cuti-Cuti a la dosis de 250 mg/kg de peso, vía oral. La determinación de la glicemia, colesterol total, HDL y triglicéridos fue realizada en el autoanalizador bioquímico Vitalab Selectra 2. La DL50 fue de 11,099 con un límite superior e inferior al 95 por ciento de 13,009.72 y 9,470.59 respectivamente...
We evaluated the acute oral toxicity and the metabolic effect on glycemia and lipidemia in mice, of the metanolic extract of Notholaena Nivea, "Cuti-Cuti" to 10%, in CYTED models. The effect on plasma glucose was evaluated in normoglycemic and hyperglycemic rats, compared with control groups which received physiological serum. Hyperglycemia was induced with Alloxan, administered by intraperitoneal route to the dose of 150 mg/kg of weight. We used 60 rats distributed in three groups (I, II and Ill), of 20 rats each one. All the animals were put under 24 hours fasting, previous to the beginning of the experiments. Group I was subdivided in two sub-groups of 10 animals each one and received physiological serum or extract of Cuti-Cuti, to observe its effects on normal blood glucose. The second group received alloxan to the dose of 150mg/Kg of weight, by intraperitoneal route, to induce experimental hyperglycemia; the values of blood glucose and lipids were determined at 1, 2, 4 and 24 hours. The third group of rats received 150 mg/kg of alloxan by intraperitoneal route. When the blood glucose level was over 300 mg%, 10 of them received 250 mg/kg of Cuti-Cuti and the others 10 received physiological serum by oral route. Determination of glucose, total cholesterol, HDL and triglycerids in plasma was made in the biochemical Autoanalizador Vitalab Selectra 2. The DL50 with superior and inferior limit of 95% was 13,009 and 9,470 mg/kg of weight with an average of 11,099 mg/kg of weight...
Assuntos
Animais , Ratos , Diabetes Mellitus , Extratos Vegetais/toxicidade , Fitoterapia , Hipoglicemiantes/uso terapêutico , Plantas Medicinais , Pteridaceae/classificação , Dose Letal Mediana , QuercetinaRESUMO
En la presente investigación realizada con semilla de lupinus mutabilis sweet se ha podido evaluar el efecto del extracto acuoso y del extracto metanólico sobre las lesiones producidas en la mucosa gástrica de ratas de acuerdo a la técnica de Lee. La indometacina en dosis superiores a 50 mg/Kg de peso produce lesiones lineales, engrosamiento y dilatación del intestino delgado, adhesiones, obstrucción parcial, inflamación granulomatosa transmural aguda y crónica, absceso en las criptas y fibrosis. El extracto acuoso en cocimiento, de lupinus mutabilis sweet fue administrado a la dosis de 2000mg/Kg de peso y el extracto metanólico a una dosis de 400mg/Kg. Se utilizaron cuatro grupos de ratas machos de aproximadamente 250g de peso a las que se les acondicionó en el Bioterio de la Facultad y se les suministró alimento y agua ad libitum. Los animales fueron distribuidos en G1: Control, G2: Ranitidina, G3: Extracto acuoso en conocimiento del lupinus mutabilis sweet y G4: Extracto metanólico de lupinus mutabilis sweet. Las sustancias fueron administradas por vía oral, previo ayuno de 48 horas, media hora antes de la Indometacina. A las cinco horas, los animales fueron sacrificados, realizándose la laparotomía para extraer el estómago y observar las lesiones producidas. Macroscópicamente apreciamos un efecto antiulceroso estadísticamente significativo según la prueba del chi cuadrado, con una probabilidad de p=0.0013 y microscópicamente una probabilidad de p=0.0053. Para el extracto acuoso en cocimiento se obtuvo un efecto antiulceroso igual al 60 por ciento; para la Ranitidina 57 por ciento y en menor proporción para el extracto metanólico (40 por ciento), pudiendo observarse la normalización de la arquitectura de la mucosa y la atenuación de la infiltración de granulocitos...
In the present research, we have evaluated the effect of Lupinus mutabilis Sweet's seed, as watery and methanolic extracts on the gastric mucous of rats, following the Lee's method. Indometacin in doses higher than 50 mg per kg of weight causes lineal lesions, enlarging and dilatation of small intestine; partial obstruction, acute and chronic transmural granulomatous inflamation; abscess in the intestine's crypts and fibrosis. 2000 mg/kg of weight of the watery extract of the Lupinus was administered by mouth and 400 mk/kg of the methanolic extract by the same way. We use four groups of ten male rats each one with 250 g of weight approximately that were previously conditionated in our laboratory supplying food and water ad libitum. The animals were distributed in four groups in aleatory way and they received saline solution, ranitidine, watery extract of Lupinus and methanolic extract of Lupinus respectively. All substances were administered by oral route 30 minutes before to administer Indometacina to the animals that were in fast for 48 hours. Five hours later the animals were sacrificed and submitted to laparotomy in order to observe the macroscopically antiulcerogenic effect that was evident and statistically significant with a value of p= 0,0013; microscopically was p= 0,0053...