Papel de la cirugía en el cáncer de ovario avanzado

Tesis Doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Obstetricia y Ginecología. Fecha de Lectura: 04-12-202

Instructivos para tratamientos con yodo-131. Resultado de un sondeo a pacientes

En el Departamento de Medicina Nuclear del Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán (INCMNSZ), se reciben cada semana entre 6 a 8 pacientes para terapia con yodo-131, como parte de su tratamiento por enfermedad tiroidea, generalmente hipertiroidismo1. Aunque este procedimiento se realiza desde hace más de 50 a˜nos en nuestro Instituto, en los últimos a˜nos ha incrementado el número de pacientes que lo reciben, por lo que, en grupo, se les ofrece una breve explicación del procedimiento y las medidas básicas de protección radiológica que deben seguirse, asumiendo que el médico tratante les ha explicado con anterioridad lo que compete al tratamiento.Introducción: Por lo general, los pacientes que reciben tratamientos con materiales radiactivos, como yodo-131 para hipertiroidismo o Cáncer de Tiroides, no están informados sobre la radioyodoterapia y acuden a recibirla con temor. Con el objeto de orientarlos, se escribió un instructivo, que se entrega con regularidad a todos los pacientes al solicitar su cita. Materiales y métodos: Durante un ano se realizó un breve interrogatorio a 291 pacientes, antes ˜ de tomar el yodo-131, con 4 preguntas para conocer su estado emocional y la información que tenían del tratamiento, para escribir un folleto informativo sobre tratamientos con yodo- 131 menores a 30 mCi para pacientes hipertiroideos. Basado en sus opiniones y sugerencias se realizaron dos folletos más, uno con modificaciones y otro para pacientes con Cáncer de Tiroides. Resultados: El primer folleto se repartió a pacientes al programar cita. Se reestructuró la información, en forma de preguntas y respuestas y se escribió el de Tratamientos para Cáncer de Tiroides, con ayuda de endocrinólogos y médicos nucleares. Los borradores se repartieron durante 6 meses a pacientes al solicitar cita para tratamientos. Las opiniones recibidas fueron positivas en contenido y claridad, por lo que se editaron nuevamente. Conclusiones: La entrega de estos instructivos, es de ayuda porque resulta muy sencillo para los pacientes leer en el folleto las medidas de protección radiológica, fomentando la cultura de la seguridad, no solo en los pacientes sino también en los médicos. Además, se cumple con la normatividad de la ley nuclear vigente

Effect of tumor burden and radical surgery on survival difference between upfront, early interval or delayed cytoreductive surgery in ovarian cancer

Procediments quirúrgics de citoreducció; Teràpia neoadjuvant; Neoplàsies d'ovariProcedimientos quirúrgicos de citorreducción; Terapia neoadyuvante; Neoplasias de ovarioCytoreduction Surgical Procedures; Neoadjuvant Therapy; Ovarian NeoplasmsObjective We sought to evaluate the impact on survival of tumor burden and surgical complexity in relation to the number of cycles of neoadjuvant chemotherapy (NACT) in patients with advanced ovarian cancer (OC) with minimal (CC-1) or no residual disease (CC-0). Methods This retrospective study included patients with International Federation of Gynaecology and Obstetrics IIIC–IV stage OC who underwent debulking surgery at 4 high-volume institutions between January 2008 and December 2015. We assessed the overall survival (OS) of primary debulking surgery (PDS group), early interval debulking surgery after 3–4 cycles of NACT (early IDS group) and delayed debulking surgery after 6 cycles (DDS group) with CC-0 or CC-1 according to peritoneal cancer index (PCI) and Aletti score. Results Five hundred forty-nine women were included: 175 (31.9%) had PDS, 224 (40.8%) early IDS and 150 (27.3%) DDS. Regardless of Aletti score, median OS after PDS was significantly higher than after early IDS or DDS, but the survival difference was higher in women with an Aletti score 10, there were no differences between PDS and early IDS, but DDS was associated with decreased OS. Conclusion The benefit of complete PDS compared with NACT was maximal in patients with a low complexity score. In patients with low tumor burden, there was a survival benefit of PDS over early IDS or DDS. In women with high tumor load, DDS impaired the oncological outcome.The project that gave rise to these results received the support of a fellowship from “la Caixa” Foundation (ID 100010434). The fellowship code is LCF/BQ/EU18/11650038

Análisis financiero de la cooperativa de ahorro y crédito “UNIBLOCK” y servicios Ltda., año 2010 - 2011

This research has made a Financial Analysis at Cooperativa de Ahorro y Crédito"UNIBLOCK" Ltd., in Latacunga city, in order to evaluate the operating performance, to know the current status of the entity and determine the financial risks to which it may be exposed, in this way to be able to take the right decisions in order to reduce risks and to reach the goals set by the Cooperative staff, the researchers searched information about topic in books, web pages and documents of the Cooperative, consequently was applied inquiries to the savers, it has yielded information of necessities and how they are covered by the institution, in the same way the investigators applied interviews to managers for determining their management criteria for the time that has been providing its services, performed the analysis of the structure general balance state of results and financial indicators, it established that the level of debt has decreased and the contribution of the partners has increased, its profitability is solved with own economic resources also gradually increased liquidity and covers all its immediate obligations, it was concluded that the administrative staff requires ongoing training in customer service and the development of their activities while strengthening their management strategies and carry just the respective analysis to prevent financial risks so it helps to improve economic and financial management, which are useful in making decisions, necessary facts for Cooperativa de Ahorro y Crédito “UNIBLOCK” Ltda., can reach a high level of economic and social development.En la presente investigación se ha realizado el Análisis Financiero a la Cooperativa de Ahorro y Crédito “UNIBLOCK” Ltda., de la ciudad de Latacunga, con el propósito de evaluar el comportamiento operativo, conocer la situación actual de la entidad y determinar los riesgos financieros a los cuales puede estar expuesta, de esta manera poder tomar las decisiones más adecuadas con el propósito de reducir los riesgos y cumplir los objetivos planteados por la Cooperativa, para ello se revisó bibliografía respecto al tema en libros, páginas electrónicas, documentación de la cooperativa, consecuentemente se realizó encuestas a los cuenta ahorristas que permitió conocer las necesidades y como estas son cubiertas por la institución, de la misma manera se procedió a la aplicación de entrevistas a los directivos ayudando a determinar su criterio sobre la gestión durante el tiempo que ha venido brindando sus servicios, se realizó el análisis de la estructura y composición del balance general, estado de resultados así como los indicadores financieros, con lo cual se pudo establecer que el nivel de endeudamiento ha disminuido y la aportación de los socios se ha incrementado, su rentabilidad está solventada con recursos propios, asimismo su liquidez aumento gradualmente es decir cubre todas sus obligaciones inmediatas, se concluyó que el personal administrativo requiere de capacitaciones continuas en atención al cliente y en el desarrollo de sus actividades a la vez fortalezcan sus estrategias de gestión y lleven a cabo el respectivo análisis para prevenir riesgos financieros así contribuir a mejorar la gestión administrativa financiera y económica que a su vez son de gran utilidad en la toma de decisiones necesarias para que la Cooperativa de Ahorro y Crédito UNIBLOCK., pueda alcanzar un nivel de desarrollo económico y social adecuado

Pathogenesis and clinicohistopathological caractheristics of melanoacanthoma: a systematic review

Introduction: The melanoacanthoma is a rare benign pigmented tumor, characterized by a fast radial growth and clinical behavior similar to melanoma. Color changes in oral mucosa and dermis are consequence of increased melanocyte activity as response to an irritant factor. There is a vast phenotypic variety. It is difficult to distinguish between a benign pigmented lesion and a melanoma at its early stage. Due to its clinical relevance is crucial to diagnose possible malignancy of the lesions. Objectives: The aim of this article is to conduct a systematic review of all published articles, as well as update and evaluate etiologic factors and clinicopathological features. Material and Methods: We carried out a search in the Medline database (PubMed) using the key words “oral melanoacanthoma” AND “oral melanoacanthosis” AND “oral melanoepithelioma”. Inclusion criteria were all published articles since its discovery. Demographic data, histological features and immunohistochemical findings were extracted from the full articles. Results: A total of 56 articles were analysed. 114 injuries drawn from these articles were studied, a total of 115 injuries with our contribution case. The 74.78% of authors claim a reactive pathogenesis. The average age of lesión appearance is 34.79 years, with an age range of 5-87 years. There is a predominance of the female sex in solitary phenotype 3: 2 and a ratio of women to men 5: 3 if it is multifocal phenotype. Bilateral phenotype is slight higher in women of 2: 1. Conclusions: Histopathological analysis of the lesión is vital to diagnose malignancy. Therefore, any heterogeneous, pigmented lesion with irregular edges, raised surface, fast growth and abrupt appearance should be biopsied. More emphasis on the potential irritants should also be put to improve the quality of life of our patients and to reduce morbidity of melanoacanthoma, as well as, several similar clinical behavior disease

The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction

Despite efforts to prevent postoperative discomfort, there are still many immediate side effects associated with the surgical extraction of impacted lower third molars. Cicatrization is a physiological process through which the loss of integrity of oral mucosa is recovered and damaged tissues are repaired. Bexident Post (ISDIN, Spain) is a topical gel that contains chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol. While this gel has many clinical indications, there are no published clinical trials evaluating its use in impacted mandibular third molar surgery. This study aims to clinically evaluate the efficacy of a gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on wound healing and reduction of postoperative side effects and complications after extraction of an impacted mandibular third molar. A split-mouth design study was carried out on a total of 50 bilaterally and symmetrically impacted third molar extractions, which were randomly placed into either a control group (CG=25) or an experimental group (EG=25). Patients were all informed of the purpose of the study and provided written consent. All procedures were carried out by the same dental practitioner, in accordance with standard surgical protocol. A different dental practitioner, unaware of which treatment had been applied, provided follow-up care. The EG applied 10 ml of topical gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol to the surgical wound three times a day for 10 days, patients in the CG did not apply any gel. The groups were homogeneous insofar as potentially confounding variables. No significant findings were found regarding postoperative swelling and pain. Neither of the groups displayed poor healing or infectious complications of the wound during the postoperative period. In all the recorded follow-ups (Day 7 p=0.001, and Day 14 p=0.01), the wound?s aesthetic appearance was better in the EG. Overall treatment tolerance was satisfactory and similar in both groups. The gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol did not aid in patients? postoperative comfort; however, improved wound healing was observed

Influence of dental treatment in place on quality of life in oral cancer patients undergoing chemoradiotherapy

This study aims to assess, in the population of patients with oral cancer treatment, the influence on the quality of life of two protocols of dental treatment: not ruled hospital treatment versus ruled hospital treatment. A quasi-experimental approach justified on ethical grounds was used. A total of 41 patients were included in the control group (not ruled treatment outpatient health center) and 40 in the experimental group (ruled hospital treatment). A total of 14 questions to both groups were conducted in three stages: before starting cancer treatment, during treatment and after treatment. the proportions of positive responses in groups and different times were compared using the chi-square test. Based on similar situations during cancer treatment were identified as six issues favorable to the experimental group difference. This number rose to nine after finishing oncological treatment. From our data we can confirm that planned dental treatment performed during the oral cancer treatment produces an improvement in the quality of life in patients with oral cancer

Evolution of oral cancer treatment in an andalusian population sample : rehabilitation with prosthetic obturation and removable partial prosthesis

Radical surgical resection as a treatment modality for oral cancer often leads to an extensive deficit in both the maxillary and mandibular levels, where the use of a palatal obturator prosthesis (POP) or removable partial denture (RPP). The aim of this study was to evaluate the treatment with POP and RPP in patients treated for oral cancer in the Unit of Prosthetic Rehabilitation of the University Hospital Virgen del Rocío in a period of 20 years. Retrospective descriptive study during the years 1991 and 2011 analyzing oral cancer type, characteristics, treatment and follow-up. The sample consisted of patients whose tumor had previously been removed and who had been referred to the Oncological Rehabilitation Unit of the Oral and Maxillofacial Surgery Unit of the ?Virgen del Rocío? University Hospital for rehabilitation. The inclusion criteria were patients whose underlying pathology was any type of neoplasia, which after its treatment had been referred to the aforementioned Oncological Prosthetic Rehabilitation unit. Of the 45 patients included in our study, 15 patients were rehabilitated with palatal obturator (33.3%) and 5 patients with removable partial denture (11.1%). The mean age of the sample of patients with POP was 57.3 ± 9.23, while the mean age of the sample of patients with RPP was 58 ± 13.5. The most common underlying pathology in patients with POP was squamous cell carcinoma (60%), whereas in patients with RPP it was 100%. The most frequent location found among POP patients was the upper jaw, while in the PRP patients there was no predominant location. The univariate and multivariate logistic regressions did not show any statistically significant association between the independent variables age, sex, smoking habit and alcoholic habit with the dependent variable type of rehabilitating prosthesis. Based on our data, we can conclude that RPP is used in few cases of oncological rehabilitation. The POP has a greater use, as long as the defect in the bones of the facial middle third is limited

Advantages of surgical simulation in the surgical reconstruction of oncological patients

Stereolithography, which consists of computer-aided designed/computer-aided manufactured (CAD-CAM) and computer simulations, is a manufacturing technologies used for the production of definitive models and prototypes printed in three dimensions, and is widely used in Oral and Maxillofacial Surgery. Surgical procedures using models made by these technologies offer several advantages. This article describes three clinical cases of our experiences with patients diagnosed with squamous cell carcinoma and mandibular osteosarcoma, who underwent surgical removal of the lesions and subsequent mandibular reconstruction with a free fibula graft using surgical guides. In all three clinical cases, surgical guides were used for the mandibular osteotomy, fibula osteotomy, and graft placement in the recipient area. Surgical guidelines are useful for improving the accuracy of surgical interventions and are appropriate for many types of resection and mandibular reconstruction