Guía del carcinoma de células renales

ObjectivesThe European Association of Urology (EAU) Guideline Group for renal cell carcinoma (RCC) prepared this guideline to help urologists assess the evidence-based management of RCC and to incorporate the guideline recommendations into their clinical practice.MethodsThe re commendations provided in the current guideline are based on a systematic literature search using MedLine, the Cochrane Central Register of Controlled Trials, and publications and review articles.ResultsA Limited Number of prospective randomized studies are available with high-level evidence.Most publications concerning RCC are based on retrospective analyses, including some larger multicentre validation studies and well-designed controlled studies.ConclusionsIt must be stressed that the current guideline contains information for the treatment of an individual patient according to a standardized general approach. Updated recommendations concerning diagnosis, treatment, and follow-up can improve the clinical handling of patients with RCC.     

Factores pronósticos del carcinoma de células renales

Renal cancer has been increasingly diagnosed in recent decades. In addition, morphological diversity of renal neoplasms has led to consider that the concept of renal cell (RC) carcinoma encompasses a wide variety of conditions. The recently publshed EROCARE-4 study showed a 5-year overall survival rate of 59.2%. In this and any other neoplastic disease, determination of adequate prognostic factors would help decide the most appropriate therapeutic strategy in each case, guide future treatments, and develop specific follow-up schemes for our patients. The diferent prognostic factors for RC may currently be classified into four groups: anatomical, clinical, histological and molecular. This paper analyzes these prognostic factors and reviews the nomograms most commonly used.     

Surgeon-performed ultrasound predictors of malignancy in patients with Hürthle cell neoplasms of the thyroid

Background

Fine-needle aspiration cannot reliably determine malignancy in patients with Hürthle cell neoplasms (HCNs) of the thyroid. Thyroid nodule size and characteristics determined by surgeon-performed ultrasound (SUS) may be useful for predicting malignancy in HCN preoperatively. This study examined whether tumor size and features by SUS can reliably predict malignancy in patients with HCN.

Materials and methods

We performed a retrospective review of 84 patients with HCN by fine-needle aspiration, who underwent SUS and thyroidectomy from 2002 to 2010. All patients underwent thyroid lobectomy with isthmusectomy unless there was a history of radiation exposure, familial thyroid cancer, obstructive symptoms, bilateral nodules, and/or patient preference, in which case total thyroidectomy was performed. Tumor size and malignant features by SUS were correlated with final histopathology using multivariate regression analysis.

Results

On final histopathology, 29 patients had malignant thyroid nodules and 55 patients had benign ones. There were no statistically significant differences in terms of age, race, ethnicity, or gender between HCN patients who revealed malignant or benign nodules on final pathology. Tumor size ≥ 4 cm measured by SUS did not predict malignancy in HCN. Hypoechogenicity and hyperechogenicity were significantly associated with malignancy, whereas isoechogenicity was predictive of benignity (P = 0.044). No other ultrasonographic features were predictive for thyroid carcinoma by multivariate analysis.

Conclusions

Tumor size and features determined by SUS do not reliably predict malignancy in patients with HCN. Such patients at risk for malignancy should initially undergo thyroid lobectomy for definitive diagnosis.     

Tratamiento del carcinoma broncogénico de célula no pequeña en estadios precoces

Treatment of lung carcinoma is multidisciplinary. There are different therapeutic strategies available, although surgery shows the best results in those patients with lung carcinoma in early stages. Other options such as stereotactic radiation therapy are relegated to patients with small tumors and poor cardiopulmonary reserve or to those who reject surgery. Adjuvant chemotherapy is not justified in patients with stage i of the disease and so double adjuvant chemotherapy should be considered. This adjuvant chemotherapy should be based on cisplatin after surgery in those patients with stages ii and IIIA.     

Complications cardiovasculaires de l’agression cérébrale

The clinical importance of cardiovascular consequences resulting from cerebral injury has long been recognized. However, interactions between the brain and the cardiovascular system remain poorly defined and their importance for the management of patients suffering from acute brain injury is largely underestimated. This should have profound consequences on treatment strategies during anaesthesia and intensive cares of these patients, taking into account not only brain perfusion, but also cardiovascular optimisation. This report summarizes the main data available regarding the cardiovascular consequences of brain death, traumatic brain injury, stroke and epilepsy.