Introducción: La tuberculosis (TBC) es una enfer-medad infecciosa causada por el Mycobacterium tuberculosis. Esta enfermedad afecta principal-mente a los pulmones, pero que presenta afección de sitios extrapulmonares como por ejemplo la laringe. En la era previa al tratamiento antibiótico, la incidencia de TBC laríngea correspondía entre el 37,5% al 48% de los casos con TBC pulmonar, actualmente no es más allá del 1%. En el presente la TBC sigue siendo un problema de salud pública, ya que el SIDA, enfermedades y tratamientos inmudepresores han aumentado la incidencia y el espectro de la TBC. Debido a que las características clínicas de la TBC laríngea están cambiando, el diagnóstico puede ser difícil. El objetivo de este estudio es evaluar las característi-cas clínicas de la TBC laríngea. Materiales y métodos: Se utilizó el registro de un hospital de Taiwan desde febrero de 1992 a marzo de 2006, obteniéndose 26 casos de TBC laríngea, que presentaban como criterio de diag-nóstico la presencia de bacilo ácido-alcohol resis-tente (BAAR) o cambios histológicos caseificantes en las biopsias. Se analizan los registros de signos y síntomas, ubicación y aspecto de las lesiones, radiografía de tórax, baciloscopías, respuesta al tratamiento y se realiza la comparación de estos datos con otras revisiones. Resultados: La edad promedio de los pacientes fue 47,11 años, la relación hombre-mujer 2,7:1. Los pacientes hombres eran significativamente mayores que las mujeres. Cuatro pacientes con antecedentes de DM tipo 2, 2 con antecedentes de TBC pulmonar, 2 en tratamiento inmunosupresor y sólo 9 pacientes con antecedente importante de tabaquismo, el resto no presentaba antecedentes mórbidos de importancia. La duración de los síntomas fue en promedio de 4,06 meses. El síntoma más importante la disfonía (84,6%), seguida de tos, odinofagia dis-nea, fiebre y estridor en menor grado. Con respecto al tipo de lesiones encontrados en laringoscopía fue variada: mucosa blanca 38,5%, inflamación inespecífica 26,9%, ulceración 13,5%, lesiones granulomatosas 13,5%, presencia de lesiones mixtas 53,8%. La inmovilidad cordal se presentó en forma unilateral en 2 pacientes y en forma bilateral en sólo uno. Los sitios laríngeos comprometidos ordenados de mayor a menor frecuencia fueron: cuerdas vocales, comisura posterior, bandas ventriculares, epiglotis, hipofaringe, orofaringe, nasofaringe, subglotis. Más de la mitad de los pacientes presen-taban compromiso de más de un subsidio, 1/3 presentó lesiones bilaterales siendo el lado dere-cho el más afectado. El 92,3% de los pacientes presentó hallazgos positivos para TBC. El cultivo de expectoración presentó el doble de rendimiento que la baciloscopía. Las lesiones y la calidad de la voz mejoraron a los 3 meses de tratamiento. Los pacientes con inmovilidad cordal unilateral recuperaron su movilidad después del tratamiento. Conclusiones: En este estudio, la TBC laríngea predomina en los hombres, la edad media de presentación en las mujeres es significativamente inferior a la de los varones, por lo que...

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Diagnostic tools may enable the clinician to obtain a definitive diagnosis in patients where there is a strong suspicion of PS via a noninvasive procedure. Computed tomography angiography may be the diagnostic imaging method of choice for optimal evaluation of the sequestrated lung and its vascular supply.

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Advanced non-small-cell lung cancer (NSCLC) patients with poor performance status (PS) are less likely to respond to chemotherapy, or to have an improvement in survival, but more likely to experience toxicity. We retrospectively evaluated the efficacy and tolerability of gefitinib in patients with advanced NSCLC and very poor PS in Taiwan. Patients with stage IIIB, IV NSCLC with an Eastern Cooperative Oncology Group (ECOG) PS of 3-4 received oral gefitinib 250 mg once daily. Totally, 52 patients were included (25 men, 27 women). Forty-three patients (82.7%) were in a PS of 3. Tumor response rate was 25.0% (13/52). Tumor response rate to gefitinib was highest in chemonaive patients 38.1% (8/21) vs. failed 1 chemotherapy regimen 13.3% (2/15) vs. failed 2 or more chemotherapy regimens 18.8% (3/16), p = 0.015. The median overall survival was 2.5 months (response group 9.1 months, stable disease 3.1 months, and progressive group 0.8 month, p < 0.001). Adverse events, mainly skin reactions and diarrhea, were generally mild (grade 1 or 2) except paronychia and acne. Thus, gefitinib has clinically antitumor activity and good tolerability in Taiwan patients with advanced NSCLC and very poor performance status, with a higher response rate than that seen Europe or in European heritage Americans. Chemonaive patients responded better than patients with prior chemotherapy. Formal clinical trials are warranted to evaluate the role of gefitinib in this situation.

The change in the environment and implementation of device bundles in the NICU might be associated with the nosocomial infection rate.

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Background: Gender, smoking history, adenocarcinoma histology, performance status, and East Asian ethnicity were predictive factors of gefitinib response in previous analysis. However, these factors tend to be correlated with each other; it is not clear whether gender, smoking history, and adenocarcinoma histology were all independent predictors for response in East Asian populations. Methods: Tumor response, survival and predictive factors of gefitinib response of advanced non-small cell lung cancer patients treated between May of 2002 and November of 2004 were collected retrospectively from three medical centers in Taiwan. Univariate and multivariate logistic regression models were used to test potential predictive factors associated with response to gefitinib. Overall survivals between groups with different predictive factors were compared by log-rank tests. Multivariate analyses were performed to identify factors that independently predict for survival. Results: A total of 428 patients were analyzed. The median follow-up duration for living patients was 19.5 months (range, 10.2-39.9). Objective tumor response was observed in 114 patients (26.6%, 95% confidence interval [CI]: 22.4%-30.8%) and disease stabilization in 129 patients (30.2%). Response rate was statistically significant higher in adenocarcinoma, good performance status, and chemonaive patients in multivariate analysis. The median survival was 7.4 months (95% CI: 5.8 -9.0) and 1-year survival was 34.3% (95% CI: 29.0%-38.0%). Significant independent predictive factors associated with longer survival in multivariate analysis were good performance status (p Ͻ 0.001) and responsiveness to gefitinib (p Ͻ 0.001). In 286 chemotherapy-treated patients, the response rate was 22.7%. Median and 1-year survival was 7.9 months and 36.7%, respectively. Good performance status was predictive of tumor response (p Ͻ 0.001) and better survival (p Ͻ 0.001) in multivariate analysis. Response to gefitinib was predictive of better survival (p Ͻ 0.001). Conclusions: Gender and smoking status were not, but good performance status (PS), no previous chemotherapy, and adenocarcinoma histology were independent predictive factors in multivariate analysis for gefitinib response in Taiwanese advanced non-small cell lung cancer population. In patients previously treated with chemotherapy, only good PS was an independent predictor for tumor response in multivariate analysis.