Parathyroid carcinoma is a rare malignant disease that presents as a sporadic or familial primary hyperparathyroidism (PHP). The latter is associated with some genetic syndromes. It occurs with equal frequency in both sexes, unlike PHP caused by parathyroid adenoma that is more common in women. It should be suspected in cases of severe hypercalcemia, with high parathyroid hormone levels and a palpable cervical mass. Given the difficulty in distinguishing between parathyroid carcinoma and adenoma prior to the surgery, the diagnosis is often made after parathyroidectomy. The only curative treatment is complete surgical resection with oncologic block resection of the primary tumor to ensure free margins. Adjuvant therapies with chemotherapy or radiation therapy do not modify overall or disease-free survival. Recurrences are common and re-operation of resectable recurrent disease is recommended. The palliative treatment of symptomatic hypercalcemia is crucial in persistent or recurrent disease after surgery since morbidity and mortality are more associated with hypercalcemia than with tumor burden.

Introducción. La neutropenia febril es una complicación frecuente de la quimioterapia para las neoplasias hematológicas. Se dispone de escasa información de sus complicaciones infecciosas en nuestro medio. Objetivo. Evaluar las características clínicas y microbiológicas de pacientes con neutropenia febril, así como su resultado clínico en una institución de referencia oncológica en Colombia. Materiales y métodos. Se conformó prospectivamente una serie de casos con pacientes con enfermedad oncológica confirmada, que consultaron o presentaron neutropenia febril durante la hospitalización. Se excluyeron aquellos con enfermedad hematológica benigna. Se recolectaron datos sobre variables demográficas, microbiológicas, clínicas, de tratamiento y de resultado de los pacientes. Se llevaron a cabo un análisis univariado y uno multivariado, con la mortalidad como resultado. Resultados. Se identificaron 130 episodios de neutropenia febril en 104 pacientes, con una edad media de 19 años y 53 % masculinos. El 86 % de los episodios ocurrieron en pacientes con alteraciones hematológicas. Se demostró infección en 65 % de los casos: 41 % con un foco infeccioso localizado y 27,7 % con bacteriemia. Los principales focos infecciosos se localizaron en el torrente sanguíneo, el aparato urinario, el sistema gastrointestinal, la piel y los tejidos blandos. De los aislamientos microbiológicos, 46,4 % fueron bacilos Gram negativos, 38,4 %, cocos Gram positivos, 9 %, hongos y, 7,1%, parásitos. La mortalidad global fue de 7,7 %. En el análisis multivariado la utilización de un tratamiento empírico apropiado se correlacionó con una menor mortalidad, de forma independiente (OR=0,17; IC 95% 0,034-0,9; p=0,037). Conclusiones. La tasa de mortalidad fue relativamente baja y fue comparable con lo reportado en países desarrollados. El tratamiento antimicrobiano inapropiado fue el principal factor asociado con mortalidad.

Introduction. Febrile neutropenia is a common complication of chemotherapy treatment of malignant hematological diseases. However, there is insufficient information regarding the infectious complications of febrile neutropenia in our country. Objective. We will evaluate the microbial characteristics of bacterial and fungal isolates and the clinical outcome of patients with febrile neutropenia who received medical attention at an oncological reference center in Colombia. Materials and methods. A prospective case series included patients with histologically confirmed oncological disease, who were admitted because of febrile neutropenia or presented with febrile neutropenia during hospitalization. Patients with benign hematological diseases were excluded. Demographic, microbiological, and clinical features as well as treatment and outcome information from patients with febrile neutropenia were obtained. We performed univariate and multivariate analyses, with mortality defined as the outcome. Results. One hundred and thirty episodes of febrile neutropenia were identified in 104 patients. The mean patient age was 19, and 53% of the patients were male. Approximately 86% of the episodes occurred in patients with hematological disorders. An infectious site was identified in 65% of patients; 41% and 24% of the febrile neutropenia pateints´ episodes exhibited a localized infectious focus and developed bloodstream infections, respectively. The majority of infections were found in blood, urine, gastrointestinal tract, and soft tissue. Distribution analysis of microbiological isolates revealed 46.4% Gram-negative bacilli, 38.4% Gram-positive cocci, 8% fungi, and 7.1% parasites; there was a 7.7% mortality rate. Appropriate empirical antimicrobial therapy was a protection-related factor in multivariate analyses (OR= 0.17; 0.034 - 0.9 95% CI; p= 0.037). Conclusions. The mortality rate was relatively low and comparable to the rate reported by developed countries. Inappropriate empirical antimicrobial therapy was the main factor associated with mortality.

Pseudomonas aeruginosa is an important and frightening microorganism for patients suffering from cancer. Multiresistant P. aeruginosa (MRPA) may appear as a consequence of exposure to multiple antibiotics or from a breakdown in infection control practices. This article reports an MRPA outbreak in a cancer treatment centre and the consequent case control study. Mechanical ventilation was identified as being the main risk factor for developing MRPA colonisation or infection; molecular analysis confirmed the outbreak. A multifaceted strategy was adopted, involving reinforcing hand-washing practices, contact isolation, antibiotic restriction and suction devices for mechanically-ventilated patients. MRPA was controlled and the outbreak ended. Such strategy may be effective in controlling MRPS in low-resource environments amongst high risk cancer patients.

Background: Functional limitations limit the independence and jeopardize the quality of life of elderly subjects. Aim: To assess the association between anthropometric measures and body composition with functional ¡imitations in community-living older people. Material and Methods: Cross-sectional survey of 377 people >6 5 years old (238 women), randomly selected from the SABE/Chile project. Complete anthropometric measurements were done. Handgrip muscle strength was measured using dynamometers. Body composition was determined using Dual-Energy X-Ray Absorptiometry. Functional limitations were assessed using self reported and observed activities. Results: Body mass index was strongly associated with fat mass (men r =0.87; women r =0.91) and with lean mass (men r =0.55; women r =0.62). Males had significantly greater lean mass (48.9 kg vs 34.9 kg), and bone mass than females (2.6 kg vs 1.8 kg) and women had higher fat mass than men (26.3 kg vs 22.9 kg). The prevalence of functional ¡imitations was high, affecting more women than men (63.7% vs 37.5%, p <0.01). Functional ¡imitations were associated with lower handgrip strength in both sexes. In the multiple regression models, with functional ¡imitations as dependent variable and anthropometric measures as contributing variables, only hand grip strength had a significant association (negative) with functional ¡imitation in both genders. Age was also a significant risk factor for functional ¡imitations among women. Conclusions: Hand grip strength was strongly and inversely associated with functional ¡imitations. Handgrip dynamometry is an easy, cheap and low time-consuming indicator for the assessment of functional ¡imitations and the evaluation of geriatric interventions aimed to improve functional ability