miércoles, 28 de febrero de 2007

GIST: tratamiento


Tumor estromal gastrointestinal
Glivec®


La cirugía es el tratamiento clásico de los GIST y el único que sigue siendo capaz de curarlos. Sin embargo, como hemos visto, muy pocos casos permanecen aún en fase operable cuando se diagnostican. Por otro lado, un porcentaje apreciable de los pacientes operados de GIST recae. La mayoría de las recaídas sucede en el primer o segundo año después de la cirugía, aunque se han documentado hasta 20 años tras la operación.
La probabilidad de recaer puede calcularse en función del tamaño del tumor y del número de mitosis (la cantidad de células que aparecen dividiéndose al observar el tumor al microscopio). Los GIST operados de menos de uno o dos centímetros y escasas o nulas mitosis recaen tan infrecuentemente que casi se consideran tumores benignos. En cambio, los tumores con más de 10 centímetros o mitosis muy numerosas ocasionan metástasis en casi todos los casos. Actualmente se está investigando si estos pacientes de alto riesgo sufren menos recaídas al tomar Glivec® después de la cirugía. Este uso del medicamento no está todavía demostrado y ningún paciente debería tomarlo fuera de un ensayo clínico aprobado por la administración sanitaria.
Si un GIST se rompe en el interior de la cavidad abdominal mientras se intenta extirparlo, la recaída es segura. Por este motivo, la cirugía laparoscópica (mediante tubos introducidos en el interior del abdomen, que permanece cerrado durante la operación) está completamente contraindicada. Por otro lado, si a un cirujano le parece que un GIST tiene mucho riesgo de romperse al manipularlo, lo correcto es iniciar el tratamiento con Glivec® y dejar la operación para meses después, cuando el tumor se haya reducido y ‘enfriado’ y resulte segura su extracción.
La forma más común de presentación de un GIST es la de un tumor tan desarrollado en el interior del abdomen que resulta imposible extirparlo por su tamaño o bien porque ya ha sembrado metástasis en otros órganos distantes. Hasta el año 2001 no existía tratamiento eficaz. Hoy en día, todos los enfermos en esta situación se tratan con el nuevo fármaco, mesilato de imatinib, al que nos referiremos en lo sucesivo por el nombre comercial, Glivec. (Dicho sea de paso, no es casual que las compañías farmacéuticas denominen a sus moléculas, de nombres complicadísimos, con marcas comerciales más sencillas. ¡Lo hacen para que nos acostumbremos a nombrarlos por la marca, y no por el producto activo, que podría ser compartido por otra compañía!).
La historia de cómo Glivec llegó a ser empleado en los GIST es curiosa y merece ser contada. Es un medicamento desarrollado por científicos de la empresa farmacéutica Novartis (poseedora de la patente de Glivec) a finales de los años noventa ex profeso para el tratamiento de la leucemia mieloide crónica.
Bcr-Abl es un enzima aberrante que ocasiona la leucemia en las células de la sangre de manera análoga a cómo KIT origina los GIST en las células intersticiales de Cajal. Para ejercer su acción, los enzimas necesitan una fuente de energía, que suele ser una molécula llamada ATP. Glivec fue diseñado para interferir con la reacció química mediante la que el ATP proporciona energía al enzima Bcr-Abl. En la metáfora del coche con el acelerador atascado a fondo y los frenos averiados, Glivec actuaría vaciando el depósito de gasolina.
Algunos investigadores se percataron muy pronto de que las estructuras de los enzimas Bcr-Abl y KIT eran casi idénticas, y decidieron ensayar el fármaco de las leucemias en los GIST. En primer lugar, emplearon células cancerosas cultivadas en laboratorio caracterizadas por tener mutaciones en KIT. Al ser incubadas con Glivec, el crecimiento incontrolado se detuvo en todos los casos. Los permisos para iniciar ensayos en humanos se obtuvieron con una rapidez desacostumbrada y en el año 2001 se trató un paciente que padecía metástasis de GIST. La respuesta fue tan espectacular y duradera que los investigadores decidieron comunicar el caso al 'New England Journal of Medicine', la revista médica más prestigiosa del mundo, vinculada a la universidad de Harvard.
Debía de hacer décadas que el 'New England' no aceptaba un artículo basado en un solo paciente, pues algo así se considera anecdótico y una publicación tan exigente sólo acepta ensayos clínicos basados en centenares o millares de casos tratados bajo las más estrictas condiciones experimentales. Sin embargo, en esta ocasión, lo hizo, y Glivec comenzó a emplearse inmediatamente en todo el mundo para tratar los GIST, con idénticos resultados.

8 comentarios:

Leonudio dijo...

Este blog es un poco vergonzoso... lo publica un usuario de internet?? o la empresa que vende el fármaco??

Anónimo dijo...

I've as a last resort liked things like sand clocks, lava lamps, and the like to good of rightful dissipate all at once staring at it as a form of catharsis. In a course, it helps me with meditation, to mitigate lay stress and just deem in the air nothing. That's why since I was a kid, in preference to of dolls and cars I've in any case sedate more of such pieces like sand clocks, lava lamps, musical boxes etc. So I was most charmed when I found the[url=http://www.dealtoworld.com/goods-1260-2-Laser++LED+Light+Show+Laser+Top+Gyroscope+with+Music+Effects.html] 2-Laser + LED Inconsiderable Appear Laser Ace Gyroscope with Music Effects[/url] from DealtoWorld.com answerable to the Toys section. It's like a melodic belt, a spinning head, and a light verify all rolled into one. Which is prodigious diversion! The gyroscope transfer spin for around a minute. The laser slight display with accompanying music makes this gyroscope a pretty corresponding exactly bauble that my friends be subjected to also been most amused with.

My dogs are also beautiful outr?nearly the laser gyroscope I got from DealtoWorld.com. They unceasingly follow the gyroscope as it spins, although at first they kept barking at the laser diverting dismiss show, and also because it produces music. But after they got tempered to it, they've stopped barking but just save up following the gyroscope whenever I start spinning it. Kids are also pretty amused by it. Off it's meet to have entertaining toys throughout the ancestry so that you can leave the toy on while the kids are being amused or playing with it while you count provide for foodstuffs or get changed. The gyroscope is a particular such fool with with this purpose.

The gyroscope I bought from DealtoWorld.com has a dragon as a intent plot on it, and produces a dainty exposition with red, blue, and unskilled colours. Take a look at the pictures I've uploaded of the gyroscope with laser joyful show. The music produced from the gyroscope is not that great but good plenty to accommodate any supplementary visitor to the house. The gyroscope is red and black, making it look extraordinarily imperturbable, and somewhat masculine with that dragon imprint.

The music luminescence make clear gyroscope runs on 6 LR44 batteries, which are replaceable anyway. I've also utilized this gyroscope to stagger my girlfriend during our anniversary celebration. I did the cheesy thing of decorating the hotel elbow-room with roses and when I led her in, I started up the gyroscope as affectionately so that the laser light clarify produces a fresh effect. I also had some battery operated candles so all the sunrise effects created a sort of mawkish atmosphere. She loved it, past the style, to my relief. I also bought the candles from DealtoWorld.com. These days it seems to be my default shopping put suitable all gifts and ideas for emotional occasions.

Since Christmas is coming, this laser light upstage gyroscope can maybe be a superb Christmas contribution for the toddler or even the humour! Alternatively, the gyroscope can altogether be a polite totalling to the ordinary Christmas decorations. I can fancy placing it within a mile of the Christmas tree and perhaps spinning it when guests hit town in the house. Looks like [url=http://www.dealtoworld.com]DealtoWorld.com[/url] is getting my business anyway again!

Anónimo dijo...

Ryan Kerrigan Jersey axiotakix
Nike T.Y. Hilton Jersey axiotakix
Marshawn Lynch Jersey Women's axiotakix
http://www.authenticniketexansjerseys.com

Anónimo dijo...

[b][url=http://www.louisvuittonhandbagsu.com/]www.louisvuittonhandbagsu.com[/url][/b] Louis Vuitton was born in France in 1821. With the age of 14 he travelled to Paris by foot. Within the age of sixteen he grew to be developed a expertise in baggage generating. - A footing pad or tail pad: This wonderful solution of package is positioned for that path of your respective surf board, commonly above the back bout. It is usually generally wherever your back feet are put on the surfboard so it helps with traction and traction even supposing accomplishing manoeuvres. The tail mat or traction mat is frequently a practical merchandise of tools to have above a surf board, how it behaves as a details for kinds back again foot and supply just seated purpose for to put your back ft.

[b][url=http://www.cheapuggbootswebsite.com/]ugg boots outlet[/url][/b] "We are plainly getting into into a new time, and it really is currently being pushed because of the customer," states Marshal Cohen, field analyst at NPD Team in New york. "The consumer is shopping for solutions which can be far more relevant, and it is actually swaying how the field operates. for panic of tarnishing its id as a status brand name.

[b][url=http://www.louisvuittonpursesmarket.com/]louis vuitton outlet[/url][/b] After building a splash that has a sexy Calvin Klein advert campaign featuring a scantily clad Eva Mendes, Steven Meisel turned up the heat for just a 2009 Calvin Klein denims promotion that showcased two model partners in various levels of undress and denims. It was a memorably alluring campaign that elevated eyebrows and pulses alike, proving that Steven Meisel nevertheless experienced the image chops to efficiently advertise a product on the visual degree and get shoppers and field sorts talking while doing so. He would also get the job done with Madonna another time in 2009 over a marketing campaign assignment for trend household, Louis Vuitton..

[b][url=http://www.uggsbootsoutletmall.co.uk/]uggs boots[/url][/b] Have your personal Style - For anyone who is a tomboy, you might be much better off selecting a pair of Toddler Phat runners than you happen to be deciding on a pair of Versace stilettos. Likewise, for anyone who is accustomed to carrying heels, a pair of flats might truly end up hurting your back again likewise. It really is vital to decide on a method of shoe that your body is employed to carrying.

[b][url=http://www.louisvuittonhandbagsu.com/]Louis Vuitton purses[/url][/b] So the following goes. Martin Luther King was a person who lived in braveness and vision each working day of his daily life. He was a person who most probably lived in panic and faced challenges for pursing his dreams and convictions. Candice Huffine is surely an American product presently signed with Ford Designs finest recognized for showing up around the deal with on the June 2011 situation Vogue Italia with Tara Lynn and Robyn Lawley shot by Steven Meisel and in the main editorial Sogne di Donna shot by Steven Meisel along with Marquita Pring, Tara Lynn, and Robyn Lawley [29]. She to start with turned properly identified right after showing inside a January 2010 editorial Curves Forward shot for V (American journal) by Solve Sundsbo with Tara Lynn, Kasia Pilewicz, Michelle Olson, and Marquita Pring[30]. Candice has long been showcased in two editorials in W (journal), Transformers shot by Steven Meisel to the September 2011 situation, as well as Girly Show shot by Mert and Marcus for your March 2012 issue[31] [32].

Anónimo dijo...

[url=http://www.23planet.com]casino[/url], also known as doc riches casinos or Internet casinos, are online versions of weighty ("chunk and mortar") casinos. Online casinos determine gamblers to pretender and wager on casino games from critical time to foot the Internet.
Online casinos habitually skiff odds and payback percentages that are comparable to land-based casinos. Some online casinos emphasize on higher payback percentages with a judgement concern gismo games, and some publish known payout diversion audits on their websites. Assuming that the online casino is using an fittingly programmed unpremeditatedly concert-hall generator, tableland games like blackjack preoccupy an established forebears edge. The payout zephyr scolding after these games are established sooner than the rules of the game.
Uncounted online casinos commission source or take their software from companies like Microgaming, Realtime Gaming, Playtech, Broad Imposture Technology and CryptoLogic Inc.

Anónimo dijo...

|
|
|

Anónimo dijo...

[url=http://www.saclongchamparefamous.sitew.us/#Page_1.A]sac longchamp[/url] It worked out great. I filled up the gigantic inner pocket with more than enough diaps Fashionable Women Mulberry Euston Leather Tote Bag Dark Gray,Hot Selling In Our Mulberry Handbags Online Shop. and wipes for the whole weekend. It kept me organized in the car and once we got to the hotel.. Marta and Maria found out they were each other's roommates about one week prior to heading to college. They had never met before. In many respects, Marta and Maria have a lot in common.
[url=http://longchamppaschers.bravesites.com/]sac longchamps[/url] The new Fashionable Mulberry Women's Oversized Alexa Leather Satchel Blue Bag, and Mulberry sale outlet online shop supply latest collections of mulberry bags with competitive price. design cuts the production cost of extracting Uranium from ocean water from $1232 to $660 per kilogram. This is still five times more expensive than Uranium mined from the Earth. "A sharp spike in uranium prices in 2007 had many people scared in terms of the sustainability of the nuclear industry," ORNL chemical scientist Sheng Dai says.
[url=http://longchamppliagea.webnode.nl/]sacs longchamps[/url] All around us are the signs of early afternoon lethargy, barely a person in sight. Shops and workshops are shut. Cars are parked slipshod, their drivers certain that no traffic will be coming through. The brand Gucci carries enormous value and so one has to exercise caution while buying the bags lest they should land up buying the replicas. Gucci bags are undoubtedly the onlookers' envy and the owner's pride. No Coveted Mulberry Outlet Standard Alexa Leather Satchel Camel Bag in cheap price and latest fashion and style doubt, they make a wonderful and ideal gift to the person you care for.. Coach Chelsea Handbags is another collection of Coach handbags you might want to check. These are considered one of the hottest and latest look in Coach Collection. Usually, you can find a Coach Chelsea handbag at a very affordable price. luxury brand, luxury brand appeal is rich. Luxury (luxury) from the Latin of light (lux). Therefore, the luxury goods should be shiny, bright,Louis Vuitton Bags, and people enjoy.

Anónimo dijo...

You commit an error. I can prove it. Write to me in PM, we will communicate.
I perhaps shall simply keep silent
Absolutely with you it agree. In it something is also idea excellent, agree with you.
In it something is. Thanks for the help in this question. All ingenious is simple.
Bravo, you were visited with simply brilliant idea

[url=http://shenenmaoyipo.esporteblog.com.br/][b]michael kors outlet online[/b][/url]
[url=http://michaelkorscheap2.eklablog.com/how-are-leather-bags-special-a65292303][b]michael kors outlet online[/b][/url]
[url=http://cheapmkbag2.newsvine.com/_news/2013/01/21/16620627-classic-notlie-designer-handbags-for-spring-2012][b]michael kors outlet online[/b][/url]
[url=http://www.homebasedbusinessprogram.com/profiles/blogs/retail-company-bags-wholesale-retail-bags][b]michael kors outlet online[/b][/url]
[url=http://shenenmaoyizzz.webstarts.com/?r=20130118213751][b]michael kors outlet online[/b][/url]