Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)

Autores:
Baracaldo Ayala, Rafael Leonardo
Peña Carvajalino, Laura Felisa
Gómez Rodríguez, Omar
Nieto, José Fernando Polo
López Correa, Patricia
Medina, Rafael Parra
Tipo de recurso:
Article of journal
Fecha de publicación:
2020
Institución:
Fundación Universitaria de Ciencias de la Salud - FUCS
Repositorio:
Repositorio Digital Institucional ReDi
Idioma:
spa
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oai:repositorio.fucsalud.edu.co:001/2107
Acceso en línea:
https://repositorio.fucsalud.edu.co/handle/001/2107
https://doi.org/10.31260/RepertMedCir.v29.n1.2020.172
Palabra clave:
carcinoma colorrectal
inestabilidad microsatelital
histopatología
carcinoma colorrectal
inestabilidad microsatelital
histopatología
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openAccess
License
Revista Repertorio de Medicina y Cirugía - 2020
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repository_id_str
dc.title.spa.fl_str_mv Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
dc.title.translated.eng.fl_str_mv Histopathologic characteristics of microsatellite instability in colorectal cancer
title Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
spellingShingle Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
carcinoma colorrectal
inestabilidad microsatelital
histopatología
carcinoma colorrectal
inestabilidad microsatelital
histopatología
title_short Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
title_full Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
title_fullStr Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
title_full_unstemmed Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
title_sort Características histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)
dc.creator.fl_str_mv Baracaldo Ayala, Rafael Leonardo
Peña Carvajalino, Laura Felisa
Gómez Rodríguez, Omar
Nieto, José Fernando Polo
López Correa, Patricia
Medina, Rafael Parra
dc.contributor.author.spa.fl_str_mv Baracaldo Ayala, Rafael Leonardo
Peña Carvajalino, Laura Felisa
Gómez Rodríguez, Omar
Nieto, José Fernando Polo
López Correa, Patricia
Medina, Rafael Parra
dc.subject.spa.fl_str_mv carcinoma colorrectal
inestabilidad microsatelital
histopatología
topic carcinoma colorrectal
inestabilidad microsatelital
histopatología
carcinoma colorrectal
inestabilidad microsatelital
histopatología
dc.subject.eng.fl_str_mv carcinoma colorrectal
inestabilidad microsatelital
histopatología
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-03-16 00:00:00
2022-02-21T20:34:13Z
dc.date.issued.none.fl_str_mv 2020-03-16
dc.date.available.none.fl_str_mv 2020-03-16 00:00:00
2022-02-21T20:34:13Z
dc.type.spa.fl_str_mv Artículo de revista
dc.type.eng.fl_str_mv Journal article
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dc.identifier.issn.none.fl_str_mv 0121-7372
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dc.identifier.eissn.none.fl_str_mv 2462-991X
dc.identifier.url.none.fl_str_mv https://doi.org/10.31260/RepertMedCir.v29.n1.2020.172
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url https://repositorio.fucsalud.edu.co/handle/001/2107
https://doi.org/10.31260/RepertMedCir.v29.n1.2020.172
dc.language.iso.spa.fl_str_mv spa
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dc.relation.references.spa.fl_str_mv Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al. The Global Burden of Cancer 2013. JAMA oncology. 2015;1(4):505-27. doi:10.1001/jamaoncol.2015.0735 2. Xiao H, Yoon YS, Hong S-M, Roh SA, Cho D-H, Yu CS, et al. Poorly differentiated colorectal cancers: correlation of microsatellite instability with clinicopathologic features and survival. Am J Clin Pathol. 2013;140(3):341-7. doi: 10.1309/AJCP8P2DYNKGRBVI 3. Müller MF, Ibrahim AE, Arends MJ. Molecular pathological classification of colorectal cancer. Virchows Archiv. 2016;469(2):125-34. doi: 10.1007/s00428-016-1956-3 4. Stigliano V, Sanchez-Mete L, Martayan A, Diodoro M, Casini B, Sperduti I, et al. Early-onset colorectal cancer patients without family history are "at very low risk" for lynch syndrome. J Exp Clin Cancer Res. 2014;33:1. doi: 10.1186/1756-9966-33-1 5. Sie AS, Mensenkamp AR, Adang EM, Ligtenberg MJ, Hoogerbrugge N. Fourfold increased detection of Lynch syndrome by raising age limit for tumour genetic testing from 50 to 70 years is cost-effective. Annals of oncology : official journal of the European Society for Medical Oncology. 2014;25(10):2001-7. doi: 10.1093/annonc/mdu361 6. Tiwari AK, Roy HK, Lynch HT. Lynch syndrome in the 21st century: clinical perspectives. QJM: An International Journal of Medicine. 2015;109(3):151-8.doi: 10.1093/qjmed/hcv137 7. Alonso-Espinaco V, Giraldez MD, Trujillo C, van der Klift H, Munoz J, Balaguer F, et al. Novel MLH1 duplication identified in Colombian families with Lynch syndrome. Genetics in medicine : official journal of the American College of Medical Genetics. 2011;13(2):155-60. doi: 10.1097/GIM.0b013e318202e10b 8. Ueno H, Hashiguchi Y, Shimazaki H, Shinto E, Kajiwara Y, Nakanishi K, et al. Objective criteria for crohn-like lymphoid reaction in colorectal cancer. Am J Clin Pathol. 2013;139(4):434-41. doi: 10.1309/AJCPWHUEFTGBWKE4 9. Cini G, Carnevali I, Quaia M, Chiaravalli AM, Sala P, Giacomini E, et al. Concomitant mutation and epimutation of the MLH1 gene in a Lynch syndrome family. Carcinogenesis. 2015;36(4):452-8. doi: 10.1093/carcin/bgv015 10. Koelzer VH, Steuer K, Gross UC, Zimmermann D, Paasinen-Sohns A, Mertz KD, et al. Colorectal Choriocarcinoma in a Patient with Probable Lynch Syndrome. Frontiers in oncology. 2016;6:252. doi: 10.3389/fonc.2016.00252 11. Funkhouser WK, Jr., Lubin IM, Monzon FA, Zehnbauer BA, Evans JP, Ogino S, et al. Relevance, pathogenesis, and testing algorithm for mismatch repair-defective colorectal carcinomas: a report of the association for molecular pathology. The Journal of molecular diagnostics : JMD. 2012;14(2):91-103. doi: 10.1016/j.jmoldx.2011.11.001 12. Marginean EC, Melosky B. Is There a Role for Programmed Death Ligand-1 Testing and Immunotherapy in Colorectal Cancer With Microsatellite Instability? Part I-Colorectal Cancer: Microsatellite Instability, Testing, and Clinical Implications. Archives of pathology & laboratory medicine. 2018;142(1):17-25. doi: 10.5858/arpa.2017-0041-RA. 13. Greenson JK, Huang SC, Herron C, Moreno V, Bonner JD, Tomsho LP, et al. Pathologic predictors of microsatellite instability in colorectal cancer. The American journal of surgical pathology. 2009;33(1):126-33. doi: 10.1097/PAS.0b013e31817ec2b1 14. Roseweir AK, McMillan DC, Horgan PG, Edwards J. Colorectal cancer subtypes: Translation to routine clinical pathology. Cancer Treat Rev. 2017;57:1-7. doi: 10.1016/j.ctrv.2017.04.006 15. Alexander J, Watanabe T, Wu TT, Rashid A, Li S, Hamilton SR. Histopathological identification of colon cancer with microsatellite instability. Am J Pathol. 2001;158(2):527-35. doi: 10.1016/S0002-9440(10)63994-6. 16. Baker K, Zlobec I, Tornillo L, Terracciano L, Jass JR, Lugli A. Differential significance of tumour infiltrating lymphocytes in sporadic mismatch repair deficient versus proficient colorectal cancers: a potential role for dysregulation of the transforming growth factor-beta pathway. Eur J Cancer. 2007;43(3):624-31. doi: 10.1016/j.ejca.2006.11.012. 17. Takemoto N, Konishi F, Yamashita K, Kojima M, Furukawa T, Miyakura Y, et al. The correlation of microsatellite instability and tumor-infiltrating lymphocytes in hereditary non-polyposis colorectal cancer (HNPCC) and sporadic colorectal cancers: the significance of different types of lymphocyte infiltration. Jpn J Clin Oncol. 2004;34(2):90-8. doi: 10.1093/jjco/hyh018. 18. Jakubowska K, Kisielewski W, Kanczuga-Koda L, Koda M, Famulski W. Stromal and intraepithelial tumor-infiltrating lymphocytes in colorectal carcinoma. Oncol Lett. 2017;14(6):6421-32. doi: 10.3892/ol.2017.7013. 19. Pages F, Galon J, Fridman WH. The essential role of the in situ immune reaction in human colorectal cancer. J. Leukoc. Biol. 2008;84(4):981-7. doi: 10.1189/jlb.1107773 20. Huh JW, Lee JH, Kim HR. Prognostic significance of tumor-infiltrating lymphocytes for patients with colorectal cancer. Arch Surg. 2012;147(4):366-72. doi: 10.1001/archsurg.2012.35 21. Klintrup K, Makinen JM, Kauppila S, Vare PO, Melkko J, Tuominen H, et al. Inflammation and prognosis in colorectal cancer. Eur J Cancer. 2005;41(17):2645-54. doi: 10.1016/j.ejca.2005.07.017. 22. Shibutani M, Maeda K, Nagahara H, Fukuoka T, Iseki Y, Matsutani S, et al. Tumor-infiltrating Lymphocytes Predict the Chemotherapeutic Outcomes in Patients with Stage IV Colorectal Cancer. In Vivo. 2018;32(1):151-8. doi: 10.21873/invivo.11218 23. Matsutani S, Shibutani M, Maeda K, Nagahara H, Fukuoka T, Nakao S, et al. Significance of tumor-infiltrating lymphocytes before and after neoadjuvant therapy for rectal cancer. Cancer Sci. 2018;109(4):966-79. doi: 10.1111/cas.13542 24. Harrison JC, Dean PJ, el-Zeky F, Vander Zwaag R. Impact of the Crohn's-like lymphoid reaction on staging of right-sided colon cancer: results of multivariate analysis. Hum Pathol. 1995;26(1):31-8. doi: 10.1016/0046-8177(95)90111-6 25. Rozek LS, Schmit SL, Greenson JK, Tomsho LP, Rennert HS, Rennert G, et al. Tumor-Infiltrating Lymphocytes, Crohn's-Like Lymphoid Reaction, and Survival From Colorectal Cancer. J Natl Cancer Inst. 2016;108(8). doi: 10.1093/jnci/djw027. 26. Deschoolmeester V, Baay M, Lardon F, Pauwels P, Peeters M. Immune Cells in Colorectal Cancer: Prognostic Relevance and Role of MSI. Cancer Microenviron. 2011;4(3):377-92. doi: 10.1007/s12307-011-0068-5. 27. Svennevig JL, Lunde OC, Holter J, Bjorgsvik D. Lymphoid infiltration and prognosis in colorectal carcinoma. Br J Cancer. 1984;49(3):375-7. doi: 10.1038/bjc.1984.60. 28. Kim JH, Kim KJ, Bae JM, Rhee YY, Cho NY, Lee HS, et al. Comparative validation of assessment criteria for Crohn-like lymphoid reaction in colorectal carcinoma. J Clin Pathol. 2015;68(1):22-8. doi: 10.1136/jclinpath-2014-202603. 29. Pyo JS, Sohn JH, Kang G. Medullary carcinoma in the colorectum: a systematic review and meta-analysis. Hum Pathol. 2016;53:91-6. doi: 0.1016/j.humpath.2016.02.018. 30. Schneider NI, Langner C. Prognostic stratification of colorectal cancer patients: current perspectives. Cancer Manag Res. 2014;6:291-300. doi: 10.2147/CMAR.S38827. 31. Kakar S, Shi M C, Berho ME, Driman DK, Fitzgibbons P, Frankel WL, et al. Protocol for the examination of specimens from patients with primary carcinoma of the colon and rectum. 8 ed. Washington, DC: College of American Pathologists; 2017. p. 28. 32. Parra-Medina R, Lopez-Correa P, Gutierrez V, Polo F. Colonic adenosquamous carcinoma and mucinous adenocarcinoma with microsatellite instability. Malays J Pathol. 2018;40(2):199-202. 33. Benedix F, Schmidt U, Mroczkowski P, Gastinger I, Lippert H, Kube R. Colon carcinoma--classification into right and left sided cancer or according to colonic subsite?--Analysis of 29,568 patients. Eur J Surg Oncol. 2011;37(2):134-9. doi: 10.1016/j.ejso.2010.12.004. 34. Lee GH, Malietzis G, Askari A, Bernardo D, Al-Hassi HO, Clark SK. Is right-sided colon cancer different to left-sided colorectal cancer? - a systematic review. Eur J Surg Oncol. 2015;41(3):300-8. doi: 10.1016/j.ejso.2014.11.001. 35. Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology. 2004;127(2):385-94. doi: 10.1053/j.gastro.2004.04.022. 36. Kirsch R, Messenger DE, Riddell RH, Pollett A, Cook M, Al-Haddad S, et al. Venous invasion in colorectal cancer: impact of an elastin stain on detection and interobserver agreement among gastrointestinal and nongastrointestinal pathologists. Am J Surg Pathol. 2013;37(2):200-10. doi10.1097/PAS.0b013e31826a92cd. 37. Messenger DE, Driman DK, Kirsch R. Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome. Hum Pathol. 2012;43(7):965-73. doi: 10.1016/j.humpath.2011.11.015 38. American Joint Committee on Cancer. The AJCC Cancer Staging Manual. 8 ed: Springer International Publishing; 2017. 39. Zhang MR, Xie TH, Chi JL, Li Y, Yang L, Yu YY, et al. Prognostic role of the lymph node ratio in node positive colorectal cancer: a meta-analysis. Oncotarget. 2016;7(45):72898-907. doi: 10.18632/oncotarget.12131 40. Arnold A, Kloor M, Jansen L, Chang-Claude J, Brenner H, von Winterfeld M, et al. The association between microsatellite instability and lymph node count in colorectal cancer. Virchows Archiv. 2017;471(1):57-64. doi: 10.1007/s00428-017-2150-y. 41. Belt EJ, te Velde EA, Krijgsman O, Brosens RP, Tijssen M, van Essen HF, et al. High lymph node yield is related to microsatellite instability in colon cancer. Ann Surg Oncol. 2012;19(4):1222-30. doi: 10.1245/s10434-011-2091-7. 42. Knijn N, Mogk SC, Teerenstra S, Simmer F, Nagtegaal ID. Perineural Invasion is a Strong Prognostic Factor in Colorectal Cancer: A Systematic Review. Am J Surg Pathol. 2016;40(1):103-12. doi:10.1097/PAS.0000000000000518 43. Ozturk MA, Dane F, Karagoz S, Tural D, Selcukbiricik F, Demirelli F, et al. Is perineural invasion (PN) a determinant of disease free survival in early stage colorectal cancer? Hepato-gastroenterology. 2015;62(137):59-64. 44. Al-Sukhni E, Attwood K, Gabriel EM, LeVea CM, Kanehira K, Nurkin SJ. Lymphovascular and perineural invasion are associated with poor prognostic features and outcomes in colorectal cancer: A retrospective cohort study. Int J Surg. 2017;37:42-9. doi: 10.1016/j.ijsu.2016.08.528 45. Alotaibi AM, Lee JL, Kim J, Lim SB, Yu CS, Kim TW, et al. Prognostic and Oncologic Significance of Perineural Invasion in Sporadic Colorectal Cancer. Ann Surg Oncol. 2017;24(6):1626-34. DOI: 10.1245/s10434-016-5748-4 46. Labalde M M, Labrador V FJ, Golitsin D A, Pinto G S, Carlin G J, García-Parreño J J. Tumor budding y el cáncer colorrectal. Rev Chil Cir. 2014;66(6):556-61. doi: 10.4067/S0718-40262014000600008 47. De Smedt L, Palmans S, Sagaert X. Tumour budding in colorectal cancer: what do we know and what can we do? Virchows Archiv. 2016;468(4):397-408. doi: 10.1007/s00428-015-1886-5. 48. Kalluri R, Weinberg RA. The basics of epithelial-mesenchymal transition. J Clin Invest. 2009;119(6):1420-8. doi: 10.1172/JCI39104 49. Ueno H, Murphy J, Jass JR, Mochizuki H, Talbot IC. Tumour 'budding' as an index to estimate the potential of aggressiveness in rectal cancer. Histopathology. 2002;40(2):127-32. doi: 10.1046/j.1365-2559.2002.01324.x 50. Graham RP, Vierkant RA, Tillmans LS, Wang AH, Laird PW, Weisenberger DJ, et al. Tumor Budding in Colorectal Carcinoma: Confirmation of Prognostic Significance and Histologic Cutoff in a Population-based Cohort. Am J Surg Pathol. 2015;39(10):1340-6. doi: 10.1097/PAS.0000000000000504 51. Rieger G, Koelzer VH, Dawson HE, Berger MD, Hadrich M, Inderbitzin D, et al. Comprehensive assessment of tumour budding by cytokeratin staining in colorectal cancer. Histopathology. 2017;70(7):1044-51. doi: 10.1111/his.13164
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spelling Baracaldo Ayala, Rafael Leonardo1b79a128281b6b8df95e2a0e66e3a0b8300Peña Carvajalino, Laura Felisab3ef714bdab48dc734ad6c1a0ee62327500Gómez Rodríguez, Omar6fcaa7d61cbb70fa0161099bebca3ad2300Nieto, José Fernando Polo9e2d8de163dcde6a9d75c08db29e9e8c300López Correa, Patriciab73e7c842f3a90e1657a47aae382bc7aMedina, Rafael Parra04f364a7b6007ab547d7a97605c67e113002020-03-16 00:00:002022-02-21T20:34:13Z2020-03-162020-03-16 00:00:002022-02-21T20:34:13ZSociedad de Cirugía de Bogotá, Hospital de San José y Fundación Universitaria de Ciencias de la SaludRevista Repertorio de Medicina y Cirugía - 2020info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by-nc-sa/4.0/http://purl.org/coar/access_right/c_abf2https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/172carcinoma colorrectalinestabilidad microsatelitalhistopatologíacarcinoma colorrectalinestabilidad microsatelitalhistopatologíaCaracterísticas histopatológicas del carcinoma colorrectal con inestabilidad microsatelital (IMS)Histopathologic characteristics of microsatellite instability in colorectal cancerapplication/pdftext/htmlapplication/epub+ziptext/xmlaudio/mpegArtículo de revistaJournal articlehttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionTexthttp://purl.org/coar/version/c_970fb48d4fbd8a8510.31260/RepertMedCir.v29.n1.2020.1720121-7372https://repositorio.fucsalud.edu.co/handle/001/21072462-991Xhttps://doi.org/10.31260/RepertMedCir.v29.n1.2020.172spaFitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, et al. The Global Burden of Cancer 2013. JAMA oncology. 2015;1(4):505-27. doi:10.1001/jamaoncol.2015.0735 2. Xiao H, Yoon YS, Hong S-M, Roh SA, Cho D-H, Yu CS, et al. Poorly differentiated colorectal cancers: correlation of microsatellite instability with clinicopathologic features and survival. Am J Clin Pathol. 2013;140(3):341-7. doi: 10.1309/AJCP8P2DYNKGRBVI 3. Müller MF, Ibrahim AE, Arends MJ. Molecular pathological classification of colorectal cancer. Virchows Archiv. 2016;469(2):125-34. doi: 10.1007/s00428-016-1956-3 4. Stigliano V, Sanchez-Mete L, Martayan A, Diodoro M, Casini B, Sperduti I, et al. Early-onset colorectal cancer patients without family history are "at very low risk" for lynch syndrome. J Exp Clin Cancer Res. 2014;33:1. doi: 10.1186/1756-9966-33-1 5. Sie AS, Mensenkamp AR, Adang EM, Ligtenberg MJ, Hoogerbrugge N. Fourfold increased detection of Lynch syndrome by raising age limit for tumour genetic testing from 50 to 70 years is cost-effective. Annals of oncology : official journal of the European Society for Medical Oncology. 2014;25(10):2001-7. doi: 10.1093/annonc/mdu361 6. Tiwari AK, Roy HK, Lynch HT. Lynch syndrome in the 21st century: clinical perspectives. QJM: An International Journal of Medicine. 2015;109(3):151-8.doi: 10.1093/qjmed/hcv137 7. Alonso-Espinaco V, Giraldez MD, Trujillo C, van der Klift H, Munoz J, Balaguer F, et al. Novel MLH1 duplication identified in Colombian families with Lynch syndrome. Genetics in medicine : official journal of the American College of Medical Genetics. 2011;13(2):155-60. doi: 10.1097/GIM.0b013e318202e10b 8. Ueno H, Hashiguchi Y, Shimazaki H, Shinto E, Kajiwara Y, Nakanishi K, et al. Objective criteria for crohn-like lymphoid reaction in colorectal cancer. Am J Clin Pathol. 2013;139(4):434-41. doi: 10.1309/AJCPWHUEFTGBWKE4 9. Cini G, Carnevali I, Quaia M, Chiaravalli AM, Sala P, Giacomini E, et al. Concomitant mutation and epimutation of the MLH1 gene in a Lynch syndrome family. Carcinogenesis. 2015;36(4):452-8. doi: 10.1093/carcin/bgv015 10. Koelzer VH, Steuer K, Gross UC, Zimmermann D, Paasinen-Sohns A, Mertz KD, et al. Colorectal Choriocarcinoma in a Patient with Probable Lynch Syndrome. Frontiers in oncology. 2016;6:252. doi: 10.3389/fonc.2016.00252 11. Funkhouser WK, Jr., Lubin IM, Monzon FA, Zehnbauer BA, Evans JP, Ogino S, et al. Relevance, pathogenesis, and testing algorithm for mismatch repair-defective colorectal carcinomas: a report of the association for molecular pathology. The Journal of molecular diagnostics : JMD. 2012;14(2):91-103. doi: 10.1016/j.jmoldx.2011.11.001 12. Marginean EC, Melosky B. Is There a Role for Programmed Death Ligand-1 Testing and Immunotherapy in Colorectal Cancer With Microsatellite Instability? Part I-Colorectal Cancer: Microsatellite Instability, Testing, and Clinical Implications. Archives of pathology & laboratory medicine. 2018;142(1):17-25. doi: 10.5858/arpa.2017-0041-RA. 13. 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Histopathology. 2017;70(7):1044-51. doi: 10.1111/his.13164https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/172/1136https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/172/1137https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/172/1138https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/172/1185https://revistas.fucsalud.edu.co/index.php/repertorio/article/download/172/1207Núm. 1 , Año 2020 : Enero - Abril129Revista Repertorio de Medicina y CirugíaPublicationOREORE.xmltext/xml2612https://repositorio.fucsalud.edu.co/bitstreams/f07e6b7a-ae67-4ce7-bb46-59de156ad5e4/downloadae4aa2f8529fb51c037b9b6d57b6be3aMD51001/2107oai:repositorio.fucsalud.edu.co:001/21072024-02-02 13:09:05.827https://creativecommons.org/licenses/by-nc-sa/4.0/Revista Repertorio de Medicina y Cirugía - 2020metadata.onlyhttps://repositorio.fucsalud.edu.coRepositorio Digital de la Fundación Universitaria de Ciencias de la Saludredi@fucsalud.edu.co