tbuckley/cabot-search huggingface dataset:
Hent1 expression in patients with pancreatic cancer treated with gemcitabine after curative intended resection: Results from the CONKO-001 trial.
Authors: Marianne Sinn, Bruno Valentin Sinn, Jens Stieler, Uwe Pelzer, Jana Kaethe Striefler, Helmut Oettle, Marcus Bahra, Bernd Dörken, Carsten Denkert, Hendrik Blaeker, Hanno Riess, Philipp Lohneis
Journal: Journal of Clinical Oncology (2014)

4124 Background: High expression of human equilibrative nucleosid transporter 1 (hent1) is considered to predict disease-free (DFS) and overall survival (OS) in patients (pts) treated with adjuvant gemcitabine for pancreatic cancer. No standard evaluation system for immunohistochemical analysis (antibody, scoring system) is established so far. Methods: CONKO-001, a prospective randomized phase III study investigated the role of adjuvant gemcitabine (gem) as compared to observation (obs). Representative formalin-fixed, paraffin-embedded (FFPE) tumor samples of 156 patients were collected and tissue microarrays (TMA) built. TMA slides (4 μm) were evaluated by immunohistochemistry for expression of hent1 (rabbit monoclonal antibody SP120 Ventana Medical Systems). The analysis was performed by an experienced pathologist blinded to clinical outcome. Hent1 high was defined as unequivocal membranous staining in more than 50% of tumor cells, all other cases were classified as hENT1 low. Kaplan-Meier analyses for median DFS (mDFS) and median OS (mOS) were performed in dependence of hent1 expression. Results: For the 88 gem and 68 obs pts, mDFS (mOS) was 12.9 (22.7) months and 6.2 (19.1) months, respectively and thus comparable to the overall study population of CONKO-001 (mDFS gem 13.4 vs obs 6.7 months, mOS gem 22.8 vs obs 20.2 months). High hent1 expression was not associated with improved mDFS (high hent1 11.5 months vs low hent1 13.2 months, p= 0.5; HR 1.19, 95% CI 0.72-2.0) or mOS (high hent1 19.7 months vs low hent1 24.4 months, p=0.92; HR 1.03, 95% CI 0.63-1.68) in the gem group nor in the obs group (median DFS high hent1 5.9 months vs low hent1 6.2 months, p=0.83; median OS high hent1 20.4 months vs low hent1 17.7 months, p=0.65). Conclusions: Corresponding to previously available and contradictory data, we can not confirm a predictive role of hent1 in our study population. Reproducible standard procedures and further investigations are urgently needed prior to the implementation or exclusion of hent1 as predictive biomarker in the treatment of pancreatic cancer.
Investigator-initiated pilot study of bicalutamide and raloxifene in hormone-resistant prostate cancer.
Authors: Thai Huu Ho, Donald W. Northfelt, Rafael Nunez Nateras, Alan H. Bryce, Amylou C. Dueck, Erik P. Castle
Journal: Journal of Clinical Oncology (2013)

e16065 Background: Estrogens, in addition to androgen may contribute to the progression of prostate cancer.The combination of bicalutamide, a non-steroidal anti-androgen, and raloxifene, a selective estrogen receptor modulator, has a synergistic effect on cell death of prostate cancer cell lines such as DU145 and PC3. We investigated the safety of combined treatment of bicalutamide and raloxifene on quality of life in patients affected by hormone-resistant prostate cancer. Methods: Eligibility requirements included metastatic hormone-resistant prostate cancer, Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received the combination of bicalutamide, 50 mg, and raloxifene, 60 mg, daily in 28 day cycles for a maximum of 6 cycles. The primary endpoint was to describe the adverse event profile of combined treatment with bicalutamide and raloxifene. The secondary endpoint was to describe the quality of life of patients receiving the combination. Adverse events were graded by the investigator using the NCI Common Terminology Criteria for Adverse Events version 4.0 and the quality of life was assessed by the patient using aLinear Analog Scale Assessment (scale of 0-100). Serum levels of estradiol and testosterone were monitored during treatment. Results: Eighteen evaluable patients were included in the statistical analysis after an initial run-in safety cohort of six patients. Two patients completed 6 cycles per protocol, the remaining sixteen patients were taken off protocol after disease progression. Patients completed a median of 2 cycles. There were no grade 4 events and grade 3 adverse events consisted of hypertension (5.6%) and back pain (5.6%). Erectile dysfunction (grade 1) was the most common adverse event (77.8%). Patient assessment of quality of life (mental, physical, social, emotional, spiritual) did not reveal any statistically different changes after 2 cycles of treatment. An analysis of testosterone and estradiol levels will be reported. Conclusions: We conclude that combination of bicalutamide and raloxifene is well-tolerated. The combination of androgen and estrogen receptor blockade warrants further study for efficacy in hormone-resistant prostate cancer. Clinical trial information: NCT01050842.
Phosphorylcholine-based stealthy nanocapsules enabling tumor microenvironment-responsive doxorubicin release for tumor suppression
Authors: Gan Liu, Hsiang-i Tsai, Xiaowei Zeng, Yixiong Zuo, Wei Tao, Jun Han, Lin Mei
Journal: Theranostics (2017)

The efficient delivery of anticancer drugs into tumor tissues to improve therapeutic efficacy remains an urgent demand.To satisfy this demand, a drug delivery system based on a stealthy nanocapsule was developed.This nanocapsule was fabricated by encapsulating stealthy cross-linked poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) and benzaldehyde groups around the protein bovine serum albumin (BSA) followed by conjugation of doxorubicin (Dox) through a pH-responsive benzoic-imine bond.The in vitro results show that the Dox-conjugated nanocapsule (nBSA-Dox) released the drug under an acidic tumor microenvironment (pH ~6.5) and killed HepG2 human liver cancer cells.The half-life of Dox conjugated to nBSA in mice was significantly prolonged, and the area-under-curve of plasma Dox of the mice treated with nBSA-Dox was as much as 242 fold of free Dox.The in vivo results confirmed that this nanocapsule efficiently accumulated in tumor tissue and significantly suppressed the tumor growth.
MORTALITY, LENGTH OF STAY, AND COST IMPLICATIONS OF PROCEDURAL BLEEDING AFTER CONTEMPORARY PERCUTANEOUS INTERVENTIONS INVOLVING LARGE-BORE CATHETERS
Authors: Bjorn Redfors, Brendan M. Watson, Thomas McAndrew, Emilie Palisaitis, Dominic Francese, Mehdi Razavi, Jordan Safirstein, Roxana Mehran, Ajay Kirtane, Philippe Genereux
Journal: Journal of the American College of Cardiology (2017)
MORTALITY OF PATIENTS WITH PREVIOUS STROKE UNDERGOING DRUG-ELUTING STENT IMPLANTATION
Authors: Do-Yoon Kang, Se Hun Kang, Ungjeong Do, Osung Kwon, Kyusup Lee, Jung Ae Hong, Pil Hyung Lee, Jung-Min Ahn, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee
Journal: Journal of the American College of Cardiology (2017)
PERFORMANCE OF THE LITHOPLASTY SYSTEM IN TREATING CALCIFIED CORONARY LESIONS PRIOR TO STENTING: RESULTS FROM THE DISRUPT CAD OCT SUB-STUDY
Authors: Todd J. Brinton, Ziad Ali, Carlo Di Mario, Jonathan Hill, Robert Whitbourn, Matthias Gotberg, Uday Illindala, Akiko Maehara, Nicolas Van Mieghem, Ian Meredith, Jean Fajadet
Journal: Journal of the American College of Cardiology (2017)
Phase I pharmacokinetic (PK) and pharmacodynamic (PD) study of intravenous dimethane sulfonate (DMS612, NSC 281612) in advanced malignancies.
Authors: Susan Elaine Bates, Sanjeeve Balasubramaniam, Robert A Parise, Christina Bryla, William Bonner, Christophe E. Redon, Asako Nakamura, John Joseph Wright, Richard Piekarz, Yixing Jiang, Julie Eiseman, Edward Chu, Chandra Prakash Belani, Jan Hendrik Beumer, Leonard Joseph Appleman
Journal: Journal of Clinical Oncology (2012)

2553 Background: DMS612 is a dimethane sulfonate compound that was identified as preferentially cytotoxic to renal cell carcinoma (RCC) cell lines in a chemical screen of the NCI-60 panel. DMS612 has bifunctional alkylating activity in vitro. Objectives of this first-in-human phase I study included determining the dose-limiting toxicity (DLT), maximum tolerated dose (MTD), recommended phase 2 dose (RP2D), PK and PD of DMS612 administered by 10 minute intravenous infusion on day 1, 8 and 15 of a 28 day cycle. Methods: Eligibility criteria included adults with advanced solid malignancies or lymphoma with ECOG performance status 0-2, life expectancy &gt; 3 months and adequate organ and marrow function. Patients were enrolled using a standard “3+3” dose escalation scheme. Plasma PK of DMS612 and metabolites was assessed by LC-MS/MS. DNA damage PD was assessed by γ-H2AX immunofluorescence. Results: 35 subjects were enrolled (22 male, 13 female) with median age 59 years (41-75). Tumor types included colorectal (8), RCC (4), cervix (2), and urothelial (2). Doses administered were 1.5, 3, 5, 7, 9 and 12 mg/m 2 . The MTD was determined to be 9 mg/m 2 , with only one DLT of grade 4 thrombocytopenia in 12 subjects enrolled. The maximum administered dose of 12 mg/m 2 was considered to be intolerable after 1 of 3 subjects had grade 4 neutropenia and 1 had prolonged grade 3 thrombocytopenia. Prolonged thrombocytopenia in later cycles was observed in other subjects, including one patient naïve to prior cytotoxic chemotherapy. One subject with RCC had a confirmed partial response at 7 mg/m 2 . DMS612 was rapidly converted into carboxy, chloroethyl and hydroxyethyl analogues and their glucuronides, some of which retained alkylating activity in vitro. Dose-dependent pharmacodynamic evidence of DNA damage induced by DMS612 in vivo was observed by γ-H2AX immunofluorescance in both peripheral blood lymphocytes and plucked scalp hairs. Conclusions: The MTD of DMS12 administered by intravenous infusion on day 1, 8 and 15 of a 28-day cycle was 9 mg/m 2 . Pre-clinical and clinical observations suggest that further study of DMS612 in RCC is warranted.
A COMPARISON OF KIDNEY FUNCTION DECLINE IN ATRIAL FIBRILLATION PATIENTS TREATED WITH NON-VITAMIN K ANTAGONIST ORAL ANTICOAGULANTS OR WARFARIN
Authors: Xiaoxi Yao, Navdeep Tangri, Lindsey Sangaralingham, Nilay Shah, Peter Noseworthy
Journal: Journal of the American College of Cardiology (2017)
Hirschsprung's disease
Authors: A. Arshad, C. Powell, M. P. Tighe
Journal: BMJ (2012)

A 3 year old boy is brought to his general practitioner again by his worried mother. She is concerned that he remains constipated despite trying a third different laxative. Further history showed that he passed his first meconium only on day 5, and since then has been opening his bowels only weekly, with associated straining. His growth has fallen from the 25th to the 2nd centile for height and weight. On examination he has a distended abdomen with palpable stool throughout the abdomen. Hirschsprung's disease is characterised by an absence of ganglion cells in the distal bowel, beginning at the internal sphincter and extending proximally. The resulting aganglionic segment of the colon fails to relax, causing a functional obstruction. Presentation is commonly in the first 28 days of life (neonatal period), with delayed passage of meconium and abdominal distension (see "Red flags" box). However, about 12% of patients present again in childhood with intractable constipation (not responsive to laxatives) and failure to thrive, with about a third of these presenting with enterocolitis.1 2 #### "Red flags" for Hirschsprung's disease*
Neurofibrillary Tangle Stage and the Rate of Progression of Alzheimer Symptoms
Authors: Jing Qian, Bradley T. Hyman, Rebecca A. Betensky
Journal: JAMA Neurology (2017)

The heterogeneity of rate of clinical progression among patients with Alzheimer disease leads to difficulty in providing clinical counseling and diminishes the power of clinical trials using disease-modifying agents.
MGCD265, a multitargeted oral tyrosine kinase receptor inhibitor of Met and VEGFR, in combination with docetaxel.
Authors: Muralidhar Beeram, Amita Patnaik, Ravi K. Amaravadi, Naomi B. Haas, Kyriakos P. Papadopoulos, Anthony W. Tolcher, Lon S. Smith, Kathleen Harlacker, Guillermo Espino, Michel A. Drouin, Manal Tawashi, James Wang, Andre Karam, Wendy Hunt, Christiane R. Maroun, Marielle Fournel, Mariam Mehran, Jeffrey M. Besterman, Peter J. O'Dwyer
Journal: Journal of Clinical Oncology (2012)

e13604 Background: MGCD265 is a multi-target oral tyrosine kinase receptor inhibitor that targets Met, VEGFRs 1, 2, 3, Tie and Ron. The maximum tolerated dose (MTD) of MGCD265 in combination with docetaxel was initially determined using micronized tablets. MGCD265 formulation was improved and the MTD of MGCD265 in combination with docetaxel using the updated formulation was re-evaluated. Methods: Patients (pts) with metastatic or advanced solid tumors were enrolled in this Phase I, open-label, dose-escalating study to assess safety, pharmacodynamics (PD) and pharmacokinetics (PK) as well as anti-tumor activity of the combination. MGCD265 was administered every day over a 3-week cycle and docetaxel (50 then 75 mg/m 2 ) was given intravenously once every 3 weeks (q3w). Results: As of January 11, 2012, 34 pts were enrolled (M/F: 19/15; ECOG 0/1: 19/15; median age: 64 years old). The MTD of the combination was initially defined as MGCD265 (72 mg/m 2 BID)+docetaxel (75 mg/m 2 q3w) based on the occurrence of dose limiting toxicities (DLTs) in 2 pts who were treated with MGCD265 at 96 mg/m 2 BID (fatigue in 1 pt and diarrhea &amp; lipase elevation in the other pt). The updated formulation of MGCD265 was introduced at 48 mg/m 2 BID (n=3) with dose escalation to 72 mg/m 2 BID (n=3) and 96 mg/m 2 (n=4) with no observed DLTs, though the exposure of the two formulations were generally comparable. Overall, objective partial responses (per RECIST 1.1) were observed in 2/9 pts with NSCLC, 1/3 pts with prostate cancer and 1/1 pt with endometrial cancer. Stable disease for 6 cycles or more was observed in 6 pts. Treatment-related ≥ grade 3 toxicity reported in ≥ 2 pts were neutropenia, leukopenia, diarrhea and elevated lipase. The PD profile indicated an increase in the plasma level of VEGF and a decrease in plasma level of HGF at Cycle 1 Day 8 compared to baseline in some patients. Conclusions: MGCD265 was found to be well tolerated using the updated formulation in combination with full-dose docetaxel. Anti-cancer activity, supporting Phase II development of the combination, was observed.
Prognostic significance of bcl-2 expression in stage III breast cancer patients who received doxorubicin and cyclophosphamide followed by paclitaxel as adjuvant chemotherapy
Authors: K. Lee, B. Kim, S. Lee, W. Han, D. Kim, S. Im, T. Kim, I. A. Park, D. Noh, Y. Bang
Journal: Journal of Clinical Oncology (2006)

670 Background: Bcl-2 is an anti-apoptotic marker and regulated by hormonal receptor pathways in breast cancer. We performed this study to assess the prognostic significance of ER, PR, p53, c-erbB2, bcl-2, Ki-67, and EGFR as a marker for relapse in breast cancer patients who received same adjuvant therapy in a single institution. Methods: A cohort of 154 curatively resected breast cancer patients who had 4 lymph nodes or more and received doxorubicin and cyclophosphamide followed by paclitaxel (AC/T) as adjuvant chemotherapy was analyzed for clinicopathologic characteristics including disease-free survival (DFS). Patients with ER and/or PR expression received 5 years of tamoxifen following AC/T. The markers were analyzed by immunohistochemistry. Results: Median f/u duration was 25 months and 32 patients (20.8%) had recurrences. Stage (IIIa vs. IIIc) affected recurrences significantly, however, types of surgery, histology, histologic grade, presence of endolymphatic emboli, or close resection margin did not. Among the immunohistochemical markers, bcl-2 expression was the only one to be associated significantly with prolonged DFS (median 54 mo in bcl-2 (−) vs. not reached in bcl-2 (+); p=0.016). Furthermore, bcl-2 was an independent prognostic factor for DFS in multivariate analysis. Bcl-2 expression was significantly correlated with ER expression (p&lt;0.001), and inversely correlated with c-erbB2 overexpression (p=0.027). Patients with both ER and bcl-2 expression had a longer DFS compared to the other patients (not reached vs. 54 mo, p=0.019). Patients with bcl-2 expression had a significantly longer DFS even in ER (+) subgroups (not reached vs 54 mo; p=0.011). Patients with c-erbB2 overexpression, ER (−) and bcl-2 (−) had a shorter DFS than the others (38 mo vs. not reached; p=0.029). Conclusions: In our homogenous patient cohort, bcl-2 expression was correlated with ER expression, and inversely correlated with c-erbB2 overexpression. Bcl-2 was an independent prognostic factor for DFS in curatively resected stage III breast cancer patients. No significant financial relationships to disclose.
Impact of Neurological Complications on the Overall Survival in Allogeneic Stem Cell Transplantation
Authors: Paloma Ibarrondo, Arancha Bermudez, Irati Ormazabal, Lucrecia Yáñez, Carmen Montes-Gaisán, Carlos De Miguel, Carlos Richard, Andrés Insunza, Eulogio Conde
Journal: Blood (2014)
MAST CELL-DEPENDENT CONVERSION OF SIDEROPHAGES INTO FOAM CELLS IS A HALLMARK OF EARLY FAT INFILTRATION IN HEMORRHAGIC MYOCARDIAL INFARCTIONS
Authors: Ivan Cokic, Avinash Kali, Hsin-Jung Yang, Richard Tang, Joseph Francis, Rohan Dharmakumar
Journal: Journal of the American College of Cardiology (2017)
Comparison of Tacrolimus Versus Cyclosporine with Methotrexate for Immunosuppression after Allogeneic Hematopoietic Cell Transplantation for Severe Aplastic Anemia: A CIBMTR Analysis
Authors: Yoshihiro Inamoto, Paul J. Martin, Mary E. Flowers, Alvaro Urbano-Ispizua, Tao Wang, Michael T. Hemmer, Corey S Cutler, Daniel R. Couriel, Amin M. Alousi, Mukta Arora, Stephen R. Spellman
Journal: Blood (2014)
A GENETIC RISK SCORE PREDICTS CARDIOVASCULAR EVENTS IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE
Authors: Morten Krogh Christiansen, Mette Nyegaard, Sanne B. Larsen, Erik Grove, Morten Würtz, Søs Neergaard-Petersen, Anne-Mette Hvas, Henrik Jensen, Steen Kristensen
Journal: Journal of the American College of Cardiology (2017)
RETURN TO WORK FOLLOWING CORONARY ARTERY BYPASS GRAFTING: A NATIONWIDE STUDY
Authors: Jawad Haider Butt, Lars Køber, Rasmus Rørth, Kristian Kragholm, Christian Torp-Pedersen, Gunnar Gislason, Søren Lund Kristensen, Emil Fosbøl
Journal: Journal of the American College of Cardiology (2017)
WHITE BLOOD CELL COUNT TO PLATELET RATIO: A NOVEL BIOMARKER OF OUTCOMES IN PATIENTS WITH CIRCULATORY SUPPORT ON LEFT VENTRICULAR IMPELLA ASSIST DEVICES
Authors: Parasuram Krishnamoorthy, Mario Naranjo, Nikoloz Koshkelashvili, Akshaya Gopalakrishnan, Alexandra Tuluca, Janani Rangaswami, Vincent Figueredo, Mark Anderson, Dennis Morris
Journal: Journal of the American College of Cardiology (2017)
Oxaliplatin for colorectal cancer: Prevalence of delayed nausea and/or vomiting
Authors: S. B. Fleishman, V. E. Gorospe, V. Rosenwald
Journal: Journal of Clinical Oncology (2009)

e20610 Background: Delayed nausea and vomiting (N&amp;V) have been associated with cisplatin and carboplatin. Its prevalence with third-generation oxaliplatin was examined in patients (pts) receiving oxaliplatin-based regimens. Methods: 64 pts (53% male, 47% female) signed IRB-approved informed consent and were enrolled on day 1 of cycle 1. 53 (83%) pts had colon cancer, and received 85mg/kg of oxaliplatin, while 11 (17%) had rectal cancer, and received 65mg/kg. Age ranged from 29 to 84 years, with 65% between 50 and 69. Data was collected on the first chemotherapy cycle of 24 pts and the first and second cycles of 40 pts, for a total of 104 cycles. Baseline demographic data were collected by chart review and interview. Maximum grade of N&amp;V for each cycle was assessed by the Functional Living Index - Emesis (FLIE). Pts also maintained a daily diary of nausea, vomiting, and anti-emetic usage for 7 days after each infusion. Results: 7 pts (11%) reported a history of motion sickness. History of morning sickness was reported by 13 (43%) of the 30 female pts. All pts received anti-emetics and steroids on day 1 of each cycle. 75% of pts received 5HT 3 inhibitors only, 22% received 5HT 3 + an oral NK-1 receptor antagonist, and 3% received an NK-1 receptor antagonist alone. Among 40 pts for whom data were collected on both first and second cycles, the occurrence of nausea was the same during cycle 1 and cycle 2: Grade 0 - 60% and 62% respectively; Grade 1 - 20% and 21%, Grade 2 - 20% and 21%. 41% of pts used rescue antiemetics (prochlorperazine, metoclopramide, or lorazepam) in cycle 1 and 43% in cycle 2. Men experienced no nausea 69% of the time, while women had no nausea in 41% of cycles. In 57% of cycles, no nausea was reported. In 88% of cycles there was no reported vomiting. Conclusions: Oxaliplatin-based regimens (65–85 mg/kg) caused minimal nausea and negligible vomiting, with a satisfactory response to 5HT 3 -inhibitor antiemetics and corticosteroids. [Table: see text] [Table: see text]
Bond oracle HER2 IHC assay for identifying low to intermediate HER2-expressing breast cancer.
Authors: Victoria Ann Reid, Mark W. Schwartz, Sonia Kumar, Yvonne Alexandra White, Rosemary Mazanet
Journal: Journal of Clinical Oncology (2013)

e11509 Background: HER2 targeted therapies are effective treatment for breast tumors that overexpress the HER2 protein to a high level (IHC score of 3+) or have amplification of the HER2 gene (HER2/CEP17 &gt;2). However, the majority of breast tumors exhibit low to intermediate expression of HER2 (IHC 1+ and 2+), for which there are limited treatment options. A new cancer vaccine candidate, E75 or nelipepimut-S, offers prevention of reoccurrence in these patients by generating a specific immune response to a HER2 peptide. To date, no companion diagnostic test is validated to differentiate HER2 at these levels of expression. The BOND Oracle HER2 IHC assay (Leica Biosystems) is being validated to reliably identify IHC HER2 1+ and 2+ cases by correlating to independent analytical measures of HER2 expression. Methods: Quantitative PCR was used to determine HER2 DNA copy number and mRNA expression in eight breast cancer cell lines spanning HER2 IHC scores of 0 to 3+ and 45 formalin fixed, paraffin embedded (FFPE) invasive breast tumor samples. HER2 receptor load was determined for the eight cell lines by flow cytometry. Data was correlated to HER2 expression levels as determined by manual interpretation using the BOND Oracle HER2 IHC assay. Results: Previous testing by Leica Biosystems (Table) demonstrates the relationship between HER2 receptor load, HER2 copy number, and HER2 IHC status on four assay control breast cancer cell lines. Preliminary results also show that HER2 mRNA expression correlates with IHC staining with the BOND Oracle HER2 IHC Assay in FFPE breast cancer tissue samples. Conclusions: Improving the discrimination of HER2 protein expression (IHC 1+, 2+) using the Bond Oracle HER2 IHC assay in breast cancer tumors will identify patients for new treatments in development such as E75. [Table: see text]
ROL DE LA PUNCIÓN ASPIRATIVA GUIADA POR ECOENDOSCOPIA EN EL ESTUDIO DE LA GLÁNDULA SUPRARRENAL
Authors: V Gallarreta, C Consiglieri, M De La Hera, T Sanchez-Salido Lia, R Llatjos, N Baixeras, I Catala, JB Gornals
Journal: Endoscopy (2015)

Introducción: La ecoendoscopia ha demostrado ser útil en el estudio y valoración de la glándula suprarrenal mediante la punción aspirativa con aguja fina, ya sea izquierda o derecha.