Prevalência de sintomas de asma e tratamento de crianças e adolescentes de 2 a 14 anos no Campus Aproximado da PUCRS / Prevalence of asthma symptoms and treatment of children and adolescents from 2 to 14 years of age in Porto Alegre, Rio Grande do Sul, Brazil

INTRODUÇAO: Nas últimas décadas tem havido aumento da prevalência da asma. OBJETIVO: Determinar a prevalência de sintomas de asma em crianças e adolescentes de 2 a 14 anos em Porto Alegre (RS), relacionando-a com o perfil socioeconômico, tratamento e hábito de fumar intradomiciliar. MÉTODO: Estudo transversal em que foram entrevistadas todas as famílias atendidas em junho de 2000. RESULTADOS: A prevalência de sintomas de asma foi de 49,5 por cento. Em 66,8 por cento das famílias a renda era inferior a quatro salários mínimos e em mais de 50 por cento a escolaridade materna e paterna era menor que cinco anos. Em 98,5 por cento não havia utilização de tratamento preventivo para asma. Nas 174 famílias estudadas 38,7 por cento das mães, 43,7 por cento dos pais e 32,7 por cento de ambos eram fumantes. Houve associação entre as seguintes variáveis: exposição ao fumo intradomiciliar e número de crises de asma no último ano (p = 0,02; RR = 2,9; IC: 1,1 - 4,5); escolaridade materna e número de crises no último ano (p = 0,03; RR = 2,03; IC: 1,01 - 4,19); aglomeração e número de crises no último ano entre as crianças expostas ao fumo (p = 0,04; RR = 2,7; IC: 1,4 - 5,1); hospitalização e número de crises no último ano (p = 0,004; RR = 1,46; IC: 1,15 -1,86); hospitalização e aglomeração (p = 0,03; RR = 1,47; IC: 1,15 -1,86). Nos menores de cinco anos, houve associação entre fumo materno e número de crises no último ano (p = 0,03; RR = 1,79; IC: 1,04 - 3,08). CONCLUSAO: A prevalência de sintomas de asma foi alta. A comunidade estudada é limitada do ponto de vista socioeconômico e não trata adequadamente a enfermidade, o que demonstra necessidade de atendimento priorizado, normatizado e com insumos e processos avaliativos para controle da doença.

Minimal requirements in prostate cancer irradiation: a consensus document by the AIRO Lombardia Cooperative Group.

PURPOSE: With the aim of establishing clinical and technical criteria to homogenize radiotherapy practice, a working group of AIRO-Lombardia (Associazione Italiana di Radioterapia Oncologica--Gruppo regionale della Lombardia) has tried to define minimal requirements for radical and postoperative irradiation in prostate cancer. The document has been structured in such a way as to be also of interest to the urological and medical oncology communities. METHODS: The working group, composed of representatives of most of the regional radiotherapy departments in the Lombardy region, had monthly meetings during 1996 and 1997. The document on minimal requirements has been derived from the participants' combined experience and knowledge, from review of the literature, and from a 1995 regional survey on current practice of prostate irradiation. RESULTS: Minimal requirements for radical and postoperative irradiation of prostate cancer have been defined with respect to treatment strategies, pre-treatment diagnostic evaluation and staging, treatment prescription, preparation and execution, and quality assurance procedures. CONCLUSION: Standards of reference for minimal requirements in prostate cancer irradiation adapted to the regional structures and resources have been defined.

The role of radiotherapy in the treatment of carcinoma of the prostate: a survey of clinical practices in Lombardy, Italy, by the AIRO-Lombardia Cooperative Group. Italian Association for Radiation Oncology.

AIMS AND BACKGROUND: We report the results of a survey performed in 1994 by the AIRO-Lombardia Cooperative Group, on the clinical patterns of radiation treatment for prostatic carcinoma in Lombardy, Italy, involving all radiotherapy centers serving an overall local population of about 8,800,000 people. METHODS: A questionnaire was sent to all 13 radiotherapy centers throughout Lombardy, asking for demographic and treatment details concerning the local population of patients with a localized (T1-4, N0-1, M0) carcinoma of the prostate treated with radiotherapy; 12 centers responded, making the basis for the present report. RESULTS: Analysis of collected data showed that in Lombardy: a) approximately 400 patients per year are irradiated for a localized carcinoma of the prostate, accounting for less than 30% of the total expected number of patients with this disease presentation; b) a complete staging (with PSA, transrectal ultrasonography, abdomino-pelvic CT or MRI scan and total-body bone scan) is performed in over 95% of patients before initiating radiotherapy; c) significant differences exist between radiotherapy centers as regards treatment planning and delivery. CONCLUSIONS: An urgent need exists for implementing procedures aimed at standardizing radiotherapy procedures within Lombardy.

Quality control by portal film analysis in radiotherapy for prostate cancer: a comparison between two different institutions and treatment techniques.

AIMS AND BACKGROUND: Accuracy and reproducibility of patient setup during radiotherapy for prostate cancer were investigated in two different Institutions (A and B), within their Quality Assurance programs. The purpose of the study was to evaluate and compare setup accuracy and reproducibility in Institutions A and B, which adopt different patient positioning and treatment techniques for prostate irradiation. MATERIALS AND METHODS: A retrospective analysis of portal localization films taken during the treatment course was performed: 30 and 21 patients in Institutes A and B, respectively, entered the study. In Institute A, patients were treated in a prone position, utilizing an individualized immobilization cast (either an alpha cradle or a heat and vacuum-formed cellulose acetate cast) with an open table top and individual abdominal wall compressor to minimize small bowel irradiation; a 5-field conformal technique was used. In Institute B, patients were treated in a supine position without any immobilization device; a 6-field BEV-based technique (conformal only for patients treated with a radical aim) was adopted. A total of 598 portal films (420 from Institute A and 178 from Institute B) were analyzed. The mean number of films per patient was 12 (range, 4-29). Systematic and random setup errors were estimated utilizing the statistical method suggested by Bijhold et al. (1992). RESULTS: When patients with a mean (systematic) error larger than 5, 8 and 10 mm in craniocaudal, lateral and posterior-anterior directions, respectively, were compared, no statistically significant difference between the two groups was observed. Similarly, when comparing portal films, a significant difference (P <0.01) appeared only in the craniocaudal direction (errors > 5 mm: Institute A = 24%; Institute B = 11%). In both Institutes, the SD of random and systematic error distribution ranged from 1.8 to 4.2 mm, with a small prevalence of systematic errors. Only for craniocaudal shifts in Institute A was the random error larger than the systematic error, and it was significantly worse than in Institute B (1 SD, 4.2 mm in Institute A vs 1.8 mm in Institute B). CONCLUSIONS: Setup errors observed in Institutes A and B were similar and in accord with data reported in the literature. In Institute B, satisfactory geometrical treatment quality was achieved without patient immobilization. In Institute A, the goal of minimizing small bowel irradiation and prostate motion through the aforementioned technique, which makes patient position less comfortable, did not seem to considerably increase daily setup uncertainty.

Clinical target volume localization using conventional methods (anatomy and palpation) and ultrasonography in early breast cancer post-operative external irradiation.

PURPOSE: To evaluate the accuracy of three methods, anatomy (A), palpation (P) and ultrasounds (US) in localizing the clinical target volume (CTV) in patients (pts) with early breast cancer (EBC) undergoing breast external irradiation as part of conservation therapy. MATERIAL AND METHODS: One hundred consecutive pts with EBC (T(is) 1%, T1 78%, T2 21%, N- 68%, N+ 32%), treated with conservation surgery and breast irradiation with opposed tangential portals, were prospectively analyzed. Anatomically, palpatory or ultrasound defined field borders for CTV localizations were determined in the same position thanks to the utilization of a vacuum-formed cellulose acetate immobilization cast, removed during CTV definitions. RESULTS: P and US CTV localizations have been found to coincide on the four margins (superior, inferior, medial, lateral) in only 1/100 pts, while no pt showed identical A and US CTV localizations. Only 31/397 (8%) field measurements with A, and 98/395 (25%) with P corresponded to US border definition. If mean and median values of each field border were considered, the CTV was generally overestimated with P appearing more accurate than A in a gross definition of the target (P < 0.01). However, a geographical miss of at least one field border of CTV occurred in 55% of pts with A and in 36% of pts with P. The most critical margin to be defined with conventional methods was the superior one: an underestimation of the cranial border of CTV with A was observed in 51% and with P in 22% of pts (22% and 8%, respectively, when an underestimation by more than 1.5 cm was considered). When pre-menopausal and peri/post-menopausal groups of pts were separately analyzed, conventional methods were highly inaccurate to define the superior border in younger pts, in which a geographical miss was noted with A in 62% and with P in 35% of cases (P < 0.05). When an underestimation of more than 1.5 cm was evaluated, these values were reduced to 33% and 12%, respectively (P = 0.02). Also, in the subgroup of pre-menopausal patients the CTV defined by palpatory reference lines appeared to be more accurate than A-method (P < 0.01). CONCLUSIONS: Conventional methods frequently appear inadequate to localize residual mammary gland in EBC post-operative external irradiation. This analysis evidentiates the inaccuracy of empirical CTV definition, and suggests that palpation or anatomical reference borders should be critically used and that state of art imaging methods should be included in treatment planning, particularly in pre-menopausal pts. If economical or individual variables have to be taken into account, palpation might be considered in post-menopausal women.

[Clinical and methodological aspects of quality assurance in external radiotherapy: optimization of radiotherapy in early cancer of the breast]. / Aspetti clinico-metodologici di assicurazione della qualità nella radioterapia esterna: ottimizzazione del trattamento radiante nel cancro precoce della mammella.

Since 1988, a specific physical and clinical quality assurance program for external whole breast irradiation has been activated in our department. Three areas of clinical investigation and related audit loops are analyzed to show our policy to improve the quality of patient care. Quality control procedures deal with (a) the evaluation of the adequacy of conventional methods of clinical target volume (CTV) localization, (b) the evaluation of the adequacy of the conventional method of determining the planning target volume (PTV) and (c) the systematic and objective assessment of acute and late side-effects. Corrective actions to maintain or meet the standards are also reported. The localization of residual mammary gland using conventional methods (anatomy and/or palpation) was compared in 100 patients with US localization: conventional methods were often inadequate and thus the use of US in PTV determination is necessary. Portal film analysis helped reduce ideal margins from 20 mm to 11 mm. The amount of irradiated ispilateral lung, retrospectively calculated in 88 consecutive patients, appeared adequate to the chosen reference standard. The systematic study of late skin reactions had shown in some patients telangectasia regions outside the boost area: since 1991, a corrective action, decreasing the thickness of the customized immobilization cast inside the treatment area, from 2 mm to 0.2 mm, has been adopted. These examples show that the routine application of quality assurance procedures can help optimize radiation treatment.

Beam modifying devices in the treatment of early breast cancer: 3-D stepped compensating technique.

A 3-D compensating technique utilizing stepped brass filters to ensure an adequate dose distribution in the breast after conservative surgery is described. No compensation for lung inhomogeneity is applied. These compensators are part of a procedure which also involves the use of a rotatable half-beam block (HBB) and of an individualized immobilization cast. Results of patient dosimetry show a good agreement with dose prescription in the target volume (measured dose/prescribed dose = 100.9% +/- 1.8% at the reference point). Phantom dosimetry is discussed.

Quality control in the conservative treatment of breast cancer: patient dosimetry using silicon detectors.

Twenty patients with early breast cancer were treated with external irradiation, delivered with two tangential beams (6 MV X-rays) using a half-beam block (HBB) and 3-D compensating filters. All patients were immobilized with individualized cellulose acetate casts. Patient dosimetry was performed using p-type silicon detectors. Midline doses were calculated by combined entrance and exit dose measurements. The mean ratio of the measured and the prescribed doses was 96.6 +/- 3.8% at the reference point, 96.8 +/- 4.3% at off-axis points on the central plane and 96.8 +/- 7.6% at off-plane points.

Early breast cancer irradiation after conservative surgery: quality control by portal localization films.

A review of geometrical errors on portal localization films in 20 patients undergoing breast irradiation after conservative surgery is presented. Patients were immobilized using a cellulose acetate individual cast. Good precision in daily set-up has been noted with a mean ventrodorsal shift of 2.7 mm on medial films and 3.0 mm on lateral films; a mean craniocaudal shift of 1.8 mm on medial films and of 2.0 mm on lateral films have been also observed. The mean half-beam block rotation error has been minimal, ranging 0.8 degrees on medial and 1.1 degrees on lateral films. A new cast was made in 3/20 (15%) patients depending on variation of breast morphology during treatment and on geometrical errors noted by portal localization film check.

[Personalized low-melting alloy shield for high-energy electrons in the treatment of superficial neoplasms of critical or esthetically important regions]. / Schermature personalizzate in lega bassofondente per elettroni di alta energia nel trattamento di neoplasie superficiali situate in regioni estetiche o critiche.

Individualized Cerrobend beam shapings for high-energy electrons have been utilized in the treatment of superficial tumours located in aesthetic or critical regions. Individualized cellulose acetate masks have been used as immobilization device. Measured transmissions through Cerrobend ranged from 0.5% at 4 MeV to 8.5% at 18 MeV. Phantom dosimetry showed a poor influence of Cerrobend on PDD (percentage depth doses). Output factor variations appeared to depend on electron energy and shielded area. It is very important to perform either empirical measurements or to adopt semiempirical models in order to exactly calculate those output factors. Three clinical examples are presented: the utilization of immobilization device and field shaping are illustrated with the main aim of sparing the dose to critical organs.

[Clinical evaluation of a posterior photopolymerizing composite: results 4 years after application]. / Valutazione clinica di un composito fotopolimerizzabile per posteriori: risultati a distanza di 4 anni dalla applicazione.

The aim of this study was to examine clinical results of class I and class II composite restorations of forty two posterior teeth, considering pulpal vitality, dentinal sensitivity, marginal integrity, contact areas, color, gingival irritation and secondary decay. The restorations were evaluated over a four-year period. The results are considered satisfactory both from a chemical-physical and biological point of view. The Authors wish to outline the importance to improve the operative technique to minimize the disadvantages of these materials and to obtain better results. The Authors propose to carry out a later control to confirm these results.

Hepatobiliary metabolism and urinary excretion of 4-demethoxydaunorubicin as compared to daunorubicin in rats.

The hepatic metabolism and biliary excretion of 4-demethoxydaunorubicin (4DDM) was studied in Crl: CD(SD) BR rats by the liver perfusion technique. In the same strains of rats urinary excretion was investigated in vivo. Daunorubicin (DM) was always included for comparison. The drugs and their metabolites were determined in the perfusion medium, in the bile and liver and in the urine by high-performance liquid chromatography with fluorimetric detection. Compared to its analogue DM, 4DDM markedly differed in the metabolic and excretory profile. The cumulative biliary and urinary excretion of 4DDM and the metabolites was quantitatively lower than that of DM (18% vs 36% of the dose) and was consistent with prolonged persistence of 4DDM in plasma in vivo. The extensive carbonyl reduction of 4DDM and DM observed in previous in vivo pharmacokinetic studies was also evident in this study. 13-hydroxy metabolites, daunorubicinol (DMol) and 4-demethoxydaunorubicinol (4DDMol), either as such or after glycosidic cleavage, i.e. 4DDMol aglycone, were present in appreciable amounts in the perfusion medium, bile, liver and urine. In the hepatobiliary system, however, the 13-hydroxy derivative of DM amounted to a much lower fraction than the DM aglycone (17% vs 50% of the total dose), 80% of the total 4DDM dose was accounted for by 4DDMol aglycone. In urine uncleaved DMol or 4DDMol represented more than 75% of the total amount excreted for both drugs. Conjugation, a major step in the excretion of aglycones, seems to play a minor role in the biliary and urinary excretion of 4DDM and 4DDMol.

Activity and distribution of iv and oral 4-demethoxydaunorubicin in murine experimental tumors.

The antitumor activity of 4-demethoxydaunorubicin ( 4DDM ) compared to its parent compound daunorubicin (DM) was investigated in C57BL/6 mice bearing a T-cell lymphoma, the EL-4, chosen because of its sensitivity to this compound. 4DDM was moderately effective against Lewis lung carcinoma and M5076 ovarian reticulosarcoma tumor systems. Against the EL-4 tumor, after either iv or oral treatment, 4DDM had a good therapeutic effect (survival time in treated mice was almost double that in untreated mice) which was comparable to that of iv doxorubicin. Serum and tissue distribution of 4DDM and its reduced metabolite 4- demethoxydaunorubicinol , given either iv or orally at therapeutic doses to EL-4-bearing mice, was then compared with iv DM using a high-performance liquid chromatography technique with fluorimetric detection. DM seemed to be cleared faster and to a greater extent by metabolism than 4DDM , with half-lives after iv treatment of 23 hrs for 4DDM versus 4.6 hrs for DM. The reduced metabolite in serum amounted to greater than 100% of the concentration of the native compound for DM and less than 20% for 4DDM . By both the iv and oral routes, 4DDM appeared to be concentrated and retained in tissues to a proportionally higher extent than DM, with drug exposure being at least twice as high with correspondingly longer half-lives in almost all tissues investigated, including the tumor. Moreover, this demethoxy analog appeared to be somewhat more selective than DM, since the relative capacity of the tumor tissue to accumulate this compound seemed higher than that of other organs (eg, heart and spleen) reported to be targets of toxicity. Oral administration gave more favorable distribution, resulting in the highest tumor to heart and spleen concentration ratio; this suggests a superiority of this route of administration.

Effects of disodium etidronate in murine tumor models.

This study was designed to elucidate the effect of ethane-1-hydroxy-1,1-diphosphonate (EHDP) in experimental rodent tumors. EHDP had no antitumor activity against the L1210 leukemia implanted i.p. and against sarcoma 180, Lewis lung carcinoma (3LL) and Walker 256/B carcinoma injected i.p., s.c. or i.m. respectively. EHDP did not interfere with the antitumor activity of commonly used conventional chemotherapeutic agents (adriamycin, cyclophosphamide, 5-fluorouracil, bis-chloroethylnitrosourea) in the L1210 and 3LL models. EHDP reduced proportionally to the dose the hypercalcemia and hypercalciuria due to the Walker 256/B carcinoma growth. In an effort to evaluate whether EHDP-treated osseous tissues were more refractory to tumor growth, cells from sarcoma 180 and 3LL carcinoma were implanted intratibially (i.t.). Growth of 3LL cells was not consistently affected by EHDP, whereas a modest, but significant, growth inhibition was consistently observed with sarcoma 180 injected i.t. Growth of sarcoma 180 implanted i.p. or s.c. was not reduced by this drug, thus suggesting that inhibition of i.t. sarcoma 180 was in fact related to alterations of osseous tissues by EHDP. Inoculation of Walker 256/B carcinoma intra-aortically resulted in osteolytic bone lesions in the hind limbs. EHDP inhibited the formation of bone metastasis under these conditions.

[Protocol in interventions in ambulatory surgery of patients under anticoagulant therapy]. / Protocollo comportamentale negli interventi di chirurgia ambulatoriale su pazienti in trattamento anticoagulante.

Protocol is established for out-patient surgery for subjects in therapy with oral anticoagulants. A brief description is given of the pharmacologic action of coumarins and hydantoins and all other drugs that strengthen or inhibit their effects are reviewed. Modalities are established for suspending anticoagulant therapy and guide-lines are indicated for dental and oral and ear, nose and throat surgery. Mention is mode of possible complications and eventual treatment.