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1.
Bull Cancer ; 111(10): 944-954, 2024 Oct.
Artigo em Francês | MEDLINE | ID: mdl-39242252

RESUMO

Bone marrow aplasia is a rare and serious hematologic disorder. Although benign, it is a hematologic disorder whose prognosis can be poor and whose spontaneous development can be fatal. Treatment is long, difficult and costly. In developing countries, the mortality rate is high due to the difficulties of therapeutic management, both supportive and specific. We conducted a retrospective study of 92 cases of AM identified in the Pediatric Hematology and Oncology Department of the 20 Août University Hospital in Casablanca over a 10-year period (January 2010-January 2020). In this work, we present an overview of the situation and highlight the difficulties encountered in the management of AM in the Pediatric Hematology and Oncology Department of the University Hospital of Casablanca. In our study, the mean age was 19 years, ranging from 3 months to 29 years, with a peak in the 15-20 age group. The sex ratio (M/F) was 2.06, with a male predominance of 67%. In our series, only 35% of patients had complete bone marrow failure. An anemic syndrome was present in 92% of patients, and hemorrhagic and infectious syndromes were present in 70% and 41% of patients, respectively. The median time from diagnosis to treatment was 82 days. According to the Camitta score, 31% of our patients had mild AM, 41% had severe AM, and 28% had very severe AM. After etiologic evaluation, we concluded that 90% of the patients had idiopathic bone marrow aplasia, 2% had constitutional bone marrow aplasia, and 8% of the patients were suspected to have secondary bone marrow aplasia: post-hepatitis (3 cases), toxic (2 cases), drug-induced (1 case), and aplastic PNH (1 case). Mortality in the first three months after diagnosis was 21%. Sixty-nine percent of our patients received specific treatment: 28 were treated with cyclosporin (CIS) alone as first-line therapy, 20 received a combination of antilymphocyte serum (ALS) and cyclosporin, 2 received hematopoietic stem cell transplantation (HSCT), while 3 were treated with androgens alone. The overall response rate was 30% with CIS, 42% with ALS+CIS and 100% with HSCT. In our study, the overall death rate was 44%, while the one-year survival rate was 40%. It is important to note that septic shock was the leading cause of death (53% of deaths), followed by hemorrhagic shock (24%). This highlights the lack of hemodynamic resuscitation and symptomatic treatment. Our multivariate study defined the following risk factors as predictive of worse survival: age greater than 16 years (RR: 3.28; CI: 1.29-8.33; P=0.012), PNN less than 200 or very severe bone marrow aplasia (RR: 3.01; 1.1-8.08; P=0.028), and failure to receive any specific treatment (RR: 4.07; 1.77-9.35; P=0.0003). The high overall mortality in our series was due to several factors: inaccessibility to effective therapies, delayed diagnosis, failure to initiate specific treatment, inadequate symptomatic treatment, and geographical and financial inaccessibility.


Assuntos
Anemia Aplástica , Soro Antilinfocitário , Ciclosporina , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Anemia Aplástica/mortalidade , Anemia Aplástica/terapia , Marrocos/epidemiologia , Estudos Retrospectivos , Prognóstico , Tempo para o Tratamento , Ciclosporina/uso terapêutico , Soro Antilinfocitário/uso terapêutico , Resultado do Tratamento , Diagnóstico Tardio
2.
Artigo em Francês | MEDLINE | ID: mdl-39307627

RESUMO

OBJECTIVE: To evaluate, in long-term, the functional abilities and the occurrence of osteoarthritis in patients treated for a posterior perilunate carpal dislocation without bone lesion associated. PATIENTS AND METHOD: This was a monocentric retrospective observational study on patients operated on at the University Hospital of Guadeloupe for a posterior perilunate dislocation without bone lesion associated with a minimum of 18years of follow-up. Ten patients were included with a mean follow-up of 22.8years. The evaluation criteria were clinical (PRWE, QuickDASH, pain, grip strength, wrist joint mobility, Watson and Reagan tests, Cooney functional score) and radiographic (Gilula curves, carpal height, carpal ulnar translation, scapholunate and radiolunar angles, scapholunate and triquetro-lunar interlines in statics and dynamics, Herzberg's classification of complications). RESULTS: The average Cooney score was 67.5/100. Mean PRWE and QuickDASH scores were 33.9 and 24.8 respectively. The mean flexion-extension arc on the injured side was 71.5° (66.7% compared to the healthy side). Mean grip strength was 27kg (72.8% compared to the healthy side). The prevalence of osteoarthritis was 60%, with three A types, two A1 types, one B type and four B1 types according to Herzberg. CONCLUSION: The factors influencing the long-term prognosis are the initial displacement of the lunate, the quality of the reduction and the presence of chronic carpal instability, particularly scapholunate. The high prevalence of osteoarthritis in our series (60%) is apparently not correlated with the functional capacities of patients over the long term.

3.
Fr J Urol ; : 102723, 2024 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-39216732

RESUMO

OBJECTIVES: Although men have a higher risk of developing a bladder cancer, women appear to have a poorer prognosis and a more advanced stage at diagnosis. We performed a retrospective population-based study on muscle invasive bladder cancer (MIBC) using data from a cancer registry in a French department to compare overall and specific survival data according to sex. MATERIAL AND METHODS: We included all patients living in the department of Hérault and diagnosed with MIBC between January 1, 2017 and December 12, 2019. Univariable and multivariable analyses were performed on all variables of interest. RESULTS: We included 124 women and 432 men. There was no significant difference in age or stage at diagnosis according to sex. Squamous cell carcinomas were more common in women (p<0.001). Cystectomy was more frequent in men than in women (50.7% vs 35.4%) (p=0.0039). By multivariable analysis, the independent factors for being treated by cystectomy were sex (p=0.004), age (p<0.001) and stage (p<0.001). Forty-seven percent of women received no treatment or palliative treatment. Overall mortality was 79% in women and 63.2% in men (p<0.001). The median specific survival was 10.8 months in women and 32.7 months in men (p<0.0001). By multivariable analysis, the independent risk factors for mortality were female sex (p=0.047), cT4 stage (p=0.005) and absence of cystectomy (p<0.001). CONCLUSIONS: Our study shows that women are less often treated with cystectomy and have worse prognosis than men. The reasons for this gender difference are multifactorial.

4.
Can J Diabetes ; 2024 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-39069232

RESUMO

OBJECTIVES: Diabetic ketoacidosis (DKA) occurring after diabetes diagnosis is often associated with risk factors for other diabetes-related complications. In this study we aimed to determine the prognostic implications of DKA on all-cause mortality and complications in type 1 diabetes (T1D). METHODS: Previously collected data from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study were obtained through the the National Institute of Diabetes and Digestive and Kidney Diseases Central Repository. Using Cox proportional hazards models with time-dependent covariates, we examined age- and sex-adjusted, glycated hemoglobin-adjusted, and fully adjusted associations of DKA with all-cause mortality, cardiovascular disease, microvascular, and acute complications over 34 years. RESULTS: Of the 1,441 study participants, 297 had 488 DKA events. Prior DKA was associated with a higher risk of age- and sex-adjusted all-cause mortality (hazard ratio [HR] 8.28, 95% confidence interval [CI] 3.74 to 18.32, p<0.001), major adverse cardiovascular events (MACEs) (HR 2.05, 95% CI 1.34 to 3.13, p<0.001), and all advanced microvascular and acute complications compared with no prior DKA. Most associations except retinopathy were significant even after adjustment for covariates. In our fully adjusted analysis, prior DKA was associated with a significantly higher risk of subsequent all-cause mortality (HR 9.13, 95% CI 3.87 to 21.50, p<0.001), MACEs (HR 1.66, 95% CI 1.07 to 2.59, p=0.03), advanced kidney disease (HR 2.10, 95% CI 1.00 to 4.22, p=0.049), advanced neuropathy (HR 1.49, 95% CI 1.05 to 2.13, p=0.03), severe hypoglycemia (HR 1.53, 95% CI 1.28 to 1.81, p<0.001), and recurrent DKA (HR 3.24, 95% CI 2.41 to 4.36, p<0.001) compared with person-time without DKA. CONCLUSIONS: DKA is a prognostic marker for diabetes complications, including excess all-cause mortality. Intensified clinical interventions, such as cardiovascular prevention strategies, may be warranted after diagnosis of DKA.

5.
Fr J Urol ; 34(9): 102673, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38945366

RESUMO

INTRODUCTION: Compare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene. MATERIALS AND METHODS: This is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver-operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25. RESULTS: A total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor. CONCLUSION: FGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene. LEVEL OF EVIDENCE: II.


Assuntos
Gangrena de Fournier , Índice de Gravidade de Doença , Humanos , Gangrena de Fournier/mortalidade , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/sangue , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Feminino , Idoso , Valor Preditivo dos Testes , Prognóstico , Neutrófilos/patologia , Adulto , Estudos de Coortes , Reprodutibilidade dos Testes
6.
Cancer Radiother ; 28(3): 236-241, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38871605

RESUMO

PURPOSE: Many cancer patients develop bone metastases, however the prognosis of overall survival differs. To provide an optimal treatment for these patients, especially towards the end of life, a reliable prediction of survival is needed. The goal of this study was to find new clinical factors in relation to overall survival. MATERIALS AND METHODS: Prospectively 22 clinical factors were collected from 734 patients. The Kaplan-Meier and Cox regression models were used. RESULTS: Most patients were diagnosed with lung cancer (29%), followed by prostate (19.8%) and breast cancer (14.7%). Median overall survival was 6.4months. Fourteen clinical factors showed significance in the univariate analyses. In the multivariate analyses 6 factors were found to be significant for the overall survival: Karnofsky performance status, primary tumor, gender, total organs affected, morphine use and systemic treatment options after radiotherapy. CONCLUSION: Morphine use and systemic treatment options after radiotherapy, Karnofsky performance status, primary tumor, gender and total organs affected are strong prediction factors on overall survival after palliative radiotherapy in patients with bone metastasis. These factors are easily applicable in the clinic.


Assuntos
Neoplasias Ósseas , Avaliação de Estado de Karnofsky , Cuidados Paliativos , Humanos , Masculino , Neoplasias Ósseas/secundário , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/mortalidade , Feminino , Prognóstico , Idoso , Pessoa de Meia-Idade , Estudos Prospectivos , Idoso de 80 Anos ou mais , Adulto , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/mortalidade , Morfina/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/mortalidade , Estimativa de Kaplan-Meier , Fatores Sexuais , Analgésicos Opioides/uso terapêutico
7.
Cancer Radiother ; 28(3): 242-250, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38876937

RESUMO

PURPOSE: The lack of reliable biomarkers for the prognosis and radiotherapy efficacy in esophageal cancer (EC) necessitates further research. The aim of our study was to investigate the predictive utility of plasma cell-free DNA (cfDNA) kinetics in patients with EC. MATERIALS AND METHODS: We retrospectively analyzed the clinical data and cfDNA levels (pre-radiotherapy [pre-RT] and post-radiotherapy [post-RT]) and the cfDNA kinetics (cfDNA ratio: post-RT cfDNA/pre-RT cfDNA) of 88 patients. We employed Kaplan-Meier curves to examine the relationship between cfDNA and overall survival (OS) as well as progression-free survival (PFS). Univariate and multivariate Cox regression analyses were executed to ascertain the independent risk factors in EC. RESULTS: The pre-RT cfDNA levels were positively correlated with clinical stage (P=0.001). The pre-RT cfDNA levels (cutoff value=16.915ng/mL), but not the post-RT cfDNA levels, were linked to a diminished OS (P<0.001) and PFS (P=0.0137). CfDNA kinetics (cutoff value=0.883) were positively associated with OS (P=0.0326) and PFS (P=0.0020). Notably, we identified independent risk factors for OS in EC treated with RT, including cfDNA ratio (high/low) (HR=0.447 [0.221-0.914] P=0.025), ECOG (0/1/2) (HR=0.501 [0.285-0.880] p=0.016), and histological type (esophagal squamous cell carcinoma [ESCC]/non-ESCC) (HR=3.973 [1.074-14.692] P=0.039). CONCLUSION: Plasma cfDNA kinetics is associated with prognosis and radiotherapy effect in EC undergoing RT, suggesting potential clinical application of a cheap and simple blood-based test.


Assuntos
Biomarcadores Tumorais , Ácidos Nucleicos Livres , Neoplasias Esofágicas , Humanos , Neoplasias Esofágicas/radioterapia , Neoplasias Esofágicas/sangue , Neoplasias Esofágicas/mortalidade , Neoplasias Esofágicas/patologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prognóstico , Idoso , Biomarcadores Tumorais/sangue , Ácidos Nucleicos Livres/sangue , Estimativa de Kaplan-Meier , Intervalo Livre de Progressão , Carcinoma de Células Escamosas do Esôfago/radioterapia , Carcinoma de Células Escamosas do Esôfago/sangue , Adulto , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/sangue , Carcinoma de Células Escamosas/mortalidade , Idoso de 80 Anos ou mais , Cinética
11.
Cureus ; 16(1): e53198, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38425615

RESUMO

INTRODUCTION: This study was conducted to describe the epidemiology, prognostic factors, and visual outcomes of open globe injuries (OGIs) at a tertiary care centre in Western Rajasthan, India. METHODS: Data of OGI patients treated at the Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, from March 2019 to December 2021 were reviewed retrospectively. Demographic details including age, gender, place of injury, wound characteristics (i.e., cause, mechanism, location, and size), visual acuity (VA), and associated ocular injuries were recorded. The Ocular Trauma Classification System (OTCS) and the Birmingham Eye Trauma Terminology (BETT) were used to categorize OGIs. All the data was entered into a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States) and analyzed with IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). RESULTS: A total of 40 patients with OGIs were included. OGI was discovered to be four times higher in males and 47.5% of the total cases were observed in patients aged 0-15 years, followed by patients aged 16-30 (27.5%). The rupture injury showed a higher incidence rate (32.5%) than the penetrating injury (62.5%). Of all OGIs, 75% were grade 4 injuries, with zone 1 being the most often affected zone and wood stick injury being the most prevalent aetiology. A significant difference was noted (p<0.001) in comparing presenting VA with final VA with paired sample t-test. A negative Spearman correlation was noted between age and final VA (r = 0.53, p = 0.000), and the grade of injury and final VA (r = 0.51, p = 0.001.) Conclusion: Young males were the most susceptible group to sustain OGIs due to their more physical activities. Health education and safety in the workplace and during sports are crucial to reduce the incidence of OGI.

12.
Cancer Radiother ; 28(2): 208-217, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38519291

RESUMO

In recent years, with the development of artificial intelligence, deep learning has been gradually applied to clinical treatment and research. It has also found its way into the applications in radiotherapy, a crucial method for cancer treatment. This study summarizes the commonly used and latest deep learning algorithms (including transformer, and diffusion models), introduces the workflow of different radiotherapy, and illustrates the application of different algorithms in different radiotherapy modules, as well as the defects and challenges of deep learning in the field of radiotherapy, so as to provide some help for the development of automatic radiotherapy for cancer.


Assuntos
Aprendizado Profundo , Neoplasias , Humanos , Inteligência Artificial , Neoplasias/radioterapia , Algoritmos , Planejamento da Radioterapia Assistida por Computador/métodos
13.
Ann Cardiol Angeiol (Paris) ; 73(2): 101740, 2024 Apr.
Artigo em Francês | MEDLINE | ID: mdl-38417204

RESUMO

INTRODUCTION: Infective endocarditis (IE) remains a serious disease with significant morbidity and mortality despite therapeutic advancements. The aim of our study was to determine the predictive factors of in-hospital mortality. PATIENTS AND METHODS: A prospective comparative study over a period of 54 months was conducted, including all patients admitted for definite infective endocarditis, diagnosed according to the modified Duke criteria published in 2015 by the European Society of Cardiology. RESULTS: Thirty-four patients were included. Drug addiction was the main risk factor for infective endocarditis (56%). Tricuspid valve involvement was predominant (50%). Staphylococcus aureus was the most commonly isolated pathogen (65%). In-hospital mortality rate was 47%. In multivariate analysis, predictive factors for mortality were acute heart failure (OR=7.4; p=0.026; 95% CI [1.2-44]) and cerebral embolic localization (OR=11.1; p=0.024; 95% CI [13-90]). CONCLUSIONS: Cardiac and cerebral complications influence the prognosis of IE. Thus, close collaboration among multidisciplinary teams is necessary for improved diagnostic and therapeutic management.


Assuntos
Endocardite Bacteriana , Endocardite , Humanos , Estudos Prospectivos , Mortalidade Hospitalar , Estudos Retrospectivos , Endocardite Bacteriana/complicações , Endocardite/diagnóstico , Fatores de Risco
14.
Ann Cardiol Angeiol (Paris) ; 73(2): 101735, 2024 Apr.
Artigo em Francês | MEDLINE | ID: mdl-38387249

RESUMO

OBJECTIVE: the study's objective was to determine impact of COVID-19 on the prognosis of pulmonary embolism. PATIENTS AND METHODS: An analytical multicenter cross-sectional study with retrospective data collection was carried out in three university hospitals and a private clinic in Ouagadougou from March, 2020 to July 2021. It included consecutive patients hospitalized for PE confirmed on chest CT angiography or by the association an acute cor pulmonale on echocardiography-Doppler with deep vein thrombosis on venous ultrasound-Doppler of the lower limbs and having carried out a COVID-19 test (RT-PCR or rapid diagnostic test). Control cases consisted of all COVID-19 negative PE cases. Data comparison was carried out using the Epi info 7 software. A univariate then multivariate analysis allowed the comparison of the prognosis of the two subpopulations. The significance level retained was p < 0.05. RESULTS: 96 patients with COVID-19+ and 70 COVID-19- PE were included. The prevalence of PE in patients hospitalized for COVID-19 was 7.05%. The average patient age was 61.5±17 years for COVID-19+ patients and 49.6±15.9 years for COVID-19- patients. Pulmonary condensation syndrome (p=0.007), desaturation (p=0.0003) and respiratory distress syndrome (p=0.006) were more common in COVID-19+ patients. The hospital death rate was 27.1% in COVID-19+ patients and 10% in COVID-19- patients (p=0.0024). Age > 65 years and COVID-19 pneumonia were the independent factors of death. CONCLUSION: COVID-19 is associated with clinical severity and excess mortality in patients with pulmonary embolism.


Assuntos
COVID-19 , Embolia Pulmonar , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , COVID-19/complicações , Estudos Retrospectivos , Estudos Transversais , Embolia Pulmonar/complicações , Prognóstico
15.
Gynecol Obstet Fertil Senol ; 52(5): 343-347, 2024 May.
Artigo em Francês | MEDLINE | ID: mdl-38211770

RESUMO

OBJECTIVE: Female genital mutilation (FGM) covers all procedures involving partial or total removal of the external genitalia for non-therapeutic purposes. The period of pregnancy and childbirth is probably more at risk of complications for these women. The main aim of this study was to compare obstetrical, maternal and neonatal outcomes in patients with a history of female genital mutilation with patients without such a history. METHODS: All deliveries taking place between January 2005 and June 2022 at Besançon University Hospital in patients with a history of FGM were included. This group was compared with a randomly selected group of deliveries of patients with no history of FGM. A total of 87 deliveries with a history of FGM were included and compared with 696 deliveries with no history of FGM. RESULTS: There were significantly more instrumental deliveries (27.6% vs. 17.5%, P=0.01), more caesarean sections (23% vs. 14.1%, P=0.01), more episiotomies (9.2% vs. 0.7%, P<0.01), more first-degree perineal tears (30.8% vs. 20.8%, P=0.02), second-degree (13.9% vs. 5.3%, P<0, 01), third-degree (3.1% vs. 0.2%, P=0.02), more anterior perineal tears (23.1% vs. 2.5%, P<0.01), increased duration of pushing efforts (13 min vs. 10 min, P=0.05) and greater blood loss (297 cc vs. 165 cc, P<0.01) in the group with a history of FGM. There was no statistically significant difference in neonatal outcome. CONCLUSION: The obstetrical prognosis of patients with a history of FGM is significantly poorer. Neonatal prognosis remains unchanged.


Assuntos
Cesárea , Circuncisão Feminina , Parto Obstétrico , Períneo , Resultado da Gravidez , Humanos , Feminino , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/estatística & dados numéricos , Gravidez , Adulto , Cesárea/estatística & dados numéricos , Recém-Nascido , Prognóstico , Períneo/lesões , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/métodos , Episiotomia/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Extração Obstétrica/efeitos adversos , Lacerações/epidemiologia , Lacerações/etiologia
16.
Cureus ; 15(11): e49575, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38156124

RESUMO

OBJECTIVE: This study aimed to evaluate the overall survival of hepatocellular carcinoma patients who qualify for transarterial chemoembolization (TACE) using the "six-and-twelve" prognostic score. The research was conducted on a patient cohort between 2009 and 2019. MATERIALS AND METHODS: A retrospective cohort study was conducted, involving patients diagnosed with unresectable hepatocarcinoma, Barcelona Clinic Liver Cancer (BCLC) staging A or B, and Child-Pugh staging A or B. Exclusion criteria included patients with spontaneous tumor rupture, other neoplasms, decompensated liver cirrhosis, and a lack of reference images. The study assessed the size of the largest nodule and the number of tumors based on imaging studies. Overall survival was defined as the time from initial TACE to death from any cause, with telephonic follow-up conducted. Patients were categorized into three groups based on tumor burden: ≤6, >6-≤12, and >12. Mortality rates at 12, 24, and 36 months were compared using the chi-square test for categorical variables and the ANOVA and Kruskal-Wallis tests for continuous variables, depending on their distribution. RESULTS: A total of 90 patients were included in the study, with a median age of 69 years (interquartile range (IQR): 62-77). Among the patients, 61.1% had a tumor burden of six or less. The overall survival rate was found to have a median of 28.4 months (IQR: 26.3-30.5), with survival rates at one, two, and three years being 84.7%, 55.2%, and 29.4%, respectively. It was observed that mortality increased in proportion to tumor burden, and this difference was statistically significant. CONCLUSION: The use of tumor burden, with cut-off points of six and 12, as a prognostic score proved to be a valuable tool for predicting mortality in the studied cohort.

17.
Cancer Radiother ; 27(8): 759-767, 2023 Dec.
Artigo em Francês | MEDLINE | ID: mdl-37925348

RESUMO

Breast tumours are the most common tumours in women but represent a very heterogeneous group. On the one hand, there are ductal and lobular carcinomas of the breast, representing 90% of tumours, whose clinicopathologic characteristics are well known. On the other hand, there are rare breast tumours, each of which represents less than 1% that limits their study through large cohorts. The objective of this work was to collect, update and synthesize knowledge on these rare tumours. A literature review was performed on the Medline and Google Scholar databases. We present here a selection of several rare tumours, providing updated data at the epidemiological, histopathological, genetic, clinical and radiographic, prognostic and therapeutic levels, taking into account the place of radiotherapy. Each tumour histology is unique and has its own characteristics, the management must therefore be adapted as much as possible and decided in a multidisciplinary meeting.


Assuntos
Neoplasias da Mama , Carcinoma Lobular , Humanos , Feminino , Prognóstico , Carcinoma Lobular/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia
18.
Cancer Radiother ; 27(6-7): 464-468, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37541796

RESUMO

The radiation therapy quality assurance of clinical trials is internationally recognized as a key factor to control the quality of radiotherapy for its impact on clinical trial's goals. Quality assessment may be performed at different levels and by different means, which are now quite standardized. The optimal radiation therapy quality assurance of clinical trials trade-off to maintain accrual rates, radiotherapy quality and optimize clinical trial research processes is yet to be defined. This article addresses current definitions, processes, limitations and directions.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Radioterapia (Especialidade) , Humanos , Ensaios Clínicos como Assunto
19.
Cureus ; 15(7): e42629, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37641758

RESUMO

Malignant primary rectal melanomas (PRM) are rare tumors. Their diagnosis is frequently delayed as these lesions are often mistaken for benign diseases, resulting in extremely poor overall survival. Histological evaluation with special immunohistochemical (IHC) stains is often indispensable for a definitive diagnosis. The main treatment for this condition involves surgical resection. Adjuvant therapy has also been long recommended. We discuss the case of a 60-year-old woman who presented with changes in bowel habits, anal pain, and perineal burning with no bleeding. A digital rectal examination revealed a nodular mass extending 5 cm from the anal verge. Rectosigmoidoscopy demonstrated an ulcerated polypoid tumor extending 4 cm from the anal verge and over 5 cm into the lower rectum. Biopsy and IHC tests confirmed the diagnosis of rectal melanoma. The patient was successfully managed with surgery followed by external beam radiotherapy and a complete response was achieved after 10 months of follow-up.

20.
Cureus ; 15(6): e40122, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37435264

RESUMO

INTRODUCTION: Clinoidal meningiomas are currently among the intracranial meningiomas with the greatest neurosurgical complexity, morbidity, and mortality associated with their resection. The worldwide literature has described tumor size (>4 cm3), patient age (>60 years), and invasion of the cavernous sinus as factors associated with a worse clinical outcome following surgery. METHODS: We describe the series of cases of patients with clinoidal meningiomas who underwent microsurgical resection at our institution between January 2014 and March 2019. The intention was to analyze the multiple preoperative variables, such as the patient's demographic, tumor, and surgical characteristics, such as the Al-Mefty Classification to find a relationship with the patient's clinical outcome during their postoperative follow-up.  Results: Death occurred in 4.8% of the cases. Postoperative morbidity was documented in 42.9%, the most frequent being ophthalmoparesis, followed by worsening of visual acuity, and new onset motor deficits. Radiological characteristics were assessed based on preoperative MRI. The maximum diameter, midline shift, invasion of the cavernous sinus, arterial encasement, and peritumoral edema were evaluated. Average intraoperative bleeding was 1.3 L. The most frequent histological grade was World Health Organization (WHO) grade 1 in 85.6% of the cases. Complete resection was obtained in 52.4% of the cases; 42.8% received fractionated stereotactic radiotherapy after surgery for disease control, and one received radiosurgery. Recurrence occurred in 33.3%. The average follow-up in months was 23.8.  Conclusions: Demographic factors and tumor characteristics in clinoidal meningioma surgery are related to the subtype of meningioma according to the Al-Mefty Classification and impact directly the degree of resection, progression of the disease, and degree of postoperative complications. To achieve maximal resection while minimizing morbidity and mortality, these factors must be considered to decide on an appropriate approach and specific plan for each case.

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