RESUMO
OBJECTIVE: Approximately 50% of cancer patients develop bone metastases in their natural disease history. The management of metastatic bone disease requires a multidisciplinary approach. Both radiofrequency ablation (RFA) and radiation therapy (RT) were safe and effective in the management of painful metastases, even if they rely on totally different action mechanisms. A synergistic combination of RT and RFA seems to result in a better pain control. A systematic review was performed to describe the feasibility and effectiveness of the association between RFA and RT in the treatment of metastatic bone pain in oligo-metastatic patients, evaluating its role in alleviating bone pain, reducing the risk of fractures, and consequently ensuring a better quality of life. MATERIALS AND METHODS: A systematic database search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This systematic review included studies that reported populations meeting the following inclusion criteria: (I) conï¬rmed bone metastases in adult patients; (II) active bone metastases pain; (III) patients treated with combined RFA-RT; (IV) Original studies. RESULTS: Three papers that evaluated the combined treatment with doses ranging from moderately hypofractionated three-dimensional conformal RT (3D-CRT) and stereotactic body radiation therapy (SBRT) schedules were selected. CONCLUSIONS: The RFA-RT combined strategy appears to be promising in terms of efficiency and safety with adequate pain control and quality of life improvement. Positive effects on time to local failure and overall survival increase were also observed. Further prospective studies are needed to better delineate RFA-RT treatment benefits.
Assuntos
Neoplasias Ósseas/terapia , Hipofracionamento da Dose de Radiação , Ablação por Radiofrequência , Radiocirurgia , Neoplasias Ósseas/secundário , Dor do Câncer/terapia , Terapia Combinada , Fraturas Ósseas/prevenção & controle , HumanosRESUMO
Group A Streptococcal (GAS) infections have increased in frequency and severity worldwide. During April 1996, a nosocomial outbreak associated to GAS infections affected seven patients admitted to a pediatric burn unit. The causative organism was likely disseminated from the source patient to another child in the emergency room before he was transferred to the burn unit. Patients developed burn infections or invasive disease. One of them died due to a toxic shock syndrome and 3 other lost their skin grafts. Perineal and nasal microbiological surveillance of 42 related health care workers identified only one of them as carrier of S pyogenes. Aim: To report a molecular analysis of an apparently clonal outbreak. Material and methods: The available isolates were analyzed by molecular methods including random amplified polymorphic DNA analysis (RAPD) with 4 different primers, Sma-I pulsed field gel electrophoresis (PFGE) analysis, and speA, speB and speC detection by polymerase chain reaction (PCR). Results: Two phylogenetically distant and sequentially isolated bacterial groups were identified either by RAPD analysis with selected primers or by Smal-PFGE analysis. The first group involved isolates identified in two patients that included the lethal case. The second bacterial group comprised 5 clinical isolates and the perineal and nasal isolates obtained from a health care worker. Only strains belonging to the first group harbored the speA gene and were associated with invasive disease. The second group could be split further in two subgroups according to their speB profile. Conclusions: RAPD analysis with selected primers can reproduce the PFGE-discriminating ability on the epidemiological analysis of GAS infections
Assuntos
Humanos , Streptococcus pyogenes , Unidades de Queimados , Queimaduras , Infecções Estreptocócicas/epidemiologia , Dados de Sequência Molecular , Surtos de Doenças , Superantígenos/isolamento & purificação , Técnicas de Sonda MolecularRESUMO
Salmonella isolates from 3920 patients with typho8id fever form 2 years in Santiago wetre analyzed to determine the frequency of association with S paratyphi B infection. This was demonstrated in 18.8% of subjects in both areas, a figure significantly higher than the 8-10% previously reported. the association S paratyphi B was higher for females, especially for the younger age agrupo. These findings suggest an infectious agentgender-age interaction which may explain the discrepancy with previously report rates of infection. Their possible relation to the chronic salmonella carrier state and association with biliary tract lithiasis and cancer is discussed
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Humanos , Masculino , Feminino , Salmonella paratyphi B/patogenicidade , Febre Paratifoide/epidemiologiaRESUMO
Las fiebres tifoidea y paratifoidea son consideradas clínica y epidemiológicamente casi una misma entidad. Sin embargo, para estudios clínico-epidemiológicos, en particular los dirigidos a estudios inmunogenéticos sobre la relación huésped-agente, estas salmonellas deben ser consideradas como diferentes. Este estudio fue hecho para estudiar posibles cambios en el comportamiento de la Salmonella paratyphi B (SPTB) luego de haber sido introducida la cepa viva de la vacuna oral Ty21a en el Area Norte de Santiago. Se revisaron los resultados de hemo y mielocultivos del Laboratorio de Microbiología del Hospital Roberto del Río hechos durante 1983 y el período 1986-89. De 1.204 fiebres tíficas bacteriológicamente comprobadas, el 22,4% correspondieron a SPTB, lo cual fue una frecuencia inesperadamente más alta que las estimaciones anteriores (p < 0,02). En mujeres tíficas, la SPTB fue más frecuente que en varones (p < 0,02). En 697 niños seleccionados por ser residentes del Area Norte, la SPTB fue dos veces más la causa de la enfermedad que en varones de la misma edad (p < 0,009). Se comenta estos resultados teniendo en cuenta que la portación crónica de salmonelas tíficas afecta principalmente a mujeres (5,5: 1). Los resultados no permiten establecer el papel de vacuna oral en los fenómenos descritos