RESUMO
RATIONALE AND OBJECTIVES: The objectives of this study were to compare the visibility and quantification of subsolid nodules (SSNs) on computed tomography (CT) using adaptive iterative dose reduction using three-dimensional processing between 7 and 42 mAs and to assess the association of size-specific dose estimate (SSDE) with relative measured value change between 7 and 84 mAs (RMVC7-84) and relative measured value change between 42 and 84 mAs (RMVC42-84). MATERIALS AND METHODS: As a Japanese multicenter research project (Area-detector Computed Tomography for the Investigation of Thoracic Diseases [ACTIve] study), 50 subjects underwent chest CT with 120 kV, 0.35 second per location and three tube currents: 240 mA (84 mAs), 120 mA (42 mAs), and 20 mA (7 mAs). Axial CT images were reconstructed using adaptive iterative dose reduction using three-dimensional processing. SSN visibility was assessed with three grades (1, obscure, to 3, definitely visible) using CT at 84 mAs as reference standard and compared between 7 and 42 mAs using t test. Dimension, mean CT density, and particular SSDE to the nodular center of 71 SSNs and volume of 58 SSNs (diameter >5 mm) were measured. Measured values (MVs) were compared using Wilcoxon signed-rank tests among CTs at three doses. Pearson correlation analyses were performed to assess the association of SSDE with RMVC7-84: 100 × (MV at 7 mAs - MV at 84 mAs)/MV at 84 mAs and RMVC42-84. RESULTS: SSN visibilities were similar between 7 and 42 mAs (2.76 ± 0.45 vs 2.78 ± 0.40) (P = .67). For larger SSNs (>8 mm), MVs were similar among CTs at three doses (P > .05). For smaller SSNs (<8 mm), dimensions and volumes on CT at 7 mAs were larger and the mean CT density was smaller than 42 and 84 mAs, and SSDE had mild negative correlations with RMVC7-84 (P < .05). CONCLUSIONS: Comparable quantification was demonstrated irrespective of doses for larger SSNs. For smaller SSNs, nodular exaggerating effect associated with decreased SSDE on CT at 7 mAs compared to 84 mAs could result in comparable visibilities to CT at 42 mAs.
Assuntos
Imageamento Tridimensional , Doses de Radiação , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador/métodosRESUMO
The increase in the number of residents in elderly care facilities has developed into a growing demand for home-based terminal care rather than treatments at medical institutions. Like many others, the Active Life Toyonaka (private skilled nursing home) has received more requests from its residents for adequate terminal care. It is unfortunate, however, that quite a few residents are obliged to be hospitalized for medical reasons that result in death. The purpose of our study is to determine what a terminal care should be like in a private skilled nursing home. The study has been conducted with the focuse on the successful case of a 90-year-old male resident diagnosed as having prostate cancer with bone metastasis. Our study has concluded that the crucial factors for a better terminal care should go as follows: (1) Having good coordination with medical institutions, (2) Reporting every change in residents' condition and administering an immediate treatment for alleviating pains of the residents, (3) Providing the residents with comfortable life of less restraint on activities in home-based care, (4) Sharing the same information among the staff of all divisions who is in charge of residents (doctors, nurses, caregivers, etc.) and (5) Establishing relationships of mutual trust with residents and their families. Nurses, especially, need to play important roles as coordinators among all the personnel concerned.
Assuntos
Redes Comunitárias , Serviços de Assistência Domiciliar , Equipe de Assistência ao Paciente , Neoplasias da Próstata/enfermagem , Instituições de Cuidados Especializados de Enfermagem , Assistência Terminal , Idoso de 80 Anos ou mais , Neoplasias Ósseas/enfermagem , Neoplasias Ósseas/secundário , Feminino , Humanos , Masculino , Neoplasias da Próstata/patologia , Assistência Terminal/éticaRESUMO
Fifteen out of 140 men (median age 67 years, range 62-75) had a serum prostate-specific antigen (PSA) level of < or = 4 ng/ml before radical prostatectomy which was performed without preoperative neoadjuvant hormonal therapy between 2001 January and 2004 September. Demographic and clinical data were analyzed. Pathological specimens were evaluated by routine hematoxylin and eosine staining and immunohistochemistry with anti-PSA antibody, for both pathological staging and grading, and for the presence of PSA production. Pathological data were compared between patients with PSA < or = 4 ng/ml and those with 4 < PSA < or = 10 ng/ml. Clinically insignificant cancer was defined as a cancer volume of < 0.5 ml and the Gleason score < or = 6. The median PSA level was 3.0 ng/ml (range 1.4-3.9). Thirteen tumors (87%) were pT2. One tumor had a Gleason score of 7 and 14 tumors had a final Gleason score of < or = 6. Nine (60%) tumors were clinically insignificant. Comparison of pathological variables, PSA < or = 4 ng/ml cancer had a significantly lower Gleason score (p = 0.0029), and a smaller cancer volume (p = 0.0451) than 4 < PSA < or = 10 ng/ml cancer. All tumors were stained strongly for PSA. During a median follow-up of 24 (9-36) months, no patient showed elevated PSA (PSA > or = 0.1 ng/ml). Most prostate cancers in men with a PSA level of < or = 4 ng/ml were pT2, and about half of them were clinically insignificant. All cancers produced PSA.
Assuntos
Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Idoso , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , ProstatectomiaRESUMO
BACKGROUND: The objective of the present study was to analyze the pathological findings of radical prostatectomy specimens diagnosed on single core positive prostate biopsy in eight systematic transrectal ultrasonography (TRUS)-guided biopsies with a Gleason score = 4. METHODS: Between January 1993 and March 2001, 975 patients underwent TRUS-guided prostate biopsy, and 32 patients were diagnosed as having prostate cancer based only on one positive core with a Gleason score = 4. In this study, 14 of the 32 patients who underwent radical prostatectomy without any neoadjuvant therapies were enrolled, and the pathological findings of their radical prostatectomy specimens were evaluated. RESULTS: The clinical stage of the 14 patients was T1c in 10 and T2 in four. Cancer was detected in the prostate apex in seven patients, the middle in two, the base of the peripheral zone (PZ) in three, the lateral horn of the PZ in one and the transitional zone (TZ) one. Pathological stage of the 14 patients was pT2a in four, pT2b in six, pT3a in three and pT3b one. Gleason score of the radical prostatectomy specimens in 11 patients was also = 4. Of the 10 patients diagnosed with cT1c, extraprostatic disease was found in only one radical prostatectomy specimen. All three patients whose cancer was detected from the base of the PZ showed pT3 disease. During the median follow-up period of 47.5 months, all patients were alive with no evidence of disease. CONCLUSION: The prognosis of patients who were diagnosed with one core positive prostate biopsy with a Gleason score = 4 is generally favorable; however, advanced disease tended to be observed in patients who were diagnosed with cT2a and/or whose cancer was detected from the base of PZ.
Assuntos
Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Idoso , Biópsia/classificação , Biópsia/métodos , Progressão da Doença , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia de Intervenção/métodosRESUMO
OBJECTIVE: The objective of the present study was to evaluate the usefulness of the combined systematic biopsy with serum prostate-specific antigen-alpha(1)-antichymotrypsin complex (PSA-ACT) level to predict the extent of prostate cancer. MATERIALS AND METHODS: Sixty-two patients with clinically organ-confined disease who underwent radical prostatectomy were evaluated for serum PSA and PSA-ACT levels, systematic biopsy, and the pathological stage. RESULTS: The incidence of extraprostatic disease in patients with more than half the biopsy cores positive or > or = 8 ng/ml PSA-ACT was significantly higher than those with less than half positive or <8 ng/ml PSA-ACT, respectively, whereas cancer in bilateral lobes or > or = 10 ng/ml PSA could not be used as a predictor of extraprostatic disease. Furthermore, in those with more than half the biopsy cores positive and > or = 8 ng/ml PSA-ACT or those with more than half the biopsy cores positive and > or = 10 ng/ml PSA, extraprostatic disease was significantly more common than in those with less than half positive and <8 ng/ml PSA-ACT or those with less than half positive and <10 ng/ml PSA, respectively. However, the incidence of extraprostatic disease predicted by these three variables was not significantly better than those by the two variables (percentage positive biopsy cores plus serum PSA-ACT or PSA). CONCLUSIONS: The combined systematic biopsy with serum PSA-ACT or PSA could be used as a useful predictor for the extent of prostate cancer. Patients with more than half the biopsy cores positive and > or = 8 ng/ml PSA-ACT or > or = 10 ng/ml PSA could avoid a prostatectomy because there is a high probability that they have extraprostatic disease.