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1.
Lancet Oncol ; 22(7): 970-976, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34051879

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted health-care systems, leading to concerns about its subsequent impact on non-COVID disease conditions. The diagnosis and management of cancer is time sensitive and is likely to be substantially affected by these disruptions. We aimed to assess the impact of the COVID-19 pandemic on cancer care in India. METHODS: We did an ambidirectional cohort study at 41 cancer centres across India that were members of the National Cancer Grid of India to compare provision of oncology services between March 1 and May 31, 2020, with the same time period in 2019. We collected data on new patient registrations, number of patients visiting outpatient clinics, hospital admissions, day care admissions for chemotherapy, minor and major surgeries, patients accessing radiotherapy, diagnostic tests done (pathology reports, CT scans, MRI scans), and palliative care referrals. We also obtained estimates from participating centres on cancer screening, research, and educational activities (teaching of postgraduate students and trainees). We calculated proportional reductions in the provision of oncology services in 2020, compared with 2019. FINDINGS: Between March 1 and May 31, 2020, the number of new patients registered decreased from 112 270 to 51 760 (54% reduction), patients who had follow-up visits decreased from 634 745 to 340 984 (46% reduction), hospital admissions decreased from 88 801 to 56 885 (36% reduction), outpatient chemotherapy decreased from 173634 to 109 107 (37% reduction), the number of major surgeries decreased from 17 120 to 8677 (49% reduction), minor surgeries from 18 004 to 8630 (52% reduction), patients accessing radiotherapy from 51 142 to 39 365 (23% reduction), pathological diagnostic tests from 398 373 to 246 616 (38% reduction), number of radiological diagnostic tests from 93 449 to 53 560 (43% reduction), and palliative care referrals from 19 474 to 13 890 (29% reduction). These reductions were even more marked between April and May, 2020. Cancer screening was stopped completely or was functioning at less than 25% of usual capacity at more than 70% of centres during these months. Reductions in the provision of oncology services were higher for centres in tier 1 cities (larger cities) than tier 2 and 3 cities (smaller cities). INTERPRETATION: The COVID-19 pandemic has had considerable impact on the delivery of oncology services in India. The long-term impact of cessation of cancer screening and delayed hospital visits on cancer stage migration and outcomes are likely to be substantial. FUNDING: None. TRANSLATION: For the Hindi translation of the abstract see Supplementary Materials section.


Assuntos
COVID-19/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Acessibilidade aos Serviços de Saúde/tendências , Oncologia/tendências , Neoplasias/terapia , Assistência Ambulatorial/tendências , COVID-19/diagnóstico , Diagnóstico Tardio , Detecção Precoce de Câncer/tendências , Hospitalização/tendências , Hospitais com Alto Volume de Atendimentos/tendências , Humanos , Índia/epidemiologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , Fatores de Tempo , Tempo para o Tratamento , Listas de Espera
2.
J Pediatr Urol ; 16(3): 387.e1-387.e8, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32340881

RESUMO

INTRODUCTION: Duplex systems can be complicated by reflux, ureterocele, obstruction (most commonly PUJ in a lower moiety) and wetting secondary to an ectopic ureteric insertion in girls. The decision making algorithm for selection of surgical approach is complex and there is no consensus. The authors described the outcomes following an upper urinary tract approach in 2011(1) and now compare these results in a similar group of patients managed using a lower approach. OBJECTIVES: To assess whether a top-down or bottom-up approach results in different likelihoods for further surgery. STUDY DESIGN: A prospectively database was maintained for consecutive patients undergoing surgery for duplex systems by a single surgeon between 2003 and 2015. Patients were classified into 2 groups; Group 1 initial intention for upper urinary tract approach (heminephroureterectomy-HN) or Group 2 lower urinary tract approach (bladder reconstructive surgery-BRS). The requirement for further surgery was recorded-endoscopic incision (EI), bladder reconstructive surgery (BRS), endoscopic correction of reflux (ECR), heminephroureterectomy (HN). Indications for initial and subsequent surgery included urinary tract infection, VUJ obstruction and incontinence. Endoscopic incision was not performed for patients with an asymptomatic ureterocele. Statistical analysis consisted of Fisher's exact test with a 2 tail p value < 0.05 being statistically significant. RESULTS: 79 patients underwent surgery for duplex systems. 39 patients had HN initially (Group 1) and 40 patients had BRS initially (Group 2). Further surgery was performed in 21% of patients from Group 1 (8 BRS) vs 5% of patients from Group 2 (1 redo BRS, 1 ECR). Significantly less additional surgical procedures were performed after BRS compared to HN (p = 0.048). The presence of both reflux and ureterocele increases the chances of further surgery in those patients who had HN initially compared to BRS (p = 0.01). No patients developed urinary retention or required intermittent catheterisation to improve bladder emptying. CONCLUSIONS: Bladder reconstructive surgery (BRS) reduces the requirement for further surgery compared to heminephroureterectomy (HN) in symptomatic patients with a duplex kidney and either dilating vesicoureteric reflux or ureterocele.


Assuntos
Nefropatias , Ureterocele , Refluxo Vesicoureteral , Feminino , Humanos , Lactente , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos
3.
AJR Am J Roentgenol ; 212(6): 1318-1326, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30933647

RESUMO

OBJECTIVE. The purpose of this study is to evaluate the ability of quantitative 18F-FDG PET parameters to predict outcomes of patients with malignant melanoma who have been treated with immune modulation therapy. MATERIALS AND METHODS. We retrospectively investigated 34 patients with malignant melanoma. Twenty-three patients received immunotherapy as first-line therapy, and 11 patients received it as second-line therapy. The maximum standardized uptake value (SUVmax), metabolic tumor volume, tumor lesion glycolysis, and intratumoral metabolic heterogeneity (as measured by the tumor heterogeneity [TH] index) were measured for the primary tumors and metastatic sites associated with up to five of the most FDG-avid lesions per patient. The TH index was calculated as the AUC value of a cumulative SUV volume histogram curve for all patients. The median follow-up was 29.5 months (range, 3-288 months). Outcome endpoints were progression-free survival and overall survival. Kaplan-Meier survival plots were used, and Cox regression analysis was performed for predictors of survival. RESULTS. A total of 101 lesions were analyzed. Five lesions were analyzed in 12 patients, four lesions in three patients, three lesions in three patients, two lesions in four patients, and one lesion in 12 patients. Of the 34 patients included in the study, 15 (44.1%) had disease progression and 11 (32.3%) had died by the time the last follow-up occurred. The mean (± SD) SUVmax, peak SUV, metabolic tumor volume, tumor lesion glycolysis, and TH values for all lesions were 9.68 ± 6.6, 7.82 ± 5.83, 81.96 ± 146.87 mL, 543.65 ± 1022.92 g, and 5841.36 ± 1249.85, respectively. TH had a negative correlation with SUVmax, peak SUV, and tumor lesion glycolysis (p < 0.0001 for all). CONCLUSION. The TH index is significantly associated with overall survival in patients with metastatic melanoma treated with immune modulation therapy as first-line or second-line therapy.

4.
J Pediatr Urol ; 15(2): 158.e1-158.e10, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30862459

RESUMO

INTRODUCTION: Urothelial cells harvested from benign diseased bladders have a compromised capacity to propagate or differentiate in vitro, potentially limiting their application in autologous tissue engineering approaches. The causative pathways behind this altered phenotype are unknown. The hypothesis is that hypoxic damage to the urothelium occurs as a bystander to chronic or recurrent episodes of infection and inflammation. OBJECTIVE: The aim of this study was to assess immunohistochemically detected nuclear hypoxia-inducible factor 1 alpha (HIF-1α) and vascular endothelial growth factor in the urothelium when exposed to hypoxia. STUDY DESIGN: Human bladder sections from a total of 29 adult and paediatric patients, representing a variety of different pathologies including neuropathy (n = 15), were analysed. Tissues from adults with bladder outlet obstruction secondary to prostatic disease (n = 1), urothelial carcinoma (n = 1) and tonsil (n = 1) were used as positive tissue controls for immunohistochemistry. Hypoxia-inducible factor 1 alpha-labelled sections were scanned using a Zeiss AxioScan Z1 slide scanner. Analysis of urothelial nuclear HIF-1α labelling was performed using HistoQuest image analysis software (TissueGnostics). Comparison of nuclear HIF-1α labelling between neuropathic and non-neuropathic sections was performed using one-way analysis of variance with the post hoc Tukey honestly significant difference (HSD) test. Patient urodynamic studies performed before tissue sample harvest were evaluated and correlated to the HIF-1α intensity using Spearman's rank correlation. RESULTS: Hypoxia-inducible factor 1 alpha appeared more intense in the urothelial compartment from neuropathic bladder samples (n = 15) than in the control tissues, including non-obstructed samples (n = 9). Image analysis supported this; median nuclear HIF-1α labelling was 29.98 ± 3.10 (standard deviation [SD]) (n = 9) in controls and 74.29 ± 7.55 (SD) in neuropathic samples (n = 15). A statistically significant difference between the control and neuropathic tissue groups was shown (P < 0.05). Of the 15 neuropathic samples, 11 had traceable urodynamic studies. Both initial and maximum detrusor pressures indicated a positive relationship when plotted against HIF-1α labelling. Spearman's rank correlation, with no missing events, confirmed significant correlations between both initial or maximum detrusor pressure and nuclear HIF-1α labelling intensity (median score); P ≤ 0.046 and P ≤ 0.05, respectively. The null hypothesis was accordingly rejected. CONCLUSIONS: This study indicates that urothelial nuclear HIF-1α may be a biomarker of hypoxia and a common feature in end-stage bladder disease associated with high-pressure systems.


Assuntos
Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Doenças da Bexiga Urinária/metabolismo , Urotélio/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hipóxia Celular , Criança , Pré-Escolar , Feminino , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/análise , Técnicas In Vitro , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Urotélio/química , Fator A de Crescimento do Endotélio Vascular/análise
5.
World J Nucl Med ; 17(4): 228-235, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30505219

RESUMO

188Rhenium-hydroxyethylidene-1,1-diphosphonate (188Re-HEDP) is a clinically established radiopharmaceutical for bone pain palliation of patients with metastatic bone cancer. Herein, the effectiveness of 188Re-HEDP for the palliation of painful bone metastases was investigated in an uncontrolled initial trial in 48 patients with different types of advanced cancers. A group of 48 patients with painful bone metastases of lung, prostate, breast, renal, and bladder cancer was treated with 2.96-4.44 GBq of 188Re-HEDP. The overall response rate in this group of patients was 89.5%, and their mean visual analog scale score showed a reduction from 9.1 to 5.3 (P < 0.003) after 1 week posttherapy. The patients did not report serious adverse effects either during intravenous administration or within 24 h postadministration of 188Re-HEDP. Flare reaction was observed in 54.2% of patients between day 1 and day 3. There was no correlation between flare reaction and response to therapy (P < 0.05). Although bone marrow suppression was observed in patients receiving higher doses of 188Re-HEDP, it did not result in any significant clinical problems. The present study confirmed the clinical utility and cost-effectiveness of 188Re-HEDP for palliation of painful bone metastases from various types of cancer in developing countries.

6.
J Pediatr Urol ; 13(1): 86-87, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27887909

RESUMO

OBJECTIVE: To describe modification of the tubularized incised plate urethroplasty (TIP) for distal hypospadias, and assess its efficacy, and functional and cosmetic outcomes. METHODS: A prospective evaluation of a consecutive series of patients operated for primary distal hypospadias was conducted at a tertiary reference center. A standardized modification of the TIP (mTIP) procedure was performed on a 10 French catheter. Clinical data were collected in a dedicated database. Intraoperative variables, postoperative complications and outcomes, by means of uroflowmetries and a validated (HOPE) questionnaire, were assessed. Efficacy was evaluated with the reported complications: functional outcome was evaluated with uroflowmetries and cosmetic assessment by a validated questionnaire (HOPE). A descriptive statistical analysis was performed. RESULTS: Of the 112 boys operated between 30/09/2011 and 1/04/2014, 50 completed long-term follow-up with functional and esthetic evaluation, as required for inclusion. Median age at surgery was 25 months (range 14-156); median follow-up time was 21.5 months (range 6-48). Complications requiring re-intervention occurred in 2/50 boys. Uroflowmetry presented a bell-shaped curve in 47/50 boys, and the median HOPE score was 9.5 (range 7.6-10.0). CONCLUSION: The mTIP procedure provided satisfactory long-term functional and cosmetic outcomes, as validated by uroflowmetries and standardized questionnaire.


Assuntos
Hipospadia/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Urodinâmica/fisiologia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Pré-Escolar , Seguimentos , Humanos , Hipospadia/fisiopatologia , Lactente , Masculino , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
7.
J Pediatr Urol ; 12(4): 229.e1-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27346071

RESUMO

INTRODUCTION: Minimally invasive pyeloplasty (MIP) for ureteropelvic junction (UPJ) obstruction in children has gained popularity over the past decade as an alternative to open surgery. The present study aimed to identify the factors affecting complication rates of MIP in children, and to compare the outcomes of laparoscopic (LP) and robotic-assisted laparoscopic pyeloplasty (RALP). MATERIALS AND METHODS: The perioperative data of 783 pediatric patients (<18 years old) from 15 academic centers who underwent either LP or RALP with an Anderson Hynes dismembered pyeloplasty technique were retrospectively evaluated. Redo cases and patients with anatomic renal abnormalities were excluded. Demographics and operative data, including procedural factors, were collected. Complications were classified according to the Satava and modified Clavien systems. Failure was defined as any of the following: obstructive parameters on diuretic renal scintigraphy, decline in renal function, progressive hydronephrosis, or symptom relapse. Univariate and multivariate analysis were applied to identify factors affecting the complication rates. All parameters were compared between LP and RALP. RESULTS: A total of 575 children met the inclusion criteria. Laparoscopy, increased operative time, prolonged hospital stay, ureteral stenting technique, and time required for stenting were factors influencing complication rates on univariate analysis. None of those factors remained significant on multivariate analysis. Mean follow-up was 12.8 ± 9.8 months for RALP and 45.2 ± 33.8 months for LP (P = 0.001). Hospital stay and time for stenting were shorter for robotic pyeloplasty (P < 0.05 for both). Success rates were similar between RALP and LP (99.5% vs 97.3%, P = 0.11). The intraoperative complication rate was comparable between RALP and LP (3.8% vs 7.4%, P = 0.06). However, the postoperative complication rate was significantly higher in the LP group (3.2% for RALP and 7.7% for LP, P = 0.02). All complications were of no greater severity than Satava Grade IIa and Clavien Grade IIIb. DISCUSSION: This was the largest multicenter series of LP and RALP in the pediatric population. Limitations of the study included the retrospective design and lack of surgical experience as a confounder. CONCLUSIONS: Both minimally invasive approaches that were studied were safe and highly effective in treating UPJ obstruction in children in many centers globally. However, shorter hospitalization time and lower postoperative complication rates with RALP were noted. The aims of the study were met.


Assuntos
Pelve Renal/cirurgia , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Obstrução Ureteral/cirurgia , Adolescente , Criança , Pré-Escolar , Europa (Continente) , Feminino , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sociedades Médicas , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/métodos , Urologia
8.
Mucosal Immunol ; 9(4): 873-83, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-26577570

RESUMO

Cigarette smoke has been associated with susceptibility to different pulmonary and airway diseases. Impaired alveolar macrophages (AMs) that are major phagocytes in the lung have been associated with patients with airway diseases and active smokers. In the current report, we show that exposure to second-hand cigarette smoke (SHS) significantly reduced efferocytosis in vivo. More importantly, delivery of recombinant granulocyte-macrophage colony-stimulating factor (GM-CSF) to the alveolar space restored and refurbished the efferocytosis capability of AMs. Exposure to SHS significantly reduced expression of CD16/32 on AMs, and treatment with GM-CSF not only restored but also significantly increased the expression of CD16/32 on AMs. GM-CSF treatment increased uptake and digestion/removal of apoptotic cells by AMs. The latter was attributed to increased expression of Rab5 and Rab7. Increased efferocytosis of AMs was also tested in a disease condition. AMs from GM-CSF-treated, influenza-infected, SHS-exposed mice showed significantly better efferocytosis activity, and mice had significantly less morbidity compared with phosphate-buffered saline-treated group. GM-CSF-treated mice had increased amphiregulin levels in the lungs, which in addition to efferocytosis of AMs may have attributed to their protection against influenza. These results will have great implications for developing therapeutic approaches by harnessing mucosal innate immunity to treat lung and airway diseases and protect against pneumonia.


Assuntos
Fator Estimulador de Colônias de Granulócitos e Macrófagos/metabolismo , Pulmão/imunologia , Macrófagos Alveolares/imunologia , Infecções por Orthomyxoviridae/imunologia , Orthomyxoviridae/imunologia , Anfirregulina/metabolismo , Animais , Apoptose , Células Cultivadas , Imunidade Inata , Camundongos , Camundongos Endogâmicos C57BL , Fagocitose , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Proteínas rab de Ligação ao GTP/genética , Proteínas rab de Ligação ao GTP/metabolismo , Proteínas rab5 de Ligação ao GTP/genética , Proteínas rab5 de Ligação ao GTP/metabolismo , proteínas de unión al GTP Rab7
9.
Ann Oncol ; 26(6): 1216-1223, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25712460

RESUMO

BACKGROUND: To determine genomic alterations in head and neck squamous cell carcinoma (HNSCC) using formalin-fixed, paraffin-embedded (FFPE) tumors obtained through routine clinical practice, selected cancer-related genes were evaluated and compared with alterations seen in frozen tumors obtained through research studies. PATIENTS AND METHODS: DNA samples obtained from 252 FFPE HNSCC were analyzed using next-generation sequencing-based (NGS) clinical assay to determine sequence and copy number variations in 236 cancer-related genes plus 47 introns from 19 genes frequently rearranged in cancer. Human papillomavirus (HPV) status was determined by presence of the HPV DNA sequence in all samples and corroborated with high-risk HPV in situ hybridization (ISH) and p16 immunohistochemical (IHC) staining in a subset of tumors. Sequencing data from 399 frozen tumors in The Cancer Genome Atlas and University of Chicago public datasets were analyzed for comparison. RESULTS: Among 252 FFPE HNSCC, 84 (33%) were HPV positive and 168 (67%) were HPV negative by sequencing. A subset of 40 tumors with HPV ISH and p16 IHC results showed complete concordance with NGS-derived HPV status. The most common genes with genomic alterations were PIK3CA and PTEN in HPV-positive tumors and TP53 and CDKN2A/B in HPV-negative tumors. In the pathway analysis, the PI3K pathway in HPV-positive tumors and DNA repair-p53 and cell cycle pathways in HPV-negative tumors were frequently altered. The HPV-positive oropharynx and HPV-positive nasal cavity/paranasal sinus carcinoma shared similar mutational profiles. CONCLUSION: The genomic profile of FFPE HNSCC tumors obtained through routine clinical practice is comparable with frozen tumors studied in research setting, demonstrating the feasibility of comprehensive genomic profiling in a clinical setting. However, the clinical significance of these genomic alterations requires further investigation through application of these genomic profiles as integral biomarkers in clinical trials.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma de Células Escamosas/genética , Perfilação da Expressão Gênica/métodos , Neoplasias de Cabeça e Pescoço/genética , Sequenciamento de Nucleotídeos em Larga Escala , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Inibidor p16 de Quinase Dependente de Ciclina/análise , Variações do Número de Cópias de DNA , DNA Viral/genética , Bases de Dados Genéticas , Feminino , Fixadores , Formaldeído , Estudos de Associação Genética , Predisposição Genética para Doença , Neoplasias de Cabeça e Pescoço/química , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/virologia , Testes de DNA para Papilomavírus Humano , Humanos , Imuno-Histoquímica , Hibridização In Situ , Masculino , Pessoa de Meia-Idade , Mutação , Papillomaviridae/genética , Inclusão em Parafina , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Carcinoma de Células Escamosas de Cabeça e Pescoço , Fixação de Tecidos
11.
AJNR Am J Neuroradiol ; 35(12): 2243-7, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25034779

RESUMO

BACKGROUND AND PURPOSE: CT-guided biopsy is the most commonly used method to obtain tissue for diagnosis in suspected cases of malignancy involving the spine. The purpose of this study was to demonstrate that a low-dose CT-guided spine biopsy protocol is as effective in tissue sampling as a regular-dose protocol, without adversely affecting procedural time or complication rates. MATERIALS AND METHODS: We retrospectively reviewed all patients who underwent CT-guided spine procedures at our institution between May 2010 and October 2013. Biopsy duration, total number of scans, total volume CT dose index, total dose-length product, and diagnostic tissue yield of low-dose and regular-dose groups were compared. RESULTS: Sixty-four patients were included, of whom 31 underwent low-dose and 33 regular-dose spine biopsies. There was a statistically significant difference in total volume CT dose index and total dose-length product between the low-dose and regular-dose groups (P < .0001). There was no significant difference in the total number of scans obtained (P = .3385), duration of procedure (P = .149), or diagnostic tissue yield (P = .6017). CONCLUSIONS: Use of a low-dose CT-guided spine biopsy protocol is a practical alternative to regular-dose approaches, maintaining overall quality and efficiency at reduced ionizing radiation dose.


Assuntos
Biópsia Guiada por Imagem/métodos , Doses de Radiação , Doenças da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coluna Vertebral
12.
Indian J Ophthalmol ; 62(2): 158-62, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24618486

RESUMO

AIM: To report our experience of brachytherapy using 'BARC I-125 Ocu-Prosta seeds' for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011. MATERIALS AND METHODS: We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty-one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult-onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15- or 20-mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor. RESULTS: For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow-up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow-up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage. CONCLUSION: The results of this retrospective study confirms that the use of 'BARC I-125 Ocu-Prosta seeds' in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.


Assuntos
Braquiterapia/instrumentação , Neoplasias Oculares/radioterapia , Adulto , Relação Dose-Resposta à Radiação , Desenho de Equipamento , Neoplasias Oculares/mortalidade , Feminino , Seguimentos , Humanos , Índia/epidemiologia , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento
13.
Paediatr Int Child Health ; 34(3): 230-2, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24621238

RESUMO

Thymolipomas are benign neoplasms that usually occur in adults and are rarely described in children. They are usually detected incidentally but can be of massive size and lead to respiratory compromise. A 6-month-old boy presented with respiratory distress and an anterior mediastinal mass which proved to be a thymolipoma. He underwent surgical resection and remains well on follow-up. Although rare, thymolipomas should be considered in the differential diagnosis even in infants presenting with an anterior mediastinum mass.


Assuntos
Lipoma/diagnóstico , Lipoma/patologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/patologia , Histocitoquímica , Humanos , Lactente , Lipoma/cirurgia , Masculino , Radiografia Torácica , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X
14.
Balkan J Med Genet ; 16(2): 53-8, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24778564

RESUMO

Interleukin-6 (IL-6) is one of the cytokines that has been well studied and implicated in many diseases including cancers. The frequency of the IL-6 -174 (G/C) polymorphism had been proven to differ in various populations. Malaysia is a country with three major ethnic populations, Malays, Chinese and Indians. In this study, we proposed to determine the G or C allele frequency of the IL-6 -174 polymorphism in these three populations. A total of 348 blood samples were available for analysis. The median age for the subjects was 31 years. There were a total of 245 males and 103 females. A total of 86 Malays (25.0%), 122 Chinese (33.0%) and 140 Indians (40.0%) were genotyped. The result showed a significant difference in the G or C allele frequency of the -174 polymorphism. The total frequencies for the G and C alleles were 91.0 and 9.0%, respectively. In the Malays, the allele frequency of the C allele was 4.0% compared with 19.0% in the Indians. The C allele was not detected in the Chinese population. This finding is the first reported on the Malaysian population and may be important in determining risk of diseases associated with the IL-6 polymorphism in these three populations.

15.
Ann Nucl Med ; 26(9): 707-14, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22797818

RESUMO

OBJECTIVE: To establish the effects of size and segmentation methods on intra-reader reliability of primary tumor metabolic tumor volume (MTV) and total glycolytic activity (TGA) in human solid tumors. METHODS: This is a retrospective study of 121 patients who had a baseline FDG PET/CT scan for oncologic staging. Volumetric parameter readings were performed in random order on two separate occasions, 12 weeks apart, by the same reader. The MTV and TGA were segmented using gradient and fixed maximum standardized uptake value (SUVmax) threshold methods. Intra-reader reliability was established by the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS: The biases for MTV were 2.95, 14.76 and 11.13% for gradient segmentation, 38 and 50% SUVmax fixed threshold segmentations, respectively (p < 0.0001). For TGA, the corresponding biases were 0.76, 10.36 and 7.46% (p < 0.0001). There were no statistically significant differences in the biases between the first and second reads for MTV segmented for small and large volume tumors by the gradient method (p < 0.34) or 50% SUVmax threshold segmentation (p < 0.08). However, there were statistically significant differences in the corresponding biases for the 38% SUVmax threshold segmentation (p < 0.04). There were no statistically significant differences in the biases between the first and second reads for TGA segmented for small and large volume tumors (p < 0.98). CONCLUSION: Intra-reader reliability for primary tumor FDG MTV and TGA is affected by the tumor size and segmentation methods. The segmentation bias was smaller for gradient method than percentage fixed threshold method for MTV. The segmentation biases were smaller for TGA than MTV.


Assuntos
Fluordesoxiglucose F18 , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Tomografia por Emissão de Pósitrons/métodos , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Carga Tumoral
16.
Pediatr Surg Int ; 27(11): 1233-7, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21877242

RESUMO

INTRODUCTION AND OBJECTIVES: We present data from a single surgeon experience of paediatric transperitoneal (TP) and retroperitoneal (RP) minimally invasive approaches for partial (PN) and total nephrectomy (TN). METHODS: A retrospective review was conducted in the patients undergoing nephrectomy between 2003 and 2008. Patients were divided depending on PN or TN and the approach (RP or TP). Primary outcome was the need to convert to an open procedure. Secondary outcomes included operation time, length of stay (LOS) and complications. Statistical analysis included Fisher's exact test. RESULTS: 68 patients underwent minimally invasive TN/PN, 49 (72%) RP versus 19 (28%) TP. There were no differences between the groups in terms of sex, age, pathology, LOS, complication rate and conversion rate. Neither group recorded mortality. Conversion occurred because of difficult anatomy or the kidney size rather than an adverse event. Overall, there was no difference in operative time between the RP and TP. This was also the case for TN only. However, the PN subgroup demonstrated a decreased operative time with RP (p = 0.049) possibly due to better anatomical delineation. There were no complications. CONCLUSIONS: Minimally invasive TN or PN can be performed via retroperitoneal or transperitoneal routes with minimal morbidity. With training, PN via retroperitoneal approach can be achieved with significantly reduced operative time.


Assuntos
Nefropatias/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrectomia/métodos , Peritônio/cirurgia , Espaço Retroperitoneal/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
Pediatr Surg Int ; 27(12): 1323-6, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21877243

RESUMO

INTRODUCTION AND OBJECTIVES: Heminephroureterectomy (HN) is our treatment of choice in a duplex system with non-functioning moiety. We examined the need for endoscopic incision (EI)/bladder reconstructive surgery (BRS) and whether ureteroceles and/or vesicoureteric reflux (VUR) influenced management options. METHODS: Retrospective study of patients undergoing HN by a single surgeon (2003-2008). Patients were classified according to the presence (Group 1) or absence (Group 2) of ureterocele. The groups were subdivided with coexisting dilating VUR (a) or not (b). Statistical analysis included Fisher's exact test. RESULTS: Thirty-one children were identified. Seventeen (54.8%) had ureterocele (Group 1) and 14 patients had no ureterocele (Group 2). Group 1 had eight with VUR (1a) and nine without (1b). Group 2 had seven with VUR (2a) and seven without (2b). Significantly more patients with ureterocele required EI/BRS (p = 0.006). Five (29%) in Group 1 required BRS versus none in Group 2 (p = 0.04). Six (75%) in Group 1a underwent EI/BRS versus three (33%) in Group 1b (p = 0.15). Significantly more in Group 1a required EI prior to HN versus Group 1b (p = 0.04). Similar numbers of patients required BRS in Groups 1a and 1b (p = 0.61). CONCLUSIONS: In the absence of ureterocele, there is minimal likelihood of requiring surgery apart from HN, independent of VUR. Presence of ureterocele is an indicator for additional procedure within the bladder. There is a higher incidence of EI when ureterocele co-exists with dilating VUR.


Assuntos
Nefropatias/cirurgia , Rim/anormalidades , Nefrectomia/métodos , Ureter/cirurgia , Ureterocele/cirurgia , Ureteroscopia/métodos , Bexiga Urinária/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Dentomaxillofac Radiol ; 39(7): 449-53, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20841465

RESUMO

Ameloblastic carcinoma is a very rare malignant odontogenic tumour with characteristic histopathological and clinical features, which requires aggressive surgical treatment and surveillance and, therefore, differs from ameloblastoma. Metastasis typically occurs in the lung. Only one patient with metastasis to the skull has previously been described and no prior case reports have presented MRI and positron emission tomography-CT (PET-CT) imaging findings. We describe a case of ameloblastic carcinoma with metastasis to the skull and lung with emphasis on imaging features including MRI and PET-CT.


Assuntos
Neoplasias Mandibulares/patologia , Tumores Odontogênicos/patologia , Adolescente , Fluordesoxiglucose F18 , Humanos , Neoplasias Pulmonares/secundário , Imageamento por Ressonância Magnética , Masculino , Neoplasias Mandibulares/diagnóstico por imagem , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/secundário , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Neoplasias Cranianas/secundário , Tomografia Computadorizada por Raios X
19.
AJNR Am J Neuroradiol ; 31(4): 598-604, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19910448

RESUMO

The hybrid technique of PET/CT has significantly impacted the imaging and management of HNSCC since its introduction in 2001 and has become the technique of choice for imaging of this cancer. Diagnostic FDG-PET/CT is useful for identification of an unknown primary tumor, delineation of extent of primary tumor, detection of regional lymph node involvement even in a normal-sized node, detection of distant metastases and occasional synchronous primary tumor, assessment of therapy response, and long-term surveillance for recurrence and metastases. The role of PET/CT is evolving in radiation therapy planning. Combined diagnostic PET/CT provides the best anatomic and metabolic in vivo information for the comprehensive management of HNSCC.


Assuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Fluordesoxiglucose F18 , Processamento de Imagem Assistida por Computador , Neoplasias Otorrinolaringológicas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Biópsia por Agulha Fina , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/terapia , Progressão da Doença , Seguimentos , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Neoplasia Residual/diagnóstico por imagem , Neoplasia Residual/patologia , Neoplasia Residual/terapia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Otorrinolaringológicas/patologia , Neoplasias Otorrinolaringológicas/secundário , Neoplasias Otorrinolaringológicas/terapia , Sensibilidade e Especificidade , Carga Tumoral , Ultrassonografia
20.
J Pediatr Urol ; 6(3): 270-3, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19800295

RESUMO

Crohn's disease is a chronic granulomatous inflammatory bowel disorder, often associated with cutaneous manifestations, termed metastatic Crohn's. Here we present two cases of paediatric metastatic Crohn's disease involving the penis, focusing on clinical presentation, histological diagnosis and treatment.


Assuntos
Circuncisão Masculina/métodos , Doença de Crohn/complicações , Prepúcio do Pênis/patologia , Metronidazol/uso terapêutico , Doenças do Pênis/etiologia , Tacrolimo/administração & dosagem , Anti-Infecciosos/uso terapêutico , Criança , Pré-Escolar , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Diagnóstico Diferencial , Quimioterapia Combinada , Seguimentos , Prepúcio do Pênis/cirurgia , Humanos , Imunossupressores/administração & dosagem , Masculino , Pomadas , Doenças do Pênis/diagnóstico , Doenças do Pênis/terapia
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