RESUMO
BACKGROUND: The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for prostate-specific antigen (PSA) failure. PATIENTS AND METHODS: RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, preoperative PSA≥10 ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ('Adjuvant-RT') or an observation policy with salvage RT for PSA failure ('Salvage-RT') defined as PSA≥0.1 ng/ml or three consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5 Gy/20 fractions or 66 Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant-metastasis (FFDM), designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10 years with Adjuvant-RT. Secondary outcome measures were biochemical progression-free survival, freedom from non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; hazard ratio (HR)<1 favours Adjuvant-RT. RESULTS: Between October 2007 and December 2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with a median age of 65 years. Ninety-three percent (649/697) Adjuvant-RT reported RT within 6 months after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10-year FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 [95% confidence interval (CI) 0.43-1.07, P=0.095]. Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95% CI 0.667-1.440, P=0.917). Adjuvant-RT reported worse urinary and faecal incontinence 1 year after randomisation (P=0.001); faecal incontinence remained significant after 10 years (P=0.017). CONCLUSION: Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy. TRIAL IDENTIFICATION: RADICALS, RADICALS-RT, ISRCTN40814031, NCT00541047.
Assuntos
Prostatectomia , Neoplasias da Próstata , Terapia de Salvação , Humanos , Masculino , Prostatectomia/métodos , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/patologia , Idoso , Terapia de Salvação/métodos , Pessoa de Meia-Idade , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Antígeno Prostático Específico/sangue , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Gradação de Tumores , Fatores de TempoRESUMO
AIMS: To characterise CT findings in renal cell carcinoma (RCC), and establish which features are associated with higher clinical T stage disease, and to evaluate patterns of discrepancy between radiological and pathological staging of RCC. MATERIALS AND METHODS: Preoperative CT studies of 92 patients with 94 pathologically proven RCCs were retrospectively reviewed. CT stage was compared with pathological stage using the American Joint Committee on Cancer (AJCC), 7(th) edition (2010). The presence or absence of tumour necrosis, perinephric fat standing, thickening of Gerota's fascia, collateral vessels were noted, and correlated with pT stage. The sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) for predicting pT stage ≥pT3a were derived separately for different predictors using cross-tabulations. RESULTS: Twenty-four lesions were pathological stage T1a, 21 were T1b, seven were T2a, 25 were T3a, 11 were T3b, four were T3c, and two were T4. There were no stage T2b. Sixty-three (67%) patients had necrosis, 27 (29%) thickening of Gerota's fascia (1 T1a), 25 had collateral vessels (0 T1a), 28 (30%) had fat stranding of <2 mm, 20 (21%) of 2-5mm and one (1%) of >5 mm. For pT stage ≥pT3a, the presence of perinephric fat stranding had a sensitivity, specificity, PPV and NPV of 74%, 65%, 63%, and 76%, respectively. Presence of tumour necrosis had a sensitivity, specificity, PPV, and NPV of 81%, 44%, 54%, and 72%, respectively. Thickening of Gerota's fascia had a sensitivity, specificity, PPV, and NPV of 52%, 90%, 81% and 70%, respectively; and enlarged collateral vessels had a sensitivity, specificity, PPV, and NPV value of 52%, 94%, 88%, and 71% respectively. CONCLUSION: The presence of perinephric stranding and tumour necrosis were not reliable signs for pT stage >T3a. Thickening of Gerota's fascia and the presence of collateral vessels in the peri- or paranephric fat had 90% and 94% specificity, with 82% and 88% PPV, respectively, for the presence of tumour stage for pT stage >T3a. These are considered reliable signs of locally advanced renal cancer.
Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodosRESUMO
High cost of chemical fertilizers and poor nutrient content in conventional organic sources (manure, compost, charcoal etc.) can be addressed through development of enriched organic amendments. However, there is a need to evaluate enriched organic amendments as a potential alternative of chemical fertilizers. Therefore, an effort was made to prepare enriched organic amendments through blending distillation waste of aromatic plant biomass (DWB) with naturally available low-grade rock phosphate (RP) and waste mica (WM). Enrich compost (ENC) was produced from DWB in a natural composting process, blended with mineral powder, whereas biochar fortified mineral (BFM) was prepared by blending biochar, derived from DWB through hydrothermal reaction, with mineral powder. The main aims of the present study were to investigate the impacts of ENC and BFM applications on soil properties, and herbage yield and quality of a medicinal herb Senna (Cassia angustifolia Vahl.). The performances of ENC and BFM at two different rates (2.5 and 5 t ha-1) were compared with the application of conventional farmyard manure (FYM, 5 t ha-1) and chemical fertilizers (CF, NPK 60-40-20 kg ha-1) in two different soils in a pot experiment. Both, ENC and EBC improved soil quality and fertility by increasing soil organic carbon, available nutrients, microbial biomass and enzyme activity. The ENC and BFM increased total herbage yields by 21 and 16.3 % compared to FYM. In both soils, the CF treatment produced the maximum dry herbage yields (32.7-37.4 g pot-1), which however were comparable to ENC (31.9-33.7 g pot-1) and BFM (30.7-35.1 g pot-1) treatments. Bioactive compound (sennoside) production in senna was significantly improved by ENC and BFM compared to CF. The present study indicates that ENC and BFM could not only help to overcome the limitation of conventional FYM, but also have the potentials to substitute costly chemical fertilizers, particularly in medicinal plant cultivation.
RESUMO
Air quality in Hyderabad, India, often exceeds the national ambient air quality standards, especially for particulate matter (PM), which, in 2010, averaged 82.2 ± 24.6, 96.2 ± 12.1, and 64.3 ± 21.2 µg/m(3) of PM10, at commercial, industrial, and residential monitoring stations, respectively, exceeding the national ambient standard of 60 µg/m(3). In 2005, following an ordinance passed by the Supreme Court of India, a source apportionment study was conducted to quantify source contributions to PM pollution in Hyderabad, using the chemical mass balance (version 8.2) receptor model for 180 ambient samples collected at three stations for PM10 and PM2.5 size fractions for three seasons. The receptor modeling results indicated that the PM10 pollution is dominated by the direct vehicular exhaust and road dust (more than 60%). PM2.5 with higher propensity to enter the human respiratory tracks, has mixed sources of vehicle exhaust, industrial coal combustion, garbage burning, and secondary PM. In order to improve the air quality in the city, these findings demonstrate the need to control emissions from all known sources and particularly focus on the low-hanging fruits like road dust and waste burning, while the technological and institutional advancements in the transport and industrial sectors are bound to enhance efficiencies. Andhra Pradesh Pollution Control Board utilized these results to prepare an air pollution control action plan for the city.
Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/estatística & dados numéricos , Modelos Químicos , Material Particulado/análise , Monitoramento Ambiental , ÍndiaRESUMO
BACKGROUND: Although statins do not affect the incidence of prostate cancer (CaP), usage reduces the risk of clinical progression and mortality. Although statins are known to downregulate the mevalonate pathway, the mechanism by which statins reduce CaP progression is unknown. METHODS: Bone marrow stroma (BMS) was isolated with ethical approval from consenting patients undergoing surgery for non-malignant disease. PC-3 binding, invasion and colony formation within BMS was assessed by standardised in vitro co-culture assays in the presence of different statins. RESULTS: Statins act directly on PC-3 cells with atorvastatin, mevastatin, simvastatin (1 µM) and rosuvastatin (5 µM), but not pravastatin, significantly reducing invasion towards BMS by an average of 66.68% (range 53.93-77.04%; P<0.05) and significantly reducing both number (76.2±8.29 vs 122.9±2.48; P=0.0055) and size (0.2±0.0058 mm(2) vs 0.27±0.012 mm(2); P=0.0019) of colonies formed within BMS. Statin-treated colonies displayed a more compact morphology containing cells of a more epithelial phenotype, indicative of a reduction in the migrational ability of PC-3 cells. Normal PC-3 phenotype and invasive ability was recovered by the addition of geranylgeranyl pyrophosphate (GGPP). CONCLUSION: Lipophilic statins reduce the migration and colony formation of PC-3 cells in human BMS by inhibiting GGPP production, reducing the formation and the spread of metastatic prostate colonies.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Metástase Neoplásica/prevenção & controle , Neoplasias da Próstata/patologia , Medula Óssea/patologia , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/fisiologia , Humanos , Masculino , Invasividade Neoplásica , Fosfatos de Poli-Isoprenil/antagonistas & inibidoresRESUMO
INTRODUCTION: Capecitabine provides an attractive alternative to intravenous (IV) 5-flourouracil (5-FU) in chemoradiation regimes for rectal cancer by avoiding the need for intravenous access and inpatient stay. We aimed to compare retrospectively the efficacy of concurrent capecitabine with IV 5-FU in preoperative pelvic chemoradiation schedules for rectal cancer in our centre. METHOD: Patients treated from January 2005 to June 2007 were included. Information was collected on patient characteristics; treatment details; pathological response to treatment; recurrence and survival. All statistical analyses were performed using SPSS V17. RESULTS: All patients had pelvic radiation. Ninety-nine patients were treated with capecitabine and 97 with 5-FU. The two groups were well matched for age, sex and TNM stage. There were significantly more PS (performance status) 0 patients in the capecitabine group (51%vs 30%) (P = 0.001). Of the 99 patients in the capecitabine group, 91 (92%) were able to undergo surgery with 84 (93%) achieving R0 resection. In the 5-FU group, these proportions were 87 (90%) and 70 (80%). The difference in the rate of R0 resection was statistically significant (P = 0.024). The APR rate was 35% in the capecitabine group compared with 47% in the 5-FU group (P = 0.06). There was no significant difference in pathological complete response (pCR) rates between capecitabine (14%) and 5-FU(12%). A higher pCR rate (30%) was observed in patients who underwent a brachytherapy boost (P = 0.051). There were three local recurrences in the whole patient group, (capecitabine 1; 5-FU 2). Thirty-five patients had distant metastases, 14 in the capecitabine and 21 in the 5-FU group. There was no significant difference in the risk of recurrence between the two groups. Six patients in each group had grade 3 toxicity with diarrhoea being more common with capecitabine. CONCLUSIONS: Preoperative chemoradiotherapy with capecitabine for rectal cancer is efficacious and comparable to 5-FU (IV). It is more convenient, is well tolerated and avoids the need for inpatient admission.
Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Fluoruracila/administração & dosagem , Neoplasias Retais/tratamento farmacológico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Capecitabina , Desoxicitidina/administração & dosagem , Intervalo Livre de Doença , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Indução de Remissão , Estudos Retrospectivos , Análise de Sobrevida , Adulto JovemRESUMO
AIM: Preoperative radiotherapy has been shown to improve local control in advanced rectal carcinoma compared with surgery alone. Several large randomized trials have confirmed that chemoradiotherapy (CRT) is better than radiotherapy alone. This pilot study was designed to increase the radiation dose using high-dose rate (HDR) brachytherapy boost following preoperative CRT to evaluate whether this strategy improves the outcome of surgery without increase in toxicity. METHOD: Since October 2004, we have used the new rectal HDR applicator for brachytherapy boost in 68 patients following CRT. The patients had CT and MRI Scans as part of staging. All had locally advanced disease either bulky low T2 or T3 with threatened circumferential resection margin and multiple suspicious lymph nodes. They were offered preoperative CRT either by 5-FU infusion 1 g/m(2) day 1-4 (week 1 + 5) or by oral capecitabine 825 mg/m(2) Monday-Friday for 5 weeks together with CT planned external beam RT 45Gy in 25 fractions over 5 weeks (CRT). Those downstage on repeat MRI scan were offered additional HDR Boost 10Gy directly to the tumour followed by surgery 6-8 weeks later [group A]. Four patients proceeded directly to surgery but because of involved resection margin had a HDR brachytherapy boost as postoperative treatment [group B]. Thirty patients were not planned for immediate surgery after CRT and brachytherapy boost, as they were either elderly or considered high risk for anaesthesia [group C]. RESULTS: There were 34 patients (median age 67 (range 39-81) years in group A, including 24 men). The PS was 0-1. The clinical stage at presentation was cT2 in five, cT3 in 23 and T4 in six patients and cN0 in 2, cN1 in 21 and N2 in 11. Thirty-three patients had CRT, and one had radiotherapy alone. All patients completed treatment without interruption. Twenty-nine patients had surgery following CRT and brachytherapy boost including anterior resection in 10 patients, Abdominoperineal excision (APR) in 18 and Hartmann's resection in one. Five patients did not have the intended surgery. Twenty-four (83%) patients had an RO resection compared with 63% having conventional preoperative CRT using bolus 5FU regimes. Pathological complete remission (pCR) was achieved in 9 (31%) compared with 12% patients having conventional CRT. There was no increase in G 3-4 toxicity from RT and no delay in wound healing or increase in anastomotic leakage. One of the four patients in group B developed local recurrence. The thirty patients in group C who had modified radical CRT followed by brachytherapy boost as a definitive treatment will be reported in a further communication. CONCLUSION: Increasing the dose of radiation by HDR brachytherapy boost appears to improve the RO resection and pCR rates compared with conventional CRT. The follow up is too short to judge its effect on disease-free survival. This study will be extended to compare this strategy in a randomized phase III trial with conventional CRT in patients who are not fit for more intensive CRT (HERCULES).
Assuntos
Braquiterapia/métodos , Neoplasias Retais/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Projetos Piloto , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Análise de SobrevidaRESUMO
Rectangular shaped α-Ce2S3 microrods have been grown with the aid of a facile, efficient, low cost and low temperature chemical bath deposition (CBD) approach in thin film form. Characterizations of α-Ce2S3 have been performed through structural, morphological and surface wettability studies. Intermixed rectangular microrods with lower contact angle provide a reduction in intrinsic resistance and effective ion diffusion path during electrochemical activities ensuring maximum utilization of the active electrode species. This leads to achieve a remarkable specific capacitance of 726â¯F/g at 2â¯mV/s scan rate with the excellent electrochemical stability of 93% at 2000 CV cycles. Efficient electrochemical findings exhibit excellent scope of α-Ce2S3 towards next-generation energy storage devices.
RESUMO
AIMS: To identify the incidence of viable local tumour in the testis of patients undergoing delayed orchidectomy after initial presentation with advanced germ cell tumour (GCT) treated by primary chemotherapy. PATIENTS AND METHODS: Thirty-three patients presenting with advanced metastatic GCT were reviewed. The median age at presentation was 34 years. All received chemotherapy without previous orchidectomy. The decision to initiate chemotherapy without orchidectomy was based on a heavy tumour load and the patient's condition at initial presentation. A histological diagnosis was available from a biopsy of metastases in 23 patients; treatment in the remaining 10 patients was initiated after diagnosis based on a combination of elevated serum tumour markers, testicular findings and the presence of a retroperitoneal mass. RESULTS: Seminomatous GCT (SGCT) was diagnosed in 13 patients, non-seminomatous GCT (NSGCT) in 17 patients and mixed GCT (MGCT) in the remaining three patients. Bleomycin/etoposide/cisplatin-based chemotherapy was the principle regimen. After initial chemotherapy, all patients with pure SGCT had only scar tissue in the orchidectomy specimen, with no residual tumour. Nine of 17 patients (52.9%) with NSGCT had viable tumour remaining in the orchidectomy specimen. All three cases of MGCT had persistent viable invasive seminoma. Twenty-seven patients (81.8%) were recurrence free and alive after a median of 49 months of follow-up. CONCLUSIONS: Thirty-six per cent of patients had residual tumour locally in the testis after primary chemotherapy for metastatic GCT of the testis. However, in the cases with pure seminomatous disease, there was no residual tumour present. It may not be necessary to undertake delayed orchidectomy in these patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/cirurgia , Adulto , Biomarcadores Tumorais/análise , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/secundário , Terapia de Salvação , Neoplasias Testiculares/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To estimate the prevalence of falls, frequency of falls, injury due to falls and to explore the relationship between cataract-related blindness and falls in older patients above or equal to 50 years of age. RESULTS: A cross-sectional study was conducted to investigate the relationship between cataract related blindness and risk of fall. Details about any fall in the previous 12 months and systemic illness history were collected through a personal interview. Overall, 70 (18.3%; 95% confidence intervals (CI) 14.4%, 22.2%) of the 382 patients investigated had experienced falls. The history of recurrent falls were more commonly seen in patients with bilateral cataract (p = 0.023). The mean presenting Logarithm of the Minimum Angle of Resolution (LogMAR) visual acuity was significantly higher in fallers when compared to non-fallers: 0.81 ± 0.41 versus 0.65 ± 0.31 (p = 0.001). The prevalence of falls was significantly higher in patients with bilateral cataract blind; adjusted odds ratio (OR): 1.76 (p = 0.042). Timely diagnosis and surgical intervention in patients with bilateral blindness due to cataract may help prevent falls in older patients in Andhra Pradesh, South India.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Cegueira/epidemiologia , Catarata/epidemiologia , Acidentes por Quedas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Catarata/complicações , Extração de Catarata , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-IdadeRESUMO
The mammalian inactive X chromosome (Xi) condenses into a bipartite structure with two superdomains of frequent long-range contacts, separated by a hinge region. Using Hi-C in edited mouse cells with allelic deletions or inversions within the hinge, here we show that the conserved Dxz4 locus is necessary to maintain this bipartite structure. Dxz4 orientation controls the distribution of contacts on the Xi, as shown by a massive reversal in long-range contacts after Dxz4 inversion. Despite an increase in CTCF binding and chromatin accessibility on the Xi in Dxz4-edited cells, only minor changes in TAD structure and gene expression were detected, in accordance with multiple epigenetic mechanisms ensuring X silencing. We propose that Dxz4 represents a structural platform for frequent long-range contacts with multiple loci in a direction dictated by the orientation of its bank of CTCF motifs, which may work as a ratchet to form the distinctive bipartite structure of the condensed Xi.
Assuntos
Alelos , Fator de Ligação a CCCTC/genética , Epigênese Genética , Inativação do Cromossomo X , Motivos de Aminoácidos , Animais , Fator de Ligação a CCCTC/química , Cromatina/química , Cromatina/genética , Metilação de DNA , Deleção de Genes , Regulação da Expressão Gênica , Inativação Gênica , Hibridização in Situ Fluorescente , Camundongos , Camundongos Endogâmicos C57BL , Polimorfismo Genético , Polimorfismo de Nucleotídeo Único , Ligação Proteica , Cromossomo XRESUMO
AIMS: To assess the toxicity and dose delivery of weekly bolus 5-fluorouracil (5-FU) at 425 mg/m(2) plus low-dose folinic acid (FA) for 24 weeks as adjuvant treatment for colorectal cancer. MATERIALS AND METHODS: Data were collected on toxicity and dose reductions, stoppages, delays and intensity from 100 consecutive patients receiving this adjuvant regimen after curative surgery. RESULTS: There were 53 men and 47 women (median age: 64 and 65 years, respectively); 77 patients with colon cancer and 23 with cancer of the rectum; 34 patients with Dukes' stage B and 66 with Dukes' stage C. Thirty-seven patients experienced at least one grade 3 or 4 toxicity, mainly diarrhoea (20 patients) or fatigue (14 patients). Only one grade 4 toxicity was noted (diarrhoea). In multivariate analysis, increased grade 3 and 4 toxicity was significantly associated with female gender (P = 0.001) and age >65 years (P = 0.046). Forty patients completed the 24 cycles without dose reduction or delay. Forty-one patients required at least one dose reduction. The median 'conventional' dose intensity (DI), calculated from the first cycle to the last, was 408 mg/m(2)/week (96%). The median DI over 24 weeks was 387 mg/m(2)/week (91%). A higher median 24-week DI was delivered to men (407 mg/m(2)/week, 96%) than women (361 mg/m(2)/ week, 85%; P = 0.009). Women older than 65 years showed a significantly reduced median DI over 24 weeks (347 mg/ m(2)/week, 82%) compared with men aged 65 years or younger (407 mg/m(2)/week, 96%; P = 0.049) and men older than 65 years (425 mg/m(2)/week, 100%; P = 0.001), although the difference against women aged 65 years or younger (377 mg/ m(2)/week, 89%) was not statistically significant (P = 0.09). CONCLUSION: This regimen has shown what might be considered high rates of grade 3 and 4 toxicity for an adjuvant treatment, although the delivered DI was acceptable. Caution is urged in the treatment of elderly female patients who have statistically higher rates of grade 3 and 4 toxicity and lower DI.
Assuntos
Neoplasias Colorretais/tratamento farmacológico , Fluoruracila/administração & dosagem , Leucovorina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/efeitos adversos , Neoplasias Colorretais/cirurgia , Relação Dose-Resposta a Droga , Esquema de Medicação , Sistemas de Liberação de Medicamentos , Feminino , Fluoruracila/efeitos adversos , Humanos , Leucovorina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Suspensão de Tratamento/estatística & dados numéricosRESUMO
PURPOSE: To evaluate the accuracy of estimated glomerular filtration rate (eGFR) against the reference standard of isotopic GFR (iGFR) in monitoring renal function during follow-up after cystectomy and urinary diversion. METHODS: Patients who had undergone cystectomy and ileal conduit urinary diversion at two centres between August 2001 and August 2006 were identified. eGFR calculated using the MDRD formula was compared to (51)Cr EDTA measured iGFR values measured at similar time-points during follow-up. RESULTS: Six hundred and fourteen paired iGFR and eGFR results were analysed from 166 patients (18% female, median age 70 years). There was a significant difference between paired iGFR and eGFR measurements (p < 0.0001) with a mean bias of +1.8 mls/min/1.73 m(2) (SD 18.0) and a 95% limit of agreement of -33.5 to 37.2 mls/min/1.73 m(2). iGFR and eGFR values converged at a GFR of approximately 45 mls/min/1.73 m(2). 70.6% of patients experienced a loss of renal function greater than expected (>0.58 mls/min/1.73 m(2)/year). In 22.4% of these patients, a decline of greater than 10% in iGFR occurred that was undetected by eGFR measurements, which overestimated GFR. There was no significant relationship between patient height, weight or body mass index and the accuracy of eGFR measurements. CONCLUSIONS: iGFR measurement is recommended following ileal conduit urinary diversion if early signs of renal function loss are to be detected. eGFR overestimates GFR in critically relevant ranges and fails to detect loss in a clinically significant proportion of patients.
Assuntos
Cistectomia/métodos , Taxa de Filtração Glomerular/fisiologia , Rim/fisiopatologia , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Creatinina/sangue , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Neoplasias da Bexiga Urinária/sangue , Neoplasias da Bexiga Urinária/fisiopatologiaRESUMO
Hispolon (HS), a natural polyphenol found in medicinal mushrooms, and its isoxazole (HI) and pyrazole (HP) derivatives have been examined for free radical reactions and in vitro antioxidant activity. Reaction of these compounds with one-electron oxidant, azide radicals ([Formula: see text]) and trichloromethyl peroxyl radicals ([Formula: see text]), model peroxyl radicals, studied by nanosecond pulse radiolysis technique, indicated formation of phenoxyl radicals absorbing at 420 nm with half life of few hundred microseconds (µs). The formation of phenoxyl radicals confirmed that the phenolic OH is the active centre for free radical reactions. Rate constant for the reaction of these radicals with these compounds were in the order kHI â kHP > kHS. Further the compounds were examined for their ability to inhibit lipid peroxidation in model membranes and also for the scavenging of 2,2'-diphenyl-1-picrylhydrazyl (DPPH) radical and superoxide ([Formula: see text]) radicals. The results suggested that HP and HI are less efficient than HS towards these radical reactions. Quantum chemical calculations were performed on these compounds to understand the mechanism of reaction with different radicals. Lower values of adiabatic ionization potential (AIP) and elevated highest occupied molecular orbital (HOMO) for HI and HP compared with HS controlled their activity towards [Formula: see text] and [Formula: see text] radicals, whereas the contribution of overall anion concentration was responsible for higher activity of HS for DPPH, [Formula: see text], and lipid peroxyl radical. The results confirm the role of different structural moieties on the antioxidant activity of hispolon derivatives.
Assuntos
Catecóis/química , Isoxazóis/química , Pirazóis/química , Antioxidantes , Radicais Livres , CinéticaRESUMO
OBJECTIVE: To survey UK urologists and radiation oncologists in the evaluation and treatment of localised prostate cancer in the adjuvant and salvage setting. METHODS: Postal questionnaires were mailed to 292 urologists and 98 radiation oncologists in the UK. RESULTS: In all, 188 (48%) questionnaires were returned. In total, 72/128 (56%) of the urologist respondents and 58/60 (97%) of the oncologist respondents perform routine radical prostate treatment. Among 43 (60%) of the urologist, 40 (69%) recommended adjuvant treatment, which could be radiotherapy, hormonal treatment or combined hormonal and radiation treatment. There is no significant difference between the modality of treatment recommended. The poor prognostic factors that would influence the decision to offer adjuvant treatment include a detectable postoperative PSA, seminal vesicle involvement, positive margins, Gleason score>8 and pathological T3. With regard to the choice of hormonal treatment, most urologists preferred antiandrogens, whereas most oncologists prefer lutienising hormone releasing hormone (LHRH) analogue (P=0.03). Regarding salvage treatment, there is a wide variation in the PSA threshold and number of PSA rises before initiation of investigations and treatment. Significantly more urologists recommended salvage radiotherapy (P=0.02), whereas oncologists recommended combined hormonal radiation therapy (P=0.03). There is a wide variation of practice regarding the duration of hormonal treatment, the type of investigations initiated, range of radiotherapy doses and treatment volumes. CONCLUSION: There is a wide variation in practice among UK clinicians.
Assuntos
Quimioterapia Adjuvante/métodos , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/terapia , Hormônio Liberador de Gonadotropina/análogos & derivados , Humanos , Masculino , Prognóstico , Próstata/patologia , Antígeno Prostático Específico/metabolismo , Radioterapia/métodos , Terapia de Salvação , Sensibilidade e Especificidade , Inquéritos e Questionários , Fatores de Tempo , Reino UnidoRESUMO
The authors retrospectively studied 150 psychiatric inpatients, 96 of whom had had nasopharyngeal EEGs and 54 of whom had had regular EEGs. The nasopharyngeal recordings did not reveal significantly more epileptiform abnormalities than did the regular EEG in patients with suspected seizures.
Assuntos
Eletroencefalografia/métodos , Epilepsia do Lobo Temporal/diagnóstico , Transtornos Mentais/complicações , Nasofaringe , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Epilepsia do Lobo Temporal/complicações , Feminino , Hospitalização , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Both ictal nystagmus and cortical blindness may occur transiently in acute cerebral disorders and therefore escape clinical detection, particularly in confused, agitated patients. The following case report describes a young woman with chronic myelogenous leukemia who became progressively ill following bone marrow transplantation. During the course of her illness, acute ictal nystagmus developed from focal right occipital ischemia; postictally she remained cortically blind with possible visual hallucinations for 48 hours.
Assuntos
Cegueira/etiologia , Ataque Isquêmico Transitório/complicações , Nistagmo Patológico/complicações , Percepção Visual , Adulto , Cegueira/diagnóstico , Eletroencefalografia , Feminino , Alucinações/etiologia , Humanos , Ataque Isquêmico Transitório/diagnóstico , Nistagmo Patológico/diagnóstico , Lobo OccipitalRESUMO
In a case of primary reading epilepsy, seizures were consistently triggered by reading, and the associated EEG abnormalities were clearly lateralized to the dominant hemisphere. On the basis of detailed EEG and activation studies, it is concluded that seizures in this patient were evoked by higher cognitive processes associated with language functions and not by simple visual or proprioceptive stimuli.
Assuntos
Epilepsia/etiologia , Leitura , Adulto , Encéfalo/fisiopatologia , Eletroencefalografia , Epilepsia/fisiopatologia , Humanos , MasculinoRESUMO
Pattern visual evoked response (PVER) and critical frequency of photic driving (CFPD) to repetitive flash stimuli were studied in 68 consecutive patients suspected of multiple sclerosis (MS) and 15 normal controls to assess the diagnostic value of combined PVER-CFPD testing. Clinically, 38 qualified for the diagnosis of MS while 30 did not. The CFPD was found to be unreliable for detecting optic nerve dysfunction (OND) in MS, since well-defined photic driving at all frequencies above 40 flashes per second was not present in 14 patients without MS (47%) and in three normal control subjects (20%). The PVER, on the other hand, was highly sensitive and specific for OND, being abnormal in 12 patients with definite MS (92%) but in none of the normal controls. It is concluded that PVER by itself is a valuable test for the diagnosis of OND in MS and additional CFPD testing is uninformative and may even be misleading.
Assuntos
Potenciais Evocados Visuais , Esclerose Múltipla/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estimulação LuminosaRESUMO
Nineteen epileptic patients with significant history of episodic aggressive behavior were subjected to intensive behavioral and electrophysiologic monitoring for an average period of six weeks in a specialized inpatient facility. Numerous seizures were recorded in these patients but none disclosed ictal aggression. Only two patients showed episodic aggressive behavior but in neither case could seizures be implicated causally. The majority of patients showed a remarkable progressive improvement in aggressive tendencies during hospitalization. It is concluded that ictal aggression is rare and that, in most cases, the aggressive behavior in epileptics is a multifactorially determined interictal phenomenon.