RESUMEN
The local use of radionuclides in the management of neoplastic processes was initially considered over 80 yr ago and has enjoyed increasing enthusiasm in the treatment of somatic and central nervous system tumours during the past 30 yr. The marriage of complex neuroimaging techniques and modern stereotactic devices has markedly enhanced the technical precision of interstitial radiobrachytherapy of malignant cerebral neoplasms. In applying these techniques, it is imperative to achieve an optimal placement of radionuclide sources in order to develop a geometrically homogenous, controlled distribution of radiation. Critical considerations include determination of tumour volume and contour, and development of a homogenous dose rate (dependent upon multiple sources at varying intensity) that will not only effect tumour cell kill but do this without excessive production of radionecrosis which necessitates craniotomy because of mass. Using the Brown-Roberts-Wells (BRW) stereotactic guidance system and an image-defined, volumetrically determined target, implants of multiple iridium 192(192Ir) sources were used to establish appropriate isodose envelopes. A methodology for achieving the described objectives is detailed as it applies to a variety of malignant intracerebral neoplasms (glioblastoma multiforme, malignant astrocytoma, malignant mixed glioma, primary cerebral lymphoma, metastatic carcinoma and malignant pineal region tumours). Technical realization of precision implantation relying upon imaging data may be acheived with this method with satisfactory responses that are dependent upon histological tumour type and the morphology of the tumour distribution as related to the image. Early and late complications related to the surgical technique and radionuclide applications were less than 5%. Although encouraging, these techniques require further definition and greater data accrual before uniform application outside major medical centres can be justified. It is anticipated that improvement in results with intrinsic gliomas and other invasive neoplasms will be realized with further definition of tumour boundaries by tract biopsy techniques and concurrent utilization of hyperthermia and brain protective methods.
Asunto(s)
Braquiterapia/métodos , Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Iridio/uso terapéutico , Linfoma/radioterapia , Glándula Pineal/efectos de la radiación , Pinealoma/radioterapia , Radioisótopos/uso terapéutico , Neoplasias Encefálicas/secundario , Estudios de Seguimiento , Glioblastoma/radioterapia , HumanosAsunto(s)
Anemia/sangre , Eritropoyesis , Linfoma no Hodgkin/sangre , Timoma/sangre , Médula Ósea/metabolismo , ADN/biosíntesis , Eritropoyetina/metabolismo , Hemo/biosíntesis , Humanos , Inmunoglobulina G/farmacología , Técnicas In Vitro , Radioisótopos de Hierro , Masculino , ARN/biosíntesis , Timidina/metabolismo , TritioAsunto(s)
Eritropoyetina/orina , Hipopituitarismo/orina , Testosterona/farmacología , Vasopresinas/farmacología , Animales , Isótopos de Cromo , Diabetes Insípida/orina , Eritropoyesis/efectos de los fármacos , Eritropoyetina/sangre , Hemoglobinometría , Humanos , Hierro/metabolismo , Isótopos de Hierro , Masculino , Ratones , Persona de Mediana Edad , Fragilidad Osmótica , Volumen Plasmático , Policitemia/orina , Albúmina Sérica RadioyodadaAsunto(s)
Ácidos Difosfoglicéricos/sangre , Eritrocitos/metabolismo , Estro , Preñez , Adenosina Trifosfato/sangre , Animales , Estradiol/farmacología , Femenino , Edad Gestacional , Hemoglobinas/análisis , Hidroxiprogesteronas/farmacología , Masculino , Embarazo , Ratas , Factores Sexuales , Estimulación Química , Testosterona/farmacologíaAsunto(s)
Eritropoyesis/efectos de los fármacos , Eritropoyetina/fisiología , Estradiol/farmacología , Hidroxiprogesteronas/farmacología , Testosterona/farmacología , Animales , Bioensayo , Antagonismo de Drogas , Femenino , Hipoxia/fisiopatología , Hierro/metabolismo , Isótopos de Hierro , Masculino , Ratones , Policitemia/metabolismo , Seudoembarazo/fisiopatología , Técnica de Dilución de Radioisótopos , Albúmina Sérica RadioyodadaAsunto(s)
Feto/fisiología , Intercambio Materno-Fetal , Oxígeno/sangre , Embarazo , Adenosina Trifosfato/sangre , Animales , Sitios de Unión , Sangre , Ácidos Difosfoglicéricos/sangre , Ácidos Difosfoglicéricos/fisiología , Eritrocitos/metabolismo , Eritropoyesis , Femenino , Hemoglobina Fetal , Hemodinámica , Hemoglobinas , Hemoglobinas Anormales/metabolismo , Humanos , Concentración de Iones de Hidrógeno , Masculino , Presión Parcial , Volumen PlasmáticoAsunto(s)
Eritropoyesis/efectos de los fármacos , Prolactina/farmacología , Adulto , Recuento de Células Sanguíneas , Enfermedades de la Médula Ósea/tratamiento farmacológico , Enfermedades de la Médula Ósea/fisiopatología , DDT/envenenamiento , Complicaciones de la Diabetes , Eritrocitos/metabolismo , Eritropoyetina/análisis , Femenino , Hemorragia/terapia , Humanos , Hierro/sangre , Cinética , Recuento de Leucocitos , Persona de Mediana Edad , Prolactina/uso terapéutico , Factores de TiempoAsunto(s)
Anemia Aplásica , Anabolizantes/uso terapéutico , Andrógenos/uso terapéutico , Anemia Aplásica/inducido químicamente , Anemia Aplásica/diagnóstico , Anemia Aplásica/etiología , Anemia Aplásica/metabolismo , Anemia Aplásica/terapia , Trasplante de Médula Ósea , Eritropoyesis/efectos de los fármacos , Eritropoyetina/biosíntesis , Células Madre Hematopoyéticas/efectos de los fármacos , Hemo/biosíntesis , Hepatitis/complicaciones , Humanos , Hierro/metabolismo , Leucemia/complicaciones , Trasplante Homólogo , Tuberculosis Miliar/complicacionesAsunto(s)
Neoplasias Encefálicas/radioterapia , Glioma/radioterapia , Braquiterapia/métodos , Neutrones Rápidos , Humanos , Radioisótopos de Yodo/uso terapéutico , Fototerapia/métodos , Porfirinas/metabolismo , Dosificación Radioterapéutica , Técnicas Estereotáxicas , Tomografía Computarizada por Rayos XRESUMEN
A case of neutropenia associated with cephapirin therapy is described. After discontinuation of cephapirin therapy, the neutrophil count returned to normal. Bone marrow examination revealed a marked reduction of polymorphonuclear leukocytes beyond the metamyelocyte stage and eosinophilia.