RESUMEN
BACKGROUND: Despite improvements in treatments, metastatic breast cancer remains difficult to cure. Bones constitute the most common site of first-time recurrence, occurring in 40-75% of cases. Therefore, evaluation for possible osseous metastases is crucial. Technetium 99 ((99)Tc) bone scintigraphy and fluorodexossyglucose (FDG) positron emission tomography (PET)-computed tomography (PET-CT) are the most commonly used techniques to assess osseous metastasis. PET magnetic resonance (PET-MR) imaging is an innovative technique still under investigation. We compared the capability of PET-MR to that of same-day PET-CT to assess osseous metastases in patients with breast cancer. METHODS: One hundred and nine patients with breast cancer, who underwent same-day contrast enhanced (CE)-PET-CT and CE-PET-MR, were evaluated. CE-PET-CT and CE-PET-MR studies were interpreted by consensus by a radiologist and a nuclear medicine physician. Correlations with prior imaging and follow-up studies were used as the reference standard. Binomial confidence intervals and a χ(2) test were used for categorical data, and paired t-test was used for the SUVmax data; a non-informative prior Bayesian approach was used to estimate and compare the specificities. RESULTS: Osseous metastases affected 25 out 109 patients. Metastases were demonstrated by CE-PET-CT in 22 out of 25 patients (88%±7%), and by CE-PET-MR in 25 out of 25 patients (100%). CE-PET-CT revealed 90 osseous metastases and CE-PET-MR revealed 141 osseous metastases (P<0.001). The estimated sensitivity of CE-PET-CT and CE-PET-MR were 0.8519 and 0.9630, respectively. The estimated specificity for CE-FDG-PET-MR was 0.9884. The specificity of CE-PET-CT cannot be determined from patient-level data, because CE-PET-CT yielded a false-positive lesion in a patient who also had other, true metastases. CONCLUSIONS: CE-PET-MR detected a higher number of osseous metastases than did same-day CE-PET-CT, and was positive for 12% of the patients deemed osseous metastasis-negative on the basis of CE-PET-CT.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Medios de Contraste , Fluorodesoxiglucosa F18 , Imagen por Resonancia Magnética , Tomografía de Emisión de Positrones/métodos , Tomografía Computarizada por Rayos X/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Radiofármacos , Estudios RetrospectivosRESUMEN
BACKGROUND: In the immediate postoperative period surgical breast cancer patients can face many problems including functional limitation of the shoulder, edema, pain and depression. Although those symptoms can alleviate during the stages of the therapeutic route, most of the time concur significantly to the everyday life discomforts decreasing sharply the quality of life. Therefore, is essential to pay attention to the functional problems of breast cancer patients in order to ensure a quick and complete physical and psychosocial recovery. AIM: Aim of this study, comparing 2 groups of patients, one that underwent to early physical rehabilitation program (EPRP) and one as a control group, is to evaluate: functional improvements of the glenohumeral joint mobility, antalgic effect of EPRP, improvements and/or worsening of quality of life. DESIGN: Randomized controlled study. SETTING: Inpatient and outpatient clinic, Breast Unit, "San Giuseppe Moscati" Hospital, Avellino, Italy. POPULATION: Seventy women planned for Madden's modified radical mastectomy or for segmental mastectomy with axillary dissection in the period from March 2010 to February 2011. METHODS: Patients were randomly assigned to treated and control group. All participants were evaluated before surgery and postoperatively at fifth day, first, sixth and twelfth month. Patients of the treated group, underwent first, to assisted cautious mobilization of hand, wrist and elbow and after drainage removal, to twenty physiotherapy sessions under the guide of a physiotherapist. RESULTS: Within group statistical analysis evidenced that TG regained normal function at 1 year after surgery while CG was unable to do so for flexion, abduction and internal rotation movements. TG manifested general and statistically significative improvements in QoL. Improvements in the grade of pain perceived were observed starting from the first postoperative month. CONCLUSION: Postoperative early physical rehabilitation programme in surgical breast cancer patients surgically treated significantly improves glenohumeral joint mobility, reduces pain and widely improves the quality of life. CLINICAL REHABILITATION IMPACT: Early rehabilitation plays a key role in the physical and psycho-social recovery for breast cancer patients surgically treated with axillary dissection.
Asunto(s)
Neoplasias de la Mama/rehabilitación , Neoplasias de la Mama/cirugía , Mastectomía Segmentaria/rehabilitación , Modalidades de Fisioterapia , Calidad de Vida , Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Periodo Posoperatorio , Estudios Prospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIM OF THE STUDY: We intended to use a radioguided technique for pre-operative localization of neck node recurrences in patients with papillary thyroid cancer (PTC) already submitted to thyroidectomy and radioiodine treatment. PATIENTS AND METHODS: We selected 20 patients affected by PTC with evidence of neck nodes recurrences at ultrasound examination. Our method has been derived from the Radioguided Occult Lesion Localization technique used for pre-operative localization of occult breast lesions. The technique involves the inoculation of human albumin macroaggregates labeled with radioactive technetium (0.4 mCi in a volume of 0.05 ml) directly in the suspicious lesion, under ultrasound guidance. The persistence of the radioactive tracer in the nodes is confirmed by a scintigraphy performed 2 h after injection. During surgery, a gamma detecting probe is used to locate the suspicious lesions as "hot spots". RESULTS: Fifty lymph-nodes were injected with the tracer. All radiolabeled lymph-nodes were located and removed during surgery. At histology, metastasis of PTC was confirmed in 38/50 (76%) lymph-nodes. At least one metastatic lymph-node per patient was removed. In 8/20 (40%) patients, reactive lymphoid hyperplasia was found in 12/50 (24%) lymph-nodes. CONCLUSIONS: This radioguided technique has been highly effective for localization and surgical treatment of suspicious lymph-node detected at neck ultrasound and may play a valuable role in case of node metastases of thyroid cancer that show no radioiodine uptake.
Asunto(s)
Carcinoma Papilar/secundario , Carcinoma Papilar/cirugía , Neoplasias de Cabeza y Cuello/secundario , Neoplasias de Cabeza y Cuello/cirugía , Escisión del Ganglio Linfático/métodos , Cirugía Asistida por Computador , Neoplasias de la Tiroides/patología , Anciano , Carcinoma Papilar/diagnóstico por imagen , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Humanos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Masculino , Persona de Mediana Edad , Cintigrafía , Radiofármacos , Agregado de Albúmina Marcado con Tecnecio Tc 99m , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , TiroidectomíaRESUMEN
The aims of this multicentre, randomised phase III trial were to evaluate: (1) the role of levamisol (LEV); and (2) the role of folinic acid (FA), added to 5-fluorouracil (5FU) in the adjuvant treatment of colorectal cancer. Patients with histologically proven, radically resected stage II or III colon or rectal cancer were eligible. The study had a 2x2 factorial design with four treatment arms: (a) 5FU alone, (b) 5FU+LEV, (c) 5FU+FA, (d) 5FU+LEV+FA, and two planned comparisons, testing the role of LEV and of FA, respectively. From March 1991, to September 1998, 1327 patients were randomised. None of the two comparisons resulted in a significant disease-free (DFS) or overall (OAS) survival advantage. The hazard ratio (HR) of relapse was 0.89 (95% confidence intervals (CI): 0.73-1.09) for patients receiving FA and 0.99 (95% CI 0.80-1.21) for those receiving LEV; corresponding HRs of death were 1.02 (95% CI: 0.80-1.30) and 0.94 (95% CI 0.73-1.20). Nonhaematological toxicity (all grade vomiting, diarrhoea, mucositis, congiuntivitis, skin, fever and fatigue) was significantly worse with FA, while all other toxicities were similar. In the present trial, there was no evidence that the addition of FA or LEV significantly prolongs DFS and OAS of radically resected colorectal cancer patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Colorrectales/tratamiento farmacológico , Adulto , Anciano , Quimioterapia Adyuvante , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Femenino , Fluorouracilo/administración & dosificación , Humanos , Leucovorina/administración & dosificación , Levamisol/administración & dosificación , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Anciano , Antibióticos Antineoplásicos/uso terapéutico , Antimetabolitos Antineoplásicos/uso terapéutico , Biopsia , Quimioterapia Adyuvante , Colonoscopía , Femenino , Fluorouracilo/uso terapéutico , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Mitomicinas/uso terapéutico , Recurrencia Local de Neoplasia , Dosis de Radiación , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Metabolismo Energético , Peroxidación de Lípido , Trasplante de Hígado/fisiología , Soluciones Preservantes de Órganos , Preservación de Órganos/métodos , Ubiquinona/metabolismo , Vitamina E/metabolismo , Adenosina , Alopurinol , Glutatión , Humanos , Insulina , Cinética , Peróxidos Lipídicos/metabolismo , Circulación Hepática , Rafinosa , SolucionesRESUMEN
Hemodynamic variables were used to evaluate the effectiveness of lumbar chemical sympathectomy in 20 patients with ischemic foot lesions. Early clinical improvement was obtained in 68% of the cases. The two-year cumulative limb salvage rate was 52%. Results indicate that lumbar chemical sympathectomy offers the same benefits as surgical sympathectomy and represents a useful alternative in patients with advanced ischemic disease of the lower limb, decreasing the rate and the level of amputations.