Measurement of the absolute gamma emission intensities from the decay of Th-229 in equilibrium with progeny.

There are few long-lived radionuclides yielding high intensity gamma-rays emission with energies ranging from 100 keV to 500 keV that can be applied as radioactive gamma standard to calibrate HPGe detectors. Furthermore, this energy range represents the main emitted energies of the majority of radionuclides used in nuclear medicine. The Brazilian National Laboratory for Ionizing Radiation Metrology (LNMRI/IRD/CNEN) has attempted to identify radionuclides that have the potential to be used as a calibration source due to their long half-life as well as their emission spectrum. Hence, LNMRI promotes standardization studies of gamma-emitting radionuclides that meet these criteria on order to disseminate them. Thorium-229, with its well-defined energies and relatively high intensities, is one such candidate radionuclide for the energy and full-energy peak efficiency calibration of high-purity gamma spectrometers. Thorium-229 was standardized by the method of 4παß(LS)-γ(NaI(Tl)) live timed anticoincidence counting. The emission intensities of gamma-rays associated with the decay of 229Th have been determined by HPGe gamma ray spectrometry with accuracy and precision. The results are in agreement with current literature data.

Prevalence of cocaine and derivatives in blood and urine samples of trauma patients and correlation with injury severity: a prospective observational study.

PURPOSE: The abuse of cocaine and its derivatives presents a likely risk factor for injury. Trauma incurred by cocaine and derivative abusers may be more severe than that incurred by non-users. OBJECTIVES: To ascertain the presence of cocaine and its derivatives in trauma patients and to correlate RTS (Revised Trauma Score) and ISS (Injury Severity Score) with the presence of cocaine and its derivatives in blood and urine samples. METHODS: All trauma victims treated in an emergency unit between November 11, 2012 and September 15, 2013 were included in the study. Blood and urine samples were collected on admission to hospital. RTS and ISS scores were then compared with the presence or absence of cocaine and its derivatives in the samples. The associations between RTS < 7.84 and ISS > 16 and the independent variables were evaluated by the gross odds ratio values, determined by univariate logistic regression. Multivariate analysis was performed using multivariate logistic regression. RESULTS: Of 453 patients (83.7% male) included in the study, 28.6% presented ISS > 16 and 33.6% presented RTS < 7.84. A total of 435 samples were collected, and 86 (19.8%) provided positive samples for cocaine, 48 (11%) for crack and 69 (15.9%) for cocaethylene. Compared to other patients, drug users showed a greater probability of RTS < 7.84 (2.18 times greater) and a greater probability of ISS > 16 (1.76 times greater). CONCLUSION: For the trauma patients included in our study, the use of cocaine and its derivatives was shown to be associated with more severe traumas, as demonstrated by their RTS and ISS scores.

Application of the sum-peak method to activity standardizations of 152Eu sources in LNMRI (BR).

The sum-peak method, an absolute measurement technique that uses coincidence counting and γ-ray spectrometry, was applied to activity standardization of 152Eu sources. The decay branch used was that of 152Sm, as it is almost entirely electron capture and exhibits X-rays with a high probability of coincidence with the 121.8keVgamma rays, as evidenced by the matrix technique used for complex decay schemes, a method for deriving counting rate equations describing coincidence summing of gamma and X-rays. The result was compared with the calibration performed by ionization chamber traceable to BIPM. The results presented uncertainty values of 0.50% (k = 1).

Towards a Brazilian radon map: consortium radon Brazil.

Recently, the idea of generating radon map of Brazil has emerged. First attempts of coordinating radon surveys--carried out by different groups across the country--and initial discussions on how to proceed on a larger scale were made at the First Brazilian Radon Seminary, Natal, September 2012. Conventionally, it is believed that indoor radon is no major problem in Brazil, because the overall benign climate usually allows high ventilation rates. Nevertheless, scattered measurements have shown that moderately high indoor radon concentrations (up to a few hundred Bq m⁻³) do occur regionally. Brazilian geology is very diverse and there are regions where an elevated geogenic radon potential exists or is expected to exist. Therefore, a Brazilian Radon Survey is expected to be a challenge, although it appears an important issue, given the rising concern of the public about the quality of its environment.

The feasibility of classical cyclophosphamide, methotrexate, 5-fluorouracil (CMF) for pre- and post-menopausal node-positive breast cancer patients in a Belgian multicentric trial: a study of consistency in relative dose intensity (RDI) and cumulative doses across institutions.

BACKGROUND: Classical cyclophosphamide, methotrexate, 5-fluorouracil (CMF) including oral cyclophosphamide is still considered an important adjuvant chemotherapy regimen in patients with early breast cancer (BC). Concern has been raised regarding the feasibility of this regimen, especially in postmenopausal patients. PATIENTS AND METHODS: 254 pre- and post-menopausal node-positive BC patients aged < or = 70 years received six cycles of CMF in the context of a Belgian multicentric phase III trial of adjuvant chemotherapy. CMF dose and schedule were as follows: cyclophosphamide 100 mg/m2 p.o. on days 1 to 14, methotrexate 40 mg/m2 intravenously (i.v.) on days 1 and 8, 5-fluorouracil 600 mg/ml i.v. on days 1 and 8; cycles q. 28 days. The relative dose intensity (RDI) was calculated as the ratio between the delivered DI and the planned DI. We also analysed the RDI in two subgroups of patients with age > or = 50 years or < 50 years. RESULTS: Overall, the percentage of patients ending the six cycles of the planned CMF regimen was 90%. The mean RDI achieved in the population of 254 patients was 90% (range 8% to 129%). The subgroup analysis of patients aged > or = 50 years and < 50 years showed that 81% and 76% of patients, respectively, received > or = 80% of the planned chemotherapy dose intensity (P = 0.33). No statistically significant difference was found between the percentage of patients who received a RDI < 80% and the participating institutions (P = 0.50). CONCLUSIONS: The classical CMF regimen was a feasible regimen in the context of a multicentric trial, in which academic institutions as well as community hospitals participated. No substantial differences in RDI and cumulative doses were found in relation to a patient's age and the participating institution.

Doxorubicin followed by docetaxel versus docetaxel followed by doxorubicin in the adjuvant treatment of node positive breast cancer: results of a feasibility study.

BACKGROUND: Doxorubicin (A) and Docetaxel (T) are amongst the most active agents in breast cancer treatment. The impact of drug sequencing is an issue still under evaluation. OBJECTIVE: To evaluate the feasibility and tolerability of two A and T-based sequential regimens, in which the sequence of drug administration was reversed. METHODS: The study included patients pts aged < or = 70 years, with operable node positive breast cancer. Two consecutive groups of patients received one of the following regimens: 1) Sequential A-->T-->CMF: Doxorubicin 75 mg/m2, i.v., day 1, q3wks x 3 cycles, followed by Docetaxel 100 mg/m2, i.v., day 1, q3wks x 3 cycles, followed by i.v. CMF days 1 and 8 q4wks x 3 cycles. 2) Sequential T-->A-->CMF: same doses for Doxorubicin and Docetaxel but reverse sequence of administration, followed by oral CMF (CPA 100 mg/m2, oral, days 1-14 + MTX 40 mg/m2, i.v., days 1 and 8 + 5FU 600 mg/m2, i.v., days 1 and 8, q4wks). An analysis of treatment administration and toxicity was performed for the first six cycles of CT, in the two treatment groups. RESULTS: Group 1 with 20 patients and group 2 with 14 patients were balanced in terms of patient and tumour characteristics. There was one early treatment discontinuation in each group due to toxicity (one allergic and one skin reaction to docetaxel). Median relative dose intensity was 100% for both drugs in both groups. The most relevant side effects were (overall incidence, group 1 vs group 2): Myalgia: 45% vs 72%; Arthralgia: 15% vs 57%; Skin: 35% vs 57%; Neurosensory: 55% vs 64%; Stomatitis 65% vs 36%; conjunctivitis 25% vs 57%; Neutropenic Fever 20% vs 21% and Fatigue 80% vs 93%. Grade 3/4 adverse events' rate was low in the two groups. CONCLUSIONS: 1) Both sequences were estimated feasible due to the optimal treatment administration and limited incidence of G3-G4 side effects. 2) The concomitant use of lenograstin might partially explain the reported incidence of myalgia and arthralgia. 3) No conclusion can be drawn on the most tolerable regimen due to the limited number of patients.

Carcinomatous meningitis as a clinical manifestation of pancreatic carcinoma.

Carcinomatous meningitis (CM) is clinically less common than brain metastasis or spinal cord compression, having dire consequences for both the quality of life and the overall survival of patients with solid tumors. It occurs in about 5% of all adult cancer patients, but autopsies may double this number. If leukemia and lymphoma are excluded, most cases are due to breast cancer, lung cancer and melanoma. In this report, we describe a 49-year-old male patient with metastatic pancreatic adenocarcinoma who developed carcinomatous meningitis. To our knowledge, this is only the second case of carcinomatous meningitis secondary to a pancreatic carcinoma described so far.

Phase II trial of paclitaxel and ifosfamide as a salvage treatment in metastatic breast cancer.

PURPOSE: Treatment results in patients failing first-line chemotherapy in metastatic breast cancer (MBC) are still unsatisfactory, with patients exhibiting poor responses to salvage therapy and a short overall survival. Both paclitaxel and ifosfamide are able to produce objective tumor responses in this disease. Therefore, the antitumor effects and toxicity of their combined use could be worthwhile studying in patients progressing after doxorubicin-containing combinations. PATIENTS AND METHODS: This Phase II trial of paclitaxel/ifosfamide included patients with bi-dimensionally measurable metastatic breast cancer in second or third relapse, following anthracycline-containing regimens; ECOG PS < 2, and adequate hepatic, cardiac, renal, and hematological functions. Paclitaxel 175 mg/m2 was given on day 1, in a 3-hour infusion with appropriate antiallergic pre-medication; while ifosfamide 1.8 g/m2 was given on days 2, 3, 4 with mesna 360 mg/m2 i.v., 15 minutes before and 4 hours after ifosfamide administration, and 720 mg/m2 P.O. 8 hours later at home, also on days 2, 3, 4. The cycles were repeated every 21 days, on an outpatient basis. RESULTS: Twenty-four patients were accrued for the study and 23 were considered eligible for the evaluation of toxicity and response. Previous chemotherapy included: CMF/FAC (16 cases); CMF plus mitoxantrone/FAC/cisplatin, vinblastine, mitomycin C (2 cases): and FAC/mitomycin C, vinblastine, and etoposide (5 cases). There were 11 (48%) objective responses (95% C.I.:27-69%), including 2 (9%) CR and 9 (39%) PR (95% C.I.:0-21% and 19-61%, respectively). Five (22%) patients attained disease stabilization. Median response duration was 7+ months (range 4 to 20+), and the median overall survival was 12 months (range 4-23+). The regimen was well tolerated. WHO nausea/ vomiting grades 1-2, alopecia grade 3, and neutropenia grades 1-2 were seen in most patients. Four patients experienced mild neuropathy, while it was grade 3 in 1 case. Seven patients had grade 3 neutropenia. In addition, grade 4 neutropenia associated with fever was documented in other 4 cases. No hypersensitivity reactions were seen. One case of reversible tachycardia after drug administration was seen. Myalgia grades 1-2 was also reported in some patients. CONCLUSION: These results suggest that the present regimen has significant activity in heavily pretreated patients with a MBC, with a manageable toxicity profile. Further trials exploiting the above mentioned drug combination are warranted.

A phase II study of doxorubicin/paclitaxel plus G-CSF for metastatic breast cancer.

This phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line therapy for patients with metastatic breast cancer (MBC) not previously exposed to anthracycline-containing regimens. Patients with measurable, visceral-dominant MBC and a performance status of 0 to 2 were included in the study. Doxorubicin 60 mg/m2 was administered as a short intravenous infusion, followed by paclitaxel 250 mg/m2 as a 3-hour intravenous infusion on day 1. Granulocyte colony-stimulating factor 5 micrograms/kg/d was given prophylactically as a subcutaneous injection from day 2 until granulocyte recovery to > or = 1,500/mm3. Treatment was repeated every 21 days for a maximum of six courses. Dose reductions (to doxorubicin 50 mg/m2 and paclitaxel 175 mg/m2) and/or treatment delay were applied in case of severe toxicity. All 25 women who entered were evaluable for response and toxicity. The main grade 3/4 toxicities observed were leukopenia, thrombocytopenia, and mucositis. Alopecia occurred in all patients. No clinically relevant cardiovascular toxicity was observed. Severe myelosuppression and/or mucositis necessitated dose reductions at courses 2 or 3 in all but one patient. The complete response rate was 28%, and the partial response rate was 52% for an overall objective response rate of 80%. Median progression-free survival for complete responders was 11 months (range, 3 to 24 months), while the progression-free survival was 7+ months (range 2 to 14+ months) for partial responders and 5 months (range, 3 to 9 months) for nonresponders. This combination produces a high objective response rate in women with MBC, but dose reductions were necessary in almost all cases. Toxicity was manageable after dose reduction, allowing patients to be re-treated for two to six courses without life-threatening toxicity or toxic deaths. Unfortunately, the duration of response was limited even among complete responders. Further trials of this combination in patients with MBC should explore improvements in this study regimen.

Tratamento cirúrgico da crepitaçäo escapulotorácica / Surgical treatment of painful snapping scapula

Quinze pacientes (um caso bilateral - 16 escápulas), com crepitaçao escapulotorácica sintomática rebelde aos tratamentos conservadores, foram operados de junho de 1983 a maio de 1994. Dez eram do sexo masculino e cinco, do feminino; a idade mínima foi de nove anos, a máxima, de 53 anos (média de 20 anos e seis meses); o tempo de evoluçäo foi de três meses e dez anos. O RX simples mostrou osteocondroma em três, margem superior e medial da escápula salientes em um, escápula alta em um, hipoplásica em um e, em nove, ausência de alteraçöes. A TAC feita em oito mostrou osteocondroma em três, irregularidade do ângulo e margens superior e medial da escápula em um, assimetria muscular do serrátil em dois e, em dois, foi normal. As indicaçöes para o tratamento cirúrgico foram dor e desconforto. Na operaçäo, foram identificadas alteraçoes ósseas escapulares relacionadas com a crepitaçäo somente em oito escápulas (irregularidade do ângulo e margem superior e medial em quatro, osteocondroma em três, neoarticulaçäo escapulocostal em um). Foi feita exérese dos três osteocondromas, ressecçäo do ângulo superior e de toda a margem medial da escápula em oito e só do ângulo e parte superior da margem medial em cinco. O resultado foi bom em 15 escápulas (ausência de dor e funçäo normal), incluindo o caso bilateral; mau em um (dor residual persistente).

Percutaneous catheterization of the subclavian vein in hemophiliac patients: report of 47 cases.

Hemophiliac patients frequently require venous access, but usually their peripheral veins are collapsed and not puncturable. Several procedures employed to overcome this difficulty present a high complication rate. The authors report 47 cases of percutaneous subclavian vein catheterization (PSC) in hemophiliacs with an overall complication rate of 23%. Six patients (13%) had complications attributed to the coagulation disorder. The complications attributed to the coagulopathy and presenting major clinical importance occurred early in the series. After the improvement of the coagulation control with a routine AHG administration policy, the authors observed that among the last 22 patients there were 3 complications related to the coagulopathy, all of them without major clinical importance. The authors conclude that, in the lack of a safer access, PSC seems to be an acceptable procedure in hemophiliac patients, if employed with strict indication, accurate technique and rigorous control of the coagulopathhy.

Reabilitacao funcional das lesoes tendinosas degenerativas do ombro / Functional rehabilitation of degenerative tendinous injuries of the shoulder

Foram estudados 60 ombros de 58 pacientes portadores de lesoes tendinosas do ombro, distribuidos em : 31 (51,6 por cento) portadores de sindrome de impacto (fase 1 e 2 de Neer), 18 (30,0 por cento) portadores de tendinite calcaria, cinco (8,33 por cento) com ruptura de manguito rotador (fase 3 de Neer), tres (5,0 por cento) com tendinite bicipital (fase 2 de Neer) e tres (5,0 por cento) com lesoes multiplas (fase 3 de Neer). Todos submeteram-se ao tratamento conservador de analgesia e fortalecimento muscular, buscando restabelecer o equilibrio mecanico da articulacao. Os resultados foram bons e duradouros em 55 por cento dos pacientes. Os piores resultados foram encontrados nas mulheres, tendinites calcarias, nos jovens e doencas de longa evolucao. As infiltracoes (maximo 3), a atividade profissional e a dominancia nao modificaram os resultados.

[Functional rehabilitation of degenerative tendinous injuries of the shoulder]. / Reabilitação funcional das lesões tendinosas degenerativas do ombro.

We studied 60 shoulders in a group of 58 patients, with injuries of shoulder tendons. Thirty-one patients presented impingement syndrome, eighteen patients calcareous tendinitis, five patients rotator cuff rupture, three patients bicipital tendinitis and three patients multiple lesions. All of them were submitted to physical therapy: ultra-sound and kinesio-therapy. Good results were obtained in 55% of the patients. Bad results were recorded in women, young people and in patients with calcareous tendinitis.

Evaluation of techniques for detection of hemophilia A heterozygotes.

Uma analise de eficiencia de varios testes de coagulacao (TR, TIP, K-TTP TCC e FVIIIC pelo metodo de um estagio) foi feita utilizando-se diferentes tipos de controles masculinos, mesmo tipo de reagentes e aparelhagem para melhor detectar portadoras de gene de hemophilia A. Alem disso, uma analise estatistica dos resultados obtidos em diferentes laboratorios foi feita usando os mesmos testes, reativos e aparelhagem para verifivar qual o teste que mostrou melhor repetibilidade e homogeneidade dos resultados obtidos entre laboratorios.De acordo com estes criterios foi escolhido o FVIIIC 1/10 como o que melhor discriminou heterozigotas definitivas de controles masculinos (liofilizado e irmao)