RESUMO
Objetivo: Evaluar la tasa de detección y la implicación terapéutica de la infiltración de la cadena mamaria interna (ICMI) mediante tomografía por emisión de positrones (PET) y resonancia magnética (RM) con 18F-fluorodesoxiglucosa (18F-PET/RM) en la estadificación de pacientes con cáncer de mama. Método: Estudio prospectivo, 41 mujeres con cáncer de mama (estadio ≥ IIB) estadificadas mediante 18F-FDG-PET/RM. Estudio en dos fases: imágenes mamarias (decúbito prono), cuerpo completo (supino). Estadificación TNM por consenso entre especialista en Medicina Nuclear y Radiología. Estudio vaso aferente (VA) a cadena mamaria interna (CMI) por RM mamaria. Correlación ICMI con edad, VA-CMI, estadificación T, cuadrante, infiltración axilar y a distancia. Revaloración terapéutica en comité multidisciplinar. Resultados: Tasa de detección de ICMN de 34% (14/41), siendo 8/14 < 55 años. Todas las 14 pacientes con ICMI muestran VA-CMI, en seis de ellas (43,9%) sin VA-axilar. De 27/41 sin ICMI, en 13 (48,1%) solo VA-axilar, en los 14 restantes (51,9%) VA-axilar y VA-CMI. Un total de 57% (8/14) son multicéntricos y 42% (6/14) focales, en cuadrantes internos en 4/6 (66,7%). En 1/14 (7,1%) solo ICMI, en 9/14 (64,3%) axilar y CMI y en 4/14 (28,6%) lesiones a distancia. Decisión del comité: sin tratamiento adicional en 27/41 (65,8%), radioterapia torácica en 10/41 (24,4%) y terapia sistémica en 4/41 (9,7%). Conclusión: La tasa de detección de la ICMI en la estadificación del cáncer de mama mediante 18F-FDG PET/RM es de 34%. Son factores asociados la edad, los tumores multicéntricos, los de cuadrantes internos, la existencia de VA-CMI, la estadificación NM. La evidencia de ICMI permite la individualización de la terapia, indicando la radioterapia torácica en 24,4%.(AU)
Objective: To evaluate the detection rate and therapeutic implication of the infiltration of the internal mammary chain (IMCI) by [18F]FDG PET/MRI for staging of patients with breast cancer. Methods: Prospective study including 41 women with breast cancer (stage ≥IIB) staged by [18F]FDG PET/MR. Two-phase exam: breast imaging (prone), whole-body (supine). TNM stage assessed by peer consensus with Nuclear Medicine and Radiology specialists. Study of the afferent vessel (AV) to IMC by breast MRI. IMCI was correlated with age, AV-IMC, T stage, breast quadrants, axillary and distant infiltration. Therapeutic re-evaluation by a multidisciplinary committee. Results: IMCI detection rate of 34% (14/41), with 8/14 patients under 55 years of age. All 14 patients with IMCI showed AV-IMC, 6 of them (43.9%) without VA-axillary. Of 27/41 patients without IMCI, in 13 (48.1%) only AV-axillary was found, in the remaining 14 (51.9%), AV-axillary and AV-IMC was found. In 57% (8/14) tumours were multicentric and 42% (6/14) focal, in inner quadrants in 4/6 (66.7%). In 1/14 patient (7.1%) only IMCI was found, in 9/14 (64.3%) axillary and IMC, in 4/14 patients (28.6%) distant lesions were detected. Committee re-evaluation: no further treatment in 27/41 patients (65.8%), thoracic radiotherapy in 10/41 patients (24.4%), systemic therapy in 4/41 patients (9.7%). Conclusion: Our detection rate of IMCI in breast cancer staging by [18F]FDG PET/MR was 34%. Related factors were age, multicentric tumours, inner quadrants, detection of AV-IMC, NM staging.The evidence of IMCI allowed tailored therapy, with thoracic radiotherapy implementation in 24.4% of patients.(AU)
Assuntos
Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Espectroscopia de Ressonância Magnética , Fluordesoxiglucose F18 , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Estudos Prospectivos , Estadiamento de Neoplasias , Compostos Radiofarmacêuticos , Medicina NuclearRESUMO
OBJECTIVE: To evaluate the detection rate and therapeutic implication of the infiltration of the internal mammary chain (IMCI) by [18F]FDG PET/MRI for staging of patients with breast cancer. METHODS: Prospective study including 41 women with breast cancer (stageâ¯≥â¯IIB) staged by [18F]FDG PET/MR. Two-phase exam: breast imaging (prone), whole-body (supine). Tumor node metastases (TNM) stage assessed by peer consensus with Nuclear Medicine and Radiology specialists. Study of the afferent vessel (AV) to IMC by breast MRI. IMCI was correlated with age, AV-IMC, T stage, breast quadrants, axillary and distant infiltration. Therapeutic re-evaluation by a multidisciplinary committee. RESULTS: IMCI detection rate of 34% (14/41), with 8/14 patients under 55 years of age. All 14 patients with IMCI showed AV-IMC, 6 of them (43.9%) without VA-axillary. Of 27/41 patients without IMCI, in 13 (48.1%) only AV-axillary was found, in the remaining 14 (51.9%), AV-axillary and AV-IMC was found. In 57% (8/14) tumours were multicentric and 42% (6/14) focal, in inner quadrants in 4/6 (66.7%). In 1/14 patient (7.1%) only IMCI was found, in 9/14 (64.3%) axillary and IMC, in 4/14 patients (28.6%) distant lesions were detected. Committee re-evaluation: no further treatment in 27/41 patients (65.8%), thoracic radiotherapy in 10/41 patients (24.4%), systemic therapy in 4/41 patients (9.7%). CONCLUSION: Our detection rate of IMCI in breast cancer staging by [18F]FDG PET/MR was 34%. Related factors were age, multicentric tumours, inner quadrants, detection of AV-IMC, NM staging. The evidence of IMCI allowed tailored therapy, with thoracic radiotherapy implementation in 24.4% of patients.
RESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário , Tomografia por Emissão de Pósitrons/instrumentação , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Neoplasias da Próstata , Neoplasias da Próstata/radioterapia , Hiperparatireoidismo Secundário/fisiopatologia , Cintilografia/métodos , Distúrbio Mineral e Ósseo na Doença Renal Crônica/complicaçõesRESUMO
OBJECTIVE: To evaluate the impact of laparoscopic sacrocolpopexy, with or without simultaneous midurethral sling (MUS), on urinary symptoms and health-related quality of life of patients. MATERIALS: A prospective analysis was carried out including 83 women with symptomatic pelvic organ prolapse who had laparoscopic sacrocolpopexy between 2009 and 2011. Patients were classified according to the preoperative clinical examination (stress test). Thirty patients with patent (group A) stress urinary incontinence (SUI) and 15 patients with occult SUI (group B) had a MUS associated with sacrocolpopexy. Thirty-eight patients with negative stress test (group C) were treated by sacrocolpopexy without MUS, even if they had history of SUI. At each visit, urinary symptoms (UDI-6) and their impact on quality of life (UIQ-7) were evaluated using validated self-questionnaires, Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire. RESULTS: After 3years of mean follow-up, SUI was improved in 22/30 (77%) of patients in group A and only one patient needed a second MUS. Dysuria was cured in 9/12 (75%), 5/7 (71%) and 16/19 (84%) of patients of groups A, B, C respectively and urge urinary incontinence in 13/19 (68%), 2/2 (100%) and 4/6 (67%) of patients. The rate of de novo urge incontinence was respectively 1/11 (9%), 2/13 (15%) and 6/32 (19%). De novo SUI appeared in 6/32 (19%) of patients in group C, but only 2 of them secondarily needed a MUS. After 3 years, our study showed a significant decrease of UDI-6 of 62, 63 and 48% comparing with preoperative score and of UIQ-7 of 77, 54 and 81%. CONCLUSION: Laparoscopic sacrocolpopexy associated with MUS for patent stress urinary incontinence improves significantly stress and urgency urinary incontinence. Laparoscopic sacrocolpopexy without MUS, when physical exam shows a negative stress test, significantly reduces voiding difficulties with very few cases of de novo stress and urge incontinence. LEVEL OF EVIDENCE: 4.
Assuntos
Laparoscopia , Prolapso de Órgão Pélvico/cirurgia , Slings Suburetrais , Incontinência Urinária por Estresse/cirurgia , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/complicações , Estudos Prospectivos , Sacro , Resultado do Tratamento , Incontinência Urinária por Estresse/etiologia , Procedimentos Cirúrgicos Urológicos/métodos , VaginaRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas , Neoplasias Tonsilares , Tomografia por Emissão de Pósitrons , Fluordesoxiglucose F18 , Papiloma/complicações , Papiloma/patologia , Vértebras Cervicais/patologia , Vértebras Cervicais , Biópsia Guiada por ImagemAssuntos
Neoplasias Ósseas/diagnóstico por imagem , Radioisótopos de Carbono , Colina , Hiperparatireoidismo Secundário/complicações , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Próstata/diagnóstico por imagem , Compostos Radiofarmacêuticos , Idoso , Neoplasias Ósseas/metabolismo , Colina/farmacocinética , Clavícula/diagnóstico por imagem , Clavícula/metabolismo , Humanos , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/metabolismo , Masculino , Neoplasias da Próstata/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Tíbia/diagnóstico por imagem , Tíbia/metabolismoAssuntos
Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Linfonodos/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Tonsila Palatina/diagnóstico por imagem , Infecções por Papillomavirus/complicações , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Carcinoma de Células Escamosas/virologia , Fluordesoxiglucose F18 , Humanos , Metástase Linfática/diagnóstico por imagem , Masculino , Pescoço , Neoplasias Primárias Desconhecidas/virologia , Tonsila Palatina/virologia , Compostos RadiofarmacêuticosRESUMO
No disponible
Assuntos
Adulto , Feminino , Humanos , Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons , Metionina , Diagnóstico Diferencial , Neoplasias Encefálicas , Glioma/complicações , Glioma , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Epilepsia/complicações , Epilepsia/cirurgia , EpilepsiaAssuntos
Astrocitoma/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Epilepsias Parciais/etiologia , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Neuroimagem/métodos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Supratentoriais/diagnóstico por imagem , Teratoma/diagnóstico por imagem , Adulto , Astrocitoma/complicações , Astrocitoma/metabolismo , Radioisótopos de Carbono/farmacocinética , Diagnóstico Diferencial , Feminino , Humanos , Metionina/farmacocinética , Neoplasias Neuroepiteliomatosas/complicações , Neoplasias Neuroepiteliomatosas/metabolismo , Compostos Radiofarmacêuticos/farmacocinética , Neoplasias Supratentoriais/complicações , Neoplasias Supratentoriais/metabolismo , Teratoma/complicações , Teratoma/metabolismo , Distribuição TecidualAssuntos
Humanos , Masculino , Feminino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho , Joelho/patologia , Joelho , Membrana Sinovial/patologia , Membrana Sinovial , TriancinolonaRESUMO
OBJECTIVE: To know the characteristics of medical care at home done by the doctor and to what extent it is justified. DESIGN: An observational, descriptive-prospective study. Form filled out by the doctor after completing the visit. SETTING: Outpatients, 7 hospitals in area 17 of the Valencian Community. PATIENTS: 188 different patients attended in February 1993 by 15 family doctors. The statistical tests used were ji-squared test, Student's t-test and Anova. MEASUREMENTS AND MAIN RESULTS: An average of 0.4 visits/doctor/day were made. Less than 2 hours/week/doctor were needed. 80.5% of the cases were resolved using usual means available in the doctors emergency briefcase. 64.5% of the patients attended were over the age of 65.66% of the visits were considered to be justified. CONCLUSIONS: 66% of medical care at home was considered justified and did not require excessive time. Elderly patients are the ones who most require medical care at home.