Pericardial metastases due to terminal ileum primary carcinoid tumour detected on 111In scintigraphy / Metástasis pericárdica debida a tumor primario carcinoide de íleon terminal detectado con 111In-octreotide

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Tomografía por emisión de positrones/tomografía computarizada de doble fase con 18F-fluorodeoxiglucosa y diuresis forzada en el diagnóstico por imagen del cáncer de vejiga / Dual phase 18F-fluorodeoxyglucose positron emission tomography/computed tomography with forced diuresis in diagnostic imaging evaluation of bladder cancer

Se considera que la 18F-FDG PET tiene un valor limitado en oncología urológica debido a la excreción urinaria del trazador. El propósito de este estudio retrospectivo fue investigar el valor clínico de FDG PET/TC de doble fase con protocolo de diuresis forzada (furosemida i.v. e hidratación oral) en el cáncer de vejiga invasivo o de alto grado. Métodos. El estudio incluyó a 51 pacientes con cáncer de vejiga. Todos ellos tuvieron un procedimiento estándar de estadificación y una FDG PET/TC antes de planificar el tratamiento. Los hallazgos de la PET/TC antes y después de la administración de furosemida i.v. se compararon para determinar la detección de patología pélvica en cada estudio. Los hallazgos de imagen se correlacionaron con el diagnóstico final (histología o seguimiento clínico durante al menos 12 meses). Resultados. La actividad intravesical de FDG se redujo significativamente en el 90% de los pacientes con el protocolo de diuresis forzada. El 88% de los hallazgos en vejiga, el 20% de las metástasis linfáticas regionales y otros hallazgos en los órganos pélvicos (invasión local y tumor síncrono de próstata) se detectaron solo en las imágenes de PET/TC adicionales de pelvis. La PET/TC de doble fase cambió la estadificación y/o la estrategia terapéutica en 16 pacientes (31%). Conclusión. La FDG PET/TC de doble fase contribuyó a la estadificación y a la toma de decisiones terapéuticas detectando enfermedad local y metástasis pélvicas con gran precisión cuando se combinó con el protocolo de diuresis forzada. Por consiguiente, recomendamos la técnica de doble fase en la PET/TC con protocolo de diuresis forzada para el estudio del cáncer vesical y otras neoplasias del aparato urogenital(AU)

Introduction. 18F-FDG PET has been regarded as a limited value in urooncology due to urinary excretion of the tracer. The purpose of this retrospective study was to investigate the clinical value of dual-phase FDG PET/CT with forced diuresis protocol (iv furosemide-voiding and oral hydration) in invasive or high grade bladder cancer. Methods. Fifty-one patients were included in this study. All patients underwent standard staging procedures and dual-phase FDG PET/CT before planned therapy. PET/CT findings before and after furosemide were compared with each other for pelvic region. Dual phase PET/CT findings were also compared with the results of prior imaging studies and all findings were correlated with final diagnosis (histopathology or clinical follow-up for at least 12 months). Results. Intravesical FDG activity significantly decreased in 90% of the patients with forced diuresis protocol. Eighty eight percent of the bladder findings and 20% of the local lymph node metastases, and other pelvic findings (local invasion and second primary malignancy of prostate) were detected only by the additional pelvic PET/CT images. As a result, dual phase PET/CT changed the staging and/or the therapy strategy in 16 patients (31%). Conclusion. Dual phase FDG PET/CT contributes staging and decision of therapy strategy by detecting local disease and pelvic metastases with high accuracy when combined with forced diuresis protocol. Thus, we recommend dual phase imaging method with forced diuresis protocol in FDG PET/CT for bladder cancer and all other urogenital system malignities(AU)

[Normal tissue tolerance to external beam radiation therapy: bladder]. / Dose de tolérance à l'irradiation des tissus sains: la vessie.

The bladder is a hollow visco-elastic organ involved in urinary continence. In relation to its anatomical location, bladder is exposed in whole or in part to ionizing radiation in external radiotherapy or in brachytherapy of the pelvic region. The acute and late functional changes after external beam radiation consist in urinary frequency, compliance defaults and hematuria. Incidence of urinary side-effects, as well as related modalities of radiotherapy, is poorly described in the literature. Medline literature searches were performed via PubMed using the keywords "bladder--radiotherapy--toxicity--radiation cystitis--tolerability--organ at risk" to describe urinary side-effects due to radiation. Some recommendations exist on the dose constraints applied to bladder. These were mainly established from prostate radiation therapy studies but without definitive consensus. In clinical practice, dose constraints take into account clinical settings: bladder cancer which requires total bladder irradiation or others pelvic tumours (prostate, uterus...) in which the bladder is considered as an organ at risk. Risks of radiation cystitis increase with total dose (above 60 Gy), bladder irradiated volume and concomitant chemoradiation. Modern techniques using conformal radiotherapy with modulated intensity will probably have beneficial impact on bladder toxicity.

Supportive care in radiotherapy: a review.

The normal tissue tolerance and the related early side effects represent the main constraint on the total radiation dose which can be administered to the target volume. The most common disorders during radiotherapy or chemo-radiotherapy are summarized in this review. Since in the recent years great advances have been made towards the improvement of acute tolerance, practically every adverse symptoms can be controlled or lowered with an adequate treatment. Some suggestions are reported in order to prevent or lower the degree and the incidence of major complications, specifically mucositis-related symptoms like stomatitis, diarrhea, cystitis. Possibly, a multicenter effort is to be made in order to optimize the quality of supportive care for irradiated patients in all radiation therapy centers.

Sensitivity of the human circadian pacemaker to moderately bright light.

The aim of the present study was to evaluate the sensitivity of the human circadian pacemaker to the resetting effect of moderately bright light (approximately 1260 lux), and to assess the direct effect of such light exposure by comparison to a control group of subjects undergoing the same behavioral manipulations but with a similarly timed exposure to darkness instead of light. Endogenous circadian phase and amplitude were assessed in dim light (approximately 10-15 lux) before and after two consecutive series of three 5-hr exposures to approximately 1260 lux or to darkness (approximately 0.03 lux) in two different groups of young healthy men, using the constant-routine technique. The light or darkness exposure was centered 1.5 hr after the initial fitted endogenous temperature minimum and 12 hr opposite the newly scheduled midpoint of the sleep episode, in order to induce a phase advance in the light-exposed subjects. The phase of the endogenous circadian pacemaker was assessed by a dual-harmonic regression model from core body temperature recorded every minute during constant routines. Urinary volume was measured at each micturition, subjective alertness every 20 min, and cognitive performance hourly. The endogenous circadian phase shifted to a significantly earlier time after each series of light exposures in the treatment group than it did in the control group (two-way analysis of variance for repeated measures: F = 67.91, p = 0.0001). The analysis of circadian curves of urine production, subjective alertness, and cognitive performance scores revealed that all variables maintained stable temporal relationships with the endogenous circadian temperature minimum--an indication that these rhythms shifted in the same direction and by an equivalent amount. Despite comparable behavioral schedules, including the timing of bedrest/sleep and social contacts, circadian temperature rhythm of control subjects free-ran under dim light conditions, indicating that moderately bright light exerted a direct biological effect on the human circadian pacemaker in the treatment group. The present study also demonstrated that light of approximately 1260 lux (which is of substantially lower intensity that the approximately 7000-12,000 lux used in prior experiments) produces robust phase advances of the endogenous circadian temperature rhythm, which has been shown to be an accurate marker of the output of the circadian pacemaker (Czeisler et al., 1989). These results support the hypothesis that the phase-shifting effect of light on the human circadian pacemaker has a strongly nonlinear relationship to illuminance levels, such that it is preserved despite marked reductions in light intensity.

[The effect of super-erythematous doses of UV-radiation on the general condition of the human body]. / Vliianie superéritemnykh doz UF-radiatsii na obshchee sostoianie organizma cheloveka.

The effect of excessive UV-radiation with 2-4, 5-6, or 7-8 minimal erythematous doses (MED) on man's health condition was investigated, when the irradiated surface area made 20% or 50% of the body surface area. Before and 1 or 3 days after exposure the following parameters were measured: skin state, skin perspiration, body temperature, fluid consumption, diuresis, ECG, PCG, occlusion plethysmography. The observations allowed the conclusion that 5-8 MEDs were threshold doses inducing early intoxication in response to local irradiation (20% of the body surface area) and upper body irradiation (50% of the body surface area). Irradiation with 7-8 MEDs caused noticeable intoxication: fever, headache, increased body temperature (37 degrees C and over), inhibited perspiration, fluid retention, and altered cardiac function.

[Effects of increased doses of ultraviolet radiation on several parameters of human metabolism]. / Vliianie povyshennykh doz ul'trafioletovoi radiatsii na nekotorye pokazateli obmena veshchestv cheloveka.

Three experimental series, in which 20 test subjects took part, were carried out to investigate the effect of super-erythemic doses of ultraviolet irradiation on metabolic parameters. It was found that UV irradiation of 12-15% of the skin area led not only to skin changes but also to functional changes in certain organs and systems, which was indicated by variations of metabolic parameters.