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1.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408109

RESUMO

An 85-year-old man with Child-Pugh A cirrhosis secondary to non-alcoholic steatohepatitis presented to casualty with four days of painless haematochezia with dark blood without haemodynamic compromise. This was in the setting of receiving stereotactic body radiation therapy (SBRT) as treatment for his hepatocellular carcinoma (HCC).He was found to have haemorrhagic radiation colitis which was treated with argon plasma coagulation (APC). Our case demonstrates the importance of considering radiation induced colitis as a cause for painless lower gastrointestinal bleeding in patients with a background of radiation therapy for HCC. Earlier review of the imaging and consideration of this differential could have prevented the need for repeat hospitalisations and would have led to prompt colonoscopy and diagnosis.


Assuntos
Carcinoma Hepatocelular/radioterapia , Colite/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Neoplasias Hepáticas/radioterapia , Lesões por Radiação/diagnóstico , Radiocirurgia/efeitos adversos , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio , Biópsia , Carcinoma Hepatocelular/patologia , Colite/etiologia , Colite/patologia , Colite/cirurgia , Colo/diagnóstico por imagem , Colo/patologia , Colo/efeitos da radiação , Colo/cirurgia , Colonoscopia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Lesões por Radiação/etiologia , Lesões por Radiação/cirurgia , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431443

RESUMO

Pubic osteomyelitis is a rare and often late-onset complication of radiation therapy and surgery for vulvar and vaginal carcinoma. It typically presents with vulvar pain, fever, vaginal discharge and/or gait disorders. Pubic osteomyelitis is often accompanied by fistulas or wound dehiscence in the pelvic area. Its accurate diagnosis and treatment are challenging and require a multidisciplinary team effort. In our patients, multiple combined surgical procedures, long-term antibiotic treatment and days to weeks of hospital admission were necessary to treat pubic osteomyelitis. We emphasise the importance of timely and adequate diagnosis and multidisciplinary approach resulting in a course of treatment that is as effective as possible, limiting the impact on quality of life, which is generally high in this group of patients.


Assuntos
Carcinoma/terapia , Quimiorradioterapia Adjuvante/efeitos adversos , Osteomielite/terapia , Lesões por Radiação/terapia , Ferida Cirúrgica/terapia , Neoplasias Vulvares/terapia , Adulto , Antibacterianos/uso terapêutico , Artrodese , Transplante Ósseo , Carcinoma/patologia , Feminino , Humanos , Aplicação de Sanguessugas , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/etiologia , Equipe de Assistência ao Paciente , Osso Púbico/diagnóstico por imagem , Osso Púbico/efeitos da radiação , Osso Púbico/cirurgia , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/efeitos da radiação , Articulação Sacroilíaca/cirurgia , Transplante de Pele , Ferida Cirúrgica/complicações , Resultado do Tratamento , Vulva/patologia , Vulva/cirurgia , Neoplasias Vulvares/patologia
3.
Cornea ; 40(1): 121-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32355114

RESUMO

PURPOSE: To report the germicidal range ultraviolet (UV) irradiation-induced phototoxicity because of unprotected exposure to the UV lamps for presumed household disinfection of SARS-CoV-2 in a domestic setting. METHODS: We report on a family of 3 adults who experienced photophobia, intense eye pain, epiphora, blurred vision, and a burning sensation over the face and neck area after a short period of unprotected exposure to the UV germicidal lamps. RESULTS: An initial examination revealed erythema and tenderness over the face and neck area, reduced visual acuity of 6/12, and conjunctival injections bilaterally in all 3 patients. Further assessment at the ophthalmology department 3 days later revealed gradual improvement of visual acuity to 6/6 bilaterally. Slit-lamp examinations revealed few punctate epithelial erosions. Fundal examinations were normal without evidence of solar retinopathy. The patients were diagnosed with germicidal range UV irradiation-induced photokeratitis and epidermal phototoxicity. Lubricants and emollients were prescribed for symptom relief, and the patients were warned against using a UV germicidal lamp for disinfection purposes without appropriate protection. CONCLUSIONS: Although SARS-CoV-2 is structurally akin to SARS-CoV-1 and MERS-CoV, and previous studies demonstrated high levels of inactivation of beta-coronavirus with germicidal-range UV, evidence for its efficacy to inactivate SARS-CoV-2 is lacking. This case report serves to emphasize the potential consequences of phototoxicity from the improper use of UV germicidal lamps for household disinfection and to highlight the fact that UV germicidal lamps currently have no established role in household disinfection of SARS-CoV-2.


Assuntos
/prevenção & controle , Dermatite Fototóxica/etiologia , Desinfecção/instrumentação , Fotofobia/etiologia , Lesões por Radiação/etiologia , Raios Ultravioleta/efeitos adversos , Adolescente , Dermatite Fototóxica/diagnóstico , Dor Ocular/diagnóstico , Dor Ocular/etiologia , Feminino , Humanos , Controle de Infecções/instrumentação , Fotofobia/diagnóstico , Lesões por Radiação/diagnóstico , Inativação de Vírus/efeitos da radiação
4.
Artigo em Inglês | MEDLINE | ID: mdl-33317789

RESUMO

Radiation therapy is an important ally when treating malignant lesions in the pelvic area, but it is not exempt of adverse events. There are some measures that can be taken to reduce the possibility of these effects, but some are non-modifiable factors related to previous treatments, location of the lesions or comorbidities. There is a wide variety of clinical presentations that can be of an acute or chronic onset that go from mild to severe forms or that can have a great impact in the quality of life. Medical available therapies as metronidazole, sucralfate, mesalizine or probiotics, can be of aid although some lack of solid evidence of efficacy. Endoscopic treatment can be performed with argon plasma coagulation, bipolar cautery, radiofrequency, laser therapy or dilation. Hyperbaric therapy can be applied in refractory cases and surgery must be reserved to selected patients due to its high morbidity and mortality.


Assuntos
Trato Gastrointestinal Inferior/patologia , Qualidade de Vida/psicologia , Lesões por Radiação/diagnóstico , Lesões por Radiação/terapia , Radioterapia/efeitos adversos , Humanos , Fatores de Risco
5.
J Vasc Interv Radiol ; 31(10): 1627-1635, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33004146

RESUMO

PURPOSE: To compare the manifestations of chronic liver injury following transarterial chemoembolization with those of transarterial radioembolization (TARE) in patients with neuroendocrine tumor (NET). MATERIALS AND METHODS: This study consisted of an Institutional Review Board-approved single-institution retrospective analysis of NET patients who received transarterial chemoembolization from 2006 to 2016 and TARE from 2005 to 2014 and survived at least 1 year from the initial treatment. Patients receiving only transarterial chemoembolization (n = 63) or TARE (n = 28) were evaluated for the presence or absence of durable hepatic toxicities occurring at least 6 months after initial treatment. The definitions and grades of liver injury were adapted from Common Terminology Criteria for Adverse Events version 4.0 and were characterized by the presence of laboratory or clinical toxicities of Grade 3 or above. RESULTS: Chronic hepatic toxicity occurred in 14 of 63 transarterial chemoembolization patients (22%) with a total of 26 Grade 3-4 events, in whom elevation of bilirubin was the most common toxicity, compared to 8 of 28 TARE patients (29%) with a total of 16 Grade 3-4 and 2 Grade 5 events, in whom ascites were the most frequent toxicity. There were more laboratory toxicities in the transarterial chemoembolization group (65% vs 38%, P = .11) and fewer Grade 4-5 injuries (6% vs 27% of patients, P = .06). There was also a significantly higher number of patients who experienced intrahepatic progression of disease in the transarterial chemoembolization cohort than in the TARE patients (75% vs 43%, respectively; P = .005). CONCLUSIONS: Delayed hepatotoxicity from transarterial chemoembolization and TARE occurred in 22% and 29% of patients, respectively, from 6 months to several years following treatment. Transarterial chemoembolization-related toxicities on average were less severe and manifested primarily as laboratory derangements, compared to TARE toxicities which consisted of clinical hepatic decompensation.


Assuntos
Doença Hepática Crônica Induzida por Substâncias e Drogas/etiologia , Quimioembolização Terapêutica/efeitos adversos , Embolização Terapêutica/efeitos adversos , Tumores Neuroendócrinos/terapia , Lesões por Radiação/etiologia , Compostos Radiofarmacêuticos/efeitos adversos , Idoso , Doença Hepática Crônica Induzida por Substâncias e Drogas/diagnóstico , Feminino , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/secundário , Lesões por Radiação/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
7.
Neurology ; 95(10): e1392-e1403, 2020 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-32631922

RESUMO

OBJECTIVE: To develop and validate a nomogram to predict epilepsy in patients with radiation-induced brain necrosis (RN). METHODS: The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 patients with RN from 2 additional hospitals. RESULTS: A total of 302 patients with RN with a median follow-up of 3.43 years (interquartile range 2.54-5.45) were included in the training cohort; 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, sex, and total cholesterol level. In the validation cohort, 28 out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C index 0.76 [training] vs 0.72 [95% confidence interval 0.62-0.81; validation]). CONCLUSION: Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that a nomogram predicts post-RN epilepsy.


Assuntos
Irradiação Craniana/efeitos adversos , Epilepsia/diagnóstico , Epilepsia/etiologia , Nomogramas , Lesões por Radiação/complicações , Encéfalo/patologia , Encéfalo/efeitos da radiação , Feminino , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Lesões por Radiação/diagnóstico , Lesões por Radiação/patologia , Estudos Retrospectivos , Fatores de Risco
8.
Muscle Nerve ; 62(3): 386-389, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32511769

RESUMO

BACKGROUND: Changes in radiation therapy practice and cancer incidence bring into question prior evidence suggesting that radiation therapy predominantly injures the brachial plexus upper trunk, while tumor invasion typically injures the lower trunk. METHODS: We reviewed electrodiagnostic brachial plexopathy reports in cancer survivors for predominant trunk involvement, injury mechanism (tumor invasion vs radiation), and primary cancer location. RESULTS: Fifty-six cases of cancer-associated brachial plexopathy were identified. There was no relationship between injury mechanism and brachial plexus injury level. However, primary cancer location superior/inferior to the clavicle increased the odds of predominantly upper/lower trunk involvement by a factor of 60.0 (95% confidence interval: 7.9, 1401, respectively). CONCLUSIONS: Cancers superior/inferior to the clavicle increase the likelihood of predominantly upper/lower trunk plexopathy, respectively, regardless plexus injury mechanism. These findings contrast with older work, possibly due to more precise radiation therapy techniques and increased incidence of radiosensitive head and neck cancers.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Neoplasias/radioterapia , Lesões por Radiação/diagnóstico , Radioterapia/efeitos adversos , Idoso , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/fisiopatologia , Eletrodiagnóstico , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/fisiopatologia
9.
Medicine (Baltimore) ; 99(26): e20788, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590759

RESUMO

BACKGROUND: Treatment for most patients with head and neck cancers includes ionizing radiation with or without chemotherapy. This treatment causes irreversible damage to salivary glands in the irradiation field accompanied by a loss of fluid-secreting acinar cells and a considerable decrease of saliva secretion. There is currently no adequate conventional treatment for this condition. In recent years, we developed an effective culture method to enhance the anti-inflammatory and vasculogenic phenotypes of peripheral blood mononuclear cells (PBMNCs), and such effectively conditioned PBMNC (E-MNC) therapy has shown promising improvements to the function of radiation-injured salivary glands in preclinical studies. However, the safety and effect of E-NMC therapy have yet assessed in human. The objective of this ongoing first-in-man study is to assess the safety, tolerability, and in part the efficacy of E-MNC therapy for treating radiation-induced xerostomia. METHODS/DESIGN: This phase 1 first-in-man study is an open-label, single-center, two-step dose escalation study. A total of 6 patients, who had no recurrence of head and neck cancer over 5 years following radiation therapy and suffered from radiation-induced xerostomia, will receive a transplantation of E-NMCs derived from autologous PBMNCs to a submandibular gland. The duration of the intervention will be 1 year. To analyze the recovery of salivary secretion, a gum test will be performed. To analyze the recovery of atrophic salivary glands, computed tomography (CT), and magnetic resonance imaging (MRI) of salivary glands will be conducted. The primary endpoint is the safety of the protocol. The secondary endpoints are the changes from baseline in whole saliva secretion and salivary gland atrophy. DISCUSSION: This will be the first clinical study of regenerative therapy using E-MNCs for patients with severe radiation-induced xerostomia. The results of this study are expected to contribute to developing the low-invasive cell-based therapy for radiation-induced xerostomia. TRIAL REGISTRATION: This study was registered with the Japan Registry of Clinical Trials (http://jrct.niph.go.jp) as jRCTb070190057.


Assuntos
Terapia Baseada em Transplante de Células e Tecidos/métodos , Leucócitos Mononucleares/transplante , Lesões por Radiação , Glândulas Salivares , Xerostomia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Imagem por Ressonância Magnética/métodos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/fisiopatologia , Lesões por Radiação/terapia , Projetos de Pesquisa , Glândulas Salivares/diagnóstico por imagem , Glândulas Salivares/patologia , Glândulas Salivares/fisiopatologia , Glândulas Salivares/efeitos da radiação , Tomografia Computadorizada por Raios X/métodos , Transplante Autólogo/métodos , Resultado do Tratamento , Xerostomia/diagnóstico , Xerostomia/etiologia , Xerostomia/fisiopatologia , Xerostomia/terapia
11.
BMC Cardiovasc Disord ; 20(1): 206, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32345217

RESUMO

BACKGROUND: In recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes. METHODS: A retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity). RESULTS: From a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p < 0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p < 0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p < 0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p < 0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p = 0.650]). CONCLUSION: The number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.


Assuntos
Sobreviventes de Câncer , Cardiologia , Prestação Integrada de Cuidados de Saúde , Cardiopatias/terapia , Oncologia , Neoplasias/terapia , Lesões por Radiação/terapia , Idoso , Antineoplásicos/efeitos adversos , Brasil , Cardiotoxicidade , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico , Cardiopatias/mortalidade , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Qualidade de Vida , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/mortalidade , Radioterapia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Especialização , Fatores de Tempo
12.
Cir. plást. ibero-latinoam ; 46(supl.1): S107-S114, abr. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193500

RESUMO

El presente artículo comprende una amplia y descriptiva revisión de la radiación desde su concepción básica, características, clasificación, fuentes, equipos, elementos radioactivos y los efectos biológicos en el ser humano. La diferencia entre radiación ionizante y no ionizante radica en la cantidad de energía del fotón individual y no en la cantidad de energía total. La radiación no ionizante se caracteriza por no contar con energía suficiente para convertir átomos o moléculas a iones, sin embargo es capaz de producir calor, útil en tratamientos fisiátricos y estéticos, pero con la posibilidad de producir quemaduras y otras lesiones que aún siguen en estudio. Entre las fuentes de radiación no ionizante tenemos la luz visible, el laser, la luz infrarroja, el microondas, y el teléfono móvil. Los diversos equipos de diagnóstico y tratamiento empleados en Medicina como rayos X, radioterapia, medicina nuclear, o en el caso de accidentes nucleares y guerras radiactivas, pueden generar radiaciones del tipo ionizante que rompen enlaces químicos, con el consecuente desarrollo de lesiones biológicas, en ocasiones graves


This article includes a broad and descriptive review of radiation from its basic conception, characteristics, classification, sources, equipment, radioactive elements and the biological effects on humans. The difference between ionizing and non-ionizing radiation lies in the amount of energy of the individual photon and not in the amount of total energy. Non-ionizing radiation is characterized by not having enough energy to convert atoms or molecules to ions; however they are capable of producing heat, useful in physiological and aesthetic treatments, with the possibility of producing burns and other injuries that are still under study. Among the non-ionizing radiation sources, we have visible light, laser, infrared light, microwave and mobile phone. The various diagnostic and treatment equipment used in Medicine such as X-rays, radiotherapy, nuclear medicine, or in the case of nuclear accidents and radioactive wars, can generate ionizing type radiation that breaks chemical bonds, with the consequent development of biological lesions that may be severe


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Queimaduras/complicações , Radiação/classificação , Radioterapia/efeitos adversos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Pele/lesões , Radiação Ionizante , Radiação não Ionizante/efeitos adversos , Lesões por Radiação/complicações
13.
Clin Exp Metastasis ; 37(3): 425-434, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32185576

RESUMO

To compare the local control and brain radionecrosis in patients with brain metastasis primarily treated by single-fraction radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). Between January 2012 and December 2017, 179 patients with only 1-3 brain metastases (total: 287) primarily treated by SRS (14 Gy) or HFSRT (23.1 Gy in 3 fractions of 7.7 Gy, every other day) were retrospectively analyzed in a single center. Follow-up imaging data were available in 152 patients with 246 lesions. The corresponding Biological Effective Dose (BED) were 33.6 Gy and 40.9 Gy respectively for SRS and HFSRT group, assuming an α/ß of 10 Gy. Local control (LC) and risk of radionecrosis (RN) were calculated by the Kaplan-Meier method. The actuarial local control rates at 6 and 12 months were 94% and 88.1% in SRS group, and 87.6% and 78.4%, in HFSRT group (p = 0.06), respectively. Only the total volume of edema was associated with worse LC (p = 0.01, HR 1.02, 95% CI [1.004-1.03]) in multivariate analysis. Brain radionecrosis occurred in 1 lesion in SRS group and 9 in HFSRT group. Median time to necrosis was 5.5 months (range 1-9). Only the volume of GTV was associated with RN (p = 0.02, HR 1.09, 95% CI [1.01-1.18]) in multivariate analysis. Multi-fraction SRT dose of 23.31 Gy in 3 fractions has similar efficacy to single-fraction SRT dose of 14 Gy in patients with brain metastases. A slightly higher occurrence of radionecrosis appeared in HFSRT group.


Assuntos
Neoplasias Encefálicas/radioterapia , Encéfalo/patologia , Fracionamento da Dose de Radiação , Lesões por Radiação/epidemiologia , Radiocirurgia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/efeitos da radiação , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/secundário , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/epidemiologia , Necrose/etiologia , Necrose/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Intervalo Livre de Progressão , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Carga Tumoral , Adulto Jovem
14.
Radiat Oncol ; 15(1): 38, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066465

RESUMO

BACKGROUND: On the elastic profiles of human teeth after radiotherapy for head and neck cancers, generation of dental complications, which may bring several side effects preventing the quality of life, has not well clarified. Thus, we aimed to show the applicability of using 320 MHz Scanning Acoustic Microscopy (SAM) in the evaluation of the tooth damage acoustically at the micrometer level following radiation therapy, and also in the determination of the safe dose limits to impede severe dental damage. METHODS: This prospective study was performed by SAM employed at 320 MHz by an azimuthal resolution of 4.7 µm resolving enamel and dentin. A total of 45 sound human third molar teeth collected between September 2018 and May 2019 were used for the acoustic impedance measurements pre- and post irradiation. Nine samples for each group (control, 2 Gy, 8 Gy, 20 Gy, 30 Gy and 60 Gy) were evaluated to acquire the acoustic images and perform a qualitative analysis. Scanning Electron Microscopy (SEM) images were obtained to establish a relationship between micromechanical and morphological characteristics of the teeth. Statistical analysis was conducted using the Student t-test succeded by Mann-Whitney U investigation (p < .05), while SEM images were assessed qualitatively. RESULTS: The analysis included 45 sound teeth collected from men and women 18 to 50 years old. Post irradiation micromechanical variations of human teeth were significant only in the radiation groups of 30 Gy and 60 Gy compared to pre-irradiation group for enamel (7.24 ± 0.18 MRayl and 6.49 ± 028 MRayl; p < 0.05, respectively). Besides, the teeth subjected to radiation doses of 20, 30 and 60 Gy represented significantly lower acoustic impedance values relative to non-irradiated group for dentin (6.52 ± 0.43 MRayl, 5.71 ± 0.66 MRayl and 4.82 ± 0.53 MRayl p < 0.05), respectively. CONCLUSIONS: These results are evidence for a safe acoustic examination device which may be a useful tool to visualize and follow the safe dose limits to impede severe dental damage through the radiation therapy treatment for head and neck cancers.


Assuntos
Elasticidade/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Microscopia Acústica/métodos , Qualidade de Vida , Lesões por Radiação/diagnóstico , Radioterapia de Intensidade Modulada/efeitos adversos , Dente/efeitos da radiação , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Prognóstico , Estudos Prospectivos , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Dente/diagnóstico por imagem , Adulto Jovem
15.
World Neurosurg ; 137: 187-193, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32058110

RESUMO

BACKGROUND: One of the most valuable innovations in high-grade glioma surgery is 5-aminolevulinic acid (5-ALA). Fluorescence is a specific and sensitive indicator of metabolically active tumor tissue. In the published literature, the main focus has been placed on false-negative cases, with only a few articles addressing false positivity. The aim of the article was to highlight settings in which 5-ALA fluorescence does not necessarily mean tumor and to point out conditions in which intraoperative 5-ALA fluorescence has to be critically interpreted. METHODS: Using PubMed, a review of pertinent literature was done to specifically investigate all conditions, including non-neoplastic and other metabolically active lesions, that can mimic high-grade gliomas and cause a misleading intraoperative diagnosis. In addition, an institutional case characterized by strong 5-ALA fluorescence in radionecrosis is presented. RESULTS: Literature results were grouped in 2 main categories according to the field of application: oncologic setting (9 articles and 1 institutional case) and nononcologic settings (5 articles). CONCLUSIONS: As reported, 5-ALA-induced fluorescence is not limited to glioma but is also evident in nonglioma and non-neoplastic conditions. Critical interpretation of intraoperative fluorescence is therefore mandatory in recurrences and in atypical cases that might hinder alternative diagnoses.


Assuntos
Ácido Aminolevulínico , Neoplasias Encefálicas/terapia , Erros de Diagnóstico , Reações Falso-Positivas , Corantes Fluorescentes , Recidiva Local de Neoplasia/diagnóstico , Oligodendroglioma/terapia , Lesões por Radiação/diagnóstico , Neoplasias Encefálicas/diagnóstico , Quimiorradioterapia Adjuvante , Feminino , Glioma/diagnóstico , Glioma/cirurgia , Humanos , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Necrose , Procedimentos Neurocirúrgicos , Oligodendroglioma/diagnóstico , Lesões por Radiação/patologia , Lesões por Radiação/cirurgia
16.
Rev Med Interne ; 41(5): 325-329, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32046868

RESUMO

Fibrogenesis is a universal and ubiquitous process associated with tissue healing. The impairment of tissue homeostasis resulting from the deregulation of numerous cellular actors, under the effect of specific cytokine and pro-oxidative environments can lead to extensive tissue fibrosis, organ dysfunction and significant morbidity and mortality. This situation is frequent in internal medicine, since fibrosis is associated with most organ insufficiencies (i.e. cardiac, renal, or hepatic chronic failures), but also with cancer, a condition with common pathophysiological mechanisms. Finally, fibrosis is a hallmark of numerous systemic autoimmune diseases such as connective tissue disorders (in particular systemic sclerosis), vasculitides, granulomatoses, histiocytoses, and IgG4-associated disease. Although the process leading to tissue fibrosis may be in part irreversible, new pharmacological approaches or cell therapies bring hope in the field of fibrotic conditions.


Assuntos
Fibrose/diagnóstico , Fibrose/etiologia , Fibrose/patologia , Fibrose/terapia , Humanos , Medicina Interna/métodos , Neoplasias/etiologia , Neoplasias/patologia , Estresse Oxidativo/fisiologia , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Lesões por Radiação/patologia , Radioterapia/efeitos adversos , Fatores de Risco , Transdução de Sinais/fisiologia , Terapias em Estudo/métodos , Terapias em Estudo/tendências
17.
Eur J Cancer ; 128: 7-16, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32109852

RESUMO

BACKGROUND: Concurrent chemoradiotherapy is the standard treatment for anal cancer. Following national UK implementation of intensity-modulated radiotherapy (IMRT), this prospective, national cohort evaluates the one-year oncological outcomes and patient-reported toxicity outcomes (PRO) after treatment. MATERIALS AND METHODS: A national cohort of UK cancer centers implementing IMRT was carried out between February to July 2015. Cancer centers provided data on oncological outcomes, including survival, and disease and colostomy status at one-year. EORTC-QLQ core (C30) and colorectal (CR29) questionnaires were completed at baseline and one-year followup. The PRO scores at baseline and one year were compared. RESULTS: 40 UK Cancer Centers returned data with a total of 187 patients included in the analysis. 92% received mitomycin with 5-fluorouracil or capecitabine. One-year overall survival was 94%; 84% were disease-free and 86% colostomy-free at one-year followup. At one year, PRO results found significant improvements in buttock pain, blood and mucus in stools, pain, constipation, appetite loss, and health anxiety compared to baseline. No significant deteriorations were reported in diarrhea, bowel frequency, and flatulence. Urinary symptom scores were low at one year. Moderate impotence symptoms at baseline remained at one year, and a moderate deterioration in dyspareunia reported. CONCLUSIONS: With national anal cancer IMRT implementation, at this early pre-defined time point, one-year oncological outcomes were reassuring and resulted in good disease-related symptom control. one-year symptomatic complications following CRT for anal cancer using IMRT techniques appear to be relatively mild. These PRO results provide a basis to benchmark future studies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias do Ânus/terapia , Medidas de Resultados Relatados pelo Paciente , Lesões por Radiação/epidemiologia , Radioterapia de Intensidade Modulada/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Neoplasias do Ânus/mortalidade , Diarreia/diagnóstico , Diarreia/epidemiologia , Diarreia/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Dispareunia/diagnóstico , Dispareunia/epidemiologia , Dispareunia/etiologia , Disfunção Erétil/diagnóstico , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Feminino , Flatulência/diagnóstico , Flatulência/epidemiologia , Flatulência/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Órgãos em Risco/efeitos da radiação , Estudos Prospectivos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Índice de Gravidade de Doença , Reino Unido/epidemiologia
19.
BMJ Open Qual ; 9(1)2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31986118

RESUMO

Cardiac catheterisation is an invasive procedure carried out under fluoroscopic guidance, which exposes the patient's skin to X-ray radiation. In some cases, the skin receives a radiation dose, which is sufficiently high to cause a radiation injury. To ensure the timely identification of patients at risk of such an injury, a skin dose investigation protocol was implemented within the United Lincolnshire Hospitals Trust. However, two shortcomings with the new protocol were identified: first, it was possible for a patient to receive a clinically significant skin dose without the protocol being triggered; second, the investigation protocol increased staff workload. The Radiation Protection Department undertook to resolve these issues by making use of two software packages (openSkin and OpenREM) to automate key processes in the skin dose investigation protocol. The automation was introduced over three distinct Plan-Do-Study-Act cycles. The introduction of openSkin and OpenREM eliminated the possibility of a high skin dose procedure failing to trigger an investigation. The time spent by staff on skin dose investigations was reduced by an estimated 94%.


Assuntos
Fluoroscopia/efeitos adversos , Doses de Radiação , Lesões por Radiação , Proteção Radiológica/normas , Radiologia Intervencionista , Pele/lesões , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Feminino , Humanos , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Software , Reino Unido , Raios X
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