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1.
Anticancer Res ; 41(4): 2101-2110, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813420

RESUMO

BACKGROUND/AIM: To evaluate if topical support therapy during static-intensity modulated radiotherapy (sIMRT) course is able to equal the characteristic minimum risk for radiation proctitis of Image-guided volumetric modulated arc therapy (IG-VMAT) treatment among localized prostate cancer patients. PATIENTS AND METHODS: Rectal toxicity data of the above patients were retrospectively collected throughout three different clinical periods at our Radiotherapy Deparment: from October 2011 to December 2012, prostate cancer patients were treated with sIMRT and in advance supported by means of daily topical corticosteroids; from January 2013 to November 2016, topical corticosteroids were replaced by daily hyaluronic acid enemas; from December 2016 to May 2018 eligible patients were treated with newly introduced IG-VMAT supported by only on-demand topical corticosteroids. RESULTS: Among 359 eligible patients, IG-VMAT was proven generally more effective than sIMRT supported by topical medications in terms of proctitis reduction, although without clinical and practical relevance. CONCLUSION: Topical medications might have a role in radiation proctitis prevention.


Assuntos
Anti-Inflamatórios/administração & dosagem , Proctite/prevenção & controle , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Beclometasona/administração & dosagem , Enema/métodos , Humanos , Ácido Hialurônico/administração & dosagem , Itália , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Proctite/etiologia , Neoplasias da Próstata/patologia , Hipofracionamento da Dose de Radiação , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia Guiada por Imagem/métodos , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Estudos Retrospectivos
2.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370929

RESUMO

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Assuntos
Infecções por HIV , Obstrução Intestinal , Penicilinas/administração & dosagem , Proctite/diagnóstico , Neoplasias Retais/diagnóstico , Reto , Treponema pallidum , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Proctite/etiologia , Proctite/fisiopatologia , Proctite/terapia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Sigmoidoscopia/métodos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/terapia , Tomografia Computadorizada por Raios X/métodos , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação
3.
Medicine (Baltimore) ; 99(39): e22298, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991434

RESUMO

RATIONALE: There are many treatments for chronic hemorrhagic radiation colorectal inflammation, but only a few treatments are supported by high-quality research evidence. Studies have shown that the occurrence and development of radiation proctitis are closely associated with the intestinal flora. Animal studies have indicated that faecal microbiota transplantation (FMT) can improve radiation enteropathy in a mouse model. PATIENT CONCERNS: A 45-year-old female patient suffered from recurrent hematochezia and diarrhea for half a year after radiotherapy and underwent recurrent transfusion treatments. Colonoscopy showed obvious congestion of the sigmoid colon and rectal mucosa, a smooth surface, and bleeding that was easily induced by touch, which are consistent with radiation proctitis. The pathological findings revealed chronic mucosal inflammation. The magnetic resonance imaging examination of the pelvic cavity with a plain scan and enhancement showed changes after radiotherapy and chemotherapy, and no obvious tumor recurrence or metastasis was found. The laboratory examinations excluded pathogen infection. DIAGNOSES: Based on the history and examinations, the final diagnosis of this patient was chronic hemorrhagic radiation proctitis. INTERVENTIONS: The patient was treated with a total of 4 individual courses of FMT. OUTCOMES: After the six-month follow-up, her hematochezia, abdominal pain and diarrhea were relieved. Furthermore, 16S rRNA sequencing of the feces showed that the intestinal bacterial composition of the patient obviously changed after FMT and became similar to that of the donors. LESSONS: This case report shows that FMT can relieve the symptoms of hematochezia and diarrhea by changing the bacterial community structure in patients with chronic hemorrhagic radiation proctitis.


Assuntos
Transplante de Microbiota Fecal/métodos , Hemorragia Gastrointestinal/terapia , Proctite/etiologia , Lesões por Radiação/complicações , Assistência ao Convalescente , Doença Crônica , Colonoscopia/métodos , Diarreia/etiologia , Fezes/microbiologia , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Proctite/diagnóstico , Proctite/patologia , RNA Ribossômico 16S/genética , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/patologia , Doadores de Tecidos , Resultado do Tratamento
4.
Am J Clin Oncol ; 43(9): 628-635, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889832

RESUMO

OBJECTIVES: Stereotactic body radiation treatment represents an intriguing therapeutic option for patients with early-stage prostate cancer. In this phase II study, stereotactic body radiation treatment was delivered by volumetric modulated arc therapy with flattening filter free beams and was gated using real-time electromagnetic transponder system to maximize precision of radiotherapy and, potentially, to reduce toxicities. MATERIALS AND METHODS: Patients affected by histologically proven prostate adenocarcinoma and National Comprehensive Cancer Network (NCCN) intermediate class of risk were enrolled in this phase II study. Beacon transponders were positioned transrectally within the prostate parenchyma 7 to 10 days before simulation computed tomography scan. The radiotherapy schedule was 38 Gy in 4 fractions delivered every other day. Toxicity assessment was performed according to Common Terminology Criteria for Adverse Events (CTCAE), v4.0. RESULTS: Thirty-six patients were enrolled in this study. Median initial prostate-specific antigen was 7.0 ng/mL (range: 2.3 to 14.0 ng/mL). Median nadir-prostate-specific antigen after treatment was 0.2 ng/mL (range: 0.006 to 4.8 ng/mL). A genitourinary acute toxicity was observed in 21 patients (dysuria grade [G] 1: 41.7%, G2: 16.7%). Gastrointestinal acute toxicity was found in 9 patients (proctitis G1: 19.4%, G2: 5.6%). Late toxicity was mild (genitourinary toxicity G1: 30.6%; G2: 8.3%; gastrointestinal toxicity G1: 13.9%; G2: 19.4%). At a median follow-up time of 41 months, 3 biochemical recurrences were observed (2 local recurrences, 1 distant metastasis). Three-year biochemical recurrence-free survival was 89.8% (International Society of Urologic Pathology Grade Group 2: 100%, Grade Group 3: 77.1%, P=0.042). CONCLUSION: Ultrahypofractionated radiotherapy, delivered with flattening filter free-volumetric modulated arc therapy and gated by electromagnetic transponders, is a valid option for intermediate-risk prostate cancer.


Assuntos
Adenocarcinoma/radioterapia , Recidiva Local de Neoplasia/sangue , Neoplasias da Próstata/radioterapia , Radiocirurgia/métodos , Radioterapia de Intensidade Modulada , Adenocarcinoma/secundário , Idoso , Diarreia/etiologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Disuria/etiologia , Fenômenos Eletromagnéticos , Humanos , Masculino , Pessoa de Meia-Idade , Noctúria/etiologia , Proctite/etiologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Lesões por Radiação/etiologia , Radiocirurgia/efeitos adversos , Radioterapia de Intensidade Modulada/efeitos adversos
5.
Medicine (Baltimore) ; 99(30): e21328, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791729

RESUMO

The purpose of this study was to report the clinicopathological characteristics and treatment outcomes of 45 rectal cancer patients who have a history of cervical cancer with or without remote radiotherapy. Twenty-nine patients (64.4%) with a history of cervical cancer treated with pelvic radiotherapy were classified as group A, 16 (35.6%) patients with a history of cervical cancer not treated with radiotherapy were classified as group B. The median duration between radiotherapy for cervical cancer and rectal adenocarcinoma diagnosis was 18 years. At the time of rectal cancer diagnosis, 5 (17.2%) patients presented stage I disease, 15 (51.7%) had stage II, 1 (3.4%) had stage III, and 8 (27.6%) had stage IV. The patients in group A had older age, higher rates of gross ulcerative lesions, low hemoglobin levels, and a lower rate of lymph node metastases. The patients with secondary rectal cancer developed after radiotherapy for cervical cancer usually presented with abnormal abdominal symptoms, such as proctitis, cystitis, or rectal fistula. Higher colostomy rate was found in this group of patients due to severe pelvic fibrosis or proctitis.


Assuntos
Segunda Neoplasia Primária/patologia , Radioterapia/efeitos adversos , Neoplasias Retais/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/secundário , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Colostomia/estatística & dados numéricos , Cistite/epidemiologia , Cistite/etiologia , Feminino , Humanos , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Induzidas por Radiação/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Proctite/epidemiologia , Proctite/etiologia , Prognóstico , Fístula Retal/epidemiologia , Fístula Retal/etiologia , Neoplasias Retais/mortalidade , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/radioterapia
7.
Acta Cir Bras ; 35(5): e202000502, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32638843

RESUMO

PURPOSE: Changrui enema, a traditional Chinese medicine prescription, is used as a supplementary treatment for acute radiation proctitis (ARP). Herein we explored the inhibition effects of Changrui enema on NF-κB and VEGF in ARP mice. METHODS: A total of 120 C57BL/6 mice were divided randomly into normal mice group, ARP mice group, western medicine enema group (dexamethasone combined with gentamicin), and Changrui enema group. ARP mice were established by pelvic local irradiation. The expression of IL-1ß, NF-κB, VEGF, AQP1, AQP3, p-ERK1/2 and p-JNK was determined by immunohistochemistry or western blot. RESULTS: The study firstly found that Changrui enema alleviated ARP mice. The expression of IL-1ß, NF-κB, VEGF, AQP1 and p-ERK1/2 was increased in ARP mice, and was reserved by Changrui enema. However, the expression of AQP3 and p-JNK was decreased in ARP mice, and was up-regulated by Changrui enema. CONCLUSIONS: Changrui enema is an effective treatment with fewer side effects for ARP. The mechanism of Changrui enema may be related to the inhibition of inflammation-induced angiogenesis. Changrui enema inhibits IL-1ß and NF-κB expression as well as VEGF expression. Interestingly, AQP1 promotes angiogenesis, while AQP3 inhibits inflammation. Changrui enema probably inhibits AQP1 expression by down-regulating p-ERK1/2, and improves AQP3 expression by up-regulating p-JNK.


Assuntos
Medicamentos de Ervas Chinesas , NF-kappa B , Proctite , Lesões por Radiação , Fator A de Crescimento do Endotélio Vascular , Animais , Medicamentos de Ervas Chinesas/farmacologia , Enema , Inflamação , Camundongos , Camundongos Endogâmicos C57BL , NF-kappa B/efeitos dos fármacos , Proctite/tratamento farmacológico , Proctite/etiologia , Lesões por Radiação/tratamento farmacológico , Lesões por Radiação/metabolismo , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos
9.
Int J Radiat Oncol Biol Phys ; 106(2): 310-319, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-31682968

RESUMO

PURPOSE: This phase II study evaluated the utility of magnetic resonance imaging (MRI) and positron emission tomography for planning radiation and brachytherapy in patients with postsurgical recurrence of cervical cancer. METHODS AND MATERIALS: The study (NCT01391065) recruited patients with residual or recurrent disease after hysterectomy. Patients underwent baseline T2 weighted (T2W) MRI, 18F-flouro-deoxyglucose (18F-FDG), 18F-flouro thymidine (18F-FLT) and 18F-flouromisonidazole (18F-F Miso) positron emission tomography (PET) and received external radiation (50 Gy/25 fractions for 5 weeks) and weekly cisplatin (40 mg/m2). MRI was performed at brachytherapy and used for delineation of clinical target volume (CTV). Patients with parametrial disease at baseline received interstitial brachytherapy (16-20 Gy/4-5 fractions) and those with vaginal disease received intracavitary brachytherapy (12-14 Gy/2-4 fractions). Kaplan-Meier analysis was performed to evaluate locoregional relapse, disease free survival, and overall survival. Common Toxicity Criteria for adverse event reporting (CTCAE) v4.1 was used for toxicity scoring and European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questtionaire Core 30 (QLQC-30) and Cx 24 for quality-of-life reporting. RESULTS: Between January 2011 and February 2016, 60 patients were included, of which 50 received study treatment. The mean gross tumor volume on T2 W MR was 20 (IQR 3.6-90) cc. The metabolic tumor volume was 15 (interquartile range [IQR] 2.1-56.1) cc. The median FLT volume was 10 (IQR 0-48) cc. A total of 8 patients had 18-F F Miso uptake. The median CTV at brachytherapy was 38 (12-85) cc. The median CTVD90 and D 98 was 71 (53-74) and 74 (53-74) Gy. At a median follow-up of 60 (5-93) months, the 5-year local control, disease free survival, and overall survival were 84%, 73%, and 74.5%, respectively. Grade III and IV proctitis and cystitis were observed in 4% and 2% of patients. On multivariate analysis baseline tumor volume, on T2 W MR impacted disease free (91% vs 65%, P = .03) and overall survival (96% vs 77%, P = .06). CONCLUSIONS: Image-guided assisted radiation and brachytherapy are associated with good to excellent local control and survival in patients with vaginal recurrences of cervical cancer.


Assuntos
Braquiterapia/métodos , Recidiva Local de Neoplasia/radioterapia , Radioterapia Guiada por Imagem/métodos , Neoplasias do Colo do Útero/radioterapia , Adulto , Idoso , Antineoplásicos/uso terapêutico , Braquiterapia/efeitos adversos , Cisplatino/uso terapêutico , Cistite/etiologia , Cistite/patologia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/mortalidade , Neoplasia Residual , Tomografia por Emissão de Pósitrons/métodos , Proctite/etiologia , Proctite/patologia , Estudos Prospectivos , Qualidade de Vida , Compostos Radiofarmacêuticos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/efeitos adversos , Carga Tumoral , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/terapia
10.
Radiol Med ; 125(1): 87-97, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31552555

RESUMO

PURPOSE: Radiomic features, clinical and dosimetric factors have the potential to predict radiation-induced toxicity. The aim of this study was to develop prediction models of radiotherapy-induced toxicities in prostate cancer patients based on computed tomography (CT) radiomics, clinical and dosimetric parameters. METHODS: In this prospective study, prostate cancer patients were included, and radiotherapy-induced urinary and gastrointestinal (GI) toxicities were assessed by Common Terminology Criteria for adverse events. For each patient, clinical and dose volume parameters were obtained. Imaging features were extracted from pre-treatment rectal and bladder wall CT scan of patients. Stacking algorithm and elastic net penalized logistic regression were used in order to feature selection and prediction, simultaneously. The models were fitted by imaging (radiomics model) and clinical/dosimetric (clinical model) features alone and in combinations (clinical-radiomics model). Goodness of fit of the models and performance of classifications were assessed using Hosmer and Lemeshow test, - 2log (likelihood) and area under curve (AUC) of the receiver operator characteristic. RESULTS: Sixty-four prostate cancer patients were studied, and 33 and 52 patients developed ≥ grade 1 GI and urinary toxicities, respectively. In GI modeling, the AUC for clinical, radiomics and clinical-radiomics models was 0.66, 0.71 and 0.65, respectively. To predict urinary toxicity, the AUC for radiomics, clinical and clinical-radiomics models was 0.71, 0.67 and 0.77, respectively. CONCLUSIONS: We have shown that CT imaging features could predict radiation toxicities and combination of imaging and clinical/dosimetric features may enhance the predictive performance of radiotoxicity modeling.


Assuntos
Algoritmos , Neoplasias da Próstata/radioterapia , Lesões por Radiação/diagnóstico por imagem , Reto/efeitos da radiação , Tomografia Computadorizada por Raios X/métodos , Bexiga Urinária/efeitos da radiação , Idoso , Área Sob a Curva , Cistite/etiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Proctite/etiologia , Estudos Prospectivos , Curva ROC , Lesões por Radiação/etiologia , Tolerância a Radiação , Dosagem Radioterapêutica , Reto/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem
11.
Rev. argent. coloproctología ; 30(4): 80-87, dic. 2019. graf, tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1096677

RESUMO

Introducción: Las infecciones transmisibles sexualmente (ITS) con afectación anorrectal constituyen un desafío pues las manifestaciones producidas por Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) y Treponema pallidum (TP) son similares. Objetivo: Evaluar si las manifestaciones anorrectales debidas a CT, NG y TP asociadas al examen proctológico permiten diagnóstico certero, sin estudios complementarios. Pacientes y método: Estudio retrospectivo. Revisión de registros de pacientes atendidos en consultorio coloproctológico. Periodo: 01/08/2015-01/07/2016. Se incluyeron pacientes con diagnóstico de ITS anorrectal, excepto aquellos con HPV únicamente. A todos se les pesquisaron ITS mediante hisopado anal para CT por inmunofluorescencia y para estudio directo y cultivo de NG, VDRL para TP y además HIV. Variables: sexo, edad, HIV, sexo anal, uso de preservativo, motivo de consulta y resultado de estudios efectuados. Resultados: Treinta y cuatro pacientes (32 hombres). Edad mediana 31,5 años (rango: 19-65). Veinticinco pacientes HIV + (73,5%). Veintinueve pacientes (28 hombres) mantenían sexo anal. 91% no usaba preservativo adecuadamente. 65% tuvo una única infección (ITS pura). Se diagnosticaron 14 sífilis (8 puras), 14 clamidiasis (7 puras) y 11 gonococcias (7 puras). Co-infección entre ellas: 9% y con HPV: 26%. La úlcera fue la manifestación en 7/8 casos de sífilis puras (todas dolorosas, excepto una). El resto presentó síntomas variados (condilomas virales atípicos, secreción purulenta y proctorragia). Más del 50% de las gonococias puras (4/7) se manifestó con úlcera, sin embargo, el dolor estuvo presente siempre (8/8) y en tres se asoció secreción purulenta. En cambio, la mitad de los pacientes con clamidiasis puras, se manifestó con proctorragia causada por un tumor rectal/sigmoideo inflamatorio, clínicamente indistinguible de neoplasia maligna. Todos las sífilis y gonococias tuvieron correlato con las pruebas diagnósticas, no así las clamidiasis cuyo diagnóstico no pudo confirmarse en tres casos (37,5%), que respondieron al tratamiento empírico. Conclusión: NG y TP anorrectal provocaron mayormente síntomas similares a los de etiología no venérea y se requirió del laboratorio para el diagnóstico etiológico. La presencia de tumor con biopsia negativa para neoplasia maligna en pacientes de riesgo para ITS obliga a descartar clamidiasis. (AU)


Introduction: Sexually transmitted infections (STIs) are a challenge in medical consultation. The clinical manifestations of infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Treponema pallidum ( TP) share symptoms at anorectal level. This implies the need for a high index of suspicion for diagnosis, which is based on history, physical examination and laboratory tests that not always are accurate or available . Purpose: Assess whether clinical signs of anorectal infections by CT, NG and TP associated with proctologic exams, lead to an accurate etiologic diagnosis without the help of specific laboratory studies. Patients and methods: Observational, retrospective study, based on a review of records of patients treated at the outpatient clinic of the Hospital Fernandez (City of Buenos Aires) department of coloproctology, in the period between August 2015 and July 2016. Patients who underwent STI diagnosis were all considered, but to those whose only diagnosis was infection by human papilloma virus (HPV) were excluded from the analysis. All patients were tested after the three etiologies of STI (anal swab for CT study by immunofluorescence, swabbing for direct study, and cultivation of NG and TP VDRL) and HIV. Variables analyzed: sex, age, presence of HIV infection, practice of receptive anal sex, proper use of condoms, signs and symptoms that prompted the consultation, and results of diagnostic tests. Results: 34 patients (32 men) were included. Median age 31.5 years (range: 19-65, interquartile range: 26-37). Twenty-five patients (73.5%) were HIV+. Twenty-nine patients (28 men) remained receptive anal sex. 91% did not use condoms properly. 65% of infections were pure, without other STI asociada-. 14 cases of syphilis (8 pure), 14 Chlamydia (7 pure) and 11 gonococcias (7puras), including co-infection in 9% of cases, no evidence of a more frequent another co-infection diagnosed. Co-infection with HPV was detected in 9 (26%) cases. The ulcer was the sign in 7/8 cases of pure syphilis (all painful, except one). The rest is expressed by a variety of symptoms (atypical viral warts, purulent and bloody diarrhea). Similarly, just over 50% (4/7) of pure gonococcias demonstrated ulcer, but the pain was always present (8/8 of pure gonococcias) and three associated with purulent discharge. Instead of the ten patients with pure chlamydia, 50% manifested with bloody diarrhea caused by a rectal tumor / inflammatory sigmoid, clinically indistinguishable from malignancy. All cases of syphilis and gonococcal were correlated with diagnostic tests; not those whose diagnosis of chlamydial infection (confirmed in eight and was negative in three, 37.5%) who responded to empiric treatment indicated by the clinical suspicion. Conclusion: While this is a small series, it shows that the NG and TP in the anorectal location mostly caused symptoms similar to those of non-venereal ethology most of the times, and laboratory assistance for etiologic diagnosis was required. The presence of tumor with negative biopsy for malignancy in patients at risk for STIs, leads chlamydia to be ruled out. (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Proctite/etiologia , Proctite/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/complicações , Doenças Bacterianas Sexualmente Transmissíveis/diagnóstico , Infecções por Chlamydia/diagnóstico , Gonorreia/diagnóstico , Sífilis/diagnóstico , Dor , Proctite/epidemiologia , Reto/microbiologia , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Comorbidade , Infecções por HIV , Estudos Retrospectivos , Distribuição por Sexo , Técnicas de Laboratório Clínico
12.
Rev Esp Enferm Dig ; 111(11): 852-857, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31595754

RESUMO

INTRODUCTION: hemorrhagic radiation proctitis appears secondary to radiotherapy. Argon plasma is an effective, safe and easy-to-use technique with a relatively low cost. OBJECTIVES: to describe the short- and long-term response to argon plasma therapy in patients with hemorrhagic radiation proctitis. METHOD: an observational prospective study was performed of a series of 82 patients with hemorrhagic radiation proctitis, attended at the National Center for Minimally Invasive Surgery between 2010 and 2016. Summary measurements and a comparison of means (paired Student's t-test) for the final and initial hemoglobin levels were used. In addition, the Kaplan-Meier method was used to determine the rectal bleeding recurrence free time. RESULTS: in the present study, 54.9% of cases required 1-3 argon sessions and 86.6% required 1-5 sessions to resolve the bleeding, with a median of 3.0 sessions. In addition, 4.9% of patients had proctalgia as a complication. There was an improvement in hemoglobin of 2 g/dl. Rectal bleeding recurrence occurred in 8.5% of the patients during the nine months after therapy. Bleeding recurrence free time at three, six and nine months was 98.8%, 96.3% and 91.5%, respectively. Short-term therapy response was observed in all patients and long-term response after one year of follow-up was 91.5%. CONCLUSION: argon plasma coagulation shows a good short- and long-term response with few therapy sessions and a low rate of complications in patients with chronic hemorrhagic radiation proctitis.


Assuntos
Argônio/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Gases em Plasma/uso terapêutico , Proctite/tratamento farmacológico , Lesões por Radiação/tratamento farmacológico , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Proctite/etiologia , Estudos Prospectivos , Lesões por Radiação/etiologia , Radioterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
Rev Esp Enferm Dig ; 111(10): 813-814, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31545062

RESUMO

Infectious proctitis by sexually transmitted diseases are increasing in incidence and should be considered in men who have sex with men with rectal symptoms. In this case, we show an exuberant form of syphilitic and chlamydial proctitis that could be diagnosed as another anorectal disease such as inflammatory proctitis or even as a neoplasm if the clinical history is not taken into account.


Assuntos
Infecções por Chlamydia/complicações , Proctite/etiologia , Sífilis/complicações , Idoso , Infecções por Chlamydia/diagnóstico , Homossexualidade Masculina , Humanos , Masculino , Sigmoidoscopia , Sífilis/diagnóstico
14.
J Med Imaging Radiat Oncol ; 63(6): 836-841, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520465

RESUMO

INTRODUCTION: To investigate whether the implantation of a hydrogel spacer (SpaceOAR) reduces long-term rectal toxicity for prostate cancer patients treated with intensity-modulated radiotherapy (IMRT). METHODS: Patients with localised prostate cancer treated with 81 Gy in 45 fx of IMRT over 9 weeks were retrospectively compared: 65 patients with SpaceOAR and 56 patients without SpaceOAR. Planning aims restricted rectal doses to V40 Gy < 35%, V65 Gy < 17%, V75 Gy < 10%. Toxicities were evaluated between 3 months and 3 years after the completion of radiotherapy and were based on the common terminology criteria for adverse events (CTCAE) assessment tool for diarrhoea, haemorrhoids, faecal incontinence and proctitis. RESULTS: The cumulative incidence of low-grade diarrhoea (G1) was significantly higher in the non-SpaceOAR group (21.4% vs 6.2%; P = 0.016). The cumulative incidence of proctitis (grades G1 and G2) was also higher in the non-SpaceOAR group (26.7% vs 9.2%; P = 0.015); the cumulative incidence of G2 proctitis was higher in the latter group (P = 0.043). There were no differences between the treatment groups for cumulative incidences of faecal incontinence and/or haemorrhoids. Three years after IMRT, diarrhoea and proctitis were higher in the non-SpaceOAR group, without reaching statistical significance. This finding was unchanged after correcting for baseline symptoms. CONCLUSION: SpaceOAR is of benefit in reducing the cumulative incidence of low-grade diarrhoea and proctitis for up to 3 years after intensity-modulated radiotherapy.


Assuntos
Hidrogéis/uso terapêutico , Órgãos em Risco/efeitos da radiação , Neoplasias da Próstata/radioterapia , Lesões por Radiação/prevenção & controle , Radioterapia de Intensidade Modulada/efeitos adversos , Reto/efeitos da radiação , Idoso , Idoso de 80 Anos ou mais , Diarreia/etiologia , Diarreia/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Proctite/etiologia , Proctite/prevenção & controle , Estudos Retrospectivos
16.
Pediatr Blood Cancer ; 66(11): e27952, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31397065

RESUMO

PURPOSE/OBJECTIVE(S): Bladder and prostate are unfavorable sites for rhabdomyosarcoma (B/P-RMS), and represent a challenging location for radiotherapy. MATERIALS/METHODS: Nineteen patients with B/P-RMS were enrolled on a prospective registry protocol (2008-2017) and treated with chemotherapy, proton beam therapy (PBT), and surgical resection (n = 8; 42%). Emphasis was given to treatment technique, disease-related outcomes, and toxicity associated with PBT. RESULTS: The majority of patients had bladder RMS (74%) of embryonal histology (95%), Group III (68%), and intermediate-risk disease by Children's Oncology Group (COG) risk stratification (89%). Seven patients (37%) had primary tumors >5 cm in size. All patients were treated according to COG protocols. With a median follow-up of 66.2 months, 5-year overall survival (OS) and progression-free survival (PFS) were 76%. Four patients (21%) experienced disease relapse, all presenting with local failure. The 5-year local control (LC) rate was 76%. Tumor size predicted LC, with 5-year LC for patients with >5 cm tumors being 43% versus 100% for those with ≤5 cm tumors (P = .006). Univariate analysis demonstrated an effect of tumor size on OS (tumor >5 cm, hazard ratio [HR] 17.7, P = .049) and PFS (HR 17.7, P = .049). Acute grade 2 toxicity was observed in two patients (11%, transient proctitis). Late grade 2+ toxicity was observed in three patients (16%; n = 1 grade 2 skeletal deformity; n = 3 transient grade 2 urinary incontinence; one patient experienced both). CONCLUSIONS: PBT for B/P-RMS affords promising disease-related outcomes with an acceptable toxicity profile. Higher local failure rates were observed for larger tumors, supporting dose-escalation components of ongoing RMS clinical trials.


Assuntos
Neoplasias da Próstata/radioterapia , Terapia com Prótons , Rabdomiossarcoma Embrionário/radioterapia , Neoplasias da Bexiga Urinária/radioterapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Pré-Escolar , Terapia Combinada , Cistectomia , Feminino , Seguimentos , Humanos , Lactente , Estimativa de Kaplan-Meier , Masculino , Estadiamento de Neoplasias , Proctite/etiologia , Intervalo Livre de Progressão , Modelos de Riscos Proporcionais , Estudos Prospectivos , Prostatectomia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Terapia com Prótons/efeitos adversos , Terapia com Prótons/métodos , Lesões por Radiação/etiologia , Sistema de Registros , Rabdomiossarcoma Alveolar/tratamento farmacológico , Rabdomiossarcoma Alveolar/patologia , Rabdomiossarcoma Alveolar/radioterapia , Rabdomiossarcoma Alveolar/cirurgia , Rabdomiossarcoma Embrionário/tratamento farmacológico , Rabdomiossarcoma Embrionário/patologia , Rabdomiossarcoma Embrionário/cirurgia , Risco , Carga Tumoral , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Incontinência Urinária/etiologia
17.
Radiat Oncol ; 14(1): 149, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429773

RESUMO

BACKGROUND: The present prospective study evaluated the safety and efficacy of the rectum following KUSHEN Ningjiaos in cervical cancer. We compared rectal wall changes during brachytherapy with or without KUSHEN Ningjiaos in cervical cancer patients and analyzed the difference in spatial dose distribution, including whole rectum-wall (R-w), anterior rectum-wall (R-a) and posterior rectum-wall (R-p). METHODS AND MATERIALS: One hundred cervical cancer patients with and without KUSHEN Ningjiaos were treated with brachytherapy (600 cGy). The whole R-w was divided into two areas of R-a and R-p, and R-w dose surface map were constructed. The volume of each R-w was compared in patients pre- and post-KUSHEN Ningjiaos. RESULTS: When the pre- vs. post-KUSHEN groups were compared the volume of R-w increased. In the post-KUSHEN group, a significantly higher proportion of the D2cc of VR-w and VR-a compared with the pre-KUSHEN group showed that the D2ccmean increased from 532.45 cGy to 564.7 cGy and 533.51 cGy to 565.26 cGy, respectively; however, results demonstrated a decrease in the D2ccmean of R-p from 260.5 cGy to 240.0868 cGy (P < 0.05). The insertion of KUSHEN Ningjiaos resulted in a reduction of the relative volume of R-p exposed to high doses, and regressive analysis showed that the DR-p-max correlated most strongly with VR-w and D2ccR-p (P < 0.01 and P < 0.05, respectively). CONCLUSION: The insertion of KUSHEN Ningjiaos can protect the rectum. KUSHEN Ningjiaos appears to be safe and well tolerated; therefore, we believe that there will be fewer adverse events after brachytherapy for patients. TRIAL REGISTRATION: A multi-center, prospective clinical trial for KUSHEN Ningjiaos was inserted into rectum to reduce the rate of radiation proctitis in three-dimensional brachytherapy of cervical cancer. ChiCTR1900021631 . 2 Mar 2019-Retrospectively registered.


Assuntos
Braquiterapia/efeitos adversos , Medicamentos de Ervas Chinesas/administração & dosagem , Proctite/prevenção & controle , Lesões por Radiação/prevenção & controle , Reto/efeitos dos fármacos , Bexiga Urinária/efeitos dos fármacos , Neoplasias do Colo do Útero/radioterapia , Feminino , Humanos , Proctite/etiologia , Prognóstico , Estudos Prospectivos , Lesões por Radiação/etiologia , Dosagem Radioterapêutica , Reto/efeitos da radiação , Estudos Retrospectivos , Bexiga Urinária/efeitos da radiação , Neoplasias do Colo do Útero/patologia
19.
Cir Cir ; 87(4): 450-458, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264991

RESUMO

Background: An increase incidence of ulcerative colitis (UC) has been reported in Mexico. It is important to know the clinical features of patients with UC, their clinical course, need for surgical treatment and outcomes. Objective: To describe the demographic and clinical features of patients with UC, emphasizing the factors associated with the need for surgical treatment. Method: A retrospective, cross-sectional, analytical study was made which included 60 patients with diagnosis of UC confirmed by histopathology. The demographic, clinical and biochemical data of each patient will be collected. The severity was measured based on the Truelove and Witts scale, endoscopic Mayo score and Riley histological index. Results: Of the patients included, the proportion was equal between men and women. The mean age of presentation was 40.6 ± 13.3 years. The extent of the disease at the time of diagnosis was proctitis in the majority of patients (61.7%). Nineteen patients (31.8%) presented extraintestinal manifestations. 55% of the patients had as sole treatment 5-aminosalicylates. Fourteen patients (23.3%) required surgical treatment mainly due to lack of response to medical treatment. Conclusions: The clinical features of UC are useful to identify patients who may present a torpid evolution of the disease and who may require surgical treatment.


Assuntos
Colite Ulcerativa/cirurgia , Adulto , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/epidemiologia , Feminino , Humanos , Incidência , Masculino , Mesalamina/uso terapêutico , México/epidemiologia , Pessoa de Meia-Idade , Proctite/etiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
20.
Rev. argent. coloproctología ; 30(2): 57-64, Jun. 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1025559

RESUMO

Introducción: Las infecciones transmisibles sexualmente (ITS) son motivo de consulta frecuente, encontrándose Chlamydia trachomatis (CT) entre las prevalentes. Este germen provoca proctitis de diversa gravedad según el biovar involucrado. Los casos más floridos suelen ser ocasionados por el biovar LGV, responsable de la entidad linfogranuloma venéreo. Se desconocen la prevalencia de CT como causa de proctitis en Argentina y los biovares implicados. Con el objetivo de estudiar estas variables, se diseñó un protocolo para detectar y genotipificar CT en pacientes con proctitis infecciosa. Pacientes y métodos: Se incluyeron pacientes mayores de 18 años con cuadro de proctitis infecciosa atendidos en un centro público y otro privado. Se excluyeron pacientes con enfermedad inflamatoria intestinal y radioterapia pelviana. El estudio fue aprobado por un Comité de Ética y los pacientes firmaron un consentimiento informado. En las muestras de hisopado anal se realizó detección y tipificación molecular de CT. Resultados: Entre 31de agosto de 2017 y 31 de mayo de 2018, se incluyeron 56 pacientes (1 mujer, 53 hombres, 2 mujeres trans), 79% HIV+. En 29 casos (52%) se detectó CT. Todos eran hombres que tienen sexo con hombres (HSH) y refirieron practicar sexo anal u oral receptivo no protegido. La mediana de edad de este subgrupo fue de 31 años; 83% HIV+ en tratamiento antirretroviral y mediana de CD4 637 cel/mm3. La coinfección con otras ITS fue del 41% (siendo las más frecuentes HPV, gonococia y sífilis). Los motivos de consulta más frecuentes fueron proctorragia, pujo y tenesmo, proctalgia y secreción. Las manifestaciones clínicas fueron variadas: proctitis, úlcera perianal, tumor endoanal/rectal y absceso/fístula. El 86% de las proctitis correspondió al biovar LGV, siendo 62% moderadas a graves. La mediana de tiempo de evolución hasta el diagnóstico fue 21 días. Los casos más prolongados correspondieron a cuadros clínicos y endoscópicos más graves. La duración del tratamiento se adecuó al biovar involucrado. Todos los pacientes respondieron favorablemente; sin embargo, las dos fístulas perianales requirieron resolución quirúrgica. Conclusiones: Proctitis, úlceras y fístulas son manifestaciones inespecíficas; el hallazgo clínico y endoscópico per se no son suficientes para definir la etiología; sólo una anamnesis minuciosa permite presumir una ITS como agente causal. La tipificación logra definir el biovar, dato fundamental para adecuar el tratamiento, cortar la cadena de transmisión y contar con datos epidemiológicos a nivel local. Como resultado de esta investigación, el Ministerio de Salud de Nación proyectó la emisión de una alerta sobre la presencia de LGV en nuestro medio. Tipo de estudio: Observacional, transversal, analítico, multicéntrico.


Introduction: Sexually transmitted infections (STI) are a frequent reason for consultation, being Chlamydia trachomatis (CT) among the most prevalent ones. It causes proctitis of varying severity depending on the biovar involved. The most severe cases are usually caused by the LGV biovar, responsible for the entity called lymphogranuloma venereum. The prevalence of CT as a cause of proctitis in Argentina and the biovars involved are unknown. In order to study these variables, a protocol was designed to detect and genotype CT in patients with infectious proctitis. Patients and methods: Patients over 18 years old with infectious proctitis were attended in a public and private center. Patients with inflammatory bowel disease and pelvic radiation therapy were excluded. The study was approved by an Ethics Committee and the patients signed an informed consent. The detection and molecular typing of CT was performed in anal swab samples. Results: Between 31-08-2017 and 31-05-2018, 56 patients were included (1 woman, 53 men, 2 trans women), 79% HIV +. In 29 cases (52%) CT was detected. All were MSM and reported to practice unprotected receptive oral or anal sex. The median age of this subgroup was 31 years; 83% HIV + on antiretroviral treatment and median CD4 637 cel / mm3. The coinfection with other STIs was present 41% (the most frequent were HPV, gonococcal and syphilis). The most frequent symptoms were bleeding, tenesmus, proctalgia and secretion. The clinical manifestations were varied: proctitis, perianal ulcer, endoanal / rectal tumor and abscess / anal fistula. 86% of the proctitis corresponded to the LGV biovar, being 62% moderate to severe. The median time of evolution until the diagnosis was 21 days. The most prolonged cases corresponded to more severe clinical and endoscopic symptoms. The duration of the treatment was adapted to the biovar involved. All patients responded favorably; however, the two perianal fistulas required surgical resolution. Conclusions: Proctitis, ulcers and fistulas are nonspecific manifestations; the clinical and endoscopic findings per se are not sufficient to define the etiology; only a meticulous anamnesis allows us to presume an STI as a causative agent. The typification allows to define the biovar, a fundamental data to adapt the treatment, stop chain of transmission and provides local epidemiological data. As a result of this investigation, the Ministry of Health of the Argentina issued an alert about the presence of LGV in our country. Type of study: Observational, cross-sectional, analytical, multicenter study.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Proctite/etiologia , Proctite/epidemiologia , Infecções por Chlamydia , Chlamydia trachomatis/patogenicidade , Doenças Retais/etiologia , Doenças Retais/epidemiologia , Linfogranuloma Venéreo/etiologia , Infecções por HIV/complicações , Prevalência , Homossexualidade Masculina
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