X-radiation does not affect the dental pulp: a morphological study in rats / A radiação X não afeta a polpa dentária: um estudo morfológico em ratos

Introduction: Radiotherapy is one of the methods used as a treatment for malignant tumors in the head and neck region and it can cause tissue damage in the irradiated areas. In head and neck radiotherapy, teeth are often included within the irradiation area and, consequently, the dental pulp; which receives high doses of radiation. Objective: To evaluate the effects of ionizing radiation on the pulp tissue of rat teeth. Methodology: A double-blind experimental assay with 35 Albinus Wistar rats divided into seven groups was performed; one control group, three groups irradiated with 15 Gy, and three groups irradiated with 25 Gy. The irradiated groups were submit-ted to a single dose of radiation and sacrificed 24 hours, 7 days, and 22 days after irradiation, respectively. The samples were evaluated for the morphological presence of inflammatory infiltrate, edema, necrosis, fibrosis, and degeneration of blood vessels. Statistical analysis was performed using the Kruskal-Wallis and Dunn tests with p < 0.05. Results: Hyaline degeneration of the pulp blood vessels in the irradiated teeth was statistically signifi-cant in all irradiated groups. Inflammatory infiltrate, edema, necrosis or fibrosis was not observed. Conclusion:A single X-radiation dose is not able to affect the dental pulp connective tissue in the long term with no clinical damage.

Introdução: A radioterapia é um dos métodos utilizados como tratamento para tumores malignos em região de cabeça e pescoço e que pode causar danos aos tecidos nas áreas irradiadas. Na radioterapia de cabeça e pescoço, os dentes são comumente incluídos dentro da área de radiação e, consequentemente, a polpa dentária, recebe altas doses de radiação. Objetivo: Avaliar os efeitos da radiação ionizante no tecido pulpar de dentes de ratos. Metodologia: Foi realizado um ensaio experimental duplo-cego com 35 ratos Albinus Wistar divididos em sete grupos: um grupo controle, três grupos irradiados com 15 Gy e três grupos irradiados com 25 Gy. Os grupos irradiados foram submetidos a uma dose única de radiação e sacrificados 24 horas, 7 dias e 22 dias após a irradiação, respectivamente. As amostras foram avaliadas quanto à presença morfológica de infiltrado inflamatório, edema, necrose, fibrose e degeneração nos vasos sanguíneos. A análise estatística foi realizada por meio dos testes de Kruskal-Wallis e Dunn com p < 0.05. Resultados: Degeneração hialina nos vasos sanguíneos pulpares dos dentes irradiados foi estatisticamente significante em todos os grupos irradiados. Não foi observado infiltrado inflamatório, edema, necrose ou fibrose. Conclusão: Uma dose única de radiação X não é capaz de afetar o tecido conjuntivo da polpa dentária a longo prazo sem danos clínicos.

Evaluación imaginológica de un caso de histiocitosis durante tres años / Imaging evaluation of a case of histiocytosis for three years

La histiocitosis de células de Langerhans es un trastorno celular dendrítico, resultado de la proliferación clonal de este tipo de células, morfológicamente redondeadas e inmaduras inmunofenotípica y funcionalmente; asociadas con eosinófilos, macrófagos, linfocitos y células multinucleadas gigantes, en ocasiones. Puede presentarse de forma monosistémica, cuando afecta a un solo sitio u órgan; o multisistémica cuando se presenta en múltiples órganos o sistemas corporales. La literatura médica y las publicaciones en las que se asocia la imaginología al estudio y caracterización de las enfermedades hematológicas son escasas, aun en la era tecnológica. En este trabajo se presenta un caso de histiocitosis de células de Langerhans que fue seguido imaginológicamente durante 3 años con el consiguiente apoyo al diagnostico, tratamiento, seguimiento y valoración; lo que demuestra la utilidad de la Imaginología como herramienta para lograr un mejor manejo del paciente y como principio de la atención medica multidisciplinaria(AU)

Langerhans cells histiocytosis is a dendritic cell disorder, result of clonal proliferation of this type of cells, morphologically rounded and immature immunophenotypically and functionally; associated with eosinophils, macrophages, lymphocytes and giant multinucleated cells at times. It can present monosystemic, affecting a single site or organ; or multisystemic disease when present in multiple organs or body systems. Medical literature and publications in which imaging is associated with the study and characterization of hematological diseases are scarce, even in the technological era. This paper presents a case of Langerhans cells histiocytosis that was followed imaging during 3 years with the subsequent support to diagnosis, treatment, monitoring and evaluation; demonstrating the usefulness of imaging as tool to achieve better patient management and as a principle of multidisciplinary medical care(AU)

Head and Neck Non-Melanoma Skin Cancer Treated By Superficial X-Ray Therapy: An Analysis of 1021 Cases.

INTRODUCTION: To report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules. MATERIALS AND METHODS: The medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979-2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis. RESULTS: The median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05-0.59). CONCLUSION: SXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.

Stereotactic breast irradiation with kilovoltage x-ray beams.

The purpose of this work is to determine, using Monte Carlo simulation and a realistic patient model, the characteristics of the resultant absorbed dose distributions when breast tumors are irradiated using small-field stereotactic body radiation therapy (SBRT) with kilovoltage x-ray beams instead of the standard megavoltage energies currently in use. The Rensselaer Polytechnic Institute (RPI) female phantom was used to model a pair of small-field SBRT breast treatments: in one treatment the tumor at depth and another one with the tumor located close to the breast surface. Each treatment consisted of 300 circular beams aimed at the tumor from a plurality of positions. The PENELOPE Monte Carlo code was used to determine the absorbed dose distribution for each beam and subsequently an optimization algorithm determined each beam weight according to a set of prescription goals. Both kilo- and megavoltage beam treatments were modeled, the latter to be used as a reference. Cumulative dose-volume histograms for eleven structures were used to compare the kilovoltage and reference treatments. Integral dose values are also reported. Absorbed dose distributions for the target volumes as well as the organs at risk were within the parameters reported in a clinical trial for both treatments. While for the ipsilateral healthy breast tissue the megavoltage treatment does offer an advantage in terms of less volume irradiated to intermediate doses, for the contralateral structures, breast and lung, the low penetration ability of the kilovoltage treatment results in a lower maximum dose. Skin dose is higher for the kilovoltage treatment but still well within the tolerance limits reported in the clinical trial.

Reacciones adversas al tratamiento radiante en el adulto mayor con cáncer / Adverse reactions to the radiation treatment in the elderly with cancer

Se realizó un estudio descriptivo y transversal para caracterizar clínicamente a 707 pacientes con cáncer, tratados en el Hospital Oncológico Provincial Docente Conrado Benítez García de Santiago de Cuba, durante el año 2013, por presentar reacciones adversas secundarias a la radioterapia. En la casuística, 484 afectados presentaron toxicidad (68,4 por ciento). Predominaron el sexo masculino, el grupo etario de 60-70 años, los tumores de próstata y mama, así como el estadio clínico II. Entre las reacciones adversas más frecuentes sobresalieron: radiodermitis, rectitis y anemia. La hipertensión, las cardiopatías y las enfermedades cerebrovasculares se asociaron al tumor. Hubo más reacciones adversas cuando se usó la radioterapia concurrente con la quimioterapia, y la remisión completa se logró en los pacientes que no interrumpieron el tratamiento(AU)

A descriptive and cross-sectional study to characterize clinically 707 patients with cancer, treated in Conrado Benítez García Teaching Provincial Oncological Hospital from Santiago de Cuba was carried out during the year 2013, for presenting secondary adverse reactions to the radiotherapy. Toxicity (68.4 percent) was present in 484 affected patients from the case material. The male sex, the age group 60-70 years, the prostate and breast tumors, as well as the clinical stage II prevailed. Among the most frequent adverse reactions there were: radiodermitis, rectitis and anemia. Hypertension, cardiopathies and cerebrovascular diseases were associated to the tumor. There were more adverse reactions when the concurrent radiotherapy was used with chemotherapy, and the complete remission was achieved in the patients who didn't interrupt the treatment(AU)

A new extended-length parallel-plate ionization chamber.

A special parallel-plate ionization chamber was developed. The motivation for the construction of this new chamber was mainly to fulfil the need of a reference system for computed tomography standard beams in the Calibration Laboratory of IPEN. However, the chamber was tested also in standard radiation beams of mammography and conventional diagnostic radiology. The chamber was manufactured at the institute workshop, as simply and cheaply as possible. Its design differs from the common ionization chambers used in dosimetric procedures of computed tomography equipment, because it is a parallel-plate chamber instead of a cylindrical chamber. However, its dimensions and sensitive volume are very similar to those of a commercial pencil ionization chamber. The new ionization chamber was submitted to several characterization and quality control tests, showing its very good performance.

Response characteristics of a tandem ionization chamber in standard X-ray beams.

A tandem ionization chamber was developed for quality control programs of the kilovoltage X-ray equipment used in radiotherapy. This chamber was tested and calibrated in low-energy X-ray beams in accordance with international recommendations, and it showed a satisfactory level of performance, mainly with regard to its main use, namely formation of a tandem system for confirmation of half-value layers in X-radiation beams previously determined by the conventional method. In this developed system no absorbers or special setups are necessary.

Aplicação de metodologia dosimétrica de feixes terapêuticos de raios X com sistema Tandem / Application of a dosimetric methodology of therapeutic X-ray beams with a Tandem system

Um sistema Tandem, constituído por um par de câmaras de ionização comerciais (uma cilíndrica e uma de placas paralelas), foi estabelecido para aplicação em instituição hospitalar, em substituição ao procedimento convencional de determinação de camadas semi-redutoras utilizando-se absorvedores. Os resultados obtidos mostram a possibilidade de utilização deste sistema em procedimentos de dosimetria para os feixes de ortovoltagem utilizados em radioterapia, como complemento de um programa de controle de qualidade.

[It's shown that "the general" has got a "heart"]. / "Se pone de manifiesto que el general tiene corazon."

There are here explained the circumstances under which there were obtained some xrays, in 1899, on the then President of the Nation, and the reason why the title of this article is such a strange one.

Câncer do lábio inferior (tratamento e reparação pelo método de Krause) / Cancer of lower lip: Repair and treatment by the Krause's technique

Os autores apresentam alguns casos de perda de substância do lábio inferior por câncer e reparados pela técnica de Krause. Fazem previamente um estudo sumário dos carcinomas cutâneos e da sua distribuição anatômica segundo os tipos mais freqüentes (baso e espinocelulares) bem como da sua incidência racial. Apontam os dois tipos princiapais de tratamento: o cirúrgico e o radioativo (roentgenterapia e radiumterapia). Referem-se à lei radioterápica dos raio x de Bergonié-Tribondeau intimemente relacionadacom o grau de imaturidade das células tumorais. Realçam alguns princípios que devem ser respeitados no tratamento cirúrgico dos tumores cutâneos. Ressaltam a importância da reparação precoce da ferida cirúrgica reultante da exérese tumoral

Avaliação do fluxo salivar em pacientes submetidos a radioterapia de cabeça e pescoço / Evaluation of salivary flow in subject patients

O propósito deste trabalo foi analisar o fluxo salivar de 15 pacientes com câncer de cabeça e pescoço, submetidos a radioterapia na Santa Casa da Misericórdia de Maceió. Em alguns pacientes, a saliva foi colhida antes, durante e após a terapia, verificando-se uma diminuição progressiva do fluxo salivar durante o período de avaliação. A serostomia foi um achado em 60 por cento dos casos avaliados

Aspectos biológicos y médicos básicos sobre las radiaciones ionizantes / Basic medical and biological aspects of ionizing radiation

Las radiaciones tienen gran utilidad en medicina, Sin embargo, existen fuentes radiactivas (como las industriales) que pueden provocar exposiciones accidentales a radiaciones ionizantes que a su vez pueden repercutir en el organismo. En este trabajo se hace una revisión sobre aspectos básicos que los médicos de cualquier especialidad (especialmente aquellos que laboran en instituciones hospitalarias) deberían conocer y poder reconocer

Tortícolis congénita / Congenital torticolis

La tortícolis congénita (TC) es un espasmo o contractura unilateral del músculo esternocleidomastoideo, que se observa durante los primeros días de la vida del recién nacido y que produce una deformidad del cuello. El tratamiento consiste en la aplicación de calor, el cual puede ser local mediante compresas humedas calientes o profunda, mediante ultrasonido. En vista de que no existen estudios concluyentes a favor de uno de los dos, se plantea el presente ensayo clínico controlado. Se formaron dos grupos, uno para cada tipo de tratamiento, asignándose al azar los pacientes a cada uno de ellos. Cada grupo estuvo formado por 13 pacientes con edades comprendidas entre dos meses y un año. El tratamiento duró tres meses. Se compararon los arcos de movilidad del cuello antes y después del tratamiento, así como el tiempo transcurrido para su recuperación. No se encontraron diferencias significativas en ninguno de los aspectos estudiados al inicio del estudio, excepto en la flexión inicial. Sin embargo, ambos grupos se recuperaron al 100 por ciento en sus arcos de movilidad. Al comparar el tiempo de tratamiento, se encontraron diferencias significativas a favor del grupo que recibió ultrasonido. Este solo aspecto hace que éste sea el tratamiento de elección