RESUMO
BACKGROUND: Access to health services in rural regions represents a challenge. The development of care models that respond to health service shortages and pay particular attention to the increasing health care needs of the elderly is an important concern. A model that has been implemented in other countries is that of mobile health units. But until now, there is no overview of their possible objectives, functions and implementation requirements. METHOD: This paper is based on a literature analysis and an internet research on mobile health units in rural regions. RESULTS: Mobile health units aim to avoid regional undersupply and address particularly vulnerable population groups. In the literature, mobile health units are described with a focus on specific illnesses, as well as those that provide comprehensive, partly multi-professional primary care that is close to patients' homes. The implementation of mobile health units is demanding; the key challenges are (a) alignment to the needs of the regional population, (b) user-oriented access and promotion of awareness and acceptance of mobile health units by the local population, and (c) network building within existing care structures to ensure continuity of care for patients. To fulfill these requirements, a community-oriented program development and implementation is important. CONCLUSIONS: Mobile health units could represent an interesting model for the provision of health care in rural regions in Germany. International experiences are an important starting point and should be taken into account for the further development of models in Germany.
Assuntos
Atenção à Saúde/métodos , Acessibilidade aos Serviços de Saúde , Unidades Móveis de Saúde , Serviços de Saúde Rural , Alemanha , Humanos , Atenção Primária à Saúde , População RuralRESUMO
The dependence on age of both the basal and the X-radiation-induced levels of apoptosis was examined in human peripheral blood mononuclear cells (PBMC). In the same samples, the base value and the extent of induced DNA single-strand breaks were determined, using a sensitive and fast microplate assay. PBMC were isolated from blood of donors of various age groups (20-30, 40-60 and > 70 years of age) and X-irradiated ex vivo using a 6 MV linear accelerator to give a total exposure of 4 Gy. The mean basal levels of apoptosis in PBMC from donors in the 40-60 year age group and the > 70 year age group were found to be only slightly higher (by 20-10%) compared to that of the 20-30 year age group, whereas the extent of DNA damage strongly and significantly (P < 0.01) increased with age by up to 2-fold. In contrast to the extent of induced DNA damage, which steadily increased in the course of ageing by up to 1.8-fold, there was only a transient increase in the level of induced apoptosis to 1.5-fold in PBMC from X-irradiated blood (4 Gy photons) from donors aged 40-60 followed by a decrease to 0.9-fold in PBMC from old donors (>70), compared to age group 20-30. The results show that X-ray-induced apoptosis and DNA damage in PBMC are not correlated during ageing.
Assuntos
Envelhecimento/efeitos da radiação , Apoptose/efeitos da radiação , DNA de Cadeia Simples/efeitos da radiação , Humanos , Leucócitos Mononucleares/citologia , Leucócitos Mononucleares/efeitos da radiação , Raios XRESUMO
A new and simple method for precise determination of lateral opposed treatment portals was developed and used in 17 patients. Compared to CT, MRI led to significant changes of portals in 59% (10/17) of cases. Individual shielding blocks could be precisely designed by use of our new method. MRI is the procedure of choice in local radiation therapy planning of brain tumors.
Assuntos
Neoplasias Encefálicas/radioterapia , Imageamento por Ressonância Magnética , Adolescente , Adulto , Idoso , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Criança , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Proteção RadiológicaRESUMO
A case is described in which bilateral subclavian vein occlusion was caused by fusiform expansion of the clavicle with hyperostosis, ankylosis of the sterno-clavicular joint, widening and thickening of the sternum and ossification of the costal cartilage of the first ribs. Histologically this proved to be due to an hyperostotic spongiosclerosis.
Assuntos
Clavícula , Exostose/diagnóstico , Costelas , Esterno , Anquilose/complicações , Anquilose/diagnóstico por imagem , Doenças das Cartilagens/complicações , Doenças das Cartilagens/diagnóstico por imagem , Circulação Colateral , Exostose/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Cintilografia , Articulação Esternoclavicular , Radioisótopos de Estrôncio , Veia Subclávia/diagnóstico por imagem , Tecnécio , Tromboflebite/diagnóstico por imagem , Tromboflebite/etiologia , Tomografia por Raios XRESUMO
The application of computer tomography should be extended for indicating the need and choice of radiotherapy for cerebral tumours, and for observing the effects of treatment. In 26 patients it has been shown that CT is superior to conventional neuro-radiological methods in showing indications and in planning of radiation therapy. Forms of treatment can be suitably adapted where the histological type of the tumour is known. In most cerebral tumours, the beneficial effect of irradiation has been evident in our patients. Our criteria were based on the concept of "clinical malignancy", no attempt was made at a histological classification of the tumours.
Assuntos
Neoplasias Encefálicas/radioterapia , Tomografia Computadorizada por Raios X/métodos , Adulto , Astrocitoma/radioterapia , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/radioterapia , Humanos , Metástase Neoplásica , Oligodendroglioma/radioterapia , Pinealoma/radioterapia , Neoplasias Hipofisárias/radioterapia , Tomografia Computadorizada por Raios X/estatística & dados numéricosRESUMO
On animal experiments was shown that Sn2+ after i.v. application with 113Sn as radioactiv indicator was deposited in the skeleton. Experiments were done with citrat-, tartrat-, pyrophosphat-, phosphat- and Sn2+/HCl-complexes. The importance of the results for the use of Sn2+-solutions in Nuclear Medicine for men are discussed.
Assuntos
Osso e Ossos/metabolismo , Estanho/metabolismo , Animais , Citratos/metabolismo , Difosfatos/metabolismo , Difosfatos/urina , Fezes/análise , Fêmur/metabolismo , Rim/metabolismo , Fígado/metabolismo , Fosfatos/metabolismo , Fosfatos/urina , Radioisótopos , Ratos , Baço/metabolismo , Tartaratos/metabolismo , Estanho/administração & dosagem , Estanho/urinaRESUMO
As a side effect after radical lymphonodectomy in the pelvic lymphatic cysts may occur on one or both sides. Only when they are big clinical signs will arise by compression. For diagnostic ultrasonic and computer tomography are superior to other radiological methods.
Assuntos
Cistos/diagnóstico por imagem , Excisão de Linfonodo/efeitos adversos , Doenças Linfáticas/diagnóstico por imagem , Cistos/etiologia , Humanos , Doenças Linfáticas/etiologia , Pelve , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The value of CT, conventional radiography and ultrasound was compared in 40 patients with 52 skeletal metastases. For superficial lesions, the combination of sonography and conventional radiography was equivalent to CT in showing the extent of bone destruction and soft tissue involvement. As expected sonography was unsatisfactory for deeper lesions. Sonography can provide useful information for planning radiation therapy for superficial lesions, but it does not replace conventional radiography.
Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias da Mama/diagnóstico por imagem , Carcinoma Broncogênico/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The results of experimental work on rats with strontium (85SrCl2, 89SrCl2) and yttrium (90Y) in a citrate complex demonstrate high affinity to bone. Rhenium perrhenat (186Re) Re-colloid and Re-methylene-diphosphonate were rapidly eliminated without bone affinity.
Assuntos
Osso e Ossos/diagnóstico por imagem , Citratos/metabolismo , Radioisótopos/metabolismo , Rênio/metabolismo , Radioisótopos de Ítrio/metabolismo , Animais , Citratos/sangue , Ácido Cítrico , Coloides , Radioisótopos/sangue , Cintilografia , Ratos , Ratos Endogâmicos , Rênio/sangue , Distribuição Tecidual , Radioisótopos de Ítrio/sangueRESUMO
Investigations with bone-seeking radionuclides (47Ca, 99mTc-PP, 113Sn) in rats of different age demonstrated a true accumulation in teeth as compared to bone. Blood flow was evaluated by 99mTcO4 and 51Cr-Albumin. Differences of accumulation depended on the isotopes used and on the age of the animals.
Assuntos
Osso e Ossos/metabolismo , Cálcio/metabolismo , Dente/metabolismo , Animais , Osso e Ossos/diagnóstico por imagem , Radioisótopos de Cálcio/metabolismo , Feminino , Radioisótopos/metabolismo , Cintilografia , Ratos , Tecnécio/metabolismo , Estanho/metabolismo , Dente/diagnóstico por imagemRESUMO
88Y was given to rats in form of citrate, diphosphonate or chloride to determine its accumulation in various organs. The activity in the bones was high but not as high as that of calcium. The application of methylene-diphosphonate showed high enrichment in the liver because of intravital colloid formation. Elimination by the kidneys depends on the type of the 88Y compound applied.
Assuntos
Radioisótopos de Ítrio/metabolismo , Animais , Injeções Intravenosas , Masculino , Ratos , Distribuição TecidualRESUMO
Therapeutic doses of 90Y-citrate show a high selective accumulation in bone. Bone marrow is the critical organ. Investigations in rats show a decrease of leucocytes, erythrocytes and thrombocytes depending on dose. A significant decrease of the leucocytes and thrombocytes was seen with 0.5 mCi (17.5 MBq) 90Y per kg bodyweight, with 2.0 mCi (74 MBq) also of the erythrocytes. This would be equivalent to a dose of 35 to 140 mCi (1.295 to 5.18 GBq) for a normal patient (70 kg). Therefore, a single dose of 10 mCi (370 MBq) of 90Y-citrate should be tolerated by a tumor patient without any blood cell depression, if there was no prior chemotherapy.
Assuntos
Células Sanguíneas/efeitos da radiação , Compostos Organometálicos , Radioisótopos de Ítrio/efeitos adversos , Animais , Contagem de Células Sanguíneas , Medula Óssea/efeitos da radiação , Citratos/administração & dosagem , Relação Dose-Resposta à Radiação , Ratos , Ratos Endogâmicos , Fatores de Tempo , Ítrio/administração & dosagem , Radioisótopos de Ítrio/administração & dosagemRESUMO
There is little change in the organ distribution of yttrium citrate complex after addition of 0.01 mg/kg BW as carrier. Adding increasing amounts of inactive yttrium up to 1 mg/kg BW caused a considerable reduction in bone uptake and an increasing accumulation in the liver and spleen by transformation to colloid. Uptake in the lung indicates formation of macro-particles. The transformation into colloid can be varied by changing the citrate concentration. The 90Y-citrate complex for therapy should be used either without or with very little carrier of inactive yttrium.
Assuntos
Compostos Organometálicos , Ítrio/metabolismo , Animais , Osso e Ossos/metabolismo , Citratos/administração & dosagem , Citratos/metabolismo , Coloides , Injeções Intravenosas , Fígado/metabolismo , Pulmão/metabolismo , Ratos , Baço/metabolismo , Distribuição Tecidual , Ítrio/administração & dosagemRESUMO
Carrier-free 87Y is produced by cyclotron irradiation of Rb. It decays with a half-life of 80.3 h, transforming via 87mSr to stable 87Sr with the emission of gamma lines of 0.48 and 0.39 MeV. Experience in 6 patients shows good scan quality and correspondence between 99mTc-DPD and 87Y images useful in 90Y-citrate therapy for bone metastases. 87Y offers new possibilities of studying biological kinetics in 90Y therapy. To avoid contamination this should only be used in departments with possibilities of radioactive waste storage and controlled disposal.
Assuntos
Neoplasias Ósseas/secundário , Carcinoma Broncogênico/secundário , Neoplasias Pulmonares/patologia , Neoplasias da Próstata/patologia , Neoplasias Gástricas/patologia , Radioisótopos de Ítrio/uso terapêutico , Idoso , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/radioterapia , Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/radioterapia , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/radioterapia , Cintilografia , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/radioterapiaRESUMO
For palliation of pain caused by bone metastases beta radiation isotope therapy was successful. As shown in experimental work on animals bone uptake of 90Y with its shorter half-life is high when it is administered as a citrate complex. 90Y can be eluted with high purity from a 90Sr "cow". The retention in man was found by whole-body counting to be higher than 80%. In preliminary trials on 16 patients the analgetic effect was the same as that of 89Sr. The properties of 90Y therapy are discussed.
Assuntos
Neoplasias Ósseas/secundário , Dor Intratável/radioterapia , Radioisótopos de Ítrio/uso terapêutico , Neoplasias Ósseas/radioterapia , Neoplasias da Mama/radioterapia , Feminino , Meia-Vida , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Melanoma/radioterapia , Cuidados Paliativos , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Neoplasias Gástricas/radioterapiaRESUMO
A multicentric, randomized study of squamous cell carcinoma (SCC) of the oral cavity and the oropharynx has been undertaken by DOSAK. The results after radical surgery alone have been compared with the results of combined preoperative radiochemotherapy followed by radical surgery. Patients with primary (biopsy proven) SCC of the oral cavity or the oropharynx with tumor nodes metastasis (TNM) stages T2-4, N0-3, M0 were included in the study. A total of 141 patients were treated by radical surgery alone, whereas 127 patients were treated by radical surgery preceded by preoperative radiochemotherapy. The preoperative treatment consisted of conventionally fractioned irradiation on the primary and the regional lymph nodes with a total dose of 36 Gy (5 x 2 Gy per week) and low-dose cisplatin chemotherapy with 5 x 12.5 mg cisplatin per m2 of body surface during the first week of treatment. Radical surgery according to the DOSAK definitions (DOSAK, 1982) was performed after a delay of 10-14 days. During the follow-up period, 28.2% of all patients suffered from locoregional recurrence, and 27.2% of the patients died. The percentages were higher after radical surgery alone for locoregional recurrence (31% and 15.6%) and for death (28% and 18.6%). The life-table analysis showed improved survival rates of 4.5% after 1 year and 8.3% after 2 years in the group of patients treated with combined therapy. The demonstrated improvement appeared to be significant with the Gehan-Wilcoxon test as well as with the log rank test below a P value of 5%.
Assuntos
Carcinoma de Células Escamosas/terapia , Neoplasias Bucais/terapia , Neoplasias Orofaríngeas/terapia , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Humanos , Tábuas de Vida , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/tratamento farmacológico , Neoplasias Bucais/radioterapia , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia , Neoplasias Orofaríngeas/tratamento farmacológico , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/cirurgia , Cuidados Pré-Operatórios , Estudos Prospectivos , Taxa de SobrevidaRESUMO
OBJECTIVE: To study the efficacy of coumarin/troxerutine for the protection of salivary glands and mucosa during irradiation. DESIGN: Prospective, randomized, placebo-controlled, double-blind trial. SETTING: University hospital, Germany. PATIENTS: 48 patients who had radiotherapy to the head and neck. MAIN OUTCOME MEASURES: Salivary gland scintigraphy and acute side-effects of radiotherapy (Radiation Therapy Oncology Group (RTOG) score). RESULTS: 23 patients (11 experimental, 12 placebo) completed the study. The global efficacy measure combining scintigraphy and RTOG score favoured the experimental arm (P=0.07). The RTOG score showed significantly fewer acute side-effects of radiation in the experimental arm (P<0.05). CONCLUSION: The results suggest that coumarin/troxerutine have a favourable effect in the treatment of radiogenic sialadenitis and mucositis.