RESUMO
In 2009, prostate cancer was the subject of a large number of communications in international urologic, oncologic and radiation therapy conferences. The most interesting studies that are likely to modify physician's daily practice were selected. This year the results from the European (ERSPC) and the American (PLCO) mass screening studies. Many abstract on prevention, natural history and tumor markers such as PCa3 and fusion gene TMPRSS2 : ERG were presented. Adjuvant hormonal treatment was evaluated in high-risk patients. Hormonal and radiation therapy association reduces recurrence, specific and overall mortality in locally advanced prostate cancer. Intermittent hormonal treatment is an option in hormone sensitive metastatic patients. toremifene and denosumab were evaluated in the prevention of fracture risk in patients under androgen deprivation therapy. The mechanism of tumor proliferation in castrate resistant prostate cancer further explained and 2 new molecules abiraterone and MDV 3100 were presented.
Assuntos
Congressos como Assunto , Neoplasias da Próstata , Terapia Combinada , Humanos , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapiaRESUMO
The usefulness of antibiotic prophylaxis in biliary surgery is well established. When antibiotic prophylaxis is not used, wound infection rates after biliary surgery range from 10% to 25%. With antibiotic prophylaxis, the rates can be reduced to less than 5%. Three questions are still controversial: Do all patients undergoing biliary surgery require antibiotic prophylaxis? What is the ideal antibiotic for use in biliary surgery? What should be the duration of antibiotic prophylaxis? In this study we prospectively evaluated the efficacy of a single dose of antibiotic prophylaxis in biliary surgery, administered to patients at high risk for infection, in a trial comparing cefonicid (a cephalosporin with a long half-life) with mezlocillin (a broad-spectrum ureidopenicillin).
Assuntos
Procedimentos Cirúrgicos do Sistema Biliar , Cefonicida/uso terapêutico , Mezlocilina/uso terapêutico , Pré-Medicação , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Cefonicida/administração & dosagem , Feminino , Humanos , Masculino , Mezlocilina/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição AleatóriaRESUMO
In the English literature, there have only been seven reports of metastasis from cancer of the gallbladder to the skin. This is the report of a 75-year-old woman who developed cutaneous metastasis from an adenocarcinoma of the gallbladder which was confirmed histologically. We report the uncommon metastatic potential of gallbladder carcinoma to the skin.
Assuntos
Adenocarcinoma/secundário , Neoplasias da Vesícula Biliar/patologia , Neoplasias Cutâneas/secundário , Idoso , Evolução Fatal , Feminino , HumanosRESUMO
Thirty-nine neonates including 29 prematures had correlation studies of trans-fontanelle ultrasounds with post-mortem anatomic findings. Occipital hyper-echogenicity can be physiological when it is symmetric in the premature infant, and may indicate ischemia and/or anoxia when it is asymmetrical. No abnormal pathology went undetected by echo. Cortical gyri were never seen prior to 32 weeks gestational age.
Assuntos
Hemorragia Cerebral/diagnóstico , Ecoencefalografia , Doenças do Recém-Nascido/diagnóstico , Hemorragia Cerebral/patologia , Ventrículos Cerebrais/patologia , Epêndima/patologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/patologia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/patologiaRESUMO
We report on two young patients with Niemann-Pick disease type B presenting with severe hepatic disease. Both children developed cirrhosis and died of intrahepatic block and mechanical hemolysis. Autopsy findings revealed complete obstruction of the sinusoids by lipid-laden Kupffer's cells. These two cases illustrate a new hepatic lesion of Niemann-Pick disease.
Assuntos
Cirrose Hepática/etiologia , Fígado/patologia , Doenças de Niemann-Pick/complicações , Pré-Escolar , Feminino , Humanos , Cirrose Hepática/patologia , Masculino , Doenças de Niemann-Pick/patologiaRESUMO
Symptomatic colonic lipomas, although unusual, continue to present difficulties in the preoperative differential diagnosis between malignant and benign colonic neoplasm. Although new imaging techniques are available, they are frequently diagnosed at laparotomy, and definitive histology is required. Local excision is adequate treatment, but segmental excision may be necessary when there is doubt about the diagnosis, or when a complication occurs.
Assuntos
Neoplasias do Colo/diagnóstico , Lipoma/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a case of diffuse hepatic and cerebral infarction in a surviving preterm co-twin and twin-twin transfusion syndrome studied by ultrasound and confirmed by post-mortem examination.
Assuntos
Infarto Cerebral/diagnóstico por imagem , Transfusão Feto-Fetal/diagnóstico por imagem , Infarto/diagnóstico por imagem , Fígado/irrigação sanguínea , Adulto , Cesárea , Feminino , Morte Fetal , Humanos , Recém-Nascido , Masculino , Gravidez , Ultrassonografia Pré-NatalRESUMO
We report a girl with tuberous sclerosis. Diagnostic criteria when she was 6 years included mental retardation, seizures and characteristic skin lesions. Disease was revealed in the first 4 months of life by marked abdominal distension due to polycystic kidney disease. This case is strikingly similar to those recently published in the pediatric literature. The similarity is further increased by histological data concerning changes in the epithelium of the cyst, that seem to be specific; the early recognition of these changes should lead to a diagnosis of tuberous sclerous sclerosis in the first months of life.
Assuntos
Doenças Renais Policísticas/etiologia , Esclerose Tuberosa/complicações , Criança , Feminino , Humanos , Rim/patologia , Esclerose Tuberosa/patologiaRESUMO
A proper organization has been set up at Antoine-Béclère's hospital in order to study the infants who died suddenly. Between July 1985 and July 1987, 69 cases (10 babies less than 1 week of age) were admitted. The purpose of this work was, for the 59 sudden deaths of infants aged more than 1 week (35 males, 24 females), to present the results of a definite protocol of investigation (past history, clinical examination, laboratory and pathological data) for determining either the etiology or the mechanism of these deaths. A thorough investigation was performed in 45/52 cases (no autopsy in 7 cases). A definite diagnosis was possible in 38/45: 13 viral infections, 5 gastro-esophageal reflux, 13 viral infections associated with reflux, 9 with an additional event (massive alimentary inhalation, slipping under blankets, major hyperthermia) to either a viral infection or a reflux, 1 cardiac malformation, 1 metabolic disorder, 2 accidents and 1 infanticide. With this protocol, 7/45 deaths remained unexplained. This medical approach of the problem of sudden deaths in infants is beneficial to the counselling of the parents and to the management of subsequent children.
Assuntos
Morte Súbita do Lactente , Autopsia , Coleta de Dados , Dieta/efeitos adversos , Esofagite Péptica/complicações , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Doenças Metabólicas/complicações , Morte Súbita do Lactente/etiologia , Morte Súbita do Lactente/patologia , Viroses/complicaçõesRESUMO
PURPOSE: To correlate magnetic resonance (MR) imaging and pathologic findings in premature infants with periventricular leukomalacia (PVL). MATERIALS AND METHODS: Eight premature infants with PVL who died after 3-7 weeks of life were studied with in vivo T1-weighted MR imaging, and imaging patterns were compared with hypoxic-ischemic injuries at pathologic analysis. RESULTS: Cavities were seen as zones of absent or weak signal intensity. Translucent sparsely cellular zones appeared as areas of intermediate intensity, and cellular reactions were seen as limited linear or punctate zones of increased intensity, usually less intense than the cortex. MR imaging provided reliable depiction of these lesions, with adequate estimation of their volume and topography. However, the extent of periventricular cellular lesions was underestimated. In one case, blood seen as hyperintense or isointense zones masked portions of cystic lesions, and in three cases small thalamic lesions were overlooked. CONCLUSION: With the above limitations, T1-weighted MR imaging offers precise evaluation of PVL.
Assuntos
Doenças do Prematuro/diagnóstico , Doenças do Prematuro/patologia , Recém-Nascido Prematuro , Leucomalácia Periventricular/diagnóstico , Leucomalácia Periventricular/patologia , Imageamento por Ressonância Magnética , Autopsia , Edema Encefálico/diagnóstico , Edema Encefálico/patologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/patologia , Ventrículos Cerebrais/patologia , Líquido Cefalorraquidiano , Feminino , Humanos , Lactente , Recém-Nascido , Leucomalácia Periventricular/classificação , Macrófagos/patologia , Imageamento por Ressonância Magnética/métodos , MasculinoRESUMO
PATIENTS AND METHODS: All cases of sudden and unexpected death occurring in maternity were studied over a period of 6 years (1985-1991). Anamnestic data, results of clinical examination of the body and findings of bacterial screening of body fluids or tissues were collected. The results at necropsy were also collected following the protocol used, with parental consent, in all cases of sudden infant death syndrome. RESULTS: There were 31 cases of sudden and unexpected death. Of these, 48% occurred before the 24th hour of life, 68% before the 36th hour and 84% before the 72nd hour. The majority of death occurred at night (55% between midnight and 6 AM, 90% between 9 PM and 9 AM). Analysis of the data provided a precise cause of death in 25 cases (81%), and a probable cause in 4 cases (13%). The major causes were perinatal anoxia, generally associated with massive amniotic inhalation (16 cases), and maternal-fetal infection (9 cases). No cause was found in 2 cases. Despite the fact that the death occurred unexpectedly, half of the newborns showed warning signs, some hours before the event. These signs were either not detected or ignored. CONCLUSION: The incidence of sudden death in neonates is 0.15 to 0.36/1,000 live births. Its causes are generally correlated with common neonatal diseases. Its occurrence at night and the existence of warning signs raise questions concerning the care of neonates in maternity.
Assuntos
Maternidades/estatística & dados numéricos , Complicações Infecciosas na Gravidez , Morte Súbita do Lactente/patologia , Líquido Amniótico , Feminino , Hipóxia Fetal/complicações , Humanos , Recém-Nascido , Masculino , Troca Materno-Fetal , Pneumonia Aspirativa/complicações , Gravidez , Morte Súbita do Lactente/epidemiologia , Morte Súbita do Lactente/etiologiaRESUMO
Various types of ischemic myocardial dysfunction can be observed after perinatal anoxia. Seven such cases are reported: 2 patients with cardiogenic shock due to left ventricle myocardial infarction; 2 patients with transient tricuspid insufficiency; 3 patients with transient myocardial ischemia in the course of a severe respiratory illness.
Assuntos
Cardiomiopatias/etiologia , Hipóxia/complicações , Doenças do Recém-Nascido/etiologia , Infarto do Miocárdio/etiologia , Insuficiência da Valva Tricúspide/etiologia , Humanos , Recém-NascidoRESUMO
A case of neonatal porencephalia is reported. It was due to antenatal hemorrhage associated with severe thrombocytopenia. Hematologic investigations showed a feto-maternal platelet incompatibility in the PLA1 system.