Prospective evaluation of CT-guided HDR brachytherapy as a local ablative treatment for renal masses: a single-arm pilot trial.

PURPOSE: In this pilot trial, we investigate the safety of CT-guided high-dose-rate brachytherapy (HDR-BT) as a local ablative treatment for renal masses not eligible for resection or nephrectomy. METHODS: We investigated renal function after irradiation by HDR-BT in 16 patients (11 male, 5 female, mean age 76 years) with 20 renal lesions (renal cell carcinoma n = 18; renal metastases n = 2). Two patients had previous contralateral nephrectomy and two had ipsilateral partial nephrectomy. Six lesions had a hilar localization with proximity to the renal pelvis and would have not been favorable for thermal ablation. Renal function loss was determined within 1 year after HDR-BT by renal scintigraphy and laboratory parameters. Further investigations included CT and MRI every 3 months to observe procedural safety and local tumor control. Renal function tests were analyzed by Wilcoxon's signed rank test with Bonferroni-Holm correction of p-values. Survival and local tumor control underwent a Kaplan-Meier estimation. RESULTS: Median follow-up was 22.5 months. One patient required permanent hemodialysis 32 months after repeated HDR-BT and contralateral radiofrequency ablation of multifocal renal cell carcinoma. No other patient developed a significant worsening in global renal function and no gastrointestinal or urogenital side effects were observed. Only one patient died of renal tumor progression. Local control rate was 95% including repeated HDR-BT of two recurrences. CONCLUSION: HDR-BT is a feasible and safe technique for the local ablation of renal masses. A phase II study is recruiting to evaluate the efficacy of this novel local ablative treatment in a larger study population.

[Interventional radiological procedures in the therapy for colorectal liver metastases]. / Radiologisch-interventionelle Verfahren zur Therapie von kolorektalen Lebermetastasen.

Microtherapeutic procedures performed by interventional radiologists pose a viable alternative or additive to systemic chemotherapy for local tumour control in cases of non-operable (for technical, functional, and comorbidity reasons or at the patient's wish) liver metastases. A main focus includes local therapies such as radiofrequency ablation and interstitial brachytherapy which are performed under ultrasound, CT or MRI guidance to achieve a thermal or radiogenic ablation of the malignancy. Although highly effective, these procedures are limited to oligonodular manifestations. For disseminated metastases, locoregional techniques like the yttrium-90 radioembolisation have become established. Here, the active principle in the form of radioactively labelled microspheres is introduced into the liver through an arterial catheter under angiographic guidance. The present article focuses on metastases of colorectal cancer as the most frequent tumour entity encountered in interventional radiotherapy.

[Small renal cell carcinoma-active surveillance and ablation]. / Kleines Nierenzellkarzinom ­ Aktive Überwachung und Ablation.

The incidence of renal cell carcinoma has been rising for years. At the same time there is an increasing prevalence of chronic renal failure with subsequent higher morbidity and shorter life expectancy in those affected. In the last decades the gold standard has thus shifted from radical to partial nephrectomy or tumor enucleation. A treatment alternative can be advantageous for selected patients with high morbidity and an increased risk of complications in anesthesia or surgery. Active surveillance represents a controlled delay in the initiation of treatment with a curative intention. Percutaneous radiofrequency ablation and laparoscopic cryoablation are currently the most commonly used treatment alternatives. Newer ablation procedures, such as high-intensity focused ultrasound, irreversible electroporation, microwave ablation, stereotactic ablative radiotherapy and high-dose brachytherapy have a high potential in some cases but are still considered experimental for the treatment.

Use and acceptance of the "paper pill". A novel approach to oral contraception.

A randomized, crossover study comparing the acceptance of and attitudes towards two dosage forms of the same oral contraceptive product - a paper presentation and the conventional tablet, was carried out in a network of rural and suburban research centers in the State of Durango, México. The results failed to show any significant advantage (in terms of acceptability or continuation) of the paper formulation. Although two-thirds of the participants indicated a preference for the conventional tablet, there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors.

PIP: A randomized, crossover study comparing the acceptance of and attitude towards 2 dosage forms of the same oral contraceptive product -- a paper presentation and the conventional tablet -- was carried out in a network of rural and suburban research centers in the State of Durango, Mexico. 68 women used the paper pill for 3 months and then switched to the tablet for another 3, while 70 women took the tablet 1st and switched to the paper pill. The results failed to show any significant advantage in terms of acceptability or continuation for the paper formulation. Both formulations were perceived as effective and easy to use. 2/3 of the participants indicated a preference for the tablets at the end of the study, but there was a high degree of acceptance of the paper formulation among new oral contraceptive acceptors. The authors believe that an improved paper formulation could be successfully introduced into a national program, if there were substantial savings in cost associated with the "paper pill."

[Prevalence of anemia in women attending family planning clinic in Durango (author's transl)]. / La prevalencia de anemia en mujeres asistentes a servicios de planificación familiar en la Ciudad de Durango.

PIP: This study investigates the prevalence of anemia in a group of 500 women requesting contraception for the first time at the Health Center in Durango, Mexico. 92% of women were between 15-34, with the majority in the age group 20-24; most had parity 1-4. The average hemoglobin level was 13.04 g/dl, with SE of 0.08. There were 70 anemic women with hemoglobin level below 12 g/dl, which gave a percentage of 14%. 90% of anemic women presented iron deficiency. 16.8% of the total number of women were within the 1st 6 weeks postpartum or postabortion; of these 32% were anemic. Of the 82.4% of women beyond this period of time only 10.4% were anemic. There was no increase in the prevalence of anemia in women with higher parity; among the 174 obese women the percentage of anemia was 86%. The relatively high prevalence of anemia in women seeking contraception compels the doctor to consider very seriously the type of contraception to be prescribed. In Mexico there is an important difference in the geographic distribution of anemia, which seems to be most common in the province of Yucatan, and which is probably caused by alimentary iron deficiency.^ieng

[Factors possibly associated with the age at the onset of menopause. Multicenter study]. / Factores que pueden estar asociados con la edad de presentación de la menopausia. Estudio multicéntrico.

A transversal study was performed in 1987 to examine 9,844 postmenopausal women aging from 39 to 59 years, residents from the cities of Durango, Monterrey, Guadalajara and Leon. They had their last menstruation at least 12 months before the interview and they were not pregnant. The objective was to know if the menarche, number of deliveries, use of contraceptive methods and smoking could affect the age of menopause. A case control analysis was performed. Based on frequency distribution of the age on which the menopause appeared, cases were classified as early and late menopause when a median value minus 2 SD and plus 2 SD were found, respectively. For control subjects a median + 1 SD was selected. Two and three controls were randomly assigned for early and late menopause, respectively. In total 1,610 subjects were studied. As a measure of association it was used the odds ratio with a confidence level of 95%. It was performed an analysis of confusion and interaction of variables in this study. The most relevant results were; a significant association between smoking 15 packages of cigarettes a year with an OR of 2.31 (1.05-5.17), to have more than five pregnancies with an OR of Mantel and Haenzel of 0.51 (0.33-0.76) for the early menopause. No association with late menopause was observed. It was found that the mean age of menopause was 45.5 years + 4.5 SD (n = 9,844).

[Prevalence of anemia in a sample of school children in Durango City]. / Prevalencia de anemia en una muestra de escolares de la ciudad de Durango.

The circulatory levels of hemoglobin and the frequency of anemia were determined in a representative sample of children with a mean age of 6.7 years. A random sample of 500 children of the city of Durango was studied. Durango has an altitude of 1893 m above sea level. The mean value of hemoglobin was 12.57 g/100 ml, with a range of 9.4 to 15.0 and a SE of 0.05. There was no difference statistically significant between the sexes. Considering 12.0 as the lower normal limit for hemoglobin values, it was found that 16% of the children were anemic, 49% of the anemic children were iron deficient, with iron serum levels of less than 60 ug/100 ml. The relationship between anemia and number of living children, birth order and weight was established. The frequency of anemia was higher among children coming from families with 4 or more living children.

Uso de tartrato de butorfanol como analgesico en salpingoclasia con anestesia local. / Use of butorphamol tartrate as analgesic in salpingography with local anesthesia

Este estudio fue disenado para determinar la utilidad del tartrato de butorfanol como analgesico en los precedimientos de esterilizacion femenina con anestesia local.Un grupo de mujeres aleatoriamente distribuidas fueron esterilizadas bajo anestesia peridural o local. En los casos de anestesia local una dosis de 4 mg de tartrato de butorfanol fue usada como analgesico. Los procedimientos empleados fueron laparoscopia y minilaparotomia, usando anestesia local y analgesia en 34 sujetos y bloqueo peridural en 31. Cuarenta casos fueron de intervalo y 25 postparto. La presencia de dolor severo en el transoperatorio se observo en ocho de los 34 casos operados con anestesia local y en dos de los 31 operados con anestesia peridural. En ningun caso la presencia de dolor impidio o dificulto el procedimiento