Routine follow-up after surgical treatment of lung cancer: is chest CT useful? / Acompanhamento de rotina após tratamento cirúrgico de câncer de pulmão: a TC de tórax é útil?

ABSTRACT Objective: To report the experience of a routine follow-up program based on medical visits and chest CT. Methods: This was a retrospective study involving patients followed after complete surgical resection of non-small cell lung cancer between April of 2007 and December of 2015. The follow-up program consisted of clinical examination and chest CT. Each follow-up visit was classified as a routine or non-routine consultation, and patients were considered symptomatic or asymptomatic. The outcomes of the follow-up program were no evidence of cancer, recurrence, or second primary lung cancer. Results: The sample comprised 148 patients. The median time of follow-up was 40.1 months, and 74.3% of the patients underwent fewer chest CTs than those recommended in our follow-up program. Recurrence and second primary lung cancer were found in 17.6% and 11.5% of the patients, respectively. Recurrence was diagnosed in a routine medical consultation in 69.2% of the cases, 57.7% of the patients being asymptomatic. Second primary lung cancer was diagnosed in a routine medical appointment in 94.1% of the cases, 88.2% of the patients being asymptomatic. Of the 53 patients who presented with abnormalities on chest CT, 41 (77.3%) were diagnosed with cancer. Conclusion: Most of the cases of recurrence, especially those of second primary lung cancer, were confirmed by chest CT in asymptomatic patients, indicating the importance of a strict follow-up program that includes chest CTs after surgical resection of lung cancer.

RESUMO Objetivo: Relatar a experiência de um programa de acompanhamento de rotina baseado em consultas médicas e TC de tórax. Métodos: Estudo retrospectivo envolvendo pacientes acompanhados após ressecção cirúrgica completa de câncer de pulmão de células não pequenas entre abril de 2007 e dezembro de 2015. O programa de acompanhamento consistiu em exame clínico e TC de tórax. Cada visita de acompanhamento foi classificada como uma consulta de rotina ou fora da rotina, e os pacientes foram considerados sintomáticos ou assintomáticos. Os desfechos do programa de acompanhamento foram ausência de evidência de câncer, recidiva ou segundo câncer de pulmão primário. Resultados: A amostra foi composta por 148 pacientes. A mediana do tempo de acompanhamento foi de 40,1 meses, e 74,3% dos pacientes realizaram menos TCs do que as recomendadas em nosso programa de acompanhamento. Recidiva e segundo câncer de pulmão primário foram encontrados em 17,6% e 11,5% dos pacientes, respectivamente. A recidiva foi diagnosticada em uma consulta médica de rotina em 69,2% dos casos, sendo 57,7% dos pacientes assintomáticos. O segundo câncer de pulmão primário foi diagnosticado em consulta médica de rotina em 94,1% dos casos, sendo 88,2% dos pacientes assintomáticos. Dos 53 pacientes que apresentaram anormalidades na TC de tórax, 41 (77,3%) foram diagnosticados com câncer. Conclusões: A maioria dos casos de recidiva, principalmente os de segundo câncer de pulmão primário, foi confirmada por TC de tórax em pacientes assintomáticos, indicando a importância de um programa de acompanhamento rigoroso que inclua TC de tórax após ressecção cirúrgica de câncer de pulmão.

Lateral elongation of flat irregular pigment epithelial detachment: A novel optical coherence tomography biomarker in polypoidal choroidal vasculopathy

Purpose: To explore novel Optical Coherence Tomography (OCT) biomarkers and precursor lesions in Polypoidal Choroidal Vasculopathy (PCV). Methods: This retrospective cohort study included 76 treatment na飗e fellow eyes of PCV. Focus was given to analyse the various morphological changes in the clinically unaffected fellow retina during the follow-up period. Results: 11 fellow eyes (14.47%) developed disease activity in the form of Sub Retinal Fluid (SRF) or Intra Retinal Fluid (IRF) within a mean follow-up of 17 months. All 11 eyes (100%) showed the presence of flat irregular pigment epithelial detachment (FIPED) and a peculiar property of lateral elongation of FIPED during disease activity. A positive correlation with the disease progression was found for the same (P < 0.0001). The mean horizontal dimension of the flat irregular PED at the enrolment was 1984 � 376u and the mean expansion of FIPED at SRF formation was 461 � 152u. ICG taken at the time of disease activity in the fellow eye revealed branching vascular network (BVN) in 9 (81.8%) eyes, polyps in 7 (63.6%) eyes, a combination of both in 5 (45.4%) eyes. Type one BVN with interconnecting channels showed faster disease progression than type two BVN. Eye tracking ICG illustrated that BVN corresponded to the FIPED in OCT and polypoidal lesions developed at the end of expanding FIPED. Conclusion: Flat irregular pigment epithelial detachment with its characteristic property of lateral elongation may be considered as a precursor lesion for PCV and as a novel OCT biomarker for the disease activity. Fellow eyes with FIPED need close monitoring to identify development of disease activity at the earliest.

Solid-phase extractions in flow analysis

ABSTRACT Coupling solid-phase extraction (SPE) to flow systems has promoted a synergistic development. Whereas SPE mechanization leads to improved precision and higher sample throughput, as well as diminishes systematic errors and contamination risks, analyte concentration and separation from the sample matrix provides a remarkable impact on detectability and selectivity in flow analysis. Historical aspects, main cornerstones, tips for system design, and recent applications are critically reviewed, in the context of analyte(s) separation/concentration, sample clean-up, and release of sorbed chemical species involving both packed (e.g. mini-columns, cartridges, and disks) or fluidized (e.g. beads and magnetic materials) particles. Novel (bio)sorbents, selective synthetic materials, and stationary phases for low-pressure chromatography are also discussed. Moreover, the feasibility of SPE for sample treatment before chromatographic separation, as well as the exploitation of direct measurements on the solid phase (optosensing) are emphasized.

Study Protocol: A Randomised Controlled Trial of Nortriptyline Added to a Smoking Cessation Intervention Conducted among Prisoners.

Background: Prisoners endure some of the worst health outcomes of any population group in the community. Smoking rates among prisoners remain high despite a significant reduction in smoking rates among the general public. This protocol describes a study in which we will assess the effectiveness of a smoking cessation intervention conducted among male prisoners. Methods/Design: 425 male smoking prisoners will be recruited. After completion of a baseline assessment, participants will receive a multi-component smoking cessation intervention comprising two half hour individual sessions of cognitive behavioural therapy and nicotine replacement therapy with either active Nortriptyline or placebo. Blinded follow up assessments will be conducted at 3, 6 and 12 months. Discussion: This study will provide data on the efficacy of Nortriptyline as a smoking cessation aid for male prisoners in combination with a multi-component smoking cessation intervention. No other smoking cessation randomised controlled trials on male prisoners has been published. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: #12606000229572. http://www.anzctr.org.au/trial_view.aspx?ID=1329.

Streptococcus pasteurianus septicemia.

Streptococcus pasteurianus is part of the normal flora of the intestine. It has also been isolated from various infection sites. However, to date it has not been reported as a cause of fulminant septicemia and death. We report the post-mortem findings in a splenectomized hemophiliac patient with cirrhosis and concurrent human immunodeficiency virus (HIV), hepatitis B and hepatitis C infections.

¿Es suficiente la protección otorgada por gafas plomadas en cardiología intervencionista? / Protection against ionizing radiation by leaded glass googles during interventional cardiology

Background: It is not known whether leaded glass goggles with 0.25 mm Pb equivalency, used in interventional cardiology procedures, attenuate radiation below the levels established by the latest recommendation of the International Commission on Radiological Protection (ICRP). Aim: To assess ifthe degree of attenuation of the secondary ionizing radiation achieved by the use of 0.25 mm Pb leaded glass goggles, in occupationally exposed workers in interventional cardiology procedures, meets the latest ICRP recommendations. Material and Methods: A prospective investigation was carried out to compare the eye exposure to secondary ionizing radiation received by occupationally exposed personnel in a 9 months period. A set of two thermo luminescent dosimeters was arranged in the front and back of leaded glass goggles in a cohort ofseven members of an interventional cardiology service, exposed to 1057 consecutive procedures. Results: The monthly dose equivalent measurement performed in front ofthe goggles ranged between 1.1 and 6.5 mSv, for paramedics and interventional cardiologists. The radiation measured in the back of the glass varied between 0.66 and 2.75 mSv, respectively. The degree of attenuation of the dose at eye level ranged from 40% to 57.7%, respectively. The projected annual exposure would reach 33 mSvfor the interventional cardiologist. Conclusions: With a similar load ofwork and wearing 0.25 mm Pb equivalent glass goggles, interventional cardiologists will exceed the crystalline equivalent dose limit recommended by the ICRP (20 mSv/year averaged over the past 5 years).

Diagnóstico de la situación de salud y propuesta de reorganización de los servicio de salud del Municipio de Briceño – Antioquia, 1999 / Health situation diagnosis and reorganization proposal of the health services in Briceño municipality, Antioquia, 1999

Con el propósito de conocer los principales problemas de salud del Municipio de Briceño (Antioquia) en la actualidad, brindar alternativas de solución a estos problemas y contar con una herramienta para controlar la evolución de los problemas identificados y el impacto de las decisiones que se tomen para enfrentarlos, se realizó el presente diagnostico de la situación de salud y la propuesta de reorganización de los servicios de salud de este municipio.