ABSTRACT
Low dose rate brachytherapy (LDR-Br) with radioactive isotopes is a curative treatment and has shown to be comparable for the management of localized prostate cancer (PCa) to more conventional treatments such as radical prostatectomy or external beam radiotherapy, but with fewer side effects. The aim of this study is to show the global, specific and biochemical recurrence-free survival in 193 patients undergoing low dose rate Brachytherapy with permanent implants with iodine 125 and analyze the quality of life impact. 193 patients with localized PCa were consecutively treated over a period of 10 years (2005-2015). All of them were followed up on levels of prostate specific antigen (PSA) and 68 of them completed a quality of life survey. The average age was 62.8 years and the average PSA was 6.4 ng/dl at the time of Br. 29.5% of patients were classified as intermediate risk, with a Gleason score sum of 7 and/or a PSA between 10 and 20 ng/dl. Mean follow-up was 64.2 months; overall, specific and biochemical recurrence-free survival were 92.8%, 99.0% and 90.2% respectively. The most significant changes in the quality of life recorded were urinary incontinence, urinary and bowel irritative symptoms, in the first 6 months after brachytherapy. Sexual function shows significant changes but all with favorable response using phosphodiesterase inhibitors. This series of patients with PCa shows similar biochemical free survival rates BFSR in low risk patients to external beam radiotherapy and radical prostatectomy, but better BFSR in intermediate risk patients. The impact in the quality of life was significant in urinary incontinence, urinary irritate symptoms, and sexual function, but they were transitory with the exception of sexual function.
Subject(s)
Brachytherapy , Prostatic Neoplasms/radiotherapy , Quality of Life , Aged , Aged, 80 and over , Follow-Up Studies , Humans , Male , Middle Aged , Radiotherapy Dosage , Risk Assessment , Self Report , Time Factors , Treatment OutcomeABSTRACT
La braquiterapia LDR (low-doserate brachytherapy) (Br LDR) con isotopos radioactivos es un tratamiento curativo para el cáncer de próstata (CaP) localizado con resultados similares a tratamientos más convencionales como la prostatectomía radical o radioterapia externa, pero con menos efectos colaterales de acuerdo a lo publicado en algunas series. El objetivo de este trabajo es comunicar la sobrevida global, específica y libre de recidiva bioquímica en 193 pacientes que padecen de CaP localizado sometidos a Br de baja tasa de dosis con implantes permanentes de yodo 125. Como objetivo secundario analizar el impacto en la calidad de vida. El análisis se realizó en pacientes que padecen CaP localizado y que fueron tratados en un período de 10 años (2005-2015). A todos se les efectuó un seguimiento con niveles de antígeno prostático específico (PSA) y a 68 pacientes se les aplicó encuesta de calidad de vida. El promedio de edad fue de 62,8 años y el PSA promedio al momento del implante fue de 6,4 ng/dl. El 29,5% de los pacientes era de riesgo intermedio, con un puntaje Gleason 7 y/o un PSA entre 10 y 20 ng/dl. La media de seguimiento fue de 64,2 meses y la supervivencia global, específica y tasa libre de recidiva bioquímica (TLRB) fue de 92,8%, 99,0% y 90,2% respectivamente. Los cambios más significativos en la calidad de vida fueron en cuanto a incontinencia urinaria, síntomas de llenado/vaciado vesical e intestinales durante los primeros 6 meses desde la braquiterapia. En la función sexual se observaron cambios negativos significativos pero con respuesta favorable a distintas dosis de inhibidores de la fosfodiesterasa. Nuestra serie muestra TSLRB similares a los obtenidos en pacientes de bajo riesgo tratados con radioterapia externa o prostatectomía radical pero mejores TSLRP en pacientes de riesgo intermedio. El impacto en la calidad de vida fue significativo en los ítems de incontinencia de orina síntomas de llenado/vaciado vesical y función sexual, estos son transitorios a excepción de la función sexual (AU)
Low dose rate brachytherapy (LDR-Br) with radioactive isotopes is a curative treatment and has shown to be comparable for the management of localized prostate cancer (PCa) to more conventional treatments such as radical prostatectomy or external beam radiotherapy, but with fewer side effects. The aim of this study is to show the global, specific and biochemical recurrence-free survival in 193 patients undergoing low dose rate Brachytherapy with permanent implants with iodine 125 and analyze the quality of life impact. 193 patients with localized PCa were consecutively treated over a period of 10 years (2005-2015). All of them were followed up on levels of prostate specific antigen (PSA) and 68 of them completed a quality of life survey. The average age was 62.8 years and the average PSA was 6.4 ng/dl at the time of Br. 29.5% of patients were classified as intermediate risk, with a Gleason score sum of 7 and/or a PSA between 10 and 20 ng/dl. Mean follow-up was 64.2 months; overall, specific and biochemical recurrence-free survival were 92.8%, 99.0% and 90.2% respectively. The most significant changes in the quality of life recorded were urinary incontinence, urinary and bowel irritative symptoms, in the first 6 months after brachytherapy. Sexual function shows significant changes but all with favorable response using phosphodiesterase inhibitors. This series of patients with PCa shows similar biochemical free survival rates BFSR in low risk patients to external beam radiotherapy and radical prostatectomy, but better BFSR in intermediate risk patients. The impact in the quality of life was significant in urinary incontinence, urinary irritate symptoms, and sexual function, but they were transitory with the exception of sexual function (AU)
Subject(s)
Humans , Male , Prostatic Neoplasms/therapy , Brachytherapy/methods , Prostate-Specific Antigen/analysis , Prostatectomy , Treatment Outcome , Quality of Life , Sickness Impact Profile , Follow-Up StudiesABSTRACT
BACKGROUND: Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. AIM: To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. MATERIAL AND METHODS: A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. RESULTS: Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. CONCLUSIONS: Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.
Subject(s)
Anastomotic Leak/diagnostic imaging , Bariatric Surgery/adverse effects , Upper Gastrointestinal Tract/diagnostic imaging , Adult , Anastomotic Leak/etiology , Contrast Media , Female , Gastrectomy/adverse effects , Humans , Laparoscopy/adverse effects , Male , Middle Aged , Obesity, Morbid/surgery , Postoperative Period , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsABSTRACT
Background: Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. Aim: To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. Material and Methods: A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Results: Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Conclusions: Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Upper Gastrointestinal Tract/diagnostic imaging , Bariatric Surgery/adverse effects , Anastomotic Leak/diagnostic imaging , Postoperative Period , Obesity, Morbid/surgery , Tomography, X-Ray Computed/methods , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Laparoscopy/adverse effects , Contrast Media , Contrast Media/adverse effects , Anastomotic Leak/etiologyABSTRACT
BACKGROUND: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. AIM: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. MATERIAL AND METHODS: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. RESULTS: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. CONCLUSIONS: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Subject(s)
Breast Neoplasms/diagnostic imaging , Sentinel Lymph Node/diagnostic imaging , Biopsy , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Female , Humans , Intraoperative Care , Lymph Node Excision , Lymphatic Metastasis , Middle Aged , Radionuclide Imaging , Retrospective Studies , Sentinel Lymph Node/pathology , Sentinel Lymph Node/surgeryABSTRACT
Background: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. Aim: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. Material and Methods: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. Results: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. Conclusions: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Subject(s)
Humans , Female , Middle Aged , Breast Neoplasms/diagnostic imaging , Sentinel Lymph Node/diagnostic imaging , Biopsy , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Radionuclide Imaging , Retrospective Studies , Sentinel Lymph Node/surgery , Sentinel Lymph Node/pathology , Intraoperative Care , Lymph Node Excision , Lymphatic MetastasisABSTRACT
OBJECTIVES: Currently there are instruments to evaluate the different features of the impact on quality of life in those patients with prostate cancer undergoing any type of treatment, but most of them have 50 or more questions and they are difficult to apply in clinical practice. An English validation of a shortened version of the EPIC (Expanded Prostate Cancer Composite), the most used instrument to measure the quality of life in patients with prostate cancer, has been published recently. This version called EPIC-CP (Expanded Prostate Cancer Composite-Clinical Practice) consists of 16 questions arranged in a page, for easy and rapid clinical application. The objective of this work is to validate a Spanish version of the EPIC-CP. METHOD: An inversa-directa Spanish translation of the original version was performed. The EPIC-CP and EQ5D questionnaires were applied to 46 patients eligible to be subjected to different treatments - open prostatectomy (OP), Robotic Prostatectomy (RP), brachytherapy (Br) or conformational radiotherapy (CR) - and 82 patients already treated (9 OP, 13 RP, 7 Br, 4 CR). For reliability evaluation, the Cronbach's alpha was used to test the internal consistency for each domain of the EPIC-CP. Treated and untreated patients' scores were compared with the Wilcoxon range sum test to assess the sensitivity to change. RESULTS: Cronbach's alpha was elevated in all the EPIC-CP domains (near or greater than 0.7), indicating a high internal consistency. There was no significant difference in age and educational level between treated and untreated patients. We found significant differences between treated and untreated patients in the total EPIC CP score, in the domains of urinary incontinence, bowel function, sexual function and hormonal function. CONCLUSION: The Spanish version of the EPIC-CP is reliable and valid, so it is a useful tool to measure the quality of life in patients with prostate cancer, as well as the impact of different treatments.
Subject(s)
Prostatic Neoplasms/therapy , Quality of Life , Surveys and Questionnaires , Aged , Aged, 80 and over , Humans , Male , Middle AgedABSTRACT
Introducción. Los sujetos dependientes de cocaína pueden presentar deterioro neurocognitivo y alteraciones conductuales con importantes implicancias sociales. En esos pacientes se han demostrado diversas anormalidades en la perfusión cerebral, especialmente en la corteza prefrontal. Esta región cortical está relacionada con funciones ejecutivas y con el control de impulsos. El Wisconsin Card Sorting Test (WCST) fue diseñado específicamente para activar la corteza prefrontal. Objetivo. En sujetos dependientes de cocaína, cuantificar cambios en la perfusion cerebral basal y post activación con WCST inducidos por la detoxificación. Método. Se estudió a 23 pacientes entre 24 y 49 años de edad (19 hombres) que cumplían criterios DSM-IV para dependencia de cocaína y con consumo reciente demostrado. En todos ellos se obtuvo SPECT de perfusión cerebral en condiciones de reposo al ingreso y tras 4 semanas de hospitalización con abstinencia controlada. En 19 sujetos se realizó además SPECT cerebral con activación usando WCST, al inicio y al final de la hospitalización. Para comparar estas cuatro condiciones se utilizó Statistical Parametric Mapping (SPM). Resultados. Al comparar la perfusión en condiciones de reposo inicial y al mes de abstinencia se observó mejoría significativa de múltiples áreas corticales especialmente en región parieto-occipital bilateral y corteza prefrontal izquierda.El análisis grupal no demostró activación de corteza prefrontal con WCST al ingreso a la terapia de detoxificación. Luego de 4 semanas de abstinencia estricta, se observó significativa activación post WCST de corteza prefrontal dorsolateral izquierda.Conclusiones. Un mes de abstinencia estricta de cocaína produce mejoría de la perfusión cerebral en pacientes dependientes. Post consumo reciente, no se demuestra activación a nivel prefrontal con el estímulo del WCST, la cual se observa luego de abstinencia, lo que indica mejoría neurocognitiva...
Introduction. Cocaine-dependent subjects might have socially disruptive behavior. Several regional cerebral blood flow (rCBF) abnormalities have been described in these patients, mainly in the prefrontal cortex, area related to executive functions and impulse control. Wisconsin Card Sorting Test (WCST) was specifically designed to activate this cortical area. Aim. To quantify rCBF and to assess prefrontal activation pre and post detoxification on cocaine-dependant subjects. Methods. We studied 23 patients who met DSM-IV criteria for cocaine dependency ranging from 24 - 49 years old (19 males), all with positive urine cocaine test. Baseline 99mTc-ECD brain perfusion SPECT was performed at admission and after 4 weeks of controlled in-hospital abstinence; in 19 patients SPECT was acquired also after WCST activation. Statistical Parametric Mapping (SPM) was used to compare SPECT studies on these 4 conditions. Results. rCBF of bilateral parieto-occipital area, left prefrontal cortex and multiple small cortical region improved after 4 weeks of cocaine detoxification. The group analysis did not show significant prefrontal cortex activation induced by WCST on admission. After 4 weeks of strict cocaine abstinence, WCST was able to induce left dorsolateral prefrontal cortex activation. Conclusions. A month of strict cocaine abstinence improved brain perfusion in dependant patients. After recent consumption, there was no prefrontal activation when using WCST, but this was observed after abstinence, supporting neurocognitive improvement. These findings may have clinical implications as potential predictors of therapy response.
Subject(s)
Humans , Male , Adult , Female , Middle Aged , Cerebrovascular Circulation/physiology , Neuropsychological Tests , Substance Withdrawal Syndrome , Substance Withdrawal Syndrome/physiopathology , Cocaine-Related Disorders , Cocaine-Related Disorders/physiopathology , Prefrontal Cortex , Prefrontal Cortex/blood supply , Tomography, Emission-Computed, Single-Photon , Cocaine-Related Disorders/rehabilitationABSTRACT
En enfermedad coronaria (EC) severa por disfunción transitoria del ventrículo izquierdo (VI) se puede observar dilatación cavitaria e incremento en la captación pulmonar del radiofármaco mediante imágenes de perfusión miocárdica, descrito inicialmente con 201Talio en estrés. La isquemia inducida por dipiridamol (DIP) que es controvertida, en cuanto a su mecanismo, también puede disminuir la función sistólica. La fracción de eyección ventricular izquierda (FEVI) post estrés puede no pesquisar esta alteración, dependiendo del momento de inicio de la adquisición gatillada. Hay diversas publicaciones al respecto con diferentes resultados. Objetivos: Evaluar la correlación de parámetros funcionales del VI e isquemia en SPECT gatillado precoz usando perfusión miocárdica en pacientes referidos para evaluación de EC. Además, se decidió revisar ampliamente las dificultades del protocolo. Método: De 158 pacientes evaluados inicialmente, se excluyó 31 por ciento por presencia de actividad extra cardiaca que interfería con la delimitación automática de bordes. El grupo analizado incluyó 109 sujetos entre 33 y 91 años (promedio 64,3 + - 11,7), 52 por ciento de mujeres. Treinta de ellos con EC conocida; 18 con infarto de miocardio y 31 con isquemia en imágenes de perfusión. El estudio tomográfico SPECT 99mTc-Sestamibi fue efectuado durante los 60 min post DIP, con protocolo de 1 día. Se usó programa Cedars QGS y QPS para FEVI, volúmenes y cálculo de dilatación isquémica transitoria (DIT) en imágenes de fin de diástole. También se calculó índice pulmón/corazón (IPC) de imágenes SPECT. Resultados: El lapso promedio entre inyección estrés y adquisición fue 27 min (rango: 18-43). No hubo diferencia significativa entre FEVI post DIP y reposo (66,55 + -17,33 por ciento versus 67,58 + - 18,41 por ciento, con delta FEVI: 1,03 + - 6,72 por ciento). Tampoco hubo correlación de los parámetros analizados en globo según presencia de isquemia, infarto o EC. Sólo se encontró diferencias...
Using myocardial perfusion studies, severe coronary artery disease (CAD) with left ventricular dysfunction could be observed through transient cavity dilation and radiopharmaceutical lung uptake increase, described initially with stress 201Tl. Dipyridamole (DIP) induced ischemia also can diminish systolic function. Delayed post stress left ventricular ejection fraction (FEVI) may not be able to detect this phenomena, depending on the acquisition timing. There are diverse reports and results in this issue. Goal: Evaluate the correlation between left ventricular parameters and ischemia presence in early gated DIP tomography in patients referred for CAD evaluation along to review the new protocol difficulties.Methods: From 158 patients evaluated initially, 31% presenting extra-cardiac activity were excluded due to interference with automatic edge detection. The analyzed group included 109 subjects between 33 and 91 years, mean age 64.3 ± 11.7; 52% women. Thirty of them were known CAD patients; 18 with myocardial infarction and 31 with ischemia in perfusion images. 99mTc-Sestamibi SPECT was carried out during the 60 min post DIP infusion, using 1 day protocol. Cedars QGS QPS Programs were used to measure LVEF and left ventricular volumes. Diastolic transient ischemic dilation (TID) calculation was performed as well as lung/heart index (LHR). Results: The mean time lapse between DIP injection and acquisition was 27 min (range: 18-43 min). There was not significant difference between DIP and rest LVEF (66.55±17.33% vs 67.58±18.41%) LVEF delta was 1.03±6.72%. There was not correlation observed between measured functional parameters and presence of ischemia, infarction or known CAD. There was clear difference in left ventricular volumes in patients with and without CAD and known myocardial infarction. Conclusion: Nor association between LHR, LVEF delta or TID and ischemia was demonstrated in early post DIP...
