ABSTRACT
Background: Background: Central Nervous System (CNS) relapse in Diffuse Large B-cell Lymphoma occurs mostly 6-8 months after disease onset. This has led to propose that CNS infiltration is an early event in the evolution of the disease. We intend to evaluate the role of magnetic resonance imaging (MR) at diagnosis to detect early SNC compromise. Methods: Prospective longitudinal cohort's study in DGCB patients treated at Hospital de Clínicas between 2013 and 2015. Skull MRI was performed in all patients at diagnosis and lumbar puncture was done according to predefined risk factors. Results: 35 patients were analyzed. Median age: 68 years (24-85 years). Stage III-IV: 62%, 57% good prognosis according to RIPI score and 43% poor prognosis. MRI was performed in all patients, with no pathological findings in any of them. Twenty-one patients fullfilled criteria for cerebrospinal fluid study. Twenty-two patients were studied and received intrathecal methotrexate prophylaxis. Meningeal relapse was observed in a single patient who had negative studies at diagnosis and had received complete prophylaxis at the end of the 6 R-CHOP series. Conclusions: Only one of the 35 patients relapsed in the CNS. This patient had a noral MRI and CSF study at diagnosis and had received prophylaxis with intrathecal chemotherapy. This results lead us to believe that the value of MRI to detect early infiltration in asymptomatic patients at diagnosis is low.
Antecedentes: la recaída en el Sistema Nervioso Central (SNC) del Linfoma No Hodgkin Difuso de Grandes Células B ocurre más frecuentemente 6-8 meses del debut de la enfermedad. Esto ha levado a plantear que la infiltración en SNC es un evento temprano en esta enfermedad. Nos proponemos evaluar el valor de la realización de estudio imagenológico por Resonancia Magnética (RM) al debut para detectar compromiso precoz. Materiales y métodos: Estudio longitudinal prospectivo de cohortes en LNH DGCB tratados en el Hospital de Clínicas entre 2013 y 2015. A todos los pacientes se les realizó RM de cráneo al debut y estudio de líquido cefaloraquídeo (LCR) según factores de riesgo predefinidos. Resultados: Se analizaron 35 pacientes. Mediana de edad: 68 años (24-85 años). Estadío III-IV: 62%; 57% presentaron buen pronóstico según score RIPI al debut y 43% mal pronóstico. Se realizó RM a todos los pacientes, no habiéndose encontrado hallazgos patológicos en ninguno de ellos. Veintitres pacientes tuvieron criterio de estudio del LCR de los cuales veintidós se estudiaron y recibieron profilaxis con metotrexate intratecal. Se observó recaída meníngea en una única paciente con estudios negativos al debut y profilaxis completa al mes de finalizadas las 6 series de R-CHOP. Conclusiones: De 35 pacientes uno sólo recayó en el SNC; el mismo había recibido profilaxis con quimioterapia intratecal y presentó una RM normal al debut de su enfermedad. Los resultados nos conducen a pensar que el valor de la RM para detectar precozmente infiltración en pacientes asintomáticos al debut es bajo.
Subject(s)
Central Nervous System Neoplasms/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Magnetic Resonance Imaging , Adult , Aged , Aged, 80 and over , Antineoplastic Agents, Immunological/therapeutic use , Central Nervous System Neoplasms/cerebrospinal fluid , Central Nervous System Neoplasms/drug therapy , Early Detection of Cancer/methods , Female , Humans , Longitudinal Studies , Lymphoma, Large B-Cell, Diffuse/cerebrospinal fluid , Lymphoma, Large B-Cell, Diffuse/drug therapy , Male , Middle Aged , Prospective Studies , Rituximab/therapeutic use , Skull Base/diagnostic imagingABSTRACT
Digital ischemia is associated with atherosclerotic, thromboembolic, or connective tissue diseases. Less often, it can be related to malignancy. Paraneoplastic vascular acrosyndromes (Raynaud's syndrome, acrocianosis, and acronecrosis) are associated with adenocarcinoma and less frequently with hematological malignancies. We report the case of a 45-year-old male, smoker, with a 10-day history of pain, cyanosis, and progressive digital necrosis in both hands. In the previous four months, he noticed painless mass in the right axillary gap, drenching night sweats, and weight loss. Physical examination at admission highlighted necrotic lesions on the distal phalanges of both hands (except the thumbs), enlarged lymph nodes in right axillary, and right supraclavicular gaps. Arteriography of upper limbs demonstrated a distal stop in all bilateral digital arteries. Digital ischemia was interpreted as a paraneoplastic phenomenon after other common etiologies were ruled out. Amputation of three phalanges was required due to necrosis. Biopsy of axillary nodes demonstrated nodular sclerosis classical Hodgkin's lymphoma (HL). The patient started conventional ABVD protocol (doxorubicin, bleomycin, vinblastine, and dacarbazine). After 6 cycles, he remained asymptomatic and symptoms of digital ischemia were completely resolved. It was concluded that the presence of acral vascular syndromes should alert the physician about the possibility of underlying malignant disease. Prompt investigation and treatment should be rapidly performed to avoid digital sequelae.
ABSTRACT
A insuficiência renal crônica consiste na perda progressiva e irreversível da função renal e representa hoje um grande problema de saúde pública. Neste sentido, este estudo objetivou descrever as condições sociodemográficas e de saúde de portadores de insuficiência renal crônica submetidos a tratamento hemodialítico no município de Jequié/BA. Trata-se de um estudo transversal, com amostra de 83 indivíduos em tratamento hemodialítico, sendo utilizado como instrumento de coleta de dados um formulário contendo questões sociodemográficas e de saúde. Os dados coletados foram organizados e processados no programa estatístico SPSS versão 13.0, sendo realizada análise estatística descritiva. Dos indivíduos avaliados a média de idade foi de 54,6 (+18,5) anos, sendo mais freqüente o sexo masculino (73,5%). As etiologias com maior distribuição da insuficiência renal foram doença policística, glomerulonefrite e diabetes mellitus. Em relação ao tempo de tratamento observou-se que a maioria dos indivíduos apresentava até um ano de tratamento hemodialítico, sendo 59,0% do sexo masculino e 59,1% do sexo feminino. As mulheres apresentaram maior prevalência de tabagismo (22,7%) do que os homens (21,3%); enquanto que os homens apresentaram maior prevalência de etilismo (16,4%) em relação as mulheres (13,6%). Desta forma, o presente estudo reforça a importância de ampliar trabalhos que visem conhecer o perfil dos pacientes com insuficiência renal a fim de buscar a melhoria da qualidade de vida desta população.
Chronic renal insufficience consists of the gradual and irreversible loss of the renal function and nowadays represents a great problem of public health. In this way, this study objectified to describe the sociodemographic and health conditions of carriers of chronic renal insufficience submitted to the hemodialic treatment in Jequié/BA city. It`s about a transverse study, with sample of 83 people in hemodialic treatment, being used as instrument of data collection a form with sociodemographic and health questions. The collected information was organized and processed in statistical program SPSS version 13.0, being carried through descriptive statistic analysis. From the evaluated people the age average was of 54.6 (+18.5) years, being more frequent the masculine sex (73.5%). The etiologies with more distribution of the renal insufficience had been policistic illness, glomerulusnefritis and mellitus diabetes. About treatment time, it was observed that the most of the people presented until one year of hemodialic treatment, being 59.0% of masculine sex and 59.1% of the feminine sex. The women presented more prevalence of tobaccoism (22.7%) than the men (21.3%); where as the men presented more prevalence of alcoholism (16.4%) in relation to the women (13.6%). In this way, the present study reinforces the importance to extend works that aim to know the profile of the patients with renal insufficience in order to search the improvement of the quality of life of this population.
