Multidisciplinary consensus on the criteria for fertility preservation in cancer patients.

Infertility is one of the main sequelae of cancer and its treatment in both children and adults of reproductive age. It is, therefore, essential that oncologists and haematologists provide adequate information about the risk of infertility and the possibilities for its preservation before starting treatment. Although many international clinical guidelines address this issue, this document is the first Spanish multidisciplinary guideline in paediatric and adult oncological patients. Experts from the Spanish Society of Medical Oncology, the Spanish Fertility Society, the Spanish Society of Haematology and Haemotherapy, the Spanish Society of Paediatric Haematology and Oncology and the Spanish Society of Radiation Oncology have collaborated to develop a multidisciplinary consensus.

Preliminary results of a vaginal constraint for reducing G2 late vaginal complications after postoperative brachytherapy in endometrial cancer: a prospective analysis.

PURPOSE: To evaluate the preliminary results of the use of 68 Gy EQD2(α/ß=3 Gy) as a dose limit to the lowest dose in the most exposed 2 cm3 of the vagina in order to reduce G2 late vaginal problems in postoperative endometrial carcinoma (EC). METHODS: From November 2016 to October 2019, 69 postoperative EC patients receiving vaginal brachytherapy (VBT) ± external beam radiotherapy (EBRT) were prospectively analyzed. The median EBRT dose was 45 Gy (range: 44-50.4 Gy), 1.8-2 Gy/day, 5 fractions(Fr)/week. VBT was administered with the following schedule: 1Fr of 7 Gy after EBRT and 2 daily Fr × 7.5 Gy in exclusive VBT. The dose was prescribed at 0.5 cm from the applicator surface with an active length of 2.5 cm; 56 patients were treated with vaginal cylinders (49-3.5 cm, 6-3 cm, and 1-2.5 cm) and 13 with the colpostat technique. The overall VBT dose was adjusted to meet the vaginal restriction of < 68 Gy EQD2(α/ß=3 Gy) at 2 cm3. Late toxicity was prospectively assessed using RTOG scores for bladder and rectum, and the objective LENT-SOMA criteria for vagina. RESULTS: With a median follow-up of 31.0 months, no vaginal-cuff recurrences were found. Late toxicity: only 1G1(1.4%) rectal toxicity; 21G1(30.4%) and 3G2(4.3%) vaginal complications. Only one (1.4%) of 3 G2 manifested as vaginal shortening. CONCLUSIONS: In postoperative EC patients treated with VBT, only one developed G2 vaginal stenosis with the use of 68 Gy EQD2(α/ß=3 Gy) as a dose constraint. These preliminary results seem to indicate the value of this dose limit for reducing G2 vaginal stenosis. Nonetheless, these findings should be confirmed in a larger number of patients with longer follow-up.

The role of brachytherapy (interventional radiotherapy) for primary and/or recurrent vulvar cancer: a Gemelli Vul.Can multidisciplinary team systematic review.

OBJECTIVE: The aim of our systematic review was to assess the role of interventional radiotherapy (IRT, brachytherapy) in the management of primary and/or recurrent vulvar carcinoma. EVIDENCE ACQUISITION: A systematic research using PubMed, Scopus and Cochrane library was performed. ClinicalTrials.gov was searched for ongoing or recently completed trials, and PROSPERO was searched for ongoing or recently completed systematic reviews. Only full-text English-language articles related to IRT for treatment of primary or recurrent VC were identified and reviewed. Conference paper, survey, letter, editorial, book chapter and review were excluded. Time restriction (1990-2018) as concerns the years of the publication was considered. EVIDENCE SYNTHESIS: Primary disease: the median 5-year LC was 43.5% (range 19-68%); the median 5-year DFS was 44.5% (range 44-81%); the median 5-year OS was 50.5% (range 27-85%). Recurrent disease: the median 5-year DFS was 64% (range 56-72%) and the median 5-year OS was 45% (range 33%-57%). Acute ≥ grade 2 toxicity was reported in three patients (1.6%). The severe late toxicity rates (grade 3-4) ranged from 0% to 14.3% (median 7.7%). CONCLUSION: IRT as part of primary treatment for primary and/or recurrent vulvar cancer is associated with promising clinical outcomes.

Radiotherapy is safe in patients with implantable cardiac devices. Analysis of a systematic interrogation follow-up.

INTRODUCTION: The number of patients who have a cardiac implantable electronic device (CIEDs) that undergo a course of radiotherapy is increasing due to the ageing population. The majority of clinical studies only evaluate any CIED malfunction at the end of a course of irradiation or in a case of there being symptoms of possible malfunction. As a result, little data has been collected on CIED status acquired during an active course of irradiation. MATERIAL AND METHODS: We aimed to evaluate the correct functioning of a CIED during a course of radiotherapy. So, a retrospective analysis was made of all patients having CIEDS in a single institution during their course of radiotherapy. All CIEDs were systematically checked before and during the course of radiotherapy according to the risk of device failure and patient dependence. RESULTS: Data was analysed from 56 patients (43 men, 13 women) with a mean age of 78.2 years, of whom 87.5% of the patients carried a pacemaker (PM), the 39% of the patients were PM dependent, and the remaining patients carried an implantable cardioverter-defibrillator (ICD). An observable dose of irradiation was evident in only 10 cases. 69.1% of the CIEDs were checked daily and the remainder were checked weekly. During the radiotherapy course, 82% of the patients did not complain of any cardiological event. The CIED of five patients experienced an increase in the threshold and, in another case, a sudden reduction in the duration of the battery was reported. Another patient with a CIED experienced a cardiac insufficiency episode triggered by a ventricular tachycardia. CONCLUSION: In conclusions, although adverse clinical events from exposure of a CIED to irradiation are rare, they can appear in any group of risk. No dose-dependency was observed on the malfunction of the CIED.

Is one brachytherapy fraction of 7 Gy similar to more fractions after external beam irradiation in postoperative endometrial carcinoma?

PURPOSE: To determine whether brachytherapy with a single hypofractionated dose of 7 Gy provides the similar vaginal-cuff relapses and safety profile in terms of complications compared to schedules of 2 or 3 fractions of lower doses in patients treated previously with external beam irradiation in postoperative endometrial carcinoma. METHODS/MATERIAL: From June 2003 to December 2016, 325 patients were treated with 3 different schedules of high-dose-rate brachytherapy after external beam irradiation for postoperative endometrial carcinoma. The patients were divided into 3 groups: Group-1: 125 patients were treated with 3 fractions of 4-6 Gy per fraction (3 fractions/week) between 2003 and 2008; Group-2: 93 patients were treated with 2 consecutive daily fractions of 5-6 Gy between 2008 and 2011; Group-3: 107 patients received a single fraction of 7 Gy between 2011 and 2016. Bladder and rectum complications were assessed using RTOG scores and with the objective scores of LENT-SOMA for the vagina. STATISTICS: the chi-square test. RESULTS: The mean follow-up of Groups 1, 2 and 3 was 95, 67 and 51 months, respectively. Three patients in Group-1, 2 in Group-2, 1 in Group-3 developed vaginal-cuff relapse (p = 0.68). No differences were found in late toxicity among the three groups. CONCLUSIONS: One single dose of 7 Gy is safe and effective and may be the best treatment schedule with a similar incidence of vaginal-cuff relapses, complications and patient comfort with less hospital attendance.

Are endometrial cancer radiotherapy results age related?

OBJECTIVE: To analyze the impact of age on radiotherapy results based on cancer-specific survival (CSS), vaginal-cuff relapses (VCR) and complications analysis in 438 patients with endometrial carcinoma (EC) receiving postoperative radiotherapy (PRT) divided into three age groups for analysis. MATERIALS AND METHODS: From 2003 to 2015, 438 patients with EC were treated with PRT and divided into three age groups: Group-1: 202 patients < 65 years; Group-2: 210 patients ≥ 65 and < 80 years; Group-3: 26 patients ≥ 80 years. Vaginal toxicity was assessed using the objective LENT-SOMA criteria and RTOG scores were recorded for the rectum, bladder, and small bowel. STATISTICS: Chi square and Student's t tests, Kaplan-Meier survival study for analysis of CSS. RESULTS: The mean follow-up was 5.6 years in Group-1, 5.6 years in Group-2 and 6.3 years in Group-3 (p = 0.38). No differences were found among the groups in distribution of stage, grade, myometrial invasion, Type 1 vs. 2 EC and VLSI (p = 0.97, p = 0.52, p = 0.35, p = 0.48, p = 0.76, respectively). There were no differences in rectal, bladder and vagina late toxicity (p = 0.46, p = 0.17, p = 0.75, respectively). A better CSS at 5 years was found in Group-1 (p = 0.006), and significant differences were found in late severe small bowel toxicity in Group-3 (p = 0.005). VCR was increased in Group-3 (p = 0.017). CONCLUSIONS: Patients ≥ 65 years had a worse outcome in comparison to younger patients. Late vaginal, rectal and bladder toxicities were similar in the three groups, although an increase of severe late small bowel toxicity led to IMRT in patients ≥ 80 years. Further larger studies are needed including quality of life analysis in patients ≥ 80 years.

Recommendations of the Spanish brachytherapy group (GEB) of Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for high-dose rate (HDR) non melanoma skin cancer brachytherapy.

Clinical indications of brachytherapy in non-melanoma skin cancers, description of applicators and dosimetry recommendations are described based on the literature review, clinical practice and experience of Spanish Group of Brachytherapy and Spanish Society of Medical Physics reported in the XIV Annual Consensus Meeting on Non Melanoma Skin Cancer Brachytherapy held in Benidorm, Alicante (Spain) on October 21st, 2016. All the recommendations for which consensus was achieved are highlighted in blue. Regular and small surfaces may be treated with Leipzig, Valencia, flap applicators or electronic brachytherapy (EBT). For irregular surfaces, customized molds or interstitial implants should be employed. The dose is prescribed at a maximum depth of 3-4 mm of the clinical target volume/planning target volume (CTV/PTV) in all cases except in flaps or molds in which 5 mm is appropriate. Interstitial brachytherapy should be used for CTV/PTV >5 mm. Different total doses and fraction sizes are used with very similar clinical and toxicity results. Hypofractionation is very useful twice or 3 times a week, being comfortable for patients and practical for Radiotherapy Departments. In interstitial brachytherapy 2 fractions twice a day are applied.

Vaginal-cuff control and toxicity results of a daily HDR brachytherapy schedule in endometrial cancer patients.

PURPOSE: To analyze the vaginal-cuff local control (VCC) and toxicity in postoperative endometrial carcinoma patients (EC) underwent high-dose-rate brachytherapy (HDR-BT) administered daily. MATERIALS AND METHODS: 154 consecutive patients received postoperative HDR-BT for EC from January 2007 to September 2011. FIGO-staging I-IIIC2 patients were divided into two groups according to risk classification: Group 1 (94/154) included high-risk or advanced disease patients and Group 2 (60/154) included intermediate-risk EC patients. Group 1 underwent external beam irradiation (EBI) plus HDR-BT (2 fractions of 5 Gy) and Group 2 underwent HDR-BT alone (4 fractions of 5 Gy). Toxicity evaluation was done with RTOG scores for bladder and rectum, and the objective criteria of LENT-SOMA for vagina. RESULTS: With a median follow-up of 46.7 months (36.6-61 months) only two patients developed vaginal-cuff recurrence in Group 1 (2.1 %) and none in group 2 (0 %). Early toxicity in Group 1 appeared 5.3 % in rectum, 7.5 % in bladder (G1-G2) and 2.1 % in vagina (G1); late toxicity was present in 7.3 % in rectum (all G1-G2 but 1 G3) and in 27.7 % in vagina (all G1-G2 but one G4). In Group 2, 6.7 % developed acute G1-G2 bladder and 6.6 % acute vaginal (G1-G2) toxicity. No late rectal or bladder toxicity was observed; 21.7 % of G1-G2 presented late problems in vagina. CONCLUSIONS: The present HDR-BT schedule of 2 fractions of 5 Gy after EBI and 4 fractions of 5 Gy administered daily showed excellent results in terms of VCC and toxicity.

Recommendations of the Spanish Brachytherapy Group of SEOR for HDR endoluminal treatments. Part 1: Oesophagus.

The endoesophageal brachytherapy technique provides good results in the treatment of oesophageal cancer, when indicated. In a consensus meeting, the Spanish Brachytherapy Group of SEOR and the Spanish Society of Medical Physics (SEFM) agreed on the indications, dose, fractionation schedule, prescription and reporting to be performed in endoesophageal brachytherapy. The results of this consensus are presented here as recommendations for medical practice.

Three or four fractions per week in postoperative high-dose-rate brachytherapy for endometrial carcinoma. The long-term results on vaginal relapses and toxicity.

BACKGROUND: High-dose-rate brachytherapy (HDR-BT) is an accepted part of treatment for endometrial carcinoma and is usually performed in 1-2 fractions per week using different total doses and doses per fraction. To reduce the overall treatment time, HDR-BT was administered with a 3-4 days/week schedule. PATIENTS AND METHODS: From June 2003 to December 2008, 164 patients with stage I-IIIc endometrial carcinoma were treated with HDR-BT (4-5 Gy per fraction). The patients were divided into two groups; Group 1 (40/164 patients) was treated with HDR-BT alone (6 fractions; 4 fractions/week) and Group 2 (124/164 patients) was treated with both (External Beam Radiotherapy [EBRT] + HDR-BT: 3 fractions/week). Complications were analyzed using RTOG scores for rectum and bladder and the objective scores of LENT-SOMA for vaginal complications. RESULTS: The mean followup was 48 months. In Group 1, 35 % of patients underwent treatment in ≤10 days and 65 % in >10 days. In Group 2, 53.2 % received treatment in ≤5 days and in 46.8 % in >5 days. Vaginal relapse was observed in only two patients (1.2 %), both having received adjuvant EBRT + HDR-BT. Acute vaginal toxicity appeared in 8.5 % and late vaginal toxicity in 20.7 % of patients with 13.4 % being G1, 6.7 % G2 and only 0.6 % being G4. No statistically significant differences were found in complications in either brachytherapy group regardless of the overall time. CONCLUSION: In our series, three fractions given in 3-5/days after EBRT or six fractions in 10 days, is a safe regimen in terms of complications and local control.

Impacto del marketing de alimentos y bebidas dirigido a niños en Argentina / Impact of marketing of food and beverages intended for children in Argentina

INTRODUCCIÓN El sobrepeso y la obesidad en niños están creciendo en Argentina, lo que impactará en la ocurrencia de enfermedades en el mediano plazo. Uno de los determinantes del consumo de alimentos y bebidas altos en calorías, grasas saturadas, sodio y azúcares refinados es el marketing de alimentos orientado a la población infantil. OBJETIVOS Describir la situación actual de la promoción de alimentos orientados a niños en Argentina. MÉTODOS Se desarrolló una investigación descriptiva, cuantitativa y cualitativa, que abordó tres aspectos: relevamiento del marco regulatorio y legislación a nivel nacional; monitoreo de 402 horas de canales de cable y aire con programación infantil; y categorización de las publicidades de alimentos emitidas según tipo, perfil nutricional y técnicas de persuasión empleadas. Para evaluar la percepción materna, se realizaron entrevistas en profundidad. RESULTADOS Se observó la ausencia de normativas claras y precisas, con criterios nutricionales, para regular la publicidad de alimentos dirigida al público infantil. El 20,9% de las publicidades emitidas en el horario infantil correspondió a alimentos (en promedio: 0,68±0,36 minutos/hora). Los lácteos, golosinas y comidas rápidas fueron los alimentos con mayor presencia. Los elementos de persuasión más utilizados fueron diversión, felicidad, fantasía, imaginación, palatabilidad, novedad, jingles y personajes. En general, las madres mostraron preocupación por la publicidad de alimentos no saludables y coincidieron en que el envoltorio, las promociones y la utilización de personajes conocidos es un incentivo para la adquisición de ciertos alimentos. DISCUSIÓN Dada la mayor prevalencia de sobrepeso evidenciada durante los últimos años en la población infantil en Argentina, el campo de la publicidad dirigida a niños presenta una oportunidad para mejorar la oferta de alimentos saludable.

Consensus on treatment of endometrium carcinoma with brachytherapy.

Radiotherapy (RT) is commonly used as adjuvant treatment following hysterectomy and double oophorectomy in endometrial carcinoma. Prophylactic vaginal brachytherapy (BT) is the most common treatment in BT units. The PORTEC and GOG 99 studies have attempted to clarify the indications of BT and postoperative external RT, changing treatment standards. However, prophylactic BT regimens are very varied and there is currently no consensus on how to treat patients in terms of dose per fraction and number of fractions. Moreover, unoperated cases of endometrium are uncommon and there is limited experience in their treatment with BT. The 9th Consensus Meeting of the SEOR and SEFM Brachytherapy Group, held in Malaga on 11 March 2011, was therefore dedicated to "Brachytherapy in Endometrial Carcinoma". This article presents the consensus on treatment of endometrial carcinoma in operated (prophylactic vaginal BT) and unoperated (endouterine BT) patients.

Primary neuroendocrine small cell undifferentiated carcinoma of the parotid gland.

Neuroendocrine small cell carcinoma is a malignant neoplasm that most frequently arises in the lung. Salivary gland involvement is rare, and the parotid is the main gland affected. We describe the fine-needle aspiration (FNA) cytology findings, the immunophenotypical study and the differential diagnosis of a small cell carcinoma that presented in the parotid of a 91-year-old man. The tumour was treated only with radiotherapy and presented a complete response, with no evidence of the disease after three years of follow-up. This is the first case reported in the literature with good outcome after exclusive irradiation.

Acidos grasos trans: actualización y situación Argentina / Trans greasy acids: update and situation in Argentina

La hidrogenación biológica de los rumiantes o la industrial producen isomerización de los ácidos grasos que componen la grasa, pudiéndose formar isómeros trans. Se ha postulado que una dieta alta de estos isómeros puede ser un riesgo para la salud, aunque no se conocen con certeza las consecuencias de su ingesta. Existen numerosos estudios epidemiológicos que asocian el consumo de ácidos grasos trans con riesgos como: aumento del colesterol LDL y disminución del HDL, aumento del riesgo de enfermedad coronaria, aumento del la Lp(a), aumento de la probabilidad de padecer cáncer de mama y de colon, la interferencia en el metabolismo de los ácidos grasos esenciales y también se cree que pueden comprometer el desarrollo fetal e infantil. En varios países se ha disminuído el consumo de isómeros trans mediante la reducción del contenido de los mismos en margarinas (una de las principales fuentes de trans) pero no así en productos alimenticios industriales. La ingesta estimada de AG trans para EE.UU. es de 5,3 - 8,1 g/día y en Europa de 1,4 - 5,4 g/día. Hasta nuestro conocimiento, en la Argentina todavía no hay datos de ingesta de AG trans como así tampoco información sobre el contenido de éstos en los alimentos. En este trabajo se incluyen los resultados de análisis realizados en algunos alimentos potenciales fuentes de AG trans y datos sobre su contenido en leche materna como reflejo de su consumo. Los valores más altos fueron hallados en las margarinas (19 a 9,5 g por ciento), mientras que papas fritas de "fast food" contenían 6,5 g por ciento y algunos panificados con 0,1 a 3,6 g por ciento. En la leche materna se halló que un 2,5 g por ciento del total de ácidos grasos se hallaban en forma de isómeros trans (AU)

Acidos grasos trans: actualización y situación Argentina / Trans greasy acids: update and situation in Argentina

La hidrogenación biológica de los rumiantes o la industrial producen isomerización de los ácidos grasos que componen la grasa, pudiéndose formar isómeros trans. Se ha postulado que una dieta alta de estos isómeros puede ser un riesgo para la salud, aunque no se conocen con certeza las consecuencias de su ingesta. Existen numerosos estudios epidemiológicos que asocian el consumo de ácidos grasos trans con riesgos como: aumento del colesterol LDL y disminución del HDL, aumento del riesgo de enfermedad coronaria, aumento del la Lp(a), aumento de la probabilidad de padecer cáncer de mama y de colon, la interferencia en el metabolismo de los ácidos grasos esenciales y también se cree que pueden comprometer el desarrollo fetal e infantil. En varios países se ha disminuído el consumo de isómeros trans mediante la reducción del contenido de los mismos en margarinas (una de las principales fuentes de trans) pero no así en productos alimenticios industriales. La ingesta estimada de AG trans para EE.UU. es de 5,3 - 8,1 g/día y en Europa de 1,4 - 5,4 g/día. Hasta nuestro conocimiento, en la Argentina todavía no hay datos de ingesta de AG trans como así tampoco información sobre el contenido de éstos en los alimentos. En este trabajo se incluyen los resultados de análisis realizados en algunos alimentos potenciales fuentes de AG trans y datos sobre su contenido en leche materna como reflejo de su consumo. Los valores más altos fueron hallados en las margarinas (19 a 9,5 g por ciento), mientras que papas fritas de "fast food" contenían 6,5 g por ciento y algunos panificados con 0,1 a 3,6 g por ciento. En la leche materna se halló que un 2,5 g por ciento del total de ácidos grasos se hallaban en forma de isómeros trans

Factores de riesgo para la salud y la situación nutricional de los adolescentes urbanos en Argentina / Fatores de risco para a saúde e estado de nutriþõo de adolescentes urbanos na Argentina / Factors of risk for the health and the nutricional situation of the urban adolescents

Se estudiaron 386 adolescentes sanos (58 porciento hombres y 42 porciento mujeres) de la población que concurrió espontaneamente al Servicio de Adolescencia del Hospital Argerich. Las encuestas de hábitos de vida, alimentaria, sacioeconómica y estudios bioquímicos mostraron que 8,5 porciento fumaban regularmente y 3,5 porciento esporádicamente. Del total, 7,6 porciento presentó colesterolemias elevadas (especialmente en el NSE alto), 6 porciento LDL elevado y 10 porciento HDL bajo(AU)

Factores de riesgo para la salud y la situación nutricional de los adolescentes urbanos en Argentina / Fatores de risco para a saúde e estado de nutriçäo de adolescentes urbanos na Argentina / Factors of risk for the health and the nutricional situation of the urban adolescents

Se estudiaron 386 adolescentes sanos (58 porciento hombres y 42 porciento mujeres) de la población que concurrió espontaneamente al Servicio de Adolescencia del Hospital Argerich. Las encuestas de hábitos de vida, alimentaria, sacioeconómica y estudios bioquímicos mostraron que 8,5 porciento fumaban regularmente y 3,5 porciento esporádicamente. Del total, 7,6 porciento presentó colesterolemias elevadas (especialmente en el NSE alto), 6 porciento LDL elevado y 10 porciento HDL bajo

Perfil de absorción de ácidos grasos en la enfermedad celiaca / Fatty acid absortion pofile in celiac disease

La enfermedad celíaca (EC) provoca un déficit en la absorción de nutrientes, siendo la mala absorción de grasas, una de las primeras manifestaciones. El objetivo de este estudio es describir el patrón de absorción de los distintos ácidos grasos (AG) en niños celíacos con esteatorrea. Se seleccionaron 37 niños con síntomas compatibles con E.C. Fueron instruidos para la realización de una dieta con una distribución de grasas de distinta longitud y grado de saturación: 25 por ciento TCM (triglicéridos de cadena media) y 75 por ciento TCL (triglicéridos de cadena larga; 32 por ciento saturados; 25 por ciento monoinsaturados; 18 por ciento poliinsaturados). El plan alimentario y el registro de consumo fueron realizados durante los 5 días previos a la biopsia intestinal, y en los últimos 3 días se indicó la recolección de todas las deposiciones. Se calculó la ingesta de grasas con diferenciación del tipo de ácido graso. A todos los pacientes se les realizó la biopsia de intestino delgado para confirmar diagnóstico. Se obtuvieron 22 biopsias compatibles con EC, siendo 15 de los niños inclidos en el estudio (12 fem.- 3 masc.), con edades comprendidas entre los 10 m y 5 a 4 m (Me: 25 m). El análisis de los ácidos grasos fecales se efectuó por el método de Lepage y Roy, por cromatografía gas líquido con columna megabore DB-WAX. Los valores se expresaron como Media y Desvió Standard. Los coeficientes de absorción fueron: grasas totales 88.8 por ciento ( más menos 7.3); TCM 99.5 por ciento (más menos 0.7); TCL 84.9 por ciento ( más menos 12.9); A.G. saturados 75 por ciento (más menos 26.5) A.G. monoinsaturados 89.6 por ciento (más menos 14.2); AG poliinsaturados 97.1 por ciento ( más menos 3.9). Los porcentajes de absorción más elevados se encontraron en los TCM y en los A. G. poliinsaturados. La dieta en la E.C debe privilegiar el consumo de las grasas que mostaron ser eficientemente absorbidas.

Factores de riesgo para la salud y la situacion nutricional de los adolescentes urbanos en Argentina / Factores de riesgo para la salud y la situacion nutricional de los adolescentes urbanos en Argentina

Foram estudados 386 adolescentes sadios (58 por cento do sexo masculino e 42 por cento do sexo feminino) de uma populacao que procurou espontaneamente o Servico de Adolescencia do Hospital Argerich. O levantamento de estilos de vida, habitos alimentares, condicao socio-economica e estudos bioquimicos mostrou que: 8,5 por cento fumavam regularmente e 3,5 por cento experimentaram eventualmente. Dos adolescentes estudados, 95 por cento desconheciam os riscos relacionados com o fumo. Do total, 7,6 por cento apresentaram hipercolesterolemia (especialmente no grupo de Nivel Socio-Economico - NSE - elevado), 6 por cento com LDL alto e 10 por cento com HDL baixo. Entre os homens 18 por cento e entre as mocas 52 por cento nao realizavam nenhum tipo de atividade fisica sistematica (P < 0.01) e os adolescentes com NSE baixo aplicaram significativamente menor quantidade de energia a atividade fisica (541 Kcal/dia mais ou menos 660 Kcal/dia) comparados com aqueles que apresentavam NSE medio (885 Kcal/dia mais ou menos 1.088 Kcal/dia) e com os que apresentavam NSE alto (948 Kcal/dia mais ou menos 1.044 Kcal/dia) (p < 0.05). Do total, 30 por cento gastavam mais de 4 horas assistindo televisao e 6 por cento apresentaram atraso cronico do crescimento; 19,1 por cento das mulheres e 13,3 por cento dos homens eram obesos. A ingestao calorica media foi de 2.697 mais ou menos 1099 Kcal/dia (gorduras 32 por cento mais ou menos 10 por cento, gorduras saturadas 13 por cento mais ou menos 5 por cento). A ingestao de gorduras e de gorduras saturadas foi significativamente maior naqueles com NSE mais elevado. A metade dos adolescentes nao atingia os niveis recomendaveis de vitamina A e de ferro, 40 por cento de vitamina C e 91 por cento de calcio. A concentracao de retinol foi de 34,1 mais ou menos 9,8 ug/dl, com diferencas de acordo com o estagio puberal, e 3,5 por cento apresentaram deficit de vitamina A. Das mulheres 12,1 por cento e dos homens 8,1 por cento apresentaram anemia. Conclui-se que os adolescentes urbanos apresentam riscos relacionados a elevada prevalencia de obesidade, escassa atividade fisica, em especial nas classes socio-economicas mais baixas, uma alimentacao com alto teor de gorduras, especialmente saturadas, e baixo teor de ingestao de alguns micronutrientes tais como o calcio, o ferro e a vitamina C, deficiencia de ferro e vitamina A e alta prevalencia de fatores de risco cardiovascular, passiveis de modificacao com mudancas no estilo de vida.

Planeación con tomografía computada de los tratamientos con radioterapia en los cánceres de cabeza y cuello / Planning with computariced tomography of the treatment with radiotherapy in head and neck tumors

Los tratamientos con radioterapia de los tumores cerebrales y del área otorrinolaringológica requieren de la correcta localización del volumen tumoral y de los tejidos críticos sanos adyacentes incluidos en el volumen anatómico a irradiar. También es esencial poder obtener una buena reproductibilidad diaria del tratamiento. La planeación a través de tomografía computada permite lograr estos objetivos. Actualmente es uno de los escasos procedimientos que aseguran un exacto conocimiento de la distribución de la dosis en el volumen tumoral y en los órganos críticos sanos. De igual forma, contribuye al control de calidad de la radioterapia y, el permitir una mejor planeación del tratamiento, permite conseguir una óptima respuesta antitumoral y disminuir la toxicidad radioinducida en los tejidos sanos peritumorales