ABSTRACT
A 38-year-old white man had a 10-year history of human immunodeficiency virus (HIV) infection (A3), with no episodes of opportunistic diseases and in good immunologic recovery (CD4 cell count: 450 and indetectable HIV viral load) while on HAART. He presented with a two-month history of mild anal symptoms, including pruritus and episodic bleeding. He referred past episodes of anal warts, self-treated with several topical compounds, all proven unsuccessful. Perianal examination showed erythema and scratching. A 0.5cm sized tumor, with infiltration at the base was detected on digital exam, located at 15mm from the anal margin. Local biopsy driven by high-resolution anuscopy (AAR) yielded a final diagnosis of infiltrative epidermoid carcinoma. Might that neoplasia have been prevented?
Subject(s)
Anus Neoplasms/diagnosis , Carcinoma, Squamous Cell/diagnosis , HIV Infections/complications , Adult , Anal Canal/pathology , Antiretroviral Therapy, Highly Active/methods , Anus Neoplasms/pathology , Anus Neoplasms/virology , Biopsy , CD4 Lymphocyte Count , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/virology , Condylomata Acuminata/complications , HIV Infections/drug therapy , Humans , MaleABSTRACT
In the multi-criteria optimization approach to IMRT planning, a given dose distribution is evaluated by a number of convex objective functions that measure tumor coverage and sparing of the different organs at risk. Within this context optimizing the intensity profiles for any fixed set of beams yields a convex Pareto set in the objective space. However, if the number of beam directions and irradiation angles are included as free parameters in the formulation of the optimization problem, the resulting Pareto set becomes more intricate. In this work, a method is presented that allows for the comparison of two convex Pareto sets emerging from two distinct beam configuration choices. For the two competing beam settings, the non-dominated and the dominated points of the corresponding Pareto sets are identified and the distance between the two sets in the objective space is calculated and subsequently plotted. The obtained information enables the planner to decide if, for a given compromise, the current beam setup is optimal. He may then re-adjust his choice accordingly during navigation. The method is applied to an artificial case and two clinical head neck cases. In all cases no configuration is dominating its competitor over the whole Pareto set. For example, in one of the head neck cases a seven-beam configuration turns out to be superior to a nine-beam configuration if the highest priority is the sparing of the spinal cord. The presented method of comparing Pareto sets is not restricted to comparing different beam angle configurations, but will allow for more comprehensive comparisons of competing treatment techniques (e.g., photons versus protons) than with the classical method of comparing single treatment plans.
Subject(s)
Models, Theoretical , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/methods , Head and Neck Neoplasms/radiotherapy , HumansABSTRACT
One approach to multi-criteria IMRT planning is to automatically calculate a data set of Pareto-optimal plans for a given planning problem in a first phase, and then interactively explore the solution space and decide on the clinically best treatment plan in a second phase. The challenge of computing the plan data set is to ensure that all clinically meaningful plans are covered and that as many clinically irrelevant plans as possible are excluded to keep computation times within reasonable limits. In this work, we focus on the approximation of the clinically relevant part of the Pareto surface, the process that constitutes the first phase. It is possible that two plans on the Pareto surface have a small, clinically insignificant difference in one criterion and a significant difference in another criterion. For such cases, only the plan that is clinically clearly superior should be included into the data set. To achieve this during the Pareto surface approximation, we propose to introduce bounds that restrict the relative quality between plans, the so-called trade-off bounds. We show how to integrate these trade-off bounds into the approximation scheme and study their effects. The proposed scheme is applied to two artificial cases and one clinical case of a paraspinal tumor. For all cases, the quality of the Pareto surface approximation is measured with respect to the number of computed plans, and the range of values occurring in the approximation for different criteria is compared. Through enforcing trade-off bounds, the scheme disregards clinically irrelevant plans during the approximation. Thereby, the number of plans necessary to achieve a good approximation quality can be significantly reduced. Thus, trade-off bounds are an effective tool to focus the planning and to reduce computation time.
Subject(s)
Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted/instrumentation , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Intensity-Modulated/methods , Algorithms , Automation , Computer Simulation , Humans , Male , Models, Statistical , Prostatic Neoplasms/radiotherapy , Radiotherapy Dosage , Reproducibility of Results , Software , Spinal Neoplasms/radiotherapyABSTRACT
Highly active antirretroviral therapy has transformed the prognosis of patient infected with human immunodeficiency virus. The efficacy of these drugs has shifted the clinicians; attention to other therapeutic aspects like QD regimens, fixed dose combinations and clinical safety. Tenofovir disoproxil fumarate(TDF) is a nucleoside monophosphate (nucleotide) analogue that inhibits reverse trascriptase enzyme. It's administered in a q.d. regimen and it's recommended by most of the clinical guidelines as a start regimen in combination with two other drugs. Currently more than 5 years of clinical experience is accumulated and confirmed that a combination of tenofovir and a nonnucleoside analogue transcriptase inhibitor is a comfortable, safe, highly effective and low pill burden regimen.
Subject(s)
Adenine/analogs & derivatives , Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Reverse Transcriptase/antagonists & inhibitors , HIV/drug effects , Organophosphonates/therapeutic use , Reverse Transcriptase Inhibitors/therapeutic use , Adenine/administration & dosage , Adenine/adverse effects , Adenine/chemistry , Adenine/pharmacology , Adenine/therapeutic use , Anti-HIV Agents/administration & dosage , Anti-HIV Agents/adverse effects , Anti-HIV Agents/chemistry , Anti-HIV Agents/classification , Anti-HIV Agents/pharmacology , Antiretroviral Therapy, Highly Active , Clinical Trials, Phase III as Topic/statistics & numerical data , Double-Blind Method , Drug Resistance, Multiple, Viral/genetics , Drug Therapy, Combination , HIV/enzymology , HIV/genetics , HIV Protease Inhibitors/administration & dosage , HIV Protease Inhibitors/adverse effects , HIV Protease Inhibitors/therapeutic use , HIV Reverse Transcriptase/genetics , Humans , Multicenter Studies as Topic , Organophosphonates/administration & dosage , Organophosphonates/adverse effects , Organophosphonates/chemistry , Organophosphonates/pharmacology , Patient Acceptance of Health Care , Practice Guidelines as Topic , Randomized Controlled Trials as Topic/statistics & numerical data , Reverse Transcriptase Inhibitors/administration & dosage , Reverse Transcriptase Inhibitors/adverse effects , Reverse Transcriptase Inhibitors/chemistry , Reverse Transcriptase Inhibitors/pharmacology , Tenofovir , Treatment OutcomeSubject(s)
Magnesium Deficiency/complications , Seizures/etiology , Acquired Immunodeficiency Syndrome/complications , Adult , Amyloidosis/complications , Amyloidosis/pathology , Arthritis, Psoriatic/complications , Biopsy , Humans , Intestinal Diseases/complications , Intestinal Diseases/pathology , Intestinal Mucosa/pathology , Magnesium Compounds/therapeutic use , Magnesium Deficiency/blood , Magnesium Deficiency/drug therapy , Male , Seizures/blood , Seizures/drug therapy , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Male , Adult , Humans , Abdominal Abscess/diagnosis , Stomach Rupture/complications , Abdominal Abscess/etiology , Gastric Fundus , Low Back Pain , Stomach Rupture , Tomography, X-Ray ComputedSubject(s)
Churg-Strauss Syndrome/complications , Churg-Strauss Syndrome/diagnosis , Olfaction Disorders/diagnosis , Olfaction Disorders/etiology , Aged , Anti-Inflammatory Agents/therapeutic use , Churg-Strauss Syndrome/drug therapy , Diagnosis, Differential , Female , Humans , Indoles , Leukotriene Antagonists/therapeutic use , Phenylcarbamates , Steroids , Sulfonamides , Tosyl Compounds/therapeutic useABSTRACT
No disponible
Subject(s)
Aged , Female , Humans , Steroids , Splenomegaly , Tosyl Compounds , Churg-Strauss Syndrome , Osteoporosis , Leukotriene Antagonists , Olfaction Disorders , Anti-Inflammatory Agents , Diagnosis, Differential , Hepatitis C , LymphomaSubject(s)
Antiviral Agents/therapeutic use , Cryoglobulinemia/diagnosis , Cryoglobulinemia/etiology , Hepatitis C, Chronic/complications , Immunologic Factors/therapeutic use , Interferon-alpha/therapeutic use , Ischemia/complications , Leg/blood supply , Cyanosis/complications , Diabetes Mellitus, Type 2/complications , Hepatitis C, Chronic/drug therapy , Humans , Male , Middle AgedABSTRACT
La anemia se define como la disminución de la concentración de hemoglobina por debajo de unos límites considerados normales para un determinado grupo de individuos de la misma edad, sexo y condiciones medioambientales. La existencia de un síndrome anémico es uno de los problemas diagnósticos más frecuentes en la práctica clínica y, en ocasiones, puede resultar una tarea difícil. Con este trabajo se pretende proporcionar unas pautas a seguir en el estudio del paciente anémico (AU)
Subject(s)
Female , Male , Humans , Anemia/diagnosis , Anemia/classification , Anemia/etiology , Anemia/therapyABSTRACT
No disponible
Subject(s)
Middle Aged , Male , Humans , Immunologic Factors , Hepatitis C, Chronic , Interferon-alpha , Antiviral Agents , Cryoglobulinemia , Cyanosis , Leg , Ischemia , Diabetes Mellitus, Type 2ABSTRACT
La aterosclerosis es la principal causa de mortalidad en los países desarrollados y representa el 20 por ciento de la mortalidad global en el mundo. En los últimos años la investigación se ha centrado en aspectos etiopatogénicos encaminados a comprender mejor el fenómeno aterosclerótico y a encontrar posibles nuevas dianas terapéuticas. Paralelamente al desarrollo de la teoría de la inflamación se han encontrado diferentes asociaciones entre aterosclerosis y determinadas infecciones.En este trabajo se analizan las diferentes evidencias en favor y en contra de la asociación aterosclerosis e infección por medio de estudios seroepidemiológicos, patológicos, modelos animales y ensayos de intervención terapéutica (AU)
