RESUMEN
Peter Hispanus, who became Pope John XXI, wrote a book about eye diseases and their treatment in the 13th century. De Oculis was not a scholarly treatise about eye diseases, but a manual intended for general physicians. Nevertheless, Latin copies were made into the 16th century, indicating its influence and importance. We present the first published English translation of De Oculis, based on a synthesis of the medieval Latin manuscripts and a German translation from the 19th century. The sources of Peter's understanding of the causes and treatment of eye diseases were the more scholarly and complete treatises by Greek and Arab writers. Many of the diseases described then cannot be correlated precisely with ophthalmic disorders known to us today because of the limited understanding of anatomy, function and pathophysiology that existed. However, De Oculis provides us with a glimpse of the practice of medicine in the Middle Ages.
Asunto(s)
Oftalmopatías/historia , Historia Medieval , Manuscritos como Asunto/historia , Oftalmología/historia , EspañaRESUMEN
OBJECTIVE: To analyze the effects of 5-fluorouracil (5-FU) chemotherapy combined with preoperative irradiation and the role of intraoperative electron beam irradiation (IOERT) on the outcome of patients with primary locally advanced rectal or rectosigmoid cancer. METHODS: From 1978 to 1996, 145 patients with locally advanced rectal cancer underwent moderate- to high-dose preoperative irradiation followed by surgical resection. Ninety-three patients received 5-FU as a bolus for 3 days during the first and last weeks of radiation therapy (84 patients) or as a continuous infusion throughout irradiation (9 patients). At surgery, IOERT was administered to the surgical bed of 73 patients with persistent tumor adherence or residual disease in the pelvis. RESULTS: No differences in sphincter preservation, pathologic downstaging, or resectability rates were observed by 5-FU use. However, there were statistically significant improvements in 5-year actuarial local control and disease-specific survival in patients receiving 5-FU during irradiation compared with patients undergoing irradiation without 5-FU. For the 73 patients selected to receive IOERT, local control and disease-specific survival correlated with resection extent. For the 45 patients undergoing complete resection and IOERT, the 5-year actuarial local control and disease-specific survival were 89% and 63%, respectively. These figures were 65% and 32%, respectively, for the 28 patients undergoing IOERT for residual disease. The overall 5-year actuarial complication rate was 11%. CONCLUSIONS: Treatment strategies using 5-FU during irradiation and IOERT for patients with locally advanced rectal cancer are beneficial and well tolerated.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Fluorouracilo/uso terapéutico , Neoplasias del Recto/terapia , Neoplasias del Colon Sigmoide/terapia , Análisis Actuarial , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Supervivencia sin Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Radioterapia Adyuvante/efectos adversos , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Neoplasias del Recto/cirugía , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/radioterapia , Neoplasias del Colon Sigmoide/cirugía , Análisis de Supervivencia , Resultado del TratamientoAsunto(s)
Historia Medieval , Oftalmopatías/historia , Oftalmopatías/terapia , Humanos , Oftalmología/historia , EspañaRESUMEN
PURPOSE: This study examines the changes of serum levels of CA 19-9 in patients with pancreatic cancer following neoadjuvant irradiation and chemotherapy to define the potential role of this tumor marker in preoperative management of these patients. MATERIALS AND METHODS: Serum CA 19-9 levels were measured in 42 patients before receiving external beam irradiation with concurrent 5-fluorouracil in preparation for laparotomy and Whipple procedure or intraoperative irradiation (IORT). The CA 19-9 levels were determined again after irradiation, and changes were correlated with findings of restaging computed tomography (CT) scan and laparotomy. RESULTS: Following preoperative irradiation, 10 patients (24%) experienced an increase in CA 19-9 levels whereas 29 patients (69%) showed a decrease in CA 19-9. There was no change in the CA 19-9 levels of 3 patients (7%) after treatment. Of the 10 patients with increased CA 19-9 levels after irradiation, 9 (90%) had developed distant metastases or local tumor progression as determined by restaging CT scan or at laparotomy. In contrast, only 6 of 29 patients (21%) with declining CA 19-9 levels after irradiation demonstrated metastases or local tumor progression on restaging CT scan or at laparotomy. The correlation of CA 19-9 increase or decrease with disease progression or control, respectively, was statistically significant (P = 0.009). CONCLUSIONS: Serum CA 19-9 levels may rise or fall during neoadjuvant therapy. A rising CA 19-9 reliably indicates cancer progression while a falling CA 19-9 connotes disease control in the majority of patients. In developing strategies for application of neoadjuvant therapy for pancreatic cancer, monitoring of CA 19-9 appears most useful for the identification of patients who manifest progressive tumor growth and metastasis in spite of this treatment.
Asunto(s)
Biomarcadores de Tumor/sangre , Antígeno CA-19-9/sangre , Neoplasias Pancreáticas/sangre , Neoplasias Pancreáticas/terapia , Adulto , Anciano , Terapia Combinada , Femenino , Fluorouracilo/uso terapéutico , Humanos , Laparotomía , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/secundario , Dosificación Radioterapéutica , Resultado del TratamientoRESUMEN
A total of 37 cases of ovarian primary squamous cell carcinoma (SCC)-19 associated with a dermoid cyst (SCCD), seven associated with endometriosis (SCCE), and 11 pure (SCCP)-are described. The last 18 cases belong within the new World Health Organization category of SCC in the surface epithelial-stromal category. The 19 patients with SCCD were 21-75 (mean, 52) years old; three of the carcinomas were in situ and seven, six, and three tumors were stages I, II, and III, respectively. The tumors and associated dermoid cysts were 6-35 cm in greatest dimension, usually forming mural nodules with intracavitary protrusion and focal necrosis and hemorrhage; two, seven, and seven tumors were grades 1, 2, and 3, respectively. SCCD was focally associated with a columnar epithelial cyst lining in 13 cases, suggesting an origin therein. One patient with stage I, grade 1 SCCD also had squamous cell carcinoma in situ (CIS) of the cervix. The seven patients with SCCE were 29-70 (mean, 49) years old, and one, three, one, and two tumors were stages I, II, III, and IV, respectively; all of the tumors were grade 3. One was associated with squamous cell carcinoma in situ of the cervix. The 11 patients with SCCP were 27-73 (mean, 56) years old, and one, four, five, and one tumors were stages I, II, III, and IV, respectively. The tumors were 6-26 cm in greatest diameter, usually solid with focal necrosis; one and 10 tumors were grades 2 and 3, respectively. Three patients with SCCP also had cervical squamous cell carcinoma in situ. The patients with SCCE had a poorer overall survival than those with SCCD. Five of the six patients with SCCE for whom adequate follow-up information was available died of their disease (mean survival, 5 months); also, in all five cases of SCCE reported in the literature, the patients died of their disease (mean survival, 4 months). The stage of the tumor and its grade correlated best with overall survival for all three types of SCC.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias Ováricas/patología , Adulto , Anciano , Carcinoma in Situ/mortalidad , Carcinoma in Situ/patología , Carcinoma de Células Escamosas/mortalidad , Quiste Dermoide/mortalidad , Quiste Dermoide/patología , Endometriosis/mortalidad , Endometriosis/patología , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Necrosis , Estadificación de Neoplasias , Neoplasias Ováricas/mortalidad , Pronóstico , Tasa de SupervivenciaRESUMEN
PURPOSE: This study examines the effect of preoperative irradiation on tumor proliferation in rectal cancer. PATIENTS AND METHODS: One hundred twenty-two patients with locally advanced rectal cancer received 45 to 50 Gy of preoperative irradiation followed by surgery. Pretreatment tumor biopsies and postirradiation surgical specimens were scored for proliferative activity by assaying the extent of Ki-67 and proliferating-cell nuclear antigen (PCNA) immunostaining and the number of mitoses per 10 high-power fields (hpf). Preirradiation and postirradiation proliferative activity was determined and correlated to clinical outcome. RESULTS: There was an overall reduction in the tumor proliferative activity of rectal cancer after irradiation compared with its preirradiation state. Decreases in the activity of all three markers of tumor proliferation (Ki-67 and PCNA immunostaining, and mitotic counts) were observed in irradiated tumors compared with pretreatment biopsies. Postirradiation tumor proliferative activity was associated with pathologic tumor stage. A high level of proliferative activity was observed in tumors downstaged to the rectal wall (T1-2) compared with tumors that retained transmural penetration (T3-4). Multivariate analysis indicated that postirradiation proliferative activity and stage were independently associated with survival following surgery. Patients with tumors that exhibited elevated proliferative activity postirradiation had improved survival compared with patients with tumors that showed less proliferative activity. CONCLUSION: Moderate- to high-dose preoperative irradiation decreases both the tumor size and proliferative activity of rectal cancers. Elevated postirradiation tumor proliferative activity correlates strongly with improved survival. This may aid in identifying high-risk patients following preoperative irradiation and surgery.
Asunto(s)
Proteínas de Neoplasias/análisis , Proteínas Nucleares/análisis , Antígeno Nuclear de Célula en Proliferación/análisis , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , División Celular/efectos de la radiación , Supervivencia sin Enfermedad , Femenino , Humanos , Antígeno Ki-67 , Masculino , Persona de Mediana Edad , Mitosis , Estadificación de Neoplasias , Neoplasia Residual , Cuidados Preoperatorios , Neoplasias del Recto/química , Neoplasias del Recto/mortalidadAsunto(s)
Enfermedades Pulmonares Obstructivas/fisiopatología , Antibacterianos/uso terapéutico , Asma/complicaciones , Asma/fisiopatología , Bronquitis/complicaciones , Bronquitis/fisiopatología , Broncodilatadores/uso terapéutico , Enfisema/complicaciones , Enfisema/fisiopatología , Cardiopatías/complicaciones , Hospitalización , Humanos , Pulmón/fisiopatología , Enfermedades Pulmonares Obstructivas/complicaciones , Enfermedades Pulmonares Obstructivas/diagnóstico , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Enfermedades Pulmonares Obstructivas/prevención & control , Enfermedades Pulmonares Obstructivas/terapia , Masculino , Persona de Mediana Edad , Oxígeno/uso terapéutico , Fumar , Teofilina/uso terapéuticoRESUMEN
Menkes' syndrome, a rare sex-linked disorder of copper metabolism, has been found to be associated with a high incidence of urologic abnormalities. Bladder diverticula were present in 3 of 4 patients reviewed. Management of incomplete bladder emptying and consequent urinary tract infection is discussed.
Asunto(s)
Encefalopatías Metabólicas/complicaciones , Síndrome del Pelo Ensortijado/complicaciones , Enfermedades de la Vejiga Urinaria/etiología , Preescolar , Humanos , Masculino , Radiografía , Enfermedades de la Vejiga Urinaria/diagnóstico por imagenAsunto(s)
Difusión , Isoproterenol/uso terapéutico , Enfermedades Pulmonares/tratamiento farmacológico , Enfermedades Pulmonares/fisiopatología , Neón , Respiración , Adulto , Resistencia de las Vías Respiratorias , Asma/tratamiento farmacológico , Asma/fisiopatología , Bronquitis/tratamiento farmacológico , Bronquitis/fisiopatología , Monóxido de Carbono , Femenino , Humanos , Técnicas de Dilución del Indicador , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Enfermedades Pulmonares Obstructivas/fisiopatología , Masculino , Persona de Mediana Edad , Circulación Pulmonar , Capacidad de Difusión Pulmonar , Enfisema Pulmonar/tratamiento farmacológico , Enfisema Pulmonar/fisiopatología , Fumar , EsputoAsunto(s)
Difusión , Esfuerzo Físico , Circulación Pulmonar , Animales , Presión Sanguínea , Gasto Cardíaco , Perros , Consumo de Oxígeno , Arteria Pulmonar/fisiologíaAsunto(s)
Monóxido de Carbono/metabolismo , Alveolos Pulmonares/fisiología , Respiración , Adulto , Humanos , Masculino , Presión Parcial , Perfusión , Presión , Circulación Pulmonar , Radioisótopos , Cintigrafía , XenónAsunto(s)
Helio , Pulmón/fisiología , Respiración , Animales , Perros , Intubación , Métodos , Oxígeno , Presión , EspirometríaAsunto(s)
Volumen Sanguíneo , Circulación Pulmonar , Choque Hemorrágico/fisiopatología , Resistencia Vascular , Animales , Presión Sanguínea/fisiología , Monóxido de Carbono/farmacología , Gasto Cardíaco/fisiología , Perros , Haplorrinos , Frecuencia Cardíaca/fisiología , Isótopos de Yodo , Fisiología ComparadaRESUMEN
22 anesthetized dogs were given a barium sulfate suspension intravenously in a dose sufficient to double mean pulmonary artery pressure. 10 sec breath-holding carbon monoxide diffusing capacity (D(LCO10)) was measured before and after this standard embolization in each dog. No post-embolic decrease in D(LCO10) was observed. In the study of this apparent paradox, it was found that the potential for further increase in D(LCO10) during exercise remained after embolization. During rest prolongation of breath holding to 60 sec decreased CO absorption significantly more in the embolized than in the nonembolized dogs. While D(LCO10) was not affected by standard barium embolization, oxygen diffusing capacity was clearly decreased. The bronchial collateral circulation did not participate in preventing a D(LCO10) decrease after embolization since surgical interruption of the bronchial circulation did not alter the response to barium. Microscopic examination of lung sections taken after standard embolization showed plugging of precapillary vessels in the 40-50 mu range. These studies suggest that acute precapillary embolic obstruction of vessels of this size interferes remarkably little with CO absorption over short periods of time, probably because of continued CO absorption in portions of the capillary net distal to the sites of impaction. The remarkable anastomotic nature of this capillary network with multiple sources of access possibly provides the anatomic basis for this observation. This study demonstrates a clear dissociation between acute changes in pulmonary vascular resistance and D(LCO10)-both during rest and exercise.