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BACKGROUND: Syphilis is a sexually transmitted disease caused by Treponema pallidum. However, there are of hematogenic and vertical transmission. All health care professionals must be aware of the manifestations of this condition, such as oral lesions. OBJECTIVES: This study to analyze and compare four clinical cases of syphilis that were diagnosed based on lesions in the oral cavity with published literature. MATERIAL AND METHODS: Four patients with a confirmed sorologic and clinical diagnosis of syphilis were examined, confirmated from manifestation of oral lesions together with analysis of serological laboratory tests and histopathological analyses. RESULTS: Lesions were found in classic sites such as lips, tongue and skin. However, there were also lesions on the hard palate, and labial commissure, which correspond to less than 5% of the syphilis oral manifestations. CONCLUSIONS: The practice of unprotected oral sex may result in infection and development of syphilis. The acknowledgment of the oral manifestations of syphilis in all its period of training for health professionals is of basic importance, the association of clinical features, histopathological findings and serological tests are required to complete the diagnosis and correct treatment.
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Enfermedades de la Boca/diagnóstico , Enfermedades de la Boca/microbiología , Sífilis/complicaciones , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Ultrasound (B-mode) was used to analyze follicular events in 12 trained female owl monkeys (Aotus azarai infulatus). The animals were examined every 48 hours for over 90 days to measure and map follicular growth in both ovaries and to measure (using Doppler velocimetry) local hemodynamic changes during the peri-ovulatory stage. There were 44 follicular growth events, each with two or three follicular waves, and a mean ± SEM interval between events of 17 ± 1.13 days. There were various hemodynamic changes during follicular growth; both vascular resistance index and pulsatility index decreased during the time when the follicle diameter peaked. Thus, both B-mode and Doppler ultrasound were useful for monitoring ovarian follicular events in owl monkeys.
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Aotidae/fisiología , Folículo Ovárico/diagnóstico por imagen , Folículo Ovárico/fisiología , Preñez/fisiología , Animales , Aotidae/anatomía & histología , Velocidad del Flujo Sanguíneo , Femenino , Arteria Ilíaca/diagnóstico por imagen , Folículo Ovárico/irrigación sanguínea , Embarazo , Ultrasonografía Doppler/veterinaria , Útero/irrigación sanguínea , Útero/diagnóstico por imagen , Útero/fisiologíaRESUMEN
In the present work, we utilized the BSS system with TLD-600 and TLD-700 to measure the neutron spectra around the GE-PETtrace 8 cyclotron of the Development Centre of Nuclear Technology (CDTN/CNEN) in Belo Horizonte, Brazil. The cyclotron is capable of accelerating protons up to 16.5 MeV, to production of fluorine-18. Four points inside the bunker of the cyclotron were studied. Two points in front of the primary radiation beam and other two opposed to the primary radiation beam. The measurements were unfolded with the BUMS and the NSDUAZ computer codes. The dosimetric quantities obtained were in agreement with the other published data and were coherent with the expected from theoretical estimates obtained from source term informed by the manufacturer of the cyclotron.
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Gastroesophageal reflux disease and its complications, such as Barrett's esophagus, are major health problems. In this review, we highlight the critical components of the disease process and surgical considerations relevant to laparoscopic anti-reflux surgery.
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Adenocarcinoma/prevención & control , Esófago de Barrett/prevención & control , Neoplasias Esofágicas/prevención & control , Fundoplicación , Reflujo Gastroesofágico/cirugía , Gastroplastia , Laparoscopía , Lesiones Precancerosas/cirugía , Adenocarcinoma/epidemiología , Esófago de Barrett/epidemiología , Esófago de Barrett/etiología , Estudios de Cohortes , Terapia Combinada , Progresión de la Enfermedad , Neoplasias Esofágicas/epidemiología , Esofagitis Péptica/epidemiología , Esofagitis Péptica/etiología , Esófago/anomalías , Esófago/cirugía , Estudios de Seguimiento , Reflujo Gastroesofágico/complicaciones , Reflujo Gastroesofágico/tratamiento farmacológico , Hernia Hiatal/complicaciones , Hernia Hiatal/cirugía , Humanos , Incidencia , Obesidad Mórbida/complicaciones , Lesiones Precancerosas/tratamiento farmacológico , Lesiones Precancerosas/epidemiología , Inhibidores de la Bomba de Protones/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Resultado del TratamientoRESUMEN
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe and cost-effective technique that allows sampling of mediastinal lymph nodes and peribronchial lesions including pulmonary and mediastinal lesions. Its major indications are the nodal staging of non-small cell carcinomas of the lung, their restaging after chemotherapy and/or radiation, the diagnosis of sarcoidosis and of metastases from extrathoracic malignancies, and the diagnosis of mediastinal lymphadenopathy and masses of unknown aetiology. From our experience at the University of Minnesota and a comprehensive review of the literature, we discuss technical aspects of the procedure, its advantages and limitations in comparison with other methods of sampling mediastinal lymph nodes, focusing on the role of the cytopathologist in ensuring the effectiveness of the procedure. An algorithmic approach to the cytological diagnosis, starting with the determination of the adequacy of the sample, is also presented.
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Bronquios/patología , Carcinoma de Pulmón de Células no Pequeñas/secundario , Endosonografía/métodos , Neoplasias Pulmonares/patología , Biopsia con Aguja Fina/economía , Biopsia con Aguja Fina/métodos , Endosonografía/economía , Costos de la Atención en Salud , Humanos , Ganglios Linfáticos/patología , Enfermedades Linfáticas/patología , Metástasis Linfática/patología , Mediastino/patología , Metaanálisis como AsuntoRESUMEN
This study assesses the feasibility and implementation of respiratory-gated whole-abdominal intensity-modulated radiation therapy (RG-WAIMRT). Three patients were treated with RG-WAIMRT. The planning target volume (PTV1) included the entire peritoneal cavity and a pelvic boost field was created (PTV2). The dose prescribed was 30 Gy to PTV1 and 14.4 Gy to PTV2. For comparison, a conventional three-dimensional (3D) plan was generated for each patient. In the WAIMRT plan, an average of 90% of PTV1 received 30 Gy compared to 70% for the conventional 3D plan. The percent volume receiving 30 Gy (V(30)) for liver averaged 54% (WAIMRT) vs 43% (3D). The percent volume receiving 20 Gy (V(20)) for kidneys averaged 19% vs 0%, and the mean V(20) for bone marrow was 74% vs 83%, respectively. Major acute toxicities were anemia (grade 2: 1/3), leukopenia (grade 3: 2/3 patients), and thrombocytopenia (grade 2: 1/3 patients, grade 3: 1/3 patients). One patient could not complete the whole-abdomen field after 19.5 Gy because of persistent nausea. No major subacute toxicity has been reported. WAIMRT demonstrated superior target coverage and reduced dose to bone marrow, with a slightly increased dose to liver and kidneys. WAIMRT is a novel and feasible technique for ovarian cancer treatment.
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Neoplasias Ováricas/radioterapia , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Ováricas/patología , Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada/efectos adversos , Radioterapia de Intensidad Modulada/métodos , Respiración , Tomografía Computarizada por Rayos X/métodosRESUMEN
OBJECTIVE: The goals of this study were to evaluate the feasibility of pelvic intensity-modulated radiotherapy (IMRT) in the adjuvant treatment of gynecologic malignancies and to compare the dose-volume histograms (DVHs) and determine the potential impact on acute and long-term toxicity based on the dose to target and nontarget tissues for both planning techniques. METHODS: Ten consecutive patients referred for adjuvant radiotherapy for gynecologic malignancies at the University of Pittsburgh School of Medicine and Magee-Womens Hospital were selected for CT-based treatment planning using the ADAC 3D version 4.2g and the NOMOS Corvus IMRT version 4.0. Normal tissues and critical structures were contoured on axial CT slices by both systems in conjunction with a gynecologic radiologist. These regions included internal, external, and common iliac nodal groups, rectum, upper 4 cm of vagina, bladder, and small bowel. Conventional treatment planning included 3D four-field box using 18-MV photons designed to treat a volume from the L(5)/S(1) border superiorly to the bottom of the ischial tuberosity on the AP/PA field and shaped blocks on the lateral fields to minimize the dose to the rectum and small bowel. A seven-field technique using 6-MV photons was used for IMRT. Restraints on small bowel for IMRT were set at 23.0 Gy +/- 5% and 35.0 Gy+/- 5% for the rectum and 37.5 Gy +/- 5% for the bladder while simultaneously delivering full dose (45.0 Gy) to the intrapelvic nodal groups in 1.8-Gy daily fractions. The dose-volume histograms where then compared for both treatment delivery systems. RESULTS: The volume of each organ of interest (small bowel, bladder, and rectum) receiving doses in excess of 30 Gy was compared in the 3D and IMRT treatment plans. The mean volume of small bowel receiving doses in excess of 30 Gy was reduced by 52% with IMRT compared with 3D. A similar advantage was noted for the rectum (66% reduction) and the bladder (36% reduction). The nodal regions at risk and the upper vagina all received the prescribed dose of 45.0 Gy. CONCLUSIONS: Intensity-modulated radiotherapy appears to offer several advantages over conventional 3D radiotherapy (3D CRT) planning for adjuvant radiotherapy for gynecologic malignancies. These include a significant reduction in treatment volume for bladder, rectum, and small bowel. It is anticipated that this reduction in volume of normal tissue irradiated would translate into overall reduction in acute and potentially late treatment-related toxicity. Prospective trials are necessary to better evaluate the advantages in a larger group of patients.
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Neoplasias Endometriales/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Neoplasias del Cuello Uterino/radioterapia , Relación Dosis-Respuesta en la Radiación , Neoplasias Endometriales/cirugía , Femenino , Humanos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/efectos adversos , Radioterapia Adyuvante/efectos adversos , Radioterapia Conformacional/efectos adversos , Neoplasias del Cuello Uterino/cirugíaRESUMEN
BACKGROUND: We previously demonstrated that surfactant dilution and inhibition occur immediately after pulmonary artery flushing with hypothermic modified Euro-Collins solution. Consequently, we speculated that increased capillary permeability contributed to these surfactant changes. To test this hypothesis, we evaluated the effects of hypothermic pulmonary artery flushing on the pulmonary capillary filtration coefficient (Kfc), and additionally performed a biochemical analysis of surfactant. METHODS: We used a murine isolated, perfused lung model to measure the pulmonary capillary filtration coefficient and hemodynamic parameters, to determine the wet to dry weight ratio, and to evaluate surfactant by biochemical analysis of lung lavage fluid. We defined three study groups. In group I (controls), we harvested lungs without hypothermic pulmonary artery flushing, and measured Kfc immediately. In group II (in situ flush), we harvested lungs after hypothermic pulmonary artery flushing with modified Euro-Collins solution, and then measured Kfc. Experiments in groups I and II were designed to evaluate persistent changes in Kfc after pulmonary artery flushing. In group III (ex vivo flush), we flushed lungs ex vivo to evaluate transient changes in Kfc during hypothermic pulmonary artery flushing. RESULTS: Groups I and II did not differ significantly in capillary filtration coefficient and hemodynamics. Group II showed significant alterations on biochemical surfactant analysis and a significant increase in wet-to-dry weight ratio, when compared with group I. In group III, we observed a significant transient increase in capillary filtration coefficient during pulmonary artery flushing. CONCLUSIONS: Hypothermic pulmonary artery flushing transiently increases the capillary filtration coefficient, leads to an increase in the wet to dry weight ratio, and induces biochemical surfactant changes. These findings could be explained by the effects of hypothermic modified Euro-Collins solution on pulmonary capillary permeability.
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Arteria Pulmonar , Resistencia de las Vías Respiratorias , Animales , Capilares/fisiología , Permeabilidad de la Membrana Celular , Filtración/métodos , Hemodinámica , Soluciones Hipertónicas/farmacología , Hipotermia/fisiopatología , Trasplante de Pulmón , Masculino , Preservación de Órganos/métodos , Soluciones Preservantes de Órganos , Tamaño de los Órganos , Fosfatidilcolinas/análisis , Proteínas/análisis , Arteria Pulmonar/citología , Surfactantes Pulmonares/antagonistas & inhibidores , Ratas , Ratas Endogámicas Lew , Esfingomielinas/análisisRESUMEN
We studied the effect of lung preservation on the surfactant system in rats. Lung surfactant is necessary to maintain normal lung mechanics, and hence normal lung function. We evaluated lung mechanics with pressure-volume (P-V) curves, and analyzed biochemical changes of surfactant in bronchoalveolar lavage (BAL) fluid. Additionally, we determined wet to dry weight ratios (W/D). We defined five study groups. In group I (controls) we harvested lungs without pulmonary artery flushing, then evaluated them immediately. In group II we flushed lungs through the pulmonary artery (PA) with hypothermic modified Euro-Collins solution (mECS), then removed and studied them immediately to determine the consequences of PA flushing alone. In groups III, IV, and V we flushed lungs with mECS, then stored them in normal saline (NS) for 6 hr (group III); in NS for 12 hr (group IV); or in mECS for 12 hr (group V). In groups III, IV, and V we evaluated lungs after storage. All four experimental groups showed significant changes in lung mechanics and surfactant biochemistry, compared with controls. Lungs in groups III, IV, and V showed additional changes in lung mechanics and surfactant biochemistry compared with group II. The W/D in stored lungs (groups III, IV, and V) was significantly higher than in controls and group II. We conclude that lung preservation induces deleterious changes in the surfactant system. Surfactant alterations are evident immediately after pulmonary artery flushing, and increase in severity with storage.