RESUMEN
PURPOSE: To determine the efficiency of lacrimal balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children who had failed two lacrimal system probings. METHODS: Between October 2004 and June 2006 we performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 30 lacrimal systems. The mean age was 32.4 months (range 18-72 months). The patients were divided into 3 types of obstructions: partial, proximal and simple membranous at the valve of Hasner and into 2 age categories: category 1 (18-36 months) and category 2 (> 36 months). The patients were evaluated 2 weeks, 3 months and 6 months after balloon catheter dilatation, with Munk's score and ophthalmic evaluation using a dye disappearance test being assessed. Clinical patency was defined as a complete resolution of signs and symptoms (Munk 0) and a negative disappearance test (grade 0). We used the chi-squared test with Yates' correction for statistical analysis. RESULTS: The procedure was successful in 83.33% of the cases and there were no complications. Statistical analysis showed no significant difference between the 3 types of obstructions treated, and age at treatment did not affect the outcome. CONCLUSION: DCP is a safe, effective therapy, easy and fast to perform and should be used in the treatment of congenital nasolacrimal duct obstruction after failure of two lacrimal system probings.
Asunto(s)
Cateterismo , Obstrucción del Conducto Lagrimal/congénito , Obstrucción del Conducto Lagrimal/terapia , Cateterismo/instrumentación , Niño , Preescolar , Diseño de Equipo , Humanos , Lactante , Estudios Prospectivos , Insuficiencia del TratamientoRESUMEN
Objetivo: Analizar el resultado de la dacriocistoplastia con balón catéter (DCP) en niños en los que han fallado dos sondajes previos. Material y métodos: Entre octubre de 2004 y junio de 2006 se practica DCP en un estudio prospectivo en 30 pacientes con una edad entre 18 y 72 meses (media 32,4 meses) con obstrucción nasolagrimal congénita en los que ha fallado el sondaje en dos ocasiones. Se estudia el tipo de obstrucción y se diferencia entre estenosis lagrimal, obstrucción proximal y membranosa. Se dividen dos grupos según la edad menores y mayores de 36 meses. Se incluye cuestionario con test de Munk y examen oftalmológico incluyendo el test de desaparición de colorante a los 5 minutos efectuados en los controles a las 2 semanas, 3meses y 6meses en todos los casos. Se define éxito cuando se normalizaron todos los síntomas y signos (Munk 0) y en el test de desaparición de colorante hay ausencia de tinción residual (Grado 0). Se utilizó el test de la chi-cuadrado con corrección de Yates para el análisis estadístico. Resultados: En el 83,33% de los pacientes se obtuvo buenos resultados. El tipo de obstrucción no se relacionó con diferentes resultados. La edad del paciente tampoco afectó a la bondad del resultado (test de la chi-cuadrado a un nivel de confianza del 95%). No hubo efectos secundarios ni complicaciones. Conclusión: La DCP es una técnica quirúrgica segura, sencilla y efectiva para el tratamiento de la obstrucción lagrimal congénita con fracasos de dos sondajes previos
Purpose: To determine the efficiency of lacrimal balloon catheter dilatation to treat congenital nasolacrimal duct obstruction in children who had failed two lacrimal system probings. Methods: Between October 2004 and June 2006 we performed a prospective study of balloon catheter dilatation for congenital nasolacrimal duct obstruction in 30 lacrimal systems. Themean age was 32.4months (range 18-72 months). The patients were divided into 3 types of obstructions: partial, proximal and simple membranous at the valve of Hasner and into 2 age categories: category 1 (18-36 months) and category 2 (> 36 months). The patients were evaluated 2 weeks, 3 months and 6 months after balloon catheter dilatation, with Munk's score and ophthalmic evaluation using a dye disappearance test being assessed. Clinical patency was defined as a complete resolution of signs and symptoms (Munk 0) and a negative disappearance test (grade 0). We used the chi-squared test with Yates´ correction for statistical analysis. Results: The procedure was successful in 83.33% of the cases and there were no complications. Statistical analysis showed no significant difference between the 3 types of obstructions treated, and age at treatment did not affect the outcome. Conclusion: DCP is a safe, effective therapy, easy and fast to perform and should be used in the treatment of congenital nasolacrimal duct obstruction after failure of two lacrimal system probings
Asunto(s)
Lactante , Preescolar , Niño , Humanos , Obstrucción del Conducto Lagrimal/congénito , Obstrucción del Conducto Lagrimal/terapia , Conducto Nasolagrimal/anomalías , Cateterismo/métodos , Resultado del Tratamiento , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
Primary bone lymphoma is a rare condition which represents a low percentage of both the malignant primary bone tumours and the non-Hodgkin extranodal lymphoma. This explains the lack of publications, lines of investigations, and specific diagnostic and treatment protocols. In the following article we will carry out a revision of the existing literature on this rare subject, using as argument a clinical case of left femoral location stage IE treated with CHOP chemotherapy and radiotherapy.
Asunto(s)
Neoplasias Óseas , Linfoma de Células B , Linfoma de Células B Grandes Difuso , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/terapia , Femenino , Humanos , Linfoma de Células B/diagnóstico , Linfoma de Células B/terapia , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/terapia , Persona de Mediana EdadRESUMEN
El cáncer de mama es la primera causa de muerte por cáncer en la mujer y la principal causa de muerte en la mujer entre los 40 y 44 años. En la actualidad se están consiguiendo importantes logros en su curación, debido a destacados avances diagnósticos y terapéuticos, así como a los programas de screenning, que hace que cada vez el diagnóstico se haga en las fases más tempranas de la enfermedad. Su tratamiento requiere una actuación multidisciplinar en la que participan cirujanos, oncólogos radioterápicos y médicos. En este capítulo, los autores realizan una puesta al día del papel de la radioterapia en el tratamiento del cáncer de mama en las diferentes etapas de la enfermedad (AU)
Asunto(s)
Femenino , Humanos , Neoplasias de la Mama/radioterapia , Carcinoma Intraductal no Infiltrante/radioterapia , Mastectomía , Neoplasias de la Mama/clasificación , Estadificación de Neoplasias/métodos , Recurrencia Local de Neoplasia/radioterapiaRESUMEN
Objetivos: Establecer la incidencia de dolor en los pacientes con cáncer en los Servicios de Oncología Radioterápica, así como su control siguiendo las recomendaciones de la Organización Mundial de la Salud (OMS). Material y métodos: Se analizó la incidencia de dolor y su tratamiento en pacientes sometidos a radioterapia o en revisión, reclutados durante 2 semanas en diferentes Servicios de la Comunidad Autónoma Andaluza y Extremeña. Para evaluar la intensidad del dolor se utilizó la Escala Analógica Visual (EVA). Resultados: De los 544 pacientes sometidos al estudio el dolor estuvo presente, en diferentes intensidades, en el 39,7 por ciento, siendo más frecuente en el grupo sometido a tratamiento que en aquellos en revisiones periódicas, correspondiendo el mayor número a pacientes con EVA < 3 (dolor débil o moderado). Conclusiones: El dolor es un síntoma frecuente en los pacientes con cáncer, afectando al 40 por ciento de los pacientes de nuestro estudio. A pesar de ello un amplio número de pacientes no reciben analgesia (19,4 por ciento) y de los que la reciben, en un alto porcentaje no se hace siguiendo las recomendaciones de la OMS, ya sea por exceso o por defecto. Ello hace necesario la creación de grupos Alleviare para extender su conocimiento y tratamiento adecuado (AU)
Asunto(s)
Humanos , Dolor/tratamiento farmacológico , Neoplasias/complicaciones , Analgesia/métodos , Oncología por Radiación/estadística & datos numéricos , Servicio de Oncología en Hospital/estadística & datos numéricos , Protocolos Antineoplásicos/métodos , Dimensión del Dolor/métodosRESUMEN
OBJECTIVES: To demonstrate the relationship between degree of cellular differentiation in colorectal cancer and topographical distribution in 215 patients diagnosed with colorectal cancer from 1997 to 2000. MATERIAL AND METHODS: 215 patients (129 men and 86 women) were studied prospectively with a mean age of 64 years (range: 23-84 years). In all patients we performed a full colonoscopy with several biopsies (in patients with colon stenosis we used barium enema), radiographic studies (CT, abdominal ultrasounds), and laboratory tests for serum tumour markers (CEA, Ca 19-9, alpha-fetoprotein). The topographic location of colorectal cancer was: rectum 35%, sigmoid colon 31%, descending colon 10%, transverse colon 6%, ascending colon 9%, caecum 5%, and we included anorectal cancer 4%. RESULTS: According to histological differentiation we found: A) well-differentiated tumours 101/215 (47%); B) moderately-differentiated tumours 98/215 (45.5%), and C) poorly-differentiated tumours 16/215 (7.5%). We found no significant association among histological differentiation, topographic location, stage according to the Astler-Coller classification, sex or age (p = ns). The prevalence of well-differentiated tumours in men was 49% and 43% in women; of moderately-differentiated cancers in men was 43%, and 49% in women; for poorly-differentiated tumours in men was 7.5%, and 7.2% in women. Regarding tumour location, 165 cancers were found in the left colon: 80 were well differentiated, 77 moderately differentiated and 8 poorly differentiated. In the transverse colon we found 12 tumours: 7 well differentiated, 3 moderately differentiated and 2 poorly differentiated. 30 cancers were localized in the right colon: 11 well differentiated, 15 moderately differentiated and 4 poorly differentiated. In the anorectum 8 tumours were found: 3 well differentiated, 3 moderately differentiated and 2 poorly differentiated. According to staging classification, well differentiated tumours (101/215) were more common in Dukes' C2 (20.7%) and B1 (32.6%), moderately differentiated cancers (98/215) were in B1 (28.5%) and C2 (20.4%), and poorly differentiated tumours (16) were more common in Dukes' C2 (25%), without differences among other stages (p = ns). CONCLUSIONS: According to our results we have found that histological differentiation of colorectal cancer has no association with topographic location, and it is independent of sex or age. We have not found any relationship either between histological differentiation and stage in the Astler-Coller classification, but well differentiated cancers were more common at any location, age or sex.
Asunto(s)
Neoplasias Colorrectales/patología , Adulto , Anciano , Anciano de 80 o más Años , Diferenciación Celular , Colonoscopía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios ProspectivosRESUMEN
Radiation-associated (RA) osteosarcomas (OS) are exceptional in children, presenting more frequently in middle-aged and elderly patients. This is a case report of RA-OS of the sinonasal cavities in a 13-yr-old girl after combined therapy for rhabdomyosarcoma (RMS) of the nose diagnosed at the age of five. The treatment of choice is radical surgery with wide margins and postoperative adjuvant chemotherapy and radiotherapy. Despite an episode of recurrence, at the present time the patient is alive and free of disease 5 yr after the initial treatment of OS. The association between radiation, chemotherapy and sarcomas is reviewed and discussed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Inducidas por Radiación/etiología , Neoplasias Nasales/tratamiento farmacológico , Neoplasias Nasales/rehabilitación , Osteosarcoma/etiología , Neoplasias de los Senos Paranasales/etiología , Radioterapia/efectos adversos , Rabdomiosarcoma/tratamiento farmacológico , Rabdomiosarcoma/rehabilitación , Adolescente , Terapia Combinada , Femenino , Humanos , Inmunohistoquímica , Recurrencia Local de Neoplasia , Neoplasias Nasales/diagnóstico , Osteosarcoma/diagnóstico , Neoplasias de los Senos Paranasales/diagnóstico , Dosis de Radiación , Rabdomiosarcoma/patología , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma Neuroendocrino/diagnóstico , Neoplasias Nasofaríngeas/diagnóstico , Nasofaringe/diagnóstico por imagen , Nasofaringe/patología , Neoplasias de los Senos Paranasales/diagnóstico , Seno Esfenoidal/diagnóstico por imagen , Seno Esfenoidal/patología , Biopsia , Carcinoma Neuroendocrino/terapia , Terapia Combinada , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasias de los Senos Paranasales/terapia , RadiografíaRESUMEN
BACKGROUND AND PURPOSE: In treatments where it is necessary to conform the field shape yielding a very small effective beam area, dosimetry and conventional treatment planning may be inaccurate. The Monte Carlo (MC) method can be an alternative to verify dose calculations. A conjunctival mucosa-associated lymphoid tissues lymphoma is presented, to show the importance of an independent assessment in critical situations. MATERIALS AND METHODS: In this work, the MC technique has been employed using the program BEAM (based on EGS4 code). Electron beam simulation has been performed and the results have been compared with those obtained with films. The patient dose distribution has been obtained by two methods: the full Monte Carlo (FMC) simulation and a conventional planning system (PLATO). RESULTS: Concerning dosimetry, some differences have been observed in the comparison of profiles obtained with film and those obtained with the MC method. Moreover, significant differences were found in the patient isodose distribution between both calculation methods. CONCLUSIONS: The results highlight that, in treatments where small beams are needed, conventional dosimetry and planning systems have some limitations. Therefore, an independent and more accurate assessment, such as MC, would be desirable.
Asunto(s)
Método de Montecarlo , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/estadística & datos numéricos , Radioterapia Conformacional/estadística & datos numéricos , Simulación por Computador , Neoplasias de la Conjuntiva/radioterapia , Humanos , Linfoma de Células B de la Zona Marginal/radioterapia , Radioterapia de Alta Energía , Película para Rayos XRESUMEN
OBJECTIVE: To present the results of a retrospective study which was conducted to analyze the utility of palliative radiotherapy in advanced bladder cancer and to evaluate the results of the different fractionation regimens in relation to the response rate and its duration, overall survival and side effects. METHODS: During a 10-year period, 56 patients with locally advanced bladder cancer received palliative external radiotherapy for the symptoms arising from their condition. The following fractionation schedules were mainly used: conventional irradiation with 40-60 Gy in 22-23 fractions in 20 cases and a low dose of 30 Gy in 10 fractions in 23. Other fractionation modalities were used in 6 patients. Eight patients received radiotherapy for symptomatic relief of pain from bony metastasis. RESULTS: 28 patients (50%) achieved complete remission of the initial symptoms and 15 (26.8%) showed a partial remission. The mean duration of response was 4 months (range 1-108). The overall uncorrected survival rate was 26.7% at one year (15 patients), 12.5% at three years (7 patients) and 7.1% at five years (4 patients), for a mean survival of 7.5 months (range 1-109). CONCLUSION: Radiotherapy is effective in the management of symptoms, specially hematuria, in patients with advanced carcinoma of the urinary bladder. Short fractionation regimens that achieve the same therapeutic results are preferred since visits to the hospital or long hospitalization can be avoided, thereby improving patient quality of life.
Asunto(s)
Neoplasias de la Vejiga Urinaria/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Paliativos , Estudios RetrospectivosRESUMEN
Radiotherapy is commonly utilised as standard treatment in the so called mucosa-associated lymphoid tissues (MALT), due to the low probability of distant relapse. The particularities of the lesion, make necessary both energy degradation and beam conformation. To keep homogeneity within acceptable limits, a lengthener attached to the electron applicator has been devised to closely fit the anatomy of the patient. Considering the small area of the outcoming field, film dosimetry is preferred, since the dimensions of an ionisation chamber and even of a semiconductor probe might be comparable to the field size.