RESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras.
Asunto(s)
Humanos , Salud de la Familia , Servicios de Salud , Salud Mental , Salud Pública , Organización y AdministraciónRESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras
Asunto(s)
Humanos , Salud de la Familia , Servicios de Salud , Salud Mental , Salud Pública , Organización y AdministraciónRESUMEN
Em 2009 o município de São Paulo desencadeou ações inter setoriais com sociedade civil e comunidade para reduzir a vulnerabilidade social, denominada Virada Social. A Secretaria Municipal de Saúde (SMS) e a Coordenadoria Regional de Saúde Sul (CRS Sul) participaram da Jornada da Saúde propiciando o acesso aos serviços de promoção e prevenção da saúde: elaboração do cartão SUS, alimentação saudável, medidas de pressão arterial, glicemia, vacinas, prevenção de gravidez precoce e doenças sexualmente transmissíveis (DST) para adolescentes, prevenção de câncer do colo de útero, dengue, saúde bucal e outras(AU)
Asunto(s)
Humanos , Salud Pública , Servicios de Salud , Salud de la Familia , Salud Mental , Organización y AdministraciónAsunto(s)
Ceguera Cortical/etiología , Demencia Vascular/etiología , Demencia Vascular/patología , Hemorragia Intracraneal Hipertensiva/patología , Lóbulo Occipital/patología , Arteria Cerebral Posterior/patología , Anciano , Ceguera Cortical/patología , Ceguera Cortical/fisiopatología , Edema Encefálico/etiología , Edema Encefálico/patología , Edema Encefálico/fisiopatología , Demencia Vascular/fisiopatología , Humanos , Hipertensión/complicaciones , Hipertensión/fisiopatología , Hemorragia Intracraneal Hipertensiva/fisiopatología , Imagen por Resonancia Magnética , Masculino , Microcirculación/patología , Microcirculación/fisiopatología , Lóbulo Occipital/irrigación sanguínea , Lóbulo Occipital/fisiopatología , Arteria Cerebral Posterior/fisiopatología , Recuperación de la Función , Convulsiones/etiología , Convulsiones/patología , Convulsiones/fisiopatologíaRESUMEN
OBJECTIVE: The purpose of this study was to determine the protective effect of edaravone, a free radical scavenger, on inner-ear barotrauma (IEB) in guinea pigs, based on a hypothesis implicating free radicals in the development of IEB. MATERIALS AND METHODS: One hundred and twenty-five guinea pigs were divided into a control group and a pretreatment group. After auditory brainstem response (ABR) testing, the pretreatment group received 9.0 mg/kg intraperitoneal edaravone. Animals were exposed to pressure loading and then to further ABR testing. RESULTS: The incidence of IEB was 62.7 per cent in the control group and 42.9 per cent in the pretreatment group (p<0.01). The distributions of threshold elevation in the control group were 37.3 per cent (for 10 dB or less), 21.3 per cent (for 20-30 dB), 18.0 per cent (for 40-60 dB) and 23.4 per cent (for 70 dB or more), and those in the pretreatment group were 57.1 per cent, 19.1 per cent, 14.3 per cent and 9.5 per cent, for the same respective decibel levels (p<0.01). CONCLUSIONS: These results suggest that protective treatment with edaravone can significantly reduce both the incidence of IEB and the severity of the resultant ABR threshold elevation.
Asunto(s)
Antipirina/análogos & derivados , Barotrauma/prevención & control , Oído Interno/lesiones , Depuradores de Radicales Libres/administración & dosificación , Animales , Antipirina/administración & dosificación , Umbral Auditivo/fisiología , Edaravona , Potenciales Evocados Auditivos del Tronco Encefálico/fisiología , Cobayas , Inyecciones Intraperitoneales , Presión , Resultado del TratamientoRESUMEN
STUDY DESIGN: Analysis of answers to a new questionnaire. OBJECTIVE: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. SETTING: Nationwide questionnaire survey to physicians in Japan. METHODS: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). RESULTS: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping. CONCLUSIONS: This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.
Asunto(s)
Vigilancia de la Población/métodos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/terapia , Enfermedades Urológicas/diagnóstico , Enfermedades Urológicas/terapia , Comorbilidad , Encuestas de Atención de la Salud , Incidencia , Japón/epidemiología , Traumatismos de la Médula Espinal/epidemiología , Encuestas y Cuestionarios , Enfermedades Urológicas/epidemiologíaRESUMEN
This study aims to treat locally-advanced nasopharyngeal cancer by concurrent conventional irradiation at 2.0 Gy/day five days per week up to a total dose of 68 Gy, and daily intra-arterial infusion of cisplatin 3 mg/m2 plus 24 hours intravenous drip infusion of 5-fluorouracil 150 mg/m2 per day, five days per week. All of five enrolled patients completed the schedule, and treatment compliance was considered to be identical. Of the five patients evaluable for response, four with complete response (80%) and one with partial response (20%), with an overall response rate of 100% was achieved. The median survival time was 26 months. Two-year survival of the patients was 80%. This regimen showed marginal mucositis but well tolerated. We concluded that this treatment option is safe and effective for the locally-advanced nasopharyngeal cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Fluorouracilo/administración & dosificación , Neoplasias Nasofaríngeas/tratamiento farmacológico , Adulto , Femenino , Humanos , Inyecciones Intraarteriales , Masculino , Persona de Mediana Edad , Neoplasias Nasofaríngeas/diagnóstico por imagen , Neoplasias Nasofaríngeas/mortalidad , Neoplasias Nasofaríngeas/patología , Estadificación de Neoplasias , Radiografía , Radioterapia Adyuvante/métodos , Inducción de Remisión , Tasa de SupervivenciaRESUMEN
Metastatic urachal cancer is often considered lethal. We report 2 cases of metastatic urachal carcinoma successfully treated with surgical excision followed by combinations of surgery, radiation, and chemotherapy against local recurrence and/or distant metastases, with a recurrence-free survival period of more than 10 years. These cases provide support for multimodal treatments of metastatic urachal cancer.
Asunto(s)
Adenocarcinoma/secundario , Adenocarcinoma/terapia , Uraco/patología , Adenocarcinoma/cirugía , Adulto , Antineoplásicos/uso terapéutico , Terapia Combinada , Cistectomía , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Metástasis Linfática , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Neoplasias Ováricas/secundario , Neoplasias Ováricas/terapia , Radioterapia Conformacional , Resultado del Tratamiento , Uraco/cirugía , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias de la Vejiga Urinaria/terapiaRESUMEN
For head and neck cancer, a recent meta-analysis of published randomized trial results showed that concurrent chemoradiotherapy, adjuvant chemotherapy and neoadjuvant chemotherapy may increase absolute survival by 12.1%, 6.5%, and 3.7%, respectively. Initial response rates to first line chemotherapy are high, but this responsiveness does not appear to translate into a survival benefit. Thus, chemotherapy can be indicated as the standard therapy for a very limited range of advanced head and neck cancers. With the aim of prolonging survival, N stage advanced nasopharyngeal cancer is a good candidate for neoadjuvant chemotherapy. Among a large number of randomized trials of neoadjuvant chemotherapy, organ function preservation studies showed the possibility of laryngeal preservation for locally resectable T2 and T3 laryngeal and hypopharyngeal cancer. Concurrent chemoradiotherapy may be indicated for advanced T stage head and neck cancers, especially those with locally unresectable lesions. For N stage advanced pharyngeal cancer patients, adjuvant chemotherapy with applied after the standard therapy has a role in the treatment. With palliative treatment in advanced and/or recurrent disease, there is less benefit from chemotherapy and indications for chemotherapy should be selected for individual patients.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bleomicina/administración & dosificación , Carcinoma de Células Escamosas/tratamiento farmacológico , Cisplatino/administración & dosificación , Terapia Combinada , Relación Dosis-Respuesta a Droga , Fluorouracilo/administración & dosificación , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Cuidados Paliativos , Calidad de Vida , Análisis de SupervivenciaRESUMEN
Mammary duct ectasia occurs rarely in childhood. The authors report on the case of a pubertal girl who was operated on for duct ectasia with bloody nipple discharge. Duct ectasia is regarded as a primary lesion; it is considered to be a cause of bloody secretion, and it has a mechanism similar to that of mammary duct papilloma.
Asunto(s)
Enfermedades de la Mama/patología , Pezones/metabolismo , Enfermedades de la Mama/cirugía , Niño , Dilatación Patológica , Exudados y Transudados , Femenino , Humanos , PubertadAsunto(s)
Adenocarcinoma de Células Claras/química , Antígeno Prostático Específico/análisis , Neoplasias Uretrales/química , Adenocarcinoma de Células Claras/sangre , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias Uretrales/sangreRESUMEN
OBJECTIVES: To assess the clinical use of intralaryngeal ultrasonography. STUDY DESIGN: A retrospective study was conducted of 16 patients with laryngeal lesions treated by laryngomicrosurgery. METHODS: An intraluminal ultrasonic tomography apparatus was connected to a radial scanning 30-MHz miniaturized probe. Under general anesthesia, ultrasonic images were obtained using the filling method. RESULTS: In cases of benign disease, such as vocal cord nodules or polyps, the layers of the mucosa could be identified. Characteristic internal echoes were noted in cases of hemorrhagic polyps, vocal cord cysts, and vocal cord cancer. In case of hemorrhagic polyps, hyperechoic regions were noted within the lesions. In cases of vocal cord cysts, internal echoes were absent, and posterior echoes were mildly enhanced. In cases of vocal cord cancer, infiltration beyond the mucosa could be visualized. CONCLUSIONS: Laryngeal lesions can be diagnosed by intralaryngeal ultrasonography using the filling method. Although it does not replace the combination of conventional endoscopy and a critical evaluation of the clinical symptoms of the individual disease, it can profitably complement them. Intralaryngeal ultrasonography can help in determining the extent of tumor involvement during microscopic laser surgery performed under general anesthesia. Confirmation of the results of this pilot study with a larger series of patients is desirable.
Asunto(s)
Endosonografía , Enfermedades de la Laringe/diagnóstico por imagen , Adulto , Anciano , Anestesia General , Carcinoma/diagnóstico por imagen , Carcinoma/cirugía , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades de la Laringe/cirugía , Neoplasias Laríngeas/diagnóstico por imagen , Neoplasias Laríngeas/cirugía , Masculino , Microcirugia , Persona de Mediana Edad , Pólipos/diagnóstico por imagen , Pólipos/cirugía , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
In patients with locally unresectable head and neck cancer with large nodal involvement, the expected five-year survival is as low as 1-2%. To improve the prognosis of these patients, we studied the usefulness of concurrent chemoradiotherapy in a phase II trial. Between September 1996 and May 1999, thirty-five patients with locally unresectable head and neck cancer were administered concurrent chemoradiotherapy consisting of low-dose and long-term treatment with cisplatin (CDDP) plus 5-fluorouracil (5FU), or (L-CF); the L-CF regimen consisted of CDDP, 3 mg/m2 on 5 days of the week and 5FU, 150 mg/m2 as a 24-hour infusion on 5 days of the week. Concurrently, conventional radiotherapy was given up to total dose of around 60 Gy. In the 33 patients evaluable for response, 17 complete and 9 partial responses were noted, with an overall response rate of 79%. Oral mucostis and myelosuppression were the major side effects and mucositis was a dose limiting toxicity. This study demonstrates increase in survival among the responders (complete + partial) in the concurrent chemoradiotherapy setting. However 8 local relapses were eventually noted in the 17 complete responders. We concluded that this treatment strategy was beneficial in patients with locally unresectable head and neck cancer.
Asunto(s)
Antimetabolitos Antineoplásicos/administración & dosificación , Antineoplásicos/administración & dosificación , Neoplasias de Cabeza y Cuello/terapia , Adulto , Anciano , Anciano de 80 o más Años , Cisplatino/administración & dosificación , Terapia Combinada , Quimioterapia Combinada , Femenino , Fluorouracilo/administración & dosificación , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
OBJECTIVE: We sought predictive indicators of functionally successful repair in 168 infertile Japanese males who underwent high ligation of a varicocele via a retroperitoneal approach. METHODS: Possible indicators evaluated included age at marriage, duration of infertility, testicular volume, varicocele grade, seminal analysis findings, and serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone. All patients had palpable or visible unilateral left varicoceles. Success in conception was evaluated in all subjects 1 year after varicocele repair. RESULTS: No associations were observed between outcome and mean age at marriage, infertility duration, varicocele grade, seminal volume, or serum PRL and testosterone concentrations, but testicular volume, sperm count, percentage of motile sperm, and serum FSH and LH concentrations were significantly associated with outcome. Multiple regression analysis of dependence of outcome revealed testicular volume and serum FSH concentrations to be independent predictors. CONCLUSIONS: Varicocele repair is likely to accomplish fertility in patients with a combined testicular volume of at least 30 mL or serum FSH concentrations lower than 11.7 mIU/mL.
Asunto(s)
Hormona Folículo Estimulante/sangre , Infertilidad Masculina/cirugía , Hormona Luteinizante/sangre , Enfermedades Testiculares/cirugía , Varicocele/cirugía , Adulto , Femenino , Fertilización , Humanos , Infertilidad Masculina/etiología , Infertilidad Masculina/fisiopatología , Japón , Masculino , Persona de Mediana Edad , Embarazo , Índice de Embarazo , Prolactina/sangre , Análisis de Regresión , Recuento de Espermatozoides , Enfermedades Testiculares/complicaciones , Enfermedades Testiculares/patología , Testículo/patología , Testosterona/sangre , Varicocele/complicaciones , Varicocele/patologíaRESUMEN
To improve survival rate in advanced head and neck cancer, we scheduled 90 patients to receive low dose cisplatin plus 5-fluorouracil regimen as neoadjuvant(NAC), concurrent(CC), adjuvant(AC), and second line chemotherapy (SC) setting. Our regimen consisted of cisplatin (CDDP 5 mg/m2/1 hr infusion on days 1-5, 8-12, 15-19, 22-26) and 5-fluorouracil (5-FU 200 mg/m2/24 hr infusion or oral administration of tegaful-uracil (UFT-E) 400 mg/body on days 1-28). The concurrent chemoradiotherapy consisted of conventional irradiation with 1.6-2.0 Gy/day on five days per week up to a total dose around 60Gy, and CDDP 3 mg/m2 by intravenous infusion over 1 hour plus 5-FU 150 mg/m2 by intravenous infusion over 24 hours per day on five days per week. For SC, 24 patients evaluable for response, 4 CR and 6 PR with RR of 42% were achieved. For NAC, 14 patients were evaluated for response, 2 CR and 7 PR were achieved. CC was indicated for locally unresectable cases. Of the 33 patients evaluable for response were 17 CR and 9 PR with RR of 79%. Dose limiting toxicities for chemotherapy were anemia and leukopenia and chemoradiotherapy was mucositis. Our treatment modality showed marginal toxicity and good response. Moreover, our regimen could be given in an outpatient setting safely so quality of life for patients was identical. We concluded that for advanced head and neck cancer, these treatment options were effective for second line and adjuvant setting. Chemoradiotherapy with this regimen also gave a impact for improving local control and survival period for locally unresectable cases.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anemia/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/radioterapia , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Esquema de Medicación , Femenino , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Terapia Neoadyuvante , Dosificación Radioterapéutica , Análisis de Supervivencia , Vómito Precoz/etiologíaRESUMEN
To better define a therapeutic time window for reducing the extent of damage in ischemic penumbra, the time courses of changes in the glycerophospholipid and free fatty acid (FFA) levels were determined in the rat cerebral cortex following induction of the permanent focal ischemia. Focal ischemia induced a biphasic increase in FFA levels in the cerebral cortex, which had been recognized as the ischemic penumbra during the early stages after permanent occlusion of the middle cerebral artery (MCA). The first increase in FFA levels, in which the polyunsaturated fatty acid (PUFA) contained a large number of arachidonic acid (C20:4) molecules, began at 30 min and reached a peak at 1 h, followed by transient return to each sham level 2-6 h after the onset of MCA occlusion. Thereafter, the delayed increase in FFA levels, showing more increases of docosahexaenoic acid (C22:6) molecules than the C20:4 in PUFA compositions, occurred at 24 h. In contrast, the levels of phosphatidylinositol 4-phosphate (PIP) and phosphatidylinositol 4,5-bisphosphate (PIP2) decreased rapidly at 30 min of ischemia and returned transiently to each sham level at 1-6 h. The levels of phosphatidylcholine (PC) and phosphatidylethanolamine (PE), including polyphosphoinositides (PIPs), began to decrease significantly during the late stages, i.e., 24 h after induction of ischemia. These results suggest that the time-dependent changes in FFA and PIPs levels during the early stages of ischemia (until 6 h after induction) might be an important determinant of the subsequent neuronal death in the ischemic penumbra and that the breakdown of glycerophospholipids in the later stages after the induction of focal ischemia was associated with the development of infarction in the cerebral cortex.
Asunto(s)
Isquemia Encefálica/metabolismo , Isquemia Encefálica/terapia , Ácidos Grasos no Esterificados/metabolismo , Fosfatidilinositol 4,5-Difosfato/metabolismo , Animales , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/metabolismo , Revascularización Cerebral , Ácidos Docosahexaenoicos/metabolismo , Ácidos Grasos Insaturados/metabolismo , Infarto de la Arteria Cerebral Media/metabolismo , Infarto de la Arteria Cerebral Media/terapia , Masculino , Ratas , Ratas Sprague-Dawley , Factores de TiempoRESUMEN
The relationship between clinical response to DNA-damaging drugs and p53 and p21 status in patients with locally advanced transitional cell carcinoma (TCC) of the bladder was assessed. The response to intraarterial chemotherapy (IAC) comprising 100 mg / m(2) of cisplatin (CDDP) and 40 mg / m(2) of pirarubicin (THP) and the prognosis were assessed in 23 patients (the mean follow-up period was 19 months). The p53 gene status of tumors was analyzed at exons 5 - 8 using polymerase chain reaction-single strand conformation polymorphism analysis in 19 patients, and paraffin-embedded tumor sections were immunostained for p53 and p21 in 23 patients. The overall objective response rate (incidence of good responders) was 70%. The negative p53 group (n = 17) showed a significantly higher objective response rate than the positive p53 group (n = 6) (82% vs. 33%; P = 0.045). The p53 gene status or p21 staining status was not significantly associated with responsiveness. When the p53 and p21 immunostaining results were combined, good responders were more accurately predicted than by p53 staining status alone; the negative p53 / positive p21 group (n = 12) showed an objective response rate of 92%, which was significantly higher than that of the positive p53 and / or negative p21 group (45%, n = 11) (P = 0.027). Cause-specific survival of the negative p53 group was significantly superior to that of the positive p53 group (P = 0.015). Negative p53 / positive p21 immunostaining is a possible predictor of favorable chemotherapeutic response in patients with TCC of the bladder.
Asunto(s)
Carcinoma de Células Escamosas/tratamiento farmacológico , Ciclinas/análisis , Proteína p53 Supresora de Tumor/análisis , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico , Adulto , Anciano , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/mortalidad , Inhibidor p21 de las Quinasas Dependientes de la Ciclina , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Mutación , Pronóstico , Neoplasias de la Vejiga Urinaria/química , Neoplasias de la Vejiga Urinaria/mortalidadRESUMEN
We compared the ability of a new urinary bladder cancer antigen (UBC) test with conventional cytology for the detection of transitional cell carcinoma of the bladder using voided urine samples. The UBC was measured and corrected for the creatinine concentration in the urine of 61 patients with transitional cell carcinoma of the bladder (group 1), 23 patients without recurrent bladder tumors during follow-up (group 2), 28 patients with benign prostatic hyperplasia (group 3), nine patients with prostate cancer (group 4), and 90 healthy volunteers free of urological diseases (group 5). The UBC concentrations were 408.8+/-578.5, 18.8+/-26.6, 23.9+/-32.7, 17.5+/-18.6 and 4.6+/-6.7 ngmg(-1) creatinine (mean+/-S. D.) for groups 1-5, respectively. The level for group 1 was significantly higher than for any other group. The sensitivity and specificity, which were optimized using receiver-operating characteristic curves for groups 1 and 2 were 82.0% and 82.6%, respectively, at a threshold value of 39 ngmg(-1) creatinine. The sensitivity and specificity of cytology for these same groups were 60.7% and 86.9%, respectively. The sensitivity of the UBC was significantly higher than that of cytology, not only for total bladder tumors (82.0% vs. 60.7%, P<0.02) but also for grade I transitional cell carcinoma of the bladder (76.5% vs. 11.8%, P<0. 001). While offering a similarly high specificity, the UBC test might have an advantage over cytology in terms of superior sensitivity, particularly for low-grade tumors.
Asunto(s)
Antígenos de Neoplasias/orina , Carcinoma de Células Transicionales/diagnóstico , Neoplasias de la Vejiga Urinaria/diagnóstico , Orina/citología , Adulto , Anciano , Carcinoma de Células Transicionales/orina , Creatinina/orina , Femenino , Humanos , Masculino , Persona de Mediana Edad , Hiperplasia Prostática/orina , Neoplasias de la Próstata/orina , Curva ROC , Sensibilidad y Especificidad , Neoplasias de la Vejiga Urinaria/orinaRESUMEN
Chemotherapy for head and neck cancer was initially used as a palliative treatment in advanced and/or recurrent disease. The overall response rate was about 30% but patient survival was sometimes short. It was also observed that complete responders had a significantly longer survival period than non-responders. Cisplatin-containing regimens including cisplatin plus 5-fluorouracil appear to be the most efficacious for this disease. In a large number of randomized trials, organ function preservation studies have shown the possibility of laryngeal preservation for T2 and T3 laryngeal and hypopharyngeal cancer. A survival benefit has been shown clearly in advanced nasopharyngeal cancer. Another survival prolongation has been demonstrated in cases of locally unresectable cancer in the oral cavity, pharynx, nose and paranasal sinus. Thus, we conclude that neoadjuvant chemotherapy can be effective in cases of locally unresectable cancer in the oral cavity, pharynx, and nose and paranasal sinus. In advanced N stage nasopharyngeal cancer, neoadjuvant chemotherapy plus adjuvant chemotherapy may be indicated. Advanced T stage nasopharyngeal cancer is a good candidate for concurrent chemoradiotherapy. For the aim of laryngeal preservation, neoadjuvant and/or concurrent chemoradiotherapy can be indicated for T2 and T3 laryngeal and hypopharyngeal cancer.