RESUMEN
PURPOSE: We present a technique that fuses pelvic CT scans and ProstaScint images to localize areas of disease within the prostate gland to customize prostate implants. Additionally, the acute toxicity results from the first 43 patients treated with this technique are reviewed. METHODS AND MATERIALS: Between 2/97 and 8/98, 43 patients with clinical stage II prostate adenocarcinoma received ultrasound-guided transperineal implantation of I-125 or Pd-103 seeds. The median patient age was 70 years (range 49-79). Prior to treatment, the median Gleason score and prostate-specific antigen (PSA) were 6 (range 3-8) and 7.5 (range 1.8-16.6 ng/mL), respectively. The median follow-up was 10 months (range 2.9-20.4 months). RESULTS: The median PSA value at 10 months is 0.7 ng/mL. Significant acute complications within the first month following implantation included 13 Grade I urinary symptoms, 24 Grade II urinary symptoms, 6 Grade III symptoms, and no Grade IV complications. Beyond 4 months, complications included 12 Grade I urinary symptoms, 17 Grade II urinary symptoms, 1 Grade III, and 1 Grade IV complications. CONCLUSIONS: The image fusion of the pelvic CT scan and ProstaScint scans helped identify regions within the prostate at high risk of local failure, which were targeted with additional seeds during implantation.
Asunto(s)
Adenocarcinoma/radioterapia , Anticuerpos Monoclonales , Braquiterapia/métodos , Radioisótopos de Indio , Neoplasias de la Próstata/radioterapia , Tomografía Computarizada por Rayos X/métodos , Adenocarcinoma/diagnóstico por imagen , Anciano , Braquiterapia/efectos adversos , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico por imagen , Cintigrafía , Trastornos Urinarios/etiologíaAsunto(s)
Enfermedades del Sistema Nervioso , Trastornos Cerebrovasculares/diagnóstico , Humanos , Trastornos Migrañosos/tratamiento farmacológico , Trastornos Migrañosos/prevención & control , Enfermedades del Sistema Nervioso/diagnóstico , Enfermedades del Sistema Nervioso/etiología , Convulsiones/tratamiento farmacológicoRESUMEN
BACKGROUND: ProstaScint (Cytogen Corporation, Princeton, NJ) murine monoclonal antibody imaging is FDA-approved for imaging of prostate cancer patients at high risk for metastatic disease and patients postprostatectomy with a rising serum prostate-specific antigen (PSA) level. ProstaScint is a murine monoclonal antibody which targets prostate-specific membrane antigen (PSMA). PSMA expression is upregulated in primary and metastatic prostate cancer. FDA Cytogen (Princeton, NJ) protocol studies using 111indium-labeled ProstaScint revealed correlation between areas of increased concentration in the prostate and biopsy-proven tumors in patients imaged pretherapy. METHODS: In our study, four transverse, single-photon emission tomography (SPECT) images were isolated and regions of interest were selected and correlated with pretherapy prostate biopsy results. Prostate cancer and normal tissue prostate/muscle background (P/M) ratios were derived, so that postprostatectomy/radiation therapy patients could be evaluated for the presence of residual prostate cancer. Twenty-three pretherapy prostate cancer patients with quadrant/sextant biopsies had SPECT 96-hr 111indium ProstaScint pelvic images. The four transverse 1-cm slices above the midline penile blood pool were chosen, and four to six 27-30-pixel regions of interest were placed over the prostate bed. The background muscle region of interest was placed over the external obturator muscle region. The P/M ratio was calculated and compared to the quadrant/sextant prostatic biopsy result. The same procedure was applied to 17 posttherapy prostate cancer patients with rising PSA. RESULTS: In the 23 pretherapy prostate cancer patients, there was a correlation between the P/M ratio of at least 3.0 in 32 of 35 prostatic cancer biopsy regions, and there was correlation with P/M ratios less than 3.0 in 82 of 89 negative biopsy regions. Seventeen posttherapy patients underwent ProstaScint studies. Six underwent biopsy, with typically one biopsy site per patient. All 6 had P/M ratios greater than 3.0 in the biopsied region. Five out of six biopsies revealed residual prostate cancer. CONCLUSIONS: A prostate/muscle ratio was developed from 111indium ProstaScint regions of interest obtained on 1-cm SPECT transverse slices through the prostate bed in 23 patients preprostatic cancer therapy. A P/M ratio above 3.0 correlated in the majority of positive cases, and a P/M ratio below 3.0 was demonstrated in negative prostatic biopsy cases. The P/M ratio of above 3.0 or below 3.0 also separated those posttherapy prostate cancer patients with rising PSA who had residual prostate carcinoma in the prostate bed.
Asunto(s)
Próstata/patología , Neoplasias de la Próstata/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único/métodos , Anciano , Anticuerpos Monoclonales , Biopsia , Humanos , Radioisótopos de Indio , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/inmunología , Neoplasias de la Próstata/patologíaRESUMEN
OBJECTIVE: The treatment of patients with stage I endometrial adenocarcinoma is often shorter and less expensive if total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and therapeutic lymphadenectomy are used rather than TAH, BSO, pelvic lymph node sampling, and pelvic external beam radiation. We studied whether the survival and morbidity of patients treated with therapeutic lymphadenectomy are equal to or better than with these alternative treatments. METHODS: We reviewed the medical records of patients with stage I endometrial adenocarcinoma who were enrolled in the MetroHealth Medical Center tumor registry between 1970 and 1993 after undergoing full pelvic lymph node dissection, in addition to total abdominal hysterectomy, bilateral salpingo-oophorectomy, and vaginal brachytherapy. The mean number of resected nodes was 33 (median, 31; interquartile range, 19). Patients were followed for 1. 6-20 years (median, 8 years; interquartile range, 5.8 years). Morbidity and survival rates were compared to published series using similar treatment strategies and to those from studies using pelvic external beam radiation and pelvic lymph node sampling rather than lymphadenectomy. RESULTS: Of 192 patients with pathologic stage I (FIGO 1988) endometrial adenocarcinoma, 178 patients had full pelvic lymph node dissection; 159 patients were evaluable. The 15-year overall survival was 98%; 10- and 15- year disease-free survivals were 96 and 94%, respectively. Overall morbidity was 18% (29/159), and moderate-to-severe morbidity was 13% (21/159). Recurrences were seen in 4.4% (7/159) of patients. Grade and myometrial invasion were not significant predictors of disease-free survival after full pelvic lymph node dissection (grade, P = 0.42; stage, P = 0.67). The results compare favorably with those of similar studies and with studies of pelvic external beam radiation. CONCLUSIONS: Primary surgical management with total abdominal hysterectomy, bilateral salpingo-oophorectomy, therapeutic pelvic lymphadenectomy, and vaginal brachytherapy is a viable and possibly preferable option for patients with stage I endometrial adenocarcinoma.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Escisión del Ganglio Linfático , Adenocarcinoma/radioterapia , Braquiterapia , Terapia Combinada , Neoplasias Endometriales/radioterapia , Femenino , Humanos , Histerectomía/métodos , Metástasis Linfática , Persona de Mediana Edad , Ovariectomía , Pelvis , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Estado Vegetativo Persistente/patología , Daño por Reperfusión/patología , Nivel de Alerta , Atención , Concienciación , Encefalopatías/patología , Encefalopatías/fisiopatología , Corteza Cerebral/patología , Corteza Cerebral/fisiopatología , Estado de Conciencia , Humanos , Sistema Límbico/patología , Sistema Límbico/fisiopatología , Estado Vegetativo Persistente/etiología , Estado Vegetativo Persistente/fisiopatología , Daño por Reperfusión/fisiopatologíaRESUMEN
Sudden unexpected death is a problem of major importance, but very little is known about its cause. Electrocardiographic abnormalities have been known to occur in the context of neurologic disease for a long time. This article discusses the neuroanatomy of the heart and lungs and neurogenic lung and heart disease. The four classes of causes of these abnormalities are catecholamine infusion, stress plus or minus steroids, nervous system stimulation, and reperfusion. These classes are tied together by a common thread, the essential feature of which is sympathetic overactivity with secondary catecholamine toxicity. A unifying hypothesis is proposed to explain all of the forms of sudden death based on the anatomic connection between the nervous system and the heart and lungs.
Asunto(s)
Muerte Súbita Cardíaca/etiología , Corazón/anatomía & histología , Pulmón/anatomía & histología , Edema Pulmonar/fisiopatología , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/fisiopatología , Catecolaminas/análisis , Catecolaminas/sangre , Sistema Nervioso Central/fisiología , Sistema Nervioso Central/fisiopatología , Femenino , Corazón/fisiología , Corazón/fisiopatología , Humanos , Pulmón/fisiología , Pulmón/fisiopatología , Masculino , Edema Pulmonar/complicacionesRESUMEN
OBJECTIVE: To study the interaction of the erbium (Er)-YAG (2.94 microns) and the Er-YSGG (2.79 microns) lasers with the human crystalline lens tissue. METHODS: Fresh human crystalline lens sections were used to measure the photovaporization threshold, rate, and damage zone of the two lasers. RESULTS: We found the photovaporization threshold for the Er-YAG and the Er-YSGG lasers to be 1.4 J/cm2 and 5.5 J/cm2, respectively. At 10 J/cm2, the photovaporization rate is 67.9 microns per pulse for the Er-YAG laser and 18.4 microns per pulse for the Er-YSGG laser. The increased rate of photovaporization as a function of radiant energy for the Er-YAG laser is almost twice that for the Er-YSGG. Damage zones for the Er-YAG laser ranged from 4 to 9 microns compared with 10 to 22 microns for the Er-YSGG. CONCLUSIONS: It is apparent that both lasers can adequately photovaporize human crystalline lens tissue and should be further studied for this purpose.
Asunto(s)
Terapia por Láser/métodos , Cristalino/patología , Extracción de Catarata/métodos , HumanosAsunto(s)
Protocolos Clínicos/normas , Coma/diagnóstico , Árboles de Decisión , Adulto , Anciano , Pruebas Calóricas , Causalidad , Angiografía Cerebral , Coma/etiología , Coma/terapia , Diagnóstico Diferencial , Medicina de Emergencia , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Examen Neurológico , Neurocirugia , Reflejo Pupilar , Punción Espinal , Tomografía Computarizada por Rayos XRESUMEN
Diagnosis of coma in the unresponsive patient can be done in a relatively short time by making key observations that will confirm disease of either the brain stem or the hemispheres, the two locations in which coma originates. Determining the location of the lesion is the primary goal in early assessment of the unresponsive patient. Examination of the patient's eyes is the single most important step in understanding coma.