RESUMO
OBJECTIVE: The objective was to compare the short- and long-term impact of 3 different treatment modalities on health-related quality of life (HRQOL) in patients treated for localised prostate cancer at a single centre in Catalonia, Spain. MATERIAL AND METHODS: This was a longitudinal, prospective study of 304 patients from a single centre in Catalonia, Spain. Patients underwent 1 of 3 treatment procedures: radical prostatectomy (114 patients), external beam radiation (134) or interstitial brachytherapy (56). HRQOL was assessed by both general and specific questionnaires, including the SF-36 health survey and the Expanded Prostate Cancer Index Composite (EPIC). Interviews were administered prior to treatment and at months 1, 3, 6, 12 and 24. One-way analysis of variance and generalised estimating equations models were constructed to assess between group differences in HRQOL. RESULTS: After initial deterioration, HRQOL scores partially recovered, although significant differences between treatment groups persisted at two years. Worsening of urinary incontinence was especially marked for the radical prostatectomy group (11.45, p=0.005), while deterioration in the urinary irritative/obstructive domain was worse following brachytherapy treatment (4.76, p=0.025). Decline in sexual function was significantly greater for the radical prostatectomy group than for the brachytherapy group (18.74, p<0.001). No significant between-group differences were observed in bowel domain scores. CONCLUSIONS: Quality of life 2 years after treatment for prostate cancer shows wide variability. Radical prostatectomy had the largest negative impact on the sexual and urinary incontinence domains. Differences between external radiation and brachytherapy were relatively small. Brachytherapy led to a moderate increase in urinary irritation compared to the other 2 groups.
Assuntos
Braquiterapia/efeitos adversos , Prostatectomia/efeitos adversos , Neoplasias da Próstata/terapia , Qualidade de Vida , Idoso , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Próstata/patologia , Próstata/cirurgia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Resultado do Tratamento , Incontinência Urinária/patologiaRESUMO
From 1960 to 1990, one hundred twenty eight (128) subjects with primary hyperparathyroidism were operated in the University Hospital. The medical records were reviewed. Serum and urine chemistries were done by conventional methods, serum PTH was done by RIA's (N-, C-, and midregion) and intact by IRMA and 1,25 dihydroxycholecalciferol by a non equilibrium receptor assay from calf thymus and preceded by double Sep-Pak chromatography. The distal third of the radius (nondominant arm) was used to evaluate radial bone density (RBD), using single photon absorptiometry (Norland) and the lumbar bone density (LBD) was measured by dual energy X Ray absorptiometry (DEXA). The RBD was done in 41 females and 15 males and the LBD in 12 females and 4 males. The series comprised 95 females, age range from 15 to 79 years, and 33 males, age range from 14 to 69 years. Prominent clinical features included nephrolithiasis in 72 subjects (56%), osteitis fibrosa cystica in 2, isolated familial hyperparathyroidism in 4 subjects in one family, 7 subjects with MEN-1 in 3 families, and 4 subjects with MEN-2 in one family. Only 7 subjects were asymptomatic. Serum calcium was elevated in all, serum alkaline phosphatase was elevated in 24% and urinary hydroxiproline was increased in 48%. Serum phosphorus was low in 92%. PTH assay was either elevated or inappropriately normal for the serum calcium in all patients tested. Serum 1,25 D was elevated in 57%. The PTH level was positively correlated with the serum calcium (r = 0.70), but had no significant correlation with the serum phosphorus and the 1,25 D. The RBD expressed as the standard deviation from that of the mean for age and sex matched controls was > or = 2 SD below the mean in 39% of females and in 40% of males. In contrast to the RBD none of the subjects tested had a LBD > or = 2 SD below the age and sex adjusted mean. 103 subjects had adenomas, 20 primary hyperplasia, 2 carcinomas and in 3 surgical exploration was unsuccessful. As to the outcome of Surgery, 117 (93%) were cured. Thus, in this series, successful surgery for primary hyperparathyroidism is the rule. Primary hyperparathroidism is rarely asymptomatic and appendicular bone disease and nephrolithiasis are commonly seen.
Assuntos
Adenoma/diagnóstico , Hiperparatireoidismo/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Adenoma/metabolismo , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Fosfatase Alcalina/sangue , Densidade Óssea , Calcitriol/sangue , Cálcio/sangue , Diagnóstico Diferencial , Feminino , Humanos , Hidroxiprolina/urina , Hiperparatireoidismo/metabolismo , Hiperparatireoidismo/cirurgia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/metabolismo , Neoplasias das Paratireoides/cirurgia , Fósforo/sangue , Resultado do TratamentoRESUMO
PTHrP has had an unidentified role in medicine since 1930, when Albright described a patient with renal cortical cell carcinoma with hypercalcemia. Since then hypercalcemia has been recognized as the most common paraneoplastic syndrome. At that time the concept of "ectopic PTH syndrome" was introduced, and remained in literature until the true etiology was finally described. In the early 1970's Roof and Benson presented evidence that PTH in humoral hypercalcemia differed from "authentic" PTH. This marked the starting point for researchers to try identifying the molecule that mimicked PTH action and structure. This molecule, named parathyroid-related peptide, has been associated to hypercalcemia seen with solid tumors, such as squamous cell carcinoma of the lung and renal cortical cell carcinoma. PTHrP has been demonstrated to have similar actions to PTH but to differ in decreasing osteoblastic activity while increasing osteoclastic activity. The more fascinating finding was the presence of the PTHrP genes throughout the body, mostly the lactating breast as well as the heart, lungs and skin among others. Despite its identification, finding its physiological roles on normal tissue still remains to be clarified.
Assuntos
Proteínas de Neoplasias/fisiologia , Hormônio Paratireóideo/fisiologia , Proteínas/fisiologia , Sequência de Aminoácidos , Animais , Feminino , Humanos , Hipercalcemia/etiologia , Hipercalcemia/fisiopatologia , Masculino , Dados de Sequência Molecular , Proteína Relacionada ao Hormônio Paratireóideo , Proteínas/análise , Proteínas/genética , Proteínas/farmacologia , Receptor Tipo 1 de Hormônio Paratireóideo , Receptores de Hormônios Paratireóideos/fisiologiaRESUMO
PTHrP has had an unidentified role in medicine since 1930, when Albright described a patient with renal cortical cell carcinoma with hypercalcemia. Since then hypercalcemia has been recognized as the most common paraneoplastic syndrome. At that time the concept of ®ectopic PTH syndrome® was introduced, and remained in literature until the true etiology was finally described. In the early 1970's Roof and Benson presented evidence that PTH in humoral hypercalcemia differed from ®authentic® PTH. This marked the starting point for researchers to try identifying the molecule that mimicked PTH action and structure. This molecule, named parathyroid-related peptide, has been associated to hypercalcemia seen with solid tumors, such as squamous cell carcinoma of the lung and renal cortical cell carcinoma. PTHrP has been demonstrated to have similar actions to PTH but to differ in decreasing osteoblastic activity while increasing osteoclastic activity. The more fascinating finding was the presence of the PTHrP genes throughout the body, mostly the lactating breast as well as the heart, lungs and skin among others. Despite its identification, finding its physiological roles on normal tissue still remains to be clarified
Assuntos
Animais , Feminino , Humanos , Proteínas de Neoplasias/fisiologia , Hormônio Paratireóideo/fisiologia , Proteínas/fisiologia , Sequência de Aminoácidos , Hipercalcemia/etiologia , Hipercalcemia/fisiopatologia , Dados de Sequência Molecular , Proteínas/análise , Proteínas/genética , Proteínas/farmacologia , Receptores de Hormônios Paratireóideos/fisiologiaRESUMO
The aim of this study was to establish the reference values of the bone mineral density (BMD) of the lumbar spine and the proximal femur in a normal adult female Puerto Rican population. In the selection of the population, exclusion criteria included diseases, use of drugs and toxic habits (smoking and alcoholism) known to affect bone and mineral metabolism. The study population comprised 131 healthy females, ages 20 to 69 years. Spinal radiographs were taken of women age 60 or more to exclude spinal defects or artifacts. The bone mineral densities were measured using the dual energy X Ray absorptiometer (DEXA, Hologic model 1000). The peak BMD was found in the lumbar spine at the age 30 to 39 years and at the age 20 to 29 years in the femoral neck, trochanter and Ward's triangle. The decrease in BMD from peak values to those at age 60 to 69 years were 18% for the lumbar spine, 16.3% for the femoral neck, 30.1% for the Ward's triangle and 12.4% for the trochanter. The major fall in the BMD was related to the menopause and compares with that of other series. There was no statistical difference from Hologic reference values in a mixed population of the USA.
Assuntos
Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Hispânico ou Latino , Vértebras Lombares/diagnóstico por imagem , Absorciometria de Fóton , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
The history, physical and radiologic findings, treatment and pathology in five unusual cases of hyperparathyroidism is presented. The hyperparathyroidism was caused by a large (113 grams) mediastinal adenoma in the first patient, who is alive 25 years after surgery. A parathyroid carcinoma with compression of the esophagus was documented in the second patient. This patient is alive and normocalcemic 23 years after surgical treatment. A third patient with hyperplasia returned with hypercalcemia 20 years postsurgery requiring reoperation. A fourth patient with advanced bone findings was found to have a parathyroid adenoma. The fifth case is a patient with tertiary hyperparathyroidism secondary to hypophosphatemic rickets.
Assuntos
Adenoma/complicações , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo/etiologia , Neoplasias do Mediastino/complicações , Neoplasias das Paratireoides/complicações , Raquitismo/complicações , Adenoma/metabolismo , Adenoma/cirurgia , Adulto , Feminino , Humanos , Hipercalcemia/etiologia , Hiperplasia , Masculino , Neoplasias do Mediastino/metabolismo , Neoplasias do Mediastino/cirurgia , Glândulas Paratireoides/patologia , Hormônio Paratireóideo/metabolismo , Neoplasias das Paratireoides/cirurgia , ParatireoidectomiaRESUMO
Through many contributing factors (ethnicity, diet, exercise, sun exposure, sex, etc.), bone density has traditionally been considered to reach a peak (PBD), during the third decade of life. More recently, data suggests this might occur earlier, mostly mediated by onset and duration of sexual maturation. In order to ascertain such contention, we studied 45 young (20-24 yr) adults utilizing single-photon absorption densitometry (SPA, Norland 2870), at the distal 1/3 of non-dominant arms, a site with 75% cortical bone. A uniform questionnaire on their life styles, ethnic/racial background, & biochemical/hormonal tests established their healthy state, as usually found among medical student volunteers. All had reached Tanner V stage. BD was obtained dividing BMC (bone mineral content, gm/cm) by BW (bone width, cm), and expressed as gm/cm2. Wt (weight) of Males (n = 24, age = 22.8 +/- 0.8 yr) was 77.9 +/- 8.9 Kg, height, (Ht) was 176.1 +/- 5 cm, both significantly higher than for Females (n = 21, Wt = 58.4 +/- 9.8 Kg, Ht = 159.2 +/- 5 cm), p < 0.0001). BMI (body mass index, kg/m2) were: M = 25.3 +/- 2.5 while F = 23.0 +/- 2.9 (p < 0.008). Ages were similar: M = 22.8 +/- 0.83, F = 22.5 +/- 0.81 years. Results were analyzed using SAS (IBM PS) & Cricket-graph (Macintosh), expressed as arithmetic means +/- SD or sem. LR (regressions) were applied whenever feasible.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Densidade Óssea , Absorciometria de Fóton , Adulto , Feminino , Humanos , Masculino , Porto Rico , Valores de ReferênciaRESUMO
During the past 20 years (1970-90), we had 24 patients with pheochromocytoma: 19 diagnosed clinically and 5 post-mortem. Their ages ranged from 17 to 74 (mean, 43.2 years). Males (n = 14) outnumbered females (n = 10), a 1.41:1 M:F ratio. A majority were symptomatic (95%), with a typical triad of headaches, palpitations and diaphoresis. Most frequent finding was hypertension (95%). It was sustained in 60% and paroxysmal in 35%. In 6 patients (25%) pheochromocytomas were bilateral, all familial. Fifteen were solitary adrenal tumors (63%); 3 (12.5%) were extra-adrenal: 2 intra-abdominal, and 1 cardiac paraganglioma of right atrium. Of 6 familial cases, 4 were associated to Von Hippel-Lindau (VHL) disease, while 2 were multiple endocrine neoplasia (MEN-II) patients. All familial cases were bilateral and in the adrenals. There were no malignancies. Among the 19 clinical cases pre-operative Dx was made by positive urine VMA or catecholamines urine levels: (95 and 100% sensitivity respectively). Preoperative visualization by CT or MRI was done in 62% of the most recent patients. In 5 earlier cases the diagnosis was made post mortem: 3 died of cerebral hemorrhage, 1 with a pons infarct and 1 with congestive heart failure (CHF). There were 2 post-operative deaths and another died 13 years later from thyroid medullary carcinoma. Of the 19 operated, 13 (68%) were cured. Thus pheochromocytomas retain considerable morbidity and some mortality. These rare tumors constitute a clinical diagnostic challenge yet a rewarding therapeutic experience for the alert physician.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico , Feocromocitoma/diagnóstico , Adolescente , Neoplasias das Glândulas Suprarrenais/classificação , Neoplasias das Glândulas Suprarrenais/cirurgia , Adulto , Idoso , Catecolaminas/urina , Criança , Diagnóstico por Imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/classificação , Feocromocitoma/cirurgia , Ácido Vanilmandélico/urinaRESUMO
Success in the treatment of primary hyperparathyroidism rest in the accurate localization and removal of the diseased gland or glands. Computerized tomography and nuclear imaging scans are being used to localize abnormal parathyroid tissue. In the present study, fifteen consecutive patients undergoing surgery for primary hyperparathyroidism were all subjected to these ancillary studies. Results were not revealed to the operating team. In all instances an adenoma was localized during neck exploration. CT Scan failed to localize 73% of the affected glands. Nuclear scans missed almost fifty percent of the parathyroid adenomas. The low yield of these ancillary localizing tests makes them unnecessary in the routine evaluation of patients undergoing surgery for primary hyperparathyroidism.
Assuntos
Adenoma/diagnóstico por imagem , Testes Diagnósticos de Rotina/economia , Hiperparatireoidismo/cirurgia , Neoplasias das Paratireoides/diagnóstico por imagem , Cuidados Pré-Operatórios/economia , Técnica de Subtração , Tomografia Computadorizada por Raios X , Adenoma/cirurgia , Adulto , Idoso , Estudos de Avaliação como Assunto , Feminino , Humanos , Hiperparatireoidismo/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias das Paratireoides/cirurgia , Cintilografia , Método Simples-Cego , Técnica de Subtração/economia , Tomografia Computadorizada por Raios X/economiaRESUMO
Recent emphasis on age-related morbidity addresses the increasing life expectancy of Western countries. Osteopenia is a multi-factorial process affecting a sizeable number of elderly individuals, with bone fractures producing significant morbidity and related mortality. A non-human primate would be a very useful experimental model for the study of age-related osteopenia, if it could be shown that it is similarly afflicted by age and if non-invasive methods utilized among humans could give a valid estimation of bone mineral content in the animal. Our previous studies utilizing SPA (single-photon absorptiometry) suggest age-related decrease in BMC (bone mineral content) among rhesus macaque skeletons, similar to that observed in humans. The present studies were done in order to further validate the utilization of bone densitometry (SPA) in the rhesus macaque, comparing their BMC and bone density (BD) with the size and weight of their corresponding bones. Both radii and the right femur of 102 adult rhesus monkey skeletons (5 to 23 years old), were obtained from the Caribbean Primate Research Center (CPRC) Skeletal Collection. There were 55 females and 47 males. Bone parameters were obtained using a Norland Digital Bone Densitometer, model 2780 at 2 scanning sites: distal 1/3 of radii and proximal 1/3 of femurs. Bone lengths (cm) and weights (gm) were compared and correlated with densitometric parameters. Excellent correlations were consistently found, with r values 0.74 to 0.96 and p less than 0.0001. Thus it appears that SPA at distal 1/3 radius or proximal 1/3 femur are a valid estimate of total bone mineral mass in rhesus monkeys.
Assuntos
Osso e Ossos/diagnóstico por imagem , Macaca mulatta/fisiologia , Macaca/fisiologia , Doenças dos Macacos/diagnóstico por imagem , Osteoporose/veterinária , Academias e Institutos , Animais , Feminino , Radioisótopos do Iodo , Masculino , Osteoporose/diagnóstico por imagem , Porto Rico , Cintilografia , Fatores SexuaisRESUMO
Fine needle thyroid aspiration (FNTA) as a diagnostic tool of thyroid disease was started at the University District Hospital (UDH) in 1983. FNTA was performed in 54 willing patients from December 1984 through December 1985. If no medical contraindications existed, thyroid surgery was recommended in order to assess diagnostic accuracy. Surgery was done in 34 (63%) patients; while not in 20:3 for medical reasons, 2 lost to follow-up, 3 refused, 7 had inappropriate FNTA, and 5 for unknown reasons. None had complications to FNTA. Cytology was classified as Class O: inadequate; Class 1: benign; Class 2: indeterminate; and Class 3: malignant. "Non-benign" cytology was obtained in 14 patients: 7 indeterminate (class 2) and 7 malignant (class 3). Four of these had carcinoma confirmed by surgery. Of the 19 with benign FNTA (class 1) only one has thyroid carcinoma. One patient had inadequate sample (Class O). The sensitivity was 80%, specificity 65%, and diagnostic accuracy 67%. All these statistical values are within the range reported in fifteen reviewed series. Thus, FNTA at UDH had a diagnostic value comparable to that described in the literature. It may be utilized as a safe, reliable tool complementary to clinical data in order to reduce the amount of unnecessary thyroid surgery, carry out earlier diagnoses of malignant nodules and increase the yield of carcinoma among those operated.
Assuntos
Biópsia por Agulha , Doenças da Glândula Tireoide/patologia , Glândula Tireoide/patologia , Adenocarcinoma/patologia , Carcinoma Papilar/patologia , Feminino , Hospitais de Ensino , Humanos , Masculino , Estudos Prospectivos , Doenças da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologiaRESUMO
The incidence of newly-diagnosed Insulin-dependent diabetes mellitus (IDDM) in a pediatric population has been found to increase with colder seasons in countries at latitudes where a marked weather change presumably triggers a higher prevalence of viral infections (especially respiratory), that may induce an insulitis which could be etiologically related with IDDM. In order to assess whether the opposite is true for a country with rather uniform climate, like Puerto Rico, we have studied the seasonal pattern of newly diagnosed IDDM seen at our institution during a 10 year period (1973-1982). Also, recent reports on a higher mortality from diabetes in Puerto Rico going from 16.6 in 1977 to 31.0 in 1983, prompted us to look at a possible secular trend of increasing incidence of IDDM. There were a total of 269 new cases of IDDM or 27 cases/year, with standard deviation (SD) of +/- 5.3, range 18 to 33, and no secular trend at all. Sex distribution was quite variable, having male:female (m/f) ratios from 1:2 to 3:1, and an over-all m/f of 13.3/13.6. Incidence of IDDM per month of year went from a low of 1.7 for April and November to a high of 3.0 for March and 2.9 for September, 2.8 for October, with a mean of 2.24 +/- 0.48 cases/month. Again, no significant seasonal differences were noted. Mean incidence for our "cold" months (November to April was 2.25/month; for our "hot" season (May to October) was 2.3/month; for our "rainy" season (July to December) 2.3 and for our "dry" season (January to April) 2.3/month. Thus, it appears that there are no such seasonal trends of IDDM In Puerto Rico.
Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Fatores Etários , Criança , Feminino , Humanos , Masculino , Conceitos Meteorológicos , Porto Rico , Estações do Ano , Fatores SexuaisRESUMO
Intrathyroidal hyperplastic parathyroid glands were responsible for primary hyperparathyroidism (PHPT) in two of three members in a family. The third had an extrathyroidal parathyroid "adenoma". Both intrathyroidal parathyroid (IThP) hyperplastic glands were the largest ones removed at the time of surgical cure. A review of the literature confirmed our postulate of a higher incidence of familial cases among patients with hyperparathyroidism and IThP with an incidence of 10.34% of IThP in familial cases versus a 4.2% in non-familial cases with PHPT. This contrasts with an incidence of 0.1% of IThP in normal patients. We hypothesize that stimulation of IThP tissue by surrounding calcitonin-producing C-cells might play a role in the seemingly preferential IThP hyperplasia. Recognition of this syndrome of Familial IThP Hyperplasia is important in order to avoid unnecessarily aggressive surgery for hyperparathyroidism.