RESUMO
PURPOSE: To develop a model that predicts survival in patients irradiated for metastatic spinal cord compression (MSCC), hence assisting in the decision between a short and a long-course radiotherapy (RT) regimen. METHODS: 138 patients diagnosed with MSCC and treated with RT alone were included. Based on a multivariate analysis, a scoring system was developed. It included four prognostic variables: age, number of vertebrae, ECOG and histology. Total scores ranged between 14 and 24 points and patients were divided into two groups. RESULTS: The 6-month survival rate was 22% for patients with a score of 14-18 points; and 69% for patients with a score of 19-24 points (P < 0.001). The system exhibits a high specificity and positive predictive value and an appropriate discriminative ability. CONCLUSIONS: Patients with scores between 19 and 24 points were found to survive longer, thus a long-course RT appears to be more appropriate.
Assuntos
Compressão da Medula Espinal/mortalidade , Compressão da Medula Espinal/radioterapia , Neoplasias da Coluna Vertebral/mortalidade , Neoplasias da Coluna Vertebral/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/secundário , Taxa de SobrevidaRESUMO
INTRODUCTION: The clinical course in patients with prostate cancer (PCa) after biochemical failure (BF) has received limited attention. This study analyzes survival time from recurrence, patterns of progression, and the efficacy of salvage therapies in patients treated with radical or postoperative radiotherapy (RT). METHODS: This is a multicenter retrospective comparative study of 1135 patients diagnosed with BF and treated with either radical (882) or postoperative (253) RT. Data correspond to the RECAP database. Clinical, tumor, and therapeutic characteristics were collected. Descriptive statistics, survival estimates, and comparisons of survival rates were calculated. RESULTS: Time to BF from initial treatment (RT or surgery) was higher in irradiated patients (51 vs 37 months). At a median follow-up of 102 months (14-254), the 8-year cause-specific survival (CSS) was 80.5%, without significant differences between the radical (80.1%) and postoperative (83.4%) RT groups. The 8-year metastasis-free survival rate was 57%. 173 patients (15%) died of PCa and 29 (2.5%) of a second cancer. No salvage therapy was given in 15% of pts. Only 5.5% of pts who underwent radical RT had local salvage treatment and 71% received androgen deprivation (AD) ± chemotherapy. The worst outcomes were in patients who developed metastases after BF (302 pts; 26.5%) and in cases with a Gleason > 7. CONCLUSIONS: In PCa treated with radiotherapy, median survival after BF is relatively long. In this sample, no differences in survival rates at 8-years have been found, regardless of the time of radiotherapy administered. AD was the most common treatment after BF. Metastases and high Gleason score are adverse variables. To our knowledge, this is the first study to compare outcomes after BF among patients treated with primary RT vs. those treated with postoperative RT and to evaluate recurrence patterns, treatments administered, and causes of death. The results allow avoiding overtreatment, improving quality of life, without negatively affecting survival.
Assuntos
Braquiterapia/mortalidade , Bases de Dados Factuais , Recidiva Local de Neoplasia/mortalidade , Neoplasias da Próstata/mortalidade , Sistema de Registros/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
BACKGROUND: Rhizopus microsporus is one of the main causative agents of mucormycosis. These mycoses are mostly described as isolated cases involving uncontrolled diabetes mellitus or immunosuppressed patients. In this work we report a nosocomial outbreak of mucormycosis due to R. microsporum involving three young immunocompetent patients whom underwent arthroscopic anterior cruciate ligament reconstruction surgery in a seven-month time span. PROCEDURES: During the outbreak period, a total of 32 surgeries of this type were performed in the clinic (mucormycosis prevalence of 9.375%). The three patients presented healthcare-associated Mucormycosis comprising the bone surrounding one of the fixation screws (femoral or tibial). In addition to these three strains, another three R. microsporus strains isolated in the medical center during the same period of time were included in the study. One of these fungi was isolated from a skin lesion of a kidney transplant patient while the other two strains were isolated from environmental sources. Classical, mass spectrometry-based (MALDI-TOFF) and molecular identification were performed. Genetic relatedness was established by Rep-PCR (RAPD variant) and by single-linkage cluster analysis mass spectra. Cluster analysis was performed by unweighed pair group method with arithmetic mean (UPGMA). MAIN FINDINGS: All the strains were identified as R. microsporum by the used phenotypic and genetic tools. Clinical strains fell into 2 different clusters separating the renal transplant recipient strain from the three strains isolated post ACLR surgery, which clustered together. CONCLUSIONS: The established genetic/mass spectra relatedness between the three post-surgery isolates suggests that these cases may be considered a healthcare-associated mucormycosis outbreak.
Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Surtos de Doenças , Mucormicose/epidemiologia , Mucormicose/microbiologia , Rhizopus/classificação , Rhizopus/genética , Adulto , Antifúngicos/farmacologia , Argentina/epidemiologia , Análise por Conglomerados , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/genética , Microbiologia Ambiental , Feminino , Genótipo , Humanos , Transplante de Rim/efeitos adversos , Masculino , Testes de Sensibilidade Microbiana , Mucormicose/diagnóstico , Técnica de Amplificação ao Acaso de DNA Polimórfico/métodos , Rhizopus/efeitos dos fármacos , Rhizopus/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Adulto JovemRESUMO
Hymenolepis nana is the most common tapeworm in humans; prevalence rates of 0.1%-58% have been reported. The aim of this study was to determine the prevalence in a health area of Southern Spain and identify the demographic variables potentially associated with increased rates of hymenolepiasis in this area. A retrospective study was performed with patients, who had H. nana eggs in fecal samples during january 2000 to december 2013. Parasitological diagnosis relied on microscopic detection in concentrated stool samples. During the study period, 73.660 stool samples were analyzed. H. nana eggs were observed in 158 patients (31 female) with a mean age of 18,9 years. The prevalence during the study period was 0,21% and 61% of the infected patients had more than one intestinal parasite. In conclusion, the prevalence of parasitism by H. nana in our population was higher than the national average and higher in adults than in children due to the characteristics of our population.
Assuntos
Fezes/parasitologia , Himenolepíase/epidemiologia , Hymenolepis nana/isolamento & purificação , Enteropatias Parasitárias/epidemiologia , Adolescente , Adulto , Animais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estações do Ano , Espanha/epidemiologia , Adulto JovemRESUMO
AIM: The purpose of the study was to describe infrastructures, treatment modalities, and workload in radiation oncology (RO) in Spain, referred particularly to prostate cancer (PC). METHODS: An epidemiologic, cross-sectional study was performed during 2008-2009. A study-specific questionnaire was sent to the 108 RO-registered departments. RESULTS: One hundred and two departments answered the survey, and six were contacted by telephone. Centers operated 236 treatment units: 23 (9.7 %) cobalt machines, 37 (15.7 %) mono-energetic linear accelerators, and 176 (74.6 %) multi-energy linear accelerators. Sixty-one (56.4 %) and 33 (30.5 %) departments, respectively, reported intensity-modulated radiation therapy (IMRT) and image-guided RT (IGRT) capabilities; three-dimensional-conformal RT was used in 75.8 % of patients. Virtual simulators were present in 95 departments (88.0 %), 35 use conventional simulators. Fifty-one departments (47.2 %) have brachytherapy units, 38 (35.2 %) perform prostatic implants. Departments saw a mean of 24.9 new patients/week; the number of patients treated annually was 102,054, corresponding to 88.4 % of patients with a RT indication. In 56.5 % of the hospitals, multidisciplinary teams were available to treat PC. CONCLUSIONS: Results provide an accurate picture of current situation of RO in Spain, showing a trend toward the progressive introduction of new technologies (IMRT, IGRT, brachytherapy).
Assuntos
Departamentos Hospitalares/organização & administração , Neoplasias da Próstata/radioterapia , Radioterapia (Especialidade) , Carga de Trabalho , Estudos Transversais , Humanos , Masculino , Espanha , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Early works have shown that when biomembranes are extracted with the non-ionic detergent Triton X-100 at 4 degrees C, only a subset of the components is solubilized. The aim of this paper was to investigate the solubilization of a cell membrane at different Triton concentrations, and to compare the lipid composition and acyl chain order/mobility of the insoluble material with those of the original membrane. We choose bovine erythrocytes, because they have an uncommon composition, as they have a huge amount of sphingomyelin and phosphatidylcholine is almost absent. We determined the degree of order/mobility of the lipid acyl chains by EPR spectroscopy, using liposoluble spin labels. Incubation of bovine erythrocytes with increasing Triton X-100 concentrations yields decreasing amounts of insoluble material which is enriched in sphingomyelin and depleted in cholesterol. Complete lipid solubilization is achieved at a detergent/lipid ratio of about 60, which is much higher than the values reported for human erythrocytes, but is in line with results obtained in model systems. An insoluble pellet is still obtained at higher Triton concentrations, which seems to consist mainly of protein. A very high correlation is found between lipid chain mobility restrictions and sphingomyelin content in the lipid structures. The human erythrocyte membrane also fits well in this correlation, suggesting a significant role of sphingomyelin in determining acyl chain organization. The analogies and differences between our insoluble material and the detergent-resistant membranes (DRM) are discussed.
Assuntos
Membrana Celular/química , Eritrócitos/química , Octoxinol/química , Animais , Bovinos , Membrana Celular/fisiologia , Colesterol/química , Espectroscopia de Ressonância de Spin Eletrônica , Eritrócitos/fisiologia , Bicamadas Lipídicas/química , Sensibilidade e Especificidade , Solubilidade , Esfingomielinas/químicaRESUMO
Abnormal zinc and lipid plasma levels occur more frequently in metabolically uncontrolled diabetic patients. These lipid alterations are key factors in the emergence of microvascular complications, which lead to death in those patients. Yet, zinc sulfate supplementation may be a therapeutical resource to recover some functioning and improve life span. This article reports the assessment of lipid profile from type 2-diabetes mellitus patients treated with hypoglycemic therapy drugs, who additionally presented zinc levels lower than average in Mexican reference. The patients received a 100 mg zinc sulfate treatment in a crossover double-blind design of clinically controlled study with starch as placebo. The diabetic patients had changes in their lipid profile after a 12-week zinc treatment as compared with placebo treatment. The 100 mg zinc sulfate treatment was well tolerated, significantly reduced total cholesterol and triglyceride concentrations, and increased those corresponding to zinc as well as HDL cholesterol in the bloodstream. Thus, using this treatment the cardiovascular involvement is expected to decrease in the type 2-diabetes mellitus patients, especially those with myocardial infarction and stroke, which are the main death causes in Mexico.
Assuntos
Diabetes Mellitus Tipo 2/metabolismo , Sulfato de Zinco/farmacologia , Adulto , Idoso , Colesterol/sangue , Estudos Cross-Over , Método Duplo-Cego , Humanos , Metabolismo dos Lipídeos/efeitos dos fármacos , Masculino , México , Pessoa de Meia-Idade , Triglicerídeos/sangueRESUMO
The in vivo and in vitro antiandrogenic activity of four aromatic esters 10a-10d, one aliphatic ester 10e based on the pregna-4,16-diene-6, 20-dione structure and two aromatic 17c, 17d and two aliphatic valeroyloxy esters 17a, 17b based on the more saturated 4-pregnene-6,20-dione skeleton was examined. The biological activity of steroids 9, 10a-10e and 17a-17d, was determined using prostate glands from gonadectomized adult male golden hamsters. In the in vitro studies, the relative binding affinity of these steroids to cytoplasmic androgen receptor (AR) of hamster prostate was determined from, the corresponding IC50 values obtained from the competitive binding plots. The standards dihydrotestosterone (DHT) and cyproterone (CA) acetate used have displaced [3H]DHT from the AR with an IC50 value of 3.2 and 4.4 nM respectively. All steroidal compounds synthesized in this study showed a binding affinity for the androgen receptor, present in the cytosol from prostate hamster; compounds 10a-10c showed the highest affinities for this receptor. The in vivo experiments showed that all steroidal derivatives were subcutaneously active, since they decreased the weight of the prostate gland in gonadectomized hamsters treated with DHT, and are antagonists for the androgen receptor since they block the DHT-induced prostate weight gain. The derivatives having the more conjugated 4,16-pregnadiene-6, 20-dione system (10a-10c) exhibited a higher antiandrogenic activity than the corresponding steroids (17a-17d) based on the more saturated 4-pregnene-6,20-dione system.
Assuntos
Antagonistas de Androgênios/metabolismo , Próstata/efeitos dos fármacos , Ligação Proteica/efeitos dos fármacos , Receptores Androgênicos/metabolismo , Esteroides/metabolismo , Antagonistas de Androgênios/síntese química , Antagonistas de Androgênios/farmacologia , Antagonistas de Receptores de Andrógenos , Animais , Cricetinae , Masculino , Mesocricetus , Próstata/metabolismo , Ligação Proteica/fisiologia , Esteroides/síntese química , Esteroides/farmacologiaAssuntos
Inibidores de 5-alfa Redutase , Inibidores Enzimáticos/síntese química , Inibidores Enzimáticos/farmacologia , Esteroides/síntese química , Esteroides/farmacologia , Animais , Cricetinae , Di-Hidrotestosterona/farmacologia , Masculino , Orquiectomia , Tamanho do Órgão/efeitos dos fármacos , Glândulas Seminais/efeitos dos fármacos , Relação Estrutura-Atividade , Testosterona/farmacologiaRESUMO
The pharmacological activity of four new progesterone derivatives: 4-bromo-17alpha-(p-fluorobenzoyloxy)-4-pregnene-3,20-dione (7), 4-bromo-17alpha-(p-bromobenzoyloxy)-4-pregnene-3,20-dione (8), 4-bromo-17alpha-(p-chlorobenzoyloxy)-pregnene-3,20-dione (9) and 4-bromo-17alpha-(p-toluoyloxy)-4-pregnene-3,20-dione (10) was determined. These compounds were evaluated as 5alpha-reductase inhibitors on gonadectomized hamster seminal vesicles and flank organs. The pharmacological data of this study indicate that compounds 7 and 9 having at C-17 p-fluorobenzoyloxy and p-chlorobenzoyloxy ester functions respectively showed the highest antiandrogenic effect as measured by the reduction of the weight of the seminal vesicles. In the flank organ model, the same compounds 7 and 9 exhibited a smaller diameter, 1.8 and 1.0 mm, respectively, than the commercially available finasteride 3 (2.3 mm), thus indicating a higher inhibitory effect on 5alpha-reductase enzyme. Steroid 7 showed a higher inhibitory activity on the conversion of T to DHT (Fig. 3) than the presently used finasteride, thus indicating a higher antiandrogenic effect. The nonsubstituted benzoyloxy ester (compound 15) showed a lower antiandrogenic activity as measured in the seminal vesicles model than the p-substituted benzoyloxy compounds.
Assuntos
Inibidores de 5-alfa Redutase , Inibidores Enzimáticos/síntese química , Progesterona/análogos & derivados , Progesterona/farmacologia , Antagonistas de Androgênios/síntese química , Antagonistas de Androgênios/farmacologia , Animais , Cricetinae , Inibidores Enzimáticos/farmacologia , Ésteres/síntese química , Ésteres/farmacologia , Indicadores e Reagentes , Masculino , Mesocricetus , Orquiectomia , Tamanho do Órgão/efeitos dos fármacos , Pigmentação/efeitos dos fármacos , Glândulas Seminais/efeitos dos fármacos , Glândulas Seminais/metabolismoAssuntos
Metabolismo dos Lipídeos , Pele/metabolismo , Acetato de Sódio/metabolismo , Esteroides/farmacologia , Inibidores de 5-alfa Redutase , Animais , Cricetinae , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/farmacologia , Finasterida/farmacologia , Injeções Subcutâneas , Masculino , Orquiectomia , Pigmentação/efeitos dos fármacos , Pele/efeitos dos fármacos , Esteroides/administração & dosagemRESUMO
Two species of Penicillium--P. chrysogenum and P. crustosum--were cultured in presence of [3H]testosterone as a substrate. Both species were shown to reduce the 4,5-double bond in testosterone to give dihydrotestosterone (DHT). The steroids produced were 5alpha-dihydrotestosterone, DHT, 3alpha-hydroxy-5beta-androstan-17-one, 3alpha-hydroy-5alpha-androstan-17-one, 4-androstene-3,17-dione, and 5alpha-androstane-3,17-dione. These products implicate the presence of the 5alpha-reductase, with maximal activity at pH 6 and 8, in both species of Penicillium. The presence of DHT in the growth medium and not in the mycelium suggests that DHT is excreted into the medium.
Assuntos
Di-Hidrotestosterona/metabolismo , Penicillium/metabolismo , Testosterona/metabolismo , 3-Oxo-5-alfa-Esteroide 4-Desidrogenase/metabolismo , Cromatografia em Camada Fina , Concentração de Íons de Hidrogênio , Oxirredução , Penicillium/enzimologia , Especificidade da EspécieRESUMO
The 5 alpha-reduction of levonorgestrel (LNG) as well as its binding capacity to the androgen receptors of the hamster flank organ were investigated. Furthermore, the effects of LNG and its 5 alpha-reduced metabolite in the flank organ test and on [U-14C]glucose incorporation into lipids by this tissue were determined. Homogenates from female hamster flank organs were incubated in the presence of [3H]LNG at pH 7.4. The radioactive 5 alpha-LNG metabolite was isolated and its purity was assessed. Competition experiments for androgen binding receptors were carried out with 1.38 nM [3H-7 alpha-17 alpha]dimethyl-19- nortestosterone (DMNT), Kd, plus a range of increasing concentrations of the different unlabeled steroid hormones. The flank organ test was performed in vivo, and [U-14C]glucose incorporation into lipids was determined under organ culture conditions. The 5 alpha-LNG had the same binding capacity to androgen receptors (AR) as LNG in male flank organs. The flank organ test demonstrated that 5 alpha-LNG activity was similar to that observed for levonorgestrel and testosterone (T) on gonadectomized male hamster flank organs. Topical applications of LNG or 5 alpha-LNG increased [U-14C]glucose incorporation into lipids in a way similar to that of T. The overall data indicate that LNG and 5 alpha-LNG produced androgenic activity in the lipid pathway of male flank organs, and that 5 alpha-reduction is not essential for the LNG effect on this tissue.
Assuntos
Levanogestrel/metabolismo , Receptores Androgênicos/metabolismo , Glândulas Sebáceas/metabolismo , Animais , Ligação Competitiva , Castração , Cricetinae , Feminino , Glucose/metabolismo , Técnicas In Vitro , Levanogestrel/química , Metabolismo dos Lipídeos , Masculino , Oxirredução , Glândulas Sebáceas/efeitos dos fármacos , Testosterona/farmacologiaRESUMO
The role of testosterone and levonorgestrel action on the flank organ by measuring sebaceous gland lipogenesis of female hamsters by the metabolic incorporation of 14C-glucose were investigated. Also, a partial characterization of the radiolabeled lipid fraction was obtained. The effects of in vivo steroids administration were evaluated by 14C-U-glucose metabolic incorporation into lipids by the female hamster flank organs in culture conditions, in the presence or absence of LNG and/or T in the incubation medium. The radioactive lipids were identified by thin layer chromatography. Levonorgestrel alone or together with testosterone on female hamster flank organs decreased the organ weight and sebum content compared with T-treatment alone. In culture conditions, a rapid and significant increase of radiolabeled glucose was observed with T. By contrast when LNG was present in the incubation medium, no differences in 14C-U-glucose incorporation were observed when compared with their controls. When T+LNG were added, a similar result to the obtained when using LNG alone was determined. Testosterone increased glycerides and free fatty acids but decreased polar lipids; whereas LNG did not have any effect in the relative proportions of 14C-U-glucose incorporated into the different classes of lipids, when it was compared with their controls. The results indicated that LNG abolished the increasing effect of 14C glucose incorporation caused by T and changed the lipid composition induced on female hamsters flank organs.
Assuntos
Levanogestrel/farmacologia , Lipídeos/biossíntese , Mesocricetus/metabolismo , Glândulas Sebáceas/efeitos dos fármacos , Animais , Cricetinae , Sinergismo Farmacológico , Feminino , Lipídeos/análise , Mesocricetus/anatomia & histologia , Tamanho do Órgão/efeitos dos fármacos , Glândulas Sebáceas/anatomia & histologia , Glândulas Sebáceas/metabolismo , Testosterona/farmacologiaRESUMO
Twenty-two infants with moderate dehydration due to diarrhea in whom oral rehydration therapy (ORT) was contraindicated or who failed to respond to this method of therapy were treated with rapid intravenous rehydration (RIR). Clinical signs of dehydration without shock allowed us to estimate 5% to 10% of weight loss. Patients were 11 days to 19 months old, and 9 of them were undernourished. A standard solution containing 90 mmol/L sodium, 80 mmol/L chloride, 30 mmol/L bicarbonate, 20 mmol/L potassium and 111 mmol/L glucose was used for all patients. The IV infusion was maintained until the rehydration was completed at a rate of 15 to 20 mL/kg/hour. Complete rehydration was successfully achieved in all patients. A total of 89.5 +/- 25.0 mL/kg (mean +/- SD) was needed and the duration of the IV infusion was 5.1 +/- 1.6 hours. Weight gain achieved was 6.5 +/- 1.6%. None of the patients developed hypernatremia following treatment. The initial base deficit, -9.5 +/- 6.6, was reduced to -3.5 +/- 2.9. All of the patients tolerated refeeding immediately after completion of the IV infusion. Our study suggests that this modality of rehydration is well tolerated, safe and effective and enhances the possibility of an early hospital discharge.