RESUMO

OBJECTIVE: The aim of this study was to investigate pre-90Y lung shunt fraction (LSF) as a prognostic factor for overall survival (OS) in 90Y (resin/glass) planning 99mTc-MAA hepatopulmonary shunt studies for primary (hepatocellular carcinoma [HCC], intrahepatic cholangiocarcinoma) and metastatic liver tumors. METHODS: A total of 366 consecutive patients with primary and metastatic liver tumors underwent pre-90Y shunt study and 90Y radioembolization (mean age, 59.2 years; 55% were male). MAA (mean activity, 3.65 mCi) was administered via the proper hepatic artery. Shunted lung activity was obtained by planar scintigraphy. Median LSF values for primary tumors and metastases were compared with OS from first 90Y therapy via Kaplan-Meier estimation and log-rank test. Correlations between LSF and tumor involvement on baseline cross-sectional imaging were analyzed using Pearson coefficient (r). Patients with LSF of greater than 20% were deemed unsuitable for 90Y. RESULTS: The study included 79 (21.5%) colorectal, 73 (20%) neuroendocrine, 70 (19.1%) HCC, 40 (10.9%) intrahepatic cholangiocarcinoma, 40 (10.9%) melanoma, 20 (5.5%) breast, and 44 (12%) other tumors including lung and pancreatic cancers. Lung shunt fractions of less than 10% and 10% to 20% were observed in 235 patients (64.2%) and 131 patients (35.8%), respectively. Median LSFs were as follows: colorectal cancer (7.60%), neuroendocrine tumor (7.01%), HCC (11.47%), cholangiocarcinoma (7.00%), melanoma (6.00%), breast cancer (7.00%), and others, including lung and pancreatic metastases to the liver (8.36%). The HCC median LSF was significantly higher than that in non-HCC tumors, 11.47% versus 7.10% (P < 0.001). High LSF (≥ 10%) in HCC correlated with poorer survival from first 90Y compared with low LSF (<10%; 4.5 vs 16.4 months, P = 0.003). Similarly, for metastatic disease, high LSF demonstrated significantly poorer survival compared with low LSF in colorectal liver metastases (13.5 vs 7.0 months, P = 0.013), neuroendocrine liver metastases (33.0 vs 9.1 months, P < 0.001), and melanoma liver metastases (12.0 vs 5.0 months, P = 0.03). No correlation between tumor burden on cross-sectional imaging and LSF was observed (r = 0.35). CONCLUSIONS: In patients who are candidates for 90Y therapy, higher LSF is a poor prognostic factor for OS in HCC and metastatic liver tumors.

Assuntos

Embolização Terapêutica , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Pulmão/fisiopatologia , Ventilação Pulmonar , Radioisótopos de Ítrio/uso terapêutico , Idoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos , Biomarcadores , Colangiocarcinoma/diagnóstico por imagem , Neoplasias Colorretais/patologia , Embolização Terapêutica/métodos , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Cintilografia , Estudos Retrospectivos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Carga Tumoral

RESUMO

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy achieved with and without the calibration method established by the DICOM standard in both medical-grade gray-scale displays and consumer-grade color displays. MATERIALS AND METHODS: This study involved 76 cases, six radiologists, three displays, and two display calibrations for a total of 2736 observations in a multireader-multicase factorial design. The evaluated conditions were interstitial opacities, pneumothorax, and nodules. CT was adopted as the reference standard. One medical-grade gray-scale display and two consumer-grade color displays were evaluated. Analyses of ROC curves, diagnostic accuracy (measured as AUC), accuracy of condition classification, and false-positive and false-negative rate comparisons were performed. The degree of agreement between readers was also evaluated. RESULTS: No significant differences in image quality perception by the readers in the presence or absence of calibration were observed. Similar forms of the ROC curves were observed. No significant differences were detected in the observed variables (diagnostic accuracy, accuracy of condition classification, false-positive rates, false-negative rates, and image-quality perception). Strong agreement between readers was also determined for each display with and without calibration. CONCLUSION: For the chest conditions and selected observers included in this study, no significant differences were observed between the three evaluated displays with respect to accuracy performance with and without calibration.

Assuntos

Terminais de Computador/estatística & dados numéricos , Terminais de Computador/normas , Apresentação de Dados/normas , Radiografia Torácica/instrumentação , Radiografia Torácica/normas , Software/normas , Colômbia , Cor , Desenho de Equipamento , Segurança de Equipamentos , Humanos , Variações Dependentes do Observador , Guias de Prática Clínica como Assunto , Radiografia Torácica/estatística & dados numéricos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Software/estatística & dados numéricos

RESUMO

INTRODUCTION: In teleradiology services and in hospitals, the extensive use of visualization displays requires affordable devices. The purpose of this study was to compare three differently priced displays (a medical-grade grayscale display and two consumer-grade color displays) for image visualization of digitized chest X-rays. MATERIALS AND METHODS: The evaluated conditions were interstitial opacities, pneumothorax, and nodules using computed tomography as the gold standard. The comparison was accomplished in terms of receiver operating characteristic (ROC) curves, the diagnostic power measured as the area under ROC curves, accuracy in conditions classification, and main factors affecting accuracy, in a factorial study with 76 cases and six radiologists. RESULTS: The ROC curves for all of the displays and pathologies had similar shapes and no differences in diagnostic power. The proportion of cases correctly classified for each display was greater than 71.9%. The correctness proportions of the three displays were different (p<0.05) only for interstitial opacities. The evaluation of the main factors affecting these proportions revealed that the display factor was not significant for either nodule size or pneumothorax size (p>0.05). CONCLUSIONS: Although the image quality variables showed differences in the radiologists' perceptions of the image quality of the three displays, significant differences in the accuracy did not occur. The main effect on the variability of the proportions of correctly classified cases did not come from the display factor. This study confirms previous findings that medical-grade displays could be replaced by consumer-grade color displays with the same image quality.

Assuntos

Apresentação de Dados/economia , Radiografia Torácica/economia , Radiografia Torácica/instrumentação , Telerradiologia/economia , Telerradiologia/instrumentação , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/instrumentação , Humanos , Intensificação de Imagem Radiográfica/economia , Intensificação de Imagem Radiográfica/instrumentação , Software , Ecrans Intensificadores para Raios X/economia

RESUMO

OBJECTIVE: To evaluate the effectiveness of alcohol-based handrubs (ABH) in reducing acute diarrheal diseases (ADD) and acute respiratory infections (ARI) among children 1-5 years of age in childcare centers with limited tap water. METHODS: This was the first cluster-randomized controlled trial in a developing country. The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centers/794 children); or to continue existing handwashing practices (control arm: 21 centers/933 children). ADD and ARI cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models. RESULTS: Child-days of surveillance totaled 336 038. Loss to follow up was 14.5%. For both ADD and ARI, there were no differences in hazard ratios during the first trimester of the study. In the second and third trimesters, significant reductions in the risk of ADD were found in the intervention compared to control arm (HR = 0.55, P < 0.001 and HR = 0.44, P < 0.001, respectively). There were also significant risk reductions for ARI in the second trimester (HR = 0.80, P < 0.05) and in the third trimester (HR = 0.69, P < 0.001). No adverse events occurred. CONCLUSIONS: ABH effectively prevent ADD and ARI, and are safe. Colombia's national public health policies for prevention of these diseases should include use of ABH, especially in settings where handwashing with soap and water is limited by water availability.

Assuntos

Controle de Doenças Transmissíveis , Desinfecção das Mãos , Criança , Pré-Escolar , Colômbia , Feminino , Humanos , Lactente , Masculino

RESUMO

OBJECTIVE: To evaluate the effectiveness of alcohol-based handrubs (ABH) in reducing acute diarrheal diseases (ADD) and acute respiratory infections (ARI) among children 1-5 years of age in childcare centers with limited tap water. METHODS: This was the first cluster-randomized controlled trial in a developing country. The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centers/794 children); or to continue existing handwashing practices (control arm: 21 centers/933 children). ADD and ARI cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models. RESULTS: Child-days of surveillance totaled 336 038. Loss to follow up was 14.5%. For both ADD and ARI, there were no differences in hazard ratios during the first trimester of the study. In the second and third trimesters, significant reductions in the risk of ADD were found in the intervention compared to control arm (HR = 0.55, P < 0.001 and HR = 0.44, P < 0.001, respectively). There were also significant risk reductions for ARI in the second trimester (HR = 0.80, P < 0.05) and in the third trimester (HR = 0.69, P < 0.001). No adverse events occurred. CONCLUSIONS: ABH effectively prevent ADD and ARI, and are safe. Colombia's national public health policies for prevention of these diseases should include use of ABH, especially in settings where handwashing with soap and water is limited by water availability.

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OBJETIVO: Evaluar la eficacia del uso de antisépticos para las manos a base de alcohol en la disminución de las enfermedades diarreicas agudas y las infecciones respiratorias agudas en niños de 1 a 5 años de edad en los centros de atención infantil donde el lavado de las manos con agua y jabón no es factible. MÉTODOS. El presente fue el primer ensayo controlado y aleatorizado por conglomerados llevado a cabo en un país en desarrollo. El estudio tuvo lugar en 42 centros de atención infantil con disponibilidad de agua esporádica y limitada ubicados en seis ciudades de Colombia. Se asignó aleatoriamente a los participantes a usar antisépticos a base de alcohol como complemento del lavado de las manos (grupo de intervención: 21 centros/794 niños) o a continuar llevando a cabo las prácticas de lavado de las manos habituales (grupo de referencia: 21 centros/933 niños). Los casos de enfermedades diarreicas agudas e infecciones respiratorias agudas fueron identificados mediante la notificación de los signos y síntomas de enfermedad por los maestros. Se efectuó un seguimiento de los acontecimientos adversos. Se obtuvieron las razones de riesgos instantáneos (HR) usando modelos de regresión multivariante de riesgos proporcionales de Cox con fragilidad compartida. RESULTADOS: Se alcanzó un total de 336 038 niño-días de vigilancia. La pérdida de contacto durante el seguimiento fue de 14,5%. Durante el primer trimestre del estudio no hubo diferencias en las razones de riesgo para las enfermedades diarreicas agudas ni para las infecciones respiratorias agudas. En el segundo y tercer trimestres se encontraron disminuciones significativas del riesgo de enfermedades diarreicas agudas en el grupo de intervención en comparación con el grupo de referencia (HR = 0,55, P < 0,001 y HR = 0,44, P < 0,001, respectivamente). Para las infecciones respiratorias agudas se observaron disminuciones significativas del riesgo durante el segundo trimestre (HR = 0,80, P ...

Assuntos

Humanos , Feminino , Lactente , Pré-Escolar , Criança , Controle de Doenças Transmissíveis , Desinfecção das Mãos , Colômbia

Assuntos

Desinfecção das Mãos , Anti-Infecciosos Locais , Gastroenteropatias , Infecções Respiratórias , Diarreia , Etanol , Pré-Escolar , Países em Desenvolvimento , Ensaios Clínicos Controlados Aleatórios como Assunto , Colômbia , Desinfecção das Mãos , Anti-Infecciosos Locais , Gastroenteropatias , Infecções Respiratórias , Diarreia , Etanol , Pré-Escolar , Países em Desenvolvimento , Ensaios Clínicos Controlados Aleatórios como Assunto , Colômbia , Controle de Doenças Transmissíveis , Desinfecção das Mãos

RESUMO

OBJETIVO: Describir los diferentes tipos de glaucoma infantil examinados y tratados en la Fundación Oftalmológica de Santander (FOS) Bucaramanga, COLOMBIA, su presentación clínica y evaluar los resultados quirúrgicos de las diferentes técnicas utilizadas: trabeculotomía, trabeculectomía y la combinación ambos tratamientos. DISEÑO: Se realizó una revisión retrospectiva y descriptiva de todos los casos de glaucoma infantil atendidos en la FOS entre Enero de 1994 y Enero de 1999, se analizaron los diferentes tipos de glaucoma infantil, cuadro clínico y sus resultados quirúrgicos. PARTICIPANTES: 50 ojos de 34 pacientes feuron incluidos en este estudio, 23 ojos tenían Glaucoma congénito primario(GCP), 7 ojos tenían Glaucoma juvenil(GJ), 6 ojos tenían Glaucomas asociados a otras anomalías congénitas(GAPC), 12 ojos tenían Glaucoma secundario(GS). INTERVENCIONES: Las cirugías realizadas fueron trabeculotomía 27 ojos, trabeculectomía con mitomicina en 13 ojos, trabeculotomía con trabeculectomía 5 ojos y otras, 5 ojos. MEDIDAS DE LOS RESULTADOS: Motivo de consulta, edad de consulta y de cirugía, tipo de glaucoma, presión intraocular pre y postoperatoria, agudezas visuales, éxito del tratamiento quirúrgico empleado y complicaciones. RESULTADOS: Los principales motivos de consulta muestran que la opacidad corneal estaba presente en el 21 por ciento de los pacientes; el lagrimeo, la fotofobia y disminución de la agudeza visual en el 11.8 porciento. Las edades de consulta y cirugía fueron en promedio 20.7 y 25.4 meses respectivamente, en los casos de GCP; y 165.6 meses para GJ; 20 y 22 meses para GAPC y 83.6 y 84 meses apra GS. El promedio de la presión intraocular (PIO) global se redujo de un nivel preoperatorio de 30mm de Hg a 16.5 mm de HG postoperatoriamente, con una presión menor de 21 mmm de Hg en el 72 porciento de los pacientes. Agudezas Visuales mayores de 20/60 se alcanzaron en el 50 porciento de los pacientes verbales. El éxito de la trabeculotomía en el control de la PIO, con o sin tratamiento adicional, fue del 63.2 porciento en el grupo de GCP, 60 por ciento en el GJ, 100 porciento en los GAPC. El éxito de la trabeculectomía fue del 100 porciento en GJ, 50 porciento en GAPC y 55.6 porciento en GS; y cuando se combinaron las técnicas, fue de 100 por ciento para GC Y GS. Los mejores resultados se dan en GCP por su temprana edad de consulta. La combinación de los procedimientos dan mejores resultados y puede ser el tratamiento de elección en nuestra población

Assuntos

Glaucoma , Pressão Intraocular , Trabeculectomia