RESUMO
PURPOSE: To determine the displacement of needles (ND) and its impact in the outcome of initial and locally advanced prostate cancer treated with conventional external beam radiation therapy (EBRT) and fractionated transrectal ultrasound-guided high-dose-rate afterloading brachytherapy (HDR-BT) as a boost. METHODS AND MATERIALS: From 03/97 to 08/98 a total of 47 patients were eligible for study entry. Patients with 1992 AJCC clinical stage T3a or less and prostatic volume =60 cm(3) were eligible. Prior to HDR-BT, all patients had a course of pelvic localized EBRT up to a median dose of 46 Gy (range 45-50.4). RESULTS: Median age was 68 years (range 47-83) and median follow-up 48 months (range 36-53). Minimal or no needle displacement occurred in 17% (8/47) of patients. There were 61.7% (29/47) of patients who needed one correction and 21.3% (10/47) who needed two corrections. There were no correlations with ND (p = 0.130) and times of ND (p = 0.295) occurrence with bNED. The crude and actuarial biochemical controls (bNED) in 53 months for all patients were 87.2 and 82.3% respectively. Actuarial bNED after 4 years in patients without and with ND were 75 and 89.7% (p = 0.254). DISCUSSION: There are many advantages when HDR-BT is used, but the most important ones are the capability of on-line dosimetry and quality control. The procedure is very conformal, with dose-volume histograms representing the administered dose, but we still need to wait for results of phase III open trials that analyze HDR-BT and conformal therapy.
Assuntos
Adenocarcinoma/radioterapia , Braquiterapia , Neoplasias da Próstata/radioterapia , Adenocarcinoma/mortalidade , Idoso , Braquiterapia/métodos , Seguimentos , Humanos , Masculino , Neoplasias da Próstata/mortalidade , Dosagem Radioterapêutica , Radioterapia de Alta Energia , Fatores de TempoRESUMO
PURPOSE: This retrospective analysis aims to report results of patients with cervix cancer treated by external beam radiotherapy (EBR) and high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS: From September 1992 to December 1996, 138 patients with FIGO Stages II and III and mean age of 56 years were treated. Median EBR to the whole pelvis was 45 Gy in 25 fractions. Parametrial boost was performed in 93% of patients, with a median dose of 14.4 Gy. Brachytherapy with HDR was performed during EBR or following its completion with a dose of 24 Gy in four weekly fractions of 6 Gy to point A. Median overall treatment time was of 60 days. Patient age, tumor stage, and overall treatment time were variables analyzed for survival and local control. Cumulative biologic effective dose (BED) at rectal and bladder reference points were correlated with late complications in these organs and dose of EBR at parametrium was correlated with small bowel complications. RESULTS: Median follow-up time was 38 months. Overall survival, disease-free survival, and local control at 5 years was 53.7%, 52.7%, and 62%, respectively. By multivariate and univariate analysis, overall treatment time up to 50 days was the only statistically significant adverse variable for overall survival (p = 0.003) and actuarial local control (p = 0.008). The 5-year actuarial incidence of rectal, bladder, and small bowel late complications was 16%, 11%, and 14%, respectively. Patients treated with cumulative BED at rectum points above 110 Gy(3) and at bladder point above 125 Gy(3) had a higher but not statistically significant 5-year actuarial rate of complications at these organs (18% vs. 12%, p = 0.49 and 17% vs. 9%, p = 0.20, respectively). Patients who received parametrial doses larger than 59 Gy had a higher 5-year actuarial rate of complications in the small bowel; however, this was not statistically significant (19% vs. 10%, p = 0.260). CONCLUSION: This series suggests that 45 Gy to the whole pelvis combined with four fractions of 6 Gy to point A with HDR brachytherapy is an effective and safe fractionation schedule in the treatment of Stages II and III cervix cancer if realized up to 50 days. To decrease the small bowel complications, we decreased the superior border of the parametrial fields to the S2-S3 level and the total dose to 54 Gy.
Assuntos
Braquiterapia/métodos , Carcinoma/radioterapia , Teleterapia por Radioisótopo , Dosagem Radioterapêutica , Neoplasias do Colo do Útero/radioterapia , Braquiterapia/efeitos adversos , Carcinoma/mortalidade , Fracionamento da Dose de Radiação , Relação Dose-Resposta à Radiação , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Intestino Delgado/efeitos da radiação , Tábuas de Vida , Pessoa de Meia-Idade , Metástase Neoplásica , Aceleradores de Partículas , Pelve/efeitos da radiação , Lesões por Radiação/epidemiologia , Lesões por Radiação/etiologia , Teleterapia por Radioisótopo/efeitos adversos , Reto/efeitos da radiação , Estudos Retrospectivos , Inquéritos e Questionários , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária/efeitos da radiação , Neoplasias do Colo do Útero/mortalidadeRESUMO
MOTIVATION: The importance of the various kinds of repetitive nucleotide sequences for the workings of bacterial DNA has been widely recognized. This work is concerned with the distribution of a particular group of repetitive sequences, the short-sequenced interrupted extragenic palindromes, on the genetic maps of Escherichia coli K-12, Haemophilus influenzae Rd and Neisseria meningitidis Z2491 and MC58. A tool has been developed based upon a statistical hypothesis test taking into account the markovian structure of random sequences in order to determine the non-random character of extragenic palindromes. RESULTS: Totals of 7631, 12904, 4722 and 5477 non-random short interrupted palindromes have been found on the E.coli, H.influenzae, and N.meningitidis serogroup A and serogroup B genomes, respectively. Their distribution patterns on the respective genomes vary according to the bacterial species considered. Based on their position on the genome, palindromes could be distinguished as those which integrate longer, repetitive sequences; those which stand in isolation, and still others are associated to specific genome sites. AVAILABILITY: The complete list of the observed palindromes is available at the site http://www/lncc.br/~atrv. CONTACT: atrv@lncc.br
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DNA Bacteriano/genética , Escherichia coli/genética , Haemophilus influenzae/genética , Neisseria meningitidis/genética , Biologia Computacional , Técnicas Genéticas , Genoma Bacteriano , Análise de Regressão , Sequências Repetitivas de Ácido NucleicoRESUMO
INTRODUCTION: The liveborn children were classified by birth weight, maternal age, maternal education level and type of delivery in the light of the importance of discovering the conditions of birth for the planning of mother-child actions. METHODOLOGY: The population studied consisted of 2,315 liveborn children from the municipality of Passos (MG), 2,311 of whom were born in hospitals and 4 at home, although these latter were immediately taken to hospital. The data refer to the set of children born alive in the municipality from April 12, 1995 to April 30, 1996. Data collection was facilitated by the implantation of the Subsystem of Information about Liveborn Children (SINASC) during that period. The instrument used for data collection was the Declaration of Liveborn Children, an official document of SINASC. The data were fed into a computer and the variables of interest for the present study were surveyed. RESULTS: The data showed that: the incidence of low birth weight was 10%, 31.1% of the mothers were between 20 and 24 years old and 19.5% were younger than 20. With respect to educational level, 68.6% of the mothers had received incomplete primary schooling and 5.7% had higher education. The proportion of cesarean sections was 59.1% and the proportion of spontaneous delivery 40.9%.
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Sistemas de Informação Hospitalar , Hospitais , Recém-Nascido , Adulto , Declaração de Nascimento , Peso ao Nascer , Brasil , Parto Obstétrico , Escolaridade , Feminino , Humanos , Idade Materna , GravidezRESUMO
The life cycle of Lagochilascaris minor was studied using material collected from human lesion and applying the experimental model: rodents (mice, hamsters), and carnivores (cats, dogs). In mice given infective eggs, orally, hatch of the third stage larvae was noted in the gut wall, with migration to liver, lungs, skeletal musculature and subcutaneous tissue becoming, soon after, encysted. In cats infected with skinned carcasses of mice (60 to 235 days of infection) it was observed: hatch of third stage larvae from the nodules (cysts) in the stomach, migration through the oesophagus, pharynx, trachea, related tissues (rhino-oropharynx), and cervical lymph nodes developing to the mature stage in any of these sites on days 9-20 post inoculation (P.I.). There was no parasite development up to the mature stage in cats inoculated orally with infective eggs, which indicates that the life cycle of this parasite includes an obligatory intermediate host. In one of the cats (fed carcass of infected mice) necropsied on day 43 P.I., it was observed the occurrence of the self-infective cycle of L. minor in the lung tissues and in the cervical region which was characterized by the finding of eggs in different stages of development, third stage larvae and mature worms. It's believed that some component of the carnivore gastrointestinal tracts may preclude the development of third stage larvae from L. minor eggs what explains the interruption of the life cycle in animals fed infective eggs. It's also pointed out the role of the intermediate host in the first stages of the life cycle of this helminth.