RESUMO
BACKGROUND: Pelvic recurrences from previously irradiated gynecological cancer lack solid evidence for recommendation on salvage. METHODS: A total of 58 patients were included in this clinical analysis. Salvage surgery was performed for locoregional relapse within previously irradiated pelvic area after initial surgery and adjuvant radiotherapy or radical external beam radiotherapy. The primary tumor diagnosis included cervical cancer (n = 47, 81%), uterine cancer (n = 4, 7%), and other types (n = 7, 12%). Thirty-three patients received adjuvant IOERT (1984-2000) at a median dose of 15 Gy (range 10-20 Gy) and 25 patients received adjuvant PHDRB (2001-2016) at a median dose of 32 Gy (range 24-40 Gy) in 6, 8, or 10 b.i.d. fractions. RESULTS: The median follow-up was 5.6 years (range 0.5-14.2 years). Twenty-nine (50.0%) patients had positive surgical margins. Grade ≥ 3 toxic events were recorded in 34 (58.6%) patients. The local control rate at 2 years was 51% and remained stable up to 14 years. Disease-free survival rates at 2, 5, and 10 years were 17.2, 15.5, and 15.5%, respectively. Overall survival rates at 2, 5, and 10 years were 58.1, 17.8, and 17.8%, respectively. CONCLUSIONS: IOERT and PHDRB account for an effective salvage in oligorecurrent gynecological tumors. Patients with previous pelvic radiation suitable for salvage surgery and at risk of inadequate margins could benefit from adjuvant reirradiation in form of IOERT or PHDRB. However, the rate of severe grade ≥ 3 toxicity associated with the entire treatment program is relevant and needs to be closely counterbalanced against the expected therapeutic gain.
Assuntos
Braquiterapia , Elétrons/uso terapêutico , Neoplasias dos Genitais Femininos/radioterapia , Recidiva Local de Neoplasia/radioterapia , Reirradiação/métodos , Terapia de Salvação/métodos , Adulto , Idoso , Braquiterapia/efeitos adversos , Intervalo Livre de Doença , Elétrons/efeitos adversos , Feminino , Neoplasias dos Genitais Femininos/mortalidade , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Cuidados Intraoperatórios , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/cirurgia , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Reirradiação/efeitos adversos , Terapia de Salvação/efeitos adversos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
PURPOSE: To investigate whether bon e metastases-directed stereotactic body radiation therapy (SBRT) delays the emergence of castration resistance in patients with oligometastatic prostate cancer (OPC). METHODS AND MATERIAL: OPC is usually managed with androgen deprivation therapy (ADT). Migration to castration-resistant prostate cancer will inevitably occur in the majority of these patients. There are several strategies aimed to delay the emergence of castration resistance including intermittent ADT, second generation antiandrogens (abiraterone, enzalutamide) or metastases-directed SBRT. The present report describes two cases of patients with OPC that received SBRT 24 Gy/3Rx to the solitary bony lesion after ADT failure. RESULTS: Both cases showed complete and durable biochemical response for 13 and 17 months, respectively. CONCLUSIONS: SBRT can be used to delay the emergence of castration resistance and the need for systemic therapy when used after ADT failure.
Assuntos
Adenocarcinoma/radioterapia , Neoplasias Ósseas/radioterapia , Neoplasias de Próstata Resistentes à Castração/radioterapia , Radiocirurgia/métodos , Adenocarcinoma/secundário , Antagonistas de Androgênios/uso terapêutico , Antineoplásicos/uso terapêutico , Neoplasias Ósseas/secundário , Resistencia a Medicamentos Antineoplásicos/efeitos da radiação , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Próstata Resistentes à Castração/patologia , Terapia de Salvação/métodosRESUMO
PURPOSE: A joint analysis of data from centers within the intraoperative radiotherapy (IORT)-Spanish cooperative initiative was performed to investigate the main contributions of IORT to the multidisciplinary treatment of trunk-wall soft-tissue sarcoma (TW-STS). MATERIALS AND METHODS: Patients with a histologic diagnosis of TW-STS (primary tumor 53 %; locally recurrent 47 %) with absence of distant metastases, undergoing surgery with radical intent and IORT (median dose 12.5 Gy) were considered eligible for participation in this study. In addition, all primary tumors received external-beam radiotherapy (median dose 50 Gy). RESULTS: From 1986 to 2012, a total of 68 patients were analyzed in the study from three Spanish institutions. With a median follow-up time of 53 months (range 4-316), 5-year local control (LC) was 58 %. Five-year IORT in-field control, disease-free survival (DFS) and overall survival were 70, 45 and 51 %, respectively. On multivariate analysis, only microscopically involved margin (R1) resection status retained significance in relation to LC (HR 3.97, p < 0.001). In regard to IORT in field control, incomplete resection (HR 3.23, p = 0.008) and recurrent disease status (HR 2.52, p = 0.04) retained a significant association in multivariate analysis. CONCLUSION: From this joint analysis emerges the fact that margin and disease status influences local and central control, but DFS remains modest, given the high risk of distant metastases. Intensified local treatment needs to be tested in the context of more efficient concurrent, neo-, and adjuvant systemic therapy.
Assuntos
Terapia Combinada/métodos , Radioterapia/métodos , Sarcoma/radioterapia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Período Intraoperatório , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sarcoma/mortalidade , Sarcoma/cirurgiaRESUMO
Seven metallo-ß-lactamase-positive isolates of Serratia marcescens were recovered from three patients hospitalized in a neonatal ward in an Argentinean hospital during the period July-September 2011. All the isolates were multidrug-resistant, they belonged to a single clone, and carried a blaVIM-16 -containing class I integron structure. This represents the first nosocomial outbreak of metallo-ß-lactamase in Enterobacteriaceae in Argentina.
Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Serratia/epidemiologia , Serratia marcescens/enzimologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Argentina/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Recém-Nascido , Masculino , Epidemiologia Molecular , Tipagem Molecular , Infecções por Serratia/microbiologia , Serratia marcescens/isolamento & purificaçãoRESUMO
BACKGROUND AND PURPOSE: Radiation pneumonitis (RP) is a restricting complication of non-small-cell lung cancer irradiation. Three-dimensional conformal radiotherapy (3D-CRT) represents an advance because exposure of normal tissues is minimised. This study tries to identify prognostic factors associated with severe RP. MATERIALS AND METHODS: Eighty patients with stage IIIA (20%) and IIIB (80%) NSCLC treated with cisplatin- based induction chemotherapy followed by concurrent chemotherapy and hyperfractionated 3D-CRT (median dose: 72.4 Gy, range: 54.1-85.9) were retrospectively evaluated. Acute and late RP were scored using RTOG glossary. Potential predictive factors evaluated included clinical, therapeutic and dosimetric factors. The lungs were defined as a whole organ. Univariate and multivariate analyses were performed. RESULTS: Early and late RP grade>or=3 were observed in two patients (2%) and 10 patients (12%), respectively. Five patients (6%) died of pulmonary toxicity, 3 of whom had pre-existing chronic obstructive pulmonary disease (COPD). Median time to occurrence of late RP was 4.5 months (range: 3-8). Multivariate analysis showed that COPD (OR=10.1, p=0.01) and NTCPkwa>30% (OR=10.5, p=0.007) were independently associated with late grade>or=3 RP. Incidence of RP>or=3 grade for patients with COPD and/or NTCPkwa>30% was 25% vs. 4% for patients without COPD and NTCPkwa<30% (p=0.01). Risk of severe RP was higher for patients with COPD and/or NTCPkwa>30% (OR=7.3; CI 95%=1.4-37.3, p=0.016). CONCLUSIONS: COPD and NTCP are predictive of severe RP. Careful medical evaluation and meticulous treatment planning are of paramount importance to decrease the incidence of severe RP.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/radioterapia , Neoplasias Pulmonares/radioterapia , Pneumonite por Radiação/diagnóstico , Radioterapia Conformacional/efeitos adversos , Adulto , Idoso , Carcinoma Pulmonar de Células não Pequenas/complicações , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Terapia Combinada , Relação Dose-Resposta a Droga , Relação Dose-Resposta à Radiação , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pneumonite por Radiação/epidemiologia , Pneumonite por Radiação/etiologia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Enteral feeding is the most common and preferred modality for providing nutritional support to hospital patients with a functional gastrointestinal tract that can not satisfy their nutritional requirements. Nevertheless, enteral feeding may be an important cause of bacterial infection. The aim of this study was to evaluate the microbial contamination level of enteral feedings distributed in Costa Rican hospitals. A total of 124 samples of enteral feeding, coming from five different hospitals from San José, Costa Rica, were evaluated during the second semester of 1997 and first of 1998 for the presence and identification of total and fecal coliforms, Pseudomonas sp. and Listeria sp. A subpopulation of the Pseudomonas isolated was analyzed for their antibiotic susceptibility patterns. The concentration of Gram negative rods in the samples of enteral feeding solutions ranged from 10(3) to 10(7) CFU/mL, markedly exceeding the permissible level (10(2) CFU/mL or less). The coliforms most frequently isolated included Enterobacter cloacae, Escherichia coil, Serratia sp. and Klebsiella pneumoniae. Pseudomonas sp. was isolated in more than 70 per cent of the samples made from commercial based solutions, fruits and vegetables. P. aeruginosa and P. fluorescens were the species most frequently isolated. Listeria sp. was not isolated from enteral solutions samples. The results obtained demonstrate that it is urgent to assure strict hygiene during the preparation and handling of all enteral feed in order to avoid bacterial growth. The implementation of HACCP (Hazard Analysis and Critical Control Points) system will be required in a near future for better quality control of enteral nutrition mixtures.
Assuntos
Humanos , Alimentos Formulados/microbiologia , Nutrição Enteral , Enterobacteriaceae/isolamento & purificação , Microbiologia de Alimentos , Pseudomonas/isolamento & purificação , Costa Rica , Serviço Hospitalar de NutriçãoRESUMO
The nutritional and microbiological quality of 80 soybean sausage samples (50% frankfurter and 50% sausage mortadela) was studied. On average, the protein content was 17.5 g/100 g in sausage mortadela and 20 g/100 g in frankfurter. The mean total fat content was 5.5 g/100 g for both products. However when products of different manufacture industries were compared, a highly significant difference (p = 0.0000) in the fatty acids speciation between both groups and between samples of the same product were found. Bigger differences were found in the content of palmitic acid (C16:0), oleic acid (C18:1) and linoleic acid (C18:2). Cholesterol was not detected in samples analyzed. On average the atherogenicity index was 0.55 for sausage mortadela and 0.59 for frankfurter. A consumption of 25 grams of of soybean protein from these sausages can bring an intake of saturated fatty acids between 20-90% of the daily recommendation. Likewise, they can supply between 12-70% of the recommended daily polyunsaturated fatty acids. These variations are owing to the big difference in fatty acids speciation in each sausage brand. Around 20% of soybean sausages studied showed total coliform levels above 10(4)/g, being more frequent in sausage mortadela. Also 60% of this product and 10% of frankfurters showed psychrotroph levels of 10(6)/g. Clostridium perfringens, in levels above 10(2)/g was evidenciated in 5% of samples, Escherichia coli was not isolated from them. The findings of this study suggest the urgent need for implementing a quality control system for soybean sausages, before national health authorities consider to support nutritional campainings that promote their consumption.
Assuntos
Conservação de Alimentos , Glycine max/química , Glycine max/microbiologia , Clostridium perfringens/isolamento & purificação , Costa Rica , Enterobacteriaceae/isolamento & purificação , Ácidos Graxos/análise , Ácidos Graxos Insaturados/análise , Valor Nutritivo , Proteínas de Soja/análiseRESUMO
PURPOSE: To determine the prevalence of coronary heart disease (CHD) risk factors among Costa Rican adolescents. METHODS: The prevalence of high blood pressure, obesity, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, sedentarism, family history of premature CHD, saturated fat intake, diabetes mellitus, and cigarette smoking was determined in 328 adolescents, ages 12-18 years (167 males, 161 females), randomly selected from San José's urban and rural high schools. RESULTS: Over 70% of the adolescents studied presented one risk factor for CHD. While the prevalence of family history of premature CHD, sedentarism, and cigarette smoking was significantly higher in urban adolescents, low HDL cholesterol and high blood pressure were significantly higher in rural adolescents. Girls demonstrated a significantly higher prevalence of sedentarism and LDL cholesterol >2.9 mmol/L than boys. Elevated saturated fat intake (>10% total energy) was found in 37% of the adolescents. CONCLUSIONS: The prevalence of CHD risk factors among Costa Rican adolescents is high; particularly of saturated fat intake, sedentarism and low HDL-C levels. Primary prevention programs are urgently needed, especially among female adolescents and in the urban areas, to reduce the increased prevalence of CHD mortality among Costa Rican adults.
Assuntos
Doença das Coronárias/epidemiologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Criança , Colesterol/sangue , Doença das Coronárias/sangue , Doença das Coronárias/etiologia , Doença das Coronárias/mortalidade , Costa Rica/epidemiologia , Complicações do Diabetes , Gorduras na Dieta/administração & dosagem , Feminino , Humanos , Hipertensão/complicações , Estilo de Vida , Masculino , Obesidade/complicações , Prevalência , Análise de Regressão , Fatores de Risco , Estudos de Amostragem , Fumar/efeitos adversosRESUMO
Enteral feeding is the most common and preferred modality for providing nutritional support to hospital patients with a functional gastrointestinal tract that can not satisfy their nutritional requirements. Nevertheless, enteral feeding may be an important cause of bacterial infection. The aim of this study was to evaluate the microbial contamination level of enteral feedings distributed in Costa Rican hospitals. A total of 124 samples of enteral feeding, coming from five different hospitals from San José, Costa Rica, were evaluated during the second semester of 1997 and first of 1998 for the presence and identification of total and fecal coliforms, Pseudomonas sp. and Listeria sp. A subpopulation of the Pseudomonas isolated was analyzed for their antibiotic susceptibility patterns. The concentration of Gram negative rods in the samples of enteral feeding solutions ranged from 10(3) to 10(7) CFU/mL, markedly exceeding the permissible level (10(2) CFU/mL or less). The coliforms most frequently isolated included Enterobacter cloacae, Escherichia coil, Serratia sp. and Klebsiella pnuemoniae, Pseudomonas sp. was isolated in more than 70% of the samples made from commercial based solutions, fruits and vegetables. P. aeruginosa and P. fluorescens were the species most frequently isolated. Listeria sp. was not isolated from enteral solutions samples. The results obtained demonstrate that it is urgent to assure strict hygiene during the preparation and handling of all enteral feed in order to avoid bacterial growth. The implementation of HACCP (Hazard Analysis and Critical Control Points) system will be required in a near future for better quality control of enteral nutrition mixtures.
Assuntos
Contaminação de Medicamentos , Nutrição Enteral , Enterobacteriaceae/isolamento & purificação , Listeria/isolamento & purificação , Pseudomonas/isolamento & purificação , Costa Rica , Manipulação de Alimentos , Hospitais , Higiene , Controle de QualidadeRESUMO
The presence of total coliforms, Escherichia coli and Listeria sp. was evaluated in 65 samples of enteral nutrition formulas. In more than the 75% of the samples made up from cooked vegetables, fruits or meat broth, the score level of total coliforms was of 10(4) UFC/g. In 12-31% of the different enteral food formula, E. coli was isolated in levels ranging form 3.0 x 10(2) to 2.1 x 10(4) UFC/g. Enteral nutrition formulas made out of fruits and those elaborated with meal broth presented this agent more frequently and in bigger quantities. Listeria sp. was isolated in 17% of the fruit preparations and in enteral formulas made with milk. L. grayi, L welshimeri and L. innocua were the species found.
Assuntos
Nutrição Enteral , Enterobacteriaceae/isolamento & purificação , Escherichia coli/isolamento & purificação , Microbiologia de Alimentos , Listeria/isolamento & purificação , Costa Rica , Serviço Hospitalar de NutriçãoRESUMO
We assessed the presence of rotavirus and Hepatitis A virus in lettuce bought in farmer markets from San José, Costa Rica, during months of low (April-June) and high (December-January) incidence of diarrhea associated with rotavirus, respectively. Lettuce samples were pooled and evaluated for rotavirus by enzyme-linked immunosorbent assay (ELISA) and for Hepatitis A virus by radioimmunoassay, polymerase chain reaction (PCR) and electron microscope. Three sample pools, collected during the period of high prevalence of diarrhea, were positive for rotavirus by ELISA and in one of them rotavirions were visualized by electron microscopy. Two samples pools collected during the same period were positive for Hepatitis A virus as shown by PCR. In almost all the pools fecal coliform bacteria were detected by cultivation and bacteriophages were visualized by electron microscopy.
Assuntos
Hepatovirus/isolamento & purificação , Lactuca/microbiologia , Rotavirus/isolamento & purificação , Ensaio de Imunoadsorção Enzimática , Reação em Cadeia da Polimerase , RadioimunoensaioRESUMO
This study reports the occurrence of some pathogenic microorganisms in vegetable consumed on a daily basis by Costa Ricans. Cryptosporidium sp. oocysts were found in 5.2% (4/80) of cilantro leaves, in 8.7% (7/80) of cilantro roots and 2.5% of lettuce samples. A 1.2% (1/80) incidence was found in other vegetables samples (carrot, cucumber, radish and tomatoe). Oocysts of this parasite were absent in cabbage. Giardia intestinalis was only detected in 5.2% (4/80) of cilantro leaves and in 2.5% (2/ 80) of cilantro roots. Entamoeba histolytica cysts were found in 6.2% (5/80) of cilantro leaves, in 2.5% (2/80) cilantro roots, in 3.8% (3/80) lettuce and in 2.5% (2/80) radish samples. At least a 2% incidence of this amoeba was found in other vegetable samples (carrot, cucumber, cabbage and tomatoe). Listeria monocytogenes was isolated in 20% (10/50) of the samples of cabbage salad. Hepatitis A virus and Rotavirus were evidenciated in three of the lettuce pooles, suggesting that at least three of the samples were contaminated with these viruses.
Assuntos
Microbiologia de Alimentos , Parasitologia de Alimentos , Verduras/microbiologia , Verduras/parasitologia , Animais , Costa Rica , Cryptosporidium , Entamoeba histolytica , Giardia lamblia , Hepatovirus , Humanos , Listeria monocytogenes , RotavirusRESUMO
In Costa Rica, a total of 640 samples from eight different vegetables used for raw consumption, were analyzed for the presence of intestinal parasites and fecal coliforms. Eighty samples of each vegetable were analyzed, forty during the dry season and forty in the rainy. A greater, but unsignificant (p > 0.05) level of fecal coliforms was found during the dry season. Levels of Escherichia coli, were higher (p < 0.05) during the dry season in lettuce (Latuca sativa) and cilantro (Coleandrum sativum) leaves. Cysts of Endolimax nana, Entamoeba coli, Entamoeba histolytica, Giardia intestinalis and Cryptosporidium sp. were found in all vegetables. The greater percentage of positive samples was found during the dry season, although these relation was only corroborated (p < 0.05) in radish (Raphanus sativus) and cilantro leaves. Only lettuce and cilantro levels showed a positive linear correlation (p < 0.05) between occurrences of intestinal parasites and fecal coliforms.
Assuntos
Microbiologia de Alimentos , Parasitologia de Alimentos , Enteropatias Parasitárias/epidemiologia , Parasitos/isolamento & purificação , Verduras/microbiologia , Verduras/parasitologia , Animais , Costa Rica/epidemiologia , Cryptosporidium/isolamento & purificação , Endolimax/isolamento & purificação , Entamoeba/isolamento & purificação , Entamoeba histolytica/isolamento & purificação , Escherichia coli/isolamento & purificação , Giardia lamblia/isolamento & purificação , Enteropatias Parasitárias/etiologia , Estações do AnoRESUMO
Two hundred samples of pasteurized milk collected from nutrition services of ten hospitals in Costa Rica, were evaluated for the presence of antibiotics residues. Bacterial inhibitory growth test were used to detect inhibitory substances. It was found that 13% (N = 200) of the samples were contaminated, with variations from 0% to 35% (N = 20) in the different hospitals tested. The larger number of positive samples corresponds to lactic industries that supply 70% of the hospital's requirements of pasteurized milk.
Assuntos
Antibacterianos/química , Serviço Hospitalar de Nutrição , Leite/química , Animais , Costa RicaRESUMO
The sanitary quality of street sold fruits was analyzed during the period from march 1990 thru march 1993 in San Jose, Costa Rica. It looked for the presence of Salmonella spp. Shigella spp., Escherichia coli as well as fecal coliforms in natural refreshments, fruit salads and the fruits most frecuently expended on streets, either in slices as the pineapple (Ananas comosus), papaya (Carica papaya), non-ripe mangoe (Mangifera indica) and watermelon (Citrullus vulgaris) and those that can be eaten without peeling, like nances (Byrsonima crassifolia) and jocotes (Spondias purpurea). 25 samples of each fruit, 50 natural refreshments and 50 fruit salads were processed according to rinse solution method, and the bacteriological determination was based in the methodology described by Vanderzant & Splittstoesser and the Bacteriological Analytical Manual. In the same way, it was used the Most Probable Number for 5 tubes described in the Standar Methods of Water and Wastewater in orden to analyze 15 samples of ready to use water by the fruit hawker. The nutritional value was studied according to the food composition tables for Costa Rica, Latin America and USA. The results show that more than 30% of fruit samples, 70% of natural refreshments and 96% of fruit salad presented fecal coliforms. Same time, all of them present important contamination indexes with E. coli. Salmonella spp. and Shigella spp. were not isolated. The water analysis revelead that 53% contained fecal coliforms, probably due to the lack of hygiene in the utensils used to collect water. The nutritional evaluation shows that fruit portions (except watermelon) satisfy more than 100% of the diary recommendation of vitamin C (60 mg) and 4-7% of the recommended ingestion of dietetic fiber (30g).
Assuntos
Dieta , Inspeção de Alimentos , Frutas/microbiologia , Costa Rica , Enterobacteriaceae/isolamento & purificação , Escherichia coli/isolamento & purificação , Valor Nutritivo , Estudos de Amostragem , Microbiologia da ÁguaRESUMO
The sanitary quality of 100 samples of salad and 100 samples of skinless fruits distributed by the Hospital Food Services were studied. Samples were processed according to rinse solution method, and the bacteriological determination was based in the methodology described by Vanderzant & Splittstoesser. The preparation scheme of each product was realized in order to analyze risks and determine the critical control points according to ICMSF (International Commission on Microbiological Specifications for Foods). Microbiological studies on the critical control points (total and fecal coliforms determinations) were done according to the surface analysis using the swab contact method as described by Vanderzant & Splittstoesser. Our results show that 93% of the salads and 65% of the fruits presented contamination of fecal origin. The hands of the operators and kitchen utensils also presented important fecal contamination indexes.