Hallazgos oculares y sist��micos en pacientes con linfomas coroideos

Els limfomes coroideus (LC) secundaris s��n freq��entment bilaterals i representen malaltia limfomatosa sist��mica disseminada. Generalment s��n limfomes de c��l���lules B grans d���alt grau (agressius). Els LC primaris s��n freq��entment unilaterals, generalment de c��l���lules B de baix grau i poc agressius. L���extensi�� extraocular ��s freq��ent. En tots dos tipus de LC, el tractament amb radioter��pia externa presenta excel���lents resultats. El LC primari aparentment t�� un millor pron��stic que el limfoma vitreoretini��. Per tant, ��s important identificar correctament tots dos tipus de limfomes ja que la difer��ncia en el pron��stic pot influir en el pla de tractament.

Relaci�� i valor pron��stic de la metilaci�� del promotor MGMT , amplificaci�� del EGFR i mutaci�� de l��� EGFRvIII en una s��rie de pacients amb glioblastoma.

Introducci��. La metilaci�� de l���enzim MGMT ��s un factor predictiu de resposta en pacients amb glioblastoma tractats amb alquilants, per�� el seu valor pron��stic s���est�� estudiant . Tanmateix, en el cas de l���amplificaci�� de l ���EGFR i la mutaci�� EGFRvIII no se s���ha demostrat cap mena de valor pron��stic ni predictiu. Objetius. Determinar la distribuci�� de la metilaci�� de l���enzim MGMT , amplificaci�� de l��� EGFR i mutaci�� EGFR vIII , l���asociaci�� entre ells i avaluar la superviv��ncia global i superviv��ncia lliure de progresi�� en relaci�� amb l���estat de metilaci�� del MGMT , amplificaci�� de l ���EGFR mutaci�� EGFR vIII . Material i m��todes. S���hi han determinat les variacions gen��tiques en una poblaci�� de 70 pacients amb glioblastoma i s���han relacionat, a m��s, amb la superviv��nciia global i temps a la progressi��. Resultats. La metilaci�� del MGMT , amplificaci�� de l��� EGFR i detecci�� de ���l EGFR vIII foren detectats en un 38,6 % , 50% y 25,7% DELS pacients , respectivament. No es va demostrar pas cap relaci�� entre l���estat de metilaci�� del MGMT i l���estat de l��� EGFR , a difer��ncia de la relaci�� entre l���amplificaci�� de l��� EGFR i la mutaci�� EGFRvIII. En l���an��lisi multivariant de superviv��ncia global i temps a la progressi��, els factors edat , radioter��pia i metilaci�� del MGMT foren significatius. . Conclusions. L���estat de metilaci�� del MGMT ��s, doncs, un factor pron��stic de superviv��ncia en pacients diagnosticats de glioblastoma tractats amb radioter��pia i quimioter��pia basada en alquilants , a diferencia de l���amplificaci�� de l��� EGFR i mutaci�� EGFRvIII.

Combined low initial DNA damage and high radiation-induced apoptosis confers clinical resistance to long-term toxicity in breast cancer patients treated with high-dose radiotherapy

BACKGROUND. Either higher levels of initial DNA damage or lower levels of radiation-induced apoptosis in peripheral blood lymphocytes have been associated to increased risk for develop late radiation-induced toxicity. It has been recently published that these two predictive tests are inversely related. The aim of the present study was to investigate the combined role of both tests in relation to clinical radiation-induced toxicity in a set of breast cancer patients treated with high dose hyperfractionated radical radiotherapy. METHODS. Peripheral blood lymphocytes were taken from 26 consecutive patients with locally advanced breast carcinoma treated with high-dose hyperfractioned radical radiotherapy. Acute and late cutaneous and subcutaneous toxicity was evaluated using the Radiation Therapy Oncology Group morbidity scoring schema. The mean follow-up of survivors (n = 13) was 197.23 months. Radiosensitivity of lymphocytes was quantified as the initial number of DNA double-strand breaks induced per Gy and per DNA unit (200 Mbp). Radiation-induced apoptosis (RIA) at 1, 2 and 8 Gy was measured by flow cytometry using annexin V/propidium iodide. RESULTS. Mean DSB/Gy/DNA unit obtained was 1.70 �� 0.83 (range 0.63-4.08; median, 1.46). Radiation-induced apoptosis increased with radiation dose (median 12.36, 17.79 and 24.83 for 1, 2, and 8 Gy respectively). We observed that those "expected resistant patients" (DSB values lower than 1.78 DSB/Gy per 200 Mbp and RIA values over 9.58, 14.40 or 24.83 for 1, 2 and 8 Gy respectively) were at low risk of suffer severe subcutaneous late toxicity (HR 0.223, 95%CI 0.073-0.678, P = 0.008; HR 0.206, 95%CI 0.063-0.677, P = 0.009; HR 0.239, 95%CI 0.062-0.929, P = 0.039, for RIA at 1, 2 and 8 Gy respectively) in multivariate analysis. CONCLUSIONS. A radiation-resistant profile is proposed, where those patients who presented lower levels of initial DNA damage and higher levels of radiation induced apoptosis were at low risk of suffer severe subcutaneous late toxicity after clinical treatment at high radiation doses in our series. However, due to the small sample size, other prospective studies with higher number of patients are needed to validate these results.

Status of radiation protection at different hospitals in Nepal.

Nepal has a long history of medical radiology since1923 but unfortunately, we still do not have any Radiation Protection Infrastructure to control the use of ionizing radiations in the various fields. The objective of this study was an assessment of the radiation protection in medical uses of ionizing radiation. Twenty-eight hospitals with diagnostic radiology facility were chosen for this study according to patient loads, equipment and working staffs. Radiation surveys were also done at five different radiotherapy centers. Questionnaire for radiation workers were used; radiation dose levels were measured and an inventory of availability of radiation equipment made. A corollary objective of the study was to create awareness in among workers on possible radiation health hazard and risk. It was also deemed important to know the level of understanding of the radiation workers in order to initiate steps towards the establishment of Nepalese laws, regulation and code of radiological practice in this field. Altogether, 203 Radiation workers entertained the questionnaire, out of which 41 are from the Radiotherapy and 162 are from diagnostic radiology. The radiation workers who have participated in the questionnaire represent more than 50% of the radiation workers working in this field in Nepal. Almost all X-ray, CT and Mammogram installations were built according to protection criteria and hence found safe. Radiation dose level at the reference points for all the five Radiotherapy centers are within safe limit. Around 65% of the radiation workers have never been monitored for radiation. There is no quality control program in any of the surveyed hospitals except radiotherapy facilities.

A woman with reddish nodule on the skin of the breast.

A 54-year-old woman presented a peri-areolar nodule located in the skin of the right breast. Clinical examination showed a 6 x 5 cm exophytic, lobed, ulcerated, and bleeding nodule. The patient reported that the tumor had grown gradually over a period of 3 months. The patient had been diagnosed 8 years prior to presentation with infiltrating ductal carcinoma of the right breast (pT2NO). This tumor was treated with partial mastectomy (conservative surgery) and lymph node dissection, then subsequently received 30 tangent field radiotherapy sessions to the breast for a total dose of 45 Gy. The rest of her cutaneous exam was normal. There was no family history of any similar tumor.

Differential outcome of concurrent radiotherapy plus epidermal growth factor receptor inhibitors versus radiotherapy plus cisplatin in patients with human papillomavirus-related head and neck cancer.

BACKGROUND Human papillomavirus (HPV)-related head and neck cancer has been associated with an improved prognosis in patients treated with radiotherapy (RT) +/- chemotherapy (CT); however, RT combined with epidermal growth factor receptor (EGFR) inhibitors has not been fully studied in this group of patients. METHODS Immunohistochemical expression of p16 and PCR of HPV16 DNA were retrospectively analyzed in tumor blocks from 108 stage III/IV head and neck cancer patients treated with RT+CT (56) or RT+EGFR inhibitors (52). Disease-free survival (DFS) and overall survival (OS) were analyzed by the Kaplan-Meier method. RESULTS DNA of HPV16 was found in 12 of 108 tumors (11%) and p16 positivity in 18 tumors (17%), with similar rates in both arms of treatment. After a median follow-up time of 35 months (range 6-135), p16-positive patients treated with RT+EGFR inhibitors showed improved survival compared with those treated with RT+CT (2-year OS 88% vs. 60%, HR 0.18; 95% CI 0.04 to 0.88; p = 0.01; and 2-year DFS 75% vs. 47%, HR 0.17; 95% CI 0.03 to 0.8; p = 0.01). However, no differences were observed in p16-negative patients (2-year OS 56% vs. 53%, HR 0.97; 95% CI 0.55 to 1.7; p = 0.9; and 2-year DFS 43% vs. 45%, HR 0.99; 95% CI 0.57 to 1.7; p = 0.9). CONCLUSIONS This is the first study to show that p16-positive patients may benefit more from RT+EGFR inhibitors than conventional RT+CT. These results are hypothesis-generating and should be confirmed in prospective trials.

Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study.

BACKGROUND In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level. METHODS Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of <10%, 10-25%, and 25% and a prescribed radiation dose of <35 Gy, 50 Gy, and 66-70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field. RESULTS A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%. CONCLUSION This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.

Polymorphisms in DNA-Repair Genes in a Cohort of Prostate Cancer Patients from Different Areas in Spain: Heterogeneity between Populations as a Confounding Factor in Association Studies.

BACKGROUND Differences in the distribution of genotypes between individuals of the same ethnicity are an important confounder factor commonly undervalued in typical association studies conducted in radiogenomics. OBJECTIVE To evaluate the genotypic distribution of SNPs in a wide set of Spanish prostate cancer patients for determine the homogeneity of the population and to disclose potential bias. DESIGN SETTING AND PARTICIPANTS A total of 601 prostate cancer patients from Andalusia, Basque Country, Canary and Catalonia were genotyped for 10 SNPs located in 6 different genes associated to DNA repair: XRCC1 (rs25487, rs25489, rs1799782), ERCC2 (rs13181), ERCC1 (rs11615), LIG4 (rs1805388, rs1805386), ATM (rs17503908, rs1800057) and P53 (rs1042522). The SNP genotyping was made in a Biotrove OpenArray�� NT Cycler. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Comparisons of genotypic and allelic frequencies among populations, as well as haplotype analyses were determined using the web-based environment SNPator. Principal component analysis was made using the SnpMatrix and XSnpMatrix classes and methods implemented as an R package. Non-supervised hierarchical cluster of SNP was made using MultiExperiment Viewer. RESULTS AND LIMITATIONS We observed that genotype distribution of 4 out 10 SNPs was statistically different among the studied populations, showing the greatest differences between Andalusia and Catalonia. These observations were confirmed in cluster analysis, principal component analysis and in the differential distribution of haplotypes among the populations. Because tumor characteristics have not been taken into account, it is possible that some polymorphisms may influence tumor characteristics in the same way that it may pose a risk factor for other disease characteristics. CONCLUSION Differences in distribution of genotypes within different populations of the same ethnicity could be an important confounding factor responsible for the lack of validation of SNPs associated with radiation-induced toxicity, especially when extensive meta-analysis with subjects from different countries are carried out.

Pattern of use of radiotherapy for lung cancer: a descriptive study.

BACKGROUND Lung cancer remains one of the most prevalent forms of cancer. Radiotherapy, with or without other therapeutic modalities, is an effective treatment. Our objective was to report on the use of radiotherapy for lung cancer, its variability in our region, and to compare our results with the previous study done in 2004 (VARA-I) in our region and with other published data. METHODS We reviewed the clinical records and radiotherapy treatment sheets of all patients undergoing radiotherapy for lung cancer during 2007 in the 12 public hospitals in Andalusia, an autonomous region of Spain. Data were gathered on hospital, patient type and histological type, radiotherapy treatment characteristics, and tumor stage. RESULTS 610 patients underwent initial radiotherapy. 37% of cases had stage III squamous cell lung cancer and were treated with radical therapy. 81% of patients with non-small and small cell lung cancer were treated with concomitant chemo-radiotherapy and the administered total dose was������60 Gy and������45 Gy respectively. The most common regimen for patients treated with palliative intent (44.6%) was 30 Gy. The total irradiation rate was 19.6% with significant differences among provinces (range, 8.5-25.6%; p<0.001). These differences were significantly correlated with the geographical distribution of radiation oncologists (r=0.78; p=0.02). Our results were similar to other published data and previous study VARA-I. CONCLUSIONS Our results shows no differences according to the other published data and data gathered in the study VARA-I. There is still wide variability in the application of radiotherapy for lung cancer in our setting that significantly correlates with the geographical distribution of radiation oncologists.

Conceitos culturais e a experi��ncia dolorosa

Este estudo objetivou verificar influ��ncia de fatores culturais na express��o do sintoma ��lgico. Foi baseado na avalia����o de 57 pacientes com doen��a oncol��gica avan��ada, atendidos no servi��o de radioterapia de um hospital geral, p��blico e de ensino que experienciaram dor na semana anterior �� entrevista. A dura����o m��dia do quadro ��lgico foi 10 meses. A dor foi moderada na maioria dos doentes e intensa em cerca de 1/ 5 deles. Observou-se que concep����es culturais err��neas dos doentes acerca da incontrolabilidade da dor no c��ncer e de que recebiam rem��dios em demasia, correlacionaram-se ��, dor de maior intensidade (p<0,05). Este estudo mostrou que cren��as err��neas relativas �� dor oncol��gica e analgesia associaram-se a dores mais intensas.

Revis��o de literatura em enfermagem sobre hipertens��o arterial na gravidez

Revis��o de literatura em enfermagem relativa �� hipertens��o arterial na gravidez, entre 1980 a 1999, com o objetivo de identificar as tend��ncias dessas publica����es. Foram encontradas 58 publica����es nos idiomas ingl��s, portugu��s e espanhol, sendo 52 artigos de peri��dicos e 6 monografias, disserta����es e teses. A maioria dos artigos foi publicada em peri��dicos de enfermagem (84,6%), predominando os de l��ngua inglesa (73,1%), redigidos por docentes, com autoria ��nica. Predominaram os enfoques assist��ncia de enfermagem (25,9%) e tratamento medicamentoso (25,9%). A partir de 1985, observou-se um incremento nas publica����es, no entanto, ainda s��o incipientes as publica����es nacionais.

Revista da Escola de Enfermagem da Universidade de S��o Paulo: 36 anos zelando pela qualidade do trabalho na Enfermagem

A REEUSP �� uma revista trimestral desde 1998, que publica de 11 a 13 artigos por n��mero nas diferentes sub��reas da Enfermagem, na sua maioria sobre ensino, tecnologia em sa��de, sa��de do adulto (nas suas diferentes especialidades), sa��de mental e psiqui��trica. O enfoque dos artigos e pesquisas continua a ser hospitalar. Por estar ligada a uma unidade de ensino, apresenta qualidade nas suas publica����es, muitas vezes geradas de teses e disserta����es. Enfrenta o desafio de estimular a publica����o de autores de outras institui����es, para n��o se tornar end��gena. Nos ��ltimos 10 anos recebeu e publicou artigos de 18 estados brasileiros e de v��rias cidades do interior de S��o Paulo. Seu projeto gr��fico tamb��m foi remodelado para 2003, permitindo maior legibilidade e facilidade na leitura. Aceita permuta com outros peri��dicos e �� indexada em v��rias Bases de Dados. Recebeu a classifica����o C internacional pela CAPES.

Programa Interunidades de Doutoramento em Enfermagem: 21 anos construindo ci��ncia

O Programa Interunidades de Doutoramento em Enfermagem foi o primeiro a ser criado na Am��rica Latina e titulou 290 enfermeiros, at�� o primeiro semestre de 2004. Este estudo apresenta algumas caracter��sticas das teses defendidas no programa, focalizando as ��reas tem��ticas e m��todos de pesquisa utilizados. Foram analisados os resumos de 287 teses, defendidas at�� o primeiro semestre de 2004. As ��reas mais investigadas, at�� o momento foram: Sa��de da Crian��a, da Mulher, do Adulto/Idoso e Educa����o. O m��todo de pesquisa quantitativo predominou at�� final da d��cada de 1980, havendo uma intensa produ����o de pesquisas no m��todo qualitativo a partir desse per��odo. Ainda na primeira d��cada do programa, os temas passaram a versar sobre os aspectos que relacionam a pr��tica da enfermagem aos contextos pol��ticos e sociais, convergindo para o atual eixo paradigm��tico do programa: "Bases te��ricas, filos��ficas, hist��ricas do saber e da pr��tica de enfermagem".

A produ����o do conhecimento na ��rea de Administra����o de Servi��os de Enfermagem do Programa de P��s-Gradua����o

O presente estudo teve como objetivo identificar e analisar a produ����o do conhecimento na ��rea de concentra����o Administra����o de Servi��os de Enfermagem, no Curso de Mestrado e Doutorado da EEUSP. Trata-se de um estudo explorat��rio, descritivo, retrospectivo, pautado na an��lise documental. A popula����o foi constitu��da por 128 produ����es cient��ficas, sendo 102 (79,7%) disserta����es de mestrado e 26 (20,3%) teses de doutorado produzidas no per��odo de 1977 a mar��o de 2004. Esses estudos foram analisados de acordo com o agrupamento dos temas, nas categorias propostas por Castro e Ciampone (2002). Os resultados permitiram visualizar a distribui����o da produ����o por tem��tica, d��cada, m��todo e correntes de pensamento adotadas nesses estudos. Permitiram, tamb��m, tra��ar considera����es a respeito da trajet��ria, necessidades e perspectivas das pesquisas em Gerenciamento em Enfermagem no ��mbito do Programa.

O conhecimento produzido no Programa de P��s-Gradua����o em Enfermagem: a enfermagem psiqui��trica

Ap��s quase 30 anos de cria����o da ��rea de Concentra����o Enfermagem Psiqui��trica, no Programa de P��s-Gradua����o da Escola de Enfermagem da USP, �� importante olhar a produ����o cient��fica gerada para que fundamentem reflex��es sobre este ensino. Este estudo �� descritivo-explorat��rio, usou como fonte os registros do Servi��o de P��s-Gradua����o, resumos de disserta����es e teses; memorandos e of��cios; os dados coletados foram analisados �� luz das transforma����es ocorridas na estrutura que titulou 60 alunos, dos quais 50 cursaram mestrado e 10 doutorado e que vem reestruturando suas disciplinas, linhas de pesquisa e projetos com o objetivo de atender as avalia����es internas e externas e ��s diretrizes das ag��ncias de fomento do Pa��s. A produ����o cient��fica, atualmente, evid��ncia alinhamento com as diretrizes da Reforma Psiqui��trica e tend��ncia de produzir conhecimentos a partir das pr��ticas concretas dos trabalhadores nos campos da assist��ncia, a gest��o e ensino de Sa��de Mental.