RESUMO
The Atacama Desert represents the highest levels of mining exploitation in Chile, which inexorably results in high levels of pollution. Raptors, and particularly scavengers, have shown their usefulness to evaluate exposure to environmental contaminants in polluted scenarios. In this study, we used primary feathers from a local avian scavenger, turkey vulture Cathartes aura, to evaluate the exposure to cadmium (Cd), lead (Pb), copper (Cu) and zinc (Zn) in two locations from the southern Atacama Desert (coastal and inland) and a third location from the bordering semiarid region, in northern Chile. All metals were detected in all analyzed samples (n = 54). Mean concentrations in Coastal Atacama were 0.68 ± 0.84 ppm for Cd; 1.97 ± 2.01 ppm for Pb; 59.11 ± 80.69 ppm for Cu; and 107.96 ± 51.00 ppm for Zn, while mean concentrations in Inland Atacama were 0.55 ± 0.42 ppm for Cd; 3.37 ± 2.61 ppm for Pb; 91.66 ± 77.74 ppm for Cu; and 214.03 ± 99.08 ppm for Zn. Mean concentrations in Coastal Coquimbo were 0.63 ± 0.69 ppm for Cd; 1.57 ± 0.92 ppm for Pb; 18.09 ± 6.12 ppm for Cu; and 149.37 ± 105.56 ppm for Zn. These differences could be explained by differences on abundance of mining settlements among areas. According to the literature, these values are very high for all metals, exceeding in some cases those values referred as responsible of health disorders in birds. We strongly recommend further research looking at potential adverse effects caused by heavy metal pollution on the health of human and wildlife populations in the southern Atacama Desert.
Assuntos
Plumas , Metais Pesados , Animais , Aves , Chile , China , Monitoramento Ambiental , Plumas/química , Humanos , Metais Pesados/análiseRESUMO
PURPOSE: The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx. METHODS/PATIENTS: We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66-69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0-2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases. RESULTS: Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01-1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18-0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01-0.24, P < 0.01). Additionally, it associated with a lower risk of mucositis (P = 0.029) compared with definitive radio (chemo) therapy. CONCLUSIONS: IMRT-SIB is a safe and feasible radiation treatment technique for pharyngo-laryngeal SCC patients with a tolerable acute toxicity profile.
Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias Laríngeas/radioterapia , Recidiva Local de Neoplasia/mortalidade , Neoplasias Faríngeas/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Faríngeas/patologia , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos , Taxa de Sobrevida , Testes de Toxicidade , Resultado do TratamentoRESUMO
PURPOSE: As elective axillary dissection is loosing ground for early breast cancer (BC) patients both in terms of prognostic and therapeutic power, there is a growing interest in predicting patients with (nodal) high tumour burden (HTB), especially after a positive sentinel node biopsy (SNB) because they would really benefit from further axillary intervention either by complete lymph-node dissection or axillary radiation therapy. METHODS/PATIENTS: Based on an analysis of 1254 BC patients in whom complete axillary clearance was performed, we devised a logistic regression (LR) model to predict those with HTB, as defined by the presence of three or more involved nodes with macrometastasis. This was accomplished through prior selection of every variable associated with HTB at univariate analysis. RESULTS: Only those variables shown as significant at the multivariate analysis were finally considered, namely tumour size, lymphovascular invasion and histological grade. A probability table was then built to calculate the chances of HTB from a cross-correlation of those three variables. As a suggestion, if we were to follow the rationale previously used in the micrometastasis trials, a threshold of about 10% risk of HTB could be considered under which no further axillary treatment is warranted. CONCLUSIONS: Our LR model with its probability table can be used to define a subgroup of early BC patients suitable for axillary conservative procedures, either sparing completion lymph-node dissection or even SNB altogether.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Lobular/secundário , Modelos Logísticos , Linfonodos/patologia , Idoso , Axila , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Feminino , Seguimentos , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Micrometástase de Neoplasia , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela , Carga TumoralRESUMO
PURPOSE: Roughly two-thirds of early breast cancer cases are associated with negative axillary nodes and do not benefit from axillary surgery at all. Accordingly, there is an ongoing search for non-surgical staging procedures to avoid lymph-node dissection or sentinel node biopsy (SNB). Non-invasive imaging techniques with very high sensitivity (Se) and negative predictive value (NPV) could eventually replace SNB. We aimed to establish the role of axillary US and MRI, alone or in combination, associated with ultrasound-guided fine-needle aspiration biopsy (US-FNAB) in the prediction of axillary node involvement. METHODS/PATIENTS: Between January 2003 and September 2015, we included 1505 of the 1538 breast cancer patients attending our centres. All patients had been referred from a single geographical area. Axillary US, magnetic resonance imaging and ultrasound-guided fine-needle aspiration biopsy (US-FNAB) were performed if required. RESULTS: 1533 axillary US examinations and 1351 axillary MRI studies were analyzed. For axillary US, Se, Specificity (Sp), Positive Predictive Value (PPV), and NPV were 47.5, 93.6, 82.5, and 73.8%, respectively. For axillary MRI, corresponding values were 29.8, 96.6, 84.9, and 68.4%. When both tests were combined, Sp and PPV slightly improved over individual tests alone. US-FNAB showed a 100% Sp and PPV, with a Se of 80%. CONCLUSION: We may confidently state that axillary US and US-FNAB have to be included in the preoperative work-up of breast cancer patients.
Assuntos
Axila/diagnóstico por imagem , Neoplasias da Mama/patologia , Metástase Linfática/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Triagem/métodos , Ultrassonografia de Intervenção , Adulto JovemRESUMO
INTRODUCTION: Until recently, completion ALND has been considered the standard of care after a positive SN in breast cancer patients. However, most patients will not display further axillary involvement. The Tenon score is a simple nomogram that can be used intraoperatively to avoid completion ALND in low-risk patients. We aimed at validating the Tenon score on a SN-positive patient sample that had been preoperatively selected using axillary US examination. PATIENTS AND METHOD: We used a retrospective analysis of our bicentric database that included 246 breast cancer patients with a positive SN. We calculated sensitivity, specificity, as well as positive and negative predictive values for each cut-off point. ROCs were constructed and corresponding AUC values were calculated as a measure of discriminative capacity. RESULTS: At least one non-SN was positive in 52 patients (21.1 %). 118 patients (48 %) had a score up to 5. Among them, three had at least one positive non-SN. NPV was 97.5 %. Using that threshold, the ROCs analysis showed an AUC of 0.822 (95 % CI 0.764-0.880). CONCLUSION: Use of preoperative axillary US examination led to a modification of the proposed Tenon cut-off value from 3.5 to 5 to attain good predictive power for non-SN status. Straightforward intraoperative use of the Tenon score may be considered an advantage over other available nomograms.
Assuntos
Neoplasias da Mama/patologia , Excisão de Linfonodo/métodos , Estadiamento de Neoplasias/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Nomogramas , Estudos Retrospectivos , Biópsia de Linfonodo SentinelaRESUMO
The aim of this study was to assess the exposure to organochlorine compounds (OC) in 91 primary wing feathers of avian scavengers, Turkey vulture (Cathartes aura), American black vulture (Coragyps atratus) and Southern crested caracaras (Polyborus plancus) from the southern tip of South America, in the Argentinean Patagonia. We analyzed for a series of OC including hexachlorocyclohexane (HCH) isomers, endosulfan, aldrin, dieldrin, endrin, dichlorodiphenyltrichloroethane (p,p'-DDT), dichlorodiphenyldichloroethane (p,p'-DDD), dichlorodiphenyldichloroethylene (p,p'-DDE), heptachlor and heptachlor-epoxide. This is the first study on OC in feathers of three terrestrial top carnivores from South America. OC concentrations found in the studied species were much higher than those found in feathers of raptors from Europe and Asia, which likely indicate their high use in the region, specifically in agriculture, and other possible uses of OC in this area. ∑HCH had the highest median concentration, followed by ∑Drins, ∑DDT, ∑Heptachlor, and ∑Endosulfan, similar to those reported in several food samples in Argentina. On the other hand, differences in OC profiles between species and areas may be related to feeding and migratory habits, as well as the molt period. Three individuals showed ∑DDT (DDT, DDD and DDE) concentrations in feathers related to sublethal effects. However, this comparison should be used with caution due to problems with extrapolating such data across tissues and species.
Assuntos
Aves , Poluentes Ambientais/análise , Hidrocarbonetos Clorados/análise , Aldrina/análise , Animais , Argentina , DDT/análise , Diclorodifenil Dicloroetileno/análise , Diclorodifenildicloroetano/análise , Dieldrin/análise , Endossulfano/análise , Plumas/química , Heptacloro/análise , Hexaclorocicloexano/análiseRESUMO
INTRODUCTION: In 2011, the St Gallen panel introduced several changes in breast cancer classification, thereby creating the luminal B Her2- subtype. In 2013, the panel also included Ki67 overexpression and PR <20 % as risk factors, while excluding GH3 in the absence of increased Ki67. We compared the classification of 2011 modified with the new 2013 St Gallen classification. PATIENTS AND METHOD: Consecutive breast cancer patients referred to the Breast Unit of the University Hospital Mútua Terrassa and Hospital of Terrassa for surgical treatment of either primary or recurrent tumors were prospectively included between 1997 and 2014. Eventually, 1,874 cases were included for the four-subtype analysis. The median follow-up was of 66 months. RESULTS: Using the 2013 St Gallen classification no significant differences were found in specific mortality rates between luminal A and B subtypes. There were significant differences at 5, 10, and, 15 years if we excluded luminal A GH3 patients in the absence of increased Ki67 (p = 0.004, 0.005, and 0.007). Luminal A sub-type patients showed significantly less distant metastases than the rest, including luminal B Her2- patients (p < 0.001). Also, luminal B patients showed significantly less distant metastases than pure Her2 (0.05) and triple negative (TN) (p < 0.001). There were no differences between pure Her2 and TN patients (0.055), neither among the different luminal B sub-types. CONCLUSION: GH3, PR, and Ki67 may all be discriminatory factors for metastasis and specific mortality. Therefore, we suggest including GH3 in the luminal B subtype in the absence of Ki67.
Assuntos
Neoplasias da Mama/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/metabolismo , Neoplasias da Mama/mortalidade , Feminino , Humanos , Antígeno Ki-67/metabolismo , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/mortalidade , Estudos Prospectivos , Receptor ErbB-2/metabolismo , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Taxa de Sobrevida , Adulto JovemRESUMO
BACKGROUND AND AIM: Recent introduction of breast units, mass-screening programmes (SP) and sentinel node biopsy (SNB) has impacted on the clinical care of breast cancer patients (BC), resulting in a significant increase of breast-conserving surgery with the goal of achieving completely free margins and good cosmetic outcome, along with significantly less axillary morbidity. In order to ascertain the combined impact of SP and SNB on BC patients, we have reviewed the primary therapeutic approach of patients diagnosed with invasive breast carcinoma in our centre, both before and after implementation of the two new procedures. METHODS: 1,942 patients operated for BC between 1997 and 2013 in two clinical centres. Two historical periods were considered: before and after the advent of the Breast Unit in our institutions and the concurrent implementation of SP and SNB (September 2002). RESULTS: Rates of breast-conserving surgery and re-operations improved in the second period. Intraoperative margin re-excision increased in the second period. Breast-conserving surgery decreased in parallel to stage: from 79 % for stage I to 31 % for stage III. The Cox analysis, including stage as adjusted for all significant variables, showed statistically significant differences in favour of the initial stages but only for specific mortality, not overall mortality. CONCLUSIONS: Combined implementation of breast units, SP, and SNB have resulted in a significant improvement of BC treatment leading to increased rates of breast-conserving surgery and decreased disease recurrence and mortality.
Assuntos
Neoplasias da Mama/diagnóstico , Programas de Rastreamento , Metástase Neoplásica/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Biópsia de Linfonodo Sentinela , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Estudos Prospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
La electroestimulación vesical tranuretral(EEV)fue propuesta por Katona en 1975 con el objetivo de mejorar la sensación y contraccion vesical en pacientes neurogénicos.Kaplan promovió un nuevo concepto:su uso como método para mejorar la adaptación y la capacidad vesical.El objetivo fue analizar el comportamiento de la capacidad y de la adaptación vesical,antes y después de series de electroestimulación.Se evaluaron 12 pacientes(11 mielomeningoceles y 1 agenesia ssacra)La edad promedio fue de 6,2 años y el promedio de seguimiento fué de 1,20 años.El protocolo seguido fue:1.Cistometría diferencial inicial,diagnóstica del tipo vejiga para seleccionar el tipo de estimulación.2.Serie de 20 sesiones,una por día,de 90 minutos de electroestimulación vesica.3.Cistometría diferencial de control,3 meses después de aplicada la serie.El tratamiento completo constó de dos series separadas por un intervalo de 3 a 6 meses.De los 12 pacientes,5 completaron dos series y 7 sólo una.Hubo un incremento global de la capacidad vesical útil con promedios de 56.92 cc entre la cistometría inicial y la cistometría posterior a la primera serie(p<0.02)La adaptación vesical tuvo un aumento global en promedio de 4.21 entre el control inicial y el post primera serie(p<0.02) y de 6.17 entre el control inicial y el control post segunda serie(p<0.05)Nuestros resultados iniciales demuestran que la EEV en pacientes con mielodisplasia logró un aumentos significativos de la capacidad y de la adaptación vesical
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Estimulação Elétrica , Disrafismo Espinal , Bexiga Urinaria Neurogênica/terapia , PediatriaRESUMO
La electroestimulación vesical tranuretral(EEV)fue propuesta por Katona en 1975 con el objetivo de mejorar la sensación y contraccion vesical en pacientes neurogénicos.Kaplan promovió un nuevo concepto:su uso como método para mejorar la adaptación y la capacidad vesical.El objetivo fue analizar el comportamiento de la capacidad y de la adaptación vesical,antes y después de series de electroestimulación.Se evaluaron 12 pacientes(11 mielomeningoceles y 1 agenesia ssacra)La edad promedio fue de 6,2 años y el promedio de seguimiento fué de 1,20 años.El protocolo seguido fue:1.Cistometría diferencial inicial,diagnóstica del tipo vejiga para seleccionar el tipo de estimulación.2.Serie de 20 sesiones,una por día,de 90 minutos de electroestimulación vesica.3.Cistometría diferencial de control,3 meses después de aplicada la serie.El tratamiento completo constó de dos series separadas por un intervalo de 3 a 6 meses.De los 12 pacientes,5 completaron dos series y 7 sólo una.Hubo un incremento global de la capacidad vesical útil con promedios de 56.92 cc entre la cistometría inicial y la cistometría posterior a la primera serie(p<0.02)La adaptación vesical tuvo un aumento global en promedio de 4.21 entre el control inicial y el post primera serie(p<0.02) y de 6.17 entre el control inicial y el control post segunda serie(p<0.05)Nuestros resultados iniciales demuestran que la EEV en pacientes con mielodisplasia logró un aumentos significativos de la capacidad y de la adaptación vesical