RESUMO
INTRODUCTION: Cardiovascular disease is the main cause of mortality worldwide. In women, its incidence increases at the sixth decade of life, coinciding with postmenopause. Whether this effect is due to menopause-related hormonal changes is not known. OBJECTIVE: To evaluate the differences in cardiovascular risk in pre- and postmenopausal women by means of the Globorisk risk scale, the triglyceride/high-density lipoproteinsHDL cholesterol (Tg/HDL-C) ratio and metabolic syndrome (MS) criteria. METHOD: Cross-sectional study that included 408 women from 40 to 60 years of age; anthropometric measurements and biochemical determinations were performed. The participants were classified as premenopausal and postmenopausal. Cardiovascular risk was assessed using the MS criteria, the Globorisk risk calculator and the Tg/HDL-C ratio. RESULTS: Postmenopausal women showed a significant increase in waist circumference, total cholesterol and triglycerides Tg in comparison with premenopausal women. Significant associations were found between hormonal state and Globorisk-measured cardiovascular risk (OR = 2.50; 95 % CI = 1.67-3.74) and the Tgtriglyceride/HDL-C ratio (OR = 1.66; 95 % CI = 1.09-2.52). CONCLUSION: Cardiovascular risk factors have a higher prevalence in postmenopause. The Globorisk scale and Tg/HDL-C ratio identify cardiovascular risk in postmenopausal women.
INTRODUCCIÓN: La laringectomía subtotal supracricoidea asociada con cricohioidoepiglotopexia es la técnica quirúrgica conservadora más eficiente para preservar las funciones laríngeas de los pacientes con carcinoma localmente avanzado de la laringe. La complicación más temida de esta intervención es la aspiración en el momento de la deglución y la neumonía secundaria; existen diversas formas de evaluar la aspiración y el grado de esta. Presentamos una novedosa forma de identificar incluso pequeñas cantidades de aspiración traqueobronquial. MÉTODO: Se incluyeron pacientes sometidos a laringectomía subtotal y cricohioidoepiglotopexia por cáncer laríngeo; todos evaluados con trago radiactivo posoperatorio. Con base en la sintomatología y resultado del gammagramma se decidió prolongar el tiempo de alimentación por sonda. RESULTADOS: Se incluyeron 37 pacientes, cuatro habían recibido radioterapia; la tasa de aspiración fue de 29.7 %; 50 % de los pacientes que habían recibido radioterapia presentó aspiración y 18 % de los pacientes con aspiración requirió prolongación del tiempo de alimentación por sonda nasogástrica; ninguno necesitó laringectomía total por aspiración que no permitiera la deglución. CONCLUSIONES: La evaluación posoperatoria de pacientes sometidos a laringectomía subtotal con trago radiactivo permite identificar líquido aspirado al árbol bronquial, incluso en cantidades mínimas, y planear el momento para iniciar la deglución.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Deglutição/fisiologia , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Aspiração Respiratória/etiologia , Carcinoma de Células Escamosas/patologia , Cartilagem Cricoide/cirurgia , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Epiglote/cirurgia , Humanos , Osso Hioide/cirurgia , Neoplasias Laríngeas/patologia , Aspiração Respiratória/epidemiologiaRESUMO
BACKGROUND: The standard of care for advanced-stage laryngeal cancer is combined treatment (chemo-radiotherapy). However, the complications with this treatment are not few, mainly in swallowing. Conservative laryngeal surgery remains an effective alternative for cancer control without the complications of chemo-radiotherapy. MATERIAL AND METHODS: Retrospective study was conducted on patients with laryngeal cancer cT3, cN0 with paraglottic infiltration, fixation of the vocal cord, minimal invasion of the hyo-thyroepiglottic space, but with normal arytenoid mobility and no sub-glottic extension, were treated with subtotal supracricoid laryngectomy. Complications, sequels of treatment, and local recurrence were evaluated. Bronchial aspiration was studied with radioactive swallow. RESULTS: There were 25 patients, 22 with negative surgical margins, one had tumour contact with the surgical margins, and 2 were positive. Two patients received postoperative radiotherapy. The mean decannulation was 15 days and removal of nasogastric tube 25 days. During the mean follow-up of 26 months, none of the patients had tumour recurrence or required conversion to total laryngectomy. In all patients swallowing has been normal and none required permanent or temporary tracheotomy or definitive gastrostomy. The voice is considered intelligible in all patients. Radioactive swallow showed aspiration in 15/25 patients, with none being clinically relevant. There were postoperative complications in 5 patients, and 4 patients required re-intervention but no conversion to total laryngectomy. CONCLUSION: Conservative surgery is an effective surgical-alternative to chemo-radiotherapy in patients with locally advanced laryngeal cancer, providing oncological control, acceptable complications and minimal sequels. Although most patients have aspiration, this does not affect functional status.
Assuntos
Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Estudos Transversais , Feminino , Humanos , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/radioterapia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Estudos RetrospectivosRESUMO
BACKGROUND AND AIMS: Approximately 85% of patients with cancer suffer severe metastatic bone pain for which radionuclide therapy has been employed for pain palliation. We undertook this study to evaluate the pain relief effect of (153)Sm-EDTMP in Mexican patients with severe and painful bone metastases from mainly prostate, breast, and renal cancer and other malignancies. METHODS: Patients (277) with intense sustained pain caused by bone metastases were referred to the Nuclear Medicine Department of the Oncology Hospital of the Mexican Social Security Institute. The patients had to have acceptable physical conditions, a previous positive (99m)Tc-MDP scan and blood values within normal range. (153)Sm-EDTMP was prepared at the Instituto Nacional de Investigaciones Nucleares (ININ) and 37 MBq/kg of body weight was injected intravenously. Pain palliation was evaluated with a visual analogue scale (VAS) and a verbal rating scale (VRS) before treatment and 3 and 12 weeks after treatment was started. RESULTS: The age interval of the patients was 24-92 years with a mean age of 64 ± 12 years. Mean values for hemoglobin, leukocyte and platelet counts did not statistically differ at zero time, 3 and 12 weeks after treatment. Pain intensity and relief assessment were statistically different: 9.1 ± 0.61 units initially; 4.2 ± 1.3 units 3 weeks later (54%) and after 12 weeks the pain diminished to 2.4 ± 1.4 units (74%) in the pain relief score scales. CONCLUSIONS: (153)Sm-EDTMP was readily available, safe and well tolerated. We conclude that (153)Sm-EDTMP was an adequate palliative agent and was the best option for our Mexican patients to relieve their severe metastatic bone pain.
Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Neoplasias da Mama/patologia , Compostos Organometálicos/uso terapêutico , Compostos Organofosforados/uso terapêutico , Dor/radioterapia , Neoplasias da Próstata/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos não Narcóticos/farmacocinética , Analgésicos não Narcóticos/uso terapêutico , Neoplasias Ósseas/complicações , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias do Colo/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/farmacocinética , Compostos Organofosforados/farmacocinética , Dor/diagnóstico por imagem , Dor/etiologia , Medição da Dor , Cuidados Paliativos/métodos , Qualidade de Vida , Cintilografia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTc-tetrofosmin scan (99mTc-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTc-TS negative predictive value (NPV) in patients with cold thyroid nodules. METHODS: An evaluation with 99mTc-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTc-tetrofosmin was administered, and scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). RESULTS: Included in the study were 86 consecutive patients. In 60 patients the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA. In this group, 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% CI = 80.73-100), specificity = 45.10 (95% CI = 30.46-59.73), positive predictive value = 53.33 (95% CI = 39.8-66.79) and NPV = 88.46 (95% CI 74.26-100). Negative probability ratio = 0.19. CONCLUSIONS: IMA-99mTc-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTc-TS may be useful in the therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.
Assuntos
Compostos Organofosforados , Compostos de Organotecnécio , Compostos Radiofarmacêuticos , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Humanos , Valor Preditivo dos Testes , CintilografiaRESUMO
Introducción: Los pacientes con nódulos tiroideos hipocaptantes sin sospecha ultrasonográfica y con citología benigna o indeterminada pueden ser vigilados. El gammagrama con Tc- 99m-tetrofosmín (Tc-99m-TS) identifica pacientes en los que la vigilancia es más segura. La ausencia de captación nunca ocurre en pacientes con carcinoma. El objetivo de este estudio fue conocer el valor predictivo negativo del Tc-99m-TS en pacientes con nódulo tiroideo. Material y métodos: Evaluación preoperatoria con Tc-99m-TS de pacientes con nódulo tiroideo candidatos a cirugía. Tiroidectomía de acuerdo con el diagnóstico en todos. Evaluación de valor predictivo negativo y sensibilidad al comparar con el resultado histopatológico. Se administraron 296-370 MBq (8-10 mCi) de Tc-99m-TS; evaluación de imágenes a los 120 minutos. Resultado reportado con actividad metabólica aumentada (AMA) o sin actividad metabólica aumentada (SAMA). Resultados: Se incluyeron 86 pacientes consecutivos. Sesenta (69.7 %) tuvieron AMA, 20/60 con carcinoma (33 %), en 67 % el diagnóstico fue de nódulo benigno. En 26 (30.2 %) SAMA, 11.5 % tuvo carcinoma y 88.4 % neoplasia benigna. Sensibilidad de 91.43 % (IC 95 % = 80.73-100 %), especificidad de 45.10 % (IC 95 % = 30.46-59.73), valor predictivo positivo de 53.33 % (IC 95 % = 39.8-66.79), valor predictivo negativo de 88.46 % (IC 95 % = 74.26-100). Razón de verosimilitud negativa = 0.19. Conclusiones: Tc-99m-TS con AMA es poco específico en cáncer tiroideo; en pacientes SAMA 13 % tiene carcinoma. La mayoría de los pacientes (70 %) mostró AMA, 33 % con carcinoma. Valor predictivo negativo en grupo SAMA = 88 %. Tc-99m-TS podría ser útil en la decisión terapéutica de pacientes con nódulo tiroideo en los que existe duda de cirugía; su utilidad radica en el valor predictivo negativo.
BACKGROUND: Patients with cold thyroid nodules without ultrasound malignant suspicion and with benign/undetermined cytology may be subjected to follow-up surveillance. 99mTc-tetrofosmin scan (99mTc-TS) may identify patients where this observation can be performed with more certainty. Absence of uptake never occurs in carcinoma patients. Our objective was to determine the 99mTc-TS negative predictive value (NPV) in patients with cold thyroid nodules. METHODS: An evaluation with 99mTc-TS was conducted prior to surgery in patients with thyroid gland tumor who were candidates for surgery. All patients underwent thyroidectomy according to histology; NPV and test sensitivity were evaluated when compared with the histopathological result. Then, 296-370 MBq (8-10 mCi) of 99mTc-tetrofosmin was administered, and scan images were evaluated after 120 min. Scan result was reported as a) with increased metabolic activity (IMA) or b) without increased metabolic activity (WIMA). RESULTS: Included in the study were 86 consecutive patients. In 60 patients the scan showed IMA, 20/60 (33%) with carcinoma, 67% with benign nodule. In 26 (30.2%) the scan was WIMA. In this group, 3/26 (11.5%) had carcinoma and (88.4%) had a benign neoplasia. Sensitivity = 91.43 (95% CI = 80.73-100), specificity = 45.10 (95% CI = 30.46-59.73), positive predictive value = 53.33 (95% CI = 39.8-66.79) and NPV = 88.46 (95% CI 74.26-100). Negative probability ratio = 0.19. CONCLUSIONS: IMA-99mTc-TS is less specific in thyroid cancer; nevertheless, in WIMA patients the possibility of carcinoma is 13%. Most patients (70%) showed IMA, 33% with carcinoma. WIMA-NPV = 30%. 99mTc-TS may be useful in the therapeutic decision of patients with thyroid nodule with concerns about surgery. Its usefulness lies in the NPV.
Assuntos
Humanos , Compostos Organofosforados , Compostos Radiofarmacêuticos , Compostos de Organotecnécio , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide , Valor Preditivo dos TestesRESUMO
BACKGROUND: The gastrin-releasing peptide receptor (GRP-R) is expressed in several normal human tissues and is overexpressed in various human tumors including breast, prostate, small-cell lung cancer and pancreatic cancer. Recently, 99mTc-EDDA/HYNIC-[Lys]-bombesin (99mTc-HYNIC-BN) was reported as a radiopharmaceutical with high stability in human serum, specific cell GRP-R binding and rapid cell internalization. AIM: The aim of this study was to determine the biokinetics and dosimetry of 99mTc-HYNIC-BN and the feasibility of using this radiopharmaceutical to image GRP-R in four early breast cancer patients and seven healthy women. METHODS: Whole-body images were acquired at 20, 90, 180 min, and 24 h after 99mTc-HYNIC-BN administration. The same regions of interest were drawn around source organs on each time frame and regions of interest were converted to activity (conjugate view counting method). The image sequence was used to extrapolate 99mTc-HYNIC-BN time-activity curves in each organ to calculate the total number of disintegrations (N) that occurred in the source regions. N data were the input for the OLINDA/EXM code to calculate internal radiation dose estimates. RESULTS: 99mTc-HYNIC-BN had a rapid blood clearance with mainly renal excretion. No statistically significant differences (P>0.05) in the radiation-absorbed doses among cancer patients and healthy women were observed. The average equivalent doses (n=11) were 24.8+/-8.8 mSv (kidneys), 7.3+/-1.8 mSv (lungs), 6.5+/-4.0 mSv (breast), 2.0+/-0.3 mSv (pancreas), 1.6+/-0.3 mSv (liver), 1.2+/-0.2 mSv (ovaries), and 1.0+/-0.2 mSv (red marrow). The effective dose was 3.3+/-0.6 mSv. The images showed well-differentiated concentration of 99mTc-HYNIC-BN in cancer mammary tissue. CONCLUSION: All the absorbed doses were comparable with those known for most of the 99mTc studies. 99mTc-HYNIC-BN shows high tumor uptake in breasts with malignant tumors so it is a promising imaging radiopharmaceutical to target site-specific early breast cancer. The results obtained warrant a further clinical study to determine specificity/sensibility of 99mTc-HYNIC-BN.
Assuntos
Bombesina/farmacocinética , Neoplasias da Mama/diagnóstico por imagem , Ácido Edético/análogos & derivados , Compostos de Organotecnécio/farmacocinética , Compostos Radiofarmacêuticos/farmacocinética , Receptores da Bombesina/metabolismo , Adulto , Neoplasias da Mama/metabolismo , Ácido Edético/farmacocinética , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Radiometria , Cintilografia , Distribuição TecidualRESUMO
BACKGROUND: Radioimmunotherapy is a molecular targeting treatment for high-risk leukemia and lymphoma. Rhenium-188-labeled anti-CD66 monoclonal antibody has been used successfully in patients with high-risk acute myeloid leukemia or myelodysplastic syndrome. Our aim was to establish the biokinetics of (188)Re-anti-CD20 in patients and to evaluate its dosimetry as a target-specific radiopharmaceutical for non-Hodgkin's lymphoma (NHL) radioimmunotherapy. METHODS: Whole-body images were acquired at various times after administration of (188)Re-anti-CD20, obtained from instant freeze-dried kit formulations with radiochemical purity >95%. Regions of interest (ROIs) were drawn around source organs in each time frame. The cpm of each ROI was converted to activity using the conjugate view counting method. The image sequence was used to extrapolate time-activity curves in each organ to calculate the total number of disintegrations (N) that occurred in the source regions. N data were the input for the OLINDA/EXM code to calculate internal radiation dose estimates. RESULTS: Dosimetric studies indicated that after administration of 4.87-8.72 GBq of (188)Re-anti-CD20, the absorbed dose to total body would be 0.75 Gy, which corresponds with the recommended dose for NHL therapies. CONCLUSIONS: The calculated absorbed doses of (188)Re-anti-CD20 indicate that it may be used in radioimmunotherapy. Therefore, these preliminary data justify a full assessment of the safety, toxicity, and efficacy of (188)Re-anti-CD20 in a clinical study.
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Anticorpos Monoclonais/farmacocinética , Linfoma não Hodgkin/radioterapia , Radioimunoterapia , Adolescente , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Murinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Rituximab , Imagem Corporal Total , Contagem Corporal TotalRESUMO
Most patients with invasive squamous cell carcinoma of the penis do not have inguinal node metastasis at the time of diagnosis and 50% of those having palpable nodes are inflammatory. Penis cancer (PC) treatment implies resection of the primary tumor and inguinal lymphadenectomy; nevertheless, morbidity related to this procedure is high and its usefulness may be questioned in patients without metastasis in dissected nodes. Lymphatic mapping with sentinel node biopsy (LMSNB) is a valid alternative, useful in other neoplasias. The objective of this study is to determine if it is possible to identify a sentinel node (SN) in patients with PC. Patients with T1-2 PC without palpable nodes (N0) were included. LMSNB was carried out with the combined technique (blue dye and radiocolloid). All patients underwent an elective bilateral inguinal lymphadenectomy. Sensitivity and false negative index were calculated. SNs were sent for transoperative study with imprint technique and, definitively, with serial cuts and hematoxylin/eosin staining. Nine patients showed results with 32 lymph carrier zones and SN was identified in all of them, 4 regions had metastasis, in 3 the SN was metastatic and in one patient was metastasis-negative (false negative); sensitivity = 80%; false negatives index = 20%. Seven patients (77%) did not have node metastasis. LMSNB is an alternative for staging PC patients and could prevent unnecessary inguinal lymphadenectomies. A larger number of patients is required to validate the sturdy. The combined technique offers a high rate of success in SN identification.
Assuntos
Carcinoma de Células Escamosas/secundário , Metástase Linfática/diagnóstico , Estadiamento de Neoplasias/métodos , Neoplasias Penianas/patologia , Biópsia de Linfonodo Sentinela , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Coloides , Corantes , Estudos de Viabilidade , Humanos , Excisão de Linfonodo , Metástase Linfática/diagnóstico por imagem , Masculino , Nanoestruturas , Neoplasias Penianas/cirurgia , Estudos Prospectivos , Cintilografia , Compostos Radiofarmacêuticos , Rênio , Corantes de Rosanilina , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Compostos de TecnécioRESUMO
In patients with oral cavity epidermoid cancer without palpable nodes, the standard cervical treatment is supraomohyoid dissection; nevertheless, lymphatic mapping with sentinel node (SN) biopsy has been useful and allows the identification of a group of patients where neck dissection may be prevented. The objective of this study was to examine which factors diagnose the possibility of metastasis in SN. A non-randomized prospective study was performed during a two year period and included patients with T1-2, N0 oral cavity cancer >4 mm thick, SN was identified by blue dye and Rhenium colloid. All patients underwent pre-operatory lymphogammagraphy and elective-selective neck dissection. Age, gender, tumor site, T, tumor thickness and number of sentinel nodes found were evaluated. In 48 patients, at least one sentinel node was found, 2 per patient on average. 10.4% showed drainage outside the supraomohyoid region, 13/48 had nodular metastasis, 4 with negative SN(8.3%). T, location, thickness and number of SN are related to non-SN metastasis. Identification of 3SN or more was related to the possibility of SN metastasis p=0 (RR 10.1, I. C. 95% 1.1 91.2). The combined technique (dye-colloid) offers a high index of success in the identification of SN in patients with oral cavity cancer, while lymphogammagraphy identifies patients with anatomically unexpected drainage. Patients with T1 less than 2cm, not located on the tongue with thickness <5 mm and more than 2 SN were less likely to have metastasis in non-sentinel nodes. The identification of at least 3 sentinel nodes decreases the possibility of identifying patients with hidden metastasis (p=0.04).
Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Bucais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática/diagnóstico , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Cintilografia , Sensibilidade e Especificidade , Biópsia de Linfonodo Sentinela/métodosRESUMO
OBJECTIVE: To present the characteristics of women with early breast cancer and clinically negative ganglia who were submitted to LM and SLNB in order to select the positive cases for axilar dissection and to identify the negative cases. MATERIAL AND METHODS: Cases included patients who attended the Breast Tumor Service of the Oncology Hospital of the National Medical Center of the Mexican Social Security Institute from March 1, 2002, to April 30, 2004. Women with early breast cancer and clinically negative ganglia (N0) were included, with out previous treatment and without previous biopsies. All cases were submitted to LM and SLNB with patent blue or double-blue technique and gamma probe. The lymph nodes were evaluated histopathologically and negative or positive results were considered, in order to determine whether or not to undertake the axilar dissection. No cases were excluded. RESULTS: Sixty cases were reviewed with an average age of 51 years. The average size of the ganglia was 1.9 cm, with stages EC-0: 9%, EC-I: 33%, EC-IIA: 58%. Sentinel lymph nodes were found in 100% and 95 ganglions were dissected, for an average of 1.6 per procedure. The histopathology was definitive in 19 women with metastasis (32%) and in 41 women with negative ganglia (68%). The results of transoperative histopathology were correlated with the histopathology report (one false positive and six false negative cases), sensitivity of 68.4%, specificity of 97.5%, positive predictive value 92.8% and negative predictive value 86.9%. CONCLUSIONS: LM and SLNB avoided radical axilar dissection in 68% of the cases and reduced the cost in 10% of the cases.