Evolução dos pacientes com condrossarcoma grau I em relação ao tipo de tratamento cirúrgico

PURPOSE: To evaluate the oncological outcome of patients with grade I chondrosarcomas according to the type of surgical treatment performed, since there is still controversy regarding the need for aggressive resections to reach a successful outcome. MATERIALS AND METHODS: The records of 23 patients with grade I chondrosarcomas were reviewed. The mean age was 38.4 years, ranging from 11 to 70 years; 52% were men and 48% were women. The femur was the site of 13 tumors. The tumors were staged as IA (17, 74%) and IB (6, 26%). Regarding tumor location, 74% (17) were medullary, 22% (5) were peripheral, and 4% (1) was indeterminate. Tumor size ranged from 2 to 25 cm, mean 7.9 cm. Regarding the surgical procedure, 11 patients underwent intralesional resection, 9 patients underwent wide resection, and 3 underwent radical resection. The follow-up period ranged from 24 to 192 months. RESULTS: None of the patients developed local recurrence or metastases; 7 patients had other general complications. CONCLUSIONS: This data supports the use of less aggressive procedures for treatment of low-grade chondrosarcomas.OBJETIVO: Avaliar a evolução oncológica de portadores de condrossarcomas grau I de acordo com o tipo de tratamento cirúrgico efetuado. Existe controvérsia em relação à necessidade de ressecções agressivas para obtenção de uma evolução clínica favorável. MATERIAIS E MÉTODOS: Os prontuários de 23 portadores de condrossarcoma grau I foram analisados. A idade dos pacientes variou de 11 a 70 anos com média de 38,4 anos, 52% eram homens e 48% mulheres. O local mais acometido foi o fêmur com 13 pacientes. Dezessete lesões (74%) foram classificadas como IA e seis (26%) como IB. Setenta e quatro por cento dos tumores eram medulares, 22% eram periféricas e uma lesão indeterminada. O tamanho dos tumores variou de 2 a 25 cm, média de 7,9 cm. Onze pacientes foram submetidos a ressecção intralesional, nove a ressecção ampla e três a ressecção radical. O seguimento variou de 24 a 192 meses. RESULTADOS: Complicações não oncológicas ocorreram em sete pacientes. Nenhum dos pacientes apresentou recidiva local ou metástase. Estes dados sugerem que os procedimentos cirúrgicos menos agressivos são seguros para o tratamento dos pacientes com condrossarcoma grau I

Comparative Study Of Planned And Unplanned Excisions For The Treatment Of Soft Tissue Sarcoma Of The Extremities.

Unplanned excision of soft tissue sarcomas is common because benign soft tissue lesions are very frequent. This study evaluated the impact of unplanned resections on overall survival, local recurrence and distant metastasis in patients with soft tissue sarcomas of the extremities. In total, 52 patients who were diagnosed with soft tissue sarcomas between May 2001 and March 2011 were analyzed in a retrospective study. Of these patients, 29 (55.8%) had not undergone previous treatment and the remaining 23 (44.2%) patients had undergone prior resection of the tumor without oncological planning. All subsequent surgical procedures were performed at the same cancer referral center. The follow-up ranged from 6 to 122 months, with a mean of 39.89 months. Age, lesion size and depth, histological grade, surgical margins, overall survival, local and distant recurrence and adjuvant therapies were compared. Residual disease was observed in 91.3% of the re-resected specimens in the unplanned excision group, which exhibited greater numbers of superficial lesions, low histological grades and contaminated surgical margins compared with the re-resected specimens in the planned excision group. No differences were observed in local recurrence and 5-year overall survival between the groups, but distant metastases were significantly associated with planned excision after adjustment for the variables. There was no difference between patients undergoing unplanned excision and planned excision regarding local recurrence and overall survival. The planned excision group had a higher risk of distant metastasis, whereas there was a high rate of residual cancer in the unplanned excision group.69579-8

Is Thyroid Stunning Clinically Relevant? A Retrospective Analysis Of 208 Patients.

Current guidelines have advised against the performance of (131)I-iodide diagnostic whole body scintigraphy (dxWBS) to minimize the occurrence of stunning, and to guarantee the efficiency of radioiodine therapy (RIT). The aim of the study was to evaluate the impact of stunning on the efficacy of RIT and disease outcome. This retrospective analysis included 208 patients with differentiated thyroid cancer managed according to a same protocol and followed up for 12-159 months (mean 30 ± 69 months). Patients received RIT in doses ranging from 3,700 to 11,100 MBq (100 mCi to 300 mCi). Post-RIT-whole body scintigraphy images were performed 10 days after RIT in all patients. In addition, images were also performed 24-48 hours after therapy in 22 patients. Outcome was classified as no evidence of disease (NED), stable disease (SD) and progressive disease (PD). Thyroid stunning occurred in 40 patients (19.2%), including 26 patients with NED and 14 patients with SD. A multivariate analysis showed no association between disease outcome and the occurrence of stunning (p = 0.3476). The efficacy of RIT and disease outcome do not seem to be related to thyroid stunning.58292-30

Translation And Cross-cultural Adaptation Of The Rowe Score For Portuguese

Objective: To translate and culturally adapt the Rowe score for use in Brazil. Methods: The translation and cross-cultural adaptation process initially involved the steps of translation, synthesis, back- -translation and revision by the Translation Group. The pre-final version of the questionnaire was then created. The Stability and Function fields were applied to 20 patients with anterior shoulder luxation, and the Mobility field was applied to 20 health professionals. Results: It was found that some of the patients had difficulty understanding some of the expressions of the questionnaire, so these were replaced with terms that were easier to understand. All health professionals understood the translation of the Mobility field. The altered questionnaire was then reapplied to another 20 patients, and this time it was understood by all the assessed subjects. Conclusion: After a careful process of translation and cultural adaptation, a definitive version of the Rowe questionnaire was obtained in Brazilian Portuguese. Level of Evidence II, Development of diagnostic criteria on consecutive patients.206346350Walton, J., Paxinos, A., Tzannes, A., Callanan, M., Hayes, K., Murrell, G.A., The unstable shoulder in the adolescent athlete (2002) Am J Sports Med., 30 (5), pp. 758-767Hovelius, L., Incidence of shoulder dislocation in Sweden (1982) Clin Orthop Relat Res., (166), pp. 127-131Simonet, W.T., Melton, L.J., Cofield, R.H., Ilstrup, D.M., Incidence of anterior shoulder dislocation in Olmsted County, Minnesota (1984) Clin Orthop Relat Res., (186), pp. 186-191Owens, B.D., Dawson, L., Burks, R., Cameron, K.L., Incidence of shoulder dislocation in the United States military: demographic considerations from a high-risk population (2009) J Bone Joint Surg Am., 91 (4), pp. 791-796Simonet, W.T., Cofield, R.H., Prognosis in anterior shoulder dislocation (1984) Am J Sports Med., 12 (1), pp. 19-24Norlin, R., Intraarticular pathology in acute, first-time anterior shoulder dislocation: an arthroscopic study (1993) Arthroscopy., 9 (5), pp. 546-549Millett, P.J., Clavert, P., Hatch, G.F., Warner, J.J., Recurrent posterior shoulder instability (2006) J Am Acad Orthop Surg., 14 (8), pp. 464-476Wang, R.Y., Arciero, R.A., Mazzocca, A.D., The recognition and treatment of first- -time shoulder dislocation in active individuals (2009) J Orthop Sports Phys Ther., 39 (2), pp. 118-123Hayes, K., Callanan, M., Walton, J., Paxinos, A., Murrell, G.A., Shoulder instability: management and rehabilitation (2002) J Orthop Sports Phys Ther., 32 (10), pp. 497-509Rowe, C.R., Patel, D., Southmayd, W.W., The Bankart procedure: a long-term end-result study (1978) J Bone Joint Surg Am., 60 (1), pp. 1-16Bot, S.D., Terwee, C.B., van der Windt, D.A., Bouter, L.M., Dekker, J., de Vet, H.C., Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature (2004) Ann Rheum Dis., 63 (4), pp. 335-341Beaton, D.E., Bombardier, C., Guillemin, F., Ferraz, M.B., Guidelines for the process of cross-cultural adaptation of self-report measures (2000) Spine (Phila Pa 1976)., 25 (24), pp. 3186-3191Guillemin, F., Bombardier, C., Beaton, D., Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines (1993) J Clin Epidemiol., 46 (12), pp. 1417-1432Rowe, C.R., Zarins, B., Recurrent transient subluxation of the shoulder (1981) J Bone Joint Surg Am., 63 (6), pp. 863-872Rowe, C.R., Zarins, B., Chronic unreduced dislocations of the shoulder (1982) J Bone Joint Surg Am., 64 (4), pp. 494-505Rowe, C.R., Evaluation of the shoulder (1988) The shoulder., pp. 631-637. , New York: Churchill LivingstoneSugaya, H., Moriishi, J., Kanisawa, I., Tsuchiya, A., Arthroscopic osseous Bankart repair for chronic recurrent traumatic anterior glenohumeral instability (2006) Surgical technique. J Bone Joint Surg Am., 88 (SUPPL. 1 PART 2), pp. 159-169Kartus, C., Kartus, J., Matis, N., Forstner, R., Resch, H., Long-term independent evaluation after arthroscopic extra-articular Bankart repair with absorbable tacks (2007) A clinical and radiographic study with a seven to ten-year follow-up. J Bone Joint Surg Am., 89 (7), pp. 1442-1448Jensen, K.U., Bongaerts, G., Bruhn, R., Schneider, S., Not all Rowe scores are the same! Which Rowe score do you use? (2009) J Shoulder Elbow Surg, 18 (4), pp. 511-514Vasconcelos, U.M.R., Leonardi, A.B.A., Reis, A.L., Filho, G.C., Chueire, A.G., Instabilidade ântero-inferior traumática do ombro: procedimento de Bankart em atletas não profissionais (2003) Acta Ortop Bras., 11 (3), pp. 150-15

[effects Of Cisapride And Chest Physical Therapy On The Gastroesophageal Reflux Of Wheezing Babies Based On Scintigraphy]

OBJECTIVE: To evaluate the effect of cisapride and chest physical therapy on the gastroesophageal reflux of wheezing babies. METHODS: We prospectively assessed the presence of technetium ((99)Tc) in the upper, middle, and lower esophagus of 25 wheezing babies (13 with GERD and 12 without GERD) using scintigraphy. Both groups underwent clinical investigation, including laboratory, X-ray and scintigraphy tests, for the etiology of the wheezing baby syndrome (WBS) and GERD. Expiratory Flow Acceleration (EFA) was performed before and after treatment with cisapride. The total time of GER episodes was accounted for each portion of the esophagus during scintigraphy and during EFA. RESULTS: Cisapride significantly reduced the total reflux time in the upper esophagus (P<0.05), but showed no influence during EFA. After cisapride therapy, EFA increased the total reflux time in the upper and medium esophagus; however, no statistical significance was found. Infants with GERD presented a shorter total reflux time in the distal esophagus (P<0.05) during EFA. After cisapride treatment, no statistical significance was found. Infants without GERD also presented reduced total reflux time in the distal esophagus during EFA (P<0.05). Those with GERD had increased total reflux time in the distal esophagus (P<0.05) before and after cisapride treatment during EFA and scintigraphy. CONCLUSIONS: Cisapride was effective in reducing the total reflux time, mainly in the upper esophagus. EFA apparently increased the number of episodes of GER, without achieving statistical significance. Further studies are necessary to investigate the effects of chest physical therapy according to body positions.77393-40

Doses cumulativas de iodo radioativo no tratamento do carcinoma diferenciado de tireoide: sabendo a hora de parar

OBJECTIVE: Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). SUBJECTS AND METHODS: The probability of progressive disease according to CDs was evaluated in patients < 45 years old and &gt; 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. RESULTS: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p < 0.0001), higher TNM stages (p < 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs &gt; 600 mCi in patients &gt; 45 years old and with CDs &gt; 800 mCi in patients < 45 years. CONCLUSION: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.OBJETIVO: Avaliar a eficácia de doses cumulativas (DCs) da terapia com iodeto-131I (RIT) no câncer diferenciado de tiroide (CDT). SUJEITOS E MÉTODOS: A probabilidade de doença em progressão conforme a DC foi calculada em pacientes com idade < 45 e &gt; 45 anos e correlacionada com o TNM, valores de tiroglobulina sérica, tipos histológicos e variantes, idade e tempo de doença. RESULTADOS: Ao final de um seguimento de 69 ± 56 meses, 85 dos 150 pacientes CDT submetidos a doses fixas de RIT não tinham evidência de doença, 47 tinham doença estável e 18, doença progressiva. DCs mais elevadas foram usadas nas variantes agressivas (p < 0,0001), maior estágio TNM (p < 0,0001) e nos carcinomas foliculares (p = 0,0034). A probabilidade de doença em progressão foi maior com DCs &gt; 600 mCi em pacientes &gt; 45 anos e com DCs &gt; 800 mCi em pacientes < 45 anos. CONCLUSÃO: Apesar de alguns pacientes ainda responderem a altas DCs, o impacto de RITs deve ser cuidadosamente avaliado e outras estratégias terapêuticas devem ser consideradas.80781

Cumulative Doses Of Radioiodine In The Treatment Of Differentiated Thyroid Carcinoma: Knowing When To Stop.

Evaluate the efficacy of cumulative doses (CDs) of 131I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). The probability of progressive disease according to CDs was evaluated in patients 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p 600 mCi in patients > 45 years old and with CDs > 800 mCi in patients < 45 years. Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted.54807-1

Cumulative doses of radioiodine in the treatment of differentiated thyroid carcinoma: knowing when to stop Doses cumulativas de iodo radioativo no tratamento do carcinoma diferenciado de tireoide: sabendo a hora de parar

ABSTRACT Objective: Evaluate the efficacy of cumulative doses (CDs) of 131 I-iodide therapy (RIT) in differentiated thyroid cancer (DTC). Subjects and methods: The probability of progressive disease according to CDs was evaluated in patients ≤ 45 years old and &gt; 45 years old and correlated to tumor-node-metastasis (TNM), thyroglobulin values, histological types and variants, age, and zduration of the disease. Results: At the end of a follow-up period of 69 ± 56 months, 85 out of 150 DTC patients submitted to fixed doses RIT had no evidence of disease, 47 had stable disease and 18 had progressive disease. Higher CDs were used in the more aggressive variants (p &lt; 0.0001), higher TNM stages (p &lt; 0.0001), and follicular carcinomas (p = 0.0034). Probability of disease progression was higher with CDs ≥ 600 mCi in patients &gt; 45 years old and with CDs ≥ 800 mCi in patients ≤ 45 years. Conclusion: Although some patients may still respond to high CDs, the impact of further RIT should be carefully evaluated and other treatment strategies may be warranted

[comparison Of The Neuropsychological Assessment In A Girl With Bilateral Cerebrovascular Disease (moyamoya) Before And After Surgical Intervention].

Moyamoya is a chronic progressive cerebrovascular disease with characteristic angiographic findings and a clinical picture with episodes of transient ischemic attacks, headache, seizures, hemiparesis, which may resolve after surgical treatment. We describe the case of a girl with the typical findings of the disease, comparing them before and after surgery with the use of neuropsychological tests, neurological examination and laboratory tests.571036-4