A combined protocol with piroxicam, chemotherapy and whole pelvic irradiation with simultaneous boost volumetric modulated arc radiotherapy for muscle-invasive canine urinary transitional cell carcinoma: first clinical experiences

The aims of this pilot study were to evaluate the feasibility and efficacy of high-dose hypo-fractionated volumetric modulated arc radiotherapy (VMAT) applied to the whole pelvic region radiotherapy (WPRT) with multilevel simultaneous integrated boost (MLSIB) combined with piroxicam and chemotherapy in canine transitional cell carcinoma (TCC) of the lower urinary tract with muscle invasion transitional cell carcinoma (TCC). Twelve dogs were enrolled, according to stage, in two groups: group 1, TCC confined to the urinary tract; group 2, TCC with metastasis. The planning target volume (PTV-tumor) dose was tailored from 36 to 42 Gy in 6 fractions. All dogs were prescribed piroxicam and radiosensitizing carboplatin and six received chemotherapy after radiotherapy. Serial follow-up with computed tomography (CT) and magnetic resonance imaging (MRI) examinations was performed. Disease control and toxicity effects were evaluated according to the Response Evaluation Criteria in Solid Tumor (RECIST) and Veterinary Radiation Therapy Oncology Group (VRTOG) criteria. The treatment was well tolerated, and no high-grade side effects were reported. The median overall survival times for group 1 and group 2 were 1,230 days and 150 days, respectively. A considerable percentage of patients in group 1 (50%) was still alive at the time of writing, and a longer follow-up could enable a more accurate survival analysis. This preliminary analysis showed that VMAT applied to the WPRT with MLSIB is an effective and safe option for dogs suffering from lower urinary TCC although the presence of metastases worsens the prognosis

Hospitais: espaços de cura e lugares de memória da saúde

O presente artigo pretende analisar o Hospital Gaffrée e Guinle, construído na década de 1920, na cidade do Rio de Janeiro, em um processo de tomada de controle, pela administração pública, da gestão da assistência hospitalar na capital federal. Esse hospital representa o encontro da filantropia com um projeto de saúde pública posto em prática no Distrito Federal à mesma época. A instituição sintetiza também o desenvolvimento da medicina e sua tradução na arquitetura hospitalar, bem como a efervescência intelectual do período, mais especificamente das idéias nacionalistas, interpretadas tanto na escolha do estilo arquitetônico - o neocolonial - quanto na questão da salvação da raça através do combate e controle da sífilis.This paper analyzes the Gaffrée & Guinle Hospital, built in Rio de Janeiro during the 1920s as the result of a process whereby the government took over the management of hospital care in the federal capital. The hospital is the point of convergence between philanthropy and a public healthcare project implemented in the Federal District at that time. It also synthesizes the development of medicine and how the latter translates into hospital architecture, as well as the intellectual effervescence at the time, more specifically the nationalist ideas which can be identified both in the choice of architectural style - namely the neocolonial - and in the theme of salvation of a race through the combat and control of syphilis

Temporal Dynamics of Interferon Gamma Responses in Children Evaluated for Tuberculosis

BACKGROUND: Development of T-cells based-Interferon gamma (IFNgamma) assays has offered new possibilities for the diagnosis of latent tuberculosis infection (LTBI) and active disease in adults. Few studies have been performed in children, none in France. With reference to the published data on childhood TB epidemiology in the Paris and Ile de France Region, we considered it important to evaluate the performance of IGRA (QuantiFERON TB Gold In Tube(R), QF-TB-IT) in the diagnosis and the follow-up through treatment of LTBI and active TB in a cohort of French children. METHODOLOGY/PRINCIPAL FINDINGS: 131 children were recruited during a prospective and multicentre study (October 2005 and May 2007; Ethical Committee St Louis Hospital, Paris, study number 2005/32). Children were sampled at day 0, 10, 30, 60 (except Healthy Contacts, HC) and 90 for LTBI and HC, and a further day 120, and day 180 for active TB children. Median age was 7.4 years, with 91% of the children BCG vaccinated. LTBI and active TB children undergoing therapy produced significant higher IFNgamma values after 10 days of treatment (p = 0.035). In addition, IFNgamma values were significantly lower at the end of treatment compared to IFNgamma values at day 0, although the number of positive patients was not significantly different between day 0 and end of treatment. CONCLUSIONS/ SIGNIFICANCE: By following quantitative IFNgamma values in each enrolled child with LTBI or active TB and receiving treatment, we were able to detect an increase in the IFNgamma response at day 10 of treatment which might allow the confirmation of a diagnosis. In addition, a decline in IFNgamma values during treatment makes it possible for clinicians to monitor the effect of preventive or curative therapy

Volumetric Modulated Arc (Radio) Therapy in Pets Treatment: The “La Cittadina Fondazione” Experience

Volumetric Modulated Arc Therapy (VMAT) is a modern technique, widely used in human radiotherapy, which allows a high dose to be delivered to tumor volumes and low doses to the surrounding organs at risk (OAR). Veterinary clinics takes advantage of this feature due to the small target volumes and distances between the target and the OAR. Sparing the OAR permits dose escalation, and hypofractionation regimens reduce the number of treatment sessions with a simpler manageability in the veterinary field. Multimodal volumes definition is mandatory for the small volumes involved and a positioning device precisely reproducible with a setup confirmation is needed before each session for avoiding missing the target. Additionally, the elaborate treatment plan must pursue hard constraints and objectives, and its feasibility must be evaluated with a per patient quality control. The aim of this work is to report results with regard to brain meningiomas and gliomas, trigeminal nerve tumors, brachial plexus tumors, adrenal tumors with vascular invasion and rabbit thymomas, in comparison with literature to determine if VMAT is a safe and viable alternative to surgery or chemotherapy alone, or as an adjuvant therapy in pets

A Combined Hypofractionated Volumetric Modulated Arc Radiotherapy, Radio-Sensitising and Adjuvant Metronomic Chemotherapy Treatment for Canine Stage IV Nasal Tumours With Intracranial Extension

Radiation therapy has become the standard of care in the treatment of canine intranasal neoplasia, but because of the poor prognosis associated with stage IV nasal tumours and the proximity of the brain to the irradiation target, few data regarding the treatment of very advanced neoplasms are available. The aim of this pilot study was to evaluate the feasibility, safety and effectiveness of a combined treatment composed of definitive high-dose hypofractionated volumetric modulated arc radiotherapy on tumours with concurrent treatment of regional lymph nodes if positive or as prophylaxis, carboplatin radio-sensitising, and adjuvant metronomic chemotherapy for stage IV canine nasal tumours with intracranial extension. A pilot observational study was conducted in 7 dogs. Magnetic resonance imaging follow-up examinations revealed complete responses in 5 dogs and partial responses in 2. The median overall survival time, evaluated via Kaplan-Meier survival analysis, was 310 days with a 95% confidence interval of 210-400 days, whereas the median progression-free survival was 240 days with a 95% confidence interval of 190-290 days. Despite the proximity of highly sensitive organs at risk, no grade III or IV toxicities were observed, and volumetric modulated arc radiotherapy seemed to be a feasible treatment option for stage IV canine nasal tumours where conformal 3D radiotherapy has proven to give higher doses with severe damage to the surrounding unaffected tissues. Further studies are needed on the role of the sphenoid bone microscopic infiltration and regional lymph node involvement. The absence of severe toxicity could also lead to a dose escalation study and chemotherapy scheme