James Fleck

5 Background: Cost-effective analysis as part of cancer treatment decision-making. Methods: We reviewed deaths of 52 metastatic cancer patients treated with multidimensional integrative medicine (MIM) approach. Patients received standard oncologic treatment plus a MIM predefined program of emotional, cognitive and social support. The method included empathy improvement, changes on physician attitude and office environment, modulation of staff behavior supporting patient’s needs and rights, promotion of belongingness, increasing on patient’s protagonism using multimedia interactive narrative and shared decision-making. Patients were categorised according to the tumor site, pathologic, molecular and IHC characteristics, clinical stage and treatment. Observed survival was defined as the time elapsed between the detection of first metastasis and death. The observed survival for each patient was compared with the median expected survival previously reported on prospective randomised tria...

A Semana Científica do HCPA tem sido utilizada ... A 21ª Edição desta Semana Científica consolida a ... A apresentação de trabalhos de inúmeras outras ... Conselho Editorial: Prof. Carlos Alberto Prompt Prof. Cléber Dario Pinto Kruel Prof. Elvino Barros Profa. Ida Freitas Xavier Prof. ...

Objective: To objectively evaluate the reversal of digital clubbing (DC) in a series of surgically treated lung cancer patients, and to review the literature on the subject. Methods: Sixty-one patients with non-small cell lung cancer—40 with and 21 without DC—were treated by pulmonary resection. Eleven (18%) received additional postoperative radiation therapy. Preoperatively, as well as on postoperative days 7, 18, and 90, the hyponychial angle (HA) and the distal phalangeal depth/interphalangeal depth (DPD/IPD) ratio were determined on profile shadow projections of the index fingers. A review of the literature on reversal of DC (1954-2007) was also performed. Results: From the preoperative period to postoperative day 90, HA decreased from 200.5 ± 5.0° to 193.3 ± 6.8° (p < 0.001), and the DPD/IPD ratio decreased from 1.014 ± 0.051 mm to 0.956 ± 0.045 mm (p < 0.001) in the group of 40 patients with DC. The HA and the DPD/IPD ratio decreased in 33 (82.5%) but remained the same i...

The Breast Imaging Reporting and Data System (BI-RADS) ultrasound (US) categorization revised in 2013 by the American College of Radiology resulted in unquestionable standardization of reports and confirmed category 3 and 5 as benign and malignant lesions, respectively. In contrast, suspected images (category 4) have subcategorization criteria, although theses have been detailed difficult to apply. The aim of the present study was to determine the role of the US 4A to 4C BI-RADS subcategories in predicting malignancy. We performed a cross-sectional study of diagnostic tests to estimate the performance of the US BI-RADS categorization to clearly differentiate benign from malignant lesions. A total of 975 US examinations performed at the Hospital Femina, Grupo Hospitalar Conceição teaching hospitals from January 2012 through March 2015 were included in the present study. The US BI-RADS lexicon was used to classify the examination findings. Suspicious lesions underwent core needle biopsy, and the US and histology reports were compared to determine the performance using receiver operating characteristic curves. Overall, the BI-RADS US categorization showed good discriminating accuracy with a receiver operating characteristic curve of 91% (95% confidence interval [CI], 88%-93%). However, BI-RADS subcategory 4b had a positive predictive value of 25% (95% CI, 20%-31%) and subcategory 4A had a positive predictive value of only 6% (95% CI, 3.5%-9.8%). Our results have shown that US BI-RADS subcategories 4A and 4B are clearly unfit for use in screening tests, because they cannot rule out the need for biopsy. Therefore, management will not be improved by subcategorizing category 4, because all suspicious lesions will still require definite biopsy.

INTRODUCTION: The amount of early radiologic findings that were not represented at the physical exam has increased with the use of screening mammography. The ecography is used as a complementary means of diagnosis, and often it is the way to guide the biopsy. Thus, breast lesions are grouped into six categories according to the BI-RADS classification, proposed by the American College of Radiology, warning about the risk of cancer diagnosis. The aim of this study was to correlate the ecographic findings with the histological diagnosis by means of the percutaneous core biopsy (PCB). METHODOLOGY: Retrospective cross-sectional study including 326 sequential patients submitted to ecography + PCB between September of 2010 and August of 2011. All the ecographies were accomplished and classified by the same ecographist, using the Ultra Vision-Elite 300 device. The PCBs were accomplished with a Bard Magnum gun and (disposable) needles 14G/10 cm long, obtaining an average of 4 fragments for the analysis. The biopsy specimens were analyzed with the hematoxylin and eosin method at our hospital’s Pathology Service. The statistical analyses were accomplished using the Epi SPSS 17. 0 program, considering the p values under 0. 05 as positive. RESULTS: Among the 326 patients, 2. 1% had an unsatisfactory histopathologic diagnosis. The histological diagnosis of the remaining 219 patients showed intraductal lesions in 1.5% and invasive lesions in 35. 4%. Among those patients with a diagnosis of malignity (n= 121), the RR was 6. 4 for Bi-RADS IVa, 91. 7 for IVb, and 124. 1 for IVc. The sensitivity of the ecography in relation to the cancer diagnosis was 85. 7% for IVa, 77. 8 for IVb, and 91. 7 for IVc. The specificity was 11.5 for IVa, 23. 1 for IVb, and 57. 7 for IVc. DISCUSSION: The ecographic BI-RADS system has been a good auxiliary image method for the MMG in the diagnosis of breast cancer. Besides, it enables the accomplishment of the biopsy in a more straightforward and less complicated way, when compared to the MMG-guided technique. The category III had a cancer diagnosis of 11. 8%, higher than the expected (below 2%), while the category IVc confirmed the diagnosis of malignity in 66. 7% of the patients, which is in accordance with the consulted literature. CONCLUSIONS: Evaluating the studied aspects, we conclude that the ecography and the use of the BI-RADS system are appropriate tools for confirmation of breast cancer diagnosis. Especially in the categories IVa, IVb, and IVc, sensitivity and specificity were appropriate.

Differentiation of Tera-2 human embryonal carcinoma cells by exposure to 2.1 mM alpha-difluoromethylornithine resulted in changes in morphology, a decrease in growth rate, and changes in the expression of SSEA-1 differentiation antigen. While the binding of 125I-insulin-like growth factor I (IGF-I) remained relatively constant during differentiation, binding of 125I-IGF-II increased 2-3-fold. Further, the binding of IGF-II was 87 times greater than IGF-I in both undifferentiated and differentiated cells. Undifferentiated Tera-2 cells exhibited a single class of binding sites for both IGF-I (KD = 1.2 nM, 7.0 x 10(3) sites/cell) and IGF-II (KD = 8.3 nM, 3.4 x 10(5) sites/cell). Following differentiation, IGF-I continued to bind to a single class of binding sites (KD 1.0 nM, 6.7 x 10(3) sites/cell) whereas IGF-II bound to both high-affinity sites (KDH 0.3 nM, 2.2 x 10(5) sites/cell) and low-affinity sites (KDL 15.1 nM, 1.6 x 10(7) sites/cell). The binding of iodinated IGF-II was blocke...

Resumo: Um estudo de coorte histórico foi desenvolvido incluindo 116 pacientes com câncer de mamaatendidas no Hospital Femina, Grupo Hospitalar Conceição (GHC), Ministério da Saúde (MS), entre setembro de 1997 e dezembro de 2000. Foi aplicado o ...

A Semana Científica do HCPA tem sido utilizada ... A 21ª Edição desta Semana Científica consolida a ... A apresentação de trabalhos de inúmeras outras ... Conselho Editorial: Prof. Carlos Alberto Prompt Prof. Cléber Dario Pinto Kruel Prof. Elvino Barros Profa. Ida Freitas Xavier Prof. ...

The objective of this study was to verify the frequency of p53 and BCL-2 immunohistochemical expres-sion in patients with endometrial carcinoma and to correlate it with histological factors (histological type, tumor grade, depth of myometrial invasion, lymph node involvement ...

To evaluate pulmonary epithelial permeability using 99mTc-DTPA scintigraphy in patients treated with bleomycin-containing regimens. Twelve non-smoking chemotherapy-naïve patients with no clinical or radiological evidence of pulmonary disease and treated with bleomycin-containing chemotherapy were tested with 99mTc-DTPA scintigraphy before the first cycle and every 3 weeks until the third month after the end of chemotherapy (total cumulative dose of bleomycin 347.9 mg). Pretreatment values (T1/2 74.93 minutes) of 99mTc-DTPA scintigraphy were significantly higher than those obtained after the total dose of bleomycin (T1/2 51.00 minutes) (p < 0.001). This difference was more important in the later evaluations especially, on the third week and third month measures after discontinuing treatment (p < 0.001). All the tests of Within-Subjects Effects were significant (p < 0.001). Comparing pretreatment and post-treatment scintigraphies the mean T1/2 99mTc-DTPA values decreased as the bleomycin dose increased. We conclude that cumulative bleomycin doses are related to increased pulmonary epithelial permeability at a dose of 256.5 mg. However, whether this is related to clinical toxicity is uncertain and large, multi-center prospective studies are needed.

Results: At steady-state, colistin methanesulphonate had a mean (± sd) total body clearance, volume of distribution and half-life of 2.01 ± 0.46 mL/min per kg, 340 ± 95 mL/kg and 124 ± 52 min, respectively. Colistin had a significantly longer mean half-life of 251 ± 79 ...

Perdicaris, Antônio André Magoulas; Queiroz, Aristides Cheto de; Oliveira, Djalma de; Alves, Elizabeth de Carvalho; Saltz, Ernani; Aquino, Estela Maria de; Abreu, Evaldo de; Delgado, Gilson Luchezi; Prego, Gilson; Juaçaba, Haroldo Gondim; Lessa, Ines; Fleck, James; Valle, José ...