Biomedical subjects
Publications and source records attributed to A Lisbona.
Extraosseous Ewing's sarcoma is an undifferentiated round-cell sarcoma that is indistinguishable histologically from Ewing's sarcoma of bone. Despite this similarity, it has been accepted as a distinct clinicopathologic entity. The authors describe a 53-year-old man who presented with extraosseous Ewing's sarcoma of the left subcostal chest wall. The lesion was demonstrated by radiography and computed tomography and confirmed by pathological examination.
The percentage of patients achieving a complete response (CR) to therapy is often used as a measure of treatment efficacy in SCLC. Chest radiographs are difficult to evaluate following therapy and differences in reported response rates may be due to interobserver variation. CT scans of the thorax are more costly and are not as easily obtained as routine studies. We wanted to determine whether the measurability rate and interobserver agreement on response was superior when using CT scans, compared to chest radiographs alone. Fourteen radiologists with expertise in CT imaging of the thorax, reviewed 15 cases of SCLC pre- and post-chemotherapy (210 observations). In the first session, reviewers were required to measure or evaluate all possible lesions on the plain chest radiograph done at pre- and post-treatment. In the second session, accompanying CT scans were provided in order to make the same assessments. The number of instances in which neoplastic disease was measurable in two cross-sectional diameters on pretreatment films was 164 (79%) on chest radiographs and 202 (97%) on CT scans. Interobserver agreement was assessed by comparing tumour measurements, as well as reports of complete disappearance of tumour (CR) among the 15 observers. The rate of CR ranged from 0 to 87% with the use of the chest radiograph, and from 0 to 95% using the CT scan. Usually after viewing the CT scan, readers changed their opinion as to whether CR had actually occurred. For example, in one case, 87% of readers judged response to therapy as a CR based on chest radiograph; upon reevaluation with a CT scan this figure decreased to 15%. Agreement as to response was better on review of the CT scans, compared to the chest radiograph in all but two cases. It is therefore recommended that pre- and post-treatment CT scans, and not just chest radiographs, be used for assessment of response to therapy.
Osteocalcin and PTH serum levels were measured in 41 insulin-dependent diabetic pregnant women through the three trimesters of pregnancy with a total of 106 determinations of osteocalcin and 137 of PTH. In parallel we quantified these parameters in 90 normal pregnant women throughout the three trimesters of pregnancy. In addition calcitriol, osteocalcin and PTH levels were quantified at delivery in 16 diabetic pregnant women and 16 normal pregnant women at delivery, in cord serum and in the infants during the first days of life. Non-pregnant women (n = 48) were the control group. In normal pregnant women PTH levels increased during the third trimester and total calcitriol increased at delivery. Osteocalcin levels decreased in the second trimester but returned to normal values during the third trimester of pregnancy. Diabetic pregnant women showed constant PTH levels throughout pregnancy. At delivery in diabetic pregnant women, total calcitriol levels increased to a smaller extent than in normal pregnant women. Osteocalcin concentrations in the second and third trimester of pregnancy were lower than in the non-pregnant group. Infants of diabetic mothers showed lower PTH and osteocalcin concentrations than infants of normal pregnant women, whereas their calcitriol levels were similar. These data indicate that diabetes decreases bone turnover during pregnancy in the mother and during the perinatal period in their offspring.
BACKGROUND: Patients with Stage III non-small cell lung cancer (NSCLC) whose cases are staged or treated surgically have different prognoses, depending on the substage (IIIa, IIIb). It is not known whether the prognostic differences apply to clinically staged nonsurgical cases. The authors wanted to determine whether radiologic Stage III substages, determined by computerized axial tomography (CT) scans, are prognostically important in these patients with NSCLC: In addition, they wanted to determine whether the observed superior survival of selected patients with Stage III NSCLC receiving chemotherapy in addition to radiation therapy (chemo-RT) (Cancer and Leukemia Group B protocol 8433: N Engl J Med 1990; 323:940-5) was influenced by an imbalance in the radiologic Stage III substage. METHODS: Review of pretreatment chest radiographs and CT scans with determination of TNM status and stage was done by the consensus of three readers, who were unaware of which treatment each patient had received (radiation therapy alone [RT] or chemo-RT). RESULTS: Patient characteristics in the two treatment arms were similar. Fifty-five percent of patients receiving RT had Stage IIIa and 33% Stage IIIb disease; in the chemo-RT treatment arm, 73% had Stage IIIa and 25% Stage IIIb disease (P = 0.11). Seven patients (12%) who received RT and one in the chemo-RT treatment arm (2%) had Stage I-II disease on CT scan. Patients with Stage IIIa disease had superior survival to those with Stage IIIb disease (median, 16.5 versus 10.5 months, respectively; P = 0.0045). Within each substage, survival was superior in the chemo-RT (versus RT) treatment arm (Stage IIIa, 17.2 versus 10.7 months, respectively; P = 0.16; Stage IIIb, 12.0 versus 6.9 months, respectively; P = 0.089). CONCLUSIONS: The survival advantage for selected patients with Stage III NSCLC treated with chemo-RT in this study did not result from a more favorable pretreatment radiologic Stage III substage. An advantage for induction chemotherapy was seen in patients with Stage IIIa and IIIb disease. Future studies in this population should prospectively assess and consider stratification for Stage III substage.
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We present the results of a study that was undertaken at a large geriatric nursing home to assess the prevalence of gallstone disease in very old institutionalized persons. One hundred seventeen residents underwent ultrasound examination of the gallbladder. Two thirds of 82 women and half of 35 men had gallstone disease. When stratified for age, 80% of women and men over the age of 90 years were positive for the disease. In summary, the prevalence of gallstone disease in our very old nursing home population was found to be unexpectedly high.
The levels of 25(OH)D have been quantified in 42 insulin diabetic pregnancies (DP) through the three trimesters of pregnancy with a total of 177 determinations. In parallel we quantified this metabolite in 114 normal pregnant women (NP) and also in 116 normal controls (NC). In addition 25(OH)D was quantified in 18 (DP) and 19 (NP) at delivery in the 35-37th week of pregnancy, and ionic calcium was measured in their newborns at 24 h of life. Grouping by trimesters of gestation, the (NP) group had 25(OH)D levels similar to those of (NC) and none showed significant differences between trimesters of pregnancy. (DP) showed in all seasons lower (25(OH)D levels than (NC) but did not have differences in these levels between trimesters of pregnancy. The newborns of (DP) had lower ionic calcium levels than newborns of (NP). Eight newborns of (DP) had hypocalcemia and seven of their mothers showed 25(OH)D levels lower than 10 ng/ml. These findings suggest that lower 25(OH)D levels in (DP) can influence the neonatal hypocalcemia in their newborns.
Fatty infiltration of the liver has been described in association with a large number of systemic conditions. The authors describe a case of multifocal fatty infiltration simulating metastatic disease. The patient had acquired immunodeficiency syndrome and pathologically proved cytomegalovirus hepatitis. To the authors' knowledge, neither entity has been described in association with this radiologic finding.
The authors report a 1-year prospective study of 8413 asymptomatic women who underwent mammography. Of 221 patients who underwent biopsy with preoperative needle localization, 61 proved to have a malignant lesion. The positive predictive value of mammography was 0.22 for microcalcifications without a mass, 0.64 for microcalcifications within a circumscribed mass or with architectural distortion and 0.33 for circumscribed densities or architectural distortions without microcalcification. The positive predictive value for carcinoma is broken down into age groups.
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A compact device for the manufacturing of electrets and for the measurement of the dose to the skin of the patient in radiography has been developed and described. The surface potential of a polarized polymer electret decreases when it is exposed to radiation. The measurement of the variation in surface potential appears to be a reliable method for the evaluation of the dose. The electret does not disturb the examination nor the radiographic image as it can be given tissue equivalent properties.
Three patients with chronic calcified "fibrothorax" and complicating empyema are reported. The so-called chronic "fibrothorax" may envelop a fluid-filled cavity. Reactivation or reinfection can occur after a very long latent period. When this occurs, it is often associated with either a bronchopleural or a pleurocutaneous fistula. Contrary to often quoted opinion, the calcification a fibrothorax is found on the parietal as well as visceral pleura.
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