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Search Results: 1 - 10 of 5180 matches for " Hugo Marsiglia "
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A Case of RhabdomyoSarcoma Following a Metal Surgical Implant
Giovanna M. Gatti,Giovanni B. Ivaldi,Eric Lartigau,Hugo Marsiglia
Sarcoma , 1999, DOI: 10.1080/13577149977794
Mixed modality treatment planning of accelerated partial breast irradiation: to improve complex dosimetry cases
Mohamed El Nemr, Steve Heymann, Rodolfe Verstraet, Bruno Biron, Fares Azoury, Hugo Marsiglia, Céline Bourgier
Radiation Oncology , 2011, DOI: 10.1186/1748-717x-6-154
Abstract: From October 2007 to March 2010, 55 patients with pT1N0 breast cancer were enrolled in a phase II APBI trial. Among them, 7 patients were excluded as they were considered as "complex cases". A dosimetric comparison was performed according to the 3 APBI modalities mentioned above and assessed: planning treatment volume (PTV) coverage, PTV/whole breast ratio, lung and heart distance within irradiated field and exposure of organs at risk (OAR).Adequate PTV coverage was obtained with the 3 different treatment planning. Regarding OAR exposure, the "mixed technique" seemed to reduce the volume of non-target breast tissue in 4 cases compared to the other techniques (in only 1 case), with the mean V50% at 44.9% (range, 13.4 - 56.9%) for the mixed modality compared to 51.1% (range, 22.4 - 63.4%) and 51.8% (range, 23.1 - 59.5%) for the reference and non-coplanar techniques, respectively. The same trend was observed for heart exposure.The mixed technique showed a promising trend of reducing the volume of non-target breast tissue and heart exposure doses in APBI "complex cases".While whole breast irradiation (50 Gy/25 fractions) followed by a boost to the tumor bed (16 Gy/8 fractions) is the standard of locoregional care for early breast cancer, the current trend is to shorten overall treatment time by delivering either hypofractionated whole breast irradiation (WBI) or accelerated partial breast irradiation (APBI). The latter technique has gained momentum and has been widely used since the American and European Societies of Radiation Oncology suggested that a breast cancer population would benefit from APBI outside of any clinical trial [1,2]. However, several issues still need to be clarified such as the optimal APBI techniques (invasive or non invasive), treatment planning modalities for 3D-conformal APBI (non-coplanar fields [3], mixed electron-photon beams [4]), the optimal total dose and dosimetric constraints that would limit late side effects.At the Institut Gustave Rou
La tiroiditis bifásica: un patrón fisiopatológico en las tiroiditis
Gaceta Médica de Caracas , 2008,
Abstract: thyroid dysfunction is commonly observed in the clinical course of thyroiditis. clinical or subclinical hypothyroidism frequently occurred in chronic autoimmune thyroiditis as a consequence of progressive glandular replacement by fibrosis and atrophy. also, permanent hypothyroidism is a common sequel of silent thyroiditis, unusual in subacute thyroiditis. thyroid inflammatory process associated to destruction of glandular epithelium and transitory thyrotoxicosis is known as ?destructive thyroiditis?, which frequently occurred in the first months of subacute or silent thyroiditis evolution or, in a little percentage, during the course of chronic autoimmune thyroiditis. disorders with different pathogenesis, as subacute thyroiditis which is entailed with viral infections or, silent-postpartum or chronic autoimmune thyroiditis, known autoimmune diseases, are responsible of similarly pathophysiological phenomena which originated ?biphasic thyroiditis?. characteristically, these cases developed sequentially transitory thyrotoxicosis, which is followed by transient hypothyroidism and recovery. in two venezuelan samples, transitory thyrotoxicosis and hypothyroidism with biphasic patron were observed, respectively, in 86 % and 27 % of thyroiditis subacute cases and, the biphasic patron, in the four cases with silent or postpartum thyroiditis. in the sample of chronic autoimmune thyroiditis, no cases of biphasic thyroiditis were observed. the pathophysiological mechanisms of biphasic thyroiditis are direct consequence of thyroidal inflammation and autoimmunity, which also imply the effects of stimulating or blocking antibodies for the stimulant thyroid hormone receptor. undoubtedly, this functional patron and its reversibility, constitutes a sui generis behavior in the endocrine glands diseases, in which spontaneous hyper or hypo function usually occurred isolated and permanently. these reasons justify the report of these typical cases of subacute, silent and chronic autoimm
Espectro clinicopatológico de las tiroiditis
Gaceta Médica de Caracas , 2007,
Abstract: clinical-pathological spectrum of thyroiditis comprises from the rare acute o suppurative thyroiditis as far as the rarest rieldel?s thyroiditis. also, subacute and silent thyroiditis (and it postpartum variant) are non common diseases, while autoimmune chronic thyroiditis or hashimoto?s disease results the most frequent thyroiditis and organ-specific autoimmune disorder, that is responsible for most part of hypothyroidism cases. effectively, in iodine-replete geographic areas, most persons with thyroid disorders have autoimmune disease. autoimmunity as primary phenomenon plays a transcendent role in etiopathogeny of chronic autoimmune thyroiditis, silent-postpartum thyroiditis and riedel?s thyroiditis and only a secondary role in subacute thyroiditis. probably, viral infections cause subacute thyroiditis, while pyogenic germs and fungus are responsible for suppurative thyroiditis. commonly, autoimmune and subacute thyroiditis are associated with thyroid dysfunction. it is known as ?destructive thyroiditis?, the thyroidal inflammatory process that is joined to destruction and transient thyrotoxicosis. usually, thyroid dysfunction in these cases adopt ?biphasic thyroiditis? pattern, in which sequentially, transient thyrotoxicosis is followed by transient hypothyroidism and recovery. disorders with different etiopathogeny as subacute thyroiditis, silent thyroiditis and hashimoto?s thyroiditis are responsible of similarly physiopathologic phenomenons that originated biphasic thyroiditis. pain in the thyroidal gland is relevant in subacute and suppurative thyroiditis and, rarely is present in silent thyroiditis or in acute exacerbation of hashimoto?s thyroiditis. in most of the cases, it is possible to establish the diagnosis of thyroiditis through clinical history, thyroidal function tests, isotopic studies and ecosonography. thyroid fine needle biopsy resolves doubtful cases. this review about ?clinical-pathological spectrum of thyroiditis?, results from the synthesis
La tiroiditis bifásica: un patrón fisiopatológico en las tiroiditis
Italo Marsiglia
Gaceta Médica de Caracas , 2008,
Abstract: La disfunción tiroidea es una observación común en el curso evolutivo de las tiroiditis. En las fases avanzadas de la tiroiditis crónica autoinmune es muy frecuente el hallazgo de hipotiroidismo clínico o subclínico, como consecuencia del reemplazo glandular por la fibrosis y atrofia resultantes. El hipotiroidismo permanente también es una secuela común en la tiroiditis silente y poco frecuente en la tiroiditis subaguda. Por otra parte, se conoce como “tiroiditis destructiva”, al proceso inflamatorio tiroideo acompa ado de destrucción del epitelio glandular y tirotoxicosis transitoria, que usualmente ocurre en los primeros meses de evolución de las tiroiditis subaguda y silente o, en un porcentaje menor, durante el curso de la tiroiditis crónica autoinmune. Desórdenes que tienen diferente patogénesis, como, la tiroiditis subaguda, vinculada con las infecciones virales, o las tiroiditis silente o posparto y la enfermedad de Hashimoto, reconocidos procesos autoinmunes, son responsables de fenómenos fisiopatológicos similares que dan origen a la “tiroiditis bifásica”. De manera característica, estos casos desarrollan secuencialmente, tirotoxicosis pasajera que va seguida de hipotiroidismo transitorio y recuperación. En dos muestras venezolanas, la tirotoxicosis pasajera y el hipotiroidismo transitorio con el patrón de la tiroiditis bifásica se observó, respectivamente, en 86 % y 27 % de los casos de tiroiditis subaguda y, el patrón bifásico, en los cuatro casos de tiroiditis silente o posparto. En la muestra de tiroiditis crónica autoinmune, no se observó ningún caso de tiroiditis bifásica. Los mecanismos fisiopatológicos de la tiroiditis bifásica son consecuencia directa de la inflamación tiroidea y la autoinmunidad, que también implica a los anticuerpos estimulantes o bloqueadores del receptor de la hormona estimulante de la tiroides. La observación de este patrón funcional y su reversibilidad, constituye indudablemente un comportamiento sui generis en las enfermedades de las glándulas endocrinas, en las que hiper o hipofunción espontáneas, suelen ocurrir aislada y permanentemente. Por eso, parece justificado presentar sendos casos típicos de tiroiditis subaguda, silente y crónica autoinmune, en los cuales, el patrón de la tiroiditis bifásica fue el hallazgo más relevante de su evolución clínica. Thyroid dysfunction is commonly observed in the clinical course of thyroiditis. Clinical or subclinical hypothyroidism frequently occurred in chronic autoimmune thyroiditis as a consequence of progressive glandular replacement by fibrosis and atrophy. Also, perma
Espectro clinicopatológico de las tiroiditis
Italo Marsiglia
Gaceta Médica de Caracas , 2007,
Abstract: El espectro clinicopatológico de las tiroiditis abarca, desde la rara tiroiditis aguda o supurativa hasta la más rara tiroiditis de Riedel. Las tiroiditis subaguda y silente (y su variante postpartum) también son enfermedades no comunes, mientras que la tiroiditis crónica autoinmune o enfermedad de Hashimoto resulta la tiroiditis y la enfermedad autoinmune órgano específica más frecuente, responsable de la mayor parte de los casos de hipotiroidismo. Efectivamente, en las áreas geográficas no deficientes en yodo, la mayor parte de los desórdenes tiroideos se deben a enfermedad autoinmune. La autoinmunidad como fenómeno primario juega un papel trascendente en la etiopatogenia de la tiroiditis crónica autoinmune, la tiroiditis silente-postpartum y la tiroiditis de Riedel y, sólo un rol secundario en la tiroiditis subaguda. Posiblemente, las infecciones virales causan la tiroiditis subaguda, mientras que los gérmenes piógenos y hongos son responsables de la tiroiditis supurativa. Las tiroiditis autoinmunes y la tiroiditis subaguda se acompa an comúnmente de disfunción tiroidea. Se conoce como “tiroiditis destructiva” al proceso inflamatorio tiroideo acompa ado de destrucción y tirotoxicosis transitoria. En estos casos, la disfunción tiroidea adopta usualmente el patrón de “tiroiditis bifásica”, en la que secuencialmente, la tirotoxicosis pasajera va seguida de hipotiroidismo transitorio y recuperación. Desórdenes con diferente etiopatogenia, como la tiroiditis subaguda, la tiroiditis silente y la enfermedad de Hashimoto, son responsables de los fenómenos fisiopatológicos similares que dan origen a la tiroiditis bifásica. El dolor en la tiroides adquiere relevancia en la tiroiditis subaguda y en la tiroiditis supurativa y, sólo raramente, está presente en la tiroiditis silente o en la exacerbación aguda de la enfermedad de Hashimoto. En la mayor parte de los casos, es posible establecer el diagnóstico de la tiroiditis mediante la historia clínica, las pruebas de función tiroidea y los estudios isotópicos y ecosonográficos. La biopsia tiroidea por aspiración con aguja fina permite resolver los casos dudosos. Esta revisión del “Espectro clínico-patológico de las tiroiditis”, resulta una síntesis de la información bibliográfica y la experiencia lograda con las tiroiditis a través de un enfoque clínico integral. Clinical-pathological spectrum of thyroiditis comprises from the rare acute o suppurative thyroiditis as far as the rarest Rieldel’s thyroiditis. Also, subacute and silent thyroiditis (and it postpartum variant) are non common diseases, while autoimmune c
Scintigraphic evaluation of oesophageal transit during radiotherapy to the mediastinum
Giuseppe Sasso, Pierfrancesco Rambaldi, Francesco S Sasso, Vincenzo Cuccurullo, Paola Murino, Paolo Puntieri, Hugo R Marsiglia, Luigi Mansi
BMC Gastroenterology , 2008, DOI: 10.1186/1471-230x-8-51
Abstract: Between January 1996 and November 1998, 11 patients affected by non-small-cell carcinoma of the lung not directly involving the oesophagus, requiring adjuvant external beam radiotherapy (RT) to the mediastinum were enrolled. Oesophageal transit scans with liquid and semisolid bolus were performed at three pre-defined times: before (T0) and during radiation at 10 Gy (T1) and 30 Gy (T2). Two parameters were obtained for evaluation: 1) mean transit time (MTT); and 2) ratio between peak activity and residual activity at 40 seconds (ER-40s). Acute radiation toxicity was scored according to the joint EORTC-RTOG criteria. Mean values with standard deviation were calculated for all parameters. Analysis of variance (ANOVA) tests and paired t-Tests for all values were performed.An increase in the ER-40s from T0 to T1 or T2 was seen in 9 of 11 patients (82%). The mean ER-40s value for all patients increased from 0.8306 (T0) to 0.8612 (T1) and 0.8658 (T2). These differences were statistically significant (p < 0.05) in two paired t-Tests at T0 versus T2 time: overall mean ER-40s and upright ER-40s (p = 0.041 and p = 0.032, respectively). Seven patients (63%) showed a slight increase in the mean MTT value during irradiation but no statistically significant differences in MTT parameters were found between T0, T1 and T2 (p > 0.05).Using oesophageal scintigraphy we were able to detect early alterations of oesophageal transit during the third week of thoracic RT.External beam RT to the mediastinum is generally recommended in the treatment of a variety of thoracic tumours, in either a curative or a palliative setting. The oesophagus is often included in the radiation treatment volume. Acute oesophagitis is therefore one of the most frequent side effects and, particularly with the current trend for combined modality therapy, can be severe enough to interrupt the planned course of radiation therapy. Its pathophysiology, however, remains poorly understood.The main clinical signs of acute
Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity
Latifa Mesbah, Raúl Matute, Sergey Usychkin, Immacolata Marrone, Fernando Puebla, Cristina Mínguez, Rafael García, Graciela García, César Beltrán, Hugo Marsiglia
Radiation Oncology , 2011, DOI: 10.1186/1748-717x-6-102
Abstract: In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume.The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity.HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.Radiation therapy is an in
Radio-induced malignancies after breast cancer postoperative radiotherapy in patients with Li-Fraumeni syndrome
Steve Heymann, Suzette Delaloge, Arslane Rahal, Olivier Caron, Thierry Frebourg, Lise Barreau, Corinne Pachet, Marie-Christine Mathieu, Hugo Marsiglia, Céline Bourgier
Radiation Oncology , 2010, DOI: 10.1186/1748-717x-5-104
Abstract: We reviewed a cohort of patients with germ-line p53 mutations who had been treated for breast cancer as the first tumor event. We assessed their outcome and the incidence of secondary radio-induced malignancies.Among 47 documented Li-Fraumeni families treated from 1997 to 2007 at the Institut Gustave Roussy, 8 patients had been diagnosed with breast cancer as the first tumor event. Three patients had undergone conservative breast surgery followed by postoperative radiotherapy and five patients had undergone a mastectomy (3 with postoperative radiotherapy). Thus, 6/8 patients had received postoperative radiotherapy. Median follow-up was 6 years. Median age at the diagnosis of the primary breast cancer was 30 years. The histological characteristics were as follows: intraductal carcinoma in situ (n = 3), invasive ductal carcinoma (n = 4) and a phyllodes tumor (n = 1). Among the 6 patients who had received adjuvant radiotherapy, the following events had occurred: 3 ipsilateral breast recurrences, 3 contralateral breast cancers, 2 radio-induced cancers, and 3 new primaries (1 of which was an in-field thyroid cancer with atypical histology). In contrast, only one event had occurred (a contralateral breast cancer) among patients who had not received radiation therapy.These observations could argue in favor of bilateral mastectomy and the avoidance of radiotherapy.Li-Fraumeni syndrome (LFS) is a rare disorder that considerably increases the risk of developing several types of cancer, particularly in children and young adults. The first observations were described by Li and Fraumeni in 1969 [1]. LFS is inherited in an autosomal dominant pattern with the frequent occurrence of soft tissue/bone sarcoma, breast cancer, leukemia, brain tumors and other cancers (melanoma, colon cancer, pancreatic cancer, adrenocortical carcinoma) [1,2]. Since then, several reports of affected families have contributed to a more precise definition of the Li Fraumeni syndrome [3].Germ-line TP53 gen
Depresión: Visión holística de la medicina interna*
Marsiglia G,Italo;
Gaceta Médica de Caracas , 2008,
Abstract: depression, and adjoined anxiety, is the most frequent and intense psychological manifestation of human suffering, which in extreme cases could lead to suicide. even though it could affect significantly the quality of life, interpersonal and social interactions and individual productivity, it astonishes that at primary care, only half of the cases are diagnosed, and only half of those diagnosed are actually treated. however, it is the responsibility of the internist to recognize depression and treat it efficiently for the following reasons: 1. internal medicine proposes the integral view of the patient as its fundamental conception; 2. functioning of mind, both normal and pathological, is established in biological principles; 3. in medical practice, anxiety and depression are the most frequent emo- tional manifestations, either as primary disorders or as associated conditions to others psychiatric and medical diseases (including their treatments), or by the emotional impact of medical and surgical disorders. psychiatric referral should be made in severe depression, unsatisfactory therapeutic response and evidence of psychosis or suicidal ideation. in managing depression, a solid medical-patient relationship is fundamental to guarantee patient liberty and integrity and to preserve professional secret, which acquires special relevance when dealing with human senses, emotions and behavior. test and scales for depression, although useful, do not substitute the personal interview with patients that allow us to appreciate depressive mood and anhedonia, which result from the desolation and defenseless state that oppress the patient. in mania, opposite extreme of mood spectrum, the agitation, expansive and grandiloquent language as well as the irritability could be accompanied by psychotic irrationality. abnormalities in norepinephrine and serotonin neurotransmitters play an important role in mood disorders, their levels and effects are less actives in depression and hypera
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