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Bilreiro C, Andrade L, Santiago I, Marques RM, Matos C. Imaging of pancreatic ductal adenocarcinoma - An update for all stages of patient management. Eur J Radiol Open 2024; 12:100553. [PMID: 38357385 PMCID: PMC10864763 DOI: 10.1016/j.ejro.2024.100553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/16/2024] Open
Abstract
Background Pancreatic ductal adenocarcinoma (PDAC) is a common and lethal cancer. From diagnosis to disease staging, response to neoadjuvant therapy assessment and patient surveillance after resection, imaging plays a central role, guiding the multidisciplinary team in decision-planning. Review aims and findings This review discusses the most up-to-date imaging recommendations, typical and atypical findings, and issues related to each step of patient management. Example cases for each relevant condition are presented, and a structured report for disease staging is suggested. Conclusion Despite current issues in PDAC imaging at different stages of patient management, the radiologist is essential in the multidisciplinary team, as the conveyor of relevant imaging findings crucial for patient care.
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Affiliation(s)
- Carlos Bilreiro
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | - Luísa Andrade
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Inês Santiago
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
| | - Rui Mateus Marques
- Nova Medical School, Lisbon, Portugal
- Radiology Department, Hospital de S. José, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Lisbon, Portugal
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
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Rodrigues NM, de Almeida JG, Castro Verde AS, Gaivão AM, Bilreiro C, Santiago I, Ip J, Belião S, Moreno R, Matos C, Vanneschi L, Tsiknakis M, Marias K, Regge D, Silva S, Papanikolaou N. Corrigendum to "Analysis of domain shift in whole prostate gland, zonal and lesions segmentation and detection, using multicentric retrospective data" [Comput. Biol. Med. 17 (2024) 108216]. Comput Biol Med 2024; 173:108352. [PMID: 38538433 DOI: 10.1016/j.compbiomed.2024.108352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Nuno Miguel Rodrigues
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal; LASIGE, Faculty of Sciences, University of Lisbon, Portugal.
| | | | | | - Ana Mascarenhas Gaivão
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation Lisbon, Portugal
| | - Carlos Bilreiro
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation Lisbon, Portugal
| | - Inês Santiago
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation Lisbon, Portugal
| | - Joana Ip
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation Lisbon, Portugal
| | - Sara Belião
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation Lisbon, Portugal
| | - Raquel Moreno
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal
| | - Celso Matos
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal
| | - Leonardo Vanneschi
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, 1070-312, Lisboa, Portugal
| | - Manolis Tsiknakis
- Institute of Computer Science Foundation for Research and Technology Hellas (FORTH), GR-700 13, Heraklion, Greece; Department of Electrical and Computer Engineering, Hellenic Mediterranean University, GR-710 04, Heraklion, Greece
| | - Kostas Marias
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, GR-710 04, Heraklion, Greece; Computational BioMedicine Laboratory (CBML), Institute of Computer Science Foundation for Research and Technology âĂŞ Hellas (FORTH), Heraklion, Greece
| | - Daniele Regge
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, Candiolo, Turin, 10060, Italy; Department of Surgical Sciences University of Turin, Turin, 10124, Italy
| | - Sara Silva
- LASIGE, Faculty of Sciences, University of Lisbon, Portugal
| | - Nickolas Papanikolaou
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal; Department of Radiology, Royal Marsden Hospital, Sutton, UK
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Rodrigues NM, Almeida JGD, Verde ASC, Gaivão AM, Bilreiro C, Santiago I, Ip J, Belião S, Moreno R, Matos C, Vanneschi L, Tsiknakis M, Marias K, Regge D, Silva S, Papanikolaou N. Analysis of domain shift in whole prostate gland, zonal and lesions segmentation and detection, using multicentric retrospective data. Comput Biol Med 2024; 171:108216. [PMID: 38442555 DOI: 10.1016/j.compbiomed.2024.108216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
Despite being one of the most prevalent forms of cancer, prostate cancer (PCa) shows a significantly high survival rate, provided there is timely detection and treatment. Computational methods can help make this detection process considerably faster and more robust. However, some modern machine-learning approaches require accurate segmentation of the prostate gland and the index lesion. Since performing manual segmentations is a very time-consuming task, and highly prone to inter-observer variability, there is a need to develop robust semi-automatic segmentation models. In this work, we leverage the large and highly diverse ProstateNet dataset, which includes 638 whole gland and 461 lesion segmentation masks, from 3 different scanner manufacturers provided by 14 institutions, in addition to other 3 independent public datasets, to train accurate and robust segmentation models for the whole prostate gland, zones and lesions. We show that models trained on large amounts of diverse data are better at generalizing to data from other institutions and obtained with other manufacturers, outperforming models trained on single-institution single-manufacturer datasets in all segmentation tasks. Furthermore, we show that lesion segmentation models trained on ProstateNet can be reliably used as lesion detection models.
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Affiliation(s)
- Nuno Miguel Rodrigues
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal; LASIGE, Faculty of Sciences, University of Lisbon, Portugal.
| | | | | | - Ana Mascarenhas Gaivão
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Carlos Bilreiro
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Inês Santiago
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Joana Ip
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Sara Belião
- Radiology Department, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Raquel Moreno
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal
| | - Celso Matos
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal
| | - Leonardo Vanneschi
- NOVA Information Management School (NOVA IMS), Universidade Nova de Lisboa, Campus de Campolide, 1070-312 Lisboa, Portugal
| | - Manolis Tsiknakis
- Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), GR 700 13, Heraklion, Greece; Department of Electrical and Computer Engineering, Hellenic Mediterranean University, GR 710 04, Heraklion, Greece
| | - Kostas Marias
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, GR 710 04, Heraklion, Greece; Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology - Hellas (FORTH), Heraklion, Greece
| | - Daniele Regge
- Department of Radiology, Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, Candiolo, Turin 10060, Italy; Department of Surgical Sciences, University of Turin, Turin 10124, Italy
| | - Sara Silva
- LASIGE, Faculty of Sciences, University of Lisbon, Portugal
| | - Nickolas Papanikolaou
- Computational Clinical Imaging Group, Champalimaud Foundation, Portugal; Department of Radiology, Royal Marsden Hospital, Sutton, UK
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Azevedo JGMD, Fernandez L, Herrando AI, Santiago I, Pares O, Parvaiz A. Watch and Wait for rectal cancer in inflammatory bowel disease. BMJ Case Rep 2023; 16:e252562. [PMID: 37429643 DOI: 10.1136/bcr-2022-252562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Colorectal cancer is currently the third most frequently diagnosed type of cancer and the second cause of cancer death in the western world. Inflammatory bowel disease patients are 2-6 times more likely to develop CRC than the general population. Patients with CRC arising through Inflammatory Bowel Disease have an indication for surgery. However, in patients without Inflammatory Bowel Disease, the use of organ (rectum) preservation strategies after neoadjuvant treatment is on the rise, which means that patients are able to keep the organ without the need for complete excision, either by treatment with radiotherapy and chemotherapy, or in combination with endoscopic or surgical techniques that allow local excision without the need for resection of the entire organ. The patient management approach known as the Watch and Wait programme was first introduced in 2004 by a team from São Paulo, Brazil. This approach suggested that patients who had an excellent or complete clinical response after neoadjuvant treatment could defer surgery and instead undergo Watch and Wait. This organ preservation technique became popular because it allowed patients to avoid the complications associated with major surgery while achieving similar oncological outcomes to those who underwent both neoadjuvant therapy and radical surgery. Following completion of neoadjuvant treatment, a decision to defer surgery is made based on whether a clinical Complete Response can be achieved, which means there is no evidence of tumour in clinical and radiological examination. The International Watch and Wait Database has published long-term oncological outcomes for patients treated with this strategy, and more patients are showing interest in this treatment option. However, it is important to note that up to 1/3 of patients selected for Watch and Wait may eventually require surgery for local regrowth (also known as 'deferred definitive surgery') at any time during follow-up after an initial 'apparent' clinical Complete Response. Compliance with a strict surveillance protocol ensures early detection of regrowth, which is usually amenable to R0 surgery and provides excellent long-term local disease control. Nonetheless, it is crucial to assess the perioperative consequences of having surgery for regrowth later and whether there are any negative effects from deferring surgery. Currently, the Watch and Wait strategy is recommended in the NCCN guidelines for clinical complete responders and only in specialised multidisciplinary centres.There is no case in the literature that portrays the use of the Watch and Wait programme for patients with inflammatory bowel disease and rectal cancer.The authors intend to present a case that demonstrates the difficulties in the assessment of patients with inflammatory bowel disease, the risks of using radiotherapy in this patients and the challenges of surveillance for patients with colorectal cancer and inflammatory bowel disease.
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Affiliation(s)
| | - Laura Fernandez
- Department of Digestive Surgery, Champalimaud Foundation, Lisboa, Portugal
| | | | - Inês Santiago
- Department of Radiology, Champalimaud Foundation, Lisboa, Portugal
| | - Oriol Pares
- Department of Digestive Surgery, Champalimaud Foundation, Lisboa, Portugal
| | - Amjad Parvaiz
- Department of Digestive Surgery, Champalimaud Foundation, Lisboa, Portugal
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Costa B, Fernandez LM, Parés O, Rio-Tinto R, Santiago I, Castillo-Martin M, Parvaiz A, Fior R. Zebrafish Avatars of rectal cancer patients validate the radiosensitive effect of metformin. Front Oncol 2022; 12:862889. [PMID: 36249066 PMCID: PMC9554544 DOI: 10.3389/fonc.2022.862889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Neoadjuvant chemoradiation (nCRT) followed by surgery represents the standard of care in patients with locally advanced rectal cancer. Increasing radiotherapy (RT) doses and chemotherapy cycles with 5FU have been associated with increased rates of complete response, however these strategies imply significant toxicity. In the last years, epidemiologic findings have demonstrated that metformin is associated with significantly higher rates of pathological complete response to nCRT. Also, pre-clinical studies using cell lines provide evidence for the radiosensitive effect of metformin. However, no studies have been performed using rectal cancer patient samples to test this radiosensitive effect of metformin and compared it to the standard 5FU. Here, we designed an experimental study to compare both radiosensitizers in the zebrafish xenograft model (zAvatar), using rectal cancer surgical specimens and diagnostic biopsies. Patient zAvatars confirmed that metformin has indeed a powerful in vivo radiosensitizer effect, similar to 5FU. Our work confirms that metformin constitutes a promising less toxic alternative to the standard 5FU, which could be game changing in elderly/frail patients to optimize tumor regression.
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Affiliation(s)
- Bruna Costa
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
- *Correspondence: Bruna Costa, ; Laura M. Fernandez, ; Rita Fior,
| | - Laura M. Fernandez
- Colorectal Surgery Department, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- *Correspondence: Bruna Costa, ; Laura M. Fernandez, ; Rita Fior,
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Ricardo Rio-Tinto
- Gastroenterology Department, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Inês Santiago
- Radiology Department, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Mireia Castillo-Martin
- Pathology Service, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Amjad Parvaiz
- Colorectal Surgery Department, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Rita Fior
- Champalimaud Research, Champalimaud Foundation, Lisbon, Portugal
- *Correspondence: Bruna Costa, ; Laura M. Fernandez, ; Rita Fior,
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Fernandez LM, Figueiredo N, Habr-Gama A, São Julião GP, Vieira P, Vailati BB, Nasir I, Parés O, Santiago I, Castillo-Martin M, Carvalho C, Parvaiz A, Perez RO. cT2N0 Distal Rectal Cancer: Do Not Believe in Fairy Tales. Dis Colon Rectum 2022; 65:e22. [PMID: 34775408 DOI: 10.1097/dcr.0000000000002307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
| | - Nuno Figueiredo
- University of São Paulo School of Medicine, Colorectal Surgery Division, Sao Paulo - Brazil
| | - Angelita Habr-Gama
- Angelita & Joaquim Gama Institute, Sao Paulo - Brazil
- University of São Paulo School of Medicine, Colorectal Surgery Division, Sao Paulo - Brazil
| | | | | | | | | | | | | | | | | | | | - Rodrigo O Perez
- Angelita & Joaquim Gama Institute, Sao Paulo - Brazil
- University of São Paulo School of Medicine, Colorectal Surgery Division, Sao Paulo - Brazil
- Ludwig Institute for Cancer Research São Paulo Branch, Sao Paulo - Brazil Hospital Lusiadas, Lisbon, Portugal
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Flor-de-Lima B, S․ Freitas P, Couto N, Castillo-Martin M, Santiago I. Pancreatic intraductal papillary mucinous neoplasm associated colloid carcinoma. Radiol Case Rep 2021; 16:2989-2992. [PMID: 34401039 PMCID: PMC8353403 DOI: 10.1016/j.radcr.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
Colloid carcinomas are rare pancreatic tumors characterized by the presence of mucin pools with scarce malignant cells. Most of these neoplasms arise from intestinal-type intraductal papillary mucinous neoplasms (IPMNs). We report a case of a 77-year-old male patient who presented with weight loss, asthenia, lumbar pain and diabetes. Imaging studies revealed a mixed-type IPMN with high-risk features and a possible invasive component. The patient underwent surgical resection and the histology confirmed an invasive colloid carcinoma of the pancreas associated with an intestinal-type IPMN. Although invasive ductal and colloid carcinomas may look similar on imaging studies, its distinction is important because the latter have a better prognosis.
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Affiliation(s)
- Beatriz Flor-de-Lima
- Radiology Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Patrícia S․ Freitas
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050 Lisbon, Portugal
| | - Nuno Couto
- Digestive Unit, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Mireia Castillo-Martin
- Department of Pathology, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
| | - Inês Santiago
- Department of Radiology, Champalimaud Foundation, Av. Brasília, 1400-038 Lisbon, Portugal
- Faculdade de Ciências Médicas - Nova Medical School, Campo dos Mártires da Pátria 130, 1169-056 Lisbon, Portugal
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Santiago I, Rodrigues B, Barata M, Figueiredo N, Fernandez L, Galzerano A, Parés O, Matos C. Re-staging and follow-up of rectal cancer patients with MR imaging when "Watch-and-Wait" is an option: a practical guide. Insights Imaging 2021; 12:114. [PMID: 34373961 PMCID: PMC8353037 DOI: 10.1186/s13244-021-01055-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/30/2021] [Indexed: 12/11/2022] Open
Abstract
In the past nearly 20 years, organ-sparing when no apparent viable tumour is present after neoadjuvant therapy has taken an increasingly relevant role in the therapeutic management of locally-advanced rectal cancer patients. The decision to include a patient or not in a “Watch-and-Wait” program relies mainly on endoscopic assessment by skilled surgeons, and MR imaging by experienced radiologists. Strict surveillance using the same modalities is required, given the chance of a local regrowth is of approximately 25–30%, almost always surgically salvageable if caught early. Local regrowths occur at the endoluminal aspect of the primary tumour bed in almost 90% of patients, but the rest are deep within it or outside the rectal wall, in which case detection relies solely on MR Imaging. In this educational review, we provide a practical guide for radiologists who are, or intend to be, involved in the re-staging and follow-up of rectal cancer patients in institutions with an established “Watch-and-Wait” program. First, we discuss patient preparation and MR imaging acquisition technique. Second, we focus on the re-staging MR imaging examination and review the imaging findings that allow us to assess response. Third, we focus on follow-up assessments of patients who defer surgery and confer about the early signs that may indicate a sustained/non-sustained complete response, a rectal/extra-rectal regrowth, and the particular prognosis of the “near-complete” responders. Finally, we discuss our proposed report template.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal.
| | - Bernardete Rodrigues
- Centro Hospitalar de Tondela-Viseu, EPE, Av. Rei Duarte, 3504-509, Viseu, Portugal
| | - Maria Barata
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Laura Fernandez
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Antonio Galzerano
- Pathology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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Parés i Grau O, Costa B, Vieira S, Stroom J, Cardoso M, Coutinho R, Rio-Tinto R, Bispo M, Santiago I, Fernandez L, Figueiredo N, Greco C, Fior R. PH-0116 Zebrafish avatars as radiosensitivity predictors in Rectal Cancer: towards personalized treatment. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Santiago I, Barata MJ, Figueiredo N, Parés O, Matos C. Early conformational changes at tumour bed and long term response after neoadjuvant therapy in locally-advanced rectal cancer. Eur J Radiol 2021; 140:109742. [PMID: 33971571 DOI: 10.1016/j.ejrad.2021.109742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/24/2021] [Accepted: 04/23/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate how changes in tumour scar depth angle and thickness in the post-neoadjuvant period relate to long-term response in locally-advanced rectal cancer patients. METHODS Informed consent was obtained from all patients and institutional review board approved this retrospective study. Sixty-nine consecutive locally-advanced rectal cancer patients who underwent neoadjuvant therapy and were selected for "Watch-and-Wait" were enrolled. Two radiologists, O1 and O2, blindly and independently reviewed the 1st and 2nd post-neoadjuvant therapy pelvic MRI T2-weighted images and recorded depth angle and thickness of the tumour scar. Value changes were calculated by simple subtraction (2nd-1st). Mann-Whitney U test was employed to assess for significant differences between sustained clinical complete responders (SCR), defined as patients with pathologic complete response or clinical complete response with a minimum follow-up of 1 year; and non-sustained complete responders (non-SCR). Interobserver agreement was estimated using intraclass correlation coefficient (ICC). Data on mrTRG, DWI and endoscopy at 1st and 2nd timepoints were retrieved for comparison. RESULTS In SCR, depth angle change between 1st (med = 10 weeks after end of radiotherapy) and 2nd (med = 23 weeks after end of radiotherapy) timepoints was significantly different (O1:p = 0.004; O2:p = 0.010): the SCR group showed a depth angle reduction (O1:med=-4.45; O2:med=-2.35), whereas non-SCRs showed a depth angle increase (O1:med=+2.60; O2:med=+7.40). Also, at 2nd timepoint, SCR scars were significantly thinner both for O1 (p = 0.003; SCR:med = 7.05 mm; non-SCR:med = 9.4 mm) and O2 (p = 0.006; SCR:med = 6.45 mm; non-SCR:med = 8.2 mm). A depth angle increase >21º between 1st and 2nd timepoints and a scar thickness >10 mm at 2nd timepoint were not sensitive but were highly specific for a non-SCR (91/94 %) for both observers. Interobserver agreement was good for scar depth angle change (ICC = 0.65) and excellent for scar thickness at 2nd timepoint (ICC = 0.84). Of the retrieved data, only DWI at 2nd timepoint was discriminative (p = 0.043) providing a similar sensitivity (33 %) and a slightly lower specificity (87.5 %). CONCLUSION Tumour scar expansion >21° between 1st and 2nd post-neoadjuvancy MRI and a scar thickness >10 mm at 2nd post-neoadjuvancy MRI may consistently indicate a non-SCR with high specificity in locally-advanced rectal cancer patients.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, Lisbon, 1400-038, Portugal; Nova Medical School, Campo Mártires da Pátria 130, Lisbon, 1169-056, Portugal.
| | - Maria-João Barata
- Radiology Department, Champalimaud Foundation, Avenida Brasília, Lisbon, 1400-038, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, Lisbon, 1400-038, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, Lisbon, 1400-038, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, Lisbon, 1400-038, Portugal
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Greco C, Pares O, Pimentel N, Louro V, Santiago I, Vieira S, Stroom J, Mateus D, Soares A, Marques J, Freitas E, Coelho G, Seixas M, Lopez-Beltran A, Fuks Z. Safety and Efficacy of Virtual Prostatectomy With Single-Dose Radiotherapy in Patients With Intermediate-Risk Prostate Cancer: Results From the PROSINT Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7:700-708. [PMID: 33704378 DOI: 10.1001/jamaoncol.2021.0039] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Ultra-high single-dose radiotherapy (SDRT) represents a potential alternative to curative extreme hypofractionated stereotactic body radiotherapy (SBRT) in organ-confined prostate cancer. Objective To compare toxic effect profiles, prostate-specific antigen (PSA) responses, and quality-of-life end points of SDRT vs extreme hypofractionated SBRT. Design, Setting, and Participants The PROSINT single-institution phase 2 randomized clinical trial accrued, between September 2015 and January 2017, 30 participants with intermediate-risk prostate cancer to receive SDRT or extreme hypofractionated SBRT. Androgen deprivation therapy was not permitted. Data were analyzed from March to May 2020. Interventions Patients were randomized in a 1:1 ratio to receive 5 × 9 Gy SBRT (control arm) or 24 Gy SDRT (test arm). Main Outcomes and Measures The primary end point was toxic effects; the secondary end points were PSA response, PSA relapse-free survival, and patient-reported quality of life measured with the International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC)-26 questionnaires. Results A total of 30 men were randomized; median (interquartile range) age was 66.3 (61.2-69.9) and 73.6 (64.7-75.9) years for the SBRT and SDRT arms, respectively. Time to appearance and duration of acute and late toxic effects were similar in the 2 trial arms. Cumulative late actuarial urinary toxic effects did not differ for grade 1 (hazard ratio [HR], 0.41; 90% CI, 0.13-1.27) and grade 2 or greater (HR, 1.07; 90% CI, 0.21-5.57). Actuarial grade 1 late gastrointestinal (GI) toxic effects were comparable (HR, 0.37; 90% CI, 0.07-1.94) and there were no grade 2 or greater late GI toxic effects. Declines in PSA level to less than 0.5 ng/mL occurred by 36 months in both study arms. No PSA relapses occurred in favorable intermediate-risk disease, while in the unfavorable category, the actuarial 4-year PSA relapse-free survival values were 75.0% vs 64.0% (HR, 0.76; 90% CI, 0.17-3.31) for SBRT vs SDRT, respectively. The EPIC-26 median summary scores for the genitourinary and GI domains dropped transiently at 1 month and returned to pretreatment scores by 3 months in both arms. The IPSS-derived transient late urinary flare symptoms occurred at 9 to 18 months in 20% (90% CI, 3%-37%) of patients receiving SDRT. Conclusions and Relevance In this randomized clinical trial among patients with intermediate-risk prostate cancer, SDRT was safe and associated with low toxicity, and the tumor control and quality-of-life end points closely match the SBRT arm outcomes. Further studies are encouraged to explore indications for SDRT in the cure of prostate cancer. Trial Registration ClinicalTrials.gov Identifier: NCT02570919.
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Affiliation(s)
- Carlo Greco
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Santiago
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sandra Vieira
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joep Stroom
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Dalila Mateus
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Soares
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - João Marques
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Elda Freitas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Graça Coelho
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Manuela Seixas
- The Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Zvi Fuks
- The Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
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12
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Santiago I, Moreno-Munoz A, Quintero-Jiménez P, Garcia-Torres F, Gonzalez-Redondo MJ. Electricity demand during pandemic times: The case of the COVID-19 in Spain. Energy Policy 2021; 148:111964. [PMID: 33071429 PMCID: PMC7553070 DOI: 10.1016/j.enpol.2020.111964] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/27/2020] [Accepted: 10/09/2020] [Indexed: 05/02/2023]
Abstract
Electricity demand and its typical load pattern are usually affected by many endogenous and exogenous factors to which the generation system must accordingly respond through utility operators. Lockdown measures to prevent the spread of COVID-19 imposed by many countries have led to sudden changes in socioeconomic habits which have had direct effects on the electricity systems. Therefore, a detailed analysis of how confinement measures have modified the electricity consumption in Spain, one of the countries most affected by this pandemic, has been performed in this work. Its electricity consumption has decreased by 13.49% from March 14 to April 30, compared to the average value of five previous years. Daily power demand profiles, especially morning and evening peaks, have been modified at homes, hospitals, and in the total power demand. These changes generate a greater uncertainty for the System Operator when making demand forecasts, but production deviations have increased by only 0.1%, thanks to the presence of a diversified generation mix, which has been modified during this period, increasing the proportion of renewable sources and decreasing CO2 emissions.
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Affiliation(s)
- I Santiago
- Universidad de Córdoba, Departamento Ingeniería Electrónica y de Computadores, Escuela Politécnica Superior, Campus de Rabanales, E-14071, Córdoba, Spain
| | - A Moreno-Munoz
- Universidad de Córdoba, Departamento Ingeniería Electrónica y de Computadores, Escuela Politécnica Superior, Campus de Rabanales, E-14071, Córdoba, Spain
| | - P Quintero-Jiménez
- Hospital Comarcal de La Axarquía, Servicio Andaluz de Salud, Torre Del Mar (Málaga), Spain
| | | | - M J Gonzalez-Redondo
- Universidad de Córdoba, Departamento Ingeniería Electrónica y de Computadores, Escuela Politécnica Superior, Campus de Rabanales, E-14071, Córdoba, Spain
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13
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Abstract
Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. .,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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14
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Reis de Sousa M, Santiago I, Barata MJ, Castillo M, Matos C. Intracholecystic papillary-tubular neoplasm in a patient with choledochal cyst and anomalous pancreaticobiliary junction: case report. BJR Case Rep 2019. [DOI: 10.1259/bjrcr.20180079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 75-year-old female incidentally presented with an enhancing intraluminal gallbladder mass, main bile duct dilatation and anomalous pancreaticobiliary junction (APBJ) during the staging of gastric adenocarcinoma. Histopathological analysis confirmed the diagnosis of intracholecystic papillary-tubular neoplasm. Intracholecystic papillary-tubular neoplasms (ICPN) of the gallbladder are rare gallbladder neoplasms, defined as intramucosal, preinvasive, exophytic, mass forming lesions. An association between choledochal cysts and anomalous pancreaticobiliary junction with gallbladder neoplasms is well known, and this case potentially illustrates gallbladder carcinogenesis related to these biliary anomalies.
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Affiliation(s)
- Marta Reis de Sousa
- Department of Radiology, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Inês Santiago
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
| | - Maria J Barata
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
| | - Mireia Castillo
- Department of Pathology, Fundação Champalimaud, Lisbon, Portugal
| | - Celso Matos
- Department of Radiology, Fundação Champalimaud, Lisbon, Portugal
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15
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Nasir I, Fernandez L, Vieira P, Parés O, Santiago I, Castillo-Martin M, Domingos H, Cunha JF, Carvalho C, Heald RJ, Beets GL, Parvaiz A, Figueiredo N. Salvage surgery for local regrowths in Watch & Wait - Are we harming our patients by deferring the surgery? Eur J Surg Oncol 2019; 45:1559-1566. [PMID: 31006589 DOI: 10.1016/j.ejso.2019.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/23/2019] [Accepted: 04/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Rectal cancer surgery conveys significant morbidity/mortality, long-term functional impairment and urinary & sexual dysfunction, especially if associated with neoadjuvant chemoradiotherapy (ChRT). Watch & Wait (W&W) is gaining momentum as an option for patients with clinical complete response (cCR) after ChRT. Approximately 30% will develop a local regrowth (RG) and need deferred surgery. Our study aimed to assess the short-term clinical outcomes after surgery for regrowths. PATIENTS AND METHODS Consecutive rectal cancer patients from a tertiary institution who underwent neoadjuvant ChRT, between January 2013 and October 2018, were identified from a prospectively maintained database. Patients with RG under W&W surveillance were operated - regrowth deferred surgery (RDS) group - and compared to those with persistent disease after ChRT who did undergo surgery - non-deferred surgery (NDS) group. RESULTS Total of 124 patients received neoadjuvant treatment: 46 (37%) underwent surgery for persistent disease; 78 (63%) with cCR entered W&W. Twenty three developed RG and underwent surgery, while 55 remain under surveillance. RDS group had lower tumors than NDS group (2.3 cm ± 2 vs 4.5 cm ± 3, p = 0.002). All RG underwent minimally invasive surgery (MIS). Anastomotic leaks, 30-day morbidity, reintervention and readmission rates were similar. Pathology features and 3-year oncological outcomes were identical between groups. CONCLUSION Patients with initial cCR and local regrowth may be safely managed by deferred surgery. Short-term outcomes suggest equivalent results to patients with incomplete clinical response and immediate radical surgery. Delayed MIS appears to have no negative impact on oncological outcomes.
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Affiliation(s)
- Irfan Nasir
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Laura Fernandez
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Pedro Vieira
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology - Champalimaud Foundation, Lisbon, Portugal
| | - Inês Santiago
- Radiology - Champalimaud Foundation, Lisbon, Portugal
| | | | - Hugo Domingos
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Jose F Cunha
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Carlos Carvalho
- Medical Oncology - Champalimaud Foundation, Lisbon, Portugal
| | - Richard J Heald
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Geerard L Beets
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal; Surgical Oncology - The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Amjad Parvaiz
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal
| | - Nuno Figueiredo
- Colorectal Surgery - Champalimaud Foundation, Lisbon, Portugal.
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16
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Carneiro C, Brito J, Bilreiro C, Barros M, Bahia C, Santiago I, Caseiro-Alves F. All about portal vein: a pictorial display to anatomy, variants and physiopathology. Insights Imaging 2019; 10:38. [PMID: 30900187 PMCID: PMC6428891 DOI: 10.1186/s13244-019-0716-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/04/2019] [Indexed: 12/17/2022] Open
Abstract
The portal vein (PV) is the main vessel of the portal venous system (PVS), which drains the blood from the gastrointestinal tract, gallbladder, pancreas, and spleen to the liver. There are several variants affecting the PV, and quite a number of congenital and acquired pathologies. In this pictorial review, we assess the embryological development and normal anatomy of the PVS, displaying selected cases consisting of normal variants, congenital anomalies, and a large and heterogeneous group of acquired conditions that may affect the PV.
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Affiliation(s)
- Carolina Carneiro
- Department of Radiology, Centro Hospitalar Universitário do Algarve EPE, Portimão, Portugal. .,ABC - Algarve Biomedical Center, Faro, Portugal.
| | - Jorge Brito
- Department of Radiology, Centro Hospitalar Universitário do Algarve EPE, Portimão, Portugal.,ABC - Algarve Biomedical Center, Faro, Portugal
| | - Carlos Bilreiro
- Department of Radiology, Centro Hospitalar Universitário do Algarve EPE, Portimão, Portugal.,ABC - Algarve Biomedical Center, Faro, Portugal
| | - Marta Barros
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Carla Bahia
- Department of Radiology, Centro Hospitalar Universitário do Algarve EPE, Portimão, Portugal.,ABC - Algarve Biomedical Center, Faro, Portugal
| | | | - Filipe Caseiro-Alves
- Medical Imaging Department, Coimbra Hospital and University Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra and Coimbra Hospital and University Centre, Coimbra, Portugal
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17
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Santiago I, Santinha J, Ianus A, Galzerano A, Theias R, Maia J, Barata MJ, Loução N, Costa-Silva B, Beltran A, Matos C, Shemesh N. Susceptibility Perturbation MRI Maps Tumor Infiltration into Mesorectal Lymph Nodes. Cancer Res 2019; 79:2435-2444. [PMID: 30894376 DOI: 10.1158/0008-5472.can-18-3682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/13/2019] [Accepted: 03/15/2019] [Indexed: 11/16/2022]
Abstract
Noninvasive characterization of lymph node involvement in cancer is an enduring onerous challenge. In rectal cancer, pathologic lymph node status constitutes the most important determinant of local recurrence and overall survival, and patients with involved lymph nodes may benefit from preoperative chemo and/or radiotherapy. However, knowledge of lymph node status before surgery is currently hampered by limited imaging accuracy. Here, we introduce Susceptibility-Perturbation MRI (SPI) as a novel source of contrast to map malignant infiltration into mesorectal lymph nodes. SPI involves multigradient echo (MGE) signal decays presenting a nonmonoexponential nature, which we show is sensitive to the underlying microstructure via susceptibility perturbations. Using numerical simulations, we predicted that the large cell morphology and the high cellularity of tumor within affected mesorectal lymph nodes would induce signature SPI decays. We validated this prediction in mesorectal lymph nodes excised from total mesorectal excision specimens of patients with rectal cancer using ultrahigh field (16.4 T) MRI. SPI signals distinguished benign from malignant nodal tissue, both qualitatively and quantitatively, and our histologic analyses confirmed cellularity and cell size were the likely underlying sources for the differences observed. SPI was then adapted to a clinical 1.5 T scanner, added to patients' staging protocol, and compared with conventional assessment by two expert radiologists. Nonmonoexponential decays, similar to those observed in the ex vivo study, were demonstrated, and SPI classified lymph nodes more accurately than standard high-resolution T2-weighted imaging assessment. These findings suggest this simple, yet highly informative, method can improve rectal cancer patient selection for neoadjuvant therapy. SIGNIFICANCE: These findings introduce an MRI methodology tailored to detect magnetic susceptibility perturbations induced by subtle alterations in tissue microstructure.
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Affiliation(s)
- Inês Santiago
- Neuroplasticity and Neural Activity Lab, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Radiology Department, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Nova Medical School, Campo Mártires da Pátria, Lisbon, Portugal
| | - João Santinha
- Computational Clinical Imaging Group, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Andrada Ianus
- Neuroplasticity and Neural Activity Lab, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Centre for Medical Imaging Computing, Department of Computer Science, University College London, London, United Kingdom
| | - Antonio Galzerano
- Pathology Department, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Rita Theias
- Pathology Department, Hospital Fernando Fonseca, Amadora, Portugal
| | - Joana Maia
- Systems Oncology Lab, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Maria J Barata
- Radiology Department, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | | | - Bruno Costa-Silva
- Systems Oncology Lab, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Antonio Beltran
- Pathology Department, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Noam Shemesh
- Neuroplasticity and Neural Activity Lab, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.
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18
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van der Sande M, Figueiredo N, Melenhorst J, Parvaiz A, Pares O, Santiago I, Beets-Tan R, Carvalho C, Beets G. Management of local regrowths in a watch-and-wait programme for rectal cancer. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Siddiqui M, Nagtegaal I, Santiago I, Knijn N, Berho M, Mirnezami A, Rao S, Brown G. Session 2: What causes liver metastases - lymph nodes or is it something else? Colorectal Dis 2018; 20 Suppl 1:39-42. [PMID: 29878686 DOI: 10.1111/codi.14077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The traditional view of progression of disease in cancer is the sequential spread of tumour to locoregional lymph nodes and then to distant metastases. However, this view may need to be challenged and modern pathology techniques such as immunohistochemistry and tumour profiling can provide us with a greater insight into the pathways and mechanisms of distant spread. Professor Nagtegaal discusses the evidence for reconsidering the current paradigm and reflects on the need for further investigation into mechanisms of distant metastatic spread.
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Affiliation(s)
- M Siddiqui
- Royal Marsden NHS Foundation Trust, London, UK.,Croydon University Hospital, Croydon, UK
| | - I Nagtegaal
- Radboud University Medical Care Academy, Nijmegen, The Netherlands
| | - I Santiago
- Champalimaud Foundation, Lisbon, Portugal
| | - N Knijn
- Radboud University Medical Care Academy, Nijmegen, The Netherlands
| | - M Berho
- Pathology and Laboratory Medicine, Cleveland Clinic, Weston, Florida, USA
| | | | - S Rao
- Royal Marsden NHS Foundation Trust, London, UK
| | - G Brown
- Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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20
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Balyasnikova S, Haboubi N, Wale A, Santiago I, Morgan M, Cunningham D, Mason M, Berho M, Brown G. Session 2: Extramural vascular invasion and extranodal deposits: should they be treated the same? Colorectal Dis 2018; 20 Suppl 1:43-48. [PMID: 29878681 DOI: 10.1111/codi.14078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Professor Nagtegaal has already highlighted that lymph nodes are probably not responsible for the development of liver metastases. If they are not, then is there another mechanism? Professor Haboubi addresses the question of extranodal deposits - their frequency and their importance in the development of metastatic disease. The experts review the evidence and discuss whether this information will alter treatment decisions and staging systems in the future.
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Affiliation(s)
| | - N Haboubi
- Surgical Pathology, Salford University, Manchester, UK
| | - A Wale
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I Santiago
- The Champalimaud Foundation, Lisbon, Portugal
| | - M Morgan
- University Hospital of Wales, Cardiff, UK
| | - D Cunningham
- Clinical Research and Development, NIHR Biomedical Research Centre, The Royal Marsden NHS Foundation Trust, London, UK
| | - M Mason
- Institute of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - M Berho
- Pathology and Laboratory Medicine, Cleveland Clinic, Weston, FL, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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Halverson G, Shanahan E, Santiago I, Mabile R, Thurrell T, Strupp A, Wolf C, Spruell P, Moulds M. The First Reported Case of Anti-Do^b Causing an Acute Hemolytic Transfusion Reaction. Vox Sang 2017. [DOI: 10.1159/000462510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Carrilho P, Santiago I, Alves M, Fidalgo P, Rodrigues E, Rodrigues B. SP615LIVER IRON CONTENT BY MAGNETIC RESONANCE IN CHRONIC KIDNEY DISEASE AT THE START OF MAINTENANCE HEMODIALYSIS AND 12 MONTHS LATER. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx153.sp615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Dattani M, Santiago I, Mahadevan V, Heald RJ. The mesorectum and mesocolon - Making sense of words. Int J Surg 2016; 36:390-391. [PMID: 27756645 DOI: 10.1016/j.ijsu.2016.09.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 09/04/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Mit Dattani
- Pelican Cancer Foundation, The Ark, Dinwoodie Drive, Basingstoke, RG24 9NN, UK.
| | - Inês Santiago
- Radiology Department, Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
| | - Vishy Mahadevan
- The Barbers' Company Professor of Anatomy, The Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London, WC2A 3PE, UK
| | - Richard J Heald
- Pelican Cancer Foundation, The Ark, Dinwoodie Drive, Basingstoke, RG24 9NN, UK; Chairman of the Colorectal Cancer Project, Champalimaud Foundation, Av. Brasilia, 1400-038, Lisbon, Portugal
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24
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Nunes V, Santiago I, Marinho R, Pires D, Theias R, Gomes A, Pignatelli N. Duodeno-colic fistula as a rare presentation of lung cancer - surgical treatment of a stage IV oligometastatic lung disease. Int J Surg Case Rep 2015. [PMID: 26197095 PMCID: PMC4529654 DOI: 10.1016/j.ijscr.2015.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Atypical presentation of stage IV oligometastatic lung disease in a young patient. Diagnostic challenge complicated by rapid evolution to a life-threatening condition. Difficult assessment of the risk/benefit of surgery due to absence of guidelines. Importance of multidisciplinary therapeutic approach in rare clinical presentations. Successful outcome at 18 month follow-up of malignancy with rare presentation.
Introduction Rare adenosquamous carcinomas have no defined standard approach given their low incidence. They present with nonspecific imaging characteristics and are described as having worse prognosis than other lung malignancies, with greater likelihood of local invasion and early metastasis. Presentation of case Male caucasian patient, 43 years, 26 pack-year smoking history, presented with watery diarrhea, early emesis and loss of 25% body weight (20 kg) in four weeks. Colonoscopy identified a left colonic mass. Abdominal CT/ultrasound showed a large fistulous lesion between the 4th portion of the duodenum and left colon. CT showed a solid mass in the right upper lung lobe. Endoscopy and transthoracic biopsy were inconclusive. En bloc D3 and D4 duodenectomy, proximal enterectomy and left hemicolectomy were performed, with inconclusive histology of the specimen. Three months later, a right upper lung lobectomy with lymphadenectomy was performed, revealing an adenosquamous carcinoma of lung origin, R0, staged as pT2pN0pM1b. Six months later, a single dural metastasis in the left cerebellopontine angle was detected and resected, with subsequent holocranial radiotherapy and systemic adjuvant chemotherapy. Patient is currently with 18 months follow-up, in good general health and with no evidence of recurrent disease. Discussion There are no specific guidelines to treat oligometastatic adenosquamous lung carcinoma. Our approach was abdominal surgery as a life-saving procedure and, months later, oncological resection of primary lung tumor and metachronous metastasis to the brain. Conclusion A systematic, patient-oriented, patient-shared, multidisciplinary approach is particularly relevant when dealing with atypical presentations of rare diseases in young patients.
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Affiliation(s)
- Vitor Nunes
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Inês Santiago
- Radiology Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Rui Marinho
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - David Pires
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - Rita Theias
- Surgical Pathology Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
| | - António Gomes
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal.
| | - Nuno Pignatelli
- B Surgery Department, Hospital Fernando Fonseca, 2720-276 Amadora, Portugal
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Baptista R, Santiago I, Jorge E, Teixeira R, Mendes P, Curvo-Semedo L, Castro G, Monteiro P, Caseiro-Alves F, Providência LA. One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: The role of multidetector computed tomography. Revista Portuguesa de Cardiologia (English Edition) 2013. [DOI: 10.1016/j.repce.2013.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Baptista R, Santiago I, Jorge E, Teixeira R, Mendes P, Curvo-Semedo L, Castro G, Monteiro P, Caseiro-Alves F, Providência LA. One-shot diagnostic and prognostic assessment in intermediate- to high-risk acute pulmonary embolism: the role of multidetector computed tomography. Rev Port Cardiol 2012; 32:7-13. [PMID: 23245344 DOI: 10.1016/j.repc.2012.05.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 05/02/2012] [Accepted: 05/06/2012] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Contrast-enhanced multidetector computed tomography (MDCT) is useful for the diagnosis of pulmonary embolism (PE). However, current guidelines do not support its use for risk assessment in acute PE patients. OBJECTIVES We compared the prognostic impact of MDCT-derived indices regarding medium-term mortality in a population of intermediate- to high-risk PE patients, mostly treated by thrombolysis. METHODS Thirty-nine consecutive patients admitted to an intensive care unit with acute PE were studied. All patients had a pulmonary MDCT on admission to the emergency room as part of the diagnostic algorithm. We assessed the following MDCT variables: right ventricular/left ventricular diameter (RV/LV) ratio, arterial obstruction index, pulmonary artery-to-aorta diameter ratio and azygos vein diameter. A 33-month follow-up was performed. RESULTS Mean age was 59.1±19.6 years, with 80% of patients receiving thrombolysis. Follow-up all-cause mortality was 12.8%. Of the MDCT-derived variables, only the RV/LV ratio had significant predictive value, being higher in patients who suffered the endpoint (1.6±0.5 vs. 1.9±0.4, p=0.046). Patients with an RV/LV ratio ≥1.8 had 11-fold higher medium-term all-cause mortality (3.8% vs. 38.8%, p<0.001). Regarding this endpoint, the c-statistic was 0.78 (95% CI, 0.60-0.96) for RV/LV ratio and calibration was good (goodness-of-fit p=0.594). No other radiological index was predictive of mortality. CONCLUSIONS MDCT gives the possibility, in a single imaging procedure, of diagnosing and assessing the prognosis of patients with intermediate- to high-risk PE. Although further studies are needed, the simple-to-calculate RV/LV ratio has good discrimination and calibration for predicting poorer outcomes in patients with acute PE.
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Affiliation(s)
- Rui Baptista
- Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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Affiliation(s)
- Inês Santiago
- Department of Radiology, Hospital Infante D. Pedro E.P.E., Aveiro, Portugal.
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Santiago I, Vilgrain V, Cipriano MA, Oliveira C, Ferreira M, Reis D. Case 183. Radiology 2012. [DOI: 10.1148/radiol.11110586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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López-Sanromán FJ, Holmbak-Petersen R, Santiago I, Gómez de Segura IA, Barrey E. Gait analysis using 3D accelerometry in horses sedated with xylazine. Vet J 2011; 193:212-6. [PMID: 22082509 DOI: 10.1016/j.tvjl.2011.10.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 09/30/2011] [Accepted: 10/14/2011] [Indexed: 11/17/2022]
Abstract
The aim of the present study was to verify the efficacy and sensitivity of an accelerometric device in detecting and quantifying the degree of movement alteration produced in horses sedated with xylazine. Horses (n=6) were randomly administered either xylazine or a control by intravenous injection, with at least 1 week between each treatment. A triaxial accelerometric device was used for the accelerometric gait assessment 15 min before (baseline) and 5, 15, 30, 45, 60, 75, 90, 105 and 120 min after each treatment. Eight different accelerometric parameters were calculated, including speed, stride frequency, stride length, regularity, dorsoventral power, propulsion power, mediolateral power and total power, with the force of acceleration and the dorsoventral, mediolateral and craniocaudal (propulsive) parts of the power then calculated. Administration of xylazine decreased many of the parameters investigated, with significant differences for speed, stride frequency, dorsoventral power, propulsion power and total power at 5, 15, 30 and 45 min after injection. There were no significant differences in stride length values at any time point. Decreases in regularity values were evident with significant differences at every time point from 5 to 120 min following xylazine injection. Force values were also significantly reduced from 5 to 30 min after treatment and a redistribution of the total power was observed 5 min after injection as the mediolateral power increased significantly, while the dorsoventral power decreased. Accelerometry offers a practical, accurate, easy to use, portable and low cost method of objectively monitoring gait abnormalities at the walk in horses after sedation with xylazine.
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Affiliation(s)
- F J López-Sanromán
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Avda. Puerta de Hierro s/n, 28040 Madrid, Spain.
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Sánchez M, Santiago I. [Specific organisational areas and preferential circuits for prevalent pathologies in emergency care]. An Sist Sanit Navar 2010; 33 Suppl 1:89-96. [PMID: 20508681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The increase in demand and the normal situations of overload of the Hospital Emergency Department (HED) make continuous organisational changes compulsory in the search for optimum working and greater quality of care. The main changes have been based on the implementation of different triage systems, with the aim of structuring care according to urgency, and adaptive change in the medical service through different formulae, such as referrals without consultation, fast-track areas and specific care circuits, such as units for thoracic pain, stoke code or sepsis code, amongst the most widespread in HED. On the other hand, HEDs have been forced to seek and use methods that favour the discharge of patients, often hindered by poor management of hospital beds by the health administrations. Hence, different alternatives to hospitalisation are suggested, such as: observation units, short stay units, day hospitals and hospitalisation at home.
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Affiliation(s)
- Miquel Sánchez
- Area de Urgencias, Hospital Clinic, Barcelona 08036, Spain.
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Louis CJ, Velilla N, Fernandez B, Beaumont C, Santiago I. Unexpected left upper quadrant abdominal pain in a 30-year-old man. Case Reports 2009; 2009:bcr2007055517. [DOI: 10.1136/bcr.2007.055517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Santiago I, Calzada MD. Population measurement of the 3p(5)4s configuration levels in an argon microwave plasma at atmospheric pressure. Appl Spectrosc 2007; 61:725-33. [PMID: 17697467 DOI: 10.1366/000370207781393343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Metastable atoms, due to their intrinsic properties, are very useful to characterize plasma and to control the scientific and technological applications carried out with it. This paper describes the implementation of a method to determine the densities of the argon 3p(5)4s metastable and resonant levels in a microwave plasma at atmospheric pressure. Because the method is based on the self-absorption of the radiation emitted by the plasma, no external radiation source is needed. Using this method, the populations of the four levels of the 3p(5)4s argon configuration were found to be in the range 10(10)-10(12) cm(-3), in agreement with the values found in the literature.
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Affiliation(s)
- I Santiago
- Grupo de Espectroscopía de Plasmas, Edificio A.Einstein (C-2), Campus de Rabanales, Universidad de Córdoba, 14071 Córdoba, Spain
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Santiago I, García MC, Calzada MD. Experimental method for determining the damping parameter of spectral lines emitted by a microwave plasma at atmospheric pressure. Appl Spectrosc 2005; 59:1457-64. [PMID: 16390583 DOI: 10.1366/000370205775142584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In this work, a simple method for experimentally obtaining the value of the damping parameter or a-parameter of the spectral lines emitted by an argon plasma generated at atmospheric pressure is presented. The value of this coefficient indicates the proportion existing between the Lorentzian and Doppler components of the total line profile, which can be approximated to a Voigt function for our experimental conditions. The a-parameter values found were within the value interval recorded in the literature. The results obtained showed that the damping coefficient of the lines next to the fundamental level remains practically constant along the plasma column, whereas for the spectral lines involving high-lying levels, the a-parameter is sensitive to the changes in the electron density in the plasma. In this work it is also proved that the self-absorption phenomenon induces errors in the calculation of a, due to an increase in the broadening of the line profile produced by this phenomenon.
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Affiliation(s)
- I Santiago
- Grupo de Espectroscopía de Plasmas, Edifico A. Einstein (C-2), Campus de Rabanales, Universidad de Córdoba, 14071 Córdoba, Spain
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Santiago I. [Contamination by chemical agents]. An Sist Sanit Navar 2003; 26 Suppl 1:181-90. [PMID: 12813485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Contamination by chemical products is a clinical situation whose handling requires very specific knowledge by the physicians in the emergency services, since they must know the most frequent types of chemical agents and their mechanism of action. This type of contamination makes it necessary for there to be concrete plans of action in the hospital milieu and coordination with the emergency outpatient mechanisms. To the risk of being surrounded by chemical products on an industrial scale on a daily basis, and the risk of leaks and accidents during transport and even in private homes, there is now added the possible use of different chemical agents as weapons of mass destruction, both in military conflicts and in terrorist acts.
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Affiliation(s)
- I Santiago
- Servicio de Urgencias, Hospital de Navarra, 31008 Pamplona, Spain.
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Santiago I. [Gas poisoning]. An Sist Sanit Navar 2003; 26 Suppl 1:173-80. [PMID: 12813484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Poisoning by gases in our area is an important problem due to its high incidence. In the specific case of carbon monoxide poisoning, this is the main cause of death by poisoning in our environment, on many occasions coexisting with cyanide poisoning. Both poisonings can be severe, their diagnosis being based on the mere suspicions of the doctor. Besides, their importance lies in the fact that both poisonings have a very specific treatment. Normo or hyperbaric oxygenotherapy is the treatment for carbon monoxide poisoning. In the case of cyanide poisoning, hydroxocobalamin is nowadays the treatment of choice, since it has proved itself to be an efficient antidote.
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Affiliation(s)
- I Santiago
- Servicio de Urgencias, Hospital de Navarra, 31008 Pamplona, Spain.
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Santiago I. Contaminación por agentes químicos. An Sist Sanit Navar 2003. [DOI: 10.4321/s1137-66272003000200011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Fernández S, Arreaza L, Santiago I, Malvar A, Berrón S, Vazquez JA, Hervada X. Impact of meningococcal vaccination with combined serogroups A and C polysaccharide vaccine on carriage of Neisseria meningitidis C. J Med Microbiol 2003; 52:75-77. [PMID: 12488569 DOI: 10.1099/jmm.0.04927-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Two studies of meningococcal carriage state were carried out in Galicia (Spain) before and after a mass vaccination campaign between December 1996 and January 1997 against Neisseria meningitidis serogroup C with meningococcal serogroups A and C polysaccharide vaccine. The studies covered two areas with different incidence rates of meningococcal disease in 1996 (high and low incidence). Carriage rates of serogroup C showed a decrease in both areas, 47 and 65 % respectively, before and after the vaccination. Results showed a decrease in carrier state in the age groups 10-14- and 15-19-year-olds, but not in the 5-9-year-olds. These results demonstrate the effect of immunization on the reduction of the carriage state.
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Affiliation(s)
- S Fernández
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - L Arreaza
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - I Santiago
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - A Malvar
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - S Berrón
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - J A Vazquez
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - X Hervada
- Dirección Xeral de Saúde Pública, Consellería de Sanidade, 15771 Santiago de Compostela, Galicia, Spain 2Laboratorio de Neisserias, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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Fernández S, Arreaza L, Santiago I, Malvar A, Berrón S, Vazquez JA, Hervada X, Gestal JJ. Carriage of a new epidemic strain of Neisseria meningitidis and its relationship with the incidence of meningococcal disease in Galicia, Spain. Epidemiol Infect 1999; 123:349-57. [PMID: 10694145 PMCID: PMC2810768 DOI: 10.1017/s0950268899003027] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In Galicia, Spain, a dramatic increase in the incidence of meningococcal disease was seen in the 1995-6. The annual incidence rose to 11 per 10(5) inhabitants, and 80% of identified strains were C:2b:P1.2,5. This led to the implementation of an intensive A+C vaccination campaign for the population aged 18 months to 19 years. During this campaign the prevalence of carriage in areas with high and low incidence was studied. Nasopharyngeal swabs were taken from 9796 subjects immediately before the administration of meningococcal vaccine, plated onto Thayer-Martin plates, incubated and sent for analysis to the Reference Laboratory for Neisseria in Spain. The prevalence of the C:2b: P1.2,5 strains was 0.6% (95% CI 0.29-0.88) in the high incidence area, and 0.41% (95 % CI 0.00-1.04) in the low incidence area, and that of serogroup C (all strains) 1.36% (95% CI 0.80-1.80) and 0.89% (95% CI 0.09-1.69) respectively. The prevalence of N. meningitidis (all strains) was almost the same in both areas (8%). Carriers of the epidemic strain were not found in the 2-4 year age group, that most affected by the disease. Our data showed a wide distribution but a low carriage rate of the epidemic strain C:2b:P1.2,5 in the high and low disease incidence areas studied; the difference in the carriage rates between the two areas was not statistically significant.
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Affiliation(s)
- S Fernández
- Dirección Xeral de Saúde Pública, Xunta de Galicia, Santiago de Compostela, España
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Halverson G, Shanahan E, Santiago I, Mabile R, Thurrell T, Strupp AM, Wolf CF, Spruell P, Moulds MK. The first reported case of anti-Dob causing an acute hemolytic transfusion reaction. Vox Sang 1994; 66:206-9. [PMID: 8036791 DOI: 10.1111/j.1423-0410.1994.tb00311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The antibodies of the Dombrock blood group system have only rarely been encountered in transfusion practice, and anti-Dob has not previously been implicated in an acute hemolytic transfusion reaction. We have encountered the first such case involving a chronically transfused black female with hemoglobin SS disease and multiple antibodies in her serum. During a previous admission for sickle cell crisis, the patient received 3 units of compatible blood with no untoward effects. Serum obtained 21 days later contained, in addition to the known antibodies, anti-S plus an unidentified antibody showing characteristics of HTLA. Blood lacking the E, K1, Fy(a), Jk(b) and S antigens was obtained, and 2 least incompatible units were transfused. While administering the second unit, the patient complained of fever and low back pain, and hemoglobinemia was detected. Anti-Dob was identified in the post-reaction samples by absorption-elution tests, and the patient was confirmed to be Do(a+b-). The first unit transfused during this hemolytic episode tested Do (b+). This case, and a similar case involving anti-Doa reported in 1986, strengthens the belief that Dombrock antibodies are clinically significant and illustrates the need for their differentiation, prior to transfusion from less clinically significant HTLA antibodies.
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Affiliation(s)
- G Halverson
- Blood Bank and Transfusion Service, New York Hospital-Cornell Medical Center, New York, NY 10021
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González R, Santiago I, Poucell S, Gutiérrez M. Myeloid metaplasia in aplastic anemia. Rev Invest Clin 1974; 26:29-34. [PMID: 4453672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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