44 results on '"D. Gonzalez Gonzalez"'
Search Results
2. Penfigoide ampolloso asociado al uso de inhibidores de la dipeptidil peptidasa IV (gliptinas)
- Author
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I. Pérez Arévalo, J. Fraile Simón, R. Gimenez Garcia, D. Gonzalez Gonzalez, and S. Sanchez Ramon
- Published
- 2019
3. [Metronidazole-induced encephalopathy: description of a case with radiological and anatomopathological findings]
- Author
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N, Gonzalez-Nafria, A, Rojo-Lopez, E, Martinez-Velasco, D, Gonzalez-Gonzalez, M A, de la Fuente-Bobillo, M A, Tola-Arribas, and F, Ortega-Valin
- Subjects
Brain Diseases ,Metronidazole ,Humans ,Female ,Magnetic Resonance Imaging ,Aged ,Anti-Bacterial Agents - Abstract
Metronidazole is a widely known and used antibiotic. In exceptional cases, an encephalopathy with characteristic lesions on magnetic resonance imaging (MRI), usually located in the cerebellum and splenium of the corpus callosum, may be an adverse effect. The incidence and pathogenesis are unknown. The suspension of the treatment usually resolves the symptoms and normalizes the MRI in a few weeks. Due to the usual good prognosis, the anatomopathological findings are exceptional. We present a clinical case with the radiological findings suggestive of metronidazole-induced encephalopathy and, exceptionally, we provide the anatomopathological findings.A 72 years-old woman with severe Crohn's disease who, months after starting treatment with metronidazole, presented a slowly progressing bradypsychia and difficulty walking until she came to coma. In MRI it showed hyperintense images in T2 in the corpus callosum, red and dentate nuclei. He improved by stopping metronidazole but later developed sepsis and died. At autopsy, softening of the red nucleus was observed and, microscopically, cell necrosis and demyelination.With the publication of the clinical, radiological and anatomopathological information of our case we intend to promote the knowledge of this infrequent treatable cause of subacute encephalopathy and provide data that help to clarify its pathogenesis.Encefalopatia inducida por metronidazol: descripcion de un caso con hallazgos radiologicos y anatomopatologicos.Introduccion. El metronidazol es un antibiotico ampliamente conocido y utilizado. En casos excepcionales puede producir como efecto adverso un cuadro de encefalopatia con unas lesiones caracteristicas en la resonancia magnetica, localizadas generalmente en el cerebelo y el esplenio del cuerpo calloso. La incidencia y la patogenia se desconocen. La suspension del tratamiento habitualmente resuelve los sintomas y normaliza la resonancia magnetica en pocas semanas. Debido al habitual buen pronostico, los hallazgos anatomopatologicos son excepcionales. Se presenta un caso clinico con los hallazgos radiologicos sugestivos de la encefalopatia inducida por metronidazol y, de forma excepcional, se aportan los hallazgos anatomopatologicos. Caso clinico. Mujer de 72 años, con enfermedad de Crohn grave, que meses mas tarde de iniciar tratamiento con metronidazol presento de forma lentamente progresiva bradipsiquia y dificultad para caminar hasta llegar al coma. En la resonancia magnetica mostraba caracteristicas imagenes hiperintensas en T2 en el cuerpo calloso, y los nucleos rojos y dentados. Mejoro al suspender el metronidazol, pero posteriormente desarrollo una sepsis y fallecio. En la autopsia se observo reblandecimiento del nucleo rojo y, microscopicamente, necrosis celular y desmielinizacion. Conclusion. Con la publicacion de la informacion clinica, radiologica y anatomopatologica de este caso se pretende fomentar el conocimiento de esta infrecuente causa tratable de encefalopatia subaguda y aportar datos que ayuden a aclarar su patogenia.
- Published
- 2019
4. Encefalopatía inducida por metronidazol: descripción de un caso con hallazgos radiológicos y anatomopatológicos
- Author
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E Martinez-Velasco, D Gonzalez-Gonzalez, M A de la Fuente-Bobillo, F Ortega-Valin, M A Tola-Arribas, A Rojo-Lopez, and N Gonzalez-Nafria
- Subjects
business.industry ,Medicine ,Neurology (clinical) ,General Medicine ,business ,Humanities - Abstract
Introduccion. El metronidazol es un antibiotico ampliamente conocido y utilizado. En casos excepcionales puede producir como efecto adverso un cuadro de encefalopatia con unas lesiones caracteristicas en la resonancia magnetica, localizadas generalmente en el cerebelo y el esplenio del cuerpo calloso. La incidencia y la patogenia se desconocen. La suspension del tratamiento habitualmente resuelve los sintomas y normaliza la resonancia magnetica en pocas semanas. Debido al habitual buen pronostico, los hallazgos anatomopatologicos son excepcionales. Se presenta un caso clinico con los hallazgos radiologicos sugestivos de la encefalopatia inducida por metronidazol y, de forma excepcional, se aportan los hallazgos anatomopatologicos. Caso clinico. Mujer de 72 anos, con enfermedad de Crohn grave, que meses mas tarde de iniciar tratamiento con metronidazol presento de forma lentamente progresiva bradipsiquia y dificultad para caminar hasta llegar al coma. En la resonancia magnetica mostraba caracteristicas imagenes hiperintensas en T2 en el cuerpo calloso, y los nucleos rojos y dentados. Mejoro al suspender el metronidazol, pero posteriormente desarrollo una sepsis y fallecio. En la autopsia se observo reblandecimiento del nucleo rojo y, microscopicamente, necrosis celular y desmielinizacion. Conclusion. Con la publicacion de la informacion clinica, radiologica y anatomopatologica de este caso se pretende fomentar el conocimiento de esta infrecuente causa tratable de encefalopatia subaguda y aportar datos que ayuden a aclarar su patogenia.
- Published
- 2019
5. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma
- Author
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J. Overgaard, S.M. Bentzen, D. Gonzalez Gonzalez, M.C.C.M. Hulshof, G. Arcangeli, O. Dahl, and O. Mella
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Hyperthermia ,Prognostic variable ,medicine.medical_specialty ,Univariate analysis ,business.industry ,Melanoma ,medicine.medical_treatment ,Urology ,General Medicine ,medicine.disease ,Metastasis ,Surgery ,Radiation therapy ,medicine ,business ,Survival rate ,Adjuvant - Abstract
The value of hyperthermia as an adjuvant to radiotherapy in patients with malignant melanoma was studied in a European multicentre trial. 134 metastatic or recurrent lesions of malignant melanoma in 70 patients were randomly assigned to receive radiotherapy (three fractions of 8 Gy or 9 Gy in 8 days) alone or followed by hyperthermia (43 degrees C for 60 min). Overall, the 2-year actuarial local tumour control was 37 (SE 5)%. Univariate analysis showed a beneficial effect of hyperthermia (radiation alone 28% vs combined treatment 46%, p = 0.008) and radiation dose (24 Gy 25% vs 27 Gy 56%, p = 0.02), but no effect of tumour size ( 4 cm 29%, p = 0.21). Cox multivariate regression analysis showed the most important prognostic variables to be hyperthermia (odds ratio for 2-year local control 1.73 [95% CI 1.07-2.78], p = 0.023), tumour size (0.91 [0.85-0.99], p = 0.05), and radiation dose (1.17 [1.01-1.36], p = 0.05). Addition of heat did not significantly increase acute or late radiation reactions. Heating was well tolerated, but because of difficulties with equipment only 14% of treatments achieved the protocol objective. The overall 5-year survival rate was 19%, but 38% of the patients for whom all known disease was controlled survived 5 years. Adjuvant hyperthermia significantly improved local tumour control when applied in association with radiation in treatment of malignant melanoma. Successful local treatment of patients with a single or a few metastatic malignant melanoma lesions has significant curative potential.
- Published
- 1995
6. Neurological complications after 434 MHz microwave hyperthermia of the rat lumbar region including the spinal cord
- Author
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H.H. De Vrind, D. Troost, D. Gonzalez Gonzalez, Jaap Haveman, Nicolaas A. P. Franken, Peter Sminia, Other departments, Radiation Oncology, CCA - Cancer biology and immunology, and CCA - Cancer Treatment and quality of life
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Hyperthermia ,Fifth lumbar vertebra ,Lumbar Vertebrae ,Radiological and Ultrasound Technology ,business.industry ,MUSCLE NECROSIS ,Anatomy ,Hindlimb ,medicine.disease ,Spinal cord ,Rats ,Necrosis ,medicine.anatomical_structure ,Lumbar ,Spinal Cord ,Diathermy ,Medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Female ,Microwave hyperthermia ,Nervous System Diseases ,business ,Vertebral column - Abstract
Hyperthermia was applied in the region of the vertebral column from the second to the fifth lumbar vertebra using a ring-shaped 434 MHz microwave radiator. In all experiments temperatures were measured at a 'reference' thermocouple which was placed against the fourth lumbar vertebra. After 60 min of heat treatment at 'reference' temperatures of 43.0 degrees C, 44.0 degrees C and 45.0 degrees C (+/- 0.05 degrees C) the average maximal temperature inside the vertebral canal were 42.6 degrees C, 43.0 degrees C and 43.8 degrees C (+/- 0.3 degrees C), respectively. At all 'reference' temperatures the maximal core temperature of the animal did not exceed 40.5 +/- 0.3 degrees C after 60 min of heat treatment. Dorsal skin and muscle temperatures in the treatment area reached 'reference' temperature, and transient skin and muscle necrosis was observed after treatment for 1 h at 'reference' temperatures at 44 degrees C and 45 degrees C. Temperatures in the peritoneal cavity approximately 1 mm ventrally of the vertebral column rose to 41.8 degrees C after 60 min at reference 43.0 degrees C. Treatment at spinal cord temperature 42.6 degrees C for 60 min did not induce any significant neurological effects. Motoric dysfunction of the hind legs, such as difficulties with walking, was observed after 60 min treatment at spinal cord temperatures of 43.0 degrees C or 43.8 degrees C. In addition, 24 h after treatment at 43.8 degrees C for 60 min loss of tail tonus was observed, as well as loss of sensory function in the hind limbs. Recovery from the neurological disorders, except for the loss of tail tonus, occurred within 2 weeks after treatment. Histopathological examination revealed necrosis in the central areas of the spinal cord at 3 days and complete necrosis at 7 days after treatment at 43.8 degrees C for 60 min.
- Published
- 1992
7. Hyperthermia as an adjuvant to radiation therapy of recurrent or metastatic malignant melanoma. A multicentre randomized trial by the European Society for Hyperthermic Oncology. 1996
- Author
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J, Overgaard, D, Gonzalez Gonzalez, M C C H, Hulshof, G, Arcangeli, O, Dahl, O, Mella, and S M, Bentzen
- Subjects
Skin Neoplasms ,Humans ,Hyperthermia, Induced ,History, 20th Century ,Neoplasm Recurrence, Local ,Combined Modality Therapy ,Melanoma - Published
- 2009
8. Influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia
- Author
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J F, Hoogeveen, A H, Van Der Kracht, J, Wondergem, D, Gonzalez Gonzalez, and J, Haveman
- Subjects
Dose-Response Relationship, Drug ,Weight Loss ,Animals ,Peripheral Nervous System Diseases ,Female ,Hyperthermia, Induced ,Cisplatin ,Rats, Wistar ,Kidney Function Tests ,Combined Modality Therapy ,Sciatic Nerve ,Drug Administration Schedule ,Rats - Abstract
The influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia was investigated. Rats received 1.7 mg/kg cisplatin i.p., twice a week for 6 weeks, up to a cumulative dose of 20.4 mg/kg. After termination of cisplatin treatment, a 5 mm segment of the nerve was locally heated at a temperature of 45 degrees C (5-30 min). Loss of motor function was assessed by means of the toe-spreading test, 24 h post heating. The calculated ED50 for control nerves was significantly (p0.01) larger than the ED50 for cisplatin treated rats; 16.3 +/- 1.1 min vs. 10.9 +/- 1.1 min. This indicates that nerves from cisplatin treated rats were more sensitive to heat than nerves from control rats (dose modifying factor = 1.5 +/- 0.2). Histopathological investigation of nerves after heat alone or after heat preceded by cisplatin confirmed these differences and showed that edema, vascular damage and axonal degenerative changes of axons and myelin sheaths occurred at lower heat doses when compared to control nerves. Recovery studies showed that cisplatin treatment before hyperthermia caused a delay in recovery from motor function loss of about 6 days. Cisplatin treatment after hyperthermia had no influence on recovery from motor function loss.
- Published
- 1993
9. External radiotherapy and extrahepatic bile duct cancer
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R A, Tollenaar, C J, van de Velde, C W, Taat, D, Gonzalez Gonzalez, J W, Leer, and J, Hermans
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Adult ,Male ,Postoperative Care ,Adolescent ,Hepatic Duct, Common ,Adenocarcinoma ,Middle Aged ,Combined Modality Therapy ,Survival Rate ,Bile Duct Neoplasms ,Humans ,Female ,Aged ,Follow-Up Studies ,Retrospective Studies - Abstract
The hospital records of patients with extrahepatic bile duct cancer who where treated surgically between 1968 and 1983 were reviewed. Of 55 patients, 16 (29%) received radiotherapy after surgery. The total dose given ranged from 40 to 60 Gy. Median follow-up time for analysis was 4.0 months and lasted until January 1988. The overall median survival was 4 months (range 0-36), that of the irradiated patients was 16 months (range 2-36), and that of the 39 patients who were not irradiated was 3 months (range 0-32). When the 13 post operative deaths were excluded the median survival was 4 months. Radiotherapy did not cause any severe complications. No firm conclusion about the role of radiotherapy can be drawn from these data because the patients were not randomly chosen to receive radiotherapy and selection was therefore biased. We conclude that most patients with extrahepatic bile duct cancer still die of locoregional disease. Effective adjuvant treatments are needed and should be evaluated in prospective randomized trials.
- Published
- 1991
10. Does additive radiotherapy after hilar resection improve survival of cholangiocarcinoma? An analysis in sixty-four patients
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P C, Verbeek, D J, Van Leeuwen, M N, Van Der Heyde, and D, Gonzalez Gonzalez
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Adenoma, Bile Duct ,Time Factors ,Bile Duct Neoplasms ,Humans ,Combined Modality Therapy ,Retrospective Studies - Abstract
Between September 1983 and January 1990, 64 patients with Klatskin tumors were treated with resective therapy in the Academic Medical Centre Amsterdam. Twenty-nine patients received postoperative adjuvant radiotherapy, 22 patients were treated with resective therapy only and there were 13 postoperative deaths. The longterm results in the patients treated with or without adjuvant radiotherapy were retrospectively assessed. Three patients had a curative resection. Comparison of both therapeutic modalities demonstrated a statistically significant difference in survival (P less than 0.001) in favour of the patients who were treated with additive radiotherapy. The radiotherapy was generally well tolerated.
- Published
- 1991
11. [Guideline in (suspected) malignant obstruction of the proximal bile ducts]
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D J, van Leeuwen, P C, Verbeek, N J, Smits, and D, Gonzalez Gonzalez
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Bile Duct Neoplasms ,Drainage ,Humans ,Cholestasis, Extrahepatic ,Algorithms - Published
- 1990
12. Accelerated radiotherapy with carbogen and nicotinamide (ARCON) for glioblastoma: Results of EORTC 22933
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Juliana Denekamp, Jacques Bernier, Raymond Miralbell, D. Van Den Berge, A. Rojas, Paolo Antognoni, Richard H. Greiner, M. Bolla, R.O. Mirimanoff, Urs R. Meier, Françoise Mornex, D. Gonzalez-Gonzalez, M. van Glabbeke, and Marianne Pierart
- Subjects
Oncology ,Cancer Research ,medicine.medical_specialty ,Radiation ,Nicotinamide ,business.industry ,medicine.disease ,chemistry.chemical_compound ,chemistry ,Carbogen ,Internal medicine ,Accelerated radiotherapy ,medicine ,Radiology, Nuclear Medicine and imaging ,business ,Glioblastoma - Published
- 1998
13. Primary non-Hodgkin's lymphoma of the central nervous system. Results of radiotherapy in 15 cases
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D. Gonzalez Gonzalez and A.L.J. Schuster-Uitterhoeve
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Cancer Research ,Pathology ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Central nervous system ,medicine.disease ,Lymphoma ,Non-Hodgkin's lymphoma ,Radiation therapy ,Cerebrospinal fluid ,medicine.anatomical_structure ,Oncology ,Cytology ,medicine ,In patient ,Radiology ,business ,Rare disease - Abstract
Primary non-Hodgkin's lymphoma (NHL) of the central nervous system is a rare disease. The number of cases reported in the literature does not exceed 200. The current series comprises 15 cases of primary NHL of the CNS. In 12 cases material for pathology was obtained at surgery. In the other three cases the diagnosis was established by cytologic examination of the cerebrospinal fluid (CSF). The type of lymphoma was predominantly the diffuse lymphocytic type. All the patients received irradiation on the whole brain by means of two opposite lateral fields. The administered total doses were 40 Gy in four weeks in ten cases, 50 to 60 Gy in 5 to 6 weeks in four cases and 30 Gy in three weeks in one case. All but three patients are dead although initially a good tumor response was obtained as confirmed in most of the cases by CT scan. The mean survival of the dead patients was 14.5 months. No relationship was found between the administered dose and the relapse-free time. In six cases (40%) evidence of seeding was observed. Because of the poor results obtained with irradiation either of only the tumor bearing area or whole brain and because of the high risk of seeding through the CSF, the irradiation of the entire CNS is recommended in patients with primary NHL of the brain.
- Published
- 1983
14. Acute and late changes following irradiation of the lung
- Author
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D, Gonzalez Gonzalez
- Subjects
Pulmonary Fibrosis ,Humans ,Radiotherapy Dosage ,Radiation Injuries ,Lung ,Respiratory Function Tests - Published
- 1979
15. International Clinical Trials in Radiation Oncology. Hyperthermia trials
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G, Arcangeli, J, Overgaard, D, Gonzalez Gonzalez, and P N, Shrivastava
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Clinical Trials as Topic ,Quality Assurance, Health Care ,International Cooperation ,Neoplasms ,Humans ,Hyperthermia, Induced - Published
- 1988
16. Effects of irradiation by single or multiple fractions per day on transplantable murine mammary carcinoma
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D. Gonzalez Gonzalez and Jaap Haveman
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Male ,Misonidazole ,Time Factors ,Fractionation ,Mammary adenocarcinoma ,Adenocarcinoma ,Tumour response ,Toxicology ,Mammary carcinoma ,chemistry.chemical_compound ,Mice ,Animal science ,Medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Irradiation ,business.industry ,Mammary Neoplasms, Experimental ,Dose-Response Relationship, Radiation ,Radiotherapy Dosage ,General Medicine ,chemistry ,Total dose ,Dactinomycin ,business ,Neoplasm Transplantation - Abstract
Effects of different fractionation schedules of irradiation were studied in an experimental mammary adenocarcinoma transplanted in the back of mice. The number of fractions per day varied from one to three, keeping the daily dose constant. It was found that an increase of the number of fractions per day did not necessarily lead to a decrease in the tumour response, as might be expected for the same total dose. At a twelve-day overall time, three fractions per day did not give such a good result as one fraction per day, but at a nineteen-day overall time three fractions per day were about as good as one fraction per day; and below 45 Gy total dose, the result with three fractions per day even seemed to be better. The effects of actinomycin D administered during the irradiation treatment show that schedules with three fractions per day possibly take better advantage of repair of sublethal and potentially lethal damage than schedules with one fraction per day. Administration of misonidazole during the irradiation treatment led to a dose-modifying effect of 1.2 in one fraction per day schedules but had no significant effect in three fractions per day schedules. The present results may provide guidelines for clinical application of irradiation schedules with more than one fraction per day.
- Published
- 1982
17. [A case of precocious puberty and pinealoma in an 8-year old boy]
- Author
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M, RAMOS MURGUIA, L, DURAN ROMANO, D, GONZALEZ GONZALEZ, S, FRENK, C, CHAVARRIA BONEQUI, and C, FUENTES OLANO
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Male ,Humans ,Infant ,Puberty, Precocious ,Supratentorial Neoplasms ,Child ,Pinealoma - Published
- 1962
18. Orbital neuromuscular choristoma of the ophthalmic nerve.
- Author
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Bermudez-Castellanos I, Marques-Fernandez V, Gonzalez-Gonzalez D, Alvarez-Garcia M, and Galindo-Ferreiro A
- Subjects
- Adult, Child, Female, Headache, Humans, Hypesthesia, Magnetic Resonance Imaging, Ophthalmic Nerve pathology, Choristoma diagnosis, Choristoma surgery, Hamartoma diagnosis, Skin Diseases
- Abstract
Introduction: Neuromuscular choristoma (NC) is a rare tumor composed of striated muscle fibers admixed with nerve fibers that often affects large peripheral nerve trunks in children. To the best of our knowledge, this is the first reported case in the literature of a NC of the ophthalmic nerve in an adult., Case Description: A 27-year-old woman presented with a 20-day history of left periorbital headache radiating to the frontotemporal region, with associated tearing, nausea, and vomiting. The examination was normal, except for hypoesthesia in the distribution of the first trigeminal nerve branch (V1). Cranial computerized tomography showed a lesion in the left orbit and cavernous sinus with widening of the superior orbital fissure. On magnetic resonance imaging, the lesion was well-defined with fusiform morphology and showed a central cystic component and peripheral enhancement. An extradural approach was performed with subtotal tumor resection. Biopsy showed proliferation of striated muscle cells admixed with nerve fascicles and Schwann cells. A pathological diagnosis of NC of V1 was determined. Six months after surgery, left hypotropia with limitation of supraduction was observed, as well as hypoesthesia and paralysis of the left forehead with ipsilateral eyebrow ptosis. The rest of the examination remained within normal limits., Conclusion: NC should be considered in the differential diagnosis of a young patient with periorbital headache and hypoesthesia in the V1 region.
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- 2022
- Full Text
- View/download PDF
19. Is it possible to modify fear memories in humans with extinction training within a single day?
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Redondo J, Fernandez-Rey J, and Gonzalez-Gonzalez D
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- Conditioning, Classical, Female, Humans, Male, Young Adult, Extinction, Psychological, Fear, Memory
- Abstract
Extinction procedures have been used widely in the study of fear memories, and different positions have been adopted regarding the efficacy of such procedures and the mechanisms involved. It has been argued that extinction may interfere with the consolidation of the fear memory if the procedure is applied with the appropriate timing after acquisition. However, the opposite position is also held, that is, that the extinction does not achieve an elimination of the fear response. The aim of the present study is to test the short-term effects of immediate extinction in fear reduction when this extinction is preceded by a retrieval trial. For this, a procedure similar to that employed by Schiller et al. (Nature 463(7277): 49-53, 2010) was used, but in a single day and with white noise as an aversive unconditioned stimulus. The results indicate that a CS+ single retrieval trial before the extinction procedure after acquisition was more effective in fear reduction than standard immediate extinction.
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- 2019
- Full Text
- View/download PDF
20. [Metronidazole-induced encephalopathy: description of a case with radiological and anatomopathological findings].
- Author
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Gonzalez-Nafria N, Rojo-Lopez A, Martinez-Velasco E, Gonzalez-Gonzalez D, de la Fuente-Bobillo MA, Tola-Arribas MA, and Ortega-Valin F
- Subjects
- Aged, Brain Diseases diagnostic imaging, Brain Diseases pathology, Female, Humans, Magnetic Resonance Imaging, Anti-Bacterial Agents adverse effects, Brain Diseases chemically induced, Brain Diseases diagnosis, Metronidazole adverse effects
- Abstract
Introduction: Metronidazole is a widely known and used antibiotic. In exceptional cases, an encephalopathy with characteristic lesions on magnetic resonance imaging (MRI), usually located in the cerebellum and splenium of the corpus callosum, may be an adverse effect. The incidence and pathogenesis are unknown. The suspension of the treatment usually resolves the symptoms and normalizes the MRI in a few weeks. Due to the usual good prognosis, the anatomopathological findings are exceptional. We present a clinical case with the radiological findings suggestive of metronidazole-induced encephalopathy and, exceptionally, we provide the anatomopathological findings., Case Report: A 72 years-old woman with severe Crohn's disease who, months after starting treatment with metronidazole, presented a slowly progressing bradypsychia and difficulty walking until she came to coma. In MRI it showed hyperintense images in T2 in the corpus callosum, red and dentate nuclei. He improved by stopping metronidazole but later developed sepsis and died. At autopsy, softening of the red nucleus was observed and, microscopically, cell necrosis and demyelination., Conclusion: With the publication of the clinical, radiological and anatomopathological information of our case we intend to promote the knowledge of this infrequent treatable cause of subacute encephalopathy and provide data that help to clarify its pathogenesis.
- Published
- 2019
- Full Text
- View/download PDF
21. Preventing the return of fear memories with postretrieval extinction: A human study using a burst of white noise as an aversive stimulus.
- Author
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Fernandez-Rey J, Gonzalez-Gonzalez D, and Redondo J
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- Behavior Therapy methods, Female, Humans, Male, Research Design, Young Adult, Conditioning, Classical physiology, Extinction, Psychological physiology, Fear physiology, Memory physiology, Noise adverse effects
- Abstract
Standard extinction procedures seem to imply an inhibition of the fear response, but not a modification of the original fear-memory trace, which remains intact (Bouton, 2002, 2004). Typically, the behavioral procedure used to modify this trace is the so-called postretrieval extinction, consisting of fear-memory reactivation followed by extinction applied within the reconsolidation window. However, the application of this technique yields mixed results, probably due to a series of boundary conditions that limit the effectiveness of postretrieval-extinction effects. In this study a number of potential, and hitherto unexplored, moderators of such effects are considered. Using an interval of 48 hr between extinction and re-extinction, the findings show a spontaneous recovery similar to that found in studies that use a 24-hr interval. Also, the use of intervals of 10 and 20 min between reactivation and extinction led to a similar fear return. Finally, the burst of white noise used as an unconditioned stimulus (US) here was shown to be as effective as the electric shock normally used in the study of fear-memory reconsolidation. These findings suggest that postretrieval extinction is an effective behavioral technique for modifying the original fear memory and for the elimination of the fear return. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)
- Published
- 2018
- Full Text
- View/download PDF
22. Hyperthermia as an adjuvant to radiation therapy of recurrent or metastatic malignant melanoma. A multicentre randomized trial by the European Society for Hyperthermic Oncology. 1996.
- Author
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Overgaard J, Gonzalez Gonzalez D, Hulshof MC, Arcangeli G, Dahl O, Mella O, and Bentzen SM
- Subjects
- Combined Modality Therapy history, History, 20th Century, Humans, Melanoma radiotherapy, Melanoma therapy, Neoplasm Recurrence, Local, Skin Neoplasms radiotherapy, Skin Neoplasms therapy, Hyperthermia, Induced history, Melanoma history, Skin Neoplasms history
- Published
- 2009
- Full Text
- View/download PDF
23. Hyperbaric oxygen therapy for cognitive disorders after irradiation of the brain.
- Author
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Hulshof MC, Stark NM, van der Kleij A, Sminia P, Smeding HM, and Gonzalez Gonzalez D
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- Adolescent, Adult, Brain Neoplasms radiotherapy, Cerebellar Neoplasms radiotherapy, Cognition Disorders diagnosis, Cognition Disorders therapy, Ependymoma radiotherapy, Female, Follow-Up Studies, Frontal Lobe, Glioblastoma radiotherapy, Glioma radiotherapy, Humans, Male, Medulloblastoma radiotherapy, Middle Aged, Neuroblastoma radiotherapy, Neuropsychological Tests, Oligodendroglioma radiotherapy, Parietal Lobe, Radiotherapy Dosage, Temporal Lobe, Time Factors, Brain radiation effects, Cognition Disorders etiology, Hyperbaric Oxygenation, Radiotherapy adverse effects
- Abstract
Purpose: Analysis of the feasibility and effect of hyperbaric oxygen treatment (HBO) on cognitive functioning in patients with cognitive disorders after irradiation of the brain., Patients and Method: Seven patients with cognitive impairment after brain irradiation, with an interval of at least 1.5 years after treatment, were treated with 30 sessions of HBO in a phase I-II study. A comprehensive neuropsychological test battery was performed before treatment, at 3 and 6 months thereafter. Patients were randomized into an immediate treatment group and a delayed treatment group. The delayed group had a second neuropsychological test at 3 months without treatment in that period and started HBO thereafter., Results: All eligible patients completed the HBO treatment and the extensive neuropsychological testing. One out of seven patients had a meaningful improvement in neuropsychological functioning. At 3 months there was a small, but not significant benefit in neuropsychological performance for the group with HBO compared to the group without HBO treatment. Six out of seven patients eventually showed improvement after HBO in one to nine (median 2.5) of the 31 tests, although without statistical significance., Conclusion: HBO treatment was feasible and resulted in a meaningful improvement of cognitive functioning in one out of seven patients. Overall there was a small but not significant improvement.
- Published
- 2002
- Full Text
- View/download PDF
24. Prognostic value of plasma transforming growth factor-beta in patients with glioblastoma multiforme.
- Author
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Hulshof MC, Sminia P, Barten-Van Rijbroek AD, and Gonzalez Gonzalez D
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- Aged, Brain Neoplasms blood, Brain Neoplasms radiotherapy, Follow-Up Studies, Glioblastoma blood, Glioblastoma radiotherapy, Humans, Middle Aged, Prognosis, Radiation Dosage, Survival Analysis, Brain Neoplasms diagnosis, Glioblastoma diagnosis, Transforming Growth Factor beta blood
- Abstract
We investigated whether the postoperative concentration of circulating transforming growth factor beta (TGF-beta) yields prognostic value in patients with glioblastoma multiforme (gbm). Blood was collected from 20 healthy volunteers and in 28 patients with mainly glioblastoma multiforme (gbm), both before radiotherapy, during and after 4 weeks of irradiation. Both latent and active TGF-beta were quantified directly in the blood plasma using a bioassay with mink lung epithelial cells transfected with a plasminogen activator inhibitor-1 promotor luciferase construct. The average plasma concentration of TGF-beta before radiotherapy for gbm patients was 26.2 ng/ml, which was significant higher than in normal controls (16.2 ng/ml, p=0.02). No correlation was found between TGF-beta and survival, nor between plasma TGF-beta and the diameter of the postoperative contrast-enhancing lesion. The pattern of plasma TGF-beta during radiotherapy did not correlate with the clinical course of patients, nor with the fractionation scheme. Plasma TGF-beta did not reveal a clinical useful prognostic value for gbm patients, which is partly due to the large variation in TGF-beta plasma levels between individual patients.
- Published
- 2001
- Full Text
- View/download PDF
25. Brachytherapy with transperineal (125)Iodine seeds for localized prostate cancer.
- Author
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Blank LE, Gonzalez Gonzalez D, de Reijke TM, Dabhoiwala NF, and Koedooder K
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- Aged, Aged, 80 and over, Disease Progression, Humans, Male, Middle Aged, Prognosis, Prostatic Neoplasms mortality, Prostatic Neoplasms pathology, Radiotherapy Dosage, Survival Rate, Brachytherapy adverse effects, Brachytherapy methods, Iodine Radioisotopes therapeutic use, Prostatic Neoplasms radiotherapy
- Abstract
Background and Purpose: To analyze the treatment results of transperineal (125)Iodine seeds in localized prostate cancer., Patients and Methods: Between 1985 and 1996, 102 patients with T1-T2 N0 prostate cancer were treated with transperineal (125)Iodine seed implants at the Academic Medical Centre in Amsterdam. Tumours were classified as T1c in four patients, T2a in 73 patients and T2b in 25 patients. The mean pre-treatment PSA was 17 ng/ml. The (125)Iodine seeds were implanted transperineally under transrectal ultrasound guidance. The mean prostate volume was 31 ml (range 15-48 ml). An average of 49 seeds (range 29-74) was implanted. The dose to the periphery of the prostate was 160 Gy. Until 1988, 27 patients had additional external pelvic irradiation to a dose of 40 Gy in 20 daily fractions of 2 Gy., Results: The 5- and 7-year actuarial survival rates were 77 and 63%, respectively (median 102 months). Ten patients (9.5%) died from prostate cancer. The 5- and 7-year clinical progression rates were 12 and 17%, respectively. Biochemical failure rates at 5 and 7 years were 39 and 44%, respectively. Age, alkaline phosphatase, creatinine, differentiation grade, additional treatment, staging procedure, number of seeds, prostate volume, treatment period and PSA were analyzed as prognostic factors. Only pre-treatment PSA was a prognosticator of clinical and biochemical outcome but not of survival. Biochemical control at 6 years varied from 30% for pre-treatment PSA values higher than 20 ng/ml to 95% for values < or =8 ng/ml. Forty-one out of 49 patients who were sexually active before brachytherapy maintained sexual function during the follow-up. Complete urinary incontinence occurred in one patient. No rectal complications were seen in patients receiving brachytherapy alone., Conclusions: Transperineal (125)Iodine seeds brachytherapy in localized prostate cancer achieves a good clinical control and overall survival with acceptable late toxicity. Biochemical failure was strongly correlated to the pre-treatment PSA value.
- Published
- 2000
- Full Text
- View/download PDF
26. Long-term survival after resection of proximal bile duct carcinoma (Klatskin tumors).
- Author
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Gerhards MF, van Gulik TM, Bosma A, ten Hoopen-Neumann H, Verbeek PC, Gonzalez Gonzalez D, de Wit LT, and Gouma DJ
- Subjects
- Adult, Aged, Bile Duct Neoplasms mortality, Bile Duct Neoplasms pathology, Cause of Death, Chi-Square Distribution, Female, Hepatic Duct, Common pathology, Humans, Klatskin Tumor mortality, Klatskin Tumor pathology, Male, Middle Aged, Neoplasm Staging, Postoperative Complications, Retrospective Studies, Survival Analysis, Bile Duct Neoplasms surgery, Hepatic Duct, Common surgery, Klatskin Tumor surgery
- Abstract
This retrospective study in 79 surgically treated patients with a proximal bile duct carcinoma revealed 12 patients with a median age of 59.5 years (range 21-73 years) who survived more than 5 years. These 12 patients were analyzed to identify specific patient characteristics for long-term survival. Fifteen patients died from postoperative complications and were excluded from this survival analysis. In relation with preoperative Bismuth classification, there were 3 (20%) long-term survivors of 15 patients with type I tumors and 9 (35%) long-term survivors of 26 patients with type II tumors. In the group of type III and IV tumors, there were no long-term survivors. Concerning the type of resection, 9 of 51 (18%) patients had long-term survival after local resection and 3 of 13 (23%) patients after local resection combined with hemihepatectomy. Complete tumor-free surgical specimen margins were found in only 4 of 64 cases (6%), among which only one patient survived more than 5 years. Negative proximal bile duct margins, absence of multifocality, and diploid tumors showed a significant correlation with long-term survival. There was no significant correlation between long-term survival and postoperative radiotherapy. Of the 12 long-term survivors, 5 died after 5 years: 2 had developed metastases and 1 a local recurrence; the other 2 died of a metastasis of an ovarian adenocarcinoma and cachexia, respectively. The remaining seven patients were still alive at the completion of this study. The mean survival of the 64 patients analyzed in this study (in which hospital mortality was excluded) was 33.7 months, with a median survival of 18.8 months. In conclusion, the preoperative Bismuth classification of the tumor, absence of multifocality, diploid-type tumors, and negative proximal bile duct margins at histopathologic examination were the only significant prognostic factors for long-term survival.
- Published
- 1999
- Full Text
- View/download PDF
27. Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis.
- Author
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Samlal RA, Van Der Velden J, Van Eerden T, Schilthuis MS, Gonzalez Gonzalez D, and Lammes FB
- Abstract
Samlal RAK, van der Velden J, van Eerden T, Schilthuis MS, Gonzalez Gonzalez D, Lammes FB. Recurrent cervical carcinoma after radical hysterectomy: an analysis of clinical aspects and prognosis. Int J Gynecol Cancer 1998; 8: 78-84. The purpose of the present study was to evaluate the clinical aspects and prognosis of patients with tumor recurrence in surgically treated stage IB and IIA cervical carcinoma patients. Two hundred and seventy-one stage IB and IIA cervical carcinoma patients underwent a Wertheim Okabayashi radical hysterectomy with pelvic lymphadenectomy. The median follow-up time was 60 months. Recurrence occurred in 27 patients (10%): 14 had a pelvic recurrence and 13, and extrapelvic recurrence. The site of recurrence was influenced by various pathological factors as well as by the primary treatment mode. 77% of recurrences were detected within three years after primary treatment. The median recurrence-free interval in patients with a pelvic recurrence was significantly shorter than in patients with an extrapelvic recurrence (14 months vs. 17 months, P = 0.03). The mortality rate of the group of patients with recurrent disease was 85% (23/27). Patients with a pelvic central recurrence had a significantly better outcome than did patients whose recurrences were located at the pelvic sidewall. Two patients with a pulmonary recurrence were treated with surgery and show no evidence of disease after 4 and 8 years respectively, of follow-up. The overall detection rate of recurrent disease by routine follow-up was only 36%. However, asymptomatic patients had a significantly better prognosis when compared with symptomatic patients. Therefore, we recommend frequent follow-up visits during the first 3 years after primary treatment to detect recurrence in an early stage.
- Published
- 1998
- Full Text
- View/download PDF
28. Hyperthermia as an adjuvant to radiation therapy of recurrent or metastatic malignant melanoma. A multicentre randomized trial by the European Society for Hyperthermic Oncology.
- Author
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Overgaard J, Gonzalez Gonzalez D, Hulshof MC, Arcangeli G, Dahl O, Mella O, and Bentzen SM
- Subjects
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Humans, Male, Melanoma secondary, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local radiotherapy, Neoplasm Recurrence, Local therapy, Radiotherapy Dosage, Radiotherapy, High-Energy, Skin Neoplasms pathology, Survival Rate, Time Factors, Hyperthermia, Induced adverse effects, Hyperthermia, Induced methods, Melanoma radiotherapy, Melanoma therapy, Skin Neoplasms radiotherapy, Skin Neoplasms therapy
- Abstract
The ESHO protocol 3-85 is a multicentre randomized trial investigating the value of hyperthermia as an adjuvant to radiotherapy in treatment of malignant melanoma. A total of 134 metastatic of recurrent malignant melanoma lesions in 70 patients were randomized to receive radiotherapy alone (3 fractions in 8 days) or each fraction followed by hyperthermia (aimed for 43 degrees C for 60 min). Radiation was given with high voltage photons or electrons. Tumours were stratified according to institution and size (above or below 4 cm) and randomly assigned to a total radiation dose of either 24 or 27 Gy to be given with or without hyperthermia. The endpoint was persistent complete response in the treated area. A number of 128 tumours in 68 patients were evaluable, with an observation time between 3 and 72 months. Sixty-five tumours were randomized to radiation alone and 63 to radiation + heat. Sixty received 24 Gy and 68 tumours received 27 Gy, respectively. Size was < or = 4 cm in 81 and > 4 cm in 47 tumours. Overall the 2-year actuarial local tumour control was 37%. Univariate analysis showed prognostic influence of hyperthermia (rad alone 28% versus rad + heat 46%, p = 0.008) and radiation dose (24 Gy 25% versus 27 Gy 56%, p = 0.02), but not of tumour size (small 42% versus large 29%, p = 0.21). A Cox multivariate regression analysis showed the most important prognostic parameters to be: hyperthermia (odds ratio: 1.73 (1.07-2.78), p = 0.02), tumour size (odds ratio: 0.91 (0.85-0.99), p = 0.05) and radiation dose (odds ratio: 1.17 (1.01-1.36), p = 0.05). Analysis of the heating quality showed a significant relationship between the extent of heating and local tumour response. Addition of heat did not significantly increase the acute or late radiation reactions. The overall 5-year survival rate of the patients was 19%, but 38% in patients if all known disease was controlled, compared to 8% in the patients with persistent active disease.
- Published
- 1996
- Full Text
- View/download PDF
29. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. European Society for Hyperthermic Oncology.
- Author
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Overgaard J, Gonzalez Gonzalez D, Hulshof MC, Arcangeli G, Dahl O, Mella O, and Bentzen SM
- Subjects
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Humans, Lymphatic Metastasis, Male, Melanoma mortality, Melanoma secondary, Middle Aged, Neoplasm Recurrence, Local radiotherapy, Neoplasm Recurrence, Local therapy, Prognosis, Regression Analysis, Skin Neoplasms mortality, Survival Rate, Treatment Outcome, Hyperthermia, Induced, Melanoma radiotherapy, Melanoma therapy, Skin Neoplasms radiotherapy, Skin Neoplasms therapy
- Abstract
The value of hyperthermia as an adjuvant to radiotherapy in patients with malignant melanoma was studied in a European multicentre trial. 134 metastatic or recurrent lesions of malignant melanoma in 70 patients were randomly assigned to receive radiotherapy (three fractions of 8 Gy or 9 Gy in 8 days) alone or followed by hyperthermia (43 degrees C for 60 min). Overall, the 2-year actuarial local tumour control was 37 (SE 5)%. Univariate analysis showed a beneficial effect of hyperthermia (radiation alone 28% vs combined treatment 46%, p = 0.008) and radiation dose (24 Gy 25% vs 27 Gy 56%, p = 0.02), but no effect of tumour size (< or = 4 cm 42% vs > 4 cm 29%, p = 0.21). Cox multivariate regression analysis showed the most important prognostic variables to be hyperthermia (odds ratio for 2-year local control 1.73 [95% CI 1.07-2.78], p = 0.023), tumour size (0.91 [0.85-0.99], p = 0.05), and radiation dose (1.17 [1.01-1.36], p = 0.05). Addition of heat did not significantly increase acute or late radiation reactions. Heating was well tolerated, but because of difficulties with equipment only 14% of treatments achieved the protocol objective. The overall 5-year survival rate was 19%, but 38% of the patients for whom all known disease was controlled survived 5 years. Adjuvant hyperthermia significantly improved local tumour control when applied in association with radiation in treatment of malignant melanoma. Successful local treatment of patients with a single or a few metastatic malignant melanoma lesions has significant curative potential.
- Published
- 1995
- Full Text
- View/download PDF
30. Ultrastructural changes in the rat sciatic nerve after local hyperthermia.
- Author
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Hoogeveen JF, Troost D, van der Kracht AH, Wondergem J, Haveman J, and Gonzalez Gonzalez D
- Subjects
- Animals, Axons pathology, Endothelium, Vascular injuries, Endothelium, Vascular pathology, Female, Microscopy, Electron, Myelin Sheath pathology, Nerve Degeneration, Rats, Rats, Wistar, Sciatic Nerve pathology, Time Factors, Hyperthermia, Induced adverse effects, Sciatic Nerve injuries
- Abstract
The rat sciatic nerve was heated over a length of 5 mm for 30 min at 43, 44 or 45 degrees C. Morphological changes were not observed after heating at 43 degrees C. Treatment at 44 degrees C resulted in endoneurial oedema and mild vascular changes, such as contraction and vacuolization of endothelial cells and thickening of the media of the larger vessels. Within 1 week several demyelinated axons were observed. The first changes after heating at 45 degrees C included oedema, blood vessel occlusion and severe endothelial cell damage. Axonal changes, e.g. the accumulation of cell organelles, appeared 8 h after treatment; 24 h after treatment most axons and myelin sheaths showed degenerative changes. Absence of blood flow in the heated area of the nerve was shown 2 h after heating at 45 degrees C. We conclude that hyperthermic treatment directly affects endothelial cells and myelin sheaths in the rat sciatic nerve. Axons degenerate most probably as a consequence of ischaemia.
- Published
- 1993
- Full Text
- View/download PDF
31. Influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia.
- Author
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Hoogeveen JF, Van Der Kracht AH, Wondergem J, Gonzalez Gonzalez D, and Haveman J
- Subjects
- Animals, Combined Modality Therapy, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Kidney Function Tests, Peripheral Nervous System Diseases pathology, Rats, Rats, Wistar, Weight Loss drug effects, Cisplatin toxicity, Hyperthermia, Induced adverse effects, Peripheral Nervous System Diseases etiology, Sciatic Nerve drug effects
- Abstract
The influence of cisplatin on the sensitivity of the rat sciatic nerve to local hyperthermia was investigated. Rats received 1.7 mg/kg cisplatin i.p., twice a week for 6 weeks, up to a cumulative dose of 20.4 mg/kg. After termination of cisplatin treatment, a 5 mm segment of the nerve was locally heated at a temperature of 45 degrees C (5-30 min). Loss of motor function was assessed by means of the toe-spreading test, 24 h post heating. The calculated ED50 for control nerves was significantly (p < 0.01) larger than the ED50 for cisplatin treated rats; 16.3 +/- 1.1 min vs. 10.9 +/- 1.1 min. This indicates that nerves from cisplatin treated rats were more sensitive to heat than nerves from control rats (dose modifying factor = 1.5 +/- 0.2). Histopathological investigation of nerves after heat alone or after heat preceded by cisplatin confirmed these differences and showed that edema, vascular damage and axonal degenerative changes of axons and myelin sheaths occurred at lower heat doses when compared to control nerves. Recovery studies showed that cisplatin treatment before hyperthermia caused a delay in recovery from motor function loss of about 6 days. Cisplatin treatment after hyperthermia had no influence on recovery from motor function loss.
- Published
- 1993
32. Neurological complications after 434 MHz microwave hyperthermia of the rat lumbar region including the spinal cord.
- Author
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Franken NA, De Vrind HH, Sminia P, Haveman J, Troost D, and Gonzalez Gonzalez D
- Subjects
- Animals, Female, Necrosis, Rats, Spinal Cord pathology, Diathermy adverse effects, Lumbar Vertebrae radiation effects, Nervous System Diseases etiology, Spinal Cord radiation effects
- Abstract
Hyperthermia was applied in the region of the vertebral column from the second to the fifth lumbar vertebra using a ring-shaped 434 MHz microwave radiator. In all experiments temperatures were measured at a 'reference' thermocouple which was placed against the fourth lumbar vertebra. After 60 min of heat treatment at 'reference' temperatures of 43.0 degrees C, 44.0 degrees C and 45.0 degrees C (+/- 0.05 degrees C) the average maximal temperature inside the vertebral canal were 42.6 degrees C, 43.0 degrees C and 43.8 degrees C (+/- 0.3 degrees C), respectively. At all 'reference' temperatures the maximal core temperature of the animal did not exceed 40.5 +/- 0.3 degrees C after 60 min of heat treatment. Dorsal skin and muscle temperatures in the treatment area reached 'reference' temperature, and transient skin and muscle necrosis was observed after treatment for 1 h at 'reference' temperatures at 44 degrees C and 45 degrees C. Temperatures in the peritoneal cavity approximately 1 mm ventrally of the vertebral column rose to 41.8 degrees C after 60 min at reference 43.0 degrees C. Treatment at spinal cord temperature 42.6 degrees C for 60 min did not induce any significant neurological effects. Motoric dysfunction of the hind legs, such as difficulties with walking, was observed after 60 min treatment at spinal cord temperatures of 43.0 degrees C or 43.8 degrees C. In addition, 24 h after treatment at 43.8 degrees C for 60 min loss of tail tonus was observed, as well as loss of sensory function in the hind limbs. Recovery from the neurological disorders, except for the loss of tail tonus, occurred within 2 weeks after treatment. Histopathological examination revealed necrosis in the central areas of the spinal cord at 3 days and complete necrosis at 7 days after treatment at 43.8 degrees C for 60 min.
- Published
- 1992
- Full Text
- View/download PDF
33. External radiotherapy and extrahepatic bile duct cancer.
- Author
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Tollenaar RA, van de Velde CJ, Taat CW, Gonzalez Gonzalez D, Leer JW, and Hermans J
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma surgery, Adolescent, Adult, Aged, Bile Duct Neoplasms mortality, Bile Duct Neoplasms surgery, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Survival Rate, Adenocarcinoma radiotherapy, Bile Duct Neoplasms radiotherapy, Hepatic Duct, Common, Postoperative Care methods
- Abstract
The hospital records of patients with extrahepatic bile duct cancer who where treated surgically between 1968 and 1983 were reviewed. Of 55 patients, 16 (29%) received radiotherapy after surgery. The total dose given ranged from 40 to 60 Gy. Median follow-up time for analysis was 4.0 months and lasted until January 1988. The overall median survival was 4 months (range 0-36), that of the irradiated patients was 16 months (range 2-36), and that of the 39 patients who were not irradiated was 3 months (range 0-32). When the 13 post operative deaths were excluded the median survival was 4 months. Radiotherapy did not cause any severe complications. No firm conclusion about the role of radiotherapy can be drawn from these data because the patients were not randomly chosen to receive radiotherapy and selection was therefore biased. We conclude that most patients with extrahepatic bile duct cancer still die of locoregional disease. Effective adjuvant treatments are needed and should be evaluated in prospective randomized trials.
- Published
- 1991
34. Does additive radiotherapy after hilar resection improve survival of cholangiocarcinoma? An analysis in sixty-four patients.
- Author
-
Verbeek PC, Van Leeuwen DJ, Van Der Heyde MN, and Gonzalez Gonzalez D
- Subjects
- Adenoma, Bile Duct radiotherapy, Adenoma, Bile Duct surgery, Bile Duct Neoplasms radiotherapy, Bile Duct Neoplasms surgery, Combined Modality Therapy, Humans, Retrospective Studies, Time Factors, Adenoma, Bile Duct mortality, Bile Duct Neoplasms mortality
- Abstract
Between September 1983 and January 1990, 64 patients with Klatskin tumors were treated with resective therapy in the Academic Medical Centre Amsterdam. Twenty-nine patients received postoperative adjuvant radiotherapy, 22 patients were treated with resective therapy only and there were 13 postoperative deaths. The longterm results in the patients treated with or without adjuvant radiotherapy were retrospectively assessed. Three patients had a curative resection. Comparison of both therapeutic modalities demonstrated a statistically significant difference in survival (P less than 0.001) in favour of the patients who were treated with additive radiotherapy. The radiotherapy was generally well tolerated.
- Published
- 1991
35. Optimisation of intraperitoneal cisplatin therapy with regional hyperthermia in rats.
- Author
-
Los G, Sminia P, Wondergem J, Mutsaers PH, Havemen J, ten Bokkel Huinink D, Smals O, Gonzalez-Gonzalez D, and McVie JG
- Subjects
- Animals, Cisplatin pharmacology, Cisplatin toxicity, Male, Neoplastic Stem Cells drug effects, Platinum metabolism, Rats, Rats, Inbred Strains, Temperature, Tissue Distribution, Tumor Cells, Cultured drug effects, Cisplatin pharmacokinetics, Hyperthermia, Induced adverse effects, Peritoneal Neoplasms metabolism
- Abstract
The purpose of this study was to optimise intraperitoneal chemotherapy by combining this modality with regional hyperthermia. In vitro data demonstrated that both the uptake of cisplatin into CC531 tumour cells and cytotoxicity were increased at temperatures of 40 degrees C (factor 4) and 43 degrees C (factor 6) compared to 37 degrees C. The increase of intracellular platinum concentration correlated well with the decrease in survival of these cells. In vivo, rats were treated intraperitoneally with cisplatin (5 mg/kg) in combination with regional hyperthermia of the abdomen (41.5 degrees C, 1 h). The mean (S.D.) temperature in the peritoneal cavity was 41.5 (0.3) degrees C and outside the peritoneal cavity 40.5 (0.3) degrees C. Enhanced platinum concentrations were found in peritoneal tumours (factor 4.1) and kidney, liver, spleen and lung (all around a factor 2.0), after combined cisplatin-hyperthermia treatment. The platinum distribution in peritoneal tumours was more homogeneous after the combined treatment than after cisplatin alone, possibly due to increased penetration of cisplatin into peritoneal tumours. Pharmacokinetic data demonstrated an increased tumour exposure for unfiltered platinum in the peritoneal cavity (area under the curve [AUC] increased from 339 mumol/l/min to 486 mumol/l/min at 37 degrees C and 41.5 degrees C, respectively), and for total and ultrafiltered platinum in the blood. The AUC for total platinum increased from 97.9 to 325.8 mumol/min and for ultrafiltered platinum from 22.2 to 107 mumol/l/min at 37 degrees C and 41.5 degrees C respectively. The latter might be due to a slower elimination of platinum from the blood. The combined treatment, intraperitoneal cisplatin and regional hyperthermia, also increased toxicity. The thermal enhancement ratio (TER) using lethality as endpoint was 1.8.
- Published
- 1991
- Full Text
- View/download PDF
36. [Guideline in (suspected) malignant obstruction of the proximal bile ducts].
- Author
-
van Leeuwen DJ, Verbeek PC, Smits NJ, and Gonzalez Gonzalez D
- Subjects
- Algorithms, Bile Duct Neoplasms complications, Bile Duct Neoplasms radiotherapy, Bile Duct Neoplasms surgery, Cholestasis, Extrahepatic etiology, Drainage methods, Humans, Cholestasis, Extrahepatic therapy
- Published
- 1990
37. Effects of irradiation by single or multiple fractions per day on transplantable murine mammary carcinoma.
- Author
-
Gonzalez Gonzalez D and Haveman J
- Subjects
- Animals, Dactinomycin therapeutic use, Dose-Response Relationship, Radiation, Male, Mice, Misonidazole therapeutic use, Neoplasm Transplantation, Radiotherapy Dosage, Time Factors, Adenocarcinoma radiotherapy, Mammary Neoplasms, Experimental radiotherapy
- Abstract
Effects of different fractionation schedules of irradiation were studied in an experimental mammary adenocarcinoma transplanted in the back of mice. The number of fractions per day varied from one to three, keeping the daily dose constant. It was found that an increase of the number of fractions per day did not necessarily lead to a decrease in the tumour response, as might be expected for the same total dose. At a twelve-day overall time, three fractions per day did not give such a good result as one fraction per day, but at a nineteen-day overall time three fractions per day were about as good as one fraction per day; and below 45 Gy total dose, the result with three fractions per day even seemed to be better. The effects of actinomycin D administered during the irradiation treatment show that schedules with three fractions per day possibly take better advantage of repair of sublethal and potentially lethal damage than schedules with one fraction per day. Administration of misonidazole during the irradiation treatment led to a dose-modifying effect of 1.2 in one fraction per day schedules but had no significant effect in three fractions per day schedules. The present results may provide guidelines for clinical application of irradiation schedules with more than one fraction per day.
- Published
- 1982
- Full Text
- View/download PDF
38. Radiotherapy with multiple fractions per day in pancreatic and bile duct cancer.
- Author
-
Schuster-Uitterhoeve AL, Gonzalez Gonzalez D, and Blank LE
- Subjects
- Adenocarcinoma pathology, Bile Duct Neoplasms pathology, Combined Modality Therapy, Follow-Up Studies, Humans, Neoplasm Staging, Pancreatic Neoplasms pathology, Radiation Injuries etiology, Radiotherapy Dosage, Adenocarcinoma radiotherapy, Bile Duct Neoplasms radiotherapy, Pancreatic Neoplasms radiotherapy
- Abstract
Twenty patients with pancreatic and bile duct cancer have been treated with external radiotherapy with multiple fractions per day (MFD). All patients had localized disease only. Sixteen patients have been treated with a split-course technique, to a dose of 60 to 70 Gy in 7-8 weeks, four patients had a continuous series of 44 Gy in 19 days. The mean survival was 7.9 months for patients with a pancreatic cancer. Four out of nine patients with pancreatic cancer in whom the tumour was evaluable showed a tumour regression, one out of nine reached a partial remission. The mean survival in the responders was 9.5 months. All patients with pancreatic cancer died of their tumour. Four out of eight patients with bile duct cancer died of their tumour, the mean survival was 10 months. Four patients with bile duct cancer are still alive (10+, 10+, 10+, 11+ months). No serious acute toxicity was seen. Six patients showed gastrointestinal toxicity at 1.5 to 9 months after the end of treatment. All of them could be treated in a conservative way. From the results obtained in this feasibility study, radiotherapy with MFD in pancreatic and bile duct cancer appears to achieve similar tumour response as conventionally fractionated radiotherapy and the observed toxicity of MFD can be considered as acceptable. MFD might be a more appropriate treatment scheme for combination with chemotherapy and radiosensitizers.
- Published
- 1986
- Full Text
- View/download PDF
39. Prognostic factors of inoperable localized lung cancer treated by high dose radiotherapy.
- Author
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Schaake-Koning C, Schuster-Uitterhoeve L, Hart G, and Gonzalez Gonzalez D
- Subjects
- Adult, Aged, Female, Humans, Lung Neoplasms mortality, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Radiotherapy Dosage, Retrospective Studies, Adenocarcinoma radiotherapy, Carcinoma, Bronchogenic radiotherapy, Carcinoma, Squamous Cell radiotherapy, Lung Neoplasms radiotherapy
- Abstract
A retrospective study was made of the results of high dose radiotherapy (greater than or equal to 50 Gy) given to 171 patients with inoperable, intrathoracic non small cell lung cancer from January 1971-April 1973. Local control was dependent on the total tumor dose: after one year local control was 63% for patients treated with greater than 65 Gy, the two year local control was 35%. If treated with less than 65 Gy the one year local control was less than or equal to 40%. Tumor doses correlated with the size of the booster field. If the size of the booster field was less than 100 cm2, the one year local control was 72%; the two year local control was 44%. Local control was also influenced by the performance status, by the localization of the primary tumor in the left upper lobe and in the periphery of the lung. Local control for tumors in the left upper lobe and in the periphery of the lung was about 70% after one year, and about 40% after two years. The one and two years survival results were correlated with the factors influencing local control. The dose factor, the localization factors and the performance influenced local control independently. Tumors localized in the left upper lobe did metastasize less than tumors in the lower lobe, or in a combination of the two. This was not true for the right upper lobe. No correlation between the TNM system, pathology and the prognosis were found.
- Published
- 1983
- Full Text
- View/download PDF
40. International Clinical Trials in Radiation Oncology. Hyperthermia trials.
- Author
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Arcangeli G, Overgaard J, Gonzalez Gonzalez D, and Shrivastava PN
- Subjects
- Clinical Trials as Topic, Humans, International Cooperation, Quality Assurance, Health Care, Hyperthermia, Induced, Neoplasms therapy
- Published
- 1988
41. Combined treatment with radiation and hyperthermia in metastatic malignant melanoma.
- Author
-
Gonzalez Gonzalez D, van Dijk JD, Blank LE, and Rümke P
- Subjects
- Combined Modality Therapy, Follow-Up Studies, Humans, Lymphatic Metastasis radiotherapy, Melanoma radiotherapy, Melanoma secondary, Pilot Projects, Radiotherapy Dosage, Skin Neoplasms radiotherapy, Skin Neoplasms secondary, Time Factors, Hyperthermia, Induced methods, Lymphatic Metastasis therapy, Melanoma therapy, Skin Neoplasms therapy
- Abstract
In 24 patients with metastatic malignant melanoma, combined treatment with radiation and hyperthermia was administered to 38 localizations, radiation alone to 8 comparative localizations and hyperthermia alone to 3 localizations. Hyperthermia was administered during one hour by using a 433 MHz microwave generator. The heat treatment was given within 30 min following irradiation. Although an intratumoral temperature of 43 degrees C was aimed, considerable variations occurred during one session and from session-to-session. Radiation schedules consisted in either one large fraction (6-8 Gy) once a week in 14-21 days or two fractions (4-5 Gy) twice a week in 21 days. In the group of patients receiving irradiation once a week, three heat treatments were administered. In the twice-a-week radiation schedule, six heat sessions were given. The overall complete response (CR) rate in patients receiving combined treatment was 50%. In the group of patients treated with hyperthermia and irradiation schedules of 8 Gy per fraction, the CR rate was 83%. Irradiation alone achieved 38% CR rate but some of these CR relapsed during follow-up whereas the comparative area treated with radiation and heat remained under control at this time. The lesions treated with heat alone did not show any response to treatment. Enhancement of the acute skin reactions was generally observed. However, because the total doses were relatively low, this enhancement did not constitute a clinical problem. CR appears to occur more frequently in small tumor sizes. The highest and lowest temperature ever registered during any session of hyperthermia did not seem to correlate with the tumor response.
- Published
- 1986
- Full Text
- View/download PDF
42. Chestwall recurrences of breast cancer: results of combined treatment with radiation and hyperthermia.
- Author
-
Gonzalez Gonzalez D, van Dijk JD, and Blank LE
- Subjects
- Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Dose-Response Relationship, Radiation, Female, Humans, Mastectomy, Middle Aged, Radiotherapy Dosage, Skin radiation effects, Breast Neoplasms therapy, Hyperthermia, Induced, Neoplasm Recurrence, Local therapy, Thoracic Neoplasms therapy
- Abstract
In 35 patients with chestwall recurrences of breast carcinoma, 45 lesions were treated with combined radiation and hyperthermia. The majority of the lesions received 6 fractions of 4 Gy, twice a week during 3 weeks. Hyperthermia was administered within 30 min after irradiation, aiming a tumor temperature of 43 degrees C during one hour. The percentage of complete response (CR) was 57%. In small lesions, the percentage of CR was 80%. The mean duration of the response was 7 months. Response rate increased with increasing temperature. Particularly, mean temperature and isoeffect thermal dose correlated very well with response rate. In nine cases, comparative lesions were treated with either radiation alone or radiation combined with hyperthermia. The response rates were 3/9 and 7/9, respectively. Acute skin reactions were enhanced by the combined treatment. However, late skin reactions were not increased. Although the prognosis of patients with chestwall recurrences is determined by the presence of distant metastases, local control remains an important objective. Combined treatment with radiation and hyperthermia offers the possibility of obtaining a high local control rate particularly in relatively small lesions.
- Published
- 1988
- Full Text
- View/download PDF
43. Acute and late changes following irradiation of the lung.
- Author
-
Gonzalez Gonzalez D
- Subjects
- Humans, Lung physiopathology, Pulmonary Fibrosis etiology, Pulmonary Fibrosis pathology, Radiotherapy Dosage, Respiratory Function Tests, Lung radiation effects, Radiation Injuries
- Published
- 1979
44. [A case of precocious puberty and pinealoma in an 8-year old boy].
- Author
-
RAMOS MURGUIA M, DURAN ROMANO L, GONZALEZ GONZALEZ D, FRENK S, CHAVARRIA BONEQUI C, and FUENTES OLANO C
- Subjects
- Child, Humans, Infant, Male, Pinealoma, Puberty, Precocious, Supratentorial Neoplasms
- Published
- 1962
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