RESUMEN

OBJECTIVE: The objective of this study was to assess the association of survival with neoadjuvant chemotherapy (NAC) in resectable pancreatic adenocarcinoma (PDAC). BACKGROUND: The early control of potential micrometastases and patient selection using NAC has been advocated for patients with PDAC. However, the role of NAC for resectable PDAC remains unclear. METHODS: Patients with clinical T1 and T2 PDAC were identified in the National Cancer Database from 2010 to 2017. Kaplan-Meier estimates, and Cox regression models were used to compare survival. To address immortal time bias, landmark analysis was performed. Interactions between preoperative factors and NAC were investigated in subgroup analyses. A propensity score analysis was performed to compare survival between multiagent NAC and upfront surgery. RESULTS: In total, 4041 patients were treated with upfront surgery and 1,175 patients were treated with NAC (79.4% multiagent NAC, 20.6% single-agent NAC). Using a landmark time of 6 months after diagnosis, patients treated with multiagent NAC had longer median overall survival compared with upfront surgery and single-agent NAC. (35.8 vs 27.1 vs 27.4 mo). Multiagent NAC was associated with lower mortality rates compared with upfront surgery (adjusted hazard ratio, 0.77; 95% CI, 0.70-0.85), whereas single-agent NAC was not. The association of survival with multiagent NAC were consistent in analyses using the matched data sets. Interaction analysis revealed that the association between multiagent NAC and a lower mortality rate did not significantly differ across age, facility type, tumor location, CA 19-9 levels, and clinical T/N stages. CONCLUSIONS: The findings suggest that multiagent NAC followed by resection is associated with improved survival compared with upfront surgery.

Asunto(s)

Adenocarcinoma , Neoplasias Pancreáticas , Humanos , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/cirugía , Terapia Neoadyuvante , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Quimioterapia Adyuvante , Pancreatectomía , Estudios Retrospectivos

RESUMEN

OBJECTIVE: To compare short-term and oncologic outcomes of patients with cancer who underwent open pancreaticoduodenectomy (OPD) versus minimally invasive pancreaticoduodenectomy (MIPD) using the National Cancer Database. SUMMARY BACKGROUND DATA: MIPD, including laparoscopic and robotic approaches, has continued to gain acceptance despite prior reports of increased short-term mortality when compared with OPD. METHODS: Patients with pancreatic cancer diagnosed from 2010 to 2015 undergoing curative intent resection were selected from the National Cancer Database. Patients submitted to OPD were compared with those submitted to MIPD. Laparoscopic and robotic approaches were included in the MIPD cohort. The primary outcome was 90-day mortality; secondary outcomes included 30-day mortality, hospital length of stay, unplanned 30-day readmission, surgical margins, number of lymph nodes harvested, and receipt of adjuvant chemotherapy. Propensity score-weighted random effects logistic regression models were used to examine the adjusted association between surgical approach and the specified outcomes. RESULTS: Between 2010 and 2015, 22,013 patients underwent OPD or MIPD for pancreatic cancer and 3754 (17.1%) were performed minimally invasively. On multivariable analysis, there was no difference in 90-day mortality between MIPD and OPD (OR, 0.92; 95% CI, 0.75-1.14). Patients undergoing MIPD were less likely to stay in the hospital for a prolonged time (OR, 0.75; 95% CI, 0.68-0.82). 30-day mortality, unplanned readmissions, margins, lymph nodes harvested, and receipt of adjuvant chemotherapy were equivalent between groups. Regardless of surgical approach, patients operated on at high volume centers had reduced 90-day mortality. CONCLUSION: Patients selected to receive MIPD for cancer have equivalent short-term and oncologic outcomes, when compared with patients who undergo OPD.

Asunto(s)

Adenocarcinoma/cirugía , Laparoscopía/estadística & datos numéricos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Pancreaticoduodenectomía/efectos adversos , Utilización de Procedimientos y Técnicas , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Tasa de Supervivencia , Resultado del Tratamiento

RESUMEN

CONTEXT: Neoadjuvant chemotherapy is increasingly used in borderline resectable and locally advanced pancreatic cancer to facilitate surgical resection. OBJECTIVE: To compare progression free survival and overall survival in patients receiving neoadjuvant FOLFIRINOX with those receiving gemcitabine/abraxane. DESIGN: Retrospective cohort study. SETTING: University of Colorado Hospital from 2012-2016. PARTICIPANTS: Patients with pancreatic adenocarcinoma. INTERVENTIONS: Neoadjuvant FOLFIRINOX or gemcitabine/abraxane. OUTCOME MEASURES: Perioperative outcomes, progression free survival, and overall survival were compared between groups. A multivariate Cox proportional hazard model was applied to evaluate survival outcomes. RESULTS: We identified 120 patients: 83 (69.2%) FOLFIRINOX and 37 (30.8%) gemcitabine/abraxane. The FOLIFRINOX group was younger and had a lower ECOG performance status (p<0.05). Patients in the FOLFIRINOX group were more likely to undergo surgical resection compared to gemcitabine/abraxane (66.3% vs. 32.4%, p=0.002). Among all patients, median follow up was 16.9 months and FOLFIRINOX was associated with improved PFS (15.3 vs. 8.2 months, p=0.006), but not overall survival (23.5 vs. 18.7 months, p=0.228). In these patients, insulin-dependent diabetes was associated with a worse progression free survival and overall survival and surgical resection was protective. Among surgically resected patients, median follow up was 21.1 months and there was no difference in progression free survival (19.5 vs. 15.1 months) or overall survival (27.4 vs. 19.8 months) between the FOLFIRINOX and gemcitabine/abraxane groups, respectively (p>0.05). Insulin-dependent diabetes and a poor-to-moderate pathologic response was associated with worse progression free survival and overall survival. CONCLUSION: Neoadjuvant FOLFIRINOX may improve progression free survival by increasing the proportion of patients undergoing surgical resection. Improved understanding of the role for selection bias and longer follow up are needed to better define the impact of neoadjuvant FOLFIRINOX on overall survival.

RESUMEN

BACKGROUND AND OBJECTIVES: To compare outcomes in patients receiving neoadjuvant stereotactic body radiation therapy (SBRT) with those receiving intensity-modulated radiation therapy (IMRT) for pancreatic adenocarcinoma. METHODS: We analyzed patients receiving neoadjuvant SBRT for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) (2012-2016). Differences in baseline characteristics, perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were compared. RESULTS: Seventy-five (82.4%) patients received SBRT and 16 (17.6%) received IMRT. There were no differences in surgical resection rates in the SBRT (n = 38, 50.7%) and IMRT (n = 11, 68.8%) groups (P = 0.188). Among resected patients, there was no difference in postoperative outcomes or pathologic outcomes including lymph node status, margin status, lymphovascular and perineural invasion, or pathologic response to neoadjuvant treatment (P > 0.05). Among all patients, median PFS and OS were 9.9 and 23.5 months in the SBRT group, respectively, and 15.3 and 21.8 months in the IMRT group, respectively (P > 0.05). Similarly, there was no difference in PFS or OS between groups when stratified by BRPC, LAPC, and surgically resected patients (P > 0.05). CONCLUSIONS: In the neoadjuvant setting, SBRT and IMRT appear to have similar rates of resection, perioperative outcomes, and survival outcomes, but additional studies with increased sample size and longer follow up are needed.

Asunto(s)

Adenocarcinoma/mortalidad , Terapia Neoadyuvante/mortalidad , Neoplasias Pancreáticas/mortalidad , Radiocirugia/mortalidad , Radioterapia de Intensidad Modulada/mortalidad , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Terapia Combinada , Fraccionamiento de la Dosis de Radiación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirugía , Atención Perioperativa , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias Pancreáticas

RESUMEN

BACKGROUND: Previous studies have demonstrated improved in-hospital mortality after hepatic resection for hepatocellular carcinoma (HCC) at teaching hospitals. The objective of this study was to evaluate if resection of HCC at academic cancer programs (ACP) is associated with improved 10-year survival. STUDY DESIGN: Using the National Cancer Data Base (NCDB) (1998 to 2011), we evaluated patients undergoing hepatic resection for HCC at ACPs, comprehensive community cancer programs (CCCPs), and community cancer programs (CCPs). High volume cancer programs (HVCPs) were defined as performing 10 or more hepatectomies per year. Multivariate Cox proportional hazard models by stepwise selection were applied to estimate hazard ratios (HR) of predictors of survival. The Kaplan-Meier method was used to generate survival curves at each facility type, and survival rates were compared using the log-rank test. RESULTS: We identified 12,757 patients undergoing hepatic resection for HCC at ACPs (n = 8,404), CCPs (n = 483), and CCCPs (n = 3,870). Sixty-two percent (n = 5,191) of patients treated at ACPs were at high volume institutions compared with 11.6% (n = 446) and 0% of CCCPs and CCPs, respectively (p < 0.0001). On multivariable analysis, patients undergoing hepatic resection at transplant centers (p < 0.0001) and HVCPs had significantly improved survival (p < 0.0001). Adjusted 10-year survival rates were 28.7% at high volume ACPs, 28.2% at high volume CCCPs, 24.9% at low volume CCCPs, 25.1% at low volume ACPs, and 21.3% at CCPs (p ≤ 0.0001). CONCLUSIONS: Patients undergoing hepatic resection for HCC at HVCPs had a significantly improved 10-year survival. Regionalization of HCC treatment to HVCPs may improve long-term survival.

Asunto(s)

Instituciones Oncológicas , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/cirugía , Hospitales de Alto Volumen , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/cirugía , Anciano , Anciano de 80 o más Años , Femenino , Hepatectomía , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia , Estados Unidos

RESUMEN

BACKGROUND: The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores. METHODS: The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease. RESULTS: Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63% vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment. CONCLUSION: Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.

Asunto(s)

Fallo Hepático/mortalidad , Fallo Hepático/cirugía , Trasplante de Hígado , Anciano , Estudios de Cohortes , Femenino , Humanos , Fallo Hepático/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Listas de Espera

RESUMEN

BACKGROUND: This study examined how reliable is the pre-transplant model for end-stage liver disease (MELD) score in predicting post-transplantation survival and analyzed variables associated with patient survival. METHODS: A cohort study was conducted. Receiver operating characteristic curve c-statistics were used to determine the ability of MELD score to predict mortality. The Kaplan-Meier (KM) method was used to analyze survival as a function of time regarding the MELD score and Child-Turcotte-Pugh (CTP) category. The Cox model was employed to assess the association between baseline risk factors and mortality. RESULTS: Recipients and donors were mostly male, with a mean age of 51.6 and 38.5 yr, respectively (n = 436 transplants). The c-statistic values for three-month patient mortality were 0.60 and 0.61 for MELD score and CTP category, respectively. KM survival at three, six and 12 months were lower in those who had a MELD score > or =21 or were CTP category C. Multivariate analysis revealed that recipient age > or =65 yr, MELD > or = 21, CTP C category, bilirubin > or = 7 mg/dL, creatinine > or = 1.5 mg/dL, platelet transfusion, hepatocellular carcinoma, and non-white color donor skin were predictors of mortality. CONCLUSIONS: Severe pre-transplant liver disease, age > or = 65, non-white skin donor, and hepatocellular carcinoma are associated with poor outcome.

Asunto(s)

Carcinoma Hepatocelular/mortalidad , Supervivencia de Injerto , Fallo Hepático/mortalidad , Neoplasias Hepáticas/mortalidad , Trasplante de Hígado/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Carcinoma Hepatocelular/cirugía , Niño , Preescolar , Estudios de Cohortes , Femenino , Rechazo de Injerto , Humanos , Fallo Hepático/cirugía , Neoplasias Hepáticas/cirugía , Trasplante de Hígado/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Pronóstico , Curva ROC , Factores de Riesgo , Tasa de Supervivencia , Adulto Joven

RESUMEN

BACKGROUND/AIM: To examine the performance of the model for end-stage liver disease (MELD) score to predict mortality three and six months after enlistment of patients with chronic diseases for their first liver transplantation (LT) and to compare the performances of the Child-Turcotte-Pugh (CTP) and the Erasmus Model for End-stage Resistant-to-therapy All etiology Liver Disease (EMERALD) scores with the MELD to predict mortality. METHODS: Cohort study. Receiver operating characteristics curve (ROC) curves were used to determine the ability of the scores for predicting three and six month mortality, the c-statistic to establish the predictive power of each score and the Cox proportional hazard model to estimate the risk of dying. RESULTS: We studied 271 patients. At enlistment, the mean MELD and EMERALD scores were 14.8 and 26.6, respectively. Approximately 61% of the cases were in the CTP B category. During the three or six month follow-up period, the percentage of patients dying, receiving LT or remaining on the list were 11.8%, 9.2%, and 79.0% or 19.2%, 17.7%, and 63.1%, respectively. The three-month mortality was similarly predicted by the scores MELD, EMERALD and CTP (c-statistic of 0.79, 0.74, and 0.70, respectively). Six-month mortality presented similar AUC and ROC curves. CONCLUSION: The scores predicted mortality for the three or six months, but the performance of the MELD was better than CTP and EMERALD scores.

Asunto(s)

Fallo Hepático/mortalidad , Modelos Biológicos , Listas de Espera , Adolescente , Adulto , Anciano , Brasil , Estudios de Cohortes , Femenino , Humanos , Trasplante de Hígado , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Curva ROC , Índice de Severidad de la Enfermedad , Adulto Joven

RESUMEN

INTRODUCTION: Adjuvant antibiotic therapy for acute abdominal conditions is widely used. Its timing, duration, dose and spectrum, however, are not homogeneous amongst surgeons and prolonged courses are often used despite the unproven benefits of this practice. OBJECTIVE: To evaluate use and compare duration of antibiotic treatments in acute abdominal surgery. METHODS: Retrospective cohort study. The medical records of 290 patients who underwent operations for acute abdomen from July 1998 to July 1999 in a teaching hospital were reviewed. The pattern of antibiotic use and rates of postoperative complications were evaluated, along with surgical diagnosis, degree of contamination/infection, and incidence of postoperative complications. The patients were stratified according to the degree of contamination/infection noted during the operation. The study population was divided in two groups according to the duration of antibiotic use (cut-off point at the median antibiotic use in days, for each group of contamination/infection degree), and outcomes were compared. RESULTS: The degree of contamination/infection was significantly associated with an increased risk of wound infection, intra-abdominal abscess, postoperative infective complications and overall postoperative complications (p < 0.001). A long course of antibiotics was not associated with lower infective complication rates. CONCLUSIONS: Shorter courses of antibiotic therapy based on the degree of contamination/infection seem to be safe. A prospective study should confirm this hypothesis.

Asunto(s)

Abdomen Agudo/cirugía , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Infecciones Bacterianas/prevención & control , Complicaciones Posoperatorias , Adulto , Anciano , Profilaxis Antibiótica , Apendicitis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infección de la Herida Quirúrgica/prevención & control

RESUMEN

Relatam-se três casos de zigomicose após transplante hepático em uma série de 300 pacientes. O diagnóstico foi anatomopatológico (dois casos à necropsia e um à cirurgia). A doença manifestou-se de diferentes formas: rinomaxilar, gastrointestinal e, em um paciente, comprometeu a anastomose da artéria hepática. Neste caso, retirada cirúrgica da região comprometida e uso de anfotericina-B possibilitaram a cura.

Asunto(s)

Persona de Mediana Edad , Humanos , Masculino , Femenino , Trasplante de Hígado , Cigomicosis , Anfotericina B , Antifúngicos , Cigomicosis

RESUMEN

We report three cases of zygomycosis following liver transplant in a series of 300 patients. Diagnosis was determined via anatomicopathological examination (on necropsy in two cases and during surgery in one case). The disease had different manifestations: rhinomaxillary, gastrointestinal and, in one case, it compromised the liver artery anastomosis. In this case, surgical removal of the affected region and use of amphotericin B achieved resolution.

Asunto(s)

Trasplante de Hígado/efectos adversos , Cigomicosis/etiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Femenino , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Cigomicosis/tratamiento farmacológico , Cigomicosis/patología

RESUMEN

pacientes com cirrose associada ao vírus da hepatite B (VHB), submetidos a transplante hepático, deve fazer profilaxia para evitar infecção do enxerto por esse vírus. O esquema profilático mais recomendado em todo mundo utiliza altas doses de imunoglobulina da hepatite B (HBIG) e lamivudina. Como a HBIG é um medicamento muito caro, há estudos que avaliam a eficácia de doses menores. Recentemente, O Ministério da Saúde disponibilizou 16.500UI de HBIG para cada paciente submetido a transplante hepático por doenças associadas ao VHB. No presente estudo, os autores registram sua experiência em uma série inicial de sete pacientes adultos, com cirrose pelo VHB e baixa replicação viral no momento do transplante, que fizeram profilaxia com a dose de HBIG acima especificada, administrada por via intravenosa, em um período de três semanas, em associação com 150mg/dia de lamivudina. Seis deles(86por cento) tornaram-se AgHBs negativos na primeira semana após o transplante e persistirem assim nas primeiras 12 semanas. O título médio anti-HBs foi de 703ñ25UI/I. Emm édia 12 semanas após o transplante, os títulos de anti-HBs diminuíram em todos os pacientes, sendo necessário prescrever doses de HBIG além das propostas pelo Ministério da Saúde. Esse estudo mostrou que com doses pequenas de HBIG, foi possível desenvolver títulos protetores de anti-HBs, mas somente por curto período de tempo. Sendo transitório o efeito da HBIG, é fundamental que o Ministério da Saúde forneça a medicação continuadamente e por tempo indeterminado

Asunto(s)

Masculino , Adulto , Persona de Mediana Edad , Profilaxis Antibiótica , Hepatitis B , Lamivudine , Trasplante de Hígado , Periodo Posoperatorio

RESUMEN

BACKGROUND: The risk factors for cutaneous malignant melanoma have been studied in populations from numerous countries around the world. There are no published studies on the risk factors for this malignancy in Brazil, the largest country in South America. METHODS: A case-control study of all melanoma patients attending a university hospital in Porto Alegre, Brazil, was conducted over a 3-year period from 1995 to 1998. Phototype, hair and eye color, solar habits, history of sunburn, use of sunscreens, and the number of nevi were evaluated through a questionnaire and full body skin examination. Bivariate analysis and a logistic regression model were used to evaluate the data. RESULTS: One hundred and three malignant melanoma patients and 206 matched controls were enrolled in the study. The female to male ratio was 2 : 1. Light phototypes were more prone to the development of cutaneous melanoma. Although stronger in the bivariate analysis, in the logistic regression model, phototypes I or II and ephelides emerged only as moderate risk factors; light eye color and light hair color were not independently significant, with adjusted odds ratios (OR) close to zero. Commonly acquired nevi (CAN) showed a significant and strong effect in the bivariate analysis only when the "30 or more" category was compared to baseline. In the logistic regression model, the presence of a large number of CAN showed an association with increased levels of risk, although these findings did not reach classical significance. Dysplastic or atypical nevi seemed to contribute more strongly, although still with a moderate excess of relative risk. When the use of sunscreens was compared to no use at all, it appeared to show progressive protection as the solar protection factor (SPF) increased. Only SPF15 or greater (SPF15+) showed strong and significant protection when compared to baseline. Physical measures offered a weaker level of protection. Nevertheless, there was a significant increase in the risk of melanoma for those with a large number of sunburn episodes. It was found that 30 or more alleged episodes of sunburn showed a very strong OR of 11.4 (95% confidence interval, 2.6-50.5), the most significant in the study. CONCLUSIONS: Phototypes I and II, freckles, a large number of acquired nevi, dysplastic nevi, and inadequate photoprotection appeared as risk factors with moderate strength for cutaneous malignant melanoma in the studied population. The color of the eyes and hair showed a very weak statistical significance as a risk factor. Sunscreens showed progressive significance corresponding to an increase in SPF, the best scores in statistical protection being achieved in users of sunscreens with SPF15 or greater. Frequent sunburn episodes appeared as the most important risk factor associated with malignant melanoma in this sample of the white population in southern Brazil.

Asunto(s)

Melanoma/etiología , Melanoma/genética , Nevo Pigmentado/etiología , Nevo Pigmentado/genética , Fenotipo , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/genética , Quemadura Solar/complicaciones , Quemadura Solar/genética , Protectores Solares/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios de Casos y Controles , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Melanoma/prevención & control , Persona de Mediana Edad , Nevo Pigmentado/prevención & control , Oportunidad Relativa , Factores de Riesgo , Neoplasias Cutáneas/prevención & control , Quemadura Solar/prevención & control

Asunto(s)

Humanos , Masculino , Femenino , Población Blanca , Melanoma/epidemiología , Melanoma/etiología , Factores de Riesgo , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversos , Estudios de Casos y Controles

RESUMEN

Os autores fazem uma revisäo crítica a respeito da biotesiometria, método de quantificaçäo da sensibilidade vibratória capaz de detectar pacientes diabéticos com alto risco de desenvolver úlceras nos pés. Säo discutidos neste artigo o princípio e técnicas utilizadas para avaliar a sensibilidade vibratória pelo biotesiômetro, suas vantagens e limitaçöes, bem como sua futura aplicaçäo na prática clínica diária com o objetivo de caracterizar a neuropatia periférica de pacientes com diabetes melito

Asunto(s)

Humanos , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Diabetes Mellitus/complicaciones , Técnicas de Diagnóstico Endocrino