Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Melanoma/patología , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Metástasis Linfática , Biopsia del Ganglio Linfático Centinela , Ganglios Linfáticos/cirugía , Ganglios Linfáticos/patología , Escisión del Ganglio Linfático , Pronóstico , Melanoma Cutáneo MalignoRESUMEN
AIMS: To present antimicrobial susceptibilities for bacteria from dogs and cats with respiratory tract infection (RTI) across Europe in 2013-2014 and compare with data from 2008-2010. METHODS AND RESULTS: Minimal inhibitory concentrations were determined for 464 isolates following Clinical and Laboratory Standards Institute standards using antibiotics approved for RTI treatment. Where possible, susceptibility was calculated using predominantly human-derived breakpoints whilst some antibiotics had no breakpoints. The main pathogen from dogs was Staphylococcus pseudintermedius which was > 90% susceptible to fluoroquinolones and oxacillin (92·5%; six isolates confirmed mecA-positive) and 53·8, 80·0 and 88·8% susceptible to tetracycline, penicillin and trimethoprim/sulfamethoxazole. Streptococci, Escherichia coli, Bordetella bronchiseptica, Staphylococcus aureus and Pseudomonas aeruginosa were also present in dog RTI. Streptococci were fully susceptible to penicillin, ampicillin and pradofloxacin. None were enrofloxacin-resistant but 31·4% had intermediate susceptibility. The least active agent against streptococci was tetracycline (51·4% susceptible). For E. coli, 90·9% were amoxicillin/clavulanic acid-susceptible; susceptibility to other compounds ranged from 63·6 to 81·8%. There are no breakpoints for B. bronchiseptica and Ps. aeruginosa. For Staph. aureus, penicillin susceptibility was low (34·8%); for other compounds 87·0-100%. The main RTI pathogen from cats was Pasteurella multocida, where only pradofloxacin has breakpoints (100% susceptible). Susceptibility of coagulase-negative staphylococci ranged from 66·7% (penicillin) to 97·2% (pradofloxacin). Streptococci from cats were 100% susceptible to all antibiotics except enrofloxacin and tetracycline (both 65·2% susceptible). CONCLUSIONS: Overall, antimicrobial resistance was low to medium in RTI in dogs and cats, although susceptibility varied widely among pathogens studied. SIGNIFICANCE AND IMPACT OF THE STUDY: Responsible use of antibiotics is crucial to maintain susceptibility and continued resistance monitoring is important to support this goal. These findings support the need for the setting of RTI-specific breakpoints for pathogens of dogs and cats.
Asunto(s)
Antibacterianos/farmacología , Enfermedades de los Gatos/microbiología , Enfermedades de los Perros/microbiología , Pruebas de Sensibilidad Microbiana , Infecciones del Sistema Respiratorio/veterinaria , Encuestas y Cuestionarios , Animales , Gatos , Perros , Farmacorresistencia Bacteriana/efectos de los fármacos , Europa (Continente)/epidemiología , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiologíaRESUMEN
Introducción: Las decisiones terapéuticas en el paciente con psoriasis están influidas por factores de la enfermedad (gravedad, localización, etc.), de las comorbilidades y de otras circunstancias demográficas y clínicas asociadas. Objetivo: Evaluar la fiabilidad de una aplicación móvil, MDi-Psoriasis(R), como instrumento de ayuda al dermatólogo en la toma de decisiones terapéuticas en pacientes con psoriasis moderada-grave. Método: Estudio de concordancia interobservador entre las recomendaciones terapéuticas emitidas por un grupo de expertos y MDi-Psoriasis(R) sobre 10 casos clínicos complejos de psoriasis moderada-grave. Para cada uno de los casos los expertos fueron preguntados por el tratamiento más adecuado, posible y no adecuado. Los mismos 10 casos clínicos fueron sometidos a la aplicación MDi-Psoriasis(R) y se calcularon las concordancias interobservador pareada (kappa de Cohen) y múltiple (kappa de Fleiss), y el porcentaje de acuerdo entre las recomendaciones. Resultados: Sobre un total de 1.210 observaciones el porcentaje promedio de acuerdo fue del 51,3% (IC 95%: 48,5-54,1%), con una concordancia pareada de kappa = 0,29 y múltiple de kappa = 0,28. El acuerdo promedio entre pares de observadores, sin MDi-Psoriasis(R), fue del 50,5% (IC 95%: 47,6-53,5%). La concordancia pareada entre las recomendaciones emitidas por MDi-Psoriasis(R) y la opinión mayoritaria de los expertos fue de kappa = 0,44, con un acuerdo del 68,2%. Conclusiones: MDi-Psoriasis(R) puede emitir recomendaciones comparables a las emitidas por un experto en psoriasis (AU)
Background: Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. Objective: We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. Method: We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. Results: The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). Conclusions: The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis (AU)
Asunto(s)
Humanos , Psoriasis/tratamiento farmacológico , Fármacos Dermatológicos/uso terapéutico , Árboles de Decisión , Sistemas de Apoyo a Decisiones Clínicas , Aplicaciones Móviles , Comorbilidad , Etanercept/uso terapéutico , Metotrexato/uso terapéuticoRESUMEN
Biofilms are frequently related to invasive fungal infections and are reported to be more resistant to antifungal drugs than planktonic cells. The structural complexity of the biofilm as well as the presence of a polymeric extracellular matrix (ECM) is thought to be associated with this resistant behavior. Scanning electron microscopy (SEM) after room temperature glutaraldehyde-based fixation, have been used to study fungal biofilm structure and drug susceptibility but they usually fail to preserve the ECM and, therefore, are not an optimised methodology to understand the complexity of the fungal biofilm. Thus, in this work, we propose a comparative analysis of room-temperature and cryofixation/freeze substitution of Candida albicans biofilms for SEM observation. Our experiments showed that room-temperature fixative protocols using glutaraldehyde and osmium tetroxide prior to alcohol dehydration led to a complete extraction of the polymeric ECM of biofilms. ECM from fixative and alcohol solutions were recovered after all processing steps and these structures were characterised by biochemistry assays, transmission electron microscopy and mass spectrometry. Cryofixation techniques followed by freeze-substitution lead to a great preservation of both ECM structure and C. albicans biofilm cells, allowing the visualisation of a more reliable biofilm structure. These findings reinforce that cryofixation should be the indicated method for SEM sample preparation to study fungal biofilms as it allows the visualisation of the EMC and the exploration of the biofilm structure to its fullest, as its structural/functional role in interaction with host cells, other pathogens and for drug resistance assays.
Asunto(s)
Biopelículas , Candida albicans/fisiología , Candida albicans/ultraestructura , Microscopía Electrónica de Rastreo , Proteínas Bacterianas/metabolismo , Metabolismo de los Hidratos de Carbono , Criopreservación/métodos , Cromatografía de Gases y Espectrometría de Masas , Microscopía Electrónica de Rastreo/métodos , TemperaturaRESUMEN
BACKGROUND: Therapeutic decisions in psoriasis are influenced by disease factors (e.g., severity or location), comorbidity, and demographic and clinical features. OBJECTIVE: We aimed to assess the reliability of a mobile telephone application (MDi-Psoriasis) designed to help the dermatologist make decisions on how to treat patients with moderate to severe psoriasis. METHOD: We analyzed interobserver agreement between the advice given by an expert panel and the recommendations of the MDi-Psoriasis application in 10 complex cases of moderate to severe psoriasis. The experts were asked their opinion on which treatments were most appropriate, possible, or inappropriate. Data from the same 10 cases were entered into the MDi-Psoriasis application. Agreement was analyzed in 3 ways: paired interobserver concordance (Cohen's κ), multiple interobserver concordance (Fleiss's κ), and percent agreement between recommendations. RESULTS: The mean percent agreement between the total of 1210 observations was 51.3% (95% CI, 48.5-54.1%). Cohen's κ statistic was 0.29 and Fleiss's κ was 0.28. Mean agreement between pairs of human observers only, excluding the MDi-Psoriasis recommendations, was 50.5% (95% CI, 47.6-53.5%). Paired agreement between the recommendations of the MDi-Psoriasis tool and the majority opinion of the expert panel (Cohen's κ) was 0.44 (68.2% agreement). CONCLUSIONS: The MDi-Psoriasis tool can generate recommendations that are comparable to those of experts in psoriasis.
Asunto(s)
Toma de Decisiones Clínicas , Fármacos Dermatológicos/uso terapéutico , Dermatología/métodos , Aplicaciones Móviles , Psoriasis/tratamiento farmacológico , Adulto , Teléfono Celular , Contraindicaciones de los Medicamentos , Estudios Transversales , Testimonio de Experto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Terapia PUVA , Psoriasis/radioterapia , Reproducibilidad de los Resultados , Terapia UltravioletaAsunto(s)
Toma de Decisiones , Árboles de Decisión , Ganglios Linfáticos/patología , Melanoma/diagnóstico , Biopsia del Ganglio Linfático Centinela/métodos , Neoplasias Cutáneas/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Metástasis Linfática/diagnóstico , Masculino , Melanoma/secundario , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Cutáneas/secundario , Adulto Joven , Melanoma Cutáneo MalignoRESUMEN
Presentamos el caso de un paciente portador de una mutación en el gen KCNH2 para el síndrome de QT largo, diagnosticado a raíz de muerte súbita de un familiar. El estudio genético para el síndrome del QT largo y otras canalopatías está siendo cada vez más utilizado en la prevención de la muerte súbita, empezando a aparecer en los últimos años las primeras recomendaciones para el manejo de los pacientes portadores de mutaciones sin expresión fenotípica (AU)
We report a carrier of the KCNH2 gene for the long QT syndrome. He was diagnosed after the sudden death of a relative. The long QT syndrome (and other canalopathies) genetic study is being a new weapon for the prevention of sudden death. In last years, clinical guidelines for the management of genetic carriers without phenotypic manifestations are being published (AU)
Apresentamos um caso de um paciente portador de uma maturação no gene KHNC2 para a síndrome de QT largo, diagnosticado à raiz de morte súbita de um familiar. O estudo genético para a síndrome do QT largo e outras canalopatias estão sendo cada vez mais utilizados na prevenção da morte súbita, começando a aparecer, nos últimos anos, as primeiras recomendações para o tratamento dos pacientes portadores de mutações sem expressão fenotípica (AU)
Asunto(s)
Humanos , Masculino , Adulto , Síndrome de QT Prolongado/tratamiento farmacológico , Síndrome de QT Prolongado/genética , Síndrome de QT Prolongado , Análisis Mutacional de ADN/métodos , Canal de Potasio KCNQ2/análisis , Canal de Potasio KCNQ2/uso terapéutico , Mutagénesis , Mutagénesis/genética , Supresión Genética , Canal de Potasio KCNQ2/genética , Medicina Deportiva/métodosRESUMEN
C8-desaturated and C9-methylated glucosylceramide (GlcCer) is a fungal-specific sphingolipid that plays an important role in the growth and virulence of many species. In this work, we investigated the contribution of Aspergillus nidulans sphingolipid Δ8-desaturase (SdeA), sphingolipid C9-methyltransferases (SmtA/SmtB) and glucosylceramide synthase (GcsA) to fungal phenotypes, sensitivity to Psd1 defensin and Galleria mellonella virulence. We showed that ΔsdeA accumulated C8-saturated and unmethylated GlcCer, while gcsA deletion impaired GlcCer synthesis. Although increased levels of unmethylated GlcCer were observed in smtA and smtB mutants, ΔsmtA and wild-type cells showed a similar 9,Me-GlcCer content, reduced by 50% in the smtB disruptant. The compromised 9,Me-GlcCer production in the ΔsmtB strain was not accompanied by reduced filamentation or defects in cell polarity. When combined with the smtA deletion, smtB repression significantly increased unmethylated GlcCer levels and compromised filamentous growth. Furthermore, sdeA and gcsA mutants displayed growth defects and raft mislocalization, which were accompanied by reduced neutral lipids levels and attenuated G. mellonella virulence in the ΔgcsA strain. Finally, ΔsdeA and ΔgcsA showed increased resistance to Psd1, suggesting that GlcCer synthesis and fungal sphingoid base structure specificities are relevant not only to differentiation but also to proper recognition by this antifungal defensin.
Asunto(s)
Aspergillus nidulans/metabolismo , Glucosilceramidas/metabolismo , Glucosiltransferasas/metabolismo , Microdominios de Membrana/metabolismo , Antifúngicos/química , Aspergillus nidulans/genética , Aspergillus nidulans/crecimiento & desarrollo , Defensinas/metabolismo , Glucosilceramidas/química , Glucosilceramidas/genética , Glucosiltransferasas/química , Glucosiltransferasas/genética , Metilación , Metiltransferasas/genética , Oxidorreductasas/metabolismo , Esfingolípidos/química , Esfingolípidos/metabolismoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Biopsia del Ganglio Linfático Centinela/instrumentación , Biopsia del Ganglio Linfático Centinela/métodos , Biopsia del Ganglio Linfático Centinela , Cirugía Asistida por Video/instrumentación , Cirugía Asistida por Video/métodos , Cirugía Asistida por Video , Supervivencia/fisiología , Melanoma , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Estadificación de Neoplasias/instrumentación , Estadificación de Neoplasias/métodos , Estadificación de Neoplasias , Procedimientos Quirúrgicos Dermatologicos/instrumentación , Procedimientos Quirúrgicos Dermatologicos/métodos , Procedimientos Quirúrgicos DermatologicosRESUMEN
INTRODUCCIÓN: Las recomendaciones actuales de pruebas de imagen en la estadificación basal del paciente con melanoma cutáneo primario se limitan a los estadios tumorales de riesgo elevado (T4b). OBJETIVO: Evaluar la frecuencia y el rendimiento de la tomografía computarizada (TC) para la estadificación basal del paciente con melanoma cutáneo primario y la tipología y la frecuencia de los incidentalomas identificados. MATERIAL Y MÉTODOS: Estudio transversal sobre pacientes con melanoma cutáneo de estadio Tis-T4bN0M0 atendidos entre 2008 y 2014 en una Unidad de Melanoma. Se revisaron las TC realizadas como parte del estudio de estadificación basal para obtener la frecuencia de TC positiva, incidentalomas, coste unitario de la detección de metástasis y factores asociados a la realización de TC. RESULTADOS: Sobre un total de 419 pacientes incluidos se realizó TC basal en el 73,99% de los pacientes (n=310TC. Tis=17, T1=137, T2=71, T3=48, T4=37), de las que el 81,61% fueron negativas y el 18,06% presentaron incidentalomas. En 2 pacientes (0,64%) se identificaron segundas neoplasias primarias y en un paciente, metástasis de melanoma (0,32%). El coste asociado a la identificación de metástasis fue de 71.234,90 €/metástasis. El estadio T2 (OR = 8,73) y la edad < 70 años (OR = 3,53) se asociaron con mayor probabilidad de solicitud de TC; la exéresis del tumor primario en la Unidad de Melanoma (OR=0,08) se asoció con menor probabilidad de solicitud de TC. CONCLUSIONES: Los resultados obtenidos en esta serie confirman las recomendaciones actuales que restringen la indicación de la TC de estadificación basal a los escenarios de alto riesgo de enfermedad metastásica (estadiosIIC-III)
BACKGROUND: Current guidelines call for baseline imaging only for very high-risk (T4b) primary cutaneous melanomas. OBJECTIVES: To estimate the frequency of computed tomography (CT) at baseline staging of primary cutaneous melanoma and the diagnostic yield of CT; and to describe the types and frequencies of incidentaloma findings. MATERIAL AND METHODS: Cross-sectional study of cutaneous melanoma cases (tumor classifications Tis to T4bN0M0) attended between 2008 and 2014 in a specialized melanoma unit. Reports of CT scans performed during baseline staging were reviewed to determine the frequency of positive scan results, incidentaloma findings, unit cost for detection of metastasis, and factors associated with the decision to order CT. RESULTS: CT results were available for 310 of the 419 patients included (73.99%). The tumor classifications were as follows: Tis, 17; T1, 137; T2, 71; T3, 48; and T4, 37. The CT results were negative in 81.61%, and incidentalomas were found in 18.06%. Additional primary tumors were found in 2 patients (0.64%), and metastasis was identified in one patient (0.32%). The cost of finding the case of metastasis was €71,234.90. A T2 tumor classification (odds ratio [OR], 8.73) and age under 70 years (OR, 3.53) were associated with greater likelihood of CT being ordered. Excision of the primary tumor in the melanoma unit (OR, 0.08) was associated with less likelihood of ordering CT. CONCLUSIONS: The results for this patient series support current recommendations restricting CT at baseline to cases where there is high risk of metastasis (stagesIIC-III)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Estadificación de Neoplasias/normas , Estadificación de Neoplasias , Melanoma , Tomografía Computarizada de Emisión/instrumentación , Tomografía Computarizada de Emisión/métodos , Tomografía Computarizada de Emisión , 51654/economía , Metástasis de la Neoplasia/diagnóstico , Estudios Transversales/métodos , Estudios Transversales/tendenciasRESUMEN
BACKGROUND: Current guidelines call for baseline imaging only for very high-risk (T4b) primary cutaneous melanomas. OBJECTIVES: To estimate the frequency of computed tomography (CT) at baseline staging of primary cutaneous melanoma and the diagnostic yield of CT; and to describe the types and frequencies of incidentaloma findings. MATERIAL AND METHODS: Cross-sectional study of cutaneous melanoma cases (tumor classifications Tis to T4bN0M0) attended between 2008 and 2014 in a specialized melanoma unit. Reports of CT scans performed during baseline staging were reviewed to determine the frequency of positive scan results, incidentaloma findings, unit cost for detection of metastasis, and factors associated with the decision to order CT. RESULTS: CT results were available for 310 of the 419 patients included (73.99%). The tumor classifications were as follows: Tis, 17; T1, 137; T2, 71; T3, 48; and T4, 37. The CT results were negative in 81.61%, and incidentalomas were found in 18.06%. Additional primary tumors were found in 2 patients (0.64%), and metastasis was identified in one patient (0.32%). The cost of finding the case of metastasis was 71,234.90. A T2 tumor classification (odds ratio [OR], 8.73) and age under 70 years (OR, 3.53) were associated with greater likelihood of CT being ordered. Excision of the primary tumor in the melanoma unit (OR, 0.08) was associated with less likelihood of ordering CT. CONCLUSIONS: The results for this patient series support current recommendations restricting CT at baseline to cases where there is high risk of metastasis (stagesiiC-iii).
Asunto(s)
Melanoma/diagnóstico , Estadificación de Neoplasias/métodos , Tomografía Computarizada por Rayos X , Costos y Análisis de Costo , Estudios Transversales , Humanos , Estadificación de Neoplasias/economía , Tomografía Computarizada por Rayos X/economíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Femenino , Queratosis Actínica/complicaciones , Queratosis Actínica/diagnóstico , Queratosis Actínica/genética , Cicatriz Hipertrófica/diagnóstico , Queratosis Actínica/metabolismo , Carcinoma Basocelular/clasificación , Carcinoma Basocelular/complicacionesRESUMEN
Intestinal immune response plays an important defensive role for pathogens, particularly for those transmitted by the oro-faecal route or for foecal shedding modulation. This work examined three parts of intestine from twelve gilts experimentally infected with PCV2-spiked semen, six vaccinated (V group) and six unvaccinated (NV group) against PCV2, 29 and 53 days post infection (DPI). An immunohistochemical investigation for IgA-, IgG- and IgM-antibody bearing plasma cells (PCs) was run on intestinal samples coupled with a sandwich immunohistochemical method to reveal anti-PCV2 antibody-secreting PCs. Plasma cell density was compared in the two groups of animals at 29 and 53 DPI. The IgA, IgG and IgM PC density did not differ between groups but displayed an increase from the upper (villus) to the lower part of the crypts while a decreasing trend in PC density was identified from duodenum to ileum. In the NV group, no increase in anti-PCV2 PC density was demonstrable in the two sampling moment: the amounts of lamina propria PCV2-specific antibody-producing PCs remained constant, 10.55 ± 4.24 and 10.06 ± 5.01 at 29 DPI and 53 DPI, respectively. In the V group a significant increase in PCV2-specific antibody-producing PCs was observed over time. The amounts of PCV2-specific antibody-producing PCs increased from 9.37 ± 13.36 at 29 DPI to 18.76 ± 15.83 at 53 DPI. The data on IgA, IgM and IgG PC counts can be considered reference values in a population of adult pigs. The sandwich method can be proposed as a technique able to identify specific antibody-secreting PCs in formalin-fixed paraffin-embedded tissues. A practical application of the sandwich method is the demonstration of a "booster-like" response of the lamina propria in vaccinated compared to unvaccinated animals. After virus challenge, vaccination induced an increase in the number of PCs containing specific anti-PCV2 antibodies at the level of intestinal mucosa.
Asunto(s)
Inmunidad Mucosa , Mucosa Intestinal/inmunología , Sus scrofa/inmunología , Animales , Anticuerpos Antivirales/biosíntesis , Infecciones por Circoviridae/inmunología , Infecciones por Circoviridae/veterinaria , Circovirus/inmunología , Inmunoglobulina A/biosíntesis , Inmunoglobulina G/biosíntesis , Inmunoglobulina M/biosíntesis , Inmunohistoquímica/métodos , Mucosa Intestinal/citología , Intestino Delgado/citología , Intestino Delgado/inmunología , Masculino , Células Plasmáticas/inmunología , Porcinos , Enfermedades de los Porcinos/inmunología , Vacunas Virales/administración & dosificaciónRESUMEN
Background: Gastric cancer is one of the leading causes of cancer-related deaths in Chile and worldwide. No consensus exists for therapeutic management. Aim: To assess clinical features and practice patterns of patients with newly diagnosed gastric cancer in Chile. Method: Chilean patients > 18 years old with newly diagnosed primary gastric adenocarcinoma enrolled by thirteen centers from different regions of Chile. Target sample size calculated according to gastric cancer prevalence in Chile. Data collected from two visits within a 10-month timeframe: baseline (patients and tumor features, treatment plan) and end of study (completion of initial treatment). Herein, baseline visit data is presented. Results: Between 2005 and 2008, 523 patients enrolled. Median age 61.3 years. Diagnosis by endoscopy in 98.5 percent patients. Location: body 35.8 percent, proximal 35.4 percent, and antral 23.9 percent. Most frequently used histopathological classification was WHO classification, with tubular adenocarcinoma being most frequent finding (53.1 percent). AJCC/UICC clinical staging (available in 31.1 percent of patients) was: 0 and I - 23.3 percent, II - 18.3 percent, III- 20.8 percent, IV - 37.6 percent. Therapeutic choice based mainly on clinical staging (49.9 percent) and included surgery in 440 patients (84.1 percent). Therapy planned by surgeon (54.9 percent) or multidisciplinary team (42.3 percent). Conclusions: REGATE is the largest prospective multicenter registry study performed in Chile. Basal visit data report that diagnosis is established frequently at advanced stages. Surgery is the most frequent therapeutic choice, (neo-) adjuvant therapies are only planned in one out of four patients. End of study visit data will provide the full scope of diagnosis and treatment of these patients.
Introducción: El cáncer gástrico es una de las principales causas de muerte por cáncer en Chile. No existe consenso acerca del tratamiento. Objetivos: Conocer características clínicas y patrón de tratamiento de pacientes con cáncer gástrico recién diagnosticado. Material y Método: Pacientes chilenos mayores de 18 años con diagnóstico reciente de adenocarcinoma gástrico primario, enrolados en 13 centros de diferentes regiones de Chile. Datos obtenidos en dos visitas dentro de período de 10 meses: basal (características del tumor y paciente, plan de tratamiento) y fin de estudio (tratamiento inicial completado). Se presentan datos de visita basal. Resultados: Entre 2005 y 2008, 523 pacientes enrolados. Mediana edad 61,3 años. Diagnóstico por endoscopia en 98,5 por ciento pacientes. Localización: corporal 35,8 por ciento, proximal 35,4 por ciento y antral 23,9 por ciento. Clasificación histopatológica más usada fue clasificación OMS, y tipo histopatológico más frecuente fue tubular 53,1 por ciento. Etapificación clínica AJCC/UICC (disponible en 37,6 por ciento de pacientes) distribuida en: 0 y I - 23,3 por ciento, II -18,3 por ciento, III - 20,8 por ciento, IV - 37,6 por ciento. Principal característica clínica para elección de terapia planeada fue etapificación clínica (49,9 por ciento). Plan de tratamiento consideró cirugía en 440 pacientes (84,1 por ciento). En mayoría de casos, plan terapéutico decidido por cirujano (54,9 por ciento) o equipo multidisciplinario (42,3 por ciento). Conclusiones: REGATE es el estudio de registro prospectivo multicéntrico más grande desarrollado en Chile. Datos visita basal informan que diagnóstico se establece frecuentemente en etapas avanzadas. Cirugía es alternativa terapéutica más frecuentemente indicada; terapias (neo-) adyuvantes sólo son ofrecidas a uno de cuatro pacientes. Datos visita fin de estudio proveerá visión completa del diagnóstico y tratamiento de estos pacientes.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano de 80 o más Años , Registros de Enfermedades , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Distribución por Edad , Chile/epidemiología , Cooperación Internacional , Infecciones por Helicobacter/epidemiología , Estudios Multicéntricos como Asunto , Estadificación de Neoplasias , Neoplasias Gástricas/clasificación , Neoplasias Gástricas/diagnóstico , Estudios Observacionales como Asunto , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
In cervical multi-level degenerative pathology, considering the morbidity of the extensive fusion techniques, some authors advocate for the multilevel disc replacement. This study compared the safety and efficacy of disc replacement with an unconstrained prosthesis in multi- versus single-level patients. A total of 231 patients with cervical degenerative disc disease (DDD) who were treated with cervical disc replacement and completed their 24 months follow-up were analyzed prospectively: 175 were treated at one level, 56 at 2 levels or more. Comparison between both groups was based on usual clinical and radiological outcomes [Neck Disability Index (NDI), Visual Analog Scale (VAS), Range of Motion, satisfaction]. Safety assessments, including complication and subsequent surgeries, were also documented and compared. Mean NDI and VAS scores for neck and arm pain were improved in both groups similarly. Improvement of mobility at treated segments was also similar. Nevertheless, in the multi-level group, analgesic use was significantly higher and occurrence of Heterotopic Ossification significantly lower than in the single-level group. Subject satisfaction was nearly equal, as 94.2% of single-level group patients would undergo the surgery again versus 94.5% in the multi-level group. The overall success rate did not differ significantly. Multi-level DDD is a challenging indication in the cervical spine. This study showed no major significant clinical difference between the two groups. We need further studies to know more about the impact of multi-level arthroplasty, especially on the adjacent segments, but these results demonstrate initial safety and effectiveness in this patient sample.
Asunto(s)
Vértebras Cervicales/cirugía , Degeneración del Disco Intervertebral/cirugía , Reeemplazo Total de Disco/métodos , Adulto , Vértebras Cervicales/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Degeneración del Disco Intervertebral/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Satisfacción del Paciente , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Fusión Vertebral/métodos , Resultado del TratamientoRESUMEN
The interest in cervical total disc replacement (TDR) as an alternative to the so-far gold standard in the surgical treatment of degenerative disc disease (DDD), e.g anterior cervical discectomy and fusion (ACDF), is growing very rapidly. Many authors have established the fact that ACDF may result in progressive degeneration in adjacent segments. On the contrary, but still theoretically, preservation of motion with TDR at the surgically treated level may potentially reduce the occurrence of adjacent-level degeneration (ALD). The authors report the intermediate results of an undergoing multicentre prospective study of TDR with Mobi-C prosthesis. The aim of the study was to assess the safety and efficacy of the device in the treatment of DDD and secondary to evaluate the radiological status of adjacent levels and the occurrence of ossifications, at 2-year follow-up (FU). 76 patients have performed their 2-year FU visit and have been analyzed clinically and radiologically. Clinical outcomes (NDI, VAS, SF-36) and ROM measurements were analyzed pre-operatively and at the different post-operative time-points. Complications and re-operations were also assessed. Occurrences of heterotopic ossifications (HOs) and of adjacent disc degeneration radiographic changes have been analyzed from 2-year FU X-rays. The mean NDI and VAS scores for arm and neck are reduced significantly at each post-operative time-point compared to pre-operative condition. Motion is preserved over the time at index levels (mean ROM = 9 degrees at 2 years) and 85.5% of the segments are mobile at 2 years. HOs are responsible for the fusion of 6/76 levels at 2 years. However, presence of HO does not alter the clinical outcomes. The occurrence rate of radiological signs of ALD is very low at 2 years (9.1%). There has been no subsidence, no expulsion and no sub-luxation of the implant. Finally, after 2 years, 91% of the patients assume that they would undergo the procedure again. These intermediate results of TDR with Mobi-C are very encouraging and seem to confirm the efficacy and the safety of the device. Regarding the preservation of the status of the adjacent levels, the results of this unconstrained device are encouraging, but longer FU studies are needed to prove it.