RESUMO
BACKGROUND: Cerebral cavernous malformations (CCM) are clusters of dilated sinusoidal channels lined by a single layer of endothelium. In contradistinction to arteriovenous malformations, these lesions do not have smooth muscle or elastin in their lining and they are angiographically occult, and the MRI is the most sensitive test for CCM detection. CCM are one of the most prevalent vascular malformations of the central nervous system, affecting about 0.4-0.6% of the general population. The main complication of this malformation is the risk of bleeding, which may cause neurological deficits that affect the quality of life (QoL) in patients. When symtomatic, they may be surgically treated for relieving the mass effect and seizures refractory to drug uses, hemorrhage and drug-refractory epilepsy. Patient-reported outcome (PRO) may be a strategy that can be used to evaluate QoL of CCM population and was used in a sample of non-operated patients. METHODS: An observational, cross-sectional analysis to evaluate the PRO using the SF-36 and EuroQol 5 dimensions (EQ-5D) questionnaires of QoL added to functional metrics using the Karnofsky Performance Status (KPS) in 49 patients not submitted to intervention and with long-term follow-up. RESULTS: During the 364 person-years of follow-up, there was an average of individual follow-up of 7.42 years. The mean age was 46.8 years (18-84) - 57% of them were female, 71% had superficial lesions, and 65% had the familial form. Comparisons of SF-36 dimensions with KPS graded <100 had a worse score only in terms of the pain (p = 0.04), vitality (p = 0.001), and general state of health (p = 0.03) domains. The domain mental health was worse in patients without surgical indication (p = 0.032). The functional capacity domain had the highest overall grading in the group. The EQ-5D dimensions of mobility (p = 0.03) and pain/discomfort (p = 0.001) were the ones with lower score compared to KPS <100. CONCLUSION: The study is the first to evaluate, with validated tools, the PRO of non-operated CCM patients and has demonstrated in a selected group of patients that it was possible to achieve long-term clinical stability, thereby maintaining QoL and functional neurological outcome.
Assuntos
Tratamento Conservador , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico , Hemangioma Cavernoso do Sistema Nervoso Central/terapia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento Conservador/efeitos adversos , Estudos Transversais , Feminino , Nível de Saúde , Hemangioma Cavernoso do Sistema Nervoso Central/fisiopatologia , Hemangioma Cavernoso do Sistema Nervoso Central/psicologia , Humanos , Avaliação de Estado de Karnofsky , Imageamento por Ressonância Magnética , Masculino , Saúde Mental , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Paciente de 94 anos e pesando 45kg apresentava carcinoma epidermóide em globo ocular direito há 20 anos (T4 N0 M0), com perda da visão ipsilateral. Houve severa infestação por larvas de miíase que comprometiam todo o bulbo ocular. Foi indicado exenteração do globo ocular. A evolução pós-operatória deu-se sem complicações.
We report a 94-year-old, 45 kg man , diagnosed. With squamous cell carcinoma (T4 N0 M0) of the right eye, 20 years ago, and with ipsilateral vision loss. There was severe myiasis of the whole eyeball. Ocular exenteration was uneventfully performed.
Assuntos
Humanos , Miíase , Carcinoma de Células Escamosas , Exenteração Orbitária , NeoplasiasRESUMO
Este trabalho tem como objetivo esclarecer as características do prontuário médico, enfatizando sua importância, determinando as vantagens, as barreiras e as etapas necessárias para sua construção e implantação. Abordam-se a falta de registro em prontuário e, sobretudo, os problemas decorrentes dessa ausência. A inexistência de um sistema de informações impossibilita várias atividades, tais como: avaliação do trabalho profissional realizado, determinação dos principais indicadores de saúde de uma população, a defesa do médico e a discussão clínica. Assim, reconhece-se a importância do preenchimento correto do prontuário, sobretudo, no suporte ao cuidado à saúde, através do aperfeiçoamento qualitativo da informação. Conclui-se, pois, que essa ferramenta certamente melhora a qualidade do trabalho médico, protegendo-o contra denúncias de má prática.
The goal of the present paper is to clarify the features of medical records, underscoring their importance in the establishment of a good relationship between physicians and patients, as well as to determine the advantages, difficulties and steps concerning their elaboration. The lack of record files and the problems that this fact may entail are pointed out. Appropriate files are particularly useful in planning and implementing a system of information through which one could take a variety of advantages, such as: assessment of the professional work done, possibility of having the populations main health indicators, physician's defense and clinical discussions. The importance of the correct fuifilment of the patient record is recognized, especially for the qualitative improvement of information in the health care system. It also allows for a broader access to data when necessary, including the integration of various information centers in the country. Therefore, one concludes that this tool certainly improves the quality of medical assistance, protecting health workers from troublesome sueing.