RESUMO
Background Breast cancer is the most common malignant tumor in women in the world. In 2005, it was incorporated to the Explicit Guaranties Health System (GES) in Chile. Aim To describe the demographic and clinical characteristics of breast cancer patients and to determine the effect of incorporating these women to GES. Material and Methods Medical records of 5,119 women with breast cancer aged 59 ± 14 years, attended at six public hospitals between 2000 and 2010 were reviewed. Median follow up was 87 months (range 1-182). Mortality was assessed using death certificates obtained at the National Identification Registry. Results Sixty six percent of women were in stage I-II, 29% in stage III and 5% in stage IV. Surgery was performed in 4023/5119 cases (79%), adyuvant radiotherapy in 3627/4517 cases (80%), chemotherapy in 3,204/3,424 cases (94%) and hormone therapy in 1,695/2,375 cases (71%). Between 2000 and 2010, there was a significant increase in the proportion of cases in stage I, from 8% to 25%, (p < 0.01). Overall survival (OS) increased 1% per year, since the beginning of GES system (p = 0.024). Five year OS was 75.1%. The figures for Stage I, II, III and IV were 93, 84, 62 and 27% respectively (p < 0.01). Patients without lymph node involvement and who were not triple negative, had a significantly better OS. Conclusions There was a significant increase in stage I cases, and a 1% per year OS improvement after GES system started, compared with the previous period.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Garantia da Qualidade dos Cuidados de Saúde/estatística & dados numéricos , Neoplasias da Mama/mortalidade , Neoplasias da Mama/terapia , Carcinoma/mortalidade , Carcinoma/terapia , Programas Nacionais de Saúde/estatística & dados numéricos , Fatores de Tempo , Neoplasias da Mama/diagnóstico , Carcinoma/diagnóstico , Chile/epidemiologia , Prontuários Médicos , Resultado do Tratamento , Distribuição por Idade , Estimativa de Kaplan-Meier , Estadiamento de NeoplasiasRESUMO
BACKGROUND: Hodgkin lymphoma is a highly curable disease. AIM: To evaluate the clinical characteristics and the treatment results of Hodgkin lymphoma patients of the National Cancer Program in Chile. PATIENTS AND METHODS: Prospective assessment of 682 patients treated in 18 adult cancer centers. Progression free survival (PFS) and overall survival (OS) were calculated. Median follow up was 127, 95, 87, 72 and 50 months for C-MOPP, radiotherapy (RT), C-MOPP/ABV, NOVP and ABVD, respectively. RESULTS: Median age was 37 years (15-84). Nodular sclerosis and mixed cellularity were equally expressed. Advanced stages (III & IV) were present at diagnosis in 61% of cases. Age over 40 was an adverse prognostic factor (p<0.001). The rate of PFS at 5 and 10 years for early stages was 73% and 66% with RT, 80% and 74% with C-MOPP+RT, 73% and 71% with C-MOPP/ABV, 59% and 59% with NOVP+RT, and 81% with ABVD+RT, at 5 years, being significantly lower for NOVP (p=0.02). The rate of OS at 5 and 10 years for advanced stages was 82% and 70% with RT, 82% and 76% with C-MOPP+RT, 82% and 80% with C-MOPP/ABV, 68% and 60% with NOVP, and 85% with ABVD at 5 years, also significantly lower for NOVP (p=0.04). For advanced stages, the rate of PFS at 5 and 10 years was 49% and 43% with C-MOPP, 69% and 62% with C-MOPP/ABVD or C-MOPP/ABV, and 71% at 5 years with ABVD, significantly lower for C-MOPP (p=0.01). The rate of OS at 5 and 10 years was 52% and 46% with C-MOPP, 70% and 63% with C-MOPP/ABVD or C-MOPP/ABV and 76% with ABVD at 5 years, significantly lower for C-MOPP (p=0.0002). CONCLUSIONS: Age over 40 years was an adverse prognostic factor. C-MOPP/ABVD, C-MOPP/ABV and ABVD had comparable results and reached a high tumor control and overall survival in both early and advanced stages.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doença de Hodgkin/tratamento farmacológico , Programas Nacionais de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Distribuição de Qui-Quadrado , Chile , Ciclofosfamida/administração & dosagem , Dacarbazina/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Seguimentos , Doença de Hodgkin/radioterapia , Humanos , Masculino , Pessoa de Meia-Idade , Mitoxantrona/administração & dosagem , Prednisolona/administração & dosagem , Prednisona/administração & dosagem , Procarbazina/administração & dosagem , Estudos Prospectivos , Resultado do Tratamento , Vimblastina/administração & dosagem , Vincristina/administração & dosagemRESUMO
Severe aplastic anemia has an elevated mortality if treatment is unsatisfactory. Immunosuppression is the treatment of choice in adults, comparable with allogeneic bone marrow transplant in children. We report two adult patients (both males, aged 59 and 67 years old) who were treated successfully with lymphoglobulin and cyclosporine. The initial response started within 3 months of treatment and was almost complete after 2 years, when cyclosporine was stopped. After three years, both patients have almost normal blood counts, with minor sequels: avascular necrosis of both femoral heads due to the use steroids, that recovered spontaneously in 1 patient and reduced vision due to thrombocytopenic retinal hemorrhages, in the other.
Assuntos
Anemia Aplástica/tratamento farmacológico , Soro Antilinfocitário/uso terapêutico , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Idoso , Anemia Aplástica/etiologia , Terapia Combinada , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Se comunica un programa de instrucción comunitaria en reanimación cardiopulmonar básica, iniciado en marzo de 1996, enmarcado en una propuesta de extensión asistencial que lleva tres años. Se destina a alumnos de quinto y sexto año de enseñanza primaria. El grupo de trabajo cree haber encontrado una metodología que permite la instrucción de estas maniobras desde edades comprendidas entre 10 y 15 años de edad. Se llevan entrenados y evaluados 622 niños de las escuelas del este del departamento de Canelones, así como 130 de sus maestros. El total de personas entrenadas desde 1994 es de 1.520. Los datos de que disponen los autores, fijan en 1 cada 266 personas capaces de realizar reanimación cardiopulmonar básica en la cuidad de Buenos Aires (Capital Federal) en mayo de 1997; en la región a la que refiere el programa, la relación promedio es actualmente de 1 cada 56, con áreas en las que ha llegado en mayo de 1997 a 1 cada 23. No se ha tenido en cuenta la población médica y de enfermería hasta no reciclarla en talleres específicos