RESUMO
BACKGROUND: Local cancer therapy by combining real-time surgical exploration and resection with delivery of a single dose of high-energy electron irradiation entails a very precise and effective local therapeutic approach. Integrating the benefits from minimally invasive surgical techniques with the very precise delivery of intraoperative electron irradiation results in an efficient combined modality therapy. METHODS: Patients with locally advanced disease, who are candidates for laparoscopic and/or thoracoscopic surgery, received an integrated multimodal management. Preoperative treatment included induction chemotherapy and/or chemoradiation, followed by laparoscopic surgery and intraoperative electron radiation therapy. RESULTS: In a period of 5 consecutive years, 125 rectal cancer patients were treated, of which 35% underwent a laparoscopic approach. We found no differences in cancer outcomes and tolerance between the open and laparoscopic groups. Two esophageal cancer patients were treated with IOeRT during thoracoscopic resection, with the resection specimens showing intense downstaging effects. Two oligo-recurrent prostatic cancer patients (isolated nodal progression) had a robotic-assisted surgical resection and post-lymphadenectomy electron boost on the vascular and lateral pelvic wall. CONCLUSIONS: Minimally invasive and robotic-assisted surgery is feasible to combine with intraoperative electron radiation therapy and offers a new model explored with electron-FLASH beams.
Assuntos
Laparoscopia , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Humanos , Elétrons , Estudos de Viabilidade , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/terapiaRESUMO
Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.
Assuntos
Síndrome de Klinefelter/patologia , Timoma/patologia , Neoplasias do Timo/patologia , Adulto , Humanos , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Masculino , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologia , Radiografia Torácica , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Klinefelter syndrome (47, XXY in most cases) is a frequently underdiagnosed chromosomal anomaly associated with multiple comorbidities in adult life. Patients with Klinefelter syndrome have a higher risk of cancer. Specifically, these patients have a higher risk for mediastinal germ cell tumors. It is estimated that 8% of male patients with mediastinal tumors have Klinefelter. We report a 42-years-old male who suffered recurrent respiratory infections. During the study, a mediastinal mass was found, whose pathological study disclosed a type B thymoma. The patient had a history of infertility, high stature, gynecomastia, obesity with gynecoid distribution of body fat and testicular atrophy. A karyotype was requested (47, XXY), confirming the diagnosis of Klinefelter syndrome.
Assuntos
Humanos , Masculino , Adulto , Timoma/patologia , Neoplasias do Timo/patologia , Síndrome de Klinefelter/patologia , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/genética , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/patologiaRESUMO
Profundulus balsanus was described by Ahl in 1935 and later placed in synonymy with P. punctatus. Recent molecular studies have demonstrated that specimens identified as P. balsanus belong to a distinct taxon. Herein we used a combination of morphometric, meristic, coloration and osteological data in order to demonstrate the distinctiveness of P. balsanus. Additionally, we used molecular data to reconstruct a phylogeny to place P. balsanus in a systematic context. Profundulus balsanus belongs to the punctatus clade within the genus Profundulus. It can be distinguished from P. oaxacae based on scale count in the lateral line and from P. punctatus based on differences in coloration in the anal fin. We provide a taxonomic key to all Mexican species of Profundulus.
Assuntos
Ciprinodontiformes/classificação , Animais , Classificação , Ciprinodontiformes/anatomia & histologia , Ciprinodontiformes/genética , Feminino , Geografia , Masculino , México , Filogenia , Análise de Sequência de DNARESUMO
RESUMEN Objetivo: conocer los rasgos de profesionalización de enfermeras/os que ejercían en hospitales de Sevilla (España), en el siglo XVII. Método: investigación cualitativa de tipo histórico, abordada desde la microhistoria, mediante el análisis de contenido de los estatutos que regían en el siglo XVII en los hospitales sevillanos de las Cinco Llagas, del Espíritu Santo, de la Santa Caridad y de los Venerables Sacerdotes. También se aportaron dos pinturas de esa época. Resultados y discusión: en las enfermeras que ejercieron en hospitales sevillanos en el siglo XVII se identificaron seis rasgos de profesionalización, pues se constató que la actividad enfermera era regulada por las autoridades hospitalarias; algunos hospitales exigían a los enfermeros requisitos académicos y formativos para ejercer; se impartía formación a enfermeras; la actividad cuidadora tenía un alto reconocimiento social; había enfermeros que además de cuidar asumían tareas de gestión del contexto hospitalario y supervisaban oficios paramédicos, y también había enfermeras remuneradas a cambio de su trabajo. El único rasgo de profesionalización no constatado fue la regulación de los contenidos curriculares formativos de los enfermeros. La ausencia de este importante rasgo impedía culminar definitivamente el proceso de profesionalización de las enfermeras.
ABSTRACT Objective: Become acquainted with the characteristics of professionalization among nurses working at hospitals in Seville (Spain) during the 17th century. Method: This is a qualitative study of a historical nature approached through microhistory, with content analysis of seventeenth century statutes governing the Sevillian hospitals of Cinco Llagas, Espiritu Santo, Santa Caridad and Venerables Sacerdotes. Two paintings from that era are included as well. Results and Discussion: Nursing activity was found to be regulated by hospital authorities, and six features of professionalization were identified among the nurses who worked at Sevillian hospitals in the 17th century. Some hospitals had academic and training requirements for nurses in order to practice. Nurses were given training, and being a caregiver was held in high regard by society. There were nurses who, in addition to providing care, assumed hospital management duties and supervised paramedical tasks. Some nurses were paid in exchange for their work. The only feature of professionalization that was not verified was the regulation of curricular content in education, a shortcoming that prevented the process of nursing professionalization from culminating definitively.
RESUMO Objetivo: conhecer as características de profissionalização de enfermeiras/os que trabalhavam em hospitais de Sevilla (Espanha), no século XVII. Método: pesquisa qualitativa de tipo histórico, abordada a partir da micro-história, mediante a análise de conteúdo dos estatutos do século XVII nos hospitais sevilhanos das Cinco Llagas, do Espíritu Santo, da Santa Caridad e dos Venerables Sacerdotes. Também foram fornecidas duas pinturas dessa época. Resultados e discussão: identificaram-se seis características de profissionalização nas enfermeiras que trabalharam em hospitais sevilhanos no século XVII, pois se constatou que a atividade de enfermagem era regulada pelas autoridades hospitalares; alguns hospitais exigiam dos enfermeiros requisitos acadêmicos e formativos para exercer a atividade; dava-se formação a enfermeiras; a atividade cuidadora tinha um alto reconhecimento social; havia enfermeiros que, além de cuidar, assumiam tarefas de gerenciamento do contexto hospitalar e supervisionavam trabalhos paramédicos; também havia enfermeiras remuneradas em troca de seu trabalho. A única característica de profissionalização que não consta foi a regulação dos conteúdos curriculares formativos; a ausência destes impedia culminar definitivamente o processo de profissionalização das enfermeiras.
Assuntos
Humanos , História do Século XVII , Papel Profissional , História do Século XVII , História da Enfermagem , Recursos Humanos de Enfermagem Hospitalar , EnfermagemRESUMO
In the media, gender stereotypes and biases appear that transmit a sexist representation of women. The aim of this study was to know the sexist stereotypes and biases that are projected on female nurses in advertising campaigns and to identify the characteristics of the female nurse model shown in advertising. A qualitative study was performed on four campaigns featuring female nurses in white dresses and caps, using descriptive and inferential content analysis. Conclusions show that female nurses appearing in advertising transmit both sexist stereotypes (female profession, gentleness, lack of control, strong affectivity, frivolousness, passivity, submissiveness, commitment to basic care, merely sexual and aesthetic value) and sexist biases (androcentrism and double standards). In particular, advertising propagates the model of the seductive nurse, depicted as a young, attractive, sensual and defiant woman that is used merely as a decorative presence.
Os meios de comunicação apresentam estereótipos e sinais "machistas" que transmitem uma representação sexual da mulher. O objetivo deste estudo foi conhecer os estereótipos e sinais sexistas projetados sobre as mulheres enfermeiras em ações publicitárias e identificar as características da mulher enfermeira descrita pela publicidade. Realizou-se um estudo qualitativo, mediante análise de conteúdo, de caráter descritivo e inferencial, a partir da análise de quatro peças publicitárias em que apareciam mulheres enfermeiras com vestido e quepe branco. Conclui-se que quando a mulher enfermeira aparece na publicidade são transmitidos estereótipos sexuais sobre ela - profissão feminina, ternura, falta de controle, afetividade marcada, frivolidade, passividade, submissão, dedicação a cuidados básicos, simples valor estético e sexual; e sinais - o androcentrismo e a norma dupla. Na publicidade transmite-se, sobretudo, a imagem da enfermeira sedutora caracterizada pela imagem de uma mulher jovem, atrativa, sensual e desafiante, com presença simplesmente decorativa.
En los medios de comunicación aparecen estereotipos y sesgos de género que transmiten una representación sexista de la mujer. El objetivo del estudio fue conocer los estereotipos y sesgos sexistas que se proyectan sobre las mujeres enfermeras en acciones publicitarias, e identificar las características del modelo de mujer enfermera que transmite la publicidad. Se realizó un estudio cualitativo mediante análisis de contenido descriptivo e inferencial, de cuatro acciones publicitarias donde aparecían mujeres enfermeras con vestido y cofia blanca. Se concluye que cuando la mujer enfermera aparece en la publicidad se transmiten estereotipos sexistas sobre ella -profesión femenina, ternura, falta de control, afectividad marcada, frivolidad, pasividad, sumisión, dedicación a cuidados elementales, simple valor estético y sexual, y sesgos sexistas - el androcentrismo y la doble moral. En la publicidad se transmite, sobre todo, el modelo de enfermera seductora, caracterizado como mujer joven, atractiva, sensual y desafiante, con presencia simplemente decorativa.
Assuntos
Humanos , Feminino , Preconceito , Estereotipagem , Publicidade , Papel do Profissional de EnfermagemRESUMO
INTRODUCTION: Standard fractionation radiation therapy (RT) combined with concomitant chemotherapy (CT) based on cisplatin schemes is actually the standard treatment for locally advanced non-resectable squamous cell carcinoma of head and neck (SCCHN). The appearance of taxoids has introduced a new kind of treatment with high antitumoral power. The aim of this study is to add more information about the role of this new approach. MATERIALS AND METHODS: Twenty-six patients with locally advanced non-resectable SCCHN were recruited at six institutions in Spain, between January 2001 and January 2003. Docetaxel was administered weekly, for 6 weeks, concurrently with RT. RESULTS: The mean total delivered dose of RT was 70'2 Gy (range 64-74 Gy). The median and mean duration of time were 63 days and 61 days (range 49-103 days) respectively. After a median time control of 19 months (range 3.3-42.2 months), the response rate was 83.4%. The median time to local progression was 16.4 months (95% confidence interval [CI]=4.4-28.4 months). The median survival time was 26.9 months, with one- and two-year overall survival of 66.9% (95% CI=48.1-85.7%) and 57.5% (95% CI=37.3-77.7%) respectively. The median duration time response was 15.1 months (95% CI=3.7-26.5 months). The median time until treatment failure was 9.4 months (95% CI=4.7-14.1). Incidence of grade III-IV mucositis was 88%, neutropenia 72% and skin toxicity 92% (24% grade III-IV). The incidence of severe late toxicity (grade III and IV) due to RT/CT was 31.4%. CONCLUSIONS: Although therapeutics results are equivalent to cisplatin schemes of concurrent CT-RT, mucositis and cutaneous toxicity registered in this trial must be considered as limiting factors to application of this new approach.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Neoplasias de Cabeça e Pescoço/radioterapia , Taxoides/uso terapêutico , Adulto , Idoso , Antineoplásicos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Terapia Combinada , Intervalos de Confiança , Docetaxel , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Estimativa de Kaplan-Meier , Avaliação de Estado de Karnofsky , Neoplasias Laríngeas/tratamento farmacológico , Neoplasias Laríngeas/mortalidade , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/radioterapia , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/radioterapia , Neoplasias Faríngeas/tratamento farmacológico , Neoplasias Faríngeas/mortalidade , Neoplasias Faríngeas/patologia , Neoplasias Faríngeas/radioterapia , Faringe/patologia , Radioterapia/efeitos adversos , Dosagem Radioterapêutica , Taxoides/administração & dosagem , Taxoides/efeitos adversos , Fatores de Tempo , Resultado do TratamentoRESUMO
The concurrent use of erythropoietin beta (EPO)and radiotherapy in head and neck cancer patients has been reported by Henke et al (Lancet 2003;362:1255-60) to correct anemia and impair cancer control. Due to the potential impact in daily clinical practice of this information a systematic critical review of the mentioned article was performed. Authors selected 10 arguments to question the contents regarding methodological and statistical aspects of the trial, and added 14 comments of controversy in more basic scientific concepts mentioned in the text as published. The panel including epidemiologist and radiation oncologists with expertise in clinical research concluded with 5 additional remarks recommending caution in interpretation of these results in terms of changes in daily practice of anemic patients support, and advising not to use EPO at experimental doses or after reaching physiological concentrations of hemoglobin.
Assuntos
Anemia/tratamento farmacológico , Eritropoetina/efeitos adversos , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/radioterapia , Eritropoetina/uso terapêutico , HumanosRESUMO
Prescribed total radiation dose should be administered within in a specific time-frame and delays in commencing treatment and/or unplanned interruptions in radiation delivery are unacceptable because, in certain cancer sites, treatment-time prolongation can have a deleterious effect on local tumour control, and on patient outcomes. The present review evaluated the causes of initial treatment delays as well as interruptions in the scheduled radiotherapy. The literature search highlighted a significant concern in avoiding treatment-time prolongation in head and neck, cervix, breast and lung cancer. Among the causes involved in delay in radiotherapy commencement factors such as waiting lists, lack of material and human resources, and an increase complexity in planning, simulation and verification are highlighted. Most authors recommend radiotherapy commencement as soon as possible in radical (exclusive irradiation with active tumour present) and palliative situations with a maximum delay of no more than 6 to 8 weeks in the case of adjuvant radiotherapy (post-resection) programs. Interruptions during the course of treatment include: planned unit maintenance and servicing, acute patient toxicity or unexpected malfunction of linear accelerators; this last feature has the most deleterious effect on patients as well as radiotherapy practitioners. Interruptions that impact on the programmed time-course for radiotherapy needs to be compensated-for so as assure the biological equivalence in treatment efficacy with respect to cancer site and stage.
Assuntos
Radioterapia/métodos , Radioterapia/normas , Humanos , Fatores de TempoRESUMO
Se trata de un paciente de 11 años quien presenta cuadro clínico de un año de evolución caracterizado por: insomnio con despertar durante la noche, expectación ansiosa, ideas fóbicas con relación a la posibilidad de sufrir algún daño él o sus familiares, disminución del rendimiento académico, temor a quedarse solo en casa y necesidad de estar cerca a alguno de sus familiares, irritabilidad, restricción en las actividades recreativas y sociales. Esta sintomatología se inició dos meses después de que el paciente y su familia sufrieran un atraco en su casa.
Assuntos
Humanos , Criança , Transtornos de Adaptação/classificação , Transtornos de Adaptação/diagnóstico , Transtornos de Adaptação/enfermagem , Transtornos de Adaptação/psicologia , Transtornos de AnsiedadeRESUMO
Se describen las características clínicas, sociodemográficas y familiares, al igual que el tratamiento y su respuesta al mismo, en siete pacientes con dolor abdominal recurrente quienes fueron remitidos al servicio de Psiquiatría de la Consulta Externa del Hospital Pediátrico de la Misericordia, en Santafé de Bogotá, durante el período comprendido entre mayo de 1989 y septiembre de 1991. Se trataron con psicoterapia. Cinco de estos pacientes mejoraron con el tratamiento y se mantenían sin dolor abdominal recurrente dos años después de terminado el mismo. El grupo tiene características similares a las informadas en la literatura. El paciente prototipo es una adolescente inteligente, de buen rendimiento escolar, preocupada por obtener una buena imagen de las personas significativas que la rodean, quien tiende a expresar sus emociones desagradables a través de síntomas somáticos. Un 45 por ciento de las madres tenía depresión, ansiedad o incapacidad de expresar verbalmente sus afectos.