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PURPOSE: This study leverages CDC National Health Interview Survey data to examine Financial Distress (FD) among genitourinary (GU) cancer survivors, specifically prostate cancer (PC), kidney cancer (KC), and bladder cancer (BC). It investigates the economic impacts faced by these patients, especially in relation to disparities in insurance coverage and its effects on material, psychological, and behavioral aspects of FD. METHODS: We retrospectively analyzed responses from GU cancer survivors, stratifying by cancer status and age (18-64 years, ≥65 years). Medical financial hardship was divided into three domains: material, psychological, and behavioral. Associations between cancer history, hardship, and clinical factors were assessed using generalized ordinal logistic regressions. RESULTS: Significant health care access disparities were found, particularly for mental health services, with 25% of younger BC survivors and 4.7% of younger KC survivors reporting affordability issues, in contrast to 2.7% of noncancer individuals. Dental care was also problematic, with higher avoidance rates among younger BC (27%) and KC (15%) survivors compared with the general population. Surprisingly, noncancer individuals reported more difficulty in affording prescriptions than BC survivors across both age groups. PC survivors, however, showed lower FD across all domains versus noncancer controls, indicating fewer concerns about medical bills and a lesser tendency to forgo care. CONCLUSION: The study underscores significant gaps in the financial support system for GU cancer survivors, with urgent needs in mental and dental health care access. Policy interventions, including comprehensive insurance reforms, are imperative to alleviate the financial burdens on these individuals.
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PURPOSE: There is significant interest in identifying complete responders to neoadjuvant chemotherapy (NAC) before radical cystectomy (RC) to potentially avoid removal of a pathologically benign bladder. However, clinical restaging after NAC is highly inaccurate. The objective of this study was to develop a next-generation sequencing-based molecular assay using urine to enhance clinical staging of patients with bladder cancer. METHODS: Urine samples from 20 and 44 patients with bladder cancer undergoing RC were prospectively collected for retrospective analysis for molecular correlate analysis from two clinical trials, respectively. The first cohort was used to benchmark the assay, and the second was used to determine the performance characteristics of the test as it correlates to responder status as measured by pathologic examination. RESULTS: First, to benchmark the assay, known mutations identified in the tissue (MT) of patients from the Accelerated Methotrexate, Vinblastine, Doxorubicin, Cisplatin trial (ClinicalTrials.gov identifier: NCT01611662, n = 16) and a cohort from University of California-San Francisco (n = 4) were cross referenced against mutation profiles from urine (MU). We then determined the correlation between MU persistence and residual disease in pre-RC urine samples from a second prospective clinical trial (The pT0 trial; ClinicalTrials.gov identifier: NCT02968732). Residual MU status correlated strongly with residual disease status (pT0 trial; n = 44; P = .0092) when MU from urine supernatant and urine pellet were assessed separately and analyzed in tandem. The sensitivity, specificity, PPV, and NPV were 91%, 50%, 86%, and 63% respectively, with an overall accuracy of 82% for this second cohort. CONCLUSION: MU are representative of MT and thus can be used to enhance clinical staging of urothelial carcinoma. Urine biopsy may be used as a reliable tool that can be further developed to identify complete response to NAC in anticipation of safe RC avoidance.
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Biomarcadores Tumorais , Cistectomia , Estadiamento de Neoplasias , Neoplasias da Bexiga Urinária , Humanos , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/urina , Neoplasias da Bexiga Urinária/cirurgia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Neoplasias da Bexiga Urinária/genética , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Biomarcadores Tumorais/urina , Biópsia , Estudos Retrospectivos , Terapia NeoadjuvanteRESUMO
INTRODUCTION: Treatment naïve patients with high-risk non-muscle invasive bladder cancer (NMIBC) are treated with bacillus Calmette-Guérin (BCG) therapy as the standard of care. Recently, intravesical sequential gemcitabine-docetaxel in the BCG-naïve setting was shown to be well-tolerated and effective, raising the possibility of a new first line intravesical therapy. Cost effectiveness of this intervention remains unknown; therefore, we designed a cost effectiveness study evaluating BCG vs. sequential gemcitabine-docetaxel in patients with high risk NMIBC. METHODS: Using TreeAgePro 2019 software, we developed a Markov model to evaluate BCG vs. gemcitabine-docetaxel from the U.S. Medicare perspective with a 2-year time horizon. Model probabilities and utilities were derived from published literature. Direct costs were obtained from Medicare cost databases. Our primary outcomes were effectiveness (measured in quality adjusted life years [QALYs]), cost and the incremental cost-effectiveness ratio with a willingness to pay threshold of $100,000. RESULTS: Our results indicate that while both treatments resulted in similar QALYs of 1.76, the mean costs per patient at 2 years were $12,363 and $7,090 for BCG and gemcitabine-docetaxel, respectively. Therefore, the BCG strategy was dominated by the gemcitabine-docetaxel strategy as it was equally effective and less costly. One way sensitivity analyses were completed and gemcitabine-docetaxel remained a cost-effective strategy. CONCLUSIONS: The findings of this preliminary cost-effectiveness analysis are novel in that they highlight a well tolerated, efficacious drug that is less expensive than the traditional gold standard therapy. In modern medicine, we are more often challenged by agents with marginally increased efficacy but at significantly higher costs; gemcitabine-docetaxel represents a rare entity which is a success for both patients and healthcare systems alike.
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Neoplasias não Músculo Invasivas da Bexiga , Neoplasias da Bexiga Urinária , Idoso , Humanos , Estados Unidos , Gencitabina , Docetaxel/uso terapêutico , Vacina BCG/uso terapêutico , Análise de Custo-Efetividade , Medicare , Neoplasias da Bexiga Urinária/terapia , Administração Intravesical , Adjuvantes Imunológicos/uso terapêutico , Invasividade NeoplásicaRESUMO
INTRODUCTION: Prostate MRI detecting PI-RADsâ¯=â¯3 lesions has low diagnostic utility for prostate malignancy. Use of PSA density has been suggested to further risk-stratify these men, to potentially avoid biopsies in favor of monitoring. We evaluate the ability of PSA density (PSAd) to risk-stratify PIRADs 3 lesions across patients who underwent a prostate biopsy in a large multi-institutional collaborative. MATERIALS AND METHODS: Pennsylvania Urology Regional Collaborative (PURC) is a voluntary quality improvement collaborative of 11 academic and community urology practices in Pennsylvania and New Jersey. A retrospective analysis was performed on all patients in the PURC database that had a prostate MRI with PI-RADs 3 lesions only. PSA just before the MRI and prostate size reported on MRI were used to calculate the PSA. Clinicopathologic data were evaluated. Univariable analysis using Chi-Square and Kruskal Wallis tests and multivariable logistic regression were used to identify predictors of any PCa, and clinically significant prostate cancer (csPCa) was defined as ≥ Grade Group 2 (GG2.) RESULTS: Between May 2015 and March 2021, 349 patients with PIRADs 3 lesions only were identified and comprised the cohort of interest. Median PSA was 5.0 with a prostate volume of 58cc and a median PSA density of 0.11, 10.6% of the cohort was African American with 81.4% being Caucasian. Significant prostate cancer was detected in 70/349 (20.0%) men. Smaller prostate volume, abnormal DRE, and higher PSAd were significantly associated with clinically significant prostate cancer on univariable analysis. In men with PSAd <0.15, 31/228 (13.6%) harbored csPCa. Multivariable analysis confirmed that men with PSAd >0.15 were more likely to harbor clinically significant prostate cancer (P < 0.001). CONCLUSION: Across a large regional collaborative, patients with PIRADs 3 lesions on mpMRI were noted to have clinically significant cancer in 20% of biopsies. Using a PSA density cut-off of 0.15 may result in missing clinically significant prostate cancer in 13.6%. This information is useful for prebiopsy risk stratification and counseling.
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Antígeno Prostático Específico , Neoplasias da Próstata , Masculino , Humanos , Antígeno Prostático Específico/análise , Neoplasias da Próstata/patologia , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Próstata/patologia , Biópsia Guiada por ImagemRESUMO
The endoplasmic reticulum (ER)-to-Golgi intermediate compartment (ERGIC) is a membranous organelle that mediates protein transport between the ER and the Golgi apparatus. In neurons, clusters of these vesiculotubular structures are situated throughout the cell in proximity to the ER, passing cargo to the cis-Golgi cisternae, located mainly in the perinuclear region. Although ERGIC markers have been identified in neurons, the distribution and dynamics of neuronal ERGIC structures have not been characterized yet. Here, we show that long-distance ERGIC transport occurs via an intermittent mechanism in dendrites, with mobile elements moving between stationary structures. Slow and fast live-cell imaging have captured stable ERGIC structures remaining in place over long periods of time, as well as mobile ERGIC structures advancing very short distances along dendrites. These short distances have been consistent with the lengths between the stationary ERGIC structures. Kymography revealed ERGIC elements that moved intermittently, emerging from and fusing with stationary ERGIC structures. Interestingly, this movement apparently depends not only on the integrity of the microtubule cytoskeleton, as previously reported, but on the actin cytoskeleton as well. Our results indicate that the dendritic ERGIC has a dual nature, with both stationary and mobile structures. The neural ERGIC network transports proteins via a stop-and-go movement in which both the microtubule and the actin cytoskeletons participate.
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Retículo Endoplasmático , Complexo de Golgi , Citoesqueleto de Actina/metabolismo , Retículo Endoplasmático/metabolismo , Complexo de Golgi/metabolismo , Microtúbulos/metabolismo , Transporte Proteico/fisiologiaRESUMO
Pseudogonatodes furvus is an endemic gecko from the region of the Sierra Nevada de Santa Marta, an isolated massif located in the continental Caribbean region of Colombia. Pseudogonatodes furvus is the type species of the genus, and its morphology and natural history remain poorly known. This lizard was described based on two specimens. After its description, the species has only been mentioned in a handful of taxonomic studies of Pseudogonatodes, in which a few morphological characters of P. furvus have been mentioned. One other paper reported two new localities, without providing new information on the external morphology, especially the lepidosis of the newly obtained specimens. Here we review the external morphology of P. furvus, based on examination of the holotype and six additional specimens. We provide an extended diagnosis and definition, description of holotype, variation, comparisons with other Pseudogonatodes, geographic distribution (adding a fourth locality to the known distribution for the species), and conservation status. Additionally, we describe osteological features for the diagnosis of the genus.
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Lagartos , Animais , Tamanho Corporal , OsteologiaRESUMO
La enfermedad por coronavirus (COVID-19) se convirtió en una pandemia con implicaciones clínicas y emo-cionales, a veces invisibles para los gastroenterólogos. Aunque morir es parte de la vida, el riesgo para algunos médicos puede ser mayor. Específicamente, los gastroenterólogos nos vemos afectados por el temor a reiniciar nuestras consultas y procedimientos endoscópicos. En medio de un mar de información incluso con contradicciones entre diferentes expertos, seguir los lineamientos de las Asociaciones Colombianas del Aparato Digestivo podría ayudar a tranquilizar a los médicos y pacientes. Aunque las patologías seguirán apareciendo, el miedo de la población a contagiarse puede generar consecuencias como el retraso en el tratamiento de un cáncer de vías digestivas. El autocuidado físico mediante estrategias de protección y el cuidado emocional son clave para ayudar a nuestro sistema inmunológico. Adaptarnos a funcionar en medio de la pandemia por medio de la teleorientación en plataformas digitales es una forma creativa de disminuir la angustia colectiva.(AU)
COVID-19 is a pandemic with clinical and emotional implications, sometimes invisible to gastroenterologists. Although dying is part of life, the risk for some doctors may be greater. Specifically, gastroenterologists are affected by the fear of restarting medical check-ups and endoscopic procedures. Amid a sea of information even with contradictions between different experts following the guidelines of the Colombian Associations of the Digestive Tract could help reassure doctors and patients. Although the pathologies will continue to appear, the fear of the population to be infected can generate consequences such as delaying the treatment of digestive tract cancers. Physical self-care through protection strategies and the emotional care, are important to help our immune system. Adapting to function during the pandemic, using tele-orientation through digital platforms, is a creative way to reduce collective anxiety.(AU)
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Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Saúde Mental , Infecções por Coronavirus/psicologia , Gastroenterologistas/psicologia , TeleorientaçãoRESUMO
PURPOSE: To validate currently used recurrence prediction models for renal cell carcinoma (RCC) by using prospective data from the ASSURE (ECOG-ACRIN E2805; Adjuvant Sorafenib or Sunitinib for Unfavorable Renal Carcinoma) adjuvant trial. PATIENTS AND METHODS: Eight RCC recurrence models (University of California at Los Angeles Integrated Staging System [UISS]; Stage, Size, Grade, and Necrosis [SSIGN]; Leibovich; Kattan; Memorial Sloan Kettering Cancer Center [MSKCC]; Yaycioglu; Karakiewicz; and Cindolo) were selected on the basis of their use in clinical practice and clinical trial designs. These models along with the TNM staging system were validated using 1,647 patients with resected localized high-grade or locally advanced disease (≥ pT1b grade 3 and 4/pTanyN1Mo) from the ASSURE cohort. The predictive performance of the model was quantified by assessing its discriminatory and calibration abilities. RESULTS: Prospective validation of predictive and prognostic models for localized RCC showed a substantial decrease in each of the predictive abilities of the model compared with their original and externally validated discriminatory estimates. Among the models, the SSIGN score performed best (0.688; 95% CI, 0.686 to 0.689), and the UISS model performed worst (0.556; 95% CI, 0.555 to 0.557). Compared with the 2002 TNM staging system (C-index, 0.60), most models only marginally outperformed standard staging. Importantly, all models, including TNM, demonstrated statistically significant variability in their predictive ability over time and were most useful within the first 2 years after diagnosis. CONCLUSION: In RCC, as in many other solid malignancies, clinicians rely on retrospective prediction tools to guide patient care and clinical trial selection and largely overestimate their predictive abilities. We used prospective collected adjuvant trial data to validate existing RCC prediction models and demonstrate a sharp decrease in the predictive ability of all models compared with their previous retrospective validations. Accordingly, we recommend prospective validation of any predictive model before implementing it into clinical practice and clinical trial design.
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Carcinoma de Células Renais/epidemiologia , Neoplasias Renais/epidemiologia , Carcinoma de Células Renais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Recidiva Local de Neoplasia , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Projetos de PesquisaRESUMO
Intraoperative cell salvage (IOCS) has been used in urologic surgery for over 20 years to manage intraoperative blood loss and effectively minimize the need for allogenic blood transfusion. Concerns about viability of transfused erythrocytes and potential dissemination of malignant cells have been addressed in the urologic literature. We present a comprehensive review of the use of IOCS in urologic oncologic surgery. IOCS has been shown to preserve the integrity of erythrocytes during processing and effectively provides cell filtration to mitigate the risk of tumor dissemination. Its use is associated with reduction in the overall need for allogenic blood transfusion, which clinically reduces the risk of hypersensitivity reactions and disease transmission, and may have important implications on overall oncologic outcomes. In the context of a variety of urologic malignancies, including prostate, urothelial, and renal cancer, the use of IOCS appears to be safe, without risk of tumor spread leading to metastatic disease or differences in cancer-specific and overall survival. IOCS has been shown to be an effective intraoperative blood management strategy that appears safe for use in urologic oncology surgery. The ability to reduce the need for additional allogenic blood transfusion may have significant impact on immune-mediated oncologic outcomes.
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Resumen Se desarrolló un análisis retrospectivo sobre las ventas de trece biotecnológicos regulados, entre junio del 2010 y junio del 2014, en dos escenarios: valores facturados después de la regulación de precios y valores supuestos, calculados a partir del precio de venta promedio de los seis meses anteriores a la regulación, más el índice de precios al consumidor en salud. La diferencia entre ambos escenarios supone un ahorro al sistema. Los biotecnológicos analizados generaron un ahorro de USD $95 000 000 en dicho periodo; en el primer año el 10.2%, el segundo año el 17.2% y en el tercero el 30.5%. El biotecnológico que más ahorro representó fue el rituximab (40,9%), equivalente a USD $38 510 787. La regulación directa de precios de medicamentos biotecnológicos le ha generado ahorros significativos al sistema de salud, visto desde las ventas registradas en Audifarma. Probablemente, el ahorro económico que ha generado esta política es superior a lo estimado inicialmente por el Gobierno.
Abstract We developed a retrospective analysis on the sales of thirteen biotechnological regulated medicines between June, 2010, and June, 2014, in two scenarios: amounts billed after the price and assumed value regulation, calculated based on the average sale price during the six months prior to the regulation, plus the health consumer price index. The difference between both scenarios entails a saving for the system. The biotechnological medicines analyzed generated savings for US $95 Million in said period; 10.2% during the first year, 17.2% during the second, and 30.5% during the third. The biotechnological medicine that generated the most savings was rituximab (40.9%), equivalent to US $38,510,787. The direct regulation of biotechnological medicines has generated significant savings for the healthcare system, as seen from the sales registered by Audifarma. Probably, the economic savings generated by this policy are above the initial government estimates.
Resumo Análise retrospectiva sobre as vendas de treze biotecnológicos regulados entre junho de 2010 e junho de 2014 desenvolvida em dois cenários: valores faturados após regulamentação de preços e valores supostos, calculados a partir do preço de venda médio dos seis meses prévios à regulamentação, mais o índice de preços ao consumidor em saúde. A diferença entre ambos cenários supõe poupança para o sistema. Os biotecnológicos analisados geraram poupança de USD $95 000 000 nesse período; no primeiro ano o 10.2%, o segundo ano o 17.2% e no terceiro o 30.5%. O biotecnológico que mais poupança gerou foi o rituximab (40,9%), equivalente a USD $38 510 787. A regulamentação direta de preços de medicamentos biotecnológicos gerou poupança significativa ao sistema de saúde, visto desde as vendas registradas em Audifarma. Provavelmente, a poupança econômica gerada por esta política é superior do estimado inicialmente pelo Governo.
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Resumen: la tosferina es una enfermedad aguda bacteriana, causada por Bordetellapertussis, que afecta el tracto respiratorio superior, produciendo fuertes accesos de tos, asfixia y cianosis. Otros microorganismos pueden producir un cuadro similar a la tosferina, conocido como síndrome coqueluchoide, el cual es su principal diagnóstico diferencial. La enfermedad se presenta en su mayoría en lactantes menores, especialmente los que no están adecuadamente inmunizadosy están en contacto con adolescentes y adultos, potenciales reservorios de la enfermedad. Actualmente se realiza el diagnóstico mediante criterios clínicos y microbiológicos, que permiten clasificar al paciente en caso probable o confirmado.En cuanto al tratamiento el manejo estándar de la enfermedad incluye antibióticostipo macrólidos. Dependiendo de la severidad del cuadro se implementa tratamiento de soporte con oxígeno, corticoides, vasodilatadores pulmonares y sedantes. La mejor forma de prevención es una alta cobertura de vacunación cumpliendo los esquemas propuestos. La protección inducida por la vacuna alcanzaentre 70%-85% de los títulos de anticuerpos, los cuales disminuyen entre los 4-7 años posvacunación, lo que hace imprescindible la implementación de una dosis de refuerzo a los 18 meses y 5 años. En Colombia todavía falta el establecimiento de otras opciones a edades más avanzadas, previniendo que la persona joven y adulta sea el reservorio de la enfermedad. En general, los hallazgos y avances en el estudio de la tosferina evidencian que es una entidad clínica con un aumento significativo en su incidencia en la población pediátrica, a pesar de que se cree que está totalmente controlada.
Abstract: pertussis is an acute bacterial disease caused by Bordetella pertussis that affects the upper respiratory tract, producing severe cough, asphyxia, and cyanosis. Other microorganisms can cause a similar clinical picture to pertussis, known as coqueluchoide syndrome, which is the main differential diagnosis. The disease occurs mainly in infants, especially those who are not adequately immunizedand are exposed to adolescents and adults, the potential reservoirs of the disease. Currently the diagnosis is by clinical and microbiological criteria for classifying the patient as probable or confirmed case. The treatment standard management is with antibiotic, especially macrolides. Depending on the severity of case, support treatment including oxygen, steroids, sedatives, and pulmonary vasodilators is implemented. The best prevention of disease is high vaccination coverage, fulfilling with the schemes proposed. The induced protection by the vaccine reaches between 70%-85% of antibody titers, which decrease between 4-7 years post vaccination, which make essential to implement a strategy of booster shot at 18 months and 5 years-old. However, Colombia has not developedother options at older ages, that prevent the young and adults become the reservoir of the disease. Overall findings and advances in the whooping cough study shows that is a clinical entity with a significant increase of its incidence in the pediatric population, although it is believed that is fully controlled.
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Humanos , Bordetella pertussis , Tosse , Vacina contra Coqueluche , Terapêutica , CoquelucheRESUMO
Este estudio revisa la distribución para el Caribe colombiano de las especies Kinosternon scorpioides, Trachemys callirostris, Mesoclemmys dahli y Chelonoidis carbonaria y nuevas localidades en la distribución de dichas especies para la región. La especie K. scorpioides es registrada por primera vez en la cuenca del río Manzanares, en Santa Marta, Magdalena. Trachemys callirostris fue registrada en el río Cañas, La Guajira, constituyéndose en el primer registro para la especie en un riachuelo de la cara norte de la Sierra Nevada de Santa Marta. Chelonoidis carbonaria fue registrada en un humedal ubicado en la ciudad de Santa Marta. Se registró una hembra de M. dahli en el corregimiento Monterrubio, municipio Sabana de San Ángel, Magdalena. Tres de las cuatro especies incluidas en esta revisión se encuentran en alguna categoría de amenaza; la falta de conocimiento en la biología y distribución de estas especies podría incluirse como una amenaza para ellas, pues el desconocimiento impide conocer su estado de conservación y generar planes de manejo necesarios para su protección.
This research reviews the Colombian Caribbean distribution of the species Kinosternon scorpioides, Trachemys callirostris, Mesoclemmys dahli and Chelonoidis carbonaria, and to present new records for the region. The species K. scorpioides is reported for the first time in the Manzanares River drainage, Santa Marta, department of Magdalena. Trachemys callirostris was recorded in the Cañas River, department of La Guajira, being the first record for this species in a small river on the north side of the Sierra Nevada de Santa Marta. Chelonoidis carbonaria was recorded in a wetland in Santa Marta. We recorded a female M. dahli in the village of Monterrubio, municipality of Sabanas de San Angel, department of Magdalena. Three of the four species included in this account are listed in some category of threat. The lack of knowledge of the biology and distribution of these species could be considered a threat to them because ignorance precludes the establishment of their true conservation status and hinders the development of management plans required for their protection.
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Objetivo: Caracterizar clínicamente a los pacientes intervenidos con stent medicado y convencional en el año 2004, en la Unidad Cardiovascular de la Clínica Medellín. Métodos: Estudio Cross-sectional, realizado con base en las historias clínicas de 157 pacientes, intervenidos con stent en la Clínica Medellín en el año 2004 a los cuales se les hizo la caracterización de acuerdo al stent implantado. Resultados: De los 157 pacientes, 61,1% fueron hombres; a 23.3% de los pacientes se les implantó stent medicado y a 77,7% stent convencional. Como antecedentes patológicos se encontró hipertensión arterial en el 63,7%, diabetes mellitus en el 24,2%, Y dislipidemia en 38,2%. Los síntomas postquirúrgicos mas frecuentes fueron angina 11.5% y dolor precordiall 0,2%. La muerte ocurrió en 9 pacientes (5,7%), de los cuales ocho (88,9%) tenía stent convencional y 11,1% medicado. Los stents convencionales se implantan con mayor frecuencia en pacientes adultos mayores, de sexo masculino con antecedentes personales de tabaquismo e hipertensión arterial y con antecedentes familiares de enfermedad coronaria. En pacientes con infarto agudo del miocardio se prefiere usar stent convencional. La complicación más importante es el síndrome coronario y un número muy limitado de pacientes muere por causas relacionadas con el stent.
Objective: To characterize the clinical features of patients intervened with either medicated or conventional stent in 2004, at the Cardiovascular Unit of Clinica Medellín. Methodology: Cross sectional descriptive study of 157 patients intervened with stent in the Clinica Medellin during 2004. Patients were analyzed according to the implanted stent. Results: From the 157 patients, 96 were men (61.1%). The implanted stent was medicated in 23.3% and conventional in 77,7%. In terms of comorbidities hypertension was found in 63,7%, diabetes in 24,2 and dyslipidemia in 38,2%. The most frequen postsurgical symptoms were angina in 11.5% and chest pain in 10,2%; 5.7% patients died, 88.9% of them with conventional stent, 11.1 % drug-eluting stent, and one case related to the implantation by itself.
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Humanos , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Procedimentos Cirúrgicos Operatórios , Stents , Saúde Pública , Tabagismo/genética , Tabagismo/mortalidadeRESUMO
El síndrome de Crouzon tiene una incidencia sumamente baja en nuestro medio y son pocos los casos que se reportan mundialmente. Poco se conoce acerca de técnicas anestésicas específicas y menos en pacientes en edad adulta. Se presenta el caso de una mujer de 41 años con la enfermedad, para avance craneofacial y reconstrucción maxilar en varios tiempos hasta su estadio terapéutico final. El abordaje del caso se hizo por neurocirugía, cirugía maxilofacial y el grupo de anestesia del Hospital Simón Bolívar; en la valoración preanestésica se hizo énfasis en los predictores de vía aérea difícil, evaluación oftalmológica y en la pérdida sanguínea; se descartaron otras anomalías estructurales. El manejo transoperatorio inicial, que fue el mayor, se hizo convencionalmente con una técnica mixta; se trasladó a UCI para extubación programada, evolucionando satisfactoriamente. Se hicieron otros procedimientos para completar el avance basados en la misma técnica anestésica. La paciente evoluciona adecuadamente y es dada de alta