RESUMO
Gastroenteropancreatic neuroendocrine tumours (GEP-NET) have heterogenic clinical presentations. The majority of GEP-NET tumours have an indolent behaviour, but patients will eventually develop symptoms of tumour progression or hormone secretion that may require systemic medical interventions. Cytotoxic chemotherapy has been tested in GEP-NETs since the 80s, but treatment recommendations are controversial in many instances. Patient selection is mandatory for optimal use of chemotherapy. Important prognostic factors such as primary tumour site, tumour differentiation, tumour staging and proliferation index have been identified and validated in retrospective and prospective series. The combination of those factors and the natural history of GEP-NET provide valuable information with respect to treatment planning. In this report we provide treatment recommendations to improve systemic therapy in patients with advanced GEP-NETs based on a comprehensive review of the literature.
Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias Intestinais/tratamento farmacológico , Tumores Neuroendócrinos/tratamento farmacológico , Neoplasias Pancreáticas/tratamento farmacológico , Seleção de Pacientes , Neoplasias Gástricas/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Capecitabina , Proliferação de Células , Dacarbazina/análogos & derivados , Dacarbazina/uso terapêutico , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Fluoruracila/análogos & derivados , Fluoruracila/uso terapêutico , Humanos , Neoplasias Intestinais/patologia , Gradação de Tumores , Estadiamento de Neoplasias , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Prognóstico , Neoplasias Gástricas/patologia , Estreptozocina/uso terapêutico , TemozolomidaRESUMO
BACKGROUND: Therapeutic options for patients with advanced hepatocellular carcinoma (HCC) are limited. There is emerging evidence that the growth of cancer cells may be altered by very low levels of electromagnetic fields modulated at specific frequencies. METHODS: A single-group, open-label, phase I/II study was performed to assess the safety and effectiveness of the intrabuccal administration of very low levels of electromagnetic fields amplitude modulated at HCC-specific frequencies in 41 patients with advanced HCC and limited therapeutic options. Three-daily 60-min outpatient treatments were administered until disease progression or death. Imaging studies were performed every 8 weeks. The primary efficacy end point was progression-free survival î¶6 months. Secondary efficacy end points were progression-free survival and overall survival. RESULTS: Treatment was well tolerated and there were no NCI grade 2, 3 or 4 toxicities. In all, 14 patients (34.1%) had stable disease for more than 6 months. Median progression-free survival was 4.4 months (95% CI 2.1-5.3) and median overall survival was 6.7 months (95% CI 3.0-10.2). There were three partial and one near complete responses. CONCLUSION: Treatment with intrabuccally administered amplitude-modulated electromagnetic fields is safe, well tolerated, and shows evidence of antitumour effects in patients with advanced HCC.
Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Magnetoterapia/métodos , Adolescente , Adulto , Idoso , Algoritmos , Carcinoma Hepatocelular/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Hepáticas/patologia , Magnetoterapia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Mucosa Bucal , Doses de Radiação , Resultado do Tratamento , Adulto JovemRESUMO
This investigation was conducted with the purpose of identifying the changes in the professional practice of nurses at a public teaching hospital as a result of the arrival of HIV/AIDS. Through interviews with 100 nurses it was found that 76 (76%) referred changes in their professional practice. Of these, 52 (68.4%) referred to the use of garments; 17 (22.3%) to continuing education; and 7 (9.2%) to nursing care. Of a total of 76 reasons presented by the nurses, 46 (60.5%) were related to fear of becoming infected; and 30 (39.5%) related to nursing care. The study revealed that the advent of HIV/AIDS has risen various changes in practical activities of nurses, especially in those related to garments, having as the main concern the fear of becoming infected. Continuing education programs that aim not only to identify the causes that determine low adherence to standard precaution measures and undesirable behavior as well as biosafety surveillance are needed.
Assuntos
Síndrome da Imunodeficiência Adquirida/enfermagem , Atitude do Pessoal de Saúde , Infecções por HIV/enfermagem , Recursos Humanos de Enfermagem Hospitalar , Brasil , Hospitais de Ensino , HumanosRESUMO
This investigation was carried out in order to: identify the occurrence of professional accidents with perforate cutting potentially contaminated material among nurses and nursing auxiliaries that work in a general teaching hospital in the interior of the state of São Paulo. The other objectives were: to associate the occurrence of accident with the professional category and period of work; to identify the type of perforate cutting material most involved in accidents, to identify the attitudes taken by the person accidented. The data were collected on individual interview based on a structured formulary in which the following information was registered: the probable reason of accident, how long the professional has been working on such function, the material involved in the accident, the actions taken after the accident. It was evidenced that the Standard Precautions or the Universal Precautions as they used used to be nominated are not being used as they should be. Such attitude brings risks to the nursing team. We think that this team needs specific orientations through continuing education concerning the theme.