RESUMO
Background: Central Cord Syndrome is the most common incomplete spinal cord injury, and it represents 9% of all spinal injuries of the adult. Objective: to determine the risk factors associated with lethality or/and mechanical ventilation (MV) in patients with Central Cord Syndrome (CCS). Material and Methods: upon a retrospective cohort with patients with posttraumatic CCS we evaluated at the time of emergency admission and until the hospital discharge. The dependent variable was dead or MV. We calculated incidence, relative risk (RR) with CI95% and a multivariate model for the association of statistically significant variables by means of a risk coefficient model upon the variables that evidenciated tendencies towards risk. Results: From 101 patients with CCS, 85.1% with a severe medullary canal stenosis and 9.9% required MV; the mortality was 13.9%. The only risk factor associated with dead was the use of MV with an RR of 3.6 (CI95% 1.4-9.5); the risk with tendencies towards MV was being older than 60 RR 5.4 (CI95% 0.6-44.2). Other factors demonstrated a tendency towards mortality, but they were not statistically significant. Conclusions: MV is a risk factor associated with mortality, other factors evidenciated tendencies towards mortality; being older than 60, hypertension, diabetes mellitus, narrow spinal canal, more than 20 days of hospital stay and being intervened farther than 10 days from the accident. The incidence of mortality in our sample is greater than thus reported previously on other international articles. To know and identify these and other factors will let us identify patients with a greater risk of complications.
Introducción: el síndrome medular central es la lesión medular incompleta más común y representa el 9% de las lesiones medulares del adulto. Objetivo: determinar la letalidad del síndrome medular central (SMC) y sus factores de riesgo asociados a fallecer y/o uso de ventilación mecánica (VM). Material y métodos: cohorte retrospectiva en pacientes con SMC que acuden a urgencias y valorados hasta su egreso. La variable dependiente fue VM o muerte. Se calculó la incidencia, riesgo relativo (RR) e IC95%; se usaron modelos multivariados de asociación con las variables significativas mediante un modelo de cocientes de riesgos, y aquellas que presentaron algún grado de tendencia de acuerdo con el RR por encima de 1. Resultados: se recolectó la información de una muestra de 101 pacientes con SMC que recibieron atención en la unidad entre 2015 y 2021, 85.1% presentaron estenosis medular, 9.9% de pacientes requirieron VM, la mortalidad fue de 13.9%. El factor de riesgo asociado a muerte fue la VM con RR 3.6 (IC95%: 1.4-9.5); el factor con tendencia a VM fue ser mayor de 60, RR 5.4 (IC95%: 0.6-44.2). Otros factores evidenciaron tendencia a mortalidad o VM sin significancia estadística. Conclusiones: el factor de riesgo asociado a mortalidad fue VM, otros evidencian tendencia hacia mortalidad, como ser mayor de 60 años, hipertensión arterial, diabetes mellitus, estenosis medular por debajo de los 10 milímetros, más de 20 días de estancia hospitalaria y ser intervenidos más de 10 días posterior al accidente. La mortalidad en nuestra población se encuentra muy elevada en comparación con estudios internacionales previos. Conocer los factores de riesgo ayudaran a identificar a los pacientes con mayor riesgo de muerte o VM.
Assuntos
Síndrome Medular Central , Traumatismos da Medula Espinal , Adulto , Humanos , Síndrome Medular Central/complicações , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Hospitalização , Fatores de Risco , Respiração ArtificialRESUMO
Introduction: Oocyte vitrification is a scientific advance that has changed the reproductive perspective of human society. This procedure has been offered as an alternative to the voluntary postponement of pregnancy, giving women a new perspective on their reproductive autonomy. The number of women who consult and then choose to freeze oocytes has increased almost exponentially in Chile and throughout the world. There is little knowledge about the motivation, experience, and results of elective oocyte cryopreservation in Chile. The objective was to know the motivation, experience, and future reproductive desire of the women who underwent this technique. Methods: Cross-sectional descriptive study based on a questionnaire sent by e-mail in which females who had previously undergone elective oocyte cryopreservation between January 2011 and December 2019 at Clínica Alemana, Santiago, Chile, participated. Results: Of 342 women who had completed a cycle of elective oocyte cryopreservation, 193 agreed to participate, and of these, 98 (51%) answered the survey satisfactorily. Women who underwent this procedure for medical indication, including endometriosis, cancer, and low ovarian reserve, were excluded. The most frequent reason for the procedure was age (44%). Concerning the procedure: 94% do not regret having it done, and 74% of the women believe that they will use their oocytes at some point in their lives. Finally, from the time of oocyte cryopreservation to date, 11% of the surveyed women have used their vitrified oocytes, and 27% have become pregnant. Conclusions: Women who undergo elective oocyte cryopreservation for social reasons are mainly women without a partner whose main motivation is their reproductive age. The vast majority do not regret doing so.
Introducción: La vitrificación de óvulos es un avance científico que ha cambiado la perspectiva reproductiva de la sociedad humana. Este procedimiento se ha ofrecido como alternativa a la postergación voluntaria del embarazo, confiriéndole a la mujer una nueva perspectiva en su autonomía reproductiva. El número de mujeres que consultan y luego optan por congelar ovocitos ha aumentado en forma casi exponencial en Chile y en todo el mundo. En nuestro país, hay poco conocimiento acerca de la motivación, experiencia y resultados de la criopreservación electiva de ovocitos en Chile. El objetivo fue conocer la motivación, experiencia y el deseo reproductivo futuro de este grupo de mujeres sometidas a esta técnica. Métodos: Estudio descriptivo transversal, basado en un cuestionario enviado por correo electrónico en el que participaron mujeres que se habían sometido previamente a criopreservación electiva de ovocitos entre enero de 2011 y diciembre de 2019 en Clínica Alemana, Santiago de Chile. Resultados: De 342 mujeres que habían completado un ciclo de criopreservación electiva de ovocitos, 193 aceptaron participar y de estas, 98 (51%) de las mujeres contestaron la encuesta en forma satisfactoria. Se establecieron criterios de exclusión a aquellas mujeres que se habían sometido a este procedimiento por indicación médica como la endometriosis, el cáncer y la baja reserva ovárica. El motivo más frecuente para realizarse el procedimiento fue la edad (44%). En relación al procedimiento; el 94% no se arrepiente de haberlo realizado y 74% de las mujeres cree que utilizará sus ovocitos en algún momento de su vida. Por último, desde que se realizaron la criopreservación de ovocitos a la fecha, el 11% de las mujeres encuestadas ha usado sus ovocitos vitrificados y 27% ha logrado embarazarse con estos. Conclusión: Las mujeres que se someten a criopreservación electiva de ovocitos por razones sociales, son principalmente mujeres sin pareja que tiene como motivación principal su edad reproductiva y la gran mayoría de ellas no se arrepienten de haberlo realizado.
Assuntos
Motivação , Oócitos , Gravidez , Feminino , Humanos , Masculino , Estudos Transversais , Criopreservação , ChileRESUMO
INTRODUCCIÓN: La vitrificación de óvulos es un avance científico que ha cambiado la perspectiva reproductiva de la sociedad humana. Este procedimiento se ha ofrecido como alternativa a la postergación voluntaria del embarazo, confiriéndole a la mujer una nueva perspectiva en su autonomía reproductiva. El número de mujeres que consultan y luego optan por congelar ovocitos ha aumentado en forma casi exponencial en Chile y en todo el mundo. En nuestro país, hay poco conocimiento acerca de la motivación, experiencia y resultados de la criopreservación electiva de ovocitos en Chile. El objetivo fue conocer la motivación, experiencia y el deseo reproductivo futuro de este grupo de mujeres sometidas a esta técnica. MÉTODOS: Estudio descriptivo transversal, basado en un cuestionario enviado por correo electrónico en el que participaron mujeres que se habían sometido previamente a criopreservación electiva de ovocitos entre enero de 2011 y diciembre de 2019 en Clínica Alemana, Santiago de Chile. RESULTADOS: De 342 mujeres que habían completado un ciclo de criopreservación electiva de ovocitos, 193 aceptaron participar y de estas, 98 (51%) de las mujeres contestaron la encuesta en forma satisfactoria. Se establecieron criterios de exclusión a aquellas mujeres que se habían sometido a este procedimiento por indicación médica como la endometriosis, el cáncer y la baja reserva ovárica. El motivo más frecuente para realizarse el procedimiento fue la edad (44%). En relación al procedimiento; el 94% no se arrepiente de haberlo realizado y 74% de las mujeres cree que utilizará sus ovocitos en algún momento de su vida. Por último, desde que se realizaron la criopreservación de ovocitos a la fecha, el 11% de las mujeres encuestadas ha usado sus ovocitos vitrificados y 27% ha logrado embarazarse con estos. CONCLUSIÓN: Las mujeres que se someten a criopreservación electiva de ovocitos por razones sociales, son principalmente mujeres sin pareja que tiene como motivación principal su edad reproductiva y la gran mayoría de ellas no se arrepienten de haberlo realizado.
INTRODUCTON: Oocyte vitrification is a scientific advance that has changed the reproductive perspective of human society. This procedure has been offered as an alternative to the voluntary postponement of pregnancy, giving women a new perspective on their reproductive autonomy. The number of women who consult and then choose to freeze oocytes has increased almost exponentially in Chile and throughout the world. There is little knowledge about the motivation, experience, and results of elective oocyte cryopreservation in Chile. The objective was to know the motivation, experience, and future reproductive desire of the women who underwent this technique. METHODS: Cross-sectional descriptive study based on a questionnaire sent by e-mail in which females who had previously undergone elective oocyte cryopreservation between January 2011 and December 2019 at Clínica Alemana, Santiago, Chile, participated. RESULTS: Of 342 women who had completed a cycle of elective oocyte cryopreservation, 193 agreed to participate, and of these, 98 (51%) answered the survey satisfactorily. Women who underwent this procedure for medical indication, including endometriosis, cancer, and low ovarian reserve, were excluded. The most frequent reason for the procedure was age (44%). Concerning the procedure: 94% do not regret having it done, and 74% of the women believe that they will use their oocytes at some point in their lives. Finally, from the time of oocyte cryopreservation to date, 11% of the surveyed women have used their vitrified oocytes, and 27% have become pregnant. CONCLUSIONS: Women who undergo elective oocyte cryopreservation for social reasons are mainly women without a partner whose main motivation is their reproductive age. The vast majority do not regret doing so.
Assuntos
Humanos , Masculino , Feminino , Gravidez , Oócitos , Motivação , Criopreservação , Chile , Estudos TransversaisRESUMO
La sexualidad como tema de estudio se observa a lo largo del siglo XX en distintos tipos de publicaciones tanto expertas como populares. Partiendo de la relevancia histórica del tema el presente trabajo propone aportar al estudio de la sexualidad entre los años 1955 y 1970 tomando como fuente la Revista Ilustrada Científico-Sexológica Luz. Dicha revista de origen estadounidense tuvo una masiva difusión en el cono Sur de América. Metodológicamente se partió de la revisión sistemática y análisis crítico de dicha publicación tomando aportes de la teoría de la recepcióny el giro materialde la historia intelectual. A partir del análisis realizado se mostrará el papel que ejerció en la consolidación del discurso experto sobre temas sexuales y su relación con el público más amplio como así también el lugar de los valores de la época en la regulación de las prácticas sexuales. (AU)
Sexuality as a subject of study is observed throughout the 20th century in different types of publications, both expert and popular. Starting from the historical relevance of the subject, this paper proposes to contribute to the study of sexuality between 1955 and 1970 in Argentina, taking the Revista Ilustrada Científico-Sexológica Luzas the corpus. This journal of American origin had a massive diffusion in the country. Methodologically, it was based on the systematic review and critical analysis of such publication, taking contributions from the theory of reception and the material turn of intellectual history. Based on the analysis carried out, the role it played in the consolidation of expert discourse on sexual issues and its relationship with the broader public will be shown, as well as the place of the values of the era in the regulation of sexual practices. (AU)
Assuntos
Psicologia , Sexualidade , Princípios MoraisRESUMO
La sexualidad como tema de estudio se observa a lo largo del siglo XX en distintos tipos de publicaciones tanto expertas como populares. Partiendo de la relevancia histórica del tema el presente trabajo propone aportar al estudio de la sexualidad entre los años 1955 y 1970 tomando como fuente la Revista Ilustrada Científico-Sexológica Luz. Dicha revista de origen estadounidense tuvo una masiva difusión en el cono Sur de América. Metodológicamente se partió de la revisión sistemática y análisis crítico de dicha publicación tomando aportes de la teoría de la recepcióny el giro materialde la historia intelectual. A partir del análisis realizado se mostrará el papel que ejerció en la consolidación del discurso experto sobre temas sexuales y su relación con el público más amplio como así también el lugar de los valores de la época en la regulación de las prácticas sexuales.
Sexuality as a subject of study is observed throughout the 20th century in different types of publications, both expert and popular. Starting from the historical relevance ofthe subject, this paper proposes to contribute to the study of sexuality between 1955 and 1970 in Argentina, taking the Revista Ilustrada Científico-Sexológica Luzas the corpus. This journal of American origin had a massive diffusion in the country. Methodologically, it was based on the systematic review and critical analysis of such publication, taking contributions from the theory of reception and the material turn of intellectual history. Based on the analysis carried out, the role it played in the consolidation of expert discourse on sexual issues and its relationship with the broader public will be shown, as well as the place of the values of the era in the regulation of sexual practices.
Assuntos
Sexualidade , Princípios MoraisRESUMO
La pandemia de SARS-CoV-2 es una emergencia sanitaria sin precedentes, que ha implicado un reordenamiento en la priorización de procedimientos médicos electivos, frente a un potencial colapso del sistema de salud a nivel mundial y riesgo de contagio del personal y pacientes. Al igual que en el resto del mundo, en Chile la mayoría de los centros de medicina reproductiva han debido suspender sus diferentes terapias de reproducción asistida (TRA). Sin embargo, a raiz de la disminución del número de contagios y mayor evidencia científica disponible, la Sociedad Europea de Reproducción Humana y Embriología (ESHRE) ha recomendado reiniciar los ciclos de medicina reproductiva de forma gradual, a través de sistemas de triage, priorizando pacientes por medio de la generación de distintos escenarios. Considerando esta recomendación, se realizó una revisión sobre la evidencia existente respecto a SARS-CoV-2 / COVID-19 en medicina reproductiva recopilando diferentes directrices de las principales sociedades internacionales, con el objetivo de generar una recomendación ajustada a la realidad nacional.
SARS-CoV-2 pandemic is an unprecedented health emergency, which involves a reorganization of elective procedures, facing a potential global health system collapse. In Chile, as in the rest of the world. most reproductive medicine centers have suspended their different assisted reproduction therapies (ART). However, due to the decrease in the number of infections and due to a greater collection of scientific evidence, the European Society for Human Reproduction and Embryology (ESHRE) have recommended restarting cycles gradually through triage systems, prioritizing patients through the generation of different scenarios. With this in mind, we carried out a review of the existing evidence so far regarding SARS-CoV-2 and reproductive medicine, and we tried to compile the different guidelines of the main international societies, to generate a recommendation adjusted to our local scenario.
Assuntos
Humanos , Feminino , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Medicina Reprodutiva/normas , Técnicas de Reprodução Assistida/normas , Betacoronavirus , Indução da Ovulação , Fertilização in vitro , Triagem , Guias de Prática Clínica como Assunto , Seleção de Pacientes , Transferência Embrionária , Pandemias/prevenção & controleRESUMO
BACKGROUND: To investigate and contrast the prevalence of dry eye symptoms in construction workers and office workers using the OSDI questionnaire. METHODS: A cross-sectional, observational study was conducted using the OSDI questionnaire to evaluate dry eye symptoms and associated risk factors. Sampled size calculation with a power of 80% and a 95% degree of confidence suggested the inclusion of 298 participants. RESULTS: We studied 304 subjects (149 construction workers and 155 office workers). More than half (55%) of the participants presented dry eye symptoms (OSDI > 12). The average OSDI score was 21.30 ± 22.20 points, being lower in the group of construction workers (12.45 ± 17.50) than in-office workers (28.51 ± 22.99) (p < 0.001). Considering participants who had moderate and severe symptoms (23 to 100 points in OSDI), office workers presented dry eye symptoms 4.15 times more frequently than construction workers (OR 4.15, 95% CI 2.52, 6.85). Women presented statistical evidence of higher OSDI scores than men (32.47 ± 23.72 vs. 14.87 ± 18.48, respectively). CONCLUSIONS: construction workers have four times less risk of presenting dry eye symptoms than people working in the average office space. This highlights the pernicious effects on the ocular surface of the office environment, which poses a significant risk for the development or worsening of dry eye symptoms.
Assuntos
Síndromes do Olho Seco , Estudos Transversais , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Inquéritos e Questionários , LágrimasRESUMO
INTRODUCTION & OBJECTIVES: Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. METHODS: A cross sectional, multicenter survey of hospitalized cirrhotic patients. RESULTS: 377 patients, (62% males; 58±11 years) (BMI>25, 57%; diabetes 32%) were hospitalized at 65 centers (63 urbans; 57 academically affiliated) in 13 countries on the survey date. Main admission causes were ascites, gastrointestinal bleeding, hepatic encephalopathy and spontaneous bacterial peritonitis/other infections. Most prevalent etiologies were alcohol-related (AR) (40%); non-alcoholic-steatohepatitis (NASH) (23%), hepatitis C virus infection (HCV) (7%) and autoimmune hepatitis (AIH) (6%). The most frequent concurrent etiologies were AR+NASH. Expertise and resources in every analyzed issue were highly available among participating centers, mostly accomplishing valid guidelines. However, availability of these facilities was significantly higher at institutions located in areas with population>500,000 (n=45) and in those having a higher complexity level (Gastrointestinal, Liver and Internal Medicine Departments at the same hospital (n=22). CONCLUSIONS: The epidemiological etiologic profile in hospitalized, decompensated cirrhotic patients in Latin America is similar to main contemporary emergent agents worldwide. Medical and technical resources are highly available, mostly at great population urban areas and high complexity medical centers. Main diagnostic and therapeutic approaches accomplish current guidelines recommendations.
Assuntos
Ascite/epidemiologia , Hemorragia Gastrointestinal/epidemiologia , Encefalopatia Hepática/epidemiologia , Hospitalização , Cirrose Hepática/epidemiologia , Peritonite/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Infecções Bacterianas , Diabetes Mellitus/epidemiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Recursos em Saúde , Encefalopatia Hepática/etiologia , Hepatite C Crônica/complicações , Hepatite C Crônica/epidemiologia , Hepatite Autoimune/complicações , Hepatite Autoimune/epidemiologia , Humanos , América Latina/epidemiologia , Cirrose Hepática/complicações , Cirrose Hepática Alcoólica/complicações , Cirrose Hepática Alcoólica/epidemiologia , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Obesidade/epidemiologia , Peritonite/etiologia , Distribuição por Sexo , Inquéritos e Questionários , Adulto JovemRESUMO
Resumen: Recientemente, Sepúlveda et al. publicaron en la Revista Chilena de Cardiología(1) el caso clínico de una mujer de 60 años con una válvula aórtica cuadricúspide, diagnosticada por ecocardiografía transtorácica y transesofágica, no operada, con una extensa revisión de la literatura respectiva. En esta oportunidad, nosotros presentamos los hallazgos intraoperatorios en un hombre de 72 años operado por una insuficiencia aórtica severa secundaria a una válvula aórtica cuadricúspide no diagnosticada preoperatoriamente.
Abstracts: Recently, Sepúlveda et al. published in Revista Chilena de Cardiología1 the clinical case of a 60-year-old woman with quadricuspid aortic valve diagnosed by transthoracic and transesophageal echocardiography not operated on, including an extensive review of the literature. We present the intraoperative findings of a 72-year-old man with severe aortic insufficiency and a quadricuspide aortic valve, not preoperatively diagnosed.
Assuntos
Humanos , Masculino , Idoso , Valva Aórtica/anormalidades , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologiaRESUMO
Abstract: We report a 72-years-old male patient with extensive differentiated thyroid cancer (DTC), who required a tracheostomy and gastrostomy. Considering his clinical condition, risk of aspiration and management of the ostomies, radioiodine (131I) was administered intravenously, using recombinant human thyrotropin (rhTSH) and levothyroxine. The procedure was successful, both clinically and in terms of radioprotection.
Assuntos
Humanos , Masculino , Idoso , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tirotropina Alfa/administração & dosagem , Câncer Papilífero da Tireoide/tratamento farmacológico , Radioisótopos do Iodo/administração & dosagem , Antineoplásicos/administração & dosagem , Tiroxina/administração & dosagem , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Traqueostomia , Gastrostomia , Cintilografia , Resultado do Tratamento , Administração Intravenosa , Câncer Papilífero da Tireoide/cirurgia , Câncer Papilífero da Tireoide/diagnóstico por imagemRESUMO
Ligneous conjunctivitis is an uncommon and recurrent type of chronic conjunctivitis. A prevalent cause of this disease is a Plasminogen deficiency, resulting from recessive mutations in the human encoding plasminogen (PLG) gene. This deficiency affects the conjunctiva and also other mucous membranes. Only few hundred cases have been reported in the literature. Here we report a case of a 9-year-old boy with diagnosis of ligneous conjunctivitis. Histopathological examination in hematoxylin-eosin (HE) staining and sequencing of PLG gene were performed to confirm diagnosis. Histopathological findings confirmed the diagnosis of ligneous conjunctivitis. The patient is compound heterozygous for c.1026T>G (p.Val342Gly) and c.2384G>C (p.Arg795Pro) mutations in PLG gene. Both mutations have not been described previously, and the bioinformatic analysis strongly suggests that are causative of the disease. To the best of our knowledge, this is the first case report of a Chilean patient with ligneous conjunctivitis.
Assuntos
Conjuntivite/genética , Conjuntivite/patologia , Mutação , Plasminogênio/deficiência , Plasminogênio/genética , Dermatopatias Genéticas/genética , Dermatopatias Genéticas/patologia , Criança , Humanos , Masculino , PrognósticoRESUMO
Un sistema de PET/CT integrado o multimodal es una combinación física de PET y CT que incluye adquisición secuencial de porciones de PET y CT. El paciente permanece en la misma posición durante los dos exámenes. Un examen 68Ga-PSMA PET/CT puede cubrir diversos rangos de imágenes coaxiales1. PSMA es una proteína transmembrana presente principalmente en todos los tejidos prostáticos. Este articulo tiene como objetivo ayudar a los médicos imagenólogos para clínicos, a reconocer las imágenes de 68Ga-PSMA PET/CT mostrar características propias y ofrecer conocimientos generales de su interpretación en el área de diagnósticos dirigido al cáncer de próstata.
Assuntos
Humanos , Masculino , Feminino , Traçadores Radioativos , Processamento de Imagem Assistida por Computador , Tomografia por Emissão de Pósitrons , Sistemas de Informação em Radiologia , DiagnósticoRESUMO
Resumen: El compromiso simultáneo del arco aórtico y aorta descendente proximal, ya sea por disección o aterosclerosis, constituye uno de los mayores desafíos que puede enfrentar un cirujano cardiovascular. La prótesis híbrida Thoraflex, introducida en los últimos años, ha resultado ser una importante ayuda para el tratamiento quirúrgico de esta compleja y grave patología. Esta consiste en un tubo protésico de Dacron con 4 ramas, para el reemplazo del arco aórtico y sus troncos braquiocefálicos y perfusión corporal distal, y una endoprótesis que queda como "trompa de elefante suspendida" en la aorta descendente proximal. Presentamos en esta oportunidad nuestra experiencia inicial en 4 pacientes, 3 con disección aórtica crónica y una con un aneurisma aterosclerótico, usando la prótesis híbrida Thoraflex.
Abstract: Atherosclerotic aneurysm or dissection of the aortic arch and proximal descending thoracic aorta is one of the major challenges for a cardiovascular surgeon. The new hybrid prosthesis Thoraflex has become an important devise to simplify the surgical treatment of this very complex and technically demanding aortic pathology. This hybrid prosthesis consists of a 4-branched arch graft with a stent-graft at the distal end. The proximal part is a gelatin-coated woven polyester prosthesis. The stented section is a self-expanding endoprosthesis constructed of thin-walled polyester and nitinol ring stents that is left in the proximal descending aorta as a "frozen elephant trunk". We present our initial experience with the Thoraflex prosthesis in four patients, three of them with chronic aortic dissection and one with an atherosclerotic aneurysm.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Dissecção Aórtica/cirurgia , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Dissecção Aórtica/diagnóstico por imagemRESUMO
We report a 72-years-old male patient with extensive differentiated thyroid cancer (DTC), who required a tracheostomy and gastrostomy. Considering his clinical condition, risk of aspiration and management of the ostomies, radioiodine (131I) was administered intravenously, using recombinant human thyrotropin (rhTSH) and levothyroxine. The procedure was successful, both clinically and in terms of radioprotection.
Assuntos
Antineoplásicos/administração & dosagem , Radioisótopos do Iodo/administração & dosagem , Câncer Papilífero da Tireoide/tratamento farmacológico , Neoplasias da Glândula Tireoide/tratamento farmacológico , Tirotropina Alfa/administração & dosagem , Administração Intravenosa , Idoso , Gastrostomia , Humanos , Masculino , Cintilografia , Câncer Papilífero da Tireoide/diagnóstico por imagem , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Tiroxina/administração & dosagem , Traqueostomia , Resultado do TratamentoRESUMO
Signet ring gallbladder carcinoma is a rare aggressive variant of mucinous adenocarcinoma with poor prognosis. Positron emission tomography/computed tomography (PET/CT) with Fluor18 deoxyglucose (F18-FDG) is a useful tool in the staging of gallbladder cancer. We report a 68 years old man with a surgically resected acute cholecystitis, whose biopsy was positive for signet ring cell gallbladder carcinoma. During surgery, locoregional lymph nodes, liver or peritoneal involvement were not detected. A PET/CT was performed for staging, finding multiple hypermetabolic lytic bone lesions. Percutaneous biopsy of a pelvis bone lesion, confirmed a metastasis of the tumor. In this case, the staging with PET/CT allowed the diagnosis of unsuspected bone metastases and was a useful tool for deciding the best site of biopsy for histologic confirmation.
Assuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/secundário , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Idoso , Evolução Fatal , Fluordesoxiglucose F18 , Humanos , Masculino , Imagem Multimodal , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos RadiofarmacêuticosRESUMO
Signet ring gallbladder carcinoma is a rare aggressive variant of mucinous adenocarcinoma with poor prognosis. Positron emission tomography/computed tomography (PET/CT) with Fluor18 deoxyglucose (F18-FDG) is a useful tool in the staging of gallbladder cancer. We report a 68 years old man with a surgically resected acute cholecystitis, whose biopsy was positive for signet ring cell gallbladder carcinoma. During surgery, locoregional lymph nodes, liver or peritoneal involvement were not detected. A PET/CT was performed for staging, finding multiple hypermetabolic lytic bone lesions. Percutaneous biopsy of a pelvis bone lesion, confirmed a metastasis of the tumor. In this case, the staging with PET/CT allowed the diagnosis of unsuspected bone metastases and was a useful tool for deciding the best site of biopsy for histologic confirmation.
Assuntos
Humanos , Masculino , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/secundário , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Evolução Fatal , Compostos Radiofarmacêuticos , Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estadiamento de NeoplasiasRESUMO
BACKGROUND: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. AIM: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. MATERIAL AND METHODS: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. RESULTS: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. CONCLUSIONS: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Biópsia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Cuidados Intraoperatórios , Excisão de Linfonodo , Metástase Linfática , Pessoa de Meia-Idade , Cintilografia , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgiaRESUMO
Background: Sentinel node detection localizes the first node that drains a malignant lesion aiming to detect tumor dissemination. Aim: To assess the yield of sentinel node detection in breast cancer, using pre or intraoperative scintigraphy. Material and Methods: Review of medical records of patients with breast cancer who had a scintigraphic detection of sentinel nodes. Lymph node scintigraphy and surgery were performed in the same day. Results: We studied 174 women aged 53 ± 13 years, operated with a diagnosis of breast cancer, including six highly suspicious lesions in the contralateral breast (totaling 180 studied breasts). Preoperative scintigraphy showed a sentinel node in 174 of 180 breasts (97%). Intraoperative gamma probe confirmed the presence of the sentinel node in the same 174 breasts and detected an additional one reaching a detection yield of 97%. Four patients in whom a sentinel node was not detected in the preoperative scintigraphy, had macrometastases. Frozen section biopsies were available in 177 of 180 breasts. Metastases were informed in 45 patients who underwent axillary lymph node dissection, plus one additional patient with a suspicious lesion. Conclusions: A high rate of sentinel node detection in the preoperative scintigraphy was observed. Most sentinel nodes not detected with nuclear medicine had macrometastases. In 71% of patients, the detection of sentinel node avoided axillary lymph node dissection.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Biópsia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Cintilografia , Estudos Retrospectivos , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Cuidados Intraoperatórios , Excisão de Linfonodo , Metástase LinfáticaRESUMO
Embryo cryopreservation improves efficiency and security of assisted reproduction techniques. Nonetheless, it can be questionable, so it must be justified from technical, legal and ethical points of view. This article analyses these perspectives. Embryo cryopreservation maximizes the probability of pregnancy, avoids new ovary stimulations and reduces the occurrence of multiple gestations. There is consensus that the in vitro embryo deserves legal protection by its own, although not as a newborn. Very few countries prohibit embryo cryopreservation based on the legal duty to protect human life since fecundation. Those countries that allow it, privilege women's reproductive rights. In Chile and in Latin America, no laws have been promulgated to regulate human assisted reproduction. The moral status of the embryo depends on how it is considered. Some believe it is a potential person while others think it is just a group of cells, but all recognize that it requires some kind of respect and protection. There is lack of information about the number of frozen embryos and their final destination. As a conclusion the authors propose that women or couples should have the right to decide autonomously, while institutions ought to be clear in their regulations. And the legislation must establish the legal status of the embryo before its implantation, the couples' rights and the regulation of the embryo cryopreservation. Personal, institutional or legal decisions must assume a concept about the moral status of the human embryo and try to avoid their destruction or indefinite storage.
Assuntos
Criopreservação/ética , Embrião de Mamíferos , Técnicas de Reprodução Assistida/ética , Técnicas de Reprodução Assistida/legislação & jurisprudência , Chile , Feminino , Regulamentação Governamental , Humanos , Autonomia Pessoal , Pessoalidade , Gravidez , Direitos Sexuais e Reprodutivos/ética , Direitos Sexuais e Reprodutivos/legislação & jurisprudênciaRESUMO
El cansancio oncológico es uno de los síntomas más frecuentes e incapacitantes en este tipo de pacientes, tanto durante su tratamiento como en estados avanzados de su enfermedad y afecta en forma significativa la dimensión física, afectiva y cognitiva del paciente. Sin embargo, es el síntoma menos estudiado por la oncología moderna.Actualmente, no contamos con un estándar de tratamiento. La mejor evidencia disponible muestra en pequeño estudio asociado al beneficio de la dexametasona versus placebo en fatiga oncológica en casos con enfermedad avanzada; además, existe evidencia de resultados positivos mediante estrategias no farmacológicas, como los programas de ejercicios aeróbicos y técnicas de manejo del estrés. Este estudio tiene por propósito investigar la eficacia en el cansancio oncológico en enfermedad avanzada de un tratamiento multimodal (basado en estrategias no farmacológicas más uso de dexametasona) versus tratamiento farmacológico sólo usando dexametasona (terapia unimodal). Para ello, en estudio prospectivo y doble ciego, se randomizó 1:1 80 pacientes entre 20 y 80 años de edad con neoplasias avanzadas a tratamiento multimodal o brazo A (terapia farmacológica y no farmacológica) versus terapia unimodal o brazo B (terapia farmacológica sola). Al inicio del estudio se permitió el ingreso de pacientes con fatiga 4 o más sobre 10 aplicando instrumento Brief Fatigue Inventory, que es una forma de Escala Visual Análoga (EVA) aplicada al cansancio oncológico; y al menos otros 2 síntomas relacionados (depresión, ansiedad y/o insomnio), con función cognitiva normal, sin infecciones sobreagregadas, sin neoplasia encefálica, con función tiroidea normal y hemoglobina mayor de 9 gr/dl (recuérdese que una disfunción tiroidea o la anemia favorecen la sensación de fatiga y de no excluirse estos factores no permitiría sacar conclusiones válidas). Al mes de tratamiento se reevaluó mediante EVA la fatiga (end point primario)...
The Cancer Fatigue is one of the most common and disabling symptoms in these patients both during treatment and in advanced stages of their disease; and significantly affect the physical , emotional and cognitive dimension of the patient. And yet it is the symptom less studied by modern oncology. Currently we do not have a standard treatment. The best available evidence shows benefit in small study of dexamethasone versus placebo in cancer fatigue in patients with advanced disease; there is also evidence of positive results by non-pharmacological strategies such as aerobic exercise programs and stress management techniques. This study is aimed to investigate the efficacy in cancer fatigue in advanced disease of a multimodal treatment (based on nonpharmacological strategies more use of dexamethasone) versus using dexamethasone treatment alone (unimodal therapy). To do this in prospective, double-blind study 80 patients 1:1 between 20 and 80 years old with advanced malignancies were randomized to arm A multimodal treatment (pharmacological and nonpharmacological therapy) versus unimodal therapy or arm B (single drug therapy). At study entry patients were allowed to fatigue 4 or more out of 10 using Brief Fatigue Inventory instrument, which is a form of visual analog scale (EVA) applied to cancer fatigue; and at least 2 other related symptoms (depression, anxiety and / or insomnia), with normal cognitive function , without a superimposed infections, without brain cancer, with normal thyroid function and increased hemoglobin 9 g / dl (remember that thyroid dysfunction or anemia favors the sensation of fatigue and not excluded these factors would not draw valid conclusions)...