RESUMO
A prevalência da nefrolitíase está em torno de 1-15% com estimativa crescente, sendo a ureterolítíase comum nos atendimentos de urgência. Custos elevados estão associados ao manejo da ureterolitíase em proporções que chegam ultrapassar 5 bilhões de dólares nos EUA. A cateterização com duplo-J por pielonefrite obstrutiva pode, em alguns casos, ser a única intervenção necessária. O objetivo foi analisar o impacto da retirada de cateteres duplo-J em pacientes com pielonefrite obstrutiva por ureterolitíase menor ou igual a 7 mm, sem intervenção cirúrgica prévia. Foi realizado um estudo clínico prospectivo, no período de Outubro de 2021 a Abril de 2023 em um hospital terciário da cidade de São Paulo. O estudo incluiu pacientes sem manipulação endourológica prévia, submetido à passagem de cateter duplo-J por pielonefrite obstrutiva secundária à ureterolitíase menor ou igual a 7mm. O cateter foi retirado a partir de 21 dias do evento inicial, e tomografia computadorizada foi realizada 14 dias após a extração do cateter. Durante o período, 36 pacientes foram incluídos no estudo, sendo 19 homens, e 61,1% com topografia em ureter distal. Desses, 29 pacientes (80,5%) apresentaram depuração do cálculo na tomografia de controle, apenas 7 (19,5%) desses pacientes foram submetidos ao retratamento. O diâmetro médio dos cálculos no grupo de pacientes que depuraram foi de 4,9mm (variação de 3 a 7 mm), com tempo médio de permanência do cateter de 39,5 dias. Em relação ao grupo que necessitou de retratamento, o diâmetro médio foi de 5,2 mm (variação de 4 a 7 mm), com tempo de permanência de 52,1 dias. Pacientes com ureterolitíase não infecciosa podem, inicialmente, serem tratados clinicamente. No tratamento da pielonefrite obstrutiva a utilização do cateter ureteral pode ser uma ferramenta única, devido à elevada depuração e incidência mínima de complicações, reduzindo a morbidade e os custos aos serviços de saúde. Palavras-chave: Ureterolitíase. Pielonefrite. Cateter duplo-J.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ureter/cirurgia , Cateterismo/métodos , Cateterismo Urinário , Urolitíase/cirurgiaRESUMO
BACKGROUND: The aim of this study is to evaluate the interaction between treatment delay and stage on the mortality from non-small cell lung cancer (NSCLC). METHODS: We performed a survival analysis in a cohort of patients admitted to the reference cancer center. The following data were collected: age, gender, smoking status, tumor staging, type of lung cancer, and time from the date when the patient was diagnosed with cancer to the starting date of effective treatment. Univariable and multivariable Cox proportional hazard models were used to investigate the association between potential confounders identified during the study design. After the final adjusted model was determined, tests for interaction among all predictors were performed. RESULTS: Inclusion criteria were met by 359 patients. In the adjusted analysis, delayed treatment delivery was a protective factor for the risk of death, with a crude hazard ratio (HR) =0.75 (0.59-0.97; P=0.02) and an adjusted HR =0.59 (0.46-0.77; P<0.001). However, a statistically significant interaction with mortality was observed between timely treatment and tumor stage. Patients with stage II disease who received delayed treatment had a higher risk of death [HR =3.08 (1.05-9.0; P=0.04)]. On the other hand, stage IV patients who received delayed treatment had a 52% reduction in mortality [HR =0.48 (0.35-0.66; P<0.001)]. CONCLUSIONS: Stage of disease influenced the association between start of the treatment and mortality, and only the subgroup of stage II patients seemed to benefit from early treatment.
RESUMO
OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Neoplasias Pulmonares/terapia , Tempo para o Tratamento/estatística & dados numéricos , Brasil , Diagnóstico Tardio , Feminino , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Setor Público , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVES: The aim of this study is to evaluate the access of patients with lung cancer in a densely populated area of São Paulo to the Brazilian Public Health System, focusing on the time spent from symptom onset or initial diagnosis until the beginning of treatment. METHODS: We retrospectively reviewed 509 patients with malignant lung neoplasms who were admitted to a single reference oncology center of the public health system between July 2008 and December 2014. Patients were considered eligible for this study if they were older than 18 years and had not undergone any previous oncology treatment when they were admitted to the institution. The following data were collected from all patients: age, gender, smoking status, tumor staging, time from the when the first symptoms were experienced by the patient to when the patient was diagnosed with cancer, time from the first appointment to cancer diagnosis, and time from when the patient was diagnosed with cancer to the initiation of treatment. RESULTS: The median time from symptom onset to diagnosis was three months. From the first appointment to diagnosis, the median time interval was one month; however, 79% of patients were diagnosed in up to two months. The median time from diagnosis to the start of treatment was one month, but most patients (82.5%) started treatment in up to two months. CONCLUSION: In our highly populated region with preferential access to the public health system, patients are required to wait a relatively long time to effectively begin treatment for lung cancer. This type of study is important to alert medical societies and government health agencies.