RESUMO
PURPOSE/OBJECTIVE(S): To improve the curative resection rates and prognoses, a variety of neoadjuvant (NA) strategies have been explored in PDAC. In our institution, non-metastatic PDACs have been treated with a NA intent with induction multiagent chemotherapy and SBRT. The primary endpoint was to increase R0 resection rate. The secondary endpoints were the analysis of the clinical tolerance, the pathological response, the local control (LC) and the OS. MATERIALS/METHODS: All consecutive patients with non-metastatic PDAC underwent SBRT as part of the NA strategy were included. A total dose of 40-62 Gy were delivered in 5-10 fractions. Surgery was performed after SBRT and restaging. RESULTS: Since February 2014 to December 2018, 45 patients were enrolled. Thirty-two patients underwent surgery (71.1%), 10 out of 15 were initially unresectable disease patients (66.75%). R0 resection rate was 93% (30 patients) and pN0 status was achieved in 20 patients (60.6%). Tumour regression grade (TRG): 12 patients with complete response or marked response (TRG 0-1: 37.5%), 16 patients with moderate response (TRG 2: 50%) and four patients with poor response (TRG 3: 12.5%). The median follow-up was 16.2 m (range 6.6-59.6 m) since diagnosis. The LC rate achieved was very high (95.5%). Actuarial 12 and 24 m OS was 67.4% and 35.9% respectively. No grade 3 or higher toxicity related to SBRT was observed. CONCLUSION: The results are encouraging, suggesting that SBRT has a significant role in the management of these patients and further studies will be necessary to prove these findings.
Assuntos
Pancreatectomia/métodos , Neoplasias Pancreáticas/tratamento farmacológico , Neoplasias Pancreáticas/radioterapia , Radiocirurgia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Síndrome da Leucoencefalopatia Posterior/complicações , Complicações na Gravidez , Transtornos Psicóticos/complicações , Adolescente , Feminino , Humanos , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/terapia , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapiaRESUMO
INTRODUCTION: Epilepsy is a group of long-term neurological disorders characterised by seizures that may respond to pharmacological treatment. OBJECTIVE: Determine the prescribing patterns of anticonvulsants for patients covered by the healthcare system in Colombia. METHODS: Cross-sectional study using a database containing 6.5 million people. From among residents in 88 Colombian cities, we selected patients of both sexes and all ages who were treated continuously with anticonvulsants between June and August 2012. We designed a drug consumption database and performed multivariate analysis for combination treatment and co-medication using SPSS 20.0. RESULTS: A total of 13,793 patients with mean age of 48.9±22.0 years were studied; 52.9% of the participants were women. Of the patient total, 74.4% were treated in monotherapy and 25.6% received two or more anticonvulsants. Globally, 72.9% of the patients were initially treated with classic anticonvulsants and 27.1% with new drugs. The most frequently used drugs were valproic acid (33.3%), carbamazepine (30.2%), clonazepam (15.7%), pregabalin (10.3%), phenytoin (10.0%) and levetiracetam (7.9%). Most agents were used in higher doses than recommended. The most common combinations were valproic acid+clonazepam (10.9%), valproic acid+carbamazepine (10.0%), carbamazepine+clonazepam (5.6%), valproic acid+phenytoin (4.4%). The most frequently prescribed co-medications were antihypertensives (61.0%), lipid-lowering drugs (45.8%), antidepressants (36.7%), antipsychotics (20.1%), anxiolytics (7.9%), and lithium (1.8%). DISCUSSION: Doctors predominantly prescribe drugs with a high therapeutic value and favour anticonvulsant monotherapy. Most agents were used in higher doses than recommended. This underlines the need to design educational strategies addressing these prescribing habits, and to undertake research on the effectiveness of treatment.
Assuntos
Anticonvulsivantes/uso terapêutico , Epilepsia/tratamento farmacológico , Padrões de Prática Médica , Colômbia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Ergot derivatives are drugs with vasoconstrictor effects that are used to abort migraine attacks. This study aims to determine how ergot derivatives are prescribed by physicians in Colombia, find variables associated with inappropriate prescribing, and review potential interactions in our patients. METHODS: We reviewed 86 411 formulas during April 2012, identifying the prescription by drug, dose, interval, duration of use, and indication. We interviewed 288 randomly selected patients in whom we also investigated concomitant use of a) antihypertensive agents b) ischaemic heart disease treatments c) antiretrovirals d) other antimigraine drugs, and e) macrolides, because of their potential for interactions. RESULTS: We identified 801 prescriptions from patients in 27 cities with a mean age of 35.1±14.1 years; 82.5% of the prescriptions were for women, 96.5% were written by primary care physicians, and 65.4% (n=524) corresponded to migraine treatments. There were 26 different prescription types and 797 prescriptions were incorrect with regard to usage recommendations (99.5%). Inappropriate prescribing was significantly associated with the health centre providing patient care (P=.005). Of the patients who were interviewed by telephone, 266 (92.4%) took the drug according to the erroneous indication. A total of 54 patients (6.7%) were treated with antihypertensive drugs, 24 (2.9%) with macrolides, and 5 (0.6%) with another concomitant antimigraine drug. DISCUSSION: Most patients take ergotamine improperly, apart from the fact that potential interactions may increase the risk of health problems such as ergotism and coronary events. Physicians will require assessment measures, updated information, and continuous training.
Assuntos
Ergotamina/uso terapêutico , Erros de Medicação , Transtornos de Enxaqueca/tratamento farmacológico , Vasoconstritores/uso terapêutico , Adulto , Colômbia , Centros Comunitários de Saúde , Interações Medicamentosas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacoepidemiologia , Médicos de Atenção Primária , Padrões de Prática Médica/estatística & dados numéricos , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricosRESUMO
Colorectal cancer (CRC) incidence has increased during the past decades in Spain, being the first malignant tumour in incidence. Observed mortality for CRC is mainly due to liver and lung metastases. The only curative treatment is surgery; new surgical techniques and neoadjuvant treatments have increased the number of surgery candidate patients. Patients should be managed with a multidisciplinary approach that includes imaging techniques, chemotherapy, surgery and pathological assessment. As an answer to this approach, a group of pathology experts interested on CRC liver metastases aimed to review the diagnosis and prognosis of liver mestastases and developed practical recommendations for its assessment. The expert group revised the current literature and prepared questions to be discussed based on available evidence and on their clinical practise. As a result, recommendations for the assessment of tumour regression of liver metastases are proposed, which could be implemented in oncology centres allowing assessment standardisation for these patients. Prospective multi-center studies to evaluate these recommendations validity will further contribute to improve the standard care of CRC liver metastases patients.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Terapia Neoadjuvante , Feminino , Humanos , Neoplasias Hepáticas/secundário , Masculino , EspanhaRESUMO
El objetivo del presente estudio fue comparar los niveles de triglicéridos (TG), colesterol total (CT) y fraccionado en caballos peruanos de paso (CPP) de la Región Lambayeque. Se analizaron sueros de 50 CPP (25 sedentarios, 25 activos). Los TG y CT se determinaron con el uso de kits comerciales, mientras que las lipoproteínas HDL-C y LDL-C se determinaron después de precipitación selectiva con polímeros precipitantes selectivos (sulfato de dextrán, Mg++). Las VLDL-C se calcularon restando al CT los valores de HDL-C + LDL-C. Los niveles promedio fueron de 25.69 mg/dl para TG, 108.71 mg/dl para CT, 66.55 mg/dl para HDL-C, 21.38 mg/dl para LDL-C, y 20.78 mg/dl para VLDLC. Los valores séricos de HDL-C en CPP activos fueron estadísticamente superiores que en los sedentarios (p<0.01), en tanto que los valores de TG fueron inferiores en caballos castrados en comparación con las yeguas (p<0.05). Los CPP sedentarios tuvieron niveles menores de HDL-C que los activos, aunque estos últimos tienen menor riesgo aterogénico; sin embargo, tanto caballos activos como sedentarios son poco susceptibles a sufrir hipertrigliceridemia.
The objective of the study was to compare the level of triglycerides (TG), total cholesterol (TC) and its fractions (VLDC-C, LDL-C and HDL-C) in blood serum of Peruvian Paso Horses (CPP) in the Lambayeque Region. Serum of 50 CPP animals (25 sedentary and 25 active) were analyzed. TG and TC levels were determined using commercial kits, whereas HDL-C and LDL-C were determined using selective polymer precipitants (dextransulphate, Mg++). VLDL-C was calculated by subtracting HDL-C + LDL-C values from TC levels. Mean values were 25.69 mg/dl for TG, 108.71 mg/dl for TC, 66.55 mg/dl for HDL-C, 21.38 mg/dl for LDL-C, and 20.78 mg/dl for VLDL-C. HDL-C serum values in active CPP animals were statistically higher than in sedentary horses (p<0.01), whereas TG values.
Assuntos
Animais , Cavalos , Cruzamento , HDL-Colesterol , LDL-Colesterol , Triglicerídeos , VLDL-Colesterol , PeruRESUMO
Irregularities of the cervical margin of restorations facilitate the retention of bacterial plaque, hindering plaque control through the habitual procedures of oral hygiene and favoring the development of periodontal disease. The aim of this study was to evaluate the periodontal condition and treatment needs (applying CPITN) in relation to the cervical margin of dental restorations. Three hundred and sixty-seven teeth with class II and V cavities restored with amalgam, class III cavities restored with composite resin, cast metal restorations and unitary prostheses were examined. With a WHO periodontal probe, the position of the cervical margins of restorations was verified (supragingival, subgingival or at the gingival margin level); the presence of defects (lack or excess of restoring material) and the presence of score 2 of CPITN were also assessed. After the analysis of the data, it was possible to conclude that: 1) supragingival margins offered the best marginal adaptation and the lowest frequency of score 2; 2) both the lack and the excess of restoring material favor the development of score 2, despite the utilized material and 3) in subgingival margins, incorrect marginal adaptation was the most frequent event, mainly due to excess of restoring material, and in these cases there was higher frequency of score 2 of CPITN.
Assuntos
Adaptação Marginal Dentária/normas , Doenças Periodontais/cirurgia , Índice Periodontal , HumanosRESUMO
Expone una revisión de las indicaciones en que la histerectomía radical juega un papel crucial como tratamiento primario para el carcinoma invasor del cérvix uterino. Se menciona, asimismo, los casos seleccionados en quienes está contraindicado efectuar tal procedimiento quirúrgico. Se comentará brevemente la técnica realizada en nuestro instituto, que va de acuerdo a lo desarrollado por centros internacionales. Se plantearan los criterios utilizados en nuestro medio en el momento de decidir cirugía vs. radioterapia, especialmente en los estadíos iniciales. Mencionaremos las complicaciones que con mayor frecuencia hemos encontrado luego de la histerectomía radical. Por último, pero no por eso menos importante estableceremos algunos criterios a tomar en cuenta en el momento de la linfadenectomía...
Assuntos
Feminino , Displasia do Colo do Útero , HisterectomiaRESUMO
Excellent correction of the scoliotic deformity in the three space planes is planes is obtained with the use of the Lea-Plaza frame. This article discusses the indications and contraindications, surgical technique, results, and complications of this technique.
Assuntos
Dispositivos de Fixação Ortopédica , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Adolescente , Fios Ortopédicos , Desenho de Equipamento , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgiaRESUMO
La presente revisión pretende entregar una puesta al día acerca de las diferentes formas de enfermedad periodontal y sus factores etiológicos. Se entrega una clasificación y descripción de cada una de ellas. El factor etiológico fundamental de las diferentes formas de enfermedad periodontal es la placa bacteriana. Existen evidencias de la existencia de una base genética que modifica la respuesta inmune local en las periodontitis de inicio precoz. Se han establecido relaciones positivas entre pacientes con enfermedad periodontal de avance rápido y la presencia del determinante antigénico de la clase II HLA-DR4 y entre pacientes resistentes a la enfermedad y determinantes de la clase I, HLA-B5 y HLA-A29. El control de la placa bacteriana es la clave en la prevención y mantención del paciente tratado. La enfermedad se produce cuando se rompe, a nivel del crévice, el equilibrio entre la agresividad de las bacterias y las defensas del hospedero
Assuntos
Humanos , Infecções Bacterianas/complicações , Doenças Periodontais/diagnóstico , Antígenos HLA/isolamento & purificação , Doenças Periodontais/etiologiaRESUMO
El Hospital Nacional Edgardo Rebagliati Martins (H.N.E.R.M.) absorbió durante el período Enero a Julio de 1991, el 67 por ciento de atención a pacientes portadores de I.R.C. Fue el Programa Ambulatorio el que prestó mayor atención (61 por ciento), en comparación con el Programa Eventual (39 por ciento). El rendimiento máquina/paciente mensual oscila entre 84.8 y 99.0 sesiones de diálisis máquina y el rendimiento diario es de 3.2 a 3.8 (3.6 promedio diario). En relación a costos tenemos que durante los meses de Enero a Julio de 1991, el costo del tratamiento de hemodiálisis en el H.N.E.R.M. fue de $ 937,744 dólares. El costo total, el cual incluye el pago por Servicios Médicos Contratados fue de $ 1'973,794 dólares. Entre los años 1987 a 1991, se efectuaron 149 trasplantes renales, con un costo promedio de $ 6,764 dólares en caso de donante vivo, y de $ 5,915 dólares en caso de donante cadavérico; en el segundo año de evaluación el paciente beneficiario de trasplante renal representará un costo de $ 1,012 dólares y en el tercero, éste se reducirá a $ 759 dólares. En cambio un paciente sometido al tratamiento de diálisis durante 156 sesiones, 12 meses al año, 3 veces por semana, representa un gasto de $ 7,800 anual, que en el período de análisis hace un total de $ 23,400 dólares, es decir el gasto anual es constante y el paciente permanecerá en tratamiento indefinidamente.
Assuntos
Humanos , Masculino , Feminino , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/terapia , Análise Custo-Eficiência , Transplante de Rim/economia , Análise Custo-Benefício/economia , Análise Custo-Benefício/estatística & dados numéricosRESUMO
OBJECTIVES: Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane). MATERIAL AND METHODS: We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications. RESULTS: Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane. CONCLUSIONS: Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.
Assuntos
Halotano , Isoflurano , Administração por Inalação , Criança , Pré-Escolar , Feminino , Halotano/administração & dosagem , Halotano/efeitos adversos , Humanos , Lactente , Isoflurano/administração & dosagem , Isoflurano/efeitos adversos , MasculinoRESUMO
This review discusses aspects related to the use, advantages and side effects of the oral irrigator and chlorhexidine areas of difficult access in treated periodontal patients
Assuntos
Humanos , Clorexidina/uso terapêutico , Placa Dentária/prevenção & controle , Cárie Dentária/prevenção & controle , Gengivite/prevenção & controle , Higiene Bucal , Irrigação TerapêuticaRESUMO
An approach to the prevention of drug abuse among adolescents by promoting mental health was implemented in a study carried out in 1983 in the schools of La Reina, a district of the metropolitan region of Santiago, Chile. A series of workshops, organized for the training of students and teachers, focused on the acquisition of communication abilities, the resolution of day-to-day conflicts and the improvement of self-esteem. The workshop training was intended to enable the trainees to replicate the knowledge and experience gained with their fellow classmates and teachers. The evaluation, carried out by means of a questionnaire administered at the beginning and at the end of the training programme, showed positive results among students and teachers, but better results were obtained among the teachers.