RESUMO
Members of the trochoidean genus Margarella (Calliostomatidae) are broadly distributed across Antarctic and sub-Antarctic ecosystems. Here we used novel mitochondrial and nuclear gene sequences to clarify species boundaries and phylogenetic relationships among seven nominal species distributed on either side of the Antarctic Polar Front (APF). Molecular reconstructions and species-delimitation analyses recognized only four species: M. antarctica (the Antarctic Peninsula), M. achilles (endemic to South Georgia), M. steineni (South Georgia and Crozet Island) and the morphologically variable M. violacea (=M. expansa, M. porcellana and M. pruinosa), with populations in southern South America, the Falkland/Malvinas, Crozet and Kerguelen Islands. Margarella violacea and M. achilles are sister species, closely related to M. steineni, with M. antarctica sister to all these. This taxonomy reflects contrasting biogeographic patterns on either side of the APF in the Southern Ocean. Populations of Margarella north of the APF (M. violacea) showed significant genetic variation but with many shared haplotypes between geographically distant populations. By contrast, populations south of the APF (M. antarctica, M. steineni and M. achilles) exhibited fewer haplotypes and comprised three distinct species, each occurring across a separate geographical range. We hypothesize that the biogeographical differences may be the consequence of the presence north of the APF of buoyant kelps - potential long-distance dispersal vectors for these vetigastropods with benthic-protected development - and their near-absence to the south. Finally, we suggest that the low levels of genetic diversity within higher-latitude Margarella reflect the impact of Quaternary glacial cycles that exterminated local populations during their maxima.
Assuntos
Gastrópodes/classificação , Gastrópodes/genética , Filogeografia , Animais , Regiões Antárticas , Teorema de Bayes , DNA/genética , DNA Mitocondrial/genética , Filogenia , Polimorfismo Genético , América do Sul , Especificidade da Espécie , Fatores de TempoRESUMO
Tanto para el médico como para el paciente es fácil entender el dolor como un fenómeno asociado a trauma o daño tisular. Sin embargo, frente al dolor crónico este enfoque no funciona ni para explicar el dolor ni para tratarlo en forma efectiva. Apareció, entonces el concepto de dolor psicosomático, el cual explicaba el dolor como un proceso originado en la mente y carente de sustrato somático real. Esta visión orientó a la terapia de la mente (psicólogo o psiquiatra) como solución al cuadro de dolor crónico, lo que tampoco produjo los resultados esperados. El modelo biopsicosocial ha contribuido a dar una mejor explicación de los factores que generan la experiencia de dolor y a obtener mejores resultados en muchos cuadros de dolor crónico merced a una terapia orientada bajo esta perspectiva.
Assuntos
Humanos , Dor/diagnóstico , Limiar da DorRESUMO
El cuidado óptimo del paciente quirúrgico incluye el control del dolor postoperatorio, pero la incidencia de dolor postoperatorio moderado y severo sigue siendo alta. Las complicaciones relacionadas con el trauma quirúrgico y el dolor asociado a éste justifican un manejo enérgico. En 1988 Ready y col. describió el concepto de Servicio de Dolor Agudo (SDA) como una entidad multiprofesional dedicada a evaluar el dolor, administrar la analgesia y monitorizarla en el postoperatorio. En noviembre de 1996 y dependiendo del Departamento de Anestesiología se da inicio al Programa de Dolor Agudo (PDA) de Clínica Las Condes. Hasta noviembre del 2006 se han atendido 6.913 pacientes. Junto a los pacientes postquirúrgicos, el PDA recibe un número significativo de pacientes no quirúrgicos (15,2 por ciento). Nuestros resultados muestran una caída significativa del dolor a las 12 horas estabilizándose en EVA 2 y efectos colaterales bajos. La incidencia de complicaciones severas es muy bajo. 90 por ciento de los pacientes encuestados se mostraron satisfechos o muy satisfechos con la atención recibida.
Assuntos
Humanos , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/terapia , Doença Aguda , Cuidados Pós-Operatórios/métodos , Clínicas de Dor , Medição da DorRESUMO
El paciente de dolor crónico habitualmente llega al médico con una mala experiencia previa como resultado de intentos terapéuticos inefectivos. Algunos llegan con una cierta ira hacia el sistema de salud ya que éste ha sido inefectivo para librarlo de un dolor que ha trastornado su vida. Otros se han adaptado a esta condición y recurren al médico como un intento más pero sin muchas esperanzas. El tratamiento bajo la perspectiva biopsicosocial requiere una nueva visión del cuadro de dolor por parte del paciente y que éste adopte una actitud activa y no pasiva frente a la terapia que se le ofrece. Por otro lado, el tratamiento producirá cambios en la percepción del dolor y en la condición de vida del paciente en la medida que éste comprenda que no hay tratamientos rápidos para un dolor que lleva años en su vida y en la medida que realice la terapia multidisciplinaria que normalmente comprende un período de alrededor de ocho semanas. Estos y otros factores hacen difícil el tratamiento duradero de los cuadros de dolor crónico.
Assuntos
Humanos , Dor/psicologia , Dor/terapia , Doença CrônicaRESUMO
OBJECTIVE: To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay. DESIGN AND METHODS: A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center's Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100% of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75% and 50% respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served RESULTS: One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56% males and 44% females age range: 0.25 - 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51% insured generating 69% total revenue, 18% Private producing 16% Revenue, and 31% Government patients generating 15%. Financial models were created to predict revenue behaviour in various scenarios. CONCLUSION: Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, by sharing the burden of care between the private, user and government sectors.
Assuntos
Institutos de Cardiologia/organização & administração , Assistência Integral à Saúde/organização & administração , Comportamento Cooperativo , Política de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Modelos Organizacionais , Bahamas , Institutos de Cardiologia/economia , Assistência Integral à Saúde/economia , Países em Desenvolvimento , Tabela de Remuneração de Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Setor Privado , Setor Público , Estudos RetrospectivosRESUMO
OBJECTIVE: To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay. DESIGN AND METHODS: A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center's Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75and 50respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served RESULTS: One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56males and 44females age range: 0.25 - 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51insured generating 69total revenue, 18Private producing 16Revenue, and 31Government patients generating 15. Financial models were created to predict revenue behaviour in various scenarios. CONCLUSION: Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, by sharing the burden of care between the private, user and government sectors.
OBJETIVO: Evaluar la prestación de servicios médicos especializados avanzados, usando el modelo de cuidados mediante asociación, como medio de proporcionar acceso económico a todos, con independencia de su capacidad de pago. DISEÑO Y MÉTODOS: Se llevó a cabo un análisis retrospectivo de todas las personas que acudieron a una unidad privada de cardiología The Bahamas Interventional Cardiology Center (BICC) por un periodo del 8.5 años, a saber, de marzo de 1996 a septiembre de 2004. El sistema de servicio de descuentos del Centro Cardiológico de Bahamas, había sido aplicado desde el principio a todos los pacientes en tres grupos. Los mismos comprendían: los pacientes con seguro quienes pagaban el 100% de la suma estipulada por la Asociación Médica de Bahamas para los procedimientos realizados, los pacientes privados auto-financiados, y los pacientes con asistencia gubernamental, que abonaban 75% y 50% respectivamente. Se analizó su distribución respectiva y sus contribuciones al ingreso total. Se construyó una serie de modelos financieros tomando en consideración las variables que podrían influir en los porcentajes de ingresos percibidos por cada sector así como el número de individuos atendidos. RESULTADOS: Mil quinientos cuarenta y dos pacientes recibieron servicios en el BICC por espacio de 8.5 años (56% hombres y 44% mujeres). El rango de edad: 0.2596 años, con una edad media de 55.7 años). Se realizaron mil ochocientos ochenta y ocho procedimientos por los cuales el 51% constituido por los asegurados generó un ingreso total del 69%; el 18% formado por los privados produjo un ingreso del 17%; y el 31% representado por los pacientes gubernamentales generó una entrada del 15%. Se crearon modelos financieros a fin de predecir el comportamiento de los ingresos en diversos escenarios. CONCLUSIÓN: El cuidado mediante asociación es una alternativa viable, mediante la cual los gobiernos (los ministerios de salud) de los países en vías de desarrollo pueden brindar a sus respectivas poblaciones, servicios de salud especializados que de otra forma serían costosos con costos y desembolso de capital mínimos. Los cuidados mediante asociación reducen la carga del costo de la atención a la salud para los gobiernos carga que de otra forma resultaría realmente abrumadora, especialmente en los países en vías de desarrollo. Esto se logra mediante el procedimiento de compartir la carga de los cuidados médicos entre los tres sectores referidos el de los usuarios, el privado, y el gubernamental.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Acessibilidade aos Serviços de Saúde/organização & administração , Assistência Integral à Saúde/organização & administração , Comportamento Cooperativo , Institutos de Cardiologia/organização & administração , Modelos Organizacionais , Política de Saúde , Assistência Integral à Saúde/economia , Bahamas , Estudos Retrospectivos , Institutos de Cardiologia/economia , Países em Desenvolvimento , Setor Privado , Setor Público , Tabela de Remuneração de ServiçosRESUMO
A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months. The common surgical procedures were valve surgery--replacement and repair (37.65), correction of patent ductus arteriosus (25.2%) and repair of congenital heart disease (24.2%). Coronary arterial bypass grafting procedures constituted a small percentage (4.1%) of the cardiac surgical operations. A considerable number of patients have undergone CS in Jamaica, but much more needs to be done as the patient load exists. The future of the cardiac surgical service therefore depends on improvement in the facilities at both institutions and the cadre of the intensive care nursing staff The building of the Cardiothoracic-Neurosurgical Unit (commenced in March, 2003) is an essential step towards this.
Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Cirurgia Torácica/tendências , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/classificação , Procedimentos Cirúrgicos Cardíacos/mortalidade , Criança , Feminino , Humanos , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Análise de Sobrevida , Cirurgia Torácica/estatística & dados numéricos , Fatores de TempoRESUMO
A retrospective review of the files of all patients who underwent cardiac surgery at the University Hospital of the West Indies (UHWI) and the Bustamante Hospital for Children (BHC), during the period April 1968 to June 2003 was undertaken. Data collected included age, gender New York Heart Association risk score, type and date of cardiac surgery. The mortality rate of patients who underwent surgery during the period January 1994 to June 2003 was also analyzed A total of 2202 patients had undergone cardiac surgery (CS) in Jamaica during the study period of 35 years and two months. The common surgical procedures were valve surgery--replacement and repair (37.65), correction of patent ductus arteriosus (25.2) and repair of congenital heart disease (24.2). Coronary arterial bypass grafting procedures constituted a small percentage (4.1) of the cardiac surgical operations. A considerable number of patients have undergone CS in Jamaica, but much more needs to be done as the patient load exists. The future of the cardiac surgical service therefore depends on improvement in the facilities at both institutions and the cadre of the intensive care nursing staff The building of the Cardiothoracic-Neurosurgical Unit (commenced in March, 2003) is an essential step towards this
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Cirurgia Torácica/tendências , Hospitais Universitários , Procedimentos Cirúrgicos Cardíacos , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos , Análise de Sobrevida , Cirurgia Torácica/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Jamaica/epidemiologia , Procedimentos Cirúrgicos Cardíacos/classificação , Procedimentos Cirúrgicos Cardíacos/mortalidadeRESUMO
The treatment for thymic tumours and/or myaesthenia gravis (MG) includes thymectomy. Controversy exists as to the optimal timing and operative approach to thymectomy. At the University Hospital of the West Indies, Kingston, Jamaica, the results of thymic surgery during the period 1992 to 2000 were studied retrospectively. There were 26 patients operated on, 17 females and nine males. Twenty-three underwent thymectomy to treat MG, and three to remove a thymoma. The average age for females was 30.7 years, and 25.1 years for males. Average duration of symptoms prior to surgery was 16 months (all patients), and the interval between diagnosis and referral averaged 2.6 months. All patients underwent thymectomy via median sternotomy with a cervical extension of the incision if required. A policy of phrenic nerve preservation, even if residual tumour was left behind, was followed. Patients with thymomas were given post-operative radiotherapy. Chemotherapy was not given to any patient. The medium and long term results of thymic surgery in a developing country are presented. The results are within international norms, although the small patient population makes statistical analysis difficult. There appears to be no need to change current practice, despite the reported efficacy of less invasive approaches to thymic surgery.
Assuntos
Miastenia Gravis/cirurgia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Jamaica , Masculino , Resultado do TratamentoRESUMO
The treatment for thymic tumours and/or myaesthenia gravis (MG) includes thymectomy. Controversy exists as to the optimal timing and operative approach to thymectomy. At the University Hospital of the West Indies, Kingston, Jamaica, the results of thymic surgery during the period 1992 to 2000 were studied retrospectively. There were 26 patients operated on, 17 females and nine males. Twenty-three underwent thymectomy to treat MG, and three to remove a thymoma. The average age for females was 30.7 years, and 25.1 years for males. Average duration of symptoms prior to surgery was 16 months (all patients), and the interval between diagnosis and referral averaged 2.6 months. All patients underwent thymectomy via median sternotomy with a cervical extension of the incision if required. A policy of phrenic nerve preservation, even if residual tumour was left behind, was followed. Patients with thymomas were given post-operative radiotherapy. Chemotherapy was not given to any patient. The medium and long term results of thymic surgery in a developing country are presented. The results are within international norms, although the small patient population makes statistical analysis difficult. There appears to be no need to change current practice, despite the reported efficacy of less invasive approaches to thymic surgery
Assuntos
Humanos , Masculino , Feminino , Adulto , Miastenia Gravis/cirurgia , Neoplasias do Timo/cirurgia , Timectomia , Timoma/cirurgia , Jamaica , Resultado do TratamentoRESUMO
During the period January 1994 to December 1999, a total of 395 patients--adults and children--underwent various types of open heart surgical (OHS) procedures. The age range of these patients was 10 days to 77 years. Most (43.5) of these patients underwent valve replacement--first time and 'redo'--as a result of rheumatic heart disease of varying duration and severity. The other large group was the complex congenital heart abnormalities (16), followed by the group that underwent repair of atrial septal defect (13), coronary artery bypass graft (13) and repair of ventricular septal defect (12). Open valve repair (2) and excision of atrial myxoma (0.5) were uncommon OHS procedures. Nine patients (2.3) developed severe neurological complications (NCs) post-OHS. These included: a short period (< 48 hours) of irritability and fluctuating consciousness level; seizure activity associated with hemisparesis and/or blindness; severe encephalopathy and vegetative state. Four patients showed complete recovery, but one died as a result of complications of the anti-seizure medication. Of the other five, four died as a result of the NCs, and one was discharged in a vegetative state. Such severe neurological complications after an otherwise successful cardiac surgery represent a devastating outcome for patients and their families, and the social and economic impacts are enormous. Several risk factors were identified. The main ones being mitral valve replacement (MVR), especially 'redo' surgery, female gender, age over 60 years, high New York Heart Association functional class and post-operative hypotension. However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre- and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first time and 'redo'.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Cardiopatias , Complicações Pós-Operatórias , Doenças do Sistema Nervoso/etiologia , Paresia , Convulsões , Estudos Retrospectivos , Coma , Procedimentos Cirúrgicos Cardíacos , Jamaica , Complicações Pós-Operatórias/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , ReoperaçãoRESUMO
During the period January 1994 to December 1999, a total of 395 patients--adults and children--underwent various types of open heart surgical (OHS) procedures. The age range of these patients was 10 days to 77 years. Most (43.5%) of these patients underwent valve replacement--first time and 'redo'--as a result of rheumatic heart disease of varying duration and severity. The other large group was the complex congenital heart abnormalities (16%), followed by the group that underwent repair of atrial septal defect (13%), coronary artery bypass graft (13%) and repair of ventricular septal defect (12%). Open valve repair (2%) and excision of atrial myxoma (0.5%) were uncommon OHS procedures. Nine patients (2.3%) developed severe neurological complications (NCs) post-OHS. These included: a short period (< 48 hours) of irritability and fluctuating consciousness level; seizure activity associated with hemisparesis and/or blindness; severe encephalopathy and vegetative state. Four patients showed complete recovery, but one died as a result of complications of the anti-seizure medication. Of the other five, four died as a result of the NCs, and one was discharged in a vegetative state. Such severe neurological complications after an otherwise successful cardiac surgery represent a devastating outcome for patients and their families, and the social and economic impacts are enormous. Several risk factors were identified. The main ones being mitral valve replacement (MVR), especially 'redo' surgery, female gender, age over 60 years, high New York Heart Association functional class and post-operative hypotension. However, the true incidence of NCs (gross and subtle) in the study group cannot be ascertained. A detailed, structured neurological and neuropsychiatric assessment, both pre- and post-operatively, is therefore needed to document the true incidence of this complication. There is also the need for public education, especially for those with valvular disease, in order to encourage changes in attitude and behaviour towards continued follow-up care and valve surgery, both first time and 'redo'.
Assuntos
Cardiopatias/cirurgia , Doenças do Sistema Nervoso/etiologia , Complicações Pós-Operatórias , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Criança , Pré-Escolar , Coma/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Jamaica/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Paresia/etiologia , Complicações Pós-Operatórias/epidemiologia , Reoperação , Estudos Retrospectivos , Convulsões/etiologiaRESUMO
The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica, was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods. The treatment of PDA at this centre has shown excellent long-term results, with minimal mortality and morbidity.
Assuntos
Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Permeabilidade do Canal Arterial , Procedimentos Cirúrgicos Cardíacos , Permeabilidade do Canal Arterial , Endocardite , Procedimentos Cirúrgicos Cardíacos , Jamaica , Análise de Sobrevida , Complicações Pós-Operatórias , Hospitais UniversitáriosRESUMO
Penetrating injury to the great vessels in the thorax is an increasingly common and alarming clinical scenario in the West Indies, and in Jamaica in particular. The management of these often life-threatening injuries involves careful surgical planning and prompt operation, with close adherence to the principles of adequate pre-operative stabilization and investigations, and intra-operative exposure and repair. While this may be more easily accomplished in tertiary care centres, the geographical realities of the West Indies require that every surgeon be familiar with these techniques. A report of the management of some recent cases is followed by a review of the subject and recommended treatment strategies are outlined.
Assuntos
Artérias/lesões , Traumatismos Torácicos/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Serviços Médicos de Emergência , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Torácicos/diagnóstico , Fatores de Tempo , Procedimentos Cirúrgicos Vasculares , Índias Ocidentais , Ferimentos Penetrantes/diagnósticoRESUMO
The surgical treatment of Patent Ductus Arteriosus (PDA) at the University Hospital of the West Indies, Kingston, Jamaica, was examined over an eight-year period. The results of standard surgical modalities were comparable to large published series. A review of the literature regarding the treatment options for PDA does not support a change in management strategy in favour of non-surgical methods. The treatment of PDA at this centre has shown excellent long-term results, with minimal mortality and morbidity.
Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Permeabilidade do Canal Arterial/cirurgia , Adolescente , Adulto , Procedimentos Cirúrgicos Cardíacos/economia , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Permeabilidade do Canal Arterial/mortalidade , Endocardite/etiologia , Feminino , Hospitais Universitários , Humanos , Lactente , Recém-Nascido , Jamaica/epidemiologia , Masculino , Complicações Pós-Operatórias , Análise de SobrevidaRESUMO
Granulosa-theca cell tumours are ovarian neoplasms of low malignancy with hormone secreting potential, accounting for 2-3% of all ovarian cancers. They have an uncertain clinical course and a potential for late recurrence after surgical removal. Clinical features of a patient presenting with pulmonary metastases 21 years after removal of the primary tumour are described, along with a review of the management options.
Assuntos
Tumor de Células da Granulosa/secundário , Neoplasias Pulmonares/secundário , Neoplasias Ovarianas/patologia , Tumor da Célula Tecal/secundário , Feminino , Seguimentos , Tumor de Células da Granulosa/patologia , Tumor de Células da Granulosa/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/cirurgia , Ovariectomia , Pneumonectomia , Tumor da Célula Tecal/patologia , Tumor da Célula Tecal/cirurgiaRESUMO
Granulosa-theca cell tumours are ovarian neoplasms of low malignancy with hormone secreting potential, accounting for 2-3of all ovarian cancers. They have an uncertain clinical course and a potential for late recurrence after surgical removal. Clinical features of a patient presenting with pulmonary metastases 21 years after removal of the primary tumour are described, along with a review of the management options.