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OBJECTIVE: To determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios. RESULTS: 18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027). CONCLUSION: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.
OBJETIVO: Avaliar se a carga metabólica tumoral do corpo inteiro medida na tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose (18F-FDG PET/CT) é um indicador prognóstico em pacientes com câncer de pulmão de células não pequenas (CPCNP) em estágio avançado (estágio III ou IV). MATERIAIS E MÉTODOS: Avaliamos, prospectivamente, a carga tumoral na 18F-FDG-PET/CT de estadiamento em pacientes com CPCNP avançado. Os parâmetros avaliados do tumor primário (tu) e do corpo inteiro (wb) (incluindo o primário) foram: SUV máximo (wbSUVmax e tuSUVmax), volume metabólico tumoral (wbMTV e tuMTV), glicólise total da(s) lesão(ões) (wbTLG e tuTLG), além das seguintes razões: wbSUVmax/tuSUVmax, wbMTV/tuMTV e wbTLG/tuTLG. Os parâmetros medidos na 18F-FDG-PET/CT, variáveis clínicas e patológicas foram correlacionados com a sobrevida global (SG) e a sobrevida livre de progressão (SLP). RESULTADOS: 18F-FDG-PET/CT foi realizada em 52 pacientes (tempos mediano/médio de sobrevida = 11,0/11,7 meses). A SLP mediana foi de 9,6 meses e a SG foi de 11,6 meses. Houve correlação significativa da wbTLG (hazard ratio [HR] = 1,001; intervalo de confiança de 95% [IC 95%]: 1,000-1,001; p = 0,0361) e wbTLG/tuTLG (HR = 1,705; IC 95%: 1,232-2.362; p = 0,0013) com a SG. Na análise multivariada, a razão wbTLG/tuTLG associou-se independentemente com a SG (HR = 1,660; IC 95%: 1,193-2,310; p = 0,0027). CONCLUSÃO: A razão wbTLG/tuTLG é um indicador prognóstico independente de SG em CPCNP avançado.
RESUMO
Abstract Objective: To determine whether the whole-body tumor burden, as quantified by 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT), is a prognostic indicator in advanced (stage III or IV) non-small cell lung cancer (NSCLC). Materials and Methods: This was a prospective study in which we evaluated 18F-FDG PET/CT staging parameters to quantify tumor burdens in patients with stage III or IV NSCLC. The following parameters were evaluated for the whole body (including the primary tumor) and for the primary tumor alone, respectively: maximum standardized uptake volume (wbSUVmax and tuSUVmax); metabolic tumor volume (wbMTV and tuMTV); and total lesion glycolysis (wbTLG and tuTLG). To determine whether the 18F-FDG PET/CT parameters were associated with overall survival (OS) and progression-free survival (PFS), we evaluated the wbSUVmax/tuSUVmax, wbMTV/tuMTV, and wbTLG/tuTLG ratios. Results: 18F-FDG PET/CT was performed for staging in 52 patients who were followed for a median of 11.0 months (mean, 11.7 months). The estimated median PFS and OS were 9.6 months and 11.6 months, respectively. In the univariate analysis, OS was found to correlate significantly with wbTLG (hazard ratio [HR] = 1.001; 95% confidence interval [95 CI]: 1.000-1.001; p = 0.0361) and with the wbTLG/tuTLG ratio (HR = 1.705; 95% CI: 1.232-2.362; p = 0.0013). In the multivariate analysis, only the wbTLG/tuTLG ratio was independently associated with OS (HR = 1.660; 95% CI: 1.193-2.310; p = 0.0027). Conclusion: The wbTLG/tuTLG ratio is an independent prognostic indicator of OS in advanced-stage NSCLC.
Resumo Objetivo: Avaliar se a carga metabólica tumoral do corpo inteiro medida na tomografia por emissão de pósitrons/tomografia computadorizada com 18F-fluordesoxiglicose (18F-FDG PET/CT) é um indicador prognóstico em pacientes com câncer de pulmão de células não pequenas (CPCNP) em estágio avançado (estágio III ou IV). Materiais e Métodos: Avaliamos, prospectivamente, a carga tumoral na 18F-FDG-PET/CT de estadiamento em pacientes com CPCNP avançado. Os parâmetros avaliados do tumor primário (tu) e do corpo inteiro (wb) (incluindo o primário) foram: SUV máximo (wbSUVmax e tuSUVmax), volume metabólico tumoral (wbMTV e tuMTV), glicólise total da(s) lesão(ões) (wbTLG e tuTLG), além das seguintes razões: wbSUVmax/tuSUVmax, wbMTV/tuMTV e wbTLG/tuTLG. Os parâmetros medidos na 18F-FDG-PET/CT, variáveis clínicas e patológicas foram correlacionados com a sobrevida global (SG) e a sobrevida livre de progressão (SLP). Resultados: 18F-FDG-PET/CT foi realizada em 52 pacientes (tempos mediano/médio de sobrevida = 11,0/11,7 meses). A SLP mediana foi de 9,6 meses e a SG foi de 11,6 meses. Houve correlação significativa da wbTLG (hazard ratio [HR] = 1,001; intervalo de confiança de 95% [IC 95%]: 1,000-1,001; p = 0,0361) e wbTLG/tuTLG (HR = 1,705; IC 95%: 1,232-2.362; p = 0,0013) com a SG. Na análise multivariada, a razão wbTLG/tuTLG associou-se independentemente com a SG (HR = 1,660; IC 95%: 1,193-2,310; p = 0,0027). Conclusão: A razão wbTLG/tuTLG é um indicador prognóstico independente de SG em CPCNP avançado.
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[RESUMEN]. Objetivo. Conocer la opinión de las escuelas de medicina sobre la existencia de políticas públicas y la suficiencia de financiamiento público y mecanismos regulatorios para la formación médica de pregrado e identificar áreas que permitan mejorar la disponibilidad de médicos generales en la Región de las Américas. Métodos. Estudio transversal, descriptivo realizado con 105 escuelas de medicina, 51 públicas y 54 privadas, de 17 países. Se utilizó un cuestionario con una escala tipo Likert para explorar tres dimensiones (contextos político, económico y regulatorio) integradas por 4, 2 y 4 variables cada una, respectivamente, y validado con el método Delphi. Se estimaron frecuencias de respuestas a las preguntas del cuestionario. Se realizó un análisis de frecuencias, y para identificar diferencias entre escuelas públicas y privadas se efectuó un análisis bivariante aplicando la prueba de Chi cuadrado para comparar porcentajes. Resultados. El contexto político fue favorable para 64% de las escuelas, el contexto económico, para 37% y la regulación, para 23%. Sólo hubo diferencias significativas entre escuelas públicas y privadas en la variable recursos financieros que ellas administran. Conclusiones. Es necesario fortalecer las políticas públicas, la inversión pública y la regulación de la educación médica, para mejorar la formación y disponibilidad de médicos generales en los países de la Región.
[ABSTRACT]. Objective. To gather opinions from medical schools regarding the existence of public policies on the health workforce (human resources for health) and whether sufficient public financing and regulatory mechanisms are in place for undergraduate medical education; and to identify areas of opportunity to improve the availability of general practitioners in the Region of the Americas. Methods. Cross-sectional, descriptive study conducted with 105 medical schools (51 public and 54 private) in 17 countries. A questionnaire with a Likert scale was used to explore three dimensions (political, economic, and regulatory contexts) composed of 4, 2, and 4 variables each, respectively, and validated with the Delphi method. Frequencies of responses to the questions were estimated. A frequency analysis was performed, as well as a bivariate analysis to identify differences between public and private schools, applying the Chi-square test to compare percentages. Results. The political context was considered favorable by 64% of the schools; the economic context, by 37%; and the regulatory context, by 23%. The only significant differences between public and private schools were in the financial resources they administer. Conclusions. It is necessary to strengthen public policies, public investment, and the regulation of medical education in order to improve the education and availability of general practitioners in the countries of the Region.
[RESUMO]. Objetivo. Conhecer a opinião das faculdades de medicina sobre o volume de políticas públicas e financiamento público e mecanismos reguladores para graduação médica e identificar áreas que possibilitem aumentar o número de clínicos gerais na Região das Américas. Métodos. Estudo transversal descritivo realizado com 105 faculdades de medicina (51 públicas e 54 particulares) em 17 países. Um questionário com uma escala tipo Likert foi usado para explorar três dimensões (contexto político, contexto econômico e regulamentação), contendo 4, 2 e 4 variáveis cada, e foi validado com o método Delphi. As frequências de respostas às perguntas do questionário foram calculadas e analisadas. A fim de identificar diferenças entre as faculdades públicas e particulares, uma análise bivariada com teste qui-quadrado foi realizada para comparar porcentagens. Resultados. O contexto político foi considerado favorável por 64% das faculdades; o contexto econômico por 37%; e a regulamentação por 23%. Apenas foi observada diferença significativa entre as faculdades públicas e particulares na variável recursos financeiros geridos. Conclusões. É necessário fortalecer as políticas públicas, o investimento público e a regulamentação da educação médica para melhorar a formação e aumentar o número de clínicos gerais nos países da Região.
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Recursos Humanos , América Latina , Recursos Humanos , Educação Médica , Cobertura Universal de Saúde , América Latina , Educação Médica , Cobertura Universal de Saúde , Educação Médica , Cobertura Universal do Seguro de SaúdeRESUMO
A Faculdade de Ciências Médicas da Unicamp implantou uma ampla reforma curricular, que antecedeu as Diretrizes Curriculares Nacionais (DCN) de 2001. Analisou-se a trajetória profissional e o impacto da reforma curricular na formação pela percepção dos egressos. Alunos concluintes de 1991-2005 compuseram o grupo pré-reforma e os de 2006-2012, o grupo pós-reforma, que receberam um questionário semiestruturado on-line por e-mail e redes sociais. Obtiveram-se 213 (15,8%) respostas do grupo pré e 126 (16,1%) do pós-reforma. Os dados apontaram pouca dispersão geográfica dos ex-alunos, ocupação de 2,4 postos de trabalho por médico, entendimento da residência como necessária, maior frequência a cursinhos preparatórios no grupo pós-reforma e sugestão de inclusão de administração/gestão em saúde no currículo. A integração entre áreas básicas/clínicas apresentou significante melhora pós-reforma. A percepção sobre a graduação foi altamente positiva. O estudo contribuiu para implantar o acompanhamento sistemático de egressos no curso de Medicina.(AU)
La Facultad de Ciencias Médicas de Unicamp implantó una amplia reforma curricular que antecedió a las directrices curriculares nacionales de 2001. Se analizó la trayectoria profesional y el impacto de la reforma curricular en la formación a partir de la percepción de los egresados. Alumnos concluyentes de la promoción 1991-2005 compusieron el grupo pre-reforma y los de 2006-2012 el grupo post-reforma, recibiendo un cuestionario semi-estructurado, on line, por e-mail y redes sociales. Se obtuvieron 213 (15,8%) respuestas del grupo pre-reforma y 126 (16,1%) del post-reforma. Se encontró poca dispersión geográfica de los ex-alumnos, ocupación de 2,4 puestos de trabajo/médico, comprensión de la residencia como necesaria, mayor frecuencia a cursos preparatorios en el grupo post-reforma y sugerencia de inclusión de administración/gestión en salud en el currículo. La integración entre áreas básicas/clínicas presentó una mejora significativa post-reforma. La percepción sobre la graduación fue altamente positiva. El estudio contribuyó para implantar el acompañamiento sistemático de egresados en el curso de Medicina.(AU)
The School of Medical Sciences of UNICAMP implemented a new curriculum in 2001, predating the national guidelines. This study analyzed the professional trajectory and the new curriculum's impact. Graduates from 1991 to 2005 were grouped in the pre-curricular renovation group, and those from 2006 to 2012 in the post-group. A semi-structured survey was sent through e-mail and social media. There were 213 (15.8%) answers from pre-renovation group and 126 (16.1%) from post. Data showed low geographic dispersion of alumni, 2.4 work posts per physician, residency as a necessary complementation, suggestions for curricular inclusion of management issues and higher frequency of preparatory courses for residency in post-renovation group. There are signs of better integration between basic and clinical areas after the reform. Alumni showed positive perceptions regarding their undergraduate course. The study contributes to the implementation of systematic follow-up of graduates.(AU)
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Faculdades de Medicina , Educação Médica , Avaliação Educacional , Internato e Residência , BrasilRESUMO
OBJECTIVE:: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. METHODS:: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". RESULTS:: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. CONCLUSION:: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction. OBJETIVO:: avaliar a intensidade de sudorese reflexa com o grau de ansiedade e sua interferência na qualidade de vida de indivíduos submetidos à simpatectomia por videotoracoscopia nos períodos pré e pós-operatório. MÉTODOS:: foram avaliados 54 pacientes com média de idade de 26 anos (16 a 49 anos), submetidos à simpatectomia em nível R3-R4. Dois questionários foram aplicados em três momentos diferentes: "Qualidade de vida em pacientes com hiperidrose primária e "Escala para ansiedade e depressão". RESULTADOS:: dos pacientes estudados, 93% mostrou melhora significativa na qualidade de vida após 30 dias da cirurgia, com os efeitos remanescentes após seis meses. Não houve complicações pós-operatórias. A análise mostrou que o nível de ansiedade do paciente é altamente correlacionado com a intensidade da sudorese reflexa após 30 e 180 dias. CONCLUSÃO:: a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.
Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Hiperidrose/cirurgia , Qualidade de Vida , Reflexo , Sudorese , Simpatectomia/métodos , Toracoscopia , Adolescente , Adulto , Ansiedade/complicações , Depressão/complicações , Feminino , Humanos , Hiperidrose/complicações , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Adulto JovemRESUMO
ABSTRACT Objective: to compare the intensity of reflex sweating with the degree of anxiety and its interference in the quality of life of patients undergoing Thoracoscopic (VATS) sympathectomy in the pre- and postoperative period. Methods: we evaluated 54 patients with a mean age of 26 years (16-49 years) undergoing sympathectomy in the R3-R4 level. We applied two questionnaires at three different times: "Quality of life in patients with primary hyperhidrosis" and "Scale for anxiety and depression". Results: of the patients studied, 93% showed significant improvement in quality of life 30 days after surgery, the effects remaining after six months. There were no postoperative complications. The patient's level of anxiety is highly correlated with the intensity of reflex sweating after 30 and 180 days. Conclusion: Thoracoscopic sympathectomy improves quality of life of patients with primary hyperhidrosis, even with the emergence of reflex sweating. Anxiety directly relates to the intensity of reflex sweating, without compromising the degree of patient satisfaction.
RESUMO Objetivo: avaliar a intensidade de sudorese reflexa com o grau de ansiedade e sua interferência na qualidade de vida de indivíduos submetidos à simpatectomia por videotoracoscopia nos períodos pré e pós-operatório. Métodos: foram avaliados 54 pacientes com média de idade de 26 anos (16 a 49 anos), submetidos à simpatectomia em nível R3-R4. Dois questionários foram aplicados em três momentos diferentes: "Qualidade de vida em pacientes com hiperidrose primária e "Escala para ansiedade e depressão". Resultados: dos pacientes estudados, 93% mostrou melhora significativa na qualidade de vida após 30 dias da cirurgia, com os efeitos remanescentes após seis meses. Não houve complicações pós-operatórias. A análise mostrou que o nível de ansiedade do paciente é altamente correlacionado com a intensidade da sudorese reflexa após 30 e 180 dias. Conclusão: a simpatectomia torácica por videotoracoscopia melhora a qualidade de vida de pacientes com hiperidrose primária, mesmo com o surgimento de sudorese reflexa. A ansiedade está diretamente relacionada com a intensidade da sudorese reflexa, sem comprometer o grau de satisfação do paciente.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Ansiedade/epidemiologia , Qualidade de Vida , Reflexo , Sudorese , Simpatectomia/métodos , Toracoscopia , Depressão/epidemiologia , Hiperidrose/cirurgia , Ansiedade/complicações , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Depressão/complicações , Hiperidrose/complicações , Pessoa de Meia-IdadeRESUMO
INTRODUÇÃO: As neoplasias pulmonares podem causar deterioração na função pulmonar e capacidade funcional, prejudicando a evolução do paciente após cirurgia de ressecção. OBJETIVO: Avaliar a força muscular respiratória, a função pulmonar e a capacidade funcional de pacientes no pré-operatório de ressecção pulmonar por neoplasia, comparar aos valores de normalidade e por estadiamento. MÉTODOS: Foram incluídos pacientes na faixa etária de 30 a 80 anos com diagnóstico de neoplasia de pulmão que aguardavam cirurgia de ressecção pulmonar. A avaliação pré-operatória incluiu medida de força muscular respiratória por manovacuometria, função pulmonar por espirometria e capacidade funcional pelo teste de caminhadados seis minutos (TC6). Os valores obtidos foram comparados aos valores preditos pela literatura e comparados os estadiamentos inicial e avançado. RESULTADOS: Foram avaliados 59 pacientes com idade média de 58,5±9,46 anos. Houve diferença estatisticamente significante entre obtido e predito, respectivamente, para os valores de pressão expiratória máxima (PEmáx): 91 e 111,8 cmH2O; capacidade vital forçada (CVF): 3,14 e 4,08 L; volume expiratório forçado no primeiro segundo (VEF1): 2,42 e 3,12 L; razão VEF1/CVF: 75 e 101%; e capacidade funcional: 453,9 e 562,9 m, sendo que os pacientes apresentaram valores inferiores aos preditos pela literatura, exceto a CVF. Não houve diferença para a pressão inspiratória máxima (PImáx): 110 e 102 cmH2O. Entre os grupos de estadiamento houve diferença apenas para a CVF (inicial: 2,89; avançado: 3,41 L). CONCLUSÃO: Os pacientes com diagnóstico de neoplasia pulmonar em pré-operatório de ressecção possuem prejuízos na força muscular expiratória, na função pulmonar e na capacidade funcional.
INTRODUCTION: Lung cancer can cause deterioration in lung function and functional capacity, impairing patient outcome after resection. OBJECTIVE: To evaluate the respiratory muscle strength, lung function and functional capacity of patients in preoperative of lung resection for cancer, compared to normal values and staging. METHODS: Patients of both genders were includedaged 30-80 years with a diagnosis of lung cancer awaiting pulmonary resection surgery. Preoperative evaluation included measurement of respiratory muscle strength by manometer, lung function by spirometry and functional capacity through the sixminute walk test (6MWT). The values obtained were compared with predicted values obtained from equations proposed in the literature and compared the staging initial and advanced.RESULTS: 59 patients with a mean age of 58.5±9.46 years were evaluated. There was a statistically significant difference between the obtained and the predicted values for maximum expiratory pressure (MEP): respectively 91 and 111.8 cmH2O, forced vital capacity (FVC): 3.14 and 4.08 L; forced expiratory volume in the first second (FEV1): 2.42 and 3.12 L; FEV1/FVC:75 and 101%; and functional capacity: 453.9 and 562.9 m, in which the patients had lower values than those predicted by the literature, except FVC. There was no difference for inspiratory muscle strength (MIP: 110 and 102 cmH2O). Among the groups of patients only showed a difference of FVC (initial: 2.89; advanced: 3.41 L). CONCLUSION: Patients diagnosed with lung cancer in preoperative of resection, have impairments in expiratory musclestrength, lung function and functional capacity.
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Humanos , Masculino , Feminino , Neoplasias Pulmonares , Período Pré-Operatório , Testes de Função RespiratóriaRESUMO
PURPOSE: To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating. METHODS: Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy. RESULTS: The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants. CONCLUSION: Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.
Assuntos
Cerâmica/uso terapêutico , Implantes Experimentais , Osseointegração/fisiologia , Crânio/cirurgia , Titânio/uso terapêutico , Animais , Fosfatos de Cálcio , Cerâmica/química , Materiais Revestidos Biocompatíveis , Masculino , Teste de Materiais , Microscopia Eletrônica de Varredura , Ratos Wistar , Reprodutibilidade dos Testes , Espectrometria por Raios X , Propriedades de Superfície , Fatores de Tempo , Titânio/química , Resultado do TratamentoRESUMO
PURPOSE: To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating. METHODS: Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy. RESULTS: The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants. CONCLUSION: Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity. .
Assuntos
Animais , Masculino , Cerâmica/uso terapêutico , Implantes Experimentais , Osseointegração/fisiologia , Crânio/cirurgia , Titânio/uso terapêutico , Fosfatos de Cálcio , Materiais Revestidos Biocompatíveis , Cerâmica/química , Teste de Materiais , Microscopia Eletrônica de Varredura , Ratos Wistar , Reprodutibilidade dos Testes , Espectrometria por Raios X , Propriedades de Superfície , Fatores de Tempo , Resultado do Tratamento , Titânio/químicaRESUMO
PURPOSE:To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating.METHODS:Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy.RESULTS:The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants.CONCLUSION:Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.(AU)
Assuntos
Animais , Ratos , Osseointegração , Titânio , Próteses e Implantes , Materiais Biocompatíveis , Cerâmica , Crânio/lesões , Crânio/transplanteRESUMO
INTRODUCTION: Desmoid tumor (DT) is a common manifestation of Gardner's Syndrome (GS), although it is a rare condition in the general population. DT in patients with GS is usually located in the abdominal wall and/or intra-abdominal cavity. PRESENTATION OF CASE: We report a case of a 32 years-old female patient with familial adenomatous polyposis (FAP), who was already submitted to total colectomy and developed multiple DT, located in the abdominal wall and in the left breast. The patient underwent several surgical procedures, with a multidisciplinary team of surgeons. Wide surgical resections of the left breast and the abdominal wall tumors were performed in separate steps. Polypropylene mesh reconstruction and muscle flaps were needed to cover the defects of the thoracic and abdominal walls. After partial necrosis of the adipose-cutaneous flap in the abdomen that required a new skin graft, she had a satisfactory outcome with complete healing of the surgical incisions. DISCUSSION: DT is frequent in GS, however, breast localization is very rare, with few cases reported in the literature. Recurrence of DT is not negligible, even after a wide surgical resection. GS patients must be followed up closely, and clinical examination, associated with imaging studies, should be performed to detect any signs of tumor. CONCLUSION: DT represents one of the most significant causes of the morbidity and mortality that affects FAP patients following colectomy. In general, the surgical procedures to excise DT are highly complex, requiring a multidisciplinary team.
RESUMO
CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS: There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION: NCT01285648.
Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Pneumonectomia/reabilitação , Adulto , Idoso , Análise de Variância , Dispneia/fisiopatologia , Feminino , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Medição da Dor , Cuidados Pós-Operatórios , Período Pós-Operatório , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
CONTEXT AND OBJECTIVE: Noninvasive mechanical ventilation during the postoperative period (PO) following lung resection can restore residual functional capacity, improve oxygenation and spare the inspiratory muscles. The objective of this study was to assess the efficacy of continuous positive airway pressure (CPAP) associated with physiotherapy, compared with physiotherapy alone after lung resection. DESIGN AND SETTING: Open randomized clinical trial conducted in the clinical hospital of Universidade Estadual de Campinas. METHOD: Sessions were held in the immediate postoperative period (POi) and on the first and second postoperative days (PO1 and PO2), and the patients were reassessed on the discharge day. CPAP was applied for two hours and the pressure adjustment was set between 7 and 8.5 cmH2O. The oxygenation index (OI), Borg scale, pain scale and presence of thoracic drains and air losses were evaluated. RESULTS : There was a significant increase in the OI in the CPAP group in the POi compared to the Chest Physiotherapy (CP) group, P = 0.024. In the CP group the OI was significantly lower on PO1 (P = 0,042), than CPAP group. The air losses were significantly greater in the CPAP group in the POi and on PO1 (P = 0.001, P = 0.028), but there was no significant difference between the groups on PO2 and PO3. There was a statistically significant difference between the groups regarding the Borg scale in the POi (P < 0.001), but there were no statistically significant differences between the groups regarding the pain score. CONCLUSION: CPAP after lung resection is safe and improves oxygenation, without increasing the air losses through the drains. CLINICAL TRIAL REGISTRATION: NCT01285648 .
CONTEXTO E OBJETIVO: A ventilação mecânica não invasiva no período pós-operatório (PO) de ressecção pulmonar pode restaurar a capacidade residual funcional, melhorar a oxigenação e poupar os músculos inspiratórios. O objetivo deste estudo foi avaliar a eficácia da CPAP associada à fisioterapia comparada à fisioterapia unicamente após ressecção pulmonar. ESTUDO E LOCAL: Ensaio clínico randomizado aberto, realizado no Hospital das Clínicas da Universidade Estadual de Campinas. MÉTODO: Os atendimentos foram realizados nos PO imediato (POi), primeiro e segundo (PO1, PO2) dias, e a reavaliação na alta hospitalar. A CPAP foi aplicada durante duas horas e o ajuste pressórico estabelecido entre 7 e 8,5 cmH2O. Foram analisados índice de oxigenação (IO), escala de Borg e de dor, presença e perda aérea dos drenos torácicos. RESULTADOS: No grupo CPAP ocorreu aumento significativo do IO no POi (P = 0,024), comparado com o grupo fisioterapia respiratória. Houve redução significativa do IO no PO1 (P = 0,042) para o grupo fisioterapia respiratória, comparando-se à CPAP. A perda aérea foi significativamente maior para o grupo CPAP no POi e PO1 (0,001; 0,028), mas nos PO2 e no PO3 não houve diferença significativa entre os grupos. Foi verificada diferença significativa entre os grupos para a escala de Borg no POi (P < 0,001), porém para a escala de dor não foram verificadas diferenças significativas entre os grupos. CONCLUSÃO: A CPAP após ressecção pulmonar é segura e melhora a oxigenação sem aumentar a perda aérea pelos drenos. REGISTRO DE ENSAIO CLÍNICO: NCT01285648 .
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pressão Positiva Contínua nas Vias Aéreas/métodos , Pneumonectomia/reabilitação , Análise de Variância , Dispneia/fisiopatologia , Pulmão/fisiopatologia , Oxigênio/sangue , Medição da Dor , Cuidados Pós-Operatórios , Período Pós-Operatório , Testes de Função Respiratória , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases. .
OBJETIVO: Descrever características demográficas, resultados operatórios, complicações pós-operatórias e taxa de sobrevida global em pacientes com metástases pulmonares tratados cirurgicamente. MÉTODOS: Análise retrospectiva de 119 pacientes submetidos a um total de 154 cirurgias de ressecção de metástase pulmonar entre 1997 e 2011. RESULTADOS: Do total de 119 pacientes, 68 (57,1%) eram do sexo masculino, e 108 (90,8%) eram brancos. A mediana de idade foi de 52 anos (variação, 15-75 anos). Nessa amostra, 63 pacientes (52,9%) apresentaram comorbidades, sendo as mais frequentes hipertensão arterial sistêmica (69,8%) e diabetes (19,0%). Tumores primários colorretais (47,9%) e musculoesqueléticos (21,8%) foram os principais sítios de origem das metástases. Aproximadamente 24% dos pacientes foram submetidos a mais de uma ressecção das lesões, e 71% fizeram tratamento adjuvante prévio à metastasectomia. A taxa de recidiva de metástase pulmonar foi de 19,3%. A mediana do intervalo livre de doença foi de 23 meses. A principal via de acesso usada foi toracotomia (78%), e o tipo de ressecção mais frequente foi em cunha e segmentectomia (51%). O índice de complicações pós-operatórias foi de 22% e o de mortalidade perioperatória foi de 1,9%. As taxas de sobrevida global em 12, 36, 60 e 120 meses foram, respectivamente, de 96%, 77%, 56% e 39%. A análise de Cox confirmou que complicações nos primeiros 30 dias pós-operatórios associaram-se a pior prognóstico (hazard ratio = 1,81; IC95%: 1,09-3,06; p = 0,02). CONCLUSÕES: O tratamento cirúrgico das metástases pulmonares oriundas de diferentes sítios tumorais é efetivo e seguro, com boa sobrevida global, especialmente nos casos com um menor número de lesões ...
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias Colorretais/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Sarcoma/secundário , Intervalo Livre de Doença , Tempo de Internação , Neoplasias Pulmonares/mortalidade , Recidiva , Taxa de Sobrevida , Sarcoma/mortalidade , Sarcoma/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: To investigate the anti-inflammatory effects of simvastatin in rats undergoing one-lung ventilation (OLV) followed by lung re-expansion. METHODS: Male Wistar rats (n=30) were submitted to 1-h OLV followed by 1-h lung re-expansion. Treated group received simvastatin (40 mg/kg for 21 days) previous to OLV protocol. Control group received no treatment or surgical/ventilation interventions. Measurements of pulmonary myeloperoxidase (MPO) activity, pulmonary protein extravasation, and serum levels of cytokines and C-reactive protein (CRP) were performed. RESULTS: OLV significantly increased the MPO activity in the collapsed and continuously ventilated lungs (31% and 52% increase, respectively) compared with control (p<0.05). Treatment with simvastatin significantly reduced the MPO activity in the continuously ventilated lung but had no effect on lung edema after OLV. The serum IL-6 and CRP levels were markedly higher in OLV group, but simvastatin treatment failed to affect the production of these inflammatory markers. Serum levels of IL-1ß, TNF-α and IL-10 remained below the detection limit in all groups. CONCLUSIONS: In an experimental one-lung ventilation model pre-operative treatment with simvastatin reduces remote neutrophil infiltration in the continuously ventilated lung. Our findings suggest that simvastatin may be of therapeutic value in OLV-induced pulmonary inflammation deserving clinical investigations.
Assuntos
Anti-Inflamatórios/farmacologia , Infiltração de Neutrófilos/efeitos dos fármacos , Ventilação Monopulmonar/métodos , Sinvastatina/farmacologia , Animais , Anti-Inflamatórios/uso terapêutico , Proteína C-Reativa/análise , Citocinas/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Modelos Animais , Peroxidase/fisiologia , Distribuição Aleatória , Ratos , Ratos Wistar , Reprodutibilidade dos Testes , Sinvastatina/uso terapêutico , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
PURPOSE: To investigate the anti-inflammatory effects of simvastatin in rats undergoing one-lung ventilation (OLV) followed by lung re-expansion. METHODS: Male Wistar rats (n=30) were submitted to 1-h OLV followed by 1-h lung re-expansion. Treated group received simvastatin (40 mg/kg for 21 days) previous to OLV protocol. Control group received no treatment or surgical/ventilation interventions. Measurements of pulmonary myeloperoxidase (MPO) activity, pulmonary protein extravasation, and serum levels of cytokines and C-reactive protein (CRP) were performed. RESULTS: OLV significantly increased the MPO activity in the collapsed and continuously ventilated lungs (31% and 52% increase, respectively) compared with control (p<0.05). Treatment with simvastatin significantly reduced the MPO activity in the continuously ventilated lung but had no effect on lung edema after OLV. The serum IL-6 and CRP levels were markedly higher in OLV group, but simvastatin treatment failed to affect the production of these inflammatory markers. Serum levels of IL-1β, TNF-α and IL-10 remained below the detection limit in all groups. CONCLUSIONS: In an experimental one-lung ventilation model pre-operative treatment with simvastatin reduces remote neutrophil infiltration in the continuously ventilated lung. Our findings suggest that simvastatin may be of therapeutic value in OLV-induced pulmonary inflammation deserving clinical investigations.
Assuntos
Animais , Masculino , Ratos , Anti-Inflamatórios/farmacologia , Infiltração de Neutrófilos/efeitos dos fármacos , Ventilação Monopulmonar/métodos , Sinvastatina/farmacologia , Anti-Inflamatórios/uso terapêutico , Proteína C-Reativa/análise , Citocinas/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Modelos Animais , Peroxidase/fisiologia , Distribuição Aleatória , Ratos Wistar , Reprodutibilidade dos Testes , Sinvastatina/uso terapêutico , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/métodosRESUMO
OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.
Assuntos
Neoplasias Colorretais/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Sarcoma/secundário , Adolescente , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Neoplasias Pulmonares/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Sarcoma/mortalidade , Sarcoma/cirurgia , Taxa de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: To investigate the anti-inflammatory effects of simvastatin in rats undergoing one-lung ventilation (OLV) followed by lung re-expansion. METHODS: Male Wistar rats (n=30) were submitted to 1-h OLV followed by 1-h lung re-expansion. Treated group received simvastatin (40 mg/kg for 21 days) previous to OLV protocol. Control group received no treatment or surgical/ventilation interventions. Measurements of pulmonary myeloperoxidase (MPO) activity, pulmonary protein extravasation, and serum levels of cytokines and C-reactive protein (CRP) were performed. RESULTS: OLV significantly increased the MPO activity in the collapsed and continuously ventilated lungs (31% and 52% increase, respectively) compared with control (p<0.05). Treatment with simvastatin significantly reduced the MPO activity in the continuously ventilated lung but had no effect on lung edema after OLV. The serum IL-6 and CRP levels were markedly higher in OLV group, but simvastatin treatment failed to affect the production of these inflammatory markers. Serum levels of IL-1β, TNF-α and IL-10 remained below the detection limit in all groups. CONCLUSIONS: In an experimental one-lung ventilation model pre-operative treatment with simvastatin reduces remote neutrophil infiltration in the continuously ventilated lung. Our findings suggest that simvastatin may be of therapeutic value in OLV-induced pulmonary inflammation deserving clinical investigations.(AU)