RESUMO
BACKGROUND: Therapeutic options for patients with advanced hepatocellular carcinoma (HCC) are limited. There is emerging evidence that the growth of cancer cells may be altered by very low levels of electromagnetic fields modulated at specific frequencies. METHODS: A single-group, open-label, phase I/II study was performed to assess the safety and effectiveness of the intrabuccal administration of very low levels of electromagnetic fields amplitude modulated at HCC-specific frequencies in 41 patients with advanced HCC and limited therapeutic options. Three-daily 60-min outpatient treatments were administered until disease progression or death. Imaging studies were performed every 8 weeks. The primary efficacy end point was progression-free survival î¶6 months. Secondary efficacy end points were progression-free survival and overall survival. RESULTS: Treatment was well tolerated and there were no NCI grade 2, 3 or 4 toxicities. In all, 14 patients (34.1%) had stable disease for more than 6 months. Median progression-free survival was 4.4 months (95% CI 2.1-5.3) and median overall survival was 6.7 months (95% CI 3.0-10.2). There were three partial and one near complete responses. CONCLUSION: Treatment with intrabuccally administered amplitude-modulated electromagnetic fields is safe, well tolerated, and shows evidence of antitumour effects in patients with advanced HCC.
Assuntos
Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Magnetoterapia/métodos , Adolescente , Adulto , Idoso , Algoritmos , Carcinoma Hepatocelular/patologia , Progressão da Doença , Feminino , Humanos , Neoplasias Hepáticas/patologia , Magnetoterapia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Mucosa Bucal , Doses de Radiação , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To test the hypothesis that technology availability, staffing, and diagnostic diversity in an intensive care unit (ICU) are associated with the ability to decrease hospital mortality. DESIGN: Prospective multicenter descriptive cohort study. SETTING: Ten Brazilian medical-surgical ICUs. PATIENTS: 1734 consecutive adult ICU admissions. MEASUREMENTS AND RESULTS: We recorded the amount of technology, number of diagnoses, and availability of nurses at each ICU. We also used demographic, clinical and physiologic information for an average of 173 admissions to each ICU to calculate standardized mortality ratios (SMRs) for each ICU. The mean SMR for the ten ICUs was 1.67 (range 1.01-2.30). A greater availability of ICU equipment and services was significantly (p < 0.001) associated with a lower SMR. CONCLUSION: The ability of Brazilian ICUs to reduce hospital mortality is associated with the amount of technology available in these units.
Assuntos
Cuidados Críticos/organização & administração , Difusão de Inovações , Recursos em Saúde/normas , Mortalidade Hospitalar , Ciência de Laboratório Médico , Qualidade da Assistência à Saúde , Adulto , Brasil , Estudos de Coortes , Pesquisa sobre Serviços de Saúde , Humanos , Avaliação de Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
OBJECTIVE: To compare patients and their outcomes at ten Brazilian intensive care units (ICUs) with those reported from the United States. DESIGN: Prospective multicenter inception cohort study. SETTING: Ten Brazilian adult medical-surgical ICUs. PATIENTS: 1734 consecutive adult ICU admissions. MEASUREMENTS AND RESULTS: We used demographic, clinical and physiologic information and the APACHE III prognostic system to predict risk of hospital death for 1734 ICU admissions. We then divided the observed by the predicted hospital death rate to calculate standardized mortality ratios (SMRs) for patient groups and each ICU. Hospital mortality for Brazilian patients (34%) was double that found in the United States (17%, p < 0.01). Discrimination of survivors from non-survivors using APACHE III was good (area under a receiver operating characteristic curve = 0.82), but the predicted risk of death was significantly (p < 0.0001) lower than observed outcome (SMR = 1.67). Three of the ten Brazilian ICUs, however, had SMRs of 1.01 to 1.1 and no significant difference between observed and predicted outcomes; the remaining seven ICUs had significantly higher SMRs, ranging from 1.50 to 2.30. CONCLUSION: The APACHE III prognostic system was a good discriminator of hospital mortality for ICU admissions at 10 Brazilian ICUs. There was substantial and significant variation, however, in SMRs among the Brazilian ICUs, which suggests that further evaluations of international differences in intensive care using a common risk assessment system should be performed and factors associated with variations in risk-adjusted mortality scrutinized.
Assuntos
APACHE , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Avaliação de Resultados em Cuidados de Saúde , Adulto , Brasil , Distribuição de Qui-Quadrado , Humanos , Prognóstico , Estudos Prospectivos , Qualidade da Assistência à Saúde , Análise de Sobrevida , Estados UnidosAssuntos
Lesões Encefálicas/fisiopatologia , Isquemia Encefálica/fisiopatologia , Cuidados Críticos , Antioxidantes/uso terapêutico , Fenômenos Bioquímicos , Bioquímica , Lesões Encefálicas/metabolismo , Isquemia Encefálica/metabolismo , Classificação , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Estado Terminal/terapia , Endotélio/fisiologia , Humanos , Imunidade Celular , Inflamação , Leucócitos/fisiologia , Biologia Molecular , Óxido Nítrico , Fisiologia , Espécies Reativas de Oxigênio , Pesquisa/tendênciasRESUMO
Although alcoholism is often regarded as an intractable disorder that requires intensive treatment, studies of the natural history of alcoholism indicate that unaided, spontaneous recovery may be the most common pathway to remission from alcoholism. Negative environmental consequences of alcoholic drinking have been invoked to explain spontaneous recovery, but a more compelling reason for sudden changes in drinking behavior concerns shifts in the personal meanings surrounding alcohol use. Extensive interviews in a multimodal format were conducted with two groups of alcoholics: one group comprised of 7 subjects who spontaneously recovered without treatment and the other group comprised of 9 people who believed formal treatment was necessary to abstain from drinking. Spontaneously recovered alcoholics reported experiencing vivid sensations and images at the time they decided to quit drinking, and they reported subsequent transformations of their personal identities. Active alcoholics reported no comparable experiences in imaginal, sensory, and cognitive modalities. Implications of the results for current alcoholism treatments are discussed.
Assuntos
Alcoolismo/psicologia , Transtornos Cognitivos/psicologia , Transtornos Dissociativos/psicologia , Imaginação , Transtornos de Sensação/psicologia , Temperança/psicologia , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/complicações , Alcoolismo/reabilitação , Conscientização , Aconselhamento , Feminino , Humanos , Controle Interno-Externo , Masculino , Teste de RealidadeRESUMO
To define better the temporal relationship between alterations in thyroid hormone metabolism and changes in illness severity, we studied thyroid function in 12 children preoperatively and at 2, 12, 24, 48, and 72 hours after cardiac surgery. We then compared these findings with illness severity as assessed by a modification of the Therapeutic Intervention Scoring System (TISS). All patients had significant (p less than 0.01) reduction in serum T3 (mean 35% of baseline levels) and elevation in serum rT3 (mean 237% of baseline levels) in the postoperative period. Average correlation coefficients for the combined data were as follows: TISS and T3 levels, -0.63 +/- 0.17; TISS and rT3 levels, 0.51 +/- 0.18. Examination of individual patient data normalized to preoperative T3 and rT3 levels and compared with TISS scores demonstrated a lag in alterations of serum rT3 and T3 levels relative to illness severity during recovery from cardiac surgery. We conclude (1) the euthyroid sick syndrome occurs in all pediatric cardiac surgery patients, regardless of procedure complexity, (2) changes in rT3 levels parallel but follow changes in degree of therapeutic intervention, indicating that these alterations result from, and do not cause, increasing severity of illness, (3) rT3 levels return toward normal before T3 levels, which remain low beyond the critical postoperative period, and (4) clinical indicators of illness severity are fairly well inversely correlated with T3 levels, supporting an adaptive reduction in 5'-deiodinase activity during the postoperative period.