RESUMO
Randomised clinical trials (RCTs) are considered the basis of evidence-based medicine. It is recognised more and more that application of RCT results in daily practice of clinical decision-making is limited because the RCT world does not correspond with the clinical real world. Recent strategies aiming at substitution of RCT databases by improved population-based registries (PBRs) or by improved electronic health record (EHR) systems to provide significant data for clinical science are discussed. A novel approach exemplified by the HemoBase haemato-oncology project is presented. In this approach, a PBR is combined with an advanced EHR, providing high-quality data for observational studies and support of best practice development. This PBR + EHR approach opens a perspective on randomised registry trials.
Assuntos
Mineração de Dados/métodos , Registros Eletrônicos de Saúde , Medicina Baseada em Evidências/métodos , Hematologia/métodos , Oncologia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Sistema de Registros , Coleta de Dados , Humanos , Registro Médico CoordenadoAssuntos
Síndrome Nefrótica/diagnóstico , Doenças Retais/patologia , Adulto , Antibacterianos/uso terapêutico , Humanos , Masculino , Síndrome Nefrótica/etiologia , Síndrome Nefrótica/patologia , Penicilina G/uso terapêutico , Proteinúria/tratamento farmacológico , Proteinúria/etiologia , Proteinúria/patologia , Doenças Retais/etiologia , Fatores de Risco , Sífilis/complicações , Sífilis/tratamento farmacológico , Sífilis/patologiaRESUMO
Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive variant of diffuse large B-cell lymphoma with frequent involvement of the central nervous system. Its atypical presentation often delays the diagnosis and due to its aggressive behaviour, the diagnosis is made post-mortem in half of the cases. We report a case of a 67-year-old male patient presenting with speech difficulties and balance disturbances in whom a magnetic resonance imaging (MRI) scan showed multiple lesions of the white matter, denoted as embolic infarctions. He was treated for a suspected endocarditis with antibiotics, but deteriorated neurologically with persistent fever. A consecutive FDG -PET /CT revealed an increased uptake in the adrenals, of which a biopsy showed IVLB CL. The patient was successfully treated with systemic R-CHOP with intrathecal methotrexate and achieved complete remission after six cycles of chemotherapy. The potential role of FDG-PET/CT is illustrated by this case leading to an exceptional diagnosis of IVLBCL.