Efficacy and safety of catheter ablation for atrial fibrillation in elderly patients: a systematic review and meta-analysis.

BACKGROUND: Catheter ablation (CA) is a well-established therapy for patients with atrial fibrillation (AF); however, there is paucity of data for elderly patients. We aimed to assess long-term efficacy and safety of CA for elderly patients with AF. METHODS: Medline, BVS, Cochrane, and Embase were searched through April 2023 to investigate comparative outcomes between elderly patients > 75 or 80 years, as per-study cutoff, and individuals ≤ 75/80 years, undergoing CA. Primary efficacy and safety endpoints (AF recurrence and procedure-related major complications) were pooled with the Comprehensive Meta-Analysis 3.0 software. Subgroup analyses were performed by age groups and type of procedure (radiofrequency vs. cryoballoon). RESULTS: Four thousand eight hundred twenty-nine titles were screened, and 27 studies were included, being 26 observational and 1 randomized trial, comprising 117,869 patients, being 8714 (7.4%) elderly > 75/80 years, with follow-up from 11.7 to 72.3 months. In comparative studies (N = 17 studies), elderly > 75/80 years had a higher risk of AF recurrence compared to those ≤ 75/80: relative risk (RR) 1.16 (95% CI 1.05-1.27, p = 0.002. However, funnel plot indicated publication bias, and after imputation of 5 studies, the groups were similar (RR 1.07 (95% CI 0.97-1.19)). The rates of major complications (N = 14 studies) were higher in elderly > 75/80 years (RR 1.30 (95% CI 1.10-1.54), I2 = 0, p = 0.002), but were similar in cryoablation studies (N = 7) (RR 1.10, 95% CI 0.94-1.29, p = 0.24, I2 = 0.0). Results were similar when individual study arms (N = 27 studies) were pooled. CONCLUSION: AF ablation is feasible in elderly patients > 75/80 years, with success rates compared to younger individuals. Complication rates, however, were higher.

Contribuição da ressonância nuclear magnética para o diagnóstico e tratamento da cardiomiopatia isquêmica / ontribuição da ressonância nuclear magnética para o diagnóstico e tratamento da cardiomiopatia isquêmica

A doença arterial coronária é a primeira causa de mortalidade nos países desenvolvidos e a segunda no nosso país, tendo grande impacto socioeconômico

Câncer de mama com 10 ou mais linfonodos axilares comprometidos / Breast cancer with 10 or more axillary lymph nodes compromised

A presença de comprometimento axilar e o número de linfonodos comprometidos são os fatores pronósticos mais importantes para o câncer de mama feminina. O objetivo do presente estudo foi analisar os fatores associados ao comprometimento axilar, recidiva e sobrevida global em pacientes com câncer de mama que se submeteram a mastectomia e que apresentaram 10 ou mais linfonodos axilares positivos. Foram estudadas 63 pacientes. O seguimento médio foi de 14 meses, apresentando sobrevida global de 79,9%. Em análise multivariada, nenhuma variável foi estatisticamente associada com o comprometimento axilar, enquanto o tamanho do tumor foi fator preditivo da recidiva local (p=0,02). O fator associado à sobrevida global foi recidiva sistêmica (p<0,01). A estratificação das pacientes quanto ao número de linfonodos axilares comprometidos não foi importante para a sobrevida

Lymph node involvement at diagnosis is the most important prognostic factor to breast cancer evolution. The purpose of this study was to analyze factors related to axillary involvement, recurrence and overall survival in patients with breast cancer treated with mastectomy that presented 10 or more involved axillary lymph nodes. A study of 63 patients was carried out. The patients were followed-up to 14 months, revealing 79.9% of overall survival rate. In a multivariate analysis, none of variables were statistically associated with axillary involvement, while tumor size was a predictive factor for local recurrence (p=0.02). The factor associated with overall survival was distant metastasis (p<0.01). The divisions of axillary lymph nodes weren't important for survival

Câncer de mama em homens: estudo retrospectivo de oito casos / Male breast: a retrospective study of eight cases

Câncer de mama em homens é raro e a idade ao diagnóstico é após os 60 anos, embora homens de todas as idades possam ser acometidos. A sua etiologia é desconhecida, porém o desenvolvimento da doença está relacionado à exposiçäo a fatores de risco. Este estudo faz uma análise de oito casos de câncer de mama masculina, enfatizando a idade dos pacientes, tipo de tumos, tratamento, recidiva e sobrevida