RESUMO
Acinetobacter baumannii is a major cause of healthcare-associated infection, often affecting critically ill patients. The purpose of the study was to examine the associations of carbapenem resistance with mortality, length of hospital stay and hospital costs among patients infected with A. baumannii in intensive-care units (ICUs) in Colombia. A prospective, multicentre cohort study was conducted among 165 patients with A. baumannii infection admitted to ICUs between April 2006 and April 2010. Patients with carbapenem-resistant A. baumannii had higher risk of 30-day mortality than patients with carbapenem-susceptible A. baumannii in the univariate analysis (unadjusted hazard ratio = 2.12; 95% CI 1.14-3.95; p 0.018). However, carbapenem resistance was not significantly associated with risk of mortality (adjusted hazard ratio = 1.45; 95% CI 0.74-2.87; p 0.28) after adjusting for APACHE II score and other confounding factors. We did not find a significant difference in length of stay in ICU after the onset of infection between the two groups in the multivariate analysis (adjusted mean = 13.1 days versus 10.5 days; p 0.14). The average total cost of hospitalization among patients with carbapenem-resistant A. baumannii was significantly higher than that among patients with carbapenem-susceptible A. baumannii in the multivariate analysis (adjusted cost; US$ 11 359 versus US$ 7049; p <0.001). Carbapenem resistance was not significantly associated with mortality, though we are unable to rule out an increased risk due to the limited sample size. Carbapenem resistance was associated with an additional cost of hospitalization.
Assuntos
Infecções por Acinetobacter/economia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Carbapenêmicos/farmacologia , Custos de Cuidados de Saúde , Resistência beta-Lactâmica , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Colômbia , Infecção Hospitalar/economia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Acinetobacter baumannii has emerged as a major cause of healthcare-associated infections. Controversy exists as to whether antimicrobial resistance increases the risk of mortality. We conducted a systematic review and meta-analysis to examine this association. We searched MEDLINE and EMBASE databases up to May 2013 to identify studies comparing mortality in patients with carbapenem-resistant A. baumannii (CRAB) vs. carbapenem-susceptible A. baumannii (CSAB). A random-effects model was used to pool Odds Ratios (OR). Heterogeneity was examined using I(2). We included 16 observational studies. There were 850 reported deaths (33%) among the 2546 patients. Patients with CRAB had a significantly higher risk of mortality than patients with CSAB in the pooled analysis of crude effect estimates (crude OR = 2.22; 95% CI = 1.66, 2.98), although substantial heterogeneity was evident (heterogeneity I(2) = 55%). The association remained significant in the pooled adjusted OR of 10 studies. Studies reported that patients with CRAB compared to patients with CSAB were more likely to have severe underlying illness and also to receive inappropriate empirical antimicrobial treatment, which increases the risk of mortality. Our study suggests that carbapenem resistance may increase the risk of mortality in patients with A. baumannii infection. However, cautious interpretation is required because of the residual confounding factors and inadequate sample size in most studies.
Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Farmacorresistência Bacteriana , HumanosRESUMO
Objetivo. El artículo presenta la propuesta teórico-metodológica que, a partir de elementos ya trabajados previamente, se construyó durante la primera fase de un proyecto de largo alcance que busca elaborar una historia comparada de la medicina y la salud pública en América Latina. Metodología. Para exponer dicha propuesta, en un primer momento se elabora un breve balance historiográfico de la literatura existente sobre la historia de la medicina y de la salud pública en América Latina; en un segundo momento, se plantea una reconfiguración del concepto de 'campo de la salud', basada en un análisis crítico del concepto, y que se va perfilando como el marco de referencia para un programa de investigación en estudios sociales de la salud de largo plazo, en la Universidad del Rosario, programa en el cual se enmarca este proyecto comparativo; y, en un tercer momento, se presentan los lineamientos generales de la propuesta sobre la que se sustentará el proyecto. Resultados: Como resultado final se presenta una matriz que se estructuró a partir de todos los elementos teórico-metodológicos articulados en este estudio historiográfico. Dicha matriz está compuesta de nueve atributos y sus correspondientes categorías, que se utilizarán para llevar a cabo la segunda fase del proyecto comparativo de la historia de la medicina y la salud pública. La matriz se usará tanto para guiar la búsqueda de la información histórica como para llevar a cabo el análisis y la comparación conclusión.
The article shows the theoretical and methodological proposal that, grounded in previous studies, was built during the first phase of a long-term project that seeks to develop a comparative history of medicine and public health in Latin America. For laying out purposes, this article initially develops a brief historiographical overview of the literature on the history of medicine and public health in Latin America. It then proposes a reconfiguration of the 'health field' concept, based on a critical analysis of the concept, that begins to appear as a framework for a long term program of Social Studies of Health Research in El Rosario University, in which this comparative proposal is articulated. In a third moment, the article presents the general outlines of the proposal. As a final result, it presents a matrix to be used in the second phase of the comparative project of the history of medicine and public health in Latin America. It was structured upon all the theoretical and methodological elements discussed in this historiography study. This matrix was composed by nine attributes and their corresponding categories, which will be used as a guide to gather the historical records and to do the respective analysis and comparison.
Objetivo. O artigo apresenta a proposta teórico-metodológica que, a partir de elementos já trabalhados previamente, se construiu durante a primeira fase de um projeto de longo alcance que busca elaborar uma história comparada da medicina e a saúde pública na América Latina. Metodologia. Para expor dita proposta, em um primeiro momento elabora-se um breve balanço historiográfico da literatura existente sobre a história da medicina e da saúde pública na América Latina;em um segundo momento expõe-se uma reconfiguração do conceito de "campo da saúde", baseada em uma análise crítica do conceito, e que vai-se perfilando como o marco de referência para um Programa de Pesquisa em Estudos Sociais da Saúde de longo prazo, na Universidad del Rosario, programa no qual moldura-se este Projeto Comparativo; e em um terceiro momento, se apresentam os lineamentos gerais da proposta sobre a que se sustentará o Projeto. Resultados. Como resultado final apresenta-se uma matriz que se estruturou a partir de todos os elementos teórico-metodológicos articulados neste estudo historiográfico. Dita matriz está composta de nove atributos e suas categorias correspondentes, que se utilizarão para levar a cabo a segunda fase do projeto comparativo da história da medicina e a saúde pública. A matriz se usará tanto para guiar a busca da informação histórica quanto para levar a cabo a análise e a comparação.
Assuntos
Humanos , História da Medicina , Estudo Comparativo , Saúde Pública , Ciências da Saúde , Historiografia , MedicinaRESUMO
The analysis of polymorphic markers within or closely linked to the cystic fibrosis transmembrane regulator (CFTR) gene is useful as a molecular tool for carrier detection of known and unknown mutations. To establish the association between mutations in the CFTR gene in western Mexican cystic fibrosis (CF) patients, the distribution of XV2c/KM19 haplotypes was analyzed by PCR and restriction enzyme digestion in 384 chromosomes from 74 CF patients, their unaffected parents, and normal subjects. The haplotype analysis revealed that haplotype B was present in 71.9% of CF chromosomes compared to 0% of non-CF chromosomes. The F508del and G542X mutations were strongly associated with haplotype B (96.7% and 100% of chromosomes, respectively). The haplotype distribution of the CF chromosomes carrying other CFTR mutations had a more heterogeneous background. Our results show that haplotype B is associated with CFTR mutations. Therefore, haplotype analysis is a suitable alternate strategy for screening CF patients with a heterogeneous clinical picture from populations with a high molecular heterogeneity where carrier detection programs are not available. In addition, it may be a helpful diagnostic tool for genetic counseling and carrier detection in the relatives of CF patients and in couples who are planning to have children.
Assuntos
Regulador de Condutância Transmembrana em Fibrose Cística/genética , Fibrose Cística/genética , Mutação Puntual , Adulto , Feminino , Frequência do Gene , Aconselhamento Genético , Testes Genéticos , Haplótipos , Humanos , Lactente , Recém-Nascido , Masculino , México , Pessoa de Meia-IdadeRESUMO
AIM: To review a series of neurological problems that we frequently encounter in our day-to-day clinical practice and which are difficult to diagnose correctly because of the type of presenting symptoms and clinical features they have. DEVELOPMENT: In spite of the fact that a good patient record and detailed neurological examination are still essential, use of long-term (LT) video-EEG monitoring is sometimes indispensable given the ambiguity of the clinical signs and symptoms. Selected subjects were young adult patients of both sexes who had been referred to the Epilepsy Unit at our hospital for study, due to the existence of doubts about their diagnosis. A detailed patient record was drawn up for each patient, and they were also submitted to a neurological examination and LT video-EEG monitoring, which lasted between two and six days. In some of these patients, the diagnosis was modified following their admission and important changes were introduced in their treatment. CONCLUSIONS: LT video-EEG is an important test when it comes to establishing a correct neurological diagnosis in patients with mixed or poorly defined clinical symptoms.
Assuntos
Epilepsia/diagnóstico , Adulto , Feminino , Humanos , Masculino , SíndromeRESUMO
BACKGROUND AND OBJECTIVES: Although the use of drugs which damage stem cells is common in patients with Hodgkin's disease (HD), factors affecting peripheral blood progenitor cell (PBPC) mobilization have not been clearly established in this group of patients. The aim of this study was to identify factors associated with poor PBPC mobilization in patients with HD. DESIGN AND METHODS: In order to address this issue we have evaluated in 54 patients with HD mobilized with G-CSF alone the following factors: sex, age, histologic subtype, B symptoms at diagnosis, status of remission, previous chemotherapy and radiotherapy, interval from diagnosis and last chemotherapy cycle to harvest, and dose of G-CSF. Univariate analysis was performed using Student's t-test, Pearson's correlation and Spearman's correlation. A stepwise regression model was used to determine which of the variables was the most predictive of PBPC mobilization. RESULTS: In univariate analysis poorer PBPC mobilization was observed in patients who had previously received at least two courses of mini-BEAM (p=0.006), a high number of different chemotherapy regimens (p=0.002), a chemotherapy score >30 (p=0.02) and more than 9 months of alkylating agents (p=0.07). We did not find radiotherapy to be a significant factor affecting progenitor cell yield (p=0.59). In the stepwise regression model, only the previous administration of two or more mini-BEAM cycles predicted a poor PBPC yield (p=0.006). INTERPRETATION AND CONCLUSIONS: Previous chemotherapy, principally exposure to a mini-BEAM regimen, seems to be the principal factor affecting collection of PBPC in patients with HD mobilized with G-CSF alone. Since mini-BEAM is an effective salvage regimen in relapsed or refractory HD, collection of PBPC should be planned when there has been no or only minimal exposure to a mini-BEAM regimen.
Assuntos
Mobilização de Células-Tronco Hematopoéticas/normas , Doença de Hodgkin/terapia , Adolescente , Adulto , Antineoplásicos/efeitos adversos , Feminino , Doença de Hodgkin/diagnóstico , Humanos , Leucaférese/normas , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de RiscoAssuntos
Medula Óssea/patologia , Leucemia Monocítica Aguda/diagnóstico , Muramidase/urina , Síndrome Nefrótica/diagnóstico , Proteinúria , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Leucemia Monocítica Aguda/tratamento farmacológico , Leucemia Monocítica Aguda/patologia , Leucemia Monocítica Aguda/urina , Masculino , Muramidase/sangue , Síndrome Nefrótica/urina , Indução de RemissãoAssuntos
Globinas/genética , Mutação/genética , Cromossomos Humanos Par 16/genética , Análise Mutacional de DNA , Sondas de DNA , Saúde da Família , Hemoglobina H/genética , Hemoglobinúria/sangue , Hemoglobinúria/etnologia , Hemoglobinúria/genética , Humanos , Espanha/epidemiologia , Espanha/etnologia , Talassemia alfa/sangue , Talassemia alfa/etnologia , Talassemia alfa/genéticaRESUMO
Veno-occlusive disease of the liver (VOD) is an important complication in hematological transplantation. The aim of this study is to analyze the risk factors for VOD and other forms of liver toxicity in a cohort of 180 peripheral stem cell transplants performed in our Center. We find that elevated pretransplant levels of serum ferritin are the most important risk marker for VOD. We believe that ferritin reflects damage induced by oxygen radicals resulting from iron-mediated catalysis. We also discuss different risk factors for VOD and other forms of liver toxicity, suggesting diferent pathogenic mechanisms.
RESUMO
In order to assess the potential clinical benefit of filgrastim (G-CSF) after peripheral blood stem cell (PBSC) autotransplantation a randomized study was begun in our center in July 1997: 62 patients were involved (30 received filgrastim after PBSC infusion and 32, the control group, received no cytokines). All were adults (median 40 years, range 18-65). Patients with one of three different pathologies were recruited: 28 had advanced breast carcinoma, 23 had lymphomas (12 Hodgkin's disease and 11 non-Hodgkin's lymphoma) and 11 had de novo AML. All of them were transplanted using myeloablative chemotherapy conditioning regimens. G-CSF was administered subcutaneously from day +5 in the treated group at a dose of 5 microg/kg body weight/day. The numbers of CD34+ and mononuclear (MNC) cells infused were similar in each group. Only minor differences regarding the use of G-CSF could be inferred from the analysis of the data. Faster granulocyte engraftment was evident in the treated group (mean of 10 vs 12 days to achieve >0.5 x 109/l granulocytes, P = 0.0008), without differences in incidence and severity of infections, days of fever or duration of antibiotic treatment between groups. There was slightly slower platelet engraftment (mean of 15 days in the group with G-CSF vs 12 days in the other group to achieve >20 x 109/l platelets, P = NS) in this series, but there were no differences in incidence and severity of haemorrhage or platelet transfusion support. Considering the economical costs, the median expenditure per inpatient stay was Eur5961 (range Eur4386-Eur17186) in the G-CSF group compared with Eur5751 (range Eur3676-Eur15640) in the control group (P = 0.47). From our data it could be concluded that for adult patients transplanted with PBSC there is no clear beneficial impact of post-infusion G-CSF administration.
Assuntos
Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Adolescente , Adulto , Idoso , Custos e Análise de Custo , Feminino , Hematopoese , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hemorragia/etiologia , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Transplante AutólogoAssuntos
Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas , Neoplasias/terapia , Adulto , Criança , Filgrastim , Humanos , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Proteínas Recombinantes , Reprodutibilidade dos Testes , Projetos de Pesquisa , Resultado do TratamentoRESUMO
Physicians may administer intravenous dyes to patients, most commonly to delineate vascular or urinary anatomy, without an appreciation of the potential hazards associated with these compounds. We report two cases in which skin eruptions followed the intravenous administration of the dyes fluorescein and methylene blue; these eruptions were the same colors as the dyes. In our first patient, urticaria, which was yellowish in color and fluorescent under a Wood's lamp, occurred after the administration of fluorescein. In the second patient, painful blue macules appeared randomly on the forearm within 15 seconds after methylene blue was injected into a free-flowing intravenous cannula on the dorsal aspect of the hand.
Assuntos
Corantes/efeitos adversos , Toxidermias/etiologia , Fluoresceína/efeitos adversos , Azul de Metileno/efeitos adversos , Urticária/induzido quimicamente , Adulto , Toxidermias/patologia , Humanos , MasculinoRESUMO
Veno-occlusive disease of the liver (VOD) is an important complication in hematological transplantation. The aim of this study is to analyze the risk factors for VOD and other forms of liver toxicity in a cohort of 180 peripheral stem cell transplants performed in our Center. We find that elevated pretransplant levels of serum ferritin are the most important risk marker for VOD. We believe that ferritin reflects damage induced by oxygen radicals resulting from iron-mediated catalysis. We also discuss different risk factors for VOD and other forms of liver toxicity, suggesting diferent pathogenic mechanisms.
RESUMO
Primary epiploic appendicitis include torsion and primary inflammation of appendices epiploicae. These uncommon pathologies have been until present exceptionally diagnosed before surgery. Clinical and biological features have a small specificity. However, US and CT findings suggest the diagnosis. Our study reports 6 cases.
Assuntos
Abdome Agudo/etiologia , Colo , Doenças do Colo/diagnóstico , Abdome Agudo/diagnóstico , Abdome Agudo/diagnóstico por imagem , Adulto , Idoso , Criança , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Anormalidade Torcional , UltrassonografiaRESUMO
A simplified cryopreservation method for bone marrow (BM) and peripheral blood progenitor cells (PBPC) was utilized in hematopoietic cell transplantation of 213 patients with hematological or solid neoplasms after ablative chemotherapy (187 with peripheral blood progenitor cells and 26 with bone marrow). Cells were cryopreserved, after addition of autologous fresh plasma with DMSO, without HES, by freezing to -80 degrees C in a methanol bath and non-programmed freezer. For the patients autotransplanted with PBPC, the median period necessary for recovery of more than 0.5 x 10(9)/l granulocytes was 11 days (range 6-44), and 15 (8-204) days were required to obtain more than 20 x 10(9)/l platelets. For the patients autotransplanted with BM, the median period necessary to recover >0.5 x 10(9)/l granulocytes was 12 days (range 9-33), and 24 (12-57) days to obtain more than 20 x 10(9)/l platelets. These results support this method as being very effective in achieving high-quality cryopreservation. The procedure, which uses a non-programmed freezer, simplifies and reduces enormously the cost of the technical measures currently in use, enabling its adoption in almost any clinical oncological institution.
Assuntos
Coleta de Amostras Sanguíneas/métodos , Células da Medula Óssea , Transplante de Medula Óssea/métodos , Criopreservação/métodos , Crioprotetores , Dimetil Sulfóxido , Transplante de Células-Tronco Hematopoéticas/métodos , Derivados de Hidroxietil Amido , Metanol , Substitutos do Plasma , Solventes , Adolescente , Adulto , Idoso , Remoção de Componentes Sanguíneos , Sobrevivência Celular , Criança , Pré-Escolar , Feminino , Células-Tronco Hematopoéticas , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Projetos Piloto , SoftwareRESUMO
The incidence of trisomy 12 and p53 deletion was studied in a group of chronic B-lymphocytic leukemia (B-CLL) patients, using fluorescence in situ hybridization (FISH). Trisomy 12 was detected in eight of 50 patients (16%) and p53 deletion in six of 38 cases analyzed (15.8%). A statistically significant difference was observed between the incidence of trisomy 12 in patients with typical and atypical morphology (3.03% versus 41.18%). No correlation was found between this alteration and the rest of the clinical and biological parameters studied (adenopathies, hepatomegaly, splenomegaly, lymphocyte count, staging, CD11c expression, and resistance to chemotherapy). The p53 deletion was correlated with the presence of hepatomegaly and splenomegaly, advanced stage of disease, and resistance to conventional chemotherapy. The application of FISH to whole blood cell nuclei, without prior manipulation or culture, showed a higher percentage of cells with trisomy 12 than when the method was used following culture. We conclude that 1) FISH is a simple and sensitive technique for the detection of numerical and structural chromosome abnormalities; 2) Its application to uncultured samples obviates the alteration of results originated by the probable growth advantage of the normal or neoplastic cell population in vitro; 3) Trisomy 12 appears to define a B-CLL subgroup of atypical morphology; and 4) The p53 deletion is correlated with advanced stage of disease and resistance to treatment.
Assuntos
Cromossomos Humanos Par 12 , Resistencia a Medicamentos Antineoplásicos/genética , Deleção de Genes , Genes p53 , Leucemia Linfocítica Crônica de Células B/genética , Trissomia , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cosmídeos , Ciclofosfamida/administração & dosagem , Feminino , Humanos , Hibridização in Situ Fluorescente , Interfase , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/patologia , Linfócitos/citologia , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Vincristina/administração & dosagemRESUMO
In this retrospective study the respective values of MRI and CT in the location and nature diagnoses of facial nerve haemangiomas were evaluated. The four male patients examined were 31, 44, 56 and 62 years old; they presented with facial nerve pals and/or cochlear-vestibular dysfunction. The haemangiomas were located in the internal auditory canal, the geniculate ganglion, the tympanic segment of the facial nerve and the petrous bone apex. MRI revealed a tumoral process, while CT showed intratumoral calcifications and provided a diagnosis of mass nature in two cases. In the other cases the pre-operative diagnosis was neurinoma of the VIIIth or VIIth cranial nerve. Histology ascertained the diagnosis. MRI is the method of choice in cases of facial paralysis or cochlear-vestibular dysfunction if a tumoral cause is suspected. Haemangioma is an uncommon tumour without specific image, except for calcifications and neighbouring osseous reactions. It must also be considered on the basis of clinical and topographical findings revealed by CT and MRI imaging.
Assuntos
Neoplasias dos Nervos Cranianos/diagnóstico , Doenças do Nervo Facial/diagnóstico , Hemangioma/diagnóstico , Adulto , Calcinose/diagnóstico , Calcinose/diagnóstico por imagem , Nervo Coclear/patologia , Neoplasias dos Nervos Cranianos/diagnóstico por imagem , Neoplasias dos Nervos Cranianos/patologia , Doenças do Nervo Facial/diagnóstico por imagem , Doenças do Nervo Facial/patologia , Paralisia Facial/diagnóstico , Gânglio Geniculado/patologia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Osso Petroso/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Nervo Vestibular/patologia , Doenças do Nervo Vestibulococlear/diagnósticoRESUMO
A simplified method to remove and cryopreserve peripheral blood stem cells (PBSC) was utilised to restore the bone marrow in 31 patients with haematological or solid neoplasms after ablative chemotherapy. Mobilization was performed with subcutaneous G-CSF, starting 4 days before the first PBSC harvest and continuing to the last day of harvest. Cryopreservation was carried out by freezing cells to -80 degrees C after addition of autologous fresh plasma with DMSO, in a methanol bath and non-programmed freezer. The PBSC were reinfused in all cases. The mean quantity of CD34 cell (x 10(6)/kg) infused was 6.5 +/- 6.7. The mean number of procedures needed to harvest an appropriate number of PBSC was 3.6 +/- 1.3. The mean times necessary to recover more than 0.5 x 10(9)/l granulocytes were 11 +/- 4 (8-30) days and 23 +/- 13 (8-55) days to obtain more than 20 x 10(9)/l platelets. These results confirm our method as very effective in achieving a high-quality harvest, and it was used in paediatric and adult patients without problems. This procedure, using a non-programmed freezer, simplifies and reduces enormously the cost of the technical measures currently used, enabling their adoption in almost any clinical oncological institution.