RESUMO
BACKGROUND: Local excision (LE) after chemoradiotherapy is a new option in low rectal cancer, but morbidity has never been compared prospectively with total mesorectal excision (TME). Early and late morbidity were compared in patients treated either by LE or TME after neoadjuvant chemoradiotherapy for rectal cancer. METHOD: This was a post-hoc analysis from a randomized trial. Patients with clinical T2/T3 low rectal cancer with good response to the chemoradiotherapy and having either LE, LE with eventual completion TME, or TME were considered. Early (1 month) and late (2 years) morbidities were compared between the three groups. RESULTS: There were no deaths following surgery in any of the three groups. Early surgical morbidity (20 per cent LE versus 36 per cent TME versus 43 per cent completion TME, P = 0.025) and late surgical morbidity (4 per cent versus 33 per cent versus 57 per cent, P < 0.001) were significantly lower in the LE group than in the TME or the completion TME group. of LE, was associated with the lowest rate of early (10 versus 18 versus 21 per cent, P = 0.217) and late medical morbidities (0 versus 7 versus 7 per cent, P = 0.154), although this did not represent a significant difference between the groups. The severity of overall morbidity was significantly lower at 2 years after LE compared with TME or completion TME (4 versus 28 versus 43 per cent grade 3-5, P < 0.001). CONCLUSION: The rate of surgical complications after neoadjuvant chemoradiotherapy in the LE group was half that of TME group at 1 month and 10 times lower at 2 years. LE is a safe approach for organ preservation and should be considered as an alternative to watch-and-wait in complete clinical responders and to TME in subcomplete responders.
Assuntos
Neoplasias Retais , Quimiorradioterapia/efeitos adversos , Humanos , Morbidade , Estadiamento de Neoplasias , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Resultado do TratamentoRESUMO
We present a microfluidic platform that allows undergoing different chemical operations in a nanoliter droplet starting from the colloidal suspension of magnetic iron oxide (γ-Fe2O3) nanoparticles "NPs" (ferrofluid). These operations include: mixing, flocculation, magnetic decantation, colloidal redispersion, washing, surface functionalization, heating and colloidal assembly. To prove the platform capabilities, we produced fluorescent and magnetic nanoassemblies composed of fluorescent silica and magnetic NPs.
RESUMO
Calmette is a national university hospital with 220 adult beds. It has emergency, surgical, medical and gynecology and obstetrics departments, along with a radiology unit, a laboratory for medical analyses, a central pharmacy and an outpatient clinic. This hospital has an unusual statute, with managerial autonomy and a system of cost recovery that currently provides 64% of the hospital's income. Since 1994, it has benefited from a French cooperation program. The French NGO, Médecins du Monde, has been present at Calmette since 1990, providing support for <
Assuntos
Sistemas de Informação Hospitalar , Hospitais Gerais , Adulto , Camboja , Feminino , França , Humanos , Cooperação Internacional , Masculino , Sistemas Computadorizados de Registros MédicosRESUMO
The obstetrical referral patients admitted to the Sanon Souro hospital in Bobo-Dioulasso (Burkina Faso) during 1991 were retrospectively reviewed. During the study period 741 women were admitted. The median distance between the referring centre and Bobo-Dioulasso was 33 km. Median age was 22 years and median parity was 3. Indications for referral were dominated by obstructed labour, haemorrhages and infections. The proportion of maternal mortality in the study was 5.4% and was not related to maternal age or parity. However, there was a linear trend of increasing mortality according to the distance between the referring centre and Bobo-Dioulasso (X2 for trend: 7.56; p = 0.006). The perinatal mortality rate of 420 p. thousand was not related to maternal age, but a parity exceeding 4 was a risk factor for the occurrence of perinatal death (relative risk: 1.4; 95% C.I.: 1.2-1.7). As for maternal mortality, there was a linear increase of perinatal mortality with the distance from the referring centre (X2: 20.8; p = 0.00001). There was no marked seasonal variation in the number of referrals nor in the mortality rates per month.
Assuntos
Mortalidade Infantil , Mortalidade Materna , Adulto , Burkina Faso , Demografia , Feminino , Hospitalização , Humanos , Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/mortalidade , Encaminhamento e Consulta , Transporte de PacientesRESUMO
The 1986-87 outbreak of paralytic poliomyelitis in Senegal, with 676 reported cases, provided an opportunity to evaluate the efficacy of an enhanced-potency inactivated poliovirus vaccine (N-IPV) in the Kolda region, where this vaccine has been used since 1980. 89 cases, confirmed to have poliomyelitis with residual paralysis, were enrolled in a case-control study, up to 5 matched controls being obtained for each case. The clinical efficacy for one dose of N-IPV was 36% (95% confidence interval 0%, 67%) and for two doses was 89% (95% CI 62%, 97%).