RESUMEN
OBJECTIVE: Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS: We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS: The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION: A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.
Asunto(s)
Neoplasias Esofágicas/cirugía , Esofagectomía/rehabilitación , Lesiones Precancerosas/cirugía , Anciano , Actitud del Personal de Salud , Actitud Frente a la Salud , Cuidadores/psicología , Atención a la Salud , Neoplasias Esofágicas/psicología , Neoplasias Esofágicas/rehabilitación , Esofagectomía/psicología , Femenino , Humanos , Persona de Mediana Edad , Apoyo Nutricional , Prioridad del Paciente , Modalidades de Fisioterapia , Lesiones Precancerosas/psicología , Lesiones Precancerosas/rehabilitación , Reinserción al Trabajo , Apoyo SocialRESUMEN
The Kaposi sarcoma-associated herpes virus (KSHV) or human herpesvirus 8 (HHV-8) is a gamma-herpesvirus (Rhadinovirus) present in all clinical cases of Kaposi sarcoma (KS). HHV-8 can be transmitted by blood and blood products, as well as in saliva during mother-child transfer. Sexual transmission is also possible although not conclusively proven. Actually the goal of treating KS is to reduce symptoms and, not to produce complete tumor remission. In patients with HIV- and posttransplant-associated KS; an improved immune status is essential. In addition, specific topical or systemic approaches are available. Therapeutic strategies to treat HHV-8 infection, in order to prevent the development of KS are currently investigated.
Asunto(s)
Antineoplásicos/uso terapéutico , Herpesvirus Humano 8 , Inmunosupresores/uso terapéutico , Lesiones Precancerosas , Sarcoma de Kaposi , Humanos , Lesiones Precancerosas/diagnóstico , Lesiones Precancerosas/prevención & control , Lesiones Precancerosas/rehabilitación , Lesiones Precancerosas/virología , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/rehabilitación , Sarcoma de Kaposi/virologíaRESUMEN
BACKGROUND: Atrophic gastritis and intestinal metaplasia are premalignant conditions for gastric cancer. Their reversibility by Helicobacter pylori eradication remains controversial. AIM: To evaluate the reversibility of atrophic gastritis and intestinal metaplasia by H. pylori eradication with long-term follow-up. METHODS: 598 subjects were prospectively enrolled and followed for up to 10 years. They were categorised as H. pylori-negative (n = 65), H. pylori non-eradicated (n = 91), and H. pylori-eradicated (n = 442). Histological assessment was performed for antrum and corpus by Sydney classification. RESULTS: Histological follow-up was performed regularly at 1, 2, 3-4 and ≥5 years, with mean follow-up of 1.07 ± 0.21, 2.29 ± 0.83, 3.93 ± 1.02, and 6.45 ± 1.28 years, respectively. Atrophic gastritis in antrum and corpus gradually and significantly (both P < .05 for all timepoints) improved only in the H. pylori-eradicated group compared to that at baseline. Significant difference in atrophic gastritis between H. pylori-eradicated and H. pylori-negative groups disappeared from 1-year follow-up. Similarly, intestinal metaplasia in antrum and corpus improved significantly (both P < .05 for all timepoints) only in the H. pylori-eradicated group in comparison with that at baseline. Significant difference in intestinal metaplasia between H. pylori-eradicated and H. pylori-negative groups disappeared from ≥5 years of follow-up in the antrum and from 3 years of follow-up in the corpus. CONCLUSION: H. pylori eradication may be a preventative strategy for intestinal-type gastric cancer by regression of atrophic gastritis and intestinal metaplasia.
Asunto(s)
Gastritis Atrófica/rehabilitación , Infecciones por Helicobacter/terapia , Intestinos/patología , Lesiones Precancerosas/rehabilitación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Gastritis Atrófica/microbiología , Gastritis Atrófica/patología , Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/patología , Helicobacter pylori/fisiología , Humanos , Intestinos/microbiología , Masculino , Metaplasia/microbiología , Metaplasia/rehabilitación , Persona de Mediana Edad , Lesiones Precancerosas/microbiología , Recuperación de la Función/fisiología , Factores de Riesgo , Adulto JovenRESUMEN
The outcomes of 18 patients treated with pure laparoscopic management (treated conservatively in 14 patients) of serous borderline ovarian tumors with peritoneal implants were reviewed. Eight patients relapsed (three with an invasive recurrence), but none of the patients without residual disease at the end of surgery, or invasive implants or disease with a micropapillary pattern relapsed under the form of invasive carcinoma.