ABSTRACT
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
Subject(s)
Health Planning , National Health Programs/organization & administration , Neoplasms/prevention & control , Health Care Reform , Humans , Latin America/epidemiology , Models, Organizational , Neoplasms/epidemiology , Neoplasms/mortality , Quality Improvement , West Indies/epidemiologyABSTRACT
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies(AU)
Subject(s)
Humans , Neoplasms/epidemiology , Neoplasms/mortality , Neoplasms/prevention & control , National Health Programs/organization & administration , Health Planning , Latin America/epidemiology , Uruguay , Bibliography, NationalABSTRACT
Os autores revisam a literatura e relatam parte de sua experiência sobre o tratamento da hemoptise maciça. Adotam um conceito menos matemático e mais fisiológico para o sangramento maciço, enfatizando a necessidade de se estabelecer uma rotina que possa ser executada rápida e eficientemente. Destacam o papel da embolizaçäo seletiva das artérias brônquicas, especialmente para os casos näo cirúrgicos. Propöem a cirurgia de ressecçäo pulmonar com a única forma definitiva de tratamento
Subject(s)
Humans , Male , Female , Hemoptysis/surgery , PneumonectomyABSTRACT
Os autores fixam os objetivos no manejo do derrame pleural neoplásico associado ao carcinoma brônquico, com ênfase nas medidas que melhoram a qualidade da sobrevida. Discutem a conduta nos casos em que a citologia do líquido pleural e a histopatologia da pelura säo negativas para células malígnas e destacam o papel de talcagem e da tetraciclina intrapleural como paliativos eficientes no controle dos derrames pleurais
Subject(s)
Humans , Male , Female , Carcinoma, Bronchogenic/complications , Lung Neoplasms/complications , Pleural Effusion/complicationsABSTRACT
Este trabalho, tem como objetivo principal testar a eficácia da embolizaçäo de artérias brônquicas como a última medida terapêutica no tratamento da hemoptise maciça originada de resíduos de tuberculose, em pacientes inoperáveis. Pelos critérios adotados, foram incluídos no estudo pacientes com história comprovada de, no mínimo, um tratamento prévio para tuberculose pulmonar, hemoptise maciça única e/ou de repetiçäo, baciloscopia negativa em pelo menos três amostras de escarro, ausência de colonizaçäo fúngica intracavitária por Aspergillus fumigatus comprovada por imunodifusäo em gel de ágar e radiograma de tórax que sugerisse lesäo de aspecto cicatricial, em comparaçäo com documentos radiológicos prévios. Nos 31 casos estudados, a cirurgia de ressecçäo pulmonar foi contra-indicada pela existência de doença extensa e bilateral e/ou pelos resultados desfavoráveis obtidos da avaliaçäo funcinal pulmonar e cardiovascular. O uso de drogas tuberculostáticas também foi descartado pela inexistência de bacilos no escarro. As medidas terapêuticas para fungos foram excluídas pela inexistência de achado radiológico e imunológico sugestivo de colonizaçäo fúngica nas lesöes cavitárias. Estudou-se, através da arteriografia, a vascularaizaçäo sistêmica da lesäo pulmonar, com especial atençäo para a circulaçäo brônquica sem ignorar, no entanto, a importância da circulaçäo sistêmica näo brônquica. Uma vez identificada, a circulaçäo medular espinal näo se constituiu em uma contra-indicaçäo formal à embolizaçäo, fato que contraria a grande maioria dos autores