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1.
Rev. chil. endocrinol. diabetes ; 12(3): 175-178, jul. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1006639

RESUMO

Los nódulos tiroideos suelen ser benignos en más del 95% de los casos y eutiroideos. La probabilidad de cáncer de tiroides en el hipertiroidismo es baja. Al enfrentarse a un nódulo tiroideo la importancia radica en excluir patología maligna, pero se debe mantener el orden en el algoritmo de estudio para evitar un diagnóstico incorrecto y caer en costos innecesarios. Se presenta el caso de una mujer de 23 años de edad con hipertiroidismo que en la ecografía aparece un nódulo tiroideo y adenopatía derecha, ambos con elementos sospechosos de malignidad, por lo que se pide punción de ambas estructuras, y se confirma el carcinoma papilar en el nódulo tiroideo, no así en la adenopatía. En el centellograma se observa un nódulo caliente que coincide con el nódulo maligno. Se realiza biopsia intraoperatoria de la adenopatía sospechosa y resulta ser una metástasis de carcinoma papilar. Se procedió a la tiroidectomía total con vaciamiento ganglionar central y lateral derecho. La anatomía patológica confirmó la presencia del carcinoma papilar clásico con metástasis de la adenopatía sospechosa. Posteriormente se administraron 130 mCi de radioyodo. Se debe considerar que los carcinomas pueden enmascararse ocasionalmente como nódulos «calientes¼ en el centellograma y en este caso, si bien en principio no estaría indicada la punción con aguja fina del nódulo dado que es hipercaptante en el centellograma, la ecografía demuestra elementos sospechosos contundentes de malignidad. En este caso el hilo conductor fue la ecografía y se rompió con el esquema clásico en la solicitud de estudios paraclínicos, obteniendo finalmente la confirmación diagnóstica de un cáncer y se realizó el tratamiento adecuado del mismo.


Thyroid nodules are usually benign in more than 95% of cases and euthyroid. The likelihood of thyroid cancer in hyperthyroidism is low. When dealing with a thyroid nodule the importance lies in excluding malignant pathology, but order must be maintained in the study algorithm to avoid an incorrect diagnosis and to fall into unnecessary costs. We present the case of a 23-year-old woman with hyperthyroidism who presented a thyroid nodule and right adenopathy on ultrasound, both with suspicious elements of malignancy, so puncture of both structures was requested, and papillary carcinoma was confirmed in the thyroid nodule, but not in adenopathy. In the scintigraphy a hot nodule is observed that coincides with the malignant nodule. Intraoperative biopsy of the suspected adenopathy is performed and it turns out to be a metastasis of papillary carcinoma. Total thyroidectomy was performed with central and right lateral lymph node dissection. The pathological anatomy confirmed the presence of classic papillary carcinoma with metastasis of the suspected adenopathy. Subsequently, 130 mCi of radioiodine was administered. It should be considered that carcinomas can occasionally be masked as «hot¼ nodules in the scintigraphy and in this case, although in principle the fine needle puncture of the nodule is not indicated given that it is hypercaptant in the scintigraphy, the ultrasound shows blunt suspicious elements of malignancy. In this case, the common thread was ultrasound and it was broken with the classic scheme in the request for paraclinical studies, finally obtaining the diagnostic confirmation of a cancer and the appropriate treatment was carried out.


Assuntos
Humanos , Feminino , Adulto Jovem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Carcinoma Papilar/diagnóstico por imagem , Nódulo da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologia , Cintilografia , Ultrassonografia , Nódulo da Glândula Tireoide/cirurgia , Nódulo da Glândula Tireoide/patologia , Pertecnetato Tc 99m de Sódio , Hipertireoidismo
2.
Autops. Case Rep ; 9(2): e2018083, Abr.-Jun. 2019. ilus
Artigo em Inglês | LILACS | ID: biblio-994679

RESUMO

Heterotopic ossification has been described in papillary thyroid carcinoma in association with high incidence of extrathyroidal invasion, multifocality, lymph node metastasis, and older age. Nevertheless, it has not been described as a specific subtype of papillary thyroid carcinoma, because of its rarity. We described the case of an 80-year-old female patient, with familial history of papillary thyroid carcinoma. In the annual screening examination, she was diagnosed with thyroid nodules. The patient was submitted to a thyroidectomy because the fine needle aspiration cytology was positive for malignancy according to the Bethesda classification. The surgical specimen analyses showed a multifocal papillary carcinoma with one major lesion in the left lobe measuring 0.9 cm, and two small lesions (0.4 cm and 0.2 cm) in the right lobe. Only the biggest lesion in the right lobe had the osteoid matrix with rare osteoclasts and fat metaplasia with progenitor cells. There was perineural invasion, but vascular invasion was not identified. The margins were free and there was no extrathyroidal extension. In the left lobe there was an oncocytic nodule and a lipomatous follicular nodule. In recent years there has been a significant increase in the diagnosis of thyroid cancer, mainly because of the finding of microcarcinomas as a result of many requests for cervical image exams. Future studies may define (i) whether papillary thyroid carcinoma with heterotopic ossification is a true histological variant; (ii) the causes of that alteration; and (iii) eventual follow-up implications.


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Neoplasias da Glândula Tireoide/complicações , Ossificação Heterotópica/patologia , Carcinoma Papilar/complicações , Nódulo da Glândula Tireoide/complicações
3.
Rev. cuba. endocrinol ; 29(2): 1-16, mayo.-ago. 2018. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-978381

RESUMO

Introducción: el carcinoma diferenciado del tiroides representa la neoplasia maligna más frecuente en Endocrinología. Su presentación clínica y su diagnóstico se han modificado gracias a la disponibilidad de herramientas diagnósticas, tales como, el ultrasonido tiroideo y la biopsia aspirativa con aguja fina. Objetivos: describir las características clínicas, ultrasonográficas y citohistológicas de los pacientes intervenidos quirúrgicamente por enfermedad tiroidea maligna, y evaluar en ellos la prevalencia de hipocalcemia crónica y el valor de la hormona estimulante del tiroides. Métodos: se realizó un estudio descriptivo retrospectivo, en el cual se revisaron los informes consecutivos de Anatomía Patológica de todos los pacientes intervenidos quirúrgicamente por enfermedad tiroidea nodular en el Hospital General Provincial Camilo Cienfuegos en el periodo comprendido de enero de 2012 a diciembre 2014. La muestra estuvo conformada por 118 historias clínicas de pacientes operados por enfermedad tiroidea nodular que reunieron los criterios siguientes: datos clínicos, resultados según los criterios de Bethesda de la punción aspirativa con aguja fina, del ultrasonido del tiroides y la biopsia. A estos pacientes se les citó para una evaluación clínica y se les determinó en ayunas, la hormona estimulante del tiroides y en 2 días diferentes, la calcemia. Los pacientes fueron clasificados en portadores de: enfermedad tiroidea maligna (n= 39) y enfermedad tiroidea benigna (n= 79). Resultados: clínicamente solo el 15,4 por ciento de los pacientes con enfermedad tiroidea maligna presentaron dolor o molestia espontánea y/o a la palpación de la glándula del tiroides. La enfermedad tiroidea maligna se diagnosticó en todas las categorías del citodiagnóstico: I: 1/1 (100 por ciento), II: 8/83 (9,6 pòr ciento), III: 4/6 (66,7 por ciento), IV: 2/2 (100 por ciento), V: 18/20 (90 por ciento), VI: 6/6 (100 por ciento). El carcinoma papilar representó la neoplasia más frecuentemente diagnosticada (37/39 pacientes), el 33,3 por ciento de estos enfermos mostraron cifras de hormona estimulante del tiroides por encima de 2,0 mU/L, y hubo un 46,15 por ciento de hipocalcemia crónica. Conclusiones: el carcinoma papilar fue la neoplasia más frecuentemente diagnosticada en los pacientes operados por enfermedad tiroidea maligna. La mayoría de estos pacientes tuvieron un comportamiento subclínico, un tercio de valores no óptimos de la hormona estimulante del tiroides y una prevalencia alta de hipocalcemia crónica(AU)


ntroduction: differentiated thyroid carcinoma represents the most frequent malignant neoplasia in Endocrinology. Its clinical presentation and diagnosis have been modified thanks to the availability of diagnostic tools, such as thyroid ultrasound and fine needle aspiration biopsy. Objectives: to describe the clinical, ultrasonographic and cytohistological characteristics of patients undergoing surgery for malignant thyroid disease, and to evaluate in them the prevalence of chronic hypocalcemia and the value of the thyroid´s stimulating hormone. Methods: a retrospective descriptive study was carried out, in which consecutive reports of Pathological Anatomy of all patients surgically treated for nodular thyroid disease at Camilo Cienfuegos Provincial General Hospital in the period from January 2012 to December 2014 were reviewed. The sample consisted of 118 medical records of patients operated on for nodular-thyroid disease that met the following criteria: clinical data, results according to the Bethesda criteria of fine needle aspiration, thyroid ultrasound and biopsy. These patients were called for a clinical evaluation and they were indicated to be fasting. The patients were classified into carriers of: ETM (n=. 39) and benign thyroid disease (n= 79). Results: in clinical terms, only 15.4 percent of the patients with malignant thyroid disease presented spontaneous pain or discomfort, and / or during palpation of the thyroid glands. Malignant thyroid disease was diagnosed in all categories of cytodiagnosis: I: 1/1 (100 percent), II: 8/83 (9.6 percent), III: 4/6 (66.7 percent), IV: 2/2 (100 percent), V: 18/20 (90 percent), VI: 6/6 (100 percent). Papillary carcinoma represented the most frequently diagnosed neoplasm (37/39 patients); 33.3 percent of these patients showed thyroid stimulating hormone levels above 2.0 mU / L, and there was 46.15 percent of chronic hypocalcemia. Conclusions: papillary carcinoma was the most frequently diagnosed neoplasm in patients operated of malignant thyroid disease. The majority of these patients had a subclinical behavior, a third of non-optimal values of the thyroid stimulating hormone and a high prevalence of chronic hypocalcemia(AU)


Assuntos
Humanos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Biópsia por Agulha Fina/métodos , Carcinoma Papilar/diagnóstico por imagem , Epidemiologia Descritiva , Estudos Retrospectivos
4.
Cienc. Serv. Salud Nutr ; 9(1): 12-19, abr. 2018.
Artigo em Espanhol | LILACS | ID: biblio-981821

RESUMO

El cáncer tiroideo es una patología frecuente en Ecuador por lo que es necesario determinar sus factores de riesgo, ya que esto ayudaría a diagnosticar esta patología tempranamente. El objetivo del presente estudio fue identificar factores de riesgo de cáncer tiroideo en pacientes sometidos a tiroidectomía en el "Hospital del Instituto Ecuatoriano de Seguridad Social (IESS)". Para ello, se realizó un estudio descriptivo de corte transversal usando datos obtenidos de las historias clínicas de los pacientes. En total se incluyeron 101 pacientes. Nuestros hallazgos indican que existe una alta prevalencia (52%) de cáncer tiroideo, en particular carcinoma papilar de patrón convencional, que representó al rededor del 65% de casos positivos. Diferencias en cuanto a edad, hipoecogenicidad y calcificaciones ecográficas de nódulos tiroideos según el Thyroid Image Reporting and Data System (TIRADS) y el diagnóstico por Punción Aspiración con Aguja Fina (PAAF) fueron determinantes en el diagnóstico de cáncer tiroideo. Se evidenció además que la asociación rango de edad y TIRADS proporciona alta sensibilidad y especificidad para diagnosticar cáncer tiroideo por lo que se recomienda su uso conjunto en Atención Primaria de Salud. La realización de exámenes tiroideos y screaning a través de TIRADS es muy útil en el diagnóstico de cáncer tiroideo, especialmente en menores de 50 años.


Thyroid cancer is a common pathology in Ecuador, for this reason it is necesary to determine its risk factors, it will help in the diagnosis of the pathology at early stages. The objective of the present stuyd was to determine risk factors for thyroid cancer in patients that underwent thyroidectomy in the "Hospital del Instituto Ecuatoriano de Seguridad Social (IESS)". In order to do that we conducted an observational, cross­sectional study, using data obtained from the medical reports of patients. In total we included 101 patients. Our findings indicate that there is a high prevalence (52%) of thyroid cancer, especially papillary thyroid carcer of the conventional type, which represented around 65% of positive cases. Differences related to age, hypoechogenicity and calcifications of thyroid nodules identified by ultrasound and staged according to the Thyroid Image Reporting and Data System (TIRADS), results of Fine Needle Aspiration (FNA) were determinant in the diagnosis of thyroid cancer. We also found that matching age group and TIRADS provided great sensitivity and specificity for the diagnosis of thyroid cancer, for this reason it is recommended to encourage their use in Primary Health Care settings. Performing thyroid tests and TIRADS screening is very important in the diagnosis of thyroid cancer, specially in patients younger than 50 years of age.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Atenção Primária à Saúde , Tireoidectomia , Neoplasias da Glândula Tireoide , Carcinoma Papilar , Fatores de Risco , Equador
5.
Rev. Col. Bras. Cir ; 45(5): e1934, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-976934

RESUMO

RESUMO Objetivo: conhecer o perfil epidemiológico dos pacientes submetidos à cirurgia do carcinoma bem diferenciado da tireoide no Hospital Universitário Cassiano Antônio Moraes da Universidade Federal do Espírito Santo, assim como os resultados oncológicos e as principais complicações pós-operatórias. Métodos: estudo transversal e retrospectivo de pacientes portadores de carcinoma bem diferenciado da tireoide operados no período de janeiro de 2008 a dezembro de 2015. Resultados: no período do estudo, dos 353 pacientes submetidos a tratamento cirúrgico da glândula tireoide, 95 eram portadores de CBDT. O carcinoma papilífero da tireoide foi o mais frequente (91,57%). A tireoidectomia total não associada a esvaziamento cervical foi o procedimento cirúrgico mais frequente (65,26%). As complicações pós-operatórias ocorreram em 6,31% dos pacientes, sendo o hematoma a mais frequente. O tempo médio de seguimento foi de 36,9 meses. A recidiva ocorreu em quatro pacientes (4,21%), sendo locorregional em todos os casos. Os fatores prognósticos analisados, como sexo, idade, tamanho do tumor, acometimento linfonodal, estadiamento, tipo de cirurgia, histologia e iodoterapia complementar não demonstraram significância estatística. Conclusão: o carcinoma papilífero da tireoide foi a neoplasia maligna mais frequente, acometendo o sexo feminino na faixa etária dos 49 anos mais frequentemente. A recidiva locorregional ocorreu em quatro pacientes. O hematoma foi a complicação mais frequente.


ABSTRACT Objective: to know the epidemiological profile of patients undergoing surgery for well-differentiated thyroid carcinoma at the Cassiano Antônio Moraes University Hospital of the Federal University of Espírito Santo, as well as the oncological results and the main postoperative complications. Methods: we conducted a cross-sectional, retrospective study of patients with well-differentiated thyroid carcinoma (WDTC) operated from January 2008 to December 2015. Results: During the study period, 95 of the 353 patients undergoing surgical treatment of the thyroid gland had WDTC. Papillary carcinoma was the most frequent (91.57%). Total thyroidectomy not associated with cervical emptying was the most frequent surgical procedure (65.26%). Postoperative complications occurred in 6.31% of patients, hematoma being the most frequent. The mean follow-up time was 36.9 months. Relapse occurred in four patients (4.21%), being locoregional in all cases. The prognostic factors analyzed, such as gender, age, tumor size, lymph node involvement, staging, type of surgery, histology and complementary iodine therapy did not show statistical significance. Conclusion: papillary carcinoma was the most common thyroid malignant neoplasm, affecting women in the 49-year-old age group more frequently. Loco-regional recurrence occurred in four patients. Hematoma was the most frequent complication.


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Neoplasias da Glândula Tireoide/cirurgia , Carcinoma Papilar/cirurgia , Tireoidectomia , Brasil/epidemiologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/epidemiologia , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/epidemiologia , Estudos Transversais , Estudos Retrospectivos , Seguimentos , Pessoa de Meia-Idade , Estadiamento de Neoplasias
7.
Rev. argent. endocrinol. metab ; 54(2): 51-63, abr.-jun. 2017. ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-967123

RESUMO

Las metástasis ganglionares regionales del cuello están presentes en un gran porcentaje de los casos con CPT. Sin embargo, en varios trabajos se pudo observar como no todo compromiso ganglionar tiene igual impacto en la evolución de dicha patología. Recientemente en Argentina, Chile y Brasil se modificaron las guías del manejo del CDT y estas recomiendan una estratificación de riesgo y abordaje terapéutico diferente según el número, el tamaño y la extensión del compromiso ganglionar. En esta monografía se analizaron las características de las metástasis ganglionares y su impacto en la evolución del CDT y esto fue realizado previamente a la reciente publicación de las nuevas guías de la ATA. Dada esta situación, se incorporaron a la monografía original algunos aspectos de las guías de ATA


Cervical lymph node metastases are usually present in a high number of cases with papillary thyroid carcinoma. However, many studies have shown that not all lymph node metastases have the same impact on the outcome of this disease. Argentina, Chile, and Brazil have recently changed their differentiated thyroid carcinoma (DTC) guidelines and recommend a different ranking of risk and therapeutic approach according to the number, size, and extension of lymph node metastasis. An analysis of lymph node metastases is presented in this article, which includes their characteristics and impact on DTC. As this analysis was made before the latest publication of the new American Thyroid Association guidelines, some aspects of these guidelines have also been included


Assuntos
Humanos , Masculino , Feminino , Prognóstico , Carcinoma Papilar/complicações , Metástase Linfática/fisiopatologia , Neoplasias da Glândula Tireoide/complicações , Gânglios/fisiopatologia
8.
Rev. chil. cir ; 69(3): 264-267, jun. 2017.
Artigo em Espanhol | LILACS | ID: biblio-844371

RESUMO

Durante los últimos años se ha estudiado la relación entre enfermedad de Graves (EG), TSH, TRAb y cáncer de tiroides, existiendo estudios que demuestran mayor prevalencia y agresividad del cáncer de tiroides en pacientes con EG, mientras otros refutan estos hallazgos sugiriendo que serían producto del sesgo de selección. Aquellos estudios que plantean una relación causal entre EG y el desarrollo de cáncer de tiroides, la atribuyen a la presencia de autoanticuerpos TSI, que estimularían el foco de malignidad. Se cree que las citoquinas producidas localmente en pacientes con EG trabajarían en conjunto con los TRAb para determinar la agresividad del cáncer papilar de tiroides en estos pacientes. Dentro de las células reclutadas por el tumor para evadir la respuesta inmune se encuentran los linfocitos Treg, que estarían elevados en paciente con EG, llevando a la disminución de la respuesta inmune y creando un ambiente permisivo para la proliferación celular. Por tratarse de una línea de investigación reciente, no existe consenso sobre el tema y sus implicancias en el tratamiento de los pacientes con EG. La finalidad de este artículo es realizar una revisión de la literatura que exponga y contraste la información disponible a la fecha.


In recent years the relationship between Graves’ disease (GD), TSH, TRAb and thyroid carcinoma has been studied. Research studies show a higher prevalence and aggressiveness of thyroid carcinoma in patients with GD, however other researchers refute these findings suggesting it’s due to selection bias. Increasing evidence suggests a causal relationship between GD and the development of thyroid carcinoma, mainly because of the existence of TSI autoantibodies that could stimulate the focus of malignancy. It is believed that cytokines produced locally in patients with GD work alongside with TRAb regulating the aggressiveness of papillary thyroid carcinoma in these patients. Within the cells recruited by the tumor to elude the immune system we find Treg lymphocytes, which have been found to be increased in patients with GD, leading to a diminished immune response, creating a permissive environment for cell proliferation. Since this is a relatively new line of research, there is no consensus on the subject and its relevance for the treatment of patients with GD. The aim of this article is to show recent literature available on the subject.


Assuntos
Humanos , Doença de Graves/epidemiologia , Doença de Graves/imunologia , Linfócitos T Reguladores/imunologia , Neoplasias da Glândula Tireoide/epidemiologia , Neoplasias da Glândula Tireoide/imunologia , Carcinoma Papilar/epidemiologia , Doença de Graves/complicações , Receptores da Tireotropina/imunologia , Risco , Neoplasias da Glândula Tireoide/etiologia
9.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 214-218, jun. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-902766

RESUMO

El carcinoma tiroideo familiar no medular (CFTNM) representa aproximadamente entre el 3,2% y 9,6% de todos los cánceres de tiroides, y se define por la presencia de cáncer diferenciado de tiroides en 2 o más familiares, en ausencia de otros síndromes familiares conocidos o exposición a radiación. Si bien su fisiopatología es aún incierta, algunos investigadores postulan un patrón de herencia dominante con penetrancia incompleta, no habiendo aún un gen específico responsable. Esta entidad suele presentarse a una menor edad y con características más agresivas que en su forma esporádica. Dado el interés por conocer la presentación de esta enfermedad y las recomendaciones para su manejo, se presenta el caso de una paciente diagnosticada con cáncer papilar de tiroides con el antecedente de 4 familiares con la misma patología. Actualmente el tamizaje mediante ecografía cervical y biopsia por punción aspiración con aguja fina de los nódulos tiroideos es el examen de elección ante la presencia del antecedente de CFTNM, ya que aún no hay estudios genéticos disponibles. La tiroidectomía total más disección ganglionar es el tratamiento de elección. Debido al comportamiento más agresivo y peor pronóstico del CFTNM, es necesaria un alto índice de sospecha y una investigación completa en la presencia de un componente familiar.


The non-familial medullary thyroid carcinoma (FNMTC) represents approximately between 3.2 and 9.6% of all thyroid cancers, and is defined by the presence of differentiated thyroid cancer in 2 or more families in the absence of other known familial syndromes or radiation exposure. Although the pathophysiology is still uncertain, some investigators posit a dominant pattern of inheritance with incomplete penetrance, but still there is no specific gene responsible. It occurs at a younger age and with more aggressive characteristics than the sporadic form. Because of the interest in learning about the presentation of this disease and its recommendations, we present the case of a patient diagnosed with papillary thyroid cancer with a history of 4 family with the same pathology. Actually cervical screening by ultrasound and the fine needle aspiration biopsy (FNAB) of thyroid nodules is the examination of choice in the presence of a history of FNMTC, since no genetic studies yet available. Total thyroidectomy with lymph node dissection is the treatment of choice. Because the more aggressive behavior and poor prognosis of FNMTC, a high index of suspicion and a full investigation is required in the presence of a familial component.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/genética , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/genética , Neoplasias da Glândula Tireoide/cirurgia , Carcinoma Papilar/cirurgia , Predisposição Genética para Doença
10.
Int. arch. otorhinolaryngol. (Impr.) ; 21(1): 38-41, Jan.-Mar. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-840786

RESUMO

Abstract Introduction Patients with thyroid cancer in different age groups present with different prognosis. Objective The objective of this study is to analyze the clinicopathological pattern of thyroid carcinoma presentation according to age groups. Methods This is a retrospective study. From 2000 to 2010, 623 patients underwent thyroidectomy for cancer in our institution, with 596 enrolled. Patients were divided into groups of 10 years and then in four age subgroups (≤ 24, 25-44, 45-64, and ≥65 years) for statistical analysis. We compared age, gender, and histopathological characteristics between groups. Results Individuals belonging to the earlier age group presented with a highest prevalence of neuro-vascular invasion, capsular invasion and lymph node metastasis. Together with individuals of advanced age, that group also had larger tumor diameter and higher prevalence of extra-glandular disease. Even when analyzed only cases with well-differentiated carcinoma, younger individuals remain with a highest prevalence of lymph node metastasis, neuro-vascular invasion and larger tumor diameter. Conclusion We observed a distinct pattern of clinicopathological manifestation of thyroid cancer according to age. Individuals belonging to age extremes resemble in several pathological features, and young people usually present with more aggressive disease characteristics.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Carcinoma Papilar , Metástase Neoplásica , Neoplasias da Glândula Tireoide , Efeito Idade
11.
Rev. AMRIGS ; 60(3): 249-252, jul.-set. 2016. ilus
Artigo em Português | LILACS | ID: biblio-832499

RESUMO

O tumor sólido pseudopapilar de pâncreas (TSPP) é uma neoplasia maligna de baixo grau, que acomete predominantemente mulheres jovens e corresponde a um processo tumoral ovoide pardo-avermelhado e de crescimento lento. Os autores relatam um caso incidental de TSPP, e discutem os achados anatomopatológicos e clínicos desta rara neoplasia. Paciente feminino, 45 anos, obesa mórbida, sem outras queixas clínicas, em avaliação para procedimento de cirurgia bariátrica, apresentou, nos exames de ultrassonografia e tomografia computadorizada do abdome, lesão tumoral sólido-cística na cauda do pâncreas, que mediu 7,1 cm no maior eixo. A paciente foi submetida à ressecção do processo. Aos cortes, foi identificada uma lesão tumoral ovoide, pardo-avermelhada, predominantemente sólida, circunscrita, que mediu 7,4 x 6,0 x 5,3 cm. Ao exame microscópico, identificou-se uma neoplasia de cé- lulas epitelioides monomórficas de tamanho intermediário, com citoplasma exibindo pequenos glóbulos hialinos, dispostas em áreas sólidas e císticas. O processo exibiu imunoexpressão positiva para pancitoqueratina, betacatenina, sinaptofisina, cromogranina A, CD56 e receptores de progesterona, e imunoexpressão negativa para E-caderina, CDX-2 e TTF-1. O diagnóstico de Tumor Sólido Pseudopapilar do Pâncreas foi então estabelecido. Após um seguimento de quatro meses, não foram encontradas evidências clínicas ou radiológicas de recidiva tumoral(AU)


The solid pseudopapillary tumor of the pancreas (SPTP) is a malignant neoplasm of low degree, which predominantly affects young women and corresponds to an ovoid reddish-brown tumor process of slow growth. The authors report an incidental case of SPTP and discuss the clinical and pathological findings of this rare neoplasm. A female patient, 45 years old, morbidly obese, with no other clinical complaints, in evaluation for bariatric surgery procedure, presented, in ultrasound examination and computed tomography of the abdomen, a solid-cystic tumor lesion in the pancreas tail, which measured 7.1 cm in the major axis. The patient underwent resection process. The cuts showed an ovoid reddish-brown tumor lesion predominantly solid, circumscribed, which measured 7.4 x 6.0 x 5.3 cm. Microscopic examination identified a tumor of monomorphic epithelioid cells of intermediate size, with cytoplasm exhibiting small hyaline globules arranged in solid and cystic areas. The process showed positive immunoreactivity for pancytokeratin, beta-catenin, synaptophysin, chromogranin A, CD56 and progesterone receptors, and negative immunoreactivity for E-cadherin, CDX-2 and TTF-1. The diagnosis of solid pseudopapillary tumor of the pancreas was then established. At a four-month follow-up, there was no clinical or radiological evidence of tumor recurrence(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Carcinoma Papilar , Neoplasias Pancreáticas , Pâncreas/cirurgia
12.
Ciênc. saúde coletiva ; 21(8): 2451-2462, ago. 2016. tab
Artigo em Português | LILACS | ID: lil-792969

RESUMO

Resumo Objetivou-se uma abordagem qualitativa de fatores que determinariam a qualidade de vida de pacientes com carcinoma papilífero de tireoide tratados. Foram feitas 16 entrevistas em profundidade com indivíduos de 18 a 45 anos sobre suas representações e experiências com esta enfermidade, seguidas por análise de conteúdo de enunciados. Os resultados contêm aspectos já previstos em questionários estruturados sobre qualidade de vida, mas outros estão parcialmente presumidos nesses questionários (manejo do conceito de etiologia da doença, a inserção “forçada” dos pacientes no universo conceitual médico, o medo do prognóstico e as mudanças “positivas” no estilo de vida). A interpretação desses resultados beneficiou-se de elaborações teóricas de desenvolvimento recente: as angústias sobre a experiência da doença parecem configurar-se, para os participantes, como um “risco moderno”, no contexto de uma “sociedade de riscos”. O desenvolvimento de questionários estruturados de qualidade de vida requer constantes estudos qualitativos que captem mudanças nos aspectos subjetivos do construto, dada a dinamicidade dos significados histórico-culturais e psicológicos do processo saúde-doença, constantemente influenciados por inovações tecnológicas e sucessivas interpretações epidemiológicas.


Abstract The aim of this study was to develop a qualitative approach of determinant factors of the quality of life of treated patients with papillary thyroid carcinoma. Sixteen in-depth interviews were conducted with individuals 18 to 45 years old regarding their disease representations and experiences, followed by statements content analysis. The results show issues already provided in structured questionnaires about quality of life, although others were only partially assumed in these surveys (management of the concept of disease etiology; the “forced” patient introduction into the medical conceptual universe; the fear of the prognosis and positive changes in lifestyle). The results interpretation were benefited from recently developed theoretical elaborations: the anxieties related to illness experience seem to be configured as a “modern risk”, in the context of a “risk society”. The development of structured questionnaires on quality of life requires frequent qualitative studies to capture changes in subjective aspects of the construct, given the dynamic changes of historical, cultural and psychological meanings of the health disease process, constantly influenced by technological innovations and continuing epidemiological interpretations.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Carcinoma Papilar/terapia , Qualidade de Vida , Neoplasias da Glândula Tireoide/terapia , Pesquisa Qualitativa
13.
Clinics ; 71(6): 311-314, tab
Artigo em Inglês | LILACS | ID: lil-787422

RESUMO

OBJECTIVE: To predict the American Joint Cancer Committee tumor-node-metastasis stage in patients with papillary thyroid carcinoma by evaluating the relationship between the preoperative neutrophil-to-lymphocyte ratio and the tumor-node-metastasis stage. METHODS: We retrospectively examined 161 patients with a diagnosis of papillary thyroid carcinoma. The Neutrophil-to-Lymphocyte Ratio was calculated according to the absolute neutrophil counts and absolute lymphocyte counts on routine blood tests obtained prior to surgery and patients with a Neutrophil-to-Lymphocyte Ratio of 2.0 or more were classified as the high NLR group, while those with a Neutrophil-to-Lymphocyte Ratio less than 2.0 were classified as the low Neutrophil-to-Lymphocyte Ratio group. Clinicopathological variables, which were stratified by the Neutrophil-to-Lymphocyte Ratio, were analyzed. A multivariate analysis was performed to determine factors that affect the Neutrophil-to-Lymphocyte Ratio. The association between the Neutrophil-to-Lymphocyte Ratio and the TNM stage in patients ≥45 years of age was analyzed using the Spearman rank correlation. RESULTS: Various blood indices, including hemoglobin, platelet and thyroid-stimulating hormone levels in the two groups showed no significant differences. Lymph node metastasis, multifocality and tumor size exhibited significant differences in the two groups (p=0.000, p=0.000 and p=0.035, respectively). Correlation analysis indicated that a higher preoperative Neutrophil-to-Lymphocyte Ratio was observed in patients with lymph node metastasis, larger tumor size and multifocality (r=0.341, p=0.000; r=0.271, p=0.000; and r=0.182, p=0.010, respectively). For patients ≥45 years of age, the number of patients with an advanced TNM stage in the high NLR group was higher than that in the low Neutrophil-to-Lymphocyte Ratio group (p=0.013). A linear regression analysis showed that the preoperative Neutrophil-to-Lymphocyte Ratio was positively correlated with the American Joint Cancer Committee tumor-node-metastasis stage (rho=0.403, p=0.000). CONCLUSION: The preoperative Neutrophil-to-Lymphocyte Ratio was closely related to the stage of papillary thyroid carcinoma. The increase in the preoperative Neutrophil-to-Lymphocyte Ratio contributed to the advanced tumor-node-metastasis stage of papillary thyroid carcinoma patients ≥45 years of age.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Carcinoma Papilar/secundário , Contagem de Linfócitos , Neutrófilos , Neoplasias da Glândula Tireoide/patologia , Biomarcadores Tumorais/sangue , Carcinoma Papilar/sangue , Carcinoma Papilar/patologia , Metástase Linfática , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Prognóstico , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/cirurgia
15.
Rev. chil. urol ; 81(1): 11-13, 2016. ilus
Artigo em Espanhol | LILACS | ID: biblio-906281

RESUMO

INTRODUCCIÓN: El carcinoma papilar de células renales es el segundo tipo más común de los canceres renales, representando el 5-15 por ciento . Los síntomas son inespecíficos. Generalmente, son bien circunscritos, poseen necrosis y degeneración quística. Es más frecuente entre la cuarta y quinta década, con una razón hombre-mujer de 2:1. Se caracteriza por un crecimiento más lento y un mejor pronóstico que otros carcinomas de células renales. CASO CLÍNICO: Masculino de 63 años, con dolor mesogástrico, crónico, severo, irradiado a flanco derecho. Tomografía Axial Computarizada muestra dos masas sólidas en polo superior e inferior de riñón derecho, de 3 cm, con componentes isodensos; a nivel de polo renal izquierdo se reconoce lesión quística simple de 70 mm. Resonancia magnética confirma lesiones descritas. Se realiza nefrectomía radical derecha. Estudio anatomopatológico concluye carcinoma de células renales Papilar bifocal tipo 1. El paciente finalmente presenta evolución satisfactoria. DISCUSIÓN: El carcinoma de células renales papilar posee baja incidencia. Se describen alteraciones cromosómicas como trisomía 7 y pérdidas cromosomales Y. Existen dos variantes, la Tipo 1 con mejor sobrevida, que muestra papilas cubiertas de una sola capa de células, y la Tipo 2 con pseudoestratificación e hipercromasia nuclear. Los estudios imagenológicos no son específicos; se ha sugerido estudios angiográficos en vista de la hipovascularidad de la lesión. El tratamiento definitivo se obtiene por nefrectomía radical dada su tendencia multifocal.(AU)


INTRODUCTION: Papillary renal cell carcinoma is the second most common type of kidney cancers, accounting for 5-15 pertcent. The symptoms are nonspecific. Generally, they are well circumscribed, with necrosis and cystic degeneration. It is most common between the fourth and fifth decade, with a male to female sex ratio of 2: 1. It is characterized by slower growth and a better prognosis than other renal cells carcinomas. CASE REPORT: Male of 63 years with mesogastric, chronic, severe pain radiating to the right flank. Computed Tomography shows two solid masses in the upper and lower pole of the right kidney of 3 cm, with isodense components; a level of left kidney pole a simple cystic lesion of 70 mm is recognized. Magnetic Resonance Imaging confirmed injuries described. Right radical nephrectomy was performed. Pathological study concludes bifocal papillary renal cell carcinoma type 1. The patient eventually presented satisfactory evolution. DISCUSSION: Papillary renal cell carcinoma has low incidence. Chromosomal abnormalities such as trisomy 7 and lost chromosomal Y are described. There are two variants, the Type 1 with better survival, shows covered buds of a single layer of cells, and the Type 2 with pseudostratification and nuclear hyperchromasia. Imaging studies are not specific, so that angiographic studies have been suggested in view of the hipovascularity of the injury. The definitive treatment is obtained by radical nephrectomy because of tendency multifocal.(AU)


Assuntos
Masculino , Carcinoma de Células Renais , Carcinoma Papilar , Nefrectomia
16.
São Paulo; s.n; 2016. [189] p. ilus, graf, tab.
Tese em Português | LILACS | ID: biblio-870921

RESUMO

O mapeamento do linfonodo sentinela (MLNS) é largamente utilizado em pacientes com melanoma cutâneo, câncer de mama e outras neoplasias malignas sólidas com a finalidade de estadiá-las e indicar esvaziamento linfático apenas na presença de metástase. Nos últimos anos aumentou o interesse pelo uso do MLNS em pacientes com carcinoma papilífero de tireoide (CPT) sem metástases linfáticas detectáveis clinicamente (estádio cN0), devido à alta frequência de metástases ocultas nesses pacientes. O MLNS pode evitar o esvaziamento linfático do compartimento central (ECC) em portadores de CPT sem metástase. Mesmo que não se planeje o ECC eletivo, o MLNS pode também ser usado para estadiar adequadamente o pescoço e indicar tratamento posterior com radioiodoterapia em casos com metástase. Esse estudo tem como objetivo verificar: 1) a efetividade da técnica do MLNS nos pacientes com CPT; 2) a acurácia do MLNS em diagnosticar as metástases linfáticas; 3) se o MLNS pode modificar o estadiamento dos pacientes com CPT cN0. MÉTODOS: Trata-se de estudo de acurácia, prospectivo longitudinal de 38 casos consecutivos de CPT clinicamente N0, atendidos em um único centro, no período de 2010 a 2015. Todos foram submetidos à tireoidectomia total, MLNS com radiofármaco e ECC eletivo. Os resultados relativos ao MLNS foram comparados com o exame anatomopatológico do conteúdo do ECC. RESULTADOS: O tempo médio de seguimento dos doentes foi de 36 ± 13 meses. Os LNS foram localizados com maior frequência nos níveis VI e III. O LNS foi detectado em 95% da casuística e os valores de avaliação de testes diagnósticos foram: 1 falso negativo, 95% de sensibilidade, 100% de especificidade, 94% de valor preditivo negativo e 97% de acurácia. O MLNS foi capaz de reestadiar 49% dos pacientes inicialmente N0 para pN positivo. Quanto ao grupo de estadiamento AJCC (que leva em conta a idade), 3% dos pacientes foram reestadiados para estádio III e 18% para estádio IV. CONCLUSÕES: 1) a técnica de...


Sentinel lymph node mapping (SLNM) is widely perfomed in melanoma, breast cancer and other solid tumors, to adequately stage these diseases. More recently, the interest in SLNM for clinically N0 Papillary Thyroid Cancer (PTC) has increased due to the high rate of occult metastases in these patients, to avoid unnecessary central neck dissection (CND), and its complications. Even if routine elective CND is not planned, SLNM can be used to adequately stage the neck, and to indicate further treatment with radioiodine in cases with neck metastases, for instance. This study aims to evaluate 1) SLNM effectiveness in PTC patients, 2) SLNM accuracy to diagnosis lymph node metastases and 3) if SLNM can upstage cN0 PTC patients. METHODS: This is a prospective longitudinal, diagnostic test accuracy study with 38 consecutive cN0 PTC patients, treated in a single center between 2010 and 2015. Surgical treatment in all cases included total thyroidectomy and elective CND after SLNM. Results of SLNM were compared to CND pathological findings, in order to verify if sentinel lymph node (SLN) predicted the occurrence of PTC occult lymph node metastasis. RESULTS: The mean patients' follow-up was 36 ± 13 months. 133 SLN were found in the neck, on levels VI and III. The SLN was identified in 95% of the patients with 1 false negative, 95% sensitivity, 94% negative predictive value and 97% accuracy. The SLNM upstaging from cN0 to pN+ was 49%, with 3% stage III and 18% stage IVa. CONCLUSION: 1) SLNM was effective in 95% of procedures, 2) SLNM accuracy was 97%, 3) SLNM upstaging from cN0 to pN+ was 49%, and to stage III and IVa was 21%...


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Carcinoma Papilar , Metástase Linfática , Esvaziamento Cervical , Biópsia de Linfonodo Sentinela , Glândula Tireoide
17.
Rev. chil. cir ; 67(6): 643-646, dic. 2015. ilus
Artigo em Espanhol | LILACS | ID: lil-771609

RESUMO

Background: Differentiated thyroid cancer has a good prognosis. If there is local tumor infiltration, the prognosis depends on its complete excision. Case report: We report a 67 years old woman with a papillary thyroid cancer and a bleeding skin ulcer. The initial assessment disclosed local tumor infiltration of neck structures and cervical lymph nodes. She was subjected to a radical thyroidectomy, radical neck dissection and dissection of involved structures. She was also treated with radioiodine and levothyroxine and remains asymptomatic after two years of follow up.


Introducción: Los cánceres tiroideos, de la variedad diferenciada, son tumores malignos con buen pronóstico. Los subtipos más comunes son el carcinoma papilar y el carcinoma folicular. Incluso cuando infiltran localmente, tienen un pronóstico relativamente bueno cuando se pueden resecar completamente. Caso clínico: Presentamos un caso de cáncer papilar de una señora mayor que se presentó con una úlcera sangrante de piel. En la evaluación se encontró que tenía infiltración de estructuras del cuello locales y de los ganglios linfáticos cervicales. Fue tratada con tiroidectomía total y disección radical de cuello modificada, así como la resección de las estructuras involucradas. Más tarde fue tratada con yodo radiactivo y levo tiroxina. A pesar de la infiltración local permanece asintomática a los dos años de seguimiento.


Assuntos
Humanos , Feminino , Idoso , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Carcinoma Papilar/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Tomografia Computadorizada por Raios X , Úlcera Cutânea/etiologia
18.
Clinics ; 70(10): 686-690, Oct. 2015. tab
Artigo em Inglês | LILACS | ID: lil-762963

RESUMO

OBJECTIVE:The cytokine interleukin-22 (IL-22), which is produced by T cells and natural killer cells, is associated with tumorigenesis and tumor progression in cancers. However, the role of IL-22 in bladder cancer has not been investigated.MATERIALS AND METHODS:A prospective hospital-based case-control study comprising 210 patients with pathologically proven bladder cancer and 210 age- and gender-matched healthy controls was conducted. The genotypes of 3 common polymorphisms (-429 C/T, +1046 T/A and +1995 A/C) of the IL-22 gene were determined with fluorogenic 5' exonuclease assays.RESULTS:Patients with bladder cancer had a significantly higher frequency of the IL-22 -429 TT genotype [odds ratio (OR)=2.04, 95% confidence interval (CI)=1.19, 3.49; p=0.009] and -429 T allele (OR=1.42, 95% CI=1.08, 1.87; p=0.01) than the healthy controls. These findings were still significant after a Bonferroni correction. When stratifying according to the stage of bladder cancer, we found that patients with superficial bladder cancer had a significantly lower frequency of the IL-22 -429 TT genotype (OR=0.48, 95% CI=0.23, 0.98; p=0.04). When stratifying according to the grade and histological type of bladder cancer, we found no statistical association. The IL-22 +1046 T/A and IL-22 +1995 A/C gene polymorphisms were not associated with the risk of bladder cancer.CONCLUSION:To the authors' knowledge, this is the first report documenting that the IL-22 -429 C/T gene polymorphism is associated with bladder cancer risk. Additional studies are required to confirm this finding.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Carcinoma Papilar/genética , Interleucinas/genética , Polimorfismo Genético , Neoplasias da Bexiga Urinária/genética , Estudos de Casos e Controles , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Genótipo , Interleucinas/classificação , Reação em Cadeia da Polimerase , Estudos Prospectivos , Fatores de Risco
19.
Rev. chil. cir ; 67(3): 285-291, jun. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-747502

RESUMO

Introduction: The solid-pseudopapillary tumor of pancreas (STP) is a low-grade malignant neoplasm. In Chile, 21 cases have been reported since 2008, most of them treated in Santiago. The present series contributes to the national case-load and has the purpose to describe the experience with this uncommon neoplasm in the IV Region. Patients and Methods: From January 2004 to March 2014, a total of 38 benign and malignant pancreatic neoplasms have been informed in the data-base of our Regional Pathology Service. We selected the biopsies informed as STP and 5 cases (13 percent) were found. The clinical records of these patients were retrospectively reviewed. The results were reported using descriptive statistics with central tendency measures and dispersion. Results: Most patients were women with a mean age of 44.8 years. All patients were studied with either abdominal ultrasound; computed tomography or magnetic resonance. In 2 patients the STP was located in the pancreatic tail, and they were submitted to distal pancreatectomy. The other 3 patients had the STP in the pancreatic head and were resolved by pancreatoduodenectomy. All tumors were confirmed by immunohistochemistry. Late follow-up showed malignant behavior in 1 patient while the other 4 patients are currently free of disease. Conclusions: The general characteristics of STP in the IV Region are similar to what is currently known. They present a high incidence compared with the habitually published incidence.


Introducción: El tumor sólido pseudopapilar del páncreas (TSP) es una neoplasia con bajo potencial maligno. En Chile se han reportado 21 casos desde el año 2008, 18 de ellos tratados en instituciones de Santiago. La presente serie además de contribuir a la casuística nacional, tiene como objetivo la descripción de la experiencia de la IV Región con el manejo de estos tumores. Pacientes y Métodos: Entre enero de 2004 y marzo de 2014 se informaron 38 biopsias de tumores pancreáticos benignos y malignos en la base de datos del Servicio de Patología Regional. Se seleccionaron las biopsias informadas como TSP, las que constituyen 5 casos (13 por ciento) y se revisaron las fichas clínicas en forma retrospectiva. Para el informe de los resultados se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Resultados: El promedio de edad fue 44,8 años, siendo la mayoría mujeres. Los pacientes fueron estudiados con ecografía, tomografía computarizada y resonancia magnética. En 2 pacientes el TSP se localizaba en la cola del páncreas, estos pacientes fueron sometidos a pancreatectomía distal. En los otros 3 casos el TSP se encontraba en la cabeza del páncreas y fueron resueltos mediante pancreatoduodenectomía. Los TSP fueron confirmados por inmunohistoquímica. El comportamiento posterior fue benigno en 4 casos y maligno en 1 caso. Conclusiones: Las características de los TSP en la IV Región son similares a las conocidas y presentan una alta incidencia comparada con la habitualmente reportada.


Assuntos
Humanos , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Carcinoma Papilar/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreatectomia/estatística & dados numéricos , Chile , Carcinoma Papilar/patologia , Neoplasias Pancreáticas/patologia , Pancreaticoduodenectomia , Estudos Retrospectivos
20.
Rev. chil. cir ; 67(3): 292-298, jun. 2015. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: lil-747503

RESUMO

Introduction: The process design is one of the most interesting tools to ensure the quality of health care before the start of an activity. Although the gold standard treatment of superficial bladder tumors remains transurethral resection (TUR), the onset of laser energy source with better endourological systems allows us to adopt alternative therapies. The aim of this pilot study is to describe the design and protocol in 37 patients with a novel process consisting of outpatient treatment under local anesthesia of bladder tumors with holmium laser. Material and Methods: Pilot study includes 37 patients between January 2012 and December 2013, for the development of a process of holmium laser bladder fulguration without anesthetic infiltration in outpatient study. It analyzes and studies the procedure tolerance, development of immediate complications, visual analog scale (VAS) of pain, patient satisfaction, hospital stays avoided, problems during the application process and development. Results: The mean age of the patients was 69.2 +/- 10.3 years, 100 percent of patients prefer this procedure instead conventional transurethral resection and VAS rating presenting ≤ 3. There were no important complications. Only one patient was admitted at hospital due to hematuria resolved without surgical treatment. Conclusions: The development and implementation of fulguration of superficial papillary bladder tumors with holmium laser process is simple, well tolerated, ambulatory and without complications, with no need of hospital stay.


Introducción: El diseño de procesos es una de las herramientas de mayor interés para asegurar la calidad de la asistencia sanitaria antes del comienzo de una determinada actividad. Aunque el gold standard del tratamiento de los tumores vesicales superficiales sigue siendo la resección transuretral (RTU), la aparición de la fuente de energía láser con mejores medios endourológicos nos permite adoptar otras alternativas terapéuticas. El objetivo de este estudio piloto es describir el diseño y protocolo en 37 pacientes de un proceso novedoso consistente en el tratamiento en régimen ambulatorio y bajo anestesia local intravesical de los tumores de vejiga con láser de holmium. Material y Métodos: Estudio piloto que incluye 37 pacientes entre enero de 2012 y diciembre de 2013, para la elaboración de un proceso de fulguración vesical con láser de holmium sin infiltración anestésica en régimen ambulatorio. Se analiza y estudia tolerancia al procedimiento, desarrollo de complicaciones inmediatas, escala visual analógica (EVA) del dolor, satisfacción del paciente, estancias hospitalarias evitadas, problemas durante la aplicación del proceso y desarrollo del mismo. Resultados: La edad media de los pacientes fue 69,2 +/- 10,3 años, presentando puntuación EVA ≤ 3. No existieron complicaciones importantes. Hubo un ingreso por hematuria tardía que se resolvió de forma conservadora. Conclusiones: La elaboración y aplicación del proceso de fulguración de tumores vesicales papilares superficiales con láser holmium es una técnica sencilla, con buena tolerancia, ambulatoria y sin complicaciones de interés, con eliminación de estancias hospitalarias.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Carcinoma Papilar/cirurgia , Eletrocoagulação/métodos , Neoplasias da Bexiga Urinária/cirurgia , Terapia a Laser/métodos , Procedimentos Cirúrgicos Ambulatórios , Protocolos Antineoplásicos , Anestesia Local/métodos , Tempo de Internação , Medição da Dor , Satisfação do Paciente , Projetos Piloto , Recidiva Local de Neoplasia/cirurgia
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