ABSTRACT
Sorafenib has been widely used to treat unresectable hepatocellular carcinoma (HCC) but most studies have been done in Child-Pugh A (CP-A) patients with well-preserved liver function. We evaluated the overall survival (OS) and tolerance to sorafenib in a large cohort of Child-Pugh B (CP-B) HCC patients as compared to CP-A HCC patients. We prospectively studied 130 patients with advanced HCC who started sorafenib between January 2011 and December 2015. Patients were classified as CP-A (n = 65) or CP-B (n = 65). The average OS for all 130 patients was 10 months. CP-A patients had a median survival rate significantly longer than CP-B patients: 12 months vs. 6 months. The OS found in our group of CP-B patients was 6.5 months, which is higher than that found in most studies done so far. When stratified, our CP-B patients had better OS than ever reported. The dose of the drug was interrupted due to adverse events (AEs) in 38 (29%) of the patients, of whom 20 (30%) were CP-A patients and 18 (28%) were CP-B patients. This real-life cohort of CP-B HCC patients treated with sorafenib had a higher survival than that described in the literature, with a satisfactory safety profile. Despite the high prevalence of severe AEs in CP-B patients, there were fewer treatment interruptions in this group, indicating that Child-Pugh B patients can tolerate treatment and may benefit from sorafenib.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular/drug therapy , Liver Neoplasms/drug therapy , Protein Kinase Inhibitors/therapeutic use , Sorafenib/therapeutic use , Aged , Carcinoma, Hepatocellular/blood , Carcinoma, Hepatocellular/classification , Female , Humans , Liver Neoplasms/blood , Liver Neoplasms/classification , Male , Middle Aged , Survival Analysis , alpha-Fetoproteins/analysisABSTRACT
A prevenção e o controle das doenças crônicas não transmissíveis adquiridos com a prática regular de atividade física podem contribuir na melhoria da saúde dos indivíduos, o que pode reduzir o uso dos serviços de saúde e os gastos do governo. O objetivo do estudo foi verificar a influência da prática de exercícios físicos no uso dos serviços de saúde na Atenção Básica de Saúde (ABS). Participaram do estudo 26 mulheres de um programa de exercícios físicos em unidades de saúde da ABS do município de Rio Claro- SP. Foi aplicado um questionário com as participantes do programa de 2009 a 2011, contendo questões referentes à participação no programa, condições de saúde, percepção dos participantes em relação ao uso dos serviços de saúde sobre consultas médicas, medicamentos, doenças/queixas e internações, no momento anterior e posterior ao ingresso no programa. Foi realizada análise descritiva e de comparação, na qual foi utilizada a análise por intervalo de confiança para médias e frequências, sendo este de 95%. Após iniciar no programa, houve melhora da percepção de saúde das participantes, bem como relatos de diminuição do número de visitas à unidade de saúde, do número de medidas da pressão arterial, do descontrole da pressão arterial e da glicemia. Houve também manutenção do número e da dose de medicamentos, do número de doenças/queixas e do número de medidas da glicemia. A prática de exercícios físicos oferecida pelo programa contribuiu para melhora nos níveis de saúde percebida e para diminuição do uso dos serviços de saúde.
The prevention and control of chronic non-communicable diseases, promoted by the regular practice of physical activity, can improve the health status of individuals, and this can reduce government spending and the use of healthcare services. The aim of this study was to investigate the influence of physical activity practice on the use of Primary Care services. Twenty-six women enrolled in a physical activity program held in Primary Care units located in the city of Rio Claro, state of São Paulo, participated in this study. A questionnaire was administered to the women who participated in the program from 2009 to 2011, containing questions regarding participation in the program, health conditions, and participants? perceptions concerning the use of healthcare services related to medical appointments, medications, diseases/complaints and hospitalizations, in the moments before and after the enrolment in the program. A descriptive and comparative analysis was carried out, in which confidence interval analysis for means and frequencies was used, with 95% confidence intervals. After starting the program, there was an improvement in the participants? health perception, as well as reports of decrease in the number of visits to the healthcare unit, in the number of blood pressure measurements, in uncontrolled blood pressure and blood glucose. On the other hand, the number and dose of drugs remained the same, as well as the number of diseases/complaints and the number of blood glucose measurements. The practice of physical exercises offered by the program contributed to improve the levels of perceived health and to reduce the use of the healthcare services.
Subject(s)
Humans , Female , Primary Health Care , Health Services , Motor ActivityABSTRACT
OBJETIVO: Relatar os resultados preliminares da aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal. MATERIAIS E MÉTODOS: Cinco pacientes (três mulheres e dois homens, com idade média de 62 anos, intervalo de 49-72 anos) com aneurismas da artéria renal variando de 10 a 25 mm de diâmetro, de colo largo, foram tratados com técnicas de embolização assistidas por "remodelagem do colo" com balão durante o período de três anos. O microbalão era posicionado diante do colo do aneurisma e insuflado, temporariamente, durante a colocação das micromolas destacáveis no interior do aneurisma. RESULTADOS: O posicionamento do balão e a colocação das micromolas foram realizados com êxito em todos os casos. Oclusão completa do aneurisma, sem protrusão de micromolas ou obstrução do vaso parental, foi alcançada em todos os pacientes. CONCLUSÃO: Nossa experiência preliminar indica que a aplicação da técnica de "remodelagem do colo" no tratamento dos aneurismas de colo largo da artéria renal é tecnicamente viável e eficaz para o tratamento endovascular de aneurismas complexos da artéria renal, sem o sacrifício de qualquer ramo arterial.
OBJECTIVE: To report preliminary results of aneurysm neck remodeling in the management of wide-necked renal artery aneurysms. MATERIALS AND METHODS: Five patients (three women and two men between 49-72 years; mean age, 62 years) with wide-necked renal artery aneurysms measuring from 10 to 25 mm in diameter were submitted to balloon-assisted coil embolization along a three-year period. The micro-balloon was placed along the aneurysm neck and temporarily inflated for introduction of detachable microcoils into the aneurysmal sac. RESULTS: Balloon positioning and microcoil embolization were successfully completed in all of the cases with achievement of complete aneurysm occlusion without coil protrusion or parent vessel obstruction. CONCLUSION: The present preliminary experiment indicates that the "aneurysm neck remodeling" is technically feasible and effective in the management of complex renal artery aneurysms without sacrificing any arterial branch.
