ABSTRACT
La cirugía cardiovascular pediátrica ha experimentado avances significativos en los últimos años, beneficiándose de los avances tecnológicos conseguidos no solo en la especialidad de la Cirugía Cardiovascular, sino también de los avances y la implicación de profesionales de Anestesia, Cuidados Intensivos, Neonatología y especialmente la Cardiología Pediátrica. Es muy amplio el espectro de pacientes que son intervenidos en nuestro ámbito asistencial: desde el neonato nacido pretérmino a las 24-25 semanas de gestación con ductus arterioso persistente hasta el adolescente o adulto joven con cardiopatía congénita que pudo ser o no intervenido durante su infancia y ha sido seguido evolutivamente hasta llegar a esa edad. Las intervenciones se centran preferentemente cada vez más en los grupos extremos de edad, con tendencia clara hacia la cirugía precoz y correctora en el primer año de vida. Por tanto una buena parte de los procedimientos son en la actualidad realizados en lactantes y neonatos. La progresiva mejora de resultados en los últimos años y la transparencia en el conocimiento y utilización de los mismos hace que en la actualidad el listón esté muy alto en cuanto a la exigencia en la mejora continua y la evaluación periódica de las distintas unidades. En este artículo describimos los avances más importantes que se han producido en los últimos años en el campo de la cirugía de las cardiopatías congénitas así como una breve mención de la actividad realizada en nuestro centro (AU)
Paediatric cardiac surgery has undergone significant improvements over the last years, due to the technological advances made in this area, as well as advances and implication of other disciplines, mainly Anesthesia, Intensive Care, Neonatology and especially Pediatric cardiology. There is a wide range of patients that are operated, from the premature baby with patent ductus arteriosus born at 24-25 weeks of gestation, to the grown-up congenital heart disease patient. Operations currently performed are focused on the end groups of age. There is a very clear tendency towards early corrective surgery; therefore most of interventions are done preferentially in neonates and infants. The btter outcomes that have been produced over the last years and the transparency of results have made most surgical groups take action towards continuous medical improvements and periodical evaluation of the different units. In this article the most important advances in the field of congenital heart surgery are described and a brief summary from our results is given (AU)
Subject(s)
Child , Female , Humans , Infant, Newborn , Male , Heart Defects, Congenital/surgery , Ultrafiltration/instrumentation , Ultrafiltration/methods , Intraoperative Care/methods , Oxygenation/methods , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units, Neonatal/standards , Intensive Care, Neonatal/methodsABSTRACT
Objetivo: Describir el impacto clínico de la PET/TC en el manejo delas pacientes con cáncer de vulva. Material y métodos: Análisis retrospectivo de 13 estudios de PET/TC con 18F-FDG (6 de estadificación y 7 por sospecha de recurrencia), correspondientes a 10 pacientes diagnosticadas de cáncer de vulva mediante biopsia, con una edad media de 64,5 años. Se analizó cualitativamente el estudio PET/TC preoperatorio, según la región de la lesión. Se realizó exéresis quirúrgica, abordando todas las zonas sospechosas según el estudio de PET/TC. Se comparó con el análisis histopatológico. Resultados: Se encontró captación patológica vulvar en 9 de los 13 estudios, e invasión de estructuras adyacentes (uretra, ano o vagina) en 5 de ellos. En 3 estudios se consideró afectados los ganglios inguinofemorales, y en uno de ellos apareció también afectación ganglionar pélvica. Cuatro de los estudios presentaron diseminación extralinfática: 3 en el pulmón y uno en la fosa isquiorrectal. La PET/TC mostró una sensibilidad para la detección de la lesión vulvar del 100% en carcinoma epidermoide y del 60% en el no epidermoide. Se encontró un falso positivo en cuanto a invasión local debido a contaminación urinaria. Uno de los estudios con metástasis pulmonares procedía de un tumor de mama sincrónico. Todos los niveles ganglionares patológicos detectados en la PET/TC fueron confirmados en el estudio histopatológico. No se identificaron nuevas lesiones en la cirugía. La PET/TC cambió el manejo terapéutico en 8 de los 13 estudios (61,5%). Conclusiones: La PET/TC se postula como una prueba de imagen útil en el manejo del cáncer de vulva, particularmente en la identificación de la afectación ganglionar, pudiendo influir tanto en la planificación quirúrgica como en el manejo clínico. Se necesitan series más extensas que confirmen nuestros hallazgos (AU)
Objective: To describe the clinical impact of PET/CT in the management of patients with vulvar cancer. Material and methods: Retrospective analysis of 13 PET/CT studies with 18F-FDG (6 staging and 7 suspected recurrence) corresponding to 10 patients diagnosed with vulvar cancer by biopsy, with a mean age of 64.5 years. The preoperative PET/CT study was analyzed qualitatively according to the lesion region. Surgical excision was carried out, covering all the suspected areas according to the PET/CT study. This was compared with the histopathologic analysis. Results: Abnormal vulvar PET/CT uptake was found in 9 out of the 13 studies and invasion of adjacent structures in 5 of them (urethra, perineal, vagina). The inguinal-femoral lymph nodes were considered as affected in 3 studies and one pelvic lymph node was also affected. Four of the studies had extralymphatic involvement: 3 in lung and 1 in ischiorectal fossa. The PET/CT showed a 100% sensitivity for the detection of the vulvar lesion in squamous cell carcinomas and 60% in non-squamous cell ones. There was a false positive result for local invasion due to urine contamination. One of the studies with lung metastases was related to a synchronous breast tumor. All the pathological lymph node levels detected in the PET/CT study were confirmed in the histopathology study. No new lesions were identified by surgery. PET/CT changed the therapeutic management in 8/13 studies (61.5%). Conclusions: PET/CT is postulated as a useful imaging test for the management of vulvar cancer, mainly in the identification of nodal metastases. It may affect both surgical planning and clinical management. Larger series are needed to confirm our findings (AU)
Subject(s)
Humans , Female , Vulvar Neoplasms/pathology , Positron-Emission Tomography/methods , Retrospective Studies , Biopsy , Sentinel Lymph Node Biopsy , Ganglia/pathology , Lymphatic Metastasis/pathologyABSTRACT
OBJECTIVE: To describe the clinical impact of PET/CT in the management of patients with vulvar cancer. MATERIAL AND METHODS: Retrospective analysis of 13 PET/CT studies with (18)F-FDG (6 staging and 7 suspected recurrence) corresponding to 10 patients diagnosed with vulvar cancer by biopsy, with a mean age of 64.5 years. The preoperative PET/CT study was analyzed qualitatively according to the lesion region. Surgical excision was carried out, covering all the suspected areas according to the PET/CT study. This was compared with the histopathologic analysis. RESULTS: Abnormal vulvar PET/CT uptake was found in 9 out of the 13 studies and invasion of adjacent structures in 5 of them (urethra, perineal, vagina). The inguinal-femoral lymph nodes were considered as affected in 3 studies and one pelvic lymph node was also affected. Four of the studies had extralymphatic involvement: 3 in lung and 1 in ischiorectal fossa. The PET/CT showed a 100% sensitivity for the detection of the vulvar lesion in squamous cell carcinomas and 60% in non-squamous cell ones. There was a false positive result for local invasion due to urine contamination. One of the studies with lung metastases was related to a synchronous breast tumor. All the pathological lymph node levels detected in the PET/CT study were confirmed in the histopathology study. No new lesions were identified by surgery. PET/CT changed the therapeutic management in 8/13 studies (61.5%). CONCLUSIONS: PET/CT is postulated as a useful imaging test for the management of vulvar cancer, mainly in the identification of nodal metastases. It may affect both surgical planning and clinical management. Larger series are needed to confirm our findings.
Subject(s)
Fluorodeoxyglucose F18 , Multimodal Imaging , Positron-Emission Tomography , Radiopharmaceuticals , Tomography, X-Ray Computed , Vulvar Neoplasms/diagnosis , Vulvar Neoplasms/therapy , Female , Humans , Middle Aged , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Venous Thrombosis , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography/instrumentation , Positron Emission Tomography Computed Tomography/methods , Positron Emission Tomography Computed Tomography/trends , Adenocarcinoma , Rectal Neoplasms , Positron Emission Tomography Computed Tomography , Nuclear Medicine/methods , Nuclear Medicine/trendsABSTRACT
No disponible
Subject(s)
Male , Infant , Humans , Catheterization/methods , Heart Defects, Congenital/surgery , Heart Septum/surgery , Heart Atria/surgery , Treatment Outcome , EchocardiographyABSTRACT
No disponible
Subject(s)
Male , Infant , Humans , Respiratory Sounds , Aorta, Thoracic , Deglutition Disorders , Subclavian Artery , Aortic Diseases , Diverticulum , Deglutition DisordersABSTRACT
No disponible
Subject(s)
Male , Infant, Newborn , Humans , Abnormalities, Multiple , Heart Defects, Congenital , Thoracic WallABSTRACT
Interferon (IFN) is the drug universally used in the treatment of B and C chronic hepatitis. Due to its low efficacy, 40% in the treatment of chronic hepatitis B and 10-20% in the treatment of chronic hepatitis C, and to its adverse events, in some cases severe, new antiviric molecules are being investigated. Lamivudin, famciclovir and the association of ribavirin and IFN are the more relevant and will be clinically accepted in an immediate future. It is also probable that rigid indications for hepatic transplantation in patients with liver cirrhosis by B virus change in the next years due to the use of these new antiviric drugs before and after transplantation. In this revision we analyze the current situation of these new therapies. However, most information come from pilot studies, and multicentric randomized studies are needed to establish firm conclusions about the role that these new therapies are going to play in the treatment of viral chronic hepatitis.
Subject(s)
Antiviral Agents/therapeutic use , Hepatitis B, Chronic/drug therapy , Hepatitis C, Chronic/drug therapy , 2-Aminopurine/analogs & derivatives , 2-Aminopurine/therapeutic use , Antimetabolites/therapeutic use , Clinical Trials as Topic , Famciclovir , Humans , Lamivudine/therapeutic use , Prodrugs/therapeutic use , Reverse Transcriptase Inhibitors/therapeutic use , Ribavirin/therapeutic useSubject(s)
Hepatitis C/therapy , Interferons/therapeutic use , Algorithms , Chronic Disease , Humans , PrognosisABSTRACT
We analyze 402 drug-adverse events consisting of movement disorders or aggravation of parkinsonisms, submitted to Sistema Español de Farmacovigilancia until 1994. Our aim is to know patient characteristics and the drugs related with these submissions. Most of them (64) belong to calcium-entry blocker group (31%) and benzamides (27%). Case age intervals more frequent were 11-30 and 60-80 years-old and the events affect predominantly females. The percentage of serious adverse events were near 80%. We think that drug-related parkinsonisms have high prevalence rate and that the role of calcium-entry blockers in these events should be considered at the moment to prescribe groups.