RESUMO
INTRODUCTION: Decisions not to admit a patient to intensive care units (ICU) as a way of limiting life support treatment (LLST) is a practice that can affect the operation of the emergency services and the way in which patients die. METHODS: Post hoc analysis of the ADENI-UCI study. The main variable analysed was the reason for refusal of admission to the ICU as a measure of LLST. For the present post hoc analysis, the registered patients were divided into 2 groups: the patients assessed in the intensive medicine services from the emergency department and the patients assessed from the conventional hospitalization areas. Student t was used in the comparative statistics when the mean values of the patient sub-cohorts were compared. Categorical variables were compared with the χ2 tests. RESULTS: The ADENI-ICU study included 2,284 decisions not to admit to the ICU as a measure of LLST. Estimated poor quality of life (p=.0158), the presence of severe chronic disease (P=.0169) and futility of treatment (P=.0006) were percentage decisions with greater weight within the population of hospitalized patients. The percentage of disagreement between the consulting physician and the intensivist was significantly lower in patients assessed from the emergency services (P=.0021). CONCLUSIONS: There are appreciable differences in the reasons for consultation, as well as in those for refusal of admission to an ICU between the consultations made from an emergency department and a conventional hospitalization facility.
Assuntos
Unidades de Terapia Intensiva , Qualidade de Vida , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Admissão do Paciente , Encaminhamento e ConsultaRESUMO
Undifferentiated (embryonal) liver sarcoma is a rare tumor about 2% of all malignant liver tumors with a poor prognosis and usually occurs in children, this review aims to assess cases of primary embryonal sarcoma of the liver presented at our institution the past 8 years and improve recognition of its variants and evaluate immunohistochemical characteristics that help differentiated it from other tumors. Six cases of undifferentiated liver sarcoma were histologically evaluated and investigated by immunohistochemistry with a panel of antibodies using the equipment âÅAutostainer Link 48â. Usually masses were on average more than 20 cm, with solid, cystic, mucinous areas. The microscopic features include cells of spindle cell appearance, oval, starry, epithelioid and multinucleated cells densely arranged in a myxoid matrix. Trapped bile ducts and hepatic cords often present in the periphery of tumors. Intracellular and extracellular PAS positive hyaline globules. Immunohistochemistry showed very divergent differentiation.
Assuntos
Neoplasias Hepáticas/diagnóstico , Sarcoma/diagnóstico , Adulto , Biomarcadores Tumorais/metabolismo , Criança , Feminino , Humanos , Fígado/metabolismo , Fígado/patologia , Neoplasias Hepáticas/metabolismo , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Peru , Sarcoma/metabolismo , Sarcoma/patologiaRESUMO
El sarcoma indiferenciado (embrionario) hepático es un tumor poco frecuente, alrededor del 2% de todos los tumores malignos del hígado, con un pobre pronóstico y usualmente se presenta en niños, la presente revisión tiene como objetivo evaluarlos casos de sarcoma embrionario primario de hígado presentados en nuestra institución los 8 últimos años y mejorar el reconocimiento de sus variantes y evaluar sus características inmunohistoquímicas que ayuden a diferenciarlo de otros tumores. Seis casos de sarcoma indiferenciado hepático fueron evaluados histológicamente e investigados por inmunohistoquímica con un panel de anticuerpos utilizando el equipo ôAutostainer Link 48õ. Por lo general eran grandes masas en promedio mayor de 20 cm, con áreas sólidas, quísticas y gelatinosas. Las características microscópicas incluyen células de aspecto fusocelular, oval, estrellada, epitelioide o células multinucleadas densamente dispuestos en una matriz mixoide. Conductos biliares atrapados y cordones hepáticos a menudo presentes en la periferia de los tumores. Glóbulos hialinos intracelulares y extracelulares PAS positivos. La inmunohistoquímica mostró diferenciación muy divergente...
Undifferentiated (embryonal) liver sarcoma is a rare tumor about 2% of all malignant liver tumors with a poor prognosis and usually occurs in children, this review aims to assess cases of primary embryonal sarcoma of the liver presented at our institution the past 8 years and improve recognition of its variants and evaluate immunohistochemical characteristics that help differentiated it from other tumors. Six cases of undifferentiated liver sarcoma were histologically evaluated and investigated by immunohistochemistry with a panel of antibodies using the equipment ôAutostainer Link 48õ. Usually masses were on average more than 20 cm, with solid, cystic, mucinous areas. The microscopic features include cells of spindle cell appearance, oval, starry, epithelioid and multinucleated cells densely arranged in a myxoid matrix. Trapped bile ducts and hepatic cords often present in the periphery of tumors. Intracellular and extracellular PAS positive hyaline globules. Immunohistochemistry showed very divergent differentiation...
Assuntos
Humanos , Masculino , Adulto , Feminino , Criança , Pessoa de Meia-Idade , Diagnóstico Diferencial , Imuno-Histoquímica , Metanálise como Assunto , Neoplasias HepáticasRESUMO
Menciona que las microfinanzas en Bolivia posee retos muy difíciles que se deben vencer para fortalecerlo. Entre ellos, desarrollar nuevos servicios financieros (Principalmente ahorros), lograr la sostenibilidad financiera de sus instituciones, adecuar mejor el marco regulatorio para facilitar el acceso de más entidades de microfinanciamiento, apoyar programas de fortalecimiento patrimonial...
