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BACKGROUND: For the study of quantitative and qualitative muscle parameters, ultrasound and bioelectric impedance analysis are reliable, non-invasive, and reproducible. The aim of this study was to test the combined role of those techniques for the diagnosis of sarcopenia in a population of hospitalized older males and females. METHODS: A total of 70 subjects were recruited, including 10 healthy adults and 60 hospitalized elderly patients with a good level of independence and cooperation, with and without sarcopenia. The rectus femoris cross-sectional area (CSA), thickness, echogenicity, and compressibility were measured with ultrasound echography. The phase angles (PhAs) and skeletal muscle mass were calculated by bioimpedence analysis. The muscle quality index (MQI) was calculated as the product of CSA and PhA. RESULTS: Muscle compressibility was greater and PhA was lower in sarcopenic when compared with non-sarcopenic subjects. The threshold values for sarcopenia diagnosis in both sexes of CSA, of PhA, and of the MQI were identified. The obtained CSA values showed an AUC of 0.852 for women and 0.867 for men, PhA of 0.792 in women and 0.898 in men, while MQI was 0.900 for women and 0.969 for men. CONCLUSIONS: The newly calculated cut-off values of CSA, PhA, and MQI predicted the presence of sarcopenia with good sensitivity and specificity values. The use of the MQI proved to be more promising than the separate use of CSA and PhA in both male and female subjects.
Assuntos
Impedância Elétrica , Músculo Esquelético , Sarcopenia , Ultrassonografia , Humanos , Sarcopenia/diagnóstico por imagem , Sarcopenia/diagnóstico , Masculino , Feminino , Idoso , Ultrassonografia/métodos , Músculo Esquelético/diagnóstico por imagem , Idoso de 80 Anos ou mais , Hospitalização , Músculo Quadríceps/diagnóstico por imagem , Composição CorporalRESUMO
BACKGROUND: Nephrolithiasis is frequently associated with cardiovascular diseases. These conditions present common risk factors: systemic inflammation that promotes oxidative stress leading to arterial wall stiffening may also play a role in plaque formation predisposing to nephrolithiasis. OBJECTIVES: The aim of this study was to evaluate arterial stiffness indices at baseline and after a 10-year follow-up, in patients with nephrolithiasis compared with patients without. METHODS: A total of 82 patients (37 men; mean age 45â±â13âyears) were enrolled at the Geriatrics and Nephrology Outpatient Clinic: 66 were diagnosed with nephrolithiasis, whereas the control group consisted of 16 individuals. At baseline and after 10âyears, they underwent clinical evaluation and arterial stiffness measurement, such as carotid-femoral pulse wave velocity (CF-PWV), by arterial applanation tonometry. RESULTS: At baseline, when compared with the control group, patients with nephrolithiasis showed higher SBP and CF-PWV. After 10âyears, patients with nephrolithiasis, but not those without, showed a significant raise in CF-PWV, even after adjustment for age and sex. In a stepwise regression model, with CF-PWV changes during the follow-up as the dependent variable, and age, sex, follow-up years, Δ mean arterial pressure, BMI, hypertension and nephrolithiasis as independent variables, nephrolithiasis was proved to be the only significant predictor of ΔCF-PWV, accounting for 6% of the variance. CONCLUSION: Our study shows higher baseline CF-PWV and greater increase in ΔCF-PWV within 10âyears in individuals with nephrolithiasis than in those without, demonstrating an increased cardiovascular risk for nephrolithiasis patients.
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Doenças Cardiovasculares , Nefrolitíase , Rigidez Vascular , Humanos , Rigidez Vascular/fisiologia , Masculino , Pessoa de Meia-Idade , Feminino , Estudos Prospectivos , Nefrolitíase/fisiopatologia , Nefrolitíase/complicações , Adulto , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/etiologia , Análise de Onda de Pulso , Fatores de Risco , Seguimentos , Fatores de Risco de Doenças CardíacasRESUMO
BACKGROUND: Polypharmacy is a primary risk factor for the prescription of potentially inappropriate medications (PIMs), drug-drug interactions (DDIs), and ultimately, adverse drug reactions (ADRs). Medication review and deprescribing represent effective strategies to simplify therapeutic regimens, minimize risks, and reduce PIM prescriptions. This systematic review and meta-analysis of experimental and observational studies aimed to evaluate the impact of different medication review and deprescribing interventions in hospitalized older patients. METHODS: Experimental and observational prospective cohort studies evaluating the clinical effects of medication review and deprescribing strategies in older hospitalized patients were searched in the bibliographic databases, PubMed, Embase, and Scopus, from inception until January 8, 2024. A narrative synthesis of the results was provided, along with a meta-analysis of dichotomous data (i.e., re-hospitalizations and mortality). RESULTS: Overall, 21 randomized controlled trials, 7 non-randomized interventional studies, and 2 prospective cohort studies were included in the systematic review. Of these, 14 (46.7%) assessed medication appropriateness as the primary outcome, while the remaining evaluated clinical outcomes (e.g., length of hospital stay, hospital readmissions, emergency department visits, and incidence of ADRs) and/or quality of life. The meta-analysis revealed a slight but statistically significant 8% reduction in hospital readmissions (HR: 0.92; 95% CI: 0.85-0.99) following medication review and deprescribing, but no significant impact on mortality (HR: 0.98; 95% CI: 0.96-1.00). Of the 30 included studies, 21 were considered at high risk of bias, mostly due to potential deviations from intended interventions and randomization processes. The remaining nine studies had "some concerns" (eight studies) or were considered at "low" risk of bias (one study). CONCLUSION: Medication review and deprescribing are associated with potential benefits in reducing hospital readmission rates among hospitalized older patients, particularly through the reduction of PIM prescriptions. The integration of thorough medication review and deprescribing protocols in hospital settings may improve post-discharge outcomes and reduce overall healthcare costs.
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Recent medical advancements have increased life expectancy, leading to a surge in patients affected by multiple chronic diseases and consequent polypharmacy, especially among older adults. This scenario increases the risk of drug interactions and adverse drug reactions, highlighting the need for medication review and deprescribing to reduce inappropriate medications and optimize therapeutic regimens, with the ultimate goal to improving patients' health and quality of life. This position statement from the Italian Scientific Consortium on medication review and deprescribing aims to describe key elements, strategies, tools, timing, and healthcare professionals to be involved, for the implementation of medication review and deprescribing in different healthcare settings (i.e., primary care, hospital, long-term care facilities, and palliative care). Challenges and potential solutions for the implementation of medication review and deprescribing are also discussed.
Assuntos
Desprescrições , Humanos , Idoso , Prescrição Inadequada/prevenção & controle , Qualidade de Vida , Revisão de Medicamentos , Polimedicação , ItáliaRESUMO
Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.
Assuntos
Neoplasias Pulmonares , Radiologia , Cirurgia Torácica , Humanos , Neoplasias Pulmonares/diagnóstico , Brasil/epidemiologia , Detecção Precoce de Câncer/métodos , Tomografia Computadorizada por Raios X/métodos , Programas de RastreamentoRESUMO
Background: Aging is associated with a higher prevalence of sarcopenia, sarcopenic obesity (SO), and increased arterial stiffening, with possible detrimental effects on morbidity and mortality. The aim of this study was to assess the relationships between sarcopenia, SO, and different indexes of arterial stiffness in older adults. Methods: A total of 77 hospitalized patients (mean age 78.68 ± 9.65 years) were evaluated, obtaining anthropometric variables, biochemical samples, handgrip test, and body composition assessment. Arterial stiffness was evaluated by measuring both carotid-femoral pulse wave velocity (cfPWV), a proxy for central stiffness, and cardio-ankle vascular index (CAVI), as well as considering peripheral arteries. The population was sorted into four subgroups: obese, sarcopenic, SO, and controls. Results: The highest CAVI (11.31 ± 2.58) was found in sarcopenic patients. SO had the highest value of cfPWV (15.18 ± 8.44â m/s), even after adjustment for significant covariates. In multiple regressions, SO diagnosis resulted as a significant predictor of cfPWV (p = 0.03, R2 = 0.20), and sarcopenia diagnosis resulted as a predictor of CAVI (p = 0.042, R2 = 0.12). Conclusions: In conclusion, a positive correlation is found between sarcopenia, SO, and arterial stiffness among older subjects. In particular, greater central arterial stiffness is associated with SO, outlining a remarkable effect on the cardiovascular risk profile.
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BACKGROUND: Hospital readmissions among older adults are associated with progressive functional worsening, increased institutionalization and mortality. AIM: Identify the main predictors of readmission in older adults. METHODS: We examined readmission predictors in 777 hospitalized subjects (mean age 84.40 ± 6.77 years) assessed with Comprehensive Geriatric Assessment (CGA), clinical, anthropometric and biochemical evaluations. Comorbidity burden was estimated by Charlson Comorbidity Index (CCI). Median follow-up was 365 days. RESULTS: 358 patients (46.1%) had a second admission within 365 days of discharge. Estimated probability of having a second admission was 0.119 (95%C.I. 0.095-0.141), 0.158 (95%C.I. 0.131-0.183), and 0.496 (95%C.I. 0.458-0.532) at 21, 30 and 356 days, respectively. Main predictors of readmission at 1 year were length of stay (LOS) > 14 days (p < 0.001), albumin level < 30 g/l (p 0.018), values of glomerular filtration rate (eGFR) < 40 ml/min (p < 0.001), systolic blood pressure < 115 mmHg (p < 0.001), CCI ≥ 6 (p < 0.001), and cardiovascular diagnoses. When the joint effects of selected prognostic variables were accounted for, LOS > 14 days, worse renal function, systolic blood pressure < 115 mmHg, higher comorbidity burden remained independently associated with higher readmission risk. DISCUSSION: Selected predictors are associated with higher readmission risk, and the relationship evolves with time. CONCLUSIONS: This study highlights the importance of performing an accurate CGA, since defined domains and variables contained in the CGA (i.e., LOS, lower albumin and systolic blood pressure, poor renal function, and greater comorbidity burden), when combined altogether, may offer a valid tool to identify the most fragile patients with clinical and functional impairment enhancing their risk of unplanned early and late readmission.
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Hospitalização , Readmissão do Paciente , Humanos , Idoso , Idoso de 80 Anos ou mais , Tempo de Internação , Comorbidade , Albuminas , Fatores de Risco , Estudos RetrospectivosRESUMO
ABSTRACT Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.
RESUMO O câncer de pulmão (CP) é uma das neoplasias mais comuns e letais no Brasil, e apenas 15% dos pacientes são diagnosticados nos estágios iniciais. O tabagismo persiste como o responsável por mais de 85% de todos os casos. O rastreamento do CP (RCP) por meio da TC de baixa dosagem de radiação (TCBD) reduz a mortalidade do CP em 20%, e, quando combinado com a cessação do tabagismo, essa redução chega a 38%. Na última década, diversos países adotaram o RCP como recomendação de saúde populacional. No Brasil, embora ainda incipiente, a discussão sobre o tema é cada vez mais ampla e necessária. Com o intuito de aumentar o conhecimento e estimular o debate sobre o RCP, a Sociedade Brasileira de Cirurgia Torácica, a Sociedade Brasileira de Pneumologia e Tisiologia e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem constituíram um painel de especialistas para elaborar as recomendações para o RCP. As recomendações aqui apresentadas foram baseadas em revisão narrativa da literatura, com ênfase em grandes estudos populacionais, em revisões sistemáticas e em recomendações de diretrizes internacionais, sendo construídas após ampla discussão pelo grupo de especialistas. Os temas revisados foram os seguintes: porque rastrear, considerações gerais sobre tabagismo, epidemiologia do CP, critérios de elegibilidade, achados incidentais, lesões granulomatosas, modelos probabilísticos, requisitos mínimos da TCBD, aquisições volumétricas, riscos do rastreamento, estrutura mínima e papel da equipe multidisciplinar, conduta segundo o Lung CT Screening Reporting and Data System (Lung-RADS), custos vs. benefícios e perspectivas do rastreamento.
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Introduction: Tobacco smoke is the leading risk factor for the development of lung cancer (LC). However, several countries have recently reported increases in LC in never-smokers. Objective: The study aimed to verify epidemiological and survival characteristics in never-smoker LC patients. Method: The study was based on a historical cohort of never-smokers with LC diagnosed from 2000 to 2009. Overall survival was compared using log-rank test, and Cox regression analysis was used to identify independent prognostic factors. Results: A total of 254 never-smoker LC patients were studied (median age 65.5 years; 66.5% women). The most common histological type was adenocarcinoma (65.7% in women and 60.0% in men), and the majority of the patients had advanced stages (III-IV) (79.6% in women and 92.8% in men). 9.9% of the patients were treated with surgery (13.1% of women and 3.6% of men). The overall survival rates at one, three, and five years were 37.2%, 14.2%, and 9.5%, respectively. Median overall survival was 8.3 months. Women showed better survival than men (9.6 vs. 6.9 months; p=0.023). Non-surgical treatment (p<0.001), performance status 2-4 (p=0.038), and stages III and IV (p<0.001) were associated with worse overall survival. Conclusions: The majority of LC cases in never-smokers were advanced-stage adenocarcinoma, submitted to non-surgical treatment. Women showed better survival than men. Based on the low overall survival, the data emphasize the importance of early diagnosis of LC in never-smoker patients.
Introducción: El tabaquismo es el factor de riesgo predominante para el de cáncer de pulmón (CP). Sin embargo, un aumento reciente de CP en no fumadores es prominente en algunos países. Objetivo: El objetivo de este estudio fue verificar las características epidemiológicas y de sobrevida en no fumadores con CP. Método: Cohorte histórica de no fumadores con CP diagnosticados de 2000-2009. La supervivencia global fue comparada usando análisis de log-rank y la regresión de Cox para identificar factores pronósticos independientes. Resultados: Una muestra totalizando 254 pacientes no fumadores con CP fue estudiada (mediana de edad: 65,5 años, 66,5% de mujeres). El tipo histológico más común correspondió a adenocarcinoma (65,7% en las mujeres y el 60,0% en los hombres) y la mayoría en estadio avanzado (III-IV) (79,6% en las mujeres y el 92,8% en los hombres). Un total de 9,9% de pacientes fueron tratados con cirugía (13,1% en mujeres y 3,6% en hombres). Las tasas de supervivencia global de 1, 3 y 5 años fueron, respectivamente, el 37,2%, el 14,2% y el 9,5%. La supervivencia mediana global correspondió a 8,3 meses. Fue observada una mejor sobrevida en mujeres que em hombres (9,6 frente a 6,9 meses, p=0,023). El tratamiento no quirúrgico (p <0,001), el estado de equilibrio del estado 2-4 (p=0,038) y los estadios III-IV (p <0,001) se encontraron asociados con una peor sobrevida global. Conclusiones: Se encontró una mayor ocurrencia de adenocarcinoma, estadificación avanzada y tratamiento no quirúrgico. Las mujeres mostraron una sobrevida mejor que los hombres. En función de la baja sobrevida global, estos datos refuerzan la importancia del diagnóstico precoz del CP en no fumadores.
Introdução: O tabagismo é o fator de risco predominante para o desenvolvimento do câncer de pulmão (CP). Contudo, um aumento recente de CP em não fumantes é proeminente em alguns países. Objetivo:O objetivo deste estudo foi verificar as características epidemiológicas e de sobrevida em não fumantes com CP. Método: Coorte histórica de não fumantes com CP diagnosticados de 2000 a 2009. A sobrevivência global foi comparada usando o teste Log-rank e a análise de regressão de Cox foi usada para identificar fatores prognósticos independentes. Resultados: Um total de 254 pacientes com LC não fumantes foram estudados (mediana de idade: 65,5 anos, 66,5% de mulheres). O tipo histológico mais comum foi o adenocarcinoma (65,7% nas mulheres e 60,0% nos homens) e a maioria tinha estadiamento avançado (III-IV) (79,6% nas mulheres e 92,8% nos homens). Um total de 9,9% dos pacientes foi tratado com cirurgia (13,1% em mulheres e 3,6% em homens). As taxas de sobrevida global de 1, 3 e 5 anos foram, respectivamente: 37,2%, 14,2% e 9,5%. A sobrevida global mediana foi de 8,3 meses. As mulheres tiveram melhor sobrevida do que os homens (9,6 vs. 6,9 meses, p=0,023). O tratamento não cirúrgico (p<0,001), o performance status 2-4 (p=0,038) e os estádios III-IV (p<0,001) foram associados com uma sobrevida global pior. Conclusão: Encontrou-se uma maior ocorrência de adenocarcinoma, estadiamento avançado e tratamento não cirúrgico. As mulheres tiveram uma sobrevida maior do que os homens. Em razão da baixa sobrevida global, esses dados reforçam a importância do diagnóstico precoce do CP em não fumantes.
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Humanos , Masculino , Feminino , Poluição por Fumaça de Tabaco , Neoplasias Pulmonares/epidemiologia , Prognóstico , Sobrevivência , não Fumantes , Neoplasias Pulmonares/diagnósticoRESUMO
Introdução: O tratamento paliativo dos pacientes com Derrame Pleural Maligno (DPM) deve ser individualizado uma vez que esses pacientes têm sobrevida reduzida. O objetivo deste estudo foi desenvolver um modelo capaz de identificar os fatores prognósticos relacionados à sobrevida dos pacientes com DPM. Métodos: É um estudo retrospectivo, descritivo, observacional para identificar fatores prognósticos relacionados ao DPM em pacientes com diagnóstico confirmado de câncer oriundos do banco de dados do Instituto Nacional do Câncer (INCA), vinculado ao Ministério da Saúde. A análise multivariada de Kaplan-Meier e o modelo de regressão de Cox foram utilizadas para determinar os fatores com potencial prognóstico relacionados à sobrevida desses pacientes. A sobrevida foi definida como o tempo do diagnóstico anátomo patológico até o óbito. Resultados: Cento e sessenta e cinco pacientes foram incluídos no estudo; 77 homens (47%), e 88 mulheres (53%). A mediana da idade foi de 60 anos (1,0 95,0), e todos os pacientes tinham DPM confirmados por exames cito e/ou histopatológicos. O carcinoma de pulmão, do tipo não pequenas células (36%), a neoplasia de mama (26%) e os linfomas (13%) foram os tumores mais frequentemente diagnosticados. A mediana da sobrevida global dos pacientes a partir do diagnóstico foi de 5 meses (1,0-96,0). A análise univariada de Kaplan-Meier demonstrou que a sobrevida dos pacientes estava significativamente relacionada com os seguintes fatores prognósticos: a escala de capacidade funcional (PS) da Eastern Cooperative Oncology Group (ECOG) (HR 10,0, IC 95%: 5,96 a 18,50, p < 0,0001), local do tumor primário (HR 1,99, IC 95%: 1,23 a 3,22, p < 0,01), citologia oncótica do líquido pleural positiva (HR 1,25, IC 95%: 0,88 a 1,78, p = 0,04), e exame histológico da pleura positivo (HR 1,33, IC 95%: 0,97 a 1,81, p = 0,04). Outros fatores prognósticos independentes avaliados não tiveram influência na sobrevida. A análise de regressão de Cox demonstrou que somente a escala da capacidade funcional (PS) da ECOG estava altamente relacionada com a sobrevida dos pacientes (HR 73,58, IC 95%: 23,44 a 230,95, p < 0,0001). Conclusões: a escala da capacidade funcional (PS) da ECOG foi um fator previsor independente de sobrevida para os pacientes com DPM no momento do diagnóstico inicial. Este fator prognóstico pode auxiliar os médicos na seleção dos pacientes para o tratamento paliativo apropriado da síndrome do DPM. AU
Background: The approach to palliative treatment of malignant pleural effusion (MPE) should be individualized because these patients generally have poor survival. This study aimed to develop a model to identify prognostic factors for survival time in patients with MPE. Methods: This is a retrospective, descriptive, observational study to identify prognostic factors related to MPE in patients with a confirmed diagnosis of cancer. Cox regression analysis was used to determine significant potential prognostic factors with respect to survival time. Survival time was defined as the time from pathological diagnosis to death. Results: One hundred and sixty-five patients were included; 77 were men (47%) and 88 were women (53%). The median age was 60 years (1.0 95.0), and all of the patients were pathologically proven to have MPE. Non-small-cell lung cancer (36.0%), breast carcinoma (26%), and lymphoma (13.0%) were the most frequently diagnosed tumors. The median overall survival of patients from the initial diagnosis was 5 months (range: 1.096.0 months). The KaplanMeier univariate analysis showed that survival was significantly related to the following prognostic factors: Eastern Cooperative Oncology Group - Performance Status (ECOG - PS) (HR 10.0; 95% CI: 5.96 to 18.50, p < 0.0001); primary cancer site (HR 1.99; 95% CI: 1.23 to 3.22, p < 0.01); positive pleural cytology (HR 1.25; 95% CI: 0.88 to 1.78, p = 0.04); and positive histology (HR 1.33; 95% CI: 0.97 to 1.81, p = 0.04). Other potential independent diagnostic factors that were examined did not affect survival. Cox regression analysis showed that only the ECOG PS was highly predictive of survival (HR 73.58; 95% CI: 23.44 to230.95, p < 0.0001). Conclusions: ECOG PS is an independent predictor of survival in patients with MPE at initial diagnosis. This prognostic factor can help physicians select patients for appropriate palliative treatment of this syndrome. AU
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Prognóstico , Análise de Sobrevida , Derrame Pleural Maligno/terapia , Epidemiologia Descritiva , Estudos Retrospectivos , Estudos Observacionais como Assunto , NeoplasiasRESUMO
A DPOC e o câncer do pulmão são duas doenças fatais. Há na literatura dados que demonstra muma incidência crescente do câncer do pulmão em pacientes portadores de DPOC. Cada vez mais se aponta para um mecanismo fisiopatológico comum para as duas enfermidades. A inflamação crônica da DPOC parece desempenhar um papel significativo no desenvolvimentodo câncer do pulmão. Este artigo descreve aspectos relacionados com a incidência, mecanismos de associação e opções terapêuticas para o câncer de pulmão em portadores de DPOC
Lung cancer and COPD are common diseases, and both are fatal. Data in the literature demonstrate that the incidence of lung cancer is on the rise among COPD patients. There is increasing evidence that the two diseases share a common patho-physiology. The chronic inflammation associated with COPD appears to play a role in the development of lung cancer. This review describes aspects of the incidence of lung cancer in COPD, as well as the mechanistic links between the two diseases, together with treatment options and outcomes.
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Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapiaRESUMO
Nos últimos anos, o uso de testes de exercício é reconhecido como um método conveniente na avaliação da função respiratória em função da necessidade de se conhecer as reservas dos vários sistemas corporais a fim de que uma ideia mais completa sobre as capacidades funcionais do paciente seja obtida. Visto que o ato de andar é uma das principais atividades da vida diária, os testes de caminhada têm sido propostos para medir o estado ou a capacidade funcional do paciente. O teste de caminhada de seis minutos provou ser reprodutível e é bem tolerado pelos pacientes. Ele avalia a distância que uma pessoa pode percorrer sobre uma superfície plana e rígida em seis minutos e tem como principal objetivo a determinação da tolerância ao exercício e da saturação de oxigênio durante um exercício submáximo. Nesta revisão, apresentamos várias áreas clínicas nas quais o teste pode fornecer informações úteis.
Over the last few years, the use of exercise tests has come to be recognized as a convenient method of evaluating respiratory function, because the reserves of the various systems in the human body should be known in order to provide a more complete portrayal of the functional capacities of the patient. Because walking is one of the main activities of daily living, walk tests have been proposed in order to measure the state or the functional capacity of patients. The six-minute walk test has proven to be reproducible and is well tolerated by patients. It evaluates the distance a person can walk on a flat, rigid surface in six minutes. Its main objective is to determine exercise tolerance and oxygen saturation during submaximal exercise. In this review, we present various clinical areas in which the test can provide useful data.
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Humanos , Teste de Esforço/métodos , Tolerância ao Exercício/fisiologia , Pneumopatias/diagnóstico , Doença Cardiopulmonar/diagnóstico , Caminhada/fisiologia , Pneumopatias/fisiopatologia , Doença Cardiopulmonar/fisiopatologiaRESUMO
Tumores localmente avançados como forma de apresentação inicial dos tumores localizados na árvore traqueobrônquica não são um fenômeno raro. Os sintomas resultantes dessas lesões são comuns de câncer do pulmão e têm um impacto negativo significativo na qualidade de vida dos pacientes portadores de neoplasias pulmonares. As opções terapêuticas são múltiplas, sendo no entanto dependentes de variáveis, como a terapêutica inicial utilizada, o local da recorrência, a sintomatologia e as condições clínicas dos pacientes. Os objetivos principais foram demonstrar as principais vantagens terapêuticas da braquiterapia endobrônquica com alta taxa de dose em tumores da árvore respiratória. No período de 1998 a 2009, 42 pacientes com neoplasia pulmonar foram tratados paliativamente com braquiterapia endobrónquica com alta taxa de dose, com um total de 110 inserções, no Instituto Nacional de Câncer, Rio de Janeiro. A regressão endoscópica completa do tumor foi observada em 75% dos pacientes. A regressão tumoral teve relação direta com a melhora dos sintomas, especialmente da dispnéia. A sobrevida global foi de 56%, em 15 meses de acompanhamento. Não houve nenhum caso de hemoptise volumosa ou fatal, fistulas ou abscessos. Desse modo, concluimos que a braquiterapia endobrônquica com alta taxa de dose, é um excelente método com tratamento paliativo para os pacientes portadores de neoplasias pulmonares obstrutivas.
Locally advanced tumors as the initial form of presentation of tumors in the tracheobronchial tree are not a rare event. Symptoms resulting from these tumors are common in lung cancer and have a significant negative impact on quality of life of patients with lung cancer. The therapeutic options are manifold, but being dependent on variables such as the initial therapy used, the site of recurrence, the symptoms and the clinical condition of patients. The main objectives were to demonstrate the main advantages of brachytherapy treatment with high dose rate in tumors of the respiratory tree. In the period 1998-2009, 42 patients with lung cancer were treated with brachytherapy palliatively with high dose rate, with a total of 110 insertions, at the National Cancer Institute, Rio de Janeiro. The endoscopic complete tumor regression was observed in 75% of patients. The tumor regression was directly related to improvement of symptoms, especially dyspnea. Overall survival was 56% in 15 months monitoring. There were no cases of massive or fatal hemoptysis, fistulae or abscess. Thus, we conclude thatbrachytherapy with high dose rate, is an excellent method to palliative treatment for patients with obstructive lung cancers.
Assuntos
Humanos , Masculino , Feminino , Cuidados Paliativos , Braquiterapia/métodos , Irídio , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Técnicas de Diagnóstico do Sistema Respiratório , Qualidade de Vida , TerapêuticaRESUMO
Os sintomas resultantes das lesões endobrônquicas são comuns nos pacientes portadores de câncer do pulmão e tem um impacto negativo significativo na qualidade de vida. Inúmeras opções terapêuticas estão disponíveis para o tratamento paliativo destes pacientes: braquiterapia endobrônquica, colocação de próteses endobrônquicas, ressecção com laser ou eletrocautério ou a radioterapia convencional. Esta revisão tem como objetivos descrever o método e o papel da braquiterapia endobrônquica em pacientes portadores de neoplasia pulmonar e mostrar nossa experiência com o método em nossa instituição.
Symptoms resulting from tumors extending to the endobronchial wall are common in patients with lung cnacer and significantly impacts quality of life. A number of treatment options are available for palliation, including endobronchial brachytherapy, stent placement, laser photoresection, eletrocautery resection and external-beam radiation therapy. This reviewwill focus on the methodology and role of endobronchial brachytherapy in patients with lung cancer and will review ourexperience with this procedure.
Assuntos
Humanos , Masculino , Feminino , Cuidados Paliativos , Braquiterapia , Neoplasias Pulmonares , Braquiterapia , Braquiterapia/história , Braquiterapia/métodos , Qualidade de VidaRESUMO
O fenótipo neuroendócrino define um grupo específico de células que possuem grânulos secretórios no seu citoplasma. Os tumores pulmonares neuroendócrinos possuem diferentes graus de agressividade. São exemplos: os carcinomas brônquicos de pequenas células, os tumores carcinóides típicos e atípicos, entre outros. Expressam marcadores neuroendócrinos em comum que podem ser demonstrados pela técnica de imuno-histoquímica. A cromogranina A e a enolase neurônio-específica são exemplos de marcadores neuroendócrinos. Diferentes síndromes paraneoplásicas podem acompanhar esses tumores. Os dois maiores subgrupos de carcinomas brônquicos podem ser difíceis de diagnosticar sem uma avaliação neuroendócrina. Os autores concluem que, atualmente, além do diagnóstico histopatológico, a expressão de fenótipo neuroendócrino deve fazer parte do estadiamento dos carcinomas brônquicos. Além de ser mais um parâmetro para auxiliar no diagnóstico, também tem significado como prognóstico e para o controle terapêutico.