RESUMO
Purpose To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. Methods A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. Results Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean 5511.59 vs 1457.22; P = 0.028) and ED costs (161.25 vs 14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). Conclusion This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Síndrome do Carcinoide Maligno/economia , Síndrome do Carcinoide Maligno/terapia , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Custos Diretos de Serviços , Hospitalização/estatística & dados numéricos , Estudos Retrospectivos , Estudos Transversais , Hospitalização/economiaRESUMO
PURPOSE: To report healthcare resource use and associated costs in controlled versus uncontrolled carcinoid syndrome (CS) in patients with neuroendocrine tumours. METHODS: A cross-sectional, non-interventional multicentre study was conducted with retrospective data analysis. Resource use was compared between two patient groups: those with controlled CS (> 12 months with no uncontrolled CS episodes) and uncontrolled CS (< 12 months since last uncontrolled episode). Patients were matched for age, sex, and origin and grade of tumour. When no matching patients were available, data from deceased patients were used. Information on healthcare resource use came from review of medical records, patient history and physician reports. Working capacity was assessed using the Work Productivity and Activity Impairment General Health questionnaire. RESULTS: Twenty-six university hospitals in Spain participated, between July 2017 and April 2018. 137 patients were enrolled; 104 were analysed (2 groups of 52). Patients with uncontrolled CS had 10 times more emergency department (ED) visits (mean 1.0 vs 0.10 visits; P = 0.0167), were more likely to have a hospital admission (40.4% vs 19.2%; P = 0.0116) and had longer hospital stays (mean 7.87 vs 2.10 days; P = 0.0178) than those with controlled CS. This corresponded to higher annual hospitalisation costs (mean 5511.59 vs 1457.22; P = 0.028) and ED costs (161.25 vs 14.85; P = 0.0236). The mean annual total healthcare costs were 60.0% higher in patients with uncontrolled than controlled CS (P = NS). CONCLUSION: This study quantifies higher health resource use, and higher hospitalisation and ED costs in patients with uncontrolled CS. Better control of CS may result 3in lower medical costs.
Assuntos
Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Síndrome do Carcinoide Maligno/economia , Absenteísmo , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Custos Diretos de Serviços , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Síndrome do Carcinoide Maligno/patologia , Síndrome do Carcinoide Maligno/terapia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/economia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/terapia , Presenteísmo/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Trabalho/estatística & dados numéricosRESUMO
OBJECTIVE: To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS: A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS: A total of 106 patients (61 [57.5%] women, mean age 52.3⯱â¯14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8⯱â¯14.2 years vs 54.5⯱â¯13.9 years, pâ¯<â¯.001). Familial PCCs were more frequently associated with MEN2A (nâ¯=â¯8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3â¯cm (3-6â¯cm); 27.7% of the patients had tumors ≥6â¯cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4â¯cm [2.4-5.0â¯cm] vs 5.6â¯cm [4.0-7.0â¯cm], pâ¯<â¯.001). Scintigraphy by ¹²³I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS: PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.
Assuntos
Neoplasias das Glândulas Suprarrenais , Feocromocitoma , 3-Iodobenzilguanidina , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/genética , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/terapia , Antagonistas Adrenérgicos alfa/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Catecolaminas/urina , Conversão para Cirurgia Aberta/estatística & dados numéricos , Doxazossina/uso terapêutico , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Metanefrina/urina , Pessoa de Meia-Idade , Neoplasia Endócrina Múltipla Tipo 2a/complicações , Neoplasias Pancreáticas/genética , Fenoxibenzamina/uso terapêutico , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/genética , Feocromocitoma/patologia , Feocromocitoma/terapia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Carga Tumoral , Adulto JovemRESUMO
Objetivo Analizar las características clínicas y analíticas, las pruebas diagnósticas, los tratamientos y los resultados del feocromocitoma (FCC). Diseño y métodos Estudio multicéntrico retrospectivo en pacientes con FCC tratados quirúrgicamente y seguidos en 3 hospitales terciarios de referencia españoles. Resultados Se analizó a un total de 106 pacientes (61 [57,5%] mujeres, edad media 52,3 ± 14,8 años). En el diagnóstico, el FCC fue sintomático en el 62% de los casos y esporádico en el 83%. Los pacientes con FCC familiar eran significativamente más jóvenes que aquellos que presentaban la enfermedad esporádica (40,8 ± 14,2 años vs. 54,5 ± 13,9 años, p < 0,001). El FCC familiar se asociaba con mayor frecuencia a la MEN2A (n = 8). Los niveles de metanefrinas en orina de 24h se relacionaron positivamente con el tamaño del tumor. El diámetro tumoral máximo fue 4,3cm (3-6cm); el 27,8% de los pacientes tenían tumores ≥ 6cm. Los FCC incidentales eran significativamente más pequeños que los FCC sintomáticos (3,4cm [2,4-5,0cm] vs. 5,6cm [4,0-7,0cm], p < 0,001). La gammagrafía con 123I-metaiodobencilguanidina mostró una alta sensibilidad (81,9%). En el 93,6% de los casos se usó el bloqueo alfa preoperatorio con fenoxibenzamina y con doxazosina en los demás casos. En 2/3 de los pacientes se empleó la cirugía laparoscópica, con una baja tasa de conversión (1,9%) a cirugía abierta. Aproximadamente en el 20% de los pacientes aparecieron complicaciones perioperatorias, principalmente crisis hipertensivas (9,4%). La enfermedad recurrente apareció en el 10% de los casos y el FCC maligno fue raro (6,3%). Conclusiones Los FCC tratados quirúrgicamente en España suelen ser tumores grandes, sintomáticos y esporádicos diagnosticados alrededor de la sexta década de vida. El FCC hereditario está generalmente asociado con MEN2A. La cirugía laparoscópica es el tipo principal de técnica quirúrgica utilizada y la prevalencia del FCC metastásico es baja (AU)
Objective To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). Design and methods A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. Results A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs. 54.5 ± 13.9 years, p<.001). Familial PCCs were more frequently associated with MEN2A (n=8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3cm (3-6cm); 27.7% of the patients had tumors ≥6cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4cm [2.4-5.0cm] vs. 5.6cm [4.0-7.0cm], p<.001). Scintigraphy by 123I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). Conclusion PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/terapia , Feocromocitoma/diagnóstico , Feocromocitoma/terapia , Estudos Retrospectivos , SeguimentosRESUMO
OBJECTIVE: To analyze the clinical and analytical features, diagnostic tests, therapies, and outcomes of pheochromocytoma (PCC). DESIGN AND METHODS: A multicenter retrospective study in surgically treated patients with PCC followed in 3 Spanish tertiary referral hospitals. RESULTS: A total of 106 patients (61 [57.5%] women, mean age 52.3 ± 14.8 years) were evaluated. At diagnosis, PCC was symptomatic in 62% and sporadic in 83%. Patients with familial PCC were significantly younger than those with sporadic disease (40.8 ± 14.2 years vs. 54.5 ± 13.9 years, p<.001). Familial PCCs were more frequently associated with MEN2A (n=8). Levels of 24-h urinary fractionated metanephrines were positively related to tumor size. The maximum tumor diameter was 4.3cm (3-6cm); 27.7% of the patients had tumors ≥6cm. Incidental PCCs were significantly smaller than symptomatic PCCs (3.4cm [2.4-5.0cm] vs. 5.6cm [4.0-7.0cm], p<.001). Scintigraphy by 123I-metaiodobenzylguanidine showed a high sensitivity (81.9%). Preoperative alpha blockade with phenoxybenzamine was used in 93.6% and doxazosin in the rest. Laparoscopic surgery was used in 2/3 of the patients, with a low conversion (1.9%) to open surgery. Perioperative complications appeared in approximately 20% of patients, mainly hypertensive crisis (9.4%). Recurrent disease appeared in 10%, and malignant PCC was uncommon (6.3%). CONCLUSIONS: PCCs surgically treated in Spain are usually large, symptomatic, and sporadic tumors diagnosed around the sixth decade of life. Hereditary PCC is usually associated with MEN2A. The main type of surgical technique used is laparoscopic surgery, and the prevalence of metastatic PCC is low.
Assuntos
Pan-Uveíte/patologia , Vasculite Retiniana/patologia , Tuberculose Ocular/patologia , Adulto , Diagnóstico Diferencial , Hemianopsia/microbiologia , Hemianopsia/patologia , Humanos , Isquemia/microbiologia , Isquemia/patologia , Masculino , Pan-Uveíte/microbiologia , Vasculite Retiniana/microbiologia , Tuberculose Ocular/complicaçõesRESUMO
Ocular syphilis is a resurgent clinical condition due to unsafe sexual practices. It has been reported in both immunocompromised and immunocompetent patients, but in HIV positive patients, it is more likely to exhibit a more aggressive course and adopt atypical clinical patterns such as optic nerve involvement. Herein we report an atypical case of optic neuritis secondary to syphilis in an HIV negative patient. This case highlights the importance of considering syphilis in the differential diagnosis of ocular inflammation and of obtaining HIV serology, since both diseases share common risk factors.
Assuntos
Infecções Oculares Bacterianas/patologia , Doenças do Nervo Óptico/microbiologia , Sífilis/complicações , Soronegatividade para HIV , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Óptico/patologia , Sífilis/patologiaRESUMO
CONTEXT: Health-related quality of life (HRQoL) is impaired in primary hyperparathyroidism (PHPT) but instruments to specifically assess this are scarce. OBJECTIVE: Validate the new disease-specific Primary Hyperparathyroidism Quality of Life (PHPQoL) questionnaire in usual clinical practice. DESIGN: Observational, prospective, and multicenter. SETTING: Public hospital ambulatory care. PATIENTS: Patients with PHPT of both sexes, aged more than or equal to 18 years either initiated treatment for PHPT (group A) or had stable PHPT, not requiring therapy (group B). Patients in group A had at least one surgical criterion according to the 2009 Third International Workshop on Management of Asymptomatic PHPT. INTERVENTION: Sociodemographic, clinical, and HRQoL data (PHPQol, Short Form-36, Psychological Well-Being Index, and patients' self-perceived health status) were collected. Group A underwent 4 evaluations (baseline, 3 ± 1, 6 ± 1, and 12 ± 2 months after a therapeutic intervention) and group B 2, at baseline and 1 month later to assess test-retest reliability. RESULTS: A total of 182 patients were included (104 group A, 78 group B) with a mean age (SD) of 61.4 (12.1) years; 79.7% were women. Group A increased PHPQoL score (SD) (better HRQoL) (52 ± 23 at baseline; 62 ± 24 at 12 months; P < .001). At baseline, symptomatic patients had a lower PHPQoL score (worse) than asymptomatic ones (51 ± 21 vs 68 ± 21; P < .001). Correlations were seen between PHPQoL and Short Form-36, Psychological Well-Being Index, and self-perceived health status (P < .001). PHPQoL had good internal consistency (Cronbach's α = 0.80), test-retest reliability (group B, intraclass correlation coefficient > 0.80), and sensitivity to detect HQRoL changes over time. CONCLUSIONS: PHPQoL is a valid HRQoL measure to assess the impact of PHPT on health perception in clinical practice.
Assuntos
Hiperparatireoidismo Primário/psicologia , Psicometria , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade de Vida , Feminino , Humanos , Hiperparatireoidismo Primário/terapia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are rare neoplasms capable of producing hormones. The development of new treatments has improved progression-free survival, albeit with increased toxicity. Health-related quality of life (HRQoL) has become an important endpoint in clinical research to evaluate patients' well-being in such a contradictory scenario. In this review, we examine key reported outcomes across clinical studies exploring HRQoL in patients with GEP-NETs. We have conducted a review of the literature using PubMed, The Cochrane Library, EMBASE, and Google Scholar. Selection criteria for articles were (1) publication in English between 1995 and 2014, (2) patients with GEP-NET, and (3) analysis of HRQoL, including mental health and psychological symptoms. Forty-nine studies met the inclusion criteria (31 clinical trials, 14 observational studies, and 4 developments of NET-specific HRQoL instruments). The scope and nature of the literature was diverse with 27 instruments used to measure aspects of HRQoL. EORTC QLQ-C30 was the most frequently used, in 38 of the 49 studies. Standardized measures revealed that in spite of generally good HRQoL, GEP-NET patients have specific psychological and physical complaints. The clinical benefit of somatostatin analogs and sunitinib has been clearly supported by HRQoL assessment. Improvement in HRQoL scores or symptom relief over time was also reported in 14 trials of peptide receptor radionuclide therapy, however the absence of randomized studies obviate definitive conclusions. We have also identified several unanswered questions that should be addressed in further research concerning chemotherapy, everolimus, surgery, local ablative therapies, and chemoembolization. Future research should incorporate GEP-NET-specific HRQoL instruments into phase III trials. This review may help both clinicians and researchers to select the most appropriate tools to assess changes in HRQoL in this population.
Assuntos
Neoplasias Intestinais/complicações , Neoplasias Intestinais/psicologia , Neoplasias Intestinais/terapia , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/psicologia , Tumores Neuroendócrinos/terapia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/psicologia , Neoplasias Pancreáticas/terapia , Qualidade de Vida , Neoplasias Gástricas/complicações , Neoplasias Gástricas/psicologia , Neoplasias Gástricas/terapia , HumanosRESUMO
Purpose. To study whether a corneal thickness segmentation model, consisting in a central circular zone of 1 mm radius centered at the corneal apex (zone I) and five concentric rings of 1 mm width (moving outwards: zones II to VI), could boost the diagnostic accuracy of Heidelberg Retina Tomograph's (HRT's) MRA and GPS. Material and Methods. Cross-sectional study. 121 healthy volunteers and 125 patients with primary open-angle glaucoma. Six binary multivariate logistic regression models were constructed (MOD-A1, MOD-A2, MOD-B1, MOD-B2, MOD-C1, and MOD-C2). The dependent variable was the presence of glaucoma. In MOD-A1, the predictor was the result (presence of glaucoma) of the analysis of the stereophotography of the optic nerve head (ONH). In MOD-B1 and MOD-C1, the predictor was the result of the MRA and GPS, respectively. In MOD-B2 and MOD-C2, the predictors were the same along with corneal variables: central, overall, and zones I to VI thicknesses. This scheme was reproduced for model MOD-A2 (stereophotography along with corneal variables). Models were compared using the area under the receiver operator characteristic curve (AUC). Results. MOD-A1-AUC: 0.771; MOD-A2-AUC: 0.88; MOD-B1-AUC: 0.736; MOD-B2-AUC: 0.845; MOD-C1-AUC: 0.712; MOD-C2-AUC: 0.838. Conclusion. Corneal thickness variables enhance ONH assessment and HRT's MRA and GPS diagnostic capacity.
RESUMO
CASO CLÍNICO: Mujer de 24 años con rash maculopapular, aftas orales y genitales, dolor abdominal, disnea leve y disminución de la agudeza visual en ambos ojos. La funduscopia reveló una vasculitis oclusiva bilateral que incluía los vasos centrales. Se inició tratamiento con bolos de metilprednisolona (1 g/24 h) e infliximab 5 mg/kg/día (0-2-6 semanas y cada 8 semanas). El tratamiento indujo una rápida remisión. La agudeza visual mejoró. Tras un año de seguimiento no ha presentado ningún nuevo brote. DISCUSIÓN: Un tratamiento de inicio con infliximab debe considerarse en brotes graves de enfermedad de Behçet como una vasculitis oclusiva bilateral con isquemia
CASE REPORT: A 24 year old woman who complained of maculo-papulo rash, genital and bucal aphthous ulcers, abdominal pain, minor dyspnea and visual loss in both eyes. Funduscopy revealed a bilateral occlusive vasculitis including central vessels. Treatment was initiated with a methylprednisolone bolus (1 g/24 h) and infliximab 5 mg/kg/day (0-2-6 weeks and every 8 weeks). The treatment prescribed induced a fast remission. Visual acuity improved. The patient did not suffer any other relapse after one year of follow-up. DISCUSSION: An initial treatment with Infliximab should be considered in Behçet disease for serious outbreaks, such as macular occlusive vasculitis with ischemia
Assuntos
Feminino , Humanos , Vasculite/congênito , Vasculite/metabolismo , Estomatite Aftosa/complicações , Estomatite Aftosa/enfermagem , Dispneia/complicações , Dispneia/fisiopatologia , Acuidade Visual/genética , Vasculite/complicações , Vasculite/fisiopatologia , Estomatite Aftosa/metabolismo , Estomatite Aftosa/patologia , Dispneia/diagnóstico , Dispneia/enfermagem , Acuidade Visual/fisiologiaRESUMO
CASE REPORT: A 24 year old woman who complained of maculo-papulo rash, genital and bucal aphthous ulcers, abdominal pain, minor dyspnea and visual loss in both eyes. Funduscopy revealed a bilateral occlusive vasculitis including central vessels. Treatment was initiated with a methylprednisolone bolus (1 g/24h) and infliximab 5mg/kg/day (0-2-6 weeks and every 8 weeks). The treatment prescribed induced a fast remission. Visual acuity improved. The patient did not suffer any other relapse after one year of follow-up. DISCUSSION: An initial treatment with Infliximab should be considered in Behçet disease for serious outbreaks, such as macular occlusive vasculitis with ischemia.
Assuntos
Síndrome de Behçet/diagnóstico , Imunossupressores/uso terapêutico , Infliximab/uso terapêutico , Metilprednisolona/uso terapêutico , Vasculite/tratamento farmacológico , Síndrome de Behçet/complicações , Feminino , Angiofluoresceinografia , Humanos , Oftalmoscopia , Indução de Remissão , Tomografia de Coerência Óptica , Vasculite/diagnóstico por imagem , Vasculite/etiologia , Adulto JovemRESUMO
OBJETIVO: Comparar los valores de presión intraocular (PIO) del nuevo tonómetro de no contacto Corvis ST (CST) con la tonometría de aplanación de Goldmann (GAT) y la tonometría de rebote Icare Pro (PRO). MATERIAL Y MÉTODOS: Se seleccionaron 178 ojos de 178 voluntarios sanos a los que se les midió la PIO de manera aleatorizada con CST, PRO y GAT. Se midió el espesor corneal central (GCC) con paquimetría ultrasónica. Para cada variable, se tomaron 3 medidas y la media de las 3 fue introducida en el análisis estadístico. La concordancia entre los tonómetros se determinó mediante las gráficas de Bland-Altmann. RESULTADOS: La PIO medias obtenidas con los 3 tonómetros fueron de 15,5 ± 2,8 mmHg para GAT, 14,6 ± 2,3 mmHg para PRO y 15,4 ± 2,8 mmHg para CST. La diferencia media entre pares de tonómetros fue: GAT-PRO = 0,9 ± 1,7 mmHg (p < 0,001); GAT-CST: 0,1 ± 2,2 (p = 0,398) y PRO-CST: −0,8 ± −0,7 mmHg, p < 0,001. En los 3 casos se encontró una correlación significativa con el GCC: GAT: r = 0,325, p < 0,001; PRO: r = 0,385, p < 0,001 y CST: r = 0,428; p < 0,001. CONCLUSIONES: Las diferencias encontradas entre el PRO y el GAT son significativamente mayores que entre el CST y el GAT, sin diferencias significativas entre las medidas de estos 2. Las medidas de los 3 tonómetros se ven afectadas por el GCC
PURPOSE: To compare intraocular pressure (IOP) between the new non-contact tonometer Corvis ST (CST), the Goldmann applanation tonometry (GAT) and Icare Pro rebound tonometer (PRO). METHODS: A total of 178 eyes of 178 healthy subjects were selected for the study. Measurements of IOP were made in a random order with GAT, PRO and CST. Central corneal thickness (CCT) was determined by ultrasound pachymetry. The mean of three valid measurements of each variable was used in the statistical analysis. The relationship between the tonometers was established using Bland-Altman plots. RESULTS: Mean IOP was 15.5±2.8 mmHg for GAT, 15.4±2.8 mmHg for CST, and 14.6±2.3 mmHg for PRO. The mean differences between pairs of tonometers were: GATPRO= 0.9±1.7 mmHg (P<0.001), GAT-CST: 0.1±2.2 (P=0.398), and PRO-CST: −0.8±−0.7 mmHg,p < 0.001. A positive relationship was detected between CCT and the three tonometers: GAT:r = 0.325, P<0.001; PRO: r = 0.385, P<0.001, and CST: r = 0.428; P<0.001. CONCLUSIONS: The differences found between PRO and GAT were significantly higher than those found between CST and GAT, which showed non-significant differences. The measurements of the three tonometers were affected by the CCT
Assuntos
Humanos , Tonometria Ocular/métodos , Pressão Intraocular , Determinação da Pressão Arterial/métodos , Reprodutibilidade dos TestesRESUMO
PURPOSE: To compare intraocular pressure (IOP) between the new non-contact tonometer Corvis ST (CST), the Goldmann applanation tonometry (GAT) and Icare Pro rebound tonometer (PRO). METHODS: A total of 178 eyes of 178 healthy subjects were selected for the study. Measurements of IOP were made in a random order with GAT, PRO and CST. Central corneal thickness (CCT) was determined by ultrasound pachymetry. The mean of three valid measurements of each variable was used in the statistical analysis. The relationship between the tonometers was established using Bland-Altman plots. RESULTS: Mean IOP was 15.5 ± 2.8 mmHg for GAT, 15.4 ± 2.8 mmHg for CST, and 14.6 ± 2.3 mmHg for PRO. The mean differences between pairs of tonometers were: GAT-PRO=0.9 ± 1.7 mmHg (P<.001), GAT-CST: 0.1 ± 2.2 (P=.398), and PRO-CST: -0.8 ±-0.7 mmHg, p<0.001. A positive relationship was detected between CCT and the three tonometers: GAT: r=0.325, P<.001; PRO: r = 0.385, P<.001, and CST: r = 0.428; P<.001. CONCLUSIONS: The differences found between PRO and GAT were significantly higher than those found between CST and GAT, which showed non-significant differences. The measurements of the three tonometers were affected by the CCT.
Assuntos
Pressão Intraocular , Tonometria Ocular/métodos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Tonometria Ocular/instrumentaçãoRESUMO
This paper summarizes the current understanding of the biology of somatostatin receptor (sst), role of immunotherapy in neuroendocrine tumor (NET), new agents for PPRT, and methods to assess response and clinical benefit in NET. One of the most interesting aspects of sst biology is the recent discovery of truncated variants of the sst5 receptor subtype with unique tissue distribution and response to somatostatin (SST). These truncated receptors are associated with bad patient prognosis, decreased response to SST analogs, and may be new targets for diagnoses and treatment. IFN remains a cost-effective agent, particularly in classic mid gut carcinoids, and there is interest to continue examining immunotherapy's in this disease. PRRT remains a key strategy for treatment and imaging. In addition to the classic agents, there are a series of new agents targeting other receptors such as the incretin receptors (GLP-1R; GIPR) and other G-protein coupled receptors with great potential. With regards to therapy monitoring, the most commonly used criteria are Response Criteria Evaluation in Solid Tumors (RECIST). However, for different reasons, these criteria are not very useful in NET. Incorporation of other criteria such as Choi as well as functional imaging assessment with PET would be of great interest in this area.