Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 40
Filtrar
Filtros adicionais











País/Região como assunto
Intervalo de ano
1.
Support Care Cancer ; 27(10): 3997-4010, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286229

RESUMO

PURPOSE: To update the clinical practice guidelines for the use of natural and miscellaneous agents for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer / International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. RESULTS: A total of 78 papers were identified within the scope of this section, out of which 29 were included in this part, and were analyzed with 27 previously reviewed studies. A new Suggestion was made for oral glutamine for the prevention of OM in head and neck (H&N) cancer patients receiving radiotherapy with concomitant chemotherapy. The previous Recommendation against the use of parenteral glutamine for the prevention of OM in hematopoietic stem cell transplantation (HSCT) patients was re-established. A previous Suggestion for zinc to prevent OM in H&N cancer patients treated with radiotherapy or chemo-radiotherapy was reversed to No Guideline Possible. No guideline was possible for other interventions. CONCLUSIONS: Of the vitamins, minerals, and nutritional supplements studied for the management of OM, the evidence supports a Recommendation against parenteral glutamine in HSCT patients and a Suggestion in favor of oral glutamine in H&N cancer patients for the management of OM.

2.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31109823

RESUMO

INTRODUCTION: There is no agreement on the procedures to be used for diagnosis and treatment of gestational thyroid dysfunction. Controversy still exists on the normal range of thyroid-stimulating hormone (TSH) levels and use of gestational hypothyroidism (GH) screening. The aim of this study was to assess diagnosis and treatment of thyroid dysfunction during pregnancy in a group of Spanish hospitals. STUDY DESIGN: This was a retrospective, multicenter study in pregnant females with GH attending Spanish healthcare centers from March 2013 to July 2014. Variables analyzed included diagnosis criteria for GH (availability of universal screening for gestational thyroid disorders and TSH reference values (RVs) by trimester of pregnancy): risk factors for GH, iodine intake from food or supplementation, gestational age (at diagnosis/treatment) and l-thyroxine treatment. RESULTS: Fourteen centers participated in the study. Universal screening was performed in only half of the centers, and only 14% had their own TSH RVs. Overall, 257 pregnant women were enrolled, 53.7% with hypothyroidism (HT) diagnosed before pregnancy (pre-GH) and 46.3% with HT diagnosed during pregnancy (intra-GH). A comparison of intra-GH and pre-GH women showed that intra-GH women made their first visit later (59.7% vs. 75.4% respectively before week 12, p=0.007) and had more frequently high TSH levels (>2.5µIU/ml) during the first trimester (94.4% vs. 67.0% respectively, p<0.001). CONCLUSIONS: Our results suggest that GH may be underdiagnosed or inadequately diagnosed in most healthcare centers. These findings suggest the need of improving the current practice in Spain.

3.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30962160

RESUMO

Although iodine nutrition in Spain has improved in recent years, the problem is not completely resolved. It is necessary that health institutions establish measures to ensure an adequate iodine nutrition of the population, especially among the highest risk groups (children and adolescents, women of childbearing age, pregnant women and nursing mothers). A low salt intake should be advised, but it should be iodized. It is also imperative that food control agencies establish effective control over adequate iodization of salt. Indicators on iodine nutrition should be included in future health surveys. The EUthyroid study and the Krakow Declaration on iodine nutrition provide an opportunity to set up a pan-European plan for the prevention of iodine deficiency that should be considered and used by health authorities.

4.
J Glob Health ; 9(1): 010410, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30643635

RESUMO

Background: Maternal and reproductive health services are far from universalization and important gaps exist in their distribution across groups of women in sub-Saharan Africa (SSA). The aim of this study is to determine the magnitude of this unequal distribution of maternal and reproductive health-related opportunities and outcomes and to identify the major sources of inequality. Methods: Demographic and Health Surveys data were used to analyse 15 opportunities for women of reproductive age (15-49), pregnant women and older adolescent girls (15-19), across 29 SSA countries. The tool employed is the Human Opportunity Index (HOI), a composite indicator that combines the availability of an opportunity (the coverage rate) with a measure of how equitably it is distributed among groups of women with different characteristics (or circumstances). Decompositions are used to assess the contribution of each individual circumstance to inequality. Results: The maternity care package of services is found to have lowest average HOI (26%), while exclusive breastfeeding among children aged 0-6 months has the highest HOI (77%). The other indicators show low HOIs, sometimes lower than 50%, indicating low coverage and/or high inequality. Wealth, education and area of residence are the main contributors to inequality for women of reproductive age. Among adolescent girls, marital status is the major contributor. Conclusions: Reproductive and maternal health opportunities for women in SSA are scarce and far from reaching the global goals set by the post 2015 agenda. Further progress in improving women's and adolescents' health and well-being can only be achieved by a strong expansion of coverage to produce a more equitable and efficient distribution of health care. Failure to do so will compromise the likelihood of achieving the post-2015 Sustainable Development Goals (SDG). New metrics such as the HOI allows better understanding of the nature of challenges to achieving equity in perinatal and reproductive health, and offers a tool for monitoring progress in implementing a strong equity agenda as a part of the SDG initiative.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , África ao Sul do Saara , Demografia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto Jovem
5.
Clin J Oncol Nurs ; 22(4): 429-437, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30035789

RESUMO

BACKGROUND: Patients with breast cancer undergoing radiation therapy can experience dermatologic adverse events. Oncology nurses can advocate for radiation dermatitis (RD) prophylaxis to minimize dermatologic adverse events. OBJECTIVES: This quality improvement project was conducted to evaluate the effect of implementing an RD prevention protocol. The objectives of this study were to (a) improve clinicians' knowledge of screening, assessment, and prevention of RD in patients with breast cancer and (b) decrease the incidence of RD by 10% at a tertiary care cancer center. METHODS: Center-wide standards of care were created and implemented. A retrospective chart analysis was performed before and after protocol implementation. An education session was used to analyze protocol effectiveness. FINDINGS: Surveys completed by nurses (N = 11) before and after the education session demonstrated a significant increase in overall confidence in assessing RD. Statistically significant increases were noted in using topical steroids for prophylaxis.

6.
Radiother Oncol ; 128(2): 260-265, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29960684

RESUMO

PURPOSE: The therapeutic strategy for non-benign meningiomas is controversial. The objective of this study was to prospectively investigate the impact of high dose radiation therapy (RT) on the progression-free survival (PFS) rate at 3 years in WHO grade II and III meningioma patients. MATERIALS AND METHODS: In this multi-cohorts non-randomized phase II and observational study, non-benign meningioma patients were treated according to their WHO grade and Simpson's grade. Patients with atypical meningioma (WHO grade II) and Simpson's grade 1-3 [Arm 1] entered the non-randomized phase II study designed to show a 3-year PFS > 70% (primary endpoint). All other patients entered the 3 observational cohorts: WHO grade II Simpson grade 4-5 [Arm 2] and Grade III Simpson grade 1-3 or 4-5 [Arm 3&4] in which few patients were expected. RESULTS: Between 02/2008 and 06/2013, 78 patients were enrolled into the study. This report focuses on the 56 (median age, 54 years) eligible patients with WHO grade II Simpson's grade 1-3 meningioma who received RT (60 Gy). At a median follow up of 5.1 years, the estimated 3-year PFS is 88.7%, hence significantly greater than 70%. Eight (14.3%) treatment failures were observed. The 3-year overall survival was 98.2%. The rate of late signs and symptoms grade 3 or more was 14.3%. CONCLUSIONS: These data show that 3-year PFS for WHO grade II meningioma patients undergoing a complete resection (Simpson I-III) is superior to 70% when treated with high-dose (60 Gy) RT.


Assuntos
Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Adulto , Assistência ao Convalescente , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Neoplasias Meníngeas/mortalidade , Neoplasias Meníngeas/cirurgia , Meningioma/mortalidade , Meningioma/cirurgia , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Dosagem Radioterapêutica , Radioterapia Adjuvante/efeitos adversos , Radioterapia Adjuvante/métodos , Estudos Retrospectivos , Falha de Tratamento
7.
Endocrinol Diabetes Nutr ; 65(2): 107-113, 2018 Feb.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29396214

RESUMO

There is currently no consensus among the different scientific societies on screening for thyroid dysfunction in the first trimester of pregnancy. Indeed, diagnosis and treatment of subclinical hypothyroidism during pregnancy are controversial, as no cut-off value for thyrotropin (TSH) is universally accepted. TSH measurement may be influenced by different factors throughout pregnancy, but especially during the first trimester. The association between overt hypothyroidism during pregnancy and obstetric and perinatal complications is well established. It is also accepted that thyroid hormones are important for neurodevelopment of the offspring. However, there is no scientific evidence available about the impact of subclinical hypothyroidism and its treatment during the first trimester of pregnancy on children's neurodevelopment. In recent years, studies conducted in the offspring of mothers with subclinical hypothyroidism have reported new biochemical parameters which may eventually serve as biomarkers of offspring neurodevelopment and which are more reproducible and are measured at an earlier time than the conventional clinical tests.

8.
Endocrinol. diabetes nutr. (Ed. impr.) ; 65(2): 107-113, feb. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-171952

RESUMO

There is currently no consensus among the different scientific societies on screening for thyroid dysfunction in the first trimester of pregnancy. Indeed, diagnosis and treatment of subclinical hypothyroidism during pregnancy are controversial, as no cut-off value for thyrotropin (TSH) is universally accepted. TSH measurement may be influenced by different factors throughout pregnancy, but especially during the first trimester. The association between overt hypothyroidism during pregnancy and obstetric and perinatal complications is well established. It is also accepted that thyroid hormones are important for neurodevelopment of the offspring. However, there is no scientific evidence available about the impact of subclinical hypothyroidism and its treatment during the first trimester of pregnancy on children's neurodevelopment. In recent years, studies conducted in the offspring of mothers with subclinical hypothyroidism have reported new biochemical parameters which may eventually serve as biomarkers of offspring neurodevelopment and which are more reproducible and are measured at an earlier time than the conventional clinical tests (AU)


En la actualidad no existe un consenso entre las diferentes sociedades científicas para la detección de la disfunción tiroidea en el primer trimestre del embarazo. De hecho, el diagnóstico y tratamiento del hipotiroidismo subclínico durante el embarazo es controvertido, ya que no se acepta universalmente el valor límite para la tirotropina (TSH). La determinación de TSH puede estar influenciada por diferentes factores durante todo el embarazo, pero especialmente durante el primer trimestre. La asociación entre el hipotiroidismo clínico durante el embarazo y las complicaciones obstétricas y perinatales está bien establecida. También se acepta que las hormonas tiroideas son importantes para el desarrollo neurológico del feto. Sin embargo, falta evidencia científica sobre el impacto en el neurodesarrollo infantil del tratamiento del hipotiroidismo subclínico en el primer trimestre de gestación. En los últimos años, los estudios realizados en hijos de madres con hipotiroidismo subclínico han descrito nuevos parámetros bioquímicos que eventualmente pueden servir como biomarcadores del neurodesarrollo fetal, siendo más reproducibles y pudiendo determinarse en un período anterior al de las pruebas clínicas clásicas (AU)


Assuntos
Humanos , Feminino , Gravidez , Hipotireoidismo/terapia , Hipotireoidismo/diagnóstico , Primeiro Trimestre da Gravidez , Tireotropina , Mortalidade Perinatal , Sociedades Científicas/normas , Biomarcadores , Período Pós-Parto/metabolismo
9.
J Am Acad Dermatol ; 78(6): 1102-1109, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29273489

RESUMO

BACKGROUND: Dermatologic conditions cause morbidity and mortality among hospitalized cancer patients. An improved understanding is critical for implementing clinical and research programs in inpatient oncodermatology. OBJECTIVE: To characterize inpatient dermatology consultations at a large comprehensive cancer center. METHODS: Retrospective database query of new admissions and medical record review of initial inpatient dermatology consultations comparing inpatients consulted and not consulted during January-December 2015. RESULTS: In total, 412 of 11,533 inpatients received 471 dermatology consultations (54% male, median age 59.5 years). Patients with hematologic cancers were 6 times more likely to receive dermatologic consultations compared with nonhematologic cancers (odds ratio 6.56, 95% confidence interval 5.35-8.05, P < .0001). Patients consulted by a dermatologist had a significantly longer length of stay than inpatients not consulted by dermatology (median 11 vs 5 days, P < .0001). Among the 645 dermatologic conditions diagnosed, the most common categories were inflammatory diseases, infections, and drug reactions; the most frequent conditions were contact dermatitis, herpes zoster, and chemotherapy-induced drug eruptions. LIMITATIONS: The study's retrospective nature and single-institution setting are potential limitations. CONCLUSION: Hematologic malignancies are a significant risk factor for dermatology inpatient consultations. A significantly longer length of stay was associated with dermatology consultations, suggesting high comorbidities in these patients. Increased dermatologic care of these inpatients might improve quality of life, dermatologic health, and ability to receive anticancer agents.

10.
Semin Oncol Nurs ; 33(4): 393-401, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28943034

RESUMO

OBJECTIVE: To review the emerging sub-specialty of oncodermatology and the role of oncodermatology nurses as facilitators of interprofessional collaboration between the oncology team and the dermatology team. DATA SOURCES: Journal articles indexed on the National Library of Medicine database. CONCLUSION: The complexity of cancer care with new cancer therapies and their associated dermatologic adverse events profiles benefit from a collaborative, interprofessional approach between dermatology and oncology in the care of the patient with cancer. IMPLICATIONS FOR NURSING PRACTICE: Oncodermatology nurses are in roles that can facilitate interprofessional collaboration, optimizing the care of patients with cancer.


Assuntos
Antineoplásicos/toxicidade , Antineoplásicos/uso terapêutico , Dermatologia/métodos , Oncologia/métodos , Neoplasias/tratamento farmacológico , Dermatopatias/etiologia , Dermatopatias/terapia , Humanos , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Papel Profissional
11.
Pediatr Dermatol ; 34(5): 547-553, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28804919

RESUMO

BACKGROUND/OBJECTIVES: Mycosis fungoides (MF) in young patients is rare and may have atypical presentations. There are limited data in these patients. The objective was to determine the clinical outcome and prognosis of young patients with MF. METHODS: A search of our institutional cancer registry database was conducted for patients diagnosed with MF at younger than 30 years of age. RESULTS: Our study included 74 patients (median age at diagnosis 25.5 yrs). Sixty-five (88%) presented with early stage disease and variants of MF (n = 44 [59%]), leading to a median delay in diagnosis of 2.5 years. Hypopigmented MF (n = 27 [36.5%]) was the most common variant, affecting predominantly African American (44.4% vs 19%; p = 0.02) and younger (20 vs 26 yrs; p < 0.001) patients. All patients with hypopigmented MF presented with early stage disease and were less likely to develop progressive disease (PD) than those with other variants (11% vs 34%; p = 0.03). Nineteen patients (26%) developed PD during a median follow-up of 3.5 years, which was associated with advanced-stage disease (89% vs 17%; p < 0.001), older age (>20 yrs) (31% vs 13%; p = 0.08), African American race (52.6% vs 20%; p = 0.009), and poikilodermatous presentation (p < 0.01). Overall survival was good (97.2% at 5 yrs, 95.9% at 10 yrs) despite the delay in diagnosis and atypical presentation. CONCLUSIONS: Progressive disease is associated with older age, African American race, the poikilodermatous variant, and advanced-stage disease. The hypopigmented variant is a common presentation in young patients and has an indolent disease course. Our study confirms an overall favorable prognosis in young patients with MF.


Assuntos
Micose Fungoide/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Criança , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Masculino , Micose Fungoide/mortalidade , Micose Fungoide/terapia , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/terapia , Taxa de Sobrevida , Adulto Jovem
12.
Clin J Oncol Nurs ; 21(2 Suppl): 45-52, 2017 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-28315555

RESUMO

BACKGROUND: Immunotherapy, specifically the use of checkpoint inhibitors, offers patients with cancer an alternative to chemotherapy, targeting different pathways to destroy cancer cells. The side effects of immunotherapies, as well as their impact on normal tissue, need to be assessed and managed based on their mechanisms of action. OBJECTIVES: This article presents an overview of immune-related adverse events (AEs). 
. METHODS: Common immune-related toxicities, as well as rare and refractory toxicities, are reviewed. 
. FINDINGS: Immunotherapy treatment is an option for many patients with cancer, and nurses must understand the distinct side effect profile of these agents. Prompt identification and expert management are the cornerstones of success when dealing with immune-related AEs, and oncology nurses play a key role in improving patient care.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/enfermagem , Melanoma/imunologia , Melanoma/enfermagem , Enfermagem Oncológica/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Educação Continuada em Enfermagem , Feminino , Humanos , Imunoterapia/efeitos adversos , Imunoterapia/enfermagem , Masculino , Melanoma/tratamento farmacológico , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto
13.
J Diabetes ; 9(12): 1065-1072, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28220621

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) has been proposed as an independent cardiovascular risk factor. The present study evaluated the prevalence of NAFLD in a cohort of type 1 diabetic (T1D) patients and its potential relationship with subclinical cardiovascular disease (CVD). METHODS: One hundred T1D patients (mean [±SD] age 39.4 ± 7.8 years, disease duration 21.7 ± 8.6 years) were included in the present cross-sectional study. All subjects underwent abdominal ultrasonography for detection of NAFLD, carotid ultrasonography to measure the carotid intima-media thickness (CIMT) and atheroma plaques, and cardiac tomography for evaluation of the coronary artery calcium score (CACS). RESULTS: Of the study cohort, 12% had NAFLD and 23% had a CACS >0. The T1D subjects with NAFLD had a greater CIMT than those without NAFLD (0.65 ± 0.17 vs 0.55 ± 0.14 mm; P = 0.029), but there were no significant differences between the two groups with regard to CACS, glycemic control, or the presence of carotid plaques. Patients with high liver enzyme concentrations (>20 U/L) had a higher CIMT (0.60 ± 0.16 vs 0.54 ± 0.13; P = 0.04) and there was a higher proportion of altered CACS (17 [73.9%] vs 6 [26.1%]; P = 0.001) and detection of carotid plaques (10 [76.9%] vs 3 [23.1%]; P = 0.014) in this group. CONCLUSIONS: A low prevalence of NAFLD was found in the T1D cohort that was associated globally with a low proportion of abnormal CVD imaging markers, although these imaging parameters were worse in subjects in whom NAFLD was detected.


Assuntos
Doenças Cardiovasculares/epidemiologia , Espessura Intima-Media Carotídea , Diabetes Mellitus Tipo 1/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Doenças Cardiovasculares/sangue , Estudos de Coortes , Comorbidade , Diabetes Mellitus Tipo 1/sangue , Hemoglobina A Glicada/análise , Humanos , Lipídeos/análise , Lipídeos/sangue , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/sangue , Prevalência , Fatores de Risco , Espanha/epidemiologia
14.
J Adv Pract Oncol ; 8(2): 138-145, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29900022

RESUMO

Advanced care providers (ACPs) and nurses are fundamental players in the assessment and management of immunotherapy-related dermatologic adverse events (irdAE). Pembrolizumab, nivolumab, and ipilimumab are approved for unresectable or metastatic melanoma, metastatic non-small cell lung cancer (pembrolizumab and nivolumab), metastatic head and neck squamous cell carcinoma (pembrolizumab and nivolumab), advanced renal cell carcinoma, and Hodgkin lymphoma (nivolumab). Atezolizumab is approved for urothelial carcinoma. These agents function as immune checkpoint inhibitors, activating T-cell-mediated antitumor immune responses through the inhibition of the programmed cell death protein 1 (PD-1) or cytotoxic T-lymphocyte antigen 4 (CTLA-4). Immune checkpoint inhibitors have been reported to cause irdAEs, including rash, pruritus, and vitiligo, requiring an interdisciplinary approach to avoid dose reduction or discontinuation of treatment and to maintain quality of life. Advanced care providers and nurses play a critical role in the attribution, grading, and management of these untoward events and must be knowledgeable about their pathophysiology, incidence, assessment, and clinical presentation.

15.
Int J Dermatol ; 55(11): 1248-1254, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27369070

RESUMO

BACKGROUND: Primary cutaneous CD4+ small-medium pleomorphic T cell lymphoma (SMPTCL) is a low-grade cutaneous T cell lymphoma. Its clinical and histopathologic features are comparable with those of CD8+ lymphoid proliferations (LPs) of the ear and acral sites. OBJECTIVES: We performed a retrospective analysis of patients with CD4+ SMPTCL or CD8+ LP to elucidate the clinical course, prognosis, and outcomes. METHODS: Demographic, clinical, and treatment data were reviewed. Histopathologic data based on architectural, cytomorphologic, and immunohistochemical features were assessed. Immunohistochemical staining for T and B cell markers was evaluated. RESULTS: A total of 25 patients including 22 with CD4+ SMPTCL and three with CD8+ LP were identified. All patients presented with a single lesion, predominantly on the head, neck, or upper trunk (84%). No patients showed extracutaneous disease at any evaluation. The most common histopathologic changes showed a dense nodular infiltrate of small cells with hyperchromatic nuclei without significant follicular or adnexal involvement. Patients were treated with excision (48%), local radiation (28%), or topical or intralesional steroids (24%). All patients achieved complete resolution of disease. Five patients demonstrated cutaneous relapse at new sites. CONCLUSIONS: The CD4+ SMPTCL/CD8+ LP subgroup usually presents with solitary lesions and demonstrates an indolent clinical course. Typical presentation, classic histopathology, widespread expression of follicular T helper cell markers, and loss of a T cell antigen are diagnostic features of CD4+ SMPTCL, whereas monomorphous CD8+ infiltrate without follicular T helper cell markers is consistent with CD8+ LP. Local skin-directed therapy is appropriate in these patients.


Assuntos
Neoplasias de Cabeça e Pescoço/patologia , Linfoma Cutâneo de Células T/patologia , Segunda Neoplasia Primária/patologia , Neoplasias Cutâneas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Linfócitos T CD4-Positivos , Linfócitos T CD8-Positivos , Feminino , Seguimentos , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Extremidade Inferior , Linfoma Cutâneo de Células T/terapia , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/terapia , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/terapia , Prognóstico , Recidiva , Estudos Retrospectivos , Neoplasias Cutâneas/terapia , Fatores de Tempo , Tronco , Carga Tumoral , Extremidade Superior , Adulto Jovem
16.
Cancer Immunol Res ; 4(5): 383-9, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26928461

RESUMO

Monoclonal antibodies (mAb) targeting immune checkpoint pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed death 1 (PD-1) may confer durable disease control in several malignancies. In some patients, immune checkpoint mAbs cause cutaneous immune-related adverse events. Although the most commonly reported cutaneous toxicities are mild, a subset may persist despite therapy and can lead to severe or life-threatening toxicity. Autoimmune blistering disorders are not commonly associated with immune checkpoint mAb therapy. We report a case series of patients who developed bullous pemphigoid (BP), an autoimmune process classically attributed to pathologic autoantibody formation and complement deposition. Three patients were identified. Two patients developed BP while receiving the anti-PD-1 mAb nivolumab, and one while receiving the anti-PD-L1 mAb durvalumab. The clinicopathologic features of each patient and rash, and corresponding radiologic findings at the development of the rash and after its treatment, are described. Patients receiving an anti-PD-1/PD-L1 mAb may develop immune-related BP. This may be related to both T-cell- and B-cell-mediated responses. Referral to a dermatologist for accurate diagnosis and management is recommended. Cancer Immunol Res; 4(5); 383-9. ©2016 AACR.


Assuntos
Antineoplásicos/efeitos adversos , Antígeno B7-H1/antagonistas & inibidores , Erupção por Droga/etiologia , Penfigoide Bolhoso/induzido quimicamente , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Erupção por Droga/diagnóstico , Erupção por Droga/patologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Masculino , Melanoma/tratamento farmacológico , Melanoma/secundário , Nivolumabe , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/patologia , Tomografia Computadorizada por Raios X
17.
Eur Radiol ; 26(4): 1048-55, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26188660

RESUMO

OBJECTIVES: To evaluate early post-operative magnetic resonance (EPMR) as a prognostic tool after resection of glioblastoma. METHODS: Sixty EPMR examinations were evaluated for perioperative infarct, tumour growth between diagnosis and EPMR, contrast enhancement pattern, and extent of resection (EOR). The EOR was approached with the subjective evaluation of radiologists and by quantifying volumes. These parameters were tested as predictors of survival using the Kaplan-Meier method. RESULTS: Contrast enhancement was found in 59 patients (59/60; 98 %). Showing a thin-linear pattern of enhancement was the most favourable finding. Patients with this pattern survived longer than patients with thick-linear (median overall survival (OS) thin-linear=609 days; thick-linear=432 days; P = .023) or nodular (median OS = 318 days; P = .001) enhancements. The subjective evaluation of the EOR performed better than its quantification. Patients survived longer when resection was total (median OS total resection=609 days; subtotal=371 days; P = .001). When resection was subtotal, patients survived longer if it was superior to 95 % (median OS resection superior to 95 %=559 days; inferior to 95 %=256 days; P = .034). CONCLUSIONS: EPMR provides valuable prognostic information after surgical resection of glioblastomas. A thin-linear pattern of contrast enhancement is the most favourable finding. Further prognostic stratification may be obtained by assessing the EOR. KEY POINTS: • Some kind of contrast enhancement may be found in most EPMR examinations. • Thin-linear enhancements in the EPMR may be considered benign findings. • The EOR evaluated in the EPMR may stratify prognostic groups of patients. • The subjective evaluation of the EOR performs slightly better than its quantification.


Assuntos
Neoplasias Encefálicas/patologia , Glioblastoma/patologia , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias/patologia , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Meios de Contraste , Feminino , Glioblastoma/cirurgia , Humanos , Aumento da Imagem , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
18.
BMC Endocr Disord ; 15: 73, 2015 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-26610707

RESUMO

BACKGROUND: To evaluate the efficacy, safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. METHODS: Thirty consecutive patients (46 ± 10 years; 82% women) with symptomatic benign thyroid cysts relapsed after drainage were included. In all cases, cytology prior to treatment, maximum cyst diameter and volume were determined. PEIT was conducted using the established procedure, and the volume of fluid removed and pain perceived by the patient were assessed. In each procedure, the volume of alcohol instilled was <2 ml. After follow-up, final cyst diameter and volume were determined and the persistence of symptoms and QoL were assessed by a questionnaire (SF-36). RESULTS: Mean symptom duration was 10 ± 20 months. A single session of PEIT was required to complete the procedure in 45% of patients, two in 31% and three in 13%. Mean initial maximum cyst diameter was 3.5 ± 1.0 cm and mean extracted liquid volume 61 ± 36 ml. During PEIT, 39% of patients experienced virtually no pain, 43% mild pain and 17% moderate pain. No complications of PEIT were observed. After 12.1 ± 1.4 months of follow-up, cysts were reduced more than 70% in volume in 86.3% of patients, more than 80% in 61.9% and more than 90% in 42%. On the health-related QoL SF-36 questionnaire, patient scores 6 months post-PEIT did not differ significantly from those of the healthy Spanish population. With respect to cosmetic complaints or local symptoms of compression, PEIT-treated patients presented an initial score of 22 ± 8 and 13 ± 5 after treatment (p < 0.05). CONCLUSIONS: In our experience, percutaneous ethanol injection has prove to be an effective, safe and well-tolerated first-line treatment of symptomatic thyroid cysts.


Assuntos
Cistos/terapia , Etanol/administração & dosagem , Qualidade de Vida , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Doenças da Glândula Tireoide/terapia , Glândula Tireoide/patologia , Ultrassonografia de Intervenção , Cistos/diagnóstico por imagem , Relação Dose-Resposta a Droga , Feminino , Nível de Saúde , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Percepção da Dor , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Espanha/epidemiologia , Doenças da Glândula Tireoide/diagnóstico por imagem , Resultado do Tratamento
19.
BMJ Open ; 5(6): e007326, 2015 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-26070794

RESUMO

OBJECTIVE: To explore the acceptability of implementing an online tool for the assessment and management of childhood obesity (Computer-Assisted Treatment of CHildren, CATCH) in primary care. DESIGN AND SETTING: An uncontrolled pilot study with integral process evaluation conducted at three general practices in northwest London, UK (November 2012-April 2013). PARTICIPANTS: Families with concerns about excess weight in a child aged 5-18 years (n=14 children). INTERVENTION: Families had a consultation with a doctor or nurse using CATCH, which assessed child weight status, cardiometabolic risk and risk of emotional and behavioural difficulties and provided personalised lifestyle advice. Families and practitioners completed questionnaires to assess the acceptability and usefulness of the consultation, and participated in semistructured interviews which explored user experiences. OUTCOME MEASURES: The primary outcome was family satisfaction with the tool-assisted consultation. Secondary outcomes were practitioners' satisfaction, and acceptability and usefulness of the intervention to families and practitioners. RESULTS: The majority of families (86%, n=12) and all practitioners (n=4) were satisfied with the consultation. Participants reported that the tool was easy to use, the personalised lifestyle advice useful and the use of visual aids beneficial. Families and practitioners identified a need for practical, structured support for weight management following the consultation. CONCLUSIONS: The results of this pilot study indicate that an online tool for assessment and management of childhood obesity can be implemented in primary care, and is acceptable to patients, families and practitioners. Further development and evaluation of the tool is warranted.


Assuntos
Internet , Obesidade Pediátrica/terapia , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde/métodos , Encaminhamento e Consulta , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Entrevistas como Assunto , Estilo de Vida , Londres , Masculino , Sobrepeso/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Satisfação do Paciente , Projetos Piloto , Inquéritos e Questionários , Resultado do Tratamento
20.
Am J Surg ; 210(2): 340-4, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25701890

RESUMO

BACKGROUND: Predictors of weight loss (WL) or weight regain (WR) after Roux-en-Y gastric bypass (RYGBP) are not established. The aim of this study was to analyze the usefulness of some baseline peptides (leptin, insulin, and ghrelin) as biomarkers of WL and WR in morbid obese patients after RYGBP at long term. METHODS: Seventy-six morbid obese (47 women, age 41.6 ± 9.6 years, body mass index [BMI] 52.1 ± 8 kg/m(2)) patients were evaluated at baseline and at 1, 2, and 6 years after surgery. RESULTS: Excess body weight loss after 6 years was of 63.9%. Age, BMI, and studied hormones at baseline or their changes over time did not predict long-term excess body weight loss. WR greater than 10% was observed in 36.8% of patients between 2 and 6 years of follow-up, but it was not correlated with BMI, age, or baseline peptide concentrations. CONCLUSION: Measurement of ghrelin, insulin, and leptin before surgery is not useful as predictors of WL or WR at long term after RYGBP.


Assuntos
Derivação Gástrica , Grelina/sangue , Insulina/sangue , Leptina/sangue , Obesidade Mórbida/cirurgia , Ganho de Peso , Perda de Peso , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Recidiva , Fatores de Tempo
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA