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2.
Scand J Immunol ; 91(1): e12811, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31378960

RESUMO

Hypomorphic mutations in the gene encoding Bruton tyrosine kinase (BTK) may result in milder phenotypes and delayed diagnosis of B-cell related immunodeficiencies due to residual BTK function. Newborn screening for kappa-deleting-recombination-excision circles (KRECs) reliably identifies classical X-linked agammaglobulinaemia (XLA) patients with profound B-cell lymphopenia at birth but has not been evaluated in patients with residual BTK function. We aimed to evaluate clinical findings, BTK function and KREC copy numbers in three patients with BTK mutations presenting with impaired polysaccharide responsiveness without agammaglobulinaemia. One patient had an invasive pneumococcal infection at the age of 4 years. All three patients (two brothers) had visible tonsils, normal to slightly decreased immunoglobulin G levels, undetectable pneumococcal antibodies despite pneumococcal conjugate vaccinations, no antibody response after a diagnostic polysaccharide vaccination as well as profound B-cell lymphopenia with residual B-cell differentiation. BTK mutations were identified by Sanger sequencing. BTK staining and phosphorylation assays were performed on peripheral B cells. KREC copy numbers were determined from dried blood spots obtained within the first week of life as well as once at the age of 8, 6 and 3 years, respectively. BTK staining showed residual protein expression. Also, residual BTK activity could be demonstrated. KREC copy numbers from dried blood spots were above the threshold set for detection of patients with profound B-cell lymphopenia. Male patients with impaired polysaccharide responsiveness should be evaluated for B-cell lymphopenia followed by BTK analyses irrespective of immunoglobulin levels or tonsil size.


Assuntos
Tirosina Quinase da Agamaglobulinemia/genética , Agamaglobulinemia/diagnóstico , Agamaglobulinemia/etiologia , Mutação , Fenótipo , Polissacarídeos/imunologia , Biomarcadores , Criança , Pré-Escolar , Variações do Número de Cópias de DNA , Análise Mutacional de DNA , Seguimentos , Genótipo , Humanos , Imunofenotipagem , Recém-Nascido , Masculino , Triagem Neonatal , /etiologia , Avaliação de Sintomas
3.
Med Clin North Am ; 104(1): 177-187, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757235

RESUMO

Mast cell activation syndrome (MCAS) is a heterogeneous and rare disorder with episodic and severe activation of mast cells. Because symptoms of mast cell activation are nonspecific, it is important to base the diagnosis on best available clinical and scientific evidence, and not make it one of exclusion. MCAS, much like the mast cell itself, as a whole is greater than the sum of its proposed diagnostic criteria. When each component is considered in isolation, criteria can seem nonspecific, and thus, a broad constellation of symptoms can be attributed to MCAS when they may be due to other disease processes.


Assuntos
Mastocitose/diagnóstico , Avaliação de Sintomas , Diagnóstico Diferencial , Humanos
5.
Am Surg ; 85(11): 1265-1268, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775969

RESUMO

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Preoperative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25-82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable (P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.


Assuntos
Laringoscopia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia , Paralisia das Pregas Vocais/diagnóstico , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Dispneia/etiologia , Feminino , Rouquidão/etiologia , Humanos , Laringoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Fatores Sexuais , Avaliação de Sintomas/métodos , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/diagnóstico , Nódulo da Glândula Tireoide/cirurgia , Paralisia das Pregas Vocais/complicações
6.
Bull Cancer ; 106(11): 969-974, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31615647

RESUMO

Colorectal cancer is the most common digestive cancer. The objectives of this study was to analyse the frequency, aetiologies, and the therapeutic and progressive aspects of colorectal cancer in young adults in Burkina Faso. This study was a 10-years descriptive study conducted in 2 regional hospitals in Burkina Faso. It included all patients aged 20 to 45 years admitted to these two hospitals for colon cancer or rectal cancer during the study period. A total of 116 patients were included, which was 39.2% of all patients admitted for colorectal cancer during the same period. The average age of the included patients was 35.4 years old. There were 70 male patients (60.3%). Seven patients had a history of chronic inflammatory bowel disease, and six had a family history of colon cancer. The average consultation time was 6.2 months. In 25 cases (19.9%), the cancer was discovered in the context of an abdominal emergency. Ninety-two patients (79.3%) were diagnosed at stage 3 or stage 4 according to the TNM Staging System. The most common histological type was adenocarcinoma (103 cases, 88.9%). Therapeutically, surgery was performed on 87 patients (75%) and chemotherapy was used in 37 cases (31.9%). Sixteen patients received radiotherapy. The intra operative mortality rate was 4.6%. The 5-year survival rate was 17%. In conclusion, colorectal cancer in young adults occurs without obvious risk factors in Burkina Faso. Mortality remains high because of the limited therapeutic arsenal.


Assuntos
Neoplasias Colorretais , Adulto , Distribuição por Idade , Burkina Faso/epidemiologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Neoplasias Colorretais/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Avaliação de Sintomas , Tempo para o Tratamento , Adulto Jovem
7.
J Opioid Manag ; 15(4): 285-293, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637681

RESUMO

OBJECTIVE: To compare dependence characteristics between patients with chronic pain treated within an addiction medicine setting with those attending specialist pain clinics. SETTING AND PATIENTS: Forty patients with chronic non-cancer pain taking opioid analgesics for >1 year were recruited from university-affiliated, tertiary teaching hospital clinics; 20 from an addiction medicine clinic (addiction clinic group) and 20 from specialist pain clinics (pain clinic group). DESIGN AND MAIN OUTCOME MEASURES: Data regarding demographics, past and current substance use, pain history and current daily opioid intake were collected. Patients completed three questionnaires: the Severity of Opioid Dependence Questionnaire, Leeds Dependence Questionnaire, and Pain Disability Index. A novel "Opioid Problem Checklist score" assessing drug-related problems was also determined for each patient. RESULTS: The addiction clinic group were younger, more likely to have experienced drug overdose and had a shorter duration of chronic pain. No significant differences in dependence questionnaire scores were found between groups. However, higher Pain Disability Index scores and higher Opioid Problem Checklist scores (indicating more drug-related problems) were found for the addiction clinic group. CONCLUSIONS: Some degree of dependence was present across both addiction and pain clinic groups, supporting the notion a state of dependence can be identified among chronic pain patients taking opioids long term. Aberrant behaviors were not common in the pain clinic sample, suggesting these patients are unlikely to meet Diagnostic and Statistical Manual of Mental Disorders-V criteria for Substance Use Disorder. However, opioid dependence carries significant risks for relapse, chronicity, morbidity and mortality, warranting specific medical management. Management of such risks should be considered routine care in chronic pain patients taking opioids long term.


Assuntos
Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Comportamento Aditivo , Dor Crônica , Transtornos Relacionados ao Uso de Opioides , Dor Crônica/tratamento farmacológico , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Clínicas de Dor , Avaliação de Sintomas
9.
J Strength Cond Res ; 33(11): 3129-3135, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31644518

RESUMO

Orysiak, J, Witek, K, Malczewska-Lenczowska, J, Zembron-Lacny, A, Pokrywka, A, and Sitkowski, D. Upper respiratory tract infection and mucosal immunity in young ice hockey players during the pretournament training period. J Strength Cond Res 33(11): 3129-3135, 2019-The aim of this study was to determine the effects of 17 days of training during preparation for the Ice Hockey Under 18 World Championship of the Polish ice hockey national team on the mucosal immune function and monitor upper respiratory tract infection (URTI) incidence before, during, and after the competition. Twelve male ice hockey players (age, 17.7 ± 0.5 years) were recruited for this study. The first saliva and blood collection took place at the beginning of the training camp (without training at the training camp), the second one was collected on the 9th day of the training camp immediately after the intensification of training, and the third collection was performed on the 13th day of training (4 days before leaving for the World Championship) in the tapering phase. To assess the mucosal immune function, concentrations of secretory immunoglobulin A (sIgA), sIgA1, and sIgA2 were analyzed in saliva. Cortisol concentration and creatine kinase activity were determined in blood, as indicators of stress and muscle damage, respectively. The Wisconsin Upper Respiratory Symptom Survey-21 questionnaire was used to assess URTI symptoms. A significant increase in the sIgA1 and sIgA2 concentrations was observed in the third collection compared with the second time point (114.45 ± 33.00 vs. 77.49 ± 27.29 and 88.97 ± 25.33 vs. 71.65 ± 32.44 U, respectively). There were no statistically significant correlations between the URTI incidence and saliva variables. In conclusion, the tapering period positively affects the mucosal immune function, especially sIgA1 and sIgA2 concentrations, with no significant change in the frequency of URTI in young ice hockey players.


Assuntos
Hóquei/fisiologia , Imunidade nas Mucosas , Imunoglobulina A Secretora/metabolismo , Condicionamento Físico Humano/fisiologia , Infecções Respiratórias/imunologia , Adolescente , Creatina Quinase/sangue , Humanos , Hidrocortisona/sangue , Incidência , Masculino , Saliva/metabolismo , Inquéritos e Questionários , Avaliação de Sintomas
11.
Medicine (Baltimore) ; 98(42): e17530, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626114

RESUMO

Serious bacterial infection (SBI) is a major cause of morbidity and mortality in children. Distinguishing SBI from self-limiting viral infections is a very important task in the emergency department (ED), especially in the children with fever without source (FWS). The aim of this study was to analyze whether parents' statements about clinical manifestations, which were categorized according to grades, are related to the actual diagnosis of SBI in children with FWS.Retrospective analysis was conducted using prospectively acquired cohort data for all febrile children in the pediatric ED of Seoul National University Hospital from August 2016 to August 2017. The association of clinical manifestations and SBI was the main outcome of this study. The SBIs included diagnoses such as bacteremia, bacterial meningitis, urinary tract infection, and pneumonia. Clinical manifestations including activity, urination, and feeding were categorized into 3 or 4 grades according to the parents' statements. The linear-by-linear association test was used to examine linear associations between the severity of clinical manifestations and SBI. Receiver operating characteristic curves for clinical manifestations were constructed for patients with SBI. Area under the curve (AUC) statistics and 95% confidence intervals (CIs) were obtained to evaluate the predictive performance of clinical manifestations.There was no linear association between SBI and non-SBI when compared by severity of the clinical manifestations, such as duration of fever (P = .299), activity (P = .781), feeding (P = .161), and urination (P = .834). The AUC was 0.54 (95% CI 0.41-0.67) for duration of fever, 0.52 for activity (95% CI 0.40-0.64), 0.42 for feeding (95% CI 0.32-0.53), and 0.51 for urination (95% CI 0.39-0.62).There was no evidence that the test performance of the clinical manifestations is valid for predicting SBIs, even considering the severity of manifestations. For optimal evaluation of the children with FWS, more comprehensive approach including laboratory tests, are needed.


Assuntos
Infecções Bacterianas/diagnóstico , Febre de Causa Desconhecida/diagnóstico , Pais , Avaliação de Sintomas/estatística & dados numéricos , Pré-Escolar , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seul , Avaliação de Sintomas/métodos
12.
Anticancer Res ; 39(9): 4619-4625, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519559

RESUMO

Cancer patients are at risk for both venous and arterial thrombotic events. Accumulating evidence suggests a link between cancer and arterial thrombosis events. The pathophysiology of arterial thrombosis in cancer is complex and multifactorial. The risk of arterial thrombosis in cancer patients relies on individual risk factors, on cancer-related hypercoagulability, on anticancer drugs and radiotherapy often via a common underlying mechanism of endothelial dysfunction. This review describes the mechanisms involved in the development of arterial thrombotic events and their clinical manifestations. Furthermore, it provides an overview on therapeutic agents associated with arterial thrombosis.


Assuntos
Artérias/patologia , Neoplasias/complicações , Trombose/etiologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Gerenciamento Clínico , Humanos , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/terapia , Neovascularização Patológica , Radioterapia/efeitos adversos , Radioterapia/métodos , Avaliação de Sintomas , Trombose/diagnóstico , Trombose/epidemiologia
13.
Anticancer Res ; 39(9): 4941-4945, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519599

RESUMO

AIM: This study describes the demographic, socioeconomic, and tumor-specific characteristics of patients who refuse breast cancer surgery. MATERIALS AND METHODS: This is a retrospective study of breast cancer patients from 2004-2015 captured by the National Cancer Data Base. Demographic, socioeconomic, and tumor-specific predictors were compared between patients who refused breast cancer surgery versus those who agreed to surgery, using bivariate and multivariate models. RESULTS: A total of 2,445,870 patients met the inclusion criteria. On multivariate analysis, black and Asian patients had higher odds of refusing surgical treatment compared to whites (OR=2.16, CI=2.05-2.28, p<0.001), (OR=1.58, CI=1.41-1.76, p<0.001), respectively. Moreover, patients with government insurance (OR=1.97, CI=1.86-2.09, p<0.001) and uninsured patients (OR=3.91, CI=3.50-4.36, p<0.001) were found to have higher odds of surgical treatment refusal when compared to patients with private insurance. CONCLUSION: Specific demographic and disease-specific characteristics are related to refusing potentially life-saving breast cancer surgery.


Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamografia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Razão de Chances , Estudos Retrospectivos , Fatores Socioeconômicos , Avaliação de Sintomas , Recusa do Paciente ao Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
14.
Urology ; 134: 97-102, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31499079

RESUMO

OBJECTIVE: To determine whether women overactive bladder symptoms would report more frequent unhealthy toileting behaviors. METHODS: A community-based sample of adult women was electronically recruited to complete the Toileting Behavior Scale and the International Consultation on Incontinence Questionnaire - Overactive Bladder module, as well as clinical and demographic questionnaires. The associations between overactive bladder and toileting behavior subscales were assessed as continuous variables using Spearman's rank correlation and as dichotomous variables with multivariable logistic regression. RESULTS: Of the 6562 adult women included in the analytic sample, 1059 (16.1%) were classified as having overactive bladder. Of the toileting behavior subscales, convenience voiding had the highest, positive association with overactive bladder score (r = 0.301, P < .0001). On multivariable logistic regression, women with overactive bladder (OAB) were more likely to report behaviors of convenience voiding (odds ratio [OR] 1.13, confidence intervals [CI] 1.11-1.15), delayed voiding (OR 1.05, CI 1.02-1.08), straining to void (OR 1.05, CI 1.03-1.07), and position preference (OR 1.13, CI 1.08-1.18). CONCLUSION: OAB symptoms were associated with specific toileting behaviors of convenience voiding, delayed voiding, straining to void, and position preference. Further investigation is needed to determine if toileting behaviors are a risk factor for OAB or a compensatory adaptation to mitigate symptoms.


Assuntos
Sintomas Comportamentais/diagnóstico , Qualidade de Vida , Autocuidado , Bexiga Urinária Hiperativa , Incontinência Urinária de Urgência , Micção , Adulto , Aparelho Sanitário , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Autocuidado/métodos , Autocuidado/psicologia , Inquéritos e Questionários , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos , Estados Unidos , Bexiga Urinária Hiperativa/diagnóstico , Bexiga Urinária Hiperativa/epidemiologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/etiologia , Incontinência Urinária de Urgência/psicologia
15.
Urology ; 134: 72-78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31487513

RESUMO

OBJECTIVE: To assess the symptoms associated with long-term Double-J ureteral stenting including the influence of biofilms on ureteral stents. METHODS: Patients with long-term (>8 weeks) uni- or bilateral ureteral stents completed the Ureteral Stent Symptoms Questionnaire (USSQ) at the day of stent exchange. Repeated assessment of patients was possible to allow for analysis of intraindividual changes. Assessment of biofilm mass on the stents was performed according to a validated method, its correlation with the USSQ total score was defined as primary outcome. Secondary outcomes included further analyses of stent-associated symptoms and their temporal course. RESULTS: A total of 87 stent indwelling periods in 35 patients were investigated. Median USSQ total score did not differ significantly between unilateral and bilateral stenting (42 vs 39 points; P = .17). An increasing total stent treatment time up to study inclusion did not correlate with the USSQ total score, but was significantly correlated with less urinary symptoms and a better quality of life. USSQ total score and subscores within individual patients did not significantly increase or decrease over the sequence of stent indwelling periods. Higher total biofilm masses were not associated with higher USSQ total scores or subscores. CONCLUSION: Long-term Double-J stenting provides a valuable treatment option, if stent-associated symptoms are low during the initial indwelling period. Thus, symptoms remain stable over the long-term course and the majority of patients are satisfied with the treatment. Furthermore, biofilm formation on ureteral stents does not seem to be the relevant driver of symptoms.


Assuntos
Bactérias , Biofilmes , Efeitos Adversos de Longa Duração , Implantação de Prótese , Infecções Relacionadas à Prótese , Qualidade de Vida , Stents , Obstrução Ureteral/cirurgia , Idoso , Bactérias/classificação , Bactérias/isolamento & purificação , Correlação de Dados , Remoção de Dispositivo/métodos , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Humanos , Efeitos Adversos de Longa Duração/diagnóstico , Efeitos Adversos de Longa Duração/microbiologia , Efeitos Adversos de Longa Duração/psicologia , Masculino , Desenho de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/psicologia , Stents/efeitos adversos , Stents/microbiologia , Inquéritos e Questionários , Suíça , Avaliação de Sintomas/métodos
16.
Eur J Oncol Nurs ; 42: 97-102, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31479847

RESUMO

PURPOSE: (a) To identify subgroups with unique psychoneurological symptom-cluster experience (depression, cognitive impairment, fatigue, sleep disturbance, and pain) and (b) to examine whether the selected demographic, clinical, psychological, and biological factors determine a symptom-cluster experience in cancer patients. METHOD: The sample included 203 patients with diverse cancer types recruited from a Korean university hospital. Latent profile analyses were conducted to identify subgroups. Influencing factors of subgroup membership (demographic/clinical variables, hemoglobin level, social support, and psychological stress) were included as covariates in latent profile analysis and analyzed by multinomial logistic regression. RESULTS: Latent profile analyses classified patients into two subgroups with a unique symptom cluster experience: patients experiencing high intensity in all symptoms within the cluster (the all-high-symptom subgroup, 71%) and patients experiencing low intensity in all symptoms within the cluster (all-low-symptom subgroup, 29%). The validity of the two subgroups was confirmed by the group classification accuracy (97% of the all-low-symptom subgroup and 99% of the all-high-symptom subgroup) and by significant Wald's mean equality tests, showing each symptom (depression, cognitive impairment, fatigue, sleep disturbance, and pain) significantly differentiated the two subgroups (ps < .001). Psychological stress independently determined the subgroup membership. Patients with high levels of stress were more likely to be in the all-high-symptom group (OR = 4.69, p < .0001). Hemoglobin level, cancer diagnosis, social support, and previous chemotherapy experience did not influence group membership. CONCLUSIONS: A large number of patients experience five psychoneurological symptoms simultaneously due to psychological stress. Interventions targeted to stress would be beneficial for those patients.


Assuntos
Neoplasias/complicações , Neoplasias/psicologia , Estresse Psicológico/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Dor do Câncer/diagnóstico , Dor do Câncer/epidemiologia , Dor do Câncer/psicologia , Análise por Conglomerados , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/psicologia , Fadiga/diagnóstico , Fadiga/epidemiologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/diagnóstico , Avaliação de Sintomas , Síndrome , Adulto Jovem
18.
In Vivo ; 33(5): 1411-1420, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471386

RESUMO

Recent studies report a significant age-specific increase in hepatocellular carcinoma (HCC) development among persons over 75 years old. Therefore, there is an urgent need to determine the optimal treatment strategy in elderly patients with HCC. This systemic review examines the clinical characteristics, efficacy, and safety of first-line treatment modalities. The literature was searched regarding epidemiology and clinical outcomes in elderly patients (age ≥75 years) undergoing first-line treatment for HCC. Causative or comorbid conditions of HCC in elderly patients differed from those in younger patients. Radiofrequency ablation may be effective and safe in early stages. Surgical resection may also be feasible in the early stages for selected patients. Transarterial chemoembolization may be safe and effective for intermediate HCC, and sorafenib may be feasible in elderly patients with advanced HCC. Prospective randomized trials are needed to establish the treatment strategy for elderly patients with HCC.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/mortalidade , Terapia Combinada/métodos , Gerenciamento Clínico , Avaliação Geriátrica , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/mortalidade , Gradação de Tumores , Estadiamento de Neoplasias , Avaliação de Resultados da Assistência ao Paciente , Avaliação de Sintomas
19.
Clin Sports Med ; 38(4): 483-496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472761

RESUMO

Cardiac disease can present in the training room through three portals: the preparticipation history and physical may identify concerns, the athlete may present with symptoms, or screening modalities may demonstrate abnormal findings. Training-related cardiovascular remodeling can mimic real disease, therefore providers must be able to separate the two. Sports medicine providers must be knowledgeable in how these present and how to care for these concerns to ensure proper care and avoid unnecessary restrictions of athletes. This article discusses 10 common cardiac concerns that can arise in the training room.


Assuntos
Doenças Cardiovasculares/diagnóstico , Anamnese , Exame Físico , Medicina Esportiva/métodos , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/genética , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia , Humanos , Programas de Rastreamento , Avaliação de Sintomas
20.
Clin Sports Med ; 38(4): 497-511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472762

RESUMO

Concussion is a challenging and controversial medical diagnosis that can test even the most seasoned practitioner. Knowledge on this topic is ever evolving. It was not so long ago that grading guidelines were based on loss of consciousness and amnesia. Medicine has seen a renaissance of discovery over the past 20 years in concussion evaluation and management. A PubMed search for "concussion" between 1990 and 2000 produced just over 1000 articles and that same search including the last 18 years expands to over 10,000 publications. The most recent knowledge and recommendations are discussed based on the published evidence.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia , Humanos , Exame Físico , Medicina Esportiva/métodos , Avaliação de Sintomas
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