Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 61.621
Filtrar
1.
Medicine (Baltimore) ; 98(41): e17289, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593081

RESUMO

INTRODUCTION: Fibromyalgia (FM) is a chronic condition characterized by chronic pain, fatigue and loss of function which significantly impairs quality of life. Although treatment of FM remains disputed, some studies point at the efficacy of interdisciplinary therapy. This study aims to analyze the effectiveness, cost-utility and benefits of a multicomponent therapy on quality of life (main variable), functional impact, mood and pain in people suffering from FM that attend primary care centers (PCCs) of the Catalan Institute of Health (ICS). METHODS AND ANALYSIS: A 2-phase, mixed methods study has been designed following Medical Research Council guidance. Phase 1: Pragmatic randomized clinical trial with patients diagnosed with FM that attend one of the 11 PCCs of the ICS Gerència Territorial Terres de l'Ebre. We estimate a total sample of 336 patients. The control group will receive usual clinical care, while the multicomponent therapy group (MT group) will receive usual clinical care plus group therapy (consisting of health education, exercise and cognitive-behavioural therapy) during 12 weeks in 2-hourly weekly sessions. ANALYSIS: the standardized mean response and the standardized effect size will be assessed at 3, 9, and 15 months after the beginning of the study using multiple linear regression models. Utility measurements will be used for the economic analysis. Phase 2: Qualitative socio constructivist study to evaluate the intervention according to the results obtained and the opinions and experiences of participants (patients and professionals). We will use theoretical sampling, with 2 discussion groups of participants in the multicomponent therapy and 2 discussion groups of professionals of different PCCs. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P18/068). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04049006.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia por Exercício/métodos , Fibromialgia/terapia , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Qualidade de Vida , Adulto , Terapia Cognitivo-Comportamental/economia , Terapia Combinada , Análise Custo-Benefício , Terapia por Exercício/economia , Estudos de Viabilidade , Feminino , Fibromialgia/economia , Fibromialgia/psicologia , Implementação de Plano de Saúde , Humanos , Masculino , Avaliação de Processos e Resultados (Cuidados de Saúde) , Aceitação pelo Paciente de Cuidados de Saúde , Cooperação do Paciente , Educação de Pacientes como Assunto/economia , Atenção Primária à Saúde/economia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
2.
Medicine (Baltimore) ; 98(41): e17333, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593082

RESUMO

Patients with structural heart disease (SHD) are more difficult to ablate than those with a structurally healthy heart. The reason may be technical problems. We compared periprocedural data in unselected patients (including SHD group) recruited for zero-fluoroscopy catheter ablation (ZF-CA) of supraventricular arrhythmias (SVTs).Consecutive adult patients with atrioventricular nodal reentry tachycardia (AVNRT), accessory pathways (AP), atrial flutter (AFL), and atrial tachycardia (AT) were recruited. A 3-dimensional electroanatomical mapping system (Ensite Velocity, NavX, St Jude Medical, Lake Bluff, Illinois) was used to create electroanatomical maps and navigate catheters. Fluoroscopy was used on the decision of the first operator after 5 minutes of unresolved problems.Of the 1280 patients ablated with the intention to be treated with ZF approach, 174 (13.6%) patients with SHD (age: 58.2 ±â€Š13.6; AVNRT: 23.9%; AP: 8.5%; AFL: 61.4%; and AT: 6.2%) were recruited. These patients were compared with the 1106 patients with nonstructural heart disease (NSHD) (age: 51.4 ±â€Š16.4; AVNRT: 58.0%; AP: 17.6%; AFL: 20.7%; and AT: 3.7% P ≤ .001). Procedural time (49.9 ±â€Š24.6 vs 49.1 ±â€Š23.9 minutes, P = .55) and number of applications were similar between groups (P = 0.08). The rate of conversion from ZF-CA to fluoroscopy was slightly higher in SHD as compared to NSHD (13.2% vs 7.8%, P = .02) while the total time of fluoroscopy and radiation doses were comparable in the group of SHD and NSHD (P = .55; P = .48).ZF-CA is feasible and safe in majority of patients with SHD and should be incorporated into a standard approach for SHD; however, the procedure requires sufficient experience.


Assuntos
Arritmias Cardíacas/cirurgia , Ablação por Cateter/métodos , Fluoroscopia/métodos , Cardiopatias Congênitas/cirurgia , Taquicardia Supraventricular/cirurgia , Adulto , Idoso , Arritmias Cardíacas/congênito , Estudos de Viabilidade , Feminino , Cardiopatias Congênitas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Taquicardia Supraventricular/congênito , Resultado do Tratamento
3.
MMW Fortschr Med ; 161(Suppl 6): 3-8, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31587170

RESUMO

BACKGROUND: Family members of patients with severe illness are burdened with the care and participation in challenging decisions regarding medical treatment and care in addition to the challenges of their own lives. They express a wish for low-threshold support services. However, there are few publications on targeted interventions for the support of family members of patients with a serious illness. METHOD: An information brochure was developed on the basis of a systematic review and its feasibility and acceptance were tested with an evaluation sheet, handed out to family members in 3 different settings (3 palliative care units, 21 family practices, and 2 home palliative care services) over a period of 6 weeks. Satisfaction was measured using a 5-point Likert scale (1 = very satisfied, 5 = not satisfied at all). To assess the acceptance of the brochure the participants were asked about their willingness to read. The benefit was judged on questions of information gain. In addition, deficiencies could be named and suggestions for improvement could be made. RESULTS: Overall, 27 evaluation sheets were analysed. 93% of the participating relatives read the whole brochure. 63% of the relatives were satisfied or very satisfied with the flyer (median 2 = satisfied). 70% of the relatives said they had received new information. CONCLUSIONS: In this feasibility study, the acceptance and usefulness of the information flyer for a large number of relatives was confirmed. Such an information flyer thus provides a low-threshold supplement to the support of families in the care at the end of life.


Assuntos
Disseminação de Informação/métodos , Folhetos , Relações Profissional-Família , Família/psicologia , Estudos de Viabilidade , Serviços de Assistência Domiciliar , Humanos , Cuidados Paliativos
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 961-965, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630494

RESUMO

Objective: To introduce a new technique of protective ostomy using the specimen extraction auxiliary incision following laparoscopic low anterior resection for rectal cancer, and to compare the pros and cons of loop ileostomy (LI) and loop transverse colostomy (LTC). Methods: A retrospective cohort study was performed. The data of patients who underwent laparoscopic low anterior resection for rectal cancer and ostomy using the auxiliary incision in Peking Union Medical College Hospital from January 2010 to December 2017 were retrospectively analyzed. Inclusion criteria: (1) patient underwent neoadjuvant chemoradiotherapy before operation; (2) patient was classified as tumor stage II or III; (3) patient was followed up and underwent stoma closure at our center; (4) ostomy was performed through specimen extraction incision. Patients with multiple gastrointestinal carcinomas or inflammatory bowel disease were excluded. Two hundred and eight patients were included in the study and divided into the LI group (n=86) and LTC group (n=122). The operation parameters and postoperative complications were compared between the two groups. Results: There were 135 males and 73 females (1.85∶1.00). Mean age of the 208 patients was (59.6±11.6) years (range 29-85 years). There were no significant differences between LI and LTC groups in baseline data (all P>0.05). All of the patients completed surgery successfully. The severe complication rate after ostomy was 2.9% (6/208). In the fecal diversion period, LI group showed significantly faster defecation [(1.6±1.0) days vs. (2.2±1.9) days, t=-2.918, P=0.004] and lower incidence of parastomal hernia [8.1% (7/86) vs. 19.7% (24/122), χ(2)=5.290, P=0.021], but higher incidence of peristomal dermatitis [18.6% (16/86) vs. 4.9% (6/122), χ(2)=9.990, P=0.002] as compared to LTC group. The incidence of renal insufficiency was lower in LTC group, though the difference was not significant [4.9% (6/122) vs. 10.5% (9/86), χ(2)=2.320, P=0.128]. The severe complication rate after stoma closure was 1.9% (4/208). In the stoma closure period, a significantly higher incidence of wound infection was noted in LTC group [18.0% (22/122) vs. 4.7% (4/86), χ(2)=8.258, P=0.004]. There were no significant differences between the two groups in the incidence of anastomotic leakage, stenosis, and incisional hernia (all P>0.05). All complications were improved after treatment. Conclusions: Both LI and LTC through auxiliary incision following laparoscopic low anterior resection for rectal cancer are safe and feasible. LTC is an optional method for those patients with sensitive skin.


Assuntos
Colostomia , Ileostomia , Protectomia/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ferida Cirúrgica
5.
Psychiatr Danub ; 31(3): 333-339, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596826

RESUMO

BACKGROUND: Early intervention for Autism Spectrum Disorder (ASD) in France is heterogeneous and poorly evaluated to date. Early Start Denver Model (ESDM) is a developmental and behavioral model of intervention for toddlers with ASD which has already shown very interesting outcomes on the development of children with ASD in various studies with different settings. However, it is not possible with the current research to agree on the best setting. Thus, we implemented an ESDM program according to our context where children are often pre-schooling early from 30 months old. This therapy was applied by a multidisciplinary team working in close collaboration with parents and other partners. SUBJECTS AND METHODS: A prospective observational study including 19 toddlers with ASD was conducted. We evaluated improvement on the cognitive level of toddlers with ASD receiving therapist-delivered ESDM intervention for 12 hours per week. RESULTS: Significant improvements in verbal and nonverbal cognitive skills at the Mullen Scale of Early Learning were obtained after 10 months of intervention in our sample. The largest improvement was in receptive language development quotient with a mean improvement of 19.6 points. We also observed promising outcomes in daily adaptive behavior, with a slight improvement in communication at the Vineland Adaptive Behavioral Scale. These outcomes, when compared to the conclusions of previous studies, are leading us to the need for a therapy duration beyond 10 months. CONCLUSIONS: Our outcomes were very encouraging even with low cognitive and nonverbal children. These outcomes may be confirmed in a multicenter randomized controlled trial that is ongoing.


Assuntos
Transtorno do Espectro Autista/psicologia , Transtorno do Espectro Autista/terapia , Intervenção Precoce (Educação) , Pré-Escolar , Estudos de Viabilidade , Humanos , Estudos Multicêntricos como Assunto , Pais/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
6.
Acta Gastroenterol Belg ; 82(3): 375-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566324

RESUMO

BACKGROUND: Colorectal recurrent lesions after endoscopic mucosal resection (EMR) often contain severe fibrosis. In such lesions, repeat EMR is often difficult and endoscopic piecemeal mucosal resection (EPMR) has a high risk of repeated recurrence, while surgery is considered overtreatment. Whether ESD can be used safely and reliably to treat such difficult lesions has not been adequately verified. We analyzed the treatment outcomes of ESD for recurrent lesions after EMR. METHODS: Among 653 colorectal ESD conducted in our institution between April 2012 and August 2017, 27 consecutive patients underwent the procedure for recurrent lesions after EMR. Treatment outcomes including en bloc resection rate, R0 resection rate, and curative resection rate; complications were analyzed. RESULTS: Treatment outcomes of the 27 patients were as follows: en bloc resection rate 81.5%, R0 resection rate 74.1%, curative resection rate 74.1%, median procedure time 47 min (range 10‒210 min), perforation rate 0%, and delayed bleeding rate 3.7%. The corresponding rates for 626 patients who underwent colorectal ESD during the same period for lesions other than recurrence after EMR were 97.2%, 95.5%, 88.7%, 37 min (7-225 min), 0.5%, and 2.8%. There were no differences in complication rates. Treatment outcomes including en bloc resection rate were inferior in the recurrence group compared to non-recurrent group, but no local recurrence was found in all patients. CONCLUSIONS: Colorectal ESD is feasible for recurrent colorectal lesions after EMR. The procedure is safe and achieves good treatment outcomes with no local recurrence.


Assuntos
Neoplasias Colorretais/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/cirurgia , Recidiva Local de Neoplasia/cirurgia , Colonoscopia , Neoplasias Colorretais/patologia , Estudos de Viabilidade , Humanos , Mucosa Intestinal/patologia , Resultado do Tratamento
7.
Zhonghua Er Ke Za Zhi ; 57(10): 786-791, 2019 Oct 02.
Artigo em Chinês | MEDLINE | ID: mdl-31594066

RESUMO

Objective: To explore the feasibility of gender assignment in 46,XY disorders of sex development (DSD) with severe undermasculinisation mainly based on molecular diagnosis. Methods: A retrospective study of 45 patients of 46, XY DSD with severe undermasculinisation were admitted between November 2015 and October 2018 at Children's Hospital, Zhejiang University School of Medicine. The initial social gender were all female, of whom the external genital manifestations were Prader 0 to 2; the degree of masculinity was scored using external masculinisation score (EMS); the position and development of the gonads were examined by ultrasound, cystoscopy and laparoscopy, also including assessing the development of the Wolffian tube and the Müllerian tube. The level and ratio of testosterone to dihydrotestosterone before and after hCG stimulation were evaluated for the function of Leydig cell and 5α-reductase-2. Gender role scales and sandbox games were used to assess gender role behavior. Genital sensitivity to androgen stimulation was assessed; A panel including 163 genes related to gender development were determined by second-generation sequencing in all 45 patients. Finally, a multidisciplinary team (MDT) makes a gender assignment after a comprehensive analysis mainly based on the molecular etiological diagnosis. Results: Thirty-nine out of 45 patients (87%) had an identifiable genetic etiology, and the remaining 6 (13%) were negative for genetic testing. Forty-five patients had EMS less than or equal to 3 points. Sexual psychological assessment was performed in 39 patients, with male dominance in 24 (62%) and female dominance in 15 (38%). The gender assignment was 23 cases (51%) for male and 19 cases (42%) for female, and 3 cases (7%) were not completely determined. Conclusions: Molecular diagnosis provides a strong basis for appropriate gender assignment of 46, XY DSD children with severe undermasculinisation. Based on molecular diagnosis, each DSD should be analyzed by professional MDT to analyze the clinical symptoms/signs, gonadal development, gonad tumor risk, external genital morphology, sexual psychological assessment, potential fertility opportunities, parental views, Social and cultural factors, etc. make appropriate gender assignment.


Assuntos
3-Oxo-5-alfa-Esteroide 4-Desidrogenase/deficiência , Transtorno 46,XY do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/etiologia , Identidade de Gênero , Desenvolvimento Sexual/fisiologia , Maturidade Sexual/genética , Virilismo/genética , Criança , Transtorno 46,XY do Desenvolvimento Sexual/diagnóstico , Transtorno 46,XY do Desenvolvimento Sexual/patologia , Transtornos do Desenvolvimento Sexual/genética , Transtornos do Desenvolvimento Sexual/patologia , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Masculino , Estudos Retrospectivos , Virilismo/etiologia
8.
Sante Publique ; Vol. 31(3): 405-415, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640328

RESUMO

INTRODUCTION: Poor oral health in persons with schizophrenia is a major public health issue affecting 600,000 people in France. The aim of this article was to present the different stages in the development of a specific oral health educational program for persons with schizophrenia. It takes into account experimental knowledge of these persons and presents the results of the feasibility study. PATIENTS AND METHOD: The focus group method was applied to a group of health professionals and users to highlight an exploratory corpus in order to develop an oral health educational program. An expert group including persons with schizophrenia among others validated the fields and tools of this program. A feasibility study was then conducted in a control group of 7 persons with schizophrenia. RESULTS: Altogether, 26 persons participated in this feasibility study. The main fields investigated by the expert group aimed to promote personal responsibility for one's health, to improve access to the healthcare system and to promote the global management of health. The feasibility study showed the ability of this program to change persons with schizophrenia representations and knowledge of this health problem. Most educational tools were considered relevant. CONCLUSION: An oral health educational program was built as part of a caregiver-persons with schizophrenia partnership and showed its feasibility. A multicentric randomized trial is currently ongoing to assess the efficacy of this program with a high level of proof.


Assuntos
Cuidadores/psicologia , Saúde Bucal/educação , Educação de Pacientes como Assunto/organização & administração , Esquizofrenia/terapia , Estudos de Viabilidade , Grupos Focais , França , Humanos
9.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(9): 737-741, 2019 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-31550846

RESUMO

Objective: To explore the feasibility and safety of a newly developed simple and rapid axillary vein puncture technique based on the surface landmarks for pacemaker implantation. Methods: From January to November 2018, we enrolled 110 patients who underwent pacemaker implantation in Beijing Anzhen Hospital. Basic clinical characteristics, such as gender, age, major diagnosis, type of pacemaker, and His-purkinje system pacing, were collected. The success rate of this axillary vein puncture technique, complications, and technical parameters of present puncture method were analyzed. Results: There were 58 (52.7%) male patients in this cohort and the average aged was (70.26±10.45) years old. This "blind" axillary vein puncture method was successful in 105 out of 110 patients (95.5%). The relevant puncture-related parameters included: the distance between points "a and b" was (3.89±0.40) cm, the first angle α was (25.84±5.54)° and the second angle ß was (66.18±10.26)°. There were no puncture-related complications, such as hematoma, pneumothorax and hemothorax. Conclusion: The new "blind" axillary vein puncture approach is a simple, effective and safe technique for pacemaker implantation, which is easy to learn and practice and suitable for promotion.


Assuntos
Veia Axilar , Marca-Passo Artificial , Implantação de Prótese , Punções/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia
10.
Stud Health Technol Inform ; 267: 254-261, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483280

RESUMO

Funding agencies and field experts promote reuse of scientific data and biomaterial beyond the scope of the original project. The availability of research data, however, is limited by the interest of original authors as well as the privacy rights of the study participants, especially in the biomedical sciences. On the other hand, for an available data set to be a useful contribution to the scientific community, it has to be findable and accessible with reasonable effort. Therefore, using the R Shiny library, we designed and implemented a software for data discovery and feasibility analyses with compliance to regulatory and contractual regulations. Due to its genericity, it was successfully tested with heterogeneous data sets and ultimately applied to the data and biomaterial of the German Center for Cardiovascular Research (DZHK). The resulting tool - named the Feasibility Explorer - is publicly available and can be used by researchers to get an overview of data and biomaterial available in the DZHK and to select collectives in the process of submitting a usage application. To implement the rights of participants and original authors, data is integrated by querying the informed consent and not persistently stored. All calculations on the data are performed server-sided and only aggregated information is send to a client, whereas the extent of information was strictly limited to a necessary minimum that allows an applicant to assess whether an application is worthwhile.


Assuntos
Pesquisa Biomédica , Privacidade , Estudos de Viabilidade , Armazenamento e Recuperação da Informação , Consentimento Livre e Esclarecido
11.
Anticancer Res ; 39(9): 5057-5064, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519615

RESUMO

BACKGROUND/AIM: Multiplex gene panel tests using next-generation sequencing (NGS) are clinically available for gastric cancer (GC). The NGS tests can reveal unexpected pathogenic variants to be associated with hereditary diseases, i.e., secondary genetic findings. We investigated whether GC patients at high risk of having hereditary gastric cancer (HGC) can be identified by their clinicopathological variables before they undergo NGS cancer gene panel tests. PATIENTS AND METHODS: The cases of 2,286 patients with GC treated at our hospital during the years 1999-2017 were retrospectively analyzed; of them, 143 patients were identified as being at high risk of having HGC (HR-HGC), and the remaining 2,143 patients were classified as having sporadic gastric cancer (SGC). RESULTS: Compared to the SGC group, the HR-HGC status was significantly associated with younger age, female gender, macroscopic type IV and a histologically diffuse type. In a multivariate analysis, being young (i.e., ≤50 years old) was an independent risk factor for HR-HGC. CONCLUSION: Female and young patients with diffuse-type GC are closely associated with a high risk of having HGC, and these factors might predict the detection of secondary genetic findings by NGS testing.


Assuntos
Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/epidemiologia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologia , Adulto , Idoso , Suscetibilidade a Doenças , Estudos de Viabilidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Síndromes Neoplásicas Hereditárias/mortalidade , Medição de Risco , Fatores de Risco , Neoplasias Gástricas/mortalidade
12.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(10): 1239-1244, 2019 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-31544432

RESUMO

Objective: To explore the feasibility and effectiveness of maintaining the reduction of unstable intertrochanteric fractures by Kirschner wire-fixation-cortical bone technique. Methods: Forty patients with intertrochanteric fracture [AO/Orthopaedic Trauma Association (AO/OTA) type 31-A2.2] admitted between May 2015 and January 2017 and requiring closed reduction and proximal femoral nail antirotation (PFNA) were randomly divided into trial group (intraoperative Kirschner wire-fixation-cortical bone technique group, 20 cases) and control group (conventional treatment group, 20 cases). There was no significant difference in general data of gender, age, side, body mass index, cause of injury, time from injury to operation between the two groups ( P>0.05). The operation time, intraoperative blood loss, and intraoperative fluoroscopy times of the two groups were recorded; the reduction quality of fracture was observed according to the corresponding relationship between medial and anterior cortex (positive, neutral, and negative support) of intraoperative fluoroscopy proposed by ZHANG Shimin, and the stability of internal fixation and fracture healing were observed; Harris score was used to evaluate the recovery of hip function at 12 months after operation. Results: In the trial group, 6 cases (30%) had 2 Kirschner wires implanted less than 4 times, 7 cases (35%) had 5-8 times, and 7 cases (35%) had 9 times or more. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05), but the blood transfusion volume and intraoperative fluoroscopy times in the trial group were significantly less than those in the control group ( P<0.05). Both groups were followed up 13-21 months, with an average of 17 months. There was no complications such as wound infection, deep venous thrombosis of lower extremities, refracture, and internal fixation-related complications. The quality of intraoperative reduction in the trial group was significantly better than that in the control group ( Z=-2.794, P=0.024). The Harris score of the trial group was significantly better than that of the control group at 12 months after operation ( t=2.98, P=0.01). Conclusion: The use of Kirschner wire-fixation-cortical bone technique during intertrochanteric fracture closed reduction and PFNA internal fixation surgery can effectively maintain the reduction effect, reduce the number of fluoroscopy, improve the reduction quality, reduce allogeneic blood input, obtain better hip function, and do not increase the operation time and intraoperative blood loss.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Pinos Ortopédicos , Fios Ortopédicos , Osso Cortical , Estudos de Viabilidade , Humanos , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(36): e16935, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490376

RESUMO

BACKGROUND: Although several previous studies demonstrated the feasibility and efficacy of indocyanine green (ICG) for thyroid cancer surgery, ICG was administered through venous injection and focused on parathyroid gland protection. We thus aimed to study the feasibility of imaging using ICG combined with carbon nanoparticles (CNs) in the identification of sentinel lymph nodes (SLNs) in patients diagnosed with papillary thyroid microcarcinoma (PTMC). METHODS: Two approaches were applied to detect lymph nodes in PTMC surgery. Patients were randomized into 2 groups. ICG and CNs were injected into the thyroid in Group A. In Group B, only CNs was injected. Black-stained or fluorescent nodes observed using near-infrared fluorescence imaging systems were defined as SLNs. SLN and central lymph node (CLN) dissection was completed in both groups. The pathological and postoperative outcomes were compared between 2 groups. RESULTS: There were 40 patients in Group A and 60 in Group B. A total of 138 SLNs were identified; 72 and 66 SLNs were detected and dissected in Groups A and B, respectively. The number of SLNs identified (per patient) in Group A was higher than that in Group B (P = .027). The number of harvested CLNs was 161 and 192 in Groups A and B, respectively, out of which 45 and 48 lymph nodes with metastasis were confirmed by permanent pathology. The CLN metastatic rate in Group A was higher than that in Group B (P = .048). CONCLUSION: Imaging using ICG combined CNs is feasible and safe for SLN identification in PTMC patients. Compared with using only CNs, more SLNs can be removed and more metastatic lymph nodes can be confirmed when using the combined method. Although the combined method appears to accurately stage tumors, further research is needed.


Assuntos
Carbono/administração & dosagem , Carcinoma Papilar/patologia , Verde de Indocianina/administração & dosagem , Excisão de Linfonodo/métodos , Nanopartículas/administração & dosagem , Linfonodo Sentinela/cirurgia , Neoplasias da Glândula Tireoide/patologia , Adulto , Carbono/química , Carcinoma Papilar/cirurgia , Corantes/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Nanopartículas/química , Imagem Óptica/métodos , Linfonodo Sentinela/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos
14.
Zhonghua Zhong Liu Za Zhi ; 41(9): 654-658, 2019 Sep 23.
Artigo em Chinês | MEDLINE | ID: mdl-31550854

RESUMO

Objective: This study aims to explore the clinical value of fusion indocyanine green fluorescence imaging (FIGFI) in total laparoscopic radical resection for right colon cancer. Methods: From October, 2018 to December, 2018, 15 patients who underwent total laparoscopic radical resection for right colon cancer using FIGFI in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were retrospectively enrolled in this study. Data regarding surgical outcomes, postoperative recovery, pathological outcomes and complications were collected and analyzed. Results: All patients successfully underwent total laparoscopic radical resection for right colon cancer using FIGFI. 1 patients (6.7%) received extended resection of bowel due to poor blood supply after mesentery excision. The average operation time was 133.7 minutes and intraoperative blood loss was 26.7 ml. The average time to ground activities, fluid diet intake, first flatus and postoperative hospitalization were 19.1 h, 11.7 h, 32.5 h and 5.0 d, respectively. The average length of tumor was 4.5 cm. The average proximal and distal resection margins were 14.9 cm and 12.1 cm, respectively. The average number of lymph nodes retrieved was 29.3 per patient. Only one patient suffered from incisional fat liquefaction after surgery and was managed effectively by regular dressing change. No severe complications such as indocyanine green allergy, anastomotic stenosis, anastomotic leakage, abdominal bleeding, bowel obstruction, pulmonary infection, and abdominal infection occurred in any patients. Conclusions: FIGFI is helpful to judge the blood supply of intestinal segments and anastomotic stoma in total laparoscopic radical resection for right colon cancer quickly. It is a safe and feasible technique with satisfactory short-term effect.


Assuntos
Anastomose Cirúrgica/métodos , Colectomia/métodos , Colo/irrigação sanguínea , Neoplasias do Colo/cirurgia , Corantes/administração & dosagem , Verde de Indocianina/administração & dosagem , Imagem Óptica/métodos , Fístula Anastomótica/prevenção & controle , Colo/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Estudos de Viabilidade , Humanos , Laparoscopia/métodos , Estudos Retrospectivos , Resultado do Tratamento
15.
J Extra Corpor Technol ; 51(3): 175-178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31548742

RESUMO

In extracorporeal membrane oxygenation (ECMO), blood is drained from the patient, and pumped through a membrane oxygenator/lung (ML) for gas exchange and then back to the patient. For monitoring blood gases, samples may be sampled downstream from the ML. This exposes the patient for embolization risk (air/clot) when the stopcocks are flushed. For safe sampling procedures, the Loop was introduced. It is a constant low-flow arteriovenous shunt (AVS) used preferably in venoarterial ECMO. It is composed of three different length and diameter three-way stopcocks connected to the circuit just downstream the ML with its return upstream the pump. It offers safe arterial blood sampling and a simultaneous access point to the venous side of the circuit. Since its introduction, no patient complications have been reported to be accounted for by the Loop. The Loop is an AVS permitting a safe access point for post membrane blood sampling and for injections in the venous pre-pump limb. It has a low cost and is easy to install and maintain. It may be used in any ECMO configuration.


Assuntos
Oxigenação por Membrana Extracorpórea , Gasometria , Estudos de Viabilidade , Humanos , Masculino , Oxigenadores de Membrana , Diálise Renal
16.
Medicine (Baltimore) ; 98(37): e17178, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517873

RESUMO

The role of palliative primary tumor resection (PPTR) in improving survival in patients with synchronous unresectable metastatic colorectal cancer (mCRC) is controversial. In this study, we aimed to evaluate whether our novel scoring system could predict survival benefits of PPTR in mCRC patients.In this retrospective cohort study consecutive patients with synchronous mCRC and unresectable metastases admitted to Sir Run Run Shaw Hospital between January 2005 and December 2013 were identified. A scoring system was established by the serum levels of carcinoembryonic antigen (CEA), cancer antigen 19-9 (CA19-9), neutrophil/lymphocyte ratio (NLR), and lactate dehydrogenase (LDH). Patients with scores of 0, 1-2, or 3-4 were considered as being in the low, intermediate, and high score group, respectively. Primary outcome was overall survival (OS).A total of 138 eligible patients were included in the analysis, of whom 103 patients had undergone PPTR and 35 had not. The median OS of the PPTR group was better than that of the Non-PPTR group, with 26.2 and 18.9 months, respectively (P < .01). However, the subgroup of PPTR with a high score (3-4) showed no OS benefit (13.3 months) compared with that of the Non-PPTR group (18.9 months, P = .11). The subgroup of PPTR with a low score (52.1 months) or intermediate score (26.2 months) had better OS than that of the Non-PPTR group (P < .001, P = .017, respectively).A novel scoring system composed of CEA, CA19-9, NLR, and LDH values is a feasible method to evaluate whether mCRC patients would benefit from PPTR. It might guide clinical decision making in selecting patients with unresectable mCRC for primary tumor resection.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Metástase Neoplásica/terapia , Cuidados Paliativos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Projetos de Pesquisa , Estudos Retrospectivos , Adulto Jovem
18.
Rev Port Cir Cardiotorac Vasc ; 26(2): 93-100, 2019.
Artigo em Português | MEDLINE | ID: mdl-31476808

RESUMO

BACKGROUND: In selected cases, aortic valve repair (RVAo) is an alternative to prostesic aortic valve replacement. AIM: To compare mid-term survival, need of reoperation and echocardiographic findings associated with RVAo. METHODS: Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent RVAo between 2012 and 2017. A comparison was made with a group of patients who underwent mechanical aortic valve replacement (SVAo) in the same period. The groups were characterized and compared using Chi-Square and t-tests for independent samples and survival and reoperation were analyzed using Kaplan-Meier curves and Cox regressions. RESULTS: We included 72 patients submitted to RVAo. Mean follow-up time was 4 years, maximum 7. Although the mean age was relatively low (47±13 years), patients undergoing RVAo presented a lower prevalence of rheumatic etiology (3%). The cardiopulmonary bypass (148±74 minutes) and cross clamping aortic times (108±52 minutes) are the usual times for this type of surgery and similar to those of the comparing group (SVAo). In the echocardiographic follow-up (median of 3 months), we verified a left ventricular mass regression of 21% and a prevalence of aortic insufficiency of 4%. At 7 years, cumulative survival and freedom from reoperation of patients undergoing RVAo were 98.8% and 97.6%, respectively. CONCLUSION: RVAo can be a safe and effective alternative, with good mid-term results if patient selection is judicious.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Adulto , Estudos de Viabilidade , Implante de Prótese de Valva Cardíaca , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Br J Radiol ; 92(1103): 20181026, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31529985

RESUMO

OBJECTIVE: To evaluate safety and efficacy of image guided-hypofractionated radiation therapy (IG-HRT) in patients with thoracic nodes oligometastases. METHODS: The present study is a multicenter analysis. Oligometastatic patients, affected by a maximum of five active lesions in three or less different organs, treated with IG-HRT to thoracic nodes metastases between 2012 and 2017 were included in the analysis. Primary end point was local control (LC), secondary end points were overall survival (OS), progression-free survival, acute and late toxicity. Univariate and multivariate analysis were performed to identify possible prognostic factors for the survival end points. RESULTS: 76 patients were included in the analysis. Different RT dose and fractionation schedules were prescribed according to site, number, size of the lymph node(s) and to respect dose constraints for relevant organs at risk. Median biologically effective dose delivered was 75 Gy (interquartile range: 59-86 Gy). Treatment was optimal; one G1 acute toxicity and seven G1 late toxicities of any grade were recorded. Median follow-up time was 23.16 months. 16 patients (21.05%) had a local progression, while 52 patients progressed in distant sites (68.42 %).Median local relapse free survival was not reached, LC at 6, 12 and 24 months was 96.05% [confidence interval (CI) 88.26-98.71%], 86.68% (CI 75.86-92.87) and 68.21% (CI 51.89-80.00%), respectively. Median OS was 28.3 months (interquartile range 16.1-47.2). Median progression-freesurvival was 9.2 months (interquartile range 4.1-17.93).At multivariate analysis, RT dose, colorectal histology, systemic therapies were correlated with LC. Performance status and the presence of metastatic sites other than the thoracic nodes were correlated with OS. Local response was a predictor of OS. CONCLUSION: IG-HRT for thoracic nodes was safe and feasible. Higher RT doses were correlated to better LC and should be taken in consideration at least in patients with isolated nodal metastases and colorectal histology. ADVANCES IN KNOWLEDGE: Radiotherapy is safe and effective treatment for thoracic nodes metastases, higher radiotherapy doses are correlated to better LC. Oligometastatic patients can receive IG-HRT also for thoracic nodes metastases.


Assuntos
Neoplasias do Mediastino/radioterapia , Neoplasias Torácicas/radioterapia , Idoso , Neoplasias da Mama/mortalidade , Progressão da Doença , Intervalo Livre de Doença , Relação Dose-Resposta à Radiação , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Intestinais/mortalidade , Neoplasias Renais/mortalidade , Neoplasias Pulmonares/mortalidade , Metástase Linfática , Masculino , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/mortalidade , Pessoa de Meia-Idade , Hipofracionamento da Dose de Radiação , Radioterapia Guiada por Imagem/métodos , Estudos Retrospectivos , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/mortalidade , Tomografia Computadorizada por Raios X/métodos
20.
Prensa méd. argent ; 105(8): 431-435, sept 2019. graf
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1023142

RESUMO

Introducción: La monitorización con hormona tiroidea intraoperatoria (IOPTH) es utilizada en la práctica médica para predecir la cura bioquímica durante la paratiroidectomía del hiperparatiroidismo primario. Sin embargo, existen diversos criterios utilizados para predecir la normocalcémica luego de una paratiroidectomía. El propósito de este estudio es determinar cuál criterio es aquel que se corresponde con el menor riesgo de presentar un hiperparatiroidismo persistente luego de una paratiroidectomía por hiperparatiroidismo primario. Material y métodos: Se han analizado publicaciones realizadas en los últimos 10 años tomando como fuente de recopilación la base de datos de Pub-Med, trabajos publicados en Journal of the American Medical Associatiion y World Journal of Surgery. Conclusión: El criterio de IOPTH final en valores por debajo de los 65 pg/mL, y en especial, por debajo de los 40 pg/mL parece comportarse como mejor predictor de bajo riesgo de enfermedad persistente en comparación con el criterio de disminución de IOPTH por debajo del 50% del valor basal (AU)


Introduction: Monitoring with intraoperative thyroid hormone (IOPTH) is used in medical practice to predict the biochemical cure during the parathyroidectomy of primary hyperparathyroidism. However, there are several criteria used to predict normocalcemia after a parathyroidectomy. The purpose of this study is to determine which criterion is the one that correspons to the lowest risk of presenting a persistent hyperparathyroidism after a parathyroidectomy due to primary hyperparathyroidism. Materials and methods: Publications made in the last 10 years have been analyzed taking as a source of compilations the PubMed database, works published in Journal of the American Medical Association and World Journal of Surgery. Conclusiion: The final IOPTH criterion in values below 65 pg/mL, and especially below 40 pg/mL, seems to be the best predictor of low risk of persistent disease compared to the IOPTH decrease criterior Below 50% of the basal value (AU)


Assuntos
Humanos , Hormônio Paratireóideo , Neoplasias das Paratireoides/cirurgia , Medição de Risco , Hiperparatireoidismo Primário/cirurgia , Estudos de Viabilidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA