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1.
Medicine (Baltimore) ; 100(35): e26752, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477115

RESUMO

ABSTRACT: To describe the outcomes of elective cancer surgeries and adverse consequences on the patients and medical staff due to the surgical interventions in children during the Coronavirus Disease 2019 (COVID-19) pandemic.The study included children younger than 15 years who underwent elective cancer surgeries from March 4, 2020 and December 3, 2020.A total of 121 patients (62% male; median age, 3 years) underwent surgery. The surgical procedures included nephrectomies (n = 18), neuroblastoma (n = 26) and soft tissue tumor resections (n = 24) and complex surgical procedures like extended liver resections (n = 2), intra-atrial thrombectomy under cardiopulmonary bypass (n = 2), pancreatoduodenectomy (n = 1), and free microvascular flaps (n = 7). Clavien-Dindo Grade III complications were 5% (n = 6), and there were no postoperative deaths. Preoperative COVID-19 testing was performed in 82% of children, and only 2% showed severe acute respiratory syndrome coronavirus 2 positivity. Postoperatively, 26 children were tested because of specific symptoms and, 6 tested positive for severe acute respiratory syndrome coronavirus 2. Except for a median delay of 23 days in treatment, none of the patients with COVID-19 required critical hospital management. None of the surgical residents or faculty acquired COVID-19, while 4 each medical and support staff were tested positive in the study period.COVID-19 was not a deterrent for continued cancer care, and surgeries could be safely performed adopting universal preventive measures without any added morbidity from COVID-19. Caregivers and centers dealing with childhood cancers can be encouraged to sustain or seek early healthcare.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Neoplasias/cirurgia , Adolescente , COVID-19/diagnóstico , COVID-19/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Pandemias , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária/estatística & dados numéricos
4.
Clin J Oncol Nurs ; 25(4): 457-464, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34269347

RESUMO

BACKGROUND: Healthcare delivery has been significantly changed because of the COVID-19 pandemic. Patients undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to infections because of their immunocompromised status. The risk of nosocomial infection may be reduced by providing care to patients at home. OBJECTIVES: This article describes one cancer center's approach for delivering safe patient care through homecare encounters, the benefits of home care for HSCT, and future directions. METHODS: Patients received detailed information on home encounters. Advanced practice providers visited patients daily and then returned to the clinic to formulate a plan of care with the interprofessional care team. Transplantation RNs visited patients on the same day to provide the prescribed care. FINDINGS: Based on evaluations from 32 patients and 12 providers, the results indicated that home care was safe, feasible, and beneficial for patient care post-HSCT during the COVID-19 pandemic.


Assuntos
Transplante de Células-Tronco Hematopoéticas/enfermagem , Serviços de Assistência Domiciliar/normas , Neoplasias/enfermagem , Neoplasias/cirurgia , Enfermagem Oncológica/normas , Terapias em Estudo/normas , Transplante Homólogo/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Pandemias , Guias de Prática Clínica como Assunto , SARS-CoV-2
5.
J Surg Oncol ; 124(5): 876-885, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34133760

RESUMO

BACKGROUND AND OBJECTIVES: There is lack of information on the quality of care provided to the rapidly increasing population of cancer survivors in Latin America. Our study attempts to address this gap and to identify areas needed to be improved. METHODS: A random sample of 210 breast and colorectal cancer survivors were selected from a hospital-based registry in Chile. Cancer registry information, electronic chart review, and personal interviews were used to assess medical and nonmedical care over a 5-year period. Survivorship care practices were compared to a standardized reference based on the US Institute of Medicine domains and the American Cancer Association guidelines. RESULTS: Over 80% of breast and colorectal cancer survivors received appropriate medical care, ongoing testing surveillance and risk factors assessment. Only a third of survivors were assessed for psychosocial disorders and 25% of them received interdisciplinary care. Overall, 66.1% of breast and 58.6% of colorectal cancer survivors reached the expected quality level of cancer survivorship care according to the reference standard (p < .001). CONCLUSION: Medical care practices reached a high standard in a leading cancer center in Latin America. However, a much stronger psychosocial assessment and interdisciplinary care is needed to improve survivorship cancer quality care.


Assuntos
Sobreviventes de Câncer/psicologia , Transtornos Mentais/prevenção & controle , Neoplasias/cirurgia , Equipe de Assistência ao Paciente/normas , Qualidade de Vida , Sobrevivência , Idoso , Sobreviventes de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , América Latina , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Prognóstico , Psicologia , Qualidade da Assistência à Saúde , Estudos Retrospectivos , Estresse Psicológico/prevenção & controle , Taxa de Sobrevida
6.
J Surg Oncol ; 124(5): 894-905, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34137038

RESUMO

BACKGROUND: Management of coagulopathy during major oncologic surgery can be multifactorial and challenging. Viscoelastic assays (VEAs) can be useful in providing vital data about the mechanism of coagulopathy in these dynamic circumstances. OBJECTIVES: A prospective nonrandomized observational study with the aim of describing the coagulation parameters of patients undergoing major oncologic surgery using the Quantra® and TEG® 5000 systems. Our secondary objectives included the correlation between Quantra and TEG parameters, and the times to result for both technologies. METHODS: This study included 74 adults undergoing oncologic surgery with an anticipated blood loss of more than 500 ml. For each subject, whole blood samples for each device were collected at multiple points perioperatively for comparison. RESULTS: Correlation coefficients between Quantra and TEG parameters were 0.8 and above, indicating a very strong correlation (p < .001). Correlation coefficients between conventional laboratory tests and Quantra ranged from 0.74 to 0.83, indicating a moderate correlation (p < .001). The mean time to obtain results and total processing time was shorter for Quantra in comparison to TEG. CONCLUSIONS: Quantra parameters strongly correlated with TEG parameters; however, Quantra parameters were available in shorter amount of time as it is specifically designed as a closed point of care device.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Técnicas Hemostáticas/instrumentação , Neoplasias/cirurgia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tromboelastografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos da Coagulação Sanguínea/etiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Ensaios Clínicos Controlados não Aleatórios como Assunto , Prognóstico , Estudos Prospectivos , Adulto Jovem
7.
Eur J Oncol Nurs ; 52: 101981, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34091407

RESUMO

PURPOSE: The purpose of this systematic review was to determine whether adequate research evidence exists to support utilizing multimedia technology in the preoperative education of adult cancer patients. METHODS: A systematic search of Medline, CINAHL, Web of Science, and PsycINFO databases from 2010 through September 24, 2020, was performed. The review included quantitative studies that examined whether education delivered by multimedia impacted levels of anxiety, knowledge acquisition, satisfaction, and compliance. The research quality was evaluated using the Joanna Briggs Institute Critical Appraisal Tool specific to the study design. RESULTS: The database search identified 529 scientific articles, of these nine studies met the eligibility criteria (n = 5 randomized controlled trials; n = 4 quasi-experimental studies). The education interventions included a variety of researcher-developed, multimedia modalities, consisting of video (n = 7), a computer program (n = 1), and a tablet application (n = 1). The methodological rigor varied among these studies. Multimedia patient education resulted in decreased anxiety and improved knowledge acquisition within groups; however, there was no significant difference when compared to traditional methods. Patients were also similarly satisfied and compliant with both education methods. CONCLUSIONS: In all studies, the healthcare provider played a prominent role in both multimedia and traditional interventions, revealing the strong influence of the interpersonal connection in the delivery of preoperative education. Future research is needed to investigate whether more interactive technology could improve patient outcomes.


Assuntos
Multimídia , Neoplasias , Adulto , Ansiedade/prevenção & controle , Pessoal de Saúde , Humanos , Neoplasias/cirurgia , Educação de Pacientes como Assunto
8.
J Surg Oncol ; 124(4): 665-668, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34159613

RESUMO

Resection of the inferior vena cava may be required in the courses of oncological surgeries for the tumors originating from or invading it. Management of the remaining defect depends on the extension of the resection. Partial or complete replacement of the inferior vena cava, with a patch or interposition graft, may be required. Standard techniques for the reconstruction with a prosthetic material or the autologous veins can be associated with the prosthetic graft infection, high cost, long-standing anticoagulation, technical difficulties, and/or need for extra incisions. The use of the autologous peritoneum represents an easy and inexpensive alternative for the partial and complete inferior vena cava reconstructions.


Assuntos
Neoplasias/cirurgia , Peritônio/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Veia Cava Inferior/cirurgia , Humanos , Prognóstico , Transplante Autólogo
9.
World J Surg ; 45(9): 2661-2669, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34152449

RESUMO

BACKGROUND: The Lancet Commission on Global Surgery (LCoGS) recommended an annual surgical rate at which low- and middle-income countries (LMICs) could achieve most of the population-wide benefits of surgery. However, condition-specific guidelines were not proposed. To inform rates of surgery for cancer, we sought to assess the current met and unmet need for oncologic surgery in Ghana. METHODS: Data on all operations performed in Ghana over a one-year period (2014-15) were obtained from representative samples of 48/124 first-level and 12/16 referral hospitals and scaled-up for nationwide estimates. Procedures for cancer were identified by indication. Using modified LCoGS methodology with disease prevalence, Ghana's annual rate of cancer surgery was compared to that of New Zealand to quantify current unmet needs. RESULTS: 232,776 surgical procedures were performed in Ghana; 2,562 procedures (95%UI 1878-3255) were for cancer. Of these, 964 (37%) were surgical biopsies. The annual rate of procedures treating cancer was 2115 surgeries/100,000 cancer cases, or 21% of the New Zealand benchmark. Cervical, breast, and prostate cancer were found to meet 2.1%, 17.2%, and 32.1% of their respective surgical need. CONCLUSIONS: There is a large unmet need for cancer surgery in Ghana. Cancer surgery constitutes under 2% of the total surgeries performed in Ghana, an important proportion of which are used for biopsies. Therapeutic operative rate is deficient across most cancer types, and may lag behind improvements in screening efforts. As cancer prevalence and diagnosis increase in LMICs, cancer-specific surgical capacity must be increased to meet these evolving needs.


Assuntos
Neoplasias , Oncologia Cirúrgica , Benchmarking , Gana/epidemiologia , Hospitais , Humanos , Masculino , Neoplasias/epidemiologia , Neoplasias/cirurgia
10.
J Gastrointest Surg ; 25(8): 2129-2141, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34100251

RESUMO

BACKGROUND: Surgery is required for cure of most solid tumors, and general anesthesia is required for most cancer surgery. The vast majority of cancer surgery is facilitated by general anesthesia using volatile inhalational agents such as isoflurane and sevoflurane. Only recently have the immunologic and oncologic effect of inhalational agents, and their alternative, propofol-based total intravenous anesthesia (TIVA), come under investigation. METHODS: Between January 2019 and June 2020, English language articles on PubMed were searched for the keywords "Propofol" "TIVA" or "IV anesthesia" and either "cancer surgery" or "surgical oncology." Duplicates were removes, manuscripts classified as either in vitro, animal, translational, or clinical studies, and their results summarized within these categories. RESULTS: In-vitro and translational data suggest that inhalational anesthetics are potent immunosuppressive and tumorigenic agents that promote metastasis, while propofol is anti-inflammatory, anti-tumorigenic, and prevents metastasis development. Clinically there is a recurring association, based largely on retrospective, single institution series, that TIVA is associated with significant improvements in disease-free interval and overall survival in a number of, but not all, solid tumors. The longer the surgery is, the more intense the surgical trauma is, the more aggressive the malignancy is, and the higher likelihood of an association is. DISCUSSION: Prospective randomized trials, coupled with basic science and translational studies, are needed to further define this association.


Assuntos
Anestesia , Anestésicos Inalatórios , Neoplasias , Propofol , Anestesia Intravenosa , Anestésicos Intravenosos , Humanos , Neoplasias/cirurgia , Estudos Prospectivos , Estudos Retrospectivos
11.
BMC Med Inform Decis Mak ; 21(1): 200, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34182974

RESUMO

Postoperative complications are still hard to predict despite the efforts towards the creation of clinical risk scores. The published scores contribute for the creation of specialized tools, but with limited predictive performance and reusability for implementation in the oncological context. This work aims to predict postoperative complications risk for cancer patients, offering two major contributions. First, to develop and evaluate a machine learning-based risk score, specific for the Portuguese population using a retrospective cohort of 847 cancer patients undergoing surgery between 2016 and 2018, for 4 outcomes of interest: (1) existence of postoperative complications, (2) severity level of complications, (3) number of days in the Intermediate Care Unit (ICU), and (4) postoperative mortality within 1 year. An additional cohort of 137 cancer patients from the same center was used for validation. Second, to improve the interpretability of the predictive models. In order to achieve these objectives, we propose an approach for the learning of risk predictors, offering new perspectives and insights into the clinical decision process. For postoperative complications the Receiver Operating Characteristic Curve (AUC) was 0.69, for complications' severity AUC was 0.65, for the days in the ICU the mean absolute error was 1.07 days, and for 1-year postoperative mortality the AUC was 0.74, calculated on the development cohort. In this study, predictive models which could help to guide physicians at organizational and clinical decision making were developed. Additionally, a web-based decision support tool is further provided to this end.


Assuntos
Neoplasias , Complicações Pós-Operatórias , Estudos de Coortes , Humanos , Neoplasias/cirurgia , Portugal/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Curva ROC , Estudos Retrospectivos
12.
World J Surg Oncol ; 19(1): 191, 2021 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187485

RESUMO

BACKGROUND: Clinical evidence has proved that enhanced recovery after surgery (ERAS) can improve short-term clinical outcomes after various types of surgeries, but the long-term benefits have not yet been examined, especially with respect to cancer surgeries. Therefore, a systematic review of the current evidence was conducted. METHODS: The Pubmed, Cochrane Library, Embase, and Web of Science databases were searched using the following key words as search terms: "ERAS" or "enhanced recovery" or "fast track", "oncologic outcome", "recurrence", "metastasis", "long-term outcomes", "survival", and "cancer surgery". The articles were screened using the inclusion and exclusion criteria, and the data from the included studies were extracted and analyzed. RESULTS: A total of twenty-six articles were included in this review. Eighteen articles compared ERAS and conventional care, of which, 12 studies reported long-term overall survival (OS), and only 4 found the improvement by ERAS. Four studies reported disease-free survival (DFS), and only 1 found the improvement by ERAS. Five studies reported the outcomes of return to intended oncologic treatment after surgery (RIOT), and 4 found improvements in the ERAS group. Seven studies compared high adherence to ERAS with low adherence, of which, 6 reported the long-term OS, and 3 showed improvements by high adherence. One study reported high adherence could reduce the interval from surgery to RIOT. Four studies reported the effect of altering one single item within the ERAS protocol, but the results of 2 studies were controversial regarding the long-term OS between laparoscopic and open surgery, and 1 study showed improvements in OS with restrictive fluid therapy. CONCLUSIONS: The use of ERAS in cancer surgeries can improve the on-time initiation and completion of adjuvant chemotherapy after surgery, and the high adherence to ERAS can lead to better outcomes than low adherence. Based on the current evidence, it is difficult to determine whether the ERAS protocol is associated with long-term overall survival or cancer-specific survival.


Assuntos
Recuperação Pós-Cirúrgica Melhorada , Laparoscopia , Neoplasias , Humanos , Tempo de Internação , Neoplasias/cirurgia , Prognóstico , Recuperação de Função Fisiológica
13.
Curr Oncol ; 28(3): 1867-1878, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068441

RESUMO

Cancer causes substantial emotional and psychosocial distress, which may be exacerbated by delays in treatment. The COVID-19 pandemic has resulted in increased wait times for many patients with cancer. In this study, the psychosocial distress associated with waiting for cancer surgery during the pandemic was investigated. This cross-sectional, convergent mixed-methods study included patients with lower priority disease during the first wave of COVID-19 at an academic, tertiary care hospital in eastern Canada. Participants underwent semi-structured interviews and completed two questionnaires: Hospital Anxiety and Depression Scale (HADS) and Perceived Stress Scale (PSS). Qualitative analysis was completed through a thematic analysis approach, with integration achieved through triangulation. Fourteen participants were recruited, with cancer sites including thyroid, kidney, breast, prostate, and a gynecological disorder. Increased anxiety symptoms were found in 36% of patients and depressive symptoms in 14%. Similarly, 64% of patients experienced moderate or high stress. Six key themes were identified, including uncertainty, life changes, coping strategies, communication, experience, and health services. Participants discussed substantial distress associated with lifestyle changes and uncertain treatment timelines. Participants identified quality communication with their healthcare team and individualized coping strategies as being partially protective against such symptoms. Delays in surgery for patients with cancer during the COVID-19 pandemic resulted in extensive psychosocial distress. Patients may be able to mitigate these symptoms partially through various coping mechanisms and improved communication with their healthcare teams.


Assuntos
Ansiedade/epidemiologia , COVID-19/prevenção & controle , Depressão/epidemiologia , Neoplasias/cirurgia , Tempo para o Tratamento , Adaptação Psicológica , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/psicologia , COVID-19/epidemiologia , COVID-19/transmissão , Controle de Doenças Transmissíveis/normas , Estudos Transversais , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Nova Escócia/epidemiologia , Pandemias/prevenção & controle , Angústia Psicológica , Psicometria/estatística & dados numéricos , Pesquisa Qualitativa , Autorrelato/estatística & dados numéricos , Triagem/normas , Incerteza
14.
J Cancer Res Ther ; 17(2): 556-564, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34121708

RESUMO

Objective: Cancers have been reported to worsen the clinical course of coronavirus disease 2019 (COVID-19) infection. We aimed to demonstrate the real-life data on health outcomes in COVID-19-infected cancer patients. Materials and Methods: We analyzed the data of 43 COVID-19-infected cancer patients in our COVID-19 clinics between March 25, 2020, and May 9, 2020, retrospectively. Results: We determined that 1051 patients were followed up with COVID-19 infection and 43 (4%) of them were cancer patients. The mean age of the patients was 64.3 ± 12.3 years. Lung cancer is the most common cancer type among the patients (23.2%). Dyspnea (51.2%) was the most common symptom in the first admission. Typical ground-glass consolidation or patchy appearance with peribronchial thickening resembling bronchopneumonia on high-resolution computed tomography (HRCT) was present in 29 (67.4%) patients. COVID-19 was diagnosed in 14 (32.5%) patients based on reverse transcriptase-polymerase chain reaction analysis of nose-throat swab samples without any sign of lung involvement on HRCT. Total mortality of the COVID-19 infection was 46.5% (n = 20). Presence of heart disease (hazard ratio [HR]: 3.5; 95% confidence interval [CI]: 1.29-9.4), previous surgeries to the respiratory system (HR: 6.95; 95% CI: 1.29-27.7), and presence of dyspnea at admission (HR: 4; 95% CI: 1.31-12.3) were statistically significantly associated with death (P = 0.01, 0.02, and 0.01, respectively). Conclusion: Our practices supported that cancer patients were more affected by COVID-19 disease than the normal population. However, our findings can not be generalized due to being retrospective and single centered study, Also, we did not compare the findings with noncancer patients with COVID19 disease.


Assuntos
COVID-19/diagnóstico , Pulmão/diagnóstico por imagem , Neoplasias/complicações , Idoso , COVID-19/mortalidade , COVID-19/terapia , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Estudos de Casos e Controles , Progressão da Doença , Dispneia/epidemiologia , Feminino , Seguimentos , Cardiopatias/epidemiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/imunologia , Neoplasias/cirurgia , Prognóstico , RNA Viral/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/imunologia , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Centros de Atenção Terciária/estatística & dados numéricos , Tomografia Computadorizada por Raios X , Turquia/epidemiologia
16.
Clin Nutr ; 40(5): 2914-2922, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33962360

RESUMO

BACKGROUND: Patients undergoing surgery for cancer are at particular risk of post-operative complications. The pre-operative period is an opportunity to identify and mitigate risk factors and improve outcome. Bioelectrical impedance analysis (BIA) may offer an additional means of identifying patients at risk of post-operative morbidity. AIMS: The aim of this systematic review was to assess the use of measures and estimates of body composition determined by BIA as markers of peri-operative risk in adult patients undergoing elective surgery for cancer. METHODS: This review was performed in accordance with the PRISMA guidelines. The electronic databases of MEDLINE, EMBASE, CINAHL, CENTRAL and the Web of Science were searched from inception. Studies of adult participants having elective surgery for cancer were included if participants underwent BIA in the peri-operative period and were assessed for post-operative complications. RESULTS: 2578 studies were identified, of which 12 were eligible for inclusion. In total the studies report data from 1508 subjects. Five studies examined phase angle or standardized phase angle, six examined derived measures and one examined both. Eight of the 12 demonstrated an association between phase angle and/or body composition and an increased risk of post-operative complications. CONCLUSIONS: Bioelectrical impedance analysis in the peri-operative period may be useful in predicting the risk of complications following elective cancer surgery. Phase angle more consistently demonstrates an association than derived estimates. Further high quality studies are needed and should report the raw impedance values, standardized phase angle and the equations used to derive body composition.


Assuntos
Composição Corporal , Impedância Elétrica , Neoplasias/cirurgia , Complicações Pós-Operatórias/diagnóstico , Humanos , Valor Preditivo dos Testes , Medição de Risco
18.
Int J Mol Sci ; 22(9)2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33946583

RESUMO

Molecular imaging of pathologic lesions can improve efficient detection of cancer and cardiovascular diseases. A shared pathophysiological feature is angiogenesis, the formation of new blood vessels. Endoglin (CD105) is a coreceptor for ligands of the Transforming Growth Factor-ß (TGF-ß) family and is highly expressed on angiogenic endothelial cells. Therefore, endoglin-based imaging has been explored to visualize lesions of the aforementioned diseases. This systematic review highlights the progress in endoglin-based imaging of cancer, atherosclerosis, myocardial infarction, and aortic aneurysm, focusing on positron emission tomography (PET), single-photon emission computed tomography (SPECT), magnetic resonance imaging (MRI), near-infrared fluorescence (NIRF) imaging, and ultrasound imaging. PubMed was searched combining the following subjects and their respective synonyms or relevant subterms: "Endoglin", "Imaging/Image-guided surgery". In total, 59 papers were found eligible to be included: 58 reporting about preclinical animal or in vitro models and one ex vivo study in human organs. In addition to exact data extraction of imaging modality type, tumor or cardiovascular disease model, and tracer (class), outcomes were described via a narrative synthesis. Collectively, the data identify endoglin as a suitable target for intraoperative and diagnostic imaging of the neovasculature in tumors, whereas for cardiovascular diseases, the evidence remains scarce but promising.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Endoglina/análise , Neoplasias/diagnóstico por imagem , Animais , Doenças Cardiovasculares/cirurgia , Humanos , Imageamento por Ressonância Magnética/métodos , Neoplasias/cirurgia , Imagem Óptica/métodos , Tomografia por Emissão de Pósitrons/métodos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Ultrassonografia/métodos
19.
Khirurgiia (Mosk) ; (6. Vyp. 2): 45-51, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34032788

RESUMO

OBJECTIVE: To determine the predictors of safe enhanced recovery after surgery in elderly cancer patients with comorbid chronic heart failure (CHF) and preserved left ventricular ejection fraction (LVEF). MATERIAL AND METHODS: There were 75 patients over 65 years old (mean 73.6±5.6 years) with cancer of abdominal and pelvic organs and comorbid cardiovascular diseases for the period from January 2018 to July 2020. All patients underwent total resections with enhanced postoperative recovery at the Petrovsky National Research Centre of Surgery. RESULTS: CHF with preserved LVEF was diagnosed in 42 (56%) patients (NYHA class I - 20 patients, class II - 19 patients, class III - 3 patients). ACE/ARA/neprilysin inhibitors were described in 74.7% of patients, beta-blockers - 70.7%, calcium channel blockers - 37.3%, diuretic therapy - 21.3%, antithrombotic therapy - 62.7%, statins - 54.7%, antiarrhythmic therapy - 12%. Preoperative correction of cardiac therapy was required in 60% of patients. Mean LVEF was 58.5±6.8%, pulmonary artery systolic pressure - 29±7.8 mm Hg, impairment of local myocardial contractility was observed in 6.7% of patients. Serum NT-proBNP level was 534.5±63.9 pg/ml, LDL-C - 3.3±1.1 mmol/l, GFR - 65.95±17.1 ml/min/1.73m2, glycated hemoglobin 6.37±0.67%. Perioperative risk of cardiovascular complications within 30-day postoperative period was assessed using the Revised Cardiac Risk Index (RCRI) score (6% in 59 patients, 10.1% in 11 patients, and 15% in 5 patients). Incidence of cardiovascular complications in early postoperative period was 4%, postoperative 30-day mortality rate - 1.3%. CONCLUSION: Our small study of surgical treatment of elderly cancer patients with comorbid CHF with preserved LVEF demonstrates the need for a personalized assessment of preoperative clinical and instrumental data to optimize cardiac therapy and perioperative monitoring. Multidisciplinary approach reduces perioperative mortality and cardiovascular morbidity from 7.2% to 4%.


Assuntos
Insuficiência Cardíaca , Neoplasias , Idoso , Doença Crônica , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Humanos , Neoplasias/complicações , Neoplasias/cirurgia , Volume Sistólico , Função Ventricular Esquerda
20.
Clinics (Sao Paulo) ; 76: e2741, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34008773

RESUMO

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.


Assuntos
Neoplasias , Coluna Vertebral , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Coluna Vertebral/cirurgia
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