• Refine Query
  • Source
  • Publication year
  • to
  • Language
  • 102
  • 12
  • 5
  • 2
  • 1
  • 1
  • 1
  • 1
  • 1
  • Tagged with
  • 134
  • 134
  • 95
  • 91
  • 24
  • 24
  • 24
  • 23
  • 23
  • 20
  • 19
  • 18
  • 18
  • 18
  • 18
  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
21

Avaliação clínica retrospectiva de restaurações estéticas : classe III, IV e V / Retrospective clinical evaluation of esthetic restorations : class III, IV and V

Vieira, Rodrigo Monteiro January 2015 (has links)
O objetivo do presente estudo foi realizar uma avaliação clínica retrospectiva de restaurações diretas de resina composta de classe III, IV e V em dentes anteriores e pré-molares utilizando os métodos USPHS e FDI. Oitenta e sete pacientes foram selecionados através de uma pesquisa dos prontuários presentes no Setor de Acolhimento da Faculdade com restaurações realizadas entre 2000 a 2013 que possuíam um período mínimo em boca de 6 meses. Foram incluídos pacientes adultos de ambos os sexos que receberam tratamento com restaurações de classe III, IV ou V realizadas com as resinas compostas: Charisma, Z350 XT, Durafill VS, Esthet-X HD, Fillmagic e Opallis; realizadas com sistema adesivo convencional; em dentes vitais ou não vitais. Aqueles pacientes que possuíam higiene oral precária ou com necessidades especiais não foram incluídos no estudo. A avaliação clínica foi feita através dos métodos USPHS e FDI modificados por um examinador calibrado. A análise de sobrevivência das restaurações foi realizada através do método Kaplan-Meier e teste Log-Rank para comparação entre os grupos. A regressão de Cox multivariada e Hazard Ratio foram empregadas para verificar os fatores associados à falha das restaurações. O nível de significância foi de 5%. Foram avaliadas 272 restaurações, com um intervalo de tempo em boca de 8 meses até 13 anos (média - 4,8 anos). Foram avaliadas 120 restaurações classe III, entre elas, 15 apresentaram falhas (12,5%), com uma taxa de falha anual de 2,74%. Já para as restaurações de classe IV, realizou-se a avaliação de 80 restaurações, 38 demonstraram falhas (47,5%), como uma taxa de falha anual de 12,6%. E para as de classe V, foram analisadas 72 restaurações, sendo observada a presença de falhas em 27 delas (37,5%), com uma taxa de falha anual de 9,3%. O motivo mais comum de falha foi por fratura e/ou retenção para as três classes, ocorrendo em 73 casos. Dentes não vitais demonstraram 50% de falha em um tempo médio de 4,8 anos com uma taxa de falha anual de 13,4%; enquanto os dentes vitais apresentaram 28,1% de falha com uma taxa de falha anual de 6,6%. A regressão de Cox revelou associação entre marca comercial do compósito, classe da restauração e vitalidade pulpar com falha das restaurações. Conclui-se que restaurações de resina composta demonstraram um desempenho clínico satisfatório ao longo do tempo, apresentando sucesso em 70,6% dos casos em uma média de 4,8 anos, sendo que as de classe III apresentaram melhor desempenho clínico que classe V e classe IV e as restaurações em dentes desvitalizados apresentaram 2,37 vezes mais risco de falhas que restaurações em dentes vitais. Os principais motivos de falha para todos os tipos de restauração foi por fratura e/ou perda de retenção. Os dois métodos (USPHS e FDI) se demonstraram eficazes no processo de avaliação clínica em restaurações em dentes anteriores. / The aim of this study was to evaluate direct composite restorations Class III, IV, V in anterior teeth and premolars through the USPHS and FDI methods. Eighty-seven patients were selected through a search of the patients’ records present in the School of Dentistry. Restorations performed between 2000 to 2013 which a minimum of six months in mouth were selected. Adult patients of both sexes were included, who received treatment with restorations class III, IV or V with the follow composites: Charisma, Z350 XT, Durafill VS, Esthet-X HD, Fillmagic and Opallis; all restorations with total etch adhesive system; on vital and non-vital teeth. Patients with poor oral hygiene or special needs were not included in the study. Clinical evaluation was performed by USPHS and FDI modified methods, by one calibrated examiner. The survival of the restorations was analyzed using the Kaplan-Meier method and log-rank test to compare the groups, and multivariate Cox regression and hazard ratio were employed to identify factors associated with the failure of the restorations. The significance level was 5%. 272 restorations were evaluated with a time interval in service from 8 months to 13 years (mean 4.8 years). 120 class III restorations were evaluated, among them, 15 had failures (12.5%), with an annual failure rate of 2.74%. For the class IV type, 80 restorations were evaluated, 38 demonstrated failures (47.5%), with an annual failure rate of 12.6%. And for the class V, 72 restorations were analyzed, being observed the presence of failures in 27 of them (37.5%), with annual failure rate of 9.3% .The most common reason for failure was fracture or retention loss, for the three types of classes, occurring in 73 cases. Non-vital teeth showed 50% of failure in an average of 4.8 years, with an annual failure rate of 13.4%; while the vital teeth showed 28.1% of failure, with an annual failure rate of 6.6%. Cox regression revealed an association between brands, class type and tooth vitality with failures of the restorations. It was concluded that composite restorations showed a satisfactory clinical performance over time, with success in 70.6% of cases in a mean time of 4.8 years. Class III showed better clinical performance than class IV and V. Non-vital teeth restorations had 2.37 times the risk of failures than vital teeth. The main reasons for failure for all types of restoration was fracture and / or retention loss. Both methods (USPHS and FDI) demonstrated efficient in the process of clinical evaluation for anterior teeth.
22

Famílias incestuosas: diferenciação das funções familiares / Incestuous families: differenciation of family functions

Mariana Lanna Pinheiro 19 June 2015 (has links)
Introdução: A presente dissertação foi desenvolvida com o intuito de investigar as possíveis mudanças na dinâmica das famílias incestuosas, após intervenção do tratamento psicoterapêutico. A hipótese é de que mudanças primárias e secundárias ocorrem nas famílias encaminhadas ao Centro de Estudos e Atendimentos Referente ao Abuso Sexual (CEARAS) a partir do tratamento proposto. Essa dissertação foi elaborada a partir de uma perspectiva psicanalítica, com enfoque psicossocial, na qual o sujeito é considerado a partir de sua imersão na cultura. Para tanto, se tomou como base de reflexão o trabalho desenvolvido por este Centro de Estudos, em relação às famílias incestuosas. Objetivo: Refletir sobre as mudanças primárias e secundárias apresentadas pelas famílias incestuosas que foram atendidas no CEARAS. Metodologia: Trata-se de uma pesquisa retrospectiva documental. Foram analisados os prontuários de 19 famílias atendidas no CEARAS no período de 1993 a 2013 que compuseram a amostra final. Levantaram-se as informações sobre os atendimentos, condições de prontuários e quanto ao tratamento. As mudanças descritas nos prontuários foram divididas em dois grupos: mudanças primárias e secundárias. Uma análise descritiva e quantitativa das variáveis foi realizada. Resultados: A maior parte das famílias que foram encaminhadas para o CEARAS não finalizaram o tratamento proposto. Em relação às mudanças observadas, 53% das famílias apresentaram mudanças primárias e secundárias, 37% primárias e 10% secundárias. Em relação às mudanças primárias, a simbolização das funções familiares foi a mais frequente e a autonomia do membros familiares a menos frequente nos prontuários analisados. Não houve predomínio de mudanças secundárias. Observou-se um maior número de mudanças nas familías que não passaram pelo processo de troca de terapeutas. Conclusão: Percebeu-se a viabilidade do trabalho, o quanto ele se faz necessário. A pesquisa apontou que as mudanças primárias e secundárias são possíveis de acontecer através da terapia familiar. A transferência das famílias não ocorre somente com a instituição, mas também com os terapeutas envolvidos no tratamento / Introduction:This research aims to investigate possible changes to the dynamics of incestuous families after the commencement of psychotherapeutic treatment. Hypothetically, primary and secondary changes happen to the families taken to the Sexual Abuse Study and Help Center (Centro de Estudos e Atendimentos Referente ao Abuso Sexual - CEARAS) from the proposed treatment. This essay has been elaborated from a psychoanalytical perspective with psychosocial emphasis, in which the individual is considered from his cultural context. To do so, the grounds for the analysis is the work developed by the Study Center with the incestuous families. Objective: To think about the primary and secondary changes that arose from the therapeutic treatment provided by CEARAS to the dysfunctional families. Methodology: This is a retrospective document research. The handbook of the 19 families supported by CEARAS from the period between 1993 and 2013 which were part of the final sample have been analysed. The information about the calls, handbook conditions and treatment have been searched. The changes described in the handbooks were split in two groups: primary and secondary changes. Results: Most families under CEARAS\' care have not finished the proposed treatment. In relation to the changes detected, 53% of the families have shown primary and secondary changes; 37% have shown primary; and 10% secondary. It has been observed in the handbooks under analysis that, in relation to primary changes, the simbolization of the family functions was the most outstanding change whereas the autonomy of the family members was the least. There was no predominance of secondary changes. There has been a higher number of changes in families that did not have to change therapists. Conclusion: It is noticeable that the work is feasible and how necessary it is.The research shows that the primary and secondary changes are possible to take place by way of family therapy. The transfer in families does not happen only with the institution but also with the therapists involved in the treatment
23

Effect of target temperature management at 32-34℃ in cardiac arrest patients considering assessment by regional cerebral oxygen saturation: A multicenter retrospective cohort study / 局所脳酸素飽和度を用いた患者層別化による蘇生後体温管理(32-34℃)の効果:多施設過去起点コホート研究

Nakatani, Yuka 23 July 2018 (has links)
京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第21301号 / 医博第4390号 / 新制||医||1030(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 小池 薫, 教授 福原 俊一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
24

No Significant Difference in Clinically Relevant Findings Between Pillcam SB3 and Pillcam SB2 Capsules in a United States Veteran Population

Aasen, Tyler D., Wilhoite, David, Rahman, Aynur, Devani, Kalpit, Young, Mark, Swenson, James 16 February 2019 (has links)
BACKGROUND: Capsule endoscopy (CE) allows for a non-invasive small bowel evaluation for a wide range of gastrointestinal (GI) symptoms and diseases. Capsule technology has been rapidly advancing over recent years, often improving image frequency and quality. The Pillcam SB3 (SB3) capsule is one such technology that offers an adaptive frame rate advantage over the previous versions of the capsule the Pillcam SB2 (SB2). Some have proposed that this improvement in capsule technology may lead to increased diagnostic yields; however, real world clinical data is currently lacking. AIM: To evaluate the clinically relevant findings of SB3 and SB2 capsules in a population of United States veterans. METHODS: A retrospective analysis of 260 consecutive CE studies was performed including 130 SB3 and 130 SB2 capsule studies. Recorded variables included: age, gender, type of capsule, body mass index, exam completion, inpatient status, opioid use, diabetes, quality of preparation, gastric transit time, small bowel transit time, indication, finding, and if the exam resulted in a change in clinical management. The primary outcome measured was the detection of clinically relevant findings between SB3 and SB2 capsules. RESULTS: Mean age of the study population was 67.1 ± 10.4 years and 94.2% of patients were male. Of these 28.1% were on opioid users. The most common indications for capsule procedure were occult GI bleeding (74.6%) and overt GI bleeding (14.6%). Rates of incomplete exam were similar between SB3 and SB2 groups (16.9% 9.2%, = 0.066). The overall rate of clinically relevant finding was 48.9% in our study. No significant difference was observed in SB3 SB2 capsules for clinically relevant findings (46.2% 51.5%, = 0.385) or change in clinical management (40.8% 50.0%, = 0.135). CONCLUSION: Our study found no significant difference in clinically relevant findings between SB3 and SB2 capsules.
25

Influência da invasão tumoral da linha de anastomose na sobrevivência de pacientes com câncer de coto gástrico / The influence of tumor invasion in anastomotic line on survival of patient with gastric stump cancer

Carrasco, Ana Lúcia Granja Scarabel Nogueira 20 August 2008 (has links)
Os objetivos deste trabalho foram, em indivíduos com câncer de coto gástrico: identificar o padrão de disseminação de linfonodos acometidos, quantificar a invasão tumoral da linha de anastomose, correlacionar a invasão da linha de anastomose com o comprometimento linfonodal e mesenterial, correlacionar o acometimento linfonodal com sobrevivência e correlacionar o acometimento da linha de anastomose com sobrevivência. Foi realizado estudo retrospectivo com revisão de prontuários, peças cirúrgicas e exames anátomo-patológicos de 113 pacientes. O câncer de coto gástrico não tem um padrão de disseminação linfonodal específico; 75% dos pacientes apresentaram invasão tumoral da linha de anastomose; em 66,7% dos casos ocorreu invasão da linha anastomótica e linfonodal concomitantes; menos de 10% dos casos exibiam invasão mesenterial; houve óbito em 86,5% dos casos com invasão linfonodal e 64,7% com invasão da linha de anastomose e em 100% com invasão mesenterial. / The objectives of this study are to identify the metastatic pattern of lymph node for gastric stump cancer; to quantify the invasion of anastomotic site by tumor; to relate the invasion of anastomotic site with metastasis lymph node or mesenterial lymph node and these parameters with the survival of patients with gastric stump cancer. One hundred and thirteen patients with gastric stump cancer were retrospectively analyzed along with their medical records, surgical pieces and histopathologic exam. The metastatic pattern of lymph node isnt specific to gastric stump cancer. 75% of patients had tumoral invasion in the anastomotic site. In 66.7% of the cases there was an invasion of the anastomotic site with metastatic lymph nodes. 9% of patients had mesenterial lymph node invasion by tumor. Fatal cases occurred in 86,5% of the patients with metastatic lymph node, 64,7% with invasion of the anastomotic site and 100% with mesenterial lymph node invasion.
26

Operação de Serra Dória no tratamento do megaesôfago operado com recidiva dos sintomas / The Serra Dória procedure for reoperation of megaesophagus with recurrence of symptoms

Trevenzol, Hélio Ponciano 14 November 2003 (has links)
Nas operações de cardiomiotomia para tratamento do megaesôfago ocorre recidiva dos sintomas em até 15% dos pacientes, sendo que alguns necessitam reoperação. Foram estudados de forma retrospectiva, 20 pacientes com megaesôfago previamente tratados por cardiomiotomia e submetidos a reoperação, por cardioplastia com gastrectomia parcial em Y-de-Roux, conforme técnica proposta por Serra Dória et al (1970). A causa de recidiva dos sintomas foi esofagite de refluxo em nove (45,0%), miotomia incompleta em um (5,0%), cicatrização da miotomia em cinco (25,0%) e presença de megaesôfago avançado em cinco (25,0%). Foram analisadas as complicações intra e pósoperatórias. Os pacientes foram avaliados sob o ponto de vista clínico (disfagia, regurgitação, pirose e variação de peso), radiológico e endoscópico, no pré e no pós-operatório imediato e tardio. Cinco (25,0%) doentes apresentaram complicações no pós-operatório imediato. Não houve mortalidade. Todos os doentes melhoraram da disfagia, com quase total desaparecimento da regurgitação e pirose. Houve manutenção ou aumento de peso em 64,7% dos pacientes. O estudo radiológico mostrou diminuição do calibre do esôfago em 53,0% e manutenção nos demais. Não houve aumento do calibre em nenhum dos pacientes. No exame endoscópico realizado no pós-operatório tardio em 17 pacientes, observou-se que seis entre nove que apresentavam esofagite de refluxo, melhoraram; dois entre oito, que apresentavam esôfago normal no préoperatório, desenvolveram esofagite. Concluiu-se que a operação de Serra Dória para tratamento do megaesôfago, operado por cardiomiotomia com recidiva dos sintomas apresentou baixa morbidade e ausência de mortalidade. Permitiu expressivo alívio dos sintomas e diminuição do calibre do esôfago em vários doentes. Possibilitou também melhora da esofagite de refluxo, havendo, entretanto, a possibilidade de sua manutenção, bem como do seu aparecimento em doentes que não a apresentavam / After cardiomyotomy for the treatment of megaesophagus, recurrence of symptoms occur in up to 15% of the patients, but only some require a reoperation. Twenty patients with megaesophagus were retrospectively studied. They were previously treated by cardiomyotomy, and underwent to reoperation through cardioplasty with Roux-en-Y partial gastrectomy, according to the technique proposed by Serra Dória et al (1970). The etiology of symptoms recurrence was reflux esophagitis in nine (45.0%) patients, incomplete myotomy in one (5.0%), healing of the myotomy in five (25.0%) and end staging megaesophagus in five (25.0%). Intra and postoperative complications were analyzed. The patients were studied by clinical (dysphagia, regurgitation, heartburn and weight gain), radiological and endoscopic evaluation, in the preand postoperative period. Five (25.0%) patients had complications in the immediate postoperative period. No deaths were observed. Dysphagia improved in all the patients. Regurgitation and heartburn almost disappeared in the whole group. Weight was maintained or increased in 64,7% of the patients. Radiological studies showed a decrease in the caliber of the esophagus in 53.0%, while the remaining patients maintained the pre-operative diameter. Endoscopy, performed during the late postoperative period in 17 patients, showed that six among the nine with reflux esophagitis improved; two among the eight with a normal esophagus during the preoperative period, developed esophagitis. It was concluded that the Serra Dória procedure for the treatment of megaesophagus in patients who had already undergone a cardiomyotomy and whose symptoms recurred, presented a low morbidity and no mortality. It afforded a significant relief of symptoms with a decrease of the caliber of the esophagus in several patients. The patients also improved with regards to reflux esophagitis. In some cases reflux was still present after surgery. Others with normal esophagus in the pre operative period developed esophagitis
27

Efetividade de interferon peguilado e ribavirina no tratamento da hepatite C crônica em pacientes atendidos em um centro universitário no Estado de São Paulo / Effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C among patients treated at a reference center in São Paulo state

Grando, Aline Vitali 23 June 2016 (has links)
Introdução: Informações de vida real relativas ao tratamento da hepatite C crônica com interferon peguilado (Peg-IFN) e ribavirina (RBV) servem para mensurar sua efetividade nos anos em que o seu uso foi amplamente difundido, além de auxiliar em tomada de decisões futuras. Objetivos: Avaliar a taxa de resposta virológica sustentada (RVS) nos pacientes com hepatite C crônica tratados com Peg-IFN e RBV, fora de protocolos de pesquisa. Determinar os fatores associados à obtenção de RVS, frequência e causas de interrupção precoce do tratamento e de redução ou interrupção temporária dos medicamentos. Métodos: Estudo observacional retrospectivo de uma coorte de pacientes de dois ambulatórios de um centro de referência brasileiro localizado em São Paulo/SP. Resultados: Dos 440 indivíduos analisados, 182 apresentaram RVS (prevalência: 41,4% [IC95%: 36,7 - 46,1]). A RVS ocorreu em 33,5% (104/310) dos pacientes com genótipo 1 e em 53,8% (7/13) e 60,5% (69/114) daqueles com genótipos 2 e 3, respectivamente. Após análise multivariada, a RVS esteve positiva e independentemente associada à presença dos genótipos 2 ou 3 (p < 0,001), ausência de esteatose (p = 0,025) e de tratamento prévio (p = 0,038). Os eventos adversos mais frequentemente relacionados à redução de dose ou suspensão temporária de Peg-IFN ou RBV foram anemia (15,6%) e plaquetopenia (3,9%). Dos eventos adversos que levaram 79 (18%) pacientes a interromper o tratamento precocemente, distúrbios psiquiátricos (15,1%) e anemia (13,9%) foram os mais frequentes. Conclusões: A taxa de RVS foi semelhante àquela obtida em outros estudos de vida real. A RVS esteve independentemente associada à: presença dos genótipos 2 ou 3, ausência de esteatose e ausência de tratamento prévio. As principais causas de redução de dose dos medicamentos foram anemia e plaquetopenia e de interrupção precoce do tratamento, desordens psiquiátricas, e citopenias / Introduction: The association of pegylated interferon (Peg-IFN) and ribavirin (RBV) was considered a first line treatment for chronic hepatitis C during the past decade. Routine clinical practice information and real-life treatment outcomes can guide future therapeutic strategies for this group of patients. Objectives: The main objective of our study was to determine the sustained virological response (SVR) rate under current clinical practice. The secondary objectives were: 1- to investigate the factors that before or during treatment could predict SVR 2- to identify the causes of treatment interruption. Method: This cross-sectional study enrolled hepatitis C patients treated with Peg-IFN and RBV in a tertiary outpatient clinic setting. Data were collected retrospectively on patients treated for hepatitis C. Demographics, treatment outcomes and potential predictors of outcome were recorded. Results: Among the 440 analyzed patients 182 achieved SVR (prevalence: 41.4% [95% CI: 36.7 to 46.1]). On an intention-to-treat basis, SVR rates were 33.5% (104/310), 53.8% (7/13) and 60.5% (69/114) in genotypes 1, 2 and 3 respectively. After multivariate analysis, SVR was independently associated with presence of genotypes 2 or 3 (p < 0.001), no hepatic steatosis (p=0.025) and absence of prior treatment (p = 0.038). Anemia (15.6%) and thrombocytopenia (3.9%) were the most frequent causes of treatment dose reduction. Among the adverse events that led 79 patients into treatment discontinuation, the most frequent were psychiatric complications (15.1%) and anemia (13.9%). Conclusion: In our cohort, the treatment success rate (SVR) was similar to that observed in other in real-life setting studies. The SVR was independently associated with: presence of genotypes 2 or 3, no hepatic steatosis and absence of prior treatment. Psychiatric disorders and anemia were the main causes of premature treatment discontinuation
28

Sarcomas cutâneos primários: estudo retrospectivo de casos registrados na divisão de Dermatologia do Hospital das Clínicas da FMUSP no período de 1992 a 2002 / Primary cutaneous sarcomas: a retrospective study of cases studied in the Dvision of Dermatology of Hospital das Clínicas, São Paulo University Medical School from 1992 to 2002

Fleury Junior, Luiz Fernando Froes 28 March 2007 (has links)
Os sarcomas cutâneos primários são tumores raros e de grande heterogeniedade histológica. Com a evolução da oncologia cutânea e da cirurgia dermatológica, os dermatologistas têm sido cada vez mais requisitados para diagnóstico e orientação terapêutica de tumores menos freqüentes. Entretanto são escassos os estudos sobre o tema, sobretudo na literatura nacional. O presente trabalho apresenta como objetivos estudar casos diagnosticados como sarcoma cutâneo primário pelo Laboratório de Dermatopatologia da Divisão de Dermatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no período de 1992 a 2002. Os casos levantados foram revisados histologicamente, selecionando 65 casos que foram classificados em subtipos histológicos. Foi realizado revisão de prontuários médicos e estudadas as características demográficas, clínicas, evolutivas, histológicas e imuno-histoquímicas. O sarcoma de Káposi foi excluído deste estudo por possuir características epidemiológicas e etiopatogênicas específicas. Dos 65 casos, 34 foram de dermatofibrossarcoma protuberans (DFSP), 10 angiossarcomas, cinco sarcomas epitelióides, quatro fibroxantomas atípicos, três leiomiossarcomas, três mixofibrossarcomas, dois sarcomas pleomórficos, um fibrohistiocitoma maligno, um lipossarcoma, um rabdomiossarcoma, um fibrossarcoma. A análise dos resultados permitiu avaliar o perfil epidemiológico, clínico, anatomopatológico e imuno-histoquímico dos casos, bem como os tratamentos empregados e evolução dos pacientes. Os achados epidemiológicos deste estudo não diferiram significativamente da bibliografia consultada, demonstrando tratar-se de tumores raros representando cerca de um caso para cada 1000 biópsias neste serviço no mesmo período. Quanto a distribuição por idade e sexo os dados foram superponíveis à literatura com exceção feita ao angiossarcoma que mostrou-se mais freqüente no sexo feminino. A cirurgia micrográfica mostrou ser o melhor método para abordagem terapêutica do DFSP. Os casos de angiossarcoma e sarcoma epitelióide apresentaram pior prognóstico. / Soft tissue tumours represent a heterogeneous group of mesenchymal and neural lesions. The cutaneous presentation of these tumours is rare. With the evolution of dermatologic surgery and cutaneous oncology, dermatologists have emerged as the primary physicians for skin cancers management. The lack of epidemiological data about this topic in the brazilian population guided us to present this study. Our goal was to systematically review cases of primary cutaneous sarcomas diagnosed at the Dermatophatology laboratory of the Dermatology division of Hospital das Clínicas of São Paulo from January 1992 to December 2002. After a thorough chart review we could retrieve demographic and clinical data, histopathological and immunohistochemical characteristics, in addition to the type of treatment, response to treatment and follow up from each case studied. Kapos\'s sarcoma due to its peculiar characteristics was not included in this study. A total of 65 cases of primary cutaneous sarcoma were included. In respect to its pathological characterization 34 cases were diagnosed dermatofibrosarcoma protuberans (DFSP), 10 angiosarcoma, five epithelioid sarcoma, four atipical fibroxanthoma, tree leiomyosarcoma, tree myxofibrosarcoma, two pleomorfic sarcoma, one malignant fibrohistiocytoma, one liposarcoma, one rabdomyossarcoma, one fibrossarcoma. Our findings were in agreement with international published data available after a medline search. In summary, sarcomas with primary cutaneous presentation are rare tumors with an incidence of 0.1% from all the pathology slides received in our service during this period. Angiosarcoma and epithelioid sarcomas had the worse prognosis and micrographic surgery was the best treatment for the DFSP.
29

Efetividade de interferon peguilado e ribavirina no tratamento da hepatite C crônica em pacientes atendidos em um centro universitário no Estado de São Paulo / Effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C among patients treated at a reference center in São Paulo state

Aline Vitali Grando 23 June 2016 (has links)
Introdução: Informações de vida real relativas ao tratamento da hepatite C crônica com interferon peguilado (Peg-IFN) e ribavirina (RBV) servem para mensurar sua efetividade nos anos em que o seu uso foi amplamente difundido, além de auxiliar em tomada de decisões futuras. Objetivos: Avaliar a taxa de resposta virológica sustentada (RVS) nos pacientes com hepatite C crônica tratados com Peg-IFN e RBV, fora de protocolos de pesquisa. Determinar os fatores associados à obtenção de RVS, frequência e causas de interrupção precoce do tratamento e de redução ou interrupção temporária dos medicamentos. Métodos: Estudo observacional retrospectivo de uma coorte de pacientes de dois ambulatórios de um centro de referência brasileiro localizado em São Paulo/SP. Resultados: Dos 440 indivíduos analisados, 182 apresentaram RVS (prevalência: 41,4% [IC95%: 36,7 - 46,1]). A RVS ocorreu em 33,5% (104/310) dos pacientes com genótipo 1 e em 53,8% (7/13) e 60,5% (69/114) daqueles com genótipos 2 e 3, respectivamente. Após análise multivariada, a RVS esteve positiva e independentemente associada à presença dos genótipos 2 ou 3 (p < 0,001), ausência de esteatose (p = 0,025) e de tratamento prévio (p = 0,038). Os eventos adversos mais frequentemente relacionados à redução de dose ou suspensão temporária de Peg-IFN ou RBV foram anemia (15,6%) e plaquetopenia (3,9%). Dos eventos adversos que levaram 79 (18%) pacientes a interromper o tratamento precocemente, distúrbios psiquiátricos (15,1%) e anemia (13,9%) foram os mais frequentes. Conclusões: A taxa de RVS foi semelhante àquela obtida em outros estudos de vida real. A RVS esteve independentemente associada à: presença dos genótipos 2 ou 3, ausência de esteatose e ausência de tratamento prévio. As principais causas de redução de dose dos medicamentos foram anemia e plaquetopenia e de interrupção precoce do tratamento, desordens psiquiátricas, e citopenias / Introduction: The association of pegylated interferon (Peg-IFN) and ribavirin (RBV) was considered a first line treatment for chronic hepatitis C during the past decade. Routine clinical practice information and real-life treatment outcomes can guide future therapeutic strategies for this group of patients. Objectives: The main objective of our study was to determine the sustained virological response (SVR) rate under current clinical practice. The secondary objectives were: 1- to investigate the factors that before or during treatment could predict SVR 2- to identify the causes of treatment interruption. Method: This cross-sectional study enrolled hepatitis C patients treated with Peg-IFN and RBV in a tertiary outpatient clinic setting. Data were collected retrospectively on patients treated for hepatitis C. Demographics, treatment outcomes and potential predictors of outcome were recorded. Results: Among the 440 analyzed patients 182 achieved SVR (prevalence: 41.4% [95% CI: 36.7 to 46.1]). On an intention-to-treat basis, SVR rates were 33.5% (104/310), 53.8% (7/13) and 60.5% (69/114) in genotypes 1, 2 and 3 respectively. After multivariate analysis, SVR was independently associated with presence of genotypes 2 or 3 (p < 0.001), no hepatic steatosis (p=0.025) and absence of prior treatment (p = 0.038). Anemia (15.6%) and thrombocytopenia (3.9%) were the most frequent causes of treatment dose reduction. Among the adverse events that led 79 patients into treatment discontinuation, the most frequent were psychiatric complications (15.1%) and anemia (13.9%). Conclusion: In our cohort, the treatment success rate (SVR) was similar to that observed in other in real-life setting studies. The SVR was independently associated with: presence of genotypes 2 or 3, no hepatic steatosis and absence of prior treatment. Psychiatric disorders and anemia were the main causes of premature treatment discontinuation
30

A Prognostic Index for Predicting Lymph Node Metastasis in Minor Salivary Gland Cancer

Lloyd, Shane 01 September 2009 (has links)
We hypothesized that lymph node involvement in minor salivary gland cancers is associated with clinical and pathological factors commonly available to the clinician after a typical initial workup. Our aim was to identify these factors using a dataset that allowed us to compile the largest series of minor salivary gland cancers in the published literature. Using this dataset we also aimed to characterize the distribution of histological types by primary site, identify the predictors of the use of external beam radiation therapy and neck dissection, and examine the effect of lymph node involvement on survival. Using the SEER database, we identified 2667 minor salivary gland cancers with known lymph node status from 1988 to 2004. Univariate and multivariate analyses were conducted to identify factors associated with the use of neck dissection, the use of external beam radiation therapy, and the presence of cervical lymph node metastases. Kaplan Meier survival curves were constructed to examine the effect of lymph node involvement on survival. 426 (16.0%) patients had neck nodal involvement. Factors associated with neck nodal involvement on univariate analysis included increasing age, male gender, increasing tumor size, high tumor grade, T3-T4 stage, adenocarcinoma or mucoepidermoid carcinomas, and pharyngeal site of primary malignancy. On multivariate analysis, four statistically significant factors were identified, which included male gender, T3-T4 stage, pharyngeal site of primary malignancy, and high-grade adenocarcinoma or high-grade mucoepidermoid carcinomas. The proportions (and 95% confidence intervals) of patients with lymph node involvement for those with 0, 1, 2, 3 and 4 of these prognostic factors were 0.02 (0.01-0.03), 0.09 (0.07-0.11), 0.17 (0.14-0.21), 0.41 (0.33-0.49), and 0.70 (0.54-0.85) respectively. Grade was a significant predictor of metastasis for adenocarcinoma and mucoepidermoid carcinoma but not for adenoid cystic carcinoma. Overall survival was significantly worse at 5, 10, and 15 years for patients with lymph node involvement on presentation. A prognostic index using the four clinicopathological factors listed above can effectively differentiate patients into risk groups of nodal metastasis. The precision of this index is subject to the limitations of SEER data and it should be validated in further clinical studies.

Page generated in 0.4736 seconds