ABSTRACT
Antecedentes: El carcinoma a células de Merkel (CCM) es un tumor cutáneo infrecuente, de alto grado de malignidad. Existe controversia acerca del rol de la cirugía (CX) y radioterapia (RT) en su tratamiento. Objetivos: Describir las características de nuestra población, modalidades terapéuticas y resultados. Diseño: Retrospectivo. Lugar de aplicación: Servicio hospitalario universitario y práctica privada. Población: Entre marzo de 1988 y marzo de 2000 se trataron 8 pacientes con CCM. Seis eran de sexo femenino, edad promedio 74,4 años, 4 casos localizados en mejilla, el tamaño varió entre 1 y 5 cm. Tres casos consultaron por un tumor primario (E I) y 5 presentaban compromiso ganglionar (E II). Método: En E I se efectuó CX amplia del primero. En 2 casos se agregó RT adyuvante. En E II: CX amplia más disección ganglionar y RT postoperatoria. Un caso E II se trató únicamente con RT. Resultados: Sólo recidivó localmente 1 de 7 pacientes tratados con CX, este caso fue el único que no recibió RT adyuvante. La recidiva en N fue del 50 por ciento. Las metástasis a distancia se presentaron en el 50 por ciento. Todos los pacientes que recidivaron fallecieron por la enfermedad. En E I sobreviven 2 de 3 pacientes. En E II 1 de 5 pacientes. La supervivencia global fue 37,5 por ciento. Conclusiones: La RT postoperatoria pareciera disminuir la recidiva local. Seis pacientes (75 por ciento) presentaron compromiso linfático, de éstos 4 desarrollaron metástasis alejadas y 5 fallecieron por la enfermedad. La enfermedad a distancia siempre fue precedida por el compromiso ganglionar. Esto pareciera avalar tratamiento electivo del N. La supervivencia se relacionó con la estadificación
Subject(s)
Humans , Male , Female , Middle Aged , Carcinoma, Merkel Cell , Head and Neck Neoplasms , Skin Neoplasms , Carcinoma, Merkel Cell , Head and Neck Neoplasms , Immunohistochemistry , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective Studies , Survival RateABSTRACT
BACKGROUND: The incidence of maternal anaemia continues to be high (over 70%) in India in spite of a major nationwide intervention programme. This study was carried out in June 1996 on a representative sample of pregnant women from K.V. Kuppam and Gudiyatham blocks of Vellore district, Tamil Nadu, India. METHODS: Haemoglobin (Hb) estimations were done in a sample of 895 pregnant women in both the blocks while serum ferritin (SF) levels were estimated on a subsample of 445 pregnant women. RESULTS: The prevalence of maternal anaemia (Hb < 11 g/dl) was 69.3% (35.8% moderately anaemic, 30.2% mildly anaemic and 3.3% severely anaemic). The mean Hb was 10.1 g/dl. Prevalence of iron deficiency was 36.3% [SF < 12 micrograms/L, mean SF 24.3 micrograms/L (range: 1.5-153 micrograms/L)]. Iron deficiency anaemia as defined by Hb < 11 g/dl and SF < 12 micrograms/L was 29.5%. CONCLUSION: The prevalence of maternal anaemia and iron deficiency anaemia continues to be high in spite of planned interventions implemented at the national level.
Subject(s)
Adolescent , Adult , Anemia, Iron-Deficiency/epidemiology , Female , Government Programs , Hemoglobins/metabolism , Humans , India/epidemiology , Iron/deficiency , Male , Pregnancy , Pregnancy Complications/epidemiology , Prevalence , Rural PopulationSubject(s)
Adolescent , Adult , Anemia/epidemiology , Educational Status , Female , Humans , India/epidemiology , Iron, Dietary , Nutritional Status , Prevalence , Regression Analysis , Rural Population , Socioeconomic FactorsABSTRACT
A cross-sectional nutritional survey of children belonging to Tamil Nadu State of India, aged 0-3 years was conducted on a representative sample of 2039 children. The collected data was analysed using the recommended indices of height-for-age and weight-for-height based on standard deviation (SD scores) and cross-classified using the SD scores. The nutritional status of these children was compared with the NCHS standard. Prevalence of stunting (27.6%), wasting (9.9%) and simultaneous wasting and stunting (10.7%) was high among the children studied.
Subject(s)
Body Height , Body Weight , Child, Preschool , Developing Countries , Female , Humans , India , Infant , Male , Nutrition Surveys , Protein-Energy Malnutrition/diagnosis , Reference ValuesABSTRACT
BACKGROUND: Information on the existing morbidity pattern, pattern of health care utilization and the per capita health expenditure is essential to provide need-based health care delivery to a rural population. To obtain this information we performed a study in the K.V. Kuppam Block, North Arcot Ambedkar District, Tamil Nadu. METHODS: We did a cross-sectional study, interviewing respondents from 300 households, from 3 panchayats using a multistage sampling technique. Information relating to 1440 persons was collected. The morbidity data was obtained initially for the week prior to the day of interview, followed by one week to one month and then for two months to one year. RESULTS: During 1990-91, 825 of the 1440 persons (57.3%) did not have any illness. Sex had no bearing on the number of illnesses. Of the 60 children less than 2 years of age, 42 (70%) had one or two illnesses. The period prevalence of infective and parasitic diseases was found to be 21.9% with an average of 3 episodes. Services rendered by private practitioners (registered, non-registered and indigenous) were utilized by 59% of the households and 79% of the households had used allopathic treatment at some time. The average per capita per annum health expenditure was Rs 89.9 (Rs 449 per household). This increased significantly with increase in the household size (p < 0.001) and per capita income (p < 0.01). CONCLUSION: The health-seeking behaviour of this population can be changed if efficient services are rendered through government primary health centres and subcentres. This would allow the existing voluntary agency to withdraw without much change in the per capita health expenditure.
Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Female , Health Expenditures , Humans , India , Infant , Infant, Newborn , Male , Middle AgedABSTRACT
In a prospective epidemiological study from 1981 to 1986 in four villages belonging to the KV Kuppam block of North Arcot Ambedkar district in Tamil Nadu, we detected 328 patients of chronic obstructive pulmonary disease (COPD) amongst the 9946 inhabitants who were aged 30 yr or more. Majority of the population was from the lower income group and they were agricultural workers residing in these villages which were generally free from atmospheric pollution. Of the 328 patients with COPD, 198 were males and 130 were females showing an overall age specific prevalence of 33.0/1,000 with a prevalence of 40.8/1,000 for males and 25.5/1,000 for females, respectively. In nearly half of the patients who had chest radiography, changes consistent with COPD were observed; only one patient had clinical, radiological and electrocardiographic evidence of cor-pulmonale. Peak expiratory flow rate (PEFR) along with height (cm) were measured in 258 patients and compared to the predicted normal values. Most of those tested showed evidence of airways obstruction; severe defect was observed in 106 patients. Among the males, 122 gave a history of smoking; majority of the heavy smokers amongst them had severe impairment of PEFR. Females from these villages denied any history of smoking. Cooking for long hours using firewood and cowdung cakes could have contributed to the development of COPD in these village women.
Subject(s)
Aged , Female , Humans , India/epidemiology , Lung Diseases, Obstructive/epidemiology , Male , Middle Aged , Peak Expiratory Flow Rate , Prevalence , Prospective Studies , Rural PopulationABSTRACT
In a prospective study conducted in four villages of North Arcot Ambedkar district of Tamil Nadu in south India over a 5 yr period from 1981-86, 279 patients were detected to have pulmonary tuberculosis (PTB). Thirty one of them were found to have associated hypereosinophilia (HE) with total blood eosinophil level of > or = 2000 per cumm; besides cough with expectoration they also complained of dyspnoea and wheeze. Twelve of the 18 patients with intestinal parasites had remission with deworming agents alone. The other 6 non responsive patients like the 13 who did not have parasitic infestation, needed treatment with diethylcarbamazine for eosinopenic remission and thus could be classified as patients of tropical pulmonary eosinophilia (TPE). The association of hypereosinopilic state as a whole as well as TPE with tuberculosis as compared to that prevalent in the general population was found to be highly significant (P < 0.001). The frequent association of TPE with tuberculosis as observed by us suggests the possibility of an early hypersensitivity reaction to mycobacterial antigens triggering a florid TPE state in susceptible patients from an area endemic for filariasis. A similar mechanism may also operate in cases of pulmonary eosinophilia induced by other helminths in areas where they are endemic.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , India/epidemiology , Male , Middle Aged , Prospective Studies , Pulmonary Eosinophilia/complications , Rural Population , Tuberculosis, Pulmonary/complicationsABSTRACT
Maternal factors comprising of social, obstetric and anthropometric are found to influence LBW. The present study had found association between obstetric risk factors like age of the mother, parity and gravida with LBW. Similar association was also observed between maternal height, and maternal weight with LBW. However, social factors were not found to be associated with LBW. This could probably be due to RUHSA's intervention which requires a further inquiry.
Subject(s)
Adult , Case-Control Studies , Female , Humans , India/epidemiology , Infant, Low Birth Weight , Infant, Newborn , Maternal Age , Middle Aged , Parity , Risk Factors , Socioeconomic FactorsSubject(s)
Adolescent , Child , Child, Preschool , Female , Humans , India/epidemiology , Infant , Male , Prevalence , Rural Population , Xerophthalmia/epidemiologyABSTRACT
Se efectuó un estudio retrospectivo de 42 pacientes adultos portadores de sarcomas de partes blandas de cabeza y cuello, que recibieron tratamiento con intención curativa entre 1969 y 1991. Con una evolución conocida del 93%se obtuvo una supervivencia total del 44.8%y una supervivencia libre de enfermedad del 36.1%a 5 años. El tamaño tumoral resultó el factor pronóstico más importante (T1 vs T2 p= 0.003 para recurrencias y 0.02 para supervivencia). La cirugía amplia constituye el factor terapéutico de mayor significación para obtener mejores resultados (cirugía amplia vs completa: p= 0.007 para supervivencia). La comparación entre grados histológicos (GI vs GII-III) indicó una tendencia a mejores supervivencias en GI, sin alcanzar valor estadístico. Pareciera aconsejable la realización sistemática de radioterapia postoperatoria, sugerida por la disminución de las recurrencias locales en la población así tratada, aunque los grupos irradiados y no irradiados no fueron estrictamente comparables
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Head and Neck Neoplasms/epidemiology , Sarcoma/surgery , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Lung Neoplasms/secondary , Lymphatic Metastasis , Neoplasm Metastasis , Neoplasm Recurrence, Local/epidemiology , Neoplasm Staging , Sarcoma/drug therapy , Sarcoma/radiotherapy , Survival RateABSTRACT
A total of 328 consecutive births born between July and September 1990 were analysed. The rate of LBW was 24.6%. The mean birth weight was 2.72 kg (+/- 0.44 kg). Association between LBW and parity, mother's age, mother's height, gestational weight, risk status at pregnancy and antenatal care was observed. These results indicate that there is a need to strengthen maternal services to address the problem of LBW in India.
Subject(s)
Birth Weight , Body Height , Female , Humans , India , Infant, Low Birth Weight , Infant, Newborn , Male , Maternal Age , Parity , Pregnancy , Prenatal Care , Risk Factors , Rural HealthABSTRACT
Se analizan los factores pronósticos en 296 varones portadores de carcinoma epidermoide de laringe tratados entre 1969 y 1987. Se detallan los resultados del análisis univariado y se destaca que en el análisis multivariado sólo el grado de compromiso ganglionar, la ingesta de alcohol y la movilidad cordal (o la traqueotomía previa) resultaron estadísticamente significativos con respecto a la sobrevida. Como conclusión práctica se señala la importancia del tratamiento del componente ganglionar y la conveniencia de seleccionar grupos de riesgo para su tratamiento electivo
Subject(s)
Humans , Male , Laryngeal Neoplasms/epidemiology , Multivariate Analysis , Carcinoma, Squamous Cell , Ethanol/adverse effects , Glottis , Lymphatic Metastasis , Neoplasms by Site , Prognosis , Retrospective Studies , Risk , Smoking , Survival Rate , Vocal Cords/pathologyABSTRACT
Se reportaron 60 casos de Colecistectomía laparoscópica, efectuados en la Clínica Dr. Abel González con éxito. Se destacan las ventajas de este nuevo método sobre la forma clásica de hacer la operación
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Cholecystectomy , Cholecystitis/surgery , LaparoscopyABSTRACT
Se presenta la experiencia obtenida con 5 casos de defectos de la pared laringotraqueal reparados con un colgajo mioperióstico de esternocleidomastoideo. Se destaca la posibilidad de resolver una pérdida de sustancia relativamente larga y no circunferencial con este procedimiento, así como los resultados satisfactorios obtenidos. Su relativa simplicidad, seguridad y la posibilidad de resolver el problema en un sólo tiempo operatorio lo señalan como un recurso a tener en cuenta para reparar estos defectos.
Subject(s)
Humans , Adult , Middle Aged , Male , Surgical Flaps/methods , Larynx/surgery , Trachea/surgery , Surgery, Plastic/methods , Surgical Procedures, OperativeSubject(s)
Female , Health Knowledge, Attitudes, Practice , Humans , Immunization , India , Infant , MothersABSTRACT
Se analizan 219 pacientes portadores de carcinoma de lengua, de los cuales 147 fueron tratados con intención curativa y son evaluables en cuanto a los resultados. Se puede indicar que el tratamiento preferible para las lesiones avanzadas es el quirúrgico; la radiosobrevida muy pobre de los enfermos con invasión capsuslar ganglionar hace deseable el feccionar el enfoque terapéutico y la alta incidencia de los estadios III y IV (75%) señala la importancia de la educacicón de la población y de la profesión médica tendientes a eliminar esta distorsión
Subject(s)
Middle Aged , Humans , Male , Female , Tongue Neoplasms/surgery , Carcinoma , Follow-Up Studies , Prognosis , Tongue Neoplasms/classification , Tongue Neoplasms/radiotherapyABSTRACT
Se analizan los resultados obtenidos en 250 punciones citológicas con aguja fina, efectuadas a pacientes portadores de tumores laterales de cuello. La certeza de la serie fue del 94,8%, con una sensibilid del 92,7, y una especificidad del 97,9%. Se registraron 11 falsos negativos y 2 falsos positivos. No se observaron complicaciones significativas. Estos resultados coinciden con los publicados en el resto de la literatura mundial. Concordamos con los demás autores que han abordado el tema, en señalar que la punción citológica con aguja fina disminuye el número de biopsias ganglionares innecesarias, orienta en la búsqueda del tumor primario oculto, acelera el diagnóstico en los linfomas y carece de complicaciones de importancia. Es un método simple, rápido, de escaso costo y con resultados confiables en más del 90% de los casos