ABSTRACT
Um estudo de coorte histórico foi desenvolvido incluindo 116 pacientes com câncer de mamaatendidas no Hospital Femina, Grupo Hospitalar Conceição (GHC), Ministério da Saúde (MS),entre setembro de 1997 e dezembro de 2000. Foi aplicado o índice prognóstico de Nottingham(IPN) na população em estudo e avaliada a sua associação com a recidiva da doença. O IPNconseguiu identificar um grupo com bom prognóstico, em que de 26 pacientes somente 2 (7,7%)evoluíram para recidiva, e um grupo de 32 pacientes com pobre prognóstico, em que 24 delas(75%) evoluíram para recidiva em cinco anos. Nesta amostra composta de pacientes provenientesda rede pública, a média e o desvio-padrão do tamanho tumoral foi de 3,1 ± 1,8 cm e somente25% das mulheres apresentaram tumores menores do que 2 cm na primeira consulta no hospitalterciário. Isso sugere que o diagnóstico de câncer de mama ainda está sendo realizado tardiamente,em nosso meio.
A history cohort study that included 116 breast cancer patients treated at the Femina Hospital, GrupoHospitalar Conceição (GHC), Health Ministry (HM), between September 1997 to December 2000 wasconducted. The Nottingham Prognostic Index (NPI) and its association with the disease recidivationwas assessed in the study population. The NPI identified two groups; good prognosis group (n = 26) with7.7% recidivation and a poor prognosis group (n = 32) with 75% recidivation at 5 years. The tumorsize in our study population was 3.1 ± 1.8 cm and it was less than 2 cm in only 25% of the patients atthe first consultation at a tertiary hospital. These observations suggested that the breast cancer diagnosis isperformed late in our environment.
Subject(s)
Adult , Middle Aged , Aged, 80 and over , Neoplasm Recurrence, Local , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Cohort Studies , Hospitals, Public , PrognosisABSTRACT
The associations between malignancy, immunossupression and infectious morbidity and mortality have been established, and the use of more intensive chemotherapic regimens have produced a higher number of immunosuppressed oncologic patients. Thus, the benefits of the antineoplastic therapy can be limited by the mortality associated with the complications of life-threatening infection. This have raised the necessity of empiric therapy, which main goal is to prevent the death in the carly stage, until a more specific choice can be determined based on the results of the bacteriological examination and the patient's response. Pulmonary infiltrates, which are generally the first manifestation of respiratory infection in immunocompromised patients, can be classified as localized (early, refractory or late) or diffuse. this classification helps to establish more directed empiric approaches. The choices of the initial empiric antibiotic therapy include (a) aminoglycoside + extended-spectrum beta-lactam, (b) complication of 2 beta-lactams, or (c) extended-spectrum monotherapy. It is also possible to coadministrate speciffically oriented. The optimal duration of empiric therapy and empiric antifungal therapy are also discussed in this review. The prevention of pulmonary infections is justified by the reduction in the morbidity, mortality, and hospital costs. Selective decontamination with the use of agents that preserve the anaerobic flora have had variable results, being SMZ/TMP the agent more commonly used for this purpose. Hemotopoietic growth factors have shown to be effective in reducing the duration and the severity, but not the incidence of the chemotherapy-associated neutropenia, the number of infection episodes, or the mortally associated to infection.
Subject(s)
Neutropenia , Respiratory Tract DiseasesABSTRACT
Os autores apresentam os marcadores tumorais mais utilizados na pratica da clinica, associando-os ao diagnostico e seguimento de doencas malignas