ABSTRACT
Background: The guidelines for the treatment of severely burned patients, ineluded in the explicit guarantees in health care (GES), accept having a Garces' index over 70, among others, as an inclusion criterion. This criterion allows elderly patients with small total burn surface area (TBSA) to have access to GES. Aim: To analyze if a universal access to GES for this group of patients is justified. Material and Methods: Revision of medical records of adult patients admitted to a burn service. Causative agent, TBSA, associated illnesses and outcome were compared between 218 subjects aged 65 years or more and 720 subjects aged less than 65 years. Results: Older subjects had smaller TBSA, a lower prevalence of inhalation injury and more associated diseases. Their lethality was three times greater than that of younger subjects and their risk of dying. When adjusting for TBSA, presence of inhalation injury and associated diseases was 11 times greater. Conclusions: The inclusion of older people with lower TBSA in the explicit guarantees in health is fully justified, considering the lethality of burns in this age group.
Subject(s)
Adult , Aged , Female , Humans , Male , Burns/therapy , Eligibility Determination/standards , Health Services Accessibility/legislation & jurisprudence , Patient Selection , Age Factors , Body Surface Area , Burns, Inhalation/epidemiology , Burns/mortality , Burns/pathology , Comorbidity , Geriatric Assessment , Multivariate Analysis , Risk FactorsABSTRACT
Objetivo: Conocer el significado clínico y anátomopatológico de la presencia de microcalcificaciones BIRADS 4. Método: Análisis retrospectivo de 204 pacientes con microcalcificaciones BIRADS 4, sometidas a mastectomía parcial uni o bilateral en la Unidad de Patología Mamaria del Hospital Barros Luco-Trudeau, entre enero de 1993 y diciembre de 2004. Las pacientes ingresan a pabellón previa marcación con arpón metálico en zona de microcalcificaciones y control radiológico posterior de la pieza quirúrgica. Resultados: La localización de microcalcificaciones BIRADS 4 fue la mama izquierda en el 52 por ciento (106 casos), la mama derecha 42 por ciento (85 casos), y ambas 6 por ciento (13 casos). En la biopsia diferida destacan 17 casos con cáncer mamario (8,3 por ciento), condición fibroquística 197 casos (96,6 por ciento), hiperplasia sin atipía 49 casos (24 por ciento), hiperplasia con atipía 17 casos (8,3 por ciento), ectasia ductal 7 casos (3,4 por ciento), papilomatosis 6 casos (2,9 por ciento), mastitis crónica 4 casos (2 por ciento), fibroadenoma 4 casos (2 por ciento), galactoforitis 2 casos (1 por ciento) y necrosis grasa 2 casos (1 por ciento). Conclusión: Las microcalcificaciones BIRADS 4 constituyen un hallazgo mamográfico relevante por asociarse con cáncer de mama y lesiones de alto riesgo en un elevado porcentaje.