ABSTRACT
ABSTRACT Purpose To estimate statewide presentation delay, misdiagnosis rate, inter-hospital transfer times and testicular salvage for testicular torsion patients treated in our state's public health system. Patients and Methods Case series of consecutive testicular torsion patients treated in our state's public health system between 2012-2018. Predictors included presentation delay (time from symptoms to first medical assessment), facilitie's level-of-care (primary, secondary, tertiary), first diagnosis (torsion, epididymitis, other), Doppler-enhanced ultrasound request (Doppler-US) and inter-hospital transfer times, with surgical organ salvage as the main response. We used Bayesian regression to estimate the effect of first examining facilitie's level-of-care, first diagnosis, and Doppler-US on transfer time. Results 505 patients were included, most (298, 59%) with presentation delay >6 hours. Misdiagnosis at first examining facility raised transfer time from median 2.8 to 23.4 (epididymitis) and 37.9 hours (other) and lowered testicular salvage rates from 60.3% (torsion) to 10.7% (epididymitis) and 18.3% (other). Doppler-US had negligible effects on transfer time once controlling for misdiagnosis in the regression model. Although organ salvage in patients presenting before 6 hours at the tertiary facility was high (94.6%, and about 20% lower for those presenting at lower levels-of-care), the overall salvage rate was more modest (46%). Conclusion Our low overall testicular salvage rates originated from a large proportion of late presentations combined with long transfer times caused by frequent misdiagnoses. Our results indicate that efforts to improve salvage rates should aim at enhancing population-wide disease awareness and continuously updating physicians working at primary and secondary levels-of-care about scrotal emergencies.
Subject(s)
Humans , Male , Spermatic Cord Torsion/surgery , Spermatic Cord Torsion/diagnostic imaging , Brazil , Retrospective Studies , Bayes Theorem , Treatment Outcome , Diagnostic Errors , HospitalsABSTRACT
SUMMARY This recommendation consensus for hypofractionated whole-breast radiotherapy (RT) was organized by the Brazilian Society of Radiotherapy (SBRT) considering the optimal scenario for indication and safety in the technology applied. All controversies and contraindication matters (hypofractionated RT in patients who underwent chemotherapy [CT], hypofractionated RT in lymphatic drainage, hypofractionated RT after mastectomy with or without immediate reconstruction, boost during surgery, hypofractionated RT in patients under 50 years old, hypofractionated RT in large breasts, hypofractionated RT in histology of carcinoma in situ [DCIS]) was discussed during a meeting in person, and a consensus was reached when there was an agreement of at least 75% among panel members. The grade for recommendation was also suggested according to the level of scientific evidence available, qualified as weak, medium, or strong. Thus, this consensus will aid Brazilian radiotherapy experts regarding indications and particularities of this technique as a viable and safe alternative for the national reality.
RESUMO Este consenso de recomendações para a radioterapia (RT) hipofracionada de toda a mama foi organizado pela Sociedade Brasileira de Radioterapia (SBRT) considerando o cenário ideal para indicação e segurança na tecnologia aplicada. Questões de controvérsias e contraindicações (RT hipofracionada em pacientes submetidas à quimioterapia [QT], RT hipofracionada nas drenagens linfáticas, RT hipofracionada após mastectomia com ou sem reconstrução imediata, a realização de reforço de dose em leito cirúrgico [ou boost], RT hipofracionada em pacientes com idade menor que 50 anos, RT hipofracionada em mamas volumosas, RT hipofracionada em histologia de carcinoma in situ [CDIS]) foram discutidas em encontro presencial, sendo o consenso atingido quando existisse concordância de pelo menos 75% dos panelistas. O grau de recomendação foi também sugerido de acordo com o nível de evidência científico disponível, qualificado entre fraco, médio ou forte. Assim, este consenso deverá servir para auxiliar os especialistas da radioterapia brasileira em relação às indicações e particularidades dessa técnica, como uma alternativa segura e viável para a realidade nacional.
Subject(s)
Humans , Female , Breast Neoplasms/radiotherapy , Carcinoma/radiotherapy , Radiation Dose Hypofractionation/standards , Brazil , Breast/radiation effects , Breast Neoplasms/pathology , Carcinoma/pathology , Risk Factors , Evidence-Based MedicineABSTRACT
Ter de adaptar-se à rotina dos quartéis e das bases, aprender a marchar e a manusear armas ainda é um desafio para os dentistas ingressantes nas Forças Armadas, mas a garantia de um emprego vitalício, a aposentadoria integral e uma possível patente de coronel compensam o esforço
Subject(s)
Military Dentistry , Military Dentistry/organization & administrationABSTRACT
Os autores fazem uma análise do tratamento do carcinoma de esôfago em 149 casos, atendidos no Serviço de radioterapia do Hospital de Caridade no periodo de 1980 à 1985. Sao discutidos os aspectos clínicos, técnicas de tratamento e os resultados obtidos com a irradiaçao exclusiva e pré-operatória, ressaltando os benefícios da radioterapia.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Particle Accelerators , Esophageal Neoplasms/radiotherapyABSTRACT
Em marco de l980, o Serviço de Radioterapia do Hospital de Caridade, passou a contar com um acelerador linear de 10 Mev. que além de feixes de fótons, possibilitam a utilizaçäo de feixes de elétrons com energias variáveis de 6, 8 e 10 Mev. Desta data, até junho de l983, 112 pacientes com câncer de pele foram tratados com eletrons, num total de 148 lesöes, entre intactas (95) e operadas (53). A análise destes casos revelou um controle de 134 lesöes (90.5%) por um tempo de seguimento mínimo de 12 meses e máximo de 54 meses. Ocorreram 14 recidivas locais (9.5%). Os autores, através dos resultados observados, comprovaram que a eletroterapia é a modalidade ideal de tratamento dos carcinomas de pele localizados em áreas críticas, extensas e recidivantes