Do Improved Trunk Mobility and Isometric Strength Correlate with Improved Pain and Disability after Multimodal Rehabilitation for Low Back Pain? / A melhora da mobilidade e da força isométrica do tronco se correlacionam com a melhora da dor e da incapacidade após a reabilitação multimodal para dor lombar?

Abstract Objective To determine the correlation between posttreatment trunk range of motion (ROM) and isometric strength (TIS) and pain and disability in patients who underwent multimodal rehabilitation for low back pain (LBP). Methods In this prospective cohort study, 122 patients undergoing multimodal rehabilitation for LBP were analyzed. The pre- and posttreatment numerical pain rating scale (NPRS) and the Oswestry disability index (ODI) scores, as well as trunk ROM and TIS were compared. The Pearson correlation was used to determine correlation between posttreatment clinical outcomes and ROM and TIS. Results At the end of treatment, the mean NPRS (p< 0.0001) and ODI (p< 0.0001) scores, mean trunk extension (p< 0.0001), and flexion (p< 0.0001) ROMs improved significantly. Similarly, posttreatment, the mean extension (p< 0.0001) and flexion (p< 0.0001) TISs improved significantly. There was a weak correlation between the NPRS score and ROM extension (r = -0.24, p= 0.006) and flexion strength (r = -0.28, p= 0.001), as well as between the ODI score and TIS extension (r = -0.30, p= 0.0007) and flexion (r = -0.28, p= 0.001). Conclusion Despite significant improvement in pain, disability, trunk ROM, and TIS with multimodal treatment, there was a weak correlation between posttreatment pain and function and trunk ROM and TIS. Improvement in pain and function with physical rehabilitation treatment for LBP is a complex phenomenon and needs further investigation.

Resumo Objetivo Determinar a correlação entre a amplitude de movimento (ADM) do tronco pós-tratamento e a força isométrica do tronco (FIT) e a dor e a incapacidade em pacientes submetidos à reabilitação multimodal para dor lombar (DL). Métodos Neste estudo de coorte prospectiva, 122 pacientes submetidos à reabilitação multimodal para DL foram analisados. Foram comparados os escores de escala numérica de dor pré- e pós-tratamento (END) e do índice de incapacidade Oswestry (Oswestry disability index - ODI), a ADM do tronco e a FIT. A correlação de Pearson foi utilizada para determinar a correlação entre desfechos clínicos e a ADM e a FIT pós-tratamento. Resultados Ao final do tratamento, as médias de ADM (p< 0,0001) e ODI (p< 0,0001), as ADMs médias de extensão (p< 0,0001) e a flexão (p< 0,0001) do tronco melhoraram significativamente. Da mesma forma, a FIT pós-tratamento, as FITs médias de extensão (p< 0,0001) e flexão (p< 0,0001) melhoraram significativamente. Houve uma correlação fraca entre o escore do END e a ADM de extensão (r = -0,24, p= 0,006) e força de flexão (r = -0,28, p= 0,001) pós-tratamento, assim como entre o escore de ODI e FIT de extensão (r = -0,30, p= 0,0007) e flexão (r = -0,28, p= 0,001) pós-tratamento. Conclusão Apesar da melhora significativa da dor, capacidade, ADM do tronco e FIT com tratamento multimodal, houve uma fraca correlação entre dor pós-tratamento e função e ADM e FIT de tronco. A melhora da dor e da função com o tratamento de reabilitação física para DL é um fenômeno complexo e precisa de uma investigação mais aprofundada.

Factores asociados al control de síntomas nucleares en pacientes pediátricos con trastorno de déficit de atención e hiperactividad, en un centro especializado de Medellín entre 2018 y 2019 / Factors associated with the control of nuclear symptoms in pediatric patients with Attention Deficit Hyperactivity Disorder in a specialized center in Medellín between 2018 and 2019 / Fatores associados ao controle de sintomas nucleares em pacientes pediátricos com transtorno de déficit de atenção e hiperatividade, em um centro especializado em Medellín entre 2018 e 2019

Objetivo: el trastorno de déficit de atención e hiperactividad (TDAH) ha sido descrito como el trastorno del neurodesarrollo más común en la infancia. Esta condición se asocia a un significativo deterioro en calidad de vida, múltiples comorbilidades y, a largo plazo, a menores logros académicos y laborales. A pesar de que se ha evidenciado que en los pacientes de ascendencia latina se presenta un posible subdiagnóstico, que en Colombia se han estimado prevalencias mayores a las descritas en el planeta, y que los efectos de la pandemia por Covid-19 han podido exacerbar esta problemática, el volumen de estudios con estimaciones reproducibles sobre las características, tratamientos recibidos y control de síntomas de estos pacientes aún requiere ampliarse. Este estudio busca establecer los factores sociodemográficos, clínicos y del tratamiento asociados al control de los síntomas nucleares de este trastorno, que consisten en patrones persistentes y generalizados de inatención, impulsividad e hiperactividad. Metodología: estudio descriptivo con intención analítica en una cohorte retrospectiva de pacientes pediátricos con trastorno de déficit de atención e hiperactividad seguidos durante seis meses en un centro especializado de Medellín, Colombia, entre 2018 y 2019. Resultados: se identificó una incidencia de control de síntomas de 46,7% que se asoció de manera significativa con la adherencia al tratamiento y con historia familiar de TDAH. Conclusiones: puede afirmarse que, en pacientes pediátricos con TDAH, estos factores podrían aumentar la probabilidad de lograr el control de los síntomas nucleares.

Objective: Attention Deficit Hyperactivity Disorder (ADHD) has been described as the most common neurodevelopmental disorder in childhood. This condition is associated with significant deterioration in the quality of life, multiple comorbidities and, in the long term, lower academic and work achievements. Despite the fact that it has been shown that patients of Latin descent present a possible underdiagnosis, that in Colombia higher prevalence has been estimated than those described worldwide, and that the effects of the Covid-19 pandemic have been able to exacerbate this problem, the volume of studies with reproducible estimates on the characteristics, treatments received, and symptom control of these patients still needs to be expanded. This study seeks to establish the sociodemographic, clinical and treatment factors associated with the control of the core symptoms of this disorder, which consist of persistent and generalized patterns of inattention, impulsivity and hyperactivity. Methodology: Descriptive study with analytical intent in a retrospective cohort of pediatric patients with attention deficit hyperactivity disorder followed up for 6 months in a specialized center in Medellín, Colombia, between 2018 and 2019. Results: An incidence of symptom control of 46.7% was identified, which was significantly associated with adherence to treatment and with a family history of ADHD. Conclusions: It can be affirmed that, in pediatric patients with ADHD, these factors could increase the probability of achieving control of nuclear symptoms.

Objetivo: o transtorno dedéficit de atenção e hiperatividade (TDAH) tem sido descrito como o transtorno do neurodesenvolvimento mais comum na infância. Esta condição está associada a uma deterioração significativa na qualidade de vida, múltiplas comorbidades e, a longo prazo, menores rendimentos acadêmicos e profissionais. Apesar de ter sido demonstrado que os pacientes de ascendência latina apresentam um possível subdiagnóstico, e que na Colômbia foram estimadas prevalências mais altas do que as descritas no planeta e que os efeitos da pandemia de Covid-19 foram capazes de exacerbar esse problema, o volume de estudos com estimativas reprodutíveis sobre as características, tratamentos recebidos e controle de sintomas desses pacientes ainda precisam ser ampliados. Este estudo busca estabelecer os fatores sociodemográficos, clínicos e de tratamento associados ao controle dos sintomas centrais desse transtorno, que consistem em padrões persistentes e generalizados de desatenção, impulsividade e hiperatividade. Metodologia: estudo descritivo com intenção analítica em uma coorte retrospectiva de pacientes pediátricos com transtorno de déficit de atenção e hiperatividade acompanhados por seis meses em um centro especializado em Medellín, Colômbia, entre 2018 e 2019.Resultados: identificou-se uma incidência de controle dos sintomas de 46,7%, signifi-cativamente associada à adesão ao tratamento e ao histórico familiar de TDAH.Conclusões: Pode-se afirmar que, em pacientes pediátricos com TDAH , esses fatores podem aumentar a probabilidade de controle dos sintomas nucleares.

Research progress in nano-drug delivery systems for antitumor multi-drug combinational application / 药学学报

Due to the complexity of tumor pathology, the demand for the combined use of multiple drugs in clinical treatment has become increasingly clear-cut. Multi-drug combination can act on multiple pathways and multiple targets simultaneously to exert synergistic effects. However, the current delivery strategy for multi-drug combination still needs to be optimized. Nano-drug delivery systems can carry drugs to overcome physiological and pathological barrier to target tumor tissues and cells, achieve the goal of continuous, controllable, and targeted delivery, and enhance the efficacy of anti-tumor synergism and detoxification. To meet the new requirements for smarter and more accurate antitumor multi-drug combinational therapy, the nano-drug delivery system has been well-designed to realize more functions. For instance, delivery of multiple drugs in accurate proportions and doses can make the multi-drug synergistic effect more precise; stimulus-responsive drug release can improve selectivity and reduce side effects; controlling the time-course relationship of multiple drugs can realize sequential drug combination effect. It has shown broad prospects in the field of tumor multidrug therapy and has become one of the new directions of research and development. This article reviews the recent developments in the application of tumor drug combination therapy strategies and their delivery systems, and analyzes the new requirements and challenges of multidrug combination for the development of nano-drug delivery systems.

Cost-effectiveness of the use of acerto protocol in major digestive surgery / Custo-efetividade do uso do protocolo acerto em cirurgia digestiva de grande porte

ABSTRACT - BACKGROUND: Hospital costs in surgery constitute a burden for the health system in all over the world. Multimodal protocols such as the ACERTO project enhance postoperative recovery. OBJECTIVE: The aim of this study was to analyze the hospital costs in patients undergoing major digestive surgical procedures with or without the perioperative care strategies proposed by the ACERTO project. METHODS: Retrospective data from elective patients undergoing major digestive surgical procedures in a university hospital between January 2002 and December 2011 were collected. The investigation involved two phases: between January 2002 and December 2005, covering cases admitted before the implementation of the ACERTO protocol (pre-ACERTO period), and cases operated between January 2006 and December 2011, after implementation (ACERTO period). The primary outcome was the comparison of hospital costs between the two periods. As secondary end point, we compared length of stay (LOS), postoperative complications, surgical-site infection (SSI) rate, and mortality. RESULTS: We analyzed 381 patients (239 of the pre-ACERTO period and 142 of the ACERTO period) who underwent major procedures on the gastrointestinal tract. Patients operated after within the ACERTO protocol postoperative LOS had a median of 3 days shorter (p=0.001) when compared with pre-ACERTO period [median (IQR): 10 (12) days vs. 13 (12) days]. Mortality was similar between the two periods. Postoperative complications risk, however, was 29% greater (RR: 1.29; 95%CI 1.11-1.50) in the pre-ACERTO period (p=0.002). SSI risk was also greater in pre-ACERTO period (RR: 1.33; 95%CI 1.14-1.50). Costs (mean and SE) per patients were R$24,562.84 (1,349.33) before the implementation and R$19,912.81 (1,459.89) after the ACERTO protocol (p=0.02). CONCLUSION: The implementation of the ACERTO project in this University Hospital reduced the hospital costs in major digestive procedures. Moreover, the implementation of this modern perioperative care strategy also reduced postoperative complications, SSI risks, and LOS.

RESUMO - RACIONAL: Custos hospitalares em cirurgia constituem um peso para o sistema de saúde. Protocolos multimodais como o projeto ACERTO aceleram a recuperação pós-operatória. OBJETIVO: O objetivo deste estudo foi o de analisar custos hospitalares em pacientes submetidos a procedimentos cirúrgicos de grande porte no aparelho digestivo com ou sem as estratégias de cuidados perioperatórios proposta pelo projeto ACERTO. MÉTODOS: Foram coletados dados retrospectivos de pacientes eletivos submetidos a procedimentos cirúrgicos de grande porte no aparelho digestivo em um Hospital Universitário entre Janeiro de 2002 e Dezembro de 2011. O estudo envolveu duas fases: Entre Janeiro de 2002 a Dezembro 2005 envolvendo casos internados antes da implementação do protocolo ACERTO (período pré-ACERTO) e casos operados entre Janeiro de 2006 a Dezembro de 2011, após a implementação (período ACERTO). O desfecho primário foi a comparação de custos hospitalares entre os dois períodos. Como desfechos secundários, comparou-se o tempo de internação (LOS), complicações pós-operatórias, taxa de infecção de sitio cirúrgico (ISS) e a mortalidade. RESULTADOS: Foram analisados 381 pacientes (239 do período pré-ACERTO e 142 do período ACERTO) submetidos a procedimento cirúrgicos de grande porte no trato gastrointestinal. Pacientes operados dentro do protocolo ACERTO apresentaram mediana (IQR) mediana de tempo de internação três dias menor (p=0.001) quando comparados ao período pré-ACERTO (mediana (IQR): 10 (12) vs. 13 (12) dias). A mortalidade foi similar entre os dois períodos. Entretanto, o risco de complicações pós-operatórias foi 29% maior (RR: 1.29; IC95%: 1.11 - 1.50) no período pré-ACERTO (p=0.002). O risco de SSI também foi maior no período pré-ACERTO (RR: 1.33; 95%CI: 1.14-1.50). Custos (media e SE) per paciente foram de R$ 24562,84 (1349,33) antes da implementação e R$ 19912,81 (1459,89) após o protocolo ACERTO (p=0.02). CONCLUSÕES: A implementação do projeto ACERTO neste hospital universitário reduziu custos hospitalares em cirurgias digestivas de grande porte. Além disso, a prescrição de estratégias modernas de cuidados perioperatórios também reduziu riscos de complicações pós-operatórias e de SSI e o tempo de internação.

Efficiency of deep venous thrombosis prevention in proximal femur fractures / Eficiência da prevenção da trombose venosa profunda nas fraturas do fêmur proximal

ABSTRACT Objective: To determine the efficiency of the deep venous thrombosis (DVT) prophylaxis protocol in postoperative patients due to proximal femoral fractures and to assess any statistical difference between the types of fractures. Methods: A retrospective observational study based on the analysis of patients' medical records who underwent to a surgical intervention due to proximal femoral fractures in 2017 and 2021 at Hospital IFOR - Rede D'Or São Luiz. These patients were selected according to previously determined inclusion and exclusion criteria. A total of 99 patients were included divided by sex, age, laterality, length of stay, and death. According to the institutional protocol, was used chemoprophylaxis with low-molecular-weight heparin, associated use of pneumatic compression with compression stockings, and early gait. The DVT diagnosis was determined by clinical evaluation and imaging tests such as venous Doppler ultrasonography and laboratory tests. Results: The protocol was effective in our study. Only one (1.01%) patient developed DVT. Due to the lack of samples, we could not achieve our secondary objective. Conclusion: The institutional protocol is efficient for DVT prophylaxis and essential in these cases. Level of Evidence II, Prognostic Study.

RESUMO Objetivo: Determinar a eficiência do protocolo de profilaxia contra trombose venosa profunda (TVP) em pacientes de pós-operatório devido à fratura do fêmur proximal e avaliar a diferença estatística entre os tipos de fratura. Método: Estudo retrospectivo observacional a partir da análise de prontuários de pacientes submetidos à intervenção cirúrgica em razão de fratura do fêmur proximal no período de 2017 e 2021 no Hospital IFOR - Rede D'Or São Luiz. Foram selecionados 99 pacientes segundo critérios de inclusão e exclusão determinados previamente, que foram catalogados por: idade, sexo, lateralidade, dias de internação, entre outros. Conforme protocolo institucional, utilizou-se quimioprofilaxia com heparina de baixo peso molecular, associado ao uso concomitante de compressão pneumática e meias elásticas, e deambulação precoce. O diagnóstico de TVP foi determinado por meio de avaliação clínica e exames de imagem, como a ultrassonografia com Doppler venoso e exames laboratoriais. Resultados: A utilização do protocolo se mostrou eficaz neste estudo, havendo apenas um paciente (1,01%) que desenvolveu TVP. Não foi possível atingir o objetivo secundário, pois a amostragem foi insuficiente. Conclusão: O protocolo institucional para a profilaxia de TVP foi eficiente, uma vez que apenas um paciente evoluiu com tal complicação. Nível de Evidência II, Estudo Prognóstico.

Desregulación emocional en población con TDAH; una aproximación teórica / Emotional dysregulation in the population with ADHD. A Theoretical Approach

Resumen El trastorno por déficit de atención e hiperactividad (TDAH) constituye un trastorno del neurodesarrollo, cuyos síntomas nucleares constituyen la inatención, la hiperactividad y la impulsividad. Esta última puede ser verbal, motora y cognitiva, también emocional. Se expresa por la desregulación emocional y afecta la capacidad de autorregularse emocionalmente e inhibir las emociones. Por lo anterior, el objetivo de este documento es realizar una aproximación teórica-descriptiva desde diferentes autores sobre la desregulación emocional presente en la población con TDAH. Es importante la revisión de este concepto, porque la regulación emocional constituye una de las funciones ejecutivas que se afecta en las personas con TDAH al originar un impacto en el funcionamiento personal y social a lo largo de la vida. A partir de la revisión, se concluyó que hay un auge en el estudio y el análisis de este tema en la comunidad científica en las últimas décadas, que validan la importancia del conocimiento y del abordaje de la desregulación emocional en esta población, pues brinda elementos clínicos que facilitan el diagnóstico diferencial y la identificación de comorbilidades que este trastorno podría presentar. Finalmente, la desregulación emocional, junto con la inatención, la hiperactividad y la impulsividad constituyen parte de los síntomas que deben considerarse en el tratamiento multimodal del TDAH.

Abstract: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder, whose nuclear symptoms constitute inattention, hyperactivity and impulsivity, the latter may be verbal, motor and cognitive, but also emotional, expressed by emotional dysregulation, which affects a person's ability to emotionally self-regulate and inhibit emotions. Therefore, the objective of this document is to take a descriptive theoretical approach from different authors about the emotional dysregulation present in the population with ADHD. It is important to review this concept since emotional regulation is one of the Executive Functions that is affected in people with ADHD, causing an impact on the person and their social functioning throughout life. From this review, we concluded that there has been a boom in the study and analysis of this topic in the scientific community during the last decade. This validates the importance of knowledge about and approach to emotional dysregulation in this population, since it provides clinical elements that facilitate differential diagnoses and the identification of comorbidities that this disorder could present. Finally, emotional dysregulation, along with inattention, hyperactivity and impulsivity, is part of the symptoms that should be considered in the multimodal treatment of ADHD.

Factors related to the reduction of the risk of complications in colorectal surgery within perioperative care recommended by the acerto protocol / Fatores associados à redução do risco de complicações na cirurgia colorretal com cuidados peri-operatórios recomendados pelo projeto acerto

ABSTRACT Background: Perioperative care multimodal protocol significantly improve outcome in surgery. Aim: To investigate risk factors to various endpoints in patients submitted to elective colorectal operations under the ACERTO protocol. Methods: Cohort study analyzing through a logistic regression model able to assess independent risk factors for morbidity and mortality, patients submitted to elective open colon and/or rectum resection and primary anastomosis who were either exposed or non-exposed to demographic, clinical, and ACERTO interventions. Results: Two hundred thirty four patients were analyzed and submitted to 156 (66.7%) rectal and 78 (33.3%) colonic procedures. The length of hospital postoperative stay (LOS) ≥ 7 days was related to rectal surgery and high NNIS risk index; preoperative fasting ≤4 h (OR=0.250; CI95=0.114-0.551) and intravenous volume of crystalloid infused > 30ml/kg/day (OR=0.290; CI95=0.119-0.706). The risk of postoperative site infection (SSI) was approximately four times greater in malnourished; eight in rectal surgery and four in high NNIS index. The duration of preoperative fasting ≤4 h was a protective factor by reducing by 81.3% the risk of surgical site infection (SSI). An increased risk for anastomotic fistula was found in malnutrition, rectal surgery and high NNIS index. Conversely, preoperative fasting ≤4 h (OR=0.11; CI95=0.05-0.25; p<0.0001) decreased the risk of fistula. Factors associated with pneumonia-atelectasis were cancer and rectal surgery, while preoperative fasting ≤ 4 h (OR=0.10; CI95=0.04-0.24; p<0.0001) and intravenous crystalloid ≤ 30 ml/kg/day (OR=0.36; CI95=0.13-0.97, p=0.044) shown to decrease the risk. Mortality was lower with preoperative fasting ≤4 h and intravenous crystalloids infused ≤30 ml/kg/day. Conclusion: This study allows to conclude that rectal procedures, high NNIS index, preoperative fasting higher than 4 h and intravenous fluids greater than 30 ml/kg/day during the first 48 h after surgery are independent risk factors for: 1) prolonged LOS; 2) surgical site infection and anastomotic fistula associated with malnutrition; 3) postoperative pneumonia-atelectasis; and 4) postoperative mortality.

RESUMO Racional: Protocolos multimodais de cuidados perioperatórios melhoram significativamente resultados na cirurgia. Objetivo: Investigar fatores de risco para vários desfechos clínicos em pacientes submetidos às operações colorretais eletivas com o emprego do protocolo ACERTO. Métodos: Coorte analisando indivíduos expostos ou não expostos às variáveis de risco demográficas, clínicas e intervenções ACERTO, através de um modelo de regressão logística, determinando fatores independentes de risco para morbidade e mortalidade. Resultados: Duzentos e trinta e quatro pacientes foram submetidos a 156 (66,7%) operações retais e 78 (33,3%) colônicas. Mantiveram relação com tempo de internação ≥7 dias operação retal e escore NNIS alto; jejum pré-operatório > 4h e volume de cristalóides >30 ml/kg/dia. O risco de infecção de sítio cirúrgico foi aproximadamente quatro vezes maior em desnutridos; oito em operações retais; e quatro com NNIS alto. Tempo de jejum pré-operatório ≤4 h reduziu em 81,3% o risco de infecção de sitio cirúrgico. Risco aumentado para fístula ocorreu em desnutridos, operação retal e escore NNIS elevado. Tempo de jejum pré-operatório ≤4 h constituiu fator de proteção para ocorrência de fístulas. Os fatores associados à pneumonia/atelectasia foram câncer e operação retal, enquanto que tempo de jejum pré-operatório ≤4 h e volume de cristalóides intravenoso ≤30 ml/kg/dia foram fatores de proteção. Mortalidade foi menor com jejum ≤4 h e fluidos endovenosos ≤30 ml/kg/dia. Conclusão: Este estudo permite concluir que operações retais, presença de fator de risco NNIS, tempo de jejum pré-operatório superior a 4 h e fluidoterapia com cristaloides endovenosos superior a 30 ml/kg/dia nas primeiras 48 h de pós-operatório constituem-se em fatores de risco independentes e aplicáveis para: 1) tempo de internação pós-operatória prolongada; 2) para infecção do sítio cirúrgico e fístula anastomótica associadas à desnutrição; 3) para pneumonia/atelectasia no pós-operatório; e 4) para mortalidade pós-operatória.

Rapid Functional Enhancement of Ankylosing Spondylitis with Severe Hip Joint Arthritis and Muscle Strain

Arthritis of hip joints deteriorates the quality of life in ankylosing spondylitis (AS) patients. Secondary to the articular inflammatory process, the shortened hip-girdle muscles contribute to the decreased joint mobility which may lead to the functional impairment. As the limitation of range of motion (ROM) usually progress slowly, clinicians regard it as a chronic condition and prescribe long-term therapy. However, by short-term intensive multimodal treatment, a 20-year-old man diagnosed as AS with severely limited hip joint ROM who relied on crutches doubled the joint angle and could walk independently only within 2 weeks. The combination included intra-articular steroid injection, electrical twitch obtaining intramuscular stimulation, extracorporeal shock wave therapy, heat, manual therapy, and stretching exercises. The management focused on the relaxation of hip-girdle muscles as well as the direct control of intra-articular inflammation. Hereby, we emphasize the effectiveness of intensive multimodal treatment in improving the function even within a short period.

Drug therapy for advanced hepatocellular carcinoma: approach, controversy and progress / 中华肝胆外科杂志

For unresectable advanced hepatocellular carcinoma (HCC),besides sorafenib,alternative drugs and treatment modalities are required.Clinical studies of hepatic arterial infusion chemotherapy (HAIC),transcatheter arterial chemoembolization (TACE),and system chemotherapy have shown favorable efficacy and tolerance in advanced HCC patients.In addition,the potential efficacy of sorafenib combined with focal treatment is also an interesting issue.As more therapies become available,decision-making for treating advanced HCC becomes increasingly complex.In our opinion,diverse treatment modalities should be utilized for the best interest of patients.Based on predictive biomarkers,we should develop a precise patient stratification system to select suitable candidates for each treatment modality in future studies,as is useful for improving prognosis of patients with advanced HCC.

The current status and perspectives of esophagectomy / 中国肿瘤临床

Surgery is the main treatment of esophageal cancer. Esophagectomy by right transthoracic approach is recently recom-mended in China. Minimally invasive esophagectomy is feasible and safe with low perioperative morbidity and offers results that are as good as open thoractomy. Multimodal treatment, especially neoadjuvant chemoradiotherapy or chemotherapy, may improve surviv-al and has become one of the standard treatments for locally advanced esophageal cancer. Fast-track esophagectomy may reduce length of hospital stay, perioperative morbidity, and hospital charges. The surgery of esophageal cancer tends to be minimally invasive, individual, comprehensive, and standardized.

Actualización del tratamiento multimodal para la metástasis cerebral única. Revisión sistemática cualitativa / Update of multimodal treatment for single brain metastasis. Systematic qualitative review

El tratamiento de la Enfermedad Metastásica Cerebral única es paliativo y multimodal desconociéndose con certeza la modalidad o combinación terapéutica óptima. Se planteó como objetivo determinar las diferencias entre la Radioterapia Holocraneal, Radiocirugía, y Resección Quirúrgica en cuanto a la Sobrevida Global, Sobrevida Con Independencia Funcional, Control Local, Muerte Neurológica y Neurocognición en los pacientes con enfermedad metastásica cerebral única con tumor primario controlado. Se realizó un estudio retrospectivo del tipo revisión sistemática cualitativa. Se incluyeron Ensayos Clínicos Aleatorizados que compararon la Cirugía (con o sin Radioterapia Holocraneal), con la Radiocirugía (con o sin Radioterapia Holocraneal) en la Enfermedad Metastásica Cerebral Única independientemente de la localización del tumor primario. La búsqueda encontró inicialmente 971 artículos, de ellos 19 Ensayos Clínicos Aleatorizados. Al aplicar la herramienta de riesgo de sesgos de Cochrane se derivó una muestra de 14 Ensayos Clínicos que presentaron bajo riesgo de sesgos. La combinación de RQ y RTH ofreció mayor SG que la RTH sola. La combinación de RTH y RC ofreció un mejor CL que la RQ y RTH. La combinación de RTH Y RC ofreció un mejor CL y SG que la RTH sola. No se encontraron diferencias significativas entre la RTH y RC versus RC sola. Los resultados en cuanto a la neurocognición y SIF fueron inconsistentes. El tratamiento óptimo de los pacientes con EMC aún no está bien definido constituyendo aún un tema controvertido.

The treatment of Isolated Cerebral Metastatic Disease is both multimodal and palliative. At present, the optimal treatment protocol is unknown. The objective of the present study was to determine outcome differences between Whole Brain Radiotherapy (WBRT), Radiosurgery (RS), and Surgical Resection (SR) or a combination of them, regarding Global Survival, Functional Independent Survival, Local Control, Neurological Death & Cognitive Status in patients with a unique cerebral metastasis and a controlled primary tumor. A retrospective study with a systematic qualitative literature review was performed. Randomized clinical trials comparing surgery (with or without whole brain radiotherapy), disregarding the localization of the primary tumor, were searched, resulting in 971 studies, only 19 of them being randomized. After applying Cochrane´s Risk of Bias Tool, only 14 studies showed a low risk of bias. The combination of SR & WBRT showed a longer survival, while WBRT & RS showed a better local control when compared with SR & WBRT. No statistical differences where found between WBRT & RS versus RS alone. Results regarding Cognitive Status & Functional Independent Survival were inconsistent. The optimal treatment in Isolated Metastatic Cerebral Disease still remains controversial.

The Effectiveness of Additional Treatment Modalities after the Failure of Recanalization by Thrombectomy Alone in Acute Vertebrobasilar Arterial Occlusion

OBJECTIVE: Acute vertebrobasilar artery occlusion (AVBAO) is a devastating disease with a high mortality rate. One of the most important factors affecting favorable clinical outcome is early recanalization. Mechanical thrombectomy is an emerging treatment strategy for achieving a high recanalization rates. However, thrombectomy alone can be insufficient to complete recanalization, especially for acute stroke involving large artery atheromatous disease. The purpose of this study is to investigate the safety and efficacy of mechanical thrombectomy in AVBAO. METHODS: Fourteen consecutive patients with AVBAO were treated with mechanical thrombectomy. Additional multimodal treatments were intra-arterial (IA) thrombolysis, balloon angioplasty, or permanent stent placement. Recanalization by thrombectomy alone and multimodal treatments were assessed by the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcome was determined using the National Institutes of Health Stroke Scale (NIHSS) at 7 days and the modified Rankin Scale (mRS) at 3 months. RESULTS: Thrombectomy alone and multimodal treatments were performed in 10 patients (71.4%) and 4 patients (28.6%), respectively. Successful recanalization (TICI 2b-3) was achieved in 11 (78.6%). Among these 11 patients, 3 (27.3%) underwent multimodal treatment due to underlying atherosclerotic stenosis. Ten (71.4%) of the 14 showed NIHSS score improvement of >10. Overall mortality was 3 (21.4%) of 14. CONCLUSION: We suggest that mechanical thrombectomy is safe and effective for improving recanalization rates in AVBAO, with low complication rates. Also, in carefully selected patients after the failure of recanalization by thrombectomy alone, additional multimodal treatment such as IA thrombolysis, balloons, or stents can be needed to achieve successful recanalization.

Zygomycosis as a Rare Cause of Surgical Site Infection: A Case Report and Review Literature

Zygomycosis is a rare invasive fungal infection seen most often in patients with haematological malignancies, particularly in the neutropenic phase[1]. Fungal infection causing surgical site infection is uncommon, of which yeast attributes predominant cause, followed by aspergillosis. But zygomycosis manifesting as the surgical site infection is still very rare entity. The treatment of zygomycosis is multimodal, and consists of surgical debridement, use of antifungal drugs and reversal of underlying risk factors, if possible. We report a case of zygomycosis presenting as post-caesarean surgical site infection.

A Case of Endovascular Treatment for Followed by Side to Side Bypass for Vertebral Artery Dissecting Aneurysms Involved Posterior Inferior Cerebellar Artery

Treatment of complex aneurysms usually entails not only direct clipping but also alternative treatment modality. We recently experienced a case of vertebral artery dissecting aneurysm and obtained good treatment outcomes. Our case suggests that the endovascular segmental occlusion with posterior inferior cerebellar artery (PICA) to PICA side anastomosis might be a good treatment option in patients with complex vertebral artery dissecting aneurysms. A 45-year-old woman has a left vertebral dissecting aneurysm with dizziness. Based on the aneurysmal morphology and the involvement of PICA, the patient underwent side to side anastomosis of the PICA. This was followed by the endovascular segmental coil occlusion. The aneurysmal sac was completely obliterated. At a 2-year follow-up, the patient achieved a good patency of both PICA. In conclusion our case suggests that the endovascular segmental occlusion of the parent artery followed by PICA to PICA bypass surgery through a midline suboccipital approach is a reasonable multimodal treatment option in patients with complex vertebral artery dissecting aneurysms.

Conocimientos, creencias y actitudes en padres mexicanos acerca del trastorno por déficit de atención con hiperactividad (TDAH) / Knowledge and beliefs in Mexican parents about attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) generates controversy among the general population on its diagnosis and treatment. This could be explained by the sparse level of education about mental health, which affects the parent's knowledge and beliefs about this disorder. ADHD is highly prevalent and 3-5% of school-age children can be diagnosed. In Mexico it represents 1.5 million cases. It represents more than 30% of all cases in clinical pediatric settings. The reports in health services have shown that the time gap between symptoms identification and treatment is around 8 to 15 years. Moreover, only 25% of the affected children's parents recognize conduct or emotional problems on them and 13% receive mental health care. Attention seeking has been associated with higher severity of the disorder and parent's superior educational level. Despite the advances in the research on neurobiology and psychopharmacology, understanding of the social context that surrounds the disorder is incomplete. Comparatively little is known regarding how parents conceive the symptoms and causes of ADHD and how these parental views may relate to children's treatment. Understanding these factors is important due to the central role of parents in selecting and accessing treatments and service providers for children with ADHD. For parents and children, getting information about ADHD is a lottery that depends on which professional they see and what they read or gather from television and the Internet. Mental health professionals most give complete information to parents and children, so risks and benefits of the different treatments may be considered along with the family's needs, values and cultural background. A better understanding about the parent's knowledge, beliefs and attitudes regarding ADHD would help to improve the communication mechanisms between mental health professionals and parents during the treatment. Objective To describe the knowledge, beliefs and attitudes regarding ADHD in Mexican parents. Methods The study was approved by the local investigation review board. Informed consent was obtained and parents of children and adolescents diagnosed with ADHD were recruited at four mental health facilities (three public and one private) in two cities. Each parent completed the questionnaire of knowledge and beliefs about ADHD (CASE ADHD, parent's version). The questionnaire was created for this study as an instrument with three versions: a) Parents, b) Teachers, c) Health professionals. Results of parent's version were included in this report. This questionnaire incorporates information of other instruments such as Barkley's Evaluation Questionnaire and the one used in the National Colombian Survey for the Consensus of treatment of ADHD 2008. CASE ADHD includes three parts: 1. An identification record with the mother's or father's general data, 2. The ADHD Rating Scale-IV, and 3. A 36 multiple choice questionnaire related to six main areas: a) The caretaker report of symptoms and clinical characteristics related with ADHD, b) The knowledge about ADHD, c) The pathways to care report, d) The Beliefs about ADHD treatment, e) The professional mental health's performance, and f) The parent's perceptions about ADHD. The questionnaire must be completed with the assistance of a mental health professional. The average application time is 30 minutes. For statistical analysis central tendency measures were used; as means, standard deviations and percentages. Results The total sample was integrated by 288 parents of children or adolescents. The 80.1% of the questionnaires were fulfilled by the mother. The mean age of those who answered was 40.06 years, 25.4% reported to complete professional studies. The mean age of patients was 11.15 years (SD = 3.54), 58% were children and 74% were male, their ADHDRS-IV average score was 27.5 (SD = 14.03). Knowledge about ADHD. The 85.4% (N = 246) of the surveyed sample considered ADHD as a disease and 8.3% as a rearing difficulty. The 69.2% (N = 198) of parents said they knew what is ADHD, but only 62.1% reported to receive information by the physician or psychologist about this condition. Attitudes about ADHD. When questioned about what would they do if they suspected that their child had ADHD, 35.1 % (N = 101) would consult a psychiatrist, 21.2% a psychologist, and 12.2% a neurologist or pediatric neurologist. The 28% of parents were deemed unable to manage their child's behavior problem. When we asked about who is able to diagnose ADHD, 49.5% answered that the psychologist, 48.5% the psychiatrist and 19.8% that the pediatrician. The psychiatrist was considered able to treat this condition by 45.8% of the sample followed by psychologist (19.8%), and neurologist (10.4%). Beliefs about diagnosis and treatment. Nearly 63% of the sample (N = 183) considered that the best treatment for ADHD was the combined treatment; 16.3% preferred the psychological approach and psychopharmacology was chosen by only 6.6%. Almost half (48.5%, N= 129) of the sample considered that drug treatment only supports the psychosocial treatment and does not have a therapeutic effect by itself, 46.2% (N = 133) of the sample believed that <

Introducción A pesar de la evidencia científica acerca de las características neurobiológicas del Trastorno por Déficit de Atención e Hiperactividad (TDAH) que apoya el uso de medicamentos para su tratamiento, este padecimiento sigue generando controversia con respecto a su existencia, su persistencia a lo largo de la vida y su tratamiento óptimo. La prevalencia del TDAH a nivel mundial es alta. Los estudios epidemiológicos muestran que 3 a 5% de los niños en edad escolar pueden recibir este diagnóstico. En México se estima que hay aproximadamente 33 millones de niños y adolescentes, de los cuales 1.5 millones podrían ser diagnosticados con TDAH. En el contexto clínico, al menos 30% de los pacientes que acuden a valoración de primera vez en los servicios de psiquiatría infantil presentan problemas de inatención, hiperactividad o impulsividad. Algunos estudios epidemiológicos han mostrado que sólo el 25% de los padres de sujetos con síntomas de trastornos de conducta o del afecto consideraban que sus hijos necesitaban atención médica, y de ellos, el 13% acudió a los servicios de salud mental. La búsqueda de atención especializada se ha asociado con una mayor intensidad del trastorno y un mayor nivel educativo de los padres. Diversas publicaciones relacionadas con el tratamiento del TDAH a lo largo de la vida resaltan la importancia de la intervención multimodal, es decir, un tratamiento multidisciplinario que va más acorde al modelo biopsicosocial el cual, a su vez, se encuentra relacionado con los factores etiológicos y de pronóstico a mediano y largo plazo en el TDAH. En diversos estudios se ha subrayado la importancia de brindar educación adecuada sobre el trastorno y su tratamiento. También sugieren que un mejor entendimiento acerca de las creencias y conocimientos de los padres de niños y adolescentes con TDAH ayudará a mejorar los mecanismos de comunicación, atención y colaboración entre los distintos elementos participantes en el tratamiento del TDAH y reducirá el tiempo entre la identificación del problema y el inicio del tratamiento. Objetivo Describir los conocimientos, las creencias y actitudes de los padres de niños y adolescentes con TDAH acerca de la naturaleza de la enfermedad, la conducta en la búsqueda de atención médica y su tratamiento. Material y métodos La muestra fue conformada por padres de niños y adolescentes que habían recibido el diagnóstico de TDAH por un clínico calificado. Participaron cuatro centros de atención psiquiátrica, tres en la Ciudad de México y otro en la ciudad de San Luis Potosí. El instrumento principal (CASO ADH padres) es un cuestionario autoaplicable y fue escrito específicamente para este estudio. CASO ADHD es un instrumento con tres versiones: a) Padres, b) Maestros y c) Profesionales de la salud. En este estudio se exponen los resultados de la primera versión. Resultados La muestra total se conformó de 288 padres. El 69.2% dijo saber qué es el TDAH, 85.4% consideró al TDAH como una enfermedad y el 8.3% como una dificultad de la crianza; el resto lo consideró un mito, una moda, un invento de la industria farmacéutica o no existente. Alrededor del 63% de la muestra consideró que el mejor tratamiento para el TDAH sería el tratamiento combinado, el 16.3% prefirió el enfoque psicológico y sólo 6.6% eligió la psicofarmacología. Casi la mitad de la muestra, 48.5%, consideró que el tratamiento farmacológico solamente apoya al tratamiento psicosocial. La mayoría de los padres (60%) identificaron los síntomas de sus hijos en su propia conducta durante los años escolares. Conclusiones Es importante mejorar la cantidad y la calidad de educación acerca del TDAH y su tratamiento entre los padres de los pacientes, para que sus decisiones terapéuticas sean más informadas y tengan mejor efecto sobre el pronóstico del paciente.

Estratégia para a implementação de um serviço de tratamento da dor no hospital das clínicas da universidade federal de Goiás / Strategy to implement a pain management service in the clinicas hospital, federal university of Goiás.

JUSTIFICATIVA E OBJETIVOS: Apesar do sintoma dor ser considerado o 5º sinal vital e seu controle influenciar positivamente na boa evolução dos pacientes, o Hospital das Clínicas da Universidade Federal de Goiás não dispõe de um serviço de tratamento das síndromes álgicas. O objetivo deste estudo foi por meio de um projeto piloto estruturar o Serviço de Dor neste hospital, por meio de palestras educativas, bem como orientar os médicos residentes no diagnóstico e tratamento das síndromes álgicas.MÉTODO: O projeto se desenvolveu em três etapas: educação, avaliação dos pacientes selecionados e análise dos dados. Foram realizadas cinco aulas para os médicos residentes e antes do início da aula eles responderam um questionário confidencial sobre conhecimentos básicos, avaliação e tratamento da dor. Na segunda etapa, uma equipe de dois médicos residentes de Anestesiologia e dois anestesiologistas com formação complementar em dor foi estruturada para atender e orientar o tratamento do paciente com dor. Na terceira etapa foram analisadas as fichas e os resultados foram estratificados e analisados, sendo os resultados apresentados em percentuais. RESULTADOS: Apenas 37% dos residentes referiram possuir algum estágio ou formação em terapêutica da dor, 68,9% referiram que usavam rotineiramente algum método de avaliação da dor e apenas 3,4% deles não conheciam a escala analógica visual, sendo que a dor como 5º sinal pela ainda não é rotina e, respectivamente, 70% e 81% dos médicos prescrevem rotineiramente opioides e anti-inflamatórios não esteroides (AINES) de horário. Todos concordaram que o tratamento da dor é fundamental para a boa evolução dos pacientes.CONCLUSÃO: O projeto mostrou a necessidade de educação sobre a fisiopatologia e terapêutica da dor e da estruturação do Serviço de Dor no Hospital das Clínicas da Universidade Federal de Goiás

BACKGROUND AND OBJECTIVES: Although pain being considered the fifth vital sign and controlling it influences positive evolution of patients, Clinicas Hospital, Federal University of Goiás does not have a service to manage painful syndromes. This study aimed at structuring a Pain Service in this hospital through a pilot project, educational presentations as well as at orienting resident physicians on how to diagnose and manage painful syndromes.METHOD: The project was developed in three stages: education, evaluation of selected patients and data analysis. Five classes were ministered to resident physicians and before beginning of the class they have answered a confidential questionnaire about basic pain knowledge, evaluation and management. In the second stage, a team of two Anesthesiology resident physicians and two anesthesiologists with additional qualification in pain was structured to assist and orient the treatment of painful patients. In the third stage records were analyzed, results were stratified and analyzed and results were presented in percentages. RESULTS: Only 37% of residents have referred some training or qualification in pain therapy, 68.9% have referred routine use of some pain evaluation method and only 3.4% of them were not familiar with the visual analog scale. Pain as the fifth vital sign is still not routine and, respectively, 70% and 81% of physicians routinely prescribe opioids and time non steroid anti-inflammatory drugs (NSAIDS). All agreed that pain management is paramount for the positive evolution of patients.CONCLUSION: The project has unveiled the need for education on pain pathophysiology and therapy and for the structuring of the Pain Service in the Clinicas Hospital, Federal University of Goiás

Psicoterapia psicodinâmica e o tratamento do jogo patológico / Psychodynamic psychotherapy and the treatment of pathological gambling

OBJETIVO: A busca por tratamentos com base empírica para o jogo patológico está em sua infância, havendo relativamente poucos ensaios clínicos e uma ausência de estudos naturalísticos. A adesão dos jogadores ao tratamento tem sido um problema, sendo que o tratamento cognitivo-comportamental e os estudos farmacoterápicos relatam índices particularmente altos de abandono. As abordagens psicodinâmicas, com sua ênfase na relação terapêutica e no significado dos comportamentos autodestrutivos e aparentemente irracionais, e nos obstáculos à capacidade de se perdoar, poderiam melhorar o desfecho. MÉTODO: Após uma descrição da psicoterapia psicodinâmica, foi feita uma revisão da literatura que investigou a eficácia de tratamentos psicoterápicos de curto e longo prazo para uma série de transtornos. Com relação ao jogo patológico, foi feito um resumo da literatura psicanalítica inicial (1914-1970) e a seguir foi revisada a literatura mais recente sobre a utilização da psicoterapia psicodinâmica no jogo patológico. RESULTADOS: A pesquisa da literatura recente sobre psicoterapia psicodinâmica não revelou nenhum estudo controlado aleatorizado sobre a eficácia ou efetividade desse tratamento. No entanto, há oito estudos com desfechos positivos descritos como ecléticos multimodais; a metade destes parece utilizar abordagens psicodinâmicas. São descritos dois programas entre os que obtiveram maior êxito. CONCLUSÕES: Uma observação sobre os desfechos mais gerais da psicoterapia psicodinâmica na literatura demonstra eficácia suficiente para uma variedade de transtornos que justificam um ensaio clínico sobre o jogo patológico. A psicoterapia psicodinâmica de curto prazo, com seu foco em questões nucleares, pode ser particularmente aplicável à necessidade dos jogadores patológicos de evitar ou escapar de efeitos e problemas intoleráveis. Terapias de mais longo prazo podem ser necessárias para modificar um padrão evitativo de comportamento e defesas psicodinâmicas.

OBJECTIVE: The search for empirically based treatments for pathological gambling is in its infancy, with relatively few clinical trials and an absence of naturalistic studies. Treatment retention of gamblers has been a problem; cognitive-behavioral treatment and pharmacotherapy studies report especially high dropout rates. Psychodynamic approaches, with their emphasis on the therapeutic relationship, and the meaning of the patient's self-destructive and seemingly irrational behaviors, and on obstacles to self-forgiveness, might improve outcome. METHOD: After a description of psychodynamic psychotherapy, the literature on both short-term and longer therapies is reviewed regarding their efficacy for a variety of disorders. With regard to pathological gambling, the author summarizes the early (1914-1970) psychoanalytic literature then reviews the more recent psychodynamic psychotherapy literature on pathological gambling. RESULTS: A review of the recent psychodynamic psychotherapy literature on pathological gambling failed to disclose a single randomized controlled study of treatment efficacy or effectiveness. However, there are eight positive outcome studies described as multi-modal eclectic; half of those seem to utilize psychodynamic approaches. Two of the more successful programs are described. CONCLUSIONS: A review of the outcomes literature for psychodynamic psychotherapy demonstrates efficacy for a variety of disorders sufficient to justify a clinical trial for pathological gambling. Short-term psychodynamic psychotherapy, with its focus on core issues, may be particularly applicable to the pathological gambler's need to avoid or escape intolerable affects and problems. Longer therapies may be needed to modify an avoidant coping style and defenses.

Long Term Follow-up of Wilms' Tumor: 20 Year Experience in a Single Pediatric Center

PURPOSE: Wilms' tumor is the most common malignant tumor of the kidney during the childhood period. This is a potentially curable disease with an excellent prognosis due to the development of the multimodal treatments, including chemotherapy, radiotherapy and nephrectomy. The aim of this study was 1) to analyze our clinical experiences with of Wilms' tumor at a single tertiary medical center, including the survival rate and recurrence of disease after treatment and 2) to investigate the prognostic factors affecting the survival of patients. METHODS: We performed retrospective analysis of the clinicopathologic data of 68 patients who underwent operation for Wilms' tumor during 20 years from March 1986 to March 2005 at Yonsei Medical Center. RESULTS: 40 (58.8%) patients were male and 28 patients (41.2%) were female. The median age at diagnosis was 25 month (range: 2 month to~10 year 10 month). Preoperative neoadjuvant chemotherapy was given in 27 patients (39.7%), and initial nephrectomy followed by chemotherapy was performed in 41 patients (60.3%). Postoperative adjuvant radiotherapy was performed in 27 patients (39.7%). The median duration of follow-up period was 8 year 2 month (range: 24 day to~18 year 6 month). The overall 5-year survival rate and 5-year disease free survival rate were 87.0% and 76.9%, respectively. Univariate analysis showed that the significant prognostic factors affecting survival were age at diagnosis (P=0.016), pathologic stage (P=0.032) and, Tumor spillage or rupture during operation (P=0.005) and tumor cell anaplasia (P=0.031). Multivariate analysis showed that tumor spillage or rupture during operation was the most significant prognostic factor (Relative Risk=4.5). CONCLUSION: Early diagnosis, meticulous surgical technique and proper pre-or postoperative adjuvant chemotherapy and radiotherapy according to the tumor histology significantly increase the patient's survival rates.

The Clinical Approaches to Learning Disorder for Primary Physicians

It is not uncommon for children and adolescents with learning disabilities to have neurologically based disorders and other associated psychosocial problems. Those children have learning disorder need systematic psychiatric and neuropsychological evaluations for proper managements. Moreover many educational test instruments and special educational literatures use an information processing model for understanding learning and learning disabilities. Any learning disorders can involve more than one area in various dysfunctional processes; input disabilities (visual and auditory perceptions, and other sensory integrations), integration disabilities (sequencing, abstraction, and organization), memory disabilities, and output disabilities (language and motor). Individuals with learning disability require appropriate interventions, whether they are clinical or educational. They must be screened primarily by family physicians, pediatricians, and psychiatrists, and have psychosocial supports for themselves and their family, and then be referred to child and adolescent psychiatrists for optimal treatment planning and multimodal managements.

The Study for Prognostic Factors in Anaplastic Carcinoma of the Thyroid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anaplastic carcinoma of thyroid gland is a lethal entity: few patients live more than 12 months following the diagnosis. We retrospectively reviewed the experience with this entity at our institute with respect to prognostic factors influencing survival. MATERIALS AND METHODS: Thirteen cases of anaplastic carcinoma of thyroid gland diagonsed from 1995 to 2000 were analyzed retrospectively. The median age at presentation was 66.2 years; the male/female ratio was 1.17:1: and the most common symptom was a rapidly enlarging neck mass. RESULTS: All but one patient died within one year of diagnosis. Tumor size of less than 7 cm and complete resection of tumor were significant prognostic factors. Patients who had operation with or without radiotherapy and/or chemotherapy survived significantly longer than other patients. Median survival duration was 74 days. CONCLUSION: This study showed that complete resection and multimodal treatment for tumor of size less than 7 cm resulted in prolonged survival for a subgroup of patients with anaplastic thyroid carcinoma.