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1.
Estima (Online) ; 21(1): e1313, jan-dez. 2023.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1510121

ABSTRACT

Introdução:O câncer é causado por mutações celulares anormais. O câncer de cólon e reto ocupa a segunda posição no ranking de incidências no Brasil. Objetivo: Descrever o perfil sociodemográfico e clínico de pessoas com estomia por causa oncológica no estado do Ceará. Método: Estudo epidemiológico, observacional, longitudinal com abordagem retrospectiva, realizado no Ceará, em prontuários de pacientes acompanhados pelo Serviço de Atenção ao Paciente com Estomia. Resultado: Foram analisados 655 prontuários, dos quais a maioria dos pacientes eram do sexo feminino (53%), idosos (61,41%), aposentados e pensionistas (46,9%), casados (42%), com filhos (67,9%), cuja escolaridade predominante foi o fundamental (34,2%); 72,8% não possuíam comorbidades, não utilizaram quimioterapia (54,5%), colostomia (64,7%), terminal (65,3%), definitiva (46%), em quadrante inferior esquerdo (52,5%), vermelha (64,4%), ovalado (47,2%), baixo perfil (44,6%) e pastoso (33,9%), utilizavam bolsa de uma peça (60,6%), com uma média de 10 bolsas mensalmente (95%), realizando troca de 3 a 5 dias (43,1%), sem a necessidade de uso de adjuvantes (71%). Conclusão: Um perfil dos pacientes deve ser traçado, a fim de melhorar a assistência e planejamento das ações a esse público.


Introduction:Cancer is caused by abnormal cell mutations. Colon and rectum cancer occupies the second position in the ranking of incidences in Brazil. Objective: To describe the sociodemographic and clinical profile of people with an ostomy due to cancer in the state of Ceará. Method: Epidemiological, observational, longitudinal study with a retrospective approach, carried out in Ceará, in medical records of patients monitored by the Service of Attention to the Patient with Stoma. Result: A total of 655 medical records were analyzed, in which most of the patients were female (53%), elderly (61.41%), retired and pensioner (46.9%), married (42%), with children (67.9%), whose predominant schooling was elementary school (34.2%); 72.8% had no comorbidities, did not use chemotherapy (54.5%), colostomy (64.7%), terminal (65.3%), definitive (46%), in the lower left quadrant (52.5%) , red (64.4%), oval (47.2%), low profile (44.6%) and pasty (33.9%), used a one-piece bag (60.6%), with an average of 10 bags monthly (95%), changing every 3 to 5 days (43.1%), without the need to use adjuvants (71%). Conclusion: A profile of patients should be drawn in order to improve assistance and planning of actions for this public.


Introducción:El cáncer es causado por mutaciones celulares anormales. El cáncer de colon y recto ocupa la segunda posición en el ranking de incidencias en Brasil. Objetivo: Describir el perfil sociodemográfico y clínico de las personas con estoma por cáncer en el Estado de Ceará. Método: Estudio epidemiológico, observacional, longitudinal con abordaje retrospectivo, realizado en Ceará, en prontuarios de pacientes acompañados por el Servicio de Atención al Paciente con Estoma. Resultado: Se analizaron 655 prontuarios, la mayoría del sexo femenino (53%), adulto mayor (61,41%), jubilado y pensionado (46,9%), casado (42%), con hijos (67,9%), cuya escolaridad predominante fue la primaria. (34,2%). El 72,8 % no tenía comorbilidades, no usaba quimioterapia (54,5 %), colostomía (64,7 %), terminal (65,3 %), definitiva (46 %), en cuadrante inferior izquierdo (52,5 %), rojo (64,4 %), ovalado (47,2 %), bajo perfil (44,6 %) y pastoso (33,9 %), usaba bolsa de una sola pieza (60,6 %), con un promedio de 10 bolsas mensuales (95 %), cambiando cada tres a cinco días (43,1 %), sin necesidad de utilizar adyuvantes (71%). Conclusión: Debe elaborarse un perfil de pacientes para mejorar la atención y planificación de acciones para este público.


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Ostomy/nursing , Sociodemographic Factors , Neoplasms/surgery , Brazil , Retrospective Studies , Age and Sex Distribution , Enterostomal Therapy
2.
Braz. J. Anesth. (Impr.) ; 73(1): 78-84, Jan.-Feb. 2023. tab, graf
Article in English | LILACS | ID: biblio-1420649

ABSTRACT

Abstract Background There has been a growing interest in the use of ketamine following orthopedic surgeries. We hypothesized that low dose intravenous ketamine during surgery would help in mobilization following total knee replacement (TKR) in oncology patients as assessed by the timed to up and go (TUG) test at 72 hours post-surgery. Our secondary objectives were to compare the opioid requirement at the end of 72 hours, pain scores, satisfaction with pain management, adverse effects, range of joint movement achieved in the post-operative period and the functional recovery at the end of 1 month. Methods After the ethics commitee approval, registration of the trial with the Clinical Trial Registry - India (CTRI), and informed consent, this double-blinded trial was conducted. Using computer generated randomization chart, an independent team randomized the patients into ketamine group which received at induction, a ketamine bolus dose of 0.5 mg.kg-1 before the incision followed by 10 µg.kg-1min-1 infusion which was maintained intraoperatively till skin closure and the saline group received an equivalent volume of saline. Postoperatively, patient controlled morphine pumps were attached and the pain score with morphine usage were recorded for 72 hours. The TUG tests and range of motion were assessed by the physiotherapists until 72 hours. Results Fifty-two patients were enrolled in the trial. Demographics were comparable. No significant intraoperative hemodynamic changes and post-operative adverse events were noted between the groups. A decrease in the TUG test, along with decreased opioid usage with a better range of movements was noted in the ketamine group, but this was not statistically significant. Day of discharge, patient satisfaction score, and functional recovery assessed by Oxford Knee Score (OKS) were comparable between the groups. Conclusion In conclusion, low dose intraoperative ketamine infusion does not provide clinical benefit in perioperative pain management and postoperative rehabilitation following total knee endoprosthetic replacement in oncology.


Subject(s)
Humans , Arthroplasty, Replacement, Knee , Ketamine , Neoplasms/surgery , Neoplasms/complications , Pain, Postoperative/prevention & control , Pain, Postoperative/drug therapy , Double-Blind Method , Pain Management , Analgesics , Analgesics, Opioid , Morphine
3.
Rev. cir. (Impr.) ; 74(4): 392-399, ago. 2022. tab
Article in Spanish | LILACS | ID: biblio-1407941

ABSTRACT

Resumen Introducción: El linfedema es una enfermedad inflamatoria crónica que afecta cerca de 250 millones de personas en el mundo. El tratamiento tradicional es la terapia descongestiva. Últimamente, existe la opción de complementar el tratamiento tradicional con procedimientos quirúrgicos fisiológicos como anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Sin embargo, la evidencia del uso de la terapia descongestiva en los cuidados pre y posoperatorios en estas cirugías es limitada. Objetivo: Evaluar el uso de terapia descongestiva como complemento a la cirugía de linfedema mediante anastomosis linfáticovenosas y transferencia de linfonodos vascularizados. Materiales y Método: Se realizó una revisión de la literatura en las siguientes bases de datos: Cochrane, Pubmed y Google académico, utilizando los siguientes términos mesh: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes", "bypass", "lymphedema and microsurgery". Se incluyó aquellos artículos que describían el uso de la terapia descongestiva en los cuidados pre- y posoperatorios. Resultados: Se identificó un total de 201 artículos y 12 fueron incluidos en el análisis. La evidencia reporta que las terapias más usadas en el cuidado pre- y posoperatorio son compresión, drenaje linfático manual y tratamientos personalizados. Sin embargo, la mayoría de los autores hace una descripción vaga de las terapias mencionadas. Discusión y Conclusión: La evidencia respecto al uso de terapia descongestiva como tratamiento complementario es débil. Los expertos recomiendan su uso, sin embargo, se necesitan futuras investigaciones que describan el uso de cada uno de sus componentes como complemento de procedimientos quirúrgicos fisiológicos para el manejo del linfedema.


Background: Lymphedema is a disease that affects about 250 million people around the world. The traditional treatment is decongestive therapy. In the past years, there is the option to complementing the traditional treatment with physiological surgical procedures such as lymphatic-venous anastomosis (LVA) and vascularized lymph node transfer (VLNT). However, the evidence for the use of decongestive therapy in pre- and post-operative care in these surgeries is limited. Aim: To evaluate the use of decongestive therapy as a complement to lymphedema surgery such a lymphatic-venous anastomosis and transfer of vascularized lymph nodes. Materials and Method: A literature review was carried out in the following databases: Cochrane, Pubmed and Academic Google, using the following mesh terms: "anastomosis, surgical", "lymphedema", "perioperative care", "microsurgery", "rehabilitation", "therapy", "lymph nodes","bypass", "lymphedema and microsurgery". "Those articles that described the use of decongestive therapy in pre- and post-operative care were included. Results: 201 articles were identified and 12 were included in the analysis. The evidence reports that the most used therapies in pre- and post-operative care are compression, manual lymphatic drainage and personalized treatments. However, most of the authors give a vague description of the mentioned therapies. Discussion and Conclusion: The evidence regarding the use of decongestive therapy as a complementary treatment is weak. Experts recommend its use; however, future research is needed to describe the use of each of its components as a complement to physiological surgical procedures for the management of lymphedema.


Subject(s)
Humans , Lymphatic Vessels/surgery , Lymphatic Vessels/diagnostic imaging , Lymphangitis/surgery , Lymphedema/surgery , Lymphedema/etiology , Neoplasms/surgery , Neoplasms/complications , Software Design , Anastomosis, Surgical/methods , Treatment Outcome , Lymph Nodes , Microsurgery/methods
4.
Chinese Journal of Oncology ; (12): 725-727, 2022.
Article in Chinese | WPRIM | ID: wpr-940932

ABSTRACT

Malignant tumor is a class of diseases with extremely poor prognosis. Current treatment methods mainly include surgical resection, radiotherapy, chemotherapy, immunotherapy, target-therapy, endocrine therapy, and traditional Chinese medicine. For solid malignant tumors, surgical resection is one of the most effective methods. This review proposes a new concept of "target-territory resection" by summarizing a large amount of clinical experience, which can better standardize the implementation of malignant tumor surgery. This technology defines the target-territory area through the principles of differentiation, dynamics and intelligence, thereby determining the optimal operation timing and resection range. According to the "fourstandard surgery" , this operation tries to achieve zero tumor burden, and enables patients to obtain better treatment outcomes.


Subject(s)
Humans , Neoplasms/surgery , Prognosis , Treatment Outcome
5.
Rev. cuba. cir ; 60(3): e1166, 2021. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1347388

ABSTRACT

Introducción: La pérdida de funcionalidad es una condición común en adultos mayores con cáncer y la decisión de intervenir quirúrgicamente depende de las comorbilidades y estado funcional. Objetivo: Determinar la asociación entre el estado funcional y complicaciones quirúrgicas en adultos mayores varones con cáncer en el Centro Médico Naval. Métodos: Se realizó un estudio de tipo cohorte retrospectiva, análisis secundario de una base de datos de adultos mayores varones con cáncer, seguidos por dos años y atendidos en el Centro Médico Naval del Perú. Las variables fueron: complicaciones quirúrgicas, estado funcional, comorbilidades, síndromes geriátricos y tipo de cáncer. Resultados: Se evaluó a 385 participantes, edad promedio de 79,69 años (desviación estándar = 4,55). El 39,74 por ciento (n =153) presentó complicaciones quirúrgicas, con una asociación a la presencia de comorbilidades, presencia de dos o más síndromes geriátricos 69,93 por ciento (n =107), dependencia funcional para actividades básicas 51,63 por ciento (n =79) y dependencia funcional para actividades instrumentales 35,95 por ciento (n = 55). De acuerdo con la frecuencia de complicaciones según el tipo de neoplasia se encontró más frecuente para cáncer colorrectal en un 46,41 por ciento (n = 71). Conclusiones: Existe una asociación significativa entre la dependencia funcional y complicaciones quirúrgicas, por lo que es importante no solamente para el tratamiento quirúrgico sino también farmacológico, considerar el estado funcional del paciente para un tratamiento favorable y por lo tanto un mejor pronóstico(AU)


Introduction: Loss of functionality is a common condition in older adults with cancer, while any decision to intervene surgically depends on comorbidities and functional status. Objective: To determine the association between functional status and surgical complications in male older adults with cancer at Centro Médico Naval. Methods: A retrospective cohort-type study was carried out, with secondary analysis of a database of male older adults with cancer followed up for two years and treated at Centro Médico Naval of Peru. The variables were surgical complications, functional status, comorbidities, geriatric syndromes and type of cancer. Results: A number of 385 participants were assessed. Their mean age was 79.69 years (standard deviation: 4.55). 39.74 percent (n=153) presented surgical complications, with an association to the presence of comorbidities, the presence of two or more geriatric syndromes in 69.93 percent (n=107), functional dependence for basic activities in 51.63 percent (n=79), and functional dependence for instrumental activities in 35.95 percent (n=55). Regarding the frequency of complications according to type of neoplasm, the most frequent occurrence was that of colorectal cancer, accounting for 46.41 percent (n=71). Conclusions: There is a significant association between functional dependence and surgical complications, a reason why it is important, not only in surgical but also in pharmacological treatment, to consider the functional status of the patient in view of a favorable treatment and, therefore, a better prognosis(AU)


Subject(s)
Humans , Aged , Postoperative Complications/etiology , Colorectal Neoplasms/complications , Geriatric Assessment/methods , Neoplasms/surgery , Retrospective Studies , Cohort Studies
6.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 67(7): 971-974, July 2021. tab
Article in English | LILACS | ID: biblio-1346952

ABSTRACT

SUMMARY OBJECTIVE: The aim of this study is to evaluate the early results of robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction, regarding the operative time, operative and early postoperative complications, hospital stay, and pathological reports in a series of 10 patients. METHODS: From November 2016 to October 2019, case series study on patients diagnosed with RC was included in this study. All robotic-assisted low anterior resection of the rectum, vaginal removal of the specimen, colorectal anastomosis, and loop ileostomies were performed using the Da Vinci XI system. RESULTS: The mean age of patient was 64.8 (58-72) years. Low anterior resection was performed to seven patients, and very low anterior resection was performed to three patients. Total mesorectal excision of the rectum, transvaginal specimen extraction, transanal anastomoses, and protective ileostomy were performed in all 10 patients. The mean operative time was 275±30.50 min, and estimated blood loss was 50±10.50 mL. No patient required conversion to conventional surgery. Negative circumferential resection, proximal, and distal margins were accomplished negative. Mean number of lymph nodes harvested was 20±5.5. According to the pathological reports, all were adenocarcinoma. T1 stage was 80.0%, and T2 stage was 20.0%. Lymph node metastasis accounted for 80.0%. CONCLUSIONS: To our literature search, this is the first study reporting the early outcomes of the novel robotic surgery-assisted low anterior resection for rectal cancer and transvaginal specimen extraction by using the Da Vinci Xi system. It can be performed safely and successfully in selected patients by providing an excellent cosmetic body image, which may be important for women.


Subject(s)
Adenocarcinoma/surgery , Laparoscopy , Robotic Surgical Procedures , Neoplasms/surgery , Rectum , Treatment Outcome , Operative Time , Middle Aged
8.
Rev. medica electron ; 43(2)mar.-abr. 2021. graf
Article in Spanish | CUMED, LILACS | ID: biblio-1251944

ABSTRACT

El tumor sólido pseudopapilar del páncreas, conocido también como tumor de Frantz, es una enfermedad rara: neoplasia bien delimitada, de lento crecimiento, no agresiva pero maligna, habitualmente con pronóstico favorable. El tratamiento de elección es quirúrgico. Aunque algunos de ellos son agresivos a nivel local, la mayoría de los pacientes se curan con la resección completa del tumor. Se reportó el caso de una mujer de 30 años, ingresada en el Servicio de Cirugía General del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, con diagnóstico presuntivo clínico e imagenológico, de tumor pseudopapilar sólido del páncreas, con confirmación histológica tras la resección quirúrgica. Este infrecuente tumor debe ser considerado en el diagnóstico diferencial de los tumores pancreáticos, fundamentalmente en mujeres jóvenes(AU)


The solid pseudo-papillary carcinoma, also known as Frantz´s tumor, is a rare disease. It is a well-defined neoplasia, of low growth, non-aggressive but malignant, usually with a favorable prognosis. The elective treatment is the surgery. Although some of them are locally aggressive, most patients are healed with the complete tumor resection. The authors reported the case of a woman, aged 30 years who entered the Service of General Surgery of the University Hospital Comandante Faustino Pérez Hernández, with a presumptive clinical and imaging diagnosis of pancreas solid pseudo-papillary tumor, histologically confirmed after surgical resection. This infrequent tumor should be taken into account in the differential diagnosis of pancreatic tumors, mainly in young women(AU)


Subject(s)
Humans , Female , Adult , Pancreatic Neoplasms/diagnosis , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/etiology , Biopsy , Clinical Diagnosis , Neoplasm Metastasis , Neoplasms/surgery , Neoplasms/diagnosis
9.
Chinese Journal of Medical Instrumentation ; (6): 176-182, 2021.
Article in Chinese | WPRIM | ID: wpr-880447

ABSTRACT

The methods of monitoring the thermal ablation of tumor are compared and analyzed in recent years. The principle method results and insufficient of ultrasound elastography and quantitative ultrasound imaging are discussed. The results show that ultrasonic tissue signature has great development space in the field of real-time monitoring of thermal ablation, but there are still some problems such as insufficient monitoring accuracy difficulty in whole-course monitoring and insufficient


Subject(s)
Humans , Catheter Ablation , Elasticity Imaging Techniques , Hyperthermia, Induced , Liver/surgery , Neoplasms/surgery , Ultrasonography
10.
Ribeirão Preto; s.n; 2021. 109 p. ilus, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1373078

ABSTRACT

Introdução: O manejo da ferida operatória limpa no pós-operatório é uma importante intervenção para prevenção da infecção do sítio cirúrgico. O uso de curativo estéril na ferida operatória, aproximada por primeira intenção, deve ser utilizado de forma asséptica e tem como principal objetivo impedir a contaminação por microrganismo. No entanto, para as diretrizes clínicas para prevenção de infecção do sítio cirúrgico, não existe consenso sobre a escolha do curativo ideal. Objetivo: Sintetizar as evidências sobre o curativo efetivo para prevenção da infecção de sítio cirúrgico aplicado na ferida operatória, aproximada por primeira intenção, em pacientes oncológicos adultos submetidos a cirurgia eletiva. Materiais e Método: Trata-se de uma revisão sistemática pautada no Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), registrada sob o número CRD42020156908, constituída das etapas: 1) Elaboração e registro do protocolo da revisão; 2) Delimitação da pergunta da revisão; 3) Definição dos critérios de elegibilidade; 4) Busca e seleção dos estudos; 5) Coleta de dados; e 6) Síntese e apresentação dos resultados da revisão sistemática. A estratégia de busca foi realizada nas bases de dados: Cochrane Central, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus e Web of Science. A estratégia de busca foi fundamentada no objetivo da revisão e adaptada para cada base de dados consultada. Utilizaram-se descritores controlados e palavras-chave, a saber: Neoplasms AND Bandages AND Surgical Wound Infection AND prevention and control. A literatura cinzenta consultada foi o Google Acadêmico e a ProQuest Dissertations and Theses Database. As etapas foram realizadas de forma independente e mascarada por dois revisores, e um terceiro para resolução de conflitos. Ao término da seleção dos estudos primários, realizou-se a busca manual nas listas de referências dos estudos primários incluídos. Resultados: A amostra compôs-se de sete ensaios clínicos aleatorizados. Os curativos absorventes foram comparados em cinco estudos incluídos. A mupirocina foi avaliada em dois estudos. Os curativos com prata foram avaliados em três estudos. O mel, a parafina, o tempo de retirada do curativo e a terapia por pressão negativa aparecem em um único ensaio cada. Em relação ao risco de viés, foram avaliados os sete estudos incluídos pela ferramenta da Cochrane Risk of Bias (RoB 2), sendo seis de baixo risco e um estudo avaliado como risco incerto. A metanálise foi realizada com três ensaios que testaram curativo de prata versus o curativo absorvente, não demonstrando diferenças estatisticamente significantes (p= 0.77) na prevenção da infecção do sítio cirúrgico. O Intervalo de Confiança (IC) do diamante metanalítico varia de 0,41 a 1,06, assim não demonstra diferença estatisticamente significante na efetividade entre os tipos de curativo. A certeza da evidência foi avaliada pelo sistema GRADE e foi considerada forte em todos os domínios. Conclusões: A ausência de padronização em relação ao tipo e tempo de curativo utilizados nos estudos pode ser um dificultador para as recomendações do curativo ideal. E apesar dos resultados promissores com curativo impregnado com prata, ainda não é possível concluir qual é o curativo mais efetivo aplicado na ferida operatória, para prevenção de infecção de sítio cirúrgico, com fechamento primário, em pacientes oncológicos adultos submetidos a cirurgia eletiva


Introduction: The management of clean surgical wounds in the postoperative period is an important intervention to prevent surgical site infections. The use of sterile dressings in operative wounds, held together by primary intention, should be used aseptically, with the main objective of preventing microbiological contamination. However, clinical guidelines for the prevention of surgical site infection do not provide a consensus about the choice of the optimal dressing. Objective: The aim of this review was to summarize the existing evidence about effective surgical site dressings for the prevention of operative wound infections, held together by primary intention in adult oncological patients submitted to elective surgery. Materials and Method: This was a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), registered under number CRD42020156908. It was developed according to the following phases: 1) preparing and registering the review protocol; 2) defining the review question; 3) defining the eligibility criteria; 4) searching and selecting the studies; 5) data collection; and 6) summarizing and presenting the results of the systematic review. The search strategy was carried out in the following databases: Cochrane Central, Cinahl, Embase, Lilacs, Livivo, PubMed, Scopus, and Web of Science. The search strategy was based on the objective of the review and adapted for each of the consulted databases. Controlled descriptors and keywords were used, namely: Neoplasms AND Bandages AND Surgical Wound Infection AND prevention and control. The grey literature consulted was Google Scholar, ProQuest Dissertations and Theses Database. The stages were carried out independently and blindly by two reviewers, while a third reviewer was used to settle any conflicts. After selecting the primary studies, the researchers manually searched the reference lists of the included primary studies. Results: The sample consisted of seven randomized clinical trials. Absorbent dressings were compared in five included studies. Mupirocin was evaluated in two studies. Silver dressings were evaluated in three studies. Honey, paraffin, dressing removal time, and negative pressure therapy all appeared in a single trial each. Regarding the risk of bias, the seven studies were assessed using the Cochrane Risk of Bias tool (RoB 2); six presented a low risk of bias and one study presented uncertain risk. The meta-analysis was performed with three trials that tested silver dressings versus absorbent dressings, with no statistically significant differences (p= 0.77) in the prevention of surgical site infection. The confidence interval (CI) of the diamond ratio varied between 0.41 and 1.06, thus it did not demonstrate a statistically significant difference in effectiveness between the types of dressing. Certainty of the evidence was evaluated using the GRADE system, which considered it strong in all categories. Conclusions: The lack of standardization regarding the type and duration of dressing used in the studies can make it difficult to recommend the ideal dressing. And despite the promising results with dressings impregnated with silver, it is still not possible to conclude which is the most effective dressing applied to the surgical wound, to prevent surgical site infection, with primary closure, in adult cancer patients undergoing elective surgery


Subject(s)
Humans , Surgical Wound Infection/prevention & control , Surgical Wound/drug therapy , Neoplasms/surgery , Occlusive Dressings
11.
Clinics ; 76: e2741, 2021. tab
Article in English | LILACS | ID: biblio-1249588

ABSTRACT

OBJECTIVES: To determine the rate of and main risk factors for postoperative infection in cancer patients who underwent spine surgery in the last 5 years in order to determine whether there is an association between postoperative infection and increased mortality during hospitalization. METHODS: All cancer patients who underwent surgical procedures between January 2015 and December 2019 at a single hospital specializing in spine cancer surgery were analyzed. The primary outcome of interest was postoperative infection. Bivariate logistic regression was used to estimate the odds ratio and 95% confidence interval for each variable in relation to the occurrence of infection. RESULTS: We evaluated 324 patients, including 176 men (54.3%) and 148 women (45.7%) with a mean age of 56 years. The incidence of postoperative infection was 20.37%. Of the 324 patients, 39 died during hospitalization (12%). CONCLUSIONS: Surgical time greater than 4 hours, surgical instrumented levels greater than 6, and an Eastern Cooperative Oncology Group of 3 or 4 were associated with an increased risk of postoperative infection, but these factors did not lead to an increase in mortality during hospitalization.


Subject(s)
Humans , Male , Female , Middle Aged , Spine/surgery , Neoplasms/surgery , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Incidence , Retrospective Studies , Risk Factors
12.
Rev. bras. cancerol ; 67(1): e-101211, 2021.
Article in Portuguese | LILACS | ID: biblio-1147123

ABSTRACT

Introdução: A fisioterapia pré-operatória em pacientes oncológicos tem papel fundamental para redução das complicações pós-operatórias. Sabe-se que a avaliação pré-operatória identifica os fatores de risco e é decisiva na redução do desenvolvimento de tais complicações. Objetivo: Verificar o efeito da cinesioterapia pré-operatória e do treino muscular inspiratório nas complicações pulmonares pós-operatórias em pacientes oncológicos. Método: Trinta pacientes foram divididos aleatoriamente em grupo cinesioterapia, grupo treinamento muscular inspiratório e grupo controle, com dez participantes em cada grupo. Foram realizadas avaliação da força muscular respiratória, teste de caminhada de seis minutos e força muscular periférica. Foi utilizado o teste de Wilcoxon para comparação pré e pós-tratamento. Também foi realizado o teste Kruskal Wallis para comparação do resultado pós-tratamento e o teste qui-quadrado para variáveis categóricas. Utilizou--se o teste de Cohen (d) para identificação do tamanho do efeito. Resultados: Nove (90%) indivíduos do grupo controle apresentaram complicações, enquanto, nos grupos cinesioterapia e de treinamento muscular inspiratório, as complicações foram observadas em dois (20%) e três (30%) pacientes, respectivamente. As pressões inspiratória máxima (PImáx) e expiratória máxima (PEmáx) no treinamento muscular inspiratório e a PImáx no grupo cinesioterapia demonstraram impacto clínico quando comparados ao grupo controle. Conclusão: A cinesioterapia e o treinamento muscular inspiratório impactaram na redução das complicações pós-operatórias das cirurgias oncológicas.


Introduction: Preoperative physiotherapy in cancer patients plays a fundamental role in reducing postoperative complications. It is known that the preoperative assessment identifies risk factors and is critical in reducing the development of such complications. Objective: Identify the effect of preoperative kinesiotherapy and inspiratory muscle training on postoperative pulmonary complications in cancer patients. Method: Thirty patients were randomly divided into a kinesiotherapy group, inspiratory muscle training group and control group, with 10 participants in each group. Respiratory muscle strength assessment, 6-minute walk test and peripheral muscle strength were performed. The Wilcoxon test was used for comparison before and after treatment. The Kruskal Wallis test was also performed to compare the post-treatment result and the Chi-square test for categorical variables. The Cohen test (d) was also performed to identify the effect size. Results: Nine (90%) individuals in the control group had complications, while in the kinesiotherapy and inspiratory muscle training groups, complications were observed in two (20%) and three (30%) patients, respectively. Maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) in inspiratory muscle training and MIP in the kinesiotherapy group demonstrated clinical impact when compared to the control group. Conclusion: Kinesiotherapy and inspiratory muscle training impacted the reduction of postoperative complications of oncology surgeries.


Introducción: La fisioterapia preoperatoria en pacientes oncológicos tiene un papel fundamental en la reducción de las complicaciones posoperatorias. Se sabe que la evaluación preoperatoria identifica factores de riesgo y es decisiva para reducir el desarrollo de tales complicaciones. Objetivo: Verificar el efecto de la kinesioterapia preoperatoria y el entrenamiento de los músculos inspiratorios sobre las complicaciones pulmonares postoperatorias en pacientes con cáncer. Método: Treinta pacientes fueron divididos aleatoriamente en un grupo de kinesioterapia, un grupo de entrenamiento de los músculos inspiratorios y un grupo de control, con diez participantes en cada grupo. Se realizó una evaluación de la fuerza de los músculos respiratorios, la prueba de marcha de seis minutos y la fuerza de los músculos periféricos. Se utilizó la prueba de Wilcoxon para comparar antes y después del tratamiento. También se realizó la prueba de Kruskal Wallis para comparar el resultado postratamiento y la prueba de chi-cuadrado para variables categóricas. También se realizó la prueba de Cohen (d) para identificar el tamaño del efecto. Resultados: Nueve (90%) individuos en el grupo de control tuvieron complicaciones, mientras, en los grupos de kinesioterapia y entrenamiento de los músculos inspiratorios, se observaron complicaciones en dos (20%) y tres (30%) pacientes, respectivamente. Las presiones inspiratorias (MIP) y espiratorias máximas (MEP) en el entrenamiento de los músculos inspiratorios y MIP en el grupo de kinesioterapia demostraron un impacto clínico en comparación con el grupo de control. Conclusión: La kinesioterapia y el entrenamiento de los músculos inspiratorios impactaron en la reducción de las complicaciones posoperatorias de las cirugías oncológicas


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Preoperative Care , Physical Therapy Modalities , Neoplasms/complications , Breathing Exercises/adverse effects , Neoplasms/surgery
13.
Rev. bras. cancerol ; 67(1): e-151201, 2021.
Article in Portuguese | LILACS | ID: biblio-1147221

ABSTRACT

Introdução: Pacientes cirúrgicos, que apresentam risco nutricional ou de sarcopenia, podem evoluir com piores desfechos no pós-operatório. Objetivo: Investigar se existe associação entre o risco nutricional e a sarcopenia com complicações e mortalidade no pós-operatório de pacientes oncológicos submetidos a cirurgias de grande porte. Método: Estudo bicêntrico de coorte, prospectivo, realizado com 220 pacientes oncológicos adultos, submetidos a operações de grande porte no Hospital de Câncer e na Santa Casa de Misericórdia em Cuiabá, Mato Grosso. Os pacientes foram classificados com ou sem risco nutricional pela Nutritional Risk Screening 2002 e de sarcopenia segundo o questionário Strength, Assistance with walking, Rise from a chair, Climb stairs - and Falls, no pré-operatório. As variáveis de desfecho foram complicações infecciosas e óbito no pós-operatório. Resultados: Os pacientes com risco nutricional mostraram maior risco de complicações infecciosas (24,6 vs. 5,1%; RR=4,8 IC95% 1,94-12; p<0,001) e de óbito (11,5 vs. 1,0%; RR=11,2 IC95%1,5-84,0; p=0,002) no pós-operatório, quando comparados aos sem risco nutricional. Não houve associação do risco de sarcopenia com a presença de complicações infecciosas e óbito ao longo do período pós-operatório (p>0,05). Conclusão: Ospacientes oncológicos em risco nutricional foram aqueles que apresentaram maior risco de complicações infecciosas e de óbito no pós-operatório, quando comparados aos sem risco nutricional ou em risco de sarcopenia.


Introduction: Surgical patients who are at either nutritional or sarcopenia risk may have worst outcomes in the postoperative period. Objective: To investigate whether nutritional or sarcopenia risk is associated with mortality and postoperative complications in cancer patients undergoing major operations. Method: Prospective cohort bicentrical study enrolling 220 adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. Patients were classified with or without nutritional risk per the Nutritional Risk Screening 2002 and sarcopenia risk according to the Strength, Assistance with walking, Rise from a chair, Climb stairs - and Falls questionnaire preoperatively. The outcomes variables were postoperative infectious complications and death. Results: Patients with nutritional risk showed higher risk of infectious complications (24.6 vs. 5.1%; RR=4.8 CI95% 1.94-12; p<0.001) or die (11.5 vs. 1.0%; RR=11.2 CI95% 1.5-84.0; p=0.002) in post-operation when compared to patients without nutritional risk. There was no association between sarcopenia risk with infectious complications or mortality during post-operation (p>0.05). Conclusion: Oncological patients with nutritional risk have higher risk of developing postoperative infectious complications or die when compared with patients without nutritional risk or in risk of sarcopenia.


Introducción: Los pacientes de cáncer quirúrgico con riesgo nutricional o de sarcopenia pueden evolucionar con peores resultados en el postoperatorio. Objetivo: Investigar si existe una asociación entre el riesgo nutricional y la sarcopenia con complicaciones y mortalidad en el postoperatorio de pacientes con cáncer sometidos a operaciones mayores. Método: Estudio prospectivo de cohorte bicéntrico realizado con 220 pacientes adultos con cáncer que se sometieron a operaciones importantes en el Hospital de Cáncer y Santa Casa de Misericordia en Cuiabá, Mato Grosso. La muestra estudiada se clasificó con o sin riesgo nutricional por Nutritional Risk Screening 2002 y sarcopenia de acuerdo con el cuestionario Strength, Assistance with walking, Rise from a chair, Climb stairs - and Falls, en el pre operatorio. Las variables de resultado fueron complicaciones infecciosas y muerte en la postoperatorio. Resultados: Los pacientes con riesgo nutricional mostraron un mayor riesgo de complicaciones infecciosas (24,6 vs. 5,1%; RR=4,8 IC95% 1,94-12; p<0,001) y muerte (11,5 vs. 1,0%; RR=11,2 IC95%1,5-84,0; p=0,002) en la postoperatorio en comparación con aquellos sin riesgo nutricional. Sin embargo, no hubo asociación entre el riesgo de sarcopenia y la presencia de complicaciones infecciosas y muerte durante el período postoperatorio (p> 0.05). Conclusión: Los pacientes con cáncer en riesgo nutricional según NRS-2002, fueron aquellos que tenían un mayor riesgo de complicaciones infecciosas y muerte en la postoperatorio, en comparación con aquellos sin riesgo nutricional o con riesgo de sarcopenia.


Subject(s)
Humans , Male , Female , Nutritional Status , Sarcopenia , Neoplasms/surgery , Postoperative Complications , Neoplasms/mortality
14.
Rev. bras. anestesiol ; 70(5): 527-533, Sept.-Oct. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1143961

ABSTRACT

Abstract Background: The current evidence suggests that oncological surgery, which is a therapy used in the treatment of solid tumors, increases the risk of metastasis. In this regard, a wide range of tumor cells express Voltage-Gated Sodium Channels (VGSC), whose biological roles are not related to the generation of action potentials. In epithelial tumor cells, VGSC are part of cellular structures named invadopodia, involved in cell proliferation, migration, and metastasis. Recent studies showed that lidocaine could decrease cancer recurrence through its direct effects on tumor cells and immunomodulatory properties on the stress response. Objective: The aim of this narrative review is to highlight the role of VGSC in tumor cells, and to describe the potential antiproliferative effect of lidocaine during the pathogenesis of metastasis. Contents: A critical review of literature from April 2017 to April 2019 was performed. Articles found on PubMed (2000-2019) were considered. A free text and MeSH-lidocaine; voltage-gated sodium channels; tumor cells; invadopodia; surgical stress; cell proliferation; metastasis; cancer recurrence - for articles in English, Spanish and Portuguese language - was used. A total of 62 were selected. Conclusion: In animal studies, lidocaine acts by blocking VGSC and other receptors, decreasing migration, invasion, and metastasis. These studies need to be replicated in humans in the context of oncological surgery.


Resumo Justificativa: As evidências atuais sugerem que a cirurgia oncológica, usada no tratamento de tumores sólidos, aumenta o risco de metástase. Nesse sentido, uma ampla gama de células tumorais expressa Canais de Sódio Dependentes de Voltagem (CSDV), cujos papéis biológicos não estão relacionados à produção de potencial de ação. Nas células epiteliais tumorais, o CSDV é parte integrante de estruturas celulares denominadas invadópodes, que participam da proliferação, migração e metástase celular. Estudos recentes mostraram que a lidocaína pode diminuir a recorrência do câncer através de efeitos diretos nas células tumorais e de propriedades imunomoduladoras na resposta ao estresse. Objetivo: O objetivo desta revisão narrativa é analisar o papel do CSDV nas células tumorais e descrever o possível efeito antiproliferativo da lidocaína na patogênese das metástases. Conteúdo: Foi realizada uma revisão crítica da literatura de Abril de 2017 a Abril de 2019. Os artigos encontrados no PubMed (2000 − 2019) foram analisados. Pesquisamos textos de linguagem livre e descritores MeSH-lidocaína; canais de sódio dependentes de voltagem; células tumorais; invadópodes; estresse cirúrgico; proliferação celular; metástase; recorrência do câncer − em artigos publicados em inglês, espanhol e português. Foram selecionadas 62 publicações. Conclusão: Em estudos empregando animais, a lidocaína atua bloqueando o CSDV e outros receptores, diminuindo a migração, invasão e metástase. Esses estudos precisam ser replicados em humanos submetidos a cirurgia oncológica.


Subject(s)
Humans , Animals , Voltage-Gated Sodium Channels/drug effects , Lidocaine/pharmacology , Neoplasms/surgery , Cell Movement/drug effects , Cell Proliferation/drug effects , Voltage-Gated Sodium Channels/metabolism , Voltage-Gated Sodium Channel Blockers/pharmacology , Neoplasm Metastasis/prevention & control , Neoplasms/pathology
15.
Rev. Col. Bras. Cir ; 47: e20202470, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136533

ABSTRACT

ABSTRACT Objectives : to investigate the impact of oncological surgical procedures on the muscle function of patients with and without nutritional risk. Methods: cross-sectional study conducted with cancer patients undergoing major operations between July 2018 to March 2019 in Cuiabá, Mato Grosso, Brazil. Patients were assessed preoperatively for the nutritional risk by the Nutricional Risk Screening-2002, and handgrip strength (FPP) was assessed both on the pre- and 2nd and 5th postoperative days (PO). Results: 92 patients were evaluated, of whom 55.4% were men and 44.6% women, with a mean age (SD) of 64 (10.81) for patients at risk and 51 (12.99) for patients without nutritional risk. The preoperative nutritional risk evaluation indicated that 34.8% of the patients had no risk and 65.2% had a nutritional risk. The FPP was lower (p = 0.008) in the group with nutritional risk in the preoperative period. In both groups, there was a significant drop in FPP on the 2nd PO day. The preoperative FPP compared with the 2nd PO FPP was more pronounced in patients without nutritional risk (p = 0.039). Patients with nutritional risk had a longer hospital stay (p = 0.049). Conclusion: surgical trauma causes loss of muscle function in the early PO. Patients without nutritional risk have a more significant decrease in muscle strength after surgical oncological procedures than those with nutritional risk. These results may infer the need to implement pre-habilitation in all patients who will undergo major oncological procedures.


RESUMO Objetivo: investigar o impacto de procedimentos cirúrgicos oncológicos na função muscular de pacientes com e sem risco nutricional. Métodos: estudo observacional realizado com pacientes oncológicos candidatos a operações de grande porte entre julho de 2018 a março de 2019 em Cuiabá, Mato Grosso, Brasil. Os pacientes foram avaliados no pré-operatório quanto ao risco nutricional pela Nutricional Risk Screening-2002 e avaliou-se a força de preensão palmar (FPP) tanto no pré- quanto no 2º e 5º dia de pós-operatório (PO). Resultados: Foram avaliados 92 pacientes, dos quais 55,4% eram homens e 44,6% mulheres, com média (DP) de idade de 64 (10,81) para pacientes com risco e 51 (12,99) para pacientes sem risco nutricional. A avaliação nutricional pré-operatória mostrou que 34,8% dos pacientes não tinham risco e 65,2% apresentavam risco nutricional. A FPP foi menor (p=0,008) no grupo com risco nutricional no pré-operatório. Em ambos os grupos houve queda significativa da FPP no 2º dia de PO. A queda da FPP do pré-operatório para o 2º dia de PO foi mais pronunciada em pacientes sem risco nutricional (p=0,039). Pacientes com risco nutricional apresentaram maior tempo de internação (p=0,049). Conclusão: O trauma cirúrgico acarreta perda da função muscular no PO precoce. Pacientes sem risco nutricional apresentam queda da força muscular mais expressiva após procedimentos cirúrgicos oncológicos do que aqueles com risco nutricional. Esses resultados servem como argumento bastante forte para a implementação da Pré-habilitação em todos os pacientes candidatos a operações oncológicas de grande porte.


Subject(s)
Humans , Male , Female , Adult , Aged , Surgical Procedures, Operative/adverse effects , Nutritional Status , Neoplasms/surgery , Postoperative Period , Nutrition Assessment , Hand Strength/physiology , Middle Aged , Muscles/physiology , Neoplasms/classification
16.
Rev. Col. Bras. Cir ; 47: e20202528, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136579

ABSTRACT

ABSTRACT Objective: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. Method: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. Results: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank <0,001). The Cox multivariate regression showed that PS was an independent risk factor (HR=5.8 95%CI 1.49-22.58; p=0.011) for mortality. Conclusion: patients bearing PS submitted to major oncological surgery have less probability of short term survival and preoperative PS is an independent risk for postoperative mortality.


RESUMO Objetivo: avaliar o impacto da provável sarcopenia (PS) pré-operatória na sobrevida de pacientes oncológicos submetidos a operações de grande porte. Métodos: estudo bicêntrico de coorte prospectivo, realizado com pacientes oncológicos adultos, submetidos a operação de grande porte no Hospital de Câncer e na Santa Casa de Misericórdia em Cuiabá-MT. A variável principal foi a ocorrência de óbito pós-operatório. Coletou-se dados demográficos, clínicos e o diagnóstico de PS, definido pela presença de: 1) risco de sarcopenia pelo questionário SARC-F e 2) baixa força muscular (Kgf) mensurada pela dinamometria. Calculou-se a taxa de sobrevida acumulada para os pacientes com e sem PS pela curva de Kaplan-Meier. Aplicou-se o modelo de regressão de Cox uni e multivariado para avaliar a associação da mortalidade com covariáveis de confundimento investigadas. Resultados: participaram do estudo 220 pacientes com idade média (DP) de 58,7±14,0 anos, sendo 60,5% do sexo masculino. Quatorze (6,4%) pacientes foram considerados com PS. Os pacientes com PS apresentaram risco aumentado para a ocorrência de óbito (RR=5,35 IC95% 1,95-14,66; p=0,001) e para complicações infecciosas (RR=2,45 IC95% 1,12-5,33; p=0,036). A sobrevida média em 60 dias, foi menor para os pacientes com PS: 44 (IIQ=32-37) vs 58 (IIQ=56-59) dias (log rank <0,001). A regressão Multivariada de Cox, mostrou que a PS foi fator de risco independente (HR=5,8 IC95% 1,49-22,58; p=0,011) para a mortalidade. Conclusão: os pacientes com PS submetidos a operações oncológicas de grande porte apresentam menor probabilidade de sobrevida a curto prazo e a PS pré-operatória, é fator de risco independente para mortalidade pós-operatória.


Subject(s)
Humans , Male , Female , Adult , Aged , Sarcopenia/complications , Neoplasms/surgery , Postoperative Complications/epidemiology , Algorithms , Brazil/epidemiology , Survival Rate , Prospective Studies , Surveys and Questionnaires , Risk Factors , Sarcopenia/mortality , Middle Aged , Neoplasms/mortality
17.
Rev. Col. Bras. Cir ; 47: e20202601, 2020.
Article in English | LILACS | ID: biblio-1136586

ABSTRACT

ABSTRACT Objective: to suggest a script for surgical oncology assistance in COVID-19 pandemic in Brazil. Method: a narrative review and a "brainstorming" consensus were carried out after discussion with more than 350 Brazilian specialists and renowned surgeons from Portugal, France, Italy and United States of America. Results: consensus on testing for COVID-19: 1- All patients to be operated should be tested between 24 and 48 before the procedure; 2- The team that has contact with sick or symptomatic patients should be tested; 3 - Chest tomography was suggested to investigate pulmonary changes. Consensus on protection of care teams: 1 - Use of surgical masks inside the hospitals. Use of N95 masks for all professionals in the operating room; 2 - Selection of cases for minimally invasive surgery and maximum pneumoperitoneal aspiration before removal of the surgical specimen; 2 - Optimization of the number of people in teams, with a minimum number of professionals, reducing their occupational exposure, the consumption of protective equipment and the circulation of people in the hospital environment; 3 - Isolation of contaminated patients. Priority consensus: 1- Construction of service priorities; 2 - Interdisciplinary discussion on minimally invasive or conventional pathways. Conclusion: the Brazilian Society of Surgical Oncology (BSSO) suggests a script for coping with oncological treatment, remembering that the impoundment in the assistance of these cases, can configure a new wave of overload in health systems.


RESUMO Objetivo: sugerir roteiro de assistência oncológica cirúrgica em meio à pandemia COVID-19 no Brasil. Método: foi realizada revisão narrativa da literatura e consenso tipo "brainstorming" após discussão com mais de 350 especialistas brasileiros e cirurgiões renomados de Portugal, França, Itália e Estados Unidos da América. Resultados: consenso sobre testagem para COVID-19: 1-Todos os pacientes a serem operados devem ser testados entre 24 e 48 antes do procedimento; 2-Equipe que tenha contato com doentes ou sintomáticos deve ser testada; 3-Tomografia de tórax foi sugerida para pesquisa de alterações pulmonares. Consenso sobre proteção das equipes de assistência: 1-Uso de máscaras cirúrgicas dentro de hospitais. Uso de máscaras N95 para todos os profissionais na sala cirúrgica; 2-Seleção dos casos para cirurgia minimamente invasiva e aspiração máxima do pneumoperitônio antes da retirada da peça cirúrgica; 2-Otimização das equipes, com número mínimo de profissionais, reduzindo a exposição ocupacional, o consumo de equipamento de proteção e a circulação de pessoas no ambiente hospitalar; 3 -Isolamento de pacientes contaminados. Consenso sobre priorizações: 1-Construção de prioridades de atendimento; 2- Discussão interdisciplinar sobre via minimamente invasiva ou convencional. Conclusão: a Sociedade Brasileira de Cirurgia Oncológica (SBCO) sugere roteiro de enfrentamento para o tratamento oncológico, lembrando que o represamento na assistência desses casos, pode configurar uma nova onda de sobrecarga em sistemas de saúde.


Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Consensus , Betacoronavirus , Neoplasms/surgery , Paris , Pneumonia, Viral/diagnosis , Portugal , Specimen Handling , Brazil/epidemiology , Preoperative Care , Washington , Occupational Exposure/prevention & control , Health Personnel , Coronavirus Infections/diagnostic imaging , Minimally Invasive Surgical Procedures , Pandemics , Personal Protective Equipment , SARS-CoV-2 , COVID-19 , International Cooperation , Italy , Lung/diagnostic imaging , Masks , Neoplasms/complications
18.
Rev. bras. anestesiol ; 69(5): 484-492, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1057451

ABSTRACT

Abstract Background and objectives: The administration of antifibrinolytics has been shown to be effective in reducing blood loss and the need for transfusions in surgeries. However, few studies have evaluated these drugs in cancer surgery. The objective was to review the efficacy and safety of the treatment with antifibrinolytics in patients who underwent oncologic surgeries. Contents: An electronic bibliographic research was conducted in PubMed, OVID, MEDLINE, EMBASE, EBSCO and in the Cochrane Library data basis in order to identify randomized clinical trials performed in any type of oncologic surgery. The data evaluated were blood loss, need for transfusion and incidence of arteriovenous thromboembolism. Five randomized controlled trials evaluating 838 patients met the inclusion requirements. In the analysis of the incidence of thromboembolic events in the five RCTs, there was no statistically significant difference between the administration of tranexamic acid when compared with the placebo (OR = 0.36, 95% IC: 0.11‒1.19, p= 0.09, I2 = 0%). However, when total estimated blood loss and need for blood transfusion are analyzed, the use of tranexamic acid was associated with a significant reduction over placebo (MD = −135.79, 95% CI: −179.50 to −92.08, p< 0.00001, I2= 68%) and (OR = 0.45, 95% CI: 0.32‒0.65, p< 0.00001, I2= 60%), respectively. Conclusions: This meta-analysis found no evidence that the administration of antifibrinolytics increases the risk of thromboembolic complications in patients submitted to oncologic surgery, and has shown evidence that it is effective in reducing total perioperative blood loss and the need for blood transfusion.


Resumo Justificativa e objetivos: A administração de agentes antifibrinolíticos mostrou ser eficaz para reduzir a perda sanguínea e a necessidade de transfusões em cirurgias. No entanto, poucos estudos avaliaram esses agentes em cirurgias oncológicas. O objetivo foi revisar a eficácia e segurança do tratamento com antifibrinolíticos em pacientes submetidos a cirurgias oncológicas. Conteúdo: Uma pesquisa bibliográfica foi conduzida nos bancos de dados eletrônicos PubMed, OVID, MEDLINE, EMBASE, EBSCO e na Biblioteca Cochrane para identificar ensaios clínicos randomizados feitos em qualquer tipo de cirurgia oncológica. Os dados analisados foram perda sanguínea, necessidade de transfusão e incidência de tromboembolismo arteriovenoso. Cinco ensaios clínicos randomizados que avaliaram 838 pacientes atenderam aos critérios de inclusão. Na análise da incidência de eventos tromboembólicos em cinco ECR, não houve diferença estatisticamente significativa entre a administração do ácido tranexâmico, comparado ao placebo (OR = 0,36, IC 95%: 0,11-1,19, p = 0,09; I2 = 0%). No entanto, quando a perda sanguínea total estimada e a necessidade de transfusão de sangue foram analisadas, o uso do ácido tranexâmico foi associado a uma redução significativa, comparado ao placebo. (DM: -135,79, IC 95%: -179,50 a -92,08, p < 0,00001, I2 = 68%) e (OR = 0,45, IC 95%: 0,32-0,65, p < 0,00001, I2 = 60%), respectivamente. Conclusões: Esta metanálise não encontrou evidências de que a administração de antifibrinolíticos aumente o risco de complicações tromboembólicas em pacientes submetidos à cirurgia oncológica e apresentou evidências de que é eficaz para reduzir a perda sanguínea total no perioperatório e a necessidade de transfusão de sangue.


Subject(s)
Humans , Antifibrinolytic Agents/therapeutic use , Neoplasms/surgery , Postoperative Complications/chemically induced , Postoperative Complications/epidemiology , Thromboembolism/chemically induced , Thromboembolism/epidemiology , Treatment Outcome , Antifibrinolytic Agents/adverse effects
19.
Rev. bras. cir. plást ; 34(3): 362-367, jul.-sep. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047155

ABSTRACT

Introdução: Os retalhos interpolados são opções cirúrgicas eficazes para reconstruções de defeitos cutâneos em várias áreas do corpo, inclusive na face. O retalho proposto dispensa cuidados pós-operatórios com o pedículo exposto e pode ser realizado em tempo único. O objetivo é avaliar a utilidade do retalho interpolado de sulco nasogeniano (RISN) em ilha, na reconstrução de segmentos nasais e do canto interno da órbita, bem como discutir refinamentos em seu design e execução. Métodos: Estudo retrospectivo de prontuários de pacientes com defeitos nasais ou de canto interno da órbita, e que foram reparados com retalho interpolado do sulco nasogeniano. Todos os retalhos foram confeccionados de maneira randômica, realizando-se túnel subcutâneo para evitar pedículo exposto e cicatriz que comunicasse a área doadora e o defeito. Resultados: cinco pacientes foram incluídos no estudo, com idade entre 30 e 92 anos. Em todos os casos foi realizada biópsia de congelação intraoperatória que revelou margens livres de doença, orientando a extensão da ressecção. O CBC foi encontrado em 4 pacientes e o CEC em um paciente. Não houve complicações como sangramento pós-operatório ou necrose. Bons resultados funcionais e estéticos foram alcançados em todos os pacientes. Discussão: Vale ressaltar a versatilidade do retalho nasogeniano interpolado, sendo capaz de auxiliar na reconstrução de defeitos extensos não apenas de asa, ponta e columela nasais, mas também de dorso e canto medial do olho. Destaca-se também o aspecto estético mais favorável do pedículo do retalho interpolado em ilha comparado ao de transposição. Conclusão: O RISN interpolado em único estágio é uma opção confiável na reconstrução de segmentos faciais. Apresenta boa vascularização, possibilidade se ser realizado em único tempo e pode ser utilizado para cobertura nos locais onde há poucas opções reconstrutivas disponíveis.


Introduction: Interpolation flaps are effective surgical options for reconstructing skin defects in various areas of the body, including the face. The proposed flap does not require postoperative care with the pedicle exposed and can be performed in a single surgery. The objective is to evaluate the usefulness of the nasolabial interpolation island flap (NIF) for reconstructing nasal segments and the inner corner of the eye, as well as discuss improvements in its design and performance. Methods: In this retrospective study, medical records of patients with nasal defects that were repaired with a nasolabial interpolation flap were reviewed. All flaps were created with a subcutaneous tunnel to avoid pedicle exposure and prevent scar connection with the donor area and the defect. Results: Five patients aged 30­92 years were included. In all cases, intraoperative frozen biopsy revealed disease-free margins, indicating the extent of the resection. Basal cell carcinoma was found in four patients and squamous cell carcinoma in one. There were no complications such as postoperative bleeding or necrosis. Good functional and aesthetic results were achieved. Discussion: The NIF can help in the reconstruction of extensive defects of the nasal ala, tip, columella, and medial dorsum as well as the corner of the eye. We also highlight the more favorable aesthetic aspect of the pedicle in the interpolation island versus transposition flap. Conclusion: The single-stage NIF flap is a reliable option for reconstructing facial segments as it has good vascularization, can be performed in a single surgery, and can be used to cover places where few other reconstructive options are available.


Subject(s)
Humans , Male , Female , Adult , Aged, 80 and over , History, 21st Century , Orbit , Nose , Medical Records , Retrospective Studies , Plastic Surgery Procedures , Face , Nasolabial Fold , Perforator Flap , Neoplasms , Orbit/abnormalities , Orbit/surgery , Nose/abnormalities , Nose/surgery , Medical Records/standards , Plastic Surgery Procedures/methods , Face/abnormalities , Face/surgery , Nasolabial Fold/abnormalities , Nasolabial Fold/surgery , Perforator Flap/surgery , Perforator Flap/adverse effects , Neoplasms/surgery
20.
Rev. bras. anestesiol ; 69(4): 342-349, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042006

ABSTRACT

Abstract Background and objectives Predicting postoperative nausea and vomiting risk is the cornerstone for deciding prophylaxis. Apfel's score does not define how long a person must be abstinent from smoking to be considered a non-smoker, and the use of intraoperative spinal opioids as a risk factor for predicting postoperative nausea and vomiting is also not addressed. The aim of this study was to quantify predicting postoperative nausea and vomiting risk by an ordinal smoking status and the use of intraoperative opioids (systemic or neuraxial), and to develop a new predictive model. Methods Patients scheduled for cancer surgery were prospectively evaluated for predicting postoperative nausea and vomiting in the first 24 h after surgery. Results Of 2014 initially included patients, 185 participants were excluded. Smoking status classification was associated with predicting postoperative nausea and vomiting incidence rates of 14.1%, 18.1%, 24.7%, 29.4% and 33.9% for smokers, patients who stopped smoking up to 1 month prior to surgery, one to 6 months prior, more than 6 months prior or patients who never smoked, respectively, which was significant in the multiple comparisons analysis (adjusted p = 0.015). The multiple comparisons-adjusted hypothesis tests for association with predicting postoperative nausea and vomiting for sex, age, previous predicting postoperative nausea and vomiting, chemotherapy-induced nausea, and ordinal smoking status had p-values of <0.001. The type of surgery (p = 0.04), total fentanyl consumption (p = 0.04), both intraoperative and postoperative, were significant predictors. A new model was developed and showed higher discriminative power than Apfel's score (AUC 67.9% vs. 63.7%, p < 0.001). Conclusion Smoking status showed a significant and linear impact on predicting postoperative nausea and vomiting incidence, and we developed a new model that uses unambiguous smoking and opioid predictors.


Resumo Justificativa e objetivos A previsão do risco de náusea e vômito no pós-operatório é a base para a decisão da profilaxia. O escore de Apfel não define por quanto tempo uma pessoa deve se abster de fumar para ser considerada não fumante, e o uso de opioide espinhal intraoperatório como fator de risco para náusea e vômito também não é abordado. Nosso objetivo foi quantificar o risco de náusea e vômito no pós-operatório por um estado tabagístico ordinal e o uso de opioides intraoperatórios (sistêmicos ou neuraxiais) e desenvolver um novo modelo preditivo. Métodos Pacientes agendados para cirurgia oncológica foram prospectivamente avaliados para náusea e vômito nas primeiras 24 horas após a cirurgia. Resultados De 2.014 pacientes inicialmente incluídos, 185 foram excluídos. A classificação de tabagismo foi associada a taxas de incidência de náusea e vômito no pós-operatório de 14,1%, 18,1%, 24,7%, 29,4% e 33,9% para fumantes, pacientes que pararam de fumar até um mês antes da cirurgia, de um a seis meses antes da cirurgia, mais de seis meses antes da cirurgia ou pacientes que nunca fumaram, respectivamente, o que foi significativo na análise de comparações múltiplas (p = 0,015 ajustado). Os testes de hipóteses foram ajustadas para múltiplas comparações para associação com náusea e vômito no pós-operatório para sexo, idade, náusea e vômito no pós-operatório anterior, náusea induzida por quimioterapia e estado tabagístico ordinal apresentaram valores de p < 0,001. Tipo de cirurgia (p = 0,04), consumo total de fentanil (p = 0,04) e períodos intraoperatório e pós-operatório foram preditivos significativos. Um novo modelo foi desenvolvido e apresentou um poder discriminativo maior do que o escore de Apfel (AUC 67,9% vs. 63,7%, p < 0,001). Conclusão O estado tabagístico mostrou um impacto significativo e linear sobre a incidência de náusea e vômito no pós-operatório e desenvolveu-se um novo modelo que usa preditores não ambíguos de tabagismo e opioides.


Subject(s)
Humans , Male , Female , Adult , Aged , Postoperative Nausea and Vomiting/epidemiology , Analgesics, Opioid/administration & dosage , Models, Theoretical , Neoplasms/surgery , Smoking/epidemiology , Fentanyl/administration & dosage , Risk Factors , Middle Aged
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