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1.
Ann. hepatol ; 16(3): 421-429, May.-Jun. 2017. tab, graf
Artículo en Inglés | LILACS | ID: biblio-887254

RESUMEN

ABSTRACT Background. Evidence supporting benefit of hepatocellular carcinoma (HCC) surveillance in reducing mortality is not well-established. The effect of HCC surveillance in reducing mortality was assessed by an inverse probability of treatment weighting (IPTW)- based analysis controlled for inherent bias and confounders in observational studies. Material and methods. This retrospective cohort study was conducted on 446 patients diagnosed with HCC between 2007 and 2013 at a major referral center. Surveillance was defined as having at least 1 ultrasound test within a year before HCC diagnosis. Primary outcome was survival estimated using the Kaplan-Meier method with lead-time bias adjustment and compared using the log-rank test. Hazard ratio (HR) and 95% confidence interval (Cl) were computed using conventional Cox and weighted Cox proportional hazards analysis with IPTW adjustment. Results. Of the 446 patients, 103 (23.1%) were diagnosed with HCC through surveillance. The surveillance group had more patients with the Barcelona-Clinic Liver Cancer stage A (80.6% vs. 33.8%, P < 0.0001), more patients eligible for potentially curative treatment (73.8% vs. 44.9%, P < 0.0001), and longer median survival (49.6 vs. 15.9 months, P < 0.0001). By conventional multivariate Cox analysis, HR (95% Cl) of surveillance was 0.63 (0.45-0.87), P = 0.005. The estimated effect of surveillance remained similar in the IPTW-adjusted Cox analysis (HR: 0.57; 95% Cl: 0.43-0.76, P < 0.001). Conclusions. HCC surveillance by ultrasound is associated with a 37% reduction in mortality. Even though surveillance is recommended in all guidelines, but in practice, it is underutilized. Interventions are needed to increase surveillance rate for improving HCC outcome.


Asunto(s)
Humanos , Carcinoma Hepatocelular/mortalidad , Carcinoma Hepatocelular/terapia , Carcinoma Hepatocelular/diagnóstico por imagen , Tailandia , Factores de Tiempo , Efecto de Cohortes , Modelos de Riesgos Proporcionales , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Ultrasonografía/normas , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Estimación de Kaplan-Meier , Detección Precoz del Cáncer/métodos , Neoplasias Hepáticas/mortalidad , Neoplasias Hepáticas/terapia , Neoplasias Hepáticas/diagnóstico por imagen , Estadificación de Neoplasias
2.
Artículo en Inglés | IMSEAR | ID: sea-41244

RESUMEN

Spontaneous intestinal hematoma is a rare complication of anticoagulant therapy. The authors reported three cases of intramural and submucosal small bowel hematoma resulting from warfarin administration. The first patient presented with abdominal pain, had intramural hematoma at jejunum, the most common site of intramural small bowel hematoma. Another patient who had submucosal duodenal hematoma presented with massive upper gastrointestinal bleeding, a rare manifestation of small bowel hematoma. The third patient presented with intramural ileal hematoma that caused abdominal pain and palpable mass after a short period of warfarin therapy. Typical findings on abdominal computerized tomography yielded the diagnosis. All patients rapidly improved after conservative treatment. The history of anticoagulant use with prolonged INR value in patients presented with abdominal pain should alert physicians to search for this entity. It is extremely important to recognize this syndrome in order to avoid an unnecessary operation since the outcome is usually excellent after conservative treatment.


Asunto(s)
Dolor Abdominal/etiología , Anciano , Anticoagulantes/efectos adversos , Femenino , Hemorragia Gastrointestinal/inducido químicamente , Hematoma/inducido químicamente , Humanos , Relación Normalizada Internacional , Masculino , Factores de Riesgo , Tailandia , Factores de Tiempo , Warfarina/efectos adversos
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