Câncer de pulmão e retardo no diagnóstico: análise de 300 casos / Lung cancer and the delay in the diagnosis: analysis of 300 cases

This is a prospective study involving 300 persons with lung cancer admitted to the "Arnaldo Vieira de Carvalho" Cancer Institute (ICAVC). The intention of the survey was to detect delay in diagnosis after the initial symptoms. THe authors tried to identify causes of this delay and its implications. Patients were asked about the day that the symptoms started, medical care and specialists sought, number of physicians seen and their diagnosis, also examinations carried out and referrals. Results showed that 78 of cases were seen firstly by general practitioners and 69.6 looked for medical assistance at least 30 days after the clinical beginning of the disease. Chest X-rays could identify only 9 cases (3) without symptoms. The most common clinical diagnoses were: pneumonia (20), neoplasia (19), bronchitis/emphysema (9.3) and tuberculosis (8). The number of first appointments seen by the Public Health Services and Contracted Private Hospital Network was 64.1 and the second appointment was 70. Only 24 (8) of the patients were referred to ICAVC just after their first appointment and 64.4 after the third. The time lost between the first appointment and the diagnosis was longer than 90 days in 55.7 of cases. These people needed to see 3 to 4 doctors (as an average) to obtain a positive diagnosis. The diagnostic techniques used more frequently were bronchoscopy (59.7) and fine needle lung biopsy (18.4) and the delay was 20 and 10 days on average, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Timectomia. / Thymectomy

Os autores apresentam sete pacientes com miastenia gravis submetidos a tratamento cirurgico da Faculdade de Medicina de Mogi das Cruzes no periodo 1981-1983. A idade dos pacientes variou de 26 a 62 anos; o sexo feminino, em quatro, e a cor branca, em cinco, amarela, em um, e preta, em um.Cinco dos pacientes apresentavam forma generalizada moderada da doenca; um, generalizada intensa fulminante, e um, forma ocular pura, de acordo com a classificacao proposta por Osserman. O tempo de inicio dos sintomas e a cirurgia variou de quatro meses a seis anos. Cinco pacientes tinham grande limitacao funcional decorrente de fraqueza e insuficiencia respiratoria, enquanto que dois exibiam incapacidades relativas para os afazeres domesticos ou profissionais devido a ptose palpebral bilateral permanente. Todos tomaram anticolinesterasicos no periodo pre-operatorio, sendo que, em tres, foi realizada imunossupressao com 80 a 100mg diarios de predmisona durante 15 a 20 dias.Sao apresentados os dados clinicos, cirurgicos e a evolucao pos-operatoria dos pacientes