Assuntos
Adolescente , Criança , Pré-Escolar , Humanos , Testes Diagnósticos de Rotina/normas , Medicina Baseada em Evidências , Projetos de Pesquisa/normas , Testes Diagnósticos de Rotina/métodos , Vírus da Influenza A/isolamento & purificação , Vírus da Influenza B/isolamento & purificação , Influenza Humana/diagnóstico , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Background In 2002, we reported the initial results of a trial comparing radical prostatectomy with watchful waiting in the management of early prostate cancer. After three more years of follow-up, we report estimated 10-year results. Methods: From October 1989 through February 1999, 695 men with early prostate cancer (mean age, 64.7 years) were randomly assigned to radical prostatectomy (347 men) or watchful waiting (348 men). The follow-up was complete through 2003, with blinded evaluation of the causes of death. The primary end point was death due to prostate cancer; thesecondary end points were death from any cause, metastasis, and local progression. Results: During a median of 8.2 years of follow-up, 83 men in the surgery group and 106 men in the watchful-waiting group died (P=0.04). In 30 of the 347 men assigned to surgery (8.6 percent) and 50 of the 348 men assigned to watchful waiting (14.4 percent), death was due to prostate cancer. The difference in the cumulative incidence of death due to prostate cancer increased from 2.0 percentage points after 5 years to 5.3 percentage points after 10 years, for a relative risk of 0.56 (95 percent confidence interval, 0.36 to 0.88; P=0.01 by Gray's test). For distant metastasis, the corresponding increase was from 1.7 to 10.2 percentage points, for a relative risk in the surgery group of 0.60 (95 percent confidence interval, 0.42 to 0.86; P=0.004 by Gray's test), and for local progression, the increase was from 19.1 to 25.1 percentage points, for a relative risk of 0.33 (95 percent confidence interval, 0.25 to 0.44; P<0.001 by Gray's test). Conclusions: Radical prostatectomy reduces disease-specific mortality, overall mortality, and the risks of metastasis and local progression. The absolute reduction in the risk of death after 10 years is small, but the reductions in the risks of metastasis and local tumor progression are substantial.
Assuntos
Humanos , Masculino , Idoso , Medicina Baseada em Evidências , Prostatectomia , Neoplasias da Próstata/terapia , Progressão da Doença , Seguimentos , Metástase Neoplásica , Neoplasias da Próstata/mortalidade , Neoplasias da Próstata/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de SobrevidaRESUMO
El siguente artículo es una revisión de la obesidad vista desde la perspectiva de la psiquiatría. Se puede considerar que el transtorno alimentario más prevalente en el mundo actual es la obesidad, a pesar de que está no se encuentre dentro de una clasificación psiquiátrica establecida. Se considara aquí la obesidad como una enfermedad crónica de origen multifactorial caractrizada por un aumento anormal del tejido graso secundario a un aumento de la energía absorbida con respecto a la gastada, que conlleva riesgos para la salud. Se revisa en este artículo desde la epidemiología, etiología, clasificación y diagnóstico de la obesidad hasta sus aspectos psicopatológicos y sociales que permiten considerar a esta enfermedad como un transtorno alimentario. Por último se incluye una reseña del tratamiento multidisciplinario de la obesidad con énfasis en el papel del psiquiatra