Retrospective analysis of clinical manifestations and treatment outcomes of patients diagnosed with langerhans cell histiocytosis from a tertiary cancer hospital in South India

Background: Langerhans cell histiocytosis (LCH) comprises a diverse group of disorders where pathologic Langerhans cells accumulate in a variety of organs. Aims and objectives of the study is to analyse the clinical manifestations and treatment outcomes of patients diagnosed with LCH in a tertiary cancer hospital in South India.Methods: Retrospective analysis of the case records of patients presenting with histological proven case of LCH over a period of 7 years from 2011 to 2018, being treated at Vydehi Institute of Medical Sciences and Research Centre.Results: 10 patients with biopsy proven LCH were included. The median age of diagnosis was 8 years (range 1 to 73 years) and 3 patients aged 18 years or older at the time of diagnosis. The male: female ratio was 3:2. Multisystem involvement was found in 4 patients (40%) and Single system Involvement in remaining 6 patients. Isolated bone lesions were found in 4 patients (40%), 1 patient had isolated Lymph node involvement; 1 patient had oral cavity lesion. None of the 4 patients with multisystem diseases had skin/mucosal involvement; 3 had bony involvement, 2 patients had lung involvement. One patients with multisystem disease expired while 5 patients were lost to follow-up. 4 out of the 10 patients are on regular follow-up and are in remission.Conclusions: Despite limitation by the retrospective nature, this descriptive study was done to provide further disease information regarding Indian population. Data from this study clearly confirms the known fact that most of the patients with Single System LCH have a very good response rate. Patients with multisystem disease have the highest risk of disease related mortality and morbidity as one among the 4 patients with multisystem disease died just after initiating treatment.

Clinical analysis of 112 patients with single-system Langerhans cell histiocytosis / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics,treatment and prognosis of single-system Langerhans cell histiocytosis (LCH) in children.Methods A retrospective analysis was performed in single-system LCH patients registered between January 2006 and December 2012 in Beijing Children＇s Hospital Affiliated to Capital Medical University.The patients were divided into 2 groups:the bone involvement group and the other organ involvement group.The patients were assessed at 5 weeks,11 weeks,25 weeks,3 months,6 months,1 year and 3 years.The data were analyzed by using SPSS 17.0 software.Results A total of 112 patients (66 boys and 4,6 girls) with a median age of 5 years at diagnosis of LCH were analyzed.The most frequently affected organ was the bones(91 cases,81.3％),followed by skin(15 cases,13.4％).Few patients (27.6％) had acentral nervous system risk lesion,who were younger than those with other bone lesion(2.5 years vs 6.6 years).Patients with bone lesions were diagnosed at a significantly older age than other patients(5.6 years vs 1.5 years) (P ＜ 0.01).All patients received chemotherapy that included Prednisone and Vinblastine for 25 weeks.Twenty-five patients (22.3 ％) showed reactivation.Of these,4 patients exhibited reactivation in the pituitary.Three-year overall survival rate was expected to reach 100％,and no-event survival was expected at (73.22 ± 4.47) ％.Age of less than 2 years old was the factor of reactivation (P =0.033);sex,organ involvement and member of bone involved were not related with reactivation (P =0.679,0.142,0.639).Conclusions The bones were the frequent involvement organ in single-system LCH patients.These patients have a good prognosis.The rate of reactivation of single system-LCH can be decreased by chemotherapy.

Progress in the treatment of Langerhans cell histiocytosis / 临床儿科杂志

Treatment of Langerhans cell histiocytosis (LCH) needs to be tailored for each individual patient according to LCH classiifcation currently. Single-system LCH (SS-LCH) has an excellent prognosis. However, there is a poor prognosis in multisystem LCH (MS-LCH) with risk organs (RO) involvement and refractory or recurrent LCH (Re-LCH). The prognosis of MS-LCH with RO involvement and Re-LCH has been improved markedly accompanying with progress of chemotherapy in recent years. The 5-year survival rate of MS-LCH reached above 80%, and the effective rate of Re-LCH reached above 60% after chemotherapy. Re-LCH can be cured by hematopoietic stem cell transplantation.

Gestão unificada do sistema único de saúde e do sistema único de assistência social em Pindamonhangaba, São Paulo, Brasil, no período de 2005 a 2008 / Shared management of the unified health system and the unified social services in Pindamonhangaba, São Paulo, Brasil, from 2005 to 2008

Este estudo considera como ponto de partida a Constituição Federal de 1988 onde no capítulo da Seguridade Social os direitos do cidadão na saúde, assistência social e na previdência social foram garantidos. Objetiva descrever e analisar o processo de gestão unificada, de dois sistemas públicos relacionados com a proteção e exercício de direitos sociais, o de saúde (SUS) e de assistência social (SUAS), segundo os componentes do financiamento, planejamento, gestão do trabalho e descrever a participação do controle social neste processo, dentro do centro integrado de saúde e assistência social (CISAS) em Pindamonhangaba, no período de 2005 a 2008. Utiliza como procedimentos metodológicos a pesquisa qualitativa descritiva, do tipo de estudo de caso onde foi realizada coleta de dados secundários para análise de estratégias para unificar o SUS e o SUAS no CISAS, um equipamento de atenção básica onde a estratégia de saúde da família e o centro de referencia de assistência social atendem aos usuários dentro dos preceitos legais, na lógica da territorialização. Concluiu-se que a equipe gestora se empenhou em realizar uma gestão unificada mais não consolidou a proposta do trabalho unificado junto aos funcionários e a população, e encontra dificuldade para unificar políticas publicas que já se separaram em outras esferas de governo.

This study considers as a starting point the 1988 Federal Constitution, in which the rights of citizens health, social care and social welfare have been assured. It aims to describe and analyze the process of unified management of two public systems, related to protection and social rights, the Health System (SUS) and the Social Care (SUAS), according to the financing, planning and work management components and to describe the participation of the social control in this process, inside the Integrated Center for Health and Social Care (CISAS) in Pindamonhangaba, in the period of 2005 to 2008. As methodological procedures, it uses the descriptive qualitative research, such as the case study in which the secondary data have been collected in order to analyze the strategies to unify the SUS and the SUAS in the CISAS, a primary health care tool where the strategy of Familys Health and the Social Care Reference Center attend the users, according to the legal guidelines, following the logic of municipal territorialization. It has been concluded that the management team made efforts to perform an integrated and coordinated management, but it did not consolidated the proposal of unified network with the work-team and the population, and is finding difficulties to unify the public policies that have already been separated in other government levels.

Humanização nos hospitais: reforma na gestão e nas práticas de saúde no contexto de produção de novos sujeitos / Hospital humanization: changes in the management and in the health care practices producing new subjects

O artigo tem por objetivo apresentar a Política Nacional de Humanização (PNH), fundamentando, entre outros, sua opção pelo método da inclusão, como orientação ético-política de seu modo de fazer, seu modo de lidar com problemas e desafios que permanecem no campo da gestão e do cuidado. A partir dessa explicitação, são apresentados alguns elementos e forças responsáveis pela produção de problemas importantes no campo da gestão dos processos de trabalho nos hospitais, os quais incidem na emergência de fenômenos adjetivados de "desumanizaçào" da gestão e do cuidado. Por fim, no cerne destas questões, apresentam-se algumas "pistas" para ação institucional no contexto hospitalar, na perspectiva de se lidar com essas situações problemáticas, a partir do pressuposto de que seu enfrentamento, contorno, ultrapassagem e resolução são mais estáveis e ganham novas possibilidades quando resultam de processos coleti- vos, portanto, quando acionados pelo método da inclusão proposto pela PNH...

The article aims is to introduce the National Humanization Policies / Política Nacional de Humanização (PNH), as the basis, among others, for its option for the inclusion method, as ethical-political guidelines of its way of doing, way of dealing with problems and challenges in the field of management and care. From this explanation, some ele- ments and forces are presented, which are responsible for important problems in the field of management of hospital work processes related to the emergency of the phenomena of management and care "dehumanization". Finally, in the core of these issues, some "clues" are presented for the institutional action in the hospital context, to solve these problematic situations, assuming that the lineament, overcoming and resolution of these situations are more stable and acquire new possibilities when generated as a collective process, therefore, with the Inc/usion Method proposed by PNH...

Estratégias para humanização propostas pelos alunos do quarto ano do curso de Odontologia da Universidade Estadual de Maringá / Humanization strategies proposed by the fourth year students at Maringá State University Dentistry course

A explanação proposta neste artigo está apoiada nas estratégias desenvolvidas pelos alunos do quarto ano do curso de Odontologia da Universidade Estadual de Maringá (UEM) no ano de 2009. A eles foi proposto que, organizados em grupos, criassem alternativas embasadas nos princípios da Política Nacional de Humanização (PNH), para melhorar, em amplos aspectos, a qualidade dos serviços desenvolvidos na Clínica Odontológica da UEM. Simultaneamente a essa ação, sucedeu-se um curso de extensão que abordou o tema "hurnanizaçào", tendo como um dos objetivos principais a formação de um Grupo de Trabalho em Humanização (GTH) composto de alunos, servidores e docentes e que contou com o suporte de uma consultora do Ministério da Saúde (MS). Tais iniciativas têm sido articuladas em resposta a um cenário de contínua transformação na formulação e condução das políticas de saúde no MS, assim como na criação e implantação da PNH. Atualmente, acompanham-se os desdobramentos dessas estratégias na rotina da Clínica Odontológica da UEM para saber se os princípios construídos nessas experimentações poderão se reverter em melhor qualidade para o ensino e a prestação de serviços odontológicos no ambiente universitário...

This article is based on the strategies developed by the fourth year students at the Odontology course of the State University of Maringá (VEM) in 2009. ft was proposed that, in groups, they created alternatives based on lhe Político Nacional de Humanização (PNH) / National Humanization Policies (NHP), to great/y improve the quality of the services developed by the UEM Odontologic Clinic. Sirnultaneously an extension course was held approaching the theme "Humanization", having as one of the main objectives the formation of a Humanization Work Group / Grupo de Trabalho em Humanização (GTH) including students, staff and teachers, which had the support of the Ministry of Health consultant. Such initiatives have been articulated in response to scenery of continuous change in the formulation and procedures of the MS health core policies, as well as in the creation and implementation of the National Health Policies. Currently, the effects of these strategies in the routine of the State Unioersity of Maringa Dental Clinic may be followed to find out if the concepts built by the experimentation can improve the quality of teaching and dental services in the University environment...

Clinical Observation of the Ureterocele: 29 Cases / 대한비뇨기과학회지

Ureterocele, congenital dilatation of the terminal or intramural portion of the ureter, may be classified as either simple or ectopic and has a broad spectrum of presentation, anatomy and treatment must be individualized. From February, 1986 to March, 1994, our experiences with 8 single system ureteroceles and 12 duplex system ureteroceles were reviewed. Their presentation, radiographic findings, operative management and postoperative results were discussed. The patients in this series were distribution from 1 year old to 66 years old and the male and female ratio was 4:16. The most presenting symptom was flank pain, affecting 7 cases, and ureterocele was associated with ureteral stone: 7 cases, VUR: 2 cases, renal cyst: 1 case, and IgA nephropathy:1 case. In 8 cases of single system ureterocele, Transurethral incision(TUI) of ureterocele in 1 case, ureterocelectomy with ureteroneocystostomy in 3 cases were done. In 12 cases of duplex system ureterocele, TUI of ureterocele in 2 cases, heminephrectomy with partial ureterocelectomy in 2 cases were done. After operation was done, there was no evidence of complication. We conclude that the surgical approach to the problems associated with a ureterocele is modified by patient age, renal anomaly and the pathological condition of the lower urinary tract.