ABSTRACT
Objetivo Avaliar recidivas em pacientes com carcinoma endometrial quanto à frequência, localização, sintomas, fatores prognósticos, propedêutica diagnóstica da recidiva e sobrevida livre de doença e após recidiva. Métodos Foram avaliadas 196 mulheres, estádio clínico I, submetidas à cirurgia, com ou sem tratamento adjuvante, no período de janeiro de 1989 a julho de 1996. Utilizou-se o método de Kaplan-Meier e o teste de Wilcoxon. Resultados Quinze por cento das pacientes apresentaram recidivas, sendo 86,6% até 36 meses após a cirurgia e o carcinoma vaginal o mais frequente (40,0%), seguido do pulmonar e linfonodal, que estavam relacionados a fatores de alto risco para recidiva. Metade das pacientes era sintomática e, destas, 46,6% tinham metástases à distância. Os exames clínico e/ou ginecológico alterados orientaram exames complementares em todas as pacientes sintomáticas e dois terços das assintomáticas. O diagnóstico foi feito por ultrassom e Raios X do tórax em um terço das assintomáticas. A citologia oncológica foi dispensável. A presença ou não de sintomas não influenciou na sobrevida livre de doença e pós-recidiva. Apesar da maior sobrevida das pacientes com recidivas vaginais, não houve diferença significativa ao se comparar aos outros sítios de recidiva (p=0,05). Conclusão A maioria das pacientes apresentou recidivas nos primeiros três anos após o tratamento, tinham sinais/sintomas que orientaram a solicitação dos exames complementares e estavam associados a fatores de mau prognóstico. A recidiva mais frequente foi a vaginal e a citologia oncológica foi dispensável. A presença de sintomas e o sítio da recidiva não influenciaram na sobrevida das pacientes. Todos estes resultados devem ser considerados nos protocolos de seguimento.
Objective This study aimed to assess recurrence rate of endometrial cancer regarding frequency, location, symptoms, prognostic factors, diagnostic methods for detecting recurrence, disease-free survival and survival after recurrence. Methods A total of 196 women with clinical stage I were submitted to surgery with or without adjuvant treatment, from January 1989 to July 1996. The Kaplan-Meier method and Wilcoxon test were used. Results Recurrence occurred in 15.0% of the patients, 86.6% up to 36 months after the surgery. Vaginal carcinoma (40.0%) was the most common, followed by pulmonary and lymph node carcinomas, which were associated with risk factors for recurrence. Fifty percent of the patients were symptomatic and 46.6% of these had distance metastases. All of the symptomatic patients and 2/3 of the symptomatic patients had abnormal clinical and/or gynecological examinations, calling for other tests. The diagnosis was made by ultrasound and chest radiograph in 1/3 of the asymptomatic patients. Cancer cytology did not help diagnosis. The presence or absence of symptoms did not influence disease-free survival or survival after recurrence. Despite the longer survival of patients with vaginal recurrence, there was no significant difference when other recurrence sites were compared (p=0.05). Conclusion Recurrence in most of the patients occurred in the first three years after treatment. These patients had signs and/or symptoms which demanded complementary tests and were associated with bad prognostic factors. The most common recurrence was vaginal carcinoma and cancer cytology was not helpful. The presence of symptoms and recurrence site did not influence patient survival. All these results must be considered in the follow-up protocol.
Subject(s)
Humans , Female , Endometrial Neoplasms , Medical History Taking , Neoplasm Recurrence, Local , Survival AnalysisABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
Subject(s)
Algorithms , Antipsychotic Agents/therapeutic use , Pirenzepine/analogs & derivatives , Pirenzepine/therapeutic use , Psychomotor Agitation/drug therapy , Administration, Oral , Antipsychotic Agents/administration & dosage , Benzodiazepines , Humans , Latin America , Mental Health Services , Olanzapine , Pirenzepine/administration & dosageABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
ABSTRACT
Behavioral emergencies are a common and serious problem. However, partly because of the inherent dangers of this situation, there is little research to guide the clinical responses to this challenge. The traditionally accepted treatment for such patients involves the use of a typical antipsychotic and a benzodiazepine. Beside the atypical antipsychotics side-effects profile, the utility of this medications in the emergency setting has been relatively unexplored. The recent availability of rapidly dissolving tablets and intramuscular preparations of some atypical agents has provided useful alternatives in some cases. Not less important is the transition to the continuation and maintenance periods. The increased risk of relapses during the transition from acute treatment is one of the most common reasons for the prolonged use of higher doses of typical antipsychotics during the management of the acute episode, and is also a very important limitating factor to release the patient from the institutional (inpatient) services. Those higher doses expose the patient to potential dangerous side effects like acute dystonia, akathisia, ataxia, ortostatic hypotension and cardiac arhytms. This article proposed an algorithm for the control of agitated patients with different preparations of olanzapine in Latin America, following the recommendations of the Eli Lilly Latin America Advisory Board and an extensive review of the literature and data on file of such company about olanzapine in the control of agitated patients and their transition to the maintenance phase.
