ABSTRACT
The congress of the International Society for Pharmacoeconomics and Outcomes Research is one of the main worldwide forums for the dissemination of research and knowledge on healthcare economics. Brazil is the largest country in Latin America, with a per-capita gross domestic product of $15 200 in 2017 and healthcare expenditure of the order of $1 318 per inhabitant. Brazilian specialists participated actively in the society's latest congress, which took place in Boston, Massachusetts, from May 20 to 24, 2017. They met to discuss the main topics dealt with at the congress and their applicability to Brazilian realities. The topics chosen were precision medicine, new challenges for economic modeling within oncology and immuno-oncology, data to aid in managerial decision making (ie, data from real-world studies), and, lastly, strategies for accessing high-cost medications in Brazil. This opinion article sought to report the main conclusions and consensus reached by this group of specialists on the occasion of this discussion.
Subject(s)
Medical Oncology , Private Sector , Antineoplastic Agents/economics , Antineoplastic Agents/therapeutic use , Brazil , Congresses as Topic , Drug Costs , Economics, Pharmaceutical , Health Policy , Humans , Medical Oncology/economics , Medical Oncology/organization & administration , Neoplasms/drug therapy , Neoplasms/economics , Neoplasms/therapy , Policy Making , Private Sector/economics , Private Sector/organization & administrationABSTRACT
A doença por refluxo gastroesofágico (DRGE) é uma entidade relativamente recente que vem se tornando freqüente na prática clínica, haja vista que responde por 75% das doenças de esôfago. A introdução rotineira de métodos investigatórios mais apurados, como a pHmetria de 24 horas e a esofagomanometria, aliadas à endoscopia com biópsia, trouxeram ao cirurgião dados que lhe permitiram utilizar com segurança a videolaparoscopia na cura cirúrgica desta afecção. A confecção de válvulas anti-refluxo, parciais ou totais, proporcionam resultados bastante animadores. Na série apresentada, foram estudados 30 pacientes operadospor videolaparoscopia, num período de 36 meses, com excelentes resultados, sendo que apenas um paciente, após seis meses de cirurgia, apresentou, à endoscopia de controle, hérnia de hiato, com esofagite leve, mas absolutamente assintomática. Concluindo, os resultados mostraram que a fundoplicatura por vialaparoscópica é um método seguro para a cura da doença por refluxo gastroesofágico, estando indicada emsuas complicações e em pacientes refratários ao tratamento clínico, pelo baixo índice de morbimortalidadeapresentado.
The aim of this study is to show the effectiveness of videolaparoscopic fundoplication as the definitive treatment of GERD. From April 1996 to April 1999, 30 patients underwent fundoplication and hiatoplasty for the treatment of reflux esophagitis through videolaparoscopy. Sixteen (53%) were males and 14 (46%) females. The mean age was 44.1, ranging from 3 to 70 years old. Indications for surgery wererefractory GERD after prolonged clinical treatment and paraesophageal hernia with hemorrhage (0.3%). Five trocars were employed for each surgical procedure. Hiatoplasty was performed with 00 cotton sutures, wrapping with a X both arms of the diaphragmatic pillars. For fundoplication, after the tranpositionof the gastric fundus behind the abdominal portion of the esophagus, an inicial suture was set on the two gastric extremities of the anterior wall, without passing through the esophagus. Then, another 2 or 3 sutures, now including the esophagus, completing the valve. There was no mortality, convertion orcomplications inherent to the method. We conclude that videolaparoscopic fundoplication is a safe procedurefor the definitive treatment of GERD, and provides the advantages of a simple surgical technique, with a low incidence of complications.
ABSTRACT
Os autores descrevem um caso de paracoccidioidomicose anal, uma localizaçäo rara, dando ênfase ao seu quadro clínico, anatomopatológico e tratamento exclusivo com sulfadiazina
