Assuntos
Angioplastia Coronária com Balão/instrumentação , Fármacos Cardiovasculares/administração & dosagem , Doença da Artéria Coronariana/terapia , Stents Farmacológicos , Metais , Stents , Angioplastia Coronária com Balão/efeitos adversos , Angioplastia Coronária com Balão/economia , Fármacos Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Ensaios Clínicos como Assunto , Doença da Artéria Coronariana/economia , Análise Custo-Benefício , Stents Farmacológicos/economia , Custos de Cuidados de Saúde , Humanos , Inibidores da Agregação Plaquetária/uso terapêutico , Desenho de Prótese , Sistema de Registros , Stents/economia , Resultado do TratamentoAssuntos
Stents Farmacológicos , Doença das Coronárias/mortalidade , Doença das Coronárias/terapia , Reestenose Coronária/prevenção & controle , Trombose Coronária/etiologia , Trombose Coronária/mortalidade , Stents Farmacológicos/efeitos adversos , Stents Farmacológicos/economia , Stents Farmacológicos/normas , Métodos Epidemiológicos , França , Humanos , Infarto do Miocárdio/mortalidade , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/normasRESUMO
PURPOSE: Although important for the diagnosis of familial clustering of colorectal cancer and hereditary nonpolyposis colorectal cancer, the accuracy of familial cancer history assessment in the office setting has been questioned. Furthermore, there are few publications describing the optimal method for accurately capturing a family cancer history. The purpose of this study was to determine how well family cancer history is assessed in patients with early age-of-onset colorectal cancer at initial surgical consultation compared with a telephone interview and mailed questionnaire. METHODS: Medical records of patients 40 years old or younger at the time of colorectal cancer surgery were reviewed for documentation of family cancer history at initial surgical consultation. In addition, family cancer history was solicited from surviving patients or their next of kin by telephone and a mailed questionnaire. The kappa coefficient was used to measure degree of correlation between family cancer history obtained at initial surgical consultation and subsequent telephone interview and questionnaire. RESULTS: One hundred twenty-five patients were available for analysis. Family cancer history was documented on the initial surgical consultation report in 78 percent of cases. Although 31.2 percent were identified as having no family cancer history at initial surgical consultation, this proportion decreased to 13.5 percent after telephone interviews and questionnaires. Family history assessment at initial surgical consultation also failed to identify 7 of 11 individuals meeting Amsterdam criteria for hereditary nonpolyposis colorectal cancer and 10 of 16 individuals meeting modified clinical criteria for hereditary nonpolyposis colorectal cancer. CONCLUSIONS: Although family cancer history was commonly obtained during the initial surgical consultation of patients with colorectal cancer, there was a tendency to underestimate the extent of familial cancer. A telephone interview and questionnaire conducted at a later date may reveal a more comprehensive family cancer history. This is an important observation, because individuals identified as high-risk for hereditary nonpolyposis colorectal cancer or familial clustering of colorectal cancer require special consideration with respect to screening, surveillance, and surgical management.
Assuntos
Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/cirurgia , Neoplasias Colorretais/genética , Neoplasias Colorretais/cirurgia , Saúde da Família , Encaminhamento e Consulta , Adolescente , Adulto , Feminino , Predisposição Genética para Doença/genética , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Inquéritos e QuestionáriosAssuntos
Neoplasias Intestinais , Pólipos Intestinais , Síndromes Neoplásicas Hereditárias , Polipose Adenomatosa do Colo/diagnóstico , Polipose Adenomatosa do Colo/genética , Polipose Adenomatosa do Colo/terapia , Neoplasias Colorretais Hereditárias sem Polipose/diagnóstico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/terapia , Aconselhamento Genético , Testes Genéticos , Síndrome do Hamartoma Múltiplo/diagnóstico , Síndrome do Hamartoma Múltiplo/genética , Síndrome do Hamartoma Múltiplo/terapia , Humanos , Neoplasias Intestinais/diagnóstico , Neoplasias Intestinais/genética , Neoplasias Intestinais/terapia , Pólipos Intestinais/diagnóstico , Pólipos Intestinais/genética , Pólipos Intestinais/terapia , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/terapia , Fatores de RiscoRESUMO
Gauze forgotten at operations can be potentially life threatening, but such cases are seldom reported because of the medicolegal implications. We have presented a series of seven patients with long-term surgical gauze retention, four after pelvic operations, one after cholecystectomy, one after laryngectomy, and one after mastectomy. The median time interval between operation and gauze removal was 5 years. In three patients this was diagnosed as a tumoral mass, in three as an intestinal occlusion, and in one the gauze was found incidentally. All foreign bodies were removed and no patient died. The clinical and diagnostic aspects of retained surgical gauze have been discussed and the need for radiopaque markers in them have been emphasized.
