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1.
Pediatr Blood Cancer ; 63(4): 604-10, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26702872

RESUMO

BACKGROUND: Ewing sarcoma (EWS) of the head and neck is rare. Multimodal treatment consists of chemotherapy and local treatment; however, local treatment for EWS of the head and neck is challenging. The first objective was to describe local treatment administered to the patients with localized EWS of the head and neck according to the EURO-E.W.I.N.G.99-trial, and to assess the impact on survival. The second objective was to systematically review the scientific literature available for this topic. PROCEDURE: Fifty-one patients were included. Local control consisted of surgery and/or radiotherapy (RT). Event-free survival (EFS) and overall survival (OS) were determined. Outcome was analyzed by comparing local treatment approaches. A Medline search was performed for EWS of the head and neck. RESULTS: Eighty-six percent of patients had localized disease. Most common primary sites included the skull (45%), maxilla (14%), and mandible (12%). Three-year EFS was 74% and 3-year OS was 87% for patients with localized disease. EFS was 40% for patients >15 years compared to 81% for patients <15 years. Local control consisted of surgery (S; 33%), RT (18%), or S + RT (45%). Related 3-year EFS was 81% (S), 80% (RT), and 72% (S + RT); 3-year OS was 80%, 76%, and 81%, respectively. CONCLUSIONS: In patients with EWS of the head and neck, age, and stage are important prognostic factors. Although not statistically significant, large tumor volume seems to be a negative prognostic factor. No difference in EFS and OS could be found when comparing patients treated with surgery, RT, or combined surgery and RT.


Assuntos
Neoplasias Ósseas/terapia , Terapia Combinada/métodos , Neoplasias de Cabeça e Pescoço/terapia , Sarcoma de Ewing/terapia , Adolescente , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Intervalo Livre de Doença , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Procedimentos Ortopédicos , Modelos de Riscos Proporcionais , Radioterapia , Radioterapia Adjuvante/métodos , Fatores de Risco , Sarcoma de Ewing/mortalidade , Sarcoma de Ewing/patologia , Resultado do Tratamento , Adulto Jovem
2.
Int J Hyg Environ Health ; 211(1-2): 205-12, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17692566

RESUMO

Colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a risk factor for MRSA infection causing increased costs in patient's care and treatment. To evaluate cost efficiency, pre-admission MRSA screening and subsequent MRSA decolonization of patients admitted to the Department of General Surgery at the University Hospital of Münster were determined. In 2004, 2054 (89.3%) out of the total of 2299 hospital-admitted patients were screened for MRSA (1769 elective and 530 direct admissions); 1536 patients underwent pre-admission MRSA screening (86.8% of the 1769 elective admissions), of whom seven patients (0.5%) were MRSA-positive and five of these were successfully decolonized before admission. In case of direct admissions, i.e., emergency cases or transferral from other hospitals, 2.4% and 8.6% were MRSA-positive, respectively. There were 25 patients MRSA positive during their hospital stay, two of these were nosocomially acquired, which represent 0.1 nosocomial MRSA cases in 1000 in-patients. The average MRSA carrier was (65+/-15 years) older than the other patients (55+/-17 years), had a significantly higher rate of pulmonary disease, coronary heart disease and certain infections; and had a longer hospital stay (27 versus 10 days, p<0.05). The total costs of the MRSA screening were approximately 20,000 euro. Since the estimated costs for handling MRSA treatment and isolation during a hospital stay are 6000-10,000 euro for each affected patient, we estimated that approximately 20,000 euro could be saved by detecting and successfully decolonizing a total of five patients through pre-admission screening. In this calculation, additional costs due to the increased morbidity and mortality of MRSA carriers and the possible spread of MRSA through unrecognized colonization were not included. In conclusion, pre-admission screening for MRSA is an effective method to reduce the hospital burden of MRSA-colonized patients and the savings due to consistent decolonization before elective admission outweigh the costs of screening.


Assuntos
Infecção Hospitalar/prevenção & controle , Custos Hospitalares , Programas de Rastreamento/economia , Resistência a Meticilina , Admissão do Paciente , Infecções Estafilocócicas/prevenção & controle , Idoso , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Análise Custo-Benefício , Infecção Hospitalar/economia , Alemanha/epidemiologia , Humanos , Pessoa de Meia-Idade , Vigilância da População/métodos , Infecções Estafilocócicas/economia , Infecções Estafilocócicas/epidemiologia , Procedimentos Cirúrgicos Operatórios
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