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[PMID]:29016508
[Au] Autor:Smid MC; Dotters-Katz SK; Grace M; Wright ST; Villers MS; Hardy-Fairbanks A; Stamilio DM
[Ad] Endereço:Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina; the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa.
[Ti] Título:Prophylactic Negative Pressure Wound Therapy for Obese Women After Cesarean Delivery: A Systematic Review and Meta-analysis.
[So] Source:Obstet Gynecol;130(5):969-978, 2017 Nov.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To summarize available studies on wound complication outcomes after prophylactic negative pressure wound therapy for obese women (body mass index 30 or greater). DATA SOURCES: We conducted a systematic review and meta-analysis using electronic database search (PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Google scholar, and Web of Science), Cochrane, and trial registries including ClinicalTrials.gov. METHODS OF STUDY SELECTION: We conducted an electronic search of research articles from 1966 to January 2017 for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies of negative pressure wound therapy compared with standard dressing after cesarean delivery among obese women. Our primary outcome was defined as a composite of wound complication, including wound or surgical site infection, cellulitis, seroma, hematoma, wound disruption, or dehiscence. For cohort studies and RCTs, we performed a descriptive systematic review. For available RCTs, we performed a meta-analysis and pooled risk ratios using a random-effects model. We assessed for heterogeneity using χ test for heterogeneity and I test. We assessed for publication bias using a funnel plot. TABULATION, INTEGRATION, AND RESULTS: Of 10 studies meeting eligibility criteria, five were RCTs and five were cohort studies. Results of cohort studies were varied; however, all had a high potential for selection bias. In the meta-analysis, there was no difference in primary composite outcome among those women with negative pressure wound therapy (16.8%) compared with those who had standard dressing (17.8%) (risk ratio 0.97, 95% CI 0.63-1.49). There was no statistically significant heterogeneity (χ test 4.80, P=.31, I=17%). CONCLUSION: Currently available evidence does not support negative pressure wound therapy use among obese women for cesarean wound complication prevention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: International prospective register of systematic reviews, 42016033948.
[Mh] Termos MeSH primário: Cesárea/métodos
Tratamento de Ferimentos com Pressão Negativa/métodos
Obesidade/cirurgia
Complicações Pós-Operatórias/prevenção & controle
Complicações na Gravidez/cirurgia
Procedimentos Cirúrgicos Profiláticos/métodos
Ferida Cirúrgica/terapia
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Feminino
Seres Humanos
Obesidade/complicações
Complicações Pós-Operatórias/etiologia
Gravidez
Complicações na Gravidez/etiologia
Ferida Cirúrgica/etiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002259


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[PMID]:28885426
[Au] Autor:Dilley SE; Straughn JM; Leath CA
[Ad] Endereço:Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
[Ti] Título:The Evolution of and Evidence for Opportunistic Salpingectomy.
[So] Source:Obstet Gynecol;130(4):814-824, 2017 Oct.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In the absence of significant benefit from either novel therapeutics or screening, the focus of decreasing ovarian cancer incidence and mortality has shifted toward primary prevention. Histopathologic data have demonstrated that up to 70% of ovarian cancers may actually arise from the fallopian tube. This has led to the increased adoption of opportunistic salpingectomy as a tool for ovarian cancer prevention. In turn, the potential surgical risks and ovarian cancer prevention of this emerging practice have generated multiple studies. In this comprehensive review, we address the origins of ovarian cancer, the historical context and recent trends of tubal surgery, the existing population-based data on ovarian cancer risk reduction, and provide a detailed review of the evidence on surgical risks of salpingectomy. To date, the safety and ovarian cancer risk reduction evidence sheds a positive light on opportunistic salpingectomy. Although research on this subject has grown substantially in recent years, there remains a paucity of large, prospective studies that examine clinical outcomes.
[Mh] Termos MeSH primário: Histerectomia/utilização
Neoplasias Ovarianas/prevenção & controle
Padrões de Prática Médica
Procedimentos Cirúrgicos Profiláticos/utilização
Salpingectomia/utilização
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Neoplasias Ovarianas/mortalidade
Estados Unidos
Serviços de Saúde da Mulher
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002243


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[PMID]:28638008
[Au] Autor:Lednev PV; Belov YV; Komarov RN; Stonogin AV; Katkov AI
[Ad] Endereço:Petrovsky Russian Research Center of Surgery.
[Ti] Título:[The results of pulmonary veins isolation to prevent postoperative atrial fibrillation].
[Ti] Título:Rezul'taty radiochastotnoi abliatsii ust'ev legochnykh ven kak metoda profilaktiki posleoperatsionnoi fibrilliatsii predserdii..
[So] Source:Khirurgiia (Mosk);(6):16-21, 2017.
[Is] ISSN:0023-1207
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To compare an efficacy of primary surgical (epicardial bipolar pulmonary veins isolation) and pharmacological (amiodarone) prevention of postoperative atrial fibrillation. MATERIAL AND METHODS: The study included 117 patients with coronary artery disease without previous paroxysms of atrial fibrillation who were randomized into 3 groups. The first (I) group (n=39) included patients who underwent coronary artery bypass grafting without radiofrequency ablation of pulmonary veins and prophylactic amiodarone administration. The second (II) group (n=38) consisted of patients who received amiodarone as a prevention of postoperative atrial fibrillation. In the third (III) group (n=40) simultaneous CABG and pulmonary veins isolation were made. RESULTS: The incidence of atrial fibrillation in early postoperative period was significantly lower in the 3rd group compared with control group (90% vs 69.2%, p=0.021). 1-year freedom from atrial fibrillation was 97.5% in group III vs. 84.2% in group II (p=0.004). In group I the incidence of early postoperative atrial fibrillation was 30.8% with following decrease to 17.9% in 12 months. CONCLUSION: Simultaneous preventive pulmonary veins isolation during CABG is safe and effective, significantly reduces duration of hospital-stay and incidence of postoperative atrial fibrillation.
[Mh] Termos MeSH primário: Amiodarona/uso terapêutico
Fibrilação Atrial
Ablação por Cateter/métodos
Quimioprevenção/métodos
Ponte de Artéria Coronária/efeitos adversos
Complicações Pós-Operatórias/prevenção & controle
Procedimentos Cirúrgicos Profiláticos/métodos
[Mh] Termos MeSH secundário: Idoso
Antiarrítmicos/uso terapêutico
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/etiologia
Fibrilação Atrial/prevenção & controle
Ponte de Artéria Coronária/métodos
Doença da Artéria Coronariana/cirurgia
Feminino
Seres Humanos
Cuidados Intraoperatórios/métodos
Tempo de Internação/estatística & dados numéricos
Masculino
Meia-Idade
Veias Pulmonares/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-Arrhythmia Agents); N3RQ532IUT (Amiodarone)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170623
[St] Status:MEDLINE
[do] DOI:10.17116/hirurgia2017616-21


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[PMID]:28577884
[Au] Autor:Dilley SE; Havrilesky LJ; Bakkum-Gamez J; Cohn DE; Michael Straughn J; Caughey AB; Rodriguez MI
[Ad] Endereço:Department of Obstetrics and Gynecology, Oregon Health and Science University, Mail Code L-466, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States. Electronic address: sedilley@uabmc.edu.
[Ti] Título:Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention.
[So] Source:Gynecol Oncol;146(2):373-379, 2017 Aug.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Data suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. METHODS: We created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. RESULTS: In the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. CONCLUSIONS: Opportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.
[Mh] Termos MeSH primário: Histerectomia/métodos
Neoplasias Ovarianas/prevenção & controle
Procedimentos Cirúrgicos Profiláticos/métodos
Salpingectomia/métodos
Esterilização Tubária/métodos
[Mh] Termos MeSH secundário: Adulto
Análise Custo-Benefício
Feminino
Seres Humanos
Histerectomia/economia
Laparoscopia/economia
Laparoscopia/métodos
Meia-Idade
Modelos Econômicos
Método de Monte Carlo
Neoplasias Ovarianas/economia
Complicações Pós-Operatórias/economia
Complicações Pós-Operatórias/epidemiologia
Procedimentos Cirúrgicos Profiláticos/economia
Anos de Vida Ajustados por Qualidade de Vida
Programa de SEER
Salpingectomia/economia
Esterilização Tubária/economia
Doenças Uterinas/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170605
[St] Status:MEDLINE


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[PMID]:28411387
[Au] Autor:McLean T; Kerr SJ; Giddings CEB
[Ad] Endereço:Department of Otolaryngology and Head and Neck Surgery, Monash Health, Victoria, Australia.
[Ti] Título:Prophylactic dissection of level V in primary mucosal SCC in the clinically N positive neck: A systematic review.
[So] Source:Laryngoscope;127(9):2074-2080, 2017 Sep.
[Is] ISSN:1531-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To review the evidence for level V dissection in the management of previously untreated mucosal squamous cell carcinoma (SCC) of the head and neck presenting with nodal metastasis when level V is clinically uninvolved. DATA SOURCE: The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) were used to conduct a systematic review of the current literature, including all English language articles published after 1990. A literature search was performed on November 29, 2015, of Medline, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. REVIEW METHODS: The search yielded a total of 270 papers. Strict inclusion and exclusion criteria were applied, leaving 20 eligible papers. Overall prevalence was calculated using random effect meta-analysis. RESULTS: The overall prevalence of level V occult disease in the node (N)-positive neck, irrespective of subsite, was 2.56% (95% confidence interval 1.29-3.84) (2,368 patients and 2,533 necks). The prevalence of occult level V metastasis was up to 7.7% for oral cavity and 8.3% for oropharyngeal tumors. Five studies reported regional recurrence rates over variable time periods. There is exceedingly limited data on outcomes, such as spinal accessory nerve function, quality of life, and perioperative complications. CONCLUSION: Mucosal head and neck SCC presenting with nodal metastasis but with level V clinically uninvolved has a low prevalence of occult level V disease. Routine dissection of level V does not appear to be warranted; however, a definitive conclusion is unable to be drawn due to limited data on morbidity and oncological outcomes. Laryngoscope, 127:2074-2080, 2017.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/cirurgia
Neoplasias de Cabeça e Pescoço/cirurgia
Metástase Linfática/prevenção & controle
Esvaziamento Cervical/métodos
Neoplasias Epiteliais e Glandulares/cirurgia
Procedimentos Cirúrgicos Profiláticos/métodos
[Mh] Termos MeSH secundário: Carcinoma de Células Escamosas/patologia
Neoplasias de Cabeça e Pescoço/patologia
Seres Humanos
Linfonodos/patologia
Linfonodos/cirurgia
Neoplasias Bucais/patologia
Neoplasias Bucais/cirurgia
Pescoço
Estadiamento de Neoplasias
Neoplasias Epiteliais e Glandulares/patologia
Neoplasias Orofaríngeas/patologia
Neoplasias Orofaríngeas/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170915
[Lr] Data última revisão:
170915
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170416
[St] Status:MEDLINE
[do] DOI:10.1002/lary.26573


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[PMID]:28390820
[Au] Autor:Havrilesky LJ; Moss HA; Chino J; Myers ER; Kauff ND
[Ad] Endereço:Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Duke University Medical Center, United States; Department of Obstetrics and Gynecology, Duke University Medical Center, United States; Duke Cancer Institute, Durham, NC 27710, United States. Electronic address: havri001@mc.du
[Ti] Título:Mortality reduction and cost-effectiveness of performing hysterectomy at the time of risk-reducing salpingo-oophorectomy for prophylaxis against serous/serous-like uterine cancers in BRCA1 mutation carriers.
[So] Source:Gynecol Oncol;145(3):549-554, 2017 Jun.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To estimate the survival benefit and cost-effectiveness of performing hysterectomy during risk-reducing salpingo-oophorectomy (RRSO) for BRCA1 mutation carriers. METHODS: Based on a recent prospective cohort study indicating an elevated incidence of serous/serous-like uterine cancers among BRCA1 mutation carriers, we constructed a modified Markov decision model from a payer perspective to inform decisions about performance of hysterectomy during RRSO at age 40. We assumed patients had previously undergone a risk-reducing mastectomy and had a residual risk of death from breast or ovarian cancer. Disease-specific survival, age-adjusted competing hysterectomy rates, and deaths from other causes were incorporated. Costs of risk-reducing surgery, competing hysterectomy, and care for serous/serous-like uterine cancer were included. RESULTS: A 40year old woman who undergoes RRSO+Hysterectomy gains 4.9 additional months of overall survival (40.38 versus 39.97 undiscounted years) compared to RRSO alone. The lifetime probabilities of developing or dying from serous/serous-like uterine cancer in the RRSO group are 3.5% and 2%, respectively. The RRSO alone strategy has an average cost of $9013 compared to $8803 for RRSO+Hysterectomy, and is dominated (less effective and more costly) when compared to RRSO+Hysterectomy. In an alternative analysis, delayed hysterectomy remains a cost-effective prevention strategy with an ICER of less than $100,000/year for up to 25years following RRSO at age 40. CONCLUSIONS: The addition of hysterectomy to RRSO in a 40year old BRCA1 mutation carrier results in a mean gain of 4.9 additional months of life and is cost-effective.
[Mh] Termos MeSH primário: Cistadenocarcinoma Seroso/prevenção & controle
Genes BRCA1
Mutação em Linhagem Germinativa
Histerectomia/economia
Procedimentos Cirúrgicos Profiláticos/economia
Neoplasias Uterinas/prevenção & controle
[Mh] Termos MeSH secundário: Adulto
Idoso
Análise Custo-Benefício
Cistadenocarcinoma Seroso/economia
Cistadenocarcinoma Seroso/genética
Cistadenocarcinoma Seroso/mortalidade
Feminino
Seres Humanos
Histerectomia/métodos
Cadeias de Markov
Meia-Idade
Modelos Estatísticos
Ovariectomia/economia
Ovariectomia/métodos
Procedimentos Cirúrgicos Profiláticos/métodos
Estados Unidos/epidemiologia
Neoplasias Uterinas/economia
Neoplasias Uterinas/genética
Neoplasias Uterinas/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170410
[St] Status:MEDLINE


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[PMID]:28334425
[Au] Autor:Long Roche KC; Abu-Rustum NR; Nourmoussavi M; Zivanovic O
[Ad] Endereço:Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
[Ti] Título:Risk-reducing salpingectomy: Let us be opportunistic.
[So] Source:Cancer;123(10):1714-1720, 2017 May 15.
[Is] ISSN:1097-0142
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Because there is no screening test for ovarian cancer, effective prevention strategies may be the best way to reduce the mortality of this most lethal gynecologic malignancy. Increasing evidence supports the hypothesis that the fallopian tube is the site of origin for the vast majority of high-grade serous carcinomas. Our growing understanding of the pathogenesis of this disease offers a rare opportunity to explore new preventive measures, such as bilateral salpingectomy, which may provide great benefit without compromising ovarian function. If the tubal paradigm is accurate, then the impact of bilateral salpingectomy could extend to BRCA1 and BRCA2 mutation carriers, high-risk noncarriers, and average-risk women. The authors present a review of the literature on the role of risk-reducing salpingectomy in all women and in high-risk groups, with a focus on morbidity, ovarian function, potential clinical applicability, and epidemiological considerations. Cancer 2017;123:1714-1720. © 2017 American Cancer Society.
[Mh] Termos MeSH primário: Síndrome Hereditária de Câncer de Mama e Ovário/cirurgia
Neoplasias Epiteliais e Glandulares/prevenção & controle
Neoplasias Ovarianas/prevenção & controle
Procedimentos Cirúrgicos Profiláticos/métodos
Salpingectomia/métodos
[Mh] Termos MeSH secundário: Feminino
Genes BRCA1
Genes BRCA2
Doenças dos Genitais Femininos/cirurgia
Síndrome Hereditária de Câncer de Mama e Ovário/genética
Seres Humanos
Menopausa Precoce
Mutação
Medição de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170324
[St] Status:MEDLINE
[do] DOI:10.1002/cncr.30528


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[PMID]:28214786
[Au] Autor:Schrauder MG; Brunel-Geuder L; Häberle L; Wunderle M; Hoyer J; Reis A; Schulz-Wendtland R; Beckmann MW; Lux MP
[Ad] Endereço:Friedrich-Alexander University Erlangen-Nürnberg (FAU), Department of Obstetrics and Gynecology, Erlangen University Hospital, University Breast Center for Franconia, Erlangen, Germany. Electronic address: Michael.Schrauder@uk-erlangen.de.
[Ti] Título:Cost-effectiveness of risk-reducing surgeries in preventing hereditary breast and ovarian cancer.
[So] Source:Breast;32:186-191, 2017 Apr.
[Is] ISSN:1532-3080
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Risk-reducing surgeries are a feasible option for mitigating the risk in individuals with inherited susceptibility to cancer, but are the procedures cost-effective in the current health-care system in Germany? This study compared the health-care costs for bilateral risk-reducing mastectomy (BRRM) and risk-reducing (bilateral) salpingo-oophorectomy (RRSO) with cancer treatment costs that could potentially be prevented. PATIENTS AND METHODS: The analysis is based on interdisciplinary consultations with individuals with a high familial risk for breast and ovarian cancer at the University Breast Center for Franconia (Germany) between 2009 and 2013 (370 consultations; 44 patients with BRCA1 mutations and 26 with BRCA2 mutations). Health-care costs for risk-reducing surgeries in BRCA mutation carriers were calculated as reimbursements in the German diagnosis-related groups (DRG) hospital pricing system. These costs for the health-care system were compared with the potential cancer treatment costs that could possibly be prevented by risk-reducing surgeries. RESULTS: Long-term health-care costs can be reduced by risk-reducing surgeries after genetic testing in BRCA mutation carriers. The health-care system in Germany would have saved € 136,295 if BRRM had been performed and € 791,653 if RRSO had been performed before the development of cancer in only 50% of the 70 mutation carriers seen in our center. Moreover, in patients with combined RRSO and BRRM (without breast reconstruction), one further life-year for a 40-year-old BRCA mutation carrier would cost € 2,183. CONCLUSION: Intensive care, including risk-reducing surgeries in BRCA mutation carriers, is cost-effective from the point of view of the health-care system in Germany.
[Mh] Termos MeSH primário: Grupos Diagnósticos Relacionados/economia
Custos de Cuidados de Saúde
Síndrome Hereditária de Câncer de Mama e Ovário/prevenção & controle
Ovariectomia/economia
Mastectomia Profilática/economia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Neoplasias da Mama/economia
Neoplasias da Mama/prevenção & controle
Análise Custo-Benefício
Feminino
Predisposição Genética para Doença
Alemanha
Síndrome Hereditária de Câncer de Mama e Ovário/economia
Seres Humanos
Meia-Idade
Neoplasias Ovarianas/economia
Neoplasias Ovarianas/prevenção & controle
Ovariectomia/métodos
Procedimentos Cirúrgicos Profiláticos/economia
Estudos Retrospectivos
Comportamento de Redução do Risco
Ubiquitina-Proteína Ligases/genética
Adulto Jovem
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.3.2.27 (BRAP protein, human); EC 2.3.2.27 (Ubiquitin-Protein Ligases)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170320
[Lr] Data última revisão:
170320
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170220
[St] Status:MEDLINE


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[PMID]:28196033
[Au] Autor:Aneja A; Jiang JJ; Cohen-Rosenblum A; Luu HL; Peabody TD; Attar S; Luo TD; Haydon RC
[Ad] Endereço:1Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina 2Department of Orthopaedic Surgery, University of Chicago Medicine, Chicago, Illinois 3Department of Orthopaedic Surgery, Northwestern University, Galter-Pavilion-Northwestern Memorial Hospital, Chicago, Illinois.
[Ti] Título:Thromboembolic Disease in Patients with Metastatic Femoral Lesions: A Comparison Between Prophylactic Fixation and Fracture Fixation.
[So] Source:J Bone Joint Surg Am;99(4):315-323, 2017 Feb 15.
[Is] ISSN:1535-1386
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: We are not aware of any previous studies that have compared the rate of venous thromboembolic events in patients who underwent prophylactic intramedullary nailing because of an impending fracture with the rate in patients who underwent intramedullary nailing after a pathological fracture. The objective of the present study was to determine if the rate of venous thromboembolic events varies between patients who are managed with prophylactic fixation and those who are managed with fixation after a pathological fracture. METHODS: We performed a retrospective comparative study in which the Nationwide Inpatient Sample database was used to identify all patients who had undergone femoral stabilization, either for a pathological femoral fracture or for prophylactic fixation of femoral metastatic lesion, over a period of 10 consecutive years (between 2002 and 2011) in the United States. Demographic data, comorbidities, venous thromboembolic event rates, and other common postoperative complications were compared between the 2 groups. RESULTS: Patients who were managed with prophylactic fixation had significantly higher rates of pulmonary embolism (p < 0.001; adjusted odds ratio, 2.1) and deep-vein thrombosis (p = 0.03; adjusted odds ratio, 1.5). Patients who were managed with fixation after a pathological fracture had a significantly greater need for blood transfusion, higher rates of postoperative urinary tract infection, and a decreased likelihood of being discharged to home (p < 0.001 for all). CONCLUSIONS: Patients with metastatic disease who undergo prophylactic intramedullary nailing have higher observed rates of venous thromboembolic events than those who undergo nailing for the treatment of a pathological fracture and should be actively and vigilantly managed in the postoperative period. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
[Mh] Termos MeSH primário: Neoplasias Femorais/cirurgia
Fixação Intramedular de Fraturas/efeitos adversos
Procedimentos Cirúrgicos Profiláticos/métodos
Tromboembolia/etiologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Neoplasias Femorais/complicações
Neoplasias Femorais/secundário
Fixação Intramedular de Fraturas/métodos
Seres Humanos
Masculino
Meia-Idade
Complicações Pós-Operatórias
Estudos Retrospectivos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170407
[Lr] Data última revisão:
170407
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170215
[St] Status:MEDLINE
[do] DOI:10.2106/JBJS.16.00023


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[PMID]:28190649
[Au] Autor:Mai PL; Piedmonte M; Han PK; Moser RP; Walker JL; Rodriguez G; Boggess J; Rutherford TJ; Zivanovic O; Cohn DE; Thigpen JT; Wenham RM; Friedlander ML; Hamilton CA; Bakkum-Gamez J; Olawaiye AB; Hensley ML; Greene MH; Huang HQ; Wenzel L
[Ad] Endereço:Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States. Electronic address: maip@mail.magee.edu.
[Ti] Título:Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study.
[So] Source:Gynecol Oncol;145(1):122-129, 2017 04.
[Is] ISSN:1095-6859
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. METHODS: Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. RESULTS: Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates. CONCLUSIONS: Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
[Mh] Termos MeSH primário: Comportamento de Escolha
Genes BRCA1
Genes BRCA2
Neoplasias Ovarianas/prevenção & controle
Ovariectomia
Procedimentos Cirúrgicos Profiláticos
Salpingectomia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Estudos de Coortes
Detecção Precoce de Câncer
Escolaridade
Feminino
Predisposição Genética para Doença
Seres Humanos
Meia-Idade
Análise Multivariada
Mutação
Neoplasias Ovarianas/diagnóstico
Neoplasias Ovarianas/genética
Percepção
Estudos Prospectivos
Qualidade de Vida
Risco
Comportamento de Redução do Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, N.I.H., INTRAMURAL
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170214
[St] Status:MEDLINE



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