Fatores prognósticos em câncer de cólon localmente avançado tratado com ressecção extendida

The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01), and postoperative deaths were associated with the type of surgery and Karnofsky performance status at the time of admission (P = .001). CONCLUSIONS: Some patients with locally advanced colon adenocarcinomas undergoing extended resections have a 5-year overall survival rates of 58.3%. Patients could benefit from palliative-intent procedures, but these measures should cautiously be indicated and avoided in patients with low Karnofsky performance status due to high rates of postoperative mortality and poor survival.Foi avaliado o impacto de variáveis clínicas, patológicas e cirúrgicas na morbidade e mortalidade pós operatórias de pacientes submetidos à ressecção extendida de carcinoma do cólon. MÉTODOS: Prontuários médicos de 95 pacientes submetidos á ressecção extendida de carcinoma de cólon entre os anos de 1953 e 1996 foram revisados. Em todos os casos, além de colectomia, um ou mais órgãos e/ou estruturas foram ressecados em bloco devido á suspeição de invasão tumoral macroscópica. As variáveis clínicas, patológicas e cirúrgicas foram analizadas. As taxas de sobrevida global foram analizadas de acordo com o método de Kaplan and Meier. A análise multivariada foi realizada empregando-se o modelo de risco proporcional de Cox. RESULTADOS: Oitenta e seis pacientes foram tratados com cirurgia curativa e o restante com ressecção paliativa. Invasão microscópica de órgãos e/ou estruturas adjacentes e linfonodos regionais foi encontrada em 48 e 31 pacientes respectivamente. O tempo de seguimento mediano, sem mortalidade pós operatória, foi de 47.7 meses. A taxa de sobrevida global em 5 anos foi de 52.6%. A taxa de sobrevida global para pacientes submetidos à cirurgia curativa e paliativa foi de 58.3% e zero, respectivamente. A sobrevida mediana no grupo de pacientes com cirurgia paliativa foi de 3.1 meses. A análise multivariada mostrou que a performance status de Karnofsky fortemente correlacionou com risco de complicações pós operatórias (p=0.01), e que o risco de morte pós operatória estava associada com o tipo de cirurgia e a performance status de Karnofsky na admissão (p=0.001) CONCLUSÕES: Pacientes com adenocarcinoma de cólon localmente avançados submetidos à ressecção extendida têm taxa de sobrevida global em 5 anos de 58.3% Este tipo de cirurgia pode ser empregada com intuito paliativo, mas deve ter indicação criteriosa e ser evitada em pacientes com baixa performance status de Karnofsky devido às altas taxas de mortalidade pós operatória e baixa sobrevida

The Trans-Neptunian Object (84922) 2003 VS2 through Stellar Occultations

We present results from three world-wide campaigns that resulted in the detections of two single-chord and one multi-chord stellar occultations by the plutino object (84922) 2003 VS2. From the single-chord occultations in 2013 and 2014 we obtained accurate astrometric positions for the object, while from the multi-chord occultation on 2014 November 7, we obtained the parameters of the best-fitting ellipse to the limb of the body at the time of occultation. We also obtained short-term photometry data for the body in order to derive its rotational phase during the occultation. The rotational light curve present a peak-to-peak amplitude of 0.141 ± 0.009 mag. This allows us to reconstruct the 3D shape of the body, with principal semi-axes of a = 313.8 ± 7.1 km, b = 265.5- + 9.8 8.8 km, and c = 247.3- + 43.6 26.6 km, which is not consistent with a Jacobi triaxial equilibrium figure. The derived spherical volume equivalent diameter of 548.3- + 44.6 29.5 km is about 5% larger than the radiometric diameter of 2003 VS2 derived from Herschel data of 523 ± 35 km, but still compatible with it within error bars. From those results we can also derive the geometric albedo (0.123- + 0.014 0.015) and, under the assumption that the object is a Maclaurin spheroid, the density r = 1400- + 300 1000 for the plutino. The disappearances and reappearances of the star during the occultations do not show any compelling evidence for a global atmosphere considering a pressure upper limit of about 1 microbar for a pure nitrogen atmosphere, nor secondary features (e.g., rings or satellite) around the main body. © 2019. The American Astronomical Society. All rights reserved.G.B.-R. is thankful for the support of the CAPES and FAPERJ/PAPDRJ (E26/203.173/2016) grant. Part of the research leading to these results has received funding from the European Research Council under the European Community's H2020 (2014-2020/ERC grant agreement No. 669416 >LUCKY STAR>). The research leading to these results has received funding from the European Union's Horizon 2020 Research and Innovation Programme, under grant agreement No. 687378 (SBNAF). P.S.-S. and J.L.O. acknowledge the financial support by the Spanish grant AYA-2017-84637-R and the Proyecto de Excelencia de la Junta de Andalucia J.A. 2012-FQM1776. P.S.-S., J.L.O., and R.D. acknowledge financial support from the State Agency for Research of the Spanish MCIU through the >Center of Excellence Severo Ochoa> award for the Instituto de Astrofisica de Andalucia (SEV-2017-0709). Based on observations made with ESO Telescopes at the La Silla Paranal Observatory under program ID 094.C-0352. M. A. thanks CNPq (grants 427700/2018-3, 310683/2017-3, and 473002/2013-2) and FAPERJ (grant E-26/111.488/2013). J.I.B.C. acknowledges CNPq grant 308150/2016-3. R. V.-M. thanks grants: CNPq-304544/2017-5, 401903/2016-8, Faperj: PAPDRJ-45/2013, and E-26/203.026/2015. F.B.-R. acknowledges CNPq grant 309578/2017-5. E.F.-V. acknowledges UFC 2017 Preeminent Postdoctoral Program (P3). TRAPPIST-South is a project funded by the Belgian Fonds (National) de la Recherche Scientifique (F.R.S.-FNRS) under grant FRFC 2.5.594.09. F. E.J. is a FNRS Senior Research Associate. A.A.C. acknowledges support from FAPERJ (grant E-26/203.186/2016) and CNPq grants (304971/2016-2 and 401669/2016-5). B.M. thanks the CAPES/Cofecub-394/2016-05 grant. A.R.G.J. and R.S. thank the financial support of FAPESP (proc. 2018/11239-8, proc. 2011/08171-3, proc. 2016/24561-0). A. M. thanks Caisey Harlingten for the use of his 50 cm telescope. We thank V. Buso and R. Condori for the observation efforts

O impacto dos efeitos da ocupação sobre a saúde de trabalhadores: II - Mortalidade The impact of occupation on worker's health: II - Mortality

Foi realizada revisão bibliográfica analítica com o objetivo de quantificar o impacto dos efeitos da ocupação sobre a mortalidade de trabalhadores em suas implicações sobre o setor saúde. As repercussões sobre a mortalidade de trabalhadores são medidas através das mortes diretamente relacionadas com o trabalho (acidentes do trabalho fatais e intoxicações fatais) e das indiretamente relacionadas. Partindo das grandes causas de morte entre adultos - doenças cardiovasculares, câncer e mortes violentas - e explorando as informações obtidas em estudos epidemiológicos realizados em outros países, estimou-se a força da contribuição da ocupação sobre a mortalidade. O peso e a complexidade das repercussões sobre o setor saúde pressupõem um desempenho mais ativo na definição de políticas e responsabilidades, e na organização de ações destinadas a identificar, reduzir ou eliminar a participação dos riscos ocupacionais nas grandes causas de doença e morte.<br>An attempt to estimate the impact of occupation on worker's health was made as part of the rationale for the progressive integration of Occupational Health into the Health Sector. In this second study, based on a critical review of the literature, the repercussions on mortality are discussed on this basis analysis of the Brazilian data on deaths directly related to occupation (fatal occupational accidents and acute poisonings), as well as on those indirectly so related. The analysis of the major causes of adult deaths - cardiovascular diseases, cancer and violent deaths - compared with the proportion of "work-relatedness" according to several epidemiologic studies carried out in developed countries, make possible an estimation of the influence of the contribution of occupation on mortality. The size of this contribution is the main argument for an active involvement of the health sector in Occupational Health issues, because of the heavy toll in terms of adult morbidity and mortality exacted on industrialized societies