255 research outputs found
Sentinel lymph node biopsy in squamous cell carcinoma of the head and neck: 10 years of experience
Sentinel node (SN) biopsy of head and neck cancer is still considered investigational, and agreement on the width of the surgical sampling has not yet been reached. From May 1999 to Dec 2009, 209 consecutive patients entered a prospective study: 61.7% had primary tumour of the oral cavity and 23.9% of the oropharynx. SN was not found in 26 patients. Based on these data and definitive histopathological analysis, we proposed six hypothetic scenarios to understand the percentage of neck recurrences following different treatments Among patients with identified SN, 54 cases were pN+: 47 in SN and 7 in a different node. Considering the six hypothetic scenarios: "only SN removal", "SN level dissection", "neck dissection from the tumour site to SN level", "selective neck dissection of three levels (SND)", "dissection from level I to IV" and "comprehensive I-V dissection", neck recurrences could be expected in 6.5%, 3.8%, 2.18%, 2.73%, 1.09% and 1.09% of cases, respectively. SN biopsy can be considered a useful tool to personalize the surgical approach to a N0 carcinoma. The minimum treatment of the neck is probably dissection of the levels between the primary tumour and the level containing the SN(s). Outside the framework of a clinical study, the best treatment can still be considered SND
CĂĄlculo de la longitud mĂnima de aproximaciĂłn para una canaleta Parshall a travĂ©s de la comparaciĂłn del comportamiento hidrĂĄulico entre un modelo numĂ©rico y un modelo fĂsico
Trabajo de InvestigaciĂłnLa canaleta Parshall es una estructura hidraulica de gran empleabilidad dentro del campo de la Ingenieria, uno de sus usos es aforador de caudal o instrumento medidor. Pero en medio de su funcionalidad presenta problemas a la hora de encontrar obstaculos a la entrada de la canaleta, lo que hace que se alteren las laminas de agua, causando grandes problemas a su funcionalidad. El presente estudio propone un analisis en la longitud de aproximacion a la entrada de la canaleta en donde al interponer obstaculos, no se causara ninguna interferencia a las laminas de agua.
Para el estudio efectivo se utiliza la herramienta computacional OpenFoam, con el fin de de determinar que longitud es la mĂĄs exacta para no alterar las condiciones del flujo. De la misma manera estos resultados son comparados con un modelo a escala de laboratorioINTRODUCCIĂN
1. GENERALIDADES
2. MARCO DE REFERENCIA
3. METODOLOGIA
4. RESULTADOS
5. CONCLUSIONES
6. RECOMENDACIONES
7. ANEXOS
8. BIBLIOGRAFIAPregradoIngeniero Civi
Osteocondromas da coluna vertebral: um diagnĂłstico a considerar nas sĂndromes de compressĂŁo medular
Cerebrospinal fluid fistula as the presenting manifestation of pituitary adenoma: case report with a 4-year follow-up
Clinical features and comorbidity pattern of HCV infected migrants compared to native patients in care in Italy: A real-life evaluation of the PITER cohort
Background: Direct-acting antivirals are highly effective for the treatment of hepatitis C virus (HCV) infection, regardless race/ethnicity. We aimed to evaluate demographic, virological and clinical data of HCV-infected migrants vs. natives consecutively enrolled in the PITER cohort. Methods: Migrants were defined by country of birth and nationality that was different from Italy. Mann-Whitney U test, Chi-squared test and multiple logistic regression were used. Results: Of 10,669 enrolled patients, 301 (2.8%) were migrants: median age 47 vs. 62 years, (p < 0.001), females 56.5% vs. 45.3%, (p < 0.001), HBsAg positivity 3.8% vs. 1.4%, (p < 0.05). Genotype 1b was prevalent in both groups, whereas genotype 4 was more prevalent in migrants (p < 0.05). Liver disease severity and sustained virologic response (SVR) were similar. A higher prevalence of comorbidities was reported for natives compared to migrants (p < 0.05). Liver disease progression cofactors (HBsAg, HIV coinfection, alcohol abuse, potential metabolic syndrome) were present in 39.1% and 47.1% (p > 0.05) of migrants and natives who eradicated HCV, respectively. Conclusion: Compared to natives, HCV-infected migrants in care have different demographics, HCV genotypes, viral coinfections and comorbidities and similar disease severity, SVR and cofactors for disease progression after HCV eradication. A periodic clinical assessment after HCV eradication in Italians and migrants with cofactors for disease progression is warranted
Economic consequences of investing in anti-HCV antiviral treatment from the Italian NHS perspective : a real-world-based analysis of PITER data
OBJECTIVE:
We estimated the cost consequence of Italian National Health System (NHS) investment in direct-acting antiviral (DAA) therapy according to hepatitis C virus (HCV) treatment access policies in Italy.
METHODS:
A multistate, 20-year time horizon Markov model of HCV liver disease progression was developed. Fibrosis stage, age and genotype distributions were derived from the Italian Platform for the Study of Viral Hepatitis Therapies (PITER) cohort. The treatment efficacy, disease progression probabilities and direct costs in each health state were obtained from the literature. The break-even point in time (BPT) was defined as the period of time required for the cumulative costs saved to recover the Italian NHS investment in DAA treatment. Three different PITER enrolment periods, which covered the full DAA access evolution in Italy, were considered.
RESULTS:
The disease stages of 2657 patients who consecutively underwent DAA therapy from January 2015 to December 2017 at 30 PITER clinical centres were standardized for 1000 patients. The investment in DAAs was considered to equal âŹ25 million, âŹ15 million, and âŹ9 million in 2015, 2016, and 2017, respectively. For patients treated in 2015, the BPT was not achieved, because of the disease severity of the treated patients and high DAA prices. For 2016 and 2017, the estimated BPTs were 6.6 and 6.2 years, respectively. The total cost savings after 20 years were âŹ50.13 and âŹ55.50 million for 1000 patients treated in 2016 and 2017, respectively.
CONCLUSIONS:
This study may be a useful tool for public decision makers to understand how HCV clinical and epidemiological profiles influence the economic burden of HCV
L'Italia come modello per l'Europa e per il mondo nelle politiche sanitarie per il trattamento dell'epatite cronica da HCV
The World Health Organization foresees the
elimination of HCV infection by 2030. In light of this and the curre
nt, nearly worldwide, restriction in direct-acting agents
(DAA) accessibility due to their high price, we aimed to evaluate
the cost-effectiveness of two alternative DAA treatment
policies: Policy 1 (universal): treat all patients, regardless of the fibrosis stage; Policy 2 (prioritized): treat only priori
tized
patients and delay treatment of the
remaining patients until reaching stage F3. T
he model was based on patientâs data
from the PITER cohort. We demonstrated that extending HC
V treatment of patients in any fibrosis stage improves health
outcomes and is cost-effective
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