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Caracas, Venezuela

OBJECTIVE: To analyze results of combined treatment of cervical cancer. METHODS: In 236 medical records were reviewed between the years 2000-2010 at GURVE, Oncological Radiotherapy Unit. The patients received a treatment of external radiotherapy that consisted in 4 500 cGy to pelvis plus 1 000 cGy to parametrium, concurrent with weekly chemotherapy using cisplatin (40 mg/m2), followed by high rate of brachytherapy. RESULTS: The age range was between 26 and 86 years old, with an average of 52.3 and a median of 51 years. The largest group age was between 41 and 60 years old. The most common histological variety was the epidermoid (75.7 %). The 81.7 % of the patients received radiotherapy concurrent with chemotherapy, followed or interspersed with the brachytherapy. It was observed that the 50.6 % of the patients reached the complete treatment time in less than 8 weeks. 110 patients achieved it over the 8 weeks. 223 patients received brachytherapy. At present time, 163 (69.3 %) are alive free of disease, 24 of them continued with disease (10.21 %); 8 patients died for different causes (3.40 %) and 40 patients died with the disease, (17.02 %). The average time of follow-up was of 46.5 months (April 2012). The overall survival was 77.8 % at 5 years. CONCLUSIONS: Our results are similar with international publications. To add cisplatin as standard therapy reduce recurrence and death related disease for all the stages. Treatments appropriate time periods ensure better survival. Source

Bonilla P.,Instituto Medico La Floresta
Revista Venezolana de Oncologia

The patients with advanced disease and terminal state may have refractory symptoms, producing a great suffering for it palliative sedation therapy is used. But their use is controversial; this is a review attempts to clarify the ethical concepts, the decision making for it use, and so clarify the moral legitimacy. Source

Nunez Bragayrac L.A.,Instituto Medico La Floresta | Nunez Bragayrac L.A.,Advance Urology Center Lima | Azhar R.A.,University of Southern California | Azhar R.A.,King Abdulaziz University | Sotelo R.,Instituto Medico La Floresta
Current Opinion in Urology

Urological fistulas are an underestimated problem worldwide and have devastating consequences for patients. Many urological fistulas result from surgical complications and/or inadequate perinatal obstetric healthcare. Surgical correction is the standard treatment. This article reviews minimally invasive surgical approaches to manage urological fistulas with a particular emphasis on the robotic techniques of fistula correction. RECENT FINDINGS: In recent years, many surgeons have explored a minimally invasive approach for the management of urological fistulas. Several studies have demonstrated the feasibility of laparoscopic surgeryand the reproducibility of reconstructive surgery techniques. Introduction of the robotic platform has provided significant advantages given the improved dexterity and exceptional vision that it confers. SUMMARY: Fistulas are a concern worldwide. Laparoscopic surgery correction has been developed through the efforts of several authors, and difficulties such as the increased learning curve have been overcome with innovations, including the robotic platform. Although minimally invasive surgery offers numerous advantages, the most successful approach remains the one with the surgeon is most familiar. © 2015 Wolters Kluwer Health, Inc. Source

Romero K.J.,Instituto Medico La Floresta | Trujillo M.H.,Instituto Medico La Floresta | Trujillo M.H.,University Hospital of Caracas
Heart and Lung: Journal of Acute and Critical Care

Objective: We describe the clinical features of a 17-year-old girl with severe asthma exacerbations. On admission to the intensive care unit, she manifested expiratory dyspnea, cyanosis, and an unproductive cough. Her chest x-rays showed extensive pneumomediastinum (PM), mild subcutaneous emphysema at the right anterior triangle of the neck, and right upper-lobe atelectasis. Her PM resulted from the "Macklin effect," which involves a three-step process: overly distended alveolar rupture, air dissection along the bronchovascular sheaths, and air spreading into the mediastinum. Methods: Treatment consisted of oxygen therapy, parenteral corticosteroids, and nebulized bronchodilators. Results: She made a good recovery, and was discharged from the intensive care unit after 2 days. Conclusion: This case illustrates that conservative management strategies in this severe and unusual complication of asthma exacerbation can result in rapid and complete recovery. Nonetheless, every asthma exacerbation should be considered potentially life-threatening, and must be treated promptly and adequately. © 2010 Elsevier Inc. Source

Sanchez-Salas R.,Institute Montsouris | Clavijo R.,Instituto Medico La Floresta | Barret E.,Institute Montsouris | Sotelo R.,Instituto Medico La Floresta
Indian Journal of Urology

Laparoendoscopic single site (LESS) has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS) in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscripts bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon's ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena. Source

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