ABSTRACT Peritoneal carcinomatosis (PC) indicates advanced stage cancer, which is generally associated with a poor outcome and a 6 to 12 months. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is an option for treating patients with primary PC, such as mesothelioma, or secondary PC, such as colorectal cancer (CRC) or pseudomixoma. Until recently, such patients were deemed untreatable. Objective: The purpose of this study was to assess the results of CRS + HIPEC in patients with PC. Postoperative complications, mortality and survival rates were evaluated according to the diagnosis. Results: Fifty-six patients with PC, undergoing full CRS + HIPEC between October 2004 and January 2020, were enrolled. The mortality rate was 3.8% and the morbidity rate was 61.5%. Complications were significantly higher in proportion to the duration of surgery (p<0.001). The overall survival rates, as shown in the Kaplan-Meyer curve, were respectively 81%, 74% and 53% at 12, 24 and 60 months. Survival rates according to each diagnosis for the same periods were 87%, 82% and 47% in patients with pseudomixoma, and 77%, 72% and 57% in patients with CRC (log-rank 0.371, p=0.543). Conclusion: CRS with HIPEC is an option for pacients with primary or secondary PC. Although complication rates are high, a longer survival rate may be attained compared to those seen in previously published results; in some cases, patients may even be cured.

RESUMO O diagnóstico de carcinomatose peritoneal (CP), indica um estágio avançado do câncer e em geral está associado a um mau prognóstico com sobrevida média variando de 6 a 12 meses. A cirurgia citorredutora (CRS) associada à quimioterapia intraperitoneal hipertérmica (HIPEC) tem sido descrita como uma opção de tratamento para os pacientes portadores de CP primária como nos portadores de mesotelioma, ou secundária como em portadores de cancer colorretal ou pseudomixoma, até recentemente considerados sem possibilidade terapêutica. Objetivo: Avaliar os resultados do tratamento de pacientes portadores de CP submetidos a CRS + HIPEC. Foram analisadas as taxas complicações pós-operatórias, mortalidade e a sobrevida desses pacientes. Resultados: Foram incluídos 56 pacientes com CP, submetidos a c CRS + HIPEC, no período de Outubro 2004 a Janeiro 2020. A taxa de mortalidade foi de 3,8% e taxa de morbidade de 61,5%, sendo a ocorrência de complicações significativamente maior quanto maior o tempo cirúrgico (p<0,001). A sobrevida global pela curva de Kaplan-Meyer foi de 81%, 74% e 53% em 12, 24 e 60 meses respectivamente. Já a sobrevida por diagnóstico nos mesmos períodos foi de 87%, 82%, 47% para os pacientes portadores de pseudomixoma e de 77%, 72% e 57% para pacientes portadores de câncer colorretal (Log -RANK 0,371, p=0,543). Conclusão: A CRS + HIPEC é uma opção de tratamento para pacientes portadores de CP primária ou secundária. Embora com taxa de complicações elevadas, pode proporcionar aumento da sobrevida quando comparado com resultados prévios da literatura e em alguns casos até a cura.

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

O consumo de substâncias capazes de alterar o comportamento, a consciência e o humor dos sujeitos é milenar. A família, juntamente com a escola e os amigos, exerce função de socialização primária de crianças e adolescentes e pode funcionar como fator de proteção ou de risco. O presente estudo teve como objetivo analisar os significados, sentidos e experiências dos familiares relacionados ao usuário de crack em situação de tratamento. Trata-se de um estudo qualitativo, crítico e reflexivo, realizado com trabalhadores do Centro de Atenção Psicossocial, álcool e outras drogas (CAPSad), bem como usuários de crack em tratamento e seus familiares. Para coleta de dados, utilizou-se a entrevista semiestruturada. Além disso, utilizou-se a análise de conteúdo, a qual possibilitou estabelecer convergências, divergências e complementaridades. Percebe-se que os familiares atribuem sentidos e significados relacionados ao usuário de crack bastante negativos, e isso acontece, muitas vezes, em decorrência de uma relação familiar conflituosa, marcada pela perda de vínculos familiares do usuário. No entanto, quando o familiar passa a ser alvo de intervenções realizadas pelo CAPSad, há uma mudança de significados em relação ao usuário, o que melhora o relacionamento familiar e contribui para a manutenção do tratamento do ente que faz uso de crack. Diante do exposto, conclui-se pela importância de se trabalhar os sentidos e significados dos familiares atribuídos aos usuários de crack em tratamentos relacionados ao uso da droga.

The use of substances that affect the behavior, consciousness and mood of a person is ancient. The family, as well as school and friends, plays the role of primary socialization role for in children and adolescents and may function as a protective or a risk factor or a risk. The present is study aims to analyze the meanings, senses and experiences of family members related to crack addicts in treatment. This is a qualitative study, critical and reflective, conducted with workers CAPSad workers (Psychosocial Care Center, alcohol and other drugs), and crack addicts undergoing treatment and their families. For data collection, a semi-structured interview was used. Also, it was conducted a cContent analysis was also conducted, which allowed the establishment of convergences, divergences and complementarities. It is observed that family members attribute very negative meanings relatinged to crack addicts which are very negative, often due to a family relationship conflict, marked by the loss of family ties concerning with the crack addict. However, when the family becomes a target for interventions by CAPSad, there is a change of meaning in relation to the addict, which improves family relationships and contributes to the maintenance of the crack addict’s treatment. Given the above, it is perceived the importance of working on the meanings assigned to the family of addicts in treatment related forto drug use is perceptible.

O consumo de substâncias capazes de alterar o comportamento, a consciência e o humor dos sujeitos é milenar. A família, juntamente com a escola e os amigos, exerce função de socialização primária de crianças e adolescentes e pode funcionar como fator de proteção ou de risco. O presente estudo teve como objetivo analisar os significados, sentidos e experiências dos familiares relacionados ao usuário de crack em situação de tratamento. Trata-se de um estudo qualitativo, crítico e reflexivo, realizado com trabalhadores do Centro de Atenção Psicossocial, álcool e outras drogas (CAPSad), bem como usuários de crack em tratamento e seus familiares. Para coleta de dados, utilizou-se a entrevista semiestruturada. Além disso, utilizou-se a análise de conteúdo, a qual possibilitou estabelecer convergências, divergências e complementaridades. Percebe-se que os familiares atribuem sentidos e significados relacionados ao usuário de crack bastante negativos, e isso acontece, muitas vezes, em decorrência de uma relação familiar conflituosa, marcada pela perda de vínculos familiares do usuário. No entanto, quando o familiar passa a ser alvo de intervenções realizadas pelo CAPSad, há uma mudança de significados em relação ao usuário, o que melhora o relacionamento familiar e contribui para a manutenção do tratamento do ente que faz uso de crack. Diante do exposto, conclui-se pela importância de se trabalhar os sentidos e significados dos familiares atribuídos aos usuários de crack em tratamentos relacionados ao uso da droga.

The use of substances that affect the behavior, consciousness and mood of a person is ancient. The family, as well as school and friends, plays the role of primary socialization role for in children and adolescents and may function as a protective or a risk factor or a risk. The present is study aims to analyze the meanings, senses and experiences of family members related to crack addicts in treatment. This is a qualitative study, critical and reflective, conducted with workers CAPSad workers (Psychosocial Care Center, alcohol and other drugs), and crack addicts undergoing treatment and their families. For data collection, a semi-structured interview was used. Also, it was conducted a cContent analysis was also conducted, which allowed the establishment of convergences, divergences and complementarities. It is observed that family members attribute very negative meanings relatinged to crack addicts which are very negative, often due to a family relationship conflict, marked by the loss of family ties concerning with the crack addict. However, when the family becomes a target for interventions by CAPSad, there is a change of meaning in relation to the addict, which improves family relationships and contributes to the maintenance of the crack addict’s treatment. Given the above, it is perceived the importance of working on the meanings assigned to the family of addicts in treatment related forto drug use is perceptible.