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101.
best practice onkologie - 相似文献
102.
目的探讨前列腺原发胃肠道外间质瘤诊治要点。
方法回顾性分析我院2017年9月诊治的1例高危原发性前列腺胃肠道外间质瘤临床病理特征资料、随访情况,总结现有文献讨论总结本病诊治心得。
结果65岁男性,因"前列腺电切术后2年,反复血尿3个月余"入院。术前MRI考虑为来源不清的盆腔巨大实性占位(115 mm×105 mm×85 mm),经直肠穿刺诊断为梭形细胞来源的肿瘤。行盆腔肿瘤切除+膀胱前列腺腺切除+盆腔淋巴结清扫术+Bricker术。术后病理提示为前列腺原发胃肠道外间质瘤[CD117(+);Dog1(+);CD34(+);PSA(+);AR(+);P504s(+);Ki-67(2%)]。术后肿瘤组织全外显子测序提示为C-Kit基因(Exon 11 p.Q556-V560del)存在明显临床意义突变,筛选靶向药物甲磺酸伊马替尼+比卡鲁胺(PSA平稳后停用)口服,术后随访18个月无肿瘤复发及不良并发症。
结论前列腺原发胃肠道外间质瘤罕见,需与前列腺其他良恶性肿瘤相鉴别诊断。全外显子测序了解其发病高危基因,同时筛选药物辅助治疗可使患者生存获益。 相似文献
103.
de Morais Pollyana C. V. Gama Allyne F. Fernandes Gabrielle M. Oliveira Andre H. B. Lima Marcielly F. B. dos Santos Felipe R. Martins Davi A. Nascimento Ronaldo F. Cavalcante Rivelino M. 《Bulletin of environmental contamination and toxicology》2019,102(1):66-76
Bulletin of Environmental Contamination and Toxicology - This work describes the development of an analytical protocol combining cleanup by liquid–solid extraction and GC–MS for the... 相似文献
104.
105.
F. Dezoteux R. Dubois G. Lefèvre J.P. Lecoutre D. Staumont-Sallé O. Carpentier 《European annals of otorhinolaryngology, head and neck diseases》2019,136(1):47-49
Introduction
Kimura disease (KD) is a chronic lymphoproliferative disorder of unknown etiology that affects the skin and lymph nodes, mostly observed in males of Asian descent. The natural history of asymptomatic epiglottal KD remains unknown. This rare site of KD is often only diagnosed when tumor growth starts to obstruct the upper airways.Observation
A 34-year-old North African male presented with fatigue and multiple, slowly progressive, fluctuating skin nodules in the right mandibular and retroauricular regions. Computed tomography of the head and neck revealed a large soft tissue tumor close to the right mandibular body and unexpected thickening of the epiglottis. Transnasal laryngoscopy confirmed the CT findings and showed thickening of the epiglottis. The diagnosis of KD was based on histological examination of biopsy specimens taken from the right mandibular tumor, a cervical lymph node, and the epiglottis.Discussion
Most cases of KD with epiglottal involvement present with dysphonia and dysphagia. No consensus guidelines are available concerning the complementary investigations that should be performed. This case report raises the question of whether patients with suspected KD should be systematically screened for lesions in unusual and potentially dangerous anatomic sites. 相似文献106.
J.C. Leclere R. Marianowski P.J. Monteyrol M. Akkari F. Chalumeau P. Fayoux N. Leboulanger P. Franco V. Couloigner M. Mondain 《European annals of otorhinolaryngology, head and neck diseases》2019,136(4):301-305
ObjectivesTo present the 2017 Clinical Practice Guidelines of the French Society of Otorhinolaryngology concerning the role of the ENT specialist in the diagnosis of pediatric obstructive sleep apnea-hypopnea syndrome. This article focuses specifically on medical history and physical examination.MethodsA multidisciplinary work-group drew up a first version of the guidelines, graded according to level of evidence following the GRADE grading system. The final version was obtained by including the suggestions and comments from the editorial group.ResultsAt the end of the process, guidelines were established and graded regarding the following points: interview and analysis of the various interview scores recommended in the literature; clinical examination with awake upper-airway endoscopy; and indications for referral to non-ENT specialists. 相似文献
107.
Catherine F. Eubanks Jessica Lubitz J. Christopher Muran Jeremy D. Safran 《Psychotherapy research》2019,29(3):306-319
Objective: Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes. Method: We used the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance. Results: Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs?=?.85 to .98), as well as ratings of the therapist’s contribution to ruptures and the extent to which ruptures were resolved (ICC?=?.92). Predictive validity analyses found that confrontation markers (d?=?.74), successful resolution (d?=?.67), and ratings of the therapist’s contribution to ruptures (d?=?.61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d?=?1.54) and therapist self-reported alliance (r?=??.50, p?=?.002). Conclusions: This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout.
Clinical or methodological significance of this article: This study provides evidence of the reliability and validity of the 3RS, an observer-based measure of alliance ruptures and resolution processes. The 3RS can be used to identify problems in the therapeutic relationship that are associated with premature dropout from therapy. 相似文献
108.
A. Montalto V. Piazza F. Albi R. Gherli C. Contento A. Palermo F. Musumeci 《Transplantation proceedings》2019,51(1):206-209
Background
Pump speed optimization in patients implanted with a ventricular assist device represents a major challenge during the follow-up period. We present our findings on whether combined invasive hemodynamic ramp tests and cardiopulmonary exercise testing (CPX) can help optimize patient management.Methods
Eighteen patients implanted with a HeartMate 3 (HM3) device underwent ramp tests with right heart catheterization (including central venous pressure [CVP], pulmonary artery pressure, pulmonary capillary wedge pressure [PCWP], and blood pressure) and echocardiography. Data were recorded at up to 4 speed settings. Speed changes were in steps of 200 revolutions/min (rpm). Evaluation of functional capacity by CPX was conducted according to the modified Bruce protocol.Results
Only 30% of patients had normal PCWPs at their original rpm settings. In going from lowest to highest speeds, cardiac output improved by 0.25 ± 0.35 L/min/step (total change, 1.28 ± 0.3 L/min), and PCWP decreased by 1.9 ± 0.73 mm Hg/step (total change, 6 ± 1.6 mm Hg). CVP and systolic blood pressure did not change significantly with rpm. The rpm assessment was adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in all patients. On CPX, all patients demonstrated good performance (peak VO2, 16.8 ± 3.5 mL/kg/min).Conclusion
Hemodynamic ramp testing provides an objective means of optimizing rpm, and has the potential to provide good exercise tolerance. 相似文献109.
Daniel Rohan Phadke Daniel P. Sheeran Luke R. Wilkins John A. Kern Margaret C. Tracci John F. Angle 《Journal of vascular and interventional radiology : JVIR》2019,30(4):572-577
Purpose
To characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget–Schroetter syndrome.Materials and Methods
A single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15–72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation.Results
Primary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation.Conclusions
Severity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention. 相似文献110.
J. Yoo F. Shah S. Velangi G. Stewart J. S. Scarisbrick 《Clinical and experimental dermatology》2019,44(4):414-417
Secukinumab is an interleukin (IL)‐17 monoclonal antibody inhibiting T‐helper (Th)1‐mediated immune response. It has proven high efficacy for moderate to severe psoriasis but data on its long‐term toxicities are limited. We describe two patients who received secukinumab for clinically presumed psoriasis, but were subsequently diagnosed with mycosis fungoides (MF) following skin biopsies triggered by skin deterioration while on secukinumab. Previous studies suggested decreased numbers of regulatory T cells (Tregs) with increasing stage of MF, which may lead to the shift in the Treg/Th17 balance towards the Th17 pathway. Theoretically, the use of IL‐17 monoclonal antibodies to inhibit Th17 pathway may lead to further immunosuppression and disease progression in cutaneous T‐cell lymphoma (CTCL) by shifting the balance towards Tregs, although this hypothesis has not been proven. With uncertainty over the role of IL‐17 and Treg/Th17 as well as diagnostic challenges in CTCL, we recommend that patients should have a confirmatory skin biopsy prior to the commencement of biologic therapy. 相似文献