BACKGROUND: Osteosarcoma of the jaw (JOS) constituting 5% to 13% of all osteosarcoma is a locally aggressive malignant mesenchymal tumor with high tendency to local recurrence and the ability to produce tumor osteoid. Compared to osteosarcoma of the remaining skeleton (SOS) JOS metastasizes relatively rarely and relatively late. It differs significantly from SOS in its biological behaviour. CASE REPORT: The presented case deals with a 60-year-old male patient suffering from a newly occurred polypous mucosal tumor of the right-sided maxillary alveolar ridge bioptically diagnosed as a granulation tissue polyp first. After transmaxillary resection of the tumor and consultation of a bone tumor reference center the final diagnosis of a high-grade chondroblastic osteosarcoma could be made. The recommended radical resection of the tumor was declined by the patient because of the expected cosmetic consequences. After surgical reduction of the rapidly growing sarcoma chemotherapy according to the COOS/EURO-B.O.S.S. protocol was initiated at a stage when computed tomography showed diffuse metastatic disease to the lungs. Chemotherapy could delay the progress of the disease only temporarily. The patient died from respiratory insufficiency. CONCLUSION: In JOS radical surgical resection is the therapy of first choice. For substantiation of the diagnosis and central registration of the cases a bone tumor reference center should be contacted. 相似文献
BACKGROUND: An association with subcutaneous adipose tissue TNFalpha expression and insulin resistance has been suggested in obesity/type-2 diabetes, but this has not been examined directly. In the first part of the study we investigated whether this association is present in 7 lean, 10 obese nondiabetic and 9 type-2 diabetic men. In the second part of the study we examined the relationship between adipose tissue TNFalpha mRNA levels and BMI in 81 nondiabetic subjects spanning a wide range of BMIs. METHODS: Subcutaneous adipose tissue TNFalpha mRNA levels and insulin sensitivity were determined with quantitative RT-competitive PCR and hyperinsulinaemic clamp, respectively. RESULTS: Subcutaneous adipose tissue TNFalpha mRNA levels were similar in 7 lean and 10 obese nondiabetic and 9 type-2 diabetic men (P = 0.68), and did not change in response to 240-min hyperinsulinaemia. TNFalpha mRNA levels and insulin sensitivity were not correlated. Unexpectedly, no correlation between TNFalpha mRNA and BMI was found. The relationship between adipose tissue TNFalpha mRNA and BMI was examined further in 31 male and 50 female nondiabetic subjects. The subcutaneous adipose tissue TNFalpha mRNA level correlated with BMI in all subjects (rS = 0.32, P < 0.01), and in a subgroup analysis in men (rS = 0.55, P < 0.01) but not in women (rS = - 0.08). The correlation in men was dependent on a fourfold higher TNFalpha mRNA level in 5 morbidly obese men while there was no difference in TNFalpha mRNA levels in lean or obese men. CONCLUSIONS: Subcutaneous adipose tissue TNFalpha expression does not correlate with insulin sensitivity in nondiabetic or type-2 diabetic men; is not regulated by acute hyperinsulinaemia; and is increased only in morbidly obese men. 相似文献
Clinically diagnosed metastasis to the thyroid gland is rare. The authors present the first reported case of metastasis to the thyroid gland from a primary adenocarcinoma of the uterine cervix. 相似文献
BACKGROUND: We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization. METHODS: We selected 39 family physicians at random, and 315 of their patients participated. Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients' health, assessed by a visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting for the clustering of patients by physician and controlling for confounding variables. RESULTS: Patient-centered communication was correlated with the patients' perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals. CONCLUSIONS: Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals. 相似文献
Brian G. Feagan, MD; William J. Sandborn, MD; Ulrich Mittmann, MD; Simon Bar-Meir, MD; Geert DHaens, MD, PhD; Marc Bradette, MD; Albert Cohen, MD; Chrystian Dallaire, MD; Terry P. Ponich, MD; John W. D. McDonald, MD, PhD; Xavier Hébuterne, MD, PhD; Pierre Paré, MD; Pavel Klvana, MD; Yaron Niv, MD; Sandro Ardizzone, MD; Olga Alexeeva, MD; Alaa Rostom, MD; Gediminas Kiudelis, MD; Johannes Spleiss, MSc; Denise Gilgen, PhD; Margaret K. Vandervoort, MSc; Cindy J. Wong, MSc; Guang Yong Zou, PhD; Allan Donner, PhD; Paul Rutgeerts, MD, PhD
JAMA. 2008;299(14):1690-1697.
Context Maintenance therapy for Crohn disease featuresthe use of immunosuppressive drugs, which are associated withan increased risk of infection. Identification of safe and effectivemaintenance strategies is a priority.
Objective To determine whether the oral administrationof omega-3 free fatty acids is more effective than placebo forprevention of relapse of Crohn disease.
Design, Setting, and Patients Two randomized, double-blind,placebo-controlled studies (Epanova Program in Crohn's Study1 [EPIC-1] and EPIC-2) conducted between January 2003 and February2007 at 98 centers in Canada, Europe, Israel, and the UnitedStates. Data from 363 and 375 patients with quiescent Crohndisease were evaluated in EPIC-1 and EPIC-2, respectively.
Interventions Patients with a Crohn's Disease ActivityIndex (CDAI) score of less than 150 were randomly assigned toreceive either 4 g/d of omega-3 free fatty acids or placebofor up to 58 weeks. No other treatments for Crohn disease werepermitted.
Main Outcome Measure Clinical relapse, as defined by aCDAI score of 150 points or greater and an increase of morethan 70 points from the baseline value, or initiation of treatmentfor active Crohn disease.
Results For EPIC-1, 188 patients were assigned to receiveomega-3 free fatty acids and 186 patients to receive placebo.Corresponding numbers for EPIC-2 were 189 and 190 patients,respectively. The rate of relapse at 1 year in EPIC-1 was 31.6%in patients who received omega-3 free fatty acids and 35.7%in those who received placebo (hazard ratio, 0.82; 95% confidenceinterval, 0.51-1.19; P = .30). Corresponding valuesfor EPIC-2 were 47.8% and 48.8% (hazard ratio, 0.90; 95% confidenceinterval, 0.67-1.21; P = .48). Serious adverse eventswere uncommon and mostly related to Crohn disease.
Conclusion In these trials, treatment with omega-3 freefatty acids was not effective for the prevention of relapsein Crohn disease.