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81.
The indications for elective treatment of the neck in cancer of the major salivary glands. 总被引:8,自引:0,他引:8
J G Armstrong L B Harrison H T Thaler H Friedlander-Klar D E Fass M J Zelefsky J P Shah E W Strong R H Spiro 《Cancer》1992,69(3):615-619
To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982. Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors (P less than 0.00001). High-grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate-grade or low-grade tumors (P less than 0.00001). In view of the low frequency of occult metastases in the entire group, routine elective treatment of the neck is not recommended. High-grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group. 相似文献
82.
Pallav J Shah Manoj Durairaj Ian Gordon John Fuller Alex Rosalion Siven Seevanayagam James Tatoulis Brian F Buxton 《European journal of cardio-thoracic surgery》2004,26(1):118-124
OBJECTIVE: The purpose is to define factors influencing long-term patency of the internal thoracic artery (ITA) to optimize the operative strategy. METHODS: 1482 left internal thoracic artery (LITA) and 636 right internal thoracic artery (RITA) symptom-directed angiograms were studied in 1434 patients. Data were prospectively collected from patients who had primary coronary artery bypass surgery during the period 1982-2002. The mean age of patients was 59 years; 85% were male. The mean period from operation to re-angiogram was 80 months. LITA was grafted to left anterior descending coronary artery (LAD) in 82% of cases, RITA to right coronary artery (RCA) in 40% and circumflex artery in 35% of cases. Graft failure was defined as > or =80% stenosis. RESULTS: 96.3% of LITA and 88.1% of RITA grafts were patent. No patient variables were significantly associated with graft patency (age, gender, diabetes, hypertension, LVEF, NYHA, AMI). Target coronary artery was associated with patency of both LITA and RITA grafts with maximum patency when grafted to LAD (P = 0.02) RITA had the worst patency to RCA, patency for the left system was identical to LITA. Proximal anastomosis to aorta (free RITA) had significantly better patency when compared with in situ RITA to RCA system (P = 0.005) while similar patency when grafted to left system. ITA diameter and target artery diameter were not associated with graft patency. Recent operations had better RITA patency (P = 0.03). The interval from operation to angiogram was not associated with ITA patency (96% patency for LITA and 88% patency for RITA, remained stable when studied at <1, 1-4, 5-9, 10-14 and >15 years). CONCLUSIONS: Even in a patient cohort that had adverse symptoms, excellent LITA and RITA patency was achieved which almost remained constant through all time intervals studied. 相似文献
83.
Anjali Shah Eric Eggenberger Robert Zivadinov Olaf Stüve Elliot M. Frohman 《Neurotherapeutics》2007,4(4):627-632
Physicians who treat multiple sclerosis (MS) face the challenge of patients exhibiting ongoing disease activity, including
exacerbations, loss of functional capabilities, intellectual decline, and radiologic progression, despite being on a disease-modifying
agent (DMA). After searching for factors that might at least in part explain these changes—such as nonadherent drug-taking
behavior, or the presence of interfer-on-neutralizing antibodies—some providers may ultimately decide to switch the patient
to another DMA. In most circumstances, patients likely derive only partial effects from these agents, even in the absence
of compromising factors. Thus, a number of factors must be considered in order to intensify the treatment regimen in response
to disease progression. In the context of an inadequate treatment response to a DMA, some clinicians will convert the patient
to an alternative therapy, and others will instead use a second agent in combination with the first (the so-called platform
agent). In the first of this two-part series, we explored the use of anti-inflammatory CS and ACTH to treat MS exacerbations.
Although we underscored the limited availability of evidence-based studies to support specific regimens for this purpose,
there is an even greater paucity of data to support the routine use of these agents in order to achieve chronic disease-modifying
effects in those who continue to deteriorate clinically, radiographically, or both. Without doubt, a number of factors influence
the formulation of combination treatment plan for MS. Nevertheless, we will focus on the rationale and practical schemes that
can be considered for using corticosteroids (CS) (and perhaps even ACTH) in an attempt to modify various domains of ongoing
disease activity. 相似文献
84.
Deacon E. Harle Keri Davies Rakhee Shah Syma Hussain Susan Cowling Tejinder K. Panesar Jonathan Bourton Bruce J. W. Evans 《Ophthalmic & physiological optics》2007,27(1):100-105
Despite the current popularity of binocular indirect ophthalmoscopy, direct ophthalmoscopes are still commonly used by clinicians for fundus examination. They are considered to be expensive, however, and it has been suggested that this cost can prevent their use by healthcare professionals in developing countries. The Optyse Lens Free Ophthalmoscope is a novel direct ophthalmoscope, without a lens focus system, that allows for comparatively inexpensive manufacture and supply. We compared the clarity of view with the Optyse to that with standard direct ophthalmoscopes, over a sequential cohort of patients with a variety of refractive errors and ocular conditions. The grade of clarity of view with the Optyse Lens Free Ophthalmoscope was less than conventional ophthalmoscopes (Wilcoxon signed rank test, p < 0.0001). This grade of clarity of view was not associated with the ametropia of the ophthalmoscopic observation (Spearman r < or = 0.03, p > or = 0.28) but was with the presence of cataracts (chi2 test, p < 0.0001) with both the Optyse and the conventional ophthalmoscopes. Despite its limitations, the retinal view with Optyse was often within acceptable clinical limits suggesting that this relatively inexpensive ophthalmoscope may have a place when cost prohibits any other type of ophthalmoscope use. 相似文献
85.
The effects of the calcium antagonists verapamil and nifedipine on blood glucose levels, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic effect of tolbutamide were studied in normal nondiabetic rabbits. Daily dosage of 40 mg/kg verapamil and 5 mg/kg nifedipine given orally up to 7 days did not affect blood glucose level, glucose tolerance, insulin secretion during glucose tolerance and hypoglycaemic activity of tolbutamide 250 mg/kg p.o. 相似文献
86.
87.
88.
Protective effect of transforming growth factor beta 1 on experimental autoimmune diseases in mice. 总被引:36,自引:3,他引:33
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A P Kuruvilla R Shah G M Hochwald H D Liggitt M A Palladino G J Thorbecke 《Proceedings of the National Academy of Sciences of the United States of America》1991,88(7):2918-2921
Interleukin 1 (IL-1) and tumor necrosis factor alpha are thought to contribute to the inflammatory response associated with autoimmune diseases. Transforming growth factor beta 1 (TGF-beta 1) counteracts many effects of these cytokines and has various immunosuppressive properties. In the present study, it is shown that microgram amounts of TGF-beta 1, injected daily for 1-2 weeks, protect against collagen-induced arthritis (CIA) and relapsing experimental allergic encephalomyelitis (REAE), the animal models for rheumatoid arthritis and multiple sclerosis, respectively. When administered during induction of the disease, TGF-beta 1 prevents CIA but only delays the onset of REAE by 2-3 days. However, when administered during a remission. TGF-beta 1 prevents the occurrence of relapses in REAE. The results suggest that TGF-beta 1 has powerful anti-inflammatory effects, mimicking in some respects the beneficial effects of immunosuppressive drugs in these experimental models of autoimmune disease, but without discernable adverse effects. 相似文献
89.
90.
This is a report of a patient on treatment for duodenal tuberculosis, who developed obstructive jaundice due to a benign stricture of the terminal common bile duct. This complication of duodenal tuberculosis, to our knowledge, has not been reported before. Percutaneous, transhepatic balloon dilatation of the stricture alleviated the jaundice. 相似文献