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971.
Hutcheon AW Heys SD Sarkar TK;Aberdeen Breast Group 《Breast cancer research and treatment》2003,79(Z1):S19-S24
Neoadjuvant chemotherapy produces substantial increases in clinical response rates and rates of breast conserving therapy. Pathologic response rate, though generally low, is an important outcome as it is presumably associated with eradication of micrometastatic disease and may likely result in improved outcomes. Anthracyclines have long been considered the most efficacious chemotherapy agents for neoadjuvant therapy of early breast cancer. Unfortunately, not all patients respond to neoadjuvant anthracycline-based chemotherapy. In an effort to improve primary tumor response, docetaxel, an active agent in breast cancer, has been evaluated in the neoadjuvant setting. Several randomized trials, including the NSABP B-27, GEPAR-duo, and the Aberdeen trial, evaluating docetaxel in sequence with a doxorubicin-based neoadjuvant regimen have been reported, with encouraging findings. We designed the Aberdeen trial with two primary aims: (1) to evaluate primary docetaxel in patients that initially fail a neoadjuvant anthracycline-based polychemotherapy regimen, and (2) to compare a docetaxel-based neoadjuvant regimen with a standard anthracycline-based regimen in patients who do respond to the first four cycles of the anthracycline-based regimen. Eligible patients (n = 162) had previously untreated large (> or = 3 cm) or locally advanced (T3, T4, T x N2) breast cancer. All received four cycles of CVAP, after which clinical response was assessed. Responding patients were then randomized to four additional cycles of CVAP or to docetaxel 100 mg/m2 every 3 weeks for four cycles. Patients failing to respond to CVAP received the docetaxel regimen. After the first four cycles of CVAP, the overall response rate (ORR) was 67%. Ultimately, responses were higher in the group randomized to docetaxel compared with those continuing CVAP (cCR: 94% vs. 66%; p = 0.001; pCR 34% vs. 16%; p = 0.04). The addition of docetaxel improved overall survival and disease-free survival for patients responding to four cycles of CVAP as compared with those receiving eight cycles of CVAP. Relative dose intensity was higher and the incidence of severe leukopenia was lower in the group randomized to docetaxel. These data and data from the NSABP B-27 and GEPAR-duo trials strongly support a combined anthracycline/docetaxel regimen in the neoadjuvant setting. 相似文献
972.
Tarun Weeramanthri Bill Beresford 《Australian and New Zealand journal of public health》1992,16(4):431-434
Abstract: We aimed to develop a method to classify those errors in the completion of death certificates arising from misunderstanding of the certification process. We reviewed 430 Western Australian death certificates registered in March 1990 using a method devised to differentiate between major and minor errors. Major errors were found in 16 per cent of certificates (95 per cent confidence interval 12 to 20 per cent). The error rate did not vary significantly between city and country areas, nor between teaching hospitals and other locations. The method was validated on a separate sample of 120 certificates. It has potential as a tool to monitor a critical but neglected step in the production of mortality statistics and to assess understanding of the process of death certification. 相似文献
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975.
Jacques Jougon Marie Nadine Laborde Marie Parrens Tarun MacBride 《European journal of cardio-thoracic surgery》2002,22(3):476-478
Primary cardiac tumors are rare and myxomas are the most frequent. Cystic lymphangiomas are most often of cervicomediastinal locations and are exceedingly rare in the mediastinum. Cystic lymphangioma involving the heart has never been reported. We report a case of cystic lymphangioma involving the posterior wall of left atrium mimicking a mediastinal tumor. Complete resection was performed via a median sternotomy under cardiopulmonary bypass and cardiac arrest after transection of the aorta and pulmonary trunk. 相似文献
976.
Neoadjuvant chemotherapy in breast cancer: significantly enhanced response with docetaxel. 总被引:50,自引:0,他引:50
Ian C Smith Steven D Heys Andrew W Hutcheon Iain D Miller Simon Payne Fiona J Gilbert Antoinne K Ah-See Oleg Eremin Leslie G Walker Tarun K Sarkar S Peter Eggleton Keith N Ogston 《Journal of clinical oncology》2002,20(6):1456-1466
PURPOSE: To compare the efficacy of neoadjuvant (NA) docetaxel (DOC) with anthracycline-based therapy and determine the efficacy of NA DOC in patients with breast cancer initially failing to respond to anthracycline-based NA chemotherapy (CT). PATIENTS AND METHODS: Patients with large or locally advanced breast cancer received four pulses of cyclophosphamide 1,000 mg/m(2), doxorubicin 50 mg/m(2), vincristine 1.5 mg/m(2), and prednisolone 40 mg (4 x CVAP) for 5 days. Clinical tumor response was assessed. Those who responded (complete response [CR] or partial response [PR]) were randomized to receive further 4 x CVAP or 4 x DOC (100 mg/m(2)). All nonresponders received 4 x DOC. RESULTS: One hundred sixty-two patients were enrolled; 145 patients completed eight cycles of NA CT. One hundred two patients (66%) achieved a clinical response (PR or CR) after 4 x CVAP. After randomization, 50 patients received 4 x CVAP and 47 patients received 4 x DOC. In patients who received eight cycles of CT, the clinical CR (cCR) and clinical PR (cPR) (94% v 66%) and pathologic CR (pCR) (34% v 16%) response rates were higher (P =.001 and P =.04) in those who received further DOC. Intention-to-treat analysis demonstrated cCR and cPR (85% v 64%; P =.03) and pCR (31% v 15%; P =.06). Axillary lymph node examination revealed residual tumor in 33% of patients who received 8 x CVAP and 38% of patients who received further DOC. In patients who failed to respond to the initial CVAP, 4 x DOC resulted in a cCR and cPR rate of 55% and a pCR rate of 2%. Forty-four percent of these patients had residual tumor within axillary lymph nodes. CONCLUSION: NA DOC resulted in substantial improvement in responses to DOC. 相似文献
977.
Sarang Agarwal Loveneesh G. Krishna Anish Agarwalla Jatin Talwar Ashish Rustagi 《Indian Journal of Orthopaedics》2021,55(3):780
Coronal plane fracture of the posterior femoral condyle, Hoffa fracture is a rare injury pattern. We report a case of a 32-year-old male with closed Lateral Hoffa fracture along with patella and medial condyle of tibia fracture. Patient was treated using 02 cannulated cancellous screws and a lateral recon plate for Hoffa fracture, tension band wiring for patella fracture and 02 cannulated cancellous screws for tibia fracture through modified swashbuckler approach. Twenty-four months postoperatively, the range of movement in the knee was 0°–130°. In this complex case, our technique provided stable fixation of the fragments and a satisfactory final functional outcome. 相似文献
978.
979.
Neelam Mohan Sakshi Karkra Amit Rastogi Maninder S. Dhaliwal Veena Raghunathan Deepak Goyal Sanjay Goja Prashant Bhangui Vijay Vohra Tarun Piplani Vivek Sharma Dheeraj Gautam S. S. Baijal A. S. Soin 《Indian pediatrics》2017,54(11):913-918
Objective
To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years.Materials and Methods
A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome.Results
Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease.Conclusions
Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.980.