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71.
At the Department of Radiation Oncology, Westmead Hospital, between 1980 and 2000, 60 patients with squamous cell carcinoma of anal canal or margin (including 15 with Stage IIIA or IIIB) were treated radically; 55 received chemoradiation (89% were prescribed mitomycin C and 5‐fluorouracil). Five‐year overall survival was 64% (95% confidence interval (CI): 48–79%), with a median survival of 9.75 years (median follow up 5.6 years, range 5 months to 22.5 years). Ten patients have died of disease. At 2 years the local control rate was 86%, and colostomy‐free survival was 83%. Relapse after 2 years was uncommon. Tumour size was the main factor driving outcomes, especially survival. Patients with larger tumours (T > 4 cm) had a hazard ratio for survival of 5.7 (95% CI: 1.8–17). Fourteen (24%) patients experienced treatment interruptions as a result of acute toxicity, including one death from neutropoenic sepsis. Seven (12%) patients, in total, experienced one or more late toxicities, grade 3 or above, including four women (all postmenopausal) who developed a radiation‐induced bone injury. Most patients with anal cancer can expect to retain a functional sphincter after chemoradiation/radiation. Further studies are in progress to determine the optimal chemoradiation protocol. 相似文献
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73.
Alveolar capillary dysplasia. Report of a case of prolonged life without extracorporeal membrane oxygenation (ECMO) and review of the literature 总被引:3,自引:0,他引:3
Al-Hathlol K Phillips S MK Seshia Casiro O Alvaro RE Rigatto H 《Early human development》2000,57(2):85-94
We describe an unusual infant with the diagnosis of alveolar capillary dysplasia who had a relatively prolonged life without extracorporeal membrane oxygenation (ECMO). We have used this case as a springboard for a thorough review of the literature. This was a full-term female infant who presented with a picture of persistent pulmonary hypertension of the newborn. She was treated as such, with various ventilatory modes, alkalinizing agents, surfactant therapy, tolazoline, prostacyclin and nitric oxide. Because of the prolonged clinical course the possibility of alveolar capillary dysplasia was raised. The parents refused ECMO. Despite all efforts she progressively deteriorated and died at 22 days of age. Macro- and microscopic examination of the lung at autopsy were diagnostic of alveolar capillary dysplasia. A detailed review of 39 cases published in the literature with comments regarding incidence, etiology, pathophysiology, clinical picture, diagnosis and treatment is presented. 相似文献
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Bhan MK 《International journal of antimicrobial agents》2000,14(1):71-73
Diarrhoea continues to have a devastating impact in infants and children. It is a major cause of retarded growth. Substantial declines in hospitalization rates and possibly in the mortality due to diarrhoea have occurred following the launch of programmes based on oral rehydration therapy, and yet about 1 million diarrhoea-related deaths occur each year in South-East Asia. The World Health Organization currently recommends oral rehydration therapy plus continued breast- and complementary feeding for children with diarrhoea, and antibiotics for dysentery or associated systemic infection. Although oral rehydration therapy has achieved substantial acceptance, physicians and families continue to prescribe and seek drug therapy to reduce diarrhoeal duration and severity. Research is aimed at developing improved oral rehydration salt solutions or identifying adjunct therapy that will provide substantial benefit in reducing stool output together with safety and selectivity of action. It must, however, be recognized that control of malnutrition is a key requirement to reduce the duration and severity of acute diarrhoea. 相似文献
77.
R Bahl N Bhandari MK Bhan M Saxena A Bagati 《Acta paediatrica (Oslo, Norway : 1992)》1996,85(11):1290-1294
Objectives : To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. Methods : In this double-blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results : In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment ( p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them ( p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions : These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use. 相似文献
78.
Salim E. Kabawat Robert C. Bast William R. Welch Robert C. Knapp Atul K. Bhan 《International journal of cancer. Journal international du cancer》1983,32(5):547-554
Expression of histocompatibility antigens and the intensity of inflammatory cellular infiltrate were evaluated in frozen tissue sections from 70 human ovarian tumors and six normal ovaries using monoclonal antibodies and an avidin-biotin immunoperoxidase technique. In the normal human ovary, surface epithelial cells, mature granulosa cells and lutein cells reacted with anti-HLA-A, B, C (HLA) and beta2-microglobulin antibodies but not with anti-la (la-like, HLA-DR). Stromal cells and granulosa cells of the primordial follicles did not react with any of the antibodies. Among the neoplasms examined, all benign epithelial tumors, 86% of borderline an 81% of malignant epithelial tumors reacted with anti-HLA and/or beta2-microglobulin antibodies. HLA-negative epithelial tumors were of serous or endometrioid types. Although la was not found in normal ovarian surface epithelium, the antigen could be detected in 44% of benign, and 43% of borderline and malignant epithelial ovarian tumors. Mono-nuclear cellular infiltrate was generally scarce in ovarian tumors and consisted mainly of T cells. Malignant epithelial tumors contained significantly more T cells than did benign tumors. More T cells were observed in HLA-positive ovarian tumors than in HLA-negative neoplasms, but the difference did not achieve statistical significance. No correlation could be found between la expression and the intensity of T-cell infiltrate. Significantly more T8 and Leu-3a-positive cells were found in the tumor stroma than amongst neoplastic cells. HNK-I-positive natural killer cells, OK-MI-positive macrophages and BI-positive B lymphocytes were rarely encountered either in the tumor stroma or between adjacent tumor cells. 相似文献
79.
A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years 总被引:13,自引:0,他引:13
Bhan S Malhotra R Kiran EK Shukla S Bijjawara M 《The Journal of bone and joint surgery. American volume》2005,87(10):2290-2296
BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II. 相似文献
80.