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21.
Surgical treatment strategies and outcome in patients with breast cancer metastatic to the spine: a review of 87 patients 总被引:3,自引:0,他引:3
Joseph A. Shehadi Daniel M. Sciubba Ian Suk Dima Suki Marcos V. C. Maldaun Ian E. McCutcheon Remi Nader Richard Theriault Laurence D. Rhines Ziya L. Gokaslan 《European spine journal》2007,16(8):1179-1192
Aggressive surgical management of spinal metastatic disease can provide improvement of neurological function and significant
pain relief. However, there is limited literature analyzing such management as is pertains to individual histopathology of
the primary tumor, which may be linked to overall prognosis for the patient. In this study, clinical outcomes were reviewed
for patients undergoing spinal surgery for metastatic breast cancer. Respective review was done to identify all patients with
breast cancer over an eight-year period at a major cancer center and then to select those with symptomatic spinal metastatic
disease who underwent spinal surgery. Pre- and postoperative pain levels (visual analog scale [VAS]), analgesic medication
usage, and modifed Frankel grade scores were compared on all patients who underwent surgery. Univariate and multivariate analyses
were used to assess risks for complications. A total of 16,977 patients were diagnosed with breast cancer, and 479 patients
(2.8%) were diagnosed with spinal metastases from breast cancer. Of these patients, 87 patients (18%) underwent 125 spinal
surgeries. Of the 76 patients (87%) who were ambulatory preoperatively, the majority (98%) were still ambulatory. Of the 11
patients (13%) who were nonambulatory preoperatively, four patients were alive at 3 months postoperatively, three of which
(75%) regained ambulation. The preoperative median VAS of six was significantly reduced to a median score of two at the time
of discharge and at 3, 6, and 12 months postoperatively (P < 0.001 for all time points). A total of 39% of patients experienced complications; 87% were early (within 30 days of surgery),
and 13% were late. Early major surgical complications were significantly greater when five or more levels were instrumented.
In patients with spinal metastases specifically from breast cancer, aggressive surgical management provides significant pain
relief and preservation or improvement of neurological function with an acceptably low rate of complications. 相似文献
22.
Acquired immunodeficiency syndrome-associated non-Hodgkin's lymphomas and other malignancies in patients with hemophilia 总被引:3,自引:0,他引:3
Ragni MV; Belle SH; Jaffe RA; Duerstein SL; Bass DC; McMillan CW; Lovrien EW; Aledort LM; Kisker CT; Stabler SP 《Blood》1993,81(7):1889-1897
Non-Hodgkin's lymphoma (NHL) is the most common human immunodeficiency virus (HIV)-associated malignancy in hemophiliacs. We studied the incidence and clinicopathologic features of NHL in 3,041 hemophiliacs followed at 18 US Hemophilia Centers between 1978 and 1989. Of the 1,295 (56.6%) who were HIV(+), 253 (19.5%) developed acquired immunodeficiency syndrome (AIDS), of whom 14 (5.5%) developed NHL. Three NHL occurred in HIV(-) hemophiliacs, for a 36.5-fold greater risk in HIV(+) than HIV(-) hemophiliacs (P < .001). The NHL incidence rate was 29-fold greater than in the US population by Surveillance, Epidemiology, and End Results (SEER) estimates (P < .001). Between 0 and 4 lymphomas have been observed per year between 1978 and 1989. At presentation 13 (92.9%) of the HIV(+) NHL were extranodal. Ten were stage IV, 1 stage II, and 3 stage IE. Ten (71.4%) were high-grade, 3 (21.4%) intermediate-grade, and 1 (7.1%) was a low-grade B-cell lymphoma. Epstein-Barr virus (EBV) DNA was detected in 36% by in situ hybridization, including one central nervous system (CNS) lymphoma. The mean CD4 cell count at NHL diagnosis was 64/mm3, the mean latency from initial HIV infection was estimated to be 59 months, and the median survival was 7 months. The incidence of basal cell carcinoma in HIV(+) hemophiliacs was 18.3-fold greater than in HIV(-) hemophiliacs (P < .001) and 11.4-fold greater than in the US population (P < .001). In conclusion, incidence rates of NHL and basal cell carcinoma in HIV(+) hemophiliacs are significantly increased over rates in HIV(-) hemophiliacs and over rates in the US population. Clinicopathologic presentation of NHL in HIV(+) hemophiliacs is similar to that in HIV(+) homosexual men. 相似文献
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25.
Recruitment and screening policies and procedures used to establish a paid donor oocyte registry 总被引:3,自引:2,他引:1
We have reviewed the demographic characteristics of, and report
abnormalities noted in, the de-novo growth and development of a paid oocyte
donation programme. The personal profiles of all prospective oocyte donors
were reviewed. Acceptance or rejection of candidates was based upon
screening the results of medical, genetic and psychological testing. A
total of 603 candidates initially responded to our advertisement. From this
pool, 313 individuals were considered suitable and contacted by telephone.
Following further conversation, 176 women were scheduled an entry
interview. On completion of the formal screening process, 17.6% (n = 31) of
those actually interviewed were denied entry. Thus, from the initial
interested parties, only 23% of women wishing to participate in oocyte
donation were considered suitable candidates. Given the high attrition
rate, we concluded that the need for rigorous and thorough medical,
psychological and genetic testing is mandatory for the establishment of a
donor registry. Furthermore, professional counselling of prospective donors
with respect to the results of tests and the implications of test results
with respect to their future medical and reproductive health, are important
parts of providing comprehensive care.
相似文献
26.
Paulo Henrique Pires de Aguiar Adriana Tahara Antonio Nogueira Almeida Renata Simm Arnaldo Neves da Silva Marcos Vinicius Calfatt Maldaun Alexandros Theodoros Panagopoulos Carlos Alexandre Zicarelli Pedro Gabriel Silva 《Journal of clinical neuroscience》2009,16(9):1168-1173
Olfactory groove meningiomas (OGM) account for 4.5% of all intracranial meningiomas. We report 21 patients with OGMs. Tumors were operated on using three surgical approaches: bifrontal (7 patients), fronto-pterional (11 patients) and fronto-orbital (3 patients). Total tumor removal (Simpson Grade 1) was achieved in 13 patients and Simpson II in 8 patients. Perioperative mortality was 4.76%. The average size of the OGM was 4.3 ± 1.1 cm. The overall recurrence rate was 19%. We preferred to use the pterional approach, which provides quick access to the tumor with less brain exposure. It also allows complete drainage of cisternal cerebrospinal fluid, providing a good level of brain relaxation during surgery. However, for long, thin tumors, hemostasis can be difficult using this approach. 相似文献
27.
28.
WE Gillies FRACO FRACS FRCS Anne MV Brooks MD PhD FRACO FRACS FRACP 《Clinical & experimental ophthalmology》1992,20(3):239-242
A method of combined cataract extraction with posterior chamber intraocular lens and trabeculectomy using separate incisions was tested in 44 operations on 38 patients. The mean preoperative intraocular pressure (IOP) of 28.1 ± 11.7 (range 12 to 56) mmHg on maximum medication was lowered to 13.9 ± 3.4 (9 to 23) mmHg at one year, with half the eyes still requiring topical medication. The IOP was 40 mmHg or more preoperatively in eight eyes and 20 mmHg or more in only two patients at one year. There were no rises in IOP above 20 mmHg in the early postoperative period (days 1 and 2). Visual acuity was 6/9 or better in 27 and 6/12 in three eyes. There was an expulsive haemorrhage in one case, rupture of the posterior capsule in two eyes and a choroidal detachment in one eye, but no flat anterior chambers. The two-incision method allowed placement of an intraocular lens with good postoperative pressure control. 相似文献
29.
MV Pravin Charles Joshy M Easow Noyal M Joseph M Ravishankar Shailesh Kumar Umadevi Sivaraman 《The Australasian medical journal》2013,6(9):430-434
Background
Ventilator-associated pneumonia (VAP) is a common type of nosocomial pneumonia encountered in intensive care units. There are several aetiological agents which make treatment challenging. Improper antibiotic treatment of ventilated patients may lead to the emergence of multidrug resistant (MDR) pathogens.Method
A prospective study was performed over a period of 20 months. Our study had two arms: the first, ‘Incidence and risk factors of VAP in a tertiary care hospital’ was the subject of an earlier publication; we therefore present the second investigative arm in this work. The aetiological agents of patients on mechanical ventilation (MV) were identified by standard bacteriological method. The susceptibility pattern was evaluated by Kirby-Bauer disc diffusion method. Extended spectrum beta lactamase (ESBL) testing was performed by combination disc method, and metallo-beta lactamase (MBL) testing was performed by EDTA disk synergy test (EDS).Results
Late-onset VAP was associated with Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli, while early-onset VAP was commonly caused by members of Enterobacteriaceae, Candida albicans and Staphylococcus aureus. 72.2 per cent of VAP patients had monomicrobial and 27.8 per cent had polymicrobial infection. Out of the 24 isolates obtained from patients with VAP, seven (29.2 per cent) were MDR pathogens. ESBL and MBL production was detected in 40 per cent and 20 per cent of Klebsiella pneumoniae isolated in our study. Around 50 per cent of isolates associated with late-onset VAP were MDR, while 22.2 per cent isolates obtained from patients with earlyonset VAP were MDR.Conclusion
VAP is a nosocomial pneumonia that is common among ventilated patients. The aetiological agents vary from common organisms to MDR pathogens that are difficult to treat. A proper knowledge of MDR pathogens and early isolation followed by prevention of prolonged antibiotic therapy can reduce the mortality of late onset VAP. 相似文献30.