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Vinciullo C Elliott T Francis D Gebauer K Spelman L Nguyen R Weightman W Sheridan A Reid C Czarnecki D Murrell D 《The British journal of dermatology》2005,152(4):765-772
BACKGROUND: Basal cell carcinoma (BCC) may be difficult to treat by conventional means, particularly if the lesions are large or located in the mid-face (H-zone). Photodynamic therapy (PDT) using topical methyl aminolaevulinate (MAL) may be a good noninvasive option for these patients. OBJECTIVES: To investigate the efficacy and safety of PDT using MAL for BCCs defined as 'difficult to treat', i.e. large lesions, in the H-zone, or in patients at high risk of surgical complications. METHODS: This was a prospective, multicentre, noncomparative study. Patients were assessed 3, 12 and 24 months after the last PDT treatment. One hundred and two patients with 'difficult-to-treat' BCC were treated with MAL PDT, using 160 mg g(-1) cream and 75 J cm(-2) red light (570-670 nm), after lesion preparation and 3 h of cream exposure. Results Ninety-five patients with 148 lesions were included in the per protocol analysis. The histologically confirmed lesion complete response rate at 3 months was 89% (131 of 148). At 12 months, 10 lesions had reappeared, and therefore the cumulative treatment failure rate was 18% (27 of 148). At 24 months, an additional nine lesions had reappeared, resulting in a cumulative treatment failure rate of 24% (36 of 148). The estimated sustained lesion complete response rate (assessed using a time-to-event approach) was 90% at 3 months, 84% at 12 months and 78% at 24 months. Overall cosmetic outcome was judged as excellent or good in 79% and 84% of the patients at 12 and 24 months, respectively. Follow-up is continuing for up to 5 years. CONCLUSIONS: MAL PDT is an attractive option for 'difficult-to-treat' BCC. Because of the excellent cosmetic results, the treatment is particularly well suited for lesions that would otherwise require extensive surgical procedures. 相似文献
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The introduction of prenatal ultrasonography as a screening method entails an increasing number of infants diagnosed with prenatal hydronephrosis. Ureteropelvic junction obstruction accounts for 35% of prenatal hydronephrotic cases. Urinary tract obstruction that occurs during early kidney development affects renal morphogenesis, maturation and growth, and in the most severe cases this will ultimately cause renal insufficiency. A major challenge in the clinical management of these patients is to preserve renal function by selection of the 15%-20% who require early surgical intervention, leaving those for whom watchful waiting may be appropriate because of spontaneous resolution/stabilization without significant loss of renal function. Today, this requires medical surveillance, including repetitive invasive diuretic renograms relying on arbitrary threshold values, and therefore there is a need for non-arbitrary, non-invasive urinary biomarkers that may be used as predictors for renal structural changes and/or decreasing renal function, and thereby provide the surgeon with more clear indications for surgical intervention. In this review, we summarize the currently well-known facts about urinary biomarkers in ureteropelvic junction obstruction concerning renal function, and we also suggest potential novel urinary biomarkers. 相似文献
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Pharmacologic Cardiac Resynchronization of a 1-Year-Old Boy With Severe Left Ventricular Dysfunction
Postero-septal accessory pathways (AP) are a rare cause of intraventricular dyssynchrony and severe LV dysfunction in children. Beside the common treatment with radiofrequency ablation of septal substrates we present the case of a successful pharmacologic resynchronization in a 13/12 years old male toddler with Wolff-Parkinson-White syndrome (WPW) and severe LV dysfunction (left ventricular biplane EF of 31?%) due to intraventricular dyssynchrony with septal to posterior wall motion delay (SPWMD) of 350 ms. Interventricular mechanical delay (IVMD) was 65 ms. Using propafenone, pharmacologic cardiac resynchronization could be achieved. Pharmacologic resynchronization should be considered as safe and effective alternative to catheter ablation in very young children. 相似文献
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Peter Foley MBBS BMedSc MD FACD Kurt Gebauer OAM MBBS FACD FACP John Sullivan MBBS FACD Erin McMeniman MBBS FRACGP MPH PhD FACD Stephen Shumack MBBS OAM FACD Jonathan Ng MBBS FACD Amelia James BSc MD Morton Rawlin MBBS FRACGP Shireen Sidhu MBBS FACD Dev Tilakaratne MBBS FACD Murray Turner LLB BArts Barbara Radulski RN Peter Nash MBBS FRACP Christopher Baker MBBS FACD FRCP 《The Australasian journal of dermatology》2023,64(4):476-487