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51.
The work of a child psychiatrist and a social worker with a group of adolescent juvenile diabetics is described. The conceptual framework that emerged from this experience draws on developmental and psychodynamic theory that may be applied to other chronic disease patients. The authors provide recommendations for the practical application of the model for pediatricians and describe the acceptance of the diagnosis as akin to the mourning process. 相似文献
52.
J W Mackenzie R J Lewis G E Sisler W Lin J Rogers I Clark 《The Annals of thoracic surgery》1984,38(2):133-139
Rats with aflatoxin-B1-induced hepatomas and dimethylnitrosamine-induced nephroblastomas excreted greater than normal amounts of urinary modified nucleosides and bases, catabolites of ribonucleic acid (RNA). Although both neoplasms caused increased excretions of the same catabolites, their quantitative profiles differed, suggesting that it may be possible to distinguish between tumors. Rats with transplanted tumors (e.g., hepatomas and osteogenic sarcomas) did not excrete elevated levels of urinary RNA catabolites until approximately 20 days after transplantation despite rapid growth of the tumor for the first 15 days. These data suggest that the source of the elevated levels of these excretory products may be the host's tissue RNA. Preliminary studies in human beings with lung cancer showed marked elevation of one or more urinary RNA catabolites. Resection of the diseased tissue in 2 patients caused a drop in levels. The measurement of urinary RNA catabolites may be useful in the diagnosis, prognosis, and evaluation of therapy in patients with lung cancer. 相似文献
53.
Nikhil Yegya-Raman Meral Reyhan Sinae Kim Matthew P. Deek Ning Yue Wei Zou Jyoti Malhotra Joseph Aisner Salma K. Jabbour 《Practical radiation oncology》2019,9(1):e74-e82
Purpose
This study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy.Methods and materials
We reviewed the records of 82 patients with inoperable NSCLC treated between 2009 and 2016 with concurrent chemoradiation. All patients received positron emission tomography–based treatment planning, 4-dimensional computed tomography simulation to define an internal target volume, and daily cone beam computed tomography. We quantified variations in target volume margins with a margin deviation index (MDI), calculated as the percentage change in equivalent uniform dose between the original planning target volume (PTV) and a standard reference PTV 10 mm beyond the original gross tumor volume, consistent with the minimum margins mandated by recent NSCLC trials. Greater MDIs equated to smaller effective target volume margins. We dichotomized patients by the upper tercile MDI value (5.8%). Endpoints included time to locoregional progression and time to grade ≥ 3 radiation esophagitis (RE3) or radiation pneumonitis (RP3), modelled with the Fine-Gray method.Results
Median follow-up was 37.8 months (range, 5.9-58.1 months). Larger MDIs correlated with smaller clinical target volume (CTV) + PTV margins, larger gross tumor volumes, later treatment year, and intensity modulated radiation therapy use. The risk of locoregional progression did not differ for MDI ≥5.8% versus <5.8% (adjusted hazard ratio: 0.88; P = .76), but the risk of RE3 or RP3 was decreased for MDI ≥5.8% (adjusted hazard ratio: 0.27; P = .027). Patients with MDI ≥5.8% were treated with smaller CTV + PTV margins (median, 5.6 vs 8 mm; P < .0001) and a marginally lower volume of esophagus receiving ≥50 Gy (median, 31.1% vs 35.3%; P = .069).Conclusions
Smaller margins were used for larger tumors but were not associated with an increase in locoregional failures. Additional studies could clarify whether smaller margins, when used alongside modern radiation therapy techniques, decrease treatment-related toxicity for inoperable NSCLC. 相似文献54.
55.
H C Kim H H Kesarwala M Colvin P Saidi 《The Journal of allergy and clinical immunology》1985,76(4):591-594
Generalized urticaria and fever were noted in a patient with IgA (kappa) myeloma after intravenous cyclophosphamide. Intradermal skin testing revealed no reaction to cyclophosphamide and its analog, isophosphamide. However, phosphoramide mustard, a principle metabolite of cyclophosphamide, evoked an immediate wheal-and-flare response. Subsequent therapy with isophosphamide was well tolerated. These findings suggest that acute hypersensitivity reactions to cyclophosphamide are due to its metabolites and can be delineated with skin testing. 相似文献
56.
P S Mueller 《Psychosomatics》1985,26(8):654-662
This article reviews the pathophysiology of neuroleptic malignant syndrome, including characteristics of the population most at risk, clinical precautions to take against its occurrence or rapid development, and the specifics of treatment with bromocriptine or dantrolene. Emphasis is placed on the need for prompt differential diagnosis and treatment of this sporadic but severe reaction to intake of neuroleptics or to withdrawal of indirect dopaminergic agonists, such as antiparkinsonism agents. Without such immediate recognition of the problem, the prospects of pennanent disability, coma, or death are high. 相似文献
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Iliac artery dissection in the setting of renal transplant is a rare but potentially catastrophic event that may result in loss of kidney and lower extremity perfusion. We report a right external iliac artery dissection in a 45-year-old man with end-stage renal disease, diabetes, and hypertension who underwent a renal transplant at our institution. An external iliac artery dissection was diagnosed intraoperatively after completion of the arterial anastomosis given the mottled appearance of the kidney and loss of Doppler signal. The dissection was repaired via open endarterectomy, intimal tacking, bovine patching, and re-anastomosis of the kidney to a proximal site on the external iliac artery. To date, 23 cases of transplant-related iliac artery dissection have been described in the literature. Predisposing risk factors include atherosclerosis and hypertension combined with trauma from vascular clamps or suturing. There is a slight male predominance. Only one group utilized an open endarterectomy approach similar to ours, whereas others used synthetic vascular grafts (12 of 23), endovascular stents (4 of 23), donor iliac artery grafts (4 of 23), or saphenous vein grafts (2 of 23). In the absence of long-term outcomes data, the optimal repair mechanism is yet to be established. 相似文献