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1.
Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. 总被引:3,自引:0,他引:3
Between 1977 and 1986, 75 black and 615 white women with American Joint Committee (AJC) Stages I and II breast cancer were treated with excisional biopsy, axillary dissection, and radiation therapy for breast conservation. Cyclophosphamide, methotrexate, and 5-fluorouracil, with and without prednisone and tamoxifen, was given to 92% of premenopausal, 83% of perimenopausal, and 63% of postmenopausal node-positive women; 20 of 106 (19%) postmenopausal node-positive women received tamoxifen only. The clinical characteristics of the similarly treated patients were compared. The 5-year actuarial local only first failure rate was 5% for black women and 6% for white women (P = 0.53). Regional only failure as the first site of failure was 9% for blacks versus 1% for whites (P = 0.002), with regional recurrence as any component of first failure being 16% for blacks and 4% for whites (P = 0.001). The supraclavicular fossa was identified as the primary site of regional recurrence in black patients with either pathologically positive or negative axillae. Distant metastases as the only site of first failure were significantly greater in the black population with a 20% 5-year actuarial failure rate versus 11% in white patients (P = 0.01). The 5-year actuarial overall survival for the black patients was 82% versus 91% for the white patients (P = 0.01), with no-evidence-of-disease (NED) survival being 64% and 83% (P = 0.0002) and relapse-free survival (RFS) being 61% and 77% (P = 0.01), respectively. Black patients younger than 40 years of age or with pathologically positive axillary nodes had significantly worse NED, RFS, and overall survival compared with similarly staged white patients. Cosmetic results were analyzed at 3 and 5 years after completion of therapy. Although significantly fewer black patients had an excellent-to-good cosmetic result at 3 years compared with white patients, the results were not significantly different at 5 years. These results show that appropriately selected black patients with early stage breast cancer have excellent local control after conservative surgery and radiation therapy and should continue to be offered breast preservation as an alternative to mastectomy. Patterns of failure, however, demonstrated higher regional and distant recurrence rates and lower NED, RFS, and overall survival rates in most subsets of black patients reviewed. 相似文献
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David H. Miller M.D. Theodore T. Miller M.D. Elizabeth Schultz M.D. Baruch Toledano M.D. 《Emergency radiology》1997,4(3):172-176
We report a case of dislocation of the second through fifth carpometacarpal joints and review the mechanism of injury and radiographic findings in such injuries. 相似文献
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M. H. Baums G. Spahn M. Nozaki H. Steckel W. Schultz H.-M. Klinger 《Knee surgery, sports traumatology, arthroscopy》2007,15(5):687-644
Frozen shoulder is said to be a self-limiting entity but full recovery often takes more than 2 years. For that, most patients
are unwilling to tolerate painful restriction while awaiting resolution. We prospectively investigated 30 patients (16 women,
14 men) for the outcome of arthroscopic capsular release in idiopathic frozen shoulder. Results were determined by the assessment
of subjective and objective parameters to estimate both shoulder function and general health status. Symptoms persisted without
improvement for a minimum of 6 months of conservative treatment. Preoperative average American shoulder and elbow surgeons
score (ASES) was 35, visual analog scale (VAS) to measure pain was 7, and simple shoulder test (SST) was 4. Mean scores of
the physical component of SF-36 were considerably reduced. Mean forward elevation was 85°, average abduction was 70°, mean
internal rotation was 15°, and mean external rotation was 10°. Patients were followed-up at 6 weeks, 3, 6, 12 months and by
a mean of 36 months. Range of motion for all planes improved (P < 0.05). Median VAS reduced to 2, average ASES increased to 91, and SST enhanced to a mean of 10 (P < 0.05). We stated improvement of the physical components in the SF-36 questionnaire in particular bodily pain and the role-physical
score. There were no significant differences between the measurements in the early postoperative phase compared to the mid-term
follow-up (P > 0.05). Our results demonstrate that arthroscopic release of refractory idiopathic frozen shoulder combined with a gentle
manipulation provides reliable expectations for improvement in both clinical and general health status for most patients.
We recommend the use of a limb-specific and a general-health-status questionnaire to conclude the benefit of the surgical
intervention and contribute the optimization of a therapy concept more effectively. 相似文献
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Robert M. Pascuzzi Scott A. Shapiro Aruna N. Rau Charles E. Schultz Robin M. Bowman Karen S. Caldemeyer David S. Wilkes David S. Wilkes 《Journal of neuroimaging》1996,6(1):61-62
A 45-year-old woman with history of iritis, uveitis, and sarcoidosis of the skin presented with a subacute cervical myelopathy. Magnetic resonance imaging (MRI) ;howed patchy, multifocal, gadoliniumenhancing intramedullary lesions of the spinal cord, and extramedullary lesions of the basal cisterns and fourth ventricle. Symptoms and MRI abnormalities were improved within 1 month of corticosteroid therapy. 相似文献