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1.
AM Manganoni† C Farisoglio† G Tucci† F Facchetti‡ PG Calzavara Pinton† 《Journal of the European Academy of Dermatology and Venereology》2007,21(10):1333-1336
BACKGROUND: Development of more than one primary melanoma in a patient is a relatively uncommon but well-recognized phenomenon. Its frequency has ranged from 1.2% to 8.2% in several series. This subgroup of patients with multiple primary lesions has not been characterized sufficiently. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. METHOD: Study subjects were drawn from 1240 patients with histologically confirmed melanoma, including melanoma in situ. From this group, multiple melanomas developed in 47 patients (3.79%). Every one of our patients has been taught to perform self-examination of the skin to detect suspicious pigmented lesions. RESULTS: Of the 47 patients described in this study, 38 had two primary melanomas, 7 had three melanomas and 2 had 5 and 10 melanomas, respectively. Mean age at first diagnosis was 46.2 years. The majority of subsequent melanomas (74.5%) were removed within 5 years of the initial operation. Synchronous lesions were found in 10 patients. In male patients, the lesion appeared most frequently on the trunk; in female patients, melanoma appeared mostly on the lower extremities. The second primary melanomas developed in the same anatomic region from the first in 53.2% of our patients. The proportion of in situ to invasive melanomas was greater for the second melanomas compared with the first melanomas. Regarding invasive melanomas, the mean thickness of the first melanomas was 1.31 mm compared with 0.66 mm for the second ones. Dividing patients into two groups, of more and less than 50, it is highlighted that in older patients synchronous lesions appear more frequently (36.4% vs. 8.0%); the median time interval between sequential melanomas is longer (84 vs. 63.7 months); and the ratio between the primary and secondary melanoma mean thickness is lower (1.21 : 1.08 vs. 1.43 : 0.63 mm). CONCLUSIONS: The study confirms that second primary melanoma is usually thinner than the first lesion, and it is more common in the same region of the body as the initial melanoma. The highest risk for a second melanoma is during the first 5 years, but a much longer time interval of 28 years is possible. Continued medical follow-up with complete skin examinations seems prudent, but it is very important to promote self-skin evaluation in patients to detect not only metastases but also subsequent primary melanomas in their earliest phases. 相似文献
2.
3.
Tortoriello DV; McGovern PG; Colon JM; Loughlin J; Santoro N 《Human reproduction (Oxford, England)》1998,13(11):3005-3008
We report an instance of critical ovarian hyperstimulation syndrome in a
highly responsive in-vitro fertilization patient despite the preventive
measure of a 4 day 'coast' interval during which no gonadotrophins were
administered while gonadotrophin-releasing hormone agonist therapy
continued until serum oestradiol concentrations fell below 3000 pg/ml.
相似文献
4.
5.
J Holden S O'Donnell J Brindley L Miles 《The British journal of general practice》1998,48(432):1409-1412
BACKGROUND: The death of a patient is a significant event that occurs often enough in general practice for it to have the potential to tell us much about the care we provide. There are few large series in the literature and we still know little about the collaborative use of this outcome measure. AIM: To determine the pattern of deaths and potentially preventable factors in our practices. METHOD: We completed a standard data collection form after each death in four general practices over a 40-month period. The results were discussed at quarterly meetings. RESULTS: A total of 1263 deaths occurred among our registered patients during the period of the audit. Preventable factors contributing to deaths were considered to be attributable to: patients (40%): mainly cigarette smoking, poor compliance, and alcohol problems; general practice teams (5%): mainly delayed referral, diagnosis and treatment, and failure to prescribe aspirin to patients with vascular disease; hospitals (6%): mainly delayed diagnosis and perceived treatment problems; the environment (3%): mainly falls, principally resulting in fractured neck of femur. CONCLUSION: A simple audit of deaths along the lines that we describe gives important information about the care provided by general practice teams and those in hospital practice. It has both educational value and is a source of ideas for service improvement and further study, particularly when carried out over several years. 相似文献
6.
7.
Battaglia C; Artini PG; Giulini S; Salvatori M; Maxia N; Petraglia F; Volpe A 《Human reproduction (Oxford, England)》1997,12(11):2477-2482
The objective of this study was to evaluate the Doppler flow variations
which occur following the use of different protocols of ovarian stimulation
in an IVF programme, and to investigate the thromboxane production by
cultured endometrial cells and its influence on embryo implantation. A
total of 60 patients underwent three different ovarian stimulation
protocols: long gonadotrophin-releasing hormone agonist (GnRH-a), short
GnRH-a and no GnRH-a. Transvaginal ultrasonography and colour Doppler
analysis were performed before and during the treatment. On the day that
the Doppler examination took place, luteinizing hormone, follicle
stimulating hormone, plasma oestradiol and thromboxane concentrations were
assayed. On the day of oocyte retrieval, endometrial cells were collected
and cultured, and their thromboxane production evaluated. No significant
differences in hormonal, ultrasonographic or Doppler parameters were
observed between the three groups. Ten out of 56 patients who had a
successful embryo transfer became pregnant. In the group of pregnant women
the pulsatility index values of both uterine and spiral arteries was lower
than in non-pregnant patients, and was associated with significantly lower
thromboxane concentrations from cultured endometrial cells. It is concluded
that thromboxane plays a role in embryo implantation, and that Doppler flow
analysis of uterine and spiral arteries in infertile patients may be
important in the management of ovarian stimulation.
相似文献
8.
A longitudinal study of maternal serum inhibin-A, inhibin-B, activin-A, activin-AB, pro-alphaC and follistatin during pregnancy 总被引:6,自引:1,他引:6
Fowler PA; Evans LW; Groome NP; Templeton A; Knight PG 《Human reproduction (Oxford, England)》1998,13(12):3530-3536
Maternal serum concentrations of inhibin-A, inhibin-B, activin-A,
activin-AB, pro-alphaC-related inhibin forms, total follistatin, steroids
and gonadotrophins were measured longitudinally in six normal singleton
pregnancies. Maternal venous blood was collected randomly during a
spontaneous follicular phase prior to donor insemination, at 5, 7, 9, 11,
16, 20, 24, 28, 32 and 36 weeks after the first missed menses and in the
early puerperium. Steroid and gonadotrophin profiles conformed to previous
reports. While at week 5 of gestation inhibin-A, activin-A and follistatin
concentrations were similar to those at the follicular phase, all three
increased progressively (P < 0.001) to maximal concentrations in week
36: approximately 48-fold (3740 +/- 1349 ng inhibin-A/ml), approximately
22-fold (6109 +/- 1443 ng activin-A/ml) and approximately 10-fold (3563 +/-
418 ng follistatin/ml) higher. Pro- alphaC concentrations reached a maximum
in weeks 5 (approximately 5- fold, P < 0.001) and 36 (1027 +/- 174
pg/ml, P < 0.01). Inhibin-B (71 +/- 23 pg/ml prior to pregnancy) was
undetectable (<12 pg/ml) between week 5-16 of gestation but increased
slightly in the third trimester (26 +/- 7 pg/ml in week 36). Activin-AB was
undetectable throughout pregnancy. Post-partum concentrations of inhibin-A
(41 +/- 12 ng/ml), inhibin-B (<12 pg/ml), activin-A (950 +/- 149 pg/ml),
pro-alphaC (128 +/- 22 pg/ml) and follistatin (990 +/- 79 ng/ml) were
substantially lower than at week 36 of gestation. The activin-A:follistatin
ratio increased from 0.5 in week 5 to 1.8 in week 36, suggesting that more
free activin-A is available in the maternal circulation during late
pregnancy.
相似文献
9.
Catt SL; Sakkas D; Bizzaro D; Bianchi PG; Maxwell WM; Evans G 《Molecular human reproduction》1997,3(9):821-825
Controlling the sex of offspring by the separation of X and Y
chromosome-bearing spermatozoa using flow cytometry has been reported as a
clinical technique aiding prevention of X-linked diseases. Although this
technique has resulted in several hundred normal births in animals and at
least one human birth, there is still concern over its genetic safety due
to the involvement of two potentially mutagenic agents: UV light and the
fluorochrome dye, Hoechst 33342 (H33342). Human spermatozoa, particularly
those considered abnormal, may be more likely to suffer DNA damage
following exposure to mutagenic agents, compared with other mammalian
species. The stability of normal fresh and decondensed human spermatozoa
were examined after exposure to a range of levels of UV and H33342
staining, using an assay that detects endogenous nicks in the DNA of
spermatozoa. The stability of abnormal and normal, fresh and frozen-thawed
human spermatozoa was examined following UV laser, H33342 staining and flow
cytometry treatments utilizing the same assay. There was an increase in the
presence of endogenous nicks when spermatozoa were decondensed compared
with fresh spermatozoa. There was no increase in the incidence of nicks in
any group of spermatozoa after UV and fluorochrome exposure compared with
controls without exposure.
相似文献
10.
Charles J. Brindley R. Barbara Pedley Pari Antoniw Edward S. Newlands 《Cancer chemotherapy and pharmacology》1987,19(3):221-225
Summary The in vivo antitumor activity of etoposide and mitozolomide was assessed in nude mice bearing a xenograft (CC3) of human gestational choriocarcinoma. Both agents demonstrated, at best, marginal activity observed as a delay in tumour growth. This lack of sensitivity suggests that the CC3 xenograft is not a good model for selection of agents for clinical evaluation in gestational choriocarcinoma.Plasma and tissue concentrations of etoposide and mitozolomide were measured in nude mice. Drug concentrations found in tumour tissue were 60% and 30% of plasma levels for mitozolomide and etoposide respectively.Etoposide and mitozolomide activity was also evaluated in vitro with another choriocarcinoma cell line (JAR). Maximum cell-kill was achieved after exposure to etoposide 0.05–1 g/ml for 3–24 h. In vitro response to etoposide demonstrates the importance of exposure time in determining cytotoxicity. In contrast, mitozolomide at concentrations from 1–100 g/ml did not have a marked effect against JAR after exposure for 3–24 h.This work was supported by the Cancer Research Campaign 相似文献