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排序方式: 共有67条查询结果,搜索用时 15 毫秒
1.
Sterling Richard K. King Wendy C. Khalili Mandana Kleiner David E. Hinerman Amanda S. Sulkowski Mark Chung Raymond T. Jain Mamta K. Lisker-Melman M auricio Wong David K. Ghany Marc G. 《Digestive diseases and sciences》2022,67(2):676-688
Digestive Diseases and Sciences - There are limited data on noninvasive methods to identify hepatic steatosis in coexisting hepatitis B virus (HBV) infection. To evaluate the diagnostic performance... 相似文献
2.
OBJECTIVE: To determine the morbidity and mortality of percutaneous dilational tracheostomy with bronchoscopic guidance when performed by medical intensivists. DESIGN: A retrospective analysis. SETTING: A tertiary care university hospital. PATIENTS: Fifty consecutive patients who underwent percutaneous dilational tracheostomy for prolonged mechanical ventilation. INTERVENTION: Bedside percutaneous dilational tracheostomy with bronchoscopic guidance. RESULTS: Seventeen women and 33 men with a mean age of 62 +/- 17 years. Operative mortality was 0 with four (8%) operative complications. Complications included one posterior tracheal abrasion, one anterior tracheal laceration, one episode of endobronchial hemorrhage requiring bronchoscopy, and one pneumothorax. Thirty-day mortality was 28% and overall mortality was 40%. All deaths were related to the patients' underlying disease. CONCLUSIONS: Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications. 相似文献
3.
Hypopharyngeal carcinoma 总被引:1,自引:0,他引:1
Hinerman RW Amdur RJ Mendenhall WM Villaret DB Robbins KT 《Current treatment options in oncology》2002,3(1):41-49
Opinion statement For more than 20 years, the policy at the University of Florida has been to treat patients with favorable stage T1-T2 pyriform
sinus carcinoma by using radiation therapy alone, or with a planned neck dissection if advanced nodal disease is present.
This approach usually leaves the patient with nearly normal swallowing and speech, and provides bilateral coverage of the
regional neck and retropharyngeal lymphatics. More advanced lesions often are not controlled with radiation alone and are
usually considered for partial or total laryngopharyngectomy if the patient is medically operable [1]. Radiation is usually
administered postoperatively in this setting, unless the neck disease is thought to be unresectable, in which case preoperative
radiation is given. Recent data have shown that adjuvant chemotherapy administered concomitantly with radiotherapy results
in improved cure rates for patients with advanced disease compared with irradiation alone. Time-honored established guidelines
are still used, although the edges have become blurred. Therefore, patients with larger primary tumors now may be considered
for organ preservation treatment with irradiation and chemotherapy, reserving surgery for salvage situations. The subset of
patients with advanced T4 pyriform sinus cancers (in whom cure with chemoradiation would likely result in tracheostomy and/or
gastrostomy dependence) may be better served with elective surgery and postoperative irradiation. The definition of this subset
of patients is unclear but probably includes patients with significant cartilage destruction and those who require pretreatment
tracheostomy. The policy at the University of Florida is to treat essentially all pharyngeal wall cancers with external-beam
irradiation alone. 相似文献
4.
PURPOSE: To report long-term rates of tumor control after radiotherapy (RT) for carcinoma in situ (CIS) of the true vocal cords (TVC). A comprehensive literature review was performed, and outcomes with other modalities of treatment for CIS of the TVC were compared. METHODS AND MATERIALS: Thirty patients with CIS of the TVC were treated between July 1967 and May 1998 with curative intent using megavoltage RT. Most patients (28 of 30) were treated with cobalt-60 through small (usually 5 x 5 cm) fields. Median RT dose was 56.25 Gy (range, 56.25-75 Gy; mean dose, 59.15 Gy) at 2.25 Gy per fraction. One patient was treated for a synchronous head and neck primary malignancy with large fields to a total dose of 75 Gy at 1.8 Gy per fraction. Approximately two thirds of the patients (19 of 30) were referred for RT because of recurrence after at least one stripping procedure. RESULTS: With a mean follow-up of 7.1 years (range, 2-17 years), the 5-year rates of local control, local control with larynx preservation, and ultimate local control (including salvage surgery) were the following: 88%, 88%, and 100%, respectively. Invasive squamous cell carcinoma developed in three (10%) of the patients. Time to failure was 14 months, 34 months, and 48 months, respectively. All three patients were surgically salvaged with a total laryngectomy. Cause-specific survival at 5 years was 100%. There were no late complications. CONCLUSIONS: RT to approximately 60 Gy at 2.25 Gy per fraction using small (5 x 5 cm) fields produces excellent results with CIS of the TVC. 相似文献
5.
Feigenberg SJ Mendenhall WM Hinerman RW Amdur RJ Friedman WA Antonelli PJ 《Head & neck》2002,24(4):384-389
PURPOSE: To report the outcome of patients with paraganglioma of the temporal bone treated with stereotactic radiosurgery at the University of Florida. METHODS AND MATERIALS: Between January 1997 and June 1999, five patients with paraganglioma of the temporal bone were treated with Linac-based stereotactic radiosurgery at the University of Florida. The ages of the three female and two male patients were between 40 and 88 years (median, 49 years). Four patients were treated at initial presentation, and one had recurrent disease. Treatment volumes ranged from 4.9 cm3 to 18.4 cm3, with a mean of 10.84 cm3. The dose applied to the margin of the tumor varied from 12.5 to 15 Gy (median, 15 Gy). The treatment dose was specified to the 80% isodose shell in two cases and to the 70% isodose shell in three cases. The median follow-up time was 27 months, ranging from 14 to 50 months. RESULTS: One of four previously untreated patients had a relapse at the primary tumor site. Treatment failure occurred at the field margin 6 months after radiosurgery; the patient was subsequently treated with fractionated stereotactic radiotherapy and at the time of analysis had no evidence of disease, 21 months after initiation of salvage therapy. The patient treated at the time of recurrence after conventional radiotherapy had a local recurrence 40 months after radiosurgery. At the time of this recurrence, the patient had biopsy-proven metastatic disease in two cervical lymph nodes, and no salvage therapy was performed. All patients were alive at the time of the analysis, one with disease present. Presenting symptoms improved in two patients and stabilized in one. The two patients who had local recurrence develop had worsening of their symptoms. One patient had a cranial nerve V palsy develop 6 months after treatment, which resolved after a few months. CONCLUSIONS: In this series, the results with stereotactic radiosurgery are discouraging compared with our results with conventional fractionated radiotherapy in patients with paraganglioma of the temporal bone. 相似文献
6.
Impact of race on outcome after definitive radiotherapy for squamous cell carcinoma of the head and neck 总被引:1,自引:0,他引:1
BACKGROUND: The objective of the current study was to evaluate the impact of race (black vs. white) on the outcome of patients with invasive squamous cell carcinoma of the head and neck. METHODS: Between 1983 and 1997, 686 patients completed definitive, twice-daily radiotherapy (RT) alone or combined with a planned neck dissection; no patients received adjuvant chemotherapy. The minimum follow-up was 2 years, and median follow-up was 7 years for living patients. No patients were lost to follow-up. Fifty-five patients were black (8%). RESULTS: Although the two groups had similar 5-year local-regional control rates (black patients vs. white patients: 70% vs. 76%, respectively; P = 0.275), black patients had double the risk for distant recurrence compared with white patients (27% vs. 13%; P = 0.012). The 5-year cause-specific and absolute survival rates were lower for black patients (52% vs. 74% [P = 0.001] and 29% vs. 52% [P < 0.001], respectively). Multivariate analyses revealed that race was an independent predictor of freedom from distant metastasis (P = 0.013), cause-specific survival (P = 0.005), and absolute survival (P < 0.001). CONCLUSIONS: Although equal local-regional control rates can be achieved in black patients and white patients with squamous cell carcinoma of the head and neck, the risk of distant recurrence was significantly higher in black patients and resulted in decreased survival. Reevaluation of current strategies for pretreatment metastatic work-ups and development of more effective systemic therapy will be key to improving the survival disparity in this group. 相似文献
7.
Breast boost: are we missing the target? 总被引:3,自引:0,他引:3
8.
PURPOSE: To analyze parameters that influence the risk of distant metastases after definitive radiotherapy. METHODS: Between 1983 and 1997, 873 patients were treated with definitive radiotherapy and had follow-up for 2 years or more. Univariate and multivariate analyses were performed to evaluate risk factors that might influence the risk of distant metastases. RESULTS: The 5-year distant metastasis-free survival rate was 86%. Univariate analyses revealed that the risk of distant metastases was significantly influenced by gender (p =.0092), primary site (p =.0023), T stage (p <.0001), N stage (p <.0001), overall stage (p <.0001), level of nodal metastases in the neck (p <.0001), histologic differentiation (p =.0096), control above the clavicles (p <.0001), and time to locoregional recurrence (p <.0001). Multivariate analysis of freedom from distant metastases revealed that gender (p =.0390), T stage (p <.0001), N stage (p =.0060), nodal level (p <.0001), and locoregional control (p <.0001) significantly influenced this end point. Multivariate analysis revealed that gender (p =.0049), T stage (p <.0001), N stage (p <.0001), and locoregional control (p <.0001) significantly influenced cause-specific survival. CONCLUSIONS: The risk of distant metastases after definitive radiotherapy is 14% at 5 years and is significantly influenced by gender, T stage, N stage, nodal level, and locoregional control. 相似文献
9.
PURPOSE: To evaluate feeding tube use. MATERIALS AND METHODS: Nine hundred thirty-four patients were treated with radiotherapy (RT). RESULTS: Feeding tubes were placed in 235 patients (25%): 212 patients (22.5%) for acute toxicity, 18 patients (2%) for late effects, and 5 patients (0.5%) for both. Median duration of tube dependence for acute toxicity was 3.8 months. Multivariate analysis revealed that feeding tube placement for acute toxicity was increased with higher RT dose (p <.0001), adjuvant chemotherapy (p =.0002), advanced age (p =.0002), and the presence of neck disease (p =.0045). The risk of a feeding tube for late effects was 2% at 5 years. The likelihood of feeding tube placement for late effects was greater for women (p =.0293), higher RT dose (p =.0345), and primary sites, including the hypopharynx and multiple synchronous primary tumors (p =.0360). Feeding tube placement for late effects was unrelated to tube placement for acute toxicity. CONCLUSION: Likelihood of long-term feeding tube dependence was low and unrelated to placement for acute effects. 相似文献
10.
Treatment of paragangliomas with radiation therapy 总被引:3,自引:0,他引:3
Mendenhall WM Hinerman RW Amdur RJ Stringer SP Antonelli PJ Singleton GT Cassisi NJ 《Otolaryngologic clinics of North America》2001,34(5):1007-20, vii-viii
Paragangliomas of the head and neck may be treated successfully with surgery, radiation therapy, or stereotactic radiosurgery. The choice of treatment depends on the location and extent of the tumor, the presence of multiple tumors, the age and health of the patient, and the preference of the patient and attending physician. This article reviews the role of radiation therapy in the treatment of patients with paragangliomas of the head and neck. 相似文献