Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 8 de 8
Filtrar
Mais filtros








Base de dados
Intervalo de ano de publicação
1.
Clin Oncol (R Coll Radiol) ; 36(3): 183-192, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38184401

RESUMO

AIMS: For women with breast cancer, seminal studies have shown that adjuvant hypofractionated external beam radiation therapy (hEBRT) maintains similar outcomes and may reduce overall costs compared with conventionally fractionated external beam radiation therapy (cEBRT). However, it is unclear whether hEBRT may be associated with differential risk of development of radiation-induced second malignancies compared with cEBRT. Because the occurrence of second malignancies is small, large databases may improve our understanding of the relative risk of second malignancies between hEBRT and cEBRT. MATERIALS AND METHODS: Using the National Cancer Database, we carried out a retrospective cohort analysis of women diagnosed with non-metastatic, stage 0-III breast cancer from 2004 to 2017. All patients had a lumpectomy or mastectomy and a follow-up time of at least 60 months after diagnosis. The probability of second malignancies in women receiving adjuvant cEBRT or hEBRT was compared using multivariable logistic regression adjusting for sociodemographic, geographical, clinical and treatment factors, allowing for relative (but not absolute) comparison of second malignancy risk. Temporal sensitivity analyses stratified by year of diagnosis and length of follow-up time were also conducted. RESULTS: Of the 125 228 women in our study, 115 576 (92.3%) received cEBRT and 9652 (7.71%) received hEBRT. The median age of the cohort was 60 (interquartile range 51-68) years at diagnosis and the median follow-up time was 99.61 (interquartile range 77.5-128.49) months. Upon adjusting for sociodemographic and clinical factors, patients who received hEBRT had no difference in relative risk than patients who received cEBRT (odds ratio 0.937, 95% confidence interval 0.869-1.010, P = 0.091). In analyses stratified by year of diagnosis, and stratified by length of follow-up, there was no difference in second malignancy probability between patients who completed hEBRT and patients who completed cEBRT. CONCLUSIONS: In this analysis of over 120 000 women with non-metastatic breast cancer, hEBRT was not associated with different odds of developing second malignancies compared with cEBRT. Our findings may inform patient counselling in the choice of radiation regimens for breast cancer and further support the safety of hypofractionated regimens for breast cancer.


Assuntos
Neoplasias da Mama , Segunda Neoplasia Primária , Humanos , Feminino , Pré-Escolar , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/patologia , Mastectomia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/etiologia , Estudos Retrospectivos , Risco , Radioterapia Adjuvante/efeitos adversos
2.
J Laryngol Otol ; 137(9): 1054-1057, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36503555

RESUMO

BACKGROUND: In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification. TECHNICAL DESCRIPTION: A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated. CONCLUSION: The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome.


Assuntos
Epistaxe , Artéria Oftálmica , Humanos , Epistaxe/cirurgia , Nariz , Ligadura/métodos , Órbita/cirurgia
3.
J Laryngol Otol ; 137(12): 1401-1405, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36503647

RESUMO

BACKGROUND: Transorbital endoscopic approaches are becoming increasingly popular for skull base pathologies; the superior lateral orbital portal is one such approach to the middle cranial fossa. This paper provides a technical description that maximises the surgical portal and minimises morbidity. TECHNICAL DESCRIPTION: A superior lid crease incision is made extending laterally and the orbital rim is exposed. A subperiosteal dissection of the lateral and superior orbit is performed, with elevation of periosteum off Whitnall's tubercle, ligation of the recurrent branch of the middle meningeal artery, and identification of the superior orbital fissure. The lacrimal keyhole is then drilled away. The middle cranial fossa is accessed by drilling posterior to the orbital rim to expose: the temporalis muscle anterior-laterally, the dura of the temporal lobe posterior-laterally, the anterior cranial fossa superiorly and the periorbita medially. CONCLUSION: These surgical steps can maximise the surgical portal and minimise morbidity, with avoidance of injury to surrounding structures.


Assuntos
Fossa Craniana Média , Procedimentos Neurocirúrgicos , Humanos , Fossa Craniana Média/cirurgia , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Endoscopia , Órbita/cirurgia , Cadáver
4.
J Hosp Infect ; 83(1): 77-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23158685

RESUMO

Clostridium difficile infection (CDI) is the most important bacterial cause of hospital-acquired diarrhoea. Although reports of deaths associated with CDI have been decreasing since a peak in 2007 in England and Northern Ireland, it remains a major cause of morbidity and mortality. The Health Protection Agency's Clostridium difficile Ribotyping Network (CDRN) aims to provide information to help optimize the management of cases of CDI. This study assesses the value of ribotyping to detect outbreaks of potential strains causing severe disease.


Assuntos
Clostridioides difficile/classificação , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Ribotipagem , Idoso , Idoso de 80 Anos ou mais , Clostridioides difficile/genética , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/microbiologia , Infecção Hospitalar/microbiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular/métodos , Reino Unido
5.
Ann Oncol ; 21(2): 269-274, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19901014

RESUMO

BACKGROUND: Docetaxel (T; Taxotere) with capecitabine (X) is active against metastatic breast cancer (MBC); bevacizumab (BV) has demonstrated efficacy with taxanes in the first-line setting. This study was conducted to assess the safety and efficacy of TX-BV in patients with MBC. PATIENTS AND METHODS: In this single-arm, multicenter phase II study, patients received first-line bevacizumab 15 mg/kg and docetaxel 75 mg/m(2) on day 1 and capecitabine 825 mg/m(2) twice per day on days 1-14 every 21 days. Primary and secondary end points were tumor response rate (RR), overall survival (OS), progression-free survival (PFS), and toxicity. RESULTS: A total of 45 assessable patients received TX-BV for a median of seven cycles. Two complete and 20 partial responses were observed (overall RR 49%); nine patients had stable disease >6 months, for a clinical benefit rate of 69%. Median response duration was 11.8 months. Median OS and PFS were 28.4 and 11.1 months, respectively. Grade 3/4 adverse events included hand-foot syndrome (29%), fatigue (20%), febrile neutropenia (18%), and diarrhea (18%). In cycles 3-10, median dose levels of docetaxel and capecitabine were 60 mg/m(2) and 660 mg/m(2), respectively. CONCLUSION: TX-BV demonstrated significant activity; dose modifications were required to manage drug-related toxic effects.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Desoxicitidina/análogos & derivados , Fluoruracila/análogos & derivados , Taxoides/administração & dosagem , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Bevacizumab , Neoplasias da Mama/patologia , Capecitabina , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Intervalo Livre de Doença , Docetaxel , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Metástase Neoplásica , Taxoides/efeitos adversos , Resultado do Tratamento , Estados Unidos
6.
Trop Med Int Health ; 14(9): 1064-70, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19552658

RESUMO

We report a retrospective and descriptive study of four immunocompromised patients (three with HIV-1 and one with idiopathic CD4+-lymphopenia) with relapsing visceral leishmaniasis seen at the Hospital for Tropical Diseases, London, in whom pentamidine was used as secondary prophylaxis to prevent relapse. Patients experienced between one and four relapses before commencing prophylaxis with subsequent relapse-free periods ranging from 5 to 98 months. Based on these observational data, we recommend large trials to investigate the efficacy of pentamidine over other agents in preventing relapse of VL in the immunocompromised patient.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antiprotozoários/uso terapêutico , HIV-1 , Hospedeiro Imunocomprometido , Leishmaniose Visceral/tratamento farmacológico , Pentamidina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Linfócitos T CD4-Positivos , Humanos , Leishmaniose Visceral/imunologia , Linfopenia/complicações , Linfopenia/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Prevenção Secundária
7.
Indian J Gastroenterol ; 14(4): 134-6, 1995 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-8868355

RESUMO

BACKGROUND: Suppression of gastric acid may lead to gastric colonization by aerobic and anaerobic bacteria, and consequent clinical manifestations. The risk is likely to be higher with poor environmental hygiene. AIMS: To study the effect of short-term acid suppression with omeprazole on gastric bacterial flora. METHODS: Twenty-five ambulatory patients with acid-peptic diseases underwent clinical assessment and gastric juice collection (for pH and culture) prior to start of therapy with 20 mg omeprazole daily, on days 7 and 14 of therapy, and 7 days after omission of therapy (day 21). RESULTS: Eighteen patients completed the study. The median gastric pH was 1.8, 7.5, 7.5 and 3.4 on days 0, 7, 14 and 21 respectively. Positive gastric cultures were obtained in 13 of 25, 17 of 21, 18 of 18 and 14 of 18 patients on respective study days, with median colony counts of 1.5 x 10(4), 7.5 x 10(5), 8.7 x 10(7) and 7.3 x 10(4) cfu/mL respectively. Three patients developed self-limiting diarrhea during therapy and two more immediately after discontinuing therapy. CONCLUSIONS: Gastric colonization is common with short-term profound acid-suppression, and may cause diarrhea. Acid suppressive therapy should be used with caution especially in patients with poor environmental hygiene.


Assuntos
Antiulcerosos/uso terapêutico , Bactérias/crescimento & desenvolvimento , Ácido Gástrico/metabolismo , Omeprazol/uso terapêutico , Estômago/microbiologia , Adulto , Bactérias/isolamento & purificação , Enterobacteriaceae/crescimento & desenvolvimento , Feminino , Mucosa Gástrica/efeitos dos fármacos , Mucosa Gástrica/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Staphylococcus/crescimento & desenvolvimento
8.
J Assoc Physicians India ; 40(2): 126-8, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1629123

RESUMO

A patient who developed syncope due to carotid sinus syndrome is described. The patient was suffering from carcinoma of the pyriform fossa for the past one year and received radiotherapy in the region of the neck for the same. Demand pacing was ineffective in alleviating syncopal episodes. The patient responded to oral administration of an anticholinergic (belladonna) and a sympathomimectic agent (orciprenaline).


Assuntos
Seio Carotídeo , Neoplasias de Cabeça e Pescoço/complicações , Síncope/etiologia , Adulto , Atropa belladonna , Eletrocardiografia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Metaproterenol/uso terapêutico , Recidiva Local de Neoplasia , Plantas Medicinais , Plantas Tóxicas , Síncope/tratamento farmacológico , Síndrome
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA