Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Mammography/economics , Mammography/instrumentation , Mastectomy/economics , Breast Neoplasms/economics , Cost-Benefit Analysis , Female , Humans , Imaging, Three-Dimensional/economics , Intraoperative Care/economics , Margins of Excision , Mastectomy/methods , Operative Time , Pilot Projects , Radiologists , Sentinel Lymph Node Biopsy , SurgeonsSubject(s)
Extracorporeal Membrane Oxygenation/methods , Respiratory Insufficiency/therapy , Thoracic Injuries/therapy , Time-to-Treatment , Wounds, Penetrating/therapy , Adolescent , Humans , Male , Respiratory Insufficiency/etiology , Retrospective Studies , Thoracic Injuries/complications , Treatment Outcome , Wounds, Penetrating/complicationsABSTRACT
BACKGROUND: The Cancer and Leukemia Group B (CALGB) 9343 clinical trial proved that omission of radiotherapy (RT) in patients 70 and older with T1cN0M0, estrogen receptor-positive tumors who undergo breast conservation therapy (BCT) and receive 5 years of endocrine therapy (ET) had no change in overall survival, distant disease-free survival, or breast preservation. We examined our institution's practice with this patient subset. PATIENTS AND METHODS: A single-institution retrospective chart review was performed on patients 70 years and older with T1N0M0, estrogen receptor-positive tumors, and who underwent BCT between April 2010 and October 2015. RESULTS: A total of 123 patients met inclusion criteria: 46% received RT and 73% received ET. The ET group had a mean age of 76.2 years, whereas the non-ET group had a mean age of 80.2 years (P = .00006). Race did not influence if patients received ET (P = .4). In patients who received ET, mean age at time of diagnosis for those that completed 5 years of therapy was 75.5 years, whereas those who stopped therapy early had a mean age of 77.6 years (P = .053). In patients who received ET but stopped early, reasons for cessation included side-effect profile (67%), death (22%), and noncompliance (11%). Of the 27% of patients that did not receive ET, 62% were not offered therapy, 24% refused, and 14% were lost to postoperative follow-up. CONCLUSION: Increasing age showed significant association to not receive ET. Contraindication to ET and provider's assessment of minimal benefit are the most common reasons why patients are not prescribed ET. If patients are non-compliant with ET, RT should be reconsidered.
Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Breast Neoplasms/drug therapy , Patient Compliance/statistics & numerical data , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/trends , Age Factors , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Case-Control Studies , Chemotherapy, Adjuvant , Female , Follow-Up Studies , Humans , Neoplasm Staging , Retrospective StudiesSubject(s)
Breast Neoplasms/diagnosis , Hemangiosarcoma/diagnosis , Aged, 80 and over , Female , HumansABSTRACT
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in childhood and is caused by insulin deficiency resulting from the autoimmune destruction of insulin producing beta cells of the pancreas. Most children in the US with new onset T1DM present with the classic signs and symptoms of hyperglycemia and 30% with diabetic ketoacidosis (DKA). Neurologic manifestations are relatively rare and mostly include lethargy, decreased level of consciousness, and coma as a result of DKA. In this article, five cases of new onset T1DM with exceedingly rare or unreported neurologic manifestations in the pediatric age group are presented, along with a review of the literature.