RESUMO
OBJECTIVES: The objectives of this study are to determine the utility of re-excision after a primary diagnosis of vulvar carcinoma by assessing the frequency of residual carcinoma found upon re-excision and to quantitate the wound breakdown and carcinoma recurrence rates. METHODS: We reviewed 1122 cases of VIN or vulvar carcinoma. Women who underwent re-excisional procedures, as part of their initial surgical treatment were identified. Associations between the margin status of the original excisional sample and histology of re-excision, as well as association between the depth of invasion upon initial excision and histology of re-excision were analyzed with Chi-square tests. RESULTS: We identified 84 evaluable patients, 72 with stage I disease, 4 with stage II, and 7 with stage III disease. Upon the initial excisional procedure, 33 patients (39%) had carcinoma-positive margins, 27 patients had VIN-positive margins (32%) and 24 patients (28%) had negative margins (>1mm). Upon re-excision, 1/24 (4%) patients with negative margins, 2/27 (7%) patients with VIN-positive margins, and 11/33 (33%) patients with carcinoma-positive margins were found to have carcinoma in the re-excision specimens (p<0.0001, χ(2)=31). Deeper tumor invasion of the initial excisional specimen (1-12mm) was associated with a higher chance of finding carcinoma upon re-excision (range 18-42%, depending on depth of invasion) (p=0.015, χ(2)=19). Nineteen patients (23%) had vulvar wound breakdown post re-excision. Twelve patients (15%) experienced recurrences. CONCLUSIONS: The yield of micro- or invasive carcinoma at re-excision is low, with a high wound breakdown rate. Re-excision should be considered for patients with margins positive for carcinoma, especially for women with deep invasion, while women with VIN or close but clear margins may be followed.
Assuntos
Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasia Residual , Reoperação , Vulva/patologia , Doenças da Vulva/patologia , Adulto JovemRESUMO
OBJECTIVE: To determine the prevalence and presenting complaints of HIV/AIDS patients attending a chiropractic outpatient teaching clinic in downtown Toronto, and explore their self-reported comorbidities, medications used, and consumption of other complementary health care. METHODS: A random sample was drawn from the entire clinic file collection spanning the years 2007 to 2013. Files were anonymized and coded to ensure confidentiality. RESULTS: A total of 264 files were radomly pulled from approxinately 3750 clinic files. The prevalence of HIV positive patients was 5.7% (15/264), predominantly males, with 3 patients having developed AIDS. Co-infection with Hepatitis B and/or C was identified in 5/15 patients. The most common presenting complaint was neck pain (80%), followed by low back pain (47%) compared to 20% and 43% respectively for the general cohort. Eleven of 15 patients were on antiretroviral treatment (ART); The frequency of comorbidities was 8/15 (53%) however, none were identified as being dominant. In addition to chiropractic, 7/15 patients reported receiving other complementary therapies. CONCLUSIONS: A relatively small proportion of HIV/ AIDS patients were found to be receiving treatments in this downtown chiropractic clinic situated within a community health clinic setting. The principal presenting complaint was neck pain.
OBJECTIF: Établir la prévalence des symptômes des patients séropositifs ou atteints du sida fréquentant un clinique chiropratique d'enseignement au centre-ville de Toronto et étudier les comorbidités autodéclarées, les médicaments utilisés et les soins de santé complémentaires. MÉTHODOLOGIE: On a choisi au hasard des dossiers de patients parmi tous les dossiers de la clinique, à partir de 2007 jusqu'en 2013. Les dossiers ont été anonymisés et codés pour assurer la confidentialité. RÉSULTATS: Au total, 264 dossiers ont été choisis par hasard parmi les quelque 3 750 de la clinique. La prévalence des patients séropositifs était de 5,7 % (15/264); la plupart étaient des hommes, 3 patients avaient développé le sida. Une co-infection par l'hépatite B et (ou) l'hépatite C avait été diagnostiquée chez 5 patients sur 15. Les symptômes les plus fréquents étaient la cervicalgie (80 %) suivie de la lombalgie (47 %); la fréquence de ces symptômes étaient de 20 % et de 43 % respectivement dans la cohorte générale. Onze des 15 patients suivaient un traitement antirétroviral (ARV). La fréquence des comorbidités était de 8 patients sur 15 (53 %), mais aucune n'était considérée comme dominante. Sept patients sur 15 ont déclaré suivre des traitements complémentaires en plus des traitements chiropratiques. CONCLUSIONS: Une proportion relativement petite de patients séropositifs ou atteints du sida recevait des traitements dans cette clinique chiropratique du centre-ville située dans un établissement de soins de santé communautaire. La cervicalgie était le principal symptôme dont se plaignaient les patients.