ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Although definitive radiotherapy in the management of early glottic carcinomas continues to offer excellent control, a small proportion of patients will have relapse. Between January 1972 and December 1984, 148 patients with squamous cell carcinoma of the glottis (stage I in 95 patients and stage II in 53 patients) had definitive radiotherapy at the University of Virginia Medical Center. We retrospectively analyzed patient data in an attempt to identify patients at risk for relapse and the patterns of failure. The three-year determinate survival for the entire population was 94.5% (stage I—100%, stage II—86%). Twenty of the 148 patients (14%) had relapse after radiotherapy. Failure in the primary site alone was observed in 17 patients (11%), two patients (1%) had relapse in the lymphatics of the neck without evidence of primary recurrence, and one patient (0.7%) had both neck and distant disease. Of the 19 patients who had definitive surgery after recurrence, 13 (68%) were successfully salvaged. Multivariate analysis was done to identify independent factors on relapse and survival. Statistically significant factors included persistent hoarseness after radiotherapy (P= .00005), impaired cord mobility (P= .00002), subglottic extension (P= .02), anterior commissure extension (P= .001), and multifocal involvement in stage I disease (P= .0008). We conclude that a majority of the small patient population with recurrent glottic carcinoma after radiotherapy may be salvaged with surgery, and we have identified patients at increased risk for recurrence.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Ten persons who had eaten at a seafood meal in North Carolina had gastrointestinal and neurologic symptoms suggestive of ciguatera fish poisoning. In five persons, the neurologic morbidity lasted 30 days or longer. The meal included barracuda, dolphin fish (mahimahi), and yellow-fin tuna, all of which were caught in North Carolina coastal waters. Analysis of food-specific attack rates implicated the barracuda as the probable cause of the outbreak. We believe this is the first suspected or confirmed report of ciguatera fish poisoning associated with consumption of fish harvested from mainland US coastal waters outside of Florida. Physicians treating patients with a syndrome resembling ciguatera fish poisoning should inquire about consumption of fish not only from areas where the disease is endemic but also from the southeastern US.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We report the cases of eight children and adolescents with adenocarcinoma of the colon treated at three large referral hospitals over a 25-year period. We recorded demographic factors, initial symptoms, stage at operation, type of operation, pathologic grade, and survival, and compared our results to those in the English literature. There were seven male patients and one female patient, with an average age of 15.1 years and an average duration of symptoms of 7½ months. The most common initial complaint was rectal bleeding (6/8 patients, 75%). Pain, anemia, and abdominal distention were present in five of the eight patients (63%). Six of our eight patients (75%) had stage C or D disease at diagnosis, and six of the eight tumors (75%) were poorly differentiated. Only three of the eight patients lived for more than six months. Unexplained gastrointestinal bleeding or abdominal complaints in children should prompt a thorough investigation of the gastrointestinal tract.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

Charts of 302 patients from four groups who had transurethral prostatectomy were reviewed with respect to patient characteristics and complications. The four groups were similar in average age and amount of tissue resected. Patients from the University of Alabama Hospital and Veterans Administration Hospital tended to have more associated illnesses than patients in the two private practices. Bleeding, the most frequently seen intraoperative and immediate postoperative complication, occurred most often in the University of Alabama Hospital series and in patients with prostates weighing more than 45 gm. Incontinence, the most frequent long-term complication, occurred most often in patients from the Veterans Administration Hospital. Complications and characteristics are compared with those in previously reported series of patients having transurethral prostatectomy and with those of the American Urological Association cooperative study.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

The obstructive sleep apnea syndrome (OSAS) is being recognized with increasing frequency in patients whose loud “heroic” snoring is coupled with significant and frequently debilitating daytime somnolence. Polysomnographic testing can clearly establish the diagnosis of this problem, but the etiology is multifactorial and the treatment options are varied. Although mandibular retrusion is not infrequently identified in patients with OSAS, the role of mandibular advancement surgery in the treatment of OSAS has not been defined. A nonobese 43-year-old white man with documented OSAS and mandibular retrusion had multidisciplinary treatment including surgical advancement of the mandible in conjunction with orthodontic treatment and prosthetic dental rehabilitation. No operation was done on the palate, nor was any other treatment provided for the OSAS. Resolution of the OSAS with dramatic improvement of the patient's snoring was achieved. This case illustrates the successful integration of corrective jaw surgery into the treatment plan for this type of patient.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

A cardiovascular screening protocol was applied prospectively to 1,900 soldiers over 40 years of age to identify individuals with latent coronary artery disease. Primary screening included a cardiovascular history, physical examination, electrocardiogram, serum cholesterol and serum glucose determinations, and calculated Framingham risk index. Seven hundred ninety-six individuals required secondary screening, consisting of stress testing and cardiac fluoroscopy. The screening process led to coronary angiography in 43 individuals; of these, 17 had obstructive coronary artery disease, ten had nonobstructive coronary artery disease, and 16 had normal coronary arteries. Application of primary screening before exercise testing increased the posttest probability of obstructive coronary artery disease to 50% in the individuals with a positive treadmill test. This is four times the expected value of 11% calculated using Bayes' theorem. The combination of a positive treadmill test and the finding of coronary artery calcification on fluoroscopy was an excellent predictor of obstructive coronary artery disease.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID

摘要:

We found a program of intravenous and subsequent oral clindamycin, combined with oral primaquine, to be effective forPneumocystis cariniipneumonia in nine patients with AIDS. The pneumonias were either primary or recurrent and sometimes severe, with cavity formation and/or pneumothorax. Maintenance therapy at lowered dose by mouth was effective in preventing recurrence in seven patients. One patient died of other opportunistic infections on day 24, and therapy was discontinued in another on day 11 because of skin rash. We conclude that clindamycin/primaquine is effective for therapy ofP cariniipneumonia in patients with AIDS, as well as for long-term secondary prophylaxis at lowered dosage.

ISSN:0038-4348    

出版商:OVID    

年代:1990

数据来源: OVID