ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Early stage breast cancer is a major cause of morbidity and mortality for women worldwide. Therefore, effective management of this disease is of critical importance. A variety of risk factors for this disease have been identified, including genetic mutations which confer susceptibility to breast cancer. Despite knowledge of these risk factors, no effective prevention strategy for breast cancer has yet been developed although there are several prevention trials currently underway.Decades of clinical trials and meta-analyses compiling these data have led to consensus about some issues in the treatment of breast cancer. There is no difference in survival between women treated with breast conserving therapy and those treated with mastectomy. Adjuvant chemotherapy is clearly beneficial for women with early stage breast cancer regardless of age or nodal status. Adjuvant tamoxifen improves survival for women with hormone receptor-positive tumours, particularly those over the age of 50 years. Recent efforts have attempted to stratify women by risk to identify both those who might safely forego adjuvant therapy and those who would benefit from more effective options than the current standard. A number of important questions remain unanswered and are the focus of ongoing study. Along with increased and successful use of adjuvant therapy has come a recognition and study of the late effects of therapy on the survivors of breast cancer.This article reviews the current standards for management of early stage breast cancer including risk factors, staging and prognosis, local therapy, adjuvant therapy, and late effects of therapy.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Atheroselerosis is a diffuse disease of arteries. It cannot be definitively treated by procedures such as bypass surgery or angioplasty which correct only discrete anatomical lesions. The only definitive treatments for atherosclerosis are medical. In both men and women with coronary disease, treatment includes interventions such as smoking cessation, lipid management and blood pressure lowering, restriction of dietary calories, fat, and salt, increased physical activity, body weight reduction, &bgr;-adrenoceptor blocking drugs during the first 6 to 12 months or so after an infarct, and, in patients with congestive heart failure, the use of angiotensin-converting enzyme (ACE) inhibitors.Specific guidelines describing the use of these interventions have recently been released by a consensus panel of the American Heart Association. These guidelines apply to both men and women with coronary disease, even though the preponderance of evidence on which they are based has been derived from intervention trials that included mostly men. The application of these guidelines cannot guarantee that coronary disease will not recur. It is unclear what, if any, additive effects they may have. Unlike anatomical interventions, however, they attack the underlying process of atherogenesis in whatever vascular bed it occurs, Failure to include these interventions in the care of patients with established coronary disease is a serious and potentially life-threatening omission.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

The objective of this paper is to review available benign prostatic hyperplasia (BPH)-specific, symptoms-based and quality-of-life (QOL) questionnaires to provide researchers and clinicians with descriptive information on their content and psychometric properties (construct validity, internal consistency, test-retest reliability and sensitivity to change). This will provide a basis for selecting instruments for use in research and clinical practice.11 questionnaires were found in a literature search [Boyarsky Scoring System, Madsen-Iversen Scoring System. Maine Medical Assessment Program (MMAP) Symptom Index, Epstein's Benign Prostatic Hyperplasia Health-Related Quality of Life Questionnaire. American Urological Association/International Prostate Symptom Score (AUA-7/1-PSS) BPH Symptom Index. Eri's Visual Analogue Scale, the Danish Prostatic Symptom Score, the French BPH-specific Quality-of-Life Scale, Barry's Symptom Problem Index (SPI), Barry's BPH Impact Index (BII), and the International Continence. Society Male (ICSm) Questionnaire].Frequency, intermittency, urgency, stream, strain and nocturia were the symptoms most frequently included in these instruments. Validity, reliability and sensitivity to change had been assessed for the majority of instruments but the extent and thoroughness of this testing varied greatly. There are numerous validated instruments for use with BPH patients. The choice of instrument should be based on the requirements of particular studies, or on clinical grounds.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

摘要:

Benign prostatic hyperplasia (BPH) affects men with increasing frequency as they age. The course of BPH is highly variable and not all men develop symptoms.For most patients with mild symptoms of BPH, regular monitoring and reassessment (watchful waiting) are most appropriate. For those with moderate to severe symptoms, surgery [usually transurethral resection of the prostate (TURP)] or drug therapy (with finasteride or &agr;1-receptor antagonists such as terazosin) are most frequently used. Surgery is indicated for men with complicated BPH.Both terazosin and finasteride reduce voiding (obstructive) and total symptom scores and improve parameters of urinary function such as peak urinary flow rates in men with symptomatic BPH. However, results from a comparative trial of these agents show terazosin to be more effective than finasteride in reducing symptoms and increasing urinary flow rates. Although the study has been criticised for not stratifying patients by baseline prostate volumes and for the low mean prostate volumes of study participants, the findings have subsequently been confirmed in a subset of men with large prostates (> 50ml).In common with other &agr;1-receptor antagonists, terazosin reduces smooth muscle tone and contraction in the bladder neck and prostate, which results in a decrease in urethral pressure. The drug does not reduce prostate volume and efficacy is not influenced by prostate size. Terazosin has favourable effects on blood pressure and the lipid profile.Finasteride acts by inhibiting the 5&agr;-reductase enzyme in the prostate, thus reducing circulating levels of dihydrotestosterone, the androgen primarily responsible for prostatic enlargement. Consequently, finasteride reduces prostate volume and the drug has been thought to be most effective in men with a prostate volume ≥40 or 50ml; however, whether baseline prostate volume is an accurate predictor of response to pharmacotherapy has now been questioned. Finasteride has a slow onset of action compared with terazosin (≈6 months versus a few weeks), but preliminary evidence indicates that disease progression may be halted or reversed when finasteride is used long term (≥2 years). Furthermore, finasteride has been shown to reduce the incidence of acute urinary retention and surgical intervention associated with BPH.In men with symptomatic BPH, there are few clear-cut criteria for initiation of treatment or for predicting which treatment will be most beneficial. The long term costs and benefits of various treatment options remain to be fully determined. On the basis of available data, terazosin may be used in patients with moderate to severe symptomatic BPH irrespective of prostate size; this agent may be particularly useful in men with concomitant hypertension. Finasteride appears to be best limited to patients with a prostate volume ≥40 or 50ml. Symptomatic improvement appears to be greater with terazosin than with finasteride, whereas finasteride is the only agent, to date, which has been shown to halt or reverse disease progression and reduce surgical intervention and acute urinary retention in this patient group. In the final analysis, treatment decisions must be individualised and guided by clinical experience and judgement as well as patient preference.

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS

ISSN:1173-8790    

出版商:ADIS    

年代:1997

数据来源: ADIS