ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In a retrospective analysis of 714 patients with melanoma who had node dissection for histologically positive regional axillary or inguinal node metastases at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston during a 30-year interval (1944 to 1974), with a minimum of ten years of follow-up, we determined that the major prognostic factor of survival was the number of positive nodes. Other prognostic variables independent of the number of positive nodes were the favorable survival in patients with primary melanoma on the calf, and the adverse survival effect of extranodal melanoma at node dissection or recurrent metastases within the node dissection region. Factors that did not predict survival after the development of regional node disease were the age, sex, and race of the patient; location of the primary melanoma other than calf; immediate versus delayed node dissection; adjuvant treatment after node dissection; and the development of regional in-transit cutaneous metastases. Metastasis to regional nodes as a harbinger of disseminated disease was reflected in the 33% five-year and 28% ten-year survivals calculated from the date of node dissection.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

From Jan 1, 1978 through Dec 31, 1983, 64 patients with epithelial ovarian tumors, frankly malignant or borderline, were managed at one institution. Nineteen patients (29.7%) were under age 40. The youngest patient was 19 years old. Nulliparity was present in 32% of this group of patients. Of these young patients, 58% had borderline epithelial tumors, compared to 13% of patients over 40 years of age. Twenty-one percent of the young patients were initially managed by unilateral adnexal surgery. The overall cumulative actuarial survival rate of all young patients was 93%. Young patients with epithelial ovarian tumors tend to have earlier grades of epithelial neoplasms, and survival is better than that reported for older patients with similar tumors.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

This retrospective study of 129 pregnancies treated with cervical cerclage was done to analyze differences, if any, in reproductive outcome according to gestational age, race, history of previous successful pregnancy, gravidity, and procedure used (McDonald vs Shirodkar cerclage). Fetal salvage was significantly improved only when cerclage was done before 18 weeks of gestation. Cervical cerclage between 18 and 26 weeks' gestation significantly increased the prematurity rate. Cervical cerclage significantly improved fetal salvage in both the black and white populations but at the expense of increasing the prematurity rate in the former. There was no difference in fetal salvage whether the patient had had a previous successful pregnancy or not, or whether the patient was a primigravida or multigravida. Fetal salvage was significantly improved with both the McDonald and Shirodkar procedures, with no significant differences in the complication, prematurity, or cesarean section rates.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Nipple discharge is an important clinical entity ranking second only to a lump as the most common complaint among 7,588 patients having breast surgery (560/7,588, or 7.4%). In the office and clinic it is even more common, since many patients can be treated medically and do not require an operation. To be significant, a discharge should be true, spontaneous, persistent, and nonlactational. Nipple discharge can be milky, multicolored and sticky, purulent, clear (watery), yellow (serous), pink (serosanguineous), or bloody (sanguineous). Watery, serous, serosanguineous, and sanguineous discharges are surgically significant; while they are most often caused by intraductal papillomas or fibrocystic disease, they can be due to cancer or a precancerous mastopathy. Among 503 patients operated on for one of these types of discharge, 67 (13.3%) had cancer, and 36 (7.2%) had a precancerous mastopathy. Among the 67 patients with cancer, eight (11.9%) had no palpable mass, 11 (16.4%) had negative cytologic findings, and seven (10.4%) had a negative mammogram. The incidence of associated cancers increases when the discharge is, in order of increasing frequency, serous, serosanguineous, sanguineous, or watery, when it is accompanied by a lump, when it is unilateral and from a single duct, when there are positive cytologic or mammographic findings, and when the patient is more than 50 years of age. Milky discharge caused by galactorrhea is treated medically except when caused by a pituitary adenoma. Multicolored sticky discharge due to duct ectasia is also treated medically except in advanced cases. Purulent discharge caused by an abscess requires drainage and a biopsy of the abscess wall. Except in women less than 30 years of age or in those anxious to have children, we advise a complete central duct excision for patients with surgically significant types of discharge. If done carefully, this procedure can yield good cosmetic results.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Thirty-five patients with prostatic adenocarcinoma were treated by bilateral pelvic lymphadenectomy and temporary implantation of iridium 192 strands with adjuvant external beam radiotherapy. With the implant the prostate received between 3,200 and 3,500 gray (Gy) followed in two weeks by small-field external beam irradiation for an additional dose of approximately 3,400 Gy. Morbidity included an ileofemoral thrombosis in one patient, and transient radiation proctitis in four patients; one patient required transurethral prostatic resection for obstruction at one year. Local response of the primary tumor was dramatic in every case at three-month follow-up. In 11 of 15 patients (73%), biopsy at one year showed no evidence of disease.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We present our 12-year experience with surgical treatment of aneurysms of the thoracic aorta in a high-risk patient population. Of 52 patients with aneurysms, 36 patients, aged 19 to 80 years, had operation. In 24 of the 36, there were three or more associated major disease processes, such as chronic bronchitis, hypertensive cardiovascular disease, aortic valve disease, cerebrovascular disease, abdominal aortic aneurysm, and coronary artery disease. Eight patients with acute type A (ascending aorta) and seven with acute type B (descending aorta) aneurysms had emergency repair, with survival in four and seven, respectively. All patients with chronic type A or B aneurysms had elective repair, and all patients with acute or chronic type A aneurysms had surgical treatment. Four patients with acute type A and two with acute type B aneurysms had elective operation, with survival in three and one, respectively. Nine patients with chronic type A and six with chronic type B aneurysms had elective operation, and all survived. Twelve patients with chronic type B aneurysms did not have operation, and all were alive at early follow-up. Mortality for patients having acute type A aneurysms requiring emergency operation was greater than that after elective repair of acute or chronic type A aneurysms. Short-term survival for chronic type B aneurysms was similar whether the patient was treated medically or surgically.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Delay in appendectomy occurs from failure to contact a physician, or from a physician's failure to make a proper diagnosis. In our study delay was due to physician error in 32 of 422 children who had appendectomy. Symptoms consistent with appendicitis were documented on the initial visit in each case, but 22 patients had a history of previous similar pain or recent viral illness to confuse the diagnosis. Misdiagnosis was responsible for the delay in 14 cases (gastroenteritis in ten and urinary tract infection in four). Antibiotics given before proper diagnosis in 22 instances increased diagnostic difficulty in 20. Late referral is increasing, perhaps because of a perceived innocuous nature of appendicitis. Complicated appendicitis was found in 26 children (81%), compared with 38% of the total experience. Their hospital stay averaged nine days, as opposed to 6.6 days in the nondelayed group. Failure of resolution of symptoms after therapy begins mandates reassessment to avoid progression of this common surgical disease.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In South Carolina over a nine-year period, the adjusted odds that infants who died of injuries had been of low birth weight were 2.65:1 as compared to a live-born control group. The odds that injury victims were black were 1.84:1 as compared to control subjects. For victims of accidents only, the odds ratio for low birth weight was 2.37, and for black race, 1.61. For victims of homicide, the odds ratio for low birth weight was 6.15, and for black race, 4.76. Male sex, high birth order, low Apgar score, and the presence of a congenital anomaly were not significant infant risk factors by multifactorial analyses.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We reviewed the first 100 consecutive patients treated with extracorporeal shock wave lithotripsy (ESWL) at one institution. A total of 115 treatments were delivered to 58 men and 42 women. Patients with calculi of various sizes were treated and compared for (1) length of hospitalization, (2) ancillary procedures, (3) repeat ESWL, (4) obstructive complications, (5) parenteral analgesic requirements, and (6) stone-free rate. Patients were grouped according to calculus length. Group A consisted of 76 patients with calculi totaling less than 3 cm. Group B contained 24 patients with calculi totaling more than 3 cm. In group A, 96% required a single ESWL procedure. Hospitalization averaged two days, and none had obstructive complications; 33% required no parenteral analgesics. In group B, 58% received a single ESWL treatment, whereas 88% required ancillary procedures. Results showed extracorporeal shock wave lithotripsy to be effective treatment of urinary calculi measuring less than 3 cm. Larger calculi required combinations of ESWL with other endourologic treatment.

ISSN:0038-4348    

出版商:OVID    

年代:1988

数据来源: OVID