The effect of psychosocial factors on cancer prognosis.
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Biomedical subjects
Publications and source records attributed to J Baruch.
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Pyoderma gangrenosum (PG) consists of extensive necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic diseases. However post-surgical idiopathic PG can occur. One post-mastectomy case is reported. PG can first be suspected on clinical appearance and the lack of a specific etiology. PG is a diagnosis of exclusion that is made only after other possibilities have been ruled out. The treatment is surgical excision and systemic corticosteroids.
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Bone grafts's traditional donor sites in cranio-maxillo-facial surgery have been for many years and are still in some occasions the ribs, iliac crest and tibia. Bone grafts taken from the calvaria have been used by some surgeons in the past but its wide acceptance was only achieved after Paul Tessier had reported his own experience. The calvaria is composed of inner and outer tables that encloses a layer of cancellous bone called the diploe. A high degree of variability exist with respect to skull thickness. Nevertheless parietal bones is the preferable site for the harvesting of the graft. The embryonic origin of the cranium should be responsible for greater survival of the graft. Membranous bone would maintain its volume to a greater extent than endochondral bone when autografted in the cranio-facial region. However this remains controversial. Two techniques can be used for the harvesting of a calvarial bone grafts. A split thickness calvarial graft involves removal of the outer table while leaving the inner layer in place. Its main disadvantage is the relatively thinness of the bone transferred. A full thickness segment of skull involves the cranium cavity be entered. A half of the graft can be split along the diploe space and returned to fill the donor site. The other half is used for reconstruction. It is a more complicated procedure. Cranial grafts have been used in the following cases. Correction of contour defect of the forehead and zygomatic bones, orbital floor reconstruction, restoration of the nasal bridge, bone grafting of the maxilla and mandibule. The advantages are the following: the donor and recipient sites are in adjacent surgical fields, the donor site scar is hidden in the scalp, morbidity associated with removing the graft is almost inexistent. (ABSTRACT TRUNCATED AT 250 WORDS)
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Pyoderma gangrenosum (PG) is a extending necrotic ulceration with bluish and purplish red margins. This disease is often associated with ulcerative colitis, systemic, hematologic or rheumatic affections. However post-surgical idiopathic PG can occur. One post-mammectomy case is reported. PG can first be suspected on clinical aspect, lack of a specific etiology. PG is a diagnosis of exclusion that is made only after others possibilities are ruled out. The treatment is surgical excision and general corticotherapy.
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UNLABELLED: The purpose of this study of 36 patients was to assess the oncological, functional and cosmetic results of surgery in the treatment of basal cell carcinoma of the eyelid and to compare them with those obtained with other possible therapeutic methods. MATERIAL AND METHODS: We report a series of 36 cases of histologically proven basal cell carcinoma principally located on the lower eyelid and the inner canthus. 27 p. 100 of the patients had previously been treated and presented with a recurrent tumour. Mean age was 61 years. Minimum follow-up was 5 years. Reinforced and potentiated local anaesthesia was given in most cases. Tumoral excision was complete in 31 patients, insufficient or borderline in 5 patients. Intraoperative extemporaneous biopsy was performed in 8 p. 100 of the cases. Repair was carried out by direct suture or by grafting, the flap being simple or combined with a mucosal or chondromucosal graft. The lacrymal passages were destroyed in 5 cases and were not reconstructed in 4 of them. There was no postsurgical therapy. RESULTS: As regards the malignancy itself, the recurrence rate was 6 p. 100 and affected patients who had previously been treated. The cure rate was 100 p. 100 in patients for whom surgery was the first treatment, and 94 p. 100 in the totality of patients. Functionally, there was one case of ectropion, and epiphora developed in 7.4 p. 100 of the cases. In this series epiphora was associated with destruction of the lacrymal passages in only one patient. Satisfactory cosmetic results were obtained in 85 p. 100 of the cases, bearing in mind that the assessment was necessarily subjective. DISCUSSION: Treatments of basal cell carcinoma are numerous. We shall analyze their results, advantages and drawbacks compared with those of surgery. Cryotherapy raises technical problems of execution which are responsible for an excessively high recurrence rate. Chemotherapy has recently been enriched with the introduction of Solcoderm, but the follow-up is still too short. Electrocoagulation gives good oncological results, but it can only be used for small lesions. Radiotherapy (contact, penetrating or semi-penetrating X-ray therapy, electron therapy) has a cure rate of 95 p. 100 and gives acceptable cosmetic results. However, it requires numerous sessions, cannot be repeated if it fails and complicates surgical treatment; in the long term, it carries a risk of radiodystrophy. Its functional and ocular complications have been estimated at 9 p. 100. Epiphora is present in 2 to 19 p. 100 of the cases.(ABSTRACT TRUNCATED AT 400 WORDS)
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While immigrants from Morocco and Romania make up 7 and 6%, respectively, of the Israeli population, one-third of all postnecrotic cirrhosis patients come from Morocco and another third from Romania. The rate of hepatitis B virus (HBV) infection, as expressed by serum hepatitis B surface antigen, anti-HBs, and anti-HBc, was compared in immigrant patients with postnecrotic cirrhosis and in age and sex matched controls from the same countries. Among 19 Moroccan immigrants with postnecrotic cirrhosis 74% showed evidence of HBV infection. This was not significantly different from the prevalence of HBV infection (64%) in a matched control group of 61 Moroccan individuals. In the 26 Romanian cirrhotics, however, a significantly higher prevalance of HBV infection than in the 60 matched controls was observed (54 and 23%, respectively, p less than 0.01). The difference was detected only when anti-HBc was looked for in addition to hepatitis B surface antigen and anti-HBs. These results indicate that: 1) HBV infection and postnecrotic cirrhosis are associated in Romanian immigrants to Israel. 2) Association between HBV infection and cirrhosis in Moroccan immigrants cannot be shown because of the high infection rate in the control population. 3) Anti-HBc is often the only marker of HBV infection in cirrhotic patients, and should be examined in addition to hepatitis B surface antigen and anti-HBs in order to get meaningful results.
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The authors report five cases of streptococcal gangrene and stress the fundamental role of surgical excision. Parenteral anti-streptococcal antibiotics should not lead to this essential step being forgotten, its early application being the most important element in prognosis. It is thus essential to clearly understand the local and general criteria of rapid diagnosis in this condition, which is far from rare.
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