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At least 127 records · Page 7Linked to original sources
PubMed2005

Cost determinants in aggressive non-Hodgkin's lymphoma.

BACKGROUND AND OBJECTIVES: The 5 factors of the International Prognostic Index (IPI) for aggressive non Hodgkin's lymphoma (NHL) age, disease stage, serum lactate dehydrogenase (LDH), performance status, number of extranodal sites) are validated predictors of a patient's survival. Given the need for economic evaluations, we analyzed whether the IPI and the presence of B-symptoms (night sweats, fever, weight loss) can identify subgroups of patients with favorable or unfavorable cost profiles. DESIGN AND METHODS: Chart data for 374 patients with newly diagnosed stage II-IV aggressive NHL treated between 1993-2001 with CHOP chemotherapy were used. Costs were calculated up to two years from the start of treatment. The cost of granulocyte colony-stimulating factor (G-CSF) was not included, as some patients received this due to trial participation. Regression analyses and non-parametric bootstrap tests were performed to determine the significance of prognostic factors. RESULTS: Mean first-line treatment costs (excluding G-CSF) were pound sterling 10047 (<60 years) and pound sterling 12232 (>60 years). Two-year follow-up costs averaged pound sterling 14039 and pound sterling 9026 for the two age groups, respectively. The 5 IPI variables, the 2 IPI risk group variables (resulting from the 5 factors) and B-symptoms all showed significant univariate associations with first-line treatment costs. They were also associated with higher 2-year costs, except for age, LDH, and standard risk group index. Lower predictability of total 2-year costs was due to wide variations in second-line treatments. INTERPRETATION AND CONCLUSIONS: The IPI factors and B-symptoms are predictive of treatment costs. The detailed information presented in this paper is of value for those who need to make cost-effectiveness estimations in NHL, which is a relevant topic, given new treatment modalities that are emerging.

Adolescent↗
PubMed2006

Sweat-gland tumours: a clinical review of cases in one centre over 20 years.

AIMS: Sweat-gland tumours (SGTs) are uncommon, but malignant varieties are very rare. We have added our data on 30 new cases seen at the Royal Marsden NHS Foundation Trust to the published literature, particularly concentrating on clinical issues. We include a literature review. MATERIALS AND METHODS: The Royal Marsden NHS Foundation Trust database was searched for cases of SGT from 1972. Data were collected on all cases, including patient demographics and tumour characteristics, treatment and outcome. RESULTS: Thirty cases were confirmed histologically to be SGTs. Fourteen were malignant, 15 benign and the degree of malignancy in one was histologically indistinguishable. Mean age was 55 years (64 for malignant, 47 for benign tumours). The 15 patients with benign tumours were almost all treated with complete excision. Those with local relapse underwent successful re-excision. Their 5-year disease-free survival was 78% and cause-specific survival was 100%. Twelve of the 14 malignant tumours had localised disease at diagnosis, one had nodal disease and one had metastatic tumour nodules. All except one were treated with wide local excision. The patient with nodal involvement also had a lymph-node dissection. Two received adjuvant radiotherapy to the tumour bed. One received a melphalan limb perfusion. Eight of the 14 had no relapse. Six had locoregional relapse, and four of these also developed distant metastases. Visceral disease was always fatal. Radiotherapy and chemotherapy at relapse were unsuccessful. Five-year disease-free survival was 45%, and cause-specific survival was 57%. CONCLUSION: These rare tumours should be treated initially with complete wide local excision. In malignant tumours, lymph-node involvement is a poor prognostic sign. Wide local excision remains the primary treatment. Adjuvant radiotherapy may be useful in high-risk cases.

Antineoplastic Agents↗
PubMed1990

False diagnosis of non-A/non-B hepatitis hiding two cases of cystic fibrosis.

We report two cases of children followed for many years with an original diagnosis of non-A/non-B hepatitis. One child developed serious cirrhosis with portal hypertension. Long-term observation of the course of their hepatic disease provided the diagnosis of cystic fibrosis. These cases demonstrate that cystic fibrosis though rarely presenting with initial hepatic signs, can manifest itself with only long-term hepatic symptoms. We therefore strongly recommend analysis of sweat chloride concentration in cases of hepatic disease of unknown origin.

Adolescent↗
PubMed1983

Cystic fibrosis--a challenging masquerader.

CF, a generalized dysfunction of the exocrine glands, is an inherited disorder with variable clinical manifestations and prognosis. Because of the multisystem involvement, CF can masquerade as other disorders, including allergy. A high index of suspicion and a knowledge of the variable manifestations of this complex multisystem syndrome are essential for early diagnosis of this challenging masquerader. Quantitative analysis of sweat electrolyte levels after pilocarpine iontophoresis is the cornerstone of the diagnosis of CF. Because respiratory involvement causes most of the morbidity and mortality, aggressive treatment of pulmonary infection and efforts to reduce obstruction of the airways are essential in the treatment of CF. Until the basic defect that causes CF is identified, control or stabilization of the disease and management of its complications, rather than a cure, are the realistic goals of treatment. A comprehensive approach to management includes education of the patient about the disease and its treatment, supportive counseling, dietary supplementation, and aggressive therapy for pulmonary disease.

Adolescent↗
PubMed1982

Urine pH and phencyclidine excretion.

Subeffective doses (0.5 mg) of 3H-phencyclidine (PCP) were given intravenously to three healthy men under two regimens designed to alkalinize or acidify their urine (oral sodium bicarbonate or ammonium chloride). The concentrations of PCP and its metabolites in saliva, plasma, and urine for 7 hr after injection were determined by high-performance liquid radiochromatography. A sample of perspiration from one subject was analyzed. The effects of physical exercise on the plasma concentration and urinary excretion of PCP were also studied. Multiple linear regression analysis showed the logarithm of renal clearance the renal clearance of PCP. PCP and its metabolites are also excreted in perspiration. Our results support clinical reports of the importance of vigorous acidification of urine and diuresis in treatment of PCP intoxication.

Adult↗
PubMed1993

Long-term treatment of major depressive disorder with paroxetine.

Recurrent unipolar depression is a common, but undertreated disorder. Many patients require long-term maintenance therapy, and full doses of antidepressant agents may be preferred for the prevention of relapse. We report results of a 1-year, multicenter, open-label study of paroxetine (10 to 50 mg/day) in 433 patients with major depressive disorder, with additional data from 110 patients who entered a long-term extension of the study. The primary measures of efficacy were the Hamilton Rating Scale for Depression (HAM-D) total and Clinical Global Impression (CGI) severity of illness scores. During the first 6 weeks of therapy, the mean HAM-D total declined approximately 50% (from 27.9 to 13.5), with continued improvement, at an attenuated rate, throughout the first year. At the end of 1 year, the mean HAM-D total was 6.9. Similarly, the CGI severity of illness score declined from 4.6 at baseline to 2.8 at week 6 and to 1.7 at the end of 1 year. Remission was maintained in the population that entered the long-term extension, with mean HAM-D total and CGI severity of illness scores of 6.4 and 1.8, respectively, after 2.5 years, and 4.2 and 1.3 after 4 years. The most common adverse events reported during long-term treatment with paroxetine were somnolence, nausea, headache, and sweating. Pharmacokinetic analysis showed no clear correlation between the concentrations of paroxetine in plasma and either clinical efficacy or tolerability. There was no increased drug accumulation during long-term treatment. Side effects tended to occur early during therapy; and no new side effects emerged during the long-term extension. These results suggest that paroxetine is effective and well tolerated in the long-term treatment of depression.

Adolescent↗
PubMed2001

Establishing predictive indicators for the status of loaded soft tissues.

Two complementary techniques were employed to assess the soft tissue response to applied pressure. The noninvasive methods involve the simultaneous measurement of the local tensions of oxygen and carbon dioxide (tcPO2 and tcPCO2) and the collection and subsequent analysis of sweat collected from the sacrum, a common site for the development of pressure sores. All tests were performed on able-bodied subjects. Results have indicated that oxygen levels (tcPO2) were lowered in soft tissues subjected to applied pressures of between 40 (5.3 kPa) and 120 mmHg (16.0 kPa). At the higher pressures, this decrease was generally associated with an increase in carbon dioxide levels (tcPCO2) well above the normal basal levels of 45 mmHg (6 kPa). There were also considerable increases, in some cases up to twofold, in the concentrations of both sweat lactate and urea at the loaded site compared with the unloaded control. By comparing selected parameters, a threshold value for loaded tcPO2 was identified, representing a reduction of ~60% from unloaded values. Above this threshold, there was a significant relationship between this parameter and the loaded/unloaded concentration ratios for both sweat metabolites. These parameters may prove useful in identifying those subjects whose soft tissue may be compromised during periods of pressure ischemia.

Adult↗
PubMedDate not supplied

[Clinical and nutritional aspects in patients with cystic fibrosis: 20 years of follow-up in the Clinical Hospital-Federal University of Minas Gerais (HC-UFMG)].

BACKGROUND: Cystic fibrosis (CF) is the most common severe autosomal recessive disease in caucasian population. The life expectancy of patients with CF has improved dramatically during the past three decades. A better approach to these patients depends on a better knowledge of clinical course and prognosis of CF. The purpose of the present study was to identify aspects clinical and nutritional on admission at Center of CF (HC-UFMG). MATERIAL AND METHODS: Over a period of 20 years 127 patients with CF were admitted, submitted to a systematic protocol and prospectively followed. Data associated with demographic conditions, clinical presentation, nutritional and laboratory findings on admission were studied. The median follow-up was 44 months. The genotype was performed by PCR method. The survival analysis was carried out by Kaplan-Meier method. RESULTS: The median age at diagnosis was 33 months. Sixty-one per cent of patients at diagnosis had chronic pulmonary and gastrointestinal symptoms. Seventeen patients (16%) were homozygous for DF508 mutation and 30 (28%) were heterozygous. There was a standard prevalence of malnutrition of 63% at diagnosis and of 45% at the end of follow up. Twenty patients (15,7%) died during follow up. The estimated probability of survival after one year from diagnosis was 96% and after five years was 80%. CONCLUSIONS: CF diagnosis has been later in our country and the survival is shorter than in developed countries. Management of cystic fibrosis in pediatric specializing centers results in a better nutritional state in spite of clinical progression of the disease.

Adolescent↗
PubMedDate not supplied

Relationship between electrical skin resistance and rectal temperature in man during physical exercise.

Electrical skin resistance (ESR) and rectal temperature (Tre) were examined in 13 unacclimated human subjects performing bicycle exercise at an intensity of 50% VO2max. After the beginning of exercise the electrical skin resistance decreased according to an exponential curve with a delay of 4 min and time constant of 9 min. The dynamic parameters of ESR were shorter than those reported for sweating. Statistical analysis showed a correlation between individual time constants of ESR and increases in rectal temperature of the subjects (r = 0.705, p less than 0.01). It is concluded that measurement of dynamics of the electrical skin resistance may be useful for estimation of thermal effects in exercising subjects.

Adult↗
PubMed1996

Changes in bone mineral content in male athletes. Mechanisms of action and intervention effects.

OBJECTIVES: To determine changes in bone mineral content (BMC) in male athletes, to examine the mechanisms of changes, and to evaluate the effects of intervention. DESIGN: Dual-energy x-ray absorptiometry (DEXA) tests were administered over a 2-year period, and calcium loss during training was determined by analysis of sweat and urine. Calcium supplementation was administered during year 2. SETTING--A midsouth university. PARTICIPANTS: Eleven members of a college Division I-A basketball team. INTERVENTION: Based on observed calcium loss, athletes received differential levels of calcium supplementation. Intervention commenced the week prior to the fall training season and continued through postseason play. MAIN OUTCOME MEASURE--Changes in BMC. RESULTS: Total body BMC decreased 3.8% from preseason to midseason of year 1 (mean decrease, 133.4 g, P = .02), increased nonsignificantly by 1.1% (mean increase, 35.3 g, P = .22) during the offseason, but decreased an additional 3.3% during summer months when practices resumed (mean decrease, 113.1 g, P = .01). Dermal calcium loss averaged 247 mg [corrected] per training session. From preseason to late summer, there was an overall decrease of 6.1% in total BMC and a 10.5% decrease in BMC of the legs. Calcium supplementation was associated with significant increases in BMC and lean body mass. CONCLUSIONS: Bone loss is calcium related and exercise is positively related to BMC provided that calcium intake is sufficient to offset dermal loss.

Absorptiometry, Photon↗
PubMed1998

[Surgical treatment of pleomorphic adenoma of the parotid gland. Apropos of 192 cases].

Tumors of the salivary glands are exceptional, representing approximately 2% of head and neck tumors. The parotid gland is most often involved, at a frequency reaching 80%. Histology examination generally shows a pleomorphous adenoma. The choice of a surgical technique best adapted to curative treatment depends on the type of tumor and is widely debated. Our management strategy is based on simultaneous histology examination and superficial parotidectomy. Several pre and intra-operative factors determine the need for resection. We verified our strategy with a retrospective study.

Actuarial Analysis↗