An evaluation of treatment strategies for head and neck cancer in an African American population / Evaluación de las estrategias del tratamiento para el cáncer de cabeza y cuello en una población afroamericana

OBJECTIVE: This study evaluated treatment strategies for head and neck cancers in a predominantly African American population. METHODS: Data were collected utilizing medical records and the tumour registry at the Howard University Hospital. Kaplan-Meier method was used for survival analysis and Cox proportional hazards regression analysis predicted the hazard of death. RESULTS: Analysis revealed that the main treatment strategy was radiation combined with platinum for all stages except stage I. Cetuximab was employed in only 1% of cases. Kaplan-Meier analysis revealed stage II patients had poorer outcome than stage IV while Cox proportional hazard regression analysis (p = 0.4662) showed that stage I had a significantly lower hazard of death than stage IV (HR = 0.314; p = 0.0272). Contributory factors included tobacco and alcohol but body mass index (BMI) was inversely related to hazard of death. CONCLUSIONS: There was no difference in survival using any treatment modality for African Americans.

OBJETIVO: Este estudio evaluó las estrategias del tratamiento para los cánceres de cabeza y cuello en una población predominantemente afroamericana. MÉTODOS: Se recopilaron datos utilizando historias clínicas y el registro de tumores del Hospital Universitario Howard. Se utilizó el método de Kaplan-Meier para el análisis de supervivencia, y el análisis de regresión de riesgos proporcionales de Cox para predecir los riesgos de muerte. RESULTADOS: El análisis reveló que la estrategia principal para el tratamiento fue la radiación combinada con platino para todas las etapas, excepto la etapa I. Se empleó cetuximab en sólo 1% de los casos. El análisis de Kaplan-Meier reveló que los pacientes de etapa II tuvieron resultados más pobres que los de la etapa IV, mientras que el análisis de regresión de riesgos proporcionales de Cox (p = 0.4662) mostró que la etapa I tenía un riesgo de muerte significativamente menor que la etapa IV (HR = 0.314; p = 0.0272). Los factores contribuyentes incluyeron el tabaco y el alcohol, pero el índice de masa (IMC) fue inversamente proporcional al riesgo de muerte. CONCLUSIONES: No hubo diferencias en la supervivencia con ninguna de las modalidades de tratamiento para los afroamericanos.

Photoselective vaporization of the prostate in men taking clopidogrel

To evaluate the peri-operative morbidity of men taking clopidogrel who underwent photoselective vaporisation of the prostate [PVP]. A prospective database was collected. Between March 2005 and July 2010, 480 men underwent PVP. Of these, 18 men underwent PVP treatment while on clopidogrel. The surgery was carried out with either an 80W KTP laser or a 120W lithium triborate laser. In the peri-operative period there were no complications related to PVP. There were no urinary tract infections, nor did any patient require bladder re-catheterisation. No cardiovascular events were reported within 3 months of the procedure. At 3 months post operatively, the International Prostate Symptom Score +/- standard deviation had improved from was 17.5 +/- 10.6 to 9.2 +/- 6.1 P<0.05. While the Quality of Life +/- standard deviation improved from 4.7 +/- 1.2 to 2.2 +/- 1.5 P<0.01. The maximum flow rate [Qmax], and post void residual volume [PVR] improved from 6.2 +/- 3.0 mL/s to 19.7 +/- 9.1 mL/s [P<0.01], and 140 +/- 102 mL to 59 +/- 77 mL [P<0.05], respectively. PVP is a safe and efficacious in the treatment of high risk patients with bladder outlet obstruction. Further, the ability to continue therapeutic anticoagulation and anti-platelet agents, is a significant advantage over Holmium enucleation of the prostate and conventional transurethral resection of the prostate. Larger studies with greater numbers of patients are required prior to PVP becoming the gold standard for high-risk patients with bladder outlet obstruction