Subject(s)
Black or African American , Dermatofibrosarcoma/secondary , Lung Neoplasms/secondary , Skin Neoplasms/pathology , Dermatofibrosarcoma/diagnosis , Dermatofibrosarcoma/ethnology , Dermatofibrosarcoma/therapy , Diagnosis, Differential , Female , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/ethnology , Lung Neoplasms/therapy , Middle Aged , Skin Neoplasms/diagnosis , Skin Neoplasms/ethnology , Skin Neoplasms/therapyABSTRACT
BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue tumor that is locally aggressive and has traditionally had a high rate of recurrence after surgical intervention. OBJECTIVE: To review the current literature on DFSP and present its epidemiology, clinical features, histology, immunohistochemisty, tumor biology, prognosis, and treatment options. MATERIALS AND METHODS: Literature review using PubMed search for articles related to DFSP. RESULTS: DFSP is a slow-growing tumor that often presents as a skin-colored plaque on the trunk, although it may arise anywhere on the body. DFSP has a distinctive histologic appearance but can mimic other diseases, and immunhistochemical studies can be helpful in making the diagnosis of DFSP. Most tumors have a translocation between chromosomes 17 and 22. Surgery is the treatment of choice, in the form of Mohs micrographic surgery (MMS) or wide local excision (WLE), although imatinib has emerged as a promising treatment option for advanced disease. CONCLUSION: For DFSP, MMS is associated with a lower rate of recurrence than WLE and is particularly useful for tumors on the head and neck. Imatinib is used in advanced disease and may take on a larger role in the treatment of DFSP in the future.
Subject(s)
Dermatofibrosarcoma/diagnosis , Dermatofibrosarcoma/therapy , HumansSubject(s)
Adjuvants, Immunologic/adverse effects , Aminoquinolines/adverse effects , Condylomata Acuminata/drug therapy , Lymphatic Diseases/chemically induced , Adjuvants, Immunologic/administration & dosage , Administration, Topical , Adult , Aminoquinolines/administration & dosage , Burkitt Lymphoma/epidemiology , Comorbidity , Condylomata Acuminata/epidemiology , HIV Seropositivity/epidemiology , Humans , Imiquimod , Lymphatic Diseases/immunology , Male , Positron-Emission TomographyABSTRACT
PURPOSES: The aim of the study was to identify predictors of acute decompensation within 48 hours of admission among infected emergency department (ED) patients admitted to a regular nursing floor. PROCEDURES: This used a case control study of infected ED patients admitted to a regular nursing floor and who received a discharge diagnosis of sepsis. A multivariate logistic regression model was constructed with the dependent variable as transfer to an intensive care unit (ICU) within 48 hours of admission. FINDINGS: Seventy-eight patients were enrolled-34 in the ICU group and 44 in the floor group. Only low bicarbonate (<20 mmol/L) (odds ratio [OR], 7.40; 95% confidence interval [CI], 2.35-23.30) and absence of fever (OR, 3.66; 95% CI, 1.11-12.60) were predictive of ICU transfer. CONCLUSIONS: Among infected ED patients admitted to a regular floor, absence of fever and low bicarbonate were independently associated with ICU transfer within 48 hours. Particular attention should be paid to similar patients to ensure appropriate identification of severe infection and appropriate risk stratification.
Subject(s)
Emergency Service, Hospital , Heart Failure/etiology , Sepsis/complications , Case-Control Studies , Emergency Service, Hospital/statistics & numerical data , Female , Heart Failure/diagnosis , Humans , Intensive Care Units , Logistic Models , Male , Middle Aged , Patient Admission , Predictive Value of Tests , Risk Factors , Shock, SepticABSTRACT
Medication shortages pose serious problems in health care. This study examines the impact of a computer-based reminder in addressing a national methylprednisolone shortage. An alert was designed and implemented in a computerized order entry platform at a children's hospital. The alert informed physicians of the shortage and provided an alternative prescribing pathway. Data regarding the number and type of parenteral corticosteroid prescriptions were collected for a one-month period before and after the alert was implemented. The alert resulted in a 55% relative reduction in methylprednisolone use and an average reduction of more than three orders each day. Dexamethasone and hydrocortisone, the recommended alternative medications, increased in use by 12% and 49%, respectively. The alert resulted in a $36,552 annualized cost reduction to the institution. Similar alert applications have great potential for effectively altering physician prescribing behavior.
