ABSTRACT
PURPOSE: Recent randomized trials in women with node-positive breast cancer who received systemic treatment report that locoregional radiation therapy improves survival. Previous trials failed to detect a difference in survival that results from its use. A systematic review of randomized trials that examine the effectiveness of locoregional radiation therapy in patients treated by definitive surgery and adjuvant systemic therapy was conducted. METHODS: Randomized trials published between 1967 and 1999 were identified through MEDLINE database, CancerLit database, and reference lists of relevant articles. Relevant data was abstracted. The results of randomized trials were pooled using meta-analyses to estimate the effect of treatment on any recurrence, locoregional recurrence, and mortality. RESULTS: Eighteen trials that involved a total of 6,367 patients were identified. Most trials included both pre- and postmenopausal women with node-positive breast cancer treated with modified radical mastectomy. The type of systemic therapy received, sites irradiated, techniques used, and doses of radiation delivered varied between trials. Data on toxicity were infrequently reported. Radiation was shown to reduce the risk of any recurrence (odds ratio, 0.69; 95% confidence interval [CI], 0.58 to 0.83), local recurrence (odds ratio, 0.25; 95% CI, 0.19 to 0.34), and mortality (odds ratio, 0.83; 95% CI, 0.74 to 0.94). CONCLUSION: Locoregional radiation after surgery in patients treated with systemic therapy reduced mortality. Several questions remain on how these results should be translated into current-day clinical practice.
Subject(s)
Breast Neoplasms/radiotherapy , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Humans , Randomized Controlled Trials as Topic , Survival AnalysisSubject(s)
Esophageal Achalasia/pathology , Esophagogastric Junction/pathology , Esophagoscopy , Aged , Humans , MaleABSTRACT
From 1985 to 1990, 62 patients have undergone pneumatic dilatation with the modified Gruntzig (Levine) dilator in the treatment of achalasia. A single dilatation with a 30-mm balloon dilator was successful in 85% of the patients. Nine patients required additional procedures. One elected for operative surgical repair, and eight patients underwent a second dilatation with a 35-mm balloon dilator. One patient required a third procedure with a 40-mm dilator. Two patients developed dysphagia for solids after pneumatic dilatation, and did not demonstrate delay or obstruction to the passage of technetium on follow up study. We have described this syndrome as dysfunctional dysphagia, and believe that it is related to the rapid ingestion of a food bolus, and is relieved by eating smaller portions at a slower rate. This is to be differentiated from reflux esophagitis and/or stricture secondary to reflux. One patient required bougie dilatation of a stricture, and three other patients were treated with omeprazole, ranitidine, or antacids with relief of reflux symptoms. The safety and efficacy of the procedure of pneumatic dilatation under direct endoscopic control with the modified Gruntzig dilator has been demonstrated in patients from 8 to 93 yr old, and in patients who have had prior Heller myotomy.
Subject(s)
Catheterization/instrumentation , Esophageal Achalasia/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Child , Deglutition Disorders/etiology , Deglutition Disorders/therapy , Esophageal Achalasia/complications , Esophageal Achalasia/drug therapy , Esophagogastric Junction/pathology , Esophagoscopy , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
A system was developed to give an alternative to the standard Jackson Cross Cylinder test. This system eliminates the major difficulty of the Jackson Cross Cylinder test, which is alternative viewing of the images. The advantages of this system are: 1) ease of patient choice, 2) speed of testing, 3) patient preference, and 4) ease of understanding the test. The major disadvantage of this test system was that a few patients had difficulty viewing two images. Most difficulties could be easily resolved by a variation in the examination technique. (It helped if the patients were told they would now see double, or two rows of letters.) Occasionally, patients who had a field loss found this test difficult. The second problem was similar to one encountered with the Jackson Cross Cylinder test in that some patients would report one target clearer, regardless how one changed the lens. This was overcome by turning the testing lens system over so that the testing lens on the bottom was now on the top. Recently, we have relied only on the MSR technique as our subjective refraction, and the final prescription was based on it. These patients have reported no problems and have had good acuities. The MSR technique, when tested on a large number of patients, is demonstrated to be both efficient and reliable. The simultaneous refraction technique is not meant to be used to the exclusion of all other cylinder subjective tests, but, rather as an adjunct to our standard technique when conditions warrant its use.
Subject(s)
Refraction, Ocular , Vision Tests/methods , Vision, Monocular , Astigmatism/diagnosis , Humans , Optics and PhotonicsABSTRACT
Electrophoretic transport of proteins across the interface between the phases of an aqueous polymer two-phase system can be greatly impeded in comparison with transport within the individual phase. This effect can be controlled by modifying the affinity of the protein for a phase by suitable manipulations of such variables as pH. The effect is not caused by differences in the electrophoretic velocity between the two phases, nor by large changes in pH at the interface. An analogy exists between this phenomenon and the related subject of diffusion of electrolytes across the phase interface.
Subject(s)
Diffusion , Electrophoresis , Globins/chemistry , Buffers , Coloring Agents , Dextrans , Hemoglobins/chemistry , Hydrogen-Ion Concentration , Kinetics , Myoglobin/chemistry , Polyethylene Glycols , Serum Albumin/chemistry , ThermodynamicsABSTRACT
We investigated whether serum lactate dehydrogenase activity (LD) is significantly elevated in patients with acquired immunodeficiency syndrome (AIDS) and Pneumocystis carinii pneumonia (PCP) when compared to patients with non-Pneumocystis pneumonia. We measured LD (U/L), blood total lymphocyte count (1,000/cu mm), and alveolar-arterial oxygen tension difference P(A-a)O2 (mm Hg), in 30 patients with AIDS and PCP (group 1), four patients with AIDS or AIDS-related complex (ARC) and non-Pneumocystis pneumonia (NPCP) (group 2), and seven patients with pneumococcal pneumonia and bacteremia (PPB) (group 3). In patients with AIDS and PCP, LD was 509 +/- 35 (mean +/- SE), which was significantly elevated in comparison to both AIDS/ARC patients with NPCP (228 +/- 21) (p less than .001), and patients with PPB (211 +/- 21) (p less than .001). There was a significant positive correlation between LD and P(A-a)O2 (r = .51, p = 0.01). P(A-a)O2 was markedly elevated in both AIDS patients with PCP (48 +/- 3), and patients with pneumococcal pneumonia (44 +/- 3), but only moderately elevated in AIDS/ARC patients with NPCP (29 +/- 6). These results suggest that measurement of LD may be useful in differentiating Pneumocystis pneumonia from non-Pneumocystis pneumonia. In addition, the increase in LD correlates with the degree of pulmonary oxygen transfer abnormality.
Subject(s)
Acquired Immunodeficiency Syndrome/enzymology , L-Lactate Dehydrogenase/blood , Pneumonia, Pneumocystis/enzymology , Acquired Immunodeficiency Syndrome/complications , Adult , Humans , Isoenzymes , Pneumococcal Infections/enzymology , Pneumonia/enzymology , Pneumonia, Pneumococcal/enzymology , Pneumonia, Pneumocystis/etiology , Sepsis/enzymologyABSTRACT
Pneumatic dilation of the lower esophageal sphincter was accomplished by endoscopic visualization and positioning of a modified polyurethane dilator (90 F diameter) without fluoroscopy in 17 consecutive patients with advanced symptomatic achalasia. All patients were monitored for completeness of dilation by pre- and postdilation radionuclide scintiscan. Despite advanced megaesophagus, prior dilatations, or complicating disease, all patients showed prompt relief of symptoms.
Subject(s)
Esophageal Achalasia/diagnostic imaging , Adult , Aged , Dilatation/methods , Esophageal Achalasia/therapy , Esophagoscopy , Female , Follow-Up Studies , Humans , Male , Middle Aged , Radionuclide ImagingABSTRACT
Celiac sprue is associated with an increased risk of malignant lymphoid tumors. A patient is presented with celiac disease and adenocarcinoma of the duodenum; this association suggests that a careful search for complicating malignant tumors be undertaken in those patients with sprue whose clinical course has changed or deteriorated.
Subject(s)
Adenocarcinoma/etiology , Celiac Disease/complications , Duodenal Neoplasms/etiology , Adenocarcinoma/pathology , Aged , Celiac Disease/pathology , Duodenal Neoplasms/pathology , Female , Humans , Intestinal Mucosa/pathologySubject(s)
Duodenum/microbiology , Paratyphoid Fever/diagnosis , Salmonella paratyphi A/isolation & purification , Salmonella typhi/isolation & purification , Typhoid Fever/diagnosis , Adolescent , Bacteriological Techniques , Bone Marrow/microbiology , Child , Child, Preschool , Evaluation Studies as Topic , Humans , Hydrogen-Ion Concentration , Paratyphoid Fever/microbiology , Sepsis/microbiology , Typhoid Fever/microbiologyABSTRACT
The initial results of a Phase I evaluation of misonidazole in the U.S.A. are described, as well as the U.S. National Cancer Institute programme for radiosensitizer development. A total of 12 patients have been given 1--6 doses of 1--2 g/m2. Serum levels ranged from 25--87 microgram/ml at 4--6 h. One patient has developed mild peripheral neuropathy. Urinary excretion was chiefly of a demethylated metabolite as measured by HPLC assay.
