RESUMO
BACKGROUND: Initial studies of sentinel lymphadenectomy for patients with breast carcinoma confirmed that the status of the sentinel lymph nodes was an accurate predictor of the presence of metastatic disease in the axillary lymph nodes. Sentinel lymphadenectomy, as an axillary staging procedure, has risks of morbidity that have yet to be defined. METHODS: Patients were enrolled in a two-phase protocol that included concurrent data collection of patient characteristics and treatment variables. During the first (validation) phase, 72 patients underwent sentinel lymph node excision followed by a level I-II axillary dissection. After the technique had been established, the second phase commenced, during which only patients with positive sentinel lymph nodes underwent an axillary dissection. RESULTS: During the second phase, lymphedema was identified in 9 of 303 patients (3.0%) who underwent sentinel lymphadenectomy alone and in 20 of 117 patients (17.1%) who underwent sentinel lymphadenectomy combined with axillary dissection (P < 0.0001). Of 303 patients who underwent sentinel lymphadenectomy alone, 8 of 155 patients (5.1%) with tumors located in the upper outer quadrant and 1 of 148 patients (0.7%) with tumors in other locations developed lymphedema (P = 0.012). CONCLUSIONS: The risk of developing lymphedema after undergoing sentinel lymphadenectomy was measurable but significantly lower than after undergoing axillary dissection. Tumor location in the upper outer quadrant and postoperative trauma and/or infection were identifiable risk factors for lymphedema.
Assuntos
Neoplasias da Mama/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfedema/etiologia , Neoplasias da Mama/patologia , Protocolos Clínicos , Humanos , Estadiamento de Neoplasias , Fatores de RiscoRESUMO
A child who ingested approximately 3500 mg of carisoprodol gradually deteriorated and died within 36 h. GC analysis of serum, urine, and gastric samples indicated that meprobamate was the principal metabolite of carisoprodol.
Assuntos
Carisoprodol/intoxicação , Carisoprodol/metabolismo , Pré-Escolar , Cromatografia Gasosa , Medicina Legal , Humanos , Masculino , Meprobamato/metabolismoAssuntos
Infecção Hospitalar/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Unidades de Terapia Intensiva , Infecções por Pseudomonas/epidemiologia , Sangue/microbiologia , Cateterismo/efeitos adversos , Pré-Escolar , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Recém-Nascido/mortalidade , Masculino , Faringe/microbiologia , Pneumonia/etiologia , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/isolamento & purificação , Sepse/etiologia , Texas , Traqueia/microbiologia , Umbigo/microbiologiaRESUMO
A single intramuscular dose of 100 mg carbenicillin/kg produced measured peak concentrations of approximately 150 to 175 mug/ml in newborn infants. The carbenicillin serum half-life of 1.0 hr in normal adults was prolonged to 2.7 hr in infants of normal birth weight and to 4.0 hr in babies of low birth weight in the first week of life. One-third of a dose administered to babies of low birth weight and two-thirds of that given to babies weighing over 2,500 g was excreted by the kidney in 12 hr. Postadministration 6-hr urinary carbenicillin concentrations averaged 1,399 mug/ml after an intramuscular dose of 50 mg/kg and 2,689 mug/ml after a 100 mg/kg injection. Although carbenicillin is excreted by both glomerular and tubular mechanisms in adults, serum half-life and urinary carbenicillin excretion correlated well with creatinine clearance. Recommendations for dosage of carbenicillin and intervals of administration in the neonatal period are made based upon mathematical predictions from pharmacokinetic data.
