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1.
BMC Med ; 18(1): 114, 2020 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-32460859

RESUMO

BACKGROUND: The five-tiered Cambridge Prognostic Group (CPG) classification is a better predictor of prostate cancer-specific mortality than the traditional three-tiered classification (low, intermediate, and high risk). We investigated radical treatment rates according to CPG in men diagnosed with non-metastatic prostate cancer in England between 2014 and 2017. METHODS: Patients diagnosed with non-metastatic prostate cancer were identified from the National Prostate Cancer Audit database. Men were risk stratified according to the CPG classification. Risk ratios (RR) were estimated for undergoing radical treatment according to CPG and for receiving radiotherapy for those treated radically. Funnel plots were used to display variation in radical treatment rates across hospitals. RESULTS: A total of 61,999 men were included with 10,963 (17.7%) in CPG1 (lowest risk group), 13,588 (21.9%) in CPG2, 9452 (15.2%) in CPG3, 12,831 (20.7%) in CPG4, and 15,165 (24.5%) in CPG5 (highest risk group). The proportion of men receiving radical treatment increased from 11.3% in CPG1 to 78.8% in CGP4, and 73.3% in CPG5. Men in CPG3 were more likely to receive radical treatment than men in CPG2 (66.3% versus 48.4%; adjusted RR 1.44; 95% CI 1.36-1.53; P < 0.001). Radically treated men in CPG3 were also more likely to receive radiotherapy than men in CPG2 (59.2% versus 43.9%; adjusted RR, 1.18; 95% CI 1.10-1.26). Although radical treatment rates were similar in CPG4 and CPG5 (78.8% versus 73.3%; adjusted RR 1.01; 95% CI 0.98-1.04), more men in CPG5 had radiotherapy than men in CPG4 (79.9% versus 59.1%, adjusted RR 1.26; 95% CI 1.12-1.40). CONCLUSIONS: The CPG classification distributes men in five risk groups that are about equal in size. It reveals differences in treatment practices in men with intermediate-risk disease (CPG2 and CPG3) and in men with high-risk disease (CPG4 and CPGP5) that are not visible when using the traditional three-tiered risk classification.


Assuntos
Neoplasias da Próstata/terapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
2.
Br J Surg ; 101(9): 1166-72, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24916313

RESUMO

BACKGROUND: This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery. METHODS: Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with recording of morbidity (recorded blind to CPET variables). Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity. RESULTS: Of 105 patients assessed, 95 (72 men) were included; ten patients had no surgery and were excluded (3 by choice, 7 owing to unresectable metastasis). Sixty-eight patients had received neoadjuvant treatment. ROC curve analysis of oxygen uptake (V˙o2 ) at estimated lactate threshold (θ^L ) and peak V˙o2 gave an area under the ROC curve of 0·87 (95 per cent confidence interval 0·78 to 0·95; P < 0·001) and 0·85 (0·77 to 0·93; P < 0·001) respectively, indicating that they can help discriminate patients at risk of postoperative morbidity. The optimal cut-off points identified were 10·6 and 18·6 ml per kg per min for V˙o2 at θ^L and peak respectively. CONCLUSION: CPET can help predict morbidity after rectal cancer surgery.


Assuntos
Teste de Esforço/métodos , Aptidão Física/fisiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/cirurgia , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Terapia Neoadjuvante , Consumo de Oxigênio/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Curva ROC , Neoplasias Retais/fisiopatologia , Reoperação/estatística & dados numéricos , Medição de Risco , Resultado do Tratamento
3.
Int Clin Psychopharmacol ; 17(5): 217-25, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12177584

RESUMO

Abrupt interruption or cessation of selective serotonin reuptake inhibitor (SSRI) treatment may result in discontinuation or treatment interruption symptoms. Recent reports suggested these symptoms occur more frequently with shorter half-life SSRIs. Previous studies indicated a 5-8-day treatment interruption resulted in fewer discontinuation-emergent adverse events in fluoxetine-treated patients than in paroxetine-treated patients. This study examines the effects of shorter treatment interruption (3-5 days), as would occur if patients miss just a few doses of medication. Patients successfully treated for depression with fluoxetine or paroxetine underwent treatment interruption in a double-blind fashion. Treatment interruption-emergent symptoms were assessed using the Discontinuation-Emergent Signs and Symptoms checklist. Other assessments included the Montgomery-Asberg Depression Rating Scale, Clinical Global Impressions-Severity scale and a social functioning questionnaire. Of 150 patients enrolled, 141 completed the study. Following treatment interruption, fluoxetine-treated patients experienced fewer treatment interruption-emergent events than did paroxetine-treated patients. The paroxetine treatment group also experienced significant increases in depressive symptoms, clinical global severity scores and difficulty in social functioning; the fluoxetine treatment group did not. These results are consistent with reports suggesting abrupt interruption of treatment with paroxetine is more often associated with somatic and psychological symptoms than is abrupt interruption of fluoxetine. Patients treated with fluoxetine appeared to be protected by its longer half-life.


Assuntos
Antidepressivos de Segunda Geração/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/efeitos adversos , Paroxetina/efeitos adversos , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Síndrome de Abstinência a Substâncias/diagnóstico , Adulto , Antidepressivos de Segunda Geração/uso terapêutico , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/psicologia , Método Duplo-Cego , Feminino , Fluoxetina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Paroxetina/uso terapêutico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Comportamento Social , Síndrome de Abstinência a Substâncias/etiologia
5.
Paediatr Anaesth ; 11(5): 618-21, 2001.
Artigo em Inglês | MEDLINE | ID: mdl-11696130

RESUMO

We describe a new technique of intubation for use in difficult paediatric airway cases utilizing the laryngeal mask airway, a Cook Airway Exchange Catheter and a paediatric intubation fibrescope. This method has a number of potential advantages over previously described methods.


Assuntos
Anestesia por Inalação/métodos , Artrogripose , Intubação Intratraqueal/instrumentação , Máscaras Laríngeas , Desenho de Equipamento , Tecnologia de Fibra Óptica/instrumentação , Hérnia Inguinal/cirurgia , Humanos , Lactente , Intubação Intratraqueal/métodos , Laringoscopia , Masculino
6.
Br J Anaesth ; 82(4): 639-40, 1999 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-10472237

RESUMO

In a double-blind, randomized, placebo-controlled study, 41 patients received clonidine 3 micrograms kg-1 or placebo at induction of isoflurane and nitrous oxide in oxygen anaesthesia. Metoprolol was also given to achieve a systolic arterial pressure of 80 mm Hg. Requirements for metoprolol were significantly less in the clonidine group (P < 0.00035), with no significant difference in mean arterial pressures over time. It would appear that clonidine is an i.v. hypotensive agent worthy of consideration, but data during the recovery period are required to comment further on the safety of this technique.


Assuntos
Anestesia por Inalação , Anti-Hipertensivos/uso terapêutico , Clonidina/uso terapêutico , Hipotensão Controlada/métodos , Pré-Medicação , Adolescente , Adulto , Método Duplo-Cego , Orelha Média/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia
7.
Anesthesiology ; 91(2): 436-41, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10443607

RESUMO

BACKGROUND: Low-dose combined spinal-epidural analgesia in labor has proved popular with women because lower-limb motor power is preserved, allowing ambulation. However, there has been debate about the safety of allowing women to walk following low-dose regional analgesia because of somatosensory impairment. The authors undertook a prospective controlled observational study using computerized dynamic posturography to examine balance function in pregnant women after combined spinal-epidural analgesia. METHODS: The authors performed posturographic testing on 44 women in labor after institution of regional analgesia and compared them with a control group of 44 pregnant women. A separate group of six women were tested both before and after combined spinal-epidural analgesia. RESULTS: Neurologic examination after regional analgesia showed two parturients (4%) to have motor weakness (excluded from posturography). Four women (9%) had clinical dorsal column sensory loss; these women all completed posturography. The spinal-epidural analgesia group showed a small, statistically significant reduction in one of six posturographic sensory-organization tests; however, this difference was functionally minor. There were no other differences in posturography between the control and spinal-epidural groups. Similar results were found in the paired study, in which there was minimal change in balance function after spinal-epidural analgesia. CONCLUSIONS: This is the first study to objectively examine the effect of spinal-epidural analgesia on balance function. Using computerized dynamic posturography, the authors were unable to find any functional impairment of balance function after spinal-epidural ambulatory analgesia in women in labor who had no clinical evidence of motor block.


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Equilíbrio Postural , Adulto , Feminino , Humanos , Postura , Gravidez , Estudos Prospectivos
8.
Br J Anaesth ; 82(2): 228-32, 1999 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10364999

RESUMO

To assess calculated equivalent doses of intrathecal and epidural opioids for elective Caesarean section in terms of quality and duration of analgesia, and incidence of side effects, we have compared 50 patients, allocated randomly to one of two groups to receive either diamorphine 0.25 mg intrathecally (group 1) or 5 mg epidurally (group 2), in addition to intrathecal bupivacaine 10 mg, using a combined spinal-epidural technique. There was no significant difference in duration of analgesia between groups (group 1 mean 14.6 (SD 5.9) h, group 2 14.2 (6.5) h; mean difference 0.8 h; 95% Cl -2.8-4.5; P = 0.65) or quality of analgesia (VAPS and VRS scores). The degree of pruritus was similar in both groups (80-88%) but the incidence of postoperative nausea and vomiting was significantly higher in the epidural group (24% vs 4%; P < 0.05). Intrathecal diamorphine 0.25 mg produced the same duration and quality of postoperative analgesia as epidural diamorphine 5 mg for elective Caesarean section but with significantly less nausea and vomiting.


Assuntos
Analgesia Epidural , Analgesia Obstétrica/métodos , Analgésicos Opioides/administração & dosagem , Cesárea , Heroína/administração & dosagem , Adulto , Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Analgésicos Opioides/efeitos adversos , Feminino , Heroína/efeitos adversos , Humanos , Injeções Espinhais , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Gravidez , Prurido/induzido quimicamente
9.
Anaesthesia ; 53(4): 382-7, 1998 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9613305

RESUMO

Walking after regional blockade for labour using low-dose combinations of bupivacaine and fentanyl is possible due to the maintenance of lower limb motor power. In order to investigate concerns that dorsal column function, important in maintaining balance, is impaired after such techniques, clinical assessment of lower limb proprioception and vibration sense was evaluated in parturients after either low-dose epidural (n = 30) or spinal blockade (n = 30) for labour analgesia and compared with spinal anaesthesia (n = 30) for elective Caesarean section using a larger total dose of local anaesthetic. Of the patients receiving low-dose regional labour analgesia 7% (n = 4) had abnormal dorsal column function compared with 97% (n = 29) receiving spinal anaesthesia for Caesarean section (p < 0.001). All patients in the Caesarean section group developed lower limb motor weakness, compared with only 10% (n = 6) in the low-dose groups (p < 0.001). There were no significant differences between the low-dose groups with respect to sensory block, motor block or dorsal column function. Overall, 90% of patients receiving low-dose bupivacaine/fentanyl regional labour analgesia had both normal lower limb motor power and dorsal column function. Assessment of these parameters is recommended before allowing patients to walk after low-dose regional techniques for labour.


Assuntos
Analgesia Epidural , Analgesia Obstétrica/métodos , Medula Espinal/efeitos dos fármacos , Caminhada/fisiologia , Adulto , Analgésicos Opioides/farmacologia , Raquianestesia , Anestésicos Locais/farmacologia , Cesárea , Esquema de Medicação , Feminino , Humanos , Movimento/efeitos dos fármacos , Gravidez , Sensação/efeitos dos fármacos , Medula Espinal/fisiologia , Vibração
13.
Br Dent J ; 180(12): 462-4, 1996 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-8703599

RESUMO

Cocaine abuse is a major public health problem worldwide and is increasingly common in Europe. Oral use of cocaine in two patients resulted in unusual white lesions on their anterior maxillary gingivae/vestibule. GDPs should be alert to this newly described lesion.


Assuntos
Cocaína , Doenças da Gengiva/induzido quimicamente , Entorpecentes , Transtornos Relacionados ao Uso de Substâncias/complicações , Administração Oral , Administração Tópica , Adolescente , Adulto , Anfetaminas/administração & dosagem , Estimulantes do Sistema Nervoso Central/administração & dosagem , Cocaína/administração & dosagem , Humanos , Masculino , Entorpecentes/administração & dosagem
15.
J Infect Dis ; 134(5): 476-85, 1976 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-825582

RESUMO

Ticarcillin, a semisynthetic penicillin, was evaluated in the treatment of 75 serious gram-negative infections, 50 of which were caused by Pseudomonas aeruginosa. The overall rate of response was 81%. Septicemia and urinary tract infections responded more frequently (93%) than infections of the lower respiratory tract (71%). Response to therapy was comparable to results achieved previously with larger doses of carbenicillin. Response was not correlated with levels of drug in serum. Patients with nonfatal underlying disease were the most likely to respond to treatment. Ticarcillin-resistant organisms were isolated during therapy in 39% of the cases, and superinfection occurred in 12%. Colonization with resistant organisms did nto correlate with success or failure of therapy, severity of underlying disease, or levels of ticarcillin in serum. The clinical response and incidence of colonization were not altered by concurrent use of gentamicin, nor was the development of superinfection affected. Combination of ticarcillin and gentamicin in treatment of 19 patients did not produce toxicity. Eosinophilia, phlebitis, and hypokalemia occurred, as seen with carbenicillin, but major toxicity was not encountered.


Assuntos
Infecções por Enterobacteriaceae/tratamento farmacológico , Penicilinas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Ticarcilina/uso terapêutico , Adolescente , Adulto , Idoso , Carbenicilina/farmacologia , Criança , Pré-Escolar , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/metabolismo , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Resistência às Penicilinas , Pseudomonas/efeitos dos fármacos , Infecções por Pseudomonas/metabolismo , Pseudomonas aeruginosa , Infecções Respiratórias/tratamento farmacológico , Sepse/tratamento farmacológico , Ticarcilina/metabolismo , Ticarcilina/farmacologia , Infecções Urinárias/tratamento farmacológico
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