RESUMO
BACKGROUND: Vulval intraepithelial neoplasia (VIN) is a precancerous condition that may progress to invasive malignancy. VIN is associated with human papillomavirus (HPV) infection in most cases, and with inflammatory skin disorders in a smaller proportion of patients. Treatment of VIN has traditionally been surgical excision; however, topical treatments, including imiquimod cream, are becoming increasingly used. Patient factors influencing response to imiquimod therapy, in particular smoking, have not yet been published. AIM: To assess the impact of smoking and other patient characteristics that may influence the treatment response to topical imiquimod for VIN. METHODS: This was a retrospective cohort study of 46 women treated with topical imiquimod for VIN in a single centre dermatology unit from January 2011 to July 2017. RESULTS: Complete clinical resolution of VIN was observed in 28 of 46 patients (61%), but was significantly reduced in the smoking cohort. CONCLUSIONS: Smoking may impair response to imiquimod for VIN, and should be considered when discussing VIN treatment options with patients.
Assuntos
Imiquimode/uso terapêutico , Fumar/efeitos adversos , Neoplasias Vulvares/tratamento farmacológico , Adjuvantes Imunológicos/uso terapêutico , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/patologia , Feminino , Humanos , Imiquimode/administração & dosagem , Pessoa de Meia-Idade , Infecções por Papillomavirus/complicações , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Vulvares/epidemiologia , Neoplasias Vulvares/patologiaAssuntos
Doença da Artéria Coronariana/genética , Receptores Citoplasmáticos e Nucleares/genética , Fatores de Transcrição/genética , Idoso , Substituição de Aminoácidos , Arteriosclerose/sangue , Arteriosclerose/genética , Arteriosclerose/patologia , Índice de Massa Corporal , Estudos de Coortes , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/patologia , Diabetes Mellitus/sangue , Diabetes Mellitus/genética , Diabetes Mellitus/patologia , Feminino , Frequência do Gene , Genótipo , Haplótipos , Humanos , Hipertensão/sangue , Hipertensão/genética , Hipertensão/patologia , Íntrons/genética , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/genética , Infarto do Miocárdio/patologia , Polimorfismo Genético , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Fatores Sexuais , Triglicerídeos/sangueRESUMO
BACKGROUND: Tracheostomy after cardiac operation through a median sternotomy is believed to increase the risk of mediastinitis, leading to debate as to whether early tracheostomy is safe in these patients. METHODS: A record search of patients undergoing cardiac operation through median sternotomy was done. Day and duration of tracheostomy were correlated to day of positive bacteriological evidence and clinical outcome for the patient. The method of tracheostomy was also recorded. RESULTS: Of 174 cases, 4 patients had mediastinitis, 3 before tracheostomy was performed. Of these three patients, 2 survived and the third died of multiorgan failure 46 days after the procedure. The fourth patient, on immunosuppressive therapy for severe rheumatoid arthritis and pulmonary fibrosis, had tracheostomy performed at primary operation, developed fatal mediastinitis after 6 days, and died 18 days postoperatively of multiorgan failure. Of the tracheostomies performed, 24 (14%) were percutaneous, and 110 (63%) were achieved using standard surgical techniques (in 40 cases type was unrecorded). In 72 cases (41%), tracheostomy was performed on or before day 7, 11 (6%) being performed before 48 hours. Mortality occurred in 38 (22%). CONCLUSIONS: There is no demonstrable relationship between early tracheostomy and mediastinitis in median sternotomy patients.
