344 previously untreated patients, under 19 years of age, with soft tissue sarcoma (STS) entered the first German STS Study, CWS-81. 218 of them with chemosensitive STS (Group A: rhabdomyosarcoma [RMS], synovial sarcoma, extraosseous Ewing's sarcoma, undifferentiated sarcoma and malignant peripheral neuroectodermal tumor) were evaluable for this analysis after a minimum potential follow-up of 6 years. A staging system based on the extent of disease, defined post-surgically, was used. The chemotherapy for stages I-III (VACA cycle) consisted of vincristine, dactinomycin, cyclophosphamide and doxorubicin. Patients with metastatic disease as well as stage III patients who failed to respond to VACA, were given ifosfamide instead of cyclophosphamide. The definitive local tumor control procedure for patients in stages II-III depended upon the tumor status at second-look surgery after 16 weeks of chemotherapy (no irradiation, 40Gy or 50Gy). The DFS rate after 5 years for group A was 57 +/- 4% and for patients with non-metastatic tumors (Stages I-III), 69 +/- 4%. There was no difference in prognosis between stages I and II (DFS rate 88 +/- 5% and 88 +/- 6% respectively). The DFS rate for stage III was 54 +/- 5% and for stage IV, 11 +/- 5%. Lack of local tumor control was the main cause of therapy failure: 10% of patients with localized disease never achieved CR, 18% relapsed locally. The most important prognostic factors were tumor size (p = .0002) and the degree of tumor regression after primary chemotherapy (p = .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

[Improved local tumor control by early and risk-adjusted use of radiotherapy in primary non-resectable rhabdomyosarcomas: results of CWS 81 and 86 studies].

Since the lack of local tumor control was a major cause of therapy failure in the CWS-81 Study, the concept of the definitive local tumor control in patients with primary non-resectable RMS has been changed. In the CWS-81 Study RT was stratified according to the results of SL surgery at week 16-20 (after 2 cycles of CT), given only to patients who at this time stage had still microscopic or macroscopic tumor residuals. In the CWS-86 Study irradiation was given prior to SL surgery after one cycle of CT (7-10 weeks). The cumulative dose was stratified according to the degree of tumor volume reduction (32 Gy and 54.4 Gy) and given simultaneous to the second CT. The single dose was reduced (1.6 Gy) and given twice a day (accelerated hyperfractionation). This analysis excluded patients with parameningeal and extremity primaries since this group had special RT recommendation in both studies. 62% of patients had been irradiated in the CWS 81 Study and 70% in the CWS 86. The local tumor control improved dramatically in the CWS-86 Study in the group of patients who had been irradiated prior to SL surgery and still had macroscopic residues at the start of RT (rate of local tumor control 25% vs. 95%, p < .001). The average RT dose for this group was even lower in the CWS-86 Study (38.8 vs. 40 Gy). In the patients who were irradiated in clinical remission, no major change in local tumor control between studies was observed (CWS 81 82% vs. 75% CWS 86).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Breast feeding: a transcultural perspective. Part I].

Explore the source record for details and available documents.

Breast Feeding↗

PubMedDate not supplied

13.56 MHz hyperthermia temperature distribution in phantoms, and clinical results of therapy.

Hyperthermia with 13.56 MHz was studied experimentally and clinically. Experimental studies revealed the following. To spare the surface electrodes greater than half of the phantom in diameter should be employed preferably. By cooling the electrodes, the surface is additionally spared, which is important in patients with thick subcutaneous fat. The application of different electrode sizes induces higher temperature in the vicinity of the smaller electrode. Relatively homogeneous heat distribution occurred in the brain. In contrast, thorax mediastinum and hilar areas do show much temperature increase, whereas lung parenchyma shows a high increase. Pelvis generally demonstrates a uniform temperature increase. High frequency currents do hardly penetrate bones but it achieves higher temperature by convection sequence. The best clinical results were obtained in superficial tumors; for example, breast carcinoma showed an 80% remission rate. ENT tumors responded well, with a remission rate of 73%. Glioblastoma showed no improvement with hyperthermia. Hyperthermia is well tolerated. Therefore, this treatment mode is highly recommended to be used as an adjunct to radiotherapy in palliative treatment.

Body Temperature↗

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Severe late complications after operative correction of aortic coarctation by interposition of prosthesis.

Out of 198 patients with aortic coarctation who were operated on with the implantation of an orthotopic bypass vascular prosthesis, 7 developed severe late complications 9-20 years postoperatively with late anastomosis dehiscence which resulted either in acute rupture and sudden death from massive hemorrhage (2 patients) or in false aneurysms with or without delayed rupture. Reoperation was done in 4 patients. After elective reoperation 2 of 3 patients survived, one elective and one emergency case died. The only evident reason for the late suture disruption was complete absorption of polyamide suture material in 6 cases. Therefore all patients with polyamide-sutured anastomosis should be followed-up thoroughly even in the late postoperative period in order to detect indications for elective reoperation. Suture material for anastomosis with any prosthesis must be nonabsorbable for lifetime.

Adult↗

PubMedDate not supplied

A diagnostic cluster system for skilled nursing facilities.

BACKGROUND AND OBJECTIVES: Diagnostic cluster systems have been developed to assist in analyzing diagnoses in outpatient and inpatient settings but not in convalescent hospital settings. We developed a diagnostic cluster system for skilled nursing facilities (SNFs) designed to include or capture a greater proportion of such diagnoses than a previously established inpatient diagnostic cluster system. METHODS: We tested the ability of the new SNF diagnostic cluster system to code diagnoses on records from SNFs in different geographic areas. Then we compared the proportion of admitting diagnoses captured by the new SNF diagnostic cluster system and by a previously established inpatient system. RESULTS: The new diagnostic cluster system captured between 92% and 96% of admitting diagnoses at the study SNFs. There was no statistically significant difference among the facilities in the proportion of diagnoses captured by the new system. By comparison, the previously established inpatient system captured only 59%-65% of these admitting diagnoses. The new system captured significantly more diagnoses than the previously established inpatient system. CONCLUSIONS: The new SNF diagnostic cluster system can be used to capture and code diagnostic data from SNFs.

Cluster Analysis↗