In children with hepatoblastoma, cure or a prolonged disease-free interval can only be accomplished with surgical resection of the primary tumor. Less than 50% of children with hepatoblastoma are felt to have resectable tumors at the time of diagnosis. Clinical studies have recently focused on the hypothesis that adjuvant chemotherapy can convert the unresectable tumor to a tumor that can be resected. Short-term outcomes for patients treated with adjuvant chemotherapy and subsequent resection are nearly equal to those patients treated with initial resection followed by chemotherapy. This study is a review of the current literature of the chemotherapeutic conversion of unresectable hepatoblastoma and an update on the long-term follow-up of some of these patients.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

Echocardiographic prediction of neonatal ECMO outcome.

Cardiopulmonary physiology was assessed by Doppler echocardiography in neonates undergoing pre-ECMO evaluation for meconium aspiration syndrome, congenital diaphragmatic hernia, persistent fetal circulation, and sepsis, from March 1987 through July 1992 (n = 136). Percent survival by diagnosis was: meconium aspiration syndrome, 86%; persistent fetal circulation, 68%; congenital diaphragmatic hernia, 63%; sepsis, 33%. Survival odds by diagnosis predicted a better outcome for meconium aspiration syndrome than for congenital diaphragmatic hernia and sepsis, and a better outcome for persistent fetal circulation than for sepsis. Percent survival for right-to-left patent ductus arteriosus flow (PDA) was 56%; other patent ductus arteriosus flow was 84%. In multivariate analysis, percent survival in congenital diaphragmatic hernia and persistent fetal circulation patients with right-to-left PDA flow suggested a worse outcome (% survival right-to-left vs other: congenital diaphragmatic hernia, 13% vs 70%; persistent fetal circulation, 25% vs 85%), whereas percent survival did not appear to suggest the same in meconium aspiration syndrome or sepsis patients. Similar analysis in non-ECMO patients suggested a worse outcome with right-to-left PDA flow in patients with meconium aspiration syndrome and congenital diaphragmatic hernia. Right-to-left PDA flow, sepsis, and congenital diaphragmatic hernia were associated with a poorer ECMO outcome. Initial assessment of PDA flow helps predict ECMO outcome.

Ductus Arteriosus, Patent↗

PubMedDate not supplied

An audit of treatment of genital warts: opening the feedback loop.

An audit of the treatment of patients (100 men and 90 women) presenting with a first episode of anogenital warts to the Genitourinary Medicine Department at Leeds General Infirmary was performed. Treatment of patients was monitored for a period of 6 months from the time of presentation. The management of patients with genital warts lacked a clearly defined strategy and treatment was unselective and poorly monitored. Excluding patients who defaulted, at follow-up 44 (44%) men and 36 (38%) women still had genital warts at 3 months. Of those patients clear of warts at 3 months, the mean time to remission for men and women was 7.1 and 8.3 weeks respectively. Podophyllin 25% in tincture of benzoin was by far the predominant therapeutic modality used. A total of 96 (96%) men and 76 (84%) women received treatment with podophyllin. Both male and female patients had a mean of 5 treatments with podophyllin 25% (range 1-19 and 1-12 respectively). Physical methods of treatment i.e. cryotherapy and electrocautery, were underutilized, both as primary therapies and when topical agents had failed. Patients saw an average of 3 (range 1-7) doctors over the course of their treatment. Patients with warts affecting 2 or more sites, male patients with anal/perianal warts, and female patients with cervical and vaginal warts had higher failure rates from treatment at 3 months. On the basis of these findings, specific treatment protocols for the management of anogenital warts have been devised.

Adolescent↗

PubMedDate not supplied

Is Trichomonas vaginalis still a marker for other sexually transmitted infections in women?

Trichomonas vaginalis (TV) has, in the past, been regarded as a useful marker for other asymptomatic sexually transmitted infections such as gonorrhoea and chlamydia in women. The aim of this study was to determine whether TV is still such a marker. All women attending the Department of Genito-urinary Medicine at the Leeds General Infirmary with a diagnosis of TV during 1983 and 1993 were identified and concurrent infections were tabulated. In 1993 approximately 30% of women with TV had at least one other sexually transmitted infection. The prevalence of gonorrhoea in women with trichomoniasis fell from 20% in 1983 to 10% in 1993 whilst the prevalence of chlamydia in these women remained unchanged at 15%. Thus trichomoniasis is still frequently associated with other pathogens in women and screening of these women for other infections remains essential.

Animals↗

PubMedDate not supplied

Audits of the treatment of genital warts: closing the feedback loop.

An initial audit of the treatment of patients presenting to the GUM Department at Leeds General Infirmary with a first episode of anogenital warts was reported in 1993. Treatment was found to be unselective and poorly monitored and the results of treatment were disappointing. As a consequence, guidelines for the management of new patients presenting with genital warts were devised. In order to establish whether these guidelines had produced any improvements in outcome, a second audit was performed looking at the results of treatment in patients with new genital warts who attended 6 months or more after the new guidelines were introduced. Progress was documented for 6 months after presentation. There was a significant fall in the numbers of patients receiving podophyllin 25% solution as first-line treatment, and corresponding increases in the initial use of cryotherapy, trichloracetic acid and, in men, podophyllotoxin solution. (Podophyllotoxin was not licensed for use in women at the time of the second audit.) There were significant improvements in the outcome of treatment. Originally 44% of men had warts despite receiving treatment for 3 months, and 32% were still attending for treatment 6 months after presentation. After the introduction of treatment guidelines, these figures had fallen to 8% and 3% respectively. In the first audit 38% of women still had warts after 3 months' treatment but in the second audit this figure was reduced to 18%. At 6 months, the percentage of women still attending for treatment was halved from 12% in the first audit to 6% in the second audit. The mean number of clinic visits fell from 5 to 3 in men and from 9 to 6 in women. The treatment protocols have been modified and now include the use of podophyllotoxin cream and solution in both men and women.

Adolescent↗

PubMedDate not supplied

The quiet revolution.

Explore the source record for details and available documents.

Attitude of Health Personnel↗

PubMedDate not supplied

Using the resources you have to optimize your control of C.S. and materials management.

Explore the source record for details and available documents.

Central Supply, Hospital↗