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PubMed2004

Greater trochanter bursitis pain syndrome in females with chronic low back pain and sciatica.

Trochanteric bursitis is a clinical condition which simulates major hip diseases and low back pain, it may also mimic nerve root pressure syndrome. Patients with greater trochanteric bursitis pain syndrome (GTBPS) usually suffer from pain radiating to the posterolateral aspect of the thigh, paraesthesiae in the legs, and tenderness over the iliotibial tract.. The purpose of this study is to indicate the similarity between the clinical features of the GTBPS and those of chronic low back pain, and to highlight the importance of diagnosing GTBPS in patients complaining of low back conditions. Three hundred female patients were included in this prospective study. All patients complained about chronic low back pain or sciatica and had a failed long term conservative treatment. Local injection of the tender peritrochanteric area was only done in half of the patients (group 1). Patients were required to answer the Oswestry Disability Index Questionnaire during all periods of follow-up. Patients of group 1 had a better clinical outcome (p < 0.0005) than the patients in group 2 where no injection was done. We conclude that greater trochanter bursitis pain syndrome is a frequent syndrome which may be associated with low back symptoms. Patients with a long standing history of low back pain and sciatica should be routinely checked for GTBPS. GTBPS is easy to diagnose and can be treated. Peritrochanteric infiltration with glucocorticoids mixed with 2% lidocaine relieves patients from their symptoms for a long period of time. Recurrence should always be expected, but treatment may be repeated.

Activities of Daily Living↗
PubMed2005

Expression of transcription factor Yin Yang 1 in prostate cancer.

The transcription repressor Yin Yang 1 (YY1) is expressed in several human cancer cell lines and its expression correlates with resistance to immune-mediated apoptosis. This study used tissue microarrays to investigate the expression and localization of YY1 in 1364 representative tissue samples from 246 hormone naive prostate cancer patients who underwent radical prostatectomy. Staining intensity and frequency measures for both YY1 nuclear and cytoplasmic expression were higher in neoplastic tissues and in PIN samples compared to matched benign cells (p < 0.0001 for all comparisons). Expression of YY1 is predominantly elevated in early malignancy (PIN), as well as in tumors of intermediate to high morphologic grade (Gleason's grade 3-5). Using multivariate Cox proportional hazards analysis, we observed that low nuclear YY1 staining is an independent predictor of a shorter time to recurrence (p = 0.012). Based on these results, we hypothesize that YY1 may play a role in prostate cancer development; however, decreased YY1 may give metastatic cells a survival advantage. These results may also implicate YY1 as a useful diagnostic and prognostic marker.

Aged↗
PubMed2005

Lymphoscintigraphy with intraoperative gamma probe sentinel node detection: clinical impact in patients with head and neck melanomas.

AIM: The aims of this paper were to evaluate the clinical relevance of lymphoscintigraphy with intraoperative gamma-probe detection in identifying sentinel nodes (SNs) and to study the prognostic value of SN biopsy in head and neck melanoma patients. METHODS: Sixty-one patients had lymphoscintigraphy with intradermal injections of 99mTc-Nanocoll (40 MBq), 24 h before surgery. Tumor-positive SNs patients underwent total lymph node dissection. Postoperative histological examination was performed. Patients were followed up for 1 to 5 years (median 3 years). The tumor relapses and the overall survival were evaluated by means of statistical methods. RESULTS: Lymphoscintigraphy showed lymphatic distribution to more than one basin in 45 patients (74%), in 15 patients one basin was visualized and no basin in 1 patient. In 41 patients the SN was negative for metastases, while in 20 was positive. In a high percentage of patients (30%), metastatic involvement occurred in more than one lymph node basin. During follow-up in the negative SN group, 40 patients remained disease free and 1 relapsed. In the positive SN group, 10 patients remained disease free and 10 relapsed. Recurrence time ranged from 6 to 11 months. The overall survival of the SNs negative group was significantly higher than the positive SN group. CONCLUSIONS: This approach was able to distinguish: a) patients with tumor-negative SNs with a favorable clinical course (98% did not relapse, P<0.001); b) patients with tumor-positive SNs with a high rate of tumor relapse (50%, P<0.001). Therefore SN biopsy may give information about prognosis in head and neck melanoma patients.

Adult↗
PubMed1991

Prognosis of orbital rhabdomyosarcoma in children in Japan.

Retrospective studies were made of patients with orbital rhabdomyosarcoma (RMS) who were registered in the Japan Children's Cancer Registry and the National Registry of Ocular Tumors in Japan during 1974-1989. Thirty-five children under 15 years of age were registered as orbital RMS patients. The median age of onset was 5 years and 2 months; lid swelling was the most frequent initial symptom and finding. Histologically, 79% were classified as the embryonal type. Orbital exenteration was the standard treatment until the mid-1970's, but all the 5 patients who had only surgical therapy experienced relapses. Since the mid-1970's, a combined regimen of surgery, radiation and chemotherapy has been used. Chemotherapy has recently been considered to play the most important role in this combined therapy. Among the 35 patients studied, three patients with only biopsy as the surgical procedure have had no relapses up to the present time. Recurrent tumors developed in 15 of the remaining 32 patients: 7 of those were local, 8 were distant. All relapses (10 of the 14 patients in the 1970's, and 5 of the 18 in the 1980's) occurred within 1 year and 11 months after initial treatment. The 3-year survival rate of these 32 patients, estimated by the Kaplan-Meier method, was 70% (52% in the 1970's, 86% in the 1980's).

Adolescent↗
PubMed1991

Decompression sickness: risk factors and the monoplace chamber--a case report.

Discussions regarding the use of monoplace chambers for the treatment of decompression sickness (DCS) have continued for some time. Recently the role of these chambers has been reviewed by Kindwall (12) and critiqued by Moon (13). Various principles and concerns presented in their articles are illustrated by this case presentation of type II (serious) DCS with pulmonary and neurologic manifestations. Closely timed recurrent altitude exposure is discussed as a risk factor for DCS. Also, a newly defined risk factor (menstrual phase) is considered relevant to this case. Finally, we recommend that arrangements be made early in the management of DCS cases for transfer to a chamber which can provide definitive therapy.

Adult↗
PubMed1990

Flow cytometric analysis of nuclear DNA content in patients with recurrent epithelial ovarian cancer.

Numerous reports have recently indicated that the DNA content of various malignant tumors can be of great value in predicting biological behavior and prognosis of the tumors. This study was undertaken to determine the nuclear DNA content in the primary and recurrent ovarian carcinoma of the same 20 consecutive patients by flow cytometry, and the results on clinical outcome was examined. The tissue samples of the recurrent tumors were obtained at second-look laparotomy. Of the primary tumors, 12 were diploid, 4 were pure aneuploid, and 4 were "mosaic", while of the recurrent tumors, 17 were diploid and 3 showed pure aneuploid. No significant difference of the DNA index at recurrence was observed. DNA ploidy was preserved in 12 out of 20 patients at recurrence. The time to recurrence after the initial treatment showed no significant difference versus DNA ploidy and change of ploidy. The sites and status of recurrence differed by DNA ploidy. At recurrence, the patients with DNA diploidy had a tendency to survive longer than those with DNA aneuploidy. The determination of DNA ploidy at recurrence may be useful as a variable parameter in predicting the survival of patients with ovarian carcinomas.

DNA, Neoplasm↗
PubMed1990

Antibiotic therapy for common infections.

Several important points regarding the treatment of urinary tract infections should be made. Single-dose and short-course antibiotic therapy is appropriate only for women with acute bacterial cystitis due to E. coli. Studies comparing single-dose to full-course therapy have not been sufficiently designed to draw valid statistical conclusions, and only TMP/SMX is recommended at this time. Recurrent UTI in women is almost always due to reinfection, which is best managed by prophylactic antibiotics. Acute bronchitis and acute exacerbations of chronic bronchitis are often due to viral infections, and therefore antibiotic therapy is not always needed. In acute exacerbations of chronic bronchitis, the clearest success rates for antibiotic therapy have been in patients, who have all three of the following symptoms: increased dyspnea, increased sputum production, and sputum purulence. Mupirocin is an important addition to the agents used to treat bacterial skin infections due to streptococcal and staphylococcal strains. In impetigo, mupirocin has been demonstrated to be as effective or superior to oral erythromycin. In prostatitis, data on the fluoroquinolones appears impressive, but further comparative trials are needed. They may become first-line, empiric therapy. The newer oral antibiotics are not recommended as initial, empiric therapy in the outpatient management of common infections, with the possible exception of the treatment of prostatitis. These newer agents may be more important in the treatment of recurrent or resistant infections.

Anti-Bacterial Agents↗
PubMed1990

[Primary malignant non-Hodgkin's lymphoma of the breast. A study of 5 cases].

Five cases of primary non-Hodgkin's lymphomas of the breast (stage IE in the Ann Arbor staging system) are described. No clinical or radiological feature has permitted to make the diagnosis before surgery. Histologically, all lymphomas are diffuse and B type. Three cases are high grade lymphomas, one of lymphoblastic type. Two cases are of lymphoplasmacytoid type, one of them associated with an occult invasive ductal carcinoma within the same breast, the other changing in high grade lymphoma at the recurrence time. Three of them reveal histological aspects of lymphoepithelial lesions and appear as mucosa-associated lymphoid tissue lymphomas (MALT). The differential diagnosis with a carcinoma is now easily done by immunohistochemical techniques. The importance of a diagnosis before surgery by cytopunction and drill-biopsy has to be emphasized, to prevent an useless mastectomy.

Adult↗
PubMed1989

[The effect of pharmacologic therapy of hyperthyroidism on automatic heart conduction].

Investigations of the heart automatism were carried out in 10 patients with hyperthyreoidism before thiamazol therapy and after restoration of the euthyroid status. A control group was comprised of 34 healthy subjects. In order to determine the electrophysiologic parameters the transoesophageal atrium extrastimulus technique and the over-driving stimulation were applied. Restoration of the euthyroid status was accompanied by a significant prolongation of the atrial refraction, the border interval, the border conductivity and the sinus rhythm recurrence time. In a half of the patients were atrioventricular and intraventricular conductibility disturbances observed. The authors conclude, that in the early period of the euthyroid status restoration after thiamazole therapy there still exists a risk of cardiologic complications.

Adult↗
PubMed1989

Juvenile malignant melanoma.

Malignant melanoma in children and adolescents is a rare phenomenon. During a retrospective computer-aided chart review, 78 patients less than 20 years of age were identified who had the diagnosis of malignant melanoma. This accounted for 1.8 per cent of all the melanomas registered at the University Melanoma Clinic. Fifty-one per cent were females, and all the patients were white. Most of the lesions were found on the primary areas of the trunk and extremities. Sixty-seven per cent of the melanomas were of the superficial spreading type, and 82 per cent were invasive to Clark level III and IV. The range of tumor thickness was 0.32 to 5.22 millimeters, with a mean of 1.76 millimeters. Similar population characteristics were noted in the adult and juvenile populations. Controlling for the two most powerful prognostic factors for Stage I melanoma, that is, ulceration and tumor thickness, the actuarial survival times between the two population groups were similar. The median survival times in the adult and juvenile population were 12.9 and 11.9 years, respectively (p = 0.54). There was a trend toward a shorter disease-free interval in the juvenile population. The five year disease-free interval was 65 per cent for adults with melanoma compared with 57 per cent for juveniles with malignant melanoma (p = 0.16). Multiple regression analysis failed to reveal age less than 20 years to be an independent prognostic factor for the development of metastases or over-all survival time. Recurrent disease was observed in 46.2 per cent of juveniles with melanoma who were initially Stage I at diagnosis. Eighty per cent of the relapses occurred in either the local skin or regional lymph nodes. Although malignant melanoma is rare in populations of patients younger than 20 years of age, clinicians should be aware that melanoma does occur in juveniles. With an aggressive approach to surgical therapy, survival rate is comparable with that of the adult population.

Adolescent↗
PubMed1986

Prophylactic oophorectomy in the treatment of carcinoma of the breast.

Several prospective clinical trials have been conducted to investigate the efficacy of prophylactic ovarium ablation in the primary treatment of carcinoma of the breast. The results have varied and the follow-up periods have been rather short. A prospective randomized study was done at our institution from 1961 to 1966 to test the value of prophylactic oophorectomy in the treatment of carcinoma of the breast. The patients have now been studied for 17 to 22 years. Patients were randomized into two groups: a control group and a group treated by surgical castration. By December 1983 280 patients were evaluable, 154 in the control group and 126 in the oophorectomy group. One hundred and forty-nine patients died during the observation time. All but 11 patients underwent autopsy. There are no significant differences between the group regarding age, axillary node involvement, menstrual status, perinodal tumor growth and distribution in the different TNM stages. The results of the study did not demonstrate any significant differences in cure rate, survival time, recurrence free intervals or intervals between recurrence of the disease and death. The results were independent of nodal status, TNM classification and menstrual status of the patient. These findings do not support the use of prophylactic oophorectomy in the treatment of operable carcinoma of the breast in TNM Stages I and II, whereas no conclusion can be drawn regarding TNM Stage III as the number of patients in this stage is small.

Adult↗
PubMed1986

Prevalence and treatment of palpebral neoplasms in the dog: 200 cases (1975-1983).

The prevalence and treatment of 255 eyelid tumors in 200 dogs was related to breed, age, sex, location, and tumor type. Treatment methods included cryosurgery and surgical excision. The mean age of all dogs with eyelid tumors was 9.6 years (+/- 0.2 SEM). Beagles, Siberian Huskies, and English Setters had a higher risk of tumor development, whereas the mixed-breed dogs had a lower risk. Sebaceous tarsal gland adenomas, benign melanomas, and papillomas were observed most often (88%). Malignant tumors (melanoma, adenocarcinoma, basal cell carcinoma, mast cell tumor, squamous cell carcinoma, hemangiosarcoma, and myoblastoma) comprised 8.2% of the tumors. Tumor recurrence rates between dogs treated with cryosurgery and those treated surgically were not significantly different (15.1% and 10.5%, respectively). The mean recurrence time after cryosurgery was 7.4 months (+/- 1.9 SEM), whereas it was 28.3 months (+/- 7.2 SEM) after surgical excision. Using either treatment, the long-term side effects were similar. The overall cosmetic appearance was observed to be better with cryosurgery.

Animals↗
PubMed1977

[Endoscopic resection in the treatment of non-invasive excreto-urinary carcinomas of the bladder 146 endoscopic resections carried out in 53 patients].

The authors divided their cases of excreto-urinary tumours of the bladder using the classification of Chome and Algazi. The diagnosis was made in 8 cases out of 10 on the basis of the cystogram obtained by IV pyelography. The upper urinary tract was free of disease in all cases. All patients were treated by endoscopic resection with or without the addition of intravesical instillations of triaziridinyl phosphine sulphide. The effectiveness of such instillations would not appear to have been conclusively demonstrated at the present time. Recurrences of intravesical tumours are extremely common (33/53 patients), but were always at the initial stage: i.e. highly differentiated non-invasive carcinoma. Up to the present none of these 53 patients (maximum follow-up 10 years) has died of an invasive carcinoma of the bladder.

Adult↗
PubMed1982

[Giant cutaneous horn developed at the expense of a total orbital skin graft and rapidly evolving into an epithelioma].

The author reports a patient who at the age of 4 years presented a tumour of the left internal canthus thus which after many extirpations presented as many times recurrences. An intense radiotherapy put an end to the recurrences at the cost of the atrophy of the left eye and of the destruction of the periocular tissues. After 25 years necrosis of these periocular tissues necessitated the exenteration of the left orbit followed by a free skin graft. 12 years later on the floor of the left orbit developed a giant cutaneous horn which was extirpated. After 4 months a similar tumour grew on the medial wall of the orbit which developed rapidly filling the orbit and invading the maxillary and ethmoidal sinuses. The histological examination of the tumour showed the characteristics of a squamous cell epithelioma. The author discusses further the possible role of the area on which was transplanted the skin, the role of the irradiation and finally of the scarce vascularization of the this orbit, in the tumoral proliferation.

Adult↗
PubMedDate not supplied

Treatment of two cases of perigraft seroma with fistulization to the skin.

Perigraft seromas are an uncommon complication of prosthetic vascular reconstructive surgery. The unclear etiology is perhaps partly responsible for a delay in diagnosis. Two cases with fistulization to the skin after implantation of a Dacron graft are presented. Relation to the graft material was observed in the first patient where successive identical graft implants caused each time recurrence of symptoms. In both patients the condition was successfully treated only after removal of the affected graft and replacement with a polytetrafluoroethylene prosthesis.

Aged↗
PubMed1994

[A case of catamenial pneumothorax associated with diaphragmatic endometriosis].

A case of catamenial pneumothorax associated with diaphragmatic endometriosis was reported. A 43-year-old woman had 4 times-recurrent pneumothorax on right side for recent 5 months. Each onset was related to the beginning of menses. Right thoracotomy revealed the presence of multiple darkly-pigmented spots and several pinhole like perforations in the central tendon of diaphragm. The area showing these lesions were considered to be the focal region, and this part of diaphragm was excised. Histology showed the stromal endometriosis surrounded by hemosiderin pigment deposits. The patient has been asymptomatic for 4 years after operation. Our case may give support to Maurer's hypothesis. Surgeons should be aware of the importance of carefully inspecting the diaphragm during operation.

Adult↗
PubMed1993

[Tetracycline pleurodesis for treatment of malignant pleural effusions. Retrospective study of 91 cases].

BACKGROUND: Malignant pleural effusions (MPE) are a common complication in patients with advanced neoplasms. Even though no large series confirming this exist, tetracycline pleurodesis has become the therapy of choice. The aim of this retrospective study was to evaluate its efficacy, adverse effects and possible factors predicting the success of the method. METHODS: Between 1985 through 1991, 91 patients with cytologically or histologically confirmed MPE were treated with 1,000-1,500 mg tetracycline pleurodesis. There were 49 females and 42 males, with a mean age of 59 years. The most common malignancies were lung, breast and unknown primary carcinomas. 85% patients complained of dyspnea and the volume of the effusion was moderate in half the cases. 12 variables were analyzed in relation with the probability of response through chi 2 test; survival and recurrence times were calculated with Kaplan and Meier's method. RESULTS: 73 patients were evaluable, with a 67% response rate (22 complete, 27 partial). Time to relapse was significantly higher for partial responses (mean 112 days) than for failures (mean 33 days). 37 patients presented mild complications (pain and fever). Karnofsky performance status (70% or greater), size of the effusion (small or moderate), chest radiograph (only effusion) and pleural LDH (600 U/l or less) attained favourable prognostic significance. Median survival was reached at 6 months. CONCLUSIONS: Tetracycline pleurodesis is an effective and well-tolerated paliative treatment for MPE. Along with other known parameters (pleural pH and glucose levels), Karnofsky performance status, size of the effusion, chest radiograph and pleural LDH allow to predict its results and optimize its indications.

Adult↗
PubMed1996

[Anal fissure: conservative treatment].

Anal fissure is a common and painful disorder. Conservative treatment must be reserved for acute forms. Hygiene rules, stool softeners and topical local anaesthetic agents are the mainstays of treatment. Healing often takes long time. Recurrences can be prevented with chronical prescription of stool softeners. Surgical treatment is indicated for chronic fissures, acute fissures refractory to 2 monthes conservative treatment and persistent painful forms.

Administration, Topical↗