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At least 613 records · Page 34Linked to original sources
PubMed2000

Adult herpetic laryngitis with concurrent candidal infection: a case report and literature review.

Rarely, adult herpetic laryngitis without involvement of the oropharynx has been reported. However, to our knowledge, laryngitis caused by herpes simplex virus with coexisting Candida albicans has not been reported. We report what we believe to be the first case of localized herpetic laryngitis superimposed by laryngeal Candida species infection in an immunosuppressed patient. This diagnosis was made on the basis of the findings of a laryngeal mucosal biopsy and ancillary testing using fungal stains and immunohistochemical stains for herpetic antigens. We also review the literature and discuss the clinical and diagnostic presentations, including potential pitfalls in the diagnosis.

Anti-Inflammatory Agents↗
PubMed2004

Concurrent chemoradiotherapy for esophageal cancer: comparison between intermittent standard-dose cisplatin with 5-fluorouracil and daily low-dose cisplatin with continuous infusion of 5-fluorouracil.

BACKGROUND: Although current standard treatment for advanced esophageal cancer is intermittent standard-dose cisplatin with 5-fluorouracil (5-FU) (ISD-FP), daily low-dose cisplatin with continuous infusion of 5-FU (CLD-FP) is advocated for equivalent effectiveness and lower toxicity. The feasibility of these two concurrent chemoradiotherapeutic protocols was retrospectively reviewed for local control rate, overall survival, toxicity, and compliance in a single institutional situation. METHODS: Concurrent chemoradiotherapy, using 60 Gy of radiation and ISD-FP or CLD-FP was non-randomly scheduled for 29 patients between June 1994 and March 2001. RESULTS: Complete response in the irradiated volume at the end of primary treatment was shown by 8 of 15 and 9 of 14 patients in the ISD-FP and CLD-FP groups, respectively. The projected overall survival rate at 2 years was 55% for stage III patients and 13% for stage IV. Median survival times were 14 months versus 15 months in the ISD-FP and CLD-FP groups, with no significant difference. Toxicities were similar, including two treatment-related deaths in each group. Chemotherapy was completed for 10 of 15 and 11 of 14 patients in the ISD-FP and CLD-FP groups, respectively. Modification of the planned regimen was more often required for the CLD-FP group. CONCLUSION: CLD-FP therapy has no apparent advantage over ISD-FP therapy from the perspective of compliance and safety. A randomized phase II clinical trial comparing ISD-FP and CLD-FP, currently being performed, is expected to provide further information. Although current standard treatment for advanced esophageal cancer is intermittent standard-dose cisplatin with 5-fluorouracil (5-FU) (ISD-FP), daily low-dose cisplatin with continuous infusion of 5-FU (CLD-FP) is advocated for equivalent effectiveness and lower toxicity. The feasibility of these two concurrent chemoradiotherapeutic protocols was retrospectively reviewed for local control rate, overall survival, toxicity, and compliance in a single institutional situation.

Adenocarcinoma↗
PubMed2000

Concurrence of sarcoidosis and aortitis: case report and review of the literature.

Takayasu arteritis (TA) is a rare manifestation of systemic large vessel vasculitis which affects predominantly the aorta and its main branches, but often remains unrecognised owing to delayed diagnosis and non-characteristic clinical features. Sarcoidosis, too, is a systemic inflammatory disease which can affect virtually any organ system. Reports about the coincidence of both diseases have appeared. The case presented here is characterised by a significant time lag between detection of TA and appearance of clinical signs of sarcoidosis. The woman, now 39 years old, had erythema nodosum, circumscript alopecia, and recurrent uveitis, which dated back to 1980 and was attributed to sarcoidosis. At least 12 years later aortic valve insufficiency with progressive cardiac failure developed. Histology performed at the time of aortic valve prosthesis in 1997 disclosed a diagnosis of TA, which was confined to the aortic root. Incidentally, sarcoidosis was diagnosed in adjacent lymph nodes. A thorough check up failed to detect further manifestations of TA; thus, possibly, the patients had aortitis similar to, but not identical with, TA. Several related cases previously reported are discussed, suggesting that both diseases may be inherently related as they are characterised by certain non-specific, immunoinflammatory abnormalities. This case report suggests that the prevalence of TA, or related forms of arteritis, may be higher than expected and should be considered, especially in younger patients with non-characteristic cardiovascular symptoms and suspected systemic inflammatory disease. Moreover, the association with sarcoidosis in this and other previously described cases suggests that the two diseases may be related and that TA or TA-like vasculitis may even be a complication of sarcoidosis.

Adult↗
PubMed1999

Acute tumor lysis syndrome associated with concurrent biochemotherapy of metastatic melanoma: a case report and review of the literature.

BACKGROUND: Treatment of solid tumors rarely has been associated with tumor lysis syndrome. However, to the authors' knowledge the clinical scenario has not been reported previously in melanoma patients. METHODS: A patient with bulky metastatic melanoma was treated with concurrent biochemotherapy using interleukin-2, interferon-alpha, and a combination of cisplatin, vinblastine, and dacarbazine. RESULTS: Within 24 hours of the initiation of treatment, brisk tumor lysis occurred and led to a fatal outcome. CONCLUSIONS: Improvements in the treatment of solid tumors may increase the incidence of tumor lysis syndrome for tumors once believed to be marginally responsive. Oncologists should remain cognizant of this problem as more active regimens become available.

Acute Disease↗
PubMedDate not supplied

Results of arthroscopic subacromial decompression in patients with subacromial impingement and glenohumeral degenerative joint disease.

The purpose of this study was to determine the efficacy of shoulder arthroscopy with subacromial decompression in patients with concurrent glenohumeral arthrosis. A retrospective review of 36 patients who had arthroscopic subacromial decompression with concurrent glenohumeral degenerative joint disease was conducted. Office charts, operative notes, standard shoulder questionnaires, radiographs, and clinical examinations were used. The mean age of patients was 61 years, with 5-year follow-up. Patients with Outerbridge grade 1, 2, or 3 changes on either the glenoid or humerus had a mean final L'Insalata score of 90. Ten patients with grade 4 changes registered an ultimate score of 50. Radiographic arthrosis correlated similarly but with less reliability. Arthroscopic subacromial decompression for resistant impingement symptoms in the face of mild to moderate glenohumeral degenerative joint disease can improve shoulder function and provide durable results. Full-thickness loss of articular cartilage or radiographically severe degenerative joint disease had less predictable results.

Acromion↗
PubMed1984

Studies on the pathology of non-Hodgkin's lymphoma of childhood. I. The role of routine histopathology as a prognostic factor. A report from the Children's Cancer Study Group.

Between April 1977, and August 1980, the Children's Cancer Study Group (CCSG) conducted a clinical trial of childhood non-Hodgkin's lymphoma (NHL), randomizing 256 patients to one of two treatment regimens. A 4-drug regimen (regimen 1, modified cyclophosphamide, Oncorin [vincristine], methotrexate, prednisone [COMP] ) was compared with a 10-drug regimen (regimen 2, modified LSA2-L2). Using the Rappaport classification, the review pathologist diagnosed the 213 evaluable tissue specimens as follows: lymphoblastic (LC), 73; Burkitt's tumor (BT), 40; "undifferentiated" non-Burkitt's type (NB), 67; large cell or "histiocytic" lymphoma (HI), 29; and other types (OT), 4. Concurrence in classification between the review and institutional pathologists was poor when using the above four categories; however, concurrence was 88% between the review pathologist and other hematopathologists, and 99% when classifying the specimens as lymphoblastic or nonlymphoblastic. For patients with nonlocalized disease, this randomized controlled study demonstrated a new important correlation of histopathology with the effectiveness of treatment. When analyzed without stratification into lymphoblastic and nonlymphoblastic types, the two regimens showed identical relapse free survival (RFS) curves for patients with nonlocalized involvement. However, when patients were stratified according to histologic classification, regimen 2 was superior to regimen 1 for patients with lymphoblastic lymphoma, achieving 74% RFS at 30 months compared to 31% for regimen 1 (P = 0.001). Conversely, those with nonlymphoblastic types (BT, NB, HI) treated with regimen 1 had a 58% RFS at 30 months compared to 32% for those treated on regimen 2 (P = 0.01). This study demonstrates that proper, routine histopathologic classification of NHL is the best criterion for choice of therapy in children with nonlocalized involvement. As a result of this study, all patients with nonlocalized disease, diagnosed after August 1980, were no longer randomized but were assigned to the appropriate treatment regimen based on prospective review of histopathology.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Single umbilical artery. Prenatal detection of concurrent anomalies.

Prenatal sonographic findings were reviewed in 30 fetuses with a single umbilical artery (SUA) to determine the reliability of ultrasound for detecting concurrent anomalies. Additional anomalies were identified in 15 fetuses, including 3 fetuses with minor anomalies and 12 fetuses with major or multiple concurrent anomalies. Minor anomalies observed in 3 fetuses included 1 case each of pelvic kidney, unilateral absent kidney, and mild cerebral ventricular dilatation. Major abnormalities detected in 12 fetuses involved a variety of organ systems and included cardiac defects, holoprosencephaly, skeletal dysplasia, hydrocephalus, omphalocele, hydrothorax, enlarged cisterna magna, and diaphragmatic hernia. Clinical and pathologic correlation showed that all fetuses were correctly categorized regarding the presence of other anomalies; none of the 15 fetuses in whom an SUA was considered an isolated finding had a significant anomaly at birth. Chromosome abnormalities were found in 6 of 12 fetuses with major abnormalities but in none of the 18 remaining fetuses. We conclude that prenatal ultrasound can reliably identify major concurrent anomalies in fetuses with SUA. In the absence of additional anomalies, prenatal detection of SUA should not alter obstetric management.

Abnormalities, Multiple↗
PubMed1989

Acute nonlymphocytic leukemias of childhood. Inter-observer variability and problems in the use of the FAB classification.

The French-American-British (FAB) classification system and some recent modifications were applied to 486 children with a diagnosis of acute nonlymphocytic leukemia (ANLL) to determine the distribution of the subtypes in children, to document the extent of inter-observer variation in assigning subtypes, and to examine the reasons for the differences. The distribution of FAB subtypes of childhood ANLL was similar to that reported for adults. In the initial year of the study, the inter-observer concurrence between the institutional diagnosis and the reviewing pathologists was 50%, but in the more recent years, concurrence between institutions and the review pathologist has approached 80%, averaging around 73% for the entire study. Many problems remain to be solved with this classification system, including the imprecision in wording, the subjectiveness of the interpretation, errors due to the random distribution of cells, and the current lack of evidence that certain FAB subtypes, such as M1 and M2, differ significantly in terms of biological behavior and prognosis.

Adolescent↗
PubMed1997

AGUS in cervical endometriosis.

OBJECTIVE: To evaluate cervical endometriosis as a source of abnormal glandular cells in cervicovaginal smears. STUDY DESIGN: Histologically documented cases of cervical endometriosis with concurrent cervicovaginal smears were reviewed. The cytologic specimens were evaluated for the presence of glandular abnormalities. RESULTS: There were eight cases of superficial endometriosis (five of which had concurrent tuboendometrioid glandular metaplasia) and two cases of deep endometriosis in this series. Five of the eight cases of superficial endometriosis had abnormal glandular cells in the smears; neither of two cases of deep endometriosis had glandular abnormalities. Four of the eight cases of superficial endometriosis had previously undergone conization for cervical intraepithelial neoplasia (CIN) (squamous intraepithelial lesion [SIL]) and were being monitored for recurrence. Of the five cases of atypical glandular cells of unknown significance (AGUS), one case had concurrent high grade CIN (SIL). Another case was originally misinterpreted as recurrent glandular dysplasia. CONCLUSION: Physicians monitoring patients after treatment for CIN need to be aware that endometriosis and tuboendometrioid metaplasia may be the source of atypical glandular cells and on occasion may be subject to misinterpretation.

Cervix Uteri↗
PubMed2006

Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies.

OBJECTIVE: To determine the strength of evidence underlying recommendations for use of statins during the perioperative period to reduce the risk of cardiovascular events. DESIGN: Systematic review of studies with concurrent control groups. DATA SOURCES: Four electronic databases, the references of identified studies, international experts on perioperative medicine, and the authors of the primary studies. Review methods Two reviewers independently extracted data from studies that reported acute coronary syndromes or mortality in patients receiving or not receiving statins during the perioperative period. MAIN OUTCOME MEASURE: Random effects summary odds ratios for death or acute coronary syndrome during the perioperative period. RESULTS: 18 studies--two randomised trials (n=177), 15 cohort studies (n=799,632), and one case-control study (n=480)--assessed whether statins provide perioperative cardiovascular protection; 12 studies enrolled patients undergoing non-cardiac vascular surgery, four enrolled patients undergoing coronary bypass surgery, and two enrolled patients undergoing various surgical procedures. In the randomised trials the summary odds ratio for death or acute coronary syndrome during the perioperative period with statin use was 0.26 (95% confidence interval 0.07 to 0.99) and the summary odds ratio in the cohort studies was 0.70 (0.57 to 0.87). Although the pooled cohort data provided a statistically significant result, statins were not randomly allocated, results in retrospective studies were larger (odds ratio 0.65, 0.50 to 0.84) than those in the prospective cohorts (0.91, 0.65 to 1.27), and dose, duration, and safety of statin use was not reported. CONCLUSION: The evidence base for routine administration of statins to reduce perioperative cardiovascular risk is inadequate.

Case-Control Studies↗
PubMed2004

Treatment of terminal restlessness: a review of the evidence.

Terminal restlessness is an important issue in the management of symptoms at the end of life with between 25% and 88% of dying patients exhibiting this condition. (1-5) The purpose of this review was to examine the empiric evidence about the pharmacological treatment for terminal restlessness. All available literature, in all languages, from 1966-2002 including randomized trials, concurrent observations, retrospective chart reviews, single case studies, clinical practice guidelines, expert consensus, single expert opinion articles, and editorials were reviewed as "best available evidence." Of the 72 articles reviewed, 14 met the criteria and were chosen for analysis. Despite the majority of authors recommending neuroleptic medications as a first or second line pharmacological treatment of restlessness, a number of studies demonstrated the effectiveness of other medications such as benzodiazepines (notably midazolam and lorazepam), or phenothiazines, either alone or in combinations. There is insufficient evidence to suggest that a single medication or class of medications is appropriate for terminal restlessness. There is a clear need for additional trials of neuroleptics, benzodiazepines, barbiturates, and combination protocols to determine which protocols are the most effective and have the least side effects.

Antipsychotic Agents↗
PubMed1984

Physician involvement in quality assurance.

Effective physician involvement in quality assurance in hospitals is necessary both to identify problems in patient care and to bring about problem resolution. This report describes a controlled, longitudinal study designed to measure effects on physician performance of involving physicians in setting medical audit criteria, reviewing audit results, and receiving concurrent reminders on a case-by-case basis. Unexpected low hemoglobin levels was the topic for audit. During phase 1 of the study, three randomly composed physician groups were involved in criteria setting plus review of audit results, review of audit results alone, or no treatment. During phase 2, 6 months later, the physicians in all three groups were exposed to 4 months of concurrent reminders. During phase 1, the group involved in review of audit results only achieved 51% compliance with the preset criteria compared with 26% for the group involved in criteria setting and review of audit results (P = 0.002). During phase 2, when concurrent reminders were provided, the group that was formerly the control group in phase 1, achieved 77% compliance as compared with 56% for the group previously involved in criteria setting and review of audit results (P = 0.004). These findings challenge the common assumption that physicians should be involved in criteria setting. They also suggest that providing the individual physician with information concurrently on a case-by-case basis may be superior to reviewing audit results for changing physician behavior.

Adult↗
PubMed2002

Ethical oversight of public health research: can rules and IRBs make a difference in developing countries?

Controversies in the conduct of international research continue to pose challenges for the system of ethical review, particularly for developing countries. Although the concept of vulnerability is key to addressing these challenges, ethical review has typically ignored the agency of vulnerable participants and groups in determining what kind of review process is needed. Concurrent with developments shaping the new public health that seek to operationalize empowerment of communities by placing them as initiators and organizers of their own health, ethical review of public health research must find ways to recognize the agency of vulnerable individuals, groups, and communities in the review process if it is to address effectively the ethical dilemmas currently evident in collaborative international research.

Coercion↗
PubMed2003

A comparison of 50 initial endoluminal endograft repairs for abdominal aortic aneurysm with 50 concurrent open repairs.

PURPOSE: To review the results of our initial experience with endovascular repair of abdominal aortic aneurysm (AAA) with respect to morbidity and mortality and to compare these outcomes with those of transabdominal repair. METHODS: We reviewed the first 50 consecutive endovascular AAA repairs performed at our institution from November 1999 to January 2002. Pre-operative risk factors, intraoperative variables and post-operative outcomes were assessed. All endovascular patients were followed with periodic examination, contrast-enhanced computed tomography and/or duplex scanning. Comparison was made to 50 patients undergoing standard open repair over a similar time period. RESULTS: Fifty patients underwent endovascular AAA repair (mean age 72.5, AAA size 5.5 cm). Endovascular devices employed were manufactured by Ancure (Guidant Corp.), and AneuRx (Medtronic). Preoperative risk factors were similar to patients undergoing transabdominal repair. Mean operative time was 169 minutes and estimated blood loss was 450cc with average blood replacement of.18 units. Median ICU stay was 0 days and mean hospital stay was 2.3 nights. There were no conversions to open repair, however there was one aborted endovascular attempt. Morbidity included MI (2%), colon ischemia (1%), acute renal insufficiency (4%) and leg ischemia (4%). There was one death within 30 days. Seven endoleaks were identified (6 type II and 1 type I) and were managed angiographically. CONCLUSIONS: The short-term surgical morbidity and mortality rates for endovascular repair of AAA are acceptably low and are comparable to the transabdominal approach.

Aged↗
PubMed1999

Chronic insomnia: a practical review.

Insomnia has numerous, often concurrent etiologies, including medical conditions, medications, psychiatric disorders and poor sleep hygiene. In the elderly, insomnia is complex and often difficult to relieve because the physiologic parameters of sleep normally change with age. In most cases, however, a practical management approach is to first consider depression, medications, or both, as potential causes. Sleep apnea also should be considered in the differential assessment. Regardless of the cause of insomnia, most patients benefit from behavioral approaches that focus on good sleep habits. Exposure to bright light at appropriate times can help realign the circadian rhythm in patients whose sleep-wake cycle has shifted to undesirable times. Periodic limb movements during sleep are very common in the elderly and may merit treatment if the movements cause frequent arousals from sleep. When medication is deemed necessary for relief of insomnia, a low-dose sedating antidepressant or a nonbenzodiazepine anxiolytic may offer advantages over traditional sedative-hypnotics. Longterm use of long-acting benzodiazepines should, in particular, be avoided. Melatonin may be helpful when insomnia is related to shift work and jet lag; however, its use remains controversial.

Behavior Therapy↗
PubMed1995

Quality audit--a review of the literature concerning delivery of continence care.

This paper outlines the role of quality audit within the framework of quality assurance, presenting the concurrent and retrospective approaches available. The literature survey provides a review of the limited audit tools available and their application to continence services and care delivery, as well as attempts to produce tools from national and local standard setting. Audit is part of a process; it can involve staff, patients and their relatives and the team of professionals providing care, as well as focusing on organizational and management levels. In an era of market delivery of services there is a need to justify why audit is important to continence advisors and managers. Effectiveness, efficiency and economics may drive the National Health Service, but quality assurance, which includes standards and audit tools, offers the means to ensure the quality of continence services and care to patients and auditing is also required in the purchaser/provider contracts for patient services. An overview and progress to date of published and other a projects in auditing continence care and service is presented. By outlining and highlighting the audit of continence service delivery and care as a basis on which to build quality assurance programmes, it is hoped that this knowledge will be shared through the setting up of a central auditing clearing project.

Concurrent Review↗
PubMed1991

Cytologic and clinicopathologic features of abnormal nipple secretions: 225 cases.

A case review of 225 patients with abnormal breast nipple secretions (NS) was done to determine diagnostically useful clinical and cytologic features. The cytologic specimens and medical records from all patients and 45 concurrent breast biopsies were reviewed. Nipple discharge was attributed to fibrocystic disease (FCD) in 81 cases, physiologic disturbances in 62, papillomas in 18, ductal carcinoma (CA) in 5, miscellaneous benign disorders in 14, and unknown causes in 45. Although cytologic examination of NS was very specific in identifying malignancy, the sensitivity of cytology was low. Carcinoma was diagnosed or suspected cytologically in only three of the five CA cases, with no false-positive cytopathologic interpretations. Malignant NS were usually unilateral, hemorrhagic, mass-associated, and in older patients. Males with nipple discharge had a significantly higher incidence of breast cancer (two of nine; 22%) than women with abnormal NS (3 of 216; 1.5%). Papilloma NS were generally unilateral and hemorrhagic; FCD and physiologic NS were mostly serous or milky. Benign NS were not cytologically distinguishable. We conclude that cytologic examination of NS is a specific but insensitive method to identify underlying malignancy. Additional clinical features, including patient age, laterality and character of NS, and radiographic findings, were found to be diagnostically useful.

Adult↗