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At least 667 records · Page 37Linked to original sources
PubMed1995

Childhood T-cell lymphoblastic lymphoma--does early resolution of mediastinal mass predict for final outcome? The United Kingdom Children's Cancer Study Group (UKCCSG).

This study presents a retrospective review of chest radiography in children with Murphy stage III T-cell lymphoblastic lymphoma. All received a standard leukaemia-based protocol with intensive induction, consolidation and continuing chemotherapy. Neither initial thoracic disease bulk nor the presence of a pleural effusion predicted outcome. However a significant difference was found when the 50 patients in whom the chest radiograph returned to normal within 60 days of commencing treatment were compared with the 18 patients with persistent mediastinal abnormalities, for both event-free [hazard ratio < or = 60 days to > 60 days (HR) 3.55 (95% CI 1.33-9.48); P = 0.007] and overall survival [HR 2.95 (95% CI 1.07-8.18); P = 0.03]. It appears that this relatively simple estimate of chemosensitivity may identify a group of particularly good-risk patients in whom drugs associated with late morbidity such as anthracyclines may be reduced and conversely a higher risk group in whom further intensification of treatment would be justified.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

Surgical management of coccidioidomycosis in children.

BACKGROUND/PURPOSE: Operations for Coccidioides immitis infection in children have received little study. The authors perceived an increase in the number of patients requiring operations for coccidioidomycosis at Phoenix Children's Hospital. The authors therefore reviewed the surgical management of children with C immitis infection in Phoenix, Arizona. METHODS: The medical records of all children hospitalized from 1994 to 1999 with a confirmed laboratory diagnosis of coccidioidomycosis were reviewed. Age, gender, race, immune status, laboratory data, operations, and outcome were recorded. RESULTS: Of 39 children with proven coccidioidomycosis, 21 patients (54%) underwent a total of 49 operations. Boys represented 72% of all children reviewed. Sixteen patients (29% of the operative cohort) were immunocompromised. Thoracic procedures (19 cases) were most frequent. CONCLUSIONS: Over half the children hospitalized for coccidioidomycosis required at least 1 operation. Most were immunocompetent boys with thoracic disease. Pediatric surgeons, who provide the bulk of operative care, should expect to encounter coccidioidomycosis in endemic areas, and increasingly in nonendemic areas.

Adolescent↗
PubMed2002

Noninvasive positive pressure home ventilation in restrictive disorders: outcome and impact on health-related quality of life.

Noninvasive positive-pressure home ventilation (NIPPHV) improves arterial blood gases, dyspnea and health-related quality of life (HRQL) in patients with restrictive thoracic diseases. Whether these changes persist during the follow-up remains unclear. The aim of this study was to investigate the long-term effects of NIPPHV upon dyspnea, HRQL, lung function and hospitalization rate in 35 patients with kyphoscoliosis and 27 individuals with several neuromuscular disorders. So, we measured dyspnea, HRQL, lung function and nocturnal oxygen saturation (SaO2) before and after 3, 6, 9, 12 and 18 months after NIPPHV. Dyspnea was assessed with the Borg scale and HRQL was measured using the Spanish validated version of the SF-36 questionnaire. The kyphoscoliosis group showed significant improvement of PaCO2 and SaO2 at 3 months and minor dyspnea changes at 6 months after NIPPHV had been started. These patients also showed improved health status in the following categories: "physical role" and "emotional role" at 3 months and in the categories "social functioning", "vitality" and "mental health" at 6 months after NIPPHV; some of these changes persisted at 9, 12 and 18 months. In the neuromuscular group, a significant improvement of SaO2 was observed at 3 months and this persisted for 18 months. Changes of HRQL in this group included a significant improvement in "physical role" at 3 months, "emotional role" and "social functioning" at 6 months and "physical functioning" at 9 months. The hospitalization rate decreased significantly in all patients from a mean annual admission rate of 1.1 (1.4) before NIPPHV to 0.6 (1.1) after 12 months of ventilatory support (P<0.005). We conclude that: (a) NIPPHV had a higher impact on arterial blood gases, dyspnea and health-related quality of life in patients with kyphoscoliosis than in those with neuromuscular disorders; (b) most clinical and functional changes persisted at long term and (c) a significant decrease in the hospitalization rate after NIPPHV occurred in both groups.

Adult↗
PubMed2002

Early enteral nutrition in the cardiothoracic intensive care unit.

BACKGROUND AND AIMS: Early enteral nutrition (EN) improves intestinal integrity, motility and immunocompetence. However, technical problems such as diarrhoea and gastric residual volumes are said to be associated with the method and have prevented its implementation. We have prospectively assessed clinical problems connected to early EN. PATIENTS AND METHODS: Seventy-three consecutive patients eligible for EN were assessed and observed until discharge from the intensive care unit (ICU) or until they resumed oral nutrition. They had surgery for coronary artery bypass grafting and/or valvular disease, thoracic or thoracoabdominal aortic aneurysms or other combined procedures. Two cardiac patients were not subjected to surgery. RESULTS: In 59/73 patients, EN was started within 3 days. EN was discontinued in half of the patients when they were able to feed themselves. Twelve patients vomited, one of them severely. Dislocation of the nasogastric tube occurred in 28 patients. The 15 patients with diarrhoea were treated with 2-6 broad-spectrum antibiotics during their ICU-stay. Out of 73, 40 patients did not show any gastric residual volume (GRV). GRV decreased during EN in 50% of the patients with fairly large or large residual volumes. The incidence of aspiration pneumonia was 10%. CONCLUSION: In the cardiothoracic ICU, individually adjusted early EN is feasible with few problems.

Adult↗
PubMed2001

[Body build and radiation exposure in static roentgen studies (I): A contribution for determining a national reference dose value. Promoted by the Federal Office for Radiation Protection (St.Sch 4163)].

PURPOSE: To contribute data on radiation exposure in static x-ray procedures and to compare them with anthropometric parameters. METHOD: 121 chest x-rays and 100 lumbar spine examinations were carried out and the dose-area product (DAP) measured for each of the projections. Additionally, body height, body weight and the sagittal and transversal diameters of the examined regions were recorded. Dose measurements were statistically evaluated and the following data determined: Frequency distribution, median, 25%- and 75%-percentiles as well as correlations with sex, body weight and diameters. RESULTS: Median DAP was 13 (men: 16; women: 11) resp. 50 (62; 37) cGycm2 with pa resp lateral chest x-ray. Values were closely correlated with body weight (r = 0.704/0.659) and diameter of the chest (r = 0.657/0.579). Median DAP was 175 (239; 126) resp 531 (670; 361) cGycm2 with ap resp lateral lumbar spine examinations. Values were closely correlated with body weight (r = 0.678/0.666) and diameter of the abdomen (r = 0.664/0.658). CONCLUSIONS: DAP of chest x-rays and lumbar spine examinations is strongly influenced by the constitution of the patients. Men are nearly twice as largely exposed to radiation as women.

Adult↗
PubMed2003

[Prevalence and type of incidental extramammary findings in MRI of the breast].

PURPOSE: To analyze prevalence and type of relevant incidental findings in patients undergoing breast MRI. MATERIALS AND METHODS: This prospective investigation consists of 1013 patients who underwent breast MRI as follow-up after breast cancer therapy, for pre-operative staging, and for screening of high-risk patients as well as for clarification of unclear clinical examinations and inconclusive conventional mammography. Prevalence and type of relevant incidental extramammary findings were recorded together with the indication of the examination. RESULTS: Incidental extramammary findings were encountered in 92 (9%) of the 1013 patients. MRI had markedly more incidental extramammary findings with the staging examinations (39.5%) and follow-up examinations (11.6%). The prevalence of incidental malignant findings was 81% in patients examined for pre-operative staging. Incidental benign and malignant findings were equally frequent in patients followed after breast cancer therapy. The incidental findings were exclusively benign in patients without a history of breast cancer. CONCLUSION: The interpretation of breast MRI should incorporate a careful analysis of the adjacent extramammary structures. Especially patients followed after breast cancer therapy can be expected to have incidental malignant findings outside the breast.

Breast Neoplasms↗
PubMed2003

[Focal lesions in the opacified lung: a sonographic pictorial essay].

Transcutaneous ultrasound of pleural lesions has been established as a method complementary to conventional X-ray examination. The opacified lung allows the sonographical investigation of the lung parenchyma for synchronous and metachronous focal lesions. The aim of the pictorial essay is to describe the sono graphic patterns and to discuss the differential diagnosis, as well as the pathological correlation of focal lesions in the opacified lung.

Aged↗
PubMed2004

Endobronchial ultrasonography.

Endobronchial ultrasonography (EBUS) allows visualization of the tracheobronchial tree with real-time ultrasound and permits visualization of the internal structure of pulmonary lesions, which may narrow the differential diagnosis. The indications for EBUS are to (1) determine the depth of tumor invasion of tracheobronchial lesions, (2) define positional relationships with the pulmonary artery and veins and hilar structures and determine the extent of tumor invasion, (3) visualize paratracheal and peribronchial lymph nodes and metastatic lesions and enable EBUS-guided transbronchial needle aspiration (TBNA), and (4) localize and diagnose peripheral pulmonary lesions (benign or malignant). New and evolving applications of EBUS will increase the cost-effectiveness of EBUS in the diagnosis and treatment of thoracic diseases.

Journal Article↗
PubMed1997

[Biopsy of thoracic space-occupying lesions--from computerized tomography to ultrasound-controlled puncture].

PURPOSE: Having practised CT-controlled biopsies only, we introduced sonographically guided punctures since 1993 for pulmonary diagnoses. The effects are studied. METHOD: In a retrospective study 166 CT-guided biopsies from 1/89 to 12/95 and 50 sonographically guided biopsies from 7/93 to 12/95 were analysed. RESULTS: By CT, 67% intrapulmonary, 22% peripheral pulmonary and 11% pleuropulmonary, pleural and chest wall lesions were punctured. In 66% a diagnosis could be made. 13% of the patients experienced complications, most of them pneumothorax. Half of the patients subjected to sonographic biopsy showed peripheral pulmonary lesions, the other half tumours of the pleura, pleura and lung, mediastinum and chest wall. In 92% a positive result was obtained, whereas pneumothorax occurred in 2%. Leaving aside the intrapulmonary lesions, which would not have been visible by ultrasound, diagnosis with CT could be achieved in only 56% of the cases. CONCLUSION: In diagnosis of pleural, peripheral pulmonary and chest wall lesions, ultrasound guided biopsy is a safe, cost-effective, convenient and accurate method without exposure to x-rays.

Adolescent↗