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At least 1,693 records · Page 94Linked to original sources
PubMed1995

[Chemotherapy of small cell bronchial cancers. Prognostic importance of complete response (1,280 patients). Groupe Petites Cellules].

OBJECTIVE: Pretherapeutic prognostic factors for patients given chemotherapy for small cell lung carcinoma have been widely studied. We evaluated response to chemotherapy in patients included in 4 multicentric trials with less restrictive entry criteria in order to determine the contribution of clinical outcome as a predictive factor. METHODS: Pretherapeutic and therapeutic prognostic factors were assessed in 1280 patients included in 4 successive multicentric therapeutic trials on chemotherapy for small cell lung carcinoma conducted from January 1, 1983 to April 1, 1992. Logrank test for univariate analysis and Cox's stepwise method for multivariate analysis were used to evaluate the results. RESULTS: Univariate analysis identified pretherapeutic factors as significant for prognosis: Karnofsky index (p < 0.0001), alkaline phosphatase level (p < 0.0002), white cell count (p < 0.0005), age (p = 0.0007), presence of brain metastasis (p = 0.0004), presence of liver metastasis (p = 0.03), initial extension (p = 0.04). Multivariate analysis taking into account pretherapeutic and therapeutic factors demonstrated that complete response after the second and after the sixth treatment session were predictive of longer survival (p = 0.0001). This factor was more powerful than all the pretherapeutic factors including the Karnofsky index, initial extension and brain metastasis. CONCLUSION: For patients with small cell lung carcinoma, the prognostic value of early response to chemotherapy suggests that high-doses should be used starting at the first session.

Adult↗
PubMed1999

Giant cell arteritis, polymyalgia rheumatica, and viral hypotheses: a multicenter, prospective case-control study. Groupe de Recherche sur l'Artérite à Cellules Géantes.

OBJECTIVE: Although suspected, a viral etiology has never been proven in giant cell arteritis (GCA). We tested for viruses known to induce multinucleated giant cells in human pathology, which include the parainfluenza viruses (HPIV), respiratory syncytial virus, measles virus, herpesviruses type 1 and 2, and the Epstein-Barr virus. METHODS: A multicenter case-control study on incident cases of temporal arteritis (TA) and polymyalgia rheumatica (PMR). Population based age and sex matched controls were randomly selected. Serological tests for IgG and IgM directed against the viruses listed above were performed, on blood samples taken at the time of clinical diagnosis. RESULTS: Three hundred five new patients were included over a 5 year period, of whom 159 presented with positive biopsy TA, 70 with negative biopsy TA, and 76 with negative biopsy PMR. Thirty-eight percent of cases versus 20.9% of controls were positive for IgM directed against HPIV (p = 0.00005). The association was stronger in the positive TA subgroup [positivity rate 43.31%; odds ratio with controls 2.89 (95% CI 1.82-4.60, p = 0.000006)] than in the PMR or negative biopsy TA subgroups. Only HPIV type 1 was associated with the disease, regardless of the season or the geographical origin of the cases. Positivity rates for HPIV types 2 and 3 and for the other viruses tested were similar in cases and controls. CONCLUSION: Our findings suggest that reinfection with HPIV type 1 is associated with the onset of GCA in a subset of patients, particularly in cases with positive TA biopsy.

Aged↗
PubMed1982

Factors affecting the results of below knee amputation in patients with and without diabetes.

During a five year period, 113 below knee amputations were performed upon 100 patients. Multiple factors were examined for the effects on wound complication and reamputation rates. Healing without reamputation occurred in 91.9 per cent of those in the diabetic group and in 76.5 per cent of those in the nondiabetic group, p less than 0.05. Cellulitis of the foot did not significantly affect healing below the knee in patients with diabetes, 82.5 per cent with cellulitis versus 87.5 per cent without cellulitis, p greater than 0.05, but did affect healing in those in the nondiabetic group, 81.8 per cent success versus 66.7 per cent, p less than 0.05, and affected their minor wound complication rate, 50.0 per cent with cellulitis versus 26.5 per cent without cellulitis. Absence of femoral pulses uniformly predicted a nonhealing below the knee amputation in patients with cellulitis, whereas in patients without cellulitis, healing occurred in 85 per cent. Hemoglobin levels were inversely proportional to success rates only in patients with diabetes and cellulitis, 10.54 +/- 1.68 versus 12.85 +/- 2.30 grams per deciliter for failures, p = 0.016. Elevated white blood counts were predictive of failure to heal below the knee amputations only in those in the nondiabetic group without cellulitis, 10,110 +/- 3,200 cells per millimeter3 for success versus 13,750 +/- 3,300 cells per millimeter3 for failures, p = 0.018. Use of wound drains correlated with a 55.0 per cent wound complication rate versus 16.1 per cent when drains were not used. Wound complications were minimized when amputations were closed with subcuticular suture and skin tapes.

Amputation, Surgical↗
PubMed1994

Diagnosis of peritonsillar abscess: value of intraoral sonography.

OBJECTIVE: Clinical differentiation of peritonsillar abscess from peritonsillar cellulitis can be difficult and often relies on blind needle aspiration of the tonsillar fossa to locate pus. The objective of this study was to establish a noninvasive and reliable sonographic technique for differentiating peritonsillar abscess from peritonsillar cellulitis in equivocal cases and to thereby avoid unnecessary needle aspiration. SUBJECTS AND METHODS: The study population included three healthy volunteers and 18 patients with clinically suspected peritonsillar abscess. The tonsils were assessed by using transcutaneous and intraoral sonography. RESULTS: The tonsils were visualized on both transcutaneous and intraoral sonograms in all three volunteers and in 16 patients. In one patient, the tonsils were not visualized on transcutaneous imaging; intraoral imaging showed cellulitis. In another patient, the intraoral examination was unsuccessful, whereas transcutaneous sonograms showed normal tonsils. On the basis of findings on transcutaneous sonograms, tonsils were considered normal in seven patients. Subsequent intraoral sonograms showed peritonsillar abscesses in four and peritonsillar cellulitis in two. Intraoral imaging was unsuccessful in one patient. On the basis of findings on transcutaneous sonograms, nine patients were thought to have peritonsillar cellulitis. Subsequent intraoral sonograms confirmed cellulitis in four and showed peritonsillar abscess in five. Transcutaneous sonography showed one peritonsillar abscess that was confirmed by findings on intraoral sonography. Surgical confirmation of sonographic findings was obtained in 12 of 18 patients; nine of 10 peritonsillar abscesses had surgical drainage, and three of seven cases of peritonsillar cellulitis had a dry, blind needle aspiration. CONCLUSION: These results show that enlarged tonsils can be visualized with transcutaneous sonography, but intraoral sonography is necessary to adequately define the heterogeneous or cystic nature of a peritonsillar abscess. Intraoral sonography is a useful, simple, and well-tolerated noninvasive technique that can be used to accurately differentiate peritonsillar abscess from peritonsillar cellulitis in clinically equivocal cases. This technique eliminates the need for blind needle aspiration of the tonsillar fossa before surgical drainage. Intraoral sonography also can be used to monitor patients' responses after treatment.

Adult↗
PubMed1998

Do temperature and atmospheric pressure affect the incidence of serious odontogenic infection?

OBJECTIVE: The purpose of this study was to investigate the popular belief that the incidence of odontogenic cellulitis is weather-related. Two meteorologic parameters were examined: temperature and atmospheric pressure. STUDY DESIGN: To test the hypothesis being studied, a retrospective cohort study design was used. Medical reports of all patients with serious odontogenic cellulitis who were treated at the Salpêtrière University Hospital between January 1, 1995, and December 31, 1995, (a total of 301 cases) were evaluated in relation to the weather. Hypothesizing that the incidence of odontogenic cellulitis was constant over a period of 1 year, the authors calculated the probability of observed incidence for each month over a 12-month period. The mean number of cases of odontogenic cellulitis (+/- standard error of the mean) for days on which (1) the temperature was within the same 2 degrees -C (3.6 degrees -F) interval and (2) the atmospheric pressure was within the same 3-hPa (2.25-mmHg) interval was also calculated. RESULTS: When the monthly incidence of odontogenic cellulitis and either the average temperature or the average atmospheric pressure for each month were examined together, fluctuation in the former seemed to be independent of the latter. Similarly, when we calculated the mean number of cases of odontogenic cellulitis for several intervals of temperature and atmospheric pressure without taking the calendar into account, no direct relationship could be observed. CONCLUSION: The results of the study suggest that the occurrence of odontogenic cellulitis is not influenced by the weather, at least insofar as weather is measured by temperature and atmospheric pressure.

Adolescent↗
PubMed1988

A clinical prospective study of peritonsillar abscess in children.

Distinguishing peritonsillar abscess from cellulitis is an important clinical problem, particularly in children, who may require a general anesthetic for drainage of these abscesses. In order to identify those clinical factors most significant for peritonsillar abscess, we did a prospective study of 21 patients who presented with sore throat, fever, trismus, and tonsillar bulge; all symptoms that are consistent with the diagnosis of peritonsillar abscess. On admission, the following parameters were recorded: patient age, duration of sore throat, fever, white blood cell count, drooling, the degree of trismus (measured exactly as incisor-incisor distance), the degree of pharyngotonsillar bulge, and change in voice. After 24 to 48 hours of parenteral antibiotics, 12 patients (57%) had improved sufficiently and were continued on antibiotics until resolution (cellulitis group). Nine patients (43%) had no improvement and underwent surgery for drainage of the peritonsillar abscess (abscess group). At the end of the 18-month study period, the cellulitis and abscess groups were compared. On admission, no significant difference was found in age, duration of sore throat, fever, or white blood cell count. The pharyngotonsillar bulge was mild in 58% and moderate in 42% of the cellulitis group, while in the abscess group, the pharyngotonsillar bulge was mild in only 33% and moderate in 67%. After 24 to 48 hours of parenteral antibiotics, all patients in the cellulitis group had improvement of at least one symptom; whereas, all patients in the abscess group had no change or worsening of at least one symptom, including trismus, dysphagia, voice change, drooling, or pharyngotonsillar bulge. On admission, the precise measurement of trismus was not significantly different in the two groups (24.7 mm in cellulitis group vs. 22.5 mm in abscess group). However, after 24 hours of antibiotics, trismus averaged 7 mm more in the abscess group versus the cellulitis group (p less than 0.05).

Adolescent↗
PubMed1994

Mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia. A new spectrum.

OBJECTIVE: To describe the mucocutaneous and soft tissue infections caused by Xanthomonas maltophilia in patients with cancer. DESIGN: A retrospective 15-month clinical study. SETTING: Academic, referral-based cancer center. PATIENTS: Of 237 patients with X. maltophilia isolated from all sites during the 15-month study period, 114 patients were judged to have true X. maltophilia infections. Only patients with mucocutaneous and soft tissue infections were included in the study. RESULTS: 17 (15%) of the 114 patients with X. maltophilia infection had mucocutaneous and soft tissue infections: Six patients had metastatic cellulitis, 5 had primary cellulitis usually associated with catheter use, and 6 had infected mucocutaneous ulcers. The metastatic cellulitis consisted of previously undescribed multiple, hard, tender nodules with surrounding and distant cellulitis (5 patients) or ecthyma gangrenosum (1 patient). Four of these patients died of the infection. Metastatic cellulitis and mucocutaneous infections occurred in hospitalized, neutropenic patients who received broad-spectrum antibiotics (beta-lactams, quinolones), often with in vitro activity against the infecting organisms. Response usually correlated with recovery from myelosuppression and administration of trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate. Catheter removal contributed to response in the treatment of primary cellulitis. CONCLUSIONS: Mucocutaneous and soft tissue infections caused by X. maltophilia are not uncommon, and X. maltophilia can cause metastatic nodular skin lesions that mimic disseminated fungal infections. It also causes serious morbidity and high mortality in patients with metastatic skin nodules and can cause superinfections in patients receiving broad-spectrum beta-lactam or quinolone antibiotics to which the organisms are susceptible when the infections develop. Catheter removal contributes to a favorable outcome in patients with catheter-associated cellulitis without bacteremia. Xanthomonas maltophilia infection should be added to the differential diagnosis of mucocutaneous or soft tissue infection in patients with cancer. Trimethoprim-sulfamethoxazole with or without ticarcillin-clavulanate is the current treatment of choice for culture-proven infections, but early empiric therapy may improve outcome.

Adult↗
PubMed1994

[Computed tomography in acute inflammation of the orbit].

Acute orbital infection, which is usually secondary to sinusitis, requires prompt diagnosis and timely treatment to prevent the infection from spreading and to avoid severe complications, such as osteomyelitis, orbital and cerebral abscesses, meningitis and cavernous sinus thrombophlebitis. Fifteen young patients with orbital cellulitis were examined: they were 13 men and 2 women, whose mean age was 23 years, with orbital cellulitis secondary to fronto-ethmoidal sinusitis (10 cases), to maxillary sinusitis (4 cases) and to craniofacial trauma (1 case). On the basis of CT findings the patients were divided into two groups according to whether the inflammatory process involved the preseptal (4 cases) or the postseptal (11 cases) space; postseptal cellulitis was classified as orbital cellulitis and subperiosteal abscesses. The site of the inflammatory process must always be accurately located because orbital septum integrity does affect treatment choice, which in our series was medical in preseptal cellulitis and always surgical in subperiosteal abscess. After describing the CT patterns of cellulitis and its possible complications, the authors emphasize the role of CT as the method of choice to confirm clinical diagnosis and to demonstrate the site, the extent and the complications of acute orbital cellulitis.

Acute Disease↗
PubMed2001

Differences in length of stay for Hospital in the Home patients: comparing simple clinical coding with medical record review.

AIM: To determine whether the apparently longer length of stay (LOS) reported for patients with cellulitis managed in Hospital in the Home (HITH) compared with those managed as inpatients was correct. METHODS: Data, including LOS, from the Victorian In-patient Minimum Database (VIMD) of all patients with cellulitis managed between July 1998 and June 1999 at a large metropolitan teaching hospital were analysed and compared with a retrospective medical record review of the same patients. RESULTS: In the VIMD data, there were 266 episodes of cellulitis during the study period. However, the medical record review found that six episodes were not separate, but rather a continuation of treatment for the same episode of cellulitis, and that 18 were not episodes of cellulitis, but were pilonidal sinus infections. In the VIMD data set, the mean LOS for patients treated in HITH was generally longer than that for inpatients (7.2 days vs 5.1 days, respectively, P = 0.002). However, in the retrospective medical record review, the LOS for patients treated in HITH was similar to inpatients (7.3 days versus 7.0 days, respectively, P = 0.68). CONCLUSIONS: In contrast to the VIMD data, the medical record review demonstrated that, overall, patients with cellulitis had a similar LOS irrespective of whether they were managed at home or in hospital. This study confirms that caution is required in interpreting the VIMD data, highlights the importance of carefully monitoring the introduction of new treatment modalities and indicates areas for further research.

Analysis of Variance↗