This case report describes the unusual presentation of a patient who had findings which were initially suggestive of a type Ⅳ choledochal cyst. Her liver biopsy demonstrated biliary cirrhosis. She was treated with en...This case report describes the unusual presentation of a patient who had findings which were initially suggestive of a type Ⅳ choledochal cyst. Her liver biopsy demonstrated biliary cirrhosis. She was treated with endoscopic retrograde cholangiopancreatography and biliary stent exchanges over one year. Her cholangiogram one year later demonstrated resolution of the biliary cystic dilation which led to her initial diagnosis, with beading and stricturing of the hepatic ducts consistent with primary sclerosing cholangitis. Liver-associated enzymes and physical findings also improved. A liver biopsy one year later demonstrated a marked improvement in hepatic fibrosis with no evidence of cirrhosis.展开更多
Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdis...Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gene expression alterations and likely co-regulation of genes/pathways critical in the biology of PCa onset/progression.展开更多
Spontaneous pregnancy is rare after radical cytoreduction and intraperitoneal chemotherapy. Case. We present a case of a 28- year-old female with extensive, bulky malignant peritoneal epitheliod mesothelioma who under...Spontaneous pregnancy is rare after radical cytoreduction and intraperitoneal chemotherapy. Case. We present a case of a 28- year-old female with extensive, bulky malignant peritoneal epitheliod mesothelioma who underwent optimal cytoreductionwith peritonectomy followed by intraoperative hyperthermic cisplatin and postoperative intraperitoneal paclitaxel and fluorouracil. Fourteen months after the conclusion of her therapy, she spontaneously conceived, resulting in an uneventful term pregnancy and spontaneous vaginal delivery. Conclusion. Fertility may be preserved in select patients after radical cytoreduction and hyperthermic intraperitoneal chemotherapy.展开更多
Objective. To determine the prevalence of HR- HPV DNA in ASC- US Pap smears following implementation of the Bethesda 2001 classification system. Methods. A computer database of Pap smears obtained within Department of...Objective. To determine the prevalence of HR- HPV DNA in ASC- US Pap smears following implementation of the Bethesda 2001 classification system. Methods. A computer database of Pap smears obtained within Department of the Army medical facilities was queried for the study period August 2002 to June 2004. All ASC- US Pap smears that underwent reflex testing for HR- HPV DNA were included. Additional clinical and demographic data were obtained from facilities within the US northeast region to evaluate the differences in ASC- US and SIL rates between the current and former Bethesda classification systems. Results. 550,000 Pap smears were collected during the study period. The HR- HPV prevalence was 40.8% (95% confidence interval [CI] = 40.3 to 41.3) among 40,870 patients with ASC- US Pap smears. Within the northeast region, the HR- HPV prevalence in ASC- US Pap smears decreased from 61.2% (95% CI = 57.4 to 64.8% ) in patients 18- 22 years old to 24.9% (95% CI = 23.1 to 26.8% ) in patients age 29 and older. When comparing the two classification systems, significant increases in both ASC- H and SIL and decreases in ASC- US were appreciated after the institution of Bethesda system 2001. Conclusion. In our large, diverse cohort, the implementation of the Bethesda II system has resulted in a decrease in ASC- US Pap smear results. Additionally, the prevalence of HR- HPV in theASC- US population was 40.8% , significantly lower than the rate noted in the ALTS trial under the Bethesda I classification system.展开更多
Objectives. To determine if there is an association of hemoglobin level before or during concurrent cisplatin and radiotherapy (RT) with disease outcome in wo men with locally advanced cervical cancer, and to assess i...Objectives. To determine if there is an association of hemoglobin level before or during concurrent cisplatin and radiotherapy (RT) with disease outcome in wo men with locally advanced cervical cancer, and to assess if the association is p articularly significant at a specific interval or time during treatment. Methods . A retrospective review of 494 patients treated on two consecutive prospective Gynecologic Oncology Group (GOG) trials was conducted. Demographic data, patholo gic information, treatment-related factors, and hemoglobin values at baseline a nd during each week of therapy were collected. Cox proportional hazards model wa s performed to evaluate the impact of hemoglobin level on progression-free surv ival (PFS). Results. Of the combined patients, 278 (56%) and 216 (44%) were di agnosed with Stage II and Stage III/IV disease, respectively. Controlling for ag e, race, performance status, disease stage, tumor size, cell type, and duration of radiotherapy, mean hemoglobin values during treatment were predictive of dise ase progression (P < 0.0001). The pretreatment level was not significant when he moglobin levels during treatment were included in the multivariate analysis. Whe n the 6-week treatment coursewas divided into 2-week periods (early,middle, an d late), analysis revealed hemoglobin values during the late period were the mos t predictive of disease progression (P = 0.0289). Conclusions. Hemoglobin levels during combined radiotherapy and cisplatin were independent predictors of treat ment outcome in advanced cervical carcinoma. The pretreatment level was not a si gnificant predictor of outcome when hemoglobin levels during treatment were incl uded in the multivariate regression model. Levels in the last part of treatment were the most predictive of disease recurrence and survival.展开更多
Background: Ultralow- fat diets are known to reduce high- density lipoprotein cholesterol(HDL- C) levels. In the setting of a multicomponent lifestyle intervention program, relationships between exercise variables and...Background: Ultralow- fat diets are known to reduce high- density lipoprotein cholesterol(HDL- C) levels. In the setting of a multicomponent lifestyle intervention program, relationships between exercise variables and HDL- C levels were examined to determine whether exercise moderates this dietary effect on serum lipids and apolipoproteins. Methods: We performed a 3- month, prospective, nonrandomized lifestyle intervention study(≤ 10% dietary fat; aerobic exercise [180 min/wk], group support, and yoga [60 min/day]) in 120 subjects with or at risk for coronary artery disease. Results: After 3 months, dietary fat intake was reduced to 8.7% ± 2.6% of total intake and the median weekly exercise time was 194 minutes. High- density lipoprotein cholesterol levels decreased by 8.3± 11.3 mg/dL(P< .001), and triglyceride levels increased by 17.6± 102.7 mg/dL(P=.026). A small dense low- density lipoprotein cholesterol(LDL- C) phenotype emerged indicated by a 13.8% LDL- C reduction accompanied by only a 2.3% reduction in apolipoprotein B levels(P=.064). Among subjects with exercise amounts less than those of the group median,HDL- C reductions were greater in those with more than(- 13.5± 16.0 mg/dL) versus less than(- 2.5± 7.5 mg/dL) the median reductions in fat intake(P=.026). Even among subjects who exercised >194 min/wk, HDL- C was reduced compared with baseline(- 7.4± 7.9 mg/dL, P< .001). Conclusions: An ultralow- fat diet as a component of a comprehensive lifestyle intervention induces reductions in HDL- C and the emergence of a dyslipidemic lipid profile. Aerobic exercise only partially mitigates this effect.展开更多
Background: Computed tomographic (CT) colonography, also called virtual colono scopy, is an evolving technology under evaluation as a new method of screening f or colorectal cancer. However, its performance as a test ...Background: Computed tomographic (CT) colonography, also called virtual colono scopy, is an evolving technology under evaluation as a new method of screening f or colorectal cancer. However, its performance as a test has varied widely acros s studies, and the reasons for these discrepancies are poorly defined. Purpose: To systematically review the test performance of CT colonography compared to col onoscopy or surgery and to assess variables that may affect test performance. Da ta Sources: The PubMed, MEDLINE, and EMBASE databases and the Cochrane Controlle d Trials Register were searched for Englishlanguage articles published between January 1975 and February 2005. Study Selection: Prospective studies of adults undergoing CT colonography after full bowel preparation, with colonoscopy or sur gery as the gold standard, were selected. Studies had to have used stateofth eart technology, including at least a singledetector CT scanner with supine an d prone positioning, insufflation of the colon with air or carbon dioxide, colli mation smaller than 5 mm, and both 2-dimensional and 3-dimensional views durin g scan interpretation. The evaluators of the colonogram had to be unaware of the findings from use of the gold standard test. Data Abstraction: Data on sensitiv ity and specificity overall and for detection of polyps less than 6 mm, 6 to 9 m m, and greater than 9 mm in size were abstracted. Sensitivities and specificitie s weighted by sample size were calculated, and heterogeneity was explored by usi ng stratified analyses and metaregression. Data Synthesis: 33 studies provided data on 6393 patients. The sensitivity of CT colonography was heterogeneous but improved as polyp size increased (48%[95%CI, 25%to 70%] for detection of p olyps< 6 mm, 70%[CI, 55%to 84%] for polyps 6 to 9 mm, and 85%[CI, 79%to 91%] for polyps >9 mm). Characteristics of the CT colonography scanner, including width of collimation, type of detector, a nd mode of imaging, explained some of this heterogeneity. In contrast, specifici ty was homogenous (92%[CI, 89%to 96%] for detection of polyps < 6 mm, 93% [CI , 91%to 95%] for polyps 6 to 9 mm, and 97%[CI, 96%to 97%] for polyps >9 mm) . Limitations: The studies differed widely, and the extractable variables explai ned only a small amount of the heterogeneity. In addition, only a few studies ex amined the newest CT colonography technology. Conclusions: Computed tomographic colonography is highly specific, but the range of reported sensitivities is wide . Patient or scanner characteristics do not fully account for this variability, but collimation, type of scanner, and mode of imaging explain some of the discre pancy. This heterogeneity raises concerns about consistency of performance and a bout technical variability. These issues must be resolved before CT colonography can be advocated for generalized screening for colorectal cancer.展开更多
Objective. The liquid-based cytology Pap test was adopted as the exclusive collection method for cervical cytology in military treatment facilities within the National Capital Area in 2001. We sought to determine the ...Objective. The liquid-based cytology Pap test was adopted as the exclusive collection method for cervical cytology in military treatment facilities within the National Capital Area in 2001. We sought to determine the impact of converting from conventional to liquid-based cervical cytology. Methods. A retrospective population-based study was performed to analyze the cervical cytology results from the National Capital Area for fiscal years 1999, 2000, 2002, and 2003. Using a computer database, the results of 78,738 conventional and 76,675 liquidbased cervico-vaginal cytology examinations were reviewed. All cytology samples during the study period were collected with the same collection device and were processed in a single laboratory. Results. An increase of 116%(P < 0.005) in the mean rate of LSIL detection and a 38%(P < 0.005) increase in HSIL detection were noted with conversion to liquid-based cytology. A 65%(P < 0.005) decrease in the mean rate of atypical glandular cell detection was also observed. However, a mean increase of 46%(P < 0.005) per year was noted in the unsatisfactory rate with conversion to liquid-based cytology. The incidence of cervical carcinoma did not change during the study period. Conclusions. Consistent with previous reports, conversion from conventional to liquid-based Pap testing in this population resulted in a significant increase in the detection rates of both LSIL and HSIL. Contrary to earlier studies, we noted an almost 50%increase in the number of unsatisfactory samples after conversion. Further studies are warranted to determine the potential etiology of these findings to include the role of collection devices.展开更多
Background. Split-thickness skin grafts are often utilized for vulvo-vaginal reconstruction. Unfortunately, infection and sloughing may occur in up to 22% of patients with standard techniques especially at irradiated ...Background. Split-thickness skin grafts are often utilized for vulvo-vaginal reconstruction. Unfortunately, infection and sloughing may occur in up to 22% of patients with standard techniques especially at irradiated recipient sites. Cases. We report seven cases of vulvo-vaginal reconstruction using split-thickness skin grafts. In this series, we used fibrin tissue adhesives with and without vacuum-assisted closure devices to augment graft adherence and viability. We briefly describe the clinical history, surgical techniques, and outcomes of the cohort. Conclusion. Fibrin tissue adhesives and wound vacuum-assisted closure devices may improve the viability of split-thickness skin grafts during vulvo-vaginal reconstruction.展开更多
Introduction. Advanced or recurrent gynecologic malignancies can invade or obstruct the lower urinary tract. If extirpation is necessary for cytoreduction or repair of radiation sequalae, treatment has typically invol...Introduction. Advanced or recurrent gynecologic malignancies can invade or obstruct the lower urinary tract. If extirpation is necessary for cytoreduction or repair of radiation sequalae, treatment has typically involved creation of either an ileal conduit or a cutaneous continent urinary diversion. As an alternative, a more limited resection with urinary tract reconstruction using ileum for interposition or augmentation may allow for the preservation of urethral voiding. Cases. We describe the use of ileal segments for lower urinary tract reconstruction in the treatment of ten patients with advanced or recurrent gynecologic malignancies. The clinical history, surgical technique, and patient outcomes are reviewed. Discussion. These cases demonstrate that limited bladder or ureteral resection with reconstruction using ileal segments may offer select patients preservation of urethral voiding.展开更多
Background.: Bevacizumab has demonstrated activity against a variety of solid tumors, including ovarian carcinoma. However, there have not been reproducible prognostic features associated with its activity. Cases.: On...Background.: Bevacizumab has demonstrated activity against a variety of solid tumors, including ovarian carcinoma. However, there have not been reproducible prognostic features associated with its activity. Cases.: One patient each with recurrent, refractory well-differentiated serous-endometrioid ovarian carcinoma, micropapillary serous carcinoma of the ovary, and primary peritoneal micropapillary serous carcinoma were treated with single agent bevacizumab(15 mg/m2 intravenously every 3 weeks). All three have had dramatic sustained responses of 15, 15, and 22 months’duration. Conclusion.: Bevacizumab may have significant activity against well-differentiated ovarian carcinoma and micropapillary serous carcinomas of the ovary or peritoneum. Since these tumors are generally indolent and not responsive to adjuvant therapy, further investigation is warranted.展开更多
A case report of cutaneous onchocercias acquired during travels to Africa is presented. The salient epidemiologic, clinical, diagnostic, and therapeutic aspects are reviewed. Clinical and laboratory differences betwee...A case report of cutaneous onchocercias acquired during travels to Africa is presented. The salient epidemiologic, clinical, diagnostic, and therapeutic aspects are reviewed. Clinical and laboratory differences between onchocerciasis patients who are inhabitants of endemic areas and those who are occasional visitors to such areas are discussed. Parasitic infections, including onchocerciasis, should be considered in the differential diagnosis of pruritic eruptions in patients with a history of foreign travel to Africa, Central and South America.展开更多
文摘This case report describes the unusual presentation of a patient who had findings which were initially suggestive of a type Ⅳ choledochal cyst. Her liver biopsy demonstrated biliary cirrhosis. She was treated with endoscopic retrograde cholangiopancreatography and biliary stent exchanges over one year. Her cholangiogram one year later demonstrated resolution of the biliary cystic dilation which led to her initial diagnosis, with beading and stricturing of the hepatic ducts consistent with primary sclerosing cholangitis. Liver-associated enzymes and physical findings also improved. A liver biopsy one year later demonstrated a marked improvement in hepatic fibrosis with no evidence of cirrhosis.
基金Project supported by the Center for Prostate Disease Researchthe Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
文摘Objective： To investigate molecular alterations associating with prostate carcinoma progression and potentially provide information toward more accurate prognosis/diagnosis. Methods： A set of laser captured microdissected （LCM） specimens from 300 prostate cancer （PCa） patients undergoing radical prostatectomy （RP） were defined. Ten patients representing ＂aggressive＂ PCa, and 10 representing ＂non-aggressive＂ PCa were selected based on prostate-specific antigen （PSA） recurrence, Gleason score, pathological stage and tumor cell differentiation, with matched patient age and race between the two groups. Normal and neoplastic prostate epithelial cells were collected with LCM from frozen tissue slides obtained from the RP specimens. The expressions of a panel of genes, including NPY, PTEN, AR, AMACR, DD3, and GSTP1, were measured by quantitative real-time RT-PCR （TaqMan）, and correlation was analyzed with clinicopathological features. Results： The expressions of AMACR and DD3 were consistently up-regulated in cancer cells compared to benign prostate epithelial cells in all PCa patients, whereas GSTP1 expression was down regulated in each patient. NPY, PTEN and AR exhibited a striking difference in their expression patterns between aggressive and non-aggressive PCas （P=0.0203, 0.0284, and 0.0378, respectively, Wilcoxon rank sum test）. The lower expression of NPY showed association with ＂aggressive＂ PCas based on a larger PCa patient cohort analysis （P=0.0037, univariate generalized linear model （GLM） analysis）. Conclusion： Despite widely noted heterogeneous nature of PCa, gene expression alterations ofAM,4CR, DD3, and GSTP1 in LCM-derived PCa epithelial cells suggest for common underlying mechanisms in the initiation of PCa. Lower NPY expression level is significantly associated with more aggressive clinical behavior of PCa; PTEN and AR may have potential in defining PCa with aggressive clinical behavior. Studies along these lines have potential to define PCa-associated gene expression alterations and likely co-regulation of genes/pathways critical in the biology of PCa onset/progression.
文摘Spontaneous pregnancy is rare after radical cytoreduction and intraperitoneal chemotherapy. Case. We present a case of a 28- year-old female with extensive, bulky malignant peritoneal epitheliod mesothelioma who underwent optimal cytoreductionwith peritonectomy followed by intraoperative hyperthermic cisplatin and postoperative intraperitoneal paclitaxel and fluorouracil. Fourteen months after the conclusion of her therapy, she spontaneously conceived, resulting in an uneventful term pregnancy and spontaneous vaginal delivery. Conclusion. Fertility may be preserved in select patients after radical cytoreduction and hyperthermic intraperitoneal chemotherapy.
文摘Objective. To determine the prevalence of HR- HPV DNA in ASC- US Pap smears following implementation of the Bethesda 2001 classification system. Methods. A computer database of Pap smears obtained within Department of the Army medical facilities was queried for the study period August 2002 to June 2004. All ASC- US Pap smears that underwent reflex testing for HR- HPV DNA were included. Additional clinical and demographic data were obtained from facilities within the US northeast region to evaluate the differences in ASC- US and SIL rates between the current and former Bethesda classification systems. Results. 550,000 Pap smears were collected during the study period. The HR- HPV prevalence was 40.8% (95% confidence interval [CI] = 40.3 to 41.3) among 40,870 patients with ASC- US Pap smears. Within the northeast region, the HR- HPV prevalence in ASC- US Pap smears decreased from 61.2% (95% CI = 57.4 to 64.8% ) in patients 18- 22 years old to 24.9% (95% CI = 23.1 to 26.8% ) in patients age 29 and older. When comparing the two classification systems, significant increases in both ASC- H and SIL and decreases in ASC- US were appreciated after the institution of Bethesda system 2001. Conclusion. In our large, diverse cohort, the implementation of the Bethesda II system has resulted in a decrease in ASC- US Pap smear results. Additionally, the prevalence of HR- HPV in theASC- US population was 40.8% , significantly lower than the rate noted in the ALTS trial under the Bethesda I classification system.
文摘Objectives. To determine if there is an association of hemoglobin level before or during concurrent cisplatin and radiotherapy (RT) with disease outcome in wo men with locally advanced cervical cancer, and to assess if the association is p articularly significant at a specific interval or time during treatment. Methods . A retrospective review of 494 patients treated on two consecutive prospective Gynecologic Oncology Group (GOG) trials was conducted. Demographic data, patholo gic information, treatment-related factors, and hemoglobin values at baseline a nd during each week of therapy were collected. Cox proportional hazards model wa s performed to evaluate the impact of hemoglobin level on progression-free surv ival (PFS). Results. Of the combined patients, 278 (56%) and 216 (44%) were di agnosed with Stage II and Stage III/IV disease, respectively. Controlling for ag e, race, performance status, disease stage, tumor size, cell type, and duration of radiotherapy, mean hemoglobin values during treatment were predictive of dise ase progression (P < 0.0001). The pretreatment level was not significant when he moglobin levels during treatment were included in the multivariate analysis. Whe n the 6-week treatment coursewas divided into 2-week periods (early,middle, an d late), analysis revealed hemoglobin values during the late period were the mos t predictive of disease progression (P = 0.0289). Conclusions. Hemoglobin levels during combined radiotherapy and cisplatin were independent predictors of treat ment outcome in advanced cervical carcinoma. The pretreatment level was not a si gnificant predictor of outcome when hemoglobin levels during treatment were incl uded in the multivariate regression model. Levels in the last part of treatment were the most predictive of disease recurrence and survival.
文摘Background: Ultralow- fat diets are known to reduce high- density lipoprotein cholesterol(HDL- C) levels. In the setting of a multicomponent lifestyle intervention program, relationships between exercise variables and HDL- C levels were examined to determine whether exercise moderates this dietary effect on serum lipids and apolipoproteins. Methods: We performed a 3- month, prospective, nonrandomized lifestyle intervention study(≤ 10% dietary fat; aerobic exercise [180 min/wk], group support, and yoga [60 min/day]) in 120 subjects with or at risk for coronary artery disease. Results: After 3 months, dietary fat intake was reduced to 8.7% ± 2.6% of total intake and the median weekly exercise time was 194 minutes. High- density lipoprotein cholesterol levels decreased by 8.3± 11.3 mg/dL(P< .001), and triglyceride levels increased by 17.6± 102.7 mg/dL(P=.026). A small dense low- density lipoprotein cholesterol(LDL- C) phenotype emerged indicated by a 13.8% LDL- C reduction accompanied by only a 2.3% reduction in apolipoprotein B levels(P=.064). Among subjects with exercise amounts less than those of the group median,HDL- C reductions were greater in those with more than(- 13.5± 16.0 mg/dL) versus less than(- 2.5± 7.5 mg/dL) the median reductions in fat intake(P=.026). Even among subjects who exercised >194 min/wk, HDL- C was reduced compared with baseline(- 7.4± 7.9 mg/dL, P< .001). Conclusions: An ultralow- fat diet as a component of a comprehensive lifestyle intervention induces reductions in HDL- C and the emergence of a dyslipidemic lipid profile. Aerobic exercise only partially mitigates this effect.
文摘Background: Computed tomographic (CT) colonography, also called virtual colono scopy, is an evolving technology under evaluation as a new method of screening f or colorectal cancer. However, its performance as a test has varied widely acros s studies, and the reasons for these discrepancies are poorly defined. Purpose: To systematically review the test performance of CT colonography compared to col onoscopy or surgery and to assess variables that may affect test performance. Da ta Sources: The PubMed, MEDLINE, and EMBASE databases and the Cochrane Controlle d Trials Register were searched for Englishlanguage articles published between January 1975 and February 2005. Study Selection: Prospective studies of adults undergoing CT colonography after full bowel preparation, with colonoscopy or sur gery as the gold standard, were selected. Studies had to have used stateofth eart technology, including at least a singledetector CT scanner with supine an d prone positioning, insufflation of the colon with air or carbon dioxide, colli mation smaller than 5 mm, and both 2-dimensional and 3-dimensional views durin g scan interpretation. The evaluators of the colonogram had to be unaware of the findings from use of the gold standard test. Data Abstraction: Data on sensitiv ity and specificity overall and for detection of polyps less than 6 mm, 6 to 9 m m, and greater than 9 mm in size were abstracted. Sensitivities and specificitie s weighted by sample size were calculated, and heterogeneity was explored by usi ng stratified analyses and metaregression. Data Synthesis: 33 studies provided data on 6393 patients. The sensitivity of CT colonography was heterogeneous but improved as polyp size increased (48%[95%CI, 25%to 70%] for detection of p olyps< 6 mm, 70%[CI, 55%to 84%] for polyps 6 to 9 mm, and 85%[CI, 79%to 91%] for polyps >9 mm). Characteristics of the CT colonography scanner, including width of collimation, type of detector, a nd mode of imaging, explained some of this heterogeneity. In contrast, specifici ty was homogenous (92%[CI, 89%to 96%] for detection of polyps < 6 mm, 93% [CI , 91%to 95%] for polyps 6 to 9 mm, and 97%[CI, 96%to 97%] for polyps >9 mm) . Limitations: The studies differed widely, and the extractable variables explai ned only a small amount of the heterogeneity. In addition, only a few studies ex amined the newest CT colonography technology. Conclusions: Computed tomographic colonography is highly specific, but the range of reported sensitivities is wide . Patient or scanner characteristics do not fully account for this variability, but collimation, type of scanner, and mode of imaging explain some of the discre pancy. This heterogeneity raises concerns about consistency of performance and a bout technical variability. These issues must be resolved before CT colonography can be advocated for generalized screening for colorectal cancer.
文摘Objective. The liquid-based cytology Pap test was adopted as the exclusive collection method for cervical cytology in military treatment facilities within the National Capital Area in 2001. We sought to determine the impact of converting from conventional to liquid-based cervical cytology. Methods. A retrospective population-based study was performed to analyze the cervical cytology results from the National Capital Area for fiscal years 1999, 2000, 2002, and 2003. Using a computer database, the results of 78,738 conventional and 76,675 liquidbased cervico-vaginal cytology examinations were reviewed. All cytology samples during the study period were collected with the same collection device and were processed in a single laboratory. Results. An increase of 116%(P < 0.005) in the mean rate of LSIL detection and a 38%(P < 0.005) increase in HSIL detection were noted with conversion to liquid-based cytology. A 65%(P < 0.005) decrease in the mean rate of atypical glandular cell detection was also observed. However, a mean increase of 46%(P < 0.005) per year was noted in the unsatisfactory rate with conversion to liquid-based cytology. The incidence of cervical carcinoma did not change during the study period. Conclusions. Consistent with previous reports, conversion from conventional to liquid-based Pap testing in this population resulted in a significant increase in the detection rates of both LSIL and HSIL. Contrary to earlier studies, we noted an almost 50%increase in the number of unsatisfactory samples after conversion. Further studies are warranted to determine the potential etiology of these findings to include the role of collection devices.
文摘Background. Split-thickness skin grafts are often utilized for vulvo-vaginal reconstruction. Unfortunately, infection and sloughing may occur in up to 22% of patients with standard techniques especially at irradiated recipient sites. Cases. We report seven cases of vulvo-vaginal reconstruction using split-thickness skin grafts. In this series, we used fibrin tissue adhesives with and without vacuum-assisted closure devices to augment graft adherence and viability. We briefly describe the clinical history, surgical techniques, and outcomes of the cohort. Conclusion. Fibrin tissue adhesives and wound vacuum-assisted closure devices may improve the viability of split-thickness skin grafts during vulvo-vaginal reconstruction.
文摘Introduction. Advanced or recurrent gynecologic malignancies can invade or obstruct the lower urinary tract. If extirpation is necessary for cytoreduction or repair of radiation sequalae, treatment has typically involved creation of either an ileal conduit or a cutaneous continent urinary diversion. As an alternative, a more limited resection with urinary tract reconstruction using ileum for interposition or augmentation may allow for the preservation of urethral voiding. Cases. We describe the use of ileal segments for lower urinary tract reconstruction in the treatment of ten patients with advanced or recurrent gynecologic malignancies. The clinical history, surgical technique, and patient outcomes are reviewed. Discussion. These cases demonstrate that limited bladder or ureteral resection with reconstruction using ileal segments may offer select patients preservation of urethral voiding.
文摘Background.: Bevacizumab has demonstrated activity against a variety of solid tumors, including ovarian carcinoma. However, there have not been reproducible prognostic features associated with its activity. Cases.: One patient each with recurrent, refractory well-differentiated serous-endometrioid ovarian carcinoma, micropapillary serous carcinoma of the ovary, and primary peritoneal micropapillary serous carcinoma were treated with single agent bevacizumab(15 mg/m2 intravenously every 3 weeks). All three have had dramatic sustained responses of 15, 15, and 22 months’duration. Conclusion.: Bevacizumab may have significant activity against well-differentiated ovarian carcinoma and micropapillary serous carcinomas of the ovary or peritoneum. Since these tumors are generally indolent and not responsive to adjuvant therapy, further investigation is warranted.
文摘A case report of cutaneous onchocercias acquired during travels to Africa is presented. The salient epidemiologic, clinical, diagnostic, and therapeutic aspects are reviewed. Clinical and laboratory differences between onchocerciasis patients who are inhabitants of endemic areas and those who are occasional visitors to such areas are discussed. Parasitic infections, including onchocerciasis, should be considered in the differential diagnosis of pruritic eruptions in patients with a history of foreign travel to Africa, Central and South America.
