Clinical disease course during the last year in ovarian cancer
carcinoma; chemotherapy; cytoreductive surgery; disease course; end; end-of-life; gynecologic cancer; Obstetrics & Gynecology; obstruction; of-life care; Oncology; ovarian-cancer; palliate; prognostic-factors; survival
Objective(s). The objective was to determine whether there were changes in the pattern and nature of hospitalizations during the last year that could be used in the assessment of whether chemotherapy should be continued. Methods. Retrospective data were collected from patients who died from ovarian cancer between 1/2000 and 12/2001. Charts from four hospitals were reviewed to abstract chemotherapy, reason for hospitalization, and the incidence of three significant clinical events (bowel obstruction, pleural effusion requiring thoracentesis, and abdominal ascites requiring paracentesis). Data were analyzed in 3-month intervals. Results. Sixty-two patient charts were reviewed. Quarterly admissions increased linearly over the year (7, 18, 27, and 47, P < 0.0001). Hospitalizations for ascites, bowel obstruction, and pleural effusion began increasing around 6 months preceding death. Twenty-two patients did not receive chemotherapy during the last 3 months. Of the 40 patients receiving chemotherapy in the last 3 months, over half were not hospitalized during the period 4-6 months before death, and a further 20% were hospitalized for nonsignificant clinical events. Approximately one-quarter of the patients, however, continued to receive chemotherapy following hospitalization for a significant clinical event. Conclusion(s). There were significant changes in the pattern and nature of hospitalization during the last 6 months that included hospitalizations for bowel obstruction, pleural effusion, or ascites. The occurrence of these events suggests that further chemotherapy should be realistically evaluated with the patient, which may reduce the number of patients who receive chemotherapy during their last few months of life. (C) 2003 Elsevier Inc. All rights reserved.
Von Gruenigen V E; Frasure H E; Reidy A M; Gil K M
Gynecologic Oncology
2003
2003-09
Journal Article
<a href="http://doi.org/10.1016/s0090-8258(03)00418-9" target="_blank" rel="noreferrer noopener">10.1016/s0090-8258(03)00418-9</a>
STAPHYLOCOCCUS-AUREUS ENDOCARDITIS AT A COMMUNITY TEACHING HOSPITAL, 1980 TO 1991 - AN ANALYSIS OF 106 CASES
acquired infective endocarditis; bacteremia; bacterial-endocarditis; drug-users; experience; General & Internal Medicine; manifestations; neurologic complications; prognostic-factors; transesophageal echocardiography; vancomycin
Background: The clinical diagnosis of infective endocarditis due to Staphylococcus aureus can be difficult, and many patients with this disease are only diagnosed post mortem. There are few published reports of large series of patients with S aureus endocarditis and none from a community hospital. I reviewed the clinical and laboratory findings of a large number of patients with S aureus endocarditis in a community hospital. Methods: I reviewed medical records identified through consultation records, International Classification of Diseases, Ninth Edition codes, and autopsy records of patients who fulfilled the criteria for the diagnosis of S aureus endocarditis during 1980 to 1991. Results: During the 12-year period, there were 106 cases, for a prevalence of 0.34 per 1000 admissions. Ninety-three (87.7%) of these patients were seen by me. The patients' ages ranged from 12 to 83 years (median, 61 years). Eighteen cases were nosocomial (15 were associated with intravascular catheters). Twenty-one patients were injecting drug users. Severe back pain was the chief complaint in nine patients. Twenty-seven patients had no heart murmur at the time of diagnosis. The overall mortality was 25.5%. Conclusions: Age 60 years or older, female gender, community-acquired infection, absence of heart murmur, presence of congestive heart failure, or central nervous system involvement was associated with higher mortality. Tricuspid valve endocarditis alone was associated with lower mortality.
Watanakunakorn C
Archives of Internal Medicine
1994
1994-10
Journal Article
<a href="http://doi.org/10.1001/archinte.154.20.2330" target="_blank" rel="noreferrer noopener">10.1001/archinte.154.20.2330</a>
The Art and Science of Surgical Margins for the Dermatopathologist
basal cell carcinoma; basal cell carcinoma; cutaneous melanoma; Dermatology; excision; field cells; lentigo maligna melanoma; local recurrence; margins; neurotropic melanoma; perineural invasion; primary cutaneous melanoma; prognostic-factors; skin cancer; squamous cell carcinoma; staged excision; surgical; tumor-cells
Basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and primary cutaneous melanoma (PCM) are the major forms of skin cancer. Surgical excision is one of the most frequently utilized treatment modalities for these tumors. Methods: literature review. Results: recommendations for lateral surgical excision margin (LEM) for BCCs is 4 mm for low-risk BCCs and Mohs surgery or resection with complete circumferential peripheral and deep margin assessment for high risk. Recommended LEM is 4-6 mm for low-risk SCCs and Mohs surgery or resection with complete circumferential peripheral and deep margin assessment for high risk BCCs. If SCC or BCC is >20 mm in area L with no other high-risk factors and can be repaired primarily, 10-mm clinical margins may be used. Recommended LEM is 5 mm for melanoma-in-situ; 1 cm for PCM <1 mm (Breslow); 1-2 cm for PCM 1.01-2 mm (Breslow); and, 2-3 cm for high-risk PCM >2.01 mm (Breslow). Tumor subtype-specific recommendations for histologic margins are offered which provide the greatest degree of certainty regarding the completeness of excision. Conclusion: Recommendations can be made regarding appropriate surgical excision margins by classifying skin cancers as low-risk or high-risk based on histopathological and clinical factors. Ascertaining that histopathologic margins are free of tumor is not a perfect science and requires thoughtful sampling, grossing, and staining procedures.
Weinstein M C; Brodell R T; Bordeaux J; Honda K
American Journal of Dermatopathology
2012
2012-10
Journal Article
<a href="http://doi.org/10.1097/DAD.0b013e31823347cb" target="_blank" rel="noreferrer noopener">10.1097/DAD.0b013e31823347cb</a>