<strong>Background:</strong><span style="font-family:Verdana;"> Treatment options available for breast cancer are Surgery [Breast conservation surgery (BCS) or Modified radical mastectomy (...<strong>Background:</strong><span style="font-family:Verdana;"> Treatment options available for breast cancer are Surgery [Breast conservation surgery (BCS) or Modified radical mastectomy (MRM)];Radiation treatment [Conventional radiation treatment or CRT and Hypofractionated radiation treatment or HRT] and Chemotherapy. In the postmastectomy or post lumpectomy setting, radiotherapy (RT) improves loco-regional control. CRT for breast include</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> 50</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 25 fractions (2</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy per fraction) and HRT include</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> 42.5</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 16 fractions (2.7</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy per fraction) or extreme hypofractionation like 26</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 5 fraction</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;">. Alpha/beta value for breast is less, so HRT is ideal for breast. So, there will be good loco-regional control, without increased normal tissue damage. This study aims to identify recurrence rate and toxicity in breast cancer patients treated using conventional and hypofractionated postmastectomy radiotherapy among Indian population. </span><b><span style="font-family:Verdana;">Primary objective: </span></b><span style="font-family:Verdana;">To assess recurrence rate of disease in breast cancer patients treated using hypofractionated postmastectomy radiation and to compare it with breast cancer patients treated using conventional postmastectomy radiation. </span><b><span style="font-family:Verdana;">Secondary objective:</span></b><span style="font-family:Verdana;"> To assess the toxicity in hypofractionation and conventional fractionation arm. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This is a prospective observational study conducted in Department of Radiation Oncology from December 2017 to June 2019. Radically treated breast cancer patients who received radiation treatment either conventional or hypofractionated as one of the treatment modalities were included in the study. Data were collected using a structured proforma, history and physical examination, master file of the patients, lab results and the imaging reports, written informed consent form, ECOG performance status scale (Eastern Cooperative Oncology Group), RTOG (</span></span><span style="font-family:Verdana;">Radiation Therapy Oncology Group) </span><span style="font-family:""><span style="font-family:Verdana;">Acute Radiation Morbidity Scoring Schema. Patients were monitored for 18 months to identify recurrence rate and toxicity in each arm. </span><b><span style="font-family:Verdana;">Results and discussion:</span></b><span style="font-family:Verdana;"> A total of 241 patients were enrolled into this study, among them 175 patients (73%) were given hypofractionation radiotherapy and 66 patients (27%) were given conventional radiotherapy. </span></span><span style="font-family:Verdana;">In hypofractionation arm, recurrence was found in 14 patients (8%), of which, 3 were local recurrences [chest wall] and 11 were systemic recurrences, while in conventional arm, recurrence was found in 4 patients (6%) and all of them were systemic recurrences. </span><span style="font-family:Verdana;">Recurrence rate in hypofractionation arm was 8% and in conventional arm was 6.10%.</span><span style="font-family:""><span style="font-family:Verdana;"> The Kaplan Meier curve shows no significant difference between the two arms with p value = 0.76. Acute toxicities assessed were dermatitis, esophagitis and pneumonitis. Among acute dermatitis, 4 patients had grade 3 and 2 patients had grade 4 in hypofractionation arm, while in conventional arm, 7 patients had grade 3 and 1 patient had grade 4. Grade 1 and 2 together versus grade 3 and 4 acute dermatitis showed a statistically significant difference between the two arms, with more acute toxicity in the conventional arm. Among acute esophagitis, 1 patient had grade 3 and no patients had grade 4 in hypofractionation arm;while in conventional arm, no grade 3 and grade 4 acute esophagitis were found. Among acute pneumonitis, 2 patients had grade 3 and 1 patient had grade 4 in hypofractionation arm, while in conventional arm, 1 patient had grade 3 and no patients with grade 4 were found. Grade 2 and grade 3 acute lung toxicities were found in patients with central lung distance more than 1.5 cm. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> It was found that the recurrence rate of hypofractionation radiotherapy was comparable to conventional fractionation radiotherapy. With respect to acute dermatitis, grade 1 and grade 2 were significantly more in conventional than hypofractionation arm. Hypofractionated radiotherapy is an equally effective option to conventional radiotherapy and should be encouraged, especially for developing countries like India where the resource is limited, and the incidence of tumour is high.</span></span>展开更多
AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 fema...AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.展开更多
Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Meth...Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2 - 6 hours from the onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40 - 100 min for the Graham patch repair and 120 - 155 min for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch” group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.展开更多
Background: Both 30% supramolecular salicylic acid (SA) and isotretinoin erythromycin gel (IEG) have proven efficacy with good safety profiles in the treatment of acne vulgaris. Objectives: This study compared the cli...Background: Both 30% supramolecular salicylic acid (SA) and isotretinoin erythromycin gel (IEG) have proven efficacy with good safety profiles in the treatment of acne vulgaris. Objectives: This study compared the clinical efficacy and safety of 30% SA peeling and IEG in the treatment of moderate-to-severe acne vulgaris. Methods: Patients with moderate-to-severe acne vulgaris were randomized into 3 groups of 30 persons each, and treated with SA peel, or IEG, or SA combine with IEG (SA + IEG group). Evaluation of acne was done by effective rate and individual lesion counts. And the adverse effects and recurrence were recorded. Results: The SA + IEG group was better in clinical efficacy and treating noninflammatory and inflammatory lesions than that of single treatment group (P 0.05). Conclusion: 30% SA combined with IEG had a significant effect in the treatment of moderate-to-severe acne lesions.展开更多
Oral hairy leukoplakia(OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish...Oral hairy leukoplakia(OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish the normal characteristics of the tongue, to eliminate pathogenic microorganisms, to improve patient comfort and for cosmetic reasons. Proposed treatments for this condition include surgery, systemic antiviral treatment and topical management. Topical treatment is an inexpensive and safe therapy that is easy to apply, noninvasive, free of systemic adverse effects and effective over a long period of time. The aim of this study was to present a review of the literature for topical therapy for OHL. Gentian violet, retinoids, podophyllin, acyclovir and podophyllin associated with topical antiviral drugs were used to treat OHL. Reports with this focus are limited, and since 2010, no new studies have been published that discuss the efficacy of topical treatments for OHL. Podophyllin with acyclovircream was found to be effective, causing regression of lesions with no recurrences. Additional searches are necessary to provide clinical evidence of topical man agement effectiveness.展开更多
It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placeme...It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.展开更多
Objective:To systematically evaluate the clinical effect (including effective rate and recurrence rate) of the combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis (GM).Me...Objective:To systematically evaluate the clinical effect (including effective rate and recurrence rate) of the combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis (GM).Methods: Computer searches CNKI, Wanfang database, VIP, PubMed, web of science and EMBASE, Chinese biomedical database, and selects randomized controlled trial (RCT) of treating granulomatous mastitis with the combination of traditional Chinese and Western medicine. The retrieval time is from July 2019 to July 2019. Then, we used Revman 5.3 software to meta analyze the data.Results: Nine RCTs were included, six of which were effective observation, two of which were recurrence rate observation, one of which was effective observation and reexamination rate observation. A total of 664 patients were included, including 456 in the experimental group and 208 in the control group. After analysis, it was found that the effective rate of GM in the experimental group was 92.3%, which was significantly higher than that in the control group (Western medicine alone) by 75.5% (or = 4.09, 95% CI (2.28, 7.36), P < 00001), the recurrence rate of GM in the experimental group (treated with integrated traditional Chinese and Western Medicine) was 21.6%, which was significantly lower than that in the control group (treated with western medicine alone) by 55.7% (or = 0.19, 95% CI (0.10, 0.37), P < 0.0001).Conclusion: The combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis can not only improve the effective rate of clinical treatment, but also reduce the recurrence rate of granulomatous mastitis.展开更多
文摘<strong>Background:</strong><span style="font-family:Verdana;"> Treatment options available for breast cancer are Surgery [Breast conservation surgery (BCS) or Modified radical mastectomy (MRM)];Radiation treatment [Conventional radiation treatment or CRT and Hypofractionated radiation treatment or HRT] and Chemotherapy. In the postmastectomy or post lumpectomy setting, radiotherapy (RT) improves loco-regional control. CRT for breast include</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> 50</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 25 fractions (2</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy per fraction) and HRT include</span><span style="font-family:Verdana;">s</span><span style="font-family:Verdana;"> 42.5</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 16 fractions (2.7</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy per fraction) or extreme hypofractionation like 26</span><span style="font-family:""> </span><span style="font-family:Verdana;">Gy in 5 fraction</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;">. Alpha/beta value for breast is less, so HRT is ideal for breast. So, there will be good loco-regional control, without increased normal tissue damage. This study aims to identify recurrence rate and toxicity in breast cancer patients treated using conventional and hypofractionated postmastectomy radiotherapy among Indian population. </span><b><span style="font-family:Verdana;">Primary objective: </span></b><span style="font-family:Verdana;">To assess recurrence rate of disease in breast cancer patients treated using hypofractionated postmastectomy radiation and to compare it with breast cancer patients treated using conventional postmastectomy radiation. </span><b><span style="font-family:Verdana;">Secondary objective:</span></b><span style="font-family:Verdana;"> To assess the toxicity in hypofractionation and conventional fractionation arm. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This is a prospective observational study conducted in Department of Radiation Oncology from December 2017 to June 2019. Radically treated breast cancer patients who received radiation treatment either conventional or hypofractionated as one of the treatment modalities were included in the study. Data were collected using a structured proforma, history and physical examination, master file of the patients, lab results and the imaging reports, written informed consent form, ECOG performance status scale (Eastern Cooperative Oncology Group), RTOG (</span></span><span style="font-family:Verdana;">Radiation Therapy Oncology Group) </span><span style="font-family:""><span style="font-family:Verdana;">Acute Radiation Morbidity Scoring Schema. Patients were monitored for 18 months to identify recurrence rate and toxicity in each arm. </span><b><span style="font-family:Verdana;">Results and discussion:</span></b><span style="font-family:Verdana;"> A total of 241 patients were enrolled into this study, among them 175 patients (73%) were given hypofractionation radiotherapy and 66 patients (27%) were given conventional radiotherapy. </span></span><span style="font-family:Verdana;">In hypofractionation arm, recurrence was found in 14 patients (8%), of which, 3 were local recurrences [chest wall] and 11 were systemic recurrences, while in conventional arm, recurrence was found in 4 patients (6%) and all of them were systemic recurrences. </span><span style="font-family:Verdana;">Recurrence rate in hypofractionation arm was 8% and in conventional arm was 6.10%.</span><span style="font-family:""><span style="font-family:Verdana;"> The Kaplan Meier curve shows no significant difference between the two arms with p value = 0.76. Acute toxicities assessed were dermatitis, esophagitis and pneumonitis. Among acute dermatitis, 4 patients had grade 3 and 2 patients had grade 4 in hypofractionation arm, while in conventional arm, 7 patients had grade 3 and 1 patient had grade 4. Grade 1 and 2 together versus grade 3 and 4 acute dermatitis showed a statistically significant difference between the two arms, with more acute toxicity in the conventional arm. Among acute esophagitis, 1 patient had grade 3 and no patients had grade 4 in hypofractionation arm;while in conventional arm, no grade 3 and grade 4 acute esophagitis were found. Among acute pneumonitis, 2 patients had grade 3 and 1 patient had grade 4 in hypofractionation arm, while in conventional arm, 1 patient had grade 3 and no patients with grade 4 were found. Grade 2 and grade 3 acute lung toxicities were found in patients with central lung distance more than 1.5 cm. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> It was found that the recurrence rate of hypofractionation radiotherapy was comparable to conventional fractionation radiotherapy. With respect to acute dermatitis, grade 1 and grade 2 were significantly more in conventional than hypofractionation arm. Hypofractionated radiotherapy is an equally effective option to conventional radiotherapy and should be encouraged, especially for developing countries like India where the resource is limited, and the incidence of tumour is high.</span></span>
文摘AIM:To analyze the anatomical and functional outcomes in the inferior recurrences of rhegmatogenous retinal detachment(RRD)depending on the surgical approach.METHODS:Eighty-one eyes of 81 patients(47 males and 34 females with a mean age of 54.8±14.1y)who demonstrated at least one inferior recurrence of RRD were included in this retrospective study.All patients were categorized as having received either circular scleral buckling(SB),pars plana vitrectomy(PPV),a combination of SB and PPV(SB+PPV),PPV with retinotomy(PPV+RT),or PPV+RT and short-term postoperative perfluorocarbon liquid tamponade(PPV+RT+pPFCL).All cases were followed up until successful retinal reattachment or third recurrence.The primary outcome measures were the achievement of the surgical goal without recurrence of RRD and bestcorrected visual acuity(BCVA).RESULTS:After the treatment of the first recurrence,the recurrence rate in the PPV+SB group was statistically significantly lower than that of the PPV(P=0.0012),PPV+RT(P=0.028),or PPV+RT+pPFCL(P=0.047)group.There was no statistically significant difference between PPV+SB,PPV+RT,and PPV+RT+pPFCL groups in the recurrence rate after treatment of the second recurrence(42 eyes).However,there was a statistically significant(P=0.016)trend towards a decrease of recurrence rate after PPV+RT+pPFCL.There was no statistically significant improvement of BCVA in either study group(P>0.05)after both first and second recurrence surgery.The mean time follow-up was 109.0±91.0d before the first recurrence and 210.0±186.6d between previous surgery at second recurrence.CONCLUSION:Patients with first inferior recurrence of RRD may benefit from SB as an adjunct to PPV.RT and short-term pPFCL tamponade in the second recurrence may allow better anatomical outcomes,however,without functional improvement.
文摘Purpose: During the last decade laparoscopic approach to perforated peptic ulcer has gained wide acceptance over the traditional open repair on the basis of being an equally efficient and less invasive technique. Methods: 198 patients with perforated duodenal or prepyloric ulcer that were surgically treated from 2003 to 2014 were included in this study. 140 were operated within 2 - 6 hours from the onset of symptoms, 55 within 6 - 24 hours, and 3 patients after 24 hours. Results: Laparoscopic simple closure with Graham patch was performed in 179 patients. In 19 patients with known chronic ulcer resistant to pharmacologic therapy, who were operated within 6 hours from the onset of symptoms, laparoscopic Taylor procedure was undertaken. Conversion to open repair was necessitated in four patients. The operating time was 40 - 100 min for the Graham patch repair and 120 - 155 min for the Taylor procedure. During follow-up, 48% of patients from the “Graham patch” group and no one from the “definitive procedure” group had recurrent ulcer. Conclusions: Laparoscopic treatment of perforated peptic ulcer is technically feasible and safe when performed by experienced surgeons. In certain cases more definitive procedures may achieve better long-term results.
文摘Background: Both 30% supramolecular salicylic acid (SA) and isotretinoin erythromycin gel (IEG) have proven efficacy with good safety profiles in the treatment of acne vulgaris. Objectives: This study compared the clinical efficacy and safety of 30% SA peeling and IEG in the treatment of moderate-to-severe acne vulgaris. Methods: Patients with moderate-to-severe acne vulgaris were randomized into 3 groups of 30 persons each, and treated with SA peel, or IEG, or SA combine with IEG (SA + IEG group). Evaluation of acne was done by effective rate and individual lesion counts. And the adverse effects and recurrence were recorded. Results: The SA + IEG group was better in clinical efficacy and treating noninflammatory and inflammatory lesions than that of single treatment group (P 0.05). Conclusion: 30% SA combined with IEG had a significant effect in the treatment of moderate-to-severe acne lesions.
基金National Council for Scientific and Technological Development(CNPq)Office of the Dean of Research of Universidade Federal de Minas Gerais(PRPq,#01/2014).
文摘Oral hairy leukoplakia(OHL) is a disease associated with Epstein-Barr virus and human immunodeficiency virus infections. OHL is usually an asymptomatic lesion, but in some cases treatment is recommended to reestablish the normal characteristics of the tongue, to eliminate pathogenic microorganisms, to improve patient comfort and for cosmetic reasons. Proposed treatments for this condition include surgery, systemic antiviral treatment and topical management. Topical treatment is an inexpensive and safe therapy that is easy to apply, noninvasive, free of systemic adverse effects and effective over a long period of time. The aim of this study was to present a review of the literature for topical therapy for OHL. Gentian violet, retinoids, podophyllin, acyclovir and podophyllin associated with topical antiviral drugs were used to treat OHL. Reports with this focus are limited, and since 2010, no new studies have been published that discuss the efficacy of topical treatments for OHL. Podophyllin with acyclovircream was found to be effective, causing regression of lesions with no recurrences. Additional searches are necessary to provide clinical evidence of topical man agement effectiveness.
文摘It has been found that 8%-29%of colorectal cancers are obstructive.The use of“stent as bridge to surgery”is one of the most debated topics in obstructive leftsided colorectal cancer management.The endoscopic placement of a selfexpanding metallic stent as bridge to surgery(BTS)could turn an emergency surgery to an elective one,increasing the number of primary anastomoses instead of stoma and facilitating the laparoscopic approach instead of an open one.However,in recent years the possible risk of perforations and microperforations facilitating cancer spread related to the use of self-expanding metallic stent for BTS has been highlighted.Therefore,despite the useful short-term outcomes related to BTS,the recent literature has focused on long-term outcomes investigating the disease-free survival,the recurrence rate and the overall survival.Due to discordant data,international guidelines are still conflicting,and the debate is still open.There is not agreement about using self-expanding metallic stent for BTS as the gold standard.
基金Shandong Province TCM science and technology development plan project(2019-0159)
文摘Objective:To systematically evaluate the clinical effect (including effective rate and recurrence rate) of the combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis (GM).Methods: Computer searches CNKI, Wanfang database, VIP, PubMed, web of science and EMBASE, Chinese biomedical database, and selects randomized controlled trial (RCT) of treating granulomatous mastitis with the combination of traditional Chinese and Western medicine. The retrieval time is from July 2019 to July 2019. Then, we used Revman 5.3 software to meta analyze the data.Results: Nine RCTs were included, six of which were effective observation, two of which were recurrence rate observation, one of which was effective observation and reexamination rate observation. A total of 664 patients were included, including 456 in the experimental group and 208 in the control group. After analysis, it was found that the effective rate of GM in the experimental group was 92.3%, which was significantly higher than that in the control group (Western medicine alone) by 75.5% (or = 4.09, 95% CI (2.28, 7.36), P < 00001), the recurrence rate of GM in the experimental group (treated with integrated traditional Chinese and Western Medicine) was 21.6%, which was significantly lower than that in the control group (treated with western medicine alone) by 55.7% (or = 0.19, 95% CI (0.10, 0.37), P < 0.0001).Conclusion: The combination of traditional Chinese and Western medicine in the treatment of granulomatous mastitis can not only improve the effective rate of clinical treatment, but also reduce the recurrence rate of granulomatous mastitis.
