子宫内膜息肉(endometrial polyps,EP)是一种良性病变,患病率7.8%~34.9%,宫腔镜下子宫内膜息肉切除术(transcervical resection of polyp,TCRP)一直被认为是治疗EP的"金标准"。EP无症状患者居多,恶变的风险仅约0.8%,且约有25%...子宫内膜息肉(endometrial polyps,EP)是一种良性病变,患病率7.8%~34.9%,宫腔镜下子宫内膜息肉切除术(transcervical resection of polyp,TCRP)一直被认为是治疗EP的"金标准"。EP无症状患者居多,恶变的风险仅约0.8%,且约有25%的EP患者能自发消退,所以对于某些绝经前患者,常规TCRP可能不是最佳选择。展开更多
Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was ...Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Methods: Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Results: Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6% ). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8% , respectively. In addition, the sensitivity for invasive cancer according to Dukes’ stage showed 50.0% for Dukes’ stage A, 70.0% for Dukes’ stage B, and 78.3% for Dukes’ stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7% , P = .00007). Conclusions: Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.展开更多
PURPOSE: Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged...PURPOSE: Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged 80 years and older to assess the risks and diagnostic yield in this population. METHODS: We reviewed retrospectively the endoscopic and pathologic reports from consecutive colonoscopies performed on patients aged 80 years and older at a single, high-volume endoscopy center between August 1999 and May 2003. Patient characteristics, indications for examination, findings at colonoscopy, and complications were recorded and analyzed. RESULTS: A total of 1,199 colonoscopic examinations were performed on 1,112 patients. Average age was 83.1 (range, 80-100) years. Male∶female distribution was 1∶1.7. Leading exclusive indications for colonoscopy included: polyp surveillance, 227 (19 percent); altered bowel habits, 168 (14 percent); iron-deficiency anemia, 132 (11 percent); and cancer follow-up, 108 (9 percent). Eighty-six examinations (7 percent) were performed solely for an indication of colorectal cancer screening. Twenty-two percent of patients had more than one indication for colonoscopy. Forty-five malignancies were found (3.7 percent). No cancers were found in the screening group, and two malignancies (0.7 percent) were detected in patients undergoing colonoscopy for polyp surveillance. There were eight (0.6 percent) reported major complications. CONCLUSIONS: Colonoscopy can be performed safely in patients aged 80 years and older. However, the diagnostic yield is low, particularly in patients undergoing routine screening or surveillance exam-inations. Colonoscopy should for the most part be limited to elderly patients with symptoms or specific clinical findings.展开更多
This report summarizes the efficacy, safety, and feasibility of intracardiac ultrasound(ICUS) and local electrographic-guided pulmonary vein(PV)-left atrial disconnection, including the isolation of common PV trunks a...This report summarizes the efficacy, safety, and feasibility of intracardiac ultrasound(ICUS) and local electrographic-guided pulmonary vein(PV)-left atrial disconnection, including the isolation of common PV trunks accomplished in 170 consecutive patients with atrial fibrillation(AF). A left common PV was found in 43%of patients with AF. During a follow-up of 549±330 days after ablation, the AF-free survival rate was 80%and comparable in paroxysmal and persistent AF. PV stenosis was detected in only 1 asymptomatic patient, who required no intervention.展开更多
Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the a...Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the attitudes of patients wi th epithelial OVCA and staff towards palliative chemotherapy for recurrent OVCA with a cross-sectional questionnaire study. Results. Instruments were developed and piloted in 15 patients. This exploratory study reflects substantial bias in the sample populations. One hundred twenty-two patients and 37 staff were enro lled in the US and 39 patients and 25 staff were enrolled in the UK. UK patients had a lower educational status (P = 0.001), lower stage disease (P = 0.025), an d less prior lines of chemotherapy (P < 0.001). 61%of patients had recurrent OV CA and 67%of staff were physicians. Seventy-three percent of patients recalled a discussion about prognosis and 74%wanted to know details of the prognosis fo r a typical patient (US = UK). Most patients (48%) thought that their physician was realistic, and 57%of staff felt that they were optimistic. The vastmajorit y of both staff and patients thought that patients positively reinterpreted what they were told. Five percent of staff thought that palliative care was incomp atiblewhen considering chemotherapy as an option for their second recurrence o f OVCA, compared with 36%of US patients, significantly more than the 12%of UK patients (P = 0.007). Patients thought that standard chemotherapy for a second r ecurrence of OVCA produced remission in 50%and cure in 15%of patients. Staff r eported 20%and 0%, respectively. Fifty percent of patients and 57%of staff wo uldwant chemotherapy as an asymptomatic patient with a normal CT and a rising CA -125. Patients generally appear to be very tolerant of grade II chemotherapy-i nduced toxicity with staff being less tolerant than patients of nausea, anorexia , diarrhea, and rash. Staff rated life prolongation by 3 months to 1 year very m uch less acceptable than patients (P < 0.001). A展开更多
Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia. Objective: To evaluate the clinical and laborator...Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia. Objective: To evaluate the clinical and laboratory features of spirochetemic patients. Design: Cross- sectional study. Setting: Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002. Patients: 213 untreated adults with erythema migrans. Intervention: Blood culture for Borrelia burgdorferi. Measurements: Symptom scores and selected laboratory measures. Results: Spirochetemia was found in 93 (43.7% ) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2% ; P=0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0% ; P < 0.001) than patients without spirochetemia. However, 8 (22.9% ) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks. Limitations: Long- term outcome data were not available. Conclusions: The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.展开更多
文摘子宫内膜息肉(endometrial polyps,EP)是一种良性病变,患病率7.8%~34.9%,宫腔镜下子宫内膜息肉切除术(transcervical resection of polyp,TCRP)一直被认为是治疗EP的"金标准"。EP无症状患者居多,恶变的风险仅约0.8%,且约有25%的EP患者能自发消退,所以对于某些绝经前患者,常规TCRP可能不是最佳选择。
文摘Background & Aims: The fecal occult blood test (FOBT) is recommended as a screening test for colorectal cancer, but there are few reliable studies on the accuracy of immunochemical FOBT. The aim of this study was to analyze the sensitivity of immunochemical FOBT and to compare the results with the findings from complete colonoscopy. Methods: Asymptomatic adults underwent 1-time immunochemical FOBT and total colonoscopy simultaneously. The prevalence and location of colorectal neoplasia were determined by colonoscopy. The results of immunochemical FOBT and the colonoscopic findings were compared. Results: Of 21,805 patients, immunochemical FOBT was positive in 1231 cases (5.6% ). The sensitivity of 1-time immunochemical FOBT for detecting advanced neoplasia and invasive cancer was 27.1% and 65.8% , respectively. In addition, the sensitivity for invasive cancer according to Dukes’ stage showed 50.0% for Dukes’ stage A, 70.0% for Dukes’ stage B, and 78.3% for Dukes’ stages C or D. The sensitivity for detecting advanced neoplasia at the proximal colon was significantly lower than that detected in the distal colon (16.3% vs 30.7% , P = .00007). Conclusions: Although the screening of asymptomatic patients with immunochemical FOBT can identify patients with colorectal neoplasia to a certain extent, the sensitivity is relatively low and different according to the tumor location. Therefore, programmatic and repeated screening by immunochemical FOBT may be necessary to increase sensitivity for colorectal cancer detection.
文摘PURPOSE: Current colonoscopy guidelines do not address the issue of when to stop performing screening and surveillance colonoscopy in the elderly. We reviewed our experience and results of colonoscopy in patients aged 80 years and older to assess the risks and diagnostic yield in this population. METHODS: We reviewed retrospectively the endoscopic and pathologic reports from consecutive colonoscopies performed on patients aged 80 years and older at a single, high-volume endoscopy center between August 1999 and May 2003. Patient characteristics, indications for examination, findings at colonoscopy, and complications were recorded and analyzed. RESULTS: A total of 1,199 colonoscopic examinations were performed on 1,112 patients. Average age was 83.1 (range, 80-100) years. Male∶female distribution was 1∶1.7. Leading exclusive indications for colonoscopy included: polyp surveillance, 227 (19 percent); altered bowel habits, 168 (14 percent); iron-deficiency anemia, 132 (11 percent); and cancer follow-up, 108 (9 percent). Eighty-six examinations (7 percent) were performed solely for an indication of colorectal cancer screening. Twenty-two percent of patients had more than one indication for colonoscopy. Forty-five malignancies were found (3.7 percent). No cancers were found in the screening group, and two malignancies (0.7 percent) were detected in patients undergoing colonoscopy for polyp surveillance. There were eight (0.6 percent) reported major complications. CONCLUSIONS: Colonoscopy can be performed safely in patients aged 80 years and older. However, the diagnostic yield is low, particularly in patients undergoing routine screening or surveillance exam-inations. Colonoscopy should for the most part be limited to elderly patients with symptoms or specific clinical findings.
文摘This report summarizes the efficacy, safety, and feasibility of intracardiac ultrasound(ICUS) and local electrographic-guided pulmonary vein(PV)-left atrial disconnection, including the isolation of common PV trunks accomplished in 170 consecutive patients with atrial fibrillation(AF). A left common PV was found in 43%of patients with AF. During a follow-up of 549±330 days after ablation, the AF-free survival rate was 80%and comparable in paroxysmal and persistent AF. PV stenosis was detected in only 1 asymptomatic patient, who required no intervention.
文摘Background. Recurrent ovarian cancer (OVCA) has become the model for ca ncer as a chronic disease, yet little is known about what motivates patients and physic ians in treatment choices. Methods. We investigated the attitudes of patients wi th epithelial OVCA and staff towards palliative chemotherapy for recurrent OVCA with a cross-sectional questionnaire study. Results. Instruments were developed and piloted in 15 patients. This exploratory study reflects substantial bias in the sample populations. One hundred twenty-two patients and 37 staff were enro lled in the US and 39 patients and 25 staff were enrolled in the UK. UK patients had a lower educational status (P = 0.001), lower stage disease (P = 0.025), an d less prior lines of chemotherapy (P < 0.001). 61%of patients had recurrent OV CA and 67%of staff were physicians. Seventy-three percent of patients recalled a discussion about prognosis and 74%wanted to know details of the prognosis fo r a typical patient (US = UK). Most patients (48%) thought that their physician was realistic, and 57%of staff felt that they were optimistic. The vastmajorit y of both staff and patients thought that patients positively reinterpreted what they were told. Five percent of staff thought that palliative care was incomp atiblewhen considering chemotherapy as an option for their second recurrence o f OVCA, compared with 36%of US patients, significantly more than the 12%of UK patients (P = 0.007). Patients thought that standard chemotherapy for a second r ecurrence of OVCA produced remission in 50%and cure in 15%of patients. Staff r eported 20%and 0%, respectively. Fifty percent of patients and 57%of staff wo uldwant chemotherapy as an asymptomatic patient with a normal CT and a rising CA -125. Patients generally appear to be very tolerant of grade II chemotherapy-i nduced toxicity with staff being less tolerant than patients of nausea, anorexia , diarrhea, and rash. Staff rated life prolongation by 3 months to 1 year very m uch less acceptable than patients (P < 0.001). A
文摘Background: Bloodstream invasion in Lyme disease has been difficult to study because until recently blood culture methods were too insensitive to detect spirochetemia. Objective: To evaluate the clinical and laboratory features of spirochetemic patients. Design: Cross- sectional study. Setting: Lyme Disease Diagnostic Center in Valhalla, New York, 1997 to 2002. Patients: 213 untreated adults with erythema migrans. Intervention: Blood culture for Borrelia burgdorferi. Measurements: Symptom scores and selected laboratory measures. Results: Spirochetemia was found in 93 (43.7% ) patients. Spirochetemic patients were more often symptomatic (89.2% vs. 74.2% ; P=0.006) and more often had multiple erythema migrans lesions (41.9% vs. 15.0% ; P < 0.001) than patients without spirochetemia. However, 8 (22.9% ) of the 35 asymptomatic patients with a single skin lesion nevertheless had a positive blood culture. Risk for spirochetemia was present the day the patient noticed the lesion and continued for more than 2 weeks. Limitations: Long- term outcome data were not available. Conclusions: The high rate, early onset, and prolonged duration of risk for spirochetemia explain why untreated patients with erythema migrans are at risk for dissemination of B. burgdorferi to anatomic sites beyond the lesion site. Differences in the strain of the infecting spirochete, as well as host factors, may be important determinants of hematogenous dissemination.
