Minerva medica
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Postoperative adjuvant radiotherapy is used to reduce local recurrences following breast-conserving surgery for early breast cancer. This review examines factors that may be used to select patients at low risk of local failure following breast-conserving surgery alone.
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Older individuals (subjects aged >65 years) largely contribute to the percentage deaths due to myocardial infarction (MI) and stroke. The incidence of venous thromboembolism (VTE) is also higher >65 years old patients. However, the risk of bleeding complications in patients on antithrombotic drugs increases with age and with clinical conditions, as cognitive/psychiatric diseases, traumas, hypertension, poor compliance with medications, common in the elderly. ⋯ As to prophylaxis of VTE in surgery, in subjects at low-moderate risk, or in medical patients, low-dose heparin or low-dose LMWHs are effective. As to prophylaxis of VTE in surgery in subjects at high risk, adjusted-dose heparin or high-dose LMWHs are recommended. Finally, as to prevention of stroke in patients older than 75 with atrial fibrillation (AF), warfarin is of choice.
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Systemic vasculitides are multisystem diseases characterised pathologically by necrotising inflammation of blood vessels. The clinical presentation of vasculitis depends on the vessels involved. ⋯ It will examine the clinical characteristics of these diseases, the use of ANCA in diagnosis and monitoring of disease along with current and novel treatment strategies. The immunopathology of the ANCA-associated vasculitides will also be explored reviewing the roles of ANCA, neutrophils, T cells and apoptosis in the production of disease.
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Glaucoma is the leading cause of irreversible blindness worldwide. The World Health Organization reported in 1995 that 5.1 million persons were bilaterally blind from glaucoma. Its morbidity and prevalence make it a significant public health problem. ⋯ Treatment of glaucoma consists of topical or systemic intraocular pressure lowering agents, laser treatment or surgery. Primary Open Angle Glaucoma is an often-unrecognized disease due to its slow course and lack of symptoms. Because the decline in vision may be slowed but not restored by treatment, it is important that this condition be diagnosed early in its course.
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An innovative approach to peritoneal neoplasm therapy is based on the surgical exeresis of visceral neoplasms, peritonectomy and lastly perfusion of the abdominal cavity with cytostatic drugs in hypothermia (1PCH). Cisplatin (CDDP) is one of the most frequently used drugs for peritoneal perfusion owing to its excellent synergy with hypothermia, reduced ability to penetrate the peritoneal- plasma barrier and its demonstrated efficacy against the majority of neoplasms causing peritoneal carcinosis. A major restriction is that CDDP causes renal toxicity. In order to minimise the risk of renal damage, the authors studied the use of amifostin to protect the renal system. A phase-1 study was performed to find the dose of amifostin that guarantees effective renal protection without causing hypotension. ⋯ Some patients undergoing cytoreduction+IPCH without the use of amifostin developed severe renal toxicity; acute renal failure occurred in 1 patient requiring hemodialysis and was the main cause of death. None of the 28 patients treated with amifostin 550 mg/m2 developed hypotension or renal insufficiency; only 2 cases showed a slight transient increase in renal function markers. Amifostin appears to be an effective drug for protecting renal emunctory from the toxic effects of CDDP used in cytoreduction+IPCH in patients with peritoneal carcinosis. The dose of 550 mg/m2 used in this study does not cause hypotension and is recommended for this type of clinical use.