RESUMEN
ABSTRACT: Selected Issues in Sport-Related Concussion (SRC | Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus articles written for the practicing team physician. This document provides an overview of select medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC.
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Traumatismos en Atletas , Conmoción Encefálica , Médicos , Medicina Deportiva , Deportes , Atletas , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/terapia , Consenso , HumanosRESUMEN
Selected Issues in Sport-Related Concussion (SRC|Mild Traumatic Brain Injury) for the Team Physician: A Consensus Statement is title 22 in a series of annual consensus documents written for the practicing team physician. This document provides an overview of selected medical issues important to team physicians who are responsible for athletes with sports-related concussion (SRC). This statement was developed by the Team Physician Consensus Conference (TPCC), an annual project-based alliance of six major professional associations. The goal of this TPCC statement is to assist the team physician in providing optimal medical care for the athlete with SRC.
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Traumatismos en Atletas , Conmoción Encefálica , Médicos , Medicina Deportiva , Deportes , Atletas , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/terapia , HumanosRESUMEN
The beach chair position has been popularized for shoulder surgeries, particularly those involving arthroscopy. Several published case reports and studies have raised concerns for neurologic complications related to anesthesia for surgery performed with patients in the beach chair position. The question has been raised whether cerebral perfusion monitoring should be used routinely to minimize these potential complications. This prospective study evaluated cognitive outcomes in patients who underwent anesthesia in the beach chair position. Patients were randomized to 2 groups. In group 1, the anesthesiologist was blinded to the cerebral monitoring and could treat based only on mean arterial pressure (MAP). In group 2, the anesthesiologist was aware of the results of the cerebral monitoring and could treat any desaturation events. All patients were evaluated pre- and postoperatively with a cognitive assessment tool. A total of 80 patients were enrolled in the study, with 40 patients in each group. There were no significant differences regarding age, body mass index, or American Society of Anesthesiologists score. Only 3 desaturation events occurred with no significant change in cognitive function. The findings indicate no advantage to cerebral perfusion monitoring during anesthesia for surgery performed with patients in the beach chair position as long as MAP is maintained within strict limits. Although little is known about the level of cerebral desaturation that will result in cognitive dysfunction, it may likely be related to MAP and cerebral perfusion. The findings of this study reinforce the need for careful monitoring of MAP during surgery and dispute the need for additional expensive monitoring devices. [Orthopedics. 2020; 43(1):e27-e30.].
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Anestesia/métodos , Circulación Cerebrovascular/fisiología , Cognición/fisiología , Monitoreo Intraoperatorio/métodos , Posicionamiento del Paciente/métodos , Adolescente , Adulto , Anciano , Artroscopía/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Adulto JovenRESUMEN
CASE: Medial patellar instability (MPI) is a known sequela of previous lateral retinacular release. Literature on surgical intervention is scarce. We present a case of a 35-year-old woman with hypermobility type Ehlers-Danlos syndrome, with bilateral iatrogenic MPI (IMPI) and lateral patellar instability. This condition led to a marked decrease in quality of life, 10/10 persistent pain, and frequent dislocation events. She was successfully treated surgically, and at 2 years had 0/10 pain and no further dislocations. CONCLUSIONS: Our technique for medial and lateral patellofemoral ligament reconstruction is a viable intervention for patients with IMPI, even in the setting of underlying collagen disorder.
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Artroplastia/métodos , Síndrome de Ehlers-Danlos/cirugía , Inestabilidad de la Articulación/cirugía , Ligamentos Articulares/cirugía , Articulación Patelofemoral/cirugía , Adulto , Femenino , HumanosRESUMEN
Although clavicle fractures often heal well with nonoperative management, current literature has shown improved outcomes with operative intervention for specific fracture patterns in specific patient types. The 2 most common methods of midshaft clavicle fracture fixation are intramedullary and plate devices. Through retrospective analysis, this study performed a direct cost comparison of these 2 types of fixation at a single institution over a 5-year period. Outcome measures included operative costs for initial surgery and any hardware removal surgeries. This study reviewed 154 patients (157 fractures), and of these, 99 had intramedullary fixation and 58 had plate fixation. A total of 80% (79 of 99) of intramedullary devices and 3% (2 of 58) of plates were removed. Average cost for initial intramedullary placement was $2955 (US dollars) less than that for initial plate placement (P<.001); average cost for removal was $1874 less than that for plate removal surgery (P=.2). Average total cost for all intramedullary surgeries was $1392 less than the average cost for all plating surgeries (P<.001). Average cost for all intramedullary surgeries requiring plate placement and removal was $653 less than the average cost for all plating surgeries that involved only placement (P=.04). Intramedullary fixation of clavicle fractures resulted in a statistically significant cost reduction compared with plate fixation, despite the incidence of more frequent removal surgeries. [Orthopedics.2016; 39(5):e877-e882.].
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Placas Óseas/economía , Clavícula/lesiones , Fijación Intramedular de Fracturas/economía , Fijación de Fractura/economía , Fracturas Óseas/cirugía , Adolescente , Adulto , Anciano , Costos y Análisis de Costo , Femenino , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Fijación Intramedular de Fracturas/estadística & datos numéricos , Fracturas Óseas/economía , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Acromioclavicular (AC) dislocation with an associated displaced fracture of the middle third of the clavicle is a rare injury with no established standard treatment. Previous AC fixation techniques described have not included simultaneous internal fixation of the clavicle. We present the case of a 19-year-old man who sustained this combined injury pattern with a type IV AC dislocation. He underwent open reduction and internal fixation of the clavicle fracture with open reduction of the AC joint and coracoclavicular (CC) screw fixation through the plate to stabilize the AC dislocation. The CC screw was removed 3 months after surgery. By 1-year follow-up, the patient had returned to manual labor and normal activities of daily living. In comparison with previously described treatment, his case highlights a unique approach to this rare shoulder entity.
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Articulación Acromioclavicular/cirugía , Clavícula/cirugía , Fracturas Óseas/cirugía , Luxaciones Articulares/cirugía , Articulación Acromioclavicular/diagnóstico por imagen , Articulación Acromioclavicular/lesiones , Clavícula/diagnóstico por imagen , Clavícula/lesiones , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Humanos , Luxaciones Articulares/diagnóstico por imagen , Masculino , Radiografía , Recuperación de la Función , Adulto JovenRESUMEN
Cartilage defects have a limited ability to self-heal. Stem cell treatment is a promising approach; however, replicative senescence is a challenge to acquiring large-quantity and high-quality stem cells for cartilage regeneration. Synovium-derived stem cells (SDSCs) are a tissue-specific stem cell for cartilage regeneration. Our recent findings suggest that decellularized stem cell matrix (DSCM) can rejuvenate expanded SDSCs in cell proliferation and chondrogenic potential. In this study, we were investigating (1) whether transforming growth factor (TGF)-ß1 and TGF-ß3 played a similar role in chondrogenic induction of SDSCs after expansion on either DSCM or plastic flasks (plastic), and (2) whether DSCM-expanded SDSCs had an enhanced capacity in repairing partial-thickness cartilage defects in a minipig model. SDSCs were isolated from synovium in two 3-month-old pigs and DSCM was prepared using SDSCs. Passage 2 SDSCs were expanded on either DSCM or plastic for one passage. The expanded cells were evaluated for cell morphology, chondrogenic capacity, and related mechanisms. TGF-ß1 and TGF-ß3 were compared for their role in chondrogenesis of SDSCs after expansion on either DSCM or plastic. The chondrogenic induction medium without TGF-ß served as a control. In 13 minipigs, we intraarticularly injected DSCM- or plastic-expanded SDSCs or saline into knee partial-thickness cartilage defects and assessed their repair using histology and immunohistochemistry. We found DSCM-expanded SDSCs were small, had a fibroblast-like shape, and grew quickly in a three-dimensional format with concomitant up-regulation of phosphocyclin D1 and TGF-ß receptor II. Plastic-expanded SDSCs exhibited higher mRNA levels of chondrogenic markers when incubated with TGF-ß3, while DSCM-expanded SDSCs displayed comparable chondrogenic potential when treated with either TGF-ß isotype. In the minipig model, DSCM-expanded SDSCs were better than plastic-expanded SDSCs in enhancing collagen II and sulfated glycosaminoglycan expression in repair of partial-thickness cartilage defects, but both groups were superior to the saline control group. Our observations suggested that DSCM is a promising cell expansion system that can promote cell proliferation and enhance expanded cell chondrogenic potential in vitro and in vivo. Our approach could lead to a tissue-specific cell expansion system providing large-quantity and high-quality stem cells for the treatment of cartilage defects.
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Cartílago/citología , Células Madre/citología , Membrana Sinovial/citología , Animales , Células Cultivadas , Condrogénesis/efectos de los fármacos , Condrogénesis/fisiología , Inmunohistoquímica , Porcinos , Factor de Crecimiento Transformador beta1/farmacología , Factor de Crecimiento Transformador beta3/farmacologíaRESUMEN
Pseudoseptic arthritis is primarily described in rheumatoid arthritis and other systemic inflammatory conditions. To our knowledge, only 1 case report of pseudoseptic arthritis associated with intra-articular injection of a pneumococcal polyvalent vaccine (PPV) has been published. Here, a second case is presented in which a patient presented with swelling, pain, and erythema of the affected shoulder. A 59-year-old woman presented to the emergency department with a 3-day history of severe pain and decreased mobility of her left shoulder after receiving a PPV vaccination. Her clinical and laboratory workup was suspicious for septic arthritis; however, magnetic resonance imaging of the affected shoulder with and without contrast showed only a partial thickness tear of the rotator cuff, fluid in the subacromial/subdeltoid bursa, and subcutaneous edema without evidence of an abscess. Based on the clinical and laboratory data, she underwent arthroscopic debridement. There was inflammatory tissue throughout the shoulder but no obvious purulent material. She did well postoperatively with a supervised range of motion rehabilitation protocol. Her cultures remained negative. At 12 weeks, she was discharged from follow-up. We suspect that the vaccination was inadvertently injected into the glenohumeral joint directly through the rotator cuff given the lack of a full-thickness tear and the patient's thin body habitus, which could explain her aseptic inflammatory arthritis.
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Artritis Infecciosa/etiología , Artritis Infecciosa/prevención & control , Vacunas Neumococicas/efectos adversos , Articulación del Hombro/microbiología , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/microbiología , Femenino , Humanos , Inyecciones Intraarticulares , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
PURPOSE: The purpose of this study was to investigate complications of the medial opening wedge high tibial osteotomy (HTO) procedure at our institution. METHODS: All cases of medial opening wedge HTO performed between 2001 and 2004 at our institution were identified. Medical records, operative reports, and radiographs were retrospectively reviewed for all patients who experienced a complication within 12 months postsurgery. All complications were identified for analysis. RESULTS: Forty-six patients were included in this study; 17 (36.9%) patients had a documented complication. There were 7 patients (15.2%) with loss of correction, 2 (4.3%) with intraoperative lateral cortex fractures, 2 (4.3%) with postoperative lateral cortex fractures, 2 (4.3%) with deep venous thrombosis, 2 (4.3%) with delayed unions, and 2 (4.3%) with symptomatic hardware. Patients with a loss of angular correction had a greater body mass index (BMI) than those without a loss of correction (mean BMI, 32.5 v 28.8; P = .0416). Of the 7 patients with loss of angular correction, 6 had a first-generation fixation device and 1 had a second-generation device. There was no apparent association between delayed union and graft type (allograft v autograft). CONCLUSIONS: The medial opening wedge HTO is associated with a moderate frequency of complications. The frequency and type of complications seem to be similar to those reported for the lateral closing technique. Although there are technical advantages offered by the medial opening wedge HTO, their influence on the frequency and type of complications experienced by patients in our series was not apparent. LEVEL OF EVIDENCE: Level IV, case series.
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Osteoartritis de la Rodilla/cirugía , Osteotomía , Complicaciones Posoperatorias/epidemiología , Tibia/cirugía , Adolescente , Adulto , Placas Óseas , Trasplante Óseo , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/etiología , Falla de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuropatías Peroneas/epidemiología , Neuropatías Peroneas/etiología , Arteria Poplítea/lesiones , Complicaciones Posoperatorias/etiología , Seudoartrosis/epidemiología , Seudoartrosis/etiología , Embolia Pulmonar/epidemiología , Embolia Pulmonar/etiología , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Tromboflebitis/epidemiología , Tromboflebitis/etiología , Fracturas de la Tibia/epidemiología , Fracturas de la Tibia/etiología , Trasplante Homólogo , Adulto JovenRESUMEN
BACKGROUND: Recently published studies have raised the question of whether arteriography is warranted in the evaluation of multiligamentous injuries of the knee. PURPOSE: The objective is to report the frequency of associated vascular injuries in the multiligament-injured knee and examine the role arteriography plays in the treatment protocol. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective analysis was performed on 71 patients over a 12-year period who had a diagnosis of multiligamentous injury of the knee with a tibial-femoral dislocation documented based on physical examination and magnetic resonance imaging findings. RESULTS: Of 72 knee injuries involving multiple ligaments, 12 vascular injuries were identified. Four knees were found to have a vascular injury at initial presentation based on abnormal physical examination and confirmed with arteriography. Eight patients with a vascular injury had normal pulses. Routine arteriography discovered an intimal injury of the popliteal artery in 5 of these patients. Arteriography in the remaining 3 patients was interpreted as normal. CONCLUSION: These findings suggest that physical examination alone is not sufficient in detecting the majority of vascular injuries after a suspected knee dislocation.
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Vasos Sanguíneos/lesiones , Traumatismos de la Rodilla/fisiopatología , Ligamentos/lesiones , Traumatismo Múltiple/diagnóstico , Adolescente , Adulto , Angiografía , Femenino , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Traumatismo Múltiple/fisiopatología , Estudios Retrospectivos , Adulto JovenRESUMEN
The purpose of this study was to evaluate the preoperative use of a two-part standardized assessment program (Prime-MD, Biometrics Research Department, New York State Psychiatric Institute) to objectively detect psychiatric disorders in facial plastic surgery patients, and to compare its use to findings identified by the facial plastic surgeon. Seventy-five new patients requesting aesthetic facial surgery at two academic centers and two private practice locations were evaluated.
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Cara/cirugía , Trastornos Mentales/diagnóstico , Cuidados Preoperatorios , Cirugía Plástica , Femenino , Humanos , Entrevista Psicológica , Masculino , Encuestas y CuestionariosRESUMEN
BACKGROUND: [F-18]Fluorodeoxyglucose (FDG)-positron emission tomography (PET) can measure the metabolic activity of tissues; FDG-PET may be able to predict response to chemotherapy by identifying changes in tumor metabolism. Measurement of response to treatment may help improve survival in the management of advanced head and neck cancer. We evaluated this particular use of FDG-PET in patients participating in a neoadjuvant organ-preservation protocol using taxol and carboplatin and compared pathologic response after chemotherapy with changes in tumor metabolism measured by FDG-PET. METHODS: Serial FDG-PET studies (n = 56) were performed in patients (n = 28) with stage III/IV head and neck cancer participating in a neoadjuvant organ-preservation protocol. The FDG-PET studies were performed before and after chemotherapy. All patients had tissue biopsies before and after chemotherapy. Patients were classified as pathologic complete response (PCR) or residual disease (RD) based on tissue biopsies. Visual analysis of PET scans was performed to identify patients with complete response by PET, and these findings were compared with pathology results. Metabolic changes were also evaluated using standardized uptake ratios (SUR) of FDG. RESULTS: The sensitivity and specificity of PET for residual cancer after therapy was 90% (19/21) and 83% (5/6), respectively. Two patients had initially negative biopsies and positive PET studies for persistent disease. Pathology review and rebiospy led to confirmation of the PET results in these cases, giving a sensitivity of 90% for initial tissue biopsy. CONCLUSIONS: In this preliminary analysis, FDG-PET was accurate in classifying response to chemotherapy in most patients. Fluorodeoxyglucose-PET may identify residual viable tumor when it is otherwise undetectable.
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Antineoplásicos/uso terapéutico , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Radiofármacos , Tomografía Computarizada de Emisión , Animales , Biopsia , Neoplasias de Cabeza y Cuello/metabolismo , Neoplasias de Cabeza y Cuello/patología , Humanos , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The expression of p53 protein has been reported to be in the range of 35% to 67% in head and neck squamous cell carcinoma (HNSCC). Mutations of the gene for p53 protein have been associated with rapidly proliferating tumors, and p53 protein expression has been shown to be a significant predictor of worse survival in surgically resected HNSCC. To determine whether p53 protein expression in advanced (stages III and IV) HNSCC has any impact on tumor response to 2 to 3 courses of paclitaxel (Taxol) and carboplatin, we prospectively studied prechemotherapy specimens from patients with previously untreated, advanced-stage HNSCC. We also attempted to study residual tumors after chemotherapy to determine if the p53 status of the tumor changed. DESIGN: The expression of p53 protein was evaluated by immunohistochemical analysis (clone BP53-12-1; Bio-Genex, San Ramon, Calif). SETTING: Tertiary university medical center. INTERVENTION: Two to 3 courses of chemotherapy with paclitaxel and carboplatin. MAIN OUTCOME MEASURES: Pathologic complete remission or residual tumor. RESULTS: The results of p53 immunostaining were positive in 24 (67%) of 36 HNSCC specimens before chemotherapy. After chemotherapy, 8 patients achieved pathologic complete remission. Before chemotherapy, the tumor was p53 negative in 2 patients and positive in 6 patients. CONCLUSIONS: No correlation of p53 protein expression with response to chemotherapy was noted. The expression of p53 protein converted from positive to negative in 5 (42%) of 12 specimens from patients with residual tumor after chemotherapy, with no impact on clinical outcome.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/química , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Proteína p53 Supresora de Tumor/metabolismo , Adolescente , Adulto , Anciano , Carboplatino/administración & dosificación , Carcinoma de Células Escamosas/patología , Esquema de Medicación , Neoplasias de Cabeza y Cuello/patología , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Mutación , Neoplasia Residual , Paclitaxel/administración & dosificación , Estudios Retrospectivos , Proteína p53 Supresora de Tumor/genéticaRESUMEN
BACKGROUND: Standard therapy for advanced head and neck carcinoma is surgery and radiation, and the subsequent 5-year survival with this treatment has been less than 50%. New combined modality treatment strategies are being tested to improve survival. New chemotherapy combinations are being developed and administered simultaneously with, or sequenced with, radiation and surgery. This article reports the Phase I results of administering paclitaxel and carboplatin preoperatively. The authors' objective was to develop an outpatient chemotherapy that would downstage tumors and allow organ preservation with equal or improved survival as compared with standard therapy. METHODS: Thirty-six patients with untreated Stage III/IV head and neck carcinoma were treated and were evaluable for toxicity. All patients had lesions that were measurable in perpendicular planes. A nonrandomized, Phase I design was used, according to which cohorts of patients were treated every 21 days with escalating doses of paclitaxel (150-265 mg/m2) given as a 3-hour infusion immediately preceding carboplatin. Premedication was used to avoid acute hypersensitivity reactions. Carboplatin was administered intravenously over 1 hour at a constant dose calculated with the Calvert formula (area under the curve, 7.5). RESULTS: The dose-limiting toxicities were neuropathy and thrombocytopenia at a paclitaxel dose of 265 mg/m2. Neutropenic fever was observed in 30% of patients at a paclitaxel dose of 250-265 mg/m2. Other observed adverse effects included pruritus, myalgia, arthralgia, alopecia, nausea, and vomiting. CONCLUSIONS: Toxicity was acceptable. The maximum tolerated dose of paclitaxel was 230 mg/m2 without hematopoietic growth factor, or 250 mg/m2 with hematopoietic growth factor, the carboplatin dose held constant, calculated at area under the curve of 7.5. Phase II studies of this combination are warranted in the treatment of these carcinomas.
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Antineoplásicos Fitogénicos/administración & dosificación , Antineoplásicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carboplatino/administración & dosificación , Carcinoma/tratamiento farmacológico , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Paclitaxel/administración & dosificación , Adolescente , Adulto , Anciano , Atención Ambulatoria , Antineoplásicos/efectos adversos , Antineoplásicos Fitogénicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Área Bajo la Curva , Carboplatino/efectos adversos , Carcinoma/patología , Carcinoma/cirugía , Estudios de Cohortes , Terapia Combinada , Femenino , Fiebre/inducido químicamente , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Enfermedades del Sistema Nervioso/inducido químicamente , Neutropenia/inducido químicamente , Paclitaxel/efectos adversos , Cuidados Preoperatorios , Tasa de Supervivencia , Trombocitopenia/inducido químicamenteRESUMEN
BACKGROUND: The authors report on anemia observed during preoperative paclitaxel and carboplatin chemotherapy in patients with advanced head and neck carcinoma and discuss how the use of recombinant human erythropoietin (r-HuEPO) ameliorates this anemia, reducing the need for subsequent packed red blood cell (PRBC) transfusions. METHODS: Response to r-HuEPO was defined as reduced hemoglobin fall during preoperative chemotherapy and reduced transfusion requirements during surgery. Thirty-six patients with advanced head and neck carcinoma were evaluable after treatment with preoperative chemotherapy using paclitaxel and carboplatin. Group 1 was comprised of 14 patients who empirically received r-HuEPO at a dose of 150 U/kg 3 times per week for 3 weeks; in patients deemed nonresponders, the dose was increased to 300 U/kg and 450 U/kg in the subsequent courses. Group 2 was comprised of 22 patients who did not receive r-HuEPO. RESULTS: During preoperative chemotherapy, the mean hemoglobin fall was 0.5 g/dL in Group 1 (P = 0.40). In Group 2 there was a statistically significant mean hemoglobin fall of 3.3 g/dL (P < 0.0001). There was also a nonstatistically significant trend toward fewer PRBC transfusions: none of 14 patients (0%) in Group 1 versus 4 of 22 patients (18%) in Group 2 (P = 0.141). CONCLUSIONS: A significant fall in hemoglobin and an increase in the need for transfusions were observed in head and neck carcinoma patients receiving carboplatin and paclitaxel chemotherapy prior to surgery. Empiric r-HuEPO therapy appeared to prevent anemia and reduced the need for PRBC transfusions.
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Anemia/prevención & control , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Transfusión de Eritrocitos , Eritropoyetina/uso terapéutico , Neoplasias de Cabeza y Cuello/sangre , Hemoglobina A/efectos de los fármacos , Adolescente , Adulto , Anciano , Anemia/inducido químicamente , Carboplatino/efectos adversos , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Paclitaxel/efectos adversos , Proteínas RecombinantesRESUMEN
BACKGROUND: Quality of life levels fluctuate depending on treatment type and at various points throughout treatment. In patients with advanced head and neck cancer, quality of life is thought to be treatment dependent. The purpose of this study is to compare levels of patients self-reported quality of life across treatment. PATIENTS AND METHODS: Preliminary data presented here are based on 24 patients enrolled so far in an experimental organ-preservation protocol. The two treatment groups consist of one group treated with chemotherapy (paclitaxel and carboplatin) followed by radiation therapy and the second group which is treated with chemotherapy (paclitaxel and carboplatin) followed by surgery and postoperative radiation. Data is collected pretreatment and at uniform points throughout the course of treatment. RESULTS: Preliminary results suggest that quality of life is significantly higher in the nonsurgical group than in the surgical group at the last treatment point reported. Social distress/avoidance is also lower in the nonsurgical group. Because of the small number of patients represented in this study, results should be interpreted with caution and should be viewed as descriptive at this juncture. CONCLUSION: Quality of life seems to be preserved in patients who experience less invasive and disfiguring treatment, and who also have compromised eating and communication abilities. Data collection in this study is ongoing.
Asunto(s)
Carcinoma de Células Escamosas/terapia , Neoplasias de Cabeza y Cuello/terapia , Calidad de Vida , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Células Escamosas/cirugía , Quimioterapia Adyuvante , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radioterapia AdyuvanteRESUMEN
Advances in the technical aspects of heart transplantation and the medical management of rejection have allowed a shift toward research evaluating psychological factors affecting heart transplant candidates and psychosocial sequelae following transplantation. This study examined the psychological and cognitive status of patients presenting for heart transplant evaluation. The findings indicated that this patient group was characterized by impaired verbal memory and a tendency toward depression and anxiety. The second part of the study examined changes in psychological and cognitive status from the initial evaluation to a follow-up assessment 1 year after transplantation. The results indicated that psychological distress (depression, anxiety) and several indices of cognitive function improved after transplantation. Finally, correlations were determined to evaluate the association between the psychological and cognitive measures and episodes of rejection in the first 6 months after transplantation. Anxiety, depression, and a nonverbal measure of intelligence were found to be associated with the number of episodes of rejection. The implications of these findings are discussed.
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Trastornos de Ansiedad/etiología , Cardiomiopatías/complicaciones , Trastorno Depresivo/etiología , Trasplante de Corazón , Trastornos de la Memoria/etiología , Selección de Paciente , Adulto , Cardiomiopatías/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Resultado del TratamientoRESUMEN
BACKGROUND: the psychological status of patients treated for advanced head and neck cancer is an area of patient care that has not received sufficient attention from caregivers and can be influential in terms of patient outcomes. METHODS: Thirty patients participated in this study designed to evaluate areas of psychological distress associated with treatment of advanced head and neck cancer. Patients completed a set of questionnaires related to various psychosocial variables including anxiety, depression, social support, health locus of control, adjustment to illness, illness-related behaviors, and compliance. RESULTS: Moderate levels of depression and anxiety, disability, and psychological distress characterize this sample of patients. Additionally, patient self-report of compliance reveals different variable combinations to be related to overall diet and medication compliance, and different levels of each compliance type were observed. CONCLUSION: Head and neck cancer therapy presents a unique set of challenges for patients. Awareness of the impact of the illness and the psychological distress that are experienced should improve patient compliance and medical outcome.