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- 저자 : Mark L. George (검색결과 3 건)
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Mark W. Ball,Zeyad R. Schwen,Joan S. Ko,Alexa Meyer,George J. Netto,Arthur L Burnett,Trinity J. Bivalacqua 대한비뇨의학회 2017 Investigative and Clinical Urology Vol.58 No.1
Purpose: To determine the impact of lymph node density (LND) on survival after inguinal lymph node dissection (ILND) for penile cancer. Materials and Methods: Our institutional penile cancer database was queried for patients who underwent ILND. Clinicopathologic characteristics including LND and total number of positive lymph nodes (LNs) were analyzed to determine impact on recurrence-free survival (RFS) and overall survival (OS). LND, or the percent of positive LN out of total LN, was calculated as a categorical variable at varying thresholds. Results: Twenty-eight patients with complete follow-up were identified. Indications for ILND were stage >T2 in 20 patients (71.4%), palpable adenopathy in 7 (25%), high grade T1 in 1 (3.6%). Median node yield was 17.5 (interquartile range, 12−22), and positive LNs were found in 14 patients (50%). RFS and OS were significantly lower for patients with >15% LN density (median RFS: 62 months vs. 6.3 months, p=0.0120; median OS: 73.6 months vs. 6.3 months, p<0.001). Controlling for age, medical comorbidities, number of positive LN, T stage, pelvic LN status and indication, LN density >15% was independently associated with worse RFS (hazard ratio [HR], 3.6; p=0.04) and OS (HR, 73.6; p=0.002). The c-index for LND was higher than total positive LNs for RFS (0.64 vs. 0.54) and OS (0.79 vs. 0.61). Conclusions: In this small, retrospective penile cancer cohort, the presence of nodal involvement >15% was associated with decreased RFS and OS, and outperformed total number of positive LN as a prognostic indicator.
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실행 요약: 당뇨병의 진단과 관리에서 검사실적 분석에 대한 지침과 권고안
David B. Sacks,Mark Arnold,George L. Bakris,David E. Bruns,Andrea Rita Horvath,M. Sue Kirkman,Ake Lernmark,Boyd E. Metzger,David M. Nathan 대한진단검사의학회 2011 Laboratory Medicine Online Vol.1 No.4
Background: Multiple laboratory tests are used in the diagnosis and management of patients with diabetes mellitus. The quality of the scientific evidence supporting the use of these assays varies substantially. Approach: An expert committee compiled evidencebased recommendations for the use of laboratory analysis in patients with diabetes. A new system was developed to grade the overall quality of the evidence and the strength of the recommendations. A draft of the guidelines was posted on the Internet, and the document was modified in response to comments. The guidelines were reviewed by the joint Evidence-Based Laboratory Medicine Committee of the AACC and the National Academy of Clinical Biochemistry and were accepted after revisions by the Professional Practice Committee and subsequent approval by the Executive Committee of the American Diabetes Association. Content: In addition to the long-standing criteria based on measurement of venous plasma glucose, diabetes can be diagnosed by demonstrating increased hemoglobin A1c (HbA1c) concentrations in the blood. Monitoring of glycemic control is performed by the patients measuring their own plasma or blood glucose with meters and by laboratory analysis of Hb A1c. The potential roles of noninvasive glucose monitoring, genetic testing,and measurement of autoantibodies, urine albumin, insulin, proinsulin, C-peptide, and other analytes are addressed. Summary: The guidelines provide specific recommendations based on published data or derived from expert consensus. Several analytes are found to have minimal clinical value at the present time, and measurement of them is not recommended.
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Colovesical Fistula: Should It Be Considered a Single Disease?
Qamar Hafeez Kiani,Mark L. George,Emin A. Carapeti,Alexis M. P. Schizas,Andrew B. Williams 대한대장항문학회 2015 Annals of Coloproctolgy Vol.31 No.2
different aetiologies. Methods: Retrospective data were collected from 2002 to 2012 and analyzed with SPSS ver. 17. Age, gender, aetiology, management, hospital stay, postoperative complications, and mortality were studied and compared among colovesical fistulae of different aetiologies. Results: A total of 55 patients, 46 males (84%) and 9 females (16%), with a median age of 65 years (interquartile range [IQR], 48–75 years) were studied. Diverticular disease was the most common benign cause and recto-sigmoid cancer the most common malignancy. Anterior resection and bladder repair were the most frequent operations in benign cases, as was total pelvic exenteration in the malignant group. Multiple intestinal loop involvement and subsequent resection were significantly higher in those with Crohn disease than it was in patients of colovesical fistula due to all other causes collectively (60% vs. 6%, P = 0.006). Patients with malignancy had a higher postoperative complication rate than patients who did not (12 [80%] vs. 7 [32%], P = 0.0005). Pelvic collection (11, 22%) was the most frequent early complication (predominantly in the malignant group) whereas incisional hernia (8, 22%) was the most common late complication, with a predominance in the benign group. The median hospital stay was significantly prolonged in the malignant group (32 days; IQR, 17–70 days vs. 16 days; IQR, 11–25 days; P < 0.001). Conclusion: Despite their having similar clinical presentation, colovesical fistulae of various aetiologies differ significantly in management and outcome.
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