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RISS 인기검색어
- 검색키워드
- 저자 : Michael Fehr (검색결과 3 건)
- 무료
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Disease progression and recurrence in women treated for vulvovaginal intraepithelial neoplasia
Mathias K. Fehr,Marc Baumann,Michael Mueller,Daniel Fink,Siegfried Heinzl,Patrick Imesch,Konstantin Dedes 대한부인종양학회 2013 Journal of Gynecologic Oncology Vol.24 No.3
Objective: The malignant potential of intraepithelial neoplasia of the vulva and vagina after treatment is not well defined. Our objective was to examine risk factors for recurrence and invasive disease. Methods: Four hundred sixty-four women with biopsy proven high-grade intraepithelial neoplasia of the vulva and vagina were identified in the electronic databases of four colposcopy clinics. Inclusion criteria were a follow-up of more than one year, no history of invasive cancer and no invasive cancer within the first year after initial treatment. We investigated the potential factors associated with recurrence and progression using a logistic regression analysis to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Of the 411 eligible patients, 123 patients (29.9%) recurred later than one year after initial treatment and 24 patients (5.8%) progressed to invasive disease. According to multivariate analyses, the risk factors associated with recurrence were multifocality (OR, 3.33; 95% CI, 2.02 to 5.51), immunosuppression (OR, 2.51; 95% CI, 1.09 to 5.81), excision as initial treatment (vs. laser evaporation; OR, 1.79; 95% CI, 1.11 to 2.91) and smoking (OR, 1.61; 95% CI, 1.02 to 2.55). Risk factors for progression to invasive disease were immunosuppression (OR, 4.00; 95% CI, 1.30 to 12.25), multifocality (OR, 3.05; 95% CI, 1.25 to 7.43) and smoking (OR, 2.97; 95% CI, 1.16 to 7.60), but not treatment modality. Conclusion: Laser evaporation combined with extensive biopsy is at least as efficacious as initial treatment of intraepithelial neoplasia with excision. Smoking is a risk factor for both recurrence and progression to invasive disease. Hence, smoking cessation should be advised and maintaining a long follow-up period due to late relapses is necessary.
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장인호,안미영,Michael Fehr 한국임상수의학회 1998 한국임상수의학회지 Vol.15 No.2
A female Green iguana (Iguana iguana) was brought to the small animal clinic in Hannover Veterinary school because of anorexia and convulsion. Two months ago, the owner bought two iguanas, one female and one male and had to take a female to the one of local small animal clinic because she, born in 19931 didn't eat well and showed the tremor of the legs. The veterinarian suspected it to have a calcium deficiency and gave an injection of calcium and vitamin D3. But still during the last two months, the female iguana did only eat some lettuce while the other male ate lettuce, fruits and commercial cat-food ($Whiskas^{\circledR}$, Effem, Verden). It was not possible to evaluate the rations of these different "food-components". They are kept in the terrarium with water container. By palpation of the abdomen, hard thing like stone was palpated in the mid-region. The blood test wasn't carried out because of the difficulties of getting blood and because of her bad condition. It was firmly diagnosed as cystic calculus through radiography. Since the animal is in shock state already, the prognosis after surgery was bad. It was assumed to be too late to expect its surviving with the surgery carried out or without it. Cystotomy was performed in the cranial ventral paramedian incision in order to preserve the large ventral abdominal vein in the linen alba region. After two stay sutures ("holding suture" ) with 5-0 polyglactin 910 ($Vicryl^{\circledR}, Ethicon$) on the bladder, cystotomy was carried out and the stone inside was removed. Then, the bladder was closed in one-layer sutures. The abdomen was closed in simple interrupted suture with same material after the instillation of 10 ml saline solution into the abdominal cavity. The cystic calculus was in a size of $5.8{\times} 5.O{\times} 3.5 cm$. The analysis of the stone was carried out in two ways which are the infrared spectroscopy of the stone and quick analysis by $Merckognost^{\circledR}$(Diagnostica Merck, Merck). In the result of the infrared spectroscopy, the stone wee composed of 10% ammonium urate and 90% dihydrated uric acid. This iguana wasn't able to survive.n't able to survive.
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