Xem 1-20 trên 70 kết quả Benign and malignant
  • Harrison's Internal Medicine Chapter 91. Benign and Malignant Diseases of the Prostate Benign and Malignant Diseases of the Prostate: Introduction Benign and malignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90% and malignant changes in 70% of individuals. The high prevalence of these diseases among the elderly, who often have competing causes of morbidity and mortality, mandates a risk-adapted approach to diagnosis and treatment. This can be achieved by considering these diseases as a series of states.

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  • TRUS is the imaging technique most frequently used to assess the primary tumor, but its chief use is directing prostate biopsies, not staging. No TRUS finding consistently indicates cancer with certainty. CT lacks sensitivity and specificity to detect extraprostatic extension and is inferior to MRI in visualization of lymph nodes. In general, MRI performed with an endorectal coil is superior to CT to detect cancer in the prostate and to assess local disease extent.

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  • The PSA criteria used to recommend a diagnostic prostate biopsy have evolved over time. The goal is to increase the sensitivity of the test for younger men more likely to die of the disease and to reduce the frequency of detecting cancers of low malignant potential in elderly men more likely to die of other causes. Age-specific reference ranges reduce the upper limit of normal for younger men and increase it for older men. Different thresholds alter the sensitivity and specificity of detection. The threshold for performance of a biopsy was 4.0 ng/mL, which has been reduced to 2.6...

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  • Pathology The noninvasive proliferation of epithelial cells within ducts is termed prostatic intraepithelial neoplasia. PIN is a precursor of cancer, but not all PIN lesions develop into invasive cancers. Of the cancers identified, 95% are adenocarcinomas; the remainder are squamous or transitional cell tumors or, rarely, carcinosarcomas. Metastases to the prostate are rare, but in some cases colon cancers or transitional cell tumors of the bladder invade the gland by direct extension.

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  • Radical Prostatectomy The goal of radical prostatectomy is to excise the cancer completely with a clear margin, to maintain continence by preserving the external sphincter, and to preserve potency by preserving the autonomic nerves in the neurovascular bundle. Radical prostatectomy is advised for patients with a life expectancy of 10 years and is performed using a retropubic, perineal, or laparoscopic approach. Outcomes can be predicted using postoperative nomograms that consider pretreatment factors and the pathologic findings at surgery. PSA failure is defined as a value above 0.

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  • Antiandrogens Nonsteroidal antiandrogens such as flutamide, bicalutamide, and nilutamide block the binding of androgens to the receptor. When an antiandrogen is given alone, testosterone levels remain the same or increase. Compared to testosteronelowering therapies, antiandrogens cause fewer hot flashes, less of an effect on libido, less muscle wasting, fewer personality changes, and less bone loss. Gynecomastia remains a significant problem but can be alleviated in part by tamoxifen.

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  • Metastatic Disease: Castrate Castration-resistant disease can manifest in many ways. For some it is a rise in PSA with no change in radiographs and no new symptoms. In others it is a rising PSA and progression in bone with or without symptoms of disease. Still others will show soft tissue disease with or without osseous metastases, and others have visceral spread. The prognosis, which is highly variable, can be predicted using nomograms designed for the castration-resistant disease state.

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  • Brachytherapy Brachytherapy is the direct implantation of radioactive sources into the prostate. It is based on the principle that the deposition of radiation energy in tissues decreases as a function of the square of the distance from the source (Chap. 81). The goal is to deliver intensive irradiation to the prostate, minimizing the exposure of the surrounding tissues. The current standard technique achieves a more homogeneous dose distribution by placing seeds according to a customized template based on CT and ultrasonographic assessment of the tumor and computer-optimized dosimetry.

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  • For patients with a rising PSA after radiation therapy, salvage prostatectomy can be considered if the disease was "curable" at the outset, if persistent disease has been documented by a biopsy of the prostate, and if no metastatic disease is seen on imaging studies. Unfortunately, case selection is poorly defined in most series, and morbidities are significant. As currently performed, virtually all patients are impotent after salvage radical prostatectomy, and ~45% have either total urinary incontinence or stress incontinence.

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  • Benign Disease Symptoms Benign proliferative disease may produce hesitancy, intermittent voiding, a diminished stream, incomplete emptying, and postvoid leakage. The severity of these symptoms can be quantitated with the self-administered American Urological Association Symptom Index (Table 91-2), although the degree of symptoms does not always relate to gland size. Resistance to urine flow reduces bladder compliance, leading to nocturia, urgency, and, ultimately, urinary retention.

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  • Benign and malignant changes in the prostate increase with age. Autopsies of men in the eighth decade of life show hyperplastic changes in 90% and malignant changes in 70% of individuals. The high prevalence of these diseases among the elderly, who often have competing causes of morbidity and mortality, mandates a risk-adapted approach to diagnosis and treatment. This can be achieved by considering these diseases as a series of states.

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  • (BQ) Part 2 book "Treatment for skin color" presents the following contents: Pigmentary disorders, follicular disorders and alopecias, tumors benign and malignant, cosmetics, complementary and alternative medicine.

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  • Diagnosis and Treatment by Clinical State The disease continuum—from the appearance of a preneoplastic and invasive lesion localized to the prostate, to a metastatic lesion that results in symptoms and, ultimately, mortality from prostate cancer—can span decades. Management at all points is centered on competing risks that are defined by considering the disease as a series of clinical states (Fig. 91-1).

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  • Viruses are obligate parasites which depend on living cells to multiply. Their ability to deliver stable RNA and DNA into cells has determined their use in gene therapy. In 1983 Mann et al. developed one of the first retroviral gene therapy vectors for delivery in vitro (Mann, Mulligan et al. 1983). This development was followed by many successfully gene therapy trials of retroviruses (Anderson, Blaese et al. 1990; Levine and Friedmann 1991; Blaese, Culver et al. 1993). Now, retrovirual vectors are implemented in nearly 22.2% of clinical trials (http://www.wiley.

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  • In Mozambique, Pathfinder is going beyond traditional maternal and child health to ensure the survival of children into adulthood. In addition to their traditional role distributing family planning information and products, CHWs have begun distributing water-purification solution and insecticide-treated bed nets for malaria prevention to pregnant women and mothers of children under five. They are promoting exclusive breast-feeding to the age of six-months, iron and folate supplements for pregnant women, growth monitoring, deworming, and proper nutrition.

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  • We analyze the susceptibility of the Internet to random faults, malicious attacks, and mixtures of faults and attacks.We analyze actual Internet data, as well as simulated data created with network models. The network models generalize previous research, and allow generation of graphs ranging from uniform to preferential, and from static to dynamic.We introduce new metrics for analyzing the connectivity and performance of networks which improve upon metrics used in earlier research.

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  • Two large blocks of land were appraised for suitability for the development of planta- tion crops: Block A, north-west of Cameroon Mountain, including some areas of its foothills; Block B, extending eastward from the Douala-Mbanga road at Kompina toward the Wouri and Dibombe rivers (see Text Maps 1.1, 1.2 and 3.1). Block B was rejected because most of the area was topographically unsuitable. Several areas in Block A were also rejected because they were already settled or topographically unsuit- able.

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  • Schools reported the manner in which their nutrition education efforts are coordinated by a person or group. The majority of public schools (61 percent) have no nutrition education coordination, meaning each teacher is responsible for his or her nutrition lessons (table 6). About 9 percent of the schools have one person within the school coordinating nutrition education; 24 percent coordinate using a group or committee; and about 6 percent have someone outside the school, for example from the district, coordinate nutrition education.

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  • Particulate leaching is one of the popular techniques that are widely used to fabricate scaffolds for tissue engineering applications (Ma & Langer, 1999; Lu et al, 2000). Salt, wax or sugars known as porogens are used to create the pores or channels. Here salt is grounded into small particles and those particles that have desired size are poured into a mold and filled with the porogen. A polymer solution is then cast into the salt-filled mold. After the evaporation of the solvent, the salt crystals are leached away using water to form the pores of the scaffold. The process...

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  • Earlier this year, the Texas Health and Human Services Commission reported to its state legislature that WHP has been effective in reducing unplanned births and has saved the state millions of dollars due to the reduction in Medicaid costs associated with those births. It estimated that over 8,000 births were averted in 2011, yielding $54 million in net savings (federal plus state), including more than $23 million in state savings.

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