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  • 1
    ISSN: 1615-5947
    Keywords: Carotid endarterectomy ; elderly patients
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The records of 146 patients 80 years of age or older who underwent 183 carotid endarterectomy operations from 1964 through 1990 were reviewed to determine surgical risk. The indications for operation were asymptomatic patients with carotid stenosis (n=36); ipsilateral transient ischemic attacks (n=46); ipsilateral stroke (n=28); ipsilateral retinal embolus (n=15); nonlateralizing symptoms (n=40); and asymptomatic side in patients with contralateral symptoms (n=18). Postoperatively, three patients (1.6% of operations) had a stroke with a residual deficit and three (1.6%) died. All deaths were from myocardial infarction. For comparison, during the same time period, the combined stroke with residual deficit and death rate for patients less than 80 operated upon for similar indications was 3.5%. Since 80-year-old patients have a life expectancy of at least five years, the authors conclude that elderly patients should be evaluated for carotid endarterectomy using criteria similar to that used for younger patients.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1615-5947
    Keywords: Carotid endarterectomy ; asymptomatic patient ; stenosis ; prophylactic operation ; stroke ; arteriography ; cerebral ischemia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We reviewed the records of 291 asymptomatic patients who underwent 377 carotid endarterectomy operations. The study excludes endarterectomies performed simultaneously with other operations that influence morbidity as well as endarterectomies on patients with symptoms caused by contralateral carotid stenosis. Postoperatively, nine patients had a stroke but two of the nine recovered completely after reoperation. Seven patients (2% of operations) were discharged with a neurologic deficit. One patient died of a myocardial infarction. Combined strokes with residual deficit and deaths totaled eight patients (2.2% of operations). During the time of the study the indication for operation changed from 〉 60% stenosis of the carotid artery to 〉 80% stenosis. This paper argues that, based on information currently available, a surgical morbidity rate of 〈 3% justifies prophylactic endarterectomy. Surgeons must audit their results to demonstrate they can perform the operation with low risk to the patient.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    Springer
    Breast cancer research and treatment 17 (1990), S. 3-7 
    ISSN: 1573-7217
    Keywords: cholesterol ; tamoxifen ; adjuvant therapy ; breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The serum cholesterol levels of 123 consecutively and newly diagnosed women with Stage I and II breast cancer taking tamoxifen were compared with a control group of 81 consecutively newly diagnosed women with Stage I and II breast cancer who were not taking a hormonal treatment or supplement. Other factors that were evaluated were age, menopausal status, tumor size, weight, height, Quetelet index, and smoking and alcohol intake history. The mean cholesterol change in patients on tamoxifen (34.2 ± 3.6 mg/dl) was significantly greater than controls (1.0 ± 4.1 mg/dl) (P〈0.001). Serum cholesterol fell by more than 10 mg/dl in 72.9% of women on tamoxifen vs. 35.1% of controls and by more than 40 mg/dl in 39.9% of women on tamoxifen vs. 12.6% of controls. Multivariate analysis revealed that tamoxifen administration (P〈0.0001), initial cholesterol level (P = 0.001), and age (P = 0.04) were significant factors in producing a decrease in serum cholesterol. The administration of tamoxifen as adjuvant therapy to women with newly diagnosed breast cancer resulted in a significant fall in serum cholesterol. This effect of tamoxifen on the serum cholesterol may prove to be an additional benefit in the form of reduced cardiovascular risk in these women.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    Breast cancer research and treatment 3 (1983), S. 221-224 
    ISSN: 1573-7217
    Keywords: Adjuvant therapy ; breast cancer ; ceruloplasmin ; recurrence prediction ; response to therapy ; tumor markers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Ceruloplasmin (CP), an acute phase reactant, has been found to be elevated in patients with various tumors including breast cancer. We found that the CP level was elevated in 89% of 103 patients with metastatic breast cancer. In 27 patients with measurable metastatic disease that responded to treatment the mean CP level fell by 35% (p〈0.001) and in 22 patients whose disease progressed on treatment, the mean CP level rose by 44% (p〈0.001). Of those patients with Stage II breast cancer that were treated with adjuvant chemotherapy, only 6% of patients with a normal post mastectomy CP level have recurred, whereas 44% of patients with an elevated post mastectomy CP level have recurred (p〈0.01). In following patients with breast cancer, we noted that in those patients that recurred, the CP level became elevated 16–34 weeks prior to any clinical evidence of metastases. We also noted that the CP level became elevated after initially falling in patients receiving adjuvant chemotherapy and on occasion, the initially elevated CP level did not even fall. These circumstances may represent resistant microscopic disease, so that changing to a noncross-resistant chemotherapeutic regimen might be appropriate.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Journal of behavioral medicine 17 (1994), S. 127-141 
    ISSN: 1573-3521
    Keywords: breast cancer ; adjustment ; cluster analysis ; coping ; fighting spirit
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Psychology
    Notes: Abstract By means of cluster analytic techniques, four subtypes of psychosocial adjustment were identified in a sample of 122 breast cancer patients who completed the Psychosocial Adjustment to Illness Scale. Internal consistency and internal validity of the derived typology were suggested by the finding that two different hierarchical agglomerative clustering methods (average linkage between groups, Ward's) produced similar solutions. Three of the derived subtypes reported normal affect levels but different patterns of relative strengths and dysfunctions, while the fourth subtype appeared to be highly distressed and globally maladjusted. External validation was demonstrated by differentiating the subtypes on variables of negative affect, avoidance coping, and fighting spirit. The clinical and heuristic implications of these findings are discussed. The findings highlight the need for comprehensive assessment of psychosocial functioning of cancer patients. They demonstrate that even non-emotionally distressed patients can have very different profiles of adjustment and may benefit from correspondingly individually tailored psychosocial interventions.
    Type of Medium: Electronic Resource
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