eMedicine创建于1996年，由近万名临床医师作为作者或编辑参与此临床医学知识库的建设，其中编辑均是来自美国哈佛、耶鲁、斯坦福、芝加哥、德克萨斯、加州大学等各分校医学院的教授或副教授。

eMedicine

http://www.hu.ufsc.br/projeto_hpv/CAP%204%20-%20MANEJO%20HPV%206%20E%2011.pdf

Chapter 4: Burden and management of non-cancerous HPV-related conditions: HPV-6/11 disease.

Human Papillomavirus (HPV)-6 and -11 are the causative agents of ano-genital wans (GWs) and recurrent respiratory papillomatosis (RRP). They are low-risk HPV types that are uncommonly found in malignant lesions. GWs are an extremely prevalent sexually transmitted disease, whereas RRP is a rare disease that can be life threatening and requires multiple surgical procedures. GWs and RRP cause substantial healthcare costs. A quadrivalent HPV-6/11/16/18 vaccine (Merck/SPMSD) has shown essentially 100% protection against GWs in women in early studies. Cost-effectiveness analyses are needed to assess the benefits of the HPV-6/11 virus-like particle (VLP) components of the quadrivalent vaccine in population-based vaccination programmes.

Burden and management of non-cancerous HPV-related conditions : HPV-6/11 disease

BACKGROUND
The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H & N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN).

METHODS
The FACT-H & N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy).

RESULTS
FACT-H & N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H & N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H & N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being.

CONCLUSIONS
The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H & N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome. Cancer 1996;77:2294-301.

The performance status scale for head and neck cancer patients and the functional assessment of cancer therapy‐head and neck scale: A study of utility and validity

Background:

Nutritional status plays an important role in the incidence of postoperative complications and the prognosis of various tumours. The prognostic value of preoperative nutritional factors in patients with pancreatic cancer is not known.



Methods:

This retrospective study included 268 patients who underwent resection for adenocarcinoma of the pancreas. The predictive value of preoperative nutritional status for postoperative outcome (survival, complications) was assessed. Nutritional factors included the three constitutional indices, serum albumin and Onodera's prognostic nutrition index (PNI), calculated as 10 × serum albumin (g/dl) + 0·005× total lymphocyte count (per mm3).



Results:

In multivariable analysis preoperative low PNI (but not low albumin) was an independent prognostic factor for poor survival: hazard ratio (HR) 1·73 (95 per cent confidence interval (c.i.) 1·21 to 2·47). The accuracy of a PNI value of less than 45 as cut-off for clinically significant preoperative malnutrition in predicting 1- or 2-year survival after surgery was, however, limited (66·4 and 56·3 per cent respectively). Low preoperative albumin concentration and PNI were significantly associated with postoperative complications: odds ratio 1·98 (95 per cent c.i. 1·18 to 3·32) and 2·14 (1·23 to 3·73) respectively. Low PNI and low body mass index were independently associated with pancreatic fistula: HR 2·52 (1·37 to 4·63) and 0·40 (0·17 to 0·93) respectively.



Conclusion:

The PNI is associated with overall survival and postoperative complications, in particular pancreatic fistula, in patients with pancreatic cancer. The moderate accuracy of PNI as a predictor of survival limits its clinical use. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Nutritional predictors of postoperative outcome in pancreatic cancer

Nonunion of the mandible: an analysis of contributing factors.

• Assuming that intraorbital volume is a space defined by the orbital walls, and that intraorbital contents represent a space occupied by soft tissues, changes between volume and contents will result in movement of the globe in usually a forward (exophthalmic) or backward (enophthalmic) direction. An understanding of the phenomenon is important if the clinician is to judge the effects of traumatic displacement of an orbital wall on globe positions and if the clinician is to design a reconstructive procedure to correct these changes. To study such relationships, we have designed physical models based on measurements of five dry human skulls. With these models, it has been possible to move a whole wall or part of a wall and, thereby, adjust the orbital volume. The experimental manipulations are useful in predicting the relationships of the orbital wall position and volume—information that can be ultimately used for diagnosis and reconstructive purposes. ( Arch Otolaryngol Head Neck Surg 1988;114:743-747)

Orbital Wall and Volume Relationships

Objectives/Hypothesis: The main objective was to demonstrate that human papillomavirus (HPV) type 11 is an aggressive virus that plays a significant role in the development of laryngeal cancer in patients with a history of recurrent respiratory papillomatosis (RRP). We have done so by preliminary investigation into the molecular mechanism underlying the malignant transformation of RRP to invasive squamous cell carcinoma. Study Design: An experimental, nonrandomized, retrospective study using tissue specimens from nine patients with a history of RRP that progressed to laryngeal or bronchogenic cancer was performed. Methods: DNA and RNA were extracted from 20 formalin-fixed, paraffin-embedded specimens from six patients with a history of early onset RRP and laryngeal cancer and from three patients with early onset RRP and bronchogenic cancer. Polymerase chain reaction (PCR) was performed on DNA to determine the HPV type in each specimen. Reverse-transcriptase PCR specific for virus transcripts was performed on RNA to determine whether the viral genome was integrated into the host genome. Results: HPV-11 but not HPV-6, 16, or 18 was found in all of the laryngeal and bronchogenic cancers in patients with a history of early onset RRP in this study. RNA, sufficiently intact for examination, was obtained from seven patients. Analysis of HPV 11 transcripts revealed integration of the viral genome in three of seven patients. Conclusions: HPV type 6 and 11 are considered low-risk viruses and are not associated with genital cancers, as are HPV types 16 and 18. However, our data suggests that HPV type 11 is an aggressive virus in laryngeal papilloma that should be monitored in patients with RRP.

Integration of human papillomavirus type 11 in recurrent respiratory papilloma-associated cancer.

OBJECTIVE: We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF).STUDY DESIGN: All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes.RESULTS: A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required.CONCLUSION: Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension.SIGNIFICANCE: This is the largest single institution report of CCNF with thoracic extension id...

Craniocervical necrotizing fasciitis: an 11-year experience.

Objective: Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups. Study Design: Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center. Methods: Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test. Results: A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23 ± 2.26 mm as compared with 17 ± 2.65 mm for white males (P > .025). Black females demonstrated a mean projection of 17.27 ± 1.44 mm as compared with 15.98 ± 2.22 mm for white females (P > .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH. Conclusions: These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.

Robert H. Mathog

Papers

Nonunion of the mandible: an analysis of contributing factors.

Orbital Wall and Volume Relationships

Integration of human papillomavirus type 11 in recurrent respiratory papilloma-associated cancer.

Craniocervical necrotizing fasciitis: an 11-year experience.

Orbital measurement in black and white populations.