St. Clare Hospital

About: St. Clare Hospital is a healthcare organization based out in Lakewood, Washington, United States. It is known for research contribution in the topics: Bolus (medicine) & Internal medicine. The organization has 17 authors who have published 17 publications receiving 176 citations. The organization is also known as: Lakewood General.

Accuracy of Clinical Examination, Digital Mammogram, Ultrasound, and MRI in Determining Postneoadjuvant Pathologic Tumor Response in Operable Breast Cancer Patients

Abstract: To determine the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of clinical examination and breast imaging techniques in determining pathologic complete response in patients with locally advanced breast cancer after neoadjuvant therapy. A retrospective review was performed of data collected from patients treated with either neoadjuvant hormonal or chemotherapy between January 2005 and September 2010. Patients were evaluated by one of three surgical breast oncologists before neoadjuvant therapy and within 1 month before surgery by clinical breast examination (CBE), digital mammogram, breast ultrasound, and/or magnetic resonance imaging (MRI). The accuracy, NPV, and PPV of each modality was calculated on the basis of the final pathologic report. Available data from the literature was synthesized. Sixty-two tumors in 61 patients with a mean age of 56 (range 34–87) years were evaluated. Overall accuracy ranged from 54% (CBE) to 80% (breast ultrasound). All modalities had a PPV greater than 75% for identifying the presence of residual disease. The PPV of each modality was generally higher in the younger patients. The NPV of all methods was less than 50%. The accuracy and NPV were compromised even further in younger patients. The combination of our own data with data available from the literature revealed MRI to be superior with regard to accuracy and PPV, but the NPV of MRIs remained poor at 65%. All measured tests are good at predicting the presence of disease on final pathology, but none are able to reliably predict a pathologic complete response.

The effects of smoking on periodontal structures: a literature review.

Abstract: Periodontal disease seems to be more prevalent in smokers than in nonsmokers Studies have reported both increases and decreases in gingival blood flow due to smoking Smoking does not increase the presence of the periodontopathogens Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Bacteroides intermedius Both the chemotaxis and the phagocytic capacity of the polymorphonuclear leukocytes (PMNs) harvested from smokers are lower than with those harvested from nonsmokers Furthermore, smokers have lower IgA, IgG, IgM, and suppressor CD8 lymphocytes levels than nonsmokers These differences between smokers and nonsmokers should be taken into account by clinicians during periodontal examinations, therapy, and the healing process

The need for axillary dissection in patients with positive axillary sentinel lymph nodes.

Abstract: The need for completion axillary dissection after a positive sentinel node biopsy continues to be challenged In the 2 years since we last reviewed this subject, a number of authors have shared their experiences about micrometastatic disease and isolated tumor cells, opining both for and against axillary treatment Data from the ACOSOG Z0011 trial and other small studies do not appear to support the use of completion axillary dissection even for macro-metastatic disease in patients with clinically node-negative (N0) disease While existing guidelines still recommend axillary dissection for patients with clinically positive nodes, even when conversion to clinically negative disease following neoadjuvant chemotherapy has occurred, this concept is being questioned in ACOSOG Z1071 and in several other recent small trials The surgical approach to the treatment of breast cancer continues to move away from the traditional Halstedian concept

Efficacy, Safety, and Timing of 5% Sodium Chloride Compared With 23.4% Sodium Chloride for Osmotic Therapy.

Abstract: Background: Bolus doses of 23.4% sodium chloride (NaCl) are commonly used for the treatment of intracranial hypertension; however, delays in administration may occur in patients without central intravenous access. At our institution, equiosmolar bolus doses of 5% NaCl have emerged as potential alternatives to 23.4% NaCl because they may be safely administered through peripheral lines. Objectives: We sought to assess the efficacy in reducing intracranial pressure (ICP), time to administration, and safety of 5% NaCl as compared with 23.4% NaCl for the treatment of intracranial hypertension. Methods: Patients admitted from July 2012 to June 2014 who received boluses of 5% NaCl or 23.4% NaCl for a sustained ICP >20 mm Hg were included. Data collected included measurements of ICP, time to administration, and adverse events. Results: A total of 44 patients were identified; 11 received 5% NaCl, and 33 received 23.4% NaCl. The median percentage reductions in ICP at 30, 60, and 120 minutes in patients who received...