The records of 34 patients diagnosed with primary small bowel non-Hodgkin's lymphoma during a 10-year period between January 1996 and December 2005, including 27 cases for which complete follow-up records were available, were studied. Abdominal pain (70.6% of patients) was the main presenting symptom, followed by intestinal obstruction (38.2%). The most common primary site was the ileum (58.8%), followed by the jejunum (26.5%) and duodenum (17.6%); one case had tumours at two sites in the small bowel. Twenty-seven patients had small bowel B-cell lymphoma (24 diffuse large B-cell lymphoma; three mucosa-associated lymphoid tissue B-cell lymphoma) and seven patients had small bowel T-cell lymphoma. Cumulative survival in patients with small bowel B-cell lymphoma was higher than that in patients with small bowel T-cell lymphoma. Data on 16 male and eight female patients with diffuse large B-cell lymphoma showed that 62.5% of these patients presented with disease stages I or II and 37.5% with stages III or IV. Cumulative survival in patients at stages IE or IIE was significantly higher than that of patients at stages IIIE or IVE. Four of five patients who died from diffuse large B-cell lymphoma had abnormal levels of lactate dehydrogenase and serum albumin.
Replenishment of LM gets priority rather than FM and BMC during the first 3 months after RAI, and the increase in LM starts from the upper body; head is the regional site in which FM recovery occurs first.
To evaluate the cost-effectiveness, from the Hong Kong healthcare perspective, of CYP2C19 genotype-guided selection of antiplatelet therapy compared with universal use of clopidogrel or ticagrelor (irrespective of genotype) for acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI). MethOds: A two-part model consisting of a 1-year decision tree and a lifetime Markov model was developed to compare: (i) generic clopidogrel or ticagrelor based on CYP2C19*2 genotype (52% carriers locally), (ii) universal clopidogrel and (iii) universal ticagrelor. Risks of non-fatal myocardial infarction, nonfatal stroke, stent thrombosis, major bleeding and death were estimated from the Asian sub-study of PLATO. The Markov model was built to simulate the progress of a typical cohort of 60-year-old Chinese patients with ACS undergoing PCI. Follow-up was until age 85 years. Costs were estimated from a prospective PCI registry in a Hong Kong tertiary referral hospital, and expressed in 2016 Hong Kong dollars (HKD). All costs and quality-adjusted life-years (QALYs) were discounted at an annual rate of 3%. Incremental cost-effectiveness ratios (ICERs) of < HKD 268,333 (1 time GDP of Hong Kong) were considered cost-effective. Results: Universal ticagrelor use was cost-effective compared with universal clopidogrel (ICER= HKD 64,039/ QALY). With CYP2C19 genetic testing at a minimum cost of HKD117 (USD15), genotype-guided antiplatelet therapy was dominant compared to universal ticagrelor. Sensitivity analysis showed that under the ceiling price of HKD17,711 (USD2270), genotype-guided therapy remained a cost-effective strategy compared with universal clopidogrel or ticagrelor. cOnclusiOns: CYP2C19*2 genotype-guided antiplatelet therapy selection was considered a cost-effective strategy compared to either unselected generic clopidogrel or ticagrelor in ACS patients after PCI in Hong Kong. CE4 ThE MulTidisCiplinary risk assEssMEnT and ManagEMEnT prograM -diabETEs MElliTus (raMp-dM) was CosT-EffECTivE for Managing paTiEnTs wiTh diabETEs MElliTus
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