SummaryA double-blind placebo controlled trial of Mucodyne (carbocisteine, Berk Pharmaceuticals), Actifed (triprolidine HCI and pseudoephedrine HCI, Wellcome) and combined Mucodyne and Actifed in the treatment of middle-ear effusions is reported. The trial was undertaken to assess whether either preparation, alone or in Combination, would reduce the number of children requiring surgical treatment for this condition. No statistical difference between the various groups in avoiding surgical treatment with Mucodyne was associated with a significantly greater number of ears restored to a normal appearance and middle ear function as measured by tympanometry. All patients relapsing after surgery belonged to the groups receiving placebo, Actifed or the combination of Mucodyne and Actifed prior to the operation.
Background: Women diagnosed with atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), and borderline ADH/DCIS are at increased risk for breast cancer, but the precise degree of risk varies widely in the literature. Information from prior studies is limited by grouping ADH and ALH together and by small cohort sizes. Objectives: To identify women with a pathologic diagnosis of ADH, ALH, LCIS, and borderline ADH/DCIS using Natural Language Processing. To evaluate breast cancer risk based on atypia type. Methods: Using Natural Language Processing, we reviewed all electronically available pathology reports from Massachusetts General Hospital, Brigham and Women's Hospital, and Newton-Wellesley Hospital (members of Partners HealthCare System) from 1987–2010. We identified all women with a diagnosis of ADH, ALH, LCIS, and borderline ADH/DCIS with no prior or concurrent diagnosis of breast cancer. We determined the incidence of subsequent invasive and noninvasive breast cancer, the side of cancer diagnosis compared to original atypia side, and the time to cancer diagnosis for each atypia type. Results: We reviewed 76,333 path reports in 42,950 unique individuals and identified 3049 women who were diagnosed with atypical breast lesions over this 14-year period; 1233 (40.4%) had ADH, 851 (27.9%) had ALH, 595 (19.5%) had LCIS, and 370 (12.1%) had borderline ADH/DCIS. The mean age for atypia diagnosis was 51 years (range: 18–93). At a mean follow-up of 66 months, cancer occurred in 7.0% of women with ADH, 11.3% of women with ALH, 11.1% of women with LCIS, and 8.4% of women with borderline ADH/DCIS. The median time to breast cancer diagnosis was 48 months with ADH, 50 months with ALH, 47 months with LCIS, and 60 months with borderline ADH/DCIS. Significantly more ipsilateral cancers developed than contralateral cancers for all types of atypia combined (p=0.027). The development of invasive versus noninvasive breast cancer was not significantly affected by atypia type. Subsequent cancers were DCIS in 121 patients (43.4%) and invasive in 158 patients (56.6%). Kaplan Meier curves for time to cancer diagnosis based on atypia type were created. The curves for ADH and borderline ADH/DCIS were similar and significantly different than the curves for ALH and LCIS (p<0.001). The estimated 5 and 10-year breast cancer risks for each atypia type are presented in Table 1. Conclusion: A diagnosis of ADH, ALH, LCIS, or borderline ADH/DCIS increases a woman's risk of invasive and noninvasive breast cancer in either breast. The breast cancer risk at 5 and 10 years is significantly higher in those with ALH or LCIS compared to those with ADH or borderline ADH/DCIS, but there is little difference in risk between ADH and borderline ADH/DCIS or between LCIS and ALH. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr S4-4.
SU_Ml\1A~Y: A case of ext radural and l'crchellar absces.o,; complicating chronic car disease iu an 18 year old C hmese grr) IS reported. The case hi!!o1ory illustrates the difficulties experienced in makinJ,; the diagnosi,,_ Case ReportAn 18 year old Chinese girl was admitted with a one week history of fever, headache, constipation and pain in her left ear. She gave a history of recurrent ear problems during cruldhood. On examination temperature was 39.3 QC with a pulse rate of 1.00 per minute. Pus discharged through a perforation of her left tympanic membrane. The ESR was 100 mm in the first hour, haemoglobin 11.4 Gms / 100 mls. white cell co unt 11.7 x 10 3 C.m m with 79 % polymorphonuclear leucocytes. C hest X-ra y_ urea a nd electrolytes and a Denco were all normal. Swabs from the thoat and left ear, and blood and urine <.:ultures were negative. X-rays of her skull showed a large bon y defect in the left mastoid, which was otherwise scJeroti<.: and poo rly pneumatised.She was sLa rt ed on benzylpenicillin and continued on cotrimoxazole. Two hours a fter admission she su!fered a generalised convulsion which lasted 3 m inu tes. Immediat~l y after this she \\'a5 delirious and had an axillary te mperature of 42°C. She was cha nged from intramuscular to intravenous benzylpenicillin.On the se~ond da y of admission hcr temperature was 38~C .. She was lethargic and had a slight degree of menmgIsm but there were no other neurological abnormalities. There was evidence of acute on chronic ear disease but there was no evidence of acute masto iditis.On the morning of the fourth day of admission she was apyrexial, lethargic and mentally dulled. She had early left sided papilloedema but there were no other neuro logical abnormalities. A CAT scan was arranged for the next day. That evening, however, ~hc became pyrcxia J and was found to ha ve left Sid ed cerebellar signs, n ystagmus. bi latera l extensor planta r and absent abdominal reflexes Emergency mastoidec tomy revealed extensive cholesteatomatous di~ea~e invading the mastoid . The fl oor of the temporal fossa over the atric was removed and norm a l dura found . The bony plate over the sigmoid sinus was removed and a large extradural co llection of pus was found . A modi fied radi cal (;aVil y was formed . Streptococc us Group C wa ... cultured from the left mastoid cavity and Streptococcus pneumoniae from the extradural absces~. Dexamethasone was started postoperatively.She slowly improved over the next week and tbe cerebellar signs gradually disappeared. The drowsiness. however. did not improve and on the fourlct:nth day of admission she agai n developed gross signs suggesling a left sided cerebeHar lesion.
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