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Mukhtar RA, Chau H, Woriax H, Piltin M, Ahrendt G, Tchou J, Yu H, Ding Q, Dugan CL, Sheade J, Crown A, Carr M, Wong J, Son J, Yang R, Chan T, Terando A, Alvarado M, Ewing C, Tonneson J, Tamirisa N, Gould R, Singh P, Godellas C, Larson K, Chiba A, Rao R, Sauder C, Postlewait L, Lee MC, Symmans WF, Esserman LJ, Boughey JC. Breast Conservation Surgery and Mastectomy Have Similar Locoregional Recurrence After Neoadjuvant Chemotherapy: Results From 1462 Patients on the Prospective, Randomized I-SPY2 Trial. Ann Surg 2023; 278:320-327. [PMID: 37325931 DOI: 10.1097/sla.0000000000005968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Neoadjuvant chemotherapy (NAC) increases rates of successful breast-conserving surgery (BCS) in patients with breast cancer. However, some studies suggest that BCS after NAC may confer an increased risk of locoregional recurrence (LRR). We assessed LRR rates and locoregional recurrence-free survival (LRFS) in patients enrolled on I-SPY2 (NCT01042379), a prospective NAC trial for patients with clinical stage II to III, molecularly high-risk breast cancer. Cox proportional hazards models were used to evaluate associations between surgical procedure (BCS vs mastectomy) and LRFS adjusted for age, tumor receptor subtype, clinical T category, clinical nodal status, and residual cancer burden (RCB). In 1462 patients, surgical procedure was not associated with LRR or LRFS on either univariate or multivariate analysis. The unadjusted incidence of LRR was 5.4% after BCS and 7.0% after mastectomy, at a median follow-up time of 3.5 years. The strongest predictor of LRR was RCB class, with each increasing RCB class having a significantly higher hazard ratio for LRR compared with RCB 0 on multivariate analysis. Triple-negative receptor subtype was also associated with an increased risk of LRR (hazard ratio: 2.91, 95% CI: 1.8-4.6, P < 0.0001), regardless of the type of operation. In this large multi-institutional prospective trial of patients completing NAC, we found no increased risk of LRR or differences in LRFS after BCS compared with mastectomy. Tumor receptor subtype and extent of residual disease after NAC were significantly associated with recurrence. These data demonstrate that BCS can be an excellent surgical option after NAC for appropriately selected patients.
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Affiliation(s)
- Rita A Mukhtar
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Harrison Chau
- Department of Surgery, University of California San Diego, San Diego, CA
| | - Hannah Woriax
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Mara Piltin
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Julia Tchou
- Department of Surgery, University of Pennsylvania, Philadelphia, PA
| | - Hongmei Yu
- Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - Qian Ding
- Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - Catherine Lu Dugan
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Jori Sheade
- Department of Surgery, Northwestern University, Chicago, IL
| | - Angelena Crown
- Department of Surgery, Swedish Cancer Institute, Seattle, WA
| | - Michael Carr
- Department of Surgery, University of Louisville, Louisville, KY
| | - Jasmine Wong
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Jennifer Son
- Department of Surgery, Georgetown University, Washington, D.C
| | - Rachel Yang
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Theresa Chan
- Department of Surgery, Ironwood Cancer and Research Centers, Phoenix, AZ
| | - Alicia Terando
- Department of Surgery, Cedars-Sinai Cancer at Huntington Hospital Cancer Center, Pasadena, CA
| | - Michael Alvarado
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Cheryl Ewing
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Jennifer Tonneson
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Nina Tamirisa
- Department of Surgery and Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rebekah Gould
- Department of Surgery and Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Puneet Singh
- Department of Surgery and Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kelsey Larson
- Department of Surgery, University of Kansas, Kansas City, KS
| | - Akiko Chiba
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Roshni Rao
- Department of Surgery, Columbia University, New York, NY
| | - Candice Sauder
- Department of Surgery, University of California Davis, Davis, CA
| | | | | | - William Fraser Symmans
- Department of Surgery and Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Laura J Esserman
- Department of Surgery, University of California San Francisco, San Francisco, CA
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O'Keefe TJ, Chau H, Harismendy O, Wallace AM. Risk factors for breast cancer mortality after ductal carcinoma in situ diagnosis differ from those for invasive recurrence. Surgery 2023; 173:305-311. [PMID: 36435650 DOI: 10.1016/j.surg.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 09/12/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Breast cancer mortality after ductal carcinoma in situ is rare, making it difficult to predict which patients are at risk and to identify whether risk factors for this outcome are the same as those for invasive recurrence. We aimed to identify whether risk factors for invasive recurrences are similar to those for breast cancer death after a diagnosis of pure ductal carcinoma in situ. METHODS The Surveillance, Epidemiology, and End Results Program was queried for female patients diagnosed with pure ductal carcinoma in situ. Cumulative incidence was estimated by treatment group using competing risks. Competing risks regression was then performed for the development of in-breast invasive recurrence with competing risks of breast and non-breast cancer death. Competing risks regression was then again performed for development of breast cancer mortality with the competing risk of non-breast cancer death. RESULTS A total of 29,515 patients were identified. Of them, 164 patients suffered breast cancer mortality without an intervening invasive recurrence, and 44 suffered breast cancer mortality after an invasive in-breast recurrence. On competing risks analysis for invasive in-breast recurrence, significant factors included lesion size >5 cm (hazard ratio = 1.59, 95% confidence interval 1.24-2.04, P < .001), diffuse disease (hazard ratio = 0.0005, 95% confidence interval 0.0003-0.0007, P < .001), other race (hazard ratio = 1.29, 95% confidence interval 1.10-1.52, P = .002), Black race (hazard ratio = 1.21, 95% confidence interval 1.01-1.46, P = .04), age at diagnosis (hazard ratio = 0.99, confidence interval 0.98-1.00, P = .02), low-grade disease (hazard ratio = 0.79, 95% confidence interval 0.64-0.96, P = .02), lumpectomy with radiation (hazard ratio = 0.67, 95% confidence interval 0.58-0.77, P < .001), and mastectomy (hazard ratio = 0.36, 95% confidence interval 0.30-0.44, P < .001). Significant factors for breast cancer mortality included age at diagnosis (hazard ratio = 1.04, 95% confidence interval 1.03-1.05, P < .001), Black race (hazard ratio = 2.88, 95% confidence interval 2.08-3.99, P < .001), diffuse disease (hazard ratio = 6.02, 95% confidence interval 1.39-26.07, P = .02), lumpectomy with radiation (hazard ratio = 0.51, 95% confidence interval 0.36-0.72, P < .001), and mastectomy (hazard ratio = 0.60, 95% confidence interval 0.50-0.92, P = .02). CONCLUSION Our results suggested that risk factors for in-breast invasive recurrence after a diagnosis of pure ductal carcinoma in situ differ from risk factors for breast cancer mortality and development of metastatic recurrence. In-breast invasive recurrence is not the only consideration for breast cancer specific mortality in ductal carcinoma in situ patients.
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Affiliation(s)
- Thomas J O'Keefe
- Division of Breast Surgery and the Comprehensive Breast Health Center, University of California San Diego, La Jolla, CA.
| | - Harrison Chau
- Division of Breast Surgery and the Comprehensive Breast Health Center, University of California San Diego, La Jolla, CA
| | - Olivier Harismendy
- Moores Cancer Center and Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, CA
| | - Anne M Wallace
- Division of Breast Surgery and the Comprehensive Breast Health Center, University of California San Diego, La Jolla, CA
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Mou Z, Chau H, Kalavacherla S, Radgoudarzi N, Soliman SI, Zhao B, Mekeel K. Tailored order set in the electronic health record decreases postoperative opioid prescriptions. Surgery 2022; 172:677-682. [DOI: 10.1016/j.surg.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/22/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
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Abstract
BACKGROUND Ultrasonography for trauma is a widely used tool in the initial evaluation of trauma patients with complete ultrasonography of trauma (CUST) demonstrating equivalence to computed tomography (CT) for detecting clinically significant abdominal hemorrhage. Initial reports demonstrated high sensitivity of CUST for the bedside diagnosis of pneumothorax. We hypothesized that the sensitivity of CUST would be greater than initial supine chest radiograph (CXR) for detecting pneumothorax. METHODS A retrospective analysis of patients diagnosed with pneumothorax from 2018 through 2020 at a Level I trauma center was performed. Patients included had routine supine CXR and CUST performed prior to intervention as well as confirmatory CT imaging. All CUST were performed during the initial evaluation in the trauma bay by a registered sonographer. All imaging was evaluated by an attending radiologist. Subgroup analysis was performed after excluding occult pneumothorax. Immediate tube thoracostomy was defined as tube placement with confirmatory CXR within 8 hours of admission. RESULTS There were 568 patients screened with a diagnosis of pneumothorax, identifying 362 patients with a confirmed pneumothorax in addition to CXR, CUST, and confirmatory CT imaging. The population was 83% male, had a mean age of 45 years, with 85% presenting due to blunt trauma. Sensitivity of CXR for detecting pneumothorax was 43%, while the sensitivity of CUST was 35%. After removal of occult pneumothorax (n = 171), CXR was 78% sensitive, while CUST was 65% sensitive (p < 0.01). In this subgroup, CUST had a false-negative rate of 36% (n = 62). Of those patients with a false-negative CUST, 50% (n = 31) underwent tube thoracostomy, with 85% requiring immediate placement. CONCLUSION Complete ultrasonography of trauma performed on initial trauma evaluation had lower sensitivity than CXR for identification of pneumothorax including clinically significant pneumothorax requiring tube thoracostomy. Using CUST as the primary imaging modality in the initial evaluation of chest trauma should be considered with caution. LEVEL OF EVIDENCE Diagnostic Test study, Level IV.
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Affiliation(s)
- Jarrett E Santorelli
- From the Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, Department of Surgery, UC San Diego School of Medicine, San Diego, California
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Parekh JR, Lam J, Chau H, Berumen J, Schnickel GT, Mekeel K. Impact of diabetes and chronic dialysis on post-transplant survival in combined heart-kidney transplant recipients. Clin Transplant 2021; 35:e14338. [PMID: 33948985 DOI: 10.1111/ctr.14338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
Growing research supports an increased survival benefit of combined heart and kidney transplantation in patients with both heart and renal failure. As a result, the frequency of these combined transplants continues to increase. Despite this trend, little has been done to quantify the impact of chronic illness in this population. We identified adult recipients of combined heart-kidney transplant from the Scientific Registry of Transplant Recipients (SRTR) database between 2005 and 2018. We focused on renal disease secondary to diabetes and duration of dialysis as markers of chronic illness. The primary outcome was post-transplant mortality. Our final multivariable Cox proportional hazard model found that diabetes-associated renal disease (HR 1.57, 95% CI 1.14-2.15, p = .01) and dialysis duration (HR 1.08, 95% CI 1.01-1.15, p = .02) were significant predictors of post-transplant mortality. Given the significant impact of dialysis duration and renal disease secondary to diabetes mellitus, these chronically ill patients should be closely examined for conditions such as peripheral vascular disease and frailty, which have been shown to affect mortality in heart transplant recipients and are prevalent in the chronic dialysis population.
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Affiliation(s)
- Justin R Parekh
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Jenny Lam
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Harrison Chau
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Jennifer Berumen
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Gabriel T Schnickel
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
| | - Kristin Mekeel
- Division of Transplantation, Department of Surgery, University of California San Diego, La Jolla, CA, USA
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Wong CHF, Chau H, Man CW, Chu SK. Case of nephropulmonary fistula and literature review. Urol Case Rep 2019; 28:101046. [PMID: 31709148 PMCID: PMC6833353 DOI: 10.1016/j.eucr.2019.101046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/12/2019] [Accepted: 10/15/2019] [Indexed: 11/28/2022] Open
Abstract
From the literature, the managements for nephropulmonary fistula were variable. We would like to present our case and review the literature for the best method of care. The common features were 1) infected kidney; 2) ipsilateral lower lobe pneumonia or pleural effusion; 3) sputum and urine culture growing the same organism. Renal gaseous content may not be present on x-ray or even CT scan. The choice of management for the nephropulmonary fistula was diverse. However, conservative managements including antibiotics, endourological procedures for stone clearance, percutaneous drainage were not successful. Nephrectomies were required. Operative tips and anaesthesia preparation recommendations are given.
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Affiliation(s)
- C H F Wong
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - H Chau
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - C W Man
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - S K Chu
- Division of Urology, Department of Surgery, Tuen Mun Hospital, Hong Kong
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Abstract
Asymptomatic emphysematous pyelonephritis is a rare but potentially life-threatening disease. Diabetes mellitus is the most recognised risk factor. Aim of this case report is to review evidence of emphysematous pyelonephritis to identify risk factors and treatment options.
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Affiliation(s)
- Amh Yeung
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - C H Cheng
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - Psk Chu
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - C W Man
- Department of Surgery, Tuen Mun Hospital, Hong Kong
| | - H Chau
- Department of Surgery, Tuen Mun Hospital, Hong Kong
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Ramdat JE, Chong R, Ng R, Chau H, May YZ, Loke A. P-18 Continuous quality improvement to increase ACP visibility in inpatient wards. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Chong R, Ramdat JE, Ng R, Chau H, May YZ, Loke A. P-103 Honouring patients’ advance care plan – a post-death audit review. BMJ Support Palliat Care 2015. [DOI: 10.1136/bmjspcare-2015-000978.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Poirrier AL, Ahluwalia S, Kwame I, Chau H, Bentley M, Andrews P. External nasal valve collapse: validation of novel outcome measurement tool. Rhinology 2014; 52:127-32. [PMID: 24932623 DOI: 10.4193/rhino13.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. METHODOLOGY For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. RESULTS The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. CONCLUSION External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.
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Poirrier A, Ahluwalia S, Kwame I, Chau H, Bentley M, Andrews P. External nasal valve collapse: validation of novel outcome measurement tool. Rhinology 2014. [DOI: 10.4193/rhin13.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ng R, Chong R, Chau H, Poi CH, Eng Ramdat J, May YZ, Loke A, Wu HY. STARTING PILOTS IN ADVANCE CARE PLANNING IN A TERTIARY HOSPITAL IN SINGAPORE: 1 YEAR REVIEW. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ng R, Chong R, Chau H, Poi CH, Eng Ramdat J, May YZ, Loke A, Wu HY. ADVANCE CARE PLANNING AS A DYNAMIC PROCESS: A DESCRIPTIVE 1 YEAR REVIEW OF CHANGES IN ACP PLANS IN TAN TOCK SENG HOSPITAL. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Facial nerve neuromas occur throughout the course of the facial nerve and its branches, however lesions occurring on the chorda tympani branch are exceptionally rare. We present a case where the diagnosis was made intra-operatively; the patient was pre-operatively thought to have had a cholesteatoma. Total resection is the treatment of choice for these cases. Early diagnosis, aided by high resolution computed tomography (CT) scanning, will facilitate complete excision without damage to the facial nerve itself or the ossicular chain. The slow growing nature of the neuroma is likely to allow compensatory mechanisms to occur without the patient experiencing dysgeusia. As with any rarity the diagnosis can only be made with a high index of suspicion.
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Affiliation(s)
- C Hopkins
- Department of Otolaryngology, Royal Sussex County Hospital, Brighton, UK.
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Desrosiers P, Carlson E, Chandler W, Chau H, Cong P, Doolen R, Freitag C, Lin S, Masui C, Wu E, Crevier T, Mullins D, Song L, Lou R, Zhan J, Tangkilisan A, Ung Q, Phan K. High throughput screening techniques for pre-formulation: salt selection and polymorph studies. Acta Crystallogr A 2002. [DOI: 10.1107/s0108767302085446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
This study surveys Vietnamese refugees attending two psychiatric clinics to determine both the prevalence of panic disorder (PD) as well as panic attack subtypes in those suffering PD. A culturally valid adaptation of the SCID-panic module (the Vietnamese Panic Disorder Survey or VPDS) was administered to 100 Vietnamese refugees attending two psychiatric clinics. Utilizing culturally sensitive panic probes, the VPDS provides information regarding both the presence of PD and panic attack subtypes during the month prior to interview. Of 100 patients surveyed, 50 (50%) currently suffered PD. Among the 50 patients suffering PD, the most common panic attack subtypes during the previous month were the following: "orthostatic dizziness" (74% of the 50 panic disorder patients [PDPs]), headache (50% of PDPs), wind-induced/temperature-shift-induced (24% of PDPs), effort-induced (18% of PDPs), gastro-intestinal (16% of PDPs), micturition-induced (8% of PDPs), out-of-the-blue palpitations (24% of PDPs), and out-of-the-blue shortness of breath (16% of PDPs). Five mechanisms are adduced to account for this high PD prevalence as well as the specific profile of subtypes: 1) a trauma-caused panic attack diathesis; 2) trauma-event cues; 3) ethnic differences in physiology; 4) catastrophic cognitions generated by cultural syndromes; and 5) a modification of Clark's spiral of panic.
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Affiliation(s)
- D Hinton
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
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Abstract
OBJECTIVE To assess the efficacy of rectally administered gemeprost pessaries in the treatment of severe postpartum hemorrhage. DESIGN Retrospective analysis of a twelve month period in which all patients having postpartum hemorrhage treated with rectal gemeprost were analyzed. SETTING Royal Darwin Hospital, Northern Territory, Australia. POPULATION Fourteen women with established postpartum hemorrhage not responding to oxytocine and ergometrine regimens, or not responsive to oxytocine and having contraindications to ergometrine. MAIN OUTCOME MEASURES Per vaginum bleeding with continued postpartum hemorrhage; adverse patient reactions to gemeprost; need for operative intervention. RESULTS All patients who were treated with rectally administered gemeprost pessaries had cessation of bleeding per vaginum. There were no adverse side effects noted from the medication and no patient required surgical treatment. CONCLUSIONS Rectally administered gemeprost administered pessaries appear to be safe and effective method of treating severe postpartum hemorrhage in those patients in whom the standard oxytocic regimens fail. This form of treatment may avoid the need for parenteral prostaglandins or surgical intervention.
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Affiliation(s)
- S Craig
- Department of Obstetrics and Gynecology, Royal Darwin Hospital, Northern Territory, Australia
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