1,494 research outputs found

    Ultrasound mapping of lymph node and subcutaneous metastases in patients with cutaneous melanoma: Results of a prospective multicenter study

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    Background: Ultrasound (sonography, B-mode sonography, ultrasonography) examination improves the sensitivity in more than 25% compared to the clinical palpation, especially after surgery on the regional lymph node area. Objective: To evaluate the distribution of metastases during follow-up in the draining lymph node areas from the scar of primary to regional lymph nodes ( head and neck, supraclavicular, axilla, infraclavicular, groin) in patients with cutaneous melanoma with or without sentinel lymph node biopsy (SLNB) or former elective or consecutive complete lymph node dissection in case of positive sentinel lymph node (CLND). Methods: Prospective multicenter study of the Departments of Dermatology of the Universities of Homburg/Saar, Tubingen and Munich (Germany) in which the distribution of lymph node and subcutaneous metastases were mapped from the scar of primary to the lymphatic drainage region in 53 melanoma patients ( 23 women, 30 men; median age: 64 years; median tumor thickness: 1.99 mm) with known primary, visible lymph nodes or subcutaneous metastases proven by ultrasound and histopathology during the follow-up. Results: Especially in the axilla, infraclavicular region and groin the metastases were not limited to the anatomic lymph node regions. In 5 patients (9.4%) ( 4 of them were in stage IV) lymph node metastases were not located in the corresponding lymph node area. 32 patients without former SLNB had a time range between melanoma excision and lymph node metastases of 31 months ( median), 21 patients with SLNB had 18 months ( p < 0.005). In 11 patients with positive SLNB the time range was 17 months, in 10 patients with negative SLNB 21 months ( p < 0.005); in 32 patients with CLND the time range was 31 m< 0.005). In thinner melanomas lymph node metastases occurred later ( p < 0.05). Conclusions: After surgery of cutaneous melanoma, SLNB and CLND the lymphatic drainage can show significant changes which should be considered in clinical and ultrasound follow-up examinations. Especially for high-risk melanoma patients follow-up examinations should be performed at intervals of 3 months in the first years. Patients at stage IV should be examined in all regional lymph node areas clinically and by ultrasound. Copyright (c) 2006 S. Karger AG, Basel

    Gifting personal interpretations in galleries

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    The designers of mobile guides for museums and galleries face three major challenges: fostering rich interpretation, delivering deep personalization, and enabling a coherent social visit. We propose an approach to tackling all three simultaneously by inviting visitors to design an interpretation that is specifically tailored for a friend or loved one that they then experience together. We describe a trial of this approach at a contemporary art gallery, revealing how visitors designed personal and sometimes provocative experiences for people they knew well. We reveal how pairs of visitors negotiated these experiences together, showing how our approach could deliver intense experiences for both, but also required them to manage social risk. By interpreting our findings through the lens of ‘gift giving’ we shed new light on ongoing explorations of interpretation, personalization and social visiting within HCI

    Telaprevir-based triple-therapy in patients with chronic hepatitis C in Germany: a 12-week interim analysis of real-life data

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    Telaprevir (TVR)-based triple therapy in patients (pts) with chronic hepatitis C (HCV) in daily practice in Germany is investigated in this non-interventional study. Aims are the evaluation of the implementation of futility rules, as well as safety and efficacy of TVR-based therapy. This prospective, multi-center study investigates TVR-based therapy in therapy-na&#x00EF;ve and pretreated pts with genotype 1 chronic HCV in Germany, including pts with HIV co-infection. Patients are treated with a combination of TVR, ribavirin and peg-interferon. This interim analysis includes data from the first 100 pts (12.5% of the planned total) at 32 sites completing 12 weeks (W) of treatment. 66% of pts were pretreated for HCV. 36.4% of pts with pre-treatment were prior relapsers and 30.3% null or partial responders. Cirrhosis was present in 11% of all pts at baseline. HCV RNA levels below 800.000 IU/ml at baseline were present in 50% of pts. 67% of pts showed rapid virological response (RVR, undetectable HCV RNA at W4). Adherence to the futility rule (treatment stop if HCV-RNA&#x003E;1000 IU/ml at W4) was 100% (N=9). At W12, 91.4% of pts had undetectable HCV RNA. 57.7% of therapy-na&#x00EF;ve pts and 86.4% of previous relapsers were HCV-RNA negative at both W4 and 12 (70.8% in total). Only one patient achieving RVR at W4 suffered a virologic breakthrough. Nearly all pts (99%) had adverse events (AE) during the first 12W, 6% reported serious adverse events (SAE). AEs were mostly mild (63.9%) or moderate (34.6%) and frequently mentioned dry skin/pruritus (54%), gastrointestinal disorders (48%), anorectal discomfort (30%), rash (29%) and anemia (23%). Rash was mostly rated as mild or moderate (97.1%). An Hb decrease&#60;12 g/dl (female) or&#60;13 g/dl (male) was reported in 87% of pts. Mean Hb levels decreased from 14.8 g/dl at baseline to 10.6 g/dl at W12; Hb levels&#60;8.5 g/dl at any time within the first 12W of treatment were present in 11% of anemia cases and 6.6% required transfusion. Only one patient received erythropoietin treatment. 2 cases each of anemia and rash were considered as SAE. These interim results suggest that TVR-based triple-therapy is efficient against GT1 chronic hepatitis C in a real life setting. Adherence to futility rules was confirmed in all patients. As observed in clinical trials, adverse events were reported frequently, including anemia and rash. As more data become available, results will be updated

    Surrender, catch and the imp of fieldwork

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    We build on the work of Kurt Wolff to capture some distinctive aspects of ethnographic fieldwork. Drawing on the sociology of knowledge and phenomenology, Wolff introduced and developed the idea of surrender-and- catch in order to encapsulate the twin processes of engagement and reflection. We extend the idea to incorporate what we call the 'imps’ of ethnographic fieldwork. For neither surrender nor catch are themselves predictable or perfectly under the ethnographer’s control. While fieldwork is itself unpredictable, there may be many unanticipated ‘catches’. Moreover, there is often an ethnographic ‘imp’ that intrudes itself, questioning the very desirability or good sense of the fieldwork itself. The imps arise unbidden but can pose searching, sometimes unwelcome – though ultimately productive – questions. We illustrate the paper from a brief fieldwork encounter with the world of studio photography

    52-week efficacy and safety of telbivudine with conditional tenofovir intensification at week 24 in HBeAg-positive chronic Hepatitis B

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    Background and Aims: The Roadmap concept is a therapeutic framework in chronic hepatitis B for the intensification of nucleoside analogue monotherapy based on early virologic response. The efficacy and safety of this approach applied to telbivudine treatment has not been investigated. Methods: A multinational, phase IV, single-arm open-label study (ClinicalTrials.gov ID NCT00651209) was undertaken in HBeAg-positive, nucleoside-naive adult patients with chronic hepatitis B. Patients received telbivudine (600 mg once-daily) for 24 weeks, after which those with undetectable serum HBV DNA (<300 copies/mL) continued to receive telbivudine alone while those with detectable DNA received telbivudine plus tenofovir (300 mg once-daily). Outcomes were assessed at Week 52. Results: 105 patients commenced telbivudine monotherapy, of whom 100 were included in the efficacy analysis. Fifty-five (55%) had undetectable HBV DNA at Week 24 and continued telbivudine monotherapy; 45 (45%) received tenofovir intensification. At Week 52, the overall proportion of undetectable HBV DNA was 93% (93/100) by last-observation-carried-forward analysis (100% monotherapy group, 84% intensification group) and no virologic breakthroughs had occurred. ALT normalization occurred in 77% (87% monotherapy, 64% intensification), HBeAg clearance in 43% (65% monotherapy, 16% intensification), and HBeAg seroconversion in 39% (62% monotherapy, 11% intensification). Six patients had HBsAg clearance. Myalgia was more common in the monotherapy group (19% versus 7%). No decrease in the mean glomerular filtration rate occurred in either treatment group at Week 52. Conclusions: Telbivudine therapy with tenofovir intensification at Week 24, where indicated by the Roadmap strategy, appears effective and well tolerated for the treatment of chronic hepatitis B. Trial Registration: ClinicalTrials.gov NCT0065120

    The hydrogen–air burning rate near the lean flammability limit

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    This paper investigates the inner structure of the thin reactive layer of hydrogen–air fuellean deflagrations close to the flammability limit. The analysis, which employs seven elementary reactions for the chemistry description, uses the ratio of the characteristic radical and fuel concentrations as a small asymptotic parameter, enabling an accurate analytic expression for the resulting burning rate to be derived. The analysis reveals that the steady-state assumption for chemical intermediaries, applicable on the hot side of the reactive layer, fails, however, as the crossover temperature is approached, providing a nonnegligible higher-order correction to the burning rate. The results can be useful, for instance, in future investigations of hydrogen deflagration instabilities near the lean flammability limit

    Counterparts: Clothing, value and the sites of otherness in Panapompom ethnographic encounters

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    This is an Author's Accepted Manuscript of an article published in Anthropological Forum, 18(1), 17-35, 2008 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/10.1080/00664670701858927.Panapompom people living in the western Louisiade Archipelago of Milne Bay Province, Papua New Guinea, see their clothes as indices of their perceived poverty. ‘Development’ as a valued form of social life appears as images that attach only loosely to the people employing them. They nevertheless hold Panapompom people to account as subjects to a voice and gaze that is located in the imagery they strive to present: their clothes. This predicament strains anthropological approaches to the study of Melanesia that subsist on strict alterity, because native self‐judgments are located ‘at home’ for the ethnographer. In this article, I develop the notion of the counterpart as a means to explore these forms of postcolonial oppression and their implications for the ethnographic encounter
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