tailieunhanh - PRINCIPLES OF INTERNAL MEDICINE - PART 3

Điều trị bệnh nhân chán ăn tâm thần nghiêm trọng (75% trọng lượng cơ thể dự kiến ) đòi hỏi phải cẩn thận chăm sóc y tế và tâm thần. Bệnh nhân có thâm hụt trọng lượng nặng nên phải nhập viện, tại thời gian đó một chương trình phục hồi dinh dưỡng với ăn uống với thực phẩm bổ sung chất lỏng | V. Oncology And Hematology Answers 73 cancer. About 16 of patients with prostate cancer have an elevated level of serum PSA as their sole diagnostic abnormality. However additional studies need to be done to delineate precisely the role of PSA evaluation in screening. Fewer than 10 of ambulatory volunteers older than 50 years have elevated serum PSA values. A serum PSA between 4 and 10 ng mL indicates that cancer is 25 likely whereas values 10 ng mL increase the likelihood of cancer to about 60 . About 20 of those with an elevated PSA alone compared with 10 of those with a suspicious digital rectal examination alone will have prostate cancer. The vast majority of cancers that are detected by screening for PSA are localized clinically and therefore have an excellent chance of being cured with either radiation or surgery. Moreover few tumors detected by PSA screening are incidental since most have a high volume or a worrisome Gleason score indicating a poor prognosis based on histologic grade . On the other hand additional studies demonstrating a screening-induced decrease in cancer-related mortality are necessary in order to convince all that screening for prostate cancer with PSA determinations is beneficial. A clear use for serum PSA determination is in postoperative evaluation. If the postoperative serum PSA value is detectable the presence of residual tumor is likely. A rising PSA value after definitive radiation therapy indicates a high likelihood of eventual metastatic spread. The use of systemic hormonal therapy for metastatic prostate cancer should be reserved for those patients with certain evidence of locally advanced or metastatic disease. V-78. The answer is B. Chap. 89. Early Breast Cancer Trialists Collaborative Group Lancet 352 930-942 1998. For premenopausal women who have node-negative breast cancer axillary metastases only chemotherapy when employed as an adjuvant therapy leads to a statistically significant reduction in the recurrence rate. It is