java barcode reader api open source Prognosis in Objective-C

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The median survival of patients with indolent lymphomas has been 6 8 years, but this appears to be changing for the better These diseases ultimately become refractory to chemotherapy This often occurs at the time of histologic progression of the disease to a more aggressive form of lymphoma The International Prognostic Index is now widely used to categorize patients with intermediate-grade lymphoma into risk groups Factors that confer adverse prognosis are age over 60 years, elevated serum LDH, stage III or stage IV disease, and poor performance status Patients with no risk factors or one risk factor have high complete response rates (80%) to standard chemotherapy, and most responses (80%) are durable Patients with two risk factors have a 70% complete
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HODGKIN S DISEASE
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ESSENTIALS OF DIAGNOSIS
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Painless lymphadenopathy Constitutional symptoms may or may not be present Pathologic diagnosis by lymph node biopsy
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Hodgkin s disease is a group of cancers characterized by Reed Sternberg cells in an appropriate reactive cellular
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background The malignant cell is derived from B lymphocytes of germinal center origin
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Clinical Findings
There is a bimodal age distribution, with one peak in the 20s and a second over age 50 years Most patients present because of a painless mass, commonly in the neck Others may seek medical attention because of constitutional symptoms such as fever, weight loss, or drenching night sweats, or because of generalized pruritus An unusual symptom of Hodgkin s disease is pain in an involved lymph node following alcohol ingestion An important feature of Hodgkin s disease is its tendency to arise within single lymph node areas and spread in an orderly fashion to contiguous areas of lymph nodes Only late in the course of the disease will vascular invasion lead to widespread hematogenous dissemination Hodgkin s disease is divided into several subtypes: lymphocyte predominance, nodular sclerosis, mixed cellularity, and lymphocyte depletion Hodgkin s disease should be distinguished pathologically from other malignant lymphomas and may occasionally be confused with reactive lymph nodes seen in infectious mononucleosis, cat-scratch disease, or drug reactions (eg, phenytoin) Patients undergo a staging evaluation to determine the extent of disease The staging nomenclature (Ann Arbor) is as follows: stage I, one lymph node region involved; stage II, involvement of two lymph node areas on one side of the diaphragm; stage III, lymph node regions involved on both sides of the diaphragm; and stage IV, disseminated disease with bone marrow or liver involvement In addition, patients are designated stage A if they lack constitutional symptoms and stage B if 10% weight loss over 6 months, fever, or night sweats are present If symptoms indicate careful evaluation for higher numerical stage, clinical stage IB (for example) is highly likely to emerge as stage II or stage IIIB
patients who are older, those who have bulky disease, and those with lymphocyte depletion or mixed cellularity on histologic examination The prognosis of those with the lymphocyte-predominant form of the disease is better than in other subtypes, with cure seen in > 70% of those with disseminated disease and with limited treatment needed for those with early-stage disease Others whose disease recurs after initial radiotherapy treatment may still be curable with chemotherapy The treatment of choice for patients who relapse after initial chemotherapy is highdose chemotherapy with autologous stem cell transplantation This offers a 35 50% chance of cure when disease is still chemotherapy sensitive
Bonadonna G et al ABVD plus subtotal nodal versus involved-field radiotherapy in early-stage Hodgkin s disease: long-term results J Clin Oncol 2004 Jul 15;22(14):2835 41 [PMID: 15199092] Engert A et al Hodgkin's lymphoma in elderly patients: a comprehensive retrospective analysis from the German Hodgkin's Study Group J Clin Oncol 2005 Aug 1;23(22):5052 60 [PMID: 15955904] Nogova L et al Biology, clinical course and management of nodular lymphocyte-predominant hodgkin lymphoma Hematology Am Soc Hematol Educ Program 2006:266 72 [PMID: 17124071] Re D et al From Hodgkin disease to Hodgkin lymphoma: biologic insights and therapeutic potential Blood 2005 Jun 15;105(12): 4553 60 [PMID: 15728122]
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