University of Toronto Medical Journal最新文献

Stereotactic Body Radiation Therapy (SBRT) Versus Transarterial Chemoembolization (TACE) for Treatment Of Hepatocellular Carcinoma: a Meta-Analysis of Propensity Matched Studies 立体定向体放射治疗 (SBRT) 与经动脉化疗栓塞 (TACE) 治疗肝细胞癌：倾向匹配研究的元分析

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University of Toronto Medical Journal Pub Date : 2024-01-31 DOI: 10.33137/utmj.v101i1.41240

Sangyang Jia, Nicholas Lao, R. G. Boldt, Amol Mujoomdar, Ronald Chow, Charles B Simone, Michael Lock

{"title":"Stereotactic Body Radiation Therapy (SBRT) Versus Transarterial Chemoembolization (TACE) for Treatment Of Hepatocellular Carcinoma: a Meta-Analysis of Propensity Matched Studies","authors":"Sangyang Jia, Nicholas Lao, R. G. Boldt, Amol Mujoomdar, Ronald Chow, Charles B Simone, Michael Lock","doi":"10.33137/utmj.v101i1.41240","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41240","url":null,"abstract":"Introduction: There are currently limited data comparing the efficacy of stereotactic body radiation therapy (SBRT) to transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC). The aim of this systematic review and meta-analysis was to report on the summary effect estimate of overall survival and local control at 1-year based on available evidence. \u0000Methods: A literature search was conducted in PubMed from database inception until April 2020. Articles were independently screened by two reviewers and included if they reported on a propensity-matched study design comparing SBRT to TACE for the treatment of HCC with at least 1 year follow up. Event data of overall survival and local control at 1-year were extracted. A random-effects model was applied to generate summary odds ratio and corresponding 95% confidence intervals (CI). \u0000Results: Four studies with 606 patients were identified and included. SBRT (73.6%) and TACE (67.0%) had similar 1-year rates of OS, with an OR of 0.87 (0.56, 1.37). SBRT (88.4%) had greater local control at 1 year compared to TACE (71.7%); OR of 0.34 (0.13, 0.86). \u0000Conclusion: SBRT is comparable to TACE in terms of 1-year survival for the treatment HCC and may provide an advantage in terms of local control. Future controlled trials are necessary to determine the clinical advantages and best indications for each treatment.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140473483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

An Exploration of Ethical Considerations in Adolescent Maternal-Fetal Conflict – Balancing of Ethical Principles and Factors Unique to Adolescence Through Applications of Microethics 探讨青少年母胎冲突中的伦理考虑--通过微观伦理学的应用平衡伦理原则和青少年特有的因素

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University of Toronto Medical Journal Pub Date : 2024-01-31 DOI: 10.33137/utmj.v101i1.40751

Stephanie Dephoure

引用次数: 0

Sarcoidosis Masquerading as Miliary Tuberculosis: A Case Report 肉样瘤病伪装成睫状体结核：一份病例报告

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University of Toronto Medical Journal Pub Date : 2024-01-31 DOI: 10.33137/utmj.v101i1.40965

Tony Abdelmaseeh, Rakesh Shah, John Sobuto, Renee Frank, Steven Archambault

引用次数: 0

Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy 肾病综合征急性肾动脉血栓形成的罕见病例：血管内人工抽吸血栓切除术的异常表现和疗效

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University of Toronto Medical Journal Pub Date : 2024-01-31 DOI: 10.33137/utmj.v101i1.41619

Fatin Syahirah Sulaiman, N. Mohamad, Mohd Hafizuddin Husin@Mohd Hussin, Chiew Chea Lau, K. A. Sayuti

{"title":"Rare Case of Acute Renal Artery Thrombosis in Nephrotic Syndrome: The Unusual Presentations and Outcomes of Endovascular Manual Aspiration Thrombectomy","authors":"Fatin Syahirah Sulaiman, N. Mohamad, Mohd Hafizuddin Husin@Mohd Hussin, Chiew Chea Lau, K. A. Sayuti","doi":"10.33137/utmj.v101i1.41619","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41619","url":null,"abstract":"Renal artery thrombosis is a rare condition that requires early diagnosis and urgent intervention to prevent renal infarction and permanent renal damage. Possibility of renal artery thrombosis should be considered in patients with underlying hypercoagulable state presented with acute unremitting flank pain, nausea and vomiting. We report a case of a 35-year-old man with underlying nephrotic syndrome who presented with three days history of acute non-localized and non-resolving abdominal pain and vomiting. He was initially referred to general surgery for acute intestinal obstruction. Contrast-enhanced computed tomography (CECT) abdomen revealed acute left renal infarction secondary to total thrombotic occlusion of the left renal artery. The patient was treated with endovascular manual aspiration thrombectomy resulting in partial revascularization of left renal artery with restoration of renal function, complete resolution of symptom and good clinical outcomes. This case report serves as a reminder for physicians to include renal infarction in the differential diagnosis when evaluating a patient with acute abdomen, particularly in patient with hypercoagulable state. This case also aligns with other experiences demonstrating positive outcomes after endovascular thrombectomy, even in the presence of prolonged renal ischemia time of more than 72 hours.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140472676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Chronic Neck Swelling: A Case Report of Migrating Fish Bone 慢性颈部肿胀鱼骨移位病例报告

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University of Toronto Medical Journal Pub Date : 2024-01-31 DOI: 10.33137/utmj.v101i1.41242

Saiful Islam BIN AHMAD HUSNI, Mawaddah Binti Azman, Timothy Wong Leong Wei

{"title":"Chronic Neck Swelling: A Case Report of Migrating Fish Bone","authors":"Saiful Islam BIN AHMAD HUSNI, Mawaddah Binti Azman, Timothy Wong Leong Wei","doi":"10.33137/utmj.v101i1.41242","DOIUrl":"https://doi.org/10.33137/utmj.v101i1.41242","url":null,"abstract":"Background: Foreign bodies in the upper aerodigestive tract are frequently seen in otolaryngological practice, but migration of foreign body and oesophageal penetration are rare occurrences. Most reported cases of migration in literature involve fish bones, which are usually found in the lateral neck soft tissue or thyroid lobule. This can cause serious complications if left untreated. In most cases, fish bones can be removed safely by endoscopy, but they may migrate extraluminally to the skin in rare cases. Computed tomography (CT) neck with contrast is the investigation of choice to confirm migration.\u0000Case presentation: We present a case of an elderly lady with fish bone ingestion which migrated and embedded itself over the right thyroid cartilage region that required open surgery for removal. In this case, the patient underwent two open surgeries to locate the presence of the foreign body despite the CT neck done to aid in mapping intraoperatively. We used surgical clips in the first unsuccessful operation in locating the foreign body, and later performed a repeat CT scan and the clips were used to pinpoint the exact location of the foreign body during second surgery. By doing so, we successfully managed to remove the foreign body and patient was discharged well.\u0000Conclusion: This case has illustrated how versatile surgical clips are in helping us to locate the position of the foreign body rather than blindly exploring and causing further iatrogenic injury. With supplementation from a thorough repeat CT scan, we do think that in a presenting case of foreign body migration with difficulty locating the exact foreign body location, imaging adjunct such as C arm fluoroscopy and ultrasound guidance as reported in the literature can be used to avoid unnecessary iatrogenic injury and cause more harm to the patient.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140470796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Navigating long wait times for rheumatological health issues and suggestions for further investigations 导航风湿病健康问题的漫长等待时间和进一步调查的建议

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.39276

John-Peter Bonello, Claire Sethuram

{"title":"Navigating long wait times for rheumatological health issues and suggestions for further investigations","authors":"John-Peter Bonello, Claire Sethuram","doi":"10.33137/utmj.v100i2.39276","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.39276","url":null,"abstract":"Canada continues to struggle with wait times for patients transitioning from primary to specialized care. Since 2019, wait times for speciality consultation and time to specialty treatment have increased significantly throughout Canada, with Ontario ranking third overall among the provinces for the longest wait times. In addition to Ontario having the largest population among the provinces, musculoskeletal (MSK) based issues make up approximately 30% of all primary care reasons for visits and ranks among the longest wait times by specialty. Thus, a large proportion of patients seeking MSK based health care in Ontario are experiencing significant delays. This commentary discusses the burden of wait times for MSK patients requiring specialized care and offers a guide on how to assess, interpret, and possibly challenge the current care model. Essentially, this commentary suggests further studies be conducted through a qualitative lens to gather and assess information about patients’ perspectives on access, feasibility, and patient-provider alignment of care. Through this subjective lens, a better understanding may be gained regarding how patients interact with the current model of care for MSK health, and this knowledge can be applied in creating patient-education resources, guiding continuing medical education, and most importantly, increasing awareness for prominent systemic impacts such as wait times.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75615040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Infusing artificial intelligence into hemophilia care: taking the next step 将人工智能注入血友病护理:迈出下一步

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41464

Pascal Tyrrell

引用次数: 0

A unique case report of sigmoid colon cancer metastasising to the breasts, ovaries and stomach in pregnancy 乙状结肠癌在妊娠期转移到乳房、卵巢和胃的独特病例报告

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.37765

Victoria Phooi Khei Tan, W. Teng, Fong Juen Kiew, N. Azizan, F. Hayati

引用次数: 0

Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery 诊所家具安排导致患者自报血压差异:一例罕见的左锁骨下动脉完全闭塞

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.37887

Mohd Azzahi Mohamed Kamel, I. A. Ismail, Jazlan Jamaluddin, M. F. Hamdan

引用次数: 0

Introduction of a Patient as Teacher Program into family medicine residency: an exploratory pilot study 在家庭医学住院医师中引入病人为教师计划:一项探索性试点研究

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.40384

Muna Alkhaifi, Emily Peircell, Stephanie Mooney, Adam Clayton, J. Simpson

{"title":"Introduction of a Patient as Teacher Program into family medicine residency: an exploratory pilot study","authors":"Muna Alkhaifi, Emily Peircell, Stephanie Mooney, Adam Clayton, J. Simpson","doi":"10.33137/utmj.v100i2.40384","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.40384","url":null,"abstract":"Background: Family medicine residents should be prepared to address the psychosocial issues that breast cancer survivors may experience. \u0000Objectives: Our study aimed to implement a patient-centred approach model into the family medicine residency program and evaluate the impact of such a program on residents. \u0000Methods: An interactive virtual session (75 minutes), was integrated into the academic half-day of the family medicine residency program at St. Michael’s Hospital. The session was led by a cancer survivor and her partner. They discussed how illness has impacted their lives and reflect on their experiences with the health care system. The session was facilitated by a trained facilitator in health care. A qualitative approach was used to evaluate the impact of this program. Two focus groups for residents was conducted to evaluate the delivery mode, recommendations and impact of the proposed program. The focus group discussions were recorded, transcribed and thematically analyzed. \u0000Results: This program has had positive influences on residents by improving therapeutic relationships and enhancing the residents' understanding of the experience of illness. This program allowed residents to appreciate the importance of understating patients’ perspectives and values. Additionally, adding the partner perspective to the program was appreciated and valued by residents. \u0000Conclusions: Based on the school’s specific curriculum, this program can be integrated into the residents’ academic activities. This can improve important competencies for family medicine residents including confidence in communication and increased empathy. Family medicine residency programs wishing to enhance such humanism skills by family physicians might consider this model.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76698618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0