Favorable Outcome (favorable + outcome)

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Distribution within Medical Sciences

Selected Abstracts

FOXP3 Expression in Human Kidney Transplant Biopsies Is Associated with Rejection and Time Post Transplant but Not with Favorable Outcomes

S. Bunnag
Expression of the transcription factor forkhead box P3 (FOXP3) in transplant biopsies is of interest due to its role in a population of regulatory T cells. We analyzed FOXP3 mRNA expression using RT-PCR in 83 renal transplant biopsies for cause in relationship to histopathology, clinical findings and expression of pathogenesis-based transcript sets assessed by microarrays. FOXP3 mRNA was higher in rejection (T-cell and antibody-mediated) than nonrejection. Surprisingly, some native kidney controls also expressed FOXP3 mRNA. Immunostaining for FOXP3 was consistent with RT-PCR, showing interstitial FOXP3+ lymphocytes, even in some native kidney controls. FOXP3 expression correlated with interstitial inflammation, tubulitis, interstitial fibrosis, tubular atrophy, C4d positivity, longer time posttransplant, younger donors, class II panel reactive antibody >20% and transcript sets reflecting inflammation and injury, but unlike these features was time dependent. In multivariate analysis, higher FOXP3 mRNA was independently associated with rejection, T-cell-associated transcripts, younger donor age and longer time posttransplant. FOXP3 expression did not correlate with favorable graft outcomes, even when the analysis was restricted to biopsies with rejection. Thus FOXP3 mRNA expression is a time-dependent feature of inflammatory infiltrates in renal tissue. We hypothesize that time-dependent entry of FOXP3-positive cells represents a mechanism for stabilizing inflammatory sites. [source]

Favorable outcome of ex-vivo purging of monocytes after the reintroduction of treatment after interruption in patients infected with multidrug resistant HIV-1,

Hamid Hasson
Abstract In multidrug resistant patients treatment interruptions allow the selection of archived wild-type drug-susceptible viruses that compete for the less fit drug-resistant strains. However, the selection of viruses with increased replicative capacity is often followed by a loss of CD4+ T cells. In addition, drug resistant variants later re-emerge limiting the overall clinical benefit of treatment interruption. Blood monocytes are a key component of the HIV reservoir and can be partially removed by a system for purging of myeloid cells (MYP). This study tested the safety and efficacy of MYP on multidrug resistant patients who underwent treatment interruption. Twelve patients were randomized to receive or not six cycles of MYP during treatment interruption. An optimized antiretroviral regimen was reintroduced after the reappearance of a drug susceptible genotype. Following therapy reintroduction, a long lasting increase in CD4+ T cell counts was observed only in the treatment interruption,+,MYP patients but not in the control patients. Five/six treatment interruption,+,MYP patients never experienced virological rebound during a median follow up period of 98 weeks. In contrast, 4/6 patients who did not receive MYP never reached complete viral suppression and had a virological rebound after a median of 16.5 weeks after treatment reintroduction. The difference between the two groups in the time to virological rebound was statistically significant (P,=,0.021). A consistent decrease of HIV DNA load in CD14+ purified cells was observed only in treatment interruption,+,MYP patients. These data suggest that MYP can improve the immunological and virological response to treatment interruption. J. Med. Virol. 79:1640,1649, 2007. 2007 Wiley-Liss, Inc. [source]

Transarterial Chemoinfusion for Hepatocellular Carcinoma as Downstaging Therapy and a Bridge toward Liver Transplantation

W. De Luna
Favorable outcomes after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) are well described for patients who fall within defined tumor criteria. The effectiveness of tumor therapies to maintain tumor characteristics within these criteria or to downstage more advanced tumors to fall within these criteria is not well understood. The aim of this study was to examine the response to transcatheter arterial chemoinfusion (TACI) in HCC patients awaiting LT and its efficacy for downstaging or bridging to transplantation. We performed a retrospective study of 248 consecutive TACI cases in 122 HCC patients at a single U.S. medical center. Patients were divided into two groups: those who met the Milan criteria on initial HCC diagnosis (n = 95) and those with more advanced disease (n = 27). With TACI treatment, 87% of the Milan criteria group remained within the Milan criteria and 63% of patients with more advanced disease were successfully downstaged to fall within the Milan criteria. In conclusion, TACI appears to be an effective treatment as a bridge to LT for nearly 90% patients presenting within the Milan criteria and an effective downstaging modality for over half of those whose tumor burden was initially beyond the Milan criteria. [source]

A follow-up study of juvenile obsessive,compulsive disorder from India

Y. C. Janardhan Reddy
Objective:, To study the long-term course and outcome of juvenile obsessive,compulsive disorder (OCD). Method:, Two to 9-year follow-up of largely self-referred, drug-nave subjects (n = 58) by employing catch-up longitudinal design. Results:, The mean follow-up period was 5 years. Nearly three-fourth of the sample was adequately treated with medications. Only 21% of the subjects had clinical OCD at follow-up and 48% were in true remission (no OCD and not on treatment). Earlier age-at-onset was associated with better course and outcome. Conclusion:, Juvenile OCD has favorable outcome. Our findings are applicable to psychiatric hospital settings in India and perhaps to the general psychiatric settings in the Western countries. Whether the better outcome in this sample is the result of differing clinical characteristics or because of true cross-cultural variation in the course needs further exploration. It is speculated that early onset OCD could be a subtype of juvenile OCD with better outcome. [source]

Acute Postoperative Seizures after Frontal Lobe Cortical Resection for Intractable Partial Epilepsy

EPILEPSIA, Issue 6 2003
Simona Tigaran
Summary: Purpose: To evaluate the incidence and prognostic importance of acute postoperative seizures (APOSs) occurring in the first week after a focal corticectomy in patients with partial epilepsy of frontal lobe origin. Methods: We retrospectively evaluated 65 patients who underwent a frontal lobe cortical resection for intractable partial epilepsy between April 1987 and December 2000. All patients were followed up for a minimum of 1 year after surgery. Results: APOSs occurred in 17 (26%) patients. None of the following factors was shown to be significantly associated with the occurrence of APOSs: gender, duration of epilepsy, etiology for seizure disorder, use of subdural or depth electrodes, surgical pathology, or postoperative risk factor for seizures. Patients with APOSs were older at seizure onset and at the time of surgery (p = 0.003 and p = 0.05, respectively). At last follow-up, patients who had APOSs had a seizure-free outcome similar to that of individuals without APOSs (47.1% vs. 50.0%; p = 0.77). Patients with APOSs appeared less likely to have a favorable outcome [i.e., fewer than three seizures per year and >95% decrease in seizure activity (58.8 vs. 70.8%; p = 0.35)]. This result may not have reached statistical significance because of the sample size. No evidence suggested that precipitating factors or the timing of APOSs was an important prognostic factor. Conclusions: The presence of APOSs after frontal lobe surgery for intractable epilepsy does not preclude a significant reduction in seizure tendency. These findings may be useful in counseling patients who undergo surgical treatment for frontal lobe epilepsy. [source]

Benign Partial Epilepsies of Adolescence: A Report of 37 New Cases

EPILEPSIA, Issue 12 2001
G. Capovilla
Summary: ,Purpose: To delineate the electroclinical features of patients with partial seizures in adolescence with a benign outcome. Methods: Patients were recruited in five different Italian epilepsy centers. Patients were selected among those with partial seizures between ages 11 and 17 years. We excluded benign childhood epilepsies, those with neurologic or mental deficits, and those with neuroradiologically documented lesions. We also excluded patients with less than 3 years' follow-up or who were still receiving antiepileptic therapy. Results: There were 37 (22 male, 15 female) patients. Seizures started at the mean age of 14.5 years (range, 11,16.11). Two main electroclinical patterns emerged: 16 of 37 patients had somatomotor seizures frequently associated with focal theta discharges involving the centroparietal regions. Ten of 37 patients showed versive seizures and interictal spiking involving the posterior regions. A third group had clinical characteristics resembling the cases described by Loiseau. All had a favorable outcome. Conclusions: This relevant multicenter study further confirms the existence of benign partial epilepsies with onset during adolescence. [source]

Biallelic deletion 13q14.3 in patients with chronic lymphocytic leukemia: cytogenetic, FISH and clinical studies

Christian Chena
Abstract Background and objective:, Monoallelic deletion of 13q14.3 (13q14x1) is the most common abnormality in chronic lymphocytic leukemia (CLL). As a sole alteration, it predicts a favorable outcome. Biallelic 13q14.3 (13q14x2) deletion or concomitant 13q14x1/13q14x2 has been scarcely evaluated in the literature. We present the clinical, cytogenetic and fluorescence in situ hybridization (FISH) analysis of six CLL patients with normal karyotypes and 13q14x2 and their comparison to cases with 13q14x1 as a single abnormality. Patients and methods:, A total of 103 CLL patients were studied. Cytogenetic and FISH analysis were performed on stimulated peripheral blood lymphocytes. Specific fluorescence DNA probes for CLL were used. Results:, Six out of 103 (5.8%) patients showed normal karyotypes and 13q14x2. It was observed as a single alteration in one patient and combined with 13q14x1 in five cases. Biallelic clones were larger than monoallelic ones in 3/5 patients (60%). The comparison of clinical and hematological data between 13q14x1 and 13q14x2 groups showed progression of the disease in all 13q14x2 patients respect to 12/32 (37.5%) cases with 13q14x1 (P = 0.008), significant differences in the distribution by Rai stage (P = 0.042) and a tendency of a higher lactate dehydrogenase level in 13q14x2 patients (P = 0.054). Treatment free survival for 13q14x2 group was 28.5 months, shorter than those observed in patients with 13q14x1 alone (49 months). Conclusions:, Our data would suggest that 13q14x2 could represent a more aggressive FISH anomaly than 13q14x1 alone, probably as a consequence of clonal evolution and/or due to the complete inactivation of this critical region by mean of more complex mechanisms. [source]

Chronic cognitive sequelae after traumatic brain injury are not related to growth hormone deficiency in adults

D. Pavlovic
Objective:, The objective of the study was to asses the possible influence of hypothalamo,pituitary deficiencies, and growth hormone (GH) deficiency in particular, on cognition in adult patients with traumatic brain injury (TBI). TBI is a recently identified risk factor for cognitive deficits and hypopituitarism. Even the patients with favorable outcome after TBI may present with persistent bodily, psychosocial, and cognitive impairments, resembling patients with untreated partial or complete pituitary insufficiency. Design:, We performed retrospective and cross-sectional study of endocrine and cognitive function in TBI in 61 patients (aged 37.7 1.7 years) of both sexes (44 m,17 f), at least 1 year after TBI (3.9 0.6 years). Serum insulin-like growth factor 1 (IGF-I), thyroxin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (in men), prolactin, and cortisol were measured, and GH secretion was assessed by growth hormone releasing hormone (GHRH) + growth hormone releasing peptide-6 (GHRP-6) test. Cognitive function was assessed by using a standard neuropsychological battery. Results:, GH deficiency (GHD) and GH insufficiency (GHI) were found in 20 patients (32.8%). After adjustment for confounders [age, body mass index (BMI), education level, time elapsed from TBI], there were no significant differences in results of neuropsychological tests between patients with TBI with GHD, GHI, and normal GH secretion. There were no correlations of neuropsychological variables with stimulated peak GH secretion or IGF-I level. Conclusions:, GHD persists long after the TBI, independently of trauma severity and age at traumatic event. GH secretion is more sensitive to TBI than other pituitary hormones. No evidence is found for an association of cognitive function impairment and somatotropic axis impairment in adult patients tested more than 1 year after the TBI. [source]

Outcome prediction and risk assessment by quantitative pyrosequencing methylation analysis of the SFN gene in advanced stage, high-risk, neuroblastic tumor patients

Barbara Banelli
Abstract The aim of our study was to identify threshold levels of DNA methylation predictive of the outcome to better define the risk group of stage 4 neuroblastic tumor patients. Quantitative pyrosequencing analysis was applied to a training set of 50 stage 4, high risk patients and to a validation cohort of 72 consecutive patients. Stage 4 patients at lower risk and ganglioneuroma patients were included as control groups. Predictive thresholds of methylation were identified by ROC curve analysis. The prognostic end points of the study were the overall and progression-free survival at 60 months. Data were analyzed with the Cox proportional hazard model. In a multivariate model the methylation threshold identified for the SFN gene (14.3.3,) distinguished the patients presenting favorable outcome from those with progressing disease, independently from all known predictors (Training set: Overall Survival HR 8.53, p = 0.001; Validation set: HR 4.07, p = 0.008). The level of methylation in the tumors of high-risk patients surviving more than 60 months was comparable to that of tumors derived from lower risk patients and to that of benign ganglioneuroma. Methylation above the threshold level was associated with reduced SFN expression in comparison with samples below the threshold. Quantitative methylation is a promising tool to predict survival in neuroblastic tumor patients. Our results lead to the hypothesis that a subset of patients considered at high risk,but displaying low levels of methylation,could be assigned at a lower risk group. [source]

Usefulness of EGFR mutation screening in pleural fluid to predict the clinical outcome of gefitinib treated patients with lung cancer

Junichi Soh
Abstract The importance of epidermal growth factor receptor (EGFR) gene mutation has been recognized in nonsmall cell lung cancer (NSCLC), requiring the standardization of mutation screening system including the kind of samples. Here, we examined the EGFR mutation status in 61 pleural fluid samples from NSCLC cases using direct sequencing, nonenriched PCR, mutant-enriched PCR and peptide nucleic acid-locked nucleic acid (PNA-LNA) PCR clamp assay. The mutant-enriched PCR assay detected 16 mutant cases. Among them, the nonenriched PCR assay failed to detect 3 mutant cases. Regarding the discrepancy between mutant-enriched PCR and PNA-LNA PCR clamp assays, 3 cases of exon19-deletions were detected only by mutant-enriched PCR assay and no difference at the L858R mutation. There was no difference in results between direct sequencing and nonenriched PCR assay. We also correlated the EGFR mutation with clinical outcome of gefitinib-treated 29 cases. EGFR mutations were present in 10 cases, revealing 7 partial response and 3 no change (NC). In EGFR wild-type cases, 10 revealed NC and 9 progressive disease. The responders were significantly more frequent among the EGFR mutant cases than among the wild-type (p < 0.0001). Overall survival (p = 0.0092) and progression-free survival (p = 0.018) were significantly longer among the EGFR mutant cases than among the wild-type. In summary, we evaluated the utility of EGFR mutation screening in pleural fluid using 4 assays that showed some discrepancies arising from the designs of the assays. As clinical importance, the EGFR mutation status in pleural fluid can be a biomarker for the favorable outcome of gefitinib-treated NSCLC cases. 2006 Wiley-Liss, Inc. [source]

Presence of high-risk human papillomavirus DNA in penile carcinoma predicts favorable outcome in survival

Anne P. Lont
Abstract There is evidence that a subset of penile carcinomas is caused by infection with high-risk human papillomavirus (HPV). However, extensive studies on the possible influence of HPV infection on clinical outcome of penile cancer are lacking. This investigation is aimed to examine the prevalence of high-risk HPV in a large series of penile squamous-cell carcinomas (SCCs) and to determine the relationship between HPV and survival. Formalin-fixed, paraffin-embedded tumor specimens of 171 patients with penile carcinoma were tested for high-risk HPV DNA presence by GP5+/6+-PCR. The clinical course of the patients and the histopathological characteristics of the primary tumors were reviewed. High-risk HPV DNA was detected in 29% of the tumors, with HPV 16 being the predominant type, accounting for 76% of high-risk HPV containing SCCs. Disease-specific 5-year survival in the high-risk HPV-negative group and high-risk HPV-positive group was 78% and 93%, respectively (log rank test p = 0.03). In multivariate analysis, the HPV status was an independent predictor for disease-specific mortality (p = 0.01) with a hazard ratio of 0.14 (95% CI: 0.03,0.63). Our results indicate that the presence of high-risk HPV (29%) confers a survival advantage in patients with penile carcinoma. 2006 Wiley-Liss, Inc. [source]

The association between early hemodynamic variables and outcome in normothermic comatose patients following cardiac arrest

Background: Currently, few data exist on the association between post-cardiac arrest hemodynamic function and outcome. In this explorative, retrospective analysis, the association between hemodynamic variables during the first 24 h after intensive care unit admission and functional outcome at day 28 was evaluated in 153 normothermic comatose patients following a cardiac arrest. Methods: Medical records of a multidisciplinary intensive care unit were reviewed for comatose patients (Glasgow Coma Scale ,9) admitted to the intensive care unit after successful resuscitation from an in- or an out-of-hospital cardiac arrest. The hourly variable time integral of hemodynamic variables during the first 24 h after admission was calculated. At day 28, outcome was assessed as favorable or adverse based on a Cerebral Performance Category of 1,2 and 3,5, respectively. Bi- and multivariate regression models adjusted for relevant confounding variables were used to evaluate the association between hemodynamic variables and functional outcome. Results: One hundred and fifty-three normothermic comatose patients were admitted after a cardiac arrest, of whom 64 (42%) experienced a favorable outcome. Neither in the adjusted bivariate models (r2, 0.61,0.78) nor in the adjusted multivariate model (r2, 0.62,0.73) was the hourly variable time integral of any hemodynamic variable during the first 24 h after intensive care unit admission associated with functional patient outcome at day 28 in all patients as well as in patients after an in- or an out-of-hospital cardiac arrest. Conclusion: Commonly measured hemodynamic variables during the first 24 h following intensive care unit admission due to a cardiac arrest do not appear to be associated with the functional outcome at day 28. [source]

Microcystic adnexal carcinoma: report of four cases treated with Mohs' micrographic surgical technique

Amor Khachemoune MD
Background, Microcystic adnexal carcinoma (MAC) is a rare and aggressive malignant tumor of the sweat glands. Clinically, it often presents as a firm subcutaneous nodule on the head and neck regions. On histology, MAC exhibits both pilar and sweat duct differentiation with a stroma of dense collagen. It often extends beyond the clinical margins with local spreading in the dermal, subcutaneous, and perineural tissue planes. It has a high local recurrence rate after standard excision. Recent preliminary reports have indicated more favorable cure rates with Mohs' micrographic surgery (MMS). Objective, To present our data on four cases of MAC treated by MMS. We also compared our findings with more recently reported series in the English language literature. Methods, We reviewed the medical records of four patients (two males and two females) with MAC treated by MMS over the last 3 years. We also obtained follow-up data. Results, In all four patients with MAC treated by MMS, there were no recurrences, with a mean follow-up of 1 year. Conclusion, We report an additional four MAC cases treated by MMS. The accumulated data continue to confirm that, if the diagnosis of MAC is made early, and if the anatomic location is accessible to excision by MMS, a favorable outcome can be expected. [source]

Retrograde ureteroscopic endopyelotomy using the holmium:YAG laser

Hatsuki Hibi
Abstract Background: We report our experience of retrograde ureteroscopic endopyelotomy using the holmium laser for ureteropelvic junction (UPJ) obstruction not associated with upper tract stones. Methods: We carried out this procedure on five patients through an 8-Fr semirigid ureteroscope. The ureter was not stented before the procedure and balloon dilation was not necessary before retrograde insertion of the ureteroscope. The obstruction was incised with the holmium laser using a 200 m fiber in a linear fashion. After completion of the incision, a 12-Fr double-J ureteral stent was left for 6 weeks. Thereafter, patients were monitored with renal scan and/or ultrasound and excretory urography at 3,6 month intervals. Results: Hydronephrosis was obviously improved in four cases (80%) at an average follow up of 12.8 months (4,23 months). Although the number of treated patients was small, retrograde ureteroscopic endopyelotomy for UPJ obstruction using the holmium laser achieved good results. Conclusions: We recommend that this procedure be used initially because it is less invasive and has a favorable outcome. [source]

Endoscopic ureteral incision using the holmium:YAG laser

Abstract Background: We reviewed the results of endoscopic ureteral incision for benign ureteral stricture, ureteropelvic junction obstruction and ureteroenteroanastomotic stricture using the holmium laser. Methods: We carried out endoscopic ureteral incision using the holmium laser through an 8-Fr semirigid or 6.9-Fr flexible ureteroscope on 17 ureters in 15 patients. Balloon dilatation was not necessary before insertion of the ureteroscope. The stricture was incised with the holmium laser using a 200,365 ,m fiber through the working channel of the ureteroscope. After completion of the incision, a 12-Fr double-J catheter was left for 6 weeks. Thereafter patients were followed by renal scan and/or ultrasound and excretory urography at 3,6 month intervals. Results: The mean operative time was 65 min (18,135 min). The stricture resolved completely in 86.7% of cases at an average follow up of 20.5 months (11,32 months). Conclusions: The holmium laser endoscopic ureteral incision was associated with a good outcome in our series. We recommend this procedure to be employed initially because it is less invasive and has a favorable outcome. [source]

Role of color Doppler imaging in diagnosing and managing pregnancies complicated by placental chorioangioma

Yaron Zalel MD
Abstract Purpose The purpose of this study was to evaluate the role of color Doppler imaging in the diagnosis and management of placental chorioangioma. Methods The medical records, sonographic reports, and sonograms of all pregnant women who had placental masses diagnosed in our sonography unit during the years 1992 through 2000 and had been evaluated using both gray-scale and color Doppler sonography were included in this study. Subjective evaluation of the amount and distribution of intralesional vascularity by color Doppler imaging was made in all cases. Cases of chorioangioma of the placenta were compared with cases of placental hemorrhage or subchorionic hematoma. The outcomes of the pregnancies were also recorded. Results Fifteen cases of placental masses were evaluated; 8 of them were identified as placental hemorrhage or subchorionic hematoma on the basis of the sonographic findings. The other 7 cases were identified prenatally as placental chorioangioma, at a mean menstrual age of 23 weeks and a mean maternal age of 29 years. The mean size of the tumor was 6.5 cm (range, 4,13 cm). All cases of chorioangioma showed either substantial internal vascularity or a large feeding vessel within the tumor. Three infants were delivered at term with favorable outcome; 2 of them demonstrated reduction of the intratumoral blood flow during follow-up. The other 4 cases were delivered at or before 32 weeks' menstrual age (1 intrauterine fetal death, 2 terminated pregnancies, and 1 normal infant). No case of placental hematoma demonstrated blood flow within the lesion or was associated with complications of the pregnancy. Conclusions Color Doppler imaging helps differentiate placental chorioangioma from other placental lesions and may be useful in the prenatal follow-up of chorioangioma. 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:264,269, 2002; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.10072 [source]

Non-mycosis fungoides cutaneous T-cell lymphoma: reclassification according to the WHO-EORTC classification

Joshua Weaver
Background: Non-mycosis fungoides (non-MF) primary cutaneous T-cell lymphomas (PCTCL) are heterogeneous and divided into subgroups by the World Health Organization-European Organization for Research and Treatment of Cancer (WHO-EORTC) classification of cutaneous lymphomas. We report the first North American series to examine the applicability of the classification, compare our findings with the predominant European literature and confirm the significance of separation into the indolent and aggressive groups. Methods: Forty-four non-MF PCTCL cases with available tissue for phenotyping, adequate clinical staging information and follow-up were reclassified according to the WHO-EORTC classification. Results: Non-MF PCTCL had a longer overall survival (OS) (13.8 years) compared with secondary cutaneous T-cell lymphoma (SC-TCL) (2.5 years). Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) had the most favorable outcome (OS 14.1 years), whereas secondary and primary peripheral T-cell lymphoma, unspecified had the shortest OS (2.5 and 2.4 years, respectively). Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma (CTLCD4) appeared to have a favorable course. Conclusions: Most non-MF PCTCL can be classified according to the WHO-EORTC classification. The relative frequencies are similar to European experience. Non-MF PCTCL is a heterogeneous group with a favorable outcome compared to SC-TCL, especially PC-ALCL and CTLCD4. Separation of non-MF PCTCL into indolent and aggressive groups appears clinically significant and may provide direction for therapeutic decisions. Weaver J, Mahindra AK, Pohlman B, Jin T, His ED. Non-mycosis fungoides cutaneous T-cell lymphoma: reclassification according to the WHO-EORTC classification. [source]

Determinants of Serum Creatinine Trajectory in Acute Contrast Nephropathy

The aim of this study was to describe the trajectory of creatinine (Cr) rise and its determinants after exposure to radiocontrast media. Included were 98 subjects who underwent cardiac catheterization and were randomized to forced diuresis with IV crystalloid, furosemide, mannitol (if pulmonary capillary wedge pressure was<20 mmHg), and low dose dopamine versus intravenous crystalloid and matching placebos. Baseline and postcatheterization serum Cr levels were analyzed in a longitudinal fashion, allowing for differences in the time between blood draws, to determine the different critical trajectories of serum Cr. The mean age, baseline serum Cr, and Cr clearance (CrCl) were 69.3 10.8 years, 2.5 0.9 mg/dL, and 31.4 12.1 mL/min, respectively. The clinically driven postprocedural observation time was 5.5 5.1 days (range 19 hours and one Cr value to 25.7 days and 18 values). The mean maximum Cr was 3.3 1.4, range 1.7,8.7 mg/dL). Longitudinal models support baseline Cr clearance predictions for the change in Cr at 24 hours, time as the determinant of Cr trajectory, and requisite monitoring. For any given individual, a rise in Cr of , 0.5 mg/dL in the first 24 hours after contrast exposure predicted a favorable outcome. Baseline renal function is the major determinant of the rate of rise, height, and duration of Cr trajectory after contrast exposure. Length of observation and frequency of laboratory measures can be anticipated from these models. [source]

Fertility-preserving treatment for patients with malignant germ cell tumors of the ovary

Shin Nishio
Abstract Aim:, The aim of this study was to investigate whether fertility preservation influences the clinical outcome in patients with malignant germ cell tumors of the ovary (MGCTO). Methods:, A case study analysis was performed on patients with MGCTO treated at Kurume University Hospital between 1986 and 2004. Thirty-five patients were included in the study, 14 with immature teratoma, 11 with dysgerminoma, eight with endodermal sinus tumor, and two with mixed germ cell tumor. Twenty-three patients had International Federation of Gynecology and Obstetrics stage I (Ia, 11; Ib, 2; Ic, 10), one had stage II, seven had stage III, and four had stage IV disease. Results:, Five patients with stage III or IV disease received radical surgery. Thirty patients underwent conservative surgery. As the adjuvant treatment, 30 patients received chemotherapy, while five patients did not receive any chemotherapy. The overall survival rate was 97.1%. One patient died of the disease. She was 13 years old with a stage IV endodermal sinus tumor. Twelve have attempted conception, and eight have achieved at least one pregnancy (66.7%). Conclusions:, Irrespective of the stage of the disease, conservative surgery and adjuvant chemotherapy for MGCTO can achieve a favorable outcome in terms of survival and fertility. [source]

Laser-assisted endoscopic third ventriculostomy for obstructive hydrocephalus: Technique and results in a series of 40 consecutive cases

Bertrand C. Devaux MD
Abstract Background and Objectives To report a case series of endoscopic third ventriculostomy (ETV) using laser in 40 consecutive patients with obstructive hydrocephalus. Study Design/Materials and Methods Under stereotactic and endoscopic guidance, multiple perforations in the ventricular floor using a 1.32 ,m neodymium,yttrium/aluminum/garnet (Nd,YAG) or a 0.805 ,m diode laser unit and removal of intervening coagulated tissue ensued with a 4,6 mm opening between third ventricle and basilar cisterns. Results The procedure could be completed in all cases. A transient complication occurred in five cases. In 39 patients (mean follow-up 28 months), 31 (79%) had a favorable outcome. Failure occurred in six patients, requiring permanent shunting leading to complete recovery, and two patients remained in a poor clinical status despite ETV. Conclusions Laser-assisted ETV is a safe and efficient procedure for the treatment of obstructive hydrocephalus. Laser is advantageous in cases of distorted anatomy and may reduce technical failures. Lasers Surg. Med. 34:368,378, 2004. 2004 Wiley-Liss, Inc. [source]

Developmental and benign movement disorders in childhood,

Cecilia Bonnet MD
Abstract Developmental and benign movement disorders are a group of movement disorders with onset in the neonatal period, infancy, or childhood. They are characterized by the absence of associated neurological manifestations and by their favorable outcome, although developmental abnormalities can be occasionally observed. Knowledge of the clinical, neurophysiological, and pathogenetic aspects of these disorders is poor. Based on a comprehensive review of the literature and our practical experience, this article summarizes current knowledge in this area. We pay special attention to the recognition and management of these movement disorders in children. 2010 Movement Disorder Society [source]

Bronchial hyperresponsiveness, atopy, and bronchoalveolar lavage eosinophils in persistent middle lobe syndrome

Kostas N. Priftis MD
Abstract Most cases of middle lobe syndrome (MLS) in children are considered to be due to asthma and may recover spontaneously; however, in persistent MLS, repeated episodes of infection often institute a vicious cycle that may lead to persistent symptoms and bronchial hyperresponsiveness (BHR). The present study was undertaken to investigate whether asthma, as an underlying diagnosis, is predictive of a favorable outcome of children with persistent MLS. We evaluated 53 children with MLS who underwent an aggressive management protocol that included fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). These patients were compared to two other groups: one consisting of children with current asthma but no evidence of MLS (N,=,40) and another of non-asthmatic controls (N,=,42), matched for age and sex. Prevalence of sensitization (,1 aeroallergen) did not differ between patients with MLS and "non-asthmatics" but was significantly lower than that of "current asthmatics." A positive response to methacholine bronchial challenge was observed with increased frequency among children with MLS when compared to "current asthmatic" and non-asthmatic children. Multivariate logistic regression analysis revealed a positive correlation between an increased number of eosinophils in the BAL fluid (BALF) and a favorable outcome, whereas no correlation was detected between sensitization or BHR and BAL cellular components. In conclusion, children with MLS have an increased prevalence of BHR, even when compared to asthmatics, but exhibit prevalence of atopy similar to that of non-asthmatics. An increased eosinophilic BALF count is predictive of symptomatic but not radiographic improvement of MLS patients after aggressive anti-asthma management. Pediatr Pulmonol. 2006 Wiley-Liss, Inc. [source]

Pulmonary interstitial glycogenosis in identical twins

W. Onland MD
Abstract We present the clinical, radiological, and pathological findings of open lung biopsies from monozygotic prematurely born male twins with respiratory distress at ages 6 and 8 weeks postnatally. Radiological examination showed a reticular nodular interstititial pattern on chest radiography. High-resolution computed tomography (HRCT) revealed ground-glass opacification and thickened interstitial septae in both infants. Lung biopsies showed a similar histology. There was diffuse interstitial thickening of the alveolar septa by mesenchymal cells, without prominent hyperplasia of type 2 pneumocytes, and without airspace exudates. Sections were periodic acid-Schiff (PAS)-positive within the cytoplasm of interstitial cells, indicating the presence of glycogen. Thus the diagnosis of pulmonary interstitial glycogenosis was made. Both infants were treated with glucocorticoids and had a favorable outcome. We speculate that pulmonary interstitial glycogenosis could be a histopathological form of chronic lung disease (CLD) of infancy. Pediatr Pulmonol. 2005 Wiley-Liss, Inc. [source]

Septic arthritis in patients followed-up in neonatal intensive care unit

Sevki Kabak
Abstract Background: Septic arthritis is an uncommon, but serious disorder in neonates. Most patients survive with permanent handicaps. Due to the rarity of this condition in neonates and paucity of signs and symptoms, the diagnosis of septic arthritis in newborns is more difficult than in older children. Methods: Septic arthritis or suppurative arthritis is an infection of the joint by a variety of microorganisms, including bacteria, viruses, mycobacteria and fungi. Purulent synovial fluid, positive culture and positive Gram stain were accepted as a gold standard for exact diagnosis. Fourteen neonates who were followed-up in a neonatal intensive care unit, with septic arthritis, were included in a study based on a review of medical reports and a long-term clinical and radiological follow-up. Clinical symptoms, bacteriology, risk factors and outcomes are discussed. Results: Staphylococcus aureus was the predominant causative organism. Risk factors for septic arthritis were prematurity (4/14), umbilical catheterization or venous catheterization (3/14), sepsis (3/14), perinatal asphyxia (2/14) and difficult birth (1/14). All cases of septic arthritis in neonates were improved without squealae except in two patients. One patient died and one patient had severe squealae. In these two patients, the duration of disease from clinical onset to initiation of therapy was long. Conclusion: The most important prognostic factor in predicting a favorable outcome in neonatal septic arthritis is early diagnosis and therapy. When appropriate treatment is delayed, catastrophic sequelae are inevitable. Early diagnosis of the condition and rapid removal of pus are mandatory for the survival of the joint. Long-term follow-up may reveal effects of epiphyseal damage, early degenerative changes and limitation of the range of motion. [source]

Kikuchi Fujimoto lymphadenitis: Case report and literature review

Giuseppe Famularo
Abstract We describe a young woman with two severe episodes of Kikuchi Fujimoto disease occurring 16 years apart. Both episodes were proven by biopsy, and on the second occasion the patient remained dependent on high-dose prednisone for more than 6 months in order to control inflammation and achieve a reduction in cervical lymph node size. The second lymph node biopsy showed leukocytoclastic vasculitis in addition to the typical features of Kikuchi Fujimoto disease, but, even though the clinical interpretation of this finding was unclear, we documented no clinical or laboratory evidence of the development of other serious systemic disease over 20 years of follow-up. Kikuchi Fujimoto disease is considered a disorder with a self-limited course and a favorable outcome. However, on the basis of our experience with this patient and data from peer-reviewed literature, we suggest that this generally accepted postulate should be revised. Am. J. Hematol. 74:60,63, 2003. 2003 Wiley-Liss, Inc. [source]

OCDS Craving Scores Predict 24-Month Outcome in Alcoholic Outpatients

Michael Soyka MD
This study was conducted to replicate previous findings on the predictive value of a German version of the Obsessive Compulsive Drinking Scale (OCDS) by investigating 24-month treatment outcome in an outpatient setting. This was a prospective, observational study with 92 alcohol-dependent patients. The OCDS was used to assess craving at the end of treatment, and at the 6-, 12-, and 24-month follow-ups. Univariate and logistic regression analyses were performed. Of the 67 patients interviewed at the 24-month follow-up, 58% were abstinent and 79% improved. OCDS scores were higher in patients with a less favorable outcome. In line with previous findings, our results showed that the intensity of craving as measured by the OCDS may predict outcome in outpatient alcoholics.,(Am J Addict 2010;19:264,269) [source]

Supreme Court Litigants and Strategic Framing

Justin Wedeking
Although litigants invest a huge amount of resources in crafting legal briefs for submission to the Supreme Court, few studies examine whether and how briefs influence Court decisions. This article asks whether legal participants are strategic when deciding how to frame a case brief and whether such frames influence the likelihood of receiving a favorable outcome. To explore these questions, a theory of strategic framing is developed and litigants' basic framing strategies are hypothesized based on Riker's theory of rhetoric and heresthetic as well as the strategic approach to judicial politics. Using 110 salient cases from the 1979,89 terms, I propose and develop a measure of a typology of issue frames and provide empirical evidence that supports a strategic account of how parties frame cases. [source]

Exploring Correlates of Product Launch in Collaborative Ventures: An Empirical Investigation of Pharmaceutical Alliances

M. Berk Talay
This paper examines collaborative ventures leading toward the launch of new products in the pharmaceutical industry. These collaborative ventures are one of the most underresearched areas in the new product literature, yet the preponderance of these collaborative ventures makes it an area of great importance for scholars and practitioners alike. As such, the purpose of the study is to examine why some collaborative projects produce a favorable outcome (the launch of a product) whereas others do not. That is, what characteristics of partner firms in the collaborative ventures and what characteristics of the partnership lead to a successful launch of a new product in the pharmaceutical industry? Secondary data from the pharmaceutical industry are employed in a multinomial logit model. Data from 128 collaborative ventures from 1980 to 2004 are used in the analysis. The partner firms in the collaborative ventures are from various industries ranging from malt beverages to pharmaceutical preparations to electronic and other equipment among others. Of the 128 collaborative ventures, 66 were successful in leading to a new product launch, whereas 62 did not result in the launch of a new product. The results from the multinomial logit analysis suggest that combined marketing resources of parent companies, combined technological intensity of parent companies, and combined asset bases of parent companies contribute to the likelihood of an eventual product launch in a collaborative venture. However, the results of the analysis show that contrary to expectations, technological complementarity of partners in the collaborative venture is not a significant predictor of successful new product launch. The results of the study suggest certain aspects for managers to consider when establishing collaborative ventures. To maximize the possibilities of the collaborative venture leading to the successful launching of a new product, managers should be concerned with the resources potentially available to partners in the collaborative venture from parent firms. These resources are not only of financial nature but also of technological nature. The existence of these resources does not ensure provision of resources to the collaborative venture; however, without the possibility of these resources it appears that successful launch of a product is less likely. [source]

Survival in surgically treated, nodal positive prostate cancer patients is predicted by histopathological characteristics of the primary tumor and its lymph node metastases ,

THE PROSTATE, Issue 4 2009
Achim Fleischmann
Abstract BACKGROUND Histopathological risk factors for survival stratification of surgically treated nodal positive prostate cancer patients are poorly defined as reflected by only one category for nodal metastases. METHODS We evaluated biochemical recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) in 102 nodal positive, hormone treatment-nave prostate cancer patients (median age: 65 years, range: 45,75 years; median follow-up 7.7 years, range: 1.0,15.9 years) who underwent radical prostatectomy and standardized extended lymphadenectomy. RESULTS A significant stratification was possible, with the Gleason score of the primary and virtually all nodal parameters favoring patients with better differentiated primaries and metastases, lower nodal tumor burden, and without extranodal extension of metastases. In multivariate analyses, diameter of the largest metastasis (,10 mm vs. >10 mm) was the strongest independent predictor for RFS (P,<,0.001), DSS (P,<,0.001), and OS (P,<,0.001) with a more than quadrupled relative risk of cancer related deaths for patients with larger metastases (Hazard ratio: 4.2, Confidence interval: 2.0,8.9; 5-year RFS/DSS/OS: 18%/57%/54%). The highest 5-year survival rates were seen in patients with micrometastases only (RFS/DSS/OS: 47%/94%/94%). CONCLUSION The TNM classification's current allocation of only one category for nodal metastases in prostate cancers is unsatisfactory since subgroups with significantly different prognoses can be identified. The diameter of the patient's largest metastasis (,10 mm vs. >10 mm) should be used for substaging because of its independent prognostic value. The substage "micrometastasis only" is also useful in nodal positive prostate cancer since it designates the subgroup with the most favorable outcome. Prostate 69:352,362, 2009. 2008 Wiley-Liss, Inc. [source]

Liver Transplantation for Alcoholic Liver Disease in Europe: A Study from the ELTR (European Liver Transplant Registry)

P. Burra
Alcohol-related liver disease (ALD) is one of the most common indications for liver transplantation (LT). Long-term outcome after LT for ALD versus other etiologies is still under debate. The aim of this study was to compare outcome after LT of patients with ALD, viral (VIR), and cryptogenic cirrhosis. Donor, graft and recipient ELTR variables were analysed in transplants for alcoholic and nonalcoholic cirrhosis (1988,2005) and were correlated with patient survival. Causes of death and/or graft failure were compared between groups. Nine thousand eight hundred eighty ALD, 10 943 VIR, 1478 ALD + VIR and 2410 cryptogenic (CRYP) liver transplants were evaluated. One, 3, 5 and 10 years graft survival rates after LT in ALD patients were 84%, 78%, 73%, 58%, significantly higher than in VIR and CRYP (p = 0.04, p = 0.05). By multivariate analysis, ALD + VIR (RR 1.14) and viral alone (RR 1.06) were significant risk factors for mortality. De novo tumors, cardiovascular and social causes were causes of death/graft failure in higher percentage in ALD groups versus other etiologies. LT for ALD cirrhosis has a favorable outcome, however, hepatitis C virus co-infection seems to eliminate this advantage. Screening for de novo tumors and prevention of cardiovascular complications are essential to provide better long-term results. [source]