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Malignant Disease (malignant + disease)

Distribution by Scientific Domains

Medical Sciences	92%
Life Sciences	5%

Distribution within Medical Sciences

Oncology & Radiotherapy	18%
Surgery & Surgical Specialties	16%
Dermatology	5%
Gastroenterology & Hepatology	3%
Gastroenterology	2%
24 Other Subdomains	44%

Selected Abstracts

Use of Off-pump Coronary Artery Bypass Surgery Among Patients with Malignant Disease

JOURNAL OF CARDIAC SURGERY, Issue 1 2010
Ahmad K. Darwazah Ph.D., F.R.C.S.
The surgical strategy among these patients remains controversial. We present our experience of using a two-staged surgical strategy of managing coronary artery disease using off-pump bypass followed by tumor management. Patients and Methods: During a six-year period from 2002 to 2007, 350 patients underwent myocardial revascularization using off-pump bypass. Among these patients, associated malignant disease was found in six patients (1.7%). Two of them had papillary carcinoma of the bladder, one patient had chronic lymphocytic leukemia, and the rest suffer from carcinoma affecting the prostate, colon, and right lung. Their mean age was 54 years. Their data was evaluated. Patients were followed up to evaluate their symptoms and progress of their disease. Results: All patients were managed successfully. Complete revascularization was achieved in all patients except one due to small nongraftable vessels. The mean number of grafts was 1.8 ± 0.8. There was no evidence of postoperative infraction or stroke. The mean hospital stay was 5 ± 1.1 days. Management of cancer was done during the same hospital admission in two patients with bladder cancer. The rest had a mean interval of 6.6 ± 5.4 days. Two patients underwent surgery in the form of left hemicolectomy and right lower lobectomy. The rest had chemotherapy as a sole treatment. All patients were followed up completely for a period of 12 to 84 months (mean 39.2 ± 26.7 months). We had no late mortality. All patients remained asymptomatic except one, who had angina of class III and had recurrence of her bladder tumor, which necessitated two sessions of endoscopic resection. Conclusion: We believe that staged operation to treat coronary artery disease and malignancy can be performed safely. The use of off-pump technique to revascularize the myocardium can be performed without any complications.(J Card Surg 2010;25:1-4) [source]

Viral reactivation is not related to septic complications after major surgical resections,

APMIS, Issue 4 2008
T. VOGEL
Anastomotic leakage and septic complications are the most important determinants of postoperative outcome after major surgical resections. Malignant diseases and surgical trauma can influence immune responses and the ability to react against infectious factors, such as bacteria and viruses. Comparable immune suppression can cause viral reactivation in transplantation and trauma patients. In this prospective study, patients who underwent major surgical resections for oesophageal or pancreatic cancer were investigated for the potential involvement of viral reactivation in the development of septic complications. 86 patients (40 oesophageal resections, 27 pancreatic resections, 19 surgical explorations) were included. Viral antigens, viral DNA, antibodies against viral structures (IgG, IgM, IgA) and, in part, viral cultivation were performed for CMV, EBV, HSV1, HSV2, HZV6 and VZV in serum, urine, sputum and swabs from buccal mucosa preoperatively and at postoperative days 1, 3 and 5. Test results were compared with the postoperative outcome (30-day morbidity, in-hospital mortality) and clinical scores (SOFA, TISS). For statistical analyses Student's t -tests and Chi2 -tests were used. The overall complication rate was 19.8% (30-day morbidity) with an in-hospital mortality of 1.2% (1/86 patients). Postoperatively, anti-CMV-IgG titres were significantly reduced (p<0.05) and remained suppressed in patients with septic complications. Anti-CMV-gB-IgG were also reduced, but showed considerable interindividual differences. Anti-CMV-IgA and -IgM did not show significant alterations in the postoperative course. In addition, direct viral detection methods did not support viral reactivation in patients in any of the investigated groups. The reduction of anti-CMV antibodies is likely caused by an immune suppression, specifically by reduced B-cell counts after major surgical interventions. Viral reactivation, however, did not occur in the early postoperative period as a specific risk for septic complications. [source]

SQUAMOUS CELL PAPILLOMA OF THE ESOPHAGUS: CLINICOPATHOLOGICAL STUDY OF 24 CASES

DIGESTIVE ENDOSCOPY, Issue 4 2004
Junya Oguma
Background:, Squamous cell papilloma of the esophagus is considered to be a rare condition; however, the number of cases with this condition reported in recent years has increased, perhaps due to advances in endoscopic diagnosis. Methods:, We reviewed the clinicopathological features of 26 lesions of squamous cell papilloma of the esophagus in 24 cases seen at our hospital from 1994 to 2003. There were nine men and 15 women, with a mean age of 60.5 years (range, 31,82 years). Six patients had a history of malignant disease in the past. With regard to the presence of other lesions in the esophagus, six patients had hiatal hernia and four had gastroesophageal re,ux disease. Results:, Two patients each had two lesions of squamous cell papilloma. There were seven lesions in which in,ammatory cell in,ltration was found on hisotological examination, of which four had underlying hiatal hernia; ,ve lesions were found to have mild dysplasia on histological examination of which three had gastroesophageal re,ux disease. The median duration of follow up of the cases was 8 months (range, 1,101 months). During the follow-up period, none of the lesions showed any dramatic change of appearance or malignant transformation. Conclusion:, In principle, while it may be suf,cient to keep patients with squamous cell papilloma of the esophagus under simple follow up, the patients must be investigated to rule out malignancy of other organs, and the small probability of malignant transformation of the tumor must always be borne in mind. [source]

Detection of human papillomavirus DNA in squamous cell carcinoma of the esophagus by auto-nested PCR

DISEASES OF THE ESOPHAGUS, Issue 2 2006
A. P. Souto Damin
SUMMARY., The aim of the present study was to investigate the presence of human papillomavirus (HPV) in surgical specimens of esophageal squamous cell carcinoma. One hundred and sixty-five paraffin-embedded specimens of esophageal carcinoma were analyzed through high-sensitivity auto-nested polymerase chain reaction (PCR) using the consensus GP5+/GP6+ primer. Twenty-six specimens of esophageal mucosa without malignant disease were also studied as a control group. Two different specific primer sets targeting the E6 region of the HPVs 16 and 18 were used for typing. Direct DNA sequence analysis was conducted to confirm positive PCR results. HPV DNA was detected in 26 esophageal carcinomas (15.75%), but in none of the benign esophageal specimens (P < 0.05). Out of the 26 positive cases, 24 were HPV-16 and one was HPV-18. One tumor contained both HPV-16 and -18 DNA. Positive PCR results were confirmed by the amplified viral sequences. Our findings suggest that the presence of either HPV-16 or -18 might be related to development of the malignant phenotype in the esophagus. [source]

Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord-Trøndelag Health Study): prevalence, socio-demographics and health perceptions

EUROPEAN JOURNAL OF CANCER CARE, Issue 3 2010
A. STEINSBEKK phd, research fellow
STEINSBEKK A., ADAMS J., SIBBRITT D. & JOHNSEN R. (2010) European Journal of Cancer Care19, 346,351 Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord-Trøndelag Health Study): prevalence, socio-demographics and health perceptions The aim of the study was to identify the use of complementary and alternative medicine (CAM) practitioners among current and previous cancer patients in a total population. A secondary analysis of data from the Nord-Trøndelag Health Study (otherwise known as the HUNT 2 Study) , a total population survey conducted in central Norway , was undertaken. Analysis focused upon the response of 1406 individuals who reported to have or have had cancer and who answered a question on visits to CAM practitioners. The study identified 16.1% of respondents had visited a CAM practitioner in the prior 12 months compared with 12.8% in the total population, and the likelihood of consulting a CAM practitioner was significantly increased among those who had a university degree, who reported a lower perceived global health and who had experienced a health complaint during the last 12 months. Complementary and alternative medicine practitioner consultations among individuals with a previous or current malignant disease were highest for those with poor self-reported health status and with a recent health complaint. From the socio-demographic variables studied only the reporting of a university degree was significantly associated with higher CAM practitioner use. [source]

microRNAs in acute myeloid leukemia: Expression patterns, correlations with genetic and clinical parameters, and prognostic significance

GENES, CHROMOSOMES AND CANCER, Issue 3 2010
Rotraud Wieser
Acute myeloid leukemia (AML) is a malignant disease of hematopoietic cells whose emergence, course, and prognosis is affected by specific recurrent genetic alterations like chromosome aberrations and point mutations, as well as by changes in the expression of certain genes. In the past 2 years, microRNAs (miRNAs),a novel class of small RNA molecules involved in posttranscriptional gene regulation,have also been shown to be aberrantly expressed in AML. Furthermore, specific miRNA expression patterns were found to be associated with certain genetic and cytogenetic alterations in this disease, and two studies identified miRNAs whose expression levels were predictive of survival. Interestingly, the results of these analyses showed only very limited congruence. This review summarizes published reports on the expression patterns of miRNAs in AML, and discusses possible reasons for the differences in their results. © 2009 Wiley-Liss, Inc. [source]

PET/CT in the assessment of previously treated skull base malignancies,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2010
Richard J. Harvey MD
Abstract Background Altered anatomy, radiotherapy, hardware, and reconstructive materials distort the posttreatment ventral skull base. The diagnostic characteristics of positron emission tomography/CT (PET/CT) studies in those with suspected recurrent malignancy were assessed. Methods A retrospective review was undertaken of patients with head and neck cancer who had PET/CT for ventral skull base disease. Results Thirty-four PET/CTs were performed for suspected recurrent malignancy in the skull base (mean age, 59.6 ± 10.7 years; female 38%). The group comprised mainly minor salivary (35.3%), squamous (32.3%), and neuroectodermal (23.6%) tumors. Mean clinical follow-up after PET/CT was 256 ± 173 days. Sensitivity was 100% but specificity was 40%. Standard uptake values (SUVs) for true positives were higher than for those without disease (p = .03). Conclusions PET/CT is a highly sensitive test for malignant disease. The mucosal lining of the reconstructed skull base is a common source for inflammatory pathologies that may lead to false-positive PET/CT. Defining SUV thresholds for malignancy may improve specificity. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Technique of endoscopic retrograde puncture and dilatation of total esophageal stenosis in patients with radiation-induced strictures

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2004
Ronald J. Lew MD
Abstract Background. Complete esophageal stenosis can occur after external beam radiation therapy for malignancies. Treatment for this complication has traditionally involved surgery. Methods. A new technique to reestablish luminal patency is described. This minimally invasive technique involves retrograde endoscopy by means of gastrostomy tube tract and puncture of the stenotic occlusion followed by stricture dilatation. The procedure is performed under combined endoscopic and laryngoscopic guidance. Results. Five consecutive patients who had complete esophageal stenoses develop after radiation therapy for malignant disease underwent retrograde endoscopy by way of gastrostomy tube tracts. Stenoses were punctured under endoscopic and laryngoscopic guidance with guide wires. Strictures were dilated with wire-guided balloons or polyvinyl dilators. Luminal patency was established in all patients using this technique without procedural complications. Conclusions. Endoscopic retrograde puncture and dilatation of total esophageal stenoses is safe, effective, and useful to reestablish luminal patency for radiation-induced strictures. This technique should be attempted before more invasive treatments. © 2004 Wiley Periodicals, Inc. Head Neck26: 179,183, 2004 [source]

Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomy

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003
Magdy I. El-Sharaky MD
Abstract Background. Hypoparathyroidism with permanent hypocalcemia is a well-recognized complication after thyroid surgery. Aim. This study was conducted to assess the role of immediate parathyroid autotransplantation in the preservation of parathyroid function after total thyroidectomy. Patients and Methods. Twenty-eight patients had autotransplantation of parathyroid glands resected or devascularized during total thyroidectomy. Data were collected prospectively regarding demographics, indication for surgery, operative procedure, pathologic diagnosis, number of glands transplanted, and subsequent course. Thyroid nodules were evaluated by ultrasonography, radionuclide scanning, and/or fine-needle aspiration cytology. All patients had serum ionized calcium, phosphorus, and intact parathyroid hormone (PTH) levels measured preoperatively and monitored regularly postoperatively for a period of 14 weeks and again at 6 months after operation. Patients were categorized into three groups according to the number of glands transplanted: one (group 1, n = 6), two (group 2, n = 14), or three glands (group 3, n = 8). In three other volunteers, one parathyroid gland was transplanted in the brachioradialis and subjected to electron microscopy 1, 2, and 4 weeks after transplantation. Results. Total thyroidectomy was performed for malignant disease in 16 patients (57.1%) and for benign disease in 12 (42.9%) patients. All patients reverted to asymptomatic normocalcemia without the need for any medications within 4 to 14 weeks. Normal levels of serum markers were regained slower when one gland was transplanted compared with two or three glands (P < .01). Electron microscopic examination showed evidence of ischemic degeneration in the transplanted tissues 1 week postoperatively. Regeneration started by the second week and coincided with normalization of PTH levels. Optimum resting and nearly normal status of parathyroid tissue was achieved by the fourth week. Conclusions. This study showed that active PTH production coincides with regeneration of parathyroid cells and that autotransplantation of at least two resected or devascularized glands during total thyroidectomy nearly eliminates permanent postoperative hypoparathyroidism, thus improving the safety of total thyroidectomy performed for malignant or benign disease. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 799,807, 2003 [source]

Utility of the Gyrus open forceps in hepatic parenchymal transection

HPB, Issue 3 2009
Matthew R. Porembka
Abstract Objective:, This study aimed to evaluate if the Gyrus open forceps is a safe and efficient tool for hepatic parenchymal transection. Background:, Blood loss during hepatic transection remains a significant risk factor for morbidity and mortality associated with liver surgery. Various electrosurgical devices have been engineered to reduce blood loss. The Gyrus open forceps is a bipolar cautery device which has recently been introduced into hepatic surgery. Methods:, We conducted a single-institution, retrospective review of all liver resections performed from November 2005 through November 2007. Patients undergoing resection of at least two liver segments where the Gyrus was the primary method of transection were included. Patient charts were reviewed; clinicopathological data were collected. Results:, Of the 215 open liver resections performed during the study period, 47 patients met the inclusion criteria. Mean patient age was 61 years; 34% were female. The majority required resection for malignant disease (94%); frequent indications included colorectal metastasis (66%), hepatocellular carcinoma (6%) and cholangiocarcinoma (4%). Right hemihepatectomy (49%), left hemihepatectomy (13%) and right trisectionectomy (13%) were the most frequently performed procedures. A total of 26 patients (55%) underwent a major ancillary procedure concurrently. There were no operative mortalities. Median operative time was 220 min (range 97,398 min). Inflow occlusion was required in nine patients (19%) for a median time of 12 min (range 3,30 min). Median total estimated blood loss was 400 ml (range 10,2000 ml) and 10 patients (21%) required perioperative transfusion. All patients had macroscopically negative margins. Median length of stay was 8 days. Two patients (4%) had clinically significant bile leak. The 30-day postoperative mortality was zero. Conclusions:, Use of the Gyrus open forceps appears to be a safe and efficient manner of hepatic parenchymal transection which allows rapid transection with acceptable blood loss, a low rate of perioperative transfusion, and minimal postoperative bile leak. [source]

Use of dissecting sealer may affect the early outcome in patients submitted to hepatic resection

HPB, Issue 4 2008
I. DI CARLO
Abstract Background. Many technological devices have been used to avoid intraoperative bleeding during hepatic parenchymal transection and to avoid morbidity and mortality, but until now none is complete. The aim of this work is to prospectively analyze hepatic resection patients treated with a water-cooled high frequency monopolar device in order to evaluate its effectiveness. Patients and methods. All consecutive patients who underwent liver resection by use of this device, between January 2003 until December 2007, were analyzed prospectively. The following variables were considered: age, sex, kind of disease, kind of liver resection, number of major/minor resections, total operative time and transection time, number and time of clamping, blood loss, time of hospitalization, morbidity, and mortality. Results. Between January 2003 and December 2007, 26 patients were analyzed prospectively (69% women, 31% men). Ages ranged from 18 to 84 years. Sixty-five percent of patients had a malignant disease; 35%, a benign disease. The procedures performed were two major hepatectomies (7.6%) and 24 minor hepatectomies (92.4%). Hepatic transection was performed in 35 to 150 min. Total operative time range was 120,480 min. The average blood loss was 325 ml (range 50,600 ml). The mean postoperative stays were nine days for all the patient and six days for non-cirrhotic patients. Conclusion. The water-cooled high frequency monopolar device is useful for reducing ischemia,reperfusion damage due to the Pringle maneuver and for reducing the risk of morbidity. However, the Kelly forceps remains the only inexpensive instrument really essential for liver surgery. [source]

Sunlight ultraviolet irradiation and BRAF V600 mutagenesis in human melanoma,

HUMAN MUTATION, Issue 8 2008
Ahmad Besaratinia
Abstract The incidence of melanoma, the most lethal form of skin cancer, continues to increase in the Western world. In addition to genetic alterations in high- and low-susceptibility genes identified for melanoma, somatic mutations in BRAF gene occur frequently in human melanoma and are distinctively linked to sun exposure. Of significance is a single hotspot codon, i.e., BRAF V600, wherein up to 92% of all mutations arise. Recent work in our laboratory has demonstrated that solar ultraviolet (UV) irradiation triggers mutagenesis through induction of various DNA lesions, many of which capable of producing similar types of mutations, as those seen in BRAF V600 variants in human melanoma. In this review article, we have discussed application of "DNA damage-targeted mutagenicity" of solar UV-irradiation for determining the mechanistic involvement of sunlight UV in BRAF V600 mutagenesis in human melanoma. We envision that establishing "DNA-damage derived mutagenesis" in this exceptionally unique target gene may resolve the underlying mechanism(s) of melanoma-genesis, thus helping define preventive and therapeutic measures against this malignant disease. Hum Mutat 0, 1,9, 2008. © 2008, Wiley-Liss, Inc. [source]

Prostaglandin E2 promotes cell proliferation via protein kinase C/extracellular signal regulated kinase pathway-dependent induction of c-Myc expression in human esophageal squamous cell carcinoma cells

INTERNATIONAL JOURNAL OF CANCER, Issue 11 2009
Le Yu
Abstract Overexpression of cyclooxygenase-2 (COX-2) and elevation of its derivative prostaglandin E2 (PGE2) are implicated in human esophageal squamous cell carcinoma. The expression of c-Myc, an oncogenic transcription factor, is also upregulated in this malignant disease. This study sought to elucidate whether a functional connection exists between COX-2/PGE2 and c-Myc in esophageal squamous cell carcinoma. Results showed that PGE2 substantially increased the proliferation of cultured esophageal squamous cell carcinoma cells. In this regard, PGE2 substantially increased the mRNA and protein expression of c-Myc and its association with the binding partner Max. Knockdown of c-Myc by RNA interference also significantly attenuated PGE2 -induced cell proliferation. Further, mechanistic study revealed that PGE2 increased the protein stability and nuclear accumulation of c-Myc via phosphorylation on serine 62 in an extracellular signal regulated kinase (ERK)-dependent manner. To this end, ERK activation by PGE2 was completely abolished by protein kinase C (PKC) inhibitors. Moreover, the effect of PGE2 on c-Myc expression was mimicked by EP2 receptor agonist. In addition, knockdown of EP2 receptor by EP2 siRNA attenuated PGE2 -induced c-Myc expression. Collectively, our findings suggest that PGE2 upregulates c-Myc via the EP2/PKC/ERK pathway. This study sheds new light on the carcinogenic mechanism of PGE2 in esophageal squamous cell carcinoma. © 2009 UICC [source]

Incidence of bone and soft tissue sarcoma after radiotherapy: A cohort study of 295,712 Finnish cancer patients

INTERNATIONAL JOURNAL OF CANCER, Issue 4 2006
Anna Virtanen
Abstract Radiotherapy is commonly used for treatment of malignant disease. As a consequence of radiotherapy, an increased risk of developing a second malignant neoplasm has been shown. However, little is known about the effects of radiation on developing sarcoma. The aim of this study was to examine the risk of developing a bone or soft tissue sarcoma after radiotherapy for a first primary cancer. The study population included all the patients with primary cancers of breast, cervix uteri, corpus uteri, lung, ovary, prostate, rectum and lymphoma diagnosed during 1953,2000 and identified from the Finnish Cancer Registry. Patients were followed up for subsequent sarcomas. The follow-up yielded 1.5 million person-years at risk and 147 sarcomas. Compared to the national incidence rates, after 10 years of follow-up sarcoma risk was increased among patients who had received neither radiotherapy nor chemotherapy (standardised incidence ratio (SIR) 2.0, 95% CI 1.3,3.0), radiotherapy without chemotherapy (SIR 3.2, 95% CI 2.3,4.3), chemotherapy without radiotherapy (SIR 4.9, 95% CI 1.0,14.4), as well as combined radiotherapy and chemotherapy (SIR 3.4, 95% CI 0.4,12.5). For radiotherapy in ages below 55 the SIR was 4.2 (95% CI 2.9,5.8). In the adjusted regression analysis the rate ratio was 1.5 (95% CI 0.9,2.6) for the radiotherapy group. In conclusion, radiotherapy appears to be associated with an increased risk of developing sarcoma especially among younger patients. Further investigation is needed to clarify the dose,response of the preceding ionizing radiation. © 2005 Wiley-Liss, Inc. [source]

Lack of association between the incidence of testicular germ cell tumors and Y-chromosome haplogroups in the Japanese population

INTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2006
ASHRAF A EWIS
Background: Despite being relatively uncommon, testicular germ cell tumors (TGCT) are the most common malignant disease in young men. Epidemiological studies concerning patients with testicular cancer indicate that the most of them have poor semen quality or testicular dysgenesis. However, many studies have shown that the Y chromosome harbors many candidate genes responsible for spermatogenesis process and development and maintenance of the germ cells. The Y chromosome is thought to have a relationship with the formation and progression of TGCT. Materials and methods: To verify this relationship, we investigated if there is any correlation between the Y chromosome structural variations presented as different haplogroups and the occurrence of TGCT in the Japanese population. Using combined haplogroups based on typing of three Y chromosome polymorphic binary markers, we analyzed 68 TGCT derived from Japanese patients together with randomly selected 104 unrelated healthy Japanese matched male controls who were confirmed as residents of the same geographic area. Results: Our findings showed a lack of association between the incidence of TGCT and the different Y- chromosome haplogroups in Japanese population. Conclusion: We concluded that there are no significant variations in males from different Y chromosome lineages regarding their susceptibility or resistance for developing TGCT. The previously hypothesized role of the Y chromosome in the development of TGCT is still uncertain and needs further verification. [source]

Incidence and growth pattern of simple cysts of the kidney in patients with asymptomatic microscopic hematuria

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2003
KEN MARUMO
AbstractBackground: We examined the incidence and natural history of simple renal cysts found by ultrasonography (US) in patients referred for asymptomatic microscopic hematuria. Methods: Among the 906 patients aged 18,78 years, 743 patients who had undergone US were included in the present study. The natural history of simple renal cysts was investigated in 55 patients who underwent periodical US examinations for more than 3 years. Results: The incidence of simple renal cysts was 4.3% for ages 29 years or younger, 15.3% for ages 30,39, 21.8% for ages 40,49, 23.3% for ages 50,59 and 32.6% for ages 60 years or older; thus the incidence increased in older age groups (P = 0.0005 for men, P = 0.0020 for women). Men tended to have a higher incidence than women. The degree of hematuria did not influence the incidence of renal cysts (P = 0.9044). The annual growth rate of the mean maximum diameter was 4.2% during a 3-year follow-up period in 55 patients and 5.1% during a 6-year follow-up in 31 patients. Conclusion: Since the diameter of a renal cyst may increase by 5% annually, the diameter of the cyst may increase by 1.6 times in 10 years. The scheduling of follow-up examinations depends on the size at the time of disclosure, the effects on calyceal systems, or the suspicion of a concurrent malignant disease. However, the most simple renal cysts may be followed-up at an interval of more than 10 years, once a diagnosis has been established. [source]

Predictors of prostate cancer on repeat transrectal ultrasound-guided systematic prostate biopsy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2003
SOO-JEON PARK
AbstractBackground: We analyzed the outcome of repeated transrectal ultrasound (TRUS)-guided systematic prostate biopsy in Japanese men whose clinical findings were suspected of prostate cancer after previous negative biopsies. Methods: Between January 1993 and March 2002, 1045 patients underwent TRUS-guided prostate biopsy. Among them, 104 patients underwent repeat biopsy due to indications of persistent elevated serum prostate-specific antigen (PSA), abnormal digital rectal examination (DRE) or TRUS, increased PSA velocity, and/or previous suspicious biopsy findings. Several clinicopathological factors were evaluated for their ability to predict the detection of prostate cancer on repeat biopsy. Results: Prostate cancer was detected in 22 of 104 patients (21.2%) who underwent repeat biopsies. PSA concentration and PSA density at both the initial and repeat biopsies, and PSA velocity in men with positive repeat biopsy were significantly greater than those in men with negative repeat biopsy. The incidence of abnormal findings in DRE and TRUS at initial biopsy in men with positive repeat biopsy was also significantly higher than that in men with negative repeat biopsy. However, neither the presence of prostatic intraepithelial neoplasia nor number of biopsy cores at initial biopsy had a significant association with the results of the repeat biopsy. Furthermore, multivariate analysis revealed that PSA and PSA density at both the initial and repeat biopsies, PSA velocity, and DRE and TRUS findings at initial biopsy were independent predictors of malignant disease on repeat biopsy. Conclusion: Despite an initial negative biopsy, repeat TRUS-guided biopsy should be carried out to exclude prostate cancer in cases of suspicious clinical findings, such as elevated PSA or PSA-related parameters, or abnormal findings of DRE or TRUS. [source]

Toll-Like Receptors in Older Adults

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2007
David Van Duin MD
Toll-like receptors (TLRs) recognize a limited number of conserved elements in pathogens and, by activating antigen-presenting cells such as dendritic cells and monocytes and macrophages, play a crucial role in the immune response to infection and vaccination. Most data on TLR function in the context of human aging focus on responses to lipopolysaccharide, an integral component of gram-negative bacteria, which signals through TLR4. However, such studies have not led to a consensus conclusion and are limited by differences in epidemiological and laboratory methods. A recent comprehensive evaluation of TLR function in monocytes from older adults was conducted using a multivariable mixed statistical model to account for covariates. It was found that cytokine production after TLR1/2 engagement, which is essential for the recognition of triacylated lipopeptides found in a variety of bacteria, is substantially lower in monocytes from older adults. The upregulation of costimulatory proteins such as CD80, essential for optimal activation of T cells, on monocytes from older adults was less for all TLR ligands tested than for cells from young individuals, and the extent of CD80 upregulation predicted subsequent antibody response to influenza immunization. These and other consequences of aging on human TLR function may impair activation of the immune response and contribute to poorer vaccine responses and greater morbidity and mortality from infectious diseases in older adults. Such age-associated alterations have particular relevance in view of the interest in TLR agonists as therapeutic agents not only for infections, but also for allergic, autoimmune, and malignant disease. [source]

Mortality Risk in Older Inner-City African Americans

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007
Theodore K. Malmstrom PhD
OBJECTIVES: To investigate mortality risks in a sample of poor, inner-city-dwelling, older African Americans. DESIGN: Prospective cohort study. SETTING: St. Louis, Missouri. PARTICIPANTS: Six hundred twenty-two African Americans aged 68 to 102 at the time of their 1992 to 1994 baseline interviews. MEASUREMENTS: Risk factors previously identified in the literature were examined for seven categories: demographic, socioeconomic, psychosocial, biomedical, disability and physical function, perceived health, and health services utilization. Vital status was ascertained through 2002. RESULTS: Three hundred eighty-six subjects (62.1%) were deceased and 236 were alive (mortality higher than in matched controls). Significant risks for mortality were older age, male sex, annual income less than $10,000, cancer, cerebrovascular disease, dependencies in lower-body function, and number of physician visits in the 12 months before baseline. CONCLUSION: In addition to improving the risk factors for stroke and malignant disease in this population, studies focused on improving lower-body functioning may be warranted as a part of efforts aimed at enhancing longevity in older African-American adults. [source]

Use of Off-pump Coronary Artery Bypass Surgery Among Patients with Malignant Disease

VEGF concentration from plasma-activated platelets rich correlates with microvascular density and grading in canine mast cell tumour spontaneous model

JOURNAL OF CELLULAR AND MOLECULAR MEDICINE, Issue 3 2009
R. Patruno
Abstract Canine cutaneous mast cell tumour (CMCT) is a common cutaneous tumour in dog, with a higher incidence than in human. CMCT is classified in three subgroups, well and intermediately differentiated (G1 and G2), corresponding to a benign disease, and poorly differentiated (G3), corresponding to a malignant disease, which metastasize to lymph nodes, liver, spleen and bone marrow. In this study, we have evaluated serum (S), platelet-poor plasma (P-PP), plasma-activated platelet rich (P-APR) and cytosol vascular endothelial growth factor (VEGF) concentrations, microvascular density (MVD) and mast cell density (MCD) in a series of 86 CMCTs and we have correlated these parameters with each other, by means of ELISA detection of VEGF and immunohistochemistry. Results show that VEGF level from cytosol P-APR and MVD were significantly higher in G3 CMCTs as compared to G1 or G2 subgroups. Moreover, a significantly strong correlation among VEGF levels from P-PAR and cytosol, MVD and MCD was found in G3 subgroup. Because VEGF levels from P-APR well correlated with MVD and malignancy grade in CMCT, we suggest that VEGF might be secreted from MCs and it may be a suitable surrogate inter-species angiogenetic markers of tumour progression in CMCT. Finally, CMCT seems to be a useful model to study the role of MCs in tumour angiogenesis and inhibition of MCs degranulation or activation might be a new anti-angiogenic strategy worthy to further investigations. [source]

Role of Helicobacter pylori infection in gastric cancer pathogenesis: A chance for prevention

JOURNAL OF DIGESTIVE DISEASES, Issue 1 2010
Peter MALFERTHEINER
Gastric cancer in the absence of strategies implemented for early detection continues to have a dismal prognosis. There are limited options for a curative therapy once patients present with clinical manifestations of this malignant disease. Helicobacter pylori (H. pylori) infection plays a key role in gastric carcinogenesis, supported by epidemiological, preclinical and clinical studies. The recognition of H. pylori infection as a critical risk factor in the development of gastric cancer opens the chance for new venues in prevention strategies. [source]

Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosis

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2008
Lakshmana Ayaru
Abstract Background:, Self-expanding metal bile duct stents provide good palliation for inoperable malignant disease. However, problems may arise if metal stents are inserted before definitive histological diagnosis. The aim of this study was to evaluate the outcome of such patients. Methods:, A retrospective case note review was conducted of patients referred to a tertiary pancreaticobiliary center between 1992 and 2004 in whom a metal bile duct stent was inserted for presumed unresectable malignant disease before definitive histological diagnosis. Results:, There were 21 patients identified. Final diagnoses were: group 1, benign disease (n = 3); group 2, resectable malignancy (n = 2); group 3, unresectable malignancy (n = 12); and group 4, diagnosis remains uncertain (n = 4). During a follow-up of 22, 38 and 111 months, the patients in group 1 had one, eight and five episodes of stent occlusion. In group 2, both patients underwent pancreaticoduodenectomy for ampullary carcinoma, 2 and 6 months after presentation. In group 3, the median time to a confirmed malignant diagnosis was 2 months (range 1,27 months). In group 4, a median of two biopsies (range 1,4) were negative for malignancy, during a median follow up of 13 months (range 3,46). Overall in eight patients, the metal stents caused artifacts on computed tomography and/or were associated with tissue in-growth making the differentiation between benign and malignant disease difficult. Conclusion:, These cases indicate that metal bile duct stent insertion before definitive histological diagnosis can be problematic. A proportion of cases will have benign strictures and in others the confirmation of malignancy may be made more difficult. [source]

The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg

JOURNAL OF INTERNAL MEDICINE, Issue 5 2000
P. Lindmarker
Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601,606. Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. Design. An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. Setting. Sixteen hospitals in central Sweden. Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (±SD) period of 31(±29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4,1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis. [source]

Effect of slice thickness on liver lesion detection and characterisation by multidetector CT

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2010
JT Smith
Summary The purpose of our study was to compare the effectiveness of 3.2 mm, 5 mm and 7.5 mm slice thicknesses in the detection and characterisation of liver lesions found on CT in patients with known or suspected malignant disease. 110 patients underwent portal phase imaging using four-slice MDCT. Two blinded observers independently read hard copy images at each slice thickness. The size and location of each lesion detected was recorded by each observer on a diagram of liver segmental anatomy. Each lesion was characterised as benign, malignant or indeterminate in nature. A diagnostic confidence score was allocated for each lesion on a scale of 1,4. The pathology or behaviour of lesions was assessed using surgery with intra-operative ultrasound (IOUS) and histology, or interval imaging with MRI, CT, or sonography. 294 lesions were detected, 64 (22%) of which were malignant. Both observers detected significantly more lesions on the 3.2 mm versus 7.5 mm slice thickness (p < 0.0001). Both observers detected more malignant lesions on 3.2 mm and 5 mm slice thicknesses versus 7.5 mm. As slice thickness decreased there was a significant increase in the sensitivity of malignant lesion detection for observer 1 (p < 0.001) and borderline significance for observer 2 (p = 0.07). As slice thickness decreased the proportion of lesions characterised as indeterminate by both observers fell. With thinner slices, both detection and characterisation of liver lesions were improved. A slice thickness no greater than 5 mm should be used to maximise both detection and correct characterisation of liver lesions. [source]

An analysis of oral and maxillofacial pathology found in adults over a 30-year period

JOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 7 2006
A. V. Jones
Background:, The aim of this study was to determine the range of histologically diagnosed lesions in 44 000 oral and maxillofacial pathology specimens, from adults 17 years and older, submitted for diagnosis to our laboratory over a 30-year period (1973,2002). Materials:, All entries for specimens from the patients were retrieved and compiled into 12 diagnostic categories. Results:, During the period, 44 007 specimens comprised a male-to-female ratio of 0.9:1. The diagnostic category with the largest number of specimens was mucosal pathology (36.0%) followed by odontogenic cysts (13.8%). Malignant tumours accounted for 5.4% of all specimens and benign tumours 4.6%. Conclusion:, This survey showed that while the majority of diagnoses are benign, approximately one in 19 cases required major head and neck surgery for malignant disease. [source]

Tattoo removal by non-professionals , medical and forensic considerations

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 7 2010
S Karsai
Abstract Tattoos are common phenomena in the western world and the demand for their removal has become widespread in the recent years. The introduction of quality-switched lasers has provided an effective removal method that is increasingly being exploited by tattoo studios themselves. Dermatologists, however, are frequently confronted with complications and side effects of tattoo removals that were performed by non-professionals. The objective of this study is to assess potential risks and pitfalls of laser tattoo removal when performed by medical laymen. The methods followed are systematic and evidence-based review of the literature. Four major problem areas were identified: rare but potentially severe allergic or toxic effects of decomposition products of the tattoo pigments; bodily harm caused by out-of-specification usage of the laser devices; malignant disease that is obscured within the area of a tattoo and requires meticulous dermatological diagnosis; and insufficient pre-operative consultation of patients about the risks, side effects and realistic expectations on the therapeutic outcome. We came to a conclusion that tattoo laser removal by medical laymen is unacceptable from the point of view of patient safety and the laws need to ban this practice swiftly. [source]

Clinical trial: a randomized trial of early endoscopy, Helicobacter pylori testing and empirical therapy for the management of dyspepsia in primary care

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 1 2009
A. E. DUGGAN
Summary Background, Early endoscopy, Helicobacter pylori eradication and empirical acid suppression are commonly used dyspepsia management strategies in primary care but have not been directly compared in a single trial. Aim, To compare endoscopy, H. pylori test and refer, H. pylori test and treat and empirical acid suppression for dyspepsia in primary care. Methods, Patients presenting to their general practitioner with dyspepsia were randomized to endoscopy, H. pylori,test and treat', H. pylori test and endoscope positives, or empirical therapy with symptoms, patient satisfaction, healthcare costs and cost effectiveness at 12 months being the outcomes. Results, At 2 months, the proportion of patients reporting no or minimal dyspeptic symptoms ranged from 74% for those having early endoscopy to 55% for those on empirical therapy (P = 0.009), but at 1 year, there was little difference among the four strategies. Early endoscopy was associated with fewer subsequent consultations for dyspepsia (P = 0.003). ,Test and treat' resulted in fewer endoscopies overall and was most cost-effective over a range of cost assumptions. Empirical therapy resulted in the lowest initial costs, but the highest rate of subsequent endoscopy. Gastro-oesophageal cancers were found in four patients randomized to the H. pylori testing strategies. Conclusions, While early endoscopy offered some advantages ,Test and treat' was the most cost-effective strategy. In older patients, early endoscopy may be an appropriate strategy in view of the greater risk of malignant disease. [source]

Antibiotic prophylaxis for percutaneous endoscopic gastrostomy for non-malignant conditions: a double-blind prospective randomized controlled trial

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2005
A. SAADEDDIN
Summary Background :,The use of antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy insertion has been encouraged following development of guidelines by a number of professional societies within the past few years. However, not all evidence supports routine prophylaxis, particularly in patients with ,benign' disease indications for percutaneous endoscopic gastrostomy insertion. Aim :,To identify whether prophylactic antibiotic usage is beneficial in patients undergoing percutaneous endoscopic gastrostomy insertion without malignant disease. Methods :,Adult patients without malignant disease who were referred for percutaneous endoscopic gastrostomy insertion at our unit were assessed for participation in this prospective, double-blind, randomized controlled study. Patients were randomized to receive either placebo or 2.2 g co-amoxiclav (or 2 g cefotaxime if penicillin-allergic) at time of percutaneous endoscopic gastrostomy insertion. Clinical endpoints studies were percutaneous endoscopic gastrostomy site or systemic infection and death within 7 days of percutaneous endoscopic gastrostomy insertion. Results :,Ninety-nine patients completed the study (51 antibiotics, 48 placebo). Outcomes in the antibiotic and placebo groups respectively were: percutaneous endoscopic gastrostomy site infection, 11% vs. 47% (P < 0.01); systemic infection, 16% vs. 38% (P < 0.05); and death, 8% vs. 15% (P = 0.5). Conclusions :,Antibiotic prophylaxis prior to percutaneous endoscopic gastrostomy insertion reduces both percutaneous endoscopic gastrostomy site and systemic infections in patients without malignant disease. [source]

Liver transplantation and pancreatic resection: A single-center experience and a review of the literature

LIVER TRANSPLANTATION, Issue 12 2009
John A. Stauffer
Liver transplantation may occasionally be indicated in patients with unique clinical scenarios. Little is known regarding the outcomes of patients who have had a pancreatic resection prior to, in combination with, or after liver transplantation. A retrospective review of all patients undergoing liver transplantation from March 1998 to March 2008 identified 17 patients who also underwent pancreatic resection. An additional literature review was performed. Five underwent pancreatic resection prior to liver transplantation (1.7, 3.6, 3.8, 6.8, and 8.1 years), another 9 underwent pancreatic resection together with liver transplantation, and 3 underwent pancreatic resection after liver transplantation (2.2, 2.6, and 3.8 years). Indications for pancreatic resection included cholangiocarcinoma (n = 6), neuroendocrine tumor (n = 5), pancreatic cancer (n = 2), gastrointestinal stromal tumor (n = 1), periampullary adenocarcinoma (n = 1), duodenal adenomas (n = 1), and benign pancreatic mass (n = 1). Indications for liver transplantation were metastatic neuroendocrine tumor disease (n = 5), primary sclerosing cholangitis (n = 5), hepatitis C virus (n = 2), metastatic gastrointestinal stromal tumor (n = 1), Klatskin tumor (n = 1), alcohol cirrhosis (n = 1), alpha-1 antitrypsin deficiency (n = 1), and chemotherapy-induced cirrhosis (n = 1). One patient died intraoperatively, 7 patients died of tumor recurrence, 2 patients died from transplant complications, and 7 patients are still alive. Pancreatic resection,related complications included 4 pancreatic fistulas. A literature review confirmed liver transplantation/pancreatic resection,related complications. In conclusion, liver transplantation and pancreatic resection remain uncommon, and a good outcome can be achieved. Recurrence of malignant disease is the main factor limiting survival, and specific morbidity may be related to pancreatic resection and liver transplantation. Liver Transpl 15:1728,1737, 2009. © 2009 AASLD. [source]