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Patients Prospectively (patient + prospectively)
Selected AbstractsMesalazine with or without cholestyramine in the treatment of microscopic colitis: Randomized controlled trialJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 6 2007Carlo Calabrese Abstract Background:, Collagenous colitis (CC) and lymphocytic colitis (LC) are chronic inflammatory diseases of the colon with a benign and sometimes relapsing course. Frequency among patients with chronic diarrhea and normal looking colonoscopy is around 10,15%. To date, treatment of CC and LC is not well defined. Data about these conditions are mostly derived from retrospective studies. The aim of the present study was to evaluate the response to treatment and the clinical course of CC and LC in a large group of patients prospectively diagnosed. Methods and Results:, A total of 819 patients underwent a colonoscopy because of chronic watery diarrhea and among them we found 41 patients with LC and 23 with CC. These patients were later randomized and assigned to treatment with mesalazine or mesalazine + cholestyramine for 6 months. Fifty-four patients (84.37%) had resolved diarrhea in less than 2 weeks. After 6 months a colonoscopy with biopsies was repeated. Clinical and histological remission was achieved in 85.36% of patients with LC and in 91.3% with CC, with a better result in patients with CC treated with mesalazine + cholestyramine. During a mean period of 44.9 months, 13% of patients relapsed; four with LC and three with CC. They were retreated for another 6 months. At the end of this period one patient with CC was still symptomatic and persistence of CC was confirmed at histology. Conclusions:, Treatment with mesalazine seems to be an effective therapeutic option for LC to date, while mesalazine + cholestyramine seems to be more useful in the treatment of CC. [source] Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms in High-Risk Patients:JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2004A Single Center Experience Background: Endovascular stent graft (EVG) repair can be a safe alternative to open surgical repair to treat abdominal aortic aneurysms (AAA) in high-risk patients. We report our results with EVG repair in such high-risk patients at our institution. Objectives: We wanted to show that EVG repair can be performed successfully and with a low complication rate in patients with serious comorbidities. Methods: All patients prospectively studied underwent EVG repair of AAA from February 2000 to July 2002. Results: Of the 60 patients studied, 45 (75%) were high-risk surgical candidates because of associated comorbidities; their aneurysms ranged from 4.5 to 10 cm (mean: 5.7 ± 1.2 cm). Fifty-nine of 60 patients (98.3%) were treated successfully. Two (3.3%) who underwent surgical intervention for site-related complications died from postoperative complications. Hospital stay was <48 hours in 46 (77%) patients. Conclusion: Our preliminary results show that EVG is safe, feasible, and yields excellent technical success even in patients at high risk for complications. Teamwork between interventional cardiologists and vascular surgeons is advised. (J Interven Cardiol 2004;17:71,79) [source] Second trimester trisomy 21 maternal serum marker screening.PRENATAL DIAGNOSIS, Issue 10 2002Results of a countrywide study of 854 902 patients Abstract Objectives In France, maternal serum marker screening is governed by specific legislation. We conducted a study of the countrywide trisomy 21 screening based on second trimester maternal serum markers. Methods We reviewed the medical records of 854 902 patients prospectively screened for second trimester maternal serum markers in the 60 authorised laboratories over the two-year period 1997,1998. All patients screened in France were included. The risk of trisomy 21 was calculated from the combination of maternal age and maternal serum markers. The same cut-off (1/250) was used in all laboratories. Results In 1998, 65% of pregnant women underwent maternal serum screening. In the 837 765 patients under 38 years of age who were screened, 54 321 (6.48%; 5% CI 6.42,6.53%) had a calculated risk >1/250. Of the 884 Down syndrome cases observed, 626 were detected by maternal serum markers (70.8%; 5% CI 67.8,73.8%). These good results can be explained by a strict quality control of all steps. For the 13 891 patients over 38 years of age, the Down syndrome detection rate was 98.9% for a 34% false-positive rate. Conclusions Strict rules covering prenatal trisomy 21 screening are of benefit to patients, practitioners and laboratories alike, and ensure good quality control, a high trisomy 21 detection rate and a low amniocentesis rate. Copyright © 2002 John Wiley & Sons, Ltd. [source] Auditory Brainstem Response versus Magnetic Resonance Imaging for the Evaluation of Asymmetric Sensorineural Hearing Loss,THE LARYNGOSCOPE, Issue 10 2004Roberto A. Cueva MD Abstract Objectives/Hypothesis: Auditory brainstem response (ABR) testing and magnetic resonance imaging (MRI) are compared for the evaluation of patients with asymmetric sensorineural hearing loss (SNHL). MRI with gadolinium administration is the current gold standard for identifying retrocochlear lesions causing asymmetric SNHL. The study seeks to determine the sensitivity and specificity of ABR in screening for possible retrocochlear pathology. Most important among SNHL etiologies are neoplastic lesions such as vestibular schwannomas, cerebellopontine angle (CPA) tumors, as well as multiple sclerosis, stroke, or other rare nonneoplastic causes. The study results will allow the author to recommend a screening algorithm for patients with asymmetric SNHL. Study Design: The study is a multi-institutional, institutional review board approved, prospective, nonrandomized comparison of ABR and MRI for the evaluation of patients with asymmetric SNHL. Methods: Three hundred twelve patients (between the ages of 18 and 87) with asymmetric SNHL completed the study. Asymmetric SNHL was defined as 15 dB or greater asymmetry in two or more frequencies or 15% or more asymmetry in speech discrimination scores (SDS). These patients prospectively underwent both ABR and MRI. The ABR and MRI were interpreted independently in a blinded fashion. In addition to the ABR and MRI results, a variety of clinical and demographic data were collected. Results: Thirty-one (9.94%) patients of the study population of 312 were found on MRI to have lesions causing their SNHL. Of the 31 patients with causative lesions on MRI there were 24 vestibular schwannomas, 2 glomus jugulare tumors, 2 ectatic basilar arteries with brainstem compression, 1 petrous apex cholesterol granuloma, 1 case of possible demyelinating disease, and 1 parietal lobe mass. Twenty-two of the 31 patients had abnormal ABRs, whereas 9 patients (7 with small vestibular schwannomas) had normal ABRs. This gives an overall false-negative rate for ABR of 29%. The false-positive rate was found to be 76.84%. Sensitivity of ABR as a screening test was 71%, and specificity was 74%. Conclusions: Ten percent of patients with asymmetric SNHL (by this study's criteria) are likely to have causative lesions found on MRI. Although the recently reported annual incidence of vestibular schwannoma in the general population is 0.00124%, for patients with asymmetric SNHL in this study, the incidence was 7.7% (nearly 4 orders of magnitude higher). ABR has been demonstrated to have low sensitivity and specificity in the evaluation of these patients and cannot be relied on as a screening test for patients with asymmetric SNHL. Keeping the use of MRI conditional on the results of ABR will annually result in missed or delayed diagnosis of causative lesions in 29 patients per 1,000 screened. The author recommends abandoning ABR as a screening test for asymmetric SNHL and adoption of a focused MRI protocol as the screening test of choice (within certain guidelines). [source] A study comparing various noninvasive methods of detecting bladder cancer in urineBJU INTERNATIONAL, Issue 4 2002A. Saad Objectives To compare the nuclear matrix protein (NMP)-22 assay, bladder tumour specific antigen (BTAstat) test, telomerase activity (using the telomeric repeat amplification protocol assay, TRAP) and a haemoglobin dipstick test for their ability to replace voided urine cytology (VUC) for detecting bladder cancer. Patients and methods The study included 120 urological patients prospectively recruited and assessed before surgery. A single freshly voided urine sample (,100 mL) was collected from each patient and aliquoted for each test. All assays were conducted according to the manufactures' guidelines; 79 patients were tested for telomerase activity. The results were then compared with VUC and the diagnosis confirmed by cystoscopy and histology. Results Fifty-two patients had histologically confirmed transitional cell carcinoma. The overall sensitivity for BTAstat, NMP22, telomerase, VUC and dipstick testing was 63%, 81%, 84%, 48% and 50%, respectively. Combining the results for telomerase and NMP22 gave a sensitivity of 100%. For G1 tumours the respective sensitivities were 23%, 62%, 56%, 23% and 15%, for G2 tumours, 68%, 86%, 92%, 50% and 41% and for G3 tumours 88%, 88%, 100%, 71% and 82%. For pTa tumours the respective detection rates were 48%, 70%, 84%, 39% and 30%, for pT1 tumours 80%, 90%, 90%, 50% and 50%, for pT2/pTis tumours, 100/100%, 100/100%, 100/100%, 88/100% and 88/83%. The overall specificity for the respective tests was 82%, 87%, 93%, 87% and 54%; combining the results of NMP22 and telomerase activity increased the specificity to 96%. Conclusions There was significantly better detection than VUC when using the NMP22 and TRAP assay, especially for well-differentiated (P < 0.001 and 0.0027, respectively) and superficial tumours (P < 0.001 and 0.034, respectively). Combining the results of NMP22 and telomerase activity yielded values comparable with cystoscopy. [source] MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complicationsCLINICAL TRANSPLANTATION, Issue 4 2010Piero Boraschi Boraschi P, Donati F, Gigoni R, Volpi A, Salemi S, Filipponi F, Falaschi F. MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications. Clin Transplant 2010: 24: E82,E87. © 2009 John Wiley & Sons A/S. Abstract:, Background:, To assess the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating biliary complications in a large series of liver transplants. Methods:, One hundred and twenty-nine patients prospectively underwent magnetic resonance (MR) imaging and MR cholangiography at 1.5-T device after orthotopic liver transplantation (OLT). After the preliminary acquisition of axial T1- and T2-weighted images, MRC involved respiratory-triggered, thin-slab (2 mm), heavily T2-weighted fast spin-echo and breath-hold, thick-slab (10,50 mm), single-shot T2-weighted sequences. MR images were blindly evaluated by two experienced readers in conference to determine the biliary anatomy and the presence of complications, whose final diagnosis was based on endoscopic retrograde cholangiography, percutaneous trans-hepatic cholangiography, and by integrating clinical follow-up with ultrasound and/or MR findings. Results:, Biliary complications were found in 60 patients (46.5%) and were represented by ischemic-type biliary lesions (n = 21); anastomotic strictures (n = 13); non-anastomotic strictures (n = 5); anastomotic strictures associated to lithiasis (n = 6); lithiasis (n = 6); papillary dysfunctions (n = 9). The sensitivity, specificity, positive predictive value, and negative predictive value of the reviewers for the detection of all types of biliary complications in patients with OLT were 98%, 94%, 94%, and 98%, respectively. Conclusions:, MRC is a reliable technique for detecting post-OLT biliary complications and should be recommended before planning therapeutic interventions. [source] | ||||||||||