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Recurrent Disease (recurrent + disease)

Distribution by Scientific Domains

Medical Sciences	95%
Mathematics and Statistics	2%

Distribution within Medical Sciences

Transplantation	26%
Oncology & Radiotherapy	21%
Surgery & Surgical Specialties	17%
Otolaryngology (Ear, Nose & Throat)	7%
Urology	3%
18 Other Subdomains	26%

Selected Abstracts

Phenotypic Expression of Recurrent Disease After Liver Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2010
J. G. O'Grady
Recurrence of the primary disease has become a major focus for transplant hepatologists both when investigating graft dysfunction and when tailoring immunosuppression to maximize graft survival. However, disease recurrence varies in penetrance, can be predictable or random, and does not always conform to the expected pattern of disease. The cholestatic hepatitis syndromes associated with hepatitis B and C are the most dramatic examples of phenotypic change. Being on immunosuppressive drugs may intensify the progression of infectious and malignant diseases, but this effect is not predictable. A significant minority of patients with each of the autoimmune diseases, counter-intuitively, get recurrent disease despite immunosuppression of a potency that is adequate to prevent rejection of the liver graft. Disease patterns emerge after liver transplantation for cryptogenic cirrhosis that shed light on the cause of the native liver disease, for example, nonalcohol-related fatty liver disease and autoimmune hepatitis. The phenotypic expression of disease recurrence can be modified by specific drugs used for immunosuppression and by HLA-antigen matching profiles. Understanding and modifying the phenotypic expression of recurrent disease after liver transplantation is a fertile area for research and continued refinement of clinical care. [source]

Recurrent Disease after Kidney Transplantation,It Is Time to Unite to Address This Problem!

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2006
A. J. Matas
Considering the magnitude of the problem, and the lack of progress toward a solution, the issue of recurrent disease after renal transplantation should be given a higher profile. See also the minireview by Choy et al in this issue on page 2535. [source]

A Mixture Point Process for Repeated Failure Times, with an Application to a Recurrent Disease

BIOMETRICAL JOURNAL, Issue 7 2003
O. Pons
Abstract We present a model that describes the distribution of recurring times of a disease in presence of covariate effects. After a first occurrence of the disease in an individual, the time intervals between successive cases are supposed to be independent and to be a mixture of two distributions according to the issue of the previous treatment. Both sub-distributions of the model and the mixture proportion are allowed to involve covariates. Parametric inference is considered and we illustrate the methods with data of a recurrent disease and with simulations, using piecewise constant baseline hazard functions. [source]

Estimation of the Causal Effects on Survival of Two-Stage Nonrandomized Treatment Sequences for Recurrent Diseases

BIOMETRICS, Issue 3 2006
Xuelin Huang
Summary In the treatment of cancer, patients commonly receive a variety of sequential treatments. The initial treatments administered following diagnosis can vary, as well as subsequent salvage regimens given after disease recurrence. This article considers the situation where neither initial treatments nor salvage treatments are randomized. Assuming there are no unmeasured confounders, we estimate the joint causal effects on survival of initial and salvage treatments, that is, the effects of two-stage treatment sequences. For each individual treatment sequence, we estimate the survival distribution function and the mean restricted survival time. Different treatment sequences are then compared using these estimates and their corresponding covariances. Simulation studies were conducted to evaluate the performance of the methods, including their sensitivity to the violation of the assumption of no unmeasured confounders. The methods are illustrated by a retrospective study of patients with soft tissue sarcoma, which motivated this research. [source]

Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience

HPB, Issue 1 2007
D. Gomez
Abstract Background: The outcome of surgical intervention for hepatic metastases from gastrointestinal stromal tumours (GIST) is still uncertain. This study evaluated the outcome of patients following aggressive surgical resection and Imatinib mesylate therapy (IM). Patients and methods: This was a retrospective analysis of patients managed with hepatic metastases from GIST over a 13-year period (January 1993 to December 2005). Results: Twelve patients were identified with a median age at diagnosis of 62 (32,78) years. The primary sites of GIST were stomach (n= 5), jejunum (n= 4), sigmoid (n= 1), peritoneum (n= 1) and pancreas (n= 1). Eleven patients underwent surgical resection with curative intent and one patient had cytoreductive surgery. Following surgery with curative intent (n= 11), the overall 2- and 5-year survival rates were both 91%, whereas the 2- and 5-year disease-free rates following primary hepatic resection were 30% and 10%, respectively. The median disease-free period was 17 (3,72) months. Eight patients had recurrent disease and were managed with further surgery (n= 3), radiofrequency ablation (RFA) (n= 2) and IM (n= 8). Overall, there are four patients who are currently disease-free: two patients following initial hepatic resection and two patients following further treatment for recurrent disease. There was no significant association in clinicopathological characteristics between patients with recurrent disease within 2 years and patients who were disease-free for 2 years or more. Overall morbidity was 50% (n= 6), with one postoperative death. The follow-up period was 43 (3,72) months. Conclusion: Surgical resection for hepatic GIST metastases may improve survival in selected patients. Recurrent disease can be managed with surgery, RFA and IM. [source]

Flash-echo contrast sonography in the evaluation of response of small hepatocellular carcinoma to percutaneous ablation

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2006
Jing-Houng Wang MD
Abstract Purpose. To evaluate the use of flash-echo contrast sonography (FECS) in subtraction mode in assessing small hepatocellular carcinoma (HCC) after percutaneous local ablation therapy. Methods. Between March 2000 and February 2002, we prospectively assessed small HCCs after percutaneous local ablation therapy using FECS in subtraction mode. Thirty-three patients (22 men, 11 women) with 35 tumors ranging in size from 1.1 to 3.0 cm (mean ± SD, 2.0 ± 0.5) were enrolled. Twenty-one tumors received percutaneous ethanol injection only, 13 tumors received percutaneous microwave ablation therapy only, and the remaining tumor received both treatments. CT, hepatic angiography, and follow-up were used as gold standards in analyzing the accuracy of FECS in detecting residual tumors. Results. The agreements between FECS and CT, FECS and hepatic angiography, and all 3 imaging modalities were 80% (28/35), 85.7% (30/35), and 77.1% (27/35), respectively. Twenty-one patients with 23 completely ablated tumors were followed up for 5 to 39 months (mean ± SD, 20.2 ± 11.2). Recurrent disease was detected in 11 (52.4%) patients; local tumor recurrence occurred in 4 (17.4%) patients. The sensitivity, specificity, accuracy, and positive and negative predictive value of FECS in detecting viable tumors were 53.8% (7/13), 90.9% (20/22), 77.1% (27/35), 77.8% (7/9), and 76.9% (20/26), respectively. Conclusions. FECS in subtraction mode shows good agreement with hepatic angiography and CT in the assessment of small HCC after percutaneous local ablation therapy. The sensitivity of FECS in detecting residual tumors is suboptimal. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:161,168, 2006 [source]

Selective Neck Dissection in the Management of the Clinically Node-Negative Neck ,

THE LARYNGOSCOPE, Issue 12 2000
A. Sefik Hosal MD
Abstract Objective To evaluate the efficacy of the selective neck dissection (SND) in the management of the clinically node-negative neck. Study Design Case histories were evaluated retrospectively. Methods The results of 300 neck dissections performed on 210 patients were studied. Results The primary sites were oral cavity (91), oropharyn- (30), hypopharyn- (16), and laryn- (73). Seventy-one necks (23%) were node positive on pathological e-amination. The number of positive nodes varied from 1 to 9 per side. Of necks with positive nodes, 17 (24%) had e-tracapsular spread. The median follow-up was 41 months. Recurrent disease developed in the dissected neck of 11 patients (4%). Two recurrences developed outside the dissected field. The incidence of regional recurrences was similar in patients in whom nodes were negative on histological e-amination (3%) when compared with patients with positive nodes without e-tracapsular spread (4%). In contrast, regional recurrence developed in 18% of necks with e-tracapsular spread. This observation was statistically significant. Patients having more than two metastatic lymph nodes had a higher incidence of recurrent disease than the patients with carcinoma limited to one or two nodes. Recurrence rate in the pathologically node positive (pN+) necks was comparable to recurrence in those pathologically node negative (pN0) necks in the patients who did not have irradiation. Conclusion SND is effective for controlling neck disease and serves to detect patients who require adjuvant therapy. [source]

Cyclosporine A Protects Against Primary Biliary Cirrhosis Recurrence After Liver Transplantation

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010
A. J. Montano-Loza
Primary biliary cirrhosis (PBC) reoccurs in a proportion of patients following liver transplantation (LT). The aims of our study were to evaluate the risk factors associated with PBC recurrence and determine whether recurrent disease constitutes a negative predictor for survival. One hundred and eight patients receiving LT for end-stage PBC were studied. Recurrent disease was diagnosed in 28 patients (26%). Probability of recurrent PBC at 5 years was 13% and 29% at 10 years with an overall incidence of 3.97 cases per 100 patient years. By univariate Cox analysis use of tacrolimus (HR 6.28, 95% CI, 2.44,16.11, p < 0.001) and mycophenolate mofetil (HR 5.21, 95% CI, 1.89,14.33, p = 0.001) were associated with higher risk of recurrence; whereas use of cyclosporine A (CsA) and azathioprine were associated with reduced risk of recurrence (HR 0.13, 95% CI 0.05,0.35, p < 0.001 and HR 0.27, 95% CI 0.11,0.64, p = 0.003, respectively). In the multivariate Cox analysis, only CsA was independently associated with protection against recurrence (HR 0.17, 95% CI 0.06,0.71, p = 0.02). Five-year probability of survival was 83% and 96%, in patients without and with recurrence (log-rank test, p = 0.3). Although PBC transplant recipients receiving CsA have a lower risk of disease recurrence, the development of recurrent PBC did not impact on long-term patient survival. [source]

Efficacy and toxicity of reirradiation using intensity-modulated radiotherapy for recurrent or second primary head and neck cancer

CANCER, Issue 20 2010
David J. Sher MD
Abstract BACKGROUND: Patients with locally recurrent squamous cell cancer of the head and neck (SCCHN) are reported to have a poor prognosis and limited therapeutic options. Optimal management is selectively applied and morbid. Both surgical resection and chemoradiotherapy are reported to result in median survivals of approximately 12 months. Intensity-modulated radiotherapy (IMRT) is a highly conformal approach for delivering RT. This study reported the experience of the Dana-Farber Cancer Institute (DFCI) with IMRT-based chemoradiotherapy with or without surgery for locally recurrent SCCHN. METHODS: The current study was a retrospective study of all patients treated at DFCI who were diagnosed with nonmetastatic second primary or recurrent SCCHN and who received reirradiation based on IMRT. The primary endpoint was overall survival (OS), and secondary endpoints were locoregional (LRC) and distant control and acute and chronic toxicity. RESULTS: Thirty-five patients were treated from August 2004 until December 2008. Recurrent disease was treated in the oral cavity (4 patients), larynx/hypopharynx (13 patients), oropharynx (7 patients), nasopharynx (2 patients), and neck (9 patients). The median radiation dose was 60 Gray (Gy), and all patients received concurrent chemotherapy. The median follow-up was 2.3 years. The 2-year actuarial OS and LRC rates were 48% and 67%, respectively. Approximately 91% and 46%, respectively, of all patients developed at least 1 acute and late grade 3 toxicity. Four (11%) late deaths occurred in patients with no evidence of disease (2 aspiration events, 1 oropharyngeal hemorrhage, and 1 infectious death). CONCLUSIONS: Aggressive chemoradiotherapy with IMRT was found to be feasible and resulted in favorable survival outcomes in comparison with published reports. Acute and late toxicities were substantial. The apparently improved LRC appears to carry a significant risk of developing late complications. Cancer 2010. © 2010 American Cancer Society. [source]

How we do it: the Farrior-Olaizola mastoidectomy technique in the management of squamous chronic otitis media

CLINICAL OTOLARYNGOLOGY, Issue 3 2005
R.P.S. Harar
Keypoints ,,In the Farrior-Olaizola mastoidectomy the connection between the antrum and attic is closed with a cartilage plate ,,the antrum exclusion and attic elimination on demand technique'. This prevents future tympanic membrane retraction and recurrent disease. ,,It is a suitable treatment for most cases of cholesteatoma, including children. ,,As a canal wall up technique residual disease occurred in 18% of adults and 22% of children in our series. These have been discrete encapsulated epithelial pearls easily removed at the second look stage. ,,Recurrent disease was uncommon (3.5%). [source]

Cutaneous melanoma: interferon alpha adjuvant therapy for patients at high risk for recurrent disease

DERMATOLOGIC THERAPY, Issue 1 2006
Marko Lens
ABSTRACT:, Systemic adjuvant therapy in melanoma patients is the systemic treatment that is administered with the goal of eradicating micrometastatic deposits in patients who are clinically free of disease after surgical removal of the primary melanoma, but with a high risk of systemic recurrence. Interferon-alpha (IFN-,) is one of the most frequently used adjuvant therapies. Several randomized trials evaluated the efficacy of IFN-, in melanoma patients. However, results from conducted trials are controversial. Twelve randomized IFN-, trials are discussed in detail. All trials, including meta-analysis, failed to demonstrate a clear impact of IFN-, therapy on overall survival in melanoma patients. Based on currently available evidence, IFN-, therapy in the adjuvant setting should not be considered standard of care for patients who have melanoma. Results from ongoing studies are awaited. Further research for this therapy is required. [source]

The role of surveillance endoscopy and endosonography after endoscopic ablation of high-grade dysplasia and carcinoma of the esophagus

DISEASES OF THE ESOPHAGUS, Issue 2 2008
A. D. Savoy
SUMMARY., Barrett's esophagus (BE) with high-grade dysplasia (HGD) or early carcinoma treated with surgery or photodynamic therapy (PDT) is at risk of recurrence. The efficacy of endoscopic ultrasound (EUS) for surveillance after PDT is unknown. Our objective was to determine if EUS is superior to esophagogastroduodenoscopy (EGD) and/or CT scan for surveillance of BE neoplasia after PDT. The study was designed as a retrospective review with the setting as a tertiary referral center. Consecutive patients with BE with HGD or carcinoma in situ treated with PDT were followed with EUS, CT scan and EGD with jumbo biopsies every 1 cm at 3, 4, or 6-month intervals. Exclusion criteria was < 6 months of follow up and/or < 2 EUS procedures. Main outcome measurements were residual or recurrent disease discovered by any method. Results showed that 67/97 patients met the inclusion criteria (56 men and 11 women). Median follow-up was 16 months. Recurrent or residual adenocarcinoma (ACA) was detected in four patients during follow-up. EGD with random biopsies or targeted nodule biopsies detected three patients. EUS with endoscopic mucosal resection of the nodule confirmed T1 recurrence in one of these three. In the fourth patient, CT scan revealed perigastric lymphadenopathy and EUS-FNA (fine needle aspiration) confirmed adenocarcinoma. There were two deaths, one related to disease progression and one unrelated. The rate of recurrent/persistent ACA after PDT was 4/67 = 6%. EUS did not detect disease when EGD and CT were normal. Limitations of this study include non-blinding of results and preferential status of non-invasive imaging (CT) over EUS. Our experience suggests that EUS has little role in the surveillance of these patients, unless discrete abnormalities are found on EGD or cross-sectional imaging. [source]

Salvage treatment for recurrent oropharyngeal squamous cell carcinoma

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2010
Christof Röösli MD
Abstract Background. This study evaluates the oncological outcome of patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after primary radiation therapy ± chemotherapy, primary surgical therapy, and surgical therapy followed by radiation therapy ± chemotherapy. Methods. A total of 156 patients (36%) of a cohort of 427 treated for OPSCC between 1990 and 2006 developed recurrent disease. Fifty-one patients (12%) qualified for salvage treatment. Study endpoints were 5-year overall survival (OS) and disease-specific survival (DSS). Results. The 5-year OS and DSS rates after salvage treatment were 29% and 40%; after initial primary radiation therapy, 25% and 40%; after initial surgery followed by radiation therapy, 40% and 40%; and after initial surgery alone, 20% and 40%. Conclusions. Patients with an advanced OPSCC have a considerable risk for recurrence. Despite poor ultimate outcome, salvage treatment should be attempted in patients with resectable disease, good performance status, and absence of distant metastases. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Salivary duct carcinoma: A clinical and histologic review with implications for trastuzumab therapy

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2007
Vishad Nabili MD
Abstract Background Salivary duct carcinoma (SDC) is an aggressive tumor of the head and neck with a poor prognosis. The objective was to study SDC and recommend the use of trastuzumab as adjuvant therapy. Methods A retrospective chart review of patients seen between 1993 and 2006 was performed. Tumor specimens were examined for HER-2 protein overexpression via immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) methods. Results Of the 7 patients with SDC, 57% had tumors arising in the parotid gland, the majority having facial nerve paralysis, 71% with nodal disease, and 43% having recurrence. All samples were HER-2 positive on IHC. Three patients had FISH-positive tumors, recurrent disease, and recieved trastuzumab therapy; 1 of the 3 died after 20 months and a second has shown disappearance of metastatic disease. Conclusions Trastuzumab is effective in treating HER-2-positive breast cancer. Given immunohistochemical similarities between SDC and ductal carcinoma of the breast, patients with FISH-positive HER-2/neu SDC should be considered for trastuzumab therapy. © 2007 Wiley Periodicals, Inc. Head Neck 2007 [source]

CT of the chest and abdomen in patients with newly diagnosed head and neck squamous cell carcinoma,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2005
Harri T. Keski-Säntti MD
Abstract Background. The benefits of CT scanning of the chest and abdomen as a routine screening method for patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC) remain unclear. Methods. Consecutive patients with a primary HNSCC (T classification, T2,T4) and or regionally metastatic disease (ie, N+) were eligible for inclusion. Patients who were considered incurable and patients with recurrent disease were excluded. CT scans of the chest and abdomen were performed. Results. We examined 100 patients. Two patients had pulmonary metastases at presentation. An occult aortic aneurysm required surgical repair before anticancer therapy in one patient. In many patients, nonspecific CT findings warranted further examinations or close follow-up. The abdominal CT was negative for metastatic HNSCC in all patients. Conclusions. Routine CT screening of the chest and abdomen resulted in upstaging of disease in two patients (2%) and altered the treatment approach in three patients (3%). Abdominal CT does not seem beneficial in patients with previously untreated HNSCC. Chest CT is not indicated routinely. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Odontogenic ghost cell carcinoma

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2004
David Goldenberg MD
Abstract Background. Odontogenic ghost cell carcinoma (OGCC), a malignant counterpart of the calcifying odontogenic cyst (COC), is exceedingly rare. Previous descriptions of this tumor were based on identification of malignant histologic characteristics such as infiltration, cellular pleomorphism, numerous mitoses, and necrosis concurrent with classical benign COC or its solid benign variant, the odontogenic ghost cell tumor. Methods. We present a case of a young Asian man who underwent multiple local excisions of a recurring maxillary COC. After one such excision, a rapid onset of painful swelling ensued, and the patient was referred to our institution for definitive surgery. Results. The patient underwent a right subtotal maxillectomy. Intraoperatively, a 5-cm tumor was found to be extending into the right maxillary sinus and nasal cavity. The excised tumor was diagnosed as an OGCC. The tumor was excised with clear margins, and no adjunctive radiotherapy was given. The patient was free of residual or recurrent disease 18 months after surgery. Conclusions. On the basis of this case and prior cases found in the literature, OGCCs show a spectrum of growth from slow growing locally invasive tumors to highly aggressive, rapidly growing, infiltrative tumors. Wide local excision with histologically clean margins is the recommended mode of treatment. We recommend close long-term surveillance of recurrent or long-standing benign COCs and OGCC. © 2003 Wiley Periodicals, Inc. Head Neck26: 378,381, 2004 [source]

Definitive radiotherapy in the management of chemodectomas arising in the temporal bone, carotid body, and glomus vagale

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001
Russell W. Hinerman MD
Abstract Purpose To evaluate the results of treatment for 71 patients with 80 chemodectomas of the temporal bone, carotid body, or glomus vagale who were treated with radiation therapy (RT) alone (72 tumors in 71 patients) or subtotal resection and RT (8 tumors) at the University of Florida between 1968 and 1998. Methods and Materials Sixty-six lesions were previously untreated, whereas 14 had undergone prior treatment (surgery, 11 lesions; RT, 1 lesion; or both, 2 lesions) and were treated for locally recurrent disease. All three patients who received prior RT had been treated at other institutions. Patients had minimum follow-up times as follows: 2 years, 66 patients (93%); 5 years, 53 patients (75%); 10 years, 37 patients (52%); 15 years, 29 patients (41%); 20 years, 18 patients (25%); 25 years, 12 patients (17%); and 30 years, 4 patients (6%). Results There were five local recurrences at 2.6 years, 4.6 years, 5.3 years, 8.3 years, and 18.8 years, respectively. Four were in glomus jugulare tumors and one was a carotid body tumor. Two of the four patients with glomus jugulare failures were salvaged, one with stereotactic radiosurgery and one with surgery and postoperative RT at another institution. Two of the five recurrences had been treated previously at other institutions with RT and/or surgery. Treatment for a third recurrence was discontinued, against medical advice, before receiving the prescribed dose. There were, therefore, only 2 failures in 65 previously untreated lesions receiving the prescribed course of RT. The overall crude local control rate for all 80 lesions was 94%, with an ultimate local control rate of 96% after salvage treatment. The incidence of treatment-related complications was low. Conclusions Irradiation offers a high probability of tumor control with relatively minimal risks for patients with chemodectomas of the temporal bone and neck. There were no severe treatment complications. © 2001 John Wiley & Sons, Inc. Head Neck 23: 363,371, 2001. [source]

Pain as sign of recurrent disease in head and neck squamous cell carcinoma

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2001
Miriam Smit MSc
Abstract Background The role of pain in head and neck cancer is seldom addressed. This retrospective study examined in a group of 190 curatively treated patients to what extent pain complaints should be considered to be the first sign of recurrent disease. Methods The research population exists of 95 patients with a recurrent head and neck carcinoma and control group matched for age, gender, primary tumor, and duration of follow-up. Results Of the patients with proven recurrent disease, 70% reported pain complaints as the first symptom. In 35% of these cases, the complaints concerned referred pain, whereas in 65% localized pain complaints in the head and neck were registered. The median interval between reporting localized pain complaints and histologic confirmation of recurrence was 4 months. In the case of referred pain, this delay was 2.5 months. No statistically significant correlation between pain complaints and site of recurrence could be demonstrated. Only 2% of the control group reported pain complaints. Conclusions This study confirms that each pain complaint after intentional curative treatment should be regarded as a warning sign. Recurrence of disease without preceding pain complaints (30%) emphasizes the importance of a thorough follow-up. © 2001 John Wiley & Sons, Inc. Head Neck 23: 372,375, 2001. [source]

Cyclooxygenase-2 expression correlates with phaeochromocytoma malignancy: evidence for a Bcl-2-dependent mechanism

HISTOPATHOLOGY, Issue 6 2007
I S Cadden
Aims:, Phaeochromocytomas are rare but potentially life-threatening neuroendocrine tumours of the adrenal medulla or sympathetic nervous system ganglia. There are no histological features which reliably differentiate benign from malignant phaeochromocytomas. The aim of the study was to evaluate cyclooxygenase (COX)-2 and Bcl-2 as tissue-based biomarkers of phaeochromocytoma prognosis. Methods and results:, COX-2 and Bcl-2 expression were examined immunohistochemically in tissue from 41 sporadic phaeochromocytoma patients followed up for a minimum of 5 years after diagnosis. There was a statistically significant association between COX-2 histoscore (intensity × proportion) and the development of tumour recurrence or metastases (P = 0.006). A significant relationship was observed between coexpression of COX-2 and Bcl-2 in the primary tumour and the presence of recurrent disease (P = 0.034). A highly significant association was observed between (i) tumour-associated expression of these two oncoproteins (P = 0.001) and (ii) COX-2 histoscore and the presence of Bcl-2 expression (P = 0.002). COX regression analysis demonstrated no significant relationship between (i) the presence or absence of either COX-2 or Bcl-2 and patient survival or (ii) COX-2 histoscore and patient survival. Conclusions:, COX-2 and Bcl-2 may promote phaeochromocytoma malignancy, and these oncoproteins may be valuable surrogate markers of an aggressive tumour phenotype. [source]

Aggressive surgical resection for the management of hepatic metastases from gastrointestinal stromal tumours: a single centre experience

Controversies in the laparoscopic treatment of hepatic hydatid disease

HPB, Issue 4 2004
Koray Acarli
Background Laparoscopic treatment of hydatid disease of the liver can be performed safely in selected patients. Methods Six hundred and fifty patients were treated for hydatid disease of the liver between 1980 and 2003 at the Hepatopancreato-biliary Surgery Unit of Istanbul Medical Faculty, Istanbul University. Of these, 60 were treated laparoscopically between 1992 and 2000. A special aspirator-grinder apparatus was used for the evacuation of cyst contents. Ninety-two percent of the cysts were at stages I, II or III according to the ultrasonographic classification of Gharbi. Results Conversion to open surgery was necessary in eight patients due to intra-abdominal adhesions or cysts in difficult locations. There was no disease- or procedure-related mortality. Most of the complications were related to cavity infections (13.5%) and external biliary fistulas (I 1.5%) resulting from communications between the cysts and the biliary tree. There were two recurrences in a follow-up period ranging between 3.5 and I I years. Discussion Laparoscopic treatment of hydatid disease of the liver is an alternative to open surgery in well-selected patients. Important steps are the evacuation of the cyst contents without spillage, sterilization of the cyst cavity with scolicidal agents and cavity management using classical surgical techniques. Our specially designed aspirator-grinder apparatus was safely used to evacuate the cyst contents without causing any spillage. Knowledge of the relationship of the cyst with the biliary tree is essential in choosing the appropriate patients for the laparoscopic technique. In our experience of 650 cases, the biliary communication rate was as high as 18%; half of these can be detected preoperatively. In the remaining, biliary communications are usually detected during or after surgery. Endoscopie retrograde cholangiopancreatography (ERCP) and sphincterotomy are helpful to overcome this problem. As hydatid disease of the liver is a benign and potentially recurrent disease, we advocate the use of conservative techniques in both laparoscopic and open operations. [source]

Prognostic impact of hematogenous tumor cell dissemination in patients with stage II colorectal cancer

INTERNATIONAL JOURNAL OF CANCER, Issue 12 2006
Moritz Koch
Abstract Adjuvant chemotherapy is not routinely recommended in patients with colorectal cancer stage UICC II. Some of these patients, however, develop recurrent disease. Therefore, valid prognostic criteria are needed to identify high-risk patients who might benefit from adjuvant therapy. Disseminated tumor cells, detected in blood and bone marrow, may prove to be a valid marker, however, the prognostic relevance of these cells remains debated. In our study, we examined the prognostic significance of disseminated tumor cells in blood and bone marrow of patients with stage II colorectal cancer. Ninety patients with potentially curative (R0) resection of colorectal cancer stage II were prospectively enrolled into the study. Bone marrow and blood samples were examined for disseminated tumor cells by CK 20 RT-PCR. Patient, tumor and treatment factors were analyzed as prognostic factors. Multivariate analysis confirmed tumor cell detection in blood (hazard ratio 2.1, p = 0.03) and T-category (hazard ratio 2.2, p = 0.02) to be independent prognostic factors for relapse-free survival. Tumor cell detection in postoperative blood samples (hazard ratio 7.7, p < 0.001) and number of removed lymph nodes (hazard ratio 6.4, p < 0.001) were independent prognostic factors for disease-specific survival. Detection of circulating tumor cells in blood samples of patients with stage II colorectal cancer identifies patients with poor outcome. This finding should be confirmed by further studies and could then be used as a basis for conducting a randomized trial evaluating the effect of adjuvant chemotherapy in stage II patients. © 2006 Wiley-Liss, Inc. [source]

The mechanisms of coronary restenosis: insights from experimental models

INTERNATIONAL JOURNAL OF EXPERIMENTAL PATHOLOGY, Issue 2 2000
Gordon A.A. Ferns
Since its introduction into clinical practice, more than 20 years ago, percutaneous transluminal coronary angioplasty (PTCA) has proven to be an effective, minimally invasive alternative to coronary artery bypass grafting (CABG). During this time there have been great improvements in the design of balloon catheters, operative procedures and adjuvant drug therapy, and this has resulted in low rates of primary failure and short-term complications. However, the potential benefits of angioplasty are diminished by the high rate of recurrent disease. Up to 40% of patients undergoing angioplasty develop clinically significant restenosis within a year of the procedure. Although the deployment of endovascular stents at the time of angioplasty improves the short-term outcome, ,in-stent' stenosis remains an enduring problem. In order to gain an insight into the mechanisms of restenosis, several experimental models of angioplasty have been developed. These have been used together with the tools provided by recent advances in molecular biology and catheter design to investigate restenosis in detail. It is now possible to deliver highly specific molecular antagonists, such as antisense gene sequences, to the site of injury. The knowledge provided by these studies may ultimately lead to novel forms of intervention. The present review is a synopsis of our current understanding of the pathological mechanisms of restenosis. [source]

Osteosarcoma of the testis

INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2006
HICHAM TAZI
Abstract, This report describes a case of primary osteosarcoma of the testis in a 60-year-old man. Treatment consisted of an inguinal orchiectomy with no adjuvant therapy. The patient is alive and doing well without recurrent disease at 18 months after diagnosis. Only three reports have been published on primary osteosarcoma of the testis. The origin of this tumor from undifferentiated mesenchymal cells or from a malignant transformation of pre-existing teratomatous elements is still unclear. Management guidelines are difficult to establish due to the rarity of such tumors, but inguinal orchiectomy with careful follow up appears to be sufficient treatment. [source]

Surveillance for Early Detection of Aggressive Parathyroid Disease: Carcinoma and Atypical Adenoma in Familial Isolated Hyperparathyroidism Associated With a Germline HRPT2 Mutation,,

JOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2006
Thomas G Kelly
Abstract Familial hyperparathyroid syndromes involving mutations of HRPT2 (also CDC73), a tumor suppressor, are important to identify because the relatively high incidence of parathyroid malignancy associated with such mutations warrants a specific surveillance strategy. However, there is a dearth of reports describing experience with surveillance and early detection informed by genetic insight into this disorder. Introduction: Familial isolated hyperparathyroidism (FIHP) is a rare cause of parathyroid (PT) tumors without other neoplasms or endocrinopathies. Germline mutations in CASR, MEN1, and rarely, HRPT2 have been identified in kindreds with FIHP. HRPT2 mutations may be enriched in FIHP families with PT carcinoma, underscoring the importance of identifying causative mutations. Materials and Methods: A 13-year-old boy, whose father had died of PT carcinoma, developed primary hyperparathyroidism. A left superior PT mass was identified by ultrasonography and removed surgically. Aggressive histological features of the boy's tumor included fibrous trabeculae, mitoses, and microscopic capsular infiltration. Two years later, under close biochemical surveillance, primary hyperparathyroidism recurred 5 months after documentation of normocalcemia and normal parathyroid status. Ultrasound and MRI identified a newly enlarged right superior PT gland but indicated no recurrent disease in the left neck. Histologic features typical of a benign adenoma were evident after surgical extirpation of the gland. Results: Leukocyte DNA analysis revealed a frameshift mutation in exon 2 of HRPT2. The initial tumor manifested the expected germline HRPT2 mutation, plus a distinct somatic frameshift mutation, consistent with the Knudson "two hit" concept of biallelic inactivation of a classic tumor suppressor gene. Genetic screening of the patient's 7 asymptomatic and previously normocalcemic siblings revealed three with the same germline HRPT2 mutation. One of the siblings newly identified as mutation-positive was noted to be hypercalcemic at the time of the genetic screening. He was found to have a PT adenoma with aggressive features. Two of the five children of another mutation-positive sibling also carry the same HRPT2 mutation. Conclusions: Despite the reported rarity of HRPT2 mutations in FIHP, a personal or family history of PT carcinoma in FIHP mandates serious consideration of germline HRPT2 mutation status. This information can be used in diagnostic and management considerations, leading to early detection and removal of potentially malignant parathyroid tumors. [source]

Rituximab as an adjunct to plasma exchange in TTP: A report of 12 cases and review of literature,

JOURNAL OF CLINICAL APHERESIS, Issue 5 2008
Sushama Jasti
Abstract Idiopathic thrombotic thrombocytopenic purpura (TTP) is caused by the production of autoantibodies against the Von Willebrand factor cleaving enzyme. This provides a rationale for the use of rituximab in this disease. We report a retrospective review of 12 patients treated with rituximab for TTP refractory to plasma exchange. Eleven patients were treated during initial presentation, and one patient was treated for recurrent relapse. Ten patients responded to treatment. Median time to response after first dose of rituximab was 10 days (5,32). Of the 11 patients treated during initial presentation, nine remain free of relapse after a median follow-up of 57+ months (1+,79+). Two patients died during initial treatment. One patient was lost to follow-up 1 month after achieving complete response. The patient treated for recurrent disease during second relapse remained disease free for 2years, relapsed and was treated again with rituximab, and was in remission for 22 months. She relapsed again, was retreated, and has now been in remission for 21+ months. We conclude that rituximab is an useful addition to plasma exchange treatment in TTP, but its exact role and dosing need to be verified in prospective studies. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. [source]

Initial outcome and long-term effect of surgical and non-surgical treatment of advanced periodontal disease

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 10 2001
G. Serino
Abstract Aim: A clinical trial was performed to determine (i) the initial outcome of non-surgical and surgical access treatment in subjects with advanced periodontal disease and (ii) the incidence of recurrent disease during 12 years of maintenance following active therapy. Material and Methods: Each of the 64 subjects included in the trial showed signs of (i) generalized gingival inflammation, (ii) had a minimum of 12 non-molar teeth with deep pockets (6 mm) and with 6 mm alveolar bone loss. They were randomly assigned to 2 treatment groups; one surgical (SU) and one non-surgical (SRP). Following a baseline examination, all patients were given a detailed case presentation which included oral hygiene instruction. The subjects in SU received surgical access therapy, while in SRP non-surgical treatment was provided. After this basic therapy, all subjects were enrolled in a maintenance care program and were provided with meticulous supportive periodontal therapy (SPT) 3,4 times per year. Sites that at a recall appointment bled on gentle probing and had a PPD value of 5 mm were exposed to renewed subgingival instrumentation. Comprehensive re-examinations were performed after 1, 3, 5 and 13 years of SPT. If a subject between annual examinations exhibited marked disease progression (i.e., additional PAL loss of 2 mm at 4 teeth), he/she was exited from the study and given additional treatment. Results: It was observed that (i) surgical therapy (SU) was more effective than non-surgical scaling and root planing (SRP) in reducing the overall mean probing pocket depth and in eliminating deep pockets, (ii) more SRP-treated subjects exhibited signs of advanced disease progression in the 1,3 year period following active therapy than SU-treated subjects. Conclusion: In subjects with advanced periodontal disease, surgical therapy provides better short and long-term periodontal pocket reduction and may lead to fewer subjects requiring additional adjunctive therapy. Zusammenfassung Zielsetzung: Eine klinische Studie wurde durchgeführt, um 1.) die Kurzzeitergebnisse nicht-chirurgischer und chirurgischer Therapie von Patienten mit fortgeschrittener marginaler Parodontitis und 2.) das Auftreten von Parodontitisrezidiven im Verlauf von 12 Jahren unterstützender Parodontitistherapie (UPT) zu untersuchen. Material und Methoden: Jeder der 64 Patienten, die in diese Studie aufgenommen wurden, wies 1.) Zeichen generalisierter gingivaler Entzündung auf und hatte 2.) mindestens 12 Zähne, die keine Molaren waren, mit tiefen Taschen (6 mm) sowie 6 mm Knochenabbau. Diese Patienten wurden zufällig auf 2 Therapiegruppen verteilt: 1.) chirurgische (MW: modifizierter Widman-Lappen) und 2.) nicht-chirurgische (SRP: subgingivales Scaling und Wurzelglättung) Therapie. Nach der Anfangsuntersuchung wurden allen Patienten ihre Erkrankung ausführlich erläutert und eine Mundhygieneinstruktion gegeben. Sowohl MW als SRP wurden unter Lokalanästhesie und in 4,6 Sitzungen durchgeführt. Nach der aktiven Therapiephase wurden die Patienten in ein UPT-Programm eingegliedert, das 3,4 Sitzungen pro Jahr umfasste. Stellen, die während der UPT-Sitzungen auf Sondierung bluteten (BOP) und Sondierungstiefen (ST) 5 mm aufwiesen, wurden einer erneuten subgingivalen Instrumentierung unterzogen. Gründliche Nachuntersuchungen wurden in den Jahren 1, 3, 5 und 13 der UPT durchgeführt. Wenn ein Patient zwischen den jährlichen Routineuntersuchungen deutliche Parodontitisprogression zeigte (zusätzlicher Attachmentverlust 2 mm an 4 Zähnen) wurde er/sie aus der Studie herausgenommen und einer weiterführenden Behandlung zugeführt. Ergebnisse: Es wurde beobachtet, dass 1.) die chirurgische Therapie (MW) hinsichtlich Reduktion der mittleren ST (ST nach 1 Jahr: MW: 2.6 mm; SRP: 4.2 mm; p<0.01) und Eliminierung der tiefen Taschen effektiver war als nicht-chirurgische Therapie (SRP) und dass 2.) in den ersten 1,3 Jahren nach aktiver Therapie bei mehr Patienten aus der SRP-Gruppe (8/25%) ein Fortschreiten der Parodontitis auftrat also bei Patienten der MW-Gruppe (4/12%). Schlussfolgerungen: Bei Patienten mit fortgeschrittener marginaler Parodontitis führte chirurgische Therapie zu günstigeren Kurz- und Langzeitergebnissen hinsichtlich ST-Reduktion und scheint deshalb bei weniger Patienten eine zusätzliche unterstützende Therapie erforderlich zu machen als SRP. Résumé But: Un essai clinique a été réalisé pour déterminer (i) le résultat initial des traitements non chirurgicaux et chirurgicaux chez des sujets présentant des parodontites avancées et (ii) l'incidence de maladie récurrente pendant les 12 ans de maintenance qui ont suivi la thérapeutique active. Matériaux et méthodes: Chacun des 64 patients inclus dans cette étude présentait des signes de (i) inflammation gingivale généralisée, (ii) avaient au minimum 12 dents en dehors des molaires avec des poches profondes (6 mm) et avec une perte osseuse 6 mm. Ils furent assignés au hasard à deux groupes de traitement (chirurgical (SU) et non chirurgical (SRP)). Après un examen initial, tous les patients reçurent une mallette de présentation détaillée comportant des instructions d'hygiène bucco-dentaire. Les sujets SU subirent une chirurgie d'accès alors qu'un traitement non chirurgical était donné au groupe SRP. Suite à ce traitement de base, tous les sujets suivirent un programme de maintenance comportant de méticuleux soins parodontaux de soutien (SPT) 3,4 × par an. Les sites qui, lors d'une visite de contrôle saignaient légèrement au sondage et présentatient une valeur de PPD 5 mm étaient à nouveau instrumentés. De nouveaux examens complets êtaient réalisées après 1, 3, 5, 13 ans de SPT. Si un sujet présentait entre deux visites annuelles une progression évidente de la maladie, (par exemple, une perte d'attache supplémentaire 2 mm sur plus de 4 dents), il ou elle était exclu de l'étude et recevait un traitement complémentaire. Resultats: Il fut observé que (i) le traitement chirurgical (SU) était plus efficace que le traitement non-chirurgical (SRP) pour réduire les profondeurs de poche au sondage moyennes générales et pour l'élimination des poches profondes, (ii) et plus de sujets du groupe SRP présentaient des signes de progression de leur maladie avancée dans la période de 1,3 ans suivant le traitement actif. Conclusions: Chez les sujets présentant une maladie parodontale avancée, le traitement chirurgical apporte de meilleures réductions des poches parodontales à court et long terme et pourrait diminuer le nombre de sujets nécessitant une traitement supplémentaire. [source]

Diagnostic and treatment delays in recurrent clostridium difficile,associated disease

JOURNAL OF HOSPITAL MEDICINE, Issue 2 2008
Danielle Scheurer MD
Abstract BACKGROUND: Because Clostridium difficile,associated disease (CDAD) is primarily an inpatient issue, hospitalists are at the forefront of the timely diagnosis and treatment of patients with this disease. DESIGN: The study was a retrospective cohort of all inpatients with CDAD at Brigham and Women's Hospital from 1997 to 2004 in order to determine the time to diagnosis and treatment in initial and recurrent episodes of disease. RESULTS: The mean time to sampling, between 2.09 and 2.24 days, was not significantly different between initial and recurrent CDAD hospital episodes. The mean time to treatment (from symptoms and sampling) was shorter in recurrent episodes but was still 2.5 days. CONCLUSIONS: Patients with recurrent disease were more likely to be treated earlier but not diagnosed earlier than those with initial disease. Because both groups had significant diagnostic and treatment delays, this is an area in which hospitalists can have a major impact on patient care. Journal of Hospital Medicine 2008;3:156,159. © 2008 Society of Hospital Medicine. [source]

Nasopharygeal carcinoma in Queensland, Australia: A review of 10 years experience

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007
CH-K Wong
Summary The purpose of this study was to compare the treatment outcomes of patients with nasopharyngeal carcinoma in Queensland in a 10-year period during which synchronous chemoradiotherapy has come into use and to compare characteristics of patients of different racial origins and their prognostic factors. Eighty-one patients treated between 1991 and 2001 at the Queensland Radium Institute, Brisbane, Queensland for histologically confirmed nasopharyngeal carcinoma were included. Seventeen patients were treated using the Intergroup protocol, 32 patients with miscellaneous synchronized chemoradiotherapy, 6 patients with neoadjuvant regimens and 26 patients with radiotherapy only. Asian patients were found to present earlier than White Australian patients (P < 0.02). No significant difference was identified in the histological presentation between the two ethnic groups. Asian patients were more likely to have a relapse and poor loco-regional control. Overall survival, however, was not different. Patients treated according to the Intergroup protocol had better disease-specific survival and relapse-free survival than the other groups. The median follow up was 36 months. Twenty-five patients (30%) developed recurrent disease. The 5-year salvage survival or survival after relapse was 15%. Our experience with the Intergroup protocol in our population is similar to other studies, with likelihood of improved results. [source]

High-risk HPV presence in cervical specimens after a large loop excision of the cervical transformation zone: Significance of newly detected hr-HPV genotypes

JOURNAL OF MEDICAL VIROLOGY, Issue 3 2007
Maaike A.P.C. van Ham
Abstract Large loop excision of the cervical transformation zone (LLETZ) is a well-established treatment for high-grade cervical intraepithelial neoplasia. It has even been postulated that LLETZ is responsible for the elimination of the infectious agent, human papillomavirus (HPV), causing the lesion. Most studies on HPV detection after LLETZ have focused on the persistence of high-risk (hr-) HPV to identify women at risk for residual or recurrent disease. Therefore, the appearance and significance of hr-HPV types newly detected after surgical treatment has not been studied extensively so far. The presence of hr-HPV in 85 high-grade squamous cervical LLETZ biopsies and in the first follow-up smear was determined. In 80 (94%) of the LLETZ biopsies hr-HPV was detected in contrast to 30 (35%) hr-HPV positive follow-up scrapes. Twenty of the 80 hr-HPV positive women (25%) had the same hr-HPV genotypes in their follow-up cervical smears as was found in the corresponding biopsies. In the follow-up smear of 13 women a new hr-HPV genotype was detected and HPV 18 was newly detected in 8 of them. The remarkably high presence of newly detected HPV 18 genotypes may argue for a release or re-activation of this virus from proximal layers of the cervical canal incised during surgery. J. Med. Virol. 79:314,319, 2007. © 2007 Wiley-Liss, Inc. [source]