Retrospective Multicenter Study (retrospective + multicenter_study)

Distribution by Scientific Domains

Selected Abstracts

Pediatric Crohn's disease activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years later

Tamara Mesker MD
Abstract Background: No studies have been performed in which therapeutic regimens have been compared between mild and moderate-to-severe pediatric Crohn's disease (CD) at diagnosis. The aim was to analyze pediatric CD activity at diagnosis, its influence on pediatrician's prescribing behavior, and clinical outcome 5 years later. Methods: In a retrospective multicenter study we divided pediatric CD patients at diagnosis into mild or moderate-severe disease. We compared initial therapies, duration of first remission, number of exacerbations, height-for-age and weight-for-height evolvement, and cumulative duration of systemic steroid use in a 5-year follow-up period. Results: Forty-three children were included (25 with mild and 18 with moderate-severe disease). Aminosalicylate monotherapy was more frequently prescribed in the mild group (40% versus 17%; P < 0.01). The median duration of systemic steroid use was 18.3 months in the mild group and 10.4 months in the moderate-severe group (P = 0.09). Duration of first remission was 15.0 months in the mild group and 23.4 months in the moderate-severe group (P = 0.16). The mean number of exacerbations was 2.2 in the mild group and 1.8 in the moderate-severe group (P = 0.28). Conclusions: CD patients with mild disease were treated with aminosalicylate monotherapy more frequently. These patients, however, tend to have more exacerbations, shorter duration of first remission, and longer total duration of systemic steroid use. Our data support the concept that severity of disease at diagnosis does not reliably predict subsequent clinical course. This study suggests that there is no indication that children with mild CD should be treated differently compared to children with moderate-severe disease. (Inflamm Bowel Dis 2009) [source]

Prognosis in pediatric hematologic malignancies is associated with serum concentration of mannose-binding lectin-associated serine protease-2 (MASP-2)

Aina Zehnder MD
Abstract Background Mannose-binding lectin (MBL) and MBL-associated serine protease-2 (MASP-2) are key components of the lectin pathway of complement activation. Their serum concentrations show a wide interindividual variability. This study investigated whether the concentration of MBL and MASP-2 is associated with prognosis in pediatric patients with cancer. Methods In this retrospective multicenter study, MBL and MASP-2 were measured by commercially available ELISA in frozen remnants of serum taken at diagnosis. Associations of overall survival (OS) and event-free survival (EFS) with MBL and MASP-2 were assessed by multivariate Cox regression accounting for prognostically relevant clinical variables. Results In the 372 patients studied, median serum concentration of MBL was 2,808 g/L (range, 2,10,060) and 391 g/L (46,2,771) for MASP-2. The estimated 4-year EFS was 0.60 (OS, 0.78). In the entire, heterogeneous sample, MBL and MASP-2 were not significantly associated with OS or EFS. In patients with hematologic malignancies, however, higher MASP-2 was associated with better EFS in a significant and clinically relevant way (hazard ratio per tenfold increase (HR), 0.22; 95% CI, 0.09,0.54; P,=,0.001). This was due to patients with lymphoma (HR, 0.11; 95% CI, 0.03,0.47; P,=,0.003), but less for those with acute leukemia (HR, 0.35; 95% CI, 0.11,1.15; P,=,0.083). Conclusion In this study, higher MASP-2 was associated with better EFS in pediatric patients with hematologic malignancies, especially lymphoma. Whether MASP-2 is an independent prognostic factor affecting risk stratification and anticancer therapy needs to be assessed in prospective, disease-specific studies. Pediatr Blood Cancer 2009;53:53,57. 2009 Wiley-Liss, Inc. [source]

Surfactant protein C gene (SFTPC) mutation-associated lung disease: High-resolution computed tomography (HRCT) findings and its relation to histological analysis,,

M. Mechri MD
Abstract Aim of the Study Determine high-resolution tomography (HRCT) scan characteristics in children with SFTPC mutation and correlate them to histological findings. Patients and Methods This retrospective multicenter study included 15 children (7 females and 8 males) with SFTPC mutations. HRCT scans have been performed in all the children and lung biopsies in 8 children. Results From all signs assessed on initial HRCT scans, ground-glass opacities (n,=,14, 93%) and lung cysts (n,=,6, 40%) were predominant. Interlobular septal thickening (n,=,1, 7%), air space consolidation (n,=,1, 7%), paraseptal emphysema (n,=,2, 13%), and pulmonary nodules (n,=,1, 7%) were also found. Histological analysis revealed accumulation of macrophages in the alveolar lumen, type II pneumocyte hyperplasia, and alveolar septal thickening. Dilatation of the respiratory bronchiole and alveolar duct associated with muscular hyperplasia were also described. Interestingly, lung cysts on HRCT scans were associated with dilatation of terminal bronchioli and alveolar duct in lung biopsies. Conclusion In children with SFTPC mutations, HRCT scan finding was highly correlated to the histological findings and, as such, represent a useful tool to identify patients that may require SFTPC gene sequencing. Pediatr Pulmonol. 2010; 45:1021,1029. 2010 Wiley-Liss, Inc. [source]

Current trends of laparoscopic gastrectomy for gastric cancer in Japan

T Etoh
Abstract Laparoscopic gastrectomy with lymph node dissection, such as laparoscopy-assisted distal gastrectomy (LADG), is widely accepted for the treatment of early gastric cancer with a risk of lymph node metastasis. In Japan, a nationwide survey conducted by the Japan Society of Endoscopic Surgery has shown that the number of laparoscopic gastrectomies is gradually increasing. So far, the following advantages of laparoscopic surgery for the treatment of gastric cancer have been well documented: favorable clinical course after operation, pulmonary function and immune response. A retrospective multicenter study in Japan has shown that the short-term outcomes of laparoscopic gastrectomy are beneficial and that the long-term outcomes are the same as those for open surgery. Recently, the Gastric Cancer Surgical Study Group of the Japan Clinical Oncology Group conducted a multi-institutional, phase II trial (JCOG0703) to evaluate the safety of LADG for clinical stage I gastric cancer. In the future, laparoscopic surgeons will need to design and implement education and training systems for standard laparoscopic procedures, evaluate clinical outcomes through multicenter randomized controlled trials and clarify the oncological aspects of laparoscopic surgery in basic studies. [source]

Is laparoscopic surgery acceptable for advanced colon cancer?

CANCER SCIENCE, Issue 4 2009
Seigo Kitano
Laparoscopic surgery is widespread in the treatment of colorectal cancer. In Japan, a nationwide survey has shown that the rate of advanced colorectal cancer has increased gradually to 65% of total laparoscopic surgeries in 2007. Many randomized controlled trials have demonstrated that in the short term, laparoscopic surgery is feasible, safe, and has many benefits, including reduction of peri-operative mortality. In terms of long-term outcomes, four randomized controlled trials suggest that there are no differences in laparosupic and open surgery for colon cancer. However, important issues, including long-term oncological outcome, cost effectiveness, and the impact on the quality of life of patients, should be addressed in well-designed large-scale trials. In Japan, a retrospective multicenter study has demonstrated that the short-term outcomes of laparoscopic surgery are beneficial, and the long-term outcomes are the same as for open surgery. In 2004, a prospective large-scale randomized controlled trial (JCOG0404) to compare laparoscopic surgery with open surgery was started to evaluate oncological outcomes for advanced colon cancer. This trial is supported in part by a Grant-in-Aid for Cancer Research from the Japanese Ministry of Health, Labour, and Welfare. In the present study, laparoscopic surgery is found to be acceptable for stage I disease of colon cancer, whereas it is controversial for stage II/III disease because of inadequate clinical evidence. Whether laparoscopic surgery is acceptable for advanced colon cancer or not should be confirmed by the Japanese large-scale prospective randomized controlled trial (JCOG0404) in the near future. (Cancer Sci 2009; 100: 567,571) [source]