Stage III (stage + iii)

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Distribution within Medical Sciences

Terms modified by Stage III

  • stage iii disease

  • Selected Abstracts


    Radiation technique influence on percutaneous endoscopic gastrostomy tube dependence: Comparison between two radiation schemes

    HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2009
    Georges F. Hatoum MD
    Abstract Background. Our aim was to determine whether percutaneous endoscopic gastrostomy (PEG) dependence was significantly different between 2 prospective trials with different radiation fractionation schemes. Methods. Stage III or IV locally advanced head and neck squamous cell carcinomas arising from the oral cavity, hypopharynx, oropharynx, nasopharynx, paranasal sinuses, or larynx were treated using hyperfractionation (A-3 protocol) or accelerated fractionation (A-4 protocol) with chemotherapy. Amifostine was administered 15 to 30 minutes preradiation, at a dose of 500 mg/day in both protocols. It was given as an infusion over 5 to 7 minutes (A-3 protocol) or subcutaneously (A-4 protocol). Data regarding PEG placement and removal were collected prospectively. Results. Thirty-five evaluable A-3 protocol patients, 14 evaluable A-4 protocol patients, and 6 patients treated per A-4 protocol guidelines, but without amifostine as they refused the medication, were included in the analysis. Pretreatment characteristics, such as sex, age, race, T classification, N classification, American Joint Committee on Cancer (AJCC) stage, were compared between the 2 groups of patients. The only significant difference between the 2 groups was AJCC stage. Thirty-five A-3 patients and 20 A-4 patients had overall survivals of 88% versus 80%, 82% versus 75%, and 66% versus 67.5% at 1, 2, and 3 years, respectively (p = .958). With regard to PEG dependence, no significant differences were seen between the 2 groups at 6, 12, or 18 months. Conclusion. PEG dependence was not significantly different between the 2 study groups. Type of altered fractionation scheme may not influence PEG dependence in patients treated with similar protocols. Future randomized studies are needed to confirm these findings. 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]


    High serum levels of YKL-40 in patients with squamous cell carcinoma of the head and neck are associated with short survival

    INTERNATIONAL JOURNAL OF CANCER, Issue 4 2008
    Anne Roslind
    Abstract YKL-40 is a glycoprotein secreted by macrophages, neutrophils and malignant tumor cells. Elevated serum levels of YKL-40 are associated with poor prognosis in several malignancies. In this study, we examined the prognostic value of serum YKL-40 before treatment and during follow-up in patients with squamous cell carcinoma of the head and neck (HNSCC). YKL-40 was determined by ELISA retrospectively in serum from 173 patients with primary HNSCC before treatment and up to 2 years after treatment. Median follow-up time was 7.9 years. YKL-40 protein expression in tumor biopsies was assessed by immunohistochemistry in 50 patients. Pretreatment serum YKL-40 was elevated in 53%. Patients with high serum YKL-40 had shorter survival than patients with normal serum YKL-40 (33 vs. 84 months; p = 0.008). Multivariate Cox analysis including pretreatment serum YKL-40, age, sex, primary tumor site, TNM classification and treatment demonstrated that TNM classification (HR = 2.61, p = 0.02) and serum YKL-40 (log-transformed continuous variable: HR = 1.55, p < 0.0001) were independent prognostic variables of overall survival (OS). Multivariate Cox analysis demonstrated that TNM classification (HR = 5.77, p = 0.001) and serum YKL-40 (dichotomous variable: HR = 2.75, p = 0.01) were independent predictors of recurrence-free survival. During follow-up after radiotherapy, a high serum YKL-40 (log-transformed continuous variable) in patients with TNM Stage III and IV disease predicted poorer OS within 6 months (HR = 1.95, p < 0.0001). Immunohistochemical analysis showed YKL-40 expression in the malignant tumor cells. In conclusion, serum YKL-40 was demonstrated to be an independent prognostic biomarker of recurrence-free and overall survival in patients with HNSCC. 2007 Wiley-Liss, Inc. [source]


    Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing Homes

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2007
    (See editorial comments by Dr. George Taler on pp 167, 1675)
    The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long-term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes. In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities. Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care. [source]


    Ultrahigh-pressure metamorphism and exhumation of garnet peridotite in Pohorje, Eastern Alps

    JOURNAL OF METAMORPHIC GEOLOGY, Issue 1 2006
    M. JANK
    Abstract New evidence for ultrahigh-pressure metamorphism (UHPM) in the Eastern Alps is reported from garnet-bearing ultramafic rocks from the Pohorje Mountains in Slovenia. The garnet peridotites are closely associated with UHP kyanite eclogites. These rocks belong to the Lower Central Austroalpine basement unit of the Eastern Alps, exposed in the proximity of the Periadriatic fault. Ultramafic rocks have experienced a complex metamorphic history. On the basis of petrochemical data, garnet peridotites could have been derived from depleted mantle rocks that were subsequently metasomatized by melts and/or fluids either in the plagioclase-peridotite or the spinel-peridotite field. At least four stages of recrystallization have been identified in the garnet peridotites based on an analysis of reaction textures and mineral compositions. Stage I was most probably a spinel peridotite stage, as inferred from the presence of chromian spinel and aluminous pyroxenes. Stage II is a UHPM stage defined by the assemblage garnet + olivine + low-Al orthopyroxene + clinopyroxene + Cr-spinel. Garnet formed as exsolutions from clinopyroxene, coronas around Cr-spinel, and porphyroblasts. Stage III is a decompression stage, manifested by the formation of kelyphitic rims of high-Al orthopyroxene, aluminous spinel, diopside and pargasitic hornblende replacing garnet. Stage IV is represented by the formation of tremolitic amphibole, chlorite, serpentine and talc. Geothermobarometric calculations using (i) garnet-olivine and garnet-orthopyroxene Fe-Mg exchange thermometers and (ii) the Al-in-orthopyroxene barometer indicate that the peak of metamorphism (stage II) occurred at conditions of around 900 C and 4 GPa. These results suggest that garnet peridotites in the Pohorje Mountains experienced UHPM during the Cretaceous orogeny. We propose that UHPM resulted from deep subduction of continental crust, which incorporated mantle peridotites from the upper plate, in an intracontinental subduction zone. Sinking of the overlying mantle and lower crustal wedge into the asthenosphere (slab extraction) caused the main stage of unroofing of the UHP rocks during the Upper Cretaceous. Final exhumation was achieved by Miocene extensional core complex formation. [source]


    Silica precipitates in omphacite from eclogite at Alpe Arami, Switzerland: evidence of deep subduction

    JOURNAL OF METAMORPHIC GEOLOGY, Issue 5 2002
    L. F. Dobrzhinetskaya
    Abstract Observations of oriented SiO2 precipitates in omphacite from eclogite with tholeiitic basalt protolith bordering the Alpe Arami garnet peridotite massif, Ticino, Switzerland, and petrological studies of the eclogitic mineral assemblages, suggest that this rock was subjected to higher-pressure metamorphism than previously realized. We employed various calibrations of the Fe2+ , Mg exchange thermometer and calculations of equilibria with thermodynamic data, considering the calcium,Tschermak's component (CaAl2SiO6), of garnet-pyroxene pairs. From these calculations, it is concluded that the eclogitic lenses have recorded at least four stages of mineral growth corresponding to the following: Stage I (prograde) c. 2.4 GPa; 700 C; Stage IIa (maximum recorded grade) c. 7.0 GPa; 1100 C; Stage IIb (retrograde) c. 3.7 GPa; 900 C; Stage III (retrograde) c. 2.1 GPa; 750 C. Because of the preservation of Stage I, a relatively rapid subduction and exhumation of Alpe Arami eclogite is suggested. The exhumation path of the eclogitic rock is in good agreement with most exhumation paths inferred for the Alpe Arami garnet lherzolite proposed previously by several authors based upon a variety of different observations, although the eclogite and peridotite exhumation paths may diverge at depths greater than 120 km. [source]


    Management of cancer gallbladder found as a surprise on a resected gallbladder specimen

    JOURNAL OF SURGICAL ONCOLOGY, Issue 8 2006
    FRCS (Glasg), Mahesh Chandra Misra MS
    Abstract Carcinoma gallbladder is associated with an overall 5-year survival rate reported less than 5% due to late diagnosis. Advent of ultrasound scanning may help in detecting gallbladder polyps and an early gallbladder cancer. Excellent 5-year survival (up to 100%) has been reported for Stage Ia disease and the survival has significantly improved for Stage Ib, II, and III if appropriate re-operation is carried out soon after the incidental detection of gallbladder cancer. Laparoscopic cholecystectomy (LC) is contraindicated in the presence of gallbladder cancer. It is recommended to excise all laparoscopic port sites, at the time of re-operation. Re-operation for Stage II gallbladder cancer is associated with a 90,100% 3-year survival rate. Patients with Stage III and IV tumors also benefit from an extended cholecystectomy. Patients with bulky primary tumors without lymph node metastases (T4N0) seem to have a better prognosis than those with distant lymph node metastases, and should be treated aggressively. It is advantageous to perform the appropriate extent of surgery for gallbladder cancer at the initial operation. Heightened awareness of the presence of cancer and the knowledge of appropriate management are important. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated for all disease except Stage Ia. Radiotherapy and chemotherapy have not been found effective as an adjuvant or palliative therapy in gallbladder cancer. J. Surg. Oncol. 2006;93:690,698. 2006 Wiley-Liss, Inc. [source]


    Using SWAT to Model Streamflow in Two River Basins With Ground and Satellite Precipitation Data,

    JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 1 2009
    Kenneth J. Tobin
    Abstract:, Both ground rain gauge and remotely sensed precipitation (Next Generation Weather Radar , NEXRAD Stage III) data have been used to support spatially distributed hydrological modeling. This study is unique in that it utilizes and compares the performance of National Weather Service (NWS) rain gauge, NEXRAD Stage III, and Tropical Rainfall Measurement Mission (TRMM) 3B42 (Version 6) data for the hydrological modeling of the Middle Nueces River Watershed in South Texas and Middle Rio Grande Watershed in South Texas and northern Mexico. The hydrologic model chosen for this study is the Soil and Water Assessment Tool (SWAT), which is a comprehensive, physical-based tool that models watershed hydrology and water quality within stream reaches. Minor adjustments to selected model parameters were applied to make parameter values more realistic based on results from previous studies. In both watersheds, NEXRAD Stage III data yields results with low mass balance error between simulated and actual streamflow (13%) and high monthly Nash-Sutcliffe efficiency coefficients (NS > 0.60) for both calibration (July 1, 2003 to December 31, 2006) and validation (2007) periods. In the Middle Rio Grande Watershed NEXRAD Stage III data also yield robust daily results (time averaged over a three-day period) with NS values of (0.60-0.88). TRMM 3B42 data generate simulations for the Middle Rio Grande Watershed of variable qualtiy (MBE = +13 to ,16%; NS = 0.38-0.94; RMSE = 0.07-0.65), but greatly overestimates streamflow during the calibration period in the Middle Nueces Watershed. During the calibration period use of NWS rain gauge data does not generate acceptable simulations in both watersheds. Significantly, our study is the first to successfully demonstrate the utility of satellite-estimated precipitation (TRMM 3B42) in supporting hydrologic modeling with SWAT; thereby, potentially extending the realm (between 50N and 50S) where remotely sensed precipitation data can support hydrologic modeling outside of regions that have modern, ground-based radar networks (i.e., much of the third world). [source]


    Relapsed or refractory nongastric marginal zone B-cell lymphoma: Multicenter retrospective analysis of 92 cases,

    AMERICAN JOURNAL OF HEMATOLOGY, Issue 12 2009
    Sung Yong Oh
    Over its long survival duration, marginal zone B-cell lymphoma (MZL) routinely involves frequent relapses. In this study, we conducted a retrospective analysis to identify the clinical features and outcomes of relapsed or refractory MZL. From 1995 to 2008, a total of 92 patients with relapsed MZL were retrospectively analyzed. The median age of our subjects was 53.5 years (range: 23,82 years). The most common primary sites of involvement were the orbit and ocular adnexa (28.3%) followed by the lymph node and lymphatic organs (23.9%), and multiple mucosa-associated lymphoid tissue (MALT) sites (13.0%). The median time to relapse from initial diagnosis was 25.5 months. Of the 53 patients with Stage I or II at diagnosis, 42 patients (79.2%) evidenced locoregional recurrence. Among these locoregional relapsed patients, 27 patients achieved CR (54.1%) or PR (18.9%). In addition to the 39 patients initially in advanced Stage III or IV, a total of 50 patients were in advanced stage at relapse. Among those patients with advanced stage at relapse, 44 patients were treated. The overall response rate was 54.5% (24 patients), with 18 CRs and 6 PRs. The median time to progression (TTP) was 34.1 months (95% CI: 11.3,56.9 months) and the estimated 5-year overall survival (OS) was 84.3%. The majority of them was controlled well with salvage treatment, and could achieve prolonged survival. However, patients' refractory to initial therapy and advanced relapse evidenced shorter TTP and OS. Thus, we need to consider more aggressive treatment in cases of refractory MZL or advanced relapsed MZL. Am. J. Hematol., 2009. 2009 Wiley-Liss, Inc. [source]


    Impact of vitamin D deficiency on the clinical presentation and prognosis of patients with newly diagnosed multiple myeloma,,

    AMERICAN JOURNAL OF HEMATOLOGY, Issue 7 2009
    Alvin C. Ng
    Vitamin D is a fundamental mediator of skeletal metabolism. It also has important nonskeletal actions. We hypothesized that vitamin D deficiency may play an important role in skeletal morbidity and clinical outcomes in MM. We studied 148 newly diagnosed MM patients from January 1, 2004 through December 31, 2008 who had a serum 25-hydroxyvitamin D [25(OH)D] obtained within 14 days of diagnosis. Subjects with vitamin D deficiency [25(OH)D level less than 50 nmol/L (20 ng/mL)] had higher mean values of serum C-reactive protein (CRP) (2.40 mg/L vs. 0.84 mg/L, P = 0.02) and creatinine (1.75 mg/dL vs. 1.24 mg/dL, P = 0.03) and lower serum albumin values (3.12 g/dL vs. 3.39 g/dL, P = 0.003) compared to subjects without vitamin D deficiency. The prevalence of vitamin D deficiency increased in parallel with International Staging System (ISS): 16% of subjects in Stage I, 20% in Stage II, and 37% in Stage III (P = 0.03) were vitamin D deficient. No differences were detected between the two groups in terms of skeletal morbidity. Association of vitamin D deficiency with higher serum CRP, serum creatinine and ISS stage at time of diagnosis suggests that vitamin D deficiency may portend poorer outcomes in subjects with MM. Am. J. Hematol. 2009. 2009 Wiley-Liss, Inc. [source]


    Epithermal Gold-Silver Mineralization of the Asachinskoe Deposit in South Kamchatka, Russia

    RESOURCE GEOLOGY, Issue 4 2007
    Ryohei Takahashi
    Abstract The Asachinskoe epithermal Au-Ag deposit is a representative low-sulfidation type of deposit in Kamchatka, Russia. In the Asachinskoe deposit there are approximately 40 mineralized veins mainly hosted by dacite,andesite stock intrusions of Miocene,Pliocene age. The veins are emplaced in tensional cracks with a north orientation. Wall-rock alteration at the bonanza level (170,200 m a.s.l.) consists of the mineral assemblage of quartz, pyrite, albite, illite and trace amounts of smectite. Mineralized veins are well banded with quartz, adularia and minor illite. Mineralization stages in the main zone are divided into stages I,IV. Stage I is relatively barren quartz,adularia association formed at 4.7 0.2 Ma (K-Ar age). Stage II consists of abundant illite, Cu-bearing cryptomelane and other manganese oxides and hydroxides, electrum, argentite, quartz, adularia and minor rhodochrosite and calcite. Stage III, the main stage of gold mineralization (4.5,4.4 0.1,3.1 0.1 Ma, K-Ar age), consists of a large amount of electrum, naumannite and Se-bearing polybasite with quartz,adularia association. Stage IV is characterized by hydrothermal breccia, where electrum, tetrahedrite and secondary covellite occur with quartz, adularia and illite. The concentration of Au+Ag in ores has a positive correlation with the content of K2O + Al2O3, which is controlled by the presence of adularia and minor illite, and both Hg and Au also have positive correlations with the light rare-earth elements. Fluid inclusion studies indicate a salinity of 1.0,2.6 wt% NaCl equivalent for the whole deposit, and ore-forming temperatures are estimated as approximately 160,190C in stage III of the present 218 m a.s.l. and 170,180C in stage IV of 200 m a.s.l. The depth of ore formation is estimated to be 90,400 m from the paleo-water table for stage IV of 200 m a.s.l., if a hydrostatic condition is assumed. An increase of salinity (>CNaCl, 0.2 wt%) and decrease of temperature (>T , 30C) within a 115-m vertical interval for the ascending hydrothermal solution is calculated, which is interpreted as due to steam loss during fluid boiling. Ranges of selenium and sulfur fugacities are estimated to be logfSe2 = ,17 to ,14.5 and logfS2 = ,15 to ,12 for the ore-forming solution that was responsible for Au-Ag-Se precipitation in stage III of 200 m a.s.l. Separation of Se from S-Se complex in the solution and its partition into selenides could be due to a relatively oxidizing condition. The precipitation of Au-Ag-Se was caused by boiling in stage III, and the precipitation of Au-Ag-Cu was caused by sudden decompression and boiling in stage IV. [source]


    Orogenic Gold Mineralization in the Qolqoleh Deposit, Northwestern Iran

    RESOURCE GEOLOGY, Issue 3 2007
    Farhang Aliyari
    Abstract The Qolqoleh gold deposit is located in the northwestern part of the Sanandai-Sirjan Zone, northwest of Iran. Gold mineralization in the Qolqoleh deposit is almost entirely confined to a series of steeply dipping ductile,brittle shear zones generated during Late Cretaceous,Tertiary continental collision between the Afro-Arabian and the Iranian microcontinent. The host rocks are Mesozoic volcano-sedimentary sequences consisting of felsic to mafic metavolcanics, which are metamorphosed to greenschist facies, sericite and chlorite schists. The gold orebodies were found within strong ductile deformation to late brittle deformation. Ore-controlling structure is NE,SW-trending oblique thrust with vergence toward south ductile,brittle shear zone. The highly strained host rocks show a combination of mylonitic and cataclastic microstructures, including crystal,plastic deformation and grain size reduction by recrystalization of quartz and mica. The gold orebodies are composed of Au-bearing highly deformed and altered mylonitic host rocks and cross-cutting Au- and sulfide-bearing quartz veins. Approximately half of the mineralization is in the form of dissemination in the mylonite and the remainder was clearly emplaced as a result of brittle deformation in quartz,sulfide microfractures, microveins and veins. Only low volumes of gold concentration was introduced during ductile deformation, whereas, during the evident brittle deformation phase, competence contrasts allowed fracturing to focus on the quartz,sericite domain boundaries of the mylonitic foliation, thus permitting the introduction of auriferous fluid to create disseminated and cross-cutting Au-quartz veins. According to mineral assemblages and alteration intensity, hydrothermal alteration could be divided into three zones: silicification and sulfidation zone (major ore body); sericite and carbonate alteration zone; and sericite,chlorite alteration zone that may be taken to imply wall-rock interaction with near neutral fluids (pH 5,6). Silicified and sulfide alteration zone is observed in the inner parts of alteration zones. High gold grades belong to silicified highly deformed mylonitic and ultramylonitic domains and silicified sulfide-bearing microveins. Based on paragenetic relationships, three main stages of mineralization are recognized in the Qolqoleh gold deposit. Stage I encompasses deposition of large volumes of milky quartz and pyrite. Stage II includes gray and buck quartz, pyrite and minor calcite, sphalerite, subordinate chalcopyrite and gold ores. Stage III consists of comb quartz and calcite, magnetite, sphalerite, chalcopyrite, arsenopyrite, pyrrhotite and gold ores. Studies on regional geology, ore geology and ore-forming stages have proved that the Qolqoleh deposit was formed in the compression,extension stage during the Late Cretaceous,Tertiary continental collision in a ductile,brittle shear zone, and is characterized by orogenic gold deposits. [source]


    Classification of the External Auditory Canal Cholesteatoma

    THE LARYNGOSCOPE, Issue 3 2005
    Ramin Naim
    Abstract Objectives/Hypothesis: The external auditory canal cholesteatoma (EACC) is a rare disease in the field of otolaryngology. Only 1 in 1,000 new otologic patients present with this entity, which was first described by Toynbee. The aim of this article is to classify EACC by different histopathologic and clinical findings of patients presenting to the Department of Otolaryngology at the University of Mannheim, Germany. Methods: From 2000 to 2004, 17 patients presented to our clinic with EACC. The cholesteatoma were treated surgically, and the specimens were investigated histologically. Clinical findings were also recorded. We classified four stages: stage I with hyperplasia of the canal epithelium, stage II including periosteitis, Stage III including a defective bony canal, and stage IV showing an erosion of adjacent anatomic structure. Results: Eight patients presented with stage II, five patients with stage III, three with stage I, and only one patient presented with erosion of the mastoid cells, which was determined as stage IV. Conclusion: In summary, our classification serves to describe the different histopathologic and clinical stages of EACC. [source]


    An experimental assessment on the effects of photoperiod treatments on the somatic and gonadal growth of the juvenile European purple sea urchin Paracentrotus lividus

    AQUACULTURE RESEARCH, Issue 7 2010
    Eimear McCarron
    Abstract Determining the optimum light conditions for sea urchins reared in land-based systems is vital for the future use and assessment of possible commercial systems of sea urchin farming. The effects of two different light regimes, complete darkness and a long day photoperiod of 16 h light:8 h darkness, on the somatic and gonadal growth of the European sea urchin Paracentrotus lividus (19.5,23.0 mm) was investigated using the commercial UrchinPlatter System over a 6-month period (5 March to 5 September). Hatchery-produced P. lividus were transported to the Aquaculture Fisheries Development Centre (AFDC, University College, Cork UCC). Before arrival at the AFDC, sea urchins were reared on a diet of Laminaria digitata. Females were the predominant species of the animal group, displaying a reproductive Stage III (growing stage) where gametogenesis was commencing. Results show that darkness supports higher somatic growth than the photoperiod treatment. Feeding rates were higher for sea urchins reared under darkness with gonadal growth increasing for both experimental treatments. Individuals reared under darkness had a higher per cent change in gonad index from the initial sample taken at the beginning of the experiment. [source]


    Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma

    CANCER, Issue 3 2006
    Mirjam J. A. Engelen M.D.
    Abstract BACKGROUND Consultant gynecologic oncologists from the regional Comprehensive Cancer Center assisted community gynecologists in the surgical treatment of patients with ovarian carcinoma when they were invited. For this report, the authors evaluated the effects of primary surgery by a gynecologic oncologist on treatment outcome. METHODS The hospital files from 680 patients with epithelial ovarian carcinoma who were diagnosed between 1994 and 1997 in the northern part of the Netherlands were abstracted. Treatment results were analyzed according to the operating physician's education by using survival curves and univariate and multivariate Cox regression analyses. RESULTS Primary surgery was performed on 184 patients by gynecologic oncologists, and on 328 patients by general gynecologists. Gynecologic oncologists followed surgical guidelines more strictly compared with general gynecologists (patients with International Federation of Gynecology and Obstetrics [FIGO] Stage I,II disease, 55% vs. 33% [P = 0.01]; patients with FIGO Stage III disease, 60% vs. 40% [P = 0.003]) and more often removed all macroscopic tumor in patients with FIGO Stage III disease (24% vs. 12%; P = 0.02). When patients were stratified according to FIGO stage, the 5-year overall survival rate was 86% versus 70% (P = 0.03) for patients with Stage I,II disease and 21% versus 13% (P = 0.02) for patients with Stage III,IV disease who underwent surgery by gynecologic oncologists and general gynecologists, respectively. The hazards ratio for patients who underwent surgery by gynecologic oncologists was 0.79 (95% confidence interval [95%CI], 0.61,1.03; adjusted for patient age, disease stage, type of hospital, and chemotherapy); when patients age 75 years and older were excluded, the hazards ratio fell to 0.71 (95% CI, 0.54,0.94) in multivariate analysis. CONCLUSIONS The surgical treatment of patients with ovarian carcinoma by gynecologic oncologists occurred more often according to surgical guidelines, tumor removal more often was complete, and survival was improved. Cancer 2006. 2005 American Cancer Society. [source]


    High-dose-rate brachytherapy as part of a multidisciplinary treatment of nasopharyngeal lymphoepithelioma in childhood

    CANCER, Issue 3 2005
    Ricardo Akiyoshi Nakamura M.D.
    Abstract BACKGROUND Nasopharyngeal carcinoma in childhood is rare. Radiochemotherapy is considered the standard treatment and yields increased survival and local control rates. In this article, the authors report on the results from the multidisciplinary treatment of pediatric patients who had nasopharyngeal lymphoepithelioma with radiochemotherapy, including high-dose-rate brachytherapy of the primary tumor site. METHODS Between May 1992 and May 2000, 16 children with nasopharyngeal lymphoepithelioma received neoadjuvant chemotherapy, conventional external beam radiotherapy, high-dose-rate brachytherapy, and adjuvant chemotherapy. Patients ranged in age from 7 years to 18 years, and 9 patients were male. Patient distribution according to clinical disease stage was as follows: Stage III, 1 patient; Stage IVA, 5 patients; Stage IVB, 9 patients; and Stage IVC, 1 patient. Three cycles of neoadjuvant and adjuvant chemotherapy in 3-week intervals were administered with cyclophosphamide, vincristine, doxorubicin, and cisplatin. The median doses of external beam radiotherapy to the primary tumor, positive lymph nodes, and subclinical areas of disease were 55 grays (Gy), 55 Gy, and 45 Gy, respectively. Children received 2 insertions of high-dose-rate brachytherapy at 5 Gy per insertion: These were performed with metallic applicators inserted through the transnasal access under local anesthesia. RESULTS The median of follow-up was 54 months. At the time of last follow-up, 13 patients were alive without disease, 2 patients had died of disease, and 1 patient had died of treatment-related cardiac failure. Local control was achieved in 15 of 16 patients. Chemotherapy-related and radiotherapy-related acute toxicity was relevant but tolerable. CONCLUSIONS In the current study, it was shown that the treatment was effective in the control of both local and distant disease, although there was relevant acute and late toxicity. High-dose-rate brachytherapy was deliverable on an outpatient basis with local anesthesia. Close follow-up of these patients was necessary to evaluate the significance of treatment-related late effects and their impact on quality of life. Cancer 2005. 2005 American Cancer Society. [source]


    Differences in colorectal carcinoma stage and survival by race and ethnicity

    CANCER, Issue 3 2005
    Chloe Chien M.S.
    Abstract BACKGROUND In the United States, blacks with colorectal carcinoma (CRC) presented with more advanced-stage disease and had higher mortality rates compared with non-Hispanic whites. Data regarding other races/ethnicities were limited, especially for Asian/Pacific Islander and Hispanic white subgroups. METHODS Using data from 11 population-based cancer registries that participate in the Surveillance, Epidemiology and End Results program, the authors evaluated the relation among 18 different races/ethnicities and disease stage and mortality rates among 154,103 subjects diagnosed with CRC from 1988 to 2000. RESULTS Compared with non-Hispanic whites, blacks, American Indians, Chinese, Filipinos, Koreans, Hawaiians, Mexicans, South/Central Americans, and Puerto Ricans were 10,60% more likely to be diagnosed with Stage III or IV CRC. Alternatively, Japanese had a 20% lower risk of advanced-stage CRC. With respect to mortality rates, blacks, American Indians, Hawaiians, and Mexicans had a 20,30% greater risk of mortality, whereas Chinese, Japanese, and Indians/Pakistanis had a 10,40 % lower risk. CONCLUSIONS The authors observed numerous racial/ethnic disparities in the risks of advanced-stage cancer and mortality among patients with CRC, and there was considerable variation in these risks across Asian/Pacific Islander and Hispanic white subgroups. Although the etiology of these disparities was multifactorial, developing screening and treatment programs that target racial/ethnic populations with elevated risks of poor CRC outcomes may be an important means of reducing these disparities. Cancer 2005. 2005 American Cancer Society. [source]


    Small cell carcinoma of the urinary bladder

    CANCER, Issue 6 2005
    The Mayo Clinic experience
    Abstract BACKGROUND Small cell carcinoma (SCC) of the urinary bladder accounts for 0.35,0.70% of all bladder tumors. There is no standard approach to the management of SCC of the urinary bladder. METHODS The authors performed a retrospective study at Mayo Clinic (Rochester, MN) to characterize the clinical and pathologic features of patients with SCC of the urinary bladder diagnosed between 1975 and 2003 with emphasis on management. RESULTS Forty-four patients were identified who had primary bladder SCC, 61.4% of whom had pure SCC. The male:female ratio was 3:1, the mean age was 66.9 years, and the mean follow-up was 3.2 years. Twelve patients (27.3%) had Stage II disease, 13 patients (29.6%) had Stage III disease, and 19 patients (43.2%) had Stage IV disease. The overall median survival was 1.7 years. The 5-year survival rates for patients with Stage II, III, and IV disease were 63.6%, 15.4%, and 10.5%, respectively. Six of eight patients with Stage II bladder SCC achieved a cure with radical cystectomy. Five patients with Stage IV disease had obvious metastases and received chemotherapy. Fourteen patients underwent radical cystectomy and were diagnosed later with locally advanced disease (T4b) or lymph node metastasis (N1,N3; Stage IV disease). Only 2 of 19 patients with Stage IV disease who received adjuvant chemotherapy were alive at 5 years. CONCLUSIONS Patients with bladder SCC should undergo radical cystectomy except when metastatic disease is present (M1), in which case, systemic chemotherapy is indicated. Adjuvant treatment is not indicated for patients with Stage II disease after radical cystectomy but should be considered for patients with Stage III and IV disease. Chemotherapy should be a platinum-based regimen. Cancer 2005. 2005 American Cancer Society. [source]


    Association between serum levels of soluble tumor necrosis factor receptors/CA 125 and disease progression in patients with epithelial ovarian malignancy,,

    CANCER, Issue 1 2004
    A Gynecologic Oncology Group study
    Abstract BACKGROUND A prospective study was undertaken within the Gynecologic Oncology Group to determine whether serum levels of soluble tumor necrosis factor receptors I (sTNFR-I) and II (sTNFR-II), alone or in combination with CA 125, were associated with clinicopathologic characteristics or outcome in patients with epithelial ovarian malignancies. METHODS Quantitative immunoassays were performed on valid pretreatment serum specimens obtained from patients with epithelial ovarian malignancies to assess levels of sTNFR-I, sTNFR-II, and CA 125. The authors then analyzed the results of these immunoassays for potential correlations with clinicopathologic characteristics and outcome. RESULTS The median age of the 139 women evaluated was 59 years. Seventy-eight percent had Stage III or IV disease, and 58% had serous carcinomas. sTNFR-II was associated with age (P = 0.013), and CA 125 was associated with histologic subtype (P = 0.0009). In addition, sTNFR-I (P = 0.037) and CA 125 (P < 0.0001) were associated with extent of disease. After adjusting for patient age, histologic subtype, and extent of disease, all three biomarkers were predictive of progression-free survival, but not overall survival, when the combination was included in the model. The authors observed a 51% reduction (hazard ratio [HR], 0.49; 95% confidence interval [CI], 0.24,0.99), a 2.9-fold increase (HR, 2.87; 95% CI, 1.15,7.20), and a 22% increase (HR, 1.22; 95% CI, 0.99,1.51) in the risk of progression for each unit increase in the log-transformed levels of sTNFR-I, sTNFR-II, and CA 125, respectively. CONCLUSIONS The observations made in the current study,that among patients with low or high CA 125 levels, those with high sTNFR-I levels and low sTNFR-II levels had the lowest risk, that patients with low-low or high-high sTNFR-I and sTNFR-II levels, respectively, had an intermediate risk, and that patients with low sTNFR-I levels and high sTNFR-II levels had the highest risk of progression,suggested the potential value of simultaneous assessment of all three biomarkers in patients with epithelial ovarian malignancies. Cancer 2004. 2004 American Cancer Society. [source]


    Long-term follow-up of autologous stem cell transplantation in patients with diffuse mantle cell lymphoma in first disease remission

    CANCER, Issue 12 2003
    2 -microglobulin, The prognostic value of, the tumor score
    Abstract BACKGROUND The current study was conducted to analyze the long-term results of autologous stem cell transplantation (ASCT) in patients with diffuse mantle cell lymphoma (MCL) in first disease remission. METHODS Thirty-three patients were treated. Thirty-one patients had Ann Arbor Stage III or Stage IV disease. The hyper-CVAD regimen (hyperfractionated intense-dose cyclophosphamide, vincristine, continuous intravenous infusion of doxorubicin, and dexamethasone, alternating with high doses of cytarabine and methotrexate plus leucovorin rescue) was used for cytoreduction before ASCT. Patients were consolidated with high-dose cyclophosphamide (120 mg/kg), total body irradiation, and ASCT. RESULTS At a median follow-up of 49 months, the overall survival and disease-free-survival rates at 5 years were estimated to be 77% and 43%, respectively. Patients whose M. D. Anderson Lymphoma Tumor Score (TS) was , 1 at the time of diagnosis or transplantation experienced longer disease-free survival compared with those whose TS was > 1 (P = 0.02). A ,2 -microglobulin (,2m)level , 3 mg/L at the time of diagnosis or transplantation was also found to be strongly predictive of longer survival (5-year survival rate of 100% vs. 22% in patients with a ,2m level > 3 mg/L) (P = 0.0001). CONCLUSIONS ASCT may prolong the overall survival in a subset of patients with MCL. This improvement has been observed for the most part in patients with low ,2m levels (, 3 mg/L) and TS (, 1). Randomized trials are required to fully assess the benefits of this strategy. Cancer 2003;98:2630,5. 2003 American Cancer Society. [source]


    Medullary thyroid carcinoma as part of a multiple endocrine neoplasia type 2B syndrome

    CANCER, Issue 1 2002
    Influence of the stage on the clinical course
    Abstract BACKGROUND Multiple endocrine neoplasia type 2B (MEN 2B) is an exceptional syndrome, for which the optimal age of thyroidectomy is poorly established and the course of medullary thyroid carcinoma (MTC) is ill-defined. PATIENTS All the 18 patients with a MEN 2B syndrome examined at the Institut Gustave Roussy were included in a single-center retrospective study. RESULTS There were 9 men and 9 women with a mean age of 13 years (range, 2,27 years) at diagnosis. The diagnosis of MTC was based on the presence of a thyroid nodule or involved neck lymph nodes and on dysmorphic features of MEN 2B in 60% and 40% of the cases, respectively. The classic M918T mutation in exon 16 was found in the 16 patients in whom it was investigated. At diagnosis, 2 patients had Stage I MTC, 15 patients had Stage III, and 1 patient had Stage IV disease. T1 MTC was found in 4 patients aged 2.1,3.7 years. However, two of these patients already had N1 disease. One patient with Stage I MTC, aged 3.4 years and 2 patients with Stage III disease, aged 14 and 25 years, had undetectable basal calcitonin (CT) after initial surgery. During follow-up, basal CT became detectable in one of three patients. Among the 15 other patients with an elevated postoperative CT level, metastases were demonstrated in 5 patients after a mean follow-up of 2 years. Five patients died, three of MTC, one of the MEN 2B syndrome, and one of intercurrent disease. Five- and 10-year overall survival rates were 85% and 75%, respectively. CONCLUSIONS This study confirms the need for early treatment of MTC in patients with the MEN 2B syndrome, preferably within the first 6 months of life. The phenotype of MTC occurring in the MEN 2B syndrome was not more aggressive than sporadic MTC or MTC occurring in other familial syndromes. Cancer 2002;94:44,50. 2002 American Cancer Society. [source]


    Dose rounding of chemotherapy in colorectal cancer: An analysis of clinician attitudes and the potential impact on treatment costs

    ASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2010
    Kathryn FIELD
    Abstract Aim: The aims of this study were to calculate theoretical cost savings of oxaliplatin dose rounding in colorectal cancer (CRC), and to assess clinician attitudes to chemotherapy dose rounding. Methods: Data were obtained from a prospective data repository (BioGrid Australia) from four hospitals regarding the use of oxaliplatin, given at a standard dose of 85 mg/m2. We examined potential cost savings for patients with a body surface area (BSA) between 1.77 m2 and 1.94 m2, resulting in a calculated dose up to 10% above 150 mg (a 100 mg and 50 mg vial). The attitudes of oncologists at these hospitals toward minor dose reductions were assessed. Results: From January 2003 to June 2008, of 676 patients with Stages III or IV CRC, 227 (33.58%) received oxaliplatin. Overall 66 patients (29%) had a calculated BSA between 1.77 m2 and 1.94 m2. The potential cost saving for these hospitals in one year, if oxaliplatin doses were rounded down to 150 mg, is $AU51 898. Extrapolated to the Australian population, estimated savings are over $AU2.5 million per year. Three of nine (33.3%) oncologists were comfortable with an initial dose reduction of up to 10% in the adjuvant disease setting, and seven of nine (77.8%) in the setting of metastatic disease. Conclusion: Minor dose reductions for CRC to accommodate vial sizes would lead to significant cost savings. Oncologists are more comfortable with minor dose reductions when treatment is given in a palliative setting. [source]


    Oral mucositis in patients undergoing radiation treatment for head and neck carcinoma

    CANCER, Issue 2 2006
    Risk factors, clinical consequences
    Abstract BACKGROUND The current study was conducted to characterize the risks and clinical consequences of oral mucositis (OM) in patients with head and neck carcinoma (HNC) who are receiving radiation therapy. METHODS Data regarding 450 HNC patients who had received radiation therapy were collected via chart review from 154 U.S. medical and radiation oncologists. Information obtained included patient characteristics, treatments received, highest recorded grade of OM during radiation therapy (none, mild, moderate, or severe), and outcomes potentially associated with mucosal injury. RESULTS The mean age ( standard deviation [SD]) of the study subjects was 61.3 years (12.3 yrs); the majority of patients (80%) were men. Primary tumor locations included the oropharynx (26.4%), larynx (26.4%), oral cavity including the lip (24.4%), hypopharynx (13.6%), and nasopharynx (9.1%). The majority of tumors were new and were classified as AJCC Stages III or IV. The majority of patients (83%) received standard radiation therapy; the mean ( SD) cumulative dose was 6285 centigrays (cGy) ( 1158 cGy). Approximately 33% of the patients received concomitant chemotherapy. The majority of patients (83%) developed OM; 29% developed severe OM. Patients with severe OM were more likely to have nasopharyngeal or oropharyngeal tumors (adjusted odds ratio [OR] of 10.1 [95% confidence interval (95% CI), 2.1,49.9] and 6.9 [95% CI, 2.4,19.7], respectively), and to have received cumulative radiation doses > 5000 cGy (OR of 10.4; 95% CI, 2.9,37.1) and concomitant chemotherapy (OR of 3.3; 95% CI, 1.4,8.0). Patients with OM had more unplanned breaks in radiation therapy (OR of 3.8; 95% CI, 1.7,8.5) and hospital admissions (OR of 3.5; 95% CI, 1.3,9.5). CONCLUSIONS HNC patients with nasopharyngeal or oropharyngeal tumors, and those who receive cumulative radiation doses > 5000 cGy or concomitant chemotherapy, are more likely to develop OM. Patients with OM are at a higher risk of unplanned breaks in radiation therapy and hospitalization. Cancer 2006. 2005 American Cancer Society. [source]


    Safety and efficacy of bortezomib in high-risk and elderly patients with relapsed multiple myeloma

    BRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2007
    Paul G. Richardson
    Summary Adverse prognostic factors in multiple myeloma include advanced age, number of prior therapies, and higher International Staging System (ISS) disease stage. In the international, randomised, phase-3 Assessment of Proteasome Inhibition for Extending Remissions (APEX) study, bortezomib demonstrated significantly longer time to progression (TTP), higher response rates and improved survival compared with high-dose dexamethasone in patients with relapsed multiple myeloma following one to three prior therapies. In this APEX subgroup analysis, efficacy of bortezomib and dexamethasone was compared in elderly (age ,65 years) and high-risk (>1 prior line of therapy; ISS stage II/III; refractory to prior therapy) patients. Bortezomib demonstrated substantial clinical activity in these patients. Response rate (34,40% vs. 13,19%), including complete response rate (5,8% vs. 0,1%), was significantly higher with bortezomib versus dexamethasone in all four subgroups. Similarly, median TTP was significantly longer with bortezomib versus dexamethasone, and 1-year survival probability was significantly higher in all subgroups. As in the total APEX population, rates of grade 3/4 adverse events were higher in bortezomib- versus dexamethasone-treated patients aged ,65 years and with >1 prior line, while rates of serious adverse events were similar; toxicities generally proved manageable. Bortezomib should be considered an appropriate treatment for elderly and high-risk patients with relapsed multiple myeloma. [source]


    Photodynamic Therapy of Cutaneous Lymphoma Using 5-Aminolevulinic Acid Topical Application

    DERMATOLOGIC SURGERY, Issue 8 2000
    Arie Orenstein MD
    Background. Photodynamic therapy (PDT) with topical application of 5-aminolevulinic acid (ALA) is a new and effective modality for treatment of superficial basal and squamous cell carcinomas. Objective. We present the kinetics of ALA-induced protoporphyrin IX (PP) accumulation and the results of ALA PDT treatment on two patients with different stages (stage I and stage III) of mycosis fungoides (MF)-type cutaneous T-cell lymphoma (CTCL). Methods. ALA-Decoderm cream was applied to the lesions for 16 hours. Spectrofluorescence measurements of PP accumulation were carried out before, during, and 1 hour after photoirradiation (580,720 nm) using the VersaLight system. Results. Different patterns of PP fluorescence kinetics were observed in patients with early and advanced stages of the disease. During photoirradiation the intensity of fluorescence decreased depending on the lesion thickness. One hour after the photoirradiation procedure no PP fluorescence was observed in the stage I MF lesion, while in the thick stage III MF lesions, PP fluorescence reappeared; after an additional 10,15 minutes of irradiation PP fluorescence disappeared. Complete response with excellent cosmetic results was observed in the stage I lesion after a single irradiation with a light dose of 170 J/cm2; in five stage III lesions, complete response was achieved after fractionated irradiation with a total light dose of 380 J/cm2 (follow-up at 27 and 24 months, respectively). Conclusion. The results showed a high response of both stage I and stage III MF lesions to ALA PDT. This modality appears to be very effective and can be used successfully for MF treatment. [source]


    Preemptive effect of nucleus of the solitary tract stimulation on amygdaloid kindling in freely moving cats

    EPILEPSIA, Issue 3 2010
    Victor M. Magdaleno-Madrigal
    Summary Purpose:, The nucleus of the solitary tract (NTS) is a primary site where vagal afferents terminate. The aim of this study was to analyze the preemptive effect of NTS electrical stimulation on daily amygdaloid kindling (AK) in freely moving cats. Methods:, Seven adult male cats were used. Bipolar electrodes were stereotaxically implanted into both amygdalae, lateral geniculate bodies, hippocampi, and prefrontal cortices. In addition, a bipolar stainless steel electrode was implanted in the left NTS. Cats were recorded under the following experimental conditions: The NTS was stimulated for 6 days before the initiation of AK (1 min on/5 min off, 1 h total). AK was performed by stimulating the amygdala every 24 h (1 s, 60 Hz, 1 ms) until behavioral stage VI was reached. Results:, The number of stimulations to reach stage VI in control animals was 23.4 3.7, in lateral tegmental field (LTF) animals was 17.0 2.1 days. Animals subjected to preemptive NTS stimulation showed a significant increase (53.8 5.9). In addition, behavioral development was retarded, with an increase in the number of stimulations required to reach stage III. In this group, overall kindling development was delayed, and amygdaloid afterdischarge duration did not show a progressive increase as was observed in the control group. Discussion:, Our results indicate that preemptive NTS electrical stimulation interferes with epileptogenesis. This anticonvulsive effect could be related to the activation of certain structures that inhibit seizure development. Therefore, results suggest that NTS mediates the anticonvulsive effect of vagus nerve stimulation. [source]


    Successful treatment of a patient with lymphocyte-predominant Hodgkin's lymphoma with yttrium-90-ibritumomab tiuxetan

    EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2008
    Niklas Zojer
    Abstract Lymphocyte-predominant Hodgkin's lymphoma (LPHL) is known to be radiosensitive, and radiotherapy often forms part of the treatment of patients with stage III or IV LPHL. In addition, as LPHL is thought to arise from a germinal centre B-cell, and LPHL cells express the B-cell marker CD20 there is a rationale for using anti-CD20 therapies for the treatment of LPHL. We report a 42-yr-old man with stage III B LPLH who underwent successful treatment of LPHL with 90Y-ibritumomab tiuxetan. To our knowledge, this is the first report on the use of an anti-CD20 radiolabeled antibody for the treatment of LPHL. [source]


    CD34+ cells derived from fetal liver contained a high proportion of immature megakaryocytic progenitor cells

    EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2000
    Dong-Chu Ma
    Abstract: Endoreplication and maturation of the megakaryocyte (MK) may be retarded or delayed during ontogenesis. In this study, CD34+ cells were isolated from both human fetal liver and adult bone marrow and incubated with thrombopoietin (TPO). The cell number, morphological characteristics, platelet-associated antigen phenotype, maturation stage and DNA ploidy of CD41+cells were examined from day 0 to day 12 in culture. 1) TPO stimulated the proliferation of fetal liver (FL)-derived CD34+ cells with a mean 73.14-fold increase of CD41+ cells after 12 d in culture. Adult BM-derived CD34+ cells increased only slightly, with a mean 8.18-fold increase of CD41+ cells. 2) Although the membrane phenotype of both FL CD34+ -derived MKs and BM CD34+ -derived MKs analyzed with CD41a, CD42a, CD61 and CD34 were similar, all FL CD34+ -derived MKs were in maturation stage I and II and in low ploidy (<4N) class. By comparison, BM CD34+ MKs possessed 15% MKs in maturation stage III and IV and with 23% MKs in high ploidy class (>4N). 3) Most of cultured FL-derived CD34+ cells did not have a well developed demarcation system (DM) and numerous ,-granules after 12 d incubation. von Willebrand factor (vWF) appeared earlier on the cultured BM-derived CD34+ cells than on FL-derived CD34+ cells. 4) The expression of both cyclin E and cyclin B1 progressively increased in FL CD34+cells induced by TPO during 12 d in culture. 5) The expression of cyclin D1 gradually decreased in FL CD34+cells induced by TPO over 12 d incubation. 6) Immunocytochemical analysis showed that cyclin D3 was detected only in cytoplasm of cultured FL-derived CD34+ cells, whereas in both cytoplasm and nuclei of cultured BM-derived CD34+ cells. These data suggest that FL-derived CD34+ cells contain a high proportion of immature megakaryocytic progenitor cells. It further suggests that TPO can push these progenitor cells into proliferation by upregulating the expression of cyclins B1 and E, and drive a high proportion of cells into megakaryocytic lineage. [source]


    The effect of stage of Parkinson's disease at the onset of levodopa therapy on development of motor complications

    EUROPEAN JOURNAL OF NEUROLOGY, Issue 1 2002
    V. S. Kosti
    The aim of this study was to ascertain whether the stage of Parkinson's disease (PD) (according to the Hoehn and Yahr staging system) would affect the length of time between the introduction of levodopa therapy and appearance of levodopa-associated motor complications. Forty patients with clinically definite PD were studied. In all, clinical and therapeutic data were collected from the time of diagnosis to the time of levodopa-associated motor complications (i.e. dyskinesia, motor fluctuations). In 17 patients, levodopa could be started in Hoehn and Yahr stage I (H&Y-I; 16.2 months after the onset of PD), whilst in 13 patients levodopa could be started in H&Y-II (19.6 months after the onset of the disease) and in 10 in H&Y-III (45.1 months after the onset of PD). Cox proportional hazard regression model shows that the PD patients in whom the initial levodopa treatment was introduced at stage III develop both dyskinesias and motor fluctuations significantly earlier than the patients whose levodopa started in stage I and II of PD. The median interval to develop dyskinesias was 66, 72 and 24 months for patients in whom levodopa was introduced in stage I, II and III, respectively. These values were 64, 55 and 14 months for motor fluctuations. These findings add to the clinical arguments that favour an essential role of severity of PD at levodopa initiation as a risk factor for the development of levodopa-associated motor complications. [source]


    Larval lobster (Homarus americanus) distribution and drift in the vicinity of the Gulf of Maine offshore banks and their probable origins

    FISHERIES OCEANOGRAPHY, Issue 2 2005
    G. C. HARDING
    Abstract Surveys for lobster larvae in offshore waters of the north-eastern Gulf of Maine in 1983, 1987 and 1989 confirm that local hatching occurs mainly at depths <100 m over the banks, including Georges and Browns Banks. Detailed studies in the vicinity of Georges Bank in late July of both 1987 and 1989 indicate that the first and second moult stages were located primarily over the bank whereas stages III and IV lobster were collected both over and off the bank. At times stage IV lobster were more abundant off the bank than over it. The condition of stage III and IV lobster, as measured by a lipid index, was better off than over Georges Bank in 1988 and 1989 indicating a possible physiological advantage to being off the bank. In addition, the higher surface temperatures off Georges Bank would shorten larval development time to settlement. To determine the probable hatch sites of stage IV lobster collected off of Browns Bank in 1983 and off of Georges in 1987 and 1989, a 3-D circulation model of the Gulf of Maine was used to simulate larval lobster drift backwards in time. In all cases, areas off Cape Cod, MA, and off Penobscot Bay, ME were suggested as the source of the larvae, although most of the larval trajectories never reached these near-shore waters that are well-known, larval hatching areas. The model-projected larval release times match most closely the observed inshore hatch off Massachusetts but model uncertainties mean that coastal Maine cannot be ruled out as a source. Georges Bank is also a potential source because the present model does not take into account short-term wind events, off-bank eddy transport or the possibility of directed off-bank larval swimming. Examination of weather records prior to and during our 1988 and 1989 sampling periods indicates that winds were not of sufficient intensity and duration to induce larval transport off Georges Bank. The shedding of eddies from the northern flank of Georges Bank into the Gulf of Maine are a relatively common phenomenon during summer but not enough is known about them to evaluate their contribution to possible cross-bank transport of lobster larvae. Directed larval swimming is another possible source for the stage IV lobster found near Georges Bank. Plankton distributions across the northern frontal zone of Georges Bank in 1988 were used as proxies for the scarce larval lobsters. The more surface distribution of the microplankton, in particular, supports the possibility that wind and eddy events may be important in the transport of stage III and IV lobsters off of Georges Bank. Further studies are needed to evaluate these possible additional sources of advanced stage lobster larvae found off of the offshore banks. [source]


    Altered fractionation and adjuvant chemotherapy for head and neck squamous cell carcinoma

    HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2010
    William M. Mendenhall MD
    Abstract Background The aim of this review was to discuss the role of altered fractionation and adjuvant chemotherapy for patients treated with definitive radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC). Methods This review explores the pertinent literature and discusses the optimal management of previously untreated patients with stage III,stage IVA and/or -B HNSCCs. Results Depending on the schedule, altered fractionation improves locoregional control and survival. Both hyperfractionation and concomitant boost RT improve locoregional control and are associated with improved overall survival (OS). Adjuvant chemotherapy improves OS; the greatest impact is observed after concomitant versus induction or maintenance chemotherapy. Monochemotherapy appears to be equivalent to polychemotherapy. Drugs associated with the greatest survival benefit include fluorouracil and cisplatin. Intraarterial chemotherapy offers no advantage over intravenous chemotherapy. Concomitant cetuximab and RT results in improved outcomes similar to those observed after concomitant cisplatin-based chemotherapy and RT. Conclusions Altered fractionation and/or concomitant chemotherapy result in improved outcomes compared with conventionally fractionated definitive RT alone for stage III,stage IV HNSCC. The optimal combination of RT fractionation and chemotherapy remains unclear. 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]