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Follow-up Strategies (follow-up + strategy)
Selected AbstractsValue of Different Follow-Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005CHRISTOPHER PIORKOWSKI M.D. Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30,40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients. [source] Fine needle aspiration of renal cortical lesions in adultsDIAGNOSTIC CYTOPATHOLOGY, Issue 10 2010Adebowale J. Adeniran M.D. Abstract The role of fine needle aspiration (FNA) biopsy of renal cortical lesions was controversial in the past because the result of the FNA did not affect clinical management. All renal cortical lesions, except metastasis, were subject to surgical resection. However, with the advances in neoadjuvant targeted therapies, knowledge of the renal cortical tumor histological subtype is critical for tailoring clinical trials and follow-up strategies. At present, there are clinical trials involving the use of novel kinase inhibitors for conventional (clear cell) and papillary renal cell carcinoma. We studied 143 consecutive cases of renal cortical lesions, evaluated after radical or partial nephrectomies over a 2-year period. An air-dried smear and a Thinprep® slide were prepared in all cases. The slides were Diff-Quick and Papanicolaou stained, respectively. The cytology specimens were reviewed and the results were then compared with the histologic diagnosis. Cytology was highly accurate to diagnose conventional RCC, while the accuracy for papillary RCC, chromophobe RCC, and papillary urothelial carcinoma was much lower. Our results indicate that ancillary studies might have an important role in the subclassification of renal cortical neoplasms for targeted treatment. Diagn. Cytopathol. 2010;38:710,715. © 2009 Wiley-Liss, Inc. [source] Role of Pap Test terminology and age in the detection of carcinoma invasive and carcinoma in situ in medically underserved California womenDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2004Lydia P. Howell M.D. Abstract Our goals were to evaluate Pap Test findings classified by the Bethesda system, and follow up biopsies from participants in the California Breast and Cervical Cancer Control Program (Ca-BCCCP) for: 1) correlation in the detection of carcinoma in situ (CIS) and carcinoma invasive (CI), and 2) age-related trends, with discussion in the context of the 2001 ASCCP Management Guidelines. Women (n = 52,339) who had their initial screening Pap Tests with Ca-BCCCP between January 1995,December 1999 were followed for diagnostic services through December 2000. Descriptive and analytical methods were used in the analysis. Of the Pap results, 81.9% were negative, 10.6% showed infection, 4.7% showed an epithelial abnormality as defined by the Bethesda system (atypical squamous cells of undertermined significance (ASCUS), low-grade squamous intraepithelial lesion (LSIL), or high-grade squamous intraepithelial lesion (HSIL)), 0.1% showed squamous-cell cancer (SCC), and 2.7% showed other or unsatisfactory. Subsequent to the initial Pap Test, follow-up results of carcinoma in situ (CIS) and carcinoma invasive (CI) accounted for 0.36% and 0.05% of the population, respectively. Among HSIL Pap Tests (n = 285), 40.7% had follow-up showing CIS. Among SCC Pap Tests, 17.9% had follow-up results of CIS and 28.6% CI. Of the 191 patients with CIS as a follow-up finding, the initial Pap smear showed: HSIL 60.7%, SCC 2.6%, LSIL 10.5%, ASCUS 13.6%, and negative or infection 9.9%. Of the 27 patients with CI, the initial Pap Test showed: HSIL 40.7%, SCC 29.6%, LSIL 7.4%, ASCUS 7.4%, and negative or infection 11.1%. Pap diagnoses of other or unsatisfactory accounted for 2.6% of the Pap results from patients with CIS and 3.7% of Pap results from patients with CI. Except for LSIL, there was an increasing age trend in the number of cases in each of Pap results, with the exception of age 65+ yr. However, the ratio of LSIL and ASCUS to negative cases decreased with age. (P < 0.0001 and 0.0293, respectively). HSIL Pap results indicate a reasonably high probability of CIS and CI. However, approximately 1/3 of patients with CIS and 1/4 of patients with CI presented with Pap diagnoses of less severity than HSIL. When a negative Pap Test result is chosen as reference group, there is a negative age trend for LSIL and ASCUS, and no age trend for other results. These findings all have important implications in the design of follow-up strategies, and support the 2001 ASCCP Consensus Guidelines for the Management of Women with Cervical Abnormalities. Diagn. Cytopathol. 2004;30:227,234. © 2004 Wiley-Liss, Inc. [source] Molecular identification and characterization of rifampicin-resistant Mycobacterium tuberculosis isolates by line probe assay: an approach for rapid diagnosis of multidrug-resistant tuberculosisLETTERS IN APPLIED MICROBIOLOGY, Issue 3 2008C. Bicmen Abstract Aim:, Early identification and characterization of rifampicin-resistant (Rr) Mycobacterium tuberculosis isolates recovered from the samples of tuberculosis (TB) patients in the Aegean (West Anatolian) Region was intended. Methods and Results:, Sixty isolates [47 (78·3%) multidrug-resistant (MDR)], which were identified as M. tuberculosis complex and phenotypically resistant to rifampicin by both BACTEC mycobacteria growth indicator tube (MGIT) 960 and 460 systems were analysed by a commercial line probe assay (INNO-LiPA Rif TB). The concordance of LiPA with the in vitro susceptibility test was found as 98·3%. Among the isolates, S531L (R5 pattern; 46·7%) and L511P/R, S512T, Q513L/K (,S1 pattern; 11·7%) were the most frequent mutation patterns. As compared with the BACTEC systems and conventional techniques for cultivation, identification and in vitro susceptibility testing, INNO-LiPA Rif TB after cultivation in BACTEC MGIT 960 system provided an average of 20 days early diagnosis of RrM. tuberculosis isolates. Conclusions:, Rapid molecular identification and characterization of RrM. tuberculosis isolates after BACTEC MGIT 960 cultivation would be useful for faster diagnosis, infection control and planning of accurate treatment in MDR-TB patients. Significance and Impact of the Study:, Patients with MDR-TB need a specified treatment and efficient follow-up strategies. Rapid and practical methodologies to diagnose and follow these patients should be applied in routine use. [source] Relation between inflammation and symptoms in asthmaALLERGY, Issue 3 2009I. Tillie-Leblond Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggest that there is a relationship between the perception of symptoms and eosinophilic inflammation and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease-modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids. [source] Superficial bladder tumours: analysis of prognostic factors and construction of a predictive indexBJU INTERNATIONAL, Issue 4 2003B. Ali-El-Dein OBJECTIVES To assess the prognostic factors that could be used to predict tumour recurrence and progression, and to construct and validate a predictive index. PATIENTS AND METHODS Between June 1991 and December 2000, 533 patients (418 men and 115 women; mean age 55.4 years) underwent complete transurethral resection of histologically confirmed pTa and pT1 transitional cell carcinoma of the bladder, after which 377 (test series) were randomized into two subsequent studies, of six groups, to receive adjuvant intravesical sequential bacillus Calmette-Guérin (BCG) and epirubicin, BCG alone, epirubicin (50 or 80 mg), adriamycin 50 mg or no adjuvant therapy. Factors potentially affecting tumour recurrence or progression were assessed using univariate and multivariate analysis, i.e. tumour stage, histological grade, DNA ploidy, history of recurrence, multiplicity, size, tumour configuration, associated carcinoma in situ, recurrence at the first 3-month check cystoscopy and the use of adjuvant therapy. The regression coefficients determined by Cox regression analysis were used to construct a predictive index (PI). The algebraic sum of the regression coefficients of the factors with independent and significant association with disease-free survival for each case represented a proportional hazard score (PHS). The PI was validated in another series of 156 patients (validation series) in whom the same regression coefficients for the same significant factors as the test series were used to categorize it into three risk groups. Kaplan-Meier survival curves were plotted to compare the different risk categories in both test and validation series. RESULTS The mean (sd, range) follow-up in the test and validation series were 58 (19, 5,96) and 28.3 (14.9, 2,94) months, respectively. In the test series, tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration, cystoscopy result and the type of adjuvant therapy had independent significance for recurrence on multivariate analysis. For progression, the cystoscopy result, DNA ploidy and grade were the only independent and significant predictors. The ranges of PHS for the factors affecting recurrence-free and progression-free survival were 0.0,7.14 and 0.0,5.84, respectively, which were divided equally into three risk categories with significant differences on Kaplan-Meier curves and a log-rank test (P < 0.001). The three categories in the validation series were significantly different from each other and each was comparable with that in the test series. CONCLUSIONS Tumour stage, DNA ploidy, multiplicity, history of recurrence, tumour configuration and type of adjuvant therapy affected independently the rate of recurrence after resecting superficial bladder tumour. Recurrence at the 3-month cystoscopy, histological grade and DNA ploidy were the only predictors of progression to muscle-invasion. The PI dividing the patients into three risk groups with different treatment and follow-up strategies for recurrence and progression was reproducible in a validation series. [source] Improved prediction of recurrence after curative resection of colon carcinoma using tree-based risk stratificationCANCER, Issue 5 2004Martin Radespiel-Tröger M.D. Abstract BACKGROUND Patients who are at high risk of recurrence after undergoing curative (R0) resection for colon carcinoma may benefit most from adjuvant treatment and from intensive follow-up for early detection and treatment of recurrence. However, in light of new clinical evidence, there is a need for continuous improvement in the calculation of the risk of recurrence. METHODS Six hundred forty-one patients with R0-resected colon carcinoma who underwent surgery between January 1, 1984 and December 31, 1996 were recruited from the Erlangen Registry of Colorectal Carcinoma. The study end point was time until first locoregional or distant recurrence. The factors analyzed were: age, gender, site in colon, International Union Against Cancer (UICC) pathologic tumor classification (pT), UICC pathologic lymph node classification, histologic tumor type, malignancy grade, lymphatic invasion, venous invasion, number of examined lymph nodes, number of lymph node metastases, emergency presentation, intraoperative tumor cell spillage, surgeon, and time period. The resulting prognostic tree was evaluated by means of an independent sample using a measure of predictive accuracy based on the Brier score for censored data. Predictive accuracy was compared with several proposed stage groupings. RESULTS The prognostic tree contained the following variables: pT, the number of lymph node metastases, venous invasion, and emergency presentation. Predictive accuracy based on the validation sample was 0.230 (95% confidence interval [95% CI], 0.227,0.233) for the prognostic tree and 0.212 (95% CI, 0.209,0.215) for the UICC TNM sixth edition stage grouping. CONCLUSIONS The prognostic tree showed superior predictive accuracy when it was validated using an independent sample. It is interpreted easily and may be applied under clinical circumstances. Provided that their classification system can be validated successfully in other centers, the authors propose using the prognostic tree as a starting point for studies of adjuvant treatment and follow-up strategies. Cancer 2004;100:958,67. © 2004 American Cancer Society. [source] Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatmentCANCER, Issue 3 2002Risk factors analysis Abstract BACKGROUND Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment-related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (, 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations. Cancer 2002;95:605,12. © 2002 American Cancer Society. DOI 10.1002/cncr.10687 [source] Systematic review of the follow-up of oral dysplasiaCLINICAL OTOLARYNGOLOGY, Issue 3 2006T. Rattay Objectives.,To assess effectiveness, safety, and acceptability of follow-up regimens for oral dysplasia with regards to malignant transformation rate and duration to transformation. Method.,Study design,Systematic literature review with criteria for identifying studies, assessing quality and data extraction. Selection criteria,Cohort studies, case-control studies, or randomised-controlled trials (RCTs). Interventions,Clinical follow-up and surveillance, surgical and non-surgical treatment, modification of aetiological factors. Outcome measures,Malignant transformation rate, predictive value of clinical prognostic indicators. Data collection and analysis,Using selection criteria, we identified published data by electronic searching. The validity of studies and extracted data was independently assessed by two authors. Quantitative data is compared and summarized in a table. Qualitative data is also discussed. Results. There are no RCTs assessing follow-up strategies. Nineteen cohort studies (level II and III evidence) reported follow-up, of which 12 were included in the meta-analysis. The malignant transformation rate varies widely between studies (6.6,36.0%). Surgical treatment appears to be more effective than non-surgical modalities, but recurrence is high. Tobacco and alcohol use, site and histological grade of the lesion are associated with progression to cancer. Conclusions. There is currently no evidence-based or consensus strategy for malignant risk quantification and follow-up of patients with oral dysplasia. We present a follow-up protocol based on best evidence. Large randomised-controlled trials are needed to assess these new strategies, including the use of molecular markers to quantify risk and follow-up these lesions. [source] Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with EpilepsyEPILEPSIA, Issue 1 2006Katriina Viinikainen Summary:,Purpose: This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. Methods: We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. Results: During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (,0.6,10.2%; 95% confidence interval) in the 127 children of WWAE. Conclusions: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed. [source] Value of Different Follow-Up Strategies to Assess the Efficacy of Circumferential Pulmonary Vein Ablation for the Curative Treatment of Atrial FibrillationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005CHRISTOPHER PIORKOWSKI M.D. Background: The objective of this study was to compare transtelephonic ECG every 2 days and serial 7-day Holter as two methods of follow-up after atrial fibrillation (AF) catheter ablation for the judgment of ablation success. Patients with highly symptomatic AF are increasingly treated with catheter ablation. Several methods of follow-up have been described, and judgment on ablation success often relies on patients' symptoms. However, the optimal follow-up strategy objectively detecting most of the AF recurrences is yet unclear. Methods: Thirty patients with highly symptomatic AF were selected for circumferential pulmonary vein ablation. During follow-up, a transtelephonic ECG was transmitted once every 2 days for half a year. Additionally, a 7-day Holter was recorded preablation, after ablation, after 3 and 6 months, respectively. With both, procedures symptoms and actual rhythm were correlated thoroughly. Results: A total of 2,600 transtelephonic ECGs were collected with 216 of them showing AF. 25% of those episodes were asymptomatic. On a Kaplan-Meier analysis 45% of the patients with paroxysmal AF were still in continuous SR after 6 months. Simulating a follow-up based on symptomatic recurrences only, that number would have increased to 70%. Using serial 7-day ECG, 113 Holter with over 18,900 hours of ECG recording were acquired. After 6 months the percentage of patients classified as free from AF was 50%. Of the patients with recurrences, 30,40% were completely asymptomatic. The percentage of asymptomatic AF episodes stepwise increased from 11% prior ablation to 53% 6 months after. Conclusions: The success rate in terms of freedom from AF was 70% on a symptom-only-based follow-up; using serial 7-day Holter it decreased to 50% and on transtelephonic monitoring to 45%, respectively. Transtelephonic ECG and serial 7-day Holter were equally effective to objectively determine long-term success and to detect asymptomatic patients. [source] | ||||||||||