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High Recurrence Rate (high + recurrence_rate)
Selected AbstractsHigh recurrence rate after atypical resection for pancreatic metastases from renal cell carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2003C. Bassi Background: Pancreatic metastases from renal cell carcinoma are rare but highly resectable. The aim of this study was to review a series of patients with this condition. Methods: The study involved 22 consecutive patients with histologically proven pancreatic metastases from renal cell cancer. Results: Seventeen of the 22 patients had surgery. No patient died but eight of the 17 patients had a postoperative complication. Median follow-up was 33 (range 1,96) months. The 24- and 60-month survival probabilities were 0·84 and 0·53 respectively. Five patients who did not undergo surgery had 24- and 60-month survival probabilities of 0·53 and 0·26 respectively. The difference between the two groups was significant (P = 0·040). Conclusion: Despite the slow development of these secondaries and their well encapsulated morphology, the high rate of recurrence after limited resection suggests that radical resection should be recommended. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Status Epilepticus in Children with Epilepsy: Dutch Study of Epilepsy in ChildhoodEPILEPSIA, Issue 9 2007Hans Stroink Summary:,Purpose: To study course and outcome of epilepsy in children having had a status epilepticus (SE) as the presenting sign or after the diagnosis. Methods: A total of 494 children with newly diagnosed epilepsy, aged 1 month through 15 years, were followed prospectively for 5 years. Results: A total of 47 Children had SE. Forty-one of them had SE when epilepsy was diagnosed. For 32 (78%), SE was the first seizure. SE recurred in 13 out of 41 (32%). Terminal remission at 5 years (TR5) was not significantly worse for these 41 children: 31.7% had a TR5 <1 year versus 21.2% of 447 children without SE. They were not more often intractable. Five out of six children with first SE after diagnosis had a TR5 <1 year. Mortality was not significantly increased for children with SE. Independent factors associated with SE at presentation were remote symptomatic and cryptogenic etiology, and a history of febrile convulsions. Children with first SE after inclusion more often had symptomatic etiology. Conclusions: Although we find a trend for shorter TR5 in children with SE at presentation, outcome and mortality are not significantly worse. Etiology is an important factor for prognosis. Children with SE during the course of their epilepsy have a worse prognosis and a high recurrence rate of SE. This outcome is not due to the SE itself, but related to the etiology and type of epilepsy. The occurrence of SE is just an indicator of the severity of the disease. [source] External auditory canal eccrine spiradenocarcinoma: A case report and review of literatureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2003Tanya K. Meyer MD Abstract Background. Eccrine spiradenocarcinoma is a rare dermal appendage carcinoma believed to arise from transformation of a long-standing benign spiradenoma. This tumor demonstrates highly malignant biologic behavior with a high recurrence rate, frequent lymph node metastases, and overall poor survival. Methods. We report the first case of eccrine spiradenocarcinoma arising in the external auditory canal. The management of this tumor, its histopathologic characteristics, and a review of literature are presented. Results. A literature review identified 17 cases of eccrine spiradenocarcinoma in the head and neck region. Local recurrence occurred in 58.8% of patients, with an average of 23 months from diagnosis. Lymph node metastasis occurred in 35.3%, with an average of 31 months from diagnosis. Other metastatic sites included skin, bone, and lung. Disease-specific mortality was 22.2%. Conclusions. Eccrine spiradenocarcinoma is an aggressive tumor with a poor prognosis. Primary treatment should include wide local excision with or without regional lymphadenectomy. Isolated successful treatments have been documented with adjuvant hormonal manipulation, chemotherapy, and radiation therapy. © 2003 Wiley Periodicals, Inc. Head Neck 25: 505,510, 2003 [source] Eletriptan in Migraine Patients Reporting Unsatisfactory Response to RizatriptanHEADACHE, Issue 7 2006Jerome Goldstein MD Objective.,The objective of this open-label study was to evaluate the efficacy of switching patients who had a previous unsatisfactory response to rizatriptan to eletriptan 40 mg. Background.,The characteristics of individual migraine patients can vary tremendously and can have a significant impact on treatment outcomes. In addition, clinical experience has demonstrated that the triptans are not identical or interchangeable and that patients who respond poorly or who are dissatisfied with one agent can derive benefit by being switched to another agent within the triptan class. Methods.,Patients were eligible if they met International Headache Society criteria for migraine, with a frequency of 1 to 6 migraine attacks per month, and had documented "unsatisfactory treatment response" to rizatriptan within the past year (54% on the melt formulation; 46% on tablets). Reasons for dissatisfaction with rizatriptan (>1 could be cited) included inadequate (84%) or slow onset (50%) of pain relief, high recurrence rate (69%), and lack of improvement in associated symptoms (60%). One hundred twenty-three patients were eligible for treatment. Patients were instructed to take eletriptan 40 mg as soon as they were certain that their headache was a migraine, regardless of level of pain severity (8% treated headaches that were mild). Results.,Headache response at 2 hours (first-attack data) was 64%. Absence of nausea (from baseline to 2 hours) increased from 50% to 78%, absence of photophobia from 30% to 72%, and absence of phonophobia from 39% to 77%. Functional response at 2 hours was 63%, with 41% of patients reporting normal functioning. Treatment with eletriptan 40 mg was associated with a 27% to 40% reduction in migraine attack-related functional impairment, as measured by the PQ-7. Recurrence rates were 36.6%. Overall, 72% of patients rated eletriptan as a "good-to-excellent" treatment, and 78% reported overall satisfaction with the degree of headache relief. Conclusion.,The results of this study suggest that eletriptan is an efficacious treatment option for patients who are dissatisfied with their response to rizatriptan. [source] Rainfall patterns and critical values associated with landslides in Povoação County (São Miguel Island, Azores): relationships with the North Atlantic OscillationHYDROLOGICAL PROCESSES, Issue 4 2008Rui Marques Abstract São Miguel Island (Azores) has been affected by hundreds of destructive landslide episodes in the last five centuries, triggered either by earthquakes, volcanic eruptions or rainfall episodes, which were responsible for many deaths and very important economic losses. Among the instability causes, meteorological factors are of primary importance on Povoação County, namely the high recurrence rate of calamitous rainfall triggering landslides. The most recent catastrophic episode took place on the 31st October 1997 when almost 1000 soil slips and debris flows were triggered, and 29 people died in the Ribeira Quente village. The role of rainfall on regional landslide activity was analysed applying cumulative rainfall methods. The method comprises the reconstruction of both absolute and calibrated antecedent rainfalls associated with each major landslide event. The critical rainfall combination (amount-duration) responsible for each landslide event was assessed and a rainfall critical threshold for landslide occurrence was calculated. Rainfall-triggered landslides in the study area are ruled by the function I = 144·06 D,0·5551, and they are related both to short duration precipitation events (1,3 days) with high average intensity (between 78 and 144 mm/day) and long-lasting rainfall episodes (1,5 months) with a lower intensity (between 9 and 22 mm/day). The impact of the North Atlantic Oscillation (NAO) on the regional precipitation regime was evaluated. It is shown that the monthly precipitation of São Miguel is largely modulated by the NAO mode presenting a significant negative correlation with the NAO index. This result arises from the NAO control on the travelling latitude of most storm tracks that cross the Northern Atlantic Ocean. Copyright © 2007 John Wiley & Sons, Ltd. [source] Molecular margin analysis predicts local recurrence after sublobar resection of lung cancerINTERNATIONAL JOURNAL OF CANCER, Issue 6 2005Brett G. Masasyesva Abstract Sublobar resection for early-stage lung cancer has been used for patients who are not candidates for lobar resection. However, sublobar resection is associated with high local recurrence rates in the context of tumor-free parenchymal margins. The mechanism underlying this high recurrence rate is not well understood. We hypothesized that this elevated risk of local recurrence is due to undetected tumor cells present at parenchymal margins thought to be negative by conventional light microscopy. Thirteen of 44 patients who underwent sublobar resection for lung cancer were found to have a k-ras mutation at codon 12.1. A novel fluorescence-based assay for detection of rare copies of mutant DNA in a background of wild-type DNA, fluorescent gap ligase chain reaction, was used to quantitate the mutant/wild-type DNA in a range of 1 to 1/10,000 in histologically normal margins from these resections. Nine of 13 patients had at least one margin with the number of mutant cells over or equal to a threshold of 1/5,000, and of these, 6/9 (67%) recurred locally. None of the remaining 4 patients without mutant DNA in any surgical margin had evidence of recurrence. The higher rate of local recurrence associated with sublobar resection of lung cancer is likely due to the occult presence of tumor cells at resection margins. These occult tumor cells can be quantitated using a novel fluorescence-based assay and define a group of patients at high risk for local recurrence who are candidates for adjuvant therapy or more extensive resection. This methodology may be adaptable to a real-time format for intraoperative use. © 2004 Wiley-Liss, Inc. [source] Squamous cell carcinoma arising from perineal lesion in a familial case of Hidradenitis suppurativaINTERNATIONAL WOUND JOURNAL, Issue 2 2009K Chandramohan ABSTRACT Hidradenitis suppurativa (HS) is a chronic dermatologic disorder characterised by multiple vesiculopustular cutaneous lesions in skin. It sometimes express autosomal dominant mode of inheritance. In some patients, it can give rise to squamous cell carcinoma of skin. Unlike the usual marjolin's ulcer which develops in chronic scars, this disease carries a grave prognosis with high recurrence rate and mortality. Here we are reporting the case of a 40-year-old gentle man with hidradenitis suppurativa, who presented with squamous cell carcinoma in the perianal region, and had multiple family members affected with HS. A short history and review of literature are discussed. Squamous cell carcinoma arising from HS is a major therapeutic challenge. This malignancy carries very high rates of recurrence and mortality. Careful surveillance of the lesions of HS, especially occurring in perineal region is very important to diagnose secondary malignancies. Similarly, meticulous surgical excision with careful resection of all sinus tracks and frozen section examination of margins are very important to eradicate the disease. [source] Patients with Scar-Related Right Ventricular Tachycardia: Determinants of Long-Term OutcomeJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2009ADRIANUS P. WIJNMAALEN M.D. Introduction: Patients with established arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) based on task force (TF) criteria and ventricular tachycardia (VT) are at risk of VT recurrence and sudden death. Data on patients with VT due to right ventricular (RV) scar not fulfilling TF criteria are lacking. The purpose of this study was to assess the long-term arrhythmia recurrence rate and outcome in patients with scar-related right VT with and without a diagnosis of ARVC/D. Methods: Sixty-four patients (age 43.5 ± 15 years, 49 males) presenting with nonischemic scar-related VT of RV origin were studied. Scar was identified by electroanatomical mapping, contrast echocardiography, and/or magnetic resonance imaging (MRI). Patients were evaluated and treated according to a standard institute protocol. Results: Twenty-nine (45%) patients were diagnosed with ARVC/D according to TF criteria (TF+) and 35 (55%) with RV scar of undetermined origin (TF,) at the end of follow-up (64 ± 42 months). Patients were treated with antiarrhythmic drugs, radiofrequency catheter ablation, and/or implantable cardioverter-defibrillator (ICD) implantation. VT recurrence-free survival for TF+ and TF, was 76% versus 74% at 1 year and 45% versus 50% at 4 years (P = ns). Patients with fast index VT (cycle length [CL], 250 ms, n = 31) were more likely to experience a fast VT during follow-up than patients with a slow index VT (CL > 250 ms, n = 33) (61% vs 3%, P < 0.001). Conclusions: Scar-related RV VTs have a high recurrence rate in TF+ and TF, patients. Patients presenting with a fast index VT are at high risk for fast VT recurrence and may benefit most from ICD therapy. [source] Ablation of Focally Induced Atrial Fibrillation:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2004Selective or Extensive? Introduction: Focally induced atrial fibrillation (AF) often is due to ectopic activity in the pulmonary veins (PV). Although initial approaches were aimed at ablating only the ectopic foci, more extensive ablation approaches have evolved that isolate all PVs empirically and/or create circumferential ablation lines in the left atrium (LA). These techniques last longer and may be associated with more risks. We retrospectively evaluated the outcome and risks of ablation for focally induced AF in a single-center patient population. Methods and Results: We report on 47 patients (32 men and 15 women; age 47 ± 10 years) in whom 52 ablations were performed. In 19 patients (22 sessions), ablation was directed at the site(s) of overt ectopic activity ("selective" group), whereas in 28 patients (30 sessions) without sufficient ectopy to determine the culprit PV a mean of 3.5 PVs were empirically targeted for bidirectional disconnection from the LA ("extensive" group). On a preprocedural Holter recording, the "selective" group had significantly more isolated atrial ectopy (3,276 ± 2,933 vs 620 ± 937 beats/24 hours) and runs of atrial tachycardia (330 ± 202 vs 53 ± 87 runs/24 hours) than the "extensive" group (P < 0.01 for both). Only 11% had persistent AF before ablation. Acute procedural success was 81% (elimination of all ectopy) and 83%, respectively (bidirectional and fully circumferential isolation of all targeted PVs). Procedure and fluoroscopy times were significantly shorter in the "selective" group. There were no major complications, but 7 minor complications and 2 acute PV stenoses > 50% in the 30 "extensive" procedures were observed. Mean follow-up was 8.4 ± 8.5 months (median 6.9). Kaplan-Meier analysis, excluding recurrences during only the first month ("delayed cure"), showed AF recurrence in 45% after 6 months and in 55% after 1 year. Outcome was not dependent on ablation approach ("selective" or "extensive") nor was time to first AF (22 ± 64 days and 30 ± 69 days). AF recurrence tended to be higher in patients with larger LA (P = 0.08), underlying heart disease or hypertension (P = 0.08), and those "extensive" patients in whom not all 4 PVs were targeted (P = 0.07). Conclusion: Trigger-directed ablation for focally induced AF is associated with a relatively high recurrence rate during follow-up. Apart from recurrence of the ectopic trigger, this may point to underlying structural changes in the atrial substrate not addressed by the ablation. Prospective evaluation of the risk-to-benefit profile of any technique (selective, extensive, including linear lines) is required. (J Cardiovasc Electrophysiol, Vol. 15, pp. 200-205, February 2004) [source] Long-term follow-up of endoscopic therapy of anal canal condylomata acuminata with podophyllotoxinJOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2007C Tzathas Abstract Background, Condylomata acuminata of the anal canal, a common sexually transmitted disease, are difficult-to-treat lesions with a high recurrence rate after initial successful treatment. Objective, Our aim was to evaluate by anoscopy the efficacy of podophyllotoxin 0.5% solution topically applied for the treatment of anal warts. Methods, We prospectively studied consecutive patients with condylomata acuminata of the anal canal that spared the rectum. They were treated with 0.5% podophyllotoxin solution topically applied on the warts, by anoscopy. Podophyllotoxin solution was administered on days 1, 2 and 3 every week (a treatment cycle) for a maximum of 4 weeks. Patients whose warts were not completely eradicated were classified as failures. Follow-up anoscopy was performed monthly for the first 6 months and every 6 months thereafter. Those who relapsed during the follow-up period were retreated. Results, Twenty-two immunocompetent patients entered the study. The primary clearance rate was 22.7, 54.5, 68.1 and 86.3% after 1, 2, 3 and 4 treatment cycles, respectively. During the follow-up period (46, 12,60 months), seven patients (36.8%) relapsed. Four of them were successfully retreated. Thus, a complete cure was achieved in 16 out of 22 patients (72.7%). Adverse side-effects were mild. They included proctalgia in six (27.2%), bleeding in four (17.2%), and both proctalgia and bleeding in two (9%) patients. Conclusions, Endoscopic topical application of 0.5% podophyllotoxin solution is an effective and well-tolerated method for the treatment of condylomata acuminata of the anal canal. [source] Outcome after radical prostatectomy with a pretreatment prostate biopsy Gleason score of ,8BJU INTERNATIONAL, Issue 6 2003M. Manoharan The use of radical prostatectomy to treat patients with high-grade prostate cancer is the subject of much discussion, and the authors from Miami present their considerable experience in this field. They show that patients with a pre-treatment biopsy of Gleason score of ,8 may benefit from radical prostatectomy, assuming a clinical stage of T1,T2, and particularly if their PSA level is <20 ng/mL. Authors from Palermo present data on the long-term outcome of antiandrogen monotherapy in advanced prostate cancer, with the 12-year results of a phase II study. This is a very interesting evaluation, showing that patients with an early objective response have a prolonged progression-free and overall survival. In a large series of superficial bladder tumours, urologists from Tokyo identify a group of patients with tumours of low malignant potential with a high recurrence rate, but a very low invasive property. They suggest that those tumours should be referred to as having a low malignant potential, rather than being called superficial bladder carcinoma. OBJECTIVE To determine the outcome and predictors of recurrence in patients with a pretreatment prostate biopsy Gleason score (GS) of ,,8 and treated with radical prostatectomy (RP). PATIENTS AND METHODS We retrospectively reviewed 1048 consecutive patients who underwent RP by one surgeon (M.S.S.); patients who had a pretreatment biopsy GS of ,,8 were identified. Information was recorded on patient age, initial prostate specific antigen (PSA) level, clinical stage, biopsy GS, pathology GS, extraprostatic extension (EPE), tumour volume, surgical margin status, seminal vesicle invasion (SVI), and lymph node involvement. The results were assessed statistically using the Kaplan-Meier method, univariate log-rank tests and multivariate analysis using Cox's proportional hazards regression. RESULTS In all, 123 patients met the initial selection criteria; 44 were excluded from further analyses (five salvage RP, 23 <,1 year follow-up and 16 adjuvant treatment). Thus 79 patients were included in the uni- and multivariate analyses; 25 (31%) patients had a GS of ,,7 in the RP specimen and 54 (69%) remained at GS ,,8. The mean follow-up was 55 months, the age of the patients 63 years and the mean (sd) initial PSA level 13 (12) ng/mL. The overall biochemical failure rate was 38% (41% if the final GS was , 8 and 32% if it was ,,7). For those with a GS of ,,8 in the RP specimen, 20% (11/54) were organ-confined; two patients (2.5%) in this group developed local recurrence. If the final GS was ,,7, 52% (13/25) were organ-confined. In the univariate analysis, significant risk factors for recurrence were PSA ,,20 ng/mL, EPE, SVI, a positive surgical margin and tumour volume. Cox's proportional regression indicated that a PSA of ,,20 ng/mL (hazard ratio 7.9, 95% confidence interval 2.6,24.2, P < 0.001), the presence of EPE (4.2, 1.6,10.9, P = 0.004) and a positive surgical margin (3.8, 1.5,9.7, P = 0.005) were significant independent predictors in a multivariate analysis. CONCLUSION RP is a reasonable treatment option for patients with a prostate biopsy GS of ,8 and clinical stage T1,2. These patients have a high chance of remaining disease-free if their PSA level is ,,20 ng/mL. Patients with a pretreatment biopsy GS of ,,8 should be counselled about the potential differences between the biopsy and the RP specimen GS. [source] Differential distribution of haematopoietic and nonhaematopoietic progenitor cells in intralesional and extralesional keloid: do keloid scars provide a niche for nonhaematopoietic mesenchymal stem cells?BRITISH JOURNAL OF DERMATOLOGY, Issue 6 2010S.A. Iqbal Summary Background, Keloid disease is a benign, quasineoplastic disease with a high recurrence rate. Mesenchymal-like stem cells (MLSC) have previously been demonstrated in keloid scars and may be involved in keloid pathobiology. However, as these cells have only been examined by single colour fluorescence activated cell sorting (FACS) alone, they need to be more comprehensively characterized so that the key cellular contributors to keloid scars can be better understood. Objectives, To identify and characterize MLSC in intralesional and extralesional keloid, and to distinguish haematopoietic stem cells (HSC) from mesenchymal stem cells (MSC). Methods and patients, Punch biopsies from intralesional (top, middle and margin) and extralesional keloid scar sites were obtained from 17 patients with a keloid. Multicolour FACS analysis using antibodies specific for HSC markers CD34 and CD117 and MSC markers CD13, CD29, CD44 and CD90 was performed on freshly isolated keloid scar cells and on passage 0 and 1 cells. This was complemented by real-time quantitative polymerase chain reaction (PCR) and immunohistological in situ analyses. Results, Keloid scars contain distinct subpopulations of MLSCs. Cells positive for CD13, CD29, CD44 and CD90 were found to be significantly (P < 0·05) higher in the top and middle compartments of keloid scars compared with extralesional skin, where cells positive for CD34, CD90 and CD117 (representing HSCs) predominated. A unique population of CD34+ cells (cells positive for CD13, CD29, CD34, CD44 and CD90) were found in keloid scars and in extralesional skin. FACS and quantitative PCR analysis showed that many of the MSC markers were progressively downregulated and all HSC markers were lost during extended keloid fibroblast culture up to passage 1. Conclusion, We have found distinct subpopulations of haematopoietic and nonhaematopoietic MSC in keloid scars, whereby HSC accumulate extralesionally, while keloids seem to provide a niche environment for nonhaematopoietic MSC. Future therapy of keloids may have to target differentially both stem cell populations in order to deprive these tumours of their regenerative cell pools. [source] Diversity of human papillomavirus types in periungual squamous cell carcinomaBRITISH JOURNAL OF DERMATOLOGY, Issue 6 2009A. Kreuter Summary Background, There is accumulating evidence that infections with certain high-risk ,-human papillomaviruses (HPVs) are involved in the pathogenesis of digital squamous cell carcinomas (SCCs) and their precursor lesions (SCCs in situ). Objectives, This study was initiated to search for ,- and ,-HPV infections in a collective of SCC and SCC in situ located on the hands. Methods, HPV typing for 36 high-risk and low-risk ,-HPV types and 25 ,-HPV types was performed in SCCs located at different sites of the hands. Additionally, immunohistochemical staining for p16INK4a and Ki67 was performed in 15 samples. Results, In total, 25 SCCs/SCCs in situ (six periungual lesions, eight lesions from the proximal or lateral part of the finger, and 11 lesions from the dorsal part of the hand) were analysed for the presence of ,- and ,-HPV types. Only one lesion (an SCC in situ positive for HPV11 and HPV31) of the dorsal hand and none of the proximal or lateral part finger lesions were ,-HPV positive. In contrast, all six periungual lesions were ,-HPV positive, and the majority (83%) of them carried HPV types other than HPV16 (HPV26, HPV33, HPV51, HPV56 and HPV73). ,-HPV types were found in only two biopsies. p16INK4a and Ki67 expression was significantly higher in HPV-positive lesions as compared with HPV-negative tumours, and both markers significantly correlated with each other. Conclusions, In contrast to other locations of the hands, periungual SCCs are frequently associated with ,-HPV infections. Several high-risk HPV types other than HPV16 can induce periungual SCCs. Given the high recurrence rate and high proliferative activity of HPV-associated periungual SCCs, aggressive treatment and close follow-up of these tumours is mandatory. [source] Serum squamous cell carcinoma antigen is a useful biologic marker in patients with inverted papillomas of the sinonasal tractCANCER, Issue 1 2002Ryuji Yasumatsu M.D. Abstract BACKGROUND Inverted papilloma (IP) is a frequent benign sinonasal tumor that is characterized histologically by squamous metaplasia, epithelial acanthosis, and hyperplasia of the nasal epithelium. Because of its high recurrence rate and malignant transformation potential, careful long-term follow up is necessary. METHODS The purpose of the current report was to study the expression of squamous cell carcinoma (SCC) antigen in sinonasal IPs and to evaluate the usefulness of SCC antigen as a biologic marker for the follow-up of patients with sinonasal IP. The expression of SCCA1 in three sinonasal IP cases, three sinonasal SCC cases, and cases of normal nasal epithelium were examined by Western blot analysis, and the SCCA1 expression pattern in 31 IP specimens and 4 carcinoma in IP specimens were evaluated immunohistochemically. The serum levels of SCC antigen in 11 patients with sinonasal IP also were analyzed. RESULTS SCCA1 was overexpressed in all three sinonasal IP tissues compared with sinonasal SCC tissues or normal nasal epithelium. SCCA1 cytoplasmic immunoreactivity was detected in the suprabasal epidermal keratinocytes of all 31 sinonasal IP cases. In the four carcinoma in IP specimens, SCCA1 expression in the papillomatous lesion was more intense than in the cancerous lesion. The serum SCC antigen level was high in 10 of 11 patients with IP (91%) and significantly decreased after surgical resection of the tumors. CONCLUSIONS The results of the current study indicate that SCCA1 frequently is overexpressed and may play a biologic role in the development of sinonasal IPs. Serum SCC antigen may be a useful biologic marker in patients with sinonasal IP. Cancer 2002;94:152,8. © 2002 American Cancer Society. [source] Amniotic membrane grafting in the surgical management of primary pterygiumCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2004Rohan W Essex FRANZCO Abstract Background:,To evaluate the efficacy of amniotic membrane transplantation in primary pterygium surgery. Methods:,Patients presenting to the outpatient clinic of the Royal Victorian Eye and Ear Hospital with primary pterygium requiring surgical management were included in this study. The pterygia were excised to bare sclera and the conjunctival defects were closed with amniotic membrane grafts. The primary outcome was pterygium recurrence. Results:,Twenty-eight pterygia of 26 patients were included. Twenty-three patients (88%, 25 eyes) completed 12 months follow up. By 12 months postoperatively 16 of these eyes (64%) had developed corneal recurrence and a further two had developed a limbal recurrence (9%). Five required repeat surgery during the 12 month follow-up period. No association was found between pterygium recurrence and pterygium size (P = 0.33), amniotic membrane graft dimension (P = 0.12), patient age (P = 0.53) or patient sex (P = 0.63). Conclusion:,Amniotic membrane grafting for primary pterygium was associated with an unacceptably high recurrence rate in this population. [source] Extramammary Paget's disease,a proliferation of adnexal origin?HISTOPATHOLOGY, Issue 6 2006S Regauer Aim :,To investigate a possible follicular origin of extramammary Paget's disease (EPD). EPD is a predominantly intraepidermal tumour with extensive involvement of adnexal structures and high recurrence rates suggesting a follicular stem cell origin. Cytokeratin (CK) 15 and CK19 are considered markers for follicular stem cells located in the hair follicle bulge region. Methods and results :,Formalin-fixed paraffin-embedded tissues of 12 cases of primary EPD (three anal, nine vulvar) were studied immunohistochemically with antibodies to CK15 and CK19. All cases of EPD showed polygonal Paget cells in the interfollicular epidermis, hair follicles, sebaceous and apocrine glands distributed individually, in nests and in gland-like areas. The polygonal Paget cells were intimately associated with small, flat, mitotically active, ,compressed' keratinocytes. The large Paget cells uniformly expressed CK19 in 12/12 EPD. The small ,compressed' keratinocytes showed strong cytoplasmic CK15 staining in 9/12 EPD with focal accentuation, while the polygonal Paget cells were negative. Conclusions :,These histological and immunohistochemical observations allow the following conclusions: (i) the small, flat, ,compressed' keratinocytes are an integral part of EPD; (ii) the dual cell population is reminiscent of sebaceous glands with mature sebocytes and germinative keratinocytes; (iii) since both cell types express cytokeratins typical for follicular differentiation, EPD may be a proliferation of adnexal stem cells residing in the infundibulo-sebaceous unit of hair follicles and adnexal structures. [source] Diffuse In-Stent RestenosisJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2001HANS STÖRGER M.D. Stent restenosis, especially the diffuse pattern, has developed into a significant clinical and economical problem. It has been estimated that up to 250,000 patients developed in-stent restenosis in 2,000 alone, two thirds of them can be expected to have diffuse in-stent restenosis, which is difficult to treat because of high recurrence rates. None of the conventionally available interventional treatment modalities provides optimal long-term results. Intravascular radiation therapy is currently the only effective percutaneous therapy, for combating in-stent restenosis. Late thrombotic complications have largely been eliminated by extended antiplatelet regimens. Geographical miss, a major reason for recurrence of in-stent restenosis after brachytherapy, can be reduced by an improved radiation technique. The first preliminary data on drug-eluting stents, showing only minimal neointimal proliferation at 6-month postimplantation, could represent a major breakthrough in the quest to solve restenosis. [source] Alcohol Neurolysis of the Sciatic and Femoral Nerves to Improve Pressure Ulcer HealingPAIN PRACTICE, Issue 2 2009Denise Wilkes MD Abstract Successful pressure ulcer treatment is challenging and is often plagued with prolonged hospitalizations, multiple surgeries, and high recurrence rates. Pressure ulcer secondary to spinal cord injury is further complicated by spasticity, which contributes to both ulcer continuance and healing. This report illustrates the use of neurolytic regional techniques for spasticity control and pressure ulcer healing. Case report: We present our experience with a paraplegic man who suffered from chronic right trochanteric and ischial pressure ulcers that failed to heal despite surgical and conservative treatment. We report the successful treatment of knee and hip flexor spasticity with a femoral and sciatic alcohol neuroablation technique. It was not until the successful control of his lower extremity spasticity that the pressure ulcers showed signs of healing. Neuroablation nay be considered for spasticity control when more conservative approaches fail or are not feasible. [source] Iatrogenic recto-urethral fistula: perineal repair and buccal mucosa interpositionBJU INTERNATIONAL, Issue 2 2009Martin Spahn OBJECTIVE To present a new and promising technique for repairing recto-urethral fistulae (RUF) using a perineal approach and buccal mucosa graft interposition, as RUF are rare but severe complications of rectal or urinary tract surgery, radiation treatment, trauma or inflammation, and the repair of recurrent or persistent RUF is particularly difficult when previous surgical attempts have failed, resulting in high recurrence rates. PATIENTS AND METHODS Between 2004 and 2006, five men (aged 61,67 years) with iatrogenic RUF had the perineal fistula closed using a buccal mucosa graft interposition. The RUF had developed after laparoscopic or retropubic radical prostatectomy in four patients and after radical cystectomy and ileal neobladder in the fifth. Four of the patients had had at least one failed RUF repair before their referral to our institution. RESULTS Four of the five RUF were repaired successfully using the perineal approach and buccal mucosa graft interposition. Failure occurred in one patient who had developed a RUF after laparoscopic radical prostatectomy followed by two unsuccessful attempts at closure. The failure was most probably due to a previously undetected postoperative perineal haematoma with infection. CONCLUSION Our perineal approach for repairing RUF, combined with buccal mucosa graft interposition, is a simple technique fulfilling all the requirements for successful fistula closure, especially in repeat surgery. [source] Successful treatment of multiple actinic keratoses in organ transplant patients with topical 5% imiquimod: a report of six casesBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2006C. Ulrich Summary Background, Nonmelanoma skin cancer represents a significant cause of morbidity in organ transplant recipients (OTRs). Cutaneous malignancies, mainly invasive squamous cell carcinoma and its precursor actinic keratosis (AK), appear approximately 5,10 years after organ transplantation. Impaired wound healing and high recurrence rates in immunocompromised patients treated with destructive therapies such as cryosurgery or topical 5-fluorouracil represent frequently known complications. Objectives, To evaluate the safety and efficacy of imiqimod 5% in the treatment of AKs in OTRs. Methods, Six OTRs (two kidney, two heart, one lung and one liver) with extensive AKs were treated with imiquimod 5% cream two to three times weekly in an open-label uncontrolled, nonrandomized pilot study. Results, In five of six patients treated with imiquimod 5% cream all AK lesions were cleared after 12,16 weeks. One patient showed partial response. Local adverse events at the site of application included erythema, oedema and mild erosion. No wound infection or scarring was observed in any of these patients. All graft-related laboratory parameters were stable during and after treatment. Immunosuppressive therapy remained unchanged throughout the treatment. Conclusions, These results suggest that imiquimod 5% cream may be useful for the local treatment of precancerous AK lesions in OTRs. [source] Topical 5-aminolaevulinic acid-photodynamic therapy for the treatment of urethral condylomata acuminataBRITISH JOURNAL OF DERMATOLOGY, Issue 4 2004X.L. Wang Summary Background, Electrocoagulation and laser evaporation for urethral condylomata acuminata have high recurrence rates and can be associated with urethral malformations. Objectives, To investigate the effect of photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (ALA) on urethral condylomata acuminata and to examine the histological changes in lesions of condylomata acuminata after ALA-PDT. Methods, Patients with urethral condylomata (n = 164) were given topical ALA followed by intraurethral PDT through a cylindrical fibre. Patients included 11 individuals with 16 penile or vulval condylomatous lesions which were biopsied before or after treatment; the histological changes were then evaluated by light microscopy and electron microscopy. Results, The complete response rate was 95% and the recurrence rate was 5% after 6,24 months of follow-up. Light microscopy revealed keratinocytes in the middle and upper layers of the epidermis showing marked vacuolation and some necrocytosis 1 and 3 h after PDT. Necrosis in all layers of the epidermis was noted 5 h after PDT. Electron microscopy of keratinocytes revealed distinct ultrastructural abnormalities of mitochondria and the endoplasmic reticulum, and membrane damage. Apoptotic bodies were detected 3 h after PDT and a large number of keratinocytes exhibited necrosis 5 h after PDT. Conclusions, Results suggest that, compared with conventional therapies, topical ALA-PDT is a simple, effective, safe and well-tolerated treatment for urethral condylomata acuminata that is associated with a low recurrence rate. The mechanism might be the triggering of both apoptosis and necrosis by ALA-PDT in human papillomavirus-infected keratinocytes. [source] Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional herniaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 1 2002Dr M. Korenkov Background: Since conventional suture repair for incisional hernia is associated with high recurrence rates, alloplastic and autoplastic prosthetic techniques have been suggested. Methods: In a randomized trial, 160 patients with simple or complex hernias underwent either suture repair, autodermal skin graft or onlay polypropylene mesh repair. Suture repair was not done in complex hernias. This report concerns a planned interim analysis. Results: At mean follow-up of 16 months, there were 17 hernia recurrences that were distributed similarly between the surgical techniques. There were fewer infectious complications after suture repair (three of 33 patients) than after skin graft or mesh repair (seven of 39 and five of 28 for simple hernias; seven of 31 and ten of 29 respectively for complex hernias) (P not significant). The severity of infections after polypropylene mesh implantation prompted the trial committee to discontinue the study. No differences were noted in duration of stay in hospital and quality of life. However, pain was significantly more frequent after polypropylene mesh repair (pooled risk ratio 2·9 and 1·8 at 6 weeks and 1 year respectively). Conclusion: Suture repair was safe for small incisional hernias. Both autoplastic and alloplastic hernia repair yielded comparably low recurrence rates, but led to a high rate of wound infection. © 2002 British Journal of Surgery Society Ltd [source] | ||||||||||||||||||||||||||||