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Selected AbstractsSafety and efficacy of sonographic-guided random real-time core needle biopsy of the liverJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2009Siddharth A. Padia MD Abstract Purpose. To determine the safety and efficacy of real-time, sonographic-guided, random percutaneous needle biopsy of the liver in a tertiary medical center. Method. From an IRB-approved biopsy database, all patients who had random liver biopsy performed over a 24-month period were selected. In 350 patients, 539 random percutaneous needle biopsies of the liver were performed under real-time sonographic visualization. The following were recorded from the electronic medical record: patient demographics, indication for biopsy procedure; radiologist's name; needle type and gauge and number of passes; use and amount of IV sedation or anesthesia; adequacy of the specimen; and complications following the procedure. Result. Of 539 biopsies, 378 (70%) biopsy procedures were performed on liver transplant recipients. Of the biopsy procedures in nontransplant patients, 81/161 (50%) concurrently underwent biopsy of a focal liver mass. An 18-gauge automated core biopsy needle was used in 536/539 (99%). Median number of passes per biopsy procedure was 1 (mean, 1.7; range, 1,6). Sedation using midazolam and fentanyl was used in 483/539 (90%). There were only 8 inadequate specimens (1.5%, [2.3, upper 95% confidence limit, fully described in Statistical Analysis]). Complications were identified in 11/539 biopsy procedures (2.0%, [2.6, upper 95% confidence limit]): 5 with severe postprocedural pain, 3 with symptomatic hemorrhage, 2 with infection, and 1 with a rash. There were no sedation-related complications and no deaths related to the procedure. Conclusion. Real-time, sonographic-guided, random core-needle liver biopsy is a safe and highly effective procedure. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source] MINOR PAPILLA SPHINCTEROTOMY FOR PANCREATITIS DUE TO PANCREAS DIVISUMANZ JOURNAL OF SURGERY, Issue 4 2008Vu Kwan Background: Pancreas divisum (PD) is the commonest congenital pancreatic abnormality and is implicated as a cause of acute recurrent pancreatitis (ARP). We report our experience in minor papilla sphincterotomy (MPS) for this condition. Studies published at present have not examined MPS as the primary treatment method in a homogenous (i.e. only those with ARP) patient group. Methods: Patients with PD and ARP were identified from an endoscopic database. Treatment protocol consisted of minor papilla guidewire cannulation and sphincterotomy with either sphincterotome over the wire or needle knife over pancreatic stent. A 5-Fr stent was placed for 1 week. Adjunctive therapy was carried out as required. Follow-up data was collected by interview with the patient and referring doctors and review of the medical record. Results: Twenty-one patients underwent MPS for PD and ARP (median age = 33 years, range 9,77 years, men = 14). Median number of procedures to achieve cannulation and MPS was 1 (range 1,3). Complications encountered were pancreatitis (n = 2) and pain (n = 3). MPS restenosis occurred in 2. Adjuvant therapy was required in 14: stricture dilatation (n = 9), stone extraction (n = 7) and extracorporeal shock-wave lithotripsy (n = 6). Complete stone clearance was achieved in 7/7. Median follow up was 38 months (range 4,67 months). Median total number of pancreatitis episodes and hospitalizations pre-MPS were 4 and 2, respectively (range 1,20 and 0,5, respectively). Post-MPS these were reduced to 0 and 0, respectively (range 0,8 and 0,4; P = 0.0007 and P = 0.0003), with complete abolition of episodes in 13 patients. Conclusion: MPS in association with other endoscopic therapies imparts a significant clinical benefit to patients with ARP and PD. Complete clinical resolution occurs in the majority. Treatment is safe, and the response is durable. [source] Local excision and endoscopic posterior mesorectal resection versus low anterior resection in T1 rectal cancer,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2008I. Tarantino Background: Rectum-preserving endoscopic posterior mesorectal resection (EPMR) removes the local lymph nodes in a minimally invasive manner and completes tumour staging after transanal local excision (TE). The aim of this study was to compare the morbidity and mortality of TE and EPMR with those of low anterior resection (LAR) in patients with T1 rectal cancer. Methods: Between 1996 and 2006 EPMR was performed 6 weeks after TE in 18 consecutive patients with a T1 rectal cancer. Morbidity and mortality were recorded prospectively and compared with those in a group of 17 patients treated by LAR. Lymph node involvement and local recurrence rate were analysed in both groups. Results: Two major and three minor complications were noted after EPMR, and four major and four minor complications after LAR (P = 0·402 for major and P = 0·691 for minor complications). Median number of lymph nodes removed was 7 (range 1,22) for EPMR and 11 (range 2,36) for LAR (P = 0·132). Two of 25 patients with a low-risk rectal cancer were node positive. No patient developed locoregional recurrence. Conclusion: EPMR after TE is a safe option for T1 rectal cancer. This two-stage procedure has a lower morbidity than LAR and may reduce locoregional recurrence compared with TE alone. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Vincristine sulfate liposomes injection (Marqibo) in heavily pretreated patients with refractory aggressive non-Hodgkin lymphoma,CANCER, Issue 15 2009Report of the Pivotal Phase 2 Study Abstract BACKGROUND: Marqibo, a sphingosomal/cholesterol encapsulation of vincristine sulfate has targeted, increased, and sustained delivery of vincristine to tumor tissues. A phase 2, open-label, single-arm, and multinational study evaluated the efficacy and tolerability of Marqibo as a single agent in patients with multiply relapsed or refractory aggressive non-Hodgkin lymphoma (NHL). METHODS: Eligible patients had relapsed or refractory de novo or transformed aggressive NHL and prior treatment with at least 2 multiagent chemotherapy regimens. Marqibo was administered at 2 mg/m2, every 2 weeks, for a maximum of 12 cycles or until toxicity or disease progression. RESULTS: One hundred and nineteen patients were enrolled and treated on trial. Ninety-six had histological confirmed de novo (N = 89) or transformed (N = 7) aggressive NHL. Median number of cycles was 4 (median dose/cycle 4 mg). Overall response (CR and complete response unconfirmed and PR) was 25% (95% confidence interval [CI], 17, 35), CR and complete response unconfirmed confirmed by external reviewers was 5%. Median overall survival was 6.6 months (Kaplan-Meier estimate, 95% CI, 4.7, 9.8). Grade 3 of 4 neurotoxicity occurred in 32% of patients. All patients had prior neurotoxic agents, and 85% had baseline residual neuropathy symptoms (grades 1-2) from prior treatment. CONCLUSIONS: Marqibo is an active agent in patients with heavily pretreated aggressive NHL, and tolerated at approximately twice the dose intensity of standard vincristine. Its activity supports further investigation as a substitution for vincristine in combination treatment of lymphoid disorders. Cancer 2009. © 2009 American Cancer Society. [source] Early post-operative morbidity after superficial parotidectomy: a prospective study concerning pain and resumption of normal activityCLINICAL OTOLARYNGOLOGY, Issue 1 2007S. Foghsgaard Keypoints ,,The degree of pain and time to return to work following superficial parotidectomy has not previously been reported. ,,Pain is measured by use of visual analogue scale and the use of analgesics is registered 14 days after superficial parotidectomy. ,,Results showed that pain is generally weak after superficial parotidectomy and can be treated with mild analgesics. Pain is considerably lower than, e.g. after tonsillectomy. ,,Median number of days until total recovery was 12 days (range: 3,70), and median time to return to work was 16 days (range: 3,70). ,,We recommend 2 weeks recreation period after superficial parotidectomy. [source] Fetomaternal hemorrhage in relation to chorionic villus sampling revisitedPRENATAL DIAGNOSIS, Issue 3 2006Denise M. Pelikan Abstract Objective To investigate whether chorionic villus sampling (CVS) results in a proportional increase of alpha-fetoprotein (AFP) and fetal red cells in maternal blood. Methods Blood samples were collected before and after CVS. The AFP concentration was measured and supervised automated microscopy of Kleihauer,Betke slides was applied to quantify fetal red cells. Results AFP analysis was performed in 53 paired samples and automated microscopic scanning in 59 paired samples. Median AFP concentrations before and after CVS were 12.0 µg/L (range 6.4,36.4) and 18.7 µg/L (range 8.2,668.9), respectively, indicating a significant increase (p < 0.0001). Median numbers of fetal red cells detected before and after CVS were 0 (range 0,36) and 0 (range 0,31), respectively. No significant increase of fetal cells was observed (p = 0.72). The delta (,) fetal red cells and the , AFP correlated poorly (, = ,0.22, p = 0.11). The amount of villi correlated moderately with the , AFP (, = 0.32, p = 0.02) and did not correlate with the , fetal red cells (, = ,0.11, p = 0.43). Conclusions Although the AFP concentration after CVS increased, no increase of fetal red cells was detected. These findings suggest that CVS results in a leakage of proteins due to placental tissue damage, rather than increased trafficking of fetal cells. Copyright © 2006 John Wiley & Sons, Ltd. [source] Risperidone long-acting injection: a 6-year mirror-image study of healthcare resource useACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009D. Taylor Objective:, To evaluate naturalistic use of risperidone long-acting injection (RLAI) and its effect on healthcare resource use. Method:, Mirror-image comparison of healthcare resource use for 3 years before RLAI initiation and 3 years after. Results:, In total, 211 of 277 patients consecutively prescribed RLAI were evaluable over the full 6-year study period. Median days in hospital/patient increased significantly in the 3 years after RLAI initiation [87 days (inter-quartile range 25,236) before vs. 192 days (47,426) after; P < 0.001]. Those 34 patients who continued RLAI for 3 years showed no change in median bed days [64 days (6.5,182) before vs. 64 days (12,180) after] and median number of admissions was decreased [1.5 (1,2.25) before vs. 1.00 (0,1.25) after; P = 0.001]. Healthcare costs more than doubled for the whole cohort (P < 0.001) and discontinuers (P < 0.001) and increased significantly for continuers (P = 0.010). Conclusion:, RLAI did not decrease either time spent in hospital or overall healthcare costs in this patient cohort. [source] Endoscopic bougienage of benign anastomotic strictures in patients after esophageal resection: the effect of the extent of stricture on bougienage resultsDISEASES OF THE ESOPHAGUS, Issue 6 2008G. Marjanovic SUMMARY., The aim of our retrospective study was to determine the incidence of benign anastomotic strictures (BAS) in patients after esophageal resection and to examine the influence of the extent of BAS on the results of bougienage therapy. From January 2001 to July 2006, 79 patients at risk of BAS development were included in the study. BAS was diagnosed with a median delay of 8 weeks (4,26) postoperative in 23 patients (29%). A median of 4 bougienage sessions (2,20) was needed for success (success rate 100%). The mean follow-up time was 22 months [range 3,47]. There were no late recurrences of BAS. Five patients had an anastomosis diameter <5.5 mm and 14 patients >5.5 mm. There was no difference in median number of bougienage procedures in these subgroups (4.5 [2,9] vs. 4 [2,20]). Patients who presented with BAS earlier than 6 weeks postoperative had more procedures (median 8 [2,20] vs. 4 [2,9]) than those presenting later. Patients in whom first bougienage was possible to only 16 mm diameter needed more procedures than patients in whom first dilation was possible to more than 16 mm (median 5.5 [3,20] vs. 3 [2,9]). In conclusion, both early BAS development and the diameter of bougienage at first endoscopy, but not the extent of stricture, seem to be predictive factors for longer bougienage therapy. In order to influence the BAS formation early, we now routinely examine every patient after esophageal resection endoscopically in the 6th postoperative week. [source] If cannabis caused schizophrenia,how many cannabis users may need to be prevented in order to prevent one case of schizophrenia?ADDICTION, Issue 11 2009England, Wales calculations ABSTRACT Background We consider how many cannabis users may need to be prevented in order to prevent one case of schizophrenia or psychosis [defined as number needed to prevent (NNP)]. Method Calculation for England and Wales using best available estimates of: incidence of schizophrenia; rates of heavy and light cannabis use; and risk that cannabis causes schizophrenia. Results In men the annual mean NNP for heavy cannabis and schizophrenia ranged from 2800 [90% confidence interval (CI) 2018,4530] in those aged 20,24 years to 4700 (90% CI 3114,8416) in those aged 35,39. In women, mean NNP for heavy cannabis use and schizophrenia ranged from 5470 (90% CI 3640,9839) in those aged 25,29 to 10 870 (90% CI 6786,22 732) in 35,39-year-olds. Equivalent mean NNP for heavy cannabis use and psychosis were lower, from 1360 (90% CI 1007,2124) in men aged 20,24 and 2480 (90% CI 1408,3518) in women aged 16,19. The mean and median number of light cannabis users that would need to be prevented in order to prevent one case of schizophrenia or psychosis per year are four to five times greater than among heavy users. Conclusions The number of young people who need to be exposed to an intervention to generate NNP and prevent one case of schizophrenia will be even larger. The public health importance of preventing cannabis to reduce schizophrenia or psychosis remains uncertain. More attention should be given to testing the hypothesis that cannabis is related causally to psychotic outcomes, and to considering what strategies will be the most effective in reducing heavy cannabis use among young people. [source] Fluorescence-controlled Er:YAG laser for caries removal in permanent teeth: a randomized clinical trialEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2008Henrik Dommisch The aim of this randomized clinical study was to compare the efficacy of a fluorescence-controlled erbium-loaded yttrium aluminum garnet (Er:YAG) laser with conventional bur treatment for caries therapy in adults. Twenty-six patients with 102 carious lesions were treated using either the Er:YAG laser, at threshold levels of 7, 8, 9, and 10 [U], or rotary burs. Both techniques were applied to each lesion at separate locations. After treatment, dentine samples were obtained using a carbide bur. The viable counts of Streptococcus mutans (SM) and lactobacilli (LB) [expressed as colony-forming units (log10 CFUs)], treatment time, pain, vibration, and sound intensity were determined. The median numbers of CFUs for SM and LB were not statistically different between laser and bur treatment at threshold levels 7 and 8 [U]. At threshold levels 9 and 10 [U], the median number of CFUs for LB [1.11 (range: 0.00,2.04)] were significantly higher following laser treatment than following bur treatment [0.30 (range: 0.00,0.60)]. The results indicate that treatment with a fluorescence-controlled Er:YAG laser at threshold levels of 7 and 8 removed caries to a level similar to that achieved using conventional bur treatment, with clinically irrelevant amounts of remaining bacteria. Although more time consuming, laser treatment provided higher patient comfort than bur treatment. [source] Safety and efficacy of a plasma-derived monoclonal purified factor VIII concentrate during 10 years of follow-upHAEMOPHILIA, Issue 6 2007E. P. MAUSER-BUNSCHOTEN Summary., In 1995, AAFACT®, a new monoclonal purified factor VIII concentrate (FVIII), derived from human plasma, was introduced in the Netherlands. The monoclonal purification based production process includes a viral inactivation step by solvent/detergent treatment. Products manufactured according to this procedure, for example Hemofil M® are used worldwide. The aim of the present study was to assess inhibitor development in a large cohort of previously treated patients (PTPs) who were followed up for 10 years. In addition, efficacy, HIV and hepatitis C virus (HCV) transmission, and allergic reactions were monitored. All 165 patients with severe haemophilia A (FVIII < 1%) known at the van Creveldkliniek who ever used AAFACT® during the period from October 1995 to September 2005 were included. Two of them were previously untreated patients (PUPs) and two others had <50 exposure days. Data on FVIII consumption, number of exposures, bleedings and hospitalization days were collected from start of AAFACT® until last clinical and laboratory evaluation while on this product. At the end of follow-up, 91 patients were still using this plasma-derived FVIII. Median age at start of follow-up was 26 years (range 1,52). None of the patients reported lack of efficacy. Median FVIII consumption per patient during follow-up was 2058 IU kg,1 bodyweight per year, and median number of exposures was 148 per year. During 1029 patient-years of follow-up, one inhibitor was diagnosed in a previously treated patient PTP. This patient developed high titre inhibitor following surgery for which he, during 1 week, had been treated with continuous infusion with recombinant FVIII. No inhibitor occurred during 68 cases of surgery using continuous infusion with AAFACT®. No viral transmissions or other adverse events occurred during 10 years of follow-up; AAFACT® appeared to be an effective and safe FVIII product. [source] Experience of prophylaxis treatment in children with severe haemophiliaHAEMOPHILIA, Issue 2 2002T. T. YEE The practice of prophylactic treatment of boys with severe haemophilia has been evaluated in our centre. Prophylaxis was started at the median age of 3.7 years (range 0.4,12.7 years) in 38/41 children (93%) under 17 years of age. Median follow-up was 4.1 years (range 0.4,12.7 years). The criteria of primary prophylaxis according to the definition by the European Paediatric Network of Haemophilia Management was fulfilled by 9/38 (24%). Although a majority [76%, 29/38] of the children started prophylaxis after a median number of joint bleeds of 3.5, 70% of the children in this group had clinical joint scores of 0. Intravenous catheter insertion was required at a median age of 15.5 months (range 5,36 months) in 21% of the children, resulting in a catheter infection rate of 1.74 per 1000 catheter days. None developed an inhibitor on prophylaxis and three patients who had low-titre inhibitors (< 5 Bethesda units) prior to prophylaxis had undetectable inhibitors after prophylaxis. The home-treatment training programme required considerable time and cost. As a result, 87% of the children used peripheral venous access and hospital visits declined as prophylaxis became established. Parents' incentives for prophylaxis were that the children undertook many physical activities and sports previously not recommended, there was less parental anxiety and an overall improvement in the quality of life for the whole family. [source] The effects of pay and job satisfaction on the labour supply of hospital consultantsHEALTH ECONOMICS, Issue 12 2007Divine Ikenwilo Abstract There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the European Working Time Directive, knowledge of the size of labour supply elasticities is crucial in examining the effects of these major changes. This paper estimates a modified labour supply model for hospital consultants, using data from a survey of consultants in Scotland. Rigidities in wage setting within the NHS mean that the usual specification of the labour supply model is extended by the inclusion of job quality (job satisfaction) in the equation explaining the optimal number of hours worked. Generalised Method of Moments estimation is used to account for the endogeneity of both earnings and job quality. Our results confirm the importance of pay and non-pay factors on the supply of labour by consultants. The results are sensitive to the exclusion of job quality and show a slight underestimation of the uncompensated earnings elasticity (of 0.09) without controlling for the effect of job quality, and 0.12 when we controlled for job quality. Pay increases in the new contract for consultants will only result in small increases in hours worked. Small and non-significant elasticity estimates at higher quantiles in the distribution of hours suggest that any increases in hours worked are more likely for consultants who work part time. Those currently working above the median number of hours are much less responsive to changes in earnings. Copyright © 2007 John Wiley & Sons, Ltd. [source] Laparoscopic adrenalectomy for functioning and non-functioning adrenal tumors: Analysis of surgical aspects based on histological typesINTERNATIONAL JOURNAL OF UROLOGY, Issue 12 2005JA H KU Background: The aim of this study was to evaluate whether hormonal functions of the tumor influence the operative results of laparoscopic adrenalectomy, and to analyse the clinical outcomes in patients with various hormonally active adrenal tumors. Methods: Clinical and pathological records of 68 patients were reviewed. The average age of patients was 40 years (range 20,75); 39 were women and 29 men. For the comparison, patients were divided into the non-functioning tumor group (n = 22) and the functioning tumor group (n = 46). Results: All laparoscopic adrenalectomies were finished successfully, and no open surgery was necessary. The median operative time and blood loss in the two groups were similar; however, in subgroup analysis, operative time for pheochromocytoma was significantly longer than that for non-functioning tumor (P = 0.044). No difference was noted in intra- and postoperative data between the groups. Of the 22 patients with aldosteronoma, 18 (81.8%) became normotensive and no longer required postoperative blood pressure medications. Adrenalectomy led to an overall reduction in the median number of antihypertensive medications (P < 0.001). All patients with Cushing adenoma had resolution or improvement of the signs and symptoms during follow-up periods. There was no evidence of biochemical or clinical recurrence in any patient with pheochromocytoma. Conclusion: The results of this retrospective review document that laparoscopic adrenalectomy is a safe and effective treatment for functioning as well as non-functioning adrenal tumors, although endocrinologic features may play a significant role. [source] Catheter Ablation of Recurrent Scar-Related Ventricular Tachycardia Using Electroanatomical Mapping and Irrigated Ablation Technology: Results of the Prospective Multicenter Euro-VT-StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2010HILDEGARD TANNER M.D. Catheter Ablation of Ventricular Tachycardia.,Introduction: Ventricular tachycardia (VT) late after myocardial infarction is an important contributor to morbidity and mortality. This prospective multicenter study assessed the efficacy and safety of electroanatomical mapping in combination with open-saline irrigated ablation technology for ablation of chronic recurrent mappable and unmappable VT in remote myocardial infarction. Methods and Results: In 8 European institutions, 63 patients (89% males) were enrolled in the study. All patients had remote myocardial infarction and presented with a median number of 17 (range 1,380) VTs in the preceding 6 months. Incessant VT was present in 14 patients (22%). Left ventricular ejection fraction measured 30 ± 13%. A mean of 3 VTs were targeted per patient and 22% of all patients had only unmappable VT. The mean follow-up period was 12 ± 3 months. A total of 164 VTs were targeted during catheter ablation. Ablation was acutely successful in 51 patients (81%). One patient (1.5%) experienced a major complication with degeneration of VT into ventricular fibrillation necessitating cardiopulmonary resuscitation maneuvers. However, no death occurred acutely or within the first 30 days after catheter ablation. During the follow-up, 19 of the initially successful ablated patients (37%) and 31 of all ablated patients (49%) developed some type of VT recurrence. Conclusions: The results of this multicenter study demonstrate the high acute success rate and a low complication rate of irrigated tip catheter ablation of all clinical relevant VTs in remote myocardial infarction. However, during the follow-up a relevant number of recurrences occurred. (J Cardiovasc Electrophysiol, Vol. 21, pp. 47,53, January 2010) [source] Peripheral blood stem cell collection in pediatric patients: Feasibility of leukapheresis under anesthesia in uncompliant small children with solid tumors ,JOURNAL OF CLINICAL APHERESIS, Issue 2 2006Fernando Ravagnani Leukapheresis demands patient's compliance and adequate vascular accesses, which can require invasive methods in very small children whose treatment protocol includes hemopoietic stem cell collection for myeloablative chemotherapy and stem cell rescue. Since 1998, at the Istituto Nazionale Tumori of Milan, in selected uncompliant small children, the placement of peripheral vascular accesses and leukapheresis have been performed at the same time under general anesthesia. Peripheral venous cannulas were positioned for blood collection, while blood was returned through either peripheral cannulas or mono-lumen central catheters previously installed for chemotherapy. A continuous-flow cell separator was used for leukapheresis. Between 1998 and 2003, 47 children with solid tumors underwent anesthesia for a total of 54 leukaphereses. The patients' age ranged from 12.7 to 93 months (median 30.3) and their weight ranged from 7 to 20 kg (median 14.1). Neither metabolic nor anesthesiological complications were recorded. In 89% of cases, the CD 34+ cell target was achieved at a single harvest; the median number of CD 34+ cells was 10.8 × 106/kg/leukapheresis (range 1,117) and the median collection efficiency was 63.4% (range 25,100.6). Leukapheresis under anesthesia is feasible and safe in very low-weight children whose compliance is lacking due to age and disease. J. Clin. Apheresis, 2005 © 2005 Wiley-Liss, Inc. [source] A randomized controlled trial of a community nurse-supported hospital discharge programme in older patients with chronic heart failureJOURNAL OF CLINICAL NURSING, Issue 1 2008Timothy Kwok MD Aims and objectives., To evaluate the effectiveness and cost-effectiveness of a community nurse-supported hospital discharge programme in preventing hospital re-admissions, improving functional status and handicap of older patients with chronic heart failure. Design., Randomized controlled trial; 105 hospitalized patients aged 60 years or over with chronic heart failure and history of hospital admission(s) in previous year were randomly assigned into intervention group (n = 49) and control group (n = 56) for six months. Intervention group subjects received community nurse visits before discharge, within seven days of discharge, weekly for four weeks, then monthly. Community nurse liaised closely with a designated specialist in hospital and were accessible to subjects during normal working hours. Control and intervention group subjects were followed up in the same specialist medical clinics. Primary outcome was the rate of unplanned re-admission at six months. Secondary outcomes were number of unplanned re-admissions, six-minute walking distance, London Handicap Scale and public health care and personal care costs. Results., At sixth months, the re-admission rates were not significantly different (46 vs. 57% in control subjects, p = 0·233, Chi-square test). But the median number of re-admissions tended to lower in the intervention group (0 vs. 1 in control group, p = 0·057, Mann Whitney test). Intervention group subjects had less handicap in independence (median change 0 vs. 0·5 in control subjects, p = 0·002, Mann Whitney test), but there was no difference in six-minute walking distance. There was no significant group difference in median total public health care and personal care costs. Conclusion., Community nurse-supported post-discharge programme was effective in preserving independence and was probably effective in reducing the number of unplanned re-admissions. The cost benefits to public health care were not significant. Relevance to clinical practice., Older chronic heart failure patients are likely to benefit from post-discharge community nurse intervention programmes. More comprehensive health economic evaluation needs to be undertaken. [source] Early emergence of raltegravir resistance mutations in patients receiving HAART salvage regimensJOURNAL OF MEDICAL VIROLOGY, Issue 1 2010Fausto Baldanti Abstract The emergence of drug-resistance mutations in HIV-1 integrase of patients receiving HAART salvage regimens including raltegravir was investigated in 11 heavily pretreated patients (median number of treatment failures 12, range 5,22) within an expanded access program in Pavia, Italy. HIV-1 RNA levels in plasma, CD4+ T-cell counts and sequencing of HIV-1 reverse transcriptase (RT), protease (PR), gp41, and integrase genes were performed at baseline and after 1, 2, 3, 6, and 12 months. The treatment baseline median HIV-1 RNA levels in plasma decreased from 7,510 (range 118,407,107) to <50,copies/ml (range <50,7,562), while median CD4+ T-cell counts remained unchanged (from 212,cells/µl, range 10,764 to 262,cells/µl, range 13,760). Mutations at positions involved in raltegravir resistance (E92G, G140S, Q148H, and N155H) were detected in 4 of 11 (36.3%) patients as early as 1 month after initiating salvage HAART. Of note, the E,,,G change at codon 92 was not reported previously. In two patients with raltegravir resistance, the simultaneous appearance of additional mutations (Y143R and E170A) with an unclear impact on susceptibility to raltegravir or on integrase activity was observed. It is concluded that raltegravir resistant HIV-1 strains may emerge as early as 1 month after initiating HAART salvage regimens. A new mutation associated with the emergence of raltegravir resistance is described, and the simultaneous appearance of primary and secondary mutations was observed. The effect of single and multiple mutations on integrase activity, raltegravir susceptibility, and on the capacity of viral replication remains to be elucidated. J. Med. Virol. 82:116,122, 2010. © 2009 Wiley-Liss, Inc. [source] Lymph node involvement in ampullary cancer: The importance of the number, ratio, and location of metastatic nodesJOURNAL OF SURGICAL ONCOLOGY, Issue 1 2009Marek Sierzega MD Abstract Background and Objectives Lymph node involvement significantly affects survival of cancer patients. The aim of this study was to evaluate the importance of the number, ratio, and location of metastatic lymph nodes in ampullary cancers. Methods Medical records of 111 patients who underwent curative pancreaticoduodenectomy for ampullary carcinomas were reviewed. Results Metastatic lymph nodes were found in 52 (47%) patients and the median number of involved nodes was 3 (95% confidence interval (CI) 3,4; range 1,17). In the univariate analysis, gender, type of pancreaticoduodenectomy, depth of tumor invasion, perineural invasion, presence of metastatic nodes, their number, and ratio of metastatic nodes significantly correlated with patient survival. However, the location of metastatic nodes did not influence survival among patients with nodal involvement. Only four or more metastatic nodes (relative risk 7.35, 95% CI 3.34,16.17) and tumor invasion of peripancreatic soft tissues (relative risk 5.00, 95% CI 1.20,20.92) were the independent prognostic factors in the multivariate analysis. Conclusions The number of metastatic nodes significantly affected patient survival. Although the location and ratio of metastatic nodes were not independent prognostic factors, these variables should be further evaluated with large-scale population data sets. J. Surg. Oncol. 2009;100:19,24. © 2009 Wiley-Liss, Inc. [source] Variability in axillary lymph node dissection for breast cancer,,JOURNAL OF SURGICAL ONCOLOGY, Issue 1 2004Michael Schaapveld MSc Abstract Background The axillary nodal status may influence the prognosis and the choice of adjuvant treatment of individual breast cancer patients. The variation in number of reported axillary lymph nodes and its effect on the axillary nodal stage were studied and the implications are discussed. Methods Between 1994 and 1997, a total of 4,806 axillary dissections for invasive breast cancers in 4,715 patients were performed in hospitals in the North-Netherlands. The factors associated with the number of reported nodes and the relation of this number with the nodal status and the number of positive nodes were studied. Results The number of reported nodes varied significantly between pathology laboratories, the median number of nodes ranged from 9 to 15, respectively. The individual hospitals explained even more variability in the number of nodes than pathology laboratories (range in median number 8,15, P,<,0.0001). The number of reported nodes increased gradually during the study period. A decreasing trend was observed with older patient age. A higher number of reported nodes was associated with a markedly increased chance of finding tumor positive nodes, especially more than three nodes. The frequency of node positivity increased from 28% if less than six nodes to 54% if ,20 nodes were examined, the percentage of tumors with ,4 positive nodes increased from 4 to 31%. Multivariate analysis confirmed these results. Conclusions This population-based study showed a large variation in the number of reported lymph nodes between hospitals. A more extensive surgical dissection or histopathological examination of the specimen generally resulted in a higher number of positive nodes. Although the impact of misclassification on adjuvant treatment will have varied, the impact with regard to adjuvant regional radiotherapy may have been considerable. J. Surg. Oncol. 2004;87:4,12. © 2004 Wiley-Liss, Inc. [source] Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988,2006)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 6 2009DACVIM, Jennifer L. McCown DVM Abstract Objective , To determine whether the dose of antivenin administered is associated with a difference in survival of crotalid-envenomated dogs. A secondary objective was to determine whether other covariables affect survival. Design , Retrospective study (1988,2006). Setting , Private referral center and university small animal teaching hospital. Animals , Two hundred and eighteen dogs with evidence of crotalid envenomation and treatment with equine-derived antivenin. Interventions , Administration of antivenin. Measurements and Main Results , Patient signalment, physical and clinicopathologic data at time of presentation, treatments, complications of antivenin therapy, length and cost of hospitalization, and outcome were recorded. Confidence intervals were determined for the difference in median number of vials administered and for median dosage for patients that lived versus died. Penalized logistic regression was performed to evaluate the effect of other covariables on survival. The median age of affected dogs was 3 years (range 6 w,12 y) with a median weight of 25.7 kg (range 1.95,86.4 kg). The median number of antivenin vials administered was 1.0 (range 1.0,10.0). Acute and chronic reactions were reported in 7% (16/218) and 0.9% (2/218) of dogs, respectively. Nine of 218 dogs (4.1%) died. The median number of vials administered to the nonsurvivors and survivors were 2.0 (range 1,5 vials) and 1.0 (range 1,10 vials), respectively. The median number of vials received was significantly different in dogs that died versus those that lived (P<0.05). Increased heart rate (P=0.02) and petechiation (P=0.04) were associated with decreased likelihood of survival, while diphenhydramine (P=0.02) and fluoroquinolone (P=0.046) administration was associated with increased likelihood of survival. The median duration of hospitalization was 1.0 day (range 2 h,22 d). The median cost of hospitalization was US$1592.00 (range US$267.20,US$6738.00). Conclusion , The administration of more vials of antivenin is potentially associated with negative outcome; however, a causal relationship has not been established. Controlled, prospective studies are needed to optimize antivenin administration. [source] Abundance of stable flies on heifers treated for control of horn flies with organophosphate impregnated ear tagsMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2004A. A. Guglielmone Abstract., Ear tags containing 40% organophosphate insecticides (diazinon or diazinon plus chlorpyrifos-ethyl) were applied to control Haematobia irritans (L.) (Diptera: Muscidae) in treated (TG01 and TG02) and untreated (UG01 and UG02) groups of Holstein heifers born in 2001 and 2002, respectively. Control and treated groups were assessed for the abundance of Stomoxys calcitrans (L.) (Diptera: Muscidae) from August 2001 to April 2002 and again from August 2002 to April 2003. The treatment had a high efficacy for control of horn flies (maximum median number per heifer of TG01 and TG02 = 5) but a low effect on the abundance of stable flies. The total numbers of S. calcitrans were 1251 (42.9% of the total) and 1668 (57.1%) for TG01 and UG01, and 1423 (48.8%) and 1494 (51.2%) in TG02 and UG02, respectively. No significant difference in stable fly burden was found in 55 of the 76 weeks evaluated. A unimodal peak of abundance in the spring was found during the first fly season, and a bimodal abundance, with peaks in the spring and autumn, during the second season. No strong associations between horn fly and stable fly burdens was found in individuals of the CG01 (correlation coefficient = 0.13, P > 0.05) or CG02 (correlation coefficient = 0.538, P < 0.05, determination coefficient = 0.289). [source] Atrial Linear Lesions: Feasibility Using CryoablationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2006KLAUS KETTERING Background: Long linear lesions are created in the left atrium to modify the atrial substrate, thereby curing atrial fibrillation. The creation of long linear left atrial lesions using radiofrequency (RF) ablation is time consuming and difficult. Furthermore, it might result in significant complications. Cryoablation might overcome some of the disadvantages of RF ablation. Therefore, the aim of our study was to assess whether the creation of a long linear lesion is possible using cryotherapy. Methods: A right atrial septal linear lesion was created in six pigs (median weight: 50 kg; range: 40,60 kg). The ablation procedure was performed with a 7-F Freezor cryocatheter. The nonfluoroscopic mapping system LocaLisa was used as a navigation tool. At each point, freezing was maintained at the lowest attainable temperature (,75°C) for 4 minutes. The CARTO system was used for the evaluation of the linear lesions. Furthermore, all animals were sacrificed immediately after the ablation procedure and a postmortem examination of the lesions was performed. Additionally, an analysis of the amplitudes of the intracardiac electrograms registered via the ablation catheter was performed before and after the ablation procedure. Results: A right atrial septal linear lesion could be created successfully in all six pigs. For the performance of this ablation line, a median number of 16 cryoapplications (range, 11,26) was necessary. The amplitudes of the intracardiac electrograms registered via the ablation catheter decreased significantly after ablation. The CARTO bipolar voltage map revealed very low potentials along the ablation line and showed a sharply demarcated ablation area at the septum in all pigs. Further analysis of the CARTO map revealed an incomplete conduction block in all cases. Most of the pigs had a small gap close to the fossa ovalis. The postmortem examination of 2,3,5-triphenyl-tetrazolium chloride-stained specimens showed sharply demarcated lesions without any ulcerations. There were no major complications during the procedure. Conclusions: The creation of long linear lesions using cryoablation is feasible and safe. Lesion characteristics are different and more favorable than those created by RF. However, the aim of creating a transmural lesion and a complete conduction block remains an unsolved problem even with current cryoablation techniques. Nevertheless, growing experience and technical improvements might overcome some of the current limitations of this new technique. [source] Hematopoietic and immune recovery after allogeneic peripheral blood stem cell transplantation and bone marrow transplantation in a pediatric populationPEDIATRIC TRANSPLANTATION, Issue 4 2002Yoshihisa Nagatoshi Abstract: To compare the hematopoietic and immune recoveries after allogeneic transplantation with different cell sources, we analyzed the recovery patterns of blood components after allogeneic peripheral blood stem cell transplantation (PBSCT) in comparison with that after allogeneic bone marrow transplantation (BMT) in a pediatric population. Sixteen patients received PBSCT, and 24 received BMT between January, 1995 and March, 2000. The patients had acute lymphoblastic leukemia (ALL; n = 22), acute myelogenous leukemia (AML; n = 8), myelodysplastic syndrome (MDS; n = 3), or other diseases (n = 7). The median ages of patients in the PBSCT and BMT groups were 9 yr and 6 yr, respectively. Cyclosporin A (CsA) plus methotrexate or methylprednisolone was used as a graft-vs.-host disease (GvHD) prophylaxis regimen in the PBSCT group, whereas CsA alone or methotrexate alone was used in the BMT group. Circulating lymphocyte numbers and subpopulations determined by flow cytometric analysis were used as markers of immune recovery. In the PBSCT group, the median number of harvested CD34+ cells was 7.25 (range: 1.3,27.6) × 106/kg of the recipient's body weight, while the median number of harvested nucleated cells was 4.7 (range: 3.7,10.5) × 108/kg. All of the patients were engrafted. Myeloid engraftment occurred sooner after PBSCT than after BMT (median number of days to achieve absolute neutrophil counts (ANC) > 0.5 × 109/L; 11 and 15, respectively; p < 0.0001) and similar results were found for platelet engraftment (median number of days to achieve a platelet count of > 20 × 109/L; 12 and 21, respectively; p = 0.004). On the other hand, after PBSCT the absolute numbers of total circulating lymphocytes and lymphocyte subpopulations were not significantly different from those after BMT. The incidence of acute GvHD after PBSCT was the same as that after BMT, while chronic GvHD developed more frequently after PBSCT than after BMT (p = 0.005). In a pediatric population, the indications for PBSCT and BMT should be based on these findings in addition to regard for the donor's safety. [source] Reduced dose of lenograstim is as efficacious as standard dose of filgrastim for peripheral blood stem cell mobilization and transplantation: A randomized study in patients undergoing autologous peripheral stem cell transplantationAMERICAN JOURNAL OF HEMATOLOGY, Issue 8 2008Selmin Ataergin In vitro studies have demonstrated a 27% increased efficacy of lenograstim over filgrastim. However, equal doses of 10 ,g/kg/day of filgrastim and lenograstim have been recommended for mobilization of CD34+ cells without associated chemotherapy. In this study, we investigated whether a 25% reduced dose of lenograstim at 7.5 ,g/kg/day is equavalent to 10 ,g/kg/day filgrastim for autologous peripheral blood stem cell (PBSC) mobilization and transplantation. A total of 40 consecutive patients were randomized to either filgrastim (n = 20) or lenograstim (n = 20). The two cohorts were similar in regard to disease, sex, body weight, body surface area, conditioning regimens, previous chemotherapy cycles and radiotherapy. Each growth factor was administered for 4 consecutive days. The first PBSC apheresis was done on the 5th day. In the posttransplant period, the same G-CSF was given at 5 ,g/kg/day until leukocyte engraftment. Successful mobilization was achieved in 95% of patients. Successful mobilization with the first apheresis, was achieved in 10/20 (50%) patients in the filgrastim group versus 9/20 (46%) patients in the lenograstim group. No significant difference was seen in the median number of CD34+cells mobilized, as well as the median number of apheresis, median volume of apheresis, percentage of CD34+ cells, and CD34+ cell number. Leukocyte and platelet engraftments, the number of days requiring G-CSF and parenteral antibiotics, the number of transfusions were similar in both groups in the posttransplant period. Lenograstim 7.5 ,g/kg/day is as efficious as filgrastim 10 ,g/kg/day for autologous PBSC mobilization and transplantation. Am. J. Hematol., 2008. © 2008 Wiley-Liss, Inc. [source] Does stretching induce lasting increases in joint ROM?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2002A systematic review Abstract Background and Purpose Stretching (that is, interventions that apply tension to soft tissues) induces increases in the extensibility of soft tissues, and is therefore widely administered to increase joint mobility and reverse contractures. However, it is not clear whether the effects of stretching are lasting. A systematic review was conducted to determine if stretching (either self-administered, administered manually by therapists or by some external device such as a splint) produces lasting increases in the mobility of joints not directly affected by surgery, trauma or disease processes. Method In order to determine the lasting effects of stretching, only studies that measured joint range of motion (ROM) at least one day after the cessation of stretching were included. MEDLINE (from 1966 to June 2000), EMBASE (from 1988 to June 2000), the Cochrane Controlled Trials Register and PEDro databases were searched, and citation tracking was used to identify randomized studies that met the inclusion criteria. Each study was rated by two independent assessors on the PEDro scale, which rated trials according to criteria such as concealed allocation, blinding and intention-to-treat analysis. Results Thirteen studies satisfied the inclusion criteria. All examined the effect of stretching (median number of stretch sessions = eight) on joint ROM in healthy subjects without functionally significant contractures. Four studies were of ,moderate' quality and the remaining nine were of ,poor' quality. The ,moderate' quality studies suggest that regular stretching increases joint ROM (mean increase in ROM = 8°;95% CI 6° to 9°) for more than one day after cessation of stretching and possibly that the effects of stretching are greater in muscle groups with limited extensibility. Conclusions The results of four ,moderate' quality studies show a convincing effect of stretching in people without functionally significant contracture. These findings require verification with high-quality studies. Lasting effects of intensive stretching programmes (for example, stretching applied for more than six weeks or for more than 20 minutes a day) or of stretching on people with functionally significant contracture have not yet been investigated with randomized studies. Copyright © 2002 Whurr Publishers Ltd. [source] Patterns of dysmorphic features in schizophrenia,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 8 2001L.E. Scutt Abstract Congenital dysmorphic features are prevalent in schizophrenia and may reflect underlying neurodevelopmental abnormalities. A cluster analysis approach delineating patterns of dysmorphic features has been used in genetics to classify individuals into more etiologically homogeneous subgroups. In the present study, this approach was applied to schizophrenia, using a sample with a suspected genetic syndrome as a testable model. Subjects (n,=,159) with schizophrenia or schizoaffective disorder were ascertained from chronic patient populations (random, n,=,123) or referred with possible 22q11 deletion syndrome (referred, n,=,36). All subjects were evaluated for presence or absence of 70 reliably assessed dysmorphic features, which were used in a three-step cluster analysis. The analysis produced four major clusters with different patterns of dysmorphic features. Significant between,cluster differences were found for rates of 37 dysmorphic features (P,<,0.05), median number of dysmorphic features (P,=,0.0001), and validating features not used in the cluster analysis: mild mental retardation (P,=,0.001) and congenital heart defects (P,=,0.002). Two clusters (1 and 4) appeared to represent more developmental subgroups of schizophrenia with elevated rates of dysmorphic features and validating features. Cluster 1 (n,=,27) comprised mostly referred subjects. Cluster 4 (n,=,18) had a different pattern of dysmorphic features; one subject had a mosaic Turner syndrome variant. Two other clusters had lower rates and patterns of features consistent with those found in previous studies of schizophrenia. Delineating patterns of dysmorphic features may help identify subgroups that could represent neurodevelopmental forms of schizophrenia with more homogeneous origins. © 2001 Wiley-Liss, Inc. [source] Quality of Life, Functional Outcome, and Costs of Early Glottic Cancer,THE LARYNGOSCOPE, Issue 1 2003Jonathan C. Smith MD Abstract Objective To analyze quality of life, functional outcome, and hidden costs by primary treatment with surgery or radiation therapy in patients with early glottic cancer. Study Design Retrospective study in a tertiary care facility. Methods A group of 101 patients with carcinoma in situ and T1 invasive squamous cell carcinoma treated primarily with either surgery or radiation, between January 1990 and December 2000, were identified from searching our tumor registry. Patients completed two previously validated questionnaires and one local questionnaire. Statistical significance was assessed with the rank sum test, ,2 test, or Fisher's Exact test. Results Questionnaires were completed in 59% (44 of 74) of the surgical cohort and 41% (11 of 27) of the radiation therapy cohort. The primary surgical treatments were endoscopic excision (86%), hemilaryngectomy (12%), and total laryngectomy (1%). Patient-reported problems with swallowing, chewing, speech, taste, saliva, pain, activity, recreation, and appearance showed no difference between the endoscopic excision or radiation therapy cohorts. Comparing endoscopic excision versus radiation therapy, respectively, median number of treatments (2 vs. 35), total median travel distance (150 vs. 660 miles), total median travel time (180 vs. 1440 min), and total median number of hours of work missed (76 vs. 24) all differed significantly (P <.01). Conclusions Almost all patients with early glottic cancer, whether treated with surgery or radiation therapy, reported excellent quality of life outcomes and functional results. In addition to actual costs, the hidden costs for radiation therapy versus endoscopic excision were all greater in terms of total number of hours of work missed, total travel time, and total travel distance. [source] Stereologic estimation of the total numbers, the composition and the anatomic distribution of lymphocytes in cone biopsies from patients with stage I squamous cell carcinoma of the cervix uteri,APMIS, Issue 12 2007BETTINA S. NEDERGAARD The aim of this study was to present a method to obtain basic biological data on the in situ cellular immune response towards cancer. Using stereology, we estimated the density and frequency of immune cells of 10 different phenotypes in cone biopsies from 20 patients with FIGO stage I cervical squamous cell carcinoma. The anatomic distribution of immune cells with respect to intraepithelial, periepithelial or stromal compartments was recorded in normal epithelium, dysplastic epithelium and carcinoma. We estimated the number of immune cells per cancer cell, and the 3D total number of immune cells, inside cancer tissue. The tumor volume was estimated in 3D and corrected for shrinkage occurring during tissue processing. We found more immune cells in cancer compared to dysplasia and normal epithelia. A median total number of 278 ? 103 CD3+, 69.1 ? 103 CD4+ and 113 ? 103 CD8+ cells were present in the cancers. A median number of 63 CD3+, 11 CD4+ and 29 CD8+ cells were present per cancer cell. The average volume of tumors in stage IA was significantly smaller than that of stage IB. This method was found to be usable and of potential value in clinical pathology research, and for development and evaluation of immunotherapy. [source] Chromosomal aberrations in lymphocytes of employees in transformer and generator production exposed to electromagnetic fields and mineral oilBIOELECTROMAGNETICS, Issue 3 2001Knut Skyberg Abstract The objective was to study the risk of cytogenetic damage among high voltage laboratory workers exposed to electromagnetic fields and mineral oil. This is a cross sectional study of 24 exposed and 24 matched controls in a Norwegian transformer factory. The exposure group included employees in the high voltage laboratory and in the generator soldering department. Electric and magnetic fields and oil mist and vapor were measured. Blood samples were analyzed for chromosomal aberrations in cultured lymphocytes. In addition to conventional cultures, the lymphocytes were also treated with hydroxyurea and caffeine. This procedure inhibits DNA synthesis and repair in vitro, revealing in vivo genotoxic lesions that are repaired during conventional culturing. In conventional cultures, the exposure group and the controls showed similar values for all cytogenetic parameters. In the DNA synthesis- and repair-inhibited cultures, generator welders showed no differences compared to controls. Among high voltage laboratory testers, compared to the controls, the median number of chromatid breaks was doubled (5 vs. 2.5 per 50 cells; P<0.05) the median number of chromosome breaks was 2 vs. 0.5 (P>0.05) and the median number of aberrant cells was 5 vs. 3.5 (P<0.05). Further analysis of the inhibited culture data from this and a previous study indicated that years of exposure and smoking increase the risk of aberrations. We conclude that there was no increase in cytogenetic damage among exposed workers compared to controls in the conventional lymphocyte assay. In inhibited cultures, however, there were indications that electromagnetic fields in combination with mineral oil exposure may produce chromosomal aberrations. Bioelectromagnetics 22:150,160, 2001. © 2001 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||