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At least 235 records · Page 13Linked to original sources
PubMed2000

Limited but definite efficacy of prophylactic hepatic arterial infusion chemotherapy after curative resection of colorectal liver metastases: A randomized study.

BACKGROUND: Greater than 50% of patients who undergo curative resection of liver metastases from colorectal carcinoma develop recurrent disease in the residual liver. Although several studies have attempted to use hepatic arterial infusion (HAI) chemotherapy to prevent recurrence, to the authors' knowledge the efficacy of the treatment has not yet been determined. METHODS: Nineteen patients who underwent curative hepatectomy for metastatic colorectal carcinoma randomly were assigned into the HAI group (nine patients) or the control group (ten patients). Patients in the HAI group received continuous intraarterial infusion of 5-fluorouracil (5-FU) (500 mg/day) for 4 days followed by a 3-day rest. The treatment was continued for 6 weeks. RESULTS: The median follow-up period was 62.2 months. The recurrence was confirmed in three patients in the HAI group and in eight patients in the control group. Of these, recurrence in the remnant liver was observed in one patient and in six patients, respectively. The median disease free interval after hepatectomy was 62.6 months in the HAI group and 13.8 months in the control group. The 1-year, 2-year, and 3-year disease free survival rates were 77.8%, 77.8%, and 66.7%, respectively, in the HAI group and 50.0%, 30.0%, and 20.0%, respectively, in the control group. Significant prolongation of disease free survival was observed in the HAI group (P = 0.045). No patients in the HAI group reported any adverse effect of >/= Grade 2 (according to the National Cancer Institute Common Toxicity Criteria). Two patients in the HAI group and five patients in the control group were dead of disease at the time of last follow-up. The 1-year, 3-year, and 5-year cumulative survival rates for the HAI group were 88.9%, 77.8%, and 77.8%, respectively, whereas those of the control group were 100.0%, 50.0%, and 50.0%, respectively (P = 0.2686). CONCLUSIONS: This randomized study revealed that short term HAI of 5-FU after curative resection of colorectal hepatic metastases is effective in preventing the recurrence of disease without any serious complications.

Administration, Oral↗
PubMed2000

P53 mutational status improves estimation of prognosis in patients with curatively resected adenocarcinoma in Barrett's esophagus.

The incidence of adenocarcinomas in Barrett's esophagus has been rising in the last two decades in the United States and Western Europe for yet unknown reasons. We reported previously a large multi-institutional trial implicating p53 mutations as being involved in the pathogenesis of Barrett's cancer and representing an early marker for the malignant potential of Barrett's epithelium. A prospective study was performed to evaluate the prognostic impact of p53 mutations on survival in 59 patients with Barrett's cancer. Tissue for DNA analysis was obtained by endoscopic biopsy or immediately after surgical resections from the tumor, Barrett's epithelium, and normal stomach and esophagus. p53 mutation analysis was performed by PCR-single strand conformational polymorphism screening of exons 5-9 and DNA sequencing to unequivocally prove the presence of a mutation. p53 mutations were identified in 30 of 59 (50.8%) patients. The presence of a p53 mutation in the tumor had a significant impact on survival after curative resections (RO-resections) with cumulative 5-year survival probabilities of 68.8+/-9.7% for mutation-negative tumors and 24.3+/-9.9% for mutation-positive tumors (log rank: P < 0.001). By Cox proportional hazard analysis, including the parameters of gender, age, Union International Contre Cancer tumor stage, grading, and p53 mutation status, only Union International Contre Cancer tumor stage (P < 0.0001) and p53 mutation status (P < 0.02) were of significant independent prognostic importance. p53 mutation analysis by DNA sequencing is of significant independent prognostic importance next to histopathological tumor stage in patients with curatively resected (RO-resection) Barrett's cancer. It appears that p53 mutational status is a valuable parameter to define low-risk (p53 mutation-negative) and high-risk (p53 mutation-positive) groups for treatment failure after curative resections.

Adenocarcinoma↗
PubMed2001

Follow-up after attempted curative surgery for colorectal cancer; postal survey of New Zealand surgeons' practice.

AIMS: The role of follow-up after attempted curative resection of colorectal cancer (CRC) is not clearly defined. We wished to establish the frequency, duration and type of follow-up practised by New Zealand surgeons. METHODS: A postal survey was performed of surgeons on the General Medical Register, asking about the follow-up of asymptomatic patients after potential curative surgery. RESULTS: The response rate was 66%(107/163). There was wide variability in the frequency, duration and type of the indicated follow-up practice. 97% of surgeons followed their patients on average four monthly for the first year. At five years, 79% of surgeons followed their patients. Routine blood tests were performed 54%, while serum carcinoembryonic antigen (CEA) levels were measured by 56% of surgeons for the first two years. 41% performed abdominal imaging in the first two years. 97% of surgeons screened the remaining colon (88% by colonoscopy). 90% performed colonic screening three to five yearly. CONCLUSIONS: Follow-up after potential curative surgery for CRC appears to be widely practised in New Zealand. There is, however, considerable variation between surgeons in the frequency, duration and type of follow-up. This may reflect the conflicting evidence in the literature on the value of follow-up. The outcome of current large prospective randomised trials may confirm whether or not such follow-up is worthwhile and what form it should take.

Carcinoembryonic Antigen↗
PubMedDate not supplied

Retrospective study on the effects of lipiodolization before a potentially curative hepatectomy for colorectal liver metastases: long-term results of a pilot study.

BACKGROUND/AIMS: Lipiodolization, a selective regional cancer chemotherapeutic modality using lipiodol plus anticancer drugs, can prolong the survival time of patients with unresectable liver cancer. A preliminary study was conducted with adjuvant lipiodolization before a potentially curative hepatectomy for patients with metachronous colorectal liver metastases. The ultimate aim of this study was to improve the long-term survival after hepatectomy. METHODOLOGY: Twenty-one consecutive patients with colorectal hepatic metastases were included in this study. Seven patients underwent preoperative lipiodolization, while the remaining 14 patients did not receive any preoperative adjuvant therapy. The clinicopathological features and prognoses of these patients were investigated. The median follow-up period after a curative hepatectomy was 56 months. RESULTS: The clinicopathological factors did not differ markedly between the 2 groups. However, the cumulative survival rate of the 7 patients receiving preoperative lipiodolization was significantly (P < 0.05) better than that in those not receiving any preoperative treatment. CONCLUSIONS: Based on the above encouraging findings, we therefore propose that a prospective randomized trial should be carried out to confirm the beneficial effects of our adjuvant chemotherapeutic modality on patient survival following a curative hepatectomy for the patients with colorectal liver metastases.

Aged↗
PubMed2000

[Local curative treatment of superficial adenocarcinoma in Barrett's esophagus. First results of photodynamic therapy with a new photosensitizer].

Pre-cancerous lesions and mucosally confined superficial cancers can benefit from local therapy given with curative intent due to the absence of near metastatic lymph nodes. Photodynamic therapy (PDT) which acts by laser irradiation with an appropriate wave-length after administration of a photosensitiser retained preferentially by the cancerous tissue can destroy tumour cells selectively, but its efficiency depends upon the photosensitiser. The results presented concern 10 sites on Barrett's mucosa (BO). They consisted of either an association of intramucosal cancer (IMC) with high-grade dysplasia (HGD) or of high-grade dysplasia alone. The method consisted of intravenous injection of Temoporfin 0,15 mg/kg 4 days before irradiation of the lesion with a green laser light emitting 514 nm through a windowed diffuser. The light fluence was 75 J per cm2 and irradiation 100 mW per cm2. Irradiation time was 12,5 mn. Omeprazole was routinely prescribed after treatment at a dose of 40 mg daily. The follow-up protocol was 2 years with endoscopic surveillance at 2, 3, 6, 12, 18 and 24 months. Biopsies obligatory at 2 and 3 months were in fact carried out at all the other delays. Efficacy was judged on the absence of high-grade dysplasia or intra mucosal carcinoma on biopsies at treated sites. Undesirable side effects noted have been moderate for the most part. No stenosis appeared. Treatment has been 100% successful for the 10 lesion after 15 treatments with PDT. The follow up varies from 6-36 months and was more than 18 months for 6 lesions on 5 patients. Our series has demonstrated a great heterogeneity in lesions which were sometimes visible and highly localised, but more often invisible, multi-focal and diagnosable only by biopsy at different levels. In keeping with the literature and our experience, PDT has several advantages over the other locally curative therapies, mucosectomy and thermocoagulation. These are the possible treatments without general anaesthesia, selectively for cancer cells, an action on more extensive areas with eradication of non visible lesions. Temoporfin has contributed notably to the field of photodynamic therapy compared to previously used sensitisers. It is a pure, synthetic product which guarantees more reproducible results. Compared with Photofrin, Temoporfin has many advantages with smaller doses of drugs and less energy, better selectivity and rapid elimination which reduce the risk period for photosensitisation. The frequency of important undesirable side effects is diminished. Finally, it produces a consistent effect on the surface and in depth producing a complete reepithelialisation of the treated zones. Subject to validation of the method on a greater number of patients, the first results obtained on superficial cancer in Barrett's aesophagus allow us to propose green light Temoporfin PDT as an alternative first line therapy with curative intent.

Adenocarcinoma↗
PubMed1998

[Curative effect of TCM-WM therapy on Wilson disease with different clinical phenotypes and polymorphisms of ATP7B gene].

OBJECTIVE: To investigate the curative effect of TCM-WM therapy on Wilson disease (WD) with different clinical phenotypes and polymorphisms of ATP7B gene. METHODS: One hundred and twenty-two WD patients with different clinical phenotypes were treated with unithiol 20 mg/kg per day and Gandou tablet ([symbol: see text]) for 1 month. Exon 18 of ATP7B gene extracted from patients and 20 healthy volunteers were amplified with PCR technique, mutations and polymorphisms were screened by SSCP analysis. RESULTS: Four kinds of abnormal migration bands in PCR-SSCP were seen in 37 patients, mutation frequencies of three different clinical phenotypes and curative effect between mutation and non-mutation patients did not show any significant difference, P > 0.05. But total effective rate of patients with Wilson type or pseudosclerosis type was significantly higher than that of patients with hepatic type, P < 0.05. CONCLUSIONS: The exon 18 of ATP7B gene of Chinese WD patients may be one of the regions with higher mutation frequency, most of them are compound heterozygotes and patients with different clinical phenotypes have different response to TCM-WM therapy. It indicate that specific mutations at least in part play a role in influencing clinical phenotypes and curative effect.

Adenosine Triphosphatases↗
PubMed2001

The utility of (18)F-FDG PET for suspected recurrent non-small cell lung cancer after potentially curative therapy: impact on management and prognostic stratification.

UNLABELLED: After potentially curative therapy of non-small cell lung cancer (NSCLC), masses or symptoms suggestive of relapse are common but may be difficult to characterize. Early detection is important because salvage therapies are available for localized recurrence. This study evaluated whether (18)F-FDG PET is useful and predictive of outcome in this setting. METHODS: For 63 consecutive patients with suspected relapse >6 mo after definitive treatment of NSCLC, the apparent extent of disease on conventional restaging was compared with that on FDG PET. Patients with already confirmed systemic metastases were excluded unless locally aggressive treatment of these was being considered. Serial imaging and pathologic results were obtained during a median follow-up of 19 mo to validate diagnostic findings. Prognostic significance was tested using the Cox proportional hazards regression model. RESULTS: PET had positive findings in 41 of 42 patients with confirmed relapse (sensitivity, 98%). No disease was evident during a minimum follow-up of 12 mo in 14 of 15 patients with clinically suspected relapse but negative PET findings (negative predictive value, 93%). PET induced a major management change in 40 patients (63%), including 6 whose treatment was changed from curative to palliative, 3 whose treatment was changed from palliative to curative, and 9 for whom negative PET findings prevented active management. Both the presence (P = 0.012) and the extent (P < 0.0001) of relapse on PET were highly significant prognostic factors. There was also significant prognostic stratification based on the treatment delivered after the PET study (P = 0.011), but after adjustment for this treatment, PET status remained highly predictive of survival. CONCLUSION: PET better assesses the status of disease and stratifies prognosis than does conventional staging, affects patient management, and should be incorporated into paradigms for suspected recurrence of NSCLC.

Aged↗
PubMed1999

[Analysis on curative effects of teeth with chronic apical periodontitis in elderly people].

OBJECTIVE: To study of the curative effect of teeth with chronic apical periodontitis in elderly people and the usage of assessment index. METHODS: Fifty eight teeth from 49 elderly and 50 teeth from 40 young patients were reexamined, which had received root canal therapy or resinifying therapy 2 to 9 years ago. The curative effects were evaluated based on clinical examination and radiographic assessment using periapical index (PAI). RESULTS: Statistically no significant difference for the overall healing rates between the two groups. But when the reexamination period was longer than 4 years, the healing rates in elderly people (58.0%) were significantly lower than those of the young people (87.1%). The treatment method and the size of the periapical lesion had significant influence on the results of the elderly people, whereas no influence on the young patients. According to our data, deep periodontal pocket and occlusal trauma were the main reasons of failure. CONCLUSION: The long-term curative effects of teeth with chronic apical periodotitis in elderly is lower than that of the young people. The PAI system is worth of utilizing popularly in the clinical dentistry.

Adolescent↗
PubMed2002

[A patient with advanced gastric cancer surviving for more than 5 years after neoadjuvant chemotherapy and curative resection].

The patient was a 54-year-old female who was diagnosed as a Borrmann 4 type gastric cancer with invasion to the descending part of the duodenum and hepatic flexure of the colon. Curative resection was considered to be impossible from the clinical findings, so low-dose CDDP + 5-FU therapy and MTX/5-FU sequential therapy were given. After the chemotherapy, the primary lesion was decreased remarkably and the invasive foci disappeared. Therefore total gastrectomy with perigastric lymphadenectomy and splenic preservation was performed. The histological findings revealed that viable cancer cells remained only in the mucosal layer of the primary lesion. The patient has been alive without recurrence for 66 months after the curative resection. This case report suggests that patients who have good response to neoadjuvant chemotherapy with curative resection appear to have prolonged disease-free and overall survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2000

[Observation on curative effect of acute ischemic cerebrovascular disease treated with different dosage of ligustrazine].

OBJECTIVE: To compare clinical curative effect of acute ischemic cerebrovascular diseases (ICVD) treated with different dosage of ligustrazine and to observe the effect of ligustrazine on hemorrheology. METHODS: Sixty-nine patients with ICVD were randomized into three groups, the Group A, B and C treated with 120 mg, 240 mg and 480 mg of ligustrazine respectively, the clinical curative effect, the changes in nerve function deficit score and hemorrheologic parameters before and after treatment were observed. RESULTS: The clinical curative effect and improvement of hemorrheologic parameters in Group C were better than those in Group A and B significantly (P < 0.05, P < 0.01 respectively). Ligustrazine also showed obvious effect in lowering blood level of fibrinogen in Group C. CONCLUSION: Treatment of acute ICVD with large dose of ligustrazine is good in improving clinical effect and hemorrheology, and without side effect basically.

Adult↗
PubMed2002

[Quantitation of alpha-fetoprotein messenger RNA in peripheral blood of nude mice and its relationship with tumor recurrence and metastasis after curative resection of hepatocellular carcinoma].

OBJECTIVE: To assess the level of alpha-fetoprotein (AFP) messenger RNA (mRNA) in peripheral blood of nude mice, and to study its relationship with tumor recurrence and metastasis after curative resection of hepatocellular carcinoma (HCC). METHODS: The metastatic model of human HCC in nude mice LCI-D20 was used in this study. Curative resection was performed at 10th day after tumor implantation in 28 nude mice. Interferon alpha-1b (IFN alpha-1b) was administered subcutaneously from the next day after resection, at doses of 3 10(7)U/kg/d (8 nude mice), 1.5 10(7) U/kg/d (8 nude mice) respectively in the treatment groups, and normal saline alone in the controlled group (12 nude mice). Thirty-five days after treatment, one milliliter of peripheral blood was taken and AFP mRNA was quantitatively analyzed using TaqMan real-time quantitative RT-PCR. The mice were sacrificed. The size of recurrent tumor was measured and the presence of lung metastases was observed. RESULTS: The liver recurrent rate, lung metastatic rate and positivity of AFP mRNA in the controlled group were all 100% (12/12), whereas it was 62.5% (5/8), 0% (0/8), 87.5% (7/8) respectively in the IFN alpha-1b 1.5 10(7)U/kg/d treated group. The recurrent tumor in liver of the IFN alpha-1b 1.5 10(7)U/kg/d treated group was much smaller than that of the controlled group (25 mm(3) 2 mm(3) vs 1143 mm(3) 3 mm(3), t =9.27, P<0.01), and the level of AFP mRNA was also lower than that of the controlled group [(85 6)copies/mug vs (955 2) copies/mug, t =4.33, P<0.01]. In the IFN alpha-1b 3 10(7)U/kg/d treated group, there was only one recurrent tumor (0.5 mm(3)), no lung metastasis, and the positivity of AFP mRNA was 0% (?(2)=11.67, P<0.01). CONCLUSIONS: These results suggest that the level of AFP mRNA in peripheral blood may indicate recurrence and/or metastasis after curative resection of HCC. TaqMan real time quantitative RT-PCR is a very sensitive and convenient method for detecting circulating cancer cells.

Animals↗
PubMed2002

A multicentre retrospective audit of outcome of patients undergoing curative resection for rectal cancer.

AIM: This study describes the outcome of patients with rectal cancer treated in four New Zealand public hospitals before the advent of specialised colorectal units in order to provide a baseline against which any changes in management can be measured. METHODS: A retrospective review of case notes of patients who underwent resection of rectal cancer with curative intent over a period of 7-10 years up to 1995 in Christchurch, Wellington, Nelson, and Masterton Public Hospital's, was undertaken. Patients were identified from hospital records using a combination of methods (pathology data bases, clinical case mix data, operating logs and audit data). Metastatic disease was considered to be present if confirmed on histology or the clinical course of the patient was consistent with metastatic disease. Patients were excluded if there was perioperative evidence of metastatic disease or if they had transanal excision. Previously published results from Auckland and Dunedin Hospitals are compared. RESULTS: 524 patients with rectal cancer were identified who had undergone surgery with curative intent in the four hospitals. The overall permanent stoma rate was 37%. The overall 30-day mortality was 2.9%, five-year survival was 63% and local recurrence at five years was 26%. CONCLUSION: While low perioperative mortality and good long-term survival were achieved, there were high rates of local recurrence. These data are a baseline against which the impact of new approaches to curative resection for rectal cancer can be measured.

Colorectal Neoplasms↗
PubMed2002

[Long-term curative effects of suture plus proximal gastric vagotomy or triad-therapy for duodenal ulcer with acute perforation].

OBJECTIVE: To study the long-term curative effects of suture plus proximal gastric vagotomy (PGV) and suture plus triad-therapy (omeprazole, amoxycillin and flagyl taken orally) for the treatment of duodenal ulcer with acute perforation. METHODS: Three hundred and twenty-nine patients with duodenal ulcer and acute perforation were treated with 2 different methods, respectively. Method A was suture plus PGV (group A, 153 cases), and method B was suture plus triad-therapy (group B, 176 cases). Follow-up was made by means of correspondence, outpatient reexamination and cooperation with local hospitals in 5 to 8 years after operation. The contents of follow-up included symptom acquisition (such as upper abdominal pain or distention, pyrosis, belch, acid regurgitation, vomiting, diarrhea and conditions of living or working), gastroscopy and Helicobacter pylori (HP) detection. The curative effects were evaluated by the Visick scale. RESULTS: Three hundred and one patients were followed up (group A 142 and group B 159). According to the Visick scale, 97 (68.3%), 19 (13.4%), 13 (9.15%) and 13 (9.15%) patients in group A, and 31 (19.5%), 28 (17.6%), 24 (15.1%) and 76 (47.8%) in group B were classified as Visick I, II, III and IV respectively (Z = -9.818, P < 0.01). As for HP detection, there were 130 (91.5%) patients in group A and 94 (59.1%) in group B (chi(2) = 41.438, P < 0.01). CONCLUSIONS: The long-term curative effects of suture plus PGV were superior to those of suture plus triad-therapy for duodenal ulcer with acute perforation although HP positive rate was higher in group A than in group B. HP infection is one of the etiological factors of duodenal ulcer. The increased excitability of the vagus nerve remains to play an important role in duodenal ulcer.

Acute Disease↗
PubMedDate not supplied

Kinetics of postoperative serum vascular endothelial growth factor (VEGF)--can it be used to predict curative resections in colorectal cancer?

BACKGROUND: Vascular endothelial growth factor (VEGF) is considered to be probably the most important and final mediator of neovascularisation. We have shown that VEGF can predict stage in colorectal cancer (Clin Cancer Res 1998, 17). This study was conducted to study the kinetics of serum VEGF after colorectal resections over ten postoperative days. PATIENTS AND METHODS: The study comprised 154 healthy controls and 108 colorectal resections (79 curative, 15 palliative and 14 benign). Samples were collected at 4-6 hours, days 1,3,5,7 and 10 post surgery. RESULTS: Six-hour levels were significantly lower in the curative group (p < 0.0005) but not in the benign and palliative groups (p = 0.27 and 0.3, respectively). Sensitivity and specificity at 20% cut-off fall in VEGF gives 83.5% sensitivity with 80% specificity in predicting curative resection. CONCLUSION: Early postoperative serum VEGF levels show significant fall and may help to identify the oncological status of colorectal cancer resections.

Adult↗
PubMed2003

[Curative effect on aggressive B cell non-Hodgkin's lymphoma and relevant influencing factors of its prognosis, a study of 203 cases].

OBJECTIVE: To analyze the curative effect of aggressive B cell non-Hodgkin's lymphoma and relevant influencing factors of its prognosis. METHODS: The curative effects of aggressive non-Hodgkin's lymphoma which were diagnosed as diffuse small cleaved (E), diffuse mixed (F), diffuse large cell (G) or diffuse immunoblastic lymphoma (H) pathologically and certified as B cell lymphoma immunohistologically and treated with CHOP or other ADM-containing regimens for at least 4 cycles from 1993 to 1997 were analyzed. An analysis of the correlation of prognosis with different factors was made. RESULTS: The curative effects of 191 out of the 230 cases were evaluated. 131 (68.9%) patients achieved CR, and 47 (24.6%) achieved PR. The 6-year overall survival (OS) rates and progress free survival (PFS) rates were 51.4% and 43.3% respectively. According to IPI risk stratification, the 6-year OS rates were 66.6%, 42.2%, 23.6%, and 10.0% in the low-risk, low-intermediate-risk, high-intermediate-risk, and high risk groups respectively (P = 0.000 0). The 6-year PFS rates were 59.7%, 30.2%, 16.7%, and 10.3% in the low-risk, low intermediate risk, high-intermediate-risk, and high risk groups respectively. The prognosis analysis showed that OS and PFS were significantly correlated with different clinical characteristics such as stage, PS, number of extra-nodal lesions, LDH bulky disease, and B symptom. CONCLUSION: The treatment with CHOP as its main component has a beneficial effect on aggressive B cell lymphoma in low risk group, but is less effective for the low-intermediate, high-intermediate, and high risk.

Adolescent↗
PubMed2003

Endoscopic follow-up of patients after curative surgery for colorectal cancer: results of a medical assistance protocol.

AIMS: To evaluate the results of an endoscopic follow-up assistance protocol for colorectal cancer (CRC) after curative surgery. PATIENTS AND METHODS: Between 1994 and 1996, 205 patients with CRC were submitted to curative surgery in our hospital. An endoscopic follow-up was proposed to the patients based on an endoscopy six months following surgery, in the case they did not have a complete endoscopy prior to surgery, or one year after surgery if they did, another one two years later, and a third endoscopy between the third and fifth year. We retrospectively analyzed the follow-up outcome and endoscopic findings. RESULTS: 155 patients were submitted to follow-up, of which 74,2% completed the protocol. 3 synchronous tumours, 4 anastomosis relapses and 2 metachronous tumours were detected. Curative surgery was performed on 100% of the synchronous tumours, 50% of the relapses and 50% of the metachronous tumours. 48.3% and 20.6% of the patients had synchronous and metachronous polyps, respectively. 14.7% of the polyps were larger than 1 cm, 21.7% and 4.8% were tubulovillous and villous, respectively, and 3.7% had severe dysplasia. Finally, patients with synchronous polyps had higher risk of developing metachronous polyps (RR 7.1, CI 95% 2.3; 22.2, p<0.0001). CONCLUSIONS: The rate of adenomatous polyps with high risk of malignant degeneration, metachronous tumours or relapses detected by colonoscopy is low in our series. On the other hand, the detection of polyps during follow-up was related to the presence of synchronous polyps.

Aged↗
PubMed2003

[Meta-analysis on curative effects of surgical procedures for intrahepatic bile duct lithiasis].

OBJECTIVE: To compare curative effects of various surgical procedures of bile duct stones. METHODS: Two thousand nine hundred and fifty-five patients with intrahepatic bile duct lithiasis who had undergone various surgical procedures were analysed with Meta-analysis. Some of these cases were reported in Chinese Medical Journals from January 1990 to March 2001 and others were from Tongji Hospital. RESULTS: There was a significant difference between curative effects of non-hepatectomy and that of hepatectomy (chi(2) = 62.945, P < 0.01), and the outcomes of hepatectomy were much better than those of non-hepatectomy with OR(S) equalled to 0.303 (0.222 - 0.413). There was not a significant difference between curative effect of interposed jejunum and that of hepatectomy (95% CI of RR from 0.98 to 1.04). All the other operation, effects were worse than hepatectomy (upper limit of 95% CI of RR < 1). CONCLUSIONS: Hepatectomy is the most ideal surgery for intrahepatic bile duct stones and operation methods should be diversified since good effect could also be obtained when other operations are performed on suitable cases.

Bile Duct Diseases↗
PubMed2003

Curative ablation for atrial fibrillation: what clinical trials do we need to establish efficacy.

In contrast to other supraventricular tachycardias, curative treatment of atrial fibrillation, although increasingly available and rapidly evolving, is neither as effective nor the first choice. Until recently, the unavailability of nonsurgical curative treatment may have fueled a debate on the relative importance of restoring sinus rhythm versus controlling the ventricular rate during atrial fibrillation. Recent randomized trials (PIAF, AFFIRM, and RACE) using very limited atrial fibrillation burden assessment show that pharmacologic ventricular rate control is much safer and possibly more effective than pharmacologic restoration of sinus rhythm. A clinical trial comparing a truly curative treatment of atrial fibrillation-such as catheter ablation targeting pulmonary vein isolation-with pharmacologic treatment is required. It should focus on reliable efficacy parameters, use vigilant assessment of safety, and, most importantly, be structured to provide all-important prognostic information on long-term outcome. Atrial fibrillation burden is a theoretically robust efficacy parameter, but accurate quantification over a sufficiently long period of monitoring will require technologically innovative noninvasive rhythm monitoring devices.

Anti-Arrhythmia Agents↗