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PubMed1988

Recurrent meningioma.

Single meningiomas are histologically classified as benign tumors, but clearly malignant types have been encountered. The standard mode of management is total macroscopic removal with excision of the dural attachment and abnormal bone, if there is any. Despite this aggressive surgery, recurrence rates of approximately 9% have been reported with the removal of benign tumors, and the rate is much higher with the removal of malignant meningiomas. Recurrence most frequently occurs at the original tumor site and is most often explained by incomplete removal, which, in turn, is a function of the anatomic location of the tumor. Less common are regional recurrences, which may be explained on the basis of the multicentric origin of meningiomas. This theory may also explain the rare entity, "multiple meningioma." This article documents an unexpected regional recurrence of meningioma. The pertinent literature is reviewed.

Brain↗
PubMed1999

Surgical treatment of hepatocellular carcinoma and related basic research with special reference to recurrence and metastasis.

OBJECTIVE: To summarize the progress of surgical treatment of hepatocellular carcinoma (HCC) and related basic research at the Liver Cancer Institute of Shanghai Medical University in the recent years, with special reference to recurrence and metastasis. METHODS: Published and unpublished update clinical and experimental data in the above-mentioned areas are summarized. RESULTS: Surgical resection has played an important role in improving prognosis of HCC, the 5-year survival were 63.4% for small HCC resection (n = 806), 39.6% for large HCC resection (n = 1061), 64.7% for cytoreduction (using hepatic artery cannulation and ligation) and sequential resection of initially unresectable HCC (n = 93), 56.0% for cytoreduction using transcatheter arterial chemoembolization (TACE) and followed by resection (n = 65), and 22.4% for hepatic resection with removal of tumor thrombi in portal vein (n = 103). Unfortunately, the 5-year recurrent rate after curative resection of HCC was up to 61.5%, which was mainly a result of intrahepatic "metastasis" and multicentric origin of HCC. Clinically, re-resection of subclinical recurrence yielded 56% of 5-year survival (n = 202); prevention of recurrence by transcatheter arterial chemoembolization (TACE) + Interferon, or LAK/IL-2 therapy have decreased 3-year recurrent rate from 33% to 11%-18%. In experimental aspect, metastatic human HCC model in nude mice (LCI-D20) and HCC cell line with metastatic potential (MHCC97) have been established; studies on HCC invasiveness in the molecular level revealed similar results that reported in other solid cancers, and small HCC showed slightly better biological characteristics as compared with large HCC; microvessel density (MVD) that reflecting angiogenesis adversely correlated with 5-year survival of small HCC; experimental interventions using antisense H-ras, bispecific antibody, BB94, as well as anti-angiogenic agents (TNP470, suramin, CAI, heparin, antisense VEGF, etc.) have been demonstrated to inhibit tumor growth and lung metastasis in nude mice model. CONCLUSIONS: Recurrence and metastasis are the major obstacle to further improve prognosis of HCC, studies should be conducted both in clinical and experimental aspects, "HCC invasiveness" will be the major target to be studied, particularly in the molecular level, and anti-angiogenesis will be one of the important approach.

Angiogenesis Inhibitors↗
PubMed2003

Acute disseminated encephalomyelitis in children: outcome and prognosis.

BACKGROUND: Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disorder of childhood. Its clinical features, prognosis and treatment vary in different reports. OBJECTIVES: To examine a series of children with ADEM for clinical findings, course, recurrences, and possible variables affecting outcome. METHODS: Multicentric data collected from 7 tertiary referral centers were registered and evaluated in a central database in 1990 - 2001 for clinical, laboratory, and MRI features. Course and prognosis were assessed in patients with at least 12 months' follow-up. RESULTS: Forty-six patients were evaluated. Median age at onset was 8 years, M/F ratio, 1.7/1. Most common symptoms and signs pertained to the motor system and consciousness. Of 39 children with 12 months' follow-up, 71 % recovered completely. Thirteen (33 %) children had relapses. Patients who had more than one relapse (n = 4) presented with new symptoms at each attack. Treatment with high-dose methylprednisolone was associated with complete recovery, and tapering over more than 3 weeks, with a lower rate of relapses. MRI lesions could persist even in asymptomatic patients; in particular, periventricular lesions tended to disappear later than others. CONCLUSIONS: Complete clinical recovery is common and serious complications are rare in childhood ADEM, but the rate of relapses is considerable. Clinical picture at first relapse may help to identify patients likely to experience multiple relapses. The timing and duration of steroid treatment affects outcome.

Adolescent↗
PubMedDate not supplied

The preventive effect of antineoplaston AS2-1 on HCC recurrence.

Once hepatocellular carcinoma (HCC) develops, it repeats intrahepatic metastasis and has multicentric occurrence, which requires frequent treatment. We designed a phase II clinical trail to clarify whether antineoplaston AS2-1, a mixture of sodium salts of phenylacetylglutamine and phenylacetic acid at a ratio of 1:4, prolongs the recurrence-free interval of HCC patients who undergo frequent treatments for recurrence. Ten patients were enrolled in this trial, 2 in stage I, 6 in stage II, 1 in stage III, 1 in stage IV-B at initial diagnosis. Ten patients experienced 35 recurrence-free intervals. Recurrence-free intervals during antineoplaston AS2-1 administration were significantly longer than those without antineoplaston AS2-1 (16.19+/-15.916 versus 5.05+/-2.897 months: p<0.01). Patients who experienced recurrence-free intervals with and without antineoplaston AS2-1 showed longer intervals during antineoplaston AS2-1 administration than those before and after antineoplaston AS2-1 administration (14.47+/-13.821 versus 5.07+/-2.989 versus 5.02+/-3.009 months: p<0.05). Two patients in stage I showed longer recurrence-free intervals than those in more advanced stages. In conclusion, antineoplaston AS2-1 could not prevent recurrence of HCC but prolonged the recurrence-free interval between regional treatments and improved survival rate of these patients.

Administration, Oral↗
PubMedDate not supplied

Risk of developing a mitochondrial DNA deletion disorder.

BACKGROUND: Pathogenic mitochondrial DNA (mtDNA) mutations are found in at least one in 8000 individuals. No effective treatment for mtDNA disorders is available, making disease prevention important. Many patients with mtDNA disease harbour a single pathogenic mtDNA deletion, but the risk factors for new cases and disease recurrence are not known. METHODS: We did a multicentre study of 226 families in which a single mtDNA deletion had been identified in the proband, including patients with chronic progressive external ophthalmoplegia, Kearns Sayre syndrome, or Pearson's syndrome. We studied the relation between maternal age and the risk of unaffected mothers having an affected child, and determined the recurrence risks among the siblings and offspring of affected individuals. FINDINGS: We noted no relation between maternal age and the risk of unaffected mothers having children with an mtDNA deletion disorder. None of the 251 siblings of the index cases developed clinical features of mtDNA disease. Risk of recurrence among the offspring of affected women was 4.11% (95% CI 0.86-11.54, or one in 117 to one in nine births). Only one of the mothers who had an affected child had a duplication of mtDNA in skeletal muscle. INTERPRETATION: Unlike nuclear chromosomal rearrangements, incidence of mtDNA deletion disorders does not increase with maternal age, and unaffected mothers are unlikely to have more than one affected child. Affected women were previously thought to have a negligible chance of having clinically affected offspring, but the actual risk is, on average, about one in 24 births.

Adult↗
PubMedDate not supplied

Management of ductal carcinoma in situ.

The management of ductal carcinoma in situ (DCIS) is one of the most controversial topics in the treatment of breast cancer. With the introduction and utilization of screening mammography, clinically occult or microscopic DCIS has become the most frequent presentation of this disease. Recent advances in the characterization of DCIS according to histologic subgroupings, size and extent of disease, and nuclear grade have provided important information regarding the natural history of this heterogeneous group of lesions. Critical issues such as multicentricity, occult invasion, and potential for local recurrence and axillary metastases have been addressed in recent series. Prospective, single institution trials and data from the National Surgical Adjuvant Breast and Bowel Project (NSABP-B17) protocol have demonstrated that in many patients with mammographically detected DCIS, mastectomy may be over-treatment. Treatment issues for DCIS now focus on the clinical selection process to identify patients best suited for wide local excision alone vs. wide local excision and breast irradiation.

Biopsy↗
PubMed1978

Radiotherapy of Kaposi's sarcoma.

Between 1958 and 1976, 34 patients with Kaposi's sarcoma were seen. Two patients were kidney transplant recipients. Co-existing malignancies were seen in 22% of patients. From 1958 to 1965, cutaneous lesions were treated solely with local radiotherapy techniques, single doses of 800 rads being found adequate to produce a complete response. In 1965, because of the multicentric occurrence of the disease and frequent recurrences after local radiotherapy techniques, extended field radiotherapy was begun. Ten of twelve patients thus treated responded completely. It is concluded that extended field radiotherapy using a single dose of 800 rads offers complete relief of symptoms and better control of the disease when compared to local radiotherapy. There was very little morbidity, with the extended field technique.

Adult↗
PubMed2002

Early gastric carcinoma: spread and multicentricity.

BACKGROUND: In early gastric carcinoma (EGC), after subtotal gastrectomy, recurrent lesions limited to the gastric remnant are the cause of about 20% of deaths from recurrence. Therefore, it has been suggested to perform total gastrectomy in all cases of EGC. METHODS: We studied a case series of 82 consecutive patients operated on for an EGC, with a mean follow-up time of 72 months (range, 1-120 months). Subtotal distal gastrectomy was performed 61 patients, total gastrectomy in 15, and other procedures in 6. Outcome measures were recurrence and causes of mortality, focusing on patients with resection line involvement and multifocal lesions. RESULTS: EGC was limited to the mucosa in 43 patients and had invaded the submucosa in 39. Ten patients had a lymph node involvement. In 4 patients having had a subtotal gastrectomy, resection line involvement was detected. In 3 patients, the involvement was detected peroperatively on frozen sections, and a re-resection was performed. In the fourth patient, the involvement was detected postoperatively, but follow-up endoscopies failed to show any residual tumor. In 17 patients, multifocal lesions were observed. No recurrence was observed in the gastric remnant of patients having undergone a subtotal gastrectomy. CONCLUSION: In distal EGC, a subtotal gastrectomy may be performed under two conditions: (1) careful endoscopic and peroperative examination of the upper part of the stomach to detect multifocal lesions and (2) a systematic frozen-section assessment of the resection margin to avoid inadequate resection.

Adult↗
PubMed2006

Chondromatous hamartoma of the chest wall: description of 3 new cases and literature review.

Chondromatous hamartoma of the chest wall is an extremely rare, benign lesion that usually occurs in early infancy. It typically arises in the rib cage and produces a large mass. It is composed of a varying admixture of hyaline cartilage that has features resembling growth plate cartilage, fascicles of spindle cells, woven bone, and hemorrhagic cysts. Treatment consists mainly of surgical excision, which is usually curative. We present 3 new cases, which demonstrated interesting findings, including multicentricity, involvement of the sternum, and local recurrence, and we discuss these findings in the context of a literature review.

Cartilage Diseases↗
PubMed2005

Inconclusive triple diagnosis in breast cancer imaging: is there a place for scintimammography?

UNLABELLED: Scintimammography (SM) can be used as a complementary test to mammography in patients with suspected breast cancers. This study was undertaken to evaluate the impact of SM on the management of patients with a doubtful or discordant triple diagnosis-that is, mammography, ultrasound, and fine-needle aspiration cytology. The clinical question was variable: initial diagnosis of cancer, suspicion of recurrence, doubtful tumor extension, or search for a primary tumor. METHODS: We performed a retrospective study of 118 procedures in 104 patients with a suggestion of breast cancer, either at initial presentation or after treatment (relapse), with an inconclusive triple diagnosis. Planar and tomographic imaging was performed after injection of (99m)Tc-labeled methoxyisobutylisonitrile ((99m)Tc-MIBI). Results were compared with histopathologic analysis (surgery or core biopsy) in 82 cases and with clinical and imaging follow-up in 36 cases. RESULTS: Breast cancer was proven in 69 cases. SM-SPECT had a sensitivity of 88.4% and a specificity of 67%. Eleven cancers were detected by SPECT, although planar images were negative. SM-SPECT was more sensitive in patients scanned at initial presentation (95%) than in those with suspected recurrence (81%). SM-SPECT correctly evaluated multicentricity or bilaterality in 8 of 11 patients and resulted in an increased tumor size in 8 patients. Overall, SM-SPECT modified the patient management in 58 of 118 cases (49%): SM made the diagnosis of cancer in 30 cases with doubtful or discordant triple diagnosis and ruled out malignancy in 28 cases. CONCLUSION: SM-SPECT is a useful complementary tool for the diagnosis and evaluation of disease extent in patients with an inconclusive triple diagnosis including fine-needle aspiration. The procedure altered the patient management in 49% of the population. These results must be confirmed in a prospective trial.

Adult↗
PubMed1994

Therapeutic efficacy and safety of pidotimod in the treatment of urinary tract infections in children.

The activity of pidotimod ((R)-3-[(S)-(5-oxo-2-pyrrolidinyl) carbonyl]-thiazolidine-4-carboxylic acid, PGT/1A, CAS 121808-62-6) was studied vs. placebo in a double-blind, randomized, multicentre trial, involving 60 pediatric patients with recurrent urinary tract infections. Recovery from acute events was quicker with pidotimod than with placebo (9.6 vs. 12.3 days). In treated patients antibiotic therapy was shorter (6.9 vs. 8.3 days) and main symptomatic parameters (body temperature, vesical tenesmus, stranguria, pollakiuria, total number of symptoms, total symptomatic intensity, rate of asymptomatic patients, haematuria, leukocyturia, positive urinary culture) receded quickly. In patients receiving the drug as well as in patients treated with placebo changes in laboratory parameters were observed, indicating recovery from the acute infectious disease. A significant trend to normalization of the immune response, expressed by chemotaxis and index of leukocyte phagocytosis, was found only in patients treated with pidotimod. After the acute episode a significant decrease of risk of relapses (69%) was observed in these patients. If a relapse occurs, the response of treated patients is quicker (duration of fever, total time of relapses) than for control patients. These findings allow to correlate the individual immune response activation to the resistance to recurrent infections and also to a better response to therapy if the disease occurs and becomes clinically relevant. No side effects were observed. Mild reactions (4 nausea/vomiting, 1 erythema) occurred only in 5 patients (2 pidotimod, 3 placebo) but were attributed to concomitant antibiotic therapy. No alterations of main laboratory parameters were found. These findings confirm the tolerability of the drug also in long-term treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents, Urinary↗
PubMed1997

[Is laryngeal papillomatosis always juvenile?].

After recording an increased frequency of adult-onset recurrent respiratory papillomatosis, the authors propose a multicentric investigation. The aim of the investigation is to determinate the frequency of the new cases and their clinical form. The preliminary results confirm the increased frequency of the adult-onset form and show the possibility of a clinical form change.

Adolescent↗
PubMedDate not supplied

Predictive factors affecting early recurrence after hepatectomy for hepatocellular carcinoma in 5-year survivors.

BACKGROUND/AIMS: This study was undertaken to establish a therapeutic strategy for long-term recurrence-free survival in hepatocellular carcinoma (HCC) patients treated by hepatectomy by determining the factors that predict intrahepatic recurrence. METHODOLOGY: This study included 72 patients who survived more than 5 years after hepatectomy for HCC. Based on the interval between hepatectomy and intrahepatic recurrence, they were classified into 3 groups: those with early recurrence within 2 years after surgery (n=15), those with recurrence between 2 and 5 years (n=18), and those without recurrence within 5 years (n=39). Twenty-six parameters concerning host-related, tumor-related, treatment-related factors, and postoperative levels of serum transaminases were evaluated. RESULTS: Among host-related and tumor-related factors, serum albumin level, serum levels of transaminases, indocyanine green retention rate at 15 minutes, tumor number, intrahepatic metastasis and TNM stage were determined to be significantly different between the patients with recurrence within 5 years and those without recurrence. Among treatment-related factors, curability was highly associated with recurrence. The period until increase in the levels of transaminases after surgery was significantly shorter in patients with recurrence compared to the patients without recurrence. CONCLUSIONS: Curative operation minimizing intrahepatic metastasis and postoperative anti-inflammatory treatment lowering the occurrence of multicentric carcinogenesis are useful therapeutic strategies for achieving long-term recurrence-free survival for HCC patients treated with surgery.

Alanine Transaminase↗
PubMed1994

Management of the patient with bladder cancer. Urethral recurrence.

Urethral recurrence develops in roughly 10% of patients following cystectomy for bladder cancer and appears to be another manifestation of the multicentric nature of TCC. By far the greatest risk factor for recurrence is tumor involvement of the prostate in the radical cystectomy specimen, with prostatic stromal invasion more ominous than either ductal or mucosal involvement. For patients in whom orthotopic diversion is contemplated, precystectomy screening of the prostate is recommended by means of deep transurethral biopsy. Surveillance of the urethra following cystectomy should be done by urethral wash cytology at 6-month to yearly intervals and must be continued for life. Management of documented urethral recurrence should be by total urethrectomy, including the meatus.

Carcinoma, Transitional Cell↗
PubMed2006

Can atrial fibrillation with a coarse electrocardiographic appearance be treated with catheter ablation of the tricuspid valve-inferior vena cava isthmus? Results of a multicentre randomised controlled trial.

OBJECTIVE: To see if strategy of ablating the tricuspid annulus-inferior vena cava isthmus (TV-IVC) is superior to electrical cardioversion to prevent recurrences in patients with coarse atrial fibrillation. DESIGN: Prospective randomised controlled multicentre study. SETTING: Four tertiary referral hospitals in the UK. PATIENTS: 57 patients with persistent coarse atrial fibrillation (irregular P waves > or =0.15 mV in > or =1 ECG lead). INTERVENTIONS: Patients were randomised to receive external cardioversion (group A, n = 30) or TV-IVC ablation +/- DC cardioversion (group B, n = 27). MAIN OUTCOME MEASURES: Cardiac rhythm, scores on quality of life and symptom questionnaires were assessed at 4, 16 and 52 weeks after the procedure. RESULTS: 20 (67%) patients in group A and 19 (70%) patients in group B were in sinus rhythm immediately after their index procedure. At 4, 16 and 52 weeks, the number of patients in sinus rhythm were 5, 3 and 2 in group A and 3, 3 and 1 in group B (p = NS). The quality of life and symptom questionnaire scores were similar in the two groups at each period of follow-up, although they were significantly better for sinus rhythm than for atrial fibrillation at each follow-up visit. CONCLUSIONS: As a first-line strategy, TV-IVC ablation offers no advantages over direct current cardioversion for the management of coarse atrial fibrillation.

Atrial Fibrillation↗
PubMedDate not supplied

High efficacy and low frequency of headache recurrence after oral sumatriptan. The Oral Sumatriptan Italian Study Group.

This multicentre, double-blind study compared (100 mg) sumatriptan administered orally with placebo in treating an acute attack of migraine; 238 patients were studied over a 48-h period. Four hours after treatment, 92 of the 142 evaluable sumatriptan patients (65%) showed significant reductions (P < 0.001) in headache severity, clinical disability and accompanying symptoms compared with 32 of the 80 evaluable placebo-treated patients (40%). The duration of attack prior to taking medication and the history of persistent migraine do not influence the observed difference between the two treatment regimens (sumatriptan and placebo), which remained statistically significant (P < 0.001) in both cases. The incidence of headache recurrence in patients who experienced relief 4 h after initial treatment was low, occurring in 16 (17%) and 4 (13%) of the sumatriptan- and placebo-treated patients, respectively. Only patients with a history of migraine attacks lasting longer than 24 h suffered headache recurrences, and these recurrences were not consistent with the International Headache Society definition of migraine. Treatment with sumatriptan was well tolerated.

Acute Disease↗
PubMed2001

Recurrence of curetted and bone-grafted giant-cell tumours with and without adjuvant phenol therapy.

AIMS: Giant-cell tumour of bone (GCT) represents 5% of all primary bone tumours. The aim of this study was to compare the outcome of GCT treated with or without phenol. METHODS: Out of 53 patients primarily treated for a giant-cell tumour, 47 were followed, with a median follow-up of 11 (range 4-43) years. All patients were disease-free at the latest follow-up. Of the 40 tumours (85%) located in long bones, 14 (35%) were treated by curettage and bone grafting and 12 (30%) by additional adjuvant phenol treatment. Fourteen patients (35%) received different therapies, including en-bloc resection, endoprosthesis, cement packing or other therapy. RESULTS: There were seven (17.5%) recurrences in long bones after a median of 12 (range 4-60) months, three (3/14, 21%) in the group treated without phenol and three (3/12, 25%) in the group with phenol. Of the seven tumours located in the axial skeleton, two patients died within the first year after surgery. The remaining five patients were followed, with a median follow-up of 12 (range 8-23) years. No patients had metastases or a multicentric tumour. CONCLUSIONS: Despite the different rates of recurrence reported in literature, this study suggests that local recurrence rate of giant-cell tumours located in long bones treated with or without phenol is similar. Adequate removal of the tumour seems to be a more important predictive factor for the outcome of surgery than the use of phenol as an adjuvant therapy.

Adolescent↗
PubMed2005

Local recurrence of squamous-cell carcinoma of the esophagus after EMR.

BACKGROUND: Multicentric squamous dysplasia is frequent in the esophagus and can be visualized by chromoendoscopy (Lugol's solution) as multiple Lugol-voiding lesions (LVLs). Although EMR commonly is used to treat superficial esophageal cancer, new lesions can arise and incomplete resection can result in residual disease. Little is known about the risk factors for local recurrence or the appropriate treatment for recurrent lesions. METHODS: A total of 116 consecutive patients with a total of 165 esophageal squamous-cell carcinomas were studied retrospectively. Follow-up examination by means of chromoendoscopy (Lugol's solution) and biopsies was performed every 3 months during the first year after EMR and every 6 months thereafter. Lesions were defined as a local recurrence when cancer was detected at the site of the EMR scar. Risk factors associated with local recurrence were investigated by using logistic analysis. RESULTS: At a median follow-up of 35 months (range 12-110 months), local recurrence was detected for 33 (20%) of 165 lesions. Of the patient-related factors, multivariate logistic analysis showed that multiple LVLs (OR 3.1: 95% CI[1.1, 8.5]; p = 0.03) was an independent risk factor for local recurrence after EMR. The cumulative local recurrence rates at 3 years in patients with multiple LVLs and those without multiple LVLs were 39% and 14% (p < 0.01), respectively. All of the recurrent lesions except two could be removed by EMR, which was not associated with any serious complication. The remaining two patients had chemoradiotherapy. Overall cause-specific survival at 3 years was 100%. CONCLUSIONS: Patients with multiple LVLs are at risk of local recurrence after EMR. Although careful long-term endoscopic follow-up is needed for such patients, EMR is potentially curative for recurrent lesions.

Adult↗