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PubMed2001

[Recurrent inguinal hernia after mesh hernioplasty. An emerging problem?].

BACKGROUND: In spite of the successful results of tension free hernioplasties, recurrent inguinal hernias are not an uncommon finding in the clinical practice. METHODS: The authors report their experience in 24 patients observed from January 1994 to December 2000 (23 men, 1 women, min. age 28 yrs, max 78 yrs, mean 58 yrs) who had recurrent inguinal hernia after a tension free hernioplasty. In 22 patients a tension free hernioplasty (Lichtenstein technique 5 patients, Trabucco 7 patients, unclassifiable 10 patients) through an anterior approach was performed while in two, respectively, a Stoppa procedure and a laparoscopic hernioplasty were the first operations; mean recurrence time was 17 months. RESULTS: Mesh and/or plug dislocation was the most frequent cause of recurrence (15 patients), followed by a failure of the internal ring reconstruction (6 patients) and loss of the pubic stitch (2 patients); in 1 patient the mesh was of reabsorbable type. CONCLUSIONS: Mesh hernioplasties represent a valuable progress in inguinal hernia therapy, but increasing clinical experience shows that, together with the experience of the surgeon in the surgical technique, suture of a wide mesh to the surrounding tissues and a adequate inguinal ring reconstruction are critical condition for good results.

Adult↗
PubMed1997

[Osteochondral fractures of the external femoral condyle after traumatic patellar dislocation during physical exercise in children].

PURPOSE OF THE STUDY: Nineteen osteochondral fractures of the lateral femoral condyle associated with acute traumatic patellar dislocation resulting from sport injury in children were studied. The purpose of this study was to specify clinical and radiological features. MATERIAL AND METHOD: This study was led with special care to injury circumstances, fracture visibility on X-rays, size and location of the fracture, treatment delay, presence of femoro-patellar dysplasia signs. Treatment results were evaluated on knee pain, bone consolidation and recurrent dislocation. RESULT: Thirteen boys and six girls aged 8 to 16 years (average 14 years) were included. The injury resulted from a rotatory-compression stress in 75 per cent cases. The patella was always in place at the time of examination. Thirteen fractures were diagnosed within 24 hours and 5 fractures were diagnosed within 1 week after injury. One fracture was not visible on X-rays and was diagnosed 6 weeks after injury. Only the lateral view showed the fracture in more than one case out of two. Seven patients whose fracture was less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, were treated by knee arthroscopy and removal of the osteochondral fragment. Twelve patients were treated by arthrotomy and excision (one case) or replacement of the osteochondral fragment (11 cases). The replaced fracture was fixed with biological glue ten times, and screwed once. The knee was immobilised in a cylinder cast and weight-bearing prohibited for six weeks. Bone consolidation was obtained in 9 cases out of 11, in an average of 8 weeks. Knee pain occurred 5 times. Recurrence of the dislocation occurred 3 times within 6 months. Eighty per cent of these children showed patello-femoral dysplasia. DISCUSSION: This fracture complicated 31.6 per cent of traumatic patellar dislocation resulting from sport injury in children which we observed during the last ten years. It may be overlooked if it is suspected and carefully looked for by radiographic examination including antero-posterior, lateral, oblique and true skyline views of the patella. The presence of fat in the hemarthrosis may help. Early surgery is recommended. Arthroscopy may be performed to evaluate fracture location and size. After ten days, host area begins to fill in and free fragment will not fit back well. Fragments less than 5 mm, or involving a non-weight-bearing portion, or diagnosed within more than ten days after injury, may be removed. CONCLUSION: Lateral femoral condyle osteochondral fractures are associated with nearly one third of traumatic patellar dislocation resulting from sport injury in children. A detailed radiographic examination can help diagnosis. Treatment depends on the delay after injury, the size and location of the fracture.

Adolescent↗
PubMed2003

Symptoms at the time of arrhythmia recurrence in patients receiving azimilide for control of atrial fibrillation or flutter: results from randomized trials.

BACKGROUND: Azimilide is a new antiarrhythmic agent being developed for the management for atrial fibrillation and flutter (AF). Four randomized, placebo-controlled, double-blind trials have been performed that investigated the effect of azimilide on time to first recurrence of symptomatic AF. This paper examines the data collected during those studies regarding the symptoms reported by patients at the time of AF recurrence METHODS: At the time that patients reported their first documented symptomatic recurrence of arrhythmia, they were systematically asked whether or not they were experiencing any of the following 6 symptoms: palpitation, fatigue, chest pain, shortness of breath, dizziness, or sweating. Patients were required to answer yes or no. A symptom score was created varying from 0 to 6, in increasing order of number of symptoms reported. This was compared for patients receiving either of 2 doses of azimilide or placebo. The relationship between the number of symptoms, heart rate at time of arrhythmia recurrence and treatment was analyzed. RESULTS: In 2 separate studies, azimilide at a dose of 125 mg/day significantly reduced the number of symptoms at the time of arrhythmia recurrence compared to placebo. On the other hand, in 2 studies, the dose of 100 mg/day did not significantly reduce symptom burden. The individual symptoms significantly reduced by azimilide125 mg/day were fatigue, shortness of breath, chest pain and dizziness. Palpitations and sweating were not significantly reduced. Modeling of heart rate at the time of arrhythmia recurrence, symptoms and treatment indicated that a small reduction in heart rate with azimilide accounted for only a small part of the symptom reduction. There was another effect of azimilide: an average reduction of 0.38 symptoms (P <.01) that was independent of heart rate. CONCLUSION: Azimilide (125 mg/day) reduces the number of symptoms reported at the time of AF recurrence.

Anti-Arrhythmia Agents↗
PubMed2004

[Clinical and neuroimage characteristics of primary central nervous system lymphoma].

OBJECTIVE: To analyze the clinical and neuroimage characteristics of primary central nervous system lymphoma and explore the methods of treatment. METHODS: The clinical data of 28 cases of primary central nervous system lymphoma were analyzed retrospectively. RESULTS: All the 28 patients with lyphoma were proved by craniotomy and pathologic study. The survival periods were 5 days to 40 months after the craniotomy. Eighteen patients received radiotherapy after the operation. Sixteen recurrent cases were proved by neuroimage and the minimum recurrent time was the 29th day after the operation. CONCLUSION: The duration of primary lymphoma in the central nervous system is short and the clinical symptom is serious. The neuroimage of primary lymphoma in the central nervous system has some characteristic changes. The recurrence may occur over a brief time after the operation even though the tumor has been totally removed under the microscope. The majority of lymphomas are sensitive to radiotherapy.

Adolescent↗
PubMed1999

A novel form of ascertainment bias in case-control studies of cancer screening.

In case-control studies of cancer screening, some have generally admonished investigators against case definitions based on diagnosis dates because of lead-time bias. However, perhaps partly due to vagueness, the admonitions have been frequently ignored. A recurrence-time model simulates case ascertainment when diagnosis must occur within a specific calendar period. The model depends on screening test sensitivity and rate, age-specific preclinical incidence rates, and preclinical duration time and survival time distributions. For one study of sigmoidoscopic screening for colorectal cancer, when the true odds ratio is 1, its estimate is 0.50 to 0.75 under plausible assumptions. This bias can affect any observational study wherein case definition depends on diagnosis times (e.g., health-plan enrollment data). To avoid bias in observational investigations of cancer screening wherein the case definition depends on the diagnosis date, one must ensure that both screening and preclinical incidence do not occur before the case definition period.

Adult↗
PubMed1998

The mesh plug technique for recurrent groin herniorrhaphy: a nine-year experience of 407 repairs.

BACKGROUND: Recurrent inguinal hernias can be repaired efficaciously by mesh plug techniques, which have had better results than traditional tissue-based repairs in several small studies. This report provides a detailed description and assessment of the anterior, tension-free, "umbrella" mesh plug method for recurrent groin herniorrhaphy. METHODS: We performed a retrospective analysis of 407 patients with recurrent inguinal and femoral hernias treated with an umbrella mesh plug repair since 1989. Information was recorded about postoperative recovery and complications, and patients were examined for rerecurrences 1 week after operation and annually thereafter. RESULTS: Of the 320 patients with a first-time recurrence, 6 (2%) had a recurrence after placement of a mesh plug. Of the 87 patients who had undergone 2 or more prior repairs, 8 (9%) had a rerecurrence subsequent to a mesh plug hernioplasty. Nine (64%) of the 14 rerecurrences were noted within 1 year of operation; 4 (29%) were found 2 years after operation and 1 (7%) during postoperative year 3. During the 9 years of follow-up study, a mesh plug has not been involved in any infectious process requiring removal. There have been no instances of draining sinus tracts, ischemic orchitis, long-term pain, vascular and embolic phenomena, or plug erosion and migration. Two hundred fifteen (53%) of the patients took no pain medication. One hundred fifty-nine patients (39%) used nothing more than nonprescription pain medicine. Three hundred seventy-five patients (92%) returned to normal daily activities within 4 days of the herniorrhaphy. CONCLUSIONS: Patients with recurrent groin hernias, who undergo a minimal-dissection umbrella mesh plug repair, have a rapid recovery and few postoperative complications.

Follow-Up Studies↗
PubMed1976

Surgical salvage after radiation for laryngeal cancer.

From January, 1962, through December, 1973, 1,084 patients with cancer of the intrinsic larynx were treated at the Mayo Clinic. Of the 1,084 patients, 136 were retreated after radiation therapy failed to cure their cancer (105 glottic, 30 supraglottic, and one subglottic cancers). Recurrence of glottic cancer was generally recognized later than recurrences in the supraglottic area; likewise, glottic cancers were more advanced at recurrence than supraglottic growths. When feasible, conservation surgery was carried out on both glottic and supraglottic growths. Unfortunately, many growths were too advanced for conservation surgery by the time recurrence was recognized. The concept of "radiate-and-watch" for early glottic and supraglottic cancers is designed to save larynges. The concept is not supported by this study.

Adolescent↗
PubMedDate not supplied

[Results of point stenting of extended coronary stenosis in patients with ischemic heart disease].

The paper analyzes the immediate and long-term results of point stenting in patients with extended (more than 30 mm) coronary stenoses and compares them with those obtained by routine stenting. The study included 177 patients with varying extent stenoses who underwent traditional implantation of intracoronary stents. Thirty-seven patients undergone the so-called point stenting formed a separate group. There was no significant difference in clinical and angiographic success rates between the patients of all three groups. Significant difference was also absent in subacute stent thrombosis between the patients of Groups 2 and 3 and those of the point stenting group. Thus, acute or subacute stent thrombosis was noted in 4 (2.3%) patients from the routine stenting groups, all the patients being from Groups 2 and 3, and in 2 (5.4%) from the point stenting group. No significant difference was found in the incidence of recurrent angina pectoris (restenosis) between Groups 1 and 2 and between Groups 2 and 3. At the same time, recurrent angina (restenosis) significantly more frequently developed in the patients of Group 3 than those of Group 1. As compared with Groups 2 and 3 patients, there was no significant difference in the incidence of recurrent angina (restenosis).

Acute Disease↗
PubMed2004

Procedures of choice for resection of primary and recurrent liver metastases from colorectal cancer.

Although liver resection offers the only realistic chance of cure for patients with liver metastases from colorectal cancer, no consensus exists as to the procedure of choice for managing these tumors. Data from 193 patients who underwent hepatectomy for liver metastases from colorectal cancer and 26 of 193 patients who underwent repeat hepatectomy for recurrent metastases were collected. The suitability of resection was evaluated retrospectively based on known risk factors for recurrence and patterns of recurrence. On multivariate analysis, a positive surgical margin (SM+) was the only risk factor for recurrence after the initial resection (p < 0.01). SM+ (p < 0.01) and nonanatomic resection (p < 0.05) that was less than a sectionectomy (p < 0.05) were risk factors for recurrence after repeat hepatectomy. Multiple tumors (four or more) was the most common pattern of recurrence after initial hepatectomy, and recurrence close to the line of resection was most common after repeat hepatectomy. Based on tumor doubling times, recurrence after initial hepatectomy seemed to originate from the primary colorectal lesion, whereas recurrence after repeat hepatectomy was derived from a hepatic metastasis. Retrospective analysis suggests that hepatectomy with clear surgical margins is more important than anatomic resection for initial hepatectomy, and at least sectionectomy is necessary for repeat hepatectomy.

Colorectal Neoplasms↗
PubMed2006

Recurrent localized fibrous tumor of the pleura.

Localized fibrous tumors of the pleura are rare. They are often asymptomatic and may have symptoms based on size, bronchial invasion, or hormone production, or a combination of these. Complete resection offers the best chance of cure. However, recurrence is reported in a significant number of patients and can often be treated by repeated resection, albeit with increasing difficulty. We present a case in which delayed recurrence occurred after excision of such a tumor. This required a chest-wall resection and reconstruction after which a second recurrence occurred. Further thoracotomy including a latissimus dorsi free flap procedure was needed for a third-time recurrence.

Diaphragm↗
PubMed1984

Application of simulation techniques for estimating duration of multiple sclerosis derived from prevalence-formed cohorts.

Comparisons of the average duration of multiple sclerosis derived from a prevalence survey of cases alive in 1970 in a low-risk area (Los Angeles County, California) and a high-risk area (King and Pierce Counties, Washington) suggest that patients in the high-risk area had a longer duration of disease than patients in the low-risk area. Because this finding was unexpected and because the underlying population of these two areas has been increasing at different rates, two simulation models were developed to estimate the duration of multiple sclerosis from a prevalence survey, taking into account the effects of changes in the population over time. Comparison of the durations derived from the two simulation studies suggested that underestimation of true backward recurrence time from the simulation studies was similar for the two study areas. Thus, the observed differences in duration between the two areas probably reflect the course of disease rather than differences in rate of growth of the two populations. These studies demonstrate the usefulness of simulation studies in estimating disease duration from cohorts derived from prevalence surveys of non-stable populations.

Adult↗
PubMed1995

Prognostic factors for head and neck tumor recurrence.

The introduction of new treatment methods has stimulated the identification of further prognostic factors capable of defining the clinical and biological characteristics of the tumor type in question and improving treatment programming. The aim of this study was to identify which characteristics of the host and tumor are of prognostic value in relation to the onset of locoregional tumor recurrence. A total of 396 patients were studied. The tumor site distribution can be summarized as follows: 267 laryngohypopharyngeal, 74 oropharyngeal, 55 oral cavity. Variables regarding patient, tumor and histology were evaluated for the purpose of analysis. Multivariate analysis of these prognostic factors was performed using PLR software by BMDP. Mean tumor recurrence time was 19 months. Seventeen of the 29 variables analysed did not influence the probability of tumor recurrence. Two variables reduced the risk of tumor recurrence: age > 61 years and abundant and prevalently lymphocytic intra-and peritumoral infiltrate. The study of tumor recurrence onset mechanisms is justified by its impact on the evolution of disease. The use of multivariate analysis in this study showed that some clinical and pathological characteristics of squamous cell carcinoma of the head and neck have a statistically significant impact on tumor recurrence.

Adult↗
PubMed2003

Recurrence of fidelity in nearly integrable systems.

Within the framework of simple perturbation theory, recurrence time of quantum fidelity is related to the period of the classical motion. This indicates the possibility of recurrence in nearly integrable systems. We have studied such possibility in detail with the kicked rotor as an example. In accordance with the correspondence principle, recurrence is observed when the underlying classical dynamics is well approximated by the harmonic oscillator. Quantum revival of fidelity is noted in the interior of resonances, while classical-quantum correspondence of fidelity is seen to be very short for states initially in the rotational Kolmogorov-Arnold-Moser region.

Journal Article↗
PubMedDate not supplied

Postoperative adjuvant chemotherapy is effective in gastric cancer with serosal invasion: significance in patients chosen for multivariate analysis.

There are few reports on overall usefulness of adjuvant chemotherapy in gastric cancer patients. We tried to clarify, using multivariate analysis, usefulness of postoperative adjuvant oral chemotherapy in advanced gastric cancer patients after curative resection. Four hundred and eighty-two gastric cancer patients enrolled in a randomized controlled trial were classified into 2 groups based on postoperative chemotherapeutic regimen: oral doxifluridine (5'-DFUR, an intermediate metabolite of capecitabine) (n=245) or oral 5-fluorouracil (5-FU) (n=237). The significant prognostic factors in patients with serosal invasion were chemotherapeutics (5'-DFUR vs. 5-FU) (risk ratio 1.649; 95% CI, 1.112-2.437), lymph node metastasis (no vs. yes) (2.823; 1.422-5.604), and tumor differentiation (differentiated vs. undifferentiated) (1.727; 1.068-2.791). Significant factors influencing peritoneal recurrence time were chemotherapeutics (1.756; 1.063-2.902), serosal invasion (no vs. yes) (2.237; 1.264-3.961), lymph node metastasis (2.541; 1.267-5.095), tumor differentiation (2.656; 1.374-5.136), and tumor location (others vs. total) (3.595; 2.006-6.443). There were no differences in the overall survival between chemotherapy. However, 5'-DFUR produced a better survival time of patients with serosal invasion than 5-FU, that might be attributed to the prevention of peritoneal recurrence in this subset.

Aged↗
PubMedDate not supplied

[Results of point stenting of extended coronary stenoses in patients with ischemic heart disease].

The paper analyzes the immediate and long-term results of point stenting in patients with extended (more than 30 mm) coronary stenoses and compares them with those obtained by routine stenting. The study included 177 patients with varying extent stenoses who underwent traditional implantation of intracoronary stents. Thirty-seven patients undergone the so-called point stenting formed a separate group. There was no significant difference in clinical and angiographic success rates between the patients of all three groups. Significant difference was also absent in subacute stent thrombosis between the patients of Groups 2 and 3 and those of the point stenting group. Thus, acute or subacute stent thrombosis was noted in 4 (2.3%) patients from the routine stenting groups, all the patients being from Groups 2 and 3, and in 2 (5.4%) from the point stenting group. No significant difference was found in the incidence of recurrent angina pectoris (restenosis) between Groups 1 and 2 and between Groups 2 and 3. At the same time, recurrent angina (restenosis) significantly more frequently developed in the patients of Group 3 than those of Group 1. As compared with Groups 2 and 3 patients, there was no significant difference in the incidence of recurrent angina (restenosis).

Coronary Stenosis↗
PubMed2003

Increased risk of cholestatic hepatitis C in recipients of grafts from living versus cadaveric liver donors.

Histologic injury caused by recurrent hepatitis C virus (HCV) has been reported in up to 90% of HCV-infected patients who undergo liver transplantation with a cadaveric graft. However, the natural history of HCV after living donor liver transplantation (LDLT) is not well described. We performed a retrospective analysis of 68 consecutive HCV-infected adult patients: 45 recipients of cadaveric grafts (CAD) were compared with 23 LDLT patients. Elevated serum transaminases, positive HCV RNA, and liver biopsy consistent with histologic evidence of HCV defined recurrence. When comparing CAD with LDLT, both the incidence of HCV recurrence and time to recurrence were not different. The overall incidence of severe sequelae of HCV recurrence, either cholestatic hepatitis, grade III-IV inflammation, and/or HCV-induced graft failure requiring retransplantation, was also not different when comparing CAD with LDLT. However, when comparing CAD versus LDLT, no CAD patient developed cholestatic hepatitis C, compared with 17% of LDLT who developed this complication (P =.001). Thus, in this patient population, the timing and incidence of HCV recurrence were not different when comparing CAD versus LDLT, but the incidence of cholestatic hepatitis was significantly greater in patients with HCV who underwent LDLT.

Adult↗
PubMed2003

[The surgical management of sacral tumors].

OBJECTIVE: To investigate the way of sacral tumors surgical treatment. METHODS: This retrospective study included 119 cases of sacral tumors surgically treated from July, 1996 to December, 2001. The age of patients ranged from 18 to 80 years (mean 57 years), including of 72 male and 47 female. Out of the patients, there were 52 chordomas, 16 giant cell tumor, 5 neurofibroma, 23 metastases tumors, 9 myeloma, 2 osteoblastomas, 5 aneurysmal bone cysts, 3 osteosarcomas, 4 chondrosarcomas. Posterior approach and combined anterior-posterior approach were used in 83 and 36 cases respectively. Twenty-nine patients had received surgical management at least once and 16 of them had received radiation therapy before came to our department. RESULTS: Three patients died on the complication around the surgery. Most of the patients with metastases tumor or multiple myeloma died 1 to 3 years after the surgery. Out of three osteosarcoma patients, 2 died and one alive with tumor. Three chondrosarcoma patients died, and one alive with tumor. Out of 52 chordoma patients, 3 patients had died of metastatic chordoma, 3 patients died of many times recurrence. Among the other 46 patients who were stay alive, 31 were free from disease with average follow-up time of 42 months. In the patients whose sacral nerve roots had been reserved bilaterally at and above S(3) level, the sphincter muscle function of bladder and bowl was good. While the function of sphincter muscle impaired in 2 patients with nerve roots reserved only at and above S(1) level. To manage these 2 patients, indwelling bladder catheters were used, but colostomy had not been performed. CONCLUSIONS: Complete resection of tumor (radical surgery when possible) is the most effective way to manage sacral tumors. Postoperative adjuvant radiation therapy can reduce the tumor recurrence rate, but it also can cause troubles that would hinder further surgical managements. Even if the tumor is relatively huge and the upper resection margin is as high as at S(1) or S(2) level, the tumor can be removed successfully by posterior approach and the postoperative complications could be accepted. To the patients with aneurysmal cyst or giant cell tumor on sacrum, for control bleeding purpose, anterior approach should be performed to ligate the bilateral internal iliac artery.

Adolescent↗
PubMed2003

The management of high risk prostate cancer.

PURPOSE: A major problem that urologists encounter is the recurrence of prostate cancer after local therapy or the failure of primary therapy. There is no consensus on the treatment of these groups of patients. The role of radiotherapy, hormonal therapy or chemotherapy must be defined. MATERIALS AND METHODS: A comprehensive literature review of the current management of recurrence after primary therapy in prostate cancer was performed using MEDLINE, a review of current urology and oncology journals, and abstracts from recent urology meetings. The data collected focused on the role of radiotherapy, hormonal therapy and chemotherapy in this setting. RESULTS: Defining a high risk group of patients using Gleason score, seminal vesicle or pelvic lymph node involvement and prostate specific antigen recurrence time is important for treating the problem early in disease course. Adjuvant radiotherapy cannot offer a survival advantage but it provides longer biochemical recurrence-free survival. Early administration of salvage radiotherapy in adequate doses provides a success rate similar to that of adjuvant radiotherapy in patients with low prostate specific antigen. Although there is no good evidence that early androgen deprivation definitely prolongs patient survival, increased time to progression in addition to excellent palliation with early hormonal therapy was reported in the majority of trials. Early trials of the use of chemotherapy showed improved survival rates with adjuvant chemotherapy alone or with a combination of hormonal therapy, especially in patients with nonmetastatic disease. CONCLUSIONS: Although analysis of current literature revealed that patients who have recurrence after primary therapy would benefit from radiotherapy, hormonal therapy, chemotherapy or a combination of therapies, additional prospective randomized studies are needed to support these findings.

Antineoplastic Agents, Hormonal↗