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PubMed2006

A multi-centre randomized controlled trial comparing electrothermal arthroscopic capsulorrhaphy versus open inferior capsular shift for patients with shoulder instability: protocol implementation and interim performance: lessons learned from conducting a multi-centre RCT [ISRCTN68224911; NCT00251160].

BACKGROUND: The shoulder is the most frequently dislocated joint in the body. Multiple causes and pathologies account for the various types of shoulder instability. Multi-directional instability (MDI) and multi-directional laxity with antero-inferior instability (MDL-AII) are similar in pathology, less common and more difficult to treat. These instabilities are caused by ligamentous capsular redundancy. When non-operative management fails for these patients, quality of life is significantly impaired and surgical treatment is required to tighten the ligaments and joint capsule. The current reference (gold) standard treatment for MDI/MDL-AII is an open inferior capsular shift (ICS) surgical procedure. An alternative treatment involves arthroscopic thermal shrinkage of redundant capsular tissue to tighten the joint. However, there is a lack of scientific evidence to support the use of this technique called, electrothermal arthroscopic capsulorrhaphy (ETAC). This trial will compare the effectiveness of ETAC to open ICS in patients with MDI and MDL-AII, using patient-based quality of life outcome assessments. METHODS: This study is a multi-centre randomized clinical trial with a calculated sample size of 58 patients (p = 0.05, 80% power). Eligible patients are clinically diagnosed with MDI or MDL-AII and have failed standardized non-operative management. A diagnostic shoulder arthroscopy is performed to confirm eligibility, followed by intra-operative randomization to the ETAC or ICS surgical procedure. The primary outcome is the disease-specific quality of life questionnaire (Western Ontario Shoulder Instability Index), measured at baseline, 3, 6, 12 and 24 months. Secondary outcomes include shoulder-specific measures (American Shoulder and Elbow Surgeons Score and Constant Score). Other outcomes include recurrent instability, complications and operative time. The outcome measurements will be compared on an intention-to-treat basis, using two-sample independent t-tests to assess statistical significance. A Generalized Estimated Equations (GEE) analysis will determine whether there is an effect over time. DISCUSSION: This ongoing trial has encountered unexpected operational and practical issues, including slow patient enrollment due to high intra-operative exclusion rates. However, the authors have a greater understanding of multi-directional laxity in the shoulder and anticipate the results of this trial will provide the medical community with the best scientific clinical evidence on the efficacy of ETAC compared to open ICS.

Journal Article↗
PubMed1996

Two-stage cementless revision THR after infection. 5 recurrences in 40 cases followed 2.5-7 years.

We revised 40 infected hip prostheses in 40 patients as a two-stage procedure, including intravenous and oral antibiotics, gentamicin beads, and delayed cementless implantation of porous-coated THR. The duration of antibiotic treatment was 8 weeks. The interval from resection to reimplantation was, on average, 48 (8-108) weeks. 39 patients were followed, on average, 4 (2.5-7) years. 5 patients had a recurrent infection. In patients who did not have a recurrent infection, the Harris hip score exceeded 80 in 32 patients. Radiographically, femoral component migration of 2-6 mm was noted in 3 cases. The recurrent infection rate, and the functional and radiographic results are comparable with those obtained using a two-stage procedure with antibiotic cement.

Adult↗
PubMed1976

Two biological rhythms of perception distinguishing between intact and relatively damaged brain function in man.

A simple test of perception, the Critical Flicker Fusion threshold (CFF) was given successively for 20 mins. to 69 healthy subjects aged 7-63 and to 53 comparable neuropsychiatric patients. The latter could be divided into a functionally sick group and a group with brain damage. Auto-correlation analysis revealed significant sine-wave cycles of amplitude and ultradian frequency for the CFF mean scores and the CFF "Scatter* scores. Both cycles of recurrence showed frequencies which distinguished significantly between the total healthy subjects and the patients. Further analysis showed no difference between controls and emotionally sick patients (i.e. those with sociopathy, schizophrenia and manic depressive psychosis) but there was a highly significant difference between these three groups and patients with relatively damaged C.N.S. (i.e. those with mental deficiency, organic brain syndrome and organic dementia). Even among the control group a progressive increase in frequency of these perceptual cycles occurred with advancing age. These CFF results point to the existence of a cycle of perceptual acuity and another of vigilance in the organism. Both appear to relate to the neural integrity of the C.N.S.

Adolescent↗
PubMed1999

Cementless acetabular revision. Evaluation at an average of 10.5 years.

This study reviews the clinical and radiographic results of 138 consecutive cementless acetabular revisions in 131 patients performed for aseptic loosening at a mean of 10.5 years followup. Kaplan-Meier survivorship of these components was 84% at 11.5 years. Two components (1.8%) in two patients were considered aseptically loose based on radiographic criteria; one patient was symptomatic but the component was not revised because of the patient's poor health, and the other patient was asymptomatic. Pelvic osteolysis was present in 19 hips (17%), appearing at a mean of 103 months. All but two of these were small lesions (< 2 cm) at the periphery of the components. Nevertheless, the incidence of osteolysis has increased with time, and continued followup is warranted. Separation or fragmentation of the fiber-metal porous pads was uncommon (8.3%), but was significantly associated with pelvic osteolysis; this finding has not been reported before with this component. Five patients underwent late revision surgery (after 100 months), one for deep infection, one for periprosthetic femur fracture, and three for late recurrent dislocation. Harris hip scores averaged 81 points (good) at final followup, which is unchanged from the authors' last report on this group. Acetabular revision with a fiber-metal hemispherical component appears durable at a mean followup of more than 10 years.

Acetabulum↗
PubMed1999

[Results of the surgical treatment of patients with basal extracerebral parastem tumors of large and giant dimensions].

A retrospective analysis of the results of treatment of 123 patients with large and giant basal extracerebral parastem tumors was made. The majority of the neoplasms (81%) were acoustic neuromas and meningiomas. The nearest results of the treatment were good in 103 patients and unfavorable results were noted in 20 patients. Postoperative mortality was 8.9%. Four factors negatively influencing the outcome were revealed during the statistical analysis (p < 0.05): low Karnofsky score at admission, regrowth (recurrence) of the tumor, previously performed radiation therapy and shunt surgery as the first stage of treatment. These prognostic factors must be taken into account when choosing the best treatment of patients with parastem tumors.

Adolescent↗
PubMed2000

Local control of prostate cancer by transrectal HIFU-therapy.

Transrectal high intensity focused ultrasound (HIFU) as a minimal invasive treatment approach of localized prostate cancer was evaluated concerning its efficacy and security. Post-operative monitoring included PSA-levels and histological results of control random biopsies. Seventy-three HIFU sessions were performed on 62 patients during the period from November 1997 to April 2000. Patients were classified in 4 indication groups: 1) localized prostate cancer, T1-T2, initial PSA < 15 ng/ml, Gleason score < 7, volume < 30 cc, no more than 4 of 6 random biopsies affected by cancer, not suitable for radical prostatectomy; 2) localized prostate cancer, T1-T3, no PSA or Gleason score limitation; 3) local recurrence after first line therapy (RPE, radiation, hormonal ablation); 4) for local debulking. Mean plus or minus standard deviation for patient age was 67.5 +/- 7.48 years, for PSA was 7.64 +/- 5.26 ng/ml and for prostate volume was 21.3 +/- 7.9 cc. Median follow up was 15 months (range 5-29) and included PSA development, control sextant biopsies and transrectal color coded duplex sonography (TCCDS) at 1, 3, 6, 12 and 24 months. At least 1 control biopsy result was available in 48 patients. We evaluated the therapy in 3 categories: 1) group 1 (complete response) included 33/48 patients (68.7%) with no residual cancer and PSA < 4 ng/ml; 2) group 2 (biochemical control) 8/48 patients (16.7%) with small residual cancer and PSA < 4 ng/ml; 3) group 3 (failure) 7/48 patients (14.6%) with residual cancer and PSA > 4 ng/ml (4 of them received hormone therapy). As major complications 2 urethrorectal fistulas occurred, both in post-radiation patients, 3 stress-incontinences II-III after TUR post HIFU. In 20 patients (32.3%) transurethral manoeuvres were necessary to remove obstructive necrotic tissue or because of bladderneck or urethral strictures. 11 of these patients were among the first 20 treated patients. Regarding the individual learning curve about technique, indication and the technical developments HIFU treatment can currently be considered as a valid alternative treatment strategy for patients with localized prostate cancer, who are not suitable for radical surgery. HIFU treatment can be repeated depending on biopsy result and PSA development. Local control of the localized prostate cancer was observed in group 1 and 2 (85%).

Aged↗
PubMed2002

[Risk profiles and preventive measures of falls in elderly persons].

Falls in elderly persons are an important health problem. The results of the Longitudinal Aging Study Amsterdam show that thirty percent of older adults over the age of 65 years who live in the community (n = 1285) fall at least once a year. Recurrent falls were reported by about 11% of the participants. In one-year of follow-up, 22 fractures were recorded. In the 'single fall' group 11 subjects (3.9%) suffered from a fracture and in the 'recurrent fall' group 9 subjects (6.1%). The strongest predictors identified in the risk profile for recurrent falls were previous falls, urinary incontinence, visual impairment and functional limitations (Area Under Curve, 0.71). The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7% (95% CI, 4.0-5.4%) to 46.8% (95% CI, 43.0-50.6%). Risk profiles are needed to identify people at high risk. For matters of feasibility and efficiency, preventive measures of falls should preferably be focussed on those subgroups that have the highest risk of falls.

Accidental Falls↗
PubMed2002

Preservation of parotid function with uncomplicated conformal radiotherapy.

BACKGROUND AND PURPOSE: To evaluate (1) parotid function, (2) subjective xerostomia and (3) pattern of relapses after conformal parotid-sparing radiotherapy (RT) for head and neck cancer. (4) To study dose-response curves of parotid glands. MATERIAL AND METHODS: From September 1999 to November 2000, 39 head and neck cancer patients requiring bilateral neck RT were treated with a fairly simple conformal RT technique (three-field set-up+anterior lower neck field; two opposed oblique boost fields). The contralateral parotid was spared. Parotid function was assessed by salivary gland scintigraphies performed before, early (median 4 weeks) and late (median 28 weeks) after RT. Xerostomia was monitored by visual analogue scales (VAS) and LENT SOMA scores. Location of locoregional recurrences was studied in relation to the radiation fields. A dose-response curve of parotids was created using logistic regression. RESULTS: (1) Early after RT, on salivary gland scintigraphy, the mean loss of secretion function in the spared parotid was 67% and total in the non-spared. Late after RT, the mean loss remained 19% in the spared and total in the non-spared parotid. Normal excretion function was regained in 75% of the spared parotids. (2) Late after RT, 78% of patients had no, minimal or acceptable subjective xerostomia. (3) No recurrence was seen near the spared parotid (11/39 locoregional recurrences). (4) The dose-response curve of parotids showed that the mean parotid dose should preferentially be < or =20 Gy, to obtain a good chance (> or =70%) for preservation of its function on scintigraphy. CONCLUSIONS: An easy conformal parotid-sparing RT technique prevents moderate or severe subjective xerostomia in 78% of patients. In the spared parotids, nearly complete to complete recovery is obtained after 6-12 months.

Adult↗
PubMed2002

Results of inguinal canal repair in athletes with sports hernia.

AIMS: To evaluate the role of surgical exploration and repair of the inguinal canal in athletes suspected of having a sports hernia. METHODS: Thirty-five (34 males, 1 female) athletes with a suspected sports hernia underwent surgical exploration and inguinal hernia repair. After six months, all athletes were sent questionnaires to assess any improvement in analogue pain scores, return to sport, recurrence of symptoms and the overall result of surgery. RESULTS: Operative findings revealed a tear in the external oblique aponeurosis with or without a significant posterior bulge (n=20), a lone significant posterior bulge (n=10), a tear in the conjoint tendon with dilated superficial ring (n=3), small direct hernial sac (n=1) and lipoma of the spermatic cord (n=1). Surgery consisted of repair of external oblique tear (when present) and prolene darn or lichtenstein mesh repair of the posterior inguinal canal. Twenty-seven patients replied to the questionnaire giving a response rate of 78%; of these, 25 patients (93%: 95% CI 83-100) had returned to normal athletic activities at pre-injury level. There was a marked improvement in level of pain (median pain level=8 pre-operative vs 2 post-operative, p<0.001). Eleven patients (41%) rated the results as excellent, eleven (41%) as good and five (18%) as fair and none worse. Six patients complained of occasional discomfort related to the scar. Three patients complained of recurrence of their symptoms after 4 to 5 months following strenuous exercise. CONCLUSION: Sports hernia presents with a spectrum of surgical findings. Athletes with sports hernia should be considered for routine hernia repair, as the majority of the patients benefit from surgery. It is important to offer a structured rehabilitation programme to maximise the benefits of surgery.

Adult↗
PubMed2006

[Clinical observation on Qingling Dingxuan Decoction in treating vertigo cause by insufficient blood-supply of ventebrobasilar artery].

OBJECTIVE: To observe the therapeutic effect of Qingling Dingxuan Decoction (QDD) on vertigo caused by insufficient blood-supply of ventebrobasilar artery (IBVA). METHODS: Thirty-nine patients were divided into the flunarizine group (n=19) and the QDD group (n=20) treated with respective medicine on the base of routine treatment with Chinese and Western medicine. The clinical efficacy and recurrent rate were observed and compared. RESULTS: Compared with those in the flunarizine group, clinical curative effect was better, recurrent rate lower, symptom score higher, hemorheological parameters and transcranial doppler indexes were improved more significant in the QDD group (P < 0.01 or P < 0.05). CONCLUSION: QDD had obvious therapeutic effect on IBVA. Improvement of microcirculation and reduction of blood viscosity may be one of the therapeutical mechanisms.

Adult↗
PubMed1994

The open palm technique in the treatment of Dupuytren's disease.

Twenty-eight patients (33 hands) were reviewed an average 2.5 years after an open palm technique combined with partial fasciectomy for the correction of Dupuytren's disease. They were assessed by diathesis evaluation and Tubiana's score. Results show a recurrence rate of 33.5% (3% severe), an extension rate of 51.5% and an overall complication rate of 21% without reflex sympathetic dystrophy. Fifteen percent and 12% had an important deficit in flexion and extension respectively. These findings are comparable to those found in the literature.

Adult↗
PubMed1998

The influence of hepatitis C virus genotypes on the outcome of liver transplantation.

BACKGROUND: The aim of this study was to report the influence of hepatitis C virus (HCV) genotypes and HLA matches on the outcome of liver transplantation, hepatitis recurrence, and progression to cirrhosis after transplantation. METHODS: HCV genotypes were determined from pretransplantation sera and/or liver explant tissues from 202 patients with HCV-related end-stage liver disease. One hundred fifty patients with known infecting genotype for whom posttransplantation biopsy specimens were available or who had normal results of liver injury tests constituted the group analyzed. Patients were followed up for up to 4.5 years. Hepatitis activity index scores at the time of disease recurrence were used to assess disease activity. Cirrhosis was diagnosed by using histological evidence. The number of HLA matches with respect to A, B, DR, and DQ loci was determined. RESULTS: The rates of hepatitis recurrence were 25% and 75% at 1 year and 4 years, respectively; Kaplan-Meier survival analysis did not reveal significant differences between the infecting genotypes with respect to overall rates of survival or recurrence of hepatitis. At hepatitis recurrence, hepatitis activity index scores did not differ between the genotype groups. The distribution of infecting genotypes among the 7 patients who developed cirrhosis is reflective of pretransplantation distribution. Neither HLA site-specific nor total matches affected the rates of survival or disease recurrence. CONCLUSIONS: The infecting HCV genotype had no influence on the incidence or severity of recurrent hepatitis, rate of survival, or development of cirrhosis. HLA matching does not influence transplantation outcome for HCV-related disease.

Adult↗
PubMed2002

Improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason score.

PURPOSE: Previous studies have suggested that prostate specific antigen (PSA) density is a significant independent predictor of biochemical failure after primary therapy. We determined whether pathological PSA density using surgical weight of the radical prostatectomy specimen was an independent predictor of adverse pathological features or biochemical recurrence after radical prostatectomy. We also examined whether combining pathological PSA density with biopsy Gleason score improved risk stratification compared with serum PSA and biopsy Gleason score for predicting PSA recurrence after prostatectomy. MATERIALS AND METHODS: Multivariate analysis was used to determine whether pathological PSA density was an independent predictor of adverse pathology or PSA recurrence after radical prostatectomy in 325 patients treated at a Veterans Affairs medical center. Cutoff points of pathological PSA density were generated to identify patients at various risks for biochemical recurrence. These cutoffs were combined with biopsy Gleason cutoff points 2 to 6, 7 and 8 to 10 to generate a risk stratification system that was compared with a previous risk stratification system using PSA and biopsy Gleason score cutoff points. The validity of the risk stratification system using pathological PSA density and biopsy Gleason score was evaluated in another cohort of 490 patients treated with radical prostatectomy at a tertiary care medical center. RESULTS: Pathological PSA density was an independent predictor of positive surgical margins (p <0.001), nonorgan confined disease (p <0.001), seminal vesicle invasion (p = 0.003) and biochemical recurrence after radical prostatectomy (p <0.001). The cutoff points for pathological PSA density of less than 0.3, 0.3 to 0.7 and greater than 0.7 ng./ml./gm. separated patients into 3 distinct groups at increasing risk for biochemical failure after radical prostatectomy (p <0.001). Pathological PSA density cutoffs combined with biopsy Gleason score cutoffs 2 to 6, 7 and 8 to 10 provided better risk stratification for biochemical failure than cutoffs based on a combination of PSA and biopsy Gleason score in patients treated at the Veterans Affairs (hazards ratio 3.04, confidence interval 2.25 to 4.11, p <0.001) and tertiary care (hazards ratio 2.38, confidence interval 1.78 to 3.18, p <0.001) medical centers. CONCLUSIONS: Pathological PSA density was a strong predictor of advanced pathology and biochemical failure after radical prostatectomy. Pathological PSA density combined with biopsy Gleason score defined a novel risk group system that improved risk stratification compared with a combination of PSA and biopsy Gleason score. These results were validated in another cohort of patients treated with radical prostatectomy at a tertiary care medical center. Further studies are required using PSA density values calculated from preoperative transrectal ultrasound measurements to determine whether a combination of PSA density and biopsy Gleason score provides significant pretreatment risk stratification.

Aged↗
PubMed2001

Correlation of perineural invasion on radical prostatectomy specimens with other pathologic prognostic factors and PSA failure.

OBJECTIVE: The aim of this study is to evaluate the relationship between perineural invasion (PNI) and other pathologic prognostic factors in radical retropubic prostatectomy (RRP) specimens and also to assess the role of PNI in prostate-specific antigen (PSA) recurrence after RRP. METHOD: 191 consecutive patients had undergone RRP for clinically localized prostate cancer between 1992 and 2000. PNI in RRP specimens and its relation to histopathologic stage and surgical margins is investigated retrospectively. PNI, histopathologic stage, surgical margin status, Gleason score and PSA parameters were used as variables in multivariate analysis for recurrence. RESULTS: PNI is correlated statistically significantly with histopathologic stage, positive surgical margins, specimen Gleason score and recurrence. Mean time to failure was earlier in patients with PNI than patients without PNI (56 vs. 73 months, log-rank 15.67, p<0.001). Lymph node involvement, positive surgical margins and PNI remained as independent predictors of recurrence in multivariate analysis. All patients with PNI, positive surgical margins and lymph node metastasis failed in 6 months. CONCLUSION: PNI is an important prognostic factor that should be taken into consideration in clinical patient management and follow-up after RRP. The presence of PNI together with positive surgical margins and lymph node metastasis may warrant early adjuvant treatment.

Aged↗
PubMed2001

Cell proliferation activity in posterior uveal melanoma after Ru-106 brachytherapy: an EORTC ocular oncology group study.

AIM: To evaluate the cell proliferation activity in posterior uveal melanomas after Ru-106 brachytherapy. METHODS: Eyes containing choroidal or ciliary body melanoma from seven ocular oncology centres, which were enucleated after first being treated by Ru-106 brachytherapy and which had enough melanoma tissue to enable histological assessment, were included. The 57 eligible specimens were divided into a group of 44 eyes that were enucleated because of tumour regrowth, and a non-recurrent group of 13 eyes that were enucleated because of complications such as neovascular glaucoma. 46 non-irradiated eyes harbouring uveal melanoma served as a control group. All specimens underwent routine processing. They were cut into 5 microm sections, and were stained with two main cell proliferation markers: PC-10 for PCNA and MIB-1 for Ki-67. The stained sections were assessed, and the cells that were positive in the immunostaining were counted in each section. The results were evaluated by various statistical methods. RESULTS: The PC-10 score showed a statistically significant difference across the three groups (p = 0.002). The control group showed the highest PC-10 score (median 31.0 PCC/HPF) followed by the tumour regrowth group (median 4.9 PCC/HPF). The lowest PC-10 scores were found in the non-recurrent tumours (median 0.05 PCC/HPF). The MIB-1 score in the control group (median 5.77 PCC/HPF) was similar to the regrowth group (median 5.4 PCC/HPF). In contrast, the MIB-1 score in the non-recurrent tumours was statistically significantly lower (median 0.42 PCC/HPF). The PC-10 and MIB-1 scores were similar in tumours composed of either spindle cells or epithelioid cells in all groups. CONCLUSIONS: The non-recurrent melanomas demonstrate significantly lower cellular proliferation activity than melanomas that showed regrowth or that were not irradiated at all. In our hands, PCNA gave more meaningful information than Ki-67. Our findings strongly support the need for treating regrowing posterior uveal melanoma either by enucleation or re-treatment by brachytherapy. On the other hand, also in the non-recurrent uveal melanomas there are viable cells with potential for proliferation, although fewer in number, with unknown capacity for metastatic spread. Therefore, the irradiated tumours should be followed for many years, probably for life.

Analysis of Variance↗
PubMed2003

Erythropoietin and the erythropoietin receptor are expressed by papillary thyroid carcinoma from children and adolescents. Expression of erythropoietin receptor might be a favorable prognostic indicator.

Erythropoietin (EPO) and the EPO receptor (EPO-R) have been implicated in solid tumors of the brain, breast, kidney and female genital tract. Based on their expression by a variety of tumors, we hypothesized that EPO and/or EPO-R might be expressed by thyroid cancers. To test this, we determined EPO and EPO-R expression by immunohistochemistry in 17 papillary thyroid carcinomas (PTC) from children and adolescents. Only a minority of PTC (4/17, 24%) expressed EPO, and there were no significant differences between the PTC that did or did not express EPO. In contrast, EPO-R was detected in the majority of PTC (11/17, 65%). The average tumor size (1.5 +/- 0.8 cm), MACIS score (3.6 +/- 0.2) and risk of recurrence (0/11) for the EPO-R(+) PTC were significantly less than those for PTC that failed to express EPO-R (average tumor size = 3.6 +/- 2.4 cm, p = 0.021; average MACIS score = 4.3 +/- 0.7, p = 0.004; recurrence = 3/6, p = 0.029). We conclude that the majority of PTC from children and adolescents express EPO-R, a finding associated with favorable prognostic indicators and a lower risk of recurrence.

Adolescent↗
PubMed2004

Causes and treatment of recurrent dysphagia after self-expanding metal stent placement for palliation of esophageal carcinoma.

BACKGROUND AND STUDY AIMS: Recurrent dysphagia frequently complicates the palliative treatment of esophageal cancer with self-expanding metal stents. Strategies for repeat interventions and subsequent outcomes have not been adequately reported to date. PATIENTS AND METHODS: A total of 216 patients underwent placement of a self-expanding metal stent (Ultraflex, n = 75; Flamingo Wallstent, n = 71; Z-stent, n = 70) for malignant dysphagia, and were followed up prospectively. The causes of stent-related recurrent dysphagia, the intervals after first stent placement, and the procedures used for repeat intervention and their outcomes were evaluated. RESULTS: Seventy-four episodes of stent-related recurrent dysphagia occurred in 63 patients (29 %), mainly due to tumor overgrowth (n = 30; median 129 days), stent migration (n = 26; median 92 days) and food bolus obstruction (n = 16; median 80 days). Stent migration occurred more frequently ( P = 0.05), whereas tumor overgrowth occurred less frequently ( P = 0.05) with Ultraflex stents in comparison with Flamingo Wallstents and Z-stents. Tumor overgrowth was treated in 25 patients mainly by a second stent (n = 19) and was effective in 23 of the 25 patients (92 %). Five patients received no further treatment. Stent migration was treated by placing a second stent (n = 14), repositioning the migrated stent (n = 7), other treatments (n = 3), or no further treatment (n = 2), and treatment was effective in 20 of 24 (83 %) patients. Food bolus obstruction was treated by endoscopic stent clearance in all patients. Repeat intervention for stent-related recurrent dysphagia improved the dysphagia score from a median of 3 to 1 ( P < 0.001). The median survival period after repeat treatment was 68 days. CONCLUSIONS: Recurrent dysphagia occurs in almost one-third of patients after stent placement. Repeat interventions for stent-related recurrent dysphagia are effective in over 90 % of patients. New innovations in stent design are needed to reduce the risk of stent-related recurrent dysphagia.

Adenocarcinoma↗
PubMed2005

Stratification of intermediate-risk endometrial cancer patients into groups at high risk or low risk for recurrence based on tumor gene expression profiles.

PURPOSE: Endometrial cancers classified as "intermediate risk" based on clinical and/or pathologic features are associated with a 15% to 20% risk of recurrence. Here, we test whether global gene expression profiling can distinguish intermediate-risk tumors into high-risk and low-risk subgroups. EXPERIMENTAL DESIGN: Tumor specimens were obtained from 75 intermediate-risk endometrial cancer patients, 13 who had recurred and 62 who had not recurred with a median follow-up of 24 months. Gene expression profiles were obtained using the Affymetrix U133A GeneChip oligonucleotide microarray. The genes most associated with risk of recurrence were used to create a risk score using a leave-one-out cross-validation method and the univariate Cox proportional hazards regression model. Time to recurrence curves for the high-risk and low-risk subgroups were estimated using the Kaplan-Meier method, and the difference in time to recurrence between these two subgroups was tested using the log-rank test. RESULTS: There was a significant difference in time to recurrence between high-risk and low-risk patients using risk scores as defined above (P = 0.04). The estimated hazard ratio (95% confidence interval) was 3.07 (1.00-9.43). CONCLUSIONS: Patients with intermediate-risk endometrial cancers identified as high-risk for recurrence according to a gene expression-based risk score have a significantly increased risk for recurrence compared with those classified as low risk. These findings suggest that gene expression profiling can potentially contribute to the clinical classification and management of intermediate-risk endometrial cancers.

Aged↗