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PubMed2003

Salvage radiotherapy for biochemical recurrence after radical prostatectomy: a study of 62 patients.

OBJECTIVES: To determine the predictive factors of prostate-specific antigen (PSA) recurrence after salvage radiotherapy (RT) for biochemical recurrence following radical prostatectomy (RP) to identify patients who may benefit from this treatment. METHODS: From June 1992 to January 2002, 62 patients experiencing PSA recurrence after RP were treated with RT at a dose of 65 Gy. No patient received hormonal therapy. PSA recurrence after RT was defined as three consecutive increased PSA measurements. The risk of experiencing PSA recurrence after RT was analyzed according to 10 factors: patient age, pre-RP PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after RP, time to PSA recurrence after RP, pre-RT PSA level, PSA nadir after RT, and length of follow-up after RT. RESULTS: With a mean follow-up of 44 months (range 3 to 110), 23 patients (37.1%) experienced PSA recurrence after RT. Using univariate analysis, six factors were found to be predictive of PSA recurrence after RT: the length of follow-up after RT (P <0.0001), PSA nadir after RP (P = 0.0004), time to PSA recurrence after RP (P = 0.003), pre-RP PSA level (P = 0.008), Gleason score (P = 0.011), and pre-RT PSA level (P = 0.028). Using multivariate analysis, only the Gleason score (P = 0.015) and length of follow-up after RT (P = 0.02) were found to be predictive of PSA recurrence after RT. A Gleason score greater than 7 was a significant predictor of PSA recurrence after salvage RT (P = 0.04). CONCLUSIONS: In our experience, the Gleason score and length of follow-up were the sole independent predictors of PSA recurrence after salvage RT. Our findings suggest that patients with a Gleason score of 7 or less are more likely to benefit from salvage RT after RP and that the durability of the PSA response may be only transient.

Adenocarcinoma↗
PubMed2005

VEGF significance in peritoneal recurrence from gastric cancer.

BACKGROUND: In gastric cancer, the management of peritoneal dissemination in the Peritoneal cavity is extremely important; however, peritoneal dissemination in the final stage of gastric cancer remains untreatable. Peritoneal dissemination involves several steps, including tumor-cell attachment, invasion, and growth in the peritoneum. Many cytokines, growth factors, matrix metalloproteinases (MMPs), and angiogenic factors play important roles in these steps. So far, few studies have investigated the correlation, if any, between peritoneal dissemination and the angiogenic factor, vascular endothelial growth factor (VEGF). METHODS: Immunohistochemical staining, using the avidin-biotin peroxidase complex method, was performed on slides of surgical specimens from 40 patients with stage II gastric cancer with serosal invasion, who underwent surgery at our hospital between 1990 and 2000. Anti-human VEGF rabbit polyclonal IgG was used as the primary antibody. VEGF expression was classified in one of four categories depending on the percentage of tumor-cell staining (P). VEGF expression was also classified in one of three categories depending on the staining intensity (I). The VEGF expression score was calculated as P x I. RESULTS: There were ten patients with peritoneal recurrence. Of these, seven had macroscopic type-4 scirrhous-type gastric carcinoma. In the immunohistochemical study, the VEGF score of patients with peritoneal recurrence was 9.40 +/- 2.46; on the other hand, that of patients without peritoneal recurrence was 3.47 +/- 2.36. The VEGF score of patients with peritoneal recurrence was significantly higher than that of patients without peritoneal recurrence. In patients with macroscopic type 4, the VEGF score of those with peritoneal recurrence was 9.14 +/- 2.19, while on the other hand, that of the patients without peritoneal recurrence was 3.80 +/- 3.03. The VEGF score of these patients with peritoneal recurrence was significantly higher than that of those without peritoneal recurrence. The survival rate in the VEGF low-expression group was significantly higher than that in the VEGF high-expression group. Multivariate analysis showed that the VEGF score was a significant parameter of peritoneal recurrence. CONCLUSION: These results suggested that VEGF was correlated with peritoneal metastasis from gastric cancer, and that VEGF was a useful indicator of peritoneal recurrence.

Adenocarcinoma, Scirrhous↗
PubMed2001

Expression of the proliferating cell nuclear antigen and clinicopathological features in intracranial meningiomas.

PC10, a monoclonal antibody (mAb) to proliferating cell nuclear antigen (PCNA) is known to show immunoreactivity in paraffin-embedded specimens. The authors present the relation between PCNA expression and clinicopathological features in 38 intracranial meningiomas. PCNA scores were obtained by immunohistochemical staining of the paraffin-embedded sections using a streptavidin-biotin immunoperoxidase method with PC10 mAb. Univariate analysis showed that high PC10 scores were associated with old age (> or = 50 years old), male, recurrent tumours, and meningothelial type. However, these high scores did not reach a statistical significance (P> 0.05). PC10 scores of the basal meningioma tended to be higher than that of the hemispheric meningioma (P< 0.05). The staining intensity of PCNA was also markedly increased in basal meningiomas. It is suggested that the proliferative potential is higher in basal meningiomas than in hemispheric meningiomas. Moreover, these results could reflect high recurrence and difficulty in management of the skull base meningiomas.

Adult↗
PubMed2026

Infancy IgE methylation score and childhood wheezing and asthma: Multicohort study.

BACKGROUND: Early-life epigenetic programming may mediate gene-environment interactions underlying recurrent wheezing and asthma. Multi-CpG methylation scores can summarize the epigenetic potential for high IgE beyond what is captured by observed IgE levels. OBJECTIVE: We sought to establish and examine the residual effect of an epigenetic total IgE (DNAm-IgE) score on respiratory morbidity in a pediatric population. METHODS: We used data from the 35th Multicenter Airway Research Collaboration (MARC-35; n = 560), the 43rd Multicenter Airway Research Collaboration (MARC-43; n = 177), and the Boston Birth Cohort (BBC; n = 80). DNA methylation (Illumina EPIC array) was measured in blood during infancy (MARC-35, MARC-43) and in cord blood at birth (BBC). Total IgE was assessed in blood at infancy, recurrent wheezing at age 3 years, and asthma at age 6 years for all cohorts. RESULTS: MARC-35 data were used to train and evaluate a DNAm-IgE score (R = 0.502 vs total IgE). MARC-43 and BBC data were used to validate the score (R = 0.309 and R = 0.132). In meta-analyses of the 3 cohorts, 1 standard deviation of DNAm-IgE score residuals (DNAm-IgE score regressed on total IgE) was associated with recurrent wheezing (OR = 1.33 [95% confidence interval, 1.11, 1.60], Pheterogeneity = .92), while 1 standard deviation of total IgE was associated with asthma (OR = 1.45 [95% confidence interval, 1.19, 1.76], Pheterogeneity = .29). All models were adjusted for sex, race/ethnicity, and birth weight. CONCLUSION: Early-life epigenetic patterns related to total IgE may contribute to subsequent respiratory morbidity beyond measured IgE levels. The DNAm-IgE score and its residual component should be viewed as exploratory tools that require further validation and mechanistic study.

Humans↗
PubMed2003

The percentage of prostate needle biopsy cores with carcinoma from the more involved side of the biopsy as a predictor of prostate specific antigen recurrence after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

BACKGROUND: The authors previously found that, although the total percentage of prostate needle biopsy cores with carcinoma was a significant predictor of prostate specific antigen (PSA) failure among men undergoing radical prostatectomy (RP), there was a trend toward a lower risk of recurrence in patients with positive bilateral biopsies, suggesting that high-volume, unilateral disease was a worse predictor of outcome than an equivalent number of positive cores distributed over two lobes. In the current study, the authors sought to compare the total percentage of cores with carcinoma directly with the percentage of cores from the more involved or dominant side of the prostate with carcinoma for their ability to predict outcome among men who underwent RP. METHODS: A retrospective survey of 535 patients from the Shared Equal Access Regional Cancer Hospital database who underwent RP at 4 different equal-access medical centers between 1988 and 2002 was undertaken. The total percentage of cores positive was compared with the percentage of cores positive from the dominant and nondominant sides for their ability to predict biochemical recurrence after RP. The best predictor then was compared with the standard clinical variables PSA, biopsy Gleason score, and clinical stage in terms of ability to predict time to PSA recurrence after RP using multivariate analysis. RESULTS: The adverse pathologic features of positive surgical margins and extracapsular extension were significantly more likely to be ipsilateral to the dominant side on the prostate biopsy. The percentage of cores positive from the dominant side provided slightly better prediction (concordance index [C] = 0.636) for PSA failure than the total percentage of cores positive (C = 0.596) and markedly better than the percentage of cores from the nondominant side (C = 0.509). Cutoff points for percentage of cores positive from the dominant side were identified (< 34%, 34-67%, and > 67%) that provided significant risk stratification for PSA failure (P < 0.001). On multivariate analysis, the percentage of cores positive from the dominant side was the strongest independent predictor of PSA recurrence (P < 0.001). Biopsy Gleason score (P = 0.017) also was a significant, independent predictor of recurrence. There was a trend, which did not reach statistical significance, toward an association between greater PSA values and biochemical failure (P = 0.052). Combining the PSA level, biopsy Gleason score, and percentage of cores positive from the dominant side of the prostate resulted in a model that provided a high degree of prediction for PSA failure (C = 0.671). CONCLUSIONS: The percentage of cores positive from the dominant side of the prostate was a slightly better predictor of PSA recurrence than was the total percentage of cores positive. Using the percentage of cores from the dominant side along with the PSA level and the biopsy Gleason score provided significant risk stratification for PSA failure.

Aged↗
PubMed1995

Beyond the Hamilton depression scores in long-term treatment of manic-melancholic patients: prediction of recurrence of depression by quality of life measurements.

This study should be considered as a pilot study to investigate the applicability and validity of quality of life scales in manic-melancholic patients in long-term, prophylactic treatment. The quality of life instruments included the SmithKline Beecham Quality of Life (SBQOL) scale, the PCASEE questionnaire (a modified paper-and-pencil version of the computerized SBQOL), the Psychological General Well-Being (PGWB) scale, and the Medical Outcomes Study (SF-36) scale. The patients (n = 23) fulfilled the DSM-IV criteria of bipolar or recurrent depressive disorders. They were investigated in a symptom-free period (HAM-D < 14) and again 4 weeks later. The results showed that the quality of life scales had an adequate applicability and internal validity. Furthermore, at first visit a factor analysis identified two factors of which the quality of life scales loaded on the first factor (positive well-being) and the Hamilton scales loaded on the second factor (negative well-being). At the second visit, only one, general, factor emerged, because some of the patients had relapsed. Those patients with a relapse had low quality of life scores at the first visit indicating that the quality of life scales can predict recurrence of depression.

Adult↗
PubMed2004

Rifaximin plus mesalazine followed by mesalazine alone is highly effective in obtaining remission of symptomatic uncomplicated diverticular disease.

BACKGROUND: Rifaximin plus mesalazine has been showed to be more effective than rifaximin alone in the treatment of recurrent and complicated diverticulitis of the colon. We investigated the effectiveness of the combination rifaximin/mesalazine followed by mesalazine alone to evaluate tolerability and effectiveness in symptomatic remission in uncomplicated diverticular disease. MATERIAL/METHODS: We studied 90 consecutive patients (39 M, 51 F, mean age 67.2 yrs, range 32-91 yrs) with symptomatic uncomplicated diverticular disease. We assessed the following symptoms, scoring them on a quantitative scale: 1) constipation, 2) diarrhea, 3) abdominal pain, 4) rectal bleeding, and 5) mucus with stools. All were treated with 800 mg/day rifaximin plus 2.4 gr/day mesalazine for 10 days, followed by 1.6 gr/day mesalazine for 8 weeks. They were re-evaluated at the end of mesalazine-alone treatment. RESULTS: Eighty-six patients completed the study (95.56%): the total score decreased from 1439 to 44 (p<0.001). 70 patients (per-protocol: 81.40% (C.I.: 67-94%); on intention-to-treat: 77.78% (C.I.: 60-85%)) were completely asymptomatic after the 8th week of treatment with mesalazine alone (total symptomatic score: 0), while 16 (per-protocol: 18.60%; on intention-to-treat: 17.77%) showed only slight symptoms (total score: 44). Two (2.22%) showed recurrence of diverticulitis after 4 and 6 weeks of treatment with mesalazine alone. Two patients (2.22%) were withdrawn from the study for diarrhea after starting mesalazine. Two others (2.22%) showed transitory pruritus (one) and epigastric pain (one). CONCLUSIONS: The results show that rifaximin/mesalazine followed by mesalazine alone is extremely effective in resolving symptoms in patients with symptomatic uncomplicated diverticular disease.

Adult↗
PubMed2005

Expression of cyclooxygenase-2 and epidermal growth factor receptor in primary and recurrent glioblastoma multiforme.

PURPOSE: To investigate the pattern and level of cyclooxygenase-2 (COX-2) expression in a series of high grade primary and recurrent glioblastoma multiforme (GBM) and correlation with time to recurrence and patients' survival following therapy. The relationship between COX-2 and epidermal growth factor receptor (EGFR) immunoreactivities was evaluated. MATERIALS AND METHODS: Specimens of 14 primary and 14 recurrent GBMs (eight pairs) following surgery and full course radiation therapy were processed for immunostaining on COX-2 and EGFR. Tumor cell positivity was semi-quantitatively scored. COX-2 scores of the primary tumor and recurrence were correlated with the time to radiological tumor progression and patients' survival. RESULTS: COX-2 positive tumor cells were disseminated throughout the tumor parenchyma. The intensity and pattern of COX-2 expression were heterogeneous, with predominant expression in areas surrounding tumor necrosis. Scoring of COX-2 positivity revealed values between 1 and 80% of the cells. Primary GBMs with COX-2 expression levels between 25% and 70% of the tumor cells showed a shorter time to radiological recurrence than GBMs with <10% COX-2 positive tumor cells (respectively, 219 +/- 50 and 382 +/- 77 days). No correlation was found between the COX-2 expression in the primary tumor and patients' survival (r (s) = -0.073) following therapy. No correlation was found either between COX-2 and EGFR immunoreactivity. CONCLUSIONS: Immunohistochemical expression of COX-2 in GBM showed large variation. Hence, determination of COX-2 expression in tumor specimen for each individual might be relevant for selection of those patients, who could benefit from adjuvant therapy with selective COX-2 inhibitors.

Adult↗
PubMedDate not supplied

Serum PSA and cure perspective for prostate cancer in males with nonpalpable tumor.

INTRODUCTION: Many studies have shown the association between PSA levels and the subsequent detection of prostate cancer. In the present trial, we have studied the relationship between preoperative PSA levels and clinical outcome following radical prostatectomy in men with clinical stage T1c. MATERIALS AND METHODS: 257 individuals with clinical stage T1c undergoing retropubic radical prostatectomy were selected in the period from 1991 to 2000. Following surgery, biochemical recurrence-free survival curves were constructed according to PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL. RESULTS: Of the total of 257 selected patients, 206 (80%) had Gleason scores from 2 to 6 and 51 (20%), presented Gleason scores 7 and 8, as defined by the pathological report from prostate biopsy. There was no biochemical recurrence of disease when the PSA was lower than 4, regardless of Gleason score. Biochemical recurrence-free survival according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 was 100%, 87.6%, 79% and 68.8% for Gleason scores 2-6 and 100%; 79.4%; 40% and 100% for Gleason scores 7-8 respectively. When all individuals were grouped, regardless of their Gleason scores, the probability of biochemical recurrence-free survival was 100%, 65.1%, 53.4% and 72.2% according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL respectively. CONCLUSION: Non-palpable prostate cancer presents higher chances of cure when the PSA is inferior to 4 ng/mL.

Aged↗
PubMedDate not supplied

Recurrence rate, clinical outcome, and cellular proliferation indices as prognostic indicators after incomplete surgical excision of cutaneous grade II mast cell tumors: 28 dogs (1994-2002).

The objectives of this study were to determine local recurrence rate, clinical outcome, and prognostic value of the number of argyrophylic nucleolar organizer regions (AgNORs), presence of proliferating cell nuclear antigen (PCNA), and number of Ki-67-positive nuclei after incomplete surgical excision of canine cutaneous grade II mast cell tumors (MCTs). This retrospective study included 30 MCTs in 28 dogs. Medical records were examined and follow-up information was obtained from owners and referring veterinarians. Only cases in which excision was incomplete and no anvcillary therapy (other than prednisone) for MCT was given were included. Paraffin-embedded tumor tissues were retrieved for AgNORs, PCNA, and Ki-67 staining. Median follow-up time was 811.5 days. Seven (23.3%) tumors recurred locally. Median time to local recurrence was not reached with a mean of 1,713 days. The estimated proportions of tumors that recurred locally at 1, 2, and 5 years were 17.3, 22.1, and 33.3%, respectively. Eleven (39.3%) dogs developed MCTs at other cutaneous locations. Median progression-free survival was 1,044 days. Median overall survival was 1,426 days. The combination of Ki-67 and PCNA scores was prognostic for local recurrence (P = .03) and development of local recurrence was prognostic for decreased overall survival (P = .04). Results suggest that a minority of incompletely excised MCTs recur. Therefore, ancillary local therapies may not always be necessary. However, local recurrence can negatively affect survival of the affected dogs. Cellular proliferation indices may indicate the likelihood of MCT recurrence after incomplete excision.

Animals↗
PubMed1989

Risk factors of recurrent disc herniation.

The causes of 100 disc herniation reoperations are analyzed and discussed in a review: we find a recurrence of disc herniation at the same level in 62% of the reoperated cases, a pseudorecurrence in 24% and a closely connected nerve route in 14%. We reoperated on 44% within the first two years and on 69% within the first five years. The interval between the operations is longer, when there is a short painfree interval following surgery and also a long history of pre-operative symptoms. The variables of risk of prolapse recurrence are recorded as a risk score. Retrospectively, 64% belonged to a risk group according to this score. The correlation between operation intervals and scores show, that patients with a short interval have high scores.

Adult↗
PubMed1996

Linkage studies in bipolar affective disorder with markers on chromosome 21.

Straub et al. (1994: Nature Genet. 8. 291-296) have suggested that a susceptibility gene for bipolar affective disorder is located at chromosome 21q22.3, on the basis of linkage analysis in one large family. This result has been supported by Gurling et al. (1995: Nature Genet. 10, 8-9) who also found some evidence for linkage to this region under locus heterogeneity. In order to investigate the validity of these results and to estimate how broadly applicable they are, we performed a linkage study between bipolar affective disorder and two DNA markers (D21S171 and PFKL) from 21q22.3 using 60 bipolar pedigrees from three European centres and Brazil. The most positive result obtained was a maximised admixture lod score of 1.2 for the marker PFKI, under the assumption of locus heterogeneity, dominant transmission and a diagnostic classification which included recurrent unipolar depression. However, since lod scores obtained for both markers were substantially negative overall, we conclude that there is no common major gene for bipolar affective disorder at 21q22.3. It remains possible that a gene of major effect in this region operates in a minority of families.

Bipolar Disorder↗
PubMed2000

High expression of somatostatin receptors and messenger ribonucleic acid for its receptor subtypes in organ-confined and locally advanced human prostate cancers.

To evaluate the potential application of somatostatin (SST) analogs as an adjuvant treatment for prostate cancer, we characterized the binding sites for SST octapeptide analogs on prostate cancers in patients treated with radical prostatectomy. The affinity and density of binding sites for SST analog RC-160 on 80 surgical specimens of prostate cancers were determined by ligand competition assays. The expression of messenger ribonucleic acid (mRNA) for SST receptor subtype 1 (SSTR1), subtype 2 (SSTR2), and subtype 5 (SSTR5) was also investigated in 22 samples by RT-PCR. Fifty-two of 80 specimens (65%), showed a single class of specific binding sites for RC-160 with a mean dissociation constant (K(d)) of 9.44 nmol/L and a mean maximal binding capacity of 754.8 fmol/mg membrane protein. The mRNA for SSTR1 was detected in 86% of samples, whereas the incidences of mRNA for SSTR2 and SSTR5 were 14% and 64%, respectively. The expression of SSTR2 and/or SSTR5 was 100%, consistent with the presence of RC-160 binding. In patients at high risk of cancer recurrence (stage pT3 and/or Gleason score of 8-10), the incidence of RC-160 binding (65.7%) was similar to that observed in the low risk group (64.3%). The demonstration of the high incidence of octapeptide-preferring SSTRs in organ-confined and locally advanced prostate cancers supports the merit of further investigations of the application of SST analogs and their radionuclide and cytotoxic derivatives for adjuvant treatment of patients at high risk of cancer recurrence after radical prostatectomy. Such approaches could be also considered for patients with advanced prostate cancer at the time of relapse.

Aged↗
PubMed1999

[Columbia University experience of detection of circulating cells by RT-PCR PSA in prostate cancer as a predictive factor of stage and biochemical recurrence].

OBJECTIVES: The Columbia University experience of RT-PCR PSA as a predictive factor of stage and biochemical recurrence is reviewed by trying to explain its differences. PATIENTS AND METHODS: 319 patients were included between January 1993 and March 1998. Radical prostatectomy was performed in all patients by the same surgeon. The RT-PCR protocol has been previously described (Katz et al., Urology, 1994). Biochemical recurrence was defined by a PSA greater than or equal to 0.2 ng/ml. RESULTS: Histological examination diagnosed 218 pT2 and 101 pT3 tumours. Thirty-four of the 218 pT2 patients (16%) had a positive RT-PCR versus 51 of the 101 pT3 patients (51%, p < 0.001). Analysis of Kaplan-Meier curves showed an 84% recurrence-free survival when RT-PER was negative versus 47% when RT-PCR was positive (Log-rank test, p = 0.0002). Multivariate analysis showed that independent predictive factors of biochemical recurrence were stage (p = 0.004), Gleason score estimated on the operative specimen (p = 0.010) and serum PSA (p = 0.047); RT-PCR (p = 0.075), strongly correlated with stage, was not an independent predictive factor. By exclusively comparing preoperative parameters, PSA (p = 0.004) and RT-PCR (p = 0.006) were found to be independent predictive factors compared to digital rectal examination (p = 0.371) and Gleason score on biopsies (p = 0.076). CONCLUSION: In this institution, RT-PCR PSA is a predictive parameter of stage and biochemical recurrence. No consensus has yet been reached in the literature concerning the reference protocol, as each team has developed its own RT-PCR technique applied to its own patient population. Comparison of results is therefore difficult.

Adult↗
PubMed2000

Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means?

OBJECTIVES/HYPOTHESES: Salvage surgery is widely viewed as a "double-edged sword." It is the best option for many patients with recurrent cancer of the upper aerodigestive tract, especially when original therapy included irradiation, yet it may provide only modest benefit at high personal cost to the patient. The stakes are high because alternatives are of limited value. The primary objective of this study was to fully assess the value of salvage surgical procedures in the treatment of local and regional recurrence. The following hypotheses were developed to focus the study design and data analysis. 1) The efficacy of salvage surgery correlates recurrent stage, recurrent site, and time to presalvage recurrence. 2) The economic and noneconomic costs of salvage surgery increase with higher recurrent stage. 3) Information relating the value of salvage surgery to recurrent stage and recurrent site will be useful to these patients and the physicians who treat them. STUDY DESIGN: Two complimentary methods of investigation were used: a meta-analysis of the published literature and a prospective observational study of patients undergoing salvage surgery for recurrent cancer of the upper aerodigestive tract. METHODS: The meta-analysis combined 32 published reports to obtain an estimate of average treatment effect for salvage surgery with regard to survival, disease-free survival, surgical complications, and operative mortality. The prospective observational study included detailed data in 109 patients who underwent salvage surgery. In addition to parameters studied in the meta-analysis, we obtained baseline and interval quality of life data (Functional Living Index for Cancer [FLIC] scores), baseline and interval performance status evaluations (Performance Status Scale for Head and Neck Cancer Patients [PSS head and neck scores]), length of hospital stay, and hospital and physician charges, and related this data primarily to recurrent stage, recurrent site, and time to presalvage recurrence. RESULTS: The weighted average of 5-year survival in the meta-analysis was 39% in 1,080 patients from 28 different institutions. In the prospective study, median disease-free survival was 17.9 months in 109 patients, and this correlated strongly with recurrent stage, weakly with recurrent site, and not at all with time to presalvage recurrence. Noneconomic costs for patients and economic costs correlated with recurrent stage, but not with site. Baseline FLIC and PSS head and neck scores correlated with recurrent stage, but not with site. After salvage surgery the percentage of patients reaching or exceeding baseline was 51% for FLIC scores, and this differed significantly with recurrent stage. Postoperative interval "success" in PSS head and neck subscale scores for diet and eating in public also correlated with recurrent stage. CONCLUSIONS: Overall, the expected efficacy for salvage surgery in patients with recurrent head and neck cancer was surprisingly good, but success was limited and costs were great in stage III and, especially, in stage IV recurrences. A strong correlation of efficacy and noneconomic costs with recurrent stage allowed the creation of expectation profiles that may be useful to patients. Additional systematic clinical research is needed to improve results. In the end, the decision to undergo salvage surgery should be a personal choice made by the patient after honest and compassionate discussion with his or her surgeon.

Carcinoma, Squamous Cell↗
PubMed2005

Laparoscopic rectopexy for full-thickness rectal prolapse: a single-institution retrospective study evaluating surgical outcome.

BACKGROUND: The laparoscopic approach promises to become the gold standard for the transabdominal management of full-thickness rectal prolapse. The aim of this study was to review our experience and to highlight the functional results achieved with this new technique. METHODS: Forty-eight patients with full-thickness external prolapse underwent laparoscopic repair between February 1997 and February 2003. All patients underwent preoperative evaluation of their rectal function. Patients with isolated rectal ulcer without prolapse or with internal prolapse and patients deemed by the anesthesiologist to be unfit for general anesthesia were excluded from the study. The laparoscopic technique was either a mesh rectopexy without resection (n = 35) or a suture rectopexy with sigmoid resection (n = 13). Patients with intractable constipation preceding the development of the rectal prolapse were advised to have a resection-rectopexy. In the postoperative follow-up, attention was paid to mortality, morbidity, recurrent prolapse, incontinence, and constipation. Follow-up was done by clinical review and postal questionnaire. RESULTS: There were no deaths and no septic or anastomotic complications. The postoperative morbidity rate was 5%. Oral intake was started on postoperative day 1. Discharge from the hospital was on postoperative day 4 in patients without sigmoid resection and on postoperative day 7 in patients with sigmoid resection. Two patients (4%) developed recurrent total prolapse during a median follow-up period of 36 +/- 15 months (range, 7-77). The functional results were good or excellent in 72% of the cases, without digitations or dyschesia. Continence was improved in 31% of the patients and remains unchanged in 64% of them. In 11 patients (23%), constipation was worsened by the procedure. CONCLUSION: Laparoscopic rectopexy with or without resection is both safe and effective. Advantages include low-morbidity, improved cosmesis, the rapid return of intestinal function, early discharge from hospital, and a low recurrence rate. The fecal continence score is improved; however, constipation is frequently worsened.

Adolescent↗
PubMed1991

Results of surgery for duodenal ulcer: assessment by patients.

A questionnaire was administered to 224 patients who had undergone 246 operations for duodenal ulcer to see how well this correlated with Visick grading and to provide insight into the patients' feelings about the results of their surgery. The patients were divided into three groups by Visick grade: good (grade I, n = 70), satisfactory (grades II and IIIs, n = 104) and poor (grades IIIu and IV, n = 72). The distribution of questionnaire responses in each group was statistically different (P less than 0.01). Dividing the questionnaire responses into three corresponding groups, 72 per cent of patients assigned themselves to the same group as their Visick grade. Three observations were made regarding the Visick system: recurrent ulceration is over-scored and should be included only if symptomatic; grading should acknowledge a wider range of symptoms related to ulcer disease and its treatment; only three grades are necessary.

Adult↗
PubMed1998

One-year follow-up comparison of the cost and effectiveness of chiropractic and physiotherapy as primary management for back pain. Subgroup analysis, recurrence, and additional health care utilization.

STUDY DESIGN: A randomized trial was conducted in which patients with back and neck pain, visiting a general practitioner, were allocated to chiropractic or physiotherapy. OBJECTIVES: To compare outcome and costs of chiropractic and physiotherapy as primary treatment for patients with back and neck pain, with special reference to subgroups, recurrence rate, and additional health care use at follow-up evaluation 12 months after treatment. SUMMARY OF BACKGROUND DATA: Earlier studies on the effect of spinal manipulation have shown inconsistent results. Mostly they include only short-term follow-up periods, and few cost-effectiveness analyses have been made. METHODS: A group of 323 patients aged 18-60 years who had no contraindications to manipulation and who had not been treated within the previous month were included. Outcome measures were changes in Oswestry scores, pain intensity, and general health; recurrence rate; and direct and indirect costs. RESULTS: No differences were detected in health improvement, costs, or recurrence rate between the two groups. According to Oswestry score, chiropractic was more favorable for patients with a current pain episode of less than 1 week (5%) and physiotherapy for patients with a current pain episode of greater than 1 month (6.8%). Nearly 60% of the patients reported two or more recurrences. More patients in the chiropractic group (59%) than in the physiotherapy group (41%) sought additional health care. Costs varied considerably among individuals and subgroups; the direct costs were lower for physiotherapy in a few subgroups. CONCLUSIONS: Effectiveness and costs of chiropractic or physiotherapy as primary treatment were similar for the total population, but some differences were seen according to subgroups. Back problems often recurred, and additional health care was common. Implications of the result are that treatment policy and clinical decision models must consider subgroups and that the problem often is recurrent. Models must be implemented and tested.

Adolescent↗