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PubMed1997

Operative versus closed treatment of primary dislocation of the patella. Similar 2-year results in 125 randomized patients.

To assess whether initial surgery is beneficial for patients with primary dislocation of the patella, we carried out a prospective randomized study. Knee stability was examined under anesthesia, and associated injuries were excluded by diagnostic arthroscopy. 55 patients then had closed treatment and 70 patients were operated on with individually adjusted proximal realignment procedures. Surgery gave no benefit based on 2 years of follow-up. The subjective result was better in the non-operative group in respect of mean Houghston VAS knee score (closed 90, operative 87), but similar in terms of the patient's own overall opinion and mean Lysholm II knee score. Recurrent instability episodes (redislocation or recurrent subluxation) occurred in 20 nonoperated and in 18 operated patients. Of these, 15 and 12, respectively, then suffered redislocations. Function was better after closed treatment. Serious complications occurred after surgery in 4 patients. In conclusion, the recurrence of patellar dislocation may be more frequent than reported, whatever the form of treatment. Routine operative management cannot be recommended for primary dislocation of the patella.

Adolescent↗
PubMed1988

Intestinal mucosa diamine oxidase activity reflects intestinal involvement in Crohn's disease.

The activity of diamine oxidase (DAO), an enzyme found in the apical villous cells of the small intestine mucosa, should reflect the status of the intestinal mucosa. Our purpose was to determine whether DAO activity in the intestinal mucosa is diminished in patients with Crohn's disease and correlates with the severity of histological changes. Mucosal DAO activity was determined in 42 tissue specimens from patients with Crohn's enteritis (n = 15), Crohn's colitis (n = 9), and ulcerative colitis (n = 11), and from patients with no intestinal disease (n = 7). DAO activity was estimated by the metabolism of [14C]putrescine. Histologic changes were graded on a scale of 0-4. Normal histology was graded as zero, mild edema, and inflammation in the lamina propria as one, crypt abscess formation and inflammation as two, more severe inflammation plus or minus granulomata as three, and most severe inflammation with active ulceration as four. Tissue DAO activity was significantly less in patients with ileitis (4.8 +/- 3.6) compared with those with Crohn's colitis (15.0 +/- 11.6), ulcerative colitis (16.8 +/- 19.7), and normal intestine (17.6 +/- 14.3 U/mg protein/h, p less than 0.05). Intestinal DAO activity showed a positive correlation with the histologic scores. Recurrence of Crohn's disease developed postoperatively in two patients with low tissue DAO activity (1.4 and 2.9 U/mg protein/h). Intestinal DAO activity is diminished in patients with Crohn's ileitis and correlates with the severity of histologic changes. Tissue DAO activity might prove useful in predicting the risk of recurrence or anastomotic complications after resection for Crohn's disease.

Adult↗
PubMed1998

Symptoms in hemodialysis patients and their relationship with biochemical and demographic parameters.

Symptoms can markedly influence the hemodialysis patients well-being and quality of life. The aim of this paper is to study the frequency of symptoms at home and how these relate to biochemical and treatment variables. Seventy-three hemodialysis patients were questioned on the absence, occasional presence or daily recurrence (score = 0, 1, 2) of 14 symptoms and a record was made of their biochemical parameters, age, time on treatment and KtIV as a function of each symptom. The following relationships were detected: thirst with high Osm and BUN; asthenia with old age and hypoalbuminemia; insomnia with hypercalcemia; hypersomnia with hypoxemia and hypernatremia; anorexia with hypokalemia; dyspnea with old age, hypernatremia and hypokalemia; dysgeusia with hypoxemia; nausea with alkalemia, hypoxemia and low BUN; vomiting with alkalemia. Pruritus, arthralgia, restless legs syndrome, cramp and tremor showed no relationships. Monitoring acid-base balance and plasma electrolytes could help to alleviate symptoms and ameliorate quality of life of hemodialysis patients.

Age Factors↗
PubMed1995

Nuclear morphometry for improved prediction of the prognosis of human bladder carcinoma.

BACKGROUND: Histologic grade and clinical stage generally are used for estimating the prognosis of bladder carcinoma. However, both methods have been reported to have a rather low reproducibility and to be unsatisfactory for predicting the recurrence and progression of superficial bladder carcinoma. Recently, nuclear morphometry was used to quantitate the malignant potential of cancer cells in a more objective and reproducible manner. The authors quantitatively analyzed the malignant potential of bladder carcinoma at initial presentation using a combination of several nuclear morphometric variables. METHODS: The subjects were 156 patients with previously untreated bladder carcinoma. Three morphometric variables were measured in each subject: the mean nuclear volume (MNV), the nuclear roundness factor (NRF), and the variation of nuclear area (VNA). RESULTS: Univariate analysis showed that MNV and NRF were significant prognostic indicators for survival (MNV, P < 0.0001; NRF, P = 0.008). In addition, MNV was a prognostic indicator for tumor recurrence (P = 0.001), whereas MNV and NRF were prognostic indicators for invasive progression (MNV, P = 0.02; NRF, P = 0.009). For accurate prediction of the prognosis of patients with bladder carcinoma, a prognostic score, a recurrence score, and a progression score were designed using the coefficients of MNV and NRF in a proportional hazards model. The prognostic score clearly divided the patients into two different groups with 5-year survival rates of 88% and 64% (P = 0.0002). In addition, patients with superficial bladder carcinoma and a low recurrence score had a significantly higher 5-year recurrence free rate than those with a high recurrence score (40% vs. 23%, P = 0.0004), and the 5-year progression free rate of patients with a low progression score was significantly higher than that of those with a high progression score (98% vs. 73%, P = 0.0006). CONCLUSIONS: These findings suggest that nuclear morphometry is a reliable technique with which to identify prognostic indicators for human bladder carcinoma. A combination of several nuclear morphometric variables provides a more accurate indication of prognosis than any single parameter.

Adult↗
PubMed1997

Proposal of invasiveness score to predict recurrence and survival after curative hepatic resection for hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most malignant human tumors and is associated with a high incidence of postoperative recurrence. There is no generally accepted definition for HCC invasiveness. Moreover, the predictive value of the pathologic factors that reflect HCC invasiveness was previously studied as separate events, with much controversy among different study groups. In this study, we proposed an invasiveness scoring system based on the relative importance of six criteria for HCC invasiveness: portal vein invasion, intrahepatic metastasis, hepatic vein invasion, serosal invasion, absence of tumor capsule, or presence of capsular invasion. METHODS: A total of 137 patients (111 male and 26 female) who underwent curative hepatectomy for HCC were included. Scoring of the six pathologic parameters was based on the clinical significance of each parameter as a single predictor for recurrence after curative resection. According to our scoring system, the patients were divided into three groups: low invasive HCC group A with a total invasiveness score 0 to 1, moderately invasive group B with a score of 2 to 4, and highly invasive group C with a total score of 5 or greater (5 to 11 points). RESULTS: Evaluation of the current scoring system showed a significant stepwise increase in the incidence of recurrence as the invasiveness score increased. Moreover, disease-free survival was significantly different among the three groups (log rank p < 0.0001). The 1-, 3-, 5-, and 8-year disease-free survival rates were 89%, 59%, 54%, and 54% in group A; 72%, 32%, 12%, and 10% in group B; and 54%, 19%, 7%, and 0 in group C, respectively. Multivariate analysis showed that the patients of groups B and C had a significantly worse prognosis compared with those of group A (p < 0.0001). CONCLUSIONS: The current scoring system can classify HCCs into three invasive categories and predict more accurately recurrence and disease-free survival after curative hepatectomy compared with any single invasive parameter previously proposed. Moreover, this system can be used as a therapeutic guide during and after the surgical decision making.

Adult↗
PubMed1999

Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases.

OBJECTIVE: There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease. METHODS: Clinical, pathologic, and outcome data for 1001 consecutive patients undergoing liver resection for metastatic colorectal cancer between July 1985 and October 1998 were examined. These resections included 237 trisegmentectomies, 394 lobectomies, and 370 resections encompassing less than a lobe. The surgical mortality rate was 2.8%. RESULTS: The 5-year survival rate was 37%, and the 10-year survival rate was 22%. Seven factors were found to be significant and independent predictors of poor long-term outcome by multivariate analysis: positive margin (p = 0.004), extrahepatic disease (p = 0.003), node-positive primary (p = 0.02), disease-free interval from primary to metastases <12 months (p = 0.03), number of hepatic tumors >1 (p = 0.0004), largest hepatic tumor >5 cm (p = 0.01), and carcinoembryonic antigen level >200 ng/ml (p = 0.01). When the last five of these criteria were used in a preoperative scoring system, assigning one point for each criterion, the total score was highly predictive of outcome (p < 0.0001). No patient with a score of 5 was a long-term survivor. CONCLUSION: Resection of hepatic colorectal metastases may produce long-term survival and cure. Long-term outcome can be predicted from five criteria that are readily available for all patients considered for resection. Patients with up to two criteria can have a favorable outcome. Patients with three, four, or five criteria should be considered for experimental adjuvant trials. Studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.

Adult↗
PubMed1993

[Surgical therapy of pterygium. Incidence of recurrence after free conjunctival transplant and surgical techniques without transplantation].

A retrospective examination was conducted on 104 patients who had undergone operations for a pterygium over a time period of 2-73 months. Thirty-one patients were operated on with a free autologous conjunctival transplant; in 40 cases a conjunctival suture was performed and in 33 cases the bare sclera technique was used. The pterygium and any recurrences were scored clinically from 0 to 4. Small recurrences with a score less than 3 and a small conjunctival corpus were called "calm" recurrences. A bigger corpus and a head with a score > or = 3 and parallel vessels were called "active" recurrences. The recurrence rates were taken as the total calm and active recurrences. Autologous conjunctival transplant had a recurrence rate of 32.3%, excision with conjunctival suture 58.5%, and the bare sclera technique had a recurrence rate of 66.7%. Excision techniques cause high rates of recurrences, severe conjunctival scarification and irritation for a long time. A free autologous conjunctival transplant from the same or other eye to the place of excision improves the rate of recurrences even when the condition is more severe initially. Even though more complicated operation methods decrease the rate of recurrence, but 20-35% recurrence rates are still not satisfactory.

Conjunctiva↗
PubMed1994

The significance of nucleolar organizer region (AgNOR) score in predicting meningioma recurrence.

BACKGROUND: Argyrophilic nucleolar organizer region (AgNOR) has been demonstrated in recent studies of human brain tumors, including meningiomas. The authors used this technique in meningiomas to analyze whether the mean numbers of AgNOR per nucleus (AgNOR score) are related to the recurrence rate or the proliferative potential of meningiomas. METHODS: AgNOR staining technique was applied to paraffin-embedded sections of 60 meningiomas. Twenty of these specimens also were investigated immunohistochemically with monoclonal antibody (MoAb) against DNA polymerase alpha (Pol.alpha) and with MoAb Ki-67 to compare the AgNOR score with the proliferative potential. RESULTS: There was a statistically significant difference between the AgNOR score in nonrecurrent meningiomas (2.48 +/- 0.73) and recurrent histologically benign meningiomas after gross total resection (3.20 +/- 0.96) (P < 0.02). The recurrence rate of tumors after gross total resection with an AgNOR score of 3.0 or more was significantly higher than that with an AgNOR score of less than 3.0. The AgNOR score did not always correlate with Pol.alpha or Ki-67 score; the AgNOR score of malignant meningioma that had high proliferative score was not always high. CONCLUSIONS: This study indicates that AgNOR staining appears to be a simple and useful method for estimating the probability of histologically benign meningioma recurrence even after gross total resection.

Adult↗
PubMed1996

Angiographic left ventricular wall motion score to predict arrhythmia recurrence in patients with sustained ventricular tachycardia or fibrillation.

METHODS: Sixty-nine patients with sustained ventricular tachyarrhythmias were followed up to evaluate the predictive value of functional capacity (i.e., New York Heart Association class and peak oxygen consumption) and resting left ventricular function (i.e. radionuclide left ventricular ejection fraction, angiographic left ventricular wall motion score and echocardiographic dimensions) with respect to arrhythmia recurrence. RESULTS: During a mean follow-up of 19 months 18 patients (26%) had an arrhythmia recurrence. Parameters of functional capacity and echocardiographic dimensions were not related to arrhythmia recurrence. Left ventricular ejection fraction and wall motion score were worse in patients with a recurrence compared with the arrhythmia-free patients: 30 +/- 16% versus 40 +/- 19% (mean +/- SD, P = 0.035) and 25 +/- 7 versus 20 +/- 7 (P = 0.01), respectively. Multivariately the most powerful parameter was left ventricular wall motion score (odds ratio 1.12, 95% Cl 1.02-1.23). CONCLUSIONS: Arrhythmia recurrence in ventricular tachyarrhythmia patients relates to resting left ventricular function and not to functional capacity. Since angiographic left ventricular wall motion score is prognostically more important than ejection fraction this parameter should be considered for risk stratification in these patients.

Aged↗
PubMed2003

Over expression of metallothionein predicts resistance of transitional cell carcinoma of bladder to intravesical mitomycin therapy.

PURPOSE: Metallothionein, a low molecular weight intracellular protein, binds mitomycin with high affinity protecting the tumor DNA. We prospectively studied the relationship of metallothionein expression in bladder transitional cell carcinoma and resistance to intravesical mitomycin. MATERIALS AND METHODS: A series of 45 consecutive patients with superficial transitional cell carcinoma treated with intravesical mitomycin were studied. Resected tumor tissues were stained with metallothionein monoclonal antibody E9. Two pathologists scored staining intensity and distribution. All patients were followed with regular flexible cystoscopy. RESULTS: Median patient age was 73 years (range 44 to 89). Tumor grade was 1 to 3 in 6, 33 and 6 cases, respectively. In 20 patients (44.44%) tumor recurred after mitomycin therapy. Median cytoplasmic staining scores for recurrent and nonrecurrent tumors were 5 (range 0 to 61) and 0 (0 to 14), respectively. Median nuclear staining scores for recurrent and nonrecurrent tumors were 3 (range 0 to 56) and 0 (0 to 11), respectively. Median followup of patients without recurrence was 18 months (range 12 to 36). Nuclear and cytoplasmic staining scores were significantly higher in recurrent than in nonrecurrent tumors. There was no significant relationship of metallothionein expression with tumor grade. CONCLUSIONS: Over expression of metallothionein predicts the resistance of bladder transitional cell carcinoma to intravesical mitomycin therapy.

Administration, Intravesical↗
PubMed1992

A scoring system for predicting recurrence of cervical cancer.

An evaluation was made of factors that affect the recurrence of cervical cancer after primary surgery, these including age, clinical stage, histology, grade, involvement of uterine body, parametrium or vagina and lymph node metastases. During a period of at least 3 years, 702 of 1508 patients who underwent radical hysterectomy and pelvic lymph node dissection were studied by using a scoring system. A comparison between the group of women scored at or greater than 13 that scored less than 13 revealed that the risk of recurrence was higher in the former group. One hundred and twenty five of 702 patients found to have positive pelvic node involvement scored greater than 13, which rendered them eligible for further mangement as follows: the recurrence rate in 99 patients receiving multi-agent chemotherapy was 34.4%, compared with 65.4% in 26 patients receiving no treatment (P < 0.01). Applying this score to other patients in planning adjuvant therapy, the recurrence rate may be reduced further. The number of patients needlessly exposed to the toxic effects of multi-agent chemotherapy may be reduced also.

Journal Article↗
PubMed2000

Significance of the CAG repeat polymorphism of the androgen receptor gene in prostate cancer progression.

PURPOSE: The CAG repeat polymorphism of the androgen receptor gene has been associated with an increased prostate cancer risk, and the repeat length correlated with cancer stage and grade at presentation. Men with an allele length of </= 18 CAG repeats have a 2-fold increase in risk for high-stage or high-grade prostate cancer, compared with patients with a longer CAG repeat. We examined the significance of the CAG repeat polymorphism of the androgen receptor gene for predicting prostate cancer progression among 318 patients treated by radical prostatectomy for clinically localized prostate cancer between 1987 and 1994. MATERIALS AND METHODS: Leukocyte DNA was collected and genotyping of the CAG repeat polymorphism was performed using a PCR-based direct sequencing method. Risk ratios were calculated for developing biochemical recurrence for patients associated with an allele length of </= 18 CAG repeats, compared with patients with an allele length of >18 CAG repeats, controlling for grade, stage and serum PSA level at diagnosis using Cox proportional hazard modeling. RESULTS: Overall, the CAG repeat allele was not predictive of recurrence; tumor grade, stage and PSA level at diagnosis were the only predictors of recurrence in a multivariate analysis. However, for patients at low risk for recurrence (Gleason score 2 to 6, stage pT2, and PSA </= 10 ng./ml.), the relative risk of recurrence associated with an allele of </= 18 CAG repeats was 8.07 (95% C.I., 2.02 to 32.2, p = 0.004), compared with patients with an allele length of >18 CAG repeats. In contrast, for patients at high risk of recurrence (Gleason score >/= 7, stage pT3/4, or PSA >10 ng./ml.), the relative risk associated with the </= 18 CAG repeat allele was 0.72 (95% C.I., 0.33 to 1.57, p = 0.41), compared with patients with the >18 CAG repeat allele. CONCLUSIONS: The length of the CAG repeat polymorphism of the androgen receptor gene may be important for prostate cancer recurrence among patients who are otherwise at low risk for recurrence after radical prostatectomy. These findings have potential implications for patient selection for adjuvant treatment, and for the development of novel treatments.

Alleles↗
PubMed2004

Clusterin as a possible predictor for biochemical recurrence of prostate cancer following radical prostatectomy with intermediate Gleason scores: a preliminary report.

Disease recurrence following radical prostatectomy is a major concern in prostate cancer patients. Gleason scores are useful in predicting recurrence. Low Gleason scores are usually associated with long disease-free intervals, while high Gleason scores are suggestive of early recurrence. However, prediction of recurrence has been difficult with intermediate Gleason scores. Clusterin is a ubiquitous secretory sulfated glycoprotein. It is also an antiapoptotic mediator in prostate cancer. The objective of the present study is to determine if clusterin can serve as a predictive biomarker for recurrence of prostate cancer with intermediate Gleason scores in patients following radical prostatectomy. Prostatic specimens with Gleason score of 6 (3+3) or 7 (3+4) were obtained from the archival bank. Three groups of specimens were investigated. The first group was from nine patients who developed recurrent disease according to a persistent rise of serum PSA within 3 years following radical prostatectomy. Those in the second group and the third group were from patients who showed no evidence of disease recurrence for at least 5 y (11 patients) and 10 y (eight patients), respectively following the surgery. Histological sections were subjected to immunohistochemical staining using a monoclonal antibody specific for clusterin. The staining intensity was scored as 0, 1, 2, and 3, with 0 being no staining, 1 showing less than 25% positive staining, 2 being 25-50% positive, and 3 showing greater than 75% positive staining. One-way ANOVA with Bonferroni correction was used for statistical analysis. Evaluation of the scores of clusterin staining was carried out according to four specific areas in each specimen. They were (a) benign epithelial cells, (b) malignant epithelial cells (cancer epithelia), (c) stromal cells surrounding benign cells, and (d) stromal cells surrounding malignant cells (cancer stroma). Staining score in prostatic epithelial cells, benign as well as malignant, showed no significant relationship among the three patient groups. However, when staining scores in stromal cells were compared, there was a significant difference between patients with recurrent disease and those showed no evidence of disease recurrence for at least 10 y. Results of this preliminary study support the important role of clusterin in the stromal component for prostate cancer progression. Clusterin immunostaining may be useful to aid the prediction of chance of disease recurrence in patients with Gleason score 6 or 7 prostate cancer following radical prostatectomy. Further studies with a large number of cases are warranted to verify this preliminary finding.

Biomarkers, Tumor↗
PubMedDate not supplied

Concurrent 5-fluorouracil, mitomycin C and radiation with or without brachytherapy in recurrent cervical cancer: a scoring system to predict clinical response and outcome.

AIMS AND PURPOSE: This is a prospective, phase II study aimed to evaluate the effect of concurrent 5-fluorouracil, mitomycin C, and radiation with or without brachytherapy on the clinical outcome of a series of recurrent cervical cancer patients and to determine the prognostic impact of a subset of factors. METHODS: Thirty-three patients with locally recurrent, non-metastatic cervical cancer received external beam radiation (4-week split course: 23.4 + 23.4 Gy) plus two courses of concomitant chemotherapy (5-fluorouracil, 96-h continuous infusion, days 1-4, 1 g/m2/day; mitomycin C, 10 mg/m2, bolus i.v., day 1). Twelve patients with vaginal recurrence (36.4%) underwent endocavitary low-dose rate brachytherapy boost (20-25 Gy); 11 patients with lateral pelvic recurrence (33.3%) received external beam radiation boost (14-20 Gy). RESULTS: Fourteen complete responses (42.4%), 7 partial responses (21.2%), 5 disease stabilizations (15.1%) and 7 progressions (21.2%) were obtained. After a median follow-up of 34 months (range, 6-127), overall actuarial 3-year survival, progression-free survival and local progression-free survival were 59.7%, 48.1% and 51.7%, respectively. Patients with vaginal recurrence of less than 4 cm and negative lymph nodes proved to respond best to the treatment. Two patients (6.1%) experienced hematologic grade 3 toxicity. One patient had grade 3 intestinal toxicity (3.0%). No patient had major skin or urological acute toxicity. Severe late toxicity was infrequent. Three patients had prolonged leukopenia (9.0%). Four patients showed severe vaginal stenosis (12.1%). A clinical score of 0 to 1 was assigned to each patient on the basis of the absence (score = 0) or presence (score = 1) of any of the following prognostic factors: time between surgery and recurrence shorter than 12 months, pelvic wall site of recurrence, positive lymph nodes, hemoglobin < 11 g/dL. Using this system, it was clear that patients with a low total score had a significantly better outcome (clinical remission, 51% of patients with a score < or = 2 vs 12% of patients with a score > 2, P = 0.06), local control of the disease (65% vs 20% after 3 years, P = 0.001,) and overall survival (75% vs 30% after 3 years, P = 0.032). CONCLUSIONS: Our data suggest that this combined modality therapy was relatively well tolerated and resulted in reasonable local control and survival. The scoring system proved to be helpful to identify patients with the greatest chance of benefiting from the treatment. Further studies are probably needed to salvage the other patients, whose prognosis remains severe.

Adult↗
PubMedDate not supplied

Concurrent 5-fluorouracil, mitomycin C and radiation, with or without brachytherapy, in recurrent endometrial cancer: a scoring system to predict clinical response and outcome.

AIMS AND BACKGROUND: This prospective, phase II study aimed to test the efficacy of concurrent 5-fluorouracil, mitomycin C and radiation, with or without brachytherapy, on the clinical outcome of a series of recurrent endometrial cancer patients and to determine the prognostic impact of a subset of factors. METHODS: Thirty patients with locally recurrent, nonmetastatic endometrial cancer received external beam radiation (4-week split course: 23.4 + 23.4 Gy) plus two courses of concomitant chemotherapy (5-fluorouracil, 96-h continous infusion, days 1-4; 1 g/m2/day; mitomycin C, 10 mg/m2, bolus iv, day 1). Nineteen patients (63.3%) underwent endocavitary, low-dose brachytherapy boost (20-25 Gy); eight patients (26.7%) received external beam radiation boost (14-20 Gy). RESULTS: Eleven complete responses (36.7%), 11 partial responses (36.7%), 6 disease stabilizations (20.0%) and 2 progressions (6.6%) were observed. After a median follow-up of 27 months (range, 1-108), overall actuarial 3-year survival, progression-free survival and local progression-free survival were 46.8%, 35.2% and 41.2%, respectively. Two patients (6.7%) experienced hematological grade 3 toxicity. Two patients (6.7%) had grade 3 intestinal toxicity. Severe late toxicity was infrequent, only 3 patients showing severe vaginal stenosis (10.0%). A clinical score of 0 to 1 was assigned to each patient on the basis of the absence (score = 0) or presence (score = 1) of any of the following prognostic factors: time between surgery and recurrence shorter than 12 months, pelvic wall site of recurrence, positive lymph nodes, hemoglobin < 11 g/dL. With this device, it was clear that patients with a low score had a significantly better outcome (clinical remission: 77.2% of patients with a score < 2 vs 25.0% of patients with a score > or = 2, P = 0.009), better local control of the disease (50.2% vs. 0 at 3 years, P = 0.014,) and better overall survival (65.8% vs 0 at 3 years, P = 0.003). CONCLUSIONS: Our data suggest that this combined modality therapy was relatively well tolerated and resulted in reasonable local control and survival. The scoring system proved to be helpful in identifying patients with the best chance of benefiting from the treatment.

Adult↗
PubMed1984

Symptomatic and asymptomatic ulcer recurrence following highly selective vagotomy.

An assessment of outcome has been made after highly selective vagotomy performed by two surgeons on 174 patients. The median time to followup was 36 months (range 3-94). The group comprised 74% males and 26% females (median age 45 years, range 19-75). Assessment was by review of medical history, endoscopy (irrespective of presence or absence of symptoms) and questionnaire. Symptomatic ulcer recurrence had already been diagnosed in 16 patients (9%). There were 2 unassociated deaths and 14 patients remained untraced. The remaining 142 patients were assessed by questionnaire and asked to undergo an endoscopy. One hundred and nineteen agreed to endoscopy and ulcers were found in 11 patients (9%). Five were sited in the duodenum and 6 in the stomach. Duodenitis was found in 30% of patients. Patients with ulcers in the pyloric region were at significantly greater risk than the general group for developing a recurrence. Patients who agreed to endoscopy (119) underwent Visick grading prior to endoscopy. A poor correlation was found between ulcer recurrence and Visick score. The "asymptomatic" recurrence rate of 9% following highly selective vagotomy should be considered when assessing the outcome of the surgery.

Adult↗
PubMed2006

Percentage of positive biopsy cores, preoperative prostate-specific antigen (PSA) level, pT and Gleason score as predictors of PSA recurrence after radical prostatectomy: a multi-institutional outcome study in Japan.

OBJECTIVE: To evaluate the clinical outcome of radical prostatectomy (RP) in Japan, by retrospectively analysing the clinicopathological data in patients with clinical T1-T2 prostate cancer treated by RP, as there can be prostate-specific antigen (PSA) recurrence after RP in substantially many patients, and its character can differ according to ethnic group and/or country. PATIENTS AND METHODS: We reviewed 1192 patients who had a RP from 1993 to 2002 with no neoadjuvant/adjuvant therapy and whose PSA level after RP decreased at least once to undetectable levels (<0.2 ng/mL). PSA recurrence was defined as > or = 0.20 ng/mL. The patient data were collected from the Urological Oncology Study Group, a subgroup of Japan Clinical Oncology Group. RESULTS: The patients' median (range) age was 67 (47-83) years and their PSA level before RP was 8.7 (1.0-153) ng/mL. During the median follow-up of 45.6 months, 302 of the 1192 patients (25.3%) developed PSA recurrence. The median time to recurrence was 369 (61-2128) days after RP. A log-rank test showed that five significant clinicopathological factors were associated with PSA recurrence after RP: the percentage of prostate needle-biopsy cores with cancer, the biopsy Gleason score, PSA level before RP, pathological stage, and the Gleason score of the RP specimen (P < 0.001 for all). In multivariate analyses, the percentage of positive biopsy cores, PSA level before RP, pT and the Gleason score of the RP specimen were all independent significant predictors of PSA recurrence after RP in Japanese men. CONCLUSIONS: The frequency of PSA recurrence after RP was 25.3% in Japan and the percentage of positive biopsy cores, PSA level before RP, pT and the Gleason score of the RP specimen were independent significant factors for PSA recurrence.

Aged↗