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PubMed2001

Local recurrence after curative anterior resection with principally blunt dissection for carcinoma of the rectum and rectosigmoid.

PURPOSE: The aim of this study was to determine the incidence of local pelvic recurrence of carcinoma of the rectum and rectosigmoid (tumors where the lower edge is 18 cm or less from the anal verge) in a consecutive series of patients operated on by a single surgeon. All patients underwent curative anterior resection and a formal anatomic dissection of the rectum where mobilization was achieved through a principally careful blunt manual technique along fascial planes, preserving an oncologic package. METHOD: During the period April 1986 to December 1997, 157 consecutive anterior resections for carcinoma of the rectum and rectosigmoid were performed by one surgeon (ALP). One hundred thirty-eight (87.9 percent) were curative, and 19 (12.1 percent) were palliative. The mean follow-up period was 46 +/- 31.6 (range, 2-140) months. Data were retrospectively collated and computer coded by an independent contracted medical research team. Follow-up data were available on all patients. RESULTS: Four (3.1 percent) of the 131 patients undergoing curative anterior resection had local recurrence. Local recurrences occurred between 16 and 38 months from the time of resection, and the cumulative risk of developing local recurrence at five years was 5.2 percent. All tumors in which pelvic recurrence occurred were high grade, and the probability of developing local recurrence at five years for this group was 13.9 percent, which is significantly higher compared with patients who had average or low-grade tumors (P = 0.01). The probability of developing local recurrence at five years for Stage I tumors was 0, Stage II was 5.9 percent, and Stage III was 8.9 percent. In addition, there was a significantly higher incidence of local recurrence in the group of patients undergoing ultralow anterior resection (between 3 and 6 cm from the anal verge) as compared with patients undergoing low or high anterior resection (P = 0.03). Local recurrence developed in 3 of 28 (10.7 percent) patients having ultralow anterior resection, 1 of 57 (1.8 percent) patients having low anterior resection (between 6 and 10 cm from the anal verge), and no patients having high anterior resection (above 10 cm from the anal verge). The clinical anastomotic leak rate for curative anterior resection was 7 of 131 patients (5.3 percent). Thirty-seven of the 131 (28.2 percent) required a proximal defunctioning stoma; 35 (41.2 percent) of these were established for low or ultralow anterior resections and 2 for high anterior resection. The overall five-year cancer-specific survival rate of the entire group of 131 patients was 81.8 percent, and the overall probability of being disease free at five years including both local and distal recurrence was 72.9 percent. Three local recurrences occurred in the 101 patients (77 percent) who did not receive any form of adjuvant therapy. One local recurrence occurred in the 18 patients (13.7 percent) who had adjuvant chemoradiation. No recurrence occurred in the 12 patients (9.2 percent) who had adjuvant chemotherapy alone. CONCLUSION: Curative anterior resection for carcinoma of the rectum and rectosigmoid with principally blunt dissection of the rectum in this study is associated with a 3.1 percent incidence and a 5.2 percent probability at five years of developing local recurrence. Evidence from this study indicates that, as with sharp pelvic dissection, a low incidence and probability of local recurrence can be achieved by a principally blunt mobilization technique through careful attention to preservation of fascial planes in the pelvis and removal of an oncologic package with selective rather than routine adjuvant or neoadjuvant chemoradiation.

Aged↗
PubMed2006

Evolutionary and physiological importance of hub proteins.

It has been claimed that proteins with more interaction partners (hubs) are both physiologically more important (i.e., less dispensable) and, owing to an assumed high density of binding sites, slow evolving. Not all analyses, however, support these results, probably because of biased and less-than reliable global protein interaction data. Here we provide the first examination of these issues using a comprehensive literature-curated dataset of well-substantiated protein interactions in Saccharomyces cerevisiae. Whereas use of less reliable yeast two-hybrid data alone can reject the possibility that local connectivity correlates with measures of dispensability, in higher quality datasets a relatively robust correlation is observed. In contrast, local connectivity does not correlate with the rate of protein evolution even in reliable datasets. This perhaps surprising lack of correlation with evolutionary rate appears in part to arise from the fact that hub proteins do not have a higher density of residues associated with binding. However, hub proteins do have at least one other set of unusual features, namely rapid turnover and regulation, as manifest in high mRNA decay rates and a large number of phosphorylation sites. This, we suggest, is an adaptation to minimize unwanted activation of pathways that might be mediated by adventitious binding to hubs, were they to actively persist longer than required at any given time point. We conclude that hub proteins are more important for cellular growth rate and under tight regulation but are not slow evolving.

Biological Evolution↗
PubMed2000

Evaluation of the Maruyama computer program accuracy for preoperative estimation of lymph node metastases from gastric cancer.

Controversy still exists about the optimal lymph node (LN) dissection for potentially curable gastric cancer. For rational LN dissection it is important to know the incidence of metastasis at each LN station. For this purpose a computer program was developed using data from 4302 primary gastric cancers treated at the National Cancer Center Hospital in Tokyo between 1969 and 1989. To evaluate the accuracy of the computer program, the differences between the individual reports generated by the computer and the stored data were investigated in 282 Italian patients submitted to curative gastrectomy and D2 or more extended LN dissections for gastric cancer. Receiver operating characteristic (ROC) analysis was used to assess the sensitivity and specificity of the program for predicting LN metastases in each of the 16 regional LN stations. The computer program showed good predictive ability for LN metastases in most of the 16 LN stations, as the areas under the curve ranged from 0.741 (station 15) to 0.944 (station 8), with a mean of 0.856. A critical cutoff point of 18% of the program's expected percentage was the value maximizing the validity of the prediction. Using an "absolute" cutoff point of 0%, the overall rate of false-negative (FN) predictions in 176 N+ patients was 11.9%; of these, 11 (6.2%) were absolute FNs, in which the program totally failed to estimate LN metastases; the remaining 10 cases (5.7%) were relative FNs because the specific prediction was positive for a different depth of stomach invasion. The low number of D3/D4 lymph-adenectomies in the historical database may affect the low estimate of metastases to N3/N4 nodes generated by the program. Based on these data, the program predicts with good accuracy the extent of LN metastases from gastric cancer, but it is not recommended for directing the surgeon to perform more extensive lymphadenectomy.

Chi-Square Distribution↗
PubMed2004

Role of radiotherapy in Ewing tumors.

BACKGROUND: The objective of this review article is to outline the role of radiotherapy in a curative multimodal treatment concept. PROCEDURE: We have analyzed the data from major multi-institutional prospective trials in Ewing tumors for to evaluate the impact of radiotherapy on local control and survival. RESULTS: Surgery yields in general better local control and survival figures as compared to radiotherapy. The efficacy of radiotherapy as compared to surgery varies among the studies and seems to be dependent on patient selection and sequencing with chemotherapy. Combined local therapy (surgery plus post- or pre-operative radiotherapy) has yielded excellent local control rates in patients with high-risk lesions (e.g., pelvic tumors); although not proven by randomized studies, an impact on survival is likely. Indications for post-operative radiotherapy are unradical or marginal resections and poor histological response. In patients with chest wall primaries, adjuvant hemithorax irradiation has reduced the relapse rate significantly. Pre-operative irradiation offers theoretical advantages. Bilateral lung irradiation (as consolidation after chemotherapy) seems to improve prognosis in patients with metastases at diagnosis. CONCLUSIONS: Patients with high-risk lesions probably benefit from combined local treatment (surgery plus radiotherapy). Improving local control after radiotherapy is a major issue for future studies, and sequencing with chemotherapy seems to be critical factor. The possible curative potential of radiotherapy in metastatic disease requires further investigation.

Child↗
PubMed2005

Categorisation of dental care provided in the Netherlands.

OBJECTIVE: To describe the dental care provided in the Netherlands and investigate to what extent variations can be explained in accordance with certain general characteristics of patients. METHOD: Besides the more usual classification of treatment into groups of dental procedures, in this study it is done using constructed categorisation of dental care based on characteristics such as 'preventive', 'curative', 'new', 'time-consuming', 'complicated' and 'lucrative' treatment. The data were collected from various groups of dentists. Two smaller groups of dentists-informants were asked to categorise dental procedures: 16 out of 55 (29%) and 57 out of 150 (38%). Finally this resulted in six type-scores for each procedure. From another larger group of dentists (n = 607) data were collected about the procedures they performed on a 25% random sample of their patients. Categorisations of dental care per patient were calculated by combining the data on the factual procedures performed with the six 'type-scores' for the procedures concerned. Furthermore, the financial returns dentists generated per patient were calculated from the care they provided. RESULTS: Multilevel analysis shows that considerable variation exists in the categorisations of dental care provided according to age, gender, insurance situation and income level of patients. In youths, for example, relatively more 'preventive' and less 'curative', 'complicated' and 'lucrative' treatment is done and 'older' adults receive relatively less 'preventive' and more 'curative', 'time-consuming' and 'complicated' treatment. CONCLUSIONS: By classifying the dental care provided in certain categories, a general view is obtained of the variations between patients in the care provided. The age of patients appears to be the most critical factor, but there are differences among dentists in the way the age of patients influences their conduct in the provision of dental care.

Adolescent↗
PubMed2004

Cost-effectiveness of two follow-up strategies for curative resection of colorectal cancer: comparative study using a Markov model.

The follow-up of patients with curative resection of colorectal cancer is still controversial. The means mobilized for postoperative monitoring come at a high cost. However, the modalities are neither formalized nor validated with regard to an improved 5-year survival rate. To compare the cost-effectiveness of both strategies for patient follow-up during the 7 years following curative resection of colorectal cancer, we performed a costeffectiveness analysis adjusted for quality of life. Using data from the literature and a population study, a simulation of follow-up on patients who had undergone curative resection of colorectal cancer was carried out over a 7-year period using a Markov model. Two Markov processes were modeled to compare the cost-effectiveness ratio adjusted for quality of life in patients with a follow-up in accordance with the recommendations of the 1998 French Consensus Conference (standard follow-up) with the carcinoembryonic antigen (CEA) assay and a simplified follow-up. The influence of standard follow-up on the quality-adjusted life expectancy of patients who had Duke's stage A and B colorectal cancer appears to be modest, with increases of 2.5 months and 1.3 months, respectively; it is more acceptable for patients who had had Duke's stage C, with an increase of 11 months. The high variability of cost-effectiveness ratios (> 7 years) of +/- 44,830 and 180,195 Euro per quality-adjusted life-years (QALY), respectively) did not favor the standard follow-up. The cost-effectiveness ratio (> 7 years) of patients having had Duke's stage C colorectal cancer was 1,058 (sd: 2746) Euro per QALY and could favor the standard follow-up. This study showed that standard follow-up with CEA assay tended to preferentially improve the survival of Duke's stage C patients. The type of examination needed and the frequency with which it has to be carried out should take account of the stage, treatment for the initial illness, and the patient's age.

Aged↗
PubMed1989

Postoperative adjuvant chemotherapy inhibits early recurrence of early gastric carcinoma.

Data on 300 patients with early gastric carcinoma who underwent curative resection were analyzed for the suppressive effects of postoperative adjuvant chemotherapy on early recurrences. Retrospective grouping was done as follows: no chemotherapy (NC) group (169 patients), mitomycin C (MMC) group (108), and another group (23). In all, 24 patients (16 in the NC, 6 in the MMC, and 2 in the other group) who died of other diseases within 5 years after surgery were excluded. Therefore, data on 153 individuals in the NC and 102 in the MMC group were analyzed. The recurrence rate in patients with Pen A type carcinoma, with a propensity toward an early recurrence in the liver, was 37.5% in the NC and 9.1% in the MMC group. Among 27 Pen A type patients, 3- and 4-year survival was significantly higher in those receiving MMC (100%) than in those given NC (62.5%). Recurrences in the liver occurred in 6/14 of the NC patients within 3 years after surgery, whereas there were no recurrences in 11 MMC patients. Thus, the postoperative adjuvant chemotherapy with mitomycin-C has an inhibitory effect on early recurrence in patients with Pen A type early gastric carcinoma.

Carcinoma↗
PubMed1999

Prevalence of visual impairment in children: a review of available data.

Data on the prevalence, magnitude and causes of blindness and severe visual impairment in children are needed for planning and evaluating preventive and curative services for children, and for planning special education and low vision services. Prevalence data can be obtained from a variety of different sources, each of which has limitations. The available data suggest that there may be a ten-fold difference in prevalence between the wealthiest countries of the world and the poorest, ranging from as low as 0.1/1000 children aged 0-15 years in the wealthiest countries to 1.1/1000 children in the poorest. In this paper, the available data are reviewed and the epidemiological methods and findings are discussed.

Adolescent↗
PubMed2005

Life, illness and death--existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer.

The aim of this study is to describe cancer patients' existential reflections and how these reflections were met by the nursing staff. A qualitative method of data collection was used. Ten patients with breast- or prostate cancer who had completed curative treatment were interviewed. The results showed that the cancer diagnosis resulted in existential reflections in some of the patients. These reflections concerned the meaning of life, God/a higher power, health, work, relations and sexuality. Reflections on the cancer consisted in beliefs about the causes of cancer, treatment and cancer and sexuality. It could also be seen that loss of important life values, such as health and sexuality could lead to loss of meaning of life. Explicit reflections on sexuality were only made by two of the men in the study. The patients reported a need of existential support as well as obstacles for giving such support. Obstacles could be lack of time and lack of continuity, as well as lack of knowledge resulting in an inability to identify existential issues. Some of the patients had wanted existential support from nurses, while others received the support they needed from family and friends.

Adaptation, Psychological↗
PubMed2004

Three-dimensional conformal radiotherapy in the treatment of prostate cancer in Australia and New Zealand: Report on a survey of radiotherapy centres and the proceedings of a consensus workshop.

There is an increasing use of 3-D conformal radiotherapy (3DCRT) in the radiotherapeutic management of prostate cancer. The Faculty of Radiation Oncology Genito-Urinary Group carried out a survey of Australian and New Zealand radiotherapy centres in the preparation of a consensus workshop. Of the 19 centres that were represented, there were 24 radiation oncologists, 16 radiation therapists and 12 medical physicists. The survey collected demographic information and data on the practices undertaken at those centres when delivering curative radiotherapy in the treatment of prostate cancer. There was much variation in the delivery of treatment in the areas of patient set-up, contouring of target volumes and organs of interest during computer planning, the techniques and the dose constraints used in these techniques, the use of adjuvant androgen deprivation therapy and the quality assurance processes used in monitoring effects of treatment. This variability reflects the range of data in the published literature. Emerging trends of practices were also identified. This is a first report on a multi-disciplinary approach to the development of guidelines in 3DCRT of prostate cancer.

Australia↗
PubMed1998

[Prevalence of malnutrition in the Mbao Health District].

Protein-energy malnutrition is a real health priority in developing countries specially in african ones. So, a cross-sectional study was conducted, from April 14 to July 28 1995, in the health district of Mbao in Senegal, to determine the prevalence of protein-energy malnutrition (PEM) in a population of children 0-5 year old utilizing the health center, for a curative care, an immunization, a growth monitoring. Anthropometric and sociodemographic data were collected and analysed using a microcomputer with WHO/CDC Epi Info 6.0. The index weight/age expressed on Zscore was used with comparison to NCHS/CDC/WHO population's international reference. Among 204 children, 89 (43.6%) present a PEM.51 (57.3%) are male. More than 60% of the children with PEM are 6-29 months old. 74 (83.2%) live in the surroundings of Mbao. They all come from different ethnic group. 67.4% utilize the health center for a curative care and 7.9% for growth monitoring. There is no relation statistically significant between protein-energy malnutrition and the parameters we studied. To overcome such problem, it is necessary to strengthen the management of malnourished children in specialized centers, to educate families in the nutritional properties of local products and to improve the socioeconomic status of the population for better access to these products.

Anthropometry↗
PubMed2004

Private care and public health: do vaccination and prenatal care rates differ between users of private versus public sector care in India?

OBJECTIVE: To determine whether patients who use private sector providers for curative services have lower vaccination rates and are less likely to receive prenatal care. DATA SOURCES/STUDY SETTING: This study uses data from the 52d round of the National Sample Survey, a nationally representative socioeconomic and health survey of 120,942 rural and urban Indian households conducted in 1995-1996. STUDY DESIGN: Using logistic regression, we estimate the relationship between receipt of preventive care at any time (vaccinations for children, prenatal care for pregnant women) and use of public or private care for outpatient curative services, controlling for demographics, household socioeconomic status, and state of residence. DATA COLLECTION/EXTRACTION METHODS: We analyzed samples of children ages 0 to 4 and pregnant women who used medical care within a 15-day window prior to the survey. PRINCIPAL FINDINGS: With the exception of measles vaccination, predicted probabilities of the receipt of vaccinations and prenatal care do not differ based on the type of provider at which children and women sought curative care. Children and pregnant women in households who use private care are almost twice as likely to receive preventive care from private sources, but the majority still obtains preventive care from public providers. CONCLUSIONS: We do not find support for the hypothesis that children and pregnant women who use private care are less likely to receive public health services. Results are consistent with the notion that Indian households are able to successfully navigate the coexisting public and private systems, and obtain services selectively from each. However, because the study employed an observational, cross-sectional study design, findings should be interpreted cautiously.

Adolescent↗
PubMed2004

GDR (Genome Database for Rosaceae): integrated web resources for Rosaceae genomics and genetics research.

BACKGROUND: Peach is being developed as a model organism for Rosaceae, an economically important family that includes fruits and ornamental plants such as apple, pear, strawberry, cherry, almond and rose. The genomics and genetics data of peach can play a significant role in the gene discovery and the genetic understanding of related species. The effective utilization of these peach resources, however, requires the development of an integrated and centralized database with associated analysis tools. DESCRIPTION: The Genome Database for Rosaceae (GDR) is a curated and integrated web-based relational database. GDR contains comprehensive data of the genetically anchored peach physical map, an annotated peach EST database, Rosaceae maps and markers and all publicly available Rosaceae sequences. Annotations of ESTs include contig assembly, putative function, simple sequence repeats, and anchored position to the peach physical map where applicable. Our integrated map viewer provides graphical interface to the genetic, transcriptome and physical mapping information. ESTs, BACs and markers can be queried by various categories and the search result sites are linked to the integrated map viewer or to the WebFPC physical map sites. In addition to browsing and querying the database, users can compare their sequences with the annotated GDR sequences via a dedicated sequence similarity server running either the BLAST or FASTA algorithm. To demonstrate the utility of the integrated and fully annotated database and analysis tools, we describe a case study where we anchored Rosaceae sequences to the peach physical and genetic map by sequence similarity. CONCLUSIONS: The GDR has been initiated to meet the major deficiency in Rosaceae genomics and genetics research, namely a centralized web database and bioinformatics tools for data storage, analysis and exchange. GDR can be accessed at http://www.genome.clemson.edu/gdr/.

Computer Graphics↗
PubMed1989

Computer analysis in making preoperative decisions: a rational approach to lymph node dissection in gastric cancer patients.

In Japan, R2 lymph node dissection is standard practice for all curatively resected gastric cancer patients. From 1969 to 1984, data were collected prospectively to evaluate this procedure and to provide information for a more rational approach to node dissection for each individual case. A total of 3843 cases was included in this study and an evaluation was made of the prognostic variables and lymph node involvement at various locations. Using a computer program, it is possible to compile a group of treated patients, with prognostic variables exactly matching those of an individual patient. Analysis of this group can then give an indication of the extent of lymph node dissection required for an individual patient. This paper gives a demonstration of the structure of such a system by means of an example.

Decision Making, Computer-Assisted↗
PubMed1982

Effect of operation on cell-mediated immune response to autologous tumor extract in cancer patients.

Utilizing lymphocyte proliferation assay, effects of operation on cell-mediated immune response to autologous tumor extract were studied in 33 patients with gastric or colon carcinoma. To evaluate the lymphocyte proliferation response to autologous tissue extract preoperatively, the lymphocytes were left in culture for 24-30 hours before addition of the extract while 3 M KCl extract of autologous tissue was being processed. A significant level (P less than 0.001) of correlation was observed between stimulation index values to autologous tumor extract added at the initiation of culture and after a 24-30-hour period of incubation. Using this type of assay system, lymphocyte proliferation response to autologous tumor extract was examined immediately before operation and 1, 2, and 4 weeks after operation serially. Data comparing the responses of 20 patients who had curative resection and 13 patients who underwent noncurative resection appeared to fall into three categories in each group. The clinical courses of these patients in each category might clarify the significance of changes in the response following operation.

Colonic Neoplasms↗
PubMed1976

Anatomical rationale of ablative surgery for temporal lobe seizures and dyscontrol: suggested stereo-chemode chelate-blockade alternative.

Anatomical data now strongly suggest that the common factor in curative ablative operations for the commonest (i.e. ammonshorn-sclerosis) form of temporal-lobe epilepsy is the cutting of the ipsilateral temporoammonic perforant path's "nozzle" where it leaves the entorhinal cortex to "spray" along the length of the ammonshorn. This substantially deafferences ipsilateral dentate granule-cells and hence the unsclerosed pyramidal neurons notably in "resistant sector" CA2, which are probably the source of the seizures. Stereo-chemoding of long-lasting (experimentally tested) chelates along the zone of peculiarly zinc-rich synapses of the mossy fibre system should block the commissural as well as the ipsilateral inputs to these residual neurons, to give higher percentage cures, and could probably be performed bilaterally (where indicated, in adults) without endangering memory function.

Chelating Agents↗
PubMed2005

Should we deny surgery for malignant hepato-pancreatico-biliary tumors to elderly patients?

Malignant hepato-pancreatico-biliary (HPB) tumors have their highest incidence within the sixth to eighth decades of life. The aging of the world population has resulted in a dramatic increase in the number of elderly patients considered for resection of malignant HPB tumors. Because elderly patients are more likely to have more co-morbidities, cognitive impairment, and decreased life expectancy, the benefit and appropriateness of these procedures must be scrutinized for geriatric patients. Therefore, many surgeons have compared the perioperative and long-term outcome of hepatic and pancreatic resections for elderly and younger patients. In most series the elderly population was defined by an age of 70 years or older. The results demonstrate that hepatic resection for hepatocellular carcinoma and colorectal liver metastases can be safely performed in well-selected elderly patients with long-term outcome comparable to younger patients. Similar findings are also reported for pancreatic resection in elderly patients with either ampullary or pancreatic cancer. Although the survival benefit of pancreatico-duodenectomy is limited in all age groups, the absence of competitive therapy justifies this procedure as the sole curative option in younger as well as older patients. Data on resection of gallbladder cancer and hilar bile duct cancer in the elderly are sparse, but there is evidence from large series on resection of these types of tumors that advanced age per se is not a risk factor for reduced outcome. Therefore, surgical options should not be denied to elderly patients with a malignant HPB tumor, and the evaluation should include surgeons expert in HPB surgery.

Age Factors↗
PubMed2006

Uncovering the "skeleton in the closet": the issue of bone and joint disorders in the Maldives and the opportunities for primary prevention and health promotion.

Disorders of bones and joints are the most common cause of severe long-term pain and disability around the world yet receive inadequate attention in many countries. Bone/joint health is absent from current health policy and the primary prevention/health promotion agenda in Maldives and diagnostic and curative infrastructure is very limited. In 2004, tentative evidence emerged indicating that degenerative bone and joint conditions may impose a large burden on community health. A study was undertaken amongst a representative community sample of women aged 15-50 to further investigate the issue. One third reported bone/joint problems; very high proportions manifested a range of osteoporosis risk factors, and sizeable numbers appear to be at elevated risk of osteoarthritis. Bone/joint health knowledge was very limited. The findings suggest strong potential for primary prevention on modifiable risk factors, need for research with other population groups, and development of screening and curative care. EDITORS' STRATEGIC IMPLICATIONS: The author provides important data on the burden of disorders of bones/joints on a "developing" community and presents recommendations for behavioral and educational prevention strategies that may prove useful across societies.

Adolescent↗