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PubMed2000

Clinical evaluation of polyacid-modified resin composite posterior restorations: one-year results.

OBJECTIVE: The aim of this investigation was to evaluate the clinical performance of a new compomer restorative system, Dyract AP, placed in combination with Non-Rinse Conditioner and Prime & Bond NT in permanent posterior teeth. METHOD AND MATERIALS: Fifty Class II and 41 Class I restorations were placed in 39 patients by 1 dentist. The restorations were evaluated directly, with modified US Public Health Service criteria, and indirectly, with color slides and polyvinyl siloxane impressions, at baseline and 6 months and 1 year after placement. Preoperative and 1-year postoperative bitewing radiographs were also taken. RESULTS: All 82 restorations available for 1-year evaluation were in situ. No postoperative sensitivity or pulpal problems were reported. Four Class II restorations (4.9%) failed because of partial fracture or recurrent caries. The percentages of Alfa score for each criterion were color match, 95.1%; marginal discoloration, 57.3%; marginal integrity, 35.4%; anatomic form, 98.8%; and surface texture, 91.5%. The average wear rate of Dyract AP was low (18.5 +/- 11.7 microns at 6 months and 35.7 +/- 13.6 microns at 12 months). CONCLUSION: The excellent handling characteristics, the good clinical performance, and the improved wear resistance suggest that this compomer will provide reliable direct tooth-colored restorations in stress-bearing areas.

Acid Etching, Dental↗
PubMed1997

Predictive value of argyrophilic nucleolar-organizer-region-associated proteins in bladder cancer, using cell-imprint preparations.

The predictive value of quantifying argyrophilic nucleolar-organizer-region-associated proteins (Ag-NOR) in routinely processed paraffin-embedded tissue sections of bladder cancer remains controversial. The purpose of this study was to determine whether cell-imprint preparations facilitate a more accurate determination of the mean number of Ag-NOR per cell (Ag-NOR score). The utility of using the Ag-NOR scores of cell-imprint preparations as a prognostic indicator in patients with bladder cancer was explored. We evaluated 90 patients with newly diagnosed bladder cancer using cell-imprint preparations to determine Ag-NOR score. The score significantly correlated with known prognostic factors associated with this tumor, including histological grade (P < 0.001), pathological stage (P < 0.01), and papillary structure (P < 0.001). Furthermore, the Ag-NOR score appeared to be an independent predictor of intravesical tumor recurrence of superficial bladder cancer (P < 0.05). These results suggest that the Ag-NOR score determined in a cell imprint preparation may serve as a useful prognostic indicator in bladder cancer.

Carcinoma, Transitional Cell↗
PubMed1997

Clinical and personality correlates of outcome in depressive disorders in a Turkish sample.

Effects of clinical and personality traits on the course of depression were investigated after a mean period of 30 months. 66 out of 119 depressive patients (according to DSM-III-R and ICD-10 diagnostic criteria) were re-assessed by the same clinicians of the index episode. Schedule for Standardized Assessment of Depressive Disorders (SADD) was the main instrument for the initial phase; the follow-up schedule of SADD was used for the second phase. In both phases personality was evaluated by Eysenck Personality Questionnaire (EPQ). Severity of the disorder was assessed by Beck Depression Inventory. We found a chronicity rate of 9.1%, recurrence rate of 31.8%. Common features of chronic depressives were female sex, being over 30 years of age, gradual and late onset, presence of anxiety and multiple life events. EPQ results of the subjects who were free of depression were compared at the follow-up assessment. The remitted recurrent depression group showed significantly lower neuroticism scores than remitted single depression group. Neurotic depression subgroup was significantly associated with higher neuroticism scores.

Adult↗
PubMed1994

The correlated binomial model in the analysis of clinical diagnostic test parameters for recurrence of periodontitis.

In the present study, recall data of 29 patients with advanced periodontitis were utilized to calculate diagnostic test parameters for bleeding scores or increased residual probing depth on increase of periodontal probing depth of > or = 2 mm after 2 years, comparing the simple binomial and correlated binomial model. 5.6% of sites were identified, where the periodontal probing depth increased 2 mm or more during 2 years of maintenance. Within-patient correlation coefficient of sites were found to be small, in general (p < 0.02), with the exceptions for predictive value of a positive test for frequent (> or = 3/4 times) bleeding on probing and residual probing depth of > or = 4 mm (p = 0.137 and p = 0.086, respectively), and specificity for no bleeding (p = 0.151). Point estimates of test parameters generally did not differ between simple binomial and correlated binomial model. The respective standard deviations were either over- or underestimated in the simple binomial model. It was concluded that the suggestion of a limited diagnostic value of bleeding scores or increased residual postoperative probing depth to predict recurrence of periodontitis cannot be rejected after application of a correlated binomial model.

Adolescent↗
PubMed1998

Feasibility and efficacy of external beam radiotherapy after hyperthermic isolated limb perfusion with TNF-alpha and melphalan for limb-saving treatment in locally advanced extremity soft-tissue sarcoma.

PURPOSE: Hyperthermic isolated limb perfusion (HILP) with tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), and melphalan is associated with a dramatic antitumor effect in locally advanced extremity soft-tissue sarcomas (STS). The aim of this study was to demonstrate the feasibility and efficacy of adjuvant radiotherapy after HILP with TNF-alpha, IFN-gamma, and melphalan and delayed surgical resection. METHODS AND MATERIALS: Between 1991 and 1995, 34 patients--16 males and 18 females, median age 50 (range 18-80) years--underwent HILP for locally advanced extremity STS. Resection of the residual tumor mass was performed in most patients after 6-8 weeks. Fifteen patients with histopathological viable tumor after resection received adjuvant 60-70 Gy external beam radiotherapy (EBRT) (44%, HILP + EBRT group). Nineteen patients received HILP without adjuvant EBRT (56%, HILP-only group). Five patients in the HILP-only group had also distant metastases (15%) and received HILP as a palliative treatment. Treatment morbidity, local recurrences, and regional and distant metastases were scored. RESULTS: During a median follow-up of 34 months (range 8-54), limb salvage was achieved in 29 patients (85%): 14 patients after HILP + EBRT and 15 patients after HILP only. None of the patients from the HILP + EBRT group developed local recurrences; however, five patients from the HILP-only did (26%) (p < 0.05). Regional metastases were observed in one patient from the HILP + EBRT group (7%) and in two patients from the HILP-only group who were treated with curative intent (14%). Distant metastases occurred in four patients after HILP + EBRT (27%) and in four patients after HILP only with curative intent (29%). The mean morbidity (subjective, objective, medical management, and analytical evaluation) score in both groups was, respectively, 0.33 for skin and subcutaneous tissue and for muscle and soft tissue, 0.34 (HILP + EBRT group) and 0.33 (HILP-only group). CONCLUSION: Adjuvant EBRT after HILP with TNF-alpha, IFN-gamma, and melphalan and delayed tumor resection of locally advanced extremity STS is feasible and may increase local tumor control without increasing treatment morbidity.

Adolescent↗
PubMed1998

Can exercise testing in patients with a history of myocardial infarction predict fatal and non-fatal reinfarction?

BACKGROUND AND OBJECTIVES: Exercise testing (ET) is the preferred initial strategy for risk stratification in patients who are able to exercise and have an interpretable electrocardiogram. However, although it is often suggested and widely applied, its usefulness years after myocardial infarction (MI) is questionable. Therefore, this study was designed to assess the value of exercise testing in predicting the risk of fatal or non-fatal reinfarction in patients with chronic stable coronary artery disease (CAD) due to old myocardial infarction. METHODS: Our study involved 766 consecutive stable subjects [mean (SD) age 57 (8.6) years; male: 89%] with stable CAD due to old MI [mean time from MI: 2.8 (0.75) years], who underwent a Bruce treadmill test and whose data were prospectively entered into our institutional database. Patients were followed up for an average of 7 (0.6) years. RESULTS: Reinfarction was observed in 62 patients; 54 non-fatal and 8 (13%) fatal. Relative risk (RR) of cardiac death for subjects with reinfarction was 4.02 [95% confidence interval (CI): 2.46 to 6.55]. Univariate predictors of fatal or non-fatal reinfarction were: multivessel disease (RR 7.99, CI 1.12 to 56.82), EF < 40% (RR 2.91, CI 1.64 to 7.17), ST depression on rest ECG (RR 2.4, CI 1.30 to 4.45), BP increase with exercise < 10 mmHg (RR 2.36, CI 1.41 to 3.93), BP/HR interaction < 10 mmHg + < 85% max (RR 2.16, CI 1.24 to 3.76). Markers of reduced risk of recurrence included low-risk Duke Treadmill Score (RR 0.55, CI 0.33 to 0.91) and EF > or = 40% (RR 0.34, CI 0.19 to 0.60). A Cox regression model with clinical and exercise parameters detected ST depression on rest ECG (RR 1.47, CI 1.07 to 2.02), BP increase with exercise < 10 mmHg (RR 1.41, CI 1.07 to 1.87), low-risk Duke Treadmill Score (RR 0.79, CI 0.60 to 1.02). A model with coronary anatomy and ejection fraction was also able to identify multivessel disease (RR 2.95, CI 1.43 to 6.09), EF < 40% (RR 1.62, CI 1.17 to 2.25) and BP increase with exercise < 10 mmHg (RR 2.53, CI 1.35 to 4.71). CONCLUSIONS: Stable patients with a history of MI represent a very low-risk population in whom reinfarction continues to have a severe prognosis. ET is unable to identify subjects in whom there is a risk of recurrence, especially if only ischemic parameters are evaluated (in this setting, a clinical or anatomic risk stratification may be better). The application of the Duke Treadmill Score could help to identify a very low-risk group in which no additional testing is required. Therefore, routine ET in stable patients with a history of MI is better at identifying a very low-risk group than in predicting recurrence.

Adult↗
PubMed1999

Measurement of the quality of life during different clinical phases of breast cancer.

This cross-sectional study was designed to evaluate the self-rated quality of life of Taiwanese breast cancer patients at the time of diagnosis and during various phases of treatment. A total of 115 patients at different clinical stages of breast cancer completed the study. The questionnaires consisted of the Medical Outcome Survey 36-Item Short Form Health Surveys (SF-36), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Cancer 30 (EORTC QLQ-C30), and questions measuring utility using visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods. The patients filled out the questionnaires, with interviewers' assistance as requested. Cronbach's alpha coefficients of internal consistency for the SF-36, based on the US factor structure, were 0.84 for raw scores and 0.87 and 0.88 for the physical and mental components, respectively. Cronbach's alpha for the EORTC QLQ-C30 was 0.86. The correlations between items in the SF-36 and the EORTC QLQ-C30 that examined similar dimensions were high. Significant differences were found in most dimensions of quality of life across different clinical stages. The three utility scores, however, showed no significant differences among patients in different clinical stages. Patients in the chemotherapy and recurrence phases usually had the lowest quality of life scores, while those in the follow-up phase had the highest. The results of this study demonstrate the applicability of quality of life measurements in helping health professionals identify the physical, mental, and social problems of breast cancer patients in different phases of the clinical process.

Adult↗
PubMed2026

Primary Tumor Epigenetic and Transcriptomic Alterations Associated with Nodal Burden and Metastatic Risk in ER+/HER2- Breast Cancer.

De-escalation of axillary surgery has resulted in the loss of pathologic nodal information, yet the extent of lymph node involvement remains an important determinant of treatment decisions in estrogen receptor-positive (ER+)/HER2- disease. We examined whether primary tumors differed molecularly according to the extent of this regional dissemination. Genome-wide DNA methylation profiling of primary ER+/HER2- tumors from 47 patients with pN1 (n = 29) vs. >pN1 (n = 18) disease showed differences concentrated at promoters of developmental and cell-adhesion genes. By integrating methylomes with transcriptomes from the TCGA-BRCA cohort (n = 148) and clinical outcomes from KM Plotter (RFS, n = 1154; OS, n = 442; DMFS, n = 423), we identified four genes (ARL10, RIC3, CXCL14, KCNH2) showing concordant molecular and clinical associations, from which we derived the Lymph-node Involvement Outcome Numerator (LION) score. Lower LION scores were observed in metastatic lesions from the AURORA US cohort (n = 45). In SCAN-B (n = 3969), lower scores were associated with shorter distant recurrence-free intervals (HR = 0.38; 95% CI 0.23-0.62); this association persisted after adjustment for age, nodal and tumor category but was lost after adjustment for histological grade (HR = 0.83; 95% CI 0.48-1.44), indicating that the score and grade capture overlapping biology. These findings suggest that primary tumors already display coordinated epigenetic and transcriptional alterations associated with the extent of metastatic dissemination.

Humans↗
PubMed1995

[Clinical course and social outcome in schizophrenia. Results from a retrospective study].

OBJECTIVE: The aim of the present study is to investigate the possible clinical and symptomatological determinants of social outcome in schizophrenic patients. METHOD: 40 schizophrenic patients (DSMIII-R), 21 males and 19 females, mean age 4 +/- 5 years, have been evaluated in the present retrospective study. All of them had first undergone psychiatric hospitalization between 1978 and 1981. The following data have been collected: socio-anagraphic features and course of the illness (AMDP), contacts with community health centre and pharmacological compliance. Social disability has been investigated by means of a semi-structured interview developed from the "Disability Assessment Schedule" named "Accertamento Disabilità e Carico Familiare" (ADC), which has been administered to the main carer, usually a cohabitant relative. Presence and level of social support have also been evaluated. One Way Analysis of Variance (ANOVA), "t" test with Bonferroni correction and Pearson Correlation test have been used for data analysis. RESULTS: Patients with less severe social disability (lower scores at ADC) were mainly those with recurrent course of illness without residual symptoms or remitted ones (p = 0.0001), better pharmacological compliance (p = 0.004), more frequent and regular contacts with community health centres (p = 0.0001) and better social support (p = 0.01). On the contrary, score at ADC resulted positively correlated with number of hospitalizations (r = 0.57, p = 0.01), number of compulsory admission (r = 0.32, p = 0.01) and length of illness (r = 0.40, p = 0.01). CONCLUSIONS: Although in our study the influence of severity of illness on social disability has been confirmed, suggestive evidence about importance of other factors, such as compliance or social support, may be drawn.

Age of Onset↗
PubMed1999

Blood-based reverse transcriptase polymerase chain reaction assays for prostatic specific antigen: long term follow-up confirms the potential utility of this assay in identifying patients more likely to have biochemical recurrence (rising PSA) following radical prostatectomy.

Reverse transcriptase polymerase chain reaction (RT-PCR) assay is a sensitive technique to detect circulating cells expressing prostate-specific antigen (PSA) in blood or bone marrow from patients with prostate cancer. When applied to prostate cancer patients at our institution, this technique identifies those patients with a greater likelihood of extra-prostatic disease. We evaluated RT-PCR PSA as a predictor of PSA recurrence and compared it with pre-operative (serum PSA, digital rectal examination, Gleason score on biopsy) and post-operative parameters (pathological findings). Three hundred nineteen men scheduled for radical prostatectomy had an enhanced RT-PCR PSA assay before surgery. The enhanced RT-PCR PSA protocol has been previously described. PSA recurrence was defined as any serum PSA value above 0.2 microgram/l. Forty-six patients had PSA recurrence. The mean follow-up was 25.4 months. Recurrence free survival was 53% for patients with positive RT-PCR PSA vs. 84% if RT-PCR PSA was negative. By using multivariate analyses, RT-PCR PSA status was not an independent predictor of PSA recurrence compared to pathological stage pT3, Gleason score on prostate specimen and serum PSA. If only pre-operative parameters were studied, serum PSA and RT-PCR PSA status were 2 independent pre-operative predictors of PSA recurrence compared with Gleason score on biopsy and digital rectal examination. Int. J. Cancer (Pred. Oncol.) 84:360-364, 1999.

Disease-Free Survival↗
PubMedDate not supplied

Prehospital severity scoring at major rock concert events.

INTRODUCTION: Rock and contemporary music concerts are popular, recurrent events requiring on-site medical staffing. STUDY OBJECTIVE: To describe a novel severity score used to stratify the level of acuity of patients presenting to first-aid stations at these events. METHODS: Retrospective review of charts generated at the first-aid stations of five major rock concerts within a 60,000 spectator capacity, outdoor, professional sports stadium. Participants included all concert patrons presenting to the stadium's first-aid stations as patients. Data were collected on patient demographics, history of drug or ethanol usage while at the concert event, first-aid station time, treatment rendered, diagnosis, and disposition. All patients evaluated were retrospectively assigned a "DRUG-ROCK" Injury Severity Score (DRISS) to stratify their level of acuity. Individual concert events and patient dispositions were compared statistically using chi-square, Fisher's exact, and the ANOVA Mean tests. RESULTS: Approximately 250,000 spectators attended the five concert events. First-aid stations evaluated 308 patients (utilization rate of 1.2 per 1,000 patrons). The most common diagnosis was minor trauma (130; 42%), followed in frequency by ethanol/illicit drug intoxication (98; 32%). The average time in the first-aid station was 23.5 +/- 22.5 minutes (+/- standard deviation; range: 5-150 minutes). Disposition of patients included 100 (32.5%) who were treated and released; 98 (32%) were transported by paramedics to emergency departments (EDs); and 110 (35.5%) signed-out against medical advise (AMA), refusing transport. The mean DRISS was 4.1 (+/- 2.65). Two-thirds (67%) of the study population were ranked as mild by DRISS criteria (score = 1-4), with 27% rated as moderate (score = 5-9), and 6% severe (score > 10). The average of severity scores was highest (6.5) for patients transported to hospitals, and statistically different from the scores of the average of the treated and released and AMA groups (p < 0.005). CONCLUSION: The DRISS was useful in stratifying the acuity level of this patient population. This severity score may serve as a potential triage mechanism for future mass gatherings such as rock concerts.

Adolescent↗
PubMed2002

Functional recovery and length of stay after recurrent hip fracture.

OBJECTIVE: To evaluate the functional recovery and the rehabilitation length of stay after the sequential fracture of both hips in elderly patients. DESIGN: A total of 372 in-patients with hip fractures consecutively admitted to our rehabilitation hospital were included in this retrospective study. A total of 333 out of 372 were admitted for rehabilitation of their first hip fracture, and the other 39 patients had a second contralateral fracture. The functional recovery was evaluated by the Barthel index. The comparison between the two groups was performed by unpaired t test. Stepwise linear multiple regression analysis was performed, including nine prognostic factors together with the number of hip fractures (first or recurrent) as independent variables and the Barthel index score on discharge as the dependent variable. The statistical analysis was repeated, substituting hospital length of stay for Barthel index. RESULTS: Both the functional recovery and the length of stay of the patients affected by recurrent fracture were similar to the ones of the patients suffering from a single fracture. Regression analysis showed that the previous hip fracture was associated neither with the Barthel index nor with the length of stay. CONCLUSIONS: Our data suggest that the functional recovery in elderly patients with hip fractures is not significantly influenced by a previous fracture of the contralateral hip and that no significant prolonged rehabilitation length of stay is needed after the recurrent fracture.

Age Factors↗
PubMed2003

Multiplex biomarker approach for determining risk of prostate-specific antigen-defined recurrence of prostate cancer.

BACKGROUND: Molecular signatures in cancer tissue may be useful for diagnosis and are associated with survival. We used results from high-density tissue microarrays (TMAs) to define combinations of candidate biomarkers associated with the rate of prostate cancer progression after radical prostatectomy that could identify patients at high risk for recurrence. METHODS: Fourteen candidate biomarkers for prostate cancer for which antibodies are available included hepsin, pim-1 kinase, E-cadherin (ECAD; cell adhesion molecule), alpha-methylacyl-coenzyme A racemase, and EZH2 (enhancer of zeste homolog 2, a transcriptional repressor). TMAs containing more than 2000 tumor samples from 259 patients who underwent radical prostatectomy for localized prostate cancer were studied with these antibodies. Immunohistochemistry results were evaluated in conjunction with clinical parameters associated with prostate cancer progression, including tumor stage, Gleason score, and prostate-specific antigen (PSA) level. Recurrence was defined as a postsurgery PSA level of more than 0.2 ng/mL. All statistical tests were two-sided. RESULTS: Moderate or strong expression of EZH2 coupled with at most moderate expression of ECAD (i.e., a positive EZH2:ECAD status) was the biomarker combination that was most strongly associated with the recurrence of prostate cancer. EZH2:ECAD status was statistically significantly associated with prostate cancer recurrence in a training set of 103 patients (relative risk [RR] = 2.52, 95% confidence interval [CI] = 1.09 to 5.81; P =.021), in a validation set of 80 patients (RR = 3.72, 95% CI = 1.27 to 10.91; P =.009), and in the combined set of 183 patients (RR = 2.96, 95% CI = 1.56 to 5.61; P<.001). EZH2:ECAD status was statistically significantly associated with disease recurrence even after adjusting for clinical parameters, such as tumor stage, Gleason score, and PSA level (hazard ratio = 3.19, 95% CI = 1.50 to 6.77; P =.003). CONCLUSION: EZH2:ECAD status was statistically significantly associated with prostate cancer recurrence after radical prostatectomy and may be useful in defining a cohort of high-risk patients.

Adult↗
PubMed1998

Loss of expression of transforming growth factor-beta receptors is associated with poor prognosis in prostate cancer patients.

Transforming growth factor beta (TGF-beta) is a potent inhibitor of proliferation in most cells and exerts its effects through an interaction with membrane receptors type I (TGF-betaRI) and type II (TGF-betaRII). Recently, we have demonstrated a correlation between the loss of expression of TGF-betaRI and TGF-betaRII and increasing Gleason score in archival human prostate cancer tissues. To evaluate the potential prognostic value of this observation, the present study investigated the expression of TGF-beta receptors in association with disease progression after the initial diagnosis in 52 archival human prostate cancer tissues. The expression of both TGF-betaRI and TGF-betaRII was correlated with the Gleason score, clinical tumor stage, 4-year survival rate, and serological recurrence rate after radical prostatectomy. Results revealed that there was a significant association between the Gleason score and the loss of expression of TGF-betaRI (P < 0.025) and TGF-betaRII (P < 0.01). However, only the loss of TGF-betaRI expression showed a statistically significant association with the clinical tumor stage (P < 0.05), 4-year survival rate (P < 0.05), and serological recurrence rate after radical prostatectomy (P < 0.025). Therefore, these data indicate that the loss of TGF-betaRI expression as measured by immunohistochemical staining may be a potential prognostic marker in prostate cancer patients.

Humans↗
PubMed1995

Proliferative activity in colonic adenomas as a predictor of metachronous adenomas as assessed by proliferating cell nuclear antigen immunohistochemistry.

OBJECTIVES: The aim of this study was to determine whether cell proliferation in colonic adenomas, as estimated by proliferating cell nuclear antigen (PCNA), predicts the development of metachronous colonic adenomas. METHODS: Forty patients who underwent prior endoscopic polypectomy for colonic adenomas were reevaluated by colonoscopy 2 yr later. The expression of PCNA was studied in all adenomas that were removed. A five-point semiquantitative scale of 1-5 was used to estimate the PCNA score by the percentage of positively stained cells. RESULTS: Among the 40 patients studied, 16 developed recurrent adenomas (group A) and 24 were free of adenomas (group B). At initial colonoscopy, a total number of 51 adenomas (25 in group A and 26 in group B), were found. The median PCNA score in group A and group B index adenomas was 4 (interquartile range, 3-5) and 2 (interquartile range, 1-3), respectively (p < 0.01, Mann-Whitney U-test). A stepwise logistic regression analysis showed that PCNA score is a significant risk factor (p = 0.007, odds ratio 15.8, 95% confidence interval 2.2-112.4) in predicting adenoma recurrence. The median PCNA score in metachronous adenomas was 2 (interquartile range, 1-3). The difference in the PCNA score between group A index and metachronous adenomas was again statistically significant (p < 0.01, Mann-Whitney U-test). CONCLUSIONS: We conclude that the increased expression of PCNA in colonic adenomas may be a predictor for metachronous adenomas.

Adenoma↗
PubMed2001

Moyamoya: Indiana University Medical Center experience.

BACKGROUND: Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. Treatment remains controversial. DESIGN AND OBJECTIVE: We reviewed our experience from June 1995 to August 1999 of 20 adult and pediatric angiographically diagnosed patients with moyamoya to report their clinical presentation, radiological findings, management, and clinical outcomes. RESULTS: The mean age of patients at symptom onset was 17 years (range, 2-54 years). Patients were divided into 2 age groups (group 1, <18 years; group 2, > or =18 years). There were 13 patients in group 1 and 7 patients in group 2. Ischemic strokes or transient ischemic attacks were the predominant initial presentations in both groups. One patient in group 2 had an intraparenchymal brain hemorrhage. Five patients received medical treatment, and 15 had surgical revascularization. The mean time from symptom onset to surgical procedure was significantly longer for patients in group 1 than for those in group 2 (P =.03). The mean follow-up time was 36 months. One patient in group 1 had an ischemic stroke. There was no difference in stroke recurrence, mortality, or modified Rankin scale score among medically or surgically treated patients. CONCLUSIONS: Moyamoya disease may have a different presentation and more benign natural history in our population than in Asian populations. Our findings emphasize the need to better understand the natural history of patients with moyamoya as well as the clinical benefit of different treatment modalities. Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya in the United States.

Adolescent↗
PubMedDate not supplied

Growing endoprostheses for primary malignant bone tumors.

Twenty years of experience with the use of growing endoprostheses for limb salvage in skeletally immature patients is reported. Alternatives for the management of primary malignant bone tumors in this group of patients are amputation, rotationplasty, and allograft or autograft reconstruction. The development of the currently used implant is charted, with commentary on the complications and difficulties which gave rise to design changes. Over this period, 123 expanding endoprostheses have been inserted in 108 patients in this institution, and the results of a series of 54 consecutive distal femoral replacements are reported. The mean functional score was 72%, and the local recurrence rate was 11%. The technique was successful in maintaining limb-length equality. We conclude that in specialized centers of orthopedic oncology that utilize an endoprosthesis with proven reliability of the expansion mechanism, the short- and long-term results of this technique justify its continued use.

Adolescent↗
PubMed2006

Significance of circulating endothelial progenitor cells in hepatocellular carcinoma.

This study evaluated the significance of circulating bone marrow-derived endothelial progenitor cells (EPCs) in patients with hepatocellular carcinoma (HCC), a solid tumor with rich neovasculature. Eighty patients with HCC were recruited for the study, and 16 patients with liver cirrhosis and 14 healthy subjects were also included for comparison. Blood samples were taken before treatment. Total mononuclear cells were isolated from peripheral blood, preplated to eliminate mature circulating endothelial cells, and colony-forming units (CFUs) formed by circulating EPCs were counted. To validate the CFU scores, FACS quantification of EPCs using CD133, VEGFR2, and CD34 as markers was performed in 30 cases. Our study showed significantly higher mean CFU scores in patients with HCC compared to patients with cirrhosis and healthy controls (P = .001 and .009, respectively). Furthermore, the CFU scores of patients with HCC positively correlated with levels of serum alpha-fetoprotein (r = .303, P = .017), plasma VEGF (r = .242, P = .035), and plasma interleukin-8 (IL-8) (r = .258, P = .025). Patients with unresectable HCC had higher CFU scores than patients with resectable tumors (P = .027). Furthermore, for those who underwent curative surgery, higher preoperative CFU scores were observed in patients with recurrence within 1 year compared with those who were disease-free after 1 year (P = .013). In conclusion, higher circulating levels of EPCs are seen in patients with advanced unresectable HCC as compared to patients with resectable HCC or those with liver cirrhosis. Our evidence supports the potential use of circulating level of EPCs as a prognostic marker in patients with HCC.

Adult↗