Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Recurrence score”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 613 records · Page 34Linked to original sources
PubMed1998

Expression of platelet-derived endothelial cell growth factor in oral and oropharyngeal carcinoma.

Platelet-derived endothelial cell growth factor (PD-ECGF) was isolated as an endothelial cell mitogen from platelets. In this study, we investigated the expression of PD-ECGF and counted microvessels in 58 oral and oropharyngeal squamous cell carcinoma (SCC) specimens by an immunohistochemical technique to examine their prognostic significance and performed tumor in vitro sensitivity to 5-fluorouracil (5-FU) and cisplatin as determined by a bioluminescence assay of the ATP values of tumor cells after continuous exposure. The percentage of PD-ECGF-positive tumor cells (PD-ECGF score) was correlated with the frequency of the recurrence of disease (P=0.0043) but not with sex, tumor size, metastasis, or clinical stage. Overall survival of the high PD-ECGF expression group (>40% PD-ECGF score) was shorter than the low expression (<40%) group (P=0.0365). Vessel count was correlated with lymph node metastasis and clinical stage. The survival of patients with hypervascularity (more than the median of intratumor vessel counts, >82) was shorter than that of those with hypovascularity (vessel count <81, P=0.0446). However, there was no association between PD-ECGF expression and vessel count. Cox proportional multivariate analysis showed that PD-ECGF expression was the most significant independent prognostic indicator for overall survival. The susceptibility to 5-FU cytotoxicity in the extremely high PD-ECGF expression groups (>70% of PD-ECGF score) was significantly higher than that in the low group, whereas there was no difference in their sensitivity to cisplatin. These results showed that carcinoma cells with high PD-ECGF expression were sensitive to 5-FU in spite of poor prognosis. These data provide further information when deciding on adjuvant therapy for oral and oropharyngeal SCCs.

Analysis of Variance↗
PubMed1995

Evaluation of cellular immunity following bacillus Calmette-Guérin therapy in patients with superficial bladder cancer.

Despite its marked effectiveness in the prevention of tumor recurrences, a great deal of information on the mode of action of Bacillus Calmette-Guérin (BCG) as an antitumor therapy modality is still lacking. In this prospective study, by performing lymphocyte subset analysis and quantitative assessment of delayed hypersensitivity skin reactions before transurethral resection of the detected tumor and 3-6 months after intravesical BCG administration in 23 patients with superficial bladder carcinoma, we tried to demonstrate the immunostimulatory effect of BCG therapy. We had 4 recurrences at 6 months' follow-up. Evaluation of lymphocyte subset analysis readings in our group revealed a statistically significant difference (p < 0.05) in CD4+/CD8+ ratio between baseline values and that obtained following BCG administration at 3 and 6 months. However, there was no statistically significant increase of this value in 4 patients who had tumor recurrences. Evaluation of delayed hypersensitivity skin test score results revealed a statistically significant increase in the whole group at 3 months of follow-up (p < 0.05) but the same evaluation at 6 months of follow-up showed no statistically significant difference with respect to this evaluation. Again, no statistically significant difference was found in 4 patients who had tumor recurrences. These results support the idea that BCG-associated antitumor activity is an immune-mediated reaction and the assessment of T-lymphocyte subsets together with quantitative evaluation of delayed hypersensitivity skin reactions would give us a definite idea about the immunotherapeutic effects of BCG in such patients.

Administration, Intravesical↗
PubMed2005

Chronic transfusion therapy for children with sickle cell disease and recurrent acute chest syndrome.

The objective was to study the effects of chronic transfusion therapy (CTX) on the prevention of new episodes of acute chest syndrome (ACS) in children with sickle cell disease (SCD) and recurrent or unusually severe ACS. A retrospective chart review was performed of patients given CTX for recurrent or severe ACS. Frequency, median severity score, and median hospital stay for ACS episodes were determined. Differences in these values before and during CTX were analyzed. Twenty-seven patients were identified. Before treatment, the ACS incidence was 1.3 episodes per patient-year; during treatment, it decreased to 0.1 episodes per patient-year (P < 0.0001). The median severity score for ACS episodes was 0.8 (range 0-5) before CTX and 0.5 (0-3) during CTX (P = 0.84). The median hospital stay was 5 days (range 3-15 days) before CTX and 3 days (2-7 days) during CTX (P = 0.38). CTX significantly reduces the incidence of ACS events among patients with a history of recurrent or severe episodes but does not significantly decrease their severity. The effectiveness of CTX should be prospectively compared with that of hydroxyurea and stem cell transplantation.

Adolescent↗
PubMed2005

Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma.

BACKGROUND: The role of central neck dissection (CND) in differentiated thyroid cancer remains controversial. This study aims at elucidating the potential benefits and drawbacks of CND associated to total thyroidectomy in papillary cancer. METHODS: Protocols of patients undergoing total thyroidectomy and CND for papillary cancer were reviewed. The following data were recorded: macroscopic appearance of central nodes; nodes obtained at operation; number of metastatic nodes and parathyroid glands incidentally resected; metastases, age, completeness, invasiveness, size score; postoperative s-Ca; complications; and recurrences. Differences between therapeutic (gross nodal involvement) and prophylactic (no apparent node involvement) CNDs were studied. RESULTS: Forty-three patients (mean age, 52 +/- 17 years) were studied. A mean of 8.4 +/- 6.6 nodes were resected per patient. A 60% prevalence (26/43) of presence of nodal involvement (N+) was found with no difference between low- and high-risk patients. Twenty-five (60%) patients developed transient hypocalcemia, which was associated with incidental parathyroidectomy, number of nodes resected, and thymectomy. Two patients (4.6%) developed permanent hypoparathyroidism and 3 (7%), transient vocal cord paralysis. Parathyroid glands were found in 19% of the specimens. At follow-up, there were no central neck recurrences, but 5 patients developed lateral recurrences despite treatment with I(131). All 5 patients had had therapeutic CND with 6 or more metastatic nodes obtained in the CND specimen. No lateral neck recurrences were observed after prophylactic CND or in patients with < 6 nodes involved. CONCLUSIONS: CND prevents central neck recurrences. Morbidity of bilateral CND is significant, and its systematic implementation in the absence on gross nodal involvement requires reassessment.

Adult↗
PubMed1992

Preoperative prediction of mortality following surgery for esophageal cancer.

Ninety-five patients with thoracic esophageal cancer who had undergone radical esophagectomies through right thoracotomies from 1986 to 1989 were statistically analyzed semi-quantitatively to identify the risk factors predicting "operative (within 45 days of operation) or hospital death." Age, pulmonary function (%VC or %FEV1.0), cardiac function (EKG or Master test), renal function (Ccr), hepatic function (R15'ICG), diabetes mellitus (75 OGTT), extent of tumor invasion to the adventitia, and the type of operative procedure were each scored according to severity; 0 (no risk), 1, 2, or 3 (high risk). Patients with no severe postoperative complications had an accumulated score of less than 8 and comprised Group I, while those suffering an an "operative death" had a total score of 8 or more, and comprised Group II. Group III included those suffering a "hospital death." There was a significant difference between Group I and Group II (p < 0.005), but not between Group I and Group III. "Operative deaths" could be preoperatively predicted from the risk factors. However, "hospital deaths" could not be predicted, since they resulted mainly from recurrences of the cancer. In cases with scores of 8 or more the operative procedure should be changed to a simpler one for an improved prognosis.

Adult↗
PubMed2003

Prognostic significance of preoperative factors in localized prostate carcinoma treated with radical prostatectomy: importance of percentage of biopsies that contain tumor and the presence of biopsy perineural invasion.

BACKGROUND: Predicting outcome for men with clinically localized prostate carcinoma treated with curative intent remains imprecise and further evaluation of accepted and potential predictive factors is needed. METHODS: The authors studied 696 men with localized prostate carcinoma diagnosed on transrectal biopsy and treated with radical prostatectomy at one institution between 1986 and 1999 to determine the relation between putative pretreatment prognostic factors and disease-free survival. Clinical stage, Gleason score, perineural invasion, number of biopsies containing tumor, and serum prostate specific antigen (PSA) were evaluated as predictors of extracapsular extension, seminal vesicle involvement, lymph node metastases, and surgical margin involvement as well as outcome after surgery. Kaplan-Meier method and Cox regression analyses were used to evaluate the contribution of different factors to adverse pathologic features and relapse. RESULTS: At mean follow-up of 56.9 months (range, 1.0-177.9 months; median, 54.9 months), 26.1% (182 of 696 patients) of patients had developed a disease recurrence. Pretreatment serum PSA concentration, biopsy Gleason score, and clinical stage as well as number of biopsies involved with tumor as a percentage of the total number obtained were found to be independent predictors of outcome. In patients with PSA > 10 ng/mL, biopsy perineural invasion and percentage of biopsies containing tumor were found to independently predicted disease recurrent. Increased number of biopsies involved with tumor independently predicted extracapsular extension, margin involvement, seminal vesicle, and lymph node involvement. CONCLUSIONS: This study demonstrated that the proportion of prostate biopsy cores containing tumor is an independent predictor of outcome after subsequent radical prostatectomy and suggested that perineural invasion has a predictive role in patients with a preoperative PSA > 10 ng/ml.

Adenocarcinoma↗
PubMed2006

A colorectal cancer patient focus group develops an information package.

INTRODUCTION: In order to deliver high quality care and empower cancer patients in decision-making, good quality information and communication are essential. We describe the development of an information booklet. PATIENTS AND METHODS: A total of 22 colorectal cancer patients (12 male; median age, 72 years, range, 40-86 years) met on 3 occasions. Patients were asked to define their information needs and score them (1-4) according to importance. The information document was written. The second meeting involved feedback on the booklet. The modified booklet was reviewed/approved by the group before submission for local ethics committee approval prior to its distribution to other patients. RESULTS: All participants felt the project a good idea. Essential information included the surgeon's individual morbidity, mortality, survival, recurrence data and details of adjuvant therapies (score = 4). Also important were type of surgery, complications and postoperative recovery (score = 3). Simple anatomical drawings were also considered important. CONCLUSIONS: The booklet is now used to personalise information for all our patients and serves, in part, as a record of the key issues discussed during the consultation. The booklet has been evaluated in a randomised trial.

Adult↗
PubMed1997

Risk factors for recurrence of hemorrhagic endovasculitis of the placenta.

OBJECTIVE: To assess the potential for recurrence of placental hemorrhagic endovasculitis and to identify clinical or pathologic cofactors that might influence recurrence of this lesion or subsequent pregnancy outcome. METHODS: Ninety-seven women with a placenta affected by hemorrhagic endovasculitis, who also had at least one placenta referred to the Michigan Placental Tissue Registry from a subsequent pregnancy, were identified from 10,531 referrals between 1978 and 1988. Histologic slides from 209 placentas and clinical data from 211 infants (two sets of twins) from initial (first) and subsequent referrals were analyzed. Placentas were graded for the presence, extent, and severity of hemorrhagic endovasculitis and chronic villitis of unknown etiology; for placental lesions indicative of hypertensive maternal vessel disease; and for intravascular nucleated erythrocytes and chorionic thrombi. Maternal data included age, gravidity, number of previous losses, and history of toxemia or hypertension. All data were analyzed for significance using chi2 and t tests. Outcome assessment was based on recurrence of hemorrhagic endovasculitis and infant viability with the second referral. RESULTS: With first referrals, 80 of 98 infants (81.6%) were stillborn. Among second referrals, 26 of 98 infants (26.5%) were stillborn. Hemorrhagic endovasculitis recurred in 28 second placentas (28.9%); of these, 18 infants (64.3%) were stillborn. Higher rates of recurrence were found with progressively higher first-referral chronic villitis severity scores (P < .02), higher hypertensive placental lesion scores (P < .001), and first referrals with a history of toxemia or hypertension (P < .02). Recurrence of hemorrhagic endovasculitis was higher in patients with two or more of these factors in first referrals (P < .001). Subsequent stillbirth was more frequent with progressively higher first-referral hypertensive placental lesion scores (P < .01) and in first placentas with two or more risk factors (P = .064). Hemorrhagic endovasculitis severity scores, intravascular nucleated erythrocytes, and chorionic thrombi were associated with stillbirth in index pregnancies only. Maternal age, gravidity, or history of prior losses were not predictive. CONCLUSIONS: Placental hemorrhagic endovasculitis is associated with pregnancy loss and can recur in some patients. Interrelations among placental hemorrhagic endovasculitis, chronic villitis, maternal hypertension, and adverse outcomes in subsequent pregnancies are apparent. This information may be useful in patient counseling.

Adolescent↗
PubMed2002

Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy?

PURPOSE: Prostate cancer incidence and mortality are higher in black than in white American men. We determined whether ethnicity is an independent predictor of disease recurrence in men undergoing radical prostatectomy. MATERIALS AND METHODS: We studied 1,468 patients who underwent radical prostatectomy at the University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor database, a longitudinal disease registry of patients with prostate cancer. Preoperative characteristics, including age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage, biopsy Gleason score and percent positive prostate biopsies at diagnosis were determined in each patient. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment at least 6 months after surgery. Cox proportional hazards analysis was performed to determine independent predictors of time to disease recurrence. To control for pretreatment disease characteristics simultaneously patients were assigned to previously described risk groups based on clinical tumor stage, PSA at diagnosis and biopsy Gleason score. The likelihood of disease recurrence per risk group stratified according to ethnicity was determined using the Kaplan-Meier method and compared using the log rank test. Additional multivariate analysis was performed in the subset of patients enrolled in Cancer of the Prostate Strategic Urological Research Endeavor on whom education and income information was available. RESULTS: Disease recurred in 304 of the 1,468 patients (21%). Black ethnicity, serum PSA at diagnosis, biopsy Gleason score and percent positive prostate biopsies were independent predictors of recurrence on multivariate analysis. Black ethnicity remained an independent predictor of disease recurrence in the multivariate model after stratifying patients into risk groups (p = 0.0007). Ethnicity was most important in patients at high risk, in whom estimated 5-year disease-free survival was 65% and 28% in white and black men, respectively. Education, income and ethnicity correlated highly. When education and income were entered into the multivariate model, ethnicity was no longer an independent predictor of outcome after prostatectomy. CONCLUSIONS: Ethnicity appears to be an independent predictor of disease recurrence after adjusting for pretreatment measures of disease extent in patients undergoing radical prostatectomy. It appears to be particularly important in those with high risk disease characteristics. However, black ethnicity, education and income are highly correlated variables, suggesting that sociodemographic factors may contribute to the poorer outcomes in black patients even after adjusting for differences in pretreatment disease characteristics.

Black or African American↗
PubMed1991

Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.

OBJECTIVES: To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP). DESIGN: Retrospective, noncomparative. SETTING: At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987. PATIENTS: This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up. MAIN OUTCOME MEASURES: The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility. RESULTS: The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence. CONCLUSIONS: From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.

Abdomen↗
PubMed1999

Two-year maintenance treatment with citalopram, 20 mg, in unipolar subjects with high recurrence rate.

BACKGROUND: The efficacy of citalopram, 20 to 60 mg/day, in relapse prevention in major depression was demonstrated in 6-month placebo-controlled studies. The authors tested the efficacy of citalopram, 40 mg/day, in relapse prevention over a 4-month period and citalopram, 20 mg/day, in recurrence prevention over a 24-month period. METHOD: Fifty inpatients with recurrent major depressive disorder (DSM-IV criteria) who had had at least one depressive episode during the 18 months preceding the index episode were openly treated with citalopram, 40 mg/day. Thirty-six subjects had a stable response to citalopram and remained in the continuation treatment with citalopram, 40 mg/day, for 4 months as outpatients. At the time of recovery, 32 patients gave their written informed consent before entering the 24-month maintenance period with citalopram, 20 mg/day. They were evaluated monthly by trained psychiatrists on the basis of the 21-item Hamilton Rating Scale for Depression. Every 3 months, patients were given the Sheehan Disability Scale, a self-rating instrument, to assess their psychosocial adjustment. RESULTS: No relapse was observed in the 4-month continuation period. Sixteen (50%) of 32 patients who entered the 24-month maintenance period had a new recurrence. Patients with recurrence showed a persistent moderate disability on Sheehan Disability Scale score, while no further differences were highlighted in clinical and demographic characteristics between patients with and without recurrence. CONCLUSION: In agreement with previous findings, these data suggest that a full dose of antidepressant is strongly recommended in prophylactic therapy of patients with recurrent major depression. Moreover, it appears that psychosocial impairment may increase the risk of recurrence, thus conditioning a poor outcome.

Adult↗
PubMedDate not supplied

[Surgical treatment of complete rectal prolapse. Experience at a colon and rectal surgery service].

BACKGROUND: Rectal prolapse is as ancient humanity. Treatment must be surgical in adult patients. There is no gold standard procedure to date; thus, this has given rise to controversy. OBJECTIVE: One objective was to analyze our results, complications, mortality, and recurrence in a Colorectal Surgery Service for surgical treatment of complete rectal prolapse. PATIENTS AND METHODS: We reviewed records of all patients treated surgically with rectal prolapse at our Service from March 1995 to March 2001. RESULTS: 31 patients; 22 were female and nine male with age range of 24 to 89 years. Evolution time was 6 months to 40 years; 11 patients had preoperative incontinence. We carried our four procedures, abdominal procedure hospital stay was 4 to 7 days; we had 18% long-term complications with no mortality or recurrence. Hospital stay in perineal procedures was 1 to 2 days with one procedure associated with death due to AV blockade, with 14% recurrence for helicoidal suture procedure, and no complications. Altemeier procedure recurred at 1 month of surgery. Continence score of Miller improve postoperatively. CONCLUSIONS: Abdominal procedures have less recurrence than perineal procedures; abdominal procedures must be considered in young patients with low risk, and perineal procedures in older patients with high risk, that are coantraindications for a major surgical procedure.

Adult↗
PubMedDate not supplied

Psychosocial impairment and recurrence of major depression.

Major depressive disorder is often marked by multiple recurrences. Unfortunately, it is difficult to predict specifically which patients will suffer a recurrence. This study examined whether psychosocial impairment is a risk factor for recurrence. A total of 290 subjects with unipolar major depressive disorder according to Research Diagnostic Criteria (RDC) were prospectively followed for up to 15 years as part of the Collaborative Depression Study (CDS), a multicenter longitudinal observational study of the mood disorders. Follow-up data on course of illness and psychosocial functioning were collected with the Longitudinal Interval Follow-up Evaluation (LIFE). The association of psychosocial impairment with recurrence of major depression was examined with mixed-effects logistic regression. The mean (SD) score for psychosocial functioning during recovery from an episode of major depression was 9.0 (2.7), with a possible range of 4 (no impairment) to 20 (severe impairment). For euthymic subjects who recovered from an episode of major depression, elevated psychosocial impairment was significantly associated with subsequent recurrence of major depression, with an odds ratio of 1.12 (95% confidence interval [CI], 1.06 to 1.19). The odds ratio of 1.12 indicates that for each 1-point increase in the functional impairment score, the risk of recurrence increases by about 12%. In patients who have recovered from an episode of major depression, the presence of psychosocial impairment may help identify who is at increased risk of recurrence.

Adolescent↗
PubMed2000

Prevention of recurrent depressive episodes with milnacipran: consequences on quality of life.

BACKGROUND: Depression is now seen as a chronic disabling condition that spans the patient's lifetime and creates significant medical, economic and quality of life consequences. METHODS: 500 depressed patients were treated with milnacipran for 6 months. A total of 214 recovered patients were randomised to receive either milnacipran (50 mg bid) or a matching placebo for a 1-year recurrence prevention phase. Recurrence rate was the primary criteria; quality of life (QoL) consequences were evaluated through a shortened version of the French Sickness Impact Profile (SIP), the Depression Impact Profile (DIP). RESULTS: Milnacipran demonstrated its ability to reduce recurrences (Odds-Ratio=1.5; P<0.05), with a more marked effect in recovered patients with few residual symptoms (Odds-Ratio=3.0). Responders who continued treatment with milnacipran had a dramatic improvement in their quality of life, although patients with residual symptoms still experienced some deterioration in their QoL (recreation, emotional, social, alertness and home assistance scores). Even recovered patients having zero scores on the Hamilton Depression Rating Scale-21 items (HDRS) had some QoL deterioration. The DIP emotional score was found to be more predictive of recurrence than the HDRS. Overall, the QoL was improved for those in the milnacipran group in comparison to placebo on the mobility, communication, psycho-social and total scores. LIMITATIONS: The QoL evaluation was a secondary criteria; no a priori sample size estimate was performed. The choice of a generic QoL instrument might have reduced the sensitivity to clinical changes in depression. CONCLUSIONS: Prevention of recurrence in MDD with milnacipran contributes to an improvement in the QoL.

Adolescent↗
PubMed2003

Transoral laser microsurgery for squamous cell carcinoma of the base of the tongue.

OBJECTIVE: To determine the role of transoral laser microsurgery for base of tongue squamous cell carcinoma. DESIGN: Retrospective unicenter study of the oncologic and functional results of laser microsurgery of tongue base carcinoma performed between 1986 and 1997. SETTINGS: University hospital department. PATIENTS: We reviewed 48 previously untreated patients with base of tongue squamous cell carcinoma, who were treated with transoral laser microsurgery. Distribution of the T categories were T1, 2%; T2, 25%; T3, 15%; and T4, 58%; 94% belonged to the stages III and IVa. Selective neck dissection was performed in 43 patients; 23 patients underwent postoperative radiotherapy with or without simultaneous chemotherapy. MAIN OUTCOME MEASURES: Local control rate, recurrence-free and overall survival rates, mean performance status scale scores for normalcy of diet and understandability of speech. RESULTS: The Kaplan-Meier 5-year local control rate was 85%. There was no local recurrence in T1 and T2 lesions, but there was a 20% local recurrence rate in T3 and T4 tumors. Kaplan-Meier 5-year recurrence-free and overall survival rates were 73% and 52%, respectively. Mean performance status scale scores were 92% for normalcy of diet and 88% for understandability of speech. Twenty-one patients survived at least 5 years after treatment. They have a preserved larynx and live without tracheostoma or gastrostomy tube. CONCLUSIONS: Our concept of organ and function preserving laser microsurgery for selected patients with base of tongue cancer seems to be justified considering the achieved oncological and functional results. Final proof of the effectiveness of the new therapeutic concept presented herein requires well-designed prospective studies.

Adult↗
PubMedDate not supplied

Arthroscopic revision Bankart repair: a prospective outcome study.

PURPOSE: The clinical outcome of the revision surgery for the failed Bankart repair is not well known. The purpose of this study was to prospectively analyze a series of patients with recurrent instability after primary Bankart repair that were revised arthroscopically using a suture-anchor technique. TYPE OF STUDY: Prospective, nonrandomized outcome study. METHODS: Twenty-three patients with failed Bankart repair were treated with arthroscopic surgery and were followed up for a mean of 36 months (range, 24-52 months; SD, 9 months). There were 21 men and 2 women with the mean age of 24 years (range, 17-34 years; SD, 4.4 years). Eight patients had previously received an open Bankart repair (5 transosseous-suture technique, 3 suture-anchor technique), and 15 had received an arthroscopic repair (10 transglenoid multiple-suture technique, 5 suture-anchor technique). The revision surgery included repair of the anterior labrum using suture anchors and nonabsorbable sutures, capsular plication, and proximal shift of the inferior capsule with or without closure of the rotator interval. The characteristics of the patients, possible modes of failure, surgical findings, shoulder scores (University of California at Los Angeles [UCLA] scale, Simple Shoulder Test, and Rowe score), and clinical outcome were evaluated. RESULTS: Recurrent instability developed at a mean of 21 months (range, 11-39 months; SD, 8 months) after the initial stabilization. A possible cause of failure in 5 patients was a nonanatomic repair, with the labral tissue fixed proximal or medial to the glenoid margin. At the follow-up, 15 patients had excellent results, 4 good, 3 fair, and 1 poor, according to the UCLA scale. The mean Rowe score improved from 87.3 (range, 30-100; SD, 12.6) to 91.2 (range, 40-100; SD, 14.2) (P =.023). The Simple Shoulder Test responses improved from 8 yes responses preoperatively to 11 postoperatively. Eighteen patients achieved an activity return of more than 90% of preinjury level. Five patients had recurrence after revision surgery (1 frank dislocation, 2 subluxation, 2 positive anterior apprehension sign). Engagement in contact sports was correlated with the recurrence (r =.683, P =.003). With the number available, no significant difference could be detected in the outcome between the types of the primary surgery. Arthroscopic revision Bankart repair did not result in any additional loss of external rotation compared with the contralateral side (P =.723). The most predictable factor for the functional return was preoperative range of external rotation (r =.793, P =.001). CONCLUSIONS: Arthroscopic revision Bankart surgery using suture anchors can provide a satisfactory outcome, including a low recurrence rate and reliable functional return, in carefully selected patients.

Adolescent↗
PubMed1998

Hyperthermic isolated limb perfusion with tumour necrosis factor-alpha and melphalan as palliative limb-saving treatment in patients with locally advanced soft-tissue sarcomas of the extremities with regional or distant metastases. Is it worthwhile?

The management of locally advanced soft-tissue sarcomas (STS) of the extremities in patients who present with regional and/or distant metastases at the time of diagnosis remains an unsolved problem. The recently introduced hyperthermic isolated limb perfusion (HILP) with tumour necrosis factor (TNF)-alpha and melphalan has been shown to be an effective limb-saving treatment modality, but is it feasible to use this approach with palliative intent? Nine patients, five men and four women, mean age 41 (range 21-75) years with locally advanced extremity STS and regional (n = 3) or distant (n = 6) metastases at the time of diagnosis, underwent a palliative HILP with TNF-alpha and melphalan. Resection of the residual tumour mass was performed, if possible, 6-8 weeks after HILP. Treatment-related morbidity, local recurrences and the limb salvage rate were scored during follow-up. The median follow-up period was 9 (range 3-39) months (seven deaths, but six were due to metastatic disease). Treatment-related morbidity was seen after 3 of the 10 perfusions performed (30%) and consisted of superficial wound infections (n = 2), blow out of the external iliac artery followed by an iliac thrombosis (n = 1). Two patients showed local recurrences after HILP followed by resection of the residual tumour mass, and one patient showed local progression after two perfusions without resection. Limb salvage was achieved in 8 patients (89%). Therefore, HILP with TNF-alpha and melphalan for locally advanced extremity STS in patients with disseminated disease is feasible. The local management of locally advanced extremity STS should be the same whether the intent is curative or palliative, as the local control improves the quality of life.

Adult↗
PubMedDate not supplied

Otitis media and the development of speech and language.

Otitis media is one of the most common infectious diseases of childhood, and many children have many episodes in infancy. Fluid persists in the middle ear for weeks to months after every episode of acute otitis media in spite of apparently appropriate antimicrobial therapy. Persistent or fluctuating hearing loss accompanies middle ear fluid. Children from a high socioeconomic group with recurrent and persistent otitis media in infancy scored lower on tests of speech and language administered at 3 years of age than did their disease-free peers.

Child, Preschool↗