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PubMed2006

Long-term durability of laparoscopic decortication of symptomatic renal cysts.

OBJECTIVES: To assess the long-term results of patient symptoms and radiologic outcomes of laparoscopic renal cyst decortication in the treatment of symptomatic simple renal cysts. Renal cysts are common in the adult population. Symptomatic renal cysts have traditionally been treated by percutaneous aspiration with or without injection of sclerosant agents; however, this has a high rate of recurrence. METHODS: From April 1994 through July 2005, 45 patients underwent laparoscopic decortication of symptomatic simple renal cysts with renal cyst wall excision and fulguration of the epithelial lining. Complex renal cysts were excluded. Of the 45 patients, 24 (53.3%) had undergone previous cyst aspiration with injection of sclerosant material for intended ablation. The Wong-Baker pain scale was used to assess the preoperative and postoperative pain scores. Radiologic success was indicated as no recurrence on the most recent computed tomography scan. RESULTS: Of the 45 procedures, 44 were completed laparoscopically. One patient (1.8%) underwent open conversion because of excessive bleeding. The mean operative time was 89 minutes (range 48 to 170). Symptomatic success was achieved in 91.1% of patients, with a median follow-up of 52 months (range 3 to 132), and radiographic success was achieved in 95.5% of patients, with a median follow-up of 39 months (range 3 to 96). CONCLUSIONS: Long-term follow-up has confirmed that laparoscopic cyst decortication is an effective and durable treatment option for symptomatic simple renal cysts during long-term follow-up. The greater and durable success rates of this minimally invasive technique may favor this treatment option over other treatment modalities.

Adolescent↗
PubMedDate not supplied

Bankart repair in patients aged fifty years or greater: results of arthroscopic and open repairs.

Currently, there is little information on the results of Bankart repairs in older patients. Therefore, the purpose of this study was to determine the results, complications, and rates of revision among patients aged 50 years or greater undergoing Bankart repairs. Between 1992 and 1999, 12 Bankart repairs were performed on patients aged 50 years or greater (mean, 57 years) at our institution. Eleven patients with complete clinical records, operative reports, and minimum 3-year follow-up (mean, 6.5 years) were included in the study. All patients had shoulder instability as a result of specific trauma. Six patients underwent open repairs, and five underwent arthroscopic repairs. There were no patients with full-thickness rotator cuff tears. At the most recent follow-up, there were no shoulders with recurrent instability. The mean simple shoulder test score was 10.8 in the open group and 9.8 in the arthroscopic group. The mean American Shoulder and Elbow Surgeons score was 98 in the open group versus 87 in the arthroscopic group. At the most recent follow-up, mean elevation in the open group was 178 degrees versus 174 degrees in the arthroscopic group. Mean external rotation was 70 degrees in the open group and 72 degrees in the arthroscopic group. The data from this study suggest that Bankart repair in older patients is associated with a low recurrence rate, and similar results may be obtained with either open or arthroscopic procedures.

Arthroscopy↗
PubMed2005

Measurement of the uncomplexed fraction of tissue inhibitor of metalloproteinases-1 in the prognostic evaluation of primary breast cancer patients.

Several studies have demonstrated an association between high tumor tissue levels of total tissue inhibitor of metalloproteinases-1 (TIMP-1) and a poor prognosis of primary breast cancer patients. In the present study we investigated whether measurements of the uncomplexed fraction of TIMP-1 added prognostic information to that already obtained from total TIMP-1. We measured the uncomplexed fraction of TIMP-1, using a thoroughly validated ELISA specific for this fraction, in 341 tumor tissue extracts obtained from patients with primary breast cancer. These measurements were related to previously performed measurements of total TIMP-1 as well as to patient outcome. The observation time was 8.3 years (range, 7.3-11.3 years). During this period 136 patients died, and 153 patients experienced recurrence of disease. Cox regression analysis of recurrence-free survival (RFS) suggested that a score based on both uncomplexed and total TIMP-1, reflecting the tumor level of TIMP-1/MMP complexes, would be a more precise estimate of prognosis than total TIMP-1 alone. Univariate survival analysis showed a highly significant relationship between high values of the score and poor outcomes for RFS (p = 0.0002; hazard ratio = 2.7; 95% confidence interval, 1.5-4.8). Similar results were found for overall survival (p = 0.0001; hazard ratio = 3.3; 95% confidence interval, 1.8-6.3). Multivariate analysis of RFS and overall survival demonstrated that the score was significant including the classical prognostic factors used in breast cancer (p < 0.0001). The present study raises the hypothesis that it is the tumor level of TIMP-1/MMP complexes (i.e. activated matrix metalloproteinases) rather than TIMP-1 itself that determines prognosis, supporting the use of the combined score and not only total TIMP-1 in stratification of breast cancer patients.

Breast Neoplasms↗
PubMedDate not supplied

Objective and subjective assessment of nasal obstruction in patients undergoing endoscopic sinus surgery.

Functional endoscopic sinus surgery (FESS) is the surgical treatment of choice for many physicians in chronic inflammatory diseases of the sinuses. Although subjective benefit has been claimed after surgery, there are not enough studies reporting objective improvement. We evaluated 40 patients undergoing FESS for chronic and recurrent sinusitis with visual analog scale (VAS) scoring of sensation of nasal obstruction and active anterior rhinomanometry of nasal resistance. The results of postoperative measurements demonstrated that baseline total nasal resistance measured with rhinomanometry and evaluated with VAS scoring (baseline and after decongestion) were significantly lower than preoperative measurements. However, improvement in nasal resistance was not statistically significant after decongestion, whereas VAS scoring was. These findings indicate that FESS improves nasal mucosal edema but does not change the structural anatomy of the nose.

Adolescent↗
PubMed2004

Syndecan-1 expression in locally invasive and metastatic prostate cancer.

OBJECTIVES: To determine the significance of syndecan-1 expression, a cell-surface heparan sulfate proteoglycan in localized and metastatic prostate cancer. METHODS: We performed a retrospective analysis of 76 men with Gleason sum 6 or 7 prostate cancer treated by radical prostatectomy and a separate cohort of 75 men with metastatic prostate cancer. Syndecan-1 immunoreactivity was measured in primary prostate specimens or in samples from metastatic sites and correlated with patient outcome. RESULTS: Syndecan-1 was expressed in normal basal and secretory epithelial cells, 26% of radical prostatectomy specimens, and 35% of metastatic disease. No association was found between syndecan-1 positivity and prostate-specific antigen recurrence in the collective cohort of Gleason sum 6 and 7 cancers. However, when stratified by Gleason sum, syndecan-1 immunoreactivity (immunoreactivity score 150 or greater) was associated with a greater recurrence rate in Gleason sum 7 cancers. Expression of syndecan-1 was significantly greater in soft tissue than in bone metastasis (P = 0.048, Fisher's exact test). CONCLUSIONS: Consistent with a possible biochemical role for syndecan-1 in prostate cancer progression and metastasis, syndecan-1 expression correlated with serologic recurrence in Gleason sum 7 prostate cancer and was highly expressed in soft-tissue metastases.

Adenocarcinoma↗
PubMed2003

The prognostic value of p53 and DNA ploidy following radical prostatectomy.

This study assesses the correlation of p53 immunoreactivity and DNA ploidy status with biochemical recurrence after radical prostatectomy. p53 protein expression and DNA ploidy were evaluated on 84 archival paraffin-embedded radical prostatectomy specimens. Patients were divided into two groups: those with low (38/84, 45%) and those with high (46/84, 55%) p53 immunoreactivity. The results were correlated with Gleason score, stage and serum PSA. Kaplan-Meier biochemical recurrence free survival and the Cox hazard-regression model were used for analysis. Multivariate analysis revealed p53, DNA ploidy, Gleason score, PSA and stage to be independent prognostic factors in this order. Kaplan-Meier analysis showed a significant difference in biochemical recurrence when p53 high expression and DNA aneuploidy were combined. The results of this study suggest that stratification for p53 expression and DNA ploidy status can provide additional prognostic information for patients with prostate carcinoma after radical prostatectomy.

Aged↗
PubMed2000

Eating pathology and obesity in women at risk for breast cancer recurrence.

OBJECTIVE: This cross-sectional study investigated the relationship among obesity, depressive symptoms, eating attitudes and behaviors, and dietary intake. It compared women at risk for recurrence of breast cancer and women who had not been diagnosed with breast cancer and were recruited from the same community and age group (middle-aged and older). METHOD: Body mass index (BMI), dietary intake, self-reported depressive symptoms, and eating disorder psychopathology (assessed with the Eating Disorder Examination - Questionnaire [EDE-Q]) were examined in women who had been diagnosed with breast cancer (n = 56) and the comparison group of women with no breast cancer history (n = 52). Multivariate regression analysis was used to identify factors independently associated with global and subscale EDE-Q scores and BMI. RESULTS: BMI and depressive symptoms were significantly and independently associated with global and subscale EDE-Q scores in women at risk for breast cancer recurrence and women with no breast cancer history. Dietary restriction was also significantly associated with EDE-Q scores in the group with no breast cancer history. CONCLUSIONS: An association among obesity, depressive symptomatology, and abnormal eating attitudes and behavior may affect response to standard nutritional interventions in women at risk for breast cancer recurrence.

Body Mass Index↗
PubMed1999

Hyperthermic isolated limb perfusion with tumor necrosis factor alpha, interferon gamma, and melphalan for locally advanced nonmelanoma skin tumors of the extremities: a multicenter study.

BACKGROUND: Hyperthermic isolated limb perfusion (HILP) with tumor necrosis factor alpha (TNF-alpha), interferon gamma, and melphalan has proved to be useful in the treatment of recurrent malignant melanoma and of locally advanced soft tissue sarcomas of the extremities. OBJECTIVE: To determine whether this modality is also effective in the treatment of locally advanced nonmelanoma skin tumors of the extremities. PATIENTS AND METHODS: Fifteen patients with locally advanced primary, recurrent, or metastatic skin tumors of the extremities (12 with squamous cell carcinoma and 3 with Merkel cell carcinoma) underwent HILP with TNF-alpha, interferon gamma, and melphalan. Six tumors were localized in the upper extremity (40%), and 9 in the lower extremity (60%). Treatment-related complications, limb salvage rate, local recurrence, and regional and distant metastases were scored during a median follow-up of 20 months. RESULTS: After HILP, 9 patients (60%) showed a complete response (with histopathological confirmation). Four patients (27%) showed a partial response (with histopathological confirmation in 1 patient), and 2 patients (13%) showed no change (with histopathological confirmation in 1 patient and with clinical evidence in 1 patient). Two patients (13%) showed treatment-related complications. The limb salvage was achieved in 12 patients (80%), and the local recurrences developed in 4 patients (27%). During follow-up, regional lymph node metastases were observed in 2 patients (13%) and distant metastases in 2 patients (13%). CONCLUSION: Based on our results, HILP with TNF-alpha, interferon gamma, and melphalan should be considered as a limb-saving treatment modality in patients with locally advanced nonmelanoma skin tumors of the extremities who would otherwise be candidates for ablative surgery.

Adult↗
PubMed1998

Development, recurrence, and severity of infections in Mexican patients with rheumatoid arthritis. A nested case-control study.

OBJECTIVE: To determine factors associated with development, recurrence, and severity of infections in patients with rheumatoid arthritis (RA). METHODS: A hospital based nested case-control study in a referral center. The same evaluator reviewed clinical charts of 195 consecutive patients with RA seen in our clinic during 1993. Patients who had had at least one infection were classified as "cases" and the others as "controls." We examined 24 demographic, clinical, therapeutic, and infection related variables. A severity index was developed according to scores provided by 12 independent multidisciplinary evaluators. Recurrent infection was defined as > 2 different infections in the same patient during followup. Descriptive statistics were employed, with comparison between cases and controls by univariate analysis and multiple logistic regression. RESULTS: Two hundred eleven infections were detected in 1274 patient-years (incidence of 0.17 new infections per patient-year). We studied 174 women and 21 men, mean 41 years of age, with a mean duration of symptoms of RA of 5 years. Ninety-five were cases and 100 controls. Cases had longer disease duration before admission and followup (p < 0.05). Infections most commonly seen were upper respiratory tract (n = 74), skin (41), urinary tract (27), and herpes zoster (15). Steroids and/or methotrexate (MTX) were associated in 95% of infections. Infection was associated with duration of RA before admission and followup, comorbidity, extraarticular disease, mean cumulative dose of MTX, time taking steroids, and mean daily dose of D-penicillamine, by univariate analysis. Severity of infection was related to the same variables and years of formal education, and recurrence of infection was related to time of followup and mean dose of MTX and steroids. Multiple logistic regression showed that variables associated with infection were cumulative MTX dose, time taking steroids, and mean daily dose of D-penicillamine. CONCLUSION: Infections were frequent in our RA population. The risk factors associated with infections were the cumulative dose of MTX, duration taking steroids, and mean daily dose of D-penicillamine.

Adolescent↗
PubMed2006

Outcome of revision discectomies following recurrent lumbar disc herniation.

STUDY DESIGN: Retrospective study. OBJECTIVES: To assess the difference in the outcome score between a primary surgery to treat lumbar disc herniation and a revision surgery for recurrent herniation at the same location with the use of a validated lumbar spine outcome instrument. SUMMARY OF BACKGROUND DATA: Paucity of studies comparing the results of revision discectomy for true recurrent disc herniation at the same location to that reported for primary discectomy. METHODS: A total of 27 patients who had undergone revision discectomies for recurrent lumbar disc herniations were surveyed to assess their clinical outcomes. Patients were compared with a control group of 30 matched patients who had undergone only a primary discectomy. The spine module of the MODEMS outcome instrument was used to evaluate the patients' satisfaction, their pain and functional ability following discectomy, as well as their quality of life. All patients were also asked whether they were improved or worsened with surgery. Those undergoing revision surgery were asked whether the improvement following the second surgery was more or less than the improvement following the first surgery. RESULTS: Improvement following the repeat discectomy was not statistically different from the improvement that occurred in patients who underwent just the primary operation. Differences in residual numbness/tingling in the leg and/or the foot as well as in frequency of back and/or buttock pain were identified. CONCLUSION: Based on patient derived outcome data using a validated instrument, revision discectomy is as efficacious as primary discectomy in selected patients.

Adult↗
PubMed2006

A risk profile for identifying community-dwelling elderly with a high risk of recurrent falling: results of a 3-year prospective study.

INTRODUCTION: The aim of the prospective study reported here was to develop a risk profile that can be used to identify community-dwelling elderly at a high risk of recurrent falling. MATERIALS AND METHODS: The study was designed as a 3-year prospective cohort study. A total of 1365 community-dwelling persons, aged 65 years and older, of the population-based Longitudinal Aging Study Amsterdam participated in the study. During an interview in 1995/1996, physical, cognitive, emotional and social aspects of functioning were assessed. A follow-up on the number of falls and fractures was conducted during a 3-year period using fall calendars that participants filled out weekly. Recurrent fallers were identified as those who fell at least twice within a 6-month period during the 3-year follow-up. RESULTS: The incidence of recurrent falls at the 3-year follow-up point was 24.9% in women and 24.4% in men. Of the respondents, 5.5% reported a total of 87 fractures that resulted from a fall, including 20 hip fractures, 21 wrist fractures and seven humerus fractures. Recurrent fallers were more prone to have a fall-related fracture than those who were not defined as recurrent fallers (11.9% vs. 3.4%; OR: 3.8; 95% CI: 2.3-6.1). Backward logistic regression analysis identified the following predictors in the risk profile for recurrent falling: two or more previous falls, dizziness, functional limitations, weak grip strength, low body weight, fear of falling, the presence of dogs/cats in the household, a high educational level, drinking 18 or more alcoholic consumptions per week and two interaction terms (high education x 18 or more alcohol consumptions per week and two or more previous falls x fear of falling) (AUC=0.71). DISCUSSION: At a cut-off point of 5 on the total risk score (range 0-30), the model predicted recurrent falling with a sensitivity of 59% and a specificity of 71%. At a cut-off point of 10, the sensitivity and specificity were 31% and 92%, respectively. A risk profile including nine predictors that can easily be assessed seems to be a useful tool for the identification of community-dwelling elderly with a high risk of recurrent falling.

Accidental Falls↗
PubMed2002

Prognostic score of gastric cancer determined by cDNA microarray.

PURPOSE: To estimate gastric cancer patients' prognosis more comprehensively,we tried to develop a prognostic scoring system using a cDNA microarray. EXPERIMENTAL DESIGN: RNA was extracted from tumor/normal paired samples of 43 patients with gastric cancer, and cDNA microarray hybridization was performed. RESULTS: We selected 78 genes that were differentially expressed between aggressive and nonaggressive groups with respect to five conventional pathological factors. Next, we determined a coefficient for each gene. Thereafter a prognostic score was calculated by summing-up the value for each gene. It ranged from -47 to 201 with a median of 114. There were two peaks in its distribution. Ten of 11 patients who were alive with no evidence of recurrence >5 years after the operation showed a score of <100 points, whereas all 19 patients who died of disease showed >100 points. In 13 patients who were alive but the follow-up time was <5 years, 2 of the 3 patients with >100 points revealed recurrent disease during the follow-up. CONCLUSIONS: These findings demonstrate that such a system with cDNA microarray can contribute to the comprehensive analysis of malignant behavior of the tumor and may provide accurate information on prognosis.

Blotting, Northern↗
PubMed1988

Relationship of DNA content to conventional prognostic factors in clinically localised carcinoma of the prostate.

One hundred and nine patients treated by total prostatectomy for apparently localised carcinoma were analysed to investigate the prognostic significance of capsular invasion and penetration, seminal vesicle invasion, lymph node metastases, grade as assessed by the Gleason and MD Anderson Hospital (MDAH) systems and DNA content measured by flow cytometry of nuclear material extracted from paraffin embedded tumour. Comparison of DNA content was made with 36 benign prostates. Mean follow-up/survival was 60.7 months, at which time 21 patients had evidence of recurrence or had died. Only 5 patients had local recurrence. Tumour grade, as assessed by both the Gleason Sum Score and the MDAH system, correlated with anatomical extent and was the most important determinant of time to recurrence. Fifty-nine tumours were diploid, 44 tetraploid and 6 aneuploid. One of 36 benign prostates showed aneuploidy. Ploidy did not correlate with the anatomical extent of the tumour or with grade. Tetraploid tumours recurred earlier than diploid tumours. None of 6 aneuploid tumours have recurred, although only 3 have been followed beyond 5 years. Multivariate analysis showed that after accounting for grade, none of the other variables, including ploidy, contributed any additional significant prognostic information. Although the results must be regarded as preliminary, in view of the small number of patients with recurrence, they suggest that DNA content offers limited prognostic information in clinically localised prostate cancer.

Aged↗
PubMed2004

Expressions of matrix metalloproteinases in early-stage oral squamous cell carcinoma as predictive indicators for tumor metastases and prognosis.

PURPOSE: Matrix metalloproteinase (MMP)-2 and MMP-9 are considered to play an important role in the metastasis of malignant tumors. Membrane type 1-MMP (MT1-MMP) and tissue inhibitor of metalloproteinase 2 (TIMP-2) are essential factors for the activation of pro-MMP-2. There are some reports about expressions of MMP family in relationship to clinical features of head and neck squamous cell carcinoma (SCC), but the results were not uniform and the prognostic value of their expressions remains unclear. EXPERIMENTAL DESIGN: The study group consisted of 53 Japanese patients with oral SCC of early stage (T(1-2)N(0)M(0)). Expressions of MMP-2, MMP-9, MT1-MMP, and TIMP-2 were examined using immunohistological methods on the sections of tumor biopsy samples. The intensity of MMP expression was categorized into four grades (score 0-3) by semiquantitative analysis using a computer with NIH image, and correlation between this grade and clinical aspects such as tumor recurrence, metastasis, and prognosis were examined. RESULTS: The expression score of MMP-2 correlated with that of MMP-9 (r = 0.291; P = 0.036), MT1-MMP (r = 0.286; P = 0.039), and TIMP-2 (r = 0.257; P = 0.050). Patients who developed regional lymph node and/or distant metastasis showed significantly higher scores in the expressions of MMP-9 and TIMP-2 than patients without any tumor metastases (P = 0.036 and P = 0.043, respectively). Kaplan-Meier analyses as well as univariate analyses using the Cox proportional hazards model showed that expression of MMP-9 (P = 0.0143 and P = 0.0418, respectively) and marked expression of TIMP-2 (P < 0.0001 and P = 0.0004, respectively) correlated with worse-cause-specific survival. Multivariate analysis confirmed that marked expression of TIMP-2 was the only independent factor for cause-specific death (hazard ratio, 7.543; confidence interval, 1.693-33.610; P = 0.0080). CONCLUSIONS: Expressions of MMP-9 and TIMP-2 have predictive value for tumor metastases and cause-specific survival. High expression of TIMP-2 is the most independent factor for worse prognosis in early-stage oral SCC.

Adult↗
PubMed2006

High stromal versican expression predicts unfavourable outcome in oral squamous cell carcinoma.

BACKGROUND: Versican, an extracellular matrix proteoglycan, has been noted to be expressed in several malignant tumours and has been suggested to play an important role in cancer development and tumour growth. AIMS: To investigate whether the versican expression level in the peritumoural stromal tissue of primary oral squamous cell carcinoma (OSCC) predicts relapse-free or disease-specific survival. Also, to study the associations between versican expression and several other clinicopathological variables, as well as tumour cell proliferation. METHODS: Immunohistochemistry was used to study the expression of versican and tumour cell proliferative activity in 139 OSCCs. All pertinent clinical data were collected retrospectively from the hospital records. RESULTS: In this cohort, versican expression did not correlate with the clinicopathological factors or tumour cell proliferation. In univariate analyses, higher risk for disease recurrence was associated with higher stromal versican expression score (p = 0.02), positive neck node status (p = 0.02), lower Karnofsky performance status (p = 0.03) and higher tumour cell proliferation index (p = 0.04). Increased disease-specific risk of death was associated with high stromal versican expression score (p = 0.005) higher T class (p = 0.002), positive neck node status (p<0.001), higher stage (p<0.001), poorer histological differentiation (p = 0.005), worse general condition of the patient (p = 0.049) and increased tumour cell proliferative index (p = 0.02). In multivariate disease-specific survival analysis, high stromal versican expression score (p = 0.048), poorer histological differentiation (p = 0.047) and higher stage (p = 0.002) independently predicted poorer disease outcome. CONCLUSIONS: In this cohort, increased stromal versican expression correlated with both increased risk for disease recurrence and shortened survival. High stromal versican expression may thus be considered an independent and adverse prognostic marker in OSCC.

Adolescent↗
PubMed1995

[Functional and anatomical results after surgical treatment of ruptures of the rotator cuff. 2: postoperative functional and anatomical evaluation of ruptures of the rotator cuff].

PURPOSE OF THE STUDY: The authors examined the anatomic condition and the function of the rotator cuff obtained after an average period of four years following surgical repair in a series of 100 full thickness rotator cuff tears. The aim was to assess the validity of Constant's scoring method and to analyse risk factors and the frequency of recurrent tears. MATERIAL AND METHODS: The series comprised 98 patients, 62 men and 36 women whose average age was 56 years. It included 69 tears of less than 2 cm in size (39 cases) or between 2 to 4 cm (3 cases) of the supra-spinatus, 22 tears of the supra- and infraspinatus measuring between 2 to 4 cm, and 9 massive tears. The tendon of the long head of the biceps was pathological in 1/3 of cases. All 98 patients were operated on by the same surgeon using the same repair technique, and all followed ambulatory rehabilitation along the same principles of self-rehabilitation applied pre operatively. In each patient function was assessed using Constant's scoring method, and the condition of the repaired cuff was determined by ultrasonography at the time of clinical follow-up. The average follow-up period was 4 years (2 to 6 years). RESULTS: Ultrasonography revealed intact cuffs in 65 per cent, thinned cuffs in 11 per cent and recurrent full thickness tears in 24 per cent of cases. The risk of recurrent tear increased with the extent of the tear to be repaired (57 per cent), in older patient (25 per cent) and with a higher level of post-surgical occupational use (18 per cent). A drop in the post-operative Constant score had a predictive value for a full thickness recurrent defect. DISCUSSION: Constant's scoring method appears to be a reliable, reproducible method for analysing functional results following surgical repair of full thickness cuff tears and to reflect the anatomic condition of the repaired cuff. At clinical follow-up, the anatomic condition of the cuff is more determinant of final functional results than initial tear size. CONCLUSIONS: Assessment of functional results must be complemented by anatomic examination using ultrasonography in order to specify the size of any possible recurrent defect and to detect thinning of the cuff which cannot be identified by Constant's score. Analysis of the risk factors for recurrent tear led the authors to question the necessity of repairing massive tears in older patients and pointed to the valuable advantages of reinforcing fragile cuffs during initial repair especially in very active patients.

Adult↗
PubMed1996

Refractory periodontitis or recurrence of disease.

Refractory periodontal disease is characterized by low plaque scores and low responsiveness to periodontal therapy. The patients often have a history of antibiotic therapy and therefore have a high incidence of resistance in the subgingival microflora. The above features are in contrast to adult chronic periodontal disease and recurrence of disease. The subgingival microflora of refractory disease may be either predominantly gram-positive with elevated levels of Streptococcus intermedius or may be gram negative and contain elevated levels of the classical periodontal pathogens. In some cases serum IgG antibodies against Porphyromonas gingivalis are elevated and seem to decrease after therapy. Smoking may be an important factor in refractory periodontal disease. Treatment with directed antibiotic therapy as an adjunct to scaling and root planing retards the progression of disease for a limited time. Many questions are still not answered and suggestions are made for future directions in research.

Adult↗
PubMed2006

Patient-reported outcomes after inguinal herniorrhaphy.

BACKGROUND: Patient-reported outcomes (PRO) reflect the functional outcomes of inguinal herniorrhaphy. We studied the effect of hernia recurrence and complications on PRO for participants in the Veterans Affairs trial of Open or Laparoscopic Repair of Inguinal Hernia. METHODS: Analyzed PRO included (1) the Medical Outcomes Study Short Form 36, version 2, (2) the Surgical Pain Scale, (3) the Activities Assessment Scale, and (4) patient satisfaction. Recurrences and complications were recorded at follow-up visits. Complications were categorized by (1) hematoma/seroma, (2) orchitis, (3) neuralgia, and (4) other. Univariate and multivariable regression analyses identified variables significantly associated with postoperative PRO. RESULTS: Of the 1603 patients with PRO data, 105 had a recurrence and 342 had a complication at 2 years. Multivariable analyses showed neuralgia (P < .0005) adversely affected all PRO, and recurrence (P < .05) affected patient-reported pain, activity, and satisfaction, but not the score for the Medical Outcomes Study Short Form 3. Patients with a recurrence after open repair had more pain than those with a recurrence after laparoscopic repair (P = .0001). Patients with other complications after laparoscopic repair reported more pain and less activity than those with other complications after open repair (P = .003 and P = .009, respectively). CONCLUSIONS: The effectiveness of inguinal herniorrhaphy should be measured by the rate of recurrence and neuralgia. Postoperative neuralgias have a deleterious effect on all patient-reported outcomes.

Activities of Daily Living↗