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PubMed2003

Biochemical (prostate specific antigen) recurrence probability following radical prostatectomy for clinically localized prostate cancer.

PURPOSE: We retrospectively reviewed the clinical followup for a large series of men with clinically localized prostate cancer who underwent radical retropubic prostatectomy to identify clinical and/or pathological indicators of biochemical (prostate specific antigen [PSA]) recurrence. We then used those indicators to develop multivariate models for determination of recurrence probability following radical retropubic prostatectomy. MATERIALS AND METHODS: From 1982 to 1999, 2,091 consecutive men underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized adenocarcinoma of the prostate (clinical stage T1c or T2 disease with Gleason score 5 or greater). Actuarial analysis was performed comparing freedom from biochemical recurrence after radical retropubic prostatectomy (PSA 0.2 ng./ml. or greater.) using the Kaplan-Meier method. Event time distributions for the time to recurrence were compared using the log rank statistic or the Cox proportional hazards regression model. The first model was developed using preoperative variables only and the second model using all available variables. Observed and predicted recurrence-free survival curves for different models were compared to select a model for calculation of predicted recurrence-free probabilities and confidence intervals. RESULTS: With a median followup of 5.9 years (range 1 to 17) 360 men (17%) had biochemical recurrence. Overall actuarial 5, 10 and 15-year biochemical recurrence-free survival rates were 84%, 72% and 61%, respectively. The relative risk of biochemical recurrence following surgery decreased with time, even after adjusted for other perioperative parameters. Variables identified for the preoperative model were biopsy Gleason score, clinical TNM stage and PSA. Variables identified for the postoperative model were prostatectomy Gleason score, PSA and pathological organ confinement status. Nomograms were generated and corrected for the decreasing relative risk of biochemical recurrence over time. CONCLUSIONS: Using 3 preoperative or postoperative parameters, these nomograms can easily be used to determine the 3, 5, 7 and 10-year biochemical recurrence-free survival probabilities among men who undergo radical retropubic prostatectomy for clinically localized prostate cancer in the modern era.

Adenocarcinoma↗
PubMed2007

Porcine skin collagen implants to prevent anterior vaginal wall prolapse recurrence: a multicenter, randomized study.

PURPOSE: We evaluated the efficacy of the Pelvicol porcine collagen implant for preventing recurrent anterior vaginal wall prolapse in women undergoing primary surgery for pelvic organ prolapse. MATERIALS AND METHODS: This was a prospective, randomized, multicenter trial in 206 women with stage II or greater anterior vaginal wall prolapse (point Ba -1 or greater) according to the pelvic organ prolapse quantification system. The patients were randomly assigned to undergo anterior vaginal repair or the same procedure with Pelvicol implant reinforcement. SPSS software was used for data analysis. RESULTS: A total of 201 women were available for surgical outcome analysis, including 98 and 103 in the implant and no implant groups, respectively. All completed the 1-year followup visit. Most women were satisfied with the postoperative condition with a significant decrease in the visual analog scale score in each group (p <0.001). Anatomical anterior recurrence (point Ba greater than -1) was observed in 7 women (7%) in the implant group and in 20 (19%) in the other groups (OR 3.13, 95% CI 1.26-7.78, p = 0.019). Additionally, there were 11 women (3 and 8, respectively, or 5%) with posterior recurrence and 6 (3 per group or 3%) with unsatisfactory results at the upper vaginal segment. One patient who received a porcine implant had vaginal extrusion of the mesh 1 month after surgery. CONCLUSIONS: Our data show that the Pelvicol implant can be easily and readily used to augment and reinforce anterior colporrhaphy. The prolapse recurrence rate was considerably lower in the implant group compared with outcomes in patients treated with simple anterior repair.

Aged↗
PubMed2006

Increased 5-HT(2A) receptor binding in euthymic, medication-free patients recovered from depression: a positron emission study with [(11)C]MDL 100,907.

OBJECTIVE: A previous positron emission tomography (PET) study reported increased serotonin 5-HT(2A) receptor binding in unmedicated depressed patients with high scores on the Dysfunctional Attitudes Scale. The purpose of the present study was to use the highly selective 5-HT(2A) receptor ligand [(11)C]MDL 100,907 in a PET imaging paradigm to assess 1) 5-HT(2A) receptor binding potential in euthymic subjects with a history of recurrent depression and 2) the relationship between receptor binding and scores on the Dysfunctional Attitudes Scale. METHOD: Cortical 5-HT(2A) receptor binding was measured in 20 unmedicated, fully recovered unipolar depressed patients and 20 age- and gender-matched comparison subjects. Regional estimates of binding potential were obtained using a reversible plasma input function compartmental model and the cerebellum as a reference region to estimate the free and non-specifically bound [(11)C]MDL 100,907 in brain tissue. RESULTS: Relative to the comparison subjects, the recovered depressed patients demonstrated significantly higher 5-HT(2A) receptor binding potential in the frontal cortex (mean increase: 19%), parietal cortex (mean increase: 25%), and occipital cortex (mean increase: 19%). 5-HT(2A) receptor binding potential correlated negatively with age in both patients and comparison subjects and positively with the Dysfunctional Attitudes Scale in the recovered patients. CONCLUSIONS: These findings should be considered preliminary but suggest that recovered subjects with a history of recurrent major depression have elevated binding potential of cortical 5-HT(2A) receptors. The correlation of increased 5-HT(2A) receptor binding potential with increased scores on Dysfunctional Attitudes Scale supports earlier work suggesting that increased 5-HT(2A) receptor availability characterizes a group of depressed patients with high levels of dysfunctional attitudes.

Adult↗
PubMed2006

Pituitary tumour transforming gene (PTTG) expression correlates with the proliferative activity and recurrence status of pituitary adenomas: a clinical and immunohistochemical study.

BACKGROUND: The pituitary tumour transforming gene (pttg) plays a central role in pituitary tumorigenesis, but PTTG protein expression is poorly documented and its relationship with tumour cell proliferation and the prognosis of pituitary adenomas is unclear. AIM: The aim of this study was to evaluate the immunohistochemical expression of PTTG and Ki-67 in 45 human pituitary adenomas according to the tumour histotype, aggressiveness and persistence/recurrence status. PATIENTS AND METHODS: The tumours comprised 37 macroadenomas and 8 microadenomas. Twenty patients experienced disease persistence or recurrence after transsphenoidal surgery. Disease recurrence was observed in 16 patients, 8-72 months after surgery. RESULTS: No PTTG or Ki-67 expression was detected in normal pituitary tissue. In pituitary adenomas, tumour nuclei were positive for PTTG and Ki-67 in 89 and 98% of samples, respectively, and there was a strong correlation between the expression of the two proteins (P < 0.001). By the ROC curves method, a PTTG score of 3.3% was the best cut-off for distinguishing between recurrent and nonrecurrent pituitary adenomas (P < 0.05; sensitivity 60%; specificity 76%). A 2.9% cut-off was obtained for both PTTG (P < 0.01; sensitivity 77%; specificity 71%) and Ki-67 (P < 0.05; sensitivity 85%; specificity 64%) among patients with more than 1 year of follow-up. Neither PTTG nor Ki-67 expression was influenced by the maximal tumour diameter, tumour grade, age, gender or presurgical medical treatment. Both PTTG and Ki-67 tumour score > 2.9% identified a subgroup of patients with a significantly higher recurrence-free interval (P < 0.01). By multivariate analysis, a > 2.9% Ki-67 tumour score was the best predictor of pituitary tumour persistence/recurrence after surgery (chi(2) = 8.2, P < 0.01). CONCLUSION: PTTG is expressed in approximately 90% of pituitary tumours of different histotypes but with a high variability from one case to another. As expected, PTTG expression parallels that of Ki-67 and both are correlated to a more aggressive behaviour. However, a 2.9% Ki-67 cut-off proved to be the most reliable biological marker for predicting the recurrence potential of these tumours, when an adequate postsurgical follow-up is considered.

Adenoma↗
PubMed1995

Prognostic factors for local and distant recurrence in stage I and II cervical carcinoma.

PURPOSE: The effects of tumor size, parametrial involvement, and other variables on treatment outcome for patients with Federation Internationale de Gynecologie et d'Obstetrique (FIGO) Stage I or II cervical carcinoma, as well as treatment complications, were analyzed retrospectively. METHODS AND MATERIALS: Records of 125 patients with FIGO Stage I or II carcinoma of the uterine cervix selected for curative radiotherapy between January 1980 and December 1990 were reviewed. Twelve patients (9.9%) underwent adjuvant extrafascial hysterectomy and 8 patients (6.4%) received chemotherapy. Median age was 55 years. Median follow-up time was 40 months, and minimum follow-up time was 24 months. The data were analyzed for site of first relapse, survival, overall incidence of complications, and incidence of grade 4 complications. RESULTS: The overall 5-year survival was: Stage IA: 100%, Stage IB: 72%, Stage IIA: 90%, and Stage IIB: 72%. The 5-year survival with no evidence of disease (NED) was: Stage IA: 100%, Stage IB: 67%, Stage IIA: 90%, and Stage IIB: 50%. Patients with bulky (> 5 cm) tumors had a shorter overall and NED survival than patients with nonbulky tumors (53% vs. 83%; p = 0.0008 and 44% vs. 78%; p = 0.0001, respectively). Thirty-nine tumor recurrences (39 out of 125 = 31%) occurred and were scored as local (23 out of 125 = 18.3%), if initial failure had a local component, or distant (16 out of 125 = 12.7%), if initial failure was distant only. Patients with bulky (more than 5 cm) tumors (32 out of 125) were more likely to experience a recurrence (18 out of 32 = 56%) than patients with nonbulky tumors (21 out of 93 = 22%; p = 0.0004). The initial site of recurrence was more likely to be local for bulky tumors (14 out of 18 = 78%) than for nonbulky tumors (9 out of 21 = 43%; p = 0.03). The probability of a recurrence increased with the number of involved parametria (none: 20 out of 78 = 25%; one: 12 out of 34 = 35%; two: 7 out of 13 = 54%; p = 0.04 for linear trend), as did the probability that the initial failure was distant rather than local (none: 4 out of 20 = 20%; one: 7 out of 12 = 58%; two: 5 out of 7 = 71%; p = 0.01 for linear trend). Positive lymph nodes, vessel invasion, and low hemoglobin level all correlated with an increased risk of a recurrence (RR 2.41, p = 0.004; RR 2.20, p = 0.01; OR 2.02, p = 0.01, respectively). There were 46 complications among 37 (29%) patients. The incidence of grade 4 complications was 8.8% (11 out of 125). History of pelvic surgery and bulky tumor were significant predictors of a grade 4 complication (p < 0.0001 and 0.021, respectively). Also, a dose rate to point A of > 0.6 Gy/h increased the chance of a grade 4 complication (p = 0.007). CONCLUSION: For patients with FIGO Stage I or II cervical carcinoma, tumor size was more predictive of local recurrence than was overall stage, and the extent of parametrial involvement was strongly predictive of distant recurrence, as was the stage. These findings suggest that tumor size and extent of parametrial involvement should be incorporated into the staging system. Patients with bulky tumors had a shorter survival and were more likely to experience a grade 4 toxicity of therapy. Dose rate to point A of > 0.6 Gy/h was associated with the increased risk of grade 4 complications.

Adenocarcinoma↗
PubMed2004

Cognition and quality of life in patients with carotid artery occlusion: a follow-up study.

BACKGROUND: Little is known about long-term cognitive functioning and quality of life (QoL) in patients with symptomatic carotid artery occlusion who do not undergo revascularization surgery. OBJECTIVE: To assess the course of cognitive impairment and changes in QoL in these patients and whether impaired cerebral metabolism predicts the course of cognitive functioning. METHODS: In 73 consecutive patients with TIA or a minor stroke associated with an occlusion of the internal carotid artery (ICA), cognition and health-related QoL in a 1-year follow-up study were examined. The presence of cerebral ischemic lesions was examined by MRI; the metabolic N-acetyl aspartate/creatine ratio and the presence of lactate were measured by 1H-MR spectroscopy in the centrum semiovale ipsilateral to the symptomatic ICA occlusion. RESULTS: Seventy percent of patients with a stroke and 40% of patients with a TIA were cognitively impaired. In patients with recurrent TIAs during follow-up, cognitive functioning remained at the same (impaired) level (mean impairment score: at baseline 0.7, at 1-year follow-up 0.6; p = 0.646). In patients without lactate at baseline and without recurrent symptoms during follow-up, cognitive functioning improved (mean impairment score: at baseline 1.1, at 1-year follow-up 0.7; p < 0.001). Self-perceived QoL remained affected at 12 months' follow-up, although not to a large extent (mean SD from norm scores <1). CONCLUSIONS: In patients with a symptomatic ICA occlusion, cognitive functioning improved within 1.5 years after the ischemic event, if no further symptoms occurred and patients had no lactate at baseline. Self-perceived QoL remained slightly affected.

Brain↗
PubMed2006

Impact of polypropylene amount on functional outcome and quality of life after inguinal hernia repair by the TAPP procedure using pure, mixed, and titanium-coated meshes.

BACKGROUND: Laparoscopic inguinal hernia repair requires the use of prosthetic material. This prospective, single-center study was intended to investigate the impact of the amount of polypropylene (PP) mesh used in hernia repair on functional results and quality of life. METHODS: For this series, 672 consecutive patients with primary inguinal hernia undergoing transabdominal preperitoneal hernia repair (TAPP) using a heavyweight PP mesh (Prolene 10 x 15 cm, 1.5 g, group I, n = 232), a mixed PP- and Polyglactin mesh (Vypro II, 10 x 15 cm, 0.53 g, group II, n = 217), or a light-weight titanized PP mesh (Ti-Mesh, 10 x 15 cm, 0.24 g, group III, n = 223) were compared in terms of postoperative complications (seroma, wound healing disorders), quality of life score (pain development, physical condition, urologic disorders), and hernia recurrence. RESULTS: During a 12-month follow-up there were no significant differences in the recurrence rate (1.3%-1.7%). Patients with a pure PP mesh (group I) showed significantly more postoperative seromas (12.1% versus 4.1%/1.8%), foreign body sensations (9.1% versus 5.5%/3.5%), and sensitivity to weather changes (5.6% versus 3.2%/2.2%) compared to groups II and III. In all groups, the quality of life score was improved postoperatively. However, among those patients in our series with few preoperative complaints, the postoperative quality of life was worsened when heavy-weight PP meshes (group I+II) were used but significantly improved when light-weight titanized PP meshes were used. CONCLUSIONS: Comparable functional results, fewer postoperative complications, and improved quality of life can be achieved by reducing the amount of PP in meshes used for laparoscopic hernia repair by TAPP procedure.

Adult↗
PubMed1998

Prediction of functional recovery and prognosis in patients with acute myocardial infarction by 123I-BMIPP and 201Tl myocardial single photon emission computed tomography: a multicenter trial.

123I-BMIPP [15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid] was developed for metabolic imaging with SPECT. A multicenter collaborative study was conducted on a large patient series to determine whether 123I-BMIPP and 201Tl myocardial SPECT are of use in predicting the prognosis and ventricular function after acute myocardial infarction (AMI). Patients with uncomplicated first AMI underwent resting 123I-BMIPP and 201Tl myocardial SPECT in the subacute phase after the onset of AMI. Of these, 167 patients who had been followed up for an average of 22 months were retrospectively reviewed to predict serious cardiac events and recurrent ischemia. In addition, the association between changes in radionuclide parameters and recurrent ischemia was investigated in Subgroup A (58 patients) who had repeated SPECT in the chronic phase. Furthermore, prediction of the ejection fraction (EF) was investigated in Subgroup B (94 patients) and Subgroup C (76 patients) in whom left ventriculography was performed at the time of discharge and 90 days or more after the onset, respectively. The prognosis was generally favorable, with 4 cases of cardiac death (2%), 3 of heart failure (2%), 4 of nonfatal reMI (2%), and 25 of recurrent ischemia (15%). The results of Cox multivariate regression analysis revealed a high probability of serious cardiac events in patients who were elderly (p = 0.04), who had 90% or more residual stenosis of the infarct-related artery (p = 0.09), and who had a high BMIPP defect score (p = 0.17). There was a high probability of recurrent ischemia in elderly patients (p = 0.10) who had multi-vessel disease (p = 0.03), but no association was found with radionuclide parameters in the subacute phase. In Subgroup A, however, the probability of recurrent ischemia tended to be high in patients with a large mismatch scorebetween 123I-BMIPP and 201Tl in the subacute to chronic phase. An important observation was that the extent of BMIPP defect was more strongly correlated with EF at the time of discharge and 90 days or more after the onset than the extent of Tl defect (r = -0.60 vs. r = -0.47, and r = -0.53 vs. r = -0.43, respectively). In addition, multiple regression analysis showed that parameters related to the BMIPP defect were also better predictive factors of EF both at the time of discharge and 90 days or more after the onset. In conclusion, resting 123I-BMIPP and 201Tl myocardial SPECT performed in the subacute phase of AMI were shown to be useful in predicting prognosis and ventricular function for patient management.

Aged↗
PubMed1990

[Local recurrence of rectal cancers. Multidimensional analysis by anatomoclinical factors and role of irradiation].

Pre- or postoperative radiation therapy reduces the incidence of local recurrence after surgical treatment of rectal carcinoma. Factors related to local recurrence were analyzed retrospectively by uni- and multivariate analysis. One hundred and fifty-five patients (mean age: 65 years) were operated on with curative intent between 1967 and 1984. Ninety-four patients (46 patients having abdominoperineal resections (APR), and 48 having anterior resections) did not receive radiation therapy. Sixty-one patients had preoperative radiation therapy followed by APR in 59 cases. Univariate analysis showed that the risk of local recurrence increased significantly with male sex (p less than 0.006), positive lymph nodes (p less than 0.01), vascular invasion (p less than 0.02), and Astler-Coller classification (p less than 0.05). Tumor located at less than 5 cm from the anal verge was significantly related to recurrence only in patients not receiving radiation therapy (p less than 0.02). Multivariate analysis including therapeutic modalities showed that local recurrence was significantly related with male sex (p less than 0.02), positive lymph nodes (p less than 0.01), and distance to anal verge (p less than 0.01). The beneficial role of radiation therapy appeared only for tumors located 5 cm or less from the anal verge. Prognostic scores were established using these variables and the effect of irradiation was evaluated according to these scores. Radiation therapy significatively reduced the risk of local recurrence in low-risk patients, i.e., female with low-lying tumor and with negative lymph nodes (p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2003

Total hip arthroplasty in adult patients who had childhood infection of the hip.

BACKGROUND: Adult patients with a history of infection of the hip in childhood present a challenge as candidates for total hip arthroplasty because of abnormal bone development, soft-tissue contractures, the possibility of reinfection, and their relative youth. The purpose of this study was to analyze the mid-term results of primary total hip arthroplasty in adult patients who had had infection of the hip in childhood. METHODS: We retrospectively analyzed 170 total hip arthroplasties that had been performed between 1983 and 1996 in patients who had had infection of the hip during childhood. Forty-seven hips had cemented or hybrid total hip replacements, and 123 hips had cementless total hip replacements. The age of the patients at the time that the infection was contracted was an average of 7.3 years (range, one to eleven years). The average age of the patients at the time of the index total hip arthroplasty was 41.9 years in the cemented or hybrid group and 42.7 years in the cementless group. The interval between active infection and arthroplasty was 34.9 years in the cemented or hybrid group and 31.9 years in the cementless group. All but two hips (one patient) had a quiescent period of infection of more than ten years. The average duration of follow-up was 9.8 years (range, seven to seventeen years) in the cemented or hybrid group and 10.8 years (range, seven to seventeen years) in the cementless group. RESULTS: All hips with a quiescent period of more than ten years had no recurrence of infection. The remaining two hips in one patient with a quiescent period of seven years had recurrence of the infection. The mean Harris hip scores improved from 50 points preoperatively to 85 points at the latest follow-up examination in the cemented or hybrid group and from 50 points preoperatively to 89 points at the latest follow-up examination in the cementless group. Eight (17%) of forty-seven hips with cemented or hybrid fixation and eighteen (15%) of 123 hips with cementless fixation had revision of both components because of aseptic loosening and/or osteolysis. The mean rate of linear wear of the polyethylene was 0.25 mm per year in the cemented or hybrid group and 0.29 mm per year in the cementless group. The prevalence of osteolysis was 53% (twenty-five of forty-seven hips) in the cemented or hybrid group and 59% (seventy-two of 123 hips) in the cementless group. CONCLUSIONS: There was no recurrence of infection after total hip arthroplasty in the patients with a quiescent period of infection of more than ten years. These young, active patients with technically difficult arthroplasties were at considerable risk for aseptic loosening. The prevalence of polyethylene wear and osteolysis was attributable to the less than optimal prosthetic designs and materials used during the time-period of this study.

Adolescent↗
PubMed2001

Detection of the 67-kD laminin receptor in prostate cancer biopsies as a predictor of recurrence after radical prostatectomy.

OBJECTIVES: Reliable prognostic indicators are needed for a better pretherapeutic assessment of the agressiveness of organ-confined prostate cancer (PC) lesions. The 67-kD laminin receptor (67LR) is a cell-surface-associated protein involved in the acquisition of the invasive and metastatic phenotype of a variety of human cancer cell types. We have previously shown that 67LR detection in PC tissues from radical prostatectomy (RP) specimens is an independent predictor of biochemical (PSA) relapse in patients with clinically localized PC. In this study, we assessed 67LR detection in diagnostic PC biopsies as a predictor of biochemical relapse after RP. METHODS: Diagnostic biopsy and subsequent RP tissue specimens from 151 patients with clinically localized PC were immunohistochemically analyzed for 67LR expression. The level of 67LR expression was evaluated by both intensity and extent of the staining. Clinicopathological preoperative and postoperative parameters, including 67LR expression, were correlated with each other and tested as predictors of biochemical relapse. RESULTS: 67LR was detected in 67.5 and 68.2% of biopsies and RPs, respectively. 67LR detection in RP specimens was an independent predictor of relapse. The level of 67LR expression in the biopsy was significantly associated with the biopsy Gleason score (p<0.05) but failed to predict the pathological stage (p>0.1). Biochemical progression-free estimates for patients whose biopsy did or did not express the protein differed with only borderline statistical significance (p = 0.05). Multivariate analysis identified biopsy Gleason score as the only independent preoperative predictor of recurrence. Significant discrepancies in levels of 67LR expression were found between matched biopsy and RP specimens (p<0.05), with exact agreement rates <40%. CONCLUSIONS: 67LR detection in PC biopsies was not a significant preoperative predictor of outcome after RP. Heterogeneity of 67LR expression and biopsy sampling errors most likely represented the main reasons for discordant results between biopsy and RP specimens.

Adenocarcinoma↗
PubMed1991

[Role of tianeptine in the prevention of depression relapse and recurrence. First estimations].

The potential activity of tianeptine in the prevention of depressive relapses or recurrences was evaluated in the course of a long-term multicenter study. Five hundred and ten patients were treated for a one-year period. During the first six months, 22 percent of patients responders to the treatment relapsed into depression or had a methodological equivalent of depressive relapse (a MADRS score equal to or higher than 25). This percentage of depressive relapses is comparable to those obtained with other antidepressants. After six months of treatment, 7 percent of patients with a stabilized recovery recurred into depression or had a methodological equivalent of depressive recurrence (a MADRS score equal to or higher than 25). An analysis compared this percentage with those obtained in the course of other studies. These percentages are classically more important. The role of diagnoses of depression was analysed. Percentages of depressive relapses and recurrences were also evaluated in the sub-sample of patients treated with tianeptine alone.

Adult↗
PubMed2005

The high prevalence of bipolar spectrum disorders in young adults with recurrent depression: toward an innovative diagnostic framework.

BACKGROUND: Young adults with early-onset major depressive disorder (MDD) may be at high risk of progression to bipolar disorder. Although hypomanic symptoms are common in young people with depression, many do not reach the strict DSM-IV and ICD-10 criteria for hypomania. We used an emerging innovative framework for bipolar spectrum to evaluate this question. METHODS: Consecutive referrals to a psychiatric outpatient clinic at a university health service were assessed for recurrent episodes of depression. DSM-IV diagnoses were based on a SCID-1 interview. We used two approaches to delineate bipolar spectrum. The first focused on bipolar spectrum disorder (BSD, as defined by Ghaemi et al. [Can. J. Psychiatry 47 (2002) 125]), and the second on a symptoms perspective based on MDD with a history of hypomanic symptoms, using a 15-point hypomanic symptoms checklist with a cut-off > or =8 or more symptoms (modified from J. Affect. Disord. 73 (2003) 39 and J. Affect. Disord. 73 (2003) 73). Data were also obtained on family history of affective disorder, course and number of episodes of depression, symptom severity, psychosocial functioning, suicidality and deliberate self-harm, and drug and alcohol use. RESULTS: High rates of bipolar and bipolar spectrum disorder were identified. Under DSM-IV, 14 subjects (16.1%) had bipolar affective disorder and 73 subjects (83.9%) had recurrent MDD. Depending on the method used to diagnose bipolar spectrum, between 47.1% and 77.0% of the total cohort could be so diagnosed. Hypomanic symptom counts, irrespective of duration, yielded the highest estimates for bipolar spectrum. High rates of pharmacological hypomania were also identified: 12 subjects (16.4%) with recurrent MDD group reported this, and all could be diagnosed with bipolar spectrum. LIMITATIONS: The reliability of using the 15-point hypomanic scale for the diagnostic assignments was not tested. All subjects were recruited from a university health service and, given the affluence of their parents, findings may not generalise to other populations. Most importantly, because bipolar family history and pharmacological hypomania were part of the diagnostic criteria of the BSD group, they could not be used as external validators for Ghaemi's BSD construct. CONCLUSIONS: Bipolar disorders emerge as extremely common in this cohort of young adults with recurrent depression. Antidepressant-induced hypomania and high scores on a hypomanic symptoms checklist help to identify patients who are likely to have a bipolar spectrum illness, but who do not meet DSM-IV criteria for bipolar disorder. This is a preliminary study, and further evidence from external validating strategies are needed to verify the bipolar status of these patients in a larger and unselected cohort representing a broader socio-economic demographic profile.

Adult↗
PubMed2002

Her-2/neu oncogene amplification in clinically localised prostate cancer.

AIM: To examine the incidence of Her-2/neu oncogene amplification in clinically localised prostate cancer using in situ hybridisation. METHODS: One hundred and seventeen patients, who had undergone radical prostatectomy, were identified and in situ hybridisation was performed on formalin fixed, paraffin wax embedded tissue using the Quantum Appligene probe for Her-2/neu. The enzyme peroxidase was used to detect the probe because this enabled a permanent record to be kept. Tumours in which there were five or more signals in each nucleus in > 20% of the tumour cells were considered to have a significantly increased copy number. A serial section from these tumours was then hybridised with the chromosome 17 alpha satellite probe. The ratio of the percentage of cells showing an increase in Her-2/neu copy number to the number showing polysomy for chromosome 17 was calculated. A ratio above 2 was considered amplified. RESULTS: Biochemical recurrence occurred in 50 (43%) patients and 24 (21%) had clinical recurrence. In situ hybridisation for Her-2/neu was accessible in 114 (97%) patients. A significant increase in copy number was present in two patients (1.75 %), but chromosome 17 hybridisation showed that the increase was the result of polysomy rather than true amplification. Both these patients had a Gleason score of 7 and stage T3; they also had recurrent clinical disease with distal metastasis within two and 19 months. CONCLUSIONS: Increased Her-2/neu oncogene copy number appears to be rare in clinically localised prostatic adenocarcinoma and is related to chromosome 17 polysomy rather than true amplification. As a result, it would not be a useful biomarker for identifying those patients who will have recurrences after radical prostatectomy.

Adenocarcinoma↗
PubMed2003

Chronic rejection with or without transplant vasculopathy.

BACKGROUND: Chronic allograft nephropathy (CAN) is defined and graded in the Banff '97 scheme by the severity of interstitial fibrosis and tubular atrophy. It has been denoted that chronic rejection can be diagnosed if the typical vascular lesions are seen, consisting of fibrointimal thickening. We observed several patients who developed CAN without vascular changes or signs of cyclosporine toxicity. Therefore, we assessed the risk factor profiles of CAN with and without transplant vasculopathy. METHODS: A cohort of 654 cadaveric renal transplants performed between 1983 and 1997 that functioned for more than 6 months was studied. Fifty-four transplants had CAN defined by a significant decline in renal function together with interstitial fibrosis and tubular atrophy without signs of cyclosporine nephrotoxicity or recurrent disease. Using the Banff chronic vascular (CV) score, 23 of 54 cases (43%) had a chronic vasculopathy score of 0 or 1 whereas 31 cases (57%) had a CV score of 2 or 3. Applying multivariate logistic regression, predictor variables of the two groups were compared with 231 transplants with a stable function for at least 5 yr. RESULTS: Graft histology was obtained at a mean of 2.4 and 2.9 yr after transplantation in the group with or without vasculopathy, respectively. Acute rejection episodes (AREs) after 3 months post-transplantation were the strongest risk factor for both forms of CAN, odds ratio (OR) 14.7 (6.0-36.0). CAN with vasculopathy was also associated with transplants performed in the 1980s, OR 4.95 (1.65-14.9) and with creatinine clearance at 6 months, OR 0.58 (0.44-0.75) per 10 mL/min increase. In contrast, young recipient age, OR 0.69 (0.47-0.99) per 10-yr increase, and the presence of panel reactive antibodies at the time of transplantation, OR 1.26 (1.08-1.47) per 10% increase, were independent risk factors for CAN without vasculopathy. CONCLUSIONS: After exclusion of cyclosporine toxicity or recurrent disease CAN occurred without moderate or severe transplant vasculopathy in 43% of the cases. The correlation with young recipient age, sensitization and late ARE suggest an immune pathogenesis, consistent with chronic rejection.

Acute Disease↗
PubMed2005

[Prognostic factors influencing postoperative survival in patients with </= 3 cm small hepatocellular carcinoma].

OBJECTIVE: To summarize the experience of surgical resection, and to analyze the prognostic factors that can influence the postoperative survival in patients with small hepatocellular carcinoma (small HCC) of </= 3 cm in diameter. METHODS: The clinicopathologic data of 105 cases with small HCC after resection between 1986 and 2003 were analyzed, all of which had been followed up for more than half a year (median time, 33 months). Nine clinicopathologic factors including preoperative alpha-fetoprotein (AFP) level, liver cirrhosis, Child-Pugh score, tumor size (> 2 cm vs. </= 2 cm) and number (single vs. multiple), capsule formation, portal vein tumor thrombi (PVTT), Edmondson tumor grade and surgical method were analyzed through the way of Log-rank and Cox Regression tests. RESULTS: Postoperatively, the cumulative survival rate of 1, 3 and 5-year were 86.5%, 70.3% and 55.2% respectively, and the disease-free survival rate of 1, 3 and 5-year were 78.0%, 58.9% and 45.6% respectively. One patient died from esophagogastric variceal hemorrhage in 2 weeks after re-operation. Up to the time of following up, 36 had intrahepatic recurrence or metastases postoperatively. Thirty-four patients died, of which, 4 died from variceal hemorrhage, 1 from liver failure, 1 died of pneumonia and 2 from distant metastases, while the others died from intrahepatic recurrences or metastases. Kaplan-Meier and multivariate Cox Regression tests indicated that poor Child-Pugh score, tumor more than 2 cm in diameter, PVTT and multiple lesions (including satellitic lesions) were adverse factors affecting postoperative survival. Multivariate Cox Regression tests indicated that tumor size, PVTT and multiple lesions were the factors affecting postoperative disease-free survival. CONCLUSIONS: Limited hepatectomy with a margin no less than 1 cm is an appropriate surgical approach. Adverse preoperative Child-Pugh score and postoperative intrahepatic recurrences are main factors leading to the death of patients with small HCC.

Adult↗
PubMed2005

Whole genome linkage scan of recurrent depressive disorder from the depression network study.

Genome-wide linkage analysis was carried out in a sample of 497 sib pairs concordant for recurrent major depressive disorder (MDD). There was suggestive evidence for linkage on chromosome 1p36 where the LOD score for female-female pairs exceeded 3 (but reduced to 2.73 when corrected for multiple testing). The region includes a gene, MTHFR, that in previous studies has been associated with depressive symptoms. Two other regions, on chromosomes 12q23.3-q24.11 and 13q31.1-q31.3, showed evidence for linkage with a nominal P < 0.01. The 12q peak overlaps with a region previously implicated by linkage studies of unipolar and bipolar disorders and contains a gene, DAO, that has been associated with both bipolar disorder and schizophrenia. The 13q peak lies within a region previously linked strongly to panic disorder. A fourth modest peak with an LOD of greater than 1 on chromosome 15q lies within a region that showed genome-wide significant evidence of a recurrent depression locus in a previous sib-pair study. Both the 12q and the 15q findings remained significant at genome-wide level when the data from the present study and the previous reports were combined.

Adolescent↗
PubMed2006

Wireless capsule endoscopy versus ileocolonoscopy for the diagnosis of postoperative recurrence of Crohn's disease: a prospective study.

BACKGROUND AND AIMS: Following ileocolonic resection for Crohn's disease (CD), early endoscopic recurrence predicts recurrence of symptoms. The aim of the study was to compare ileocolonoscopy and wireless capsule endoscopy (WCE) for the detection of postoperative recurrence in CD. METHODS: WCE and ileocolonoscopy were performed within six months following surgery in 32 prospectively enrolled patients. Two independent observers interpreted the results of WCE. Recurrence in the neoterminal ileum was defined by a Rutgeerts score>or=1. When observers at WCE did not concur, WCE results were considered as either true negative or true positive and sensitivity and specificity were calculated according to both assumptions. RESULTS: Recurrence occurred in 21 patients (68%) and was detected by ileocolonoscopy in 19 patients. Sensitivity was 90% and specificity 100%. Sensitivity of WCE was 62% and 76% and specificity was 100% and 90%, respectively, depending on assumptions. There was a correlation between the severity of the lesions measured by both methods (p<0.05). Lesions located outside the scope of conventional endoscopy were detected by WCE in two thirds of patients with excellent interobserver agreement (kappa>0.9) for all lesions with the exception of ulceration (kappa=0.7). CONCLUSIONS: The sensitivity of WCE in detecting recurrence in the neoterminal ileum was inferior to that of ileocolonoscopy. In contrast, WCE detected lesions outside the scope of ileocolonoscopy in more than two thirds of patients. Additional follow up studies are needed to assess the clinical relevance of such lesions. At the present time, it seems that WCE cannot systematically replace ileocolonoscopy in the regular management of patients after surgery.

Adult↗