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At least 883 records · Page 49Linked to original sources
PubMed2002

Tamoxifen in the treatment of hepatocellular carcinoma: 5-year results of the CLIP-1 multicentre randomised controlled trial.

BACKGROUND: In 1998, when data of a meta-analysis on tamoxifen in the treatment of hepatocellular carcinoma (HCC) had suggested a little advantage for this treatment, we published the results of a multicenter randomised controlled trial, that showed no survival benefit for tamoxifen vs. control. Here we report an updated analysis of the study results 4.5 years after the closure of enrollment. METHODS: The study had a planned sample size of 480 patients. Patients with any stage HCC were eligible, irrespective of locoregional treatment. Tamoxifen was given orally, 40 mg/die, from randomisation until death. RESULTS: 496 patients were randomised by 30 Institutions from January 1995 to January 1997. Information was available for 477 patients. As of July 2001, 374 deaths (78%) were recorded, and median survival times were 16 and 15 months (p=0.54), in the control and tamoxifen arm. Data were further analysed separately for advanced patients and for those eligible to potentially curative locoregional treatments: relative hazard of death for patients receiving tamoxifen was equal to 0.98 (95% CI 0.76-1.25) for the former group and 1.38 (95% CI 0.95-2.01) for the latter. The prognostic score recently devised by our group (CLIP score) was, as expected, strictly correlated (p<0.0001) to the locoregional treatment received and strongly correlated with prognosis. CONCLUSIONS: the update of the present study confirms that tamoxifen is not effective in prolonging survivals, both in advanced patients and in those potentially curable and that the CLIP score is able to predict prognosis.

Carcinoma, Hepatocellular↗
PubMedDate not supplied

A comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage in gastric carcinoma.

BACKGROUND/AIMS: To clarify what staging system of lymph node metastasis is suitable for evaluating prognosis of gastric cancer patients. METHODOLOGY: We analyzed the survival 5 years after operation of 186 advanced gastric cancer patients who underwent potentially curative gastric resection. The following 3 systems were compared using multivariate analyses by the logistic regression model. Nodal status in pathology was classified as follows: (a) nodal stage according to the General Rules for the Gastric Cancer Study of the Japanese Research Society for Gastric Cancer (the Japanese Rules), (b) number of metastatic nodes according to the new UICC staging system (the TNM system), (c) number of metastatic nodes in n1 group of the Japanese Rules (the new classification). RESULTS: The TNM system revealed better results than the nodal stage in sensitivity and -2 log likelihood. The new classification revealed the best result among the 3 systems in sensitivity, specificity, accuracy and -2 log likelihood. CONCLUSIONS: The TNM system is a better prognostic factor than the nodal stage in the Japanese Rules, and the new classification is the best prognostic factor of the above 3 systems in potentially curative advanced gastric cancer patients. Furthermore, the new classification might be useful in comparing data between some facilities.

Adenocarcinoma↗
PubMed2006

Neurogenic bladder dysfunction in patients with neoplastic spinal cord compression: adaptation of the bladder management strategy to the underlying disease.

OBJECTIVES: To study the outcome of different bladder management strategies in patients with neoplastic spinal cord compression. METHODS: 22 patients with neoplastic spinal cord compression underwent urodynamic examination. According to the urodynamic data and the underlying disease different bladder management strategies were recommended. In patients with curatively treated disease a full bladder rehabilitation program was arranged. In patients with metastatic malignant disease, voluntary voiding was continued if possible or a suprapubic catheter was placed. RESULTS: Eight patients were treated with curative intention. Of those, 2 patients were able to void during urodynamics continued normal voluntary voiding. Six patients were taught intermittent catheterisation, with three additionally received oral anticholinergic treatment because of UMN lesion. At follow-up, all patients had successfully finished bladder rehabilitation program and at follow up, all patients were continuing their previously recommended bladder rehabilitation program. Fourteen patients had malignant disease and were treated palliatively. In 2 patients with UMN lesion, voluntary control of micturition was maintained and both continued voluntary voiding. In 12 patients a suprapubic catheter was inserted. At follow-up, 9 out of 14 had died (mean 8 month after primary visit), the remaining 5 continued treatment with suprapubic catheters. CONCLUSION: Underlying disease and life expectancy should be considered for the selection of bladder management in patients with neoplastic spinal cord compression. In patients with curatively treated disease, a full bladder rehabilitation program is recommended while in patients with malignant disease and palliative care, a suprapubic catheter might be the treatment of choice.

Adult↗
PubMed1987

[Clinical and basic studies on the treatment of cancer metastasis].

Lung resection for metastatic lung tumors from cancers of other organs has shown a significant curative success rate among affected patients. Hepatectomy also shows promise as a good curative approach for patients with liver metastasis from cancers of various abdominal organs. Descriptive data and their analysis of metastases by Bross and Viadana indicate a cascade spreading process. The fact that key-sites such as the lung and/or liver which, for some time, have proved a stumbling block to the generalization of cancers by metastases, has led to the success of therapy for metastasis in the clinical field. Chemotherapy as an adjuvant therapy to surgery for key-site metastatic foci is anticipated to raise future cure rates.

Humans↗
PubMedDate not supplied

Vancomycin therapy for infective endocarditis.

The use of vancomycin is increasing for the treatment of serious life-threatening staphylococcal and other bacterial infections, including infective endocarditis, in patients who are allergic to the penicillins. The literature through 1978 reveals approximately 55 cases of infective endocarditis treated with vancomycin alone or with combined antibiotic therapy. Many of these 55 patients were treated by different clinicians, were given variable regimens of therapy, received other therapy before vancomycin, had associated valve replacement; various amounts of data were provided for the reported cases. A summary of these reports indicates a cure in 48 (87%) of the 55 patients. Recent in vitro and in vivo animal and patient data indicate that vancomycin alone or as part of combined therapy is bactericidal and curative in patients allergic to penicillin for infective endocarditis caused by staphylococci and streptococci-both enterococcal and nonenterococcal (Streptococcus bovis and viridans group streptococci) infections. In this study, 10 patients with infective endocarditis were treated with vancomycin or combined therapy; seven were cured. Five of the 10 patients with infective endocarditis caused by viridans streptococci were cured with combined vancomycin-streptomycin given in short-term therapy for two weeks.

Adolescent↗
PubMed1994

[After-care in colorectal cancer--data and patient oriented evaluation].

The results and the costs of a routine follow-up program for patients with curatively resected colo-rectal carcinoma were evaluated in a retrospective matched pair study. Patients, who never had participated in such a program, were used as controls. In addition 58 patients were questioned prospectively regarding their opinion about the value of the follow-up program for their present and future life. Significantly more local recurrences and distant metastases were diagnosed at an average of 1.5 years earlier in the follow-up group as compared with the control group. Neither the hereby resulting higher number of curatively resected local recurrences or distal metastases nor a more aggressive oncological approach in unresectable cases resulted in a substantial improvement of survival time in the follow-up group. Considering the relatively high costs of the program, only the diagnosis of several other illnesses which one was able to treat, and the high appreciation by the patients speak in favor of the follow-up program. 86.2% of the patients believed that routine follow-up would be of essential value for their future life.

Aftercare↗
PubMed1994

An analysis on the effect of blood transfusion on recurrence and survival in patients undergoing extended lymphadenectomy for colorectal cancer.

In a retrospective study data were collected from 644 patients with cancer of the colon or rectum undergoing curative surgery with extended lymphadenectomy to evaluate a possible effect of blood transfusion, given perioperatively, on tumor recurrence and patient survival. Univariate analysis showed depth of bowel wall invasion, number and level of lymph node metastases to be of highly significant prognostic factors. After 5 years the overall recurrence rate was 16.6% for the non-transfused (n = 223) and 26.1% for the transfused (n = 421; p < .01) patients, and survival rates showed borderline significance favoring the non-transfused patients (90.5% vs. 80.0% after 5 years; p < 0.05). However, after stratification for the prognostically important factors, in a multivariate analysis a possible detrimental effect of perioperative blood transfusions could not be demonstrated.

Adenocarcinoma↗
PubMed1996

[Current topics and endoscopic characteristics of the diagnosis how to detect in early gastric or colon cancer].

It is now an era of diversity of treatment for early cancer. Endoscopic diagnosis for both early gastric and colon cancer have focused on the detection of small or minute cancers(smaller than 5 mm), which could be resected by endoscopically. It has been generally considered that endoscopic curative treatment for the small cancer (smaller than 10 mm) is useful from the data of lymph node metastasis in early gastric cancer, however, a high incidence of recurrence (7.5 approximately 22.9%) after endoscopic mucosal resectomy has been found. High cancer rates and high rates of sm invasion are recognized in the superficial type, especially IIc, IIc + IIa, IIa + IIc, of colon tumor. The degree of invasion should be defined and a criteria for indication of endoscopic treatment should be determined from the endoscopic findings.

Colonic Neoplasms↗
PubMed2006

Short- and long-term experience in pulmonary vein segmental ostial ablation for paroxysmal atrial fibrillation.

INTRODUCTION: Segmental ostial pulmonary vein isolation (PVI) is considered a potentially curative therapeutic approach in the treatment of paroxysmal atrial fibrillation (PAF). There is only limited data available on the long-term effect of this procedure. METHODS: Patients (Pts) underwent a regular clinical follow up visit at 3, 6 and 24 months after PVI. Clinical success was classified as complete (i.e. no arrhythmia recurrences, no antiarrhythmic drug), partial (i.e. no/only few recurrences, on drug) or as a failure (no benefit). The clinical responder rate (CRR) was determined by combining complete and partial success. RESULTS: 117 patients (96 male, 21 female), aged 51+/-11 years (range 25 to 73) underwent a total of 166 procedures (1.4/patient) in 2-4 pulmonary veins (PV). 115 patients (98%) had AF, 2 patients presented with regular PV atrial tachycardia. ,109/115 patients. exhibited PAF as the primary arrhythmia (versus persistent AF). A total of 113 patients with PVI in the years 2001 to 2003 were evaluated for their CRR after 6 (3) months. A single intervention was carried out in 63 patients (55.8%), two interventions were performed in 45 patients (39.8%) and three interventions in 5 patients (4.4%). The clinical response demonstrated a complete success of 52% (59 patients), a partial success of 26% (29 patients) and a failure rate of 22% (25 patients), leading to a CRR of 78% (88 patients). Ostial PVI in all 4 PVs exhibited a tendency towards higher curative success rates (54% versus 44% in patients with 3 PVs ablated for the 6 month follow up). Long-term clinical outcome was evaluated in 39 patients with an ablation attempt at 3 PVs only (excluding the right inferior PV in our early experience) and a mean clinical follow up of 21+/-6 months. At this point in time the success rate was 41% (complete, 16 patients) and 21% (partial, 8 patients), respectively, adding up to a CRR of 62% (24 patients). In total, 20 patients (17.1%) had either a single or 2 (3 patients, 2.6%) complications independent of the number of procedures performed with PV stenosis as the leading cause (7.7%). CONCLUSION: The CRR of patients with medical refractory PAF in our patient cohort is 78% at the 6 month follow up. PV stenosis is the main cause for procedure-related complications. Ablation of all 4 PV exhibits a tendency towards higher complete success rates despite equal CRR. Calculation of the clinical response after a mid- to long-term follow of 21+/-6 months in those patients with an ostial PVI in only 3 pulmonary veins (sparing the right inferior PV) shows a further reduction to 62%, exclusively caused by a drop in patients with a former partial success. To evaluate the long-term clinical benefit of segmental ostial PVI in comparison with other ablation techniques, more extended follow up periods are mandatory, including a larger study cohort and a detailed description of procedural parameters.

Journal Article↗
PubMed1990

Factors influencing utilization of the curative health services among children aged 6-60 months in Bahrain (Part II).

Two hundred twenty one out of 2587 children aged 6-60 months were selected at random from 8 villages in Western region of Bahrain. The data were collected by interviewing the mothers and checking out the health records. The study revealed that family size, mother's education, socioeconomic status and mother's attitude toward the curative services were significant factors for the use of the curative care. However, no significant relationships were found between the utilization of the curative care and age and sex of child, family structure and the situational factors.

Attitude to Health↗
PubMed1990

Changing remuneration systems: effects on activity in general practice.

OBJECTIVE: To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN: Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING: General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS: 265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES: Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS: Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105.3, 107.6 and curative services 106.0, 115.0) whereas referral rates to secondary care fell (specialist referrals 90.1 (80.7 to 100.6) and 77.0 (68.6 to 86.4) and hospital referrals 87.4 (71.1 to 107.5) and 68.4 (54.7 to 85.4] in doctors in the city. CONCLUSIONS: Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Capitation Fee↗
PubMed2002

Quality of life after stem cell transplantation: a patient, partner and physician perspective.

Background: Although increasing data are available on quality of life (QOL) issues after stem cell transplantation (SCT), many issues are still unresolved. With the increasing use of transplants in non-curative situations, quality of life issues have become especially important. Methods: All patients who had undergone SCT and had no recurrent disease were asked to provide quality of life data using the EORTC QLQ-C30 questionnaire at about 2.5 (n=52) and 4.5 years (n=33) after transplantation. In addition, the patients' partners and physicians were asked to estimate the patients' quality of life. Results: Scores on the functional scales ranged from 65 to 80 and were comparable initially and at the 23-month follow-up. The initial, overall quality of life of the patients was 75. After an additional 23-month follow-up, the overall quality of life was 73. Fatigue, sleeping disturbances, and financial problems scored relatively high. Generally, in contrast to partners, physicians underestimated symptoms and overestimated functions and quality of life significantly. Conclusions: We conclude that SCT has a long-term impact on such quality of life issues as fatigue, sleep disturbances, dyspnea, and financial problems. Physicians tend to overestimate quality of life in their patients. With the increasing numbers of patients undergoing transplantation, more attention should be focussed on these issues.

Journal Article↗
PubMed2005

Operative salvage for locoregional recurrent colon cancer after curative resection: an analysis of 100 cases.

PURPOSE: Locoregional recurrence after resection of colon carcinoma is an uncommon and difficult clinical problem. Outcome data to guide surgical management are limited. This investigation was undertaken to review our experience with surgical resection for patients with locoregional recurrence colon cancer, determine predictors of respectability, and define prognostic factors associated with survival. PATIENTS AND METHODS: A prospective database was queried for patients who had recurrent colon cancer between January 1991 and October 2002. Patients were selected for analysis if they had either isolated resectable locoregional recurrence or concomitant resectable distant disease. Disease-specific survival analysis was performed with the Kaplan-Meier actuarial method, and factors associated with outcome were determined by the log-rank test and Cox regression. RESULTS: During this period of time, 744 patients with recurrent colon cancer were identified and 100 (13.4 percent) underwent exploration with curative intent for potentially resectable locoregional recurrence: 75 with isolated locoregional recurrence, and 25 with locoregional recurrence and resectable distant disease. The median follow-up for survivors was 27 months. Locoregional recurrence was classified into four categories: anastomotic; mesenteric/nodal; retroperitoneal; and peritoneal. Median survival for all patients was 30 months. Fifty-six patients had an R0 resection (including distant sites). Factors associated with prolonged disease-specific survival included R0 resection (P < 0.001); age <60 years (P < 0.01); early stage of primary disease (P = 0.05); and no associated distant disease (P = 0.03). Poor prognostic factors included more than one site of recurrence (P = 0.05) and involvement of the mesentery/nodal basin (P = 0.03). The ability to obtain an R0 resection was the strongest predictor of outcome, and these patients had a median survival of 66 months. CONCLUSION: Salvage surgery for locoregional recurrence colon cancer is appropriate for select patients. Complete resection is critical to long-term survival and is associated with a single site of recurrence, perianastomotic disease, low presalvage carcinembryonic antigen level, and absence of distant disease.

Adult↗
PubMed2006

MINT: the Molecular INTeraction database.

The Molecular INTeraction database (MINT, http://mint.bio.uniroma2.it/mint/) aims at storing, in a structured format, information about molecular interactions (MIs) by extracting experimental details from work published in peer-reviewed journals. At present the MINT team focuses the curation work on physical interactions between proteins. Genetic or computationally inferred interactions are not included in the database. Over the past four years MINT has undergone extensive revision. The new version of MINT is based on a completely remodeled database structure, which offers more efficient data exploration and analysis, and is characterized by entries with a richer annotation. Over the past few years the number of curated physical interactions has soared to over 95 000. The whole dataset can be freely accessed online in both interactive and batch modes through web-based interfaces and an FTP server. MINT now includes, as an integrated addition, HomoMINT, a database of interactions between human proteins inferred from experiments with ortholog proteins in model organisms (http://mint.bio.uniroma2.it/mint/).

Animals↗
PubMed1998

[Radiotherapy alone in endometrial neoplasms. The authors' own experience].

INTRODUCTION: Adenocarcinoma of the endometrium is the most common invasive genital malignancy in women and the majority of the cases are in stage I (80-85%) at the time of diagnosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is the treatment of choice for most patients with uterine carcinoma. However, a number of women with endometrial cancer cannot undergo surgical treatment because of poor medical conditions. In these patients, who cannot tolerate surgery, radiation therapy is the only effective alternative. It is performed either as external treatment plus intracavitary brachytherapy or as brachytherapy alone. This retrospective study reports our data on survival, complications and local control in a consecutive series of patients treated with curative radiotherapy. MATERIAL AND METHODS: From January, 1985, to December 1995, at the Radiotherapy Department of "Casa Sollievo della Sofferenza" Hospital in San Giovanni Rotondo (Foggia, Italy), 60 patients were treated with combined external beam radiation therapy (ERT) and high-dose-rate intracavitary brachytherapy (HDR-BRT) or with high dose rate intracavitary brachytherapy alone. The average age of patients was 69 years (range 50-90). FIGO stage distribution was: 41 patients in stage I, 11 in stage II and 8 in stage III. The ERT was given by means of 6-8 MV linear accelerator, with conventional technique (with two opposed AP-PA pelvic fields in 15 patients, with the four fields-box technique in 41 patients) and a daily fraction to a total dose of 45-50 Gy. HDR-BRT was delivered by means of an HDR remote afterloading unit, containing a linear source of 192-Iridium (370 Gbq). The dose was specified to Point A in 32 patients and to uterine outline in 26. 2-3 intracavitary insertions (mean dose 6-8 Gy per fraction) were performed with weekly intervals. RESULTS: At the time of the analysis, all the patients were available for follow-up. Median follow-up was 25 months. 60% of patients were alive and well with no evidence of disease; 3.3% were alive with disease; 20% had died of this and 16.7% of other diseases. Five-year actuarial specific survival, obtained with the Kaplan and Meier method, was 77.7% in stage I, 90% in stage II, and 75% in stage III. Local relapses were observed in 14 patients. Complications (grade 2-3) scored with the French-Italian Glossary, were gastrointestinal in 10% of cases and genital in 6.6%. CONCLUSIONS: Radical radiotherapy achieved acceptable specific survival, local control and complications rates in patients with medically or surgically inoperable uterine carcinomas. Complications and survival rates, in our experience, are consistent with the literature data. The treatment is comfortable for the patients, because there is no need for long immobilization and it can frequently be performed on an outpatient basis. Besides, the completely standardized procedure was carried out easily with remote control allowing maximal radiation protection.

Aged↗
PubMed2004

High-efficacy 5-HT1A receptor activation causes a curative-like action on allodynia in rats with spinal cord injury.

The selective, high-efficacy 5-HT(1A) receptor agonist, (3-chloro-4-fluoro-phenyl)-[4-fluoro-4-[[(5-methyl-pyridin-2-ylmethyl)-amino]-methyl]piperidin-1-yl]-methanone (F 13640) has been reported to produce long-term analgesia in rodent models of chronic nociceptive and neuropathic pain; it also preempts allodynia following spinal cord injury. Here, rats underwent spinal cord injury, fully developed allodynia, and were infused with saline or 0.63 mg/day of F 13640 for 56 days. Infusion was then discontinued, and further assessments of allodynia (vocalization threshold to von Frey filament stimulation, responses to brush and cold) were conducted for another 70 days. F 13640-induced analgesia persisted during this post-treatment period. The data offer initial evidence that high-efficacy 5-HT(1A) receptor activation produces an unprecedented curative-like action on pathological pain.

Analgesics↗
PubMed1996

The role of flow cytometric DNA analysis in determining prognosis of resectable ductal adenocarcinoma of the pancreas.

Carcinoma of the pancreas is a leading cause of cancer mortality in the United States. Improvement in prediction of survival is needed. Flow cytometric analysis as a prognostic tool has produced conflicting results. We retrospectively analyzed the clinicopathologic features, operative factors, and outcome of 39 curative resections for ductal adenocarcinoma of the head of the pancreas performed at Indiana University Medical Center between 1989 and 1994. The group was composed of 20 females and 19 males. Procedures performed were Whipple without vagotomy (n = 5), Whipple with vagotomy (n = 19), pylorus-preserving Whipple (n = 12) and total pancreatectomy (n = 3). Thirty-two tumors were suitable for DNA analysis. Of the 32 patients with flow cytometric data, 33 per cent (3/9) of living patients and 39 per cent (9/23) of deceased patients had aneuploid tumors (P = 0.999). The average S-phase for living patients was 8.3 per cent +/- 3.8 per cent, and 16.1 per cent +/- 13.6 per cent for deceased patients (P = 0.115). In the multivariate analysis, only lymphatic invasion (P = 0.015) and alkaline phosphatase level (P = 0.024) predicted poor survival. Our data show no correlation between flow cytometric DNA ploidy, S-phase analysis, and prognosis in patients undergoing curative resection for ductal adenocarcinoma of the pancreatic head.

Adenocarcinoma↗
PubMedDate not supplied

Pancreatic liver metastases after curative resection combined with intraoperative radiation for pancreatic cancer.

BACKGROUND/AIMS: A high proportion of patients even after curative resection for pancreatic cancer suffer from hepatic metastases. The aim of this study was to identify clinicopathological predictors of liver metastases after surgery, retrospectively. METHODOLOGY: Forty-one patients underwent extended radical pancreatectomy combined with intraoperative radiotherapy, which is one of the best local control methods for ductal cell carcinoma of the pancreas. Of the 41 patients, twenty-one patients regarded as being in a cancer free state after this combined therapy were studied to analyze clinicopathological predictors of hepatic metastases. Odds ratios and their 95% confidence intervals were calculated from data using logistic regression analysis. Statistical difference was considered significant at p<0.05. RESULTS: Liver metastases after curative resection occurred in 11 patients. Preoperative biliary drainage, jaundice, elevated preoperative serum tumor-associated carbohydrate antigens levels, microscopic distal bile duct invasion, duodenal wall invasion, extrapancreatic nerve plexuses invasion were factors influencing postoperative liver metastases. CONCLUSIONS: We found clinicopathological predictors of postoperative liver metastases. Patients with these factors require consideration in careful follow-up and perioperative adjuvant therapy for prevention of postoperative liver metastases.

Adult↗