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PubMed2005

Analyzing patterns of staining in immunohistochemical studies: application to a study of prostate cancer recurrence.

BACKGROUND: Immunohistochemical studies use antibodies to stain tissues with the goal of quantifying protein expression. However, protein expression is often heterogeneous resulting in variable degrees and patterns of staining. This problem is particularly acute in prostate cancer, where tumors are infiltrative and heterogeneous in nature. In this article, we introduce analytic approaches that explicitly consider both the frequency and intensity of tissue staining. METHODS: Compositional data analysis is a technique used to analyze vectors of unit-sum proportions, such as those obtained from soil sample studies or species abundance surveys. We summarized specimen staining patterns by the proportion of cells staining at mild, moderate, and intense levels and used compositional data analysis to summarize and compare the resulting staining profiles. RESULTS: In a study of Syndecan-1 staining patterns among 44 localized prostate cancer cases with Gleason score 7 disease, compositional data analysis did not detect a statistically significant difference between the staining patterns in recurrent (n = 22) versus nonrecurrent (n = 22) patients. Results indicated only modest increases in the proportion of cells staining at a moderate intensity in the recurrent group. In contrast, an analysis that compared quantitative scores across groups indicated a (borderline) significant increase in staining in the recurrent group (P = 0.05, t test). CONCLUSIONS: Compositional data analysis offers a novel analytic approach for immunohistochemical studies, providing greater insight into differences in staining patterns between groups, but possibly lower statistical power than existing, score-based methods. When appropriate, we recommend conducting a compositional data analysis in addition to a standard score-based analysis.

Biomarkers, Tumor↗
PubMed2000

Predicting outcome of angioplasty and selective stenting of multisegment iliac artery occlusive disease.

BACKGROUND: Patients who require angioplasty and stenting of multiple iliac arterial segments often require reintervention to maintain long-term patency. Morphologic predictors and causes of failure are unknown. The purpose of the current study was to define arteriographic predictors of angioplasty and selective stent failure in the treatment of multisegment iliac occlusive disease. METHODS: All iliac segments (two common and two external) of 75 patients who underwent angioplasty and selective stent placement for multisegment iliac occlusive disease (>/= two segments) were scored through use of a modification of the Society of Cardiovascular and Interventional Radiology classification for iliac angioplasty (0 = no lesion; 4 = most severe). Total iliac score was calculated by summing scores from each segment. A separate external iliac score was calculated by adding only the external iliac scores. Arteriograms were reviewed initially and at the time of lesion recurrence and stratified by lesion location and previous intervention. RESULTS: The area of previous endovascular intervention was the site of recurrence in 75% of patients. New lesions, presumably a result of progressive atherosclerosis, occurred in 15% of patients, and lesions occurred in both new and previously treated iliac segments in 10% of patients. Only the external iliac score was an independent predictor of failed endovascular therapy despite reintervention. For patients with an external iliac score of 2 or less, the endovascular primary-assisted patency rates at 6, 12, and 24 months were 96%, 92%, and 89%, respectively. This was improved in comparison with the 90%, 63%, and 45% patency rates observed in patients with an external iliac score of 3 or more (P =.001). Patients with an external iliac score of 3 or more had a significantly lower incidence of hemodynamic and clinical improvement after intervention and a threefold higher need for surgical inflow procedures than patients with an external iliac score of 2 or less. CONCLUSIONS: Lesion formation after treatment of multisegment iliac occlusive disease typically occurs in areas of prior intervention. The extent of external iliac disease can be used to stratify patients with multisegment iliac occlusive disease who will likely respond to endovascular treatment with a durable result. Patients with extensive external iliac disease (score >/= 3) have poor results after angioplasty and selective stenting as applied in this study, even with endovascular reintervention. They are ideal subjects for prospective comparative studies of competing initial therapies, including stenting, endografting, and aortobifemoral bypass grafting.

Aged↗
PubMed2004

The direct closure of the internal fistula opening without advancement flap for transsphincteric fistulas-in-ano.

PURPOSE: The recommended closure techniques for transsphincteric fistulas demonstrate divergent results for postoperative continence and recurrence rates. An incontinence rate of 35 percent and a recurrence rate of up to 54 percent has been reported after transanal advancement techniques. The authors hypothesize that a direct closure of the internal fistula opening without tissue mobilization is easier to facilitate and generally leads to better clinical and functional results. METHODS: A prospective, observational study between 1995 and 1999 was undertaken in 90 patients with transsphincteric fistulas. A direct closure of the internal fistula opening without a flap was performed in all patients. A three-layer, nonstaggered closure of mucosa, submucosa, internal, and external anal sphincters was performed. The follow-up time periods ranged from one-half to six (median, 2.6) years and included assessment of fistula recurrence and continence using patients' histories, physical examinations, proctoscopy, and continence scores. Statistical analysis was performed using Student's t-test or chi-squared test. RESULTS: Data from 90 patients with a total of 106 operations were analyzed (65 males and 41 females; average age 46 (range, 22-78) years). Sixty-six patients had previous anorectal abscess surgery, and 41 had a previous fistula operation. The mean number of previous fistula operations was 1.7. All patients were continent before surgery. Mean elapsed operative time period was 37 +/- 11 minutes, and the mean anal retraction time was 20 +/- 7 minutes. Suture line dehiscence was the main postoperative complication. It was found to occur between the fourth and tenth postoperative days in 15 patients (14 percent). In 12 of 15 patients (80 percent), the fistula persisted and operative treatment was necessary. In three patients (20 percent), spontaneous closure took place. A recurrent fistula after wound healing was observed in seven patients (6.6 percent). The risk of developing a suture line dehiscence leading to a persistent fistula or a recurrent fistula was 22.5 percent. Ninety-four percent of the patients were continent (continence score 0), 6 percent had a minimal disorder of continence (score 4). A continence level for all patients was determined by the international classification of continence disorders. CONCLUSIONS: Direct closure for the treatment of transsphincteric fistulas is a safe and effective approach and achieves a good functional outcome; a small risk of suture line dehiscence, which may lead to a recurrent or persistent fistula, remains.

Adult↗
PubMed2003

Genome-wide linkage survey for genetic loci that influence the development of depressive disorders in families with recurrent, early-onset, major depression.

In this report, we describe the results of the first genome-wide linkage survey for genetic loci that influence the development of unipolar Mood Disorders in 81 families identified by individuals with Recurrent, Early-Onset, Major Depressive Disorder (RE-MDD). Model-free linkage analysis was performed using genotypes for 392 highly informative polymorphisms with an average spacing of 9 cM. The highest maximum LOD score observed, 8.19 (genome-wide adjusted P << 0.0001), occurred for Recurrent Major Depressive Disorder (R-MDD) at D2S2321 (205 cM), located 121 kb proximal to CREB1. Nineteen chromosomal regions contained linkage peaks that reached genome-wide statistical significance (genome-wide adjusted P < 0.05) and ten of these were "highly significant" (adjusted P < 0.001). Six of the 19 linkage peaks were revealed only when the analysis included covariates to control for the effects of sex and linkage to CREB1. Sex-specific susceptibility loci were common and preferentially affected the vulnerability of women to developing unipolar Mood Disorders. Five loci revealed evidence of interaction with the CREB1 locus in determining susceptibility (epistasis). A systematic candidate gene analysis is presented and potential overlaps of the linkage regions for unipolar Mood Disorders with those reported for other psychiatric disorders are discussed. The findings suggest that genes whose products participate in cellular signaling pathways that converge on CREB, as well as the target genes whose expression they regulate, may also harbor alleles that affect the development of Mood Disorders and related conditions.

Chromosome Mapping↗
PubMed2005

Gleason grade remains an important prognostic predictor in men diagnosed with prostate cancer while on finasteride therapy.

OBJECTIVE: To evaluate men treated with finasteride for lower urinary tract symptoms, who subsequently were diagnosed with prostate cancer and had a radical prostatectomy (RP) at our institution, to determine if finasteride therapy prevented accurate Gleason grade assignment and prediction of biochemical recurrence. PATIENTS AND METHODS: Between May 1996 and July 2003, 45 men were identified who had RP and had previously been treated with finasteride for > or = 6 months before the diagnosis of prostate cancer. Clinical and pathological information was gathered from a RP database. Serum prostate-specific antigen (PSA) level, duration of finasteride therapy, biopsy Gleason grade, clinical stage, RP Gleason grade and pathological stage were reviewed. Freedom from recurrence was predicted using validated nomograms before and after RP, and compared against actuarial 5-year freedom from recurrence using the Kaplan-Meier method. RESULTS The mean duration of finasteride therapy before diagnosis was 23.6 months, the mean serum PSA (doubled to account for finasteride use) 11.02 ng/mL and mean biopsy Gleason score 6. When comparing the biopsy and RP specimen Gleason score, it was downgraded by 1 point in six men, upgraded by 1 point in eight, and upgraded by 2 points in one. The Gleason score was constant in 30 patients. The nomograms predicted freedom from recurrence in 83% and 85%, respectively; the 5-year actuarial freedom from recurrence was 86%. CONCLUSION: Finasteride does not appear to compromise the assignment of Gleason grade for use in prediction tools before or after RP in men undergoing prostate biopsy or RP. The actuarial 5-year freedom from recurrence was similar to that predicted by the validated nomograms. Gleason grade remains an important prognostic predictor in men treated with finasteride and undergoing RP for clinically localized prostate cancer.

Enzyme Inhibitors↗
PubMed1994

Predicting falls: the role of mobility and nonphysical factors.

OBJECTIVE: Our purpose was to test a four-domain predictive model of recurrent falls developed for this study. In this model, limited mobility is considered a necessary but not sufficient element in risk of recurrent falls. Three other domains, attitudinal, social, and environmental, are proposed to influence fall risk only in persons with impaired mobility. DESIGN: Prospective cohort study. SETTING: Veterans Affairs Ambulatory Care Service serving rural and urban central North Carolina. SUBJECTS: Male Veterans aged 70 or older (n = 306) were monitored prospectively for falls. At baseline, 159 screened as high-risk mobility status and 147 as low-risk mobility status. MEASUREMENTS: The primary outcome was recurrent falls. The mobility screen used for risk assignment defined immobile as unable to sit without support for 60 seconds, mobile and stable as meeting criteria for normal ambulation and stair climbing, and mobile but unstable as those who met neither of the above criteria. The high-risk subjects were further assessed in their homes for mobility in more detail, attitude toward risk, social supports, and environmental status. Other data included demographics, functional status, diagnoses, and medications. RESULTS: Recurrent falls occurred in 37 (23.3%) high-risk subjects and seven (4.8%) low-risk subjects (relative risk = 4.8, confidence interval 2.5 to 9.6, P < 0.001). Within the high-risk group, the probability of recurrent falls was significantly affected by degree of impaired mobility (P < 0.001), attitude toward risk (P = 0.005), and environment score (P = 0.03). CONCLUSIONS: A simple mobility screen can identify elders at increased risk for recurrent falls. Risk within this group is further modified by risk-taking behavior and environment.

Accidental Falls↗
PubMed2005

Recurrent lumbar disc herniation after discectomy: outcome of repeat discectomy.

BACKGROUND: Recurrent disc herniation after discectomy is relatively lacking in specific studies and is usually reviewed along with other causes of failed disc surgery. The purpose of the current study was to address the outcome in the patients who had recurrent disc herniation treated with repeat discectomy and to identify the factors that may influence the outcome. METHODS: Thirty-nine patients who underwent repeat discectomy for recurrent lumbar disc herniation were retrospectively analyzed. Of these patients, 27 had recurrent disc herniation at the L4 to L5 level, 11 at the L5 to S1, and 1 at the L3 to L4. They almost had the typical presentation of sciatica. The time from prior discectomy to that of recurrence ranged 6 months to 17 years (average, 5 years and 4 months). The Japanese Orthopaedic Association (JOA) score averaged 12 (range, -3 to 18). All patients had a follow-up evaluation at 1 and 15 years (average, 7 years and 8 months) after surgery. RESULTS: Their JOA score increased to 12 to 29 (average, 24), with the recovery rate of 29% to 100% (average, 72%). Twenty-nine patients returned to their previous work status or normal daily activity, 7 had significant improvement, and 3 needed analgesic drugs although they had pain relief to different degrees. CONCLUSIONS: The outcomes of repeat discectomy for recurrent disc herniation were satisfactory. No factors such as age, sex, traumatic events, times of prior surgery, level of herniation, side of recurrence, pain-free interval, duration of recurrence symptoms, walking capacity, the preoperative JOA score, associated spinal stenosis, procedures of revision surgery, and dural tear were found to be of predictive value for a prognosis of revision surgery for recurrent disc herniation (P>.05).

Adult↗
PubMed2001

Patients' perspectives on the burden of recurrent genital herpes.

The purpose of this study was to quantify the impact of recurrent genital herpes (RGH) on health-related quality of life, healthcare resource and workplace productivity. This was a cross-sectional survey conducted in 5 countries (Australia, Denmark, Italy, The Netherlands and UK). Patients with a confirmed history of RGH completed the MOS 36-Item Short Form Health Survey (SF-36) and the Recurrent Genital Herpes Quality of Life questionnaire (RGHQoL). Questionnaires addressing frequency of access to healthcare services and workplace productivity were also completed and patients' medical history was obtained. Scores for 6 of the 8 domains of the SF-36 were significantly lower (P<0.001) i.e. worse, compared with scores for the normal population. The RGHQoL score was significantly lower in patients experiencing more frequent or more severe recurrences. Forty-five per cent of patients estimated that their work effectiveness was reduced by between 25% and 50% due to genital herpes symptoms.

Adolescent↗
PubMedDate not supplied

Postoperative outcome of intracranial meningiomas; long-term prognosis.

A retro- and prospective study was carried out in 150 patients who underwent surgery for benign (grade I) intracranial meningiomas (ICM). The mean duration of the follow-up was of 4 years. The subjects were divided into 4 groups according to the intervals of follow-up examination. The following variables were analysed: preoperative (clinical and paraclinical diagnosis), operative (macroscopic investigation) and postoperative (complications, sequelae, recurrences). The data were statistically processed. Conclusions are drawn concerning early results as well as predictors of long-term prognosis. Immediate improvement of the neurological and mental status was noted in 51% of patients. Late favourable outcome was found in only 35% of patients, demonstrating a tendency of late worsening. Postoperative morbidity includes complications (21%), sequelae (32%) and recurrence (22%). Predictor criteria in operated ICM patients are: onset type of illness, preoperative score, tumor location, edema and excessive vascularization of the brain as inspected at operation, early and late sequelae. Histological predictors for recurrence are: nuclear pleiomorphism, cellular mitoses, cell agglomerations. The frequency of recurrence, regardless of the operative technique, demonstrates the tendency toward malignancy of many of these tumors.

Adult↗
PubMed1998

Evaluation and management of the man who has failed primary curative therapy for prostate cancer.

The recurrence of prostate cancer after potentially curative local therapy is becoming a significant urologic problem. There are few prospective randomized trials, and the optimal diagnostic and treatment strategies for men who fail potentially curative therapy are not known. The experience to date seems to suggest the following as a reasonable approach. A detectable serum PSA level (> or = 0.4 ng/mL) after radical prostatectomy is evidence of residual or recurrent prostate cancer. Men with low- or moderate-grade cancers (Gleason score < 7), with capsular penetration, or with positive surgical margins in whom disease recurs more than 2 years after radical prostatectomy with a PSA doubling time greater than 12 months seem likely to harbor a local recurrence and are the only good candidates for salvage therapy. Unless there is a palpable recurrence, transrectal ultrasound and biopsy are generally not recommended, and CT scanning and bone scintigraphy usually do not provide helpful information. The role of monoclonal antibody scanning is currently investigational. Men with high-grade tumors (Gleason score > or = 7) or with seminal vesicle or lymph node involvement in whom disease recurs within 2 years of radical prostatectomy are most appropriately observed or treated with early hormonal therapy. Men who do not achieve a PSA nadir of 0.5 ng/mL or less within 2 years of radiotherapy are very likely to harbor residual disease. For young healthy men who are willing to accept a substantial risk of impotency, urinary incontinence, and bladder neck contractures, salvage radical prostatectomy is a reasonable option if the preradiation tumor characteristics are acceptable (PSA < 10 ng/mL, Gleason score < or = 6) and if the current PSA is less than 10 ng/mL. Salvage cryotherapy may result in substantial morbidity and should only be offered on an investigational basis. Other men failing radiation may be observed or treated with hormonal therapy. There is seldom a role for repeat biopsy. Because the optimal time to begin hormone therapy is still not known, early or delayed treatment are both reasonable options. Testicular androgen ablation by orchiectomy or LHRH agonists is considered standard therapy. Combined therapy with an antiandrogen does not seem to be beneficial for all patients and should not be routinely used. Sexually active men in whom preservation of potency is important can be offered an investigational regimen such as a 5-alpha-reductase inhibitor combined with an oral antiandrogen or intermittent LHRH agonist therapy. It is hoped that the results of ongoing randomized trials and future research will establish efficient and effective practice guidelines to evaluate and treat men who have failed potentially curative therapy for localized prostate cancer. This remains a very important and controversial topic that will challenge many practicing urologists.

Cryotherapy↗
PubMed2002

Continued multicenter followup of cadaveric prolapse repair with sling.

PURPOSE: Since our initial description of the technique of combining a transvaginal sling with a cystocele repair using solvent dehydrated cadaveric fascia lata and bone anchors we have continued to follow our outcomes closely to determine long-term results. We present the updated, multicenter results of the cadaveric prolapse repair with sling. MATERIALS AND METHODS: A total of 172 patients 35 to 90 years old (mean age 62.1) have undergone cadaveric prolapse repair with sling with a mean followup of 12.4 months (range 6 to 28). Of these patients 132 (76.7%) completed followup. Repair was performed for grade 2 cystoceles in 73 cases, grade 3 cystoceles in 43 and grade 4 cystoceles in 16. Followup included physical examination (degree of pelvic prolapse), SEAPI scores, complications, patient reported continence, perceived improvement and satisfaction. The latter 2 parameters were obtained using a validated questionnaire. RESULTS: Of the 132 patients 15 (11.4%) had grade 1 and 2 (1.5%) had grade 2 cystocele recurrence, which required no further treatment, and 13 (9.8%) had recurrent or de novo apical vaginal prolapse. Preoperative and postoperative SEAPI scores were 5.58 and 0.9, respectively (p <0.001). A total of 90 patients (68.2%) do not use any pads for protection. Of the 132 patients 24 (18.2%) have stress incontinence of any degree, including 14 (10.6%) with pure stress urinary incontinence, 8 (6.0%) report de novo urge incontinence, 26 (19.7%) have persistent urge incontinence, 21 (15.9%) have any degree of urgency without urge incontinence, 28 (21.2%) report resolution of preoperative urgency or urge incontinence symptoms, 7 (5.3%) have mixed incontinence and 1 had prolonged urinary retention requiring urethrolysis. There has been 1 case of osteitis pubis and no osteomyelitis. Of the patients 94 (71.2%) reported greater than or equal to 70% subjective improvement overall, including 12 who were dry preoperatively, 99 (75.0%) were greater than or equal to 70% satisfied, 105 (79.9%) would repeat the surgery and 102 (77.4%) would recommend the surgery to a friend. With regard to continence 31 (23.8%) patients were less than or equal to 50% improved. A total of 108 (81.8%) patients have no stress urinary incontinence, and patient improvement, satisfaction and complication rates have been acceptable. We have been particularly impressed by the results of the cystocele repair. Surgeons must consider that patient perceived improvement and satisfaction level are essential components of the measure of success or failure of a given therapy. CONCLUSIONS: With a maximum of 28 months of followup of the cadaveric prolapse repair with sling procedure, we continue to be satisfied with the success of the cystocele repair and the competitive stress urinary incontinence cure rate.

Adult↗
PubMed2005

[Clinical study on intervention of liuwei dihuang pill on hormonotherapy in treating nephrotic syndrome].

OBJECTIVE: To observe the intervention of liuwei dihuang pill (LDP) on therapeutic effectiveness and adverse reaction of hormonotherapy in treating nephrotic syndrome. METHODS: Patients allocated in two groups were medicated with initial dose of prednisone 1 mg/kg once a day at 8 am in the morning. After being medicated for 8 to 12 weeks, the dose of prednisone was decreased by 5.0 mg every 2 weeks till 0.5 mg/kg per day. Then the medication was changed to that two days' dosage orally take once a day with the daily dose reduced by 5.0 mg/kg every 2 to 3 weeks, and maintained at 0.4 mg/kg once every two days. At same time, necessary symptomatic treatment was given. To the treated group oral administration of LDP 8 capsules was given additionally, 3 times per day until prednisone decreased to maintenance dose. RESULTS: Therapeutic effect in the treated group was significant better than that in the control group (P < 0.05). Urinary protein, plasma albumin, triglyceride (TG) and total cholesterol (TC) in both groups were obviously improved (P < 0.05 or P < 0.01). However, as compared with the control group, the improvement was better, and the recurrent rate was lower (P < 0.05) in the treated group. Scores of Yin-deficiency caused excessive Fire syndrome and incidence rate of adverse reaction in the treated group were lower than those in the control group (P < 0.05 or P < 0.01). CONCLUSION: LDP can markedly improve the therapeutic effectiveness and counteract the adverse reaction of hormonotherapy in treating nephrotic syndrome, and reduce the recurrence of the disease.

Adolescent↗
PubMed2002

Managing patients with papillary thyroid carcinoma: insights gained from the Mayo Clinic's experience of treating 2,512 consecutive patients during 1940 through 2000.

2,512 consecutive patients with papillary thyroid carcinoma (PTC) were managed during 1940 through 2000 at the Mayo Clinic. During that period, there were two significant therapeutic trends. The first was a change in surgical practice during 1940-69 from an initial unilateral lobectomy (UL) to a bilateral lobar resection (BLR). The second was the increasing use since 1970 of I-131 for radioactive-iodine remnant ablation (RRA). The advent of BLR resulted in significantly improved tumor recurrence (TR) rates in both low-risk (MACIS scores < 6) and high-risk (MACIS scores 6+) patients, and also reduced cause-specific mortality (CSM) in high-risk patients. By contrast, RRA did not significantly improve the outcome (either CSM or TR) in low-risk (MACIS < 6) patients previously treated with initial near-total or total thyroidectomy. These data encourage a more selective use of I-131 in PTC management and do not lend support to the current widespread use of RRA in low-risk PTC.

Carcinoma, Papillary↗
PubMed2007

Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years.

The present study was conducted to review the long-term results of femoral varus osteotomy with/without pelvic osteotomy of spastic cerebral palsy. We also evaluated the spastic hip score with following factors: migration index of Reimer's, Shenton's line, shape of the femoral head, shape of the roof of the acetabulum, and presence of windblown effect. Of the 31 children (61 hips) reviewed, 49 hips (80%) had satisfactory outcomes after 10 years of follow-up. Twelve hips showed unsatisfactory outcomes with recurrent dislocation or significant osteoarthritis. A low preoperative spastic hip score was more indicative of a better outcome.

Adolescent↗
PubMed1980

Recurrent dislocation of the shoulder after age fifty.

Recurrent dislocation of the shoulder is infrequent in patients over the age of 50. In a small group of 6 patients with an average age of 64 years and multiple recurrences, 4 subsequently were treated by anterior capsulorraphy (Bankart). There was an unusual degree of loose jointedness in all 6 cases. When compared with a group of patients under the age of 30 with recurrent dislocation of the shoulder, the older group was functionally rated 19.4 out of a possible score of 25 points, compared with a rating of 10.8 in the younger group. In the older population, recurrent dislocation may become a problem if the patient is loose-jointed. Immobilization for 3 to 4 weeks may not be helpful in this group of patients. Anterior capsulorraphy is as successful as in younger patients and is not followed by unusual joint stiffness.

Age Factors↗
PubMed2003

Ten-year survival after radical prostatectomy: specimen Gleason score is the predictor in organ-confined prostate cancer.

Pathologic stage is a major prognostic factor in patients with clinically localized prostate cancer. However, disease recurrence occurs even in patients with organ-confined disease. With the advent of prostate-specific antigen (PSA) testing, the percentage of patients with pathologically organ-confined tumors has increased significantly. We studied clinical/pathologic factors that will predict disease recurrence in patients with pathologically organ-confined tumors. Patients with clinically localized newly diagnosed prostate cancer who had not received prior therapeutic intervention but who underwent radical prostatectomy as definitive treatment between 1990 and 1999, were included in this study. Clinical/pathologic parameters including age, race, clinical stage, preoperative PSA, and biopsy and specimen Gleason scores (grouped as 2-6, 7, and 8-10) were correlated with disease-free survival in patients with organ-confined disease. Metastasis-free and cancer-specific survival for the cohort was also assessed. A total of 1045 patients fulfilled our inclusion criteria. Overall, the 10-year estimates of PSA progression-free, metastasis-free, and cancer-specific survival were 75%, 91%, and 92%, respectively. Cancer was confined to the prostate in 532 of 1045 patients (51%), of whom 96% (511 of 532) remain PSA progression-free, compared to 65% (335 of 513) with extraprostatic disease (P = 0.0001). Interestingly, in patients with organ-confined disease, the specimen Gleason score was the only prognostic factor for disease recurrence after multivariable analysis. Radical prostatectomy provided excellent cancer control. For patients with pathologically organ-confined tumors, the specimen Gleason score is the only factor predictive of disease-free survival. Of note, Gleason scores of 8-10 are uncommon in these patients.

Disease-Free Survival↗
PubMed2004

How appropriate is the OM6 as a discriminative instrument in children with otitis media?

BACKGROUND: The OM6 is a 6-item condition-specific handicap measure developed in the United States for children with recurrent acute otitis media and otitis media with effusion. Easy and quick to use, it has high test-retest repeatability and is sensitive to change after ventilation tube insertion. OBJECTIVES: To explore aspects of the validity of OM6 in a United Kingdom population and to specifically address the instrument's ability to discriminate between children with different burdens of disease. DESIGN: The parents of 179 consecutive newly referred children with otitis media with effusion or recurrent acute otitis media completed the OM6 on their first visit to the hospital. The parents of 72 children with sore throats completed the OM6 for comparison. Scores were compared with markers of disease severity, demographic variables, and generic quality-of-life measures. RESULTS: Poorer scores were found in those with ear complaints than in those with sore throats. The OM6 scores were not associated with age, sex, socioeconomic class, or respondent (mother vs father). The OM6 scores did not correlate with frequency of otalgia, frequency of otorrhea, or time off school in the recurrent acute otitis media group. In the otitis media with effusion group, poorer scores were associated with bilateral B or C2 tympanometric findings but not with a better ear threshold of more than 20 dB. Correlation with a global 10-cm visual analog scale for quality of life and with the Health Utilities Index Mark III was good. CONCLUSIONS: The OM6 scores correlate well with global quality-of-life measures and are free from many potential biases. However, OM6 does not adequately reflect disease severity, which may limit its usefulness as a discriminative measure.

Acute Disease↗
PubMed2006

Is prostate-specific antigen (PSA) density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy?

OBJECTIVE: To investigate the relationship of preoperative prostate-specific antigen (PSA) level and PSA density with several clinical and pathological variables, including biochemical recurrence after radical prostatectomy (RP), and to compare the preoperative PSA level and PSA density as prognostic factors in prostate cancer. PATIENTS AND METHODS: The study included 348 patients who had a RP at one institution, with whole-mount specimens of the prostate examined by one pathologist. Univariate and multivariate analyses were used to assess the relationship of the preoperative PSA level and PSA density with clinical and pathological variables, and by receiver operating characteristic (ROC) analysis to evaluate the relative usefulness of the two factors as predictors for biochemical recurrence. RESULTS: The PSA level before RP was significantly correlated (Spearman's rank correlation) with patient age (P = 0.003), prostate weight (P < 0.001), cancer volume (P < 0.001) and Gleason score (P = 0.033), and with surgical margin status and pathological stage (both P < 0.001) in the RP specimen. In the multivariate analysis controlling for tumour stage, surgical margin status, and Gleason score, both PSA level and PSA density were significant predictors of PSA recurrence (P = 0.027 and 0.01, respectively). ROC analysis showed no statistical difference between the PSA level and PSA density in predicting PSA recurrence after RP (P = 0.40). CONCLUSIONS: These results show a significant correlation of the preoperative PSA level with other established prognostic factors for prostate cancer. In the multivariate analysis, both PSA level and PSA density were independent predictors of PSA recurrence. Because the PSA level is as effective as PSA density in predicting PSA recurrence, the extra effort required to calculate PSA density may not be warranted. We recommend that the PSA level before RP be considered in stratifying patients into different prognostic groups, and in determining the optimum management.

Adult↗