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PubMedDate not supplied

The Belsey Mark IV antireflux procedure: indications and long-term results.

UNLABELLED: From 1977 to 1990, a Belsey Mark IV antireflux procedure was performed in 177 patients. The primary indication was gastro-oesophageal reflux (GOR) resistant to medical treatment in all but 5 patients presenting themselves with a complicated para-oesophageal hernia. Ninety-eight patients (53.5%) had some form of additional pathology or complication: grade III oesophagitis: 26, grade IV: 6, Barrett's oesophagus: 38, reintervention: 14, concomitant duodenal ulcer requiring highly selective vagotomy: 14, bleeding: 23, small benign tumours: 2. There was one postoperative and one late mortality. At one year an objective evaluation was made in all patients operated on since this interval (N = 147), consisting in endoscopy: 121, Barium-swallow: 113, 24 hour oesophageal pH-monitoring: 81, manometry: 69. A recurrence was documented in 11 patients (7.4%). The mean follow-up of these 147 patients is 4.4 years with a range from 1 to 13 years. Over the entire follow-up period 17 patients (11.5%) had symptoms suggestive of recurrent reflux. Subjective and objective recurrence rate was 13%. Undesired gastrointestinal side effect were seen in 13 patients (8.8%), whereas post-thoracotomy pain was equally noticed in 13 patients (8.8%). The final score combining recurrence rate and side effects showed excellent to very good results in 77.5% of the patients, good results in 7.5% and bad results in 15%. CONCLUSION: Candidates for surgical treatment of GOR often present themselves with a variety of reflux related complications or additional pathology. Long term follow-up shows good reflux control in 87% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Value of the Van Nuys Prognostic Index in prediction of recurrence of ductal carcinoma in situ after breast-conserving surgery.

BACKGROUND: The Van Nuys Prognostic Index (VNPI), an algorithm based on tumour size, tumour grade, presence of necrosis and excision margin width, is claimed to predict local recurrence after breast-conserving surgery for ductal carcinoma in situ (DCIS). The aim of this study was to examine the validity of the VNPI in a UK population. METHODS: Clinicopathological data, including VNPI subgroups, for 237 patients who had breast-conserving operations for DCIS were examined. Multivariate data analysis was performed using a Cox regression model to examine the independence and relative importance of different variables in predicting recurrence, and to compare the data with those used in derivation of the VNPI. RESULTS: The median follow-up was 47 months. There were 37 ipsilateral local recurrences. Excision margin width (P < 0.001) and tumour grade (by Van Nuys grading (P = 0.014) or simple nuclear grading (P = 0.004)) were the only independent risk factors for local recurrence. Excision margin width had three times more power than grade in predicting local recurrence. Subgrouping data by VNPI score predicted recurrence-free survival (P < 0.001), but stratified 78 per cent of patients into a group with a moderate risk of local recurrence. CONCLUSION: Excision margin width is the most important predictor of local recurrence after breast-conserving surgery for DCIS. The VNPI lacked discriminatory power for guiding further patient management.

Adult↗
PubMed2000

[Multicenter prospective study of prognostic factors of gastroduodenal ulcer hemorrhages. Reevaluation of clinical and endoscopic factors in the era of endoscopic hemostasis].

AIM: To evaluate in a prospective study the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk peptic ulcer bleeding routinely treated by endoscopic hemostasis. PATIENTS AND METHODS: A multicenter study was carried out in 8 Western French hospitals in 144 patients with gastrointestinal bleeding peptic from ulcer type I or IIa, b as defined by Forrest classification. Thirty four and 38 parameters were studied respectively in order to predict recurrent bleeding and death. Significant predictive factors (P < 0.1) in univariate analysis were entered in a multivariate logistic regression analysis. RESULTS: Endoscopic hemostasis was performed in 108 of 144 cases (75%). Recurrent bleeding and death occurred in 39 (28%) and 22 cases (15%), respectively. By multivariate analysis, the only predictor of rebleeding was hypovolemia at admission. Predictors of death were ASA score, cardiovascular Goldman score and recurrent bleeding. In this study, prevalence of Helicobacter pylori infection was low (41%) but was not a predictive factor. CONCLUSIONS: In a selected population of peptic ulcer bleeding patients with high risk of rebleeding, prevalence of recurrent bleeding and death remains rather high, despite routine endoscopic hemostasis. In the era of endoscopic hemostasis, clinical parameters remain the best prognostic factors of peptic ulcer bleeding outcome.

Aged↗
PubMed2003

Comparison of generic health survey SF-36 and arrhythmia related symptom severity check list in relation to post-therapy AF recurrence.

AIM: The effect of applied therapy on quality of life (QoL) in patients with atrial fibrillation (AF) was investigated in recent studies. However, no information on clinical relevance of QoL assessing instruments in relation to post-ablation recurrence of AF is currently available. The aim of this study was to evaluate the clinical relevance of SF-36 and Arrhythmia Related Symptom Severity Check List (SSCL) to post-procedure AF recurrences in patients with paroxysmal AF undergoing pulmonary vein isolation (PVI). METHODS AND RESULTS: Sixty consecutive patients with AF were enroled in the study. The QoL was measured using SF-36 scale and SSCL. The questionnaires were administered at baseline then 3, 6, 9 and 12 months after the procedure. In order to define statistical power in relation to AF recurrence the scores were dichotomized. Positive and negative predictive accuracy (PPA, NPA) and test efficiency (sum of PPA and NPA) were calculated. Twenty-one out of 60 patients experienced a total of 66 recurrences of AF during follow-up. The parameters of SF-36 provided maximum test efficiency of 1.36, whereas the test efficiency of SSCL was 1.79. CONCLUSION: We conclude that SSCL is more specific instrument for a measurement of PVI success or failure.

Atrial Fibrillation↗
PubMed2001

[Treatment of ASS-Associated Polyposis (ASSAP) with a cysteinyl leukotriene receptor antagonist - a prospective drug study on its antiinflammatory effects].

BACKGROUND: In a high rate of cases with recurrent polyposis an association with ASS-intolerance is detectable despite missing pulmonary symptoms. New examinations of a disturbed arachidonic acid metabolism lead to the development of new therapeutical options. Treatment with leukotriene-receptor antogonists (LTA) showed primarily good results in therapy of ASS-associated asthma. METHODS: 18 patients with ASS-intolerance trias - diagnosed by oral provocation - were treated with the LTA Montelukast, after undergoing sinus surgery. Patients underwent a diagnostic pathway of provocation including four groups: recurrent chronic sinusitis, excessive polyposis, polyposis associated with asthma and anaphylactic symptoms after oral ASS-intake. Clinically we examined the following parameters periodically after sinus surgery: nasal and pulmonal symptoms by scoring levels, recurrency of polypoid hyperplasia by endoscopic follow-ups and serum ECP-levels. To evaluate antiinflammatory tissue effects of LTA EG1/EG2 labelled cells and cytokine levels of Interleukin 5 in mucosa samples of the lower turbinate were analysed under LTA-therapy. RESULTS: Under therapy with LTA we saw a beneficial effect on nasal and pulmonary symptoms and a significant reduction of recurrent polyposis in endoscopic examinations in relation to the untreated group. Results were proven by a permanent reduction of serum ECP-level. A reduction of the rate of EG2-positive cells according to decreased Interleukin 5 levels in the nasal mucosa unter LTA-treatment assumed antiinflammatory effects on ASS-associated polyposis. CONCLUSIONS: We could demonstrate antiinflammatory effects of Leukotriene-Receptor-Antagonists primarily during postoperative treatment of patients with ASS-associated nasal polyps.

Acetates↗
PubMed1998

What is the value of hospitalisation in antepartum haemorrhage of uncertain origin?

This retrospective analysis was designed to determine the need for hospitalisation in cases of antepartum haemorrhage of uncertain origin (AUO). All the cases of AUO that presented at the Chelsea and Westminster Hospital from February 1993 to December 1995 were analysed. AUO accounted for 72% of cases of antepartum, haemorrhage Hospitalisation of the cases of AUO conferred no benefit in terms of gestation at delivery, birth weight centile, 5 minutes Apgar score and recurrent haemorrhage. Also, the duration of stay in hospital was not significantly related to the gestation at delivery ( r = 0.084, P > 0.05), the birth weight centile ( r = 0.032, P > 0.05) or the Apgar score at 5 minutes ( r = 0.062, P > 0.05). We conclude that it is not necessary to hospitalise women with AUO in the absence of heavy or repeated bleeding, evidence of fetal or maternal compromise on any suggestion of the onset of labour.

Journal Article↗
PubMed2000

Utility assessment for different clinical phases of breast cancer in Taiwan.

BACKGROUND AND PURPOSE: Utility is an important index of health-related quality of life (HRQoL). The purpose of this study was to assess utility in different clinical phases of breast cancer in patients in Taiwan. METHODS: Based on a review of HRQoL literature pertaining to breast cancer and medical records of 979 breast cancer patients admitted to National Taiwan University Hospital from 1991 to 1995, a semi-open checklist describing the diagnosis and treatment activities and impacts of different clinical phases of breast cancer was constructed. The checklist was then reviewed and revised in consultation with surgeons, medical oncologists, radiation oncologists, nurses, and breast cancer patients. Thirty-one clinical and public health experts were invited to assess the utility of each phase with the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods, according to the description of the average patient's life in the checklist. The Delphi technique was used to reach expert consensus. RESULTS: The VAS utility scores were highest during screening phases (100 or 90), lower in phases of incidental finding of a tumor (75) and diagnosis (70), and lower still in the initial treatment phases, especially during adjuvant chemotherapy (50). The scores improved during the follow-up phases. There was a higher score for breast-conserving surgery (65) than modified radical mastectomy (60) only in the early follow-up phase. The scores for recurrence or metastasis (30) and terminal stage were considerably lower and reached the lowest level (10 in a general ward and 12.5 at home or in a hospice) among all phases. The utility scores assessed by SG and TTO were higher than those assessed by VAS. CONCLUSIONS: In this study, we established a consensus among clinical and public health experts on the impact of different clinical phases of breast cancer on utility. The results of this study may be useful in cross-cultural comparisons and cost-utility analyses for breast cancer.

Adult↗
PubMed2005

Inguinal versus subinguinal varicocele vein ligation using magnifying loupe under local anesthesia: which technique is preferable in clinical practice?

OBJECTIVES: To compare the intraoperative results of inguinal versus subinguinal varicocelectomy using magnifying loupe, in terms of vein ligation and arterial preservation, recurrence rate, and patient tolerability. METHODS: Ninety-nine patients were randomized to undergo a varicocele repair with an inguinal or a subinguinal approach under local anesthesia. Data concerning the number of veins ligated and arterial preservation were recorded during each procedure. The amount of intraoperative and postoperative pain was assessed by means of visual analogue scale (VAS) scores. The recurrence rate was documented by color Doppler ultrasound examination. RESULTS: The average number of ligated veins was 5.6 with a subinguinal dissection and 4.4 with the inguinal approach. Inadvertent injury of the spermatic artery occurred in 6 of 47 subinguinal and 3 of 50 inguinal dissections; the artery could not be identified during 2 subinguinal and 1 inguinal dissection. Recurrent varicocele was detected in 8% and 14.9% of patients after an inguinal and a subinguinal approach, respectively. The intraoperative VAS score was significantly higher in the inguinal than in the subinguinal patients (P = 0.008). CONCLUSIONS: In our hands, the inguinal approach to the spermatic cord showed a trend toward an easier preservation of the artery and a reduced incidence of persistent pathologic vein reflux. The subinguinal approach had a lower degree of intraoperative pain. On the whole, an inguinal repair might be preferable when magnifying loupe are used for varicocelectomy.

Adult↗
PubMed2005

Severe comorbidity negatively influences prognosis in patients with oral and oropharyngeal cancer after surgical treatment with microvascular reconstruction.

The aim of the study was to investigate the possible impact of comorbidity on survival of patients undergoing composite resection and microvascular reconstruction for oral/oropharyngeal cancer. Patient, tumour and treatment data were recorded. Comorbidity was graded by the Adult Comorbidity Evaluation (ACE-27) test. Survival and statistics were calculated. Comorbidity score ACE-27 grade 2 was present in 47% of patients, for ACE-27 grade 3 this was 13%. The median follow-up was 50 (3-87) months. Thirty-eight patients died, 32 developed a recurrence. Comorbidity score ACE-27 grade 3 turned out to be a clear predictor for overall survival (p<0.05). For ACE-27 grade 3 (n=13) 5-years survival was 29%, for ACE-27 grade 2 (n=87) this was 64%. No multivariate influences on the effects of comorbidity were found. Improved knowledge of the effect of comorbidity on survival may lead to better patient selection and counselling for major surgery and microvascular reconstruction.

Adult↗
PubMed2004

2',5'-Oligoadenylate synthetase activity analysis and human papilloma virus typing as prognostic factors in patients with recurrent respiratory papillomatosis.

OBJECTIVE: Determination of early prognostic factors in patients with recurrent respiratory papillomatosis is extremely important, so the major goal of our prospective, multicentre study was to evaluate (1) the feasibility of various factors to determine prognosis of the clinical course, as well as (2) the response to interferon-alpha therapy in recurrent respiratory papillomatosis. METHODS: Forty-two patients with recurrent respiratory papillomatosis were treated with interferon-alpha (3 MU/m(2) three times per week; mean therapy duration was 2.7 +/- 1.8 years) in 1983-1994 and followed-up until 2003. Human papilloma virus (HPV) type, recurrent respiratory papillomatosis severity and 2',5'-oligoadenylate synthetase activity were determined by standard methods and analysed for correlation with the results of long-term clinical outcome. RESULTS AND CONCLUSION: Patients with HPV type 11, a severity score >4, a high number of surgical procedures prior to interferon-alpha therapy and a high basal 2',5'-oligoadenylate synthetase activity should be considered at high risk of an aggressive clinical course, often with spread to lower airway passages, malignant transformation and death. Human papilloma virus type, score for recurrent respiratory papillomatosis severity, number of surgical procedures and 2',5'-oligoadenylate synthetase activity showed significant association with response to interferon-alpha therapy and the long-term clinical course, so these factors have value in predicting prognosis in recurrent respiratory papillomatosis.

2',5'-Oligoadenylate Synthetase↗
PubMed1995

[Long-term cyclic and periodic omeprazole in the prevention of recurrences of duodenal ulcer].

The aim of this study was to establish if the discontinuous assumption of omeprazole was effective to reduce the recurrence of duodenal ulcer disease as the cyclic periodical assumptions of the same drug. Consequently two different posologies, after duodenal ulcer recovery, were compared, both based on omeprazole. In the first trial 20 mg/die were administrated for the first 15 days of every month, for 1 year. In the second, the same dose were administrated for 15 days only when symptoms occurred. It was not utilised a comparison with placebo or other drugs. Symptomatic score and recurrence rate were evaluated by means of EGDS after 6 months and 1 year. In some patients were also controlled the gastrinemia. Both trials were effective in the prevention of duodenal ulcer relapse, without increasing gastrinemia. Nevertheless patients assuming omeprazole only when symptomatic, showed a greater symptomatic score. Concluding, the assumption of omeprazole only when symptoms occur is effective in the prevention of relapse but require a close relation between patients and the medical team.

Adult↗
PubMedDate not supplied

Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears.

Two hundred twenty shoulders with a rotator cuff tear repaired by simple tendon-to-bone suture were analyzed to determine whether the severity of presurgical fatty degeneration had an influence on their anatomic and functional outcome. Fatty degeneration was evaluated for each muscle with the 5-stage grading system developed by Goutallier et al. A global fatty degeneration index (GFDI), the mean value of the 3 muscles, was calculated for each shoulder. Cuff integrity was evaluated by magnetic resonance imaging (116 cases) or computed arthrotomography scan (104 cases) at a mean 37 months' follow-up, and functional outcomes were evaluated with the Constant score. A recurrent tear was found in 79 cases (36%) and was more frequently encountered in posterosuperior tears. The likelihood of a recurrent tear was greater for tendons whose muscle showed fatty degeneration greater than grade 1. Fatty degeneration of the infraspinatus or subscapularis muscles had an influence on supraspinatus tendon outcome. A GFDI lower than 0.5 was necessary to yield less than 25% retears. The mean global Constant score was 75 at revision, significantly lower when a retear was present (70.5 versus 77.5). In the subgroup of watertight cuffs, it was lower when GFDI was higher. Fatty degeneration is an important prognostic factor in rotator cuff surgery.

Adipose Tissue↗
PubMed2004

Pre and post operative medical therapy for endometriosis surgery.

BACKGROUND: Endometriosis is a common gynaecological condition which affects approximately 10% of women of reproductive age (Askenazi 1997). There is a range of symptoms and most commonly women present with dysmenorrhoea, pelvic pain, infertility or a pelvic mass. Direct visualisation and biopsy during laparoscopy or laparotomy is the gold standard diagnostic test for this condition and enables the gynaecologist to identify the location, extent and severity of the disease. Surgical therapy can be performed concurrently with diagnostic surgery and may include removal (excision) or destruction (ablation) of endometriotic tissue, division of adhesions and removal of endometriotic cysts. Laparoscopic excision or ablation of endometriosis has been shown to be effective in the management of pain in mild-moderate endometriosis. Adjunctive medical treatment pre or post-operatively may prolong the symptom-free interval. OBJECTIVES: To determine the effectiveness of systemic medical therapies used for hormonal suppression before or after surgery for endometriosis, or before and after surgery for endometriosis in the eradication of endometriosis, improvement of symptoms, pregnancy rates and overall tolerability by comparing them with no treatment or placebo. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility group trials register (searched 10 September 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3 2003), MEDLINE (January 1966 to September 2003), EMBASE (January 1985 to September 2003) and reference lists of articles. We also contacted researchers in the field. SELECTION CRITERIA: Trials were included if they were randomised controlled trials of the use of systemic medical therapies for hormonal suppression before or after, or before and after surgery for endometriosis. DATA COLLECTION AND ANALYSIS: Data extraction and quality assessment was performed independently by using relative risk or weighted mean difference and 95% confidence intervals. MAIN RESULTS: Eleven trials were included in the review. One study comparing pre-surgical medical therapy with surgery alone showed a significant improvement in AFS scores in the medical therapy group (WMD -9.60, 95% CI -11.42 to -7.78) but this may or may not be associated with better outcomes for the patients. Post surgical hormonal suppression of endometriosis compared to surgery alone (either no medical therapy or placebo) showed no benefit for the outcomes of pain or pregnancy rates but a significant improvement in disease recurrence (AFS scores (WMD -2.30, 95% CI -4.02 to -0.58)). There were no trials identified in the search that compared hormonal suppression of endometriosis before and after surgery with surgery alone. There is no significant difference between pre surgery hormonal suppression and post surgery hormonal suppression for the outcome of pain in the one trial identified (RR 1.01, 95% CI 0.49 to 2.07). Information concerning AFS scores and ease of surgery was reported only as a descriptive summary so any difference between the groups can not be quantified from the information in the report of this trial. REVIEWERS' CONCLUSIONS: There is insufficient evidence from the studies identified to conclude that hormonal suppression in association with surgery for endometriosis is associated with a significant benefit with regard to any of the outcomes identified. There may be a benefit of improvement in AFS scores with the pre-surgical use of medical therapy. The possible benefit should be weighed in the context of the adverse effects and costs of these therapies.

Chemotherapy, Adjuvant↗
PubMed2004

Impairment across executive functions in recurrent major depression.

Depression is associated with impairment of cognitive functions, and especially executive functions (EFs). Despite the fact that most depressed patients experience recurrence of episodes, the pattern and the severity of executive impairment have not been well characterized in this group of depressed patients. We asked if and to what extent these patients were impaired on a range of neuropsychological tests measuring EFs, and also when confounding factors were adjusted for. Forty-five patients (aged 19-51 years) with moderate to severe (Hamilton score >18) recurrent major depressive disorder (DSM-IV) were compared to 50 healthy controls matched on age, education, gender and intellectual abilities. The subjects were administered a set of neuropsychological tests that assesses sub-components of EFs. The depressed patients were impaired compared to the control group on all selected tests, with a severity of impairment within -1 standard deviation from the control group mean. The group difference was statistically significant for eight of the 10 EFs that were assessed. These were measures of verbal fluency, inhibition, working memory, set-maintenance and set-shifting. The group difference was still significant for all sub-components except for set-shifting (Wisconsin Card Sorting Test) and planning (Tower of London), when additional medication and retarded psychomotor speed was adjusted for. In conclusion, the depressed subjects were mildly impaired across a wide range of EFs. This may have a negative impact on everyday functioning for this group of patients.

Adult↗
PubMed2005

Cardiovascular reactivity in fibromyalgia: evidence for pathogenic heterogeneity.

OBJECTIVE: To evaluate disease-specific cardiovascular reactivity patterns in patients with fibromyalgia (FM) using a recently described method called fractal and recurrence analysis score (FRAS). METHODS: The study group included 30 women with FM, average age 46.7 years (SD 7.03). An age matched group of 30 women with other rheumatic disorders or having a dysautonomic background [chronic fatigue syndrome (CFS), non-CFS fatigue, neurally mediated syncope, and psoriatic arthritis (PsA)] served as controls. Subjects were evaluated with a head-up tilt test with beat-to-beat recording of the heart rate (HR) and pulse transit time. A 10-minute supine phase was followed by 600 cardiac cycles recorded on tilt. Data were processed by recurrence plot and fractal analysis. Variables acting as independent predictors of the cardiovascular reactivity were identified in FM patients versus controls. RESULTS: No statistically significant differences were found between the groups by univariate analysis comparing 92 variables of cardiovascular reactivity in FM patients compared to controls. CONCLUSION: Study of cardiovascular reactivity utilizing a head-up tilt test and processing the data using the FRAS method did not reveal a specific FM-associated abnormality. Our data confirm studies that utilized other methodologies and reached similar conclusions. Patients with FM represent a heterogenous group with respect to their pattern of cardiovascular reactivity.

Arthritis, Psoriatic↗
PubMed2006

Isolated limb perfusion with tumor necrosis factor alpha and melphalan for locally advanced soft tissue sarcoma: the value of adjuvant radiotherapy.

BACKGROUND: The aim was to investigate the value of adjuvant radiotherapy for locally advanced soft tissue sarcoma after hyperthermic isolated limb perfusion (ILP) with tumor necrosis factor alpha and melphalan followed by limb-saving surgery. METHODS: From 1991 to 2003, 73 patients (median age, 54 years; range, 14-80 years) underwent 77 ILPs, followed by resection in 68 patients (93%). Radiotherapy was administered in case of marginally or microscopically positive resection margins. Local recurrences were scored and calculated according to the Kaplan-Meier method and log-rank test. RESULTS: After residual tumor mass resection, 58% received radiotherapy (external beam radiotherapy [EBRT]+ group), and 42% did not (EBRT- group). The median follow-up was 28 months (range, 2-159 months). A significantly better local control rate was observed in the EBRT+ compared with the EBRT- group (P<.0001). When only R0 resections in patients without metastasis were considered, the significance remained between groups (P=.0003). In the EBRT- group, an R1 or R2 resection resulted in earlier relapse of local disease compared with R0 resections (P=.0475). CONCLUSIONS: Adjuvant EBRT reduces the risk for local recurrence after delayed resection in soft tissue sarcoma patients treated with ILP and tumor necrosis factor and is indicated when resection margins are close or microscopically positive. It also seems beneficial after an R0 resection.

Adolescent↗
PubMed2001

The influence of an uncaring partner on the type and outcome of depression.

BACKGROUND: We seek to clarify recent inconsistent research findings in relation to the Intimate Bond Measure (IBM), where low IBM care scores have been held to be over-represented in non-melancholic depression and to predict a poor depressive episode outcome. METHODS: A sample of 82 subjects meeting DSM criteria for a major depressive episode lasting less than 2 years, took part in a 1-year follow-up study. The IBM was completed at initial assessment and depression severity assessed at baseline and at follow-up assessment, allowing a measure of "outcome". RESULTS: A significantly greater proportion of DSM-defined non-melancholic than melancholic depressives perceived their partner as providing deficient care and were classified as being in a dysfunctional relationship, seemingly unrelated to demographic differences or by depression severity, chronicity or recurrence. IBM scores were again established as independent of a number of putative distorting influences, such as depression severity and "neuroticism". Although the IBM failed to significantly predict outcome, there was a clear trend for greater improvement in those in IBM care score-defined "functional relationships". LIMITATIONS: The study failed to assess the change in patients' perceptions of care over time, which may have contributed to the failure to replicate past findings in relation to outcome. CONCLUSIONS: The significance of examining the relevance of psychosocial factors such as deficient intimacy to separate depressive sub-types is highlighted. Implications of these findings for clinical intervention and future research studies are discussed.

Adult↗
PubMed1996

The correlation of Banff scoring with reversibility of first and recurrent rejection episodes.

Recurrent acute rejection remains a significant problem for recipients of renal allografts, with a large proportion of patients progressing to graft loss. The newly introduced Banff schema was used to determine whether the histologic pattern of acute rejection (severity and renal compartment scoring) could discriminate recurring from nonrecurring rejections and to examine whether objective rejection scoring had predictive value for rejection reversal and outcome. A total of 67 biopsies obtained from 50 patients with acute rejection were examined for the occurrence of recurrent allograft rejection. All patients were maintained on a cyclosporine-based triple immunosuppressive protocol and had biopsy-proven acute rejection without chronic changes. Rejection recurred in 13 patients (26%), of whom 4 further developed a third rejection. The majority of the patients developed this first rejection within 2 months posttransplantation. Demographics, prebiopsy renal function, immunosuppression, and peak serum creatinine level at the time of biopsy were similar in patients with multiple and single rejection. Peak levels of reactivity to panel of lymphocytes seemed higher in the group of patients with recurrent rejection, whereas HLA matching was similar for all patients. Banff scores for acute rejection did not discriminate patients at risk of rejection recurrence who had lower vascular (0.6 vs. 1.2), tubular (0.6 vs. 1.1), and lower cumulative SUM (3.0 vs. 4.5) scores on their first rejection when compared with patients with one rejection. Histological scoring was, however, significantly different when first and third episodes were compared in the same patient, indicating increased rejection severity with recurrence. Moreover, the rate of reversal of recurrent rejection by anti-lymphocyte therapy was significantly less than that of first rejection (P<0.05). In conclusion, these data demonstrate that Banff scoring correlated with rejection reversal and steroid responsiveness, yet rejection recurrence was independent of histological score of the first rejection. Furthermore, Banff schema provided an objective histological correlation to the poor clinical outcome seen with recurrent rejection. The data also suggest that patients with early mild rejection continue to be at risk for recurrence and graft loss.

Acute Disease↗