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PubMed1999

Tc-99m DMSA renal scan in first-time versus recurrent urinary tract infection-yield and patterns of abnormalities.

PURPOSE: To determine the yield and patterns of abnormalities noted by Tc-99m DMSA renal imaging in cases of first-time versus recurrent urinary tract infections (UTIs) in children. MATERIALS AND METHODS: We reviewed 101 Tc-99m DMSA studies performed for 52 first-time and 49 recurrent UTIs in 99 children during a period of 1 year. The average age of the patients was 4.4 years, and the female:male ratio was 7:1. Static images of the kidneys were acquired 2 hours after injection of Tc-99m DMSA in anterior, posterior, and right and left posterior oblique views. SPECT was performed in 9% of the cases. The studies were scored as normal or abnormal. RESULTS: The yield of abnormal scans in first-time UTIs was 22 (42%) and in recurrent UTI 27 (55%). Three categories of abnormalities were noted: 1) renal cortical defects (55% of the abnormal scans in first-time UTIs and 59% of the abnormal scans in recurrent UTIs; P = 0.40); 2) dilated pelvicalyceal system (27% of the abnormal studies in first-time UTIs and 63% of the abnormal studies in recurrent UTIs; P < 0.01); and 3) renal swelling showing disproportionate function with size (41% of the abnormal scans in first-time UTIs and 22% of the abnormal scans in recurrent UTIs; P = 0.21). CONCLUSIONS: The high yield of renal abnormalities by Tc-99m DMSA scanning emphasizes the importance of testing all cases of UTI, including patients with a first-time infection. Documentation of the pattern of abnormalities may help in planning for subsequent management of UTIs in these patients.

Adolescent↗
PubMed2026

Comparative efficacy of LDL-C-lowering therapies in first-time vs. recurrent myocardial infarction prevention: a meta-analysis of large-scale randomized controlled trials.

AIMS: Reducing elevated low-density lipoprotein cholesterol (LDL-C) is central to global efforts to prevent myocardial infarction (MI). While many studies have evaluated LDL-C-lowering therapies in first-time and recurrent MI prevention, direct comparisons of their relative efficacy are lacking. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy of LDL-C-lowering therapies in first-time vs. recurrent MI prevention. METHODS AND RESULTS: We searched three databases until 30 November 2024, for randomized controlled trials (RCTs) with at least 1000 patient-years of follow-up. Efficacy was quantified as relative risk (RR) with 95% confidence intervals (CIs). Differences in benefit magnitude were assessed using Cochran's Q test. Data were pooled with a random-effects model, and heterogeneity was measured using the I2 statistic. Additionally, we applied the Cochrane Risk of Bias Tool to evaluate study quality and utilized the GRADE method to assess the certainty of the evidence. This study included 22 large-scale RCTs involving 180 304 participants. In first-time MI prevention, LDL-C-lowering therapies achieved a remarkable 38% reduction in MI risk [12 RCTs; 79 604 participants; RR, 0.62 (95% CI, 0.55-0.69); P < 0.001]. In recurrent MI prevention, these therapies were associated with a more modest but significant 16% risk reduction [11 RCTs; 100 700 participants; RR, 0.84 (95% CI, 0.80-0.88); P < 0.001]. Importantly, the benefit magnitude between the two groups was significantly different (Q = 22.63; P < 0.001), highlighting the greater relative benefit in first-time MI prevention. Furthermore, the robustness of our findings was consistently supported by leave-one-out analyses, the absence of publication bias, high-quality GRADE evidence, and subgroup and sensitivity analyses. CONCLUSION: Our findings suggest that LDL-C-lowering therapies may offer a greater benefit in preventing first-time MI compared with recurrent MI.

Humans↗
PubMed2002

Antimicrobial resistance in staphylococci from canine pyoderma: a prospective study of first-time and recurrent cases in Sweden.

In a prospective study involving eight veterinary clinics during 1995 and 1996, samples from first-time and recurrent cases of canine pyoderma were collected by a needle technique. Three hundred and ninety-four staphylococci were isolated and their susceptibility to various antimicrobial drugs was assessed by a microdilution technique. Resistance to macrolides, lincosamides, fusidic add, tetracycline and streptomycin was significantly more common in isolates from the recurrent cases than from the first-time cases; 20 per cent of the isolates from the first-time cases were resistant to three or more of the antimicrobials tested, compared with 45 per cent of those from the recurrent cases. Coresistance between macrolide-lincosamides, tetracyclines and streptomycin was common. No resistance to penicillinase-stable beta-lactams was observed. A comparison with earlier studies indicated that there had been a marked increase in resistance during the previous five years.

Animals↗
PubMed2004

Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institution.

BACKGROUND: The authors reviewed changes in the initial clinical presentation, management techniques, and patterns of disease recurrence over time (1981-1996) in patients with breast carcinoma treated with breast-conserving therapy (BCT) at a single institution. The goals of the current study were to determine the frequency and use of optimal local and systemic therapy techniques and to evaluate the impact of these changes on treatment efficacy. METHODS: Six hundred seven patients with American Joint Committee on Cancer Stage I or II invasive breast carcinomas treated with BCT at William Beaumont Hospital (Royal Oak, MI) constituted the study population. All patients received at least an excisional biopsy of the primary tumor, an axillary lymph node staging procedure, and postoperative radiotherapy (RT) (a median tumor bed dose of 61 Gray [Gy] was administered). All sides were reviewed by one pathologist. Numerous clinicopathologic and treatment-related factors were analyzed to monitor changes that occurred over time. Changes in patterns of disease recurrence and treatment efficacy over time also were analyzed. RESULTS: Over the time period analyzed, changes at initial presentation included an increase in the mean age at diagnosis (age 56.1 years vs. 61.4 years; P < 0.001), a decrease in the number of patients with clinically palpable tumors (78% vs. 36%; P < 0.001), a decrease in the mean tumor size (2.2 cm vs. 1.6 cm; P < 0.001), but no change in the percentage of patients with negative lymph nodes (79% vs. 78%; P = 0.83). No differences over time were observed in mean tumor grade (2.0 vs. 1.9; P = 0.2) or the presence of angiolymphatic invasion (27% vs. 26%; P = 0.25). Changes in surgical management and pathologic assessment included the more frequent use of reexcision (46% vs. 81%; P < 0.001), larger mean total volumes of breast tissue specimens excised (115 cm3 vs. 189 cm3; P = 0.001), a larger percentage of patients with final negative surgical margins (74% vs. 97%; P < 0.001), and a small increase in the mean number of lymph nodes excised (13.8 lymph nodes vs. 14.1 lymph nodes; P = 0.01). The only other significant change in the pathologic management of patients over time included a doubling in the mean number of slides examined (10.6 slides vs. 21.1 slides; P < 0.001). Changes in adjuvant local and systemic therapy included an increase in the percentage of patients treated with > 60 Gy to the tumor bed (66% vs. 95%; P < 0.001), a doubling in the mean number of days from the last surgery to the start of RT (24 days vs. 50 days; P < 0.001), and a decrease in the use of regional lymph node RT (24% vs. 8%; P < 0.001). The use of adjuvant tamoxifen increased from 10% to 61% (P < 0.001). Finally, improvements were observed in the 5-year and 12-year actuarial rates of local disease recurrence (8% vs. 1% and 21% vs. 9%, respectively; P = 0.001) and distant metastases (12% vs. 4% and 22% vs. 9%, respectively; P = 0.006). No changes in the mean number of years to ipsilateral (6.5 years vs. 6.4 years; P = 0.59) or distant disease recurrence (4.6 years vs. 3.8 years; P = 0.73) were observed. CONCLUSIONS: The impact of screening mammography and substantial changes in surgical, pathologic, RT, and systemic therapy recommendations were observed over time in the study population. These changes were associated with improvements in 5-year and 12-year local and distant control rates and suggested that improvements in outcome can be realized through adherence to best practice guidelines and continuous monitoring of treatment outcome data.

Adult↗
PubMed2000

Long-term results after video-assisted thoracoscopic surgery for first-time and recurrent spontaneous pneumothorax.

BACKGROUND: Few investigators have reported on results after video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax (SP) with follow-up periods longer than 24 months. The aim of this study was to evaluate VATS for first-time and recurrent SP and to follow patients long-term. METHODS: One hundred nine patients were followed long-term after treatment of SP by VATS. Ninety-five patients had primary SP and 14 had secondary SP. Sixty-two patients had a first episode and 47 had a recurrence. In 72 patients leaks or ruptured blebs were identified and excised without subsequent pleurodesis. In 37 patients showing no ruptured bullae or leaks only pleurodesis was applied. RESULTS: Median follow-up was 53.2 months. Postoperative complications were rare. Three patients (2.7%) had a prolonged air leak. The long-term recurrence rate was 4.6%. Only those patients who had not received pleurodesis at the time of first treatment by VATS experienced recurrence. CONCLUSIONS: Immediate postoperative results show VATS to be a safe and reliable method in first-time and recurrent SP to obtain quick reexpansion of the lung. Long-term recurrence rates are acceptable and compare with results after open thoracotomy. Pleurodesis should be included in each procedure for adequate recurrence prevention.

Adult↗
PubMedDate not supplied

Neural timing nets.

Formulations of artificial neural networks are directly related to assumptions about neural coding in the brain. Traditional connectionist networks assume channel-based rate coding, while time-delay networks convert temporally-coded inputs into rate-coded outputs. Neural timing nets that operate on time structured input spike trains to produce meaningful time-structured outputs are proposed. Basic computational properties of simple feedforward and recurrent timing nets are outlined and applied to auditory computations. Feed-forward timing nets consist of arrays of coincidence detectors connected via tapped delay lines. These temporal sieves extract common spike patterns in their inputs that can subserve extraction of common fundamental frequencies (periodicity pitch) and common spectrum (timbre). Feedforward timing nets can also be used to separate time-shifted patterns, fusing patterns with similar internal temporal structure and spatially segregating different ones. Simple recurrent timing nets consisting of arrays of delay loops amplify and separate recurring time patterns. Single- and multichannel recurrent timing nets are presented that demonstrate the separation of concurrent, double vowels. Timing nets constitute a new and general neural network strategy for performing temporal computations on neural spike trains: extraction of common periodicities, detection of recurring temporal patterns, and formation and separation of invariant spike patterns that subserve auditory objects.

Action Potentials↗
PubMed2003

Time to first recurrence as a trial endpoint: time to change?

There has been a rapidly increasing interest in developing new therapies for management of atrial fibrillation. The optimal method for evaluating their efficacy is by measuring changes in outcomes such as mortality, quality of life or cost of care; requiring trials of large sample size. In order to reduce the sample size, there is a need to develop appropriate surrogate endpoints. "Is time to first recurrence of symptomatic atrial fibrillation" an appropriate surrogate endpoint for quality of life? Since a surrogate endpoint must capture the net effect of the treatment, it was assumed (a) that frequency of symptomatic episodes captures the net effect on quality of life and (b) "time to first recurrence" is a measure of the frequency of symptomatic episodes. The effect of frequency of symptomatic episodes or their duration and symptom severity on quality of life has not been evaluated. "Time to first symptomatic recurrence" was proposed because data from a few patients demonstrated that symptomatic atrial fibrillation episodes arose independently and randomly and could be represented mathematically by a Poisson distribution. Recent data from a greater number of patients with implantable devices that detect symptomatic and asymptomatic episodes of atrial tachyarrhythmias indicate that these episodes tend to cluster in time and cannot be well represented by a Poisson distribution. Because all atrial tachyarrhythmia episodes do not follow a Poisson distribution, it is unlikely that only symptomatic episodes would follow the same distribution, although this needs to be proved. A non-Poisson distribution requires a larger sample to detect differences in clinical trials. This should be taken into consideration when designing prospective trials. Alternative methods may include measuring frequency of symptomatic episodes as well their severity and duration. In patients with implanted devices, total duration of time spent in atrial tachyarrhythmias or objective measures of rate control should also be evaluated as surrogate endpoints. If surrogate endpoints cannot be developed, changes in clinical outcomes will need to be demonstrated to evaluate therapeutic efficacy.

Atrial Fibrillation↗
PubMed1992

Recurrent squamous carcinoma of the vulva.

OBJECTIVE: This study reviews experience at Indiana University with recurrent squamous carcinoma of the vulva over an 18-year period from 1971 to 1989. The pattern of recurrence, time interval to recurrence, and efficacy of salvage therapy are evaluated in the context of the primary tumor. STUDY DESIGN: This is a retrospective study of 40 patients, 21 of whom underwent primary therapy for invasive squamous carcinoma of the vulva at Indiana University. RESULTS: Vulvar recurrences were observed in 17 patients (43%), the groin was involved in 12 (30%), whereas pelvic and distant recurrences were observed in 2 (5%) and 9 (22.5%) patients, respectively. Salvage surgery and/or radiotherapy were successful in 25 patients (62.5%) alive from 1 to 144 months (median 8 months) from secondary therapy. Survival after retreatment varied significantly by site of recurrence (p = 0.002), tumor grade (p = 0.009), and interval to recurrence (p < 0.001). Best outcomes were in patients with initial stage I or II disease (International Federation of Gynecology and Obstetrics), grade 1 tumors, local failure, and interval to relapse of > 16 months' duration. Two of 12 patients with groin recurrences were salvaged with surgery and radiotherapy. CONCLUSION: Long-term follow-up of patients with vulvar cancer and careful restaging at the time of recurrence are mandatory. Although local and nodal recurrences may be controlled with surgery and/or radiotherapy, regional recurrences are usually fatal.

Adult↗
PubMed2005

Retrospective analysis of time to recurrence in the ATAC trial according to hormone receptor status: an hypothesis-generating study.

PURPOSE: Arimidex, tamoxifen alone, or in combination (ATAC) trial of anastrozole (Arimidex) versus tamoxifen or a combination of the two in 9,366 postmenopausal patients with primary breast cancer found a significant improvement in disease-free survival and time to recurrence (TTR) for anastrozole compared with tamoxifen, that was restricted to patients with hormone receptor-positive (ie, estrogen receptor-positive [ER+] and/or progesterone receptor-positive [PgR+]) disease, the target population for these therapies. We retrospectively tested the hypothesis that this benefit might differ according to PgR status. PATIENTS AND METHODS: TTR was compared between the three treatment groups for subgroups defined by ER and PgR status using Cox's proportional hazards model, with and without adjustment for baseline variables. RESULTS: The unadjusted hazard ratio (HR) for anastrozole versus tamoxifen for TTR was 0.74 (95% CI, 0.64 to 0.87) for women with either ER+ or PgR+ tumors. In the ER+/PgR+ subgroup (n = 3,834) the HR was 0.84 (95% CI, 0.69 to 1.02) compared with 0.43 (95% CI, 0.31 to 0.61) in the ER+/PgR-negative (PgR-) subgroup (n = 880). In the adjusted model the HRs were 0.83 and 0.45, respectively. CONCLUSION: Time to recurrence was longer for anastrozole- than tamoxifen-treated patients in both ER+/PgR+ and ER+/PgR- subgroups, but the benefit was substantially greater in the PgR- subgroup. As this was an "exploratory" analysis, this effect should be considered as hypothesis generating and assessed prospectively in other trials comparing the adjuvant use of an aromatase inhibitor with tamoxifen.

Anastrozole↗
PubMed2004

Time to recurrent stone formation in patients with bladder or continent reservoir reconstruction: fragmentation versus intact extraction.

PURPOSE: Stone formation following bladder or continent reservoir reconstruction in children is a major source of long-term morbidity. We determine whether the method of stone removal (fragmentation or intact extraction) affected the time to stone recurrence in children after bladder reconstruction. MATERIALS AND METHODS: Medical records from 1993 to 2003 were examined to identify patients with urinary reconstruction subsequently treated for bladder calculi at our institution. Retrospective review of the medical records was performed to determine the type of urinary reconstruction, time to stone recurrence, method of stone removal and length of followup. Kaplan-Meier analysis was performed with each stone episode considered as an individual event. Time to recurrence was measured in months from stone removal to identification of recurrent stones. RESULTS: A total of 60 patients with bladder or continent reservoir reconstructions had undergone 103 stone removal procedures (range 1 to 8 procedures per patient). Patients were rendered stone-free after each procedure. Stones recurred following 42.4% of intact and 43.9% of fragmented extractions at a mean of 27.0 (SD 31.3) and 27.6 (SD 21.8) months, respectively. Kaplan-Meier survival analysis curves for intact and fragmented extractions were not statistically different. CONCLUSIONS: Time to stone recurrence in patients with bladder or continent reservoir reconstruction is not altered by the method of stone removal (fragmented versus intact extraction). Since recurrence remains a frequent problem in children after bladder augmentation and/or reconstruction, use of the least invasive modality should be the initial management recommendation.

Child↗
PubMed1988

Effect of adjuvant chemotherapy on time to recurrence and survival of stage I uterine sarcomas.

We have evaluated the effect of adjuvant chemotherapy on time to recurrence and survival in two prospective trials of women with stage I uterine sarcomas. The first trial compared surgery only to surgery plus Adriamycin. The 5-year estimated survival rate was 36% for surgery alone and 63% for surgery plus Adriamycin. The 5-year recurrence free rate for surgery alone was 46% as compared to 75% for surgery plus Adriamycin. The second trial, without a concurrent control group, included patients with stage I uterine sarcoma and adjuvant cyclaphosphamide, vincristine, Adriamycin, and dacarbazine (CYVADIC) chemotherapy. The 5-year survival rate was 89% and the recurrence-free rate was 80%. In all of these trials, as well as in the report of Van Nagell et al (Cancer 57:1451-1454, 1986) of adjuvant vincristine, actinomycin-D, and cyclophosphamide (VAC) chemotherapy, there are too few patients to make any formal statistical comparison of the groups, although the surgery plus CYVADIC group appears to be the most promising.

Adult↗
PubMed2001

Omnibus tests of the martingale assumption in the analysis of recurrent failure time data.

The Andersen-Gill multiplicative intensity (MI) model is well-suited to the analysis of recurrent failure time data. The fundamental assumption of the MI model is that the process Mi(t) for subjects i = 1, ..., n, defined to be the difference between a subject's counting process and compensator, i.e., Ni(t) - Ai(t); t > 0, is a martingale with respect to some filtration. We propose omnibus procedures for testing this assumption. The methods are based on transformations of the estimated martingale residual process Mi(t) a function of consistent estimates of the log-intensity ratios and the baseline cumulative hazard. Under a correctly specified model, the expected value of Mi(t) is approximately equal to zero with approximately uncorrelated increments. These properties are exploited in the proposed testing procedures. We examine the effects of censoring and covariate effects on the operating characteristics of the proposed methods via simulation. The procedures are most sensitive to the omission of a time-varying continuous covariate. We illustrate use of the methods in an analysis of data from a clinical trial involving patients with chronic granulatomous disease.

Female↗
PubMed1998

Metabolic risk factors in patients with first-time and recurrent stone formations as determined by comprehensive metabolic evaluation.

OBJECTIVES: To determine whether patients with recurrent calcium stone formation have more significant metabolic abnormalities compared with patients with first-time stone formation as determined by a comprehensive metabolic evaluation. METHODS: We investigated metabolic abnormalities in 37 patients (14 men, 23 women) with first-time and 136 patients (83 men, 53 women) with recurrent calcium stones, stratified according to sex. Calcium oxalate supersaturation indexes of Tiselius (1991) and Ogawa (1996) were also compared between the groups. In addition to the specific metabolic abnormalities, we analyzed the total number of such defects for each group. RESULTS: In men, the average number of metabolic abnormalities in each patient was greater in patients with recurrent stones (2.20+/-0.86) than in those with first-time stones (1.46+/-1.27). Such a difference could only be demonstrated for women if low urine volume was excluded as a specific abnormality. Although the frequency of each abnormality was higher in patients with recurrent stones, a statistically significant difference was only noted in the frequency of hypocitraturia between women with first-time and recurrent stone formation (11.1% versus 37.8%, P < 0.05). There were no significant differences in the calcium oxalate supersaturation indexes between first-time and recurrent stone formation in either men or women. CONCLUSIONS: Women with recurrent stones have a higher prevalence of hypocitraturia than women with first-time stones. Potassium citrate therapy for prevention of urolithiasis may be especially useful for this patient population.

Calcium Oxalate↗
PubMed1990

[Changes in left ventricular hemodynamics and contractility and significance of various reperfusion phase times in recurrent short duration ischemia in the human].

The time courses of left ventricular systolic (LVSP) and enddiastolic (EDP) pressures as well as changes in peak dp/dtmax and peak dp/dtmin using high-fidelity-tip catheters were studied in 35 out of 179 consecutive patients undergoing elective percutaneous transluminal angioplasty (PTCA) of the left anterior descending artery (LAD). Only patients with global and regional normal left-ventricular function and without collateral filling of the target vessel in the diagnostic angiograms were included. Occlusion time of the LAD was 50 and 60 s during each cycle. Reperfusion time between each vessel occlusion was 60 s in 15 patients and 180 s in 20 patients. During every ischemic period identical significant decreases of LVSP (p less than 0.005), peak dp/dtmax (p less than 0.001), and peak dp/dtmin (p less than 0.001) and significant increases of EDP (p less than 0.001) were documented. The maximum of hemodynamic changes in every patient was within the first 20 s after vessel occlusion. With a reperfusion period of 60 s LVSP and EDP did not return to basic level and the difference reached statistical significance (p less than 0.05) during the fourth occlusion. This could not be documented when the reperfusion period lasted 180 s. For clinical implications a reperfusion time of 180 s between consecutive repeated short periods of ischemia during PTCA could be recommended.

Angioplasty, Balloon, Coronary↗
PubMed1991

Radical surgery and postoperative split-course radiotherapy in squamous cell carcinoma of the mobile tongue: factors influencing local control and the time to recurrence.

During 1981-1988 63 patients with squamous cell carcinoma of the oral tongue (27 females and 36 males) were treated with radical surgery and postoperative split-course radiotherapy. The 3-week rest period was compensated with a 10% increase in the total radiation dose to 66 Gy. The local control rate was 76% in stage I, 71% in stage II, 45% in stage III and 0% in stage IV. Failures were observed in 25 (40%) patients, and 8 patients died of intercurrent diseases. For further analysis the material was stratified in three groups according to the time interval between surgery and postoperative radiotherapy: less than 6 weeks, 6-8 weeks and greater than 8 weeks. The local control rate in the three strata were 75, 57 and 44%, and the 5-year actuarial survival 61, 46 and 30%, respectively. In the logistic regression analysis and the proportional hazard's regression analysis the histologic grade of the primary tumour and the time interval between surgery and the start of radiotherapy were the most important factors influencing respectively local control and time to recurrence. However, it appeared that the lengthening of the time interval was often caused by factors or events which directly can influence the prognosis, such as surgical complications, infections and poor general condition. When cases with such special causes for lengthening of the interval were excluded, the effect of the time interval nearly completely disappeared. It would seem that a final evaluation of the effect of the time interval requires a prospective randomized trial. The same may well hold true for reliable evaluation of the influence of overall treatment time.

Carcinoma, Squamous Cell↗
PubMed2003

Time to recurrence after recovery from major depressive episodes and its predictors.

BACKGROUND: Depression is a remitting but recurring disease. However, there is a paucity of prospectively recorded data on the course of depression after recovery. METHOD: A multi-centre prospective serial follow-up study of an inception cohort of hitherto untreated unipolar major depression (N = 95) for 6 years. We report the time to recurrence after recovery from the index depressive episode and their predictors. RESULTS: The cumulative probability of remaining well without subthreshold symptoms was 57% (95% CI, 46 to 68%) at 1 year, 47% (95% CI, 36 to 58%) at 2 years and 35% (95% CI, 23 to 47%) at 5 years. The same without full relapse was 79% (95% CI, 70 to 88%) at 1 year, 70% (95% CI, 60 to 80%) at 2 years and 58% (95% CI, 46 to 70%) at 5 years. The median duration of well-interval from the end of the index episode to the beginning of the subthreshold episode was 19-0 months (95% CI, 2-4 to 35-7), and that to the end of the full episode was over 6 years. Residual symptoms at time of recovery predicted earlier recurrence. CONCLUSIONS: The median length of the well-interval was much longer than previously reported in studies employing similar definitions but dealing with a more severe spectrum of patients. However, the sobering fact remains that less than half of the patients can expect to remain virtually symptom-free for 2 years or more after recovery from the depressive episode.

Adolescent↗
PubMed1998

Frequency and timing of recurrent events in infants using home cardiorespiratory monitors.

OBJECTIVE: To determine the incidence, type, timing, and factors predictive of recurrent significant events in infants with home cardiorespiratory monitors. STUDY DESIGN: We reviewed data accumulated for 147 patients with an event-recorder type of monitor. The infants were allocated to one of four diagnostic categories: apparent life-threatening events (ALTE, n = 73), former premature infants with persistent apnea and bradycardia (n = 29), siblings of victims of sudden infant death syndrome (SIDS) (n = 24), and parental anxiety after a nonsignificant event (n = 21). RESULTS: Compliance with monitoring was excellent; the monitors were used on 94% of the prescribed days. Fifty-three (36%) of 147 infants had significant events; of those, 46 (87%) experienced their first event during the first month of monitoring, and 69% of the events occurred during that first month. The most prevalent event type was a bradycardic event. Among infants in the ALTE group, events during the initial investigation period predicted the likelihood of events at home; 2 of the 47 infants (4%) with negative results for an investigation and no events recorded in hospital had apnea, and 4 had a bradycardic event (9%). In contrast, when significant events were recorded in hospital, the events were likely to recur at home (69% and 35% of the infants had apnea or bradycardia, respectively; p < 0.001). CONCLUSION: Because most apnea, bradycardia, and recurrent clinical events began during the first month of monitoring, we emphasize the need for vigilant follow-up care of infants immediately after institution of home monitoring. Readmission for investigation is warranted in infants with severe or multiple recurrent events.

Anxiety↗
PubMedDate not supplied

Association of time to recurrence with thymidylate synthase and dihydropyrimidine dehydrogenase mRNA expression in stage II and III colorectal cancer.

Patients with International Union Against Cancer (UICC) stage IIb and III colon cancer and stage II and III rectal cancer may receive adjuvant chemotherapy with 5-fluorouracil (5-FU). High levels of thymidylate synthase (TS) and dihydropyrimidine dehydrogenase (DPD) have been associated with resistance to 5-FU in advanced colorectal cancer. The aim of this study was to investigate the association of TS and DPD mRNA levels with recurrence-free survival in patients with colorectal cancer who are receiving adjuvant 5-FU-based chemotherapy. TS and DPD mRNA quantitation was retrospectively performed in primary colorectal cancer specimens from patients receiving adjuvant 5-FU using a reverse transcription- polymerase chain reaction technique. The median TS mRNA level in patients with a recurrence (n = 142) was 0.68, and in patients without a recurrence (n = 206) the median level was 0.80 (P < 0.01). Patients with a recurrence who had a low TS level (TS < or = 0.9; n = 102) had a median recurrence-free survival of 18 months (range 3.0 to 54 months), and those with a high TS level (TS > 0.9; n = 40) had a median recurrence-free survival of 11 months (range 1.7 to 53 months; P = 0.0024). There was no difference in the median recurrence-free survival of patients with low and high DPD mRNA levels. The TS mRNA level may be a useful marker to predict the time to recurrence in patients with colorectal cancer who are receiving adjuvant 5-FU treatment.

Aged↗