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PubMed1998

[The radiosurgery of glioblastoma multiforme in cases of recurrence. The Heidelberg experiences compared to the literature].

AIM: To describe the clinical results a prospective phase II study of radiosurgically treated patients with recurrent glioblastoma multiforme. PATIENTS AND METHOD: Since 1986, 62 patients were irradiated stereotactically. Including criteria were residual tumor < or = 5 cm and Karnofsky performance score > or = 70. Twenty-seven patients (mean age 50 years) were treated for recurrent tumor. The planning target volume was defined by the contrast enhancing region demonstrated by magnetic resonance imaging (MRI) scans which were performed in treatment position. A safety margin of 2 to 5 mm was added. The mean dose was 17 Gy. The median interval from the time of initial diagnosis and therapy to radiosurgery for recurrent tumor was 9.6 months. Initial therapy consisted of surgery and irradiation (60 Gy). Survival curves were calculated according to the Kaplan Meier method. Quality of life was evaluated using objective criteria such as neurological findings, frequency of seizures and steroid medication. RESULTS: The median survival calculated from the time of diagnosis was 18 months, calculated from the time of radiosurgery 9 months. 4.5 months after therapy, 50% of the patients showed improved or stable quality of life. CONCLUSION: Radiosurgery demonstrates efficacy in selected patients suffering from recurrent glioblastoma multiforme.

Adult↗
PubMed1998

Indium-111 capromab pendetide (ProstaScint) imaging to detect recurrent and metastatic prostate cancer.

This study evaluated the utility of In-111 capromab pendetide imaging to detect prostate cancer metastases or local recurrence. The specific goal was to identify clinical factors such as prostate-specific antigen, pathologic stage, and Gleason score that were most predictive of a positive scan outcome. In addition, a new concept of a weighted Gleason score was defined and correlated with the scan outcome. Fifty-one patients with an elevated prostate-specific antigen level and otherwise negative workup were studied. Forty-eight patients had been treated by radical prostatectomy, two by radiation therapy, and one patient was studied before prostatectomy. Each patient received an intravenous injection of approximately 5 mCi of In-111 containing 0.5 mg of CYT 356, a conjugated site-specific monoclonal antibody against prostate specific membrane antigen. Tomographic blood pool images were obtained the day of injection. Four days later planar images and tomographic images of the abdomen and pelvis were obtained. Scans were interpreted by two experienced nuclear medicine physicians. Differences in the scan interpretation were settled by consensus. Scan outcomes were correlated with prostate-specific antigen levels, pathologic stage, Gleason score, weighted Gleason score, and clinical data. Of 51 scans, 70.6% (36 of 51) were positive. Eight patients had abnormal activity in the prostatic fossa, 12 patients had abnormal activity in the abdominal or pelvic lymph nodes, and 16 patients demonstrated abnormal activity in both areas. One patient with a positive scan underwent lymphadenectomy and was confirmed to be a true positive. Patients with a prostate-specific antigen level greater than 10 ng/ml, a weighted Gleason score higher than 4.5, or prostate-specific antigen levels greater than 2 ng/ml plus a weighted score higher than 4.5 showed positive rates of 100% (6 of 6), 88.2% (14 of 16), and 100% (6 of 6), respectively. In-111 capromab pendetide imaging was useful to detect metastases or local recurrence. Serum prostate-specific antigen levels and weighted Gleason scores are good predictive factors of the likelihood of a positive scan outcome.

Abdominal Neoplasms↗
PubMed2001

Methodology and reporting in studies of local recurrence after curative excision of the rectum for cancer.

BACKGROUND: Widely varying rates have been reported in the extensive literature published in the English language on local recurrence after curative excision of rectal carcinoma. These variations may be attributable to differences in the case mix of pathological factors influencing recurrence, differences in surgical technique or expertise, differences in the administration of adjuvant therapy and various combinations of these. They may also arise from methodological differences among studies. METHODS: This paper reviews the adequacy of methodology and reporting in 21 recent studies of local recurrence after curative resection of rectal cancer. RESULTS: Many flaws in reporting and apparent inadequacies in methodology were identified. On an index of 26 criteria examined, eight studies scored no more than 8 and only three studies scored more than 11. CONCLUSION: To date, the value of reports of local recurrence rates following curative excision of rectal cancer has been limited by inadequacies in documentation and methodology. Suggestions are made for preferred procedures to be followed in the reporting of future studies.

Clinical Trials as Topic↗
PubMed1976

Risk of new myocardial infarction in middle-aged men with manifest coronary heart disease.

Men incuring coronary heart disease (CHD) during surveillance of an employed population were studied for risk factors associated with additional myocardial infarctions. The coronary-prone Type A behavior pattern measured by a test score, number of cigarettes smoked daily, and serum cholesterol were significantdiscriminators between the 67 men with recurrent CHD and the 220 with but a single clinical CHD event. Diastolic blood pressure and fasting serum triglycerides were not significant discriminators. Statistical analyses directed to possible sources of bias occasioned by the combined retrospective-prospective study design revealed that these problems are negligible and do not alter the findings observed. Type A score appears relatively unaffected by whether the measure was made before or after the initial CHD event. Multivariable discriminant function equations showed Type A score to be the strongest single predictor of recurrent CHD among the variables available. Number of cigarettes smoked and serum cholesterol accounted for additional variance. Future field trials for the secondary prevention of myocardial infarction would be strengthened by consideration of the possible role of Type A behavior.

Adult↗
PubMed2006

Lack of association between conversation partners' nonverbal behavior predicts recurrence of depression, independently of personality.

High neuroticism and low extraversion are related to depression and its recurrence. We investigated whether nonverbal involvement behavior during social interaction is one of the factors via which these relations are effectuated. We measured nonverbal expressions of involvement from videotaped behavior of remitted depressed outpatients (n=101) and their conversation partners, and assessed self-reported neuroticism and extraversion scores. During a 2-year follow-up, we assessed the recurrence of depression. Twenty-eight participants (27.7%) experienced a recurrent episode. Time to recurrence was predicted by neuroticism and extraversion, and also by the degree of association between levels of nonverbal involvement behavior of conversation partners. The behavioral effect did not explain the personality effect. Neuroticism moderated the behavioral effect. The results point to the independent relevance of personality and nonverbal behavior in the long-term course of depressive disorder.

Adult↗
PubMed2006

Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression.

STUDY DESIGN: A retrospective study of consecutive patients who underwent microdecompression for far lateral disc or foraminal stenosis. OBJECTIVES: To evaluate the risk factors for unsatisfactory outcome. SUMMARY OF BACKGROUND DATA: There has been no detailed analysis of postoperative radicular pain, although it is not infrequent following foraminal and far lateral microdecompression. METHODS: A total of 184 patients, who were followed up for more than 2 years, were reviewed. Microdecompression was performed through lateral intermuscular approach. In cases of double herniation (combination of intracanalicular disc at the same level), additional intracanalicular decompression was simultaneously performed. The unsatisfactory outcomes included persistent or recurrent leg pain, based on the Japanese Orthopedic Association leg pain score, and revision surgery at the same level. The potential risk factors, including gender, age, symptom period, preoperative radiologic and intraoperative findings, were determined. RESULTS: The average follow-up period was 38.4 months, with a maximum 70 months. Forty of the 184 patients (21.7%) had persistent or recurrent leg pain, with nine requiring revision surgeries. The statistically significant risk factor for unfavorable outcomes was double herniation, with odds ratio of 2.89 (P = 0.004). CONCLUSION: Facet preserving microdecompression is an effective method for foraminal and far lateral root compression. However, in cases of double herniation, total facetectomy is preferable.

Adult↗
PubMed2001

Frequency and perception of cough severity.

OBJECTIVE: The frequency of the common symptom of cough in children is unknown. The aim of this study was to compare cough frequency and perception of cough severity in children with and without recurrent cough. METHODOLOGY: Eighty-four children with (C) and without (NC) recurrent cough were recruited in the same season. Cough frequency (measured with cough-meter) and subjective cough severity (measured on parent-completed and child-completed diary cards on two subjective systems), were compared between the two groups. RESULTS: Cough frequency in C (median 65/day) was significantly higher than in NC (10/day). The correlation between daytime and night-time cough was higher in NC (rs = 0.51, P < 0.00001) than in C (rs = 0.3, P = 0.05). The C group had significantly higher coughs per score than NC, for both subjective methods. CONCLUSIONS: Children with recurrent cough have a higher frequency and different pattern of cough than controls enrolled in the same season. Subjective perception of cough severity is dependent on the population studied.

Adolescent↗
PubMed1994

A clinicopathological evaluation of nucleolar organizer region proteins in human breast carcinoma.

The number of nucleolar organizer region proteins (NORs) identified by silver staining (Ag) was studied in 106 primary breast carcinomas. The AgNOR score (mean +/- SD) in tumours smaller than 2 cm was significantly lower than that in tumours larger than 2 cm (P < 0.05). However, there was no significant difference according to other clinicopathological characteristics. According to postoperative distant recurrence, the AgNOR count was significantly higher in the group with recurrence than in the group without recurrence (P < 0.05). Further, the survival rate was significantly lower in the high AgNOR score (> or = 3) group than in the low score (< 3) group (P < 0.01). The present study indicates that the AgNOR score in human breast cancer cells is useful for evaluating cell proliferative activity and may help predict postoperative distant recurrence and, ultimately, the postoperative prognosis of patients.

Adult↗
PubMed2000

[Antileukotrienes in the prevention of postoperative recurrence of nasal polyposis in ASA syndrome].

There is a high incidence of post-surgical recurrences of nasal polyps (NP) in patients suffering from the ASA Syndrome. The numerous theories as to the pathogenesis of the ASA Syndrome include an increase in lipoxygenase-mediated arachidonic acid metabolism, with the subsequent hyperproduction of leukotrienes (LT), and an inhibition of the cycloxygenase. Therefore, based on the information acquired on the immunobiological action mechanism of montelukast, a cysteinyl-LT receptor antagonist, it appeared worth testing the effectiveness of this substance in preventing post-surgical NP recurrences in a group of ASA Syndrome patients. After taking a case history, filling out a questionnaire scoring nasal symptoms, undergoing rhinoendoscopy and rhinomanometry, 40 patients suffering from ASA-Syndrome and NP (age range 30-72 years) were recruited for the study. They were uniformly classified according to Lund and Mackay using high resolution CT of the nose and paranasal sinuses performed after at least 1 month of nasal medical treatment. All the patients underwent microendoscopic anterior-posterior ethmoidectomy and bilateral maxillary antrostomy. After removing the nasal packing, the only treatment administered was 10 mg of montelukast/die for 6 months, with the drug suspended for 1 months after the first 3 months of treatment. The monthly follow-up included rhinoendoscopy, rhinomanometry and the questionnaire to score symptoms. After the seventh month a new CT was performed and compared with the pre-operative CT. In a control group of subjects, homogeneous with the test group, momethasone furoate nasal spray was administered at a dose of 100 mcg per nostril/die and loratadin tablets 10 mg/die. The results obtained in the patients treated with montelukast were analogous with those obtained in the second group, and during follow-up all patients showed total absence of any local recurrence, good nasal patency and no significant nasal symptom score on the questionnaire. In no case did the comparative CT, performed after the seventh month, show any signs of recurrence. The patients taking the montelukast reported a significant reduction in the use of steroids and bronchodilator inhalants during the course of the study than did the second group; indeed the number of asthmatic episodes dropped and they reported an improvement in the quality of life. Based on these results, the authors suggest that the use of montelukast in the treatment of post-surgical NP recurrences in ASA Syndrome is possible and advisable, even in synergetic association with the treatment administered to the second group. The positive results also support the hypothesis of altered arachidonic acid metabolism and call attention to the role of cysteinyl-LT in the pathogenesis of the ASA Syndrome.

Acetates↗
PubMedDate not supplied

Cardiovascular risk factors do not predict clinically defined restenosis after percutaneous transluminal angioplasty for lower limb ischemia.

The purpose of this study was to evaluate risk factors predicting restenosis and primary patency after percutaneous transluminal angioplasty. Follow-up data (including cardiovascular risk factor scores according to SCVIR criteria, preinterventional and postinterventional clinical data and patient history) of all patients who underwent successful percutaneous transluminal angioplasty for lower limb ischemia were analyzed retrospectively and patients, relatives, or referring physicians underwent a telephone interview. Patients with incomplete follow-up data were examined by means of a clinical examination, including Doppler measurements and treadmill test. Additionally all angiograms were evaluated to calculate lesion length, number of treated lesions, lesion type (SCVIR score), and runoff. The outcome was categorized into four groups: early recurrence (< 1 month, group I), mean recurrence (1-6 months, group II), late recurrence (>6 months, group III), and no recurrence (group IV). According to common concepts group I was defined as early (thrombotic) reocclusion, group II as clinically defined restenosis, and group III as progression of atherosclerosis. One hundred thirty-seven patients underwent percutaneous transluminal angioplasty of 148 extremities. The groups differ significantly only with respect to a higher diabetes score for group I in comparison to group IV (p=0.002, Kruskal-Wallis test), and a worse runoff of group I compared with group IV (p =0.008). There was a trend toward a higher diabetes score for group II in comparison to group IV (p = 0.014). There were no differences with regard to hyperlipemia, hypertension, and tobacco use between patient groups. Mean primary patency was 436 days. Predictors for lower patency rates were diabetes mellitus (p<0.001), runoff (p=0.005), and number of treated lesions (p=0.007) in a stepwise, multiple regression analysis. Patients with clinically defined restenosis showed no specific risk factor profile in this study. Predictors for lower primary patency were diabetes mellitus, number of treated lesions, and runoff.

Aged↗
PubMed1999

Latanoprost increases the severity and recurrence of herpetic keratitis in the rabbit.

PURPOSE: To determine whether topically applied latanoprost increases the severity of acute herpes simplex keratitis, the rate of recurrence of herpes keratitis, or both, in the rabbit. METHODS: To determine the effect on severity of acute herpetic keratitis, the corneas of New Zealand white rabbits were infected with either the less-corticosteroid-sensitive McKrae strain or the corticosteroid-sensitive F(MP)E strain of herpes simplex virus type 1. Rabbits were randomly assigned to twice-a-day treatment with latanoprost 0.005%, dexamethasone sodium phosphate 0.1%, or balanced saline solution within 3 days of infection and evaluated daily for up to 13 days after infection. The severity of keratitis was graded in a masked manner. To determine the effect on recurrences of herpetic keratitis, animals infected with McKrae strain herpes simplex virus type 1 that survived to day 32 after infection were randomized to treatment with latanoprost 0.005% or balanced saline solution and evaluated for the presence of corneal lesions from postinfection day 32 to day 47. RESULTS: In the severity studies, treatment of F(MP)E-infected corneas with latanoprost or dexamethasone significantly worsened herpetic keratitis; by postinfection day 5, F(MP)E-infected eyes treated with dexamethasone or latanoprost demonstrated significantly higher severity scores than the eyes treated with balanced saline solution (P = .0001 and .008, respectively). Scores of McKrae-infected corneas treated with latanoprost or dexamethasone were not significantly different from scores of balanced saline solution-treated corneas. In the recurrence study, treatment with latanoprost significantly increased the appearance of clinical recurrences in McKrae-infected eyes, compared with balanced saline solution treatment (P = .0064). CONCLUSION: Latanoprost may worsen acute herpetic keratitis in the rabbit eye and increase the risk of recurrences in latently infected animals.

Acute Disease↗
PubMed2005

Survival factors after resection of small hepatocellular carcinoma.

BACKGROUND: Early resection of hepatocellular carcinoma is a key measure to prolong the survival of patients. This study was designed to summarize our experience in surgical resection of small hepatocellular carcinoma (HCC), and to analyze the factors influencing the postoperative survival of patients. METHODS: The clinicopathologic data of 105 patients with small HCC after resection from 1986 through 2003 were analyzed; the patients had been followed up for more than half a year (median 33 months). Nine clinicopathologic factors, preoperative alpha-fetoprotein (AFP) level, liver cirrhosis, Child-Pugh score, tumor size (>2 cm vs. < or = 2 cm) and number (single vs. multiple), capsule formation, portal vein tumor thrombi (PVTT), Edmondson tumor grade and surgical method, were analyzed by the log-rank test and the Cox proportional harzards model analysis. RESULTS: The cumulative 1-, 3- and 5-year survival rates after the operation were 86.5%, 70.3% and 55.2%, respectively, and the 1-, 3- and 5-year disease-free survival rates were 78%, 58.9% and 45.6%, respectively. One patient died from esophagogastric varices hemorrhage in 2 weeks after reoperation. Thirty-six patients had intrahepatic recurrence or metastasis postoperatively and 34 patients died. The Kaplan-Meier method and the Cox proportional harzards model analysis indicated that poor Child-Pugh score, tumor more than 2 cm in diameter, PVTT and multiple lesions (including satellitic lesions) were adverse factors affecting postoperative survival. The Cox proportional harzards model analysis indicated that tumor size, PVTT and multiple lesions were the factors influencing postoperative disease-free survival. CONCLUSIONS: Limited hepatectomy with a margin more than 1 cm is an appropriate surgical approach. Adverse preoperative Child-Pugh score and postoperative intrahepatic recurrences are the main factors leading to the death of patients with small HCC.

Adult↗
PubMed2005

Preoperative serum DNA GSTP1 CpG island hypermethylation and the risk of early prostate-specific antigen recurrence following radical prostatectomy.

PURPOSE: Hypermethylation of the CpG island at the promoter region of the pi-class glutathione S-transferase gene (GSTP1) is the most common somatic genome abnormality in human prostate cancer. We evaluated circulating cell-free DNA GSTP1 CpG island hypermethylation as a prognostic biomarker in the serum of men with prostate cancer. EXPERIMENTAL DESIGN: Prostate cancer DNA GSTP1 CpG island hypermethylation was detected using a restriction endonuclease quantitative PCR technique. We analyzed preoperative serum from 85 men with clinically localized prostate cancer treated with radical prostatectomy and from 35 men with a negative prostate biopsy. We then assayed preoperative serum from a data set of 55 pairs of men with clinically localized prostate cancer treated with radical prostatectomy, matched for Gleason score, comprising 55 men suffering prostate-specific antigen (PSA) recurrence (median, 2 years) and 55 men who were free of disease at last follow-up (median, 3 years). The association of serum GSTP1 CpG island hypermethylation and PSA recurrence was determined. RESULTS: Circulating cell-free DNA with GSTP1 CpG island hypermethylation was not detected in the serum of men with a negative prostate biopsy but was detected in 12% of men with clinically localized disease and 28% of men with metastatic cancer (P = 0.003). In the matched data set, eight men (15%) who developed PSA recurrence were positive for DNA with GSTP1 CpG hypermethylation, whereas no patient who was free of disease was positive for GSTP1 CpG island hypermethylation (McNemar test, chi(2) = 6.1, P = 0.01). In a multivariable analysis that accounted for recognized prognostic factors, the presence of serum DNA with GTSP1 CpG island hypermethylation was the most significant predictor of PSA recurrence (hazard ratio, 4.4; 95% confidence interval, 2.2, 8.8; P < 0.001). CONCLUSION: Our study suggests that GSTP1 CpG island hypermethylation may be an important DNA-based prognostic serum biomarker for prostate cancer.

Adult↗
PubMed2002

Surgery and functional outcomes in deaf children receiving cochlear implants before age 2 years.

OBJECTIVE: To examine the feasibility of cochlear implantation in children younger than 2 years regarding surgery and functional outcomes. DESIGN: Prospective study. SETTING: Tertiary pediatric cochlear implant center. PATIENTS: A consecutive sample of 12 children younger than 2 years at the time of cochlear implantation (8 boys and 4 girls). The cause of hearing loss was meningitis in 6 children and congenital in 6. INTERVENTIONS: Multichannel cochlear implantation using the Nucleus C124M (Cochlear Co, Sydney, Australia) device. Functional outcome was assessed using the Listening Progress Profile and the Categories of Auditory Performance. MAIN OUTCOME MEASURES: Perioperative and postoperative surgical complications and functional outcome. RESULTS: Eight children had a completely patent cochlea. Four children required a 3- to 5-mm drilling to reach the scala tympani because of ossification after meningitis. Full insertion was achieved in 11 patients; the other child received 18 electrodes. One patient had temporary facial nerve weakness; 2 others had wound edema and serous discharge that resolved with conservative management. In the longer term, 1 child experienced a single episode of acute otitis media; another had recurrent episodes of otitis media. Mean Listening Progress Profile scores increased from 1 to 42 and median Categories of Auditory Performance scores increased from 0 to 5 at 2 years postsurgery. Comparison with the scores in the 2- to 5-year group showed no significant differences. No significant tuning difficulties were experienced with all children. CONCLUSIONS: Cochlear implantation is feasible in children younger than 2 years without significant surgical complications or particular tuning difficulties. Functional results 2 years after implantation were as good as or better than those of children who underwent implantation between ages 2 and 5 years.

Cochlea↗
PubMed2005

Prevention of relapse following cognitive therapy vs medications in moderate to severe depression.

BACKGROUND: Antidepressant medication prevents the return of depressive symptoms, but only as long as treatment is continued. OBJECTIVES: To determine whether cognitive therapy (CT) has an enduring effect and to compare this effect against the effect produced by continued antidepressant medication. DESIGN: Patients who responded to CT in a randomized controlled trial were withdrawn from treatment and compared during a 12-month period with medication responders who had been randomly assigned to either continuation medication or placebo withdrawal. Patients who survived the continuation phase without relapse were withdrawn from all treatment and observed across a subsequent 12-month naturalistic follow-up. SETTING: Outpatient clinics at the University of Pennsylvania and Vanderbilt University. PATIENTS: A total of 104 patients responded to treatment (57.8% of those initially assigned) and were enrolled in the subsequent continuation phase; patients were initially selected to represent those with moderate to severe depression. INTERVENTIONS: Patients withdrawn from CT were allowed no more than 3 booster sessions during continuation; patients assigned to continuation medication were kept at full dosage levels. MAIN OUTCOME MEASURES: Relapse was defined as a return, for at least 2 weeks, of symptoms sufficient to meet the criteria for major depression or Hamilton Depression Rating Scale scores of 14 or higher during the continuation phase. Recurrence was defined in a comparable fashion during the subsequent naturalistic follow-up. RESULTS: Patients withdrawn from CT were significantly less likely to relapse during continuation than patients withdrawn from medications (30.8% vs 76.2%; P = .004), and no more likely to relapse than patients who kept taking continuation medication (30.8% vs 47.2%; P = .20). There were also indications that the effect of CT extends to the prevention of recurrence. CONCLUSIONS: Cognitive therapy has an enduring effect that extends beyond the end of treatment. It seems to be as effective as keeping patients on medication.

Adult↗
PubMedDate not supplied

Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support.

BACKGROUND: Over the past decade, high dose chemotherapy with autologous bone marrow (HDC-ABMT) support has been used increasingly in the treatment of patients with breast cancer. In evaluating the results of HDC-ABMT in patients with breast cancer, an assessment of quality of life can add to the traditional endpoints (toxicity, and disease-free and overall survival) that are routinely assessed in clinical trials. PURPOSE: This study evaluated the quality of life (QOL) of breast cancer patients who had survived 1 or more years following high dose chemotherapy with autologous bone marrow transplant (HDC-ABMT) support. METHODS: Eighty-two patients who had undergone HDC-ABMT were surveyed by written questionnaire and follow-up telephone interview at least 1 year following HDC-ABMT. Patients were asked to complete the Functional Living Index-Cancer (FLIC), the Symptom Distress Scale (SDS), and a survey of sexual function developed as part of the study. RESULTS: The mean FLIC score among all patients was 130 +/- 19.1 (possible range 22-154). FLIC scores were significantly lower in patients with evidence of recurrent disease than in patients who were free of disease. The most commonly reported symptoms after HDC-ABMT were insomnia, fatigue, and pain. Sexual interest and sexual activity were reported to be lower after participation in HDC-ABMT than prior to the procedure. The majority of patients who were employed outside the home prior to HDC-ABMT returned to work with a median time away from work of 48 weeks. CONCLUSIONS: Patients with breast cancer who survive 1 or more years following HDC-ABMT rate their QOL at a relatively high level and frequently return to work. Less than one-third of patients who were interviewed reported moderate to severe symptoms. Problems with sexual functioning were common. IMPLICATIONS: Future research is needed on long-term outcomes after HDC-ABMT and on specific areas of concern, such as sexual functioning.

Adult↗
PubMed2000

The expression of Met/hepatocyte growth factor receptor gene in giant cell tumors of bone and other benign musculoskeletal tumors.

Overexpression of the hepatocyte growth factor receptor (Met/HGF receptor), a transmembrane tyrosine kinase encoded by the MET proto-oncogene, is involved in transformation and invasive behavior of human carcinomas and sarcomas. We have previously found that bone sarcomas express high levels of Met/HGF receptor while in some cases the ligand HGF is co-expressed with the receptor, activating an autocrine loop. In this study, we analyzed 40 biopsy samples of a collection of giant cell tumors and other rare benign tumors of bone for expression of the MET proto-oncogene. These included nonossifying fibromas, osteoblastomas, desmoplastic fibromas of bone, chondroblastomas, and giant cell tumors of bone. Snap frozen samples were tested for the MET and HGF gene expression by immuno-histochemistry and Western blotting with anti-MET antibodies and RT-PCR. Over 50% of all cases scored positive for MET expression being constantly positive in recurrent or locally aggressive lesions. Sporadic co-expression of the Met/HGF receptor and ligand is also demonstrated. Met/HGF receptor expression in benign bone neoplasms suggests its early involvement in sarcomagenesis.

Adult↗
PubMed2004

Interventions for preventing depression after stroke.

BACKGROUND: Abnormal mood is an important consequence of stroke and may affect recovery and outcome. However, depression and anxiety are often not detected or inadequately treated. This may in part be due to doubts about whether anti-depressant treatments commenced early after the onset of stroke will prevent depression and improve outcome. OBJECTIVES: To determine if pharmaceutical or psychological interventions can prevent the onset of depression, including depressive illness and abnormal mood, and improve physical and psychological outcomes, in patients with stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register (June 2003). In addition we searched the following electronic databases: Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2002), MEDLINE (1966 to September 2002), EMBASE (1980 to September 2002), CINAHL (1982 to September 2002), PsychINFO (1967 to September 2002), Applied Science and Technology Plus (1986 to September 2002), Arts and Humanities Index (1991 to September 2002), Biological Abstracts (1969 to September 2002), General Science Plus (1994 to September 2002), Science Citation Index (1992 to September 2002), Social Sciences Citation Index (1991 to September 2002), and Sociofile (1974 to September 2002). Reference lists from relevant articles and textbooks were searched, and authors of known studies and pharmaceutical companies who manufacture psychotropic medications were contacted. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing different types of pharmaceutical agents (eg selective serotonin reuptake inhibitors) with placebo, or various forms of psychotherapy against standard care (or attention control), in patients with a recent clinical diagnosis of stroke, where the treatment was undertaken with the explicit intention of preventing depression. DATA COLLECTION AND ANALYSIS: The primary analyses focussed on the proportion of patients who met the standard diagnostic criteria for depression applied in the trials at the end of follow-up. Secondary outcomes included depression or mood scores on standard scales, disability or physical function, death, recurrent stroke, and adverse effects. MAIN RESULTS: Twelve trials involving 1245 participants were included in the review. Data were available for nine trials (11 comparisons) involving different pharmaceutical agents, and three trials of psychotherapy. The time from stroke onset to entry ranged from a few hours to six months, but most patients were recruited within one month of acute stroke. The duration of treatments ranged from two weeks to one year. There was no clear effect of pharmacological therapy on the prevention of depression or on other measures. A significant improvement in mood was evident for psychotherapy, but this treatment effect was small and from a single trial. There was no effect on diagnosed depression. REVIEWERS' CONCLUSIONS: This review identified a small but significant effect of psychotherapy on improving mood, but no effect of either pharmacotherapy or psychotherapy on the prevention of depressive illness, disability, or other outcomes. More evidence is therefore required before any recommendations can be made about the routine use of such treatments to improve recovery after stroke.

Affect↗