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PubMedDate not supplied

Protein expression and gene copy number analysis of topoisomerase 2alpha, HER2 and P53 in minimally invasive urothelial carcinoma of the urinary bladder--a multitissue array study with prognostic implications.

BACKGROUND: Due to their variable clinical course, there is a need for new prognostic parameters in minimally invasive (stage T1) bladder carcinomas. MATERIALS AND METHODS: Using multitissue arrays, protein expression and gene copy numbers of topoisomerase (TOP2alpha), HER2 and p53 were investigated by immunohistochemistry and by fluorescence in situ hybridization (FISH) in 73 T1 tumors. The results were compared with tumor recurrence and progression. RESULTS: The median TOP2alpha and p53 index was 21% (range, 3-59%) and 7% (range, 0-93%), respectively. HER2 overexpression (score 3+) was detected in 9 cases (12%). High TOP2alpha and p53 indices and HER2 overexpression were significantly associated with earlier tumor recurrence, but not with earlier tumor progression. While TOP2alpha and p53 gene amplification was detected in no case, 5 cases (8%) showed HER2 gene amplification, which was related to HER2 3+ score in 4 cases. Loss of TOP2alpha, HER2 and p53 gene was observed in 4 (8%), 8 (13%) and 6 cases (12%), respectively. By univariate analysis, TOP2alpha index (p=0.0267), HER2 score (p =0.028) and p53 index (p=0.0188) were significantly and loss of TOP2alpha gene (p=0.0575) tendentially correlated with tumor recurrence, while loss of HER2 gene (p=0.069) and loss of p53 gene (p=0.0587) were tendentially correlated with tumor progression. In a multivariate analysis, which also included tumor grade and T1 substage, TOP2alpha index (p=0.043) and p53 index (p=0.02) were identified as independent predictors of tumor recurrence and loss of p53 gene (p=0.012) and T1 substage (p=0.029) as independent predictors of tumor progression. CONCLUSION: Immuno-histochemical TOP2alpha and p53 staining as well as FISH analysis of p53 gene copy numbers and T1 substaging are helpful means of providing additional information on the biological behavior of T1 transitional cell carcinomas.

Adult↗
PubMed2002

Intravenous chlorpromazine in the emergency department treatment of migraines: a randomized controlled trial.

The aim of this study is to assess, in a double blind randomized clinical trial, the effect of chlorpromazine (CPZ) on the pain and associated symptoms in patients with migraine. Sixty patients with migraine with aura and 68 patients with migraine without aura were assigned at random to receive IV 0.1 mg/Kg CPZ or placebo. We assessed pain intensity, nausea, photophobia, and phonophobia at baseline, 30 min, and 60 min post-IV administration. End-point efficacy at 60 min was used to calculate the number needed to treat (NNT). We also recorded adverse effects, need for rescue medication at 24 h, and recurrence of headache at 24 h. We found clinically and statistically significant (p < 0.01) improvement associated with CPZ in pain scores, nausea, photophobia, phonophobia, and need for rescue medication, all at 60 min, and in rate of recurrence at 24 h, both in patients with and without aura. NNT = 2. Those allocated to CPZ had less nausea and dyspepsia, but more drowsiness and postural hypotension than those receiving placebo. CPZ is an excellent option for the treatment of migraines, with and without aura, in the Emergency Department.

Chlorpromazine↗
PubMed2003

Clinical outcomes and changes in venous hemodynamics after subfascial endoscopic perforating vein surgery.

BACKGROUND: We evaluated the clinical results of subfascial endoscopic perforating vein surgery (SEPS) in patients with severe chronic venous insufficiency (CVI) (clinical class 4-6) and assessed the hemodynamic changes associated with SEPS using air plethysmography (APG). METHODS: Forty-five patients with severe CVI who had undergone SEPS were evaluated. Clinical score and venous hemodynamics, as measured by APG before operation and at 1 month and 1 year after operation, were compared using the Wilcoxon signed rank test. Patient satisfaction (on a visual analogue scale of 0 to 100%) was also assessed. RESULTS: There were 29 men and 16 women; their mean age was 60 years (range, 37-83). Thirty-five patients (78%) had active venous ulcers; the ulcers' mean size was 7.8 +/- 11.9 cm2 and the mean duration of ulceration was 9 +/- 10 months. There were no hospital deaths. Postoperative complications were uncommon (one groin wound infection and one case of thrombophlebitis). At a mean follow-up of 15 +/- 9 months, 34 ulcers (97%) had healed. The cumulative ulcer healing was 82% at 3 months. There were five recurrent ulcers (15%). Significant improvement was seen in the clinical scores (10 +/- 3 before operation, 6 +/- 4 at 1 month, and 4 +/- 3 at 1 year after operation). The venous filling index was also significantly improved after operation; this improvement was maintained at 1-year follow-up (7.36 +/- 6.23 ml/sec before operation, 3.63 +/- 3.90 ml/sec at 1 month, and 3.14 +/- 2.06 ml/sec at 1 year). The degree of patient satisfaction was also remarkable, with 74 +/- 17% and 90 +/- 12% satisfaction at 1-month and 1-year follow-up, respectively. CONCLUSIONS: SEPS is a safe and effective treatment for patients with severe CVI. It leads to hemodynamic improvement, with rapid ulcer healing, and it is associated with a high degree of patient satisfaction.

Adult↗
PubMed2005

Ineffectiveness of Lactobacillus johnsonii LA1 for prophylaxis of postoperative recurrence in Crohn's disease: a randomised, double blind, placebo controlled GETAID trial.

BACKGROUND AND AIMS: Early endoscopic recurrence is frequent after intestinal resection for Crohn's disease. Bacteria are involved, and probiotics may modulate immune responses to the intestinal flora. Here we tested the probiotic strain Lactobacillus johnsonii LA1 in this setting. PATIENTS AND METHODS: This was a randomised, double blind, placebo controlled study. Patients were eligible if they had undergone surgical resection of <1 m, removing all macroscopic lesions within the past 21 days. Patients were randomised to receive two packets per day of lyophilised LA1 (2 x 10(9) cfu) or placebo for six months; no other treatment was allowed. The primary endpoint was endoscopic recurrence at six months, with grade >1 in Rutgeerts' classification or an adapted classification for colonic lesions. Endoscopic score was the maximal grade of ileal and colonic lesions. Analyses were performed primarily on an intent to treat basis. RESULTS: Ninety eight patients were enrolled (48 in the LA1 group). At six months, endoscopic recurrence was observed in 30/47 patients (64%) in the placebo group and in 21/43 (49%) in the LA1 group (p = 0.15). Per protocol analysis confirmed this result. Endoscopic score distribution did not differ significantly between the LA1 and placebo groups. There were four clinical recurrences in the LA1 group and three in the placebo group. CONCLUSION: L johnsonii LA1 (4 x 10(9) cfu/day) did not have a sufficient effect, if any, to prevent endoscopic recurrence of Crohn's disease.

Adult↗
PubMed2000

Long-term neoadjuvant hormone therapy prior to radical prostatectomy: evaluation of risk for biochemical recurrence at 5-year follow-up.

OBJECTIVES: To assess the effects of 8 months of neoadjuvant therapy on pathologic stage and biochemical recurrence rates. METHODS: One hundred fifty-six men with clinically localized prostate cancer were treated with neoadjuvant combined androgen withdrawal therapy for 8 months prior to radical prostatectomy. Preoperative clinical stage, Gleason score, and serum prostate-specific antigen (PSA) levels were compared with treatment outcome (pathologic stage and PSA recurrence). RESULTS: PSA at diagnosis was 10 microg/L or higher in 36% with a mean of 11.5 microg/L. Clinical stage was T1c in 18%, T2 in 74%, and T3a in 8%. Gleason score was 6 or lower in 76% and 7 or higher in 24%. Pathologic stage was T0 in 13%, T2 in 66%, T3 (specimen confined) in 13%, T3 (margin positive) in 6%, and TxN+ in 2%. Incidence of positive margins increased with clinical stage T3a versus organ-confined disease (25% versus 4%, P <0.05), pretreatment Gleason scores 7 or higher versus Gleason scores 6 or lower (11% versus 4%, P = NS), and pretreatment PSA levels higher than 10 microg/L compared with PSA levels lower than 10 microg/L (15% versus 0%, P <0.01). Overall PSA recurrence rate was 12.2% after a mean postoperative follow-up of 54 months. Risk of PSA recurrence increased with clinical stage (25% T3 versus 11% organ confined, P <0.01), pretreatment PSA (7% if PSA lower than 10 microg/L versus 21% if 10 microg/L or higher, P <0.02), Gleason score (9% if 6 or lower versus 22% if 7 or higher, P <0.02), and pathologic stage (6% of pT2, 24% of pT3M-, and 56% of pT3M+, P <0.01). PSA recurrences occurred in 6% of patients with no adverse preoperative risk factors, 12% with any one of the high-risk factors, and 29% with any two of the high-risk factors. CONCLUSIONS: Risk of PSA recurrence after 8 months of neoadjuvant therapy is low after 5 years of follow-up and remains proportional to the presence of adverse preoperative risk factors. Prospective randomized studies are required to determine whether longer duration of neoadjuvant therapy reduces the risk of biochemical recurrence after radical prostatectomy.

Adult↗
PubMed2000

Executive dysfunction and long-term outcomes of geriatric depression.

BACKGROUND: This study investigated the relationship of executive and memory impairment to relapse, recurrence, and course of residual depressive symptoms and signs after remission of geriatric major depression. METHODS: Fifty-eight elderly subjects remitted from major depression received continuation nortriptyline treatment (plasma levels 60-150 ng/mL) for 16 weeks and then were randomly assigned to either nortriptyline maintenance therapy or placebo for up to 2 years. Diagnosis was made using the Research Diagnostic Criteria and the DSM-IV criteria after an interview using the Schedule for Affective Disorders and Schizophrenia. Executive dysfunction and memory were assessed with the Dementia Rating Scale, disability and social support were rated with the Philadelphia Multiphasic Instrument, and medical burden was assessed with the Cumulative Illness Rating Scale. RESULTS: Abnormal initiation and perseveration scores, but not memory impairment, were associated with relapse and recurrence of geriatric depression and with fluctuations of depressive symptoms in the whole group and in subjects who never met criteria for relapse or recurrence during the follow-up period. Memory impairment, disability, medical burden, social support, and history of previous episodes did not significantly influence the outcome of depression in this sample. CONCLUSIONS: Executive dysfunction was found to be associated with relapse and recurrence of geriatric major depression and with residual depressive symptoms. These observations, if confirmed, will aid clinicians in identifying patients in need of vigilant follow-up. The findings of this study provide the rationale for investigation of the role of specific prefrontal pathways in predisposing or perpetuating depressive syndromes or symptoms in elderly patients.

Age Factors↗
PubMed2006

[Quantitative evaluation of the focus range of juvenile onset recurrent respiratory papillomatosis].

OBJECTIVE: To investigate the clinical application of quantitative evaluation of the focus range of juvenile onset recurrent respiratory papillomatosis (JO-RRP). METHOD: Disease severity was scored as the sum of ratings of 1 (minimal), 2 (moderate), or 3 (severe) for involvement of 22 areas of the respiratory tract and digestive tract. Sixty-eight cases with JO-RRP patients underwent 238 procedures were removed papillomas. A Storz laryngoscope was used to exposed and suspend the larynx, and an endoscope video system was used to display the pathological changes. RESULT: The score of these cases range from 2 to 20, most of them range from 7 to 14. Papillomas were found in the larynx in each case, vocal cords and false vocal cords were the most common places involved. Nose, pharynx, hard palate, lung or esophagus involved was seldom found. The score declined as the patients underwent more procedures. It is in accord with the clinical characteristic of JO-RRP. CONCLUSION: We concluded that our means of JO-RRP focus range quantitative evaluation could evaluate the severity and clinical curative effect objectively. It was a scientific and convenient way, and worth to be generalized.

Child↗
PubMedDate not supplied

Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa.

Small intestinal submucosa (SIS) has been used for reinforcement of other tissues in the body with success and has been shown to act as a bioabsorbable tissue scaffold that promotes and assists healing. The effectiveness of using porcine SIS as a tissue scaffold for reinforcement of rotator cuff repair is unclear. This study evaluates both clinical and magnetic resonance imaging (MRI) follow-up at 6 months in patients with large and massive rotator cuff tears treated with open repair and SIS reinforcement or interpositional grafting. Eleven consecutive patients who underwent open rotator cuff repair with SIS augmentation for large or massive tears were selected retrospectively, and their charts were reviewed. Magnetic resonance images were then obtained at least 6 months after the index procedure. Patients were evaluated clinically and with a questionnaire, and an American Shoulder and Elbow Surgeons shoulder score was calculated. Results showed retear on MRI in 10 of 11 patients with recurrence of large, retracted tears. One repair remained intact by MRI evaluation at 10 months. Clinically, there was no statistically significant difference between preoperative and postoperative shoulder scores by use of a paired t test analysis (P =.70). Five patients had worse scores postoperatively. We concluded that, though SIS xenografting may be effective in other areas of the body for tendon healing, its use in reinforcement of large and massive rotator cuff repairs seems to be ineffective and does not improve clinical outcome.

Aged↗
PubMed2000

Gleason score 7 prostate cancer: a heterogeneous entity? Correlation with pathologic parameters and disease-free survival.

OBJECTIVES: Gleason score 7, in different proportions of grades 3 and 4, is the score most frequently assigned to prostate cancer in our radical prostatectomy specimens (RPSs). We correlated the major grade component of score 7 tumors with clinicopathologic parameters and disease-free survival. METHODS: All Gleason score 7 RPSs were classified as having a major grade of 3 or 4 carcinoma. The two groups were compared according to patient age, race, serum prostate-specific antigen (PSA) level, clinical and pathologic stage, tumor volume, and biochemical recurrence. RESULTS: Of the 534 patients analyzed, 356 and 178 had major grade 3 or 4 tumors, respectively. Compared with patients with 3+4 tumors, those with 4+3 had significantly more advanced clinical and pathologic stages, larger tumor volume, higher preoperative PSA levels, and older age and a higher proportion were African American (P <0.05 for all above parameters). With a mean follow-up of 34.6 months, patients with 3+4 tumors experienced lower rates of PSA recurrence than did those with 4+3 tumors (P = 0.0021). Furthermore, for the subset of patients with organ-confined disease, multivariable analysis that included race, age, clinical stage, preoperative PSA level, tumor volume, and major grade component found only the latter to be a significant predictor of recurrence, with patients who had major grade 4 component tumors experiencing a higher incidence of PSA recurrence than those with major grade 3 tumors (P = 0.012). CONCLUSIONS: The major grade 4 component in Gleason score 7 carcinoma indicates a higher likelihood of biochemical recurrence, particularly for the increasing proportion of patients with organ-confined disease after radical prostatectomy.

Aged↗
PubMed2004

Arthroscopic versus open treatment of Bankart lesion of the shoulder: a prospective randomized study.

PURPOSE: The purpose of this study was to compare the results of arthroscopic and open repair of isolated Bankart lesions of the shoulder using metallic suture anchors. TYPE OF STUDY: Prospective randomized clinical study. METHODS: Sixty patients with traumatic anterior shoulder instability underwent a surgical repair of an isolated Bankart lesion. The patients were divided into 2 groups of 30 patients each. In group 1, an arthroscopic repair was performed, and in group 2, an open procedure was performed. The groups were homogeneous for gender, age, dominance, number of dislocations, time elapsed between first dislocation and surgery, and pathologic findings. In all cases of both groups, the lesion was repaired using metallic suture anchors carrying nonabsorbable braided sutures. Postoperative rehabilitation was the same for the 2 groups. Two years' follow-up evaluation included Constant and Rowe shoulder scores. Statistical analysis of data was performed using an unpaired t test (significance for P <.05). RESULTS: No recurrence of dislocation of the involved shoulder has been reported in either group. Follow-up Constant and Rowe scores of the 2 groups were not significantly different. The only significant difference seen between the 2 groups was for range of motion evaluation with the Constant score. The mean value for group 1 (39.6 +/- 0.8) was significantly greater (P =.017) than that for group 2 (37.8 +/- 2.0). CONCLUSIONS: Arthroscopic repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion. Open repair does not offer a significantly better 2-year result in terms of stability, and furthermore, can negatively affect the recovery of full range of motion of the shoulder. LEVEL OF EVIDENCE: Level I.

Adult↗
PubMed2005

Chondroblastoma of bone: long-term results and functional outcome after intralesional curettage.

We undertook this retrospective study to determine the rate of recurrence and functional outcome after intralesional curettage for chondroblastoma of bone. The factors associated with aggressive behaviour of the tumour were also analysed. We reviewed 53 patients with histologically-proven chondroblastoma who were treated by intralesional curettage in our unit between 1974 and 2000. They were followed up for at least two years to a maximum of 27 years. Seven (13.2%) had a histologically-proven local recurrence. Three underwent a second intralesional curettage and had no further recurrence. Two had endoprosthetic replacement of the proximal humerus and two underwent below-knee amputation after aggressive local recurrence. One patient had the rare malignant metastatic chondroblastoma and eventually died. The mean Musculoskeletal Tumour Society functional score of the survivors was 94.2%. We conclude that meticulous intralesional curettage alone can achieve low rates of local recurrence and excellent long-term function.

Adolescent↗
PubMed2000

Race is not an independent predictor of biochemical recurrence after radical prostatectomy in an equal access medical center.

OBJECTIVES: To compare the racial differences in clinical and pathologic features between black and white men who underwent radical prostatectomy (RP) in an equal access health care center and to determine whether race is an independent predictor of biochemical recurrence. METHODS: A retrospective survey of 273 patients (125 black, 148 white) who underwent RP at the West Los Angeles Veterans Affairs Medical Center between 1991 and 1999 was undertaken. Patients were analyzed for racial differences in age at diagnosis, clinical stage, preoperative serum prostate-specific antigen (PSA), and Gleason score of the prostate biopsy specimens. Surgical specimens were studied to determine pathologic stage, Gleason score, incidence of seminal vesicle invasion, positive surgical margins, capsular penetration, and pelvic lymph node involvement. Patients were followed for PSA recurrence (greater than 0.2 ng/mL). Multivariate analysis was used to determine the clinical and pathologic variables that were significant in predicting biochemical recurrence after RP and to determine whether race was an independent predictor of biochemical failure. RESULTS: No significant differences were found between black and white men in the preoperative factors (clinical stage, age at diagnosis, biopsy Gleason score, and serum PSA) or in the pathologic features of the RP specimens (Gleason score, pathologic stage, incidence of positive surgical margins, capsular penetration, seminal vesicle invasion, or lymph node involvement). In addition, no differences were found between black and white men in the PSA recurrence rates after RP using Kaplan-Meier survival curves (P = 0.651). Multivariate analysis revealed that serum PSA (P = 0.010), biopsy Gleason score (P = 0. 003), younger age (P = 0.010), surgical Gleason score (P = 0.005), and lymph node involvement (P = 0.022) were all independent predictors of biochemical recurrence. Race was not a significant predictor of biochemical failure in multivariate analysis (P = 0. 199). CONCLUSIONS: In an equal access medical care facility, no differences were evident between black and white men in the preoperative clinical factors or the pathologic features of the RP specimens. In addition, no differences were observed in the PSA recurrence rates after RP. Serum PSA, biopsy Gleason score, younger age, surgical Gleason score, and lymph node involvement were all independent predictors of biochemical recurrence. Race was not an independent predictor of biochemical recurrence.

Black People↗
PubMed2005

Immunohistochemical study of chromogranin A in Stage D2 prostate cancer.

OBJECTIVES: To study the clinical and pathologic factors that affect the time to recurrence after hormonal therapy in patients with Stage D2 prostate cancer and to determine whether cells positive for chromogranin A (CgA) in tissue biopsied at diagnosis is a useful marker for predicting the duration to recurrence after hormonal therapy. METHODS: A total of 50 patients diagnosed with Stage D2 prostate cancer at our institution from January 1998 to December 2001 were studied. The needle prostate biopsy specimens obtained at diagnosis were stained by immunohistochemistry using the labeled streptavidin biotin method, and the results were considered positive if CgA-positive cells constituted 10% or more of the tumor area. RESULTS: No significant differences were found between patients on the basis of the time to recurrence of less than 2 years versus 2 years or more with respect to prostate-specific antigen level, patient age, Gleason score, or extent-of-disease grade. Of the 50 patients, 11 (22.0%) had positive cell staining for CgA. No significant differences were found between the CgA-positive group and the CgA-negative group in age, prostate-specific antigen level, Gleason score, extent-of-disease grade, T stage, or N stage. The rate of freedom from recurrence after 2 years as analyzed by the Kaplan-Meier method was 18.2% for the CgA-positive group and 47.4% for the CgA-negative group, and the CgA-positive group had a significantly shorter time to recurrence (P < 0.0122). CONCLUSIONS: The results of our study have shown that patients with overexpression of CgA-positive cells in the prostate have a significantly shorter time to recurrence after hormonal therapy than patients with CgA-negative cells; thus, CgA expression may be a useful marker predictive of the time to recurrence.

Aged↗
PubMed1998

[Interim results of surgical therapy of patellar dislocation by Insall proximal reconstruction].

Between 1984 and 1991, 57 patients with diagnosis of an acute or recurrent patellar dislocation were treated operatively using proximal realignment with vastus medialis transfer and lateral release (Insall operation). A total of 45 patients (15 with acute and 30 with recurrent patellar dislocation) were reviewed at an average follow-up of 6.5 years (2-9.6 years). The average age at injury was 21.5 years, with a predominance of female patients. Follow-up examination included routine knee examination, clinical review using the modified knee scoring scale of Larsen and Lauridsen, sports activity level and subjective satisfaction. Radiographics from 27 patients (60%) were evaluated. One patient from each group suffered recurrence of patellar dislocation. All patients had stable knee joints and a full range of motion. There was no statistical difference in the pre- and postoperative sports activity level in both groups. Three patients (19.9%) with acute patellar dislocation and seven patients (23.3%) with recurrent patella dislocation had excellent results using the Larsen and Lauridsen score scale. Ten patients (66.6%) with acute and 12 (39.9%) with recurrent dislocation had good results. One patient with recurrent patellar dislocation had a fair result. Subjective evaluation revealed the operative result in 93% of cases as very good, good or satisfactory. Patellofemoral osteoarthritis was seen in 11 (40.7%) of 27 patients. Our results show good clinical results for the treatment of acute patellar dislocation in young, active patients with the proximal realignment procedure. The recurrence rate of patellar dislocation can be reduced for acute and recurrent patellar dislocation. Subjective satisfaction with this procedure is rated very good.

Acute Disease↗
PubMed2003

Arthroscopic capsular shrinkage of the shoulder for the treatment of patients with multidirectional instability: Minimum 2-year follow-up.

PURPOSE: The study goal was to evaluate the arthroscopic treatment of patients with multidirectional instability of the shoulder (MDI). MDI is a disabling condition as a result of pain and restriction of activity. The treatment of MDI is primarily nonsurgical (supervised physiotherapy). TYPE OF STUDY: Prospective cohort study. METHODS: Arthroscopic capsular shrinkage, using a bipolar radiofrequency system, was performed in 32 patients (33 shoulders). The mean age was 27 years (range, 15 to 49). The Constant score was used for assessment preoperatively and at 6-month intervals. In 8 patients, labral lesions were revealed at arthroscopy and were addressed using arthroscopic methods. RESULTS: The follow-up was from 24 to 33 months (26 mean). Patients without labral pathology (group A) and patients with labral lesions (group B) are discussed separately. Group A showed an increase in the mean Constant score at 6 months, but the scores reached a plateau after 6 months. Statistical analysis using 1-way analysis of variance (ANOVA) showed that the mean difference between the preoperative Constant score and the score at latest follow-up was statistically significant (P <.0001; 95% confidence interval, 13.4 to 31.6; standard error, 2.2). The rate of failure or complication was 16%. Three patients experienced recurrence of instability and another developed adhesive capsulitis. Overall, patient satisfaction was 83%. Group B showed an improvement in the Constant scores, and all 8 patients were satisfied. No clinical recurrence of the instability was seen in this group. However, 1 patient developed adhesive capsulitis. This group is too small to draw any statistically valid conclusions. CONCLUSIONS: The early results are encouraging. Postoperative physiotherapy is of paramount importance. Continued long-term follow-up of this relatively new technique is required to determine the failure rate increase that is likely to occur at longer time intervals.

Activities of Daily Living↗
PubMed2004

Limited efficacy of salvage radiotherapy for biopsy confirmed or clinically palpable local recurrence of prostate carcinoma after surgery.

BACKGROUND AND PURPOSE: To assess the efficacy of salvage radiotherapy (RT) for biopsy confirmed or clinically palpable local recurrence of prostate adenocarcinoma after radical prostatectomy (RP). PATIENTS AND METHODS: We retrospectively analyzed 44 patients treated with salvage RT for biopsy confirmed or clinically palpable local recurrence between 1991 and 2000. Thirty-six had positive biopsy for local recurrence and the rest without histological confirmation had clinically palpable disease. All had rising PSA at the time of RT (median: 3.7). Median interval from RP to RT was 2.6 years. Thirty-six received salvage RT alone, while eight had a short course (<4 months) of androgen ablation prior to RT. RT doses were 60-66Gy in 30-33 fractions. Freedom from PSA failure was defined as the maintenance of PSA<or=0.2. RESULTS: Median follow-ups from RP and salvage RT were 8.7 and 5.5 years, respectively. All but one achieved local control clinically. The actuarial PSA relapse-free and survival rate at 5 years were 11 and 87%, respectively. On Cox regression analysis, significant predictors for relapse were PSA level prior to salvage RT, and Gleason score. CONCLUSIONS: The efficacy of salvage RT alone for local recurrence was limited. This study suggests a need to explore other strategies incorporating systemic therapy, and the importance of timely referral for consideration of salvage RT in patients with rising PSA after surgery.

Adenocarcinoma↗
PubMed2006

A patient with severe, recurrent hypoglycemia and glycemic lability who underwent islet transplantation.

BACKGROUND: A 48-year-old woman who was diagnosed with type 1 diabetes at 5 years of age presented to our Clinical Islet Transplant Program with severe, recurrent hypoglycemia and glycemic lability. She was diligent with her diet, used a continuous subcutaneous insulin infusion pump (32 U per day), and monitored her glucose levels typically eight times a day. The patient usually had one hypoglycemic reaction a day, experienced a severe reaction once a month, and had marked variability of her glucose values. On presentation, her HYPO score was 584 and her lability index was 868 mmol/l(2)/h per week. INVESTIGATIONS: HYPO score, lability index score, screening for diabetes complications, and routine pretransplant evaluation. DIAGNOSIS: Severe, recurrent hypoglycemia and glycemic lability associated with type 1 diabetes. MANAGEMENT: The patient underwent islet transplantation. Post-transplant, the problems with hypoglycemia abated and excellent stable glycemic control was attained, although some side effects from the immunosuppressive drug, sirolimus, were evident. Insulin was reinstituted 2.5 years after surgery, at lower doses than before the transplant because of deterioration in graft function. Occasional episodes of hypoglycemia have occurred and some glycemic lability has recurred, although endogenous insulin secretion is still preserved.

Blood Glucose↗
PubMed1982

Recurrent venous thrombosis: the sole manifestation of an occult myeloproliferative disease.

A myeloproliferative disorder manifested by thrombocytosis, a high leukocyte alkaline phosphatase (LAP) score and an increased red blood cell mass was found in a 64-yr-old woman. During the previous 15 yr, recurrent venous occlusions had taken place, necessitating the resection of ischemic bowel segments and leading to extrahepatic portal venous obstruction. Numerous blood counts obtained during repeated hospitalizations were normal, and these thrombotic events remained unexplained. The sequence of events strongly suggests that the myeloproliferative disorder existed in an occult form during these years and was responsible for the venous occlusions. The possibility of a "smoldering" myeloproliferative disorder should be considered in patients with otherwise inexplicable thrombotic phenomena.

Female↗