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PubMed2005

Tarsal navicular stress injury: long-term outcome and clinicoradiological correlation using both computed tomography and magnetic resonance imaging.

BACKGROUND: Tarsal navicular stress fracture is a condition that has curtailed many athletic careers. Management protocols remain varied and somewhat controversial. HYPOTHESES: (1) Clinical practice does not mirror the recommendations reported from previous case series. (2) Clinical outcome is poor when navicular stress fracture is managed in a variety of ways. (3) Imaging does not correlate strongly with clinical status at long-term follow-up after navicular stress fracture. STUDY DESIGN: Case series (prognosis); Level of evidence, 4. METHODS: From a computer registry, we identified patients who had attended a university sports medicine center between 1996 and 2002 and whose final diagnosis was navicular stress fracture (n = 11) or navicular stress reaction (n = 9). All patients had provided demographic and clinical data at their original evaluation, and all had undergone bone scans and computed tomographic imaging. These data were extracted by chart review. Follow-up clinical and imaging assessments took place a median of 3.7 years later (range, 1-15.7 years). At these assessments, we administered a questionnaire, performed a structured physician examination (blinded to other data), scanned both feet with computed tomography, and obtained magnetic resonance images of the affected foot. RESULTS: Only 2 of 11 patients (18%) with navicular stress fractures received the literature-recommended treatment of at least 6 weeks' nonweightbearing cast immobilization. Of these 11 patients, only 6 (55%) returned to sports at their previous level. Only 3 patients with navicular stress fractures regained normal imaging appearance at follow-up. Pain score, stiffness, sporting success, current sporting involvement, and recurrence/time to recurrence were not statistically associated with computed tomographic or magnetic resonance imaging parameters. Of 9 patients with navicular stress reactions, 7 developed clinical and radiological features of navicular stress fracture, but 6 of 9 patients (67%) returned successfully to sports. CONCLUSIONS: Contemporary management of navicular stress fracture differs from that recommended in the literature. This stress fracture prevented almost half of the participants in this study from returning to sports at their previous level. Imaging parameters do not correlate with the clinical assessment of a patient at long-term follow-up of navicular stress fracture.

Adolescent↗
PubMed2005

A prospective multicenter study of the efficacy and tolerability of cryopreserved allogenic human keratinocytes to treat venous leg ulcers.

Allogeneic human keratinocyte cultures have been used to treat burn wounds, donor sites, and chronic skin ulcers with some success. Cryopreservation of these cultures allows for the production of large standardized batches that are readily available for use. The aim of the study presented in this report was to study effects of cryopreserved cultured allogenic human keratinocytes (CryoCeal) on chronic lower extremity wounds. Parameters were measured to study efficacy, tolerability, pain associated with chronic wounds, and quality of life of patients. Twenty-seven patients with hard-to-heal venous leg ulcers received a maximum of 9 applications of CryoCeal in a prospective, uncontrolled multicenter study lasting 48 weeks. Eleven out of 27 patients (41%; 95% CI: 22%-61%) had complete wound closure within 24 weeks (1 week). The time required for complete wound closure in these 11 patients ranged from 4.1 to 24.9 weeks. Only 1 patient had recurrence of the ulcer at 48 weeks. Local (wound) pain scores decreased from a mean of 2.5 at baseline to 0.9 at week 24. Fifty percent of the patients attained a pain score of 0 after 12 weeks and remained stable at this score until the end of the study. Overall, the patient quality of life was better at week 24, compared to baseline values. The treatment was well tolerated, and wound infection was the most frequently occurring adverse event.

Adult↗
PubMed2006

The use of complementary and alternative medicines among patients with locally advanced breast cancer--a descriptive study.

BACKGROUND: Complementary and alternative medicine (CAM) use is common among cancer patients. This paper reviews the use of CAM in a series of patients with locally advanced breast cancer (LABC). METHODS: Women with LABC attending a specialist clinic at a single Canadian cancer centre were identified and approached. Participants completed a self-administered survey regarding CAM usage, beliefs associated with CAM usage, views of their risks of developing recurrent cancer and of dying of breast cancer. Responses were scored and compared between CAM users and non-users. RESULTS: Thirty-six patients were approached, 32 completed the questionnaire (response rate 89%). Forty-seven percent of LABC patients were identified as CAM users. CAM users were more likely to be younger, married, in a higher socioeconomic class and of Asian ethnicity than non-users. CAM users were likely to use multiple modalities simultaneously (median 4) with vitamins being the most popular (60%). Motivation for CAM therapy was described as, "assisting their body to heal" (75%), to 'boost the immune system' (56%) and to "give a feeling of control with respect to their treatment" (56%). CAM therapy was used concurrently with conventional treatment in 88% of cases, however, 12% of patients felt that CAM could replace their conventional therapy. Psychological evaluation suggests CAM users perceived their risk of dying of breast cancer was similar to that of the non-Cam group (33% vs. 35%), however the CAM group had less severe anxiety and depression. CONCLUSION: The motivation, objectives and benefits of CAM therapy in a selected population of women with LABC are similar to those reported for women diagnosed with early stage breast cancer. CAM users display less anxiety and depression and are less likely to believe they will die of their breast cancer. However the actual benefit to overall and disease free survival has yet to be demonstrated, as well as the possible interactions with conventional therapy. Consequently more research is needed in this ever-growing field.

Adult↗
PubMed2007

Hepatitis C-associated granulomas after liver transplantation: morphologic spectrum and clinical implications.

Liver granulomas have been described in biopsy specimens from people with de novo chronic hepatitis C virus (HCV) infection and in allograft biopsy specimens from recipients of transplants for HCV-related liver disease. The latter have not been well studied, and there are no data regarding the prevalence, morphologic spectrum, and clinical significance of HCV-associated granulomas after liver transplantation. We observed granulomas in allograft liver biopsy specimens of 4 (8%) of 53 recipients of transplants for HCV-related end-stage liver disease during a 3-year period. Initial appearance of granulomas ranged from 4 to 41 weeks after transplantation. Lobular and portal nonnecrotizing, epithelioid granulomas and lobular microgranulomas were observed, with the latter predominating. Serum transaminase and alkaline phosphatase levels were significantly higher in patients with granulomas than in age- and sex-matched control subjects, but histologic disease activity, cellular rejection scores, HCV genotypes, viral titers, and retransplantation rate owing to recurrent disease were not significantly different. Our study suggests that a granulomatous response to HCV infection occurs in a subset of patients after transplantation; however, this histologic finding does not portend a worse clinical outcome.

Adult↗
PubMed2002

Crotaline Fab antivenom for the treatment of children with rattlesnake envenomation.

OBJECTIVE: There is little data regarding safety or efficacy of Crotalinae polyvalent immune Fab (ovine) antivenom (crotaline Fab) in pediatric patients. Our objective was to provide the first information regarding safety and effectiveness of this new drug in children. METHODS: Data were collected prospectively and retrospectively for all consecutive pediatric patients bitten by rattlesnakes and treated at 2 urban hospitals during 2001. Cases were included if there were signs of envenomation at presentation, patient age was 13 years or less, and there was administration of crotaline Fab. Cases were excluded if antivenin (Crotalidae) polyvalent (equine origin, the conventional antivenom) was given. Primary outcome variables were snakebite severity scores throughout the course of therapy, number of vials of crotaline Fab administered, occurrence of allergic reactions, adjunct surgical therapy, and the presence of permanent sequelae or serum sickness identified at follow-up. RESULTS: In the 12 cases studied, ages ranged from 14 months to 13 years (mean: 6.9; standard deviation: 4.2). Presentation snakebite severity scores ranged from 2 to 9 (mean: 5.3; standard deviation: 2.3). Total crotaline Fab doses ranged from 4 to 22 vials (mean: 12.7; standard deviation: 5.4). Initial control of symptoms was achieved with 4 to 16 vials (mean: 7.7; standard deviation: 3.7), and severity scores stabilized or improved within 24 hours in all patients. Recurrence of local swelling occurred in 1 case despite scheduled repeat doses of antivenom. No cases required surgical intervention, and no permanent sequelae were identified. No immediate or delayed hypersensitivity reactions occurred. CONCLUSION: In this group of pediatric patients treated for rattlesnake envenomation, crotaline Fab antivenom was safe and seemed to be effective.

Adolescent↗
PubMed2005

Combined approach for otogenic brain abscess.

Otogenic intracranial infections usually require both neurosurgical and otolaryngological surgery. This prospective, non-randomized study investigated the value of combining both surgical procedures. Thirteen patients with otogenic intracranial abscess were treated by mastoidectomy and abscess removal through the same incision between 1993 and 2002. Another 12 patients underwent abscess removal or mastoidectomy followed by the other procedure within 7 days. The clinical features of the patients were compared. Four patients died in our series. All four patients had Glasgow Coma Scale (GCS) scores of 7 or less. The preoperative GCS score was the main factor in mortality. One patient had recurrence after the combined approach compared to nine patients with recurrence after separate procedures. The surgical procedure was the main factor affecting the recurrence rate. The combined approach and total capsule excision of the abscess may reduce the risk of recurrence of otogenic intracranial abscess.

Adolescent↗
PubMed1999

Omnifit-HA stem in total hip arthroplasty. A 2- to 5-year followup.

Outcomes of the first 60 noncemented Omnifit-HA total hip arthroplasties in 56 patients were studied prospectively for 2 to 5 years. The femoral prosthesis had a proximal third circumferential hydroxyapatite coated surface treatment. The acetabular component was a hemispheric modular, porous, nonhydroxyapatite press fit cup, supplemented with screw fixation. One cup was revised for recurrent dislocation, with no femoral revisions. The mean Harris hip score was 54 (range, 20-76) before surgery and 96 (range, 83-100) at final followup, with all patients having an excellent or good outcome. Mild thigh pain occurred in 6% of hips. Subsidence occurred in 9% of hips (range, 1-2.8 mm); in all cases, subsidence was nonprogressive after 1 year. Stable bone ingrowth fixation was evident at the hydroxyapatite coated portion in 100%. A sclerotic reactive line adjacent to the nonhydroxyapatite portion of the stem occurred in 81% but was not adjacent to the hydroxyapatite coated portion of any stem. Endosteal condensation occurred in 90% and correlated with a higher Harris hip score (mean score, 96 with, 91 without). Endosteal lysis adjacent to or distal to the hydroxyapatite coating did not occur. Lytic lesions at the calcar occurred in 19% and correlated with a greater linear acetabular polyethylene wear rate (mean, 0.30 mm/year with lytic lesions, 0.17 mm/year without). This noncemented stem with proximal third hydroxyapatite coating showed excellent short term clinical and radiographic outcome. Absence of distal endosteal lysis, along with correlation of calcar erosion to polyethylene wear, suggests that early circumferential bony ingrowth afforded by hydroxyapatite coating prevents distal endosteal access to polyethylene debris at short term followup.

Adult↗
PubMedDate not supplied

[Proliferative markers of meningiomas: immunohistochemical analysis and prognostic value].

Routine pathological examination cannot precisely predict the clinical course of meningiomas because even histologically benign tumors may recur after total removal. And so, numerous efforts have been made for evaluation of meningioma growth fraction and its prognostic value. In this study the prognostic significance of DNA toposiomerase II alpha (topoII) and cyclin A immunohistochemistry was examined in a series of 263 meningiomas. The topoII and cyclin A scores exhibited a close correlation with Ki-67 immunostaining. Significant differences between the indices for all the three markers were noted among the three grades of meningiomas. The scores for all the three markers were significantly different between recurrent and non-recurrent meningiomas including removed benign tumors. The most important information for an individual clinical outcome of histologically benign meningiomas should be elicited from simultaneous evaluation of all the three proliferative markers.

Adult↗
PubMed2005

[Allograft replacement in management of giant cell tumor of bone: a report of 77 cases].

OBJECTIVE: To evaluate the functional outcome and the complications of allograft replacement in management of giant cell tumors of bone. METHODS: Seventy-seven patients who underwent bone tumor resection and massive allograft reconstruction of bone defects between 1992 and 2002 were evaluated. The length of the resected part ranged from 5 to 11 centimeters. Fresh-frozen allografts were employed as osteoarticular grafts (n = 47), hemi-condylar (n = 12), massive (n = 14) or allograft-prosthesis composite (n = 4). Most of the lesions located in proximal and distal femur, proximal tibia and humerus. The oncological parameters that were evaluated including survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft. Mankin evaluation system was used to assess functional outcome. RESULTS: At a median of 35 months (range from 12 to 135 months) after the operation, 76 of the patients in the study group were free of disease, and one had died of disease. Eleven (14.1%) patients had local recurrence and 12 (15.4%) nonunion. Late complications included 5 (6.4%) fractures of the allograft and 5 (6.4%) infections of the graft. Instability of the joint in the form of subluxation was noted in 5 (6.4%) patients. One extremity were amputated due to local recurrence. On the basis of Mankin functional evaluation, the total satisfied rate was 83.2 percent. Osteoarticular graft got the highest score (91.5%) and hemi-condylar got the lowest (66.6%). Massive grafts and composite were at the middle (ranges from 71.4% to 75%). CONCLUSION: Allografts offer many types of reconstruction for bony defects after tumor resection. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity. It is also a method with high complication, and decreasing the complications could improve the functional score. Less resection could get better reconstruction and better function, less margin resulted at the same time. The risk of recurrence increases when less surgical margin achieves. The main end-result-influencing factor is local recurrence.

Adolescent↗
PubMed1993

Low-molecular-weight heparins for the treatment of deep-vein thrombosis.

The pharmacologic characteristics of low-molecular-weight (LMW) heparins and unfractionated heparin are reviewed, and clinical trials comparing LMW heparins with unfractionated heparin for the initial treatment of deep-vein thrombosis (DVT) are described. LMW heparins are derived from native heparin and range in mass from 3000 to 8000 daltons. All LMW heparins contain the antithrombin III-specific pentasaccharide unit found on unfractionated heparin. LMW heparins are stronger inhibitors of factor Xa than unfractionated heparin, but their mechanisms of action, like that of unfractionated heparin, is predominantly the inhibition of thrombin. The efficacy of LMW heparins in the prophylaxis of DVT is not correlated with activated partial thromboplastin time (APTT); monitoring of APTT or anti-factor Xa may not be necessary. Compared with unfractionated heparin, LMW heparins have a lower affinity for heparin cofactor II, platelet factor 4, von Willebrand factor, and vascular epithelium. Subcutaneously administered LMW heparins are more bioavailable than s.c. unfractionated heparin. In clinical trials in patients with DVT, LMW heparins (dalteparin, enoxaparin, nadroparin, and tinzaparin) have resulted in venography scores similar to those obtained with unfractionated heparin. Frequencies of recurrent thromboembolism and bleeding complications were also similar. Dalteparin and logiparin were effective when administered in single daily subcutaneous doses; this could lead to lower treatment costs. Additional studies are needed to compare LMW heparins and unfractionated heparin with respect to efficacy, bleeding complications, mortality, and cost. LMW heparins may be valuable alternatives to unfractionated heparin for the treatment of DVT.

Clinical Trials as Topic↗
PubMed1996

The outcome and functional results of diaphyseal endoprostheses after tumour excision.

Improvement in the life expectancy of patients with primary bone tumours has led to increased emphasis on limb salvage and preservation of function. Between 1979 and 1994 we used custom-made endoprostheses in 18 patients to reconstruct diaphyseal defects after excision of primary bone tumours. The mean age at operation was 26 years (9 to 64) and the median follow-up 65 months (6 to 188). Fifteen patients have survived and are free from local or metastatic disease. Local recurrence developed in one patient. Using the modified Enneking functional scoring system, 77% of the patients achieved 80% or more of their premorbid functional capability. Mechanical loosening, limb shortening and secondary osteoarthritis were the main complications. There were no infections. We conclude that diaphyseal endoprostheses offer a good clinical and functional outcome in the lower limb.

Adolescent↗
PubMed1997

Laparoscopic Nissen fundoplication at a teaching center: prospective analysis of 103 consecutive patients.

The Nissen fundoplication is the most extensively studied and successfully employed surgical solution to gastroesophageal reflux disease (GERD). Early success with the application of minimally invasive techniques to this procedure has been reported by several authors. One hundred three consecutive patients were operated on for the symptoms and complications of GERD. Preoperative evaluation consisted of esophagogastroduodenoscopy and esophageal manometry. Twenty-four-hour esophageal pH was obtained selectively. All cases were performed in a traditional training environment, adhering to techniques previously described in the open literature. Clinical data consisted of operative time, postoperative hospital days, days to resumption of normal activities, and morbidity. Patients were followed clinically for the incidence of dysphagia, bloating, and recurrent reflux symptoms. These were graded using a modified Visick score prior to discharge, at 1, 3, and 6 months, and then annually. All patients underwent completion of their procedure; however, four required conversion to open technique and were excluded from analysis. Mean operative time for the 99 laparoscopic procedures was 180 min. Mean operative time was significantly longer for the first 50 cases (202.1 min) than the last 49 (164.2 min). Mean postoperative hospital stay was 2.3 days with 10 days to resumption of normal activities. Mean follow-up was 15 months (range 3-39 months). Three of the four treatment failures underwent open revision with good subsequent results. Patient satisfaction as reflected by the modified Visick score reveals 96% good to excellent results (Visick 1 or 2) with no persistent dysphagia. The Nissen fundoplication can be safely performed using minimally invasive techniques with the benefit of postoperative recovery typical of other laparoscopic procedures. By strictly adhering to the primary technical principles previously described in the open approach, early results are comparable. The procedure can be safely performed in a traditional training environment. The modified Visick system is a simple and effective method to quantify postoperative patient satisfaction.

Female↗
PubMed2003

Secretory carcinoma of the breast: a genetically defined carcinoma entity.

Secretory carcinomas (SBC) are characterized by their characteristic histomorphology and more favorable prognosis compared to invasive ductal carcinoma of usual type (IDC). On this basis, 13 SBCs are evaluated by molecular and immunohistochemical (IH) methods. 13 SBCs and 4 IDCs were analyzed for ETV6-NTRK3 gene fusion by reverse transcriptase-polymerase chain reaction (RT-PCR) and by Fluorescence in situ Hybridization (FISH). 8 of 13 microdissected SBCs with evaluable DNA were evaluated for genetic alterations (GA) by comparative genomic hybridization (CGH). IH included estrogen-receptor (ER), progesterone-receptor (PR), Her-2/neu and Ki-67 (MIB-1) in all 13 cases. Molecular and immunohistochemical results in SBCs were compared with previous data regarding immunohistochemical and molecular characteristics of IDCs. 12 of 13 (92 %) SBC cases, but not IDCs expressed the ETV6-NTRK3 fusion gene which encodes a chimeric tyrosine kinase. Retroviral transfer of ETV6-NTRK3 (EN) into murine mammary epithelial cells resulted in transformed cells that readily formed epithelial tumors in nude mice. CGH revealed an average of 2.0 GAs (range 0-6), including recurrent gains of chromosome 8q and 1q and losses of 22q. Four SBCs were positive for ER and 2 were positive for PR. The mean MIB-1-labeling index was 11.4% (range: <1-34%). Her-2/ neu protein overexpression was detected in 1 case (score 3+). Compared to previous findings in IDCs, SBCs are characterized by the recurrent expression of ETV6-NTRK3 fusion gene, a relatively low number of GAs, low proliferative rate, infrequent Her-2/ neu protein overexpression and a lower rate of steroid hormone receptor expression. These results support the hypothesis that SBCs have immunohistochemical and genetic features that specifically distinguish them from IDCs.

3T3 Cells↗
PubMed2006

Long-term prognostic significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer: impact on prostate cancer specific survival.

PURPOSE: We determined the long-term clinical significance of primary Gleason pattern in patients with Gleason score 7 prostate cancer. MATERIALS AND METHODS: We reviewed the records of all patients who underwent bilateral pelvic lymph node dissection and radical retropubic prostatectomy for Gleason score 7 prostate cancer at our institution. All patients who underwent adjuvant hormonal or radiation therapy were excluded from analysis. Patients were monitored for biochemical failure, that is PSA progression, systemic recurrence and cancer specific survival. RESULTS: We identified 1,688 patients who met admission criteria, of whom 1,256 (74.4%) had primary Gleason pattern 3 and 432 (25.6%) had primary Gleason pattern 4. Median followup was 6.9 years. At 10 years primary Gleason pattern 3 was associated with increased biochemical recurrence-free survival (48% vs 38%, p <0.001), lower systemic recurrence (8% vs 15%, p <0.001) and higher cancer specific survival (97% vs 93%, p = 0.013) for Gleason primary grades 3 and 4, respectively. All of these end points remained significant on multivariate analysis when controlling for preoperative PSA, seminal vesicle involvement, margin status, DNA ploidy and TNM staging. PSA doubling time was shorter in patients with primary Gleason pattern 4 (1.64 vs 1.01 years). Systemic recurrence and cancer specific survival were associated with a PSA doubling time of less than 1 year. CONCLUSIONS: Gleason score 7 prostate cancer is a heterogeneous entity. We should continue to stratify patients according to primary Gleason pattern. Patients with Gleason score 4 + 3 prostate cancer have more aggressive disease and experience higher rates of biochemical failure, systemic recurrence and cancer specific death.

Adult↗
PubMed1998

Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique.

METHODS: From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper. RESULTS: Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission < 13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue necrosis alone (P < 0.05). CONCLUSIONS: The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score > or = 13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.

APACHE↗
PubMed1996

Overexpression of p53 protein and its significance for recurrent progressive bladder tumours.

OBJECTIVE: To determine the prognostic value of the overexpression of p53 protein as determined by immunohistochemistry in recurrent progressive transitional cell carcinomas of the bladder. PATIENTS AND METHODS: A total of 222 tumours from 86 patients with recurrent disease, 20 from patients with no evidence of recurrence after resection of initial tumour and 11 normal bladder (controls) were investigated. Using a microwave technique to expose antigens, formalin-fixed sections were immunohistochemically stained for p53 using a polyclonal antiserum. Two independent observers scored the sections for evidence of overexpression of p53. RESULTS: Of 86 patients with recurrent disease, 51 demonstrated overexpression of p53 protein, as did six of 20 patients with non-recurrent disease. Overexpression was not linked to recurrence (P = 0.5) but was related to worsening histological stage (P < 0.01) and increasing grade (P < 0.01). Regression analysis showed that overexpression of p53 for the primary tumour was not of predictive prognostic value for death from bladder cancer, time to progression or time to recurrence. Tumour grade was the only variable of prognostic value in all the statistical models. Patients with overexpression of p53 showed no reduction in overall survival. CONCLUSION: These findings suggest that overexpression of p53, as determined immunohistochemically, appears to have no predictive prognostic value over stage and grade in bladder tumours.

Aged↗
PubMed2000

Is microvascular invasion on radical prostatectomy specimens a useful predictor of PSA recurrence for prostate cancer patients?

OBJECTIVE: Angiogenesis is believed to play an important role in tumor progression and metastasis. The goal of this study was to investigate the clinical utility of vascular invasion in prostate cancer patients treated by radical prostatectomy as a predictor of PSA recurrence. METHODS: Between 1993 and 1998, 241 patients underwent radical prostatectomy at our institution and had routine analysis of vascular and/or lymphatic invasion (V/LI). V/LI was correlated with preoperative parameters including digital rectal examination (DRE), Gleason score (GS) on biopsy and serum PSA, with the pathological findings and with biochemical recurrence. RESULTS: V/LI incidence was 12.4% (30 of 241 patients). Of the 30 patients with V/LI, 28 (93%) had GS > or =7 (67%) had a pT3 disease and 7 had SV invasion (23%). V/LI was not associated with DRE and GS on prostate needle biopsy. However, V/LI was correlated with the worst pathological findings including pT3 disease, seminal invasion, positive surgical margins and GS on prostate specimen > or = 7. Biochemical recurrence-free survival was 92.5% for the patients without V/LI as compared to 30.1% for patients with V/LI on prostate specimen examination (p = 0.0001). Multivariate analysis showed that preoperative serum PSA, Stage and V/LI were independent predictors of PSA recurrence. Patients with pT2 disease without V/LI had a biochemical recurrence-free survival of 99 vs. 31% in patients with V/LI (p = 0.0001). CONCLUSION: This study demonstrated that V/LI is strongly associated with biochemical recurrence after radical prostatectomy. The routine analysis of V/LI should be considered as a routine evaluation of the radical prostatectomy specimen.

Adult↗
PubMed1983

Patterns of care outcome studies. Results of the national practice in cancer of the cervix.

This report summarizes the national data collected by the Patterns of Care Study in the process and outcome of care in the treatment of carcinoma of the cervix. Substantial variation was found from a consensus of best current management, although training facilities tended to score higher than nontraining on a compliance measure. Four year national averages for control of cervical cancer are: Stage I, 87%, Stage II, 66%, Stage III, 28%. Factors relating to recurrences include failure to use intracavitary irradiation, the type of equipment, the central dose, and Karnofsky Score. The presence of complications is associated with daily dose, lateral dose and central dose, among other factors, and was shown to be unacceptably high in Stage I.

Adult↗