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At least 127 records · Page 7Linked to original sources
PubMed2001

Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer.

OBJECTIVE: Even after curative resection of early endometrial cancer, some patients die as a result of recurrence. We believe that these patients likely had occult lymph node metastases at the time of diagnosis. In an attempt to identify the responsible occult metastases, the clinicopathological significance of cytokeratin expression in lymph nodes with unconfirmed metastasis was evaluated retrospectively in patients with endometrial carcinoma. METHODS: We examined 304 pelvic lymph nodes and 46 primary tumors excised from 46 patients with endometrial cancer, including 36 with Stage I disease and 10 with Stage IIIc disease. Formalin-fixed paraffin-embedded tissue sections were stained immunohistochemically using antibodies against cytokeratin, CA125, and macrophage-related antigen. Sections were also stained with hematoxylin and eosin. RESULTS: In 10 patients with Stage IIIc disease, cytokeratin expression was detected in cells other than the tumor cells in all 13 lymph nodes with metastasis and also in 20 (30.3%) of 66 lymph nodes without metastasis. Cytokeratin expression was observed in 37 (16.4%) of 225 lymph nodes with unconfirmed metastasis, which were obtained from 14 of 36 patients with Stage I disease. Five of fourteen patients with lymph nodes expressing cytokeratin had recurrent disease in the pelvic cavity, while all 22 patients with unconfirmed cytokeratin expression in their lymph nodes showed no recurrence. Cytokeratin and CA125 were detected simultaneously on macrophages in lymph nodes. Cytokeratin expression in lymph nodes was closely related to lymph-vascular space involvement of the primary tumor, but was not related to either histological grade or depth of myometrial invasion. Multivariate analysis identified cytokeratin expression as an independent risk factor for recurrence in Stage I endometrial cancer. CONCLUSIONS: The immunohistochemical expression of cytokeratin in lymph nodes with undetected metastases predicts occult metastasis to these nodes and is a risk factor for recurrence in early-stage endometrial cancer.

CA-125 Antigen↗
PubMed1993

Foot volumetry can predict recurrent ulceration after subfascial ligation of perforators and saphenous ligation.

PURPOSE: The purpose of this study was to determine whether foot volumetry is of value in predicting the outcome after superficial venous surgery for chronic venous ulceration. METHODS: Fifty-three patients who underwent subfascial ligation of perforating veins with or without saphenous vein ligation for recurrent venous ulceration had foot volumetry performed before operation, immediately after operation (1 month), and at regular intervals during follow-up (median 60, range 3 to 144 months). RESULTS: Fourteen patients (26%) had recurrent ulceration (median time to recurrence 48, range 10 to 72 months) and 39 patients remained ulcer free. Before operation expulsion fraction (EF) and half refilling time (HRT) were significantly higher in the no recurrence group. Both groups gained improvement in EF and HRT from their surgery; however, although this was sustained in the no recurrence group, by the time of first recurrence in the recurrence group, EF and HRT had returned to preoperative levels. CONCLUSIONS: Preoperative foot volumetry can therefore predict failure after subfascial perforator and saphenous vein ligation, probably by identifying patients with deep venous incompetence. After operation deterioration in foot volumetry and can also be used to predict the onset of recurrent ulceration.

Adult↗
PubMed2000

Evaluation of portosystemic collaterals by SPECT imaging after endoscopic variceal sclerotherapy: usefulness for predicting recurrence.

UNLABELLED: Bleeding from esophageal varices is a major cause of morbidity and mortality in cirrhotic patients. Identification of patients at high risk for bleeding is particularly important. The aim of this study was to determine whether detection of portosystemic collaterals by SPECT could predict the outcome of endoscopic injection sclerotherapy of esophageal varices and be useful for selecting appropriate therapy. METHODS: Sixty-two patients with liver cirrhosis who were considered at high risk of bleeding were treated with endoscopic injection sclerotherapy. Endoscopy was performed every 3 mo after therapy or until bleeding occurred. Before and within 2 wk after therapy, tomographic images of intra-abdominal blood pool were constructed by SPECT. RESULTS: Before therapy, the following portosystemic collateral routes were observed: coronary veins in 53 (85.5%) of 62 patients, short gastric veins in 8 patients (12.9%), splenorenal shunts in 10 patients (16.1%), and paraumbilical veins in 6 patients (9.7%). Patients positive for imaging of coronary veins were divided into 3 groups on the basis of changes in images after therapy: complete responders (n = 17), whose coronary vein images disappeared completely; partial responders (n = 18), whose images became smaller; and nonresponders (n = 18), whose images did not change significantly before or after therapy. The rates of recurrence after endoscopic injection sclerotherapy until 6 mo in complete responders (4/17, 23.5%) and partial responders (7/18, 38.9%) were significantly less (P < 0.05) than that in nonresponders (11/13, 84.6%). The rate of recurrence of esophageal varices until 6 mo in nonresponders treated with additional submucosal injection sclerotherapy (1/5, 20.0%) was significantly less (P < 0.05) than that in nonresponders without additional submucosal injection sclerotherapy (11/13, 84.6%). CONCLUSION: Abdominal blood-pool SPECT, a noninvasive method, is useful for evaluating the therapeutic effectiveness of endoscopic sclerotherapy, for predicting the recurrence of varices, and for selecting appropriate management after sclerotherapy.

Collateral Circulation↗
PubMed2007

Mesorectal grades predict recurrences after curative resection for rectal cancer.

PURPOSE: Local recurrence after curative excision for rectal cancer is frequently regarded as a failure of surgery. The macroscopic quality of the excised mesorectum after total mesorectal excision has been proposed as a means of assessment of the adequacy of surgery. This study was designed to determine the utility of mesorectal grading in prediction of local and overall recurrence after curative surgery. METHODS: All patients undergoing resection for primary adenocarcinoma of the rectum had a mesorectal grading prospectively applied to their resection specimens, according to the classification proposed by Quirke et al. (Grades 1-3; 3 is the best). The outcome of patients undergoing potentially curative surgery from 2001 to 2003 was reviewed. Prognostic significance of mesorectal grades was determined by multivariate regression analyses. RESULTS: A total of 130 patients with a median follow-up of 26 (range, 17-42) months were studied. The local and overall recurrences were 8.4 and 15 percent, respectively. The mesorectum was reported as Grade 3 in 61 patients (47 percent), Grade 2 in 52 patients (40 percent), and Grade 1 in 17 patients (13 percent). Patients with Grade 1 mesorectum had 41 percent local recurrence and 59 percent overall recurrence, respectively. However, patients with Grade 2 and Grade 3 mesorectum had 5.7 and 1.6 percent local recurrences, respectively, and 17 and 1.6 percent overall recurrence, respectively. By Cox's regression analysis, grade of mesorectum independently influenced both local and overall recurrences. CONCLUSIONS: The macroscopic quality of mesorectum after curative excision of rectal cancer is an important predictor of local and overall recurrences. The mesorectal grades may be of value in decisions regarding postoperative adjuvant therapy.

Adenocarcinoma↗
PubMed2006

The N ratio predicts recurrence and poor prognosis in patients with node-positive early gastric cancer.

BACKGROUND: The metastatic status of the regional node is the most significant prognostic factor for early gastric cancer (EGC). However, diverse prognoses are evident even among the same N classifications of the current tumor-node-metastasis system. The aim of this study was to evaluate the prognostic significance of the ratio of metastatic to retrieved lymph nodes (N ratio) in identifying a high-risk subgroup with node-positive EGC. METHODS: From a prospective database of 1264 EGC patients between 1987 and 1997, 156 (12.4%) were found to have histologically confirmed node metastasis. A number of prognostic factors, including the N ratio, were evaluated by univariate and multivariate analysis. RESULTS: The recurrence rate of node-positive EGC was 16.7% (n = 26). The overall 5-year survival rate of all patients was 84.0%. It was 26.9% and 95.4% in patients with and without recurrence, respectively (P < .0001; log-rank test). The cutoff value of the N ratio was set at .07. The 5-year survival rate of patients with an N ratio <.07 was 94.0%; this was significantly higher than the rate (72.6%) for those with a ratio >.07 (P < .0001; log-rank test). Both univariate and multivariate analysis identified the N ratio as the most significant predictive factor for recurrence and overall survival. Regarding stage migration, it shows superiority in comparison to the number-based N classification. CONCLUSIONS: The N ratio is a more effective and rational indicator for prognostic stratification of patients with lymph node-positive EGC than the current N classification of the tumor-node-metastasis system.

Adult↗
PubMed1993

The use of nuclear morphometry in predicting recurrence of transitional cell carcinoma.

Despite apparently adequate surgical resection, metastases develop in about 50% of the patients who undergo radical cystectomy for invasive bladder cancer and they die of disease within 2 years of surgery. Recent reports have shown that combination chemotherapy with regimens including cisplatin results in significant improvement in time to progression and overall survival for patients with transitional cell carcinoma. We have used quantitative nuclear morphometry in an effort to predict which individual patients with muscle invasive transitional cell carcinoma are at increased risk for recurrence and in need of adjuvant therapy. A total of 14 patients with deeply invasive tumors without known metastases (tumors, nodes and metastasis stage P3A-B, N-, M0) who had not received perioperative radiation or systemic chemotherapy was studied. Of the patients 7 (group 1) had no evidence of disease with a mean followup of 41 months and 7 (group 2) had recurrent transitional cell carcinoma at a mean followup of 17 months. Both groups were similar with respect to age and could not be distinguished by standard pathological analysis of stage (p = 0.66) or grade (p = 0.99). A total of 150 tumor nuclei from each patient was digitized and analyzed by a high resolution quantitative morphometric imaging system, developed in this laboratory, to determine if nuclear shape descriptors could separate these 2 clinically distinct groups. A multivariate analysis combining 3 independent nuclear shape descriptors (average nuclear area, minimum feret-diameter ratio and kurtosis of feret-diameter ratio) was highly significant (p = 0.003) and separated patients in group 1 from group 2 without overlap. These encouraging results suggest that nuclear morphometry may be valuable in determining which patients are at increased risk of disease recurrence following radical cystectomy and, therefore, who should receive adjuvant chemotherapy.

Aged↗
PubMed2001

Predicting recurrence of major depressive disorder in young adults: a prospective study.

Sixty-five young adults with remitted major depressive disorder (MDD) were followed for 18 months. Recurrence of MDD was reported by 41.5% of the initial sample and 49.1% of those who completed the study (n = 53). Survival analyses were used to identify predictors of recurrence so that individuals at greatest risk could be targeted for intervention. Potential predictors included measures of comorbid psychopathology (Axis II pathology, and current and lifetime nonmood Axis I diagnoses), depression-specific clinical features (number of episodes, past treatment, and suicidality), and self-reported cognitive and interpersonal constructs (hope, dysfunctional attitudes, and interpersonal problems). Only personality pathology (specifically, the total dimensional and Cluster B dimensional scores on the International Personality Disorder Examination) significantly predicted hazard of recurrence.

Adolescent↗
PubMed1995

Size and timing of local recurrence predicts metastasis in soft tissue sarcoma. Growth rate index retrospectively analyzed in 134 patients.

Our study combined size and timing of the first local recurrence to create a growth rate index (GRI-ratio of size (cm) to timing (mo)) which we analyzed for an association with metastasis. We analyzed 134 locally recurrent tumors from a series of 460 adult patients with soft tissue sarcoma of the extremities and trunk wall who were diagnosed and treated between 1964 and 1990, with a median follow-up of 10 (2-28) years for survivors. None of the patients had metastases at diagnosis. One half (74) of local recurrences were from inadequately treated primaries, one half (71) were associated with metastases, and two thirds (89) were seen in non-center-treated patients. There were equal numbers of patients with GRI < or = 0.4 (low) and > 0.4 (high). Patients with a low GRI had a better 2-year metastasis-free survival (80 percent) than those with a high GRI (30 percent). High GRIs were associated with large, high grade primary tumors and a short metastasis-free interval in comparison to low GRI tumors. Time to local recurrence strongly correlated with the time to metastasis (R2 0.85, p < 0.001). GRI was a good discriminator of metastasis in patients with tumors larger than 5 cm and of malignancy grade IV. Our study suggests that clinical characteristics (e.g., GRI) of local recurrence rather than presence, per se, are important in predicting tumor behavior.

Adolescent↗
PubMed1991

Logistic multiple regression analysis of factors predicting recurrence of hyperthyroidism after medical treatment of toxic diffuse goitre.

In order to determine which factors predict the outcome of short term antithyroid drug treatment we studied 42 patients with diffuse goitre in whom 43 instances of thyrotoxicosis were treated. Treatment duration ranged from 24 to 61 wk (median 30 wk). All patients received high-dose carbimazole and thyroid hormone substitution. Patients in remission were followed for 39 to 134 wk (median 73 wk). The relapse rate at 1 yr and at 2 yr after cessation of antithyroid drug treatment was 51%. Of the parameters studied presence or absence of eye signs and initial serum levels of thyroxine, triiodothyronine and immunoglobulin-G in the relapse group and in the remission group showed significant differences in univariate analysis. No significant differences were found for age, sex, family history of thyroid disease, thyroid gland volume or TSH-receptor stimulating autoantibodies. Linear discriminant analysis shows that of the four remaining factors thyroxine is not important in separating both groups. Cox analysis yields only initial serum triiodothyronine and eye signs as significant prognostic factors. With these two factors 18 out of 23 predictions of remission and 16 out of 18 predictions of relapse in the 41 patients with known initial serum triiodothyronine concentrations are correct. Such predictions can be used in the choice of therapy, short-term medical treatment for patients with a low risk and long-term medical treatment or, at the appropriate time, a destructive form of therapy for patients with a high risk of relapse.

Analysis of Variance↗
PubMed2005

Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the sapheno-femoral junction after five years.

OBJECTIVE: To investigate whether the results of duplex examination 1 year after sapheno-femoral junction (SFJ) ligation might be helpful in predicting long-term results after 5 years. PATIENTS AND METHODS: Follow-up data concerning patients operated on for primary or recurrent varicose veins of the great saphenous vein were studied 1 year and 5 years after surgery, focusing on the thigh and groin region. Clinical examination was undertaken to detect recurrent thigh varicose veins. The site of SFJ ligation was carefully screened for any signs of neovascularisation by duplex ultrasound. Sensitivity, specificity, positive and negative predictive value of the 1-year duplex scan were calculated, based upon the outcome of a further duplex scan 5 years following surgery. RESULTS: A total of 100 limbs were studied: 50 limbs operated on for primary varicose veins and 50 limbs for recurrent varicose veins. The 1-year duplex ultrasound of the SFJ ligation site had a sensitivity of 80%, a specificity of 91%, a positive predictive value of 70% and a negative predictive value of 95% in assessing the 5 year recurrence rate. CONCLUSION: A postoperative duplex scan of the SFJ 1 year after varicose vein surgery to the great saphenous vein predicts which patients are most likely to have a good outcome 5 years after surgery. The 1-year duplex scan is a reliable diagnostic tool for future studies evaluating the effect of new methods of treating sapheno-femoral incompetence.

Adult↗
PubMed2001

Airflow limitation during respiratory syncytial virus lower respiratory tract infection predicts recurrent wheezing.

BACKGROUND: Respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) is frequently followed by recurrent wheezing. Thus far no clinical risk factors have been identified to predict which infants will have wheezing episodes subsequent to RSV LRTI. OBJECTIVE: To determine clinical predictors for airway morbidity after RSV LRTI. METHODS: In a 1-year follow-up study we investigated the predictive value of auscultatory findings characteristic of airflow limitation (wheezing) during RSV LRTI for subsequent airway morbidity. Clinical characteristics, including the presence or absence of signs of airflow limitation, of hospitalized infants with RSV LRTI were prospectively recorded during 2 winter epidemics. During a 1-year follow-up period parents of 130 infants recorded daily airway symptoms. OUTCOME MEASURE: Recurrent wheezing defined as > or = 2 episodes of wheezing. RESULTS: Signs of airflow limitation during RSV LRTI were absent in 47 (36%) infants and present in 83 (64%) infants. Recurrent wheezing was recorded in 10 (21%) infants without signs of airflow limitation and in 51 (61%) with signs of airflow limitation during initial RSV LRTI (relative risk, 0.29, P < 0.001). In a multiple logistic regression model, airflow limitation during initial RSV LRTI proved independent from other clinical parameters, including age, parental history of asthma and smoke exposure. CONCLUSIONS: A sign of airflow limitation during RSV LRTI is the first useful clinical predictor for subsequent recurrent wheezing.

Auscultation↗
PubMed1995

Free-form neutrophil elastase is an independent marker predicting recurrence in primary breast cancer.

We have measured the immunoreactive neutrophil elastase (ir-NE) concentration in tumor extracts of 313 primary human breast cancers using an enzyme-linked immunosorbent assay recently developed and have evaluated its association with disease-free survival. This is a sensitive assay that enables rapid measurement of both free-form and alpha 1-proteinase inhibitor (alpha 1-PI)-complexed form of ir-NE. Breast cancer patients with high ir-NE concentrations had a significantly shorter disease-free survival (P = .013) than those with a low ir-NE concentration at the cutoff point of 9.0 micrograms/100 mg protein, which was determined in another group of 49 patients. In multivariate analysis, the ir-NE level was found to be an independent prognostic factor (relative risk = 2.2, P = .025) for disease recurrence in human breast cancer. Furthermore, when multivariate analysis was repeated with inclusion of each level of free-form and alpha 1-PI-complexed form, the former level was an independent predictor of recurrence (relative risk = 2.5, P = .015), whereas the latter was not independently predictive (P = .43). These results support the hypothesis that this enzyme may play an active role in the tumor progression that leads to metastasis in human breast cancer.

Adult↗
PubMed2003

Positive surgical margins and ipsilateral breast tumor recurrence predict disease-specific survival after breast-conserving therapy.

BACKGROUND: The current study identified determinants of systemic recurrence and disease-specific survival (DSS) in patients with early-stage breast carcinoma treated with breast-conserving surgery and radiation therapy (breast-conserving therapy, or BCT). METHODS: The study population consisted of 1,043 consecutive women with Stages I or II breast carcinoma who underwent BCT between 1970 and 1994. Clinical and pathologic characteristics evaluated included age, tumor size, tumor grade, estrogen and progesterone receptor status, surgical margins, axillary lymph node involvement, and use of adjuvant therapy. RESULTS: At a median follow-up time of 8.4 years, 127 patients (12%) had developed an ipsilateral breast tumor recurrence (IBTR), and 184 patients (18%) had developed a systemic recurrence. On multivariate logistic regression analysis, tumor size greater than 2 cm, positive lymph nodes, lack of adjuvant tamoxifen therapy, and positive margins (odds ratio [OR], 3.7; 95% confidence interval [CI], 1.1-12.3; P = 0.034) were predictors of systemic recurrence. When IBTR was added into the model, adjuvant therapy and surgical margins were not independent predictors; however, IBTR was an independent predictor of systemic recurrence (IBTR vs. no IBTR; OR, 6.2; 95% CI, 3.1-12.3; P < 0.001). The 10 year DSS rate after BCT was 87%. On multivariate Cox proportional hazards model analysis, the following factors were independent predictors of poor DSS: tumor size greater than 2 cm (vs. < or = 2 cm; relative risk [RR], 2.3; 95% CI, 1.2-4.3; P = 0.010), negative progesterone receptor status (vs. positive; RR, 2.7; 95% CI, 1.4-5.1; P = 0.003), positive margins (vs. negative; RR, 3.9; 95% CI, 1.4-11.5; P = 0.011), and IBTR (vs. no IBTR; RR, 5.5; 95% CI, 2.8-11.0; P < 0.001). CONCLUSIONS: Positive surgical margins and IBTR are predictors of systemic recurrence and disease-specific survival after BCT. Aggressive local therapy is necessary to ensure adequate surgical margins and to minimize IBTR.

Breast Neoplasms↗
PubMed2004

Hemorrhage burden predicts recurrent intracerebral hemorrhage after lobar hemorrhage.

BACKGROUND AND PURPOSE: Small asymptomatic cerebral hemorrhages detectable by gradient-echo MRI are common in patients with intracerebral hemorrhage (ICH), particularly lobar ICH related to cerebral amyloid angiopathy (CAA). We sought to determine whether hemorrhages detected at the time of lobar ICH predict the major clinical complications of CAA: recurrent ICH or decline in cognition and function. METHODS: Ninety-four consecutive survivors of primary lobar ICH (age > or =55) with gradient-echo MRI at presentation were followed in a prospective cohort study for 32.9+/-24.0 months. A subset of 34 subjects underwent a second MRI after a stroke-free interval of 15.8+/-6.5 months. Study endpoints were recurrent symptomatic ICH or clinical decline, defined as onset of cognitive impairment, loss of independent functioning, or death. RESULTS: The total number of hemorrhages at baseline predicted risk of future symptomatic ICH (3-year cumulative risks 14%, 17%, 38%, and 51% for subjects with 1, 2, 3 to 5, or > or =6 baseline hemorrhages, P=0.003). Higher numbers of hemorrhages at baseline also predicted increased risk for subsequent cognitive impairment, loss of independence, or death (P=0.002) among subjects not previously demented or dependent. For subjects followed after a second MRI, new microhemorrhages appeared in 17 of 34 and predicted increased risk of subsequent symptomatic ICH (3-year cumulative risks 19%, 42%, and 67% for subjects with 0, 1 to 3, or > or =4 new microhemorrhages, P=0.02), but not subsequent clinical decline. CONCLUSIONS: Hemorrhages identified by MRI predict clinically important events in survivors of lobar ICH. Detection of microhemorrhages may be useful for assessing risk in ICH patients and as a surrogate marker for clinical studies.

Aged↗
PubMed2026

Transcriptome-based high-frequency recurrence index predicts frequent recurrence in non-muscle-invasive bladder cancer after Bacillus Calmette-Gu&#xe9;rin therapy.

BACKGROUND: High-frequency recurrence (HfR,&#x2009;&#x2265;&#x2009;2 recurrences) in non-muscle-invasive bladder cancer (NMIBC) poses a significant clinical burden. Current risk models, such as the European Organization for Research and Treatment of Cancer (EORTC), the European Association of Urology (EAU), and the UROMOL classification, offer limited predictive accuracy for identifying patients at risk for frequent recurrence despite appropriate treatment. METHODS: A 75-gene high-frequency recurrence index (HfRI) was constructed by selecting recurrence-associated genes using differential expression and Cox regression analyses. The HfRI was computed as a weighted sum of normalized gene expression values. The model was trained on a discovery cohort and validated in multiple cohorts (n&#x2009;=&#x2009;1379) using machine-learning approaches. Clinical relevance was assessed using recurrence-free survival (RFS) and Cox models, and predictive performance was compared with that of the EORTC, EAU, and UROMOL classifications using the area under the curve (AUC) and the concordance index (c-index). RESULTS: The HfRI robustly stratified patients into high-risk and low-risk groups across six independent NMIBC cohorts. Patients classified as HfRI-high had a significantly greater likelihood of experiencing&#x2009;&#x2265;&#x2009;2 recurrences (&#x3c7;2, p&#x2009;=&#x2009;0.001) and showed markedly reduced RFS (log-rank test, p&#x2009;<&#x2009;0.001). The adverse prognostic effect of the HfRI persisted even among patients treated with BCG therapy (log-rank test, p&#x2009;=&#x2009;0.02). Multivariate analysis revealed that the HfRI was an independent predictor of HfR (HR&#x2009;=&#x2009;2.82, 95% CI&#x2009;=&#x2009;1.89-4.20, p&#x2009;<&#x2009;0.001). Compared with established clinical risk classifiers, the HfRI demonstrated superior predictive performance (AUC&#x2009;=&#x2009;0.736, c-index&#x2009;=&#x2009;0.673) in terms of the EORTC (AUC&#x2009;=&#x2009;0.594), EAU (AUC&#x2009;=&#x2009;0.557) risk groups, and UROMOL2021 (AUC&#x2009;=&#x2009;0.596) classification. Pathway analysis revealed that HfRI-high tumors were characterized by upregulation of cell cycle progression and DNA replication pathways, accompanied by suppression of immune signaling pathways. These biological features provide a mechanistic explanation for the reduced responsiveness to intravesical BCG therapy, underscoring the role of HfRI not only as a predictor of recurrence risk but also as a biomarker capable of identifying patients unlikely to benefit from standard BCG treatment. CONCLUSIONS: HfRI represents a robust, transcriptome-based tool for predicting frequent recurrence in NMIBC patients. The HfRI supports earlier identification of patients at risk of high-frequency recurrence, thereby supporting personalized treatment strategies.

Humans↗
PubMedDate not supplied

Cyclic vertigo with predictable recurrence.

The long-term follow-up of six children with "cyclic vertigo," that has recurred for years, at strikingly predictable intervals, is presented. Vertigo and photophobia, lasting several hours, start early in the morning, daily for several consecutive days, and recur at predictable intervals without evidence of long-term neurological deficits. The interval between events increases with age. Diagnostic criteria are suggested. Cyclic vertigo may be a migraine equivalent caused by periodic derangement of the mechanisms controlling the generation of circadian rhythms.

Adolescent↗
PubMedDate not supplied

Preoperative serum level of CA19-9 predicts recurrence after curative surgery in node-negative colorectal cancer patients.

BACKGROUND/AIMS: We hypothesize that a subset of node-negative colorectal cancer patients exists that is at high risk for recurrence after curative surgery. Preoperative serum levels of sialyl Lewisa (CA19-9), sialyl Lewisx (SLX), sialyl Tn (STN), and carcinoembryonic (CEA) antigens were analyzed for their value in predicting for such a group. METHODOLOGY: One-hundred-forty-five patients with node-negative, T1-4, M0 colorectal cancers were divided into groups of low or high serum antigen levels. Disease-free interval served as the endpoint in evaluating the prognostic strength of each variable. RESULTS: Twenty-seven patients (18.6%) were included in the high group for CA19-9 antigen, 11 (7.6%) for SLX, 13 (9.0%) for STN, and 51 (35.2%) for CEA. The median follow-up was 62.1 months. As compared to those with low levels, patients with elevated CA19-9 had a shorter disease-free interval (P = 0.0026). No significant difference in disease-free interval was noted between low and high groups of SLX, STN, and CEA antigens. Cox regression analysis identified elevated serum CA19-9 level as a predictor for decreased disease-free interval, independent of T-stage or tumor location. CONCLUSIONS: Elevated preoperative serum levels of CA19-9 may serve as a useful marker in identifying patients with node-negative colorectal cancers at high risk for recurrence after surgery.

Adenocarcinoma↗