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PubMed1999

Functional results after partial pelvic resection in Ewing's sarcoma of the ilium.

Ewing's sarcoma of the pelvis has an unfavourable prognosis. The clinical and functional results of 7 patients who had a Ewing's sarcoma of the pelvis stage IIB were reviewed. All patients received multiple-agent chemotherapy pre- and postoperatively (modified T6 and T2 protocol according to Rosen) and underwent local resection of the pelvic tumour. According to Enneking, five patients had a type IA resection, one patient type I and another type IIA. One patient received a course of radiation therapy postoperatively (50 Gy). Six of seven patients showed a good regression of the tumour after preoperative chemotherapy. One patient who had a giant-cell Ewing's sarcoma died of local recurrence and lung metastases 29 months postoperatively. The remaining six patients were monitored radiographically and clinically according to Enneking's functional evaluation score after a follow-up period of 136 months (range 40-199 months). All were free of disease and had neither local recurrence nor metastases. In five patients the functional results were rated as "good" or "excellent". The good results depend mainly on the reconstruction of the pelvic girdle and its mechanical stability.

Adolescent↗
PubMed1999

Adjuvant small field pelvic radiation for patients with high risk, stage IB lymph node negative cervix carcinoma after radical hysterectomy and pelvic lymph node dissection. A pilot study.

BACKGROUND: After radical hysterectomy and pelvic lymph node dissection, an identifiable subgroup of patients with International Federation of Gynecology and Obstetrics Stage IB lymph node negative cervix carcinoma remains at high risk of pelvic recurrence. This study attempted to determine whether postoperative small field of pelvic radiation can improve the disease free survival (DFS) of this high risk group of patients without producing significant morbidity. METHODS: Between 1991 and 1995, after radical surgery, 25 patients with Stage IB lymph node negative cervix carcinoma were considered to be at high risk of pelvic recurrence on the basis of tumor dimension, depth of stromal invasion, and the presence of lymph-vascular space invasion. All had a score >/= 120 as determined by the Gynecologic Oncology Group (GOG) study. These patients received 50.4 gray of adjuvant radiation to a small central pelvic field and were followed prospectively. A Kaplan-Meier 5-year DFS curve was generated. A log rank analysis produced an estimated log rank P value (est P value) by comparing the 5-year DFS of the patients in the current study with the 5-year DFS of the corresponding high risk group of the GOG study (observation only). The morbidity of small field pelvic radiation was recorded. RESULTS: Among the 25 patients who received small field pelvic radiation, the mean GOG score was 166 (range, 120-263) and the mean follow-up was 32 months (range, 12-64 months). There was 1 recurrence (4%) recorded at 16 months. The log rank analysis demonstrated a significant improvement in the 5-year DFS for the group who received adjuvant small field pelvic radiation (est P value = 0.005) when compared with the DFS of the high risk GOG patients who were observed postoperatively. Four cases of minor morbidity were recorded: lymphedema (three cases) and mild rectal incontinence (one case). No major morbidity was reported. CONCLUSIONS: With low morbidity, adjuvant small field pelvic radiation appears to improve significantly the 5-year DFS of patients with high risk, lymph node negative Stage IB cervical carcinoma. However, this pilot study requires verification.

Adult↗
PubMed2006

Comparison of pulsed radiofrequency with conventional radiofrequency in the treatment of idiopathic trigeminal neuralgia.

The aim of this prospective, randomized, double-blinded study was to evaluate the effect of pulsed radiofrequency (PRF) in comparison with conventional radiofrequency (CRF) in the treatment of idiopathic trigeminal neuralgia. A total of 40 patients with idiopathic trigeminal neuralgia were included. The 20 patients in each group were randomly assigned to one of the two treatment groups. Each patient in the Group 1 was treated with CRF, whereas each patient in the Group 2 was treated by PRF. Evaluation parameters were: pain intensity using a Visual Analogue Scale (VAS), patient satisfaction using a Patient Satisfaction Scale (PSS), additional pharmacological treatment, side effects, and complications related to the technique. The VAS scores decreased significantly (p<0.001) and PSS improved significantly after the procedure in Group 1. The VAS score decreased in only 2 of 20 patients from the PRF group (Group 2) and pain recurrence occurred 3 months after the procedure. At the end of 3 months, we decided to perform CRF in Group 2, because all patients in this group still had intractable pain. After the CRF treatment, the median VAS score decreased (p<0.001) and PSS improved (p<0.001) significantly. In conclusion, the results of our study demonstrate that unlike CRF, PRF is not an effective method of pain treatment for idiopathic trigeminal neuralgia.

Adult↗
PubMed2005

The presence of benign prostatic glandular tissue at surgical margins does not predict PSA recurrence.

BACKGROUND: Serum prostate specific antigen (PSA) increases after radical prostatectomy are thought to indicate recurrent disease, although some suggest they result from benign prostatic epithelial tissue left at surgical margins. AIMS: To investigate whether presence, location, and extent of benign prostatic tissue at radical prostatectomy surgical margins influence patient outcome. METHODS: One hundred and ninety nine patients with prostate cancer and negative surgical margins were studied. The prostectomy specimens were totally embedded using the whole mount technique. The apex and bladder neck, dissected as a cone from the specimen, were serially sectioned. The total length of benign prostatic tissue at the margins, measured for each location using an ocular micrometer, was obtained by summing the length of all positive sites. The presence, anatomical location, and extent of benign prostatic tissue at the margin were correlated with clinicopathological characteristics and postoperative PSA increases. RESULTS: Fifty five cases had benign prostatic glandular tissue at the surgical margin. The mean length was 2.19 mm (0.1-14.7). The most frequent location of benign prostatic tissue was the apex (40 patients). Presence, anatomical location, and length of benign prostatic tissue at the margin were not significantly associated with age, preoperative PSA, prostate weight, pathological stage, tumour volume, largest tumour dimension, Gleason score, extraprostatic extension, seminal vesical invasion, tumour multifocality, perineural invasion, or PSA recurrence. CONCLUSIONS: Benign prostatic tissue was frequently found in margins of apex and bladder base, but uncommon in the anterior or posterior prostate. The presence of benign prostatic tissue at surgical margins had no prognostic relevance.

Adult↗
PubMed2000

Serum hepatitis C virus RNA levels and histologic findings in liver allografts with early recurrent hepatitis C.

BACKGROUND: Histopathologic features of early recurrent hepatitis C after orthotopic liver transplantation (OLTx) may be modified by immunosuppressive therapy or complicated by other conditions. Hepatitis C virus (HCV) RNA level usually increases after OLTx, but its correlation to histologic findings is not clear. OBJECTIVE: To evaluate the histologic findings of early recurrent hepatitis C in liver allografts and its correlation to serum HCV RNA level. METHODS: We studied 14 patients who underwent OLTx for chronic HCV infection. Thirty liver biopsy specimens and HCV RNA levels of 22 corresponding plasma samples obtained during the first 6 months following OLTx were analyzed. The control group (9 patients, 25 biopsy specimens) was chosen at random from patients with chronic liver disease other than HCV who were undergoing OLTx, and all tested negative for HCV RNA by polymerase chain reaction after OLTx. RESULTS: Statistically significant pathological features of early recurrent HCV infection were the number of acidophilic bodies, piecemeal necrosis, lymphocyte predominance in the portal tracts, and fibrous septum. These findings and histologic activity index scores increased with time after OLTx. The HCV RNA levels determined by branched DNA assay showed no significant correlation with histologic features. However, patients with higher histologic activity index scores tended to have higher RNA levels. CONCLUSIONS: Liver biopsy specimens are helpful for the diagnosis or confirmation of early recurrent hepatitis C in liver allografts, but serial biopsy specimens are sometimes required for definite diagnosis. The HCV RNA levels are usually higher in patients who display signs of more severe liver damage.

Biopsy↗
PubMed1997

Treatment of steroid-resistant and recurrent acute cardiac transplant rejection with a short course of antibody therapy.

The purpose of this study was to assess the efficacy of short courses of OKT3 and ATG, respectively, for steroid resistant or recurrent acute allograft cardiac rejection (AR). Between June 1988 and March 1994, 101 heart transplant patients were treated with a quadruple sequential immunosuppression protocol (ATG, azathioprine, CsA, and prednisone). AR was diagnosed by endomyocardial biopsy (EMB), and patients with scores > 2 (ISHLT) received pulse methylprednisolone, 500 mg i.v. on 3 consecutive days. In cases of steroid-resistant or recurrent AR, OKT3 (5 mg/d) or ATG (1.5-2.5 mg/kg/d), was administered for 5-7 d instead of the usual 10-14 d course. OKT3 (17 courses; 10 steroid resistant, 7 recurrent AR; 5.3 +/- 0.7 doses) was given to 16 patients (4F/12M, 45 +/- 11 yr), 29-269 d after transplantation. ATG (8 courses; 5 steroid resistant, 3 recurrent AR; 4.9 +/- 0.6 doses) was given to 8 patients (1F/7M, 53 +/- 7 yr), 23-503 d after transplantation. Successful treatment of AR with a score < 2 at the first and second EMB after treatment was 88% and 88% with OKT3, and 87.5% and 100% with ATG, respectively. Throughout follow-up (50 +/- 22 months after OKT3; 49 +/- 28 months after ATG), there was a trend towards lower incidence of subsequent AR after ATG (25% vs. 69%, P = 0.09), and similar incidence of infections, graft atherosclerosis and mortality. No cases of lymphoproliferative disorder were observed. We conclude that short courses of OKT3 or ATG are safe and effective for the treatment of steroid resistant or recurrent AR, with a similar incidence of complications. These results may have cost-effectiveness implications and need to be confirmed in a randomized study.

Acute Disease↗
PubMed2003

Coagulopathy and outcome in patients with chronic subdural haematoma.

OBJECTIVE: The coincidence of coagulatopathy and chronic subdural haematoma (CSH) requires correction of coagulation to facilitate surgery. We investigated the correlation between coagulopathy and outcome in CSH patients. MATERIAL AND METHODS: We analysed past medical history, surgical treatment and coagulation parameters of 114 patients. RESULTS: Coagulation disorders were found in 42%. Preoperative treatment with prothrombin complex concentrate was necessary in 14%. A significant difference (P < 0.05) of the preoperative level of platelets was found between recurrent CSH and non-recurrent group. Totally, we had to perform re-operations in 17.5%. Eighty-one patients presented with Glasgow coma scale (GCS) > or = 13. After surgery GCS was > or = 13 in n = 92. There was an improvement of GCS in 46 cases, 61 patients maintained GCS score levels. Outcome was significantly worse in the alcoholic group (P < 0.001), and in the recurrent group (P < 0.05). In patients with substitution of coagulation factors, outcome was worse in the group with post-operative substitution only (P < 0.05). CONCLUSION: In CSH, the coagulation parameters and a subtle correction of coagulation are of special interest, regarding the worse outcome in patients with recurrent CSH and in those requiring post-operative substitution.

Adolescent↗
PubMed2006

Laparoscopic versus open ventral hernia mesh repair: a prospective study.

BACKGROUND: An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open and laparoscopic ventral hernia repair. METHODS: The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair technique in all cases. RESULTS: The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30-83 years). The patients in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640-23.0227 months). The mean surgery durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair than among those who had open repair (30% and 10%, respectively). CONCLUSIONS: The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of choice for ventral hernia repair.

Female↗
PubMed2005

Measuring quality of life in preschool children with sore throats and otitis media using the TAPQOL questionnaire.

OBJECTIVES: TNO-AZL Preschool Quality of Life Questionnaire (TAPQOL) is one of the few instruments designed to assess health-related quality of life in preschool children but its applicability to otolaryngology is unknown. STUDY DESIGN AND SETTING: We studied a consecutive series of children aged 1 to 5 years referred to hospital with recurrent sore throats, recurrent acute otitis media, or otitis media with effusion. RESULTS: TAPQOL domain scores were not influenced by age, sex, or socio-economic class, but correlated with markers of disease severity (frequency of sore throat or pyrexia, time off school), ear-related handicap (assessed with the OM6 questionnaire), and other measures of health-related quality of life (visual analogue scale, 5-point rating scale and the Health Utilities Index mark III). Comparison with published data from healthy children suggests that these common otolaryngologic problems have a large impact on a child's quality of life. CONCLUSIONS: TAPQOL seems to be appropriate for use in this context. Marked ceiling effects in some domains, however, may limit their sensitivity.

Child, Preschool↗
PubMed1994

Bacterial vaginosis: efficacy and safety of intravaginal metronidazole treatment.

OBJECTIVE: We evaluated the effectiveness and safety of intravaginal metronidazole in the treatment of bacterial vaginosis. Demographic data, Gram stain score, and individual clinical diagnostic criteria for bacterial vaginosis were evaluated for association with therapeutic outcome. METHODS: According to accepted diagnostic criteria and blinded Gram stain scoring for quality control, a multicenter, prospective, double-blinded trial of patients randomized to either 0.75% metronidazole gel 5 gm twice daily for 5 days or placebo was undertaken. Therapeutic response after completion of treatment was evaluated by examination at 4 to 16 days and again at 28 to 32 days for patients initially cured. RESULTS: After metronidazole treatment, 38 (78%) of 49 patients were cured initially, compared with 11 (27%) of 41 placebo recipients (p < 0.001). One month after treatment 31 (91%) of 34 in the group initially cured by metronidazole remained cured. Side effects were uncommon and mild. Significant intercenter differences were noted for vaginal discharge assessment but not for other diagnostic criteria. Among patients cured initially with metronidazole, mean Gram stain score was 0.58 among those in whom cure was maintained versus 2.33 for those in whom recurrent bacterial vaginosis developed 1 month after treatment (p = 0.03). Curative metronidazole treatment was found initially in 4 (100%) of 4 patients with sperm present on gram stain compared with 34 (76%) of 45 with sperm absent (p = 0.56) and in 6 (100%) of 6 and 25 (89%) of 28, respectively, at the final visit (p = 1.0). CONCLUSIONS: Intravaginal metronidazole is effective, safe, well-tolerated, durable therapy for bacterial vaginosis. Characterization of vaginal discharge appears to be the most variable among the diagnostic criteria for bacterial vaginosis. Gram stain score may be able to identify patients cured early after therapy who are at risk for later recurrence. Exposure to semen does not appear to affect efficacy of intravaginal metronidazole.

Administration, Intravaginal↗
PubMed2001

Results of breast-conserving therapy for ductal carcinoma in situ: the Kyoto University experiences.

BACKGROUND: The purpose of this study was to evaluate the results of breast-conserving therapy (BCT), defined as the combination of breast-conserving surgery with axillary dissection and definitive radiation therapy for ductal carcinoma in situ (DCIS). METHODS: Between November 1987 and March 1998, 33 patients with DCIS undergoing BCT at our hospital were examined. The mean age was 48. All patients underwent quadrantectomy or wide excision as well as axillary dissection. Radiation therapy consisted of 50 Gy to the ipsilateral whole breast. Boost irradiation of 10 Gy was given to 15 patients with close or positive margins. Nearly all patients received adjuvant chemotherapy with 5-fluorouracil or its derivatives and adjuvant endocrine therapy with tamoxifen for 2 years. RESULTS: The minimum and median follow-up periods were 32 and 80 months, respectively. All patients but one were followed. Only one patient had a non-invasive local recurrence, 23 months after her operation. This patient was salvaged with simple mastectomy. Her prognostic index score was 8. The five-year local control rate was 97%. No serious acute or late complications were noted. CONCLUSION: The results of this retrospective study substantiate favorable data and appear to confirm the efficacy and reasonable local recurrence rate of BCT for the treatment of DCIS.

Adult↗
PubMed1999

"Crohn's disease activity index" is inaccurate to detect the post-operative recurrence in Crohn's disease. A GISC study. Gruppo Italiano per lo Studio del Colon e del Retto.

BACKGROUND: Even though endoscopy is considered to be the gold standard for the detection of post-operative recurrence in Crohn's disease, the Crohn's disease activity index continues to be used for this purpose. AIM: The aim of this study was, therefore, to assess the accuracy of Crohn's disease activity index to detect post-operative recurrence in Crohn's disease in comparison to endoscopy. PATIENTS AND METHODS: The study was performed in 110 patients submitted to intestinal resection for Crohn's disease of the terminal ileum. Crohn's disease activity index score was assessed at 6, 12, 24 and 36 months after surgery. At the same intervals colon-ileoscopy was performed in all patients. The Receiver Operating Characteristic analysis was used to assess the accuracy of the Crohn's disease activity index score. Some routine laboratory variables were also analyzed. RESULTS: Crohn's disease activity index was able to discriminate patients with and without recurrence in 65% of the cases. Considering 150 the standard cut-off value of Crohn's disease activity index, this figure corresponds to a specificity of 89% and a sensitivity of 30%. Out of the laboratory variables erythrocyte sedimentation rate, chloraemia and serum albumin, globally considered in a discriminant function, showed a predictive ability significantly better than Crohn's disease activity index (z = 1.97; two tailed p-value = 0.04). These variables were able to discriminate patients with and without recurrence in 88% of the cases, and at the same value of specificity for the Crohn's disease activity index reached double value of sensitivity (65%). Positive and negative predictive values of laboratory variables (80% and 78%, respectively) were better than the corresponding values of the Crohn's disease activity index score (71% and 56%, respectively). CONCLUSIONS: These results indicate that the Crohn's disease activity index alone is inadequate for detection of post-operative recurrence in Crohn's disease.

Blood Cell Count↗
PubMed2006

Recurrent shoulder instability among athletes: changes in quality of life, sports activity, and muscle function following open repair.

BACKGROUND: Recurrent anterior shoulder instability is a disabling condition in young athletes with possibly underestimated impact on quality of life and sports activity. Commonly used clinical scoring systems do not reflect the impairment of quality of life and sports activity. It was our aim to assess the return to preinjury levels of quality of life and sports activity as well as the changes in muscle function among competitive and recreational athletes. HYPOTHESIS: Patients suffering from post-traumatic recurrent shoulder instability have to adopt their participation in sports and therefore discover a reduction in quality of life. Open stabilization procedures are able to improve shoulder function and to reduce recurrence rates. However, return to preinjury shoulder function is not guaranteed. STUDY DESIGN: Retrospective longitudinal cohort study on 19 consecutive athletes with recurrent, post-traumatic shoulder instability. All patients were treated with an open, capsulo-labral repair. The minimum follow-up was 24 months. METHODS: Life quality (SF12) and sports activity data (Athletic Shoulder Outcome Scoring System) were retrospectively collected for the time before injury (time 1) and for the time with recurrent instability (time 2). Two years after surgical stabilization (time 3), we followed our patients with different clinical outcome scores, rotator surface EMG measurement, isokinetic muscle strength testing, and a radiological evaluation. This design of a three-step follow-up allowed for calculating the impact on quality of life and sports activity following the injury. RESULTS: Two years after surgery, the clinical scoring systems revealed good-to-excellent results in all patients. Quality of life physical component summary remained diminished by 9.2% despite the surgical procedure and was therefore significantly lower as compared to preinjury levels (p < 0.05). Sports activity was also significantly lower at the time of follow-up (p < 0.05). In this specific procedure, external rotation was not impaired postoperatively. EMG testing showed an overall reduction of muscle activity, however not significant. Isokinetic muscle strength was significantly diminished for external rotation and shoulder abduction. CONCLUSIONS: Open reconstruction procedures for recurrent shoulder instability can restore shoulder function and stability to near-normal values. Despite good-to-excellent clinical results, there is a significant impairment of quality of life and sports activity 2 years after surgery. Muscle activity and muscle strength are diminished. Recurrent shoulder instability remains a disabling condition to the young athlete. Future strategies have to emphasize restoration of quality of life, sports activity, and muscle function.

Adolescent↗
PubMed1989

Serum CA-125 levels in women with endometriosis.

Forty-two women with laparoscopically-confirmed pelvic endometriosis (assessed according to the American Fertility Society modified classification) had serum levels of the cell-surface antigen CA-125 measured before, during and after medical therapy with nafarelin acetate or danazol combined with follow-up laparoscopic surgery or laparotomy. Serum levels before treatment (39.3 [SE 6.6] U/ml) were elevated above accepted normal levels in many subjects, and these were highly significantly suppressed during medical therapy with both nafarlin and danazol (13.1 [SE 1.5] U/ml at 5 months); t = 3.198; p = 0.002). Levels tended to rise following therapy but a clear correlation between a rise in serum CA-125 and recurrence of disease was not demonstrated. In 3 individuals treated with nafarelin a dramatic rise in serum CA-125 levels was seen after 2 weeks of therapy. This did not correlate with any exacerbation of symptoms or with any rise in serum oestradiol or with pretreatment AFS scoring. Serum CA-125 levels provide a potential approach to the monitoring of treatment and recurrence in a substantial proportion of women with endometriosis, although preliminary evidence suggests that there will be individual exceptions to any broad correlations.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed2004

Radical retropubic prostatectomy in men younger than 45 years diagnosed during early prostate cancer detection program.

OBJECTIVES: To evaluate the incidence and outcome of prostate cancer in men younger than 45 years of age treated with radical retropubic prostatectomy after screening in an early prostate cancer detection program. METHODS: Our study group comprised 19,302 men younger than 45 years old who participated in this program. The indications for prostate biopsy were a prostate-specific antigen (PSA) level of 1.25 ng/mL or greater and a percent-free PSA value of 18% or less. Patients with prostate cancer underwent nerve-sparing radical retropubic prostatectomy. Intraoperative and early postoperative complications, clinical and pathologic stage, Gleason score, and surgical margins were reviewed retrospectively. In addition, potency, continence, and biochemical recurrence were assessed at the last follow-up visit. RESULTS: Of the study population eligible for prostate biopsy (1027 patients), only 175 (17%) consented to undergo the procedure (mean PSA 3.8 ng/mL). Twenty-eight men were diagnosed with prostate cancer, corresponding to 0.14% of the screened population and 16% of the biopsied patients. Twenty-six patients agreed to undergo radical retropubic prostatectomy. Pathologic examination revealed organ-confined disease in 22 (84.6%) and extraprostatic extension in 4 (15.4%). Positive surgical margins were seen in 2 patients (7.7%). The Gleason score was 7 or greater in 11 (42.3%) and 6 or less in 15 patients (57.7%). During a mean follow-up period of 15.8 months (range 3 to 36), all patients were continent, and 13 of the 16 patients with a follow-up of 12 months or longer were potent. CONCLUSIONS: In a large screening population younger than 45 years old, 16% of biopsied patients were positive for prostate cancer. These tumors were clinically significant but of a low stage and therefore potentially curable by surgery.

Adenocarcinoma↗
PubMed1993

Radical retropubic prostatectomy and postoperative adjuvant radiation for pathological stage C (PcN0) prostate cancer from 1976 to 1989: intermediate findings.

Between 1976 and 1989, 114 patients undergoing radical retropubic prostatectomy and bilateral pelvic lymph node dissection for prostatic adenocarcinoma were found to have stage PcN0 lesions. Postoperative adjuvant radiation therapy without hormonal treatment was given to 95 of these patients (83%): 26 (27%) with stage C1, 37 (39%) with stage C2 and 32 (34%) with stage C3 disease. The median radiation dose was 45 Gy. given at 180 cGy. daily. Median followup was 4.4 years (range 1.4 to 13.3). The overall 5 and 10-year actuarial rates for the patients were 94% and 70%, respectively. Disease-specific 5 and 10-year actuarial survival rates were 99% and 78%, respectively. At 5 and 10 years the chance of clinical recurrence was estimated as 6% and 13%, respectively, and the chance of recurrence (clinical or indicated by prostate specific antigen levels) was estimated to be 34% and 46%, respectively. Patients with high Gleason scores (8 to 10) and seminal vesicle involvement (stage C3) fared worst. There were 5 patients with clinical distant metastases, 1 with a clinical local recurrence and 1 with both conditions. Detectable elevation of prostate specific antigen without clinically evident recurrence was noted in 25 patients. Radiation therapy was well tolerated with minimal morbidity. Disease-specific survival and survival without clinical recurrence were improved over historical control in patients with stage PcN0 prostate cancer treated by radical prostatectomy alone. These data support a role for adjuvant radiation therapy in stage PcN0 prostate adenocarcinoma following radical prostatectomy.

Adenocarcinoma↗
PubMed2005

Psychiatric profile, quality of life and risk of syncopal recurrence in patients with tilt-induced vasovagal syncope.

AIM: The aim of this study was to investigate the prevalence of psychiatric disorders and quality of life (QoL) in patients with tilt-induced vasovagal syncope and no other comorbidities, and their relationship with the syncopal burden and the risk of recurrence. METHODS: We studied 61 patients with recurrent syncope and positive tilt testing. Controls consisted of 61 sex- and age-matched healthy subjects. Psychiatric diagnoses were formulated on the basis of a structured interview and the Minnesota Multiphase Personality Inventory-2 questionnaire. QoL was assessed by means of the Short-Form Health Survey questionnaire. Patients were followed up for at least 1 year. RESULTS: The presence of psychiatric disorders was higher among patients than controls (71% vs. 23%, P < 0.001), with a prevalence of anxiety (28% vs. 5%), mood (18% vs. 3%), and somatization disorders (29% vs. 3%). The scores of all the QoL scales were statistically lower in patients than controls. An inverse correlation was found between QoL scale scores and syncopal burden. The presence of psychiatric disorders was predictive of syncopal recurrence during follow-up. CONCLUSION: Psychiatric disorders are common in patients with tilt-induced vasovagal syncope, and seem to predict the risk of recurrence. QoL is impaired in these patients, and is inversely correlated with the syncopal burden.

Adult↗
PubMed2003

Recurrent cardiac ischemic events early after discontinuation of short-term heparin treatment in acute coronary syndromes: results from the Thrombolysis in Myocardial Infarction (TIMI) 11B and Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) studies.

OBJECTIVES: The aim of this study was to determine whether discontinuation of low-molecular-weight heparin (LMWH) treatment results in a clustering of cardiac ischemic events as previously observed after cessation of unfractionated heparin (UFH) in acute coronary syndrome (ACS) patients. BACKGROUND: Clinical trials in patients with ACS have shown early recurrent ischemic events after discontinuation of UFH treatment. We analyzed whether LMWH cessation also results in early ischemic recurrence events and if continuation of a fixed-dose LMWH prevents this complication. METHODS: The combined incidence of death, myocardial infarction, or urgent revascularization in the first seven days after discontinuation of UFH (n = 3,012), short-term enoxaparin 1 mg/kg subcutaneously twice a day (n = 2,011), and short-term enoxaparin followed by prolonged enoxaparin 60 mg subcutaneously twice a day (n = 1,075) was analyzed from the combined Thrombolysis In Myocardial Infarction (TIMI) 11B/Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) database in a per patient analysis. RESULTS: The cessation of both UFH and short-term enoxaparin resulted in a similar clustering of recurrent ischemic events on the first day, with an incidence of the primary end point of 2.8% in both groups. Of all recurrent events in the first week after cessation, 40% occurred in the first 24 h. The continuation of a fixed-dose enoxaparin treatment prevented this early excess, with a first day incidence of 0.4% (p < 0.0001). The TIMI risk score characteristics predicted the incidence of early rebound ischemic events. CONCLUSIONS: There is significant clustering of recurrent ischemic events within 24 h after cessation of both short-term UFH and enoxaparin treatment, and patients should be carefully monitored during that period. This early rebound may be prevented by continuation of a fixed dose of enoxaparin.

Anticoagulants↗