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[Laryngeal epithelial dysplasia vs. laryngeal intraepithelial neoplasia].

Laryngeal cancer is the most frequent malignancy of the upper respiratory tract. Only the very early treatment of tumors or even of their precursor lesions will be both curative and organ preserving. Microsurgical techniques facilitate early detection and complete removal of limited lesions can be achieved quite frequently, but follow-up data for such lesions are difficult to obtain. The resulting lack of endpoint observations (i.e., malignant transformation, spontaneous involution) hampers the development, testing, and application of grading systems focusing on epithelial alterations, especially changes with only mild nuclear atypia and minimal structural alteration. Such lesions may be entirely benign or may indicate premalignant stages of well-differentiated carcinoma. For diagnosis we recommend a modified Kleinsasser's system to classify premalignant epithelial changes. Only the complete removal of suspicious lesions as far as possible or regular clinical follow-up in cases where complete removal cannot be achieved can prevent the development of advanced stage cancer.

Diagnosis, Differential↗

[Therapy of acute myeloid leukemia in the elderly patient].

Incidence and mortality rates of acute myeloid leukemia (AML) increase exponentially with advancing age. AML diagnosed in elderly patients differs from that diagnosed in younger patients. But not only disease-specific differences are important. Treating elderly patients with AML age-associated differences in the patients general presentation, such as physiological changes in organ function, decreased ability to react to stress, dependence in activities of daily living, existence of other morbidities (co-morbidity), the need to take drugs for those diseases and the reduced life expectancy can force alterations in the disease management. Clinical trials for the treatment of AML have been excluding elderly patients for years. Even trials accepting elderly patients with AML did select the group of otherwise healthy elderly patients for participation in the trial. Thus the data for AML management in elderly patients do not reflect the whole group of elderly patients with AML. If the patient is treated with curative intention, therapy of choice is the so-called 3 + 7 protocol for induction of complete remission, followed by a consolidation therapy and in some cases by maintenance therapy. In some situations, especially in very old patients, a palliative intention to treatment is favored. There are no generally accepted criteria to measure treatment benefit in this setting nor established chemotherapy protocols for this situation. Further trials for elderly patients with AML have to offer treatment options for the whole group of patients and have to determine what treatment approach is the best for which individual patient.

Adolescent↗

Proteomics at scale: Bottlenecks and opportunities for early-career researchers in a fast developing field.

The field of proteomics has rapidly evolved over the last five years enabled by rapid advances in instrumentation and computation. At the same time, the proteomics community is also growing. This is reflected by the increasing participation in international conferences such as those organized by the European Proteomics Association and the Human Proteome Organization. These events provide early-career researchers with unique opportunities to exchange ideas, develop collaborations, and build networks that support professional development. One such network is the Young Proteomics Investigators Club, a European initiative supported by European Proteomics Association and led by early-career researchers. In this Community-Driven project, we investigate recent trends in proteomics by screening conference abstracts and evaluating the session attendance at Human Proteome Organization Congresses and European Proteomics Association conferences. Based on these analyses, we identified five areas that, from our perspective, are shaping the current trends in proteomics: clinical proteomics, proteomics of post-translational modifications, single-cell proteomics, systems biology and multi-omics, and computational proteomics. For each area, we highlight both unique challenges and identify a common theme: a shift from exploratory studies with manageable sample numbers towards large screenings and cohorts and the generation of big data, which often comes with the lack of computational support, organizational networks, and infrastructure. In this light, we describe the unique challenges and opportunities faced by early-career researchers. We point to actionable directions for enabling reproducible and transparent proteomics as well as community-driven projects and initiatives, which are often providing training and support. SIGNIFICANCE: In this perspective, the Young Proteomics Investigators Club (YPIC) discusses advances in analytical developments and computational approaches in proteomics research. Based on empirical analysis of recent European Proteomics Association conference and Human Proteome Organization congresses contributions, we identify clinical, single-cell, post-translational and systems-level proteomics as the research areas that have gained most momentum in the last three to five years. What makes this work distinctive is that it is written by and for early-career researchers, thereby uniquely identifying where momentum, challenges, and unmet needs converge for the newest generation of proteomics researchers. Rather than cataloguing advances, we examine the widening gap between what modern proteomics can generate and what individual researchers can realistically process, validate, and interpret. We describe specific structural barriers including access to high performance computing, limited formal training in scalable data analysis, the need for unified benchmarking standards and navigating clinical collaboration frameworks. We then highlight opportunities for the field, such as community-curated benchmarks, interdisciplinary mentorship models, and shared computational infrastructure. By making these challenges explicit from an early-career researchers standpoint, we aim to inform how training, funding, and community initiatives can be shaped to support the next generation of proteomics researchers.

Proteomics↗

Dose-response relationship of nasopharyngeal carcinoma above conventional tumoricidal level: a study by the Hong Kong nasopharyngeal carcinoma study group (HKNPCSG).

BACKGROUND AND PURPOSE: To define the dose-response relationship of nasopharyngeal carcinoma (NPC) above the conventional tumoricidal dose level of 66 Gy when the basic radiotherapy (RT) course was given by the 2D Ho's technique. PATIENTS AND METHODS: Data from all five regional cancer centers in Hong Kong were pooled for this retrospective study. All patients (n = 2426) were treated with curative-intent RT with or without chemotherapy between 1996 and 2000 with the basic RT course using the Ho's technique. The primary endpoint was local control. The prognostic significance of dose-escalation ('boost') after 66 Gy, T-stage, N-stage, use of chemotherapy, sex and age (< or =40 years vs >40 years) was studied. Both univariate and multivariate analyses were performed. RESULTS: On multivariate analysis, T-stage (P < 0.01; hazard ratio [HR], 1.58) and optimal boost (P = 0.01; HR, 0.34) were the only significant factors affecting local failure for the whole study population, and for the population of patients treated by radiotherapy alone, but not for patients who also received chemotherapy. The following were independent determinants of local failure for patient groups with different T-stages treated by radiotherapy alone: use of a boost in T1/T2a disease (P = 0.01; HR, 0.33); use of a boost (P < 0.01; HR, 0.60) and age (P = 0.01; HR, 1.02) in T3/T4 tumors. Among patients with T2b tumors treated by radiotherapy alone and given a boost, the use of a 20 Gy-boost gave a lower local failure rate than a 10 Gy-boost. There was no apparent excess mortality attributed to RT complications. CONCLUSIONS: Within the context of a multi-center retrospective study, dose-escalation above 66 Gy significantly improved local control for T1/T2a and T3/4 tumors when the primary RT course was based on the 2D Ho's technique without additional chemotherapy. 'Boosting' in NPC warrants further investigation. Caution should be taken when boosting is considered because of possible increase in radiation toxicity.

Adult↗

Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer.

PURPOSE: Three-dimensional conformal radiation therapy (3D-CRT) is a technique designed to deliver prescribed radiation doses to localized tumors with high precision, while effectively excluding the surrounding normal tissues. It facilitates tumor dose escalation which should overcome the relative resistance of tumor clonogens to conventional radiation dose levels. The present study was undertaken to test this hypothesis in patients with clinically localized prostate cancer. METHODS AND MATERIALS: A total of 743 patients with clinically localized prostate cancer were treated with 3D-CRT. As part of a phase I study, the tumor target dose was increased from 64.8 to 81 Gy in increments of 5.4 Gy. Tumor response was evaluated by post-treatment decrease of serum prostate-specific antigen (PSA) to levels of < or = 1.0 ng/ml and by sextant prostate biopsies performed > or = 2.5 years after completion of 3D-CRT. PSA relapse-free survival was used to evaluate long-term outcome. The median follow-up was 3 years (range: 1-7.6 years). RESULTS: Induction of an initial clinical response was dose-dependent, with 90% of patients receiving 75.6 or 81.0 Gy achieving a PSA nadir < or = 1.0 ng compared with 76% and 56% for those treated with 70.2 Gy and 64.8 Gy, respectively (p < 0.001). The 5-year actuarial PSA relapse-free survival for patients with favorable prognostic indicators (stage T1-2, pretreatment PSA < or = 10.0 ng/ml and Gleason score < or = 6) was 85%, compared to 65% for those with intermediate prognosis (one of the prognostic indicators with a higher value) and 35% for the group with unfavorable prognosis (two or more indicators with higher values) (p < 0.001). PSA relapse-free survival was significantly improved in patients with intermediate and unfavorable prognosis receiving > or = 75.6 Gy (p < 0.05). A positive biopsy at > or = 2.5 years after 3D-CRT was observed in only 1/15 (7%) of patients receiving 81.0 Gy, compared with 12/25 (48%) after 75.6 Gy, 19/42 (45%) after 70.2 Gy, and 13/23 (57%) after 64.8 Gy (p < 0.05). CONCLUSIONS: The data provide evidence for a significant effect of dose escalation on the response of human prostate cancer to irradiation and defines new standards for curative radiotherapy in this disease.

Aged↗

What is the best postoperative treatment for patients with pT3bN0M0 adenocarcinoma of the prostate?

The purpose of this paper to identify the optimal therapy after radical prostatectomy (RP) for patients with adenocarcinoma of the prostate invading the seminal vesicles (pT3bN0M0 or SVI). A PubMed search using the keywords 'prostate', 'seminal vesicle', 'prostatectomy', 'radiotherapy', 'androgen blockade' was performed to identify literature regarding rates of disease failure in patients with SVI who are observed or treated with androgen blockade (AB), radiotherapy (RT) or RT + AB after RP. The outcome of 68 patients treated at Duke University with post-operative AB, RT or RT + AB for pT3bN0M0 is also presented. More than 70% of patients with SVI develop disease recurrence after surgery. For many, recurrence occurs within 2 y after RP. These patients have poor control rates with postoperative RT alone. While experience with AB and RT+AB is limited, control rates are generally superior to RT alone. At Duke University, after a median follow-up of nearly 4 y, patients treated with RT + AB or AB alone for pT3bN0M0 achieved better 5-y progression-free survival (PFS) compared with those who received RT alone (78 and 68 vs 30%, P = 0.03 and 0.046, respectively). There was no PFS difference between those who received AB alone or RT + AB (68 vs 78%, P=0.5). Seminal vesicle invasion confers a poor prognosis after RP. SVI is a consistent predictor of poor outcome after RT. The limited data available examining AB and RT + AB in pT3bN0M0 disease, including data from Duke University, are encouraging. Nonetheless, postoperative AB, RT and RT + AB for pT3bN0M0 disease require prospective evaluation, as RP alone is rarely curative.

Adenocarcinoma↗

[Prospective multicenter trial of gastric cancer surgery--a contribution to clinical research on quality control].

By the mean of a prospective multicenter observational study (East German Gastric Cancer Study - EGGCS), 1 139 consecutive patients with gastric cancer were enrolled in 80 East German surgical departments from January 1 to December 31, 2002. Out of them, 1,031 (90.5%) underwent surgical intervention. The resection rate was 86.4% (n = 891); the R0 resection rate (n = 726) was 81.5%. Gastrectomy was performed in 79.8 % (n = 649) of subjects with radical resections (n = 813). In approximately 70 % of the interventions with curative intention, lymph node resection of the D2 compartment was carried out. The postoperative hospital mortality was 8.3%. The results were compared with the data obtained in the German Gastric Cancer Study (GGCS 1992); relevant differences and aspects were discussed.

Adolescent↗

From latent disseminated cells to overt metastasis: genetic analysis of systemic breast cancer progression.

According to the present view, metastasis marks the end in a sequence of genomic changes underlying the progression of an epithelial cell to a lethal cancer. Here, we aimed to find out at what stage of tumor development transformed cells leave the primary tumor and whether a defined genotype corresponds to metastatic disease. To this end, we isolated single disseminated cancer cells from bone marrow of breast cancer patients and performed single-cell comparative genomic hybridization. We analyzed disseminated tumor cells from patients after curative resection of the primary tumor (stage M0), as presumptive progenitors of manifest metastasis, and from patients with manifest metastasis (stage M1). Their genomic data were compared with those from microdissected areas of matched primary tumors. Disseminated cells from M0-stage patients displayed significantly fewer chromosomal aberrations than primary tumors or cells from M1-stage patients (P < 0.008 and P < 0.0001, respectively), and their aberrations appeared to be randomly generated. In contrast, primary tumors and M1 cells harbored different and characteristic chromosomal imbalances. Moreover, applying machine-learning methods for the classification of the genotypes, we could correctly identify the presence or absence of metastatic disease in a patient on the basis of a single-cell genome. We suggest that in breast cancer, tumor cells may disseminate in a far less progressed genomic state than previously thought, and that they acquire genomic aberrations typical of metastatic cells thereafter. Thus, our data challenge the widely held view that the precursors of metastasis are derived from the most advanced clone within the primary tumor.

Algorithms↗

Surgery for obstructive sleep apnea: effects on sleep, breathing, and oxygenation.

Advances in the treatment of obstructive sleep apnea have evolved rapidly over the past two decades. Nasal continuous positive airway pressure (CPAP) devices are effective, but are neither curative nor universally well tolerated. Uvulopalatopharyngoplasty (UPPP) has been reported to have widely varying success rates; many studies of this procedure do not include data about sleep quality, oxygenation, or patient satisfaction. The role of nasal surgery in the treatment of obstructive sleep apnea in the hands of a single surgeon, specifically evaluating its effects on sleep and oxygenation parameters. Overall, 12 of 15 patients (80%) had marked improvement, reflected by oximetry and patient interview. This pilot study shows that the combined use of UPPP and nasal surgery, when indicated, for obstructive sleep apnea is an acceptable alternative in nasal CPAP-intolerant patients. Further studies with larger numbers are needed to further substantiate these findings.

Adolescent↗

The neurotrophic factor artemin promotes pancreatic cancer invasion.

OBJECTIVE: To analyze the role of Artemin in pancreatic ductal adenocarcinoma (PDAC) in terms of expression, influence on cancer cell behavior, and pain correlation. SUMMARY BACKGROUND DATA: PDAC is characterized by prominent local nerve alterations and perineural invasion, which frequently affects the extrapancreatic nerve plexus, causing severe pain and precluding curative resection. Artemin, a neurotrophic protein controlling growth, regeneration, and survival of neurons was analyzed to highlight the neuro-cancer interactions in PDAC. METHODS: Artemin and its receptors (GFRalpha3/RET) were studied in PDAC tissues and normal pancreas by Western blot analysis and immunohistochemistry. RNA expression was analyzed in pancreatic tissues (normal, cancer) and pancreatic cancer cell lines by QRT-PCR. To evaluate whether Artemin influences cancer cell proliferation and invasion, MTT-growth and Matrigel-invasion assays were used. In addition, the tissue expression of Artemin was correlated with pain in PDAC. RESULTS: Artemin and GFRalpha3/RET were both detected at enhanced levels in PDAC compared with normal pancreas, localizing predominantly in hypertrophic nerves and arterial walls, as well as in cancer cells of primary and metastatic lesions. The levels of Artemin and GFRalpha3 did not correlate with pain in PDAC patients. However, Artemin promoted pancreatic cancer cell invasion up to 5-fold, without affecting cancer cell proliferation. CONCLUSION: Artemin expression was not associated with pain in PDAC. However by increasing cancer cell invasion, Artemin seems to influence neural invasion and thereby contribute to cancer cell spreading along pancreatic nerves.

Adenocarcinoma↗

Cost effectiveness of radiofrequency catheter ablation in the treatment of symptomatic supraventricular tachyarrhythmias.

BACKGROUND: The recent advent of radiofrequency (RF) catheter ablation as a curative therapy for supraventricular tachyarrhythmias has challenged the role of long term drug treatment, which is essentially a palliative therapy. To date, however, no data have been published on the cost-effectiveness of RF ablation as compared with drug treatment in the Australian setting. AIMS: The study aimed to compare actual and projected costs of these two treatment options in a consecutive group of patients having RF ablation as treatment for symptomatic tachyarrhythmias. METHODS: The cost effectiveness of RF catheter ablation was assessed in 26 patients having RF ablation, using a hypothetical model of continued drug therapy in the same group of patients. A 'cost saving' criterion was used for cost effectiveness. Actual costs for the RF ablation and for continued drug therapy were based on data from medical records and from the answers to a detailed patient questionnaire. Analysis included costs of prior diagnostic electrophysiology (EP) study (17/26 patients), general anaesthesia (GA: 20/26 patients), post-ablation echocardiography (10/26 patients), and late follow-up EP study (7/26 patients). The in-hospital stay for the RF ablation was two days in all cases, and no patient required implantation of a permanent pacemaker. The RF ablation procedure was successful in 23/26 patients (88.5%) with late recurrence of tachycardia in one patient. After a median follow-up of nine months, 22/26 patients no longer require antiarrhythmic drug therapy. RESULTS: The mean per patient cost of RF ablation was $4067 in the study group. This reduces to $2546 if prior EP study and GA are excluded. The mean per patient cost of continued medical therapy was $700 per year. Extrapolating over 20 years and allowing for an annual 5% inflation factor, RF ablation becomes cost saving in 5.5 years (3.8 years if prior EP and GA are excluded). Over 20 years, continued drug therapy would be four to five times more expensive than RF ablation in the patient study group. We consider RF ablation to be a cost-effective alternative to long term drug therapy in patients with supraventricular tachyarrhythmias.

Adolescent↗

Neoadjuvant Therapy for Cancer of the Esophagus.

BACKGROUND: The standard of care for esophageal cancer has historically been surgical resection. However, survival following surgical treatment of esophageal cancer remains poor. In inoperable patients, both radiation therapy and chemotherapy alone and in combination have been used with some success. Consequently, these therapies have been utilized in the neoadjuvant setting to improve palliation and prolong survival. METHODS: The author reviewed the literature regarding clinical trials that employed neoadjuvant chemotherapy and radiation therapy in the treatment of squamous cell carcinoma and adenocarcinoma of the esophagus. RESULTS: In most patients, surgery alone is noncurative therapy, even when performed with curative intent. Most phase III trials of neoadjuvant therapy have not been designed with adequate statistical power to detect clinically relevant improvement. The available data are insufficient to determine a benefit to preoperative radiation therapy alone. Preoperative chemotherapy with 5-FU plus cisplatin followed by surgery probably offers little or no improvement over surgery alone. Trials of combined preoperative chemoradiation therapy have yielded promising but not definitive results. CONCLUSIONS: Outside of a clinical trial, neoadjuvant therapy for esophageal cancer should be reserved for only a select group of patients. Future clinical trials may determine a role for neoadjuvant chemoradiation and identify more active chemotherapeutic agents and populations most likely to benefit.

Journal Article↗

The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy.

Carcinoma of the gallbladder is a rare disease, but when encountered in the patient undergoing laparoscopic cholecystectomy, it can pose a number of dilemmas. Familiarity with the risk factors for malignant gallbladder disease can help identify patients in whom more extensive preoperative evaluation is warranted. When carcinoma is identified preoperatively, cholecystectomy should be performed as an open procedure. If malignancy is encountered unexpectedly during laparoscopic cholecystectomy, the procedure should be converted to an open resection to allow for appropriate evaluation of the stage of disease and appropriate surgical management. Most commonly, malignancy is identified postoperatively, only after pathological examination of the resected gallbladder. Except in rare circumstances, open reoperation is necessary to achieve an adequate curative resection. The current concerns about port site recurrence and carcinomatosis after laparoscopic resection of a gallbladder carcinoma are unwarranted based on current published data. The role of prophylactic excision or irradiation of port sites is uncertain based on current understanding of the biological behavior of the disease.

Cholecystectomy, Laparoscopic↗

The tumor growth-promoting effect of allogeneic blood transfusions.

Over the past decade, many studies have suggested that allogeneic blood transfusions (ABT) may adversely affect a recipient. The ABT-associated deleterious effects include the development of transfusion reactions, graft-versus-host disease, alloimmunization, and immunomodulation. While the ABT-associated immunosuppressive effects might be beneficial for recipients of kidney allografts, in reducing the relapse rate in patients with Crohn's disease, and in ameliorating the rate of abortion in women with recurrent spontaneous abortions; evidence is accumulating that the immunosuppression associated to perioperative ABT might adversely affect overall prognosis in patients with a malignancy undergoing curative cancer surgery. In addition, the ABT-associated immunomodulation has been reported to be associated with an increased risk for postoperative bacterial infections. Data from both inbred and outbred experimental animal models indicate that ABT promote tumor growth. Evidence is available that this ABT-promoting tumor growth effect can be adoptively transferred to naive animals, using splenic immunocytes. Furthermore, data from the experimental animal models indicate that the ABT effect on the growth of tumors is due to the presence of the donor leukocytes in the transfused allogeneic blood, and that this deleterious effect can be ameliorated by the pre-storage leukodepletion of the allogeneic blood. Importantly, recent evidence suggests that post-storage leukodepletion is inefficacious in preventing the ABT-associated tumor growth promotion effect. While results from studies in experimental animals cannot necessarily be extrapolated to the clinical situation, these studies suggest that ABT promote tumor growth and that pre-storage leukodepletion ameliorates this effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Antitumor activity evaluation of bromine-substituted analogues of ifosfamide. I. Stereodifferentiation of biological effects and selection of the most potent compounds.

The series of 9 compounds, including 3 racemates and 6 enantiomers of bromine-substituted analogues of ifosfamide (bromo-, chlorobromo- and dibromofosfamides) have been evaluated for antitumor activity against L1210 leukemia, Lewis lung carcinoma and B16 melanoma in mice. Effective and curative doses of tested compounds were estimated on the basis of computer-assisted elaboration of the dose-effect curves obtained from experimental data. Two oxazaphosphorine drugs, ifosfamide and its congener cyclophosphamide, were used as referentials. Elementary toxicity studies were conducted in parallel in healthy animals and lethal doses were determined. Selection of the most potent compounds was based on the comparison of their therapeutic indices, calculated from the ratio of lethal to effective doses. In effect four compounds which have been shown therapeutically more effective than both referential drugs, were selected for further evaluation in mice bearing advanced tumours. Stereodifferentiation of evaluated biologic effects favouring S(-) isomers was observed in all three groups of compounds. Preliminary observation was also made indicating significant lethality reduction after per os administration of selected agents, which was not paralleled by diminution of their antitumor effectivity.

Animals↗

Which patients with advanced, proximal gastric cancer benefit from complete clearance of spleno-pancreatic lymph nodes?

BACKGROUND: The prognostic significance of dissecting spleno-pancreatic nodes remains unclear in patients with advanced proximal gastric cancer. MATERIALS AND METHODS: Data from a total of 104 patients (74 males and 30 females; age range, 21 to 76 years; mean, 56.0 years), who had undergone curative total gastrectomy combined with spleno-pancreatectomy for advanced proximal gastric cancer, were analyzed with respect to clinicopathological features and patient survival. RESULTS: Metastases to spleno-pancreatic nodes were found in 24 patients (23.1%). Tumor size > 40 mm (p = 0.0218), histologically-undifferentiated type (p = 0.0346) and both Japanese and TNM node-stages (p < 0.0001) were associated with metastases to these nodes. The 5-year survival rate of patients with a T2 tumor was 65.4% in patients with no metastases to the spleno-pancreatic nodes and 45.5% in patients with metastases to these nodes (p = 0.0699). No patients with a T3 tumor and metastases to the spleno-pancreatic nodes survived more than 4 years. CONCLUSION: Complete clearance of SP-nodes for patients with advanced proximal gastric cancer is beneficial for patients with a T2 tumor but not for patients with a T3 tumor. Metastases to these nodes appear to be rare in tumors less than 40 mm. Thus, this treatment should not be routinely performed in patients with proximal advanced gastric cancer. It should not be considered in patients with T3 tumors or with tumors < or = 40 mm.

Adult↗

[Clinical analysis of surgery for rectal cancer in 122 elderly patients].

BACKGROUND & OBJECTIVE: Patients with rectal carcinoma in the elderly are usually complicated with coexisting diseases. For selection of operative procedure, it is necessary to consider the various factors. The aim of this study was to assess the treatment and prognosis of rectal carcinoma in patients over 65 years of age. METHODS: The data of 122 such patients treated from January 1987 to December 1998 in Cancer Hospital of Chinese Academy of Medical Sciences was analyzed retrospectively. Curative resection was performed for all patients, including abdominoperineal resection (45), anterior resection (66), Hartmann's operation (7), and transanal local excision (4). Postoperative complication developed in 10 patients (8.2%). No death occurred within 30 days post operation. Survival analysis was estimated using the Kaplan-Meier method and compared using the log-rank test. Cox regression was used in multivariate analysis. RESULTS: The overall 3- and 5- year survival rates were 76.4% and 61.0% for the whole group, 81.6% and 70.6% for the lymph node negative group (Dukes A, B), 60.9% and 40.4% for the lymph node positive group (Dukes C), respectively. The difference between the two groups was highly significant (Chi(2)=10.1, P< 0.01). However, histological type, coexisting disease, and tumor size had no significant association with prognosis (P< 0.05). Cox regression showed that lymph node metastasis was an important prognostic factor. CONCLUSION: Suitable radical surgery are crucial for long-term survival of the elderly patients wtih rectal carcinoma. Lymph node metastasis is an important prognostic factor for rectal carcinoma in the elderly patients.

Aged↗

[Atrioventricular nodal reentry tachycardia in children].

BACKGROUND: Atrioventricular nodal reentry tachycardia is a supraventricular tachycardia with a double nodal pathway between the atria and the ventricles located in the normal AV-node. It may cause a reentry circuit. Atrioventricular nodal reentry tachycardia is one of the most common supraventricular tachycardias in adulthood, but is seldom diagnosed in children--perhaps because of difficulties with diagnosing them. We have studied diagnostic criteria, clinical presentation, incidence, prognosis and treatment in children and adolescents. METHODS: The article is based on the literature found in the databases PubMed and Medline. We used the search words atrioventricular nodal reentry tachycardia, AVNRT, permanent junctional reentry tachycardia, PJRT, supraventricular tachycardia, neonates, infants and children. Articles were also identified by examining the references. RESULTS: Atrioventricular nodal reentry tachycardia is rare during the first years of life, but becomes more frequent with age. There are few studies of this rhythm disturbance in children and reliable data on incidence, prognosis and prognostic variables are limited, especially for untreated cases. There are three main treatment regimens, acute and prophylactic medication and curative treatment with radiofrequency catheter ablation.

Adolescent↗