Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Recurrence score”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,531 records · Page 85Linked to original sources
PubMedDate not supplied

Shoulder function after arthroscopic anterior stabilization of the glenohumeral joint using an absorbable tac.

Among the advantages of arthroscopic stabilization could be less loss of range of motion and, with that, better functional outcome. In each of 24 shoulders, arthroscopic anterior repair of instability was performed through use of cannulated resorbable tacs (Suretacs), and the clinical outcome, especially the function, was examined in 20 shoulders after a mean follow-up of 3.4 years. The study included a retrospective analysis of 10 shoulders with documented recurrent anterior dislocations, 3 shoulders with posttraumatic subluxations, and 7 shoulders with painful apprehension and unequivocally clear Bankart lesions at arthroscopy. The evaluation of the recurrent dislocators revealed recurrence in 20%, residual instability in 10%, and a mean loss of external rotation of 28.5 degrees. No recurrence or residual instability was encountered in the other 2 groups. Mean loss of external rotation was 15 degrees in the group of subluxators and 20 degrees in the group of painful shoulders with intraoperatively evident instability. Through use of the Rowe score, failure was found in 30% of the dislocators; no failures were noted in the other groups. The painful shoulders with intraoperatively evident instability had significantly (P < .05) better Rowe scores than shoulders that had documented dislocation. Our series confirmed a relatively high failure rate for arthroscopic anterior stabilization of recurrent anterior dislocators. Our series did not confirm that arthroscopically successfully stabilized shoulders recover full function and mobility. In the light of the relatively high rate of residual instability and incomplete functional recovery in successfully stabilized shoulders, we have discontinued use of this technique for the treatment of recurrent dislocators.

Adolescent↗
PubMed1999

Medium-term results of the operative treatment of recurrent patellar dislocation by Insall proximal realignment.

Between 1984 and 1991, 36 patients with the diagnosis of recurrent patellar dislocation were treated operatively using the proximal realignment procedure. Thirty patients were available for follow-up. The average follow-up period was 6.3 years (range 2-9.6 years). The average age at injury was 21.3 years with a predominance of female patients. At follow-up all knees were physically examined. The results were evaluated using the score of Larsen and Lauridsen as well as the Tegner score and subjective assessment. Radiographs from 19 patients (63%) were available for review. At follow-up one patient suffered from a recurrence of patellar dislocation. All patients had stable knee joints and a full range of motion. There was no statistically significant difference between pre- and postoperative sports activity level. Seven patients (23.3%) had excellent results, 12 patients (39.9%) good results and 1 a poor result using the Larsen and Lauridsen score. Subjective assessment revealed the operative result as very good, good or satisfactory in 90%. Patellofemoral osteoarthritis was seen in 7 of 19 patients (36.8%). With a proximal realignment procedure good clinical results can be achieved for recurrent patellar dislocation. Subjective satisfaction with this procedure is rated as good. It is successful in preventing redislocation.

Adolescent↗
PubMed2006

Resective epilepsy surgery in childhood: the Dutch experience 1992-2002.

PURPOSE: We present the outcome of resective epilepsy surgery in 69 pediatric patients who participated in the Dutch Collaborative Epilepsy Surgery Program (DCESP) between 1992 and 2002 with special emphasis on long-term follow-up. METHODS: Sixty-nine children (aged 3 months to 17 years) operated on before 2003 were included in this study (34 temporal resections (49%), 17 extra-temporal resections (24%) and 19 hemispherectomies (27%)). Engel classification was used to assess seizure outcome annually. Cognitive outcome was assessed if possible. Two telephone surveys were carried out with an interval of 2(1/2) years to obtain data on seizure frequency, use of AEDs and on aspects op psychosocial development. Kaplan-Meier survival curves were constructed to assess recurrence of seizures after initial postsurgical seizure freedom, based on both telephone surveys. RESULTS: Seventy percent scored Engel 1, 18% Engel 2, 6% Engel 3 and 6% Engel 4 at the time of the first telephone survey (2(1/2) years later: 77% Engel 1, 8% Engel 2, 12% Engel 3 and 3% Engel 4). Temporal resections were associated with the best seizure outcome (Engel 1 74% and 82%). AEDs could be withdrawn successfully in 53% of patients at time of the last follow-up. No negative impact on cognition was found. The first long-term follow-up (mean 4.5 years after surgery) measurement showed recurrence of seizures after initial seizure freedom in 17%. At time of the second long-term follow-up measurement (mean 7.5 years after surgery) this percentage had increased to 21%. CONCLUSIONS: Our results support previous reports that surgery for intractable epilepsy in pediatric patients can be safely performed with satisfactory long-term results. Best results are attained in temporal resections.

Adolescent↗
PubMed2002

Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy.

PURPOSE: To assess the effect of nerve-sparing (NS) radical retropubic prostatectomy (RRP) on surgical margins and biochemical recurrence. PATIENTS AND METHODS: Location and incidence of positive surgical margins, recurrence, and time to recurrence were assessed in a consecutive series of 734 men who underwent RRP for localized prostate cancer from 1992 through February 2000. NS procedures were used in 33% (n = 240) of 734 patients studied. RESULTS: Surgical margins were positive for 24% (n = 58) and 31% (n = 152) of NS and non-NS patients, respectively (P =.06). No significant difference between the groups was found in location of positive margins (P =.92). Prostate-specific antigen level greater than 10 ng/mL, extraprostatic extension, tumor volume more than 20%, capsular penetration, Gleason score > or = 7, positive margins, and seminal vesicle invasion were associated with significantly increased risk of recurrence. However, NS patients were not at increased risk of recurrence compared with non-NS patients (hazard ratio, 0.96; 95% confidence interval, 0.53 to 1.72). The cumulative risk of recurrence within 3 and 5 years of surgery in NS patients was 9.7% and 14.4%, respectively, as compared with 17.1% and 21.1% for non-NS patients. CONCLUSION: In patients with localized prostate cancer, neither margin status nor biochemical-free survival within 5 years of surgery were altered by the nerve preservation technique. Given our experience, we recommend preservation of neurovascular bundles in these patients whenever the procedure is technically feasible.

Aged↗
PubMed2001

Preoperative PSA velocity and doubling time do not predict adverse pathologic features or biochemical recurrence after radical prostatectomy.

OBJECTIVES: To improve the accuracy of predicting pathologic stage and biochemical recurrence after radical prostatectomy (RP), we sought to determine whether preoperative prostate-specific antigen (PSA) velocity and doubling time predict adverse pathologic features or biochemical recurrence following RP. We also sought to determine if there were racial differences in preoperative PSA velocity and doubling time. METHODS: A total of 331 patients underwent RP at the West Los Angeles VA Medical Center between November 1991 and March 2000. Of these patients, 86 had two or more preoperative PSA values that were at least 12 months apart. Patients were analyzed to determine whether preoperative PSA velocity or doubling time was predictive of adverse pathologic features, including positive surgical margins, capsular penetration, seminal vesicle invasion, or biochemical recurrence. Additionally, PSA velocity and doubling time were compared among white, black, Hispanic, and Asian men. RESULTS: Preoperative PSA velocity and doubling time were not predictive of positive surgical margins, capsular penetration, or seminal vesicle invasion (P >0.30). In addition, there was no association between PSA velocity or doubling time and pathologic stage or surgical Gleason score (P >0.36). Preoperative PSA velocity (P = 0.581) and doubling time (P = 0.528) were not predictors of biochemical recurrence following RP. There were no racial differences in preoperative PSA velocity (P = 0.715) or doubling time (P = 0.662). CONCLUSIONS: Neither preoperative PSA velocity nor doubling time was a predictor of adverse pathologic findings or biochemical recurrence after RP. In addition, there was no difference in PSA velocity or doubling time between the races studied.

Aged↗
PubMed2004

Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis.

BACKGROUND: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. HYPOTHESIS: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures. STUDY DESIGN: Meta-analysis. METHODS: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. RESULTS: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). CONCLUSIONS: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.

Absorbable Implants↗
PubMed2006

Arthroscopic and open Bankart repairs provide similar outcomes.

UNLABELLED: Recurrent instability after arthroscopic Bankart repair has decreased, largely because of improvements in surgical technique. We wanted to know whether there were differences in functional outcomes (using a validated outcomes measure) in patients who had arthroscopic Bankart repair or open Bankart repair for recurrent anterior glenohumeral instability. We retrospectively reviewed 106 patients who had a Bankart repair for recurrent anterior glenohumeral instability from 1998-2001. Of the 93 patients included, 69 patients had arthroscopic Bankart repair and 24 patients had open Bankart repair. The indications for surgery in the two groups were similar. The average age of the patients was 29.9 years (arthroscopic Bankart repair, 31 years; open Bankart repair, 28 years). The followup ranged from 24-77 months. The average modified American Shoulder and Elbow Surgeons score (PENN score) for pain, satisfaction, and function were 26.3, 8.5, and 55.1, respectively, in the arthroscopic Bankart repair group and 26.6, 8.8, and 54.2, respectively, in the open Bankart repair group. The total score was 90 in the arthroscopic Bankart repair group and 89.5 in the open Bankart repair group. Recurrent instability occurred in one patient in each group. We found no difference in outcomes between the arthroscopic and open Bankart repair groups using patient-assessed outcomes. LEVEL OF EVIDENCE: Therapeutic Study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2003

Risk factors and coagulation parameters in relationship to phlebographic response and clinical outcome in the treatment of acute deep vein thrombosis.

Possible correlation of the effects of pharmacotherapy on the inhibition of the in-vivo generation of thrombin and on the prevention of thrombus extension in patients with deep vein thrombosis (DVT) could help to define patients at higher risk. Patients with symptomatic deep vein thrombosis confirmed by phlebography were randomised to intravenous unfractionated heparin (UFH), or a subcutaneous low-molecular-weight heparin (reviparin) twice daily for one week, or a subcutaneous reviparin once daily for four weeks. The patients were treated with oral anticoagulants for at least 3 months. Main endpoints were regression of thrombus on phlebography on Day 21 and recurrent symptomatic venous thromboembolism up to 3 months. Coagulation parameters, markers of in-vivo thrombin generation, and TFPI-release were determined at randomisation, weeks 1 and 3. Four hundred sixty six responders (reduction of at least 30 per cent in Marder score) and 419 non-responders (Marder score unchanged or changed less than +/-30%) showed no significantly different baseline characteristics. The non-responder group had a higher median Marder score at baseline and after one and three weeks of treatment, and had significantly higher fibrinogen levels, TAT complexes and F1+2 values than responders. There were no significant differences in coagulation parameters between non-responders and patients with asymptomatic + symptomatic VTE with the exception of higher TAT complexes at baseline. Significant differences in Marder score and coagulation parameters at baseline were found between responders and nonresponders. Non-responders have a higher risk tosuffer recurrent VTE and may need intensified treatment.

Acute Disease↗
PubMed2003

Clinical significance of recurrent psychogenic nonepileptic seizure status.

To explore the clinical significance of a history of recurrent psychogenic nonepileptic seizure status (PNES-status), this study describes the frequency of PNES-status in 85 consecutive PNES patients and examines whether there are relevant differences between patients with a history of recurrent PNES-status and other PNES-patients. PNES patients were also compared with 64 patients with epilepsy. Data were extracted from hospital records and a postal questionnaire (Dimensional Assessment of Personality Pathology-Basic Questionnaire; Screening for Somatoform Symptoms; Dissociative Experience Scale). Of the PNES-patients, 77.6% reported at least one seizure > 30 minutes (PNES-status), 27 % admission to intensive care with status. 38.8% reported recurrent hospital admissions with status (PNES-status group), the remaining patients served as PNES-controls. The only clinical difference between the two PNES groups was that status patients were younger than PNES-controls (mean age 20.3 vs. 30.3 years, p = 0.001). Our results suggest that PNES status is common and often unrecognised. There were no substantial psychometric differences between patients with recurrent PNES-status and other PNES patients although both PNES-groups had more abnormal somatisation, dissociation and personality scores than patients with epilepsy.

Adolescent↗
PubMed2026

[Complex therapy of chronic bacterial prostatitis using the immunomodulatory drug sodium aminodihydrophthalazinedione].

INTRODUCTION: Chronic bacterial prostatitis (CBP) is characterized by a recurrent course caused by pathogen persistence and impaired local immunity of the prostate. AIM: To assess the effectiveness of the use of sodium aminodihydrophthalazinedione in the complex therapy of chronic bacterial prostatitis. MATERIALS AND METHODS: The prospective comparative study included 60 men aged 21-50 years with CBP (NIH category II). Patients were randomized into two groups of 30: the comparison group received levofloxacin 500 mg/day for 28 days; the main group additionally received rectal sodium aminodihydrophthalazinedione. NIH-CPSI, IPSS, QoL, uroflowmetry, leukocyte and lecithin body counts in prostatic secretion, and bacteriological examination were assessed at baseline and on day 28, and the recurrence rate over 3 months. RESULTS: By day 28, the main group showed a more pronounced decrease in the total NIH-CPSI score (8.1+/-2.1 vs 13.4+/-2.6; p<0.001), restoration of lecithin bodies (+65.1% vs +24.5%; p<0.05), normalization of uroflowmetry, and pathogen eradication in 86.7% vs 66.7% of patients (p<0.05). The 3-month recurrence rate decreased from 26.7 to 10.0% (p<0.05). No adverse events were registered. DISCUSSION: The advantage of combinationtherapy is due to the combination of anti-inflammatory,immunomodulatory,antioxidantandregenerativeeffects of the drug,which is confirmed by the restoration of the secretoryfunction of the prostateepitheliumaccording to the dynamics of lecithingrains. CONCLUSION: The inclusion of sodium aminodihydrophthalazinedione in the combination therapy of CBP increases the clinical and microbiological efficacy of treatment and reduces the recurrence rate.

Humans↗
PubMed2002

A semiparametric model for the analysis of recurrent-event panel data.

In many longitudinal studies, interest focuses on the occurrence rate of some phenomenon for the subjects in the study. When the phenomenon is nonterminating and possibly recurring, the result is a recurrent-event data set. Examples include epileptic seizures and recurrent cancers. When the recurring event is detectable only by an expensive or invasive examination, only the number of events occurring between follow-up times may be available. This article presents a semiparametric model for such data, based on a multiplicative intensity model paired with a fully flexible nonparametric baseline intensity function. A random subject-specific effect is included in the intensity model to account for the overdispersion frequently displayed in count data. Estimators are determined from quasi-likelihood estimating functions. Because only first- and second-moment assumptions are required for quasi-likelihood, the method is more robust than those based on the specification of a full parametric likelihood. Consistency of the estimators depends only on the assumption of the proportional intensity model. The semiparametric estimators are shown to be highly efficient compared with the usual parametric estimators. As with semiparametric methods in survival analysis, the method provides useful diagnostics for specific parametric models, including a quasi-score statistic for testing specific baseline intensity functions. The techniques are used to analyze cancer recurrences and a pheromone-based mating disruption experiment in moths. A simulation study confirms that, for many practical situations, the estimators possess appropriate small-sample characteristics.

Animals↗
PubMed2003

Microdebrider versus CO2 laser removal of recurrent respiratory papillomas: a prospective analysis.

OBJECTIVE: To compare postoperative patient discomfort, voice quality, and procedure time and cost for removal of recurrent respiratory papillomas using the microdebrider versus the CO2 laser. STUDY DESIGN: A randomized prospective study comparing children undergoing excision of recurrent respiratory papillomas by CO2 laser versus excision by microdebrider. METHODS: For the 6-month study, patients for whom removal of recurrent respiratory papillomas was indicated were randomly assigned by birth year to microdebrider or CO2 laser therapy. Disease severity was scored as the sum of ratings of 1+ (minimal), 2+ (moderate), or 3+ (severe) for involvement of 27 areas of the aerodigestive tract by direct microlaryngoscopy immediately before treatment. Parents scored patient discomfort and improvement in voice quality 24 hours after surgery, using a 5-point (0 = no pain; 4 = worst pain) and a 10-point (1 = minimal change; 10 = significant improvement) scale, respectively. RESULTS: Nineteen patients ranging in age from 2.5 to 20 years underwent 32 procedures in all. Groups did not differ significantly in age, sex, or severity of disease. For disease of equivalent severity, microdebrider treatment was associated with equivalent 24-hour-postoperative pain scores, greater improvement in voice quality, shorter procedure times, and lower overall procedure cost. CONCLUSIONS: Immediate postoperative results indicate that the microdebrider may be as safe as and, at some institutions, might be more cost-effective than the CO2 laser for removal of recurrent respiratory papillomas.

Adolescent↗
PubMed2002

Hepatocellular carcinoma: strategy for optimizing surgical resection, transplantation and palliation.

In December 1997, a prospective study with informed consent was initiated to test a neoadjuvant treatment of transcatheter hepatic arterial chemo-embolization (TACE) and thermal or chemical ablation followed by transcatheter hepatic arterial chemo-infusion (TACI) in patients with hepatocellular carcinoma (HCC) referred for transplantation (OLT) and for resection. Patients were staged with American Liver Tumor Study Group-modified tumour-node-metastasis (TNM) staging classification using serial 3-6 month physical exam, alphafetoprotein (AFP), abdominal enhanced MRI, chest CT and bone scan. Sixty-five patients with HCC, out of 508 patients referred for OLT, were divided into five clinical groups and an incidental HCC patient group (n = 8), diagnosed on post-transplant explant pathology. The key focus of study was safety, site of HCC recurrence and tumour free survival. One hundred and thirty three ablation, infusion procedures were performed with an overall 24.8% morbidity, including two septic deaths. There were 13 (21.6%) HCC recurrences in 60 patients having one or more ablative treatments with only 23% hepatic HCC recurrences at 43 months of study. Eighteen HCC patients were listed for OLT (Group 3), with 12 patients transplanted after 29-424 d waiting. Two patients were removed from the OLT list due to HCC metastases, waiting a mean of 145 d. Two patients, post-OLT, had their TNM score upgraded from T2, T3 to T4. No Group 3 post-OLT patient has died or had HCC recurrence at mean follow-up of 27 +/- 15 months. No incidental HCC group post-OLT patient has died or had HCC recurrence at mean follow-up of 24 +/- 14 months. This neoadjuvant protocol is safe and effective in reducing HCC recurrence prior to and after OLT and resection.

Adult↗
PubMed2005

Does preoperative transbronchial biopsy worsen the postsurgical prognosis of lung cancer? A propensity score-adjusted analysis.

STUDY OBJECTIVES: Our aim was to clarify the hypothesis that the postsurgical prognosis of patients with non-small cell lung cancer (NSCLC) proven by preoperative diagnostic transbronchial biopsy (TBLB) was worse than that of the patients with NSCLC determined at the time of surgery. DESIGN: We entered the propensity score as a continuous variable in the Cox proportional hazards model, along with the success/failure of TBLB and other covariates that were adjusted for the bias inherent to the success/failure of the TBLB examination. PATIENTS: Five hundred ninety-nine consecutive patients with NSCLC undergoing complete resection were divided into two groups. Pathologic diagnosis by TBLB was preoperatively determined in patients belonging to group 1 (n = 367). TBLB was unsuccessful and exploratory thoracotomy or thoracoscopy was followed by surgical resection in patients belonging to group 2 (n = 232). The overall recurrence-free survival rate was examined as the surgical outcomes. RESULTS: The postsurgical recurrence-free rate was significantly higher in group 2 than in group 1. Group 2 patients showed better prognosis than group 1 patients, even when the data between the two groups were adjusted by propensity score. When the groups were subdivided by the pathologic stage of disease, the subgroup consisting of group 2 patients with stage IA and IB lung cancer still showed a higher recurrence-free rate than those in group 1 by propensity score analysis. CONCLUSIONS: The postsurgical prognosis of the patients with NSCLC was significantly better if the preoperative TBLB was unsuccessful. This result suggested that advanced NSCLC had a tendency to be diagnosed with TBLB and, possibly, that the TBLB procedure might worsen the prognosis of patients with resectable NSCLC. We suggest that intraoperative diagnosis followed by the consecutive resection of NSCLC may be beneficial for improving the surgical outcomes of NSCLC patients.

Adenocarcinoma↗
PubMed2003

Efficacy of rebamipide as adjunctive therapy in the treatment of recurrent oral aphthous ulcers in patients with Behçet's disease: a randomised, double-blind, placebo-controlled study.

BACKGROUND: Behçet's disease (BD) is a recurrent inflammatory disease involving chronic recurrent oral aphthous ulcers (aphthae), uveitis, skin lesions and genital ulcers. We prospectively investigated the efficacy of rebamipide, a gastroprotective drug, against oral aphthous ulcers in BD patients. METHODS: In a multicentre, double-blind, placebo-controlled study, 35 patients with BD, having as the main symptom oral aphthosis, were randomised to receive rebamipide 300 mg/day or placebo for 12 to 24 weeks between August 1994 and December 1996. Oral aphthosis must have occurred within 4 weeks prior to enrolment and must have been visible for at least 7 days during that time. Oral aphthae count and pain scores were recorded daily in a diary by the patients themselves. Monthly aphthae count and pain scores were defined as the sum of aphthae count and pain scores for a month, respectively. Investigators rated the global improvement in aphthae count and pain using a 6-point scale. The rate of change in monthly aphthae count and pain scores in the first 3 and last 3 months of treatment were assessed in patients with more severe symptoms whose aphthae count and pain score were >28 at baseline (trial entry). RESULTS: The rate of moderate or marked improvement in aphthae count and pain was 36% (5 of 14 subjects) in the placebo group and 65% (11 of 17 subjects) in the rebamipide group. During months 2 to 6 of treatment, aphthae count tended to increase and reached a peak at month 4 in the placebo group but decreased in the rebamipide group. Pain score decreased to the same extent in both groups for the first 3 months of treatment; however, in the fourth to sixth months of treatment, the pain score tended to increase in the placebo group but decreased in the rebamipide group. In patients with a monthly aphthae pain score >28 at baseline, pain and count scores decreased throughout the 6 months of rebamipide treatment but increased during the last 3 months of treatment in the placebo group (p < 0.01 for the between-group comparisons). CONCLUSIONS: Rebamipide is well tolerated and improves the aphthae count and pain score in BD patients. It may therefore be useful in the treatment and prevention of frequently recurrent oral aphthous ulcers (not restricted to BD). Administration of rebamipide is not cumbersome, and it does not cause any discomfort, which corticosteroid ointments for example may do; furthermore, there are no specific adverse drug reactions. Rebamipide is therefore recommended as a long-term treatment for recurrent oral aphthous ulcers.

Adult↗
PubMed1983

[Flecainide: a new antiarrhythmic agent].

The authors report their clinical experience with flecainide, a new Class I antiarrhythmic drug, in 44 patients classified into three groups. The first group (7 cases) comprised patients with a wide range of arrhythmias sensitive to the usual antiarrhythmic agents. The second (17 cases) were atrial arrhythmias resistant to the usual antiarrhythmic agents and were mainly vagal atrial arrhythmias. The last group (20 cases) comprised patients with resistant VT, 14 of whom had underlying cardiac disease (8 chronic infarcts). The results obtained were analysed by a score test because of the wide range of arrhythmias and the wide variations in their spontaneous recurrent rate. The antiarrhythmic effect was checked by repeated Holter monitoring correlated with the results of interrogation. Provocative pacing studies were performed in 5 cases of inducible VT under therapy. The results with flecainide were compared with those obtained with reference Class I antiarrhythmics: quinidine, 700 to 1100 mg/day or disopyramide, 600 mg/day. Amiodarone was often associated with each Class I antiarrhythmic because of the resistant nature of these arrhythmias. In group I the results with flecainide were equivalent to those of quinidine. In the other two groups the results were significantly better than those of the reference antiarrhythmic: mean scores: group II 3,20 +/- 0,5 compared to 1,9 +/- 0,4 (p less than 0,01); group III 3,70 +/- 0,37 compared to 1,85 +/- 0,22 (p less than 0,001). Tolerance was good apart from neurosensory side effects (loss of accomodation, vertigo) which were dose dependent and which led to the withdrawal of therapy in only 4 cases. Four types of cardiac side effects were observed: aggravation of existing sinoatrial block (1 case); aggravation of existing intraventricular block (2 cases); aggravation of contractile function which was very poor before therapy (2 cases); and sudden death during therapy in patients with ischemic heart disease in cardiac failure and with incessant resistant VT (2 cases). In these instances the role of the drug cannot be confirmed. These complications were observed with doses of more than 5 mg/kg/day and in patients with cardiac failure. Two of these patients had serum flecainide levels which were very high. It may therefore be possible to reduce the incidence of these complications by adapting dosage to the patient's clinical state and to the serum drug levels.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed2002

Treatment of recurrent malignant gliomas with stereotactic intensity modulated radiation therapy.

Malignant gliomas are usually refractory to aggressive combined-modality therapy, and the incidence of recurrence and death after treatment is very high. State-of-the-art techniques such as stereotactic intensity-modulated radiation therapy (IMRT) are now available to deliver a high dose of radiation to the tumor with relative preservation of surrounding tissues to achieve optimal tumor coverage with minimal toxicity. We report 10 patients (median age 48 years) with recurrent malignant gliomas that were treated with stereotactic directed IMRT. Initial tumor histologies included one low grade glioma (upgraded to anaplastic astrocytoma at recurrence), four anaplastic astrocytomas, and four glioblastomas multiforme. One patient was originally presumed to have a brain metastasis secondary to renal cell carcinoma but was pathologically confirmed as having glioblastoma multiforme at the time of recurrence. Before recurrence, all patients had been treated with external beam radiation therapy (median 59.7 Gy). All recurrences were confirmed by a subtotal resection (5/10) or by imaging (5/10). The median Karnofsky performance score at the time of IMRT was 80. The median tumor volume was 34.69 cm. Treatment was delivered on a 10-MV linear accelerator with a mini-multileaf collimator, MIMiC, and planned with Peacock/Corvus software. Radiation was delivered in daily fractions of 5 Gy, to a total median dose of 30 Gy at the 71% to 93% median isodose line. Median overall survival time was 10.1 months from the date of stereotactic treatment, with 1- and 2-year survival rates of 50% and 33.3%, respectively. Fractionated stereotactic intensity modulated radiation therapy is a novel technique used in the treatment of recurrent malignant gliomas, which produces results comparable to other currently used stereotactic techniques.

Adult↗