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PubMedDate not supplied

Expression of bcl-2 in papillary thyroid cancers and its prognostic value.

PURPOSE: Papillary thyroid cancer has a good prognosis. This favourable prognosis may be attributed to the apoptotic tendency of the cancer cells. This study aims to evaluate the expression of bcl-2, which is an antidote of apoptosis, and aims to evaluate the value of bcl-2 as a prognostic marker in papillary thyroid cancer. MATERIAL-METHODS: Bcl-2 expression in the archival materials of 31 patients with papillary thyroid cancer was examined with immunohistochemical methods using bcl-2 and p-53 stains. The results were compared with 31 normal thyroid tissue specimens, which consisted of the contralateral lobes of these patients. The results were then analyzed in accordance with the clinical features of the patients. RESULTS: Thirty (96.7%) patients of the control group were positive for bcl-2 whilst one (3.3%) was negative. The staining for bcl-2 was positive in 12 (%75) patients with microcarcinomas (p < 0.05) and 13 (86.6%) with papillary cancers (p > 0.05). Two cases of the papillary cancer group were admitted to the hospital with local recurrence (6.4%) and both were positive for bcl-2 (p > 0.05). All cases (4/31), whose MACIS scores were higher than 7 were positive for bcl-2. Twenty-one of 27 cases whose MACIS scores were lower than 7 (77.7%) were positive for bcl-2 (p > 0.05). All tumours of this series were negative for p-53 immunstaining. CONCLUSION: The rate of bcl-2 expression in microcarcinomas of papillary thyroid cancer decreases when compared to normal thyroid tissue. This may be an early sign of oncogenesis, and a reason for the favourable prognosis in microcarcinomas. However, bcl-2 cannot be used as a prognostic marker.

Adult↗
PubMedDate not supplied

Resection of the sciatic, peroneal, or tibial nerves: assessment of functional status.

BACKGROUND: Lower-extremity tumors are often treated by amputation rather than limb-sparing excision that sacrifices the sciatic nerve or a branch. This study assessed the functional outcome of major nerve sacrifice during limb-sparing resections for lower-extremity soft tissue sarcoma. METHODS: Patients who underwent division of the sciatic, tibial, or peroneal nerve(s) during limb-sparing sarcoma surgery (January 1982 through June 2000) were identified. Eleven surviving patients evaluated their pre- and postoperative functional status by self-administered questionnaire (six sciatic, two tibial, and three peroneal nerve divisions). RESULTS: Eighteen patients (10 male, 8 female; 14-84 years old) had nine primary and nine locally recurrent tumors. Tumors were high (16) or low grade (two). Five patients died of disease and two died of other causes. Median overall survival was 50 months. One of 11 reported increased pain. Eight had new phantom sensations with a median intensity of 4.5 (1 = least; 10 = most). All patients used an ankle brace to walk after a sciatic (four) or peroneal (one) division. Walking ability and distance after surgery was unchanged (nine), improved (one), and worsened (one). Standing improved in 7 of 11 patients. Proprioception in the affected extremity was retained in six. The median postoperative leg functional score was 8 (1 = worst; 10 = best). No patient developed foot ulcers. One patient underwent amputation for recurrence. All patients preferred their status over having an amputation. CONCLUSIONS: Objectively and subjectively, division of the major lower-extremity nerves causes acceptable functional deficits in most patients. Resection of affected sciatic nerve (branches) during limb-sparing tumor surgery is an excellent alternative to amputation.

Adolescent↗
PubMed2005

A randomized, double-blind, placebo-controlled noninferiority trial of amoxicillin for clinically diagnosed acute otitis media in children 6 months to 5 years of age.

OBJECTIVES: Debate continues with respect to a "watch and wait" approach versus immediate antibiotic treatment for the initial treatment of acute otitis media. In this double-blind noninferiority trial, we compared clinical improvement rates at 14 days for children (6 months to 5 years of age) with acute otitis media who were randomly assigned to receive amoxicillin or placebo. METHODS: We enrolled healthy children who presented to clinics or the emergency department with a new episode of acute otitis media during the fall and winter months in Ottawa (from December 1999 to the end of March 2002). The children were randomly assigned to receive amoxicillin (60 mg/kg daily) or placebo for 10 days. Telephone follow-up was performed on each of days 1, 2 and 3 and once between day 10 and day 14. The primary outcome was clinical resolution of symptoms, defined as absence of receipt of an antimicrobial (other than the amoxicillin in the treatment group) at any time during the 14-day period. Secondary outcomes were the presence of pain and fever and the activity level in the first 3 days, recurrence rates, and the presence of middle ear effusion at 1 and 3 months. RESULTS: According to clinical scoring, 415 of the 512 children who could be evaluated had moderate disease. At 14 days 84.2% of the children receiving placebo and 92.8% of those receiving amoxicillin had clinical resolution of symptoms (absolute difference -8.6%, 95% confidence interval -14.4% to -3.0%). Children who received placebo had more pain and fever in the first 2 days. There were no statistical differences in adverse events between the 2 groups, nor were there any significant differences in recurrence rates or middle ear effusion at 1 and 3 months. INTERPRETATION: Our results did not support the hypothesis that placebo was noninferior to amoxicillin (i.e., that the 14-day cure rates among children with clinically diagnosed acute otitis media would not be substantially worse in the placebo group than the treatment group). Nevertheless, delaying treatment was associated with resolution of clinical signs and symptoms in most of the children.

Acute Disease↗
PubMed2004

Preoperative somatic symptoms are associated with disease progression in patients with bladder carcinoma after cystectomy.

BACKGROUND: A link between patient psychologic factors and bladder carcinoma outcome has not been demonstrated. The purpose of the current study was to assess the association of psychologic factors measured preoperatively with bladder carcinoma progression after cystectomy. METHODS: The Brief Symptom Inventory (BSI)-18 was administered prospectively to 65 patients with clinically localized bladder carcinoma before surgery. The BSI-18 measures distress in three specific domains-depression, anxiety, and somatization (i.e., distress due to somatic symptoms)-as well as general distress. Preoperative BSI-18 scores, tumor pathologic stage, and certain clinical variables were compared with disease status. Disease progression was defined as the development of either local disease recurrence or distant metastasis. Univariate and multivariate Cox proportional hazards models were constructed for statistical analysis. RESULTS: Of the 65 patients, 49 (79.4%) had no evidence of disease, 4 (6.2%) had local disease recurrence, and 12 (18.5%) had metastatic disease at last follow-up. The mean follow-up time was 1.3 years and did not differ significantly between survival outcomes (P = 0.577). Both tumor pathologic stage and preoperative somatic distress scores were associated with time to disease progression by univariate analysis (P = 0.038 and P = 0.055, respectively). After adjusting for tumor pathologic stage, a somatic distress score of > or = 2.00 was a significant predictor of disease progression (P = 0.044, hazard ratio = 3.31, 95% confidence interval = 1.03-10.60). Patient age, gender, reconstruction type, and BSI-18 scores for depression, anxiety, and general distress were not significantly associated with disease outcome. CONCLUSIONS: The authors found no correlation between psychologic symptoms measured preoperatively (i.e., depression, anxiety, and general distress) and bladder carcinoma progression. However, they reported an association between somatic symptoms and cancer outcome. If confirmed by other studies, these results may have important implications for the diagnosis, staging, and potential treatment of patients with bladder carcinoma.

Aged↗
PubMed2005

Complete androgen ablation suppresses prostate stem cell antigen (PSCA) mRNA expression in human prostate carcinoma.

BACKGROUND: Prostate stem cell antigen (PSCA) is a recently identified glycosylphosphatidylinositol (GPI)-anchored cell surface protein belonging to the Thy-1/Ly-6 family of cell surface antigens. Prior data in prostate cancers indicated that PSCA is directly regulated by androgens and PSCA expression increases with high-tumor grade, advanced stage, extracapsular invasion, and androgen-independent progression. The effect of complete androgen ablation (CAA) on tumor PSCA mRNA expression has not been elucidated. The purpose of the present study was to investigate the variations in the expression levels of PSCA mRNA before and after CAA, and further evaluate the clinically prognostic value of PSCA in human prostate carcinoma. MATERIALS AND METHODS: PSCA in situ hybridization (ISH) was performed on the cancerous pretreatment biopsy or transurethral resection of prostate (TURP) tissue of 42 men with primarily organ-confined prostate cancer before CAA, and on their tumor tissue from radical retropubic prostatectomy after CAA with bicalutamide and goserelin acetate for 3 months prior to undergoing radical prostatectomy. Tumor cytoplasmic staining of PSCA mRNA was evaluated by two independent pathologists and the differences of PSCA mRNA expression levels between the samples before and after CAA were analyzed using the Student's t-test. Thirty-six to forty months follow-up studies after radical retropubic prostatectomy were performed and aimed at assessing the correlation of PSCA mRNA expression level with local recurrences or metastases from the cancer. RESULTS: The percent of cells positive for PSCA mRNA by ISH labeling declined from 67.3% (0-89%)+/-9.4% before CAA to 33.8% (0-92%)+/-7.7% after CAA (P<0.001). Before CAA, 40 of 42 cases (95.2%) were positive for PSCA mRNA labeling, however, after CAA the percentage of positive reactivity of PSCA mRNA was decreased to 27 of 40 cases (67.5%), in which none was found with local recurrences or distant metastases after radical prostatectomy on follow-up. This decline in PSCA mRNA labeling was dependent on the original tumor grade with Gleason score of or=8: 73.4%+/-13.8% (P<0.05, respectively). The rest 13 cases had the increased percentage of cells positive for PSCA mRNA after CAA, in which 3 cases were found with local recurrences and 4 cases with distant metastases from tumor on follow-up. CONCLUSIONS: Our data demonstrate that CAA for prostate cancer can suppress PSCA mRNA expression with a tumor grade dependence and the increased expression of PSCA mRNA after CAA may be a clinically adverse predictor for tumor recurrences or distant metastases.

Aged↗
PubMed2007

One-stage urethral reconstruction for stricture recurrence after urethral stent placement.

PURPOSE: We report our 8-year experience with 1-stage open urethral reconstruction in 10 patients with recurrent bulbar and/or membranous strictures after UroLume urethral stent placement. MATERIALS AND METHODS: Ten consecutive referral patients underwent preoperative contrast imaging and urethroscopy followed by primary anastomotic repair or substitution urethroplasty, with concomitant open UroLume removal (when the stent was still present). Postoperative evaluation included contrast imaging 3 weeks after surgery, urethroscopy 4 months after surgery, uroflowmetry, and American Urological Association symptom score assessment. RESULTS: At a medium followup of 51.2 months all patients remain free of bulbar or membranous stricture recurrence. No patient has required dilation or any other intervention. CONCLUSIONS: One-stage open reconstruction with stent extraction offers a definitive treatment option with a high success rate for patients with recurrent bulbar and/or membranous strictures following urethral stent placement.

Adult↗
PubMed2006

Bone substitution in revision hip replacement.

The aim of this retrospective study was to report the preliminary results of femoral peri-prosthetic bone defect reconstruction with a synthetic bone substitute. Twenty-one revisions of the femoral component in 20 patients were evaluated. The mean age at operation was 65.7 years (range, 30 to 79 years). Preoperative femoral deficiencies were rated grade II in 7 cases and grade III in 14 cases according to the SOFCOT classification. None was rated grade IV. Femoral revision was indicated for loosening in 18 hips (including 8 septic cases), femoral osteolysis (1 hip), persistent pain (1 hip) and recurrent dislocation (1 hip). Once the loose prosthesis had been removed, calcium phosphate ceramic (CPC) granules (14 cases) or ceramic granules + cancellous allograft (5 cases) or autograft (2) were firmly impacted in the femoral canal. The stem was standard and always cemented using modern cementing technique. At a mean follow-up of 36 months (range, 14 to 76 months), 90% of the hips were rated good or very good according to the Merle d'Aubigné score. Two diaphyseal femoral fractures occurred and later united. Two hips required re-revision (aseptic loosening; septic recurrence). The absence of radiological osteolysis in 17 cases suggested direct bonding between ceramic granules and bone. Stem subsidence occurred in two cases and was limited (5 and 8 mm). Femoral bone reconstruction using impacted CPC or CPC in conjunction with bone graft in revision hip replacement commonly provided restoration of the bone stock in the short to mid-term. Further long-term studies will be necessary to support this conclusion.

Adult↗
PubMed1995

Analysis of the factors influencing the quality of life of patients with advanced or recurrent breast cancer.

To investigate the factors influencing the quality of life (QOL) of Japanese patients with advanced or recurrent breast cancer, a newly developed QOL questionnaire, "The QOL Questionnaire for Cancer Patients Treated with Anticancer Drugs" (QOL-ACD), was answered by 23 patients, and a multiple regression analysis was performed. The demographic and medical factors relating to the overall QOL score and to the four categories of the QOL-ACD, namely (1) activity, (2) physical condition, (3) psychological condition, and (4) social relationships, were analyzed. The results indicated that skin metastasis, a heavier body weight, and bone metastasis had a strong negative influence on the overall QOL scroe, whereas endocrine therapy, the existence of a primary lesion, and more extensive first surgery had a strong positive influence on it. With regard to the analysis of the four categories, endocrine therapy was found to be positively related to all four categories. The multiple correlation coefficient (R) between the estimated overall QOL score and the observed overall QOL score was about 0.77. The results of this analysis showed that endocrine therapy can improve the QOL of patients with advanced or recurrent breast cancer, and that the QOL-ACD questionnaire could prove extremely useful for predicting the QOL of individual patients and for aiding clinicians in deciding on the most appropriate type of therapy for each patient.

Activities of Daily Living↗
PubMed2003

Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.

In this article, we report on 904 patients undergoing transplantation for follicular lymphoma. A total of 176 (19%) received allogeneic, 131 (14%) received purged autologous, and 597 (67%) received unpurged autologous transplants. Five-year treatment-related mortality (TRM) rates were 30%, 14%, and 8% and 5-year recurrence rates were 21%, 43%, and 58% after allotransplantation, purged autotransplantation, and unpurged autotransplantation, respectively. In multivariate analyses, allotransplantation had higher TRM and lower disease recurrence. Purged autotransplantation had a 26% lower recurrence risk than unpurged autotransplantation. Five-year probabilities of survival were 51%, 62%, and 55% after allogeneic, purged autotransplantation, and unpurged autotransplantation, respectively. Advanced age, prolonged interval from diagnosis to transplantation, high lactate dehydrogenase (LDH), refractory disease, bone marrow involvement, low performance scores, and transplantation between 1990 and 1993 were associated with adverse outcomes. Total body irradiation was associated with higher TRM but lower recurrence. There was no association between acute or chronic graft-versus-host disease and recurrence after allotransplantation. We conclude that both allogeneic and autologous transplantation can induce durable remissions. There may be a benefit to graft purging in autologous transplantation. The decreased recurrence after allotransplantation is offset by increased TRM. We did not detect a correlation between graft-versus-host disease (GVHD) and recurrence. Finally, outcomes of transplantation for follicular lymphoma show improvement over the past decade.

Adult↗
PubMed2004

Bipolar reconstruction for recurrent instability of the hip.

Between 1986 and 1998, 81 total hip revisions were performed for recurrent instability. Twenty-three revisions were fixed cups to bipolars. Average follow-up was 50 months. Radiographic evaluation showed no significant osteolysis and average migration of 1.7 mm. The average postoperative Harris hip score was 74. All patients who underwent revision to a bipolar prosthesis had no further instability. Acetabular revision to a bipolar prosthesis provides stability in recurrent prosthetic hip instability.

Arthroplasty, Replacement, Hip↗
PubMed1996

The results of radical prostatectomy at a community hospital during the prostate specific antigen era.

BACKGROUND: The use of radical prostatectomy in the treatment of prostate cancer has increased with the advent of prostate specific antigen (PSA) screening. Few series have examined the relapse rates after prostatectomy relative to pre-treatment prognostic factors, such as preoperative PSA and Gleason scores. The characteristics and outcome of patients diagnosed with prostate cancer and treated with radical prostatectomy at community hospitals in the prostate specific antigen era have not been described in detail. METHODS: The tumor registry records were obtained for all patients diagnosed with prostate cancer and treated with radical prostatectomy at Washington Hospital, Fremont, CA, from 1990 through 1993. The clinical and pathologic characteristics, including the original pathology report, for the 100 patients were reviewed by a single physician. Relapse was defined by the persistence or appearance of a PSA value greater than 0.2 ng/mL (Hybritech, Inc., San Diego, CA) following surgery or by clinical evidence of recurrent disease. Crude and actuarial probabilities of relapse were analyzed relative to pre-treatment PSA values, Gleason score, pathologic stage, and surgical margin status. The median follow-up time was 2.5 years. RESULTS: The pT-classification distribution of the 100 cases was as follows: T1, 4%; T2A, 14%; T2B, 11%; T2C, 49%; T3A, 8%; T3B, 2%; T3C, 6%; and N+, 6%. Pretreatment PSA values were less than or equal to 4 ng/mL for 10 patients, greater than 4 to 10 ng/mL for 38 patients, greater than 10 to 20 ng/mL for 27 patients, and greater than 20 ng/mL for 13 patients. The value was unknown for 12 patients. The Gleason score was less than or equal to 5 for 40%, 6 for 17%, 7 for 31%, and 8 to 10 for 12%. Positive surgical margins were noted in 30% of the patients. The actuarial probability of overall survival and freedom from relapse for the entire group of patients at 3 years was 95% and 73%, respectively. Pre-treatment PSA values greater than 20 ng/mL, Gleason score greater than or equal to 7, and pT3 classification were significant predictors of relapse in univariate analysis. Preoperative PSA greater than 20 ng/mL and Gleason score were significant prognostic factors in multivariate analysis. Pathologic margin status was not a significant predictor of relapse in this experience. CONCLUSIONS: Short-term relapse rates are high among those patients with preoperative PSA values greater then 20 ng/mL or Gleason scores greater than or equal to 7. Overall results of radical prostatectomy at this community hospital were similar to those reported at referral centers.

Adenocarcinoma↗
PubMed2003

Influence of depression and effect of treatment with sertraline on quality of life after hospitalization for acute coronary syndrome.

Major depressive disorders complicate recovery from acute coronary syndrome in approximately 1 in 5 patients, and have been found to be associated with significant impairments of quality of life and functioning. The aim of the present analysis was to evaluate the efficacy of sertraline in improving quality of life and functioning in patients diagnosed with major depression who had recently been hospitalized for acute coronary syndrome. Three hundred sixty-nine patients hospitalized in the previous month for acute coronary syndrome (myocardial infarction, 74%; unstable angina, 26%) who also met criteria for major depressive disorder were randomized to 24 weeks of double-blind treatment with sertraline (50 to 200 mg/day) or placebo. Quality-of-life and functional status were assessed using the Quality of Life, Enjoyment, and Satisfaction scale (Q-LES-Q) and the Medical Outcomes Study SF-36. Data from the total sample, and the recurrent depression subgroup, were analyzed. Severe baseline impairment was found in the Q-LES-Q and all subscales of the SF-36. A multivariate regression analysis identified depression as the strongest predictor of baseline quality-of-life impairment (partial r, -0.37, p = 0.001). In the recurrent depression group, treatment with sertraline resulted in significantly greater improvement than placebo in the Q-LES-Q total score and SF-36 mental component summary score, as well as the SF-36 role limitations, emotional, and mental health factors. Depression has a substantial negative impact on quality of life and functioning in patients hospitalized for acute coronary syndrome. Sertraline was associated with clinically meaningful improvement in multiple quality-of-life domains in patients with acute coronary syndrome and recurrent depression.

Acute Disease↗
PubMed1999

Expression of the Ets-1 proto-oncogene correlates with malignant potential in human astrocytic tumors.

The protein encoded by the Ets-1 proto-oncogene is a transcription factor that regulates expression of matrix proteases. It has been associated with tumor invasion and angiogenesis. Glioma progression is characterized by increased invasiveness and neovascularization, so we hypothesized that expression of Ets-1 proto-oncogene might play a role in the progression of these tumors. Therefore, we examined the expression of Ets-1 protein by immunohistochemical means and in situ hybridization in tissues obtained from 81 primary and 20 recurrent astrocytic tumors. Twenty-eight (65%) of 43 glioblastomas (Grade IV astrocytomas) stained for Ets-1. The percentage of positive cells in glioblastomas varied from 10 to 90%. Of the 16 anaplastic astrocytomas (Grade III), 4 (25%) were moderately positive (<50% of cells) for Ets-1. None of 22 cases of low-grade astrocytomas (Grade II) expressed endogenous Ets-1. The staining score was significantly associated with tumor grade (P < .0001). Normal brain tissues did not express Ets-1 protein, whereas recurrent astrocytoma cases expressed significantly more positivity for Ets-1 than did primary tumors (P = .03). The Ets-1 protein was observed mainly in the nucleus and corresponded to the cytoplasmic Ets-1 mRNA localization by in situ hybridization. Western and Northern blot analyses confirmed overexpression of Ets-1 protein and mRNA in high-grade tumors. We conclude that Ets-1 protein expression correlates with the malignant potential of tumors of astroglial origin.

Adolescent↗
PubMed1999

Long-term clinical follow-up in 265 patients with deep venous thrombosis initially treated with either unfractionated heparin or dalteparin: a retrospective analysis.

The primary objective of this retrospective study was to describe the frequency of a post-thrombotic syndrome in 265 patients previously treated for deep venous thrombosis (DVT). The secondary objectives were to document the frequency of recurrent venous thromboembolism (VTE) and mortality, especially from malignant disease. The patients were evaluated 5-14 years after inclusion in three randomized trials comparing continuous intravenous (i.v.) infusion of unfractionated heparin (UFH) (n = 85) with a low molecular weight heparin (LMWH), dalteparin (n = 180). The median post-thrombotic score at follow-up was 2 (range 0-8). In a multiple step-wise regression analysis the postthrombotic score was significantly higher among patients with initial proximal DVT (p = 0.0001) as compared with those who had distal DVT. A recurrent venous thromboembolic event was diagnosed in 29.4% of the patients treated with dalteparin and in 23.5% of the patients treated with UFH (ns). A secondary risk factor for venous thromboembolism and a longer duration of treatment with oral anticoagulants (OAC) were significantly associated with a lower risk for recurrent VTE, whereas malignant disease diagnosed during follow-up was associated with a higher risk. During follow-up a total of 40.7% of patients had died. No difference in total mortality or mortality from malignant disease was demonstrated between the two drugs. In conclusion, a severe post-thrombotic syndrome occured relatively infrequent. considering the long observation period. Proximal DVT was significantly associated with a more severe post-thrombotic syndrome. After 14 years follow-up, no significant differences were observed in overall mortality, mortality from malignant disease or recurrent VTE between UFH- and dalteparin-treated patients. Malignant disease was a risk factor for recurrent VTE, the presence of a secondary risk factor and a longer duration of treatment with OAC decreased the risk for recurrent VTE.

Anticoagulants↗
PubMed2003

Sibling recurrence risk ratio analysis of the metabolic syndrome and its components over time.

BACKGROUND: The purpose of this study was to estimate both cross-sectional sibling recurrence risk ratio (lambdas) and lifetime lambdas for the metabolic syndrome and its individual components over time among sibships in the prospectively followed-up cohorts provided by the Genetic Analysis Workshop 13. Five measures included in the operational criteria of the metabolic syndrome by the Adult Treatment Panel III were examined. A method for estimating sibling recurrence risk with correction for complete ascertainment was used to estimate the numerator, and the prevalence in the whole cohort was used as the denominator of lambdas. RESULTS: Considerable variability in the lambdas was found in terms of different time-points for the cross-sectional definition, the times of fulfilling the criterion for lifetime definition, and different components. Obesity and hyperglycemia had the highest cross-sectional lambdas of the five components. Both components also had the largest slopes in the linear trend of the lifetime lambdas. However, the magnitudes of the lifetime lambdas were similar to that of the mean cross-sectional lambdas, which were <2. The results of nonparametric linkage analysis showed only suggestive evidence of linkage between one marker and lifetime diagnosis of low high-density lipoprotein cholesterol and metabolic syndrome, respectively. CONCLUSION: The lambdas of the metabolic syndrome and its components varies substantially across time, and the lambdas of lifetime diagnosis was not necessarily larger than that of a cross-sectional diagnosis. The magnitude of lambdas does not predict well the maximum LOD score of linkage analysis.

Adolescent↗
PubMed2003

Acute pain after endoscopic totally extraperitoneal (TEP) inguinal hernioplasty: multivariate analysis of predictive factors.

BACKGROUND: Pain is the most common complaint after inguinal hernia surgery. The present study was undertaken to evaluate the significance of various perioperative clinical factors on the severity of postoperative pain following endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. METHODS: Between November 1999 and December 2002, 509 patients who underwent unilateral ( n = 389) and bilateral ( n = 120) TEP were recruited for this study. There were 491 men and 18 women. Severity of postoperative pain at rest and on coughing was assessed by a linear analogue pain score (scale, 0-10) on a daily basis after operation. Univariate and multivariate analyses were performed to identify the significant independent factors affecting pain. RESULTS: By univariate analysis, pain scores at rest were significantly higher in young (< or =65 years) female patients, as well as patients who underwent unilateral and day case TEP. Clinical factors associated with a significantly higher pain score on coughing included mesh fixation by stapling, female sex, and age (< or =65 years). Other factors, including unilateral vs bilateral TEP, seroma formation, direct vs indirect hernia, primary vs recurrent hernia, and operative time, had no impact on postoperative pain. On multiple regression analysis, age and sex were found to be independent predictive factors for mean daily pain score at rest. Independent factors influencing mean pain score on coughing included age, sex, and prosthetic stapling. CONCLUSIONS: Patient age and sex are the most significant factors determining the degree of pain after TEP. Analgesic therapy should therefore be adjusted in accordance with the age of the patient. With regard to operative factors, avoidance of prosthetic stapling might help to reduce the severity of pain on coughing.

Acute Disease↗
PubMed1989

[Surgical treatment of gastroesophageal reflux: which operation to choose: Nissen, Toupet or Lortat-Jacob? A multicenter randomized trial].

Five surgical centers conducted a clinical randomized prospective trial in order to objectively evaluate the two-year results of three anti-reflux procedures regularly performed in France: complete (360 degrees) fundoplication (Nissen), posterior partial (180 degrees) fundoplication (Toupet) and cardiophrenopexy (Lortat-Jacob). Fifty-two patients, mean age 53 years, range 28 to 74 yrs, with uncomplicated gastroesophageal reflux, as defined according to clinical, radiologic, endoscopic and pHmetry criteria, were included in this study. Twenty patients underwent a Nissen procedure, 18 had a Toupet procedure, while 14 had a Lortat-Jacob procedure. The main criterion of assessment was Minaire's pHmetry score evaluated at two years postoperative. All three groups were well matched for clinical, radiologic, endoscopic, manometry and pHmetry findings. At two years, the number of asymptomatic patients did not statistically differ within the three groups. Four patients, however, required reoperation for invalidating recurrences: three following Lortat-Jacob's procedure and one after Toupet's procedure. Nissen's and Toupet's procedures significantly improved pHmetry scores compared with Lortat-Jacob's procedure; pHmetry was improved, but non significantly, by Nissen's procedure, as compared with Toupet's procedure. Lower sphincter pressure was significantly increased (p less than 0.01) by Nissen's procedure as compared with the two other techniques. The lower sphincter was significantly lengthened by Nissen's and Toupet's procedures as compared with Lortat-Jacob's technique (p less than 0.01). The total length of esophagus was significantly increased (p less than 0.01) by Nissen's and Lortat-Jacob's procedures in comparison with Toupet's technique. The distance separating the lower sphincter of the esophagus and point of pressure reversal was significantly decreased (p less than 0.05) by the Nissen procedure only.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2003

Pathological effects of neoadjuvant hormonal therapy help predict progression of prostate cancer after radical prostatectomy.

BACKGROUND: It is not clear whether pathological changes following neoadjuvant hormonal therapy (NHT) prior to radical prostatectomy have any value as predictors of progression in prostate cancer. METHODS: We conducted a study of 100 patients with prostate cancer who underwent radical prostatectomy following NHT. We used the Japanese general rule as the criterion to assess the biochemical recurrence rate and pathological changes after NHT. RESULTS: In terms of preoperative risk factors, the probability of recurrence was significantly higher for patients with more than 20 ng/mL of pretreatment serum prostate-specific antigen (PSA) and/or a Gleason score of 7 or higher for biopsy specimens. We defined these pretreatment findings as high-risk factors. Among 65 patients with high-risk factors, patients with a post-NHT pathological effect of grade 3 according to the Japanese general rule showed no recurrence, whereas patients with a grade 0 had a poor prognosis. Patients with a PSA nadir 0.5 ng/mL or less tended to have a better prognosis. CONCLUSION: Despite preoperative high-risk factors, patients showing good pathological effects after NHT tend to have a favorable prognosis after radical prostatectomy. Therefore; assessment of the pathological effects of NHT using the Japanese general rule as the criterion proved to be useful for the prediction of biochemical recurrence.

Aged↗