Biomedical subjects

I Bairati

Publications and source records attributed to I Bairati.

At least 19 recordsLinked to original sources

PubMed2006

Women's perceptions of events impeding or facilitating the detection, investigation and treatment of breast cancer.

An integrated network is currently being implemented in the province of Quebec in order to improve the cancer care continuum. In this context, formal trajectories for cancer patients through healthcare services are being established. The investigation of patients' perceptions of the healthcare continuum is essential as it allows us to identify the issue of continuity/discontinuity of health services. In addition, patients' perceptions of continuity of cancer care should be documented since they could influence the implementation of optimal trajectories through the healthcare services. An exploratory qualitative study was conducted in order to identify events, based on the perceptions of women with breast cancer, that made the patient progress more rapidly, facilitating events, or more slowly, impeding events, within the cancer care continuum. Two consecutive series of women receiving adjuvant radiation therapy in 2002 and 2003 at the University Hospital of Quebec City were recruited, for a total of 120 participants. A semi-structured interview was administered in order to identify women's perceptions regarding impeding and facilitating events during the detection, investigation and treatment periods of cancer, as well as the actors and reasons involved. Overall, 64% of women reported having at least one impeding event, while 68% reported at least one facilitating event. The periods most frequently affected by impeding or facilitating events were the investigation period, followed by the treatment period. The main stages affected by impeding or facilitating events were the scheduling of an appointment, during the investigation period, and the onset of treatment. Impeding events particularly affected the scheduling of mammography, the initial exam of the investigation for breast cancer, as well as the onset of radiation treatment. On the other hand, facilitating events mainly occurred at the time of the scheduling of medical consultations with specialists, during the investigation period, and of the onset of surgery. Finally, women generally perceived that impeding events were due to a lack in the availability of services and that facilitating events resulted from human intervention. Patients' perceptions, such as those regarding the importance of human intervention in the process of continuity of care, should be taken into account by healthcare authorities in charge of implementing cancer control programmes.

Appointments and Schedules↗

PubMed2001

Duration of neoadjuvant androgen deprivation therapy before radical prostatectomy and disease-free survival in men with prostate cancer.

There is little evidence that neoadjuvant androgen deprivation therapy (ADT) of 3 months' duration before radical prostatectomy (RP) favorably influences disease-free survival. However, recent data suggest that prolonged treatment may improve outcome. We conducted a prospective cohort study to determine whether ADT of either standard or prolonged duration before RP influences the risk of prostate-specific antigen (PSA) failure. We followed 756 men treated for prostate cancer by RP between 1991 and 1998 in Quebec City. Of these, 240 received combined neoadjuvant ADT for either </=92 days (129 men) or >/=93 days (111 men), and 516 were treated by RP alone. Multivariate Cox regression was used to estimate the hazard ratios (HR) of PSA failure (>0.3 ng/mL) associated with treatment regimen controlling for age, clinical stage, grade, and initial PSA level. The median duration of follow-up was 4 years. Compared with men treated by RP alone, those who received neoadjuvant ADT for >/=93 days had an HR of PSA failure of 0.60. The inverse association with the risk of PSA failure became statistically significant from the third year on, reached its greatest magnitude after 4 years, and was still present 8 years after RP. No association was observed for ADT of </=92 days. These results suggest that neoadjuvant ADT before RP has a real, delayed, and persistent effect on disease-free survival, if and only if ADT is prolonged beyond 3 months.

Androgen Antagonists↗

PubMed2001

Managing atypical squamous cells of undetermined significance in Papanicolaou smears.

OBJECTIVE: To assess strategies using repeated conventional Pap smear and human papillomavirus (HPV) DNA testing, alone or in combination, for identifying women with concomitant cervical intraepithelial neoplasia 2 and 3 (CIN 2/3) in women with atypical squamous cells of undetermined significance (ASCUS) in their Pap smears. STUDY DESIGN: A total of 360 women cytologically diagnosed with ASCUS were referred for colposcopy and underwent a repeat Pap smear, a biopsy when necessary and HPV testing using three different modes of detection of high-oncogenic-risk HPV types: 1, first-generation Hybrid Capture test (HC-1) (Digene Diagnostics, Gaithersburg, Maryland); 2, second-generation Hybrid Capture test (HC-2); and 3, polymerase chain reaction (PCR). RESULTS: Nineteen patients (5.3%) had histologic CIN 2/3. The sensitivity and specificity of the repeat Pap smear alone for the detection of CIN 2/3 were 73.7% and 62.9%, respectively, when referring all women with a repeat Pap smear using an ASCUS-positive threshold. The proportion of women referred for colposcopy was 39.0%. When HPV testing for high risk was used for identification of women with histologic CIN 2/3, sensitivity and specificity were, respectively, 68.4% and 85.9% for HC-1, 89.5% and 73.9% for HC-2 and 89.5% and 59.0% for PCR. The rate of referral for colposcopy of these three modes of HPV testing was 16.9%, 29.4% and 44.0%, respectively. The sensitivity and specificity for identification of women with concomitant CIN 2/3 using a combination of repeat cytology showing a low grade squamous intraepithelial lesion or high grade squamous intraepithelial lesion and/or a test positive for high-oncogenic-risk HPV group were, respectively, 94.7% and 73.2% when used in combination with HC-2. The referral rate of women for colposcopy of this combined strategy was 30.4%. CONCLUSION: As compared to the strategy using abnormal repeat Pap smear alone, those using high-risk HPV testing with Hybrid Capture showed statistically significantly higher specificities and lower proportions of women with ASCUS referred for colposcopy. In particular, a promising strategy would be to refer for colposcopy only women with repeat Pap smears showing squamous intraepithelial lesion and/or those positive for high-risk HPV detected by Hybrid Capture testing.

Adolescent↗

PubMed2000

Lifetime occupational physical activity and incidental prostate cancer (Canada).

OBJECTIVES: The objective of this study was to assess the risk of incidental prostate cancer associated with occupational physical activity in a population of patients treated for benign prostatic hyperplasia (BPH) by transurethral resection of the prostate (TURP). METHODS: This case-control study was conducted in men aged 45 and over referred for TURP to relieve the symptoms of BPH in one of the eight hospitals of the Quebec City area between October 1990 and December 1992. Cases (n = 64) were all men incidentally diagnosed with prostate cancer and controls were the 546 patients with solely a histological diagnosis of BPH. At the time of their interview, the patients completed a diet history questionnaire and a general questionnaire including a lifetime occupational history. Physical activity was estimated for each job according to data from the US Department of Labor. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of incidental prostate cancer associated with occupational physical activity while adjusting for confounders. RESULTS: A positive association was observed between "ever having a job with sedentary/light work" and incidental prostate cancer (OR = 1.9; 95% CI = 1.1-3.3). ORs for prostate cancer associated with 0%, 1-49%, and > or =50% of life spent in jobs with sedentary/light work were 1.0, 1.6 (95% CI = 0.8-3.1), and 2.5 (95% CI = 1.2-5.2), respectively (p-value for trend = 0.01). Occupational physical activity in the job held during the longest period was inversely associated with prostate cancer: ORs were 1.0, 0.5 (95% CI = 0.2-1.2), 0.4 (95% CI = 0.2-0.9) and 0.2 (95% CI = 0.1-0.7) for sedentary, light, moderate, and high/very high levels, respectively (p-value for trend = 0.008). CONCLUSIONS: The results of this study suggest that physical activity at work could have a beneficial effect on the occurrence of prostate cancer.

Aged↗

PubMed2000

Nuclear DNA content, an adjunct to p53 and Ki-67 as a marker of resistance to radiation therapy in oral cavity and pharyngeal squamous cell carcinoma.

Factors of prognosis and radioresistance in oral cavity and pharyngeal squamous cell carcinoma (OCPSCC) are limited. In the present study, the usefulness of tumor DNA content in predicting radioresistance in patients with OCPSCC has been investigated. Radioresistance has been defined as local recurrence or tumor persistence after radiation therapy. DNA-ploidy analysis was performed by static cytometry on smears of cell suspensions obtained from formalin-fixed paraffin-embedded material and stained with Feulgen. DNA-ploidy was correlated with the proliferation rate (Ki-67) and p53 protein accumulation obtained by immunohistochemistry. The follow-up of patients ranged from 8 to 62 months. Radioresistance was more common in non-diploid tumors; 14/28 (50%) non-diploid tumors recurred, whereas only 3 (10.7%) out of 28 diploid tumors had local failure (P=0.0019). Proliferation rate and p53 accumulation, evaluated by immunohistochemistry, also added prognostic information. Twelve out of 14 failures were from non-diploid tumors with a low proliferation rate (Ki-67<20%), whereas none of 20 p53-negative diploid tumors developed recurrences. This study showed that non-diploid tumors responded poorly to radiotherapy. DNA content appeared, therefore, as a significant prognostic marker for the evaluation of OCPSCC in patients receiving radiation therapy. This study also showed that DNA content adds information to p53 accumulation and the proliferation rate (Ki-67) for the purposes of determining patient management.

Adult↗

PubMed1999

Neoadjuvant hormonal therapy before radical prostatectomy and risk of prostate specific antigen failure.

PURPOSE: To date there is little information on the long-term effect of neoadjuvant hormonal therapy on prostate cancer progression. We performed a prospective study to determine whether patients with prostate cancer receiving neoadjuvant hormonal therapy before radical prostatectomy (hormonal therapy group) have a lower risk of prostate specific antigen (PSA) failure than those treated with radical prostatectomy alone (prostatectomy group). We also evaluated whether type of neoadjuvant hormonal therapy and duration were associated with the risk of PSA failure. MATERIALS AND METHODS: We followed 680 men initially treated for prostate cancer with radical prostatectomy between January 1988 and December 1997 at our university hospital. Of the patients 292 received neoadjuvant hormonal therapy. Median followup was 38 months. Cox regression analysis was used to assess the association between neoadjuvant hormonal therapy and PSA failure (greater than 0.3 ng./ml.) controlling for age, clinical stage, grade, initial PSA and adjuvant therapies. RESULTS: Surgical margins were positive less often in the hormonal therapy (25%) than the prostatectomy (47%) group (p = 0.0001). PSA failure was observed in 163 patients and the 5-year failure rate was 33%. No difference in risk of PSA failure was observed overall between the hormonal therapy and prostatectomy groups (hazards ratio 0.94, 95% confidence interval 0.68 to 1.30). Treatments with antiandrogen alone for any duration, and those combining antiandrogen and luteinizing hormone-releasing hormone analogue for 3 months or less were not associated with improved survival. However, patients receiving combined therapy for more than 3 months had a significantly lower risk of PSA failure than those treated with radical prostatectomy alone (hazards ratio 0.52, 95% confidence interval 0.29 to 0.93). CONCLUSIONS: Prolonged neoadjuvant hormonal therapy combining antiandrogen and luteinizing hormone-releasing hormone analogue may improve disease-free survival after radical prostatectomy.

Adult↗

PubMed1999

Dietary fat and prostate cancer survival.

OBJECTIVES: Relationships between dietary factors and the incidence of prostate cancer have emerged from epidemiologic and laboratory studies, but there are no published data on the relationship between diet and disease progression among prostate cancer patients. We studied the association between dietary fat intake and prostate cancer survival. METHODS: We prospectively followed 384 men diagnosed with prostate cancer between 1990 and 1992 in the Quebec City area. On average 3 months following diagnosis, trained nutritionists interviewed the men on their usual diet using a diet history questionnaire. Deaths during follow-up were documented through record linkage with the provincial mortality file and review of hospital records. Cox proportional hazard models were used to estimate the relative risk of dying from prostate cancer associated with terciles of fat intake, expressed as percent of dietary energy, while controlling for prognostic factors and total energy. RESULTS: The median duration of follow-up was 5.2 years. During the follow-up period 32 patients died of prostate cancer and 39 died of other causes. After controlling for grade, clinical stage, initial treatment, age and total energy intake, we found that saturated fat consumption was significantly associated with disease-specific survival (two-sided p-value = 0.008). Compared to men in the lower tercile of saturated fat, those in the upper tercile had three times the risk of dying from prostate cancer (relative risk = 3.1, 95% confidence interval: 1.3-7.7). CONCLUSIONS: Our findings suggest that saturated fat is related to disease-specific survival and that, if this relation is causal, a moderate reduction of its intake might reduce the risk of dying from prostate cancer.

Aged↗

PubMed1999

Psychological stress and incidence of ischaemic heart disease.

BACKGROUND: We assessed the relationship between psychological stress and ischaemic heart disease (IHD) incidence in a population of 868 men over a 10-year follow-up period. METHODS: In 1981, 869 men aged 42-60, free from IHD and living around Quebec City completed a questionnaire assessing the presence of psychological stress in different areas of their life. They also underwent a medical examination and provided information on IHD risk factors. From 1981 to 1991, the incidence of IHD events was ascertained. The relationship between 13 stress dimensions and IHD incidence was investigated using Cox regression while controlling for important IHD risk factors. Cross-sectional analyses were also performed to investigate the relationship between stress dimensions and IHD risk factors. RESULTS: Between 1981 and 1991, 79 men (9%) experienced a first IHD event. The following risk factors were associated with the risk of IHD: age, (rate ratio (RR) = 1.93, 95% CI: 1.21-3.09), hypertension (RR = 1.90, 95% CI: 1.22-2.98), triglycerides (RR = 1.87, 95% CI: 1.19-2.95) and high density lipoprotein (HDL) cholesterol (RR = 1.64, 95% CI: 1.05-2.55). After controlling for risk factors, not one of the psychological stress dimensions significantly altered the risk of IHD. CONCLUSIONS: While confirming the influence of hypertension, age, triglycerides and HDL cholesterol on IHD incidence, this study suggests that there is no important connection between the explored stress dimensions and IHD incidence. It is unlikely that this lack of association is due to the stress questionnaire since the 13 stress dimensions were rigorously developed through independent evaluation of the questions by three specialists and many statistically significant relationships were observed between stress dimensions and IHD risk factors.

Adult↗

PubMed1999

Dietary fat and prostate cancer progression and survival.

BACKGROUND: The association between dietary factors and the occurrence of prostate cancer has been studied extensively, but there is, as yet, no published study on the relationship between diet and disease progression among prostate cancer patients. We studied the association between dietary fat intake and prostate cancer survival. METHODS: We prospectively followed 384 men diagnosed with prostate cancer between 1990 and 1992 in the Quebec City area who participated in a case-control study of diet in relation to prostate cancer occurrence. Trained nutritionists interviewed the men on their usual diet using a diet history questionnaire. Deaths in the follow-up were documented through record linkage with the provincial mortality file and review of hospital records. The cause of death was taken as written on the death certificate. Cox proportional hazards models were used to estimate the relative risk of dying from prostate cancer associated with terciles of fat intake, expressed as percent of dietary energy, while controlling for prognostic factors and total energy. RESULTS: The median duration of follow-up was 5.2 years. During the follow-up period, 32 patients died of prostate cancer and 39 died of other causes. The 5-year disease-specific survival was 91%. After controlling for grade, clinical stage, initial treatment, age and total energy intake, we found that saturated fat consumption was significantly associated with disease-specific survival (p = 0.008). Compared to men in the lower tercile of saturated fat, those in the upper tercile had three times the risk of dying from prostate cancer (hazards ratio 3.13, 95% confidence interval 1.28-7.67). CONCLUSION: Our findings suggest that, if saturated fat is causally related to disease-specific survival, a moderate reduction of its intake below 10% of energy should reduce the risk of dying from prostate cancer. This dietary goal is already recommended for health promotion and primary prevention of heart disease and cancer.

Aged↗

PubMed1999

Downward trend in prostate cancer mortality in Quebec and Canada.

PURPOSE: If new treatment strategies and screening for prostate cancer are effective they should reduce prostate cancer mortality. In this review we monitored prostate cancer mortality rates in Quebec and in Canada. MATERIALS AND METHODS: We obtained data on all deaths from prostate cancer between 1976 and 1997 in Quebec, and 1976 and 1996 in Canada. We calculated age standardized mortality rates and assessed changes with time. RESULTS: Prostate cancer mortality rates increased regularly until 1991 in Quebec and Canada. After 1991 the rates decreased moderately until 1995 and then more markedly in 1996. There was a further decline in 1997 in Quebec. Overall, age standardized prostate cancer mortality rates declined by 23% in Quebec between 1991 and 1997, and by 9.6% in Canada between 1991 and 1996. The mortality decline was observed for all age groups but was more pronounced among men younger than 75 years. CONCLUSIONS: Until 1995 the trends in prostate cancer mortality in Quebec and Canada were similar to those observed in the United States. Our data suggest that a sharper decline has occurred since 1995. It is of primary importance to identify the causes of the mortality decline. As prostate cancer mortality rates declined relatively early after the initiation of widespread screening with prostate specific antigen, it is unlikely that screening has as yet contributed in a major way to the decline. It is more likely that the mortality reduction is a consequence of better prostate cancer management or improved treatment modalities.

Age Distribution↗

PubMed1998

Quebec prostate cancer mortality dropped in 1996.

OBJECTIVE: To monitor incidence and mortality rates of prostate cancer in the province of Quebec. DESIGN: Population-based incidence and mortality trends. SETTING: Entire population of the province of Quebec between 1979 and 1996. MAIN OUTCOME MEASURES: Age-standardized incidence rates and mortality for prostate cancer. RESULTS: Prostate cancer mortality increased regularly until 1989, were stable between 1989 and 1995 and dropped in 1996 by 15%. Incidence rates increased steadily from 1989 until 1993 by an average of 9% per year. CONCLUSION: The rise in incidence is due to the increasing use of prostate specific antigen as a screening test for prostate cancer. The reasons for the reduction in prostate cancer mortality are unknown but are likely to reflect improved treatment modalities.

Age Factors↗

PubMed1998

Dietary fat and advanced prostate cancer.

PURPOSE: We identify the dietary factors, particularly fat intake, associated with advanced prostate cancer. MATERIALS AND METHODS: We performed a case series analysis restricted to prostate cancer cases recruited in a hospital based, case control study evaluating the influence of diet on the development of prostate cancer. Patients eligible for study inclusion were 45 years old or older with prostate cancer who had been hospitalized for initial surgical treatment or radiotherapy between October 1990 and December 1992 at 1 of 8 hospitals in the Quebec City area. A diet history questionnaire was administered to 427 patients with prostate cancer of whom 384 (90%) had completed a reliable questionnaire, including 142 with advanced and 242 with local stages I and II disease. Logistic regression analysis was used to evaluate the associations between dietary intake and advanced prostate cancer. Odds ratios and trend odds ratios were adjusted for patient age, energy intake, method of cancer detection and cancer treatment. RESULTS: There was a moderate, not statistically significant relation to total fat (trend odds ratio 1.15, confidence interval [CI] 0.95 to 1.39). Cases in the highest quartile of saturated fat consumption had a statistically significant odds ratio of 2.15 (CI 1.14 to 4.04). In addition, the relation increased proportionally and significantly with saturated fat intake (trend odds ratio 1.24, CI 1.02 to 1.51). Inverse associations of borderline significance were observed between advanced cancer, and polyunsaturated fat (trend odds ratio 0.88, CI 0.73 to 1.07) and linoleic acid intake (trend odds ratio 0.86, CI 0.71 to 1.04). A positive trend was observed for total animal fat intake (trend odds ratio 1.20, CI 0.99 to 1.46), while a negative trend was noted for total vegetable fat intake (trend odds ratio 0.84, CI 0.70 to 1.01). CONCLUSIONS: This study suggests an association between saturated fat consumption and prostate cancer progression. If cohort studies performed on patients with local prostate cancer confirm these results, dietary fat intake modification may be a promising intervention to prevent prostate cancer progression.

Aged↗

PubMed1997

Dietary energy and nutrients in relation to preclinical prostate cancer.

Previous studies of diet and prostate cancer have focused on advanced disease and have suggested a positive association with saturated fat intake. We report a study assessing the relationship between diet and preclinical prostate cancer. A total of 215 men with preclinical prostate cancer and 593 controls with no evidence of cancer participated in a case-control study conducted in Quebec City between October 1990 and May 1993. The study population comprised two groups: men treated surgically for benign prostatic hypertrophy and participants in a prostate cancer screening program. Trained nutritionists interviewed the participants on their usual diet using a diet history questionnaire. Odds ratios for prostate cancer associated with quartiles of dietary intake and P values for trend were estimated by logistic regression while controlling for age, education, group, and family history of prostate cancer. A positive association was observed between total energy intake and preclinical prostate cancer (p = 0.004). The odds ratios for prostate cancer increased with each quartile of energy intake: 1.00, 1.77, 1.90, and 2.67. After adjustment for energy, nutrients were not associated with prostate cancer. This study provides some evidence that total energy intake is related to preclinical prostate cancer and suggests that diet could be involved earlier than thought in the occurrence of prostate cancer.

Aged↗

PubMed1996

Determinants of persistent detection of human papillomavirus DNA in the uterine cervix.

To identify factors associated with persistence of human papillomavirus (HPV) DNA in the uterine cervix, 179 women who were 18-49 years old and who had normal cytologies and positive cervical HPV DNA test at a routine periodic examination were analyzed. Among them, 91 (50.8%) remained HPV-positive a few months (mean, 11 weeks) later. Persistence was higher in women who had used oral contraceptives for > or = 2 years (odds ratio, 3.9; 95% confidence interval, 1.5-10.3) compared with those who never used oral contraceptives or used them for <2 years. HPV types 16, 18, and 31/33/35 appeared more persistent (odds ratio, 2.5; 95% confidence interval, 1.0-6.2) than other types. Persistence seemed to increase with virus load and decrease with increasing interval between examinations.

Chronic Disease↗

PubMed1996

[Prevention of second primary cancer with vitamin supplementation in patients treated for head and neck cancers].

Second primary cancers often occur in head and neck cancer patients successfully treated by radiation therapy. Experimental and epidemiological data suggest that these second primaries might be prevented by antioxidant vitamins, in particular beta-carotene and alpha-tocopherol. A randomized double-blind clinical trial is being conducted in Canada to determine whether vitamin supplementation with beta-carotene (30 mg/d) and alpha-tocopherol (400 IU/d) reduces the incidence of second primaries in head and neck cancer patients treated by radiation therapy.

Acetylcysteine↗

PubMed1996

[Incidence and risk factors of second primary cancers in patients treated for primary pharyngeal cancer].

About 13% of patients treated for a pharyngeal cancer suffer from a second primary cancer. Excessive consumptions of tobacco and/or alcohol are recognized as risk factors of second primary cancers in these patients. Epidemiologic studies suggest that antioxidant vitamins could have a protective effect on the occurrence of second primary cancers; however, this hypothesis should be confirmed by randomized clinical trials. A better knowledge of the risk factors of second primary cancers in patients with a pharyngeal cancer could help reducing the occurrence of second primary cancers and improving the follow-up of these patients.

Canada↗

PubMed1996

Lower ischemic heart disease incidence and mortality among vitamin supplement users.

OBJECTIVE: This study assessed the relationship between vitamin supplement use and the occurrence of ischemic heart disease (IHD). DESIGN: A cohort study was conducted between 1985 and 1991 in Quebec City. In 1985, 2313 men provided baseline information on vitamin supplement use and IHD risk factors. Incidence of IHD events was ascertained over the first five years of follow-up. Cox regression models were used to assess the relation between vitamin supplement use and occurrence of IHD events while controlling for confounders. MAIN RESULTS: Vitamin supplement use was consistently associated with a lower incidence of IHD. The adjusted rate ratios and their 95% confidence intervals were: 0.31 (0.09-0.99) for IHD death, 0.53 (0.24-1.11) for MI, 0.76 (0.44-1.65) for angina and 0.73 (0.44-1.22) for a first IHD event. The associations were stronger for IHD death and myocardial infarction, two events assessed with high validity. The inverse association with IHD was more consistent for vitamin E than for any other vitamin. CONCLUSION: This study suggests that the inverse association between vitamin supplement use and IHD is real. The causal nature of the association can only be demonstrated in the context of a randomised intervention trial such as the HOPE study.

Cohort Studies↗

PubMed1993

Measurement errors in standard visual analysis of coronary angiograms: consequences on clinical trials.

OBJECTIVE: The usual assessment of coronary angiograms by standard visual analysis was compared with the assessment by quantitative computer analysis to provide evidence of the consequences of measurement errors attributable to visual assessment in the evaluation of coronary stenoses in clinical trials. METHODS: Angiograms obtained in 151 patients enrolled in a double-blind randomized controlled trial assessing the effect of fish oil supplementation on restenosis were evaluated by both visual and quantitative methods. Proportions of patients with unsuccessful angioplasty and proportions of patients with restenosis according to visual and quantitative methods were compared by standard statistical methods. RESULTS: Of the 151 patients who were considered successfully dilated by visual interpretation, 32 were not considered successfully dilated by quantitative analysis. With quantitative computer analysis, evaluation of restenosis on the 119 successfully dilated patients documented a protective effect of fish oil against restenosis (30.5% of treated patients versus 48.3% of control patients, P < 0.05). Visual evaluation of restenosis six months after angioplasty misclassified 10% of patients in each treatment group and failed to demonstrate a protective effect of fish oil against restenosis. CONCLUSIONS: Misclassification by visual assessment of both success and restenosis in the present trial led to underestimating the true effect of fish oil in the prevention of restenosis. Accurate and objective methods, such as quantitative computer analysis, are thus required for evaluating the effects of interventions on coronary arteries.

Angioplasty, Balloon, Coronary↗