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A case of recurrent panniculitis in the legs as the first clinical manifestation of recurrent acute pancreatitis secondary to cholelithiasis is described in a 59-year-old Caucasian woman.
PURPOSE: Locoregional failure after breast-conserving surgery is associated with increased risk of distant disease and death. The magnitude of this risk in patients receiving chemotherapy has not been adequately characterized. PATIENTS AND METHODS: Our study population included 2,669 women randomly assigned onto five National Surgical Adjuvant Breast and Bowel Project node-positive protocols (B-15, B-16, B-18, B-22, and B-25), who were treated with lumpectomy, whole-breast irradiation, and adjuvant systemic therapy. Cumulative incidences of ipsilateral breast tumor recurrence (IBTR) and other locoregional recurrence (oLRR) were calculated. Kaplan-Meier curves were used to estimate distant-disease-free survival (DDFS) and overall survival (OS) after IBTR or oLRR. Cox models were used to model survival using clinical and pathologic factors jointly with IBTR or oLRR as time-varying predictors. RESULTS: Four hundred twenty-four patients (15.9%) experienced locoregional failure; 259 (9.7%) experienced IBTR, and 165 (6.2%) experienced oLRR. The 10-year cumulative incidence of IBTR and oLRR was 8.7% and 6.0%, respectively. Most locoregional failures occurred within 5 years (62.2% for IBTR and 80.6% for oLRR). Age, tumor size, and estrogen receptor status were significantly associated with IBTR. Nodal status and estrogen and progesterone receptor status were significantly associated with oLRR. The 5-year DDFS rates after IBTR and oLRR were 51.4% and 18.8%, respectively. The 5-year OS rates after IBTR and oLRR were 59.9% and 24.1%, respectively. Hazard ratios for mortality associated with IBTR and oLRR were 2.58 (95% CI, 2.11 to 3.15) and 5.85 (95% CI, 4.80 to 7.13), respectively. CONCLUSION: Node-positive breast cancer patients who developed IBTR or oLRR had significantly poorer prognoses than patients who did not experience these events.
Using new 125I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity 125I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity 125I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.
The rate of post-operative dislocation after primary total hip arthroplasty in 1739 cases was 3.3 per cent; 0.9 per cent being classified as recurrent dislocations. Malposition of the socket, limb shortening or any other single technical factors could not be demonstrated to be responsible for post-operative dislocation of the hip. A previous osteotomy predisposed for dislocation, but in no case was this dislocation classified as recurrent. Cases with a previous cervical-femoral fracture were significantly more commonly dislocated compared with coxarthrosis cases. This fact probably could be explained by a high rate of alcoholism in men and old age in women.
Pediatricians find that in daily clinical practice they are frequently visited by parents with children that have recurrent abdominal pain. Clinical experience has demonstrated that, after performing all relevant diagnostic tests, no medical condition justifying such investigations is involved in more than half of these disorders. Consequently, these disorders are called functional recurrent abdominal pain. The dramatic nature of their children's symptoms often leads parents to seek urgent medical consultations and ask for additional complementary tests; in serious cases, these disorders can lead to prolonged hospitalization with no proven therapeutic efficacy and which pose an additional risk for the child's mental health. In most patients, psychological factors are involved which play a key role in the onset and persistent nature of abdominal pains. Consequently, a psychopediatric approach preserving therapeutic continuity should be adopted. For these reasons, we consider a review of the psychiatric and psychological aspects involved in this disorder to be opportune.
OBJECTIVE: To screen out recurrent-associated gene in expression pattern of laryngeal squamous cell carcinoma(LSCC). METHOD: By cDNA array chip containing 18,000 gene, the gene expression pattern of cancer and normal mucosal tissues in 2 cases of LSCC, were compared and analyzed. RESULT: 1. 218 genes expressed repeatedly and differentially in LSCC were discovery. Among these genes, up- and down-regulated were 137 and 81; 2. The genes whose expression difference was over 10 times were U02570, AW863712, AA523939 and NM_014381. CONCLUSION: The episode of recurrent LSCC was a process of disturbance of numerous gene expression. GTPase activating protein (U02570) and DNA mismatch repair gene(NM_014381) probably played a major role in the episode.
BACKGROUND: The outcome and prognosis of ovarian cancer is highly variable. The objective of this study was to compare survival and clinicopathological prognostic factors with the expression levels of two matrix metalloproteinases (MMP) and fibronectin as tumor invasion and metastasis markers in ovarian cancer patients. MATERIALS AND METHODS: Histologically-verified epithelial ovarian tumours from 27 patients were studied. The latent and the activated forms of MMP-2 and MMP-9 were measured as gelatinase activity from tumour extracts and from serum and ascites samples by a zymographic technique. The fibronectin content was quantified by immunoblotting and densitometric analysis. Molecular marker levels were correlated to clinicopathological parameters such as survival and disease recurrence during the median postoperative follow-up period of 30 months. RESULTS: The levels of MMP-9 and fibronectin, but not those of MMP-2, were significantly higher in tumour tissues and in the ascites fluid of the recurrent patient group and the patient group who did not survive, as compared to the non-reccurent cases. CONCLUSION: Our data support that high expression of MMP-9 and fibronectin indicate poor prognosis for ovarian cancer patients who have similar clinicopathological prognostic factors.
Cervical squamous cell carcinoma rarely metastasizes to the heart, and cardiac tamponade secondary to pericardial involvement has been only rarely reported. We describe a case of recurrent cervical squamous cells carcinoma presenting with cardiac tamponade secondary to extensive pericardial metastases. The patient, a 38-year old woman, initially presented with Stage IIIB cervical squamous cell carcinoma. She responded well to radiation and chemotherapy, there was no clinical or radiographic evidence of persistent disease after the initial therapy. Sixteen months after presentation, she developed shortness of breath and chest pain. The patient received additional chemotherapy; however, she died 17 months after her initial presentation. At autopsy, metastatic keratinizing squamous cell carcinoma extensively involved the pericardium and superficial myocardium. This case illustrates the unusual occurrence of recurrent cervical squamous carcinoma presenting with cardiac dysfunction secondary to pericardial metastases.
Herpes simplex virus antigen-induced lymphocyte proliferation and production of leukocyte migration inhibitory factor (LMIF) and lymphocyte-derived interferon were studied in normal individuals and patients with recurrent Herpes labialis and Herpes progenitalis. Virus-specific lymphoproliferative responses were regularly detected in patients with recurrent infection irrespective of the clinical stage of infection. In contrast, transient deficiencies in herpes-specific lymphoid production of both LMIF and interferon were regularly documented at the time of and immediately before herpes simplex-induced vesicular eruptions. During the convalescence, pronounced production of these mediators in response to antigenic stimulation with inactivated virus antigen preparations were regularly detected. The biology of these fluctuations in lymphokine production is evaluated and discussed.
Impairment of vocal cord function is a threat to patients with thyroid carcinoma; either due to the tumor having infiltrated the larynx or the recurrent nerve, or to accidental damage to the laryngeal nerves during thyroid surgery. We have reviewed 1,245 patients' records which were filed under the diagnosis of thyroid carcinoma at Det Norske Radiumhospital from 1956 to 1978. Pareses of vocal cords were noted in 465 patients (37.3%) during the course of their illness. In 135 patients (10.8%) the pareses were due to infiltration by the tumor, most commonly seen in anaplastic carcinoma. In 267 patients (21.4%) the pareses followed surgery; planned resections of the recurrent nerves were performed in 48 patients (3.9%). Transient pareses with normal vocal cord movements within months were experienced in 137 cases (11%). Permanent paralysis caused accidentally during surgery was seen in 82 patients, representing 6.6% of all patients and 4.7% of the surgically exposed nerves. We stress the need for pre- and postoperative evaluation of vocal cord movement as an aid to future diagnosis and optimal surgical planning.
From 1972 to 1982, 563 patients with Stage I and II non-Hodgkin's lymphoma received radiation therapy in the department of radiology which belongs to the JLRTS group. Local control failures were seen in only 5 cases (0.9%). The regional recurrences were found in 30 cases (5%). 17 of recurrences occurred during the first 5 years. 17 cases had remissions again, and 5 cases had 5 year survivals.
According to the dynamics of the urinary calcium excretion mechanism, we have classified the patients with urolithiasis into 4 groups, namely group I (normocalciuria; urinary calcium excretion of 270 mg/day or less for male patients and 210 mg/day or less for female patients), group II (absorptive hypercalciuria; hypercalciuric with urinary calcium excretion of 200 mg/day or less under the low calcium diet), group III (renal hypercalciuria; hypercalciuric with urinary calcium excretion exceeds 200 mg/day even under a low calcium diet), and group IV (hyperparathyroidism; hypercalciuric patients as in group III with high serum calcium). Of the 97 stone formers, 77 were classified into group I, 9 into group II, 8 into group III and 3 into group IV. Both under the restricted diet and under the ambulatory free diet, urinary calcium excretion of groups II, III and IV was significantly higher than that of the group I patients. It was noteworthy, however, that some of the patients in group I excreted much calcium without restriction of their diet. Although no difference in excretion of oxalate, magnesium and phosphate was observed between the 4 groups, the patients in groups II, and III excreted more uric acid into their urine than group I patients. As for stone recurrence rate, no difference was noted between group I and group II, III or IV. Based on these findings, we conclude that hypercalciuria has no significant role in the stone forming mechanism. However, lowering of urinary calcium and other stone forming constituents is mandatory in preventing stone recurrence until the mechanism of stone formation is elucidated more precisely.
The true incidence of recurrent disease after carotid endarterectomy (CENDX) is unknown, but noninvasive hemodynamic testing shows a paradox between the incidence of hemodynamically significant recurrent stenosis (RS) and the presence of symptomatic disease. We have shown that real-time B-mode ultrasound imaging can demonstrate the gross pathology of the arterial wall and plaque and their surface characteristics. Therefore we reviewed the clinical data and B-mode studies performed 6 months to 15 years after 276 carotid endarterectomies. Preoperative and perioperative risk factors and associated symptoms on follow-up were stored on computer. The patients were divided into three groups by the anatomy of their B-mode study. The majority of the studies were normal (203 [73.5%]), 42 (15.2%) showed mild disease, and 34 (12.3%) demonstrated significant RS. The RS group had a statistically significant increase in incidence of known lipid abnormalities (p less than 0.05), associated peripheral vascular disease, previous myocardial infarctions, and ulcerated plaque on the original carotid endarterectomy (p less than 0.01). The site of RS appeared related to the time of detection by B-mode ultrasound imaging. Internal carotid RS developed late (greater than 4 years), as did RS of the bifurcation. By contrast, stenosis at the common carotid level developed earlier. These findings suggest different pathogenic mechanisms--for the former, redevelopment of atherosclerosis; for the latter, accentuation of preexisting atherosclerosis perhaps by hemodynamic factors. Finally, in the 26 vessels with RS without occlusion, there was an 8% incidence of plaque ulcer or hemorrhage vs. a 62% incidence in 79 primary atherosclerotic plaques previously studied by both B-mode and pathologic examination. The low incidence of plaque characteristics associated with symptomatic disease may account for the low incidence of symptomatic disease associated with RS.
Recurrent disc lesions occur in about 19 percent of patients having a primary laminectomy and occurring in just under half (46 percent) of those suffering recurrent pain. The clinical features are similar to those of a primary disc lesion. The most likely site (two out of three) is the same disc level as before, with an equal probability of involving the previous or its opposite side. Re-operation appears to carry a good prognosis, with 80 percent good results, while with conservative treatment 45 percent will settle down in less than three months.
A multi-center randomized comparison study of CAF + TAM therapy (Arm A) and CAF + MPA therapy (Arm B) in advanced or recurrent breast cancer was conducted at 37 institutions in Kyushu. Out of 119 registered cases, 114 were eligible and 76 were evaluable. The response rate was 42% (15/36) in Arm A and 58% (23/40) in Arm B. In the comparison of side effects, nausea/vomiting and anorexia were significantly less and moon face and body weight gain were significantly more in Arm B. Leucocytopenia was significantly inhibited in Arm B compared with Arm A, which indicated the myeloprotective effect of MPA. These results indicated that CAF + MPA therapy (Arm B) may be more advantageous than CAF + TAM therapy (Arm A) in advanced or recurrent breast cancer.
Herpetic and aphthous ulcers can be easily separated from each other on a clinical basis. Most patients who suffer from recurrent oral ulcers, suffer from one of the three forms of aphthous stomatitis that can be effectively treated. Unfortunately, the dental and medical professions are uninformed about recurrent oral ulcer etiology and proper therapies. The result is that large numbers of patients are repeatedly told there is no adequate treatment or control for their condition when in most cases that is not true. We should not permit that trend to continue. Our patients deserve better treatment from a more informed profession.
Previous observations on mutations causing osteogenesis imperfecta (OI) suggested that unrelated patients had private mutations. Here preliminary studies on two patients with type I OI indicated that some mutations in the COL1A1 gene for type I procollagen cannot be detected by analyses of cDNAs. Therefore, we developed a protocol whereby 43 exon and exon flanking sequences of the COL1A1 gene can be amplified by PCR and scanned for mutations by denaturing gradient gel electrophoresis. Two new recurrent nucleotide mutations in the gene were found in four apparently unrelated patients with OI. Analysis of previous publications indicated that up to one-fifth of the mutations causing OI are recurrent in the sense that they were identical in apparently unrelated probands. About 80% of these identical mutations were in CpG dinucleotide sequences.
Polyclonal expansions of human Vdelta1 T cells have been described in diverse physiopathological situations without strong TCR structural data for an antigen-driven selection. Here, we have analyzed the phenotype and TCR repertoire of gamma delta T cells obtained from the peripheral blood of a 19-year-old patient with a syndrome of recurrent fever, which accounted for up to 40% of CD3(+) T cells and expressed predominantly Vgamma9 and Vdelta1 TCR regions and a memory phenotype. Sequence analysis of Vdelta1-Jdelta1 transcripts derived from peripheral blood lymphocytes (PBL) indicated that, while Vdelta1-Jdelta1 junctional sequences were diverse in length, all but one contained several recurrent motifs at conserved positions from both the 5'- and 3'-ends of the complementarity-determining region (CDR)3 loop. Analysis of gamma delta T cell clones derived from patient PBL demonstrated that Vgamma9(+) but not Vgamma9(-) T cell clones frequently expressed Vdelta1 chains with these characteristics and unveiled a hierarchy between the constraints imposed on the 5'- vs. the 3' motifs of the Vdelta1 CDR3 loops. These results constitute the first strong evidence for a nominal antigen-driven selection of Vdelta1 T cells in vivo and also suggest that the hierarchy of the constraints imposed by antigens respectively on the length and amino acid composition of TCR CDR3 loops differs between alpha beta and gamma delta T cells.