SEARCH · PubMed Health

Results for “Relapse”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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

At least 667 records · Page 37Linked to original sources

PubMed1998

Predictors of relapse in long-term abstinent alcoholics.

OBJECTIVE: The goals of this study were to examine the hazard of relapse during an average 11 years of follow-up in alcoholics who had achieved long-term abstinence and to determine predictors of later relapse. METHOD: Male alcoholics (N = 77) with at least 18 months of stable abstinence at time of entry were followed for 2 to 17 years (mean follow-up = 10.9 years). During follow-up, detailed information regarding relapse/abstinence and interim drinking behavior was recorded. Potential predictors of relapse collected at enrollment included past drinking history, severity of alcohol-related life problems, degree of neurocognitive impairment based on neuropsychological (NP) tests, psychological distress (MMPI) and past medical health. RESULTS: Twenty-four of 77 (31%) long-term abstainers relapsed during the follow-up period. The average annual hazard rate of relapse was 3.8% in the first 5 years of follow-up and 2.6% over the next 6-11 years. Based on Cox proportional hazard regression analyses, the only significant variables to predict relapse were MMPI Scale 4 (Psychopathic Deviate, relative risk = 3.16, 95% CI = 1.19-8.38) and prior history of alcohol-related life difficulty (i.e., citation for driving while intoxicated, relative risk = 2.64, 95% CI = 1.05-6.64) (chi2 = 14.2, 2 df, p < .001). CONCLUSIONS: There is approximately a 3% annual risk of relapse in alcoholics who have been able to achieve long-term abstinence, even after 5 years of abstinence. Alcoholics who resumed drinking had greater indicators of longer standing psychological trait disturbance, reflected in elevated MMPI Scale 4 and history of more alcohol-related social difficulties. Placing the present study in the context of previous research that focused primarily on predictors or relapse in the shorter term, it appears that, whereas mood disturbance predicts short-term outcome, more enduring personality traits predict long-term success in remaining abstinent.

Adult↗

PubMed2000

A simple scale of Gorski's warning signs for relapse.

OBJECTIVE: Though it has enjoyed widespread popularity, Gorski's post-acute withdrawal syndrome (PAWS) model of relapse has been subjected to little scientific scrutiny. A scale to operationalize Gorski's 37 warning signs was developed and tested in a larger prospective study of predictors of relapse. Of central interest were: (1) whether the warning signs hypothesized by Gorski are interrelated in a meaningful single factor and (2) whether the hypothesized syndrome would accurately predict subsequent relapses. METHOD: A sample of 122 individuals (84 men) entering treatment for alcohol problems was followed at 2-month intervals for 1 year. The Assessment of Warning-signs of Relapse (AWARE) scale was administered at each assessment point, and the occurrence of both slips (any drinking) and relapses (heavy drinking) was monitored during each subsequent 2-month interval. Principal factor analysis was used to study the factor structure of the warning signs. RESULTS: Of the 37 warning signs, 28 clustered as a robust single factor with excellent internal consistency (Cronbach's alpha: 0.92-0.93). A conservative evaluation of test-retest stability across 2-month intervals estimated reliability at r = 0.80. After covarying for prior drinking status, clients' AWARE scores significantly predicted subsequent slips and relapses. Relapse rates for clients with highest AWARE scores, as projected by regression equations, were 33 to 46 percentage points higher than those for clients with lowest AWARE scores, after taking into account prior drinking status. CONCLUSIONS: This scale of Gorski's warning signs appears to be a reliable and valid predictor of alcohol relapses.

Adult↗

PubMed2005

Beliefs as a predictor of relapse in alcohol-dependent Turkish men.

OBJECTIVE: The aim of the current study was to evaluate the role of beliefs about alcohol use and craving on predicting relapse as stated in Beck's cognitive theory of alcoholism in detoxified alcohol-dependent patients. METHOD: Seventy male participants who were alcohol dependent according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and who were admitted to an inpatient unit for alcohol detoxification were studied at baseline and at 6 months follow-up. Participants were administered the Structured Clinical Interviews for DSM-IV axis I and DSM-III-R axis II Disorders (SCID-I and SCID-II, respectively), the Beck Anxiety Inventory and the revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). Beliefs about alcohol use were assessed with the Beliefs About Substance Use Inventory and the Craving Beliefs Questionnaire (CBQ). RESULTS: The relapse rate of the study group was 84.1% (58 patients). The age of onset of alcohol dependence and age at first hospitalization were lower in patients who relapsed. The severity of physical dependence and presence of comorbid antisocial personality disorder were higher in the relapse group. In addition, patients who relapsed had higher scores in the CBQ. According to logistic regression analysis, craving beliefs and the degree of physical dependence were predictors of relapse in alcoholic patients. CONCLUSIONS: Our findings suggest that beliefs about craving and the severity of physical dependence may play an important role in relapse of male alcoholic patients. These factors could have a direct clinical application for predicting relapse to drinking in male alcohol-dependent patients.

Adult↗

PubMed2000

Predicting first-year relapses in children with nephrotic syndrome.

OBJECTIVE: More than half of the children diagnosed with nephrotic syndrome will have relapses. These can be infrequent relapses (IRs: <2 in 6 months or <3 in a year) or frequent relapses (FRs: >2 in 6 months or >3 in a year). Patients who relapse while on alternate day steroids or within 1 month of discontinuation of steroid therapy are considered steroid-dependent (SD; J Pediatr. 1982; 101:514-518). Patients with an IR course have a better long-term prognosis, and many of them have minimal-change disease without mesangial hypercellularity or sclerosis. The purpose of our study was to identify factors at initial presentation that could predict the relapse pattern in the first year after diagnosis, without taking into consideration the histopathology found on renal biopsy. DESIGN: We analyzed the medical records of children who were seen by us before March 1997 and followed for at least 1 year. Variables selected in the study were age, sex, race, presence or absence of hematuria, and days to remission (defined as protein-free) at the initial presentation, because they could relate to the pattern of relapses (ie, IR, FR, and SD). RESULTS: Of 70 patients, 14 were excluded because of insufficient data. There were 38 males (67.9%) and 18 females (32.1%), giving a male:female ratio of 1.8:1. Median age at presentation was 3.25 years (range: 1.5-13), and 76.9% were white, 8.9% black, 7.1% Hispanic, and 7.1% other. Of all the patients, 23 were IR (41.1%), 9 were FR (16.1%), and 24 were SD (42. 9%). Median days to remission were 10 (range: 2-60), on Prednisone 60 mg/M(2) daily. Hematuria was present initially in 26 patients (46. 4%), and absent in 30 (53.6%). Age, sex, race, and hematuria, as independent variables, were not predictors of relapses in the first year. However, using a stratified analysis based on the presence or absence of hematuria, we found that if the remission occurred within the first week of therapy, the patients without hematuria were more likely to be IR. The sensitivity and specificity of this finding were 67% and 89%, respectively, with a positive predictive value of 94%. CONCLUSION: We conclude that of all the presenting features, the rapidity of initial response to steroid therapy combined with the presence of hematuria, could predict future relapses and should be well documented.

Adolescent↗

PubMed1984

Prognostic evaluation of early detection of relapse in adult acute leukemia.

A criterion was established in a previous study to detect the relapse of adult acute leukemia in its early stage, i.e., when lymphocytes in peripheral blood increased over 45% of the leukocytes during the maintenance therapy, bone marrow puncture was immediately performed to examine the leukemic cells. By this criterion the relapse was detected earlier than by other criteria. To study the effect of early detection of the relapse in adult acute leukemia on the results, the second remission rate and the survival time were compared between the following groups. Group I consisted of 11 patients, whose relapse was determined by our criterion. Group II consisted of 8 patients whose relapse was determined by the appearance of leukemic cells in peripheral blood. The second remission was accomplished in 7 of 11 patients in Group I (64%) and in 1 of 8 in Group II (13%) (p less than 0.05). The mean (+/- S.D.) duration of complete remission in Group I was 9.7 +/- 7.8 months and not significantly longer than the value in Group II (5.3 +/- 3.9 months). The interval from relapse to death was 10.3 +/- 5.9 and 6.1 +/- 3.8 months in Groups I and II, respectively. The interval from relapse to death of 7 patients who accomplished the second remission in Group I was 12.5 +/- 5.5 months. This interval was significantly longer than in Group II (p less than 0.02). The mean survival time was 22.2 +/- 9.6 months in Group I and 13 +/- 2.5 months in Group II. The mean survival time of 7 patients accomplished the second remission in Group I was 26. 7 +/- 9.4 months which was significantly longer than in Group II (p less than 0.01). The results showed that our criterion to detect relapse in the early stage was effective for prolongation of the survival time in adult acute leukemia.

Acute Disease↗

PubMed1986

Relapsing process in FAB subtypes of adult acute leukemia and its relationship to treatment regimens.

The relapsing process in the bone marrow was studied in those 77 patients with adult acute leukemia, diagnosed according to the FAB classification who achieved complete remission (CR) and then received intermittent multi-drug intensification treatment. Relapse occurred in most of the patients who exhibited Auer rods or Ph1 chromosomes in the bone marrow, or in whom blasts increased to 8% or more, but some patients remained in CR by subsequent treatment, that is, relapsing process was reversible. With our conventional treatment, the relapse or relapsing process occurred in most of the patients with L1, L2 and M1 subtypes within 6 months and was irreversible. It occurred mainly between 5 and 13 months in those with M2, M3 and M5 and was reversible in some cases. Patients with M4 subtype received intensified treatment due to the difficulty of achieving remission; relapse was seen in only 3 of 7 cases. To prevent relapse and attain a potential cure, the treatment should be intensive before the relapsing process with adequate supporting care. In view of the above-mentioned observations, our new treatment protocols for acute leukemia were designed to be more intensive than those conventionally employed, and to be discontinued within approximately 10 months in lymphoblastic leukemia and approximately 8 months in myeloid leukemia.

Adult↗

PubMed2006

Cost-effectiveness analysis of schizophrenia relapse prevention : an economic evaluation of the ZEUS (Ziprasidone-Extended-Use-In-Schizophrenia) study in Spain.

OBJECTIVE: The aim of this study was to estimate the cost-effectiveness of schizophrenia relapse prevention in Spain using data from the ZEUS (Ziprasidone-Extended-Use-in-Schizophrenia) study. METHODS: Treatment of schizophrenia was modeled over 1 year using a retrospective deterministic model from the Spanish National Health System (NHS) perspective (year 2005). The primary outcome was the probability of relapse occurring within a 52-week period of treatment with daily doses of ziprasidone 40-160mg versus placebo. Data were obtained from a randomised, double-blind clinical trial (n = 218 patients). Antipsychotic cost, concomitant medications to treat adverse events (for example extrapyramidal symptoms) and medical costs associated with adverse events were derived from the clinical trial results and a Spanish health cost database. The average cost of a relapse admitted to hospital in Spain (3421 euro) was obtained from a retrospective study. RESULTS: The probability of psychosis relapse was 0.77 with placebo, and 0.43, 0.35, 0.36 and 0.38 with ziprasidone daily doses of 40, 80, 160mg and average dose, respectively (p < 0.01 vs placebo in all cases). The average annual incremental cost per relapse avoided was 186 euro for the average dose, ranging from a saving of 557 euro (80 mg/day) to an incremental cost of 1015 euro (160 mg/day), and was lower in all cases than the minimum cost of a relapse (2830 euro). CONCLUSIONS: According to this evaluation, psychosis relapse prevention with ziprasidone is cost effective compared with no treatment from the Spanish NHS perspective. Ziprasidone therapy avoids a considerable number of relapses at a reasonable cost, producing cost savings.

Adult↗

PubMed2000

Relapse following treatment of acute asthma in the emergency department.

Most patients presenting to the emergency department (ED) with acute asthma will have some, if not significant, relief of respiratory distress following treatment. The majority of patients are discharged to home; however, a significant portion of patients relapse and require urgent medical treatment. Many patients have continued respiratory symptoms and impairment in activities of daily living after ED treatment. In a large multicenter trial, we found that 17% of patients relapse within 2 weeks, requiring urgent medical treatment. The factors associated with asthma relapse were a history of numerous ED visits over the previous year, a history of urgent clinic visits over the previous year, use of a home nebulizer, multiple asthma triggers, and duration of symptoms between 1 and 7 days. In other studies, we found that many patients relapse before they can see their primary care physician, and that the lack of an identifiable primary care physician is associated with a higher incidence of relapse. Two interventions have been shown in studies to decrease the rate of relapse. The first, the administration of corticosteroids, has been adopted into general medical practice. Despite the routine use of corticosteroids following ED treatment, however, relapse remains a substantial problem. The second intervention involves focused long-term management by an asthma specialist. Several projects have demonstrated the efficacy of this approach in decreasing ED visits. Although it is time- and resource-intensive, this approach may be necessary for those patients who have frequent ED visits. Whether this approach is generalizable has yet to be demonstrated. In this article, we review the previous work on asthma relapse and suggest areas for further study.

Acute Disease↗

PubMed2000

Prodromal symptoms of relapse in a sample of Egyptian schizophrenic patients.

BACKGROUND: Schizophrenic patients and family members often retrospectively report having observed a number of nonpsychotic symptoms and/or certain alterations in behavior that they believe preceded any psychotic symptoms and behavior. The identification of possible relapse before its actual occurrence and the timely intervention in management are expected to spare both patient and family the suffering and pain of a full schizophrenic episode. The aim of this study was to determine if prodromal symptoms could be used as valid predictors of relapse in schizophrenic disorders and the relative diagnostic values of these symptoms in a sample of Egyptian schizophrenic patients. METHOD: One hundred Egyptian patients with schizophrenic disorders (DSM-III-R criteria) that had recently relapsed were retrospectively assessed for prodromal symptoms in the month preceding relapse. They were compared with 2 control groups, 50 Egyptian nonrelapsing schizophrenic patients and 50 healthy Egyptian individuals. RESULTS: Nonpsychotic symptoms were the most common prodromal symptoms occurring in relapsing patients. A significant difference in frequency of prodromal symptoms was found for relapsing patients versus nonrelapsing patients (p < .001) and healthy controls (p < .05). Prodromal symptoms appear to have a relatively specific value for predicting subsequent psychotic symptoms in those subjects who previously experienced such symptoms. CONCLUSION: Clusters of nonspecific prodromal symptoms exist that significantly differentiate between relapsing, nonrelapsing, and healthy controls. Fine-tuning of the identification of these symptoms could be a plausible clinical tool to be used by psychiatrists and general practitioners alike to predict a possibility of an impending relapse.

Adult↗

PubMed2000

Relapses in multibacillary leprosy patients: effect of length of therapy.

Two groups of MB leprosy patients, one treated to the point of smear negativity (TSN) and the other given therapy for fixed duration (24 doses of WHO MB regimen) (FDT), were compared for relapse rates during treatment and in the post-treatment period. During the follow-up of 980.2 person years in 260 patients treated with FDT, 20 relapses (2.04/100 patient years) were observed. In the other group of 301 patients, who received therapy till smear negativity, 12 relapses in 1085.46 person years (1.10/100 patient years) occurred. Comparison of survival rates (without relapse) has shown that although there is no difference up to 4 years, the risk of relapse was significantly higher on longer follow-up in the FDT group. In addition, when patients were compared on the basis of initial bacterial load, it was found that the relapse rates in patients with BI > or = 4 was significantly higher (P < 0.01) in the FDT group as compared to those receiving treatment till the point of smear negativity (4.29 versus 1.27/100 patient years). All the relapsed patients responded to retreatment with the same drug combination, indicating that the exacerbation in their condition was because of insufficient treatment. It is suggested that to prevent or reduce relapses, treatment where feasible would be continued till smear negativity, at least in patients with high BI.

Adolescent↗

PubMed2005

[Prognostic factors for PSA relapse of prostate cancer after endocrine therapy].

PURPOSE: Advanced prostate cancer responds well to endocrine therapy initially, but soon becomes refractory and has a poor prognosis. We analyzed the prognostic factors of prostate cancer responding well initially to endocrine therapy with lowering of serum prostate specific antigen (PSA) level but later showing PSA relapse. MATERIALS AND METHODS: In prostate cancer patients newly diagnosed from January 1992 to December 2004 at our institution, there were 93 patients in that the PSA level of 10 ng/ml or more before therapy initially dropped below 10 ng/ml by endocrine therapy, but showed PSA relapse thereafter. We investigated the relationship between clinical stage, pathological differentiation, initial PSA, duration between initiation of therapy and PSA nadir, the value of PSA nadir, duration between initiation of therapy and PSA relapse, PSA doubling time (PSA-DT) at relapse, PSA response three months after initiation of second line therapy and prognosis after PSA relapse. RESULTS: In Kaplan-Meier method, between all or some categories investigated showed significant difference in prognosis after PSA relapse. In multivariate analysis, the factors that significantly affected prognosis after PSA relapse were clinical stage, pathological differentiation, PSA nadir value, duration between initiation of therapy and PSA relapse and PSA response three months after initiation of second line therapy. CONCLUSION: We investigated the prognostic factors refractory to endocrine therapy. These results are useful in planning the therapy, and in explaining the status or future prospective of the disease to patients and families.

Aged↗

PubMed2005

Predictors of relapse and treatment resistance in antineutrophil cytoplasmic antibody-associated small-vessel vasculitis.

BACKGROUND: Predictors of treatment resistance and relapse have not been well described in antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis. OBJECTIVE: To identify clinical, pathologic, and serologic predictors of treatment resistance and relapse in a community-based cohort of patients with ANCA-associated vasculitis. DESIGN: Cohort of patients identified at or near the time of biopsy diagnosis and followed as clinically indicated. SETTING: The Glomerular Disease Collaborative Network. PATIENTS: 350 patients who received a new diagnosis of ANCA-associated vasculitis between 1985 and 2003 and were followed for a median of 49 months. MEASUREMENTS: Patients were categorized according to whether they had antiproteinase-3 (anti-PR3) antibodies or antimyeloperoxidase (anti-MPO) antibodies. Organ involvement was determined by biopsy or by well-defined clinical criteria. Treatment resistance was defined as progressive decline in kidney function with active urine sediment or the persistence or appearance of extrarenal manifestations. Relapse was defined as the time to the resurgence of vasculitic symptoms. RESULTS: Treatment resistance affected 23% of 334 treated patients and was associated with female sex, black ethnicity, and presentation with severe kidney disease (odds ratio per serum creatinine elevation of 100 micromol/L [1.13 mg/dL], 1.28 [95% CI, 1.16 to 1.39]). The following factors were associated with relapse in 258 (77%) patients who attained remission: seropositivity for anti-PR3 antibodies (hazard ratio, 1.87 [CI, 1.11 to 3.14]) and disease of the lung (hazard ratio, 1.71 [CI, 1.04 to 2.81]) or upper respiratory tract (hazard ratio, 1.73 [CI, 1.04 to 2.88]). Relapses occurred in 26% of patients with no risk factors versus 73% of patients with all 3 risk factors (hazard ratio, 3.7 [CI, 1.4 to 9.7]). Among 143 patients attaining remission who subsequently stopped all immunosuppressant therapy, relapse rates were similar for those who had received cyclophosphamide therapy for 6 months or less (34%) compared with those treated for a longer duration (35%), even after adjusting for risk factors for relapse (hazard ratio, 1.41 [CI, 0.80 to 2.50]). LIMITATIONS: The cohort mostly included patients with biopsy-proven kidney disease. Patients were not followed with uniform treatment protocols, and only limited information about their clinical course before diagnosis was available. CONCLUSIONS: Female or black patients, or those with severe kidney disease, may be resistant to initial treatment more often than other patients with ANCA-associated small-vessel vasculitis. Increased risk for relapse appears to be related to the presence of lung or upper airway disease and anti-PR3 antibody seropositivity.

Adrenal Cortex Hormones↗

PubMed1999

Paucity of leukemic progenitor cells in the bone marrow of pediatric B-lineage acute lymphoblastic leukemia patients with an isolated extramedullary first relapse.

Isolated extramedullary relapse in childhood acute lymphoblastic leukemia (ALL) may be accompanied by occult bone marrow disease. We used a highly sensitive assay to quantify leukemic progenitor cells (LPCs) in the bone marrow of such patients. Multiparameter flow cytometry and blast colony assays were used to detect LPCs in the bone marrow of 31 pediatric B-lineage ALL patients with an isolated extramedullary first relapse. Sites of relapse were central nervous system (22 patients), testes (7 patients), and eye (2 patients). Bone marrow (BM) LPC counts ranged from 0/10(6) mononuclear cells (MNCs) to 356/10(6) MNCs (mean +/- SE, 27.8+/-13.1/10(6) MNCs). LPCs were undetectable in 19 patients (61%). The BM LPC burden at the time of extramedullary relapse was similar, regardless of site (Wilcoxon P = 0.77) or time of relapse (Wilcoxon P = 0.80). Compared with higher risk, standard risk at initial diagnosis showed a trend for increased BM LPC burden (mean +/- SE, 44.6+/-17.1 versus 7.5+/-3.3; Wilcoxon P = 0.22). After successful postrelapse induction chemotherapy, LPC counts in 21 evaluated patients ranged from 0/10(6) to 175/10(6) MNCs (mean +/- SE, 15.9+/-9.6/10(6) MNCs). By comparison, LPC burden was higher after successful induction chemotherapy among children with an early BM relapse (range, 0 to 3262/ 106 MNC; mean +/- SE, 166+/-107; Wilcoxon P = 0.11). Thus, not all patients with an extramedullary relapse have occult systemic failure with substantial involvement of the bone marrow, and after reinduction therapy, LPC counts were lower in these patients than in patients treated for an overt BM first relapse.

Adolescent↗

PubMed1999

Relapse and late complications in early-stage Hodgkin's disease patients with mediastinal involvement treated with radiotherapy alone or plus one cycle of ABVD.

BACKGROUND AND OBJECTIVE: Patients affected by Hodgkin's disease (HD) in pathologic stage IA-IIA have a strong possibility of remission and long-term survival when treated with radiotherapy to extended fields. However, 20-30% of cases relapse in the five years following treatment and consequently need further therapy. This study examines the occurrence of relapse and other complications in patients with pathologic stage IIA Hodgkin's disease and mediastinal involvement treated in different ways: radiotherapy alone vs radiotherapy plus one cycle of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). DESIGN AND METHODS: Our series consisted of 73 HD patients with mediastinal involvement treated by the Department of Radiation Oncology and the Hematology Department of "La Sapienza" University of Rome from 1983 to 1989. The patients were randomized into two groups according to their initial treatment. The first group contained 37 patients treated, initially, with supradiaphragmatic radiotherapy and para-aortic irradiation (STNI); the second group was made up of 36 patients treated, initially, with supradiaphragmatic radiotherapy and para-aortic irradiation (STNI) combined with one course of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). For 28 (38%) of the patients, the follow-up period was longer than 10 years. The average follow-up period was 114 months (range 22-174 months). Overall survival and relapse-free survival were assessed using the Kaplan and Meier method, while differences were tested by the log-rank test. RESULTS: We recorded twelve cases of relapse after initial treatment. The period of time which elapsed between the end of treatment and the evidence of relapse ranged from 6 to 51 months, with an average of 22 months. Ten relapses occurred in the STNI group and two in the ABVD/STNI group. No statistically significant differences emerged between the two groups in the overall survival analysis but did in the relapse-free survival analysis (p<0.01). In the group treated with ABVD and STNI one patient developed acute non-lymphocytic leukemia and another patient treated at the age of 44 developed primary breast cancer. X-ray-related asymptomatic pulmonary fibrosis was observed in 12 patients: 10 cases in the STNI and ABVD group and 2 cases in the group treated with RT alone. The other sequelae of combined CT/RT treatment in our study were thyroid dysfunction (2 cases, hypothyroidism), whereas the sequela of RT treatment was cardiac disease (2 cases). INTERPRETATION AND CONCLUSIONS: We conclude that one cycle of ABVD and radiotherapy in early-stage HD patients with mediastinal involvement may reduce the risk of relapse. Moreover, the combination of low-toxicity CT and RT, administered preferably to limited fields, in patients who have not undergone laparotomy could be a valid alternative to current treatment for early-stage HD. However, additional data and a longer follow-up are mandatory in order to evaluate late toxicity and the potential risk of treatment.

Adult↗

PubMedDate not supplied

Proliferation and apoptosis in newly diagnosed and relapsed childhood acute lymphoblastic leukemia.

Children with acute lymphoblastic leukemia (ALL) who are treated with chemotherapy have remissions in more than 95% of the cases. However, 25% of the patients relapse and show resistance to chemotherapy. In this investigation we compared 25 newly diagnosed and 25 relapsed cases of ALL with respect to proliferation and apoptosis. Using immunocytochemistry and Western blotting, we determined the expression of cyclin A protein as a measure of the proliferative activity and the pro-apoptotic and anti-apoptotic factors, Fas, Fas ligand, caspase-3 and Bcl-2. Cyclin A expression was observed in 32% of the newly diagnosed cases and in 52% of the relapsed cases. Expression of Fas was found in 58% of the newly diagnosed and in only 27% of the relapsed samples. Of the newly diagnosed ALL, 88% expressed the Fas ligand while such expression was observed in 54% of the relapsed ALL. Sixty-four percent of the newly diagnosed cases expressed caspase-3 while only 48% of the relapsed samples did so. The anti-apoptotic factor, Bcl-2, was more frequently expressed in relapsed than in newly diagnosed cases. These data indicate that relapsed ALL more frequently exhibits high proliferative activity and reduced apoptosis than does newly diagnosed ALL.

Apoptosis↗

PubMed1998

The capability to resist smoking relapse.

BACKGROUND: Remaining in the maintenance stage and preventing a relapse of smoking is the main problem in the smoking cessation process. The objectives of this study were to compare characteristics of successful quitters with those who relapsed, to examine characteristics of the maintenance stage, and reasons for not resuming smoking. METHODS: Prospective face-to-face interviews with 1094 subjects registered with a family practice. Those who had relapsed or stopped smoking permanently comprised the study group. RESULTS: Of all subjects studied, 10.1% stated that they had stopped smoking and 10.8%, that they had relapsed. Quitters were older than relapsers, less educated, smoked significantly more cigarettes per day, and made fewer attempts to quit smoking. No significant difference was found between quitters and relapsers in marital status, country of origin, age of starting to smoke, duration of smoking, and method used to stop smoking. Age and the number of cigarettes smoked per day were associated with the maintenance stage, which was longer when smoking > or = 25 cigarettes/day. No significant association was found between the maintenance stage and marital status, country of origin, education, age of starting to smoke, and duration of smoking. Eighty-three (74.8%) of the quitters stated that the reasons for remaining in the maintenance stage were having the capability to overcome smoking and a strong resistance to temptation for relapse, 16 (14.4%) noted that they had no interest in cigarettes, 8 (7.2%) reported that cigarettes had a bad taste and deterred them from smoking, 4 (3.6%) stated that they were afraid of illness. The main factors associated with remaining in the maintenance stage were the quitters' age, heavy smoking before smoking cessation, and quitters' strong character and ability to overcome relapse and temptations to re-start smoking.

Adult↗

PubMed2001

Is an increased intestinal permeability a valid predictor of relapse in Crohn disease?

BACKGROUND: An increased intestinal permeability (IP) may be a pathogenetic factor in Crohn disease (CD). Increases in IP could be an indicator of subclinical disease and precede clinical relapses. We examined whether an increased IP is a valid predictor of relapse in CD. METHODS: 27 patients with CD in remission (CDAI <150) and 22 healthy controls ingested 3.7 MBq of 51Cr-EDTA, 20 kBq of 14C-mannitol and 5 g of unlabelled mannitol in 100 ml of distilled water. The percent urine excretion (24 h) of labelled markers was determined. Patients were followed for 1 year or until relapse, defined as CDAI > 150 and > 50 from baseline. RESULTS: Median (25th-75th percentiles). The excretion of 51Cr-EDTA was 1.55% (1.13%-2.53%) for patients and 1.20% (1.11%-1.44%) for controls (P = 0.04). Three of 9 patients with a raised, and 6 of 18 patients with a normal, 51Cr-EDTA excretion relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the 51Cr-EDTA test as a predictor of relapse was 67% and 33%, respectively. The 51Cr-EDTA/14C-mannitol index was 0.060 (0.037-0.093) for patients and 0.045 (0.038-0.054) for controls (P = 0.06). Four of 12 patients with a raised, and 5 of 15 patients with a normal, index relapsed (P = 1.00; Fisher's exact test). Thus, the specificity and sensitivity of the index test as a predictor of relapse was 56% and 44%, respectively. For controls and patients in remission, who were tested twice, variability of and fluctuations in both the 51Cr-EDTA excretion and the index were greatest for patients. CONCLUSIONS: This study supports previous findings of an increased IP in patients with CD. Although fluctuations in the permeation of markers were pronounced in CD, neither the excretion of 51Cr-EDTA nor the 51Cr-EDTA/14C-mannitol index test were valid predictors of relapse in CD.

Adult↗

PubMedDate not supplied

A retrospective analysis of treatment outcomes and time to relapse after intensive medical treatment for chronic sinusitis.

BACKGROUND: Despite the high prevalence of chronic sinusitis, there are few published studies assessing its response to medical treatment. We analyzed, retrospectively, 40 patients seen in our center who were treated for chronic sinusitis with a protocol of intensive medical therapy. Both symptomatic and radiographic improvements were assessed as well as factors associated with early relapse. METHODS: Intensive medical treatment consisted of 1 month of antibiotics, a short course of oral steroids, and adjunctive therapy (e.g., nasal irrigations plus intranasal steroids). After intensive medical therapy, adjunctive medical therapy was continued. A sinus computed tomography was performed at baseline and 6-8 weeks later and scored for extent of disease. Pre- and posttreatment symptom scores also were assessed. Time to relapse was defined as the time interval after antibiotic treatment at which a recurrence of symptoms necessitated reinstitution of antibiotics and/or oral steroids. RESULTS: Thirty-six of the 40 patients improved either symptomatically, radiographically, or both following the medical regimen. Twenty-six patients had sustained symptomatic benefit beyond 8 weeks after initial treatment. A statistically significant correlation was found between the change in pre- to posttreatment symptom scores and computed tomography scores. Using a log-rank test to compare rates of sinusitis relapse, nasal polyposis and a history of sinus surgery were significantly associated with earlier relapse (p = 0.006 and 0.018, respectively). In contrast, atopy, asthma, and persistent obstruction of the ostiomeatal unit were not associated with early relapse. CONCLUSION: Intensive medical treatment resulted in symptomatic and radiographic improvement in chronic sinusitis, and the majority of patients remained free of a relapse for >8 weeks. A history of nasal polyposis or previous sinus surgery was associated with earlier relapse of sinusitis symptoms. In contrast, the presence of atopy, a history of asthma, or persistent OMU obstruction was not associated with earlier relapse. Although long-term benefits have not been established, a prospective study of treatment outcomes from intensive medical treatment appears to be warranted.

Administration, Intranasal↗