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At least 73 records · Page 4Linked to original sources
PubMed2002

Contrast-enhanced CT colonography in recurrent colorectal carcinoma: feasibility of simultaneous evaluation for metastatic disease, local recurrence, and metachronous neoplasia in colorectal carcinoma.

OBJECTIVE: Contrast-enhanced CT colonography has the potential to detect local recurrence, metachronous disease, and distant metastases in patients with a history of invasive colorectal cancer. The purpose of our study was to determine whether colonic anastomoses prohibit adequate colonic distention on contrast-enhanced CT colonography and to estimate the performance of contrast-enhanced CT colonography in detecting recurrent colorectal carcinoma. MATERIALS AND METHODS: Fifty patients with a history of resected invasive colorectal carcinoma underwent contrast-enhanced CT colonography and colonoscopy. Colonic distention was graded for different colonic segments. Two radiologists evaluated for the presence of local recurrence, metachronous disease, and metastatic disease. Results were compared with colonoscopy, histology, and clinical follow-up. RESULTS: Most patients had adequate colonic inflation (37/50, 74%). Eleven of 13 patients with inadequate distention had collapse in the sigmoid colon, usually associated with ileocolic anastomoses. Contrast-enhanced CT colonography detected local recurrences with an accuracy of 94% (95% confidence interval, 83-99%). The accuracy of contrast-enhanced CT colonography for metachronous lesions greater than or equal to 1 cm was 92% (95% confidence interval, 80-98%), but there was only one such lesion, which was missed on initial colonoscopy. Stool, granulation tissue, and inflammation can mimic the CT appearance of local recurrence or metachronous disease and account for false-positive examinations. Contrast-enhanced CT colonography identified five patients with metastatic disease. CONCLUSION: Suboptimal sigmoid distention can be seen on contrast-enhanced CT colonography, predominantly in patients with right hemicolectomies. Contrast-enhanced CT colonography is a promising method for detecting local recurrence, metachronous disease, and distant metastases in patients with prior invasive colorectal carcinoma. The technique can also serve as a useful adjunct to colonoscopy by detecting local recurrences or metachronous disease that are endoscopically obscure or by serving as a full structural colonic examination when endoscopy is incomplete.

Adult↗
PubMed1993

[Prophylactic effects of mitomycin C (MMC) on the liver recurrence in a rabbit gastric VX2 cancer model with high frequency of the recurrence].

Prophylactic effects of mitomycin C (MMC) injection protocol with different dose, periods and routes on liver recurrence were examined, using 53 gastric VX2 cancer rabbits. All the gastric cancer lesions without liver metastases were resected 14 days after implantation of VX2 cancer cells into the stomach, and all the animals were autopsied 14 days after resection. Multiple liver recurrence was found in 75% of MMC non-injection control 8 rabbits. The recurrence was not found in 10 animals with portal MMC 0.5 and 0.25mg/kg injection after resection, although 80% of 5 animals with the 0.125mg/kg injection after resection revealed the recurrence. The recurrence was not found in 4 animals with peripheral MMC 1.0mg/kg injection, but found in 60% of 5 animals with the MMC 0.5mg/kg injection after resection. In the animals with peripheral MMC 0.25mg/kg injection 2, 1 and 0 days before resection and with portal MMC 0.125mg/mg injection after resection, the recurrence was found in 83, 60 and 80% of 6, 5 and 5 respective animals. These results suggest that prophylactic injection of MMC for liver recurrence is more effective in portal than peripheral injection, but that the preoperative and peripheral injection has no efficacy.

Animals↗
PubMed1987

Pathological characteristics of gastric cancer that develop hematogenous recurrence, with special reference to the site of recurrence.

The pathologic characteristics of gastric cancer in 57 patients with hematogenous recurrence were pathologically analyzed by the site of recurrence. In recurrence of gastric cancer that developed in the liver, macroscopic observation revealed that cancers of Borrmann type 2 and 3 were most frequent. Microscopic examination revealed that the rate of occurrence of the medullary type of differentiated or poorly differentiated adenocarcinoma were high and that there were relatively frequent invasion by cancerous cells of the blood vessel that were closely related to the hematogenous metastasis. On the other hand, with respect to recurrence of gastric cancer that had developed in the lung or bone, Borrmann type 3 and 4, respectively, were more frequently observed. In these cases, microscopic analysis revealed that these cancers were poorly differentiated adenocarcinomas. In gastric cancer with bone recurrence, the rate of recurrence of the scirrhous type of tumor were higher than that of other types. It is important, for the management of patients after gastric cancer surgery, to predict possible hematogenous recurrence and its site by evaluation of the pathologic characteristics of the gastric cancer.

Adenocarcinoma↗
PubMed2000

Locally recurrent rectal cancer: role of composite resection of extensive pelvic tumors with strategies for minimizing risk of recurrence.

Locally recurrent cancer of the rectum has been under-recognized as a complication, although it affects up to 40% of patients treated with surgery alone. Even in the best centers, rates average 25%. While radiotherapy may reduce recurrence, it is now apparent that total mesorectal excision is the most effective modality, with rates as low as 5%. The dramatic decrease in local recurrence can also be linked to increased survival in prospective studies, an effect more significant than any adjuvant therapy. The options, however, for patients with locally recurrent cancer are limited. Fifteen percent of patients with this complication die without systemic spread. Salvage by surgery offers potential cure. Other than anastomotic recurrences that can be locally resected, the best approach for long-term survival is an extensive surgical procedure requiring en bloc removal of adjacent organs and pelvic structures-so-called composite resection. With careful selection, 30% 5-year survival can be achieved and palliation is considerable, with 50% long-term local control. Intraoperative radiotherapy and brachytherapy, and/or preoperative chemoradiation may provide better results in future. Newer techniques of coloanal anastomosis, improved urinary diversion, and myocutaneous flaps for perineal reconstruction radically reduce the morbidity of these procedures. The approach to recurrent rectal cancer requires a sophisticated multidisciplinary team to obtain optimum results.

Brachytherapy↗
PubMed2002

Classifying local disease recurrences after breast conservation therapy based on location and histology: new primary tumors have more favorable outcomes than true local disease recurrences.

BACKGROUND: To distinguish true local recurrences (TR) from new primary tumors (NP) and to assess whether this distinction has prognostic value in patients who develop ipsilateral breast tumor recurrences (IBTR) after breast-conserving surgery and radiotherapy. METHODS: Between 1970 and 1994, 1339 patients underwent breast-conserving surgery at The University of Texas M. D. Anderson Cancer Center for ductal carcinoma in situ or invasive carcinoma. Of these patients, 139 (10.4%) had an IBTR as the first site of failure. For the 126 patients with clinical data available for retrospective review, we classified the IBTR as a TR if it was located within 3 cm of the primary tumor bed and was of the same histologic subtype. All other IBTRs were designated NP. RESULTS: Of the 126 patients, 48 (38%) patients were classified as NP and 78 (62%) as TR. Mean time to disease recurrence was 7.3 years for NP versus 5.6 years for TR (P = 0.0669). The patients with NP had improved 10-year rates of overall survival (NP 77% vs. TR 46%, P = 0.0002), cause-specific survival (NP 83% vs. TR 49%, P = 0.0001), and distant disease-free survival (NP 77% vs. TR 26%, P < 0.0001). Patients with NP more often developed contralateral breast carcinoma (10-year rate: NP 29% vs. TR 8%, P = 0.0043), but were less likely to develop a second local recurrence after salvage treatment of the first IBTR (NP 2% vs. TR 18%, P = 0.008). CONCLUSIONS: Patients with NP had significantly better survival rates than those with TR, but were more likely to develop contralateral breast carcinoma. Distinguishing new breast carcinomas from local disease recurrences may have importance in therapeutic decisions and chemoprevention strategies. This is because patients with new carcinomas had significantly lower rates of metastasis than those with local disease recurrence, but were more likely to develop contralateral breast carcinomas.

Actuarial Analysis↗
PubMed1991

[Tumor recurrence at the neck in papillary thyroid gland cancer. A statistical analysis of the recurrence probability after radical surgery].

308 cases of papillary thyroid carcinoma (82.6% of our patients operated on between 1952 and 1987) who had undergone potentially curative surgery were analysed postoperatively. The follow-up ranges from 1 month to 29.4 years (median 4.58 years). In 32 cases (10.4%) a cervical tumour recurrence (local recurrence and/or cervical lymph nodes) was found. 8 of these are not free of tumour at the end of the follow-up, 6 had died of thyroid carcinoma (case fatality rate 18.8%, mortality rate 66.7%, in the entire material 2.9% and 29.0% respectively). The cumulative recurrence rate is 9.98% after 5 years and 16.98% after 10 years. A statistical analysis of the probability of recurrence was carried out only for patients who could be followed at least 5 years or those who died within 5 years. Age, sex, stage of tumour and histological criteria were taken into account as statistical variables. The state of cervical lymph nodes, the differentiation of the tumour and the patients' sex turned out to be determining factors for tumour recurrence after 5 years. In order to improve the recurrence rate a differentiated surgical radicality, depending on the above mentioned variables, is recommended.

Adolescent↗
PubMed1995

Patterns of recurrence after nerve-sparing surgery for rectal adenocarcinoma with special reference to loco-regional recurrence.

PURPOSE: Since the early 1980s to relieve functional disturbances after rectal excision, we have been performing nerve-sparing surgery for rectal cancer. The aim of this study was to analyze patterns of recurrences, especially concerning causes of local ones. Furthermore, we would like to address the criteria we used in patient selection to effect successful nerve-sparing surgery. METHODS: From 1982 to 1991, 306 patients underwent nerve-sparing operations, which may be categorized into three types: 1) total autonomic nerve preservation (125 cases), 2) complete pelvic nerve preservation (105 cases), and 3) partial pelvic nerve preservation with removal of parasympathetic nerve (79 cases). Single and multivariant regression analyses were conducted to investigate patterns of recurrence, especially causes of local ones. RESULTS: Sixty-five patients (21 percent) developed recurrent tumors, 19 of which (6.2 percent) were local. Using Dukes terms, there were five patients with Dukes A 13 with Dukes B, and 47 (35 percent) with Dukes C stages. Rate of local recurrences was 13 percent in patients with Dukes C tumor. According to single-variant analysis of Dukes C patients, the following factors are thought to influence local recurrences: number of lymph nodes metastases, level of primary growth, and direction of lymphatic spread. Multivariate regression analysis suggested that lymph node metastasis was the most important and influencing factor on local regrowth (P < 0.002). CONCLUSIONS: Compared with local recurrences is so-called extended surgery appeared to be lower. Our current policy is aggressive application of nerve-sparing surgery, even to patients with node-positive rectal cancer, taking into consideration the exact extent of cancer spread. From the viewpoint of neuroanatomy related to mesorectum, we discussed patient determination for our nerve-sparing surgery.

Adenocarcinoma↗
PubMed1994

The recurrence of recurrent membranous glomerulopathy in a renal transplant recipient: case report and literature review.

We describe the first reported case of a renal transplant patient who had two consecutive recurrences of membranous glomerulopathy in his allografts. Both recurrences were detected 1 year posttransplant. The first transplanted kidney was a none of six antigen match and his second was a four of six antigen match. The patient required a second kidney transplantation within 2 years of detection of the first recurrence. The second allograft has functioned adequately for nearly 4 years after diagnosis. The case and literature review illustrate that membranous glomerulopathy can recur in both poorly and well-matched allografts, that recurrence does not always occur faster in the better-matched kidneys, that cyclosporine does not prevent recurrent disease, and that the course of recurrent membranous glomerulopathy is unpredictable.

Glomerulonephritis, Membranous↗
PubMed2002

Salvage external beam radiotherapy for local recurrence without systemic progression or prostate specific antigen recurrence of prostate cancer after initial hormonal therapy: is it possible to identify patients likely to have good treatment outcomes?

BACKGROUND: We attempted to identify factors that predict the outcomes of salvage external beam radiotherapy (sEBRT) in patients who showed local recurrence without systemic progression or isolated prostate specific antigen (PSA) recurrence after initial hormonal therapy. METHODS: The subjects were 33 patients who were diagnosed as having local recurrence without systemic progression (30 cases) or isolated PSA recurrence (three cases). Of these patients, those with continuously decreasing PSA levels, which were 1.0 ng/ml or less 1-1.5 years after sEBRT, were regarded as good responders (GR) whereas the remaining patients were regarded as poor responders (nGR). Survival rates in these patients and factors that distinguish GR from nGR were evaluated retrospectively. RESULTS: The cancer-specific 10-year survival rate was 82.4% in the 33 patients, 100% in the 21 GR patients and 55% in the 12 nGR patients (P < 0.0001). Stepwise variable selection to discriminate between GR and nGR revealed that the time from sEBRT initiation to the nadir PSA was the most significant factor (P = 0.000097). Before sEBRT, GR can be predicted in patients with pre-sEBRT PSA <30.0 ng/ml and PSA doubling time (PSADT) >7.0 months, with a sensitivity of 95.2% (20/21), a specificity of 100% and an accuracy of 97.0%. CONCLUSION: Good responses to sEBRT can be expected in patients with local recurrence without systemic progression or isolated PSA recurrence after initial hormonal therapy when the patients show both pre-sEBRT PSA <30.0 ng/ml and PSADT >7.0 months.

Aged↗
PubMed1995

Cytokeratin 20 expression by non-invasive transitional cell carcinomas: potential for distinguishing recurrent from non-recurrent disease.

Although approximately 50% of patients with non-invasive (Ta) papillary transitional cell carcinoma show no recurrence of their disease, current histopathological approaches cannot distinguish this sub-group from those patients in whom the disease will recur. In this 5 year retrospective study, we have shown that cytokeratin 20 (CK20) was expressed in 19 of 29 (65.5%) of non-invasive papillary tumours of grades 1 or 2. CK20 expression patterns were predictive of disease non-recurrence in a sub-group of eight patients, representing 51.7% of patients with non-recurrent disease. In normal bladder mucosa, CK20 expression was restricted to the terminally-differentiated superficial cell. In eight CK20-positive tumours which showed no recurrence at 5 years, CK20 expression was either restricted to, or most intense in, the luminal cells of the papillae. This pattern of expression was not seen in any of the 15 tumours from the recurrent group. Disruption of normal CK20 expression was highly significantly correlated with recurrent tumours. These results suggest that changes in the expression of differentiation-associated antigens, such as CK20, may be useful in predicting benign versus malignant behaviour and may, therefore, be useful in defining treatment strategies.

Adult↗
PubMed2000

Recurrent patterns of atrial depolarization during atrial fibrillation assessed by recurrence plot quantification.

The aim of this study was to determine the presence of organization of atrial activation processes during atrial fibrillation (AF) by assessing whether the activation sequences are wholly random or are governed by deterministic mechanisms. We performed both linear and nonlinear analyses based on the cross correlation function (CCF) and recurrence plot quantification (RPQ), respectively. Recurrence plots were quantified by three variables: percent recurrence (PR), percent determinism (PD), and entropy of recurrences (ER). We recorded bipolar intra-atrial electrograms in two atrial sites during chronic AF in 19 informed subjects, following two protocols. In one, both recording sites were in the right atrium; in the other protocol, one site was in the right atrium, the other one in the left atrium. We extracted 19 episodes of type I AF (Wells' classification). RPQ detected transient recurrent patterns in all the episodes, while CCF was significant only in ten episodes. Surrogate data analysis, based on a cross-phase randomization procedure, decreased PR, PD, and ER values. The detection of spatiotemporal recurrent patterns together with the surrogate data results indicate that during AF a certain degree of local organization exists, likely caused by deterministic mechanisms of activation.

Adult↗
PubMed2000

Anticardiolipin antibodies and recurrent coronary events: a prospective study of 1150 patients. Thrombogenic Factors, and Recurrent Coronary Events Investigators.

BACKGROUND: The association of anticardiolipin (aCL) antibodies with coronary artery disease has been shown in several studies but remains controversial. We evaluated the association of aCL and anti-beta(2)-glycoprotein I (abeta(2)GPI) antibodies with the risk of recurrent cardiac events in postinfarction patients. METHODS AND RESULTS: The study population consisted of 1150 patients with acute myocardial infarction. Levels of IgG and IgM aCL and abeta(2)GPI antibodies were determined on sera collected before hospital discharge. There were 131 recurrent cardiac events (nonfatal myocardial infarctions or cardiac deaths) over a mean follow-up period of 24.6 months. Patients with elevated IgG aCL antibodies had a higher event rate than patients with low levels (P:=0.05). Multivariate Cox analysis after adjustment for relevant clinical covariates showed that elevated levels of IgG aCL (hazard ratio=1. 63; P:=0.01) and low levels of IgM aCL (hazard ratio of 1.76; P:=0. 02) antibodies contribute independent risks for recurrent cardiac events. Patients with elevated IgG aCL and low IgM aCL antibody levels had a 3-fold higher risk of recurrent cardiac events than patients with low IgG aCL and elevated IgM aCL antibody levels (P:<0. 001). There was no significant association of the abeta(2)GPI antibodies with recurrent cardiac events. CONCLUSIONS: In postinfarction patients, elevated IgG aCL and low IgM aCL antibodies are independent risk factors for recurrent cardiac events. Patients with both elevated IgG aCL and low IgM aCL antibodies have the highest risk. These findings shed additional light on the mechanistic role of aCL antibodies in coronary artery disease in patients without autoimmune diseases.

Adult↗
PubMed1998

Cardiac sequelae in recurrent cases of Kawasaki disease: a comparison between the initial episode of the disease and a recurrence in the same patients.

OBJECTIVE: Cardiac sequelae develop more frequently after recurrent Kawasaki disease than from the initial onset of the disease. The purpose of this study was to observe the existence of the sequelae at the initial and second onsets of the disease simultaneously with a large cohort. MATERIALS AND METHODS: From the database of patients with Kawasaki disease prepared by the Japanese Kawasaki Disease Research Committee, 559 cases with recurrences recorded between 1989 through 1994 and their initial occurrence listed in the database were selected. Their proportions of cardiac sequelae after the initial and second onsets of Kawasaki disease were compared. RESULTS: Of the 68 patients with cardiac sequelae after the initial onset, 32 (47%) suffered the sequelae after the second onset, whereas 78 (16%) of the 491 who were without cardiac sequelae after the initial onset developed the sequelae after the recurrence. Both proportions were higher than proportions in all patients with Kawasaki disease. In addition to the sex (male) and the existence of the sequelae after the initial onset, age at the second onset (older age) and the interval between the two episodes (longer period) were suspected to be risk factors for sequelae attributable to recurrent Kawasaki disease. CONCLUSION: Linked data of the initial and second episodes of Kawasaki disease showed that the risk of developing cardiac sequelae attributable to recurrent Kawasaki disease is high among both those with and without the sequelae at the initial episode. mucocutaneous lymph node syndrome, recurrence, cardiac sequelae, risk factors.

Age of Onset↗
PubMed1987

Stapedial reflex in non recurrent and recurrent Bell's palsy.

The clinical relationship of the stapedial reflex with the facial function has been investigated to evaluate its prognostic accuracy in a group of non recurrent and recurrent Bell's palsy patients. One hundred and fifty-eight consecutive patients were examined. One hundred and thirty-three presented a unilateral non recurrent palsy, 16 a unilateral recurrent paralysis, while the remaining 9 complained an alternating paralysis. In the unilateral non recurrent Bell's palsy a good correlation between the evolution of the stapedial reflex and the recovery of facial function was found. This observation was not seen in the other types of paralysis. The conclusion of this paper demonstrates that the stapedial reflex is a reliable prognostic indicator only in the non recurrent Bell's palsy.

Acoustic Impedance Tests↗
PubMedDate not supplied

Recurrent lumbar disc herniation: what recurs? (A morphological study of recurrent disc herniation).

A morphological study was conducted on disc material obtained during surgical discectomy in 20 patients. The series was divided into 4 groups. Group I: 3 patients who had never been operated on before; group II: 3 patients who had already been submitted to discectomy but at a level which differed from that of the disc examined; group III: 4 patients treated surgically for contralateral herniation; group IV: 10 patients with true recurrent disc herniation, that is, already submitted to surgery for the treatment of homolateral herniation of the same disc. All of the cases submitted to surgery had been operated on more than a year previously. Moreover, the disc material obtained during autopsy in a patient operated 15 years before for disc herniation was studied. A morphological study of the cases and the data reported in the literature reveals that the fibrocartilaginous tissue of recurrences differs from that of primary herniation because of the presence of large collagen bundles associated with fibrillar framework. This aspect suggests the hypothesis that is also supported by the autoptic material examined that recurrent disc herniation is formed by repair tissue that substitutes the part of the disc that is operated on, and that recurrent herniation is caused by mechanical collapse of the repair tissue. From a surgical point of view, a distinction may be made in terms of early recurrences, which appear within one year of surgery and are formed by disc tissue which is identical to that of primary herniation, and late recurrences, the subject of this morphological study.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis.

From 1953 to 1980, 657 patients survived a seemingly complete removal of a histologically benign intracranial meningioma. Recurrence of the tumor was found in 59 of these 657 patients, but some cases of recurrence may have been missed inasmuch as only 69 patients were followed for 20 years. With ordinary life-table analysis, the overall recurrence rate was estimated to be 19% at 20 years. The reliability of this result was evaluated with a modified life-table analysis. Multivariate analysis showed that coagulation of the dural insertion, invasion of bone, and soft consistency of tumor were strong risk factors (p less than 0.01) for recurrence. The recurrence rate at 20 years was estimated to be 11% for the 249 patients with none of these risk factors, 15-24% for those with one factor, and 34-56% for those with two.

Brain Neoplasms↗
PubMed2001

Loss of 1p in recurrent meningiomas. a comparative study in successive recurrences by cytogenetics and fluorescence in situ hybridization.

Deletion of 1p is associated with histological progression to meningiomas. Detection of this alteration may be a predicting factor for recurrences in this tumor. We present 8 meningiomas from four patients: the original tumor and the first recurrence in one patient, and the first and second recurrences in the other three were studied. We compared results of monosomy 22 and deletion of chromosome 1p with cytogenetic methods and fluorescence in situ hybridization (FISH) analysis obtained from slides of direct preparations, of cultured cells and slides of touch preparations. The cytogenetic study showed normal chromosome 22 and deletion on 1p32 in both samples of one patient; only monosomy 22 in both recurrences in another patient, and normal karyotypes with different non-clonal anomalies in the other tumors. However, with FISH analysis, monosomy 22 in both recurrences of three patients was demonstrated, as well as the loss of 1p in all tumors. These results were more evident in the analysis of direct and touch preparations than in those of cultured cells.

Adult↗