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PubMed2003

[Significance of p53, c-myc and nm23 protein expression in recurrent laryngeal carcinoma].

OBJECTIVE: To evaluate the prognosis of postoperative laryngeal cancer recurrence, the study was designed to investigate the relationship of p53, c-myc and nm23 protein expression in recurrent laryngeal carcinoma. METHOD: Five hundred and seventy-four cases of laryngeal carcinoma were retrospectively reviewed. All the patients were observed for 3 years postoperatively, 56 cases with recurrence were diagnosed and 39 cases of normal laryngeal tissue were compared. The tissue microarrays was made in all the cases. The tissue chip was analyzed by the SABC immunohistochemical method. RESULT: p53, c-myc and nm23 expressed in most of the laryngeal carcinoma. The positive ratio is different. There is higher expression of c-myc in recurrent laryngeal carcinoma, and its expression has significant difference with the laryngeal carcinoma, which have no recurrence (P < 0.01). nm23 has lower expression in recurrent laryngeal carcinoma, and it's expression has significant difference with the laryngeal carcinoma which have no recurrence(P < 0.01). The expression of p53 has no significant difference between recurrent laryngeal carcinoma and the laryngeal carcinoma which have no recurrence(P > 0.05). There is the positive correlation between the expression of c-myc and the recurrent laryngeal carcinoma; and negative correlation between the expression of nm23 and the recurrent laryngeal carcinoma. CONCLUSION: c-myc and nm23 could be the prognosis marker of postoperative laryngeal cancer recurrence.

Adolescent↗

PubMed2003

Proliferative status is a risk index for recurrence in primary superficial (pTa/T1) low-grade urothelial bladder carcinoma.

The current clinicopathologic study for evaluation of superficial bladder cancer still has limitations in predicting the true behavior of recurrence. To determine the high-risk recurrence factors, we studied the influence of Ki-67, c-erbB-2, p53 and multidrug resistance-associated protein (MRP) expression. Samples were obtained from 33 pTa and 46pT1 diagnosed bladder cancer patients with a mean follow-up of 48.7 +/- 30.6 months. The contingency table method, Kaplan-Meier curve and multivariate analysis were used to evaluate the association among the immunohistochemical factors expression, clinicopathologic parameters with tumor recurrence. Stage pT1 tumors, sessile tumors and large tumors (> 3 cm) showed a significantly high recurrence rate (p = 0.0158, p = 0.0162, p = 0.0001 respectively). Tumors with overexpression of Ki-67, c-erbB-2 and p53 were more likely to recur (p = 0.0035, p = 0.0027, p = 0.0076 respectively), MRP expression was not associated with recurrence. Multivariate analysis showed that large tumors and high Ki-67 expression were independent indicators of recurrence. On the other hand, in tumors less than 1 cm, recurrence was significantly correlated with overexpression of Ki-67 and p53. High Ki-67 expression could discriminate higher recurrence cases in grade 2, pT1 and single tumors. The c-erbB-2 overexpression was more frequently associated with recurrence in sessile tumors, large tumors, multiple and grade 1 tumors. The p53 overexpression also predicted a higher risk of recurrence in pTa tumors. These data demonstrated that the use of proliferative related proteins yields significant prognostic information in addition to clinicopathological factors, high Ki-67 expression is a reliable indicator of recurrence. A combination rather than any factor alone could more accurately predict tumor recurrence.

Adult↗

PubMed1992

[Recurrent cases of chronic subdural hematoma--its clinical review and serial CT findings].

Eighty-eight cases (114 hematomas) of chronic subdural hematoma (SDH) were treated surgically using irrigation with or without drainage. 13 cases (14.8%), 13 hematomas (11.4%) showed recurrence after the 1st operation. They were compared with non-recurrent cases using clinical reviews and serial CT findings. The result of the study showed that all of the patients in whom recurrence occurred were male and elderly (mean age 70.4 years). Many of these recurrences occurred in cases of bilateral SDH, on the left hematoma side, and at intervals within 7 days from the onset of clinical symptoms after the 1st operation. All recurrent cases were treated surgically using irrigation without drainage. In preoperative CT findings, it was shown that high density areas and small-sized hematomas were detected at a slightly higher rate in recurrent cases than in non recurrent cases. In postoperative CT findings, it was shown that many of the recurrent patients deteriorated during an interval from 2 weeks to 2 months. It was shown that non-recurrent patients had become almost normal by 3 months after the operation. Residual air volume into the subdural space within 7 days in recurrent cases was greater than in non-recurrent cases. Therefore, using irrigation with drainage, planning the operative timing, and reduction of residual air volume into subdural space are proposed as suitable means to avoid recurrence of SDH. Patients of SDH need postoperative follow-up during an interval up to 3 months.

Adult↗

PubMed1992

[An early detection of the recurrence of serous cystadenocarcinoma of the ovary with the tumor marker CA125 levels].

We studied whether or not, and to what extent, it was possible to predict the recurrence of serous cystadenocarcinoma of the ovary by means of the tumor marker CA125 levels, in 35 treated cases of ovarian serous cystadenocarcinoma. The relationship between the change in CA125 levels and the frequency of recurrence was examined in two groups (recurrent group and non-recurrent group). When CA125 levels over 35U/ml were defined as positive for recurrence, the true positive rate was 22/23 in the recurrent group, and 0 in the non-recurrent group. When this cut-off level was lowered to 30U/ml, and then 25U/ml, the false positive rate in the non-recurrent group was increased to 1/12 and 4/12, respectively. A three-serial increase in CA125 levels was observed at the onset of recurrent cases including two cases with CA125 levels under 35U/ml, while it was not detected in any in the non-recurrent group. Analysis of the CA125 level increase pattern with a non-linear model showed that recurrence could be detected before the CA125 level reached 100U/ml in 13/19 (68.4%) cases if the interval between CA125 measurements was one mouth, and in 17/19 (89.5%) cases if the interval was two weeks. These results suggest that possibility that recurrence can be detected early.

Adolescent↗

PubMed2004

[Multivariate regression analysis of recurrence following curative surgery for colorectal cancer].

BACKGROUND & OBJECTIVE: Recurrence is a very important prognostic factor for colorectal cancer patients after operation. The selection of patients for individualized follow-up and adjuvant therapy after curative resection of colorectal carcinoma depends on prognostic factors for recurrence. The objective of this study was to investigate the clinicopathologic factors related to recurrence following curative surgery for colorectal cancer. METHODS: The clinicopathologic factors and follow-up data of 692 cases of colorectal cancers after surgical treatment from 1991 to 1999 were retrospectively analyzed by univariate and multivariate methods. RESULTS: The overall 3-year and 5-year survival rates were 33.1% and 19.7% in recurrent group, and 92.8% and 86.1% in nonrecurrent group, respectively. Univariate analysis showed that Dukes' stage, lymph node metastasis, tumor location, histological differentiation, gross findings and depth of bowel wall invasion were significantly associated with recurrence after operation. Multivariate analysis showed that lymph node metastasis and tumor location were prognostic factors for recurrence after operation. In separate analysis of distant metastasis and local recurrence with multivariate method, lymph node metastasis was an prognostic variable for both distant metastasis and local recurrence. Depth of bowel wall invasion was associated with distant metastasis, and tumor location was associated with local recurrence. CONCLUSION: Lymph node metastasis is the most important prognostic factor for recurrence or distant metastasis and local recurrence after operation for the patients with colorectal carcinoma. Depth of bowel wall invasion is an important prognostic factor for distant metastasis. Rectal cancer patients should be considered to have additional risks for local recurrence.

Adenocarcinoma↗

PubMed2005

[Surgical factors underlying the recurrence of primary spine tumor].

OBJECTIVE: To find the causes of the spinal primary tumors recurrence in surgical technique. METHODS: From 1989 to 2002, 38 cases of primary spine tumors, including giant cell tumor, osteoblastoma, chondrosarcoma and chordoma with wide resection via a piece-meal fashion. By adopting a retrospective method, the present study investigated the clinical and imaging materials of pre- and post-operation period and those in follow-up. RESULTS: The study included 18 cases of giant cell tumor, 6 osteoblastoma, 6 chondrosarcoma and 8 chordoma. In all cases, 63% of tumors were in cervical and cervicothoracic (C(7)-T(2)) spine; 29% in thoracolumbar (T(4)-L(5)) spine and 8% in sacrum. Tumors involved in multi-segment were 34%. And 71% patients had the tumor in the body and the arch simultaneously. And 71% of tumors formed paraspinal masses, 42% in both sides. The tumors invaded the channel in 58% of the cases. The compartment were invaded in 79% patients. Finally, 32 patients were followed up, from 1.0 approximately 14.9 years, 5.1 years average. Seventeen patients recurred after the surgery, the recurrence rate was 53%. The recurrence rate of giant cell tumor was 35%, osteoblastoma 50%, chondrosarcoma 75%, chordoma 100%. The recurrence rate of tumor in cervical and cervicothoracic spine was 63%, thoracic-lumbar 33%, sacrum 67%. The recurrence rate of multi-segment tumors was 80%, and that of single segment 41%. The recurrence rate of the tumors involving in vertebral body alone or involving the arch simultaneously reached 75% and 55% respectively; the recurrent rate in the arch alone was 33%. The recurrence rate of the tumors involving in vertebral body ranged in different segments. Those growing in cervical and cervicothoracic spine reached 73%; those growing in thoracolumbar spine was only 25%. The recurrence of the tumors without soft masses was 20%, those of single-sided soft masses was 45% and those of double-sided 91%. Among the 17 recurrent patients, 83% of the tumors were in the cervical and cervicothoracic spine. Those extending to the upper cervical and cervicothoracic amounted to 58%. All the 17 recurrent patients had body lesion and paraspinal soft masses. CONCLUSIONS: During the primary spinal tumor operation, that failure to get adequate exposure and full division is thought to be the cause of recurrence. So the precise design before surgery and adequate exposure of the tumor in the surgery is the guarantee of wide excision.

Adolescent↗

PubMedDate not supplied

Predictive factors affecting early recurrence after hepatectomy for hepatocellular carcinoma in 5-year survivors.

BACKGROUND/AIMS: This study was undertaken to establish a therapeutic strategy for long-term recurrence-free survival in hepatocellular carcinoma (HCC) patients treated by hepatectomy by determining the factors that predict intrahepatic recurrence. METHODOLOGY: This study included 72 patients who survived more than 5 years after hepatectomy for HCC. Based on the interval between hepatectomy and intrahepatic recurrence, they were classified into 3 groups: those with early recurrence within 2 years after surgery (n=15), those with recurrence between 2 and 5 years (n=18), and those without recurrence within 5 years (n=39). Twenty-six parameters concerning host-related, tumor-related, treatment-related factors, and postoperative levels of serum transaminases were evaluated. RESULTS: Among host-related and tumor-related factors, serum albumin level, serum levels of transaminases, indocyanine green retention rate at 15 minutes, tumor number, intrahepatic metastasis and TNM stage were determined to be significantly different between the patients with recurrence within 5 years and those without recurrence. Among treatment-related factors, curability was highly associated with recurrence. The period until increase in the levels of transaminases after surgery was significantly shorter in patients with recurrence compared to the patients without recurrence. CONCLUSIONS: Curative operation minimizing intrahepatic metastasis and postoperative anti-inflammatory treatment lowering the occurrence of multicentric carcinogenesis are useful therapeutic strategies for achieving long-term recurrence-free survival for HCC patients treated with surgery.

Alanine Transaminase↗

PubMedDate not supplied

[Pelvic recurrence of rectal cancer: our experience].

Isolated recurrence of rectal carcinoma have been reported from 7% to 33% with a median of 15. Increasing recurrence is associated with increasing Dukes's stage. Patient who have recurrence after a low-anterior resection are more likely to present with non fixed, surgically correctable lesion versus recurrences after abdominoperineal resection. The most common symptom related to pelvic recurrence is pain, which may be perineal or radiate to the lower extremities. The diagnosis of a locally recurrent rectal cancer was obtained with CT; imaging is the first step to estimate the extent and location of the local tumor growth and the presence or absence of distant metastases. The most common location is at or around the anastomosis and the presacral region. Apart from distant metastases locoregional recurrence is the most important factor determining prognosis and survival. If an R0 resection can be performed, a 5-year survival rate of 20-30% can be achieved. Local or locoregional recurrence implies the reappearance of carcinoma after an intended complete removal of the tumor. For rectal cancer, the adjacent organs include the perineum, bladder and vagina, and LR failure includes perineal or pelvic lesions. Total pelvic exenteration is performed in patients with local recurrence of rectal cancer and a 5-year suvival rate of 30-40% was achieved. For patient with unresectable recurrence, chemotherapy and radiation contribute to a better quality of life and prolong survival. 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 anastomotic recurrence 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. Intraoperative radiotherapy and brachytherapy, and/or preoperative chemoradiation may provide better results in future. While radioterapy remains the most common antineoplastic modality used for palliation of symptoms, surgical resection remains the mainstay of curative treatment for carcinoma of colon and rectum.

Aged↗

PubMed2006

Neck recurrence in early carcinoma tongue.

OBJECTIVE: To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck. METHODS: This is a retrospective analysis of 80 patients with early (T1/T2) carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years. RESULTS: Eighty patients were included in this study, 49 (61.3%) men and 31 (38.8%) women; 36 (45%) patients with T1 lesion and 44 (55%) with T2 lesion. Sixty two patients (77.5%) were staged cN0 and 18 patients had a clinically palpable neck nodes (cN+). Thirty seven patients were pathologically negative (pN0), whereas 22 were pathologically positive (pN+) and 21 were not operated so they were staged pathologically (pNx) (undissected necks). Thirty patients received postoperative adjuvant radiotherapy. The median follow-up was 16.5 months with a range of 10-120 months. The over-all rate of recurrence in neck was 32.5% (27 patients). The rate of recurrence was 23% in T1 and 45.8% in T2 lesion (P-value 0.09) without radiotherapy. The recurrence rates with T1 lesion patients who were given adjuvant radiotherapy did not change significantly whereas with T2 lesions the recurrence rate decreased from 45% to 25% in the group without radiotherapy. Recurrence rate was higher in undissected neck as compared to patients who underwent elective neck dissection having radiotherapy and staged pN0 (P-value 0.009) or pN+ (P-value 0.005). Patients having therapeutic neck dissection, on comparison of final pathological node staging (i.e. pN0 or pN+) the rate of recurrence in patients pN+ was 56% and in group with pN0 it was 11%, with (P-value 0.046). CONCLUSION: We did not find any effect of age, gender and surgically resected margins of primary early tongue tumor on recurrence of disease in neck. There was no significant difference between primary tumor stage T1 and T2 lesions on neck recurrence when treated with surgery alone, but adjuvant radiotherapy further reduced the neck recurrence in T2 groups. Adjuvant radiotherapy also showed a significant reduction in recurrence rates in both pN0 and pN+. Undissected necks have higher incidence of neck recurrence than dissected neck irrespective of pathological status of neck metastasis.

Adult↗

PubMed1988

[Intravesical ectopic recurrence of bladder tumors].

Conservative therapy, preserving bladder function, is most commonly done for the treatment of bladder tumors. However, prevention of intravesical ectopic recurrence remains to be the major postoperative problem. Between April, 1969 and March, 1986. 144 patients were treated conservatively at our Hospital. Initial recurrence occurred in 36.8% of the conservatively treated cases. Second recurrence occurred in 73.2% twice the rate of initial recurrence. No differences were noted between the recurrence rate of single and multiple tumors. Overall recurrence rate according to histological grade was 0% for Grade 0, 36.4% for Grade 1, 36.8% for Grade 2, and 50.0% for Grade 3. The overall recurrence rate of the group without postoperative prophylactic adjuvant therapy was 37.0%. The overall recurrence rate according to postoperative prophylactic adjuvant therapy was 28.6% for intravesical Mitomycin C (MMC) instillation, 30.0% for intravesical Adriamycin (ADM) instillation, 36.8% for external irradiation, 42.9% for fluorouracil (5FU) administration and 100% for 5FU + intravesical instillation. As a whole 5FU is not effective. However, in 1 patient who had had seven previous recurrences, no recurrence has occurred for over seven years after 5FU administration. Effect of adjuvant therapy differs in each case and cannot be regarded in the same light. High grade, high stage, and large (greater than 3 cm) tumors show a high recurrence rate. Progression (grade up, stage up) occurred in 11.3% of the recurrence cases.

Administration, Intravesical↗

PubMed1995

Recurrence of membranous nephropathy after renal transplantation. Incidence and risk factors in 1614 patients.

The exact incidence of recurrence of membranous nephropathy (MN) after renal transplantation is not well documented because of the limited number of series involving a small number of patients. The aim of this study was to assess the incidence of MN recurrence in our population of renal transplant patients, to identify the risk factors associated with the recurrence, and to analyze the influence of the recurrence on graft and patient survival rates. The recurrence was defined as biopsy-proven MN on the renal graft in a patient whose original disease was MN. Among 1614 consecutive renal transplantations performed from January 1, 1980, to June 1, 1993, the incidence of recurrence was 26.3%, i.e., 5 recurrences out of 19 transplantations. We were unable to show pretransplant epidemiological, immunological, and therapeutic factors associated with recurrence. The HLA DR3 allele was present in 2 patients with recurrence (40%), compared with 3 patients without recurrence (21.4%). The early use of cyclosporine was not associated with a decreased prevalence of MN recurrence. Graft survival was not influenced by the recurrence. Three lymphomas were observed in the 19 transplanted patients with MN as causal nephropathy.

Adult↗

PubMed1995

Influence of local treatment on the recurrence rate of ductal carcinoma in situ.

BACKGROUND: Screening mammography has resulted in a significant increase in the diagnosis of ductal carcinoma in situ (DCIS). The role of breast conservation therapy and the long-term recurrence rate are still controversial. This article compares mastectomy, wide excision alone, and wide excision with radiation as treatments for DCIS. STUDY DESIGN: One hundred twenty-four cases of DCIS were retrospectively reviewed and were found to be pure DCIS by a senior pathologist. The mean age at diagnosis was 60 years (range, 33 to 81). Originally, 101 patients (81 percent) presented with calcification on mammogram, and 23 (19 percent) presented with a palpable mass. Histologic data showed that 54 (44 percent) had noncomedo type lesions, 46 (37 percent) had comedo type, and 24 (19 percent) had unknown type DCIS. RESULTS: Four of the 124 patients had a recurrence during a mean follow-up period of 43 months. Recurrence is defined as any development of DCIS or invasive carcinoma in the ipsilateral breast. There was one (1.3 percent) recurrence in the 75 patients treated with mastectomy (an adenocarcinoma of the chest wall), which occurred at 59 months. Treatment was 5,750 cGy to the chest wall and the patient is free of disease 37 months postradiation. There were three (11 percent) recurrences at 14, 21, and 29 months, respectively, in the 28 patients treated with wide excision alone. All three recurrences were found by calcifications on mammogram and all patients had comedo type original lesions. Two recurrences were pure DCIS of the breast. Both patients were treated with mastectomy and are free of disease at 33 and five months, respectively. The third recurrence was an invasive colloid carcinoma of the breast. Treatment was a modified radical mastectomy; the patient is free of disease after 62 months. There were no recurrences in the 21 patients who were treated with wide excision and radiation. Average total dose of radiation was 5,835 cGy (range, 4,500 to 6,480). CONCLUSIONS: The results of this study indicate that both mastectomy and wide excision with radiation are associated with very low recurrence rates. Wide excision alone is associated with a higher recurrence rate. However, all recurrences were detected mammographically and all lesions were salvaged by mastectomy. Therefore, the ultimate local control and survival rates were similar for all three modalities.

Adult↗

PubMed1995

Severe or multiple rejection episodes are associated with early recurrence of hepatitis C after orthotopic liver transplantation.

Recurrent hepatitis C causes significant morbidity after liver transplantation. Because immunosuppression is associated with enhanced viral replication, we postulated that clinical recurrence of the disease may be associated with augmented immunosuppression for rejection. In 96 patients with hepatitis C who received liver transplants, we recorded the interval from transplantation to recurrence, the episodes of steroid-resistant rejection (SRR) requiring OKT3, the number of rejection episodes, and the use of OKT3 induction. Recurrence was diagnosed based on elevated transaminases and characteristic histology. Hepatitis C recurred in 43 of 96 patients. Fifteen of 21 patients (71.4%) who previously had SRR had recurrence, versus 28 of 75 patients (37.3%) who either had no SRR (72 patients) or had it after recurrence was diagnosed (3 patients) (P < .01). Mean time to recurrence was 127 +/- 31 days in the 15 patients who had had SRR versus 246 +/- 42 days in the other 28 patients (P = .02). Recurrence and number of rejection episodes were clearly associated: 6 of 33 patients (18.2%) with no rejection had recurrence (P < .05), versus 11 of 26 patients (42.3%) with one rejection episode (P < .05) and 26 of 37 (70.2%) with more than 1 episode (P < .05). OKT3 induction was used in 15 patients; 9 of 15 patients had recurrence (ns) at 337 +/- 95 days. Of 72 patients who initially received triple immunosuppression, 30 patients had recurrence at 186 +/- 25 days (P = .05). Nine patients received primary FK506; 4 had recurrence at 68 +/- 14 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Resistance↗

PubMed1993

[Surgical therapy of pterygium. Incidence of recurrence after free conjunctival transplant and surgical techniques without transplantation].

A retrospective examination was conducted on 104 patients who had undergone operations for a pterygium over a time period of 2-73 months. Thirty-one patients were operated on with a free autologous conjunctival transplant; in 40 cases a conjunctival suture was performed and in 33 cases the bare sclera technique was used. The pterygium and any recurrences were scored clinically from 0 to 4. Small recurrences with a score less than 3 and a small conjunctival corpus were called "calm" recurrences. A bigger corpus and a head with a score > or = 3 and parallel vessels were called "active" recurrences. The recurrence rates were taken as the total calm and active recurrences. Autologous conjunctival transplant had a recurrence rate of 32.3%, excision with conjunctival suture 58.5%, and the bare sclera technique had a recurrence rate of 66.7%. Excision techniques cause high rates of recurrences, severe conjunctival scarification and irritation for a long time. A free autologous conjunctival transplant from the same or other eye to the place of excision improves the rate of recurrences even when the condition is more severe initially. Even though more complicated operation methods decrease the rate of recurrence, but 20-35% recurrence rates are still not satisfactory.

Conjunctiva↗

PubMed1993

An evaluation of risk factors in incisional hernia recurrence.

In the present study, generally accepted risk factors for developing a primary incisional hernia are reviewed for their influence on the development of recurrent incisional hernia. The records of 417 patients undergoing an incisional hernia repair between 1980 and 1989 at the University Hospital Rotterdam were reviewed retrospectively, and in the event no hernia recurrence was documented, patients were asked to visit the outpatient department for physical examination. Patients having a primary incisional hernia (n = 302) were selected and patient related factors of gender, age, obesity, chronic cough, prostatism, constipation, diabetes mellitus and the use of corticosteroids were analyzed. In addition, operation related factors, including the technique of operation (mainly, one layer interrupted and one layer continuous closures), use of drains, use of antibiotics, wound contamination (fecal or purulent spill), duration of operation, technique of anesthesia, wound complications, mortality and period of hospitalization, were analyzed. Hernia related factors--the hernia-free interval, original operation, type of incision and the size of the hernias--were also analyzed. Statistical analysis of the data was performed using the chi-square test to compare percentages between groups. Cumulative percentages of patients having a recurrence along time were calculated using life-table methods. Of the group of primary incisional hernias, four patients lacked follow-up evaluation and were excluded, leaving 298 patients for study. With a mean follow-up period of 34.9 months, the recurrence rate was 36 percent; 45 percent had recurrence in the first year, 64 percent in the second year and 78 percent of all recurrences occurred within three years. Therefore, a follow-up evaluation of at least three years is recommended. The cumulative (life-table) recurrence rate after five years was 41 percent. After second, third and fourth incisional hernial repair, recurrence rates were higher (56, 48 and 47 percent, respectively). Except for the size of the hernia, none of the studied parameters led to a significantly higher recurrence rate. Obesity, diabetes mellitus, lower midline incision and wound infection did have higher recurrence rates, but these were not significant. Incisional hernias, smaller than 4 centimeters, had a significantly (p = 0.01) lower recurrence rate (25 percent) than larger hernias (41 percent). Considering these facts, a better technique is badly needed. In large defects, the use of inlay of prosthetic material consistently has the lowest recurrence rates. The question remains whether or not prosthetic material is also needed for repair of smaller hernias.

Adult↗

PubMed1996

Flow cytometric DNA ploidy and cells phase fractions in recurrent human pituitary adenomas. A correlative study of flow cytometric analysis and the expression of proliferating cell nuclear antigen.

Flow cytometric analysis was applied to embedded tissue to measure the proliferative activity and the DNA ploidy of 16 recurrent and 17 nonrecurrent pituitary adenomas. The results were compared with data from a previous study which demonstrated that proliferating cell nuclear antigen (PCNA) labeling index was higher in recurrent adenomas than in nonrecurrent adenomas. Flow cytometric analysis as a tool for predicting aggressive behavior has been useful in a variety of human tumors; however, its prognostic value in pituitary adenomas is controversial. Therefore, we decided to explore the relationship of the results of flow cytometry and proliferating cell nuclear antigen labeling indices with the prognosis of pituitary adenomas. Three out of 16 recurrent adenomas and five out of 17 nonrecurrent adenomas demonstrated a DNA aneuploid pattern. All the nonfunctional recurrent adenomas had a diploid pattern, while only 40% of the functional recurrent adenomas had a diploid pattern. The GO/G1 phase fraction was higher in the recurrent adenomas, than in the nonrecurrent ones (p = 0.0005). In contrast, the S-phase fraction and the coefficient of variation were higher in the nonrecurrent adenomas (5.9 +/- 1.0%, 7.0 +/- 0.75, respectively) than in the recurrent ones (2.5 +/- 0.6%, 4.0 +/- 0.2%, respectively) (p = 0.003 and p = 0.001, respectively). The proliferating cell nuclear antigen labeling indices were higher in the recurrent adenomas (18.9 +/- 4.5%) than in the nonrecurrent adenomas (2.6 +/- 1.6%) (p = 0.003). The S-phase of flow cytometry correlated weakly with the proliferating cell nuclear antigen labeling indices when the recurrent and the nonrecurrent adenomas were considered as one group. (r = -0.356, p = 0.033). But no significant correlations were observed when the groups of recurrent (r = -0.311, p = 0.195) and nonrecurrent tumors (r = -0.019, p = 0.942) were compared separately. The results of flow cytometric analysis suggest that recurrent adenomas may have a higher proportion of cells in the presynthetic phase than the nonrecurrent adenomas. This study suggests that flow cytometric analysis is of limited value in predicting recurrence of pituitary adenomas.

Adenoma↗

PubMed1997

Utility of screening procedures for detecting recurrence of disease after complete response in patients with small cell lung carcinoma.

BACKGROUND: Studies evaluating the efficacy of routine follow-up testing in detecting disease recurrence in treated lung carcinoma patients are lacking. METHODS: To investigate this subject, the authors studied 115 patients who had previously been entered on North Central Cancer Treatment Group (NCCTG) small cell lung carcinoma clinical trials, had achieved a complete response after chemotherapy/radiotherapy treatment, and subsequently developed disease progression. The authors included 58 patients with limited stage and 57 patients with extensive stage disease. Follow-up testing on these clinical trials was scheduled at 4-month intervals in the first year and every 6 months thereafter. At each visit, testing included a clinical history, physical examination, chest X-ray, chemistry group, and hematology group. Patients' records were evaluated to determine the first test(s) to identify disease recurrence, whether the recurrence was diagnosed at the time of routine follow-up or between scheduled follow-up evaluations, the sites of recurrence, and patient outcome. RESULTS: Recurrences occurred in 56 patients (49%) in the first follow-up year, 51 (44%) in the second year, and 8 (7%) after 2 years. Recurrences were signaled by clinical histories in 71% of patients, by physical examinations in 10%, chest X-rays in 12%, and abnormal chemistry testing in 6%. Although 41% of recurrences were detected at scheduled clinical visits, 59% of patients had disease recurrence signaled by symptoms that prompted interval visits between scheduled appointments. At last follow-up, all the patients in this study had died (median survival, 115 days [range, 1-793 days] after diagnosis of recurrence), supporting the lack of curative therapy for patients with recurrent small cell lung carcinoma. CONCLUSIONS: These data, demonstrating that clinical histories and physical examinations are the most fruitful means of detecting evidence of recurrent lung carcinoma, are consistent with data regarding the follow-up of other curatively treated cancers, such as breast carcinoma and melanoma. Chest X-rays in asymptomatic patients detect recurrences in a small proportion of patients, whereas routine blood tests appear to be of little value.

Carcinoma, Small Cell↗

PubMed1997

A retrospective review of 61 patients with antiphospholipid syndrome. Analysis of factors influencing recurrent thrombosis.

BACKGROUND: Antiphospholipid syndrome (APS) is a disorder of recurrent venous or arterial thrombosis, pregnancy losses, and thrombocytopenia. Recurrent thrombosis has particularly adverse effects on patients prognosis. The factors that influence recurrence and management techniques that prevent these events remain controversial. To add further insight regarding predisposing factors and the prevention of thrombotic recurrence, 61 well-characterized patients with APS were followed up for a median time of 77 months. METHODS: A retrospective cohort study was conducted in which the following factors were examined to determine their influence on thrombotic recurrence: primary vs secondary syndrome; the presence of hypertension, hyperlipidemia, diabetes, or smoking; patient age, sex, and race; pregnancy and oral contraceptives use; and treatment with warfarin sodium, warfarin plus aspirin, aspirin alone, prednisone, or no treatment. RESULTS: There was no difference between patients with primary and secondary APS with respect to recurrent arterial (55% vs 38%, respectively) or recurrent venous (47% vs 50%, respectively) thrombotic events. In all patients with APS, white race (P = .02) was associated with recurrent arterial events. Venous thrombosis occurred during pregnancy or in the postpartum period in 16 (30%) of 53 women and in 8 women taking oral contraceptives. Recurrent arterial and venous thromboses were significantly decreased with prophylactic warfarin use when compared with prednisone use or no treatment. Recurrences were infrequent in patients with prothrombin ratios of 1.5 to 2.0. CONCLUSIONS: Treatment with warfarin was most effective in preventing recurrent arterial and venous thrombosis. Pregnancy and the use of oral contraceptives or prednisone may also influence recurrence.

Adult↗