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PubMed1998

The anatomy of the recurrent branch of the median nerve.

One hundred one fresh-frozen cadavers were dissected under loupe magnification to spatially define the origin of the recurrent branch of the median nerve and to define its course with respect to the distal edge of the transverse carpal ligament (TCL). The spatial orientation, number, and course of the recurrent branch was carefully determined. Calipers were used to measure the distance between the recurrent branch and the TCL. Histologic analysis of the fascia surrounding the recurrent nerve was performed. The recurrent branch of the median nerve was classified into 3 types. Type I passed through the TCL; it is rare, occurring in 7% of the specimens. Type II nerves (74%) passed distal to the TCL through separate obliquely oriented fascia that originated on the TCL and inserted on the undersurface of the palmar aponeurosis. Type 111 (19%) passed distal to the TCL, but did not pass through the obliquely oriented fascia. The distance from the distal edge of the TCL was significantly different between the 3 types. Ninety-nine percent of recurrent branches originated either from the central portion of the median nerve or just radial to it. There were no ulnar origins. Four cadavers (4%) had more than 1 recurrent branch. The variability in the literature on the anatomy of the recurrent branch can be accounted for by failure to properly identify the TCL as being separate from the obliquely oriented fascia distal to the TCL through which the nerve frequently penetrates. Histologic analysis confirmed a difference between the TCL and these oblique fibers that can surround the recurrent nerve. This study concludes that the transligamentous branch (type I) is uncommon and the reported high incidence of branches passing through the TCL can be explained by mistakenly combining recurrent nerve types I and II.

Cadaver↗

PubMed2001

G20210A mutation in the prothrombin gene and the risk of recurrent venous thromboembolism.

OBJECTIVES: The study was done to determine whether the G20210A mutation in the prothrombin gene increases the risk of recurrent venous thromboembolism (VTE), both alone and in combination with factor V Leiden. BACKGROUND: Several inherited defects of coagulation are associated with increased risk of first VTE, including a recently identified G20210A mutation in the prothrombin gene. However, whether the presence of this mutation confers an increased risk of recurrent venous thromboembolism is controversial. METHODS: A total of 218 men with incident venous thromboembolism were genotyped for the prothrombin mutation and for factor V Leiden and were followed prospectively for recurrent VTE over a follow-up period of 7.3 years. RESULTS: A total of 29 men (13.3%) suffered recurrent VTE. Five of the 14 carriers of the prothrombin mutation developed recurrent VTE (35.7%; incidence rate = 8.70 per 100 person-years), while 24 of 204 individuals who did not carry the prothrombin mutation developed recurrent VTE (11.8%; incidence rate = 1.76 per 100 person-years). Thus, presence of the G20210A mutation was associated with an approximate fivefold increased risk for recurrent VTE (crude relative risk [RR] 4.93; 95% confidence interval [CI] 1.9-12.9; p = 0.001; age-, smoking-, and body mass index-adjusted RR 5.28; 95% CI 2.0-14.0; p = 0.001). In these data, recurrence rates were similar among those with an isolated mutation in the prothrombin gene (18.2%) as compared to those with an isolated factor V Leiden mutation (19.2%). However, all three study participants who carried both mutations (100%) suffered a recurrent event during follow-up. CONCLUSIONS: In a prospective evaluation of 218 men, the presence ofprothrombin mutation was associated with a significantly increased risk of recurrent VTE, particularly among those who co-inherited factor V Leiden.

Adult↗

PubMed1999

Role of bipolar electrogram polarity mapping in localizing recurrent conduction in the isthmus early and late after ablation of atrial flutter.

OBJECTIVES: Bipolar electrogram polarity was analyzed to localize the recurrent conduction site in the isthmus between the tricuspid annulus (TA) and inferior vena cava (IVC) in recurrent atrial flutter (AF). BACKGROUND: Despite the initial successful linear isthmus ablation, recurrence of transisthmus conduction and AF is not uncommon. It is unclear how the recurrent conduction site can be identified. METHODS: Fourteen patients with recurrent AF were studied: four with late recurrence remote from the first ablation and 10 with early recurrence within 60 minutes after the initial successful ablation. Bipolar electrogram polarity mapping was performed during low lateral right atrium (LLRA) pacing during sinus rhythm while recording bipolar electrograms from the septal portion of the isthmus along the previously ablated line. The septal side of the isthmus from TA to IVC was arbitrarily divided into five sites, and the bipolar electrodes with cathode at the tip and anode at the second was placed at each site. The recurrent conduction site was localized by analyzing the polarity of the bipolar electrogram recorded at each site. RESULTS: All recurrent AF was due to reentry around TA. During pacing from LLRA, as the mapping electrode was moved from TA to IVC side, the major polarity of the electrogram changed from negative to positive in all patients. A transitional electrogram with the equal amplitudes in positive and negative components was recorded between the sites showing mainly negative and positive electrograms, indicating electrogram polarity reversal at this site. Application of radiofrequency energy to this single site resulted in the elimination of transisthmus conduction in all patients with a single application in 11 patients and 2 or 3 in the remaining 3. CONCLUSIONS: Bipolar electrogram polarity mapping with attention to the polarity reversal point is useful for identifying and ablating the recurrent conduction site.

Adult↗

PubMed2003

Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography.

OBJECTIVE: We observed long-term venous ultrasound and plethysmographic changes after varicose vein surgery, to determine factors that influence recurrence. METHODS AND MATERIALS: This observational sequential prospective study was carried out in an institutional referral center with day surgery. Subjects were 92 consecutive patients, ages 20 to 75 years, with symptomatic varicose veins in 127 limbs, who were able to complete regular assessment. Superficial varicose vein surgery included significant perforator vessels only, defined at preoperative duplex ultrasound scanning and air plethysmography. Similar follow-up assessments were performed at 3 weeks, 3 months, and 1, 3, and 5 years. RESULTS: At 3 weeks venous reflux but not muscle pump function was consistently improved in all limbs. However, inadequate surgery at the major junctions was clearly identified as contributing to recurrence of disease in 7.2% of limbs. Recurrence of varicose veins occurred in 1 of 100 limbs (1%) at the saphenofemoral junction and in 8 of 33 (25%) limbs at the saphenopopliteal junction. However, after 3 years disease recurrence at these sites had increased to 23% and 52%, respectively. Incompetent perforator vessels increased progressively in number. Clinical recurrence was 47.1%, and consistent with this was gradual deterioration in air plethysmographic measures of reflux, with physiologic recurrence (venous filling index, >2 mL/s) in 66% at 5 years. Late recurrence was predicted in limbs with multiple sites of reflux preoperatively, venous filling index greater than 2 mL/s, and some other persistent abnormality at duplex scanning at 3 weeks. There was no recurrence in 40 limbs in which these factors were normal at at 3 weeks. However, 29 of 53 limbs with normal venous filling index after operative intervention had deteriorated at 3 years. CONCLUSION: Incomplete superficial surgery, in particular at the saphenofemoral and saphenopopliteal junctions, is a less frequent cause of recurrent disease, and neovascular reconnection and persistent abnormal venous function are the major contributors to disease recurrence.

Adult↗

PubMed2002

Local recurrence in the breast after conservative surgery--a study of prognosis and prognostic factors in 391 women.

In a population-based cohort of 6613 women with invasive breast cancer, who had breast-conserving surgery between 1981 and 1990, 391 recurrences in the operated breast were identified. The main aim of this study was to examine the prognosis and prognostic factors in different subgroups of local recurrences, characterised by the time to recurrence, location of recurrence and previously given radiotherapy. The median follow-up for women who had a local recurrence was 7.9 years. The life-table estimates for breast cancer-specific survival in women with local recurrences were 84.5% (standard error (S.E.) 1.8) at 5 years and 70.9% (S.E. 2.7) at 10 years. The risk of breast cancer death was highest among women who had an early (<or=2 years) recurrence in the same quadrant as the primary tumour, with a breast cancer-specific survival of 67.9% (S.E. 4.8) at 5 years and 56.0% (S.E. 5.9) at 10 years. There was a statistically significant difference in the probability of breast cancer-specific survival, as measured from the recurrence, between women who initially did or did not receive radiotherapy (P=0.0123). However, when measured from primary treatment, there was no significant difference, indicating that the difference in prognosis could be due to a lead-time bias. Independent prognostic factors for breast cancer-specific survival in women with local recurrences were time to local recurrence and the Nottingham Prognostic Index (NPI).

Adult↗

PubMed2004

Risk of seizure recurrence after a first unprovoked seizure: a prospective study among Jordanian children.

PURPOSE: There is wide variation in the reported recurrence rate after a first unprovoked seizure in children. We investigated the risk of recurrence after a first unprovoked seizure in Jordanian children and the risk factors associated with increased recurrence rate. METHODS: All consecutive patients aged 3 months-14 years who presented with their first unprovoked seizures between January 1997 and 2000, were included in a prospective study and followed up for 3 years for possible recurrence. Of the patients studied, there was slight male predominance (56.6%) and 55% of them were 2-9 years of age. Generalised seizures were reported in 75% and the remaining 25% had partial seizures. The duration of seizure was 1-4 minutes in 59%. Family history of epilepsy was positive in 31% and parental consanguinity in 32%. The role of these factors in increasing the risk of recurrence was also investigated. RESULTS: Two hundred sixty-five patients were included in the study and continued follow up for 3 years. Ninety-eight (37%) of them experienced seizure recurrence. Among the predictor factors for recurrence, partial seizure (P = 0.003) and positive family history (P = 0.000) were associated with a statistically significant increased risk. Sex, age, duration of seizure and consanguinity were not associated with increased risk of recurrence. CONCLUSION: Thirty-seven percent of the children studied experienced a second attack after a first unprovoked seizure over the 3 years follows up period. The risk of recurrence was significantly higher in children with a partial seizure (55%) and among those with a positive family history of epilepsy (59%). Age at first seizure, sex, duration of seizure and consanguinity were not significantly related to the risk of recurrence.

Brain↗

PubMed2002

Completely resected recurrent soft tissue sarcoma: primary anatomic site governs outcomes.

BACKGROUND: We define the natural history and influence of primary anatomic site for completely resected locally recurrent soft tissue sarcoma (STS) without distant metastasis. STUDY DESIGN: We selected 290 patients having at least one local recurrence (LR) after complete resection of primary STS (all sites) between 1982 and 1999. Of these, 239 patients had complete resection of their first LR: 161 extremity-trunk and 78 retroperitoneal-head and neck-visceral-thoracic sarcomas. Study end points included second local recurrence-free survival, distant recurrence-free survival, and disease-specific survival, estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed using a log-rank test and Cox's proportional hazards model for extremity-trunk and retroperitoneal (RP; n 39) tumor sites only. RESULTS: Median followup was 82 months. Complete gross resection rates declined with each subsequent recurrence. Primary tumor site (extremity-trunk: relative risk ERR] 0.74, confidence interval [CI] 0.57 to 0.96, p = 0.03) and microscopic resection margin (negative: RR 0.80, CI 0.62 to 0.99, p 0.04) independently predicted subsequent local control. Extremity-trunk sire and high tumor grade were significant independent predictors of distant disease relapse after complete resection of LR. Site also had a notable influence on disease-specific survival: RP recurrence was associated with 1.4 times increased risk of tumor-related mortality (p = 0.02; 5-year disease-specific survival: extremity-trunk 70% versus RP 57%). High tumor grade was the most marked predictor of tumor-related mortality (RR 1.66, CI 1.28 to 2.18, p<0.001. Nine percent of extremity-trunk and 77% of RP STS-related deaths were caused by advanced LR without synchronous metastasis. CONCLUSIONS: Site governs local control, distant recurrence-free and disease-specific survival for completely resected locally recurrent sarcoma without metastasis. Distant disease relapse determines outcomes for recurrent extremity-trunk STS, and local recurrence is the determinant of tumor-related death in the RP.

Disease-Free Survival↗

PubMed2001

Recurrence of leiomyomata after laparoscopic myomectomy.

STUDY OBJECTIVE: To assess recurrence of leiomyomata after laparoscopic myomectomy (LM) and evaluate predictive factors of recurrence. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: One hundred ninety-six women. INTERVENTION: Laparoscopic myomectomy with mean follow-up of 47 months. MEASUREMENTS AND RESULTS: Myoma recurrence included recurrence of initial symptomatology before LM, recurrence at clinical examination, and appearance of a myoma 2 cm or larger on ultrasound examination. Recurrence was observed in 45 patients (22.9%). The mean time before recurrence was 42 months (range 4-95 mo). Eight women (4.08%) required reoperation. The cumulative recurrence risk was 12.7% at 2 years and 16.7% at 5 years. Predictive factors for recurrence were number of myomas and nulliparity. CONCLUSION: According to our results, the cumulative rate of myoma recurrence within 5 years appears greater after LM than after laparotomy. However, this should not lead us to reject laparoscopy, which has many advantages compared with laparotomy, in particular its low morbidity.

Adolescent↗

PubMedDate not supplied

Evaluation and management of patients with recurrent peptic ulcer disease after acid-reducing operations: a systematic review.

This systematic review examines the evidence for commonly employed strategies of managing patients with recurrent ulcer disease after acid-reducing operations. Particular attention is given to recent evidence relating Helicobacter pylori (H. pylori ) and nonsteroidal anti-inflammatory drugs (NSAIDs) to ulcer recurrence after operative therapy. MEDLINE word searches of the literature from 1966 to 2001 identified 895 articles that cross-reference the terms "peptic ulcer disease (PUD)," "surgery," and "recurrence." Articles were selected for systematic review of evidence relating incomplete vagotomy, NSAIDs, and H. pylori to postoperative ulcer recurrence and evidence supporting common medical and surgical strategies. The relationship between incomplete vagotomy and recurrent ulcer disease is suggested by randomized controlled trials and well-designed prospective case series. The evidence that NSAID use is an important pathogenic factor in recurrent ulcer disease includes the relationship between NSAIDs and primary PUD, the occurrence of NSAID-induced ulcers in patients taking proton pump inhibitors, and case series demonstrating virulent ulcer disease in patients taking aspirin despite prior acid-reducing operations. The relationship between H. pylori infection and postoperative ulcer recurrence remains uncertain despite multiple controlled trials and well-designed case series that have documented high rates of H. pylori infection in postoperative patients. The initial management of patients with recurrent ulcer disease after acid-reducing operations consists of a protein pump inhibitor or a histamine-2 receptor antagonist and antibiotics directed at H. pylori, if present. Evidence for this regimen includes prospective randomized trials demonstrating the efficacy of cimetidine in healing ulcers after acid-reducing operations and prospective, randomized studies documenting the efficacy of histamine-2 receptor antagonists and protein pump inhibitors in the management of patients with primary PUD. The critical role that H. pylori infection plays in primary PUD and the minimal risks associated with H. pylori eradication strongly support the initiation of antibiotic therapy when H. pylori is present. The principal indication for operative management of recurrent PUD is the occurrence of ulcer complications that cannot be managed by medical or endoscopic means. The operative management of patients with failed acid-reducing operations is based on ulcer recurrence rates and morbidity and mortality rates in randomized and nonrandomized prospective trials of patients with primary PUD and retrospective case series of patients undergoing remedial operative procedures after various failed acid-reducing operations.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Sleep polysomnography as a predictor of recurrence in children and adolescents with major depressive disorder.

Adults with major depressive disorder (MDD) demonstrate certain sleep polysomnographic abnormalities, including sleep continuity disturbances, reduced slow-wave sleep, shortened rapid eye movement (REM) latency, and increased REM density. Findings of sleep EEG studies in depressed children and adolescents have yielded conflicting results, possibly because of methodological variations across the studies. Generally, however, studies have demonstrated that depressed children and adolescents exhibit less sleep continuity and non-REM sleep differences in comparison with control subjects than do adults. Thus, results from adult sleep polysomnography studies cannot necessarily be generalized to children and adolescents. Depressed adults who have reduced REM latency during the symptomatic episode appear more likely to have a relapse once treatment is discontinued than those with normal REM latency. No studies of the relationship between sleep polysomnographic variables and clinical course have been reported in depressed children and adolescents. Data for baseline clinical variables and 3 nights of sleep polysomnography were examined in 113 depressed children (< or = 12 yr; n = 51) and adolescents (> or = 13 yr; n = 62) (56 in-patients and 57 outpatients) where data was available on at least 1 yr of naturalistic follow-up. Subjects came from 2 studies of sleep polysomnography in children and adolescents with MDD. Clinical course was assessed using the Kiddie-Longitudinal Interval Follow-Up Evaluation (K-LIFE). This interview was used to define recovery from the index episode of MDD and recurrence, a new episode of meeting full criteria for MDD. Clinically, within 1 yr of initial evaluation 102/113 subjects had recovered from their index episode of depression (minimal or no symptoms for 60 d). Of the 102 subjects who recovered, 36 (35.3%) had a recurrence of MDD. The majority of subjects (55%) who had a recurrence were not on medication at the time of recurrence. Subjects who had a recurrence were more likely to report suicidal thoughts or attempts at baseline compared to those without a recurrence (67 vs. 37%; F = 8.77; p = 0.004). On baseline sleep polysomnography, subjects with a later recurrence had decreased sleep efficiency and delayed sleep onset (sleep latency > 10 min). Probability of recurrence at 12 months was 0.39 compared to 0.15 in subjects with non-delayed sleep onset (p = 0.005). Baseline suicidal ideation and sleep dysregulation on sleep polysomnography predicted recurrence in a large sample of depressed children and adolescents. Depression in children and adolescents is frequently a chronic, recurrent illness. Factors that can predict clinical course are important in increasing our understanding of depression in this age group.

Adolescent↗

PubMed1997

Breast conserving surgery for invasive breast cancer: risk factors for ipsilateral breast tumor recurrences.

To identify risk factors associated with an increased risk for ipsilateral breast tumor recurrence following breast-conserving surgery, a cohort of 759 women with T1-T2 tumors were studied. The majority of the patients (88%) had received postoperative radiation therapy to the breast. Median follow-up time was 10 (range: 6-17) years. There was a 1-1.5% yearly increase in ipsilateral breast tumor recurrences. For women < 50 ys the cumulative recurrence rate at 10 years was 18% and for women > or = 50 ys, 9%. Node positive women had a cumulative breast recurrence rate of 25% versus 10% for node negative women. Ten years postoperatively, irradiated patients had a cumulative recurrence rate of 11% versus 26% when no irradiation was given. The beneficial effect of radiotherapy was substantial during the first four postoperative years. The relative risk for an ipsilateral breast tumor recurrence during this period was 4.5 times higher than for non-irradiated patients. However, the protective effect of radiotherapy decreased with time. After ten years the relative risk of ipsilateral breast tumor recurrence was the same among irradiated and non-irradiated patients although the number of events during this period was low. Univariate analysis showed that seven factors were significantly associated with an increased risk of ipsilateral breast tumor recurrence, namely age < 50 ys, increasing tumor size, uncertain microscopic margins, axillary lymph node metastases, no postoperative tamoxifen treatment, premenopausal status, and no postoperative radiotherapy. Three factors remained independently significant after multivariate analysis: age < 50 ys, no postoperative radiation therapy, and positive lymph nodes. In conclusion, radiotherapy reduced the breast recurrence rate, but the effect decreased with time. Node-negative women > or = 50 were a low risk-group for ipsilateral breast tumor recurrence, with a cumulative risk at 10 years of 9% without radiation therapy and 5% with breast irradiation.

Adult↗

PubMed1997

Pattern of dissemination and survival following isolated locoregional recurrence of breast cancer. A prospective study with more than 10 years of follow up.

PURPOSES: The study evaluated prognostic factors for dissemination and survival in patients with local or regional recurrence of breast cancer. Furthermore, the aim was to define subgroups of patients at different risk of developing metastases in specific anatomical sites. PATIENTS AND METHODS: The study included 140 patients with isolated local or regional node recurrence, who entered a prospective study for staging of patients with first recurrence of breast cancer in the period 1983-85. The primary treatment was a simple mastectomy; node positive patients received adjuvant radiotherapy and chemotherapy or tamoxifen. If possible, the locoregional recurrence was treated with surgery and/or radiotherapy, otherwise by systemic therapy. RESULTS: Median follow up was 10.4 years; 78 patients developed distant metastases (soft tissue, 32%; bone, 45%; viscera 40%). Median time to dissemination was 4.4 years, and the ten year dissemination rate was 72%. Median time to dissemination was 3.7 years for patients with recurrence in the regional nodes compared to 6.5 years for patients with chest wall recurrence only, p = 0.05. No specific time sequence (temporal pattern) was observed in the anatomical distribution of metastases, and the anatomical site of recurrence could not be predicted by any of the prognostic factors. At follow up, 93 patients had died. The median survival was 5.6 years and 30% were alive after 10 years. Forty-three of the 99 patients who received local therapy only did not develop metastases. Fifteen of these patients died without evidence of metastatic disease while 28 patients were still alive without distant recurrence after a median follow up time of 9.3 years (range, 6.5-11.9 years). Level of LDH and the number of positive regional nodes (NPOS) at primary diagnosis were significant independent prognostic factors for survival after recurrence. CONCLUSIONS: Approximately one third of the patients receiving local treatment only, were alive and without distant metastases up to ten years after locoregional recurrence, indicating that there is a subset of patients which may be long term survivors after local treatment only (surgery or radiotherapy). The duration of survival can be estimated by LDH and NPOS, but the model needs validation in a separate data set before clinical use.

Breast Neoplasms↗

PubMed2001

ODC mRNA as a prognostic factor for predicting recurrence in meningiomas.

In proliferating neoplastic cells, activity of the enzyme ornithine decarboxylase (ODC) increases. Among other brain tumors, ODC activation could also be observed in meningiomas. In the present study, we have investigated ODC gene expression in primary and recurrent meningiomas at the transcriptional level. ODC mRNA (messenger ribonucleic acid), ODC activity, number of mitoses, and Ki-67 index as a marker for nuclear proliferation were quantified in three different groups of meningiomas: tumors without recurrence in a 8.4 years median follow-up period, tumors with recurrence within a median follow-up of 3.0 years, and their corresponding recurrent tumors. ODC mRNA level was significantly higher in meningiomas with later recurrence as compared to meningiomas without recurrence (p < or = 0.01), whereas it declined in the recurrences of the second group (p < or = 0.001). In contrast, ODC activity showed no difference between the two groups of primary tumors, but a significant increase of enzyme activity could be observed in the recurrences as compared to the correponding primary tumors (p < or = 0.001). Likewise, an increase of the Ki-67 index could be detected in the recurrent group (p < or = 0.001). These results suggest that ODC mRNA may represent a prognostic factor for predicting recurrence in meningiomas.

Adult↗

PubMed2003

Methodological challenges in studying recurrence of low back pain.

Recurrences of low back pain (LBP) have been shown to be both frequent and costly, with reported recurrence rates ranging from 5 to 82%. Numerous methodological approaches have been developed to identify recurrence but there has been no standardized definition of LBP recurrence or required follow-up time. The objective of this study was to compare the methodological approaches used to analyze LBP recurrence in seminal contributions and to describe the differences in definitions of LBP recurrence and follow-up structure. Twelve seminal articles were identified for review during which four types of LBP recurrence definition and two types of follow-up structure were recognized. Definitional and follow-up differences considerably contributed to variations in computed recurrence rates due either to measurement or other methodological shortcomings, such as loss to follow-up and sick person effect. The results suggest that there is a need to develop a standardized definition of LBP recurrence and a standardized approach to follow-up to allow direct comparisons of published research findings. The use of alternative definitions is also likely to impact analyses of risk factors contributing to LBP recurrence and direct and indirect costs associated with treating LBP.

Follow-Up Studies↗

PubMed2002

Evaluation of multiple recurrence events in superficial bladder cancer patients treated with intravesical bacillus Calmette-Guérin therapy using the Andersen-Gill's model.

To evaluate factors affecting recurrence after intravesical bacillus Calmette-Guérin (BCG) therapy (Tokyo 172 strain), we reviewed data for 101 patients with superficial bladder cancer (pTa [n = 80] and pT1 [n = 21]) treated between 1985 and 1999. The median follow-up period was 58.9 months. Factors affecting the first tumour recurrence were evaluated using Cox's proportional hazards model and those affecting multiple recurrence with Andersen-Gill's model. The 5-year recurrence-free rate was 63% for all 101 patients. The recurrence frequency, defined as times per 100 patient-months of follow-up, greatly decreased from 7.3 +/- 9.6 (SD) before the instillation to 2.6 +/- 5.6 after the therapy (p < 0.0001). Patients with pT1 tumours tended to have earlier recurrence than those with pTa tumours (p = 0.06). Multivariate analysis using Cox's proportional hazards model revealed that a history of bladder cancer and pathological stage were independent factors affecting the first tumour recurrence after the BCG therapy. When multiple endpoints of recurrence were evaluated using the Andersen-Gill's model, number of tumours as well as a history of bladder cancer and pathological stage demonstrated significant links to tumour recurrence after the BCG therapy. The 5-year progression-free and 5-year survival rates were 89.3% and 85.3% for all the 101 patients, respectively. Because intravesical recurrence may involve multiple events during the clinical course of patients with bladder cancer, the Andersen-Gill's model appears useful for evaluation of risk factors.

Adjuvants, Immunologic↗

PubMed2006

Recurrent varicose veins: sonography-based re-examination of 210 patients 14 years after ligation and saphenous vein stripping.

BACKGROUND: The objective of this study was to assess the frequency of varicose recurrence 14 years after flush ligation of the saphenofemoral (SFJ) or saphenopopliteal (SPJ) junction with additional stripping of the incompetent saphenous vein. PATIENTS AND METHODS: Our study group comprised 245 extremities of 210 patients operated upon in 1990 for either great saphenous vein (GSV) or small saphenous vein (SSV) incompetence. Limbs were assessed with Duplex ultrasound by a practitioner other than the original surgeon and relevant patient data was recorded. RESULTS: In 68.5% of re-examined limbs Duplex imaging provided no evidence for recurrent varicose veins at the former SFJ or SPJ. This included 15 legs (= 6.1%) where reflux immediately proximal to the junction but originating from adjacent veins (i.e. pudendal vein, epigastrical vein) was detected. In 31.5%, reflux from the operated SFJ or SPJ (junctional recurrence) was detected but only a minor percentage of legs (6.9%) had actually developed a clinically relevant recurrent varicosity (> 3 mm in diameter) branching out from the former junction and requiring treatment. Patients with a BMI < 30 were less likely to suffer recurrent varicose veins (no recurrence in 72.7%) than patients with a BMI > or = 30 (no recurrence in 54.5%). CONCLUSIONS: 14 years after flush ligation of the SFJ or SPJ with stripping of the incompetent saphenous vein, junctional recurrences were found in less than one-third of re-examined extremities. In the absence of surgical errors, we must assume neovascularisation as cause for these recurrences. Duplex US determined a clinically relevant recurrence (> 3 mm in diameter) in only 7% of limbs. Post-operative varices seem to develop less often after SPJ surgery than after SFJ surgery and according to our data, obesity (BMI > or = 30) constitutes a significant risk factor.

Adult↗

PubMed1991

DNA ploidy of primary breast cancer and local recurrence after breast-conserving therapy.

The value of DNA-flow cytometry and clinico-pathological prognostic factors for the prediction of local recurrences after breast-conserving therapy (BCT) were evaluated in a retrospective study. Thirty-one patients with a local recurrence were compared with 31 matched patients without a local recurrence. Morphology and DNA-indices of the local recurrences and their corresponding primary tumours were compared. Ductal carcinoma in situ was present significantly more often in the group with a primary recurring tumour, than in the matched group (P less than 0.001), and the same holds for lobular carcinoma (n = 5). Half of the tumours that recurred had macroscopically positive surgical margins compared to about one-fourth of the matched group. Fifty-six per cent of the DNA-aneuploid stemlines in cases with local recurrence were present in the corresponding primary tumour as well (confidence limits 45%-75%), an indication that the majority of local recurrences are true recurrences and not independently developed tumours. The lack of similarity of DNA stemlines between some primary DNA-aneuploid tumours and their local recurrences indicates that these tumours had developed independently. The percentage of DNA-aneuploid cases in the group with local recurrence (89%) did not differ significantly from that in the matched group (70%). However, the findings suggest a selective recurrence of DNA-diploid stemlines. This might indicate increased resistance of DNA-diploid tumour cells to radiotherapy as compared with the resistance level in DNA-aneuploid cells.

Aneuploidy↗

PubMed2004

Gastric and intestinal phenotypic marker expression in gastric carcinomas and recurrence pattern after surgery-immunohistochemical analysis of 213 lesions.

Both gastric and intestinal phenotypic markers are known to be expressed in gastric carcinomas, irrespective of their histologic type. In the present study, the relation between gastric and intestinal phenotypic marker expression in gastric carcinomas and the recurrence pattern after surgery was examined. The phenotypic marker expression of the tumour was determined by examining the expression of human gastric mucin (HGM), MUC6, MUC2 and CD10 in 213 advanced gastric carcinomas in 213 patients who had undergone a curative resection (97 died from recurrent gastric carcinoma and 116 were alive without recurrence at the end of the follow-up period). Tumours were classified into gastric (G), gastric and intestinal mixed (GI), intestinal (I) or unclassified (UC) phenotypes according to the immunopositivity of HGM, MUC6, MUC2 and CD10 stainings. The incidence of HGM-positive tumours and MUC2-negative tumours was significantly higher in tumours with peritoneal recurrence than in tumours without recurrence (73.3%, 44 out of 60 cases vs 54.3%, 63 out of 116 (P=0.022); and 70.0%, 42 out of 60 vs 38.8%, 45 out of 116 (P=0.0002), respectively). The incidence of G-phenotype tumours was also significantly higher in tumours with peritoneal recurrence than in tumours without recurrence (58.3%, 35 out of 60 cases vs 28.4%, 33 out of 116 (P=0.0002)). The incidence of MUC2-negative tumours and CD10-positive tumours was significantly higher in tumours with haematogenous recurrence than in tumours without recurrence (62.5%, 20 out of 32 cases vs 38.8%, 45 out of 116 (P=0.028); and 43.8%, 14 out of 32 vs 23.3%, 27 out of 116 (P=0.039); respectively). Our present findings show that the gastric and intestinal phenotypic marker expression of the tumour, determined by immunohistochemical staining for HGM, MUC6, MUC2 and CD10, can be used to predict the pattern of gastric carcinoma recurrence after curative resection.

Aged↗