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At least 109 records · Page 6Linked to original sources
PubMed2006

Long-term outcome following mucosal advancement flap for high perianal fistulas and fistulotomy for low perianal fistulas: recurrent perianal fistulas: failure of treatment or recurrent patient disease?

BACKGROUND: In this study, we determined the long-term outcome of perianal fistulas treated with mucosal advancement flap (MF) or fistulotomy (FT). METHODS: One hundred three patients with perianal fistulas were treated by MF for high fistulas or FT for low fistulas and were retrospectively assessed by case-note review and examined at the out-patient clinic. The localization and time of recurrence of the fistula were recorded. RESULTS: Forty-one patients [median follow-up of 72 months (range 48-99)] were treated by an MF, and 62 patients [median follow up of 75 months (range 48-99)] were treated by FT. After 12, 48, and 72 months, the fistula had recurred in 9 (22%), 26 (63%), and 26 (63%) patients of the MF group and in 4 (7%), 16 (26%), and 24 (39%) patients of the FT group, respectively. Eighteen (69%) of the recurrences in the MF group and ten (33%) of the FT group occurred within 24 months after surgery (p=0.01). Four (15%) of the recurrences in the MF group and 13 (54%) of the recurrences in the FT group were present in a different localization (p=0.007). CONCLUSION: The success rate of both FT and MF techniques decreases with time. Recurrence appears to be caused by failure of treatment and by recurrent patient disease.

Adult↗
PubMed2006

Recurrent gestational trophoblastic tumor: management and risk factors for recurrence.

OBJECTIVE: To analyze retrospectively the management of recurrent gestational trophoblastic tumor (GTT) patients and evaluate the recurrence associated risk factors. METHOD: 901 gestational trophoblastic tumor (GTT) patients who received treatment at Peking Union Medical College Hospital from January 1985 to January 2004 achieved complete remission (CR). Among them, thirty-one (31/901) relapsed later. Retrospective analyses were carried out on the 31 patients, and multiple regression models were used to identify the risk factors for recurrence. RESULTS: In all 31 patients, recurrences occurred 6 to 72 months (15.3 months on average) after completing treatment. Of the 25 patients who received treatment again in our hospital, 21 achieved CR, 3 achieved partial remission (PR), and 1 died of progression of disease (PD). Among the 21 CR patients, 4 relapsed repeatedly. The four recurrence associated risk factors identified by multivariate analysis were clinical stage (P<0.05), an interval of more than 12 months between the end of antecedent pregnancy and the start of chemotherapy (odds ratio=3.170, P<0.05), a negative blood beta-hCG titer after seven courses of chemotherapy (odds ratio=4.475, P<0.05), and a less than two courses of consolidation chemotherapy (odds ratio=0.441, P<0.05). CONCLUSION: More attention should be given to GTT patients with recurrence associated risk factors. Combination therapy for GTT treatment is effective. In the study, it was demonstrated that certain risk factors were associated with relapse. These factors may need to be integrated into treatment algorithms.

Adult↗
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↗
PubMed2006

Life stress and the long-term treatment course of recurrent depression: III. Nonsevere life events predict recurrence for medicated patients over 3 years.

Research has consistently documented the significance of severe life events for onset of major depression. Theory, however, suggests other forms of stress are relevant for depression's recurrence. Nonsevere life events were tested in relation to depression for 126 patients with recurrent depression in a 3-year randomized maintenance protocol. Life stress was assessed every 12 weeks and rated along dimensions of severity, focus, and independence. A significant interaction between specific types of nonsevere life events and medication was found. For medicated patients, subject-focused independent nonsevere life events predicted recurrence; for unmedicated patients, these events predicted fewer recurrences. Other nonsevere life events did not predict recurrence. The findings underscore the potential importance of specific stressors for triggering recurrences of depression.

Adult↗
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↗
PubMedDate not supplied

Effect of vaccination against leptospirosis on the frequency, days to recurrence and progression of disease in horses with equine recurrent uveitis.

OBJECTIVE: To evaluate the effect of vaccination against leptospirosis on frequency and days to recurrence of uveitis and progression of disease in horses with equine recurrent uveitis (ERU). ANIMALS: Forty-one horses with ERU. PROCEDURE: Horses were randomly assigned to experimental (vaccinated) or control groups. Vaccine containing six serovars of Leptospira or placebo was administered, an ophthalmic examination performed and blood samples drawn on days 0, 28, 180 and 365. Antibody titers were measured against each serovar. Recurrence of uveitis was verified by ophthalmic examination. Results of the initial and final ophthalmic examinations were compared and progression of disease defined as an increase in extent of synechiae, or development of new or progression of an existing cataract. RESULTS: Vaccination increased the average geometric mean serum antibody titer from 225 on day 0, to 4077 and 593 on days 28 and 180, respectively. After the second vaccination, days to first recurrence was significantly longer (median 126 days; range 24-231 days) when compared with controls (median 86 days; range 14-192 days, P=0.04). Recurrence of ERU was observed among 7/20 (35%) vaccinated horses and 12/21 (57%) controls; however, this difference was not statistically significant (P=0.061, OR 0.25, 95% CI 0.06, 1.07). More horses in the experimental group 13/20 (65%) experienced progression of disease when compared with controls 12/21(57%); however, this difference was statistically nonsignificant (P=0.35). CONCLUSIONS: Vaccine significantly increased days to recurrence, but failed to slow the progression of disease. These data do not support the use of vaccination against leptospirosis as adjunct therapy for the routine treatment of horses with ERU.

Animals↗
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↗
PubMed2006

Abdominal sacral resection for posterior pelvic recurrence of rectal carcinoma: analyses of prognostic factors and recurrence patterns.

BACKGROUND: Local recurrence of rectal cancer presents challenging problems. Although abdominal sacral resection (ASR) provides pain control, survival prolongation, and possibly cure, reported morbidity and mortality are still high, and survival is still low. Thus, appropriate patient selection and adjuvant therapy based on prognostic factors and recurrence patterns are necessary. The purpose of this study was to evaluate the results of ASR for posterior pelvic recurrence of rectal carcinoma and to analyze prognostic factors and recurrence patterns. METHODS: Forty-four patients underwent ASR for curative intent in 40 and palliative intent in 4 cases. All but one could be followed up completely. Multivariate analyses of factors influencing survival and positive surgical margins were conducted. RESULTS: Morbidity and mortality were 61% and 2%, respectively. Overall 5-year survival was 34%. The Cox regression model revealed a positive resection margin (hazard ratio, 10 [95% confidence interval, 3.8-28]), a local disease-free interval of <12 months (4.2 [1.8-9.8]), and pain radiating to the buttock or further (4.2 [1.6-11]) to be independently associated with poor survival. The logistic regression model showed that macroscopic multiple expanding or diffuse infiltrating growths were independently associated with a positive margin (7.5 [1.4-40]). Of the patients with recurrence, 56% had failures confined locally or to the lung. CONCLUSIONS: ASR is beneficial to selected patients in terms of survival. To select patients, evaluation of the resection margin, the local disease-free interval, pain extent, and macroscopic growth pattern is important. To improve survival, adjuvant treatment should be aimed at local and lung recurrences.

Adult↗
PubMed2003

The risk of recurrent venous thromboembolism: the Austrian Study on Recurrent Venous Thromboembolism.

Venous thromboembolism (VTE) is a chronic disease. After withdrawal of oral anticoagulation at least a third of patients will experience a subsequent episode of venous thrombosis. Of these patients, approximately 5% will die from pulmonary embolism. The Austrian Study on Recurrent Venous Thromboembolism (AUREC) is a prospective cohort study aiming to investigate the overall rate of recurrent VTE, the predictive value of laboratory assays, the importance of acquired or congenital risk factors for thrombosis and the impact of extended or modified secondary thromboprophylaxis on the risk of recurrence among high-risk patients. So far, the AUREC investigators have identified subgroups of patients with a particular high risk of recurrence: patients with a history of venous thrombosis, elevated levels of coagulation factors VIII, IX and XI, pulmonary embolism or superficial venous thrombosis and a history of venous thrombosis and hyperhomocysteinemia. Patients with a history of venous thrombosis and mutations in genes encoding for coagulation factors (factor V Leiden, factor II, G20210A) do not have an enhanced risk of recurrence and, thus, do not qualify for extended secondary thromboprophylaxis. At present, interventional trials are in progress in patients with high factor VIII or hyperhomocysteinemia in order to investigate if these patient groups might benefit from extended oral anticoagulation or vitamin supplementation, respectively.

Adolescent↗
PubMed2004

Differences in recurrent COL7A1 mutations in dystrophic epidermolysis bullosa: ethnic-specific and worldwide recurrent mutations.

Dystrophic epidermolysis bullosa (DEB) is caused by mutations in the gene encoding type VII collagen (COL7A1). Although most COL7A1 mutations are unique to individual families, small numbers of mutations are recurrent. The recurrent mutations R578X, 7786delG, and R2814X seem to be exclusive to a specific ethnic group, the British population. The mutations 5818delC, 6573+1G-->C, and E2857X are present only in individuals of Japanese ethnic origin. On the other hand, the mutations 425A-->G and G2043R have been found in several different ethnic groups. The purpose of this study was to clarify whether these recurrent mutations are also found in patients of other ethnic groups with DEB, mainly Asian patients. We demonstrated the absence of the recurrent mutations R578X, 7786delG, and R2814X in 42 non-British patients with DEB and detected the mutations 425A-->G in a French patient and G2043R in Japanese and Chinese patients with DEB. The mutations 5818delC, 6573+1G-->C, and E2857X were detected in 11 Japanese patients (13 alleles) with DEB. Our results confirm that R578X, 7786delG, and R2814X mutations are specifically limited to British patients, and the mutations 5818delC, 6573+1G-->C, and E2857X are frequent in Japanese patients. On the other hand, the mutations 425A-->G and G2043R can be found in different ethnic groups. In conclusion, our results further support the notion that recurrent mutations can be classified into two types, ethnic-specific mutation and worldwide mutation.

Alanine↗
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↗
PubMed2003

Frequency of recurrence among infants with supraventricular tachycardia and comparison of recurrence rates among those with and without preexcitation and among those with and without response to digoxin and/or propranolol therapy.

Approximately 60% of children with supraventricular tachycardia (SVT) develop their initial episode by 1 year of age. Despite resolution in most of these patients by 1 year, approximately 30% of the SVT will recur. We performed a retrospective review of all patients <1 year of age with SVT between January 1984 and December 2000. Recurrence was defined as documented SVT at >1 year of age. Patients were divided into: (1) a first line (FL) group (controlled with digoxin and/or propranolol) and (2) a second line (SL) group (requiring additional antiarrhythmics). The groups were divided based on the presence of preexcitation. The FL group included 116 patients, 20 of whom (17%) had Wolff-Parkinson-White (WPW) syndrome. The SL group included 34 patients, 21 of whom (62%) had WPW (p <0.001). Recurrence of SVT occurred in 32 patients (28%) in the FL group and in 23 patients (68%) in the SL group (p <0.001). SVT recurred in 36 of 41 patients (88%) with WPW compared with 19 of 109 patients (17%) without WPW syndrome (p <0.001). Logistic regression analysis demonstrated that the presence of WPW syndrome was associated with a 29-fold higher odds of SVT recurrence (p <0.001), and that patients with WPW syndrome were more likely to require additional antiarrhythmic therapy (p <0.001). Thus, patients with WPW syndrome who had SVT at <1 year of age have 29-fold higher odds of recurrence at >1 year of age versus those patients with preexcitation. These patients are also more likely to require additional antiarrhythmic therapy to control SVT. Furthermore, children with WPW syndrome who are refractory to treatment with digoxin and/or propranolol are at increased risk of SVT recurrence.

Age of Onset↗