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PubMed2004

Endoscopic approach for the treatment of relapses in cystic craniopharyngiomas.

INTRODUCTION: Craniopharyngiomas are tumours of the central nervous system of dysontogenetic origin. They are most commonly localized in the sellar region and appear to originate from an embryogenetic defect of the Rathke cleft. It is universally accepted that radical surgery should be performed as first surgery because surgery after relapses usually causes more difficulty due to tighter adhesion to surrounding structures. It is essential when relapses occur to evaluate which technique to use for treatment. For this reason, any new approach is welcomed in order to have as many alternatives as possible. MATERIAL AND METHODS: In this paper we present the treatment, with a minimum follow-up of 4 years, of 5 paediatric patients affected by cystic craniopharyngiomas who went through first traditional surgery in other institutions and suffered relapses in various anatomical structures. One had a second successful endoscopic attempt at total gross resection. In 3 cases we endoscopically implanted a stent in the cystic cavity draining the cystic liquid out from the cystic cavity of the craniopharyngioma to the sphenoid sinus in order to form an accessory sinus. In 1 case a multiphase treatment has been undertaken. RESULTS: All patients treated using a transsphenoidal endoscopic approach are still living, without relapses and no postoperative complications. In particular, there where no episodes of vasospasm (a common complication reported in the literature when the "motor oil" comes into contact with the subarachnoid space) or infections. The patient treated using the multiphase approach recovered but suffered a recurrence 2 years later due to hypothalamic infiltration. DISCUSSION AND CONCLUSIONS: Craniopharyngioma relapse needs different treatments. Many alternative approaches have been reported but none of them is the first choice alternative. We believe endoscopic stent placement in the cystic cavity is an alternative method for the treatment of cystic relapses.

Adolescent↗

PubMed2005

Work factors as predictors of smoking relapse in nurses' aides.

OBJECTIVES: The prevalence of tobacco smoking in nurses' aides (assistant nurses) is high. Many smokers make attempts to stop smoking, but a large portion of these relapse after some period of time. The objective of this study was to identify work factors that predict smoking relapse in nurses' aides. METHODS: Of 1,373 Norwegian nurses' aides--who were former smokers, not current smokers, and not on leave when they completed a questionnaire in 1999--1,203 (87.6%) filled in a second questionnaire 15 months later. A wide spectrum of physical, psychological, social, and organisational work factors were assessed by validated questionnaires at baseline. Respondents who reported smoking at least one cigarette per day at the follow-up were considered having resumed daily smoking (relapse). RESULTS: Social climate in the work unit (index with 3 items: supportive, trustful, relaxed) and frequency of exposure to threats and violence were the only work factors that were associated with the occurrence of relapse after adjustments for background factors. In a logistic regression analysis, frequent exposure to threats and violence at work (odds ratio (OR)=2.08; 95% confidence interval (CI): 1.01-4.29), and the lowest quintile of the social climate index (OR=2.12; CI: 1.03-4.36) were associated with increased risk of smoking relapse, after adjustments for age, gender, marital status, and having preschool children. CONCLUSIONS: A poor social climate in the work unit and frequent exposure to threats and violence at work may be predictors of smoking relapse in nurses' aides. It is essential that leaders in the health services put more emphasis on creating a supportive, relaxed, and trustful social climate in the work unit. It is also important that protective measures against violent patients are implemented, and that occupational health officers offer victims of violence appropriate support or therapy.

Adult↗

PubMed2005

Altered activity of plasma hemopexin in patients with minimal change disease in relapse.

Since an active isoform of plasma hemopexin (Hx) has been proposed to be a potential effector molecule in minimal change disease (MCD), we tested plasma and urine samples from subjects with MCD in relapse (n = 18) or in remission (n = 23) (after treatment with prednisolone) for presence or activity of Hx. For comparison, plasma or urine from proteinuric subjects with focal and segmental glomerulosclerosis (FSGS, n = 11), membranoproliferative glomerulonephritis (MPGN, n = 9), IgA nephropathy (n = 5) or healthy control donors (n = 10), were incorporated into the study. Electrophoresis and Western blotting methods were used for evaluation of the Hx status, whereas protease activity of Hx was tested upon kidney tissue in vitro according to standard methods. The results show (1) a decreased mean titer of plasma Hx exclusively in MCD relapse subjects as compared with MCD in remission (0.21+/-0.14 mg/ml vs 0.44+/-0.06 mg/ml; p < 0.01). Mean Hx titers in other proteinuric subjects ranged from 0.38+/-0.05 mg/ml to 0.40+/- 0.06 mg/ml, whereas, the mean titer of healthy controls was 0.59+/-0.03 mg Hx/ml; (2) an increased Hx activity (expressed in arbitrary units) exclusively in plasma from MCD relapse subjects (3.3+/-0.72 vs 1.16+/-0.56, MCD remission; p < 0.01); (3) different Western blot patterns in MCD relapse vs remission plasma; (4) reduced stainability or virtual absence of the 80-kD Hx band in blots of urine from MCD relapse in contrast to urine samples from other proteinuric subjects with FSGS, MPGN, or IgA nephropathy. It is concluded that Hx in MCD relapse subjects may exist in an altered isoform, showing enhanced protease activity as compared with subjects in remission, subjects with other forms of primary glomerulopathy, or healthy control individuals.

Adolescent↗

PubMed2007

Does providing extended relapse prevention bibliotherapy to problem gamblers improve outcome?

Relapse rates among pathological gamblers are high with as many as 75% of gamblers returning to gambling shortly after a serious attempt to quit. The present study focused on providing a low cost, easy to access relapse prevention program to such individuals. Based on information collected in our ongoing study of the process of relapse, a series of relapse prevention booklets were developed and evaluated. Individuals who had recently quit gambling (N = 169) were recruited (through media announcements) and randomly assigned to a single mailing condition in which they received one booklet summarizing all of the relapse prevention information or a repeated mailing condition in which they received the summary booklet plus 7 additional booklets mailed to them at regular intervals over the course of a year period. Gambling involvement over the course of the 12-month follow-up period, confirmed by family or friends, was compared between the two groups. Results indicated that participants receiving the repeated mailings were more likely to meet their goal, but they did not differ from participants receiving the single mailing in frequency of gambling or extent of gambling losses. The results of this project suggest that providing extended relapse prevention bibliotherapy to problem gamblers does not improve outcome. However, providing the overview booklet may be a low cost, easy to access alternative for individuals who have quit gambling.

Adult↗

PubMed1982

Factors that predict relapse of calcium nephrolithiasis during treatment: a prospective study.

We evaluated 522 patients with idiopathic, recurrent calcium nephrolithiasis using a comprehensive clinical and laboratory protocol, and obtained additional laboratory measurements during their subsequent years of treatment in our program. In 57 patients, a new calcium stone ultimately formed during treatment (relapse), whereas 189 others have been free of recurrence during at least two years (average 4.3 +/- 2.2 [SD] years) of follow-up. Compared with the patients who remained stone-free, the patients with relapse (1) had a shorter interval between the time they entered our program and the time their last recurrent, pretreatment stone formed; (2) excreted more calcium *in mg/kg of body weight pr 24 hours) in their urine during treatment (2.79 +/- 1.08 versus 2.39 +/- 0.98 [SD] for relapse and stone-free); and (3) increased their urine volume less during treatment compared with pretreatment values (delta in liters per 24 hours was -0.02 +/- 0.48 versus 0.23 +/- 0.54 for relapse and stone-free). The two groups were otherwise the same. All comparisons used only data obtained prior to relapse. A discriminant function using only these three characteristics correctly identified 72 percent of patients with relapse and 67 percent of those who remained stone-free.

Allopurinol↗

PubMed1992

Sites of relapse in patients with neuroblastoma following bone marrow transplantation in relation to preparatory "debulking" treatments.

Forty-one patients with high-risk neuroblastoma were treated between September 1977 and December 1987 at the Children's Hospital of Philadelphia with supralethal chemotherapy and total-body irradiation rescued by bone marrow transplantation. Twenty-six patients were treated following relapse and 15 were newly diagnosed. At the time of evaluation, January 1991, 11 of 41 patients (26.8%) remained in complete remission. Actuarial survival rates of patients transplanted following relapse were 0.35 and 0.31 at 2 and 5 years, respectively, and actuarial disease-free survival rates were 0.38 at 12 months and 0.27 at 24 months. The 2- and 5-year actuarial survival values for the patients with newly diagnosed disease were 0.53 and 0.25, respectively, and the 12- and 24-month disease-free survival rates were 0.47 and 0.27, respectively. There was no significant difference in survival between these groups. Twenty-nine of the 41 patients reviewed were available for analysis of the effect of local treatment. Thirteen had a combination of surgery and radiation (RT), 2 had surgery alone, 9 had RT alone, and in 5 patients no local treatment was given. The local relapse rate was 17%; it was 15% following surgery plus RT and 22% following RT alone. The failure rate combining local and distant relapse is 62% for surgery plus RT and 44% for RT alone. Although a local relapse rate of 17% is imperfect, it is a relatively small contribution to the overall relapse of 62%.

Adrenal Gland Neoplasms↗

PubMed1981

Relapsing experimental allergic encephalomyelitis induced with isolated myelin and with myelin basic protein plus myelin lipids.

To test the ability of different spinal cord fractions to reproduce the clinicopathological features of relapsing experimental allergic encephalomyelitis (R-EAE), groups of young guinea pigs were inoculated with: (1) spinal cord myelin; (2) delipidated myelin; (3) reconstituted myelin and (4) MBP plus myelin lipids. The four sets of antigens induced acute EAE in most of the animals tested. During an observation period of 18 months, only one clinical relapse was observed in animals sensitized with myelin and with MBP plus myelin lipids. Extensive CNS demyelination was found in relapsing animals injected with myelin. No demyelinated lesions were observed in non-relapsing animals. By contrast, half of the surviving guinea pigs injected with MBP plus myelin lipids had demyelinated lesions, irrespective of whether they relapsed or not. The inability of the spinal cord myelin fractions to fully reproduce the R-EAE model suggest that other non-myelin antigens may be involved in the pathogenesis of multiple relapses.

Animals↗

PubMed1982

Bone marrow and extramedullary variations of cell membrane antigen expression in childhood lymphoid neoplasias at relapse.

To increase our knowledge of the pathogenesis of tumour recurrence, cell membrane phenotypes were determined on bone marrow and extramedullary tumour cells at diagnosis and at relapse in 24 children with lymphoid malignancies. There were 19 patients with acute lymphoblastic leukemia and five with non-Hodgkin's lymphoma. Membrane characteristics used for classification were E-rosetting, T antigen, surface immunoglobulin (sIg) and Ia antigen. Twelve patients were phenotyped as non-T, non-B, five as T-like and seven as B-like leukemia/lymphoma. Eighty-eight tissue samples were assayed for cell surface markers at the time of relapse(s). Lymphoblasts from 18 children (75%) demonstrated no variation in membrane marker expression. Six patients (25%) showed alteration of antigen expression on lymphoblasts obtained during relapses. This was manifested by loss of Ia antigen in two patients, loss of E-rosetting in one patient and loss of sIgD in one patient. Lymphoblasts from two patients, initially non-reactive with the four membrane markers utilized, expressed Ia antigen on subsequent relapses. Despite these variations no patient was categorized differently (i.e. T-like becoming non-T, non-B). Simultaneous lymphoblast phenotype determination from multiple body sites in 13 children showed no variation in marker analysis. A lymphoblast's phenotype remains stable throughout repeated relapses and is not influenced by relapse site in most children with lymphoid neoplasias. This information may be helpful in designing protocols where cytotoxic monoclonal antibodies are used as a treatment modality in patients with recurrent disease.

Antigens, Surface↗

PubMed1986

Sequential studies of lymphoblast glucocorticoid receptor levels at diagnosis and relapse in childhood leukemia: an update.

For 80 children with relapsed acute lymphoblastic leukemia, glucocorticoid receptor (GR) levels were lower in blast cells from patients who developed relapse while receiving chemotherapy (p = 0.03) and in those who failed reinduction treatment (p = 0.07). Serial determinations of GR at diagnosis and at relapse in blast cells from 41 patients disclosed various changes in receptor content, which were not related to the initial GR levels, the immunophenotype of blast cells or number of relapses. Six of 9 patients for whom reinduction therapy failed and only 7 of 32 patients in whom subsequent remission was induced had decreased GR levels at relapse (p = 0.018). One patient failed reinduction despite a sharp increase in GR level. Although a decrease in GR levels between diagnosis and relapse is associated with steroid resistance, other mechanism(s) can also be responsible for the development of steroid resistance in childhood leukemia.

Child↗

PubMed1986

A study of the prostaglandin and thromboxane content of the central nervous tissues with the development of chronic relapsing allergic encephalomyelitis.

Levels of PGE, PGF2 alpha, 6-oxo-PGF1 alpha and thromboxane (TXB2) in spinal cords and cerebellums of guinea pigs at different stages of chronic relapsing allergic encephalomyelitis (CREAE) were compared with those in Freund's adjuvant-treated, age-matched controls. PGE and TXB2 levels were found to be increased in spinal cords during acute and relapse phases of the disease. The number of lesions in the spinal cord was similarly increased in acute and relapse stages. There was, however, no similar correlation between number of lesions and eicosanoid levels in the cerebellum with the clinical stages of the disease based on hind limb paralysis. In the acute phase and remission lesion numbers were low, and high levels, similar to those found in the spinal cord, were only found in the relapse phase. Eicosanoid levels were high in the acute phase and remission, and generally low in relapse. The spinal cord levels of eicosanoids in remission and relapse correlated well with previous data obtained from the CSF of patients with multiple sclerosis.

6-Ketoprostaglandin F1 alpha↗

PubMed1995

Changes in antibodies to C1q predict renal relapses in systemic lupus erythematosus.

The presence of elevated plasma levels of autoantibodies against C1q, a subcomponent of the first component of complement in sera of patients with systemic lupus erythematosus (SLE) has been found to be associated with renal involvement. The purpose of this study was to determine whether increases in anti-C1q antibodies (anti-C1q) precede renal involvement in SLE. Forty-three SLE patients were studied longitudinally to determine the relationship between manifestations of the disease and levels of anti-C1q as well as to identify antibodies against double-stranded DNA (anti-dsDNA). Increased levels of anti-C1q were detected in all 14 of the patients who developed proliferative lupus nephritis out of 17 patients with renal relapses, which was significantly more frequent (P < 0.005) than in patients with nonrenal relapses (six of 16 patients) or with inactive disease (two of 10 patients). Increased anti-dsDNA levels were observed in 14 of 17 patients with renal relapses compared with 15 of 16 patients with nonrenal relapses and five of 10 patients with inactive disease. Significant increases in anti-C1q levels prior to the relapse occurred in 10 of 14 patients who developed proliferative nephritis and in three of 16 patients with nonrenal relapses. Significant increases in anti-dsDNA levels occurred in 11 patients of the former group and in nine patients of the latter group. No significant increases in anti-C1q or anti-dsDNA levels were observed in the patients with inactive disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Self-efficacy as a predictor of relapse following voluntary cessation of smoking.

In a retrospective study 92 subjects who had quit smoking voluntarily one year earlier were classified on the basis of self-report as abstainers or relapsers. Discriminant function analysis of 11 variables showed that a 14-item self-efficacy questionnaire total score was as successful in classifying the subjects as abstainers or relapsers as analyses involving all 11 variables or the best combination of them. In a prospective study 32 subjects were administered the same variables shortly after quitting smoking and before eventual status was known. Using weights derived from the retrospective study the self-efficacy total score predicted the status of all 15 subjects who had relapsed at a four month follow-up while the seven subjects it had predicted would not relapse were still abstaining. At an eight month follow-up the predictive power of the self-efficacy measure was maintained. At both follow-up points the self-efficacy measure proved superior to the other measures. These results suggest that the self-efficacy measure may be used to identify individuals at high risk for relapse after voluntarily quitting smoking; and may enable remedial measures to be applied prior to the decision to quit being taken which would reduce the probability of relapse.

Adult↗

PubMed1991

Social support and relapse: commonalities among alcoholics, opiate users, and cigarette smokers.

Links between social support and relapse were examined in a study of alcoholics, cigarette smokers, and opiate users completing treatment for drug use (N = 221). Subjects were followed weekly until relapse for a maximum of 12 weeks after the end of treatment. Structural and functional social support and support for abstinence and drug use were investigated. With demographic variables and drug-treatment group controlled, greater structural support (as measured by an index of social integration and by partner status) predicted a lower risk of relapse. Greater experienced partner support for abstinence also predicted lower risk. Social network members' use of the subject's problem drug predicted heightened relapse risk, but the effect was not statistically significant. This study contributes to a cross-drug model of relapse. It highlights the importance of social integration and abstinence-specific functional support in predicting the risk of relapse, independent of the particular drug of abuse.

Adult↗

PubMedDate not supplied

Abstinence effects as predictors of 28-day relapse in smokers.

The present analysis sought to determine the relationship between abstinence effects in 64 ex-smokers (mean age = 41.1 years) and the rate at which they relapsed over 4 weeks of biochemically confirmed follow-up. This analysis focused on six abstinence effects that play a central role in the DSM-III-R and DSM IV definitions of withdrawal from nicotine: anger, depression, craving, appetite, confusion, and tension. Significant increases were observed for all six symptoms following cessation, and, with the exception of craving, substantial intercorrelations among the abstinence effects were noted. Cox proportional hazards survival models identified increases in anger, depressed mood, and craving to be significantly associated with a shorter time to relapse (all p < .03). Stepwise Cox proportional hazards survival analysis identified increases in depressed mood and craving as the most significant combination of abstinence effects in relation to time to relapse. A more stringent test of the potency of the relationship between these abstinence effects and time to relapse was conducted in which two other risk factors in this sample, method of quitting and education level, were also included in the model testing sequence. Even after adjustment for these significant risk factors, the increase in craving remained a significant predictor of a higher rate of relapse. This result suggests a robustness to this particular abstinence effect as a determinant of the speed with which ex-smokers relapse over a 1-month interval after cessation.

Adult↗

PubMed1986

CNS relapse despite prophylactic cranial irradiation (PCI) in small cell lung cancer (SCLC).

CNS relapse after PCI may reflect either suboptimal radiation dose schedules or reseeding from other sites of active disease. A retrospective study has been undertaken to investigate these alternative mechanisms of treatment failure. Between August 1981 and December 1983, 30 patients with SCLC treated by induction chemotherapy, followed by high-dose cyclophosphamide (7 Gm/m2), were selected for PCI on the basis of clinical, radiological, and bronchoscopic CR. Pretreatment CT brain scans were normal in all patients, and 20 Gy mid-plane dose in 5 daily fractions were delivered by lateral fields to whole brain using megavoltage X rays and localizing check films. Progressive focal neurological signs of cranial metastases developed in 7/30 (23%) patients 3-11 months after PCI, confirmed on CT scanning in 4 patients. Relapse at other sites, predominantly the thorax, occurred in all seven patients at intervals of 1-6 months prior to CNS relapse. Published clinical data of tumor volume doubling times in SCLC predict longer CNS relapse-free intervals after PCI than those observed in our patients if reseeding was responsible for relapse. This suggests that incomplete eradication of intracranial disease is the main cause of CNS relapse after PCI. Higher equivalent radiation doses may improve the results of PCI.

Adult↗

PubMed1990

Squamous cell carcinoma of the supraglottic larynx without clinically detectable lymph node metastases: problem of local relapse and influence of overall treatment time.

From January 1965 until December 1979, 203 patients with squamous cell carcinoma of the supraglottic larynx were treated with curative intent. The mean follow-up time was 10 years. The policy was to try to aim for cure by radiation therapy (RT) only, reserving surgery (S) for radiation therapy failures. For 193 patients the treatment consisted of a first series of radiation therapy to a total dose of 40 Gy; if a good response to radiation therapy was obtained, the treatment was continued to a full course of 60-70 Gy (RT-I, n = 132). Patients with tumors considered to have responded poorly to the first series of radiation therapy but who refused surgery or were found medically unfit for operation, were also carried to a full dose of 60-70 Gy (RT-II, n = 33). Surgery was performed in 33 cases; 23 patients had a laryngectomy because of a poor response to radiation therapy and 10 were treated with surgery upfront because of severe respiratory distress. This paper focuses on the local control and survival in the defined treatment groups. In summary, with advancing T-stage a lower survival and higher local relapse rate was found; that is, a 5-year relapse-free survival (RFS) of 53% and corrected survival (CS) of 83% for T2 tumors vs 39% (RFS) and 52% (CS) for T4 tumors. Age more than 60 was associated with a 2.2 times higher risk of dying due to laryngeal cancer. A lower relapse-free survival (T3,4: 43% vs 61%) but a comparable corrected survival (T3,4: 64% vs 69%) for RT-I patients compared to the surgery treated patients was found, due to salvage of the radiation therapy failures. Although the relapse-free survival of RT-I and RT-II was similar (43% vs 38%), the corrected survival for the RT-II patients was worse (44% vs 69%). No influence of dose (Gy) per se on the local relapse rate was observed; however, a positive association between local relapse rate with overall treatment time was found. Death from intercurrent disease was almost twice as high as might have been expected for the normal Dutch population. More than half of the patients who died of intercurrent disease developed a second primary tumor.

Adult↗

PubMed1995

High-dose therapy and autologous bone marrow transplantation for Hodgkin's disease patients with relapses potentially treatable by radical radiation therapy.

PURPOSE: A retrospective review evaluated the results of autologous bone marrow transplantation (A-BMT) for patients with relapsed Hodgkin's disease (HD) who were potentially treatable by radical radiation therapy (RRT). METHODS AND MATERIALS: Evaluated patient cases met the following criteria: initial treatment with chemotherapy (with or without involved field radiation therapy < 25 Gy); no history of bone marrow or extensive lung involvement; no current or previous evidence of systemic metastases except liver; radiation therapy used with salvage chemotherapy for prior relapse would not preclude use of RRT (e.g., > 20 Gy to spinal cord); HD at time of salvage therapy limited to lymph nodes, Waldeyer's ring, liver, spleen, direct extension sites, and/or one lung. RESULTS: There were 23 A-BMT patients treated between 1986 and 1991 who fulfilled the criteria. Three (13%) patients died from treatment-related complications and eight (35%) developed nonfatal Grade 3-4 complications. The 3-year actuarial disease-free survival rate was 61%. The 3-year disease-free survival rate was 55% for the nine patients with at least one prior disease-free interval (DFI) > 12 months, 67% for nine patients with DFI < 12 months, and 60% for five induction failure patients (p > 0.10). These results are comparable to retrospective studies of RRT results in selected relapsed HD patients. CONCLUSIONS: Long-term disease-free survival is frequently possible with either A-BMT or RRT in appropriately selected relapsed HD patients. In considering treatment options, important prognostic factors include initial stage of disease, number of prior relapses, DFI, and extent of relapsed disease.

Adolescent↗

PubMed1981

Post-treatment depressive symptoms and relapse to drug use in different age groups of an alcohol and other drug abuse population.

The prevalence of relapse to alcohol or other drug use and prevalence and severity of depressive symptoms were measured cross-sectionally in different age groups of alcohol and drug abusers at one, six, and twelve months post-discharge. Relapse rates increased over time since discharge for all age groups (17 - 29, 30 - 39, 40 - 49, and 50+ years). However, no differential effect of age was found on relapse rates at each of the three post-discharge intervals. Rates of depressive symptoms increased over time since discharge only for the youngest age group. Mean depressive symptom scores increased over time since discharge only for the 17 - 29 and 50+ age groups. There were significant differences between age groups in rates of depressive symptoms at six and twelve months post-discharge and on mean depressive symptom scores at one, six and twelve months post-discharge and on mean depressive symptom scores at one, six and twelve months post-discharge. In addition, for abstinent and for relapsed subjects, there were significant differences between age groups in rates of depressive symptoms and mean depressive symptom scores. Higher rates of depressive symptoms were found in relapsed than abstinent subjects at the younger ages (17 - 29 and 30 - 39 years), with mean depressive symptom scores being higher for relapsed than abstinent subjects in all age groups.

Adolescent↗