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Results for “Recurrence”

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At least 145 records · Page 8Linked to original sources

PubMed2001

Application of a topical immune response modifier, resiquimod gel, to modify the recurrence rate of recurrent genital herpes: a pilot study.

Resiquimod (R-848), a topically active immune response modifier, induced production of interferon-alpha and interleukin-12 in cultured blood mononuclear cells and decreased genital herpes recurrences in an animal model. In this study, 52 patients with frequently recurrent genital herpes applied topical resiquimod gel 0.01% (twice or thrice weekly) or 0.05% (once or twice weekly) or vehicle gel to herpes lesions for 3 weeks. During the 6-month observation period after treatment, median days to first recurrence in the pooled resiquimod group was 169 days, compared with 57 days for the vehicle group (P=.0058). In all, 32% of resiquimod-treated patients completed the observation period without a recurrence, compared with 6% of vehicle-treated patients (P=.039). Resiquimod 0.05% twice weekly produced dose-limiting inflammation at the lesion sites, but the other regimens were well tolerated. Application of resiquimod to genital herpes lesions appeared to reduce the frequency of recurrences.

Adult↗

PubMed2006

Role of azathioprine in preventing recurrences in a patient of recurrent erythema nodosum leprosum.

The pathogenesis of erythema nodosum leprosum (ENL) involves both immune complex deposition and dysfunction of cell mediated immunity. Tumour necrosis factor-alpha (TNF-alpha) plays an important role in its pathogenesis. Thalidomide and corticosteroids are the mainstay of treatment for ENL. However, there are often severe limitations to their use. We report a case of recurrent ENL treated successfully with azathioprine. A 15-year-old unmarried girl with lepromatous leprosy had recurrent ENL for 2 years. She was treated with WHO-MB MDT and prednisolone in doses of 40-90 mg a day for 2-12 weeks. Her condition was inadequately controlled. The patient was therefore treated with thalidomide 300 mg and prednisolone 40 mg. The symptoms subsided after 5 days and ENL lesions healed in 2 weeks. Prednisolone was reduced by 10 mg per week and stopped, while thalidomide was reduced to 100 twice daily after 4 weeks. Azathioprine 100 mg (2 mg/kg per day) daily orally was added to prevent recurrences. Thalidomide was further reduced and stopped after another 4 weeks while she continued with azathioprine in the same doses for 8 months. There was no recurrence of ENL lesions and no side effects of the therapy. MB-MDT was stopped 1 year ago, and she is on follow-up without any relapse. Azathioprine, therefore, appears to be an effective and safe drug to prevent recurrences of ENL.

Administration, Oral↗

PubMed2000

[Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis].

BACKGROUND: Frequently numerous recurrent laryngeal nerve injuries occur after operations on the thyroid glands. Compared with postoperative permanent hypocalcemia, unilateral and especially double-side recurrent paresis pose serious complication. As early as 1938 specialists [1] pleaded for a routine visualisation of the nervus recurrens in operations of the thyroid gland, to reduce the risk of permanently recurring paresis. In controversial discussions of the matter specialists have opted for a demonstration of the nerve also under medico-legal aspects. Implementing functionally-critical operational strategies requires the choice of an anatomically suitable operative procedure for the removal of morphological, functional and oncological changes, as well as the avoidance of complications. METHOD: Intra-operative Monitoring is highly recommendable as a neurophysiological method of supervision combined with microdissection to ensure the safe handling of recurrent laryngeal nerve. CONCLUSION: The rate of permanent paresis on the recurrent nerve can be lowered to less than 1 per cent when this is used as a routine procedure for all operations and the treatment of the thyroid gland diseases.

Electric Stimulation↗

PubMedDate not supplied

Evaluation and treatment of recurrent spasticity after recurrent laryngeal nerve section. A preliminary report.

Of 365 spastic dysphonia patients treated by recurrent laryngeal nerve (RLN) section to date, 44 (12%) have experienced recurrence of the spastic dysphonia. Most of these 44 patients had moderately severe to very severe spastic dysphonia before the RLN section was performed. We believe, therefore, that preoperative severity is an important predictor of the likelihood of recurrence. Twenty-eight patients with recurrent spastic dysphonia following RLN section were further treated by one or more carbon dioxide laser thinnings of the paralyzed vocal fold. Following this procedure, 23 patients (50%) achieved eradication of spasticity, while a mild degree of spasticity remained in 17 (39%). These findings lead us to conclude that even though spastic dysphonia may recur following RLN section, a viable secondary surgical procedure is available.

Humans↗

PubMed2002

Hormone replacement therapy after a diagnosis of breast cancer: cancer recurrence and mortality.

OBJECTIVE: To determine whether hormone replacement therapy (HRT) after treatment for breast cancer is associated with increased risk of recurrence and mortality. DESIGN: Retrospective observational study. PARTICIPANTS AND SETTING: Postmenopausal women diagnosed with breast cancer and treated by five Sydney doctors between 1964 and 1999. OUTCOME MEASURES: Times from diagnosis to cancer recurrence or new breast cancer, to death from all causes and to death from primary tumour were compared between women who used HRT for menopausal symptoms after diagnosis and those who did not. Relative risks (RRs) were determined from Cox regression analyses, adjusted for patient and tumour characteristics. RESULTS: 1122 women were followed up for 0-36 years (median, 6.08 years); 154 were lost to follow-up. 286 women used HRT for menopausal symptoms for up to 26 years (median, 1.75 years). Compared with non-users, HRT users had reduced risk of cancer recurrence (adjusted relative risk [RR], 0.62; 95% CI, 0.43-0.87), all-cause mortality (RR, 0.34; 95% CI, 0.19-0.59) and death from primary tumour (RR, 0.40; 95% CI, 0.22-0.72). Continuous combined HRT was associated with a reduced risk of death from primary tumour (RR, 0.32; 95% CI, 0.12-0.88) and all-cause mortality (RR, 0.27; 95% CI, 0.10-0.73). CONCLUSION: HRT use for menopausal symptoms by women treated for primary invasive breast cancer is not associated with an increased risk of breast cancer recurrence or shortened life expectancy.

Breast Neoplasms↗

PubMed1997

Fear of cancer recurrence--a literature review and proposed cognitive formulation to explain exacerbation of recurrence fears.

Modern treatments for cancer are resulting in cancer patients living longer with the risk of the disease returning at a later stage. Many patients who experience a recurrence blame themselves (Mahon et al., 1990), while those in remission live with the constant fear that the cancer may return. Although fear of recurrence is recognised in the literature, few researchers have focused on this aspect as a precursor to psychological distress. This paper reviews the literature about fear of recurrence and its measurement. Leventhal's Self Regulation Model of Illness is presented to help understand patients' reactions to cancer and fears for the future. The authors propose a formulation for fear of recurrence and examples of interventions that are indicated.

Adaptation, Psychological↗

PubMed2000

Anticoagulants for preventing recurrence following ischaemic stroke or transient ischaemic attack.

BACKGROUND: After a first stroke, further vascular events (especially myocardial infarction and recurrent stroke) are common and often fatal. OBJECTIVES: The objective of this review was to assess the effect of prolonged anticoagulant therapy following presumed non-embolic ischaemic stroke or transient ischaemic attack. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register. We contacted companies marketing anticoagulant agents. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing anticoagulant therapy, for at least one month, with control in people with previous non-embolic presumed ischaemic stroke or transient ischaemic attack. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS: Nine trials involving 1214 patients were included. The quality of all trials was poor. All pre-dated routine computerised tomography scanning and use of the International Normalised Ratio to monitor anticoagulation. Anticoagulant therapy did not significantly reduce the odds of death or dependency (two trials, odds ratio 0.83, 95% confidence interval 0.52 to 1.34). Death from any cause (odds ratio 0.95, 95% confidence interval 0.72 to 1.23), and death from vascular causes (odds ratio 0.86, 95% confidence interval 0.66 to 1.13) were not significantly different between treatment and control across all nine trials. Anticoagulant therapy did not reduce the risk of recurrent stroke (odds ratio 0.79, 95% confidence interval 0.56 to 1.13). However, fatal intracranial haemorrhage increased (odds ratio 2.54, 95% confidence interval 1.19 to 5.45), as did major extracranial haemorrhage (odds ratio 4.87, 95% confidence interval 2.50 to 9.49). This means anticoagulant therapy caused 11 additional fatal intracranial haemorrhages and 25 additional major extracranial haemorrhages per year for every 1000 patients given anticoagulant therapy. REVIEWER'S CONCLUSIONS: There appears to be no clear benefit from long-term anticoagulant therapy in people with non-embolic presumed ischaemic stroke or transient ischaemic attack. There appears to be a significant bleeding risk associated with anticoagulant therapy.

Anticoagulants↗

PubMed1995

Prognosis following locally recurrent soft-tissue sarcoma. A staging system based on primary and recurrent tumour characteristics.

We have shown that the clinical growth rate of local recurrence from soft-tissue sarcoma could be expressed as a growth-rate index (GRI) which was predictive for metastasis, and which was able to identify 2 equal populations of good (80% 2-year MFS) and poor survivors (33%). We now report the associations between characteristics of the primary and GRI, and combine primary and locally recurrent tumour characteristics in a staging system. We studied 460 adult patients with soft-tissue sarcomas of the extremities and trunk wall who were diagnosed and treated between 1964 and 1990, of whom 134 developed local recurrences and 151 metastases. The association of primary tumour size, histologic malignancy grade, depth, spontaneous necrosis, intratumoral vascular invasion and S-phase fraction with local recurrence, GRI and metastasis were examined. High GRI was associated with primary tumours that were larger, deeper, more malignant, underwent spontaneous tumour necrosis, demonstrated intravascular invasion and had a higher S-phase fraction. The same factors were also strongly associated with the incidence of metastasis. A multivariate analysis found GRI and primary tumour necrosis to be the strongest and most significant prognostic factors. GRI and tumour necrosis were combined in a staging system that identified groups with good survival (79 to 94% 2-year MFS), intermediate survival (61% 2-year MFS) and exceptionally poor survival (6% 2-year MFS). These findings validate our earlier assertion that high GRI reflects highly malignant tumours. A staging system composed of primary tumour necrosis and GRI can identify patients who may be suitable candidates for trials of adjuvant chemotherapy.

Adolescent↗

PubMed2005

[Recurrent disease in renal cell carcinoma. "Local recurrence" after kidney-sparing and radical resection].

Locally recurrent renal cell carcinoma (RCC) is 0-10% after nephron-sparing surgery, 2.5-4% after thermoablative interventions and 2-3% after (radical) nephrectomy. Risk-factors are: sporadic or hereditary origin, tumor size, multifocality, histologic phenotype and incomplete resection. To date, there are no significant differences in the incidence of locally recurrent tumors independently of whether open or laparoscopic techniques were preferred. Caution still has to be taken with the use of alternative tools for minimally invasive tumor ablation.Finally, no statistically proven standard therapy exists that would clearly provide a superior outcome for patients with an isolated local recurrence. However, meta-analyses strongly support the performance of a resection of the recurrence as the primary working principal.

Carcinoma, Renal Cell↗

PubMed1986

Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: summary results of the recurrent coronary prevention project.

One thousand thirteen post myocardial infarction patients were observed for 4.5 years to determine whether their type A (coronary-prone) behavior could be altered and the effect such alteration might have on the subsequent cardiac morbidity and mortality rates of these individuals. Eight hundred sixty-two of these individuals were randomly assigned either to a control section of 270 participants who received group cardiac counseling or an experimental section of 592 participants who received both group cardiac counseling and type A behavioral counseling. The remaining 151 patients, serving as a "comparison group," did not receive group counseling of any kind. Using the "Intention-to-Treat" principle, we observed markedly reduced type A behavior at the end of 4.5 years in 35.1% of participants given cardiac and type A behavior counseling compared with 9.8% of participants given only cardiac counseling. The cumulative 4.5-year cardiac recurrence rate was 12.9% in the 592 participants in the experimental group that received type A counseling. This recurrence rate was significantly less (p less than 0.005) than either the recurrence rate (21.2%) observed in the 270 participants in the control group or the recurrence rate (28.2%) in those of the comparison group not receiving any special treatment. After the first year, a significant difference in number of cardiac deaths between the experimental and control participants was observed during the remaining 3.5 years of the study. Overall, the results of this study demonstrate for the first time, within a controlled experimental design, that altering type A behavior reduces cardiac morbidity and mortality in post infarction patients.

Behavior Therapy↗

PubMed1982

Recurrent genital herpes simplex virus infection in pregnancy: infant outcome and frequency of asymptomatic recurrences.

Eighty pregnant patients with a history of recurrent genital herpes simplex virus (HSV) infection were followed up with frequent genital examinations and cultures for HSV during their pregnancies. Recurrences of genital HSV during pregnancy were documented in 67 patients. Ninety-six percent of these had external genital lesions noted at some time during their pregnancy. One hundred eighty-six (93%) of the 199 recurrences of the disease were associated with external genital lesions. Of 13 episodes of asymptomatic viral shedding documented in this patient population, six were from the vulva alone, five were from the cervix alone, and two were from both the vulva and the cervix. Of 11 episodes of cervical HSV shedding, seven were asymptomatic and four were associated with external symptomatic lesions. Despite frequent recurrences of genital HSV infection during pregnancy, all study patients were delivered at term, and although they had a high rate of delivery by cesarean section (32.5%), the outcome of their infants was good.

Adolescent↗

PubMed1986

Psychological factors in recurrent genital herpes infection: stress, coping style, social support, emotional dysfunction, and symptom recurrence.

The relationship among stress, coping style, emotional dysfunction, social support, and severity of symptoms (frequency of recurrence, and pain, duration, and bother of recurrences) was investigated in 35 females and 32 males suffering from severe cases of genital herpes infection. Level of emotional dysfunction as measured by the SCL-90 approached two standard deviations above the mean as compared with non-patient normals, and frequency, pain, and bother of recurrences were associated with level of emotional dysfunction. Negative life stress (as measured by the Life Experiences Survey) was unrelated to psychopathology, and was associated only with duration among the symptom measures. Regression analyses indicated that higher frequencies of recurrence and greater discomfort associated with symptoms were associated with an external locus of control orientation and with a tendency to use emotion-focused wishful thinking and to avoid using cognitive strategies to cope with the stress associated with herpes. It was suggested that stress management procedures involving teaching of problem-focused coping strategies and provision of social support would be most effective for this population.

Adaptation, Psychological↗

PubMed2007

Recurrent endometrial cancer: patterns of recurrent disease and assessment of prognosis.

AIM: To evaluate patterns of disease and identify factors predicting outcome in patients presenting with recurrent endometrial adenocarcinoma following primary surgery. MATERIALS AND METHODS: A retrospective review was performed of the imaging and clinical data in 86 patients (median age 66 years, range 42-88 years) presenting with recurrent endometrial adenocarcinoma following primary surgery. RESULTS: Following primary surgery recurrent disease occurred within 2 years in 64% and within 3 years in 87%. Relapse was seen within lymph nodes in 41 (46%), the vagina in 36 (42%) the peritoneum in 24 (28%) and the lung in 21 (24%). Unusual sites of disease included spleen, pancreas, rectum, muscle and brain. Univariate survival analysis showed the factors significant for poor outcome were: multiple sites of disease, liver and splenic disease, haematogenous, peritoneal and nodal spread, poorly differentiated tumour, and early relapse. The presence of disease within the vagina, bladder or lung was not associated with poor prognosis. Multivariate analysis identified multiple sites of disease, liver and splenic metastases to be independent predictors of poor outcome. CONCLUSION: The most frequently observed sites of relapse are: lymph nodes, vagina, peritoneum and lung. Significant predictors of poor outcome in recurrent disease are multiple sites of disease and liver and splenic metastases.

Adenocarcinoma↗

PubMed2006

Fear of recurrence and beliefs about preventing recurrence in persons who have suffered a stroke.

OBJECTIVES: The aim of this study was to investigate fear of recurrent stroke and beliefs about its causes and prevention. METHODS: Eighty-nine patients participated 1 month following stroke and 81 were followed up at 9 months. Interviews addressed fears and beliefs about stroke, causes, recurrence and prevention by using closed and open-ended questions. Responses were subject to quantitative and qualitative analysis, respectively. RESULTS: Fear of recurrence was common. Profound disability was a particularly feared outcome. Participants were knowledgeable about causes. However, causal controllability ratings were low. Some reported concern about preventative strategies (e.g., difficulty stopping smoking). Many reported idiosyncratic beliefs (e.g., avoiding overexertion) or fatalistic ideas about strokes (e.g., 'nothing' can prevent them). Similar quantitative results were obtained at follow-up. CONCLUSIONS: Many patients fear stroke recurrence. They lack a sense of control over causes and have fears associated with idiosyncratic and fatalistic beliefs. There is a need to elicit and address individuals' own fears and beliefs about stroke before providing evidence-based secondary prevention recommendations.

Adult↗

PubMed1996

Life stress and treatment course of recurrent depression: II. Postrecovery associations with attrition, symptom course, and recurrence over 3 years.

Life stress was studied in relation to postrecovery attrition, symptom course, and recurrence of depression over 3 years. Participants were 67 individuals with recurrent depression who had responded to treatment. Life stress was assessed for the prior 12 weeks at acute treatment entry (T1), initial recovery (T2), and after 17 weeks of sustained recovery (T3). Severe life events at T1 predicted greater attrition, a more favorable postrecovery symptom course, and a lower likelihood of recurrence over 3 years. Life stress at T2 was not predictive of outcomes. Finally, undesirable life events at T3 tended to predict a worse symptom course and a higher likelihood of recurrence, particularly for individuals on medication. The findings are discussed in terms of (a) different processes influenced by life stress over time and (b) limitations of existing longitudinal research for studying the effects of life stress over prolonged intervals.

Adult↗

PubMed1990

Prognostic factors in recurrent breast cancer: relationships to site of recurrence, disease-free interval, female sex steroid receptors, ploidy and histological malignancy grading.

Site of first recurrence, disease-free interval (DFI), female sex steroid receptors, ploidy measurements as well as histological grading have been analysed as potentially valuable predictive factors in 313 cases of recurrent breast cancer. Univariate and multivariate analyses show histological grading, site of recurrence and disease free interval to be useful prognostic variables when assessing prognosis once disease has recurred. High concentrations of oestrogen receptors (ER) were found in patients with bone metastases, whereas lower concentrations of ER were related to visceral recurrences. Ploidy measurements failed in this study to give any predictive information once disease recurred.

Breast Neoplasms↗

PubMed2001

Recurrent peritoneal mesothelioma with long-delayed recurrence.

Peritoneal mesothelioma is a rare malignancy with a poor prognosis. Etiology is unclear and presentation of this disease is often atypical. There are very few cases of long-term survival in patients with peritoneal mesothelioma. We report the case of a patient with peritoneal mesothelioma of 19 years' duration. To the best of our knowledge, there have been no reports of recurrent peritoneal mesothelioma with such long-delayed recurrence and survival. Recurrent peritoneal mesothelioma in the current patient was confirmed by comparing the biopsies of omentum taken in 1979 with that taken in 1997. An extensive literature search was undertaken to look for previous reports of recurrent peritoneal mesothelioma. Aggressive and intensive chemotherapy appeared to provide a longer survival time. Our patient had paraneoplastic manifestations that included paraneoplastic hepatopathy and a wasting syndrome. Peritoneal mesothelioma is a rare malignancy with one to two cases per million in the United States. It is known to exhibit unusual paraneoplastic manifestations, including paraneoplastic hepatopathy. Treatment is often unsuccessful, with a median survival time of approximately 18 months from diagnosis. A better understanding and aggressive management of this disease appear to help prolong survival.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Recurrent preeclampsia and perinatal outcome: a study of women with recurrent preeclampsia compared with women with preeclampsia who remained normotensive during their prior pregnancies.

OBJECTIVE: To evaluate the impact of preeclampsia recurrence on perinatal outcome. MATERIALS AND METHODS: A case-controlled study was performed in multiparous women who developed preeclampsia in index pregnancy (n = 64). Among these, women who had preeclampsia in previous pregnancies (n = 21) were compared to those who remained normotensive during their prior pregnancies (n = 43). Maternal and fetal variables were compared. Multivariate logistic analyses were performed to examine the impact of preeclampsia recurrence on fetal loss, preterm delivery, small for gestational age (SGA) occurrence and respiratory distress syndrome adjusted for confounding variables. RESULTS: No statistical significant difference was observed between the two groups in terms of age, delivery weeks, steroid use and laboratory markers. Fetal loss was higher in women with recurrent preeclampsia (19.0%) than in women with preeclampsia who had a normotensive pregnancy history (4.7%), with adjusted odds ratio (OR) of 5.77 [95% confidence interval (CI) 0.84-39.54]. CONCLUSION: Women with recurrent preeclampsia had a higher rate of perinatal loss compared to women with preeclampsia who were normotensive in their prior pregnancies.

Adult↗