bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interstitial ablative techniques for hepatic tumours
Authors: Erce C , Parks R W 
Published: February 2003

AbstractBackgroundMost patients with liver tumours are not suitable for surgery but interstitial ablative techniques may control disease progression and improve survival rates.MethodsA review was undertaken using Medline of all reported studies of cryoablation, radiofrequency ablation, microwave ablation, interstitial laser photocoagulation, high-intensity focused ultrasound and ethanol ablation of primary liver tumours and hepatic metastases.ResultsAlthough there are no randomized clinical trials, cryoablation, thermal ablation and ethanol ablation have all been shown to be associated with improved palliation in patients with primary and secondary liver cancer. The techniques can be undertaken safely with minimal morbidity and mortality.ConclusionAlthough surgical resection remains the first line of treatment for selected patients with primary and secondary liver malignancies, interstitial ablative techniques are promising therapies for patients not suitable for hepatic resection or as an adjunct to liver surgery.
Increased secretion of insulin during oral glucose tolerance test can be a predictor of stent restenosis in nondiabetic patients
Authors: Babalık Erhan , Gürmen Tevfik , Orhan Lütfullah , Bulur Hüseyin , Gülbaran Murat , Ersanlı Murat , Öztürk Servet 
Published: February 2003

AbstractInsulin is known to stimulate proliferation and migration of vascular smooth muscle cells. As the predominant mechanism of restenosis after stent implantation is neointimal tissue proliferation, one can expect a relationship between hyperinsulinemia and restenosis in these patients. The aim of this study was to determine whether hyperinsulinemia during oral glucose tolerance test is a predictor of the development of restenosis after stent implantation in nondiabetic patients. We prospectively studied 52 nondiabetic patients with effort angina who underwent elective stent implantation for single‐vessel coronary artery disease. In order to increase the statistical power of the study, numerous exclusion criteria were applied. All patients were subjected to a 75 g oral glucose tolerance test a day before the stent implantation and underwent follow‐up angiography 6 months later. Plasma insulin levels in fasting (6.77 ± 1.57 vs. 5.36 ± 1.35 μU/ml; P = 0.005), at 30 min (102.48 ± 10.6 vs. 47.74 ± 12.75 μU/ml; P = 0.001), 1 hr after (120.23 ± 14.1 vs. 63.08 ± 12.62 μ/ml; P = 0.001), 2 hr after (63.58 ± 8.64 vs. 34.88 ± 6.82 μ/ml; P = 0.001), and 3 hr after (25.71 ± 5.65 vs. 23.02 ± 4.61 μ/ml; P = 0.04) loading were significantly higher in patients with stent restenosis than in patients without stent restenosis. Insulin area and insulin area/glucose area were also significantly higher in patients with stent restenosis than in patients without (219.5 ± 23.8 vs. 118.9 ± 21.8, P = 0.001, and 0.62 ± 0.09 vs. 0.33 ± 0.06, P = 0.001, respectively). By multiple logistic regression analysis, insulin area during oral glucose tolerance test was found to be an independent predictor of stent restenosis (OR = 1.12; 95% CI = 1.01–1.25; P = 0.031). In conclusion, nondiabetic patients with hyperinsulinemia during oral glucose tolerance test have a high risk for restenosis after stent implantation, and performing this simple test before intervention may be useful for the prediction of stent restenosis. Cathet Cardiovasc Intervent 2003;58:306–312. © 2003 Wiley‐Liss, Inc.
Intracoronary beta‐brachytherapy in chronic total occlusions: A subgroup analysis from the RENO registry
Authors: Jain Deepak , Geist Volker , Lorenzen Hans‐Peter , Hartmann Franz , Wegscheider Karl , Bonan Raoul , Urban Philip , Richardt Gert 
Published: February 2003

AbstractConventional interventional therapy has been less rewarding in chronic total occlusion (CTO). Brachytherapy by its antiproliferative and positive remodeling effect may be more efficacious. Forty‐six centers registered 1,098 consecutive patients undergoing brachytherapy with the BetaCath system. Of these, 78 patients had 82 lesions (CTO) at presentation—the study population. With 67% in‐stent CTO, 8% graft CTO, 4% recurrent CTO, long lesions (27.6 ± 20.9 mm), and 31% diabetes, the cohort had high risk for recurrence. The in‐hospital event rate was 1.3%. Six‐month follow‐up revealed 1.3% death, 5.1% myocardial infarction, 21.8% target vessel revascularization, 77.8% improved angina, 34.5% binary restenosis, 12.7% reocclusion, and 10.3% late thrombosis. The results were comparable to all other patients in the registry, although late thrombosis rate was higher in the CTO group (10.3% vs. 5.0%; P = 0.047). In the in‐stent CTO subgroup (n = 52; 66.7%), there was no in‐hospital event, no follow‐up death or myocardial infarction, restenosis in 35.1%, and reocclusion in 10.8% of patients. In comparison, death or myocardial infarction was significantly higher in de novo CTO subgroup (P = 0.005). Compared to all other in‐stent restenosis patients in the registry, the patients with in‐stent CTO had similar clinical and angiographic event rate. Thus, beta‐brachytherapy was safe, feasible, and effective in this broad population of high‐risk patients with CTO presenting in day‐to‐day practice. It was particularly effective in in‐stent CTO, where conventional interventional strategies are disappointing. Cathet Cardiovasc Intervent 2003;58:322–329. © 2003 Wiley‐Liss, Inc.
Influence of stent treatment strategies in the long‐term outcome of patients with long diffuse coronary lesions
Authors: Pan Manuel , Suárez de Lezo José , Medina Alfonso , Romero Miguel , González Sandra , Segura José , Pavlovic Djordje , Rodríguez Marcos , Muñoz Juan , Ojeda Soledad , Hernández Enrique , Caballero Eduardo , Delgado Antonio , Melián Francisco 
Published: February 2003

AbstractDiffuse coronary lesions (length > 20 mm) are still considered high risk for percutaneous intervention even in the current stent era. We compared the 2‐year outcome of patients with long diffuse stenosis treated by three different stent strategies. In addition, we also analyzed the possible factors influencing a favorable late outcome. Our series is constituted by 232 patients with 247 long lesions treated between May 1994 and April 1999; 82 patients received one single long stent (group 1), 71 patients were treated by overlapped multiple stents (group 2), and 79 with multiple nonoverlapped stents (group 3). The mean age was 59 ± 11 years. There were not significant differences between groups in terms of age, risk factors, clinical presentation, type of lesion, or adjunctive medical therapy. Patients from group 1 had shorter lesions (29 ± 10 mm) than patients from groups 2 (41 ± 15 mm) and 3 (36 ± 14; P < 0.05). Major cardiac events (death, acute myocardial infarction, or repeat revascularization) at 24 ± 12 months follow‐up took place in 39 patients (17%). The probabilities of being free of major events at follow‐up were 71%, 78%, and 80% for group 1, 2, and 3 respectively (P = NS). Only three variables were identified as significant predictors of these late events: smaller vessel size, smaller minimal lumen diameter after stenting, and the type of lesion being restenotic as compared with native stenosis. Patients with diffuse lesions treated by single long stents did not have a better late outcome than those who received multiple stents. The best late outcome was observed in those patients who had bigger vessel size, larger poststent lumen dimensions and native lesions, regardless of the stent deployment strategy used. Cathet Cardiovasc Intervent 2003;58:293–300. © 2003 Wiley‐Liss, Inc.
Use of filterwire EX for distal embolic protection during complex percutaneous coronary interventions: Four case studies
Authors: Kornowski Ran , Assali Abid 
Published: February 2003

AbstractWe describe four successful cases demonstrating the use of a novel filter‐guidewire (FilterWire EX) during complex percutaneous coronary interventions in saphenous vein grafts (n = 3) and native coronary artery (n = 1) for prevention of distal embolization and consequently myonecrosis. Cathet Cardiovasc Intervent 2003;58:364‐369. © 2003 Wiley‐Liss, Inc.
Four French catheters for diagnostic coronary angiography
Authors: Mehta Haresh , Chatterjee Tushar , Windecker Stephan , Eberli Franz R. , Fleisch Martin , Seiler Christian , Hess Otto M. , Meier Bernhard 
Published: February 2003

AbstractA randomized study was conducted to assess the feasibility of 4 Fr catheters for diagnostic coronary angiograms. A total of 1,114 consecutive patients were randomized to 4 or 5 Fr catheters. Ease of use of catheters was subjectively assessed by the primary operator and the picture quality was assessed by two independent observers with a good interobserver variability (r = 0.94; P < 0.001). Predischarge local complications were recorded by the attending physician. No statistically significant difference was observed in the picture quality for the left coronary artery, right coronary artery, aorta, left ventricle, venous grafts, or renal arteries between the two groups. Fluoroscopy time (7.1 ± 5.6 for 4 Fr vs. 6.7 ± 5.7 min for 5 Fr) and contrast quantity (140 ± 58 vs. 144 ± 57 ml) were comparable between the two groups. There was a statistically significant difference in favor of the 5 Fr group as regards maneuverability of catheters (93% vs. 79%; P < 0.001), and 5 Fr pigtail catheters crossed the aortic valve easier than the 4 Fr pigtail catheters (91% vs. 81%; P < 0.001). Crossover to the other catheter size or a larger sheath was more frequent with 4 Fr catheters (33/522 vs. 3/592; P < 0.001). Median time to hemostasis was 9 min for 4 Fr and 14 min for 5 Fr (P < 0.001). Of the 4 Fr patients, 84% could be mobilized at 1 hr and 86% of 5 Fr patients at 2 hr. Significant hematomas were observed in 2% with 4 Fr or 5 Fr and small hematomas in 10% and 16%, respectively (P = NS). Time to discharge was comparable in both groups (4.0 ± 3.2 with 4 Fr vs. 4.3 ± 3.7 hr with 5 Fr). The 4 Fr catheters are a good alternative for diagnostic coronary angiograms. The increased difficulty in maneuverability and a need for catheter changes in 70% are compensated for in part by easier hemostasis. With increasing use and finesse of these catheters, the difficulty in maneuverability are likely to be overcome. Cathet Cardiovasc Intervent 2003;58:275–280. © 2003 Wiley‐Liss, Inc.
A prospective cohort study determining the prevalence of thrombotic events in children with acute lymphoblastic leukemia and a central venous line who are treated with L‐asparaginase
Authors: Mitchell Lesley G. ,   and the PARKAA Group
Published: February 2003

AbstractBACKGROUNDThrombotic events (TEs) are serious secondary complications in children with acute lymphoblastic leukemia (ALL) who receive L‐asparaginase (ASP) therapy; however, the prevalence of TEs has not been established. The primary objective of the Prophylactic Antithrombin Replacement in Kids with Acute Lymphoblastic Leukemia Treated with Asparaginase (PARKAA) Study was to determine the prevalence of TEs. The secondary objective was to detect any association of TEs with the presence of congenital or acquired prothrombotic disorders.METHODSChildren with ALL were screened for TEs at the end of ASP treatment using bilateral venograms, ultrasound, magnetic resonance imaging, and echocardiography. Symptomatic TEs were confirmed by appropriate radiographic tests. All tests were read by a blinded central adjudication committee.RESULTSTwenty‐two of 60 children had TEs, a prevalence of 36.7% (95% confidence interval, 24.4–48.8%). TEs were located in the sinovenous system of the brain in 1 patient, the right atrium in 3 patients, and the upper central venous system in 19 patients. TEs detected by venography resulted in 1) 25–100% occlusion, with 1 in 3 patients showing occlusion of > 75% of the greatest vessel dimension, and 2) the presence of collaterals in 60% of patients, with 40% categorized as major. No children with TEs were positive for factor V Leiden or prothrombin gene 20201A, and four of eight children with antiphospholipid antibodies had a TE.CONCLUSIONSThe prevalence of TEs is exceedingly high in this population, and it is likely that the extent of occlusion is likely clinically significant. No trend was seen toward an association between TEs and the presence of congenital prothrombotic disorders. A trend was seen toward an association between TEs and antiphospholipid antibodies. Carefully designed clinical trials of primary prophylaxis for the prevention of TEs are required in this patient population. Cancer 2003;97:508–16. © 2003 American Cancer Society.DOI 10.1002/cncr.11042
Mammography screening matters for young women with breast carcinoma
Authors: Buseman Sandra , Mouchawar Judy , Calonge Ned , Byers Tim 
Published: February 2003

AbstractBACKGROUNDBreast carcinoma is the leading cause of death for women between the ages of 40 and 49 years, yet questions linger regarding the effectiveness of screening mammography in reducing mortality rates among women of this age. In the current study, the authors report on the association between cancer stage at diagnosis and a history of mammography screening in a clinical setting that has emphasized informed choice regarding mammography screening for women in this age group.METHODSPrevious mammographic screening for 247 breast cancer patients 42–49 years of age who were diagnosed at Kaiser Permanente Colorado during 1994–2000 was evaluated relative to cancer stage. Cancer stage was dichotomized into early (American Joint Committee on Cancer [AJCC] Stages 0 and I) and late (AJCC Stages II–IV) and previous screening was defined as at least one normal screening mammogram within 24 months before the breast carcinoma diagnosis.RESULTSWomen who were screened were less likely to be diagnosed at a late stage than were women who were not screened (40% vs. 52% late stage, respectively). Adjusted for age, year of diagnosis, and family history, screened women were 0.56 (95% confidence interval = 0.32–0.97) times as likely as unscreened women to be diagnosed at a late stage.CONCLUSIONSWomen 42–49 of years with breast carcinoma who undergo regular screening mammography have a more favorable cancer stage than do women with breast carcinoma who do not undergo regular screening. This downstaging of breast carcinoma is likely to translate into improved breast carcinoma survival resulting from screening mammography for women 40–49 years of age. Cancer 2003;97:352–8. © 2003 American Cancer Society.DOI 10.1002/cncr.11050
Patterns of disease recurrence influenced by hematogenous tumor cell dissemination in patients with cervical carcinoma of the uterus
Authors: Janni Wolfgang , Hepp Florian , Strobl Barbara , Rack Brigitte , Rjosk Dorothea , Kentenich Christina , Schindlbeck Christian , Hantschmann Peer , Pantel Klaus , Sommer Harald , Braun Stephan 
Published: February 2003

AbstractBACKGROUNDThe presence of isolated tumor cells (ITC) in the bone marrow at the time of primary diagnosis indicates an increased risk for subsequent development of distant metastases in various solid tumors. This study evaluates the prevalence and prognostic significance of ITC in patients with primary carcinoma of the cervix uteri.METHODWe immunocytochemically analyzed bone marrow aspirates of 130 patients with newly diagnosed carcinoma of the cervix uteri for the presence of cytokeratin(CK)‐positive cells from May 1994 to January 2001. We used a quantitative immunoassay with the monoclonal anti‐CK antibody A45‐B/B3 and evaluated 2 × 106bone marrow cells per patient. Patients were followed prospectively for a median of 43 (range, 1–85) months.RESULTSIsolated tumor cells were found in the bone marrow of 38 patients (29%). The presence of ITC did not correlate with the International Federation of Gynecology and Obstetrics (FIGO) tumor stage (P= 0.61), pelvic and paraaortal lymph node involvement (P= 0.41), histopathologic grading (P= 0.67), the histologic type of the carcinoma (P= 0.93), invasion of lymph nodes (P= 0.93) and blood vessels (P= 0.92), or with menopausal status (P= 0.17). The bone marrow status at the time of primary diagnosis did not correlate with the overall survival as estimated by Kaplan–Meier analysis (P= 0.30). However, distant metastases occurred in 5% of the patients (n= 5) with negative bone marrow status and in 15% of the patients (n= 6) with positive bone marrow status (P= 0.054). The median distant disease‐free survival period was 78 months (95% confidence interval 73–82) in patients with negative bone marrow status and 72 months (95% CI 61–82) in patients with positive bone marrow status (P= 0.051). Multivariate analysis revealed the presence of ITC as a significant, independent risk factor for the subsequent development of distant metastases (relative risk 3.6,P= 0.046).CONCLUSIONDespite the locoregional predominance of cervical carcinoma at the time of primary diagnosis, the presence of ITC in the bone marrow indicates an increased risk for the development of distant metastases. This information may prove useful to stratify patients for systemic treatment. Cancer 2003;97:405–11. © 2003 American Cancer Society.DOI 10.1002/cncr.11066
Primary germ cell tumors in the mediastinum
Authors: Takeda Shin‐ichi , Miyoshi Shinichiro , Ohta Mitsunori , Minami Masato , Masaoka Akira , Matsuda Hikaru 
Published: February 2003

AbstractBACKGROUNDPrimary germ cell tumors (GCT) of the mediastinum share similar clinical and biologic characteristics, which are different from their testicular counterpart. The purpose of the current study was to review the authors' institutional experience of mediastinal GCT, emphasizing the clinical spectrum, time trends of treatment, and recent advances in therapeutic modalities for malignant GCT.METHODSBetween 1951 and 2000, 129 patients (70 males and 59 females) underwent surgical treatment for GCT, which accounted for 16.0% of the mediastinal tumors during the same period. There were 95 patients with mature teratomas, 13 patients with seminomas, and 21 patients with nonseminomatous germ cell tumors (NSGCT) with median ages of 26.4 years, 27.6 years, and 28.5 years, respectively.RESULTSAdult patients with mature teratomas were less symptomatic (33.3%) than pediatric patients (52.4%). All patients with mature teratoma were cured by resection alone. Eight of the 13 patients (61.5%) with seminoma were symptomatic and 10 of 13 patients (83.3%) survived after surgery and radiation with/without chemotherapy. Nineteen of 21 patients (90.5%) with NSGCT had dyspnea, chest pain, and superior vena cava syndrome. Before 1985, patients received radical resection and/or chemoradiotherapy. However, all patients died due to disease progression, with a median survival period of 7.6 months. After 1986, six of eight patients received cisplatin‐based chemotherapy, including three who received additional high‐dose chemotherapy with a supporting peripheral blood stem cell transplantation until tumor markers normalized. Five patients who underwent salvage resection are currently disease free with a median survival period of 58.3 months.CONCLUSIONSThe institutional experience indicates the benign nature of mediastinal mature teratomas and the excellent prognosis for patients with seminomas after resection. An improved survival advantage was ensured with cisplatin‐based preoperative chemotherapy in patients with NSGCT. Cancer 2003;97:367–76. © 2003 American Cancer Society.DOI 10.1002/cncr.11068
Sentinel lymph node biopsy for patients with problematic spitzoid melanocytic lesions
Authors: Su Lyndon D. , Fullen Douglas R. , Sondak Vernon K. , Johnson Timothy M. , Lowe Lori 
Published: February 2003

AbstractBACKGROUNDSpindle and/or epithelioid melanocytic proliferations that display overlapping histopathologic features of Spitz nevus and Spitz‐like melanoma are diagnostically difficult and controversial melanocytic tumors. There are reports of such lesions metastasizing to regional lymph nodes, with a few widely disseminating, resulting in death.METHODSThe authors reviewed clinical and histopathologic data on all patients with atypical or borderline spitzoid melanocytic proliferations who underwent sentinel lymph node biopsy (SLNB). They examined how frequently histologically problematic or borderline spitzoid melanocytic lesions metastasized to sentinel lymph nodes (SLNs) and which clinical or histologic features, if any, predisposed patients to a higher risk lesion.RESULTSSix male patients and 12 female patients, ages 5–32 years (mean, 16 years), had tumors ranging in size from 1.2 mm to 7.9 mm (mean, 3.5 mm) in thickness. Atypical histologic features that were present most frequently included incomplete maturation (18 of 18 patients), deep dermal mitoses (16 of 18 patients), nuclear pleomorphism (10 of 18 patients), and focal sheet‐like growth (10 of 18 patients). Eight of 18 patients (44%) had SLN metastasis and were offered adjuvant treatment. One of eight patients with SLN positive results who underwent regional lymphadenectomy had one additional involved lymph node. All 18 patients were alive and well with no evidence of recurrent or metastatic disease after a follow‐up of 3–42 months (mean, 12 months).CONCLUSIONSHistologically atypical or borderline spitzoid, melanocytic tumors are diagnostically challenging and controversial melanocytic lesions, some of which represent unrecognized melanomas. SLNB aids in confirming a diagnosis of melanoma and identifies patients who may benefit from early therapeutic lymph node dissection and/or adjuvant therapy. Cancer 2003;97:499–507. © 2003 American Cancer Society.DOI 10.1002/cncr.11074