Objective. The role and type of procedures of follow-up in patients with gynecological tumors are still a debatable issue. We prospectively analyzed the role of routine transabdominal and transvaginal ultrasound exami...Objective. The role and type of procedures of follow-up in patients with gynecological tumors are still a debatable issue. We prospectively analyzed the role of routine transabdominal and transvaginal ultrasound examination (US) in the detection of recurrent disease in gynecologic cancer patients. Methods. Among 552 patients who underwent surgery for gynecological cancer, 385 were available for the analysis. Follow-up examinations included clinical examination, serum tumor marker assay, transvaginal and transabdominal sonography and CT scan/MRI. Results. Positive US examination was documented in 83/385 patients (21.5%). In the overall series, the positive predictive value (PPV) of US examination was 100%, while the negative predictive value (NPV) was 92.7%failing to identify 22 cases of recurrences. When considering the subgroup of patients with positive clinical examination or abnormal tumor marker, positive US analysis was able to identify 66/66 cases of recurrence (PPV = 100%), but exhibited an NPV of 22.2%, with 21/27 (77.8%) false negative cases. Conversely, in cases without clinical/serological signs of disease, positive US recognized all cases of recurrences (17/17, PPV = 100%), and exhibited a very high NPV, with only 1 false negative case out of 275 (0.4%). The US detected recurrences appeared as a solitary lesion in 38/75 (50.6%) patients and in 28/75 (37%) appeared located centrally in the pelvis. The sonographic pattern of the ovarian recurrences was a solid lesion in most (33/40, 82%) cases. In the other gynecological tumors, the lesions appeared as solid masses in 33/35 (94%) cases. Conclusions. We showed that routine US might play a role in the follow-up of gynecologic malignancies, especially in the group of asymptomatic patients, while CT/MRI imaging might be more properly applied to patients with clinical or serological signs of disease.展开更多
Purpose: To examine the association between potential risk factors and the 14 -year incidence of age-related maculopathy (ARM). Design: Population-based co hort study. Participants: At baseline, 946 volunteers partici...Purpose: To examine the association between potential risk factors and the 14 -year incidence of age-related maculopathy (ARM). Design: Population-based co hort study. Participants: At baseline, 946 volunteers participated in the study during 1986-88. These subjects were between 60 and 80 years of age and lived in the terbro district of Copenhagen. Excluding participants who had died since baseline, 359 subjects (97.3%of survivors) were reexamined 14 years later, duri ng 2000-2002. A total of 31.8%(301/946) of the original material was included in the risk factor analyses. Methods: Participants underwent an ophthalmological examination at Rigshospitalet, the National University Hospital of Copenhagen. Similar standardized protocols for physical examination were used at the baselin e and follow-up examinations. Age-relatedm- aculopa-thy lesionswere determined by the same grader grading colour fundus p hotographs from both examinations using a modification of the Wisconsin Age-rel ated Maculopathy Grading System protocol. Results: Of the 359 participants, 94 h ad incident early ARM and 52 had incident late ARM at follow-up in either eye. In logistic regression, the risk factors for early ARM or worse were as follows: cataract (odds ratio [OR] 2.8, 95%confidence interval [CI] 1.2-6.2); fami ly h istory of ARM (OR 4.5, 95%CI 1.3-15.5), and alcohol consumption >250 g/week (O R 4.6, 95%CI 1.1-19.2). High levels of apolipoprotein B ( > 100 mg/1) decrease d the risk of development of early ARM or worse (OR 0.4, 95%CI 0.2-0.8), while high levels of apolipoprotein A1 (≥150 mg/1) increased the risk of late ARM (O R 2.5, 95%CI 1.2-5.3). Advanced age at baseline was also associated with the i ncidence of late ARM(OR2.0, 95%CI 1.4-2.9). Conclusions: These findings indica te a direct correlation between age, cataract, family history, alcohol consumpti on, the apolipoproteins A1 and B and the 14-year incidence of ARM.展开更多
Background: We investigated the mode of progression of intraductal papillary- mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow- up in order to elucidate the characteristics of malignancy and t...Background: We investigated the mode of progression of intraductal papillary- mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow- up in order to elucidate the characteristics of malignancy and to establish an effective treatment strategy. Methods: Fifty- one patients with IPMN (branch- duct type, 47; main- duct type, 4)who had undergone follow- up study by endoscopic ultrasonography (EUS)were included (mean follow- up duration, 41.0 ± 32.3 months; average number of EUS examinations performed during follow- up, 4.4). Chronological changes in EUS findings and histological findings of resected specimens were evaluated. Results: Of the patients with the branch- duct type, only 2% showed enlargement of the dilated branches. In the main- duct- type group, an increase in size of the main pancreatic duct (MPD) was observed in 75% of the patients. In 14 patients with papillary protrusions, an increase in size and lateral spreadwas observed in 71% and 43% , respectively. No patients developed invasive cancer. In 15 patients who had thick septum- like structures (TSS), the development of papillary protrusions and that of invasive cancer were observed in 53% and 13% , respectively. Twenty- nine patients who had thin septum- like structures showed no change. Two patients with dense multilocular large cysts and TSS developed invasive cancer without change in the cystic lesions. One patient developed carcinoma with multifocal stromal invasion. Conclusions: Patients with branch- duct type IPMNs without papillary protrusions or TSS are not immediate candidates for surgery. Those who have small papillary protrusions have a benign course. It is recommended that patients with the large branch- duct type with TSS should undergo surgery. Attention should be paid to the entire pancreas when performing follow- up examinations in patients with branch- duct type IPMN, as invasive ductal adenocarcinoma can develop at a site in the pancreas different from that of the IPMN.展开更多
PURPOSE:As evidence mounts for effectiveness,an increasing proportion of the United States population undergoes colorectal cancer screening.However,relatively little is known about rates of follow-up after abnormal re...PURPOSE:As evidence mounts for effectiveness,an increasing proportion of the United States population undergoes colorectal cancer screening.However,relatively little is known about rates of follow-up after abnormal results from initial screening tests.This study examines patterns of colorectal cancer screening and follow-up within the nation’s largest integrated health care system:the Veterans Health Administration.METHODS:We obtained information about patients who received colorectal cancer screening in the Veterans Health Administration from an existing quality improvement program and from the Veterans Health Administration’s electronic medical record.Linking these data,we analyzed receipt of screening and follow-up testing after a positive fecal occult blood test.RESULTS:A total of 39,870 patients met criteria for colorectal cancer screening;of these 61 percent were screened.Screening was more likely in patients aged 70 to 80 years than in those younger or older.Female gender(relative risk,0.92;95 percent confidence interval,0.9-0.95) ,Black race(relative risk,0.92;95 percent confidence interval,0.89-0.96) ,lower income,and infrequent primary care visits were associated with lower likelihood of screening.Of those patients with a positive fecal occult blood test(n = 313) ,59 percent received a follow-up barium enema or colonoscopy.Patient-level factors did not predict receipt of a follow-up test.CONCLUSIONS:The Veterans Health Administration rates for colorectal cancer screening are significantly higher than the national average.However,41 percent of patients with positive fecal occult blood tests failed to receive follow-up testing.Efforts to measure the quality of colorectal cancer screening programs should focus on the entire diagnostic process.展开更多
文摘Objective. The role and type of procedures of follow-up in patients with gynecological tumors are still a debatable issue. We prospectively analyzed the role of routine transabdominal and transvaginal ultrasound examination (US) in the detection of recurrent disease in gynecologic cancer patients. Methods. Among 552 patients who underwent surgery for gynecological cancer, 385 were available for the analysis. Follow-up examinations included clinical examination, serum tumor marker assay, transvaginal and transabdominal sonography and CT scan/MRI. Results. Positive US examination was documented in 83/385 patients (21.5%). In the overall series, the positive predictive value (PPV) of US examination was 100%, while the negative predictive value (NPV) was 92.7%failing to identify 22 cases of recurrences. When considering the subgroup of patients with positive clinical examination or abnormal tumor marker, positive US analysis was able to identify 66/66 cases of recurrence (PPV = 100%), but exhibited an NPV of 22.2%, with 21/27 (77.8%) false negative cases. Conversely, in cases without clinical/serological signs of disease, positive US recognized all cases of recurrences (17/17, PPV = 100%), and exhibited a very high NPV, with only 1 false negative case out of 275 (0.4%). The US detected recurrences appeared as a solitary lesion in 38/75 (50.6%) patients and in 28/75 (37%) appeared located centrally in the pelvis. The sonographic pattern of the ovarian recurrences was a solid lesion in most (33/40, 82%) cases. In the other gynecological tumors, the lesions appeared as solid masses in 33/35 (94%) cases. Conclusions. We showed that routine US might play a role in the follow-up of gynecologic malignancies, especially in the group of asymptomatic patients, while CT/MRI imaging might be more properly applied to patients with clinical or serological signs of disease.
文摘Purpose: To examine the association between potential risk factors and the 14 -year incidence of age-related maculopathy (ARM). Design: Population-based co hort study. Participants: At baseline, 946 volunteers participated in the study during 1986-88. These subjects were between 60 and 80 years of age and lived in the terbro district of Copenhagen. Excluding participants who had died since baseline, 359 subjects (97.3%of survivors) were reexamined 14 years later, duri ng 2000-2002. A total of 31.8%(301/946) of the original material was included in the risk factor analyses. Methods: Participants underwent an ophthalmological examination at Rigshospitalet, the National University Hospital of Copenhagen. Similar standardized protocols for physical examination were used at the baselin e and follow-up examinations. Age-relatedm- aculopa-thy lesionswere determined by the same grader grading colour fundus p hotographs from both examinations using a modification of the Wisconsin Age-rel ated Maculopathy Grading System protocol. Results: Of the 359 participants, 94 h ad incident early ARM and 52 had incident late ARM at follow-up in either eye. In logistic regression, the risk factors for early ARM or worse were as follows: cataract (odds ratio [OR] 2.8, 95%confidence interval [CI] 1.2-6.2); fami ly h istory of ARM (OR 4.5, 95%CI 1.3-15.5), and alcohol consumption >250 g/week (O R 4.6, 95%CI 1.1-19.2). High levels of apolipoprotein B ( > 100 mg/1) decrease d the risk of development of early ARM or worse (OR 0.4, 95%CI 0.2-0.8), while high levels of apolipoprotein A1 (≥150 mg/1) increased the risk of late ARM (O R 2.5, 95%CI 1.2-5.3). Advanced age at baseline was also associated with the i ncidence of late ARM(OR2.0, 95%CI 1.4-2.9). Conclusions: These findings indica te a direct correlation between age, cataract, family history, alcohol consumpti on, the apolipoproteins A1 and B and the 14-year incidence of ARM.
文摘Background: We investigated the mode of progression of intraductal papillary- mucinous neoplasm of the pancreas (IPMN) in patients who underwent follow- up in order to elucidate the characteristics of malignancy and to establish an effective treatment strategy. Methods: Fifty- one patients with IPMN (branch- duct type, 47; main- duct type, 4)who had undergone follow- up study by endoscopic ultrasonography (EUS)were included (mean follow- up duration, 41.0 ± 32.3 months; average number of EUS examinations performed during follow- up, 4.4). Chronological changes in EUS findings and histological findings of resected specimens were evaluated. Results: Of the patients with the branch- duct type, only 2% showed enlargement of the dilated branches. In the main- duct- type group, an increase in size of the main pancreatic duct (MPD) was observed in 75% of the patients. In 14 patients with papillary protrusions, an increase in size and lateral spreadwas observed in 71% and 43% , respectively. No patients developed invasive cancer. In 15 patients who had thick septum- like structures (TSS), the development of papillary protrusions and that of invasive cancer were observed in 53% and 13% , respectively. Twenty- nine patients who had thin septum- like structures showed no change. Two patients with dense multilocular large cysts and TSS developed invasive cancer without change in the cystic lesions. One patient developed carcinoma with multifocal stromal invasion. Conclusions: Patients with branch- duct type IPMNs without papillary protrusions or TSS are not immediate candidates for surgery. Those who have small papillary protrusions have a benign course. It is recommended that patients with the large branch- duct type with TSS should undergo surgery. Attention should be paid to the entire pancreas when performing follow- up examinations in patients with branch- duct type IPMN, as invasive ductal adenocarcinoma can develop at a site in the pancreas different from that of the IPMN.
文摘PURPOSE:As evidence mounts for effectiveness,an increasing proportion of the United States population undergoes colorectal cancer screening.However,relatively little is known about rates of follow-up after abnormal results from initial screening tests.This study examines patterns of colorectal cancer screening and follow-up within the nation’s largest integrated health care system:the Veterans Health Administration.METHODS:We obtained information about patients who received colorectal cancer screening in the Veterans Health Administration from an existing quality improvement program and from the Veterans Health Administration’s electronic medical record.Linking these data,we analyzed receipt of screening and follow-up testing after a positive fecal occult blood test.RESULTS:A total of 39,870 patients met criteria for colorectal cancer screening;of these 61 percent were screened.Screening was more likely in patients aged 70 to 80 years than in those younger or older.Female gender(relative risk,0.92;95 percent confidence interval,0.9-0.95) ,Black race(relative risk,0.92;95 percent confidence interval,0.89-0.96) ,lower income,and infrequent primary care visits were associated with lower likelihood of screening.Of those patients with a positive fecal occult blood test(n = 313) ,59 percent received a follow-up barium enema or colonoscopy.Patient-level factors did not predict receipt of a follow-up test.CONCLUSIONS:The Veterans Health Administration rates for colorectal cancer screening are significantly higher than the national average.However,41 percent of patients with positive fecal occult blood tests failed to receive follow-up testing.Efforts to measure the quality of colorectal cancer screening programs should focus on the entire diagnostic process.
