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Acute Infections After Fracture Repair: Management With Hardware in Place

Rightmire, Eric; Zurakowski, David; Vrahas, Mark
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
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Managing infections in fractures treated with open reduction and internal fixation is an ongoing dilemma. Little published data exist to support the current practice of treating these infections with retained hardware, irrigation, débridement, and antibiotic suppression. We evaluated the effectiveness of this approach. We identified potential subjects from a central trauma database and selected them based on chart review and specific inclusion and exclusion criteria. We divided the patients into two groups. Patients achieving successful union with original hardware in place were considered as having successful results and patients who required hardware removal before healing were considered to have failed results. Data, including age, gender, tobacco use, diabetic status, site of fracture, Orthopaedic Trauma Association class, open grade, type of fixation, joint involvement, and organism, were gathered and compared between the groups by analysis of variance. Sixty-nine cases were available for analysis. Forty-seven (68%) were successful and 22 (32%) were unsuccessful. Average time to healing was 130 days. Most of the failures occurred within 120 days from the time of injury. Smoking was a major risk factor with a 3.7 times greater likelihood of procedures being unsuccessful per month than procedures among nonsmokers. Treating infected fractures with hardware in place is less successful than widely believed.

Outcomes of a Modified CALGB 19802 Regimen in Adult Acute Lymphoblastic Leukemia

Han, A-Reum; Kim, Kihyun; Jang, Jun Ho; Kim, Won Seog; Ahn, Jin Seok; Jung, Chul Won; Lee, Mark H.; Kang, Won Ki
Fonte: The Korean Academy of Medical Sciences Publicador: The Korean Academy of Medical Sciences
Tipo: Artigo de Revista Científica
EN
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We analyzed the efficacy and toxicity of a modified Cancer and Leukemia Group B (CALGB) 19802 regimen in adult acute lymphoblastic leukemia (ALL). From February 2002 to August 2005, 25 adults with untreated ALL were enrolled in the study. Compared to the original regimen, the modified CALGB 19802 regimen consisted of a 4-drug induction (cyclophosphamide, daunorubicin, vincristine, and prednisone) instead of a 5-drug induction (L-asparaginase was added to the previous regimen). This was followed by high-dose methotrexate (1,000 mg/m2×3 days) and cytarabine (2,000 mg/m2×4 days) for the consolidation cycles. High-dose systemic and intrathecal methotrexate was given for central nervous system prophylaxis. Twenty-three patients (92%) achieved a complete remission (CR), and two patients (8%) had refractory disease. With a median follow-up of 21.5 months, 10 patients (40%) were alive and continued to be in CR. The 3-yr probability of an event-free survival and the overall survival were 39.0% and 47.4%, respectively. Treatment related mortality and major grade 3 to 4 neurotoxicity occurred in 1 patient and 3 patients, respectively. The modified CALGB 19802 regimen demonstrated a high remission rate and a favorable survival rate.

Revised Tubiana’s Staging System for Assessment of Disease Severity in Dupuytren’s Disease—Preliminary Clinical Findings

Hindocha, Sandip; Stanley, John K.; Watson, James Stewart; Bayat, Ardeshir
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
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There are few objective staging systems to assess severity of Dupuytren’s disease (DD). Previous methods to assess severity of DD were based primarily on the degree of contracture of an affected digit measured using a goniometer. Nonetheless, this method of assessment alone may be incomplete, and other factors should be considered. White (n = 92) patients diagnosed with DD from northwest of England were assessed for DD. Objective criteria for evaluating severity incorporated quantified variables. The revised severity stage was correlated to a known staging system of DD (Tubiana’s staging system) which measures total flexion deformity for a single affected digit. Total revised severity staging scores ranged between 4 and 53 (mean = 18.7) and revealed significant positive correlation to Tubiana’s original staging system (r2 = 0.8, p < 0.001). There was significant difference between severity staging scores in those with a positive family history compared to those without (p < 0.01). In current practice, often, the degree of contracture in an affected digit is used solely as a measure of disease severity. Additional objective clinical information may provide useful prognostic indices for disease progression as well as postoperative outcome.

A three-dimensional retrospective analysis of the evolution of spinal instrumentation for the correction of adolescent idiopathic scoliosis

Kadoury, Samuel; Cheriet, Farida; Beauséjour, Marie; Stokes, Ian A.; Parent, Stefan; Labelle, Hubert
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
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This is a clinical radiographic study, spanning over three decades, analyzing the three-dimensional (3-D) changes in spine geometry after corrective surgery for adolescent idiopathic scoliosis (AIS) using four generations of instrumentation systems. The objective of this study was to retrospectively evaluate the evolution of spinal instrumentation over time by measuring the 3-D changes of spinal shape before and after surgical correction of subjects with AIS using Harrington/Harrington-Luque (H/HL) instrumentation, original and recent generations of Cotrel-Dubousset Instrumentation (CDI) with rod rotation maneuvers, as well as third generation systems using thoracic pedicle screws and direct vertebral derotation (DVD) manoeuver in order to determine if the claims for improved 3-D correction from generation to next generation could be substantiated. The 3-D shape of the thoracic and lumbar spine was recorded from a pair of standing radiographs using a novel 3-D reconstruction technique from uncalibrated radiographs in 128 adolescents with AIS undergoing surgery by a posterior approach. Changes in coronal Cobb angles, kyphosis, lordosis, as well as in a series of 3-D parameters computed from the spine reconstructions before and after surgery were used to compare the four groups. Results demonstrate statistically significant differences (P = 0.05) between generations with regards to the correction of the coronal Cobb angle...

Caspase-independent type III programmed cell death in chronic lymphocytic leukemia: the key role of the F-actin cytoskeleton

Barbier, Sandrine; Chatre, Laurent; Bras, Marlène; Sancho, Patricia; Roué, Gaël; Virely, Clémence; Yuste, Victor J.; Baudet, Sylvie; Rubio, Manuel; Esquerda, Josep E.; Sarfati, Marika; Merle-Béral, Hélène; Susin, Santos A.
Fonte: Ferrata Storti Foundation Publicador: Ferrata Storti Foundation
Tipo: Artigo de Revista Científica
EN
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Stimulation of the CD47 membrane receptor activates an original mechanism of cell death in chronic lymphocytic leukemia (CLL) cells that is caspase-independent. This study provides an exhaustive characterization of the CD47 anti-tumor signaling in CLL that may help to define new targets for further therapeutic strategies.

Selective human endothelial cell activation by chemokines as a guide to cell homing

Da Silva, Claire Crola; Lamerant-Fayel, Nathalie; Paprocka, Maria; Mitterrand, Michèle; Gosset, David; Dus, Danuta; Kieda, Claudine
Fonte: Blackwell Science Inc Publicador: Blackwell Science Inc
Tipo: Artigo de Revista Científica
Publicado em /03/2009 EN
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An original model of organo-specific, immortalized and stabilized endothelial cell lines was used to delineate the part played by some chemokines (CCL21, CX3CL1, CCL5 and CXCL12) and their receptors in endothelium organo-specificity. Chemokine receptor expression and chemokine presentation were investigated on organo-specific human endothelial cell lines. Although the chemokines showed distinct binding patterns for the various endothelial cell lines, these were not correlated with the expression of the corresponding receptors (CX3CR1, CXCR4, CCR5 and CCR7). Experiments with CCL21 on peripheral lymph node endothelial cells demonstrated that the chemokine did not co-localize with its receptor but was associated with extracellular matrix components. The specific activity of chemokines was clearly shown to be related to the endothelial cell origin. Indeed, CX3CL1 and CCL21 promoted lymphocyte recruitment by endothelial cells from the appendix and peripheral lymph nodes, respectively, while CX3CL1 pro-angiogenic activity was restricted to endothelial cells from the appendix and skin. The high specificity of the chemokine/endothelium interaction allowed the design of a direct in vitro endothelial cell targeting assay. This unique cellular model demonstrated a fundamental role for chemokines in conferring on the endothelium its organo-specificity and its potential for tissue targeting through the selective binding...

Phosphodiesterase 4D Gene and Risk of Noncardiogenic Ischemic Stroke in a Korean Population

Kim, Myeong-Kyu; Kim, Jun-Tae; Choi, Sung-Min; Lee, Seung-Han; Park, Man-Seok; Cho, Ki-Hyun
Fonte: The Korean Academy of Medical Sciences Publicador: The Korean Academy of Medical Sciences
Tipo: Artigo de Revista Científica
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Recently published studies from different populations provide apparently conflicting evidence on the association between the phosphodiesterase 4D (PDE4D) gene and ischemic stroke. The relationship between a representative PDE4D genotype and ischemic stroke was explored in a case-control study of 205 consecutive Korean patients with noncardiogenic ischemic stroke and 103 healthy controls who were neurologically and radiologically proven to be stroke-free. We selected and genotyped a PDE4D single nucleotide polymorphism (SNP 41, rs152312) as a candidate marker for susceptibility to ischemic stroke because SNP 41 has shown the most significant association with stroke in both a meta-analysis and the original Icelandic study of the PDE4D gene. No significant difference was observed between the cases and controls in the distribution of the PDE4D SNP 41 genotypes. The results from the adjusted conditional logistic regression analysis (adjusted for age, hypertension, diabetes and smoking status) showed no significant association between PDE4D SNP 41 genotypes and an increased risk of noncardiogenic ischemic stroke. The PDE4D gene is not a major risk factor for noncardiogenic ischemic stroke in a Korean population, which supports the recent evidence suggesting that the causative genetic variants of ischemic stroke may differ across populations.

Inhibitory Effects of Partially Decomposed Alginate on Production of Glucan and Organic Acid by Streptococcus sobrinus 6715

Hashiguchi-Ishiguro, Michiru; Nakamura, Sadako; Oku, Tsuneyuki
Fonte: the Society for Free Radical Research Japan Publicador: the Society for Free Radical Research Japan
Tipo: Artigo de Revista Científica
EN
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Our previous study has already clarified that partially decomposed alginate (Alg53) by Vibrio alginolyticus SUN53 has a competitive inhibitory effect on sucrase. The objective of this study is to evaluate the influence of Alg53 on the production of glucan from sucrose by glucosyltransferase and acid from glucose by Streptococcus sobrinus 6715. Glucosyltransferase was prepared from cultural medium of S. sobrinus using ultrafiltration and hydroxyapatite chromatography. In order to examine the inhibitory effect of Alg53 for production of glucan by GTase, partially purified GTase, sucrose and Alg53 solution were incubated at 37°C. The influence of Alg53 on the production of acid from glucose was evaluated by a degree of pH decline during the incubation for 60 min. The original Alg53 solution markedly inhibited to 21% of the synthesis of water-insoluble glucan from sucrose and that of 10-fold diluted of Alg53 solution was 23%. However, the production of water-soluble glucan from sucrose by GTase was hardly affected by Alg53. Furthermore, Alg53 suppressed dose-dependently pH decline by organic acid converted from glucose. These results suggest that Alg53 is expected as a functional food material which prevents or reduces dental caries.

Postoperative Spinal Epidural Hematoma: Risk Factor and Clinical Outcome

Yi, Seong; Yoon, Do Heum; Kim, Keung Nyun; Kim, Sang Hyun; Shin, Hyun Chul
Fonte: Yonsei University College of Medicine Publicador: Yonsei University College of Medicine
Tipo: Artigo de Revista Científica
EN
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We report a series of epidural hematomas which cause neurologic deterioration after spinal surgery, and have taken risk factors and prognostic factors into consideration. We retrospectively reviewed the database of 3720 cases of spine operation in a single institute over 7 years (1998 April-2005 July). Nine patients who demonstrated neurologic deterioration after surgery and required surgical decompression were identified. Factors postulated to increase the postoperative epidural hematoma and to improve neurologic outcome were investigated. The incidence of postoperative epidural hematoma was 0.24%. Operation sites were cervical 3 cases, thoracic 2 cases, and lumbar 4 cases. Their original diagnoses were tumor 3 cases, cervical stenosis 2 cases, lumbar stenosis 3 cases and herniated lumbar disc 1case. The symptoms of epidural hematomas were neurologic deterioration and pain. After decompression, clinical outcome revealed complete recovery in 3 cases (33.3%), incomplete recovery in 5 cases (55.6%) and no change in 1 case (11.1%). Factors increasing the risk of postoperative epidural hematoma were coagulopathy from medical illness or anticoagulation therapy (4 cases, 44.4%) and highly vascularized tumor (3 cases, 33.3%). The time interval to evacuation of complete recovery group (29.3 hours) was shorter than incomplete recovery group (66.3 hours). Patients with coagulopathy and highly vascularized tumor were more vulnerable to spinal epidural hematoma. The postoperative outcome was related to the preoperative neurological deficit and the time interval to the decompression.

The KIDSCREEN-52 Quality of Life Measure for Children and Adolescents (KIDSCREEN-52-HRQOL): Reliability and Validity of the Korean Version

Hong, Sungdo David; Yang, Jae Won; Jang, Won Seok; Byun, Heejung; Lee, Moon Soo; Kim, Hee Soo; Oh, Mi-Young; Kim, Ji-Hae
Fonte: The Korean Academy of Medical Sciences Publicador: The Korean Academy of Medical Sciences
Tipo: Artigo de Revista Científica
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The KIDSCREEN-52 quality-of-life (KIDSCREEN-52-HRQOL) is a relevant, worldwide tool used for assessing the health-related quality of life in children and adolescents. The purpose of this study was to define measurement properties of the Korean version of the KIDSCREEN-52 HRQOL. The original questionnaire was translated following international translation guidelines. Analysis regarding psychometric properties showed that the Cronbach-alpha ranged from 0.77 to 0.95. The correlation coefficient between the PedQL and KIDSCREEN-52 dimensions were high for the assessments of similar constructs. Therefore, the Korean version of the KIDSCREEN-52 was found to be suitable for use in Korean adolescents.

Measuring the Burden of Disease in Korea

Yoon, Seok-Jun; Bae, Sang-Cheol; Lee, Sang-Il; Chang, Hyejung; Jo, Heui Sug; Sung, Joo-Hun; Park, Jae-Hyun; Lee, Jin-Yong; Shin, Youngsoo
Fonte: The Korean Academy of Medical Sciences Publicador: The Korean Academy of Medical Sciences
Tipo: Artigo de Revista Científica
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This paper provides an overview of the Korean Burden of Disease (KBoD) study, which was the first such study to assess the national burden of disease using disability-adjusted life years (DALYs) in an advanced Asian country. The KBoD study generally followed the approach utilized in the original Global Burden of Disease study (GBD), with the exception of the disease classification and epidemiological data estimation methods used, and the relative weightings of disabilities. The results of the present study reveal that the burden of disease per 100,000 of the Korean population originates primarily from; cancer (1,525 Person Years, PYs), cardiovascular disease (1,492 PYs), digestive disease (1,140 PYs), diabetes mellitus (990 PYs), and certain neuro-psychiatric conditions (883 PYs). These results are largely consistent with those of developed countries, but also represent uniquely Korean characteristics.

Double Opposing-Rhomboid Flaps for Closure of a Circular Facial Defect in a Special Position

Wu, Hui-Ling; Le, Shu-Jun; Zheng, Shu-Sen
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Various techniques are used to repair circular defects in special positions on the face. Simple closure will yield unsatisfactory results because of skin tension. As an ideal method of reconstruction, various flaps are used to provide a versatile and safe alternative. The authors applied double opposing-rhomboid flaps, which provided for closure of a circular skin defect without alteration to the original shapes of the vital structures and resulted in an imperceptible scar. With careful designing, 21 patients with circular defects caused by skin tumor excisions to special facial positions have attained effective functional and aesthetic results using this method since 2004.

Factors affecting the appearance of ‘twin language’: An original language naturally developing within twin pairs

Hayashi, Chisato; Hayakawa, Kazuo
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /05/2004 EN
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Long-term Results for Limb Salvage with Osteoarticular Allograft Reconstruction

Ogilvie, Christian M.; Crawford, Eileen A.; Hosalkar, Harish S.; King, Joseph J.; Lackman, Richard D.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
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Osteoarticular allograft reconstruction after extremity tumor resection has been shown to have a high rate of complications. Although good functional results have been seen, long-term outcomes have not been well studied. We performed a retrospective review of 20 patients who underwent primary osteoarticular allograft reconstruction after extremity sarcoma resection. All postoperative complications related to the allograft reconstruction were recorded. Musculoskeletal Tumor Society 1993 and Toronto Extremity Salvage Score scores were used for functional evaluation at last followup. Minimum followup was 10 years (mean, 16 years; range, 10–21 years). Seventy percent of patients experienced an event during the followup period. Recorded events were fracture (nine patients), progressive arthritis (five), nonunion (four), and infection (two). Sixty percent of allografts were removed at a mean of 5.2 years. Progressive arthritis led to total joint arthroplasty in five patients (25%). Mean Musculoskeletal Tumor Society and Toronto Extremity Salvage Score functional scores were 25 of 30 and 95% for patients who retained their original allograft. Osteoarticular allograft reconstruction for extremity sarcomas had a high rate of adverse events (70%) and allograft removal (60%) at long-term followup. Functional outcomes of patients with intact grafts were comparable to outcomes with segmental replacement prostheses reported in the literature.

Reconstruction of Complete Knee Extensor Mechanism Loss with Gastrocnemius Flaps

Jepegnanam, Thilak S.; Boopalan, P. R. J. V. C.; Nithyananth, Manasseh; Titus, V. T. K.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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We assessed the outcome after reconstruction of traumatic, complete, infected, extensor mechanism loss attributable to high-velocity open knee injuries in eight consecutive patients (all males) who presented to us between February 2005 and September 2007 at an average followup of 24 months. All were treated with gastrocnemius flaps. The loss in extensor mechanism was the patellar tendon in five patients, patella and patellar tendon in two patients, and combined patella, quadriceps, and patellar tendon in one patient. The size of the defect ranged from 8 × 5 cm to 15 × 15 cm. The patients were evaluated for functional outcome of the knee, resolution of infection, range of flexion of the knee, and return to work. Four patients had an excellent outcome whereas the others had a good outcome using the Hospital for Special Surgery knee rating scale. All flaps healed primarily with resolution of infection. The average knee flexion was 110°. All patients except two returned to their original occupation. Three patients had an extensor lag of 5°. The gastrocnemius flap is a good option for open knee injuries with extensor mechanism loss, giving consistent results across a wide spectrum of presentation.

The Collision of Economics and Politics in Medicaid Managed Care: Reflections on the Course of Reform in Maryland

Oliver, Thomas R.
Fonte: Milbank Memorial Fund Publicador: Milbank Memorial Fund
Tipo: Artigo de Revista Científica
Publicado em /03/1998 EN
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One of the most dynamic areas of health policy is the transition of Medicaid programs to managed care and market competition. Maryland has been a leader in this trend, initiating three different systems of managed care for the Medicaid population during the 1990s as it searched for an ideal plan. The Maryland experience illustrates the complex new demands that policy makers are facing. Health plans are expected not only to deliver budgetary savings, but also to improve the quality of their services and guarantee a place for safety-net providers in their delivery systems. As a result, there is a sizable gap between the original savings projected for the new Maryland system and its actual capacity for cost containment. The apparent collision between economic assumptions and political realities, however, may point the way to a constructive synthesis—a form of managed care that balances economy with important community, professional, and personal values.

Comparison of Parametric and Bootstrap Method in Bioequivalence Test

Ahn, Byung-Jin; Yim, Dong-Seok
Fonte: The Korean Physiological Society and The Korean Society of Pharmacology Publicador: The Korean Physiological Society and The Korean Society of Pharmacology
Tipo: Artigo de Revista Científica
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The estimation of 90% parametric confidence intervals (CIs) of mean AUC and Cmax ratios in bioequivalence (BE) tests are based upon the assumption that formulation effects in log-transformed data are normally distributed. To compare the parametric CIs with those obtained from nonparametric methods we performed repeated estimation of bootstrap-resampled datasets. The AUC and Cmax values from 3 archived datasets were used. BE tests on 1,000 resampled datasets from each archived dataset were performed using SAS (Enterprise Guide Ver.3). Bootstrap nonparametric 90% CIs of formulation effects were then compared with the parametric 90% CIs of the original datasets. The 90% CIs of formulation effects estimated from the 3 archived datasets were slightly different from nonparametric 90% CIs obtained from BE tests on resampled datasets. Histograms and density curves of formulation effects obtained from resampled datasets were similar to those of normal distribution. However, in 2 of 3 resampled log (AUC) datasets, the estimates of formulation effects did not follow the Gaussian distribution. Bias-corrected and accelerated (BCa) CIs, one of the nonparametric CIs of formulation effects, shifted outside the parametric 90% CIs of the archived datasets in these 2 non-normally distributed resampled log (AUC) datasets. Currently...

Telemedicine diagnosis for fetal alcohol syndrome – The Manitoba experience

Benoit, T; Bowes, C; Bowman, N; Cantin, D; Chudley, A; Crolly, D; Livingston, A; Longstaffe, S; Marles, S; Miller, C; Millar, M; Penko, M; Prasad, C; Riguidel, J; Wincott, L
Fonte: Pulsus Group Inc Publicador: Pulsus Group Inc
Tipo: Artigo de Revista Científica
Publicado em /03/2002 EN
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The diagnosis of fetal alcohol syndrome has been possible, with increasing precision, since the original descriptions in the 1970s. Multidisciplinary diagnostic approaches have been recognized as most appropriate, although they are often not available. Telemedicine has been used in Canada over the same time period for a variety of diagnositc applications.

Actions travel with their objects: evidence for dynamic event files

Spapé, Michiel M.; Hommel, Bernhard
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
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Moving a visual object is known to lead to an update of its cognitive representation. Given that object representations have also been shown to include codes describing the actions they were accompanied by, we investigated whether these action codes “move” along with their object. We replicated earlier findings that repeating stimulus and action features enhances performance if other features are repeated, but attenuates performance if they alternate. However, moving the objects in which the stimuli appeared in between two stimulus presentations had a strong impact on the feature bindings that involved location. Taken together, our findings provide evidence that changing the location of an object leaves two memory traces, one referring to its original location (an episodic record) and another referring to the new location (a working-memory trace).

Mucinous Adenocarcinoma Involving the Ovary: Comparative Evaluation of the Classification Algorithms using Tumor Size and Laterality

Jung, Eun Sun; Bae, Jeong Hoon; Lee, Ahwon; Choi, Yeong Jin; Park, Jong-Sup; Lee, Kyo-Young
Fonte: The Korean Academy of Medical Sciences Publicador: The Korean Academy of Medical Sciences
Tipo: Artigo de Revista Científica
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For intraoperative consultation of mucinous adenocarcinoma involving the ovary, it would be useful to have approaching methods in addition to the traditional limited microscopic findings in order to determine the nature of the tumors. Mucinous adenocarcinomas involving the ovaries were evaluated in 91 cases of metastatic mucinous adenocarcinomas and 19 cases of primary mucinous adenocarcinomas using both an original algorithm (unilateral ≥10 cm tumors were considered primary and unilateral <10 cm tumors or bilateral tumors were considered metastatic) and a modified cut-off size algorithm. With 10 cm, 13 cm, and 15 cm size cut-offs, the algorithm correctly classified primary and metastatic tumors in 82.7%, 87.3%, and 89.1% of cases and in 80.6%, 84.9%, and 87.1% of signet ring cell carcinoma (SRC) excluded cases. In total cases and SRC excluded cases, 98.0% and 97.2% of bilateral tumors were metastatic and 100% and 100% of unilateral tumors <10 cm were metastatic, respectively. In total cases and SRC excluded cases, 68.4% and 68.4% of unilateral tumors ≥15 cm were primary, respectively. The diagnostic algorithm using size and laterality, in addition to clinical history, preoperative image findings, and operative findings, is a useful adjunct tool for differentiation of metastatic mucinous adenocarcinomas from primary mucinous adenocarcinomas of the ovary.