Low-dose strontium-90 irradiation is effective in preventing the recurrence of pterygia: a ten-year study

Background

To study the long-term effects of low-dosage strontium-90 (Sr90) irradiation on the recurrence of pterygium.

Methodology/Principal Findings

One hundred twenty eyes from 104 patients with primary or recurrent pterygia were treated with surgery followed by Sr90 irradiation. In brief, starting on the sixth day after surgery, patients were treated with irradiation three times every other day at a total combined dosage of 2000 cGy to 3000 cGy. Corneal topography was used to evaluate ocular surface regularity before and after treatment. Patient follow-up was performed 2 days, 5 days, 2 weeks, 1 month, 3 months, 1 year, 5 years, and 10 years after surgery. Recurrence of pterygium was not observed in any of the patients in this study. Obvious cataract progression was observed in 6 eyes, which may be due to aging. During follow-up studies, only one eye was reported with dryness and foreign-body sensation. Significant pterygium-induced astigmatism was observed in corneal topography, which decreased after surgery.

Conclusions/Significance

Sr90 irradiation is effective in preventing the recurrence of primary and recurrent pterygia. We recommend delivering a total combined dosage of 2000 cGy to 3000 cGy of Sr90 irradiation administered in three batches every other day starting from the sixth day after surgery. Surgery is important in the rapid recovery of the cornea from pterygium-induced astigmatism.     

Histopathological evaluation of recurrent goiter

The recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. An inadequate surgical removal of the thyroid gland, lack of substitution therapy and pathological stimulation of the thyroid growth can all promote the recurrence. The aim of this study was to find the connection between the histopathological findings during the first and second operation and the recurrence of goiter. The study group consisted of 29 women and 1 man. The mean time to recurrence was 15 years. The most frequent histopathological finding during the first and second operation was struma nodosa. According to our observations different histopathological findings were found in 63.4% cases after primary and secondary thyroidectomy. Some genetic investigations showed that nodules in recurrent goiters did not derive from nodules left during the first operation but from a group of cells which had high growth potential. Thus, not only the operation technique and substitution after operation are key factors of successful therapy of goiter, but also other factors which stimulate the re-growth of thyroid tissue.     

Sunlight and incidence of pterygium on Croatian Island Rab--epidemiological study

The aim of this epidemiologic study, on small island Rab, in North Adriatic Sea, is to estimate correlation between climatic factors, specially chronic exposure to strong visible and UV light, and appearance of pterygium and exfoliation syndrome. In the first group of population which live in a village and who are agriculturists and fishermen (480 persons) appearance of pterygium is in 23% (16% in males and 7% in females), but 0.0% in urban people (61 people). The appearance of exfoliation syndrome was in the first group of agriculturists and fishermen population in 21%, of which 19% of males and 2% of females, and in urban people 0.0%. The higher intraocular pressure in exfoliation syndrome was 92%. All population in this examination were in the highest age (mean age is 65-80 years). Chronic exposure to sunlight caused the high percentage appearance of pterygium and exfoliation syndrome.     

Preserved Amniotic Membrane Transplantation for Conjunctival Surface Reconstruction

Objective. To study the efficacy of preserved human amniotic membrane in the reconstruction of conjunctival defect created during surgical removal of conjunctival lesions or symblepharon lysis. Methods. Preserved human amniotic membrane transplantation was performed in 93 eyes of 85 patients for reconstruction of various conjunctival surface problems. The indications for surgery were (1) pterygium excision (54 eyes), (2) conjunctival tumors excision (23 eyes), lysis of symblepharon (13 eyes), and covering a scleral graft (three eyes). Results. Success was noted in 69.9% (65/93) eyes, partially success in 22.6% (21/93) eyes, and failure in 7.5% (7/93) eyes with a mean follow-up of 8.9 months (1–28 months). In pterygium, conjunctival tumor, symblepharon, and scleral graft group, the success rate in each group was 70.3%, 78.3%, 53.8%, and 66.7% respectively. No serious immediate post-operative complications or graft rejection occurred. Conclusion. Amniotic membrane transplantation can be considered an alternative treatment for difficult ocular surface problems, and is effective in promoting epithelial healing, and reducing inflammation and scarring.     

老年翼状胬肉患者翼状胬肉切除与角膜缘干细胞移植联合治疗的疗效观察

摘要 目的：分析评估老年翼状胬肉患者实施翼状胬肉切除与角膜缘干细胞移植联合治疗的临床效果。方法：回顾性纳入的本院2018年08月至2020年07月期间295例翼状胬肉患者（共442只眼）的临床资料,根据术式差异将患者分为联合组（150例,共224只眼）和参照组（145例,共218只眼）,参照组病患仅择取翼状胬肉切除手术,联合组病患于以上基础实施角膜缘干细胞移植术,比较两组病患术前及术后各时间点（1周、1个月、3个月）的BUT、SIt、UCVA、CAD、CAA,统计病患术后3个月的复发情况。结果：两组BUT在术后1周较术前显著缩短（P<0.05）,而在术后1月和3月较术前显著延长（P<0.05）,两组BUT在术后1周对比差别明显（P<0.05）,而其他时间点对比没有明显差别（P>0.05）。两组术前术后SIt对比没有明显差别（P>0.05）,术后1月和3月的两组UCVA均高于术前（P<0.05）,而两组在各时间点UCVA对比没有明显差别（P>0.05）,两组术后各时间点的角膜CAD较术前显著性降低（P<0.05）,而两组角膜CAD在各时间点无明显差别（P>0.05）。两组术后CAA术后3月与术前比较,WR比例显著降低,AR、OA比例显著增加（P<0.05）,而组间对比没有明显差别（P>0.05）。术后复发率联合组（6.67%）与参照组（32.26%）对比有明显差别（P<0.05）。结论：与翼状胬肉切除术比较 ,老年翼状胬肉病患实施翼状胬肉切除与角膜缘干细胞移植术联合治疗对患者早期眼表无较大影响,两种术式均不影响泪液分泌,且能够改善裸眼视力、散光度及轴向,但联合治疗在降低术后复发率方面优势明显。     

Safety and efficacy of human amniotic membrane in primary pterygium surgery

Grafts made from human amniotic membrane are used to prevent recurrence of pterygium after excision. The success of the procedure can be affected by the quality of preparation and preservation of the grafts. We prospectively evaluated the safety and efficacy of cryopreserved amniotic membrane prepared at the research tissue bank of the Biotechnology Research Center in Tripoli, Libya, and used as adjunct therapy in primary pterygium excision. Twenty-six patients (15 males and 11 females) aged 21–78 years and indicated for primary pterygium excision were transplanted at the Tripoli Eye Hospital with the amniotic membrane grafts. Sixteen patients (62 %) were available for all three follow-up visits scheduled at 1, 3 and 6 months post-surgery. By the third visit, two patients (12.5 %) developed granuloma and three (18.8 %) had pterygium recurrence. The grafts were used after cryopreservation for ≤180 days or >180 days, but statistical analysis showed that the complications were not associated with the length of storage. Moreover, the high rate of complications in this study was not caused by use of cryopreserved AM. In conclusion, locally produced cryopreserved AM is safe as an adjunct therapy for treatment of primary pterygium excision.     

Amniotic membrane transplantation for ocular surface reconstruction

The purpose of this study is to analyze the clinical experience and the effect of human amniotic membrane transplantation on pterygium excision and bullous keratopathy. From January 1999 to January 2001 at University Hospital "Sestre milosrdnice" amniotic membrane transplantation was performed consecutively in 21 eyes: 11 eyes with bullous keratopathy and 10 with recurrent pterygia. In the group with bullous keratopathy epithelization took place in 19.6 days in 72.7% and the reduction of pain was satisfactory. Recurrence rate in group with recurrent pterygia was 20%. Based on the presented results it could be concluded that amniotic membrane transplantation can be considered as an effective alternative for treating severe ocular surface diseases and as an alternative for penetrating keratoplasty if there is a lack of grafts.     

Retrospective clinical analysis of free conjunctival autograft in treatment of pterygia

The paper is a clinical retrospective analysis of free conjunctival autograft in treatment of pterygia. In period from 1998 until 2006, 47 patients with pterygia were operated using free conjunctival autograft. There were 19 female and 38 male, average age 61 years. In the majority of patients (39/47) it was a primary pterygia. Eight patients were on topical antiglaucoma therapy. Free autograft was taken from superotemporal conjunctiva. Introduction of a single nylon suture to mark the epithelial side of the graft as well as the use of running 10-0 nylon suture for the graft that stays in up to two months, were our modifications of the standard technique. The mean follow-up was 18.7 +/- 9.8 months. Free conjunctival autograft was successfully taken in all patients. Four of them experienced transient graft edema. In glaucoma patients, delayed healing of the cornea, conjunctival harvest area and the graft was noted. The best corrected visual acuity was improved in all patients, from 1-3 Snellen lines. Recurrence of the pterygium was noted in three patients, two of them already with recurrent pterygium. Free conjunctival graft is a safe and effective method of pterygium surgery that produces only few complications and has low recurrence rate. We found useful switch from topical to systemic antiglaucoma therapy as well as adjunctive use of autologous serum drops in promoting and accelerating healing in glaucoma patients.     

Socioeconomic status and its relation with breast cancer recurrence and survival in young women in the Netherlands

BackgroundAssociations between socioeconomic status (SES) and breast cancer survival are most pronounced in young patients. We further investigated the relation between SES, subsequent recurrent events and mortality in breast cancer patients < 40 years. Using detailed data on all recurrences that occur between date of diagnosis of the primary tumor and last observation, we provide a unique insight in the prognosis of young breast cancer patients according to SES.MethodsAll women < 40 years diagnosed with primary operated stage I-III breast cancer in 2005 were selected from the nationwide population-based Netherlands Cancer Registry. Data on all recurrences within 10 years from primary tumor diagnosis were collected directly from patient files. Recurrence patterns and absolute risks of recurrence, contralateral breast cancer (CBC) and mortality – accounting for competing risks – were analysed according to SES. Relationships between SES, recurrence patterns and excess mortality were estimated using a multivariable joint model, wherein the association between recurrent events and excess mortality (expected mortality derived from the general population) was included.ResultsWe included 525 patients. The 10-year recurrence risk was lowest in high SES (18.1%), highest in low SES (29.8%). Death and CBC as first events were rare. In high, medium and low SES 13.2%, 15.3% and 19.1% died following a recurrence. Low SES patients had shorter median time intervals between diagnosis, first recurrence and 10-year mortality (2.6 and 2.7 years, respectively) compared to high SES (3.5 and 3.3 years, respectively). In multivariable joint modeling, high SES was significantly related to lower recurrence rates over 10-year follow-up, compared to low SES. A strong association between the recurrent event process and excess mortality was found.ConclusionsHigh SES is associated with lower recurrence risks, less subsequent events and better prognosis after recurrence over 10 years than low SES. Breast cancer risk factors, adjuvant treatment adherence and treatment of recurrence may possibly play a role in this association.     

翼状胬肉切除联合自体角膜缘干细胞移植术治疗翼状胬肉的临床疗效分析

目的:研究翼状胬肉切除术联合自体角膜缘干细胞移植治疗翼状胬肉的临床效果。方法:将2010年3月-2015年3月本院收治的105例翼状胬肉患者随机分为观察组和对照组。观察组患者53例,行翼状胬肉切除术联合自体角膜缘干细胞移植;对照组患者50例,行单纯翼状胬肉切除术。比较两组患者手术一般资料、手术前后视力水平、散光程度以及术后3个月和6个月的复发率。结果:术后,观察组角膜上皮修复时间、不适症状持续时间、住院时间均短于对照组;术后视力恢复情况、散光改善程度优于对照组;术后3个月和6个月治愈率显著高于对照组;而观察组术后并发率低于对照组,差异均有统计学意义(P0.05)。结论:翼状胬肉切除术联合自体角膜缘干细胞移植疗效显著、术后复发率低。     

Recurrences after completion of the treatment of acute lymphoblastic leukemia in children]

Within the past 16 years, 2004 children with the acute lymphoblastic leukemia were treated at the Centres of the Polish Pediatric Study Group. The treatment was completed in 887 patients (44.3%) with the first remission. Recurrence was noted in 180 children (20.3%). This group was analysed in view of the type of therapy and its effect on the survival rate, significance of recurrence following therapy, character and localization of recurrent disease, and further fate of patients. It was found, that patients with isolated late nuclear recurrence have greatest chances to achieve subsequent remission. Most frequent and severe is recurrent bone marrow involvement which requires intensive chemotherapy combined with bone marrow transplantation due to unfavourable prognosis. Patients with the first recurrence of the acute lymphoblastic leukemia have a chance to achieve subsequent remission and long-term survival.     

Distinct gene subsets in pterygia formation and recurrence: dissecting complex biological phenomenon using genome wide expression data

Background

Pterygium is a common ocular surface disease characterized by fibrovascular invasion of the cornea and is sight-threatening due to astigmatism, tear film disturbance, or occlusion of the visual axis. However, the mechanisms for formation and post-surgical recurrence of pterygium are not understood, and a valid animal model does not exist. Here, we investigated the possible mechanisms of pterygium pathogenesis and recurrence.

Methods

First we performed a genome wide expression analysis (human Affymetrix Genechip, >22000 genes) with principal component analysis and clustering techniques, and validated expression of key molecules with PCR. The controls for this study were the un-involved conjunctival tissue of the same eye obtained during the surgical resection of the lesions. Interesting molecules were further investigated with immunohistochemistry, Western blots, and comparison with tear proteins from pterygium patients.

Results

Principal component analysis in pterygium indicated a signature of matrix-related structural proteins, including fibronectin-1 (both splice-forms), collagen-1A2, keratin-12 and small proline rich protein-1. Immunofluorescence showed strong expression of keratin-6A in all layers, especially the superficial layers, of pterygium epithelium, but absent in the control, with up-regulation and nuclear accumulation of the cell adhesion molecule CD24 in the pterygium epithelium. Western blot shows increased protein expression of beta-microseminoprotein, a protein up-regulated in human cutaneous squamous cell carcinoma. Gene products of 22 up-regulated genes in pterygium have also been found by us in human tears using nano-electrospray-liquid chromatography/mass spectrometry after pterygium surgery. Recurrent disease was associated with up-regulation of sialophorin, a negative regulator of cell adhesion, and never in mitosis a-5, known to be involved in cell motility.

Conclusion

Aberrant wound healing is therefore a key process in this disease, and strategies in wound remodeling may be appropriate in halting pterygium or its recurrence. For patients demonstrating a profile of 'recurrence', it may be necessary to manage as a poorer prognostic case and perhaps, more adjunctive treatment after resection of the primary lesion.     

Signaling roadmap to epithelial–mesenchymal transition in pterygium,TWIST1 centralized

Pterygium as a complex disease shares common features with other malignant cells in its onset recurrence and especially epithelial–mesenchymal transition (EMT) transition. Although using different approaches including conjunctival autografts, amniotic membrane, radiotherapy, mitomycin C (MMC) has shown promising insights in the inhibition of pterygium recurrence, it needs to be investigated in more details in molecular pathways to present adjuvant target therapy. In this study, we aimed to evaluate the expression of and then illustrate the role of signaling pathways on EMT in pterygium. Using real-time polymerase chain reaction, the twist-related protein 1 (TWIST1) expression was compared in primary pterygium and normal conjunctiva. This study assessed the mRNA expression, as well as the association between the clinicopathological indices and the gene expression level. The expression level of TWIST1 was overexpressed in 36% of our cohort ( n = 76). There was a significant positive correlation between recurrence with grade T, grade V and a significant negative correlation with growth activity. Our vast literature review on different signaling pathways in pterygium showed that EMT has centralization role in recurrence of this disease. Our data confirmed that EMT is important in the recurrence of pterygium samples and different signaling pathways end up activating the EMT markers. It is suggested to evaluate the environmental factors and their correlation with molecular markers to select favorable treatment for this kind of diseases.     

羊膜移植联合低浓度丝裂霉素治疗原发性青光眼的临床疗效

目的:探究羊膜移植联合低浓度丝裂霉素在治疗原发性青光眼的临床疗效。方法:选取2013年6月~2014年1月我院收治的原发性青光眼患者58例(80眼),按照随机数字表法分为观察组(30例,40眼)和对照组(28例,40眼),观察组行小梁切除、羊膜移植联合低浓度丝裂霉素治疗,对照组行小梁切除治疗,比较两组的手术效果及术后并发症情况。结果:观察组术后优良率为97%(38/40),显著优于对照组的75%(28/40),差异有统计学意义(x2=9.764,P=0.008);两组术后1、6个月眼压较术前均明显降低(P0.05),且观察组较对照组更低(P0.05);观察组功能性滤泡明显多于对照组(x2=4.943,P=0.026),术后并发症明显低于对照组(x2=4.501,P=0.034),复发情况明显低于对照组(x2=3.914,P=0.047)。结论:羊膜移植联合低浓度丝裂霉素治疗原发性青光眼能够有效控制眼压,减缓患者视力的丧失,术后并发症及复发率均较低,值得临床推广。     

Recurrence of Subdural Haematoma in a Population-Based Cohort – Risks and Predictive Factors

Objectives

To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients.

Methods

The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 1996–2011. Information on potential predictors was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR) were estimated using Poisson regression.

Results

Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43–1.80), older age (>70 years compared to 20–49 years; RR 1.41, 95% CI: 1.21–1.65), alcohol addiction (RR 1.20, 95% CI:1.04–1.37), surgical treatment (RR 1.76, 95% CI:1.58–1.96), trauma diagnoses (RR 1.14, 95% CI:1.03–1.27), and diabetes mellitus (RR 1.40, 95% CI:1.11–1.74). Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14% for all patients) was found in surgically treated males with diabetes mellitus.

Conclusions

The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed.     

Relapse of differentiated thyroid carcinoma in low-risk patients

INTRODUCTION: The low incidence of relapse in differentiated thyroid carcinoma (DTC), primarily treated by total thyroidectomy and (131)I ablation, stimulates the search for optimal follow-up algorithms which do not include too many tests but are not connected with a risk of missing early recurrence. The aim of the study was to analyze the impact of the routine follow up examinations for early detection of DTC recurrence in low risk DTC patients. MATERIAL AND METHODS: The group consisted of 617 DTC patients diagnosed in 1995-1996. In 513 (83%) total thyroidectomy was performed. 449 (73%) received ablative (131)I therapy. After primary approach complete remission (CR) was stated in 453 (73%), persistent disease in 116 (19%), asymptomatic hyperthyroglobulinaemia in 14 (2%). Patients with CR constituted the low risk group analyzed in this study. The median follow up was 4.16 yrs. RESULTS: Recurrent disease appeared in 28 (6%) patients (23 locoregional, 9 distant metastases, both in 4). Serum Tg (thyroglobulin) level at the moment of relapse diagnosis was detectable in 44% while neck sonography was the first examination to detect recurrence in 56% of cases. CONCLUSION: In the selected group of DTC patients treated by radical primary approach and showing a low risk of recurrence only half of all relapse cases are diagnosed by the rise of serum Tg level. Regular sonography contributes to the second half of diagnoses. Thus, a special weight should be put on neck sonography as the important element of regular follow up in low risk DTC patients.     

Prognostic factors for post-recurrence survival among patients with locally advanced cervical cancer who underwent definitive concurrent chemoradiation

BackgroundThe prognostic factors affecting post-recurrence survival (PRS) in patients with locally advanced cervical cancer (LACC) who receive concurrent chemoradiation (CCRT) are not well established. This study aimed to assess the prognostic factors for PRS in patients with recurrent LACC who underwent CCRT as the primary treatment.Materials and methodsWe retrospectively reviewed the medical records of patients with a first recurrence of cervical cancer (stage IB2–IVA), who were initially treated with CCRT and completed the planned radiotherapy from 2002 to 2018. Multivariate analysis of independent factors for PRS was performed with the Cox proportional-hazards model.ResultsOf 1,658 patients with LACC primarily treated with CCRT, 424 (25.6%) had recurrence, with 142, 125, and 157 patients having locoregional, distant, and combined recurrence, respectively. Approximately 75% of recurrence cases were detected within 2 years after completed treatment, and 81.8% of cases demonstrated symptoms at recurrence diagnosis. The median PRS was 8.4 months, and the 1- and 5-year PRS rates were 36.0% and 5.3%, respectively. Multivariate analysis found that the recurrence-free interval (RFI) (p < 0.001), recurrence pattern (p < 0.001), white blood cell count (p < 0.001), and treatment at recurrence (p < 0.001) were independent prognostic factors for PRS.ConclusionThe prognosis of recurrent LACC initially treated with CCRT was notably poor. RFI, recurrence pattern, white blood cell count, and treatment at recurrence were independent prognostic factors for PRS.     

Modified operative technique for involutional lower lid entropion

The paper presents a modified operative technique for involutional lower lid entropion. The prospective noncomparative study of 101 lower eyelids of 88 patients undergoing surgery for involutional lower lid entropion was conducted in period from September 2005 until March 2012. Indication for the surgery was entropion, previously untreated, with moderate to severe horizontal lid laxity and no clinically relevant medial and lateral canthal tendon laxity. The operative technique is our modification of Quickert and Jones procedures. Photo was taken preoperatively and one month after surgery. Clinical follow-up was at 7th postoperative day, one month and six months after surgery and in case of the recurrence. Long-term follow-up was obtained via telephone interviews. There were 44 male (50%) and 44 female (50%) patients included in the study. The age of patients was in average 73.27 +/- 8.1 years (range 53-90 years). Early postoperative complication was localized lid swelling found in two patients starting 4-6 weeks postoperatively at the area of absorbable suture. It resolved spontaneously in two and three weeks respectively. There was recurrence of entropion in 11 eyelids (10.89%) of 10 patients. The mean interval between primary surgery and the recurrence was 17.45 +/- 14.84 months (range 4-48 months). In these eyelids Jones procedure was performed. However in four eyelids of four patients from the recurrent group an additional surgery needed to be performed after 6, 12, 12 and 17 months respectively. Our modification of surgical treatment for involutional lower lid entropion was effective in 89.11% of eyelids. Complications of the procedure were scarce.     

Recurrent malignant melanoma: effect of adjuvant immunotherapy on survival.

Twenty-nine patients referred consecutively to a cancer clinic because of recurrent metastatic malignant melanoma were given 5 mg of Connaught Laboratories bacillus Calmette-Guérin (BCG) by multiple cutaneous puncture at weekly and later at monthly intervals. Eight were also treated with autologous tumour vaccine and three with intralesional BCG. This group was compared with a retrospective control group of 54 patients treated with surgery and radiotherapy alone after recurrence. Prognostic features such as site of primary and of first metastasis, disease-free interval, age and sex were similar in the two groups. However, the median survival from the time of first recurrence was 12 months in the control group but 21 months in the BCG-treated group. The major improvement was in patients with disease limited to the regional lymph nodes: the median survival was 16 months in the control group but over 32 months in the BCG-treated group. Autologous tumour vaccine appeared to have no effect on survival. Serial testing of immunocompetence did not offer any prognostic advantage, although the results of some tests correleated well with extent of disease.