RECURRENCE RATE AFTER REPEAT TRANSURETHRAL RESECTION AMONG PATIENTS WITH NEWLY DIAGNOSED T1 BLADDER CANCER

2021 ◽  
pp. 51-54
Author(s):  
Md. Shafiqur Rahman ◽  
Sanjeeb Bhakta Bista ◽  
Md. Sayedul Islam ◽  
A. S. M. Shafiul Azam ◽  
Md. Shamim Hossain ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Recurrence Rate ◽  
Transurethral Resection ◽  
Tumor Recurrence ◽  
Controlled Trial ◽  
Intravesical Therapy ◽  
Newly Diagnosed ◽  
Group I ◽  
Group Ii

Background: Transurethral resection of the bladder tumor (TURBT) is the cornerstone of diagnosis and TURBT followed by selective adjuvant intravesical chemotherapy or immunotherapy is the gold standard of treatment for the patients with non-muscle invasive bladder cancer (NMIBC). Even after complete resection of the tumor there is high risk of residual tumor and subsequent recurrence and progression of the disease. The recurrence of T1 tumor is found to be around 71 % within 5 years and High grade T1 lesions recur in more than 80% of the cases and progress in 50% of the patients within 3 years. Disease status at 3 months after initial resection is an important predictor of subsequent recurrence and progression. To assess the tumor recurrence rat Objective: e among patients with newly diagnosed T1 bladder cancer between repeat transurethral resection group and single TURBT group. Ra Type of study: ndomized controlled trial. Place of study: Department of urology, BSMMU, Dhaka, Bangladesh. This Randomi Materials And Methods: zed Controlled Trial was conducted in urology department of BSMMU, Dhaka, Bangladesh from February 2017 till September 2018. A total of 50 patients, diagnosed as a case of T1 bladder cancer and who fulll the selection criteria were randomly divided in two groups consisting of 25 patients in each group. After informed consent, repeat TUR was done after 4 weeks of the initial TURBT for only 22 patients in group I since 3 of the patients did not show up on the scheduled date of surgery. Whereas, repeat TUR was not done for other 25 patients in group II. All the patients in both the groups were further treated with intravesical therapy according to the histopathological report. The patients in both the groups were followed up at 3 months and 6 months of the initial intervention where detailed history was taken, relevant investigations were done and check cystoscopy was done. TURBT was done for recurrent tumors. Out of 22 patients in group I, 2 patients were excluded for follow up on the basis of repeat TUR ndings. Whereas in group II, 2 patients missed the follow up and one of them missed the normal scheduled dose of intravesical therapy. Hence, 22 patients completed the study in group II. The baseline variables like age and Results: sex were similar in both the groups with higher male predominance. There was no statistical signicant difference in tumor characteristics such as size, number and grade of the tumor between the two groups. Out of 22 patients in group I who underwent repeat TUR at 4 weeks of initial TUR, residual disease was found in 8 (36.36%) patients. One of the patient was found to have T2 disease and 1 patient had CIS during repeat TUR. These 2 patients were not followed up since the treatment strategy changed after the results of repeat TUR. After 6 months of follow up of all the patients, 2 (10%) out of 20 patients in group I were found to have tumor recurrence however, in group II, 9 (40.9%) patients had tumor recurrence. The tumor recurrence rate between the two groups was found to be statistically signicant (p=0.023). In the light of ndings of this Conclusion: study, it can be concluded that performing repeat transurethral resection in patients with newly diagnosed T1 bladder cancer at 4 weeks of initial TURBT, helps to detect signicant number of residual tumor and reduce early recurrence rate of the tumor.

scholarly journals Evaluation of Biting Force of New Design of Extracoronal Castable Precision Attachment versus Conventional Partial Denture for Treatment of Unilateral Mandibular Distal Extension Area: A Randomized Controlled Trial

2020 ◽  
Vol 8 (D) ◽  
pp. 23-28
Author(s):  
Mohamed Afify ◽  
M. Helmy ◽  
N. Abbas
Keyword(s):  
Controlled Trial ◽  
Removable Partial Denture ◽  
Partial Denture ◽  
Masticatory Efficiency ◽  
Group I ◽  
Group Ii ◽  
Treatment Summary ◽  
Post Hoc ◽  
Distal Extension

PURPOSE: The aim of this study was to evaluate biting force of patients with unilateral mandibular distal extension area treated with two different designs of the removable partial denture (RPD), conventional RPD, and new design of extracoronal castable precision attachment (OT Unilateral attachment). MATERIALS AND METHODS: This study was conducted on 16 patients with unilateral mandibular distal extension area with the second premolar is the last abutment teeth. The patients were divided into two equal groups, Group I received conventional RPD, which provides cross arch stabilization and a double Aker clasp was fabricated. Group II received new design of extracoronal castable precision attachment (OT Unilateral attachment). Evaluation of biting force by loadstar sensor, patients of both groups were evaluated at the time of prosthesis insertion, 3, 6, and 1 year later. Statistical analysis performing one-way analysis of variance followed by Tukey’s post hoc test to compare between all follow-up periods within each group, comparison between two groups regarding each follow-up period was performed by independent t-test. RESULTS: Both treatments yielded better after-treatment summary when compared with the baseline; however, better results were obtained and showed a statistically significant increase in Group II (OT unilateral design), especially after 3, 6 months, and 1 year later. CONCLUSION: From the results of this study, it was concluded that: It is preferable to use the new design of extracoronal castable precision attachment (OT unilateral) being simpler, more comfortable to the patients and give high masticatory efficiency in the form of biting force than conventional RPD.  

scholarly journals Prospective Randomized Study between Intravesical BCG and Mitomycin-C for Non-Muscle-Invasive Urothelial Carcinoma of Urinary-Bladder Post TURBT

2016 ◽  
Vol 15 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Hari Pada Mondal ◽  
Kapang Yirang ◽  
Chandranath Mukhopadhyay ◽  
Shyam Sundar Adhikary ◽  
Biswajit Dutta ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Side Effects ◽  
Urinary Bladder ◽  
Mitomycin C ◽  
Recurrence Rate ◽  
Long Term Results ◽  
Intravesical Therapy ◽  
Intravesical Bcg ◽  
Muscle Invasive

Background: Approximately 70% of urinary bladder cancer are non-muscle invasive at presentation. It is notorious for its high incidence and recurrence rate. The five-year recurrence rate varies between 30 and 60%. The intravesical treatment evolved out of need to prevent tumour recurrence after local surgical resection.Objectives: To compare intravesical Mitomycin C and BCG therapies in the prevention of recurrences and severity of their side effects.Materials and Methods: 40 patients with superficial bladder cancer were studied in urology unit of surgery department of North Bengal Medical College, Darjeeling from June, 2012 to May, 2013. They underwent transurethral resection of bladder tumour. Post operatively 19 patients were treated by intravesical Mitomycin C and 21 patients with BCG. Post intravesical therapy, patients were monitored 3 monthly for recurrence and side effects.Results: No recurrence was observed at the 3rd month follow up, two recurrences were observed at the end of 6th month in the Mitomycin C group. Regarding side effects, cystitis had no significant difference between the two groups but fever, hematuria and retention of urine were found significantly in BCG group during the study period.Conclusions: In the prevention of recurrences, intravesical Mitomycin C and BCG therapies have comparable efficacies at the end of 6 months. A further follow up period is required to see and compare the long term results. The incidence of the side effects although mild was much higher with intravesical BCG therapy.Bangladesh Journal of Medical Science Vol.15(1) 2016 p.74-77

Single-arm phase I/II study of the safety and efficacy of OncoTherad immunomodulator in patients BCG-refractory or relapsed non-muscle invasive bladder cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e16000-e16000
Author(s):  
Wagner José Fávaro ◽  
Sonia Regina Iantas ◽  
Juliana Mattoso Gonçalves ◽  
Eduardo Augusto Rabelo Socca ◽  
Nelson Duran ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Phase I ◽  
Tumor Recurrence ◽  
Invasive Bladder Cancer ◽  
Intravesical Therapy ◽  
Urinary Cytology ◽  
Effective Treatment Option ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

e16000 Background: There is no effective intravesical second-line therapy for high-grade non-muscle-invasive bladder cancer (HGNMIBC) when Bacillus Calmette-Guerin (BCG) fails. In this scenario, a new perspective is represented by OncoTherad immunomodulator. OncoTherad is a nanostructured inorganic phosphate complex associated to glycosidic protein, developed by University of Campinas/ Brazil, which exhibits antitumor properties. The aims of the study were to evaluate the efficacy and safety of OncoTherad immunomodulator for BCG-refractory or relapsed HGNMIBC. Methods: We carried out a prospective, single-center (Municipal Hospital of Paulinia, São Paulo, Brazil), single-arm phase I/II study in 15 (10 male, 5 female) consecutive patients with HGNMIBC-refractory or relapsed (≥ 1 previous course of BCG intravesical therapy). Patients with muscle-invasive disease were excluded. OncoTherad regimen consisted of an induction course of 6 weekly intravesical instillations followed by a maintenance course of 1 monthly instillation until completing 1 year of treatment. Follow-up was performed with systematic mapping biopsies of the bladder, cystoscopy, ultrasound and urinary cytology. The primary endpoint was recurrence-free survival (RFS) rate, and secondary endpoint was safety response. The recurrence was defined as histology proven tumor recurrence (any grade), and monitored at 3-month intervals. Results: The median age and follow-up were 71 years and 14.0 months, respectively. A 14-months RFS rate in all patients was 86.7%. Only 2 patients (13.3%) showed recurrence during follow-up, however these patients showed incipient malignant lesions (downstaging of pT1G3 to pTaG1). Regarding toxicity, we reported moderate adverse systemic event of hypersensitivity to OncoTherad in 2 patients (13.3%), and minimal local side effects (dysuria and cystitis)in 6 patients (40.0%). Conclusions: In conclusion, OncoTherad seems a safe and effective treatment option for BCG-refractory or relapsed HGNMIBC patients and may provide benefit for preventing tumor recurrence. We report a RFS rate of 86.7% (14.0 months), potentially avoiding or postponing the need for radical surgery in these patients. Clinical trial information: CAAE: 93619718.7.0000.5404.

scholarly journals Clinical Research on the Postoperative Recurrence of Non Muscle-Invasive Bladder Cancer

2018 ◽  
Vol 2 (1) ◽  
pp. 6-9
Author(s):  
Hui Xu ◽  
Chang-Li Xu ◽  
Jin-Qi Song ◽  
Ya-Nan Zhou
Keyword(s):  
Bladder Cancer ◽  
Clinical Research ◽  
Recurrence Rate ◽  
Tumor Size ◽  
Tumor Recurrence ◽  
Tumor Grade ◽  
Tumor Stage ◽  
Muscle Invasive Bladder Cancer ◽  
Muscle Invasive

Background: Bladder cancer is a common malignant tumor in the urinary system, in which non muscle-invasive bladder cancer (NMIBC) is the most common. The recurrence rate of the patients after operation is high, which has a serious impact on the physical and mental health of the patients. Therefore, how to reduce the recurrence rate of NMIBC patients is the focus of clinical research. Objectives: To study the recurrent factor of NMIBC after surgery for promotion of therapeutic efficacy. Methods: Retrospective analysis of one hundred patients of carcinoma of urinary bladder were consecutively enrolled and data on gender, age, tumor stage, tumor grade, tumor size, tumor configuration, multiplicity, date of surgery, tumor histology, recurrence history, resident area, frequency of tumor recurrence, follow-up history as screening target to analyze by Cox proportional-risk model, and screen dependent factor which can be used to predict tumor recurrent risk after surgery. Results: Tumor size, tumor stage, tumor grade, frequency of tumor recurrence, multiplicity and history of regular follow-up are related to NMIBC recurrence after surgery. Conclusion: Aggregate analysis of these factors can evaluate recurrent risk of NMIBC and it is significant to the therapy of NMIBC.

Prognostic Implication of Somatic Mutations By Next Generation Sequencing: An Analysis from the Mmrf Commpass Study in Newly Diagnosed Multiple Myeloma Patients

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 2079-2079
Author(s):  
Mattia D'Agostino ◽  
Stefania Oliva ◽  
Alessandra Larocca ◽  
Stefano Spada ◽  
Manuela Gambella ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Board Of Directors ◽  
Cox Model ◽  
Newly Diagnosed ◽  
Advisory Committees ◽  
Group Iii ◽  
Mutational Status ◽  
Group I ◽  
Group Ii

Abstract Introduction: High throughput techniques, such as massively parallel sequencing, are becoming an attractive approach to characterize multiple myeloma (MM) genomic profiles. However, the clinical relevance and contribution to risk assessment of such approaches need to be established. The Multiple Myeloma Research Foundation (MMRF)CoMMpass trial (NCT01454297) has collected data from 1000 newly-diagnosed MM patients enrolled worldwide and observed through an expected follow-up of up to eight-years. Comprehensive analysis of somatic mutations detected in purified MM cells could reveal disease features with prognostic value, which may not have been detected using traditional approaches. Materials and methods: We analyzed data from the interim analysis 8 cohort. CD138+ purified MM specimens from bone marrow aspirates and mononuclear cells from peripheral blood were collected at diagnosis. Whole exome libraries from both tumor and constitutional DNA samples were created. Somatic single nucleotide variants (SNV) were identified using three different variant callers (Seurat,Strelka andMutect), only nonsynonymous SNV calls made from at least two callers were included in the analysis. Patients were analyzed on an intention-to-treat basis. We evaluated the impact on progression free survival (PFS) of recurrently mutated genes (with at least a nonsynonymous SNV in more than 10 patients) in a Cox model adjusted for international staging system (ISS) and cytogenetic profile (high risk, standard risk and missing). An additive score related to mutated genes was calculated on the basis the level of each coefficient estimated using a Cox Model with backward selection based on theAkaikeInformation Criterion (AIC). Results: 517 patients with baseline somatic mutation data were included in the analysis. Median age at diagnosis was 64 years (range 27-93). All patients received novel agents as first line treatment; 236 (45.6%) received autologous stem cell transplantation (ASCT). Each patient showed a median number of 55 nonsynonymous somatic SNV (range 8-1970) in a median number of 47 genes (range 5-1741). Excluding immunoglobulin genes, the most recurrent mutated genes were KRAS (25%), NRAS (19.5%), TTN (12.1%), MUC16 (9.1%) and DIS3 (9.1%). Based on the results of a multivariable Cox model corrected for ISS and cytogeneticprofile, we created a scoring system determined by the mutational status of 9 genes identified in a nonbiased manner (Table 1). Three groups were identified: group I (score 0-2, 17%); group II (score=3, 51%), and group III (score >3, 32%). After a median follow-up of 371 days, the 18-month PFS rate was 93% for group I, 85% for group II, and 67% for group III. In a Cox model adjusted for ISS and cytogeneticprofile, the hazard ratio was 2.34 (p=0.112) for group II versus group I, and 5.96 (p<0.001) for group III versus I. The prognostic trend of the score was confirmed in different patient subgroups including ASCT/no ASCT, standard/high risk cytogenetic profile, ISS I, II, or III. Of note, 23.3% of patients in group I had an ISS III and 30.4% of patients in group III had an ISS I. Conclusion: The use of a prognostic model based on the mutational status of 9 recurrently mutated genes could improve risk assessment of newly-diagnosed MM patients. To our knowledge, this is the largest study correlating nonsynonymous somatic SNV with MM patients' outcome. Longer follow-up and validation in independent cohorts are needed to confirm our findings. Disclosures Larocca: Amgen, Celgene, BMS, Janssen-Cilag: Honoraria. Gay:Amgen: Honoraria; Bristol-Myers Squibb: Honoraria; Celgene: Honoraria; Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Mundipharma: Membership on an entity's Board of Directors or advisory committees. Palumbo:Janssen Cilag: Honoraria; Takeda: Employment, Honoraria.

Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome

2021 ◽  
Vol 15 (8) ◽  
pp. 2522-2524
Author(s):  
Zahid Khan ◽  
Muhammad Habib Khan ◽  
Shah Hussain ◽  
Jehan Badshah ◽  
Riaz Uddin ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Recurrence Rate ◽  
Distress Syndrome ◽  
Efficacy And Safety ◽  
Group 13 ◽  
Group I ◽  
Group Ii

Objective: The aim of this study is to determine the efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. Study Design: Randomized Control Trial Place and Duration: The study was conducted at the emergency department of Lady Reading hospital Peshawar for the duration of six months during the period July to December 2020. Methods: Total 150 patients suffering from acute respiratory distress syndrome were presented in this study. Patients were aged between 40-75 years. Patients’ detailed demographics age, sex and body mass index were recorded after taking informed written consent. Patients were equally divided into-2 groups. Group I received corticosteroids and group II received placebo for 7-days of duration. At 28th day efficacy among both groups were assessed and compared in terms of low mortality, free from ventilator and reduction in complications. Complete data was analyzed by SPSS 24.0 version. Results: There were 120 males (60 in each group) and 30 (15 in each group) were females. Mean age of the patients in group I was 59.14±6.45 years with mean BMI 25.88±3.42 kg/m2 and in group II mean age was 58.38±7.46 years with mean BMI 26.41±3.54 kg/m2.Smoking was the most common cause of ARDS, in group I among 40 (53.3%) patients and 42 (56%), followed by chronic lung disease 20 (26.7%) in group I and 19 (25.3%) in group II. After regular follow up, mortality rate among patients of group II was greater 18 (24%) as compared to steroids group 13 (17.3%) and frequency of ventilator free patients were higher among steroids group 39 (52%) as compared to placebo 31 (41.3%). We found that complications reduction in steroids group was greater with minimum recurrence rate. Conclusion: We concluded in this study that the use of corticosteroids for persistent acute respiratory distress syndrome was effective and reliable in terms of low mortality and shorten the time of ventilation. Except this reduction in complications with minimum recurrence rate was found among patients those received steroids. Keywords: Acute respiratory distress syndrome, Placebo, Corticosteroids, Efficacy, Ventilator

scholarly journals THU0490 DEEP FRICTION MASSAGE VERSUS LOCAL STEROID INJECTION FOR TREATMENT OF PLANTAR FASCIITIS: A RANDOMIZED CONTROLLED TRIAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 482.3-482
Author(s):  
A. Moshrif ◽  
M. Elwan ◽  
U. Daifallah
Keyword(s):  
Steroid Injection ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Group I ◽  
Local Steroid Injection ◽  
The Mean ◽  
Group Ii ◽  
And Function ◽  
To Receive

Background:Deep friction massage (DFM) has long been proven to be effective in the treatment of some tendinopathies.Objectives:to evaluate the efficacy of DFM in the treatment of plantar fasciitis (PF) in comparison with local steroid injection.Methods:In this randomized controlled trial, 60 patients with PF were selected from those attending the rheumatology and rehabilitation outpatient clinic and then randomized to receive either 40 mg triamcinolone local injection (group I: 30 patients; 41 heals) using the medial approach or to receive seven sessions of deep transverse friction massage (10 min each) every other day (group II: 30 patients; 36 heels). The outcome measures were the pain and function assessment by visual analog scale and foot function index, respectively, at 2 and 6 weeks of follow-up.Results:Demographic data showed a statistically insignificant difference in age, female to male ratio, and BMI in both groups. The mean age was 39.42 years in group I and 41.32 years in group II (P=0.86). The female to male ratio was 3: 1 in group I and 2.75: 1 in group II, and the mean BMI was 32.41 in group I and 33.31 in group II (P=0.51). At 2 and 6 weeks of follow-up, DFM led to less improvement in pain and function compared with local steroid injection (P=0.001 and 0.002, respectively, at both time points of follow-up).Conclusion:This study revealed that DFM is not effective as a single modality in treatment of PF. Further large-scale studies are needed to support this observation.Disclosure of Interests: :None declared

Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

2021 ◽  
pp. 105566562110251
Author(s):  
Vijay Kumar ◽  
Vidya Rattan ◽  
Sachin Rai ◽  
Satinder Pal Singh ◽  
Jai Kumar Mahajan
Keyword(s):  
Bone Graft ◽  
Iliac Crest ◽  
Demineralized Bone Matrix ◽  
Bone Matrix ◽  
Volumetric Analysis ◽  
Group I ◽  
Alveolar Bone Grafting ◽  
Group Ii ◽  
Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

scholarly journals Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears

2020 ◽  
Vol 47 (1) ◽  
Author(s):  
Samah M. Alian ◽  
Rabab S. Zaghlol ◽  
Sahar S. Khalil
Keyword(s):  
Shock Wave ◽  
Outcome Measures ◽  
Platelet Rich Plasma ◽  
Extracorporeal Shock Wave Therapy ◽  
Shock Wave Therapy ◽  
Tendon Tear ◽  
Extracorporeal Shock Wave ◽  
Group I ◽  
Group Ii

Abstract Background To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear. Results Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed. Conclusion Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.

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