Posttreatment Follow-up Of Patients Research Articles

Evaluation of the ELITechGroup solution for plasma HIV-1 RNA quantification

In the last few years, many manufacturers have developed new kits for plasma HIV-1 RNA quantification. Recently, a solution consisting of the ELITe InGenius® instrument and the HIV1 ELITe MGB®kit has been commercialized worldwide. Our aim was to compare its clinical performance with the Aptima® HIV-1 Quant Dx kit by Hologic, on a panel of HIV-1 group M circulating variants, representative of viral load levels found during the pre- and post-treatment follow-up of patients. The linearity was evaluated on the AcroMetrix® HIV-1 Panel. Clinical specificity was evaluated on 100 plasma samples negative for HIV; and clinical sensitivity and sequential follow-up were evaluated on 166 HIV-1 positive plasma samples from 126 patients. The linearity data showed a difference obtained for each point of less than 0.2 Log cp/mL. No amplification was found for the 100 HIV negative clinical specimens. The overall agreement between the two kits was 83.7 %; the differences corresponded to a slightly higher detection for the Aptima kit (with more samples detected below the lower limit of quantification). A Bland & Altman analysis of the quantifiable samples showed a mean difference of −0.05 Log and Spearman's coefficient was 0.975. Only six samples presented discrepancies (above 0.5 Log), but these differences were overall similar between the two kits. Our study has shown that the HIV1 ELITe MGB® Kit can be successfully used for the monitoring of patients infected with various epidemic HIV-1 strains, and for the precise quantification of the viral load.

Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial

BackgroundPrevious studies have shown positive results of pain neuroscience education (PNE) combined with exercise in patients with chronic musculoskeletal disorders. However, the effects of this intervention in patients with carpal tunnel syndrome (CTS) admitted to a telerehabilitation program remain unexplored. ObjectiveTo compare the effectiveness of a 6-week telerehabilitation program based on PNE + exercise versus exercise alone on patient-reported outcomes after treatment and at 6-weeks post-treatment follow-up in patients with CTS awaiting surgery. DesignRandomized controlled trial. MethodsThirty participants were randomly assigned to the PNE + exercise or exercise-only group. Outcome measures included pain intensity, pain catastrophizing, kinesiophobia, symptom severity, function, symptoms of anxiety and depression, quality of life, self-perception of improvement. Inferential analyses of the data were performed using a two-factor mixed analysis of variance. ResultsTwenty-five participants completed the study. A significant time × group interaction with a large effect size was observed for kinesiophobia (F = 6.67, p = 0.005, ηp2 = 0.225) and symptom severity (F = 4.82, p = 0.013, ηp2 = 0.173). No significant interaction was observed for the other variables (p > 0.05). A significant difference in self-perceived improvement was observed in favor of the PNE + exercise group after treatment (p < 0.05). Although there were significant and clinically relevant improvements within the PNE + exercise group in pain intensity and catastrophizing, there were no significant differences between the groups. ConclusionsThe addition of PNE to a telerehabilitation exercise program showed short-term improvements in kinesiophobia and symptom severity and greater self-perceived improvement in patients with CTS awaiting surgery. This study highlighted the benefits of including PNE in telerehabilitation interventions for patients with CTS.

Pulmonary Screening Practices of Otolaryngology-Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study.

BackgroundWith respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract.ObjectiveOur cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC.MethodsThis nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out.ResultsThis study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective.ConclusionsThe participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective.

Highly sensitive electrochemical immunosensor using a protein-polyvinylidene fluoride nanocomposite for human thyroglobulin

The highly sensitive detection of serum thyroglobulin (Tg) is essential in the post-treatment follow-up of patients with differentiated thyroid cancer undergoing total or partial thyroidectomy and radioactive iodine ablation and requires sensitive, accurate and stable methods. This work proposes an electrochemical immunosensor for the detection of serum Tg antigen, making use of innovative nanocomposites including polyvinylidene fluoride (PVDF) microparticles coated with streptavidin (MP) and gold nanoparticles (AuNPs). The functionalized polymer matrices were characterized by UV–Vis, FTIR, XPS, SEM, dynamic light scattering, and free surface energy. Immobilization of biotin-labeled anti-thyroglobulin monoclonal antibodies was achieved by binding these to the polymer nanocomposite via streptavidin proteins. The analytical response was measured in quintuplicate and had a linear profile from 2.0 to 10.0 ng/mL Tg, with r2 of 0.985. The limits of detection and quantification were excellent, equal to 0.015 and 0.047 ng/mL, respectively. In addition, the recovery factor was equal to 95.4% (1.0 ng/mL Tg). Overall, the innovative polymer-based nanocomposite used herein enabled the production of an electrochemical-based immunosensor with excellent sensitivity, selectivity, and reproducibility. It evidenced the remarkable potential of determining low levels of Tg in in vitro assays, thereby suggesting that it may be considered for the analyzes of serum patients.

Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study

BackgroundAn accurate test for the diagnosis and post-treatment follow-up of patients with schistosomiasis is needed. We assessed the performance of different laboratory parameters, including the up-converting reporter particle technology lateral flow assay to detect circulating anodic antigen (UCP-LF CAA), for the post-treatment follow-up of schistosomiasis in migrants attending a dedicated outpatient clinic in a non-endemic country.MethodsRoutine anti-Schistosoma serology results and eosinophil counts were obtained of patients with positive urine/stool microscopy and/or PCR (confirmed cases) or only positive serology (possible cases), and at least one follow-up visit at 6 (T6) or 12 (T12) months after praziquantel treatment. All sera samples were tested with the UCP-LF CAA assay.ResultsForty-eight patients were included, 23 confirmed and 25 possible cases. The percentage seropositivity and median antibody titers did not change significantly during follow-up. UCP-LF CAA was positive in 86.9% of confirmed and 20% of possible cases. The percentage positivity and median CAA levels decreased significantly post-treatment, with only two patients having positive CAA levels at T12.ConclusionsThe UCP-LF CAA assay proved useful for the diagnosis of active infection with Schistosoma spp. and highly valuable for post-treatment monitoring in migrants, encouraging the development of a commercial test.Graphical

Is it possible to personalize the post-treatment follow-up of patients treated for oral squamous cell carcinoma based on their clinical and pathological risk factors?

Is it possible to personalize the post-treatment follow-up of patients treated for oral squamous cell carcinoma based on their clinical and pathological risk factors?

First-Pass Contrast-Enhanced MR Angiography in Evaluation of Treated Spinal Arteriovenous Fistulas: Is Catheter Angiography Necessary?

Catheter angiography is typically used for follow-up of treated spinal AVFs. The purpose of this study was to determine the diagnostic performance and utility of first-pass contrast-enhanced MRA in the posttreatment evaluation of spinal AVFs compared with DSA. A retrospective review was performed of all patients at our tertiary referral hospital (from January 2000 to April 2015) who underwent spine MR imaging, first-pass contrast-enhanced MRA, and DSA after surgical and/or endovascular treatment of a spinal AVF. Presence of recurrent or residual fistula on MRA, including vertebral level of the recurrent/residual fistula, was evaluated by 2 experienced neuroradiologists blinded to DSA findings. Posttreatment conventional MR imaging findings were also evaluated, including presence of intramedullary T2 hyperintensity, perimedullary serpentine flow voids, and cord enhancement. The performance of MRA and MR imaging findings for diagnosis of recurrent/residual fistula was determined by using DSA as the criterion standard. In total, 28 posttreatment paired MR imaging/MRA and DSA studies were evaluated in 22 patients with prior spinal AVF and 1 patient with intracranial AVF with prior cervical perimedullary venous drainage. Six image sets of 5 patients demonstrated recurrent/residual disease at DSA. MRA correctly identified all cases with recurrent/residual disease with 1 false-positive (sensitivity, 100%; specificity 95%; P < .001), with correct localization in all cases without interobserver disagreement. Conventional MR imaging parameters were not significantly associated with recurrent/residual spinal AVF. First-pass MRA demonstrates high sensitivity and specificity for identifying recurrent/residual spinal AVFs and may potentially substitute for DSA in the posttreatment follow-up of patients with spinal AVFs.

Diapeutic cancer-targeting alkylphosphocholine analogs may advance management of brain malignancies.

The following is a special report on alkylphosphocholine analogs as targeted imaging and therapy agents for cancer, and their potential role in diagnosis and treatment in glioblastoma and brain metastases. These novel cancer-targeting agents display impressive tumor avidity with low background in the normal brain, and multimodal diagnostic imaging and therapy capabilities. The use of these agents may significantly improve diagnosis, treatment and post-treatment follow-up in patients with brain malignancies.

Evaluation of Treatment of Ear Lobe Keloid with Triamcinolone Injection and Surgical Excision

The study includes 42 consecutive patients with 68 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40mg/ml (Group 1) and 20 mg/ml (Group 2). Different volume of TCN infiltrate according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more infiltration of TCN within two months. Post-treatment follow-up of patients was done for12 months. RESULTS: TCN at concentrations of 20mg/ml and 40mg/ml were effective for the treatment of keloids along with surgical excision,no difference between the groups (p = 0.73). CONCLUSION: The combination of infiltration of TCN monthly (1.2mg to 2.0mg per mm 3 ) and surgical

Assesment of the treatment of earlobe keloids with triamcinolone injections, surgical resection, and local pressure.

To evaluate the combined treatment of ear lobe keloids. We studied 46 consecutive patients with 81 ear lobe keloids. Patients underwent local infiltration of triamcinolone acetonide (TCN) at concentrations of 40 mg/ml (Group 1), 20 mg/ml (Group 2) and 10mg/ml (Group 3). The volume of TCN infiltrate varied according to the size of the lesion. Treatment consisted of three monthly injections before surgery, excision of keloid in the fourth month and perioperative infiltration, followed by two more leaks TCN within two months. Patients used earrings pressure on the scar after operation for four months. The pressure exerted by earrings in the ear lobe was measured electronically. Post-treatment follow-up of patients was 24 months. TCN at concentrations of 20mg/ml and 40 mg/ml were effective for the treatment of keloids, no difference between the groups (p = 0.58). However, patients in which TCN was infiltrated the 10mg/ml had poor involution of keloid and the study of this group was stopped. the combination of infiltration TCN month to 20 mg/mL (1.2mg to 2.0mg per mm3 TCN injury), surgical excision and pressure application device is effective for treatment of keloid ear lobe.

Ultrasound assessment of elbow enthesitis in patients with seronegative arthropathies

Enthesopathy is an evolving area for applied clinical research. MRI is the gold standard in the diagnosis of elbow joint pathology, but recent reports indicate that ultrasound imaging is more sensitive and accurate than MRI in detecting enthesopathy of the heels and knees. Too many patients are under-diagnosed and/or misdiagnosed because the early pathological changes of enthesitis in the different types of seronegative arthropathies are not detected. This study was undertaken to describe the ultrasound features of elbow enthesitis in patients with seronegative arthropathies. We studied 38 diseased elbows in 38 patients with spondyloarthropathies (26 men and 12 women, mean age 32years). All had elbow enthesopathy without typical conventional radiographic findings. Patients with histories of degenerative changes and/or local steroid injections were excluded. An HDI 3000 ATL ultrasound machine was used with a 5-12MHz linear transducer to examine the affected elbow joints. The elbows of 10 normal healthy individuals were examined as normal controls. The patients were examined in the supine position with the elbow flexed 30°-50°. Longitudinal and transverse scans were obtained of the radiohumeral joint, the ulnahumeral joint, and the olecranon fossa. Two independent observers unaware of the clinical diagnosis read the ultrasound images and assessed the collateral ligaments, intratendinous echogenicity, tendon calcification, tendon thickness, presence of fluid, synovial proliferation, and bony changes. The reliability of the sonographic images was assessed by review of video recordings of the ultrasound examinations. Ultrasound revealed loss of the fibrillar echopattern (100%), lack of a homogenous pattern with loss of the tightly packed echogenic dots (100%), peritendinous edema with flaring of the tendon margins (84.2%), irregular fusiform tendon thickening (100%), and hyperechoic intratendinous lesions with ill-defined focal defects (18.4%). Ultrasound also detected intratendinous calcifications of both the common extensor and common flexor tendons (52.6%). Bony erosions were seen at the tendon insertions into the lateral epicondyles (13.15%). Ultrasonographic features of elbow enthesitis differed from those described in knee and heel enthesitis. Ultrasound clearly showed early signs of tendon calcification, tendon edema, peritendinitis, and bony entheseal erosions. However, in elbow enthesitis the early bone erosion was associated with bone marrow edema, and the common extensor tendon was diffusely thickened. Ultrasound is a reliable, reproducible bedside imaging procedure. It improves the documentation of disease activity, progression, and treatment responses in patients with spondyloarthropathies. We recommend its use for the diagnosis and post-treatment follow-up of patients with enthesitis and seronegative spondyloarthropathies.

Nevus Lipomatosus Superficialis Unseen or Unrecognized: A Report of Eight Cases

Nevus lipomatosus superficialis (NLS) is a unique developmental anomaly or nevoid form of lipoma characterized by the ectopic presence of mature adipocytes in reticular dermis. The condition is rare; apart frrom isolated case reports, there are no large case series dealing with the clinicoepidemiologic characteristics and posttreatment long-term follow-up in patients with NLS and little published information on treatment outcome. To study the clinicoepidemiologic characteristics and long-term posttreatment follow-up in patients with NLS. This was an 11-year retrospective study analyzing disease characteristics and treatment outcome in eight patients with NLS. There were eight (six males, two females) patients with NLS, of whom three were children. The classic variant of NLS was the predominant presentation. One patient demonstrated a combination of both classic and solitary variants. Most patients, especially those with solitary variants, were commonly misdiagnosed before presenting to us. Four patients, including two with the solitary variant, one each with the classic and the combined type, underwent surgical resection without any recurrence over 8 years of follow-up. The rare nature of the disorder, which is commonly misdiagnosed, and the absence of long-term follow-up data prompted us to share our experience about NLS to increase its awareness among health care providers.

SPECT-CT in breast cancer

The most important prognostic factors for breast cancer are the size of primary tumor and axillary lymph node status. Role of scintimammography with the cationic lipophilic 99mTc-Tetrofosmin and 99mTc-Sestamibi in preoperative evaluation and post-treatment follow-up of patients with breast cancer is well known. The added diagnostic value of SPECT-CT has recently been investigated. Scintigraphy provides a description of function or process whereas CT depicts the precise localization and type of morphological changes that have occurred in the lesions. Combined SPECT-CT imaging enables to localize positive primary tumors and/or loco-regional lymph nodes; to evaluate effect of neoadjuvant chemotherapy in locally advanced and non-operable breast tumors. SPECT-CT studies are useful in post-therapeutic follow-up of patients to visualize suspicious local recurrence, lymphadenopathy and disease extension. CT part of the study can increase the specificity of SPECT by more accurate anatomical assessment of the sites of abnormal activity with unclear character such as radiation pulmonitis, postoperative parenchymal changes, fibrocystic changes etc. According to the results reported in literature, all the axillary metastatic nodes that were false negative on SPECT image were non-palpable, small lesion size (<10 mm) with partial metastatic involvement or micrometastases in most cases. Lymphatic mapping of SLNs is now routinely done in breast cancer patients for correct N-staging. SPECT-CT has been used for clear depiction of the SLNs to provide the useful information for intraoperative gamma-probe detection in cases that are difficult to interpret planar images, in cases with unusual drainage or in cases of nonvisualization. SPECT-CT scintimammogarphy is preferable in terms of physical characteristic, execution time and cost-effectiveness, thus suggesting wider application of this procedure. SPECT-CT is a potential new tool for LN localization and radioguided surgery in the coming years.

Does a negative post-therapy PET obviate the need for any further follow-up imaging in patients with nonbulky early-stage Hodgkin's lymphoma (HL)?

8058 Background: Recent reports suggest that medical imaging, besides potentially harmful, could turn out neither cost- effective, nor beneficial. We investigated whether this can be justified in the post-treatment follow-up of patients with nonbulky early-stage HL (nbHL) Methods: We identified all nbHL patients who underwent post-tx PET/CT from 11/04-1/09 at Az. Ospedaliera S. Croce e Carle in Cuneo, Italy or from 7/03-8/05 at the University of Iowa, and met the following criteria: received ≥ 4-8 cycles of chemotx alone or 3-6 cycles of chemotx followed by involved-field radiation therapy (IFRT); had PET/CT performed within 3-12 wks post-tx and adequate clinical, laboratory, and radiological follow-up for ≥ 1 y post-tx or until evidence of treatment failure. PET/CT scans were interpreted by nuclear medicine experts using the International Harmonization Project criteria. Results: Forty patients met the entry criteria for the study: all stage II; 23 received 4-6 cycles of ABVD alone, sixteen 3-6 cycles of ABVD followed by IFRT, 1 patient received Stanford V with RT. Thirty-seven patients (93%) had a negative post-tx PET, 3 (7%) had a positive scan. Median overall F/U was 3.1 y (range; 0.6-5.6) and 3.1 y in patients without progression. Two of the three patients with positive PET scans had persistent disease or progressed at 0.6 and 0.7 y while the third remains with no evidence of disease at 4.7 y post-tx. None of the 37 pts with negative PET progressed or relapsed. Conclusions: Incidence of relapse in nbHL patients with a negative posttherapy PET is extremely low, justifying eliminating any further follow-up imaging in these patients unless there is clinical/biochemical suspicion of recurrence. This conclusion is further supported by previous observations that > 80% of any eventual relapses are discovered by the patient and/or physician without imaging. No significant financial relationships to disclose.

Role of diffusion-weighted magnetic resonance imaging in differentiation between the viable and necrotic parts of head and neck tumors

Differentiation between the viable and necrotic parts of a tumor is essential for accurate biopsy results and for treatment planning. To determine the role of diffusion-weighted magnetic resonance (MR) imaging in differentiation between the viable and necrotic parts of head and neck tumors. Thirty patients with malignant head and neck tumors underwent postcontrast MR imaging. Diffusion MR imaging was done on a 1.5T unit using multislice single-shot echo-planar imaging. Diffusion-weighted MR images were acquired with a diffusion-weighted factor b of 0, 500, and 1000 s/mm(2), and an apparent diffusion coefficient (ADC) map was reconstructed. The ADC value was measured within the enhanced and nonenhanced part of the tumor, and the mean ADC values were calculated. The ADC value was correlated with biopsy results. The mean ADC value of a viable part of the tumor was 1.17+/-0.33 x 10(-3) mm(2)/s, and of the necrotic parts of the tumor 2.11+/-0.05 x 10(-3) mm(2)/s. The difference in the ADC value between the viable and necrotic parts of the head and neck tumors was statistically significant (P<0.001). Sensitivity, specificity, and accuracy of the ADC value were 92.9%, 93%, and 94.6%, respectively. Creation of an ADC map is an excellent method for differentiation between the viable and necrotic parts of head and neck tumors. Thus, the ADC map can be used to select the best biopsy site and to detect tumor viability in post-treatment follow-up of patients after radiation therapy.

Reliability and Validity of the Substance Abuse Outcomes Module

Reliability and Validity of the Substance Abuse Outcomes Module

Long‐term follow‐up of peginterferon and lamivudine combination treatment in HBeAg‐positive chronic hepatitis B†

We have previously demonstrated that combination peginterferon and lamivudine treatment has superior antiviral efficacy to lamivudine monotherapy in chronic hepatitis B. In this study, we investigated the long-term posttreatment virological response to this combination treatment. Sustained virological response of patients who completed 32-week peginterferon and 52-week lamivudine combination treatment was compared to patients who completed 52-week lamivudine monotherapy. Sustained response was defined as sustained hepatitis B e antigen (HBeAg) loss and HBV DNA < 100,000 copies/mL from treatment cessation until the end of follow-up. Forty-eight patients receiving combination treatment and 47 patients receiving lamivudine monotherapy were studied. The posttreatment follow-up of patients who received combination treatment was 117 +/- 34 weeks and that of patients receiving lamivudine monotherapy was 124 +/- 29 weeks. At the end of treatment, HBeAg loss occurred in 63% of patients in the combination group and 28% of patients in the lamivudine group (P = .001). The probabilities of sustained response for combination treatment and lamivudine monotherapy were 33% and 13% at week 24, 31% and 11% at week 52, and 29% and 9% at week 76, respectively (log-rank test, P = .0015). No patients developed virological relapse after week 76 until the last visit in either treatment group. All sustained responders had no biochemical relapse (alanine aminotransferase [ALT] > 2 times upper limit of normal) during follow-up. Among the non-sustained responders, biochemical relapse occurred in 32 patients (94%) in the combination group and 38 patients (88%) in the lamivudine group, respectively. In conclusion, combination treatment of peginterferon and lamivudine has a higher sustained virological response than lamivudine monotherapy up to 3 years after treatment.

Evaluation of a latex agglutination test (KAtex) for detection of Leishmania antigen in urine of patients with HIV-Leishmania coinfection: value in diagnosis and post-treatment follow-up

The usefulness of antigen detection in urine as an alternative tool for diagnosis of leishmaniasis and post-treatment follow-up in patients with Leishmania-HIV coinfection was evaluated with a latex agglutination test (KAtex; Kalon Biological, UK). Forty-nine HIV-infected patients with visceral leishmaniasis were included in the study. Antigen detection in urine (ADU) was positive in 42 of 49 (sensitivity, 85.7%) samples obtained during a primary episode. After treatment, a follow-up study in 23 patients was performed by simultaneous ADU and culture of peripheral blood mononuclear cells in 148 determinations. The two methods gave concordant results in 94 cases, 38 of which were positive and 56 negative. In five cases, ADU was negative and culture of peripheral blood mononuclear cells was positive: two of these cases corresponded to clinical relapses. In 49 cases, culture of peripheral blood mononuclear cells was negative and ADU was positive. In the absence of clinical symptoms, the detection of parasite antigens in 71 of 130 (54.6%) urine samples was not associated with clinical disease. The Kaplan-Meier estimates of the probability of relapse at 6, 12, 18, and 24 months were 16% (95%CI, 15-17%), 20% (95%CI, 18-22%), 31% (95%CI, 27-35%), and 71% (95%CI, 52-89%), respectively, in patients with a positive ADU result. In contrast, when ADU was negative, the probability of relapse was 5% at 6 months (95%CI, 2-8%) (only 2 of 11 patients who relapsed had a negative test). ADU by KAtex is appropriate for primary diagnosis of visceral leishmaniasis, for monitoring the efficacy of treatment, and for detection of subclinical infection.

Role of human papillomavirus (HPV) testing in the follow-up of patients after treatment for cervical precancerous lesions

Objective: To evaluate the role of human papillomavirus (HPV) testing in post-treatment follow-up of patients after therapeutic excision of the cervix due to positive screening tests. Study design: A hospital-based retrospective analysis was performed with prospective collection of patient data of women screened for cervical cancer at a Gynecologic Outpatient Clinic. Patients after therapeutic excision due to positive screening results were identified and followed up with HPV testing and serial cytology. Results: After 61 treatment for cervicalis intraepithelialis neoplasia (CIN), high-risk HPV infection was detected during the post-treatment follow-up at 18 cases (29.5%), 10 of them had persisting cytological atypia (positive predictive value (PPV): 56%), 5 developed CIN (PPV: 28%). When the HPV test was negative (43 patients) in the post-treatment period, neither CIN nor persisting cytological atypia developed (negative predictive value (NPV): 100%) during 1201 patient months (median 26 months). Conclusions: A negative HPV test eliminates the risk of recurrent disease after treatment for CIN.

Videofiberoptic examination of the pharyngoesophageal segment and esophagus in patients after total laryngectomy.

Posttreatment follow-up in patients with squamous cell carcinoma of the head and neck is critical because of the high risk of recurrence or a new primary tumor. However, in patients who have undergone total laryngectomy, evaluation of the pharyngoesophageal segment (PES) and esophagus is difficult. Sixty patients who had undergone total laryngectomy received a videofiberoptic examination of the PES and esophagus at the OPD office during follow-up. Satisfactory examination was achieved in 56 (93%) of the patients. Each procedure was completed within 15 minutes. Although only 11 (18%) of the patients were symptomatic at follow-up, 19 patients (34%) had significant findings, including one local recurrence and two secondary esophageal cancers. Patients were asymptomatic in all three cases. Videofiberoptic examination is a simple, effective, and relatively noninvasive method that can be performed in the OPD office to evaluate the PES and esophagus in patients after total laryngectomy.