Late recurrence

PROFESS is an ongoing large randomized trial examining combination ER-DP plus aspirin therapy compared with clopidogrel (each group also with or without telmisartan, an angiotensin receptor antagonist) for the secondary prevention of early and late recurrent stroke, and other vascular events. 

Primary haemostasis Acute sclerosing is generally performed during the first endoscopic examination. The rate of haemostasis is 70-95(-100)%. The frequency of (early and late) recurrent bleeding has been reduced to 30-50%, most effectively after several months when all varices have been obliterated. Nevertheless, an annual risk of recurrent bleeding of 10-20% remains due to newly formed varices, especially in the stomach fundus. Inpatient mortality is about 20%. However, more ways are being found to improve the life expectancy of the patient. 

Kobza R, Hindricks G, Tanner H, et al. Late recurrent arrhythmias after ablation of atrial fibrillation incidence, mechanisms, and treatment. Heart Rhythm 2004 1 676-83. 

Figure 10. Same as Fig. 7 but for N = oo. The correlation function C(c) was determined analytically as the limit of an N-point quadrature approximation as N - oo, and is given by (h/vt)J,(2vt/h) (see text). Note that the weak, early recurrences persist while the strong, late recurrences are absent. 

While anecdotal evidence indicates successful elimination of cancerous cells in some patients, case reports indicate late recurrences and metastasis of cancers, due to incomplete removal of cancerous cells, in patients who were self-treating skin cancers (Affleck and Varma 2007 Laub 2008 McDaniel and Goldman 2002). Scarring, inflammation, escharotic activity, ulceration, and acute pain have been reported after repeated topical applications of escharotic products that contain bloodroot (Affleck and Varma 2007 Jellinek and Maloney 2005 Laub 2008 McDaniel and Goldman 2002 Moran and Helm 2008). 

Late recurrence is observed when new fibroids occur usually 5 years or later after embolization [26]. MRI may be useful to detect new fibroids actually even before the patient s symptoms worsen [27]. 

In adult granulosa cell tumors,late recurrence years after the initial therapy tumor manifestation may be seen. The recurrent tumor is typically confined to the pelvis and abdomen (Fig. 10.27). However, distant metastases to the bone, supraclavicular lymph nodes, liver, and lungs have been reported [29]. 

Fig. 10.27. Late recurrence of granulosa cell tumor. Transaxial T2-weighted image in a 45-year-old patient with a history of hysterectomy and resection of a granulosa cell tumor 16 years before. Recurrent granulosa cell tirnior is identified as a solid and cystic lesion above the vaginal vault. The right border is well defined, the left posterior margin shows irregular contours arrow) extending to the posterior pelvic sidewall. Small amounts of ascites are demonstrated in the pelvis. At surgery, invasion of the iliac internal vessels was confirmed...

The use of PET/CT for post treatment assessment of the primary modality of either radiation or surgery or combination has aided the clinician s ability to make informative predictions on the possibility of early and late recurrence of the disease (Yao et al. 2005). Certainly PET CT has a higher specificity and overall diagnostic performance than CT alone in this case (Andrade et al. 2006). 

Kerion Celsi also requires a well-defined schedule of treatment terbinafine 250 mg/day for 6 weeks or itraconazole 100 mg/day for the same period. Fairly long-term follow up is recommended, and late recurrences undoubtedly occur. 

Late recurrent dysphagia may be due to stent migration or to tumour overgrowth below or, much more frequently, above the stent (Fig. 11.6). In situations where the overgrowth has occurred above the level of the stent, stent removal may prove impossible and over-stenting with a second stent will be necessary. Other techniques to deal with tumour overgrowth such as alcohol injection, laser photocoagulation or photodynamic therapy may also be appropriate. 

Different papers have reported different time-scales for the detection of recurrence. Mean time to recurrence in one series of patients with hepatocellular carcinoma treated with a range of ablation techniques was 4 months (Catalano et al. 2001). In our experience using thermal ablation techniques the median time to recurrence is 8 months but in some slow growing tumours or patients who respond to chemotherapy recurrence may be delayed until as late as 20 months. Other authors have also seen examples of late recurrence up to 14 months post treatment (Chopra et al. 2001). 

A relatively small group of 87 children treated with a mean dose of 9.75 mCi I was studied after a mean period of 12 years no cases of cancer or leukaemia were found. Hypothyroidism occurred in 46% while late recurrent hyperthyroidism was rare (1 case). The reproductive history and health status of the progeny (n = 55) was not different from the general population (29 ). This report, however, is not sufficient to declare... 

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