Survival analysis of patients with dermatomyositis and polymyositis: analysis of 192 Chinese cases.

To estimate the mortality rate and identify factors predicting survival in patients with polymyositis (PM) and dermatomyositis (DM). The medical records of 192 PM/DM patients who were treated at Chang Gung Memorial Hospital from 1999 through 2008 were retrospectively reviewed. The Taiwan National Death Registry (1999-2008) was used to obtain their survival status. Thirty-one (16.1%) of the 192 patients with PM/DM had an associated malignancy; 41 (21.4%) had interstitial lung disease (ILD). During the follow-up period, 55 (28.6%) patients died and the overall cumulative survival rate was 79.3% at 1 year, 75.7% at 2 years, 69.9% at 5 years, and 66.2% at 10 years. In univariate analysis, older age at PM/DM onset, anemia, thrombocytopenia, leukopenia, diabetes mellitus, ILD, cancer, and non-use of azathioprine were associated with higher mortality (p = 0.0172, 0.0484, <0.0001, 0.0008, 0.0001, 0.0036, 0.0010, and 0.0019, respectively). In multivariate Cox regression analysis, thrombocytopenia (hazard ratio [HR] 4.94, 95% confidence interval [CI] 2.60-9.37, p < 0.0001), diabetes mellitus (HR 2.57, 95% CI 1.38-4.80, p < 0.0001), cancer (HR 2.30, 95% CI 1.26-4.22, p = 0.0030), and ILD (HR 1.98, 95% CI 1.11-3.51, p = 0.0182) were positively associated with mortality. Use of azathioprine (HR 0.35, 95% CI 0.16-0.74, p = 0.0064) was negatively associated with mortality. This study confirmed the high mortality rate (28.6%) in PM/DM patients. Survival time was significantly reduced in patients with thrombocytopenia, diabetes mellitus, ILD, and cancer patients than in those without these conditions.

Intensity modulated radiotherapy for elderly bladder cancer patients.

BACKGROUND: To review our experience and evaluate treatment planning using intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) for the treatment of elderly patients with bladder cancer. METHODS: From November 2006 through November 2009, we enrolled 19 elderly patients with histologically confirmed bladder cancer, 9 in the IMRT and 10 in the HT group. The patients received 64.8 Gy to the bladder with or without concurrent chemotherapy. Conventional 4-field "box" pelvic radiation therapy (2DRT) plans were generated for comparison. RESULTS: The median patient age was 80 years old (range, 65-90 years old). The median survival was 21 months (5 to 26 months). The actuarial 2-year overall survival (OS) for the IMRT vs. the HT group was 26.3% vs .37.5%, respectively; the corresponding values for disease-free survival were 58.3% vs. 83.3%, respectively; for locoregional progression-free survival (LRPFS), the values were 87.5% vs. 83.3%, respectively; and for metastases-free survival, the values were 66.7% vs. 60.0%, respectively. The 2-year OS rates for T1, 2 vs. T3, 4 were 66.7% vs. 35.4%, respectively (p = 0.046). The 2-year OS rate was poor for those whose RT completion time greater than 8 weeks when compared with the RT completed within 8 wks (37.9% vs. 0%, p = 0.004). CONCLUSION: IMRT and HT provide good LRPFS with tolerable toxicity for elderly patients with invasive bladder cancer. IMRT and HT dosimetry and organ sparing capability were superior to that of 2DRT, and HT provides better sparing ability than IMRT. The T category and the RT completion time influence OS rate.

The efficacy of additive tolterodine extended release for 1-year in older men with storage symptoms and clinical benign proastatic hyperplasia.

AIM: To determine the efficacy of toterodine extended release (ER) treatment for 1 year in older men with benign prostatic hyperplasia (BPH) and storage symptoms treated with alpha-blockers and/or 5-alpha-reductase inhibitors (5ARI). METHODS: Men aged over 70 years with BPH/bladder outlet obstruction (BOO) and clinical storage symptoms were randomly treated with or without tolterodine ER in combination with alpha-blockers and/or 5ARI for 12 months. Among them, 50 patients (group 1) received additive tolterodine extended release (ER) 4 mg q.d., another 87 patients (group 2) did not. All patients had a baseline and 12th month post-treatment evaluation, which comprised of uroflowmetry, post-void residual (PVR) volume, International Prostate Symptom Score (IPSS), and quality of life index (QoL-I), transrectal ultrasound of the prostate and serum prostate specific antigen. RESULTS: One hundred thirty-seven of 153 enrolled patients with a mean age of 74.9 years completed the study. Treatment benefit demonstrated in both groups included deceased total, voiding and storage IPSS scores, increased peak urinary flow rate and deceased QoL-I. Inter-group difference was only observed on the storage domain of IPSS score (P = 0.012). The mean PVR after treatment did not significantly differ between two groups. Two patients of group 1 and three of group 2 developed acute urinary retention. Among group 1, six patients discontinued tolterodine ER for intolerable dry mouth; among group 2, three patients reported dizziness. CONCLUSIONS: This longer comparative study indicated that additive treatment with tolterodine ER in older men with BPH/BOO and significant storage symptoms is a beneficial and safe therapeutic option.

A retrospective study comparing tension-free vaginal tape and transobturator suburethral tape for surgical treatment of female stress urinary incontinence --- a preliminary report.

BACKGROUND: The aim of this study was to assess the efficacy and complications of tension-free vaginal tape (TVT) versus tension-free transobturator vaginal tape (TVT-O) from inside to outside for the surgical treatment of stress urinary incontinence (SUI) in women. METHODS: Retrospectively, 35 patients with SUI were recruited into this study; 18 patients were assigned to the TVT procedure and 17 patients to the TVT-O operation. Preoperative evaluation included subjective symptoms according to the SEAPI incontinence score (IC score), objective assessment by urodynamic study (including cystometry, electromyography, urethral pressure profile, uroflow), and bead chain voiding cystourethrogram. Patients with cystocele greater than grade II were excluded. The mean operative time, hospital stay, perioperative complications, and 1-year outcome including SEAPI IC score and late complications were compared. RESULTS: Patient characteristics and preoperative IC score were similar in the 2 groups. Mean operative time was significantly shorter in the TVT-O group (31.9 +/- 10 minutes vs. 55 +/- 12 minutes; p < 0.001). No bladder injury occurred in the TVT-O group versus 5.0% (n = 1) in the TVT group (p > 0.05). The rate of postoperative temporary dysuria was 28% (n = 5) in the TVT group versus 24% (n = 4) in the TVT-O group. The cure rate for SUI was 88%, similar for the TVT and TVT-O groups. As for late complications, no vaginal erosion was noted in the TVT-O group, but 1 bladder erosion with stone formation was found in the TVT group. In terms of bladder outlet obstruction, none developed in the TVT-O group, but 1 patient developed persistent dysuria in the TVT group. CONCLUSION: There appears to be equal efficacy between TVT and TVT-O for the surgical treatment of female SUI, but operative time was significantly shorter in the TVT-O group because intraoperative cystoscopic check-up is not required.

Urolithiasis in pregnancy.

BACKGROUND: The aim of this study was to review our experience in the diagnosis and management of urolithiasis in pregnant women, and to discuss safety, appropriate diagnostic tools and treatment modalities with review of literatures. METHODS: Nine women with pregnancy proved to have urolithiasis were included in this study. The diagnosis was made according to their symptoms and signs, and ultrasonographic findings. Conservative treatment with hydration, analgesics and antibiotics was applied initially, followed by some minimally invasive procedures, including percutaneous nephrostomy (PCN), double J (DBJ) stenting and ureterorenoscopy (URS), if initial treatment failed. RESULTS: All patients received conservative treatment at first, and 4 patients got well till delivery, another 5 patients needed further minimally invasive procedures; 1 of them received DBJ stenting, another 1 received PCN first and changed to DBJ stenting. The remaining 3 patients were treated by ureterorenoscopy with stone manipulation. All these 5 patiens had full-term delivery without obstetric sequela, except 1 patient who received left salpingoophrectomy due to left ovarian abscess. CONCLUSIONS: During pregnancy, urolithiasis is a diagnostic and therapeutic challenge. Clinical symptoms and signs are most important in establishing diagnosis, and ultrasound examination adds accuracy. Minimally invasive procedures (such as PCN, DBJ stenting, URS) can facilitate the successful management of patients requiring further intervention due to failure of conservative treatment.