Piloting a Community-Based, Culturally Adapted Health Promotion Program for Children with Autism Spectrum Disorder and Developmental Disabilities in First-Generation Korean Immigrant Families

Children with autism spectrum disorder and developmental disabilities (ASD/DD) face barriers to participation in health promotion programs due to the lack of available and/or affordable programs and trained staff at recreation centers. Children with ASD/DD in Korean immigrant families are one of the most underserved minority groups due to language, racial/ethnic discrimination, and stigma and shame within their own ethnic community. However, little research is available on development, implementation, and evaluation of a culturally adapted community health promotion program in this population. The purpose of this study is to assess effectiveness of a pilot program for children with ASD/DD from first-generation Korean immigrant families. The pilot study used a quantitative, quasiexperimental design (one-group design with pre- and posttest) following a seven-week health promotion program. We recruited 15 children with ASD/DD, ages nine through 16, from first-generation Korean immigrant families. The findings of the study suggest that the pilot program was effective in gaining nutrition knowledge and increasing physical involvement among participants. Given the fact that Asian immigrants are a fast-growing population and that nearly 75 percent of them were born abroad, development and evaluation of a community-based, culturally adapted health promotion program is urgently needed.

Intimate Partner Violence Among Hispanic/Latinx and White College Students

Hispanic/Latinx individuals disproportionately experience intimate partner violence (IPV) compared to their non-Hispanic/Latinx counterparts, and little is known about IPV among college-aged Hispanic/Latinx students. This study examines the rates of IPV victimization and perpetration and their correlates among Hispanic/Latinx and non-Hispanic White college students by analyzing cross-sectional survey data of 3,397 Hispanic/Latinx and White college students enrolled in seven universities. Compared to their White counterparts, Hispanic/Latinx students reported higher rates of IPV victimization and perpetration. Age, gender, drug use, and adverse childhood experience were associated with both IPV victimization and perpetration, while ethnicity was only associated with IPV perpetration. This study's findings highlight the urgent need for more culturally sensitive IPV prevention services and responses to support Hispanic/Latinx college students.

Childhood Community Risk Factors on Intimate Partner Violence Perpetration and Victimization Among College Students

The study examined the effect of community environments, such as community cohesion, community safety, and community poverty, in childhood on the likelihood of Intimate Partner Violence (IPV) perpetration and victimization in young adulthood. The study used the cross-sectional survey data of 2,082 college students collected in 2016-2017 from six universities in the U.S. and the data for the childhood community environment from the 2007-2011 American Community Survey. Hierarchical regressions were performed separately by gender to 1) assess the effects of community factors in addition to individual factors for IPV perpetration and victimization, and to 2) identify the interaction effect of community cohesion with community poverty on IPV perpetration and victimization. Community factors of community cohesion and community poverty were significantly correlated to different types of IPV. For IPV perpetration, only community cohesion was significant for, the interaction effect between community cohesion and poverty showed that higher community cohesion lowered the risk of community poverty on later IPV perpetration in both genders. For IPV victimization, only female students were affected by community poverty, whereas none of the community factors had an impact on male students. The findings imply the significance of early interventions and policies strengthening the community environment, especially community cohesion, for preventing IPV. The findings also suggest that assessing risk and protective factors on IPV in multiple contexts during childhood is important to develop effective programs preventing IPV.

The effects of disability status and perceived neighbourhood cohesion and safety on adverse childhood experiences among college students

Adverse childhood experiences (ACEs) are early traumatic events that can have adverse long-term developmental effects on a person's health and well-being. Individuals with disabilities are at a greater risk of all types of ACEs. However, the impact of having a disability and neighbourhood context on ACEs is under-researched, and even less is known about whether neighbourhood cohesion and safety affect the relationship between disability status and ACEs. The purpose of this study is to examine the direct and indirect pathways between disability status, childhood neighbourhood environment and ACEs. The final study sample of this study was 2,049 college students, consisting of 494 students with disabilities and 1,555 students without disabilities from six universities in the U.S. and Canada between March 2016 and June 2017. Data analysis included Pearson correlations and structural equation modelling procedures using Stata 16 software to test a partial mediation model. Having a disability has both a direct effect and an indirect effect through the neighbourhood environment on ACEs after controlling for socio-demographic characteristics associated with neighbourhood environment or ACEs. The findings suggest that neighbourhood cohesion and safety can be a mediator between disability status and ACEs, and the potential cumulative risk and protective factors that can contribute to ACEs. To elucidate the relationship between disability status and a higher risk for ACEs fully and prevent ACEs that can negatively impact the long-term health outcomes, greater attention to environmental risk and protective factors is urgently needed.

Validation of differential DNA methylation in newborns exposed to tobacco smoke during gestation using bisulfite pyrosequencing

Maternal exposure to tobacco smoke during pregnancy has been associated with many negative child health outcomes. Tobacco smoke exposure alters DNA methylation in the developing embryo/fetus and may be a mechanism that increases risk of later life disease. Previous studies have identified CpG sites in umbilical cord blood that are associated with in utero tobacco smoke exposure. We sought to validate findings for CpG sites within several of the top hit genes, AHRR , CYP1A1 , and GFI1, using targeted quantitative bisulfite pyrosequencing. Comparing results from cord blood specimens of tobacco smoke-exposed to unexposed newborns, we confirmed significance at all previously identified CpG sites tested, including one in AHRR (p=0.007), three in CYP1A1 (p<0.0001), and one in GFI1 (p=0.008). These assays also captured novel differentially methylated CpGs located near the identified sites that were not included in the prior array-based studies (p value range, 0.02 to <0.0001). These results validate the prior findings and provide a simplified and more economical approach to analysis of CpG sites for expanded use as biomarkers of in utero tobacco smoke exposure.

Help-Seeking Behaviors for Intimate Partner Violence Among College Students: Implications for Intimate Partner Violence Prevention and Intervention

This study applied Andersen's Model of Health Service Use to examine help-seeking behaviors for intimate partner violence (IPV) and predisposing, enabling, and need factors for help-seeking among college students. The sample (N = 2,719) consisted of those who experienced IPV and was recruited from six universities in the United States and one university in Canada through an online survey. Results showed that 45.4% of the sample had sought some form of help for IPV. The most utilized source of formal help was from medical services, and friends were the number one source of informal help. Gender, age, sexual orientation (predisposing factors), IPV training (enabling factor), experiencing psychological and technological violence, and IPV consequences (need factors) were associated with seeking help. Implications for research and practice are discussed.

Providers' Guidance to Parents and Service Use for Latino Children With Developmental Disabilities

To better understand disparities between Latino and White children with autism or other developmental disabilities (ASD/DD), we examined whether Latino ethnicity predicted the number of specialty care services received by children with severe functional limitations depending on medical providers' responses to parents' initial concerns about their child's development. Through linkage of the Pathways and NS-CSHCN datasets, we found ethnic disparities in the receipt of specialty services associated with providers' responsiveness to parent-reported concerns among children with ASD/DD. Among children with significant functional limitations, Latino children whose parents received passive/reassuring responses from their providers were less likely to receive specialty services than White children with ASD/DD. Providers' guidance to parents may be a promising point of intervention for future disparity reduction efforts.

Navigating the health-care system in community: Perspectives from Asian immigrant parents of children with special health-care needs

Children with special health-care needs (CSHCNs) face notable barriers to health-care access and to receiving quality and family-centered care, despite higher health-care utilization rates. Within the population of CSHCNs, there are significant inequities in health-care quality impacting immigrants who have migrated to the United States. However, little is known about the experiences and needs of Asian immigrant families who have CSHCNs. This study aimed to explore how Asian immigrant parents of CSHCNs view their child's health-care access, quality, and utilization. We conducted semi-structured qualitative interviews with 22 Vietnamese- and Cantonese-speaking parents of CSHCNs. Participants were recruited through community partners. Interviews were transcribed, translated, and coded using content analysis. Participants were generally satisfied with their children's care and had strong relationships with their primary care doctors who were often culturally 'matched'. However, participants experienced several important and culturally specific barriers, including gaps in their understanding of the health-care system, language barriers, and a sense of alienation. Parents frequently turned to informal and community supports for assistance in navigating the US health-care system. Further research to understand the drivers of health disparities and policy level solutions is warranted.

Reproductive Cancer Treatment Hospitalizations of U.S. Women With Intellectual and Developmental Disabilities

There is a dearth of existing research on the treatment of reproductive cancers among women with intellectual and developmental disabilities (IDD). This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared the prevalence of reproductive cancer treatment hospitalization discharges among women with and without IDD. Discharges linked to women with IDD had higher incidences of cancer of the uterus and lower prevalence of cancer of the cervix. Moreover, discharges linked to women with IDD indicated these women were younger, had longer hospital stays, and were more likely to have public insurance coverage. Therefore, further research and targeted interventions to increase cancer prevention and screening are urgently needed.

Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys

Purpose

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population.

Method

We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation.

Results

Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%–56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%–22% experiencing food insecurity, compared to 11%–14% of their peers without any indications of speech-language difficulties).

Conclusions

We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

Disparities in Health Care Quality among Asian Children with Special Health Care Needs

There is a dearth of information on the quality of health care for Asian American children and particularly Asian children with special health care needs (CSHCN). The goal of this article was to determine whether there were disparities in quality of health care for Asian CSHCN, whose experiences have not been studied. Data were derived from the 2009-2010 National Survey of Children with Special Health Care Needs (ns = 355 non-Hispanic Asian children and 4,343 non-Hispanic white CSHCN). Bivariate and multivariate logistic regression analyses were conducted to examine the relationship between racial identity (that is, non-Hispanic white and non-Hispanic Asian) and quality of health care. Racial disparities in quality of health care were substantial between Asian and white CSHCN in 2009-2010. Asian parents were significantly less likely than white parents to report that their health care provider provided the specific information they needed, helped them feel like a partner in their child's care, and was sensitive to the family's values and customs. The development and testing of specific, targeted policy and practice interventions to reduce disparities in health care quality for these children are urgently needed.

Role of Google Glass in improving patient satisfaction for otolaryngology residents: a pilot study

OBJECTIVES

To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication-related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.

STUDY DESIGN

Prospective randomised trial.

SETTING

Tertiary care hospital.

SUBJECT AND METHODS

To evaluate the effect on patient satisfaction, five residents were recorded using the Google Glass in an outpatient clinic setting by 50 randomised patients. Modified surveys based on the CG-CAHPS survey were completed by patients at the conclusion of each clinic encounter. The recorded videos were evaluated by two independent faculties. Summarised data and video were distributed to each resident for review as the intervention. The residents were recorded again by 45 additional patients with evaluation by patients and faculties.

RESULTS

After intervention, the scores from faculty surveys regarding patient satisfaction including the subject of better explanations (P > 0.001), listening carefully (P > 0.001), addressing patient questions (P > 0.001), displaying respect (P > 0.001) and spending adequate time (P = 0.0005) all significantly improved, as well as overall performance (P = 0.014). The scores from patient surveys did significantly improve.

CONCLUSION

This study demonstrates the improvements in patient satisfaction and patient-physician communication can be achieved with the use of Google Glass as a first-person recording device in the outpatient otolaryngology clinic setting.

Functional severity and Latino ethnicity in specialty services for children with autism spectrum disorder

BACKGROUND

Children with autism spectrum disorder (ASD) experience a range of severity levels characterised as levels of support they need for everyday functioning. By this definition, greater levels of severity should warrant greater use of services and supports among children with ASD. In previous studies, Latino children with ASD in the USA have been shown to have lower access to diagnosis and treatment services than White children. However, none have examined service use in relation to severity. In this study, we examined whether there are ethnic disparities between Latino and White children with ASD in specialty autism-related services, and whether functional severity moderates the relationship between ethnicity and receipt of autism services.

METHODS

We used data from the Survey of Pathways to Diagnosis and Services, a supplement to the National Survey of Children with Special Health Care Needs and analysed four specialty services commonly used by children with ASD, adjusting for demographic variables.

RESULTS

We found that Latino children with ASD who had severe limitations received fewer specialty autism-related services than White children with similarly severe conditions. These disparities were evident despite the fact that the sample of Latino children in these data were more privileged than the general US Latino population.

CONCLUSION

Assertive policy initiatives are needed to address these disparities and ensure that these highly vulnerable children with severe functional limitations receive appropriate services and supports.

Have Racial and Ethnic Disparities in the Quality of Health Care Relationships Changed for Children With Developmental Disabilities and ASD?

The aim of this study was to determine if racial and ethnic disparities in the quality of provider interaction have changed between 2006 and 2010 for children with developmental disabilities and autism spectrum disorders (ASD). Data from the 2005/2006 and 2009/2010 National Survey of Children With Special Health Care Needs were analyzed. Results show that racial and ethnic disparities in the quality of provider interactions were substantial in both 2005/2006 and 2009/2010. Black and Latino parents were significantly less likely than White parents to report that their provider spent enough time with their child and was sensitive to the family's values. Racial and ethnic disparities in health care quality were found to be unchanged over time. Research and policy implications are discussed.

Pregnancy Outcomes Among U.S. Women With Intellectual and Developmental Disabilities

The existing research on pregnancy outcomes for women with intellectual and developmental disabilities (IDD) is sparse. This study analyzed the 2010 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and compared deliveries among women with IDD (n = 340) to the general obstetric population. Women with IDD had longer hospital stays and were more likely to have Caesarean deliveries in contrast to other women. Rates of adverse pregnancy outcomes were elevated for women with IDD across a range of measures, including early labor, preterm birth, and preeclampsia, and their infants were more likely to have low birth weight, even after adjusting for age, race, ethnicity, and insurance type. Targeted interventions are needed to address these deleterious outcomes.

Test of an intervention to improve knowledge of women with intellectual disabilities about cervical and breast cancer screening

BACKGROUND

There is a critical need for evidence-based health education interventions for women with intellectual disabilities (IDs) to promote receipt of preventive health screenings. Previous research has established Women Be Healthy, an 8-week classroom-style intervention designed to teach women with IDs about breast and cervical cancer screenings, as a promising practice. However, additional research is needed to determine how to further improve screening-related knowledge gains. This study aimed to test a modified version of Women Be Healthy, Women Be Healthy 2, and compare its effectiveness in increasing knowledge gains to the original intervention.

METHOD

Women living in the community across one state in the United States were randomly assigned to a treatment (n = 98), delayed treatment, (n = 35), or no intervention group (n = 65). Women in the treatment group received Women Be Healthy, and women in the delayed treatment group received the modified Women Be Healthy 2. Baseline and post-intervention interviews were conducted to measure knowledge of cervical and breast cancer screening. Knowledge scores were compared across groups.

RESULTS

Among the nine knowledge items measured, one breast knowledge measure and one cervical knowledge measure showed statistically significant group differences; marginally significant differences were observed for two other knowledge measures. After adjusting for covariates, women who received Women Be Healthy 2 had increased knowledge overall compared with the women receiving no intervention.

CONCLUSION

Women Be Healthy 2 is promising, but additional efforts appear necessary to increase the knowledge women with IDs have about cervical and breast cancer screening.

Differences in Brain Waves of Normal Persons and Stroke Patients during Action Observation and Motor Imagery

[Purpose] The purpose of this study was to examine the changes in brain waves between action observation and motor imagery of stroke patients and normal subjects, and to compare them. [Methods] Twelve stroke patients and twelve normal persons participated in this research. Each group executed action observation and the motor imagery training for 3 minutes, and before and during each intervention the brain waves were measured for 3 minutes, and the relative alpha power and relative beta power analyzed. [Results] Both normal persons and stroke patients showed significant differences in relative alpha power during action observation, but no significant difference in relative alpha power was found during motor imagery. The relative beta power increased similarly in both groups but it was more significantly different during action observation than during motor imagery. [Conclusion] Both action observation and motor imagery can be used as a therapeutic method for motor learning. However, action observation induces stronger cognitive activity, so for the stroke patients who have difficulty with fine motor representation, action observation might be a more effective therapy.

Determinants of cervical cancer screening among women with intellectual disabilities: evidence from medical records

OBJECTIVE

We examined receipt of cervical cancer screening and determinants of screening for women with intellectual disabilities in one Southeastern state.

METHODS

Using medical records data from 2006 through 2010 for community-dwelling women with intellectual disabilities who were 18-65 years of age (n=163), we employed descriptive and bivariate statistics and a multivariate regression model to examine receipt of cervical cancer screening and the determinants of cervical cancer screening across women's sociodemographic and health-care provider characteristics.

RESULTS

Of women 18-65 years of age with intellectual disabilities, 55% received a Papanicolaou (Pap) test during 2008-2010, markedly below the Healthy People 2020 targets or rates of Pap test receipt of women without intellectual disabilities. Women with intellectual disabilities who lived in residential facilities, those who lived in rural communities, and those who had an obstetrician/gynecologist had higher rates of receipt of care than other women with intellectual disabilities.

CONCLUSIONS

Assertive measures are required to improve the receipt of cervical cancer screening among women with intellectual disabilities. Such measures could include education of women with intellectual disabilities, as well as their paid and family caregivers, and incentives for health-care providers who achieve screening targets.

Accuracy of self-reported cervical and breast cancer screening by women with intellectual disability

This study examines the accuracy of self-report of cervical and breast cancer screening by women with intellectual disability (n  =  155). Data from face-to-face interviews and medical records were analyzed. Total agreement, sensitivity, specificity, positive predictive value and negative predictive value were calculated. Total agreement between self-report and medical record on receipt of both procedures was 75% for Pap test and 87% for mammography. Self-reported Pap tests and mammography showed >90% sensitivity, but specificity was low for both procedures (41% for Pap test, 30% for mammogram), indicating overreporting of receipt of Pap tests and mammography similar to women without disabilities. Clinicians and researchers are cautioned to corroborate self-reported data with other sources for patients and research participants with intellectual disability.

Diversity and decay ability of basidiomycetes isolated from lodgepole pines killed by the mountain pine beetle

When lodgepole pines ( Pinus contorta Douglas ex Louden var. latifolia Engelm. ex S. Watson) that are killed by the mountain pine beetle ( Dendroctonus ponderosae ) and its fungal associates are not harvested, fungal decay can affect wood and fibre properties. Ophiostomatoids stain sapwood but do not affect the structural properties of wood. In contrast, white or brown decay basidiomycetes degrade wood. We isolated both staining and decay fungi from 300 lodgepole pine trees killed by mountain pine beetle at green, red, and grey stages at 10 sites across British Columbia. We retained 224 basidiomycete isolates that we classified into 34 species using morphological and physiological characteristics and rDNA large subunit sequences. The number of basidiomycete species varied from 4 to 14 species per site. We assessed the ability of these fungi to degrade both pine sapwood and heartwood using the soil jar decay test. The highest wood mass losses for both sapwood and heartwood were measured for the brown rot species Fomitopsis pinicola and the white rot Metulodontia and Ganoderma species. The sap rot species Trichaptum abietinum was more damaging for sapwood than for heartwood. A number of species caused more than 50% wood mass losses after 12 weeks at room temperature, suggesting that beetle-killed trees can rapidly lose market value due to degradation of wood structural components.

Sentinel Lymph Node Biopsy in Patients Who Have Negative Conversion of Axillary Lymph Node after Neoadjuvant Chemotherapy for Node Positive Breast Cancer

Background: Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) has been currently debatable. It is possible that the tumor response to chemotherapy may alter the lymphatic drainage thus causing lower SLN identification rate and higher false negative rate. Further, the response of NAC can be different in each lymph nodes. It is doubtful whether SLNB can accurately predict axillary lymph node (ALN) status after NAC. The aim of this study to determine the identification rate, the false-negative rate, and the accuracy of SLNB after NAC for node positive breast cancer.Patients and Methods: A prospective study was initiated to evaluate the results of SLNB after NAC. From January 2007 to April 2009, 81 patients with positive axillary lymph nodes enrolled from two institutions after IRB-approved. They received NAC and then evaluated negative conversion of metastatic lymph node with both PET and breast US. All of them underwent ALN dissection after SLNB with subareolar intradermal injection technique using radioisotope. We evaluated the identification rate, false negative rate, accuracy of SLNB according to the response of chemotherapy in axillary lymph nodes (negative conversion group or remaining positive group).Results: Before the NAC, 31 patients had multiple axillary lymph node metastasis and 50 patients had single metastasis. After NAC 44 cases (54.3%) turned into negative node and 37 cases (45.7%) remained positive nodes. Total identification rate was 80.2% (65 of 81), false negative rate was 19.0% (8 of 42) and accuracy was 87.7% (57 of 65). In negative conversion group showed 84.1% (37 of 44) of identification rate, 21.1% (4 of 19) of false negative rate, 89.2% (33 of 37) of accuracy. In remaining positive group revealed 75.7% (28 of 37) of identification rate, 17.4% (4 of 23) of false negative rate, 85.7% (24/28) of accuracy. There was no statistical significant difference of identification rate, false negative rate, accuracy of SLNB among the two group after NAC (p=0.343, p=0.534, p=0.478, respectively).Conclusion: This study showed relatively low detection rate and accuracy, high false-negative rate of SLNB, even if the positive nodes changed to negative node after NAC. Thus sentinel lymph node biopsy after NAC for node positive breast cancer should be cautious. Since this study had small number of negative conversion patients, further larger prospective studies are required for more proper conclusion.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1022.

Electrochemical behavior and differential pulse polarographic determination of piperacillin sodium

In an aqueous piperacillin sodium solution, a well-defined single wave or single peak was observed by direct current (DC) polarography or differential pulse polarography (DPP). The peak potential change per pH unit was -54 mV in the phosphate buffer at 18 degrees C, which indicated that protons were involved in the electrochemical reduction of the 2,3-dioxopiperazine moiety of piperacillin sodium with a H+/e- ratio of one. Using a phosphate buffer of pH 4.3, the 1.0 x 10(-7) M piperacillin sodium single peak could be determined by DPP with relative standard deviation of 1.6% (n=3). Piperacillin sodium could be analyzed without interference from penicillin G-potassium, which enabled the employment of DPP as a fast and simple technique for monitoring the synthetic process of the antibiotic.

Importance of microperineural invasion as a prognostic factor in ampullary carcinoma

BACKGROUND

This was a study of the relation of clinicopathological factors to prognosis in 25 patients who had ampullary carcinoma resected.

METHODS

The 5-year survival rate was six of the 25 patients. The presence of microperineural invasion was sought and related to outcome.

RESULTS

Factors relating to prognosis included tumour gross appearance, diameter, pancreatic invasion and microperineural invasion. The 5-year survival rate of 14 patients with microperineural invasion was 3, significantly worse than the 7 in 11 without invasion (P = 0.002, univariate analysis). By multivariate analysis, microperineural invasion was the most important prognostic factor (P = 0.02). Type of tumour recurrence was similar to that in pancreatic carcinoma.

CONCLUSION

Pancreaticoduodenectomy, rather than local resection, is the procedure of choice in patients with ampullary carcinoma.

Importance of microperineural invasion as a prognostic factor in ampullary carcinoma

BACKGROUND

This was a study of the relation of clinicopathological factors to prognosis in 25 patients who had ampullary carcinoma resected.

METHODS

The 5-year survival rate was six of the 25 patients. The presence of microperineural invasion was sought and related to outcome.

RESULTS

Factors relating to prognosis included tumour gross appearance, diameter, pancreatic invasion and microperineural invasion. The 5-year survival rate of 14 patients with microperineural invasion was 3, significantly worse than the 7 in 11 without invasion (P = 0.002, univariate analysis). By multivariate analysis, microperineural invasion was the most important prognostic factor (P = 0.02). Type of tumour recurrence was similar to that in pancreatic carcinoma.

CONCLUSION

Pancreaticoduodenectomy, rather than local resection, is the procedure of choice in patients with ampullary carcinoma.

Adjuvant hepatic arterial IL-2 and MMC, 5-FU after curative resection of colorectal liver metastases

BACKGROUND/AIMS

Based on our favorable results of interleukin-2-based immuno-chemotherapy in the treatment of unresectable liver metastases from colorectal cancer, we utilized this therapy for the prevention of liver recurrence after liver resection.

MATERIALS AND METHODS

Eighteen patients with colon cancer metastatic to the liver underwent successful hepatic resection and adjuvant immunochemotherapy that included hepatic arterial infusion of interleukin-2 and mitomycin C, 5-fluorouracil. The regimen consisted of weekly interleukin-2 (1.4-2x 10(6) units), 5-fluorouracil (250 mg) by 2-hour infusion and bolus mitomycin C (4 mg) for 6 months.

RESULTS

Fourteen of 18 patients are alive and disease-free with a median postoperative follow-up of 28.5 months. Recurrent cancer has developed in 4 of the 18 patients (22%). The site of first recurrence was the lung in three patients (17%) and the pelvis in one (6%); no patients recurred in the liver.

CONCLUSIONS

We recommend this adjuvant immuno-chemotherapy for the prevention of liver recurrence after curative resection of colorectal liver metastases.