Methods of polyp resection (endoscopic, local surgical resection, or definitive surgical resection) within both sporadic and familial patient groups were compared. Patients with known cancer were excluded. Two hundred seventy-eight patients with duodenal polyps were followed during this time period: 110 patients (39.6%) with sporadic polyps and 168 (60.4%) with familial adenomatous polyposis (FAP). Sporadic patients presented at a mean age of 66.5 years. Endoscopic resection was attempted in 44 patients (40%) with morbidity in 9% and local recurrence rate of 52% with a mean follow-up of 43 months. Surgical resection was performed in 46 patients (42%): 27 by definitive resection and local resection in 19. At a mean follow-up of 41 months, there were no local recurrences in the patients treated by definitive resection and six recurrences (32%) after local resection. Morbidity was 39%. There was a significant difference in local recurrence when comparing definitive resection to both endoscopic and local resection (p<0.001, p=0.002, respectively), but no significant difference between endoscopic and local excision (p=0.13). Cancer was discovered in the surgical specimens of 11 patients (24%) with benign preoperative biopsies. FAP patients began surveillance at a mean age of 39.5 years, and mean surveillance duration was 100 months. Endoscopic resection/ablation was attempted in 40 patients (24%) with a morbidity of 7.5%. With a mean follow-up of 77.5 months, the local recurrence rate was 72.5%. Surgical resection was performed in with local recurrence rates of 9% and 100%, respectively. Surgical morbidity was 48%. Local recurrence was significantly lower following definitive resection compared to endoscopic or local resection (p<0.001), but there was no difference in local recurrence between the latter two groups (p=0.29). Four patients (8%) undergoing surgery were discovered to have invasive cancer despite benign endoscopic biopsies. In summary, endoscopic and local surgical management for both sporadic and familial duodenal polyps are associated with a high rate of local recurrence. Definitive resection in the form of pancreaticoduodenectomy, pancreas-sparing duodenectomy, or segmental duodenectomy offers the best chance for polyp eradication and prevention of carcinoma, regardless of polyp etiology.
Satisfying relationships are important to the well-being of individuals and families. Because of increased longevity, many couples are staying together for extended periods of time. Thus, it is valuable to understand the factors that contribute to a sense of satisfaction among partners in lasting relationships. Relatively little attention has been paid in the research literature to relationships among older couples who have remained together for many years. Even less attention has been paid to the lasting relationships of couples of color and to gay male and lesbian couples. This paper focuses on understanding the factors that contribute to satisfaction of partners in the long-term relationships of a purposive sample of heterosexual and same-sex couples. Data was collected through in-depth interviews with 216 partners in 108 relationships that had lasted an average of 30 years. Using logistic regression analysis, two factors were identified as predictive of satisfaction during the recent years of these relationships: containment of relational conflict and psychologically intimate communication between partners. Based on these findings, a theoretical model for understanding satisfaction in lasting relationships is discussed.
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