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PubMed2005

Audiometric patterns and prognosis in sudden sensorineural hearing loss in southern Taiwan.

OBJECTIVES: To investigate factors affecting the prognosis of sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: This is a retrospective study of patients with SSNHL hospitalized at an academic medical center. All patients in this study were treated with prednisolone and dextran. We compared a new 7-pattern classification for audiometric pattern and prognosis analysis with Sheehy classification. RESULTS: We analyzed 148 affected ears in 146 patients. Occurrence of SSNHL was associated with changes in season. The best prognosis was with the midtone pattern of the 7-pattern classification and with the low-tone pattern of Sheehy classification. The older patients, those with vertigo, or those treated after 6 days had a poor prognosis. There was no significant association between ESR level and prognosis. CONCLUSIONS: SSNHL patients with midtone loss have the best prognosis. This study of the audiometric patterns and prognostic factors of SSNHL allow us to better predict its outcome.

Adolescent↗
PubMed1996

Prognosis of patients with stable angina pectoris on antianginal drug therapy.

Antianginal drug treatment reduces symptoms and ischemia but may also influence the prognosis of patients with stable angina pectoris. The Atenolol Silent Ischemia Study (ASIST) compared atenolol and placebo treatment (about 140 patient-years on each) in patients with mainly silent ischemia and found less aggravation of angina and a tendency toward fewer cardiac complications with atenolol treatment. The Total Ischaemic Burden European Trial (TIBET) compared slow release nifedipine, atenolol, or the combination (about 450 patient-years on each) and found no significant differences with regard to cardiac complications, a nonsignificant trend toward better prognosis on combined treatment, and more side effects on nifedipine alone compared with the other treatments. The Angina Prognosis Study in Stockholm (APSIS) compared metoprolol and verapamil (about 1,400 patient-years on each) and found similar effects on cardiovascular endpoints, tolerability, and psychosocial variables with the 2 treatments. Hypothesis-generating subgroup analyses in APSIS suggest that treatment effects may differ in hypertensive and diabetic subgroups. Beneficial effects in primary and secondary prevention, together with data from ASIST, suggest that beta 1 blockade influences prognosis favorably. The safety of short-acting nifedipine in ischemic heart disease is questioned, but TIBET data suggest that slow release nifedipine may be safe. Verapamil has beneficial effects after myocardial infarction (Danish Verapamil Infarction Trial II) and shows similar efficacy as metoprolol in the APSIS study. The paucity of placebo data (antianginal treatment cannot be withheld during long periods of time in symptomatic patients) precludes firm conclusions regarding effects of drug treatment on prognosis. It is argued that patients with stable angina pectoris do well on medical treatment, and that beta 1 blockers, verapamil, and, possibly, slow-release nifedipine may influence their prognosis favorably.

Angina Pectoris↗
PubMed1997

The ellipsis of prognosis in modern medical thought.

Contemporary textbooks of internal medicine give scant attention to the prognosis of diseases. Has this always been the case? If not, when and why did prognosis come to be de-emphasized? Using a highly regarded, standard medical textbook initially authored by William Osler, The Principles and Practice of Medicine, I performed qualitative and quantitative content analysis of entries regarding lobar pneumonia in selected editions published between 1892 and 1988, with special attention to the period between 1892 and 1947. I chose lobar pneumonia because it was a leading cause of death throughout this period and because it is recognizable across time, thus making it possible to follow the evolution in clinical thinking about prognosis while holding constant the diagnosis. I argue that two powerful forces converged to lead to the ellipsis of prognosis: (1) the emergence of effective therapy, and (2) a fundamental change in the cognitive basis of medicine. With respect to the former, I show that there is a complementary, inverse relationship between the clinical acts of prognostication and therapy; as one increases in salience in the management of a disease, the other decreases. With respect to the latter, I argue that the particular clinical facts deemed to be important about a patient's case have shifted over time, and I explore changes in the clinical and cognitive foundations of physicians' estimation of patients' prognoses-in particular, "symptoms" and "complications." I conclude that, concurrent with a shift in clinical thought from an individual-based to a diagnosis-based conceptualization of disease, prognosis came to be seen as intrinsic to diagnosis and therapy, and explicit attention to prognosis consequently diminished.

Curriculum↗
PubMed2002

[Long-term prognosis of women with non-ST-segment elevation acute coronary syndromes. a case-control study].

BACKGROUND AND OBJECTIVES: Women with ST-segment-elevation myocardial infarction have a worse prognosis than men. However, information about the prognosis of women with non-ST-segment-elevation acute coronary syndromes (NSTEACS) is scarce. The aim of this study was to determine if the long-term prognosis of men and women with NSTEACS differs. PATIENTS AND METHOD: Case-control study. In a consecutive series of 300 patients admitted for a NSTEACS and ischemic ECG changes, we compared the clinical characteristics, in-hospital and long-term follow-up of 95 women and 95 men matched for age, presence of diabetes, and past history of hypertension. RESULTS: The median age of patients was 69 years, 36% had diabetes, and 65% had a history of hypertension. There were no gender differences in the history of angina or hypercholesterolemia, clinical presentation, number of patients with ST-segment depression, and CK-MB elevation. However, smoking, coronary artery disease, and peripheral vascular disease were less frequent in women. Treatment at admission and at discharge was similar in men and women, as was the use of in-hospital diagnostic and therapeutic procedures (echocardiography: 80 vs 88%; coronary angiography: 57 vs 59%; percutaneous coronary intervention: 17 vs 14%; coronary surgery 13 vs. 11%). Women had a better mean ejection fraction (55 13 vs 49 14%; p < 0.01) and fewer stenosed coronary vessels (1.4 1.1 vs 2.2 0.9; p < 0.01). There were no differences in the frequency of recurrent angina (28 vs 25%), death, or infarction (both 3.2%) during hospitalization. However, during a 30-month follow-up the incidence of death, myocardial infarction, or a new episode of NSTEACS was significantly lower in women with a relative risk (RR) of 0.53 (95% CI: 0.33-0.86; p < 0.01). This apparently better prognosis persisted after adjusting for clinical data and ejection fraction (RR: 0.57 (0.33-0.98); p < 0.05), but disappeared after adjusting for the number of diseased coronary vessels (RR: 0.71 (0.35-1.47); p = 0.36). CONCLUSIONS: Women with NSTEACS had a better long-term prognosis than men. This better prognosis was independent of the patients' clinical characteristics and treatment, and could be explained by a less severe and less extensive coronary artery disease.

Aged↗
PubMed1998

The long-term prognosis of benign nephrosclerosis accompanied by focal glomerulosclerosis and renal cortical interstitial fibrosis, designated so-called decompensated benign nephrosclerosis by Fahr, Bohle and Ratscheck.

The long-term prognosis of decompensated benign nephrosclerosis (DBN) was investigated by a retrospective analysis of the fate of 170 patients with this disease, which yielded the following results: 1) DBN carries a particularly poor prognosis. The renal survival rate (RSR) was 35.9% at 5 years and 23.6% at 10 years. The prognosis is therefore worse than that of any other primary glomerulopathy, with the exception of rapidly progressive glomerulonephritis. 2) DBN mainly affects males (sex ratio 5:1) and differs in this respect, among others, from focal sclerosing glomerulonephritis, in which the male:female ratio is 1.2:1. 3) The prognosis for females is no better than for males. 4) The severity of proteinuria at the time of biopsy has no influence on the prognosis. 5) The prognosis is particularly poor in cases in which the serum creatinine concentration is already elevated to more than 2.0 mg% at the time of biopsy. We conclude from these findings that not only the blood pressure, but also the serum creatinine concentration, should be assessed at regular intervals in all hypertensive individuals, so that DBN can be treated at an early stage, when it is still amenable to treatment.

Adult↗
PubMed2002

Poor-prognosis high-grade gliomas: evolving an evidence-based standard of care.

Patients with high-grade glioma (HGG) can be classified as having a favourable prognosis (younger or with good performance status) or a poor prognosis (older or with poor performance status) with median survival of 12-24 months and 6-9 months, respectively. The standard management for the favourable subgroup is maximum safe resection followed by adjuvant conventionally fractionated radio therapy, with or without chemotherapy. However, most patients with HGG have a poor prognosis and their optimum management has yet to be defined. In the poor-prognosis HGG subgroup, short-course radiotherapy is equivalent to conventional radiotherapy in terms of survival and palliation (level II evidence), but chemotherapy is not recommend ed (level II evidence). The problems with the existing systems of prognosis are discussed and a pragmatic system proposed. Owing to lack of any level I evidence, the need to conduct prospective randomised trials with quality of life and palliative effect as primary endpoints is emphasised. Until such time, maximum safe resection followed by a short course of focal radiotherapy is recommended as the standard of care in poor prognosis HGG.

Age Factors↗
PubMed2000

Identification of prognostic subgroups among patients with metastatic 'IGCCCG poor-prognosis' germ-cell cancer: an explorative analysis using cart modeling.

OBJECTIVES: The IGCCCG classification has identified three prognostic groups of patients with metastatic germ-cell tumors. 'Poor prognosis' is based on primary tumor localization, the presence of visceral metastases, and/or high tumor-marker levels. The overall survival rate of these patients is about 45%-55%. The present analysis attempts to identify subsets of patients with a more or less favorable outcome among the 'poor-prognosis' group. PATIENTS AND METHODS: We retrospectively explored prognostic subgroups in 332 patients with 'IGCCCG' poor-risk GCT using the classification-and-regression-tree model (CART). The following variables were included: primary tumor localization, presence of visceral or lung metastases, presence of an abdominal tumor, number of metastatic sites, serum levels of beta-HCG, AFP and LDH. All patients had been treated with cisplatin-etoposide-based chemotherapy within controlled clinical trials between 1984 and 1997. RESULTS PATIENT CHARACTERISTICS: gonadal/retroperitoneal (G/R) primary tumor 260 patients (78%), mediastinal primary tumor 72 patients (22%), visceral metastases 205 patients (62%) including 33 patients with CNS metastases, lung metastases 247 patients (74%), abdominal tumor 241 patients (72%), elevated AFP, beta-HCG or LDH levels 235 (71%), 253 (76%) and 275 (83%) of patients, respectively. Patients with primary mediastinal disease plus lung metastases exhibited the worst two-year PFS (28%), whereas patients with a primary G/R tumor and without visceral metastases showed the highest chance of two-year PFS (75%). The latter group of patients without visceral metastases and with a primary G/R tumor also had the most favourable two-year OS (84%). In contrast, patients with a primary mediastinal tumor and visceral metastases displayed the worst two-year OS (49%). CONCLUSIONS: Different prognostic subsets of patients can be identified among the group of 'poor-prognosis' GCT patients. The CART analysis model results in a hierarchy of prognostic factors which may allow to more precisely estimate the individual patient's prognosis. Identifying subgroups of 'very poor-prognosis' among 'poor-prognosis' patients may allow to test for new treatment strategies in selected subgroups.

Adolescent↗
PubMed1974

Male breast cancer. 6. Factors influencing prognosis.

A series of 257 cases of carcinoma of the male breast in Denmark has been examined with a view to establishing the factors which might influence the prognosis. Observed and corrected 5-year survival rates of 36% and 46% respectively correspond well with the results in other series. Expressed by corrected survival rate, the prognosis appears to be somewhat more favourable during the period 1958-71 than during the period 1943-57. This improvement of prognosis can be related to a significantly better clinical stage of advancement during the latter period. Comparison of the 5-year corrected survival rates in series of male and female breast cancer shows that the prognosis in male breast cancer is not much worse than the prognosis in females. It has been proved that the duration of disease, the clinical stage and the histological degree of malignancy influence the prognosis considerably. The therapeutic results in our series correspond well with the results found in other series. We did not find any evidence to indicate that it would be better to carry out radical mastectomy than to do simple mastectomy since radical mastectomy has not given consistently better results. It is recommended that treatment of this rather uncommon disease be centralized as far as possible.

Age Factors↗
PubMed1988

A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis?

The prognostic value of several clinical and histopathological characteristics has been evaluated in patients with Dukes' B and C carcinoma of the rectum and the rectosigmoid. Data on 260 Dukes' B and 208 Dukes' C tumours entered into a prospective, randomized clinical trial of post-operative radiotherapy (50 Gy given with 2 Gy/fraction in an overall time of 7 weeks) were analyzed by means of the Cox proportional hazards model. The Dukes' stages B and C were analyzed in two separate multivariate analyses. In patients with Dukes' B tumours, a poor prognosis was associated with age above 60, perineural and venous invasion, tumour located less than 10 cm from the anal verge and elevated pre-operative carcinoembryonic antigen (CEA) (greater than 3.2 ng ml-1). In patients with Dukes' C tumours, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and elevated pre-operative CEA were associated with a poor prognosis. In addition, a large tumour diameter had a strong, negative influence on the prognosis. Males seemed to have a poorer prognosis than females among the Dukes' C patients. Resection of neighbouring organs was also associated with a poor prognosis in this stage. Post-operative radiotherapy as administered in the present series had no significant influence on prognosis. Based on the derived prognostic models patients with a hazard of death above the median in each stage were selected. A separate analysis of the survival in these high risk patients showed no survival benefit from radiotherapy. The proportional hazards model may be a useful tool in selecting patients for more aggressive adjuvant treatment.

Age Factors↗
PubMed2004

Coexpression of epidermal growth factor receptor with related factors is associated with a poor prognosis in non-small-cell lung cancer.

The epidermal growth factor receptor (EGFR) is commonly expressed in non-small-cell lung cancer (NSCLC) and promotes a host of mechanisms involved in tumorigenesis. However, EGFR expression does not reliably predict prognosis or response to EGFR-targeted therapies. The data from two previous studies of a series of 181 consecutive surgically resected stage I-IIIA NSCLC patients who had survived in excess of 60 days were explored. Of these patients, tissue was available for evaluation of EGFR in 179 patients, carbonic anhydrase (CA) IX in 177 patients and matrix metalloproteinase-9 (MMP-9) in 169 patients. We have previously reported an association between EGFR expression and MMP-9 expression. We have also reported that MMP-9 (P=0.001) and perinuclear (p)CA IX (P=0.03) but not EGFR expression were associated with a poor prognosis. Perinuclear CA IX expression was also associated with EGFR expression (P<0.001). Multivariate analysis demonstrated that coexpression of MMP-9 with EGFR conferred a worse prognosis than the expression of MMP-9 alone (P<0.001) and coexpression of EGFR and pCA IX conferred a worse prognosis than pCA IX alone (P=0.05). A model was then developed where the study population was divided into three groups: group 1 had expression of EGFR without coexpression of MMP-9 or pCA IX (number=21); group 2 had no expression of EGFR (number=75); and group 3 had coexpression of EGFR with pCA IX or MMP-9 or both (number=70). Group 3 had a worse prognosis than either groups 1 or 2 (P=0.0003 and 0.027, respectively) and group 1 had a better prognosis than group 2 (P=0.036). These data identify two cohorts of EGFR-positive patients with diametrically opposite prognoses. The group expressing either EGFR and or both MMP-9 and pCA IX may identify a group of patients with activated EGFR, which is of clinical relevance with the advent of EGFR-targeted therapies.

Adult↗
PubMed1999

Papillary renal cell carcinoma: clinicopathological characteristics and evaluation of prognosis in 42 patients.

OBJECTIVE: To determine the clinicopathological characteristics of histologically defined papillary renal cell carcinoma (RCC) in relation to prognosis. PATIENTS AND METHODS: In total, 768 patients with RCC underwent nephrectomy at our university hospital between 1957 and 1995. RCC was classified into clear-cell carcinoma in 689 patients (89.7%, no follow-up in 14), chromophobe cell carcinoma in 36 (4.7%, no follow-up in two) and papillary RCC in 43 (5.6%, no follow-up in one). In the present study, the 42 patients with papillary RCC who underwent nephrectomy and were followed up were those in whom the clinicopathological features of the papillary RCC were assessed. Factors assessed were the presence or absence of foam-cell infiltration, occurrence of bleeding and/or necrosis, presence or absence of a pseudocapsule, mixed occurrence with clear-cell carcinoma, presence or absence of solid variants, cytoplasmic appearance (basophilic vs eosinophilic cells), stage, nuclear grade of malignancy, and angiographic appearance in relation to prognosis. The prognosis was also compared among patients with clear-cell, chromophobe cell and papillary RCC. RESULTS: The prognosis was significantly better in patients with foam-cell infiltration (P=0.03), with a pseudocapsule (P=0.07), with no solid variants (P=0.001) and with basophilic cells (P<0.001). There were also significant differences in survival between patients with low-stage (1+2) and high-stage (3+4) disease (P=0.003), and among grades 1-3 (grade 1 vs 2, P=0.05; grade 1 vs 3, P<0.001, grade 2 vs 3, P=0.006). Furthermore, the prognosis in patients with papillary RCC was worse than in those with chromophobe cell carcinoma (P=0.02), but there was no significant difference in survival between patients with papillary RCC and those with clear-cell carcinoma. CONCLUSION: The clinicopathological features (e.g. the presence or absence of foam cells, of a pseudocapsule and of solid variants, cytoplasmic appearance, and the stage and nuclear grade of malignancy) are important prognostic factors for patients with papillary RCC. Furthermore, the prognosis in patients with papillary RCC is similar to those with clear-cell carcinoma.

Adolescent↗
PubMed2005

Doctor-patient communication about prognosis: the influence of race and financial status.

CONTEXT: Although many studies have documented problems in communication between physicians and patients, few have focused on discussions regarding prognosis among community dwelling patients with terminal illness. OBJECTIVE: To examine the association of patient race and financial status with patient and clinician reports of discussions about prognosis. DESIGN: Cross-sectional survey. SETTING: Participants' homes. PARTICIPANTS: Two hundred fourteen patients age 60 years or older seriously ill secondary to congestive heart failure, chronic obstructive pulmonary disease, or cancer; and their primary clinicians. MAIN OUTCOME MEASURES: Patient/clinician agreement regarding discussions of prognosis. RESULTS: In adjusted analysis, patients and clinicians were more likely to agree that discussions about prognosis had taken place when patients had a lower financial status (odds ratio [OR] 2.26, 95% confidence interval [CI] 1.03-4.96), or were nonwhite (OR 2.56, CI 0.85-7.68), compared to patients who had a higher financial status or were white. Agreement about prognosis discussions was also more likely (adjusted OR 4.12, 95% CI 1.15-14.76) when patients were younger (i.e., age < 80). CONCLUSIONS: Among a cohort of seriously ill community-dwelling patients, patients and clinicians were more likely to agree that discussions about prognosis had occurred when patients were poorer and nonwhite. These findings contrast with the majority of studies examining the relationship between race or income and patient-physician communication about other end-of-life issues.

Aged↗
PubMed2005

Communicating prognosis in cancer care: a systematic review of the literature.

Prognosis is an issue that most doctors and patients describe as difficult to discuss and the best way of presenting prognostic information to optimise patient understanding, psychological adjustment and decision-making is uncertain. A systematic review of the literature was conducted with the aim of clarifying the current available knowledge of patient preferences, clinician views and current practice regarding the communication of prognosis. Eleven primary research questions guided organisation of the review findings, which were: patient preferences for prognostic information and preferred style of communicating prognosis; disclosure of prognosis to family members; physicians' views on communication of prognosis; current practice of delivering prognostic information; patient understanding and awareness of prognostic information; cultural differences in preferences and understanding; impact of prognostic information on patient outcomes; and interventions to facilitate prognostic discussion. Predictors of patient preferences for and understanding of prognostic information were also summarised. Studies are summarised under the subcategories according to the participants' disease stage. It was found that the majority of the published research has been conducted in the early stage cancer setting providing mostly descriptive evidence, and there is little evidence of the best method of communicating prognosis or of the impact of prognostic information on patient outcomes.

Awareness↗
PubMed1990

Clinical aspects of multiple sclerosis in north-east Scotland with particular reference to its course and prognosis.

The prognosis and course of multiple sclerosis (MS) and the factors that affect them were assessed in a group of 1055 patients, representing an unselected (epidemiological) sample observed in the north-east (Grampian region) of Scotland for a period ranging between 1 and 60 yrs. In 7% the disease began before the age of 20 yrs, in 12% after the age of 50 yrs, and in the remainder onset was between the ages of 20 and 50 yrs. The male/female ratio was 1:1.8. Mean disease duration in those observed until death (216 patients) was 24.5 yrs, with no significant difference between the sexes. Prognosis was assessed either by the interval between onset and death or by the degree of disability over a defined period of time. Depending on the length of follow-up, just over one-quarter (26%) to over one-third (36.3%) had a benign course and between 8.0 and 17.7% had a poor prognosis. Nearly a third had a remittent (32.8%) or relapsing cumulative (34%) course and 9% had a progressive course from the start. Several factors were noted to affect the prognosis. Prognosis was significantly better, independent of sex, in those with (1) an early onset (less than 40 yrs of age); (2) retrobulbar neuritis or a brainstem lesion or sensory symptoms alone at onset; (3) short duration of initial symptoms (less than 6 months); (4) a long onset--first relapse interval (greater than 1 yr); (5) a remittent course in the beginning and (6) lack of a family history of MS. The factors which predicted a poor prognosis included: (1) a late onset (greater than 40 yrs of age); (2) progressive course from the start; (3) multiple sites of lesions initially, or a cerebellar or spinal cord lesion at the onset; (4) psychiatric or persistent urinary symptoms at the onset or within 10 yrs; (5) persistent initial symptoms (beyond 1 yr); (6) early first relapse (within 6 months); (7) a family history of MS; (8) social class status IV and V; and (9) bilaterally prolonged visual evoked potential (VEP) P100 latency. Address in childhood and at the onset of the disease, changes in the CSF and CT brain scan were not of predictive value.

Adult↗
PubMed2005

Severe alcoholic hepatitis in Japan: prognosis and therapy.

BACKGROUND: Recently, the incidence of alcoholic liver disease (ALD) has been increasing in Japan; this associated with an increase in alcoholic beverage consumption. Multiple organ failures are frequently observed in patients with severe alcoholic hepatitis (AH), most of whom have a poor prognosis similar to fulminant hepatitis; as well numbers of severe AH patients appear to be increasing. Although prognosis of fulminant hepatitis in Japan has been recently improved by intensive treatments such as plasma exchange (PE) that of severe AH has not changed. The objective of this study was to determine whether there was any factor that could determine the prognosis of severe AH. METHODS: We carried out nation-wide survey by asking hospitals certified by the Japanese Society of Gastroenterology and hospitals related to ours hospital for the current status of patients seen with severe alcoholic hepatitis since 1998. We investigated correlations between various factors including blood laboratory data, presence of other organ failure, and prognosis. RESULTS: Mortality of patients with severe AH was high (66.4%). The ratio of female patients with severe AH (26%) was higher than that for other ALD (approximately 10%). Mean age was older (Alive: 44 +/- 11; Dead: 50 +/- 11 years old), white blood cell (WBC) counts were higher (11600 +/- 5200; 21800 +/- 13400/microl), red blood cell counts were lower (320 +/- 95; 265 +/- 72 x 10/microl) and prothrombin time (PT) was prolonged (36.2 +/- 10.4; 29.1 +/- 9.4%, respectively) in patients who had died than in patients who had survived. However, as all differences diminished after carrying out PE, we analyzed data in patients without PE. The results were similar to those in all patients. Prevalence of infection, gastrointestinal (GI) bleeding and disseminated intravascular coagulation (DIC) was higher in patients who had died. Although intensive treatments such as PE, hemodialysis, and anticoagulation therapy did not change the prognosis of severe AH, PE improved the prognosis of patients without either GI bleeding or DIC. WBC counts were also slightly higher in patients who had died after carrying out PE. Two cases had been cured by granulocytapheresis (GCAP) CONCLUSIONS: PE can compensate for and reduce the risk due to prolonged PT in patients with severe AH. These results suggest that the patients with markedly elevated WBC counts, prolonged PT, or anemia should, if possible, be treated at an earlier stage with an intensive treatment such as PE, hemodialysis, or anticoagulation therapy before infection, GI bleeding or DIC occurs. Further, GCAP might be useful for severe AH patients with higher WBC counts.

Adult↗
PubMed1985

A long-term prognosis for the free-end saddle-bridge.

A consecutive series of eighty-seven saddle-bridges with free-end saddles, executed by the author during the years 1958-72, was investigated in 1982. The aim was to assess the long-term prognosis. Five years after application 98% of the bridges were still functioning. The corresponding percentage after 10, 15 and 20 years was 82, 69 and 49%, respectively. The risk that saddle-bridges cease to function is very low during the first 5-year period but significantly higher thereafter. Soldering fractures constitute an important cause of the removal of appliances during the first 8 years following application. After this time the most frequent causes are caries and loosening of the teeth. Factors such as sex, time of application, patient's age, length of saddle and whether the bridges were fitted in the mandible or maxilla, have not had a significant influence on the prognosis. Furthermore, no statically significant difference has been found between the long-term prognosis for full and partial saddle-bridges. On the other hand, patients with a removable full denture in the opposing jaw show a significantly worse prognosis (P less than 0.05) than patients without a denture in this jaw. The results of the present study indicate that the short-term prognosis for saddle-bridges is very favourable and that the long-term prognosis is so good that saddle-bridges can constitute an alternative therapy even in jaws with as few as three remaining teeth.

Adult↗
PubMed1976

Prognosis of the Lennox syndrome-long-term clinical and electroencephalographic follow-up study, especially with special reference to relationship with the West syndrome.

The long-term clinical and electroencephalographic follow-up studies were carried out for more than three years, up to 14 years in the longest, on 116 cases with Lennox syndrome. And the results of s-ystematic study on changing patterns and out come have been reported. The follow-up examination was performed also on West syndrome which is closely related with Lennox syndrome; especially the relationship between both syndromes regarding prognosis has been clarified. (1) According to the long-term follow-up on 116 cases with Lennox syndrome, there were 98 cases (84.5%) having mes (61.2%) and persisted as Lennox syndrome except for one case. (2) Generally speaking, the cases with age of onset before two years old showed unfavorable outcome. (3) There were 42 cases (36.2%), which were converted from West syndrome and showed markedly unfaborable prognosis in regard to intelligence as well as the remainging of seizure. (31 cases, 77.5%) (4) On thehand, in 23 idiopathic cases, which showed no developmental retardation before onset of seizure, had favorable outcome, and the remaining of seizure was observed in eight cases (34.8%). However, even in such cases, it was noticed that those displaying mental defect at the follow-up attained 14 cases (60.9%). That is to say, it was clarified that persistence of even minor seizures induced mental deterioration. (5) The cases with favorable prognosis showed usually a typical slow spike-and-wave pattern electroencephalographically, whereas those with poor prognosis showed mostly an asymmetric or disorganized slow spike-and-wave pattern. (6) In many cases displaying signs of brain atrophy with pneumoencephalograpm and accompanying overt neurological signs at the initial examination, prognosis is obviously poor. (7) From the follow-up examination on 94 cases with West syndrome for three to 15 years transformed into Lennox syndrome Among them, those cases with the remaining of seizure at the time of follow-up were 44 (46.8%) out 94 cases, of which 37 cases (83.8%) had remaining seizure as Lennox syndrome. (8) From the above results, it is emphasized that Lennox and West syndromes show close relationship with each other and that a study should be done on the interrelation between their prognosis.

Adolescent↗
PubMed1998

How accurate is the terminal prognosis in the minimum data set?

OBJECTIVES: To determine the sensitivity and specificity of terminal prognosis in institutional long-term care (LTC) DESIGN: The Minimum Data Set (MDS 1.0). Data in regard to deaths were collected 6 and 12 months after the assessment. SETTING: A geriatric hospital responsible for all hospital-based LTC services in one health district (population 71,000) in Helsinki, Finland. PARTICIPANTS: All LTC patients (N = 656; 81% female; mean age = 83 years) in treatment during a 1-week period. RESULTS: One-fourth (n = 164) of the 656 LTC patients had a terminal prognosis. Of these patients, 70.7% survived 6 months, and 58.5% were still alive after 1 year. Consequently, terminal prognosis was associated with a four-fold risk of 6-month mortality. The sensitivity of the terminal prognosis diagnosis was only 29%, whereas the specificity was 89%. The positive predictive accuracy was 47%, but the negative predictive accuracy was 79%. CONCLUSIONS: Terminal prognosis was clearly overdiagnosed. More information is needed about short-term mortality in terminal prognosis patients and whether this diagnosis affects survival rates.

Aged↗