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PubMed1986

Changes in the treatment and prognosis of breast cancer.

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94% and the tumour was found by the patient in most cases. Only two patients were younger than 30 years. The median delays to the first medical contact and to operative treatment were 30 and 20 days respectively. The delay had no influence on the prognosis. Also, the age of the patients and the localization of the tumour had no significant effect on the prognosis. Simple mastectomy with axillary lymph node excision was the main operative treatment in the present material whereas Halsted's radical mastectomy was frequently performed in the previous study. Operative radicality was the same in both studies. The prognosis has improved in all clinical stages. The present relative five year survivals in stages I-IV were 95, 83, 53 and 18%, whereas in the previous study they were 75, 58, 41 and 0%, respectively. The improvement in stage II-IV breast cancers is probably due to advances in radio- and chemotherapy. However, the improvement in the prognosis of stage I and to a lesser extent of stage II breast cancers cannot be explained on this basis alone. Neither do the shorter delays in treatment fully explain the differences in the prognosis. The most frequent sites of metastasis were bone and lung/pleura where almost half of the total metastasis occurring during the follow-up were found.

Adult↗
PubMed1981

[Course dynamics and early prognosis in traumatic intracranial hemorrhage. II. Subdural hematoma].

181 subdural haematomas were subjected to surgery within a period of 3 years. Basing on the dynamics of their course and on their prognosis, we can differentiate between acute (50.8%, interval up to 24 hours), sub-acute (10.5%, interval 2 to 10 days) and chronic types (38.7%, interval 11 days to 6 months). Acute subdural haematomas are due to severe traumas, mostly combined with skull fractures; in most cases, there is no free interval, and they are associated with severe disturbances of consciousness. Their prognosis is poor (mortality 7.2%) and less due to a space-occupying growth, namely the haematoma, than to the primarily traumatic cerebral lesion. Sub-acute subdural haematomas are often characterized by a free interval; the disturbances of consciousness are less severe, and their prognosis is much more favourable (mortality 26.3%). Chronic subdural haematomas are the sequels of milder traumas, but it is clinically impossible to distinguish them from pachymeningiosis haemorrhagica interna. They become manifest by mental changes, headache and neurological focal symptoms. If treated in time, their prognosis is favourable, the mortality being 10%. All types of subdural haematoma present a characteristic clinical pattern. Atypical courses are much rare than with the epidural haematomas. Preoperative classification with assessment of prognosis can be achieved via findings obtained by computed tomography and angiography of the carotid artery.

Acute Disease↗
PubMed1982

[Anatomo-clinical correlations in Berger's disease: evaluation of the prognosis by analysis of one hundred and one cases (author's transl)].

In order to evaluate the prognosis of IgA nephropathy semi-quantitative analysis of tubulo-interstitial and vascular alterations was performed. Three groups of patients are described. In the first group the prognosis has remained favourable until the present time. The prognosis is variable in the second group. In the last group the prognosis is always unfavourable. However, the limited duration of the study may elicit certain reservations concerning the long-term prognosis for the first and second groups.

Adolescent↗
PubMed1983

Prognosis of seizures in medically-treated adolescent and adult Nigerian epileptics.

One hundred and four unselected adolescent and adult epileptics treated in Lagos University Teaching Hospital were followed up for 3 years to determine their seizure prognosis. We found 37% completely free of seizures; marked improvement in 30%, moderate improvement in 11%, slight improvement in 10% and no improvement in seizure control in 13% of the patients. The study also indicated that prognosis of seizure control is more favourable: (a) in generalised than in partial epilepsy; (b) in patients with onset of seizures after the age of 10 years and in particular after the age of 30 years; (c) in patients with less frequent seizures; (d) in patients who started treatment within 2 years of onset of seizures; (e) in patients who had initially a normal EEG. The prognosis of seizure control was less favourable in patients who were treated with native herbs by traditional healers prior to hospital treatment probably because the majority of them started medical treatment later than 2 years after the onset of seizures. There was no relationship between seizure prognosis and the number of anti-epileptic drugs taken by the patients. Most of the patients (79%) claimed they took drugs regularly although there were no serum levels to confirm these claims. There was no relationship between seizure prognosis and drug compliance as claimed by the patients.

Adolescent↗
PubMed1984

[Various principles for evaluating the prognosis in epilepsy].

The principles of the prognostic evaluation in epilepsy are suggested. Since the concept of prognosis is complex and multifacet it is advisable to differentiate its clinical aspect (including the prognosis of paroxysmal, psychic, neurologic and other manifestations of the disease) and the social one (occupational, familial, and social). The correlation of these factors considered from the viewpoint of a dynamic approach determines the course and the prognosis of epilepsy as a whole. The degree of the patient's clinical and occupational compensation serves as one of the major criteria of the assessment of the disease course and prognosis. Clinical and social criteria taken as a whole permit a comprehensive qualification of the prognosis of epilepsy. The above principles may be applied to other mental disorders as well.

Consciousness Disorders↗
PubMed1983

[5-year survival of resected bronchial cancer. Multifactorial analysis of its prognosis].

Prognosis in patients having undergone surgery for a bronchial carcinoma (oat cell. carcinoma excluded) was studied by comparing, with two statistical methods, a group of 178 patients surviving five years and more (group I) and a group of 178 patients who died within five years (group II). The two groups had undergone treatment during the same period. Comparison of the two groups suggested that the following factors were indicators of a good prognosis: ratio weight-height within normal limits without recent weight loss, fortuitous detection of the carcinoma; normal aspect on bronchoscopy; T1 N0 type without vascular extension, limited exeresis. Recurrences of the carcinoma were generally observed in group II but could be present in group I. The differential prognosis between pulmonary metastases and a "new" bronchial carcinoma was difficult. Survival was finally determined by the frequency of recurrences and metastases. By a correspondences factorial analysis it was possible to separate and to define the main characteristics of the patients with a good prognosis and a long survival and of those with a poor prognosis and a short survival. However this proved to be exact in only 30% of the individual cases because occurrence of metastases was generally unforeseable. From these data it appears that surgery alone is indicated in only one kind of tumours; T1 N0 carcinomas detected by routine examinations.

Aged↗
PubMed1981

Prognosis of epilepsy. Remission of seizures and relapse in 808 adult patients.

In a retrospective study of 808 adult epileptic patients undertaken at the Neurological Institute of Montevideo, Uruguay, the rate of remission of seizures (three seizure-free years) was 32%, and that of relapse 39%. Remission occurred mostly during the first years after onset, and relapse during the first years after remission. Patients with generalized or partial seizures alone had a better prognosis than when both types coexisted. Patients with Petit Mal absences persisting after 14 years of age, had the lowest rate of remission. Mental status, abnormal neurological examination and age of onset showed no significant prognosis value. Remission and relapse was similar in cryptogenetic and symptomatic epilepsy. Genetic predisposition did not change the prognosis. Withdrawal of drugs after a minimal seizure-free period of three years produced a higher rate of relapse than when medication was continued. In the first EEG, only the existence of a slow background rhythm had an unfavorable prognosis. These results are compared with those of other series. It is concluded that the differing results can be attributed to a different selection of population and different methods of study. Anyway, several factors showed a similar influence on prognosis in the different series. As to indication for method of drug withdrawal after remission, and its influence on relapse, no definite conclusion can be drawn and a large, multicentric, methodical study on this topic is suggested.

Adult↗
PubMed1982

Prognosis in chronic ischemic heart disease.

The last 20 years have provided an extraordinary amount of data contributing to an improved understanding of the prognosis of chronic ischemic heart disease. However, much remains incompletely understood. The lack of more precise knowledge about prognosis encourages fuzzy clinical thinking and seems to justify the overutilization of a variety of diagnostic and therapeutic modalities. It seems probable that the information available on many individual patients is not fully utilized in assessing prognosis more accurately. An approach is outlined which attempts to utilize clinical and laboratory data in prognosis with particular emphasis on objective information concerning left ventricular function and evidence of myocardial ischemia. The importance of transition phases in the natural history of the patient with ischemic heart disease is emphasized. Table V attempts to summarize areas of clinical research which are important if we are to gain a better understanding of the prognosis of this unusually complex clinical entity, chronic ischemic heart disease.

Chronic Disease↗
PubMed1995

[The relation between delivery method and prognosis for very low birth weight infants].

To further understand the relationship between perinatal factors and prognosis (neonatal and infantile death and major handicaps), we retrospectively studied 128 singletons weighing less than 1,500g (very low birth weight; VLBW) infants, without maternal complications, IUGR or major congenital anomalies. The gestational age (mean +/- SD) at delivery and the birth weight (mean +/- SD) of subjects were 27.1 +/- 2.0 weeks and 1,041.1 +/- 264.1g, respectively. The results of the current study were as follows: 1) Malpresentation, low Apgar score (APS) and Respiratory distress syndrome (RDS) were observed more frequently in non-intact survivors than in intact survivors with statistical significance. Although the occurrence of fetal distress was correlated with low pH in the umbilical artery, no significant correlation was evident between the prognosis and either of the two above mentioned factors. The intact survivors had a significantly high frequency of PROM despite no correlation with signs of infection (WBC, CRP). 2) As to delivery methods in terms of prognosis, a cephalic-vaginal group had the best prognosis and a breech-vaginal group had the worst, with statistical significance. A higher frequency of poor prognosis for infants was found in a malpresentation group with cesarean delivery and cervical dilation of more than 4cm. Thus, vaginal delivery is a possible option in case of cephalic VLBW infants.

Delivery, Obstetric↗
PubMed1995

[Long-term prognosis in unstable angina].

The expression unstable angina pectoris covers a wide range of clinical symptoms with different pathogenetic mechanisms and clinical outcome. Several forms of unstable angina pectoris, in particular progressive angina pectoris (crescendo angina) with chest pain at rest in a previously asymptomatic patient, progressive angina pectoris with chest pain at rest in a previously symptomatic patient, and chest pain at rest of at least 15 min duration without obvious trigger mechanisms have been distinguished. In simpler terms: one may also distinguish angina pectoris of recent onset, crescendo angina, and acute coronary insufficiency. Four risk factors appear to determine the prognosis in these patients: exercise-induced angina pectoris, multiple episodes of chest pain before hospitalization, electrocardiographic changes, and recurrent angina pectoris during hospitalization. Acute coronary insufficiency and nontransmural infarction have initially better prognosis than transmural infarction; however, recurrent cardiac events are more frequent in patients with nontransmural infarction, particularly in the elderly with persistent ECG changes, cardiac decompensation, and infarct extension. Unstable angina pectoris and myocardial ischemia after myocardial infarction are generally associated with a poorer prognosis. In contrast, recurrence of angina pectoris after PTCA (within the first six months) is most commonly due to restenosis and hence prognostically not of great importance. Unstable angina pectoris after coronary bypass surgery, however, is a prognostically unfavourable sign. Prognosis in patients with Prinzmetal angina is determined by the extent of coronary disease. In summary, long-term prognosis in patients with unstable angina pectoris depends heavily on the clinical presentation and the previous clinical history of the patient.

Angina Pectoris, Variant↗
PubMed1994

[Determination of prognosis-relevant factors in patients with hypo- or oropharyngeal carcinoma].

The influence of pathomorphological parameters (keratinization, grading, nucleolar organizer region (NOR) counts, automatic analysis of micrographs) on prognosis was determined for 284 patients with carcinomas of the oropharynx or hypopharynx. Keratinization was found to have no influence on prognosis. Histopathological grading and automatic analysis of micrographs with mark 22 were seen to be of major relevance. Patients with grading 3 were noted to have a poorer prognosis than those with gradings of 1 or 2. This latter finding was statistically significant. Although the absolute NOR counts had no influence on prognosis, they did show a statistically significant effect on the extent of lymphogenic formation of metastases. Cox regression analysis of clinical and pathomorphological parameters revealed that combination therapy, tumor grading, and mark 22 of automatic analysis of micrographs were important factors relevant to prognosis.

Biomarkers, Tumor↗
PubMed1996

Poorer prognosis in older patients with endometrial adenocarcinoma.

It has been suggested that there are two types of endometrial carcinoma: the first arises in younger women who have hyperestrogenism and has a favorable prognosis and the second occurs in older women, is not associated to estrogen stimulation, and has a poorer prognosis. This study examined the hypothesis that more aggressive carcinomas are found in older patients with no evidence of estrogen stimulation. A retrospective review of all patients (N = 82) with endometrial carcinoma diagnosed and treated at our institution between 1978 and 1990 was undertaken. The following data were analyzed: age at diagnosis, stage, race, histologic type, grade, depth of myometrial invasion, absence or presence of associated hyperplasia, and survival. The mean age of the patients was 64.8 years. Sixty (73%) of the 82 patients were considered estrogen-positive either because of obesity (body mass index > or = 27.3) or the use of unopposed exogenous estrogen. There were no statistically significant differences between estrogen-positive and estrogen-negative patients. Patients > or = 65 years had a 5-year survival of 60% compared with 74% for younger patients. There was a trend toward higher histologic grade among the older patients. Otherwise no statistically significant differences were found between these two groups. Estrogen-negative women > or = 65 years had the worst prognosis with a 5-year survival of 29%. As identified by other investigators, age at diagnosis is a significant indicator of prognosis in patients with endometrial carcinoma. In this series, thin, older (> or = 65 years) women who developed endometrial carcinoma had the worst prognosis.

Adenocarcinoma↗
PubMed1997

[Prognosis of hepatic metastasis from colorectal cancer following hepatic resection and arterial infusion chemotherapy--assessment from the percentage of tumor involved area].

Prognosis of hepatic metastasis from colorectal cancer following hepatic resection and arterial infusion chemotherapy was studied from the percentage of tumor involved area (PTIA). The PTIA was calculated by the following formula: sigma S'/sigma S, with S' as the tumor area and S as the liver area on each CT slice. The subjects were 25 cases of hepatic resection (HR), and 31 cases of hepatic arterial infusion chemotherapy (HAI). The PTIA of the cases of HR and that of HAI was 1.5 to 25.9% and 0.8 to 31.3%, respectively. For comparison, all cases were divided into group A, which was not more than 10% of the PTIA, and group B, which was more than 10% of the PTIA. In the cases of HR, the prognosis of group A was significantly better than that of group B (p < 0.05). In the cases of HAI, the prognosis of group A was better than that of group B. Even in group A, the prognosis of the cases of HR was significantly better than that of HAI (p < 0.05). These results suggest that the PTIA in the cases of HR and HAI for metastasis from colorectal cancer is important factor which reflects the prognosis.

Colorectal Neoplasms↗
PubMed1997

[Usefulness of DNA ploidy, AgNORs, PCNA and c-erbB-2 as predictors of prognosis in patients with renal cell carcinoma].

Seventy one patients with renal cell carcinomas were examined for a variety of markers associated with tumor malignancy: nuclear DNA ploidy, AgNORs, PCNA and c-erbB-2. Usefulness of the markers in predicting the prognosis was studied by analyzing the relationship between each of these markers and the prognosis of the patients with renal cell carcinomas. DNA ploidy was analyzed by flow cytometry. AgNORs were stained by the silver colloid method. PCNA and c-erbB-2 were detected by immunohistochemistry. In all the patients examined, DNA ploidy, AgNORs, PCNA and c-erbB-2 were significant predictors of the prognosis. Of the patients with grade 2 carcinomas, the survival rate was significantly higher in the patients with the PCNA-positive cells of lower than 35.0% than in those with the positive cells of more than 35.0%. The patients without the expression of c-erbB-2 exhibited a significantly higher survival rate than those with the expression. In the patients with grade 2 carcinomas, however, neither DNA ploidy nor AgNoRs was a significant predictor of the prognosis. These findings suggest that PCNA and c-erbB-2 provide more accurate information than the others to understand the biological characteristics of the grade 2 carcinomas and are useful in predicting the prognosis of the patients with grade 2 renal cell carcinomas.

Adult↗
PubMed1997

[Predictive value of serum ferritin in the prognosis of acute cerebrovascular accident].

INTRODUCTION: Recent studies show that a raised level of serum ferritin indicates a poor prognosis in CVA patients, as do the well-known hyperglycemia, dyslipemia and arterial hypertension. The evolution and prognosis of acute cerebrovascular accidents are determined by a series of factors, some of which can be modified. This leads to a search for factors which can be modified and therefore influence the course of the illness. OBJECTIVE: To determine the ferritin levels and other parameters during the course of the illness of patients with serious cerebral vascular pathology and evaluate their effect on prognosis. MATERIAL AND METHODS: A prospective study was carried out on patients diagnosed as having CVA, admitted to the Neurology Department of the Miguel Servet Hospital (Zaragoza) during 1994, and who were in neurological coma (Glasgow scale less than 7) during the first 24 hours, and unable to swallow. The levels of various plasma parameters were determined (glucose, cholesterol, ferritin, etc.) on admission and then every 10 days. CONCLUSIONS: Plasma ferritin levels higher than those considered normal by the laboratory, in the first few hours after CVA, are an independent predictive factor suggesting unfavourable evolution of the vascular condition. Equally, raised ferritinemia in the first weeks after CVA indicates a worse prognosis. This laboratory test may be carried out on patients with acute CVA to obtain more information on which to base the prognosis.

Acute Disease↗
PubMed1998

[Patients with acute coronary syndrome: therapeutic approach (management patterns) and 1-year prognosis in a tertiary general hospital].

BACKGROUND: To assess the determinants of short-term and one-year prognosis of all patients with suspected acute coronary syndrome seen by the cardiologist on duty in the Emergency Service of a tertiary hospital during a six month period. PATIENTS AND METHODS: 153 consecutive patients with a diagnosis of acute myocardial infarction, 225 with a diagnosis of unstable angina and 89 with a diagnosis of atypical chest pain were identified and their in-hospital characteristics and one-year prognosis were prospectively assessed. RESULTS: Age was higher than 65 years in 53% of acute myocardial infarction and in 54% of unstable angina patients. Only 3 patients were lost to follow-up. 35% of acute myocardial infarction patients had died or had reinfarction after one year and 16% of unstable angina patients had died or had suffered acute myocardial infarction. Baseline features, management patterns and prognosis of patients admitted with acute myocardial infarction to the Cardiology Service, to other hospital areas or to other hospitals were markedly different, and admission in areas other than the Cardiology Service was an independent mortality predictor. In unstable angina, complications happened in patients older than 75 years, those with previous revascularization procedures, those undergoing revascularization or those with lesions not deemed revascularizeable. CONCLUSIONS: a) In the study population there was a predominance of elderly patients; the proportion of patients with poor prognosis was considerably high; b) a sizeable proportion of patients with severe complications was scarcely represented in the major clinical trials; c) the possibility arises of a distribution of care resources tending to concentrate the greater therapeutic efforts in the patients with good prognosis.

Acute Disease↗
PubMed2000

Lymphatic involvement in early gastric cancer: prevalence and prognosis in France.

BACKGROUND: The prognosis of early gastric cancer (EGC) is considered better than that of invasive gastric carcinoma, with a 5-year survival rate of more than 90% after surgery. The prevalence of lymph node metastasis in EGC ranges from 8% to 20% and is associated with a poor prognosis. HYPOTHESIS: The main prognostic factor of EGC in patients in France is lymphatic involvement. DESIGN, SETTING, AND PATIENTS: From January 1979 to December 1988, 332 patients with EGC were operated on in 23 centers of 2 of the French Associations for Surgical Research. Clinical, pathological, and therapeutic data were reviewed, and the reckoning point was in June 1996. MAIN OUTCOME MEASURES: The cumulative 5- and 7-year specific survival rates of EGC with or without lymphatic involvement. RESULTS: The cumulative 5- and 7-year specific survival rates of 332 patients with EGC (mean follow-up time, 80 months), excluding both operative and unrelated mortality, were 92% and 87.5%, respectively. Thirty-four patients (10.2%) had metastatic lymphatic spread: 13 exclusively in the lymphatic vessels close to the tumor, 17 in at least 1 lymph node, and 4 in both the lymphatic vessels and nodes. The rate of lymph node involvement (regardless of lymphatic vessel involvement) correlated significantly with submucosal invasion (P =. 05) and histologic undifferentiation (P =.03). Lymphatic vessel involvement correlated positively with lymph node involvement (P =. 003). Since 5- and 7-year survival rates of the 13 patients with EGC who had lymphatic vessel involvement without lymph node involvement did not differ significantly from those of patients who had EGC with lymph node involvement (85% and 84% vs 72% and 63%, respectively [P =.42]), all patients with lymph node and/or lymphatic vessel involvement were considered unique. Prognosis was poorest in these patients according to both univariate analysis (94% for 298 without node or vessel involvement vs 78% for 34 with node and/or vessel involvement; P =.006) and multivariate analysis (P =.01). Submucosal invasion was a prognostic factor independent of lymphatic involvement (P =.05). Five- and 7-year survival rates did not differ when the group of 211 patients for whom less than 15 lymph nodes were retrieved were compared with those (n = 51) for whom 15 or more lymph nodes were retrieved (95.5% vs 92% and 95.5% vs 88%, respectively), whether according to univariate (P =.21) or multivariate (P =.31) analysis. CONCLUSIONS: Our results suggest that both lymph node and lymphatic vessel involvement are important prognostic factors in patients with EGC. Lymphadenectomy in EGC is important to identify the high-risk population for whom prognosis is worse. The extent of lymphadenectomy (at least 15 nodes) in these patients, however, does not alter prognosis.

Adult↗
PubMed2004

Cancer diagnosis and prognosis in Taiwan: patient preferences versus experiences.

Considering the emphasis of nonmaleficence and beneficence and the relative power of family, there is a well-recognized suggestion that, in Asian culture, informing cancer patients about their diagnosis and prognosis should be modified according to the family's opinion. However, up until now, except in Japan, the argument that cancer patients from an Asian culture have different preferences about being informed of their diagnosis and prognosis has not been demonstrated by evidence-based studies especially by directly exploring cancer patients' preferences. The purpose of this study was to describe Taiwanese cancer patients' knowledge and experiences of being informed of their diagnosis and prognosis. Preferences of information from health-care professionals and attitudes toward disclosing information to family and even respecting family's opinions not to disclose the life-threatening diagnosis and prognosis to patients have also been explored from the patient's point of views. Evidence from this study demonstrated that Taiwanese cancer patients' information needs are substantial. However, the common practice of nondisclosure of prognosis and detailed disease-related information by health-care professionals continues. Cancer patients in Taiwan expressed a strong preference for health-care professionals to inform them of disease-related information before disclosing information to their family members. Health-care professionals need to consider and respect cancer patients' views rather than routinely taking the family's opinions into consideration first in the event of disagreement.

Adolescent↗