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PubMed1999

[Prognosis and prognostic factors of endosseous implants in the irradiated jaw].

In comparison to tumor patients not receiving radiotherapy, the rehabilitation of masticatory function after head and neck irradiation is limited due to radiation-induced caries, radioxerostomia, and the risk of osteoradionecrosis. This study focused on implants in the irradiated jaw and on the evaluation of the prognosis and the effect of potential factors on the prognosis. The retrospective study covered 197 implants (47 patients) from 1988 to 1997. The implant prognosis was determined by implant survival statistics (Kaplan-Meier). Losses not related to the implants were censored. In addition, groups were formed according to factors potentially affecting the prognosis. The significance of differences in the groups relative to survival were tested using the log-rank test. Twelve (6.1%) implants from a total of 197 were lost due to peri-implantitis, and eight (4.1%) due to possible biomechanical stress. A total of 52 losses (26.4%) due to death of patients and two (1.0%) due to resection of the jaw were censored; 111 (56.3%) implants remained at recall and the average interval was 33 months. The rates of implant survival (Kaplan-Meier) after 1 and 2 years were 95%, after 3 and 4 years 92%, and after 5 and 6 years 72%. The univariate analysis of group comparisons showed a significantly lower rate of loss after perimplant flap reconstruction (p = 0.036). There was no effect due to the doses of irradiation (p = 0.16), chemotherapy (p = 0.90), or peri-implant osteoplasty (p = 0.84). Although none of the implants inserted before radiotherapy had to be explanted, the implant survival difference in the very heterogeneous groups was not significant (preirradiation, n = 29; postirradiation: n = 156; p = 0.13). According to the literature, the rate of survival of teeth which were sound before radiotherapy (1 year, 75%; 5 years, 45%) was distinctly lower than the survival of enossal implants (1 year, 95%; 5 years, 72%). The high-quality rehabilitation of masticatory function with implant-based protheses is the preferred method of treatment for irradiated tumor patients. In addition, contraindications for enossal implants were ruled out for all studied factors affecting prognosis.

Adult↗
PubMed2001

Achalasia and esophageal cancer: incidence, prevalence, and prognosis.

Reported incidence rates of carcinoma in patients with achalasia and the prevalence of achalasia in patients with esophageal cancer vary widely in the literature. The prognosis of an "achalasia-carcinoma" is generally considered poor, although systematic studies assessing the incidence, prevalence, and prognosis of patients with "achalasia-carcinoma" are scant. We investigated the incidence of esophageal cancer in a large series of patients with known achalasia, assessed the prevalence of achalasia in patients presenting with esophageal cancer, and evaluated the prognosis of these patients compared to that of patients with esophageal cancer without achalasia. Between 1982 and 1998 a total of 124 patients with primary achalasia were treated and followed at our department. During the same time period 1366 patients presented with esophageal cancer (879 esophageal squamous cell carcinomas, 487 adenocarcinomas). Of the 124 patients with primary achalasia, 4 developed a carcinoma during a mean follow-up of 5.6 years (i.e., an incidence of one carcinoma per 173.6 patient-years of follow-up). Altogether, 13 of 879 patients (1.5%) presenting with esophageal squamous cell carcinoma and 1 of 487 patients (0.2%), presenting with esophageal adenocarcinoma had a history of primary achalasia. Seven patients with achalasia-carcinoma (50%) had early-stage disease (stage I, IIA, or IIB). There was no difference in the prognosis of patients with resected achalasia-carcinoma versus those with esophageal carcinoma but no achalasia. Thus in our population of patients with long-standing achalasia the risk for developing an esophageal cancer was increased about 140-fold over that of the general population. With liberal use of surveillance, carcinoma could often be detected at an early stage in these patients, with a prognosis that was not worse than that of patients with squamous cell esophageal cancer but no achalasia.

Adolescent↗
PubMed2004

Identifying subgroups among poor prognosis patients with nonseminomatous germ cell cancer by tree modelling: a validation study.

BACKGROUND: In order to target intensive treatment strategies for poor prognosis patients with non-seminomatous germ cell cancer, those with the poorest prognosis should be identified. These patients might profit most from more intensive treatment strategies. For this purpose, a regression tree was previously developed on 332 patients. We aimed to evaluate the performance and structure of this tree. PATIENTS AND METHODS: The previously developed tree was applied to 456 patients with a poor prognosis as defined by the International Germ Cell Cancer Collaborative Group (IGCCCG). Next, we developed a new tree to evaluate whether a similar structure to the previous tree was found. We assessed the internal validity of the new tree, and compared the 2-year survival estimates of each subgroup together with the discriminative ability for both the previously developed and the new tree. Discriminative ability was measured by a concordance (c) statistic, which varies between 0.5 (no discrimination) and 1.0 (perfect discrimination). RESULTS: The 2-year survival estimates in the IGCCCG data ranged from 33% to 63%. The ordering of the subgroups was different and discriminative ability was lower than originally found (c = 0.56 in the IGCCCG data versus 0.63 originally). The new tree differed considerably from the original tree, and identified poor prognosis subgroups with 2-year survival estimates from 38% to 73%. Internal validation showed similar discriminative ability for the new tree and the original tree (c = 0.59 versus 0.56). CONCLUSIONS: The previously developed tree showed poor validity with respect to discriminative ability and the stability of its structure. The performance of the new tree was also unsatisfactory. Given the low proportion of patients categorised as poor prognosis, it seems that the potential to identify further subgroups with the currently available patient characteristics is limited.

Adolescent↗
PubMed1986

Classification and prognosis of schizophrenic disorders in light of the Bonn follow-up studies.

In the Bonn Schizophrenia Study (Huber et al., Monogr. Gesamtgebiete Psychiat., vol. 21, Springer, Berlin 1979) 113 cases fulfilled the criteria for four types of schizo-affective and/or cycloid psychoses. Each of these subgroups had a significantly more favorable long-term prognosis than that of the Bonn sample as a whole. Several prognostically favorable factors found in the Bonn Study are identical to criteria used to classify schizo-affective, schizophreniform and cycloid psychoses, e.g., acute onset, endogenomorph-depressive symptoms, and psychoreactivity. In the Bonn main sample of 502 schizophrenics, 22% demonstrated complete recovery and 40% more or less noncharacteristic types of remission (pure asthenic defect); 56% were socially recovered, two thirds reaching their premorbid level and one third remaining below it. The 12 different types of course are described. There are four course type groups, the prognostically favorable (types I-III), the relatively favorable (types IV-VI), the relatively unfavorable (types VII-IX), and the unfavorable group (types X-XII), each embracing about one quarter of all schizophrenics. The long-term prognosis is dependent on factors such as primary personality, school success, precipitating factors and certain psychopathological initial symptoms and syndromes. The results support the assumption that early treatment, including that of the prodromes, improves the long-term prognosis or at least the chance of complete remission of the subgroup with peracute and acute onset. In spite of the more favorable long-term outcome of the schizo-affective psychoses the results cannot justify the nosological differentiation and classification of these and related psychoses as an independent disease entity but only as different prognostically favorable types of endogenous psychoses. In this respect it is possible to make a distinction between a nuclear group of schizophrenia and a different group with a better prognosis, variously termed schizophreniform, schizo-affective or psychogenic psychoses, which with respect to prognosis is an intermediate group.

Adult↗
PubMed2002

Accuracy of prognosis estimates by four palliative care teams: a prospective cohort study.

BACKGROUND: Prognosis estimates are used to access services, but are often inaccurate. This study aimed to determine the accuracy of giving a prognosis range. METHODS AND MEASUREMENTS: A prospective cohort study in four multi-professional palliative care teams in England collected data on 275 consecutive cancer referrals who died. Prognosis estimates (minimum - maximum) at referral, patient characteristics, were recorded by staff, and later compared with actual survival. RESULTS: Minimum survival estimates ranged <1 to 364 days, maximum 7 - 686 days. Mean patient survival was 71 days (range 1 - 734). In 42% the estimate was accurate, in 36% it was over optimistic and in 22% over pessimistic. When the minimum estimate was less than 14 days accuracy increased to 70%. Accuracy was related, in multivariate analysis, to palliative care team and (of borderline significance) patient age. CONCLUSIONS: Offering a prognosis range has higher levels of accuracy (about double) than traditional estimates, but is still very often inaccurate, except very close to death. Where possible clinicians should discuss scenarios with patients, rather than giving a prognosis range.

Journal Article↗
PubMed2002

[Actual situation and social prognosis of women seeking psychiatric care at the emergency hostel of Tokyo Metropolitan Women's Counseling Center].

The emergency hostel of Tokyo Metropolitan Women's Counseling Center, established in 1957, provides protection and care for about 600 Japanese or foreign women per year. The women housed there need social support for various reasons such as prostitution, poverty, somatic or mental diseases, or domestic violence (DV). We investigated the sociodemographic characteristics, psychiatric diagnoses and social prognoses of 2667 women who consulted the psychiatric clinic in the emergency hostel between 1961 and 1997. Seventy-four women consulted the psychiatric clinic per year, on average. Most were aged between 20 and 49. During the study period, there was a gradual decline in the number referred through the prostitution prevention law. Psychiatric diagnoses at the first visit varied widely. Annual comparison showed a gradual decrease in schizophrenia and manic-depressive illness, but an increase in substance abuse, psychogenic reaction, and personality disorder. Sociodemographically, most subjects appeared to have been children from underprivileged backgrounds. The social prognoses of 930 cases judged in March 1998 were good in 25%, moderate in 23% and poor in 48%. The poor prognosis group contained significantly more women with schizophrenia and personality disorder than the other two groups. The poor prognosis group tended to include more cases of substance abuse, while the good prognosis group contained more cases of depression and mental retardation. Women in the DV group tended to have more children than those in the non-DV group, and to have a higher prevalence of psychogenic reaction and a lower prevalence of schizophrenia. The DV group also tended to include more subjects with a moderate social prognosis and fewer subjects with a poor social prognosis. Specialized treatment should be provided for women after emergency admission to the hostel and this treatment needs to be aimed at improving social adaptation of the hostel residents, especially those with schizophrenia, personality disorders and substance abuse. Victims of DV should receive more conscious attention. In particular, prevention of mental disorders should be aimed not only at the residents but also their children.

Adolescent↗
PubMed2004

[Prognosis of the reproduction health care in the Czech Republic until 2010. I. Perinatal care].

OBJECTIVE: A prognosis of the development of perinatal care in the Czech Republic until 2010 DESIGN: An epidemiological study to be used as a basis for the prognosis. SETTING: Mother and Child Care Institute, Prague. METHODS: The primary source data on the indicators of the level of perinatal care as well as on some circumstances under which this care is being developed and on which their prognosis is based were drawn from the information obtained from their annual nationwide analysis. RESULTS: The prognosis of the development of perinatal care until 2010 builds on the previous prognosis from the period 1980-2000, whose results, when analysed retrospectively, proved a significant dependence of professional development on political, demographic, social and economic circumstances. Increase of the level of perinatal care, evaluated according to internationally recognised criteria, resulted in decreasing the maternal, perinatal and infant mortality rates to levels reported by a few countries in the world. The fact that these levels have been stagnating since 2000 is a result of two conflicting processes. On one hand, there is the improvement in the standard of care; on the other hand, there is deterioration in some of the above-mentioned circumstances. The fact that the reserves for further decrease in professional care have been used up and, conversely, the risk that some of the above-mentioned circumstances will deteriorate have raised concerns that some of the indicators of this care will deteriorate as shown by the extrapolation of the trend in these indicators prevalent in the last years carried out for the period until 2010. Two prognoses with differently serious impacts were formulated on the basis of this extrapolation. CONCLUSION: The development of perinatal care is dependent on the circumstances under which it is being developed. The fact that the reserves in development and organisation of this specific field have been used up, which resulted in decreasing the maternal, perinatal and infant mortality rates to levels, which are among the lowest ones in the world, and, conversely, the deterioration in some of the above-mentioned circumstances have raised concerns that the internationally recognised indicators of this care will deteriorate.

Czech Republic↗
PubMed2006

Activation of STAT3 is a marker of poor prognosis in human colorectal cancer.

It is known that the signal transducer and activator of transcription 3 (STAT3) is a key signaling molecule implicated in the regulation of growth and malignant transformation. Constitutive activation of STAT3 has been observed in a number of tumour-derived cell lines, as well as in a wide variety of human malignancies. The present study was conducted to examine p-STAT3 (activated form of STAT3) expression and its association with clinicopathological factors and prognosis in human colorectal adenocarcinomas. Expression of p-STAT3 was immunohistochemically examined in 108 cases of colorectal adenocarcinoma tissue obtained at surgery. and was found in 57.4% of tumours (62 of 108). p-STAT3 immunoreactivity significantly correlated with the depth grading of tumour invasion (p<0.001), lymphatic invasion (p<0.05), Dukes' classification (p<0.05), stage (p<0.001) and prognosis after operation (p<0.001). Expression of p-STAT3 was a marker of poor prognosis in overall survival (p<0.01). Expression of p-STAT3 was detected by Western blot analysis in three colon carcinoma tissue samples obtained at surgery. To our knowledge, this is the first study on the poor prognosis of p-STAT3 in human colorectal adenocarcinomas. These findings suggest that expression of p-STAT3 is an important factor related to tumour invasion and poor prognosis of human colorectal adenocarcinoma.

Adenocarcinoma↗
PubMed2006

[Cytogenetic disorders in chronic B-cell lymphoid leukemia and their relations with clinicobiological features and prognosis of the disease].

AIM: To study a relationship between cytogenetic disorders, clinicobiological characteristics and prognosis in chronic B-cell lymphoid leukemia (B-CLL). MATERIAL AND METHODS: Cytogenetic examination of blood, bone marrow and lymph node cells from 135 patients (90 males and 45 females aged 23-84 years) with chronic B-CLL was made. The patients were followed up from 1 month to 25 years. Before the cytogenetic examination specific therapy was not given. B-CLL was staged by K. Rai, forms--by A.L. Vorobyev and M.D. Brilliant. All the patients have undergone standard cytogenetic examination, FISH with multicolor probe to loci with possible frequent aberrations (del3q14, del11q23, del17p13, trisomia 12), determination of CD38 antigen expression on circulating tumor cells. Mutation status of the genes of immunoglobulins variable region (IgVH) was defined in 61 patients. RESULTS: Del13q14 was detected in 34 cases, del11q23--in 26, trisomia of chromosome 12--in 17 cases, del 17p13--in 8, absence of q-arm of chromosome 13--in 3 cases. 61 patients had no karyotype defects. Three prognostic groups of the patients were identified: favourable prognosis--patients without disorders of karyotype and one chromosomal aberration--del13q14; intermediate prognosis patients with dell1q23 and trisomia of chromosome 12; poor prognosis--patients with del17p13 and complex disorders of karyotype. CONCLUSION. Cytogenetic study help determine prognosis of B-CLL and detect patients in need of early therapy.

ADP-ribosyl Cyclase 1↗
PubMed1989

[Prognosis for insulin requirements in Czechoslovakia].

The submitted prognosis of insulin requirements in the CSR is based on the estimated number of type 1 diabetics and the estimated number of insulin treated type 2 diabetics. For the purpose of the prognosis these numbers are calculated for five-year age groups, separately for men and women. In the first approximation the authors assume that in the treatment of type 1 diabetics four typical therapeutic regimes are used which are consistent with conventional therapy and its intensified modification. In type 2 diabetics in the first approximation it is assumed that another four variants of therapeutic regimes will be mostly used which are typical for these patients. The sum of daily doses needed by all patients gives an estimate of the total requirements of the four basic types of insulin. This prognosis respects the basic factors which influence insulin requirements, whereby the basis is the development of the health status of the population. Comparison of different variants of the prognosis of requirements with the actual consumption makes it possible to formulate some conclusions for planning production and for evaluating the used and perspectively foreseen insulin therapy. From the results of the prognosis ensues that in 1995 the insulin consumption in the CSR will vary between 150 and 185% of the consumption in 1980.

Czechoslovakia↗
PubMed2026

Effect of Tertiary Lymphoid Structures on Immune Cell Infiltration in the Tumor Microenvironment and Prognosis in Lung Adenocarcinoma.

Tertiary lymphoid structures (TLSs) modulate immune responses in various solid tumors, but their comprehensive role in lung adenocarcinoma (LUAD) remains unclear. In this study, we analyzed RNA-seq data from 539 LUAD patients in The Cancer Genome Atlas (TCGA) and microarray data from 223 samples from the Gene Expression Omnibus (GEO, GSE13213, and GSE37745). TLS signatures were evaluated via unsupervised consensus clustering based on 12 chemokine transcriptome signatures. The relationships between TLS and clinical characteristics, tumor microenvironment (TME) cell infiltration, and prognosis were assessed using ESTIMATE and CIBERSORT. A prognostic model was established using LASSO regression and validated with external datasets. Additionally, H&E and IHC analyses were performed to explore associations between intratumoral TLS density, immune-related molecular expression, and patient prognosis in LUAD. Consensus clustering of the TCGA cohort revealed two distinct LUAD patient clusters according to TLS abundance. Cluster 1 exhibited greater immune cell infiltration, more favorable prognosis, and increased expression of immune checkpoint molecules. We developed a prognostic model comprising eight survival-associated genes that act as independent prognostic factors for patient survival. H&E/IHC analyses revealed that TLS density-regardless of pathological stage-was associated with better prognosis; higher intratumoral TLS density/proportion was also related to more favorable outcomes. IHC confirmed that survival-associated genes (CD5, HLA-DMB, and P2RY13) are independent prognostic indicators in LUAD. Our study demonstrated the close relationship between TLS signatures and an active immune microenvironment, highlighting their potential as independent prognostic indicators in LUAD.

Humans↗
PubMed1992

Prognosis in ischemic heart disease. Can you tell as much at the bedside as in the nuclear laboratory?

BACKGROUND--While the resting left ventricular ejection fraction (LVEF) predicts prognosis in ischemic heart disease, clinical evaluation is also useful. METHODS--To compare the prognostic value of LVEF by resting radionuclide ventriculography with that of clinical signs and symptoms of congestive heart failure (CHF), 170 patients with suspected ischemic heart disease were followed up in this prospective study. Patients had a standardized history and physical examination performed by a study cardiologist immediately before the nuclear scan. Chest roentgenography and radionuclide ventriculography were performed in a standard manner. The diagnosis of CHF was made by validated clinicoradiographic criteria based on the Framingham study. Mortality was determined by means of the National Death Index; median follow-up time was 3 years. RESULTS--There was CHF at baseline in 70 patients, and baseline LVEF was low (< or = 0.4) in 63 patients. Low LVEF was significantly associated with CHF. During follow-up, 55 of the subjects died (overall mortality, 32%). Subjects with CHF had a significantly higher risk of death than those without CHF, and subjects with low LVEF had a higher mortality than those with preserved LVEF. Both CHF and LVEF were independent predictors of mortality. In a Cox model, each percentage increase in LVEF was associated with a 2% decreased mortality, while subjects with CHF had a mortality 2.5 times higher than that of those without CHF. Also, CHF with preserved LVEF had a better prognosis than CHF with depressed LVEF, but this prognosis was worse than that in subjects without CHF. CONCLUSIONS--The clinical diagnosis of CHF, based on clinical evaluation and chest roentgenogram, is a valid predictor of mortality and provides information independent of the radionuclide LVEF in determining prognosis in patients with ischemic heart disease.

Aged↗
PubMed1990

The prognosis in Alzheimer's disease. 'How far' rather than 'how fast' best predicts the course.

Clinical features at the initial examination of 42 patients with probable Alzheimer's disease were tested for prognostic value at subsequent follow-up of 54 +/- 25 months. These potential prognostic features were of three types: degree of severity features (eg, IQ scores); variable clinical features (eg, extrapyramidal signs); and individual distinguishing features (eg, gender, education, and age). The power of these potential prognostic features to predict prognosis was assessed using the Kaplan-Meier life-tables method and the Cox proportional hazards model. Three clinical end points were considered: total dependence in activities of daily living; incontinence; and institutionalization at follow-up. Degree of severity features (subtests of the Wechsler Adult Intelligence Scale-Revised and the Wechsler Memory Scale, and the Clinical Severity Score) predicted subsequent dependence in activities of daily living, incontinence, and institutionalization. Historical disease duration, age, gender, family history of dementia, retrospective rate of progression, anxiety, psychosis, depression, and extrapyramidal signs did not influence prognosis. These results suggest that initial degree of severity ("how far") rather than variation in the rate of progression ("how fast") best predicts prognosis in the early to intermediate stages of Alzheimer's disease. The relationship of disease severity to prognosis should be taken into account before concluding that there are subtypes of Alzheimer's disease that have different rates of progression.

Activities of Daily Living↗
PubMed1978

Prognosis in schizophrenia. Prognostic predictors and outcome.

Eighty-eight of 92 first-admission schizophrenics from 1963, an incidence by first admission cohort, were followed up in 1974 and 1975. Epidemiologically the sample was more comparable to lower European rates and expectancy rather than to higher American figures. Prior to follow-up, factors said to predict outcome were scored. This prognostic information was complete for 79 cases. Outcome was measured on a variety of criteria. The patients fell into a "poor prognosis" group based on the prognostic indicators, which were of little value in predicting prognosis within this group. However, patients who received extensive service during the follow-up period had poorer outcomes. Outcome was better than in most earlier studies of schizophrenia, but similar to that in some other recent studies of first-admission patients; also, the use of phenothiazines, short-term hospitalization, and community services may play a part. The failure of prognostic indicators to predict more than about 25% of the outcome variance for this group of "poor prognosis" patients supports the viewpoint that "good" and "poor" prognosis schizophrenia are two different entities.

Adolescent↗
PubMed1997

Influence of cathepsin D expression in lung adenocarcinoma on prognosis: possible importance of its expression in tumor cells and stromal cells, and its intracellular polarization in tumor cells.

BACKGROUND: Cathepsin D, an aspartic lysosomal proteinase, has been described to be closely associated with tumor progression and prognosis in some human malignancies. The purpose of this study was to determine clinicopathological and prognostic significance of cathepsin D expression in lung adenocarcinoma. METHODS: Expression of cathepsin D in 152 lung adenocarcinoma patients was immunohistochemically studied using the antihuman cathepsin D antibody. RESULTS: Eighty patients (53%) showed negative immunoreactivities in tumor cells. The cathepsin D-positive patients (72 patients, 47%) were divided into two subgroups; granular type expression (48 patients, 31%) with its polarized expression mainly in the luminal side of the cytoplasm of tumor cells and basal type expression (24 patients, 16%) with its polarized expression mainly in the basal or infranuclear side of the cytoplasm. Patients with basal type expression showed significantly more marked scar formation (P = 0.042), and especially among the patients with stage I disease, those with basal type tended to show poorer prognosis (P = 0.071) than the others. Cathepsin D was also expressed in stromal cells within the tumor tissues, and 86 patients (57%) with moderate to massively infiltrating cathepsin D-positive stromal cells showed a lower grade of differentiation (P = 0.005) and higher scar grade (P = 0.0003) than those with few cathepsin D-positive stromal cells. Cathepsin D status in stromal cells was significantly associated with prognosis (P = 0.014), and in a multivariate analysis, its expression status in stomal cells was marginally an independent prognostic factor only among the stage I patients. CONCLUSIONS: In determining significance of cathepsin D expression in this disease, it is important to consider separately its expression cell type and its polarization pattern in tumor cells within the tumor tissue. How ever, only cathepsin D status in stromal cells within the tumor tissue is a marginal marker influencing prognosis among stage I patients.

Adenocarcinoma↗
PubMed1999

p16 inactivation in small-sized lung adenocarcinoma: its association with poor prognosis.

p16, an inhibitor of cell cycle machinery, is frequently inactivated in non-small cell carcinoma of the lung (NSCCL). To clarify the significance of p16 inactivation in the progression of lung adenocarcinoma, we immunohistochemically evaluated p16 protein status and Rb, p53 and cyclin D1 expression in 51 surgically resected adenocarcinomas that were less than 3 cm in diameter (median follow-up period: 52.5 months). Twenty-one of 51 adenocarcinomas showed negative immunostaining for p16. Twenty adenocarcinomas were also negative for Rb, while 31 and 13 were positive for p53 and cyclin D1, respectively. Loss of p16 expression was significantly correlated with scar grade, lymphatic permeation, lymph node metastasis and clinical stage. Rb protein expression was also inversely correlated with scar grade, pleural involvement and vascular invasion. When the cases were stratified according to the expression of both proteins, the Rb-/p16- subset (7/51) consisted of poorly differentiated adenocarcinoma with a higher grade of invasion. While Rb, p53 and cyclin D1 protein status showed no significant correlations with prognosis, p16 inactivation was significantly correlated with poor prognosis, and the prognosis of Rb-/p16- was the worst among the 4 subsets. Inactivation of p16 may play a role in accelerating scar formation and lymph node metastasis, and may contribute through these mechanisms to poor prognosis in patients with small-sized lung adenocarcinoma.

Adenocarcinoma↗
PubMed1999

Management of intermediate-prognosis germ-cell cancer: results of a phase I/II study of Taxol-BEP.

The standard chemotherapy regimen in metastatic germ-cell cancer is bleomycin, etoposide and cisplatin (BEP). Chemotherapy studies testing cisplatin dosage and the substitution of ifosfamide for bleomycin have not shown this to be superior to BEP. Paclitaxel (Taxol) has demonstrated promising activity as a second-line treatment in patients with relapsing or cisplatin-refractory germ-cell cancer. Hence, the potential of incorporating paclitaxel in first-line chemotherapy should be investigated. We assessed the feasibility of the addition of paclitaxel to BEP (T-BEP) in a phase I/II study in patients with intermediate- or poor-prognosis germ-cell cancer or with carcinoma of unknown primary (CUP). Paclitaxel was investigated at dose levels of 75, 125, 175 and 200 mg/m2 given as a 3 hr infusion on day 1, before the start of BEP. BEP comprised etoposide at a dose of either 120 mg/m2 on days 1, 3 and 5 or 100 mg/m2 on days 1-5. To deliver the highest possible dose of paclitaxel into BEP, all patients received filgrastim (G-CSF). Thirty patients were entered, 14 of whom had intermediate- (n = 7) or poor- (n = 7) prognosis germ-cell cancer. Paclitaxel up to 200 mg/m2 and BEP at 360 mg/m2 was well tolerated. There was minimal neurosensory and no neuromotor toxicity with the use of 4 T-BEP cycles. More pronounced myelotoxicity and diarrhea at the higher dose level of etoposide resulted in a recommended dose level for multicenter phase II/III testing of paclitaxel 175 mg/m2 and BEP 500 mg/m2. Of the 13 evaluable patients with intermediate- or poor-prognosis germ-cell cancer, all achieved complete response. With a median follow-up of 18 months, none of these patients has relapsed. We conclude that T-BEP is a well-tolerated induction regimen that should be further tested for its therapeutic potential. A randomized phase II/III study of T-BEP vs. BEP has been started as an EORTC trial in patients with intermediate-prognosis disease.

Adolescent↗
PubMed1996

Prognosis of nonspecific work-related musculoskeletal disorders of the neck and upper extremity.

Reviews of work-related musculoskeletal disorders (WMD) of the neck and upper extremity have typically supplied little information on prognosis. This paper reports on the methods and results of a systematic search for evidence on clinical course and prognosis of nonspecific WMD i.e., those without specific clinical diagnoses. Articles were deemed relevant if they provided primary data on current or former worker cases of WMD followed over time. WMD status had to be based on clinical evaluations. The 13 studies which met these criteria were evaluated using clinical epidemiological criteria for validity of prognostic studies. None of the studies was sufficiently strong across the criteria to provide more than weaker evidence on prognosis. Prognostic factors with promise include duration of symptoms and workplace demands. In order to improve the evidence on prognosis of WMD, we recommend closer attention to the following: clear operational definition of cases; documentation of prognostic factors including duration of symptoms and severity at baseline; incorporation of multiple follow-up assessments; inclusion of a range of outcomes; and analysis using stratified or multivariate methods.

Arm Injuries↗