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At least 55 records · Page 3Linked to original sources

Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients.

A detailed retrospective analysis was undertaken of the effect of perioperative blood transfusion on long-term survival of 113 patients with Dukes' Stages A, B and C1 cancer of the colon and 383 patients with invasive cancer of the breast who were treated in our institution between 1973 and 1978 and followed for 5 to 10 years. In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients (P = 0.007, log-rank test). Perioperative blood transfusion was associated with a relative risk of 3.42 for all deaths (P = 0.005) and 4.25 for death due to cancer (P = 0.03), after adjustment for other important variables such as age, sex, stage, location of tumor, surgical procedure, and preoperative hemoglobin level. In contrast, in our study group of patients with breast cancers, who all underwent a modified radical mastectomy, no effect of blood transfusion on long-term survival was seen. Multivariate analysis adjusting for size of tumor, number of positive regional lymph nodes, menopausal status, estrogen receptor status and the addition or absence of chemotherapy, did not show any increased risk in all deaths or death due to cancer associated with blood transfusion. Although no definite explanation is available, our data show that there seems to be a difference in the relationship between perioperative blood transfusion and survival for colon and breast cancer patients.

Aged↗

The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group.

Patients with diabetes mellitus experience a more adverse outcome after acute myocardial infarction compared with nondiabetic patients, although the mechanisms responsible for these findings are not clear. From the Multicenter Investigation of the Limitation of Infarct Size (MILIS) study, the course of acute infarction in 85 diabetic patients was compared with that in 415 nondiabetic patients, all of whom had serial assessments of left ventricular function. The diabetic patients experienced a more complicated in-hospital and postdischarge course than did the nondiabetic patients, including a higher incidence of postinfarction angina, infarct extension, heart failure and death, despite the development of a smaller infarct size and similar levels of left ventricular ejection fraction. Although diabetic patients had a worse profile of cardiovascular risk factors at the time of the index infarction, the increased incidence of adverse outcomes among them persisted despite adjustment for these baseline imbalances. Diabetic women had a poor baseline risk profile compared with the other groups categorized by gender and diabetic status, and experienced an almost twofold increase in cardiac mortality despite development of the smallest infarct size during the index event. The duration of diabetes and the use of insulin at the time of the index infarction were associated with a better in-hospital mortality rate, but the duration of diabetes did not exert a major influence on the outcome of the diabetic patients. The factors responsible for the increased incidence of adverse outcomes among diabetic patients may be related to an acceleration of the atherosclerotic process, diastolic left ventricular dysfunction associated with diabetic cardiomyopathy or other unidentified unfavorable processes.

Cardiovascular Diseases↗

Correlation between mammographic manifestations and averaged histopathologic nuclear grade using prognosis-predict scoring system for the prognosis of ductal carcinoma in situ.

This retrospective study correlated the mammographic manifestations and averaged nuclear grades using Holland, Van-Nuys, and Lagios classifications in 37 cases of ductal carcinoma in situ (DCIS); microcalcifications alone were seen in 59.4%, microcalcifications with associated mass in 19%, and mass alone in 21.6%. DCIS is more likely to be accompanied by microcalcifications than mass on mammography. Correlation is good between the nuclear grades of DCIS and mammographic manifestations.

Adult↗

The apolipoprotein epsilon4 allele determines prognosis and the effect on prognosis of simvastatin in survivors of myocardial infarction : a substudy of the Scandinavian simvastatin survival study.

BACKGROUND: Carriers of the epsilon4 allele of the apolipoprotein E gene are at a higher risk of coronary heart disease than individuals with other genotypes. We examined whether the risk of death or a major coronary event in survivors of myocardial infarction depended on apolipoprotein E genotype and whether the benefits of treatment with simvastatin differed between genotypes. METHODS AND RESULTS: Cox proportional hazards models were used to analyze 5.5 years of follow-up data from 966 Danish and Finnish myocardial infarction survivors enrolled in the Scandinavian Simvastatin Survival Study. A total of 16% of the 166 epsilon4 carriers in the placebo group died compared with 9% of the 312 patients without the allele, which corresponds to a mortality risk ratio of 1.8 (95% confidence interval, 1.1 to 3.1). The risk ratio was unaffected by considerations of sex, age, concurrent angina, diabetes, smoking, and serum lipids in multivariate analyses. Simvastatin treatment reduced the mortality risk to 0.33 (95% confidence interval, 0.16 to 0.69) in epsilon4 carriers and to 0.66 (95% confidence interval, 0. 35 to 1.24) in other patients (P=0.23 for treatment by genotype interaction). Apolipoprotein E genotype did not predict the risk of a major coronary event. Baseline serum levels of lipoprotein(a) also predicted mortality risk and could be combined with epsilon4-carrier status to define 3 groups of patients with different prognoses and benefits from treatment. CONCLUSIONS: Myocardial infarction survivors with the epsilon4 allele have a nearly 2-fold increased risk of dying compared with other patients, and the excess mortality can be abolished by treatment with simvastatin.

Adult↗

[Prognosis and long-term prognosis of epidural haematoma (a study of 83 patients) (author's transl)].

1. Early detection and treatment of epidural haematoma is vital to the chance of survival. In this respect physician's training needs to be improved. 2. The operation method of choice, particularly in the case of advanced midbrain lesions, is the extensive decompression operation (hemicranectomy) with duraplasty. In each case it is imperative to pay special attention to the relationship between blood pressure and brain perfusion until the state of decompressive is reached. 3. Late complications such as a disturbed circulation of the cerebrospinal fluid may occur and should be prevented by a shunt-operation. 4. ECG changes are still detectable even after many years. However, they give little indication on the patient's tendencies to fits. Post-traumatic cases of epilepsy may even occur more than five years after injury. 5. Patients suffering from epidural haematoma are in need of careful medical, psychiatric and social care for many years after injury, even if they seem to have been restored both neurologically and psychiatrically at the time of hospital discharge.

Accidents, Occupational↗

[An examination of the prognostic value of biological parameters exemplified by the crucial prognosis-relevant factors of the TPI in the patient load of the Jena Clinic in 1968 to 1991. Therapy-dependent Prognosis Index].

The data of 240 patients with non-pretreated oral squamous cell carcinoma were analyzed in dependence on the tumor size (T-category), on the histologic checked lymph node status and the histopathologic grade of malignancy. There is a conformity to the results published by the DOSAK regard to the tumor size (T-category). The comparison of the survival of our patients with the estimated survival rate of the TPI shows also conformable results. Differences exist in the prognostic valuation of the lymph node status by the DOSAK. The histologic verificated lymph node status and the malignancy grade will recommend as decisionsive prognostic relevant parameters.

Aged↗