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PubMed1986

[Tumor factors influencing the prognosis of renal cell carcinoma].

Fifty six patients, 40 males and 16 females, received radical nephrectomy and were diagnosed to have renal cell carcinoma pathologically at Asahi General Hospital between January, 1972 and September, 1984. The five and ten year survival rates were 44.2 and 35.7% respectively. The cancers were classified according to pTNM category and their cell type and grade were estimated. The relationship between these factors and the patient's prognosis was studied. We recognized a close correlation among pT, cell type and grade, and found that they had a serious influence on prognosis. There was a close correlation between grade and pV, but no relationship between pN, pM and grade. Cases with a positive lymph node or distant metastasis had poor prognosis. Therefore, we suggest the possibility of false negative evaluation of pN and pM, because pN and pM were estimated clinically. Consequently, we believe that the pTNM category is a good classification for evaluation tumor expansion and the prognosis.

Adult↗
PubMed1985

[Prognosis of the pancreatic carcinoma in terms of the regional lymph node reaction].

In order to elucidate immunological defense mechanism in tumor bearing host against pancreatic carcinoma, tissue reactions of the regional lymph nodes were investigated in terms of extension and prognosis of pancreatic carcinoma. As the site for investigation of lymph node reaction paracortical area, germinal center and sinus histiocytosis system were selected. In each case paracortical hyperplasia, germinal center hyperplasia and sinus histiocytosis were graded and the relation between such grade and prognosis of resected pancreatic carcinoma was studied with following results. The grades of each tissue reaction in cases without lymphatic node metastasis were higher than that observed in cases with metastasis. There was significant difference in sinus histiocytosis (p less than 0.01). Higher graded tissue reactions were observed in cases with primary lesion with histologic type classified as papillary adenocarcinoma or as well differentiated tubular adenocarcinoma as compared to those in cases of poorly differentiated histologic type. In cases with pancreatic carcinoma the prognosis was better in cases with higher grade of tissue reactions of the regional lymph nodes. In cases with pancreatic carcinoma both cellular immunity and humoral immunity are involved in host defense mechanism. It was considered that sinus histiocytosis is significant as an indicator for good prognosis and a factor to inhibit progression in pancreatic carcinoma.

Adenocarcinoma↗
PubMed1985

Clinical characteristics of and prognosis in acute transmural anterior, transmural inferior and non-transmural myocardial infarction. A comparative retrospective study.

This retrospective study was undertaken to determine whether there was any difference in the clinical characteristics of and prognosis in white patients admitted to the Intensive Coronary Care Unit (ICCU) at Tygerberg Hospital with acute non-transmural, transmural anterior and transmural inferior myocardial infarction (MI). The three groups were carefully matched, taking into consideration the possible influence of previous MI and congestive cardiac failure (CCF). There were 187 patients with non-transmural MI, and 176 with transmural anterior and 209 with transmural inferior MI. Patients with acute transmural anterior MI had the worst prognosis while at the ICCU, at 3 months' follow-up and at long-term follow-up (mean 22,2 months). This group had the greatest frequency of CCF, cardiogenic shock, acute pericarditis, ventricular premature beats, ventricular tachycardia, left anterior hemiblock and complete left bundle-branch block and the highest mortality. Acute transmural inferior MI was responsible for the highest frequency of ventricular fibrillation in the ICCU and had a worse prognosis than non-transmural MI. Acute non-transmural MI resulted in the highest incidence of early and late myocardial reinfarction; although death in the ICCU was least frequent, mortality among this group had increased dramatically by 3 months' follow-up. Hence, acute non-transmural MI is not benign and an unstable period exists for 3 months thereafter. Because of this, more aggressive diagnostic measures should be instituted during this period in order possibly to improve prognosis in this group. It would appear that this is the first such study undertaken in South Africa.

Angina Pectoris↗
PubMed1985

[Prognosis of preclinical cardiopulmonary resuscitation].

480 preclinical cardiopulmonary resuscitations performed at the Emergency Center of the Federal Military Hospital in Hamburg were analysed. The late success was 7.9%, i.e., 38 patients were released after initially successful resuscitation and subsequent clinical treatment. Prognostic parameters indicating late success were deduced from the data. The age of the patients, call times, and organisational course do not influence the survival rate. For this reason resuscitation should be attempted in every patient, even in those with longer transport times, and if resuscitation proves unsuccessful, the measures should be discontinued at the site. Patients with multiple injuries or craniocerebral trauma, who require resuscitation, and patients with asystole, who are older than 70 years of age, do not survive. Even in young patients, the prognosis for asystole is extremely poor. Although the prognosis for patients with ventricular fibrillation is better, we are of the opinion that the success rate of preclinical cardiopulmonary resuscitations can be improved by systematic use of antiarrhythmics; metaproterenol sulfate should no longer be administered. The prognosis of resuscitated patients with contracted pupils and gasping breath and of patients with severe tachycardia is relatively good. Cardiac arrest after drowning carries best prognosis: 4 of 7 patients survived.

Adolescent↗
PubMed1967

Epidemiological basis of tuberculosis eradication. 8. Some factors of significance for the prognosis for a tuberculosis patient.

It is a general clinical experience that prognosis varies not only from one disease to another, but also between different categories of patients suffering from the same disease. The object of the study reported was to demonstrate quantitatively how the prognosis of respiratory tuberculosis depends upon the patient's age and sex and upon the severity of disease at the time of diagnosis. Based as it is upon a follow-up through the years 1961-64 of all respiratory tuberculosis patients in Denmark, the study also provides an epidemiological characterization of the course of the disease in northern Europe today.TWO ASPECTS OF PROGNOSIS ARE CONSIDERED: the patients' mortality and their curability. A convenient prognosis index for a group of patients, combining the two aspects, is obtained by expressing the number of patients dying before cure as a percentage of the initial size of the group. The comparison between various patient-categories in the study material is made partly by means of this index and partly by means of annual death and cure rates.

Adolescent↗
PubMed1979

[Elements of the prognosis of invasive epidermoid carcinoma of the cervix. Study in terms of the clinical stage and histologic criteria].

The prognosis in 143 cases of squamous cell carcinoma of the uterine cervix was studied in terms of clinical stage and various histological parameters. The results were compared with those in the world literature. In our series the clinical stage proved to be the most decisive element in the prognosis: the survival rates of stages I to IV were 77.1%, 58.3%, 28.6% and 0% at five years and 65.7%, 51.7%, 20.0% and 0% at ten years. The majority of deaths due to cancer occurred in the first five years after treatment. The prognosis was less favorable when the carcinoma occurred on the cervical stump after subtotal hysterectomy. The authors found Wentz and Reagan's histological classification adopted by the WHO to be difficult if not impossible to apply uniformly without error, due to numerous mixed forms. In addition, it has no statistically significant prognostic value. Among the other parameters considered in this study, only the type of stroma appeared to have some prognostic value. The prognosis was less favorable in tumors with a stroma of the fibrous type.

Carcinoma, Squamous Cell↗
PubMed1980

Clinical features, prognosis, and response to treatment in polyarteritis.

Fifty-three patients with polyarteritis who were followed up for at least 2 years were defined clinically and studied retrospectively to determine the influence of clinical factors and treatment on the prognosis. There was a spectrum of severity of disease, and the 5-year survival in the group was 55%. A small number of patients had evidence of ongoing immune-complex disease, as indicated by the presence of cryoglobulins or hepatitis Bs antigen or by diminished serum complement. These markers were not associated with distinct clinical features and did not influence prognosis. Organ involvement that most adversely affected prognosis was that of the gut and the kidneys. Six of 8 patients with bowel infarction or serious gastrointestinal bleeding died, and 6 of 10 patients with renal insufficiency died. Hypertension and peripheral neuropathy did not influence the prognosis. Thirty-six patients were treated with corticosteroids alone and 14 with a combination of corticosteroids and cytotoxic agents (3 received no treatment); the outcome was the same in both groups. Twenty-two in the steroid-alone group and six in the combination group were alive when last seen. Early deaths were usually due to complications directly related to the vasculitis, and late deaths were often due to cerebrovascular or cardiovascular complications. At the last follow-up, 18 patients were in remission, and 13 had inactive vasculitic disease and were on maintenance treatment.

Adolescent↗
PubMed1982

[New classification of epiphyseal-plate injuries with regard to therapy and prognosis (author's transl)].

In this report a new simple classification of epiphyseal-plate injuries with regard to therapy and prognosis is pointed out. The classification can be used for each epiphysis and will be demonstrated on the injuries of the distal lower leg. Type I: There is complete separation of the epiphysis from the metaphysis without and with a metaphyseal fragment. The prognosis for growth is excellent after conservative or operative treatment. Type II: The fracture which is intraarticular (epiphyseal fragment) and the fracture across the full thickness of the epiphyseal plate and through a portion of the metaphysis needs accurate reduction. The prognosis for growth is good only after open operation. Type III: This relatively uncommon injury results from a very severe crushing force applied through the epiphysis to one area of the epiphyseal plate. The prognosis in this type is decidedly poor. The need for regular follow-up observation in these cases is obvious. At the end the good results of 40 patients after epiphyseal-plate injuries of the distal lower leg are presented.

Epiphyses↗
PubMed1982

[Hemostasis in burn patients and treatment with heparin. Relation to prognosis and infection. Pattern of blood levels of prekallikrein, alpha-2-macroglobulin, antithrombin III, plasminogen and alpha-2-antiplasmin].

In burnt patients with a fatal prognosis, the level of prekallikrein is initially low and further diminished. In burnt patients who survive, the initial decrease of the prekallikrein level is less pronounced and is progressively overcome, significantly by the sixth day. Moreover the decrease of the prekallikrein level occurs before and during clinical infection. In good prognosis patients, the level of alpha-2-macroglobulin remains low until day 20 and then increases in the noninfected patients while in fatal prognosis patients the level decreases. The level of antithrombin III and plasminogen is lower in fatal prognosis patients. These is no correlation between the level of antiplasmin and the outcome of burn injuries.

Adult↗
PubMed1982

[The etiology, course and prognosis of dilated cardiomyopathy].

UNLABELLED: In order to study the etiology, the clinical course and the prognosis of patients with DCM, clinical, morphological (endomyocardial catheter biopsy), angiographic and hemodynamic data of patients with DCM were studied. The total number of patients was 396. In 258 patients definite DCM was diagnosed, in 138 patients DCM was suspected, e.g., because of an additional history of alcoholism. ETIOLOGY: In no case acute subacute or chronic myocarditis was found in myocardial biopsies (n = 114) and at autopsy (n = 18). However, from the history strong evidence was obtained for DCM being the late stage of diphtheric heart disease predominantly among patients with complete left bundle branch block. As far as the alcoholic etiology is concerned, the only significant difference between DCM and alcoholic heart disease was a higher proportion of women among patients with DCM (28% and 5%, resp.). Clinical course and prognosis: 221 patients were studied prospectively (mean follow-up time 3.1 +/- 2.3 years), 44% of patients died or deteriorated. However, in patients with normal cardiothoracic ratio this rate amounted only to 12%. The mean annual mortality rate was 9.8% and varied significantly in relation to different subsets of patients from 0% to 17%. A bad prognosis was significantly indicated by young age, high cardiothoracic ratio, pronounced elevation of enddiastolic volume index and of left ventricular enddiastolic pressure at rest and of mean pulmonary artery pressure at exercise, by severe morphologic changes of myocardial biopsies, severe ventricular arrhythmias, the absence of transient abnormal elevation of arterial blood pressure during follow up, of complete left bundle branch block and of a positive history of diphtheria. However, the wide scatter of data diminished the significance of them for the definite prognostic evaluation of individual case. The cumulative survival curves of patients with a history of alcohol abuse did not differ from that of patients with DCM. The data demonstrate that DCM in patients with the history of diphtheria together with left bundle branch block is possible caused by an inflammatory process. According to the analysis of the clinical course and the prognosis, DCM is one of the most severe heart disease. However, in different subsets of patients, the clinical course may be stable for long time and even normal longevity cannot be excluded.

Adult↗
PubMed1983

[APUDoma of the abdominal area and bronchial system. Surgical therapy and prognosis].

28 patients with APUDomas of the abdomen or bronchial system were reexamined up to 30 years after operation to take a view on therapy and prognosis of these tumors. All patients with benign hyperinsulinism remained free of symptoms after partial pancreatectomy or tumor enucleation, in the mean 12.9 years after operation. In contrast the two patients with islet cell carcinoma died 5 months after operation at the latest. The prognosis of the carcinoid tumors depended decisively on tumor location: The prognosis was favorable in patients with carcinoid tumors of the appendix or bronchial carcinoid (survival time up to 10 years after operation). In contrast all patients with carcinoid tumors of the small intestine died within two years after operation. Tumor size had the most important influence on the prognosis of the disease.

Adult↗
PubMed1984

Infarct size as a determinant of acute and long-term prognosis.

Enzymatic estimates of infarct size based on the analysis of either plasma total or CK-MB activity are substantially larger in patients who succumb to myocardial infarction compared with survivors. Similarly, if patients are stratified according to infarct size calculations, mortality increases as infarct size increases. Enzymatic markers of infarction are closely related to other indicators of prognosis, including infarct type (transmural versus nontransmural), infarct location (anterior versus inferior), the degree of left and right ventricular dysfunction, and the frequency of ventricular dysrhythmia. Hence, at least some of the prognostic impact of these variables may be due to the initial extent of infarction sustained. Multivariate analysis has been employed by several groups to analyze the independent contribution of these clinical descriptors to prognosis after infarction. These analyses have consistently indicated a substantial independent impact of enzymatic estimates of infarct size on prognosis. In studies of patients with initial myocardial infarction, infarct size index calculated from total plasma CK time activity curves had the greatest independent influence on survival. Unfortunately, the utility of enzymatic estimates of infarction as prognostic indicators in individual patients is attenuated by alterations in the strength of the apparent association between CK infarct size and prognosis in specific clinical situations. Thrombolytic therapy is now employed with increasing frequency during acute myocardial infarction. It has become abundantly clear that plasma CK release kinetics are profoundly modified by this procedure. Peak plasma total and CK-MB activity is markedly increased compared with that of patients undergoing routine therapy for infarction, with a profoundly altered CK time activity curve.(ABSTRACT TRUNCATED AT 250 WORDS)

Creatine Kinase↗
PubMed1984

[Effect of extent of lymph node dissection on prognosis of esophageal cancer].

The lymph node metastasis of the esophageal cancer are located in three main regions such as neck (H), thoracic cavity (T) and abdominal cavity (B). We studied on the relation between the extent of lymph node dissection and prognosis, and that between the lymph node metastasis and prognosis in each region (H.T.B). The long-term survival among the cases with adequate dissection, especially with the adequate dissection in the thoracic region, was better than that among the cases without adequate dissection. Furthermore, adequately dissected cases got better survival compared to the cases without adequate dissection with post-operative prophylactic irradiation. However, in the prognosis of the esophageal carcinoma, hematogenous metastasis have to be taken into consideration as well as lymph node metastasis. Therefore, in order to improve the prognosis of esophageal cancer, it is indispensable to treat the multidisciplinary therapy with immunochemotherapy as well as complete lymph node dissection.

Combined Modality Therapy↗
PubMed1984

[Evaluation of individual prognosis in sudden deafness].

Based on a recently published paper, we attempted to assess the individual prognosis for patients suffering from sudden deafness. We selected several factors of importance in the prognosis: Positive-Factors: no deafness, no vestibular dysfunction, therapy began within 4 days, and not more than one vascular risk factor. Negative-Factors: deafness, objective vestibular dysfunction, therapy began later than 21 days and more than one vascular risk factor. Every patient was examined and given a positive or negative score between +4 and -4. According to these results a good prognosis (in 70%) can be expected for patients with at least one positive factor, whereas poor prognosis was found (in 75%) of patients without a positive-factor.

Hearing Loss, Sudden↗
PubMed1983

[Malignant salivary gland tumors. Effect of histology and site on prognosis].

From 1965-1975 we treated 207 patients with malignant tumors of the salivary glands. While the localization of these tumors (minor salivary glands, submandibular gland, parotid gland) had no distinct influence on their prognosis, the influence of the histological tumor type is substantial. After histological reclassification of all tumors with grading of differentiation of adenoid cystic carcinomas (tubular, solid, cribriform), mucoepidermoid and acinic cell carcinomas (both well-, respectively poorly differentiated) we could establish 4 different prognostic groups by observing the respective determinate survival rates. The most favorable prognosis is found for tubular adenoid cystic carcinomas, well-differentiated acinic cell and mucoepidermoid carcinomas (5 year survival rate 100%), followed by the solid and cribriform adenoid cystic carcinomas, the poorly differentiated acinic cell carcinomas and the salivary duct carcinomas (5 year survival rate about 65%). With 5 year survival rates of 40%, the adenocarcinomas, poorly differentiated mucoepidermoid carcinomas and squamous cell carcinomas have a poor prognosis, and the prognosis of the carcinomas in pleomorphic adenoma and of undifferentiated carcinomas is even poorer with a 5 year survival rate of 25%.

Humans↗
PubMed1983

[Comparative study of 2 prognostic classification systems for myeloma and examination of the correlation between initial bone marrow plasmacytosis and prognosis. A propos of a homogeneous population of 50 patients followed from diagnosis to death].

We report the outcome of the statistical analysis of 50 myeloma patients, making a comparison of the prognosis value of the staging systems proposed by Durie and Salmon and, more recently by Merlini, Waldenström and Jayakar. Moreover, we studied the relationship between initial percentage of bone marrow plasma cells and prognosis. All patients had a complete follow-up and received the same treatment. We excluded our cases of non excreting and solitary myeloma. The staging system proposed by Durie and Salmon still has the best prognosis significance. The system proposed by Merlini, Waldenström and Jayakar does not allow a staging of the patients in rigourous conditions. The absence of a relationship between initial bone marrow plasmocytosis and prognosis corroborates the poor reliability of this staging system.

Adult↗
PubMed1984

[Obstruction of the internal carotid artery and cerebral malacias. Tomodensitometric factors of the prognosis in 150 cases].

We studied clinical, CT, angiographic and prognostic parameters in 60 cases with an occlusion, 48 with a tight stenosis, and 42 with a moderate stenosis of an internal carotid artery (ICA). The volume of infarction ranged from 0 to more than 600 cm3. It was significantly related to the degree of ICA obstruction, the number of risk factors, but not to age or sex. The quality of the collateral supply did not significantly influence the size or localization of infarctions, although it was better in the patients with occlusion than in those with tight stenosis. Deep infarcts were associated with diabetes and hypertension. The volume of infarction and early/late neurological disability were closely related to each other. Early death was associated with large infarctions (greater than or equal to 250 cm3). Thus, massive sylvian infarction corresponded to a poor prognosis (life and neurological function), whereas no visible infarction on CT corresponded to a good prognosis. Superficial infarctions had a variable prognosis, and evolution of deep infarctions was size-dependent. Late death or delayed stroke were not predictable from CT parameters. The quality of collateral supply did not markedly influence the functional prognosis. The development of a unilateral ipsilateral ventricular dilation and cortical atrophy was related to the degree of obstruction and to the weakness of the collateral circulation. In occlusion patients, the occurrence of ventricular dilation was related to the volume of infarction; cortical atrophy developed later and was associated with superficial infarctions. In ICA occlusion or stenosis, the study of CT parameters may help delineate prognostic features and may thus ameliorate the therapeutic follow-up.

Carotid Artery Diseases↗
PubMed1983

[Immunomorphologic responses of regional lymph nodes and prognosis in patients with stage Ia pulmonary adenocarcinoma].

The relationship between postoperative prognosis and the immunomorphologic response of regional lymph nodes was examined in 50 patients with stage Ia peripheral bronchial adenocarcinoma and compared with 22 patients in stage Ib and II. Regarding paracortical lymphocyte hyperplasia, the prognosis of the responsive group in patients with stage Ia was significantly better than that of the non-responsive group; however, no definite relationship was found between follicular hyperplasia and prognosis. Follicular hyperplasia correlated with the size of the primary lesion or the distance from the site of the primary lesion. In stage Ib and II cases with metastasis to the pulmonary hilar lymph nodes, paracortical lymphocyte hyperplasia or follicular hyperplasia had no relation to the postoperative prognosis.

Adenocarcinoma↗