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PubMed1982

Overall prognosis of patients with diagnosed chronic organic solvent intoxication.

The prognosis of 87 patients (mean age 38.6 years) was examined who had been diagnosed 3-9 years earlier as having chronic organic solvent intoxication due to trichloroethylene, perchloroethylene, or a mixture of solvents. The methods comprised an interview, a clinical neurological examination, neurophysiological examinations (EEGs and electroneuromyographs), and a psychological examination. In order to assess the prognosis, the patient's condition at the time of diagnosis was evaluated from the hospital records, and the condition upon reexamination was compared to that at the time of diagnosis. At the time of diagnosis, 31 patients had objective clinical signs in the neurological examination, whereas the remaining 56 had only subjective symptoms and neurophysiological or psychological findings attributed to the slight solvent intoxication. Upon reexamination, 42 patients had clinical neurological signs. Based on the clinical overall evaluation, the condition of 21 patients had deteriorated during the follow-up period, the condition of 23 had improved, and that of 43 had remained unchanged. The prognoses of the results of the separate examinations correlated poorly with each other. No statistically significant correlation was found between the overall prognosis and age, sex, the duration and the level of exposure, the termination of exposure after diagnosis, the presence of other diseases, or the use of alcohol.

Adult↗
PubMed1982

Prognosis of symptoms in patients with diagnosed chronic organic solvent intoxication.

The profile and prognosis of symptoms of 87 patients (mean age 38.6 years) in whom a chronic organic solvent intoxication due to tri- or perchloroethylene or mixtures of solvents had been diagnosed 3-9 years earlier were examined by means of an interview. Both at the time of diagnosis and upon reexamination, the most common symptoms were abnormal fatigue, memory disturbances and headache. Also dizziness, sleep disturbances, sensory symptoms in the extremities, mental depression, concentration difficulties, psychic irritability, emotional lability, tremor and nausea were present in over 60% of patients at the time of diagnosis. Upon reexamination, 52% of the intoxication patients with no other contributing neurological disease felt that their overall subjective condition was better than at the time of diagnosis, 21% felt that it was worse, and 27% reported no change. Most of the individual symptoms had more often changed for the better than for the worse; the differences were statistically significant with regard to abnormal fatigue, headache, dizziness, sleep disturbances, nausea, and emotional lability, whereas memory disturbances had changed in the opposite direction. Younger persons, who had had a longer follow-up period and without regular check-ups at the Institute of Occupational Health seemed to have better prognosis at the group level. Due to the great variation between the individuals, the prognosis was, however, impossible to predict in individual cases.

Adult↗
PubMed1989

The relationship between nuclear DNA content in salivary gland tumors and prognosis. Comparison of mucoepidermoid tumors and acinic cell tumors.

Differences in prognosis between salivary gland mucoepidermoid tumors and acinic cell tumors were compared by means of conventional histopathological grading and nuclear DNA content which was assessed cytochemically by a scanning cytophotometric procedure. The mucoepidermoid tumors were found to show a stronger correlation between histopathological grading and prognosis than did the acinic cell tumors. By using DNA quantification, valuable additional information could be obtained for predicting the behavior of the mucoepidermoid tumors, whereas there was no correlation between DNA content and prognosis for the acinic cell tumors. Regarding the relatively "benign" clinical course of most mucoepidermoid tumors, the term "tumor"--as proposed by the World Health Organization's classification--seems appropriate. In contrast, the more severe clinical courses of the acinic cell tumors justify the use of the term "carcinoma" instead.

Aneuploidy↗
PubMed1985

Advanced gastric cancer and prognosis.

The morphological features of 158 gastric carcinomas were analyzed in an attempt to identify patterns best correlated with prognosis. To this end, the depth of infiltration, vascular invasion, intra- and perineoplastic lymphocytic infiltrate, lymph node metastases and number of metastatic lymph nodes were evaluated according to the several classifications for advanced gastric cancer. A good correlation between prognosis and histological features of malignancy were observed, as well as different five-year survival rates for Mulligan, Lauren and Ming histotypes. However, when the influence of each single morphological criteria of malignancy was examined, these differences disappeared for Mulligan and Lauren histotypes. On the other hand, the better prognosis for Ming expanding type carcinomas appeared unrelated to any individual feature of malignancy.

Adenocarcinoma↗
PubMed1992

Bacterial endocarditis in children: trends in its diagnosis, course, and prognosis.

In a population-based study of 41 children with bacterial endocarditis (BE), diagnosed in the period 1970 through 1989 in eastern Denmark, we analyzed trends in the diagnosis of BE and in mortality, and searched for possible prognostic factors. During this period the delay in diagnosis from first symptom to treatment did not change, but the delay from admission to treatment was significantly prolonged from 0 to 3 days, despite the introduction of echocardiography (ECHO). There was a significant improvement in the prognosis, the mortality rate having decreased from 40 to 0% [95% confidence limits: 12-74 vs. 0-26 (0.01 less than p less than 0.02)]. The improved prognosis was not explained by changes in the etiology or pattern of antibiotic resistance and may reflect a milder course of BE in children. Children with "mild anomalies"--such as bicuspid aortic valve (n = 5), coarctation of the aorta (n = 2), and prolapse of the mitral valve (n = 2)--had a significantly poorer prognosis than children with other forms of congenital heart disease (CHD) (p = 0.004), a reminder of the importance of suspecting BE in all children with unexplained long-lasting or intermittent fever, because some may have unrecognized "mild" CHD.

Child↗
PubMed1977

Prognosis in acquired aplastic anemia. An approach in the selection of patients for allogeneic bone marrow transplantation.

In a retrospective study, factors influencing the eventual course and outcome of patients suffering from aplastic anaemia were analysed. Of the 62 patients with pancytopenia concomitant with an aplastic or hypoplastic bone marrow, 36 have died during the first 24 months following diagnosis, 27 of these 36 cases within the first six months. 26 patients survived more than two years after presentation, but a further six of these cases succumbed during the following months. Of the 62 cases, 46 had neutrophil counts under 1 X 10(9)/l and platelet counts under 20 X 10(9)/l. These cases were subdivided according to their reticulocyte levels. In the age group of patients between 10 and 35 years, all those patients having more than 10,000/mul reticulocytes survived more than two years with only one exception, whereas only one of the 11 patients having reticulocyte counts below 10,000/mul has survived. In our series, the initial neutrophil and platelet counts were not of predictive value in identifying poor prognosis patients. The initial reticulocyte counts, however, appear to be a valid parameter for selecting patients in two groups, one with a favorable, and the other with an extremely unfavorable prognosis on conservative treatment. Young individuals with a poor predicted prognosis could thus be defined as possible candidates for bone marrow transplantation.

Adolescent↗
PubMed1979

[T-zone lymphoma--clinical symptoms, therapy, and prognosis (author's transl)].

The clinical symptoms, response to therapy, and prognosis of T-zone lymphoma were analyzed in 32 cases. This recently defined lymphoma entity developed relatively quickly with generalized lymphadenopathy and general malaise. Hepatomegaly and/or splenomegaly and skin efflorescence were frequent presenting symptoms. A few patients showed hyperimmune reactions and occasionally severe autoimmune hemolytic anemia. The erythrocyte sedimentation rate was usually markedly elevated. There was sometimes a polyclonal increase in serum immunoglobulin, sometimes a reduction. Blood and bone marrow smears from a few patients showed occasional atypical lymphocytes. A remarkable finding was the frequent involvement of lung or pleura (40.5% of the patients). The prognosis is unfavorable. Most of the patients were in stages III or IV at the time of diagnosis. Massive infiltration of organs, resistance to routine therapy, and decreasing resistance to infection resulted in death soon after diagnosis. The probability of survival was 0.48 in the first year after diagnosis. The prognosis for patients in stages I and II was clearly better than that for patients in stages III and IV.

Adolescent↗
PubMed1994

Classification and regression trees (CART) for estimation of prognosis in patients with gastric carcinoma.

A total of 961 patients who had received resective surgery for gastric carcinoma were grouped according to prognosis by classification and regression trees (CART). This grouping was compared to the present UICC stage grouping. For patients resected for cure (R0) the CART approach allows a better discrimination of patients with poor prognosis (5-year survival rates 15%-30%) from patients with a 5-year survival of 50%, on the one hand, and from patients with extremely poor prognosis (5-year survival rates below 5%) on the other. In the present investigation CART grouping was not influenced by the differentiation between pT1 and pT2 or between pT3 and pT4.

Decision Trees↗
PubMed1982

[On the therapy and prognosis of stomach sarcoma (author's transl)].

Between 1964 and 1980, 51 patients with non-epithelial, malignant tumours were operated on in the Surgical Clinic of the University of Mainz. The malignant stomach lymphoma group should be dealt with separately, because of the different therapy and prognosis of other stomach sarcomas. Undifferentiated sarcomas with the lowest level of tissue maturity and differentiated sarcomas of a higher level of tissue maturity should be operated on according to the criteria for cancer surgery. Follow-up with radiotherapy and cytostasis seems only appropriate for undifferentiated sarcomas. The prognosis is determined by the stage of the tumor and type of histology. The malignant stomach lymphoma is a henceforth generalised disease and must therefore, first of all, be assigned to a disease stage by means of a suitable clinical examination, as an operation is only appropriate in the first and second stages. A staging laparotomy should be carried out with the resection of the tumour, as this makes it possible to detect tumour spread in the abdominal cavity. In this way, the type of postoperative treatment can be determined. Patients with postoperative treatment (cytostasis/radiation) had a clearly better prognosis.

Humans↗
PubMed1994

Pineal parenchymal tumors: cell differentiation and prognosis.

Eleven pineal parenchymal tumors were studied using various antibodies specific to the central nervous system and cell-proliferation-related antigen MIB-1 in order to examine the divergent types of cell differentiation and also evaluate prognosis. Electron microscopy was also performed. All tumors were immunohistochemically positive to chromogranin A and alpha B crystallin, and were also highly positive to retinal S protein. Pineocytoma cells contained microtubules, intermediate filaments, glial bundles, clear-centered vesicles and synaptic apparati. Pineoblastoma cells also had microtubules and neurofilaments, but glial filaments and definite synapses were not identifiable. Pineal parenchymal tumors were considered to be of pinealocyte origin, and there was a continuous spectrum of divergent cell differentiation between pineocytoma and pineoblastoma cells. The MIB-1 labeling index correlated well with histological malignancy, neuronal differentiation evaluated immunohistochemically by both neurofilament protein and synaptophysin, and cases with seeding potentials. Although histopathological features of neuronal development were, until recently, seen as the hallmark of benign prognosis in pineal parenchymal tumors, they are now thought to be only one of the pieces of evidence that may be used for purposes of prognosis.

Adolescent↗
PubMed1992

Analysis of clinical course and prognosis of culture-positive spontaneous bacterial peritonitis and neutrocytic ascites. Evidence of the same disease.

The clinical significance and prognosis of culture-negative neutrocytic ascites in cirrhotic patients is a controversial topic. In the present study, the clinical and humoral presentation and the short- and long-term prognosis were analyzed in 36 patients with cirrhosis and culture-positive spontaneous bacterial peritonitis and in 28 patients with cirrhosis and ascitic fluid polymorphonuclear count greater than 250/mm3, a negative ascitic fluid culture, and without previous antibiotic therapy. On admission there were no significant differences between groups related to age, sex, alcoholism, fever, abdominal pain, serum albumin, serum urea, serum creatinine, Child-Pugh score, polymorphonuclear count, and total protein concentration in ascitic fluid. A greater frequency of positive blood culture was found in patients with spontaneous bacterial peritonitis (15/21 vs 2/18) (P < 0.001). Mortality during the first episode was 36% in patients with spontaneous bacterial peritonitis and 46% in patients with culture-negative neutrocytic ascites (NS). Mortality during follow-up was high and survival probability at 12 months was 32% in spontaneous bacterial peritonitis and 31% in culture-negative neutrocytic ascites. The probability of recurrence at 12 months was 33% in spontaneous bacterial peritonitis and 34% in culture-negative neutrocytic ascites. Our results show that spontaneous bacterial peritonitis and culture-negative neutrocytic ascites are variants of the same disease with a high mortality and poor prognosis.

Aged↗
PubMed1989

Prognosis and prognostic factors in chronic pancreatitis.

To evaluate the prognosis and prognostic factors of chronic pancreatitis, 84 patients with alcoholic chronic pancreatitis and 51 with nonalcoholic chronic pancreatitis have been followed for 1-21 years (average of 7.1 years). The follow-up period was defined as the period from diagnosis to death in those who died and to the present in those still alive. The following conclusions were obtained. (1) Patients with alcoholic chronic pancreatitis showed a significantly higher mortality rate (26.2%) and cancer death rate (8.3%) than the age- and sex-matched population. In patients with nonalcoholic chronic pancreatitis, however, the difference did not reach the level of statistical significance, although both rates tended to be higher. (2) Patients with alcoholic chronic pancreatitis showed a significantly poorer prognosis than those with nonalcoholic chronic pancreatitis. (3) Frequent causes of death in chronic pancreatitis were cancer (11 cases) and diabetes-associated conditions (renal failure in three cases, intractable pneumonia in one, hypoglycemic shock in two, and myocardial infarction in two). Death directly from pancreatitis was observed in four. (4) Unfavorable prognostic factors in alcoholic chronic pancreatitis included heavy drinking, continuance of drinking after diagnosis, smoking, insulin-dependent diabetes, and an advanced age. In nonalcoholic chronic pancreatitis, however, patients' age was the only significant prognostic factor; smoking did not reach the level of statistical significance, although it tended to lead to a poorer prognosis.

Adult↗
PubMed1989

Ruptured intracranial aneurysms. The influence of sex and fibromuscular dysplasia upon prognosis.

From a statistical analysis of a series of 214 cases of ruptured intracranial aneurysms, it was demonstrated that only four parameters among those collected on the admission day, are predictive of the final functional result: sex (p less than 0.001); age (p less than 0.02); clinical grade (p less than 0.001) and angiographic spasm (p less than 0.01). The surprisingly poor prognosis in women was explained by the higher frequency of spasm (p less than 0.005). Aneurysms in women predominated on the intracranial carotid artery (38%) and were frequently multiple (12%). A further angiographic study on 87 cases was then carried out including a systematic investigation of the cervical part of the vessels; it permitted one to identify angiographic features of fibromuscular dysplasia (FMD) on the cervical vessels in 20 cases. In those cases it was also observed that there was a marked female predominance (F/M = 5.6), a frequent localization on the internal carotid artery (50%), a high rate of multiple aneurysms (60%) and a poor prognosis related to spasm (50%). Therefore, intracranial aneurysms appear far more frequently than usually reported, to be related to FMD. The worse prognosis of ruptured intracranial aneurysms in females can be, at least partly explained by the association with FMD and the frequent occurrence of spasm. A careful investigation of patients exhibiting features of FMD in order to detect intracranial aneurysms before rupture, is suggested.

Arterial Occlusive Diseases↗
PubMed1978

The management and prognosis of gliomas of the optic pathways in children.

A follow-up study was made of 24 children with gliomas of the optic pathways. In gliomas restricted to one optic nerve, total excision should be performed. The prognosis is excellent. Radiotherapy is not indicated. In gliomas of the anterior chiasma a biopsy should be taken; occasionally partial removal is indicated. The prognosis is good. Radiotherapy is indicated only if the follow-up shows a progression in the visual signs. In most cases the growth of the tumour seems to be arrested. The vision remains stable, and most patients have a useful degree of vision in at least one eye. In gliomas of the posterior chiasma with hypothalamic signs the prognosis is poor. A biopsy and radiotherapy are indicated. Occasionally, long remissions are seen.

Adolescent↗
PubMed1994

Brainstem haematomas: early and late prognosis.

The purpose of the present retrospective study is to analyse 14 patients harbouring brainstem haematomas and to discuss the early and late prognosis. The patients were divided into two groups: group A (survivors), 8 patients with follow-up duration ranging between 8 months and 12 years; and group B (nonsurvivors), 6 patients. At the time of onset or hospital admission, the former were under 50 years of age and had no important clinical history. Their degree of consciousness was altered only slightly or moderately and their brainstem haemorrhages were focal or only slightly diffuse. Three patients in this group underwent surgical treatment. The members of group B, who died within days of their admission to the hospital, were over 60 years of age, had a number of clinical antecedents and severe alterations of consciousness, while 83% of them presented diffuse brainstem haemorrhages. None of the patients of this group were treated surgically. It was concluded that: 1) the indications for surgery for these lesions were progressive hydrocephalus, increase in the mass effect with progressive symptomatology and suspected "cryptic vascular malformation" with risk of later rebleeding or brain tumour; 2) surgical treatment was necessary to improve the symptomatology in 3 patients in group A, although there were no significant differences between surgically treated and nonsurgically treated patients in the same group with respect to prognosis; 3) age, clinical history, degree of alteration of consciousness and type of haemorrhage are the major factors affecting the early and late prognosis of brainstem haemorrhages.

Adult↗
PubMed1985

Prognosis and treatment of cardiomyopathy and myocarditis.

Dilated cardiomyopathy is a heterogeneous group of disorders with a prognosis that is dependent upon the severity of presenting clinical and hemodynamic abnormalities. Although this condition is characterized by a high mortality, spontaneous improvement is noted in 25% of cases. Standard therapeutic modalities are nonspecific and consist of the therapy of congestive heart failure and ventricular arrhythmia. Recent studies suggest that beta blockade and cardiac transplantation may soon become accepted modalities in this condition. Acute viral myocarditis is a common disease that has a good prognosis, however occasionally progression to chronic myocardial disease has been identified. The therapy of acute viral myocarditis should be limited to symptomatic treatment, anti-coagulation, and bed rest. When chronic myocarditis is identified on endomyocardial biopsy in patients with heart failure of unknown cause, the treatment differs little from that of dilated cardiomyopathy with the exception that recognizing that efficacy has not been proven; immunosuppressive therapy may be added in life-threatening situations. Future studies will be directed at further clarification of the prognosis of each of these conditions with intensive evaluation of the role of beta blockade and immunosuppression.

Acute Disease↗
PubMedDate not supplied

Carcinoma of the male breast: analysis of prognosis compared with matched female patients.

BACKGROUND: Considerable debate exists concerning the prognosis of breast cancer in male patients compared with that in female patients. Some studies have observed worse prognosis for men; others suggested the higher mortality rates were primarily due to delayed diagnosis. METHODS: Survival time from diagnosis with invasive disease to death resulting from breast cancer of 58 men treated between 1973 and 1989 was compared with survival of 174 women treated between 1976 and 1978 who were matched by stage of disease and age at diagnosis. All patients were treated by mastectomy and axillary dissection. RESULTS: Tumors were < or = 2 cm in 70% of cases and 55% were free of axillary metastases. The histology of the tumors differed significantly by gender (p < 0.05). Significantly more men had estrogen receptor-positive tumors (87%) than did women (55%, p < 0.001). Survival at 10 years was similar for male and female patients. Multivariate analysis controlling for tumor size, number of positive axillary lymph nodes, age at diagnosis, histology, and receptor status indicated no significant difference in survival of male compared with female patients. CONCLUSIONS: These data conflict with the conventional wisdom that breast cancer in men carries a worse prognosis than the disease in women. Although histology of the tumor and receptor status differed by gender, these factors did not have an impact on survival in these paired patients. Our data indicate that breast carcinoma in males is not biologically more aggressive than in females.

Aged↗
PubMed1995

A five-year study of severe community-acquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit.

OBJECTIVES: To characterize the epidemiology and to determine the prognosis factors in severe community-acquired pneumonia among patients admitted to an intensive care unit. DESIGN: Retrospective clinical study. SETTING: Intensive Care and Infectious Diseases Unit of a municipal general hospital of Lille University Medical School. PATIENTS: 299 consecutive patients exhibiting severe community-acquired pneumonia. MEASUREMENTS AND RESULTS: On admission to ICU, 149 patients required mechanical ventilation for acute respiratory failure and 44 exhibited septic shock. Pulmonary involvement was bilateral in 71 patients. There were 260 organisms isolated from 197 patients (65.9%), the most frequent being Streptococcus pneumoniae (n = 80), Staphylococcus spp. (n = 57) and Gram-negative bacilli (n = 81). Overall mortality was 28.5% (85 patients). According to univariate analysis, mortality was associated with age over 60 years, anticipated death within 5 years, immunosuppression, shock, mechanical ventilation, bilateral pulmonary involvement, bacteremia, neutrophil count < 3500/mm3, total serum protein level < 45 g/l, serum creatinine > 15 mg/l, non-aspiration pneumonia, ineffective initial therapy and complications. Multivariate analysis selected only 5 factors significantly associated with prognosis: anticipated death within 5 years, shock, bacteremia, non-pneumonia-related complications and ineffective initial therapy. CONCLUSION: The effectiveness of the initial therapy appears to be the most significant prognosis factor and, as the one and only related to the initial medical intervention, suggests a need for permanent optimization of our antimicrobial strategies.

Adolescent↗