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PubMed1979

Tumour regression during radiation treatment as a guide to prognosis.

The response to radiation treatment was studied in 110 patients with head and neck cancer with a minimum follow-up of two years. If the tumour had disappeared by the mid-point of treatment (3000 rad), a significantly more favourable prognosis was found in early (T1-2N0) tumours. On the other hand, whether these tumours had disappeared or were persisting at the end of treatment, there was no difference in the recurrence during the observation time of two years. In advanced tumours there was no significant relationship between disappearance by the mid-point of treatment and recurrence up to two years. But when an advanced tumour had disappeared at the end of treatment, the prognosis was significantly more favourable. The unpredictability and often impossibility of judging the prognosis in individual cases encourages the authors to stress the importance of executing the original individual surgical plan irrespective of radiation response.

Carcinoma, Squamous Cell↗
PubMed1980

Computed tomographic pointers to the prognosis of subarachnoid haemorrhage.

Ninety-three patients with subarachnoid haemorrhage were studied by computed tomography to seek features which might influence prognosis. In this series a normal scan pointed to complete recovery. The presence of a focal area of low attenuation, whether alone or in association with an haematoma, affected the outcome adversely. Prognosis was also influenced by the size of the haematoma. None of the other findings appeared to be a guide to prognosis.

Adolescent↗
PubMed2001

Lymphoepithelioma-like carcinoma of the lung with a better prognosis. A clinicopathologic study of 32 cases.

The purpose of our study was to clarify the prognosis of lymphoepithelioma-like carcinoma (LELC) of the lung, which is rare. We analyzed the clinicopathologic features of 32 cases of pulmonary LELC and compared the cases with 84 cases of pulmonary non-LELC with available long-term follow-up information. The results show that LELC of the lung as a distinct entity has a better prognosis than non-LELC. We found a significant difference in the survival rates between patients with LELC and patients with non-LELC in stage II and stages III and IV, respectively. Tumor recurrence and necrosis (5% or more of tumor) are associated with a poor prognosis. It seems that the histologic typing (Regaud type and Schmincke type) of pulmonary LELC is of no clinical value.

Adult↗
PubMed1998

Prognosis of patients with lung cancer found in a single chest radiograph screening.

BACKGROUND: The prognosis of patients with lung cancer is better when the diagnosis is made early; the disease is localized, and radical surgery is possible. Screening for lung cancer with mass radiography or sputum cytology should contribute to a more favorable prognosis. Large-scale screening studies have improved the survival rates for lung cancer but have yielded no reduction in mortality rates. METHODS: The histologic types, stages, treatments, and survival rates were studied in 93 men who were found to have lung cancer in a single chest radiograph screening of more than 33,000 men who smoked and were 50 to 69 years old ("screened cases"), and in 239 men of the same age range whose lung cancer was detected through ordinary health care system ("other cases") during the screening period. RESULTS: The distribution of the histology was similar in the two groups, but screening detected more instances of early-stage disease that were resectable more often than in the other group (37 vs 19%). The 5-year survival rate for men in the screened cases was 19%, and that of men in the other cases was 10% (relative risk, 0.65; 95% confidence interval [CI], 0.50 to 0.84). The survival rate of men in the screened cases remained significantly higher than that of men in the other cases even after adjustments for age, smoking status, histology, stage of the disease, and resectability of the disease (relative risk, 0.74; 95% CI, 0.55 to 1.00). CONCLUSIONS: According to this study, chest radiograph screening might improve the prognosis of lung cancer. Our results are, however, subject to many factors that were only partially controlled for, and they should be interpreted cautiously.

Adenocarcinoma↗
PubMed1999

Unfavorable prognosis of patients with stage II non-small cell lung cancer associated with macroscopic nodal metastases.

BACKGROUND: Patients with stage II-N1 non-small cell lung cancer (NSCLC) make up an intermediate group of patients with an unsatisfactory prognosis even though complete resection is usually possible. We retrospectively analyzed postoperative prognostic factors to devise guidelines for the proper management of this patient population. STUDY DESIGN: Among 546 patients with NSCLC who underwent surgical resection from 1979 to 1995, 43 patients were pathologically defined to be at stage II-N1 (T1-2N1M0). The influence of the following variables on postoperative survival was analyzed: gender, age, cell type, pathologic T factor, number of metastatic nodes, station of metastatic nodes (hilar or pulmonary nodes), status of nodal metastasis (macroscopic, gross involvement confirmed histologically; or microscopic, metastasis first defined by histologic examination), surgical methods, and adjuvant therapy (including 18 of chemotherapy and 2 of radiotherapy). RESULTS: The 5-year survival rates (5YSRs) of patients with microscopic (n = 21) and macroscopic nodal metastasis (n = 22) were 76.0% and 27.6%, respectively (p = 0.001). The 5YSRs of 20 patients who received adjuvant therapy and 23 who did not receive adjuvant therapy were 57.6% and 46.6%, respectively (p = 0.036). Other variables did not affect survival. The Cox proportional hazards model analysis indicated that the presence of a macroscopic nodal metastasis and postoperative adjuvant therapy were independent prognostic factors. Among patients with macroscopic N1 NSCLC, 9 patients who had undergone adjuvant therapy showed a more favorable prognosis than the 13 patients who had not received adjuvant therapy (3-year survival rate, 55.6% vs 18.5%; p = 0.037; and recurrence rate, 30.0% vs 77.8%), whereas no significant influence of adjuvant therapy on survival was observed among patients with microscopic N1 NSCLC. CONCLUSIONS: Stage II-N1 NSCLC was categorized into microscopic and macroscopic N1 diseases. The latter had a poor prognosis, which might be improved by adjuvant therapy, although a suitable regimen has not been established.

Aged↗
PubMed1999

Simplified prediction rule for prognosis of patients with severe community-acquired pneumonia in ICUs.

STUDY OBJECTIVES: To develop a simplified prognostic prediction rule for patients admitted to ICUs for severe community-acquired pneumonia (CAP). SETTING: Six ICUs in the north of France. PATIENTS: Five hundred five patients admitted to ICUs over a 9-year period (from 1987 to 1995) for severe CAP. INTERVENTIONS: Retrospective prognosis analysis and multivariate analysis using a credit scoring technique. MEASUREMENTS: The primary outcome measure was ICU mortality. RESULTS: Among the 505 patients, 472 were eligible for the prognosis study. The ICU mortality rate was 22.9%. Multivariate analysis identified, on the basis of the patient's medical history and initial examination on ICU admission, six independent predictors of mortality: age > or = 40 years, anticipated death within 5 years, nonaspiration pneumonia, chest radiograph involvement > 1 lobe, acute respiratory failure requiring mechanical ventilation, and septic shock. An initial risk score based on these factors classified patients into three risk classes of increasing mortality: 4% in class I, 25% in class II, and 60% in class III. Multivariate analysis of events occurring during ICU stay identified three independent predictors of mortality: hospital-acquired lower respiratory tract superinfections, nonspecific CAP-related complications, and sepsis-related complications. An adjustment risk score based on these factors was essential to accurately predict the final outcome of patients in the initial risk class II. CONCLUSIONS: As an aid to clinicians in stratifying the prognosis of patients with severe CAP, the simplified prediction rule used in this study could be useful for therapeutic decisions and appropriate care.

Community-Acquired Infections↗
PubMed2000

Survival in synchronous vs. single lung cancer: upstaging better reflects prognosis.

OBJECTIVE: To define prognostic parameters for patients with synchronous non-small cell lung cancer (NSCLC). DESIGN: Retrospective study of period from 1970 through 1997. PATIENTS: Patients with a single (n = 2,764) and synchronous NSCLC (n = 85) who underwent pulmonary resection. METHODS: All tumors were classified postsurgically, and the tumors of the patients with synchronous lung cancer were staged separately. The most advanced tumor was used for comparison. Actuarial survival time was estimated, and risk factors influencing survival were evaluated. Patients who died within 30 days of surgery were excluded. MEASUREMENT AND RESULTS: Five-year survival for single NSCLC was 41% and for synchronous lung cancer it was 19%. The relative risk of death for patients with synchronous lung cancer was 1.75, compared to that for patients with single lung cancer. The most advanced tumor in synchronous cancer was a significant predictor of survival (p<0.005). The survival of patients with synchronous lung cancer in which the most advanced tumors were stage I (n = 40) and stage II (n = 27) was not different from that of patients with stage II (n = 834) and stage IIIA (n = 405) single lung cancer, respectively. CONCLUSION: The poorer survival of patients with synchronous NSCLC is confirmed and quantified. The stage of the most advanced tumor was the best predictor of prognosis. The prognosis of patients with synchronous NSCLC resembles the prognosis of patients with a single lung cancer of a higher stage. Upstaging in synchronous lung cancer is recommended on the basis of these observations.

Aged↗
PubMed2004

The impact of right ventricular dysfunction on the prognosis and therapy of normotensive patients with pulmonary embolism.

The prognosis and optimal therapy of patients with pulmonary embolism (PE) are strongly influenced by the presence or absence of associated hemodynamic derangements. Patients with normal systemic arterial pressure have a relatively low risk of recurrent PE and death when treated promptly with therapeutic anticoagulation. Those who present with hypotension, shock, or cardiac arrest, however, have a much higher mortality rate and often receive thrombolytic therapy. Recent evidence indicates that the presence of right ventricular (RV) dysfunction identifies a subgroup of normotensive patients with a much more guarded prognosis who may benefit from more intensive therapy with thrombolytic agents. This article reviews our current understanding of the pathophysiology and diagnosis of RV dysfunction and its impact on the prognosis and therapy of normotensive patients with PE.

Humans↗
PubMed1982

The prognosis of patients with chronic obstructive pulmonary disease after hospitalization for acute respiratory failure.

We followed the course of 36 consecutive patients hospitalized with chronic obstructive pulmonary disease and acute respiratory failure due to exacerbation of chronic bronchitis in order to clarify the prognosis in this common group of patients. All of the patients had spirometric evidence of severe, poorly reversible airflow limitation and all had a similar cause of acute respiratory failure. In addition, all received similar treatment during hospitalization and follow-up. Patients wtih asthma and pneumonia were excluded by clinical, spirometric, and roentgenographic criteria. Hospital survival was 94 percent, and only one patient required intubation. Two-year survival was 72 percent, and none of the patients died during a readmission for acute respiratory failure. This prognosis is much better than commonly recognized and compares favorably to that of stable outpatients with similar degrees of airflow limitation. An episode of acute respiratory failure, triggered by an exacerbation of chronic bronchitis, does not necessarily alter the prognosis of patients with COPD.

Bronchitis↗
PubMed2003

Chromosome 8 numerical aberrations in stage II invasive ductal carcinoma: correlation with patient outcome and poor prognosis.

Aberrations in chromosome 8 are common in breast cancer. However, the relationship between numerical aberrations of chromosome 8 and clinical behavior (especially prognosis) in breast cancer is not well understood. In this study, a total of 40 specimens of stage II invasive ductal carcinomas (IDCs) was analyzed by fluorescence in situ hybridization (FISH) with a chromosome 8 centromere-specific probe and DNA flow cytometry (stage IIA: 20 cases; stage IIB: 20 cases). All cases were followed for at least 5.7 yr (mean: 7.5 yr; median: 7.7 yr) after surgery or until death. Single (loss), double, and triple or more signals (gain) of chromosome 8 were found in 7.6 +/- 3.5% (range: 2-16%; median: 7%), 53.7 +/- 13.2% (range: 25-81%, median: 53%), and 38.7 +/- 13.2% (range: 17-65%, median: 38%), respectively, of tumors. The frequencies of chromosome 8 gain and disomy correlated with patient outcome (respectively p < 0.05 and p < 0.01). When median ratios of chromosome 8 loss, disomy, and gain were used as the cutoff values, the survival curves revealed that patients in the low-frequency group survived significantly longer than those in the high-frequency group for chromosome 8 gain (p < 0.05), and patients in the high-frequency group survived significantly longer than those in the low-frequency group for chromosome 8 disomy (p < 0.05). Poor prognosis was not associated with age, tumor size, lymph node metastasis, histologic type, TNM stage, estrogen-receptor status, progesterone- receptor status, or DNA ploidy. Our results suggest that the frequencies of chromosome 8 gain and disomy is a potentially useful parameter for predicting prognosis of stage II IDCs.

Breast Neoplasms↗
PubMed1995

Influence of alcoholism on the prognosis of schizophrenic patients.

OBJECTIVE: This study was undertaken to investigate possible differences in clinical, social and hospital prognosis in schizophrenics with or without codiagnosed alcoholism. METHOD: A representative sample was selected by a two-stage random sample of sets from the total of 10,569 schizophrenic patients registered in the Croatian Psychotic Case Register in the period 1962-71. The resulting 449 schizophrenic patients were psychiatrically examined in 1973-75 wherever they were found--at home, in a hospital or in a social-health institution. Of these original patients, 312 with or without a dual diagnosis of schizophrenia and alcoholism who were found at home were followed up until the final examination in 1990-91. RESULTS: Rate changes in 37 patients with the dual diagnosis were significant in the following characteristics: they were more often men, married, with a paranoid-hallucinatory disease form, were aggressive during examination, and were without psychiatric aftercare or regular psychopharmacotherapy (p < .01); they came from rural areas, had a mixed clinical picture with a deteriorating disease course and were less communicative and socially functional, and were without work self-initiative and personal income (p < .05). CONCLUSIONS: Schizophrenic patients found at home with codiagnosed alcoholism have poorer clinical, hospital, social and life prognosis and need longer hospitalization. They represent a special subgroup of schizophrenics requiring special therapeutic approach and early identification, inasmuch as their course of the disease has a tendency toward rapid deterioration. Prevention of alcoholism and its adequate treatment have far reaching implications for the prognosis of schizophrenic illness.

Adult↗
PubMed1987

Pre-operative evaluation of the prognosis of hypertension in primary aldosteronism owing to adenoma.

The prognosis of hypertension was evaluated pre-operatively in 40 patients with primary aldosteronism owing to adenoma by examining the severity of hypertension, family history of hypertension, age of the patients, duration of hypertension, plasma renin activity, plasma aldosterone concentration, and efficacy of spironolactone (100 mg per day for 10 days) on blood pressure. In 30 of the 40 patients, the blood pressure was reduced to below 160/95 mmHg within a year after adrenalectomy (responders). In the other 10 patients, the blood pressure was not markedly reduced and remained above 160/95 mmHg (nonresponders). There were no significant differences in the age of the patients, family history of hypertension, plasma renin activity or plasma aldosterone concentration between these two groups. The severity of hypertension as judged by the WHO classification and the duration of hypertension prior to operation seemed to be of some use in assessing the postoperative prognosis of hypertension, but the efficacy of spironolactone was far more useful. That is to say, a reduction in mean blood pressure of more than 15 mmHg after administration of spironolactone was observed in 29 of the 30 responders. The remaining one patient showed an 11 mmHg reduction in mean blood pressure. On the other hand, none of the nonresponders revealed a reduction in mean blood pressure of more than 15 mmHg after spironolactone administration. From these results it is concluded that the pre-operative response of blood pressure to administration of 100 mg per day of spironolactone for 10 days represents a useful indicator of the postoperative prognosis of hypertension in patients with primary aldosteronism owing to adenoma.

Adenoma↗
PubMed1992

[Factors involved in the prognosis of walking in cerebral paralysis].

With the objective of studying the prognosis for walking in children with cerebral palsy a retrospective survey of 100 children being treated at the Associação de Assistência à Criança Defeituosa was made during the period from 1979 to 1988. The following parameters were analysed: (1) degree of motor dysfunction; (2) age of acquisition of sitting balance; (3) function of upper limbs; (4) degree of mental retardation; (5) presence of primitive reflexes. All the above parameters were analysed with respect to the capability of children acquiring or not walking. The results of our study show that the following factors are indicative of bad prognosis for walking: (1) severity of motor dysfunction; (2) acquisition of sitting posture after 3 years old; (3) precarius function of upper limbs; (4) severe mental retardation associated with severe physical deficiency. Clinical evaluation of primitive reflexes did not reveal direct relation to the walking prognosis.

Adolescent↗
PubMed2005

[Nurses' attitude towards revealing the prognosis of no treatment possibility: a matter of bioethics].

This study aims to get to know nurses' attitude and participation when they have to inform a patient about a prognosis of no treatment possibility. Twenty-five nurse practitioners from a general public school hospital took part in this study. Data were collected through interviews and were analyzed quantitatively and qualitatively, showing the following results: 40% of the nurses did not take a stand when informing about a prognosis of no treatment possibility; 56% did not take any part in the decision of informing the patient about the prognosis of no treatment possibility. This disclosed the need for nurses to consider bioethical matters, which can be of help in the analysis of dilemmas.

Adult↗
PubMed1991

Prognosis versus actual outcome: a long-term survey of 100 treated periodontal patients under maintenance care.

One hundred treated periodontal patients under maintenance care were evaluated for 5 years, and 39 of these patients were followed for 8 years to determine the accuracy of assigned prognoses based on commonly taught clinical criteria. The results suggested that this population reflected many of the same characteristics seen in well-maintained patients. The ultimate fate of teeth initially labeled as hopeless varied substantially, and even though the average prognosis of the teeth studied at each interval remained relatively stable over time, individual prognosis categories and individual tooth prognoses changed frequently. Possible reasons for these shifts are discussed. In conclusion, it was found that projections were ineffective in predicting any prognosis other than good, and that prognoses tended to be more accurate for single rooted teeth than for multi-rooted teeth. Further evaluation of the data is needed to determine how each of the prognostic indicators relate to the success or failure of our projection.

Adult↗
PubMed2002

Prognosis of the elderly with asymptomatic atherosclerotic plaques of the carotid arteries.

OBJECTIVE: To elucidate the prognosis of the elderly with neurologically asymptomatic atheromatous plaques of the carotid arteries. METHODS: A total of 228 subjects aged 60 years or older, examined by carotid ultrasonography and platelet aggregation test, were studied. They were divided into 3 groups based on plaque morphology: the no lesion group (n=110), the nodular plaque group (n=47), and the mural plaque group (n=71). Platelet aggregability was assessed as suppressed, normal, or accelerated. RESULTS: During the 4.0 years of mean follow-up period, 31 subjects died, and 16 of the deaths were due to vascular events such as cerebral infarction or ischemic heart disease. The annual mortality rate due to vascular events was 0.5% in the no lesion group, 1.4% in the nodular plaque group, and 4.1% in the mural plaque group, and Kaplan-Meier survival curve showed poor prognosis of the mural plaque group (logrank statistics: 12.8, Df=2, p=0.0017). According to the Cox proportional hazard model, a high hazard ratio (HR) was seen in the mural plaque group (5.3) and also the accelerated platelet aggregability group (4.0). CONCLUSION: These findings suggested that subjects with mural plaques and accelerated platelet aggregability, even when asymptomatic, have a poor prognosis due to vascular events. Antiplatelet therapy and exercise stress test for detecting coronary artery disease should be considered in these subjects.

Aged↗
PubMed2005

Pulmonary exercise testing predicts prognosis in patients with chronic obstructive pulmonary disease.

OBJECTIVE: In patients with chronic obstructive pulmonary disease (COPD), patient age and initial value of forced expiratory volume in 1 second (FEV1) have been considered the most accurate predictors of mortality among the parameters obtained from pulmonary exercise tests. However, few studies have examined the predictive variables of prognosis among exercise parameters in COPD. We therefore attempted to identify the best index for predicting long-term survival in patients with COPD among the cardiopulmonary variables obtained during exercise testing. PATIENTS AND METHODS: Fifty-eight patients with COPD (50 men and 8 women) without hypoxemia at rest or other serious complications performed resting pulmonary function tests followed by a symptom-limited ramp exercise test on a cycle ergometer with breath-by-breath gas analysis and arterial blood gas sampling. RESULTS: After 3,570+/-1,373 days follow-up (mean+/-SD), 21 died because of deaths by respiratory failure. The overall survival rates calculated by the Kaplan-Meier method were 92.9% and 75.8% at 5 years and 10 years, respectively. In univariate Cox hazards analysis, age, FEV1, VC, RV/TLC, VEmax, VO2max, VCO2max, PaO2max, PacO2max, and PaO2 at rest were found to be significant prognostic indices of survival. However, multivariate analysis revealed only FEV1, PaO2max, and age as independent predictors of mortality. In severe COPD patients (FEV1 <50% predicted, n=35), PaO2max and age also correlated with prognosis, whereas FEV1 did not. CONCLUSION: Pulmonary exercise testing is useful in predicting prognosis in patients with COPD.

Aged↗
PubMed1987

Study on relationship between the muscular pathology and prognosis in the motor neuron disease.

In order to investigate the mode of progression in motor neuron disease (MND), and find if there is any correlation between the muscular pathology and prognosis of the disease, activity index (ACT), atrophy factor of type I muscle fibers (A1), and type II (A2), hypertrophy factor of type I muscle fibers (H1), and type II (H2) and grouping factors were analyzed. Thirty-five patients with MND were evaluated whether there were any factors correlated to the severity of ACT. Among various factors, A1 showed the most significant change to the severity of ACT. Therefore, it was suggested that A1 was best correlated with the rate of prognosis of the disease process. Probably involvement of the motor neuron innervating type I muscle fibers takes place in the earlier stage than that of the neurons of type II, or there might be some difference of innervation ratio between type I and type II fibers. Further investigation is necessary to evaluate the relationship between the actual prognosis of these patients and their ACT by follow up study.

Adult↗