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PubMed1999

Functional prognosis after treatment of spinal dural arteriovenous fistulas.

Functional prognosis after treatment for spinal dural arteriovenous fistulas (SDAVFs) was retrospectively analyzed in 13 consecutive patients aged 38 to 73 years (mean 57 years) treated during the last 5 years. The duration of symptoms before diagnosis ranged from 3 to 72 months (mean 23 months). Neurological symptoms were examined before and 6 months after the treatment. Seven patients underwent embolization as the initial treatment. In four of six patients, N-butyl 2-cyanoacrylate (NBCA) embolization achieved complete obliteration of SDAVF. The other two patients with incomplete embolization and one embolized with polyvinyl alcohol particles underwent subsequent surgical treatment. Six patients were treated by direct surgery. Complete disappearance of SDAVF was confirmed in all nine patients treated surgically. Improvement of gait and micturition disturbance after the treatment was noted in six of 10 and three of six patients, respectively. Long duration of symptoms and high grade of neurological symptoms were associated with a poor functional outcome. NBCA embolization and surgery are curative treatments for SDAVF, but the functional prognosis is not always satisfactory. Embolization is the first choice of treatment for SDAVF because it is less invasive and relatively safe. However, when complete obliteration is not achieved, prompt surgery is recommended because a long duration of symptoms will result in a poor functional prognosis.

Adult↗
PubMed1996

[Long-term renal prognosis in patients with lupus nephritis treated with pulse methylprednisolone].

To elucidate the long-term renal prognosis in patients with lupus nephritis treated with pulse methylprednisolone, the renal outcome and the risk factors associated with poor renal prognosis were studied in 14 female lupus nephritis patients treated with pulse methylprednisolone. The mean age when the pulse methylprednisolone was started was 28.1 years old and their renal pathology were 3 of WHO III, 10 of WHO IV and 1 of WHO V. Four of the patients fell into renal insufficiency at 5.7 (mean, 1.3 approximately 10) years after pulse methylprednisolone, however residual 10 patients kept their renal function for 11.5 (mean, 3.5 approximately 19.6) years observation. The deterioration of renal function significantly (p = 0.033) correlated with glomerular sclerosing index before pulse methylprednisolone, but did not correlate with sustained immunological activity, hypoproteinemia or hypertension. Because glomerular sclerosing index was thought to be one of the risk factors for poor renal prognosis, the indication for pulse methylprednisolone in lupus nephritis was the patients with low glomerular sclerosing index.

Adult↗
PubMed1991

Primary sclerosing cholangitis: value of cholangiography in determining the prognosis.

We studied cholangiograms in 129 patients with primary sclerosing cholangitis (PSC) to determine if there was a correlation between any of the findings and the prognosis of the disease. The grade, length, and extent of strictures, the degree of bile duct dilatation, and the distribution of lesions were evaluated. Survival curves were generated to test the association of these radiologic signs with subsequent survival. High-grade intrahepatic duct strictures (greater than 75% narrowing) were associated with a 19% decrease in 3-year survival (p = .05) compared with lower-grade strictures. Diffuse intrahepatic strictures (involving greater than 25% of the ducts) were associated with a 16% decrease in 3-year survival (p = .012) compared with localized strictures. Statistically insignificant (p greater than .05) but measurable decreases in survival were observed with high-grade extrahepatic duct strictures, diffuse involvement of the extrahepatic ducts, long confluent strictures anywhere in the biliary tree, and marked dilatation of the intrahepatic ducts. In general, intrahepatic duct disease was found to have greater prognostic significance than extrahepatic duct disease. High-grade strictures and diffuse strictures of the intrahepatic ducts were found to be indicators of a poor prognosis in PSC and were more predictive of a poor prognosis than was extrahepatic duct disease.

Adult↗
PubMed2005

[Use of high-dosage chemotherapy with autologous hematopoietic stem cell transplantation as a first-line therapy for the patients with poor-prognosis testicular tumors].

BACKGROUND: High-dose chemotherapy followed by hematopoietic stem cell support can be used as a first-line treatment in patients with germ-cell tumor (GCT) with poor prognosis. Long-term survival rate is attained in 50% of these patients. The aim of this paper was to present the experience at the Department of Hematology, Military Medical Academy, with high-dose cytostatic therapy as first-line chemotherapy in GCT patients with poor prognosis. METHODS: Between 1997 and 2003, five patients with high-risk germ-cell tumors were treated with high-dosage chemotherapy followed by an autologous stem cell transplantation. All the patients were with non-seminomatous germ-cell tumors with mixed histology, and one was with extragonadal retroperitoneal germ-cell tumor. RESULTS: The follow-up period ranged from 8 to 33 months. Three patients achieved complete remision, two patients only partial remision, and one was not followed-up. One patient was with residual tumor resection, using retroperitoneal lymphadenectomy, after autologous stem cell transplantation. All the patients were treated according to standard protocols. CONCLUSION: Early high-dose chemotherapy associated with hematopoietic stem cell support as a first-line treatment in the patients with germ-cell tumor with a poor prognosis, represented an efficient treatment modality.

Adult↗
PubMed1995

Back pain in patients with ductal pancreatic cancer. Its impact on resectability and prognosis after resection.

BACKGROUND: Back pain is a frequent and often ominous clinical sign in patients with ductal pancreatic cancer. METHODS: From 1971 to 1993 a pancreatic carcinoma could be resected in 192 patients, whereas 261 patients underwent either probatory laparotomy alone or palliative bypass procedures. In a retrospective study including uni- and multi-variate survival analysis we have determined the impact of preoperative back pain on both resectability and long-term prognosis after resection. RESULTS: Among the presenting symptoms of patients with ductal pancreatic cancer back pain was a predictive sign of irresectability. In the presence of preoperative back pain the long-term prognosis after resection of the tumour was also significantly impaired. In a multivariate analysis it could be demonstrated that the prognostic impact of back pain was as strong as the influence of residual tumour, tumour grading, and tumour size. CONCLUSIONS: Back pain often indicates irresectability of ductal pancreatic carcinoma and also impairs the long-term prognosis even after curative resection.

Adult↗
PubMed1993

Factors affecting prognosis of neonatal tetanus.

Neonatal tetanus is associated with a high mortality rate, despite intensive care. Although it can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, neonatal tetanus is still a common cause of neonatal mortality in underdeveloped countries. In our study, hospital records of 133 newborns with neonatal tetanus were evaluated to identify the possible factors affecting prognosis of neonatal tetanus; 79 were males and 56 females, and 54 (41.6%) of the 133 died. Sex and birth weight did not affect the prognosis. As a result of our study, we found that age on admission < 10 days, symptoms < 5 days and presence of risus sardonicus and fever indicate a poor prognosis in neonatal tetanus.

Age Factors↗
PubMed1984

Relationship between lymph node metastases and prognosis in patients irradiated postoperatively for carcinoma of the uterine cervix.

Three hundred and ten patients with squamous cell carcinoma of the uterine cervix received postoperative radiation therapy and the relationship between the extent of lymph node metastases and the prognosis was analysed. Patients with lymph node metastases showed a markedly lower five-year survival rate (42.1%) than those without such metastases (91.9%). The prognosis for patients with lymph node metastases was inversely correlated to the number of nodes involved. Bilateral lymph node involvement or lymph node involvement above the bifurcation of the iliac artery gave a much poorer prognosis than unilateral involvement or involvement only below the bifurcation.

Carcinoma, Squamous Cell↗
PubMed1983

Prognosis of inflammatory joint diseases. A three-year follow-up study.

The prognosis 3 years after the onset of the disease was studied in 107 patients with definite rheumatoid arthritis, 161 with probable RA or non-specific arthritis, 84 with either ankylosing spondylitis, Reiter's disease or reactive arthritis, 14 with psoriatic arthritis and 10 with a systemic connective tissue disease. Prognosis was measured by clinical involvement of joints, radiological erosions in joints, deterioration in joint function, ESR, and working ability. A total of 44% of all patients were symptomless after 3 years. The prognosis was best in patients with an "HLA B 27-associated" disease and non-specific arthritis, and worst in RA. Two patients died during the follow-up of systemic connective tissue disease and one committed suicide with an overdose of hydroxychloroquine. Two HLA B27-positive patients developed systemic amyloidosis.

Arthritis↗
PubMed2000

Poor prognosis of depression in elderly people: causes and actions.

Depression is the most common mental health problem of older people. It is a serious disorder which can lead to persistent suffering, increased mortality, from both suicide and general medical causes, and poorer overall health. Although presenting symptoms are similar in all age groups there are different aetiological pathways. In older people the waning effect of genetic predisposition to affective disorder may be replaced by subcortical brain abnormalities of presumed vascular aetiology. These may influence prognosis. Depression in later life is often under-diagnosed and under-treated; these two factors are the main hurdles to an improved prognosis. Antidepressant treatment should be tailored to the patient and works best when combined with psychological therapy, but the latter treatment modality is woefully neglected in later life psychiatry. Improvements in prognosis are unlikely to come from new revolutionary treatments but from vigorous treatment in the acute phase, continuation after recovery for at least 12-18 months and long-term maintenance treatment for those at high risk of recurrence.

Aged↗
PubMed1994

Peripheral blood lymphocyte surface antigen expression and prognosis in myeloma: Australian Leukaemia Study Group Study.

The Australian Leukaemia Study Group myeloma study (MM1) aimed to determine the prognostic significance of clinical and immunophenotypic markers in patients with multiple myeloma. All patients were treated with standard dose melphalan and prednisone. Seventy-four patients were entered and the median survival was 27 months. Serum beta 2-microglobulin (beta 2M) and albumin levels were the only significant clinical factors influencing survival (p = 0.007 and p = 0.008, respectively). Patients with raised levels of CD38+ lymphocytes at presentation had a significantly shorter survival than patients with normal levels (p = 0.01, logrank test, median 19 months vs 33 months). CD38 antigen expression was independent of beta 2M but patients with raised levels of CD38 had significantly lower levels of albumin than patients with normal levels (p = 0.001) which may explain their poorer survival. Salmon and Durie stage was not associated with antigen expression. No other B-cell antigens (CD10, CD19, CD20, CD21, CD22, CD23, FMC1 or FMC7) or plasma cell antigens tested (PCA-1) were found to be associated with prognosis. Patients who achieved plateau phase had a better prognosis than those who did not (p = 0.04 in a landmark analysis). Patients who achieved plateau phase following an objective response appeared to have a better prognosis than those who were in plateau phase at presentation (p = 0.09 in a landmark analysis). Light chain isotype suppression (LCIS) was not associated with a significant survival advantage and did not correlate with any known prognostic indicator.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

AgNORs and myeloma prognosis.

The argyrophilic nucleolar organizer regions (AgNORs) were analysed in bone marrow biopsies from 80 patients with multiple myeloma (MM) at presentation. The mean AgNOR number per MM cell (AgNOR counts) and their distribution within the nucleus (configuration) were assessed. AgNOR counts were significantly associated with several recognized prognostic factors: Durie and Salmon clinical staging system (p = 0.02), percentage of plasma cells (PCs) in aspirates (p = 0.01) and in bone marrow biopsies (p = 0.0000), pattern of bone marrow involvement (p = 0.0003), calcaemia (p = 0.0005) and creatininaemia (p = 0.0003). AgNOR counts were also associated with the degree of PC differentiation (p = 0.0000). A single central cluster of 2-3 large-sized AgNORs (configuration A) was evident in most G1 MM; one cluster of 4-5 medium-sized dots or two clusters of 2-4 dots (configuration B) were seen in most G2 MM; many small-sized, scattered dots were present in G3 MM (configuration C). AgNOR counts and configuration were related to the prognosis: in the univariate analysis, the 5 year survival rate was 7% for cases with > 4.5 AgNORs/cell and 46% for cases with < or = 4.5 AgNORs/cell (p = 0.01), 53% for configuration A, 12% for configuration B and 0% for configuration C (p = 0.0000). AgNOR counts (p = 0.02) and configuration (p = 0.000) were independent prognostic variables in the multivariate analysis. The AgNOR counts were significantly higher in "fulminant myeloma" than in less aggressive cases (p = 0.002). The plasma cell labelling index (LI%), evaluated in 44 MM patients, showed significant correlation with prognosis: the 5 year survival rate was 51% for LI% < or = 1 and 17% for LI% > 1 (p = 0.02). More than 70% of patients with low LI% had low AgNOR counts and more than 70% of patients with high LI% had high AgNOR counts (p = 0.007). AgNOR counts and configuration reflect the myeloma cell mass, the degree of differentiation and the kinetics of the myeloma cells. They offer an exact evaluation of the tumour characteristics and can be useful additional parameters for MM prognosis.

Adult↗
PubMedDate not supplied

Chronic posttraumatic stress disorder: a review and checklist of factors influencing prognosis.

Mental health clinicians are often asked to evaluate prognosis in individuals with posttraumatic stress disorder (PTSD) in clinical, administrative, and legal contexts. Although chronicity of PTSD has been addressed in a number of trauma studies, the data have not been integrated into a coherent approach to the assessment of prognosis. In this paper, the peer-reviewed PTSD literature is surveyed to assist clinicians in making informed prognostic evaluations of the course of PTSD in adults. Potential risk factors, grouped into 11 categories (PTSD stressors, PTSD symptoms, current comorbidity, lifetime comorbidity, childhood separation and abuse, demographics, life stressors, family history, support, treatment, and functional impairment), are reviewed. Knowledge of these risk factors, and of factors associated with chronic PTSD, is helpful in assessing the potential for or degree of chronicity present at the initial evaluation of the patient, as well as in measuring treatment response during the course of therapy. Early identification and the appropriate treatment and management of remediable risk and associated factors may help prevent the development of chronic PTSD. Longitudinally assessing the response of treatable risk factors should provide an additional means for evaluating prognosis. A PTSD Prognostic Checklist, which rates risk and associated factors in each category, is proposed. Validity and reliability have not yet been established for this instrument. It is hoped that clinicians will use and conduct research on it as an initial step toward advancing its scientific utility.

Adult↗
PubMed1990

[Long-term prognosis related to coronary risk factors, clinical characteristics of acute myocardial infarction and coronary angiographic findings in the elderly].

In order to clarify the characteristics of acute myocardial infarction in the elderly, we investigated the clinical profile and long-term prognosis of patients with myocardial infarction in the past 13 years. The early fatality rate (within 30 days after onset) in the relatively younger patients (less than 65 years old) was 8.8%, and in the older patients (greater than 65 years old) was 29.1%. The fatality rate was significantly higher in older than in younger patients. On coronary and left ventriculography, the older patients showed multi-vessel lesions with decreased ejection fraction and cardiac index. According to the cumulative survival curves related to the coronary risk factors, no significant differences were found with or without smoking or hypertension. However, the long-term prognosis of the patients with controllable hypercholesteremia was better than in uncontrollable patients less than 65 years old. No significant difference was found in patients with hypercholesteremia over age 65. The long-term prognosis of the patients with uncontrollable diabetes mellitus was worse than that of controllable diabetic patients.

Aged↗
PubMed1993

[Course, prognosis and mortality in Japanese elderly diabetes mellitus--a seven year follow-up study].

Course, prognosis and mortality in Japanese elderly diabetes mellitus were studied using a 7 year follow-up study of 424 elderly diabetics whose ages were 60 years old or more (mean age: 72.6 +/- 6.2, 144 males: 280 females) at baseline. The relationships between clinical findings at baseline and prognosis, causes of death and onset of ischemic heart disease during the follow-up period were also studied. A total of 133 (31%) deaths were observed during the follow-up period. Risk factors present at baseline which significantly influenced the patients' prognosis included age, male gender, previous cerebro-vascular disease, body mass index, pharmacological treatment of diabetes and persistent proteinuria. These factors were also related to the causes of death among the patients. Cardio-vascular disease deaths (n = 66, 50%) tended to increase in patients with a relatively higher age, male gender, previous ischemic heart disease and persistent proteinuria. Malignant neoplasm deaths (n = 28, 21%) tended to increase in patients with relatively higher age and previous cerebrovascular disease. Furthermore, infectious deaths (n = 16, 12%) were relatively increased in patients with a relatively higher age, male gender, previous cerebro-vascular disease, relatively lower body mass index and higher fasting plasma glucose levels. Among various causes for cardio-vascular disease deaths, ischemic heart disease (n = 40) was the leading cause of death.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2002

[Long-term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital].

Although percutaneous endoscopic gastrotomy (PEG) has been widely acknowledged as a safer method for enteral feeding, its long-term impact on prognosis and quality of life (QOL) in elderly patients is not sufficiently understood. Regarding the indications of PEG, there still exist issues to be studied due to lack of convincing evidence for reduction of expected complications such as aspiration pneumonia or for improvement of prognosis in patients with severe dementia. In this study we investigated the survival rate after PEG placement and family satisfaction retrospectively in 78 elderly inpatients who underwent PEG, by sending questionnaires to the patients or their caregivers. The results of 68 cases (88%) recovered showed that the 1-year survival rate was 64.0%, and the 2-year survival rate was 55.5%. Fifty-three percent of families of patients showed overall satisfaction regarding the induction of PEG. The survival rate was relatively higher than that from previously reported studies. The differences we observed may be attributed to variations in patients' backgrounds (clinical, socio-economic, cultural) in therapeutic interventions. We recognized the importance of clarifying factors which would affect the prognosis and QOL in elderly patients who undergo PEG. The indication for PEG can be made based on comprehensive assessment of the relevant factors in individual cases, taking patient's or caregiver's wishes into consideration.

Aged↗
PubMed2005

Good outcome in patients with normal-pressure hydrocephalus and factors indicating poor prognosis.

OBJECT: The authors set out to describe the outcome in a subgroup of patients with normal-pressure hydrocephalus (NPH) in whom prognostic factors were poor. This subgroup of patients who had received shunts was selected according to strict criteria. METHODS: From a cohort of 56 patients with NPH in whom shunts were placed, the authors selected a subgroup with four of the factors traditionally considered to indicate poor prognosis: idiopathic type, cortical atrophy, longstanding symptoms, and presence of dementia in addition to old age. Twelve patients met the inclusion criteria. After receiving shunts, 92% of the patients showed clinical improvement on the NPH scale; gait improved in 100% of patients, sphincter control in 90%, and dementia in 33%. Improvement was significant for gait and sphincter control, general NPH score, and most daily life activity scales. No significant differences regarding clinical, cognitive, or functional changes following surgery were found in comparison with the rest of patients (the good prognosis subgroup). CONCLUSIONS: The clinical condition of patients with NPH who present with traditionally accepted markers of poor prognosis can improve after surgery, especially as regards gait and sphincter control. The authors assert that the presence of these markers should not be considered to be an absolute criterion for ruling out shunt surgery in cases of NPH syndrome.

Age Factors↗
PubMed2003

Phosphorylation, but not overexpression, of epidermal growth factor receptor is associated with poor prognosis of non-small cell lung cancer patients.

Epidermal growth factor receptor (EGFR) is commonly overexpressed in non-small cell lung cancer (NSCLC) and its tyrosine kinase phosphorylation is thought to be an ideal target in the treatment of patients with NSCLC. In the present study, we examined surgically obtained specimens from a series of 36 NSCLC patients for expression of EGFR, phosphorylated EGFR (p-EGFR), and HER2 by immunohistochemistry, and also examined the correlation with clinical characteristics. The positive rate of EGFR, p-EGFR, and HER2 was 97.2%, 44.4%, and 88.6%, respectively, and the overexpression rate was 80.6%, 0.0%, and 27.8%, respectively. EGFR overexpression and phosphorylation were seen at almost the same rate in each histological type of squamous and nonsquamous cell carcinoma (squamous vs. nonsquamous; 78.6% vs. 81.8% for EGFR, 35.7% vs. 50.0% for p-EGFR), while HER2 overexpression was seen less frequently in squamous cell carcinoma than in nonsquamous cell carcinoma (0.0% vs. 45.5%, P = 0.003). Univariate analysis revealed that EGFR overexpression was related to good performance status (P = 0.038) but not related to EGFR phosphorylation. EGFR phosphorylation was correlated to short time to progression (TTP) (P = 0.002) and poor prognosis (P = 0.002), although EGFR overexpression, HER2 overexpression, or EGFR-HER2 coexpression were not correlated to TTP or survival. Bivariate analysis showed EGFR phosphorylation was related to short TTP and poor prognosis both in early and advanced stages. Multivariate analyses confirmed that clinical stage, performance status, and p-EGFR expression were independently associated with increasing risk of short TTP and poor prognosis. These results suggest that phosphorylation, but not overexpression, of EGFR may be an important predictor for clinical outcome of NSCLCs.

Adult↗
PubMed2005

Expression of cyclooxygenase-2 in gastric cancer and its relation to liver metastasis and long-term prognosis.

AIM: To investigate the expression of cyclooxygenase-2 (COX-2) in gastric cancer and its relation with the liver metastasis and prognosis. METHODS: Expression of COX-2 mRNA and protein was examined in gastric cancer and its paired substantial normal tissue by semi-quantitative reverse transcription-polymerase chain reaction and immunohistochemistry. The relation between COX-2 expression and prognosis was investigated in 195 cases. RESULTS: The expression of COX-2 mRNA in gastric cancer tissue was significantly higher than that in normal tissue in 47 cases (w = 792, P<0.01). The COX-2 mRNA in pT3-4 tissue expressed higher than that in pT1-2 tissue (w = 204, P<0.05). The positive expression rate of COX-2 protein was 57.9% (113/195). The COX-2 expression was significantly related to histological type, lymphnode metastasis, venous invasion and liver metastasis (P<0.05). No relation was found between COX-2 expression and invasion depth, peritoneal metastasis and International Union against Cancer TNM stage. The multiple regression analysis showed that the COX-2 expression and venous invasion were obviously associated with liver metastasis (P<0.05). However, there was no significant correlation between COX-2 immunoreactivity and prognosis. CONCLUSION: COX-2 may play an important role in the development of gastric cancer, and the over-expression of COX-2 protein may be a high risk factor for liver metastasis.

Base Sequence↗