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PubMed2003

[Clinical manifestation and prognosis of myocardial bridge].

OBJECTIVE: To study the clinical manifestation, angiographic features, and prognosis of myocardial bridge. METHODS: A retrospective analysis was made on the data of the clinical manifestation, coronary angiography, and prognosis of 35 patients with myocardial bridge, 29 males and 6 females, with an average age of 52.0 +/- 9.5 years, out of 2 871 patients undergoing coronary angiography 1 January 1996 - 20 February 2001. RESULTS: The detection rate of myocardial bridge, mostly in the middle or distal parts of left anterior descending branch and 24 being isolated myocardial bridge, was 1.22% in coronary angiography. There was a significant difference in the extent of diameter stenosis during systolic stage between the group with atherosclerosis (68% +/- 15%, n = 15) and the group without atherosclerosis (54% +/- 14%, n = 20) in the vessel proximal to myocardial bridge (P < 0.01). The systolic diameter stenosis was more severe in the abnormal ECG group (63% +/- 13%, n = 12) than in the normal ECG group (54% +/- 14%, n = 12), P < 0.05. However, the systolic stenosis extent of myocardial bridge in the patients with typical angina pectoris (58% +/- 15%, n = 11) was not significantly different from that in the patients with atypical angina pectoris (54% +/- 15%, n = 13). The systolic stenosis extent of myocardial bridge were 69% +/- 9% (n = 7) and 58% +/- 16% (n = 26) in the patients with and without left ventricular wall hypertrophy respectively (P = 0.09). No malignant event occurred during the follow-up period of 3 - 50 months. CONCLUSION: (1) The more severe the extent of systolic diameter stenosis, the more severe the myocardial ischemia and the more the possibility of abnormal ECG. (2) Myocardial bridge tends to promote or accelerate the atherosclerosis of the vessels proximal to it. (3) Left ventricular wall hypertrophy may promote the formation of myocardial bridge clinically. (4) The prognosis of myocardial bridge is good.

Coronary Angiography↗
PubMed2003

[Typing and prognosis of striatocapsular hemorrhage, study of 181 cases].

OBJECTIVE: To analyze the impact of hematoma location and vascular territory on the clinical symptoms and signs, neuroimaging findings, and clinical prognosis of striatocapsular hemorrhage. METHODS: The data of 181 cases of striatocapsular hemorrhage, 124 males and 57 females, aged 28 - 89, including medical history, symptoms, and signs were analyzed. On the basis of hematoma locations and arterial territories, the striatocapsular hemorrhage was divided into six types: anterior type (with the blood supply from Heubner's artery), middle type (with the blood supply from medial lenticulostriate artery), posteromedial type (with the blood supply from anterior choroidal artery), posterolateral type (with the blood supply from posteromedial branches of lateral lenticulostriate artery), lateral type (with the blood supply from the most of lateral branches of lenticulostriate artery), and massive type (with the hematoma occupying the whole or greater part of striatocapsular region). The short-term clinical outcome and prognosis were evaluated by Modified Rankin Scale (MRS). The relationship between the type and outcome was analyzed. RESULTS: There were 22 cases of anterior type, accounting for 12.15%, of which 68.18% showed an excellent outcome (MRS = 0 - 2) and only 1 case died. There were 12 cases of middle type, accounting for 6.63%, of which 6 cases (50%) showed a poor outcome (MRS = 5) but without dead case. There were 19 cases of posteromedial type (10.50%), of which 52.63% had excellent outcome (MRS = 0 - 2) without dead case. There were 19 cases of posterolateral type (18.78%), of which 76.47% were with poor outcome (MRS = 5) and 17.65% died. Accounting for 39.23%, lateral type was the most common condition, of which 38.03% patients had a poor outcome (MRS = 5) and 8.45% cases died. The incidence rate of massive type was also high (12.71%), of which 47.82% showed a poor outcome (MRS = 5) and 47.83% cases died. CONCLUSION: Hematoma location and vascular territory are the determinating factors of prognosis of striatocapsular hemorrhage. The six-type classification system provides a simple and reliable means to predict the clinical outcomes and to guide therapeutic options of striatocapsular hemorrhage.

Adult↗
PubMed2003

[Operative results and prognosis of thoracic spinal stenosis].

OBJECTIVE: To discuss the clinical properties, operative results of thoracic spinal stenosis and factors correlating with prognosis. METHODS: From September 1992 to January 2001, 16 patients who suffered from thoracic spinal stenosis caused by degeneration, ossified ligamentum flavum, diffuse idiopathic hyperostosis and trauma, were decompressed by operation. The operative method was selected according to the compressed position of spinal cord. All patients were followed up 6 months to 9 years. The pain severity, ambulatory status and paraplegia index were compared between before operation and after operation. The correlation between prognosis and ages, the length of stenosis and the duration of disease was studied. RESULTS: The results of Wilcoxon Signed Ranks Test show significant difference in pain severity, ambulatory status and paraplegia index between before operation and after operation (P < 0.01). The results of partial correlation analyzing show that only the duration of disease was correlated with paraplegia index (P < 0.05). CONCLUSION: Thoracic spinal stenosis frequently develops in the lower-thoracic segments in middle and old aged men. Decompression by operation early can achieve a good clinical result. Duration of disease affects the prognosis.

Adult↗
PubMedDate not supplied

Positive reactions for both Cyfra21-1 and CA125 indicate worst prognosis in non-small cell lung cancer.

UNLABELLED: We examined four tumour markers [carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC), cancer antigen 125 (CA125) and cytokeratin 19 fragment (Cyfra21-1)] in 584 non-small cell lung cancer (NSCLC) patients. RESULTS: After confirmation of a significant correlation between their serum levels and clinical stages, multivariate analysis showed that Cyfra21-1 and CA125 pointed to a negative prognosis; the respective hazard ratios were 2.585 (p = 0.0008) and 2.139 (p = 0.0020) in 121 inoperable adenocarcinoma patients and 2.329 (p = 0.0004) and 1.61 (p = 0.00370) in 205 inoperable NSCLC patients. Also, patients giving positive reactions for both Cyfra21-1 and CA125 had the worst prognoses, with hazard ratios of 6.546 (p < 0.0001) in inoperable adenocarcinoma patients and 4.275 (p < 0.0001) in inoperable NSCLC patients. CONCLUSION: Cyfra21-1 or CA125 tend to imply a negative prognosis. Cyfra21-1 and CA125 together imply the worst prognosis.

Adult↗
PubMed2003

[Prognosis and factors that predict outcome in multiple sclerosis].

An understanding of the natural history of multiple sclerosis(MS) in a patient is important to begin proper treatment at the correct time, especially when there is a high risk for poor prognosis. Factors that predict unfavorable prognosis are a primary or secondary progressive course, older age at disease onset, short interval between first and second attacks, initial cerebellar or pyramidal symptoms, a large number of functional systems involved at onset, moderate to severe disability within the first 2 years, and the presence of typical plaques or greater lesion volume shown by magnetic resonance imaging results during the first 5 years. However, there are no established laboratory tests able to predict long-term prognosis.

Age of Onset↗
PubMed2003

A new prognostic scoring system involving des-gamma-carboxy prothrombin as a useful marker for predicting prognosis in patients with hepatocellular carcinoma.

A staging system for hepatocellular carcinoma was reported from Italy (CLIP). In this study, we evaluate the CLIP scoring system and establish a new scoring system for predicting the prognosis of patients with hepatocellular carcinoma. Patients (n=141) who were diagnosed and who underwent initial treatment at our single institution were recruited retrospectively into this study. We evaluated markers for prognosis, using a stratified Cox proportional hazard regression model and Kaplan-Meier survival analysis. CLIP score differentiated patients with different survival experiences by Kaplan-Meier estimated survival analysis. However, with respect the CLIP score, more than two thirds of patients were included in the early stage (CLIP 0-1), and the group with better prognosis than the survival rate of all patients was the only one with CLIP 0. Multivariate analysis revealed that des-gamma-carboxy prothrombin (DCP) >/=100 mAU/ml (relative risk, 2.06; P=0.0218) was statistically significant as a predictor of poor survival. A new prognostic scoring system included DCP classified patients to 6 well-balanced groups (score 0-5). The new prognostic scoring system 0 group (14.9% of the cohort) and the CLIP score 0 group (34.0% of the cohort) had a median survival of 66.9 and 61.6 months. The new prognostic scoring system performs better for prediction of survival than either the CLIP score or the Child-Pugh stage. In conclusion, the described scoring system provides more accurate prognostic information than the CLIP scoring system. It may help physicians decide more appropriate clinical and therapeutic management.

Aged↗
PubMed2003

[Significance of acute-phase inflammatory reactants as an indicator of prognosis after acute myocardial infarction: which is the most useful predictor?].

OBJECTIVES: To investigate the relationship between representative acute-phase inflammatory reactants [highly sensitive C-reactive protein (hsCRP), serum amyloid A protein (SAA) and interleukin-6 (IL-6)] and the severity of acute myocardial infarction and patient prognosis, and to identify the most useful predictor of the three. METHODS: This study investigated 132 consecutive patients admitted within 8 hr of onset of first acute myocardial infarction and successfully reperfused with primary percutaneous coronary intervention. Acute-phase (= 24 hr from onset) blood samples were taken for evaluation of inflammatory reactants (hsCRP, SAA and IL-6), and peak creatine phosphokinase levels were measured every 4 hr after admission for 48 hr to assess myocardial infarction infarct size. Left ventriculography was performed in the chronic stage (20 +/- 9 days post-admission) to analyze left ventricular ejection fraction and regional wall motion, using Killip's classification to determine acute myocardial infarction severity. Logistic regression analysis was used to quantify the usefulness of the reactants as predictors of patient prognosis. RESULTS: Both hsCRP and SAA showed significant positive correlations with peak creatine phosphokinase. hsCRP and SAA showed significant inverse correlations with left ventricular ejection fraction and regional wall motion in the chronic stage. Multivariate analysis identified SAA as the best predictor of severe heart failure (Killip's classification III, IV). SAA was the best predictor of a major cardiac event (shock, cardiac death). CONCLUSIONS: These results suggest a strong correlation between acute-phase SAA and the clinical course of patient outcomes after acute myocardial infarction, such as cardiac function, heart failure and cardiac death. SAA may be the most useful acute-phase inflammatory reactant for predicting the prognosis after acute myocardial infarction.

Acute-Phase Proteins↗
PubMed2003

[Fetal arrhythmias: diagnosis, treatment and prognosis].

OBJECTIVE: To evaluate patients who were referred to our center with suspicion of fetal arrhythmia for diagnosis, results of treatment and prognosis. METHODS: Thirty-three patients referred to our center for evaluation of fetal cardiac arrhythmias were examined by M-mode, two-dimensional and Doppler echocardiography for cardiac anomaly and type of dysrhythmia RESULTS: Arrhythmias were diagnosed in 15 of 33 patients. Four cases demonstrated tachycardia, 5--ectopic beats, 6--bradycardia. Of 5 fetuses with tachycardia, transplacental antiarrhythmic drugs were administered in three cases; two of them with hydrops died and conversion of the arrhythmia was achieved in one. Six patients with bradycardia had poor perinatal outcome, with 3 deaths occurred (two of them had third degree atrioventricular block, one of them had sinus bradycardia). All patients with ectopic beats had a good perinatal outcome. CONCLUSION: The results suggest that bradycardic and/or hydropic fetuses have poor prognosis, however fetuses with ectopic beats generally have desirable prognosis.

Adult↗
PubMed1992

[Long-term prognosis of kidney cancer with vena cava thrombus. Report of 30 cases].

The authors present a retrospective analysis of 30 cases of renal cancer with vena cava thrombus with a sufficient follow-up to allow analysis of the long-term prognosis. Only three patients are still alive with a follow-up of 12, 34 and 57 months. The actuarial survival for the overall population was 55%, 37% and 22% at 1, 2 and 3 years respectively. Three essential factors influenced the prognosis of these patients: the presence of distant metastases, lymph node invasion and the highest cephalic level of extension of the thrombus. Renal cancer with vena cava thrombus without metastases and without lymph node involvement has a good prognosis (100% 2-year survival), but is very rare (4 out of 30 cases), so that renal cancer with vena cava thrombus must be considered to be a serious disease (3 survivors out of 30).

Actuarial Analysis↗
PubMed1953

The prognosis in cataract operations; a correlation of preoperative appraisal with results.

The preoperative and postoperative data on 500 cases in which cataracts were removed from the eyes were reviewed to correlate the results with the preoperative prognosis as determined by light identification and macular function tests. Another purpose was to consider the adequacy of various methods of preoperative appraisal. The vision was improved to better than 20/200 in 89.4 per cent of the cases. In 5.6 per cent (28 cases) vision was improved but was 20/200 or less. In 5 per cent (25 cases) the operation was a failure, for various causes. There was wide variation in methods used to determine the condition of the retina preoperatively by means of light identification and macular function tests, and there was no uniformity of terms used to describe degree of function.A standardized method of estimating retinal function in the presence of cataract was used in 60 cases. The equipment used is simple and inexpensive. From analysis of preoperative determination of prognosis and the operative results, it would appear that this simple inexpensive procedure is more reliable in arriving at a preoperative prognosis than some of the methods frequently employed.

Cataract↗
PubMed1992

Tumor-infiltrating lymphocytes and prognosis of hepatocellular carcinoma.

Tumor-infiltrating lymphocytes (TIL) were isolated from 17 human hepatocellular carcinomas (HCC). The proliferation of TIL cultured with recombinant interleukin-2 (rIL-2) was evaluated. We also examined prognosis in relation to TIL. Successful expansion of TIL was achieved in 16 of the 17 lesions. In 10 of the 16, TIL increased more than 100-fold. Cytotoxicity to the allogeneic HCC cell line, HC-4, was demonstrated in all 13 TIL cultures tested. Maximum cytotoxicity was noted two to four weeks after culture. No statistical difference was observed either with respect to prognosis based upon growth rate or the cytotoxicity demonstrated in vitro. The initial number of TIL per unit weight of tumor was, however, significantly greater in the group for which the prognosis was good (19.0 +/- 5.1 x 10(6) vs. 5.6 +/- 1.6 x 10(6), P < 0.05). It would appear that greater lymphocytic tumor infiltration is a prognostic marker.

Aged↗
PubMed1992

[The relationship between postoperative prognosis and positivity of PIVKA-II in patients with hepatocellular carcinoma].

The relationship between postoperative prognosis and plasma level of PIVKA-II (Protein induced by vitamin K absence or antagonist-II) was studied in 56 patients with hepatocellular carcinoma. The survival rate was significantly lower in patients with positive PIVKA-II when compared with that with negative PIVKA-II. Similar results were also obtained in cases with tumor not less than 6cm in diameter (group A, 43 cases). In accordance with these results, the frequency of intrahepatic metastasis or portal tumor thrombus was significantly increased in PIVKA-II positive cases and thereby the macroscopic stage became more advanced although no significant difference was observed in curability. Tumor diameter and frequency of massive type were also increased in PIVKA-II positive patients and all of eight cases with massive type were PIVKA-II positive. Furthermore, all patients with massive type had both intrahepatic metastasis and portal tumor thrombus and their prognosis was extremely poor when compared with that with nodular type, in whom the survival rate was not different between PIVKA-II positive and negative cases. Thus, the poor prognosis of PIVKA-II positive patients might be due to the increased frequency of massive type although the cause-effect relationship remains to be elucidated.

Carcinoma, Hepatocellular↗
PubMed1992

[Effect of chemotherapy on the prognosis of ovarian cancer].

Through the collaboration of 22 institutions nationwide, a total of 1,185 cases of ovarian cancer treated between January, 1980 and December, 1987, were investigated as to their prognosis from the aspect of the chemotherapeutic effect. (1) An excellent effect of the remission-induction chemotherapy was observed in a group receiving combination therapy with CDDP as the main ingredient. In particular a significant effect was seen in stages III and IV. In addition, the effect on the remaining tumors by diameter also showed a significant difference in cases of tumors of not less than 2 cm in diameter. (2) As to the effect on histological types, a comparison in stage III showed a favourable effect on endometroid, serous and mucinous adenocarcinomas, while no effect was observed in clear cell adenocarcinoma. (3) The effect of the remission induction chemotherapy did not always give rise to an improvement in the long-term prognosis of ovarian cancer, and the establishment of a therapeutic method aimed at the prevention of recurrence was desired. (4) To improve the long-term prognosis, intermittent (or cyclic) chemotherapy with CDDP as the main ingredient was found to be very effective, but maintenance chemotherapy with orally administered of 5-Fluorouracil or Tegaful was not effective. (5) The effect of the conventional immunotherapy was not observed at all.

Adenocarcinoma↗
PubMed1976

[Determination of the latency for the prognosis of Bell's palsy (author's transl)].

In a previous study the authors discussed the value of the determination of the compound action potential amplitude of the m. orbicularis oris following supramaximal stimuli of the facial nerve for the prognosis of facial paresis. In this study they investigate the suitability of the determination of the latency periods for an early prognosis. The latency periods in 20 normal subjects and 26 patients with idiopathic facial paresis were messured and continuously checked. The study reveals that a difference of more than 0.5 msec. between the latency periods of normal and paretic patients does not even permit the proof of peripheral lesions in patients with partial denervation or absent or insufficient recovery. Ocassionally, even shorter latency were observed in paretic patients, which are probably due to a local increase of the threshold for supramaximal stimuli around the stimulation electrode. The necessary increase of the stimulus intensity probably leads to a nervous excitation further distally. Contrary to the observations of other authors these studies indicate that the determination of the latency does not constitute a useful prognostic criterion for idiopathic facial paresis; for an early prognosis the measurement of latency is less reliable than the determination of the compound action potential amplitude.

Electric Stimulation↗
PubMed1992

[Relationship between developmental prognosis and changing picture of postural findings in early infancy among early treated children].

We followed 93 infants prospectively who were treated because of moderate and severe grades of cerebral coordination disturbances since less than 6 months of age. They were divided into 3 groups according to developmental prognosis at 4 years of age; normal 44, mental retardation 18, and cerebral palsy 31. We compared the postural findings in supine and prone position, and 7 postural reactions at the first examination with those at discharge about 50 days after the first examination. We assessed the changing pictures of postural findings as improved, not changed or worsened. We analyzed the relationship between the changing pictures of postural findings during the short period in early infancy and the developmental prognosis among the 3 groups. The normal group showed improvement in a larger number of items than the other two groups. The findings of cerebral palsied children showed poor improvement, and more postural reactions changed to be more pathologic than those in the other two groups. Among the cerebral palsied children, ambulatory cases showed better improvement than those who could not crawl. But we found no significant difference between ambulatory and crawling children. This study demonstrated that assessment of changing pictures of postural findings in early infancy was helpful to predict developmental prognosis.

Age Factors↗
PubMed1992

Patients with symptomatic ischemia have larger thallium perfusion abnormalities and more adverse prognosis than patients with silent ischemia.

OBJECTIVE: To evaluate the mechanism for silent ischemia and the effect on prognosis. DESIGN: To test the hypothesis that patients with silent (compared with symptomatic) ischemia have less severe ischemia and a more favorable prognosis, the authors prospectively evaluated 152 consecutive patients with a positive exercise electrocardiogram with exercise thallium scintigraphy and followed them for two years. SETTING: Tertiary care university-based hospital. RESULTS: Asymptomatic patients during the exercise test had a greater exercise duration (9.4 +/- 3.1 versus 6.3 +/- 2.5 mins, P < 0.01), maximal heart rate (155 +/- 20 versus 136 +/- 20 beats/min, P < 0.01), systolic blood pressure (184 +/- 21 versus 176 +/- 23 mmHg, P < 0.05) and double product than patients who were symptomatic with chest pain. Although there was no difference in the magnitude of ST depression, time to ST depression was greater in the asymptomatic (5.6 +/- 2.7 mins), compared with symptomatic (4.6 +/- 2.6 mins), group (P < 0.01). Thallium ischemic score was smaller during asymptomatic ischemia (2.1 +/- 2.7) compared with symptomatic ischemia (3.9 +/- 3.1, P < 0.01). These findings were also demonstrated in a subgroup of 107 patients with both a positive exercise electrocardiogram and positive thallium scan. The patients with asymptomatic ischemia had a two-year cardiac event rate of 5.1% compared with 13.8% in the symptomatic patients (P = 0.065). CONCLUSIONS: Patients with asymptomatic ischemia have less severe myocardial ischemia and a better prognosis than patients with symptomatic myocardial ischemia during exercise testing.

Angina Pectoris↗
PubMed2003

Combining natriuretic peptides and necrosis markers in determining prognosis in heart failure.

Despite significant advances in medical therapy, patients with heart failure remain at increased risk of overall mortality, progressive ventricular dysfunction, and sudden cardiac death. Although a number of individual clinical and laboratory variables have been identified as being associated with increased mortality risk in heart failure, there remains a clear need for an integrated, accurate method of determining prognosis. Elevated plasma B-type natriuretic peptide (BNP) has been demonstrated to be a powerful marker for prognosis and risk stratification in the setting of heart failure. Patients with elevated BNP levels have been shown to be at significantly higher risk for heart failure admission or death, and higher BNP levels are associated with progressively worse prognosis. Although cardiac troponins are a well-established diagnostic and prognostic marker in acute coronary syndromes, emerging data suggest that cardiac troponins also provide independent prognostic information in heart failure. Detection of cardiac troponins in the serum of patients with heart failure has been shown to be associated with an impaired hemodynamic profile, progressive decline in left ventricular systolic function, and shortened survival. Combining a marker of myocyte injury-cardiac troponin-with BNP in a multimarker strategy appears to be a useful tool for improving risk assessment and triage in patients with heart failure. Heart failure patients with detectable cardiac troponin I and high BNP levels have been shown to have a 12-fold increased mortality risk compared with those with both undetectable cardiac troponin I and lower BNP. Integrating this multimarker approach into the routine assessment of heart failure patients will allow clinicians to more accurately identify high-risk patients who may derive increased benefit from intensive management strategies.

Biomarkers↗
PubMed2003

[Influence of dendritic cell infiltration on prognosis and biologic characteristics of progressing gastric cancer].

OBJECTIVE: To study the relation between dendritic cell (DC) infiltration and clinicopathologic parameters, biologic characteristics and prognosis of progressing gastric cancer. METHODS: The development of apoptotic cell death (apoptotic index, AI) in 61 progressing gastric carcinoma tissues was analyzed by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end labeling (TUNEL) method. The PCNA labeling index (PCNA-LI), density of dendritic cells in the tumor were detected by immunohistochemical method by the LSAB kit using antibody against S-100 protein and PC-10. RESULTS: DC infiltration was negatively correlated with lymph node metastasis, clinical stage and PCNA-LI, but positively with AI. The DCs in gastric cancer groups with and without lymph node metastasis were (5.63 +/- 4.37)/HPF and (8.51 +/- 5.57)/HPF with difference significant (P < 0.05). The DC infiltration in I, II, III stage lesions were (11.23 +/- 6.05)/HPF, (6.28 +/- 4.37)/HPF and (5.53 +/- 5.19)/HPF also with differences significant (P < 0.01). The PCNA-LI was significantly higher in the low DC group (57.10% +/- 14.18%) than that of high DC group (48.15% +/- 10.59%, P < 0.01). AI findings were 3.77% +/- 1.26% and 2.95% +/- 1.07% in the high and low DC groups (P < 0.01). A positive correlation was observed between DC infiltration and AI (r = 0.39, P < 0.01) whereas a negative correlation between DC infiltration and PCNA-LI (r = -0.47, P < 0.01). The prognosis of high DC infiltration patients was significantly better than those with low ones. CONCLUSION: The infiltrating dendritic cells in and around tumor, representing the local immune status of the host, may play an important role in immunological defense mechanism of host versus tumor. Dendritic cells may inhibit the proliferation and induce the apoptosis of the tumor cells, thus affecting the clinical features and improve the prognosis of gastric carcinoma.

Adult↗