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PubMed1989

[Diagnostic criteria and their relation to prognosis in acute pancreatitis].

Investigations were carried out in 1041 consecutive patients of acute pancreatitis, to correlate the prognosis with their symptoms and signs. It has been found that there were 15 symptoms and signs may be related to their prognosis; that is age over 60, high intake of fatty food immediately before attack, severe upper abdominal pain with vomiting, pulse rate over 100/min, pulse pressure below 2.6 kPa, peritoneal irritation, absence of peristaltic sounds, bloody ascites, serum electrolytes disorder, acidosis, more than 4000 ml of fluid were needed in first 24 h, serum calcium level below 1.9 mmol/L, blood glucose over 8.3 mmol/L, BUN over 7.0 mmol/L, and poor liver functions. If there are less than 4 positive signs, edematous pancreatitis may be present, 5 to 8 positive signs may be necrotizing pancreatitis with high risk of mortality and early operation is indicated, and more than 8 positive signs the prognosis will be very poor.

Acute Disease↗

PubMed1989

[Spinal cord evoked potential in experimental spinal cord injury: the changes of spinal cord evoked potential following impact injury, and the correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs].

The authors reported the changes of spinal-cord-evoked potential following impact injury by the weight dropping technique (Allen's method). The correlation between the change in amplitude of the spinal-cord-evoked potential after injury, and the prognosis for motor recovery of the legs was discussed. The spinal cord of adult dogs was traumatized by the weight dropping technique (Allen's method) at the level of Th10. The trauma consisted of a 300 gm-cm impact injury, a 400 gm-cm impact injury, and a 500 gm-cm impact injury. The spinal-cord-evoked potential following direct stimulation of the spinal cord was recorded from the epidural space for 5 hours. The recording electrode was located cephalad to the site of the impact injury. The stimulating electrode was located at the caudal site of the injured area. The motor function of the dogs was observed by clinical scale for rating hind limb motor function (modified Tarlov score) for one month after the trauma. The recovery of the spinal cord evoked potential following impact injury by the weight dropping technique could be estimated one hour after trauma in the 300 gm-cm injury, 30 minutes after trauma in the 400 gm-cm injury and immediately only after trauma in the 500 gm-cm injury. A greater reduction of amplitude of I potential was noted with the higher energy injury (p less than 0.05). There was no parallel correlation between the change in amplitude of the spinal cord evoked potential after injury and the prognosis for motor recovery of legs. However, the changes in amplitude corresponded moderately well to the prognosis of motor function.

Animals↗

PubMedDate not supplied

Course and prognosis of idiopathic ulcerative proctosigmoiditis in young patients.

The course and prognosis of idiopathic ulcerative proctosigmoiditis were studied in 85 young patients whose symptoms had begun before the age of 21 (mean age at onset, 16 years), and the results were compared with those in adults with proctosigmoiditis. Data regarding extension of disease, available in 66 patients, allowed us to identify two groups of patients. Presenting symptoms were the same in both groups. In Group I (41 patients, 62%), the disease remained stable or did not extend beyond the descending colon. In Group II (25 patients, 38%), there was evidence of extension to the hepatic flexure or beyond. Extension was unpredictable in individual patients, but generally occurred within 5 years from the onset of symptoms (73%). The clinical course and prognosis were different in each group. In Group I, there were more females, the disease ran a milder course, and there were few complications. In Group II, there were relatively more males, the disease was more active and severe, and a high incidence of intestinal and extraintestinal complications was observed. Fifteen patients, all from Group II, required colectomy. The natural history of proctosigmoiditis in young patients is somewhat different from that in adults, being characterized by a greater tendency to proximal extension (38% vs. 10%). However, when the disease remains confined to the rectosigmoid region (or does not spread beyond the splenic flexure), the course and prognosis are no different than in adults.

Administration, Oral↗

PubMed1986

[Treatment of epithelial ovarian carcinoma with cisplatin and adriamycin: analysis of factors influencing prognosis in advanced cases].

Thirty previously untreated patients with epithelial ovarian carcinoma were treated with cisplatin and adriamycin (PA). Of eight evaluable patients, six were responders (two CRs and four PRs). The three-year survival rates were 83% for stage I, 67% for stage II, 50% for stage III, and none for stage IV. Toxicities included moderate myelo-suppression, mild nephrotoxicity, alopecia, and severe vomiting in almost all patients. Patients with residual lesions smaller than 2 cm had excellent prognosis when PA was given for more than five courses. Patients with residual lesions larger than 2 cm, however, had poor prognosis irrespective of the number of courses. No specific relation between histological grade and prognosis could be found. From the present data, aggressive cytoreductive surgery followed by PA therapy repeated more than five times is recommended for achieving a good outcome in the treatment of epithelial ovarian carcinoma.

Adenocarcinoma, Mucinous↗

PubMed1988

[Importance of early cystectomy for the prognosis of cancer of bladder].

Between 1967 and 1985, 246 cystectomies were performed for the treatment of urothelial carcinoma of the bladder. Surgery-related mortality, initially 15%, was equal to 0% in 1985. Preoperative radiation therapy was not given. Despite strictly comparable T and N stages, prognosis was markedly better in patients who had undergone cystectomy as soon as the diagnosis of invasive cancer of the bladder was established than in patients who had undergone cystectomy after one or more recurrences of invasive carcinoma of the bladder and after transurethral resection. Twenty-six patients, undergoing cystectomy because of recurrence after curative radiation therapy, were the group with the worst 5--years survival--less than 10%. These results allow us to conclude that for the prognosis of carcinoma after total cystectomy, it is of the utmost importance to differentiate between an initially invasive tumor and a recurrence of an invasive carcinoma after transurethral resection. If performed immediately after infiltration has been demonstrated, cystectomy may greatly contribute to improving the long-term prognosis. As soon as the tumor extends to the lamina propria (pT1), one can no longer expect transurethral electroresection to suffice as reliable curative treatment of carcinoma of the bladder. As for the argument that the procedure is mutilating, one can counter with the increasing success in the last few years, of urinary derivation with continence, including bladder replacement or even total cystoprostatectomy, which does not result in impotence.

Carcinoma, Transitional Cell↗

PubMed1987

[Value of the EEG in the prognosis of post-anoxic coma following cardiocirculatory arrest].

The EEGs of 26 patients who remained at least 6 hours in coma after cardiovascular arrest were analyzed. The first EEG was recorded within few days after reanimation, classified in a 5-grade scale of increasingly severe impairment and compared with the final clinical outcome. On the basis of the present study and of a review of 408 EEG findings reported in similar investigations in the literature we conclude that the EEG can be useful in predicting the outcome of patients in postanoxic coma states: the EEG should be recorded at earliest 8-12 hours but within 2 days after reanimation, a barbiturate intoxication and hypothermia should be excluded. The classification of the recordings in a 5-grade scale has proven to be helpful and accurate in predicting the outcome: Grade I EEG findings imply a very good prognosis, a complete remission can be expected in most cases. Grade II and III findings have no definite prognosis: the EEG should be repeated one or two days later, a favorable outcome is to be expected only with rapid improvement of the tracing. Grade IV and Grade V findings have a very serious prognosis: complete recovery has been described episodically, most in the pediatric population and with findings of alpha-coma.

Adolescent↗

PubMed1987

[Has the prognosis of recent myocardial infarction changed?].

In this retrospective study changes in the prognosis of recent myocardial infarction were evaluated by comparing 731 patients hospitalized in the 1970-1974 period (group I) with 755 patients hospitalized in the 1984-1986 period (group II). The possible factors responsible for the changes observed were investigated. A 34 percent decrease in hospital mortality was recorded (19.2% in group I versus 12.6% in group II; P less than 0.001). The decrease was present irrespective of the patients' sexes and ages; it was more pronounced in patients under 65 (-42%) and in elderly women (-43%). Compared with group I patients, group II patients showed a significant decrease in cardiogenic shock (P less than 0.02), atrial fibrillation (P less than 0.05) and, chiefly, atrioventricular block (P less than 0.001). The improvement in prognosis cannot be ascribed to a change of population since both groups were matched in male to female ratio, age distribution and presence of the main risk factors. Three factors may have contributed to a better prognosis: (1) more rapid admission to hospital; the proportion of patients admitted within 6 hours of the initial symptoms rose from 37.5% in group I to 49.8% in group II (P less than 0.001); (2) modification of the conventional treatment, with a reduced prescription of digitalis and a less frequent recourse to temporary electrical pacing; (3) introduction of new treatments aimed at limiting the size of the necrotic area; these include thrombolytic agents which were administered in 19.2% of patients under 65 and may well have played the principal role in the improvement of outcome.

Adult↗

PubMed1988

The prognosis of renal vein thrombosis: a re-evaluation of 27 cases.

Twenty-seven patients with renal vein thrombosis were retrospectively studied to evaluate their long-term prognosis and relevant prognostic factors. Twenty-four patients presented with a nephrotic syndrome, and 15 had renal impairment (8 acute; 7 moderate). Ten patients had a previous history of proteinuria, and 14 of nephrotic syndrome. Renal biopsy performed in 20 patients, of whom 19 were nephrotic, showed membranous glomerulonephritis in 14, focal segmental glomerulosclerosis in three, minimal change glomerulonephritis in two, and periarteritis nodosa in one. Renal vein thrombosis was angiographically proven in all patients and was bilateral in 18, localised to the left renal vein in seven, and to the right in two. Thrombosis of the inferior vena cava was associated in seven patients. Ten patients were treated by anticoagulants alone, nine by surgical thrombectomy, seven by thrombolysis, and two did not receive any specific treatment. One patient underwent successively thrombectomy and then thrombolysis. Eleven patients died within the first 6 months, mainly from haemorrhagic complications (n = 5) or severe sepsis (n = 2). Survivors were followed up from 6 months to 19 years. Nephrotic syndrome improved or even disappeared in 12 patients, and renal function did not worsen throughout the follow-up in any patients. The main prognostic factors were initial renal function and type of nephropathy: patients with membranous glomerulonephritis had a significantly better renal function and a lower mortality rate than patients with other nephropathies. Initial renal insufficiency was significantly associated with a poor prognosis. There was no advantage, in terms of survival, kidney function and nephrotic syndrome, of either thrombectomy or thrombolysis over anticoagulants alone, despite two complete venous recanalisations after thrombolysis. Accordingly, patients with renal vein thrombosis from membranous glomerulonephritis should be treated by anticoagulants alone, since the long-term prognosis of this disease seems unaffected by intercurrent renal vein thrombosis. With respects to the risk-to-benefit ratio, thrombectomy should be avoided and thrombolysis considered only in patients with initial acute renal failure from acute renal vein thrombosis.

Adult↗

PubMed1988

[Clinical study of hypertensive subcortical hemorrhage: surgical indication and long-term, functional prognosis].

There has been no report available for determining surgical indications in hypertensive subcortical hemorrhage based on functional prognosis. The authors then studied the clinical results of hypertensive subcortical hemorrhage for evaluating the surgical indication in relation to functional prognosis. Sixty-five patients with hypertensive subcortical hemorrhage diagnosed by CT scan who were hospitalized to Matsue Red Cross Hospital from January 1980 up to December 1986 were studied. The 44 male and 21 female patients ranged in age from 37 to 86 years, and 38 of them were operated on. The results were as follows: 1) Patients with grade I (Kanaya's neurological grading) or a volume of hematoma less than 30 ml should be treated with conservative therapy. Those with grade II and III or a volume of hematoma = 30 - 50ml should be treated in accordance with proper therapeutic method, taking into consideration the site of the hematoma. Patients with more than grade IVa or a volume of hematoma greater than 50ml would be in danger of losing their lives unless surgical therapy was performed. 2) The follow up study of the patients' long-term prognosis after discharge revealed the majority of the patients showed aggravation of the illness and/or death due to cerebral apoplexy-like attack and re-bleeding. It is necessary to follow up these cases with careful systemic control, including monitoring of blood pressure.

Brain↗

PubMed1988

Prognosis in node negative breast cancer patients: the importance of tumour diameter and mean nuclear area.

In node negative breast cancer patients, tumour size and mean nuclear area (MNA) as single variables have significant impact on prognosis. Combination of the two variables gives additional information on survival, and makes it possible to predict the outcome of the disease correctly in 70% of the patients both early (82 months) and late (154 months). MNA contributes relatively more to prediction of late prognosis than tumour diameter and vice versa for early prognosis. Thus a long follow-up is needed for node negative patients, and more so for patients with favourable prognostic criteria.

Breast Neoplasms↗

PubMed1988

Long-term prognosis of malignant hypertension; difference between underlying diseases such as essential hypertension and chronic glomerulonephritis.

A long-term prognosis was studied in 69 patients with malignant hypertension, followed for an average of 56 months. Overall survival rate was 90% for a 5-year period, although the prognosis was different between two major underlying diseases, namely the 5-year survival was 79% for 33 essential hypertension (EHT) and 100% for 26 chronic glomerulonephritis (CGN); the difference is significant (p less than 0.01). In contrast, the 5-year rate for renal survival, defined as the probability of surviving without hemodialysis, was 37% in all cases. However, there was significant difference in the renal survival between EHT (60% for a 5-year period) and CGN (4% for a 18-month period). Multivariate analyses of the Cox's proportional hazards model revealed that the long-term change in renal function was different between the two groups, namely more rapid deterioration in the CGN group. These results indicate that a long-term prognosis of malignant hypertension is influenced by the underlying diseases and hemodialysis besides antihypertensive treatment may increase survival in malignant hypertension associated with severely damaged renal function.

Adult↗

PubMed1988

[Pathology and prognosis of 378 cases of primary intestinal malignant lymphoma (IML)].

Pathology and prognosis of 378 cases of IML collected from 28 colleges or hospitals, are reported. The ratio of male and female was 2:1. Ages ranged from 3 to 86 years with a peak age of 21-50. Main symptoms were abdominal pain, mass, intestinal obstruction, diarrhea and intestinal bleeding. The tumor occurred, in order of incidence, in small intestine (42%), ileocecal region (30%), colon (13%), cecum (8%), rectum (3%), duodenum (2%) and anorectum (1%). Multifoci were found in 43 cases (11%). Grossly, the tumor was divided into three types: exophytic, ulcerative and diffuse infiltrative. In histology, follicular type comprised 4% (16 cases) and diffuse type, 96% (362 cases). In the latter, the majority was cleaved, non-cleaved or mixed cell type originating from the follicular center cells. There were a few T cell lymphomas and true histiocytic types but no Hodgkin's lymphoma. Statistically, the prognosis was significantly related to the depth of invasion, gross type, tumor size and stage. By histology, lympho-plasmacytoid type and small lymphocytic type had better prognosis compared with the other diffuse types. In this series, 83 patients were treated by surgery (including operation plus chemotherapy). The survival rate of less than 1 year was 51%, nearly equal to the survival rate of more than 1 year (49%). 10 patients have survived more than 5 years and 6, more than 10 years, 2 of them, more than 18 years. It indicates that the operation plays an important role for prolonging survival. Early detection, early diagnosis and early operation are necessary.

Adolescent↗

PubMed1987

[Histology and prognosis of endometrial carcinoma].

The relationship between the histology and prognosis has been analyzed, using 608 surgically removed uterus with endometrial carcinoma. Among the uterus studied, 506 cases (92%) were determined as being an adenocarcinoma, endometrial type, including adenoacanthomas. This type of carcinoma showed a favourable postoperative survival rate (83.3%), when compared to serous adenocarcinomas (65.8%), clear cell (mesonephroid) adenocarcinomas (32.4%), and adenosquamous carcinomas (63.7%). Among adenocarcinomas of the endometrial type, these with a well differentiated variant showed a better prognosis than others. The squamous component of the adenoacanthoma was found to play no significant role in the prognosis.

Adenocarcinoma↗

PubMed1986

Renal cell carcinoma: I. Clinical indicators of prognosis.

A retrospective analysis was carried out on 162 patients presenting to Wellington Hospital with renal cell carcinoma between 1958 and 1978, to evaluate factors that may influence prognosis. Following radical nephrectomy the five year survival was 70% for stages 1 and 2, 53% for stage 3A and 13% for stages 3B and 3C. No patient with distant metastases survived this period. Those with renal vein or caval involvement had a significantly worse prognosis than those with stage 1 or 2 disease, and a significantly better survival than those with nodal spread. Once the tumour stage had been assigned as a baseline the influence of clinical, haematological and biochemical variables on the prognosis was analysed using a proportional hazard model. The only factor showing a significant independent association with survival was the presentation of the renal cancer as an incidental finding (p less than 0.01). The presence of anaemia or a low peripheral lymphocyte count may be independently associated with survival (p = 0.02, 0.08 respectively). Weight loss, symptoms length, the ESR, abnormality of liver function and tumour size, although associated when considered alone, do not have an independent association and therefore offer little added prognostic information. The age and sex of the patient were not related to survival.

Adolescent↗

PubMed1986

Clinical and biologic features predict poor prognosis in acute lymphoid leukemias in children and adolescents: a Pediatric Oncology Group review.

Although the prognosis of children with ALL has improved markedly, approximately one-half of children continue to relapse. Clinical and biologic features of ALL have been studied at the time of diagnosis and many of these features have been shown to predict the risk of relapse, permitting tailoring of therapy based on relapse hazard. Results of studies of the Pediatric Oncology Group (POG) detailed here demonstrate that high white blood cell (WBC) count at diagnosis, very young or older age within childhood, and the presence of a mediastinal mass or central nervous system leukemia predict a poor prognosis within the context of certain therapies. However, not only age and WBC count, but immunophenotype of ALL as well, were especially predictive of prognosis in these POG studies. The information reviewed here has special importance for the planning of clinical trials for children with ALL.

Adolescent↗

PubMed1987

Long-term prognosis and prognostic indices of IgA nephropathy in juvenile and in adult Japanese.

For a comparative study of IgA nephropathy occurring in Japanese adolescents and adults, the clinical and histological findings and prognosis (follow-up period; 12 +/- 6 years for children and 10 +/- 5 years for adults) were compared. The subjects studied included 98 children and 86 adults. Development into renal failure occurred in 9 children (9.2%) and in 20 adults (23.3%), (p less than 0.01). The actuarial renal survival rate at year 10 after the onset of glomerulonephritis in children and adults was 95% and 80%, respectively, and at year 20, 82% and 50%, respectively. The prognosis was definitely better in the children and this was attributable to the observation that (1) the glomerular injury at the initial biopsy in children was less extensive than in adults; (2) the frequency of complication with hypertension was lower in children (27.6%) than in adults (41.9%), (p less than 0.05); (3) hypertension was one prognostic indice, even in children, after age 30; (4) after age 40, aging and arteriosclerosis were more contributory than hypertension to the progress of IgA nephropathy; and (5) the quantity of intraglomerular immune deposits and the period of deposition were not related of prognostic indices. Thus, in the long-term prognosis of IgA nephropathy in both children and adults, immunological disorders seem to have little influence while factors such as hypertension, arteriosclerosis and aging play important roles.

Adolescent↗

PubMed1987

[Prognosis in the social and occupational adaptation of patients with slowly progressive schizophrenia].

A series of 190 patients with slowly progressive schizophrenia have been examined with the aim of studying the prognosis of their social and occupational adaptation. The authors have analyzed the dynamics of the mental status and adaptation over years. Criteria of the prognosis of social and occupational adaptation have been identified. The adaptive behaviour and prognosis in patients with slowly progressive schizophrenia have been found to depend on the type of the personality abnormality in the premorbid period, age at the disease onset, its pattern, and clinical characteristics of the active period of the disease.

Adaptation, Psychological↗

PubMed1986

Association between prognosis and hormone receptors in women with breast cancer.

Axillary node involvement, hormone receptors, tumor differentiation, and obesity have been linked to breast cancer prognosis. We have evaluated which of these factors have an independent association with disease-free survival using the Cox Proportional Hazards model. The study was carried out in 377 patients with breast cancer who underwent mastectomy and axillary node dissection between 1977 and 1984. In the univariate analysis all of the above factors were associated with differences in disease-free survival, and all entered the stepwise model. Among women with negative nodes and those with one to three positive nodes, tumor differentiation was a significant indicator of prognosis, while hormone receptors did not have prognostic significance. The opposite was noted in women with four or more involved nodes, among whom negative hormone receptors was the only significant marker of poor prognosis together with presence of obesity. Among young women node involvement and hormone receptors were significant prognostic indicators, while among older women all four variables were independent prognostic markers. These results indicate a marked heterogeneity among subgroups of women with breast cancer in relation to prognostic markers.

Adult↗