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PubMed2006

Prognostic factors and survival in patients with hereditary hemochromatosis and cirrhosis.

OBJECTIVES: The survival of treated, noncirrhotic patients with hereditary hemochromatosis is similar to that of the general population. Less is known about the outcome of cirrhotic hereditary hemochromatosis patients. The present study evaluated the survival of patients with hereditary hemochromatosis and cirrhosis. METHODS: From an established hereditary hemochromatosis database, all cirrhotic patients diagnosed from January 1972 to August 2004 were identified. Factors associated with survival were determined using univariate and multivariate regression. Survival differences were assessed using the Kaplan-Meier life table method. RESULTS: Ninety-five patients were identified. Sixty patients had genetic testing, 52 patients (87%) were C282Y homozygotes. Median follow-up was 9.2 years (range 0 to 30 years). Nineteen patients (20%) developed hepatocellular carcinoma, one of whom was still living following transplantation. Cumulative survival for all patients was 88% at one year, 69% at five years and 56% at 20 years. Factors associated with death on multivariate analysis included advanced Child-Pugh score and hepatocellular carcinoma. Patients with hepatocellular carcinoma were older at the time of diagnosis of cirrhosis (mean age 61 and 54.6 years, respectively; P=0.03). The mean age at the time of diagnosis of hepatocellular carcinoma was 70 years (range 48 to 79 years). No other differences were found between the groups. CONCLUSIONS: Patients with hereditary hemochromatosis and cirrhosis are at significant risk of developing hepatocellular carcinoma. These patients are older when diagnosed with carcinoma and may have poorer survival following transplantation than patients with other causes of liver disease. Early diagnosis and treatment of hereditary hemochromatosis by preventing the development of cirrhosis may reduce the incidence of hepatocellular carcinoma in the future.

Adult↗

PubMed2000

[Incidence of reopening and variables that influence reopening after macular hole surgery].

PURPOSE: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery. METHODS: Our study included 467 eyes in which maculor holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression. RESULTS: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, p = 0.19), biocular occurrence (r = 0.12, p = 0.026), and refraction axial length ratio (r = -0.11, p = 0.045); scalping methods: hole size (r = 0.14, p = 0.25). CONCLUSIONS: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.

Adult↗

PubMed2001

Incidence of Reopening and Variables That Influence Reopening After Macular Hole Surgery.

Purpose: To evaluate the incidence and variables of reopening of macular holes after macular hole surgery.Methods: Our study included 467 eyes in which macular holes were successfully closed after surgery. Surgical techniques consisted of conventional methods (358 eyes) and scalping methods (109 eyes) with retinal pigment scalping of the macular hole basis added in such cases: reoperation, hole size (more than 0.4 disc diameter), duration of symptoms (more than 2 years). Long term incidence of reopening was predicted by life table method. After we compared reopened cases with non-reopened cases, the variables of gender, stage, biocular occurrence, age, duration of symptoms, hole size, preoperative visual acuity, refraction axial length ratio, and intraoperative retinal tears were used for the multiple regression.Results: Reopening was found in 20 eyes (5.6%) treated by conventional methods and in 10 eyes (9.2%) treated by scalping methods. Survival ratio was 87% for the conventional methods in 6 years and 79% for the scalping methods in 5 years. The variables influencing reopening were as follows: conventional methods: gender (r = 0.065, P =.19), biocular occurrence (r = 0.12, P =.026), and refraction axial length ratio (r = -0.11, P =.045); scalping methods: hole size (r = 0.14, P =.25).Conclusions: Incidence of reopening in scalping methods was high. The variables that influenced reopening after macular hole surgery were biocular occurrence and refraction axial length ratio in conventional methods. The shape of the eye may be related to reopening.

Journal Article↗

PubMed1987

[Radiation tolerance dose of the spinal cord following conventionally fractionated irradiation].

409 patients whose spinal cord were irradiated over 30 Gy with conventionally fractionated method were surveyed to study the relation between the dose of spinal cord and the incidence of radiation myelitis. Radiation myelitis was observed in 26 cases including 3 transverse myelitis ones. 5 year incidences of transverse myelitis calculated with life table method were approximately 0% at 40 Gy, 5% at 50 Gy, 10% at 60 Gy and 20% at 70 Gy. The radiation tolerance dose of the spinal cord was considered to be 50 Gy.

Adult↗

PubMed1993

An evaluation of risk factors in incisional hernia recurrence.

In the present study, generally accepted risk factors for developing a primary incisional hernia are reviewed for their influence on the development of recurrent incisional hernia. The records of 417 patients undergoing an incisional hernia repair between 1980 and 1989 at the University Hospital Rotterdam were reviewed retrospectively, and in the event no hernia recurrence was documented, patients were asked to visit the outpatient department for physical examination. Patients having a primary incisional hernia (n = 302) were selected and patient related factors of gender, age, obesity, chronic cough, prostatism, constipation, diabetes mellitus and the use of corticosteroids were analyzed. In addition, operation related factors, including the technique of operation (mainly, one layer interrupted and one layer continuous closures), use of drains, use of antibiotics, wound contamination (fecal or purulent spill), duration of operation, technique of anesthesia, wound complications, mortality and period of hospitalization, were analyzed. Hernia related factors--the hernia-free interval, original operation, type of incision and the size of the hernias--were also analyzed. Statistical analysis of the data was performed using the chi-square test to compare percentages between groups. Cumulative percentages of patients having a recurrence along time were calculated using life-table methods. Of the group of primary incisional hernias, four patients lacked follow-up evaluation and were excluded, leaving 298 patients for study. With a mean follow-up period of 34.9 months, the recurrence rate was 36 percent; 45 percent had recurrence in the first year, 64 percent in the second year and 78 percent of all recurrences occurred within three years. Therefore, a follow-up evaluation of at least three years is recommended. The cumulative (life-table) recurrence rate after five years was 41 percent. After second, third and fourth incisional hernial repair, recurrence rates were higher (56, 48 and 47 percent, respectively). Except for the size of the hernia, none of the studied parameters led to a significantly higher recurrence rate. Obesity, diabetes mellitus, lower midline incision and wound infection did have higher recurrence rates, but these were not significant. Incisional hernias, smaller than 4 centimeters, had a significantly (p = 0.01) lower recurrence rate (25 percent) than larger hernias (41 percent). Considering these facts, a better technique is badly needed. In large defects, the use of inlay of prosthetic material consistently has the lowest recurrence rates. The question remains whether or not prosthetic material is also needed for repair of smaller hernias.

Adult↗

PubMed2002

Distal revascularization-interval ligation: a durable and effective treatment for ischemic steal syndrome after hemodialysis access.

PURPOSE: The treatment of hemodialysis access-induced ischemic steal syndrome is challenging. Despite promising early results with the distal revascularization-interval ligation (DRIL) procedure, the operation has not been widely adopted because of concerns about its complexity and long-term efficacy. The purpose of this report was to determine the efficacy and durability of the DRIL procedure in relieving hand ischemia and in maintaining access patency in the setting of hemodialysis access-induced ischemia. METHODS: A retrospective review was performed of all patients who underwent the DRIL procedure for access-induced ischemia. Demographic information was compiled, as were data regarding access and bypass patency, limb salvage, and patient survival. Arteriovenous access and brachial artery bypass patency rates were determined with life-table methods. RESULTS: Between 1995 and 2001, we performed 55 DRIL procedures in 52 patients (35 women and 17 men; mean age, 60.8 years; range, 30 to 86 years). The indications for surgery were ischemic pain in 27 patients, tissue loss in 20 patients, loss of neurologic function in four patients, and pain on hemodialysis in one patient. Most patients (92%) had diabetes. The mean interval from access placement to DRIL was 7.4 months (range, 1 to 84 months). The mean follow-up interval was 16 months (range, 1 to 67 months). The brachial artery bypass primary patency rate was 80% at 4 years, and the arteriovenous access primary patency rate was 83% at 1 year. Forty-seven of 52 patients (90%) had substantial or complete relief of ischemic hand symptoms, and 15 of 20 patients with digital ischemic lesions have healed completely. CONCLUSION: DRIL is a durable and effective procedure that reliably accomplishes the twin goals in the treatment of angioaccess-induced ischemia: persistent relief of hand ischemia and continued access patency.

Adult↗

PubMed2001

Cost effectiveness of ramipril treatment for cardiovascular risk reduction.

OBJECTIVE: To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death. DESIGN: Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively). SETTING: UK population using 1998 government actuary department data. MAIN OUTCOME MEASURE: Cost per life year gained at five years and lifetime treatment with ramipril. RESULTS: Cost effectiveness was pound36 600, pound13 600, and pound4000 per life year gained at five years and pound5300, pound1900, and pound100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis ( pound25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional pound360 million but would prevent 12 000 deaths per annum. CONCLUSIONS: Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by pound360 million.

Adult↗

PubMed1999

Improved results with conventional management of infrarenal aortic infection.

PURPOSE: Interest in alternative methods, such as autogenous vein grafts and aortic allografts, for the management of infrarenal aortic infection (IRAI) has been stimulated by the historically disappointing results with conventional surgical management. Recently, there have been dramatic improvements in the results of axillofemoral bypass grafting (AXFB) followed by excision of the IRAI that have gone relatively unrecognized. The purpose of this report is the presentation of modern-day results in the treatment of IRAI with conventional surgical methods. METHODS: From January 1, 1983, through June 30, 1998, patients with IRAI underwent treatment with AXFB and complete excision of the IRAI. The patients were followed for survival, limb salvage, and AXFB graft patency. The results were tabulated with life-table methods. RESULTS: During the 15-year study period, 60 patients (51 men, nine women; mean age, 68 years) underwent treatment for IRAI (50 graft infections, including 16 graft-enteric fistulae, and 10 primary aortic infections). The mean follow-up period was 41 months. The perioperative mortality rate was 13% (12% for graft infection, and 20% for primary infection). The overall 2-year and 5-year survival rates were 67% and 47%, respectively. The limb salvage rates at 2 and 5 years were 93% and 82%, respectively. The 5-year primary AXFB graft patency rate was 73%. CONCLUSION: These results show an improvement with the conventional management of IRAI equal or superior to those results reported with alternative methods, including femoral vein grafts or aortic allografts. These results should be regarded as the modern standard with which alternative therapies can be compared.

Aged↗

PubMed1992

Effect of the short follicular phase on subsequent conception.

The present study was designed to evaluate whether there is a lower pregnancy rate in women with short follicular phases, as defined by attaining the peak estradiol level before day 11 of the cycle. Thirty-two early ovulators with mature follicles were matched with 32 women being treated for similar infertility problems, who ovulated between days 12-20. Pregnancies were achieved by 9 (28.1%) of the early ovulators compared to 19 (59.4%) of the controls. The mean number of cycles required to achieve a pregnancy was 8.6 in the early ovulators compared to 6.4 in the controls. Using the clinical life table method, the 12-month pregnancy rate was estimated to be 31.4% for early ovulators as compared to 66.3% for controls. Whether lengthening the follicular phase by drug treatment will improve pregnancy rates remains to be seen.

Adult↗

PubMed2002

Comparative survival of dialysis patients in the United States after coronary angioplasty, coronary artery stenting, and coronary artery bypass surgery and impact of diabetes.

BACKGROUND: The optimal method of coronary revascularization in dialysis patients is controversial. The purpose of this study was to compare the long-term survival of dialysis patients in the United States after PTCA, coronary stenting, or CABG. METHODS AND RESULTS: Dialysis patients hospitalized from 1995 to 1998 for first coronary revascularization procedures after renal replacement therapy initiation were identified from the US Renal Data System database. All-cause and cardiac survival was estimated by the life-table method and compared by the log-rank test. The impact of independent predictors on survival was examined in a Cox regression model. The in-hospital mortality was 8.6% for 6668 CABG patients, 6.4% for 4836 PTCA patients, and 4.1% for 4280 stent patients. The 2-year all-cause survival (mean+/-SEM) was 56.4+/-1.4% for CABG patients, 48.2+/-1.5% for PTCA patients, and 48.4+/-2.0% for stent patients (P<0.0001). After comorbidity adjustment, the relative risk (RR) for CABG (versus PTCA) patients was 0.80 (95% CI 0.76 to 0.84, P<0.0001) for all-cause death and 0.72 (95% CI 0.67 to 0.77, P<0.0001) for cardiac death. For stent (versus PTCA) patients, the RR was 0.94 (95% CI 0.88 to 0.99, P=0.03) for all-cause death and 0.92 (95% CI 0.85 to 0.99, P=0.04) for cardiac death. In diabetic (versus PTCA) patients, the RR for CABG surgery was 0.81 (95% CI 0.75 to 0.88, P<0.0001) for all-cause death and 0.71 (95% CI 0.64 to 0.78, P<0.0001) for cardiac death, and the RR for the stent procedure was 0.99 (95% CI 0.91 to 1.08, P=NS) for all-cause death and 0.99 (95% CI 0.89 to 1.11, P=NS) for cardiac death. CONCLUSIONS: In this retrospective study, dialysis patients in the United States had better long-term survival after CABG surgery than after percutaneous coronary intervention. Stent outcomes were relatively worse in diabetic patients. Our data support the need for large clinical registries and prospective trials of surgical and percutaneous coronary revascularization procedures in dialysis patients.

Adult↗

PubMed2002

Survival analysis of human meniscal transplantations.

We describe a prospective survival analysis of 63 consecutive meniscal allografts transplanted into 57 patients. The lateral meniscus was transplanted in 34, the medial meniscus in 17, and both menisci (combined) in the same knee in six. For survival analysis we used persistent pain or mechanical damage as clinical criteria of failure. A total of 13 allografts failed (5 lateral, 7 medial, 1 medial and lateral). A significant negative correlation (p = 0.003) was found between rupture of the anterior cruciate ligament (ACL) and successful meniscal transplantation. A significant difference (p = 0.004) in the clinical results was found between lateral and medial meniscal transplants. The cumulative survival rate of the lateral, medial and combined allografts in the same knee, based on the life-table method and the Kaplan-Meier calculation, was 76%, 50% and 67%, respectively. The survival of medial meniscal allografts may improve when reconstruction of the ACL is carried out at the same time as meniscal transplantation in an ACL-deficient knee.

Adult↗

PubMed1992

Remission rate after thymectomy in myasthenia gravis when the bias of immunosuppressive therapy is eliminated.

The clinical course of all 86 myasthenia gravis (MG) patients who were thymectomized at Sahlgrenska Hospital between 1955 and 1980 was evaluated in order to estimate what the rate of complete clinical remission (with or without anticholinesterase medication) would be without immunosuppressive (IS) therapy; 19 of 73 patients without thymoma received IS therapy. A suitable way of dissociating the course after thymectomy from the influence of IS therapy is the Markov method. The calculated probability of remission was 0.18, 0.35, 0.43, 0.53 and 0.56 in the 0-1, 2-3, 4-5, 5-10 and more than 10-year periods after thymectomy. A similar result (53 +/- 7%) was obtained by a life-table method with censoring of IS-treated patients when they received such therapy. Time to remission was significantly shorter for patients with age of MG onset before 35 years. Timing of IS therapy after thymectomy is discussed, considering the post-thymectomy remission rate.

Adult↗

PubMed1996

Prognosis for total control of complex partial and secondarily generalized tonic clonic seizures. Department of Veterans Affairs Epilepsy Cooperative Studies No. 118 and No. 264 Group.

BACKGROUND: Two prospective observations of adults with symptomatic, localization-related (partial) epilepsy included 1,102 patients in VA multicenter studies (VA-118 and VA-264). Analyses assessed the likelihood of remaining seizure free for 12 and 24 months after initiating adequate antiepileptic drug therapy. METHODS: Patients were grouped as having only secondarily generalized tonic-clonic seizures (GTC), only complex partial seizures (CPS), or both types (MIXED) at entry. The cumulative proportion of patients remaining seizure free with standard antiepileptic drug therapy was determined by actuarial life table methods. RESULTS: At 12 months, 70% and 61% of GTC patients (VA-118 and VA-264, respectively) had no further GTC; 53% and 50% of MIXED, predominantly GTC patients had no further GTC, 21% and 28% of CPS patients had no further CPS and 98% and 91% were seizure free for GTC; 32% and 35% of MIXED, predominantly CPS patients had no further CPS, and 62% and 51% of patients with MIXED seizure types remained seizure free for CPS for 12 months after enrollment. CONCLUSIONS: The overall prognosis for control of seizures of any type for 12 months was best for those who had only GTC at entry (55% and 48%), worst for those who had only CPS at entry (23% and 26%), and intermediate for those with MIXED seizures at entry (32% and 25%) (all p < 0.0001). Prognosis can be based on the predominant seizure type in patients with multiple types.

Adult↗

PubMed2003

[Multivariate analysis of prognosis of patients with clinical stage I and II carcinoma of mobile tongue].

BACKGROUND & OBJECTIVE: There are many factors affecting the prognosis of the patients with clinical stage I and II carcinoma of mobile tongue. This study was designed to analyze the most important factors affecting the prognosis. METHODS: The data of long period follow-up were analyzed retrospectively for 147 patients with clinical stage I and II squamous cell carcinoma of mobile tongue to evaluate the contribution of every factors influencing on survival. Survival analysis was performed by life table method; comparison among/between groups was performed using log-rank test; multivariate analysis was carried out using Cox proportional hazard model and Logistic regression model. RESULTS: Univariate analysis showed that pathological grade (G2 and G3), status of cervical lymph node, pathological stage (stage III and IV), history of alcohol consumption, primary location recurrence, regional recurrence, primary location and regional recurrence, and cancer recurrence were risk factors of the prognosis of the patients (P< 0.05). Multivariate analysis showed that locoregional recurrence (P=0.000) and pathological stage (P=0.045) could predict the prognosis. The result of Logistic regression model indicated that status of cervical lymph node (P=0.003) and history of alcohol consumption (P=0.012) were closely associated with locoregional recurrence. CONCLUSION: Locoregional recurrence and pathological stage(stage III and IV) are the most important factors affecting the prognosis of the patients with clinical stage I and II squamous cell carcinoma of mobile tongue. The risk factors affecting locoregional recurrence of the patients are positive cervical lymph node and history of alcohol consumption.

Adult↗

PubMedDate not supplied

The longevity of space maintainers: a retrospective study.

METHODS: This retrospective study investigated the longevity of 301 space maintainers fitted in 141 patients aged 3.4-22.1 years in the Department of Pediatric Dentistry at Leeds Dental Institute between 1991 and 1995. RESULTS: Failure occurred in 190 space maintainers (63%), of which 36% were due to cement loss, 24% breakage, 10% design problems, and 9% were lost. Using the life table method, the median survival time (MST) for space maintainers was found to be 7 months. Band and loop (B&L) appliances had the highest MST of 13 months, while the lower lingual holding arch (LLHA) had the lowest of 4 months. Unilateral space maintainers survived longer than bilateral space maintainers (MST of 13 months vs. 5 months). Left B&Ls had a MST of 16 months, compared to only 4 months for right B&Ls, Gender, age, arch in which the appliance was placed, the operator planning it, fixed vs. removable, and adequacy of pretreatment assessment did not have a significant effect on survival time.

Adolescent↗

PubMed1997

A prospective, randomized, cross-over comparison of two methods of artificial insemination by donor on the incidence of conception: intracervical insemination by straw versus cervical cap.

In a prospective, randomized study of insemination with donor semen, intracervical insemination by straw was compared with insemination using a cervical cap with an intracervical reservoir. A total of 91 patients completed 486 treatment cycles. There were no significant differences in age, parity, indication for insemination by donor, or method of cycle monitoring between women who became pregnant and those who did not conceive with either insemination method. In 236 standard intracervical insemination cycles, 14 patients became pregnant (5.9% per cycle), whereas 38 patients conceived in 250 cervical cap cycles (15.2% per cycle). Both the crude pregnancy rates and the cumulative pregnancy rates calculated by the Kaplan-Meier life-table method were significantly different (chi(2)-test, P < 0.001, and log-rank test, P < 0.005 respectively). Pregnancy rates in artificial insemination with cryopreserved donor semen may be improved by the use of a cervical cap when compared to cervical insemination by straw. The use of the cervical cap may prolong the exposure of the spermatozoa to the cervical mucus and prevent the backflow of semen into the vagina.

Body Temperature↗

PubMed1983

Mortality of Reserve Mining Company employees in relation to taconite dust exposure.

Analysis of mortality among men who were employed by Reserve Mining Company from 1952 to 1976 has been carried out. Follow-up was conducted with standard methods, including searches by the Social Security Administration. Occupational exposures to dust were based on personal samples taken over the past five years by the industrial hygiene department of the company. Smoking habits were obtained by mailed questionnaires or telephone interviews. A modified life table method was used to compare death rates of the employees with those expected for white males in the state of Minnesota. Comparisons were also made with US rates for white males. The results showed that the death rates for all causes were significantly below expectation. Deaths from malignant diseases were marginally below those expected for the state. Exposures to total dust, to silica dust, or to fiber were low. There was no relationship between mortality and estimated lifetime dust exposures, nor was there any suggestion that deaths from malignant neoplasms were increased after 15 to 20 years latency. In contrast, there was a strong relationship between smoking habits and mortality from all causes, from cardiovascular diseases, and from cancer. This study does not suggest any increase in cancer mortality from taconite exposure.

Adult↗

PubMed2006

Changes in formal sex education: 1995-2002.

CONTEXT: Although comprehensive sex education is broadly supported by health professionals, funding for abstinence-only education has increased. METHODS: Using data from the 1995 National Survey of Adolescent Males, the 1995 National Survey of Family Growth (NSFG) and the 2002 NSFG, changes in male and female adolescents' reports of the sex education they have received from formal sources were examined. Life-table methods were used to measure the timing of instruction, and t tests were used for changes over time. RESULTS: From 1995 to 2002, reports of formal instruction about birth control methods declined among both genders (males, from 81% to 66%; females, from 87% to 70%). This, combined with increases in reports of abstinence education among males (from 74% to 83%), resulted in a lower proportion of teenagers' overall receiving formal instruction about both abstinence and birth control methods (males, 65% to 59%; females, 84% to 65%), and a higher proportion of teenagers' receiving instruction only about abstinence (males, 9% to 24%; females, 8% to 21%). Teenagers in 2002 had received abstinence education about two years earlier (median age, 11.4 for males, 11.8 for females) than they had received birth control instruction (median age, 13.5 for both males and females). Among sexually experienced adolescents, 62% of females and 54% of males had received instruction about birth control methods prior to first sex. CONCLUSIONS: A substantial retreat from formal instruction about birth control methods has left increasing proportions of adolescents receiving only abstinence education. Efforts are needed to expand teenagers' access to medically accurate and comprehensive reproductive health information.

Adolescent↗