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Results for “Life Table Method”

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PubMed1995

Muscularis mucosa differentiates two populations with different prognosis in stage T1 bladder cancer.

OBJECTIVES: Contrary to previous belief, the existence of a muscularis mucosa in the human urinary bladder has now been well described. Although the degree of development of this structure seems variable, it can frequently be used to differentiate two levels within the subepithelial connective tissue: the lamina propria and the submucosa. The present study evaluates whether this morphologic feature is potentially useful for the identification of two populations with Stage T1 bladder cancer: those with tumor invasion confined to the lamina propria (pT1A) and those with tumors infiltrating into the submucosa (pT1B). METHODS: A series of 170 Stage T1 papillary bladder tumors was analyzed pathologically to identify the level of subepithelial connective tissue invasion. Both the reproducibility of such a differentiation and its prognostic implication were evaluated using Kaplan-Meier survival estimates and the Cox regression model. RESULTS: In specimens from transurethral resection, categorization into T1A or T1B could be performed in 98 of 170 cases (58% of specimens). Such differentiation proved to be of prognostic value with significantly different 5-year survivals between the two subcategories (pT1A [n = 50] vs pT1B [n = 49]) (log-rank, P < 0.02). Cox's regression analysis of pT1 subcategory and grade was performed in the 99 cases in which the differentiation between pT1A/pT1B could be made. This demonstrated that the depth of subepithelial connective tissue invasion was an independent prognostic factor (P < 0.05). CONCLUSIONS: The depth of tumor infiltration can be assessed in a considerable proportion of Stage T1 bladder neoplasms. The present study validates the prognostic significance of such a distinction both by Mantel-Haenszel life table method and Cox's regression analysis.

Actuarial Analysis↗

PubMed1998

Improved visual function in IDDM patients with unchanged cumulative incidence of sight-threatening diabetic retinopathy.

OBJECTIVE: To evaluate trends in visual acuity and the cumulative incidence of diabetic retinopathy in a clinic-based observational follow-up study. RESEARCH DESIGN AND METHODS: All patients visiting Hvidore Hospital in 1984 whose diagnosis of IDDM had been made before 41 years of age and between 1965 and 1979 (n = 356) were followed until 1994 or until their deaths. All patients were Caucasians and resided in Copenhagen. Patients were divided into three prevalence cohorts based on time of diabetes onset: group A, 1965-1969 (n = 113); group B, 1970-1974 (n = 130); and group C, 1975-1979 (n = 113). RESULTS: Fifteen years after diabetes onset, the visual acuity was significantly improved in patients with increasing calendar year of the disease onset. The median (interquartile range) visual acuity was 1.0 (0.8-1.0), 1.0(0.9-1.0), and 1.0 (1.0-1.0) in groups A, B, and C, respectively (P < 0.01 overall; P = 0.28 for group A vs. group B; and P < 0.01 for group A vs. group C) with 60, 66, and 93 having a visual acuity of 1.0 in groups A, B, and C, respectively. The cumulative incidence (+/-SEM), expressed as a percentage and calculated according to the life-table method, of proliferative retinopathy, maculopathy, and laser-treated retinopathy 15 years after onset of diabetes were, respectively, 13+/-3, 11+/-3, and 12+/-3 in group A; 16+/-3, 12+/-3, and 21+/-4 in group B; 11+/-3, 5+/-2, and 12+/-3 in group C, respectively (NS). The development of proliferative retinopathy was associated with the degree of retinopathy and albuminuria at baseline and the mean HbA1c during follow-up. CONCLUSIONS: The study revealed an improvement in visual acuity with increasing calendar year of diabetes onset but an unchanged cumulative incidence of diabetic retinopathy.

Adult↗

PubMed1991

Transscleral Nd: YAG laser cyclophotocoagulation versus cyclocryotherapy.

The post-operative course of intraocular pressure (IOP) after transscleral Nd: YAG laser cyclophotocoagulation (TSYLC) in refractory glaucoma was studied using the life-table method and retrospectively compared with that of cyclocryotherapy. In all, 36 eyes of 36 patients who underwent TSYLC for the first time and 80 eyes of 75 patients who underwent cyclocryotherapy for the first time were included in the present study. The follow-up averaged 9.2 months (range, 1-21 months) in patients receiving cyclocryotherapy. In patients with a preoperative visual acuity of greater than or equal to 0.01, the successful control of IOP was represented by a value of less than 21 mmHg that was obtained without additional medication, and that in patients who had a visual acuity of less than 0.01 was represented by a decrease in IOP of at least 25%, also obtained without additional medication. The success rate of the TSYLC-treated group at 21 months after treatment was 45.2% +/- 11.7%, whereas that of the group receiving cyclocryotherapy was 38.9% +/- 6.1%. The difference between these success rates was not statistically significant (P greater than 0.05). Complications such as phthisis bulbi, hypotony, hemorrhage in the anterior chamber or swelling of the eyelids were less frequent in the TSYLC-treated group than in the group given cyclocryotherapy. TSYLC is thought to be as effective as cyclocryotherapy in lowering IOP, but with fewer complications.

Adolescent↗

PubMed2003

Myasthenia gravis (MG): epidemiological data and prognostic factors.

Data from 756 myasthenic patients were analyzed for diagnostic criteria, clinical aspects, and therapeutic approaches. The patients were followed up at our institution from 1981 to 2001. Clinical evaluation was performed according to the myasthenia gravis score adopted at our clinic. Clinical features of each patient (comprising demographic, clinical, neurophysiological, immunological, radiological, and surgical data, as well as serial myasthenia gravis scores) were filed in a relational database containing more than 7000 records. Clinical efficacy and variables influencing outcome were assessed by life-table methods and Cox proportional hazards regression analysis. Complete stable remission, as defined by the Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America, was the end point for good prognosis. Four hundred and ninety-nine patients (66%) were female and 257 (34%) were male. Mean follow-up was 55.1 +/- 48.1 months. Onset of symptoms peaked in the third decade in females, whereas the male distribution was bimodal with peaks in the third and sixth decades. Modality of myasthenia gravis presentation was as follows: ocular, 39.3%; generalized, 28.5%; bulbar, 31.3%; and respiratory, 0.8%. Thymectomy was carried out on 63.7% of our patients by different approaches: (1) transcervical; (2) transsternal; (3) video-thoracoscopic mini-invasive surgery. The last approach has been preferentially used in more recent years and accounted for 62.4% of the thymectomized myasthenia gravis population. Univariate analysis and Kaplan-Meier analysis showed that variables such as sex (female), age at onset (below 40 years), thymectomy, and histological diagnosis of thymic hyperplasia were significantly associated with complete stable remission, whereas on multivariate analysis only age at onset below 40 years and thymectomy were confirmed.

Age Factors↗

PubMed2003

Costs of glandular trichomes in Datura wrightii: a three-year study.

Models accounting for genetic variation for resistance to herbivores within plant populations often postulate a balance between the costs of that resistance and its benefits. The production of glandular trichomes by Datura wrightii was shown to be costly in a previous one-year study because plants producing glandular trichomes (sticky plants), a factor conferring resistance to some insect herbivores, also produced 45% fewer seeds than plants producing nonglandular trichomes (velvety plants) when grown in a common garden. Because sticky plants tended to be larger than velvety plants but produced fewer seed capsules, we postulated an allocation trade-off in which velvety plants are more reproduction-dominated whereas sticky plants are more growth-dominated. If a greater commitment to vegetative growth eventually allows sticky plants to compensate for reduced seed production, we would expect a reduction or elimination of the cost of resistance over time in this perennial plant. We monitored growth, survival, and seed production of plants from defined crosses of local populations for three years in a common garden when exposed to and protected from herbivores, and with and without supplemental water. The majority of plants exposed to herbivores had died by the end of the study. We used standard life-table methods to determine the net reproductive rate (R0) and the finite rate of increase (lambda) of plants of each trichome type. After three years, when plants were protected from herbivores, sticky plants were 187-245% larger than velvety plants, depending upon irrigation treatment, but sticky plants continued to be less efficient in producing seeds per unit of canopy volume. Even though the total seed production of sticky plants eventually equaled that of velvety plants, the advantage of earlier reproduction by velvety plants increased lambda by 55-230% over that of sticky plants, depending upon herbivore and irrigation treatment. Exposure to herbivores reduced lambda by 69-83%, depending upon plant type and irrigation treatment, whereas supplemental irrigation increased lambda by 29-175%, depending upon plant type and exposure to herbivores. Although there was a large allocation trade-off between growth and reproduction, the benefits of such a trade-off did not emerge before most plants were killed by herbivores. The cost of producing glandular trichomes strictly for herbivore resistance continued to exceed its benefits, and in the absence of other, unmeasured benefits from the suite of life-history characters associated with glandular trichome production, natural selection is expected to eliminate this costly resistance trait from D. wrightii populations.

Datura↗

PubMedDate not supplied

Prosthetic above-knee femoropopliteal bypass for intermittent claudication.

There is no consensus about the most appropriate management of the patient with intermittent claudication due to a superficial femoral artery occlusion. To evaluate the natural history of prosthetic above-knee femoropopliteal (AKFP) bypass, 200 operations for intermittent claudication were reviewed. One hundred AKFP bypasses were done with PTFE and 100 with dacron. In the 30 day postoperative period, four PTFE and three dacron grafts occluded without consequence and only one patient died. Analysis of results by the life-table method demonstrated statistically similar primary graft patency rates at five years (PTFE 65% SE +/- 6.5, dacron 57% +/- 6.2) and ten years (PTFE 31% +/- 18/9, dacron 32% +/- 13.2) (p greater than 0.10). Redo procedures (e.g., thrombectomy, angioplasty) were necessary on 21 grafts (12 PTFE, 9 dacron) and "secondary" patency rates at five years were 76% PTFE and 62% dacron; no grafts which required a redo procedure were patent at ten year follow-up. Major amputations during ten year follow-up were necessary in 16 (8%) patients; all amputations were in diabetic patients. Survival rates were 79% at five and 42% at ten years. An anticipated, the leading cause of death was cardiac related (25 patients); 28 (14%) patients underwent aortocoronary bypass during follow-up. A prosthetic AKFP bypass graft is a safe and durable operation which provides relief from the symptoms of intermittent claudication while allowing for the preservation of the saphenous vein for use later in the coronary or infrapopliteal circulations, should the need arise. These results indicate that the risk of amputation after AKFP is no greater than the natural history of untreated claudication; however, AKFP offers a significant improvement in life-style.

Adult↗

PubMed2005

Which distal anastomosis should be used in PTFE femoro-tibial bypass?

AIM: The PTFE prosthesis represents an alternative to the autologous saphenous vein in femoro-tibial revascularization for limb salvage in the absence of venous material in the patient. The aim of our study is to confirm the validity of PTFE revascularization and determine the best distal anastomosis in terms of patency using 3 different techniques. We carried out a retrospective analysis, evaluating patients who underwent PTFE femoro-tibial revascularization for critical ischemia. METHODS: Between January 1998 and June 2002 we performed 46 femoro-tibial revascularizations at the Vascular Surgery Division of the Poliambulanza Hospital in Brescia using a PTFE prosthesis, from a total of 192 infrainguinal revascularizations (24%). All patients presented a critical ischemia, with trophic lesions or gangrene in 76% of the cases (35/46) and who were previously treated unsuccessfully with medical therapy. Seventeen cases (36%) were a redo bypass due to previously failed revascularization. In all cases the saphenous vein was not available due to past peripheral or coronary revascularization (45%), saphenectomy (20%) or inadequate diameter (35%). The distal anastomoses were performed on the peroneal artery in 29 cases, on the anterior tibial artery in 14 cases and on the posterior tibial artery in 3 cases. The distal anastomosis was performed by interposing a segment of vein between the prosthesis and the tibial artery in 12 cases; in 22 cases the interposition was performed using a vein patch, and in the remaining 12 cases a PTFE prosthesis provided with a premanufactured expanded anastomosis (Distaflo(c)) was used. RESULTS: Average follow-up was 22.5 months (range: 3-48 months). The primary and secondary patency rate at 48 months, calculated with the Life table method, was 35% and 47%, respectively. Limb salvage in the same time period was 56%. Depending on the anastomosis performed (Distaflo(c), vein patch, distal vein) we obtained a secondary patency rate of 31%, 62%, and 44% respectively after 48 months with a significant difference between distal vein patch and the other two anastomoses (p<0.001). CONCLUSIONS: The PTFE bypass on the tibial artery performed for limb salvage in the absence of a saphenous vein represents a valid alternative to other types of prostheses with a patency percentage that is acceptable in the medium term. Within our study population, anastomosis by vein patch interposition gave better results than other types of tibial anastomosis.

Aged↗

PubMedDate not supplied

Multi-detector row computed tomography angiography: an alternative imaging method for surgical strategy in lower extremity arterial occlusive disease.

In order to show the value of CT angiography in the pretherapeutic assessment of lower leg ischemia, we studied 93 CT angiographies in 85 patients. Two groups were defined according to the level of revascularization: 52 angioscanner were made prior to suprainguinal revascularization and 41 prior to infrainguinal reconstruction. Two decision attitudes were chosen by two different physicians, a radiologist and vascular surgeon, members of the same team. The attitudes where then compared in order to evaluate the value of CT angiography. The first attitude was a pragmatic strategy based on the images as interpreted by the first physician and on the intraoperative information including surgical treatment and, if necessary, angiography. This indicates that the results of this attitude cover the performed revascularizations. The second attitude determined a virtual strategy and was chosen by the second physician a posteriori, based solely on the medical file with the same CT angiography images. These two strategies were compared in order to assess the agreement on the level of the lesion and the choice of revascularization. In 84 CT angiographies (90.3%), the analysis of the lesions and the choice of lesions to be treated were identical. In 9.6% of scans the strategies were not comparable because the lesions were interpreted differently or the scans were difficult to read. The sensitivity of CT angiography in detecting lesions and guiding the therapeutic strategy was 96% and its positive predictive value was 93%. Follow-up was reported according to the life-table method to assess the overall outcome and the results in both groups. The overall survival rate at 12 months for 85 patients was 90%. Secondary patency rates at 12 months in the group of patients who underwent a suprainguinal and infrainguinal revascularization were 98% and 71% respectively. Overall limb salvage at 12 months was 94%. In this setting, CT angiography allowed us to select adequate treatment in the majority of cases. These results obtained after a strategy based on CT angiography images are comparable with the results as published in the literature after the strategy based on conventional angiography.

Adult↗

PubMed1992

Life table analysis of the risk of type 1 (insulin-dependent) diabetes mellitus in siblings according to islet cell antibodies and HLA markers. An 8-year prospective study.

To determine whether genetic markers can improve the predictive value of islet cell antibodies for development of Type 1 (insulin-dependent) diabetes mellitus, 536 siblings aged 2-29 years were consecutively enrolled in a 8-year prospective survey. The risk of developing diabetes was estimated, using life-table methods, by years of follow-up and age, according to genetic factors (shared HLA-haplotypes, DR antigens, C4 allotypes) and islet cell antibody status. Fifteen siblings (2.8%) developed Type 1 diabetes during the study period (risk 4.4% after 8 years, 4% by age 22 years). DR3,4 heterozygosity identified higher risk (16% after 8 years, 12% by age 22 years, p less than 10(-5)) than HLA-identity (10% and 7%, respectively, p less than 0.01); risks for DR3 or DR4 positive and for haplo-identical siblings were low (4%, 3% and 4.4%, respectively, NS). C4BQO also conferred significant risk (11% vs 3% in non-C4BQO siblings, p less than 0.01). The predictive value of genetic markers alone was poor (12% for DR3,4, 7% for HLA-identity, 9% for C4BQO) compared with that of islet cell antibody levels greater than 4 Juvenile Diabetes Foundation units (41%, risk 56% after 8 years, p less than 10(-7)). HLA markers significantly contributed to risk prediction in combination with islet cell antibodies: islet cell antibody-positive DR3,4+ subjects had the highest risk (70% after 8 years, predictive value 58%, p less than 10(-7)) compared with islet cell antibody-positive DR3,4- (37% and 20%, respectively) and islet cell antibody-negative DR3,4+ (5% and 3.6%, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1998

Long-term safety and effectiveness of iron-chelation therapy with deferiprone for thalassemia major.

BACKGROUND: Deferiprone is an orally active iron-chelating agent that is being evaluated as a treatment for iron overload in thalassemia major. Studies in an animal model showed that prolonged treatment is associated with a decline in the effectiveness of deferiprone and exacerbation of hepatic fibrosis. METHODS: Hepatic iron stores were determined yearly by chemical analysis of liver-biopsy specimens, magnetic susceptometry, or both. Three hepatopathologists who were unaware of the patients' clinical status, the time at which the specimens were obtained, and the iron content of the specimens examined 72 biopsy specimens from 19 patients treated with deferiprone for more than one year. For comparison, 48 liver-biopsy specimens obtained from 20 patients treated with parenteral deferoxamine for more than one year were similarly reviewed. RESULTS: Of the 19 patients treated with deferiprone, 18 had received the drug continuously for a mean (+/-SE) of 4.6+/-0.3 years. At the final analysis, 7 of the 18 had hepatic iron concentrations of at least 80 micromol per gram of liver, wet weight (the value above which there is an increased risk of cardiac disease and early death in patients with thalassemia major). Of 19 patients in whom multiple biopsies were performed over a period of more than one year, 14 could be evaluated for progression of hepatic fibrosis; of the 20 deferoxamine-treated patients, 12 could be evaluated for progression. Five deferiprone-treated patients had progression of fibrosis, as compared with none of those given deferoxamine (P=0.04). By the life-table method, we estimated that the median time to progression of fibrosis was 3.2 years in deferiprone-treated patients. After adjustment for the initial hepatic iron concentration, the estimated odds of progression of fibrosis increased by a factor of 5.8 (95 percent confidence interval, 1.1 to 29.6) with each additional year of deferiprone treatment. CONCLUSIONS: Deferiprone does not adequately control body iron burden in patients with thalassemia and may worsen hepatic fibrosis.

Adolescent↗

PubMed1980

Starting age and subsequent birth intervals in cohabitational unions in current Danish cohorts, 1975.

This paper presents some main results of an investigation by life table methods of birth interval data in cohabitational unions (marriages as well as consensual unions) in current Danish cohorts. Our results confirm previous findings that an early age at the start of recorded exposure to childbearing risk is indicative of a rapid pace and high level of subsequent fertility. The analysis modifies previous results and adds several new details regarding cohort trends and the effect of parity at the start of reported cohabitation. For each parity within a period of cohabitation, fertility differentials by reported starting age seem to have diminished from our older cohorts (of age up to 49 years in 1975) to our younger ones (of age less than 30 years in 1975). There are indications of a dramatic change in childbearing behaviour following the arrival of novel attitudes to non-marital cohabitation and childbearing in Denmark about 1967.

Adolescent↗

PubMed1996

Randomized trial of two versus five years of adjuvant tamoxifen for postmenopausal early stage breast cancer. Swedish Breast Cancer Cooperative Group.

BACKGROUND: Postsurgical treatment with tamoxifen has been shown to improve overall survival among patients with early stage breast cancer. However, the optimal duration of tamoxifen treatment remains controversial. PURPOSE: A multicenter, randomized trial was initiated in Sweden in the early 1980s to compare 2 years with 5 years of adjuvant tamoxifen in the treatment of postmenopausal women younger than 75 years of age who had early stage, axillary lymph node-negative or -positive, invasive disease. METHODS: The trial was planned and organized by the Swedish Breast Cancer Group, and it involved five regional breast cancer study organizations (South Sweden, South-East Sweden, Stockholm, Uppsala-Orebro, and North Sweden). During the period from 1983 through 1991, a total of 3887 patients were entered in the trial; 3545 (91%) women remained alive and recurrence free at 2 years and could thus contribute meaningful information to the 2-year (n = 1801) versus 5-year (n = 1744) comparison. Primary surgery consisted of either modified radical mastectomy or breast-conserving surgery. Radiation therapy was indicated for patients with lymph node-positive disease and was generally offered to all women who were treated with breast-conserving surgery. Only 89 (2.5%) of the 3545 women who were recurrence free at 2 years received adjuvant chemotherapy concurrently with tamoxifen. Twenty-milligram daily doses of tamoxifen were used at two centers, and 40-mg daily doses were used at the remaining three centers. Estrogen receptor status of the tumor was known for 2987 women (77% of the entered patients). Primary end points in the trial were event-free survival (local-regional recurrence, distant metastasis, contralateral breast cancer, or death) and overall survival. Survival curves were estimated by use of the life-table method. The Cox proportional hazards model was used to make comparisons between the 2- and 5-year treatment groups. RESULTS: Patients assigned to receive 5 years of tamoxifen, compared with 2 years of tamoxifen, experienced statistically significant improvements in event-free survival (relative hazard = 0.82; 95% confidence interval [CI] = 0.71-0.96) and overall survival (relative hazard = 0.82; 95% CI = 0.69-0.99). These findings translate into an 18% relative reduction in both first events (95% CI = 4%-29%) and mortality (95% CI = 1%-31%) with the longer treatment. Overall survival at 10 years was estimated to be 80% among patients in the 5-year tamoxifen group who were alive and recurrence free at 2 years, compared with 74% among corresponding patients in the 2-year treatment group. The benefit associated with the longer treatment extended to women with lymph node-positive as well as lymph node-negative disease, but it appeared to be restricted to women whose tumors were classified as estrogen receptor positive. CONCLUSION: Five years of adjuvant tamoxifen is more beneficial than 2 years in the treatment of postmenopausal women with estrogen receptor-positive, early stage, invasive breast cancer.

Aged↗

PubMed2002

[High dose chemoradiotherapy with autologous hemotopoietic stem cell transplantation for treatment of patients with advanced Hodgkin's lymphoma: a report of 11 cases].

BACKGROUND & OBJECTIVES: High dose chemoradiotherapy (HDT) with autologous hemotopoietic stem cell transplantation (ASCT) has become one of the important salvaged treatments for the Hodgkin's Lymphoma(HL) patients with relapsed or resistant disease, but its role as the primary treatment remains indefinite. This study was designed to further evaluate its status in the combined modality treatment, especially, to discuss its value in the primary treatment of the patients with advanced disease and poor prognosis. METHODS: Eleven patients who had advanced or relapsed disease with poor prognosis were enrolled in this study. Among them, 9 patients were primary treatment, and 2 patients were secondary treatment. One patient received autologous bone marrow transplantation (ABMT), and 10 patients received autologous peripheral blood stem cell transplantation (APBSCT). After induction treatment 4 cases achieved complete response (CR) and 7 cases achieved partial response (PR). High dose chemotherapy combined with total body irradiation (TBI) or total lymph node irradiation(TLI)/subtotal lymph node irradiation(STLI) were applied in 7 cases and high dose chemotherapy alone was used in 4 cases as preparative treatment before transplantion. Five cases received complementary irradiation in the primary sites after transplant. RESULTS: These cases who had been CR before transplantation were consolidative therapy, and among the rest with PR, 2 cases achieved CR, 1 cases PR, and 4 cases stable disease(SD). Furthermore all these patients who maintained SD had bone involvement. With a median follow-up of 13(1-84) months for all patients, all of them were alive at that time. Four cases were event-free survival (EFS); Four cases with bone involvement are progression-free survival (PFS). Three cases experienced relapse after transplant, one of them was EFS for 42 months again after a local relapsed site irradiation; the other two cases were being given further salvaged treatment now. According to the life tables method, the cumulative probability of 6-year PFS and OS was 55.68% and 100%, respectively. The major transplant-related toxicity was bone marrow suppression of grades IV. No obvious cardiac, hepatic, and nephritic toxicity was found, neither transplant relative mortality. CONCLUSIONS: HDT combined with ASCT is a method that worth to be further study to treat the patients with advanced or relapsed Hodgkin's Lymphoma with poor prognosis.

Adolescent↗

PubMed2002

Metachronous second primary cancers after successful partial laryngectomy for invasive squamous cell carcinoma of the true vocal cord.

The current retrospective studies documented the incidence, sites of occurrence, risk factors, and outcome of metachronous second primary cancers (MSPCs) among an inception cohort of 410 patients with invasive squamous cell carcinoma of the true vocal cord successfully treated with partial laryngectomy at a single institution. The Kaplan-Meier actuarial life-table method was used to document the relationship between the incidence of MSPCs and survival data. Univariate analysis was performed for potential statistical relationships among the incidence of MSPCs, the site of occurrence, and different variables. The overall incidence of MSPCs was 23.9% (98/410). The 10-year actuarial survival estimate for MSPCs was 20.4%. The incidence curve of MSPCs was linear, resulting in a 2%/y rate of development for MSPCs. In univariate analysis, the only variable that demonstrated a statistical correlation with the incidence of MSPCs was smoking, with MSPCs being statistically more likely to occur in smokers than in nonsmokers (p = .04). The main sites of origin for MSPCs were the lung (25.5% of cases), other non-upper aerodigestive tract sites (32.7%), and the upper aerodigestive tract (41.8%). The 10-year actuarial estimates for MSPCs were 9.1% in the upper aerodigestive tract, 7.1% in sites other than the lung or upper aerodigestive tract, and 6.6% in the lung. The incidence curve for MSPCs was linear, whatever the site of origin, resulting in 1 %/y, 0.7%/y, and 0.6%/y rates of development for MSPCs in the upper aerodigestive tract, sites other than the lung or upper aerodigestive tract, and the lung, respectively. Survival was statistically reduced when an MSPC developed; the 10-year actuarial survival estimates were 76.8% in patients who did not develop an MSPC and 43.7% in patients who developed an MSPC (p < .0001). Overall, 68.4% of patients who developed an MSPC (67/98) died of this disease. The 10-year actuarial survival estimates were 24% for lung MSPCs, 43.7% for non-lung, non-upper aerodigestive tract MSPCs, and 63.4% for upper aerodigestive tract MSPCs.

Adult↗

PubMed1992

Postoperative subconjunctival 5-fluorouracil injections and success probability of trabeculectomy in Japanese: results of 5-year follow-up.

The effects of postoperative subconjunctival 5-fluorouracil (5-FU) injections on the surgical outcome of trabeculectomy in the Japanese were studied in a total of 362 eyes of 263 glaucoma patients with the postoperative follow-up of 1-9 years. The probability of successful intraocular pressure (IOP) control at the 5-year point of the continuing follow-up was calculated by the life-table method of Kaplan-Meier. The eyes that had undergone trabeculectomy with postoperative injections of 5-FU (5-FU group) included 165 eyes with primary open-angle glaucoma (POAG), 38 eyes with secondary glaucoma (SG) and 60 eyes with refractory glaucoma. The eyes that had undergone trabeculectomy without postoperative 5-FU (control group) included 46 eyes with POAG, 31 eyes with SG and 22 eyes with refractory glaucoma. The surgical techniques and postoperative care were virtually identical between the two groups, except that the control group did not receive the postoperative 5-FU. The total amount of 5-FU given to each case averaged 36.5, 36.0 and 49.5 mg for POAG, SG and refractory glaucoma, respectively. At the 5-year follow-up point, the probability of maintaining IOP control below 21 mmHg with or without medication in the 5-FU group was 92.5% for POAG, 87.4% for SG and 57.5% for refractory glaucoma; while without medication the probability was 58.2, 54.8 and 27.8%, respectively. The probability of IOP control below 16 mmHg with or without medication in the 5-FU group was 77.9% for POAG, 66.8% for SG and 26.9% for refractory glaucoma; without medication the probability was 55.2, 49.8 and 24.5%, respectively. In the control group, the corresponding probability for each type of glaucoma was much lower than that in the 5-FU group, and the probability for IOP control below 16 mmHG was 0.12% at the 5-year follow-up point. In the 5-FU group, the mean postoperative IOP in successfully treated eyes remained at about 12 mmHg throughout the first 5 years of the follow-up period. There was no significant difference in incidence of postoperative complications between the 5-FU and control groups, except that corneal epithelial defect was noted in 38.8% of the eyes in the 5-FU group. No late complications related to the use of postoperative 5-FU were observed.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1979

Mortality and cancer morbidity among cadmium-exposed workers.

Preliminary data are reported from a study of 269 cadmium-nickel battery factory workers and 94 cadmium-copper alloy factory workers. The target group comprises all workers with more than 5 years exposure to cadmium at any time since the factories started production. An internal reference group of 328 alloy factory workers without cadmium exposure was also studied. The expected number of deaths and cancers was calculated with the "life-table" method by using national average incidence rates for men in different age groups and at different calendar years. It was found that among the workers in the battery factory who started work before 1948 there was an increased general mortality in the 1950's mainly due to respiratory disease. The same group had an increased renal disease mortality. There was no increase in general cancer mortality or in general cancer incidence. The risk ratio for nasopharyngeal cancer incidence was 10 (two cases), which was statistically significant. For some other sites like prostate, lung and colon-rectum the risk ratios were also greater than 1 but not statistically significant. In the alloy factory there was a tendency for an increased mortality in prostatic cancer (four cases). After correction for the "healthy worker effect" using the reference group, the risk ratio for prostatic cancer deaths was calculated as 2.4, but this was not statistically significant. The findings in this study support the earlier reports of an association between human cadmium exposure and increased risk for prostatic cancer.

Adult↗

PubMed2003

The transformation rate of moles (melanocytic nevi) into cutaneous melanoma: a population-based estimate.

BACKGROUND: Moles, or melanocytic nevi, are both markers of an increased risk of cutaneous melanoma and direct precursor lesions. Recent strategies to reduce the burden of advanced disease have focused on early detection and ongoing surveillance of moles for malignant degeneration. Inherent in this approach is the notion that moles exhibit a certain risk of transformation into melanoma; however, this risk is unknown. OBJECTIVE: To estimate the risk of moles transforming into cutaneous melanoma. DESIGN: We first constructed a model of transformation based on the assumption that the minimal number of moles turning into cutaneous melanoma per year is roughly equivalent to the number of melanomas diagnosed each year with associated nevic components. The annual risk was then calculated as the number of mole-associated melanomas diagnosed in 1 year (stratified by 10-year age groups) divided by the number of moles in a the same 10-year age group. We also estimated the cumulative risk during the lifetime of an individual mole by using a modification of the standard life table method. RESULTS: The annual transformation rate of any single mole into melanoma ranges from 0.0005% or less (ie, </=1 in 200,000) for both men and women younger than 40 years to 0.003% (about 1 in 33,000) for men older than 60 years. The rate is similar between men and women younger than 40 years but becomes substantially higher for men older than 40 years. For a 20-year-old individual, the lifetime risk of any selected mole transforming into melanoma by age 80 years is approximately 0.03% (1 in 3,164) for men and 0.009% (1 in 10,800) for women. CONCLUSIONS: The risk of any particular mole becoming melanoma is low, especially in younger individuals. However, since moles can disappear, ones that persist into old age have an increased risk of malignant degeneration. For young people with innumerable moles and no other associated risk factors, systematic excision of benign-appearing lesions would be of limited benefit.

Adult↗

PubMed1978

Prognostic factors in the survival of 1,484 stroke cases observed for 30 to 48 months. II. Clinical variables and laboratory measurements.

Using the life table method, 962 cases of infarction, 279 cases of hemorrhage, and 243 cases of undetermined type of stroke, occurring in Manitoba between Jan 1, 1970, and June 30, 1971, were analyzed for factors affecting survival. Survival until Dec 31, 1973, was found to be adversely affected by the presence of coma or unconsciousness and the absence of localizing signs and symptoms. Also, the prognosis was poor if the heart was enlarged on the x-ray film or the ECG was abnormal. On the other hand, the presence of individual clinical entities such as hypertension, hypertensive heart disease, myocardial infarction, atrial fibrillation, or diabetes did not affect the survival significantly. These findings will help in predicting the prognosis and in planning for management of stroke cases.

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