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PubMed1986

Observations on the occurrence of atrial fibrillation in paroxysmal supraventricular tachycardia.

Paroxysmal supraventricular tachycardia (PSVT) and atrial fibrillation (AF) are both supraventricular arrhythmias, but their mechanisms are completely different. This study determines the incidence of symptomatic AF in a group of patients followed closely during routine outpatient care for PSVT. Thirty-nine patients with PSVT were followed for up to 4 years using telephone transmission of the electrocardiogram to document symptomatic arrhythmias. The cumulative proportion of patients who had AF was calculated using the Kaplan-Meier life-table method. In addition, we examined the importance of clinical variables traditionally believed to influence the occurrence of AF. The cumulative proportion of patients who had AF during follow-up was 13% at 3 months, 16% at 6 months, 22% at 1 year and 29% at 2 years. In most patients the start of AF was documented during an attack of PSVT rather than de novo as another primary arrhythmia. PSVT occurred significantly earlier during an observation period without treatment in patients in whom AF developed (p = 0.03). The occurrence of AF was not related to age, number of years of PSVT, heart rate during tachycardia or coexistent heart disease.

Adult↗

PubMed1985

Polymyalgia rheumatica. Duration of therapy and long-term outcome.

The duration of therapy and outcome were examined in 76 patients with polymyalgia rheumatica without evidence of temporal arteritis at presentation. Seventy-five patients received corticosteroids, with a mean prednisone dosage of 22.8 mg per day initially. Duration of therapy was assessed using life-table methods. No significant difference could be ascertained between groups segregated on the basis of age, sex, or initial steroid dosage. The median duration of therapy was 37.3 months. It was estimated that 40 percent of patients will require therapy longer than four years. Corticosteroids were permanently discontinued in 31 patients after a mean of 23.7 months of therapy. The data support the concept of two patient populations--one with limited disease and another requiring long-term therapy. Relapses were frequent, occurring in 56 percent of patients. Evolution of arteritis during the course of therapy was infrequent, occurring in only one patient. Steroid-related adverse effects occurred in 22.7 percent of patients and were more common in females. The data suggest that, although corticosteroids may be discontinued in some patients with polymyalgia rheumatica, prolonged therapy is required in a significant number.

Actuarial Analysis↗

PubMed1980

Cumulative conception rates following gonadotropin therapy.

During the years 1963 to 1978, 515 patients were treated with HMG. They were divided into two groups depending upon the absence (Group I) or presence (Group II) of distinct endogenous estrogen activity. Group II patients were referred after failure of clomiphene therapy. None of the patients had mechanical or male infertility factors. The cumulative pregnancy rate (life table method) in Group I patients after six cycles of treatment was 91.2%. In 77 patients from Group I, further treatment was given for a second pregnancy after the first gonadotropin conception. In this group, the cumulative conception rate was 93.6% after eight cycles of treatment. In Group II the cumulative conception rate was 50% after 12 cycles of treatment. In both groups, the results were better in patients who were less than 35 years of age than those who were 35 or more when treated.

Adult↗

PubMed1978

Femorofemoral grafts: the role of concomitant extended profundaplasty.

Twenty-one femorofemoral grafts were placed in high risk patients with symptomatic, unilateral, iliofemoral, arterial occlusive disease. There was 100 per cent immediate postoperative relief of ischemia or improvement in claudication. Three late below-knee amputations have been performed. All other living patients had healed extremities and were ambulatory at last follow-up. Cumulative graft patency determined by the life table method was 95 per cent at twenty-four months. The physiologic "steal" created by a femorofemoral bypass with donor limb and/or outflow stenosis must be considered to prevent clinical donor limb functional impairment. A gradient of 10 mm Hg or less between the radial artery mean pressure and the donor femoral artery ensured adequate donor artery flow without regard to angiographic a-pearance of the donor artery. The crucial technical problem in patients operated on for ischemia was reconstruction of adequate outflow. All but one patient required at least minimal profunda endarterectomy, and nine of seventeen (53 per cent) required concomitant extended profundaplasty procedures.

Age Factors↗

PubMed1979

Prognosis after resection of metachronous multiple bronchogenic carcinoma.

Information on 55 cases of multiple metachronous lung cancer in which both tumors were resected was collected from published reports for comparison with a series of 214 single cancer cases treated by lobectomy in Philadelphia teaching hospitals. The two groups were similar with respect to age, extent of resection, and histologic type of cancer (the second lesion in the multiple cancer group). The life table method was used to assess survival in the multiple cancer group for 4 years after the second resection. Survival in the two groups was similar in the first 2 years, but at the end of the third and fourth years the survival rate for the multiple cancer group was only half that of the single cancer group. These differences were statistically significant. Prognosis 4 years after resection of a second metachronous bronchogenic carcinoma is poor.

Actuarial Analysis↗

PubMed1982

Revascularization of the leg using polytetrafluoroethylene: cumulative patency in patients with claudication and limb salvage.

Of 196 polytetrafluoroethylene bypass grafts in the leg, 113 were placed in the femoropopliteal and 83 in the femorotibial or femoroperoneal position. Claudication was the indication for 31 percent of the grafts, and 67 percent were done for limb salvage. Cumulative patency rates calculated by the life-table method for the femoropopliteal grafts were 66 percent at 1 year, 53 percent at 2 years, and 49 percent at 3 years. Corresponding patency rates for the femorotibial or peroneal grafts were 48, 44, and 36 percent, respectively. An analysis of factors influencing graft patency indicated that the best results were obtained with femoropopliteal grafts done for claudication in the presence of good distal runoff and grafts placed in limbs without previously failed grafts. Graft occlusion was most likely in distal bypasses for limb salvage and limbs with previously failed grafts. It is concluded that alternatives to PTFE bypass should be considered in those patients at greatest risk for graft occlusion. In patients who lack a satisfactory saphenous vein but who must have a bypass graft, polytetrafluoroethylene is an acceptable arterial substitute; however, thrombectomy or revision will be required to maintain patency in a high proportion of cases.

Actuarial Analysis↗

PubMed1982

The Prentif contraceptive cervical cap: a contemporary study of its clinical safety and effectiveness.

Because they seemed to be an overlooked, underutilized, and underdeveloped means of contraception, cervical caps were offered to patients in a private gynecological practice and the first 413 acceptors were sent a detailed questionnaire about their experiences. The 371 who responded provided generous amounts of information helpful in assessing not only cap safety and effectiveness, which are dealt with herein, but also in assessing acceptability which is dealt with in the companion article that follows. With regard to safety considerations, "cervical erosion" was not found to contraindicate cap use and no other significant safety hazards were encountered, although two concerns were suggested for further evaluation. The failure rate was 8.4 per 100 women per year by the life table method. Of 25 failures, 11 were labeled method failures and 14 were labeled human failures by the respondents themselves. The role of cap dislodgement as a cause of method failures is analyzed. It is concluded that caps are as safe and effective as diaphragms and that for many women they are the most suitable form of contraception available. It is reasonable to expect that they will soon be able to be approved for general use.

Adult↗

PubMed1996

A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China.

Chinese women in Shanghai who delivered vaginally and who chose to use an IUD for contraception received a Copper T-380A IUD inserted vaginally within 10 minutes after delivery of the placenta (i.e., immediate postplacental insertion, IPPI). Among them, 97.7% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD via ring forceps. The follow-up rate of six months was 95.2%. Using Tietze's life table method and log rank test, the expulsion and other discontinuation rates were compared at three and six months postinsertion between these two different insertion techniques. Expulsions were the main reason for discontinuation. The six-month gross cumulative expulsion rates were 13.3 and 12.7 per 100 women in the hand-insertion group and ring forceps-insertion group, respectively. Discontinuation rates for medical removals (bleeding/pain) were 2.1 and 1.0 in these two groups, respectively. Neither of the differences was statistically significant (p > 0.05). No uterine perforation, infection or pregnancy occurred. The results suggest that these two different insertion techniques do not significantly affect discontinuation rates in vaginal IPPI using the TCu 380A, and the TCu 380A appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breastfeeding and IUD placement in uterine cavity, are also analyzed and discussed in this report.

Adult↗

PubMed1989

Efficacy and safety of a combination of chenodeoxycholic acid and ursodeoxycholic acid for gallstone dissolution: a comparison with ursodeoxycholic acid alone.

Chenodeoxycholic acid (CDC) and ursodeoxycholic acid (UDC) have distinct physicochemical and metabolic properties which, being complementary, should favor more rapid removal of cholesterol from gallstones when both bile acids are administered together. To see if the combination is more effective and well tolerated, we have compared 5 mg/kg of CDC plus 5 mg/kg of UDC with a 10-mg/kg dose of UDC alone in 120 patients with radiolucent, sonographically confirmed gallstones and characteristics favoring complete dissolution. Ursodeoxycholic acid was chosen as the reference because it dissolves stones faster and is better tolerated than CDC. To minimize the influence of stone size, the major determinant of dissolution, patients were divided, on admission, into two groups according to the maximum stone diameter: 50 had stones less than or equal to 5 mm, 70 had stones greater than 5 mm but less than 15 mm. The effects of treatment on stone dissolution evaluated by cholecystography and ultrasonography at 6, 12, and 24 mo, were analyzed by the actuarial life-table method. In the group with smaller stones, significantly more patients had obtained complete dissolution after treatment with the combination (52%) than after treatment with UDC alone (24%) at 6 mo. After longer periods, results were still better with the combination, although the differences from UDC alone became smaller. In the patients with larger stones, rates of complete and partial dissolutions were higher after treatment with the combination (51% vs. 24% with UDC) at 6 mo and again the differences had become smaller after longer treatment. Although not statistically significant, stone calcification occurred more often with UDC (7 cases) than with the combination (1 case). We conclude that CDC plus UDC is preferable to UDC alone because it dissolves stones more quickly, with a lower incidence of stone calcification, and may result in reduced cost of treatment.

Bile↗

PubMed1991

Primary B-cell gastric lymphoma: a clinicopathological study of 145 patients.

Resection specimens from 145 patients with primary B-cell gastric lymphoma at stage IE (n = 88) and at stage IIE (n = 57) were investigated. Histologically, low-grade malignant B-cell lymphomas arising from the mucosa-associated lymphoid tissue, including immunocytoma (n = 71), could be distinguished from high-grade malignant B-cell lymphomas with (n = 25) and without (n = 49) evidence of a low-grade component. The very rare low-grade B-cell lymphomas of centroblastic-centrocytic, centrocytic, and plasmacytic type were not considered. All patients had undergone primary gastric resection, and 65 received additional chemotherapy (n = 33), radiotherapy (n = 22), or both (n = 10). Actuarial overall survival rates calculated by the Kaplan-Meier life-table method were 76% after 5 years and 58% after 10 years. According to the Mantel test and a multivariate analysis using the Cox regression method, patients at stage IE had a significantly better survival probability than those at stage IIE (P less than 0.0001); 5-year survival rates were 87% and 61%, respectively. The survival probability for low-grade malignant lymphomas was significantly better than for tumors with secondary high-grade transformation (P less than 0.05) or for primary high-grade lymphomas (P less than 0.0001), whereas the two high-grade groups were not significantly different. Five-year survival rates were 91% for low-grade, 73% for secondary high-grade, and 56% for primary high-grade malignant lymphomas. Retrospectively, no significantly different survival rates were found between patients who had undergone gastric resection alone and patients who had received additional treatment. However, survival analyses showed that classification and grading according to the histopathological concept of mucosa-associated lymphoid tissue-derived gastric lymphomas into low-grade B-cell lymphomas of mucosa-associated lymphoid tissue type and high-grade B-cell lymphomas with or without evidence of a low-grade component has great prognostic relevance.

Actuarial Analysis↗

PubMed1986

Necrosis of the femoral head following fracture of the femoral neck.

One hundred and thirty fractures of the femoral neck treated with sliding screw-plate or sliding nail-plate were followed for up to 65 months postoperatively. Throughout the observation period the yearly incidence of necrosis of the femoral head was between 5 and 10 per cent, as estimated by the life table method, and after 5 years 37 per cent of the patients with united fractures had developed necrosis of the femoral head. The cases of necrosis were all characterized radiographically by one or more areas of subchondral cortical depression, generalized subchondral fragmentation or isolated patches of sclerosis. It is concluded that estimation of the frequency of femoral head necrosis after fracture of the femoral neck requires long-term follow-up and reliable, reproducible radiographical criteria for necrosis of the head. Because of the high mortality of patients sustaining these fractures, statistical methods employing censored data should be used.

Adolescent↗

PubMed1989

The predictive power of the salivary cortisol dexamethasone suppression test for three-year outcome in major depressive illness.

Seventy patients satisfying DSM-III and Research Diagnostic Criteria for major depression were given a salivary cortisol dexamethasone suppression test, with samples collected at 0700 h, 1500 h and 2300 h after dexamethasone. The patients were classified as nonsuppressors (mean post-dexamethasone salivary cortisol concentration greater than or equal to 2.0 ng/ml, N = 27) and suppressors (mean post-dexamethasone salivary cortisol concentration less than 2.0 ng/ml, N = 43). At 3-yr follow-up there was no difference in illness outcome as assessed by the life table method or by the length of rehospitalisation for several periods after the index episode. In multiple regression and discriminant function analyses, with outcome as the dependent variable (readmitted within 1 yr, readmitted between 1 and 3 yr, not readmitted), the mean post-dexamethasone salivary cortisol concentration was not significantly predictive of outcome.

Adult↗

PubMed1991

Lymphvascular space involvement--a prognostic indicator in endometrial adenocarcinoma.

The present study evaluates the effects of various prognostic indicators on survival of patients with clinical Stage I endometrial carcinoma. Ninety-three patients who were treated for clinical Stage I endometrial adenocarcinoma at Maimonides Medical Center from October 1979 to October 1987 had sufficient surgical-pathological information for retrospective surgical staging according to the new FIGO classification. Histology was reviewed. A new grade and surgical stage was assigned to each patient in accordance with the recent FIGO guidelines for surgical staging of corpus cancer. Poor prognostic indicators, namely, tumor grade, depth of myometrial invasion, peritoneal cytology, lymph node metastases, and lymphvascular space (LVS) involvement, were correlated with 5-year survival rates. Survival rates were calculated by the life table method. Depth of myometrial invasion, lymph node involvement, and peritoneal cytology had significant statistical correlation with poor survival. Positive finding of each of the prognostic indicators, including LVS involvement, was significantly associated with poor survival (all P less than 0.001). The value of these prognostic indicators in early endometrial carcinoma is discussed.

Adenocarcinoma↗

PubMed1979

Psychosis as a predictor of response to lithium maintenance treatment in bipolar affective disorder.

Sixty-six bipolar I lithium clinic patients were studied for a history of psychotic symptoms at some time during the course of their illness. Agreement between different sources of information was calculated, and the patient population was divided into psychotic and non-psychotic subgroups. Probability of remaining well on lithium for the different subgroups was analyzed by the life table method. Psychosis during mania appeared to be associated with especially good early lithium prophylaxis.

Actuarial Analysis↗

PubMed1994

Development of proliferative retinopathy in Japanese patients with IDDM: Tokyo Women's Medical College Epidemiologic Study.

We studied the development of proliferative diabetic retinopathy (PDR) in Japanese insulin-dependent diabetes mellitus (IDDM). Subjects were 373 patients who were diagnosed as IDDM between 1951 and 1984, before the age of 30 years, and had no PDR at the first visit to the Diabetes Center. Development of PDR was analyzed by Kaplan-Meier's life-table method in relation to the duration of IDDM. The cumulative incidence of PDR was 20% at 15 years of duration of IDDM, 40% at 19 years, and 70% at 29 years. Female patients (n = 233) developed PDR significantly faster than males (n = 140) (P < 0.002). In both sexes, patients with onset of IDDM at 0-8 years showed significantly slower development than patients with the onset at 9-17 (P < 0.0001) and 18-29 years (P < 0.001). Impact of femaleness on the development was the greatest in patients with age at onset of IDDM at 9-17 years (P < 0.005). Analysis according to the calendar year at onset of IDDM and diabetes duration at the first visit to the Diabetes Center did not show any significant influence on the development of PDR. In conclusion, sex and age at onset of IDDM may be associated with increased risk for the development of PDR in relation to the duration of diabetes in Japanese IDDM.

Adolescent↗

PubMed1983

Moderate-dose cyclophosphamide for disseminated ovarian carcinoma: a phase II study.

Fifty-six evaluable patients with advanced ovarian carcinoma (FIGO III or IV), without prior cytotoxic chemotherapy, were studied to assess the activity of single-agent moderate-dose cyclophosphamide, 40 mg/kg to a maximum dose of 3000 mg, given intravenously as a bolus injection every 3 weeks. All patients were treated as outpatients. Moderate-dose cyclophosphamide resulted in 36 (64%) objective responses (19 CR, 17 PR). Nausea and severe vomiting occurred in all patients, but no patient needed hospitalization for this complication. Other side-effects observed were alopecia (100%), leukocytes less than or equal to 2500/microliters (18%), chemical cystitis (11%) and sepsis (4%). The median duration of response was 11 months, and the estimated median survival by the life-table method for responders was 16 months and for non-responders 4 months (P less than 0.001). Clinical trials previously performed by our group comparing cyclophosphamide alone, either vs cis-platinum, adriamycin and hexamethylmelamine or vs Hexa-CAF, showed a better remission rate with the use of moderate-dose cyclophosphamide alone. Therefore we suggest further investigation of this agent in a moderate dose in disseminated ovarian carcinoma.

Adult↗

PubMed1986

Survival after first recurrence in breast cancer.

The aim of the present study was to evaluate the significance of primary stage, histopathological grade, disease-free survival and site of first relapse on survival after first recurrence. The study included 1621 female breast cancer patients admitted between 1970 and 1975. The patient material was analysed by unifactorial life table methods and the multifactorial Cox regression analysis. The primary stage and histopathological grade maintained a significant prognostic value also after relapse. Survival after first recurrence was dependent on the disease-free interval and site of first relapse, too. If the disease-free survival was over 5 years, 44% of the patients were still alive after 7 years from recurrence. Of the patients with a disease-free survival shorter than 2 years, only 10% were alive after 7 years from recurrence. Survival was significantly better after locoregional relapse than after distant relapse, but the difference levelled off within 7 years. The prognosis of axillary relapse was best and that of liver and brain metastases poorest. Regression analysis confirmed the importance of primary stage, site of recurrence and histopathological grade as prognostic variables for survival after first recurrence.

Breast Neoplasms↗

PubMed1983

Myelopathy following radiotherapy of bronchial carcinoma with large single fractions: a retrospective study.

A series of 387 patients with bronchial carcinoma treated with a concentrated split course regimen was surveyed for radiation myelitis. The total dose was 38 Gy. Three fractions of 6 Gy were given the first week. After a three-week interval the patients had a second course of radiotherapy with fractions of 4 Gy on 5 consecutive days. A spinal shield was used in 230 patients for the last two fractions of radiotherapy. The median survival for all patients was 9.4 months. Seventeen cases of radiation myelopathy were found. The life table method was used to calculate the risk of myelopathy in surviving patients, showing risk levels of 30 +/- 15% in patients surviving three years or more. The average age of the patients with myelopathy was 57.6 years, compared to 62.9% years in the total population. Statistical analysis showed a borderline significant increased risk for myelopathy in females, and a significant increased risk in younger patients (P = 0.03). No difference in the incidence of myelopathy was found in patients treated with or without a spinal shield.

Actuarial Analysis↗