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PubMed1985

Relationship between lymph nodal status and primary tumor control probability in tumors of the supraglottic larynx.

A retrospective review of 248 patients with squamous cell carcinoma of the supraglottic larynx was undertaken to determine the relationship between the probability of control of the primary lesion, the extent of neck nodal disease at initial presentation, and its ultimate control. All patients were treated at the U.T. M. D. Anderson Hospital between 1960 and 1980, and had a minimum of 3 years follow-up. The primary lesion was staged T1 in 38 patients, T2 in 132, T3 in 50 and T4 in 28. The initial volume of neck nodal disease was scored on a scale of 0 (no palpable nodes) to 9 (bilateral neck nodes greater than 6 cm in diameter). All primary lesions were treated definitively with megavoltage radiation therapy. Treatment to the neck varied according to the extent of lymph node involvement. There was no significant difference in the range of total radiation doses delivered to the primary lesion, stage for stage, in patients who presented with clinically negative or positive nodes, or in those with controlled versus uncontrolled neck disease. Analysis of the probability of primary tumor control was made by life table methods because of the poorer survival expectation in node positive patients. For T1 and T2 primary lesions, any positive node decreased the probability of primary tumor control (p = 0.06). For T3 and T4 lesions, a single node less than 3 cm in diameter did not worsen the chance of primary tumor control, but any greater degree of lymph node involvement did (p = 0.03). For both T stage groupings, the probability of primary tumor control at 5 years decreased progressively with increasing neck nodal disease. Primary tumor control probability was also significantly associated with control of the neck disease, independent of the modality of neck treatment. No correlation could be demonstrated between the histological grade of the primary tumor and initial lymph node status or tumor control probability. Possible interpretations of this manifestation of biological heterogeneity are discussed.

Biopsy↗

PubMed1986

The predictive value of skin telangiectasia for late radiation effects in different normal tissues.

Alterations in the microcirculation and parenchymal cell loss are common phenomena after irradiation of different organs. Whether parenchymal cell loss is a process well dissociated from vasculoconnective damage, or a consequence of this, is much debated. However, comprehensive radiopathological studies have shown that vasculoconnective tissue is an important common target for late effects in various organs. Scoring of skin telangiectasia was used by us as a clinical assay of late tissue effects after different dose schedules. All studies were done prospectively with standardized skin area, field size and radiation quality. The patients were scored regularly up to 10 years. The number of patients at risk for a prescribed score versus time was calculated with the life-table method. The late effects after 5 X 2.0 Gy/wk, in the dose range 40 to 70 Gy and after 2 X 4.0 Gy/wk, in the dose range 40 to 56 Gy have been established. The skin dose is 90% of the referred dose. Dose-response curves, relating the proportion of patients with a certain score at a fixed time and radiation dose and dose-latency curves, relating the latent period for a fixed proportion of patients with a certain score and radiation dose, were constructed. The analysis shows that: ED10/5 yr and ED50/5 yr for 5 X 2.0 Gy/wk is 50 Gy and 65 Gy, respectively, for distinct telangiectasia; The latent period, concerning both a certain frequency and degree of reaction, varies exponentially with dose level; The latent period for 50% of the patients, to obtain a certain score, LP50, is correlated to that for 10%, LP10, with LP50/LP10 = 2.2 +/- 0.2 (S.D.). This correlation is independent of score, total dose, and fractionation; Isoeffective doses for 5 X 2.0 Gy/wk and 2 X 4.0 Gy/wk, determined from the dose-response curves, resulted in the repair exp N between 0.31 and 0.32 and alpha/beta ratio between 2.9 and 3.1 Gy and determined from the dose-latency curves in exp N between 0.30 and 0.32 and alpha/beta ratio between 3.4 and 2.9 Gy. In conclusion, frequent and careful follow-up with registration of normal tissue reactions, until at least 10% of the patients have obtained the prescribed effect, is predictive for the further progression of the late effects. The fractionation characteristics for telangiectasia agree well with those for animal experimental morphological and functional endpoints for late effects in different organs and support the relevance of telangiectasia as a model for predicting late effects.

Breast Neoplasms↗

PubMed1987

Radical radiation and oral and intra-vesical misonidazole for bladder cancer.

Patients with T2 grade 3 and T3 bladder cancer were entered into studies to evaluate the efficacy of 40 Gy in 2 Gy fractions (5/week) to the whole pelvis followed by 12 Gy in 6 Gy fractions (1/week) to a coned down volume plus oral and intravesical misonidazole (MISO). In a pilot study of 22 patients the complete response rate at cystoscopy at 6 months was 73% and the 5-year survival rate (life-table) with and without bladder preservation was 48% and 54% respectively. The 5-year bowel major complication rate (life-table method) was 8%. These results are statistically significantly improved over that seen in a series of historical controls. A prospective randomized trial has been completed comparing the above regimen with 40 Gy to the whole pelvis followed by 20 Gy to the coned down volume in 2 Gy fractions (5/week). Fifty-eight patients were entered and 53 are evaluable. The complete response rate at cystoscopy at 6 months is 69% (18/26) in the patients treated with MISO and 63% (17/27) in those treated without MISO. As this is an important prognostic indicator, it is unlikely that there will be an advantage in either group and this is supported by the initial follow-up data. The complete response rate at cystoscopy at 6 months is higher in both arms of this study than in the historical series.

Administration, Oral↗

PubMed1990

The effect of overall treatment time on local control in patients with adenocarcinoma of the prostate treated with radiation therapy.

Studies of patients treated with radiation therapy for squamous cell carcinoma of the head and neck have demonstrated that when all other variables are constant, protraction of the overall treatment time leads to a decreased probability of local control. Few data exist on the effect of overall treatment time on local control following irradiation of tumors that are generally thought to be slowly proliferating, such as adenocarcinoma of the prostate. This analysis was undertaken to determine the time-dose relationships for local control of prostatic adenocarcinoma at the University of Florida. All patients were treated at least 5 years prior to the date of analysis. For patients with Stage A2 disease, a tumor dose of 6500 cGy in 7 to 7.5 weeks to 7000 cGy in 8 weeks resulted in local control in 17/17 patients (100%). For patients with Stage B1 disease, the local control rate was 14/16 (88%) with an overall treatment time of less than or equal to 8 weeks versus 1/3 in patients who received split-course treatment in greater than 8 weeks (p = .097). For patients with Stage B2, C1, and C2 disease who received greater than or equal to 6500 cGy, the 5-year rate of local control was lower when overall treatment time was protracted beyond 8 weeks. Results were as follows: B2 (62 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 55%, p = .002; C1 (87 patients), less than or equal to 8 weeks, 88%, versus greater than 8 weeks, 73%, p = .052; Cs (33 patients), less than or equal to 8 weeks, 81%, versus greater than 8 weeks, 65%, p = .056. Stratification by tumor grade of patients with Stage B1, B2, C1, and C2 disease who received greater than or equal to 6500 cGy demonstrated significantly lower local control rates for all grade categories when the overall treatment time was protracted beyond 8 weeks. Five-year local control rates (life-table method) for overall treatment time less than or equal to 8 weeks versus greater than 8 weeks were as follows: well differentiated, 93% versus 73% (p = .003); moderately differentiated, 86% versus 69% (p = .017); and poorly differentiated, 75% versus 59% (p = .046). These data suggest that tumor repopulation during excessively protracted treatment may be a clinically significant factor in patients with adenocarcinoma of the prostate.

Adenocarcinoma↗

PubMed1990

Treatment of advanced transitional cell carcinoma of the bladder with irradiation and concomitant 5-fluorouracil infusion.

Twenty patients with advanced transitional cell carcinoma of the bladder were treated with radiation and concomitant continuous infusion of 5-fluorouracil with or without Mitomycin. Nineteen of 20 patients were assessed for response. Fourteen of 19 patients (74%) obtained a complete response within 3 to 6 months. An additional three patients (15%) acquired and maintained a complete response after local transurethral resection of the tumor and intravesical chemotherapy, raising the overall complete response (CR) rate to 17/19 (89%). Of the two patients with persistent disease, one is alive and well after salvage cystectomy. Eighteen of 20 patients were evaluated for survival with a median follow-up of 38 months. Seven patients remain alive and well 51 to 78 months, whereas three patients died from intercurrent disease. Eight patients died of either distant metastatic disease (7 patients) or regional disease (1 patient). An adjusted survival calculated by the Life Table Method was 53.6% at 5 years, whereas the overall survival was 39%. The combined modality therapy was well tolerated with no need for treatment interruption or reduction in dose. Late bladder complications include one patient with hemorrhagic cystitis, two patients with dysuria, and two with symptoms of irritable bladder. One patient required a colostomy for a chronic hemorrhagic proctitis. Bladder preservation was achieved in 19/20 patients.

Aged↗

PubMed1989

Medical and surgical management of early Q wave myocardial infarction. I. Effects of surgical reperfusion on survival, recurrent myocardial infarction, sudden death and functional class at 10 or more years of follow-up.

To define the outcome of patients given medical or surgical therapy for Q wave myocardial infarction, 387 patients were followed up for 10 to 13 years (mean 11.4). On study entry the groups had similar distributions for variables such as mean age, gender, previous myocardial infarction, abnormal creatine kinase activity, area of infarction, number of vessels diseased and clinical classification. The hospital mortality rate of the medical versus surgical group was 11.5% (23 of 200) versus 5.8% (11 of 187) (p = 0.07). Early reperfusion (that is, less than or equal to 6 h) resulted in a lower mortality rate than did medical therapy--2% (2 of 100) versus 11.5% (23 of 200) (p less than 0.05)--whereas the hospital mortality rate with late reperfusion was 10.3% (9 of 87). The long-term mortality rate of the medical and surgical groups was 41% (82 of 200) versus 27% (51 of 187) (p = 0.0007) with use of an adjusted Cox proportional hazards model. In the survivors, the differences between medical and surgical groups in recurrent myocardial infarction, mortality associated with reinfarction and sudden death were prospectively followed and evaluated by the life table method. Recurrent myocardial infarction was not prevented by surgical reperfusion or medical therapy (23% in both groups), however, the mortality rate in patients with recurrent infarction was higher in the medical therapy group--36.6% (15 of 41) versus 17.5% (7 of 40) (p = 0.04). The mortality difference did not depend on early or late surgical reperfusion. In the in-hospital survivors, the incidence of sudden death was 17.5% in the medical (31 of 177) versus 7.4% (13 of 176) in the surgical group (p = 0.01). This difference was much more pronounced in the early reperfusion group. Functional class was significantly lower than that for medical therapy in the early reperfusion but not the late reperfusion group. Thus, in comparable groups given medical and surgical therapy for acute myocardial infarction and followed up for greater than or equal to 10 years, surgical reperfusion appears to offer improved longevity in selected cases (when implemented early) but does not prevent recurrent myocardial infarction. The associated mortality with recurrent myocardial infarction is less as is the incidence of sudden death. Finally, lower functional class occurs most often in patients given early reperfusion.

Acute Disease↗

PubMed1996

Survival for colon and rectal cancer in a population-based cancer registry.

Dukes' stage is the most powerful indicator of patient outcome for colorectal cancer. Several cancer survival studies have considered other prognostic variables, but results are often conflicting. We sought to assess the independent value of several clinical and morphological variables in defining colorectal cancer specific survival. 397 colorectal cancer patients diagnosed from 1984 to 1986, and registered in a large bowel cancer registry instituted in a local health district of Northern Italy, were actively followed-up until 31 December 1991. Univariate and multivariate survival analyses were carried out in colon and rectal cancer cases, separately, using the actuarial life-table method and Cox proportional hazard regressions. Crude and specific 5-year survival rates were 37.5 and 41.4%. In univariate analysis, TNM (tumour, nodes and metastases) stage was the strongest predictor of prognosis in both sites. Other variables significantly related to survival were age of patient at diagnosis and pattern of tumour growth in colon cancer, type of differentiation and pattern of tumour growth in rectal cancer. In multivariate analyses, after adjusting for stage, age had a weak but significant negative effect on colon cancer survival, whereas rectal tumours with the infiltrating type of growth had a significantly worse prognosis than those with the expanding type. Colorectal cancer survival should be analysed in the main large bowel subsites in order to define high-risk groups within each TNM stage category.

Aged↗

PubMed1996

Long-term outcome of patients who received Starr-Edwards valves between 1965 and 1977.

To determine the risk factors relating to long-term outcomes of the Starr-Edwards ball valve, data from 150 patients (75 males, 75 females; age range 9-67 years); who underwent valve replacement (44 aortic, 106 mitral) between 1965 and 1977 at Niigata University were reviewed retrospectively. Valve models 6120/6320 and 1260/2320 were mainly used in mitral and aortic positions, respectively. The cumulative follow-up period was 2227.4 patient-years. Using the Kaplan-Meier life-table method, actuarial probability of freedom from valve-related mortality, morbidity and thromboembolism were analysed. Thirteen patients died from various causes during hospitalization. Some 80 patients suffered 97 instances of valve-related morbidity and 58 died during follow-up (up to 28 years). Patient age > 50 years affected the actuarial probability of freedom from valve-related mortality in the entire group (P < 0.05). Valve type and the year of operation were discriminative predictors of thromboembolic complications in the entire group (both P < 0.05) and in the mitral valve replacement group (P < 0.01 and P < 0.001). However, only the year of operation affected the actuarial probability of freedom from all valve-related morbidity in the entire group and in the mitral valve replacement group (both P < 0.05). Univariate analysis revealed that age at surgery, valve type, and the year of operation were related to late postoperative outcome in patients who received a Starr-Edwards ball valve between 1965 and 1977.

Actuarial Analysis↗

PubMed2005

Relative and absolute risk of colorectal cancer for individuals with a family history: a meta-analysis.

Accurate risk estimates for individuals with a family history of colorectal cancer are important for surveillance strategies. We systematically reviewed the literature on familial risks of colorectal cancer to determine relative risk estimates for categories of family history and translated these relative risk estimates into absolute risk estimates. A random-effects meta-analysis pooled the effect estimates from individual studies and actuarial life-table methods converted relative into absolute risks. Fifty-nine studies were identified including 47 that estimated the relative risk of developing colorectal cancer given at least one affected first-degree relative. The pooled risk estimate was 2.24 (95% CI 2.06 to 2.43) which rose to 3.97 (95% CI 2.60 to 6.06) with at least two affected relatives. A population lifetime risk of 1.8% for a 50-year old increased to 3.4% (95% CI 2.8 to 4.0) with at least one affected relative or 6.9% (95% CI 4.5 to 10.4) with two or more. Accurate absolute risk estimates show how cancer risks vary over time, particularly by pattern of family history and age of individual at-risk.

Age Factors↗

PubMed2006

Trends in survival after childhood cancer in Europe, 1978-1997: report from the Automated Childhood Cancer Information System project (ACCIS).

This study, originating in the Automated Childhood Cancer Information System (ACCIS), evaluated the time trend in survival after childhood cancer in Europe. The study included more than 72,000 childhood cancer cases aged 0-14 years diagnosed in 1978-1997 and followed-up in 30 population-based cancer registries with a long history of registration and follow-up, in 15 European countries. Survival was analysed using an actuarial life-table method. Five-year cumulative survival probability increased significantly over the study period for all tumour types combined, from 54% for cases diagnosed in the period 1978-1982 to 75% in 1993-1997. Significant improvement was also observed in 10-year survival. Comparing the results for the period 1993-1997 with those for 1978-1982, the largest relative increase in survival was seen for hepatic tumours (32%) and the largest reduction in mortality for non-Hodgkin's lymphomas (60%). Least progress was seen for central nervous system (CNS) tumours. The improvement was statistically significant in all European regions and was most rapid in the East. The ranking among the European regions did not change over the study period, with highest survival in the North and the West and lowest in the East. Extended data collection is necessary to evaluate future time trends and changes in differences between European regions.

Adolescent↗

PubMed2006

Geographical comparison of cancer survival in European children (1988-1997): report from the Automated Childhood Cancer Information System project.

The aim of this study was to assess regional survival differences among childhood cancer patients in Europe. For this exercise, the Automated Childhood Cancer Information System (ACCIS) database was utilised. Survival data from 54 population-based cancer registries on 49,651 childhood cancer patients aged 0-14 years and diagnosed in 1988-1997 were analysed using life-table method. Overall, the 5-year survival was 72% among all patients, varying from 62% to 77% between the five geographical regions. The East region generally had lower survival rates than the rest of Europe. The geographical differences indicate the need for more co-ordination, systematisation and standardisation in diagnosis, referral and the treatment of childhood cancers in Europe. Increase of resources is necessary to improve the lower survival in the East region. Continuing data collection on a European level will facilitate monitoring of population-based survival of childhood cancer patients.

Adolescent↗

PubMed2006

How time affects the risk of rupture in appendicitis.

BACKGROUND: Increasing time between symptom onset and treatment may be a risk factor for a ruptured appendix, but little is known about how the risk changes with passing time. This study aimed to determine the changes in risk of rupture in patients with appendicitis with increasing time from symptom onset to treatment to help guide the swiftness of surgical intervention. STUDY DESIGN: We conducted a retrospective chart review of physician office, clinic, emergency room, and inpatient records of a random sample of 219 of 731 appendicitis patients operated on between 1996 and 1998 at 2 inner-city tertiary referral and municipal hospitals. Conditional risks of rupture were calculated using life table methods. Logistic regression was used to assess factors associated with rupture, and linear regression was used to assess factors affecting time from first examination to treatment. RESULTS: Rupture risk was < or = 2% in patients with less than 36 hours of untreated symptoms. For patients with untreated symptoms beyond 36 hours, the risk of rupture rose to and remained steady at 5% for each ensuing 12-hour period. Rupture was greater in patients with 36 hours or more of untreated symptoms (estimated relative risk [RR]=6.6; 95% CI: 1.9 to 8.3), age 65 years and older (RR=4.2; 95% CI: 1.9 to 6.1), fever > 38.9 degrees C (RR=3.6; 95% CI: 1.2 to 5.7), and tachycardia (heart rate > or = 100 beats/minute; RR=3.4; 95% CI: 1.8 to 5.4). Time between first physician examination and treatment was shorter among patients presenting to the emergency department (median, 7.1 hours versus 10.9 hours; p<0.0001), and those for whom a physician's leading diagnostic impression was appendicitis (6.3 hours versus 11.3 hours; p<0.0001). Patients sent for CT scan experienced longer times to operation (18.6 hours versus 7.1 hours; p<0.0001). CONCLUSIONS: Risk of rupture in ensuing 12-hour periods rises to 5% after 36 hours of untreated symptoms. Physicians should be cautious about delaying surgery beyond 36 hours from symptom onset in patients with appendicitis.

Adolescent↗

PubMed1992

Survival and disease progression in human immunodeficiency virus-infected women after an index delivery.

OBJECTIVE: Our objective was to provide information on survival and disease progression in human immunodeficiency virus antibody-positive pregnant women undergoing prospective evaluation. STUDY DESIGN: After an index delivery, 103 human immunodeficiency virus antibody-positive pregnant women were identified and underwent follow-up for 3 years. The patients were assessed medically and/or gynecologically when hospitalized for a human immunodeficiency virus-related illness or at each follow-up visit. The life-table method was used to estimate the cumulative probabilities of survival and remaining free of acquired immunodeficiency syndrome. Cox's proportional-hazards analyses were used to identify prognostic factors for survival and progression to acquired immunodeficiency syndrome. RESULTS: The majority of human immunodeficiency virus-infected pregnant women were alive 3 years later. Lymphadenopathy syndrome or herpes genitalis was significantly associated with a subsequent diagnosis of acquired immunodeficiency syndrome. Of the 103 original patients, six had acquired immunodeficiency syndrome at the index delivery and acquired immunodeficiency syndrome developed in 24. Approximately 94% of evaluable patients with development of acquired immunodeficiency syndrome had CD4-lymphocyte counts < 200/mm3. The most common opportunistic infection was Pneumocystis carinii pneumonia. Acquired immunodeficiency syndrome and postpartum zidovudine therapy were independent prognostic factors affecting survival. CONCLUSION: Survival was affected by Centers for Disease Control group status of human immunodeficiency virus infection at the index delivery.

AIDS-Related Complex↗

PubMed1984

The evolution of reparative techniques for the mitral valve.

Forty-eight adult patients underwent mitral valve repair for nonischemic valvular incompetence between 1963 and 1981. Early in our experience, 21 individuals received wedge leaflet resection or leaflet plication with posteromedial commissural annuloplasty. More recently, midleaflet annuloplasty has been employed in 13 patients and is now our preferred technique. Operative mortality was 6.3%, and all deaths occurred prior to 1973. Eventually valve replacement was necessary in 10 patients; all replacements were done prior to 1977. Technical errors and progression of rheumatic disease each accounted for half of these replacements. Five-year survival by the life table method was 74 +/- 9% for the entire group. Survival at 5 years for patients with prolapsing leaflets was significantly better (87 +/- 7%) than for those with normal leaflet motion (46 +/- 14%). A residual postoperative murmur of mitral insufficiency correlated with the likelihood of subsequent valve replacement. Important technical aspects of valve repair are described, and criteria for optimal patient selection are discussed. The evolution of reparative methods has led to a better understanding and broader application of mitral valve reconstruction.

Female↗

PubMed1975

Relationship of cell type and lymph node metastasis to survival after resection of bronchial carcinoma.

In the completed adjuvant chemotherapy lung trials conducted by the Veterans Administration Surgical Group, the cell type was recorded in 2,341 of 2,349 curative resections; extent of lymph node involvement was known in all cases. Nodes were normal in 1,231 patients. Five- and ten-year survival computed by the life-table method was 33.7% and 20.4%, respectively. These rates were significantly greater than the 16.2% and 8.8% recorded in 1,118 patients whose nodes showed metastases. Among patients whose cell type was known, five-year survival in 484 with hilar node involvement was 17.4% and was not significantly different from 20.1% in 364 patients in whom only lobar nodes were involved. The survival was 8.9% in 268 patients with cancer in the mediastinal nodes; this was significantly worse than either of the aforementioned groups. A five-year survival of 26.8% in 1,482 patients with squamous cell carcinoma was greater than the 24.3% in 359 with adenocarcinoma and 22.4% in 500 with undifferentiated cell types, but the differences were not significant. Variations between these groups remained nonsignificant when nodes were normal and were of only borderline significance, at the 5% level, when they showed metastasis. When a curative resection has been accomplished, cell-type as classified in this study has little bearing on long-term survival, whereas the presence of node metastasis as well as its location is of the utmost importance.

Adenocarcinoma↗

PubMed1983

Pregnancy outcomes following Tompkins metroplasty.

Eighteen patients with poor reproductive histories and 2 patients with primary infertility underwent Tompkins metroplasty for a septate uterus. There were 19 pregnancies within 2 years of surgery, and 11 patients had at least 1 viable pregnancy, for an overall success rate of 55%. One of the infertile patients conceived and delivered. The average fecundability rate for the first 24 months was 0.078 (normal, 0.20). The cumulative pregnancy rate at 27 months was 94% by the life-table method. The group of patients (n = 14) with two or more losses and no other major risk factors for reproductive failure had higher fecundability and a better success rate (71%). The Tompkins metroplasty is a technically simple procedure with a success rate similar to that of the Jones procedure.

Abortion, Habitual↗

PubMed1988

Does minimal endometriosis reduce fecundity?

Twenty-one patients with minimal endometriosis treated with artificial insemination with donor semen (AID) because of male sterility were compared with 40 patients with the same degree of endometriosis treated by "expectant management" (EM). The conception response of both groups was analyzed with the life-table method calculating the monthly fecundity rate (MFR), and the cumulative pregnancy rate (CPR). Both groups were similar in terms of woman's age and length of infertility before diagnosis. The results obtained after the 12th month showed that the group treated with AID had a CPR of 80.9% and an MFR of 0.201, much higher than the group treated with EM, in which the CPR was 47.5% and the MFR 0.060. The results of the fecundity rate of the AID-treated group was comparable to that of normal population.

Adult↗

PubMed1983

Risk of relapse in steroid-sensitive nephrotic syndrome: effect of stage of post-prednisone adrenocortical suppression.

Glucocorticoid therapy has been effective in inducing remission in the majority of children with primary nephrotic syndrome. However, glucocorticoid-induced adrenocortical suppression is associated with early relapse, whereas normal adrenocortical function seems to delay the subsequent relapse. We analyzed 201 episodes of prednisone treatment in 47 children with steroid-sensitive nephrotic syndrome by the life-table method. The effect of partial cortisol substitution was studied as well. Adrenocortical function was determined by a two-hour ACTH test. A response of 50% to 100% of the minimum normal response was diagnosed as "moderate" suppression, and a response of less than 50% as "severe." Post-prednisone adrenocortical function was normal in 99 episodes (49%). Adrenocortical suppression occurred in 102 episodes; of these, 68 were considered moderate and 34 severe. Adrenocortical suppression increased both the initial relapse rate and the final risk of a relapse. Severe suppression was always associated with a relapse, the longest remission time being 0.5 year. In moderate suppression, several long, relapse-free intervals were observed, but the risk of relapse was still higher than in episodes with normal adrenocortical function. Cortisol substitution possibly decreased the risk of a relapse after severe adrenocortical suppression, but not after moderate suppression.

Adolescent↗