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PubMed1987

A reassessment of the risk of multiple sclerosis developing in patients with optic neuritis after extended follow-up.

One hundred and one of 146 patients presenting with isolated idiopathic optic neuritis, previously reviewed in 1978, were reassessed clinically, and retyped for HLA antigens and Factor B alleles, after a mean follow-up of 11.6 years. Fifty eight patients (57%) had developed multiple sclerosis at the time of reassessment in the present study, of whom 51 (88%) had clinically definite disease. This compared with 40% of the original group, in 1978, of whom 62% then had clinically definite multiple sclerosis. When the life-table method of analysis was used, the probability of developing multiple sclerosis was 75%, 15 years after the initial episode of optic neuritis. The frequencies of HLA-DR2 and the recently defined D-region antigen, DQw1, were significantly increased in patients with isolated optic neuritis and those who subsequently developed multiple sclerosis compared with normal controls, but neither allele appears to influence progression from optic neuritis to multiple sclerosis. Patients with optic neuritis who were HLA-DR3 positive had an increased risk for the development of multiple sclerosis (RR = 2.8) and this risk was further enhanced when DR3 occurred in combination with DR2 (RR = 6.7). The overall increased risk of developing multiple sclerosis for patients with this combination was 26 times that for the normal population. When the patients' original tissue-typing was considered BT 101 no longer influenced conversion of optic neuritis to multiple sclerosis. This may partly be explained by improved methods of tissue-typing, since not all BT 101 patients were subsequently found to be positive for HLA-DR2 or HLA-DQw1 and vice versa and by extended follow-up as multiple sclerosis conversion in HLA-DR2 negative individuals increased with time. All 101 patients were typed for Factor B alleles. No significant differences in frequencies were found between individuals with isolated optic neuritis or those who progressed to multiple sclerosis compared with the control population. Recurrent episodes of optic neuritis were associated with an increased risk for the development of multiple sclerosis in this study.

Adolescent↗

PubMed1999

Survival estimates for adults with cystic fibrosis born in the United Kingdom between 1947 and 1967. The UK Cystic Fibrosis Survey Management Committee.

BACKGROUND: The UK has published observed cohort survival figures for subjects with cystic fibrosis born since 1968. Prior to 1968 cohorts cannot be established directly from routine data as cystic fibrosis was classified with a number of unrelated conditions in ICD7. Reported here are interrupted survival curves from 1978 for patients with cystic fibrosis born before 1968. METHODS: Life tables for the three year cohorts born between 1947 and 1967 were constructed by firstly estimating the numbers of patients with cystic fibrosis born in each cohort from live birth data and the disease incidence. The number of the estimated cohort that had survived to 1978 is known, which enables the proportion surviving to 1978 to be calculated. The survival of these cohorts after 1978 can be calculated in the usual way. RESULTS: The survival for each successive cohort was better than that of the previous one, but most of the improvements appear to have taken place up to the age of about 20 years. Only 3% of the 1947-49 cohort survived to 30 years of age compared with 21% for the 1965-67 cohort, and 3% of the 1953-55 cohort survived to 40 years of age. For the later cohorts the mortality rate for those aged between 26 and 30 years appears to be about 50 per 1000 per year. CONCLUSIONS: While the trend in the numbers surviving into later adulthood is upwards, the mortality rates for these ages does not appear to be improving. It is not possible to tell from these data whether the high mortality rates in adulthood will improve with better resourced adult clinics or with improved treatment during childhood.

Adult↗

PubMed1978

Different prognostic value of exercise electrocardiogram in men and women.

In 1,455 subjects (947 men and 508 women) who underwent a bicycle ergometer stress test for evaluation of atypical chest pain, the incidence of coronary events (definite myocardial infarction or sudden death) was assessed by the life table method. The follow-up period ranged from 3 to 7 years (mean 5.2 years). In men with positive exercise test (ischemic ST depression greater than or equal to 1 mm), the 5-year incidence of coronary events was 18.3%, compared with 1.9% in negative responders. In women with positive response, the 5-year incidence of coronary events was 4.6%; in negative responders, it was 0.3%. The poor predictive value of ischemic ST responses to exercise in women is emphasized.

Adult↗

PubMed1985

Renal survival rate of IgA nephropathy.

In an attempt to identify prognostic indicators in IgA nephropathy, we evaluated the relationship between clinical and histological findings and changes in renal function in 81 patients with IgA nephropathy whose creatinine clearance was more than 80 ml/min at the time of renal biopsy. The incidence of patients whose creatinine clearance decreased to less than 60 ml/min during the follow-up period was calculated with the life table method to designate the renal survival rate. This rate was compared according to the clinical and histological findings at the time of renal biopsy. In conclusion, a statistically significant decrease in the renal survival rate was observed in patients with proteinuria of more than 1.0 g/day, hypertension, severe diffuse proliferative glomerulonephritis, diffuse proliferative glomerulonephritis with focal crescents and glomerular deposition of IgM and/or fibrinogen-related antigen.

Adolescent↗

PubMed1994

Outcome and prognostic determinants in the hemolytic uremic syndrome of children.

The late outcome in 89 children with the hemolytic-uremic syndrome (HUS) observed from 1971 to 1988 was analyzed up to 17 years after onset in relationship to various clinical and pathologic features at the onset of the disease. In the first 3 months after onset (acute phase) 69% of all children needed dialysis therapy. Fifteen children died, 9 during the acute phase and 6 subsequently. All surviving patients except 7 were reexamined and divided into five prognostic categories: recovery, residual renal symptoms with normal kidney function, moderate renal insufficiency, preterminal chronic renal failure (CRF) and end-stage renal disease (ESRD). The rate of recovery calculated by the life table method increased from 35% after 10 years in 1971-1979 to 68% in 1980-1988 (p < 0.001); it was lower in infants than in older children (44 vs. 63%; nonsignificant). Children with atypical HUS experienced more often preterminal CRF, ESRD or death than those with a typical (postenteropathic) form (33 vs. 17%; p < 0.05). If oliguria lasted < 7 days, 74% of patients recovered after 10 years versus 13% in the case of oliguria > 14 days or anuria > 7 days (p < 0.0005). The rate of recovery was also significantly smaller with the duration of dialysis treatment > 7 days, central nervous system involvement and requirement for antihypertensive therapy. In the entire series 7 patients developed preterminal CRF and 5 ESRD. Of 27 cases serially followed for 5-10 years after onset, a stable course was noted in 16, a subsequent improvement in 8 and deterioration in 3 leading to ESRD in 2.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System Diseases↗

PubMedDate not supplied

Atherogenicity and carcinogenicity of high-arsenic artesian well water. Multiple risk factors and related malignant neoplasms of blackfoot disease.

The objective of this study was to examine multiple risk factors and correlated malignant neoplasms of blackfoot disease (BFD), a unique peripheral vascular disease related to continuous exposure to high-arsenic artesian well water. A total of 241 BFD cases, including 169 with spontaneous or surgical amputations of affected extremities, and 759 age-sex-residence-matched healthy community controls were studied to explore the risk factors of BFD. Multiple logistic regression analysis showed that artesian well water consumption, arsenic poisoning, familial history of BFD, and undernourishment were significantly associated with the development of BFD. The life-table method used to analyze cancer mortality of 789 BFD patients followed for 15 years showed a significantly higher mortality from cardiovascular diseases, peripheral vascular diseases, and cancers of bladder, skin, lung, and liver among BFD patients as compared with the general population in Taiwan or residents in the BFD-endemic area. The results imply the atherogenicity and carcinogenicity of the artesian well water in the BFD-endemic area.

Arsenic Poisoning↗

PubMed1979

Subclavian arterioplasty for the ipsilateral subclavian-to-pulmonary artery shunt.

A new technique is described to avoid kinking and improve flow in the ipsilateral subclavian-to-pulmonary artery shunt. Experience with this procedure is reviewed in 35 infants and children with a variety of cyanotic congenital heart disease, including 10 with tricuspid atresia. Of these, 17 had had previous shunts: a Waterston shunt in six, a Glenn shunt in six, and a contralateral Blalock-Taussig shunt in five. The mean age was 5.6 years (range, 1 day to 16 years), and the mean follow-up was 24 months (range, 11 months to 4.5 years). There were no early deaths (less than 30 days), but there were two late deaths. There were three shunt failures at 2 weeks, 1 month, and 10 months; two of the failures were in infants aged 1 day and 4 days at operation. There were no late shunt failures. The patency by the life table method was 91.4% at 6 months, 88.5% at 1 year, with no further drop-off. It is concluded that subclavian arterioplasty can be performed safely and offers improved shunt patency in comparing to the ipsilateral Blalock-Taussig shunt.

Adolescent↗

PubMed1984

Percutaneous transluminal angioplasty of the arteries of the lower limbs: a 5 year follow-up.

A total of 482 percutaneous transluminal angioplasties (PTAs) of the arteries of the lower limbs were performed in 411 patients between 1977 and 1983. The 5 year patency rate, calculated by the life table method, was 83% for iliac and 58% for femoropopliteal PTA. Clinical improvement after the procedure was confirmed by a significant drop of the arm-ankle pressure difference: 48 +/- 5 mm Hg before vs 17 +/- 5 mm Hg 2 years after iliac PTA (p less than .01) and 73 +/- 5 mm Hg before vs 28 +/- 6 mm Hg after femoropopliteal PTA (p less than .01). The majority of reocclusions occurred within the first year after angioplasty. Patients with stenoses or occlusions of less than 3 cm had a favorable long-term patency rate of 74%. Conversely, patients with femoropopliteal occlusions presenting with pain at rest, diabetes, occlusions of greater than 3 cm, or poor distal runoff had an elevated rate of reocclusion. Complications, which occurred in 8% of the patients in whom PTA was attempted, included local hemorrhage, dissection, embolism, and spasm necessitating surgical intervention in 2%. No deaths or amputations were a direct consequence of PTA. PTA of arteries of the lower limbs may thus be regarded as a valid complementary treatment to vascular surgery in patients with occlusive disease of the peripheral arteries.

Aged↗

PubMedDate not supplied

Profile of hypertensives as a determinant of long-term antihypertensive medication needs.

The experience of 110 hypertensives who participated in a worksite stepped-care treatment program has been examined to draw a patient profile at entry that would determine medication needs on a long-term basis. Patients entered untreated with a blood pressure (BP) level of greater than or equal to 160 mm Hg systolic and/or greater than or equal to 95 mm HG diastolic (DBP) and had a minimum follow-up of 1 year. Treatment was initiated with diuretics, and additional drugs were added as necessary to achieve BP control. Patients were divided into three groups according to initial DBP levels: Group A (33 patients, greater than or equal to 105 mm Hg), Group B (43 patients, 95-104 mm Hg), and Group C (34 patients, less than 95 mm Hg). Using a life table method, we analyzed the therapeutic experience of these patients to obtain 5-year cumulative rates of adding a second drug to diuretics. Within the first 2 years of treatment, the cumulative rates were: 64% in Group A, 33% in Group B, and 23% in Group C. In all three groups the rates after the second year remained stable. This stepped-care approach resulted in BP control (less than 160/95) which ranged from 78% in the first year to 96% in the fifth year. Findings suggest that initial DBP level and age are principal factors in determining medication needs. Furthermore, at higher DBP levels, younger nonwhite and younger white males are most likely to require a second drug within the first year of treatment. The need for a second drug is apparent within the first 2 years.

Adult↗

PubMedDate not supplied

Long-term antihypertensive therapy with captopril.

Most forms of hypertension require life-long treatment; thus, it is important to determine the continuing effectiveness and safety of any new therapeutic agent. While participating in various investigational studies, 7103 hypertensive patients received captopril, of whom 4397 were treated for 3 months to 4 years. The 4-year patients included 2498 with mild or moderate essential hypertension (diastolic pressure less than 120 mm Hg), 893 with severe essential hypertension, and 517 with renovascular hypertension. Repeated examinations of these long-term therapy patients, the majority of whom also were receiving a diuretic, indicated no drug tolerance to the combination, i.e., there was continuing control of the blood pressure without significant increases in dosage or addition of other drugs. Side-effects occurring during the first few months of captopril administration (rash, taste disturbances, and, rarely, neutropenia) were not a problem during prolonged therapy. A few patients (70/7,103, or 1.0%) developed proteinuria, usually reversible and seldom associated with any deterioration of renal function. The proteinuria occurred most often in patients who had preexisting renal disease and were receiving high doses of the drug. There were no significant changes in key biochemical parameters. A total of 230 patients discontinued treatment for failure to maintain adequate blood pressure reduction, and 397 for side-effects. The estimated 4-year cumulative frequency of drug discontinuance for side-effects was 11.6% (life table method), which compares favorably with other classes of antihypertensive drugs.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗

PubMedDate not supplied

A 1-4 year follow-up study of 306 cases of stroke.

To study the long-term prognosis of stroke, we performed annual follow-up examinations on 306 patients who had survived cerebrovascular accidents. All patients had been admitted to the Neurology Service, First Teaching Hospital, Beijing Medical College from January 1, 1976, to December 31, 1978, and were followed up for 1 to 4 years. The series included 217 cases of cerebral thrombosis, 54 of cerebral hemorrhage, and 35 of TIA. The life-table method was used to determine the cumulative survival rate (CSR), cumulative marked improvement rate (CMIR), and cumulative recurrence rate (CRR), for each of these three types of stroke. The main results were the following: 1. The prognosis was not significantly influenced by sex, BP level on admission, or type of cerebrovascular accident. 2. Age was an important prognostic factor. The survival rate decreased significantly in each successive age group. However, age was not a risk factor for recurrence or poor improvement. 3. The cumulative survival rate, cumulative marked improvement rate, and cumulative recurrence rate did not differ significantly among cerebral thrombosis, cerebral hemorrhage, and TIA.

Actuarial Analysis↗

PubMed2005

Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part II: Incidence and consequences of local recurrence.

Supracricoid hemilaryngopharyngectomy (SCHLP) was performed in 147 patients over a 19-year period for previously untreated invasive squamous cell carcinoma of the pyriform sinus. With a minimum of 3 years' follow-up, the current retrospective series was designed to document the incidence, risk factors, and consequences of local recurrence following SCHLP. Before operation, 97.4% of patients had an induction chemotherapy regimen. A complete clinical response and a complete histologic regression were noted in 21.7% and 16.8% of patients, respectively. A significant statistical relationship (p = .0001) was noted between complete clinical response and complete histologic regression. Postoperative radiotherapy was used in 49.8% of patients. The overall local recurrence rate was 8.2%. The 5-year actuarial (Kaplan-Meier life-table method) local control estimate was 90.4%. As a function of T stage, the 5-year actuarial local control estimates were 96.2%, 91.1%, 92.9%, and 62.6% in patients with tumors classified as T1, T2, T3, and T4a, respectively. On univariate analysis, the overall local recurrence rate varied significantly, from 5.3% to 55.6% if the apex of the pyriform sinus was invaded (p = .02), 6.9% to 18.7% if the posterior pharyngeal wall was invaded (p = .03), and 6.3% to 60% if the margins of resection were positive (p = .02). In a stepwise regression model, positive margins of resection (odds ratio, 8.4; 95% confidence interval, 2.2 to 32.2; p = .002) and invasion of the apex of the pyriform sinus (odds ratio, 6.1; 95% confidence interval, 1.1 to 33.3; p = .04) were the variables statistically associated with an increased risk of local recurrence. Local recurrence resulted in a statistically significant increased risk of nodal recurrence (p = .005) and death (p < .004). The overall laryngeal preservation rate was 91.2%. From an oncological perspective, these results suggest that SCHLP should become a major tool in the armamentarium of the head and neck surgeon and should be integrated into future trials aimed at organ preservation in patients with invasive squamous cell carcinoma of the pyriform sinus.

Adult↗

PubMed1987

Two-year evaluation of misoprostol for carcinogenicity in CD Sprague-Dawley rats.

The carcinogenic potential of misoprostol, a synthetic prostaglandin E1 analogue with anti-ulcer potential, was evaluated in CD Sprague-Dawley rats. The compound was given daily by gavage at 24, 240, and 2,400 micrograms/kg, up to 150 times the daily human dose for 2 years. Necropsies were done on all animals and the incidences of non-neoplastic and neoplastic changes analyzed for significance by life table methods. The only statistically significant non-neoplastic finding was epithelial hyperplasia and hyperkeratosis of the gastric mucosa. These changes, which are characteristic of some prostaglandins, were expected. Other non-neoplastic findings were typical of known spontaneous conditions in this strain of rats. The most frequent neoplasm was the pituitary adenoma, followed by the mammary fibroadenoma, mammary adenoma, mammary adenocarcinoma, and thyroid C-cell adenoma. A rare neoplasm, squamous cell carcinoma of the ovary was found in two rats. There was no evidence that misoprostol is carcinogenic for CD Sprague-Dawley rats.

Alprostadil↗

PubMed1987

Twenty-one-month evaluation of misoprostol for carcinogenicity in CD-1 mice.

Misoprostol, a synthetic prostaglandin E1 methyl ester analogue with anti-ulcer potential, was evaluated for its carcinogenic potential in CD-1 strain mice. The compound was given daily by gavage at 160, 1,600, and 16,000 micrograms/kg for 21 months. Necropsies were done on all animals and the incidences of non-neoplastic and neoplastic changes analyzed for significance by life table methods. The only statistically significant non-neoplastic compound-related findings were epithelial hyperplasia and hyperkeratosis of the gastric mucosa and hyperostosis of bone in the marrow cavity of sternebrae and femurs. The changes in the gastric epithelium are characteristic of some prostaglandins and were expected. The bone hyperostosis was associated with misoprostol in high dosages, and was considered unique to the mouse. Other non-neoplastic findings were typical of known spontaneous conditions in mice. The most frequent neoplasm was the hepatocellular adenoma followed by lymphosarcoma, lung alveolar carcinoma, and Harderian gland adenoma. Several proliferative lesions of the duodenum were considered to be spontaneous. These were focal avillous hyperplasia, focal atypical hyperplasia, and junctional polyp. There was no evidence that misoprostol is carcinogenic for CD-1 mice.

Alprostadil↗

PubMed1991

Middle meatus anstrostomy: patency rates and risk factors.

Two hundred patients with chronic sinusitis were operated on using functional endoscopic sinus surgery (FESS) techniques. These patients were followed closely over 3 years. Patency of the endoscopic middle meatotomy was recorded using actuarial life-table methods. The overall patency rate of the endoscopic middle meatotomy was 93.55%, and the actuarial patency rate at 36 months was 87.47%. The presence of seasonal allergy with nasal polyps was the most important variable in predicting closure. Middle turbinectomy was the most important variable in predicting patency. Symptoms were evaluated by questionnaire at 1 year. Questionnaire data indicate that 96% of these patients are improved or asymptomatic.

Actuarial Analysis↗

PubMed1983

Comments on a series of 88 invasive microcarcinomas of the breast.

Eighty-eight women with minimal invasive breast cancer were treated at the Istituto Nazionale Tumori of Milan, in the decade 1970-1980. Their tumors were smaller than 0.5 cm in diameter and were clinically assessed as T1N0M0; surgery, consisting of radical or limited procedures, was performed, always with complete axillary dissection. Pathologic assessment showed that axillary lymph nodes presented with metastases in 21.5% of cases. In 1 of N-positive cases, more than 3 nodes were affected, and in 5 cases extracapsular invasion was observed. Five-year actuarial survival, calculated by the life table method, was as high as 90%, demonstrating that these have a favorable prognosis, even when they are treated by limited surgery followed by radiotherapy on the residual breast, provided that the axilla is completely dissected. Minimal invasive breast cancer should consequently be clearly distinguished from other pathologic entities termed as "minimal", such as lobular carcinoma in situ and intraductal carcinoma, for which complete axillary dissection is not worthwhile.

Adult↗

PubMed2006

The burden of selected diseases among older people in Denmark.

OBJECTIVE: The study evaluated the health impact of specific diseases. METHOD: Life tables and health survey data are combined to estimate expected lifetime with and without long-standing illness. We compared estimates based on observed rates of mortality and prevalence of illness with those based on hypothetical rates from which a specific disease has been eliminated. RESULTS: Life expectancy would increase by 4.0 years for 65-year-olds if circulatory diseases are eliminated, and the proportion of expected lifetime without long-standing, limiting illness would increase from 59.2% to 66.5% for men and from 52.2% to 55.6% for women. Elimination of musculoskeletal diseases would not change life expectancy but would increase the proportion of expected lifetime without long-standing illness. CONCLUSIONS: Because of comorbidity, more years of illness are to be expected if lethal diseases are to be eliminated. Elimination of nonfatal diseases would mainly transfer years with long-standing illness to years without illness.

Aged↗

PubMed2001

Health expectancy in Greenland.

BACKGROUND: Mortality and disease patterns in Greenland have greatly changed since the 1950s. Infectious diseases have decreased markedly; chronic diseases, suicides and violent deaths have increased. METHODS: Life tables for the period 1991-95 were used and health status was derived from the 1993/94 Greenland Health Interview Survey. Health expectancy for the Inuit population of Greenland was calculated by an index suggested by Sullivan. RESULTS: Greenland Inuit women live longer than men, but the expected lifetime in self-rated good health was shorter for women than for men. Chronic disease rates are high in Greenland, and consequently many healthy life years are lost, especially because of musculoskeletal diseases. Health expectancy decreases with age, but for this Inuit population the proportion of healthy life years increases after the age of 60, especially among men. CONCLUSION: The many healthy life years lost in Greenland according to self-rated poor health and chronic diseases should be a cause for concern in public health planning in Greenland. Special attention should also be paid to future investigations of regional patterns of health in Greenland, since there is great population heterogeneity according to geography and urbanization.

Adult↗