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At least 1,009 records · Page 56Linked to original sources
PubMed1991

[Cox regression model analysis of influence of the transitional mucosa adjacent to rectal carcinoma on anastomotic recurrence after anterior resection].

The influence of nine clinico-pathological factors on anastomotic recurrence of rectal cancer after anterior resection was analyzed using Cox regression model. Among the nine factors, the mucin histochemical changes in mucosa at the resection margins, Dukes' stage and histological type of the cancer were of significance (P less than 0.1). The most important variable for anastomotic recurrence was mucin histochemical changes at the resection margins according to the Wald statistic value. It is suggested that the transitional mucosa adjacent to rectal carcinoma in which mucin histochemical changes take place bears great weight on the further malignant transformation after anterior resection. The biological characteristics of the transitional mucosa and clinical significance of the application of Cox regression model for prognostic analysis are discussed.

Anastomosis, Surgical↗
PubMed1991

[BCG immunotherapy in malignant lymphogranuloma].

The authors investigate within the framework of a multicentre, randomized and stratified investigation the influence of non-specific BCG immunotherapy in adult patients with Hodgkin's disease. The thus created data base was processed according to the Protocol of a prospective study. Supplementary BCG treatment was compared in a group of 112 patients with the fate of 114 patients in a control group without immunotherapy. Although the mean period of complete remission in the group of vaccinated patients regardless of the clinical stage of the disease was 94 months and in the control group 74 months, the difference was not statistically significant. The five-year survival was 93% in vaccinated patients and 91% in the control group. The probability of 10-year survival does not differ substantially in vaccinated patients (88%) and in non-vaccinated patients (85%). There was no difference in the work capacity of patients in the two groups. Immunotherapy was not selected, when testing prognostic factors by Cox' regression analysis, into any of the prognostically favourable models.

Adult↗
PubMed1991

[The optimization of combined physiotherapy in the system of rehabilitating victims with complicated fractures of the extremities].

The schemes were worked out for optimization of complex physiotherapy in rehabilitation system of patients with complicated fractures of extremities. This work was carried out on the basis of 178 dynamic clinic observations with application of biomechanical and roentgenological methods, as well as methods of mathematical modelling and prognostication. That made it possible to increase the efficiency of rehabilitation programs by 3.2--4.1 times. The article deals with the perspective trends in the development of this problem.

Adolescent↗
PubMed1990

To assess the efficacy of prophylaxis in digestive tract surgery using a predictive model of complication risk.

One hundred and ninety-one patients, all candidates for major clean-contaminated surgery, were classified according to the risk of developing postoperative wound infection, using clinical and nutritional factors. A widely validated nutritional assessment model, the Prognostic Nutritional Index (PNI), was used preoperatively to evaluate the risk and probability of post-operative septic complications. Based on the predicted outcome, patients were assigned to either a poor or a good risk group for statistical comparison. A prospective, double-blind, randomized trial was performed to compare the effectiveness of the monocyclic beta-lactam, aztreonam, with gentamicin for short-term perioperative prophylaxis. In the poor risk group (PNI greater than 40), aztreonam prophylaxis significantly reduced postoperative septic complications (p less than 0.05). The use of an objective scoring system to assess the risk of postoperative sepsis is recommended for future studies on antibiotic prophylaxis as it offers a realistic assessment basis.

Aztreonam↗
PubMed1989

Risk factors for first operation in Crohn's disease.

We studied 267 consecutive Italian patients (146 male, 121 female) with Crohn's disease. Median time from the first symptom to diagnosis at our center was 21 months (range 1-372), whereas median follow-up from the first visit was 38 months (range 1-180). The disease affected the small bowel in 93 (35%) cases, the ileum and colon in 76 (28%), and the colon in 98 (37%). Forty-nine percent of the patients underwent major abdominal surgery for the disease at least once. The cumulative probability of abdominal surgery was 36% and 55%, 60 and 120 months after the onset of symptoms, respectively. Univariate analysis indicated that patients with colon involvement (p less than 0.0001), those with a longer interval between first symptom and diagnosis (p less than 0.0001), and those at an older age at diagnosis (p less than 0.0003) had a significantly greater probability of escaping abdominal surgery. The interval between first symptom and diagnosis, the site of disease, and the age at diagnosis were confirmed as risk factors for surgery, in decreasing order of importance, by multivariate analysis with Cox's proportional hazard model. A prognostic index for first operation based on these variables is proposed.

Adolescent↗
PubMed1989

Risk classification as the basis for clinical staging of diffuse large-cell lymphoma derived from 10-year survival data.

Two hundred and fifty previously untreated adult patients with diffuse large-cell lymphomas were treated with a chemotherapy combination of cyclophosphamide, adriamycin, vincristine, prednisone, and low-dose bleomycin (CHOP-Bleo) with or without radiotherapy between 1974 and 1984. The 10-year survival rates for patients with Ann Arbor stages II, III, or IV disease of 55%, 42%, and 40%, respectively, were not significantly different. However, the survival rate of 76% for patients with stage I disease was clearly better. Factors more indicative of prognosis than stage, as found by univariant analysis, were tumor burden, serum lactic dehydrogenase level (LDH), age, and constitutional symptoms. From these, a multivariant analysis selected tumor burden, LDH level, and age as major independent factors for predicting survival (P less than .001). A prognostic risk model constructed on the basis of tumor burden and LDH levels identified four distinct risk groups (A, B, C, D) with 10-year survival rates of 85%, 66%, and 43% for A, B, and C. No patient in group D survived 10 years. These risk groups also had a strong correlation with complete remission rates and with relapse rates. Thus this model proved more effective for identifying patient populations according to their expected responses, durations of remission, and survivals than the Ann Arbor staging system. Detailed information supporting the use of this system for predicting prognosis and for treatment selection for patients with diffuse large-cell lymphomas is provided.

Adolescent↗
PubMed1978

The significance of leukemic cell volume distribution.

The use of electronic pulse spectroscopy to determine the volume distribution of a white blood cell fraction isolated by sedimentation from anticoagulated whole blood permits a rapid quantitative measure of size and dispersion of white blood cells in suspension. In patients without apparent hematologic diseases the white cell volume distribution presents as a broad peak. In patients with a large percentage of circulatory malignant cells, a single narrow volume peak is observed in acute leukemias and a broad and sometimes bimodal curve is observed in chronic leukemias. The volume of the leukemic cells is observed to shift in vivo after the start of effective chemotherapy as was predicted on the basis of a tissue culture model. The prognostic significance of the white cell volume distribution in leukemia and the use of a shift in size of leukemic cells after the start of therapy as a means of monitoring therapy are discussed.

Autoanalysis↗
PubMedDate not supplied

Results of treatment.

Overall results of management in patients admitted to the 8 Italian centers participating in the International Cooperative Study on Timing of Aneurysm Surgery were rather unsatisfactory, with good recovery in only 42% of patients, and death in 45% of patients. As compared to the other centers included in the Study, Italian centers exhibited a significantly lower recovery rate and a significantly higher mortality rate. There were significant differences also between the individual Italian centers; independently of admission neurological status and timing of surgery, the outcome was better in centers 2 and 6 (a mortality rate under 20%) and worse in centers 1 and 8 (a mortality rate around 60%). Using prognostic factor models, higher than expected mortality rates were observed in 4 centers, and lower than expected good recovery rates in 3 centers. In Italian centers vasospasm accounted for the highest morbidity and mortality rate; the difference in mortality rate from vasospasm between Italian and other centers was very significant. Other important causes of death and disability were constituted by direct effect of the initial bleed and by recurrent hemorrhage. Patients operated on in Italian centers exhibited a good recovery in 57% of cases; the mortality was 27%. Differences from the other centers were less marked than for the overall management results. Mortality rates from vasospasm and from surgical complications were significantly higher in Italian than in the other study centers. Between the individual Italian centers, vasospasm accounted for the highest mortality rate in centers 7 and 8 (17% and 28% respectively). Postoperative pneumonia was significantly more frequent in Italian than in the other centers. In regard to timing of surgery, the differences in results between Italian and other centers were less marked when surgery was performed after 10 days from hemorrhage. In Italian centers as a whole, a delayed operation was linked with a better outcome than an early or subacute operation. The lowest recovery rate was observed in drowsy patients operated on between 4 and 10 days from the hemorrhage. Focal ischemic deficits and pneumonia were prevalent after an operation within 3 days of hemorrhage, while postoperative brain swelling was most frequent in patients operated on between 4 and 10 days from hemorrhage. The differences in results between Italian and other centers and among the individual Italian centers are widely discussed; possible explanations include inadequate modalities of treatment (especially inadequate management of vasospasm) and structural deficiencies of intensive care management in seriously ill patients.

Humans↗
PubMed1986

[Activation of the complement system during hemodialysis].

One of the adverse effects of haemodialysis is activation of the complement system occurring at the contact of blood with the dialyser membrane. In vitro conditions it was found by means of a modified method of registering haemolitic complement activity pre- and post-incubation with the membrane that the activation of complement in a given blood donor depends both on the inherent complement reactivity and on the surface physico-chemical qualities. The contribution of each component was estimated by means of the coefficient of spontaneous speed (kspont) and of induced speed (kind) of complement activation. The comparison of the results of the complement system activation in vivo (in 9 dialysed patients) with the in vitro results made it possible to use the designed kinetic model in prognostication of the complement system of a given patient subjected to haemodialysis.

Cellophane↗
PubMedDate not supplied

[Prognosis of the probable morbidity rate in ischemic heart disease in patients over 50].

A mathematic model on prognostic statements as to the development of the ischaemic heart disease from the 50th year of life has been developed. By applying the probit analysis it was possible to plot curves which contain statements on the probable morbidity rate with regard to the ischaemic heart disease. The probability of becoming affected by the ischaemic heart disease increases with advancing years both in men and women. It is highest for men between 50 and 59 years and for women between 60 and 75 years. Between 70 and 74 years the risk becoming affected by the ischaemic heart disease is 4 to 5 times higher than between 50 and 54 years.

Age Factors↗
PubMed1994

Prognostic factors in aggressive non-Hodgkin's lymphoma: who has "high-risk" disease?

As the above-mentioned cellular and molecular parameters and newly identified biologic features are evaluated in larger numbers of patients with aggressive NHL, the biologic heterogeneity of this disease will be better appreciated. With a more complete understanding of the disease, it is likely that we will substitute biologic variables for clinical surrogate features in our prognostic factor models and target these biologic variables for therapy in specific subsets of patients. In the meantime, widely accepted clinical models such as the International Index and the age-adjusted index will aid in the identification of specific patient risk groups and the ongoing comparison of different therapeutic approaches. Early restaging with sensitive techniques like Ga-67 citrate scans may also identify patients with suboptimal responses to induction therapy at timepoints when additional therapeutic alternatives may be most effective.

Adult↗
PubMed1994

[Medical problems in the professional formation of young pilots in combat units].

The modern development of the AF originates the necessity to reduce the period of young pilots training in familiarizing with the new aircraft of the 4th generation. The improvement of medical support of personnel reinforcement is of great importance for this matter. The authors study these questions using new original positions and substantiating the importance and efficiency of dynamic prognostical mathematical models for evaluation of young pilots' formation qualities. These models are based on the 4-grade adaptational process. One of the advantages of these models is a multiplicity of factors which are used during the process of evaluation, including an attempt to take into account individual and psychological features of pilots, their functional and professional capabilities.

Adult↗
PubMed1996

Do-not-resuscitate orders and withheld or withdrawn treatment.

Advances in medicine have brought immense possibilities in therapy but at a price including tremendous financial costs and also protracted human suffering. Cardiopulmonary resuscitation (CPR) is an emergency procedure in patients with cardiopulmonary arrest. Out-come of the CPR depends upon the character and severity of the afflicting disease, upon the patient's condition before cardiopulmonary arrest and upon the response to therapy. CPR is instituted by emergency medical technicians automatically even in terminal condition of patients. Various models for prognostic prediction may confirm early decision about relevance of continuing treatment and writing a "DO-NOT-RESUSCITATE" order or withdrawing treatment. Numerous studies pointed out two exceptions, when CPR is not started and when the aggressive therapy is withdrawn-DNR order is written in the patient's medical record: 1. on the basis of autonomy the patient may not consent with CPR in advance or when he is incompetent, the family or surrogate decide to withdraw treatment: 2. physician is not obliged to provide diagnostic or therapeutical interventions (not even when requested by the family), when these acts are futile. The meaning of futility may be understood in a different way, but always the ethical principles must be considered: beneficence, maleficence, social justice and autonomy of the patient. In burn medicine, there are different factors encouraging the DNR orders, withheld and withdrawn treatment. This dilemma might be decided only by an interdisciplinary conference.

Advance Directives↗
PubMedDate not supplied

Prognostic indices in peritonitis.

In this review an update concerning the prognostic factors and scoring systems in peritonitis is given. The course of the disease is influenced by the physiological reserve of the patient, the acute severity and the type of the disease, the success of the operation and subsequent management and complications. The Acute Physiology and Chronic Health Evaluation Score (APACHE II) may be used with pre-operative data for the assessment of the severity of the disease or with postoperative data for monitoring. The Mannheim Peritonitis Index (MPI) and the Peritonitis Index Altona are based on pre- and intraoperative data and are also used for severity assessment. Treatment selection with respect to re-operation is supported by the Prognostic Peritonitis Model and the Abdominal Re-operation Predictive Index, covering data from the pre-, intra- and postoperative period. Adequate evaluation data are available for APACHE II and MPI, showing that these instruments are useful for risk assessment, definition of inclusion/exclusion criteria and analysis of comparability in clinical trials. Evaluation of treatment policies and quality assurance can best be performed with APACHE II, monitoring with APACHE II and Multiple Organ Failure scores. Support of individual patient care is still experimental.

APACHE↗
PubMedDate not supplied

Relationships between cathepsin-D, pS2 protein and hormonal receptors in breast cancer cytosols: inconsistency with their established prognostic significance.

In this study the unexpected findings from the analysis of 278 breast cancer tissue specimens are reported. A surprising strongly positive correlation between an unfavourable and a favourable prognosis with markers cathepsin D and pS2 respectively, was revealed by linear regression analysis (Pearson, Student-T-Test). In the relevant literature reviewed only one similar, although indirect, observation was found. On the other hand, a weak relationship between pS2 and ER has emerged using the same method, while the pS2/PgR association remained strong. The latter supports the hypothesis that pS2 positivity is associated with positive PgR and may be a marker of functioning ER, irrespective of ER status. These and other similar findings underline the need for a better understanding of the underlying molecular events as well as the necessity of an effective prognostic evaluation model for breast cancer.

Adult↗
PubMed1998

Contemporary hormonal management of advanced prostate cancer.

The traditional definition of "advanced" prostate cancer includes only patients with widespread osteoblastic or soft-tissue metastases (clinical or pathologic stage T any N any M1; or stage D2). Current evidence indicates that this definition should be broadened. Because many patients with T3 disease or local lymph node metastases progress to distant metastases, the concept of advanced prostate cancer should also include stages C and D1 (T3, T4, and any T N1). Furthermore, based on pretreatment prostate-specific antigen (PSA) levels, many men treated for clinically localized disease will progress rapidly and, depending on their age and general health, should be included in the advanced-disease category. Also, using prognostic marker modeling with PSA, tumor grade, and other factors, recurrences can be predicted even earlier in many cases. This may be particularly significant in light of recent clinical data indicating that early androgen ablation therapy delays disease progression and improves survival in patients with advanced (M0 or M1) disease. The luteinizing hormone-releasing hormone (LHRH) agonists have become the preferred method of androgen ablation in patients with advanced prostate cancer. Use of an LHRH agonist, alone or combined with an antiandrogen, is more acceptable to many patients than orchiectomy and lacks the potential cardiotoxicity associated with estrogens. Combined hormonal therapy remains controversial but may provide a modest survival benefit, especially in men with minimal metastatic disease. Intermittent hormonal therapy has great appeal, particularly because of the potentially deleterious effects of long-term hormonal therapy; however, its efficacy has yet to be proven.

Antineoplastic Agents, Hormonal↗
PubMed2000

Which venous leg ulcers will heal with limb compression bandages?

PURPOSE: To develop a simple prediction rule to identify patients in whom a venous leg ulcer will heal using a limb compression bandage (eg, Unna's boot). SUBJECTS AND METHODS: We performed a retrospective cohort study of patients with venous leg ulcers who received a limb compression bandage applied weekly. Prognostic factors were assessed from the patient's history before the start of treatment. The outcome of interest was a healed wound within 24 weeks of treatment. The final model was validated in another data set. RESULTS: Several accurate prognostic models were developed. The simplest model summed the size and duration of the wound before treatment, with 1 point given for a wound with an area >5 cm(2) and another if the wound was >6 months old. In the development data set, ulcers healed in 93% (110 of 118) of patients with a score of 0, but in only 13% (9 of 67) of those with a score of 2. In the validation data set, ulcers healed in 95% (19 of 20) of patients with a score of 0, and 37% (44 of 120) of those with a score of 2. CONCLUSIONS: This simple prognostic model can be used to discriminate between patients with a venous leg ulcer that will or will not heal within 24 weeks of care with a limb compression bandage. The model may be useful in determining which patients to treat with a limb compression, and which patients should be referred or considered for alternative treatments.

Aged↗