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PubMed1992

Survival following locoregional recurrence of breast cancer: univariate and multivariate analysis.

Although prognostic variables for locoregional recurrence of breast cancer have been evaluated by univariate analysis, multifactorial analysis has not been previously performed. In the present study, survival following chest wall and/or regional lymphatic recurrence was determined in 230 patients with locoregionally recurrent breast cancer without evidence of distant metastases treated at the Radiation Oncology Center, Mallinckrodt Institute of Radiology and affiliated hospitals. Multifactorial analysis demonstrated that the site of recurrences correlated most strongly with overall survival (p = 0.001). The 5-year actuarial overall survival was 44-49% for patients with isolated chest wall, axillary, and internal mammary lymph node recurrence. Patients with either supraclavicular, multiple lymphatic, or concomitant chest wall and lymphatic recurrence had an 21-24% 5-year overall survival. The 5-year disease-free survival was 28-37% for patients with chest wall, axillary, or internal mammary recurrences compared to 4-13% for those with supraclavicular, chest wall and lymphatic, or those with multiple sites of lymphatic recurrence. Disease-free interval from mastectomy to recurrence was also found to be a significant prognostic factor for overall survival (p = 0.005). Fifty percent of patients with a disease-free interval of at least 2 years survived 5 years following locoregional relapse, compared to 35% for those with disease-free interval of less than 2 years. In the subset of patients with small chest wall recurrences (excised or less than 3 cm) and a disease-free interval of at least 2 years, the 5-year overall and disease-free survivals were 67% and 54%, respectively. These results suggest that subsets of patients with locoregional recurrence of breast cancer can survive for long periods of time. The conventional wisdom that chest wall and/or regional nodal recurrence following mastectomy uniformly confers a dismal prognosis is not necessarily true.

Adult↗

PubMed2003

Investigation of placental stem villi arteries in fetally growth-restricted pregnancies: a multivariate analysis.

Thirteen placentas were studied from 5 normal pregnancies and 8 from pregnancies complicated by fetal growth restriction (4 with present, 3 with absent, and 1 with reversed end-diastolic velocities at Doppler interrogation of the umbilical arteries). On immunohistochemically stained slides, the diameter (d) and the wall thickness (t) of the arterial vasculature of the stem villi were measured for a total of approximately 10,000 vessels. A multivariate 'mixed effect model' statistical analysis was performed using d and t as dependent variables and gestational age, delivery mode, fetal and placental weight, the degree of vascular collapse and Doppler blood flow patterns as independent variables. Gestational age, Doppler pattern and the degree of vascular collapse significantly affected both d and t, the mode of delivery influenced d while fetal and placental weights scarcely affected the dependent variables. The above parameters should therefore be taken into account when investigating placental stem vessel morphometry.

Birth Weight↗

PubMed2006

Liver resective surgery: a multivariate analysis of postoperative outcome and complication.

INTRODUCTION: Notwithstanding technical advances and high experience of liver resection of specialized centers, the rate of complications after surgical resection could be high. In this study, we analyzed causes and foreseeable risk factors linked to postoperative morbidity on the ground of data derived from a single center surgical population. MATERIALS AND METHODS: From September 1989 to March 2005, 134 consecutive patients had liver resection for Hcc and 153 consecutive patients with liver metastasis (derived from either colorectal cancer or noncolorectal cancer) at our department. We performed 22 major hepatectomy, 20 left hepatectomy, 14 trisegmentectomy, 77 bisegmentectomy and/or left lobectomy, 74 segmentectomy, and 80 wedge resection. RESULTS: In-hospital mortality rate was 4.5%, about 7% in Hcc cases and 2.6% in liver metastasis. Morbidity rate was 47.7%, caused by the rising of ascites (10%), temporary impairment liver function (19%), biliary fistula (6%), hepatic abscess (25%), hemoperitoneum (10%), and pleural effusion (30%) sometimes combined each other. Some variables, associated with the technical aspects of surgical procedure, are responsible of the rising of complication as: Pringle maneuver length of more than 20 minutes (p=0.001); the type of liver resection procedure [major hepatectomy (p=0.02), left hepatectomy (p=0.04), trisegmentectomy (p=0.04), bisegmentectomy and/or left lobectomy (p=0.04)]; and the request of an amount of blood transfusion of more than 600 cc (p=0.04). Also, both liver dysfunction, in particular Child A vs B and C (p=0.01), and histopathological grading (p=0.01) are associated with a high rate of postsurgical complication in Hcc cases. CONCLUSION: We make the following recommendations: every liver resection should be planned after intraoperative ultrasonography, anatomical surgical procedure should be preferred instead of wedge resection, and modern devices should be used, like Argon Beam and Ligasure dissector, to reduce the incidence of both intraoperative and postoperative bleeding and biliary leakage.

Adult↗

PubMed1997

Multivariate analysis of risk factors for operative delivery in nulliparous women. Canadian Early Amniotomy Study Group.

OBJECTIVE: Our purpose was to develop predictive models of operative delivery in nulliparous women on the basis of sociodemographic, anthropometric, and obstetric risk factors. STUDY DESIGN: Data were obtained prospectively on 925 nulliparous women in spontaneous term labor with a single fetus in cephalic presentation. Operative delivery was defined as either a midforceps or a cesarean delivery. Variables were grouped into two categories: those that could be assessed at admission and those appearing during labor. Multiple logistic regression was used to identify variables predictive of operative delivery. RESULTS: Among variables that can be documented at admission, independent predictors of operative delivery were maternal age and height, pregnancy weight gain, smoking status, gestational age, and admission cervical dilatation. Of these, maternal age > or = 35 years was the most strongly related to operative delivery. When variables documented later during labor were added to this first model, variables retained in the second model were age and height, smoking status, presence of dystocia, epidural analgesia, and fetal heart rate tracing abnormalities. The adjusted odds ratio of operative delivery in the presence of epidural anesthesia was 3.4 (95% confidence interval 2.0 to 5.8). This association was similar in the presence or absence of dystocia. When the specificity was in the range of 85%, the first and second models have sensitivities of 34% and 48%, respectively, and positive predictive values of 39% and 46%, respectively, which is higher than the a priori risk of operative delivery in the study population (21%). CONCLUSIONS: The models, based on data easily available, may help to predict the need for midforceps or cesarean section in low-risk nulliparous women. Before application in a clinical setting, these statistical models require validation in a separate cohort. The observed association between epidural anesthesia and operative delivery deserves interest but clinical trials are required to determine whether this relation is causal.

Adult↗

PubMed1994

Multivariate analysis of roentgenologic characteristics and risk factors for nonpalpable carcinoma of the breast.

Screening mammography improves carcinoma of the breast survival through early detection and treatment of nonpalpable, often noninvasive, carcinomas. Consideration of the roentgenologic characteristics of mammographic masses and calcifications in combination with risk factors of patients may improve the yield of spot localization breast biopsy. Risk factors solicited by questionnaire were correlated with the roentgenologic appearance and histopathologic factors of 482 specimens from spot localization breast biopsies (39 percent malignant). Masses with irregular contour (p < 0.001) and high density (p < 0.005) were associated with malignant tumors. Packed, coarse and round calcifications were associated with benignity (p < 0.001), whereas scattered, fine and mixed calcifications were associated with malignant tumors (p < 0.05). Malignant masses with smooth contour were significantly more likely to be associated with noninvasive histology. Patients found to have malignant tumors were significantly older than patients with benign lesions (58 versus 52 years, p < 0.001). Stepwise logistic regression was used to evaluate the relative usefulness of demographics and roentgenologic features in predicting benign and malignant pathology among masses and calcifications. Age and irregular contour were independent significant predictors of malignancy for masses. Age, round, coarse, packed or scattered calcifications were significant independent predictors of benignity among calcifications. The radiologist correctly predicted malignant pathology in 60 percent of the patients and benign pathology in 78 percent. Parity, age at menarche, age at first pregnancy, age at menopause, history of benign breast disease, history of carcinoma of the breast, family history of carcinoma of the breast, birth control pill exposure and smoking were not significantly associated with the diagnosis of malignant tumor. These results suggest that risk factors for carcinoma of the breast are insignificant for nonpalpable lesions because patients referred for needle localization are already selected for high risk. Roentgenologic patterns of masses are useful for predicting which lesions are invasive.

Adult↗

PubMed2005

Multivariate analysis of the effectiveness of using antibody induction therapy according to the degree of HLA mismatches.

OBJECTIVE: HLA mismatches have a strong impact on acute rejection and renal allograft survival. The objective of this study was to evaluate the effectiveness of antibody induction according to the degree of HLA mismatches. METHODS: Of 20,429 deceased donor (DD) transplantations and 12,859 living donor (LD) transplantations reported to the United Network for Organ Sharing (UNOS) between 1999 and 2001, 51% of DD and 45% of LD transplant recipients received induction therapy. Propensity scores (PS) were calculated to indicate independent factors associated with the use of induction. Levels of HLA match examined for DD transplant recipients were 0 ABDR (n = 3239), 0 DR (n = 4210), and DR mismatched transplants (n = 12,980), and 0 (n = 1133), 1 (n = 3836), and 2 (n = 7890) haplotype mismatches for LD transplant recipients. Outcome parameters were reported as hazard ratios (HR) for graft loss and odds ratios (OR) for first-year acute rejection. RESULTS: Recipients with HLA mismatches were more likely to receive induction antibody for DR mismatch in DDs (PS = 1.11, 95% confidence interval [CI] 1.04-1.19) and for haplotype mismatch in LDs (PS = 1.36, 95% CI 1.22-1.52). Induction reduced the likelihood of acute rejection for DD transplant recipients regardless of the level of HLA mismatch (OR = 0.70; 95% CI 0.57-0.85 in 0 ABDR MM; OR = 0.76, 95% CI 0.64-0.89 in 0 DR MM; and OR = 0.69, 95% CI 0.62-0.77 in DR MM), and for 2 haplotype mismatched LD transplant recipients (OR = 0.82, 95% CI 0.70-0.96); in other LD transplant recipients, reductions in acute rejection rates were observed but not statistically significant. Induction reduced the risk of graft loss for DR mismatched DD transplant recipients by about 12% (HR = 0.88; 95% CI 0.80-0.97). CONCLUSIONS: Antibody induction resulted in a significant reduction of acute rejection and graft loss for patients with HLA mismatch.

Antibody Formation↗

PubMed2004

Prognostic factors in resected stage I non-small-cell lung cancer: a multivariate analysis of six molecular markers.

PURPOSE: To analyze the prognostic significance of six molecular biomarkers (death-associated protein kinase [DAPK] promoter methylation, interleukin-10 [IL-10] protein expression, cyclooxygenase-2 [COX-2] mRNA expression, human telomerase reverse transcriptase catalytic subunit [hTERT] mRNA expression, retinoic acid receptor-beta [RAR-beta] mRNA expression, and K-ras mutational status) in stage I non-small-cell lung cancer (NSCLC) patients. PATIENTS AND METHODS: Biomarker analyses were performed on tumors from 94 patients with stage I NSCLC who underwent surgical resection at our institution. A minimum follow-up period of 5 years was required. DAPK methylation was assessed by methylation-specific polymerase chain reaction (PCR). RAR-beta, COX-2, and hTERT mRNA levels were determined by in situ hybridization with digoxigenin-labeled antisense riboprobes. K-ras mutation status was determined by the PCR-primer introduced restriction with enrichment for mutant alleles method. IL-10 protein expression was analyzed by immunohistochemistry using a polyclonal antihuman IL-10 antibody. Cancer-specific survival was analyzed with a Cox proportional hazards model. To identify independent prognostic factors, a stepwise selection method was used. RESULTS: DAPK methylation, IL-10 lack of expression, COX-2 expression, hTERT expression, RAR-beta expression, and K-ras mutations were observed in 46.8%, 29.8%, 59.6%, 34.0%, 23.4%, and 34.0% of patients, respectively. In the final model, DAPK methylation and IL-10 lack of expression were significant negative prognostic factors for cancer-specific survival, whereas COX-2 expression was of borderline significance. CONCLUSION: In this cohort of resected stage I NSCLC patients, molecular markers that independently predict cancer-specific survival have been identified. The prognostic roles of DAPK methylation, IL-10, and other biomarkers in NSCLC merit further investigation.

Adult↗

PubMed2000

A multivariate analysis of factors associated with depression: evaluating the role of health literacy as a potential contributor.

BACKGROUND: High rates of low health literacy among elderly populations along with a high prevalence of chronic conditions may lead to increased levels of depression symptomatology. We sought to determine whether older adults with inadequate health literacy were more likely to report depressive symptoms and whether health literacy was an independent predictor of depression symptomatology. METHODS: A total of 3260 new Medicare enrollees 65 years or older were interviewed in person between June and December 1997 from 4 managed care plans (853 in Cleveland, Ohio, 498 in Houston, Tex, 975 in South Florida, and 934 in Tampa, Fla). Depression symptoms were measured by the Geriatric Depression Scale. RESULTS: Overall, 13% of respondents were classified as depressed. Individuals with inadequate health literacy had 2.7 times the odds (95% confidence interval, 2.2-3.4) of being depressed compared with individuals with adequate health literacy skills. However, after controlling for health status with multiple logistic regression, individuals with inadequate health literacy were not more likely to be depressed (adjusted odds ratio, 1.2; 95% confidence interval, 0.9-1.7). Individuals who had less social support, exercised less than twice a week, drank alcohol heavily, or had poor health status (at least 3 health conditions, physical limitations, or fair or poor self-rated health) had significantly higher odds of depression symptomatology. CONCLUSIONS: Although individuals with inadequate health literacy were more than twice as likely to report depressive symptoms, this was mostly explained by their worse health status. The strong relation between depression symptoms and poor health status suggests the need to research interventions to improve mental and physical health concurrently. The influence of particular interventions on depression, such as referral to community support contacts and recommendations for an exercise program, needs to be further evaluated. Arch Intern Med. 2000;160:3307-3314.

Activities of Daily Living↗

PubMed1997

New age-adjusted measure of body fat distribution in children and adolescents: standardization of waist-hip ratio using multivariate analysis.

OBJECTIVE: To explore a new anthropometric index of body fat distribution adjusted for ages ranging from 6-15 y in both boys and girls. DESIGN: Sex, age, and 11 anthropometric variables were subjected to principal component analysis. Based on these results, we developed a new anthropometric index, namely an age-adjusted measure of body-fat distribution. This index was evaluated statistically for suitability of use in epidemiological surveys. SUBJECTS: Japanese children, including obese and nonobese subjects, in one elementary and one junior high school in Yamanashi Prefecture, Japan: 508 boys and 549 girls whos ages ranged from 6 y 1 mon-15 y. MEASUREMENTS: Measurements included the height (Ht), body weight, circumference of the waist, hip and thigh. Body mass index, the ratios of the waist, hip or thigh to the Ht, waist-hip ratio (WHR) and waist-thigh ration were calculated. RESULTS: The first principal component (PC 1) accounted for 49.8% of the total variation, and was interpreted as an indicator of the general size on an individual. PC 2 accounted for 25.9%, and was interpreted as a shape measure that indicates body fat distribution. Calculation of WHR/Ht, a parameter that represented PC 2 adjusted by PC 1, gave an highly robust linear regression equation for age by gender. The residuals from the regression line for WHR/Ht deviated from normal distribution only in the boys, whereas the mean residual was nearly zero and distribution of the residuals was similar in three age subgroups by gender, supporting the use of the common standard deviation score in all age groups as an indicator of body fat distribution. CONCLUSION: The common standard deviation score of WHR/Ht can serve as an epidemiological index of body fat distribution adjusted for ages between 6 and 15 y.

Adipose Tissue↗

PubMed2000

The sensitivity and specificity of direct ophthalmoscopic optic disc assessment in screening for glaucoma: a multivariate analysis.

BACKGROUND: Previous studies have shown that the cup:disc (C/D) ratio has limited sensitivity and specificity. Improved sensitivity and specificity has been found with combinations of disc parameters using stereophotography or disc imaging, but the extent to which these studies reflect what can be achieved by direct assessment is unclear. The purpose of this paper is to report the sensitivities and specificities of a range of disc parameters, both in isolation and in combination, as graded during clinical examination with direct ophthalmoscopy. METHODS: Sixty-seven patients with newly diagnosed primary open angle glaucoma and 145 non-glaucomatous subjects were examined by direct ophthalmoscopy. The following features of the optic disc were graded: vertical and horizontal C/D ratios (uncorrected for disc size), narrowest rim width, presence/absence of disc haemorrhage, focal pallor of the neuroretinal rim, parapapillary atrophy, steepness of the cup-edge and presence/absence of baring of the lamina cribrosa. Subjects were validated as glaucomatous/non-glaucomatous on the basis of visual fields, independently of the results of optic disc gradings. Multiple logistic regression modelling was used to evaluate the effectiveness of combinations of disc parameters. RESULTS: Sensitivities and specificities are limited for all features when considered in isolation. The 'cupping' parameters have the highest sensitivities and specificities but no single cut-off criterion for these parameters has both high sensitivity and specificity. Multiple logistic regression modelling indicated that two disc parameters in combination, narrowest rim width and parapapillary atrophy, were independently associated with glaucoma and achieved best prediction. Combining information from these parameters achieved a sensitivity of 81% (95% CI = 69-89%) and a specificity of 90% (95% CI = 84-95%), a level of discrimination that is not significantly better than narrowest rim width alone in terms of area under the receiver operator characteristic (ROC) curve. CONCLUSION: Disc assessment during clinical examination with direct ophthalmoscopy can achieve comparable sensitivities and specificities with those previously reported for stereophotographic assessment or visual fields screening. However, since the diagnostic accuracy of disc assessment in isolation is inadequate for screening, a combined test strategy is necessary.

Adult↗

PubMed2002

The impact of face shield use on concussions in ice hockey: a multivariate analysis.

OBJECTIVE: To identify specific risk factors for concussion severity among ice hockey players wearing full face shields compared with half face shields (visors). METHODS: A prospective cohort study was conducted during one varsity hockey season (1997-1998) with 642 male ice hockey players (median age 22 years) from 22 teams participating in the Canadian Inter-University Athletics Union. Half of the teams wore full face shields, and half wore half shields (visors) for every practice and game throughout the season. Team therapists and doctors recorded on structured forms daily injury, participation, and information on face shield use for each athlete. The main outcome measure was any traumatic brain injury requiring assessment or treatment by a team therapist or doctor, categorised by time lost from subsequent participation and compared by type of face shield worn. RESULTS: Players who wore half face shields missed significantly more practices and games per concussion (2.4 times) than players who wore full face shields (4.07 sessions (95% confidence interval (CI) 3.48 to 4.74) v 1.71 sessions (95% CI 1.32 to 2.18) respectively). Significantly more playing time was lost by players wearing half shields during practices and games, and did not depend on whether the athletes were forwards or defence, rookies or veterans, or whether the concussions were new or recurrent. In addition, players who wore half face shields and no mouthguards at the time of concussion missed significantly more playing time (5.57 sessions per concussion; 95% CI 4.40 to 6.95) than players who wore half shields and mouthguards (2.76 sessions per concussion; 95% CI 2.14 to 3.55). Players who wore full face shields and mouthguards at the time of concussion lost no playing time compared with 1.80 sessions lost per concussion (95% CI 1.38 to 2.34) for players wearing full face shields and no mouthguards. CONCLUSIONS: The use of a full face shield compared with half face shield by intercollegiate ice hockey players significantly reduced the playing time lost because of concussion, suggesting that concussion severity may be reduced by the use of a full face shield.

Adult↗

PubMed2006

Resective surgery for liver tumor: a multivariate analysis of causes and risk factors linked to postoperative complications.

BACKGROUND: In spite of accurate selection of patients eligible for resection, and although advances in surgical techniques and perioperative management have greatly contributed to reducing the rate of perioperative deaths, stress must be placed on reducing the postoperative complication rates reported to be still as high as 50%. This study was designed to analyze the causes and foreseeable risk factors linked to postoperative morbidity on the grounds of data derived from a single-center surgical population. METHODS: From September 1989 to March 2005, 287 consecutive patients, affected either with HCC or liver metastasis, had liver resection at our department. Among the HCC series we recorded 98 patients (73.2%) in Child-Pugh class A, 32 (23.8%) in class B and 4 in class C (3%). In 104 colorectal metastases, 71% were due to colon cancer, 25% rectal, 3% sigmoid, and 1% anorectal. In 49 non-colorectal metastases, 22.4% were derived from breast cancer, 63.2% gastrointestinal tumors (excluding colon) and 14.4% other cancers. We performed 80 wedge resections, 77 bisegmentectomies and/or left lobectomies, 74 segmentectomies, 22 major hepatectomies, 20 left hepatectomies, and 14 trisegmentectomies. RESULTS: The in-hospital mortality rate in this series was 4.5%, and the morbidity rate was 47.7%, because of pleural effusion (30%), hepatic abscess (25%), hepatic insufficiency (19%), ascites (10%), hemoperitoneum (10%), or biliary fistula (6%). The variables associated with the technical aspects of the surgical procedure that were responsible for the complications were: a Pringle maneuver length more than 20 minutes (P=0.001); the type of liver resection procedure, including major hepatectomy (P=0.02), left hepatectomy (P=0.04), trisegmentectomy (P=0.04), bisegmentectomy and/or left lobectomy (P=0.04); and a blood transfusion of more than 600 ml (P=0.04). CONCLUSION: The evaluation of causes and foreseeable risk factors linked to postoperative morbidity during the planning of surgical treatment should play the same role as other factors weighed in the selection of patients eligible for liver resection.

Abscess↗

PubMed2000

Survey into health problems of elderly people: multivariate analysis of concordance between self-report and proxy information.

BACKGROUND: In many cases probands are unable to give information about their own history. Our objective was to compare information given by elderly people on their past and current health and family history of illness with similar information given by a relative, friend or carer. MATERIAL: In three urban and two rural areas of England and Wales a sub-sample, weighted by age and cognitive status, was drawn from random population samples of people aged >/=65, not permanently living in hospital, and interviewed between 1991 and 1994, plus for each of these a relative, friend or carer. METHODS: The relation between the reports of probands and informants on cognitive function, lifetime illnesses, current health problems, and family history of illness was analysed using multiple regression of agreement, measured using Cohen's kappa, and logistic regression of bias and of proportion of 'not known' responses. Potential explanatory variables used were: centre, proband cognitive function, proband sex, informant sex, proband age, difference in age (generation), relationship, frequency of contact, period known, modality of informant interview. RESULTS: Overall agreement per interview measured by kappa between informant and proband was lower for older probands, probands who were cognitively impaired, and those who saw one another less often; each effect adjusted for all the others using multiple regression. Informants tended to over-report relative to probands if the proband was cognitively impaired, male, they themselves were female, of a younger generation, and co-resident; each effect adjusted for all the others using logistic regression. Interviews were more likely to be missing at least one item if the informant was not the spouse, had known the proband for less time, and was not co-resident; each effect adjusted for all the others using logistic regression. CONCLUSION: There is reasonable accord between probands and informants which is enhanced by close contact, long period of knowledge, and a female informant. Degree of kinship is not critical. Informant interviews may be conducted by telephone rather than face-to-face without serious loss of quality.

Age Factors↗

PubMed2005

False-negative results at multi-detector row CT colonography: multivariate analysis of causes for missed lesions.

PURPOSE: To determine causes of false-negative results at multi-detector row computed tomographic (CT) colonography and determine presumptive causes with logistic regression analysis. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. The study included 394 colonic segments in 31 men and 25 women at high risk for colorectal cancer (mean age +/- standard deviation, 60.2 years +/- 9.3 for men and 56.8 years +/- 13.3 for women). Multi-detector row CT colonography and colonoscopy (reference standard) were performed in a blinded manner, and the results were compared. CT colonographic findings were interpreted in consensus by two readers using a primary two-dimensional with three-dimensional problem-solving approach. Adequacy of colonic preparation and distention was recorded. Sensitivity and specificity were obtained with 95% confidence intervals (CIs). Lesions missed at CT colonography were retrospectively reassessed to identify why they were missed, and, if the causes were not apparent, logistic regression analysis was performed to determine the presumptive causes. RESULTS: Colonic preparation and distention were optimal in 17 patients (30%) but suboptimal in 37 (66%) and poor enough to make the results nondiagnostic in two (4%). Twenty-nine of 63 lesions were missed at CT colonography. When all flat, sessile, and pedunculated lesions (n = 63) were included, sensitivities were 75% (nine of 12; 95% CI: 48%, 100%) for lesions 10 mm or larger and 79% (19 of 24; 95% CI: 65%, 93%) for those 6 mm or larger. When only sessile and pedunculated lesions (n = 60) were included, corresponding sensitivities were 100% (nine of nine; 73%, 100%) and 90% (19 of 21; 78%, 100%), respectively. All three missed lesions larger than 10 mm were flat, and all three flat lesions were missed. Two 3-mm high lesions, including one invasive adenocarcinoma, were misinterpreted as feces at blinded image review; one 1-mm high tubular adenoma with adenocarcinoma foci could not be visualized even in retrospect. Sessile or pedunculated polyps 5 mm or smaller were significantly more likely to be missed than those 6 mm or larger (adjusted odds ratio, 11.6; P = .027). CONCLUSION: Aside from inadequate bowel preparation and/or distention, flat lesions and small polyps are the two main causes for missed lesions at multi-detector row CT colonography.

Adenocarcinoma↗

PubMed1992

The high mortality of gastrointestinal bleeding in HIV-seropositive patients: a multivariate analysis of risk factors and warning signs of mortality in 50 consecutive patients.

The patterns of which human immunodeficiency virus (HIV)-seropositive patients underwent endoscopy for gastrointestinal bleeding at a university hospital were analyzed in 50 consecutive patients admitted from July 1984 through December 1989, and criteria were developed as to which patients are most likely to benefit from endoscopy. Analyzed patient data included the medical records, follow-up until July 1990 obtained by telephone questionnaire in 46 patients, and autopsy findings in the 11 patients undergoing autopsy. Thirty-seven percent of the patients did not undergo endoscopic or radiographic examinations indicated to determine the cause of bleeding. The adequacy of the evaluation was not related to race, intravenous drug abuse, homosexuality, hemophilia, the diagnosis of known AIDS, or being a public patient. In 21 of the 28 cases in which the cause of bleeding was determined, the diagnosed lesions had a specific, effective therapy. The mortality from gastrointestinal bleeding was 39.0%, compared with 8.3% in 48 controls without known HIV infection (p less than 0.001 by Fisher's exact test, odds ratio = 7.0, odds ratio confidence interval = 5.0-9.7). Statistically significant independent predictors of mortality included leukocytosis, concurrent major diseases, intravenous drug abuse, transfusion of 5 or more units of packed erythrocytes, and the presence of a bloody nasogastric aspirate or hematemesis (Wilk's lambda statistic = 0.369, p less than 0.0001). In particular, 10 of 11 patients (89%) with two or more concurrent major diseases died, whereas only three of 24 patients (13%) with no concurrent diseases died during the hospitalization. We conclude a large percentage of HIV-seropositive patients did not undergo a diagnostic evaluation for gastrointestinal bleeding at a university hospital, and there was no discernible rational pattern as to which patients underwent endoscopy. Endoscopy is an important and indicated procedure in HIV-seropositive patients with no or one concomitant major illness. HIV-seropositive patients with gastrointestinal bleeding and two or more concomitant major illnesses have an exceedingly poor prognosis, and are less likely to benefit from invasive diagnostic tests and aggressive therapy.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Multivariate analysis of diet in children at four and seven years of age and associations with socio-demographic characteristics.

AIM: We have previously reported on distinct dietary patterns obtained from principal components analysis (PCA) of food frequency questionnaires from 3-y-old children. In this study, we repeat these analyses at 4 and 7 y of age. DESIGN: As part of regular self-completion questionnaires, the primary source of data collection in the Avon Longitudinal Study of Parents and Children, parents were asked to record the frequency of consumption of 57 different food types for their children. A total of 9550 subjects (68% of original cohort) were available from the 4-y data sweep and 8286 (59%) from the 7-y. METHODS: Distinct dietary patterns were identified at each age using PCA. These were then related to social and demographic characteristics of the parent and child. RESULTS: Three dietary patterns were established cross-sectionally at both 4 and 7 y of age to best describe the types of diet being consumed. One component at both time points described a diet based on 'junk'-type foods with high-fat and sugar content, processed and convenience foods. A second described the 'traditional' British diet based on meat, potatoes and vegetables. The final, a 'health-conscious' pattern was associated with vegetarian style foods, rice, pasta, salad and fruit. At both time points, the 'junk' pattern was significantly more likely in white children, where maternal education level was low and where the child had more siblings. The 'traditional' pattern was more likely in girls, where the mother had a partner and in nonvegetarians (both mother and child). The 'health-conscious' pattern was more likely with increasing levels of education and increasing maternal age. CONCLUSION: We have demonstrated consistent dietary patterns in cross-sectional analyses at two ages in these children with similar socio-demographic associations evident at each age. Future analyses will track these dietary patterns over time and form a basis for the study of a variety of childhood outcomes.

Adult↗

PubMed1989

[A study on restriction of the areas working in speech function--application of multivariate analysis of aphasia test data and of lesions on CT images, by composing a "restricted-aphasia-lesion-map"].

Computed tomography (CT) gave a large contribution to morphological analysis of the aphasia syndromes. The aphasia problems are, however, still controversial and have many unresolved issues, even from a morphological point of view. In most cases with cerebral vascular lesion causing speech dysfunction, we are able to define an extent of density change on CT images. But its extent seems to be often not consistent with the area supposed to be deranged in functional work-up of speech. CT appearance of some areas may be little changed or normal when those areas are to be in poor condition in their functional maintenance. This may be due to such a vascular supply which permits brain tissues to be sustained but which does not work for their function to be normally performed. From 642 cases with cerebral vascular lesion we reviewed CT images of 382 cases: 171 cases having a lesion in the left hemisphere and 46 of them showing aphasia syndrome; 151, a lesion in the right hemisphere alone and 3, aphasic; and 60 cases having lesions on both sides and 7 showing aphasia syndrome. First, we determined anatomically the extent of CT change in 102 cases, all right-handed, with a lesion in the left hemisphere. The extents were piled and made up to a "non-aphasia-lesion-map". This map was used for eliminating those areas as not working in speech function. The other map of the areas was made out of CT images of aphasia cases (33 cases including one agraphia). The latter map was put upon the "non-aphasia-lesion-map", so that the very area working in speech function could be more restricted. The third map, "restricted-aphasia-lesion-map" demonstrated those areas related to speech function: (1) the region limited around the three rami in the Sylvian fissure (Broca A); (2) the inferior frontal gyrus and the posterior aspect of the middle frontal gyrus (Broca B); (3) the inferior aspect of the cortex and subcortex of the Reil's island; (4) most of the middle temporal gyrus, the posterior third of the superior temporal gyrus, a large portion of the supramarginal gyrus and a part of the limbic system; (5) a large portion of the limbic system; (6) the anterior aspect of the superior frontal gyrus; and (7) the corpus callosum. The Standard Language Test for Aphasia (SLTA) was applied for 33 cases of aphasia.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed2000

The prognostic value of p53 and c-erb B-2 immunostaining is overrated for patients with lymph node negative breast carcinoma: a multivariate analysis of prognostic factors in 613 patients with a follow-up of 14-30 years.

BACKGROUND: Approximately 30% of breast carcinoma patients with negative lymph nodes die of their disease. Biologic markers such p53 protein and c-erb B-2 have been related to tumor progression, but their prognostic value remains controversial. METHODS: Two large series of a total of 613 lymph node negative breast carcinoma patients from a single institution were analyzed with respect to tumor size, histologic grade, and immunohistochemical staining for p53, c-erb B-2, estrogen receptor (ER), and progesterone receptor (PgR). Interobserver variation in histologic grading was evaluated by Kappa statistics. The two series had different treatment modalities: 228 patients (SACGS group) were treated surgically with mastectomy and given 1 perioperative chemotherapy course, and 385 patients (HOST group) were treated with mastectomy and ovarian radiation and further randomized to receive postoperative treatment with radiotherapy or no adjuvant treatment. The follow-up ranged from 14-30 years. RESULTS: Immunoreactivities for p53, c-erb B-2, ER, and PgR did not differ significantly in the two series. p53 immunostaining was present in 187 of 613 tumors (29%), and c-erb B-2 immunoreactivity was present in 58 of the tumors (10%). Three hundred forty-eight tumors (57%) were positive for ER. Kappa statistics value of interobserver variation in the histologic grading of ductal carcinomas was 0.69, which is considered to be a substantial degree of agreement. No significant differences in survival were found when comparing p53, c-erb B-2, ER, and PgR positive and negative cases. However, both recurrence free survival rates and overall survival rates after 10 years were significantly better in the T1N0M0 group compared with the T2N0M0 group (81% vs. 67% [P < 0.0001] and 85% vs. 70% [P < 0.0001]). Ten-year recurrence free survival rates for patients with histologic Grade 1 versus Grades 2-3 (according to Elston and Ellis' modification of the Bloom and Richardson method) tumors were 90% and 70%, respectively (P < 0. 0001), and overall survival rates for the same groups were 94% and 81%, respectively (P=0.0002). After 30 years of follow-up, the overall survival rate for patients with tumors of histologic Grade 1 versus Grades 2-3 were 87% and 68%, respectively, and were 78% and 66%, respectively, for patients with tumors </= 2 mm versus those with tumors > 20-50 mm. Approximately 35% of the patients with tumors of histologic Grades 2-3 and measuring > 20 mm were dead after 10 years of follow-up, contrary to 6% of the patients with tumors of histologic Grade 1 measuring </= 20 mm. A significantly more favorable prognosis also was observed in patients in the HOST group treated with adjuvant radiotherapy. CONCLUSIONS: Histologic grade and tumor size were found to be major prognostic factors for patients after 30 years of follow-up. c-erb B-2 and p53 immunostaining does not appear have any independent prognostic value. Adjuvant radiotherapy may be of value in the treatment of patients with localized tumors.

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