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The influence of presensitization on graft survival rate.

Graft survival rate was evaluated in 61 recipients with greater than 50 percent frequency of performed antibodies to selected panel cells. This includes recipients of primary cadaver grafts, secondary cadaver grafts, and living related grafts. Graft survival rate also was evaluated in 199 recipients with pretransplant antibodies reacting with 10 to 50 percent of panel cells and in nonsensitized patients. The results show that good graft survival can be obtained in many hyperimmunized patients, particularly in recipients of primary renal allografts (66 percent cadaver graft survival rate at 2 years). However, sensitization following rejection of an allograft appears to confer a less favorable prognosis. The nature of recipient presensitization and the precise specificity of each reactivity cannot always be explained. This is exemplified in three patients in whom broadly reactive lymphocytotoxic antibodies were not directed against HL-A antigens. Since the number of sensitized patients who await renal transplantation is increasing, there should be no hesitation in proceeding with transplantation, particularly with primary grafts. Emphasis, however, must be placed on frequent prospective recipient serum sampling so that transient high levels of cytotoxins do not escape detection and therefore can be easily selected out for cross-matching against potential donors.

Antibodies

[Results of non-decompression surgery for esophago-gastric varices--postoperative disappearance, recurrence, rebleeding rate of varices, and cumulative survival rate].

A total of 508 patients had an non-decompression surgery for esophago-gastric varices in our department, from September 1979 to December 1991. These patients consisted of 387 cases of transthoracic esophageal transection with para-esophagogastric devascularization, 40 cases of transabdominal esophageal transection, and 81 cases of Hassab procedure. The original diseases were cirrhosis in 432 patients, IPH in 35, extrahepatic-portal occlusion in 24, primary biliary cirrhosis in 6, Budd-Chiari syndrome in 4, and others in 7. Operative mortality rate was 5.3%. By thoracic approach, esophageal varices completely disappeared. Postoperative cumulative variceal recurrence and bleeding rates at 10 years were 12% and 7%, although recurrence occurred more often than not in cases with hepatocellular carcinoma (HCC). Cumulative survival rates at 5, 10 years were 69%, 46% in liver cirrhosis without HCC. Present study confirmed that our non-decompression surgery is effective in controlling esophagogastric varices in long term of periods.

Esophageal and Gastric Varices

Survival rates after serious immersion accidents in childhood.

A study of childhood survival rates, after loss of consciousness in fresh water, has been undertaken. Age-specific, sex-specific and site-specific survival rates for childhood fresh water immersion accidents are reported for the first time. The overall survival rate, after loss of consciousness in the water was 0.49; swimming pool and domestic bath tub serious immersion accidents have a survival rate of 0.60 compared with a rate of 0.05 for similar immersion accidents in creeks and rivers. Young male schoolboys have the lowest potential survival (0.20 or less) of any group. Survival rates were significantly higher during the winter (0.86) than during the warmer months (survival rate of 0.49). This gives a quantitative expression to the protection from cerebral anoxia afforded by body chilling which is not extreme. Survival rates have increased significantly over the 5 year period 1971--1975; it is considered that this is due to public education campaigns of the potential danger of water to children. The use of survival rates to measure factors which modify the pathophysiology of human drowning and near-drowning is discussed.

Adolescent

Survival rates for childhood malignancies in Slovakia.

Survival rates (SR) for population-based series of 1564 cases of cancer in children aged 0-14, diagnosed during the decade 1978-1987 in Slovakia and derived from the National Cancer Registry, were examined. The overall 5-year SR (all types of childhood malignancies combined) was 49.8%. Different SR were ascertained for leukemias -43.8%, lymphomas -59.1%, CNS tumors -42.7% and for other remaining diagnostic groups and subgroups of childhood malignancies. Generally, the SR were slightly better for girls than for boys. Cancer patients being diagnosed during the first two years of age showed worse prognosis with a 5-year survival rate of 36.8% as compared to 52.6% for children aged 2-14 at diagnosis. Differences in 5-year survival were also found between urban and rural areas: 56.8% and 48.8%, respectively. The 5-year SR increased during the study period from 48.5% for 1978-1982 to 50.0% for 1983-1987. Comparison of SR from Slovakia with the corresponding rates observed recently in some developed countries indicated possibilities to improve prognosis of childhood malignancies in this country.

Adolescent

Low survival rate after cardiopulmonary resuscitation in a county hospital.

BACKGROUND: The standard of practice in hospitals in the United States is to perform cardiopulmonary resuscitation on all patients who suffer a cardiac arrest unless a specific order has been written to the contrary. In recent decades, however, data showing a low rate of survival to discharge under certain conditions have accumulated, leading some to question this policy. The objective of this study was to examine variables predictive of patient survival following cardiopulmonary resuscitation using standardized methods of measuring severity of illness. METHODS: All patients were identified who underwent cardiopulmonary resuscitation on the medicine service at Los Angeles County (California) Hospital from August 15, 1990, to February 15, 1991. Severity of illness was evaluated by examining diagnosis, Acute Physiology and Chronic Health Evaluation II score, and organ system failure. Cases were followed up prospectively until death or hospital discharge, and data concerning post-arrest mental status, utilization of resources, and disposition were gathered. RESULTS: Of the 131 patients identified, 22 patients (16.8%) survived for 24 hours but died before discharge; only four patients (3.1%) survived to discharge. CONCLUSIONS: This study suggests that in some settings (eg, institutions that are for sick patients under conditions where monitoring is limited because of scarcity of resources), survival after full cardiopulmonary arrest may be even lower than previously documented.

Adult

Effects of recombinant human granulocyte colony stimulating factor (rhG-CSF) on hemopoiesis and survival rate following allogeneic bone marrow transplantation in mice.

The effects of recombinant human granulocyte colony stimulating factor (rhG-CSF) on the survival rate and hemopoiesis after allogeneic bone marrow transplantation (BMT) were examined. Specific pathogen-free (SPF) C3H mice and germ-free C3H mice, kept in an isolator for germ-free animals, received 10 Gy of total body irradiation (TBI) and all the mice died by day 9 after TBI. These survival rates were improved by BMT. In the case of SPF mice, survival rates at 14 and 100 days were 33% (12/36), 17% (6/36) and in the case of germ-free mice they were 79% (15/19), 74% (14/19) respectively. When SPF mice received rhG-CSF (30 micrograms/kg/day) subcutaneously for 14 consecutive days following BMT, their survival rates were improved to 79% (30/38), 79% (30/38) respectively. The survival rate of rhG-CSF treated SPF mice were equal to that of germ-free mice. When the effect of rhG-CSF treatment on hemopoiesis of SPF mice after allogeneic BMT was examined various hematopoietic progenitor cells in the bone marrow and spleen increased until day 10 after, BMT, while only neutrophils increased in the peripheral blood during the period. No adverse effects of rhG-CSF were observed throughout the study period. It was suggested that in SPF mice treated with rhG-CSF after BMT, the neutrophil recovered in counts quickly and increased neutrophil prevented endogenous infections and improved the survival rate without apparent complications.

Animals

Survival rate in Crohn's disease and ulcerative colitis.

The survival rate in 709 patients with chronic inflammatory bowel disease (CIBD) was calculated by the log rank test. There were 297 patients with Crohn's disease (CD) and 412 patients with ulcerative colitis (UC). In both diseases there was a survival rate of about 94% in the first year of observation against an expected rate of 99.5% in a general population matched for sex and age. This was because a large number of patients were severely ill at their first admission and required immediate or early surgery. During the subsequent 11 years the death rate in CIBD was higher (two to three times) than in the general population. After 12 years the survival rate was about 77% in both CD and UC. The difference was statistically insignificant. There was no significant difference in the sex ratio. The cancer rate was low. No gastrointestinal cancer occurred among patients with CD. Colorectal cancer was found in four patients with UC, three of whom presented with cancer on their first admission. It is concluded that recurrence and reoperation for recurrence in Crohn's disease have not impaired the prognosis compared to ulcerative colitis in this series.

Adolescent

Case and survival definitions in out-of-hospital cardiac arrest. Effect on survival rate calculation.

OBJECTIVE: To determine the effect of different case and survival definitions of out-of-hospital cardiac arrest on survival rate calculations. DESIGN: A 22-month case series of nontraumatic, out-of-hospital cardiac arrests. SETTING: Southwestern city (population, 400,000; area, 390 km2) with a two-tiered emergency response system consisting of emergency medical technicians and paramedics. PATIENTS: A consecutive sample of 372 patients found without palpable pulse of spontaneous respiration. MAIN OUTCOME MEASURES: Survival rate after cardiac arrest was calculated using three case definitions of arrest and two definitions of survival. RESULTS: Twenty percent of all patients survived to hospital admission and 6% survived to hospital discharge. Twenty-six percent of adults whose collapse was witnessed survived to hospital admission, and 10% survived to hospital discharge. Patients whose collapse was witnessed and who experienced initial ventricular fibrillation survived to hospital admission in 38% and to hospital discharge in 15% of cases. CONCLUSIONS: The survival rate after out-of-hospital cardiac arrest varies widely depending on the case and survival definitions selected. To facilitate intersystem comparison and assessment of interventions designed to improve outcome, the Utstein Consensus Conference recommended that case and survival definitions should be adopted by all prehospital emergency systems.

Aged

Improving survival in gastric cancer: review of 5-year survival rates in English language publications from 1970.

In this review of English language publications from 1970, 5-year survival rates after surgery for gastric cancer have been analysed. While the proportion of patients coming to operation has fallen from 92 per cent before 1970 to 71 per cent by 1990, the proportion of operated patients undergoing resection has increased from 37 per cent before 1970 to 48 per cent before 1990. This change suggests improved preoperative staging leading to better patient selection for operation. The 5-year survival rate following all resections has increased significantly from 20.7 per cent before 1970 to 28.4 per cent before 1990, an increase of 7.7 per cent (95 per cent confidence interval 7.1-8.3 per cent). The 5-year survival rate following curative or radical resection has risen from 37.6 to 55.4 per cent over the same period, an increase of 17.8 per cent (95 per cent confidence interval 17.1-18.5 per cent). It is likely that this improvement has contributed to the decrease in the mortality rate from gastric cancer. Comparison of Japanese series with others suggests that diagnosis and treatment of the disease at an earlier stage will result in an even greater increase in 5-year survival rates outside Japan. Of the papers studied, 56 per cent were excluded from analysis, the majority because the data provided about 5-year survival rates were insufficient or the survival calculations inappropriate. Results of survival after operations for gastric cancer should be calculated and presented in a standardized manner.

Humans

Surgical treatment of the severely ischaemic leg: I. Survival rates.

Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia. Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.

Aged

Survival rates of patients with malignant melanoma of the skin.

This paper reports on cases of malignant melanoma of the skin diagnosed in Finland between 1963 and 1968. Sufficient data for estimating the survival was obtained in 691 cases. The ten-year relative survival rate for the entire series was 41% for males and 53% for females. This sex difference remained constant throughout the various divisions of the material. The ten-year relative survival rate of males with tumour in stage I was 52% and that of females 59%. The highest survival rate of stage I tumour in males was for the tumours of the lower extremities (77%) and in females for those in the head and neck (79%). The relative survival of patients with tumour of the trunk in stage I was lowest in both sexes (males 49%, females 45%). The ten-year relative survival rate of patients with a local recurrence was 33% in males and 27% in females. The relative ten-year survival rates of patients with superficial melanoma were 130% in males and 92% in females.

Female

Histopathology of nasopharyngeal carcinoma: correlations with epidemiology, survival rates and other biological characteristics.

A total of 363 cases of nasopharyngeal carcinoma (NPC) in Singapore were classified into squamous cell carcinoma (SCC; 73 cases), non-keratinizing carcinoma (NKC; 178 cases) and undifferentiated carcinoma (UC; 172 cases). Possible biological differences between these histologic types and between tumors with and without lymphocytic infiltration were investigated by correlations with survival rates and with selected epidemiologic, immunovirologic, and immunogenetic data on the disease. The 5-year survival rates following radiotherapy were 25.3% for all cases and 58.8% for tumors restricted to the nasopharynx. The 5-year survival rate for SCC was poorer than for the combined NKC and UC groups (p less than 0.05). The 3-year survival rate was better for tumors with lymphocytic infiltration (p less than 0.05), but there were no differences in the 5-year survivals. The survival rates were better in females (p less than 0.01) and in the younger age groups (p less than 0.01). There were no significant correlations between histopathology of NPC and the distributions of cases by age, sex, HLA antigen profiles, or cell-mediated immune status. Squamous cell carcinoma was associated with lower levels of antibodies to the Epstein-Barr nuclear antigen (p less than 0.05), but there were no differences with respect to antibodies against other EBV related antigens. These findings support the view that SCC, NKC, and UC of the nasopharynx, as defined in the WHO classification, are variants of a fairly homogeneous group of neoplasms in the Singapore population.

Adolescent

Improved survival-rates in presensitised recipients of kidney transplants by immunosuppression with maternal-source gamma-globulin.

The effect on cadaver-kidney transplant survival-rates of a gamma-globulin concentrate, prepared from clotted blood centrifugally expressed from placental tissue recovered from postpartum women, was evaluated in a prospective controlled trial in 195 patients who were also given a standard immunosuppressive regimen. Allograft-survival rates were analysed according to whether or not the recipient had lymphocytotoxic antibodies before transplantation (responders) and whether the graft was a first or second transplant. The graft-survival rate was improved in responder-type recipients of first transplants who had received the gamma-globulin concentrate as adjunctive therapy (control group 28.8+/-10.1% vs. gamma-globulin 55.5 + 9.7% at 2 years, p less than 0.05). The survival-rate of grafts in non-responders was not affected by administration of gamma-globulin and data on its use in recipients of a second graft were insufficient for analysis. These results suggest that the gamma-globulin concentrate was suppressing immunological responses associated with humoral-type rejection.

Adult

Equal survival rates for first, second, and third episodes of Pneumocystis carinii pneumonia in patients with acquired immunodeficiency syndrome.

BACKGROUND: Second and subsequent episodes of acute Pneumocystis carinii pneumonia (PCP) are reported to have a worse prognosis than initial episodes in patients with the acquired immunodeficiency syndrome. We tested the hypothesis that survival rates of first, second, and subsequent episodes of acute PCP in patients with the acquired immunodeficiency syndrome are equal. METHODS: Analysis of the outcomes in prospective series of patients with the acquired immunodeficiency syndrome treated for acute PCP over 5 years. RESULTS: Survival rates of 222 PCP occurrences by episode number were: first, 86%; second, 84%; third, 88%; and fourth, 67%. Survival rates for the first, second, and third episodes were not significantly different. Second and third episodes had a larger proportion of patients with mild disease than initial episodes. CONCLUSIONS: Survival rates for first, second, and third episodes of PCP in patients with the acquired immunodeficiency syndrome are not different. In contrast to earlier articles, treatment for second and third episodes of acute PCP may be as successful as in initial episodes.

AIDS-Related Opportunistic Infections

[Multi-profile analysis of survival rate and cause of death in patients with non-Hodgkin's lymphoma].

A relationship has been established between the survival rate of 378 patients who had died of non-Hodgkin's lymphoma (NHL) and their sex, age, ABO- and Rh-factors of the blood, primary focus of the tumor lesion, morphological variant, diagnostic period duration, and the treatment intensity. A higher incidence rate and a higher mean survival were recorded in 222 males, as compared to 156 females. Favourable and unfavourable for survival age interval has been distinguished for NHL disease. Patients with Rh+ showed a higher survival rate, although the incidence rate among Rh+ and Rh- subjects was similar. Prognostically favourable and unfavourable sites of the primary tumor and morphological variants of NHL were specified. The time spent for detailed verification of the diagnosis has been justified, and the presence of a direct proportional relationship between the intensity of the treatment and the mean survival of patients with varying forms of NHL has been proved.

Adolescent

Survival rates for pre- and postmenopausal Danish women with mammary carcinoma.

Survival rates for mammary carcinoma, based on the data of the Danish Cancer Registry for women admitted 1960 to 1966, show about the same values for women aged under 55 in stage I, whether surgical treatment has been combined with radiation therapy or not. For women aged over 55, combined treatment is followed by better survival rates than surgery or radiation therapy alone. For stage II, this applies both to younger and older women.

Breast Neoplasms

Improving survival rates for patients with colorectal cancer.

Between 1 January 1984 and 31 December 1990, 575 patients were operated on for colorectal cancer. The surgical procedure was performed consistently and no patients were lost to follow-up. Almost half of the patients (284 of 575) had tumours of stage I or II, with 5-year survival rates over 90 per cent. After extending the resection margins in 28 cases of colonic carcinoma there has been no case of tumour recurrence. The overall 5-year survival rate for patients with colonic carcinoma was 81 per cent. Complete resection of the mesorectum was mandatory for rectal resection. One-third of the carcinomas in the lower third of the rectum could be resected with maintenance of bowel continuity and an abdominoperineal resection avoided. Not only was the tumour recurrence rate in the former patients lower (10.5 per cent) compared with that in those undergoing abdominoperineal resection (14.3 per cent) but the 5-year survival rate at 90 versus 52 per cent was significantly higher. The overall 5-year survival rate for patients with rectal carcinoma was 71 per cent.

Aged

Improvement of survival rate in patients with cardiogenic shock by using nonpulsatile and pulsatile ventricular assist device.

Between January 1988 and January 1992, 65 patients (pts) had a ventricle assist device (VAD) inserted in our clinic. In 24 pts a VAD was applied because of primarily unsuccessful weaning from cardiopulmonary bypass (Group A). In a further 24 pts (Group B) a VAD was installed for the therapy of refractive cardiogenic shock (CS) after initially successful cardiac surgery (n = 21) and after acute myocardial infarction (n = 3). Twelve pts were bridged to heart transplantation (Group C) and five had a VAD inserted for various other reasons (Group D). In 36 (55.4%) of the total 65 pts a nonpulsatile VAD (Biomedicus 540) was used: 10 in Group A; 20 in B, 3 in C and 3 in D. In 29 pts (44.6%) a pulsatile VAD (Abiomed BVS 5000) was used: 14 in Group A, 4 in B, 9 in C and 2 in D. Weaning rate and long-term survival rates were 50% and 46% respectively in Group A and 38% and 42% in Group B. Seven pts from Group C were transplanted and six are long-term survivors. Two pts (40%) in Group D were discharged from hospital. Major postoperative complications were bleeding (46%), thromboembolism (14%), multiple organ failure (11%), renal failure (11%), arterial embolism (4.6%), sepsis (3%). The results indicate that application of a VAD can be recommended in pts with postcardiotomy CS to allow recovery of cardiac function and in pts with irreversible ventricular damage as bridging to HTX.

Adult