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  • Articles: DFG German National Licenses  (288)
  • 1995-1999  (287)
  • 1965-1969  (1)
  • 1890-1899
  • 1820-1829
  • Keywords
  • Prognosis
  • 1
    Electronic Resource
    Electronic Resource
    p21Waf1/Cip1 Expression Is a Prognostic Marker in Curatively Resected Esophageal Squamous Cell Carcinoma, but Not p27Kip1, p53, or Rb (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 481-488 
    Details
    ISSN: 1534-4681
    Keywords: Esophageal cancer ; Treatment ; Prognosis ; Cell cycle ; Immunohistochemistry ; Cyclin-dependent kinases inhibitor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: p21Waf1/Cip1 (p21), p27Kip1 (p27), p53, and Rb play critical roles in cell cycle regulation and may influence the clinical behavior of tumors. We examined whether their expression is useful to predict survival of patients with esophageal squamous cell carcinoma (ESC). Methods: Expression of p21, p27, p53, and Rb was studied by the immunohistochemical method in specimens from 62 patients with curatively resected ESC tumors and scored by a computerized image analysis system. Results: The median expression scores of p21, p27, p53, and Rb (14, 12, 27, and 50, respectively) were used as cut-off points to define low and high expression groups for each protein. The 5-year survival rate for the high p21 expression group was 68%; that for the low expression group was 31% (P = .0062). p27, p53, and Rb were not correlated with overall survival. When patients were categorized into four groups based on p21 expression level and lymph node involvement (pN), the survival curves were significantly different (P = .0017). Thus, patients without lymph node involvement but with low p21 expression had survival similar to that of patients with lymph node involvement and high p21 expression. Multivariate analysis showed that age (P = .0102), lymph node involvement (P = .0076), and p21 (P = .0276) were independent prognostic factors. Conclusions: Expression of p21 is an independent prognostic factor in curatively resected ESC. Definition of new subgroups of patients based on p21 expression may help to enhance the stratification of stage.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0481-x
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  • 2
    Electronic Resource
    Electronic Resource
    Prognostic Value of Laurén Classification and c-erbB-2 Oncogene Overexpression in Adenocarcinoma of the Esophagus and Gastroesophageal Junction (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 290-297 
    Details
    ISSN: 1534-4681
    Keywords: Laurén classification ; C-erbB-2 oncogene ; Esophageal adenocarcinoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The prognostic value of the Laurén classification and of c-erbB-2 oncogene overexpression has been described for gastric cancer. The aim of this study was to investigate the clinical significance of these factors in adenocarcinoma of the esophagus and/or gastroesophageal junction (GEJ). Methods: Forty-one adenocarcinomas of the esophagus and/or GEJ were reviewed for tumor stage, lymph node status, Laurén classification, and c-erbB-2 overexpression, as assessed by immunohistochemical analysis. Results: According to the Laurén classification, tumors were classified as intestinal-, mixed-, or diffuse-type (54%, 32%, and 15%, respectively). Diffuse-type tumors were associated with a significantly worse prognosis than were intestinal-type tumors (P = .018; log-rank test). The prognostic value of the Laurén classification was independent of stage (P = .048; Cox regression model). Overexpression of c-erbB-2 was detected in 24% of the tumors and was present exclusively in intestinal-type tumors and in intestinal-type areas of mixed-type tumors. Ten of the 30 stage III/IV tumors (33%) were c-erbB-2-positive, whereas none of the 11 stage I/II tumors (0%) overexpressed the oncogene product (P = .04; Fisher exact test). The prognostic value of c-erbB-2 overexpression was not independent of stage (P = .7; Cox regression model). Conclusions: (1) The Laurén classification is an independent prognostic factor in adenocarcinoma of the esophagus and GEJ. (2) c-erbB-2 overexpression is limited to (areas of) intestinal-type tumors, indicating that intestinal- and diffuse-type tumors differ oncogenetically. (3) c-erbB-2 overexpression is associated with the stage of disease, indicating that it is a late event during tumor progression.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0290-2
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  • 3
    Electronic Resource
    Electronic Resource
    Expression of p53 and RB Proteins in Squamous Cell Carcinoma of the Esophagus: Their Relationship With Clinicopathologic Characteristics (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 489-494 
    Details
    ISSN: 1534-4681
    Keywords: P53 ; Retinoblastoma (RB) ; Prognosis ; Esophageal cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Cancer of the esophagus is one of the most malignant tumors and has a poor prognosis. The p53 and retinoblastoma (RB) genes are involved in the regulation of cell population by suppressing cell proliferative activity. Our goal was to clarify whether expression of p53 and RB genes could be prognostic factors in squamous cell carcinoma of the esophagus. Methods: Tumor samples taken from 73 patients undergoing subtotal esophagectomy were immunohistochemically stained for the p53 and RB genes. An image analyzer was used for quantitative assessment of the staining, and clinicopathologic characteristics of those patients were investigated. Results: Patients in whom p53 expression was high had greater tumor diameter, deeper tumor invasion, and worse prognosis compared with patients in whom p53 expression was low. Patients in whom RB expression was low had a higher incidence of lymph node metastasis and more advanced disease than did those in whom RB expression was high. The combination of p53 and RB expression revealed that the cases with high p53 and low RB expression had significantly worse survival rates and deeper tumor invasion compared with other groups. In various clinicopathologic parameters, (e.g., age, sex, tumor-diameter, tumor type, location, differentiation, TNM classification,TNM stage) tumor type, tumor size, depth of invasion, lymph node involvement, distant metastasis, and combined p53 and RB expression showed significant differences in survival by univariate analysis. Among those six variables, only lymph node involvement showed an independent prognostic factor for survival (P = .0055) by multivariate analysis. Conclusions: The combination of p53 and RB expression is not a prognostic indicator in the surgical treatment of esophageal cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0489-2
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  • 4
    Electronic Resource
    Electronic Resource
    Use of preoperative ultrasound staging for treatment of rectal cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 159-166 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Rectal neoplasms therapy ; Rectal neoplasms radiotherapy ; Neoplasms staging ; Neoplasms recurrence ; Treatment outcomes ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract INTRODUCTION: Transrectal ultrasound is the standard method for preoperative staging of rectal cancer. This study reviews the accuracy of transrectal ultrasound staging for T3 disease and its use in the selection of patients for neoadjuvant chemoradiation. METHODS: One hundred seventeen patients underwent preoperative transrectal ultrasound evaluation for rectal cancer. Accuracy of transrectal ultrasound was evaluated among 70 patients not receiving preoperative chemoradiation. Forty-seven patients received neoadjuvant chemoradiation based on transrectal ultrasound results. Tumor downstaging and early recurrence were evaluated among 45 of 47 patients receiving neoadjuvant chemoradiation. RESULTS: Among 70 nonirradiated patients, 19 were pathologic Stage pT3. Transrectal ultrasound correctly identified 18 of 19 patients with Stage pT3 (sensitivity, 94.7 percent). Transrectal ultrasound correctly identified 44 of 51 patients with less than pT3 disease (specificity, 86.3 percent). After preoperative chemoradiation in 45 patients with ultrasound Stage uT3 or uT4 tumors, 56 percent of them experienced a reduction in T stage. Residual nodal disease was found in 31 percent of patients. A complete pathologic response with no residual disease at operation was observed in 22 percent of patients. During a median follow-up period of 21 months after diagnosis, seven patients experienced a recurrence of their disease at a median of 12 months after diagnosis. Five of seven patients with recurrence were among a subgroup of ten patients who both failed to downstage T and had residual nodal disease at operation. CONCLUSION: Transrectal ultrasound is an accurate modality for selecting patients for neoadjuvant treatment. Preoperative chemoradiation produced downstaging in 56 percent of patients. Factors related to early recurrence included residual nodal disease and failure to downstage T after neoadjuvant chemoradiation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237121
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  • 5
    Electronic Resource
    Electronic Resource
    Laparoscopicvs. open abdominoperineal resection for cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 930-939 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Laparoscopy ; Abdominoperineal resection ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to compare the safety and efficacy of laparoscopic abdominoperineal resection and open abdominoperineal resection for cancer. METHODS: Records of 194 patients who underwent laparoscopic abdominoperineal resection (42 patients) or open abdominoperineal resection (152 patients) at three institutions between 1991 and 1997 were reviewed. Follow-up was through office charts, American College of Surgeons cancer registry, or telephone contact. Tumors included (laparoscopic abdominoperineal resection and open abdominoperineal resection, respectively) adenocarcinoma (86 and 92 percent), squamous (12 and 7 percent), and gastrointestinal stromal (2 and 1.4 percent) types; Stages I (17 and 26 percent), II (24 and 33 percent), III (43 and 32 percent), and IV (14 and 9 percent); and those with invasion of pelvic structures (14 and 16 percent). RESULTS: Laparoscopic abdominoperineal resection was converted to open abdominoperineal resection in 21 percent because of vessel injury (33 percent), poor exposure (22 percent), adhesions (22 percent), inguinal hernia (11 percent), or radiation fibrosis (11 percent). Perineal infections occurred more often in the laparoscopic abdominoperineal resection group (24vs. 8 percent;P=0.02). Late stoma complications were similar. Mean hospital stay was shorter after laparoscopic abdominoperineal resection (7vs. 12 days). Radial margins were positive in 12 percent of laparoscopic abdominoperineal resection and 12.5 percent of open abdominoperineal resection specimens. Tumor recurrence was similar for both local (19 and 14 percent) and distant (38 and 26 percent) recurrence. Survival rates were similar by Kaplan-Meier curves, with median follow-up of 19 and 24 months, respectively (P=0.22; log rank). CONCLUSION: Laparoscopic abdominoperineal resection can be performed safely and results in a shorter hospital stay. A randomized, prospective trial is needed to determine the long-term outcome of cancer treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237105
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  • 6
    Electronic Resource
    Electronic Resource
    Accurate lymph-node detection in colorectal specimens resected for cancer is of prognostic significance (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 143-154 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal cancer ; Lymph node ; Pathology ; Prognosis ; Local recurrence ; Metastasis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Lymph-node involvement is the most important prognostic factor in colorectal cancers. Many staging systems adopted node status as a parameter of tumor classification. However, the number of identified and positive glands varies across articles, depending on specimen examination. There is a consistent risk of substaging tumors and undertreating patients. Aim of this study was to investigate the prognostic significance of different pathologic methods. METHODS: Eight hundred one patients who underwent curative resection of colorectal cancer entered the study and were divided into two groups. In Group 1 the specimen was “en bloc” fixed, and nodes were identified by sight and palpation. In Group 2 the mesentery of the excised specimen was dissected away from the bowel, stretched, and pinned to cork board. The mesenteric segment surrounding the origin of principal vessels was divided from the segment surrounding the colic vessels. All specimen segments were fixed, node identification being performed by sight and palpation. Examined and positive nodes were recorded, and metastatic rate and incidence was calculated in the two groups. Patients were classified with used of different staging systems. Survival rates were calculated, related to tumor stage, and compared statistically. Pathologic procedures were included in a multivariate analysis. RESULTS: A significantly higher number of detected and positive nodes and metastatic rate (37.5vs. 30.2 percent;P〈0.05) were observed in Group 2; 45.2 percent of Group 2 and 25.3 percent of Group 1 cases had more than three positive nodes (P〈0.05). In Group 2 several patients shifted from earlier to more advanced stages compared with Group 1 cases. Five-year and ten-year survival rates were significantly higher (P=p.pr) in Group 2 (81.5 and 77.2 percent) than in Group 1 (76.7 and 61.5 percent), mostly in patients with TNM Stage N0. Survival analysis related to Astler and Coller's and Tang's classifications confinrmed such features. Higher rates of local recurrences and distant metastases were found in Group 1, particularly if related to node status (P〈0.05). Multivariate analysis demonstrated the pathologic method is an independent prognostic factor. CONCLUSIONS: This study demonstrates the prognostic impact of specimen examination. Inaccurate methods could downstage the tumor and exclude the patient from adjuvant therapies, with detrimental effects on the outcome of the case.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237119
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  • 7
    Electronic Resource
    Electronic Resource
    Prognostic value of nuclear morphometry in colorectal cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 386-392 
    Details
    ISSN: 1530-0358
    Keywords: Nuclear morphometry ; Colorectal cancer ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: In many types of cancer, certain morphometric characteristc of tumor cells correlate with patient survival. Our observations suggested that the survival of patients with colorectal carcinomas is negatively correlated with tumor-cell nucleus size. METHODS: We investigated relationships between postsurgery survival and nucleus morphometrics in 90 patients who had undergone resection for a colorectal tumor. The nucleus-size variables considered were maximum diameter, minimum diameter, perimeter, area, and form factor (means for 100 nuclei from each patient were used in all cases). RESULTS: Our results confirmed that patients with large maximum nucleus diameter (where large = greater than the first quartile) have significantly worse survival than patients with smaller maximum nucleus diameter (mean survival, 28vs. 43 months). Similar results were obtained for the other nucleus-size variables. Stepwise Cox regression analysis was then performed, with postsurgery survival time as the dependent variable and the following candidate independent variables: age, gender, Dukes class, degree of histologic differentiation, the various nucleus-size variables, and relative frequencies of different nucleus shapes (spherical, oval, cylindrical, fusiform, and irregular). The variables selected for the prognostic model were Dukes class, relative frequency of irregular nuclei, and maximum nucleus diameter. CONCLUSIONS: These findings indicated that nucleus size and shape are useful predictors of survival. Even if Dukes class is known, consideration of nucleus size and shape significantly improves prediction of survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236359
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  • 8
    Electronic Resource
    Electronic Resource
    Current Advances and Changes in Treatment Strategy May Improve Survival and Quality of Life in Patients With Potentially Curable Gastric Cancer (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 46-56 
    Details
    ISSN: 1534-4681
    Keywords: Gastric cancer ; Early ; Advanced gastric cancer ; Surgery ; Splenectomy ; Pancreatectomy ; Extensive (D2) lymph node dissection ; Endoscopic mucosal resection ; (Neo)adjuvant chemotherapy ; Prognosis ; Quality of life.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The treatment strategy for gastric cancer is determined by the stage of disease. Advances in diagnostic techniques such as endoscopic ultrasound (EUS) and in staging have increased the accuracy of pretreatment staging. Correct staging is a prerequisite for the optimal treatment of gastric cancer patients. Long-term expected survival and quality of life (QOL) are the major criteria determining the therapeutic strategy. Results: Surgical resection offers excellent survival rates for early gastric cancer (EGC) patients. D1 resection is sufficient for mucosal cancers (T1m) and for most submucosal cancers (T1sm); however, for the rest (about 5%) of these patients with N2 disease a D2 resection is required for complete tumor resection (R0). Considering QOL, endoscopic mucosal resection (EMR) or laparoscopic wedge resection is the best frontline therapy for several mucosal cancers. Prediction and selection of node-negative patients with the help of certain macroscopic and histologic criteria can eliminate the possibility for residual disease in perigastric lymph nodes. However, long-term survival data are needed before these new techniques become more generally accepted. In contrast, an aggressive approach is necessary for the treatment of advanced gastric cancer. Total gastrectomy, with the exception of distal tumors that can be treated by subtotal gastrectomy, is the procedure of choice. Splenectomy is indicated for proximal advanced tumors. Distal pancreatectomy should be avoided, however, because its adverse effect has been documented in all randomized trials. Although the survival benefit of extended (D2) lymphadenectomy is unproven in randomized trials, D2 resection increases the R0 resection rate and may improve survival in some selected nodepositive patients. D2 resection has little effect on preventing peritoneal tumor spread and liver metastasis, and the traditional late administration of chemotherapeutic drugs has been proven ineffective. Current data suggest a possible beneficial effect of combined treatment for patients with local advanced gastric cancer (LAGC). Ongoing phase III randomized trials will prove whether patients with LAGC treated by neoadjuvant chemotherapy plus D2 resection versus surgery alone or surgery plus intraoperative intraperitoneal chemotherapy derive any benefit from these combined treatment modalities. Conclusion: Evaluation of all information concerning tumor stage, location, histologic type, expected survival, and QOL after resection is of paramount importance for the surgeon planning the extent of surgery. The therapeutic approach should be stratified according to the stage of disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0046-z
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  • 9
    Electronic Resource
    Electronic Resource
    New Approach to the Substaging of Node-Positive Colorectal Adenocarcinoma (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 161-165 
    Details
    ISSN: 1534-4681
    Keywords: Node-positive colorectal adenocarcinoma ; Prognosis ; Staging ; Substaging ; Systemic adjuvant treatment ; Venous invasion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Future developments in adjuvant modalities may require substaging of nodepositive colorectal adenocarcinoma that is accurately indicative of individual prognoses, upon which therapeutic decisions (e.g., choice of agents and intensity of treatment) may be based. This study compares substaging of node-positive colorectal cancer by venous invasion with substaging by three currently used methods, with respect to the ability of each method to define patient subsets that differ significantly in both disease-free and cancer-related survival rates. Methods: A total of 171 patients with node-positive colorectal cancer, who had undergone potentially curative resection at least 5 years earlier, were retrospectively substaged by the tumor, node, metastasis (TNM) N1/N2, Astler-Coller C1/C2, Gastrointestinal Tumor Study Group (GITSG) C1/C2, and venous invasion (positive/negative) methods. Disease-free and cancer-related survival curves were calculated (by the Kaplan-Meier method) and compared for statistical significance (using the log-rank test). Results: The separation of disease-free and cancer-related survival curves using the four methods of substaging node-positive colorectal cancer was as follows: TNM, P = .16 (not significant) and P = .12 (not significant); Astler-Coller, P 〈.01 and P = .006; GITSG, P = .067 (not significant) and P = .03; venous invasion, P = .016 and P = .007, respectively. Conclusions: Numerical substaging of node-positive colorectal cancer (TNM and GITSG methods) is an inferior predictor of prognosis, compared with substaging by the T value (Astler-Coller) or venous invasion methods. We think that the latter method is the method of choice, because it separates patients who have only lymphatic metastasis from patients who display microscopic hematogenous spread as well. This separation obviously has biological/oncological significance, and it may have practical therapeutic implications in the future.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0161-x
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  • 10
    Electronic Resource
    Electronic Resource
    Does the Extent of Operation Influence the Prognosis in Patients With Melanoma Metastatic to Inguinal Nodes? (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 263-271 
    Details
    ISSN: 1534-4681
    Keywords: Melanoma ; Lymphadenectomy ; Extent ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The role of pelvic lymphadenectomy in melanoma metastatic to the superficial inguinal region remains controversial. Some researchers advocate aggressive surgical management,whereas others feel that outcome depends more on extent of disease rather than extent of treatment.We reviewed our recent experience to investigate possible therapeutic effects of extended surgery. Methods: We performed a retrospective clinical and pathological review of 227 consecutive patients having superficial (SLND) or combined inguinal lymphadenectomy (CLND) for cutaneous melanoma. Results: A total of 174 SLNDs and 53 CLNDs were performed. Overall 5-year survival for node-positive patients was 39%. Survival for patients with positive superficial nodes was 40%; for those with positive deep nodes it was 35% (P = ns). In node-positive patients, number and size of involved lymph nodes and the presence of extranodal spread, failure to receive adjuvant therapy, and tumor ulceration were associated with poorer prognosis. Extent of surgery was not associated with differential survival, although CLND patients had worse pathological features. Subgroup analysis showed no significant survival difference between SLND and CLND. Conclusions: Some patients with deep nodal involvement apparently are cured by CLND. However, it is the biology of the disease and not the extent of surgery that primarily governs outcome. Patients with clinical or radiological evidence of pelvic nodal disease without evidence of systemic disease should have a CLND, but we find no evidence to support CLND if the pelvic nodes are clinically and radiologically negative.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0263-5
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  • 11
    Electronic Resource
    Electronic Resource
    Technology and prognostic predicaments (1999)
    Springer
    AI & society 13 (1999), S. 44-51 
    Details
    ISSN: 1435-5655
    Keywords: Assessment ; Ethics ; Prognosis ; Research and development ; Side effects
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science
    Notes: Abstract As societies become increasingly technologised, the need for careful and critical assessment rises. However, attempts to assess or normatively evaluate technological development invariably meet with an antinomy: both structurally and historically, technologies display multistable possibilities regarding uses, effects, side effects and other outcomes. Philosophers, usually expected to play applied ethics roles, often come to the scene after these effects are known. But others who participate at the research and development stages find even more difficulties with prognosis. Recent work on ‘revenge’ effects (Tenner) and negative side effects (Kevles) are examined, as well as several cases of philosophers in ‘R&D’ roles. After sketching the antinomy,I outline a heuristic pragmatics of prognosis that addresses this quandary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01205256
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  • 12
    Electronic Resource
    Electronic Resource
    Tumor cells in breast tumors: significance of their presence for prognosis (1999)
    Springer
    Hematology and cell therapy 41 (1999), S. 66-70 
    Details
    ISSN: 1279-8509
    Keywords: Tumor cells ; Monoclonal antibodies ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Through two clinical studies, tumor cells were searched for in the bone biopsies and cytapherisis of patients suffering from inflammatory tumors and who had undergone intensive therapy and autografts (Pegase 2 program). In these studies we used immunocytochemical test with two monoclonal antibodies. The results have shown the presence of tumor cells in 14 of the patients (respectively 18), with no correlation to the appearance of metastases after 4 years in the first study. Nevertheless, the presence of these tumor cells seems to be an important factor in the number of relapses. It seems important to develop research into tumor contamination especially in the selection of grafts over the next few years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s00282-999-0066-y
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  • 13
    Electronic Resource
    Electronic Resource
    The prognostic significance of tumor vascularization in patients with localized colorectal cancer (1999)
    Springer
    International journal of colorectal disease 14 (1999), S. 272-276 
    Details
    ISSN: 1432-1262
    Keywords: Key words  Colorectal cancer ; Angiogenesis ; Vessel density ; Prognosis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Angiogenesis is essential for tumor growth and metastasis, and vascular density is known as an independent prognostic factor in several tumor entities. We studied the prognostic relevance of vascular density in colorectal cancer, examining 146 patients treated surgically for cure. Tumor sections were immunostained with JC70, an endothelial cell marker. Microvessel quantification used light microscopy. The slides were scanned at a low magnification, and individual microvessel counts were made on a ×200 field in the area of the most dense neovascularization. Vascular density was found to be 75±27/visual field and to be independent of age, sex, pT and pN categories, tumor recurrence, and overall survival. Overall survival in the subgroup of patients with tumor recurrence was significantly shorter with tumors of greater vessel density (〉75) than in those of less vessel density (〈75). Multivariate analysis showed microvessel count to be an independent prognostic factor for the overall survival rate of patients with tumor recurrence; among these patients there was also a significant difference in the relapse-free survival rates between the hypovascular and the hypervascular groups. Our findings suggest that the microvessel density of the primary tumor determines the speed of tumor recurrence after metastatic disease has been triggered by other, unknown mechanisms. Although tumor vascularization can be linked to the aggressiveness of colorectal cancer, it has no value as a new prognostic marker in clinical practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050227
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  • 14
    Electronic Resource
    Electronic Resource
    bcl-2 immunoreactivity but not p53 accumulation associated with tumour response to radiotherapy in cervical carcinoma (1999)
    Springer
    Journal of cancer research and clinical oncology 125 (1999), S. 55-60 
    Details
    ISSN: 1432-1335
    Keywords: Key words: Cervix ; p53 ; bcl-2 ; Radiotherapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose : This study seeks to define the role of pretreatment expression of the tumour-suppressor p53 protein and the anti-apoptotic protein bcl-2 and their relationship to tumour response to radiotherapy in cervical carcinoma. Methods : A total of 101 patients were evaluated and the possibility of a correlation done between the pretreatment status of the two proteins and clinical outcome following radiotherapy was investigated. Such patients were either disease-free (group 1, n = 65) or had residual/recurrent disease (group 2, n = 36) at a 16-month follow-up. p53 and bcl-2 protein expression was determined by immunocytochemistry. The presence of mutant p53 was detected by a mutant specific p53 enzyme-linked immunosorbent assay. Results : There was no correlation between p53 immunoreactivity or the presence of mutant p53 protein and disease status after treatment. Expression of bcl-2 protein, however, showed significant pretreatment correlations with the final disease outcome (r = 0.643, P = 0.0001). Moreover the odds ratio of a tumour expressing moderate to intense levels of bcl-2 responding poorly to radiotherapy was 27.2 (95% CI 6.0, 123.3). Conclusions : bcl-2 protein functions in an anti-oxidant pathway to prevent apoptosis. Since radiotherapy efficacy depends on adequate DNA damage caused by free-radical generation, increased expression of bcl-2 may result in tumours becoming less responsive to radiation. Mutation of the p53 gene, however, is a rare event in cervical cancer. Since bcl-2 is negatively regulated by p53, it could be presumed that the p53 detected in the tumour cells may be non-functional or inactive possibly because of interaction with proteins such as E6 or mdm-2.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050242
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  • 15
    Electronic Resource
    Electronic Resource
    E-cadherin expression in oesophageal carcinoma treated with high-dose radiotherapy; correlation with pretreatment parameters and treatment outcome (1999)
    Springer
    Journal of cancer research and clinical oncology 125 (1999), S. 641-645 
    Details
    ISSN: 1432-1335
    Keywords: Key words E-cadherin expression ; Radiotherapy ; Oesophageal carcinoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background and purpose: E-cadherin plays an important role in the cell-cell contact of normal epithelium. Loss of E-cadherin expression may be related to tumour invasiveness and metastatic potential. In a group of patients treated for oesophageal carcinoma by radiotherapy only, we found that immunohistochemically detected p53 expression correlated with reduced survival, mainly because of the occurrence of distant metastases. We questioned whether, in this group of patients, E-cadherin expression was concomitantly altered and served as a predictive factor for the development of distant metastases. Materials and methods: Immunostaining for E-cadherin was performed on paraffin- embedded biopsy specimens from patients with adenocarcinoma and squamous cell carcinoma of the oesophagus. E-cadherin status and its correlation with regard to pretreatment parameters and treatment outcome were determined. Results: An aberrant staining pattern of E-cadherin did not correlate with any of the pretreatment parameters. In a univariate analysis, a significantly reduced metastatic potential was found for tumours that had an aberrant cellular staining pattern for E-cadherin, which was strongest for squamous cell carcinomas. However, in a multivariate analysis only p53 status correlated significantly with the occurrence of distant metastases. Conclusion: Although, in univariate analysis, aberrant E-cadherin expression served as a better, rather than a worse prognostic factor, p53 status remained the only significant parameter in multivariate analysis, in this group of patients with oesophageal carcinoma. No relationship between p53 status and E-cadherin expression was found.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050328
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  • 16
    Electronic Resource
    Electronic Resource
    Expression of CD44 variants in osteosarcoma (1999)
    Springer
    Journal of cancer research and clinical oncology 125 (1999), S. 646-652 
    Details
    ISSN: 1432-1335
    Keywords: Key words Osteosarcoma ; CD44 ; Immunohisto-chemistry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The standard form of CD44 (CD44H) is a transmembranous glycoprotein, widely distributed on a variety of human lymphoid cells, epithelial cells and tumours. CD44 has many variant forms, which are generated by alternative splicing. In recent years, CD44 has been reported to be related to the degree of tumour differentiation, tumour cell invasion, and metastasis. We investigated 44 tumour specimens in 39 patients with osteosarcoma immunochemically to analyse the expression of CD44 standard (CD44H) and variant exon-encoded gene products (CD44v3, v4, v5, v6, v7, v9, and v10). Furthermore, the relationship between CD44 expression and the clinical outcome of patients with osteosarcoma was analysed. Membrane accentuation and exclusive cytoplasmic reactivity were analysed as separate staining patterns. Tumour cells and some multinucleated giant cells were markedly stained. CD44H, v3, v4, v5, v6, v7, v9, and v10 were expressed in 85%, 49%, 54%, 59%, 46%, 5%, 28%, and 10% of the specimens respectively. The cumulative 5-year metastasis-free survival was 58% in CD44v6-negative cases and 24% in CD44v6-positive cases (P=0.046). However, the cumulative 5-year metastasis-free survival was not significantly different between cases positive and negative for other variants of CD44. Multivariate analysis (Cox proportional-hazard model) with CD44v6 expression (positive or negative), chemotherapy (intensive or non-intensive), tumour site (proximal or distal), and age (at least 30 years or less than 30 years) showed that expression of CD44v6 and chemotherapy were important prognostic factors in patients with osteosarcoma. Overexpression of CD44 isoforms containing variant v6 is correlated with poor prognosis in patients with osteosarcoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050329
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  • 17
    Electronic Resource
    Electronic Resource
    Immune functions, clinical parameters and hormone receptor status in breast cancer patients (1999)
    Springer
    Journal of cancer research and clinical oncology 125 (1999), S. 313-320 
    Details
    ISSN: 1432-1335
    Keywords: Key words Breast cancer ; Immune function ; Tumour burden ; Hormone receptors ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We have carried out a detailed analysis of the cellular immune functions of breast cancer patients in comparison with healthy controls. A possible correlation between immune and clinical parameters was analysed in 50 breast cancer patients. Immune parameters, natural killer cell and T lymphocyte functions and the numbers of circulating T lymphocytes were analysed against the clinical parameters comprising the tumour burden, the stage of the disease and the expression of hormone receptors on the tumour. In order to analyse the immune function data effectively, low responders were identified with stringent cut-off values. Considerably higher proportions of low responders were found among the patient population. Elevated numbers of circulating T lymphocytes and CD3-directed cytolysis correlated with the expression of oestrogen receptors independently of the clinical/histological parameters.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050280
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  • 18
    Electronic Resource
    Electronic Resource
    Microvessel density of hepatocellular carcinoma: its relationship with prognosis (1999)
    Springer
    Journal of cancer research and clinical oncology 125 (1999), S. 419-426 
    Details
    ISSN: 1432-1335
    Keywords: Key words Angiogenesis ; Hepatocellular carcinoma ; Prognosis ; Microvessel density
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: To elucidate the relationship between angiogenesis and prognosis after curative resection of hepatocellular carcinoma (HCC). Methods: An immunohistochemical study using anti-CD34 monoclonal antibody was carried out on surgical specimens from 78 HCC patients who had undergone curative resection; microvessel density (MVD) was counted and the overall survival and disease-free survival were analyzed retrospectively. Results: Blood vessels in the tumor were strongly stained by anti-CD34 antibody, but not those in the surrounding liver parenchyma. There were three types of tumor vessels: capillary-like (n = 59), sinusoid-like (n = 16) and mixed-type (n = 3). The median MVD count was 100 per field. The HCC were designated as hypovascular (n = 36) with an MVD count below 100, and hypervascular (n = 42) with an MVD count of 100 or more per field. The 5-year survival and disease-free survival rates were 49.7% and 42.8% respectively, and statistical analysis showed that the MVD level was not correlated with tumor size, capsule status, Edmondson's grade, α-fetoprotein level, associated cirrhosis, γ-glutamyltransferase, and serum HBsAg status. The sinusoid-like tumor vessels appeared more frequently in the more differentiated tumors (P 〈 0.05). No statistical difference in overall and disease-free survival between different MVD levels and microvessel types was found. Tumor size was the only predicting factor in the entire series. In patients with small HCC (≤ 5 cm, n = 40), 5-year survival and disease-free survival rates were 58.9% and 52.7% respectively, higher than the values in large HCC (39.8% and 32.0% respectively, P 〈 0.05). The MVD level was an independent predicting factor of disease-free survival, 5-year disease-free survival in the hypovascular group (74.6%) being better than that in the hypervascular group (34.7%, P 〈 0.05). Conclusions: The MVD level was not related to tumor size, capsule statuo, Edmondson's grade, α-fetoprotein level, associated cirrhosis, γ-glutamyltransferase and serum HBsAg status. In the entire series, tumor size was the only factor influencing survival after curative resection. However, in patients with small HCC, the MVD level was an independent factor of disease-free survival. The pathological and clinical implications of different types of tumor vessels in HCC remain to be studied.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050296
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  • 19
    Electronic Resource
    Electronic Resource
    Onkogene humane Papillomaviren Schlüsselrolle bei Plattenepithelkarzinomen der Tonsillen mit Defekt im Retinoblastomprotein* (1999)
    Springer
    HNO 47 (1999), S. 796-803 
    Details
    ISSN: 1433-0458
    Keywords: Schüsselwörter Tonsillenkarzinome ; Onkogene humane Papillomaviren (HPV) ; Retinoblastomprotein (pRb) ; Prognose ; Key words Tonsillar squamous cell carcinomas ; Oncogenic human papillomavirus ; Retinoblastoma protein ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In order to identify squamous cell carcinomas of the head and neck (HNSCC) with common biological and clinical features, we investigated the incidence and properties of carcinomas lacking retinoblastoma protein (pR6) cell cycle control. Of 208 HNSCC investigated, 23 (11%) showed a lack of pRb expression. The majority of these tumors (65%) were tonsillar carcinomas. The pRb-negative tonsillar tumors were all stage IV, had metastasized to lymph nodes at the time of diagnosis and were in general poorly differentiated or undifferentiated. Very significantly, the pRb-negative phenotype was strongly associated with the presence of oncogenic human papilloma viruses, implying a viral etiology and functional inactivation of pRb by the viral E7 oncoprotein. Despite the very adverse histopathological factors, patients with pRb-negative tonsillar carcinomas had a better clinical outcome, which was consistent with a uniform favorable responsiveness of these tumors to postoperative radiation therapy.
    Notes: Zusammenfassung Hinsichtlich biologischer Tumorcharakteristika, Genese und klinischen Eigenschaften von Plattenepithelkarzinomen im Kopf-Hals-Bereich bestehen viele Unklarheiten. Zur besseren Charakterisierung dieser Karzinome wurde geprüft, ob es Tumoren mit Defekten im Retinoblastomstoffwechsel gibt und ob weitere molekulare und klinische Gemeinsamkeiten vorliegen. Bei 11% der untersuchten Plattenepithelkarzinome des Kopf-Hals-Bereichs (23 von 208) lag ein Defekt im Retinoblastomstoffwechsel vor; 15 dieser 23 Tumoren (65%) waren in der Tonsille lokalisiert. Die pRb-negativen Tumoren lagen überwiegend als Stadium IV (UICC) vor, hatten bereits in regionäre Lymphknoten metastasiert und wiesen eine geringgradige Differenzierung auf. Dagegen waren klinische Verläufe und Gesamtüberlebenszeiten nach Operation und Strahlentherapie günstig. Die molekularbiologischen Analysen zeigten folgende Gemeinsamkeiten innerhalb dieser Gruppe der Tonsillenkarzinome: Der Retinoblastom-Protein (pRb)- und Cyclin-D1-Spiegel waren erniedrigt, p16INK4a erhöht. Es zeigte sich eine starke Assoziation mit onkogenen humanen Papillomaviren (HPV), durch deren Onkogen E7 wahrscheinlich die pRb-Inaktivierung erfolgt. Damit kommt den Papillomaviren eine wesentliche Rolle für die Entstehung und besonderen klinischen Eigenschaften dieser Tonsillenkarzinome zu.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050462
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  • 20
    Electronic Resource
    Electronic Resource
    The Palliative Prognostic Index: a scoring system for survival prediction of terminally ill cancer patients (1999)
    Springer
    Supportive care in cancer 7 (1999), S. 128-133 
    Details
    ISSN: 1433-7339
    Keywords: Key words Advanced cancer ; Palliative care ; Prognosis ; Prediction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although accurate prediction of survival is essential for palliative care, few clinical methods of determining how long a patient is likely to live have been established. To develop a validated scoring system for survival prediction, a retrospective cohort study was performed with a training–testing procedure on two independent series of terminally ill cancer patients. Performance status (PS) and clinical symptoms were assessed prospectively. In the training set (355 assessments on 150 patients) the Palliative Prognostic Index (PPI) was defined by PS, oral intake, edema, dyspnea at rest, and delirium. In the testing sample (233 assessments on 95 patients) the predictive values of this scoring system were examined. In the testing set, patients were classified into three groups: group A (PPI≤2.0), group B (2.0〈PPI≤4.0), and group C (PPI〉4.0). Group B survived significantly longer than group C, and group A survived significantly longer than either of the others. Also, when a PPI of more than 6 was adopted as a cut-off point, 3 weeks' survival was predicted with a sensitivity of 80% and a specificity of 85%. When a PPI of more than 4 was used as a cut-off point, 6 weeks' survival was predicted with a sensitivity of 80% and a specificity of 77%. In conclusion, whether patients live longer than 3 or 6 weeks can be acceptably predicted by PPI.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005200050242
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  • 21
    Electronic Resource
    Electronic Resource
    Dendritische Zellen, T-und B-Lymphozyten und Makrophagen im supraglottischen und glottischen Plattenepithelkarzinom Lokalisation und Korrelation zur Prognose der Erkrankung (1999)
    Springer
    HNO 47 (1999), S. 466-471 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Schleimhautimmunsystem ; Tumorabwehr ; Prognose ; Key words Mucosal immune system ; Squamous cell carcinoma ; Tumor defense ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Dendritic cells play an important role within the mucosal immune system of the upper aerodigestive tract. They process exogenous and endogenous antigens and are able to induce a cytotoxic TC/S lymphocyte reaction against tumors. Recently published data indicate that the in vitro application of tumor lysate incubated dendritic cells can provide a defense against melanoma. Before these new therapeutic strategies are available for the therapy of laryngeal cancer, basic studies have to be performed concerning the distribution of dendritic cells and other subpopulations, such as T- and B-lymphocytes and macrophages. In the present study the distribution of these subpopulations were examined within the epithelial and connective tissue compartments (”tumor front”) of 20 T2 squamous cell carcinomas of the supraglottis and glottis. The number of dendritic cells was compared with clinical parameters to check whether a high number of dendritic cells could be correlated with a better prognosis. In contrast to T-lymphocytes, results showed that dendritic cells were mainly located within the epithelial compartment of the tumors, their number ranging from 20 cells/mm2 to 〉700 cells/mm2. By comparing each patient’s clinical course with the number of dendritic cells, findings showed that those patients who died within the first postoperative year were characterized by a very small number of dendritic cells within their tumor tissue (〈100 cells/mm2). Although the number of patients was low, results indicate that a high number of dendritic cells within tumor tissue suggest a better prognosis.
    Notes: Zusammenfassung Dendritische Zellen nehmen eine zentrale Stellung in der Initialisierung der Immunantwort ein, denn sie sind die potenteste Subpopulation des Schleimhautimmunsystems, die T-Lymphozyten via MHC-Rezeptor aktivieren können. Dies gilt insbesondere für die Initialisierung einer zytotoxischen T-Zell-Antwort gegenüber Malignomen. Erste klinische Studien an Patienten mit therapieresistentem Melanom und Lymphom zeigen, daß in vitro mit Tumorantigen sensibilisierte dendritische Zellen erfolgreich in vivo zur Immuntherapie eingesetzt werden können. Da für das Larynxkarzinom bisher kaum grundlegende Daten über das Vorkommen von dendritischen Zellen im Tumorgewebe und deren Funktion bekannt sind, wurde in der vorliegenden Studie die Lokalisation von dendritischen Zellen und anderen Subpopulationen des Schleimhautimmunsystems, wie T- und B-Lymphozyten und Makrophagen in Plattenepithelkarzinomen der Supraglottis und der Glottis immunhistologisch untersucht. Die Daten wurden mit klinischen Parametern wie Lymphknotenstatus und postoperatives Überlebensintervall verglichen. Die Resultate zeigen, daß dendritische Zellen im Gegensatz zu T-Lymphozyten vor allem im epithelialen Kompartiment der Plattenepithelkarzinome nachweisbar sind. Ihre Anzahl weist starke Schwankungen auf (20 bis zu 〉700 Zellen/mm2). Beim Vergleich mit den klinischen Parametern zeigt sich, daß die Patienten, bei denen die Zahl der dendritischen Zellen im Karzinom gering war (〈100/Zellen/mm2), die geringste postoperative Überlebenszeit (1 Jahr) aufwiesen. Dies deutet darauf hin, daß eine hohe Zahl dendritischer Zellen im Larynxkarzinom einen günstigen Prognosefaktor der Erkrankung darstellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050406
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  • 22
    Electronic Resource
    Electronic Resource
    Möglichkeiten der Rezidivbehandlung des Zervixkarzinoms (1999)
    Springer
    Der Gynäkologe 32 (1999), S. 312-321 
    Details
    ISSN: 1433-0393
    Keywords: SchlüsselwörterZervixkarzinom ; Rezidivbehandlung ; Therapieformen ; Prognose ; Key wordsCarcinoma of the cervix ; Treatment of recurrences ; Types of therapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Approximately one out of every three patients with carcinoma of the cervix must be expected to experience a recurrence. The treatment of such relapses is dependent on the site and extension of the recurrence, the type of primary therapy administered and the patient's general condition. The limit conditions for the application of the established forms of therapy available – surgical operation, radiotherapy, chemotherapy – are complex and seldom documented by randomized studies. In general, empiric observations and historical analyses determine the backdrop against which therapy is planned. The main experiences available are compiled in this paper to give a basis for individual treatment of patients with recurrences.
    Notes: Zusammenfassung Etwa jede dritte Patientin mit einem Zervixkarzinom muß mit einem Rezidiv rechnen. Die Behandlung dieser Rezidive ist abhängig vom Sitz und der Ausbreitung des Rezidivtumors, der Art der vorangegangenen Primärtherapie und dem Allgemeinzustand der Patientin. Die Rahmenbedingungen für den Einsatz der verfügbaren etablierten Therapieformen – Operation, Bestrahlung, Chemotherapie – sind komplex und nur selten durch randomisierte Studien belegt. Im wesentlichen bestimmen Anwendungsbeobachtungen und historische Analysen den Hintergrund der Therapieplanung. Die wesentlichen verfügbaren Erfahrungen sollen im folgenden zusammengestellt werden als eine Entscheidungsgrundlage für die individuelle Behandlung von Rezidivpatientinnen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003231
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  • 23
    Electronic Resource
    Electronic Resource
    Kritische Lebensereignisse im 2-Jahresverlauf der „Major Depression”Eine prospektive Studie mit stationär behandelten Patienten (1999)
    Springer
    Der Nervenarzt 70 (1999), S. 637-644 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Kritische Lebensereignisse/Lebensbedingungen ; Endogene Depression ; Prospektivstudie ; Krankheitsverlauf ; Gesunde Kontrollgruppe ; Key words Life events/life conditions ; Endogenous depression ; Prospective study ; Prognosis ; Healthy controls
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary A number of studies has shown a significant relationship between life events/life conditions and depression. However, there is only a small number of studies investigating the effect of life events/life conditions in patients with severe depression from the endogenous subtype. The results are inconsistent. The present study examines the significance of the patients’ life events/life conditions for the two year outcome of the illness in a prospective study with assessments every three months. Patients are compared to healthy controls with regard to the period three months prior to the admission to the hospital at the index episode. The results confirm the importance of life events and life conditions for the long term outcome of depressed patients with endogenous subtype respectively severe major depression in-patients. Relapsers show considerably more undesirable life conditions than non-relapsers three to six months prior to their relapse. Depressed patients indicate significantly more undesirable life events and life conditions and fewer desirable life conditions in comparison to the control group for the time span three months prior to their hospitalisation. Clinical implications are discussed.
    Notes: Zusammenfassung In zahlreichen Studien konnten signifikante Zusammenhänge zwischen kritischen Lebensereignissen/Lebensbedingungen und Depressionen nachgewiesen werden. Es liegen jedoch nur wenige und inkonsistente Befunde zu der Bedeutsamkeit von kritischen Lebensereignissen bei schwer depressiven Patienten des endogenen Subtyps bzw. schwer depressiven stationär behandelten Patienten mit Major Depression vor. Die vorliegende Studie untersucht in einem prospektiven Längsschnittdesign über einen Zeitraum von zwei Jahren in dreimonatigen Abständen die rückfallprädiktive Bedeutung von kritischen Lebensereignissen für den Krankheitsverlauf endogen depressiver Patienten. Des weiteren werden gesunde Kontrollpersonen in einem Querschnittdesign mit den depressiven Patienten in dem Zeitraum drei Monate vor der Kliniksaufnahme verglichen. Rückfallpatienten weisen drei und sechs Monate vor dem Rückfall signifikant mehr unerwünschte Lebensbedingungen auf als Patienten mit einem günstigen Verlauf. Bezogen auf die drei Monate vor dem Klinikaufenthalt geben die endogen depressiven Patienten signifikant mehr unerwünschte Lebensereignisse und Lebensbedingungen und weniger erwünschte Lebensbedingungen an als die gesunden Kontrollpersonen. Die Ergebnisse werden unter klinischen Gesichtspunkten diskutiert.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050489
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  • 24
    Electronic Resource
    Electronic Resource
    Long-term follow-up in patients with bilateral testicular germ cell tumors: a report of ten cases (1999)
    Springer
    International journal of clinical oncology 4 (1999), S. 244-247 
    Details
    ISSN: 1437-7772
    Keywords: Key words Bilateral testicular tumor ; Treatment ; Follow-up ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Several risk factors have been identified for the development of testicular germ cell tumors with history of a testicular tumor in the contralateral testis being one of the most important factors; the incidence of bilateral tumors in large series ranges from 2% to 5%. The aim of this study was to evaluate the results of long-term follow-up in patients with bilateral testicular germ cell tumors. In a series of 247 patients with testicular germ cell tumors treated at Kobe University Hospital between 1966 and 1995, 10 patients (4.0%) had bilateral testicular tumors. Clinicopathological data are presented for these 10 patients and the literature is reviewed. Of the 10 patients with bilateral tumors, 2 had a simultaneous bilateral tumor, and in the remaining 8 patients, the second tumor was diagnosed after an interval of 2 months to 16 years. All 10 patients were diagnosed as stage I or II in both the initial and secondary tumors. Five patients had identical histological findings in both tumors. Eight patients were free of disease after a median observation period of 13.5 years, and the remaining 2 patients died of metastatic disease. The present results are essentially consistent with previous studies analyzing the features of bilateral testicular germ cell tumors. Considering these findings, close clinical follow-up and patient education appeared to be an appropriate follow-up strategy in patients with testicular tumors, as the secondary tumors can generally be cured with current treatment regimens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050062
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  • 25
    Electronic Resource
    Electronic Resource
    Safe limits for ovarian conservation in patients with adenocarcinoma of the cervix (1999)
    Springer
    International journal of clinical oncology 4 (1999), S. 384-389 
    Details
    ISSN: 1437-7772
    Keywords: Key words Adenocarcinoma of the uterine cervix ; Ovarian conservation ; Ovarian transposition ; Ovarian recurrence ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Our study had two aims: (1) to evaluate the effect of ovarian conservation on the prognosis of patients with adenocarcinoma of the cervix and (2) to determine the method by which – and the stage up to which – ovaries can be conserved without adversely affecting a favorable prognosis. Methods. We performed either radical hysterectomy with lymphadenectomy or simple hysterectomy on 70 patients in stages 0 to IIIab of adenocarcinoma of the cervix (International Federation of Gynecology and Obstetrics). The postmenopausal patients underwent oophorectomy, while the ovaries of premenopausal patients were left in situ or transposed laterally. We then followed the subsequent condition of the patients to see whether or not ovarian conservation affected their ability to survive for up to 5 years. Results. We found no evidence of ovarian metastasis among patients in stages 0 to IIab of the disease, while three cases were found in patients whose carcinoma was in stage IIIab; 94% of the patients whose ovaries had been conserved survived for 5 years; of the patients who underwent oophorectomy, 100% survived. However, the difference was not significant. Two patients (stages Ib and IIb) suffered a recurrence of cancer in the transposed ovaries: at the time of the initial surgery the lymph nodes in both patients had been positive. Conclusions. If patients with adenocarcinoma of the cervix are operated on during stages 0 to Ia of the disease, ovarian conservation will not affect survival; ovaries can be left in situ or can be transposed laterally without affecting the survival prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050089
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  • 26
    Electronic Resource
    Electronic Resource
    Neoadjuvant chemotherapy with carboplatin, ifosfamide, and peplomycin in advanced cervical squamous cell carcinoma (1999)
    Springer
    International journal of clinical oncology 4 (1999), S. 358-363 
    Details
    ISSN: 1437-7772
    Keywords: Key words Uterine cervical carcinoma ; Neoadjuvant chemotherapy ; Prognosis ; Carboplatin ; Ifosfamide ; Peplomycin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. To control advanced cervical squamous cell carcinoma more effectively and more easily, we used neoadjuvant chemotherapy, with three drugs carboplatin, ifosfamide, and peplomycin (PIP), in a study performed from July 1990 to October 1994 in nine Institutions. Methods. Sixty-five patients with untreated, inoperable squamous cell carcinoma of the cervix were treated with carboplatin (300 mg/m2 IV; low-dose PIP regimen, or 400 mg/m2 IV; high-dose PIP regimen) on day 1, ifosfamide (1000 mg/m2, IV) on days 1–3, and peplomycin (5 mg/body, IM) on days 1–6. The low-dose PIP was given between July 1990 and April 1992, and the high-dose PIP from May 1992 to October 1994. Results. Response rates for the low- and high-dose PIP regimens were 42.9% (12/28) and 59.5% (22/37), respectively. Measurable lesions were recognized in the cervix, pelvic lymph node (PeN), paraaortic lymph node (PAN), lung, and supraclavicular lymph node. Response rates in these individual lesions to our low- and high-dose PIP regimens were 35.7% (10/28) and 55.6% (20/36), respectively in the cervical lesion and more than 50% for both regimens in the PeN and PAN metastatic lesions, while the supraclavicular lymph node metastatic lesions responded poorly to both regimens. After low-dose PIP, surgery was performed in 2 patients (2/28; 7.1%), while after high-dose PIP, 12 patients (12/37; 32.4%) underwent surgery. The 3-year survival rate of patients with high-dose PIP was significantly higher than that of those with low-dose PIP (P 〈 0.01). Conclusions. Neoadjuvant chemotherapy with PIP appears feasible and effective. The link between dosage and treatment response and achievable surgery rate and survival rates suggests that results might be further optimized by considering patients' renal function, and utilizing the Calvert formula for dosing analysis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050085
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  • 27
    Electronic Resource
    Electronic Resource
    Sacrococcygeal teratoma: clinical course and prognosis with a special view to long-term functional results (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 573-576 
    Details
    ISSN: 1437-9813
    Keywords: Key words Sacrococcygeal teratoma ; Prognosis ; Functional impairment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract From 1976 to 1995, 23 children, 4 boys and 19 girls, were treated at our department for sacrococcygeal teratomas (SCT). Their records were analyzed retrospectively, considering age at operation, histopathology, recurrences, and long-term evolution. One died on the 1st day of life following tumor rupture with hemorrhagic shock without surgical intervention. All others were operated upon at a mean age of 4.2 days for those 19 (=82%) who were diagnosed in the neonatal period and whose histology proved benign. In the remaining 3 children, in whom tumor manifestation did not occur before 11 months, 13 months, and 10 years of age, respectively, histopathologic evaluation revealed 2 carcinomas and 1 yolk-sac tumor, and all 3 recurred. Overall, 5 patients died, the 1 mentioned above, 1 due to volvulus after laparotomy, and 1 from multiple associated congenital malformations. Two deaths were related to malignancy, whereby only 1 was a malignant teratoma diagnosed at the original operation. Eight children had recurrences, 2 were benign and 6 malignant, with 3 of the latter having been graded benign on histology of the primary tumor. Of the 18 surviving patients, 17 (93.5%) returned for clinical review following a standardized protocol. The average interval from the primary surgery was 12.3 years (range 3.5–22 years). Four had malignant tumors with a recurrence-free period of from 9 to 14 years; 5 (29.4%) had urinary or anorectal functional impairment. One child with a patulous anus presented with fecal soiling. Two reported nocturnal enuresis, 1 associated with perineal anesthesia. One had a neurogenic bladder with overflow voiding and bilateral third-degree vesicoureteral reflux. Second-degree reflux was found in the last patient. We conclude that follow-up after surgery for SCT should not only search for tumor recurrence but include the diagnosis and treatment of possible secondary urinary and/or fecal incontinence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050675
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  • 28
    Electronic Resource
    Electronic Resource
    Effect of dose intensity of methotrexate, doxorubicin, and ifosfamide on the prognosis of patients with osteosarcoma (1999)
    Springer
    International journal of clinical oncology 4 (1999), S. 36-40 
    Details
    ISSN: 1437-7772
    Keywords: Key words Osteosarcoma ; Chemotherapy ; Dose inten-sity ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. The prognosis of patients with osteosarcoma has improved due to the introduction of systemic chemotherapy. The current study tried to identify the effect of each anti-tumor drug on the prognosis of patients with osteosarcoma. Methods. The records of 29 patients with osteosarcoma who received systemic chemotherapy were retrospectively analyzed. All tumors were classified as stage IIB (Enneking's surgical stage) and were located around the knee joint or more distal areas. The histologic response to preoperative chemotherapy was determined in 20 patients: 9 patients had grade 1, 4 grade 2, 5 grade 3, and 2 grade 4. The mean follow-up period was 102 months. Results. The 5-year overall survival and relapse-free survival (RFS) in the 29 patients was 47.7% and 41.4%, respectively. The 5-year RFS for the 7 good responders (grade 3 and 4) was 85.7%, and that for the 13 poor responders (grade 1 and 2) was 23.1% (P = 0.008). The mean preoperative dose intensity (DI) of methotrexate (MTX) for good responders was significantly higher than that for poor responders (P = 0.028). In 23 patients who received MTX and doxorubicin (ADR) but not ifosfamide (IFOS), the DI of MTX significantly influenced the RFS (P = 0.0128). In the 13 poor responders, 6 of whom received IFOS, the DI of IFOS and ADR significantly influenced RFS (P = 0.0112, 0.0395). Conclusion. The preoperative DI of MTX was related to the histologic response rate. The DI of MTX was significartly associated with the patients' RFS. In poor responders, the DI of IFOS and ADR influenced the patients' RFS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050021
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  • 29
    Electronic Resource
    Electronic Resource
    Wheat germ agglutinin binding is a useful prognostic indicator in stomach cancer (1999)
    Springer
    International journal of clinical oncology 4 (1999), S. 96-100 
    Details
    ISSN: 1437-7772
    Keywords: Key words Wheat germ agglutinin ; Stomach cancer ; Lectin histochemistry ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background. Recent studies suggest that lectin binding activity is correlated with the metastasis and prognosis of several human carcinomas. Wheat germ agglutinin (WGA) is a lectin that recognizes mainly N-acetyl-glucosamin (GalNAc) and acetyl-neuramic acid. However, little is known about WGA expression in gastric carcinoma. The purpose of this investigation was to clarify the significance of WGA expression in human gastric carcinoma. Methods. WGA binding was examined immunohistochemically in 353 specimens of primary gastric carcinomas from patients surgically treated at the First Department of Surgery, Fukushima Medical School, between 1980 and 1990. We studied the relationship between WGA expression and various clinicopathologic features and long-term survival. Results. Overall, 145/353 of the tumors (41%) were stained for WGA. WGA expression correlated with mean patient age, lymph node metastasis, venous invasion, and liver metastasis. Patients with tumors that were nonimmunoreactive for WGA had significantly lower 5-year survival rates than those with immunostained tumors (P 〈 0.05). WGA expression emerged as an independent prognostic factor on Cox's multivariate analysis. Conclusion. WGA binding is a useful prognostic indicator. Careful follow-up and intensive postoperative therapy are required for patients with gastric carcinomas that are nonimmunoreactive for WGA.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101470050034
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  • 30
    Electronic Resource
    Electronic Resource
    Proliferation marker Ki-S11 – a prognostic indicator for squamous cell carcinoma of the hypopharynx (1999)
    Springer
    Virchows Archiv 435 (1999), S. 590-595 
    Details
    ISSN: 1432-2307
    Keywords: Key words Hypopharynx carcinoma ; Prognosis ; Proliferation ; Ki-S11 ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  As a potential prognostic factor, the proliferative activity of 131 squamous cell carcinomas (SCC) of the hypopharynx and 47 of their cervical lymph-node metastases was analyzed retrospectively by means of monoclonal antibody Ki-S11 immunostaining, which specifically detects the Ki-67 antigen on paraffin-embedded tissue. Median follow-up time was 37.6 months. Ki-S11 revealed distinctive patterns of proliferating cells related to the degree of differentiation. The proliferation fractions in the primaries and their lymph-node metastases did not differ significantly. Patients with high proliferating hypopharynx carcinomas (〉45% labeled cells) had a significantly lower 5-year-survival rate (16%) than patients with low proliferating tumors, whose 5-year-survival rate was 30% (P=0.01). A statistically significant positive correlation was also observed between proliferative activity and lymph-node status (P=0.012). In conclusion, the proliferative activity as determined by means of Ki-S11 immunostaining is of prognostic value with respect to both survival and metastatic risk in SCC of the hypopharynx.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050445
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  • 31
    Electronic Resource
    Electronic Resource
    Irregular expression of hyaluronan and its CD44 receptor is associated with metastatic phenotype in laryngeal squamous cell carcinoma (1999)
    Springer
    Virchows Archiv 434 (1999), S. 37-44 
    Details
    ISSN: 1432-2307
    Keywords: Key words Hyaluronic acid ; CD44 receptor ; Adhesion ; Laryngeal neoplasms ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The distributions of hyaluronan (HA) and its CD44 receptor were studied in 24 normal, 27 dysplastic samples of laryngeal epithelium and in 172 squamous cell carcinomas (LSCC), using a specific probe prepared from cartilage proteoglycan (bHABC, biotinylated hyaluronan binding complex) and a monoclonal antibody (Hermes 3). HA and CD44 were expressed similarly in all normal and about 90% of dysplastic and neoplastic laryngeal epithelia. In the normal epithelium HA and CD44 were homogeneously distributed throughout the epithelium, whereas the most superficial layers were negative. This was in contrast to the picture in dysplastic epithelium and well-differentiated invasive carcinomas, which were entirely HA and CD44 positive. Local areas with a low signal for HA and CD44 were present in 11% and 22% of the samples with dysplasia, and in 27% and 28% of those with carcinoma, respectively. The presence of this staining irregularity was associated with poor differentiation of the carcinoma, a significantly elevated mitotic index and a high frequency of nodal spreading and metastases. Furthermore, the irregular staining showed a trend towards poor disease-free survival, suggesting that an altered metabolism of HA is a common feature in LSCC and is associated with an aggressive growth pattern.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050302
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  • 32
    Electronic Resource
    Electronic Resource
    p27/kip1 expression in oligodendrogliomas and its possible prognostic role (1999)
    Springer
    Acta neuropathologica 98 (1999), S. 629-634 
    Details
    ISSN: 1432-0533
    Keywords: Key words p27/kip1 ; Oligodendrogliomas ; Histological grading ; Prognosis ; MIB-1
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract p27/kip1 regulates the G1-S transition of the cell cycle by inhibiting cyclinD-CDK4, cyclinE-CDK2 and cyclinA-CDK2 complexes. Regulation of p27 levels occurs mainly post-translationally by ubiquitin-mediated proteasomal proteolysis. Although genetic changes of p27/kip1 are extremely rare, in many human carcinomas p27 levels are reduced, correlate with histological malignancy, and are associated with poor prognosis. In astrocytic gliomas, p27 decreases with anaplasia and is almost absent in glioblastomas. p27/kip1 was immunohistochemically studied in 37 oligodendrogliomas, categorized according to WHO classification. In this series, the immunohistochemical reaction for p27 was confined to nuclei. p27 score showed a tendency to decrease with malignancy. When the p27 score was considered as high versus low expression (cut-off of p27 labeling index, LI, at 25%), it represented an independent prognostic factor in univariate (P = 0.02) and in multivariate analysis (P = 0.04). The risk ratio suggested that the p27 low expression group had a threefold increased possibility to show a reduced survival. Moreover, p27 levels did not correlate with MIB-1 LI, suggesting that p27 is not merely associated with the control of proliferation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051128
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  • 33
    Electronic Resource
    Electronic Resource
    Neuropathology and prognosis of foetal brain tumours (1999)
    Springer
    Acta neuropathologica 98 (1999), S. 567-576 
    Details
    ISSN: 1432-0533
    Keywords: Key words Congenital brain tumour ; Prenatal ; diagnosis ; Prognosis ; Teratoma ; Ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A survey of brain tumours that had been diagnosed prenatally by foetal sonography yielded 89 cases. The most commonly found tumour entities were teratomas (53.9%), glioblastomas (14.6%), lipomas (9.0%), plexus papillomas (7.9%) and craniopharyngiomas (5.6%). The mean gestational age at ultrasound diagnosis was 30.0 weeks, ranging between 25.4 weeks in craniopharyngiomas and 35.3 weeks in lipomas. Girls were more frequently affected (57.4%; P 〈 0.05). The average maximum tumour size at diagnosis was 6.5 cm, ranging between 1.6 cm in lipomas and 8.2 cm in teratomas. Tumours diagnosed between 1979– 1988 accounted for 29.2% of all cases and were larger when identified than the ones reported between 1989– 1998 (5.9 vs 8.4 cm; P = 0.08). Of all patients, only 18.8% were alive after the first week and 10.5% after the 1st year of life. Prognosis was particularly poor among foetuses with brain tumours detected before 30 weeks’ gestation of which 96.9% died. Significantly longer survival was found for lipomas (12.0 vs 3.8 months), tumour detection after gestational age of 30 weeks (6.3 vs 1.2 months) and in cases reported after 1988 (5.3 vs 2.9 months, all P 〈 0.05). Cytogenetic data was given for eight teratomas of which three showed a pathological and five cases a normal karyotype for both foetus and tumour. In conclusion, foetal brain tumours are rare neoplasms of whose cytogenetics little is known. They are mainly detected at the beginning of the third trimester of pregnancy with teratomas being the most common entity. Foetal brain tumours have a mainly unfavourable clinical outcome. However, their prognosis has improved in the last decade.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004010051120
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  • 34
    Electronic Resource
    Electronic Resource
    Management of mantle cell lymphoma (1999)
    Springer
    Annals of hematology 78 (1999), S. 485-494 
    Details
    ISSN: 1432-0584
    Keywords: Key words Mantle cell lymphoma ; Classification ; Pathology ; Prognosis ; Immunology ; Genetics ; Antineoplastic agents ; Combined ; Therapeutic use ; Radiotherapy ; Hematopoietic stem cell transplantation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050545
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  • 35
    Electronic Resource
    Electronic Resource
    The role of interferon-α in the treatment of idiopathic myelofibrosis (1999)
    Springer
    Annals of hematology 78 (1999), S. 533-538 
    Details
    ISSN: 1432-0584
    Keywords: Key words Idiopathic myelofibrosis ; Pathogenesis ; Prognosis ; Treatment ; Interferon-α
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Idiopathic myelofibrosis (IMF) is a chronic myeloproliferative disorder characterized by fibrosis of the bone marrow, varying degrees of extramedullary hematopoiesis, splenomegaly, anemia, and a leukoerythroblastic peripheral blood smear. Bone marrow fibrosis develops as a secondary phenomenon and is caused by increased intramedullary activity of mitogens such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and calmodulin. Because of the variable clinical course of IMF, attempts have been made to define prognostic parameters that can be helpful in detecting patients with a shortened life expectancy. The most important adverse prognostic parameters that have been reported are hemoglobin concentration, age, leukocyte count, number of thrombocytes, and cytogenetic abnormalities. However, no standardized prognostic score for IMF has yet been established. Therapeutic strategies in IMF remain predominantly supportive. The most common are blood transfusions, androgens, and cytoreductive agents such as hydroxyurea. Bone marrow transplantation is increasingly being taken into consideration, but it still has to be regarded as an experimental approach. Interferon-α (IFN-α) has shown promising results in early hyperproliferative stages of IMF but has no or only very little effect in more advanced stages of the disease. Whether IFN-α is able to postpone marrow fibrosis if administered in early disease stages remains to be determined in future clinical trials.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050554
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  • 36
    Electronic Resource
    Electronic Resource
    Prognostic impact of apoptosis and proliferation in idiopathic (primary) myelofibrosis (1999)
    Springer
    Annals of hematology 78 (1999), S. 65-72 
    Details
    ISSN: 1432-0584
    Keywords: Key words Idiopathic myelofibrosis ; PCNA labeling ; Apoptosis ; Dynamic disease features ; Prognosis ; Proportion of life loss ; Bone marrow
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  A retrospective study of 120 patients with the clinically and histologically established diagnosis of idiopathic (primary) myelofibrosis (IMF) was performed to determine prognostic factors of predictive value, including parameters characterizing the dynamics of hematopoietic cell kinetics. In contrast to previous studies, our cohort comprised the full spectrum of the disease, from initial prefibrotic to advanced osteosclerotic stages. The in situ end-labeling (ISEL) technique was used to demonstrate apoptosis, in order to determine dynamic parameters of predictive value. Cell proliferation was evaluated by employing the monoclonal antibody PC10 directed against proliferating cell nuclear antigen (PCNA). Proliferative activity (PCNA index) and frequency of apoptosis showed significant differences between early and advanced fibrosclerotic stages of disease. Decrease in proliferation indicated a significantly shorter survival, whereas a higher frequency of apoptotic cells was associated with a better prognosis. It may be speculated that a normal or enhanced proliferation rate expressed by PCNA positivity (late G1- and S-phase of the cell cycle) that is accompanied by a higher incidence of apoptosis reflects the regenerative (turnover) capacity of hematopoiesis. This may apply especially to early hypercellular stages without relevant myelofibrosis. In consideration of a recently published multivariate risk model, a simplified synthesis score for stratification of a patient's prognosis was constructed. Age, degree of anemia, leukocytes, and platelet count were regarded as the most important parameters. A substantial improvement of prognostic efficiency was further achieved by including PCNA index and frequency of apoptosis. Our results are in keeping with the assumption that generalization, indicated by myeloid metaplasia, has a prodigious impact on prognosis in IMF. Furthermore, in this context dynamic features such as proliferative activity and frequency of apoptosis exert an additional predictive value.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050474
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  • 37
    Electronic Resource
    Electronic Resource
    Central nervous system involvement in patients with mantle cell lymphoma (1999)
    Springer
    Annals of hematology 78 (1999), S. 145-149 
    Details
    ISSN: 1432-0584
    Keywords: Key words CNS involvement ; Mantle cell lymphoma ; Non-Hodgkin's lymphoma ; Prognosis ; Incidence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In small cell lymphomas, central nervous system (CNS) involvement has been considered to be very rare. Mantle cell lymphoma (MCL) is a distinct subtype of non-Hodgkin's lymphomas consisting of small or intermediate lymphatic B-cells. It has a poorer prognosis than the other small cell lymphomas. Only a few MCL patients with CNS involvement have been reported in the literature to date. We analyzed retrospectively the incidence, clinical characteristics, and outcome of CNS involvement in 94 patients with confirmed MCL treated at one center from 1980 to 1997. Four of the 94 patients (4%) developed CNS lymphoma during the median follow-up of 51 months. The diagnosis was based on clinical, cytological and radiological findings. CNS involvement appeared at 4.6, 56, 66, or 86 months from the diagnosis of MCL. All patients had neurological symptoms and a leukemic disease; two cases were seen with a blastoid morphology. Malignant lymphatic cells were detected in spinal fluid in all cases and parenchymal infiltrations in brain in two. All patients were treated with intrathecal chemotherapy, without response. Survival time after diagnosis of CNS lymphoma ranged from 18 to 55 days. At diagnosis, no adverse prognostic factors predictive of CNS lymphoma were found. CNS involvement was associated with a progressive leukemic disease as a late event or a blastoid transformation. The prognosis of MCL patients with CNS involvement is poor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050491
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  • 38
    Electronic Resource
    Electronic Resource
    Mechanical ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic obstructive pulmonary disease: prognosis and cost-utility analysis (1999)
    Springer
    Intensive care medicine 25 (1999), S. 452-457 
    Details
    ISSN: 1432-1238
    Keywords: Key words Lung disease ; obstructive ; Long-term oxygen therapy ; Prognosis ; Quality of life ; Cost analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Astract Objective: To analyze the prognosis and costs of mechanical ventilation in patients with exacerbations of chronic obstructive pulmonary disease (COPD) treated with long-term oxygen therapy. Design: A prospective cohort study. Follow-up at 1 and 5 years. Cost utility analysis. Setting: A medical-surgical intensive care unit (ICU) in a university hospital. Patients: 20 patients with previous COPD treated with long-term oxygen therapy and needing mechanical ventilation due to acute respiratory failure. Measurements and main results: Mortality in the ICU, in-hospital mortality (ICU plus ward), and mortality at 1 and 5 years, and factors associated with prognosis and cost–utility were assessed. The mean Acute Physiology and Chronic Health Evaluation II score was 20 (median 20 range 12–36). Cumulative mortality was 35 % in the ICU, 50 % in hospital, 75 % at 1 year, and 85 % at 5 years. Factors significantly associated with mortality in the ICU were low levels of albumin (p = 0.05) and sodium (p = 0.01) at admission. Patients who died in hospital and in the first year after discharge had a lower forced expiratory volume in 1 s (FEV1) than survivors (p = 0.03 and p = 0.05, respectively). The cost per Quality Adjusted Life Year (QALY) was U. S. $ 26 283 and U. S. $ 44 602 in a “best” (cost/QALY calculated for the life expectancy in Spain) and a “worst case scenario” (cost/QALY calculated for a 68-year life expectancy), respectively. Conclusions: Applying mechanical ventilation to COPD patients treated with long-term oxygen therapy carries a high mortality and cost. Factors significantly associated with mortality in the ICU were albumin and sodium concentrations and FEV1 in hospital and in the first year after discharge.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050879
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  • 39
    Electronic Resource
    Electronic Resource
    The epidemiology of occupational contact dermatitis (1999)
    Springer
    International archives of occupational and environmental health 72 (1999), S. 496-506 
    Details
    ISSN: 1432-1246
    Keywords: Key words Occupational dermatitis ; Contact dermatitis ; Allergy ; Irritation ; Exposure ; Atopy ; Prevention ; Prognosis ; Risk
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Occupational contact dermatitis (OCD) ranks first of all occupational diseases in many countries. The incidence rate is believed to be around 0.5–1.9 cases per 1000 full-time workers per year. Epidemiological studies play an important role in observing disease trends, analysing risk factors, and monitoring the effect of preventive measures. In this review article the lack of truly epidemiologic data on OCD and the difficulties of those studies are illustrated. The following issues are highlighted: case ascertainment and bias, the distribution of allergic and irritant contact dermatitis in the working population, the interrelationship between exogenous (allergens, irritants) and endogenous factors, the prognosis, the social and economic impact, and the need for intervention studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004200050407
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  • 40
    Electronic Resource
    Electronic Resource
    S-100β-Protein im Serum als Tumormarker beim malignen Melanom Aktueller Kenntnisstand und klinische Erfahrungen (1999)
    Springer
    Der Hautarzt 50 (1999), S. 250-256 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Serum-S-100-Protein ; Tumormarker ; Malignes Melanom ; Prognose ; Key words Serum S100 protein ; Tumor marker ; Malignant melanoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary S100 is an acidic-calcium-binding protein, composed as a heterodimer of two isomeric subunits α and β and was first described in cells of neuroendocrine origin. It plays an important role in various cellular processes such as cell differentiation and proliferation and interacts with the tumour suppressor gene p53. S100 is also present in melanoma cells and its immunhistochemical detection is widely used in the histopathological diagnosis of malignant melanoma. S100 has been detected in the serum of patients with malignant melanoma and many clinical studies have been performed to establish this protein as a tumor marker in different stages of the disease. The data suggest that S-100β-protein in serum of patients with malignant melanoma could be an independent prognostic marker and an additional clinical parameter for progression of metastatic disease and serological monitoring during systemic therapy. However there are patients in stage of lymph node- or systemic metastasis with negative S-100β-serum levels and no correlation to the course of disease. Our results confirm the findings for patients in stage III/IV. However, the percentage of S-100β-positive patients in stage III/IV is lower than reported in the literature, if repeatedly positive samples are excluded from statistical analysis. For monitoring in stage I and II it seems to be not helpful.
    Notes: Zusammenfassung S-100 ist ein saures, kalziumbindendes Protein, das als Heterodimer aus 2 isomeren Untereinheiten α und β besteht und erstmalig in Zellen neuroendokrinen Ursprungs beschrieben wurde. Es spielt eine Rolle bei verschiedenen zellulären Prozessen, wie z.B. der Zelldifferenzierung und der Proliferation und interagiert mit dem Tumorsuppressorprotein p53. S-100 ist ebenfalls in Melanomzellen vorhanden, und sein immunhistochemischer Nachweis ist bei der histopathologischen Diagnostik des malignen Melanoms weit verbreitet. Nachdem S-100β im Serum von Patienten mit malignem Melanom nachgewiesen wurde, folgten zahlreiche klinische Studien zur Etablierung dieses Proteins als Tumormarker in verschiedenen Stadien der Erkrankung. Die Resultate zeigen, daß S-100β-Protein im Serum von Patienten mit malignem Melanom ein unabhängiger prognostischer Marker und ein ergänzender klinischer Parameter für die Progression der metastasierten Erkrankung sowie für das Monitoring der Patienten während einer systemischen Therapie sein kann. Bei Lymphknoten- oder Fernmetastasierung gibt es jedoch auch Patienten mit negativen S-100-β-Werten, bei denen eine Korrelation mit dem Krankheitsverlauf nicht hergestellt werden kann. Eigene Ergebnisse bestätigen diese Grundaussage für Patienten im Stadium III/IV. Werden aber wiederholt positive S-100β-Serumwerte bei der statistischen Auswertung nur einmalig berücksichtigt, zeigt sich ein deutlich geringerer Anteil von Patienten im Stadium III/IV mit positiven S-100-Werten, als in der Literatur angegeben. Für das Monitoring im Stadium I und II scheint S-100β nicht geeignet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050897
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  • 41
    Electronic Resource
    Electronic Resource
    Severe head injury patients in a multidisciplinary ICU: are they a burden? (1999)
    Springer
    Intensive care medicine 25 (1999), S. 855-858 
    Details
    ISSN: 1432-1238
    Keywords: Key words Head injury ; Outcome ; Prognosis ; Age ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: Patients with severe head injury (HI) are often considered to be a burden in a multidisciplinary intensive care unit (ICU). This study was undertaken to compare the severe closed HI patients with all other patients in the ICU in terms of age group involved, stay in the unit, complications and outcome. Design: Retrospective analysis. Setting: Multidisciplinary ICU of a tertiary care hospital in Northern India. Patients and participants: All the patients admitted to the ICU between January 1995 and December 1997. The patients were classified into two groups: group A comprising patients with severe closed HI and group B consisting of all other patients. Results: The mean age of the patients was around 30 years in both the groups. The average stay of the patients in the unit was 12.71 ± 11.9 days in group A, compared to 9.9 ± 14.4 days for group B (p 〈 0.05). The duration on the ventilator or on an endotracheal airway was not different between the groups (p 〉 0.05). The mortality in group A was 46.8 % and that in group B was 38.5 % (p 〉 0.05). The mortality was directly proportional to the age in group A. Hypotension, renal failure and septicaemia were the commonest complications in both the groups but the difference was not statistically significant. Conclusions: This study demonstrates that patients with severe HI do not pose an extra burden in a multidisciplinary ICU.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050965
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  • 42
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    Electronic Resource
    Hochdifferenziertes Plattenepithelkarzinom als Spätkomplikation einer posttraumatischen Osteomyelitis (1999)
    Springer
    Der Pathologe 20 (1999), S. 236-241 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Osteomyelitis ; Plattenepithelkarzinom ; Fistelkarzinom ; Differentialdiagnose ; Prognose ; Key words Osteomyelitis ; Squamous cell carcinoma ; Fistula carcinoma ; Diagnosis ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Squamous cell carcinoma as a late complication of chronic osteomyelitis is a well known phenomenon in traumatology, often occurring as a consequence of bone fractures. The majority of cases are observed in men between 50 and 60 years of age. The time from onset of inflammatory bone disease to malignant transformation differs but usually takes 30 years. In general, prognosis is thought to be favorable when adequate surgical therapy is carried out. Nowadays, it is important to recall this condition, because it has become rare. The cases reported here illustrate the difficulties that may be encountered in diagnosing malignant transformation, especially in lesions that develop in deep tissue layers and which may be responsible for various biopsies failing to reveal the true pathology.
    Notes: Zusammenfassung Plattenepithelkarzinome als Spätfolge chronischer Osteomyelitiden sind in der Traumatologie im Verlauf von offenen Frakturen beschrieben und insbesondere bei Männern in der 5. und 6. Lebensdekade zu beobachten. Von Beginn der Knochenentzündung bis zur malignen Transformation vergehen im Durchschnitt etwa 30 Jahre. In aller Regel ist die Prognose bei frühzeitiger Diagnosestellung und adäquater chirurgischer Therapie gut. Heutzutage ist die Erkrankung nur noch selten zu beobachten und droht daher, in Vergessenheit zu geraten. Insbesondere der erste der beiden vorgestellten Fallberichte verdeutlicht die Schwierigkeit der Diagnosestellung, da die klinische Präsentation uncharakteristisch war und erst in der Tiefe der Läsion gewonnene Probebiopsien die karzinomatöse Entartung erfaßten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002920050351
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  • 43
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    Electronic Resource
    Prognostic factors in fetal hydronephrosis: a multivariate analysis (1999)
    Springer
    Pediatric nephrology 13 (1999), S. 859-864 
    Details
    ISSN: 1432-198X
    Keywords: Key words Fetal ; Hydronephrosis ; Ultrasonography ; Oligohydramnios ; Prognosis ; Multivariate analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  With the increasing use of obstetric echography fetal hydronephrosis has been reported more frequently. The purpose of this study was to identify prognostic factors associated with adverse outcome, such as renal failure and death, in fetal hydronephrosis. One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol, and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings on admission were studied. The median follow-up was 39 months. The analysis was conducted in two steps. In a univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis. This analysis, using the multivariate Cox’s model, was performed to identify variables that were independently associated with a worse prognosis. Only variables that remained independently associated with adverse outcome were included in the final model. After final adjustment by Cox’s multivariate model, three variables were identified as independent predictors of adverse outcome: oligohydramnios, prematurity, and glomerular filtration rate lower than 20 ml/min. Thus, in the presence of oligohydramnios, prematurity, and abnormal renal function, the medical team must plan appropriate follow-up for infants at health centers prepared to investigate and treat uropathies in newborns.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050716
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  • 44
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    Electronic Resource
    Pathologie der Rhabdo- myosarkome des Kindes- und Adoleszentenalters Ein Bericht des Kindertumorregisters bei der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) (1999)
    Springer
    Der Pathologe 20 (1999), S. 87-97 
    Details
    ISSN: 1432-1963
    Keywords: Schlüsselwörter Rhadomyosarkom ; Klassifizierung ; Immunhistochemie ; Genetik ; Prognose ; Key words Rhabdomyosarcoma ; Classification ; Immunohistochemistry ; Genetics ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Rhabdomyosarcoma (RMS) is the most important and a very heterogeneous group of malignant soft tissue tumors of childhood and adolescence.The two major subtypes (embryonal and alveolar) share a common myogenic differentiation, but seem to be histogenetically not related. The so-called ’International Classification of Rhabdomyosarcoma’ includes, besides the two major subtypes, the botryoid and leiomyomatous subtypes of embryonal RMS which are associated with a better prognosis and are treated less aggressively according to current protocols. In addition, the solid variant of alveolar RMS is included in the alveolar group of RMS. The identification of the various subtypes is necessary and important because the treatment with the current protocols is also related to histology. Using conventional stains and immunohistochemistry, these subtypes are distinguishable. Genetic analysis can be helpful in the demonstration of t(2;13) or t(1;13) translocations in alveolar RMS. The identification of alveolar RMS with t(1;13) translocation might become important in the future, because this type of translocation seems to be related to a better prognosis as compared to tumors with a t(2;13) translocation.
    Notes: Zusammenfassung Rhabdomyosarkome stellen eine heterogene Gruppe von ganz verschiedenartigen, histogenetisch wohl nicht zusammengehörenden Tumoren dar. Nach der heute verwendeten „Internationalen Klassifikation” der Rhabdomyosarkome werden neben der Unterteilung in embryonalen und alveoläre Rhabdomyossarkome auch Subtypen des embryonalen RMS identifiziert (botryoider und leiomyomatöser Subtyp), die durch eine günstigere Prognose und durch die Notwendigkeit einer weniger aggressive Therapie gekennzeichnet sind. Durch Einsatz von verschiedenen histologischen und immunhistochemischen Färbungen ist die Identifizierung der verschiedenen Typen der RMS heute möglich und auch zwingend notwendig, da die einzelnen Entitäten nach ganz unterschiedlichen Therapieprotokollen behandelt werden. Der Nachweis typischer molekulargenetischer Veränderungen kann in der Unterscheidung insbesondere von embryonalen und alveolären RMS hilfreich sein. In der Regel ist die Abgrenzung zwischen diesen beiden Entitäten auch an konventionell gefärbten Schnittpräparaten möglich. Die Identifizierung von alveolären RMS mit einer t(1;13)-Translokation könnte in Zukunft eine große Bedeutung haben, da diese genetische Veränderung möglicherweise mit einer günstigeren Prognose assoziert sein könnte als die t(2;13)-Translokation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002920050326
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  • 45
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    Electronic Resource
    Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula (1999)
    Springer
    Journal of neurology 246 (1999), S. 181-185 
    Details
    ISSN: 1432-1459
    Keywords: Key words Spinal dural ; arteriovenous fistula ; Symptoms ; Neurological outcome ; Treatment ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Clinical outcome was examined in 21 patients treated for spinal dural arteriovenous fistula after 5–50 months. We compared the neurological condition (motor function, pain, sensory disturbance, vegetative dysfunction) and Barthel index before and after fistula occlusion. Neurological impairment was assessed as improved, unchanged, or deteriorated. All patients initially showed paraparesis of varying degree, and a sensory loss with a defined level in 81% before treatment. The greatest postoperative change that we measured was in motor activity (67% improved), and the most important deterioration was in male potency (28% deteriorated). We observed unchanged or absent symptoms in pain in 71% of our patients. We were thus able not only to stop but even to reverse the progression of symptoms and the degree of disability. On average, neurological symptoms stabilized within 1 year. The results of this study confirm that spinal dural arteriovenous fistula should be treated as early as possible after diagnosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050331
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  • 46
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    Electronic Resource
    Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study (1999)
    Springer
    Journal of neurology 246 (1999), S. 257-264 
    Details
    ISSN: 1432-1459
    Keywords: Key words Cerebellar infarction ; Treatment ; Decompression surgery ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Surgical intervention (ventricular drainage or decompressive craniotomy) may be necessary in patients with cerebellar infarction if mass effect develops. However, patient selection and timing of surgery remain controversial, and there are few data on clinical signs in the early course that are predictive for outcome. The clinical course and neuroradiological features of 84 patients (aged 22–78, mean 58.5 years) with massive cerebellar infarction confirmed by computed tomography were prospectively observed for 21 days after admission and at 3-month follow-up using a standardized protocol. Data were gathered from 1992 to 1996 in 17 centers. The patients were assigned to three treatment groups depending on the decision of the primary caretaker: 34 underwent craniotomy and evacuation, 14 received ventriculostomy, and 36 were treated medically. Treatment groups differed regarding the level of consciousness, signs of mass effect in computed tomography and signs of brainstem involvement. The overall risk for poor outcome depended on the level of consciousness after clinical deterioration (odds ratio = 2.8). Subgroup analysis of awake/ drowsy or somnolent/stupor patients revealed no relationship to treatment. The vascular territory involved did not affect outcome. Surgical treatment for massive cerebellar infarctions was not found to be superior to medical treatment in awake/ drowsy or somnolent/stupor patients. Half of all patients deteriorating to coma treated with ventricular drainage or decompressive craniotomy had a meaningful recovery. We were unable to compare surgical versus medical therapy in this subgroup due to lack of control group. This study supports the notion that the level of consciousness is the most powerful predictor of outcome, superior to any other clinical sign and treatment assignment. Deterioration of consciousness typically occurred between days 2 and 4, with a maximum on day 3.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004150050344
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  • 47
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    Electronic Resource
    Experience of 1446 rectal cancer patients in Korea and analysis of prognostic factors (1999)
    Springer
    International journal of colorectal disease 14 (1999), S. 101-106 
    Details
    ISSN: 1432-1262
    Keywords: Key words Rectal cancer ; Prognosis ; Univariate analysis ; Multivariate analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In order to investigate the changing pattern of rectal cancers in Korea and to identify prognostic factors, we investigated the case histories of 1446 rectal cancer patients who had received surgical treatment. During the study period there were trends toward a decrease in the ratio of rectal cancer to colon cancer, earlier detection (more Dukes' stages A and B and fewer C), a decrease in the number of abdominoperineal resections, and an increase in the number of sphincter-preserving operations. Univariate analysis of prognostic factors showed that gender, obstruction symptoms, preoperative serum carcinoembryonic antigen (CEA) level, tumor size, depth of bowel wall invasion, lymph node metastases (presence and number), tumor differentiation, operative method, and date of operation were significant, but age, symptom duration, and tumor location were not. The use of sphincter-saving operations did not adversely affect the clinical outcome. Multivariate analysis showed lymph node metastasis factor to be the most significant factor (P〈0.001); the depth of bowel wall invasion, differentiation, CEA level, and date of operation were also significant (0.001〈P〈0.05). This study shows that although anatomical extent of disease (depth of invasion and lymph node metastasis) is the most reliable prognostic predictor in rectal cancer, other factors such as preoperative CEA level and tumor differentiation also provide important information on the outcome and use of an anal-preserving operation does not adversely affect the patient survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050193
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  • 48
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    Electronic Resource
    Pineal and nonpineal supratentorial primitive neuroectodermal tumors (1999)
    Springer
    Child's nervous system 15 (1999), S. 586-591 
    Details
    ISSN: 1433-0350
    Keywords: Key words Supratentorial primitive neuroectodermal tumor ; SPNET ; Pineoblastoma ; Treatment ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Pineal region supratentorial primitive neuroectodermal tumors (SPNETs; pineoblastomas) and nonpineal SPNETs are rare tumors that historically have carried a very poor prognosis. With multimodality therapy, including maximal surgical resection, craniospinal radiation therapy and chemotherapy, the survival for patients with pineal PNETs has significantly improved. Chemotherapy alone, at least in conventional doses, appears to be insufficient treatment for younger children with pineoblastomas, in whom there is almost universal rapid tumor progression and death. Survival of patients with nonpineal SPNETs remains in the order of 30–35% despite multimodality therapy. Unlike those with pineal SPNETs, a significant percentage of infants with nonpineal SPNETs who undergo gross total surgical resection followed by chemotherapy will be long-term survivors. This article gives an overview of the natural history, prognostic factors and treatment of both pineal and nonpineal SPNETs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050547
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  • 49
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    Electronic Resource
    Prognostic significance of p53 gene mutations and p53 protein expression in synovial sarcomas (1999)
    Springer
    Virchows Archiv 435 (1999), S. 407-412 
    Details
    ISSN: 1432-2307
    Keywords: Key words p53 alterations ; Synovial sarcoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Alterations to p53 seem to be of prognostic significance in soft tissue sarcomas, but their significance for synovial sarcomas has not been studied. We analysed 34 synovial sarcomas in 19 patients for p53 alterations (p53 gene mutations + p53 immunopositivity) and examined this factor for its prognostic value in a group of 15 primary tumours. DNA was prepared from paraffin-embedded tumour material by a modified proteinase K/phenol/chloroform extraction. p53 gene mutations of exons 5–8 were analysed by the PCR-SSCP-sequencing method. p53 protein expression was evaluated by immunohistochemistry using the murine monoclonal antibody DO1. We found two missense mutations (5.9%) and ten p53 immunopositive cases (29.4%). Both tumours with p53 mutations showed p53 protein expression. There was no significant correlation between p53 alteration and histological subtype, age, sex, or tumour size. The 5-year survival rate was 24.1%. Overall survival was significantly reduced in patients having synovial sarcomas with p53 alterations (P〈0.001). In the multivariate Cox’s analysis, only p53 alterations (P=0.032) and tumour size (P=0.023) emerged as independent prognostic factors. We suggest that p53 alterations may be a useful prognostic indicator in synovial sarcomas, allowing rational clinical treatment and follow-up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050418
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  • 50
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    Electronic Resource
    Supratentorial primitive neuroectodermal tumor in children: clinical features, treatment outcome and prognostic factors (1999)
    Springer
    Child's nervous system 15 (1999), S. 377-383 
    Details
    ISSN: 1433-0350
    Keywords: Key words Primitive neuroectodermal tumor ; Child ; Prognosis ; Necrosis ; Surgical resection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To investigate clinical features, treatment outcome and prognostic factors of pediatric supratentorial primitive neuroectodermal tumors(ST-PNETs), 28 ST-PNET cases were retrospectively analyzed. The prognostic importance of age, sex, size of tumor, M stage, extent of surgical resection, histological features, immunohistochemical labelling indices (Ki-67, p53), and apoptotic index were assessed. The mean age at diagnosis was 6.8 years, and the male-to-female ratio was 18:10. The presenting symptoms in 22 cases were increased intracranial pressure and focal neurological deficits. Gross total resection was achieved in 17 cases, near-total (〉90%) resection in 3, and subtotal in 7; biopsy was performed in 1 case. The mean duration of follow-up was 37 months. For 25 patients who completed planned adjuvant therapy, the 3-year survival rate was 73%. Univariate analysis showed that the presence of tumor necrosis (P=0.002) and extent of resection (P=0.04) correlated with survival. Patients with a high Ki-67 labelling index (〉10%) tended to have shorter survival (P=0.095). In multivariate analysis, tumor necrosis showed statistical significance(P=0.03).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050418
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  • 51
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    Electronic Resource
    Childhood medulloblastoma in Denmark 1960–1984 A population-based retrospective study (1999)
    Springer
    Child's nervous system 15 (1999), S. 29-37 
    Details
    ISSN: 1433-0350
    Keywords: Key words Medulloblastoma ; Childhood ; Brain tumours ; Epidemiology ; Prognosis ; Risk index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Medulloblastoma is a common paediatric brain tumour, located in the cerebellum and in the IV ventricle, surpassed in frequency only by astrocytomas. 180 children below the age of 15 with a medulloblastoma of the posterior fossa were treated in Denmark in the 25-year period from 1960 to 1984 and followed up until the end of 1996, or until death. During the 25 years they accounted for 20% of all intracranial tumours in children in Denmark. All tumours were histologically verified. The mean annual incidence was 6.4×10–6, decreasing slightly with a factor of 0.12×10–6 per year. The male/female ratio was 2.1 – twice that of the background population of children (1.05). The 5-year survival rate following diagnosis, surgery and radiotherapy was 23%, and the 25-year survival rate was 16%. The 5-year survival rate was 8% in the first 5-year period of 1960–1964, increasing to 36% in the last period 1980–1984. Presumably the increase in survival depends on many factors, e.g. improved diagnostic methods and neuroanaesthesia, better operative technique (microscope), improvements in radiotherapy and the introduction of chemotherapy. The best predictive factors of a good prognosis were preoperative CSF shunting, radical tumour removal and complete radiotherapy, i.e. irradiation of the brain, tumour bed and spinal cord. The survival rate in the last five-year period was seven times higher than the survival rate found in a comparable Danish study from the years 1935–1959. Most of the children followed Collins law of risk index. The results of treatment in children with medulloblastoma remain unsatisfactory. Accordingly, participation in international prospective studies of multimodal treatment should be encouraged, possibly using chemotherapy prior to surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050322
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  • 52
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    Electronic Resource
    Treatment of intracranial nongerminomatous malignant germ cell tumor in children: the role of each treatment modality (1999)
    Springer
    Child's nervous system 15 (1999), S. 185-191 
    Details
    ISSN: 1433-0350
    Keywords: Key words Nongerminomatous malignant germ cell tumor ; Surgery ; Radiotherapy ; Chemotherapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To investigate the role of surgical tumor resection, radiotherapy and chemotherapy, the outcome of treatment in 17 children with nongerminomatous malignant germ cell tumor (NG-MGCT) was reviewed. The median follow-up period was 38 months after diagnosis, and the overall 3-year survival rate was 75%. Eleven patients who underwent craniospinal radiation (CSRT) did not receive chemotherapy. In 4 of them more than 90% of the tumor was removed, and they were free of disease at 16, 30, 93 and 111 months after surgery. Among the other 7, who did not undergo tumor resection (n=5) or had considerable residual tumor (n=2), 2 were disease-free at 73 and 88 months after diagnosis, and 5 died of recurrences. Of 6 patients who received cisplatin and etoposide chemotherapy in addition to CSRT, none showed intracranial recurrence, regardless of the extent of removal. The authors believe that multimodal treatment is the preferred choice and that chemotherapy plays an important role, especially when a significant amount of tumor remains after surgery. CSRT plays a major role at least in some patients. If chemotherapy is not feasible, radical removal plus CSRT seems to be an alternative.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050366
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  • 53
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    Electronic Resource
    Management of dyspnea in advanced cancer patients (1999)
    Springer
    Supportive care in cancer 7 (1999), S. 233-243 
    Details
    ISSN: 1433-7339
    Keywords: Key words Dyspnea ; Frequency ; Prognosis ; Treatments ; Advanced cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Dyspnea is a frequent and devastating symptom among advanced cancer patients and is often difficult to control. However, there has been considerably less emphasis in the literature on the appropriate characterization and management of this symptom than of other cancer-related symptoms. The purpose of this paper is to review issues relating to the prevalence, causes, prognosis and treatment of dyspnea in patients with advanced cancer. A Medline search of the literature published from 1966 to February 1999 was conducted. Dyspnea occurs in 21–78.6% of advanced cancer patients and is reported to be from moderate to severe in 10–63% of the patients. The frequency and severity of dyspnea increase with the progression of the disease and/or when death is approaching. Lung cancer patients with dyspnea have shorter survival than patients with other types of cancer. Dyspnea can be a direct effect of the cancer, an effect of therapy or not related to the cancer or therapy. In addition to cancer, patients may suffer from chronic obstructive pulmonary disease, congestive heart failure, nonmalignant pleural effusion, pneumonitis, air flow obstruction, or bronchospasm associated with asthma. In the absence of lung or heart disease, dyspnea may be a clinical expression of the syndrome of overwhelming cachexia and asthenia or of severe asthenia. Many different causes may co-exist in a patient. Whenever possible, an attempt should be made to treat underlying cancer. Radiotherapy and chemotherapy may relieve dyspnea also in patients who fail to achieve a major objective response. Symptomatic measures in addition to specific treatments for the underlying cancer and/or other pulmonary and cardiovascular diseases are indicated. Oxygen therapy has proved effective in hypoxemic and nonhypoxemic patients. The role of transfusion therapy to relieve anemia-related dyspnea in advanced and terminal cancer patients is still controversial. Oral, subcutaneous and intravenous opioids are effective but underused in these patients, whereas currently available evidence does not support the clinical use of nebulized opioids. While benzodiazepines are frequently used in patients with dyspnea, these drugs were ineffective in four out of five randomized controlled trials. Other components of the symptom expression are better managed by supportive counseling, occupational therapy or physiotherapy. While the mechanism of breathing and the consequences of different pathologic conditions for both respiratory function and gas exchange are well known, the genesis and pathophysiology of dyspnea as a symptom are much less well understood. Palliative care assessment should be focused on dyspnea as a symptom rather than on the functional and gas exchange abnormalities. Increased research on the appropriate management of dyspnea is needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005200050255
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  • 54
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    Electronic Resource
    Proliferation not apoptosis as a prognostic indicator in retinoblastoma (1999)
    Springer
    Virchows Archiv 434 (1999), S. 301-305 
    Details
    ISSN: 1432-2307
    Keywords: Key words Proliferation ; Apoptosis ; Ki-67 antigen ; Prognosis ; Retinoblastoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The balance between proliferation and cell death is the major determinant of tumour growth. We analysed the proliferative and apoptotic indices (PI and AI, respectively) of 33 children with retinoblastoma. PI and AI were assessed by immunohistochemistry for Ki-67 antigen and TUNEL staining, respectively. The mean PI was 21.0±21.1%, and higher PI was associated with more advanced tumour stage (P〈0.0001) and poor clinical outcome (P〈0.05). Patients in whom amplified N-myc oncogene was found (n=6) determined by the multiplex polymerase chain reaction tended to have a higher PI (37.6±27.2%) than those without amplified N-myc (n=27; PI=17.3±18.1). A PI value of over 40% was clearly associated with an unfavourable prognosis. The AI, however, did not correlate with any of the other variables analysed. The findings suggest that proliferation, but not apoptosis, is of critical significance in retinoblastoma biology. PI, as determined by the Ki-67 antigen labelling index, seems to be a relevant histopathological parameter that can predict the clinical outcome of retinoblastoma.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050345
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  • 55
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    Reverse redistribution on thallium-201 single-photon emission tomography after primary angioplasty: a one-year follow-up study (1999)
    Springer
    European journal of nuclear medicine 26 (1999), S. 633-639 
    Details
    ISSN: 1619-7089
    Keywords: Key words: Thallium-201 ; Reverse redistribution ; Myocardial infarction ; Angioplasty ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. The prognostic significance of reverse redistribution (RR) on thallium-201 single-photon emission tomography (SPET) images after acute myocardial infarction (AMI) has not been studied in detail. Moreover, RR data in patients treated with primary angioplasty are lacking. Fifty consecutive patients (including 40 men with a mean age of 54±11 years) with a first AMI were treated with primary angioplasty and followed up for 13±5 months for the following end-points: death, reinfarction and recurrent angina requiring revascularisation. Admission and peak creatine kinase myocardial enzyme (CKMB) and ejection fraction (EF) at discharge were studied as markers of myocardial damage. Thallium-201 stress-redistribution SPET studies at 1 month were analysed using a 13-segment, 4-point scoring system. Segments showing a worsening of perfusion by at least 1 point on redistribution studies were defined as showing RR. RR was present in 13 (26%) patients (group 1) and absent in 37 (74%) (group 2). Both groups were comparable for age, sex, peak CKMB release, EF and Q-wave myocardial infarctions. TIMI flow 3 was obtained in 92% in group 1 and 95% in group 2 (P = 0.95). On admission, CKMB was significantly lower in group 1 (18±14 vs 44±41 U/l, P = 0.03). Also, segments showing reversible perfusion were significantly more frequent in group 2 (1/169 vs 57/481, P = 0.01). During follow-up, no death occurred and the combined documented endpoint of reinfarction and recurrent angina requiring angioplasty or coronary artery bypass grafting was significantly more frequently reached in group 2 (0/13 vs 10/37, P = 0.046). In conclusion, RR is common (26%) after primary angioplasty for a first AMI and is associated with lesser myocardial damage on admission. Patients with RR rarely have reversible segments on 201Tl SPET and tend to have a favourable outcome after 1 year of follow-up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002590050431
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  • 56
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    The relative bioavailability of metoprolol following oral and rectal administration to volunteers and patients (1999)
    Springer
    Pharmacy world & science 21 (1999), S. 233-238 
    Details
    ISSN: 1573-739X
    Keywords: Keywords ; Metoprolol ; Suppository ; Rectal administration ; Relative bioavailability
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The pharmacokinetics, efficacy and safety of metoprolol tartrate 25 mg fatty suppositories were studied in 5 healthy volunteers and in 8 patients suffering from instable angina pectoris. Metoprolol 25 mg capsules were used as a control oral dosage form. Metoprolol showed a considerable rectal bioavailability (AUC, C max) and was absorbed quickly from the rectum (T max). In both groups rectal bioavailability was comparable. However, oral bioavailability was much lower in the volunteer group than in the patient group. Furthermore, ratios of metoprolol/a‐OH‐metoprolol concentrations in plasma and urine gave an indication for a partial avoidance of the first pass effect after rectal administration. Further research is necessary to define an exact rectal dosage of metoprolol. In all patients, a substantial drop in heart rate, systolic and diastolic blood pressure was seen after administration of the first suppository. Metoprolol suppositories appear to be an effective, safe and suitable alternative for patients who are in need for beta blocking medication and who are unable to take oral medication for a certain amount of time.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1008792421982
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  • 57
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    Die prognostische Bedeutung verletzter Anteile bei Sprunggelenkfrakturen (1999)
    Springer
    Der Chirurg 70 (1999), S. 1323-1329 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Ankle fracture ; Prognosis ; Injury components. ; Schlüsselwörter: Sprunggelenkfraktur ; Prognose ; Verletzungskomponenten.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. In einer umfassenden retrospektiven Studie an 342 Patienten wird gezeigt, daß bei Verletzungen des oberen Sprunggelenks die Beteiligung der Innenseite und der hinteren Tibiakante für sich allein keine schlechte Prognose haben. Sie ergibt sich erst in der Kombination mehrerer Verletzungskomponenten. Subjektives, objektives, klinisches sowie radiologisches Ergebnis korrelieren miteinander und richten sich nach dem Schweregrad der Fraktur. Sie verschlechtern sich mit der Anzahl der verletzten Sprunggelenkanteile. Konturvergröberungen treten am häufigsten bei Komplexverletzungen auf und sind am ehesten auf eine Hämatomfibrosierung der Weichteile zurückzuführen. Sie führen zu einer Bewegungseinschränkung des Sprunggelenks und bestimmen das Ergebnis mit. Die vorgelegten Ergebnisse mit guten und sehr guten Bewertungen bei den nachuntersuchten (89 %) bzw. bei den nicht nachuntersuchten (94 %) Patienten bewegen sich im oberen Bereich der Literaturangaben. Sie zeigen, daß sich mit einer subtilen Operationstechnik mit exakter anatomischer Reposition bei einer primären Versorgung besonders der schweren Formen sehr gute Resultate erzielen lassen. Die Komplikationsrate von 9 % im eigenen Krankengut bewegt sich in einem auch von anderen Autoren angegebenen Bereich. Risikofaktoren sind Alter und Übergewicht.
    Notes: Summary. Injuries of the medial ankle side or the posterior tibial margin do not necessarily predict a negative outcome in ankle fractures, as shown in this comprehensive retrospective study on 342 consecutive patients. A negative predictive value results from the combination of different injured ankle components. Clinical and radiological results correlate well with each other and with the severity of the fracture. They deteriorate according to the number of injured ankle components. Thickening of the soft tissues most often results from complex injuries. It leads to a decrease in range of motion and therefore determines the clinical outcome. Eighty-nine percent of the patients with a personal follow-up and 94 % of those with a written investigation had good to very good results, which represent the upper range of other presentations. This can be achieved by a subtle surgical technique with exact anatomic reduction including primary treatment of at least the severe injuries within the first few hours after trauma. Complications occurred in 9 % of cases, which coincides with the findings of other authors. Especially elderly and obese patients are at higher risk.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050787
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    Electronic Resource
    Neonatal tetanus: A continuing challenge in the southeast of Turkey (1999)
    Springer
    European journal of epidemiology 15 (1999), S. 171-174 
    Details
    ISSN: 1573-7284
    Keywords: Neonatal tetanus ; Prognosis ; Public health ; Risk factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Neonatal tetanus (NT) still causes significant mortality in developing countries, although in 1989 WHO adopted the goal of eliminating the disease by 1995–2000. To characterize the regional characteristics, clinical charts of 55 neonates (42 males and 13 females) admitted to the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, Turkey with the diagnosis of NT from 1991 to 1997 were reviewed. Mean age at admittance was 8.9±4.3 days with a range of 3–25 days. Mean period for the appearance of first symptoms was 5.8 days ranging between 1 and 21 days. Mean birth weight of the patients was 3369±560 g. All patients were from rural areas and were delivered at home by untrained traditional birth attendants with no prior antenatal healthcare services. Razor blade (55%), scissors (27%), and knife (18%) were the instruments used to cut the cord in non-hygienic conditions. No mothers had prior vaccination with tetanus toxoid during their pregnancy. Spasticity (76%), lack of sucking (71%), trismus (60%), fever (49%), omphalitis (44%), irritability (24%), risus sardonicus (22%), and opithotonus (15%) were the most common presenting signs and symptoms. Age at admission 〈7.5 days and symptoms of onset 〈4.9 days, risus sardonicus and opisthotonus were associated with fatal outcome. All patients were treated with human tetanus immunglobulin or equine tetanus antitoxin where available, antibiotic therapy by penicillin G (100.000U/kg/day) and intravenous high dose diazepam (40mg/kg/day). Overall mortality rate was 40% (22 cases), without any equipment for mechanical ventilation. Health education of mothers and birth attendants, promotion of hospital delivery and prenatal tetanus immunization of all pregnant women particularly in rural areas are recommended, if NT is to be prevented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007500109522
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  • 59
    Electronic Resource
    Electronic Resource
    Clinical and prognostic characteristics associated with age and gender in acute myocardial infarction: A multihospital perspective in the Murcia region of Spain (1999)
    Springer
    European journal of epidemiology 15 (1999), S. 621-629 
    Details
    ISSN: 1573-7284
    Keywords: Ageing ; Myocardial infarction ; Prognosis ; Sex
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Age and female gender have been associated with poor prognosis in acute myocardial infarction (AMI). Data currently available about the prognostic significance of gender in AMI might well have led to inappropriate/incomplete conclusions. A multicenter, prospective study on 1239 patients with AMI was conducted. Clinical characteristics, complications during the acute phase and one-year follow-up were monitored. Women constituted 24.1% of all patients. Female patients were older with more prevalence of diabetes, hypertension, and previous congestive heart failure. Compared with men, the following complications were more frequently found in women: heart failure, 43% vs. 22% (p 〈 0.001); reinfarction, 5% vs. 2% (p 〈 0.05); use of pacemaker, 7% vs. 4% (p 〈 0.05). Women had higher mortality: early, during the first 24 hours post-admission, 10.7 vs. 3.1%; in-hospital, 23% vs. 8.1%; and 1-year, 33.7% vs. 16% (p 〈 0.001 for all the 3 cases of mortality). In the age-groups considered (〈65, 65–74, and ≥ 75 years), 1-year mortality increased exponentially with ageing in men: 7.8%, 21.3%, and 38.9%, whereas in women the figures were: 15.3%, 41.5%, and 38.8%. Multivariate analysis showed that, among other variables, age and female gender had independent prognostic value for in-hospital mortality whereas gender lost its prognostic significancy for 1-year mortality. Multivariate analysis restricted to those patients aged over 75 years showed that age but not gender had independent prognostic value. In conclusion, age and female sex have independent prognostic value for predicting mortality in patients with AMI. Mortality increases exponentially with ageing in men whereas it stabilises in the case of women over 65 years. Female gender loses its independent value for predicting mortality in patients over 75 years.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007679106304
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  • 60
    Electronic Resource
    Electronic Resource
    Negative Predictors of Survival in HIV-Infected Patients with Culture-Confirmed Pulmonary Tuberculosis (1999)
    Springer
    Infection 27 (1999), S. 331-334 
    Details
    ISSN: 1439-0973
    Keywords: Key words Tuberculosis ; HIV infections ; Drug-resistant tuberculosis ; Prognosis ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We performed a retrospective study based on chart review of 118 HIV-infected patients with culture-confirmed pulmonary TB, in which M. tuberculosis isolates were tested for drug susceptibility. Patients were enrolled in the period January 1987 to December 1996 and followed until September 1997. The median survival for the entire cohort was 15.2 months with a 1-year survival rate of 57%. Prior AIDS-defining illness, low CD4 count (〈 200/mm3), not having received antituberculous therapy with at least two drugs to which M. tuberculosis was susceptible in vitro, starting within four weeks of diagnosis, treatment duration of less than three weeks and multidrug resistant tuberculosis were each independently associated with decreased survival in multivariate analysis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100050038
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  • 61
    Electronic Resource
    Electronic Resource
    Small bowel tumors: diagnosis, therapy and prognostic factors (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 176-180 
    Details
    ISSN: 1435-2451
    Keywords: Key words Small-bowel tumors ; Diagnosis ; Therapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Tumors of the small bowel are rare, accounting for about 3–6% of all gastrointestinal neoplasms. However, diagnosis and treatment are difficult and an ongoing challenge. Methods: We retrospectively reviewed the medical records of 54 patients with tumors of the small intestine over a period of 10 years to elucidate important factors for diagnosis, therapy and prognosis. Results: 42 patients had malignant (36 primary, 6 secondary) and 12 had benign tumors. Histologically, adenocarcinoma (33%), leiomyosarcoma (17%) and carcinoid (17%) were the most frequent malignancies found. All 12 benign lesions were either leiomyomas or adenomas. Initial symptoms were non-specific: abdominal pain in 67% and 50%, anemia in 38% and 58% and weight loss in 38% and 42% in patients with malignant and benign tumors, respectively. Upper gastrointestinal series, endoscopy, computed tomography scan and selective angiography were the most useful diagnostic tools. Resectability rate for malignant tumors was 98%; curative resection was achieved in 51%. Survival for malignant tumors has been poor: median postoperative survival was 26.9 months, the 1- and 5-year survival rates were 42.9% and 20.8%, respectively. Conclusions: These results docu-ment the need for an aggressive diagnostic work-up in these rare tumors with non-specific symptoms, as early diagnosis and radical operative therapy are important prognostic factors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050188
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  • 62
    Electronic Resource
    Electronic Resource
    Risk factors associated with intraabdominal infections: a prospective multicenter study (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 24-32 
    Details
    ISSN: 1435-2451
    Keywords: Key words Intraabdominal infection ; Prognosis ; Prospective study ; Risk factor
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction and methods: A prospective observational multicenter study with 18 hospitals was performed to assess preoperative risk, therapeutic management and outcome of patients with peritonitis. Data collection was carried out according to standardized and recommended definitions. Included in the study were 355 patients with macroscopically confirmed peritonitis. Results: In the univariate analysis, the following factors influenced both the mortality and the incidence of postoperative complications: age, presence of certain concomitant disease, site of origin of peritonitis, type of admission and the ability of the surgeon to eliminate the source of infection. In addition, postoperative infective complications were related to the etiology of peritonitis and the exudate. In the multivariate analysis, APACHE II (P〈0.001), successful operation (P〈0.001), age (P〈0.001), liver disease (P〈0.03), malignant disease (P〈0.04) and renal disease (P〈0.05) turned out to be significant with respect to death. Escherichia coli was the predominant organism (51%), following by enterococci (30%) and bacteroides (25%). There was a significantly higher postoperative infection rate in patients with no adequate treatment of enterococci than patients with adequate treatment or no enterococci (P〈0.05). Conclusion: The study demonstrated the important role of the physiological reserve of the patient and of the surgeon, which is not adequately reflected in existing scoring systems. Further investigations are needed to study the impact of enterococci on the outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050169
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  • 63
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    Electronic Resource
    Complications associated with different surgical approaches to differentiated thyroid carcinoma (1999)
    Springer
    Langenbeck's archives of surgery 384 (1999), S. 50-53 
    Details
    ISSN: 1435-2451
    Keywords: Key words Thyroid neoplasm ; Surgery ; Complications ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Introduction: With the good prognosis associated with differentiated carcinoma, the morbidity and mortality of different surgical approaches are of crucial importance. Methods: At the Department of Surgery (Virchow Klinikum Berlin), 139 patients who underwent surgery for differentiated thyroid carcinoma between 1979 and 1994 were reviewed, focussing on postoperative complications. In 113 and 18 patients, respectively, primary and completion thyroidectomy was performed. In five patients, less than total thyroidectomy and in three patients only palliative surgery was carried out. We performed thyroidectomy without systematic lymphadenectomy (LAD) in 70 patients (51.1%). In 15 patients (10.8%), lymphadenectomy of the lateral compartment and, in 53 patients (38.1%), central LAD was performed. LAD did not significantly influence survival time in either follicular (n = 42) or papillary carcinoma (n = 97). Results: No patient died because of postoperative complications. Permanent laryngeal nerve palsy occurred in no patients after thyroidectomy without LAD, in one patient after central LAD (1.9%) and in one patient after lateral LAD (6.7%). Transient laryngeal nerve palsy was seen in ten patients [six (8.6%) after thyroidectomy only, two (3.7%) after central LAD and two (13.3%) after lateral LAD] (P = 0.19). Hypocalcemia was distributed equally within the LAD groups: total transient hypocalcemia could be recorded in 54 patients (38.8%), but permanent hypocalcemia occurred only in one patient (0.7%). Postoperative recovery was delayed in patients when a more radical approach was used (P = 0.03). Conclusion: The magnitude of the benefit of LAD in therapy for differentiated thyroid carcinoma is still controversial. This more radical approach is not necessarily accompanied, however, by higher morbidity and mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004230050173
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  • 64
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    Electronic Resource
    Expression of c-erb B-2 oncoprotein in cancer of the larynx in relation to invasion of the cartilagenous framework and prognosis (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 72-77 
    Details
    ISSN: 1434-4726
    Keywords: Key words Laryngeal carcinoma ; Cartilagenous ; invasion ; Human c-erb B-2 oncogenes ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Oncogenes are important cellular genes that in general promote in the normal growth regulatory pathways. The human c-erb B-2 proto-oncogene (HER-2 or neu) encodes a 185 kDa transmembrane putative growth factor receptor of the tyrosine kinase family. This oncogene has been shown to be over expressed and/or amplified in primary carcinoma of the breast, ovary, pancreas and salivary glands. This study was conducted to evaluate a possible link between amplification of c-erb B-2 oncoprotein and cartilage invasion in laryngeal carcinoma. In addition, data concerning overexpression were compared to other clinicopathological parameters as well as clinical outcomes. In all, 34 patients with squamous cell carcinoma of the larynx were studied prospectively. Total laryngectomy specimens were sliced in horizontal sections at 4- to 5-mm intervals. Specimens were preserved in 10% formalin, and histopathological examinations were carried out after embedding tissues in paraffin sections and then staining them with hematoxylin and eosin. Detection of c-erb B-2 oncoprotein overexpression was carried out with a polyclonal antibody and an avidin-biotin kit. The level of c-erb B-2 overexpression was determined using the Quantimet 520 Leica image analyzing system. However, no significant correlation was found between cartilage invasion and clinicopathological parameters and prognosis. Overexpression of c-erb B-2 attained no significant correlation with clinicopathological parameters. In contrast, the correlation of c-erb B-2 overexpression and cartilage invasion was statistically significant (P = 0.034). In general, overexpression of c-erb B-2 oncoprotein was related to the more aggressive tumors with high capability of invading laryngeal cartilages. Patients with +ve c-erb B-2 oncogene had a poor prognosis but this was not statistically significant when compared to the clinical outcomes of patients with the -ve c-erb B-2 oncogene.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050119
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  • 65
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    Electronic Resource
    Long-term results of organ preservation in chondrosarcoma of the cricoid (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 271-276 
    Details
    ISSN: 1434-4726
    Keywords: Key words Cricoid chondrosarcoma ; Surgical ; management ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Chondrosarcoma of the larynx is rare. The posterolateral lamina of the cricoid cartilage is the site most commonly involved. Although the symptomology, radiological and histopathological diagnostic features are well known, the condition continues to be diagnosed late and recurrences after excision are common. In general, radical surgical excision can result in long-term remission, although prognosis is related to the histopathological grade of the tumor. While a conservative surgical approach in low-grade tumors is justified, unexplained hoarseness, unilateral vocal cord paralysis and dyspnea requires CT scan examination.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050244
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  • 66
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    Electronic Resource
    Oncological and functional outcome of conservative surgery for primary supraglottic cancer (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 283-290 
    Details
    ISSN: 1434-4726
    Keywords: Key words Supraglottic carcinoma ; Supraglottic ; laryngectomy ; Lymph-node metastases ; Neck treatment ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The aim of this study was to verify the oncological and functional outcome of conservative surgical treatment of primary supraglottic squamous cell carcinoma (SGSCC) and related neck disease in order to verify the effectiveness of supraglottic laryngectomy (SL) and the validity of an “observation” policy in the control of clinically negative (N0) necks. Of a total of 252 consecutive patients affected by primary SGSCC seen between 1975 and 1990 at the Department of Otolaryngology of the University of Perugia (1975–1987) and the Catholic University of the Sacred Heart of Rome (1988–1990), a subset of 132 patients treated with classical SL was evaluated after presenting sufficient clinicopathological data and a follow-up period of at least 5 years. Tumors were staged according to the 1992 UICC TNM classification and grouped into stages I-II (n = 94) and III-IV (n = 38). Comprehensive neck dissections were performed only in the clinically positive (N+) necks (25/132 cases), while in the clinically N0 ones (107/132 cases) an “observation” policy under strict follow-up conditions was adopted. After primary surgery, the 5-year relapse-free survival (RFS) was 74%. The RFS was 80% for T1-2 disease and 65% for T3. The RFS was 80% for stages I-II tumors and 71% for stages III-IV. The actual 5-year overall survival (OS) was 89% for T1-T2 tumors and 67% for T3 disease or 93% for stages I-II and 69% for stages III-IV. The OS was 89% for N0 neck and 73% for N+. The 5-year-metastasis-free survival (MFS) was 83% for N0 patients, 74% for N+, 84% for T1-T2 N0, 71% for T1-T2 N+, 81% for T3 N0 and 68% for T3 N+. In all, SL was found to be highly effective in the management of primary SGSCC. In the presence of clinically N0 neck “observation” under strict follow-up with therapeutic comprehensive neck dissection for delayed nodal recurrence, SL was suitable for controlling the neck cancer, as well as for salvaging recurrent disease. Bilateral elective, selective or functional neck dissection in every instance of supraglottic cancer was best performed only in those SGSCC patients who were more likely to have occult nodal disease on the basis of biological factors and imaging data.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050247
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  • 67
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    Electronic Resource
    The Gregorio Marañón Hospital experience with vertical partial laryngectomies (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 296-298 
    Details
    ISSN: 1434-4726
    Keywords: Key words Larynx ; Carcinoma ; Vertical ; hemilaryngectomy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We present a retrospective study of 551 patients treated with conservative surgery for glottic carcinoma at the Gregorio Marañón Hospital between 1962 and 1996. In all, 12% of cases were locally advanced carcinomas. In early-stage carcinomas there were no statistical differences in 5-year survival between those treated by endoscopic laser resection, vertical hemilaryngectomy and radiotherapy. However, tumor recurrence after primary radiotherapy was higher (27%) than with conservative surgery (12%), while the voice preservation rate was significantly higher with surgery (83%) than with radiotherapy (72%). With locally advanced cancer, irradiated patients (to 60 Gy) had a 50% probability of recurrence with a very low chance for salvage by total laryngectomy (5-year survival rate, 38.5%). In contrast, partial laryngectomy could be performed on carefully selected patients, and the results for these patients were comparable to those for smaller lesions (with a 5-year survival rate of 81%).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050249
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  • 68
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    Electronic Resource
    Prognostic significance of histopathological parameters in cancer of the larynx (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 139-144 
    Details
    ISSN: 1434-4726
    Keywords: Key words Laryngeal neoplasms ; Laryngectomy ; Pathology ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P 〈 0.05). The patients with “well-defined margin” tumors survive significantly longer than those with “groups of cells, no distinct margin.” Patients with supraglottic tumors and a mode of invasion other than “well-defined margin” have a significantly higher risk of recurrence (P 〈 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P 〈 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P 〉 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P 〈 0.15).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050127
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  • 69
    Electronic Resource
    Electronic Resource
    The diagnostic and prognostic value of eardrum mobility in otitis media with effusion (1999)
    Springer
    European archives of oto-rhino-laryngology and head & neck 256 (1999), S. 189-191 
    Details
    ISSN: 1434-4726
    Keywords: Key words Eardrum mobility ; Otitis media with ; effusion ; Prognosis ; Tympanogram
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Diagnostic and prognostic values of eardrum mobility were determined by pneumatic otoscopy in 37 patients (56 ears) having otitis media with effusion (OME). Eardrum mobility was impaired or lost in less than half of the ears (46.4%), while a tympanogram detected 77.8% of OME. In 27 of the 37 patients (42 of the 56 ears), aeration of the middle ear space was examined by CT and demonstrated that the presence or absence of aeration was significantly correlated with the presence or absence of eardrum mobility. In another 38 children (62 ears with OME), effect of antibiotics was correlated with eardrum mobility before treatment, and the improvement rate was found to be significantly higher in ears with positive mobility of eardrum (34.3%) than in ears without eardrum mobility (10.0%). These results indicate that eardrum mobility is a good prognostic indicator of OME rather than its diagnostic indicator alone.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004050050137
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  • 70
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    Electronic Resource
    Prognostic value of tumor-associated antigens immunoreactivity and apoptosis in medulloblastomas. An analysis of 73 cases (1999)
    Springer
    Brain tumor pathology 16 (1999), S. 37-44 
    Details
    ISSN: 1861-387X
    Keywords: Medulloblastoma ; Prognosis ; Tenascin ; Apoptosis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Medulloblastomas (MB) are the most common central nervous system malignancies in children. Numerous publications describe efforts to identify the predictive value of various patterns of MB pathology and immunohistochemistry, but received data appear to be controversial. Seventy-three patients with cerebellar MB were studied retrospectively. Tumor specimens were immunohistochemically examined with antibodies to various tumor-associated antigens. Also, apoptosis detection by the in situ end-labeling method was performed. Survival analysis was made using univariate and multivariate models. Tenascin immunoreactivity and apoptotic index (AI)〉or=1.5% were found to be closely associated with poor prognosis according to an univariate analysis (P=0.008 and 0.003, respectively). The multivariate Cox proportional hazard model exhibited independent prognostic value for the apoptotic rate only (P=0.023). Tumors with tenascin expression and AI〉or=1.5% significantly prevailed among MB with metastatic dissemination, whereas expression of c-erbB2 oncoprotein and epidermal growth factor receptor was found to be more typical for cases with local tumor recurrence. We came to the conclusion that tenascin immunoreactivity and AI were useful for individual MB prognosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02478900
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  • 71
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    Prognostic factors in colorectal cancer (1998)
    Springer
    Diseases of the colon & rectum 41 (1998), S. 1033-1049 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal cancer ; Prognosis ; Survival ; Tumor stage ; Lymph node involvement ; Distant metastases ; Bowel obstruction ; Univariate analysis ; Multivariate analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Identification of prognostic factors is a primary basis for planning the treatment and predicting the outcome of patients with colorectal cancer. Reviewing studies from the literature performed using univariate and multivariate analyses and their own study, the authors critically discuss the prognostic value of the clinicopathologic parameters of the tumor. METHODS: Among 853 patients with colorectal tumors seen at the Department of Clinical Surgery of the Catholic University of Rome, Italy, 690 cases that were curatively resected entered the study. Overall survival rate, related to the clinicopathologic variables, was calculated, and univariate and multivariate analyses were performed. RESULTS: Five-year and ten-year overall survival rates were 70 and 55 percent, respectively. Univariate and multivariate analyses showed that node involvement, distant metastases, bowel obstruction, and patient gender are factors independently related to outcome. CONCLUSIONS: Data from the literature and the present study suggest that only a few clinical parameters, particularly bowel obstruction, and some pathologic factors (tumor stage, vessels invasion, and tumor ploidy) are related to patient survival rate and are the most reliable prognostic criteria. In prospective clinical studies, any other new pathologic or molecular factors should be matched with these parameters to confirm their value in outcome prediction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237397
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    Superficial extremity soft tissue sarcoma: An analysis of prognostic factors (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 41-47 
    Details
    ISSN: 1534-4681
    Keywords: Soft tissue sarcoma ; Prognosis ; Superficial sarcoma ; Extremity sarcoma ; Staging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Experience with soft tissue sarcoma has suggested that superficial tumors have a favorable prognosis. We evaluated the prognostic features of this subset of sarcoma. Methods: Prospective data on 215 patients presenting to Memorial Sloan-Kettering Cancer Center with primary extremity superficial soft tissue sarcomas between July 1, 1982 and July 1, 1996 were analyzed. Superficial sarcomas were defined as subcutaneous tumors not invading the investing fascia of the muscle. Analysis was by univariate and multivariate tests for local recurrence, metastasis, and tumor mortality. Results: Ninety (42%) patients were over 50 years of age, 115 (53%) had high-grade tumors, 53 (25%) had tumors ⩾5 cm, and 18 (8%) had positive margins following definitive resection. Median follow-up was 45 months (range 2 days to 151 months), 31 (14%) patients had local recurrences, 20 (9%) had distant metastases, and 15 (7%) died of disease. Five- and 10-year actuarial disease-specific survivals were 91% and 85%, respectively. On multivariate analysis, age 〉50 years predicted local recurrence (RR 5.7; 95% CI, 2.4–13.3;p〈0.0001). High grade (RR 4.2; 95% CI, 1.4–12.7;p〈0.006), and size ⩾5 cm (RR 4.4; 95% CI, 1.8–11;p〈0.002) predicted distant metastases. High grade (RR 7; 95% CI, 1.5–31.4;p〈0.003), size ⩾5 cm (RR 6.9; 95% CI, 2.3–20.8;p〈0.0006), and positive margins (RR 3.8; 95% CI, 1.2–12.4;p〈0.006) predicted tumor mortality. Conclusion: Primary superficial extremity soft tissue sarcomas have a favorable prognosis. Size and grade of superficial tumors are the strongest factors in predicting survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303763
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  • 73
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    Electronic Resource
    Sentinel node biopsy in breast cancer (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 126-130 
    Details
    ISSN: 1534-4681
    Keywords: Breast neoplasms ; Axillary lymph node dissection ; Staging ; Prognosis ; Lymphatic mapping
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Sentinel lymph node biopsy (SNB) in breast cancer may be used in place of axillary lymph node dissection (ALND) if SNB accurately stages the axilla. This study assessed the success and accuracy of axillary SNB with isosulfan blue (ISB) and technetium-99 sulfur colloid (TSC) compared to ALND. Methods: Forty-two women with T1 or T2 breast cancer underwent SNB and ALND. Sixty to 90 minutes before anesthetic induction, a mixture of 3 mL ISB and 1 mCi TSC was injected around the primary cancer or prior biopsy site. Intraoperatively, the SLN was identified using a gamma detector (Neoprobe 1000) or by visualization of the blue-stained lymph node and afferent lymphatics. The SLN was excised separately, and a level I/II ALND was completed. The histologic findings of the axillary contents and SLN were compared. Results: An axillary SLN was found in 38 of 42 (90%) cases. SLN localization rate and predictive value were the same for women who had and those who had not undergone excisional biopsy before the date of SNB. Fifteen of 42 (36%) patients had lymph node metastases. The SLN was positive in all women with axillary metastases (negative predictive value, 100%). Conclusions: If confirmed by larger series, a negative SNB may eliminate the need for ALND for select women with breast cancer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303845
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  • 74
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    Electronic Resource
    Predictive value of nuclear betacatenin expression for the occurrence of distant metastases in rectal cancer (1998)
    Springer
    Diseases of the colon & rectum 41 (1998), S. 1256-1261 
    Details
    ISSN: 1530-0358
    Keywords: Beta-catenin ; Immunohistochemistry ; Metastasis ; Predictive value ; Prognosis ; Rectal cancer ; Tumor marker
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Adenomatous polyposis coli protein, glycogen synthetase kinase-3-beta, T cell transcription factor/lymphoid enhancer-binding factor, and beta-catenin modulate cell differentiation and proliferation via the expression of effector genes. It has recently been postulated that betacatenin is a potent oncogene of sporadic colorectal carcinogenesis and a prognostic tumor marker. Our aim was to investigate whether the nuclear overexpression of betacatenin, possibly caused by mutations in exon 3 of betacatenin (CTNNB1), is correlated with distant metastatic spread or disease-free survival in rectal carcinoma. METHODS: Immunohistochemical analysis was performed with an anti-beta-catenin-monoclonal antibody on paraffin sections of two groups of patients (n=2 × 77) with rectal carcinoma curatively treated by surgery alone. The patients selected were all free of local disease, to exclude surgical influence. Patient groups were matched for age, gender, International Union Against Cancer stage, and year of operation (1982 to 1991) and differed only in subsequent metachronous distant metastatic spread. Follow-up was prospective (median, 9.6 years). Three staining patterns were defined: membranous (normal), diffuse cytoplasmic (pathologic), and intense nuclear staining (pathologic). When intense nuclear staining was defined, the specimen was microdissected. Then, DNA was isolated, polymerase chain reaction-amplified, and sequenced to detect mutations in exon 3. RESULTS: Nuclear overexpression of beta-catenin correlated neither with distant metastatic spread (chisquared, 0.37;P=0.79) nor with disease-free survival (log-rank with trend,P=0.62). No mutations were found in the area of the serine/threonine-kinase glycogen synthetase kinase-3-beta-phosphorylation site in exon 3 (CTNNB1) of beta-catenin. CONCLUSION: Although beta-catenin seems to play an important role in early colorectal carcinogenesis, its value as a prognostic marker is questionable. It must be assumed that metastatic ability is determined by other factors than the disturbance of the beta-catenin T cell transcription factor/lymphoid enhancer-binding factor cascade and that other mechanisms might cause the observed nuclear translocation of beta-catenin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258226
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  • 75
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    Overexpression of CD44: A useful independent predictor of prognosis in patients with colorectal carcinomas (1998)
    Springer
    Annals of surgical oncology 5 (1998), S. 495-501 
    Details
    ISSN: 1534-4681
    Keywords: CD44 ; FVIII-RA ; p21ras ; Prognosis ; Colorectal carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The goal was to investigate the potential correlation between overexpression of CD44, high microvessel count (MVC), and p21ras with length of relapse-free and overall survival in patients with colorectal adenocarcinomas. Methods: CD44, factor VIII-related antigen (FVIII-RA), and p21ras were localized immunohistochemically in patients with colorectal adenomatous polyps (n=8) and adenocarcinomas (n=98). The correlation between the expression of CD44, MVC in the areas with highest density, and p21ras with relapse-free and overall survival time was investigated. Data were analyzed statistically using univariate and multivariate systems. Results: In patients with adenomatous polyps, the positivity of CD44, FVIII-RA, and p21ras was 75%, 62%, and 88%, respectively. In patients with colorectal carcinomas the positivity of CD44 was 55%, and for p21ras it was 52%. The median of FVIII-RA was 4 MVC (range, 0.0 to 32.33). MVC was greater than 4 in 53% of the patients with colorectal carcinomas. In univariate analysis, a significantly longer relapse-free time (CD44:P=.0004; FVIII-RA:P=.0006) and overall survival time (CD44:P=.0001; FVIII-RA:P=.001) were observed for patients with CD44-negative tumors and MVC below 4 as compared to those with CD44-positive tumors and MVC greater than 4. Similar observations were noted in patients with Dukes B and C disease and the rectum as the site of tumor. In multivariate analysis, only CD44 correlated significantly with both relapse-free (P=.0003) and overall survival (P=.00001). Conclusion: Univariate analysis showed CD44 and MVC to be independent predictors of prognosis in colorectal carcinomas. Multivariate analysis showed that CD44 positivity was the most important indicator of an unfavorable prognosis for relapse-free and overall survival in patients with colorectal cancer. Thus, it can be deduced that whether CD44 is positive or negative in patients with colorectal cancer may have prognostic importance and in the future may be used as a factor in the pathologic evaluation of tumor specimens. This hypothesis needs to be tested prospectively in a larger number of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02303641
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  • 76
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    Electronic Resource
    Orale Leukoplakien bei manifestem Plattenepithelkarzinom (1998)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 2 (1998), S. 326-330 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Orale Leukoplakie ; Karzinogenese ; Plattenepithelkarzinom ; Epidemiology ; Prognose ; Key words Oral leukoplakia ; Carcinogenesis ; OSCC ; Epidemiology ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Objective: The Uppsala-definition of leukoplakia has recently redefined oral leukoplakia. Based on this definition, the aim of our study was to reevaluate the prevalence of oral leukoplakia in patients with histologically proven primary oral cancer. Design: A total of 101 inpatients in four tumor centers in Berlin were interviewed and clinically examined just prior to surgery of an oral squamous cell carcinoma (OSCC). Results: The prevalence of leukoplakia immediately adjacent to the carcinoma was 15.8%. Additional leukoplakias without relation to the carcinoma were found in 4% of the patients. There were no significant differences in age- or sex-distribution, history of tobacco habits or diet between patients with or without leukoplakia. T1 carcinomas were found in 62.5% of patients with, and 24.4% of patients without associated leukoplakia, whereas a balanced distribution was found for the pre-operative staging of the tumor. Conclusions: The prevalence of oral leukoplakia in patients with OSCC was low, compared to retrospective studies. The presence or absence of leukoplakia indicated no influence on the prognosis of the tumor, except of tumor size. The results emphasize that most OSCC develop from healthy appearing oral mucosa.
    Notes: Fragestellung: Mit der 1994 geänderten Definition ergeben sich bei Querschnittserhebungen geringere Prävalenzwerte der Leukoplakie als in früheren Untersuchungen. Ziel dieser Untersuchung war, zu überprüfen, ob dies auch für Patienten mit manifestem Plattenepithelkarzinom der Mundhöhle zutrifft. Material und Methode: 101 Patienten mit einem nachgewiesenem und unbehandelten Primärkarzinom wurden klinisch untersucht und standardisiert interviewt. Ergebnisse: Die Prävalenz mit dem Tumor lokal koinzidierender Leukoplakien lag bei 15,8%. Bei 4% der Patienten fanden sich, vom Karzinom lokal unabhängig, weitere Leukoplakien. Bezüglich Alters- und Geschlechtsverteilung, Tabak- und Alkoholanamnese unterschieden sich Patienten mit und ohne Leukoplakie nicht signifikant. Die Tumorgröße lag bei 62,5% der ersteren und 24,4% der letzteren unter 2 cm (T1), das Staging zeigte dagegen eine tendenziell gleiche Verteilung in beiden Gruppen. Schlußfolgerung: Wegen der geringen Prävalenz und dem Fehlen aussagekräftiger Einflußfaktoren ist die Frage, ob ein Karzinom in einer Leukoplakie oder de novo entsteht, von geringer Relevanz für dessen Prognose. Die im Vergleich zur Normalbevölkerung bereits zum Operationszeitpunkt deutlich erhöhte Rate weiterer Leukoplakien sollte dagegen in der Tumornachsorge Beachtung finden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060050081
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  • 77
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    Differential typology and prognosis for dissexual behavior – a follow-up study of previously expert-appraised child molesters (1998)
    Springer
    International journal of legal medicine 111 (1998), S. 133-141 
    Details
    ISSN: 1437-1596
    Keywords: Key words Dissexuality ; Pedophilia ; Prognosis ; Follow-up study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Notes: Abstract In terms of identifying socially-dysfunctional forms of sexuality – regardless of the legal valuation – dissexuality is defined as “an expression of social failure in sexual behavior.” This failure was the subject of a longitudinal analysis of 186 expert-appraised pedophile sexual delinquents at the University of Kiel from 1945 through 1981. Of the child molesters 121 were followed up between September 1990 and September 1992 and 100 were personally contacted. The goal was to empirically develop prognosis criteria, given knowledge of the former delinquents’ social development as well as sexual/dissexual practices, which could be of both forensic and interdisciplinary use. Among the bi- and homosexually-orientated pedophiles, the number of offenders for which the act is one of “compensation” was half of the initial collective. In contrast, this number was three-quarters for the heterosexually-orientated perpetrators. Correspondingly, the other half of the bi- and homosexually-orientated pedophiles were either exclusive-type or non-exclusive-type pedophiles (the so-called “true” pedophiles). Among the heterosexually-orientated offenders, the number was only onequarter. According to the empirical data, we may expect a biographically continuing potential of dissexual behavior for only the exclusive and the non-exclusive type of pedophilia. Most of the relapsed dissexual activities showed up a long time after the expert’s report. This is true for both the heterosexually- and the bi- and homosexually orientated groups. The present evaluation of the results allows assignment of behavior for certain delinquent typologies restricted to life phases or lifelong dissexual behavior.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004140050133
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  • 78
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    Tumour-proliferative fraction and growth factor expression as markers of tumour response to radiotherapy in cancer of the uterine cervix (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 456-461 
    Details
    ISSN: 1432-1335
    Keywords: Key words Cervix ; Proliferation ; Growth factor ; Radiotherapy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study seeks to define the role of pre-treatment of evaluation of tumour growth fraction in cervical cancer and its relationship to the clinical course of the disease. In addition, it also seeks to explain whether cell kinetics and growth factor expression have an association with tumour response to radiotherapy and hence could be of value in the management of patients. All pre-treatment biopsies were analysed for the tumour-proliferative compartment by evaluation of Ki67 antigen expression and argyrophilic nucleolar organiser region (AgNOR) counts. Growth factor analysis was done by analysing for expression of epidermal growth factor (EGF), epidermal growth factor receptor (EGF-R) and transforming growth factors α and β (TGFα, TGFβ). A total of 152 patients were evaluated and a correlation obtained between pre-treatment status of the tumour-growth-fraction-associated markers and clinical outcome following radiotherapy. Such patients were either disease-free (group 1, n = 106) or with residual/recurrent disease (group 2, n = 46) at a 16-month follow-up. Pre-treatment analysis of AgNOR significantly correlated to disease status after treatment (r = −0.517, P = 0.0000). This may be due to an effect of cell proliferation. Lower AgNOR counts were significantly associated with recurrent/residual tumours, suggesting that increased proliferative activity may be a positive prognostic indicator. Similar results were also obtained for the other proliferation-associated marker Ki67 (r = −0.443, P = 0.0000). Expression of EGF and EGF-R also showed significant pre-treatment correlations with the final disease outcome (r = 0.248, P = 0.031 and r = 0.503, P = 0.0000 respectively). Both these markers were expressed more by patients belonging to group 2. The opposite was the case for TGFα, where patients belonging to group 1 showed higher values (r = 0.417, P = 0.0001). The other growth factor investigated, TGFβ, also showed a conspicuous differential expression in the two groups of patients (r = −0.604, P = 0.0000). Group 1 patients showed mostly mild to moderate expression while most group 2 patients were negative for the growth factor. It therefore appears that tumours with high AgNOR counts and Ki67 index, along with expression of the two types of transforming growth factor (α and β), responded better to radiotherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050199
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  • 79
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    Clinical relevance of p53 index and expression of proliferating cell nuclear antigen and Ki-67 in gastric cancer (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 497-502 
    Details
    ISSN: 1432-1335
    Keywords: Key words Gastric cancer ; Prognosis ; p53 ; PCNA ; Ki-67
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The prognostic value of the immunohistochemical expression of p53 protein, proliferating-cell nuclear antigen (PCNA) and Ki-67 antigen was evaluated in a series of 116 stage I–II gastric cancer patients. The staining for p53 protein (staining frequency and intensity) in malignant cells was expressed as a p53 index. Similarly, the staining frequency and intensity for PCNA and Ki-67 were evaluated. The p53 index was independent of the stage and differentiation grade, but significantly related to DNA ploidy, S-phase fraction and mitotic activity. A high p53 index was a sign of inferior survival, compared to a low or intermediate index. p53-negative tumours were also associated with poor survival. In a multivariate analysis, only the depth of tumour infiltration and the presence of nodal metastases were independent prognostic factors in stage I–II gastric cancer. PCNA expression and Ki-67 antigen expression were not related to the stage, ploidy, proliferative activity or p53 expression, and they had no impact on survival. The results indicate that p53 protein expression may be of prognostic significance in gastric cancer, while PCNA and Ki-67 antigen expression have no predictive value.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050205
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  • 80
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    Electronic Resource
    The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 329-334 
    Details
    ISSN: 1432-1335
    Keywords: Key words Early gastric cancer ; Prognosis ; Neutrophil ; Neutrophil/lymphocyte ratio ; Heterogeneity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We examined 55 patients (40 male, 15 female) who were diagnosed from 1987 to 1991 as having early gastric cancer (EGC) stage I according to the general rules of classification of the Japanese Research Society for Gastric Cancer. Of the 55 patients, 42 (30 male, 12 female) were alive in April 1992. The prognosis correlated well with the ratio of neutrophils to lymphocytes (N/L ratio) but not with the total number of white blood cells in the peripheral blood. The patients were divided into two groups according to their N/L ratio. Of the 29 patients with an N/L ratio less than 2, 27 were alive in 1992, whereas only 15 of the 26 patients with an N/L ratio of 2 or more were alive (χ2 analysis, P = 0.0022). We further examined the phenotypes of neutrophils from 29 other patients with EGC at the time of diagnosis before surgical operation. These patients were divided into two groups: 17 patients with a low N/L ratio (less than 2) and 12 patients with a high N/L ratio (2 or more). CD10 and CD35 expressions on neutrophils from the patients with a low N/L ratio were lower than those from the patients with a high N/L ratio. The N/L ratio correlated well with both CD10 and CD35 expression, whereas no correlation was observed between the numbers of neutrophils and the expression of these phenotypes. The respiratory burst of neutrophils from the patients with a high N/L ratio was higher than that of neutrophils from the patients with a low N/L ratio, though there was no correlation in the phagocytic activity between both groups. It was thus suggested that the heterogeneity of neutrophils is, at least partly, related to the prognosis of patients with EGC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050178
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  • 81
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    Analysis of K-ras gene mutations in lung carcinomas: correlation with gender, histological subtypes, and clinical outcome (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 517-522 
    Details
    ISSN: 1432-1335
    Keywords: Key words K-ras oncogene ; Lung cancer ; Adenocarcinoma ; Mutation spectrum ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: AbstractPurpose: Lung cancer is respectively the leading and second-leading cause of cancer deaths among women and men in Taiwan. The commonest pathological type of lung carcinoma found in Taiwan is adenocarcinoma, and it has been documented that K-ras oncogene mutation occurs in a subset of lung adenocarcinoma. We therefore investigated the mutation spectrum and clinicopathological significance of K-ras oncogene mutations in lung cancer patients in Taiwan. Methods: The lung tumors were surgically resected from 84 lung cancer patients. DNA was isolated and the mutation spectrum was examined by direct sequencing. These data were also correlated with the clinicopathological characteristics of patients. Results: K-ras gene mutations were detected in 5 cases among the 84 patients investigated (6.0%). The majority of mutations occurred in exon 1 (80%, 4 of 5) and were located mainly in codons 12 and 13. Two patients had G · C → T · A transversions and 2 patients had G · C → A · T transitions. Notably, 1 patient had a G · C base-pair deletion from the contiguous G · C base pairs located between codons 68 and 69. All mutations occurred in male patients who were smokers. The incidences of K-ras gene mutation among male and female patients with adenocarcinoma were 13% and 0% respectively. Patients with K-ras gene mutation survived for shorter periods than those without mutations (P = 0.08, by the log-rank test). Conclusions: The incidence of K-ras gene mutations for male and female patients with adenocarcinoma was 13% and 0% respectively. Thus, the role of K-ras in the development of lung adenocarcinoma among Chinese men who are predominantly smokers is not significantly different from that in other populations worldwide. However, K-ras mutations may not be associated with adenocarcinoma among women in Taiwan, who are virtually all nonsmokers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050208
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  • 82
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    Electronic Resource
    Pretreatment serum lactate dehydrogenase as additional staging parameter in patients with small-cell lung carcinoma (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 215-219 
    Details
    ISSN: 1432-1335
    Keywords: Key words LDH ; Prognosis ; Small-cell lung cancer ; Staging
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: At present the standard staging procedure in patients with small-cell lung cancer (SCLC) is extensive, expensive and time-consuming. Furthermore, the predictive and prognostic value of the current staging system is poor. To determine the value of pretreatment clinical and biochemical parameters to predict tumour stage and to assess prognosis, a retrospective study was performed of 121 consecutive patients with newly diagnosed SCLC. Methods: On the basis of routine diagnostic procedures, 51 patients were staged as having limited disease and 70 patients as having extensive disease. During follow-up, data on tumour progression and survival were gathered. These data and the tumour stage were correlated with lactate dehydrogenase (LDH), alkaline phosphatase, liver enzymes, leucocyte count, protein, albumin, calcium, age and gender. Results: Follow-up ranged from 1 week to 96 months, during which 110 patients died. In all patients with LDH levels above 400 U/l (n = 31), metastases were found at the initial stage, whereas all patients initially staged as having limited disease and LDH levels above 240 U/l showed tumour progression. Bone and liver were found to be the most commonly involved sites, whereas the incidence of brain metastases increased during follow-up. In patients initially staged as having limited disease, no differences in survival were found between those showing local recurrence and those developing metastases during follow-up (P = 0.67). Compared to the patients initially staged as having extensive disease, the survival of both groups was significantly better (P 〈 0.001). Significant independent variables of survival were LDH, albumin, initial stage and gender, but LDH was the best overall predictor (P 〈 0.001). Conclusion: These results suggest that pretreatment LDH may be used as an additional staging parameter in SCLC, which can identify prognostic subgroups before treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050157
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  • 83
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    The role of serum and gastric juice levels of carcinoembryonic antigen, CA19.9 and CA72.4 in patients with gastric cancer (1998)
    Springer
    Journal of cancer research and clinical oncology 124 (1998), S. 450-455 
    Details
    ISSN: 1432-1335
    Keywords: Key words Tumor markers ; Gastric cancer ; Gastric juice ; Prognosis ; Diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose: The aim of the present study was to investigate carcinoembryonic antigen (CEA), CA19.9, and CA72.4 in the serum and gastric juice of patients with gastric cancer. Methods: Serum and gastric juice tumor markers CEA, CA19.9, and CA72.4 were measured in 59 patients who had gastric adenocarcinomas and were undergoing curative gastrectomy. The same markers were measured in 47 patients with benign gastric disorders and in 40 healthy subjects. The correlation between the serum and gastric juice levels of tumor markers and several clinicopathological factors were evaluated by univariate analysis. The significance of the tumor markers as prognostic factors was assessed both by univariate and multivariate analysis. Results: The positivity rates of serum CEA, CA19.9, and CA72.4 were 57.6%, 38.9%, and 18.6% respectively. The positivity rates of gastric juice CEA, CA19.9, and CA72.4 were 62.7%, 30.5%, and 23.7% respectively. The combination of serum and gastric juice markers gave a positivity of 81.3%. There was no correlation between serum and gastric juice level of each tumor marker. Positivity of gastric juice markers did not correlate with prognosis. A significant difference in prognosis was observed between patients positive and negative for serum CEA and CA19.9. Multivariate analysis also revealed that serum CEA and CA19.9 levels were independent prognostic factors. Conclusions: Levels of both serum and gastric juice tumor markers continue to have only limited diagnostic usefulness in gastric cancer patients. CEA and CA19.9 in the preoperative sera are good prognostic factors, whereas the presence of tumor markers in the gastric juice does not play any prognostic role.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004320050198
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  • 84
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    Electronic Resource
    Neural network models for breast cancer prognosis (1998)
    Springer
    Neural computing & applications 7 (1998), S. 367-375 
    Details
    ISSN: 1433-3058
    Keywords: Breast cancer ; Censoring ; Cox regression ; Neural networks ; Prognosis ; Survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Computer Science , Mathematics
    Notes: Abstract Estimating the risk of relapse for breast cancer patients is necessary, since it affects the choice of treatment. This problem involves analysing data of times to relapse of patients and relating them to prognostic variables. Some of the times to relapse will usually be censored.We investigate various ways of using neural network models to extend traditional statistical models in this situation. Such models are better able to model both non-linear effects of prognostic factors and interactions between them, than linear logistic or Cox regression models. With the dataset used in our study, however, the prediction of the risk of relapse is not significantly improved when using a neural network model. Predicting the risk that a patient will relapse within three years, say, is possible from this data, but not when any relapse will happen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01428127
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  • 85
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    Primäre Prävention von Adipositas in der Kindheit (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. S88 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Adipositas bei Säuglingen ; Kindern ; Jugendlichen ; Primäre Prävention ; Persistenz ; Prognose ; Key words Obesity ; Infants ; Children ; Adolescents ; Primary prevention ; Persistence ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The prevalence in paediatric obesity is increasing in many industrialised and developing countries and growing to a world-wide medical and socio-economic problem. In a recent report of the WHO the world-wide epidemic of obesity was addressed as a problem of highest priority. Inadequate long-term results of weight reduction in children and adolescents and the increasing socio-economic burden to the health systems, as well as the high grade of persistence of obesity aggravate the problem and demand primary prevention efforts.Future directions of primary prevention measures could be the time of onset of obesity, the ”early adiposity rebound”, intrauterine malnutrition, weight gain during infancy, low energy expenditure in infants, familial adiposity, composition of food and modification of fat intake. Several risk groups, which are predestined for overweight and obesity can be identified and could be included in preventive programs. Besides the risk-group strategy, however, population based strategies are needed for countries with high prevalence rates. However, the basis for successful programs will be to create a awareness for the neglected problem of obesity and to raise funds for successful prevention programs.
    Notes: Zusammenfassung Hintergrund: Steigende Prävalenzzahlen für Übergewicht machen Adipositas zu einem weltweiten ernährungsmedizinischen und gesellschaftspolitischen Problem. In einem jüngst erschienenen Report der WHO wird dem Problem der Adipositas mit seinem epidemischen Auftraten höchste Bedeutung und höchster Stellenwert zugeordnet. Die schlechten Therapieerfolge bei Kindern und Jugendlichen, besonders aber bei Erwachsenen, die massiv steigenden Kosten für das Gesundheitssystem sowie der hohe Persistenzgrad der Adipositas mit zunehmendem Alter machen Präventivprogramme dringend notwendig. 〈Prävention: Mögliche Ansatzpunkte für eine primäre Prävention der Adipositas im Kindesalter sind: Zeitpunkt der Manifestation der Adipositas, früher „adiposity rebound”, intrauterine Mangelernährung. Gewichtsentwicklung im Säuglingsalter, niedriger Energieverbrauch im Säuglingsalter, familiäres Umfeld und elterliches Übergewicht, Nährstoffgehalt und -zusammensetzung der Nahrung und damit verbundene Ernährungsmodifikation im Sinn einer Fettrestriktion. 〈Diskussion: Einzelne Risikogruppen, die besonders prädestiniert für Übergewicht und Adipositas sind, könnten durch individuelle präventivmedizinische Maßnahmen erfaßt und betreut werden. Dennoch scheint aufgrund der Häufigkeit des Problems aber darüber hinaus auch eine Gesamtpopulationsstrategie für die industrialisierten Länder mit hoher Prävalenz von Adipositas unbedingt notwendig und sinnvoll. Voraussetzung dafür sind die Schaffung eines Problembewußtseins für dieses, auch in weiten Kreisen von Medizinern vernachlässigte und ignorierte medizinische Anliegen und neben dem gesundheitspolitischen Willen auch noch entsprechende finanzielle Mittel.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014771
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  • 86
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    Esophageal atresia and tracheoesophageal fistula: success and failure rates in the United Arab Emirates (1998)
    Springer
    Pediatric surgery international 14 (1998), S. 214-217 
    Details
    ISSN: 1437-9813
    Keywords: Key words Esophageal atresia ; Tracheoesophageal fistula ; Prognosis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The management of esophageal atresia (EA) and tracheoesophageal fistula (TEF) has improved markedly over the years, with a current overall survival of 80%–90%. This however, is not the case in developing countries, where mortality continues to be high. The results of treatment of 41 consecutive cases EA and/or TEF have been analyzed to determine factors pertinent to the outcome. The distribution of anomalies and a postoperative survival of 86.8% were comparable to those from developed countries. Aspiration pneumonia was unusually frequent in our patients (78%), but did not adversely influence outcome. Associated congenital anomalies as well as low birth weight continue to be important predictors of outcome in our setting. Our post-operative complications were similar to those from developed countries apart from a high incidence of stricture formation. This was attributed to gastroesophageal reflux, non-ventilation post-operatively, and the use of silk sutures to construct the anastomosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050491
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  • 87
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    Prognostic significance of standardized AgNOR analysis in early and advanced gastric carcinomas (1998)
    Springer
    Virchows Archiv 433 (1998), S. 261-266 
    Details
    ISSN: 1432-2307
    Keywords: Key words AgNORs ; Standardized AgNOR analysis ; Gastric carcinoma ; Proliferation ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  To assess the prognostic significance of silver-stained nucleolar organizer region (AgNOR) proteins, a standardized AgNOR analysis was performed on 78 patients affected by early (EGC, n=24) or advanced (AGC, n=54) gastric carcinomas. The histopathological diagnosis, grading and staging were done according to WHO and UICC recommendations; the mean follow-up time was 56.9 months. Visualization and quantification of AgNORs were made in formalin-fixed, paraffin-embedded sections as specified in the guidelines of the Committee on AgNOR Quantification (1995). Statistical analysis was performed on the mean AgNOR area values (NORA). Highly significant differences (P〈0.001) were found in NORA values between EGC and AGC, between low- and high-grade gastric carcinomas and between patients dead from gastric cancer and living patients. In addition, significant P values were found on comparison of NORA values relating to pT status, pN status and stage. Comparison of Kaplan-Meier survival curves revealed that patients affected by gastric carcinomas with higher NORA values (〉5.213 μm2) had a worse prognosis. Finally, using Cox multiple regression analysis, the AgNOR quantity emerged as a useful independent prognostic variable to predict the final outcome of patients affected by EGC or AGC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050245
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  • 88
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    The influence of p53 and associated factors on the outcome of patients with oral squamous cell carcinoma (1998)
    Springer
    Virchows Archiv 433 (1998), S. 427-433 
    Details
    ISSN: 1432-2307
    Keywords: Key words Oral ; squamous cell carcinoma ; Tumour suppressor gene ; Prognosis ; Immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In several tumour entities the immunohistochemical detection of p53 has proved to be a predictive factor for the survival of the patients. In this study the effector waf1 and the regulator mdm2 responsible for the inactivation of p53 were also determined in 156 tissue samples of primary squamous cell carcinomas in the oral cavity and oropharynx, their lymph node metastases, and the epithelium outside the invasively growing tumour from 107 patients. In this latter epithelium there was a significant correlation between grade of dysplasia and staining for p53 (P〈0.01). In the dysplastic epithelium a significant correlation between p53, waf1, and mdm2 was shown (P〈0.05). Differences in the immunohistochemical staining between different blocks of the tumour tissue and also between primary tumours and their lymph node metastases were revealed in 11–44% of cases, but there was no correlation with other variables, such as formation of lymph node metastases. In contrast to the conventional tumour grading and staging, no influence of any of the variables determined on survival or recurrence-free survival could be detected. It seems that p53 and associated factors are important in the early stages of cancerogenesis but not in further tumour progression and metastatic spread.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050270
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  • 89
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    Biological and prognostic significance of stratified epithelial cytokeratins in infiltrating ductal breast carcinomas (1998)
    Springer
    Virchows Archiv 433 (1998), S. 119-129 
    Details
    ISSN: 1432-2307
    Keywords: Key words Intermediate filaments ; Cytokeratins ; Vimentin ; Prognosis ; Breast cancer
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The biological significance of the differential expression of cytokeratin (CK) polypeptides in breast carcinomas is unclear. We examined the CK profiles of 101 primary infiltrating ductal breast carcinomas using monoclonal antibodies directed against 11 different CKs and against vimentin. Two major CK phenotypes were distinguished: first, a phenotype expressing only the simple-epithelial CKs 7 (variably), 8, 18 and 19, and secondly, a bimodal phenotype co-expressing significant amounts of one or more of the stratified-epithelial CKs 4, 14 and 17. The vast majority of G1 and G2 carcinomas had the simple-epithelium phenotype, as did a subgroup of G3 carcinomas. Interestingly, the majority (62%) of G3 carcinomas exhibited the bimodal phenotype, with the expression of CKs 4, 14 and 17 being statistically correlated with poor histological differentiation and absence of steroid hormone receptors. The distribution of vimentin only partially overlapped with that of these stratified-epithelial CKs. Prognostic analyses suggested that the presence of CKs 4, 14 and/or 17 was associated with short overall and disease-free survival in subgroups comprising G3, oestrogen-receptor-negative and vimentin-negative tumours. In node-positive tumours the correlation between these CKs and a shorter disease-free interval attained statistical significance (log rank, 0.0096). Thus, abnormal CK profiles in ductal breast carcinomas appear to reflect disturbed regulation of differentiation-related gene expression programmes and may prove to be of clinical value.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050226
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  • 90
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    Bcl-2 expression in male breast carcinoma (1998)
    Springer
    Virchows Archiv 433 (1998), S. 229-235 
    Details
    ISSN: 1432-2307
    Keywords: Key words Bcl-2 protein expression ; Male breast carcinoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We have analysed the expression of bcl-2 protein retrospectively in 34 primary male breast carcinomas (MBC), using the monoclonal antibody bcl-2 in formalin-fixed, paraffin-embedded tissues. Bcl-2 expression was compared with tumour clinicopathological features, sex steroid hormone receptors, DNA content, p53 immunoreactivity and cell proliferative activity assessed by counts of the argyrophilic nucleolar organizer regions (AgNORs), the monoclonal antibody PC10 against proliferating cell nuclear antigen and the monoclonal antibody MIB-1. Most (28, or 82.3%) of the 34 cases of MBC were bcl-2 positive. No association was found with clinicopathological features of the tumours, although bcl-2 tended to be more frequently expressed in small tumours (P=0.09) and in cases without necrotic areas (P=0.1). Nor was any association found with hormone receptor status, p53 immunoreactivity, DNA content, cell proliferative activity or patient survival. In multivariate analysis, only proliferative activity (expressed by AgNOR counts) and p53 immunoreactivity had independent prognostic significance. Our results indicate that MBC differs from FBC in that in MBC bcl-2 protein is not related to an oestrogen-dependent transcription pathway and bcl-2 alone is not sufficient to induce increased proliferation. These characteristics, together with the high prognostic value of cell proliferation and the lack of prognostic significance for hormone receptor status, support the hypothesis that MBC is biologically different from FBC.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004280050241
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  • 91
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    Die Prognose des apallischen Syndroms Ein Literaturüberblick (1998)
    Springer
    Der Anaesthesist 47 (1998), S. 677-682 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Apallisches Syndrom ; Koma vigile ; Vegetativer Zustand ; Prognose ; Key words Apallic syndrome ; Coma vigil ; Persistent vegetative state ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract This study evaluates the available literature about the prognosis of patients with apallic syndrome and similar illnesses. Different therapeutic strategies are not relevant in this review. The variation of the reported material did not permit a statistical metaanalysis. However, many interesting points of view could be elaborated leading to positive assistance in everyday situations. The chance of survival and the long-term outcome of comatose patients decrease with an increase in the age of the patient, the length and the degree of the coma. Cerebral predamage worses the long-term prognosis. Traumatic head injuries have a better prognosis than nontraumatic. Children (under 18 years of age) have a better prognosis than adults.The course of the oculomotoric symptoms can be used as a prognostic criterion. The somatosensory evoked potentials in the early phase correlate with the survival-chance and the long-term prognosis. The initial speed of recovery correlates with the long term outcome. Children and adults with traumatic apallic syndrome may recover over a period of 12 months. For apallic patients with other etiologies this time limit is 3 months. Few cases of recovery have been described outside these time limits. The average survival limit of permanent apallic patients is between 3 and 5 years. Particular patients have survived decades.
    Notes: Zusammenfassung In der vorliegenden Studie wird die verfügbare Literatur zur Prognose von Patienten im apallischen Syndrom und vergleichbaren Krankheitszuständen ausgewertet. Unterschiedliche Therapieverfahren fließen in die Auswertung nicht ein. Die Heterogenität des zugrundeliegenden Materials ließ eine statistische Metaanalyse nicht zu. Dennoch ließen sich eine Reihe von Gesichtspunkten herausarbeiten, die Orientierungshilfe für die tägliche Arbeit liefern können. Die Überlebensprognose und das Langzeitergebnis von Komapatienten verschlechtern sich mit zunehmendem Lebensalter, zunehmender Komadauer und zunehmendem Schweregrad des Komas. Zerebrale Vorschädigungen verschlechtern die Langzeitprognose. Traumatische Hirnschädigungen haben eine bessere Prognose als nicht-traumatische. Kinder (unter 18. Lebensjahr) haben eine bessere Prognose als Erwachsene. Der Verlauf der Okulomotorik kann als prognostisches Kriterium herangezogen werden. Die somatosensiblen Potentiale der Frühphase korrelieren mit der Überlebens- und Langzeitprognose. Die initiale Besserungsgeschwindigkeit korreliert mit dem Langzeitergebnis. Traumatische apallische Syndrome im Kindes- und Erwachsenenalter können sich über einen Zeitraum von 12 Monaten zurückbilden. Bei apallischen Patienten sonstiger Ätiologie liegt dieses Zeitlimit bei 3 Monaten sowohl für Kinder als auch für Erwachsene. Rückbildungen außerhalb dieser Zeitgrenzen sind nur in wenigen Einzelfällen beschrieben. Die mittlere Überlebenszeit apallischer Patienten liegt bei 3–5 Jahren. In Einzelfällen können Jahrzehnte überlebt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050613
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  • 92
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    Increased serum concentration of hyaluronate in dermatomyositis patients (1998)
    Springer
    Archives of dermatological research 290 (1998), S. 579-581 
    Details
    ISSN: 1432-069X
    Keywords: Key words Hyaluronate ; Dermatomyositis ; Lung ; fibrosis ; Internal malignancy ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004030050355
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  • 93
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    Differences in rhodamine-123 efflux in B-type chronic lymphocytic leukemia suggest possible gender and stage variations in drug-resistance gene activity (1998)
    Springer
    Annals of hematology 76 (1998), S. 189-194 
    Details
    ISSN: 1432-0584
    Keywords: Key words Chronic lymphocytic leukemia ; Drug resistance ; Sex ; Multidrug resistance ; MDR1 ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Peripheral blood samples from 61 patients (36 male, 25 female) with all stages of B-type chronic lymphocytic leukemia (CLL) were studied for MDR1 phenotype using monoclonal antibodies and rhodamine-123 dye exclusion, a functional assay of MDR1 expression. The duration of the disease varied from 1 month to 22 years at the time of initial study. Overall, 74% of the patients were positive for rhodamine-123 exclusion. When analyzed by gender, significantly more men than women were positive (89% versus 48%, p〈0.001). There were more positive men than women for every stage of the disease. Female patients were found to be either MDR1 phenotype positive or negative at any stage of the disease. In contrast, all male patients with early (stages 0–II) disease were MDR1 phenotype positive. One early-stage (stage II) male patient converted from rhodamine-efflux positive to rhodamine-efflux negative as he progressed from stage-II to stage-IV disease. We suggest that some of the differences in disease biology of male versus female CLL patients (women having a more benign course) may be due to gender-dependent differences in drug-resistance gene activity, including MDR1. Our results also emphasize the need to take into account gender in evaluating the clinical course of patients with CLL.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002770050387
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  • 94
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    Prediction of outcome after resuscitation in a case of electrocution (1998)
    Springer
    Intensive care medicine 24 (1998), S. 255-257 
    Details
    ISSN: 1432-1238
    Keywords: Key words Electrocution ; Cardiopulmonary resuscitation ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Electrical shocks commonly cause widespread acute and delayed tissue damage. Cardiac arrythmias and respiratory arrest are the most life-threatening complications in the acute phase. Prediction of outcome after cardiopulmonary resuscitation is usually based on neurological findings compatible with anoxic encephalopathy. This report describes a case of electrocution followed by cardiopulmonary resuscitation. Although neurological signs on admission pointed towards severe brain injury, the patient fully recovered and was able to resume the level of cognitive functioning prior to the accident.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050560
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  • 95
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    The novel combination of fat clearance and immunohistochemistry improves prediction of the outcome of patients with colorectal carcinomas: a preliminary study (1998)
    Springer
    International journal of colorectal disease 13 (1998), S. 99-102 
    Details
    ISSN: 1432-1262
    Keywords: Key words Fat clearance ; Immunohistochemistry ; Colorectal carcinoma ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Afin d'évaluer la signification de micrométastases en relation avec le taux de survie, les pièces opératoires de 48 patients porteurs d'un cancer colorectal ont été analysées après clearance de la graisse périrectale. Le nombre et la taille des ganglions lymphatiques contenant des métastases et la signification de ces micrométastases en relation avec la survie des patients ont été déterminés. Nous avons trouvé que la majorité des métastases lymphatiques (71.8%) avaient 5 mm ou moins de diamètre et que leur taille n'avait pas d'effet sur la survie. Des colorations immunohistochimiques des ganglions lymphatiques ont révélé que 15 des 25 patients diagnostiqués comme présentant un cancer au stade B de Dukes sur des colorations de routine contenaient en fait des micrométastases et que 86% de celles-ci mesuraient moins de 5 mm de diamètre. La survie de ce sous-groupe a été considérablement plus mauvaise que celle de patients au stade B de Dukes sans micrométastases. Aucun des trois patients à un stade A de Dukes ne présentait de micrométastases. Etant donné que la plupart des métastases et micrométastases surviennent sur des ganglions lymphatiques de 5 mm et moins et que ces dernières peuvent aisément être méconnues lors d'examens de routine, nous proposons que la clearance de la graisse périrectale et une analyse immunohistochimique de routine des cancers au stade de Dukes B améliorent la prédiction de survie des patients opérés d'un cancer colorectal.
    Notes: Abstract To evaluate the significance of micrometastases in relation to survival rate, specimens from 48 colorectal carcinoma patients were analysed after fat clearance. The number and size of the lymph nodes harbouring metastases and the significance of micrometastases for patients' survival were assessed. We found that although the majority of metastatic lymph nodes (71.8%) were 5 mm or less in diameter, their size had no effect on survival. Immunohistochemical staining of lymph nodes revealed that 15 of 25 patients with Dukes' stage B diagnosed by routine staining had micrometastases, 86% of these lymph nodes being less than 5 mm in diameter. The survival rate of this subgroup was found to be considerably poorer than that of Dukes' stage B patients with no micrometastases. None of the three patients with Dukes' stage A carcinoma had micrometastases. Since most of the metastases and micrometastases occur in lymph nodes of 5 mm and less and can be easily missed by routine examination, we suggest that fat clearance and routine immunohistochemical analysis of Dukes' stage B improve the prediction of outcome of colorectal cancer patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003840050143
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  • 96
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    Das desmoplastische Plattenepithelkarzinom der Haut und Unterlippe Eine morphologische Entität mit hohem Metastasierungs- und Rezidivierungsrisiko (1998)
    Springer
    Der Hautarzt 49 (1998), S. 104-108 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Plattenepithelkarzinom der Haut und Unterlippe ; desmoplastischer Typ ; Perineurale infiltration ; Neurotopes Plattenepithelkarzinom ; Histopathologie ; Histologische Schnittrandkontrolle ; Malignität ; Key words Squamous cell carcinoma of the skin and vermilion border ; Desmoplastic type ; perineural invasion ; Neurotropic ; Fine stranded squamous cell carcinoma ; Histopathology ; Micrographic surgery ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The desmoplastic type of the squamous cell carcinoma (DSCC) of the skin is an entity which is readily distinguished by light microscopy. The DSCC has fine branches surrounded by a desmoplastic stroma and shows in some cases typical perineural, perivascular and widespread intradermal invasion (maximum 6 cm!). This type accounts for 8.2% (n=44) of our collective of 594 squamous cell carcinomas (SCC) of the skin and vermilion border. Clinically DSCC look like other malignant epithelial tumors of the skin. All tumors were followed up for at least 3 years (maximum 10 years). The local recurrence rate was high (24.3%) even though micrographic surgery was carried out. The rate of local or regional metastasis was also very high (22.7%). In comparison the recurrence rate and the rate of metatasis of the remaining common 91.8% SCC’s (n=550) was low: 2.6% and 3.8%, respectively. The DSCC seems to be identical with the so called neurotropic SCC, the fine stranded SCC or the SCC with perineural invasion which have a high rate of local recurrence and metastasis as well, but DSCC is a better generic histopathologic term for the entire group. The DSCC is best treated with micrographic surgery and wider safety margins than any other type and should be followed up very frequently.
    Notes: Zusammenfassung Der desmoplastische Typ des Plattenepithelkarzinoms der Haut (DPEK) wurde bisher in der Literatur einmal erwähnt. Der Tumor zeigt in schmalen Strängen wachsende atypische Plattenepithelien, z.T. mit Verhornungszeichen und einer auffallenden desmoplastischen Stromareaktion. In unserem Kollektiv der Plattenepithelkarzinome (PEK) der Haut und Unterlippe (n=594) ist das DPEK mit 8,2% vertreten. Klinisch läßt er sich von anderen epithelialen Tumoren nicht unterscheiden. Bei einer Nachbeobachtungszeit von minimal 3 und maximal 10 Jahren fanden wir sowohl eine hohe Lokalrezidivierungsrate (24,3%) trotz durchgeführter lückenloser histologischer Schnittrandkontrolle im Paraffinschnittverfahren als auch eine sehr hohe lokoregionäre Metastasierung (22,7%). Fälle mit perineuraler bzw. auch perivaskulärer und ausgedehnter intradermaler (Maximum 6 cm!) Infiltration kommen vor. Der gewöhnliche Typ des PEK unseres untersuchten Kollektives (91,8%) zeigt dagegen sowohl eine niedrige Lokalrezidivierungsrate (2,6%) als auch eine niedrige Metastasierungsrate (3,8%). Das DPEK scheint identisch zu sein mit dem sog. neurotopen, bzw. dem perineural infiltrierenden und dem feinstrangigen („fine stranded”) Typ des PEK, welche ebenfalls eine hohe Lokalrezidiv- und Metastsierungsrate aufweisen. Die Bezeichnung desmoplastisches Plattenepithelkarzinom stellt den histopathologisch besser definierten Oberbegriff dar. Das DPEK benötigt eine deutlich radikalere lokale Therapie sowie eine engmaschigere Nachkontrolle als die gewöhnlichen Typen des PEK der Haut.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050708
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  • 97
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    A normal platelet count at admission in acute meningococcal disease does not exclude a fulminant course (1998)
    Springer
    Intensive care medicine 24 (1998), S. 157-161 
    Details
    ISSN: 1432-1238
    Keywords: Key words Meningococcal disease ; Prognosis ; Disseminated intravascular coagulation ; Platelets ; Tumour necrosis factor ; Lactate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the value of the platelet count at admission for the assessment of the severity of disease in acute meningococcal infections. Design: Retrospective and prospective, descriptive patient study. Setting: University Hospital Intensive Care Unit (ICU). Patients: All patients (n = 92) with acute meningococcal disease from 1985 to 1997, who arrived at the ICU within 12 h after hospital admission and had more than one platelet count during the first 12 h. Measurements and results: After admission, platelets dropped in 95 % of the patients. At admission, 2/41 (5 %) of the non-hypotensive patients and 13/51 (25 %) of the hypotensive patients had platelets fewer than 100 × 109/l. During the following 12 h, these percentages increased to 15 % and 71 %, respectively. Fatalities had, at admission, a median platelet count of 111 × 109/l (range, 19–302 × 109/l), whereas the nadir, occurring at median 7.0 h (range, 1.3–12 h), was 31 × 109/l (range, 12–67 × 109/l). Plasma TNF, measured shortly after admission, correlated better with the platelet nadir (r = − 0.65, p 〈 0.0001) than with the platelet count at admission. Similarly, serum lactate correlated better with the platelet nadir. Conclusions: As platelets drop after admission, the use of the platelet count at admission for the assessment of the prognosis in acute meningococcal disease may be misleading. Frequently repeated platelet counts are a better tool for evaluating the severity of disease.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050538
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  • 98
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    Cholelithiasis following Escherichia coli O157 : H7-associated hemolytic uremic syndrome (1998)
    Springer
    Pediatric nephrology 12 (1998), S. 222-225 
    Details
    ISSN: 1432-198X
    Keywords: Key words:  Hemolytic uremic syndrome ; Escherichia coli O157 : H7 ; Cholelithiasis ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Sequelae of Escherichia coli O157 : H7-associated hemolytic uremic syndrome (HUS) 2 – 3 years following an outbreak in Washington State have been prospectively studied to identify predictors of adverse sequelae. Logistic regression analysis was used to examine associations between findings in the acute course and long-term renal and gastrointestinal outcomes. Twenty-one percent of patients had gastrointestinal sequelae, which included cholelithiasis resulting in cholecystectomy (3/29), persistent pancreatitis (2/29), late colon stricture (1/29), and/or glucose intolerance (1/29). Logistic regression analysis found long-term gastrointestinal sequelae were higher in patients who, during HUS, had hypertension [odds ratio (OR) = 21.2, 95% confidence interval (CI) = 1.9 – 164.4, P = 0.01] or gastrointestinal complications (OR = 21.2, 95% CI = 1.9 – 164.4, P = 0.01). Renal sequelae were seen in 35% of patients. One patient (4%) had persistent hypertension and 9 (31%) had minor urinary findings (hematuria or proteinuria). Thrombocytopenia lasting longer than 10 days during the acute illness was associated with a risk for subsequent renal sequelae (OR = 15.0, 95% CI = 1.98 – 1,703.0, P = 0.009). We conclude a high incidence of gastrointestinal sequelae, especially cholelithiasis presenting long after the acute illness, may be seen with HUS. The short follow-up period may underestimate the extent and severity of eventual renal sequelae.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050442
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  • 99
    Electronic Resource
    Electronic Resource
    Multiple combined therapy for severe Henoch-Schönlein nephritis in children (1998)
    Springer
    Pediatric nephrology 12 (1998), S. 244-248 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Henoch-Schönlein nephritis ; Multiple combined therapy ; Histological effects ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. From 1980 through 1992, 14 children with Henoch-Schönlein nephritis (HSN) showing severe glomerular changes (grade IV or V) were given a multiple combined therapy with prednisolone, cyclophosphamide, heparin/warfarin, and dipyridamole, and were followed for 7.5±0.9 years. The period between the onset of nephritis and the start of therapy was 0.8±0.4 years. Ten patients underwent follow-up biopsy after therapy. The percentage of glomeruli having crescents/segmental lesions was significantly reduced after therapy (70%±5% vs. 42%±7%, P 〈0.01), due mainly to the resolution of crescents (51%±8% vs. 13%±5%, P 〈0.01). Thus, histological grade was significantly improved (5 grade IV and 5 grade V vs. 7 grade III and 3 grade IV, P 〈0.01). After an average follow-up period of 7.5 years, 9 patients showed normal urine and renal function, 4 showed minor urinary abnormalities, and 1 heavy proteinuria. No patient developed chronic renal insufficiency. These findings suggest that the multiple combined therapy could be effective for histologically severe HSN, although a prospective controlled study should be performed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050447
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  • 100
    Electronic Resource
    Electronic Resource
    Hirnstammgliom (1998)
    Springer
    Der Radiologe 38 (1998), S. 904-912 
    Details
    ISSN: 1432-2102
    Keywords: Schlüsselwörter Hirnstammgliom ; CT ; MRT ; Klassifikation ; Prognose ; Key words Brain-stem glioma ; CT ; MRI ; Classification ; Prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Brain-stem gliomas occur mainly in childhood and are localized in the mesencephalon, pons and medulla oblongata. Diagnosis is a domain of MRI, requiring T2, T1 and KM. CT shows hemorrhage and calcification well. The criteria are the primary site, size, tumor growth, brain-stem enlargement, delineation, intralesional structure, exophytic components and enhancement. Secondary criteria are herniation, hydrocephalus and liquorgenic seeding. In CT glioma are hypodense, in MRI hyperintense in T2 and hypointense in T1. Enhancement is seen in 25–60% and does not allow differentiation of tumor vs nontumor or gradings. Factors influencing poor outcome are high grade, a short history, cranial nerve involvement, severe brain-stem enlargement, pontine site, diffuse growth and recurrency. The 5-year-survival rate is 30% (after radiation: focal tumors 85%, diffuse 20%). Most frequent are symptoms of brain pressure, cerebellum, cranial nerves and pyramidal tract. There is no agreement on whether biopsy is necessary or not. A diagnosis of tumor is highly suggestive if classical MRI findings fit the clinical history.
    Notes: Zusammenfassung Hirnstammgliome treten überwiegend im Kindesalter auf und sind im Mesenzephalon, Pons und der Medulla oblongata lokalisiert. Die Diagnostik ist eine Domäne der MRT und erfordert T2-, T1-Sequenzen und Kontrastmittel (KM). Die CT ist zum Nachweis von Blutungen und Verkalkungen prädestiniert. Beurteilungskriterien sind Primärsitz, Tumorgröße, Ausdehnung, Hirnstammverbreiterung, Tumorränder, Binnenstruktur, exophytische Anteile und KM-Aufnahme. Sekundäre Kriterien sind Einklemmung, Liquoraufstau und liquorgene Aussaat. Hirnstammgliome sind im CT hypodens, im MRT in T2 hyperintens, in T1 meistens hypointens. Schrankenstörungen lassen sich in 25–60% der Fälle nachweisen und erlauben keine Differenzierung von Tumor/Nichttumor oder verschiedenen Gradierungen. Diskussion: Prognostisch ungünstig sind hohe Gradierung, kurzer klinischer Verlauf, Hirnnervenbefall, ausgeprägte Hirnstammverbreiterung, pontine Lokalisation, diffuse Ausbreitung und Rezidiv. Die 5-Jahres-Überlebensrate beträgt 30%, nach Strahlentherapie bei fokalen Tumoren 85%, bei diffusen 20%. Die häufigsten Symptome sind Hirndruckzeichen, zerebelläre Ataxie, Hirnnervenbefall und Pyramidenbahnzeichen – in ca. 40% Tortikollis. Die Biopsie wird kontrovers diskutiert. Zumindest ist bei klassischem MRT-Befund und passender Klinik die Diagnose Tumor hochwahrscheinlich.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001170050441
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