Background: Non-epithelial malignant ovarian tumors and clear cell carcinomas, Brenner tumors, transitional cell tumors, and carcinoid tumors of the ovary are rare ovarian tumors (ROTs). In this study, our aim was to determine the clinicopathological features of ROT patients and prognostic factors associated with survival. Materials and Methods: A total of 167 patients with ROT who underwent initial surgery were retrospectively analyzed. Prognostic factors that may influence the survival of patients were evaluated by univariate and multivariate analyses. Results: Of 167 patients, 75 (44.9%) were diagnosed with germ-cell tumors (GCT) and 68 (40.7%) with sex cord-stromal tumors (SCST); the remaining 24 had other rare ovarian histologies. Significant differences were found between ROT groups with respect to age at diagnosis, tumor localization, initial surgery type, tumor size, tumor grade, and FIGO stage. Three-year progression-free survival (PFS) rates and median PFS intervals for patients with other ROT were worse than those of patients with GCT and SCST (41.8% vs 79.6% vs 77.1% and 30.2 vs 72 vs 150 months, respectively; p=0.01). Moreover, the 3-year overall survival (OS) rates and median OS times for patients with both GCT and SCST were better as compared to patients with other ROT, but these differences were not statistically significant (87.7% vs 88.8% vs 73.9% and 170 vs 122 vs 91 months, respectively; p=0.20). In the univariate analysis, tumor localization (p<0.001), FIGO stage (p<0.001), and tumor grade (p=0.04) were significant prognostic factors for PFS. For OS, the univariate analysis indicated that tumor localization (p=0.01), FIGO stage (p=0.001), and recurrence (p<0.001) were important prognostic indicators. Multivariate analysis showed that FIGO stage for PFS (p=0.001, HR: 0.11) and the presence of recurrence (p=0.02, HR: 0.54) for OS were independent prognostic factors. Conclusions: ROTs should be evaluated separately from epithelial ovarian cancers because of their different biological features and natural history. Due to the rarity of these tumors, determination of relevant prognostic factors as a group may help as a guide for more appropriate adjuvant or recurrent therapies for ROTs.
Regardless of the prognostic factors in papillary thyroid cancer, such as sex, age, size of tumor, extent of disease, and distant metastasis, the prognosis of papillary thyroid cancer is sometimes difficult to predict from clinical and microscopic analysis alone and additional prognostic indicators are needed. Recent studies of thyroid cancer have indicated that DNA aneuploidy may be correlated to the biological behavior of malignancy and inversely correlated to the prognosis, but it still remains contraversal. We performed this study to assess DNA ploidy patterns in relation with the previously known prognostic factors in AMES scoring system and lateral neck node metastasis in papillary thyroid cancer. A series of 132 patients with papillary thyroid cancer and 80 patients with benign thyroid tumor(27 follicular adenomas and 53 adenomatous goiters) as a control group from October 1993 to Feburary 1995 were analyzed and their nuclear DNA content was measured with flow cytometry using fresh tissue specimens. DNA aneuploidy was found in 8(6.1%) in papillary cancer and 8(10%) in benign tumor. S-phase traction(SFP) and proliferative index(PI) were higher in thyroid cancers, being 2.18$\pm$4.24%, 6.34$\pm$4.94% in the papillary thyroid cancers and 1.97$\pm$2.93%, 4.44$\pm$3.80% in the benign tumors, respectively. However there was no significant difference of values between two groups(p>0.05). Among variable prognostic factors studied(age, sex, size of tun or, extent of disease, distant metastasis in AMES scoring system and lateral neck node metastasis), DNA aneuploidy was found to be common in distant metastasis(p<0.001) and in lateral neck node metastasis(p>0.035), but there was no significant difference between the high risk and low risk group according to the AMES scoring system(p<0.08). In our study, DNA aneuploidy was not valuable in determining the presence of malignancy and did not correlate to the AMES scoring system. However, follow-up study of more cases will be needed for accurate information about the DNA ploidy as a independent prognostic factor.
Objectives : We tried to evaluate the agreement of the Charlson comorbidity index values(CCI) obtained from different sources(medical records and National Health Insurance claims data) for gastric cancer patients. We also attempted to assess the prognostic value of these data for predicting 1-year mortality and length of the hospital stay(length of stay). Methods : Medical records of 284 gastric cancer patients were reviewed, and their National Health Insurance claims data and death certificates were also investigated. To evaluate agreement, the kappa coefficient was tested. Multiple logistic regression analysis and multiple linear regression analysis were performed to evaluate and compare the prognostic power for predicting 1 year mortality and length of stay. Results : The CCI values for each comorbid condition obtained from 2 different data sources appeared to poorly agree(kappa: 0.00-0.59). It was appeared that the CCI values based on both sources were not valid prognostic indicators of 1-year mortality. Only medical record-based CCI was a valid prognostic indicator of length of stay, even after adjustment of covariables($\beta$ = 0.112, 95% CI = [0.017-1.267]). Conclusions : There was a discrepancy between the data sources with regard to the value of CCI both for the prognostic power and its direction. Therefore, assuming that medical records are the gold standard for the source for CCI measurement, claims data is not an appropriate source for determining the CCI, at least for gastric cancer.
Introduction This study reports case series of Soyangin patients with coldness in hands and feet using Sasang constitutional medicine approach. This study suggests a value of using constitutional medicine indicators as both prognostic and diagnostic tools. Methods Among patients who visited an outpatient clinic, 7 patients were selected based on the criteria. These selected patients were exclusively treated with herbal medicine and monitored every 2 to 4 weeks retrospectively. Results The average treatment period was 8 weeks. Patients with a favorable pattern showed the improvement within 8 weeks, while those with an unfavorable pattern required more time. Discussion This study confirms the significance of Sasang constitutional medicine approach in Soyangin exterior cold syndrome with coldness in hands and feet. It also validates the current coldness in hands and feet as meaningful diagnostic indicator of Soyangin exterior cold syndrome. Furthermore, it highlights the value of original symptoms as prognostic tools.
Park, Jong-Hwa;Hyun, Seung-Jae;Kim, Ki-Jeong;Jahng, Tae-Ahn
Journal of Korean Neurosurgical Society
/
v.56
no.5
/
pp.431-435
/
2014
A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.
The aims of this study were to analyze canine pyometra cases at Veterinary Medical Center of Chungbuk National University, and to identify prognostic factors of canine pyometra at the stage of diagnosis. Records of cases about intact female dogs presented to Veterinary Medical Center from 2005 to 2019 were used for analysis. A total of 147 intact female dogs with canine pyometra were analyzed from outpatients' caseload. Median outbreak age was 9.6 years (range, 8 months to 17 years). The highest prevalence of pyometra over 14 years was observed in Maltese (22.4%, n = 33). Urologic disorders (21.8%, n = 32) including acute renal failure and cystic calculi were the most frequently observed concurrent disorders in dogs with pyometra. In other cases of pyometra, tumor (15.0%, n = 29), cardiovascular disorders (15.0%, n = 22) and systemic disorders (10.9%, n = 16) were accompanied with pyometra. The concentrations of BUN, creatinine and glucose were higher than reference range in cases of poor prognosis. According to the binominal logistic regression analysis, prognosis in pyometra was related to abdominal distension (p = 0.036), urologic disorder (p = 0.016), gastrointestinal disorder (p = 0.001), and serum level of blood urea nitrogen (BUN) (p = 0.045). This study describes that prognosis of canine pyometra can be predicted at the stage of diagnosis by abdominal distension, urologic disorder, gastrointestinal disorder, and serum level of BUN.
The disease concept of interstitial lung disease with idiopathic pulmonary fibrosis at its core has been relied on for many years depending on morphological classification. The separation of non-specific interstitial pneumonia with a relatively good prognosis from usual interstitial pneumonia is also based on the perception that morphology enables predict the prognosis. Beginning with dust-exposed lungs, initially, interstitial pneumonia is classified by anatomical pathology. Diagnostic imaging has dramatically improved the diagnostic technology for surviving patients through the introduction of high-resolution computed tomography scan. And now, with the introduction of therapeutics, the direction of diagnosis is turning. It can be broadly classified into to make known the importance of early diagnosis, and to understand the importance of predicting the speed of progression/deterioration of pathological conditions. For this reason, the insight of "early lesions" has been discussed. There are reports that the presence or absence of interstitial lung abnormalities affects the prognosis. Searching for a biomarker is another prognostic indicator search. However, as is the case with many chronic diseases, pathological conditions that progress linearly are extremely rare. Rather, it progresses while changing in response to environmental factors. In interstitial lung disease, deterioration of respiratory functions most closely reflect prognosis. Treatment is determined by combining dynamic indicators as faithful indicators of restrictive impairments. Reconsidering the history being classified under the disease concept, the need to reorganize treatment targets based on common pathological phenotype is under discussed. What is the disease concept? That aspect changes with the discussion of improving prognosis.
Objective: To analyze clinicopathological characteristics, prognostic factors and survival rates of the patients with urological soft tissue sarcomas treated and followed up in Turkey. Materials and Methods: For overall survival analyses the Kaplan-Meier method was used. From medical records, nine prognostic factors on overall survival were analysed. Results: For the 53 patients (34 males, 19 females) whose charts were reviewed, the median age was 53 (range 22 to 83) years. Most frequently renal location (n=30; 56.6%) was evident and leiomyosarcoma (n=20, 37.7%) was the most frequently encountered histological type. Median survival time of all patients was 40.3 (95% CI, 14.2-66.3) months. In univariate analysis, male gender, advanced age (${\geq}50years$), metastatic stage, unresectability, grade 3, renal location were determined as worse prognostic factors. In multivariate analysis, metastatic stage, unresectability and grade 3 were determined as indicators of worse prognosis. Conclusions: Urological soft tissue sarcomas are rarely seen tumours in adults. The most important factors in survival are surgical resection, stage of the tumour at onset, grade and location of the tumour, gender and age of the patients.
Objective : This study was designed to investigate the interrelationship and clinical usefulness of sperm morphology by strict criteria (SM), acrosome reaction following ionophore challenge test (ARIC) and sperm penetration assay (SPA) using zona-free hamster ova as prognostic factors in in vitro fertilization. Materials and Methods: Semen samples were provided by 83 patients undergoing IVF. We first evaluated the differences between normal fertilization group and poor fertilization group on three andrologic tests. Secondly, we analyzed the relationship between the three andrologic tests and in vitro fertilization on IVF settings. Finally, we evaluated the effectiveness of the three andrologic tests as the prognostic indicators for fertilizing ability. Results: The fertilization rate of all men in the poor fertilization group was less than 30%; but there was no evidence that this poor fertilization was due to oocyte defects. The results of three andrologic tests were significatly higher in normal fertilization group. Fertilization rate (%) in vitro was highly correlated (p<0.001) with % normal sperm by SM, ARIC value (%), and SPA result. By using Receiver-Operator-Characteristic curve (ROC), we evaluated the effectiveness of these three tests. The sensitivity and specificity of SM, ARIC test and SPA in predicting fertilization potential in IVF setting were 76% and 75%, 84% and 90%, and 76% and 95%, respectively. Conclusion: Our data suggest that the three andrologic tests can be reliable tools as prognostic factors of sperm fertilizing ability. Among these test, ARIC test and SPA gave more accurate information on fertilizing capacity. ARIC test was shown to have a predictive value for fertilizing ability comparable to that of SPA that appears to be a simple and cost-effective addition to current andrology laboratory. Combined application of these three tests may give more information on predicting sperm fertilizing capacity.
Purpose: We evaluated the prognostic factors of open globe injuries in children and adolescents, and compared the ocular trauma score (OTS) and pediatric penetrating ocular trauma score (POTS). Methods: We performed a retrospective review of 77 children under 18 years of age who visited our clinic with open globe injuries between May 1993 and April 2014. We investigated the factors that may affect final visual acuity. We also compared the OTS and POTS using receiver operating characteristic curves as a method to predict final visual acuity. Results: By univariate analysis, an initial visual acuity less than 20/200, globe rupture, wound size greater than 7.0 mm, retinal detachment, lens dislocation, and total number of operations contributed to worse visual outcomes (<20/200). Conversely, central corneal involvement, traumatic cataract, wound size less than 7.0 mm, and initial visual acuity greater than 20/200 were better prognostic indicators (${\geq}20/32$). Both OTS and POTS had diagnostic value as a predictor of final visual acuity, although there were no statistically significant differences between the two scoring systems. Conclusions: Initial visual acuity and wound size are important prognostic factors for the final visual acuity in children and adolescent, following open globe injuries. Both OTS and POTS are reliable prognostic models for open globe injuries in children and adolescents.
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