Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated neuropathy with heterogeneous features. Appropriate treatment will produce a favorable outcome, but a poor treatment response and severe disability have also been reported. The roles of the clinical phenotypes and electrophysiological features of CIDP as well as of autoantibodies against nodal and paranodal proteins have been highlighted previously due to their association with the treatment response and long-term prognosis. This review addresses the diverse factors associated with the prognosis of CIDP.
Objective: The aim of this retrospective study is to analyze the clinical and pathological factors related to the prognosis of Chinese patients with stage Ib to IIb cervical cancer. Methods and Results: 13 clinical pathological factors in 255 patients with stage Ib to IIb cervical cancer undergoing radical hysterectomy and systematic lymphadenectomy were analyzed to screen for factors related to prognosis. The cumulative 5-year survival of the 255 patients was 75.7%. The result of the univariate analysis suggested that clinical stage, cell differentiation, depth of cervical stromal invasion, parametrial tissue involvement, and lymph node metastasis were prognostic factors for patients with stage Ib to IIb cervical cancer (P<0.05). Compared with cases with involvement of iliac nodes, obturator nodes, or inguinal lymph nodes, cases with metastasis to the common iliac lymph nodes had a poorer prognosis (P<0.05). Cases with involvement of four or more lymph nodes had a poorer prognosis than those with involvement of three or fewer lymph nodes (P<0.05). Using multivariate Cox proportional hazards model regression analysis, non-squamous histological type, poor differentiation, parametrial tissue involvement, and outer 1/3 stromal invasion were found to be independently related to patients poor prognosis (P<0.05). Conclusion: Non-squamous histological type, poor cell differentiation, parametrial tissue involvement, and outer 1/3 stromal invasion are the independent poor prognostic factors for patients with stage Ib to IIb cervical cancer.
Oh, Ji-Woong;Lee, Ji-Yong;Lee, Myeong-Sub;Jung, Hyen-Ho;Whang, Kum;Brain Research Group, Brain Research Group
Journal of Korean Neurosurgical Society
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제52권2호
/
pp.80-84
/
2012
Objective : This study analyzed the relationship between prognosis and multiple clinical factors of ruptured middle cerebral artery (MCA) aneurysm with intracerebral hemorrhage (ICH), to aid in predicting the results of surgical treatment. Methods : Enrolled subjects were 41 patients with ruptured MCA aneurysm with ICH who were treated with surgical clipping. Clinical factors such as gender, age, and initial Glasgow coma scale were assessed while radiological factors such as the volume and location of hematoma, the degree of a midline shift, and aneurysm size were considered retrospectively. Prognosis was evaluated postoperatively by Glasgow outcome scale. Results : Age and prognosis were correlated only in the groups with ICH over 31 mL or ICH at the frontal lobe or sylvian fissure. When initial mental status was good, only patients with ICH on the temporal lobe had a better prognosis. If the midline shift was less than 4.5 mm, the probability of better prognosis was 95.5% (21 of 22). If the midline shift was more than 4.5 mm, the probability of poor prognosis was 42.1% (8 of 19). Patients with ICH less than 31 mL had higher survival rates, whereas if the ICH was more than 31 mL, 41.2% (7 of 17) had a poor clinical pathway. Conclusion : Even if the initial clinical condition of the patient was not promising, by carefully examining and taking into account all factors, neurosurgeons can confidently recommend surgical treatment for these patients.
Purpose: This study aimed to evaluate the clinical features of children who have survived a water submersion incident, and to identify risk factors for prognosis. Methods: We retrospectively reviewed the medical records of patients who experienced submersion between January 2005 and December 2014. The patients were classified into 2 groups, according to complications, and prognostic factors were evaluated. Results: During the study period, 29 children experienced submersion (20 boys and 9 girls; mean age, $83.8{\pm}46.4$ months). Submersion occurred most commonly in the summer, with the peak incidence in August. The most frequent Szpilman clinical score was grade 5 (13 patients; 44.8%), followed by grade 6 (7 patients; 24.1%), and grades 1 or 2 (3 patients; 10.3%). Five children (17.2%) in the poor prognosis group died or had hypoxic ischemic encephalopathy, and the overall mortality rate was 6.9%. Poor prognosis after submersion was associated with lower consciousness levels (P=0.003), higher Szpilman scores (P=0.007), greater need for intubation and mechanical ventilator support (P=0.001), and longer duration of oxygen therapy (P=0.015). Poor prognosis was also associated with lower bicarbonate levels (P=0.038), as well as higher sodium, aspartate transaminase (AST), and alanine transaminase (ALT) levels (P=0.034, P=0.006, and P=0.005, respectively). Szpilman clinical scores were positively correlated with consciousness levels (r=0.489, P=0.002) and serum liver enzyme levels (AST and ALT; r=0.521, P=0.004). Conclusion: We characterized the prognostic factors associated with submersion outcomes, using the Szpilman clinical score, which is comparable to consciousness level for predicting mortality.
Purpose: It is important to consider both clinical factors and epidemiological factors in treating burn patients in emergency rooms. However, many emergency medical staffs happen to miss their chances of treating burns based on these considerations. This study is designed to find a better treatment for burn patients in emergency rooms along this approach. Methods: This study was conducted based on the data of the burn patients visiting the emergency room of a single general hospital from January 2015 to December 2019. The epidemiological and clinical factors were extracted out of the data, then the relationship between the prognosis and these factors were analyzed. Results: Most of burn accidents occurred at home, and were caused by hot water, soup, drinks, oil, etc. Especially, flame burns showed high hospitalization rate, surgical rate and mortality. In addition, their prognosis was poor when the affected area included facial, limb and perineal areas etc., or any inhalation burn co-existed. Also, the hospitalization rate and period increased when the treatment time was delayed or the pre-treatment was taken. There was a strong relationship between prognosis and the period of follow-up when patients were admitted during the period. Conclusion: It is difficult for medical staffs to evaluate prognosis of burns in emergency rooms due to progressive damages. Precise treatment and disposition are essential for patients' good prognosis. Therefore, medical staffs should establish treatment plans by identifying the patient's epidemiological and clinical factors, rather than giving prescriptions based on fragmentary and superficial symptoms.
Objective : Prognostic factors of metastatic brain tumors have been widely reported and their operative indications also have been extended gradually even to the poor grade patients. Authors intended to analyze the causative factors for the clinical outcome of metastatic brain tumors, especially with relevant to the poor prognosis by one year follow-up evaluation. Patients and Methods : The authors retrospectively studied the clinical characteristics of 46 cases(35 patients) with metastatic brain tumors among 466 cases(437 patients) which were operated on due to the brain tumor, during the period between January 1994 to June 1999. Statistical analysis was performed by using SPSS 8.0$^{(R)}$. A p-value of less than 0.05 was considered clinically significant. Result : Among the variable clinical factors in patients with metastatic brain tumors, Karnofsky Performance Scale (KPS) score of less than 70(16 patients), uncontrolled primary tumor(8 patients), and surgical resection without further adjuvant therapy(9 patients) showed statistically significant poor prognosis ; p value of 0.002, 0.032, and 0.001, respectively. Other tested variables, such as old age(greater than 65 years ; 10 patients), gender(male ; 20 patients), type of primary cancer(primary undefined ; 6 patients, lung cancer ; 15 patients), location(infratentorial ; 9 patients, sellar ; 5 patients), number of lesion(multiple ; 12 patients), and number of operation(multiple craniotomy ; 7 patients) were not related to the poor prognosis. Conclusions : The most common primary site of distant metastasis was lung. The poorer prognosis was highly correlated with various factors including low KPS score(<70), no postoperative adjuvant therapy, and uncontrolled primary tumors.
Purpose: We aimed to study the relationship between thrombocytosis and clinical features of gastric cancerfocussing on platelet counts and gastric cancer progression through different TNM stages. Methods: According to the normal range of platelet count in our institution, 1,596 patients were divided to two groups: a thrombocytosis group (120 patients, > $400{\times}1000/{\mu}L$) and a control group (1,476 patients, ${\leq}400{\times}1000/{\mu}L$). Results: The incidence of thrombocytosis was 7.5%. Higher platelet counts were observed in patients with older age, larger tumor size, deeper invasion, lymph node metastasis, distant metastasis and advanced TNM stage. In multivariate logistic regression, tumor size, depth of tumor invasion, lymph node metastasis and TNM stage were independent risk factors for thrombocytosis of gastric cancer patients. On prognostic analysis, age, tumor size, tumor location, histologic type, depth of tumor invasion, lymph node metastasis, distant metastasis and TNM stage and platelet count were important factors. Tumor size, invasion depth, lymph node metastasis, TNM stage and the platelet count were independent prognostic factors. Conclusion: Thrombocytosis is associated with clinical features of gastric cancer patients and correlates with a poor prognosis.
Objectives : Facial Nerve Paralysis is one kind of common diseases and it can be treated by natural therapy and the efficiency of treatment is relatively high. In clinical trial, it is not difficult to find patients who were not completely recovered from Facial Nerve Paralysis, so the symptoms are fixed permanently. This leads many doctors and patients to have interests in the progress and prognosis of the disease, so this study was to analyze clinical prognosis factors and verify the effects of Electrodiagnostic Test. Methods : The 378 subjects were chosen from 987 patients who were suffering from Peripheral Facial Palsy, diagnosed with Bell's palsy and Ramsay Hunt Syndrome and had admission treatment. They got Oriental-Western Medicine Treatment within two weeks after outbreaks of the disease and treated at least over 3 weeks using Oriental-Western Medicine Treatment. Results : 1. There was a significant difference in the results of treatment according to gender, age, types of Facial Palsy, existence of Post Auricular Pain, existence of Labyrinth Symptom, HBGS, and existence of onsets of recovery as clinical prognosis factors of Peripheral Facial Palsy, However, a statistically significant difference was not shown in the results of treatment according to the position of Facial Palsy(left or right), existence of a relapse, and diabetes, hypertension. 2. As a result of overall treatment, 77.2% of patients were recovered almost entirely and 22.8% were not, and the quelae of incomplete recovery were Synkinesis, facial contracture, facial spasm, crocodile tears and scheroma in order of frequency. 3. The results of electrodiagnostic test represented useful correlation to predict the final effects of treatment. Conclusion : Based on the above results, the prognosis factors, the degree of recovery, and the sequelae of incomplete recovery were analysed and the effects of electrodiagnostic test was verified.
Purpose: The purpose of this study was to evaluate the prognostic effect of patient compliance with supportive periodontal treatment (PC-SPT). Chronic periodontitis patients were classified based on their compliance level, and factors affecting PC-SPT and the prognosis of PC-SPT were investigated. Methods: This study selected 206 patients who started SPT after receiving periodontal treatment between 2010 and 2012. Patients who continued SPT through February 2016 were included. The patients were classified according to whether they exhibited complete compliance (100% of visits), excellent compliance (${\geq}70%$ of visits), incomplete compliance (<70% of visits), or non-compliance (only 2 visits). Patient characteristics that could affect PC-SPT, such as age, sex, distance of the clinic from their residence, implantation, and periodontal treatment, were investigated. The number of newly decayed and extracted teeth, alveolar bone level changes around the teeth and implants, and implant removal were examined to evaluate the prognosis of PC-SPT. Results: Sex and the presence of an implant significantly affected PC-SPT. Additionally, the number of newly decayed and extracted teeth and changes in alveolar bone levels around the teeth and implants were significant prognostic factors related to PC-SPT. Conclusions: PC-SPT in chronic periodontitis patients will help maintain periodontal health and prevent further periodontal disease.
Objectives : This study was designed to make beneficial proposal for clinical application on some of the most common disorders treated by Oriental medicine by analyzing treatment process and prognosis. Methods : Number of peculiar attributes pertaining to a specific disorder were analyzed and based on those attributes, patterns associated with process and prognosis were interpreted in reference with classical literatures. Results : 1. Factors which can influence the progression and prognosis include time of onset, intensity of symptoms, course of passage, effects of risk factors, condition of the patient's righteous qi(正氣), accuracy of differential diagnosis made by the practitioner, accuracy of treatment methods, and other unexpected external influences. 2. Correlation between the condition of disorders and treatment progression is closely associated with proper treatment procedures and performances. The time of onset and intensity play critical roles in the treatment process and prognosis and showed pattern tendency with mutual interactions. 3. When there is complication of various disorders, it is ideal to give priority to more urgent illness and take care of moderate illness later. If there isn't any correlation between disorders, treat them in the order of acute to chronic disorders. The approach is reversed when disorders are related, treating in the order of most chronic to most acute. 4. In a case of complication of various disorders, depending on the disorder being acute or chronic, intensity, and accuracy of treatments, either a domino effect or gradual fade out of symptoms were witnessed. 5. The concept of "Five Evils Theory" according to Nan Jing(Difficult Classic) is essential in grasping disease progression due to interrelationships between zangfu organs. Conclusions : Predicting of disease process and prognosis for vast array of disorders treated by Oriental medicine is a very difficult task, yet evaluating the disorder's peculiar properties and influential factors resulted in few principles which can be effectively applied into clinical applications.
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