Prognostic factors and a scoring system for patients with skeletal metastasis

Between 1992 and 1999, we treated 350 patients with skeletal metastases. A multivariable analysis of the patients was conducted using the Cox proportional hazards model. We identified five significant prognostic factors for survival, namely, the site of the primary lesion, the performance status (Eastern Cooperative Oncology Group status 3 or 4), the presence of visceral or cerebral metastases, any previous chemotherapy, and multiple skeletal metastases. The score for each significant factor was derived from the corresponding estimated regression coefficients (natural logarithm of the hazard ratio). The prognostic score was calculated by adding all the scores for individual factors. The rate of survival was 31% at six months and 11% at one year for the patients with a prognostic score of 6 or more. By contrast, patients with a prognostic score of 2 or less had a rate of survival of 98% at six months and 89% at one year. This scoring system can be used to determine the optimal treatment for patients with pathological fractures or epidural compression.     

五个不同预后评估系统预测进展肝癌生存率研究

目的：探讨CLIP、NCCN、JIS、TOKYO、MELD 5个预后评估系统对晚期肝细胞肝癌患者3月生存率、6月生存率和总生存率的预测价值。 方法：回顾性研究2008年9月至2010年5月253例进展期肝癌患者,使用CLIP、NCCN、JIS、TOKYO、MELD 5个不同的预后评估系统对进展期肝癌患者初次诊断时进行评分,并进行随访。应用接受者工作特征（ROC）曲线分析每个预后评估系统,评价各个预后评估系统对3月生存率、6月生存率预测的特异度及灵敏度的预测价值。应用Kaplan-Meier生存曲线和Log-rank检验比较各个预后评估系统的晚期肝癌总生存率,应用似然比检验（LRT）评价各个预后评估系统对晚期肝癌总生存率的预测价值。 结果：在预测3月生存率时,CLIP、JIS及TOKYO评分系统对于3月生存率的预后价值相似。CLIP的A值与MELD、TNM对比差异有显著的统计学意义（均P 〈 0.05）。在预测6月生存率时CLIP、JIS及Tokyo评分系统对于6月生存率的预后价值相似。CLIP的A值与JIS、TOKYO、TNM、MELD比较差异有显著的统计学意义（均P 〈 0.05）。LRT检验发现CLIP的预测总生存率能力最好。 结论：CLIP对晚期肝癌3月生存率、6月生存率及总生存率预测的能力最好。     

Prognostic scoring in patients with melanoma after adjuvant isolated limb perfusion

BACKGROUND: The clinical course in melanoma is variable. The aim of the present study was to assess adjuvant isolated limb perfusion (ILP) efficacy using a surrogate comparison of observed survival versus Cochran-predicted survival. MATERIALS AND METHODS: All patients in a single university hospital with primary, non-ulcerated limb melanoma who had undergone adjuvant ILP over 10 years (1986-1995) were studied. Clinical and pathological details including follow-up and survival were prospectively recorded in a national database. All patients were risk scored, as described by Cochran et al., to yield individual survival probability at the end of 3, 5 and 10 years and this was compared with observed survival at corresponding intervals. RESULTS: There were 85 patients who had adjuvant ILP for primary non-ulcerated limb melanoma. Of these, 14 deaths were observed (O) within the 10-year follow-up period. The Cochran score predicted (E) 20 deaths within 10 years (O/E ratio 0.7). The O/E ratios for deaths in the 0 to 3, 3 to 5, and 5 to 10 year intervals were 8/7.4, 5/6.0, and 1/6.5, respectively; prediction of late deaths tended to be overestimated. When patients were grouped by predicted 10-year mortality (<20%, 20-40%, >40%) the overestimation was found to occur mainly in the highest risk group: O/E ratios were 6/5.9, 6/8.4, and 2/5.6, respectively (P = 0.10, Hosmer-Lemeshow test). CONCLUSION: The observed and expected survival in patients receiving adjuvant ILP at the end of 3 and 5 years are comparable. The Cochran scoring system overestimated deaths during the 5 to 10 year interval. It is not clear whether this observation is a consequence of ILP efficacy or inaccuracy of the Cochran score.     

Anal endosonography is useful for postoperative assessment of anorectal malformations

Aim

This study aimed to develop and evaluate a scoring system for anal endosonography to assess anal canal structures after repair of anorectal malformations (ARM).

Methods

Forty patients with ARM aged 16 years (range, 1-22 years) and 20 controls aged 17 years (range, 0.5-20 years) were examined. Anal function was assessed clinically and by anal canal manometry. The anal canal structures were imaged by anal endosonography using a 7.5-MHz transducer. A scoring system was developed to assess the anal sphincters as visualized on the endosonographic images.

Results

Continence was significantly correlated to anal canal pressures. The estimated extent of muscle defect (measured in quadrants) and the number of disruptions in the internal and external anal sphincters correlated significantly to the rest and squeeze pressures, respectively. Thus, patients (>4 years) with squeeze pressure of less than 80 cm H₂O were characterized by more than 1 disruption in the external anal sphincter ring and 2 or more quadrants with scar tissue.

Conclusion

The extent of scar tissue and the number of disruptions in the anal sphincters correlate with anal canal pressures and continence after ARM repair. Anal endosonography may be used to study the results after different surgical techniques and for prognosis on continence in patients with ARM.     

Prognostic value of histopathological scoring and grading in patients with renal AA amyloidosis

International Urology and Nephrology - The amount and distribution pattern of amyloid deposits may contribute to renal function and outcome, given the great diversity of renal involvement in...     

Subjective global assessment is a useful method to detect malnutrition in renal transplant patients

Adequate nutrition is essential for the well-being of renal transplant patients. While body weight gain is a common widely investigated finding, a considerable fraction of patients exhibit poor nutritional status after successful kidney transplantation. In the present study, the prevalence association with nutritional parameters and clinical data of malnutrition among kidney transplant patients were determined based upon a subjective global assessment. This cross-sectional study in the transplant outpatient clinic included 47 patients (10 women, 37 men) of mean age 37.6 +/- 10.2 years. The same dietitian performed the assessment on all patients, including anthropometric measurements of body mass index (BMI), mid-arm circumference, and triceps skinfold thickness. The patient data including medications, number of hospitalizations in the preceding year, and presence of chronic allograft failure were collected from medical records. The mean laboratory values during the last 6 months included hemoglobin, creatinine, albumin, phosphorus, C-reactive protein levels, and lipid profile. The patients were classified into 3 groups defined as A (n = 31, 66%), B (n = 11, 23.4%), and C (n = 5, 10.6%), namely, A, no malnutrition versus B/C, moderate or severe malnutrition. Comparison of the 2 groups revealed the serum albumin (P < .0001), body mass index (P = .02), and mid-arm circumference (P = .02) to be higher in group A than groups B/C. Group B/C patients showed higher levels of C-reactive protein (P < .0001). When compared to the pretransplantation period, the 31 patients in group A included 26 who had increased body mass index after transplantation versus only 3 of 16 patients in groups B/C had (P < .0001). The hospitalization rates were significantly lower in group A (P = .02). Additionally, the patients in group A tended to have a lower frequency of chronic allograft rejection when compared to group B/C subjects (P = .13). In conclusion, assessment of nutritional status of renal transplant patients combined with intervention in the nutritional intake may decrease the morbidity rates in this patient group.     

Emergency endovascular stent grafting for thoracic aortic pathology

Our aim was to report single-center results of emergency endovascular treatment for thoracic aortic disease. From March 1998 to January 2006, 30 acute thoracic EVAR procedures were carried out in 29 patients. One patient received two procedures in different settings. Four patients died before treatment could be initiated. The pathology of aortic lesions included atherosclerotic aneurysm (n = 13), pseudoaneurysm (n = 6), aortic rupture (n = 5), type B dissection (n = 5), aortobronchial or aortoesophageal fistula (n = 4), and intramural hematoma (n = 1). The surgical mortality rate was 21%. Three patients died as a result of technical complications, and three patients died after technically successful procedures. The mean follow-up was 31 +/- 23 months. The late mortality rate was 40% (8 of 20). Four patients died of causes unrelated to the procedure; two patients died at home without autopsy. Two patients died as a consequence of graft infections. Three late nonfatal complications occurred. Two of these resulted in additional treatment: one patient developed a mycotic aneurysm that was treated with additional stent grafting, and one patient developed a type 3 endoleak after 6 years of follow-up and was successfully treated with a bridging stent graft. Endovascular treatment for acute thoracic disease is feasible and associated with a reasonable outcome. In selected cases, it may be considered as a first option.     

Validity of the orthopedic POSSUM scoring system for the assessment of postoperative mortality in patients with pressure ulcers

In the treatment of pressure ulcers, assessment of systemic problems is an important yet difficult step in selecting either conservative or surgical therapeutic intervention. The surgical auditing system called the Physiological and Operative Severity Score for enUmeration of Mortality and Morbidity (POSSUM) and its orthopedic version (O-POSSUM), which gives a predictive mortality rate for the first 30 postoperative days, may be useful for assessing systemic status, but have yet to be sufficiently validated for patients with pressure ulcers. To assess the validity of POSSUM and O-POSSUM, 71 procedures on 50 cases were retrospectively statistically analyzed using receiver operating characteristic curves and goodness-of-fitness testing with the Hosmer–Lemeshow χ² test for logistic regression modeling. POSSUM and O-POSSUM showed satisfactory discriminatory power in receiver operating curve analysis. The validity of the values obtained by POSSUM and O-POSSUM was also confirmed. O-POSSUM was superior to POSSUM in both analyses. O-POSSUM is useful in assessing the systemic status of patients with pressure ulcers. Some patients with pressure ulcers show extreme systemic conditions. Assessment of systemic status with O-POSSUM contributes to daily clinical practice and future studies of treatments for pressure ulcers.     

Antiemetic effect of osetron used during endovascular operations in patients with vascular pathology of brain

The data concerning Osetron application for prevention and elimination of emesis and vomiting in postoperative period in patients with an acute disorder of the brain blood circulation according to hemorrhagic, ischemic and mixed types were presented.     

Objective and useful mobility assessment of patients with arthropathy of the hip and knee

Walking ability was objectively assessed by measurements of endurance, oxygen consumption, and pulse rate response. Twenty-four control subjects and 38 patients with arthropathy of the hip or knee were asked to walk on a treadmill, initially at 1 km/hour, for four minutes. The speed was increased by 1 km/hour every four minutes, until the subjects has walked for four minutes at 7 km/hour, or until they could not continue. Oxygen consumption, heart rate, cadence, and step length were measured. The controls could all walk for 1400 m, reaching a walking speed of 6 km/hour, and showed a consistent relation between heart rate, oxygen consumption, and speed of walking. The majority of arthritic patients failed to reach either this distance or speed. They had a significantly increased metabolic cost, and there was a good correlation (r = 0.65 to 0.99) between the changes in pulse rate and oxygen consumption in each individual patient. The endurance, heart rate response, and oxygen consumption changes shown by patients proved to be reproducible characteristics in patients whose disease was static.     

骨关节炎中滑膜炎组织病理学评估

多因素导致、以关节软骨退变为特征的骨关节炎病变不仅局限于关节软骨,还累及滑膜和软骨下骨等结构.越来越多临床关节镜检查中发现无症状的滑膜炎,滑膜炎症在骨关节炎病程中的作用开始受到重视,滑膜炎症组织病理学评估也成为判断骨关节炎严重程度的参考指标.目前多采用滑膜厚度、间质细胞激活和炎症细胞浸润这3个指标来评估滑膜炎症程度,以...     

Prognostic scoring system for peripheral nerve repair in the upper extremity

So far, predictive models with individualized estimates of prognosis for patients with peripheral nerve injuries are lacking. Our group has previously shown the prognostic value of a standardized scoring system by examining the functional outcome after acute, sharp complete laceration and repair of median and/or ulnar nerves at various levels in the forearm. In the present study, we further explore the potential mathematical model in order to devise an effective prognostic scoring system. We retrospectively collected medical record data of 73 cases with a peripheral nerve injury in the upper extremity in order to estimate which patients would return to work, and what time was necessary to return to the pre‐injury work. Postoperative assessment followed the protocol described by Rosén and Lundborg. We found that return to pre‐injury work can be predicted with high sensitivity (100%) and specificity (95%) using the total numerical score of the Rosén and Lundborg protocol at the third follow‐up interval (TS3) as well as the difference between the TS3 and the total score at second follow‐up interval (TS2). In addition, the factors age and type of injured nerve (median, ulnar, or combined) can determine the time of return to work based on a mathematical model. This prognostic protocol can be a useful tool to provide information about the functional and social prospects of the patients with these types of injuries. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013.     

Arteriogram scoring systems and Pulse Generated Run-off in the assessment of patients with critical ischaemia for femorodistal bypass

Conventional arteriography is the investigation of choice in patients with critical ischaemia to select the site for the distal anastomosis of a femorodistal bypass. Several arteriographic scoring systems have been devised in an attempt to quantify the run-off. More recently Pulse Generated Run-off and intraoperative peripheral resistance measurements have been proposed as better predictors of early graft patency. Eighty-eight consecutive femorodistal bypass grafts were studied using Pulse Generated Run-off (PGR), conventional and intra-arterial digital subtraction arteriography (DSA) and peripheral resistance measurement. Three widely used arteriographic scoring systems were used to grade the arteriographic run-off. There were significant correlations between the scoring systems and the measured peripheral resistance, although PGR correlated better with peripheral resistance than arteriography (rs = -0.59, P less than 0.001). Intra-arterial DSA improved the correlation between the arteriogram scoring systems and the measured peripheral resistance in the distal popliteal artery, but not in single calf vessels. In contrast, PGR correlated much better with peripheral resistance in single calf vessels (rs = -0.82, P less than 0.001). We recommend that selection for femorodistal reconstruction be based on a combination of intra-arterial DSA and PGR. PGR will identify patent distal calf vessels not seen on arteriography and determine their continuity with the pedal arch, two features which are essential prerequisites for successful femorodistal bypass.