RESUMEN
From a multivariate analysis of more than 14,200 patient-years' experience with papillary thyroid carcinoma (PTC), we devised a prognostic scoring system based on patient age, tumor grade, extent, and size (AGES). This scoring system can identify patients at increased risk of PTC mortality and was employed as an adjustment variable for analyzing the role of different types of surgical treatment in 860 PTC patients. Cancer mortality at 25 years in patients with an AGES score of 3.99 or less was 1% after ipsilateral lobectomy (n = 131) and 2% after bilateral resection (n = 603), whether subtotal or total (p = 0.15). Of patients with an AGES score of 4 or more, those who underwent lobectomy alone (n = 30) had a mortality rate from PTC at 25 years of 65%, while those undergoing bilateral resection (n = 86) had a lower rate of 35% (p = 0.06). For patients at minimal risk (score of 3.99 or less) of PTC death, no improvement in survival was demonstrable when patients underwent more than ipsilateral lobectomy. However, in a subgroup (score of 4 or more) identified to be at significant risk of PTC death, the survival after bilateral resection was much higher than after ipsilateral lobectomy alone. In neither the "minimal" nor the "higher" risk subgroup was PTC survival significantly improved by the performance of total thyroidectomy.
Asunto(s)
Carcinoma Papilar/cirugía , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Humanos , Pronóstico/métodos , Estudios RetrospectivosRESUMEN
Trinta doentes (28 do sexo masculino), com idade média 55 + ou - 12 anos, com seguimento de 13 a 25 meses (média 20 meses), acometidos de infarto do miocárdio de localizaçäo anterior, anteriormente estudados, foram submetidos a novos ecocardiograma e a reavaliaçäo clínica. Quatro doentes (13,3%) morreram de causa cardíaca (grupo A). Os sobreviventes (83,3%) formaram o grupo B e o foram divididos em sintomáticos (28%-grupo I) e assintomáticos (72%-grupo II). Compararam-se as variáveis ecocardiográficas dos grupos A e B, tendo havido diferenças significativas no que respeita ao índice de Gaasch (IG). A comparaçäo entre os grupos I e II, revelou diferenças estatisticamente significativas em relaçäo ao diâmetro diastólico, à distância E-septo e ao IG. Conclui-se que o IG forneceu a única diferença estatisticamente significativa entre os grupos A e B (p < 0,02), sendo 3,2 um valor discriminativo entre os grupos A e B os grupos I e II (p < 0,001), constituindo uma variável ecocardiográfica com valor prognóstico nos doentes com infarto do miocárdio de localizaçäo anterior, apesar do seguimento ter sido só de 20 meses
Asunto(s)
Humanos , Masculino , Femenino , Infarto del Miocardio , Pronóstico/métodos , Ecocardiografía , Contracción MiocárdicaRESUMEN
The clinical outcome in 74 children at risk for audiologic or neurologic sequelae of a variety of perinatal insults was correlated with brainstem auditory evoked potentials (BAEPs) in the newborn period. No constant relationship was found between BAEP findings and later hearing status in preterm infants or in infants with severe brain damage. However, persistent patterns of wave I abnormality correctly predicted the presence and type of hearing loss in other infants. Central BAEP abnormalities recorded in preterm infants or in infants who had just suffered anoxia had little predictive value. The abnormalities had greater prognostic value when there was a delay between acute injury and testing. Prognostic errors could be minimized in this population by obtaining repeated recordings at least one month post term and after injury from infants who showed BAEP abnormalities in the neonatal period.
Asunto(s)
Tronco Encefálico/fisiopatología , Potenciales Evocados Auditivos , Enfermedades del Sistema Nervioso/diagnóstico , Humanos , Recién Nacido , Enfermedades del Sistema Nervioso/fisiopatología , Pronóstico/métodos , Tiempo de ReacciónRESUMEN
The literature on electrophysiological techniques used so far for the prognostication of idiopathic facial palsies contains reports on 31 patients with idiopathic facial palsy, in whom - after electric stimulation of the nervus facialis at the point where it exits from the foramen stylomastoideum - the amplitude of the compound muscle action potential of the M. orbicularis oris was measured. The extent of the SPA's decline was related to the progress of the disease. In those cases where the SPA declined by at least 75-100 per cent, the palsy regressed either in an unsatisfactory manner or not at all. However, where the decline amounted to at most 67 per cent a restitutio ad integrum took place or residual symptoms which do not disturb the patients were found. The prognosis can be made between the 5th and 10th day after the palsy has developed. If in cases of idiopathic palsy the diagnosis is made at an early date, this method is more reliable than any other technique.