Prognostic Evaluation Of Patients Research Articles

Prognostic evaluation in patients after CPR of cardiac cause by therapeutic hypothermia in coronary care unit of a Hospital University Cruces

Purpose of study: Analyze prognosis and characteristics of patients who have suffered from a cardio-respiratory failure out of hospital undergoing therapeutic hypothermia. Material and methods: Retrospective transverse study of 49 patients admitted from 2011 with CPR diagnosis subject to hypothermia fulfilling inclusion criteria. Results: 38 men (77.55%) and 11 women (22.45%) were studied. The average person was 60.63 years old (11.78). 17 people were under 53 years (×34.69), 15 between 53–65 (×30.61), and 17 older than 65 (×34.69). The admission time of 50% was 13 days (×15,136). Time from the beginning of the CPR to the monitoring of 50% was 10min (×11,666). Time between monitoring beginning until hypothermia beginning in 50% was 20min (×20,174). 14 People died (28.57%) and 35 survived (71.43%). Conclusions: Hypothermia is an option that should be considered in the context of a protocol for comprehensive care to this kind of patients that ranges from the first outpatient care to the overheating phase.

The intratumoural subsite and relation of CD8+ and FOXP3+ T lymphocytes in colorectal cancer provide important prognostic clues

Background:To find improved tools for prognostic evaluation in patients with colorectal cancer (CRC), we have analysed how infiltration of cytotoxic T lymphocytes (CD8+) and regulatory T lymphocytes (FoxP3+) correlates to prognosis, not only according to quantity and relation, but also to subsite within tumours of different molecular characteristics (microsatellite instability and CpG island methylator phenotype status).Methods:CD8 and FOXP3 expression was evaluated by immunohistochemistry in 426 archival tumour tissue samples from patients surgically resected for CRC. The average infiltration of CD8+ and FOXP3+ cells was assessed along the tumour invasive front, in the tumour centre and within the tumour epithelium (intraepithelial).Results:We found that infiltration of CD8+ T lymphocytes within the tumour epithelium provided the strongest prognostic information (P<0.001). At the tumour invasive front and tumour centre, FOXP3 expression withheld the strongest association to prognosis (P<0.001), suggesting FOXP3+ T-lymphocyte infiltration to be a better prognostic tool than CD8+ T lymphocytes at these intratumoural subsites. We further analysed the possible prognostic impact of the relation between these T-cell subsets, finding that a high intraepithelial CD8 expression was associated with a better patient outcome, independent of FOXP3 infiltration. In groups of low intraepithelial CD8 expression, however, a high infiltration rate of FOXP3+ cells at the tumour invasive front, significantly improved prognosis.Conclusions:Analyses of intraepithelial infiltration of CD8+ T lymphocytes, infiltration of FOXP3+ T lymphocytes at the tumour front or centre, and the relation between these subsets, may be a valuable tool for predicting prognosis in colon cancer.

A new prognostic evaluation of patients with acute ST-elevation myocardial infarction undergoing primary angioplasty: combined Zwolle and Syntax score

The Zwolle score (Zs) is a validated risk score used to identify low-risk patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Syntax score (Ss) is an angiographic score that evaluates the complexity of coronary artery disease. We aimed to create a simple risk score by combining these two scores for risk stratification in patients with STEMI undergoing primary PCI. 299 consecutive STEMI patients (mean age 57.4 ± 11.7 years, 240 men) who underwent primary PCI were prospectively enrolled into the present study. The study population was divided into tertiles based on admission Zs and Ss. A high Zs (> 3) and high Ss (> 24) were defined as values in the third tertiles. A low Zs and low Ss were defined as values in the lower two tertiles. Patients were then classified into four groups: high Zs and high Ss (HZsHSs, n = 26), high Zs and low Ss (HZsLSs, n = 29), low Zs and high Ss (LZsHSs, n = 48), and low Zs and low Ss (LZsLSs, n = 196). In-hospital cardiacoutcomes were then recorded. In-hospital cardiovascular mortality was higher in HZsHSs (50%) compared to the HZsLSs (27.5%), LZsHSs (0%), and LZsLSs (0.5%) groups. After adjustment for potentially confounding factors, HZsHSs (OR 77.6, 95% CI 6.69-113.1, p = 0.001), and HZsLSs (OR 28.9, 95% CI 2.77-56.2, p = 0.005) status, but not LZsHSs and LZsLSs status, remained independent predictors of in-hospital cardiovascular mortality. STEMI patients with HZsHSs represent the highest risk population for in-hospital cardiovascular mortality.

Molecular genetic methods in the diagnosis of myelodysplastic syndromes. A review

Myelodysplastic syndromes (MDS) represent a heterogeneous group of premalignant hematologic disorders characterized by ineffective hematopoiesis, peripheral blood cytopenias and increased risk of progression to acute leukemia. Cytogenetic analysis still plays a central role in the diagnosis of MDS, as clonal chromosomal abnormalities are observed in 30-50% of MDS patients. Despite their technical limitations, standard karyotyping and fluorescence in situ hybridization (FISH) are routinely used for identifying recurrent chromosomal rearrangements. However, using this approach means that submicroscopic and not targeted chromosomal aberrations, as well as somatic mutations and epigenetic changes remain largely undetected. Introduction of methods for the analysis of copy-number variations (CNV), including array-based technologies and Multiplex ligation-dependent probe amplification (MLPA) has provided novel insights into the molecular pathogenesis of MDS and considerably extended possibilities for genetic laboratory testing. Several novel molecular markers have been discovered and used for diagnosis and prognostic evaluation of patients with MDS. At present, mutational analysis is not routinely performed, as the clinical significance of somatic mutations in MDS has only begun to emerge. However, recently introduced Next-generation sequencing (NGS) technologies could help to elucidate the relationship between chromosomal and molecular aberrations in MDS and lead to further improvement in its diagnosis. This review focuses on the advantages, limitations, clinical applications and future perspectives of three molecular methods (array-based analysis, MLPA and NGS) currently used in genetic testing and/ or translational research of MDS. In conclusion, a brief summary for clinicians from the routine diagnostic point of view is given.

A New Prognostic Evaluation of Patients with Acute ST-Elevation Myocardial Infarction Undergoing Primary Angioplasty: Combined Zwolle and Syntax Score

PP-392 The Zwolle score (Zs) is a validated risk score that has been used to identify low-risk patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). The Syntax score (Ss) is an angiographic score that evaluates the complexity of

Disability, quality of life and well-being in patients undergoing brain surgery

Disability, quality of life and well-being in patients undergoing brain surgery

Prognostic evaluation of patients with pulmonary hypertension by combined non-invasive assessment of pulmonary vascular resistance and right ventricular function

Purpose: Several clinical parameters (exercise tolerance, episode of syncope, pericardial effusion, plasma BNP/NT-pro-BNP, right atrial pressure, cardiac index, tricuspid annular plane systolic excursion [TAPSE] in echocardiography) are known to predict prognosis of pulmonary hypertension (PH). However, a simple and useful method of risk stratification in PH patients is lacking. Here we examined whether combined assessment of pulmonary vascular resistance (PVR) and right ventricular (RV) function by echocardiography is useful for stratifying risks in PH patients. Methods: Consecutive 47 subjects with PH (idiopathic; n=11, connective tissue diseases; n=7, lung diseases; n=12, chronic thromboembolic; n=10, and others, age 57±20, 53% females) who underwent echocardiography were enrolled. PVR was estimated by the ratio of tricuspid regurgitation pressure gradient to the time–velocity integral of the right ventricular outflow tract (TRPG/VTI) and TAPSE was determined as an index of RV function. Cardiac event was defined as cardiac death or hospitalization due for progressive heart failure. Results: During a follow-up period (15.5±10.1 months), 6 patients died due to cardiac causes and 10 patients were hospitalized due to progressive right heart failure. Receiver operating characteristic analysis indicated that optimal cutoff values to predict of cardiac events were 3.24 for TRPG/VTI and 16 for TAPSE. Using the two cutoff values, patients were divided into 4 groups; group with TRPG/VTI ≤3.24 and TAPSE ≥16 (group 1, n=17), group with TRPG/VTI >3.24 and TAPSE ≥16 (group 2, n=12), group with TRPG/VTI ≤3.24 and TAPSE 3.24 and TAPSE <16 (group 4, n=13). Cox's proportional hazards model showed that group 4 (hazard ratio [HR] =38.7, 95% CI 4.2-358.0, p=0.001) and group 2 (HR = 9.8, 95% CI 1.0-93.6, p=0.047) had significantly higher incidences of cardiac events than in group 1. HR in group 3 was higher (HR= 4.6, 95% CI 0.3-83.8) than in group 1, though their difference was not statistically significant presumably because the number of patients in group 3 was small. Conclusions: The combined assessment of TRPG/VTI and TAPSE by non-invasive methods is useful for accurately identifying PH patients at great risk for death or progressive right heart failure. The present results confirm that increased PVR and progressive RV dysfunction underlie poor outcome in PH.

High expression of LC3B is associated with progression and poor outcome in triple-negative breast cancer

Microtubule-associated protein 1 light chain 3B (LC3B) was involved in autophagosome formation and had been as a marker of autophagy which played an important role in the development of breast cancer. The purpose of this study was to explore the level of LC3B expression in four stages of triple-negative breast cancer (TNBC) and to evaluate the prognostic significance of LC3B expression in TNBC. The ultimate aim was to identify the new factor that could be useful in predicting clinical behavior of TNBC. We evaluated the expression level of LC3B protein in four kinds of TNBC tissue samples, including intraductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC) without metastases, IDC with lymph node metastases (LNM), and IDC with distant metastases (DM). Hundred and four primary TNBC patients were involved in present study, and the expression level of LC3B protein was assessed by immunohistochemistry. Medical records of these patients were reviewed, and the clinicopathological analysis was performed. High expression of LC3B was observed in 7.7 % of DCIS (1 of 13 cases), 16.2 % of IDC (6 of 37 cases), 35.7 % of LNM (15 of 42 cases), and 58.3 % of DM (7 of 12 cases). LC3B high expression was significantly associated with tumor size (P = 0.028), lymph node metastasis (P = 0.002), and Ki-67 expression (P = 0.047). LC3B high expression patients showed poorer DFS and OS rates compared with LC3B low expression patients (P = 0.024, and P = 0.047, respectively). Multivariate analyses confirmed that high LC3B expression was an independent and significant factor for predicting the poor outcome of TNBC patients. These preliminary results demonstrated that high LC3B expression was associated with lymph node and distant metastasis. Furthermore, high LC3B protein expression was correlated with shorter survival in patients with triple-negative breast carcinoma. These findings provided preliminary evidence for the function of LC3B on the progression of TNBC and suggested LC3B was a useful marker in prognostic evaluation for patients with TNBC.

Prognostic evaluation of patients with acute left ventricular failure by Brain natriuretic peptide and ECG monitoring

Objective To analyze the acute left heart failure(ALHF) plasma brain natriuretic peptide levels and ECG characteristics,and to explore its evaluation of the ALHF prognosis.Methods To detect the content of rain natriuretic peptid in the plasma of acute attack of 76 cases ALHF patients after 6h,24h,72h,while the line ECG monitoring.The decline rate of brain natriuretic peptide,the QRS wave duration and QTc interval were calculated.According to the condition of ALHF patients discharged into prognosis ideal group and the poor prognosis group,the variation of the index in the two group were retrospectivly analyzed.Results Compared with the decline rate in 24h,the decline rate of brain natriuretic peptide,the QRS wave duration and QTc interval decreased significantly.Two groups at each time point plasma brain natriuretic peptide,the QRS wave duration,the rate of decline of QTc between groups were statistically different (all P ＜ 0.05).Conclusion The time points of plasma brain natriuretic peptide content,the QRS wave duration and the QTc interval change rate of ALHF the prognosis of patients with chnical predictive value. Key words: Heart failure, congestive ; Brain natriuretic peptide; ECG

Significance of the Absolute Number and Ratio of Metastatic Lymph Nodes in Predicting Postoperative Survival for the International Federation of Gynecology and Obstetrics Stage IA2 to IIA Cervical Cancer

This study aimed to evaluate the ratio of metastatic and removed lymph nodes (RPL) and the number of metastatic lymph nodes (MLNs) in predicting postoperative survival for International Federation of Gynecology and Obstetrics stage IA2 to IIA cervical cancer after radical hysterectomy and pelvic lymphadenectomy (RHPL). A retrospective study was conducted in which 120 patients with lymph node metastasis who underwent RHPL for cervical cancer from 2000 to 2006 was analyzed to identify the prognostic indicators by using Kaplan-Meier and Cox proportional hazard methods. Of 588 patients with cervical cancer who underwent RHPL, the 5-year survival rate (YSR) of 120 with lymph node metastasis was much lower than that of 468 without lymph node metastasis (22.4% vs 84.4%, P < 0.001). By cut-point survival analysis, RPL cutoff was designed as 10%, with the 5-YSR of 42.9% and 11.8%, and MLN count cutoffs were designed as 1 and 5, with the 5-YSR of 62.5%, 20.8%, and 7.8%, respectively. With univariate analysis, increasing RPL and MLN counts were associated with a poorer survival in women with node metastasis cervical cancers. Stage, histologic grade, RPL, and MLN count were significant independent prognostic factors for survival in a multivariate Cox proportional hazard model. In addition, RPL was verified superior to MLN count in prognostic evaluation for patients with IA2 to IIA cervical cancer after RHPL because the hazard ratio of RPL (3.195) was higher than that of MLN count (1.578). The RPL and MLN count may be used as the independent prognostic parameters in patients with cervical cancer with lymph node metastasis after RHPL. Comparison of the superiority of RPL and MLN count for better predicting the survival of patients with cervical cancer deserves to be investigated further.

Systolic Volume Index by Doppler Echocardiography Is an Useful Marker for Stratification and Prognostic Evaluation in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction

Introduction and objectivesThe prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow. MethodsWe performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35mL/m2 and the presence of a mean aortic gradient greater or lower than 40mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality. ResultsIndependent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval: 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P=.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9). ConclusionsPatients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis.

Linear quantification of lymphoid infiltration of the tumor margin: a reproducible method, developed with colorectal cancer tissues, for assessing a highly variable prognostic factor

BackgroundLymphoid infiltration is a prognostic marker in solid tumors, such as colorectal, breast and lung carcinomas. However, lymphoid infiltration is heterogeneous and the reproducibility of quantification based on single counts within a tumor is very low. We aimed to develop a reproducible method for evaluating lymphoid infiltration in tumors.MethodsVirtual slides were obtained from tissue sections from the localized colorectal carcinomas of 117 patients, stained for CD3 and CD45R0. We assessed the variation of lymphoid cell density by automatic counts in 1 mm-wide, 5 μm-long segments of the invasive front, along an axis 4 mm in length running perpendicular to the invasive front of the tumor.ResultsWe plotted curves of the variation of lymphocyte density across the tumor front. Three distinct patterns emerged from this linear quantification of lymphocyte (LQLI). In pattern 1, there was a high density of lymphocytes within the tumor. In pattern 2, lymphocyte density peaked close to the invasive margin. In pattern 3, lymphocytes were diffusely distributed, at low density. It was possible to classify all the tumors studied, and interobserver reproducibility was excellent (kappa =0.9). By contrast, single counts of CD3+ cells on tissue microarrays were highly variable for a given LQLI pattern, confirming the heterogeneity of lymphoid infiltration within individual tumors. In univariate analysis, all pathologic features (stage, metastatic lymph node ratio (LNR), vascular embolism, perineural invasion), CD3+ cell density, LQLI patterns for CD3+ and CD45R0+ cells) were found to have a significant effect on disease-free survival (DFS). In multivariate analysis, only the LQLI pattern for CD3+ cells (HR: 6.02; 95% CI: 2.74-13.18) and metastatic lymph node ratio (HR: 6.14; 95% CI: 2.32-16.2) were associated with DFS.ConclusionLQLI is an automated, reproducible method for the assessment of lymphoid infiltration. However, validation of its prognostic value in larger series is required before its introduction into routine practice for prognostic evaluation in patients with colorectal carcinomas.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/9861460717895880

Biomarkers in Traumatic Brain Injury

Traumatic brain injury (TBI) is a common cause of neurological morbidity globally, and neurologic sequelae may occur even in the setting of mild injury. At present, the tools that guide diagnostic and prognostic evaluation of patients who suffer from TBI remain limited, especially for prehospital evaluation. Biomarkers of brain injury hold promise in facilitating early management and triage decisions in the civilian and military settings. The identification of biomarkers of brain injury may also be helpful in guiding end-of-life decision making and may facilitate the design of neuroprotective trials.

Biomarkers in patients with acute dyspnoea: what for?

This editorial refers to ‘Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea’, by R.V. Shah et al. , doi:10.1093/eurheartj/ehs136 When patients present with acute dyspnoea, clinicians are faced with relevant issues. Particularly, making the right diagnosis and choosing the best therapies in a timely manner are crucial. To assess the latter, it may help to know the patient's risk, both short and long term, but the direct clinical benefit is less certain. History, physical examination, lab testing, and imaging techniques are cornerstones in order to come to the right conclusions, but they leave important open questions. Biomarkers circulating in the blood are attractive tools to improve care since they represent underlying pathophysiological processes and are relatively easy to measure. However, the question remains of what is their actual role in the clinical setting of acute dyspnoea ( Figure 1 ). Figure 1 Potential clinical usefulness of biomarkers (right-hand side) in the process of heart failure (left-hand side) with respect to diagnosis (green arrows), prognostic assessment (blue arrows), and therapy guidance (yellow arrows). The arrows point to the situation when biomarkers are applicable or of potential benefit. Level of evidence and clinical usefulness: ++, documented in large prospective trials, established, and useful; +, some data, probably useful; ††, well documented, but of unknown clinical benefit; †, less well established, unknown clinical benefit; 0, potential clinical benefit, but little or no data available; aStudy by Shah et al. ;13 brenal markers = serum creatinine, urea, uric acid, and to some extent cystatin C, newer renal markers such as KIM-1, or NGAL which are less well established; ca large number of other biomarkers have been shown to be related to poor outcome,11 of which (hs-)cTnT, haemoglobin, and creatinine are among …

Mid-regional pro-atrial natriuretic peptide and pro-adrenomedullin testing for the diagnostic and prognostic evaluation of patients with acute dyspnoea

The aim of this study was to assess diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP) and adrenomedullin (MR-proADM) for the evaluation of patients presenting to the emergency department with acute dyspnoea. A total of 560 patients from the pro-B type natriuretic peptide Investigation of Dyspnoea in the Emergency Department were evaluated; 180 had acutely decompensated heart failure (ADHF). Concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), MR-proADM, and MR-proANP were measured, and patients were followed to 4 years for survival. Logistic regression evaluated utility of MR-proANP in ADHF diagnosis. Area under the curve (AUC), multivariate Cox regression, net reclassification improvement, and Kaplan-Meier survival analyses were used for mortality analyses. Mid-regional pro-atrial natriuretic peptide was higher in patients with ADHF (median 329 vs. 58 pmol/L; P < 0.001), and remained an independent predictor of HF diagnosis even when NT-proBNP was included as a covariate (odds ratio = 4.34, 95% CI = 2.11-8.92; P < 0.001). In time-dependent analyses, MR-proADM had the highest AUC for death during the first year; after 1 year, MR-proANP and NT-proBNP had a higher AUC. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan-Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy. Among patients with acute dyspnoea, MR-proANP is accurate for diagnosis of ADHF, while both MR-proANP and MR-proADM are independently prognostic to 4 years of the follow-up.

Radionuclide Imaging in Stage B Heart Failure

This article discusses currently available radionuclide techniques in the diagnostic and prognostic evaluation of patients with chronic heart failure, with a focus on stage B/asymptomatic left ventricular dysfunction. Radionuclide imaging is promising for such patients because it can simultaneously determine left ventricular function, evaluate for the presence of obstructive coronary disease, determine the extent of viable myocardium, and evaluate dyssynchronous left ventricular contraction. Radionuclide imaging can thus provide important noninvasive insights into the pathophysiology, prognosis, and management of patients with asymptomatic left ventricular dysfunction as well as more advanced heat failure.

Clinical significance of myosin in colorectal cancer

Myosin has raised an interest in cancer research because of its role in tumor progression. The aim of this study was to investigate the expression and clinical relevance of myosin in colorectal cancer (CC). Myosin was detected in CC tumors with recurrence using matrix-assisted laser desorption/ionization time-of-flight analysis. An immunohistochemical study was performed using tissue arrays and specific antibodies against myosin heavy chain. Determinations on cancer specimens from 91 patients with resectable CCs were performed. The minimum follow-up period was of 12.5 years for these patients without tumor recurrence. Western blot and real-time polymerase chain reaction analysis were also performed. Samples of carcinomas with recurrence showed an increased expression of myosin. Tumors with high myosin expression by tumor cell were significantly associated with higher probability of metastasis. Our results suggest that myosin expression in CCs is associated with tumor progression and metastasis development. Therefore, myosin tumor expression may contribute to an improved prognostic evaluation in patients with CC.

C-Erb-b2 Oncogene Expression in Intraductal Proliferative Lesions of the Breast

The ductal intraepithelial neoplasia (DIN) classification which proposes new approaches to the diagnosis, terminology and differential diagnosis of intraductal proliferative lesions of the breast was applied to a series of female patients comprising C-erbB2 oncogene expression which may serve as an adjunct to the morphology by immunohistochemistry. The study was performed using the data of 94 patients. There was no difficulty encountered in the diagnosis of intraductal hyperplasia (IDH). In patients with Atypical Ductal Hyperplasia (AIDH), the diagnosis could be made by using the 2-mm rule of the DIN classification in patients who exhibited cytologic and structural characteristics of Ductal Carcinoma in Situ (DCIS) alone or in conjunction with classical IDH patterns. However, in lesions that mimicked classical IDH patterns despite displaying cytological features of in situ carcinomas, the experience and view point of the pathologist played a more prominent role. When the DIN classification criteria were applied to grade DCIS lesions, although the system was found to be practical, it did not provide adequate differentiation in intermediate grade (grade II-DIN 2) patients and further improvement was considered desirable. Fourty-five cases (47.8%) IDH, 19 (20.2%) AIDH, and 30 (31.9%) were DCIS. There were statistically significant differences in the levels of c-erbB2 oncogene expression between IDH, AIDH and DCIS lesions (p<0.001). In DCISs, grade, cell size, pleomorphic nuclear atypia showed statistically significant associations with c-erbB2 oncogene expression. These results suggest that c-erbB2 oncogene expression is a valuable marker in the differential diagnosis and prognostic evaluation of patients with intraductal proliferative lesions.

Surgical Treatment of Sporadic Pancreatic Neuroendocrine Tumors: A State of the Art Review

Pancreatic neuroendocrine tumors (PNETs) are rare neoplasms. They are clinically diverse and divided into functioning and nonfunctioning disease, depending on their ability to produce symptoms due to hormone production. Surgical resection is the only curative treatment and remains the cornerstone therapy for this patient group, even in patients with advanced disease. Over the last decade there has been a noticeable trend towards more aggressive surgery as well as more minimally invasive surgery in patients with PNETs. This has resulted in improved long-term survival in patients with locally advanced and metastatic disease treated aggressively, as well as shorter hospital stays and comparable long-term outcomes in patients with limited disease treated minimally invasively. There are still controversies related to issues of surgical treatment of PNETs, such as to what extent enucleation, lymph node sampling, and vascular reconstruction are beneficial for the oncologic outcome. Histopathologic tumor classification is of high clinical importance for treatment planning and prognostic evaluation of patients with PNETs. A constant challenge, which relates to the treatment of PNETs, is the lack of an internationally accepted histopathological classification system. This paper reviews current issues on the surgical treatment of sporadic PNETs with specific focus on surgical approaches and tumor classification.

Prognostic evaluation of patients treated with intravenous gamma-globulin treated patients for Kawasaki disease, according to three scoring systems

Prognostic evaluation of patients treated with intravenous gamma-globulin treated patients for Kawasaki disease, according to three scoring systems