Prognostic Table Research Articles

ПРОГНОСТИЧЕСКИЙ АЛГОРИТМ ФОРМИРОВАНИЯ ЗАДЕРЖКИ ФИЗИЧЕСКОГО РАЗВИТИЯ У ДЕТЕЙ, ПЕРЕНЕСШИХ ВНУТРИУТРОБНУЮ НАРКОТИЧЕСКУЮ ИНТОКСИКАЦИЮ

Objective: to create prognostic tables for delayed physical development of children who have experienced drug intoxication in the prenatal period. Materials and methods. The research materials are presented by the study group (51 children) and the verification group of children (10 people). The study group consisted of children aged 1 to 14 years who had prenatal exposure to opiates. Research methods included medical history, follow-up observation and statistical processing of the data obtained using the “Statistica 9.0” program. Results. A prognostic algorithm has been created in tabular expression of the most informationally significant 19 risk factors that have both a prognostically significant and leveling effect on the formation of future delays in the child’s physical development. prognostic table of risk data for the development of delayed physical development in children born to drug-addicted women. The obtained data was verified by a verification group. The effectiveness was 90 % (9 prognostic scenarios adequately reflected upcoming events. Conclusion. The developed predictive algorithms for delayed physical development in children who were exposed to opiates in the prenatal period are applicable in the practice of a pediatrician and create a real opportunity to draw up individual scenarios. The data obtained will help to prevent the development of pathology in a timely manner.

Methodological principles of diagnosis verification and treatment tactics determination in combat limb injuries with bone defects

Objective. To develop a classification system for long bone defects resulting from combat limb injuries, establish criteria for predicting pathological fractures, and determine indicators for assessing the feasibility of converting the fixation method in combat-related injuries. Methods. The modern literature regarding the treatment of combat-related long bone defects resulting was analyzed in three databases: PubMed, Scopus, and Web of Science. The analysis was conducted using keywords such as combat injuries, bone defect, non-union, auto- and allograft transplantation, Ilizarov method — bone transport, Masquelet method — induced membrane, and fixation method replacement. The clinical material used for this study was derived from the evaluation and treatment of 457 patients with long bone defects at the III–IV medical intervention stage. Results. The determination of modern perspectives on the fundamental issues of combat injuries, combined with the analysis of treatment outcomes for such patients, enabled the development and validation of a classification of bone defects that incorporates the volume of bone tissue loss. Furthermore, a prognostic table for the risk of pathological fractures in cases of bone defects and a scoring scale for assessing the feasibility of fixation method conversion have been introduced and applied. Conclusions. The proposed classification allows the verification of all types of long bone defects. Its application in clinical practice offers the possibility of obtaining optimal and standardized treatment methods for different types of bone defects, thus improving outcomes by choice of appropriate technologies for their replacement. The objectification of fracture risk factors identification for bone defects enables the choice of the method and means of segment stabilization. The assessment of the feasibility of the fixation method change allows the evaluation of the patientʼs condition and the local status, facilitating the determination of the potential for method conversion — transition from external fixation devices to intramedullary osteosynthesis, significantly reducing complications during this stage.

К ВОПРОСУ О ВОЗМОЖНОСТИ ПРОГНОЗИРОВАНИЯ РИСКА ПОТЕРИ БЕРЕМЕННОСТИ В РАННИЕ СРОКИ

This study was conducted to determine the risk factors and their prognostic significance as 
 predictors of early pregnancy loss. Materials and methods. Retrospective study examined 214 data patients: 
 social factors, information about obstetric and gynecological history, extragenital diseases, results of clinical 
 and laboratory, instrumental examinations, features and complications of a real pregnancy. To predict we used 
 Bayesian model with A. Wald analysis, calculating prognostic coefficients significant factors identified during 
 the study and their informativeness were assessed by E.V. Gubler and S. Kulbak methods. Predictive coeffi cients of aggressive and protective factors affecting the peculiarities of the course and termination of preg nancy. Study results. Retrospective review of medical records allowed determine 14 risk factors for early ges tational loss: the patient's age is 29 years or more, tobacco smoking, non-developing pregnancy, spontaneous 
 abortions and ectopic pregnancy in history, early loss in the unborn, inflammatory diseases of the genitals, 
 cytomegalovirus infection, one or more C-sections history, organ surgery
 abdominal cavity, obesity, uterine fibroids, planned in vitro fertilization. With taking into account the 
 identified factors, a prognostic model was compiled, which allows for 95% accurately calculate the prognosis 
 of the course of pregnancy. Based on the obtained values prognostic coefficients formed a table of pre-ravidar 
 assessment of the risk of loss in early dates of gestation. Conclusion. The study made it possible to identify 
 risk factors and calculate them prognostic significance in the realization of early pregnancy loss. Created the 
 prognostic table allows in the pregravidar period to formulate an accurate forecast in the ratio of early preg nancy losses and, if necessary, a rational pregravidar preparation.

Medieval Divination by Unexpected Incidents: The Tabula prenostica Salomonis

Abstract This article explores a little-known prognostic table, the so-called Tabula Salomonis, in its four oldest Latin manuscript witnesses from between ca. 1000 and 1300. Unusually for Latin prognostic texts, the table employs unexpected incidents such as animal sounds, sneezes, and bodily twitches combined with the signs of the zodiac as its starting point. Interestingly, the sources for the Tabula, a series of Late Antique texts from which the author “picked and mixed,” are not extant in Latin. Given a parallel tradition in Arabic, the authors argue that the Tabula’s direct precursor is not a Greek text (as is the case for many contemporary prognostic texts in Latin), but an Arabic work. This would make it the earliest attested prognostic text translated directly from Arabic into Latin.

Justification of the Selection Techniques in Martial Arts using Wald's Sequential Analysis

The study purpose was to develop a selection technique in martial arts based on indices of physical development using Wald's sequential analysis.
 Materials and methods. 12 anthropometric indicators were determined. 9 indexes of physical development were calculated on their basis. 16 elite athletes (candidates for masters and masters of sports) were divided into two groups. Group 1 included 7 athletes (judo, sambo, Greco-Roman and freestyle wrestling) aged 18.43±0.43. Group 2 included 9 kickboxing athletes aged 18.22±0.52.
 Results. A prognostic table containing indices of physical development has been developed. The informativeness of the indicators varied within 296.15–1.73. The content of the prognosis consists of evaluating the results, determining the corresponding coefficients and summing these coefficients until one of the prognostic thresholds is reached. In accordance with generally accepted approaches, the value of the thresholds was set at the level of ±13, which corresponds to a probability of 95% (p<0.05). Exceeding the positive threshold improves an athlete's prospects in wrestling. Achieving a negative threshold corresponds to a perspective in kickboxing.
 Conclusions. The conducted research made it possible to justify and develop a method for selecting martial arts athletes using indices of physical development. The proposed technique is based on Wald's sequential analysis and is a simple, informative and objective tool for the selection and prognosis of athletes' condition.

The age at first cutaneous manifestation of psoriasis as a prognostic factor in the timing of psoriatic arthritis diagnosis

Background. Psoriatic arthritis is a chronic inflammatory disease of joints, spine and enthesis, which develops in 640% of patients with psoriasis and has a significant impact on the quality of life of patients.
 Aims. To determine the relationship between age of cutaneous manifestation of psoriasis and the timing of psoriatic arthritis diagnosis; to examine the possibility of prediction of timing of psoriatic arthritis diagnosis depending on age of cutaneous manifestation of psoriasis.
 Materials and methods. Data of patients aged 18 years and older with psoriatic arthritis included in the psoriasis patient register were analysed. Inclusion criteria were: patient age 18 years and older; established diagnosis of psoriasis and psoriatic arthritis. Exclusion criteria were: psoriatic arthritis diagnosed before or simultaneously with cutaneous manifestation of psoriasis; the age of the cutaneous manifestation of psoriasis older than 70 years. The sample included 771 patients.
 Spearman's correlation analysis was used to assess the correlation between age of cutaneous manifestation of psoriasis and period from skin psoriasis onset to psoriatic arthritis diagnosis.
 The possibility of prediction of the period till psoriatic arthritis was diagnosed depending on age at cutaneous manifestation of psoriasis was established by means of quantile regression analysis.
 Results. Mean age at cutaneous manifestation of psoriasis (SD) was 26.0 13.5 years. The period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis averaged 13.7 10.3 years, its median [interquartile range] was 12 [619] years.
 According to Spearman's correlation analysis, a moderate (close to strong) negative correlation between varibles was revealed (Spearman's correlation coefficient = 0.490, p 0.0005).
 In accordance to quantile regression analysis, lines of 5, 25, 50, 75 and 95% quantiles were obtained and the dependence of the period till the diagnosis of psoriatic arthritis on the age of onset of skin psoriasis was demonstrated. Based on the quantile equation obtained, a prognostic table for the period from the onset of skin psoriasis to the diagnosis of psoriatic arthritis was compiled.
 Conclusions. Statistically significant inverse relationship between age of cutaneous manifestation of psoriasis and period till psoriatic arthritis diagnosis was established: older age at skin psoriasis onset is associated with shorter period till psoriatic arthritis diagnosis. Based on established relationship, presented as an equation, table and graphically, prediction of period till psoriatic arthritis diagnosis is possible. These results can be used in the clinical practice of dermatovenereologists.

Prediction of persistence of hemodynamically significant open arterial duct in profoundlypreterm infants

Objective. To develop a method for predicting the persistence of hemodynamically significant ductus arteriosus in profoundly premature newborns based on the evaluation of clinical data and the results of additional studies.
 Material and methods. Sixty-nine profoundly preterm newborns were examined including 37 with very low and 32 with extremely low body weight. Clinical and anamnestic data, the results of laboratory radiographic and instrumental examinations were evaluated. The state of the arterial duct, as well as the parameters of central and intracardiac hemodynamics were determined by echocardiography. The criteria for hemodynamically significant open arterial duct (OAD) were the following: duct size greater than 1.5 mm, left-right blood bypass, the presence of retrograde blood flow in the aorta greater than 50 % of the antegrade value. There were 2 groups: comparison (n = 41) children with hemodynamically insignificant ductus arteriosus, main (n = 28) children with hemodynamically significant ductus arteriosus after 72 hours of postnatal life.
 Results. After 72 hours of the postnatal life, a hemodynamically significant ductus arteriosus is detected in 40.6 % of profoundly premature newborns. The factors of a long-term persistence of ductus arteriosus are as follows: birth at term of gestation less than 27 weeks with a low Apgar score within the first minute of life ( 4 points), a patient has a sharp weakening or absence of reflexes of the newborn, severe muscular hypotonia, signs of peripheral circulation, moist fine wheezing and crepitation in the lungs, strengthening of their images on the radiograph due to the interstitial and vascular components, dilation of the left and right ventricles and the left atrium. The method for predicting the dynamics of the open ductus arteriosus in profoundly premature newborns has been developed.
 Conclusion. The use of the developed prognostic table makes it possible to identify with an accuracy of 85.7 % profoundly premature newborns with a high risk of persistence of a hemodynamically significant ductus arteriosus after 72 hours of postnatal life.

Профилактика дезадаптационных реакций у будущих первоклассников

The article discusses the main types of maladjustment reactions in children. The results of the authors’ experimental research are described. The experimental group consisted of 104 senior preschool children. In the course of the study, the children were observed and parents were questioned. The data obtained were entered into a prognostic table to determine the risks of an unfavorable course of adaptation at school. The main reasons for the appearance of difficulties in children in the learning process are identified, protective behavioral reactions are described. Methods and means of preventive activities of the teacher are proposed.

Risk stratification of thromboembolic complications development in surgical patients

Aim.Creating a mathematically based scale of risk stratification of thromboembolic complications in patients with acute abdominal organs pathology requiring urgent surgical treatment.Material and methods.This work is based on data from 185 case reports of patients with acute surgical diseases of the abdominal organs that had undergone emergency operations. Clinical and statistical analyses were carried out and the most significant risk factors for venous thromboembolic complications were identified. By digitally estimating the specific gravity of each of the factors, the method of sequential probability ratio criterion was applied to the obtained data.Results and discussion.Based on a retrospective analysis of clinical records, 13 most informative prognostic criteria for thromboembolic complications formed in the prognostic table were identified. Each sign, depending on its value, had a specific gravity. For the convenient using of the prognostic scale in practice, the indicators of natural logarithms are translated into arbitrary units (points). The results are checked on available archival records. The overall forecast reliability was 97%.Conclusion.The proposed prognostic scale made it possible to optimize the likelihood of a feasibility study in patients with acute diseases of the abdominal organs.

Risk of Long-Term Mortality for Complex Chronic Patients with Intracerebral Hemorrhage: A Population-Based e-Cohort Observational Study.

Over recent years there has been growing evidence of increased risk of mortality associated with hemorrhagic stroke among older patients. The main objective of this study is to propose and validate a prognostic life table for complex chronic patients after an intracerebral hemorrhage (ICH) episode in primary care settings. This was a multicenter and retrospective study (April1, 2006-December31, 2016) of a cohort from the general population presenting an episode of ICH from which a predictive model of mortality was obtained using a Cox proportional hazards regression model. In addition, Kaplan-Meier survival curves, the log-rank test, receiver operating characteristic (ROC) curves, and area under the ROC curve (AUC) were used to evaluate the ability to stratify patients according to vital prognosis. We proceeded to external validation of the model through prospective monitoring (January1, 2013-December31, 2017) of the population of complex chronic patients with an episode of ICH. A total of 3594 people aged ≥ 65years were identified as complex chronic patients (women 55.9%; mean age, 86.1 ± 8.4years) of whom 161 suffered hemorrhagic stroke during the study period (January 1, 2013-December 31, 2017). The primary outcome was death from any cause within 5years of follow-up after an ICH episode. The independent prognostic factors of mortality were age > 80years (HR 1.048, 95% CI 1.021-1.076, p < 0.001) and HAS-BLED score (HR 1.369, 95% CI 1.057-1.774, p = 0.017). Compared to the general population, the incidence density/1000 person per year (15 vs 0.22) was significantly higher with a significantly lower annual lethality rate (17% vs 49.2%); and both the prognostic factors and the risk of stratified mortality showed different epidemiological patterns. The internal validation of the model was optimal (log-rank < 0.0001) in the general population, but its external validation was not significant in the complex chronic patient population (log-rank p = 0.104). The ICH-AP is a clinical scale that can improve the prognostic prediction of mortality in primary care after an episode of ICH in the general population, but it was not significant in its external validation in a population of complex chronic patients. ClinicalTrials.gov ID: NCT03247049.

The prediction of success in kickboxing based on the analysis of morphofunctional, physiological, biomechanical and psychophysiological indicators

Purpose: To substantiate and develop a methodology for predicting success in kickboxing on the basis of analysis of morphofunctional, physiological, biomechanical and psychophysiological indicators. Material: it was examined athletes of kickboxing (n=185, age 18.58 +- 0.46 years). It was studied the features of physical development (n = 18). The main biomechanical parameters (n=45) were determined. Goniometric indices of limb joints (n=29) were studied. It was studied the features of psychophysiological reactions (n =76). The adaptive capabilities of the cardiovascular system were studied (n=17). The prognostication is carried out by means of a sequential Wald procedure. Prognostic coefficients and their informativity were calculated. Results: a prognostic table was developed containing the indicators of the functional state of kickboxing athletes. The table includes 31 criteria, the informativeness of which varied within 115,45 - 2,23. The content of the forecast consists in: an evaluation of the results; determination of the corresponding prognostic coefficient; summation of coefficients. The threshold was set at the level +- 13, which corresponds to a probability of 95% (p<0,05). Exceeding the positive threshold means a high level of success for the athlete. When the negative threshold is reached, the probability of success is low. Conclusions: The proposed methodology is based on a sequential analysis of Wald. The technique is a simple, informative and objective tool for monitoring and predicting the status of athletes.

Forecasting of development of healthcare-associated infectons in puerperas

Aim. Identification of possible risk factors, assessment of their information value, and compilation of a prognostic table for assessing the risk of healthcare associated infections in puerperas.&#x0D; Materials and Methods. Experimental and control groups were formed from among the puerperas. The experimental group included 147 women who developed purulent-septic infection within 30 days after delivery. The control group was formed by the mechanical selection of each 50th labor and delivery record for the aforementioned period and included 300 subjects. Possible risk factors were divided into groups: social factors, factors related to the state of woman's health, factors associated with the peculiarities of the pregnancy course, factors associated with the peculiarities of the labor course, factors associated with the postpartum period.&#x0D; Results. During the study, the following risk factors were identified: unregistered marriage, prenatal hospitalization to the Department of Pathology of Pregnancy for more than 1 bed-day, first labor, uncoordinated contractions, amniotomy, episiotomy, hysterocervicorrhexis, staying in the ward of separate residence in the postpartum period. Based on the sum of the values of prognostic indices, calculated for each risk factor, three prognostic groups were formed: high, average and low risk. Forecasting of the risk for healthcare associated infection development in a patient is carried out by simple arithmetic addition of prognostic indices.&#x0D; Conclusion. To prevent healthcare associated infections, it is recommended: to carry out bacteriological examination of an afterbirth and prescribing preventive course of antibiotics to puerperas of the high risk group in the postpartum period; to specify that a woman is at high or average risk, if any, in the discharge documentation to inform the Women's Health Department. The information on belonging of the puerperas to a particular risk group can be used by the hospital epidemiologist when carrying out operational and retrospective analysis.

PROGNOSTICATION OF SUCCESSFULNESS IN ARM-WRESTLING ON THE BASE OF MORPHOLOGICAL FUNCTIONAL INDICATORS’ ANALYSIS

Purpose: to work out methodic of arm wrestling successfulness prognostication by morphological functional indicators and substantiate it. Material: 189 sportsmen (of age 21.62 +- 0.85 years) were tested. We fulfilled goniometric testing of arms’ joints (n=27) and hand dynamometry (n=50). Characteristics of physiological tremor were studied (n=29). Strength of forearm’s muscles was determined (n=33) as well as the strength of hand fingers’ extensors separately (n=50). Prognostication was realized with the help of sequential procedure by Wald’s methodic, with calculation of prognostic coefficients and their informative potential. Results: prognostic table, containing functional state indicators of arm-wrestlers. It contained 18 criteria. The criteria illustrate power, goniometric and functional indicators. Informative potential varied within 64.70 - 6.33. The sense of prognosis is assessment of results and determination of appropriate prognostic coefficient. Besides, prognosis implies summing up of these coefficients for achievement of one of prognostic thresholds. The value of these thresholds was determined at level of +- 13, that corresponds to 95% probability. Achievement of threshold + 13 and more means sportsman’s successfulness higher level. In case of lower threshold achievement successfulness probability is low. Conclusions: the conducted researches permitted to work out methodic of arm wrestling successfulness prognostication by morphological functional indicators and substantiate it. The offered methodic is based on sequential analysis by Wald and is a simple, informative and objective tool of arm-wrestlers’ condition control.

The mode of evaluation of sensibilization of children to grain herbs under respiratory allergy.

The sensibilization of patients to allergens of grain herbs is characterized by expressed crossed allergic reactions to pollen of various representatives of the given family. The investigation of antibody response to allergens of grain herbs and also data of epidemiological studies, results of world and national studies permitted to develop and propose a new mode of diagnostic of allergy with evaluation of level of sensibilization of patient and also qualitative detection in blood serum the level of specific immunoglobulins E (IgE) to allergens of grain herbs. The parameter «concentration of IgE to allergens of cocksfoot» - IgE(g3) - is a key one for evaluating in blood serum of patients content of IgE to allergens of grain herbs matched to cocksfoot: randall, timothy, Kentucky bluegrass, field brome, meadow foxtail, French ryegrass. To calculate concentration of IgE to allergens of the mentioned grasses detection of IgE(g3) is necessary and sufficient. The elaborated prognostic table permits evaluating degree of ensibilization of patient to various grain herbs and also detecting concentration of IgE expressed in units kE per l without application of additional serological analyses. Therefore, the elaborated technique permits reducing number of «in vitro» tests and minimizing number of blood sample of patient and also speeding up receiving of information concerning sensibilization profile of patient.

Prediction of tension-type headache risk in adolescents

Tension-type headache is the actual problem of adolescent neurology, which is associated with the prevalence of the disease, the tendency of the disease to the chronic course and a negative impact on performance in education, work capacity and quality of patients’ life. The aim . To develop a method for prediction of tension-type headache occurrence in adolescents. Materials and methods. 2342 adolescent boys and girls at the age of 13-17 years in schools of Kharkiv were examined. We used questionnaire to identify the headache. A group of adolescents with tension-type headache - 1430 people (61.1%) was selected. The control group included 246 healthy adolescents. Possible risk factors for tension-type headache formation were divided into 4 groups: genetic, biomedical, psychosocial and social. Mathematical prediction of tension-type headache risk in adolescents was performed using the method of intensive indicators normalization of E.N. Shigan, which was based on probabilistic Bayesian’s method. The result was presented in the form of prognostic coefficients. Results. The most informative risk factors for tension-type headache development were the diseases, from which the teenager suffered after 1 year (sleep disorders, gastrointestinal diseases), autonomic disorders in the family history, traumatic brain injury, physical inactivity, poor adaptation of the patient in the kindergarten and school, stresses. Diagnostic scale has been developed to predict the risk of tension-type headache. It includes 23 prognostic factors with their gradation and meaning of integrated risk indicator, depending on individual factor strength influence. The risk of tension-type headache development ranged from 25,27 to 81,43 values of prognostic coefficient (low probability (25,27-43,99), the average probability (43,99-62,71) and high probability (62,71- 81,43)). Conclusion. The study of tension-type headache risk factors, which were obtained by using an assessed and prognostic table, shows the importance of hereditary family history of headache and autonomic dysfunction, neonatal pathology, diseases that children were suffered after 1 year of life and psychosocial disorders in adolescents.

Adverse prognostic impact of heterogeneous HER2 gene amplification in patients with esophageal adenocarcinoma (EAC).

4009 Background: HER2 expression in upper digestive cancer is reported to be heterogeneous, which substantially affects interpretation of HER2 positivity in the clinic. Yet the frequency and prognostic impact of HER2 genetic heterogeneity and polysomy 17 (poly17) are unknown in EAC. Methods: HER2 amplification (fluorescence in situ hybridization) and protein expression were examined in untreated surgical EAC specimens (N = 661) at Mayo Clinic. HER2 genetic heterogeneity was defined per ASCO/CAP as amplification (HER2/CEP17 ratio ≥ 2) in 5-50% of cancer cells; poly17 refers to ≥ 3 copies of chromosome 17. Most tumors were T3-4 (68%) or lymph node (LN)-positive (73%). Cox models were used to assess disease-specific (DSS) and overall survival (OS). Results: HER2 amplification was detected in 117 of 661 EACs (18%), of which 20 (17%) showed HER2 heterogeneity. HER2 heterogeneous tumors had a significantly higher frequency of poly17 and high tumor grade. HER2 heterogeneity by amplification vs expression were correlated. Since heterogeneity was limited to HER2-amplified tumors, survival analysis was stratified by amplification status. In multivariable analysis, only HER2 heterogeneity and metastatic LN number were prognostic (Table). Conclusions: Among HER2 amplified EACs, 17% show HER2 heterogeneity, which is associated with increased poly17 and independently predicts 2-fold higher risk of cancer-specific death. Among HER2-nonamplified cases, poly17 is independently associated with worse survival. These novel findings demonstrate aggressive subgroups in HER2-amplified and -nonamplified EACs that have important implications for HER2 analysis and evaluation of benefit from HER2 targeted therapy. [Table: see text]

Chronic osteomyelitis in children: prognosis of the current and ways of patients’ rehabilitation

For improvement results of the treatment of children with chronic osteomyelitis author offers to put into practice more frequent control examinations of patients and definition direction of the current of local pathological process with help elaborated the prognostic table. At the same time are recommended different variants of treatment and rehabilitation until the patient be under observation.

Prognostic table for predicting major cardiac events based on J-ACCESS investigation

The event risk of patients with coronary heart disease may be estimated by a large-scale prognostic database in a Japanese population. The aim of this study was to create a heart risk table for predicting the major cardiac event rate. Using the J-ACCESS database created by a prognostic investigation involving 117 hospitals and >4,000 patients in Japan, multivariate logistic regression analysis was performed. The major event rate over a 3-year period that included cardiac death, non-fatal myocardial infarction, and severe heart failure requiring hospitalization was predicted by the logistic regression equation. The algorithm for calculating the event rate was simplified for creating tables. Two tables were created to calculate cardiac risk by age, perfusion score category, and ejection fraction with and without the presence of diabetes. A relative risk table comparing age-matched control subjects was also made. When the simplified tables were compared with the results from the original logistic regression analysis, both risk values and relative risks agreed well (P < 0.0001 for both). The Heart Risk Table was created for patients suspected of having ischemic heart disease and who underwent myocardial perfusion gated single-photon emission computed tomography. The validity of risk assessment using a J-ACCESS database should be validated in a future study.

Sensorineural Hearing Loss After Dental Extraction Under General Anesthesia: Report of a Case

Sudden sensorineural hearing loss (SNHL) is an uncommon event, with an estimated incidence of 5 to 20 cases per year per 100,000 population. It is often idiopathic or secondary to infection. 1 Byl Jr, F.M. Sudden hearing loss: Eight years' experience and suggested prognostic table. Laryngoscope. 1984; 94: 647 Crossref PubMed Google Scholar It is a well-recognized event after a cardiopulmonary bypass, with a reported incidence of 1 in 1,000. This is attributed to microemboli from the cardiopulmonary tree. 2 Plasse H.M. Mittleman M. Frost J. Unilateral sudden hearing loss after open heart surgery A detailed study of seven cases. Laryngoscope. 1981; 91: 101 Crossref PubMed Google Scholar Other causes include lesions of the external, middle, and inner ear, internal auditory meatus, cerebellopontine angle, and central nervous system. 3 Goodhill V. Harris I. Brockman S.J. Sudden deafness and labyrinthine window rupture. Ann Otol Rhinol Laryngol. 1973; 82: 2 PubMed Google Scholar It is considered an otologic emergency, and early diagnosis and treatment may result in a favorable outcome. 4 Pau H. Selvadurai D. Murty G.E. Reversible sensorineural hearing loss after non-otological surgery under general anaesthetic. Postgrad Med J. 2000; 76: 304 Crossref PubMed Scopus (9) Google Scholar It is, however, extremely uncommon after general anesthesia (GA) for noncardiac and nonotologic procedures. Only 44 such cases were reported in the literature, mainly after spinal, abdominal, gynecologic, and ophthalmic procedures. 3 Goodhill V. Harris I. Brockman S.J. Sudden deafness and labyrinthine window rupture. Ann Otol Rhinol Laryngol. 1973; 82: 2 PubMed Google Scholar , 4 Pau H. Selvadurai D. Murty G.E. Reversible sensorineural hearing loss after non-otological surgery under general anaesthetic. Postgrad Med J. 2000; 76: 304 Crossref PubMed Scopus (9) Google Scholar , 5 Park P. Toung J.S. Smythe P. et al. Unilateral sensorineural hearing loss after spine surgery: Case report and review of literature. Surg Neurol. 2006; 66: 415 Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar , 6 Farrel R.W. Pemberton M.N. Parker A.J. et al. Sudden deafness after dental surgery. Br Med J [Clin Res]. 1991; 303: 1270 Google Scholar , 7 Evan K.E. Tavill M.A. Goldberg A.N. et al. Sudden sensorineural hearing loss after general anaesthesia for nonotological surgery. Laryngoscope. 1997; 107: 747 Crossref PubMed Scopus (26) Google Scholar , 8 Goodhill V. Labyrinthine membrane ruptures in sudden sensorineural hearing loss. Proc R Soc Med. 1976; 69: 565 PubMed Google Scholar We are aware of only 1 previous report of SNHL after dental extraction under GA. We report on a case of sudden SNHL after a dental extraction under GA, and we review the relevant literature.

The use of a prognostic table to aid decision making on adjuvant therapy for women with early breast cancer

Aim: Understanding the likely net benefit of chemotherapy for the individual patient helps physicians to give objective information. A prognostic table has been constructed detailing the percentage absolute survival advantage offered by polychemotherapy for patients with early breast cancer, according to their age and the Nottingham Prognostic Index of their tumour. This study aims to assess its first year of use in the Leicestershire Breast Unit.Method:Demographic, pathological and treatment data were collected prospectively onto the Leicestershire breast cancer database. Patients with a potential survival advantage of 2% or greater in the year 01/05/99 to 30/04/00 (after the prognostic table was used routinely to determine oncology referrals) were identified. Chemotherapy usage was compared with the previous year's patient group.Results: Two hundred and eighty-eight had early breast cancer, requiring surgery, eligible for consideration of adjuvant therapy. Of these, 98% of women with a potential survival advantage of 6% or more received chemotherapy. Ninety-one percent of those with a survival advantage of 4% or more was seen by an oncologist. Of those with a 2% survival advantage, 48% were referred to discuss the issues with an oncologist. Use of the table resulted in increased chemotherapy rates for women with a 4% potential survival advantage.Conclusions: We have found the prognostic table to be a useful and workable tool and advocate its use.