INDEX prognosis

The pathologic evaluation of breast lesions serves to establish the histologic diagnosis and to confirm the presence or absence of other factors believed to influence prognosis. These prognostic factors include the presence of necrosis, lymphatic or vascular invasion, nuclear grade, hormone receptor status, proliferative index, amount of aneuploidy, and HER-2/neu expression. 

Prognosis depends on histologic subtype and clinical risk factors (e.g., age more than 60 years, performance status of 2 or more, elevated lactic dehydrogenase, extranodal involvement, and stage III or IV disease). These risk factors are used to calculate the International Prognostic Index. 

Diffuse large B-cell lymphomas are the most common lymphoma in patients of all ages but most commonly seen in the seventh decade. Extranodal disease is present at diagnosis in 30% to 40% of patients. The International Prognostic Index score correlates with prognosis. Diffuse aggressive lymphomas are sensitive to chemotherapy with cure achieved in some patients. 

A method for estimating the prognosis in individual cases was recently proposed by Holmendahl the Cortinarius Nephro Toxicity (CNT) Prognosis Index. This test is based on the serum creatinine level before treatment (y) and the number of days elapsed (X) ... 

Measurements of arterial pressure, cardiac output, stroke work index, and pulmonary capillary wedge pressure are particularly useful in patients with acute myocardial infarction and acute heart failure. Such patients can be usefully characterized on the basis of three hemodynamic measurements arterial pressure, left ventricular filling pressure, and cardiac index. One such classification and therapies that have proved most effective are set forth in Table 13-4. When filling pressure is greater than 15 mm Hg and stroke work index is less than 20 g-m/m2, the mortality rate is high. Intermediate levels of these two variables imply a much better prognosis. 

Circulatory parameters The determination of circulatory parameters allows a rough calculation of the amount of blood already lost as well as optimizing the subsequent diagnostic and therapeutic measures. Loss of more than 800-900 ml blood (or less in older patients and in cases of anaemia) causes circulatory symptoms tachycardia, fall in blood pressure, decrease in both cardiac output and venous return to the heart. A central venous pressure (CVP) of < 5 cm H2O suggests an unfavourable prognosis. The Allgoewer-Burri index has proved to be a useful, objective parameter ... 

Patients with a cardiac index of less than 2.2 L/m per minute and a PAOP higher than 18 mm Hg are in hemodynamic subset TV. These patients have the worst prognosis of any subset and illustrate the typical hemodynamic profile for the patient hospitalized for severe heart failure. 

In spite of the drastic fall of cholinesterase activity in many cases of cancer, the reduction does not come early enough or with sufficient regularity to serve for cancer detection. One possible exception can be the diagnostic distinction between tumor- or gallstone-produced biliary obstruction (FI, K35, W25). The monitoring of cholinesterase activity in cancer patients, however can serve as a sensitive index of a patient s state and prognosis. 

The objective, clinical assessment of the stroke patient is important for therapeutic decisions and prognosis. The most valuable instrument during the acute stroke period is the NIH stroke scale, which is listed in Table 11.7. Two other commonly used clinical stroke scales to assess premorbid functioning or long-term functional recovery are the Modified Rankin Scale (Table 11.8) and the Barthel Index (Table 11.9). 

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