Prognoses

The generosity of the TCU Research Foundation and especially the Robert A. Welch Foundation in supporting the preparation of this chapter and much of the unpublished research reported herein is gratefully acknowledged. 

Pathology of demyelinating and axonal forms presented below is well established. Pathological changes in minor variants of GBS are not well-characterized. 

Axonal variants Unlike AIDP, axonal variants of GBS show primary axonal injury without substantial T-cell inflammation or demyelination (Griffin et al., 1995, 1996a). In AMAN, axonal degeneration predominantly involves the motor axons, whereas in AMSAN sensory axons are also involved. It has been postnlated that AMAN and AMSAN represent a pathologic spectrum and that AMSAN actually represents a more severe form of AMAN. 

In AMAN, deposition of IgG and complement can be detected on the nodal and intemodal axolemma (Hafer-Macko et al., 1996a). Macrophages are closely associated with the axons at the nodes and these cells then extend into intemodal 

In summary, the pathological and immunopathological findings in AMAN suggest that antibody-mediated injury directed against axonal antigens plays a prominent role in the pathogenesis of this disorder. 

Causes of death have been cachexia (Knox and Ramsey 1932), pneumonia (SiEGMUND 1921), heart failure (Niemann 1914, Bloom 1928), pneumococcal meningitis (Bloom 1928), enteritis (Giampalmo 1953) or other infections to which the debilitated infants are very susceptible. Today, prevention or treatment of complications may result in a more protracted course of the disease, and sequelae of the primary lesion may preponderate as cause of death. 

A slower course is the rule when the disease begins in late childhood or in adult life, and neurologic symptoms in these patients are less marked or absent. Here the prognosis is favorable, as demonstrated by the two patients described by Fredrickson (1960). 

Although today s chemical methods are of greater diagnostic value than the morphologic approach, it should be kept in mind that Pick established the 

---

Important part of validation procedure is prognosis (on basis of Phai macopoeial requirements and results of inter-laboratory trials) of sample preparation, final analytical operation and total uncertainties. It enables to forecast method uncertainty in control laboratories. 

The approaches to analytical procedures uncertainty prognosis are developed. The correctness of these approaches is confirmed in 3rd and 4th rounds of pharmaceutical laboratories inter-laboratory testing ( Phamia-Test program of State Inspection for Quality Control of Medicines, Ministry of Health of Ukraine). 

Gain agreement on the problem (expending further effort may be uneconomic if no one agrees with your prognosis). 

Criteria for initiation of drug treatment now take into consideration total cardiovascular risk rather than blood pressure alone, such that treatment is now recommended for persons whose blood pressure is in the normal range but still bear a heavy burden of cardiovascular risk factors. Thus, the role of simultaneous reduction of multiple cardiovascular risk factors in improving prognosis in hypertensive patients is stressed. In addition, more aggressive blood pressure goals are recommended for hypertensive patients with comorbid conditions such as diabetes mellitus or renal insufficiency. 

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

AA A1 A01.009 Cathepsin D Diagnosis and prognosis of breast and other cancers... 

S6K1 S6K1 is overexpressed in many breast cancers and this is correlated with poor prognosis... 

Promoting an Optimal Response to Therapy Because these dru may be used in the treatment of certain types of severe and sometimes life-threatening viral infections, the patient may be concerned about the diagnosis and prognosis. The nurse should allow the patient time to talk and ask questions about methods of treatment, especially when the drug is given IV. It is important to explain the treatment methods to the patient and family members. 

Cornetta K, Croop J, Dropcho E, Abonour R, Kieran MW, Kreissman S, Reeves L, Erickson LC, Williams DA (2006) A pilot study of dose-intensified procarbazine, CCNU, vincristine for poor prognosis brain tumors utilizing fibronectin-assisted, retroviral-mediated modification of CD34-I- peripheral blood cells with 06-methylguanine DNA methyltransferase. Cancer Gene Ther 13 886-895... 

Patients in the more aggressive categories are less likely to exhibit involvement of the skin and have a less favorable prognosis [10]. Those patients may have a definable hematological disorder such as a myelodysplastic syndrome, myeloproliferative disorder, acute leukemia, or a malignant lymphoma. In aggressive mastocytosis and mast cell leukemia, the clinical course is determined by the rapidity of the increase in mast cell numbers. 

Beck J, Pauker S. The Markov process in medical prognosis. Med Decis Making 1983 3 419-58. 

Assay of plasma enzymes aids diagnosis and prognosis. For example, a myocardial infarction elevates serum levels of lactate dehydrogenase isozyme I,. 

Although clinical deficiency disease is rare, there is evidence that a significant proportion of the population have marginal vitamin Bg status. Moderate deficiency results in abnormalities of tryptophan and methionine metabolism. Increased sensitivity to steroid hormone action may be important in the development of hormone-dependent cancer of the breast, uterus, and prostate, and vitamin Bg status may affect the prognosis. 

What else and what next A speculative prognosis... 

---