Prognosis, disease

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. 

There is growing evidence of a link between renal disease and HF.8 Renal insufficiency is present in one-third of HF patients and is associated with a worse prognosis. In hospitalized HF patients, the presence of renal insufficiency is associated with longer lengths of stay, increased in-hospital morbidity and mortality, and detrimental neurohormonal alterations. Conversely, renal dysfunction is a common complication of HF or results from its treatment. Renal failure is also a common cause for HF decompensation. 

Heart failure is more prevalent and associated with a worse prognosis in African-Americans compared to the general population.1 Unfortunately, deficiencies in disease prevention, detection, and access to treatment are well documented in minority populations. African-Americans and other races are underrepresented in clinical trials, compromising the extrapolation of results from these studies to ethnic subpopulations. The influence of race on efficacy and safety of medications used in HF treatment has received additional attention with... 

Occasional exercise testing is conducted in order to ascertain disease prognosis or suitability for heart transplant. Even though these tests can demonstrate improvement in heart function and therefore slowed disease progression, patient symptoms may not improve. 

Ascites is the accumulation of fluid in the peritoneal space and is often one of the first signs of decompensated liver disease. Ascites is the most common complication of cirrhosis and portends a dire prognosis.14... 

There are an estimated 150,000 cases of SE each year in the United States, with approximately 55,000 associated deaths, and an estimated annual direct cost for inpatient admissions of 4 billion.4,5 Status epilepticus occurs more frequently in African-Americans, children, and the elderly. Additional attention should be given to elderly individuals with SE, as other underlying disease states may complicate therapy and worsen prognosis.6... 

Secondary adrenal insufficiency occurs as a result of a pituitary gland dysfunction whereby decreased production and secretion of ACTH leads to a decrease in cortisol synthesis. Tertiary adrenal insufficiency is a disorder of the hypothalamus that results in decreased production and release of CRH, which, in turn, decreases pituitary ACTH production and release. In contrast to Addison s disease (i.e., primary adrenal insufficiency), aldosterone production is unaffected in the secondary and tertiary forms of the disease. Chronic adrenal insufficiency often has a good prognosis if diagnosed early and treated appropriately. 

Lymph node involvement. Patients with node-positive disease have a worse prognosis. 

Review the patient s diagnostic information to determine the stage of disease, overall prognosis, and goals of therapy. 

Signs and symptoms of lung cancer can be classified into three subdivisions pulmonary, extrapulmonary, and paraneoplastic syndromes. Distinguishing between these classes of symptoms is important because it can aid in determining the severity of the disease, guide treatment options, and affect prognosis. 

The prognosis for prostate cancer patients depends on the histologic grade, the tumor size, and the disease stage. More than 85% of patients with stage Aj disease but less than 1% of those with stage D2 can be cured. 

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

The major prognostic factors in newly diagnosed AML are age, sub-type (FAB M2), and chromosome status. Older adults with AML (greater than 60 years), in comparison with younger patients with the same disease, have a dismal prognosis and represent a distinct population in terms of disease biology, treatment-related complications, and overall survival. These older patients have a higher incidence of unfavorable chromosomal abnormalities, such as aberrations of chromosomes 5,7, or 8, and fewer abnormalities that are associated with a more favorable outcome, such as t(8 21) or inv(16) (see Table 92—6).9... 

AML is the most common leukemia in the elderly. In comparison with younger patients with the same disease, older adults have a poor prognosis and represent a distinct population with regard to disease biology. Older adults have a lower incidence of favorable chromosomal aberrations and a higher incidence of unfavorable aberrations.9... 

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