Clinical investigation of hospitalized human cases of West Nile virus infection in Houston, Texas, 2002-2004.

The objective of this study was to describe the clinical features of cases hospitalized with West Nile virus (WNV) infections and identify clinical parameters that could potentially predict poor outcome (death). Retrospective medical chart reviews were completed for 172 confirmed cases of WNV infection hospitalized in the Houston, Texas, metropolitan area between 2002 and 2004. Of the 172 patients, 113 had encephalitis which resulted in 17 deaths, 47 had meningitis, and 12 had uncomplicated fever. Risk factors associated with progression from encephalitis to death were absence of pleocytosis in the cerebrospinal fluid, renal insufficiency, requiring intubation and mechanical ventilation, presence of myoclonus or tremors, and loss of consciousness. These findings can aid physicians in evaluating their patients suspected of WNV infection and determining outcomes in their patients with confirmed WNV neuroinvasive disease.

Risk factors for encephalitis and death from West Nile virus infection.

We conducted a nested case-control study to determine potential risk factors for developing encephalitis from West Nile virus (WNV) infection. Retrospective medical chart reviews were completed for 172 confirmed WNV cases hospitalized in Houston between 2002 and 2004. Of these cases, 113 had encephalitis, including 17 deaths, 47 had meningitis, and 12 were fever cases; 67% were male. Homeless patients were more likely to be hospitalized from WNV compared to the general population. A multiple logistic regression model identified age [odds ratio (OR) 1.1, P<0.001], history of hypertension, including those cases taking hypertension-inducing drugs (OR 2.9, P=0.012), and history of cardiovascular disease (OR 3.5, P=0.061) as independent risk factors for developing encephalitis from WNV infection. After adjusting for age, race/ethnicity (being black) (OR 12.0, P<0.001), chronic renal disease (OR 10.6, P<0.001), hepatitis C virus (OR 23.1, P=0.0013), and immunosuppression (OR 3.9, P=0.033) were identified as risk factors for death from WNV infection.

Breast cancer in the elderly.

OBJECTIVE/METHODS: To determine the clinical behavior and outcome of breast cancer in the elderly, a series of 184 women older than age 69 years who received treatment for locoregional breast cancer at The University of Texas M. D. Anderson Cancer Center between 1976 and 1985 were studied for a median of 80 months. RESULTS: The results indicate that elderly women can tolerate standard surgical therapy and survive disease-free for many years; the breast cancer-specific survival rate of patients in this study was 79% at 7 years. Although 33% of patients had stage I disease, only 10% underwent breast conservation surgery. Despite 46% of patients having stage II and 21% having stage III breast cancer, fewer than 13% received systemic adjuvant therapy. Noncompliance with breast screening guidelines was evident in that only 3% of patients had tumors detected by routine screening mammograms and only 12% by routine physical examinations. CONCLUSIONS: Women with breast cancer should be informed of treatment options and the advantages and disadvantages of each choice based on physiologic rather than chronologic age.

Factors influencing management of breast cancer in the elderly woman.

Elderly women have the same right as their younger counterparts to be a part of the decision-making process of their health care. Women with breast cancer should be informed of treatment options and the advantages and disadvantages of each choice as it applies to their individual circumstance. Clinical judgment should be used in patients with poor performance status and known limited life expectancy as to the optimal approach that will provide the best quality of life for the maximum duration but with acceptable risks to the patient.

The prognosis of breast cancer in males. A report of 335 cases.

BACKGROUND: Because of the relative rarity of breast cancer in males, data have not been sufficient to support a definitive analysis of pertinent prognostic factors. Remarkably, no studies of male patients with breast cancer have presented survival information based on the number of histologically positive axillary nodes, the most sensitive single indicator of prognosis in women with breast cancer. METHODS: In this study, the clinical course of breast cancer was documented for 335 male patients registered from 1965 through 1986. For patients to be eligible, diagnoses had to be made within 3 months of registration and the patients had to have histologic confirmation and receive part or all of their initial treatment at 1 of 11 cancer centers participating in the International Patient Data Exchange System. RESULTS: The survival rate at 10 years was 84% for patients with histologically negative nodes, 44% for those with one to three positive nodes, and 14% for the group with four or more histologically positive nodes. The survival rates at 5 years were 90%, 73%, and 55%, respectively. In a multivariable analysis, the risk of death due to breast cancer for a patient with four or more histologically positive nodes was 6.75 times that of a patient with negative nodes. CONCLUSIONS: The findings of the authors indicate the following: (1) The number of histologically positive axillary nodes and, to a lesser degree, tumor diameter are significant prognostic factors for breast cancer in male patients. (2) The prognosis of breast cancer is the same in male and female patients when compared on the basis of the number of histologically positive nodes.

Histoplasmosis in hairy cell leukemia: case report and review of the literature.

Progressive disseminated histoplasmosis (PDH) has been described in only six patients with hairy cell leukemia (HCL). Herein we describe an additional patient with HCL and disseminated histoplasmosis. Additionally, we note that three of seven cases of disseminated histoplasmosis and HCL have occurred in East Texas. PDH is to be suspected in febrile HCL patients in an endemic area who fail to respond to antibacterial therapy. We emphasize that serologic studies are useful in the diagnosis of PDH in HCL patients, and these patients respond well to therapy.

Intracranial ependymoma in children: analysis of prognostic factors.

Between 1955 and 1986, 25 children (aged 2 weeks to 15 years) were treated for intracranial ependymoma at M.D. Anderson Cancer Center. Nine patients had supratentorial primaries (5 high-grade, 4 low-grade), and 16 had infratentorial primaries (9 high-grade, 7 low-grade). Five patients had gross complete resection and 20 had incomplete resection. Seven patients received craniospinal irradiation (25-36 Gy to the neuro-axis, 45-55 Gy to tumor bed), 12 received local field irradiation (29-60 Gy, median 50 Gy). Five infants had adjuvant chemotherapy without radiotherapy, and 6 children had post-radiotherapy adjuvant chemotherapy, and 12 patients had salvage chemotherapy with various agents and number of courses. Eight patients are alive, disease-free and without relapse from 1 year to 12 1/2 years from diagnosis (median 42 months). The primary failure pattern was local recurrence. The data suggest that 1) the long-term cure rate of children with ependymoma is suboptimal; 2) histologic grade may be of prognostic importance for supratentorial tumors; 3) prognosis appears worse for girls and infants under 3 years of age; 4) in well-staged patients routine spinal irradiation could be omitted; 5) the role of adjuvant chemotherapy is unclear.

Surgical management of groin nodal metastases from primary melanoma of the lower extremity.

A review was conducted of 264 consecutive patients who underwent surgical treatment for nodal metastases of the groin area from a primary melanoma of the lower extremity. We found no significant difference in survival or regional control created by the extent of node dissection performed, whether or not surgical treatment was a superficial femoral (n = 133) or an iliac and femoral node dissection (n = 131). We also determined that the age and sex of the patient, the location of the primary melanoma and the time that elapsed before the development of nodal metastases were not significant factors. However, the extent of tumor burden (the number of positive nodes and presence of extranodal disease) was useful in predicting patient survival and subsequent nodal basin relapse. Future improvement in survival rates will require effective systemic regimens rather than radical surgical treatment alone.

Superior sulcus tumors: treatment selection and results for 85 patients without metastasis (Mo) at presentation.

Superior sulcus (Pancoast) tumors (SST) are uncommon carcinomas of the lung with distinctive failure patterns and a somewhat more favorable prognosis than other sites of lung cancer. The most effective use of surgery (S), radiation (R), and chemotherapy (C) is not resolved. Most reported series include patients treated before the era of computed tomography (CT). A retrospective study was undertaken of all previously untreated patients with SST who received definitive management at the University of Texas M.D. Anderson Cancer Center between January 1977 and December 1987. Eighty-five patients were treated: the male:female ratio was 2.7:1, and the ages ranged from 35 to 80 (median 59) years. Karnofsky performance status (KPS) was 80 or more in 70 patients (82%). Thirty patients (35%) had lost 5% or more body weight. All had histologic or cytologic confirmation of carcinoma: 25% were squamous cell, 2% small cell, 54% adenocarcinoma, and 6% were large cell carcinoma (12% were not classified). After complete evaluation, 43 were classified as clinical Stage IIIA and 42 were Stage IIIB. One Stage IIIA patient received surgery, 13 surgery + radiation therapy, 2 surgery + radiation therapy and chemotherapy, 19 radiation therapy and 8 radiation therapy + chemotherapy. Seven Stage IIIB patients received surgery + radiation therapy, 12 radiation therapy, 2 surgery + radiation therapy + chemotherapy, 17 radiation therapy + chemotherapy and 4 chemotherapy. Surgery was a component of therapy more frequently in Stage IIIA than IIIB (p less than .05) and systemic treatment chemotherapy was used significantly more often (p less than .01) in Stage IIIB. Twenty-six patients (31%) lived 2 years or more (25+ to 131+ months) after treatment. Stage IIIA patients had a 46.5% 2-year survival rate compared to 20.6% for Stage IIIB (p = .0042). The one patient treated with surgery alone lived 2 years; 23% (7/31) of patients who had radiation therapy alone and none of the 4 who had chemotherapy lived 2 years. When surgery was a component of treatment, 52% (13/25) lived 2+ years, compared with 22% (13/60) when surgery was not part of treatment. When radiation therapy was part of treatment 31% lived 2 years and when chemotherapy was used, 18% lived 2 years. Fifty-two patients (61%) had control of the local tumor: their survival was significantly greater (p less than .01) than those who had local failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term survival and prognostic factors for 2170 breast cancer patients treated at two cancer centers (Milan and Houston).

Data on 2170 consecutive patients with breast cancer submitted to curative surgery with or without combined radiotherapy in the period 1968-1972 at the National Cancer Institute of Milan (Italy) and at the University of Texas M.D. Anderson Cancer Center of Houston (Texas, USA) were analyzed to evaluate the prognosis of breast cancer patients after loco-regional treatment only and to verify if different prognostic factors have the same relevance. Forty-four percent of patients were alive without evidence of disease at the end of the follow-up in both centers: 14% of patients treated in Milan died without evidence of breast cancer with an intercurrent disease, whereas the death rate for intercurrent disease was 27% in Houston. Thirty-seven percent of the patients in Milan and 26% of the patients in Houston died from breast cancer. A considerable percentage of patients (23.4% in Milano, 38.2% in Houston) had one or more of the required items not specified in the clinical chart. Since the lack of information was considered a possible source of bias, the series were divided into two groups: the first collecting patients with all information available, the second gathering patients with at least one of the required items missing. The latter group was defined "unknown". Multivariate analysis of survival, carried out by means of Cox's regression model, showed that mortality of these patients for all causes was significantly affected by the following criteria: status of regional nodes (P = 2 X 10(-13)), unknown (P = 10(-9)), maximum diameter of primary tumor (P = 7 X 10(-10)), age of the patients (P = 10(-4)), site of primary (P = 0.01), and Center (P = 0.04). A significant interaction was found between center and a) age of the patients, b) menopausal status and c) unknown. The relative P values were 6 X 10(-7) for age and center, 8 X 10(-3) for menopausal and center, 3 X 10(-2) for unknown and center. Multivariate analysis of breast cancer mortality was significantly affected by: status of regional nodes (P = 10(-18)), diameter of primary (P = 5 X 10(-14)), unknown (P = 2 X 10(-13)), center (P = 2 X 10(-6)), site of primary (P = 0.002), and age of the patients (P = 0.03). The same significant interaction as for mortality from all causes was found. It is concluded that comparability of results obtained in different institutions may be dependent on the standardization and availability of patients data.(ABSTRACT TRUNCATED AT 400 WORDS)

Prognostic factors in patients dying of well-differentiated thyroid cancer.

While some well-differentiated cancers of the thyroid gland are unusually aggressive, most have a more benign clinical behavior, making it difficult to evaluate factors possibly influencing patient survival such as initial surgical treatment. By studying 135 patients who received their initial surgical therapy at our institution, we have defined the prognostically significant factors. Sixteen patients (11.9%) died of disease during a ten- to 20-year follow-up period. Significant factors associated with death from disease were aged 40 years or older, primary lesion size of 2.5 cm or greater, presence of invasive characteristics, and presence of distant metastases. We recommend total thyroidectomy and postoperative sodium iodide I 131 therapy in patients 40 years of age or older, while suggesting a less aggressive approach may be appropriate in the younger patients.

Desmoplastic melanoma. Histologic correlation with behavior and treatment.

Desmoplastic (neurotrophic) melanoma is a histologic variant of cutaneous melanoma that has a distinct clinical behavior. To better understand this behavior and to treat the disease more effectively, the medical records of 16 patients treated for this disease over a 12-year period were reviewed. Thirteen patients had head and neck lesions, the ear being a common site. The average thickness of the lesions was 5.75 mm. Six (46.2%) of 13 patients had local recurrence of disease. Only two patients (15.4%) developed regional node metastases. None of the patients with clinically NO desmoplastic melanoma were found to have positive nodes after elective neck dissection, regardless of the thickness of the primary lesion. Wide excision of the primary lesion with frozen section control of surgical margins and careful examination for the presence of perineural invasion is important in determining the extent of surgical resection.

The implication of tobacco use in the young adult with head and neck cancer.

To define the biologic characteristics of head and neck cancer in the young adult, the clinical course of 83 previously untreated patients less than or equal to 40 years of age with head and neck cancer was reviewed retrospectively. Their course was compared to that in a randomly chosen, concurrently treated, site-matched and stage-matched older head and neck cancer population (matched control). Patterns of recurrence as well as overall disease-free survival in each of the two populations were not significantly different. An important stratification factor, however, was related to tobacco usage. Thirty percent of the young patients denied using tobacco compared with only 9% of the controls (P less than 0.05). The 5-year disease-free survival rate of the young adults who did not use tobacco was 66% compared with 86% for their matched control group with a history of smoking. These differences were most significant in young adults with Stage II disease (P less than 0.05 by log-rank testing). The growth and progression of head and neck cancer in the young adults is characterized by tobacco use patterns; a family history of head and neck cancer in five of 17 nontobacco using young adults raises the issue of an inherent genetic determinant.

Melanoma with metastasis to regional axillary or inguinal lymph nodes: prognostic factors and results of surgical treatment in 714 patients.

In a retrospective analysis of 714 patients with melanoma who had node dissection for histologically positive regional axillary or inguinal node metastases at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston during a 30-year interval (1944 to 1974), with a minimum of ten years of follow-up, we determined that the major prognostic factor of survival was the number of positive nodes. Other prognostic variables independent for the number of positive nodes were the favorable survival in patients with primary melanoma on the calf, and the adverse survival effect of extranodal melanoma at node dissection or recurrent metastases within the node dissection region. Factors that did not predict survival after the development of regional node disease were the age, sex, and race of the patient; location of the primary melanoma other than calf; immediate versus delayed node dissection; adjuvant treatment after node dissection; and the development of regional in-transit cutaneous metastases. Metastasis to regional nodes as a harbinger of disseminated disease was reflected in the 33% five-year and 28% ten-year survivals calculated from the date of node dissection.

Prognostic factors in patients with regional cervical nodal metastases from cutaneous malignant melanoma.

A retrospective analysis with a minimum 10 year follow-up was performed on 287 patients who underwent radical or modified neck dissections with histologically involved regional nodal metastases from cutaneous malignant melanoma. The cumulative 5 year and 10 year survival rates calculated from the time of node dissection were 33 percent and 28 percent, respectively. Age and sex of the patient, site of known primary tumor, clinical stage at presentation, and time interval from the treatment of the primary tumor to node dissection did not independently affect survival. However, an unknown site of primary disease, the presence of only one histologically involved node, and the absence of extranodal tumor invasion at the time of node dissection were statistically significant individual prognostic factors for an improved survival rate.

Structural functions of the sweet pharmacophore.

The relative sweetness, onset times, and durations of response of D-glucose, D-xylose, D-quinovose, D-galactose, L-arabinose, and D-fucose were determined at four temperatures. The results can be interpreted by simple concepts of intramolecular hydrogen bonding which indicate that the so-called gamma-function of the tripartite AH,B, gamma sweet pharmacophore plays little or no part in sugar sweetness. Probably the Lemieux effect (intramolecular hydrogen bonding between the hydroxymethyl substituent and the 4-hydroxy group) is of overriding importance in determining sugar sweetness, and the separate features of intensity and time of response indicate distinct functions of chemoreception. The absence of a gamma-function in simple hydrophilic molecules such as glucose has already been emphasized. This function distinguishes them from the artificial sweetners such as saccharin, which may be 500 times or more sweeter than sucrose, depending on their stereostructure and lipophilicity.

Free sugars and sorbitol in fruits--a complication from the literature.

The glucose, fructose, sucrose, and sorbitol content of apple, pear, plum, cherry, grape, strawberry, raspberry, blackberry, and peak fruit was compiled from the literature; their range, mean, standard deviation, and percent coefficient of variance were calculated. The individual fruits have characteristic patterns relating to their sorbitol content, glucose: fructose ratio, and sucrose content which are influenced to only a small degree by variety, season, or geographic origin. Processing in many cases has a marked effect on sucrose content.

Alpha-glactosidase activity of lactobacilli.

alpha-Galactosidase (EC 3.2.1.22) activity was observed in cell-free extracts of Lactobacillus fermenti, L. brevis, L. buchneri, L. cellobiosis, and L. salivarius subsp. salivarius. The cultural conditions under which the enzyme activity was detected suggest that the enzyme is constitutive and present in the soluble fraction in the cell. The enzyme preparations readily hydrolyzed melibiose and other oligosaccharides containing alpha(1 --> 6) linked galactose. Although the cell-free extracts of L. fermenti and L. brevis are negative for beta-fructofuranosidase (EC 3.2.1.26), they hydrolyzed melibiose, stachyose, and raffinose in decreasing order of activity. The beta-fructofuranosidase-positive L. buchneri, L. cellobiosis, and L. salivarius preparations hydrolyzed melibiose, raffinose, and stachyose in decreasing rates of activity. The alpha-galactosidases from different lactobacilli showed optimum activity in pH range 5.2 to 5.9. L. fermenti and L. salivarius preparations exhibited maximum activity between 40 to 44 C and 48 to 51 C, respectively, whereas a 38 to 42 C range was observed for other lactobacilli. Cell-free extract of L. cellobiosis was studied for transgalactosylase activity. When incubated with melibiose, a new compound was detected and tentatively identified as manninotriose.