Clinical application progress of Nottingham Hip Fracture Score / 中国基层医药

Hip fracture is the most common traumatic disease in the older adult patients, and its incidence is rising year by year. There are various clinical scoring systems for predicting postoperative complications and mortality. However, most scoring systems are not suitable for predicting postoperative complications and mortality of hip fracture. This paper summarizes the establishment, calculation, application extension and clinical application of Nottingham Hip Fracture Score, and elaborates the clinical application of Nottingham Hip Fracture Score in hip fracture patients.

Immunohistochemical evaluation of lymphovascular invasion in carcinoma breast with CD34 and D2-40 and its correlation with other prognostic markers

Background: Carcinoma breast is ever-evolving and becoming increasingly prevalent in India. Numerous prognostic factors based on morphology and immunohistochemistry (IHC) have been established which need to be interconnected to give patients best possible treatment. Aims: This study aims to confirm and analyze lymphovascular invasion (LVI) detected by hematoxylin and eosin (H and E) using IHC with CD34 and D2-40 and its correlation with other biologic and morphologic prognostic markers. Settings and Design: This was a prospective study. Materials and Methods: Fifty mastectomy specimens diagnosed as infiltrating ductal carcinoma breast on histopathology selected for the study. Evaluation of formalin-fixed paraffin-embedded sections was done using H and E and IHC for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 HER2/neu receptors, CD34, and D2-40 endothelial markers. Correlation of LVI done with prognostic markers of Carcinoma Breast, namely, age of the patient, tumor size, Nottingham grade, lymph node ratio (LNR), Nottingham prognostic index (NPI), ER/PR status, and HER2/neu status. CD34 and D2-40 utilized to distinguish blood vessel, lymph vessel, and retraction artifacts and to calculate lymphatic microvessel density (LMVD) and blood microvessel density (BMVD). Statistical Analysis Used: SPSS Software Package. Results: LVI was associated with younger age (P = 0.001), greater tumor size (P = 0.007), higher Nottingham grade (P = 0.001), higher LNR (P = 0.001), higher NPI (P = 0.001), Negative ER Status (P = 0.001), Negative PR Status (P = 0.002), Positive HER2/neu status (P = 0.021), Higher Intratumoral BMVD (P = 0.016), Peritumoral BMVD (P = 0.001), and Intratumoral LMVD (P = 0.009). Blood vessels more commonly invaded than lymph vessels. Retraction artifacts can be mistaken for LVI without IHC. Conclusions: D2-40 is a promising marker for lymphatic endothelium. LVI is a poor prognostic marker hence should be evaluated imperatively in all cases of carcinoma breast.

Feasibility of Nottingham score on predicting postoperative complications in adult patients undergoing hip surgery / 中国医师进修杂志

Objective To explore the prediction value of Nottingham hip fracture score(NHFS) on postoperative complications in patients undergoing hip surgery. Methods From January 1st 2015 to January 26th 2018, data of 904 patients who had underwent hip surgery were retrospectively analyzed. According to the NHFS, patients were divided into two groups: NHFS ≤4 scores group (783 cases) and NHFS＞4 scores group (121 cases). Patients′sex, age, height, weight, ASA grade, preoperative diagnosis, the modes of operation and anesthesia, hospital length of stay, blood loss and urinary volume, blood transfusion, using vasoactive agents, living in an institution, preoperative nurse, post-operative complications were compared. The relationship between preoperative NHFS and postoperative complications were analyzed. Results There were no significant differences between the two groups in height, weight and blood loss (P＞0.05), and 24 patients were transferred to the intensive care unit for further treatment after the operations, and 5 patients were dead during hospital stays. Compared with those in the patient of NHFS≤4 scores group, the post-operative length of stay and total hospital length of stay were significantly prolonged (P＜0.05) in the patients of NHFS＞4 scores group. Between the two groups, there were significant differences in the proportion of the male gender, body mass index, age, living in an institution, ASA grade Ⅲ- Ⅳ, proportion of fracture, the mode of anesthesia, urinary volume, proportion of blood transfusion and using vasoactive agents (P＜0.05). Postoperative renal insufficiency, pulmonary infection, heart failure or myocardial infarction, arrhythmia, deep vein thrombosis (DVT), acute cerebral infarct, electrolyte disturbance, hypoxemia, delirium, further intensive care unit treatment had significant differences between the two groups (P＜0.05). Conclusions Postoperative complications are more likely to occur in patients with higher NHFS, which might delay the postoperative length of stay and total hospital length of stay, and lead to further treatment in the intensive care unit or even mortality after the operation.

The value of Nottingham grade in breast cancer re-visited in the Sri Lankan setting

Objective: We aimed to assess the impact of Nottingham grade (NG) on breast cancer specific survival (BCSS) and recurrence free survival (RFS) of operable breast cancer (BC) patients presenting at different TNM stages in view of assessing the value of NG in prognostication of breast cancer in the Sri Lankan setting. Method: This retro-prospective study included a consecutive series of TNM stage I to III BC patients presented to our unit from 2006 to 2012. Data were collected through follow up visits, clinic and laboratory records. Grading and scoring of oestrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor 2 (Her2) expressions were done by a single investigator. Kaplan-Meier and Cox-regression models were used in the survival analysis. Results: A total of 742 (NG1-12%; NG2-45%; NG3-43%) patients with a median follow up of 39.5 (range: 12 - 138) months were included. Five-year BCSS was 94%-NG1, 80%-NG2 and 72%-NG3 (p < 0.001). Five-year RFS was 86%-NG1, 75%-NG2 and 67%-NG3 (p = 0.001). Only the lymph-node status (LNS) (p = 0.001) had an independent effect on the BCSS and RFS of NG3 patients. LNS (p = 0.001), PR (p = 0.004) and Her2 (p < 0.001) independently affected the BCSS of NG2 patients. None of the factors considered had an effect on the BCSS/RFS of NG1 patients. A significant decrease in BCSS and RFS was seen with an increase in NG in the sub-group of TNM stage III (p = 0.01 and 0.011). Conclusion: NG categorizes BC patients into prognostic groups with distinctly different survival outcomes. Sub-categorization of TNM stage III by NG is suggested.

Correlation of various histopathologic prognostic factors with Nottingham prognostic index and microvessel density in invasive breast carcinoma: A study of 100 cases.

BACKGROUND: Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. METHODS: This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. RESULTS: Of the 100 cases, 54% of the tumors were in T2 tumor size category (2‑5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41‑5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). CONCLUSION: NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.

Research progress and development direction on histological classification system of breast cancer / 实用肿瘤学杂志

Histological classification system ( HCS) is an important system in judging and predicting ma-lignant behaviors of breast cancer .This study is aimed to analyze research progress and development direction of HCS by perusing literatures ,including the origin and development progress of HCS ,contents and deficiencies of Nottingham classification system(NCS),and introduction of novel classification system .HCS of breast cancer has a history of more than one hundred years ,among which NCS is the most widely used ,based on morphological fea-tures of cancer cells .However,there are still some shortcomings about NCS ,such as few indexes incorporation , great evaluation variation and low evaluation efficiency .Recently ,many newly evaluation systems have been devel-oped,including“nucleus+proliferation”classification system ,computer assisted classification system and compre-hensive prognostic classification model .Therefore,the future development directions of HCS on breast cancer is to use high throughput analysis technology to extract and analyze the hidden molecular information in cancer cells and the surrounding tumor microenvironment ,so as to better guide personalized therapy and predict clinical prog-nosis.

Correlation between blood flow parameters by three-dimensional sonography and Nottingham prognostic index of breast cancer / 中华超声影像学杂志

Objective To study the correlation between blood flow parameters by three-dimensional sonography and Nottingham prognostic index (NPI) of breast cancer.Methods A retrospective analysis of sonographic image data of 89 patients who were pathologically confirmed invasive ductal breast cancer was made.The technology of three-dimensional color power angiography (3D-CPA) was used to obtaining vascular index (VI),flow index (FI) and vascular-flow index (VFI) before the operation.NPI was obtained by a formula which was computed on a basis of postoperative pathological data.The case of VI,FI and VFI in different grades and NPI in various prognosis groups were counted,and the relationship between blood flow parameters and NPI was analyzed.Results The correlation coefficient between VI and NPI was 0.643 (P ＜0.0001) and there was no significant correlation between FI,VFI and NPI.Conclusions Among VI and NPI there was a considerable positive correlation,VI was helpful to evaluate the prognosis of patients before operation and to provide basis for clinical treatment programs.

Avaliação da qualidade de vida de idosos em um município do Sul do Brasil / Assessment of the quality of life of elderly in a city in Southern Brazil

O objetivo do estudo foi avaliar a qualidade de vida de idosos residentes em um município do Sul do Brasil e verificar a correlação entre os domínios contemplados pelo instrumento de pesquisa e a faixa etária e o gênero. Para isso, foi conduzido um estudo observacional, transversal, com 376 idosos, utilizando um instrumento genérico de avaliação da qualidade de vida, desenvolvido na Inglaterra e adaptado para o Brasil: Perfil de Saúde de Nottingham. Os resultados apontaram uma pior qualidade de vida nos indivíduos do gênero feminino quando comparados com os indivíduos do gênero masculino, principalmente nos domínios "reações emocionais" (p=0,004), "interação social" (p=0,001) e "habilidades físicas" (p=0,009). Também em ambos os gêneros, e com exceção do domínio "interação social", constatou-se uma piora estatisticamente significativa (p<0,05) na qualidade de vida com o aumento da faixa etária. Os resultados permitem concluir que, ao longo do processo de envelhecimento, há piora na qualidade de vida.

This study aimed to evaluate the quality of life of elderly people living in a city in Southern Brazil and the correlation between the areas covered by the research instrument and the age and gender of the elderly. Therefore, a cross-sectional observational study with 376 elderly was conducted, with the use of a simple instrument of assessment of quality of life developed in England and adapted to Brazil: The Nottingham Health Profile. The results indicated poorer quality of life in women compared to men, particularly in the areas "emotional reactions" (p=0.004), "social interaction" (p=0.001) and "physical abilities" (p=0.009). Also, in both genders, and except for the area of "social interaction", a statistically significant worsening (p<0.05) in the quality of life was associated with aging. The study results showed that the more advanced the age, the worse the quality of life of the study population.

Comparisons of the Nottingham Health Profile and the SF-36 health survey for the assessment of quality of life in individuals with chronic stroke / Comparação do perfil de saúde de Nottingham e SF-36 na avaliação da qualidade de vida de indivíduos com acidente vascular encefálico crônico

BACKGROUND: Appropriate instruments for the assessment of health-related quality of life (HRQOL) domains are useful for planning therapeutic interventions for individuals with stroke. The generic quality of life (QOL) instruments, Short Form Health Survey-36 (SF-36) and Nottingham Health Profile (NHP), have been frequently employed in the Brazilian literature. However, the literature is still scarce regarding their psychometric properties when applied to stroke individuals. OBJECTIVES: To compare the Brazilian versions of the SF-36 and the NHP to verify which had better psychometric properties for the assessment of HRQOL in 120 individuals with chronic stroke. METHOD: Spearman correlation coefficients were calculated to examine the comparable domains and total scores of the SF-36 and the NPH; Cronbach's alpha coefficients, to evaluate internal consistency; intra-class correlation coefficients, to assess reliability; and Bland-Altman plots, to assess the levels of agreement, with a significance level of 5%. RESULTS: Significant positive associations were observed between the common domains and the total scores of the SF-36 and the NPH. Ceiling effects were more frequent for the NPH. The total scores of both instruments achieved adequate reliability levels, and the agreement levels were within the normal limits in 95% of the cases. CONCLUSIONS: The SF-36 and the NPH were shown to measure similar constructs and proved to be useful measures for the assessment of QOL of chronic stroke subjects. However, the SF-36 yielded better results and appeared to be more appropriate.

CONTEXTUALIZAÇÃO: Instrumentos adequados para avaliar os vários domínios da qualidade de vida (QV) relacionada à saúde (QVRS) constituem uma importante abordagem para o planejamento terapêutico e, assim, melhor assistir os indivíduos acometidos pelo acidente vascular encefálico (AVE). Na literatura brasileira, os instrumentos genéricos Formulário Abreviado de Avaliação de Saúde 36 (SF-36) e Perfil de Saúde de Nottingham (PSN) têm sido bastante empregados, entretanto, ainda existem lacunas relativas às suas propriedades psicométricas quando aplicados em indivíduos pós-AVE. OBJETIVOS: Comparar as versões brasileiras dos instrumentos SF-36 e PSN e verificar qual deles apresenta melhores propriedades psicométricas para avaliar a QVRS de 120 indivíduos na fase crônica pós-AVE. MÉTODO: A comparação entre os domínios comuns e escores totais do SF-36 e PSN foi realizada pelo Coeficiente de Correlação de Spearman, Coeficiente Alpha de Cronbach, para avaliar a consistência interna; Coeficiente de Correlação Intraclasse, para mensurar a confiabilidade, e o teste de plotagem Bland-Altman para a concordância, com nível de significância de 5% em todos os cálculos. RESULTADOS: Todas as correlações entre o SF-36 e o PSN, escores totais e domínios comuns, foram positivas e estatisticamente significativas. Observou-se maior frequência de efeito teto no PSN. Os escores totais de ambos atingiram níveis adequados de confiabilidade, e os níveis de concordância estavam dentro dos limites normais em 95% dos casos. CONCLUSÕES: SF-36 e PSN mensuraram constructos semelhantes e demonstraram ser úteis para avaliar QV de indivíduos pós-AVE crônico. No entanto, o SF-36 proporcionou melhores resultados e pareceu ser mais apropriado.

Confiabilidade do Perfil de Saúde de Nottingham após acidente vascular encefálico / Reliability of the Nottingham Health Profile after suffering a stroke

This article seeks to evaluate the reliability, internal consistency and accuracy of the Nottingham Health Profile (NHP), namely a quality of life (QL) instrument for individuals after suffering a stroke. This cross-sectional study was carried out in the communities of Recife in the State of Pernambuco. The sample was composed of 53 individuals at the chronic stroke phase. After checking the cognitive state, the NHP was applied. Descriptive statistics were employed for characterization of the sample; Cronbach's alpha (α) coefficients were used for evaluation of internal consistency, and intra-class correlation coefficients (ICC) were used for investigation of reliability, as well as consistency of the Bland and Altman plotting tests with 5% level of significance. Their perceptions of their own health were 83.3% positive for the majority of NHP criteria (average scores > 50 points), except for the "physical ability" criterion where scores ranged between 41.5 and 50 points. The NHP had good internal consistency with α values between 0.81 to 0.87; excellent reliability indices for the "pain" and "physical ability" criteria (ICC > 0.90); and 95% consistency. Besides being simple and easily applied, NHP had adequate clinimetric properties for the assessment of individuals after a chronic stroke.

O artigo tem o objetivo de avaliar a confiabilidade, a consistência interna e a concordância do instrumento de qualidade de vida (QV) Perfil de Saúde de Nottingham (PSN) em indivíduos após Acidente Vascular Encefálico (AVE). Estudo do tipo transversal realizado em comunidades da Cidade do Recife-PE. A amostra foi composta por 53 indivíduos na fase crônica do AVE. Após verificação do estado cognitivo foi aplicado o PSN. Utilizou-se estatística descritiva para caracterizar a amostra; a consistência interna foi medida através do alfa (α) de Cronbach; a confiabilidade com o coeficiente de correlação intraclasse (CCI) e a concordância pelo teste de plotagem Bland and Altman, com nível de significância de 5%. A percepção dos indivíduos sobre suas saúdes teve uma tendência positiva em 83,3% dos domínios do PSN (média > 50 pontos), exceto para o domínio "habilidades físicas" que variou entre 41,5 e 50 pontos. O instrumento obteve boa consistência interna, com α entre 0,81 e 0,87; excelente confiabilidade nos domínios "dor" e "habilidades físicas", ICC >0,90 (p <0,01); e concordância em 95% das ocasiões. O PSN, além de ser um instrumento simples e de fácil aplicação, apresentou propriedades clinimétricas adequadas para avaliar a QV de indivíduos pós-AVE na fase crônica.

Contrast-enhanced ultrasound features and Nottingham prognostic index in patients with breast cancer / 中华内分泌外科杂志

ObjectiveTo study the correlation between contrast-enhanced ultrasound (CEUS) features and Nottingham prognostic index (NPI) in patients with breast carcinoma. Methods The ultrasound features and microvascular imaging manifestation of 91 breast carcinomas confirmed by pathology were retrospectively analyzed.NPI was typically stratified into 3 major groups:NPI ＜ 3.4 ( n =19 ), NPI:3.4-5.4 ( n =52 ) and NPI ＞5.4(n =21 ). Results With the increase of NPI, the rate of heterogeneous enhancement, perfusion defects, edge enhancement higher than center enhancement, and unclear border increased.The difference among the 3 groups had statistical significance (P ＜ 0.05 ).There was no significant difference in enhancement order among the 3 groups ( P ＞ 0.05 ).The lesions of the 3 groups were mainly “high enhancement” and there was no significant difference among the 3 groups ( P ＞ 0.05 ).With the increase of NPI, the rate of early enhancement and late regression increased.The difference among the 3 groups had statistical significance ( P ＜ 0.05 ).With the increase of NPI, the rate of enlarged and twisted vessels as well as peripheral vessel burr increased.There was significant difference among the 3 groups ( P ＜ 0.05 ).ConclusionCEUS festures and microvescular architecture pattern of breast carcinoma are related to NPI, which is useful in predicating the prognosis of breast carcinoma.

Comparisons between the Nottingham Health Profile and the Short Form-36 for assessing the quality of life of community-dwelling elderly / Comparação dos instrumentos de qualidade de vida Perfil de Saúde de Nottingham e Short Form-36 em idosos da comunidade

BACKGROUND: The aging population and associated high disability rates make the assessment of health-related quality of life (HRQOL) a high priority for elderly people. OBJECTIVES: To compare the Brazilian versions of the Nottingham Health Profile (NHP) and the Short Form Health Survey-36 (SF-36) regarding their measurement properties, such as, ceiling and floor effects, inter-rater/test-retest reliabilities, internal consistency, and the associations between the total scores and those of similar domains. METHODS: The NHP and the SF-36 were randomly administered through interviews to 40 community-dwelling elderly (mean age 70.57; SD=7.42 years). The scores of the five similar domains of the NHP and the SF-36, in percentages, were compared: Energy level/Vitality (EL/V), pain, emotional reactions/mental health (EM/MH), social isolation/social functioning (SI/SF), and physical mobility/physical functioning (PA/PF). Descriptive statistics, Spearman Correlation Coefficient, a-Cronbach, and Intraclass Correlation Coefficients (ICCs) were used for analyses (a=0.05). RESULTS: Both instruments demonstrated ceiling and floor effects for all similar domains, however the NHP showed, on average, higher scores for individual domains and total scores, as well as, floor effects for the SI domain. The internal consistency (NHP=0.86; SF-36=0.80), the inter-rater reliability (NHP=0.99; SF-36=0.96) and the test-retest reliability (NHP=0.94; SF-36=0.83) were considered adequate. Positive and statistically significant correlations were found between all similar domains (p≤0.01; 0.41≤rs≤0.70), except for those related to EL and vitality (rs=0.21;p=0.19). CONCLUSIONS: The SF-36 demonstrated to be more adequate regarding the ceiling and floor effects, whereas the NHP presented a higher internal consistency and reliability levels. These findings should be considered for selecting instruments for the assessment of HRQOL of community-dwelling elderly.

CONTEXTUALIZAÇÃO: O envelhecimento populacional, associado ao aumento das incapacidades, torna a avaliação da qualidade de vida relacionada à saúde (QVRS) essencial nessa população. OBJETIVOS: Comparar a versão brasileira dos instrumentos de QVRS, Perfil de Saúde de Nottingham (PSN) e Medical Outcomes Study 36 - Item Short Form Health Survey/Short Form-36 (SF-36), quanto aos efeitos teto/chão, confiabilidade teste-reteste/interexaminadores, consistência interna e pontuação total nos domínios similares. MÉTODOS: Os instrumentos PSN e SF-36 foram aleatoriamente administrados sob a forma de entrevista em 40 idosos da comunidade (70,57±7,42 anos). A pontuação total e a obtida nos cinco domínios similares do PSN e SF-36 foram comparadas: nível de energia/vitalidade (NE/V), dor/dor, reações emocionais/saúde mental, interação social/aspectos sociais (IS/AS) e habilidades físicas/capacidade funcional. Estatística descritiva, teste de Correlação de Spearman, a-Crombach e Coeficientes de Correlação Intraclasse (CCI) foram usados para análise (a=0,05). RESULTADOS: Ambos os instrumentos apresentaram efeito teto em todos os domínios comparáveis, mas o PSN apresentou maior pontuação em cada domínio e no escore total, efeito teto na pontuação total e efeito chão no domínio de IS. Os valores de a-Crombach foram adequados para ambos (PSN=0,86; SF-36=0,80), assim como o CCI da confiabilidade interexaminadores (PSN=0,99; SF-36=0,96) e teste-reteste (PSN=0,94; SF-36=0,83). Todos os domínios similares e a pontuação total correlacionaram-se significativa e positivamente (p£0,01; 0,41£rs£0,70), excetuando os de NE/V (p=0,19; rs=0,21). CONCLUSÕES: O SF-36 mostrou-se mais adequado com relação aos efeitos teto/chão, enquanto o PSN apresentou níveis mais altos de consistência interna e confiabilidade. Esses achados devem ser considerados na escolha do instrumento de avaliação da QVRS de idosos da comunidade.

Rendimiento auditivo en pacientes menores de 2 años comparado con pacientes entre 2 y 5 años con implante coclear / Auditory performance in patients younger than 2 years old and patients between two and five years old who were intervened with cochlear implant

Objetivos: Conocer y comparar la evolución del rendimiento auditivo de los pacientes menores de 2 años (prelinguales) y entre 2 a 5 años (perilinguales) con hipoacusia neurosensorial severa a profunda que fueron intervenidos con la colocación del implante coclear. Materiales y métodos: Estudio descriptivo de pacientes del programa de implante coclear del Hospital Militar Central y el Hospital Universitario Clínica San Rafael. Se incluyeron pacientes prelinguales y perilinguales a los cuales se les realizó seguimiento del rendimiento auditivo con las pruebas de IT-MAIS y otthingham durante 3, 6 y 12 meses posimplante durante los años 2001 a 2008. Resultados: La población blanco fueron 84 pacientes de los cuales 53 pacientes cumplieron con los criterios de inclusión, 13 fueron prelinguales y 40 en proceso de adquisición del lenguaje o perilinguales, las dos pruebas alcanzaron un valor estadísticamente significativo con p menor de 0.05, a favor del grupo de pacientes prelinguales, es decir, que la intervención con el implante coclear en los pacientes prelinguales tiene mejor resultado que en los pacientes perilinguales. Conclusión: los pacientes prelinguales con implante coclear tienen mejor rendimiento auditivo que los pacientes perilinguales al año de seguimiento.

Objectives: To get to know and compare the evolution of auditory performance of children younger tan 2 years old (prelingual) and children between two and five years old (perilingual) with severe to profound sensorineural hearing loss that were implanted with a cochlear implant. Material and Methods: A descriptive study of patients that are part of the cochlear implant program at Hospital Militar central and at Hospital Universitario Clínica San Rafael. Prelingual and perilingual patients were included for follow - up of the auditory performance with the following tests IT-MAIS and Nottingham for 3, 6 and 12 months after the implant from 2001 to 2008. Results: The target population was 84 patients out of which 53 patients complied with the inclusion criteria, 13 of which were prelingual and 40 were in the process of acquiring the language or perilingual. Both tests reached a statistically significant value with p lower than 0.05, in favor of the prelingual group of patients. That is, the surgery with a cochlear implant has a better result in prelingual patients than it does in perilingual patients. Conclusion: perilingual patients with cochlear implants have a better auditory performance than perilingual patients after a follow-up of a year.

Breast carcinoma grading, estimation of tumor size, axillary lymph node status, staging, and nottingham prognostic index scoring on mastectomy specimens.

Introduction: Breast carcinoma is the most common malignant tumor and the leading cause of cancer death in women. In western countries, a sharp increase in the detection of breast carcinoma, largely due to widespread use of mammography, has recently led to a fall in breast cancer mortality. This, however, is not true for less developed countries, in which mortality continues to rise. Objective: The aim of this study was to acquire information about the extent and spread of breast carcinoma in our patients by grading the tumors, determining the tumor size, and axillary lymph node status, staging of the tumors and Nottingham Prognostic Index (NPI) scoring on the available material. Materials and Methods: One hundred and twenty consecutive mastectomy specimens with axillary lymph node sampling removed for breast carcinoma and received in the section of histopathology, Aga Khan University, in the year 2005, were included in the study. Standard protocols were used for the processing of the specimens, and reporting was done using a standard format incorporating all relevant tumor parameters. NPI was applied to the cases. Results: Out of the 120 cases, 5 (4.17) were grade 1, 91 (75.83) were grade 2, and 24 (20%) were grade 3. Also, 9 cases (7.5%) were T1 (4 were T1b, and 5 were T1c); 53 (44.16%) were T2; 50 (41.66%) were T3; and 8 (6.66%) were T4. Axillary lymph nodes were available in 107 cases. In 13 cases, no lymph nodes were recovered. Out of 107 cases 27 (25.23%) lymph nodes were negative for metastases pN0; 29 (27.10%) cases were pN1; 26 (24.30) were pN2; and 25 cases (23.36%) were pN3. Extranodal spread was present in 56 (70%) out of the 80 cases in which lymph nodes were positive. The average microscopic size of nodal metastasis was 1.7 cms. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). Tumor necrosis was present in 76 out of 120 cases (63.33%). Vascular invasion was present in 43 out of 120 cases (35.83%). NPI scores were greater than 5.4 in 60 out of 107 cases (56.1%) indicating poor prognosis. Conclusion: The large majority of the cases were grade 2 tumors. Most cases (all grades) were T2 or T3, and were axillary lymph node positive. Large majority of cases with nodel metastases showed extra nodal spread. The majority of patients had NPI scores greater than 5.4 indicating poor prognosis. Significant statistical association was found between the number of positive nodes and perinodal extension (P = 0.001). The findings show extensive and advanced disease trends in our patients.