Prognostic factors for patients with skeletal metastases from carcinoma of the breast.

AIMS: Surgical intervention in patients with bone metastases from breast cancer is dependent on the estimated survival of the patient. The purpose of this paper was to identify factors that would predict survival so that specific decisions could be made in terms of surgical (or non-surgical) management. METHODS: The records of 113 consecutive patients (112 women) with metastatic breast cancer were analysed for clinical, radiological, serological and surgical outcomes. Their median age was 61 years (interquartile range 29 to 90) and the median duration of follow-up was 1.6 years (standard deviation (sd) 1.9, 95% confidence interval (CI) 0 to 5.9). The cumulative one- and five-year rates of survival were 68% and 16% (95% Cl 60 to 77 and 95% CI 10 to 26, respectively). RESULTS: Linear discriminant analysis identified a 'quadruple A' predictor of survival by reclassifying the sum of the albumin, adjusted calcium, alkaline phosphatase and age covariates each multiplied by a determined factor. The accuracy of this 'quadruple A' predictor was 90% with a sensitivity of 100% and a specificity of 88%. A receiver operating characteristic (ROC) curve revealed an area under the curve of 79%. Survival analysis for this 'quadruple A' predictor (< = one or > one year survival) was statistically significant using the log rank test (p = 0.0004) and Cox proportional hazard (p = 0.001). Multivariate analysis showed the 'quadruple A' predictor to be the only independent predictor of survival (p = 0.01). DISCUSSION: The 'quadruple A' predictor, together with other positive predictors of survival, can be used by oncologists, orthopaedic and breast surgeons to estimate survival and therefore guide management.

Environmental and economic costs of soil erosion and conservation benefits.

Soil erosion is a major environmental threat to the sustainability and productive capacity of agriculture. During the last 40 years, nearly one-third of the world's arable land has been lost by erosion and continues to be lost at a rate of more than 10 million hectares per year. With the addition of a quarter of a million people each day, the world population's food demand is increasing at a time when per capita food productivity is beginning to decline.

Pulmonary interstitial emphysema in very low birthweight infants.

Forty six of 142 infants weighing less than 1500 g at birth, who had chest radiographs in the first 5 days of life, developed pulmonary interstitial emphysema (PIE) and in 19 this occurred in the first 24 hours. PIE was seen more frequently in infants weighing less than 1000 g at birth (24 of 57) than in those weighing 1000-1500 g (22 of 85). Ventilation for hyaline membrane disease was strongly associated with PIE, and only babies who were resuscitated, or ventilated, or had hyaline membrane disease developed the disorder. Most pneumothoraces were preceded by x-ray appearances of PIE (17 of 21). Mortality was increased in ventilated infants who developed PIE and was high in those with severe x-ray changes.

Useful radiological signs in acute appendicitis in children.

Straight X-rays of 92 control patients with acute appendicitis and 92 control subjects were studied for radiographic abnormalities. Disturbance in intestinal gas pattern was the most common abnormality. Presence of a faecolith, free peritoneal fluid, scoliosis and a soft tissue mass were useful supporting signs. Loss of the properitoneal fat line and the right psoas outline were not reliable signs as they occurred with equal frequency in both groups.