Age Greater (age + greater)

Distribution by Scientific Domains

Selected Abstracts

Malignancy after Heart Transplantation: Analysis of 24-Year Experience at a Single Center

Tahir Yagdi M.D.
The incidence, spectrum, risk factors, and clinical impact of posttransplant malignancy were investigated in a cohort of patients with long-term follow-up at a single center. Methods: Data for 835 patients who underwent heart transplantation between 1979 and 2002 and survived beyond one month were retrospectively evaluated for posttransplant skin cancer, solid organ tumors, and lymphoma. Results: One hundred thirty-nine malignancies developed in 126 patients (15.1%). Skin cancer, solid organ tumors, and lymphoma represented 49%, 27%, and 24% of the malignancies, respectively. Mean patient age at transplantation for patients developing skin cancer, solid organ tumor, and lymphoma were 50 years, 51 years, and 46 years, respectively (p = 0.024). Risk factors for skin cancer were: age greater than 40 at transplantation, number of treated rejection episodes in the first year after transplantation, and smoking history. Variables associated with solid organ malignancy development were age and smoking history. There was no variable related to the development of posttransplant lymphoma. Median survival after diagnosis of skin cancer, solid organ tumor, and lymphoma were 5.0 years, 0.3 years, and 0.7 years, respectively (p < 0.001). Conclusions: Posttransplant malignancies have different risk factors and variable clinical impact. Older age at transplantation, smoking history, and more episodes of treated rejection were related to increased incidence of nonlymphoid malignancy incidence after heart transplantation, whereas no variable was associated with lymphoid malignancy. Skin cancers have a benign course, while solid organ malignancies and lymphomas carry an unfavorable prognosis. [source]

Use of a Urine Dipstick and Brief Clinical Questionnaire to Predict an Abnormal Serum Creatinine in the Emergency Department

Daniel N. Firestone MD
Abstract Objectives:, Prior data demonstrated that a urine dipstick used alone was a sensitive predictor of abnormal creatinine, but not sufficiently enough to forego screening of serum creatinine prior to administration of contrast for diagnostic studies. The authors hypothesized that a brief historical questionnaire coupled with a urine dipstick would have high sensitivity for renal dysfunction, potentially eliminating the need for a serum creatinine prior to contrast administration. Methods:, This was a prospective study of a convenience sample of patients at two academic tertiary-care emergency departments (EDs) during 2006,2007. Subjects included patients who had both a serum creatinine result reported by the laboratory and a urine dipstick result reported in the medical record. Data included triage vital signs, basic demographic data, 14 medical history items, dipstick urinalysis, and serum creatinine results. The main outcome measure was an abnormal serum creatinine, defined as greater than 1.5 mg/dL. Results:, Complete data sets were collected on 1,354 patient visits. Of these, there were 161 (12%) with a serum creatinine of >1.5 mg/dL. Logistic regression analysis identified the following independent predictors associated with elevated creatinine: age greater than 60 years, known renal insufficiency, diabetes, hypertension, diuretic use, vomiting, and proteinuria. Nearly all patients with abnormal creatinine (98%) had at least one of these seven predictors. A decision tool combining these predictors would have identified 158 of 161 patients with an abnormal creatinine (sensitivity, 98.1%; 95% confidence interval [CI] = 95.8% to 99.9%) and a specificity of 21.2% (95% CI = 18.8% to 23.2%). Conclusions:, The absence of six historical factors and absence of proteinuria can be safely used to identify patients who are unlikely to have an abnormal creatinine. [source]

Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer

Y. Kodera
Background: Extended lymphadenectomy for gastric carcinoma has been associated with high mortality and morbidity rates in several multicentre randomized trials. Methods: Using data from 523 patients registered for a prospective randomized trial comparing extended (D2) and superextended (D3) lymphadenectomies, risk factors for overall complications and major surgical complications (anastomotic leakage, intra-abdominal abscess and pancreatic fistula) were identified by multivariate logistic regression analysis. Results: Mortality and morbidity rates were 0·8 per cent (four of 523) and 24·5 per cent (128 of 523) respectively. Pancreatectomy (relative risk 5·62 (95 per cent confidence interval (c.i.) 1·94 to 16·27)) and prolonged operating time (relative risk 2·65 (95 per cent confidence interval 1·34 to 5·23)) were the most important risk factors for overall complications. A body mass index of 25 kg/m2 or above, pancreatectomy and age greater than 65 years were significant predictors of major surgical complications. Conclusion: Pancreatectomy should be reserved for patients with stage T4 disease. Age and obesity should be considered when planning surgery. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

The value of magnetic resonance cholangiopancreatography in predicting common bile duct stones in patients with gallstone disease,

B. Topal
Background: The application of available predictive scoring systems for the detection of common bile duct (CBD) stones has not reduced the number of patients who undergo unnecessary endoscopic retrograde cholangiopancreatography. The aim of this study was to create a predictive model for CBD stones and to assess the value of magnetic resonance cholangiopancreatography (MRCP) in prediction. Methods: In 1998, 366 patients with gallstone disease (118 males, 248 females; mean age 57 (range 8,84) years) underwent cholecystectomy. Statistical analysis was performed on patient data obtained at the time of first presentation. Results: CBD stones were demonstrated in 43 (12 per cent) of 366 patients. The predictive model for common duct stones included ultrasonography showing CBD stones or bile duct dilatation, age greater than 60 years, fever, serum alkaline phosphatase level above 670 units/l and serum amylase level above 95 units/l. In patients with a predicted probability greater than 5 per cent, CBD stones were present in 11 per cent, compared with 1 per cent in patients with a probability of 5 per cent or less. MRCP had an observed sensitivity of 95 per cent, specificity of 100 per cent, positive predictive value of 100 per cent and negative predictive value of 98 per cent. Conclusion: In patients with a predicted probability for CBD stones of more than 5 per cent, MRCP is recommended in order to confirm the presence or absence of stones and as guidance in further management. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd [source]

Huntington's disease with onset ages greater than 60 years

Kunihiro Yoshida
We examined five patients with late-onset Huntington's disease (HD), who developed chorea as an initial symptom at age 60 or later. The mean disease duration from the onset of chorea was approximately 8 years (range, 2,16 years). All carried expanded HD alleles with 39 or 40 CAG repeats. Cognitive or psychiatric decline was observed in four patients, the mean duration of the disease being approximately 10 years. One of them had been institutionalized in a nursing home undiagnosed for a long time. Late-onset HD patients with shorter repeat expansions may be overlooked in Japan. Non-disabling chorea, mild cognitive or psychiatric decline in such patients are sometimes unrecognized or misunderstood as aging-related phenomena, and do not come to medical attention. Considering the potential genetic risk to younger generations, however, genetic testing on such late-onset HD patients should be conducted with careful genetic counseling and psychological support for their family members. [source]

Revisiting two local constraints of the Galactic chemical evolution

M. Haywood
ABSTRACT I review the uncertainties in two observational local constraints of the Galactic disc chemical evolution: the metallicity distribution of long-lived dwarfs and the age,metallicity relation. Analysing most recent data, it is shown first that the observed metallicity distribution at solar galactocentric radius, designed with standard methods, is more fit to a closed-box model than to the infall metallicity distribution. We argue that this is due to the specific contribution of the thick-disc population, which has been overlooked both in the derivation of the observed metallicity distribution and in the standard chemical evolution models. Although this agreement disqualifies the metallicity distribution as the best supportive (indirect) evidence for infall, we argue that the evolution must be more complex than described by either the closed-box or the standard infall models. It is then shown that recent determinations of the age,metallicity distribution (AMD) from large Strömgren photometric surveys are dominated by noise resulting from systematic biases in metallicities and effective temperatures. These biases are evaluated and a new AMD is obtained, where particularities of the previous determinations are phased out. The new age,metallicity relation shows a mean increase limited to about a factor of 2 in Z over the disc age. It is shown that below 3 Gyr, the dispersion in metallicity is about 0.1 dex, which, given the observational uncertainties in the derived metallicities, is compatible with the small cosmic dispersion measured on the interstellar medium and meteoritic pre-solar dust grains. A population that is progressively older and more metal rich arises at a metallicity greater than that of the Hyades, to reach [Fe/H],+0.5 dex at ages greater than 5 Gyr. We suggest that this is best explained by radial migration. A symmetrical widening of the metallicity interval towards lower values is seen at about the same age, which is attributed to a similar cause. Finally, the new derived ages are sufficiently consistent that an age,metallicity relation within the thick disc is confirmed. These new features altogether draw a picture of the chemical evolution in the solar neighbourhood where dynamical effects and complexity in the AMD dominate, rather than a generalized high dispersion at all ages. [source]