Age Younger (age + younger)

Distribution by Scientific Domains

Selected Abstracts

Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment

CANCER, Issue 3 2002
Risk factors analysis
Abstract BACKGROUND Brain metastases (BM) are frequent sites of initial failure in patients with locally advanced nonsmall cell lung cancer (LAD-NSCLC) undergoing multimodality treatments (MMT). New treatment and follow-up strategies are needed to reduce the risk of BM and to diagnose them early enough for effective treatment. METHODS The incidence rate of BM as the first site of recurrence in 112 patients with LAD-NSCLC treated with the same MMT protocol was calculated. The influence of patient, disease, and treatment-related factors on the incidence of BM and on the time-to-brain recurrence (TBR) was analyzed. RESULTS BM as the first site of failure was observed in 25 cases (22% of the study population and 29% of all recurrences). In 18 of those cases, the brain was the exclusive site of recurrence. Median TBR was 9 months. The 2-year actuarial incidence of BM was 29%. Central nervous system (CNS) recurrence was more common in patients younger than 60 years (P = 0.006) and in whom bulky (, 2 cm) mediastinal lymph nodes were present (P = 0.02). TBR was influenced by age (P = 0.004) and by bulky lymph node disease (P = 0.003). Multivariate analysis confirmed the prognostic role of age, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. CONCLUSIONS Our study confirmed a high rate of BM in patients with LAD-NSCLC submitted to MMT. Most of these CNS recurrences were isolated and occurred within 2 years of initial diagnosis. Age younger than 60 years was associated with an increased risk of BM and reduced TBR, whereas the presence of clinical bulky mediastinal lymph nodes was of borderline significance. Although our data require further validation in future studies, our results suggest that additional trials on prophylactic cranial irradiation and on intensive radiologic follow-up should focus on these high-risk populations. Cancer 2002;95:605,12. 2002 American Cancer Society. DOI 10.1002/cncr.10687 [source]

Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa

Josefina Castro
Abstract Objective The current study analyzed the variables related to rehospitalization after total weight recovery in adolescents with anorexia nervosa. Method One hundred and one patients first admitted for inpatient treatment, aged 11,19 years, were followed up for 12 months after discharge. Results Twenty-five subjects (24.8%) required readmission after complete weight recovery and 76 (75.2%) did not. Duration of disorder, weight loss, body mass index at first admission, and global body image distortion were similar in the two groups. Patients needing readmission had a lower rate of weight gain (p < .001), a lower mean age (p = .007), a higher mean score on the Eating Attitudes Test (EAT; p = .009), and a higher percentage of hips overestimation (p = .049). In a stepwise logistic regression analysis, these three variables predicted readmission and correctly classified 77.6% of patients. Taken as discrete variables, age younger than 15 years old, EAT score above 55, and a rate of weight gain lower than 150 grams per day were associated with a higher percentage of readmissions. Discussion The variables most clearly related to readmission were young age, abnormal eating attitudes, and a low rate of weight gain. 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 22,30, 2004. [source]

Patients with Hip Fracture: Subgroups and Their Outcomes

Elizabeth A. Eastwood PhD
OBJECTIVES: To present several alternative approaches to describing the range and functional outcomes of patients with hip fracture. DESIGN: Prospective study with concurrent medical records data collection and patient and proxy interviews at the time of hospitalization and 6 months later. SETTING: Four hospitals in the New York metropolitan area. PARTICIPANTS: Five hundred seventy-one hospitalized adults aged 50 and older with hip fracture between July 1997 and August 1998. MEASUREMENTS: Rates of return to function in four physical domains, mortality, and nursing home residence at 6 months. Cluster analysis was used to describe the heterogeneity among the sample and identify variations in 6-month mortality, nursing home residence, and level of functioning and to develop a patient classification tree with associated patient outcomes at 6 months postfracture. RESULTS: In locomotion, transfers, and self-care, 33% to 37% of patients returned to their prior level of function by 6 months, including those needing assistance, but only 24% were independent in locomotion at 6 months. Cluster analysis identified eight patient subgroups that had distinct baseline features and variable outcomes at 6 months. The patient classification tree used four variables: atypical functional status (independent in locomotion but dependent in other domains); nursing home residence; independence/dependence in self-care; and age younger than 85 or 85 and older that identified five subgroups with variable 6-month outcomes that clinicians may use to predict likely outcomes for their patients. CONCLUSION: Patients with hip fracture are heterogeneous with respect to baseline and outcome characteristics. Clinicians may be better able to give patients and caregivers information on expected outcomes based on presenting characteristics used in the classification tree. [source]

Do young hepatocellular carcinoma patients have worse prognosis?

The paradox of age as a prognostic factor in the survival of hepatocellular carcinoma patients
Abstract: Background/Aims: Our previous study showed that male hepatocellular carcinoma (HCC) patients below 40 years of age had the worst survival in the initial several years, but had the best prognosis thereafter. Thus, it seems that age has a paradoxical influence on the prognosis. To further clarify the issue of age on HCC prognosis, we initiated this study. Methods: A total of 11 312 HCC cases from seven medical centers from 1986 to 2002 were included. We analyzed the 1-year survival and survival after 1 year. Results: Male gender, age younger than 40 years old and hepatitis B virus (HBV) were associated with worse 1-year survival. In contrast, male gender, age younger than 40 years old and HBV were associated with better survival after 1 year. Higher percentage of the young HCC patients had a tumor size larger than 3 cm. 83.7% of HCC patients below 40 years of age were male and 89.8% of them were HBV carriers. Conclusions: If we encountered a young HCC patient, the patient will probably be a male HBV carrier. He would probably have larger tumor and is more likely to expire within 1 year than the older HCC patients. However, if the young HCC patient can survive for more than 1 year, he would probably have better survival in the following years than the older patients. [source]

Transmission of tuberculosis from adults to children in a Paris suburb

Fouad Madhi MD
Abstract Tuberculosis in children is often acquired by contact with a family or household member. The aim of our study was to evaluate risk factors for latent infection and active disease in exposed children in a suburb of Paris. We examined medical records for the period 1997,2000 at six departmental centers for medical prevention in Val de Marne. Thirty-nine patients aged 18 years or more with M. tuberculosis -positive sputum samples, and living with children or adolescents, were identified. Ninety-one children, aged 3 months,17 years, were exposed to these index cases. All the children initially underwent a tuberculin skin test and chest radiography, and children with no criteria for latent infection or active disease at time of initial evaluation were asked to attend a second evaluation 3 months later. Overall, 20 of the 91 (22%) children were infected, including 4 children identified only at the second evaluation. Eight (40%) of the 20 infected children had active disease, including 2 of the 4 children identified at the second evaluation. The risk of infection was not influenced by the children's age, but was significantly associated with three characteristics of the adult cases, i.e., age younger than 40 years, presence of cavitary lesions, and smears with more than 100 bacilli per microscopic field. In conclusion, our results call for early examination of all exposed children, in order to prevent infection and progression to active disease, and for a routine second evaluation after the adult contact has ended. Pediatr Pulmonol. 2002; 34:159,163. 2002 Wiley-Liss, Inc. [source]

Witnessing Intimate Partner Violence as a Child Does Not Increase the Likelihood of Becoming an Adult Intimate Partner Violence Victim

Amy A. Ernst MD
ObjectivesTo determine whether adults who witnessed intimate partner violence (IPV) as children would have an increased rate of being victims of ongoing IPV, as measured by the Ongoing Violence Assessment Tool (OVAT), compared with adult controls who did not witness IPV as children. The authors also sought to determine whether there were differences in demographics in these two groups. MethodsThis was a cross sectional cohort study of patients presenting to a high-volume academic emergency department. Emergency department patients presenting from November 16, 2005, to January 5, 2006, during 46 randomized four-hour shifts were included. A confidential computer touch-screen data entry program was used for collecting demographic data, including witnessing IPV as a child and the OVAT. Main outcome measures were witnessing IPV as a child, ongoing IPV, and associated demographics. Assuming a prevalence of IPV of 20% and a clinically significant difference of 20% between adults who witnessed IPV as children and adult controls who did not witness IPV as children, the study was powered at 80%, with 215 subjects included. ResultsA total of 280 subjects were entered; 256 had complete data sets. Forty-nine percent of subjects were male, 45% were Hispanic, 72 (28%) were adults who witnessed IPV as children, and 184 (72%) were adult controls who did not witness IPV as children. Sixty-three (23.5%) were positive for ongoing IPV. There was no correlation of adults who witnessed IPV as children with the presence of ongoing IPV, as determined by univariate and bivariate analysis. Twenty-three of 72 (32%) of the adults who witnessed IPV as children, and 39 of 184 (21%) of the adult controls who did not witness IPV as children, were positive for IPV (difference, 11%; 95% confidence interval [CI] =,2% to 23%). Significant correlations with having witnessed IPV as a child included age younger than 40 years (odds ratio [OR], 4.2; 95% CI = 1.7 to 9.1), income less than 20,000/year (OR, 5.1; 95% CI = 1.6 to 12.5), and abuse as a child (OR, 9.1; 95% CI = 4.2 to 19.6). Other demographics were not significantly correlated with having witnessed IPV as a child. ConclusionsAdults who witnessed IPV as children were more likely to have a lower income, be younger, and have been abused as a child, but not more likely to be positive for ongoing IPV, when compared with patients who had not witnessed IPV. [source]

Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease

Paula Tanabe PhD
ObjectivesTo characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. MethodsThis was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann,Whitney U test or Kruskal,Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. ResultsThere were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54,159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. ConclusionsPatients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic. [source]

Factors contributing to long graft survival in non-heart-beating cadaveric renal transplantation in Japan: a single-center study at Kitasato University

Kazunari Yoshida
Yoshida K, Endo T, Saito T, Iwamura M, Ikeda M, Kamata K, Sato K, Baba S. Factors contributing to long graft survival in non-heart-beating cadaveric renal transplantation in Japan: a single-center study at Kitasato University. Clin Transplant 2002: 16: 397,404. Blackwell Munksgaard, 2002 A total of 107 cadaveric kidneys from non-heart-beating donors (NHBDs) have been transplanted between 1974 and 2000 at Kitasato University Hospital, Sagamihara, Japan. The patient survival of the 107 recipients of cadaveric renal transplants at 1, 5 and 10 yr was 0.857, 0.770 and 0.746, respectively. The 50% graft survival was 3.8 yr. The 5 and 10-yr graft survival was 0.457 and 0.337, respectively. Twenty of the 107 recipients of non-heart-beating cadaveric renal transplantation had graft survival longer than 10 yr. Of these 20 patients, 14 survivors still maintain functioning renal grafts and two died with functioning graft, although the remaining four reverted to dialysis because of chronic rejection and nephropathy. The average graft survival of these 20 patients at the time of study was 13.3 yr and the longest was 21.4 yr. The average serum creatinine level at 10 yr after transplantation was 1.63 mg/dL, almost identical to that at 5 yr post-transplant. The donors aged on average 40.2 yr; 13 were male and seven were female. The youngest donor was 9-yr-old and the oldest was 66. The graft survival was significantly better in the group with donor age younger than 55 yr (Log-rank: p=0.007). The average weight of the renal graft was not different between the long and shorter graft survival groups. The average warm ischemic time and total ischemic time were 9.7 and 539.7 min, respectively. The duration of post-transplant acute tubular necrosis averaged 9.2 days. These parameters tended to be shorter than those in recipients with graft survival >10 yr, but with no statistical significance. The mean numbers of acute rejection (AR) episode within 3 months after transplantation were 0.25 0.66 and 0.92 0.90 (p=0.020) in long survival and shorter survival groups, respectively. Long survivors had a significantly lower incidence of AR. Two of 20 cases received conventional immunosuppression with prednisolone, azathioprine and mizoribin, and 18 had prednisolone and calcineurin inhibitor (CNI). Kaplan,Meier analysis showed a significant contribution of CNI to graft survival (p=0.036). However, the graft survival reduction rate after 1 yr post-transplant did not differ between conventional and CNI immunosuppression. These data suggest that renal grafts retrieved with proper organ procurement procedures from NHBDs may survive long-term and help to overcome donor shortage. [source]

Detrital zircon geochronology of Carboniferous,Cretaceous strata in the Lhasa terrane, Southern Tibet

BASIN RESEARCH, Issue 3 2007
Andrew L. Leier
ABSTRACT Sedimentary strata in the Lhasa terrane of southern Tibet record a long but poorly constrained history of basin formation and inversion. To investigate these events, we sampled Palaeozoic and Mesozoic sedimentary rocks in the Lhasa terrane for detrital zircon uranium,lead (U,Pb) analysis. The >700 detrital zircon U,Pb ages reported in this paper provide the first significant detrital zircon data set from the Lhasa terrane and shed new light on the tectonic and depositional history of the region. Collectively, the dominant detrital zircon age populations within these rocks are 100,150, 500,600 and 1000,1400 Ma. Sedimentary strata near Nam Co in central Lhasa are mapped as Lower Cretaceous but detrital zircons with ages younger than 400 Ma are conspicuously absent. The detrital zircon age distribution and other sedimentological evidence suggest that these strata are likely Carboniferous in age, which requires the existence of a previously unrecognized fault or unconformity. Lower Jurassic strata exposed within the Bangong suture between the Lhasa and Qiangtang terranes contain populations of detrital zircons with ages between 200 and 500 Ma and 1700 and 2000 Ma. These populations differ from the detrital zircon ages of samples collected in the Lhasa terrane and suggest a unique source area. The Upper Cretaceous Takena Formation contains zircon populations with ages between 100 and 160 Ma, 500 and 600 Ma and 1000 and 1400 Ma. Detrital zircon ages from these strata suggest that several distinct fluvial systems occupied the southern portion of the Lhasa terrane during the Late Cretaceous and that deposition in the basin ceased before 70 Ma. Carboniferous strata exposed within the Lhasa terrane likely served as source rocks for sediments deposited during Cretaceous time. Similarities between the lithologies and detrital zircon age-probability plots of Carboniferous rocks in the Lhasa and Qiangtang terranes and Tethyan strata in the Himalaya suggest that these areas were located proximal to one another within Gondwanaland. U,Pb ages of detrital zircons from our samples and differences between the geographic distribution of igneous rocks within the Tibetan plateau suggest that it is possible to discriminate a southern vs. northern provenance signature using detrital zircon age populations. [source]