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Selected AbstractsEffect of long-term nebulized colistin on lung function and quality of life in patients with chronic bronchial sepsisINTERNAL MEDICINE JOURNAL, Issue 7 2007D. P. Steinfort Abstract Recurrent Gram-negative bacterial infection is a significant cause of death in patients with bronchiectasis and severe chronic obstructive pulmonary disease (COPD). Nebulized colistin in cystic fibrosis has shown maintenance of pulmonary function and improved symptom scores. We prospectively followed 18 patients with chronic bronchial sepsis treated with nebulized colistin 30 mg daily. Mean decline in forced expiratory volume in 1 s was significantly slower following commencement of inhaled colistin (44 mL/year vs 104 mL/year, P = 0.035). Mean decline in forced vital capacity was also significantly slower following commencement of colistin (48 mL/year vs 110 mL/year, P = 0.033). Patient-reported quality of life improved following commencement of colistin (3.6 vs 6.2, P = 0.001). No patient had isolates resistant to colistin. No side-effects were reported by patients in the cohort. Use of inhaled colistin in the treatment of bronchiectasis and severe (COPD) in patients with recurrent Gram-negative infections is safe. Inhaled colistin may improve quality of life and slow decline in forced expiratory volume in 1 s and forced vital capacity. [source] A Comparison of CV-Catheters (CV) Grafts (GR) and Fistulae (FI) in Quotidian HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 1 2003C Kjellstrand We studied longevity and complications from CV, GR, and FI in 23 patients on quotidian hemodialysis. There were a total of 409 patient months, mean 18,10 months observation and a total of 9209 dialyses. There were 14 FI, 5 GR and 4 CV. 1, 1 and 2 replacements were necessary during a total observation time of 254, 105 and 50 patient months, respectively. For fistulae there were 0.02 replacements/year vs. 0.30 for GR and 0.41 for CV. P = 0.042 FI vs. other. The cumulative survival at 15 months was 100% for FI, 80% for GR and 20% for CV. P = 0.041. The cumulative survival at 3 years were 80% for fistulae and grafts, no CV lasted beyond 15 months. P = 0.013. There were 27 events requiring hospitalization or outpatient intervention. FI: 0.42/patient year, GR 1.22/patient year and CV 1.36/patient year. P = 0.080, FI vs. Other. Patients reported more problems between dialysis for FI, 3.2% of the days and least on GR (0.2%), CV (0.4%). P < 0.0001. Of the problems 85% were pain and redness. To the contrary there were more problems during dialysis with CV, 9.1% vs. FI 2.7%, and GR 0.9%. P < 0.0001. The complications and survival data are similar to those reported by others for quotidian hemodialysis and no different from reports on conventional 3 times per week dialyses. Conclusion: Daily hemodialysis does not adversely affect the different types of blood access. The survival and intervention need of accesses is best for fistulae, worst for CV, but GR, when functioning, have fewer problems between and during dialyses. [source] Prevalence and clinical characteristics of maternally inherited diabetes and deafness caused by the mt3243A > G mutation in young adult diabetic subjects in Sri LankaDIABETIC MEDICINE, Issue 3 2008P. Katulanda Abstract Aims The maternally inherited mt3243A > G mutation is associated with a variable clinical phenotype including diabetes and deafness (MIDD). We aimed to determine the prevalence and clinical characteristics of MIDD in a large South Asian cohort of young adult-onset diabetic patients from Sri Lanka. Methods DNA was available from 994 subjects (age of diagnosis 16,40 years, age at recruitment , 45 years). Mutation screening was performed using a QRT-PCR method on an ABI 7900HT system using sequence-specific probes. Samples with heteroplasmy , 5.0% were considered positive. Results Nine (four males) mutation-positive subjects were identified (prevalence 0.9%). They were diagnosed at a younger age (25.9 ± 4.8 years vs. 31.9 ± 5.6 years, P = 0.002) and were lean (body mass index [BMI] 18.7 ± 2.7 kg/m2 vs. 24.7 ± 4.0 kg/m2, P < 0.001) compared to NMCs. One mutation-positive subject (11.1%) had metabolic syndrome, compared to 633 (64.3%) of NMCs. Insulin therapy within 6 months of diagnosis was used in four (44.0%) carriers compared to 6.9% of NMCs (P = 0.002). Combined screening criteria of any two of maternal history of diabetes, personal history of hearing impairment and family history of hearing impairment only identified five (55%) of the carriers, with a positive predictive value of 7.4%. Conclusions The prevalence of mt3243A > G mutation among young adult-onset diabetic subjects from Sri Lanka was 0.9%. Our study demonstrates that a maternal family history of diabetes and either a personal and/or family history of deafness only distinguish half of patients with MIDD from Sri Lankan subjects with young-onset diabetes. [source] High-density lipoprotein cholesterol, C-reactive protein, and prevalence and severity of coronary artery disease in 5641 consecutive patients undergoing coronary angiographyEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 6 2008H. F. Alber ABSTRACT Background, Although high-density lipoprotein cholesterol (HDL-C) and C-reactive protein (CRP) are well-established predictors for future cardiovascular events, little information is available regarding their correlation with the prevalence and severity of angiographically evaluated coronary artery disease (CAD). Material and methods,, Five thousand six hundred forty-one consecutive patients undergoing coronary angiography for the evaluation of CAD were analysed. Cardiovascular risk factors were assessed by routine blood chemistry and questionnaire. CAD severity was graded by visual estimation of lumen diameter stenosis with significant stenoses defined as lumen diameter reduction of , 70%. Coronary angiograms were graded as one-, two- or three-vessel disease, as nonsignificant CAD (lumen irregularities < 70%) or non-CAD. Results,, HDL-C (60·3 ± 18·5 vs. 51·9 ± 15·3 mg dL,1; P < 0·001) was higher and CRP was lower (0·65 ± 1·68 vs. 1·02 ± 2·38 mg dL,1; P < 0·001) in non-CAD (n = 1517) compared to overall CAD patients (n = 4124). CAD patients were older (65·2 ± 10·5 years vs. 59·9 ± 11·4 years), more often diabetics (19·2% vs. 10·6%) and hypertensives (79·2% vs. 66·0%) and included more smokers (18·8% vs. 16·5%) (all P < 0·005). Low-density lipoprotein cholesterol (124·5 ± 38·3 vs. 126·0 ± 36·3 mg dL,1; P = NS) was similar in overall CAD and non-CAD patients with more statin users (43·4% vs. 27·9%; P < 0·001) among CAD patients. Comparing non-CAD with different CAD severities using analysis of variance, results did not change substantially. In a multivariate analysis, HDL-C and CRP remained independently associated with the prevalence of CAD. In addition, HDL-C is also a potent predictor for the severity of CAD. Conclusions,, In this large consecutive patient cohort, HDL-C and CRP are independently associated with the prevalence of CAD. In this analysis, HDL-C is an even stronger predictor for CAD than some other major classical risk factors. [source] Childhood Maltreatment and Migraine (Part II).HEADACHE, Issue 1 2010Emotional Abuse as a Risk Factor for Headache Chronification (Headache 2010;50:32-41) Objectives., To assess in a headache clinic population the relationship of childhood abuse and neglect with migraine characteristics, including type, frequency, disability, allodynia, and age of migraine onset. Background., Childhood maltreatment is highly prevalent and has been associated with recurrent headache. Maltreatment is associated with many of the same risk factors for migraine chronification, including depression and anxiety, female sex, substance abuse, and obesity. Methods., Electronic surveys were completed by patients seeking treatment in headache clinics at 11 centers across the United States and Canada. Physician-determined data for all participants included the primary headache diagnoses based on the International Classification of Headache Disorders-2 criteria, average monthly headache frequency, whether headaches transformed from episodic to chronic, and if headaches were continuous. Analysis includes all persons with migraine with aura, and migraine without aura. Questionnaire collected information on demographics, social history, age at onset of headaches, migraine-associated allodynic symptoms, headache-related disability (The Headache Impact Test-6), current depression (The Patient Health Questionnaire-9), and current anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. Results., A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (,15 days/month) was reported by 34%. Transformation from episodic to chronic was reported by 26%. Prevalence of current depression was 28% and anxiety was 56%. Childhood maltreatment was reported as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. In univariate analyses, physical abuse and emotional abuse and neglect were significantly associated with chronic migraine and transformed migraine. Emotional abuse was also associated with continuous daily headache, severe headache-related disability, and migraine-associated allodynia. After adjusting for sociodemographic factors and current depression and anxiety, there remained an association between emotional abuse in childhood and both chronic (odds ratio [OR] = 1.77, 95% confidence intervals [CI]: 1.19-2.62) and transformed migraine (OR = 1.89, 95% CI: 1.25-2.85). Childhood emotional abuse was also associated with younger median age of headache onset (16 years vs 19 years, P = .0002). Conclusion., Our findings suggest that physical abuse, emotional abuse, and emotional neglect may be risk factors for development of chronic headache, including transformed migraine. The association of maltreatment and headache frequency appears to be independent of depression and anxiety, which are related to both childhood abuse and chronic daily headache. The finding that emotional abuse was associated with an earlier age of migraine onset may have implications for the role of stress responses in migraine pathophysiology. [source] Hepatocellular carcinoma occurring in nonfibrotic liver: Epidemiologic and histopathologic analysis of 80 French casesHEPATOLOGY, Issue 2 2000Marie-Pierre Bralet M.D., Ph.D. Hepatocellular carcinoma (HCC) occurring in nonfibrotic liver represents a rare, ill-defined subgroup of HCC without cirrhosis in which mechanisms of hepatocarcinogenesis remain unclear. The aim of our study was to assess epidemiological factors and detailed histopathologic changes in the nontumoral liver of patients developing such tumors. Of 330 HCCs resected in our institution between 1985 and 1998, we retrospectively analyzed 80 cases (53 men, 27 women; mean age, 51 ± 16 years) in which the nontumoral liver showed no (n = 28) or minimal (n = 52) portal fibrosis without any septal fibrosis. In the group with no portal fibrosis there was no male predominance, and patients were significantly younger (44 ± 19 years vs. 54 ± 14 years) than those with minimal portal fibrosis. Sixty-seven tumors were typical HCCs, 8 were of fibrolamellar type, and 5 were hepatocholangiocarcinomas. Mean tumor size was 10 ± 5 cm. Risk factors for HCC development were found in 30 patients: hepatitis B (n = 17) or C (n = 2) virus infections, alcohol consumption (n = 11), and hemochromatosis (n = 1). In the nontumoral liver, periportal and lobular necrosis, mild portal inflammation, steatosis, and iron overload were present in 15%, 57%, 52%, and 54% of cases, respectively. Liver cell changes were noted in 6%. This study emphasizes the need for strict criteria to classify HCC without cirrhosis. HCC in nonfibrotic liver is a distinct subgroup in which nontumoral liver shows nonspecific minimal changes without regeneration or premalignant lesion. Etiologic factors are often unidentified, although presence of HBV infection in 21% suggests a direct oncogenic role of this virus. [source] The Association Between Hypothermia, Prehospital Cooling, and Mortality in Burn VictimsACADEMIC EMERGENCY MEDICINE, Issue 4 2010Adam J. Singer MD Abstract Objectives:, Hypothermia is associated with increased morbidity and mortality in trauma victims. The prognostic value of hypothermia on emergency department (ED) presentation in burn victims is not well known. The objective of this study was to determine the incidence of hypothermia in burn victims and its association with mortality and hospital length of stay (LOS). The study also examined the potential causative role of prehospital cooling in hypothermic burn patients. Methods:, This was a retrospective review of a county trauma registry. The county was both suburban and rural, with a population of 1.5 million and with one burn center. Burn patients between 1994 and 2007 who met trauma registry criteria were included. Demographic and clinical data including prehospital cooling, burn size and depth, and presence of inhalation injury were collected. Hypothermia was defined as a core body temperature of less than or equal to 35°C. Data analysis consisted of univariate associations between patient characteristics and hypothermia. Results:, There were 1,215 burn patients from 1994 to 2007. Mean age (±standard deviation [±SD]) was 29 (±24) years, 67% were male, 248 (26.7%) had full-thickness burns, and 24 (2.6%) had inhalation injury. Only 17 (1.8%) had a burn larger than 70% total body surface area (TBSA). A total of 929 (76%) patients had an initial ED temperature recorded. Only 15/929 (1.6%) burn patients had hypothermia on arrival, and all were mild (lowest temperature was 32.6°C). There was no association between sex, year, and presence of inhalation injury with hypothermia. Hypothermic patients were older (44 years vs. 29 years, p = 0.01), and median Injury Severity Score (ISS) was higher (25 vs. 4, p = 0.002) than for nonhypothermic patients. Hypothermia was present in 6/17 (35%) patients with a TBSA of 70% or greater and in 8/869 (0.9%) patients with a TBSA of <70% (p < 0.001). Mortality was higher in hypothermic patients (60% vs. 3%, p < 0.001). None of the hypothermic patients received prehospital cooling. Conclusions:, Hypothermia on presentation to the ED was noted in 1.6% of all burn victims in this trauma registry. Hypothermia was more common in very large burns and was associated with high mortality. In this series, prehospital cooling did not appear to contribute to hypothermia. ACADEMIC EMERGENCY MEDICINE 2010; 17:456,459 © 2010 by the Society for Academic Emergency Medicine [source] The influence of Patient Age and Alcohol-Relevant Laboratory Values on Physicians' Diagnoses of AlcoholismJOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH, Issue 2 2004Allison Paganelli This study investigated factors that contribute to physicians' diagnoses and ratings of prognosis when reviewing vignettes of hypothetical cases constructed to reflect alcohol dependence. Forty-nine medical residents who read the vignettes were asked to list three probable diagnoses and a prognosis. Patient descriptions in the hypothetical vignettes were identical except for age (35 years vs. 70 years) and inclusion of alcohol-relevant lab values (present vs. absent). Results indicated that the younger patient described in the vignettes was diagnosed with alcoholism more often than was the older patient. The presence of alcohol-relevant lab values was unrelated to a diagnosis of alcoholism. Prognosis, which was on average rated as fair for most patients, was unrelated to the age of the patient. [source] Effects of Interview Style and Witness Age on Perceptions of Children's Credibility in Sexual Abuse CasesJOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 2 2005Paola Castelli The present study concerned effects of interview style and victim age on perceptions of child victim/witnesses and defendant guilt. In 2 experiments, participants read written scenarios of child sexual abuse trials. The scenarios included a transcript of the child victim/ witness's forensic interview, in which questioning varied from less leading to highly leading. In Experiment 1, child age (4 years vs. 7 years) did not significantly influence guilt ratings, but mock jurors were less likely to convict the alleged perpetrator and less likely to rate the child as credible and reliable when testimony was elicited through a highly leading vs. an intermediately or less leading interview. The effect of interview style on guilt ratings replicated in Experiment 2 for a 4-year-old victim/witness but not a 7-year-old victim/witness. In both studies, women compared to men were more likely to convict the defendant and to believe the child. Implications for understanding jurors' reactions to child victim/witness testimony are discussed. [source] Preoperative Electrocardiographic Risk Assessment of Atrial Fibrillation After Coronary Artery Bypass GraftingJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2004Ph.D., YI GANG M.D. Introduction: This study evaluated the role of surface ECG in assessment of risk of new-onset atrial fibrillation (AF) after coronary artery bypass grafting surgery (CABG). Methods and Results: One hundred fifty-one patients (126 men and 25 women; age 65 ± 10 years) without a history of AF undergoing primary elective and isolated CABG were studied. Standard 12-lead ECGs and P wave signal-averaged ECG (PSAE) were recorded 24 hours before CABG using a MAC VU ECG recorder. In addition to routine ECG measurements, two P wave (P wave complexity ratio [pCR]; P wave morphology dispersion [PMD]) and six T wave morphology descriptors (total cosine R to T [TCRT]; T wave morphology dispersion of ascending and descending part of the T wave [aTMD and dTMD], and others), and three PSAE indices (filtered P wave duration [PD]; root mean square voltage of terminal 20 msec of averaged P wave [RMS20]; and integral of P wave [Pi]) were investigated. During a mean hospital stay of 7.3 ± 6.2 days after CABG, 40 (26%) patients developed AF (AF group) and 111 remained AF-free (no AF group). AF patients were older (69 ± 9 years vs 64 ± 10 years, P = 0.005). PD (135 ± 9 msec vs 133 ± 12 msec, P = NS) and RMS20 (4.5 ± 1.7 ,V vs 4.0 ± 1.6 ,V, P = NS) in AF were similar to that in no AF, whereas Pi was significantly increased in AF (757 ± 230 ,Vmsec vs 659 ± 206 ,Vmsec, P = 0.007). Both pCR (32 ± 11 vs 27 ± 10) and PMD (31.5 ± 14.0 vs 26.4 ± 12.3) were significantly greater in AF (P = 0.012 and 0.048, respectively). TCRT (0.028 ± 0.596 vs 0.310 ± 0.542, P = 0.009) and dTMD (0.63 ± 0.03 vs 0.64 ± 0.02, P = 0.004) were significantly reduced in AF compared with no AF. Measurements of aTMD and three other T wave descriptors were similar in AF and no AF. Significant variables by univariate analysis, including advanced age (P = 0.014), impaired left ventricular function (P = 0.02), greater Pi (P = 0.012), and lower TCRT (P = 0.007) or dTMD, were entered into multiple logistic regression models. Increased Pi (P = 0.038), reduced TCRT (P = 0.040), and lower dTMD (P = 0.014) predicted AF after CABG independently. In patients <70 years, a linear combination of increased pCR and lower TCRT separated AF and no AF with a sensitivity of 74% and specificity of 62% (P = 0.005). Conclusion: ECG assessment identifies patients vulnerable to AF after CABG. Combination of ECG parameters assessed preoperatively may play an important role in predicting new-onset AF after CABG. [source] Effect of Gender on Atrial Electrophysiologic Changes Induced by Rapid Atrial Pacing and Elevation of Atrial PressureJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2001HUNG-FAT TSE M.D. Atrial Electrical Remodeling.Introduction: The incidence of atrial fibrillation is greater in men than in women, but the reasons for this gender difference are unclear. The purpose of this study was to evaluate the effects of gender on the atrial electrophysiologic effects of rapid atrial pacing and an increase in atrial pressure. Methods and Results: Right atrial pressure and effective refractory period (ERP) were measured during sinus rhythm and during atrial and simultaneous AV pacing at a cycle length of 300 msec in 10 premenopausal women, 11 postmenopausal women, and 24 men. The postmenopausal women were significantly older than the premenopausal women (61 ± 8 years vs 34 ± 10 years; P < 0.01). During sinus rhythm, mean atrial ERP in premenopausal women was shorter (211 ± 19 msec) than in postmenopausal women and age-matched men (242 ± 18 msec and 246 ± 34 msec, respectively; P < 0.05). Atrial ERPs in all patients shortened significantly during atrial and simultaneous AV pacing. However, the degree of shortening during atrial pacing (43 ± 8 msec vs 70 ± 20 msec and 74 ± 21 msec; P < 0.05) and during simultaneous AV pacing (48 ± 16 msec vs 91 ± 27 msec and 84 ± 26 msec; P < 0.05) was significantly less in premenopausal women than in postmenopausal women or age-matched men. Conclusion: The results of this study demonstrate a significant gender difference in atrial electrophysiologic changes in response to rapid atrial pacing and an increase in atrial pressure. The effect of menopause on the observed changes suggests that the gender differences may be mediated by the effects of estrogen on atrial electrophysiologic properties. [source] Factors associated with discussion of care plans and code status at the time of hospital admission: Results from the Multicenter Hospitalist Study,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2008Andrew D. Auerbach MD Abstract BACKGROUND: Hospital admission is a time when patients are sickest and also often encountering an entirely new set of caregivers. As a result, understanding and documenting a patient's care preferences at hospital admission is critically important. OBJECTIVE: To understand factors associated with documentation of care planning discussions in patients admitted to general medical services at 6 academic medical centers. DESIGN: Observational cohort study using data collected during the Multicenter Hospitalist Study, conducted between July 1, 2002 and June 30, 2004. SETTING: Prospective trial enrolling patients admitted to general medicine services at 6 university-based teaching hospitals. PATIENTS: Patients were eligible for this study if they were 18 years of age or older, admitted to a hospitalist or nonhospitalist physician, and able to give informed consent. MEASUREMENTS: Presence of chart documentation that the admitting team had discussed care plans with the patient within the first 24 hours of hospitalization. Notations such as "full code" were not counted as a discussion, whereas notations such as "discussed care wishes and plan with patient" were counted. RESULTS: A total of 17,097 patients over the age of 18 gave informed consent and completed an interview and chart abstraction; of these, 1776 (10.3%) had a code status discussion (CD) documented in the first 24 hours of their admission. Patients with a CD were older (69 years vs. 56 years, P < 0.0001), more often white (52.8% vs. 43.3%, P < 0.0001), and more likely to have cancer (19.8% vs. 11.4%, P < 0.0001), or depression (35.1% vs. 30.9%, P < 0.0001). There was marked variability in CD documentation across sites of enrollment (2.8%-24.9%, P < 0.0001). Despite strong associations seen in unadjusted comparisons, in multivariable models many socioeconomic factors, functional status, comorbid illness, and documentation of a surrogate decision maker were only moderately associated with a CD (adjusted odds ratios all less than 2.0). However, patients' site of enrollment (odds ratios 1.74-5.14) and informal notations describing prehospital care wishes (eg, orders for "do not resuscitate"/"do not intubate;" odds ratios 3.22-11.32 compared with no preexisting documentation) were powerfully associated with CD documentation. Site remained a powerful influence even in patients with no documented prehospital wishes. LIMITATIONS: Our results are derived from a relatively small number of academic sites, and we cannot connect documentation differences to differences in patient outcomes. CONCLUSIONS: Documentation of a CD at admission was more strongly associated with informal documentation of prehospital care wishes and where the patient was hospitalized than legal care planning documents (such as durable power of attorney), or comorbid illnesses. Efforts to improve communication between hospitalists and their patients might target local documentation practices and culture. Journal of Hospital Medicine 2008;3(6):437,445. © 2008 Society of Hospital Medicine. [source] Secular trend of age-specific prevalence of hepatitis B surface and e antigenemia in pregnant women in TaiwanJOURNAL OF MEDICAL VIROLOGY, Issue 4 2003Ho-Hsiung Lin Abstract To elucidate the impact of aging of hepatitis B carrier women on their viral replicative markers in a hepatitis B endemic area, all the parturients admitted to the Hospital were studied from 1985 to 2000. Serum hepatitis B surface (HBsAg) and hepatitis B e antigen (HBeAg) were tested by radioimmunoassay. Mann-Whitney U and Student's t -tests were used for statistical analysis. The results showed the yearly prevalence rate of HBsAg in pregnant women seemed stable with a mean of 12.0,±,1.1% during the period. The yearly positive rate of HBeAg among HBsAg-positive pregnant women varied between 30.4% and 42.6% from 1985 to 1992 and declined from 29.6% in 1993 to 18.1% in 2000. The mean ratio of HBeAg/HBsAg in carrier parturients was 24.7% [intraquantile range (IQR) 20.5,28.4] from 1993 to 2000, which was significantly lower than that of 32.4% (IQR 31.0,39.0) from 1985 to 1992 (P,< 0.0001). The mean age of HBeAg-positive primiparas from 1993 to 2000 was 29.1,±,3.9 years and significantly higher than that of 28.0,±,3.7 years from 1985 to 1993 (P,<,0.001), as well as in secundiparas 31.2,±,3.8 years vs. 30.1,±,3.4 years (P,< 0.001) and in total parturients 30.3,±,4.2 years vs. 29.3,±,3.8 years (P,<,0.001). Thus, no significant decrease of HBsAg carriage was observed in the past 16 years, whereas a decreased ratio of HBeAg/HBsAg was noted in carrier parturients in the past 8 years and the elderly HBeAg-positive parturients from 1993 to 2000 may be the cause. J. Med. Virol. 69:466,470, 2003. © 2003 Wiley-Liss, Inc. [source] The Implementation of Intranasal Fentanyl for Children in a Mixed Adult and Pediatric Emergency Department Reduces Time to Analgesic AdministrationACADEMIC EMERGENCY MEDICINE, Issue 2 2010Anna Holdgate MBBS, FACEM ACADEMIC EMERGENCY MEDICINE 2010; 17:1,4 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine whether the introduction of intranasal (IN) fentanyl for children with acute pain would reduce the time to analgesic administration in a mixed adult and pediatric emergency department (ED). Methods:, A protocol for IN fentanyl (1.5 ,g/kg) for children age 1,15 years presenting with acute pain was introduced to the department. All children who received intravenous (IV) morphine in the 7 months prior to the introduction of the protocol and either IV morphine or IN fentanyl in the 7 months after the introduction of the protocol were identified from drug registers. Time to analgesic administration, time to see a doctor, and the ages of patients were compared between the periods before and after the introduction of IN fentanyl. Results:, Following implementation, 81 patients received IN fentanyl and 37 received IV morphine, compared to 63 patients receiving morphine in the previous 7 months. The median time to analgesic administration for IN fentanyl was significantly shorter than for morphine (32 minutes vs. 63 minutes, p = 0.001). Children receiving fentanyl were significantly younger than those receiving morphine (median = 8.5 years vs. 12 years, p < 0.001). Conclusions:, This study demonstrates that children treated with IN fentanyl received analgesic medication faster than those treated with IV morphine in a mixed ED. Younger children were more likely to receive opioid analgesia following the introduction of fentanyl. [source] Association between extent of axillary lymph node dissection and patient, tumor, surgeon, and hospital factors in patients with early breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 2 2003David W. Petrik MD Abstract Background and Objectives Axillary lymph node dissection (ALND) in patients with breast cancer is crucial for accurate staging, provides excellent regional tumor control, and is included in the standard of care for the surgical treatment of breast cancer. However, the extent of ALND varies, and the extent of dissection and the number of lymph nodes that comprise an optimal axillary dissection are under debate. Despite conflicting evidence, several studies have shown that improved survival is correlated with more lymph nodes removed in both node-negative and node-positive patients. The purpose of this study is to determine which patient, tumor, surgeon, and hospital characteristics are associated with the number of nodes excised in early breast cancer patients. Methods A random sample of 938 women with node-negative breast cancer was drawn from the Ontario Cancer Registry and the data supplemented with chart reviews. The extent of axillary dissection was studied by examining the number of nodes examined in relation to the patient, tumor, surgeon, and hospital factors. Results The mean number of lymph nodes excised was 9.8 (SD = 4.8; range, 1,31), and 49% of patients had ,10 nodes excised. Lower patient age was associated with the excision of more lymph nodes (,10 nodes: 63% of patients <40 years vs. 38% of patients ,80 years). Surgeon academic affiliation and surgery in a teaching hospital were highly correlated with each other and were significantly associated with the excision of ,10 nodes. The number of nodes excised was not associated with any tumor factors, nor with the breast operation performed. These results were confirmed with multivariable models. Conclusions Even though the number of lymph nodes found in the pathologic specimen can be influenced by factors other than surgical technique (e.g., number of nodes present, specimen handling, and pathologic examination), this study shows significant variation of this variable and an association with several patient and surgeon/hospital factors. This variation and the association with survival warrant further study and effort at greater consistency. J. Surg. Oncol. 2003;82:84,90. © 2003 Wiley-Liss, Inc. [source] Ascites in patients with noncirrhotic nonmalignant extrahepatic portal vein thrombosisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010M. C. W. Spaander Aliment Pharmacol Ther 2010; 32: 529,534 Summary Background, The clinical significance of ascites in patients with extrahepatic portal vein thrombosis (EPVT) has been poorly defined. Aims, To assess the frequency, natural history and prognostic implication of ascites in patients with EPVT and to identify risk factors for this complication. Methods, A single-centre retrospective study of consecutive patients diagnosed with noncirrhotic nonmalignant EPVT between 1985 and 2009. Results, One hundred and three patients [35% males; median age 43 (range 16,83) years] were included and followed up for a median time of 5.2 (range 0.9,32.5) years. Twenty-nine (28%) had ascites at the time of diagnosis. Overall survival was 91% at 5 years vs. 80% at 10 years. Survival in patients presenting with and without ascites was 83% vs. 95% at 5 years and 42% vs. 87% at 10 years (P = <0.01). There was no correlation between the presence of ascites and extension of the thrombus into the large splanchnic veins, duration of thrombosis or presence of gastrointestinal bleeding. Conclusions, Ascites is present in a quarter of patients presenting with noncirrhotic nonmalignant extrahepatic portal vein thrombosis. Ascites is a significant and independent prognostic factor and it is associated with a decreased long-term survival. [source] Clinical features of ileal pouch-anal anastomosis in African American patients with underlying ulcerative colitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2009L. MOORE Summary Background, The prevalence of inflammatory bowel disease in African Americans appears to be increasing. The data on differences in disease behavior and severity between the races have been conflicting. Aim, To evaluate the effect of race on outcome and natural history of patients with ileal pouch-anal anastomosis. Methods, All African American patients with underlying ulcerative colitis and ileal pouch-anal anastomosis who were seen in our subspecialty Pouchitis Clinic from 2002 to 2008 were included. The control group consisted of Caucasian patients with ulcerative colitis and ileal pouch-anal anastomosis who were randomly selected from the same Pouch Registry at a ratio of 4:1. We compared pouch failure, Crohn's disease of the pouch, and chronic pouchitis rates, as well as other 23 demographic and clinical variables between African American and Caucasian patients. Results, A total of 12 African American patients and 48 Caucasian patients were evaluated in this case-control study. There were no significant differences in the frequency of pouch failure, Crohn's disease of the pouch, or chronic pouchitis between the African American and Caucasian groups. However, African American patients were found to have a significantly shorter duration of inflammatory bowel disease (11.5 years vs. 17.0 years, P = 0.024) as well as significantly shorter duration of pouch (1.5 years vs. 4 years, P = 0.02). African Americans were also less likely to have pancolitis at the time of colectomy (83% vs. 100%, P = 0.037). Conclusions, While there were no significant differences in pouch outcomes between the races, African American patients appeared to have more left-sided colitis at the time of colectomy, with a shorter duration of inflammatory bowel and ileal pouch. This finding suggests that the natural history of ulcerative colitis and disease course before and after restorative proctocolectomy may be different between these racial groups. [source] Parkinsonism in patients with a history of amphetamine exposureMOVEMENT DISORDERS, Issue 2 2010Chadwick W. Christine MD Abstract We recently found a higher rate of prolonged amphetamine exposure in patients diagnosed with Parkinson's disease (PD) than in spouse/caregiver controls. Since distinguishing features have been described in some patients with parkinsonism due to environment exposures (e.g., manganese), we sought to compare the clinical features of patients with PD with prolonged amphetamine exposure with unexposed patients with PD. Prolonged exposure was defined as a minimum of twice a week for ,3 months, or weekly use ,1 year. We reviewed the clinical records of patients with PD who had participated in a telephone survey of drug and environmental exposures and compared the clinical features of patients with a history of prolonged amphetamine exposure to patients who had no such exposure. Records were available for 16 of 17 (94%) patients with prior amphetamine exposure and 127 of 137 (92%) of those unexposed. Age at diagnosis was younger in the amphetamine-exposed group (49.8 ± 8.2 years vs. 53.1 ± 7.4 years; P < 0.05), but other features, including presenting symptoms, initial and later treatments, development of motor fluctuations, and MRI findings were similar between these groups. Because we did not detect clinical features that differentiate parkinsonism in patients with prolonged amphetamine exposure, research to determine whether amphetamine exposure is a risk factor for parkinsonism will require detailed histories of medication and recreational drug use. © 2009 Movement Disorder Society [source] Peritoneal albumin leakage: 2 year prospective cardiovascular event occurrence and patient survival analysisNEPHROLOGY, Issue 8 2009RENGIN ELSURER SUMMARY: Aim: High peritoneal transport status is a determinant of morbidity and mortality in peritoneal dialysis (PD) patients. It was hypothesized that 24 h peritoneal albumin leakage predicted 2 year prospective cardiovascular outcome and survival in patients receiving PD. Methods: Sixty-six patients were included. A simplified peritoneal equilibration test was performed and 24 h peritoneal albumin leakage was calculated. Patients were followed up for 2 years. Patient outcome (alive or dead) and occurrence of a cardiovascular event were recorded. Results: During a 2 year follow-up period, 10 (15.2%) patients had suffered from a cardiovascular event and seven (10.6%) patients had died. Patients who had suffered from a cardiovascular event during the follow up period were older (54.0 ± 9.4 years vs 44.3 ± 14.5 years, P = 0.025), had lower serum pre-albumin concentrations (29.3 ± 10.0 g/dL vs 36.0 ± 9.2 g/dL, P = 0.034) and had higher 24 h peritoneal albumin leakage (median, 3.4 g/day (1.66,15.4 g/day) vs 2.4 g/day (0.76,7.31 g/day), P = 0.011) than patients who did not suffer from a cardiovascular event. In the Cox proportional hazards multivariate analysis of factors which differed significantly between patients with and without a cardiovascular event (age, serum pre-albumin and 24 h peritoneal albumin leakage), only advanced age (hazards ratio, 1.083; 95% confidence interval, 1.023,1.147, P = 0.006) was an independent predictor of a cardiovascular event. Conclusion: In contrast to the hypothesis, 24 h peritoneal albumin leakage is not a predictor of 2 year prospective cardiovascular outcome and patient survival. Only advanced age independently predicts the occurrence of a cardiovascular event in patients receiving PD. [source] Pseudomonas aeruginosa in children with cystic fibrosis diagnosed through newborn screening: Assessment of clinic exposures and microbial genotypes,PEDIATRIC PULMONOLOGY, Issue 7 2010Don Hayes Jr MD Abstract Background Chronic pulmonary infection with Pseudomonas aeruginosa (PA) is responsible for significant morbidity and mortality in cystic fibrosis (CF). Because of the limited studies evaluating early exposure and the progression of genetic variability of PA, our goal was to assess PA in young children with CF followed in two clinic types. Methods A total of 39 infants with CF diagnosed through newborn screening were randomly assigned to either a segregated (PA-free) or mixed (PA-positive) clinic at two different CF centers, one of which replaced an older, mixed clinic where nosocomial acquisition was suspected. Oropharyngeal (OP) swab cultures were examined with subsequent genotyping to characterize the strains of PA isolated. Results We found that 13/21 segregated clinic patients and 14/18 mixed clinic patients showed positive PA, with median acquisition ages of 3.3 and 2.2 years, respectively (P,=,0.57). The median time to PA acquisition, however, was significantly longer in the new clinic with proper hygiene precautions compared to an old site (5.0 years vs. 1.7 years, P,<,0.001). The majority of subjects isolated a single genotype of PA or AP-PCR types during the study period with eight subjects clearing the isolate after only one positive culture. The development of chronic colonization yielded the predominance of a single major genotype or AP-PCR type. Conclusions Segregation of infants and young children with CF in PA-negative or PA-positive clinics did not alter the time to first PA isolation in this randomized assessment of facilities with hygienic precautions. During the early infection period where PA is first isolated in young children with CF, patients cleared different PA strains until a predominant strain established permanent colonization. Pediatr Pulmonol. 2010; 45:708,716. © 2010 Wiley-Liss, Inc. [source] Study of anticipation in Chinese families with schizophreniaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2001Ching-Hua Lin MD Abstract The anticipation phenomenon is an important aspect in several genetic disorders in which the age at onset (AAO) decreases and the severity of illness increases in successive generations. This phenomenon has been reported in several schizophrenic family studies, and expanded repeat mutations are implicated. In the present study, we investigate the anticipation phenomenon in Chinese schizophrenic families. We compare the AAO between two generations of 38 unilinear schizophrenic families. Intergenerational comparisons show that the AAO was significantly earlier in the offspring generation (mean AAO, 22.2 years) than that in the parental generation (mean AAO, 31.0 years) (P < 0.001). When only including the offspring generation who married, the AAO difference between the two generations was not significant (28.4 years vs 31.0 years, P = 0.151). Our findings suggest that a selection bias in the parental group might greatly impact the study of anticipation in schizophrenia. Other unavoidable biases associated with these analyses are discussed in the text. [source] Me Too!: Social modelling influences on early autobiographical memoriesAPPLIED COGNITIVE PSYCHOLOGY, Issue 2 2009Tiamoyo Peterson To investigate the malleability of early memories, 200 participants were asked to describe their earliest memories. Before doing so, approximately half were exposed to confederates who described very early memories such as their first steps or a second birthday party, while others were asked only to think about their earliest memories for two,minutes before beginning writing. Participants who were exposed to confederate very early memories produced memories that were nearly a year younger on average than the memories reported by controls (2.99 years vs. 3.96 years). Additionally, when participants in the memory discussion condition were asked about an early event that a confederate had recounted they were more confident than controls that they could recall the event in their own lives. These results indicate that autobiographical memories for early events are quite susceptible to social influence and that simply hearing the very early memories of others can alter autobiographical memory. Copyright © 2008 John Wiley & Sons, Ltd. [source] Destination Therapy: One-Year Outcomes in Patients With a Body Mass Index Greater Than 30ARTIFICIAL ORGANS, Issue 2 2010Laura A. Coyle Abstract Left ventricular assist devices (LVADs) are slowly gaining acceptance as the treatment of choice in appropriately selected patients with end-stage heart failure who are not transplant candidates. Obesity is a well-known risk factor for increased cardiovascular morbidity and mortality, and frequently can be the reason some patients are turned down for heart transplantation. Because of this experience in transplant patients, many centers have also been reluctant to offer these patients an LVAD for destination therapy (DT). Subsequently, the 1-year outcomes of obese patients receiving LVADs for DT at our center were reviewed. Fifty-eight consecutive patients (83% men) were implanted with HeartMate XVE (n = 22) or HeartMate II (n = 36) LVAD. Patients were divided into normal (body mass index [BMI] , 30 kg/m2, n = 38) and obese (BMI , 30 kg/m2, n = 20) groups according to their BMI. Preoperatively, there were statistically significant differences (P < 0.05) between normal and obese groups in age (65.9 years vs. 54.7 years), weight (72.9 kg vs. 107.5 kg), BMI (24.1 kg/m2 vs. 35.2 kg/m2), and incidence of diabetes (37% vs. 60%). At 1-year follow-up, there were no statistically significant differences (P > 0.5) between normal and obese groups: creatinine levels (1.4 vs. 1.5), New York Heart Association classification (1.2 vs. 1.6), and survival (63% vs. 65%). Our initial results demonstrate that morbidly obese patients with end-stage heart failure with a contraindication for transplant may successfully undergo implantation of an LVAD for DT. [source] Demographic, migration status, and work-related changes in Asian female sex workers surveyed in Sydney, 1993 and 2003AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2006C. Pell Objective: To compare demography, sexual health awareness, migration and workplace conditions of Asian female sex workers in Sydney in 1993 and 2003. Method: A Chinese interpreter and a Thaispeaking health education officer (HEO) were used to administer a questionnaire survey to Thai- and Chinese-speaking sex workers attending sexual health clinics in 1993. A follow-up survey, which included some women contacted at work as well as clinic attenders, was administered by Thai-and Chinese-speaking HEOs in 2003. Results: Ninety-one female sex workers were surveyed in 1993 and 165 in 2003. Median age increased (26 years vs. 33 years, p=0.000), as did numbers of Chinese- versus Thai-speakers (1993, 25.3% Chinese vs. 2003, 58.2% Chinese, p=0.000). In 2003, the women reported more years of schooling and better English skills. Fewer reported previous sex work (48.4% vs. 17.6%, p=0.000). Numbers currently or ever on a contract decreased sharply (27.5% vs. 9.1%, p=0.000) and the majority were apparently working legally. Condom use at work for vaginal (51.6% vs. 84.8%) and oral sex (39.6% vs. 66.1%) increased significantly (p=0.001). Chinese-speaking sex workers were less informed about HIV transmission and safer sex practices than were Thai sex workers. Drug and alcohol use was low. Conclusions and Implications: Positive changes have occurred in the conditions of Asian female sex workers surveyed over 10 years in Sydney. Maintaining current levels of health service delivery will ensure continued improvements in health and workplace conditions and address inequalities between language groups. [source] Guardian Availability in Children Evaluated in the Emergency Department for Blunt Head TraumaACADEMIC EMERGENCY MEDICINE, Issue 1 2009James F. Holmes MD Abstract Background:, Enrolling children in research studies in the emergency department (ED) is typically dependent on the presence of a guardian to provide written informed consent. Objectives:, The objectives were to determine the rate of guardian availability during the initial ED evaluation of children with nontrivial blunt head trauma, to identify the reasons why a guardian is unavailable, and to compare clinical factors in patients with and without a guardian present during initial ED evaluation. Methods:, This was a prospective study of children (<18 years of age) presenting to a single Level 1 trauma center after nontrivial blunt head trauma over a 10-month period. Physicians documented patient history and physical examination findings onto a structured data form after initial evaluation. The data form contained data points regarding the presence or absence of the patient's guardian during the initial ED evaluation. For those children for whom the guardian was not available during the initial ED evaluation, the physicians completing the data forms documented the reasons for the absence. Results:, The authors enrolled 602 patients, of whom 271 (45%, 95% confidence interval [CI] = 41% to 49%) did not have a guardian available during the initial ED evaluation. In these 271 patients, 261 had reasons documented for lack of guardian availability, 43 of whom had multiple reasons. The most common of these was that the guardian did not ride in the ambulance (51%). Those patients without a guardian available were more likely to be older (mean age, 11.4 years vs. 7.6 years; p < 0.001), be victims of a motor vehicle collision (MVC; 130/268 [49%] vs. 35/328 [11%]; p < 0.001), have a Glasgow Coma Scale (GCS) score <14 (21/269 [7.8%] vs. 11/331 [3.3%]; p = 0.02), and undergo cranial computed tomography (CT) scanning (224/271 [83%] vs. 213/331 [64%]; p < 0.001). Multivariate analysis identified similar independent risk factors for lack of guardian presence. Conclusions:, Nearly one-half of children with nontrivial blunt head trauma evaluated in the ED may not have a guardian available during their initial ED evaluation. Patients whose guardians are not available at the time of initial ED evaluation are older and have more severe mechanisms of injury and more serious head trauma. ED research studies of pediatric trauma patients that require written informed consent from a guardian at the time of initial ED evaluation and treatment may have difficulty enrolling targeted sample size numbers and will likely be limited by enrollment bias. [source] Microsatellite instability and DNA ploidy in colorectal cancerCANCER, Issue 2 2009Potential implications for patients undergoing systematic surveillance after resection Abstract BACKGROUND: Appropriate stratification tools for targeted surveillance after resection for colorectal cancer (CRC) are lacking. The objective of the current study was to investigate the effect of microsatellite instability (MSI) and DNA ploidy on surveillance after surgery. METHODS: The authors evaluated 186 consecutive, population-based patients with stage I through III CRC who underwent surgery with curative intent and who entered a systematic surveillance program. MSI was analyzed with polymerase chain reaction for 5 known quasimonomorphic markers (BAT-26, BAT-25, NR-21, NR-24, and NR-27), and DNA ploidy was analyzed with automated cytometry. Recurrence, recurrence-free survival (RFS), and disease-specific survival (DSS) were evaluated by univariate and multivariate statistical tests. RESULTS: Patients with MSI (20%) were significantly younger than patients without MSI (median age, 61 years vs 67 years; P = .016). Proximal location (adjusted odds ratio [AOR], 5.4; 95% confidence interval [95% CI], 2.1-14.1 [P = .001]), large tumor size (,5 cm: AOR, 3.5; 95% CI, 1.3,9.6 [P = .015]), and poor tumor differentiation (AOR, 6.6; 95% CI, 2,21.8 [P = .002]) were associated with MSI. MSI conveyed an increased risk for locoregional recurrence (OR, 2.9; 95% CI, 1.2,7 [P = .016]), with a trend toward a shorter time to recurrence (P = .060). Neither MSI status nor DNA ploidy predicted distant metastasis, RFS, or DSS. Lymph node status was the best predictor of distant spread (AOR, 3.9; 95% CI, 2,7.9 [P < .001]) and DSS (hazard ratio, 4.9; 95% CI, 2.6,9 [P < .001]). CONCLUSIONS: Patients who had microsatellite instable tumors were at increased risk for locoregional recurrence, whereas lymph node status was the best predictor of distant metastasis. Clinical surveillance and choice of modality (ie, endoscopy vs radiologic imaging) may be improved when patients are stratified according to these cancer features. Cancer 2009. © 2009 American Cancer Society. [source] Changes in management techniques and patterns of disease recurrence over time in patients with breast carcinoma treated with breast-conserving therapy at a single institutionCANCER, Issue 4 2004Helen Pass M.D. Abstract BACKGROUND The authors reviewed changes in the initial clinical presentation, management techniques, and patterns of disease recurrence over time (1981,1996) in patients with breast carcinoma treated with breast-conserving therapy (BCT) at a single institution. The goals of the current study were to determine the frequency and use of optimal local and systemic therapy techniques and to evaluate the impact of these changes on treatment efficacy. METHODS Six hundred seven patients with American Joint Committee on Cancer Stage I or II invasive breast carcinomas treated with BCT at William Beaumont Hospital (Royal Oak, MI) constituted the study population. All patients received at least an excisional biopsy of the primary tumor, an axillary lymph node staging procedure, and postoperative radiotherapy (RT) (a median tumor bed dose of 61 Gray [Gy] was administered). All sides were reviewed by one pathologist. Numerous clinicopathologic and treatment-related factors were analyzed to monitor changes that occurred over time. Changes in patterns of disease recurrence and treatment efficacy over time also were analyzed. RESULTS Over the time period analyzed, changes at initial presentation included an increase in the mean age at diagnosis (age 56.1 years vs. 61.4 years; P < 0.001), a decrease in the number of patients with clinically palpable tumors (78% vs. 36%; P < 0.001), a decrease in the mean tumor size (2.2 cm vs. 1.6 cm; P < 0.001), but no change in the percentage of patients with negative lymph nodes (79% vs. 78%; P = 0.83). No differences over time were observed in mean tumor grade (2.0 vs. 1.9; P = 0.2) or the presence of angiolymphatic invasion (27% vs. 26%; P = 0.25). Changes in surgical management and pathologic assessment included the more frequent use of reexcision (46% vs. 81%; P < 0.001), larger mean total volumes of breast tissue specimens excised (115 cm3 vs. 189 cm3; P = 0.001), a larger percentage of patients with final negative surgical margins (74% vs. 97%; P < 0.001), and a small increase in the mean number of lymph nodes excised (13.8 lymph nodes vs. 14.1 lymph nodes; P = 0.01). The only other significant change in the pathologic management of patients over time included a doubling in the mean number of slides examined (10.6 slides vs. 21.1 slides; P < 0.001). Changes in adjuvant local and systemic therapy included an increase in the percentage of patients treated with > 60 Gy to the tumor bed (66% vs. 95%; P < 0.001), a doubling in the mean number of days from the last surgery to the start of RT (24 days vs. 50 days; P < 0.001), and a decrease in the use of regional lymph node RT (24% vs. 8%; P < 0.001). The use of adjuvant tamoxifen increased from 10% to 61% (P < 0.001). Finally, improvements were observed in the 5-year and 12-year actuarial rates of local disease recurrence (8% vs. 1% and 21% vs. 9%, respectively; P = 0.001) and distant metastases (12% vs. 4% and 22% vs. 9%, respectively; P = 0.006). No changes in the mean number of years to ipsilateral (6.5 years vs. 6.4 years; P = 0.59) or distant disease recurrence (4.6 years vs. 3.8 years; P = 0.73) were observed. CONCLUSIONS The impact of screening mammography and substantial changes in surgical, pathologic, RT, and systemic therapy recommendations were observed over time in the study population. These changes were associated with improvements in 5-year and 12-year local and distant control rates and suggested that improvements in outcome can be realized through adherence to best practice guidelines and continuous monitoring of treatment outcome data. Cancer 2004. © 2004 American Cancer Society [source] Advanced age at diagnosis is an independent predictor of time to death from prostate carcinoma for patients undergoing external beam radiation therapy for clinically localized prostate carcinomaCANCER, Issue 1 2003Anthony V. D'Amico M.D., Ph.D. Abstract BACKGROUND Whether age at diagnosis is predictive of time to prostate carcinoma specific death after external beam radiation therapy (RT) for patients who are diagnosed with clinically localized prostate carcinoma during the prostate specific antigen (PSA) era has not been investigated previously. METHODS A multivariate Cox regression analysis was used to evaluate the ability of pretreatment risk group and age at diagnosis to predict time to all causes of death and time to death from prostate carcinoma for 381 patients who underwent RT for clinically localized prostate carcinoma. RESULTS Age at diagnosis, as a continuous variable (Pcontinuous = 0.04), and risk group (Pcategorical = 0.02) were independent predictors of time to death from prostate carcinoma, whereas only age at diagnosis (Pcontinuous = 0.01) was a predictor of time to all causes of death. When analyzed as a categorical variable, beginning at age 73 years, age at diagnosis was an independent predictor (Pcategorical < 0.04) of time to death from prostate carcinoma. Upon further analysis, this finding was limited to high-risk patients. For example, age , 75 years at diagnosis predicted for a shorter median time to death from prostate carcinoma (6.3 years vs. 9.7 years; P = 0.002) in high-risk patients. CONCLUSIONS Patients with clinically localized, high-risk prostate carcinoma who were diagnosed at age , 73 years and were treated with RT had a worse prognosis compared with patients who were diagnosed age < 73 years, raising the possibility that a more aggressive prostate carcinoma biology may develop during andropause. Cancer 2003;97:56,62. © 2003 American Cancer Society. DOI 10.1002/cncr.11053 [source] Improved survival with drug-eluting stent implantation in comparison with bare metal stent in patients with severe left ventricular dysfunctionCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2006FACC, Giuseppe Gioia MD Abstract OBJECTIVE: We examined the efficacy of drug-eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction and compared the outcome with a similar group of patients undergoing bare metal stent (BMS) implantation. BACKGROUND: Patients with severe LV dysfunction are a high risk group. DES may improve the long term outcomes compared with BMS. METHODS: One hundred and ninety one patients (23% women) with severe LV dysfunction (LV ejection fraction ,35%) underwent coronary stent implantation between May 2002 and May 2005 and were available for follow-up. One hundred and twenty eight patients received DES (Sirolimus in 72 and Paclitaxel in 54) and 63 patients had BMS. Patients with acute S-T elevation myocardial infarction (STEMI) were excluded. The primary endpoint was cardiovascular mortality. A composite endpoint of major adverse cardiac events (MACE) including cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization (TVR) was the secondary endpoint. RESULTS: Mean follow-up was 420 ± 271 days. No differences were noted in age (69 ± 10 years vs. 70 ± 10 years, P = NS), number of vessel disease (2.3 ± 0.7 vs. 2.2 ± 0.8, P = NS), history of congestive heart failure (47% vs. 46%, P = NS), MI (60% vs. 61%, P = NS), or number of treated vessels (1.3 ± 0.5 vs. 1.3 ± 0.6, P = NS) for the DES and BMS group, respectively. Diabetes was more common among DES patients (45% vs. 25%, P = 0.01). The left ventricular ejection fraction (LVEF) was similar between the two groups (28% ± 6% vs. 26% ± 8%, P = NS for the DES and BMS, respectively). During the follow-up, there were a total of 25 deaths of which two were cancer related (2 in DES group). There were 23 cardiac deaths, 8/126 (6%) which occurred in the DES group and 15/63 (24%) in the BMS group (P = 0.05 by log-rank test). MACE rate was 10% for the DES group and 41% for the BMS group (P = 0.003). NYHA class improved in both groups (from 2.5 ± 0.8 to 1.7 ± 0.8 in DES and from 2 ± 0.8 to 1.4 ± 0.7 in the BMS, P = NS). CONCLUSION: Compared with bare-metal stents, DES implantation reduces mortality and MACE in high risk patients with severe left ventricular dysfunction. © 2006 Wiley-Liss, Inc. [source] Does gender affect the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock who undergo percutaneous coronary intervention?CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2003David Antoniucci MD Abstract This study sought to determine the impact of female gender on clinical outcome in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) due to predominant ventricular failure undergoing percutaneous coronary intervention (PCI). We analyzed gender-related differences in procedural, angiographic, and clinical outcomes in 208 consecutive patients with AMI complicated by CS. Out of 208 patients with CS, 65 were women and 143 men. Women were older than men (74 ± 10 years vs. 66 ± 12 years; P < 0.001) and had a greater incidence of a history of hypertension (43% vs. 29%; P = 0.041). The 6-month mortality rate was 42% in women and 31% in men (P = 0.157). There were no differences between groups in reinfarction rate and target vessel revascularization rate. Multivariate analysis showed age as the only variable independently related to the 6-month mortality, while female gender was not related to the risk of death. The benefit of early PCI is similar in women and men, and any potential referral bias in the use of PCI based on gender differences should be avoided. Cathet Cardiovasc Intervent 2003;59:423,428. © 2003 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||