Prognostic factors in the diagnostic work-up of cancer patients in an internal medicine department: does age matter?
Journal - International journal of clinical practice (England )
INTRODUCTION: Increasing life expectancy in the general population has led to a rise in the incidence of cancer and new challenges with regard to the diagnosis, therapy and prognosis of this disease. AIM: To assess prognostic factors in the initial work-up of patients ultimately diagnosed with cancer in an Internal Medicine Service, particularly those related with age. PATIENTS AND METHODS: A prospective study was undertaken with 224 patients ultimately diagnosed with cancer, as confirmed by histological or cytological study. The neoplasms included respiratory, gastrointestinal, genitourinary, metastatic adenocarcinoma of unknown origin, gynaecological, hepatobiliary and others. Before reaching the diagnosis, the following factors were investigated in all patients: functional status [Karnofsky Performance Status (KPS)], comorbidity (Charlson scale), body mass index (BMI), serum cholesterol and albumin concentrations, cognitive level (Mini-mental test), quality of life (Short Form 36 questionnaire), and extension of the disease according to established criteria. Survival at 1 year was analysed. Statistical analyses were done with spss 11.0 for Windows, using a forward stepwise (likelihood ratio) method to construct the model and a Cox multivariate model for the survival analysis. RESULTS: A total of 224 patients, 167 men (74.5%) and 57 women (25.5%), with a mean age of 66.1 +/- 12.3 years were studied. KPS was >or= 70 in 84% and comorbidity was zero or one in 74%. BMI was 24.25 +/- 4.3, cholesterol 180.7 +/- 4.3, albumin 3.32 +/- 0.5 and Mini-mental score 25.4 +/- 3.7. Metastasis was seen in 131 patients (58.5%) and local disease in 93 cases (41.5%). One-year survival was 38.8% (87 patients) with a mean of 203.8 +/- 143 days. In the Cox analysis, the independent predictive factors for survival were KPS [hazard ratio (HR) = 0.951; 95% CI = 0.930-0.974; p < 0.01], metastatic dissemination (HR = 2.422; 95% CI = 1.643-3.571; p < 0.01), physical quality of life (HR = 0.978; 95% CI = 0.962-0.995; p < 0.01) and albumin (HR = 0.653; 95% CI = 0.455-0.936; p < 0.01). CONCLUSIONS: In the initial work-up of patients ultimately diagnosed with cancer in an Internal Medicine Service, functional status, dissemination, the physical component in the quality of life scale and serum albumin levels were independent prognostic factors for survival. Age was not an independent prognostic factor and should not be used as a basis for adopting diagnostic or therapeutic decisions in these patients.
Prognostic value of segmental contractility assessed by cross-sectional echocardiography in first acute myocardial infarction.
Journal - European heart journal (ENGLAND )
We prospectively studied 110 patients with a first acute myocardial infarction with cross-sectional echocardiography, between 7-10 days post-infarction, to assess the value of semiquantitative segmental contractility score for the first year post-AMI risk stratification. 87 patients had acceptable recordings (40 anterior and 47 inferior infarction). Twelve patients had severe complications (severe angina or heart failure, reinfarction or death) and 40 had non-severe complications. The total segmental score was higher in complicated than in non-complicated patients. The score also differentiated angina from heart failure. The score of necrotic area was more discriminating than that of non-necrotic area. Discriminating power was higher in anterior than in inferior acute myocardial infarction. Thus we conclude that the semiquantitative assessment of segmental contractility by cross-sectional echocardiography is useful for risk stratification following acute infarction identifying severe complications, particularly heart failure, with better discrimination in anterior acute myocardial infarction.
|ISSN : ||0195-668X|
|Mesh Heading : ||Adult Aged Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction Prognosis Prospective Studies mortality|
|Mesh Heading Relevant : ||Echocardiography Myocardial Contraction physiopathology|
Five French versus eight French catheters and the Judkins technique. Advantages and limitations for studying coronary artery disease.
Journal - International journal of cardiac imaging (UNITED STATES )
In order to compare 5 French versus 8 French catheters for assessing ischemic heart disease, we prospectively studied 2 groups of 100 patients each, one with 5 French (group I) and the other with 8 French (group II) catheters by the Judkins technique. Significant differences were found in the greater easiness to catheterize LV (p less than 0.05) and LCA (p = 0.01) in group II and in better quality image for LCA in group II (p less than 0.05), although all patients in both groups had acceptable image quality. Pressure curves quality was better in group II (p less than 0.01); X-ray exposure time was longer in group I (p less than 0.001) and arterial compression time in group II (p less than 0.0001). Group I showed 3 and group II 10 mild hematomas (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter in 95 patients in group I and in 96 in group II. Thus, the Judkins technique with 5 French catheters is as valid as with 8 French for assessing ischemic patients, reducing arterial morbidity, although mildly increasing technical difficulty and mildly decreasing quality image.
|ISSN : ||0167-9899|
|Mesh Heading : ||Adult Aged Aged, 80 and over Coronary Disease Female Heart Catheterization Humans Male Middle Aged Prospective Studies Random Allocation adverse effects|
|Mesh Heading Relevant : ||radiography methods|