Prostate-specific antigen may serve as a pathological predictor in breast cancer

PSA (prostate-specific antigen), a serine protease with chymotrypsin-like activity is the most useful tumor marker for prostate cancer screening, diagnosis, prognosis and monitoring. The identification of PSA in normal and tumoral mammary gland was regarded as a curiosity, but the confirmation of PSA expression in the mammary gland by others teams of researchers and the identification of specific mRNA in tumors with PSA immunoexpression initiated new perspectives for studies. The aim of this study was to examine the prevalence of PSA in breast cancers and to evaluate the correlations between PSA expression and some clinicopathological markers. We analyzed the expression of PSA in series of consecutive breast carcinomas by immunohistochemistry and correlated the PSA expression with the histological type and grade, nodal and metastasis status, estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR) and HER2/neu expression. PSA expression was observed in 44.5% of breast cancers, particularly in lobular types of carcinoma (p<0.0001). In univariate analysis, the expression of PSA was statistically correlated with AR (p<0.0001), PR (p=0.01) and inversely correlated with HER2/neu overexpression (p=0.008) and G3 (p=0.02). PSA did not significantly correlate with ER expression, lymph node and metastasis status. In multivariate analysis, PR was a moderate predictor (p=0.024) but the lobular type (p=0.000), AR (p=0.000), HER2/neu (p=0.002) and G3 (p=0.008) were strong predictors for PSA immunoexpression.

[Prognostic value of the new international staging system in multiple myeloma. Comparison with Durie-Salmon staging system]

BACKGROUND

Since 1975, the Durie-Salmon staging system (D&S) has been a widely accepted prognostic classification of multiple myeloma (MM) patients. Recently, the new International Staging System (ISS) was developed using only the values of albumin and beta2-microglobulin.

AIM

To compare survival of patients with MM treated in six medical centers in Chile according to the D&S system and the new ISS.

MATERIAL AND METHODS

Retrospective analysis of demographic information, clinical features and survival rate of patients treated between 1998 and 2002, and grouped according to both systems.

RESULTS

Information of 81 patients aged 38 to 90 years (43 women) was retrieved. According D&S system 11% were in stage I 12% in stage II and 73% in stage III According to ISS, 34% were in stage I 35% in stage II and 31% in stage III Median of survival of all patients was 32 months. Both staging systems had a prognostic value. However, median survival for the three stages of the ISS system was significantly different (67, 29 and 14 months in stages III and III, respectively, p =0.02). Patients in advanced stages II and III of the ISS, had a higher frequency of anemia, hypercalcemia, renal failure and hypoalbuminemia. In stages II and III of ISS the presence of renal failure was associated with a non significantly different lower survival.

CONCLUSIONS

The ISS is a simple and effective grouping method for patients with MM, that predicts survival. The presence of renal insufficiency might identify a subgroup of patients included in stages II and III of ISS with a higher mortality.

Pathologic characteristics, type of treatment and follow up of patients with uterine cervical carcinoma referred to the Radiation Oncology Department, Cancer Institute, Imam Khomeini Hospital,Tehran, Iran, 1995-2001

BACKGROUND

Carcinoma of the uterine cervix is the sixth most common malignant neoplasm in women worldwide. Early stage diagnosis increases the cure rate of disease. Radiotherapy with or without concurrent chemotherapy is one of the most effective treatment modalities. After radiotherapy, accurate and regular follow-up results in early diagnosis and effective treatment of recurrence.

METHODS

In this retrospective study, we evaluated 346 cases of cervical carcinoma who have been treated with radiotherapy in the Radiation Oncology Department of the Cancer Institute of Imam Khomeini hospital from 1995 to 2001.

RESULTS

Age of the study group ranged from 26 to 78 (mean=50.5, SD=11). 30.4 percent of patients were early stage and 69.6 percent had advanced stage of disease. Some 92.2 percent of cases were squamous cell carcinomas and adenocarcinomas made up the 6.4 percent . Radical radiotherapy was most frequent radiotherapy setting and adjuvant radiotherapy (post-op) was the second. Most of the patients (43.7 percent) were followed for a short time, and a considerable number did not return for follow-up.

CONCLUSION

According to our results, patients do not pay enough attention to disease follow-up. An acceptable training plan, with emphasis on regular follow-up, is recommended.

Major hepatic resection for hilar cholangiocarcinoma without preoperative biliary drainage

Hilar cholangiocarcinoma is a rare cancer in western countries but very high incidence in the northeast of Thailand. The only chance to cure is surgical resection. Preoperative biliary drainage (PBD) for improving liver function to decrease perioperative morbidity and mortality is claimed to be beneficial. To determine whether liver resection with hilar resection is a safe procedure in obstructive jaundice patients caused by hilar cholangiocarcinoma, the records of 30 consecutive patients undergoing surgery between May 1999 and May 2002 at Srinagarind hospital, Khon Kaen University, were retrospectively analyzed. Two patients died during hospitalization, an operative mortality of 6.7%. Survival was 33% at 1 year, 12% at 2 years,10% at 3 years and 6.7% at 4 years. In our experience, it is safe in most patients with obstructive jaundice due to hilar cholangiocarcinoma to perform liver resection without preoperative biliary drainage (PBD).

[Clinical aspects of rehabilitation potential in patients with chronic obstructive pulmonary disease]

AIM

To reveal and evaluate clinical signs influencing rehabilitation potential in COPD patients.

MATERIAL AND METHODS

Clinical findings in COPD patients were analysed at medical and social expert examination (MSEE).

RESULTS

Progression of the pathological process is associated with aggravation of chest pain, fever, sputum discharge at coughing. Cough and dyspnea occurred in all the examinees irrespective of the disease etiology. Severity of respiratory failure correlated with severity of COPD. Respiratory and circulatory failure aggravate quality of life. The study determined clinical signs in patients with COPD of various etiology which influence rehabilitation potential of COPD patients. This helped specification of disability criteria and certification. Conclusion. In MSEE of COPD patients it is necessary to base on the patient's complaints, duration of the disease, severity of functional respiratory and circulation failure, complications, social problems.

[Changes in the prognosis for survival of patients with end-stage renal disease (ESRD) treated by hemodialysis]

We started dialysis treatment in our institution in 1966, and have improved hemodialysis (HD) treatment through the induction of a biocompatible dialysis membrane, recombinant human erythropoietin, activated vitamin D and purification of the dialysate. We verified improvement of the prognosis for survival of patients with ESRD during this forty-year period, retrospectively. A total of 1,690 patients who began dialysis therapy in our hospital between January 1966 and December 2005 was studied (men: 1,047, women: 643, age: 58.6 +/- 17.4 years. They were divided into four groups (A: patients who started dialysis in the period from 1966 to 1975; n = 280, B: 1976-1985; n = 455, C: 1986-1995; n = 499, D: 1996-2005; n = 456). The mean follow-up period was 8.48 +/- 8.53 years. Of the patients 1,588 were treated with HD, 78 with peritoneal dialysis (PD), and 24 with PD or HD. Age at the initiation of dialysis increased gradually (A: 40.1 +/- 14.2 y-o, B: 53.2 +/- 15.8 y-o, C: 60.0 +/- 16.0 y-o, D: 66.4 +/- 13.8 y-o), and diabetics increased (A: 6.4%, B: 19.5%, C: 25.6%, D: 33.4%). A total of 1,180 patients died; 48.5% of these patients died of cardiovascular disease, 21.3% of infectious disease, and 6.4% of malignancy. Only 13 patients had kidney-transplants. With the Cox proportional hazard model for HD cases, age at the initiation of dialysis, gender, cause of renal disease, and the periods were significant predictors of mortality. The relative risk of mortality compared with that in A was reduced progressively: 0.796 in period B (95% confidence interval [CI]: 0.659-0.961, p = 0.0178), 0.505 in period C (95% CI: 0.409-0.623, p < 0.0001), and 0.286 in period D (95% CI: 0.223-0.366, p < 0.0001).

CONCLUSIONS

Although the number of high-aged patients or diabetics with ESRD increased in these 40 years, the survival of the patients with ESRD improved.

Linear relationship between ADAMTS13 activity and platelet dynamics even before severe thrombocytopenia

Von Willebrand factor (VWF) cleaving metalloprotease, ADAMTS13, known for its causative relation to thrombotic thrombocytopenic purpura (TTP), also decreases to variable degree in other clinical conditions associated with thrombocytopenia, indicating a possible contribution of moderate deficiency of ADAMTS13 to platelet dynamics. We measured ADAMTS13 activity along with VWF activity, collagen binding activity (VWF:CB), and thrombin/antithrombin complex (TAT) in plasma drawn from patients with consumptive coagulopathy, in whom the platelet count was closely followed. ADAMTS13 activity was significantly but variably decreased in the patients, and VWF activity and VWF:CB were markedly increased as expected. The platelet count itself was not correlated with ADAMTS13 activity, VWF activity, or VWF:CB. However, the rate of decline of log-scaled platelet count (DeltaLnPLT/day) correlated well with ADAMTS13 activity and VWF:CB. ADADMTS13 activity showed inverse correlation with VWF:CB. Moreover, the correlation between ADAMTS13 and DeltaLnPLT/day was preserved even after VWF:CB was controlled. Multiple regression analysis showed that ADAMTS13 activity was the sole factor explaining DeltaLnPLT/day among ADAMTS13, VWF:CB, TAT, prothrombin time, d-dimer, and fibrinogen. TAT level and d-dimer as indicators of systemic fibrinolytic activity did not correlate with ADAMTS13 activity. In conclusion, we found that the decrease of ADADMTS13 activity in consumptive coagulopathy has stronger relationship to platelet dynamics than has generally been recognized.

[Monitoring disease activity, adjustment of conventional treatment and prognosis in rheumatoid arthritis]

In the past decade treatment strategies for patients with rheumatoid arthritis have changed dramatically. Patients are being treated earlier and more aggressively than in the past, and far more therapeutic options are available, which has increased the complexity of the management of patients with rheumatoid arthritis. The processes have had an influence on the outcome of patients with RA and on the way they are being evaluated. Disease course should regularly be evaluated with both process (i.e. erythrocyte sedimentation rate, joint counts) and outcome measures (i.e. radiological progression). For the evaluation of interventions, 'core sets' of valid measures to assess disease activity and outcome and specific criteria for improvement should be used. "Tight control" of patients with rheumatoid arthritis will enable us to adjust the therapy and to achieve the ultimate goals, remission and less disability.

[Heparin-induced thrombocytopenia]

In clinical use for over 50 years, heparin is an important and widely used anticoagulant for the prophylaxis or treatment of thromboembolic disease as well as other numerous clinical situations. Ordinarily, heparin prevents clotting and does not affect the platelets, components of the blood that help to form blood clots. However, heparin can also cause heparin-induced thrombocytopenia. Two distinct types of heparin-induced thrombocytopenia can occur: nonimmune and immune mediated. Nonimmune heparin-induced thrombocytopenia, which occurs most frequently, is characterized by a mild decrease in the platelet count and is not harmful. The second type, immune-mediated heparin-induced thrombocytopenia, occurs much less frequently but is dangerous. Immune-mediated heparin-induced thrombocytopenia causes much lower platelet count. Paradoxically, despite a very low platelet count, patients who suffer from heparin-induced thrombocytopenia are at risk for arterial or venous thrombosis. In this review article, there are discussed about pathogenesis of heparin-induced thrombocytopenia, other causes of thrombocytopenia, clinical features, laboratory confirmation of diagnosis, and management of patients (direct thrombin inhibitors, other therapies, duration of therapy, and use of oral anticoagulants). Prognosis and prophylaxis of this life-threatening disorder, which can develop from the use of unfractionated or (less commonly) low-molecular-weight heparin, are also discussed.

[Immunohistochemical markers as prognosticators in gynecologic oncology]

Cyclooxygenase and particularly COX-2 expression impaired survival in patients operated on for endometrial adenocarcinoma of the uterus: 5-year overall and relapse-free survival in absence of expression was 92% and 88%, respectively, while in cases of distinct expression, it fell down to 52% and 48%, respectively (p = 0.0004; 0.0005). Similar correlations were observed for COX-1, although with lower significance (p = 0.02). Particularly unfavorable prognosis is associated with high expression of combination of COX-2 and COX-1. The end-results of radiotherapy were associated with proliferative levels of squamous cell cervical carcinoma: for Ki-67--below median of < or = 50%, 5-year survival rate was 77%, mean survival--80 months; for Ki-67 above median of > or = 50%, the indices were 47% and 47 months, respectively, (p = 0.002). There were similar correlations for mutated suppressor-gene 53: 67%--for absence of expression and 53%--for its presence (p = 0/03). Immunohistochemical markers COX-2, Ki-67 and p53 can be used as sole prognosticators and their predictive significance is higher than that of either stage (II or III) or cell differentiation grading.

[Using the system of control of the severity of injuries in patients with associated trauma]

The application of scores for the assessment of injury severity allows a decision on the optimal strategy of treatment of patients with multiple and associated traumas at all stages of trauma disease. The correct choice of time, method and volume of surgery allows minimization of complications associated with the operative aggression on the one hand, and forced adynamia and asthenic syndrome on the other hand.

Baseline glutathione peroxidase activity affects prognosis after acute coronary syndromes

Oxidative stress is associated with atherosclerosis and plaque lesions in experimental in vitro models. Few in vivo studies have examined the association between redox status and the prognosis of acute coronary syndromes.We undertook a prospective, observational study of 137 patients who had been admitted because of an acute coronary syndrome. We determined glutathione peroxidase activity (a marker of systemic antioxidant status) and recorded clinical and angiographic features and cardiovascular events (cardiovascular death, reinfarction, readmission with a new ischemic event, or need for coronary revascularization).The mean age of the patients (78% of whom were men) was 61.7 +/- 10.9 years; 76% were admitted with non-ST-segment-elevation acute coronary syndrome. Left ventricular ejection fraction was normal in 61%. In the 23.4% who experienced cardiovascular events, glutathione peroxidase activity was higher (mean, 2.38 vs 1.76 mU/mg of protein; P < 0.01). Two-year event-free survival was lower in patients whose glutathione peroxidase activity was higher than the 50th percentile (63% vs 82%; P = 0.01). Multivariate analysis showed a direct independent relationship between glutathione peroxidase activity and cardiovascular events (hazard ratio, 3.72; 95% confidence interval, 1.53-9.02; P < 0.01).We conclude that patients who experienced acute coronary syndromes and events during follow-up had higher plasma glutathione peroxidase activity, and that glutathione peroxidase activity was an independent predictor of events during follow-up.

[Evoked potentials of the brain in early diagnostics of the cognitive disorders in the elderly patients with cardiovascular pathology]

The changes of visual, acoustic and cognitive evoked potentials of brain in 78 elderly patients were studied. Chronic ischemia of the heart and the brain with clinical signs of mild cognitive impairment was present in all patients. Distinct pathomorphologycal sings of structure disorders in brain were absent, and this fact was confirmed with the help of neuroimaging investigations. It was determined that deflections in the indexes of evoked potentials from the age according standard are objective and reliable diagnostic criterions both structural and functional changes in brain and initial cognitive deficit in the elderly patients with cardiovascular pathology. Authors offer complex examination of evoked potentials in diagnostics of the cognitive deficit and the functional separating between cortex and subcortical structures of brain.

BNP and a renal patient: emphasis on the unique characteristics of B-type natriuretic peptide in end-stage kidney disease

BACKGROUND

The widespread use of brain natriuretic peptide testing among patients with end-stage kidney disease (ESKD) has brought new insight to prognostic cardiovascular factors in this population, but has also raised questions regarding the diagnostic potential of B-type natriuretic peptide (BNP) and NT-proBNP in subjects with renal impairment.

METHODS

Highlighting the most important recent observations in the field, this review discusses the unique characteristics of BNP testing and interpretation in chronic kidney disease.

RESULTS

We review in detail the physiology and effects of BNP along with providing a thoughtful analysis of the limitations of BNP testing in patients with impaired kidney function. Additionally, the practicability of BNP in the management of renal patients with some rational suggestions for the use of BNP are presented.

CONCLUSION

Although at present the use and interpretation of BNP testing in ESKD patients is complicated by altered renal clearance and frequent cardiac co-morbidity and, moreover, the complex and in many parts unknown interplay between the heart and the kidneys (cardiorenal syndrome), the prognostic value of elevated BNP is validated in the ESKD population. The importance of improving our understanding of the mechanisms of biomarkers in heart-kidney interdependence is emphasized.

[Cognitive disturbances in patients with arterial hypertension]

Memory impairment, headaches and vertigo are considered as initial appearances of chronic cerebral vascular disorder in patients with arterial hypertension (AH). The complex analysis of complaints, cognitive functioning, emotional state and MRI data was conducted in 60 patients with AH, mean age 58,4+/-7,8 years, without a history of stroke and 30 controls matched for age, sex and education. Impairment of cognitive functioning was assessed by the Psychiatric Status Scale (a short version), the Clock Drawing Test, tests of auditory and verbal memory, attention concentration, speed of test performance, speech fluency and spatial orientation. The deterioration effect of systolic arterial pressure on cognitive functioning was found. The lesions of white matter (subcortical and/or periventricular leucoaraiosis) were observed in 76% of patients and single asymptomatic lacunar infarctions--in 20%. Cerebral vascular lesions were correlated with cognitive impairment. Anxiety and anxiety-depressive disorders which were not associated with the cerebral vascular lesion but related in large to the patient's complaints on headaches and vertigo were revealed in 62% of cases. The results of the study suggest that cognitive dysfunction proves to be the early and reliable predictor of chronic cerebral vascular disorder in patients with arterial hypertension.

[The chronic pancreatitis caused glucose metabolism disturbances before and after distal pancreatic resections]

Glucose metabolism is evaluated before and after the operation in 51 patients (41--men, 10--women), operated on account of the complicated chronic pancreatitis. The distal pancreatic resection (50% of the gland) was performed in all cases. The middle age of the patients is 41.2+/-7.9. Body mass index (BMI) was 23.7+/-3.4 kg/m2. After distal pancreatic resection 33.33% of patients with chronic pancreatitis didn't have glucose metabolism disturbances. In 27.45% of patients diabetes mellitus was diagnosed for the first time after the operation. At the same time, in 5.8% of cases the worsening from the light to the moderate form of diabetes mellitus was observed. As far as blood glucose level (glycemic control) doesn't have any prognostic value in predicting diabetes mellitus in early postoperative period, it is necessary to recommend regular supervision by the endocrinologist to the patient after discharge. All patients with chronic pancreatitis should be carefully investigated so as to detect glycaemic disorders. It is recommended to determine fasting blood glucose level, glycemia throughout the day, glycated hemoglobin, 24 hours' glucosuria. It is also essential to perform an oral glucose tolerance test (OGTT).

Increased expression of EphA2 correlates with adverse outcome in primary and recurrent glioblastoma multiforme patients

Glioblastoma multiforme (GBM) is the most aggressive form of brain tumor characterized by excessive angiogenesis. The dismal prognosis of patients with GBM warrants the development of new targeting therapies based on novel molecular markers. The EphA2 receptor tyrosine kinase plays a pivotal role in tumor angiogenesis and an increased expression in glioma patients has recently been reported. In this study, we investigated the expression of EphA2 in human normal brain, primary and recurrent GBM and correlated it with clinical pathological parameters and patient's outcome. In addition, intratumor microvascular density was quantified by immunostaining for the endothelial cell marker, von Willebrand factor. A different intensity of the membranous and cytoplastic expression of EphA2 was observed in the 40 primary and recurrent samples of GBM analyzed but not in the normal brain. A high level expression of EphA2 was demonstrated in 24 (60%) of the primary and recurrent GBM analyzed. The increased expression of the EphA2 protein was significantly associated with the adverse outcome of GBM patients (p<0.01 for overall survival). The data presented in this study define the expression pattern of EphA2 in both primary and recurrent glioblastoma and suggest an important role of EphA2 in the pathogenesis of GBM. The EphA2 may be used as a surrogate marker to screen patients for tyrosine kinase inhibitor therapy.

[Environmental cancer: malignant pleural mesothelioma]

Malignant pleural mesothelioma (MPM) remains an aggressive tumour, but medical interest has recently evolved from almost nihilism to a real interest. Significant advances are observed in the pathologic diagnosis, the staging, the knowledge of the mesothelial carcinogenesis, the identification of biological markers with potential interest in diagnosis or in treatment. Proper management implies the participation of the general population since the implementation of administrative procedures for social and economical compensation. Active and multidisciplinary therapeutic strategies are currently evaluated and the concept of multimodality treatment includes new effective chemotherapies improving survival and quality of life, modern modalities of radiotherapy and pleuropneumonectomy. This advances create hopes and interrogations because it is not currently know whether multimodality treatment will be the standard in MPM.

[The evaluation to relationship between serum vascular endothelial growth factor (VEGF) level, metastases and other tumor markers in patients with lung cancer]

Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis. Increased expression of VEGF may be associated with advanced stage and poor prognosis in patients with lung cancer. We investigated the relationship between serum VEGF level and lung cancer stage. We also studied the correlation between serum VEGF level and some other tumor markers. Forty newly diagnosed lung cancer (31 non-small cell, 9 small cell) patients and 25 age-matched controls were enrolled in this study. Serum VEGF levels of lung cancer group (345.16 +/- 159.36 pg/mL) were significantly higher than that of the control group (230.36 +/- 47.87 pg/mL) (p< 0.001). The area under the ROC curve was 0.727 (p< 0.05) for serum VEGF threshold of 249.8 pg/mL predictive sensitivity and specificity, for lung cancer were respectively 70.0% and 76.0%. There were no significant relationship between serum VEGF level and age, gender, histologic type, lung cancer stage, distant metastases and site of metastases. In addition, there were no correlation between serum VEGF level and other tumor markers (NSE, CYFRA 21-1, CEA, CA125, LDH).

[Prognostic significance of hemoperitoneum in peritoneal dialysis]

According to previous reviews, hemoperitoneum episodes appear in 6.1-8.4% of the peritoneal dialysis patients, and they are severe in a 20% of them. Due to the absence of severe hemoperitoneum in our peritoneal dialysis program, we retrospectively reviewed hemoperitoneum non-related with abdominal surgery or catheter placing. We analyzed its incidence, etiology, prognostic and clinical outcome, as well as the possible effect of recurrent hemoperitoneum on peritoneal function. A total of 132 patients were treated in our centre during a period of 173 months. Mean age at the beginning of peritoneal dialysis was 59+/-17.1 years, 43.2% were females, and 22.8% of them were menstruating women. Twenty-two patients had at least one hemoperitoneum episode during follow-up, with an incidence of 17%. The mean time interval between the start of peritoneal dialysis and the first hemoperitoneum episode was 0.66+/-0.94 years (range: 0.01-3.20 years). 73% were women. Most cases (59%) were due to menstruation. Remarkably, all the menstruating women presented hemoperitoneum at least once with a high incidence of recurrent episodes. The other hemoperitoneum episodes were mainly of unknown etiology (32% of patients), being this one the main cause in males. We only observed two more cases: a male who presented hemoperitoneum related to dicumarinic overdose and a female who presented hemoperitoneum due to mesenteric ischemia. All the 22 patients had a favourable outcome, except for the woman with mesenteric ischemia, what represented an incidence of 4.5% of severe hemoperitoneum. No significant association was found between episodes of hemoperitoneum and aspirin treatment, dicumarinic treatment or the presence of coagulopathy. There was no association either between recurrent hemoperitoneum and the number of peritonitis episodes, peritoneal function or technique survival. In conclusion, hemoperitoneum is a common and usually benign problem in peritoneal dialysis patients, frequently due to retrograde menstruation, and no deleterious long-term effects were found in patients with recurrent hemoperitoneum.

Biologic study of the effects of octreotide-LAR on growth hormone in unresectable and metastatic hepatocellular carcinoma

BACKGROUND

Animal models suggest that growth hormone participates in hepatocarcinogenesis.

OBJECTIVE

To correlate the effect of octreotide long-acting release (LAR) on insulin-like growth factor-I (IGF-I) and -II (IGF-II) with response and survival in patients with unresectable and metastatic hepatocellular carcinoma.

METHODS

We conducted a phase II, single-institution trial of octreotide-LAR (30 mg intramuscularly every 4 weeks) in 15 patients while monitoring serum IGF-I and -II levels.

RESULTS

Patients (median CLIP score 2, Okuda stage II, and ECOG performance status 1) were treated for a median of 2.0 cycles. No responses occurred. Median overall survival was 116 days (range, 27-937 days) and median progression-free survival was 60 days (range, 27-444 days). One patient had prolonged stable disease (16 months). There were no grade 4 and four grade 3 toxicities: abdominal cramping, elevated creatinine, diarrhea, and dyspnea. Median serum IGF-I decreased from baseline (42.2 ng/mL; range, 14.2-109 ng/mL) to day 29 (27.9 ng/mL; range, 5.7-71.1 ng/mL), and median serum IGF-II decreased from baseline (25,000 ng/mL; range, 12,400-93,600 ng/mL) to day 29 (18,400 ng/mL; range, 4,061-79,400 ng/mL; 2-sided P<.006 and P<.04, respectively; Wilcoxon signed rank test). This suppression did not correlate with clinical activity. Baseline serum IGF-I >30 ng/mL was associated with greater progression-free survival and overall survival (P=.0005 and P=.0173, respectively; 2-sided log-rank test).

CONCLUSIONS

Octreotide-LAR lowered serum IGF-I and -II levels; however, this lowering did not correlate with clinical activity. There were no responses, and progression-free survival and overall survival were similar to historical patients not on treatment. Baseline serum IGF-I predicted prognosis.

[The problems of endocrine ophthalmopathy]

Based on her own rich and many years' experience in following-up and treating patients with endocrine ophthalmopathy (EOP) and on the data available in the Russian and foreign literature, the author states the problems of EOP. These include the terminology and classification of a pathological process, a uniform treatment protocol by taking into account its form, compensation and development stages, the development of clear indications for decompressive operations on the orbit.

[Analysis of the factors that affect the mortality rate in severe acute pancreatitis]

BACKGROUND/AIMS

Severe acute pancreatitis occurs in about 20% of the patients with acute pancreatitis and can be associated with multiorgan failure and local complications. In patients with predicted severe acute pancreatitis, overall mortality rates are about 15-30%. The aim of this study was to determine the factors correlated with mortality in patients with severe acute pancreatitis.

METHODS

We reviewed five hundread and seventy two consecutive cases of acute pancreatitis from January, 2000 to December, 2005. Of them, 109 patients who fulfilled the criteria of Atlanta classification for severe acute pancreatitis were enrolled. Data were collected by chart reviews including age, gender, etiology, body mass index (BMI), modified Glasgow score, APACHE II score, APACHE III score, Balthazar CT index, and other laboratory parameters performed within 48 hours after the initial admission.

RESULTS

Severe acute pancreatitis was most commonly caused by alcohol. Overall mortality rate was 20.2% in severe acute pancreatitis and 10 (45%) deaths occurred within the first week. Multiple logistic regression analysis identified serum creatinine, corrected calcium concentrations, and CT index as predictors of mortality in patients with severe acute pancreatitis. The risk score (R) was calculated by combining 3 prognostic values with regression coefficients; R=2.512 loge (creatinine mg/dL)+1.729 loge (CT index)??4.780 loge (corrected calcium mg/dL). The AUC for this score was 0.877 and a cutoff level of 0 was determined to predict the mortality with 83.3% sensitivity and 89.5% specificity.

CONCLUSIONS

The newly designed risk score comprising 3 parameters can be used as the significant early predictor for hospital mortality in severe acute pancreatitis.

Evaluation of predictive and prognostic significance of serum TGF-beta1 levels in breast cancer according to HER-2 codon 655 polymorphism

The present study was conducted to clarify the predictive and prognostic significance of serum TGF-I(2)1 in breast cancer in relation to Ile655Val single nucleotide polymorphism (SNP) of human epidermal growth factor receptor-2 (HER-2). In a case-control study, 56 consecutive patients with primary breast cancer were prospectively included and evaluated. The control group consisted of 45 healthy women. Serum concentrations of TGF-I(2)1 were measured by quantitative sandwich enzyme immunoassay (ELISA). HER-2 SNP was genotyped using PCR-RFLP method. Serum levels of TGF-I(2)1 were significantly increased in breast cancer patients compared to healthy controls (p<0.001). For the evaluation of the diagnostic significance of serum TGF-I(2)1 the area under the receiver operating characteristic (ROC) curve (AUC) was 0.804, while the optimal cut-off point of 30.86 ng/ml was determined to classify breast cancer patients, which yielded sensitivity of 77%, specificity of 78% and accuracy of 77%. Significantly elevated serum TGF-I(2)1 levels were associated with advanced stages (p=0.023), positive lymph nodes (p=0.019) and postmenopausal status (p=0.031). A marginal trend towards higher TGF-I(2)1 levels was found among patients with Val-containing genotypes compared to homozygous Ile-Ile (p=0.094). In multivariate analysis lymph node metastases (p=0.009) remained the only significant independent determinant of high TGF-I(2)1 levels. With regard to prognostic significance for advanced stages (AUC, 0.704) and lymph node metastasis (AUC, 0.683), when the optimal cut-off value was set at 65.15 pg/ml, the sensitivity was 86% and 67%, the specificity was 60% and 62% and accuracy was 66% and 64%, respectively. Survival was shorter in patients with increased serum TGF-I(2)1 (36 months vs 46 months, p=0.022). Multivariate analysis demonstrated a marginal prognostic significance of serum TGF-I(2)1 for survival (p=0.072). The combination of high TGF-I(2)1 and Val-Val genotype predicts a worse prognosis than high serum TGF-I(2)1 alone. Our findings suggest that serum TGF-I(2)1 is involved in tumor malignancy and lymph node metastasis and could be used clinically as a useful tumor marker for evaluation, the extension and the outcome of the disease. They also provide clinical evidence for a significant association between HER-2 Ile655Val SNP and serum TGF-I(2)1, resulting to more aggressive phenotype of the tumor and poor prognosis.

Prostate small cell carcinoma and skin metastases: a rare entity

OBJECTIVES

To report a rare case of small cell carcinoma of the prostate with unusual skin metastasis.

CLINICAL PRESENTATION AND INTERVENTIONS

A 60-year-old was evaluated for difficulty in urinating. Abdominal computed tomography scans revealed a prostatic mass invading the surrounding tissues and multiple perirectal, periprostatic, para-aortic and pericaval lymph nodes. Needle biopsy specimens showed both small cell carcinoma and adenocarcinoma. He was treated with combination chemotherapy: cisplatin and etoposide and bilateral orchiectomy. After six cycles of the chemotherapy, disease progressed and the patient did not respond to salvage therapy; hence, palliative care was instituted. During the follow-up, papillary lesions were observed in the scrotal skin; biopsy showed metastatic small cell carcinoma.

CONCLUSION

Small cell carcinoma of the prostate is an aggressive disease with a highly metastatic potential; but skin metastases are very uncommon. It has poor prognosis despite therapy. Management resembles that of small cell carcinoma of the lung.

Prognostic impact of bone involvement in Hodgkin lymphoma

The purpose of the study is to determine incidence and prognostic impact of osseous Hodgkin lymphoma (HL). Between 1997 and 2004, 198 patients with HL were treated at our institution. Advanced stages and nodular sclerosis histology prevailed. All patients were treated according to protocols of the German Hodgkin Study Group (GHSG). After minimum follow-up of 24 months, we retrospectively analyzed the incidence of osseous HL, treatment response and parameters of survival. We recorded 14 cases of osseous HL (7 %), always with concurrent nodal disease. Axial skeleton was most frequently involved. Eleven patients (78,5 %) achieved complete remission and three (21,5 %) progressed primarily. The patients with osseous HL had significantly lower 2-year freedom from treatment failure than the patients without bone involvement (71,4 and 92,7 %, respectively, p=0,004), with no significant difference in 2-year overall survival (85,7 and 95 %, respectively, p=0,14). On multivariate analysis, advanced stage was the only independent adverse prognostic factor. In conclusion, bone involvement is a relatively common finding in HL and is not an independent adverse prognostic factor.

Prevalence of sexually transmitted infections in women attending antenatal care in Tete province, Mozambique

OBJECTIVE

To determine the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and syphilis in pregnant women.

METHODS

A cross-sectional study was conducted among women attending antenatal care clinics (ANCs). Blood samples were tested for syphilis using the rapid plasma reagin (RPR) and treponemal haemagglutination (TPHA) tests; CT and NG were diagnosed using a manual polymerase chain reaction assay on first-void urine samples. A socio-demographic questionnaire was completed. Results were compared with previous published data on sexually transmitted infection (STI) prevalence in Mozambique.

RESULTS

Blood and urine samples were collected from 1 119 and 835 women, respectively. The prevalence of CT was 4.1%, and that of NG 2.5%. The RPR test was positive in 5.2% of the women, and 7.1% had a positive TPHA test. Active syphilis was found in 4.7%. In univariate analysis, CT was associated with having had any level of education (p<0.05), reactive RPR and TPHA were associated with illiteracy (p<0.05), and TPHA was associated with age >25. Multivariate analysis did not show any significant association. In comparison with published data from 1993, a decline was observed for CT (p<0.05), NG and syphilis (p<0.001).

CONCLUSIONS

Compared with available data, a decline of STI prevalence was observed in our setting. This might be the result of community-based education programmes focusing on changes to sexual behaviour, as well as the widespread use of the syndromic approach to managing STIs and the expansion of syphilis screening in primary health care settings. However, STI rates are still high, and the problem needs more concrete and sustained efforts for its control.

Expression of the epidermal growth factor system in endometrial cancer

The aim of our study was to describe the expression of c-erbB-1, c-erbB-2, c-erbB-3 and c-erbB-4 in endometrial cancer tissue and its correlation with clinicopathologic features and prognosis of the patients. One hundred and six cases of endometrial cancer were identified from the archives of the Department of Obstetrics and Gynecology of the University of Patras. Tissue specimens from endometrial lesions were immunostained for c-erbB-1, c-erbB-2, c-erbB-3 and c-erbB-4. Statistical analyses were performed using the chi square test, Kaplan-Meier method and Cox analysis. We found a significant association between c-erbB-1 expression and patient survival. A reverse correlation was found between tumor grade and c-erbB-1 expression. Tumor grade was not significantly correlated with the expression of the remaining three receptors. Stage of the tumor showed no relationship with the expression of these receptors. The ability to predict increased risks of advanced disease, recurrence, and death from abnormal molecular markers detected in curettage or endometrial biopsy specimens will facilitate pretreatment referral of these patients to gynecologic oncologists for definitive surgical treatment.

[Clinico-histopathological analysis of renal changes in MPO-ANCA-associated vasculitis]

OBJECTIVE

The pathological and clinical findings, therapies and prognoses of MPO-ANCA-associated vasculitis, were investigated in cases who showed rapidly progressive nephritic syndrome and received renal biopsy.

METHODS

Vasculitis activity was evaluated by BVAS(Birmingham Vasculitis Activity Score). The renal biopsy findings were evaluated by scoring glomeruli, interstitial and vascular lesions. The renal prognoses were studied by dividing the cases into a dialysis group, which went onto maintenance dialysis in one year and another group without dialysis, which maintained renal functions.

RESULTS

The average age was 58.6 +/- 13.9 years, and the 60s age bracket was the largest. Vasculitis activity was 14.8 +/- 3.2 on the average by BVAS. CRP was 1.2 +/- 1.4 for the kidney-located type group, and 12.6 +/- 10.5 for the multiorgan-damaged group respectively, which shows the former to be significantly lower (p = 0.0079). Serum creatinine at renal biopsy was 3.57 +/- 2.31 mg/dL in the dialysis-independent group, and this was significantly lower than the serum creatinine level of 9.10 +/- 2.6 mg/dL of the dialysis group (p = 0.000259). As for the renal pathological findings, the percentage of global sclerosis among all the glomeruli was 24.7 +/- 19.9% in the dialysis-independent group vs. 68.5 +/- 19.7% in the dialysis group, which shows the latter to be significantly higher (p = 0.002).

CONCLUSION

CRP was significantly higher in the multi-organ-damaged group relative to the kidney-located type group. The percentage of global sclerosis determined by renal biopsy and the amount of serum creatinine at the renal biopsy were key factors in determining the renal prognosis. The absence of a significant correlation between the percentage of crescentic formation and the renal prognosis suggests the possibility of suppressing progress to global sclerosis.

[Delirium: a marker of health status in the geriatric patient]

Delirium is defined as a syndrome characterized by an acute and fluctuating decline in higher cognitive functions. The impact of this syndrome is often underestimated in the geriatric population both from the diagnostic and prognostic points of view. Many clinicians are unaware of the scale of the impact on outcomes of delirium. This review presents evidence that supports the view that delirium is independently associated with a worse overall outcome, assessed in terms of greater functional and cognitive deterioration, intrahospital complications, and a higher risk of mortality. Likewise, the impact of delirium on the health system (increases in hospital stay, referrals and costs) is discussed. Therefore, we propose that delirium be considered as a marker of health status, which would allow assessment of this syndrome to be broadened to include two fundamental considerations: firstly, that persons with delirium belong to a group with a higher risk of adverse events and secondly, that delirium is a marker of health status, which would allow the quality of health services that manage elderly patients to be evaluated, given that delirium is partly preventable and its management is multidisciplinary and complex.

Detection of bilateral, multifocal breast cancer and assessment of tumour response to neoadjuvant chemotherapy by Tc-99m sestamibi imaging - a case report

In breast cancer, neoadjuvant chemotherapy needs early indication for responsiveness. Tc-99m sestamibi scintimammography provides comprehensive information about the extent of disease including multiple foci in one or both breasts and possible involvement of nodes. In the present case, X-mammography was positive for a suspicious mass in the upper quadrant of the left breast only. On the other hand,Tc-99m Sestamibi scintimammography was able to depict the full extent of the disease, including its spread to the axillary lymph node, and gave useful information on the effectiveness of neoadjuvant chemotherapy. The case reported here demonstrates that Tc-99m sestamibi scintimammography was useful in detecting bilateral breast cancer and could provide additional information on possible axillary lymph node involvement. Furthermore, Tc-99m sestamibi scintimammography was effective in monitoring response to chemotherapy in the studied case.

[Analysis of blood hormone levels in boys of prepubertal and pubertal age with epilepsy treated with different antiepileptic drugs]

Thirty-nine boys with epilepsy, aged 8-17 years, and 61 sex- and age-matched controls have been examined. Changes of blood hormone levels were found in patients received carbamazepines, valproates, polytherapy as well as in non-treated patients. The increase of levels of progesterone, testosterone, FSH and LH, decrease of prolactin and estradiol levels and influence on thyroid gland hormones, as reflected by increasing of T4 and decreasing of T3 compared to carbamazepines, were found during the treatment with trileptal in the older group. The significant changes of decreased blood hormone levels were observed in children received phenobarbital and benzonal. In children treated with topamax, only the changes in FSH and DHEA were shown. No changes in the content of thyroid gland hormones were found in patients received topamax and non-treated patients. The increase of TTH was observed in children of the younger group treated with valproate. In conclusion, the influence of such antiepileptic drugs as carbamazepine, barbiturates may be directly related with the changes of steroid hormone metabolism. Valproic acid, a well-known protein inhibitor, may impact on the content of reproductive hormones in the blood. The changes of blood hormone levels in boys with epilepsy treated with antiepileptic drugs are thought to influence their somatic health and reproductive functions.

[Focal epilepsies in adults: prognosis of treatment effectiveness]

One hundred and seventy-five patients (73 men and 102 women, aged 16-76 years) with symptomatic and probable symptomatic epilepsies, were studied. The duration of disease was from few months to 38 years. The study included evaluation of anamnesis, clinical and neurological examination, routine EEG and/or video-EEG-monitoring, X-ray CT and/or MRI of the brain. The antiepileptic therapy was started or corrected. The period of observation was 1-3,5 years, on average 2 years. Duration of disease, correctness and effectiveness of the previous AED therapy, EEG and neuroimaging data, frequency and type of epileptic seizures were evaluated. A remission was achieved in 96 (54.8%) cases, a reduction of seizures frequency by 50% and more--in 45 (25.8%), no effect--in 34 (19.4%). Epileptiform activity on routine EEG, long disease duration, high frequency of seizures, focal seizures with/without secondary generalization were associated with ineffectiveness of the treatment. Neuroimaging findings and a character of the previous therapy did not impact on the prognosis of disease.

[Acute infectious encephalitis and pathogens coming from animals]

Despite better knowledge of pathophysiology and a wider use of new molecular technologies for the diagnosis, the etiological diagnosis of acute encephalitis is not established in most cases. Incidence, prognosis, rate of this disease and severity of sequelae remain unknown. In France, according to the published data, the incidence of encephalitis is estimated to be 1.9 cases per 100 000 inhabitants in average among non-HIV patients. The etiological diagnosis is established in less than 30% of cases. The more frequent diagnosis is herpetic encephalitis in adults and encephalitis caused by Varicella zoster virus in children younger than 16 years. Despite a difficult diagnosis and the lack of specific treatment for most of these infections, the etiological diagnosis should always be deeply explored to precise the individual prognosis, to allow better management of antibiotic therapy, and to improve epidemiological knowledge. We present the recommendations established by the French Society for Infectious Diseases. First designed to suit the French epidemiology, they take in count the possible exposure of patients to different epidemiological patterns. Three levels of etiological tests are proposed, from the most common infections and those, which required an immediate treatment, to the rarest ones.

[Tendencies in the etiopathogenesis of glaucoma--present and future]

Today, glaucoma is accepted within the family of the progressive neurodegenerative diseases caused by a multifactorial stress. The arguments that plead for the fact that glaucoma is a progressive neurodegenerative disease are (1) similarities between the glaucoma and the systemic neurodegenerative diseases, (2) similarity between the normal biological degenerative processes of the aging and the glaucoma and (3) the neurodegeneration of the optic nerve head. The factors that lead to the neurodegeneration of the retinal ganglion cells are mechanical (e.g. by an increase in intraocular pressure), ischemic/reperfusion, oxidative, autoimmune and genetic stresses.

[Utilization of MLPA to detection of genetic changes in neuroblastoma]

Neuroblastoma (NB) is a childhood cancer derived from neural crest cells, with a highly variable clinical course and biologic behavior. Several genomic imbalances correlate to prognosis in NB, with structural rearrangements, including MYCN amplification, in a near-diploid setting typically signifying high-risk tumours and numerical changes in a near-triploid setting signifying low-risk tumours. At present, many different techniques are used for detection of these copy number changes including standard chromosome karyotyping, comparative genomic hybridization (CGH), fluorescent in situ hybridization (FISH) and array CGH. Now, a new methodology called multiplex ligation dependent probe amplification (MLPA) has been developed. This new approach is based on polymerase chain reaction (PCR) amplification of ligated probes hybridized to target DNA sequences. MLPA is a highly sensitive, a rapid, accurate, reliable, and cost-effective. ENAQUA use neuroblastoma MLPA kit as a standard for detection genetic changes in neuroblastoma. We found high level concordance in FISH, CGH and MLPA investigations.

Management of the prosthetic vascular graft infections--the influence of predictive factors on treatment results

BACKGROUND

This prospective non-randomized single center study evaluated the predictive significance of various factors to the treatment outcomes of the prosthetic vascular graft infections.

METHODS

46 patients with the prosthetic vascular graft infection underwent the treatment. The prosthesis extirpation was performed in 37 cases. The extra-anatomical reconstruction was implanted in 18 and the in situ reconstruction in 12 patients. In 9 patients, only local treatment was applied. The influence of the preoperative factors (patient's age, type of primary procedure, type of infection, positive hemoculture, diabetes mellitus, comorbidity, C-reactive protein, leucocytosis, repeated interventions) on the result of the treatment was evaluated with the multivariate analysis.

RESULTS

On the 30 day, the postoperative mortality was 23.9%. One and three years after the treatment, 72.1 and 57.8% of patients, respectively, survived. C-reactive protein above 90 mg/l (Wilcoxon test p<0.02, Log-rank test p<0.01), and leucocytosis >13 x 10(9)/l (Wilcoxon test p<0.0001, Log-rank test p<0.0004) were significant factors for patients morbidity and mortality. There were no preoperative factors with a statistically significant cut-off value which should be important for the long-term graft patency.

CONCLUSION

C-reactive protein and leucocytosis are simple preoperative predictive markers of the treatment results of the prosthetic vascular graft infections. An early and aggressive diagnostic and therapeutic procedure is recommended in patients with the pre-operative levels of CRP higher than 90 mg/l and leucocytosis of 13 x 10(9)/l (Tab. 5, Fig. 3, Ref. 30). Full Text (Free, PDF) www.bmj.sk.

Glutaric aciduria type 2 and newborn screening: commentary

Glutaric aciduria type 2 is increasingly being identified through expanded newborn screening programs by tandem mass spectrometry with a goal of decreasing morbidity and mortality. This article presents 3 patients with adverse outcomes in spite of early recognition by newborn screening. Additional long term studies are necessary to determine the efficacy of newborn screening to affect outcome in this disorder.

Medical futility in asystolic out-of-hospital cardiac arrest

OBJECTIVES

To study the factors associated with short- and long-term survival after asystolic out-of-hospital cardiac arrest, with a reference to medical futility.

METHODS

This is a retrospective observational study conducted in Helsinki, Finland during 1 January 1997 to 31 December 2005. All out-of-hospital cardiac arrests were prospectively registered in the cardiac arrest database. Of 3291 arrests, 1455 had asystole as the first registered rhythm. These patients represent the study population.

RESULTS

A short time interval to the initiation of advanced life support (ALS) was associated with a long-term benefit, but a short first responding unit (FRU) response time had only a short-term benefit. Conversion of asystole into a shockable rhythm provided only a short-term benefit. The prognosis was poor if the FRU response time was over 10 min or the ALS response time was over 11 min in bystander-witnessed arrests, and if the duration of resuscitation was over 8 min in emergency medical services (EMS)-witnessed arrests. Bystander-CPR was associated with increased 30-day mortality. The 30-day survival rate after an unwitnessed arrest (n=548) was 0.5%. All survivors in this group were either hypothermic or were victims of near-drowning.

CONCLUSIONS

Resuscitation should be withheld in cases of unwitnessed asystole, excluding cases of hypothermia and near-drowning. The prognosis is poor if the FRU response time is over 10 min or the ALS response time is over 10-15 min in bystander-witnessed arrests. The decision of whether or not to attempt resuscitation should not be influenced by the presence of bystander-CPR. Early initiation of ALS should be prioritised in the treatment of out-of-hospital asystole.

Toremifene-atamestane; alone or in combination: predictions from the preclinical intratumoral aromatase model

Since most breast cancers occur in postmenopausal women and are hormone dependent, we developed a model system that mimics this situation. In this model, tumors of human estrogen receptor (ER) positive breast cancer cells stably transfected with aromatase (Ac-1) are grown in immune-compromised mice. Using this model we have explored a number of therapeutic strategies to maximize the antitumor efficacy of antiestrogens (AEs) and aromatase inhibitors (AIs). This intratumoral aromatase xenograft model has proved accurate in predicting the outcome of several clinical trials. In this current study we compared the effect of an AE toremifene and steroidal AI atamestane, alone or in combination, on growth of hormone-dependent human breast cancer. We have also compared toremifene plus atamestane combination with tamoxifen in this study. The growth of Ac-1 cells was inhibited by tamoxifen, toremifene and atamestane in vitro with IC(50) values of 1.8+/-1.3 microM, 1+/-0.3 microM and 60.4+/-17.2 microM, respectively. The combination of toremifene plus atamestane was found to be better than toremifene or atamestane alone in vitro. The effect of this combination was then studied in vivo using Ac-1 xenografts grown in ovariectomized female SCID mice. The mice were injected with toremifene (1000 microg/day), atamestane (1000 microg/day), tamoxifen (100 microg/day), or the combination of toremifene plus atamestane. In this study, our results indicate that the combination of toremifene plus atamestane was as effective as toremifene or tamoxifen alone but may not provide any additional benefit over toremifene alone or tamoxifen alone.

Therapeutic hypothermia changes the prognostic value of clinical evaluation of neonatal encephalopathy

OBJECTIVE

To evaluate whether therapeutic hypothermia alters the prognostic value of clinical grading of neonatal encephalopathy.

STUDY DESIGN

This study was a secondary analysis of a multicenter study of 234 term infants with neonatal encephalopathy randomized to head cooling for 72 hours starting within 6 hours of birth, with rectal temperature maintained at 34.5 degrees C +/- 0.5 degrees C, followed by re-warming for 4 hours, or standard care at 37.0 degrees C +/- 0.5 degrees C. Severity of encephalopathy was measured pre-randomization and on day 4, after re-warming, in 177 infants; 31 infants died before day 4, and data were missing for 10 infants. The primary outcome was death or severe disability at 18 months of age.

RESULTS

Milder pre-randomization encephalopathy, greater improvement in encephalopathy from randomization to day 4, and cooling were associated with favorable outcome in multivariate binary logistic regression. Hypothermia did not affect severity of encephalopathy at day 4, however, in infants with moderate encephalopathy at day 4, those treated with hypothermia had a significantly higher rate of favorable outcome (31/45 infants, 69%, P = .006) compared with standard care (12/33, 36%).

CONCLUSION

Infants with moderate encephalopathy on day 4 may have a more favorable prognosis after hypothermia treatment than expected after standard care.

Postoperative atrial fibrillation

Atrial fibrillation is a common arrhythmia after cardiac surgery. It is associated with an increase in morbidity, length of hospital stay, and mortality. Patients who are at higher risk of postoperative atrial fibrillation should receive prophylactic treatment. Atrial fibrillation usually resolves spontaneously after heart rate is controlled; however, if patients are highly symptomatic or hemodynamically unstable, sinus rhythm should be restored by electrical or pharmacologic cardioversion. Patients with atrial fibrillation of more than 48 hours should receive antithrombotic therapy for thromboembolism prevention.

Prognostic value of hemoglobin levels prior to radiotherapy for cervical cancer--Kuwait experience

OBJECTIVE

To evaluate hemoglobin (Hb) levels before and during radiotherapy and its role as prognostic factor on treatment results of patients treated for cancer cervix.

MATERIALS AND METHODS

One hundred and seven patients with cervical cancer were registered and managed at KCCC during 1995 - 1999. The pre-treatment and mid treatment Hb levels were found for 47 patients only. Follow-up was done for these cases aiming at evaluation the overall and disease-free survival. Statistical analysis was done using SPSS statistical package version 10.0.

RESULTS

The median age of patients were 45 and ranged between 26-80 years. Kuwaiti patients represented 21.3% of cases. The most common stage was Stage IIb representing 51.1% followed by IIIb representing 27.7%. Stage Ib and IIa represented 12.8%. About 89.4% were squamous cell carcinoma, while adenocarcinoma was 6.4%. Treatment outcome revealed 18 relapses (38.3%). Disease-free survival for cases with pre-treatment Hb level < 12 was 16.3%, while for those with Hb level > or = 12 g/dL it was 62.9%. The difference was statistically significant (P = 0.02).

CONCLUSION

Patients with pre-treatment Hb < 12 g/dL had a significantly lower disease-free survival.

Atrial fibrillation: unanswered questions and future directions

Just more than a decade ago, Haissaguerre and colleagues provided the seminal demonstration of the role of pulmonary vein triggers in the pathogenesis of atrial fibrillation (AF) and the potential therapeutic role of catheter ablation to treat patients who have paroxysmal AF. This initial observation ushered in the modern era of catheter ablation to treat patients who have AF, and tremendous progress has been made in understanding its pathogenesis and the catheter approaches to treating this rhythm. Although the current state of AF catheter ablation is well described earlier in this issue, this article reflects on some of the major unanswered questions about AF management, and the future technological and investigational directions being explored in the nonpharmacologic management of AF.

Late pulmonary, cardiovascular, and renal complications after hematopoietic stem cell transplantation and recommended screening practices

Non-malignant late effects after hematopoietic stem cell transplantation (HSCT) are heterogeneous in nature and intensity. The type and severity of the late complications depend on the type of transplantation and the conditioning regimen applied. Based on the most recent knowledge, we discuss three typical non-malignant complications in long-term survivors after HSCT, namely pulmonary, cardiovascular and renal complications. These complications illustrate perfectly the great diversity in respect of frequency, time of appearance, risk factors, and outcome. Respiratory tract complications are frequent, appear usually within the first two years, are closely related to chronic graft-versus-host disease (GVHD) and are often of poor prognosis. Cardiac and cardiovascular complications are mainly related to cardiotoxic chemotherapy and total body irradiation, and to the increase of cardiovascular risk factors. They appear very late after HSCT, with a low magnitude of risk during the first decade. However, their incidence might increase significantly with longer follow-up. The chronic kidney diseases are usually asymptomatic until end stage disease, occur within the first decade after HSCT, and are mainly related with the use of nephrotoxic drugs such as calcineurin inhibitors. We will discuss the practical screening recommendations that could assist practitioner in the follow-up of long-term survivors after HSCT.