Factors associated with depression in disease-free stomach cancer survivors

CONTEXT

Depression in cancer survivors affects the rest of their lives in many ways.

OBJECTIVES

To estimate the prevalence of depression and identify associated factors in disease-free stomach cancer survivors.

METHODS

We enrolled 391 stomach cancer survivors who had been disease-free for at least one year after surgery from the cancer registries of two hospitals in Korea. Stomach cancer survivors were mailed a survey that included the Beck Depression Inventory, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, and the associated stomach module, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Cancer Module 22.

RESULTS

Forty-four percent of survivors suffered from depression, and more women (49%) than men (42%) had high depression scores (Beck Depression Inventory >13). In multiple logistic regression analysis, lower income (odds ratio [OR] 2.49; 95% CI 1.64-3.78), problems with care before treatment (OR 1.92; 95% CI 1.23-2.98), body image change (OR 2.23; 95% CI 1.41-3.53), and symptoms of fatigue (OR 3.11; 95% CI 1.49-6.52), dyspnea (OR 2.57; 95% CI 1.48-4.45), or insomnia (OR 4.51; 95% CI 1.88-10.83) were associated with depression.

CONCLUSION

The prevalence of depression was high in stomach cancer survivors even after the completion of treatment, especially among those with problems amenable to treatment, and we identified the associated factors. We suggest that stomach cancer survivors should be screened for depression after the end of treatment.

Primary pulmonary diffuse large B-cell non-Hodgkin's lymphoma in a child

A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin's lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.

Functional impairments as symptoms in the symptom cluster analysis of patients newly diagnosed with advanced cancer

CONTEXT

Symptoms and subsequent functional impairment have been associated with the biological processes of disease, including the interaction between disease and treatment in a measurement model of symptoms. However, hitherto cluster analysis has primarily focused on symptoms.

OBJECTIVES

This study among patients within 100 days of diagnosis with advanced cancer explored whether self-reported physical symptoms and functional impairments formed clusters at the time of diagnosis.

METHODS

We applied cluster analysis to self-reported symptoms and activities of daily living of 111 patients newly diagnosed with advanced gastrointestinal (GI), gynecological, head and neck, and lung cancers. Based on content expert evaluations, the best techniques and variables were identified, yielding the best solution.

RESULTS

The best cluster solution used a K-means algorithm and cosine similarity and yielded five clusters of physical as well as emotional symptoms and functional impairments. Cancer site formed the predominant organizing principle of composition for each cluster. The top five symptoms and functional impairments in each cluster were Cluster 1 (GI): outlook, insomnia, appearance, concentration, and eating/feeding; Cluster 2 (GI): appetite, bowel, insomnia, eating/feeding, and appearance; Cluster 3 (gynecological): nausea, insomnia, eating/feeding, concentration, and pain; Cluster 4 (head and neck): dressing, eating/feeding, bathing, toileting, and walking; and Cluster 5 (lung): cough, walking, eating/feeding, breathing, and insomnia.

CONCLUSION

Functional impairments in patients newly diagnosed with late-stage cancers behave as symptoms during the diagnostic phase. Health care providers need to expand their assessments to include both symptoms and functional impairments. Early recognition of functional changes may accelerate diagnosis at an earlier cancer stage.

Comparing two approaches for studying symptom clusters: factor analysis and structural equation modeling

PURPOSE

We investigated alternative ways of understanding the relationships among co-occurring symptoms in individuals with advanced cancer. While factor analysis has been increasingly used to identify symptom clusters, we argue that structural equation modeling is more appropriate because it permits investigating and testing of a greater variety of potential causal interconnections among symptoms.

METHODS

The sample included 82 palliative patients whose symptom scores were obtained from a database of the Capital Health Regional Palliative Care Program in Alberta, Canada, from 1995 to 2000. Data were analyzed using exploratory factor analysis (SPSS PASW 18.0.0, 2009) and compared to previous results obtained using structural equation modeling (LISREL 8.8, 2009).

RESULTS

Factor models failed to fit the covariance data, even though a single factor "explained" nearly half the variance. Structural equation models fit the data and explained an average of 66 % of the variance in the dependent latent variables. The factor analytic estimates were not clinically useful because they failed to correspond to the reasonable underlying common causes of the symptoms. Structural equation models, on the other hand, incorporated and tested specific clinically anticipated causal relationships among the symptoms and changes in those symptoms over time.

CONCLUSION

We used factor analysis to reanalyze data previously investigated with structural equation modeling and found that the structural equation models fit the data better and were more interpretable from a clinical perspective. We caution that factor models should be tested for consistency with the data and critically examined for inconsistencies with clinical understandings of the causal foundations of coordinated symptoms.

The diagnosis and management of lower urinary tract symptoms in multiple sclerosis patients

Sixty-five percent of multiple sclerosis patients have moderate to severe urinary symptoms and up to 14% initially present with urinary symptomatology. Urinary retention, neurogenic detrusor overactivity, and detrusor sphincter dyssynergia, all increase the risk for urinary tract infections in patients with multiple sclerosis, and these infections may exacerbate their immune response, leading to symptom progression. Fewer than half of the patients with urinary symptoms have seen a specialist and only half have been treated for their neurogenic detrusor overactivity. Several treatments including pelvic floor muscle therapy, pelvic floor electrical stimulation, anticholinergics, desmopressin, sacral nerve neuromodulation, posterior tibial nerve stimulation, cannabinoids, and intravesical therapy with vanniloids, as well as botulinum toxin, have all been shown to be effective in treating urinary symptoms in those with multiple sclerosis. Clean intermittent catheterization is invaluable in patients with persistent urinary retention to avoid infection and upper tract dysfunction. Indwelling transurethral catheterization should be avoided because of the high risk of infection. Identification and successful treatment of these urinary conditions will improve the health and quality of life for these men and women.

[Rare infection--prolonged A. naeslundii bacteremia caused by severe caries]

Actinomyces is an anaerobic, gram positive, rod shape bacteria that doesn't create spores. Actinomyces is part of the mouth, intestines, vagina and upper respiratory system flora. The infection appears mostly on the face, neck, abdomen and pelvis in cases of mucosa injury and most common in immunosuppressed patients. The spread of Actinomyces through the blood system is rare. In this article we present a 9 year old male patient with no history of diseases who was diagnosed with prolonged bacteremia of A. naeslundii without specific infection excluding severe caries. Characterization of bacteria from the blood culture was performed by molecular biology and the patient was treated with Ampicillin and tooth extraction that led to the disappearance of the bacteremia.

Validity and reliability of the Swedish version of the Memorial Symptom Assessment Scale (MSAS): an instrument for the evaluation of symptom prevalence, characteristics, and distress

CONTEXT

There are few scales in Swedish that assess symptoms in the dimensions of frequency, severity, and distress.

OBJECTIVES

The purpose of this study was to translate and determine the validity and reliability of the Memorial Symptom Assessment Scale (MSAS) in a Swedish population of postmenopausal women newly diagnosed with primary or recurrent breast cancer.

METHODS

The original 32-item MSAS, a self-report measure for assessing symptom distress and frequency in cancer patients, was translated and administered to 206 patients (primary, n = 150 and recurrent, n = 56).

RESULTS

The MSAS psychological symptom subscale correlated with the emotional and cognitive functioning subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and showed the highest correlation with the EORTC QLQ-C30 emotional functioning subscale (r = -0.78; P < 0.01). The psychological symptom subscale also correlated with the Hospital Anxiety and Depression Scale (HADS) within values for anxiety (r = 0.68; P < 0.01) and with the EORTC QLQ-C30 within cognitive functioning values (r = -0.58; P < 0.01). The Global Distress Index (GDI)-MSAS showed satisfactory correlations with the EORTC QLQ-C30 emotional functioning subscale (r = -0.75; P < 0.01), whereas the correlation between the GDI-MSAS and the EORTC QLQ-C30 cognitive functioning subscale was somewhat lower (r = -0.54; P < 0.01). Correlations between the GDI-MSAS and the HADS anxiety subscale were confirmed (r = 0.62; P < 0.01), and a correlation between the MSAS physical symptom items and symptom items in the EORTC-QLQ-C30 was evident (r = 0.60-0.85; P < 0.01). Cronbach's alpha coefficients for the MSAS and MSAS subscales based on symptom scores ranged from 0.80 to 0.89. The internal consistency at different time points was satisfactory, ranging from 0.86 (baseline) to 0.90 (follow-up).

CONCLUSION

The Swedish version of the MSAS presents as a valid and reliable measure for assessing symptom distress, severity, and frequency in Swedish patients diagnosed with primary and recurrent breast cancer.

Evaluation of treatment- and disease-related symptoms in advanced head and neck cancer: validation of the national comprehensive cancer network-functional assessment of cancer therapy-head and neck cancer symptom index-22 (NFHNSI-22)

CONTEXT

The Functional Assessment of Cancer Therapy-Head and Neck is a well-validated assessment of quality of life used with patients diagnosed with head and neck cancers (HCNs). The present study is an attempt to evaluate and modify this instrument as necessary in light of the recent regulatory guidelines from the Food and Drug Administration on the use of patient-reported outcomes in clinical trials.

OBJECTIVES

Overall, the goal was to identify patients' highest priority cancer symptoms, compare these symptoms with those suggested by oncology experts, and construct a brief symptom index to assess these symptoms and categorize them as treatment-related, disease-related, or related to general function and well-being.

METHODS

Patients (N=49) with advanced (Stages III and IV) HCNs were recruited from participating National Comprehensive Cancer Network institutions and community cancer support organizations in the Chicago area. Patients completed open-ended interviews and symptom checklists. Participating oncology physician experts also rated symptoms. Content validity was obtained by evaluating results alongside items in the Functional Assessment of Chronic Illness Therapy system. Eleven oncologists categorized symptoms in terms of importance and also whether the symptoms were primarily related to disease, treatment, or functional well-being.

RESULTS

HCN-related symptoms endorsed as high priority by both patients and oncology experts were selected for the new National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Head and Neck Cancer Symptom Index-22. The final version includes 22 items, which are broken down into disease-related symptoms, treatment side effects, or general function and well-being. The new scale has acceptable internal consistency (Cronbach's coefficient alpha=0.86), content validity for use in chemotherapy trials of patients with advanced disease, and concurrent validity as demonstrated by moderate-to-strong correlations with the existing Functional Assessment of Chronic Illness Therapy measure.

CONCLUSION

The National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Head and Neck Cancer Symptom Index-22 adequately reflects symptom and side effect concerns of advanced HCN patients as well as oncology physicians. This instrument can be used to evaluate the most important disease-related symptoms, treatment side effects, and function/well-being in patients with advanced HCNs in clinical practice and research.

Appropriateness and reliability testing of the modified Richmond Agitation-Sedation Scale in Spanish patients with advanced cancer

CONTEXT

A tool to quantify agitation severity and sedation level in patients with advanced cancer is needed.

OBJECTIVES

To test the appropriateness and reliability of the Richmond Agitation-Sedation Scale (RASS) in Spanish patients with advanced cancer.

METHODS

The original RASS was translated into Spanish according to the standard guidelines. Face validity was assessed by members of the palliative care team, and interrater reliability was assessed, using a weighted kappa, from observations of patients admitted to the palliative care unit. The association between scores of the RASS, Ramsay Sedation Scale, and Glasgow Coma Scale was evaluated using Spearman's ρ.

RESULTS

Three hundred twenty-two observations were performed in 156 patients: 116 observations were performed for delirious patients, 76 observations for sedated patients, and 130 observations for patients admitted for other symptom control. The weighted kappa values were practically equal to or greater than 0.90 between nurses and nurses and physicians. The agreement level between observers for each RASS score was roughly 90%. The correlation between the RASS and the Ramsay and Glasgow Scale values was analyzed for 196 observations recorded in 80 patients. The sedation scale of the RASS had a strong correlation with both the Ramsay (Spearman's ρ, -0.89; P < 0.001) and the Glasgow Coma Scales (Spearman's ρ, 0.85; P < 0.001).

CONCLUSION

These data support the use of the RASS in Spanish patients with advanced cancer.

Cut points on 0-10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review

CONTEXT

To improve the management of cancer-related symptoms, systematic screening is necessary, often performed by using 0-10 numeric rating scales. Cut points are used to determine if scores represent clinically relevant burden.

OBJECTIVES

The aim of this systematic review was to explore the evidence on cut points for the symptoms of the Edmonton Symptom Assessment Scale.

METHODS

Relevant literature was searched in PubMed, CINAHL®, Embase, and PsycINFO®. We defined a cut point as the lower bound of the scores representing moderate or severe burden.

RESULTS

Eighteen articles were eligible for this review. Cut points were determined using the interference with daily life, another symptom-related method, or a verbal scale. For pain, cut point 5 and, to a lesser extent, cut point 7 were found as the optimal cut points for moderate pain and severe pain, respectively. For moderate tiredness, the best cut point seemed to be cut point 4. For severe tiredness, both cut points 7 and 8 were suggested frequently. A lack of evidence exists for nausea, depression, anxiety, drowsiness, appetite, well-being, and shortness of breath. Few studies suggested a cut point below 4.

CONCLUSION

For many symptoms, there is no clear evidence as to what the optimal cut points are. In daily clinical practice, a symptom score ≥4 is recommended as a trigger for a more comprehensive symptom assessment. Until there is more evidence on the optimal cut points, we should hold back using a certain cut point in quality indicators and be cautious about strongly recommending a certain cut point in guidelines.

Association between histological features in temporal artery biopsies and clinical features of patients with giant cell arteritis

BACKGROUND

In most cases of giant cell arteritis (GCA) the diagnosis is confirmed by temporal artery biopsy. Aside from the diagnostic purpose, histological parameters may serve as prognostic markers.

OBJECTIVES

To review positive temporal artery biopsies ofGCA in an attempt to correlate various histological parameters with clinical features, disease complications and outcome.

METHODS

Positive biopsies from 65 GCA patients were randomly selected for review by a single pathologist. In each biopsy the following parameters were scored: intensity and location of the inflammatory infiltrate, presence of giant cells and other cell types, fragmentation and calcification of the internal elastic lamina, intimal thickening, and presence of luminal thrombus. Clinical data were obtained from the patients' charts. Intensity of the initial systemic inflammatory reaction (ISIR) at the time of diagnosis was scored by the presence of five parameters: fever, anemia, thrombocytosis, leukocytosis, and sedimentation rate >100 mm/hr.

RESULTS

In cases with bilateral positive biopsy (n=27), there was good correlation between the two sides regarding intensity of inflammation (r= 0.65, P< 0.001), location of the infiltrate (r= 0.7, P< 0.001), degree of intimal thickening (r= 0.54, P 0.001), and presence of giant cells (r= 0.83, P< 0.001). The rate of corticosteroid discontinuation tended to be quicker in patients with inflammatory infiltrates confined mainly to the adventitia, but other histological parameters did not affect this rate.

CONCLUSIONS

Inflammatory infiltrates confined to the adventitia were associated with more neuro-ophthalmic ischemic manifestations, weak/moderate ISIR at the time of diagnosis, and faster rate of corticosteroid discontinuation. No association was found between other temporal artery biopsy histological parameters and clinical features of GCA patients.

Neuropsychiatric symptom assessments in toxic exposure

The goal of this review is to provide guidelines for evaluating psychiatric and mood changes that result from neurotoxicity. Mood changes that are often seen to varying degrees in neurotoxicity include increased anxiety, depression, irritability, impulsiveness, and psychosis. Some common agents that induce neurotoxicity include drugs, heavy metals, and organophosphates with presentations varying somewhat depending upon the mechanism of toxicity. The authors discuss in detail psychiatric assessment for patients with suspected of having neurotoxicologic syndrome.

Diagnosis of colon cancer differs in younger versus older patients despite similar complaints

BACKGROUND

Colon cancer is common, affecting mostly older people. Since age is a risk factor, young patients might not be given the same attention as older ones regarding symptoms that could imply the presence of colon cancer.

OBJECTIVES

To investigate whether young patients, i.e., under age 50, complain of symptoms for longer than older patients until the diagnosis of colon cancer is established.

METHODS

In this retrospective cohort study, patients were divided into two groups: < 50 years old (group 1) and > or = 50 (group 2). All had undergone surgery for left or right-colon cancer during the 10 year period of the study from January 2000 through December 2009 at one medical center. Rectal and sigmoid cancers were excluded. Data collected included age, geander, quantity and quality of complaints, duration of complaints, in-hospital versus community diagnosis, pathological staging, the side of colon involved, and overall mortality. The primary outcome was the quality and duration of complaints. Secondary outcomes were the pathological stage at presentation and the mortality rate.

RESULTS

The study group comprised 236 patients: 31 (13.1%) were < 50 years old and 205 (86.9%) were > or = 50. No significant difference was found in the quantity and quality of complaints between the two groups. Patients in group 1 (< 50 years) complained for a longer period, 5.3 vs.2.4 months (P= 0.002). More younger patients were diagnosed with stage IV disease (38.7% vs. 21.5%, P= 0.035) and fewer had stage I disease (3.2% vs. 15.6%, P= 0.06); the mortality rates were similar (41.9% vs. 39%). Applying a stepwise logistic regression model, the duration of complaints was found to be a predictor of mortality (P= 0.03, OR 1.6, 95% CI 1-3.6), independently of age (P= 0.003) and stage (P< 0.001).

CONCLUSIONS

Younger patients are more often diagnosed with colon cancer later, at a more advanced stage. Alertness to patients' complaints, together with evaluation regardless of age but according to symptoms and clinical presentation are crucial. Large-scale population-based studies are needed to confirm this trend.

Laparoscopic radical prostatectomy in a cadaveric renal transplant patient: first case in Thailand and the authors first experience--a case report

OBJECTIVE

To report the authors' experience in laparoscopic radical prostatectomy for the treatment of localized prostate carcinoma in a cadaveric renal transplant recipient.

MATERIAL AND METHOD

A 64-year-old man with chronic renal failure unknown cause had a transplant cadaveric donor kidney about nine years ago. Creatinine clearance was estimated about 68.61 ml/min. He was presented with lower urinary tract symptoms in 2008. He was diagnosed and was treated as benign prostatic hyperplasia. Digital rectal examination was normal and prostate specific antigen (PSA) was 10.84 ng/ml when he was followed-up in 2010. The authors did a prostate gland biopsy, one of four cores from right lobe of prostate gland revealed prostatic adenoma with Gleason score of 6 (3 + 3). Bone scan did not show any sign of metastases. The authors performed a Laparoscopic radical prostatectomy, extraperitoneal technique.

RESULTS

The patient underwent successful laparoscopic radical prostatectomy without any complications. The operative time was 210 minutes, the estimated blood loss of 300 ml. Pathological analyses revealed negative surgical margins with focal extraprostatic extension, and no seminal vesical, lymphatic, and perineural invasion. The patient tolerated the procedure well and was discharged on day 4. At fourth months, the patient was continent, PSA was 0.003, and renal function stable. At one year, PSA was 0.011 ng/ml and the creatinine was 1.15 mg/dl.

CONCLUSION

The authors experience suggests that extraperitoneal laparoscopic radical prostatectomy is a technically feasible and safe treatment of localized prostate cancer in renal transplant recipients.

PFAPA with facial swelling- a new association?

PFAPA (periodic fever, apthous stomatitis, pharyngitis, cervical adenitis) is a rare condition of unknown cause affecting children. Although the exact etiology is unknown, inflammatory, immunological or genetic causes have been suggested. The diagnosis is made by exclusion of other causes of periodic fever. Although management is essentially symptomatic, single corticosteroid dose, tonsillectomy and Cimetidine has been shown to be associated with resolution of symptoms. Although abdominal pain and genital ulcers have been reported in association with PFAPA, unilateral transient facial swelling has not been previously reported. The authors present a hitherto unreported association of PFAPA with recurrent episodes of unilateral facial swelling.

Clinical factors associated with classical symptoms of aortic valve stenosis

BACKGROUND AND AIM OF THE STUDY

The recognition of clinical symptoms is critical to a therapeutic strategy for aortic valve stenosis (AS). It was hypothesized that AS symptoms might have multiple causes; hence, a study was conducted to investigate the factors that separately influence the classic symptoms of dyspnea, angina and syncope in AS.

METHODS

The medical records of 170 consecutive patients with AS (> or = moderate grade) were reviewed. A multivariate logistic regression analysis was used to evaluate the hemodynamic and clinical factors that separately influence the development of three clinical symptoms: dyspnea (defined as NYHA class > or = 2), angina, and syncope.

RESULTS

The most common symptom was dyspnea (47.1%), followed by angina (12.4%) and syncope (4.7%). The factors associated with dyspnea were a higher e' ratio (p = 0.04) and peak aortic valve velocity (p = 0.01). Only the severity of AS was associated with syncope. The presence of hypertension was associated with angina (p = 0.04). Moreover, coronary angiography was performed in 59 patients before aortic valve replacement and revealed coronary stenosis (> 50% diameter stenosis) in 11/16 patients (69%) that had angina. The presence of coronary stenosis was significantly associated with angina (p = 0.02). The development of dyspnea, angina or syncope was influenced by different factors in AS.

CONCLUSION

Dyspnea and syncope were mainly associated with AS severity, and diastolic dysfunction also influenced dyspnea. In contrast, angina was mainly related to the presence of coronary stenosis rather than to AS severity. These factors should be considered when, selecting a therapeutic strategy for AS patients in the modern era.

Diagnosis of urinary incontinence

Urinary incontinence is common, increases in prevalence with age, and affects quality of life for men and women. The initial evaluation occurs in the family physician's office and generally does not require urologic or gynecologic evaluation. The basic workup is aimed at identifying possible reversible causes. If no reversible cause is identified, then the incontinence is considered chronic. The next step is to determine the type of incontinence (urge, stress, overflow, mixed, or functional) and the urgency with which it should be treated. These determinations are made using a patient questionnaire, such as the 3 Incontinence Questions, an assessment of other medical problems that may contribute to incontinence, a discussion of the effect of symptoms on the patient's quality of life, a review of the patient's completed voiding diary, a physical examination, and, if stress incontinence is suspected, a cough stress test. Other components of the evaluation include laboratory tests and measurement of postvoid residual urine volume. If the type of urinary incontinence is still not clear, or if red flags such as hematuria, obstructive symptoms, or recurrent urinary tract infections are present, referral to a urologist or urogynecologist should be considered.

Evaluation and diagnosis of wrist pain: a case-based approach

Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology.

Chronic obstructive pulmonary disease diagnosis: the simpler the better? Not always

The acronym chronic obstructive pulmonary disease (COPD) has been introduced in the early 1960s to describe a disease characterized by largely irreversible airflow obstruction, due to a combination of airway disease and pulmonary emphysema, without defining their respective contribution to the pathology. COPD is a disorder that causes considerable morbidity and mortality. Currently, it represents the fourth leading cause of death in the world, and it is expected to increase both in prevalence and in mortality over the next decades. The most widely adopted definition of COPD is that of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), that recommends the use of the post-bronchodilator forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC)<0.7 to define irreversible airflow obstruction. This approach, called "fixed ratio", has been introduced to provide a simple tool for COPD diagnosis, as it is easy to remember. Even if modern medicine and research seem to prefer rigid cut-offs and classifications, this often contrasts with the complex nature of the disease. The aim of the present review is to explain that such a fixed cut-off failed to increase COPD diagnosis, and furthermore often leads to inescapable misclassification of patients, with the risk of an excessive simplification of a clinical approach necessarily complex.

Comparison of demographic and clinical characteristics of patients with early vs. adult vs. late onset ulcerative colitis

BACKGROUND & AIMS

There is limited data comparing influence of age on the presentation, clinical course, and therapeutic response of patients with ulcerative colitis. We aimed to compare the demographic and clinical characteristics of patients diagnosed with UC in older age vs. adulthood vs. early age.

METHODS

Five-hundred sixty one patients with UC seen at our center from 1995 to 2011 were categorized into early onset (EO), adult onset (AO) and late onset (LO) due to age at date of initial diagnosis. Patients diagnosed younger than age 17 were defined as EO, while those diagnosed between 17 and 60 were defined as AO and older than age 60 as LO. All patients were analyzed for demographic and clinical characteristics.

RESULTS

There was a male predominancy among LO patients (50% vs. 57.7% vs. 78.6%, p=0.004). Patients with EO UC were more likely to be non-smokers (p<0.001), and had higher family history of UC (p=0.02). Patients with EO UC had more steroid use (p=0.03), total colectomy (p=0.04), presence of chronic active disease (p=0.04) rates when compared with AO and LO groups. Patients in EO group had higher overall probability of surgery in 1, 5 and 10 years, when compared with patients in LO group (p=0.02), but it wasn't different between EO and AO groups (p=0.09).

CONCLUSIONS

Our study showed that clinical course of UC was more aggressive in younger ages. Also the difference between the demographic characteristics suggests that different age groups have different risk factors for the disease development.