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PubMed2004

Reduced compliance of left ventricle.

Diastolic function is essential for efficient systolic performance. A normal diastole allows left ventricle (LV) filling to occur under normal intracavitary pressure. It is an energy dependent process, as such affected by ischemia. Several factors influence diastolic function of the LV: the mitral valve area, the gradient between atrium and ventricle, LV relaxation and compliance, atrial compliance, the presence of sinus rhythm, the end-systolic volume. Echocardiography is the principal diagnostic tool to assess LV diastolic function noninvasively in clinical practice. Doppler evaluation allows to analyse each phase of LV diastole through measurement of transmitral and pulmonary veins flows velocities. Tissue Doppler echocardiography and color M-mode Doppler have also been introduced in the study of diastole. The use of echocardiography in the setting of diastolic dysfunction in ICU and operatory room has relevant implications in the management of haemodynamic instability, in vasoactive d rugs titration, in the detection of myocardial ischemia, and in performing prognostic stratification. These information can guide the management of cardiac patients undergoing cardiac and non cardiac surgery, in the perioperative phase, as well as in the management of critical ICU patients. On this basis evaluating the LV filling properties can contribute to improve the quality of treatments in such challenging situations.

Compliance↗

PubMed2005

Gated single-photon emission computed tomography. The present-day ''one-stop-shop'' for cardiac imaging.

UNLABELLED: Gated single-photon emission computed tomography (SPECT) is the current state-of-the-art approach to myocardial perfusion imaging. Initially, major emphasis was given to the improvement in diagnostic accuracy of myocardial perfusion imaging for the detection of coronary artery disease, because the evaluation of wall motion and thickening allows the recognition of attenuation artifacts and increases the observer's confidence. Different processing algorithms make possible to perform a reproducible and reliable assessment of left ventricular (LV) function, which has been extensively validated against various reference METHODS: Several articles report the additional value of functional data derived from gated SPECT to increase the accuracy of myocardial perfusion imaging in particular patient groups, such as women, to enhance the detection of multivessel coronary artery disease, and to permit the recognition of severe stenosis. An extensive literature indicates that gated SPECT allows a more accurate and reliable prognostic stratification of patients with known coronary artery disease. More recently, the peculiar contribution of gated SPECT in the assessment of myocardial viability has been demonstrated, with the possibility to evaluate in a single myocardial perfusion study the presence of preserved tracer uptake and the amount of contractile reserve through the acquisition of gated SPECT during inotropic stimulation with dobutamine. The most recent advance in the application of gated SPECT is the use of this technique for the reproducible assessment of LV functional changes, at follow-up or during inotropic stimulation, with perfusion data in the background. Various clinical settings, such as assessment of response to medical or resynchronization therapy in dilated or ischemic cardiomyopathy, prediction of outcome in chronic coronary artery disease with LV remodeling, evaluation of different treatment strategies in acute myocardial infarction, could take advantage from the unique combination of perfusion and functional data made possible by the use of gated SPECT. In conclusion, myocardial perfusion imaging with gated SPECT is a convincing reality in the field of cardiac imaging and has a still largely unexplored potential for a wider use in heart disease.

Coronary Artery Disease↗

PubMed2005

Aberrant expressions of annexin A10 short isoform, osteopontin and alpha-fetoprotein at chromosome 4q cooperatively contribute to progression and poor prognosis of hepatocellular carcinoma.

Chromosome 4q exhibits high frequency of allelic loss in hepatocellular carcinoma (HCC). This study aimed to elucidate the interaction of the frequent aberrant mRNA expression of alpha-fetoprotein (AFP), osteopontin (OPN) and a novel short isoform of annexin A10 (ANXA10S) at 4q in the tumor progression among 294 patients who received surgical resection of unifocal primary HCC. AFP overexpression, OPN overexpression and ANXA10S down-regulation correlated with high-grade and high-stage tumors, early tumor recurrence (all P<0.0001), and lower 10-year survival (all P=0.000001). The AFP overexpression correlated with OPN overexpression (P=0.0026) and ANXA10S down-regulation (P=0.00001), while OPN overexpression correlated with ANXA10S down-regulation (P=0.00001). Pair-wise combinations revealed interactive effects between these genetic variants for tumor grade, tumor stage and early recurrence (all P<0.0001). HCCs with more genetic aberrations had more frequent high tumor grade, portal vein invasion (stage IIIB-IV) and early recurrence (all P<0.0001). The 10-year survival rate for HCCs with all three genetic alterations was the lowest (7%), followed by those with two (22%) or one event (29%), and the highest for those without these changes (43%), P=0.000001. The prognostic stratification using these molecular factors was similar to that of histopathological staging. These three genetic alterations also helped to identify different subgroups of patients of stage II HCC but with different prognosis (P=0.015). In conclusion, the aberrant expressions of AFP, OPN and ANXA10S cooperatively contribute to tumor progression and poor prognosis, and are useful for molecular staging of HCC and the subclassification of stage II HCC without vascular invasion.

Adolescent↗

PubMed2005

[The expression and clinical significance of early differentiation antigens in acute leukemia].

OBJECTIVE: To evaluate the expression and clinical significance of early differentiation antigens of hematopoietic cells CD(34), CD(90) and CD(133) in acute leukemia (AL). METHODS: The expression of CD(34), CD(90) and CD(133) on leukemic blasts in 76 AL patients was detected with three-color direct flow-cytometry and CD(133) mRNA was detected with hemi-quantitative reverse transcriptive polymerase chain reaction (RT-PCR). RESULTS: (1) CD(34) and CD(133) expression in AL patients was significantly higher than that in controls (46.37% vs 0.47%, 21.93% vs 0.29%, P < 0.01), but there was no obvious difference of CD(90) expression between them (0.51% vs 0.25%, P > 0.05). The expression of CD(133) antigen was highly correlated with CD(133) mRNA expression in both of the normal control donors and AL patients (r = 0.932, P < 0.01). (2) The positive rates of CD(34), CD(90) and CD(133) in all AL patients were 63.2%, 7.9% and 42.1%, respectively. The expression of CD(90) in ALL was higher than that in AML (P < 0.05). Positive expression of CD(133) in AML-M(4) was significantly higher than that in other AML subtypes (P < 0.01). The positive rate of CD(34) in B-ALL was much higher than that in T-ALL (P < 0.05). (3) CD(133) expression in AML was significantly correlated with the expression of CD(34) and HLA-DR (P < 0.01). (4) The expression of CD(34), CD(90) and CD(133) was not associated with the clinical prognostic factors such as cytogenetic or molecular aberrations, initial peripheral blood WBC counts, lactate dehydrogenase level, multiple drug resistant expression and age. (5) There was a trend toward lower completely remission (CR) rate and overall survival rate in CD(34), CD(90) and CD(133) positive cases, but only CD(34)(+)/CD(133)(+) cases had significant lower CR rate than negative ones (P < 0.05). CONCLUSIONS: It is indicated AL has significantly higher CD(34) and CD(133) expression as compared with the normal controls. CD(133)/CD(34) co-expression might provide adverse prognostic stratification of acute leukemia.

AC133 Antigen↗

PubMed2005

Patients with chronic lymphocytic leukemia with mutated VH genes presenting with Binet stage B or C form a subgroup with a poor outcome.

BACKGROUND AND OBJECTIVES: The immunoglobulin VH gene mutation status is a strong prognostic indicator in B-cell chronic lymphocytic leukemia (CLL), since unmutated VH genes are correlated with short survival. However, the traditional cut-off level dividing mutated and unmutated cases, i.e. more or less than 2% mutations, has been questioned and other cut-offs have been suggested. We investigated whether an alternative cut-off should be applied and the relation of mutational status to another prognostic marker, Binet staging. DESIGN AND METHODS: VH gene mutation status was assessed in 332 CLL cases by polymerase chain reaction amplification and nucleotide sequencing and was further correlated with overall survival using different VH mutation cut-offs (1-7%) and Binet stage. RESULTS: After testing different mutation borders, the 2% cut-off remained the best discriminative level for determining prognosis. Interestingly, prognostic stratification was improved by combining the information on VH gene mutation status with that of Binet stage: unmutated cases (all stages, n=151, mutated cases with stage A (n=77), and mutated cases with stage B or C (n=37) had a median survival of 82, 179 and 74 months, respectively. INTERPRETATION AND CONCLUSIONS: CLL cases displaying mutated VH genes with Binet stage B or C had a survival similar to that of unmutated cases and significantly shorter than that of mutated stage A CLL. Our result reveals clinical heterogeneity within the VH mutated CLL group by inclusion of Binet stage data, a finding which is of importance when considering surrogate marker(s) for VH mutation status.

Adult↗

PubMed2005

Inflammatory biomarkers of coronary atheromatous plaque vulnerability.

In the last decade, compelling evidence has evolved at both the basic science and clinical level for the implication of inflammation in the pathogenesis of atherosclerosis and its complications. The composition of the atherosclerotic plaque, rather than the degree of stenosis, is now recognized as a pivotal feature in determining plaque vulnerability and hence the risk of acute coronary ischaemic events. Current evidence supports a key role for inflammation in all phases of the atherosclerotic process, from plaque formation through to progression and, ultimately, the thrombotic complications of atherosclerosis. The growing appreciation of the role of inflammation in atherogenesis has focused attention on whether circulating levels of inflammatory biomarkers may help to identify those at risk of future cardiovascular events. In addition, the protective effects of a variety of interventions, such as statins, aspirin, and fibrates, are often associated with the evidence of reduced inflammation, further strengthening the notion that inflammation and the acute complications of atherosclerosis are causally related. The present review describes the pathophysiology of atheromatous plaque vulnerability and discusses the clinical use of inflammatory biomarkers for prognostic stratification of patients with acute coronary syndromes.

Biomarkers↗

PubMed2005

Pulmonary hypertension: echocardiographic assessment.

Pulmonary arterial hypertension (PAH) is a clinical condition characterized by elevated vascular resistance, associated with a poor prognosis and usually diagnosed in late stage. Echocardiographic assessment of PAH includes early disease detection and functional heart evaluation, in order to introduce a more accurate surveillance at an early stage of the disease and to contribute to prognostic stratification of advanced disease. Detection involves pulmonary artery systolic pressure (PASP) estimation. There is no clear consensus on defining normal distribution, but a PASP of 36 mmHg has been widely assumed as a cut-off value for mild PAH, requiring a more aggressive surveillance to detect further progression. Functional heart evaluation requires an accurate characterization of morphologic and hemodynamic changes, secondary to PAH development, which involves description of dimensional parameters, ventricular interdependency, intracardiac flow patterns, and right ventricular systolic performance. A valid assessment of these issues results in a useful evaluation of cardiac function, supporting clinical context in defining heart failure condition.

Echocardiography↗

PubMed2005

Right ventricular dysfunction in advanced heart failure.

For many years cardiologists were not interested in studying right ventricular function and the role of the right ventricle in heart failure and in other disease states has therefore been largely underestimated. More recently a consensus has grown on the critical role of right ventricular function in patients with advanced congestive heart failure. The estimation of right ventricular function is nowadays warranted in the standard evaluation of patients with heart failure either due to ischemic heart disease or to primary dilated cardiomyopathy, since it is helpful in the clinical assessment and in the prognostic stratification of such patients. Most information may be obtained non-invasively using sound but simple and reproducible echocardiographic indicators of right ventricular function.

Disease Progression↗

PubMedDate not supplied

[Natriuretic peptides in heart failure].

The recent discovery of cardiac endocrine function, together with the development of accurate and feasible assay methods for cardiac natriuretic hormone evaluation, i.e. for B-type natriuretic peptide (BNP) and inactive peptide NT-proBNP have confirmed their pathophysiological and clinical significance for cardiovascular disease assessment. Concerning heart failure, their value is for diagnostic screening in selected/unselected populations, for differential diagnosis of dyspnea and for prognostic stratification, and as a guide for follow-up and treatment of patients. Recent Italian recommendations pointed out that BNP/NT-proBNP has a role in ruling-out the diagnosis of heart failure in patients with dubious signs/symptoms: plasma BNP/NT-proBNP concentrations help in the clinical evaluation of chronic heart failure patients when risk stratification is needed, whereas the routine BNP/NT-proBNP assay is still not recommended to guide therapeutic decision-making.

Heart Failure↗

PubMedDate not supplied

[Impact of new lymph node staging on lymphadenectomy and on the prognosis of patients undergoing surgery for gastric cancer].

The TNM system has become the principal method for assessing the extent of disease, determining prognosis in gastric cancer patients, and influencing therapeutic strategies. The extent of lymph node metastases is the most important prognostic factor. The aim of the study was to compare the 4th and 6th TNM edition N-classifications and to retrospectively evaluate the prognostic value of the 2002 TNM edition. We evaluated 344 patients who underwent curative total or subtotal gastrectomy. Our data confirm the simplicity and easy application of the new staging and the better prognostic stratification of the N-stage. In multivariate analysis the difference between the old and new TNM staging is minimal. We therefore suggest comparing lymph node location and number in larger series. For the purposes of correct N-staging, 10 lymph nodes in early gastric cancer and at least 16 in the other pT stages seem sufficient to achieve effective pNO staging.

Adult↗

PubMed1991

[Indices of the malignancy of cancer--is it possible to predict the recurrence or metastasis of cancer?].

The following 3 points are important clinical problems to be resolved in the management of cancer: 1. Are there any useful procedures in the diagnosis, treatment or prevention of recurrence or metastasis of cancer? 2. Can the recurrence or metastasis of cancer be predicted? 3. Are there any parameters which reflect the degree or grade of malignancy of cancer? For the diagnosis of recurrence or metastasis, tumor markers and imaging MRI are useful, especially for colorectal cancer. Radical extended resection can lead to good survival even though the tumor recurs. A randomized prospective study of 1011 gastrectomized cancer patients treated with oral OK432 showed significantly good results, especially in n(+) cases with curative resection. Prognostic stratification and risk assessment by computer analysis using Akaike Information Criteria (AIC) showed that cancerous invasion of subserosal veins (Vd) was the most important risk factor for liver metastasis of colorectal cancer. In predicting the recurrence or metastasis of cancer computer analysis by AIC appears to be a useful procedure. DNA ploidy patterns demonstrated by flow cytometry and oncogene analysis of tumor tissue have been reported and discussed as possible indices of the grade of malignancy.

Digestive System Neoplasms↗

PubMed1990

The myelodysplastic syndromes.

The myelodysplastic syndromes are a group of diseases mainly afflicting the elderly of unknown aetiology manifesting with clinical and laboratory manifestations of ineffective haematopoiesis. This review discusses the clinical and morphological features of the syndrome followed by a critical appraisal of the French American British (FAB) group classification. The presenting symptoms are usually non-specific and relate to the peripheral cytopenia(s). The marrow is invariably hyperplastic with peripheral cytopenia(s) together with characteristic trilineage dysplastic morphological changes. Prognostic stratification and treatment are outlined. Lack of effective treatment of this syndrome remains an outstanding problem.

Humans↗

PubMed1990

[Coronary arteriography after acute myocardial infarction].

On the basis of a population of 1,848 patients with acute myocardial infarction (AMI), prognostic stratification has been developed for detection of patients with high risks of death and repeated AMI in the first year after admission for coronary arteriography (KA). Patients with ischaemia at rest during hospitalization (17% of the patients, 18% one-year mortality), with previous AMI and cardiac failure during hospitalization (8%, 25% mortality), with positive exercise ECG (6%, 11% mortality) and patients with left ventricular ejection fraction (LVEF) between 0.22 and 0.44 (12%, 12% mortality) are recommended for coronary arteriography. Patients over the age of 75 years (31% mortality), patients with very low LVEF (less than 0.20) (33% mortality), patients with negative exercise ECG (3% mortality) and patients with normal LVEF (greater than 0.45) (5% mortality) are not recommended for investigation by coronary arteriography. These guidelines for coronary arteriography after AMI, based on recommendations from abroad should be considered in Denmark in relation to the capacity for carrying out this examination.

Aged↗

PubMed1977

[Treatment of acute leukemia].

Evaluations of 650 patients with acute lymphoblastic leukemias (A.L.L.) and of 596 patients with acute granulocytic leukemias (A.G.L.) ara analyzed. The patients were treated in the department of Professeur Jean Bernard at Saint-Louis Hospital between 1964 and 1976. In A.L.L., prognosis is influenced primarely by age, being worse in infants less than 1 year old and in adults: it is also influenced by the blastic load and by other parameters such as cytology and immunological markers which could not be studied in all patients. The correlation between high blastic load and the T lymphoblasts variety is noteworthy. Random studies are still necessary to find out the best drug combinations and the optimal duration of treatment, but the necessity for meningeal prophylaxis, reinduction treatments and of L-A sparaginase consolidation is no longer discussed. Prognostic stratification is useful for therapeutical evaluation and should load to therapeutical modulation. In acute granulocytic leukemias, age is also a significant parameter and remission rate is lower for patients over 50 years of age. Cytology and cytochemistry allow to recognize acute promyelocytic leukemias and acute monoblastic leukemias which bear specific initial risks (D.I.C. for A.P.L., renal failure for acute monoblastic leukemia) but which are highly sensitive to Daunorubicin and Rubidazone respectively. In A.M.L. remission duration is not influenced by age and seems to be improved by intermittent treatment. The role of immunotherapy is still under study.

Acute Disease↗

PubMed1989

Prognostic factors in inoperable adenocarcinoma of the lung: a multivariate regression analysis of 259 patients.

The prognostic factors for survival in advanced adenocarcinoma of the lung were investigated in a consecutive series of 259 patients treated with chemotherapy. Twenty-eight pretreatment variables were investigated by use of Cox's multivariate regression model, including histological subtypes and degree of differentiation, the new international staging system for lung cancer, and seven laboratory parameters. Staging of the patients included bone marrow examination but were otherwise nonextensive without routine bone, liver, and brain scans. Factors predicting poor survival were low performance status, stage IV disease, no prior nonradical resection, liver metastases, high values of white blood cell count, and lactate dehydrogenase, and low values of asparatate aminotransaminase. The nonradical resection may not be a prognostic factor because of the resection itself but may rather serve as an indicator for patients having minimal disease spread. Liver metastases were of limited clinical value as a prognostic factor because they were detected in only seven cases in this patient population. A new Cox analysis ignoring the influence of this variable revealed no other variables than those occurring in the former Cox model to be of importance (performance status, stage, surgical resection, WBC, aspartate aminotransaminase, and lactate dehydrogenase). This simplified model appears to be a feasible clinical tool, allowing for prognostic stratification of patients when first the inoperability of the patient is known.

Adenocarcinoma↗

PubMedDate not supplied

[Autoimmunity in thyroid disease secondary to amiodarone: heredofamilial aspects].

Spontaneous autoimmune thyroid disease (SATD) shows familial aggregation. Some patients receiving amiodarone treatment have been found to develop thyroid dysfunction. Previously, we reported genetic predisposition among this group of patients, now we inform a prospective study which includes the search for autoantibodies and family history to identify risk factors in amiodarone treated patients, 40 of them with amiodarone related thyroid disfunction, and 100 without it; for comparison, 30 patients with SATD and a control group of healthy subjects were also studied. We looked for the presence of autoantibodies against thyroglobulin, smooth muscle, gastric mucosa, myocardium, mitochondria, epithelial intercellular substance, and basal membrane as well as antinuclear antibodies and rheumatoid factors; in addition the history of thyroid disease in first degree relatives was investigated. Organ-specific antibodies anti-thyroglobulin, gastric mucosa and myocardium were found with increased frequency in the three groups of patients compared with controls (p less than 0.05). The frequency of antihydroglobulin antibodies was similar in patients receiving amiodarone with or without thyroid dysfunction. Prognostic stratification revealed that this finding is independent of sex, age, dosage or duration of treatment. A family history of thyroid dysfunction was found more frequently among patients with SATD and amiodarone related dysthyroidism in comparison with patients receiving amiodarone without altered thyroid function (p less than 0.005). The appearance of clinical thyroid disease depends on individual genetical predisposition. In patients with a positive family history, the risk of developing clinical, thyroid disease is 7.6 when treated with amiodarone.

Adolescent↗

PubMed1988

Cardiac disorders: a guide to assessing risk in the elderly.

Coronary artery disease can have various clinical manifestations, from the presence of "silent" ischemia to the occurrence of an acute myocardial infarction and congestive myopathy. At each point in the clinical manifestation of coronary artery disease, the practitioner has an evolving number of techniques available to guide decisions regarding prognosis and therapy. Guidelines exist for defining which patients with "silent" ischemia need further evaluation. The clinically manifested occurrence of angina pectoris is commonly encountered in the elderly. Prognostic stratification can occur using both invasive and non-invasive techniques. Even patients with unstable angina have different outcomes depending upon clinical presentation and therapeutic management. Finally, a large pool of patients who survive an acute myocardial infarction have a varied prognosis depending upon certain risk markers as documented with widely available non-invasive testing. This article summarizes the evaluations and decisions the physician can make regarding patients who present with the various manifestations of coronary artery disease and provides a summary of recent data supporting decisions regarding prognosis and therapy.

Aged↗

PubMed1987

Western blot profiles, lymph node ultrastructure and viral expression in HIV-infected patients: a correlative study.

Sequential immunoblotting was performed on 64 patients infected with human immunodeficiency virus (HIV). Antibody profiles were related to immune function, T subsets and clinical features. In 20 patients, lymph node biopsy revealed a relationship between progressive follicular destruction, low antibody titres and ultrastructural evidence of viral replication and accumulation. Retroviral particles, including budding profiles, were confined to labyrinths formed from hypertrophied follicular dendritic (FD) cells; in some cases, including those with AIDS, the labyrinths showed degenerative changes. The demonstration of high antibody levels in asymptomatic patients with an intact FD cell network and low virion load suggests that antibody may have a protective role in vivo. Analysis of lymph node ultrastructure allows assessment of viral load and FD cell morphology. When combined with immunoblotting, it may be possible to improve prognostic stratification of patients with HIV infection.

AIDS-Related Complex↗