The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI).
Little is known about long-term outcomes following TAVI.
The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded.
Mean aortic valve gradient decreased from 46 ± 18 mm Hg to 10 ± 4.5 mm Hg after TAVI and 11.8 ± 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 ± 0.17 cm(2) to 1.67 ± 0.41 cm(2) after TAVI and 1.40 ± 0.25 cm(2) at 5 years (p for post-TAVI trend
The optimal means of initiating warfarin therapy for acute venous thromboembolism in the outpatient setting remains controversial. We have previously demonstrated the efficacy of a 10 mg initiation nomogram in a randomized controlled trial; however, some clinicians remain reluctant to use this nomogram due to a fear of potential increased bleeding. To review the safety and efficacy of a 10 mg warfarin nomogram we conducted a retrospective cohort study of patients prospectively treated for venous thromboembolism according to a 10 mg nomogram in an outpatient thrombosis clinic. All patients received standard treatment with low molecular weight heparin for 5 to 7 days and warfarin for at least 3 months. Four-hundred and fourteen patients were included in the analysis, of whom 295 (71%) fully adhered to the nomogram. In the whole cohort, 8 patients (1.9%) experienced recurrent thrombosis, 4 (0.97%) suffered a major bleeding event, and 3 (0.72%) suffered a minor bleeding event. There were no deaths related to thrombosis or bleeding. Four patients (0.97%) died from unrelated causes. Twenty-two (5.3%) patients experienced an INR > or =5.0 in the first 8 days of therapy, and none of these patients experienced a bleeding event. Eighty-four percent of patients achieved a therapeutic INR by day 5. In outpatients, a 10 mg nomogram results in timely achievement of a therapeutic INR with an acceptable incidence of bleeding and recurrent thromboembolism.
The Finnish National Programme for Chronic Bronchitis and Chronic Obstructive Pulmonary Disease (COPD) 1998-2007 was set up to reduce the prevalence of COPD, improve COPD diagnosis and care, reduce the number of moderate to severe cases of the disease, and reduce hospitalisations and treatment costs due to COPD. Over 900 events for 25,000 participating healthcare workers were arranged. The major strengths of this programme included multidisciplinary strategies and web-based guidelines in nearly all primary health care centres around the country.
Data from national registries, epidemiological studies and questionnaires were used to measure whether the goals had been reached.
The prevalence of COPD remained unchanged. Smoking decreased in males from 30% to 26% (p
Comment In: Prim Care Respir J. 2011 Jun;20(2):109-1021603847
The purpose of the study was to investigate the prognosis for patients treated for lung cancer by operative resection in the Copenhagen area. Ninety-four consecutively operated patients were followed prospectively for ten years. Seventy-one percent of the patients had been operated radically. The five- and ten-year survival for this group was respectively 46 and 27%. All non-radically operated patients were dead after four years. The postoperative mortality and long-term survival correspond to international results. Type of cancer and mode of operation did not affect survival in the radically operated patients.
BACKGROUND: The Edinburgh randomised trial of breast-cancer screening recruited women aged 45-64 years from 1978 to 1981 (cohort 1), and those aged 45-49 years during 1982-85 (cohorts 2 and 3). Results based on 14 years of follow-up and 270,000 woman-years of observation are reported. METHODS: Breast-cancer mortality rates in the intervention group (28,628 women offered screening) were compared with those in the control group (26,026) with adjustment for socioeconomic status (SES) of general medical practices. Rate ratios were derived by means of logistic regression for the total trial population and for women first offered screening while younger than 50 years. Analyses were by intention to treat. FINDINGS: Initial unadjusted results showed a difference of just 13% in breast-cancer mortality rates between the intervention and control groups (156 deaths [5.18 per 10,000] vs 167 [6.04 per 10,000]; rate ratio 0.87 [95% CI 0.70-1.06]), but the results were influenced by differences in SES by trial group. After adjustment for SES, the rate ratio was 0.79 (95% CI 0.60-1.02). When deaths after diagnosis more than 3 years after the end of the study were censored the rate ratio became 0.71 (0.53-0.95). There was no evidence of heterogeneity by age at entry and no evidence that younger entrants had smaller or delayed benefit (rate ratio 0.70 [0.41-1.20]). No breast-cancer mortality benefit was observed for women whose breast cancers were diagnosed when they were younger than 50 years. Other-cause mortality rates did not differ by trial group when adjusted for SES. INTERPRETATION: Our findings confirm results from randomised trials in Sweden and the USA that screening for breast cancer lowers breast-cancer mortality. Similar results are reported by the UK geographical comparison, UK Trial of Early Detection of Breast Cancer. The results for younger women suggest benefit from introduction of screening before 50 years of age.
Comment In: Lancet. 1999 Jun 5;353(9168):1896-710371561
The mRNA expression of 17beta-hydroxysteroid dehydrogenase (17HSD) types 1 and 2 enzymes catalyzing opposite reaction of estrogen metabolism was investigated in colon cancer. Further, the significance of the 17HSD type 2 enzyme as a possible marker of colorectal cancer (CRC) prognosis was studied. In the normal mucosa, 17HSD type 2 mRNA was predominantly expressed in the surface epithelium and in the upper parts of the crypts. In the lamina propria expression was seen in endothelial cells and mononuclear phagocytes. In colorectal tumors, 17HSD type 2 expression was in most cases downregulated. Female patients had significantly more cancers with high 17HSD type 2 mRNA expression (n=11/35; 31%) than male patients (n=3/39; 8%) (P=0.02). We observed a significant impact of 17HSD type 2 mRNA expression on survival in female patients with distal colorectal cancer (n=24), with an overall cumulative 5-year survival rate of 54% in those with low 17HSD type 2 mRNA expression. None of the female patients with high 17HSD type 2 mRNA expression survived (n=11; P=0.0068; log rank 7.32). In male patients, no significant association with survival was observed. Our data provide evidence suggesting that low 17HSD type 2 mRNA expression is an independent marker of favorable prognosis in females with distal colorectal cancer, supporting the presence of gender- and location-related differences in the pathogenesis of colon cancer.
We evaluated the predictive value of interim positon emission tomography (I-PET) after one course of chemoimmunotherapy in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). One hundred and twelve patients with DLBCL were enrolled. All patients had PET/computed tomography (CT) scans performed after one course of chemotherapy (PET-1). I-PET scans were categorized according to International Harmonization Project criteria (IHP), Deauville 5-point scale (D 5PS) with scores 1-3 considered negative (D 5PS > 3) and D 5PS with scores 1-4 considered negative (D 5PS = 5). Ratios of tumor maximum standardized uptake value (SUVmax) to liver SUVmax were also analyzed. We found no difference in progression-free survival (PFS) between PET-negative and PET-positive patients according to IHP and D 5PS > 3. The 2-year PFS using D 5PS = 5 was 50.9% in the PET-positive group and 84.8% in the PET-negative group (p = 0.002). A tumor/liver SUVmax cut-off of 3.1 to distinguish D 5PS scores of 4 and 5 provided the best prognostic value. PET after one course of chemotherapy was not able to safely discriminate PET-positive and PET-negative patients in different prognostic groups.
AIM: To reveal trends in incidence rates of acute cardiovascular diseases (ACD) in a large industrial city of the West Siberia. MATERIALS AND METHODS: Studies on WHO programs "Acute Myocardial Infarction Register" and "MONICA" have been performed in three districts of Novosibirsk. The diagnostic categories were detected without difference. The observation covered stable population of 500,000 residents aged 25-64 years. Trends in the myocardial infarction (MI) mortality, morbidity and lethality were analysed for 1977-1996. RESULTS: The above trends were stable except for 1986 when MI mortality, morbidity and lethality decreased and 1988 and 1994 when they went up. The reduction was due to 7-year prevention program while the rise was consequent to discontinuation of the preventive measures. Major risk factors of ischemic heart disease, according to screenings conducted in 1984, 1988 and 1994 remained at about the same level. Social stress closely correlates with a rise in MI morbidity and mortality. The latter in 1994 grew owing to higher rates of MI mortality and morbidity among the oldest men and females of different age groups. CONCLUSION: Urgent intensification of prophylactic measures is needed both at the populational level and the level of high risk strategy.
A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark between 1970 and 1973, were followed up with regard to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years; there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, did have a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.
25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study.
To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity.
Nationwide population based cohort study using medical registries.
All hospitals in Denmark.
234,331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008.
Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression.
The standardised incidence rate per 100,000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days.
The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.
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