Tag Archives: prognosis

Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

DOI: 10.1515/amma-2017-0003

Objectives. Evaluation of the characteristics of sleep apnea (SA) in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization.
Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years) with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha < 0.05).
Results. 12 (21.4%) subjects were free of SA (AHI – apnea-hipopnea index <5/h), 15 (26.7%) had mild SA (AHI=5-14/h), 17 (30.3%) had moderate SA (AHI 15-30/h), and 12 (21.4 %) had severe SA (AHI>30/h). The apnea was predominantly obstructive (32 cases vs. 12 with central SA). Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05) between the severity of SA and the majority of main clinical and paraclinical characteristics – age, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028) and atrial fibrillation (p=0.041) were significantly more prevalent in the group with mild or no SA.
Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis.

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The Importance of Histo-pathological Factors in Setting the Long Term Prognosis for Non-small Cell Lung Cancer

Introduction: In the last decades, the rate of pulmonary cancer has risen alarmingly. Pulmonary cancer represents the main cause of death in women and men in the United States of America, 100,000 new cases being registered annually in men and 50,000 new cases in women. The purpose of our study is to evaluate the importance of histo-pathological factors in the long term outcome of patients operated for lung cancer.
Material and methods: In order to write the present paper, we carried out a retrospective observational study on a period of 6 years. We used the casuistry of the Surgical Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș. We studied all the patients’ papers who were admitted to Surgical Clinic I from the 1st of January 2005 till 31 December 2010. Further, we based our research on 197 patients that were admitted to Surgical Clinic I for bronchopulmonary tumors.
Results: We studied the importance of the T descriptor (tumor) from the TNM staging for establishing the long term prognosis. The value of p was 0.1676 so we didn’t obtain any value of statistical importance. We also took into consideration the value of N from the TNM staging as a prediction factor for long term survival in patients who underwent surgical intervention for pulmonary cancer. The p parameter was 0.0152 so we can say that we obtained a direct connection between the stages of lymph nodes metastasis and long term survival rate.
Conclusions: Long time survival rate of the patients depends on the histological type of the tumor. Long term survival prediction rate is better if the patients are over 60 years, compared with patients under 60 years. The N descriptor can be considered an important prediction factor, while the T descriptor’s value is useless. The existence of N’s descriptor in more stages of the TNM classification shows its limits and encourages for further improvements.

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Multimarker Phenotypes of Colorectal Cancer

Objective: We tried to correlate the clinico-pathologically features of colorectal cancer (CRC) to expression of eight immunohistochemically (IHC) markers and microsatellite instability (MSI) in order to realyze a molecular subdivision of these tumors.
Methods: 300 CRC, surgical specimens, were statistically and IHC evaluated. MSI status was analyzed in 52 cases, with Real Time PCR, melting point analysis. The following IHC markers have been used: CD8, E-cadherin, HER-2, p53, Ki67, bcl-2, MLH-1, CEA. The molecular phenotypes have been reported to the node status (pN) and MSI.
Results: Based on statistically analyses, we revealed that CEA and Ki67 were not prognostic factors. MLH-1 may indicate the MSI status and the number of tumor inflitrated lymphocytes stained with CD8 seems to be higher in the MSI cases and tumors of the proximal colon. HER-2 expression was correlated to number of the lymph node metastatses and bcl-2 was negative is most of the CRC diagnosed in advanced stages.
Conclusions: The CRC may be subdivided in six molecular prognostic groups, the best prognosis showing the MSI/p53-/bcl-2+/HER-2- and the worst MSS/p53+/bcl-2±/HER-2+. These molecular subdivision may be the basis for targeted therapy in node negative CRC.

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The Prognostic Impact of the Karyotype in Patients with Acute Lymphoblastic Leukemia

Background and Objective: Acute lymphoblastic leukemia (ALL), is characterized by uncontrolled precursor lymphocyte proliferation. Chromosomal abnormalities have been found in 60–85% of ALL patients. The aim of our work was to determine the chromosomal abnormalities and to evaluate the prognostic value of cytogenetic findings in a cohort of ALL patients.
Method: The study included 36 patients with ALL from Hematology Clinics Tg. Mures, Romania. Cytogenetic analyses were done on bone marrow cultures according to standard methods.
Results: We identified 22 cases (71%) with cytogenetic abnormalities. In our study, the frequency of chromosomal abnormalities was 50% in children and 85% in adults. The most common clonal karyotype aberration in ALL patients was numerical chromosomal abnormalities, detected in 62% of cases. Structural chromosomal abnormalities were found in 38% of our cases and were represented by translocations and deletions. We included our patients in different cytogenetic risk groups: 2 patients in low cytogenetic risk group, 23 in intermediate cytogenetic risk and 6 in severe cytogenetic risk group. We did not find a statistically significant difference in the median overall survival (OS) between the three cytogenetic risk groups (p = 0.863).There was a significantly better OS in patients who had a normal karyotype compared to those who had chromosomal abnormalities (p = 0.008).
Conclusion: Our study highlights the importance of cytogenetic analysis as an important prognostic factor in ALL

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Surgical Risk Factors of Patients with Operable Gist

DOI: 10.1515/amma-2015-0031

Introduction: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the gastrointestinal tract. This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients.
Methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program, and survival analysis was done by Kaplan Meyer.
Results: During this period we analyzed a total of 28 cases, including 13 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (15 cases; 53%), small intestine in ten cases (36%) and other sites in three patients ( 11%). Multivariate analysis revealed that tumor size (P <0,05), criterion for admission (P<0,05) and secondary dissemination (P<0,05) are independed prognostic factors.
Conclusions: Factors like: age and sex of patients, size and tumor site, presence or absence of metastasis, are prognostic risk factors with significant differences in the evolution of patients with operable GIST. The small number of patients and retrospective nature of the study have created difficulties in the estimation where we concluded the need of a prospective multicentric study.

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