Changes In Clinical Characteristics Research Articles

Changes in clinical characteristics and treatment of cerebral venous and sinus thrombosis: analysis of 35 patients admitted in Peking Union Medical College Hospital

To investigate the differences in etiology, symptoms, treatment, and prognosis between the patients with cerebral venous and sinus thrombosis (CVST) before December 31 2000 and those after that date. The etiology, symptom, treatment, and prognosis of the 35 CVST patients admitted to Peking Union Medical College Hospital (PUMC) from January 1 1991 to December 31 2000 (Group A, n = 16) and those admitted from January 1 2000 to May 31 2007 (Group B, n = 19) were analyzed and compared. (1) The first two common causes were infection and hematological disease in Group A, while the first two common causes were immune disease and hematological disease in Group B. (2) The common symptoms and signs and positive rates were as follows: headache (86%), seizures (34%), focal neurological deficits (40%), vision deficits (43%), altered consciousness (31%), and papilloedema (60%) without significant differences between these 2 groups. The positive rates of the common symptoms and signs during discharge were as follows: headache (77%), altered consciousness (73%), seizures (67%), focal neurological deficits (57%), vision deficits (43%), and altered consciousness (31%) without significant differences between these 2 groups. (3) 38% of the patients in Group A (n = 6) received anticoagulation therapy, a rate significantly lower than that of Group B (79% , n = 19) (P < 0.05). Four patients in Group B received thrombolytic therapy. The etiological constituents of CVST patients admitted in PUMC has changed, the weight of infection has declined and that of the immune disease has risen. The spectrum of signs remains unchanged; however, the rate of anticoagulation has ascended.

Clinical Characteristics of Peanut-Allergic Children: Recent Changes

The goal was to determine whether patients seen in a referral clinic are experiencing initial allergic reactions to peanuts earlier, compared with a similar population profiled at a different medical center 10 years ago, and to investigate other changes in clinical characteristics of the patients between the 2 groups. We reviewed the medical charts of peanut-allergic patients seen in the Duke University pediatric allergy and immunology clinic between July 2000 and April 2006. The median ages of first peanut exposure and reaction were 14 and 18 months, respectively; the respective ages in a similar population profiled between 1995 and 1997 were 22 and 24 months. Within our patient group, those born before 2000 were first exposed to peanuts at a median age of 19 months and reacted at a median age of 21 months, compared with first exposure at 12 months and first reaction at 14 months for those born in or after 2000. Most patients (68%) demonstrated sensitization or clinical allergy to other foods (53% to eggs, 26% to cow's milk, 20% to tree nuts, 11% to fish, 9% to shellfish, 7% to soy, 6% to wheat, and 6% to sesame seeds). In the past decade, the ages of first peanut exposure and reaction have declined among peanut-allergic children seen in a referral clinic. Egg allergy is very common in peanut-allergic patients, and sesame seeds should perhaps be considered one of the major food allergens. The decline in the age of first peanut reaction seems to be attributable to earlier exposure.

Changes in Clinical Characteristics, Course, and Prognosis of Inflammatory Bowel Disease during the Last 5 Decades: A Population-Based Study from Copenhagen, Denmark

It remains uncertain whether the increasing incidence of inflammatory bowel disease (IBD) during the last decades has been accompanied by an alteration in the presentation, course, and prognosis of the disease. To answer this question, 3 consecutive population-based IBD cohorts from Copenhagen, Denmark (1962-2005), were assessed and evaluated. Phenotype, initial disease course, use of medications, cumulative surgery rate, standardized incidence ratio of colorectal cancer (CRC), and standardized mortality ratio (SMR) were compared in the 3 cohorts, which had a total of 641 patients with Crohn's disease (CD) and 1575 patients with ulcerative colitis (UC). From 1962 to 2005, the proportion of IBD patients suffering from CD increased (P < 0.001), time from onset of symptoms to diagnosis of CD decreased (P = 0.001), and median age at diagnosis of UC increased (P < 0.01). The prevalence of upper gastrointestinal involvement and pure colonic CD varied significantly between cohorts. UC patients diagnosed in the 1990s had a higher prevalence of proctitis, received more medications, and had a milder initial disease course than did previous patients. The surgery rate decreased significantly in CD but not in UC. The risk of CRC in IBD was close to expected over the entire period, whereas the mortality of patients with CD increased (overall SMR, 1.31; 95% CI, 1.07-1.60). Despite variations in the presentation and initial course of IBD during the last 5 decades, its long-term prognosis remained fairly stable. Treatment of IBD changed recently, and future studies should address the effect of these changes on long-term prognosis.

Chronological changes of clinical characteristics in 31,115 new breast cancer patients among Koreans during 1996–2004

Breast cancer has emerged as the most frequent malignancy among Korean women. Its clinical features have become closer to those now observed in Western countries. We performed this study to evaluate the chronological changes in Korean breast cancer characteristics and reproductive factors from 1996 to 2004. A nationwide multi-center survey within the Korean Breast Cancer Society (KBCS) has been performed since 1996. We analyzed the chronological changes among newly diagnosed primary breast cancer patients recruited at 41 university- and 65 surgical training-hospitals. All participating hospitals provided the essential information, including sex, age, surgical method used, American Joint Committee on Cancer classification, and other information, including reproductive factors, etc. This study showed a continuous increase in: the incidence of breast cancer (154.3% increase from 3801 to 9667 patients); breast-conserving surgery (124.1% increase from 18.7 to 41.9%); breast reconstruction after operation (25.4% increase from 5.2 to 16.4%); the percentage of early cancer (128.6% increase for stage 0; a 64.8% increase for stage I); and the number of patients with reproductive factors, such as early menarche, late menopause, late first-delivery, and no breast feeding. These results suggest that the rate of breast cancer in Korea is expected to continuously increase in the future; and that the pattern of breast cancer is perhaps mirroring that observed in Western countries.

The death rate among hospitalized heart failure patients with normal and depressed left ventricular ejection fraction in the year following discharge: evolution over a 10-year period

To investigate whether changes in clinical characteristics and treatment strategies between 1991 and 2001 have had an impact on the survival of patients hospitalized with congestive heart failure (CHF) and whether those with normal left ventricular ejection fraction (LVEF> or =50%) differ in this respect from those with depressed LVEF. We studied 1482 patients who had been admitted to the Cardiology Service of a tertiary Spanish hospital in the last 10 years with CHF. Among the 1110 for whom LVEF was evaluated, the prevalence of normal LVEF rose from 37% in the period 1991-96 (Period 1) to 47% in the period 2000-2001 (Period 3). The intensity of both diagnostic and therapeutic measures also increased during this 10-year period. The 1-year survival rate remained virtually unchanged in the whole group of patients, being 82, 84, and 82% in Periods 1, 2 (1997-99), and 3, respectively, even though the prognosis of patients with depressed LVEF (<50%) improved significantly, with 1-year survival rates of 76, 77, and 84% in Periods 1, 2, and 3, respectively; the normal LVEF group had decreasing 1-year survival rates of 88, 86, and 81% in Periods 1, 2, and 3, respectively, although the increased risk of death was not statistically significant. Although in our centre the death rate among hospitalized CHF patients with depressed LVEF during the first year after discharge has tended to fall over the past 10 years, application of current clinical guidelines has led to no such decrease for patients with normal LVEF. This situation points to a need to reconsider the diagnostic and therapeutic strategy to be employed with this latter group of patients.

Clinical analysis of recent lower lung field tuberculosis.

Because the incidence of lower lung field tuberculosis has recently increased in our affiliated hospitals, we carried out an analysis of its clinical characteristics during the past 10 years. We experienced 15 patients (7.5%) with lower lung field tuberculosis among 201 patients treated between April 1992 and March 1997, and 27 patients (11.1%) with the same condition among 243 patients treated between April 1997 and March 2002. The changes in clinical characteristics shown in the later period were as follows: (1) an increase in the percentage of elderly patients, (2) an increase in the incidence in patients who had received corticosteroid drugs for underlying disease, (3) atypical radiographic findings, such as homogeneous shadows resembling bacterial pneumonia, (4) an increase in microbiologically smear-positive patients, because more bronchoscopic examinations were performed, and (5) a high mortality rate (21.7%) with the increase being due to complications. Because there is a significant problem with nosocomial infections, patients with homogeneous shadows resembling bacterial pneumonia on admission should be examined for acid-fast bacilli containing Mycobacterium tuberculosis. We consider this problem to be not so difficult considering the progress in diagnostic methods for M. tuberculosis.

Depression scores following migraine treatment in patients attending a specialized center for headache and neurology.

To determine the changes in clinical characteristics and depression levels among patients following treatment for migraine. Epidemiologic studies have provided consistent evidence regarding an association between migraine and depression. In Puerto Rico, however, migraine has not yet been systematically investigated. A chart review of 144 Puerto Rican patients who presented with migraine, diagnosed according to the International Headache Society criteria, and depression over a 2-year period was performed. The level of depression, before and after migraine treatment, was evaluated using the Zung Self-rating Depression Scale. The mean age of patients was 37.0 +/- 14.4 years; 77.1% were women. More than half (52.8%) reported severe headache and 56.9% reported a monthly frequency of five attacks or more. Nearly 9% were using antidepressant therapy and 8% were under psychiatric treatment. The mean Zung index score at baseline was 50.6 +/- 10.9. Following treatment with triptans, the intensity and frequency of migraine and the Zung index score decreased significantly (P<.00001). A trend for a greater reduction in Zung index scores among patients receiving triptan medications for more than a year was demonstrated (P =.07). These results indicate that migraine treatment with triptans appears to be effective in decreasing the headache frequency and intensity, and depression levels, independent of antidepressant medication use or psychiatric treatment.

The Effects of Oral Nitric Oxide Donor (Molsidomine) in Patients with Variant Angina Unresponsive to Conventional Anti-Anginal Drugs

Background:We observed the changes of clinical characteristics after oral Molsidomine, a nitric oxide donor, in patients who have documented coronary artery spasm by ergonovine coronary angiogram and refractory to conventional anti-anginal therapy. Method:Molsidomine, oral nitric oxide donor, was administrated over 12 weeks in 20 patients (6 male, 14 female, 54±11.5 years) in order to observe the clinical effects in patients with coronary artery spasm unresponsive to nitrate and calcium channel blockers. Changes in the frequency of pain and sublingual nitroglycerin use, blood pressure, heart rate, side effects, electrocardiogram, and laboratory findings were evaluated before and after Molsidomine therapy. Results:The frequencies of pain and sublingual nitroglycerin use were 3.9±0.9/week before treatment and decreased to 2.9±0.9/week at 4th week after the additional Molsidomine treatment (pre-treatment vs. 4th week;p<0.001), to 1.0±0.8/week at 8th week (4th week vs. 8th week;p<0.001), and to 0.7±0.8/week at 12th week. Systolic blood pressure decreased after treatment, but there were no significant changes in diastolic blood pressure, heart rate, resting electrocardiogram and laboratory findings. Molsidomine was discontinued in one patient because of headache. Conclusions:Molsidomine is an effective and well tolerated anti-ischemic agent in patients with variant angina refractory to conventional anti-anginal therapy. (Korean Circulation J 1998;28(9):1577-1582)

Clinical Effects of Simvastatin in Patients with Hypercholesterolemia

Background:To evaluate the clinical efficacy of Simvastatin, a HMG-CoA reductase inhibitor, we observed the changes of clinical characteristics and lipid profiles after Simvastatin administration in patients with hypercholesterolemia. Methods and Results:Simvastatin 10mg was given once daily for 12 weeks in 35 patients(60± 6.0 years;14 male, 21 female with hypercholesterolemia. High density lipoprotein-cholesterol(HDL- C was increased from 38±10 to 45±9mg/dl(p<0.05. Simvastatin significantly decreased total cho- lesterol(TC from 235±15 to 181±21mg/dl(23.0%, low-density lipoprotein cholesterol(LDL-C from 164±19 to 104±18mg/dl(36.5%, TC/HDL-C from 7.0±2.0 to 4.4±1.1, LDL-C/HDL-C from 4.9±1.7 to 2.5±0.8(p<0.01 respectively. Apo B was decreased by 31%(119±19 to 87±15mg/dl, apo B/A1 ratio was decreased by 41%(1.2±0.2 to 0.7±0.2 and lipoprotein(a decreased by 12%(33 ±22 to 29±17, while apo A1 was increased by 25%(104±18 to 130±23mg/dl, p<0.01 respectively. No patients complained of chest pain, but two had skin rashes. Creatine kinase and creatinine were not changed in all patients. Conclusions:Simvastatin is an effective and well tolerated cholesterol lowering agent in patients with hypercholesterolemia.

Changes in Clinical Characteristics and Drug Treatment of Hypertension Over 40 Years at the Dunedin Hypertension Clinic

The clinical characteristics of the 4,170 hypertensive patients referred to the Dunedin Clinic from 1950 to 1989 have been compared for eight successive 5-year periods. A gradual decrease in the severity of referred hypertension and an increase in the proportion of patients already on treatment at the time of referral (currently 50%) were noted. For male patients, mean ± SD initial lying blood pressure was 179 ± 27/116 ± 19 mm Hg in 1950–1954 and 158 ± 25/91 ± 14 mm Hg in 1985–1989. Corresponding prevalence data for target organ damage among male patients were retinal grade 3 or 4, 49% and 3%; cardiomegaly on chest radiograph, 60% and 26%; electrocardiogram left ventricle strain pattern, 28% and 3%; and serum urea levels > 10 mmol/L, 16% and 5%, respectively. For women there was a similar trend. The number of patients on drugs in each of nine categories and the percent use of each drug category for each year during 1950–1989 was recovered from computerized data files. The percentage peak usage of ganglion blockers was in 1950–1958, adrenergic neuron blockers in 1963–1970, centrally acting drugs in 1965–1968, diuretics in 1960–1982, β-blockers in 1974–1987, α-blockers in 1980–1987, and angiotensin converting enzyme inhibitors and calcium antagonists in 1989. The diuretics have been the most enduring drugs, followed by the β-blockers.

Changes in Clinical Characteristics and Drug Treatment of Hypertension Over 40 Years at the Dunedin Hypertension Clinic

The clinical characteristics of the 4,170 hypertensive patients referred to the Dunedin Clinic from 1950 to 1989 have been compared for eight successive 5-year periods. A gradual decrease in the severity of referred hypertension and an increase in the proportion of patients already on treatment at the time of referral (currently 50%) were noted. For male patients, mean +/- SD initial lying blood pressure was 179 +/- 27/116 +/- 19 mm Hg in 1950-1954 and 158 +/- 25/91 +/- 14 mm Hg in 1985-1989. Corresponding prevalence data for target organ damage among male patients were retinal grade 3 or 4, 49% and 3%; cardiomegaly on chest radiograph, 60% and 26%; electrocardiogram left ventricle strain pattern, 28% and 3%; and serum urea levels greater than 10 mmol/L, 16% and 5%, respectively. For women there was a similar trend. The number of patients on drugs in each of nine categories and the percent use of each drug category for each year during 1950-1989 was recovered from computerized data files. The percentage peak usage of ganglion blockers was in 1950-1958, adrenergic neuron blockers in 1963-1970, centrally acting drugs in 1965-1968, diuretics in 1960-1982, beta-blockers in 1974-1987, alpha-blockers in 1980-1987, and angiotensin converting enzyme inhibitors and calcium antagonists in 1989. The diuretics have been the most enduring drugs, followed by the beta-blockers.