Patient Clinical Variables Research Articles

Postoperative changes in myosin light chain and comparison with postoperative clinical variables in patients who have undergone valve surgery.

We measured the levels of creatine kinase-MB (CK-MB) and myosin light chain (MLCI) in 86 patients after double valve replacement to investigate whether measurement of the postoperative changes in myosin could be useful in patients undergoing valve surgery. In particular, we compared the postoperative levels of CK-MB and MLCI with the occurrence of postoperative low cardiac output syndrome (LOS). In both groups of patients (group I: without LOS, group II: with LOS), the peak CK-MB level was observed on postoperative day 1, and the peak myosin level on postoperative day 5. No significant differences were found in the postoperative levels of CK-MB between the two groups. On the other hand, a significant difference in the levels of MLCI on postoperative day 5 was observed (p < 0.05). Our results also showed that the peak level of CK-MB significantly correlated with the cardiopulmonary bypass time (r = 0.50), while the peak level of MLCI was significantly correlated with the postoperative cardiac index (r = -0.45). Our retrospective findings suggest that postoperative measurement of MLCI may be useful for estimating the postoperative myocardial impairment after valve surgery.

Distribution of Hepatitis C Virus Genotypes Determined by Line Probe Assay in Patients with Chronic Hepatitis C Seen at Tertiary Referral Centers in the United States

To 1) verify the validity of a new line probe assay for hepatitis C virus (HCV) genotyping and 2) determine the distribution of HCV genotypes and the association between HCV genotype and clinical variables in patients with chronic hepatitis C seen in tertiary referral centers in the United States. Retrospective cross-sectional analysis. 438 patients with chronic hepatitis C from 10 tertiary referral centers. The validity of the line probe assay was first verified against a panel of serum specimens that had previously been characterized by six different HCV genotyping methods. Specimens from all 438 patients were then genotyped using this line probe assay. The associations between HCV genotype and clinical variables were examined using analysis of variance. Pairwise testing was used when the F test showed a statistically significant difference. Nonparametric alternatives were used for variables for which normality could not be assumed. The line probe assay was quick and reproducible, and it showed good concordance with other tests. In our sample, the proportions of patients with HCV types 1, 2, 3, and 4 were 71.5%, 13.5%, 5.5%, and 1.1%, respectively. Subtypes 1a and 1b were seen in approximately equal proportions of patients with HCV type 1. Mixed infection was detected in 3.7% of specimens, and 4.8% of specimens either had negative results on polymerase chain reaction or could not be typed. A higher proportion of patients with HCV type 1 than of patients with HCV-type 1 had acquired HCV through transfusion of blood products (50% compared with 25%; P < 0.001). Patients with HCV type 1 also had a longer estimated duration of infection compared with patients with HCV type 3 (P = 0.004) and type 4 (P = 0.049). Disease activity did not differ among patients infected with HCV types 1, 2, or 3. Levels of viremia were similar in patients with HCV types 1, 2, or 3, but patients with HCV type 4 had a lower level of viremia than did patients with HCV type 1 (P = 0.047). The line probe assay can be used in patients with chronic HCV infection in the United States. In patients with chronic hepatitis C referred to tertiary centers in the United States, type 1 is the most common HCV genotype. Disease activity and viremia levels do not differ among patients chronically infected with HCV types 1, 2, or 3.

Predictors of Intracranial Injury in Patients With Mild Head Trauma

Study objective: To determine the prevalence of abnormal computed tomography (CT) scans and define high-risk clinical variables in patients with mild head injury. Design: Retrospective descriptive study of patients with Glasgow Coma Scale (GCS) scores of 13 or greater who presented to the emergency department with blunt head trauma and who underwent cranial CT. Setting: Level I trauma center, university ED. Results: During the 15-month study period, 1,448 patients underwent CT scanning for mild head injury. Abnormalities resulting from the trauma were found in 119 (8.2%), and 11 patients (.76%) required neurosurgical intervention. Patients with higher GCS scores had a greater chance of having a solitary CT abnormality ( P =.004). Bicyclists and pedestrians struck by cars were more likely than others to sustain intracranial injury. High-risk clinical variables included the presence of cranial soft-tissue injury, a focal neurologic deficit, signs of basilar skull fracture and age older than 60 years. A strategy using those variables had a sensitivity of 91.6% and a specificity of 46.2% for detecting a CT abnormality. None of the patients missed by this strategy required medical or neurosurgical management for the CT finding. Conclusion: Abnormalities on CT scans in patients with mild head trauma are fairly common, although the need for neurosurgical intervention is rare. Clinical decision rules can be used to identify those patients with more serious intracranial pathology. Such strategies should be validated prospectively in various ED settings. [Borczuk P: Predictors of intracranial injury in patients with mild head trauma. Ann Emerg Med June 1995;25:731-736.]

Patterns of medication use in patients with heart failure: a report from the Registry of Studies of Left Ventricular Dysfunction (SOLVD).

To determine patterns of medication use based on clinical variables in patients with heart failure, we analyzed data from 5,999 patients participating in the Registry of Studies of Left Ventricular Dysfunction (SOLVD). The Registry comprised a broad spectrum of patients with heart failure, including some with predominantly diastolic dysfunction. Drug use was determined in a population cross-sectional manner at the time of identification (74% hospitalized). The median number of drugs per patient was four, with diuretics taken by 62%, digitalis by 45%, angiotensin-converting enzyme inhibitors (ACE-I) by 32%, calcium channel blockers by 36%, antiarrhythmics by 22%, and beta-blockers by 18%. Only 18% were on the combination of ACE-I, diuretic, and digitalis. Stratification for diagnosis, heart failure symptoms, and ejection fractions demonstrated that triple-drug therapy (digitalis, diuretic, and ACE-I) was common only in those with ejection fractions less than .20 and several signs or symptoms of heart failure. Older patients were taking diuretics frequently (73% of patients older than 70 years of age), and our European center used fewer drugs overall, while prescribing digitalis about half as frequently as North American clinics. These data serve as the baseline for analysis of evolving therapeutic practice in patients with heart failure.

Marked Heterogeneity in Niemann-Pick Disease, Type C

Niemann-Pick disease type C (NP-C) is an autosomal recessive lysosomal lipid storage disorder of unknown etiology. Diagnosis of NP-C is based on characteristic clinical findings and reduced fibroblast esterification of LDL-derived cholesterol. We describe three patients who demonstrate the NP-C spectrum of clinical heterogeneity in age of onset, presenting signs, pattern of organ system involvement, and natural history. In addition, electron microscopic analysis of skin biopsy specimens from these patients revealed marked variability in the extent and cellular distribution of intralysosomal storage and was suggestive of the correct diagnosis in only one case. These cases demonstrate both the limitations of electron microscopy for diagnosis of NP-C and the marked clinical variability in patients with this disorder. Practical clinical guidelines for appropriate suspicion of NP-C are presented.

Study of certain clinical variables in patients with psoriasis and their relation to DNA content of keratinocytes

Background: In a previous study of 26 patients with psoriasis we analyzed cytophotometrically the nuclear DNA content of the germinative compartment of involved and uninvolved skin by means of the Feulgen technique. These subjects were classified into three groups according to their DNA profile. Group 1 had a monomodal diploid profile, group 2 showed a significantly increased 2C4C population, and group 3 demonstrated high proportions of 4C and hyperdiploid keratinocytes. Objective: Our purpose was to analyze clinical variables implicated in the development of psoriasis in reference to the three groups. Methods: Nuclear DNA content of each group by quantitative histochemical studies was analyzed and correlated with variables such as chronologic age, sex, age at onset, duration of flare during the study, stress, and the Koebner phenomenon. Results: No significant differences in DNA profile were observed in the involved epidermis among the clinical variables. The only differences in the uninvolved skin pertained to the duration of the flare, where a statistically significant difference was observed between groups 1 and 3 in the basal ( p ≤ 0.0459) and suprabasal keratinocytes ( p ≤ 0.06), and in the Koebner phenomenon, which was induced in all subjects (100%) in groups 2 and 3 and in only 44% of subjects in group 1. Conclusion: Uninvolved skin of patients with psoriasis should be included in analysis of the clinical behavior of the disease. Furthermore, the Koebner phenomenon is a good clinical indicator of the DNA profile of these subjects.

Identification of a missense mutation, single base deletion and a polymorphism in the dystrophin exon 16.

Identification of a missense mutation, single base deletion and a polymorphism in the dystrophin exon 16.

Prognostic significance of exercise thallium-201 myocardial perfusion imaging compared to stress echocardiography and clinical variables in patients with unstable angina who respond to medical treatment

The prognostic value of thallium-201 imaging in patients with unstable angina is not well established. Forty consecutive patients with unstable angina who had responded to medical therapy underwent predischarge symptom-limited exercise testing and 39 of them underwent exercise thallium-201 imaging, on average 3 days after the exercise test. Exercise echocardiography was performed in 36 of these patients in conjunction with the predischarge exercise test. Patients with previous myocardial infarction, coronary revascularization, left bundle branch block and dilated cardiomyopathy were not included in the study. An echocardiographic wall-motion score index was derived by analyzing left ventricular regional wall motion. During a follow-up period of 30 ± 6.4 months, 3 patients had a non-fatal myocardial infarction and 20 required revascularization because of a recurrence of severe medically refractory angina. Univariate predictors of cardiac events (non-fatal myocardial infarction or a need for revascularization) during follow-up included ST-depression during exercise, positive exercise echocardiography, a low exercise wall-motion score index, the presence of thallium-201 redistribution and the number of myocardial segments with thallium-201 redistribution. However, stepwise logistic regression analysis revealed that the presence of thallium-201 redistribution was the only significant non-invasive predictor ( P < 0.005) of a cardiac event among patients who underwent predischarge exercise testing and exercise thallium-201 imaging. Among patients undergoing exercise echocardiography and exercise thallium-201 imaging, the number of segments with thallium-201 redistribution was the only significant predictor ( P < 0.0005) of future cardiac events. Thus, exercise thallium-201 imaging can be used to identify groups at high and low risk for future cardiac events among patients with unstable angina who respond to medical treatment.

Myocardial magnesium: Relation to laboratory and clinical variables in patients undergoing cardiac surgery : Reinhart RA, Marx JJ, Broste SK, Haas RG: J Am Coll Cardiol 17:651–656, 1991

Myocardial magnesium: Relation to laboratory and clinical variables in patients undergoing cardiac surgery : Reinhart RA, Marx JJ, Broste SK, Haas RG: J Am Coll Cardiol 17:651–656, 1991

Myocardial magnesium: Relation to laboratory and clinical variables in patients undergoing cardiac surgery

Magnesium concentration was measured in the right atrial appendage of 100 patients undergoing cardiac surgery and associations with serum and mononuclear blood cell magnesium, other laboratory values and patient clinical variables were studied. In addition, magnesium was measured in the right atrial appendage and left ventricular free wall in 23 autopsy subjects to determine whether there was a proportional relation between right atrial appendage and left ventricular free wall magnesium. The mean left ventricular free wall/right atrial appendage magnesium ratio was 2.13 +/- 0.39 (r = 0.67, p = 0.0009). In the group with cardiac surgery, the right atrial appendage magnesium concentration correlated inversely with age (r = -0.54, p = 0.001). The mean right atrial appendage magnesium concentration (micrograms/g wet weight tissue) was lower in patients with postoperative cardiac arrhythmia than in those without arrhythmia (103 +/- 13 versus 111 +/- 10, p = 0.009) and in diabetic than in nondiabetic patients (103 +/- 13 versus 109 +/- 12, p = 0.02). The right atrial appendage magnesium concentration also tended to be lower in patients receiving potassium/magnesium-losing diuretics, although this difference did not achieve statistical significance (105 +/- 14 versus 109 +/- 11, p = 0.16). Right atrial appendage magnesium concentration correlated positively with serum creatinine concentration (r = 0.31, p = 0.002) and negatively with serum calcium concentration (r = -0.29, p = 0.013). Serum magnesium did not correlate with right atrial appendage or mononuclear blood cell magnesium concentration or clinical variables. There was a statistically significant correlation between mononuclear blood cell and right atrial appendage magnesium concentrations in some subgroups of patients.

Chronic aortic insufficiency: factors associated with progression to aortic valve replacement.

To determine whether the initial measurement of clinical variables in patients with chronic stable aortic insufficiency is helpful in identifying patients at risk for earlier progression to aortic valve replacement. Prospective analysis of a cohort of patients for a median follow-up time of 44 months (range, 8 to 57). Referral-based cardiology clinics at two university hospitals and their affiliated Veterans Administration medical centers. Cohort of 50 asymptomatic or minimally symptomatic patients with chronic aortic insufficiency and left ventricular enlargement. Patients had preserved left ventricular ejection fraction at rest and no evidence of coronary artery disease or significant noncardiac illness. None. Baseline evaluation included a history and physical examination, chest roentgenogram. M-mode echocardiogram, treadmill test, and radionuclide angiogram done at rest and during supine bicycle exercise. Ten patients progressed to surgery because of the onset of limiting symptoms or objective evidence of left ventricular dysfunction, or both; the overall rate was 4% +/- 3% per year. The Breslow and Mantel-Cox statistics were used to compute survival (surgery-free) dichotomized by prognostic variables. The progression to surgery was earlier in patients with left ventricular end-diastolic volume indices of 150 cc/m2 or more, end-systolic volume indices of 60 cc/m2 or more, a left ventricular ejection fraction at maximal exercise of less than 0.50, or an end-systolic wall stress of 86 dynes/cm2 or more. Patients at higher and lower risk for early progression to aortic valve replacement can be identified through the measurement of left ventricular size and function. This information can be used to decide the frequency and intensity of follow-up evaluation in these patients.

Interstitial del(13)(q21.3q31) associated with psychomotor retardation, eczema, and absent suck and swallowing reflex.

A patient with a deletion (13)(q21.3q31) showed only eczema and absent suck and swallowing reflex, in contrast to other well documented cases with a similar deletion. Apparently there is wide...

Multi-inductive component analysis ? A powerful tool in pattern recognition

A new technique for graphical representation is given as an alternative for PCA. Main advantages are the inherent feature selection, a better understanding of the result of the transformation and its simplicity. A brief explanation of the theory is given, as well as two practical applications: a description of polluted waters in the province of Utrecht and a study of the relations between several clinical variables of patients with hyperlipoproteinemia.

Serum melatonin in relation to clinical variables in patients with major depressive disorder and a hypothesis of a low melatonin syndrome.

Maximum nocturnal serum melatonin level (MTmax) in relation to some clinical variables was studied in 32 patients with a major depressive episode and in 33 healthy subjects with reference to the outcome of the dexamethasone suppression test (DST). Significant regressions were found between MTmax levels and clinical rating scores in CPRS, interpreted as retardation symptoms. Four healthy subjects with disposition for dysthymic reactions had subnormal MTmax levels, which differed from MTmax levels in subjects without such disposition. Patients but not the healthy subjects, who reported parental loss before 17 years of age, had subnormal MTmax levels and differed from patients with no reported parental loss. Patients with no reported suicidal behaviour in clinical history had significantly lower MTmax levels than patients with reported suicide attempts. No relations were found between low MTmax levels and diagnoses, duration of illness, reported inheritance for depressive illness or sleep disturbances. A hypothetical low melatonin syndrome in depression is proposed: low nocturnal melatonin, abnormal dexamethasone suppression test, disturbed 24-h rhythm of cortisol, less pronounced daily and annual cyclic variation in depressive symptomatology.

Interrelationships of histopathology and other clinical variables in patients with germ cell tumors of the testis.

Possible relationships between histopathologic cell type and several clinical variables were examined in 253 patients with Stage III nonseminomatous germ cell tumors of the testis. No statistically significant associations were found between cell type and either the side of primary tumor or cryptorchidism. The presence of elements of choriocarcinoma was associated with the presence of retroperitoneal tumor (P less than 0.03) but no other association between cell type and site of metastasis was encountered. Elevated serum levels of human chorionic gonadotropin were found in patients with elements of choriocarcinoma but serum levels of alphafetoprotein, lactate dehydrogenase and carcinoembryonic antigen were not correlated with a specific cell type. No statistically significant association was found between cell type and either complete response to combined modality therapy or survival. These results would indicate that cell type is probably not an important prognostic variable in patients with Stage III nonseminomatous tumors of the testis.

MAO activity, csf amine metabolites, and drug-free improvement in schizophrenia.

Platelet monoamine oxidase (MAO) activity and amine metabolites in cerebrospinal fluid were compared in 22 schizophrenic patients, 8 of whom improved during a 30-day drug-free period. CSF 5-hydroxyindoleacetic acid and homovanillic acid did not distinguish between drug-free improvers and nonimprovers. However, drug-free improvers had lower platelet MAO activities than did normal controls. The authors suggest that looking at clinical variables in patients with low MAO activity might provide a means of biologically subtyping schizophrenic patients.