Cumulative Proportion Of Patients Research Articles

Risk of multiple primary cancers in prostate cancer patients in the Detroit metropolitan area: a retrospective cohort study.

Patterns of excess risk for second primary cancers (SPC) in prostate cancer patients have been observed for urinary bladder, other sites in the urinary tract, and hematolymphopoietic tissues in several, but not all, previously reported cohort studies. The risk of SPC was evaluated in 9,794 Detroit metropolitan-area men originally diagnosed with carcinoma of the prostate during 1973-1982. The cohort was assembled using Detroit Surveillance, Epidemiology, and End Results (SEER) Registry data and followed until December 31, 1993. The observed number of SPC of all sites was similar to the expected number in the cohort. A significant excess of invasive SPC of the urinary bladder [Standardized incidence ratio (SIR) = 1.57; 95% CI, 1.34-1.83] was observed in this cohort, but after excluding the first 2 months after prostate cancer diagnosis, the excess (SIR = 1.06) was no longer statistically significant. The cumulative proportion of patients with prostate cancer who developed bladder cancer during a follow-up interval of 20 years was 5.5% (95% CI, 4.1-6.9%). The patients who received first-course radiation treatment were observed to be at increased risk for bladder SPC (all stages; SIR = 1.49; 95% CI, 1.07-2.02) when compared to the Detroit-area male population. These results underscore the importance of continuing medical surveillance for urinary bladder second primary cancers in patients with prostate cancer, but are reassuring in that the magnitude of relative and absolute risks does not suggest deterring adverse effects of radiation treatment or intrinsic risks for neoplasms in other organs or tissues.

HEMOCO: a French prospective study of hemophiliacs infected by human immunodeficiency virus type 1 (HIV-1).

HEMOCO is a multicenter prospective cohort set up in 1989 to monitor 407 French hemophiliacs infected by HIV-1 and recruited in 4 hemophilia treatment centers in the Paris region. As of 15 July 1995, 42% of the patients in the cohort had developed stage B HIV disease and 29% stage C disease (AIDS); 23.1% of the patients had died. The cumulative proportion of patients with AIDS was 4.5% at 5 years and 27.4% at 10 years, while the respective mortality rates were 3.8% and 19.5%. In our study, only age was predictive of AIDS, with an estimated relative risk of 1.2 per 10-year age increment; this factor was also predictive of death. After 10 years of follow-up, 6.1% of the study population had no clinical or laboratory signs of immunodepression. The follow-up protocol in the HEMOCO protocol is the same as that in the French SEROCO study, which includes men infected by HIV-1 through sexual contact. This will allow us to compare the progression of HIV infection between these two exposure groups.

Effects of a New Metabolic Modulator, Ranolazine, on Exercise Tolerance in Angina Pectoris Patients Treated with β-Blocker or Diltiazem

Ranolazine (RS 43285) is a new piperazine derivative with anti-ischemic properties attributed to a modulation of myocardial metabolism. Its antianginal action was assessed in 104 patients recruited in a double-blind, crossover, randomized study comparing placebo with a single dose of ranolazine (10, 60, 120, and 240 mg). All patients had chronic stable angina pectoris and remained symptomatic (at least 0.1 mV ST-segment depression and angina during prestudy exercise testing) despite treatment with a beta-blocker or with diltiazem. No significant effects of ranolazine on exercise duration or time to angina were observed after the dose of 10, 60, and 120 mg. After the 240 mg dose, however, significant improvement in exercise duration (+13.1% in the combined group, two-tailed p = 0.002; +14.3% in the beta-blocker group, p = 0.009; +11.9% in the diltiazem group, p = 0.06), in time to angina (+56.8 s, p = 0.008), and in time to 1 mm ST-segment depression was observed. The cumulative proportion of patients who improved their time to angina by at least 30 s above placebo were 25, 42, 50, and 72% with the doses of 10, 60, 120, and 240 mg, respectively. Sixty-seven percent of the patients with ranolazine plasma levels above 500 ng/ml improved their time to angina against 40% at plasma levels below 500 ng/ml and summed ST-segment depression during exercise and recovery was also significantly reduced at these plasma concentrations. Both heart rate and arterial pressure at rest and at peak exercise were unchanged after ranolazine, 240 mg.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival determinants in black patients with angiographically defined coronary artery disease

Long-term survival of blacks with angiographically defined coronary artery disease was examined in a series of 1233 consecutive patients who underwent cardiac catheterization at a large urban municipal hospital. Vital status information was available at a mean of 86 weeks for the cohort as a whole, and 94 deaths were recorded. As noted in other angiographic series that included blacks, a high proportion of patients in this study had unobstructed coronary arteries (41%), and there was a preponderance of women (56%). Hypertension was present in 82% of the cases, whereas 68% of the sample had left ventricular hypertrophy as revealed by echocardiogram. The cumulative proportion of patients who were surviving at 5 years was 90 +/- 1 (+/- SEM), 79 +/- 4, and 70 +/- 4 for patients with no obstructive lesions, one-vessel disease, and multivessel disease, respectively. The survival rate at 3 years for patients who had undergone bypass surgery (N = 152) was only 82% (+/- 5%). Noninvasive univariate predictors of mortality included male sex, history of myocardial infarction, Q waves on electrocardiogram, exercise duration on treadmill stress testing, and left ventricular hypertrophy. Angiographic predictors included left ventricular end-diastolic pressure, the number of diseased coronary vessels, ejection fraction, and mean pulmonary artery pressure. Regression analysis showed an independent association for all the angiographic variables noted previously as well as for echocardiographically determined left ventricular hypertrophy. Survival rates for blacks with coronary artery disease in this series were considerably lower than those currently reported for whites, particularly for patients who underwent coronary bypass grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

Observations on the occurrence of atrial fibrillation in paroxysmal supraventricular tachycardia

Paroxysmal supraventricular tachycardia (PSVT) and atrial fibrillation (AF) are both supraventricular arrhythmias, but their mechanisms are completely different. This study determines the incidence of symptomatic AF in a group of patients followed closely during routine outpatient care for PSVT. Thirty-nine patients with PSVT were followed for up to 4 years using telephone transmission of the electrocardiogram to document symptomatic arrhythmias. The cumulative proportion of patients who had AF was calculated using the Kaplan-Meier life-table method. In addition, we examined the importance of clinical variables traditionally believed to influence the occurrence of AF. The cumulative proportion of patients who had AF during follow-up was 13% at 3 months, 16% at 6 months, 22% at 1 year and 29% at 2 years. In most patients the start of AF was documented during an attack of PSVT rather than de novo as another primary arrhythmia. PSVT occurred significantly earlier during an observation period without treatment in patients in whom AF developed (p = 0.03). The occurrence of AF was not related to age, number of years of PSVT, heart rate during tachycardia or coexistent heart disease.

Diabetes mellitus and intermittent claudication. Relation between peripheral vascular complications and location of the occlusive atherosclerosis in the legs.

Forty-seven diabetic patients with intermittent claudication without rest pain or gangrene at the initial examination were followed up over a six-year period. They were compared with 224 non-diabetic patients with intermittent claudication. The cumulative proportions of patients with gangrene were 31% in the diabetic group and 5% in the control group (p less than 0.001). The corresponding figures for rest pain and/or gangrene were 40 and 18%, respectively (p less than 0.001). The frequency of aorto-iliac and multiple stenoses was higher among diabetic patients who developed peripheral vascular complications (rest pain, gangrene) than in the control group. The frequency of multiple stenoses was also higher in the former subgroup than in diabetics without such complications. In conclusion, the degree of involvement of the large vessels in occlusive arterial disease influences the risk of development of peripheral vascular complications in diabetic patients with intermittent claudication.

Age at beginning of coitus versus chronologic age as a basis for papanicolaou smear screening: An analysis of 747 cases of preinvasive disease

Disease onset in 747 routinely screened women who developed cervical intraepithelial neoplasia was analyzed. Average age at diagnosis was 30 years; the range was 16 to 71 years. In 19% diagnosis was made after age 35, and in 1% after age 60. Grouping cases by age at beginning of coitus produced significant differences (p < 0.001) in cumulative proportions of patients with the diagnosis made at any age. In 11% of patients initiating intercourse between ages 15 and 17 diagnosis was made after age 35; the figure was 19% for the 18 to 19 age group and 36% for the 20+ group. Screening by chronologic age is effective for women initiating intercourse early. Screening by years of exposure to intercourse produced a uniform distribution regardless of age at beginning of coitus. In 75% the diagnosis was made within the first 15 years of intercourse, in 88% by year 20; and in 97% by year 30. In 70% the diagnosis was made between 6 and 20 years. Cytologic surveillance should be concentrated during the sixth through twentieth years when most cases develop.