Diagnosis Of Primary Disease Research Articles

A familial case of mitochondrial disease resembling Alport syndrome

A 38-year-old man with mild sensorineural hearing loss, diabetes mellitus, proteinuria, and slight renal dysfunction was admitted to our hospital for a renal biopsy to determine the cause of kidney disease. His elder sister and mother also had sensorineural hearing loss and renal failure, suggesting the existence of a common genetic disease in this family. Although the clinical features of the patient were similar to features of Alport syndrome, renal biopsy revealed no sign of Alport syndrome. We next considered a possibility of a mitochondrial kidney disease described by Jansen in 1997. Indeed, genetic analysis of mitochondrial DNA clarified the existence of A3243G mutation in the patient and his sister. This syndrome should be recognized by nephrologists as a differential diagnosis of Alport syndrome, diabetic nephropathy, and primary glomerular diseases.

M1139 Nationwide Referral Patterns to Specialized Medical Centers for the Inpatient Management of Inflammatory Bowel Disease

BACKGROUND: The complexity of the medical and surgical management of inflammatory bowel disease (IBD) has increased substantially over the last decade. We sought to determine whether these secular advances have prompted changes in specialization of inpatient IBD care among high-volume centers. METHODS: We queried the Nationwide Inpatient Sample, a 20% stratified sample of U.S. hospital discharges throughout the U.S., to identify admissions with a primary diagnosis of Crohn's disease (CD) or ulcerative colitis (UC) between 1998 and 2004. We calculated the proportion of admissions to specialized high-volume IBD centers (SHICs) (>100 IBD admissions per year), determined predictors of admission to SHICs, and assessed their impact on hospital outcomes. RESULTS: Over 7 years, the proportion of patients admitted to SHICs increased from 6.7% to 24%. IBD patients were less likely to be admitted to a SHIC if they were older (OR 0.88 for every 10 increase), female (OR 0.91; 95%CI: 0.86 0.96), were insured by Medicare (OR 0.74; 95%CI: 0.65 0.83) or Medicaid (0.71; 95%CI: 0.60 0.84), were uninsured (OR 0.42; 95%: 0.30 0.58), or were from the South (OR 0.43; 95%CI: 0.19 0.99 or West (OR 0.13; 95%CI: 0.04 0.45) relative to the Northeast. Factors favoring admission to a SHIC were residing in a neighborhood with above national median income (OR 1.99; 95%CI: 1.46 2.71), UC vs. CD diagnosis (OR 1.15; 95%CI: 1.05 1.26), and Black race (OR 1.44; 95%CI: 1.10 1.88). Compared to those admitted to non-SHICs, IBD patients admitted to SHICs were more likely to undergo colectomy for UC (8.8% vs. 19.9%, P<0.0001) or bowel resection for CD (16.4% vs. 25.2%, P<0.0001). These findings were similar after excluding elective surgical admissions. Though crude in-hospital mortality was considerably lower among those admitted to SHICs (4.3/1000 vs. 7.2/1000, P=0.0002), death rates were similar after adjusting for age and comorbidity. Adjusted mortality rates were, however, persistently lower in the SHIC group among those who had undergone colectomy (7.9/1000 vs. 32.4/1000, P=0.0002; adjusted OR 0.38). This mortality difference was primarily attributable to higher volumes of colectomy performed at SHICs. Average length of stay and hospital charges were similar between SHICs and non-SHICs after adjustment for patient and hospital demographics. CONCLUSIONS: There is a rising trend in referrals to SHICs for the inpatient management of IBD with disparate utilization patterns among socioeconomically defined subgroups. Prospective studies are warranted to further explore the impact of these high-volume centers on IBD health outcomes.

Endoscopically and radiologically documented coloscopy. A method for the demonstration of pathologic findings

Colo-ileoscopy is increasingly used in the primary diagnosis of diseases of the colon. But a disadvantage of the method is that the findings cannot be demonstrated spacially or documented. This can, however, be made up by instilling an iodine-containing, water-soluble contrast medium into the endoscopically demonstrated abnormal area and obtain a radiological documentation. The method is suitable for demonstrating benign and malignant stenoses and tumours of the colon, diverticula, ileocolic anastomoses, mucosal changes in ulcerative colitis of longer standing as well as Crohn's disease, fistulae, and the appendix or terminal ileum. If coloscopy is successful only as far as the right flexure, the ascending colon can be demonstrated radiologically by this method. Larger polyps can be removed at the same sitting after documentation. This form of examination was performed without complications in 104 patients. As it is simple it can be employed in the routine documentation of pathological findings in the colon.

Inclusion of electric disturbance type cardiomyopathy in the classification of cardiomyopathy: A current review

There are cases of cardiomyopathy which are not easily classifiable into hypertrophic, dilated or restrictive type. They often show ventricular arrhythmia, right or left bundle branch block, intraventricular conduction disturbance, atrioventricular conduction disturbance, and sinus node dysfunction (sick sinus syndrome). Endomyocardial biopsy in such cases reveals advanced myocardial disease, for which we propose the simpler term "electric disturbance type cardiomyopathy (ECM)". In our consecutive series of studies of cardiomyopathy employing endomyocardial biopsy in 573 cases, 264 (46%) were hypertrophic, 224 (39%) were dilated, and 85 (14.8%) were classified into the ECM.

ECG Signal Denoising By Wavelet Transform Thresholding

In recent years, ECG signal plays an important role in the primary diagnosis, prognosis and survival analysis of heart diseases. In this paper a new approach based on the threshold value of ECG signal determination is proposed using Wavelet Transform coefficients. Electrocardiography has had a profound influence on the practice of medicine. The electrocardiogram signal contains an important amount of information that can be exploited in different manners. The ECG signal allows for the analysis of anatomic and physiologic aspects of the whole cardiac muscle. Different ECG signals are used to verify the proposed method using MATLAB software. Method presented in this paper is compared with the Donoho's method for signal denoising meanwhile better results are obtained for ECG signals by the proposed algorithm.

The in-depth evaluation of suspected mitochondrial disease

Mitochondrial disease confirmation and establishment of a specific molecular diagnosis requires extensive clinical and laboratory evaluation. Dual genome origins of mitochondrial disease, multi-organ system manifestations, and an ever increasing spectrum of recognized phenotypes represent the main diagnostic challenges. To overcome these obstacles, compiling information from a variety of diagnostic laboratory modalities can often provide sufficient evidence to establish an etiology. These include blood and tissue histochemical and analyte measurements, neuroimaging, provocative testing, enzymatic assays of tissue samples and cultured cells, as well as DNA analysis. As interpretation of results from these multifaceted investigations can become quite complex, the Diagnostic Committee of the Mitochondrial Medicine Society developed this review to provide an overview of currently available and emerging methodologies for the diagnosis of primary mitochondrial disease, with a focus on disorders characterized by impairment of oxidative phosphorylation. The aim of this work is to facilitate the diagnosis of mitochondrial disease by geneticists, neurologists, and other metabolic specialists who face the challenge of evaluating patients of all ages with suspected mitochondrial disease.

287: Hematopoietic Cell Transplantation (HCT) for Chemoradiotherapy-Related Myelodysplastic Syndrome and Acute Leukemia: A Single-Center Analysis of 47 Patients

287: Hematopoietic Cell Transplantation (HCT) for Chemoradiotherapy-Related Myelodysplastic Syndrome and Acute Leukemia: A Single-Center Analysis of 47 Patients

Requirements for Physician Competencies in Allergy: Key Clinical Competencies Appropriate for the Care of Patients With Allergic or Immunologic Diseases: A Position Statement of the World Allergy Organization

Allergic diseases are quite prevalent worldwide, and the incidence of allergy is increasing everywhere [1-7]. Because allergic and immunologic processes overlap all organ systems, allergy is not always taught in medical schools as a separate subject. Indeed, lack of recognition of the specialty and of the need to teach about allergic and immunologic diseases results in allergy not being included at all in some medical school curricula [8]. With an estimated 22% of the global population experiencing allergic and immunologic diseases, it is time to recognize and strengthen education in allergy and immunology [8]. The World Allergy Organization (WAO), an alliance of 74 national and regional allergy societies, created this consensus document to establish educational guidelines for worldwide application to help identify and correct allergy education and training deficiencies and to define appropriate competencies. In creating this consensus, it is recognized that each country has its own principles and goals in medical education at the undergraduate and postgraduate levels. This document defines what WAO considers medical practitioners should know to care appropriately for allergic patients.

When eczema stay home

Although most visits for skin disease are managed by primary care physicians, diagnosis and treatment of skin disease are often difficult for family doctors. In this article, two cases of occupational allergic contact dermatitis in ironers are presented. Both patients only developed their dermatitis when they came into contact with formaldehyde. Occupational dermatitis are very frequent with important social and economic implications: thus, they represent a therapeutic challenge non only for dermatologists, but also for family doctors.

Defining the role of NMP22 in bladder cancer surveillance

Despite advances in treatment and knowledge of its pathogenesis, urothelial carcinoma of the bladder remains a significant cause of morbidity and mortality. Experience with the natural course of bladder cancer has revealed that early diagnosis of primary and recurrent disease improves patient prognosis. In this regard, cystoscopy (usually in combination with urinary cytology) has long been regarded as the gold standard for the diagnosis and surveillance of bladder cancer. However, the disadvantages inherent to cystoscopy, including invasiveness and cost, have stimulated a search for alternative methods for detecting urothelial malignancy. The ideal alternative test would duplicate the high accuracy of cystoscopy for detecting bladder tumors while eschewing its invasiveness, attendant morbidity, and high cost. The vast majority of bladder cancers arise from the urothelium, which continually sheds cells as well as intracellular contents into the urine, thereby providing a potential source of cancer-specific markers. Voided cytology and urinalysis are established tests that have been the standard tools for detection of such substances. The last decade has seen the rise of a myriad of novel urine-based bladder tumor markers, including bladder tumor antigen, urinary bladder cancer antigen, fibronectin, telomerase, and nuclear matrix proteins (e.g., NMP22). The NMP22 assay in particular has been the subject of considerable study and has demonstrated some promise as a potential adjunct to cystoscopy and cytology. Through a critical review of the literature, we seek to define the role, if any, of NMP22 in the follow-up of patients with a previous history of urothelial carcinoma of the bladder.

Assessment of the mucosa of the indefinitely diverted ileo‐anal pouch

One surgical option to treat failure after restorative proctocolectomy (RPC) is indefinite diversion (ID) without excision of the pouch. The study aimed to assess the mucosal morphology of the pouch and ileoanal anastomosis (IAA) over time after ID with particular reference to inflammation, dysplasia and carcinoma. Patients with ID were identified from the hospital's Ileal Pouch Database. Individuals were invited by mail to attend for flexible pouchoscopy and biopsy from the ileal pouch and immediately distal to the IAA. Of 1822 patients on the database, 28 had undergone ID. Of these, 20 patients (18 ulcerative colitis, one familial adenomatous polyposis, one pseudo-obstruction) of median age 42 (18-67) years took part. There were eight males. The median (range) intervals from diagnosis of primary disease, pouch surgery and ID to the time of study were 221 (63-410), 146 (31-314) and 44 (10-159) months respectively. One patient had dysplasia in the original resection specimen. Five patients developed type C changes in the pouch. Of these three were identified between RPC and ID, one developed between ID and the present assessment and one was identified for the first time at the present assessment. No case of dysplasia or cancer was found in any of the biopsies. Rectal mucosa was found in biopsies from the IAA in four patients (three stapled; one handsewn); this was inflamed in three patients. At a median follow-up of 12 years after RPC and 3.6 years after indefinite diversion no instance of dysplasia or carcinoma in the ileal reservoir or distal to the IAA was found in any of the 20 patients having ID. Type C changes occurred at some time in five (25%) patients, indicating the importance of continued follow up.

Hematopoietic Cell Transplantation (HCT) for Chemoradiotherapy-Related Myelodysplastic Syndrome and Acute Leukemia: A Single-Center Analysis of 47 Patients.

PURPOSE: To examine the value of allogeneic HCT in the treatment of therapy-related myelodysplastic syndrome/acute leukemia (t-MDS/t-AL) which develops after previous exposure to chemotherapy (CT) or radiotherapy (RT), we retrospectively analyzed the data of 47 patients who were treated at our institution between 1996 and 2007.PATIENTS AND METHODS: The primary diseases included malignant lymphoma (n=17), breast cancer (n=13) and other solid tumors (n=17) which had been treated with various cytotoxic drugs including alkylating agents (n=30), topoisomerase II inhibitors (n=22), and/or RT (n=20). The median interval between the diagnosis of the primary disease and the onset of t-MDS/t-AL was 3.8 years (range, 0.8–18.9). Twenty-five patients had AML, 5 ALL, 1 biphenotypic acute leukemia, and 16 MDS. Cytogenetic risks were assigned according to the SWOG criteria for AML patients. ALL patients with a normal karyotype were categorized in the intermediate group, and those with t(9;22) or t(4;11) were in the unfavorable risk group. MDS patients without progression to AL were categorized into the favorable risk group.RESULTS: Thirty-three patients received disease-adapted CT, with a response rate of 73%, while 14 patients were elected to receive no interventions due to an indolent clinical course such as MDS-RA (n=13). With a median follow-up of 1.9 years (range, 0.1–10.5) after the diagnosis of t-MDS/t-AL, the 3-year OS for all patients was 55%. Twenty-seven patients (median age, 48 years: range, 3–63) underwent allogeneic HCT from related (n=12) or unrelated (n=15) donors after myeloablative (n=18) or reduced-intensity (n=9) conditioning regimens. The sources of stem cells were BM in 15 patients, PBSC in 10, and CB in 2. At the time of HCT, 18 t-MDS/t-AL were in CR, 1 was in non-CR, and 8 had untreated t-MDS. Twenty patients (43%) did not undergo HCT due to various reasons, including age older than 65 years (n=11, treated before the introduction of nonmyeloablative transplant), indolent clinical course (n=4), progression of the primary disease (n=4) or t-AL (n=3), and patient refusal (n=2). The 3-year OS was significantly better in patients who received HCT than in those who did not (71% vs 31%; P=0.018; Figure). TRM after HCT was 15%. The 3-year OS was better in those who achieved CR after initial therapy for t-MDS/t-AL than in those who did not (74% vs 30%; P=0.002). A multivariate analysis revealed that HCT was associated with a significantly better OS, even after adjusting for age and other significant prognostic factors including achievement of CR in t-MDS/AL, cytogenetic risk group, and an interval between the diagnosis of primary disease and t-MDS/t-AL of longer than 3 years.CONCLUSION: Although this study is contaminated by a selection bias, it still appears that HCT was an effective therapeutic option for patients with t-MDS/t-AL, especially when patients were in CR. These results support a prospective study to examine the value of upfront HCT, particularly for patients with an unfavorable cytogenetic risk. [Display omitted]

Neuroendocrine (Merkel cell) carcinoma of the retroperitoneum with no identifiable primary site

BackgroundNeuroendocrine carcinoma is an aggressive neoplasm that mainly affects elderly Caucasians and typically arises in sun-exposed areas of the skin. The disease is rather rare and only a relatively few cases present with no apparent primary lesion.Case presentationWe report a case of an 81-year-old Caucasian male with neuroendocrine carcinoma, which initially presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed tissue consistent with neuroendocrine carcinoma. The patient underwent exploratory laparotomy and the mass was successfully excised along with an associated mesenteric lymph node.DiscussionThere are currently two possible explanations for what occurred in our patient. First, the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Alternatively, an initial skin lesion could have spontaneously regressed and the retroperitoneal mass represents a single site of metastasis. Since Merkel cell precursors have never been identified within lymph nodes, the latter theory seems more befitting. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin.ConclusionWide local excision of the primary tumor is the surgical treatment of choice for localized disease. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional as well as unconventional patients with neuroendocrine carcinoma.

Time to Hemostasis after Traction Removal of Tunneled Cuffed Central Venous Catheters

Many patients undergo placement of tunneled cuffed central venous catheters (TCCVCs) for indications including administration of medical therapy and hemodialysis. They are removed when no longer needed or if there is a device complication. There is no consensus regarding the necessity of routine preremoval coagulation studies or platelet count, so this study was performed to determine if abnormal coagulation status affects the time to hemostasis (TH) after traction removal of TCCVCs. Adult patients referred to our group for removal of a TCCVC placed via a jugular or subclavian route were considered candidates for inclusion. Blood was submitted for evaluation of prothrombin time (PT) and International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), and platelet count. Catheters were removed with the traction technique, and presence of hemostasis was assessed at 5-minute intervals of manual compression. Between November 19, 2001, and April 20, 2004, 179 subjects were enrolled and completed the study. There were 165 subjects in whom TH was within the first 5-minute interval and 14 in whom more than 5 minutes was required. Statistically significant factors associated with prolonged TH were primary diagnosis of end-stage renal disease (P = .005), use of antiplatelet agents (P = .03), and procedure performed by a "low-volume" operator (P = .002). Routine preremoval evaluation of coagulation parameters is not necessary. Patients who are likely to have abnormal platelet function but not abnormal platelet number appear to be at risk for prolonged TH, but even in those cases, the THs are rarely more than 15 minutes.

Adult Orthotopic Liver Transplantation in the United Kingdom and Ireland Between 1994 and 2005

The UK and Ireland Liver Transplant Audit collects information on all liver transplantations that are carried out in both countries. In this paper, we describe these transplantations and their outcomes in adult patients according to primary liver disease diagnosis, type of transplantation and period. A prospective cohort study of 7906 orthotopic liver transplantations carried out between April 1994 and June 2005 in the United Kingdom and Ireland. Multivariable logistic regression was used to investigate improvements in mortality according to period of transplantation adjusted for recipient and donor characteristics. A total of 6,850 transplantations were done in adults (patients 16 years or older). Of these, 836 (12.2%) were first super-urgent procedures (33.7% men; median age 36 years), and 5,072 (74.0%) first elective procedures (60.0% men; median age 52 years). The percentage of patients who received a donor organ with abnormal appearance gradually increased, especially in patients receiving an elective transplant. Mortality at 90 days after first super-urgent transplant decreased from 29.6% (95% confidence interval: 23.5% to 36.9%) before October 1, 1996 to 16.0% (11.7% to 21.7%) after October 1, 2002. Considering the same time periods, mortality at 90 days after first elective transplant decreased from 10.6% (8.9% to 12.7%) to 7.7% (6.3% to 9.3%). Multivariable analysis demonstrated that these improvements cannot be explained by changes in the risk profile of recipients and donors. Patients undergoing a liver transplantation in the most recent years had a better survival than patients with similar characteristics transplanted 10 years earlier. Posttransplant survival has improved despite a deteriorating quality of donor organs.

DNA aptamers against the MUC1 tumour marker: design of aptamer–antibody sandwich ELISA for the early diagnosis of epithelial tumours

Aptamers are functional molecules able to bind tightly and selectively to disease markers, offering great potential for applications in disease diagnosis and therapy. MUC1 is a well-known tumour marker present in epithelial malignancies and is used in immunotherapeutic and diagnostic approaches. We report the selection of DNA aptamers that bind with high affinity and selectivity an MUC1 recombinant protein containing five repeats of the variable tandem repeat region. Aptamers were selected using the SELEX methodology from an initial library containing a 25-base-long variable region for their ability to bind to the unglycosylated form of the MUC1 protein. After ten rounds of in vitro selection and amplification, more than 90% of the pool of sequences consisted of target-binding molecules, which were cloned, sequenced and found to share no sequence consensus. The binding properties of these aptamers were quantified using ELISA and surface plasmon resonance. The lead aptamer sequence was subsequently used in the design of an aptamer-antibody hybrid sandwich ELISA for the identification and quantification of MUC1 in buffered solutions. Following optimisation of the operating conditions, the resulting enzyme immunoassay displayed an EC50 value of 25 microg/ml, a detection limit of 1 microg/ml and a linear range between 8 and 100 microg/ml for the MUC1 five tandem repeat analyte. In addition, recovery studies performed in buffer conditions resulted in averaged recoveries between 98.2 and 101.7% for all spiked samples, demonstrating the usability of the aptamer as a receptor in microtitre-based assays. Our results aim towards the formation of new diagnostic assays against this tumour marker for the early diagnosis of primary or metastatic disease in breast, bladder and other epithelial tumours.

Lifestyle Modification Counseling in Patients With Gastroesophageal Reflux Disease

The purpose of this study was to determine the rate of documented counseling on lifestyle modifications in patients presenting to the primary care setting with a diagnosis of gastroesophageal reflux disease. Retrospective chart review was conducted for 502 active patients with a primary or secondary diagnosis of gastroesophageal reflux disease from two internal medicine clinics at the University of Kansas School of Medicine-Wichita. Charts were reviewed for documented counseling on four specific lifestyle modifications: (a) smoking and alcohol cessation, (b) dietary changes, (c) head of bed elevation, and (e) postprandial avoidance of recumbency. Only 12% of patients in this sample received documented counseling on lifestyle modifications. Of those patients receiving documented counseling, 71% were counseled on dietary changes, 41% smoking or alcohol cessation, 28% head of bed elevation, and 21% postprandial avoidance of recumbency. Documentation indicated that patients with gastroesophageal reflux disease are not adequately counseled regarding recommended lifestyle modifications.

Improved detection of bladder carcinoma cells in voided urine by standardized microsatellite analysis

Successful treatment of bladder cancer depends largely on early diagnosis of primary and recurrent disease. Sensitive, specific and noninvasive procedures for detection are especially needed for grade 1 and 2 bladder tumors, because of the relatively low sensitivity of cytology. Here we introduce a novel strategy to improve the sensitivity and reliability of microsatellite analyses by employing marker-specific threshold values for loss-of-heterozygosity (LOH) at 10 loci. These individual cut-offs were experimentally determined with 35 normal control tissues and subsequently validated in a retrospective study with bladder cancer biopsies from 86 patients. In a prospective analysis of voided urines samples and matched blood probes from 91 patients, LOH-analysis, UroVysion FISH and conventional urine cytology were compared with histological findings of consecutive transurethral biopsies. Whereas all samples could be analyzed by our LOH assay, only 56 samples were suitable for all 3 analyses. The highest sensitivity was obtained with our LOH-assay/cytology approach (G1-2: 72%; G3: 96%) being only surpassed by a combination of all 3 techniques (G1-2: 83%; G3: 100%). Since over 93% of the patients with recurrent disease were identified by LOH/cytology-analyses of their voided urine samples, a monitoring scheme alternating cystoscopy with LOH/cytology-examination could now be envisioned to reduce invasive interventions and consequently improve follow-up compliance, especially in patients with low grade tumors.

Metabolic disturbances following the use of inadequate solutions for hemofiltration in acute renal failure

Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 +/- 78.8 (1.5-180) months. Hyperglycemia occurred in 76.9% (n=10), and metabolic acidosis occurred in 53.8% (n=7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis.

Depression and Nursing Home Admission Among Hospitalized Older Adults With Coronary Artery Disease: A Propensity Score Analysis

Admission to a nursing home is considered a poor outcome for community-dwelling older adults. The objective of this study was to determine whether depression increased the risk of nursing home admission. Using the National Hospital Discharge Survey 2001-2003 datasets, the authors identified 28,172 community-dwelling older adults, 65 years and older, discharged alive with a primary discharge diagnosis of coronary artery disease. The objective of this study was to determine the association between depression and subsequent nursing home admissions in these patients. Propensity scores for depression, calculated for each patient using a multivariable logistic regression model, were used to match 686 depressed patients with 2058 nondepressed patients who had similar propensity scores. Logistic regression analyses were used to determine the association between depression and nursing home admission. Patients had a mean age +/- SD of 77+/-8 years, and 61% were women. Compared with 9% of nondepressed patients, 13% of depressed patients were admitted to nursing homes (relative risk, 1.42; 95% confidence interval, 1.12-1.78). When adjusted for various demographic, clinical, and care-related covariates, the association became somewhat stronger (adjusted relative risk, 1.55; 95% confidence interval, 1.21-1.99). In ambulatory older adults hospitalized with coronary artery disease, a secondary diagnosis of depression was associated with a significantly increased risk of nursing home admission.