Outpatient Follow-up Of Patients Research Articles

The Prognostic Significance of Troponin-T in Patients with Acute Myocardial Infarction: Can Late Peak Concentration of Troponin-T after Myocardial Infarction Predict Cardiovascular Events?

Backgrounds and Objectives:It has been demonstrated that the estimated infarct size is a prognostic variable which significantly influences the short-term and long-term prognosis after an acute myocardial infarction (AMI). Recently, the late peak level of troponin-T has been determined as a reliable and simple non-invasive method for estimation of infarct size. This study was performed to determine whether the late peak level of troponin-T can be used to predict cardiovascular events during in-hospital stay and out-patient follow-up in patients with AMI. Materials and Method:The study was comprised 100 patients (male 91, mean age 57±1 years) with AMI and thrombolysis which was initiated within 6 hours after the onset of symptoms. The late peak concentration of troponin-T was defined as a more larger level between 48 and 72 hours after thrombolysis. We investigated the factors influencing on the late peak level of troponin-T and assessed the relation of the late peak level and cardiovascular events. Results:1) The late peak level of troponin-T was significantly correlated with the peak creatine kinase (CK) level, (r=0.69, p=0.0001) but not ejection fraction of left ventricle (LVEF) at 7 days after AMI. The late peak level of troponin-T was significantly higher in patients with LVEF of <40% at 7 days after AMI (13.49±3.62 vs. 6.44±0.72, p= 0.035) but not different by location of AMI and reperfusion status. 2) During clinical follow-up at a mean duration of 27 months, 1 cardiac death, 10 congestive heart failure, 8 recurrent infarction, and 20 postmyocardial infarction angina were occurred. 3) In patients who occurred cardiac events during in-hospital stay, 논문접수일:1999년 10월 25일 심사완료일:2000년 2월 17일 교신저자:두영철, 134-701 서울 강동구 길동 445번지 한림대학교 의과대학 강동성심병원 내과학교실 전화:(02) 224-2649, 2216·전송:(02) 478-6925 E-mail:ycdoo97@www.hallym.or.kr

Detection of recurrent cancer of the colon and rectum.

Outpatient follow-up in patients operated upon due to carcinoma of the colon and rectum is usually performed, due to a high rate of recurrence and with the aim of finding a curable recurrence. Due to the enormous cost of an extended follow-up system, a careful evaluation of the benefit is needed. The aim of the present investigation was to study the efficacy of the different tools in an extended follow-up. One hundred ninety patients with carcinoma of the colon and rectum were--apart from traditional clinical follow-up--followed with an extensive laboratory battery including carcinoembryonic antigen (CEA), erythrocyte sedimentation rate (ESR), hemoglobin (Hb), electrophoresis, ALP, and GT. Forty-seven recurrences were found. Thirty-one of these recurrences were first detected by a rise in CEA. Seven cases were detected at clinical follow-up and six cases due to symptoms suggestive of recurrence. The predictive value of a positive test was 79.4% for CEA but very low for the other tests studied. A negative value for any of the tests in the battery was usually accurate. Follow-up after colorectal carcinoma should include CEA as the only laboratory parameter. Postoperative colonoscopy for removal of missed synchronous lesions, chest X-ray, and endoscopic investigations of the anastomotic region also seem to be of value.