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1.
Albert Ariza-Solé Francesc Formiga Victoria Lorente José C. Sánchez-Salado Guillermo Sánchez-Elvira Gerard Roura Remedios Sánchez-Prieto Maria Vila Pedro Moliner Angel Cequier 《Revista espa?ola de cardiología》2014
Introduction and objectives
The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged ≥ 75 years.Methods
We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves.Results
We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were ≥ 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P<.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% vs 3.8%; P=.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P = .027; Mehran: 0.67 in older patients, 0.73 in younger patients; P = .340; ACTION: 0.58 in older patients, 0.75 in younger patients; P = .041).Conclusions
Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.Full English text available from:www.revespcardiol.org/en 相似文献2.
Marianela Sánchez-Martínez Angel López-Cuenca Francisco Marín Pedro J. Flores-Blanco Andrea García Narbon Ignacio de las Heras-Gómez María J. Sánchez-Galian Mariano Valdés-Chávarri James L. Januzzi Sergio Manzano-Fernández 《Revista espa?ola de cardiología》2014,67(10):830-836
Introduction and objectives
Red cell distribution width has been linked to an increased risk for in-hospital bleeding in patients with non-ST-segment elevation acute coronary syndrome. However, its usefulness for predicting bleeding complications beyond the hospitalization period remains unknown. Our aim was to evaluate the complementary value of red cell distribution width and the CRUSADE scale to predict long-term bleeding risk in these patients.Methods
Red cell distribution width was measured at admission in 293 patients with non-ST-segment elevation acute coronary syndrome. All patients were clinically followed up and major bleeding events were recorded (defined according to Bleeding Academic Research Consortium Definition criteria).Results
During a follow-up of 782 days [interquartile range, 510-1112 days], events occurred in 30 (10.2%) patients. Quartile analyses showed an abrupt increase in major bleedings at the fourth red cell distribution width quartile (> 14.9%; P = .001). After multivariate adjustment, red cell distribution width > 14.9% was associated with higher risk of events (hazard ratio = 2.67; 95% confidence interval, 1.17-6.10; P = .02). Patients with values ≤ 14.9% and a CRUSADE score ≤ 40 had the lowest events rate, while patients with values > 14.9% and a CRUSADE score > 40 points (high and very high risk) had the highest rate of bleeding (log rank test, P < .001). Further, the addition of red cell distribution width to the CRUSADE score for the prediction of major bleeding had a significant integrated discrimination improvement of 5.2% (P < .001) and a net reclassification improvement of 10% (P = .001).Conclusions
In non-ST-segment elevation acute coronary syndrome patients, elevated red cell distribution width is predictive of increased major bleeding risk and provides additional information to the CRUSADE scale. 相似文献3.
David Vivas Juan C. García-Rubira Esther Bernardo Dominick J. Angiolillo Patricia Martín Alfonso Calle Iván Núñez-Gil Carlos Macaya Antonio Fernández-Ortiz 《Revista espa?ola de cardiología》2014
Introduction and objectives
Intensive glucose control with insulin in patients with an acute coronary syndrome reduces platelet reactivity during hospitalization, compared to conventional control. However, the effect of strict, long-term glucose control on platelet reactivity in these patients remains uncertain.Methods
This is a prospective, randomized trial evaluating the effects of optimized glucose control (target glucose, 80-120 mg/dL) with insulin, compared with conventional control (target glucose, <180 mg/dL), on platelet reactivity after hospital discharge in patients with an acute coronary syndrome and hyperglycemia. The primary endpoint was assessment of platelet aggregation after stimulation with adenosine diphosphate 20 μM at 12-month follow-up.Results
One hundred four patients were randomized to optimized management (n=53) or conventional management (n=51). There were no differences between groups in baseline characteristics or platelet function. After 12 months of follow-up, blood glucose levels were significantly lower in the optimized treatment group (104 vs 119 mg/dL; P<.001). However, platelet aggregation following adenosine diphosphate 20 μM stimulation showed no differences between the groups (54.2% [14.3%] vs 55.1% [18.3%] respectively; P=.81). There were no significant differences for other platelet function tests.Conclusions
Long-term optimized glucose control with insulin in patients with an acute coronary syndrome did not result in a reduction in platelet reactivity compared to conventional control.Full English text available from:www.revespcardiol.org/en 相似文献4.
Ángel López-Cuenca Sergio Manzano-Fernández Gregory Y.H. Lip Teresa Casas Marianela Sánchez-Martínez Alicia Mateo-Martínez Patricio Pérez-Berbel Javier Martínez Diana Hernández-Romero Ana I. Romero Aniorte Mariano Valdés Francisco Marín 《Revista espa?ola de cardiología》2013
Introduction and objectives
High baseline levels of interleukin-6 and C-reactive protein confer an increased risk of mortality in non-ST-segment elevation acute coronary syndrome. The aim of the study was to determine whether serial measurements of interleukin-6 and high-sensitivity C-reactive protein provide additional information to baseline measurements for risk stratification of non-ST-segment elevation acute coronary syndrome.Methods
Two hundred and sixteen consecutive patients with non-ST-segment elevation acute coronary syndrome were prospectively included. Blood samples were obtained within 24 h of hospital admission and at 30 days of follow-up. The endpoint was a composite of all-cause death, nonfatal myocardial infarction, or acute decompensated heart failure.Results
Both interleukin-6 and high-sensitivity C-reactive protein levels decreased from day 1 to day 30, regardless of adverse events (both P<.001). Interleukin-6 levels at 2 time points (interleukin-6 day 1, per pg/mL; hazard ratio=1.006, 95% confidence interval, 1.002-1.010; P=.002 and interleukin-6 day 30, per pg/mL; hazard ratio=1.047, 95% confidence interval, 1.021-1.075; P<.001) were independent predictors of adverse events, whereas high-sensitivity C-reactive protein day 1 and high-sensitivity C-reactive protein day 30 levels were not. Patients with interleukin-6 day 1≤8.24 pg/mL and interleukin-6 day 30≤4.45 pg/mL had the lowest event rates (4.7%), whereas those with both above the median values had the highest event rates (35%). After addition of interleukin-6 day 30 to the multivariate model, C-index increased from 0.71 (95% confidence interval, 0.63-0.78) to 0.80 (95% confidence interval, 0.72-0.86), P=.042, and net reclassification improvement was 0.39 (95% confidence interval, 0.14-0.64; P=.002).Conclusions
In this population, both interleukin-6 and high-sensitivity C-reactive protein concentrations decreased after the acute phase. Serial samples of interleukin-6 concentrations improved the prognostic risk stratification of these patients.Full English text available from:www.revespcardiol.org/en 相似文献5.
Oona Meroño Mercé Cladellas Lluis Recasens Cosme Garcia-Garcia Núria Ribas Victor Bazan Núria Farré Álvaro Sainz Josep Comin Jordi Bruguera 《Revista espa?ola de cardiología》2012
Introduction and objectives
Anemia at hospital admission predicts a poor outcome in patients presenting with acute coronary syndrome. It remains unclear whether in-hospital hemoglobin levels decrease (nosocomial anemia) not related to bleeding also implies a poor prognosis. We aimed to identify predictors of nosocomial anemia and its prognostic significance.Methods
We prospectively included 221 acute coronary syndrome patients admitted in our institution during the years 2009-2010, with normal hemoglobin levels at admission. Nosocomial anemia was defined as a decrease in hemoglobin levels to <13 g/dL in men and <12 g/dL in women in the absence of apparent bleeding. Clinical variables and hematological inflammatory parameters were assessed in order to identify predictors for the development of nosocomial anemia. We compared the clinical outcome after a 1-year follow-up period of patients without anemia as opposed to those who developed nosocomial anemia.Results
Nosocomial anemia was registered in 25% of study patients. A >3.1 mg/dL value of C-reactive protein was highly predictive of developing nosocomial anemia (odds ratio=5.9; 95% confidence interval, 2.6-13.4; P<.001). The incidence of mortality and cardio-vascular morbidity was higher in the patients who developed nosocomial anemia (34.5% vs 9%; P<.001). Nosocomial anemia was a strong predictor of cardio-vascular morbidity and mortality in the long-term follow-up (hazard ratio=2.47; 95% confidence interval, 1.23-4.96; P=.01).Conclusions
Nosocomial anemia predicts a poorer outcome in patients with acute coronary syndrome. Increased C-reactive protein levels, indicating inflammatory state, are predictive of developing in-hospital anemia unrelated to apparent bleeding.Full English text available from:www.revespcardiol.org 相似文献6.
Alberto Cordero Vicente Bertomeu-Martínez Pilar Mazón Juan Cosín Enrique Galve Iñaki Lekuona Fernando de la Guía José Ramón Gonzalez-Juanatey 《Revista espa?ola de cardiología》2012
Introduction and objectives
Smoking is one of the most prevalent risk factors in acute coronary syndrome patients. The aim of this study was to assess the attitudes of cardiologists to the smoking habits of these patientsMethods
A prospective multicenter registry of acute coronary syndrome patients. The primary endpoint was defined as smoking abstinence and the secondary endpoint as the incidence of all-cause mortality or nonfatal myocardial infarction.Results
The study population included 715 patients; 365 were current smokers. During follow-up (median, 375,0 days [interquartile range, 359.3-406.0 days]), 110 patients (30.6%) received smoking cessation support (19.7% at hospital discharge and 37.6% at month 3), specialized units and varenicline being the strategies most frequently used. No clinical differences were observed between patients who received smoking cessation support and those who did not, except for a higher prevalence of previous coronary heart disease in those who received support. In the multivariate analysis, the only variable independently associated with receiving smoking cessation support was previous coronary heart disease (odds ratio =3.16; 95% confidence interval, 1.64-6.11; P<.01). The abstinence rate was 72.3% at month 3 and 67.9% at 1 year; no differences were observed between the patients who received smoking cessation support and those who did not. During follow-up, a nonsignificant trend toward a lower incidence of the secondary endpoint was observed among the patients who were smokers at the time of acute coronary syndrome and who achieved abstinence (P=.07).Conclusions
Use of smoking cessation support strategies is limited in acute coronary syndrome patients and is more widespread among those with previous coronary heart disease.Full English text available from:www.revespcardiol.org 相似文献7.
Pilar Merlos Maria P. López-Lereu Jose V. Monmeneu Juan Sanchis Julio Núñez Clara Bonanad Ernesto Valero Gema Miñana Fabián Chaustre Cristina Gómez Ricardo Oltra Lorena Palacios Maria J. Bosch Vicente Navarro Angel Llácer Francisco J. Chorro Vicente Bodí 《Revista espa?ola de cardiología》2013
Introduction and objectives
A variety of cardiac magnetic resonance indexes predict mid-term prognosis in ST-segment elevation myocardial infarction patients. The extent of transmural necrosis permits simple and accurate prediction of systolic recovery. However, its long-term prognostic value beyond a comprehensive clinical and cardiac magnetic resonance evaluation is unknown. We hypothesized that a simple semiquantitative assessment of the extent of transmural necrosis is the best resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.Methods
One week after a first ST-segment elevation myocardial infarction we carried out a comprehensive quantification of several resonance parameters in 206 consecutive patients. A semiquantitative assessment (altered number of segments in the 17-segment model) of edema, baseline and post-dobutamine wall motion abnormalities, first pass perfusion, microvascular obstruction, and the extent of transmural necrosis was also performed.Results
During follow-up (median 51 months), 29 patients suffered a major adverse cardiac event (8 cardiac deaths, 11 nonfatal myocardial infarctions, and 10 readmissions for heart failure). Major cardiac events were associated with more severely altered quantitative and semiquantitative resonance indexes. After a comprehensive multivariate adjustment, the extent of transmural necrosis was the only resonance index independently related to the major cardiac event rate (hazard ratio=1.34 [1.19-1.51] per each additional segment displaying >50% transmural necrosis, P<.001).Conclusions
A simple and non-time consuming semiquantitative analysis of the extent of transmural necrosis is the most powerful cardiac magnetic resonance index to predict long-term outcome soon after a first ST-segment elevation myocardial infarction.Full English text available from: www.revespcardiol.org/en 相似文献8.
Juan Sanchis Alfredo Bardají Xavier Bosch Pablo Loma-Osorio Francisco Marín Pedro L. Sánchez Francisco Calvo Pablo Avanzas Carolina Hernández Silvia Serrano Arturo Carratalá José A. Barrabés 《Revista espa?ola de cardiología》2013
Introduction and objectives
High-sensitivity troponin assays have improved the diagnosis of acute coronary syndrome in patients presenting with chest pain and normal troponin levels as measured by conventional assays. Our aim was to investigate whether N-terminal pro-brain natriuretic peptide provides additional information to troponin determination in these patients.Methods
A total of 398 patients, included in the PITAGORAS study, presenting to the emergency department with chest pain and normal troponin levels as measured by conventional assay in 2 serial samples (on arrival and 6 h to 8 h later) were studied. The samples were also analyzed in a central laboratory for high-sensitivity troponin T (both samples) and for N-terminal pro-brain natriuretic peptide (second sample). The endpoints were diagnosis of acute coronary syndrome and the composite endpoint of in-hospital revascularization or a 30-day cardiac event.Results
Acute coronary syndrome was adjudicated to 79 patients (20%) and the composite endpoint to 59 (15%). When the N-terminal pro-brain natriuretic peptide quartile increased, the diagnosis of acute coronary syndrome also increased (12%, 16%, 23% and 29%; P=.01), as did the risk of the composite endpoint (6%, 13%, 16% and 24%; P=.004). N-terminal pro-brain natriuretic peptide elevation (>125 ng/L) was associated with both endpoints (relative risk= 2.0; 95% confidence interval, 1.2-3.3; P=.02; relative risk=2.4; 95% confidence interval, 1.4-4.2; P=.004). However, in the multivariable models adjusted by clinical and electrocardiographic data, a predictive value was found for high-sensitivity T troponin but not for N-terminal pro-brain natriuretic peptide.Conclusions
In low-risk patients with chest pain of uncertain etiology evaluated using high-sensitivity T troponin, N-terminal pro-brain natriuretic peptide does not contribute additional predictive value to diagnosis or the prediction of short-term outcomes.Full English text available from:www.revespcardiol.org/en. 相似文献9.
José Miguel Baena-Díez Francisco Javier FélixMaría Grau Antonio Cabrera de León Hector SanzManuel Leal Roberto Elosua María del Cristo Rodríguez-PérezMaría Jesús Guembe Pere ToránTomás Vega-Alonso Honorato OrtizJosé Fernando Pérez-Castán Guillermo Frontera-JuanJosé Lapetra María José Tormo Antonio SeguraDaniel Fernández-Bergés Jaume Marrugat 《Revista espa?ola de cardiología》2011,64(9):766-773
Introduction and objectives
The treatment and control of cardiovascular risk factors both play key roles in primary prevention. The aim of the present study is to analyze the proportion of primary prevention patients aged 35-74 years being treated and controlled in relation to their level of coronary risk.Methods
Pooled analysis with individual data from 11 studies conducted in the first decade of the 21st century. We used standardized questionnaires and blood pressure measures, glycohemoglobin and lipid profiles. We defined optimal risk factor control as blood pressure <140/90 mmHg and glycohemoglobin <7%. In hypercholesterolemia, we applied both the European Societies and Health Prevention and Promotion Activities Programme criteria.Results
We enrolled 27 903 participants (54% women). Drug treatments were being administered to 68% of men and 73% of women with a history of hypertension (P < .001), 66% and 69% respectively, of patients with diabetes (P = .03), and 39% and 42% respectively, of those with hypercholesterolemia (P < .001). Control was good in 34% of men and 42% of women with hypertension (P < .001); 65% and 63% respectively, of those with diabetes (P = .626); 2% and 3% respectively, of patients with hypercholesterolemia according to European Societies criteria (P = .092) and 46% and 52% respectively, of those with hypercholesterolemia according to Health Prevention and Promotion Activities Programme criteria (P < .001). The proportion of uncontrolled participants increased with coronary risk (P < .001), except in men with diabetes. Lipid-lowering treatments were more often administered to women with ≥10% coronary risk than to men (59% vs. 50%, P = .024).Conclusions
The proportion of well-controlled participants was 65% at best. The European Societies criteria for hypercholesterolemia were vaguely reached. Lipid-lowering treatment is not prioritized in patients at high coronary risk.Full English text available from: www.revespcardiol.org 相似文献10.
Atilano Carcavilla José L. Santomé Isabel Pinto Jaime Sánchez-Pozo Encarna Guillén-Navarro María Martín-Frías Pablo Lapunzina Begoña Ezquieta 《Revista espa?ola de cardiología》2013
Introduction and objectives
LEOPARD syndrome is an autosomal dominant condition related to Noonan syndrome, although it occurs less frequently. The aim of this study was to characterize the clinical and molecular features of a large series of LEOPARD syndrome patients.Methods
We collected clinical data from 19 patients in 10 hospitals. Bidirectional sequencing analysis of PTPN11, RAF1, and BRAF focused on exons carrying recurrent mutations.Results
After facial dysmorphism, structural heart defects (88%) were the most common feature described. Hypertrophic cardiomyopathy (71%) was diagnosed more often than pulmonary valve stenosis (35%). Multiple lentigines or café au lait spots were found in 84% of the series, and deafness was diagnosed in 3 patients. Mutations in PTPN11 were identified in 16 (84%) patients (10 patients had the recurrent LEOPARD syndrome mutation, p.Thr468Met) (NP_002825.3T468 M). Two other patients had a mutation in RAF, and 1 patient had a mutation in BRAF. When compared with other neurocardiofaciocutaneous syndromes, LEOPARD syndrome patients showed a higher prevalence of hypertrophic cardiomyopathy and cutaneous abnormalities, and a lower prevalence of pulmonary valve stenosis and short stature.Conclusions
LEOPARD syndrome patients display distinctive features apart from multiple lentigines, such as a higher prevalence of hypertrophic cardiomyopathy and lower prevalence of short stature. Given its clinical implications, active search for hypertrophic cardiomyopathy is warranted in Noonan syndrome spectrum patients, especially in LEOPARD syndrome patients.Full English text available from:www.revespcardiol.org/en 相似文献11.
Yolanda Molina-Salas María de las Mercedes Lomas-Campos Francisco José Romera-Guirado María Jesús Romera-Guirado 《Archivos de bronconeumología》2014
Aims
To describe the epidemiology of tuberculosis and analyzing the differences among native and immigrant patients in Area III of the Region of Murcia.Methods
Cohort study of tuberculosis cases reported to the Epidemiological Surveillance Service from 2004 to 2009. Data collection was performed through the System of Notification Diseases, reviewing clinical files and epidemiological surveys.Results
One hundred sixty two cases were detected; 110 (67.9%) were immigrants, whose incidence rates ranged from 43.4 to 101.2 cases per 100,000 inhabitants. Ecuador (42.7%), Bolivia (30%) and Morocco (18.2%) were the main nationalities.Immigrants were younger than Spanish population (P < .001). The overall diagnostic delay was 50.5 days: 59.5 in Spanish and 47 in foreigners. Moroccans had higher proportions of extrapulmonary TB (P = .02). Mainly, immigrant population took treatment with four drugs (P < .001). Natives had better treatment adherence (P = .04). Spanish cases tuberculosis were associated with smoking (P < .001), the same as alcohol consumption (P = .01) and injection drug use (P < .001), nevertheless in the foreign-born population the most relevant risk factor was overcrowding (P < .001).Conclusions
The incidence tuberculosis rates are higher among immigrant population, whose the main risk factor is overcrowding. In contrast, Spanish cases are associated with toxic substances consumption and increasing age. 相似文献12.
Adolfo Baloira Villar Guillermo Pousada Fernández Carlos Vilariño Pombo Marta Núñez Fernández Jose Cifrián Martínez Diana Valverde Pérez 《Archivos de bronconeumología》2014
Introduction
One of the pathways involved in pulmonary arterial hypertension (PAH) is the nitric oxide (NO) pathway. A polymorphism in the inducible NO synthase (NOS2) gene has been described, consisting of the CCTTT pentanucleotide repeat, which causes a reduction in NO production. The aim of this study was to determine if this polymorphism increases susceptibility to developing PAH.Methods
Sixty four patients with a diagnosis of PAH groups i and iv and 50 healthy controls were compared. DNA genotyping of the samples for this polymorphism was performed using PCR. The distribution between both groups was compared and correlated with clinical and haemodynamic parameters and therapeutic response.Results
A significantly different distribution was observed in the number of repeats between patients and controls (P < .0001). When the samples were categorised by short forms (both alleles with less than 12 repeats) and long forms (≥ 12 repeats), it was observed that the former had an almost 4-fold risk of developing PAH (odds ratio: 3.83; 95% CI: 1.19-12.32, P = .024). There were no differences between the most common types of PAH, either in therapeutic response or survival. There was no correlation between haemodynamic parameters and the number of repeats in the patients, and only a weak correlation with systolic PAH.Conclusions
There are significant differences in the distribution of the NOS2 promotor CCTTT polymorphism between patients with PAH and the healthy population. A minor CCTTT pentanucleotide repeat in the NOS2 gene may increase the risk of developing PAH. 相似文献13.
Marta Ferrer Raquel Morillo Teresa Elías Luis Jara Leticia García Rosa Nieto Emmanuel Sandoval Fernando Uresandi Remedios Otero David Jiménez 《Archivos de bronconeumología》2013
Objective
The aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE).Methods
We performed a retrospective analysis of a cohort composed of 1447 patients with acute symptomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using C statistic, which was obtained by means of logistic regression and ROC curves.Results
Overall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (C statistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (C statistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P < .001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the Spanish score (1.1% versus 4.2%), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% versus 2.3%).Conclusions
Both scores provide excellent information to stratify the risk of mortality in patients treated of PE. The usefulness of these models for nonfatal adverse events is questionable. The sPESI identified low-risk patients with PE better than the Spanish score. 相似文献14.
Tamara Lourido-Cebreiro Virginia Leiro-Fernández Antoni Tardio-Baiges Maribel Botana-Rial Manuel Núñez-Delgado M. Jesús Álvarez-Martín Alberto Fernández-Villar 《Archivos de bronconeumología》2014
Background
Cell block material from puncture can be obtained with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in many cases. The aim of this study was to analyse the value of additional information from cell blocks obtained with EBUS-TBNA samples from mediastinal and hilar lymph nodes and masses.Methods
Review of pathology reports with a specific diagnosis obtained from EBUS-TBNA samples of mediastinal or hilar lesions, prospectively obtained over a two-year period. The generation of cell blocks from cytology needle samples, the contribution to morphological diagnosis, and the possible use of samples for immunohistochemistry were analysed.Results
One hundred and twenty-nine samples corresponding to 110 patients were reviewed. The diagnosis was lung cancer in 81% of cases, extrapulmonary carcinoma in 10%, sarcoidosis in 4%, lymphoma in 2.7%, and tuberculosis in 0.9%. Cell blocks could be obtained in 72% of cases. Immunohistochemistry studies on the cell blocks were significantly easier to perform than on conventional smears (52.6% vs. 14%, P < .0001). In 4 cases, the cell block provided an exclusive morphological diagnosis (3 sarcoidosis and one metastasis from prostatic carcinoma) and in 3 carcinomas, subtype and origin could be identified. Exclusive diagnoses from the cell block were significantly more frequent in benign disease than in malignant disease (25% vs 0.9%, P = .002).Conclusions
Cell blocks were obtained from 72% of EBUS-TBNA diagnostic procedures. The main contributions of cell blocks to pathology examinations were the possibility of carrying out immunohistochemical staining for the better classification of neoplasms, especially extrapulmonary metastatic tumours, and the improved diagnosis of benign lesions. 相似文献15.
Bienvenida Carpe-Carpe Lauro Hernando-Arizaleta M. Carmen Ibáñez-Pérez Joaquín A. Palomar-Rodríguez Antonio M. Esquinas-Rodríguez 《Archivos de bronconeumología》2013
Introduction
Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain).Subjects and methods
A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression.Results
We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC] = −3.4, 95% CI: − 4.8; −2.0, P <.05) and in the group without ventilatory intervention (APC = −4.2%, −5.6; −2.8, P <.05); upward trend in the use of NIV (APC = 16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC = −4.5%, −10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC = 0.5, −1.3; 2.4) and in the group without intervention (APC = 0.1, −1.6; 1.9); downward trend with statistical significance in the NIV group (APC = −7.1, −11.7; −2.2, P <.05) and not statistically significant in the IMV group (APC = −0,8, −6, 1; 4.8). The mean stay did not change substantially.Conclusions
The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. 相似文献16.
Objective
To report a series of stenting procedures for the treatment of malignant superior vena cava (SVC) syndrome.Material and methods
A review conducted from October 2005 to July 2013 retrieved 56 consecutive patients treated for symptomatic malignant SVC syndrome with stenting.Results
SVC stenting was attempted in 56 patients (46 males, 10 females), aged 34-84 years (mean 59.3).The success rate was 49/57 (86%). Success was associated with the type of obstruction classified as: group 1 (a —SVC stenosis, or b —unilateral innominate vein occlusion with contralateral innominate vein stenosis and normal SVC), group 2 (SVC occlusion excluding bilateral innominate vein occlusion) and group 3 (bilateral innominate vein occlusion irrespective of SVC status). Success rates were 100% (39/39), 75% (9/12) and 16.6% (1/6), respectively. These differences were significant for group 1 versus group 2 + 3 (p < 0.001) and for group 2 versus group 3 (p = 0.032). Acute complications occurred in 9 patients. Patients in whom acute complications occurred were older than the others (67.8 vs. 57.6 years, p = 0.019). The procedure-related death rate was 3.5% (n = 2). Stent occlusion occurred in 3.5% (n = 2). The patient survival was poor (median 2.6; range < 1-29.6 months), independently of the success of stenting.Conclusions
Stenting for malignant SVC syndrome provides immediate and sustained symptomatic relief that lasts until death in this set of patients with a short life expectancy and restores the central venous access for administration of chemotherapy. Technical failure was associated with SVC occlusions and primarily with bilateral innominate vein occlusion. 相似文献17.
Cosme García-García Lluís Molina Isaac Subirana Joan Sala Jordi Bruguera Fernando Arós Miquel Fiol Jordi Serra Jaume Marrugat Roberto Elosua 《Revista espa?ola de cardiología》2014
Introduction and objectives
To analyze sex-based differences in clinical characteristics, management, and 28-day and 7-year prognosis after a first myocardial infarction.Methods
Between 2001 and 2003, 2042 first myocardial infarction patients were consecutively registered in 6 Spanish hospitals. Clinical characteristics, management, and 28-day case-fatality were prospectively recorded. Seven-year vital status was also ascertained by data linkage with the National Mortality Index.Results
The registry included 449 women and 1593 men with a first myocardial infarction. Compared with men, women were older, had a higher prevalence of hypertension and diabetes, and were more likely to receive angiotensin-converting enzyme inhibitors but were less likely to receive beta-blockers or thrombolysis. No differences were observed in use of invasive procedures. More women had non-ST-segment elevation and unclassified myocardial infarction than men (37.9% vs 31.3% and 9.8% vs 6.1%, respectively; both P<.001). Case-fatality at 28 days was similar in women and men (5.57% vs 4.46%; P=.39). After multivariate adjustment, the odds ratio of 28-day mortality for men was 1.06 (95% confidence interval: 0.49-2.27; P=.883) compared with women. After multivariate adjustment, men had higher 7-year mortality than women, hazard ratio 1.93 (95% confidence interval: 1.46-2.56; P<.001).Conclusions
There are demographic and clinical differences between men and women with a first myocardial infarction. The short-term prognosis of a first myocardial infarction in this century is similar in both sexes. However, the long-term vital prognosis after a first myocardial infarction is worse in men than in women. These results are observed in both ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction events.Full English text available from:www.revespcardiol.org/en 相似文献18.
Óscar Fabregat-Andrés Pilar García-González Alfonso Valle-Muñoz Jordi Estornell-Erill Leandro Pérez-Boscá Victor Palanca-Gil Rafael Payá-Serrano Aurelio Quesada-Dorador Salvador Morell Francisco Ridocci-Soriano 《Revista espa?ola de cardiología》2014
Introduction and objectives
Cardiac resynchronization therapy with a defibrillator prolongs survival and improves quality of life in advanced heart failure. Traditionally, patients with ejection fraction > 35% estimated by echocardiography have been excluded. We assessed the prognostic impact of this therapy in a group of patients with severely depressed systolic function as assessed by echocardiography but with an ejection fraction > 35% as assessed by cardiac magnetic resonance.Methods
We analyzed consecutive patients admitted for decompensated heart failure between 2004 and 2011. The patients were in functional class II-IV, with a QRS ≥ 120 ms, ejection fraction ≤ 35% estimated by echocardiography, and a cardiac magnetic resonance study. We included all patients (n = 103) who underwent device implantation for primary prevention. Ventricular arrhythmia, all-cause mortality and readmission for heart failure were considered major cardiac events. The patients were divided into 2 groups according to systolic function assessed by magnetic resonance.Results
The 2 groups showed similar improvements in functional class and ejection fraction at 6 months. We found a nonsignificant trend toward a higher risk of all-cause mortality in patients with systolic function ≤ 35% at long-term follow-up. The presence of a pattern of necrosis identified patients with a worse prognosis for ventricular arrhythmias and mortality in both groups.Conclusions
We conclude that cardiac resynchronization therapy with a defibrillator leads to a similar clinical benefit in patients with an ejection fraction ≤ 35% or > 35% estimated by cardiac magnetic resonance. Analysis of the pattern of late gadolinium enhancement provides additional information on arrhythmic risk and long-term prognosis.Full English text available from:www.revespcardiol.org/en 相似文献19.
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Domínguez-Rodríguez A Abreu-Afonso J Rodríguez S Juárez-Prera RA Arroyo-Ucar E Jiménez-Sosa A González Y Abreu-González P Avanzas P 《Revista espa?ola de cardiología》2011,64(8):661-666