Morphologies and prognostic significance of left ventricular volume/time curves with cardiac magnetic resonance in patients with non-ischaemic heart failure and left bundle branch block

The International Journal of Cardiovascular Imaging - Patients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB) can display a wide or narrow pattern (WP/NP) of the...     

Impact of gender on treatment and outcome of ICU patients

BACKGROUND: Gender modifies immunologic responses caused by severe trauma or critical illness. The aim of this study was to investigate the impact of gender on hospital mortality, length of intensive care unit (ICU) stay, and intensity of care of patients treated in ICUs. METHODS: Data on 24,341 ICU patients were collected from a national database. We measured severity of illness with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and intensity of care with Therapeutic Intervention Scoring System (TISS) scores. We used logistic regression analysis to test the independent effect of gender on hospital mortality. We compared the lengths of ICU stay and the intensity of care of men and women. RESULTS: Male gender was associated with increased hospital mortality among postoperative ICU patients [adjusted odds ratio 1.33 (95% confidence interval 1.12-1.58, P = 0.001)] but not among medical patients [adjusted odds ratio 1.02 (95% confidence interval 0.92-1.13, P = 0.74)]. Male gender was associated with an increased risk of death particularly in the oldest age group (75 years or older) and among the patients with relatively low APACHE II scores (<16). Mean length of ICU stay was 3.2 days for men and 2.6 days for women (P < 0.001). Male patients comprised 61.7% of the study population but consumed 66.0% of days in intensive care. CONCLUSION: Male gender contributes to poor outcome in postoperative ICU patients. Approximately two-thirds of ICU resources are consumed by male patients.     

Sampling rate causes bias in APACHE II and SAPS II scores

OBJECTIVE: To study the effect of sampling rate of laboratory and haemodynamic data on severity scorings and predicted risk of hospital death. DESIGN: Prospective study. SETTING: Medical-surgical intensive care unit (ICU) with 23 beds in a university hospital. PATIENTS: Sixty-nine consecutive emergency admission patients. INTERVENTIONS: Blood samples were drawn from indwelling arterial lines for the laboratory tests of all variables contained in the APACHE II and SAPS II scores at 2-hourly intervals from the time of admission up to 24 h or earlier discharge or death of the patient. Haemodynamic data and temperature were collected either manually by the attending nurse once an hour or as 2-min median values automatically using a Clinical Information Management System (CIMS, Clinisoft, Datex-Ohmeda, Helsinki, Finland). Three sets of severity scores were obtained. (1) "Traditional" scores (haemodynamic data from manual records and laboratory values from tests taken at admission and subsequently on clinical basis only). (2) "CIMS" scores (haemodynamic data from 2-min median values and laboratory values prescribed on clinical indication) and (3) "High rate" scores (haemodynamic data from 2-min median values and laboratory values at 2-hourly intervals). Probability of hospital death was calculated using the SAPS II and APACHE II scores, respectively. RESULTS: Increasing the sampling rate of haemodynamic monitoring interval to 2-min from once per hour resulted in 7.8 % and 11.5 % increases (p < 0.001) in the APACHE II and SAPS II scores, respectively. The combined effect of increased sampling rate of haemodynamic and laboratory tests on the APACHE II and SAPS II scores was 14.4 % and 14.5 % compared to traditional scores (p < 0.001), respectively. The probability of hospital death increased from 0.23 and 0.21 ("traditional" SAPS II and APACHE II) to 0.31 and 0.25 ("high rate" SAPS II and APACHE II), respectively, and, because eight patients died, standardised mortality ratio (SMR) decreased from 0.53 to 0.41 (SAPS II) and from 0.60 to 0.50 (APACHE II). CONCLUSIONS: Increased sampling rate results in higher scores and lower SMR. Comparisons between hospitals using severity scores are biased due to differences in the sampling rates.     

Gonadotropin pulsatility in a stimulated cycle: clomiphene citrate increases pulse amplitudes of both luteinizing hormone and follicle-stimulating hormone

OBJECTIVE: To elucidate gonadotropin secretory patterns during ovarian hyperstimulation for in vitro fertilization. DESIGN: All volunteers who attended the unit during a period of 3 months were prospectively investigated. SETTING: Infertility unit of the University Central Hospital of Oulu. PARTICIPANTS: Normally menstruating tubal infertility patients (n = 8) and healthy women with ovulatory cycles (hospital personnel, n = 11). All patients finished the study. INTERVENTIONS: Clomiphene citrate (CC), 50 mg, was administered on cycle days 5 to 9 and 300 IU of pure follicle-stimulating hormone (FSH) on cycle day 7 and 150 IU on cycle day 8. MAIN OUTCOME MEASURES: Serum samples for luteinizing hormone (LH) and FSH measurements were collected at 10-minute intervals for 6 hours on cycle day 7 (effect of CC) and day 9 (effect of CC/FSH), and the data were analyzed with the Munro computer program. RESULTS: The number of LH peaks was identical in the controls and study subjects on cycle days 7 and 9, whereas the pulse amplitude (P less than 0.025) and the pulse area (P less than 0.01) were higher in the CC/FSH-treated patients. The increase in overall mean LH level during the hormone therapy was not significant. In the CC/FSH-treated women, a decreased number of FSH pulses (P less than 0.01) with increased amplitude (P less than 0.001) and pulse area (P less than 0.01) was found. Clomiphene citrate treatment increased the mean FSH level (control versus cycle day 7, P less than 0.05) which was further increased (cycle day 7 versus cycle day 9, P less than 0.05) by FSH administration on cycle days 7 to 8. Otherwise pure FSH was found to be unable to modify endogenous LH or FSH secretory patterns under these conditions. CONCLUSIONS: Clomiphene citrate increases the amplitudes of both LH and FSH pulses in the midfollicular phase of a stimulated cycle, an effect which is not influenced by pure FSH administration.     

Anterior pituitary dysfunction during the luteal phase following ovarian hyperstimulation

The capacity of the pituitary to secrete prolactin (PRL) and gonadotropins was investigated during the luteal phase of eight normally menstruating tubal infertility patients after ovarian stimulation with clomiphene citrate, human menopausal gonadotropin, and human chorionic gonadotropin. The baseline values of PRL were significantly higher (P less than 0.025), those of luteinizing hormone unchanged, and those of follicle-stimulating hormone lower (P less than 0.025) during the treatment than in the control cycles. The maximal response of PRL to the dopamine antagonist metoclopramide was increased (P less than 0.01), whereas the maximal responses of luteinizing hormone (P less than 0.025) and follicle-stimulating hormone (P less than 0.001) to gonadotropin-releasing hormone were lowered in the treatment cycles. The current results indicate that ovarian hyperstimulation with clomiphene citrate/human menopausal gonadotropin/human chorionic gonadotropin may induce luteal phase pituitary dysfunction, which may affect the luteal phase functions of the corpus luteum.     

Need for maternal critical care in obstetrics: a population-based analysis

The purpose of this study was to note potential obstetric risk factors leading to maternal intensive care and to estimate the frequency, costs and outcomes of management. In a cross-sectional study of intensive care admissions in Kuopio from March 1993 to October 2000, 22 consecutive obstetric patients admitted to a mixed medical-surgical intensive care unit were followed. We recorded demographics, admitting diagnoses, APACHE II score, clinical outcomes and treatment costs. The overall need for maternal intensive care was 0.9 per 1000 deliveries during the study period. The mean age (+/-SD) of the patients was 31.7 (+/-6.6) years and the APACHE II score 10.8 (+/-6.2). The most common admission diagnoses were obstetric haemorrhage (73%) and pre-eclampsia-related complications (32%). The duration of ICU stay was 5.8 days (range 1-31) and one of the 21 patients died in the intensive care unit (4.5%). The total cost of intensive care was in the order of USD 5000 per patient. Very few obstetric patients develop complications requiring intensive care. Although several risk factors associated with maternal intensive care were documented, most cases occurred in low-risk women, which implies that the risk is relevant to all pregnancies. Long-term morbidity was rare, and collectively the outcome of intensive care was good. Further research is needed to determine effective approaches in prevention, such as uterine artery embolization.     

Baker and Itagliata's Quality of Life Scale in a group of 139 schizophrenic patients: factorial analysis and evaluation of global validity

The Satisfaction with Life Domains Scale SLDS published by Baker and Intagliata in 1982 and translated in French by Chambon and al. is one of the most used rating scales in the field of Subjective Quality of Life (SQL) for patients suffering from schizophrenia. It comprises 16 scales in 7 points and Likert format exploring the following fields: home/apartment/place of residence, neighbourhood, food, clothes, health, people they live with, friends, love life, relationships with their family, how they get on with other people, job/work day programming, spare time, what they do in the community for fun, services and facilities in their area, economic situation, general quality of life. In this study we present results on SLDS about 139 schizophrenic patients (108 males, 31 females) recruited in two centers Lyon (n = 41) and Saint-Etienne (n = 98). The SLDS was a part of more comprehensive studies including evaluation of needs for care, social support, delivery and costs of services. Diagnosis were confirmed using either the SCAN and CATEGO program (n = 108) or the list of the ICD-10 criteria (n = 31) applied at time of inclusion or on the basis of a representative episode of the illness. Patients were classified in two groups, the S group (S, n = 53) for those patients presenting clinical features at time of inclusion excepted residual forms (F 20.5) and the non S group (N-S, n = 86) for those patients free of symptoms at the time of assessment. Non parametric statistics (U test and Kendall test) were used for comparisons between groups. The field by field comparison of the scores shows the poorest level of SQL for love life (m = 4.2; sd = 1.8) and economic status (m = 4.4; sd = 1.8). Comparisons between S and non-S groups show an average range systematically higher for the non-S group and significant differences for the following fields: food, friends, how they get on with other people. The same comparisons between males and females show no significant differences excepted for the following fields: love life, economic situation. Principal components analysis with Varimax rotation were performed and a 4 factors solution was considered as the best one. Before rotation the first factor accounts for 31% of the variance and comprises all the items with loading higher than 0.4 allowing us to consider the possibility of a global score. This global score is normally distributed (m = 95.1 sd = 17.3) and shows a significant difference between S and non S-groups (S m = 92.2 sd = 20.1; non S m = 99.6 sd = 15.4 p = .02) but not between centers and between males and females. After rotation the first factor comprises relationships with family, how they get on with other people, job/work/day programming, spare time, what they do for fun and life in general. The hypothesis of unidimensionality of QV has to be tested using the RASCH model.