Hemoconcentration is a good prognostic predictor for clinical outcomes in acute heart failure: Data from the Korean Heart Failure (KorHF) Registry

Background

Hemoconcentration is a surrogate marker of effective decongestion and diuresis therapy. Recently, hemoconcentration has been associated with decreased mortality and rehospitalization in heart failure (HF) patients. However, the prognostic power of hemoconcentration in a large sample-sized HF cohort was limited until now.

Methods and results

We analyzed data from hospitalized patients with acute heart failure (AHF) that were enrolled in the Korean Heart Failure Registry(n = 2,357). The primary end point was a composite of all-cause mortality and HF rehospitalization during the follow-up period (median = 347, interquartile range = 78–744 days).Hemoconcentration, defined as an increased hemoglobin level between admission and discharge, was presented in 1,016 AHF patients (43.1%). In multivariable logistic regression, hemoglobin, total cholesterol, and serum glucose levels at admission, and ischemic HF, were significant determinants for hemoconcentration occurrence. The Kaplan–Meier curve showed that event-free survival was significantly higher in the hemoconcentration group compared to the non-hemoconcentration group (65.1% vs. 58.1%, log rank p < 0.001). In multiple Cox proportional hazard analysis, hemoconcentration was an independent predictor of the primary end point after adjusting for other HF risk factors (hazard ratio = 0.671, 95% confidence interval = 0.564–0.798, p < 0.001).

Conclusions

Hemoconcentration during hospitalization was a prognostic marker of fewer clinical events in the AHF cohort. Therefore, this novel surrogate marker will help in the risk stratification of AHF patients.     

Surgical consideration of the intraspinal component in extradural dumbbell tumors

BACKGROUND: The dumbbell tumor is considered a distinct group of tumors of the spinal nerve sheath owing to its intriguing clinical and radiological characteristics. More than half of dumbbell tumors are completely restricted to the extradural space, although preoperative MRI in some cases suggests the presence of intradural/extradural tumors. The aim of this retrospective investigation is to elucidate the clinical features and to suggest the surgical strategy to reduce the operating time and prevent additional complications in extradural type. METHODS: The medical records and radiological studies of 7 consecutive cases (4 male, 3 female, mean age 40.4 years) who underwent removal of the intraspinal component of their extradural dumbbell tumors between January 1996 and December 2005 were analyzed. Diagnosis and preoperative evaluation were performed with MRI and myelogram/CTs. RESULTS: The relationship of the tumor mass to dural sac in preoperative MRIs was so indistinct as to suggest an intradural mass in 5 cases. We found that extradural portion was covered with an attenuated dura and that the dural ring was invaginated into the intradural portion in these cases. Therefore, the author began with the epidural removal of the intraspinal and extraspinal component, followed by carefully extracting the intradural-like mass. CONCLUSIONS: In conclusion, we suggest that invagination of the dural ring is the anatomical feature that may be confused with an intradural/extradural tumor during operations for extradural dumbbell tumors. Initial epidural mass removal, extraction of intradural/extradural tumors subsequent to dural opening, and affirmation of presence of intradural tumor remnant could save time during dumbbell tumor surgery.     

Prognostic factors for Korean patients with anaplastic thyroid carcinoma

BACKGROUND: Anaplastic thyroid carcinoma (ATC), although rare, is one of the most aggressive human cancers, and patients with ATC have extremely poor prognoses despite various therapeutic measures. We wished to determine the prognostic factors of survival and effect of treatment on survival rate in patients with ATC. METHODS: We retrospectively reviewed the medical records of the 121 patients (41 men and 80 women) diagnosed with ATC from January 1995 to June 2004 at 5 major referral centers in Korea. RESULTS: Mean patient age at diagnosis was 64 +/- 11 years (range, 17-84 years). Of the 121 patients, 11 (9%) had intrathyroidal tumors, 69 (57%) had extrathyroidal tumors or lymph node involvement, 29 (24%) had distant metastases, and 12 had no data about staging (9%). The mean tumor diameter was 5.5 +/- 2.5 cm (range, 0.5-17.0 cm). At a median follow-up of 41 months (range, 26-122 months), 8 patients were alive. Median survival time was 5.1 months. The disease-specific survival rates were 42% at 6 months, 16% at 12 months, and 9% at 24 months. Sixteen patients (13%) received only supportive care, 25 (21%) received surgery alone, 20 (16%) received radiation treatment or chemotherapy without surgery, and 60 (50%) received surgery plus radiation treatment or chemotherapy. Multivariate analysis showed that age less than 60 years, tumor size less than 7 cm, and lesser extent of disease were independent predictors of lower disease-specific mortality. CONCLUSIONS: Long-term survival is possible for ATC patients less than 60 years old and with small localized tumors. Although aggressive multimodal therapy, including surgery, radiation treatment, and chemotherapy, was not significantly associated with improved survival, we advocate aggressive multimodal therapy in selected ATC patients with good prognostic factors.     

Ureteral tumor thrombus from renal cell carcinoma extending into bladder

Tumor thrombus from renal cell carcinoma (RCC) usually occurs within the renal vein. We present the first report of a tumor thrombus from RCC extending from the kidney down the ureter and into the lumen of the bladder. This case both: (1) provides evidence for growth of RCC along the urinary tract, and (2) poses a staging dilemma.     

Disseminated mycobacteriosis in a bald eagle (Haliaeetus leucocephalus)

A mature bald eagle (Haliaeetus leucocephalus) was diagnosed with mycobacterial infection after being presented for an inability to fly, emaciation, and a swelling of the left tibiotarsal-tarso metatarsal joint. Results of a complete blood cell count revealed a persistent, marked leukocytosis, with heterophilia, monocytosis, and anemia. Radiographs revealed lysis of the left distal tibiotarsus and soft-tissue swelling around the left tibiotarsal-tarsometatarsal joint, multiple pulmonary opacities, and an enlarged liver. Endoscopic evaluation and biopsy of caseated material within the left caudal coelom revealed acid-fast organisms. The eagle was euthanatized, and results of necropsy and histologic evaluation revealed caseated granulomas of the intestine, lungs, air sacs, and subcutaneous regions of the hock. Results of culture, a polymerase chain reaction testing, and direct deoxyribonucleic acid (DNA) sequencing for mycobacterial 16S ribosomal ribonucleic acid DNA determined this organism most likely to be Mycobacterium avium.     

Microsatellite instability in endometrioid type endometrial adenocarcinoma is associated with poor prognostic indicators

Microsatellite instability (MSI) has been reported in 25% to 45% of sporadic endometrial carcinoma. The clinicopathologic and molecular characteristics of MSI-high phenotype in colorectal and gastric carcinomas have been widely investigated; however, the clinicopathologic impact of MSI on endometrial carcinomas remained unclear. This study was performed to determine the clinicopathologic and molecular significance of MSI in endometrial carcinomas. We analyzed the MSI status using National Cancer Institute-recommended 5 microsatellite markers, and the immunohistochemical profiles of various regulatory proteins of cell cycle and apoptosis using tissue microarray in 100 endometrial carcinomas. The results were compared between MSI-high and MSI(-) groups as for the traditional clinicopathologic prognostic parameters and the immunoreactivities of various regulatory proteins. We especially focused on the endometrioid type adenocarcinoma to exclude the bias from nonendometrioid type adenocarcinomas with more aggressiveness and a close association with MSI(-) phenotype. The incidence of MSI-high phenotype was significantly higher in endometrioid type than in nonendometrioid serous type (20% vs. 0%, P<0.001). It showed orderly increase in the frequencies of MSI-high phenotype in higher histologic grade (13% vs. 21% vs. 50% in histologic grade I, II, and III, P=0.039). The MSI-high phenotype was related with the presence of lymphovascular invasion (P=0.008), deep myometrial invasion (P=0.040), and the higher clinical stages (P=0.018) independent of tumor grade. We also found a correlation between MSI-high phenotype and higher cyclin A and skp2 immunoreactivity (P=0.03 and 0.05, respectively), known to be the poor prognostic molecular indicators. According to these results, the MSI may represent the poor prognostic impact on the endometrioid type endometrial adenocarcinoma.