Symptoms reported by elderly patients with isolated systolic hypertension: baseline data from the SYST-EUR trial. Systolic Hypertension in Europe.
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OBJECTIVES: To determine the symptomatic well-being of elderly persons with isolated systolic hypertension. DESIGN AND SETTING: Well-being determined during the placebo run-in period prior to entry to the Systolic Hypertension in Europe (SYST-EUR) trial. SUBJECTS: 641 People, 60 years or older with an average sitting blood pressure of 173/86 mm Hg. OUTCOME MEASURES: 33 Symptomatic complaints determined by a standard interview. RESULTS: The 437 women complained of 25% of the symptoms and the 204 men 21% (P<0.001). A markedly higher prevalence was observed in women compared with men for: pain in the joints of the hands (35% of women complained of this against 22% of men); 'racing heart' (33% against 17%); dry eyes (16% against 6%); blurring of vision (35% against 23%); cramps in the legs (43% against 31%); and a sore throat (15% against 7%). Nocturia was the most frequent complaint (68% in both sexes). Eight symptoms increased with age and one (rash) tended to decline. With increasing systolic pressure women also reported more headaches, unsteadiness, blurring of vision, irregular heart beat and 'racing heart' but, of these, only headaches increased with diastolic pressure. These observations were made after adjusting for age, blood sugar and body mass index (BMI) and were not observed in men. Higher blood sugars were associated with mouth ulcers, 'racing heart', blurring of vision and cramps in the legs. A higher BMI was associated with six symptoms, and a lower age of leaving education with eight. In men, alcohol consumption was related to 'racing heart', and smoking to wheezing and having a dry cough. CONCLUSIONS: A high level of complaint was associated with female gender, increasing age, blood sugar and BMI and a low age of leaving education. (+info)
Lymphatic and hematopoietic cancer in teachers.
(34/8791)
A recent study found high rates of leukemia and related disorders among teachers. This finding may be related to exposure to childhood infections. Therefore, epidemiologic studies on the risk of lymphatic and hematopoietic cancer among teachers were systematically reviewed. Altogether 26 relevant investigations were identified, most from ad hoc publications rather than from scientific journals. Elevated risks of leukemia, lymphoma, and multiple myeloma were found in studies using proportional mortality or mortality odds ratios as outcome measures. However, these observations may reflect low overall mortality and do not necessarily indicate high death rates from the cancers of interest. In studies deriving standardized mortality or incidence ratios, the risk estimates were generally lower. The most striking finding was for non-Hodgkin's lymphoma (approximate summary relative risk 1.36, 95% confidence interval 1.13-1.62), but it was likely to have been exaggerated by publication bias. In conclusion, no compelling epidemiologic evidence exists for a hazard of leukemia or related diseases among teachers. (+info)
Evidence for effective suppression of recombination in the chromosome 17q21 segment spanning RNU2-BRCA1.
(35/8791)
Characterization of associations between polymorphic sites located throughout the approximately 200-400-kb variable-length region spanning RNU2-BRCA1 reveals nearly complete linkage disequilibrium. This segment spans the RNU2 array, which includes 6-30 tandem copies of the U2 snRNA gene, and an adjacent region containing NBR1, the LBRCA1 pseudogene, NBR2, and BRCA1 in a tandemly duplicated structure. A series of biallelic polymorphisms define two common haplotypes that do not vary significantly, in structure or frequency, between populations of primarily European (n=275) or Asian (n=34) ancestry. Lower-frequency variants occurring at distantly located sites within this region also show very strong associations. The rarer haplotype classes appear to be distinguished by mutational alteration and are not recombination products of the two major classes. The two major haplotypes also exhibit significantly different allele-length distributions for local simple tandem-repeat markers. The conservation of extensive distinct chromosomal haplotypes during a long period of human population expansion and divergence indicates that selective forces or specific chromosomal mechanisms result in effective recombination suppression. The extreme degree of long-range linkage disequilibrium at this locus may be exceeded only by that reported for the human MHC locus, where allele-specific functional interactions are believed to be significant. These findings have implications for the estimation of the time of origin of BRCA1 mutations having a founder effect, the interpretation of the significance of rare allelic variants, and the study of the origins of modern populations. (+info)
Quality of life after coronary angioplasty or bypass surgery. 1-year follow-up in the Coronary Angioplasty versus Bypass Revascularization investigation (CABRI) trial.
(36/8791)
BACKGROUND: Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) have both been shown to be safe and effective in the treatment of coronary artery disease. Nine randomized studies comparing CABG and PTCA have delivered consistent results, with no significant differences in mortality between the methods, either in single or in multivessel coronary artery disease. An important outcome measurement after intervention is the patient's subjective appraisal of the intervention. Results from the CABRI substudy on quality of life at 1 year follow-up are presented in this report. METHODS: CABRI is a multicentre, randomized, open comparison of patients assigned to either PTCA or CABG. Patients were recruited from 26 high volume European hospitals over a 53 month period starting in July 1988. A quality of life substudy was also set up, but participation was optional. Seven out of 26 centres took part in the study. One hundred and fifty-four (14.6%) out of the 1054 main study patients participated. Perceived health status was assessed at baseline and 1 year after revascularization by means of The Nottingham Health Profile and a set of 12 other questions. RESULTS: A significant improvement in quality of life in terms of the total score and in the Nottingham Health Profile for both groups, as compared with baseline, was found. A trend towards better outcome concerning energy was found favouring CABG. This trend might be due to the fact that the CABRI protocol permitted incomplete revascularization in the PTCA arm and did not exclude patients with totally occluded vessels. When adjusted for baseline differences, no difference in health-related quality of life at follow-up was found between the sexes, or between the PTCA and the CABG groups. A significant correlation was found between improvement in quality of life and severity of angina when adjusted for baseline values. CONCLUSIONS: This study has shown that there is no general difference in health-related quality of life 1 year after bypass surgery or angioplasty; however, data presented are suggestive of a more favourable outcome in degree of perceived energy in the bypass group. (+info)
Differences in drug treatment of chronic heart failure between European countries.
(37/8791)
AIMS: A large number of drugs are currently used for the treatment of chronic heart failure. Treatment for other cardiovascular disorders has been shown to differ between countries. In this study we examined whether this would also be true in heart failure. METHODS AND RESULTS: We studied patients with moderate to severe heart failure, who were enrolled in an international survival study, and compared patterns of drug use between the nine countries that each included >50 patients in the study. The results were analysed to determine whether observed differences between countries could be explained by differences in the patients recruited. 1825 patients were studied (range 81-427 per country). By trial protocol, most patients were treated with angiotensin converting enzyme (ACE) inhibitors (92%) and all with diuretics, but the proportion of patients taking high doses of these drugs was markedly different between countries. Large differences were also observed in the use of digoxin (overall 64%, 39% in the U.K. to 87% in Germany) and antiarrhythmics (overall 25%, with the highest use 44% in France). The use of beta-blockers and calcium antagonists was low (overall 6% and 8%, respectively), but also different between countries. Anticoagulants (overall 43%) were used in many patients in the Netherlands and Switzerland (around 70%), while antiplatelets (overall use 30%) were most often prescribed in Denmark (51%). CONCLUSIONS: Large differences in drug use and dosing for patients with advanced heart failure are observed between (European) countries. None of these differences could be explained by differences in patient characteristics, and whether they are related to factors such as tradition, economic circumstances and national guidelines, etc. is unknown. (+info)
External quality assessment of enterovirus detection and typing. European Union Concerted Action on Virus Meningitis and Encephalitis.
(38/8791)
Reported are the results of a study of an enterovirus proficiency panel for use in isolation and serotyping and/or the polymerase chain reaction (PCR) carried out by 12 laboratories in nine European countries. Eleven laboratories reported results of virus isolation and serotyping. In addition, four laboratories reported results of a PCR for enterovirus detection. Correct virus isolation results were obtained for 105 of 110 samples (95.5%, four false-negatives, one false-positive), and correct PCR results for 39 of 40 (97.5%, one false-negative). The highest isolation rate (87.5%) was observed in primary and tertiary monkey kidney cells; on monkey kidney cell lines, human diploid fibroblasts or human heteroploid cells the isolation rate varied between 64% and 71.4%. Serotyping results were less satisfactory. Only 63 of 106 (59.4%) isolated viruses were typed correctly. Major problems were seen with samples containing mixtures of enteroviruses and with enterovirus 71 or echovirus 4, with 9%, 50%, and 55% correct results, respectively. These results underline the need for improvement of enterovirus typing, especially in view of the poliomyelitis eradication initiative. (+info)
Allogeneic stem cell transplantation for agnogenic myeloid metaplasia: a European Group for Blood and Marrow Transplantation, Societe Francaise de Greffe de Moelle, Gruppo Italiano per il Trapianto del Midollo Osseo, and Fred Hutchinson Cancer Research Center Collaborative Study.
(39/8791)
Agnogenic myeloid metaplasia (AMM) is a chronic myeloproliferative disorder in which patients with poor prognostic features, receiving conventional treatments, have a median survival of less than 3 years. In this retrospective multicenter study, we analyze the results and try to define the indications for allogeneic stem cell transplantation in AMM. From January 1979 to November 1997, 55 patients with a median age of 42 years were transplanted from HLA-matched related (n = 49) or alternative (n = 6) donors for AMM. A multivariate analysis was conducted to identify factors associated with posttransplant outcome. The median posttransplant follow-up was 36 months (range, 6 to 223). The 5-year probability of survival was 47% +/- 8% for the overall group, and 54% +/- 8% for patients receiving an unmanipulated HLA-matched related transplant. The 1-year probability of transplant-related mortality was 27% +/- 6%. Hemoglobin level +info)
Myocardial protection: the rebirth of potassium-based cardioplegia.
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The introduction of open-heart surgery more than 4 decades ago signaled a new era in medicine. For the 1st time, previously untreatable cardiac anomalies became amenable to surgical therapy. The use of the heart-lung machine seemed to grant the surgeon unlimited time in which to operate inside the heart. Still frustrated by poor operating conditions and the threat of air embolism, Denis Melrose introduced elective cardiac arrest in 1955. His use of a potassium citrate solution seemed to offer a safe method to effect a quiet, bloodless field. However, a few years after its inception, numerous reports began to question the safety of this approach, and the Melrose technique was abandoned in the early 1960s. Nearly 15 years elapsed before potassium-based cardioplegia regained popularity. During this period, topical hypothermia, coronary perfusion with intermittent aortic occlusion, and normothermic ischemia were evaluated and discarded. A few European investigators like Hoelscher, Bretschneider, and Kirsch had maintained their interest in chemical cardioplegia, and it was through their efforts that future researchers like Hearse and Gay spearheaded the return to potassium-based cardioplegia, which today forms the core of the cardiac surgeon's myocardial protective armamentarium and has contributed towards lowering operative mortality rates. (+info)