RESUMEN
In Italy the existence of a law on health protection of competitive sports since 1982 has favored the creation and the revision of these cardiological guidelines (called COCIS), which have reached their fourth edition (1989-2009). The present article is the second English version, which has summarized the larger version in Italian. The experience of the experts consulted in the course of these past 20 years has facilitated the application and the compatibility of issues related to clinical cardiology to the sports medicine field. Such prolonged experience has allowed the clinical cardiologist to acquire knowledge of the applied physiology of exercise and, on the other hand, has improved the ability of sports physicians in cardiological diagnostics. All this work has produced these guidelines related to the judgment of eligibility for competitive sports in the individual clinical situations and in the different cardiovascular abnormalities and/or heart disease. Numerous arguments are debated, such as interpretation of the athlete's ECG, the utility of a preparticipation screening, arrhythmias, congenital heart disease, cardiomyopathies, arterial hypertension, ischemic heart disease and other particular issues.
Asunto(s)
Atletas , Determinación de la Elegibilidad , Cardiopatías/diagnóstico , Medicina Deportiva , Cardiología , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Ambiente , Cardiopatías/fisiopatología , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Italia , Examen Físico/normas , Trastornos Relacionados con SustanciasRESUMEN
In Italy the existence of a law on health protection of competitive sports since 1982 has favored the creation and the revision of these cardiological guidelines (called COCIS), which have reached their fourth edition (1989-2009). The present article is the second English version, which has summarized the larger version in Italian. The experience of the experts consulted in the course of these past 20 years has facilitated the application and the compatibility of issues related to clinical cardiology to the sports medicine field. Such prolonged experience has allowed the clinical cardiologist to acquire knowledge of the applied physiology of exercise and, on the other hand, has improved the ability of sports physicians in cardiological diagnostics. All this work has produced these guidelines related to the judgment of eligibility for competitive sports in the individual clinical situations and in the different cardiovascular abnormalities and/or heart disease. Numerous arguments are debated, such as interpretation of the athlete's ECG, the utility of a preparticipation screening, arrhythmias, congenital heart disease, cardiomyopathies, arterial hypertension, ischemic heart disease and other particular issues.
Asunto(s)
Atletas , Determinación de la Elegibilidad , Cardiopatías/diagnóstico , Medicina Deportiva , Arritmias Cardíacas/diagnóstico , Cardiología/métodos , Electrocardiografía , Ejercicio Físico/fisiología , Cardiopatías Congénitas/diagnóstico , Humanos , Italia , Examen FísicoAsunto(s)
Cardiología , Cardiopatías , Aptitud Física , Medicina Deportiva , Deportes/normas , Adulto , Electrocardiografía , Cardiopatías/complicaciones , Cardiopatías/diagnóstico , Cardiopatías/terapia , Humanos , Italia , Marcapaso Artificial , Factores de Riesgo , Deportes/legislación & jurisprudencia , Medicina Deportiva/legislación & jurisprudenciaRESUMEN
We have analysed a series of 96 patients with multiple myeloma (MM) to the purpose to verify the prognostic meaning of the beta2-microglobulin (B2M) and the validity of the staging systems proposed by Bataille and Jacobson who use the B2M respectively associated to the serum C-reactive protein (CRP) and to the serum albumin. In our series of patients the serum level of B2M at the diagnosis was directly correlated with the myelomatous cellular mass. We have found besides an inverse correlation between B2M and survival. Also the serum level of CRP was inversely correlated with the survival, while a direct correlation was found between the serum albumin and the survival: ipoalbuminemia was confirmed as a predictive index of short survival. Staging our patients with MM according to the proposal of Bataille, we identified also in our series three prognostic groups with different median survival: respectively 72, 40 and 18 months. Applying finally the staging proposal of Jacobson to our series, four stages were individualized, with median survival respectively of 70, 52, 26 and 10 months. We confirm the prognostic value of the B2M in MM.
Asunto(s)
Mieloma Múltiple/sangre , Microglobulina beta-2/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/mortalidad , Pronóstico , Tasa de SupervivenciaRESUMEN
PURPOSE: To verify the reliability of the new criteria for the diagnosis of IgM gammopathies recently proposed by an international panel of experts (Athens, 2002). EXPERIMENTAL DESIGN: A retrospective series of 698 patients with IgM gammopathy was reviewed paying attention to symptoms, serum IgM concentration, bone marrow infiltration, blood cell count and clinical course. Four clinical entities can be identified: IgM monoclonal gammopathy of undetermined significance (IgM-MGUS), asymptomatic and symptomatic Wandenstrom's macroglobulinemia (A-WM and S-WM, respectively), and IgM-related disorders, although this last was excluded from the study because of the scarcity of patients due to probable selection biases. The observed mortality was studied related to that expected in the general population of comparable age and sex and over an equivalent period of follow-up (standardized mortality ratio, SMR). RESULTS: IgM-MGUS, A-WM, and S-WM shared many clinical aspects but, with respect to the general population, patients with IgM-MGUS had a slight but definite survival advantage, those with A-WM had a mortality rate equivalent to that of the general population, whereas the SMR of patients with S-WM was 5.4. Within A-WM and S-WM the SMR values did not vary significantly in relation to marrow lymphocyte counts or serum IgM concentrations. CONCLUSIONS: Our findings represent a prognostic validation of the applied diagnostic criteria for three of the four identifiable clinical entities and highlight the importance of symptoms over serum IgM concentration and marrow infiltration.
Asunto(s)
Inmunoglobulina M/biosíntesis , Paraproteinemias/clasificación , Paraproteinemias/patología , Adulto , Anciano , Anciano de 80 o más Años , Recuento de Células Sanguíneas , Médula Ósea/patología , Femenino , Humanos , Inmunoglobulina M/análisis , Masculino , Persona de Mediana Edad , Paraproteinemias/inmunología , Paraproteinemias/mortalidad , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Análisis de Supervivencia , Macroglobulinemia de Waldenström/clasificación , Macroglobulinemia de Waldenström/inmunología , Macroglobulinemia de Waldenström/mortalidad , Macroglobulinemia de Waldenström/patologíaRESUMEN
A series of 24 consecutive patients affected by myelofibrosis with myeloid metaplasia was reviewed. The clinical-pathological features at onset were similar to those reported in literature; in particular in all the patients we observed splenomegaly and the typical leuko-erythroblastic picture in peripheral blood. The median survival of our series was of 57 months; the deaths were caused by severe anaemia and/or infection and/or haemorrhage; the blastic terminal transformations were rare. According to other authors, unfavourable prognostic factors in our patients were: male sex, advanced age, hepatomegaly, the presence of systemic signs, anaemia, leukocytosis, leukopenia, high number of circulating erythroblasts, thrombocytopenia, osteomyelosclerosis. We have confirmed the clinical value of three staging prognostic systems: the system proposed by Njoku based on haemoglobin level and reticulocytes number, the system proposed by Visani based on haemoglobin and circulating myeloid precursors number, the system proposed by Dupriez based on haemoglobin and white blood cells number.
Asunto(s)
Mielofibrosis Primaria/complicaciones , Adulto , Anciano , Anemia/etiología , Femenino , Hemoglobinas/metabolismo , Hepatomegalia/etiología , Humanos , Leucocitosis/etiología , Leucopenia/etiología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Mielofibrosis Primaria/sangre , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Esplenomegalia/etiología , Trombocitopenia/etiología , Trombocitosis/etiologíaRESUMEN
OBJECTIVE: The "International Prognostic Index" (IPI) has been published for patients with histological intermediate grade malignancy non-Hodgkin's lymphoma (NHL) according to the Working Formulation (WF). The IPI is based on pre-treatment clinical characteristics: age, performance status, Ann Arbor stage, extranodal sites, serum lactate-dehydrogenase concentration. We investigated whether the IPI also had prognostic value for NHL patients with a low grade malignancy or high grade malignancy according to the WF. PATIENTS AND METHODS: Our series included 192 patients with NHL, diagnosed in a single institution between 1986 and 1998. In each patient the relationship among IPI, response to therapy and survival was investigated. RESULTS: The IPI turned out to be of prognostic value for response rate and survival in our unselected cohort of patients, as well. In each of the three WF classes separately (low, intermediate, high grade malignancy), the four IPI classes showed going from low to high risk substantially decreasing response rates and survival percentages. CONCLUSIONS: The IPI is confirmed as an important tool for prognostic evaluation of NHL patients: an integration of IPI, histological grading and serum beta 2-microglobulin concentration is supported.
Asunto(s)
Linfoma no Hodgkin/mortalidad , Índice de Severidad de la Enfermedad , Adulto , Factores de Edad , Anciano , Biomarcadores de Tumor/sangre , Estudios de Cohortes , Femenino , Humanos , L-Lactato Deshidrogenasa/sangre , Tablas de Vida , Linfoma no Hodgkin/sangre , Linfoma no Hodgkin/patología , Masculino , Persona de Mediana Edad , Pronóstico , Riesgo , Análisis de Supervivencia , Microglobulina beta-2/análisisRESUMEN
The aim of the present research was to verify the prognostic value of some histologic bone marrow parameters in chronic myeloproliferative disorders. Diagnostic bone marrow biopsies were revised in 38 patients with chronic myeloid leukaemia, 30 with polycythemia vera, 14 with essential thrombocythemia and 16 with idiopathic myelofibrosis-myeloid metaplasia. An unfavourable clinical evolution was associated to "granulocytic" histotype in chronic myeloid leukaemia, to "erythrocytic/granulocytic and/or megacaryocytic" histotype in polycythemia vera, to "cluster" distribution of megacaryocytes in essential thrombocythemia, to classical myelofibrosis without osteomyelosclerosis in myelofibrosis-myeloid metaplasia. Bone marrow biopsy in chronic myeloproliferative disorders provides independent diagnostic and prognostic data; we support its routine execution in this group of hematologic malignancies.