RESUMEN
RATIONALE: Pulmonary artery enlargement (PAE) is associated with exacerbations in Chronic Obstructive Pulmonary Disease (COPD) and with survival in moderate to severe patients. The potential role of PAE in survival prediction has not been compared with other clinical and physiological prognostic markers. METHODS: In 188 patients with COPD, PA diameter was measured on a chest CT and the following clinical and physiological parameters registered: age, gender, smoking status, pack-years history, dyspnea, lung function, exercise capacity, Body Mass Index, BODE index and history of exacerbations in year prior to enrolment. Proportional Cox regression analysis determined the best predictor of all cause survival. RESULTS: During 83 months (±42), 43 patients died. Age, pack-years history, smoking status, BMI, FEV1%, six minute walking distance, Modified Medical Research Council dyspnea scale, BODE index, exacerbation rate prior to enrollment, PA diameter and PAE (diameter≥30mm) were associated with survival. In the multivariable analysis, age (HR: 1.08; 95%CI: 1.03-1.12, p<0.001) and PAE (HR: 2.78; 95%CI: 1.35-5.75, p = 0.006) were the most powerful parameters associated with all-cause mortality. CONCLUSIONS: In this prospective observational study of COPD patients with mild to moderate airflow limitation, PAE was the best predictor of long-term survival along with age.
Asunto(s)
Arteria Pulmonar/diagnóstico por imagen , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico por imagen , Índice de Masa Corporal , Disnea/diagnóstico por imagen , Disnea/mortalidad , Disnea/patología , Prueba de Esfuerzo , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Tamaño de los Órganos , Pronóstico , Modelos de Riesgos Proporcionales , Arteria Pulmonar/patología , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/patología , Pruebas de Función Respiratoria , Fumar/mortalidad , Fumar/patología , Tomografía Computarizada por Rayos XRESUMEN
AIMS: Evaluation of the accuracy of palpation, CT scan and Martínez-Gimeno Score System in the assessment of neck nodes metastasis in squamous cell carcinoma of the oral cavity. DESIGN: This is a prospective triple blind study performed in 40 consecutive patients with squamous cell carcinoma of the oral cavity. PATIENTS: 40 consecutive patients suffering primary oral squamous cell carcinoma, without any treatment before surgery, palpation or CT Scan. RESULTS: 40% of the cases showed metastasis in pathological study. Sensitivity was 100%, 94% and 75% for MGSS 13, CT scan and palpation, respectively. Specificity was 83%, 38% and 25-50% for palpation, CT scan and MGSS 13-17, respectively. Negative predictive result values were 100%, 90% and 83% for MGSS 13, CT Scan and palpation. The logistic regression analysis showed an independent predictor factor for palpation (p=0.001) and MGSS (p=0.01). The combination of MGSS and clinical palpation allowed a new design for evaluating neck metastasis in oral cancer. This method establishes 3 different groups at risk: 3 of very low (<2%), 2 of low risk (18-27%) and 1 of high risk (85%). CONCLUSIONS: MGSS predicts metastasis better than CT scan and palpation. Combination of MGSS and palpation improves the prediction of metastasis.