Cardiac abnormalities after aneurysmal subarachnoid hemorrhage: effects of ß-blockers and angiotensin-converting enzyme inhibitors.

BACKGROUND: Cardiac abnormalities attributed to adrenergic surge are common after aneurysmal subarachnoid hemorrhage. Prescribed medications that block adrenergic stimulation may suppress the onset of cardiopulmonary compromise in patients after aneurysmal subarachnoid hemorrhage. OBJECTIVES: To compare the incidence of early cardiac complications between patients who reported prescribed use of ß-blockers and/or angiotensin-converting enzyme inhibitors before aneurysmal subarachnoid hemorrhage and patients who did not. METHODS: A retrospective review of 254 adult patients after acute aneurysmal subarachnoid hemorrhage who were enrolled in an existing R01 study. Demographic data and history were obtained from patients'/proxies' reports and charts. Cardiac enzyme levels, 12-lead electrocardiograms, and chest radiographs were obtained on admission. Holter monitoring and echocardiograms were completed as a part of the R01 study. RESULTS: Patients reporting prescribed use of angiotensin-converting enzyme inhibitors or ß-blockers before aneurysmal subarachnoid hemorrhage had more ventricular and supraventricular ectopy on a Holter report than did patients who did not (P < .05). When age, race, sex, and injury (Fisher grade) were controlled for, patients reporting use of ß-blockers were 8 times more likely than others to have occasional to frequent ventricular ectopy (P = .02). CONCLUSION: No concrete evidence was found that exposure to adrenergic blockade before aneurysmal subarachnoid hemorrhage provides protection from neurocardiac injury.

Correlation between ED symptoms and clinical outcomes in the patient with aneurysmal subarachnoid hemorrhage.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurologic insult often presenting to the emergency department as a headache. Recognition and prompt treatment are important to good outcomes. The purpose of this analysis was to examine the presentation of aSAH patients to the emergency department and determine whether presentation predicts length of stay or death. METHODS: This is a retrospective review of data gathered from 2 existing studies. Data from patients diagnosed with acute aSAH were reviewed for symptoms, clinical presentation, history, demographics, and laboratory results. Statistical analysis was completed by use of χ(2) and regression analysis. RESULTS: This sample of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment. Symptom presentation did not appear to affect length of stay; however, survival analysis showed that patients who presented with a Hunt and Hess grade greater than 3 along with bradycardia were 15.6 times more likely to die within the first month of aSAH. DISCUSSION: Although aSAH presentation remains the same, this analysis did find a correlation between poor clinical grade and bradycardia to be a significant predictor of death at 30 days. Additional study may help to determine whether any intervention could lessen this effect. Although patient diagnosis and referral from the community emergency department to a tertiary center were relatively quick, there was a wide window of time between patient recognition of symptoms and seeking medical treatment.

Cognitive behavioral symptom management intervention in patients with cancer: survival analysis.

PURPOSE: Associations between psychological factors and cancer survival have been under debate. We retrospectively explored the effect of the Cancer Care Intervention (CCI), an individually delivered cognitive behavioral symptom management intervention on survival in individuals with cancer. METHODS: Data were obtained from a randomized controlled trial (R01 CA79280; 1997-2003) that were originally designed to evaluate the CCI to reduce symptom severity in 237 individuals with solid tumors during their first course of chemotherapy. Participants were randomized into: (1) ten-contact, 20-week CCI plus usual care (n = 118) and (2) usual care only (n = 119). Survival data as of June 2009 were censored based upon Social Security Death Index. RESULTS: Participants were mostly female (73.4%), Caucasian (92.8%), and 59.6 ± 10.5 years old. Breast (38.8%) and lung (35%) cancer were the most common cancer types. At enrollment, 66.7% of the participants had cancers at stage III or greater. Overall mortality was 53.2% (126 of 237). The CCI did not significantly affect survival (median survival, CCI = 88 months; usual care = 53.3 months; log rank = 0.30, p = 0.58). Age, stage of cancer, and surgical removal of the tumor were the only factors significantly associated with survival. Post hoc analysis stratified by cancer site and gender (women with breast cancer, women with lung cancer, men with lung cancer, and others) showed no survival effect from the CCI. CONCLUSION: In this analysis, the CCI was not associated with better survival. For future research, studies exploring survival outcomes need to consider specific characteristics of each intervention and cancer type.

Role of endothelin-1 in human aneurysmal subarachnoid hemorrhage: associations with vasospasm and delayed cerebral ischemia.

BACKGROUND: Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in the pathogenesis of vasospasm and delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients. The aim of this study was to investigate the relationship between cerebrospinal fluid (CSF) ET-1 levels and angiographic vasospasm and DCI. METHODS: Patients with aSAH were consented (n = 106). Cerebral vasospasm was determined by angiography. DCI was determined by transcranial Doppler (TCD) results and/or angiogram results with corresponding clinical deterioration. CSF ET-1 levels over 14 days after the initial insult was quantified by ELISA. ET-1 analysis included a group-based trajectory analysis and ET-1 exposure rate during 24, 48, and 72 h prior to, as well as 72 h post angiography, or clinical deterioration. RESULTS: Trajectory analysis revealed two distinct groups of subjects with 56% of patients in the low ET-1 trajectory group (mean at day 1 = 0.31 pg/ml; SE = 0.04; mean at day 14 = 0.41 pg/ml; SE = 0.15) and 44% of patients in the high ET-1 trajectory group (mean at day 1 = 0.65 pg/ml; SE = 0.08; mean at day 14 = 0.61 pg/ml; SE = 0.06). Furthermore, we observed that ET-1 exposure rate 72 h before angiography and clinical spasm was a significant predictor of both angiographic vasospasm and DCI, whereas, ET-1 exposure after angiography and clinical spasm was not associated with either angiographic vasospasm or DCI. CONCLUSION: Based on these results we conclude that ET-1 concentrations are elevated in a sub-group of patients and that the acute (72 h prior to angiography and clinical neurological deterioration), but not chronic, elevations in CSF ET-1 concentrations are indicative of the pathogenic alterations of vasospasm and DCI in aSAH patients.

Women's awareness of ovarian cancer risks and symptoms.

BACKGROUND: The vast majority of cases of ovarian cancer are diagnosed at stage III or IV, and five-year survival rates after diagnosis at these stages are 71% and 31%, respectively. Although a consensus among researchers on the signs and symptoms of ovarian cancer has evolved over time, whether women themselves know them isn't clear. OBJECTIVE: To assess how well informed women ages 40 and older are of ovarian cancer symptoms and risk factors. METHODS: In 2006 the National Ovarian Cancer Coalition developed an online survey with a private research firm that asked respondents about their familiarity with ovarian cancer symptoms and risk factors. Women were also asked whether they thought the Papanicolaou test diagnosed ovarian cancer (a common misconception) and whether they had discussed ovarian cancer with a physician. If they had discussed the issue, they were asked who had initiated the conversation. Data from a convenience sample of 1,235 responses to the online survey were analyzed, using descriptive and comparative statistics. Respondents were categorized by age, education level, race or ethnicity, and whether or not they knew someone with ovarian cancer. Comparisons were made to determine whether demographic factors were associated with women's knowledge of specific symptoms and risk factors associated with ovarian cancer. RESULTS: Only 15% of respondents were familiar with ovarian cancer symptoms, and more than two-thirds incorrectly believed that the Papanicolaou test diagnoses the disease. Four out of five had never had a conversation with a physician about symptoms and risk factors; among these, more than half assumed that because their physician had not initiated such a discussion, ovarian cancer was "not an issue." Of the 19% of women who'd had such discussions, two-thirds had initiated them themselves. Respondents were more knowledgeable about risk factors; 59% correctly identified personal or family history of breast, ovarian, or colon cancer, and half of respondents correctly identified genetic predisposition, as risk factors. CONCLUSIONS: Awareness of ovarian cancer symptoms and risk factors among women in the general population is low. Ovarian cancer is often diagnosed at late stages, when cure is difficult; consequently, heightening women's awareness of risk factors and symptoms might help to reduce delays in diagnosis. Nurses should provide women with specific information on symptoms and risk factors in educating them on ovarian cancer.