A retrospective analysis of cardiovascular morbidity in metastatic hormone-refractory prostate cancer patients on high doses of the selective COX-2 inhibitor celecoxib.

This data were previously presented in February 2007 at the American Society of Clinical Oncology's Prostate Cancer Symposium in Orlando, FL, USA. COX-2 inhibition has shown promise in treating prostate cancer, but concerns exist regarding the risk profile associated with this class of drugs. This study analyzes the cardiovascular and cerebral vascular morbidity associated with high doses of the COX-2 inhibitor, celecoxib, in patients with metastatic hormone-refractory prostate cancer (mHRPC). We retrospectively reviewed 67 patients with mHRPC who were treated at our institution between 1999 and 2005. All charts were reviewed for cardiac risk factors and the clinical course whilst on therapy and post-treatment was analyzed. This study included 34 patients who were on protocols that involved celecoxib 400 mg b.i.d.. Treatment ranged from 21 to 355 days, with a median of 118.5 days. There were three myocardial infarctions (MIs)--two in the study group and one in the control group. One patient had a MI while on treatment, but he had a significant cardiac disease history. There were also two cerebral vascular accidents (CVAs) in each group, although none in any patient who was on-study. Although this is a small study, these findings, in the context of other published data, suggest that some patients with advanced malignancies may still benefit from therapies involving COX-2 inhibitors without clinically significant increase in risk for MI or CVA.

Exercise-related syncope in the young athlete: reassurance, restriction or referral?

A common event in young adults, syncope is usually benign and only rarely requires more than simple reassurance. However, exercise-related syncope always requires investigation because it may be the only symptom that precedes a sudden cardiac death. Syncope that occurs during exercise tends to be more ominous than that occurring in the postexertional state. During the physical examination, the cardiovascular system should be evaluated carefully. An electrocardiogram is mandatory and requires close scrutiny, with further testing ordered as indicated. The investigation of syncope should specifically exclude known pathologic diagnoses before a complete return to activity is permitted. In cases where a diagnosis is not clearly established, consultation or referral may be warranted.

Sudden death in young athletes: screening for the needle in a haystack.

Nontraumatic sudden death in young athletes is always disturbing, as apparently invincible athletes, become, without warning, victims of silent heart disease. Despite public perception to the contrary, sudden death in young athletes is exceedingly rare. It most commonly occurs in male athletes, who have estimated death rates nearly fivefold greater than the rates of female athletes. Congenital cardiovascular disease is the leading cause of non-traumatic sudden athletic death, with hypertrophic cardiomyopathy being the most common cause. Screening athletes for disorders capable of provoking sudden death is a challenge because of the low prevalence of disease, and the cost and limitations of available screening tests. Current recommendations for cardiovascular screening call for a careful history and physical examination performed by a knowledgeable health care provider. Specialized testing is recommended only in cases that warrant further evaluation.

Moderators of the relationship between trait anxiety and information received by patients post-myocardial infarction.

The purpose of this study was to examine the relationship between trait anxiety and patients' evaluation of information they received during hospitalization post-myocardial infarction (MI), and to test the extent to which state anxiety and gender moderate this relationship. At the time of discharge from the hospital, 68 adult men and women who had had an MI responded to a demographic data sheet and to instruments measuring state anxiety, trait anxiety, and the quality of information they received during hospitalization. Data analysis indicated that the higher their trait anxiety, the less positively patients rated the quality of information they received during hospitalization post-MI. A series of regression analysis procedures designed to test for moderation indicated that neither state anxiety nor gender had a moderator effect on the relationship between trait anxiety and the quality of information received. The findings are interpreted within the theoretical perspectives that guided the study. Clinical implications of the findings are discussed.

The relationship of hospital process variables to patient outcome post-myocardial infarction.

This study examined the hospital process variables of nursing care, medical care, information, and hospital environment, as evaluated by patients, in relation to their outcome post-myocardial infarction (MI). The sample included 68 hospitalized men and women, aged 29-92, who were diagnosed with an MI. At the time of discharge, they responded to four subscales of the Patient Judgment of Hospital Quality Questionnaire, which measured the hospital process variables, and the Revised Haussman and Hegyvary Outcome Criteria Instrument for Acute Myocardial Infarction, which measured patient outcome post-MI. Data also were collected from patient charts and nurses. Correlational analyses revealed statistically significant relationships between nursing care and patient outcome, and between hospital environment and patient outcome; neither medical care nor information correlated appreciably with patient outcome post-MI. Regression analysis indicated that nursing care was the only significant predictor of patient outcome post-MI.

Epidural abscess as a complication of coronary angioplasty: a rare but dangerous complication.

We report a rare case of lumbosacral epidural abscess as a complication of coronary angioplasty in a 56-year-old male. We outline the mechanism of the abscess and the need for increased awareness and swift management of this entity.