Gender and age related predictive value of walk test in heart failure: do anthropometrics matter in clinical practice?

BACKGROUND: The six-minute walk test (6 WT) is a valid and reliable predictor of morbidity and mortality in chronic heart failure (CHF) patients, frequently used as an endpoint or target in clinical trials. As opposed to spiroergometry, improvement of its prognostic accuracy by correction for height, weight, age and gender has not yet been attempted comprehensively despite known influences of these parameters. METHODS: We recorded the 6 WT of 1035 CHF patients, attending clinic from 1995 to 2005. The 1-year prognostic value of 6 WT was calculated, alone and after correction for height, weight, BMI and/or age. Analysis was performed on the entire cohort, on males and females separately and stratified according to BMI (<25, 25-30 and >30 kg/m(2)). RESULTS: 6 WT weakly correlated with age (r=-0.32; p<0.0001), height (r=0.2; p<0.0001), weight (r=0.11; p<0.001), not with BMI (r=0.01; p=ns). The 6 WT was a strong predictor of 1-year mortality in both genders, both as a single and age corrected parameter. Parameters derived from correction of 6 WT for height, weight or BMI did not improve the prognostic value in univariate analysis for either gender. Comparison of the receiver operated characteristics showed no significant gain in prognostic accuracy from any derived variable, either for males or females. CONCLUSION: The six-minute walk test is a valid tool for risk prediction in both male and female CHF patients. In both genders, correcting 6 WT distance for height, weight or BMI alone, or adjusting for age, does not increase the prognostic power of this tool.

Infertility as the first symptom of male genitourinary tuberculosis.

The diagnosis of male genitourinary tuberculosis is seldom apparent until the disease is far advanced. The earliest clinical symptoms in most cases are epididymitis, dysuria, and hematuria. In the present case, evaluation of a 26-year-old male complaining about primary infertility revealed leukocytospermia and a normal sperm count. The diagnosis of genitourinary tuberculosis was based on positive morning urine culture. Infertility is an uncommon first sign of male genitourinary tuberculosis, but may be a clue to early diagnosis, as demonstrated in the present case.

[Sexuality and sterility]. / Sexualität und Sterilität.

Sterility may influence the life of man and woman in different ways. Besides influences of social life, family and even profession most important are the sexual disturbances: in 10% of patients libido is diminished by the regimentation of intercourse, and even erectile dysfunction may occur in up to 20% of men. Remarkably also the treatment of sterility may cause sexual problems which may be the reason to stop any treatment. In sterility patients sexual problems have to be interpreted as sign of disturbed relations, and in many cases all sterility treatments have to be stopped and psychological aid has to be offered.

[Transferrin concentration in seminal plasma in testicular varicocele with various sperm concentrations and various forms of azoospermia]. / Transferrinkonzentrationen im Seminalplasma bei Varikozele testis, bei unterschiedlichen Spermienkonzentrationen und verschiedenen Formen der Azoospermie.

Seminal plasma transferrin concentrations were measured in semen samples from 424 men attending a fertility unit. There was a clear positive correlation between seminal plasma transferrin concentration and sperm density: transferrin concentrations decrease with decreasing sperm density and are lowest in patients with azoospermia and those who have undergone vasectomy. The differences between the various groups in sperm density are highly significant, but individual data counts also vary widely. Furthermore, it was demonstrated that in polyzoospermia the seminal plasma transferrin concentration is increased, suggesting primary tubular hyperactivity. No correlations with other seminal parameters or hormonal values were found. Seminal plasma transferrin concentrations in normozoospermia and in varicocele testis or in cases with increased numbers of immature germ cells in the ejaculate were not significantly different. This may be interpreted as indicative of intact secretory activity of Sertoli cells in both varicocele and increased desquamation of immature germ cells. The absence of correlation with any of several important spermatological parameters and our inability to differentiate between azoospermia caused by obstruction and by tubular impairment indicate that seminal plasma transferrin is not a useful marker for Sertoli cell function or for seminiferous tubular dysfunction.

Directional, enhanced fluorescence from molecules near a periodic surface.

We extend the research of Holland and Hall on the use of waveguide modes to enhance the fluorescent signal from a layer of molecules [Opt. Lett. 10,414 (1985)] by incorporating a grating into the basic sample structure. Our measurements show that the combination of the directionality imposed by the grating and the previously reported enhancement mechanism has the effect of increasing the intensity of the signal detected over a narrow angular range from a layer of fluorescing molecules by a factor of ~ 1000 over that from a reference sample. Simultaneously our method allows for both polarization and wavelength discrimination of the emitted radiation because of the characteristic nature of the incorporated grating.

A prospective study of skeletal changes during short-term acitretin therapy.

We prospectively analyzed skeletal changes of 16 patients who were treated with acitretin for various disorders of keratinization at doses of 10-50 mg/day (overall mean 0.4 mg/kg/day) for 7-12 months (mean 11.4 months). Skeletal changes from pretherapy findings were observed in 5 patients. In 4 of 5 patients they appeared to be linked to a preexisting degenerative pathology and could not be attributed to acitretin therapy. However, in 1 patient a spinal osseous side effect could not be excluded. No retinoid-induced extraspinal tendon or ligament calcifications were observed.

Frequency of congenital nevi, nevi spili and café-au-lait spots and their relation to nevus count and skin complexion in 939 children.

To determine the prevalence of congenital melanoevocytic nevi (CMN), of so-called congenital nevus-like nevi (CNLN), nevi spili (NS) and café-au-lait spots (CLS) in childhood, a series of 939 children aged 8-16 years had total skin examination. CMN/CNLN were observed in a frequency of 5.9%, NS in 2.1% and CLS even in 32.7%. Except CLS (which occurred more frequently in boys), all of these lesions were equally represented in both sexes. According to the classification of Kopf and coworkers, 44/55 CNM/CNLN were small and 11/55 medium-sized. CMN/CNLN affected preferentially trunk and upper limbs while head and neck were spared. Such nevi occurred more frequently in dark types of skin complexion and showed a tendency to be more frequent in groups of patients with increased average number of acquired melanonevocytic nevi. Remarkably, CLS were also found in 23/55 (41.7%) children with CMN/CNLN and in 12/20 (60%) children with NS (in a higher frequency than such combinations have to be expected). Compared with the data from other studies, both CMN/CNLN and CLS in our patients were observed in highest prevalence in the literature. Since the frequency of CLS in adults is much lower, it cannot be ruled out that some of the CLS disappear in adolescence.

[Focal melanocytic atypia in dysplastic nevus cell nevi. Results of a serial section study]. / Fokale melanozytäre Atypien in dysplastischen Nävuszellnävi. Resultate einer Serienschnittuntersuchung.

Dysplastic nevi were diagnosed according to the ABCDE rule for recognition of early melanomas in 11 patients with familial dysplastic nevus syndrome (DNS) and in 39 patients with the sporadic variant of DNS. All these 50 patients exhibited multiple dysplastic nevi. On routine histological examination melanocytic atypia confirming the histological diagnosis of dysplastic nevus was found only in 12/50 cases. However, when cut consecutively dysplastic nevi with melanocytic atypia were diagnosed in 17 further cases (34%). In most cases (72.4%) only a mild degree of atypia (grade I) was found. Dysplastic nevi with severe melanocytic atypia (grades II-III) were found in all groups of sporadic and familial variants of DNS (with and without melanoma). To improve the prognostic value of the histological examination in dysplastic nevi significantly it must be of interest to add the degree of melanocytic atypia. With increasing degree of melanocytic atypia also the typical histological feature of dysplastic nevi become more significant. Since such atypia in dysplastic nevi is not necessarily sited in the centre of the lesion and since in most cases melanocytic atypia occurs focally, we believe that histological examination of dysplastic nevi must be undertaken by step section. Lesions suspected of being dysplastic nevi must be excised with margins of at least 2-5 mm for a correct histological diagnosis.

[Melanoma mortality in switzerland 1970-1986]. / Die Melanommortalität in der Schweiz 1970-1986.

Time trends of mortality from malignant melanoma in Switzerland are presented. The death rates are based on the death certificates routinely collected by the Federal Office of Statistics and are age-adjusted (standard Europe). Mortality rates in Switzerland are the highest of any country in central Europe. Time trends in mortality show a significant increase in the elderly (aged over 64 years), whereas in the younger age group (30-64 years), the trend remains constant (no significant increase). For all age groups there is a significant increase in mortality (26% for men and 20% for women). Risk factors are presented. A higher risk of mortality from malignant melanoma among upper socioeconomic strata also applies to Switzerland. In view of the reported time trend in mortality, it is suggested that elderly people be addressed more specifically in future melanoma education campaigns.

[Increased incidence of multiple melanoma in sporadic and familial dysplastic nevus cell syndrome]. / Gehäufte Mehrfachmelanome bei sporadischem und familiärem dysplastichen Nävuszellnävus-Syndrom.

In 280 melanoma patients all data concerning familial and personal history, histology, and therapy were verified. All patients underwent total-body skin examination to check for the presence of dysplastic nevus syndrome (DNS). In 257/280 patients (91.8%) solitary melanomas were found, while in 23/280 patients (8.2%) multiple melanomas occurring simultaneously or consecutively were ascertained. Surprisingly, among the 12/280 patients (4.2%) with familial variants of melanoma, multiple melanomas were not found in a increased frequency. In patients with DNS (regardless of whether sporadic or familial) the frequency of multiple melanomas is higher: in patients with solitary melanomas DNS was found in 27/257 (10.5%), while in patients with multiple melanomas DNS was diagnosed in 11/23 (47.8%) (P less than 0.0005). In both groups (solitary and multiple melanomas) the mean age of patients with DNS was around 10 years lower. The frequency of additional primary malignancies in patients with cutaneous melanomas was 8.6%, and did not vary according as whether patients had solitary or multiple melanomas with or without DNS.

[Management of acquired nevus-cell nevi in clinical practice]. / Management von erworbenen Nävuszellnävi in der Praxis.

The alarming increase in the incidence of malignant melanoma and the lack of an effective therapy in metastasizing forms focussed the interest on the early curable stages and the precursors (or tumor markers) of malignant melanoma such as dysplastic nevi. Familial variants of dysplastic nevus syndrome (DNS) are associated with increased risk for malignant melanoma; the significance of sporadic dysplastic nevi, however, remains to be elucidated. Until more is known about which clinically dysplastic lesions, if any, can be left with complete safety, it is reasonable to remove all nevi which one cannot say are with certainty benign.

Frequency of acquired melanonevocytic nevi and their relationship to skin complexion in 939 schoolchildren.

In 939 schoolchildren aged 8-16 years skin complexion was determined by a system of seven categories Anamnestic data concerning tanning ability and history of sunburns, however, were not considered owing to their obvious unreliability in children. Mean nevus count was 17.97, was significantly higher in boys than in girls and increased with age. There was a clear relation of mean nevus number and skin complexion: in fair skin type nevi are most frequent, decreasing in number by increasing of pigment content. Additionally, children with freckles have higher mean nevus count in every category of skin complexion. All literature data critically reviewed as dealing with mean mole count are not comparable in several respects. In different races, however, such studies may serve as a basis for subsequent investigations concerning the questions of probably increasing number of melanonevocytic nevi.

[Multiple primary melanomas of the hair follicles--a special form of malignant melanoma of the skin]. / Multiple primäre Melanome der Haarfollikel--eine Sonderform des malignen Melanoms der Haut.

Within 5 years, a 79-year-old male patient developed multiple primary melanomas, all which originated from the hair follicles. The fact that this patient was elderly, the high number of primary tumors, their follicular origin, and the lack of a history of such disorders in the patient's family caused us to postulate that multiple primary follicular melanomas represent a special form of malignant melanoma of the skin.

[Which malignant melanomas are genetically determined?]. / Welche malignen Melanome sind genetisch determiniert?

There are familial forms in 1%-11% of all malignant melanomas. The familial type of malignant melanoma, however, is heterogeneous and not clearly defined. Three groups of familial malignant melanoma may be distinguished: malignant melanoma without additional skin disorders, melanoma associated with disturbances in the pigmentation system (including albinism, congenital nevi, and the dysplastic nevus syndrome), and malignant melanoma in other forms of genodermatosis. The most frequent variant of familial malignant melanoma is dysplastic nevus syndrome (a skin disease whose biologic and clinic importance has been fully recognized in the past decade).

Acitretin in the symptomatic therapy for severe recessive x-linked ichthyosis.

Eight men with severe recessive x-linked ichthyosis were treated with acitretin, the main metabolite of etretinate, during four months. All of the patients showed marked clinical improvement of scaling during therapy. Hypervitaminosis A-type adverse reactions were observed in all patients. Although the overall tolerance was good, therapy was interrupted in one atopic patient because of pruritus. There were no undesirable laboratory changes in values. Thirty-five milligrams of acitretin daily provided the best efficacy, with minimal side effects. The beneficial effect of this retinoid lasted between four and six weeks after therapy was stopped. These results suggest that acitretin is a useful agent in the symptomatic therapy of severe recessive x-linked ichthyosis resistant to topical therapeutic modalities. Good results with this agent can be achieved with interval therapy adjusted to seasonal variations of the skin symptoms.