Thrombosis risk and survival in cancer patients with elevated C-reactive protein.

BACKGROUND: The incidence of venous thromboembolism (VTE) is increased among cancer patients. OBJECTIVE: We assessed serum levels of C-reactive protein (CRP) in order to study their prognostic significance for VTE and survival in the prospective observational Cancer and Thrombosis Study (CATS). PATIENTS AND METHODS: This study includes patients with recently diagnosed cancer or progression of disease after remission. Occurrence of VTE and information on the patients' anti-cancer-treatment are recorded. Observation ends with occurrence of objectively confirmed VTE, death or after 2 years. CRP levels were determined by an immunonephelometric method. RESULTS: We included 705 consecutive patients with solid tumors. During the observation period, VTE occurred in 43 (6.1%) patients and 413 (58.6%) died. The cumulative probability of VTE was 6.6% after 1 year. In univariate analysis, CRP (as metric variable, per double increase) was associated with VTE [hazard ratio (HR) 1.2, 95% confidence interval (CI) 1.1-1.3 P = 0.048]. However, in multivariable analysis including chemotherapy, surgery and radiotherapy, metastasis, cancer-site and sP-selectin the association with VTE (HR 1.0, 95% CI 0.9-1.2 P = 0.932) was no longer observed. CRP was clearly associated with worse survival probability with a HR of 1.3 (95% CI 1.2-1.3, P < 0.0001) in multivariable analysis. The cumulative survival after 12 months was 43% in patients with CRP above the 75th percentile (1.8 mg dL(-1) ) and 82% in those below the 75th percentile. CONCLUSIONS: In cancer patients elevated CRP was not independently associated with VTE. CRP was significantly associated with worse survival.

MicroPACS: a PC-based small PACS implementation.

To make picture archiving and communication systems (PACS) a practical reality for small-scale structures, it appears necessary to build a network that integrates and optimises production management, analysis and storage of images, and to include the ability to communicate with other similar remote structures. To solve the various technical problems related to small-scale PACS implementation, MicroPACS, a local area network, was developed around PC-like microcomputers. Every necessary function is assessed and implemented, including a centralised data-base, a distributed image bank, different storage levels and a specific task for image exchanges. An additional protocol was also developed for remote consultation through ISDN. Standardisation of image encapsulation and a point-to-point link between remote sites ensure easy transfers between heterogeneous local networks or bases and integrity of local databases.

Administrative and organization impact of PACS and its effect on the quality of care.

PACS integrated to RIS and HIS will have a significant impact on the hospital operation. This paper describes the current radiological process and indicates at what points PACS may prove to be important, in order to guarantee its successful implementation with the objective to improve patient care by better management of personnel, equipment and information.