Malnutrition, Cancer Stage and Gastrostomy Timing as Markers of Poor Outcomes in Gastrostomy-Fed Head and Neck Cancer Patients.

For percutaneous endoscopic gastrostomy (PEG)-fed head and neck cancer (HNC) patients, risk markers of poor outcomes may identify those needing more intensive support. This retrospective study aimed to evaluate markers of poor outcomes using TNM-defined stages, initial anthropometry [body mass index (BMI), mid-upper arm circumference (MUAC), tricipital skinfold (TSF), mid-arm muscle circumference (MAMC)] and laboratory data (albumin, transferrin, cholesterol), with 138 patients, 42-94 years old, enrolled. The patients had cancer, most frequently in the larynx (n = 52), predominantly stage IV (n = 109). Stage IVc presented a four times greater death risk than stage I (OR 3.998). Most patients presented low parameters: low BMI (n = 76), MUAC (n = 114), TSF (n = 58), MAMC (n = 81), albumin (n = 47), transferrin (n = 93), and cholesterol (n = 53). In stages I, III, IVa, and IVb, MAMC and PEG-timing were major survival determinants. Each MAMC unit increase resulted in 16% death risk decrease. Additional 10 PEG-feeding days resulted in 1% mortality decrease. Comparing IVa/IVb vs. IVc, albumin and transferrin presented significant differences (p = 0.042; p = 0.008). All parameters decreased as severity of stages increased. HNC patients were malnourished before PEG, with advanced cancer stages, and poor outcomes. Initial MAMC, reflecting lean tissue, significantly increases survival time, highlighting the importance of preserving muscle mass. PEG duration correlated positively with increased survival, lowering death risk by 1% for every additional 10 PEG-feeding days, signaling the need for early gastrostomy.

Effects of chronic exercise training on left ventricular dimensions and function in young athletes.

BACKGROUND: Exercise training-induced hemodynamic and electrophysiological changes in the myocardium lead to physiological left ventricular (LV) hypertrophy with preserved cardiac contractility and function, which differentiates it from hypertrophic cardiomyopathy, the latter being responsible for a third of sudden deaths in young athletes. The extent and mechanisms of cardiac adaptation to aerobic training are still poorly understood, which is of concern given the increasing involvement of young athletes in intensive training regimens. OBJECTIVE: The purpose of this study was to determine the effect of sports training on LV morphology and function at rest in adolescent boys. METHODS: Anthropometric measurements, estimation of body composition and resting M-mode 2-D echocardiography were performed in twenty-four boys (aged 15-16 years), 12 swimmers and 12 soccer players. LV systolic and diastolic function were evaluated by pulsed wave Doppler measurements in four-chamber apical view. RESULTS: The swimmers were significantly heavier and had greater fat-free body mass (p < 0.01) than the soccer players. LV dimensions were strongly associated with body characteristics. Fifty percent of the swimmers exhibited end-diastolic LV internal chamber diameter above normal (> 54 mm) but no indication of ventricular hypertrophy. The swimmers had greater LV end-systolic and end-diastolic dimension than the soccer group (53.62 +/- 2.38 mm and 32.73 +/- 1.70 mm vs. 47.59 +/- 3.32 mm and 28.68 +/- 2.52 mm respectively). The differences between the groups persisted after allometric correction for body dimensions. The soccer group displayed significantly greater mean values for relative end-diastolic wall thickness (p < 0.01) but both groups showed eccentric LV enlargement (< 0.44 mm), especially the swimmers (p < 0.01). CONCLUSIONS: Both groups showed an eccentric LV hypertrophy pattern. The swimmers, in particular, revealed high levels of chamber dilatation and systolic volume at rest, consistent with better venous return due to greater frequency and intensity of aerobic training.