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1.
Artigo em Inglês | MEDLINE | ID: mdl-31580459

RESUMO

OBJECTIVES: To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS). METHODS: This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome. RESULTS: A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C). CONCLUSION: Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.

2.
Anticancer Res ; 39(9): 5071-5076, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519617

RESUMO

BACKGROUND/AIM: Approximately 20% of pleural effusions are associated with cancer; about 50% require invasive procedures to perform diagnosis. Determination of the concentration of soluble cytokeratin 19-fragments (CYFRA21-1) may help identify patients with malignant effusions. However, pathologies other than cancer can increase its concentration. The identification of these possible false positives with routine tests CRP, ADA, % polymorphonuclear cells (PN) may improve diagnostic accuracy. This study aimed to determine the diagnostic accuracy of CYFRA21-1 in the detection of malignant pleural effusions and the possible false positives. MATERIALS AND METHODS: Analysis of CYFRA21-1, adenosine deaminase (ADA), C-reactive protein (CRP), and the percentage of polymorphonuclear leukocytes (PN%) in the fluid from 643 consecutive undiagnosed pleural effusions was performed. RESULTS: CYFRA21-1 showed 38.7% sensitivity and 97.3% specificity at 175 ng/ml cut-off. Effusions not suspicious of a false-positive showed 39.0% sensitivity and 98.2% specificity, while effusions suspicious of false positive showed lower sensitivity (36.4%) and specificity (95.0%). CONCLUSION: The diagnostic accuracy of CYFRA21-1 in pleural effusions can be improved by classification according to the possibility of false positives.


Assuntos
Antígenos de Neoplasias/metabolismo , Biomarcadores Tumorais , Queratina-19/metabolismo , Derrame Pleural/diagnóstico , Derrame Pleural/metabolismo , Biópsia , Feminino , Humanos , Masculino , Derrame Pleural/etiologia , Curva ROC , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
3.
Eur J Appl Physiol ; 119(4): 961-970, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30778760

RESUMO

PURPOSE: Endurance exercise competitions have shown a transient negative effect on global right ventricular (RV) performance. Most published studies are based on terrestrial sports. The aim of our study was to evaluate the cardiac effects after an open water swimming race. METHODS: We evaluated 33 healthy swimmers (mean age 40.9 ± 7.2) participating in a 9.5 km open water swimming race. All subjects underwent a standard transthoracic echocardiography including an evaluation of dimensions and myocardial ventricular deformation. Echocardiography was performed 24 h before and within the first hour of arrival at the finish line. Cardiac troponin I (cTn I), NT-ProBNP and leukocytes were also evaluated. RESULTS: No changes in left ventricle (LV) ejection fraction or LV global longitudinal strain were observed. A significant increase in RV end-diastolic area (RVEDA) was noted after the race (RVEDA at baseline 15.12 ± 1.86; RVEDA after race 16.06 ± 2.27, p < 0.05), but no changes were seen in RV fractional area change or RV global longitudinal strain. Cardiac biomarkers and leukocytes significantly increased. No association was detected between the increase in cTn I or NT-proBNP and the RV acute dilatation or LV performance. A significant association was observed between cTn I and leukocytes (r = 0.375, p < 0.05). CONCLUSIONS: An acute RV dilatation but without an impairment in RV deformation was observed after participating in an endurance swimming race. The correlation between the increase in cTn I and leukocytes, but not with ventricular performance, may support the hypothesis of an exercise-induced increase in myocardial sarcolemmal permeability due to an inflammatory response rather than myocardial injury.


Assuntos
Resistência Física/fisiologia , Natação/fisiologia , Função Ventricular Direita/fisiologia , Água , Adolescente , Adulto , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Miocárdio/metabolismo , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto Jovem
4.
Autoimmun Rev ; 18(4): 406-414, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772493

RESUMO

AIM: To analyse the clinical features, laboratory data and foetal-maternal outcomes, and follow them up on a cohort of 1000 women with obstetric antiphospholipid syndrome (OAPS). METHODS: The European Registry of OAPS became a registry within the framework of the European Forum on Antiphospholipid Antibody projects and was placed on a website in June 2010. Thirty hospitals throughout Europe have collaborated to carry out this registry. Cases with obstetric complaints related to antiphospholipid antibodies (aPL) who tested positive for aPL at least twice were included prospectively and retrospectively. The seven-year survey results are reported. RESULTS: 1000 women with 3553 episodes were included of which 2553 were historical and 1000 were latest episodes. All cases fulfilled the Sydney classification criteria. According to the laboratory categories, 292 (29.2%) were in category I, 357 (35.7%) in IIa, 224 (22.4%) in IIb and 127 (12.7%) in IIc. Miscarriages were the most prevalent clinical manifestation in 386 cases (38.6%). Moreover, the presence of early preeclampsia (PE) and early foetal growth restriction (FGR) appeared in 181 (18.1%) and 161 (16.1%), respectively. In this series, 448 (44.8%) women received the recommended OAPS treatment. Patients with recommended treatment had a good live-birth rate (85%), but worse results (72.4%) were obtained in patients with any treatment (low-dose aspirin (LDA) or low-molecular-weight heparin (LMWH) not on recommended schedule, while patients with no treatment showed a poor birth rate (49.6%). CONCLUSION: In this series, recurrent miscarriage is the most frequent poor outcome. To avoid false-negative diagnoses, all laboratory category subsets were needed. OAPS cases have very good foetal-maternal outcomes when treated. Results suggest that we were able to improve our clinical practice to offer better treatment and outcomes to OAPS patients.


Assuntos
Síndrome Antifosfolipídica/epidemiologia , Complicações na Gravidez/epidemiologia , Aborto Habitual/tratamento farmacológico , Aborto Habitual/epidemiologia , Aborto Habitual/etiologia , Adulto , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/complicações , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Aspirina/uso terapêutico , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Recém-Nascido , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/imunologia , Resultado da Gravidez , Sistema de Registros , Estudos Retrospectivos , Adulto Jovem
5.
Respir Res ; 18(1): 103, 2017 05 25.
Artigo em Inglês | MEDLINE | ID: mdl-28545517

RESUMO

BACKGROUND: Pleural effusions present a diagnostic challenge. Approximately 20% are associated with cancer and some 50% require invasive procedures to perform diagnosis. Determination of tumour markers may help to identify patients with malignant effusions. Two strategies are used to obtain high specificity in the differential diagnosis of malignant pleural effusions: a) high cut-off, and b) fluid/serum (F/S) ratio and low cut-off. The aim of this study is to compare these two strategies and to establish whether the identification of possible false positives using benign biomarkers - ADA, CRP and % of polymorphonuclear cells - improves diagnostic accuracy. METHODS: We studied 402 pleural effusions, 122 of them malignant. Benign biomarkers were determined in pleural fluid, and CEA, CA72-4, CA19-9 and CA15-3 in pleural fluid and serum. RESULTS: Establishing a cut-off value for each TM for a specificity of 100%, a joint sensitivity of 66.5% was obtained. With the F/S strategy and low cut-off points, sensitivity was 77% and specificity 98.2%, Subclassifying cases with negative benign biomarkers, both strategies achieved a specificity of 100%; sensitivity was 69.9% for single determination and 80.6% for F/S ratio. CONCLUSIONS: The best interpretation of TM in the differential diagnosis of malignant pleural effusions is obtained using the F/S ratio in the group with negative benign biomarkers.


Assuntos
Biomarcadores Tumorais/metabolismo , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Técnicas Eletroquímicas/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/metabolismo , Adulto Jovem
6.
Anticancer Res ; 35(10): 5655-60, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26408739

RESUMO

BACKGROUND: The usefulness of tumor markers in the differential diagnosis of cancer in patients with ascites remains a matter of controversy. Few studies have reported the measurement of cancer antigen 125 (CA125) and cytokeratin 19 soluble fragments (CYFRA21-1) in ascitic fluid. The aim of the present study was to evaluate the diagnostic accuracy of these tumor markers in the detection of malignant ascites. MATERIALS AND METHODS: We analyzed CA125 and CYFRA21-1 from 143 consecutive undiagnosed patients with ascitis. RESULTS: Use of CA125 gave a sensitivity of 39.7% and a specificity of 98.8%, and CYFRA21-1 a sensitivity of 50.0% and a specificity of 97.6% in differential diagnosis of malignant ascites. For combined use of CA125 plus CYFRA21-1, sensitivity was 65.5% and specificity 96.5%. In patients with negative cytology, these two tumor markers had a sensitivity of 50% and a specificity of 96.5%. CONCLUSION: The determination of tumor markers in ascitic fluid could be useful for the diagnostic assessment of patients with ascites.


Assuntos
Antígenos de Neoplasias/metabolismo , Ascite/diagnóstico , Biomarcadores Tumorais/metabolismo , Antígeno Ca-125/metabolismo , Queratina-19/metabolismo , Neoplasias/complicações , Derrame Pleural Maligno/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ascite/etiologia , Ascite/metabolismo , Antígeno Carcinoembrionário/metabolismo , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias/patologia , Derrame Pleural Maligno/etiologia , Derrame Pleural Maligno/metabolismo , Prognóstico , Curva ROC
7.
Clin Chem Lab Med ; 53(3): 485-91, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25274947

RESUMO

BACKGROUND: Diagnosing patients with signs or symptoms suggestive of cancer is difficult. Serum tumor markers (TM) may be useful, but it is known that a range of pathologies other than cancer can increase their concentrations and so TM data must be interpreted with caution. The aim of this study is to determine the diagnostic accuracy of TMs in patients with signs or symptoms of cancer. METHODS: We prospectively studied 234 patients seen at rapid diagnostic units who presented signs or symptoms suggestive of cancer. Ninety patients had wasting syndrome, 74 had pulmonary symptoms and 70 other presentations. CYFRA21-1, CEA, CA19-9, total bilirubin and creatinine were determined. The final diagnosis was obtained after 6 months' follow-up. Patients were classified according to the absence (group A) or presence (group B) of abnormal bilirubin or creatinine. RESULTS: Of the 234 patients studied, 103 (44.0%) had tumors diagnosed. Cut-off points for each TM were calculated for a specificity of 100%. For the total group, the values were CYFRA21-1, 15 µg/L, CEA, 43.8 µg/L and CA19-9, 7428 KU/L, with an overall sensitivity of 46.6%. For group A (n=142), the following cut-off points were established: CYFRA21-1, 7.8 µg/L, CEA, 13.8 µg/L and CA19-9, 101 KU/L, obtaining a sensitivity of 68.6%. For group B (n=92), the values were the same as for the whole group, and a sensitivity of 42.4% was achieved. CONCLUSIONS: We conclude that TMs can aid diagnosis in these patients with signs or symptoms suggestive of cancer. Their sensitivity can be improved by using different cut-off points in the presence and absence of renal and hepatic dysfunction.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Colorretais/sangue , Neoplasias Colorretais/diagnóstico , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/diagnóstico , Idoso , Antígenos de Neoplasias/sangue , Antígenos Glicosídicos Associados a Tumores/sangue , Bilirrubina/sangue , Antígeno Carcinoembrionário/sangue , Creatinina/sangue , Feminino , Humanos , Queratina-19/sangue , Masculino , Estudos Prospectivos
9.
BMC Cardiovasc Disord ; 13: 32, 2013 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-23617767

RESUMO

BACKGROUND: In recent decades, several studies have assessed the value of cardiac rehabilitation as secondary prevention and have reported substantial reductions in readmissions. However, conclusive evidence is scarce. The present study aims to evaluate the efficacy of a supervised exercise training program for improving percentages of hospital readmission for cardiac causes in patients with myocardial ischemia in the first year after a cardiac event. The effect on all-cause readmission, all-cause mortality, functional capacity, quality of life and adherence to regular exercise is also discussed. METHODS/DESIGN: This study will be conducted as a randomized controlled trial. Eligible patients will be randomly assigned to a control group receiving standard care or to an intervention group which, in addition to standard care, will take part in a supervised exercise training program consisting of three hours a week (spread over three alternate days) of supervised exercise training for 10 weeks. Both groups will perform an exercise stress test and a blood test during the first and third month after hospital discharge. The follow-up period will be 12 months after hospital discharge. The primary outcome measures will be the percentage of patients readmitted, total number of readmissions and length of hospitalization for cardiac disease during the first year after hospital discharge, and time to first hospital admission for cardiac disease. DISCUSSION: A representative group of hospitalized patients after myocardial ischemia will be studied in order to provide comprehensive data on the potential impact of a supervised exercise training program on hospital readmission rates. TRIAL REGISTRATION: Current Controlled Trials ISRCTN57634424.


Assuntos
Terapia por Exercício/métodos , Isquemia Miocárdica/terapia , Readmissão do Paciente/estatística & dados numéricos , Causas de Morte , Avaliação da Deficiência , Teste de Esforço , Humanos , Tempo de Internação , Cooperação do Paciente , Educação de Pacientes como Assunto , Qualidade de Vida , Prevenção Secundária
10.
Int J Biol Markers ; 27(3): e257-62, 2012 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-22815214

RESUMO

AIMS: The objective of the present study is to determine the prognostic value of clinical variables and biomarkers in patients with advanced stages of NSCLC and establish a prognostic classification of these patients. METHODS: For 135 patients with advanced NSCLC we determined their clinical variables and their levels of CEA, CA 125, CYFRA 21-1, albumin, LDH, erythrosedimentation and leukocytes. RESULTS: Multivariate analysis identified PS (ECOG) >1, metastases, no anti-neoplastic treatment, CA 125 >35 U/mL, CYFRA 21-1 >3.3 ng/mL and leukocytes >10'000/µL, as independent prognostic factors for survival. Patients were classified into 3 groups according to the number of adverse prognostic factors (APF). One point was assigned for each APF, except for chemotherapy treatment. Patients with 0-1 APF represented our reference group: patients with 2-3 APF had HR=2.7 (95% CI: 1.5-4.6), while patients with 4-5 APF had HR=8.8 (95% CI: 4.6-16.8). This "score" maintained the differences between risk groups both in patients who received antineoplastic treatment and in those who did not. CONCLUSION: The application of a score that includes clinical data and biomarkers may improve the prognostic classification of NSCLC patients.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma Pulmonar de Células não Pequenas/química , Neoplasias Pulmonares/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Carcinoma Pulmonar de Células não Pequenas/sangue , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Fatores de Risco
11.
Tumour Biol ; 33(5): 1661-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22678976

RESUMO

The utility of tumour markers (TM) in the differential diagnosis of cancer in serous effusion (fluid effusion (FE)) has been the subject of controversy. The aim of this study was to prospectively validate our previous study and to assess whether the addition of adenosine deaminase (ADA), C-reactive protein (CRP) or percentage of polymorphonuclear cells (%PN) allows the identification of false positives. In this study, carcinoembryonic antigen, cancer antigen 15-3, cancer antigen 19-9, ADA, CRP and %PN in FE were determined in 347 patients with 391 effusions. Effusions were considered as malignant effusion when at least one TM in serum exceeded the cutoff and the ratio FE/S was higher than 1.2. Also, cases with values of ADA, CRP and %PN above the established cutoffs in serous effusion were considered as potential false positives. The combined sensitivity and specificity of the three TM was 76.2 % (95 % confidence intervals (CI) 67.8-83.3 %) and 97.0 % (95 % CI 94.1-98.7), respectively. Subanalysis of the 318 cases with previous criteria and negative ADA, CRP and %PN obtained sensitivities of 78.4 % (95 % CI 69.4-85.6) and a specificity of 100 % (95 % CI 98.2-100). The results obtained validate our previous study and are improved with the addition of ADA, CRP and %PN. TM in serous effusions and serum could be useful for the diagnostic assessment of patients with serous effusions.


Assuntos
Biomarcadores Tumorais/química , Exsudatos e Transudatos/química , Derrame Pleural Maligno/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antígeno CA-19-9 , Antígeno Carcinoembrionário , Criança , Exsudatos e Transudatos/citologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural Maligno/química , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Adulto Jovem
12.
Clin Chem Lab Med ; 50(5): 927-9, 2011 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-22117782

RESUMO

BACKGROUND: Biological variation is important for determining analytical goals and for establishing the magnitude of change between two consecutive measurements. The aim of this study was to determine the biological variation for S100ß and lactate dehydrogenase in patients diagnosed with malignant melanoma but without evidence of disease recurrence. METHODS: The biological variation of S100ß and lactate dehydrogenase was estimated from a mean of four consecutive measurements in 32 patients diagnosed with malignant melanoma but without evidence of disease recurrence, 3 months after tumor resection or 4 months after finishing adjuvant treatment. The mean sampling interval was 3 months. RESULTS: Mean concentrations of S100ß and lactate dehydrogenase were 0.0557 µg/L and 6.3 µkat/L, respectively. Between-run analytical variation was 3.5% at 0.181 µg/L for S100ß and 3.5% at 2.83 µkat/L for lactate dehydrogenase. Biological variations obtained for S100ß and lactate dehydrogenase were 14.2% and 8.2%, respectively. The analytical goals (defined as 50% of biological variation) were 7.1% for S100ß and 4.1% for lactate dehydrogenase. CONCLUSIONS: The estimation of biological variation allows us to calculate analytical goals and reference change values. These are necessary tools for the correct interpretation of serial measurements in patient follow-up.


Assuntos
Testes de Química Clínica/métodos , L-Lactato Desidrogenase/análise , Melanoma/química , Fatores de Crescimento Neural/análise , Proteínas S100/análise , Biomarcadores Tumorais/análise , Testes de Química Clínica/normas , Intervalo Livre de Doença , Humanos , Melanoma/terapia , Pessoa de Meia-Idade , Valores de Referência , Risco , Subunidade beta da Proteína Ligante de Cálcio S100
13.
Clin Chem Lab Med ; 49(10): 1605-20, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21892908

RESUMO

Tumour markers are a very heterogeneous group of molecules that are generally found in very small concentrations in the plasma and serum of healthy individuals. In the process of neoplastic differentiation the cell can synthesize, release, or induce synthesis of other cells, thus increasing their concentration in plasma and serum. These substances may also increase their plasma concentration in patients without cancer due to processes that increase the release or reduce catabolism, and so give rise to false positives. An understanding of the main physiopathological processes that increase the concentrations of these substances could improve our interpretation of tumour markers and their clinical application. In this study we review the physiopathological processes that may increase the plasma concentrations of tumour markers. We performed a bibliography review in PubMed, searching for causes of false positives for the following tumour markers: α-Fetoprotein, CA 125, CA 15-3, CA 19-9, CA 72-4, carcinoembryonic antigen, CYFRA 21-1, squamous cell carcinoma, prostatic specific antigen, ß(2)-microglobulin, choriogonadotropin (ß chain), chromogranin A, neuron specific enolase, HER2-neu, progastrin releasing peptide, S-100, and thyroglobulin. The results favour the use of tests which can identify pathological processes that may increase tumour marker concentrations.


Assuntos
Biomarcadores Tumorais/sangue , Reações Falso-Positivas , Humanos , Neoplasias/sangue
14.
Clin Chem Lab Med ; 48(12): 1799-801, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20828364

RESUMO

BACKGROUND: Knowledge of biological variation (BV) is important for determining analytical goals and for establishing the magnitude of change between two consecutive measurements which indicate change in a patients' health status. The aim of this work is to determine the BV for total choriogonadotropin (ß chain) (ß-hCG) and α-fetoprotein (AFP) in patients diagnosed with testicular cancer but with no evidence of recurrence of disease. METHODS: We estimated BV from a mean of five consecutive measurements in 28 patients diagnosed with testicular cancer, 3 months after tumor resection or 4 months after complete treatment with chemotherapy. The mean sampling interval was 3 months. RESULTS: The mean concentrations of α-fetoprotein and choriogonadotropin (ß chain) were 3.9 µg/L and 0.79 IU/L, respectively. Between-run analytical variation was 7.1% at 4.1 µg/L for α-fetoprotein, and 19% at 0.65 IU/L for choriogonadotropin (ß chain). BV obtained for α-fetoprotein and choriogonadotropin (ß chain) was 12.4% and 16.7%, respectively, and the reference change value (RCV) for one-tail showed 38.2% and 60.7% for α-fetoprotein and choriogonadotropin (ß chain), respectively. CONCLUSIONS: The estimation of BV allows us to calculate analytical goals and RCVs, necessary tools for the correct interpretation of serial measurements in the follow-up of patients.


Assuntos
Gonadotropina Coriônica/análise , Neoplasias Testiculares/diagnóstico , alfa-Fetoproteínas/análise , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Neoplasias Testiculares/terapia
15.
Scand J Clin Lab Invest ; 68(5): 415-20, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19172698

RESUMO

OBJECTIVE: N-terminal pro-brain natriuretic peptide (Nt-proBNP) is a marker of left ventricular function. Although many factors can increase left ventricular dysfunction in haemodialysis patients, the role of Nt-proBNP is uncertain. MATERIAL AND METHODS: Serum concentrations of Nt-proBNP and troponin T were measured by electrochemiluminescence and C-reactive protein by immunoturbidimetry in 52 dialysis patients followed-up for 36 months. RESULTS: Nt-proBNP correlated (p<0.05) with time on haemodialysis (rho=0.345), left ventricular mass index (r=0.596), troponin T level (r=0.605) and age (r=0.296). Patients with a history of heart disease showed higher levels of Nt-proBNP (median; minimum-maximum ngl/L) (15,571; 1,553-209,451) than those without (4,535; 751-115,078) (p<0.01). Sensitivity and specificity of Nt-proBNP in the detection of left ventricular dysfunction (ventricular ejection fraction < 45%) were 1.0 and 0.782, respectively. In the univariate analysis, patients with Nt-proBNP levels > or = 33,314 ng/L, CRP > or = 5 mg/L or troponin T > or = 0.1 microg/L had poorer probabilities of 1-year, 2-year and 3-year survival than patients with lower levels. Unfavourable prognostic factors in the multivariate analysis were CRP > 5 mg/L and Tn T > 0.1 microg/L. CONCLUSIONS: Nt-proBNP showed good diagnostic performance for detecting left ventricular dysfunction and was an important predictor of mortality in haemodialysis patients in the univariate analysis. In the multivariate analysis, Nt-proBNP lost its prognostic value, whereas for CRP and Tn T it was maintained.


Assuntos
Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Diálise Renal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida
17.
Tumour Biol ; 25(5-6): 276-81, 2004 Sep-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-15627892

RESUMO

We evaluated the diagnostic utility of simultaneous determination of 5 tumor markers, CEA, CA 125, CA 15-3, CA 19-9 and cytokeratin 19 (CYFRA 21-1), in fluid and serum from 101 patients, 52 with pleural effusion (22 malignant) and 49 patients with ascites (14 malignant). Tumor marker concentrations in fluid from patients with malignant effusions were significantly higher than those obtained in benign fluids or serum. However, there are two types of tumor markers: those released/secreted by normal mesothelia such as CA 125 and cytokeratin 19 (higher levels in benign fluids than in serum) and non-released/secreted tumor markers (low concentrations in benign fluids) such as CEA, CA 19-9 and CA 15-3. The fluid/serum (F/S) ratio showed better sensitivity with maximum specificity than a single determination in fluid for CEA, CA 15-3 and CA 19-9, but not for CA 125 and CYFRA. The combination of a F/S ratio greater than 1.2 and a cut-off of 5 ng/ml for CEA, 30 U/ml for CA 15-3 and 37 U/ml for CA 19-9 showed sensitivities of 58, 57 and 44%, respectively, and a specificity of 100%, with a combined sensitivity of 82% for overall effusions and 79% for fluids with negative cytology with a specificity of 100%. In conclusion, the use of the F/S ratio in nonsecreted tumor markers such as CEA, CA 19-9 and CA 15-3 improve the sensitivity and specificity and allow standardization of the cut-off.


Assuntos
Antígenos de Neoplasias/análise , Ascite/diagnóstico , Ascite/patologia , Biomarcadores Tumorais/análise , Derrame Pleural/diagnóstico , Derrame Pleural/patologia , Área Sob a Curva , Diagnóstico Diferencial , Humanos , Estudos Prospectivos , Valores de Referência , Sensibilidade e Especificidade
18.
Anticancer Res ; 23(5b): 4277-81, 2003 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-14666638

RESUMO

The usefulness of tumor markers in non-small cell lung carcinoma (NSCLC) is not well defined. The aim of this study was to determine the predictive value for response to treatment and prognosis of pretreatment concentrations of tumor markers. The pretreatment levels of CEA, CA125 and CYFRA21-1 were determined by electrochemoluminiscence in 48 patients with advanced stage (IIIA-IV) NSCLC treated with platin-based chemotherapy. The sensitivity for CYFRA21-1, CA125 and CEA was 66.7%, 45.8% and 47.3%, respectively. The predictive factors for non-response to treatment were CA125 > 35 KU/L (OR = 5.36; p = 0.017) and presence of metastasis (OR = 6.92; p = 0.007). The prognostic factors for survival were Performance Status > 1 (HR = 4.22; p = 0.0002), presence of metastasis (HR = 3.1; p = 0.0028) and CA125 > 35 KU/L (HR = 2.33; p = 0.02). In conclusion, CA125 is a predictive factor for response to treatment and a prognostic factor for survival in patients with NSCLC treated with chemotherapy.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Carcinoma Pulmonar de Células não Pequenas/metabolismo , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/metabolismo , Idoso , Idoso de 80 Anos ou mais , Antígenos de Neoplasias/metabolismo , Antígeno Ca-125/metabolismo , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Queratina-19 , Queratinas , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Prognóstico , Análise de Sobrevida
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