Faculty Bibliography

BACKGROUND: Cancer patients have an increased incidence of venous thromboembolism (VTE). Inferior vena cava (IVC) filters are used extensively in the US, and more than 40 000 are inserted annually. The impact on survival of cancer patients receiving IVC filters has not been studied. METHODS: A retrospective study examined 206 consecutive cancer patients with VTE to compare the effects of IVC filter placement with anticoagulation (AC) therapy on overall survival (OS), as measured from the time of VTE. Patients were classified into 3 treatment groups: AC (n = 62), IVC filter (77), or combination IVC filter + AC (67). RESULTS: Treatment groups did not differ with respect to age, sex, or albumin levels. Median OS was significantly greater in patients treated with AC (13 months) compared with those treated with IVC filters (2 months) or IVC + AC (3.25 months; P < .0002). IVC patients were 1.9 times more at risk of death than AC only (hazard ratio = .528; 95% confidence interval = .374 to .745). Multivariate analysis revealed that performance status and type of thrombus were not confounders and had no effect on OS. CONCLUSION: The need for the insertion of an IVC filter projected markedly reduced survival. Patients requiring an IVC filter rather than AC as initial therapy face a 2-fold increase in risk of death. Whether or not this therapeutic procedure has a positive impact on outcome in cancer patients is uncertain. Complications resulting from thrombosis were also analyzed in this cohort. A prospective randomized trial at our institution is addressing this issue

OBJECTIVE:Because serum C-reactive protein (CRP) levels correlate with the extent of inflammatory reactions, including acute strokes, we tested whether serum CRP levels on admission to a stroke rehabilitation unit help to predict functional outcome at discharge. DESIGN/METHODS:We measured serum CRP level within 72 hrs of admission to an inpatient stroke rehabilitation unit in 102 successive patients transferred to rehabilitation within 4 wks following stroke and who met inclusion criteria. RESULTS:Patients with normal levels of serum CRP (< or =9.9 mg/dl) on admission to our rehabilitation service were more likely to be discharged home rather than to an institution (66% vs. 44%, P < 0.03). These patients with normal serum CRP had higher absolute values for total functional independence measures and functional independence measures motor scores on admission, as well as on discharge (i.e., less disability). They also had fewer infections or other medical complications. However, the absolute magnitude of improvement (DeltaFIM) and length of stay were similar in the normal and elevated CRP groups. Multivariable logistic regression model did not show serum CRP level on admission to predict rehabilitation functional outcomes. CONCLUSIONS:Serum CRP level does not predict functional outcome at discharge on inpatient rehabilitation for stroke.

BACKGROUND:We reviewed previous studies comparing schizophrenia patients and healthy subjects for performance on the Iowa Gambling Task (IGT) (a laboratory task designed to measure emotion-based decision-making), and found mixed results. We hypothesize that deficits in IGT performance in schizophrenia may be more specifically related to concurrent substance use disorders. To test this hypothesis, we compared schizophrenia patients with (SCZ((+))) or without (SCZ((-))) cannabis use disorders, to healthy subjects, on measures of cognition and IGT performance. METHODS:A comprehensive battery of cognitive tests and the IGT were administered to three groups of subjects: (1) 13 subjects with DSM-IV diagnosis of schizophrenia and no concurrent substance use disorders (mean age: 28+/-12 (SD); 54% males); (2) 14 subjects with schizophrenia and concurrent cannabis use disorders (mean age: 29+/-9 (SD); 71% males); and (3) 20 healthy subjects (mean age 33+/-10 (SD); 60% males). RESULTS:Compared to the healthy group, both schizophrenia groups were cognitively more impaired, and did worse on IGT performance. There were no differences between SCZ((+)) and SCZ((-)) patients on most of the cognitive tests, and IGT performance. CONCLUSIONS:Schizophrenia patients show widespread impairments in several cognitive domains and emotion-based decision-making. These results are consistent with the evidence that schizophrenia reflects a dorsolateral and orbitofrontal/ventromedial prefrontal cortex dysfunction. More intriguing, it appears that the concurrent abuse of cannabis has no compounding effects on cognition, as well as emotion/affect-based decision-making.