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Biomedical subjects

R J Pokorski

Publications and source records attributed to R J Pokorski.

At least 19 recordsLinked to original sources
PubMed1999

Mortality risk in patients with coronary artery disease and depression.

Investigators at Duke University Medical Center studied the impact of depression on long-term mortality risk in patients with significant coronary artery disease (CAD), defined as > or = 75% narrowing of > or = 1 coronary artery. Participants were classified after testing into nondepressed, mildly depressed and moderately to severely depressed groups. From 5-10 years after the first cardiac catheterization, the mortality ratios were progressively high for the more depressed cohort.

Actuarial Analysis↗
PubMed1998

Long-term survival of patients with infective endocarditis.

BACKGROUND: Investigators in Lyon, France reported long-term outcome of 330 patients with infective endocarditis (IE). This article compares experience of the cohort to what would be expected in the general population. RESULTS: Excess mortality persisted for many years following IE. Average annual mortality ratios were highest in the first and second years (4050% and 662%, respectively) and decreased gradually thereafter to a low of 219% during duration 10-12 years. Morbidity risk following IE would also be increased because of greater likelihood of recurrent IE, heart failure, embolism, valve thrombosis, additional valve surgery, complications of anticoagulant therapy, and stroke. CONCLUSIONS: Morbidity and mortality risk remain elevated for many years following recovery from IE.

Adult↗
PubMed1998

Influence of age on survival of patients treated surgically for lower limb ischemia.

BACKGROUND: Investigators in Norway reported long-term survival experience in patients treated surgically for lower leg occlusive atherosclerotic disease over the period 1974 to 1993. RESULTS: Ten-year survival data were provided for seven age groups. Average annual mortality ratios decreased with age at time of surgery from a high of 460% in the 50-54 year-old age group to a low of 212% in patients > 80 years of age. CONCLUSIONS: Excess mortality was related to age. This same mortality pattern is observed with most impairments, i.e., mortality ratios are usually highest at younger ages, intermediate in the middle-aged people, and lower in the very elderly.

Adult↗
PubMed1998

5-year survival after bone marrow transplantation for aplastic anemia.

The International Bone Marrow Transplant Registry reported experience from 179 transplant teams worldwide on patients treated with bone marrow transplantation for severe aplastic anemia. The cohort consisted of 470 patients (283 male, 187 female), mean age 20 years, who received an HLA-identical sibling bone marrow transplant for aplastic anemia between 1988 and 1992. The etiology of aplastic anemia was usually idiopathic, with a small number of cases caused by hepatitis or toxin exposure. Congenital aplastic anemia was not considered. Expected mortality was based on the United States 1992 Total Population Mortality Table. Additional data were obtained from the author.

Adolescent↗
PubMed1997

Morbidity and mortality associated with intracranial aneurysms.

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space. It may result from a rupture of an intracranial aneurysm, bleeding from an arteriovenous malformation, hypertensive intracerebral hemorrhage with extension into the subarachnoid space, hemorrhage from an intracranial tumor, trauma, and hematologic disorders. If trauma is eliminated as a cause of SAH, more than 80% of SAHs are due to rupture of an intracranial aneurysm. This paper will focus on morbidity and mortality associated with ruptured and unruptured intracranial aneurysms.

Adult↗
PubMed1997

Effect of age on mortality experience in patients with hypertrophic cardiomyopathy.

Medical authors typically combine all patient groups to increase the amount of data available for analysis. Use of this statistical methodology generally conceals higher mortality ratios at younger ages and masks survival differences related to disease severity and comorbid impairments. This paper discusses the effects of age and clinical characteristics on mortality experience in patients with hypertrophic cardiomyopathy. Limited data suggest the mortality pattern associated with this impairment is similar to that observed with most disorders: excess mortality (compared to the general population) that is high at younger ages, intermediate in middle-aged people, and minimal in the very elderly. Optimism regarding generally favorable mortality at older ages must be tempered with caution since studies report much poorer experience in certain subgroups of elderly patients with this impairment.

Adult↗
PubMed1997

Long-term survival experience of patients with multiple sclerosis.

BACKGROUND: Long-term survival of patients with multiple sclerosis is not well characterized because this disorder is relatively uncommon and subjects must be followed for decades after onset of symptoms. This paper reports comparative mortality experience of the world's largest series on an unselected cohort with multiple sclerosis. RESULTS: Excess mortality varied with age, gender, duration since onset and diagnosis, calender year of onset, and clinical severity. CONCLUSIONS: Compared to the general population in Denmark, patients with multiple sclerosis had less favorable survival experience during long-term follow-up.

Adult↗
PubMed1997

Effect of peripheral vascular disease on long-term mortality after coronary artery bypass graft surgery.

BACKGROUND: The Northern New England Cardiovascular Disease Study Group examined the effect of cerebrovascular disease (CVD) and lower extremity disease (LED) on long-term outcome following coronary artery bypass graft (CABG) surgery in patients with coronary heart disease (CHD). This article uses data provided by the authors to quantify the mortality implications of progressively more extensive atherosclerosis. RESULTS: After successful CABG surgery, mortality ratios for patients with CHD + CVD (107%), CHD + LED (171%), and CHD + CVD + LED (195%), respectively, were 1.6 times, 2.5 times, and 2.8 times higher than mortality ratios for patients with CHD only (69%). CONCLUSIONS: The extent of peripheral vascular disease predicted mortality experience even after successful myocardial revascularization.

Actuarial Analysis↗
PubMed1997

Outcome of patients treated with a St. Jude prosthetic heart valve.

BACKGROUND: Long-term outcome of patients treated with a St. Jude prosthetic heart valve was reported by investigators in Lausanne, Switzerland. This article quantifies the mortality and morbidity implications of single or multiple heart valve replacement. RESULTS: After hospital discharge, mortality ratios were highest for duration 5-10 years, roughly comparable in patients who received a single valve, and generally higher in those who received both an aortic and a mitral valve prosthesis. Outcome varied with preoperative myocardial function, but there was no survival difference among subjects with a history of stenotic, regurgitant, or mixed lesions. Postoperative complications included embolism, anticoagulant-related hemorrhage, stroke, prosthesis thrombosis, endocarditis, prosthesis dysfunction, hemolytic anemia, and reoperation. CONCLUSIONS: This study indicated that overall mortality experience was fairly comparable in patients who received a single St. Jude prosthetic heart valve and less favorable in those who received multiple valves. Long-term morbidity rates following insertion of a St. Jude prosthetic heart valve were high.

Female↗
PubMed1997

Insurance underwriting in the genetic era.

Genetic technology is assuming a greater role in the practice of medicine. Insurers have a vested interest because individually underwritten insurance cannot be sold without risk classification, and much of the medical information needed to classify risks will have a genetic component. This paper reviews recent genetic advances and their potential impact on life, disability income, long-term care, and critical illness insurance. Alzheimer disease is chosen to illustrate the effect of an organized effort to withhold medical information from insurance companies. Consumers will not support a private insurance mechanism with extensive cross-subsidization among policyholders and where medical information becomes inviolate simply because it is genetic. A framework for deliberations with the medical community is proposed.

Alzheimer Disease↗
PubMed1996

Morbidity and mortality associated with transient ischemic attack (TIA).

Transient ischemic attack (TIA) is defined as "an episode of focal loss of brain function attributed to ischemia that lasts less than 24 hours, is localized to a portion of the brain supplied by one vascular system, has no persistent deficit, and is not attributable to any other cause." Most TIAs are caused by small thromboemboli that originate in atheromatous areas in neck vessels or the heart. Other mechanisms include nonatherosclerotic vascular diseases, mitral valve prolapse, hematologic diseases, and abnormal blood pressure fluctuations. Even in series of fully investigated cases, there remains a group in which no cause can be found. The great majority of TIAs are extremely brief. In one series, 24% ended within 5 minutes, 39% in 15 minutes, 50% in 30 minutes, and 60% in 1 hour.

Adolescent↗
PubMed1995

Genetic information and life insurance.

Genetic testing will become the future standard of medical care. Life insurers will also need access to genetic information if the insurance industry is to survive intact and if cover is to remain affordable.

Genetic Diseases, Inborn↗