Purpose of review-To delineate how recent findings on prostate-specific antigen (PSA) can improve prediction of risk, detection, and prediction of clinical endpoints of prostate cancer (PCa).Recent findings-The widely used PSA cut-point of 4.0 ng/ml increasingly appears arbitrary, but no cut-point achieves both high sensitivity and high specificity. The accuracy of detecting PCa can be increased by additional predictive factors and combinations of markers. Evidence implies that a panel of kallikrein markers improves the specificity and reduces costs by eliminating unnecessary biopsies. Large, population-based studies have provided evidence that PSA can be used to predict PCa risk many years in advance, improve treatment selection and patient care, and predict the risk of complications and disease recurrence. However, definitive evidence is currently lacking as to whether PSA screening lowers PCa -specific mortality.Summary-PSA is still the main tool for early detection, risk stratification, and monitoring of PCa. However, PSA values are affected by many technical and biological factors. Instead of using a fixed PSA cut-point, using statistical prediction models and considering the integration additional markers may be able to improve and individualize PCa diagnostics. A single PSA measurement at early middle age can predict risk of advanced PCa decades in advance and stratify patients for intensity of subsequent screening.
Ventricular volume parameters were determined in 14 patients with isolated atrioventricular (AV) canal (Group I), five patients with AV canal and pulmonary stenosis (Group II) and 17 patients with ostium primum defect (partial AV canal) (Group III). Right ventricular (RV) and left ventricular (LV) volume parameters were determined from biplane cineangiocardiograms according to Simpson's rule method and the area length method. Right ventricular end-diastolic volume (RVEDV) and right ventricular systolic index (RVSI) were significantly greater than normal in Group I (RVEDV = 174 ± 15% of predicted normal, RVSI = 6.84 ± 0.47 1/min/m') and Group III (RVEDV = 265 + 37% of normal, RVSI = 13.54 ± 1.39 1/min/m'). Left ventricular end-diastolic volume (LVEDV) and left ventricular systolic index (LVSI) in Group I (LVEDV = 247 ± 20% of normal, LVSI = 10.04 ± 0.91 1/min/m2) and Group III (LVEDV = 169 ± 15% of normal, LVSI = 7.61 ± 0.69 I/min/m2) were both significantly greater than normal. The LV and RV ejection fractions in all groups were not significantly different from normal.These data indicate that LV and RV volumes and outputs are higher than normal in patients with AV canal or ostium primum defects. The number of patients studied, however, is small and it is possible that some very young infants with AV canal could have small ventricular chambers. Thus, ventricular volume determination should be a part of the presurgical evaluation of these patients.
Summary Twenty-one patients with endomyocardial fibrosis (EMF) and right ventricular involvement were studied by M-mode echocardiography. All 21 patients showed echocardiographic findings consisting of (i) increased right ventricular dimension, (ii) paradoxical septal motion, (iii) increased right ventricular outflow dimension (iv) thickening of the right ventricular anterior wall with increased right ventricular anterior wall motion, and (v) easily recordable tricuspid valve. In addition, some of the patients had posterior pericardial effusion, and fine fluttering of the tricuspid valve. EMF was diagnosed clinically in all the patients, haemodynamically and angiographically in 15 and confirmed at autopsy in one. None of these echo findings was present in two patients with constrictive pericarditis, and two patients with massive ascites due to portal hypertension.
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