Solitary fibrous tumor of the thyroid gland.

Solitary fibrous tumor (SFT) is a rare spindle-cell neoplasm more commonly involving the pleura, but recognized also in other tissues. Nineteen patients with SFT arising from the thyroid gland have been reported in the literature. The present report reviews these cases and discusses epidemiology, etio-pathogenesis, clinical-pathologic characteristics, differential diagnosis, therapy, and prognosis of thyroid SFT.     

Relative role of systolic,diastolic and pulse pressure as risk factors for cardiovascular events in the Brisighella Heart Study

OBJECTIVE: The objective of this study was to determine the contribution of elevated blood pressure parameters to the long-term incidence of cardiovascular events. DESIGN: A prospective, population-based longitudinal epidemiological cohort. SETTINGS: The population of the town of Brisighella. PATIENTS: The Brisighella Heart Study involved 2939 randomly selected residents of Brisighella, Italy aged 14 to 84 years, free of cardiovascular (CV) disease at enrollment and followed since 1972. Subjects were clinically evaluated at baseline and every 4 years following enrollment when extensive clinical and laboratory data were obtained in addition to the assessment of morbidity and mortality. MAIN OUTCOME MEASUREMENTS: The Cox regression analysis, adjusted for the main risk factors for CV disease was used to determine the independent prognostic significance of systolic, (SBP), diastolic (DBP), and pulse pressure (PP). The events of interest were coronary heart disease (CHD) and cerebrovascular disease (CVD). RESULTS: Adjusted hazard ratios (HRs) for combined CHD + CVD at SBP categories of 120-139, 140-159, and 159 mmHg were 1.45 [95% confidence interval, (CI), P= 0.035], 1.88 (95% CI, P= 0.0008), and 2.31 (95% CI, P<0.0001), respectively. For DBP ranges of 70-79, 80-89, and 89 mmHg, HRs were 0.91 (95% CI, P= 0.677), 1.33 (95% CI, P= 0.169), and 1.65 (95% CI, P= 0.029), respectively. PP ranges from 54-67 and 67 mmHg were associated with HRs of 1.23 (95% CI, P= 0.149), and 1.38 (95% CI, P= 0.030), respectively. Similar results were seen for CVD and CHD as separate endpoints. CONCLUSIONS: The present study demonstrates that SBP is a stronger predictor of cardiovascular events than DBP in the Brisighella population. The added prognostic significance of PP is also demonstrated, particularly if PP exceeds 67 mmHg.     

The age-related accumulation of dolichol in rat liver may correlate with expectation of life

In order to test the hypothesis that the ageing-related alteration in membrane lipids might reflect the biological age of rodents, the levels of liver dolichol were assayed by the HPLC procedure in male ad-libitum fed (AL) Sprague-Dawley rats aged 2, 6, 12 and 24months, and in 24-month-old rats on anti-aging food-restrictions (FR) differing in duration and in their effects on longevity. Results showed that the effects on liver dolichol of FR initiated at 2, 6 and 12 months of age, or initiated at 2 and interrupted at 18 months of age were significantly different, and reflected the differences in the effects of FR on expectation of life (the longer the expected residual lifespan the lower the content in liver dolichol). The conclusion is that assay of the quantity of dolichol in the liver tissue may be used as a marker of the biological age of the animal and therefore as an important biomarker of ageing. This revised version was published online in July 2006 with corrections to the Cover Date.     

Preoperative stoma site marking: a simple practice to reduce stoma-related complications

Background

To evaluate the incidence and identify the risk factors of stoma-related complications in a consecutive series of patients treated at a single institution.

Methods

For this retrospective analysis, the medical records of patients followed up at the stoma care centre of our institution over the last 16 years were reviewed. The primary end point was the incidence of stoma-related complications. Risk factors were tested using univariate and multivariate Cox proportional hazards models.

Results

Of a total of 1076 patients, 604 received a colostomy and 472 an ileostomy. In all, 1055 stoma-related complications were recorded in 797 patients. Univariate analysis identified the following risk factors for stoma-related complications: male sex (p?=?0.032), emergency surgery (p?=?0.010), open surgery (p?<?0.001), and ileostomy creation (p?=?0.004). Preoperative stoma site marking was noted to play a protective role (hazard ratio 0.739; 95% confidence interval 0.576–0.947; p?=?0.017). Multivariate analysis confirmed male sex and ileostomy creation as risk factors (p?=?0.030 and p?=?0.013, respectively) and preoperative stoma site marking as an independent protective factor (p?=?0.001).

Conclusions

Stoma-related complications are quite common, especially when an ileostomy is present. Preoperative stoma site marking was noted to play a highly protective role not only in reducing the complication rate but also in improving the patients’ quality of life.

     

Iron overload and genotype 3 are associated with liver steatosis in chronic hepatitis C.

OBJECTIVE: To determine epidemiological, biochemical, virological, and histological factors associated with liver steatosis in chronic hepatitis C. SUBJECTS: The medical histories of 53 patients biopsied for chronic hepatitis C diagnosis between June 2000 and December 2002 were retrospectively studied. Epidemiological, biochemical, and virological data were collected. Patients with hepatitis B virus or human immunodeficiency virus coinfection were excluded. Liver biopsy specimens were reviewed and scored by one pathologist. Weight and height were measured at liver biopsy time. The statistic association between qualitative and quantitative variables and the presence of liver steatosis was studied. RESULTS: Steatosis was identified in 52% of biopsies. There was no statistic association with age, sex, method of transmission, duration of infection, alcohol consumption, other diseases, body mass index, glucose, triglycerides, cholesterol, AST, ALT, GGT, alkaline phosphatase, bilirubin, or viral load. Liver steatosis was associated with serum iron, transferrin saturation, and ferritin. Genotype 3 was also associated with steatosis. Piecemeal necrosis, hepatocellular injury, Kupffer cell hyperplasia, liver iron, and portal fibrosis were also associated with steatosis. A multivariate analysis showed that genotype 3, Kupffer cell hyperplasia, and liver iron were associated with the presence of steatosis. CONCLUSIONS: Liver steatosis in chronic hepatitis C associates with genotype 3, Kupffer cell hyperplasia, and iron overload. Hepatic steatosis also associates with greater inflammation and fibrosis, and must be considered to contribute to disease progression.     

Fulminant myocarditis during HIV seroconversion: recovery with temporary left ventricular mechanical assistance.

A 32-year-old male was admitted to our intensive care unit for low cardiac output syndrome. Echocardiography was suggestive of extensive hypokinesia and the ejection fraction was 0.22. Serological tests, including anti-HIV antibodies (ELISA), were negative. The patient was intubated and an intra-aortic balloon pump was inserted. Twenty-four hours after admission a paracorporeal left ventricular assist device (LVAD-MEDOS) was implanted. The left ventricular function showed progressive improvement with normalization of the ejection fraction on day 19. The device was removed on day 20. Before discharge, the patient admitted that he had had unprotected sex with numerous male acquaintances; anti-HIV testing turned positive. The final diagnosis was fulminant myocarditis during HIV seroconversion.     

Effect of increasing age on tissue dolichol levels in ad libitum fed and food-restricted rats

In order to test the hypothesis that the ageing-related alteration in membrane lipids might reflect the biological age of rodents, we studied the effects of age in ad libitum fed (AL) and food-restricted (FR) male Sprague-Dawley rats on the levels of dolichol in different organs involved [liver (L) and kidney (K)] or not involved [brain (B), sciatic nerve (SN), heart (H), soleus (S) and extensor digitorum longus (EDL) muscles] in dolichol excretion. At the given age, tissue dolichol was extracted and assayed by HPLC procedure. Results show that the levels of dolichol were significantly different in different tissues and increased dramatically with increasing age. The anti-ageing FR regimen had significant preventive effects on dolichol accumulation in the excretory organs. The effect of FR on the liver was much bigger than that of kidney. The effect of FR retarding dolichol accumulation in the liver co-varied with the effects of FR on longevity. In conclusion, these data show that the quantity of dolichol in the hepatic tissue might be used as a marker of the biological age of the animal.     

Double-blind comparison between zofenopril and lisinopril in patients with acute myocardial infarction: results of the Survival of Myocardial Infarction Long-term Evaluation-2 (SMILE-2) study

Background Angiotensin-converting enzyme (ACE) inhibitors have been reported to be effective in placebo-controlled trials in various subsets of patients with acute myocardial infarction (MI). However, no direct comparisons have been performed between different ACE inhibitors in the same patient population.Methods This phase III, double-blind, parallel-group, multicenter study compared the safety and efficacy of zofenopril and lisinopril in 1024 thrombolyzed patients with acute MI. Patients, aged 18 to 75 years, were randomized to receive oral zofenopril (30-60 mg/day) or lisinopril (5-10 mg/day), starting within 12 hours of completion of thrombolytic therapy and continuing for 42 days. The primary study end point was the incidence of severe hypotension (systolic blood pressure <90 mm Hg), either cumulative or drug-related. Secondary end points included additional safety and efficacy parameters.Results The overall incidence of severe hypotension was slightly 5more reduced with zofenopril (10.9%) than with lisinopril (11.7%, P = .38). The incidence of drug-related severe hypotension was slightly but significantly lower with zofenopril than with lisinopril (6.7 vs 9.8%, 2-tailed P = .048). The 6-week mortality rate was 3.2% in the zofenopril group and 4.0% in the lisinopril group (P = .38), and no significant differences were observed in the incidence of major cardiovascular complications or any safety variables between the 2 ACE inhibitors.Conclusions The SMILE-2 study demonstrates that both zofenopril and lisinopril are safe and associated with a rather low rate of severe hypotension when given in accordance with a dose-titrated scheme to thrombolyzed patients with acute MI. These findings could have a positive clinical impact and increase the proportion of patients with acute MI who can be safely treated with ACE inhibitors. (Am Heart J 2003;145:80-7.)     

A new patient with dicarboxylic aciduria suggestive of medium-chain acyl-CoA dehydrogenase deficiency presenting as Reye's syndrome

A new patient with medium-chain dicarboxylic aciduria and suberyl glycinuria during an attack of acute illness is reported. When, inadvertently he was given medium-chain triglycerides for 2 days, the excretion of abnormal metabolites of medium-chain fatty acids increased and hepatomegaly became more pronounced. During remission a low excretion of the metabolites were observed. After 16 h of fasting hypoglycaemia was accompanied by an increase of urinary dicarboxylic acids and -hydroxyacids similar to that found on admission. Interestingly this urinary organic acid pattern persisted 8 h after intravenous administration of glucose. In a blood sample obtained after 16 h of fasting there was hypoketonaemia and increased levels of total free fatty acids, octanoic, decanoic andcis-4-decenoic acids. These biochemical data suggest the existence of a deficiency at the level of medium-chain acyl-CoA dehydrogenase.