TAVR: nemesis of NOACs?

Journal of Thrombosis and Thrombolysis - Data on non-vitamin K antagonist oral anticoagulants (NOACs) in transcatheter aortic valve replacement (TAVR) patients are controversial. In patients...     

Comparison of Renal Hemodynamic Effect of Ramiprilat to Captopril: Possible Role of Kinins

Sincetheintroductionofthefirstlineofangiotensinconvertingenzyme(ACE)inhibitors,ofwhichcaptoprilistheprototype,morepotentlonger-lastingagentshavebecomeavailable[l].AmongtheseisramipriIat,anonsL1lfhydrylACEinhibitorsimilarchemicallytoenalaprilatbutcontaininginadditionapentanering.Benderetal[2Jdemonstratedinvitrothatramiprilatisatleast23timesmorelipophilicthanenalaprilatwithanaffinityforACE47timesgreatc'rthanthatofcaptopril.ItwaspostulatedthatthemorelipophiIicanACEinhibitor,thebetteraccessi…     

Granular cell tumor of colon:Report of a case and review of literature

Granular cell tumor (GCT) is uncommon in the colon andrectum.Here we report a case of GCT in the transversecolon.A 48-year-old male patient underwent a screeningcolonoscopy.A yellowish sessile lesion,about 4 mm indiameter,was found in the transverse colon.An endoscopicsnare resection was performed without complication.Histological examination revealed the tumor consisted ofplump neoplastic cells with abundant granular eosinophiliccytoplasm containing acidophilic periodic acid Schiff-positive,diastase-resistant granules.Immunohistochemicalanalysis showed the tumor cells expressed S-100 proteinand neuron-specific enolase.Thus,the resected tumor wasdiagnosed as a GCT.Since GCTs are usually benign,endoscopicresection constitutes an easy and safe treatment.Colonoscopists should consider the possibility of GCT inthe differential diagnosis of submucosal tumors of the colon.     

Inflammatory pseudotumor of the liver: 13 cases of MRI findings

INTRODUCTIONInflammatory pseudotumor of the liver,a rarebenign lesion,is often confused with the malignanttumors.Until 1998,less than 80 cases had beenreported in the world.The accuracy of the pre-surgical diagnosis was low,and very fewmaterials on the diagnosis using dynamic MRI werereported.We collected thirteen cases ofinflammatory pseudotumor of the liver werecollected and proved by pathology with MRIstudies.Our purpose is to describe and analyze theMR!findings of this lesion and find out the valuablesigns suggesting the diagnosis so as to avoidunnecessary operations.     

Meta-analyses of antihypertensive therapy: Are some of them misleading?

Meta-analysis has become a very popular tool to compare the efficacy of different antihypertensive regimens. Combining results from various outcome studies may provide evidence to guide the therapeutic approach even before results from large prospective studies are available. However, meta-analysis may be misleading if it is not done meticulously. Some meta-analyses that received broad news media coverage in the recent years were misleading. One analysis suggested that the use of short-acting nifedipine in moderate to high doses in patients with coronary disease increased mortality. This claim was refuted later by observational studies. Based on another meta-analysis, it was claimed that diuretics and β-blockers are equally effective in reducing cardiovascular morbidity and mortality. Another more careful meta-analysis, omitting one study in which most patients were on combination therapy and not on b-blocker monotherapy, showed the superiority of diuretic versus β-blocker treatment in the elderly. Calcium antagonists were recently blamed for increasing the rate of myocardial infarction and congestive heart failure in hypertensive patients, and therefore their use was not recommended as first-line therapy in hypertension. This recommendation was based on a meta-analysis subject to major drawbacks and was misleading. Another notion based on meta-analysis was that angiotensin converting enzyme inhibitors reduce left ventricular mass more than diuretics. This notion was refuted by three large randomized studies. A recent meta-analysis, which showed a similar blood pressure lowering effect for all angiotensin receptor blockers, was refuted by head-to-head studies. Thus, when performed correctly, meta-analysis can be an important tool, but when uncritically employed, it is prone to be misleading.     

Lupus nephritis: consequence of disturbed removal of apoptotic cells?

In the last decade it has become clear that systemic lupus erythematosus (SLE) is an autoantigen driven T cell dependent autoimmune disease. The nucleosome has been identified as a major autoantigen. Nucleosomes are generated during apoptosis. Either an increased or delayed apoptosis or a reduced clearance of apoptotic cells (which are not mutually exclusive) leads to an increased exposure of (modified, more immunogenic) nucleosomes to the immune system. This generates the formation of nucleosome specific T cells and antinucleosome autoantibodies. After complex formation of antinucleosome or anti-double-stranded (ds)DNA antibodies with nucleosomes, these autoantibodies are targeted to basement membranes, especially the glomerular basement membrane (GBM). This nephritogenic potential is due to the binding of the positively charged histone components of the nucleosome to the negatively charged heparan sulphate (HS) within the GBM. This incites glomerular inflammation.     

Allogeneic transplantation of blood stem cells: Coming of age?

Mobilized peripheral blood progenitor cells (PBSC) are increasingly being used instead of bone marrow for allogeneic transplantation. The purpose of the present article is to give a concise and clinically oriented overview on current results and perspectives of allogeneic peripheral blood stem cell transplantation, with particular focus on reconstitution of hematopoiesis and the immune system, graft-versus-host disease, graft-versus-leukemia effects, intensity-reduced conditioning, and graft engineering.     

Sexual transmission of giardiasis: A neglected route of spread?

Sexually transmitted infections (STIs) are often discussed in the context of syphilis, gonorrhea, herpes, chlamydiasis and AIDS. However, since the past 30 years of the last century, epidemiology and natural history studies have led to improved understanding of giardiasis as a STI, as a result of oral–anal sexual contact. Studies suggest that Giardia is an increasingly recognized infection that may be underdiagnosed under the STI context. Health care providers should maintain a high index of suspicion for Giardia, obtain suitable diagnostic tests to identify and screen those at high risk for this infection, institute appropriate therapy, counsel patients regarding treatment compliance, follow-up, encourage partner notification and teach strategies for preventing the transmission of this disease, including the discussion of the risk of enteric infections after oral–anal sexual contact. We summarize some data concerning the research and clinical literature on Giardia infection as a STI and identify the specific recommendations for control of giardiasis as STI that available evidence indicates can reduce its transmission.     

Underdiagnosis of hereditary haemochromatosis: lack of presentation or penetration?

BACKGROUND: The majority of hereditary haemochromatosis (HH) patients are homozygous for the C282Y mutation in the HFE gene. We have demonstrated a homozygote frequency of 1 in 83 for the C282Y mutation in a retrospective analysis of Irish neonates. However, a fully developed phenotype is not observed at the same frequency clinically, suggesting that a large proportion of Irish HH patients may remain undiagnosed. AIMS: To determine whether underdiagnosis of HH results from the non-specific nature of early symptoms or incomplete penetrance of the C282Y mutation. METHODS: Seventy nine C282Y homozygous individuals identified from family screening for HH and 30 HH probands were investigated. Non-specific symptoms (fatigue, arthropathy, and impotence) and their association with iron indices (transferrin saturation and serum ferritin) and hepatic iron deposition were analysed. RESULTS: We found that 78% of men (mean age 42 years) and 36% of women (mean age 39 years) who were identified as C282Y homozygotes following family screening had iron overload, as defined by a transferrin saturation >or=52% combined with a serum ferritin >or=300 microg/l for men and >or=200 microg/l for women. The frequency of reports of non-specific symptoms in those individuals with iron overload was not significantly different from those who did not have iron overload. CONCLUSIONS: Our findings indicate that underdiagnosis of HH may be due to the non-specific nature of early symptoms and less frequently to the incomplete penetrance of the C282Y mutation.     

Mechanisms of disease: is osteoporosis the obesity of bone?

Osteoporosis and obesity, two disorders of body composition, are growing in prevalence. Interestingly, these diseases share several features including a genetic predisposition and a common progenitor cell. With aging, the composition of bone marrow shifts to favor the presence of adipocytes, osteoclast activity increases, and osteoblast function declines, resulting in osteoporosis. Secondary causes of osteoporosis, including diabetes mellitus, glucocorticoids and immobility, are associated with bone-marrow adiposity. In this review, we ask a provocative question: does fat infiltration in the bone marrow cause low bone mass or is it a result of bone loss? Unraveling the interface between bone and fat at a molecular and cellular level is likely to lead to a better understanding of several diseases, and to the development of drugs for both osteoporosis and obesity.