Comparative efficacy study of atorvastatin vs simvastatin, pravastatin, lovastatin and placebo in type 2 diabetic patients with hypercholesterolaemia

Although there is little information from primary or secondary prevention trials on cholesterol-lowering medication in diabetic patients, the reduction of elevated cholesterol is widely recommended for this group. The American Diabetes Association (ADA) recommends drug therapy in diabetic patients if low density lipoprotein (LDL)-cholesterol remains at > 130 mg/dl, or > 100 mg/dl in patients with macroangiopathy, after dietary intervention. When cholesterollowering medication is indicated, the choice of the drug must take into account the other lipid abnormalities that are often present and the need to maintain optimal glycaemic control. In the present study we compared the efficacy and safety of the novel HMG-CoA reductase inhibitor atorvastatin at the dose of 10 mg/day with simvastatin , lovastatin and pravastatin at doses of 10, 20 and 20 mg/day, respectively, and placebo, in type 2 diabetic patients with moderate elevation of LDL-cholesterol with or without elevation of triglycerides. All the quoted agents are enzyme inhibitors effective in lowering LDL-cholesterol in humans. The efficacy endpoints were the mean per cent changes in plasma LDL-cholesterol (primary), total cholesterol, triglycerides, and high-density lipoprotein (HDL)-cholesterol concentrations from baseline to the end of treatment (24 weeks). Atorvastatin at a dose of 10 mg/day produced: (1) a significant reduction in LDL-cholesterol (-37%) in comparison with equivalent doses of simvastatin (-26%), pravastatin (-23%), lovastatin (-21%), and placebo (-1%); (2) HDL-cholesterol increases (7.4%) comparable to or greater than those obtained with simvastatin (7.1%), pravastatin (3.2%), lovastatin (7.21%), and placebo (-0.5%); (3) a significantly greater reduction in total cholesterol (- 29%) than that obtained with simvastatin (-21%), pravastain (-16%), lovastatin (-18%), and placebo (1%); and (4) a significantly greater reduction in triglycerides than that obtained with all the other drugs and placebo. In all treatment groups no significant variation in fibrinogen concentration was observed. All reductase inhibitors studied had similar levels of tolerance. There were no incidents of persistent elevations of serum aminotransferases or myositis.     

Occipitocervical fusion

The evolution of occipitocervical fixation and new rigid universal screw-rod construct technology has allowed secure anchorage at each level of the occipitocervical junction with the elimination of rigid external orthoses. Rigid occipitocervical instrumentation constructs have achieved higher fusion rates and less postoperative immobilization-associated complications. Outcomes have improved compared with former nonrigid instrumentation techniques; however, with advances of rigid occipitocervical stabilization capability have come new challenges, risks, and operative techniques. A thorough understanding of the relevant cervical bony and soft tissue anatomy is essential for safe implantation and a successful outcome.     

Glycated albumin as a glycaemic marker in patients with advanced chronic kidney disease and anaemia: a preliminary report

Abstract

Background: The association between glycated albumin (GA) and glycaemic status has not been fully described in patients with advanced chronic kidney disease (CKD) in relation to anaemia. The aim of this study was to evaluate the relationship between GA and fasting plasma glucose (FPG) and HbA1c in patients with advanced CKD and to evaluate the influence of anaemia in such relationship.

Materials and methods: Patients with CKD stage 4 or 5 were included in the study. eGFR was calculated by the CKD-EPI creatinine equation. Plasma GA was measured by an enzymatic method.

Results: Eighty-one patients were included in the study, 46 (57%) were males; the mean age was 67?±?14?years. HbA1c was correlated with Hb (r?=?0.39; p?=?.0003), and no significant correlation was detected between plasma GA and serum albumin (p?=?.82). A significant association between FPG and GA (r²?=?0.41; p?r²?=?0.42; p?r²?=?0.55; p?Conclusions: GA, alone or in combination with other biomarkers, can be considered for the evaluation of glycaemic status in patients with advanced CKD and severe anaemia.     

The value of an operating microscope in peripheral nerve repair

Summary. The aim of this study was to test the hypothesis that the use of an operating microscope improves the results of peripheral nerve repair. Tibial nerve grafting was carried out on 48 Fischer rats divided into 2 groups: in one, a loupe was used, and in the other a surgical microscope. At 5 months after grafting, recovery was evaluated by functional, electromyographic, and morphometric tests. The mean motor nerve conduction velocity was 26.77±9.37 m/sec in the group where the loupe was used compared with 44.19±11.36 m/s when the microscope group was used. The soleus muscle weight and the diameter of myelinated fibres also confirmed better regeneration in the microscope group. These results clearly indicate that it is essential to use the microscope for peripheral nerve repair.

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Résumé. Le but de l’étude est de faire tester l’hypothèse que l’aide du microscope améliore les résultats de la chirurgie du nerf périphérique. La greffe du nerf tibial a été pratiquée sur 48 rats Fischer, repartis en deux groupes, l’un avec l’aide de la loupe et l’autre avec l’aide du microscope. Cinq mois après la greffe les résultats ont été soumis à une évaluation fonctionnelle, électromyographique et morphométrique. Les moyennes de la vitesse de la transmission motrice du nerf dans le groupe assisté par la loupe et celui assisté par le microscope étaient 26.77±9.37 m/s et 44.19±11.36 m/s respectivement. L’équivalent du test clinique, le poids du muscle soleus ainsi que les mésures du diamètre des fibres myelinisées ont aussi démontré une meilleure régénération, dans le groupe assisté par microscope. Ces resultats montrent clairement que l’aide du microscope est essentielle pour la réfection du nerf périphérique.

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Accepted: 20 June 1997     

Identification of trimoprostil metabolites excreted in rat bile formed by oxidation and taurine conjugation

14C-Trimoprostil was administered iv and orally to male rats. Radioactivity was excreted mainly via the feces after both routes of drug administration. Bile duct-cannulated rats excreted an average of 76% of an iv dose in the bile within 6 hr after dosing. Four biliary metabolites were isolated by HPLC and identified by proton NMR spectroscopy and mass spectrometry. These metabolites were taurine conjugates of: trimoprostil (approximately 11% of dose), 5,6-dihydro-2,3-dinor trimoprostil (approximately 5% of dose), 3,4-dehydro trimoprostil (less than 5% of dose) and 5,6-dihydro-2,3,4,5-tetranor trimoprostil (less than 5% of dose).     

Bladder reconstruction after cystectomy: use of ileocecal segment and three-loop ileal reservoir

We report on 11 patients who in 1980-1982 had bladder reconstruction, after cystectomy for bladder cancer, utilizing the ileocecal valve as an antireflux mechanism and a direct urethrocecal anastomosis. They received preoperative irradiation (2,000 rad) and had some early complications such as pelvic abscesses and temporary urinary fistulas. We have since omitted preoperative radiation on cases performed in 1984-1987 and they did not have these complications.     

Histochemical detection of glycoproteins in the gastric epithelia of Columba livia

A histochemical investigation was carried out to detect glycoproteins in the lining and glandular epithelia of 4 regions of the stomach of Columba livia: proventriculus, intermediate region between proventriculus and gizzard, gizzard, intermediate region between gizzard and duodenum. It was noticed the presence of neutral and sulphoglycoproteins, with a clear predominance of the latter in the lining epithelia and in the simple tubular glands of the mucosa of these regions, except for the gizzard. Absence of glycoproteins was noticed in the oxynticopeptic cells of the branched tubular glands of the proventriculus. Neutral glycoproteins and traces of sulphoglycoproteins were present in the lining epithelia of the folds of its central cavity and of its exit duct. Lining the above mentioned structures, the correspondent of the gizzard, inclusively there was a pellicle of sialoglycoproteins.     

Prazosin depression of baroreflex function in hypertensive man

Summary Prazosin is a post synaptic alpha adrenergic blocker effective in hypertension, whose hypotensive effect is unaccompanied by reflex tachycardia or hyperreninemia, nor by other evidence of increased sympathetic activity. We studied the baroreceptor reflex arc as a potential mediator of these effects. Twenty-two essential hypertensive men were treated with prazosin alone versus placebo, and experienced a blood pressure fall (from 114.8±3.6 down to 101.1±2.5 mm Hg,p<0.005) unaccompanied by any change in heart rate, plasma renin activity, or several other indices of sympathetic nervous system activity (plasma dopamine-β-hydroxylase activity; urinary excretion of free catecholamines and vanillyl mandelic acid; allp>0.1). Concomitant with the blood pressure fall, there was a significant depression of baroreflex arc sensitivity, from 11.4±2.0 ms/mmHg down to 6.6±1.9 ms/mmHg (p<0.05), without an associated change in cardiac vagal inhibition (291.2±46.2 versus 300.3±19.2 ms,p>0.1). Baroreflex arc sensitivity depression may in part explain the lack of reflex sympathetic outflow noted during prazosin treatment of hypertension.