Prognostic Value of Direct, Continuous Ambulatory Blood Pressure Monitoring in Essential Hypertension

This study assessed the prognostic value of ambulatory vs. clinic blood pressure measurement in 688 hypertensives who had undergone pretreatment 24-hour intra-arterial ambulatory blood pressure monitoring. A total of 157 first events were recorded over a follow-up period of 9.2±4.4 years. Ambulatory systolic or diastolic blood pressure parameters (whether 24-hour mean, daytime mean, or nighttime mean) or ambulatory pulse pressure provided independent prognostic information in conjunction with clinical variables. The most predictive models contained the ambulatory systolic blood pressure parameters. Age, male gender, South Asian origin, diabetes mellitus, and previous cardiovascular disease were additional independent predictors of events. In a subgroup of 295 uncomplicated patients, 24-hour ambulatory pulse pressure was an independent predictor of left ventricular mass index and maximal carotid intima-media thickness. Baseline clinic blood pressure parameters did not provide independent information for the prediction of events or target organ damage. Therefore, in this study, ambulatory blood pressure proved to be superior to clinic measurement for cardiovascular risk stratification. However, the routine use of ambulatory blood pressure monitoring is not currently recommended, mainly because of a lack of outcome trials based on the treatment of ambulatory blood pressure levels.     

An alternative angiographic view to unmask the hidden patent ductus arteriosus during device closure

Transcatheter closure of patent ductus arteriosus (PDA) with various devices has been evaluated worldwide and in selected cases can be performed successfully, thus avoiding the morbidity associated with surgical closure. Traditionally, left lateral projection is adopted for angiographic visualization of the PDA. However, rarely due to anatomical variations of the ductus, it may be difficult to properly visualize and deploy device in above‐said traditional view. In such cases, right anterior oblique projection may be used for proper visualization. © 2012 Wiley Periodicals, Inc.     

Successful treatment of three cases of primary extramammary Paget’s disease of the vulva with Imiquimod – proposal of a therapeutic schedule

Background/aim Extramammary Paget‘s disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland‐bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget‘s disease. Methods Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. Results Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. Conclusion Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.