Role of ASCA and the NOD2/CARD15 mutation Gly908Arg in predicting increased surgical costs in Crohn's disease patients: a project of the European Collaborative Study Group on Inflammatory Bowel Disease

BACKGROUND: NOD2/CARD15, the first identified susceptibility gene in Crohn's disease (CD), is associated with ileal stenosis and increased frequency of surgery. Anti-Saccharomyces cerevisiae antibody (ASCA), a serological marker for CD, is associated with ileal location and a high likelihood for surgery. We hypothesized that the presence of ASCA and NOD2/CARD15 mutations could predict increased health care cost in CD. METHODS: CD patients in a prospectively designed community-based multinational European and Israeli cohort (n = 228) followed for mean 8.3 (SD 2.6) years had blood drawn for measurement of ASCA (IgG, IgA), Arg702Trp, Gly908Arg, and Leu1007fsinsC. Days spent in the hospital and the costs of medical and surgical hospitalizations and medications were calculated. RESULTS: The median duration of surgical hospitalizations was longer in Gly908Arg-positive than -negative patients, 3.5 and 1.5 days/patient-year (P < 0.01), and in ASCA-positive than -negative patients, 1.1 and 0 days/patient-year (P < 0.001). Median surgical hospitalization cost was 1,580 euro/patient-year in Gly908Arg-positive versus 0 euro/patient-year in -negative patients (P < 0.01), and 663 euro/patient-year in ASCA-positive versus 0 euro/patient-year in -negative patients (P < 0.001). Differences in cost of medications between groups were not significant. The effect of Gly908Arg was expressed in countries with higher Gly908Arg carriage rates. ASCA raised surgical costs independently of the age at diagnosis of disease. Arg702Trp and Leu1007fsinsC did not affect the cost of health care. CONCLUSIONS: Since CD patients positive for Gly908Arg and ASCA demonstrated higher health care costs, it is possible that measurement of Gly908Arg and ASCA at disease diagnosis can forecast the expensive CD patients.     

Alpha spectrometry for measuring activity of glass-embedded 210PO isotope

Measurements of exposure to radon are performed using numerous research methods which register either temporary or periodic radon concentrations. At the end of the 1990s reports on the possibility of defining past exposure to radon on the basis of measurement of the contents of 210Pb embedded in surface layer of glass were published. The registration of alpha particles emitted with glass was made using the spectrometric system. Use of the system for alpha spectroscopy leads finally to a significant lowering of the bottom threshold of detection and limits the influence of the negative background on the examined glass.     

Increase in visual acuity in poorly-sighted patients by using spectral filters

Tinted eyeglasses were selected for 768 poor-sighted patients aged 5-86 years with various ocular diseases. The frequency of tinted glasses utilization by poor-sighted patients was as follows: filter O2 was the optimal for 38% patients, filters G2 and K4 for 16-18%, and G1 for 11% patients. Filter G1 improved visual acuity by 19%, filters G2 and K4-K5 by 23%; the highest increment of visual acuity was observed with O2 filter: by 27%. Filters of different spectral characteristics and density may be useful in the same underlying ophthalmic disease, which is explained by the underlying disease and the presence, combinations, and severity of concomitant ocular diseases.     

Unilateral necrobiosis lipoidica of the ischemic limb--a case report

A 63-year-old diabetic woman presented with new-onset intermittent claudication of the right calf accompanied by ipsilateral necrobiosis lipoidica (NL). The latter presented the typical appearance of oval, indurated plaques, with brownish-red margins and central atrophy, scattered over the right thigh and calf. Arteriography demonstrated severe obstructive lesions on the right femoral artery. NL and claudication spared the left leg. A possible ischemic pathogenesis of NL emerges from this observation and is supported by recent studies in the literature.     

Treatment of steroid-unresponsive tumefactive demyelinating disease with plasma exchange

The authors describe a patient with an isolated, gadolinium-enhancing, biopsy-proven focus of tumefactive demyelination. There was marked clinical improvement with plasma exchange after failure of high-dose i.v. corticosteroids. The post-treatment clinical course correlated with decreasing enhancement and lesion size on MRI. This patient's rapid clinical and MRI response suggests that plasma exchange may be beneficial in this disorder, and could perhaps serve as a diagnostic tool to avoid the need for brain biopsy.     

Impact of dietary sodium on cardiovascular disease morbidity and mortality

Many public health agencies recommend universal restriction of dietary sodium to 100 mmol/L or less per day. This reflects the belief that because sodium restriction reduces blood pressure, it will therefore also reduce cardiovascular disease morbidity and mortality. Although large (100 mmol/ L/24 h) reductions in sodium intake do produce a measurable decline in aggregate blood pressure, there is great heterogeneity in individual response, probably reflecting differing genetic, environmental, and behavioral characteristics. Moreover, sodium depletion has multiple other effects including activation of the renin-angiotensin system and the sympathetic nervous system, and increase in insulin resistance. Since the health effect will be the sum of these multiple good and bad effects of sodium reduction, outcome trials are needed to determine the benefit or harm of alteration in sodium intake. Unfortunately, no clinical trial has addressed the question of whether a lower sodium diet would improve or extend life. The best available data derives from six prospective cohort studies. In sum, the scant available observational data do not rule out the possibility of benefit for some and increased risk for others. Considerable experience—most recently the hormone replacement study—underscores the hazards of extrapolating clinical recommendations from observational data alone. In the absence of any evidence from randomized trials of morbidity and mortality outcomes, and in the face of inconsistent observational studies, a universal recommendation for sodium restriction is unwarranted and inconsistent with the principles of evidence-based medicine.     

Late-term myocardial infarction after surgical ligation of a giant coronary artery fistula

A case is presented of a patient with recurrent myocardial infarctions after surgical treatment of a giant coronary artery fistula. The etiology was due to thrombus development in a large blind pouch, with propagation into more proximal vessels. Stenting of the proximal vessel provided temporary benefit, but recurrence eventually required surgical closure of the blind pouch.     

The Safety of Simultaneous Arterial and Coronary Sinus Perfusion: Experimental Background and Initial Clinical Results

Concern over myocardial damage from simultaneous arterial (antegrade) and coronary sinus (retrograde) perfusion has led to alternating between these delivery routes to maximize their individual benefits. Based upon predominant retrograde drainage via Thebesian veins, this study: (1) confirms experimentally the safety of simultaneous arterial and coronary sinus perfusion; and (2) reports initial clinical application of this combined strategy in 155 consecutive patients. Experimental: Five mini-pigs (25 to 30 kg) underwent 1 hour of aortic clamping with simultaneous aortic and coronary sinus perfusion at 200 mUmin with normal blood (37°C) before and after 30 minutes of perfusion with either warm (37°C) or cold (4°C) blood cardioplegia. Coronary sinus pressure was always less than 30 mmHg. There was no right or left ventricular edema, lactate production, or lipid peroxidation as transmyocardial and myocardial conjugated dienes were unaltered, and postbypass recovered left ventricular end-systolic elastance (conductance catheter) and preload recruitable stroke work Index 101%± 3% and 109%± 90%, respectively. Clinical: Simultaneous arteriaVcoronary sinus perfusion was used in 155 consecutive high risk patients (New York Heart Association Class III to IV) undergoing isolated coronary artery bypass grafting (CABG) (n = 109) and CABG + valve replacementlrepair or aneurysm (n = 46). Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. Mean aortic clamping time averaged 90 ± 4 minutes (range 30 to 207), with 3.5 ± 0.1 grafts per patient; all anastomoses were performed with the aorta clamped. Cold intermittent blood cardioplegia was used for distal anastomoses and valve implantationhepair in 123 patients, and warm continuous blood cardioplegia was used in 32 patients. Following a warm cardioplegic reperfusate, all patients received warm non-cardioplegic blood perfusion simultaneously via grafts and coronary sinus. Coronary sinus pressure was always less than 40 mmHg. Of 18 patients requiring postoperative mechanical circulatory support (IABP), 16 had IABP placed preoperatively for cardiogenic shock. There were three postoperative myocardial infarctions (2%), and six patients died (3.9% mortality). Conclusion: These experimental and clinical findings overcome perceived concerns about myocardial damage from simultaneous arterial and coronary sinus perfusion, and suggest this approach may add to the armamentarium of cardioprotective strategies. (J Card Surg 1994;9:15–25)