Is heart failure more prevalent in patients with peripheral arterial disease? A meta-analysis

Because risk factors for heart failure (HF) cluster in persons with peripheral artery disease (PAD), the authors conducted a meta-analysis to examine the prevalence of HF in individuals with PAD. MEDLINE searches were performed to review all PAD clinical trials (1966-2003). Expected control population prevalence rates for HF were derived from the National Health and Nutrition Examination Survey (NHANES) database. In total, 11,304 patients were evaluated. The average age of the patients was 67+/-5 years. The prevalence of HF in patients with PAD was 7.9% (range, 5.3%-13.9%) compared with an expected prevalence of 4.1%(range, 3.7-4.5%). The relative risk for increased HF prevalence among those with PAD was 1.9 (range, 1.35-3.10; P<.001). Thirteen (range, 7-19) PAD patients needed to be screened to detect 1 case of HF. The presence of PAD is associated with a 2-fold increase in the prevalence of HF. The use of PAD as a risk marker for underlying HF may enhance the effectiveness of screening criteria for HF detection.     

Endovascular management of acute ischemic stroke: advances in patient and treatment selection

Selection of patients for acute-stroke therapy has traditionally been based on rigid time criteria in clinical trials. Recent advances in radiographic imaging have allowed clinicians to estimate brain physiology and thus utilize radiographic parameters to select patients for acute-stroke therapies. Both a better understanding and the quantification methods of salvageable tissue versus irreversibly injured tissue can help guide clinicians to which treatment modality to utilize. The evolution of endovascular techniques to treat acute stroke has resulted in treatment modalities that include mechanical and chemical methods to revascularize occluded cerebral arteries. Prior technical limitations to accessing distal-cerebral arteries have been partially overcome by modifications in technology. Patient and treatment-modality selection can help reduce hemorrhagic complication rates and also potentially increase revascularization rates, which may translate into improved clinical outcomes. We review the recent advances in radiographic imaging that have advanced patient selection in treating acute ischemic stroke and also consider current endovascular treatment options that are available to interventionalists performing these procedures.     

IV levetiracetam in the management of non-convulsive status epilepticus

Introduction  

Status epilepticus (SE) is a medical emergency requiring prompt treatment to try to limit mortality and improve outcome. So far, newer antiepileptic drugs (AED) have not assumed a noticeable role in the treatment of SE. This may be in part due to the lack of IV forms for the newer AEDs. The IV form of Levetiracetam (IV-LEV) has recently become available and has a potential role in the treatment of SE.     

Potential of Azadirachta indica against Salmonella typhimurium-induced inflammation in BALB/c mice

Objective:  To evaluate the potential of Azadirachta indica leaf extracts against Salmonella typhimurium-induced inflammation in BALB/c mice. Design:  Qualitative tests of A. indica leaf extracts were conducted for screening of various phytochemicals. The antiinflammatory potential of A. indica leaf extracts on S. typhimurium and its outermembrane proteins (OMPs)-induced inflammation was assessed by hyperalgesic (flicking) response of the mice inflammed paws. The monokines (IL-1α, IL-6 and TNF-α) activities in the culture supernatants of macrophages (infected with bacteria and interacted with OMPs) in the presence or absence of A. indica leaf extracts was assessed by ELISA. Results:  Aqueous and petroleum ether A. indica leaf extracts reduced the inflammation caused by S. typhimurium and its OMPs as assessed by paw flicking response. Petroleum ether A. indica leaf extract was found to be more effective than aqueous A. indica leaf extract. Significantly lower levels of monokines (IL-6 and TNF-α) were also observed in the presence of petroleum ether A. indica leaf extracts than aqueous A. indica leaf extract. These observations may be due to the presence of steroids and triterpenoids observed in petroleum ether extract. Conclusion:  Petroleum ether A. indica leaf extract seems promising to combat S. typhimurium-induced inflammation. Received 6 June 2008; accepted 29 October 2008     

Angiogenesis and angiogenic inhibitors in renal cell carcinoma

In most patients with renal cell carcinoma (RCC) of clear cell subtype, there is inactivation of the von Hippel-Lindau (VHL) tumor-suppressor gene, which leads to a proangiogenic state with overexpression of vascular endothelial growth factor (VEGF). This molecular level knowledge has led to the development of multiple antiangiogenic therapies directed against the VEGF protein or the VEGF receptor. These therapies have significant clinical activity in metastatic RCC. Therefore, a therapeutic strategy based on targeting VEGF in RCC has a sound molecular basis and therapy with VEGF-targeting agents has significant clinical activity. To further improve efficacy, future research should focus on better identification of patients who will most benefit from such therapy. We reviewed the published literature regarding angiogenesis, the VHL gene, VEGF biology, and antiangiogenic therapies in metastatic RCC. This article reviews the role of angiogenesis in RCC and summarizes data regarding antiangiogenic therapy in metastatic RCC.     

Chordoid glioma: report of two rare examples with unusual features

Summary Background. Chordoid glioma, a rare tumour of the third ventricle, represents a distinct clinico-pathologic entity. Thirty nine examples have been described in the literature, mostly in females and in the third ventricle. The clinical presentation is variable but they tend to occur mostly in adults. There is only one report of a chordoid glioma in a 12 year old child. Finding. This paper describes two examples of chordoid glioma in a seven year old female child and a 70 year old male respectively. Radiologically, the paediatric chordoid glioma was located in the juxtaventricular region in the occipital horn of the lateral ventricle and was of mixed density whereas the adult patient had a typical third ventricle location with homogenous contrast enhancement. Gross total surgical removal was achieved in both but the adult patient died post-operatively due to intra ventricular bleeding and bacterial meningitis. The younger patient is doing well at the last follow up two years post-operatively. Microscopically, both showed the classic morphology of chordoid glioma. Ultrastructural examination was suggestive of ependymal differentiation. Conclusion. The younger age and unusual location are some of the rare features which need documentation and have not been described earlier. We propose that chordoid glioma is a variant of an ependymoma (WHO grade II) which arises from tanycytes and should be included in the WHO classification of brain tumors. Correspondence: Dr. Mehar Chand Sharma, M.D., Associate Professor, Department of Pathology, AIIMS, New Delhi 110029, India.