Cervical internal carotid artery dissecting hemorrhage: diagnosis using MR

Two men underwent high-resolution magnetic resonance (MR) imaging of the internal carotid artery (ICA) 12 and 16 days after spontaneous dissection of this vessel. One underwent follow-up MR imaging 7 weeks later. T1-weighted images were obtained in both cases, and T2-weighted images were obtained in one patient. In both cases, the MR findings corresponded to the angiographic abnormalities. On both the T1- and T2-weighted images, there was a hyperintense lesion expanding the wall and narrowing the lumen of the ICAs. Follow-up MR imaging showed complete resolution of the mural lesion. Axial images best demonstrated the anatomic and MR signal alterations. The hyperintensity of the lesion on both T1- and T2-weighted images indicated a short T1 and a long T2 as expected in a subacute hematoma. High-resolution MR imaging, therefore, can specifically demonstrate a thrombosed carotid dissection noninvasively at least as early as 12 days. The potential to diagnose carotid dissection in the acute phase using high-field-strength MR imaging and its importance for the prevention of embolic strokes are also discussed.     

Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men.

OBJECTIVE: Because of the available conflicting epidemiological data, we investigated the possible impact of fasting blood glucose as a risk factor for cardiovascular death in nondiabetic men. This study reports the results from a 22-year prospective study on fasting blood glucose as a predictor of cardiovascular death. RESEARCH DESIGN AND METHODS: Of the 1,998 apparently healthy nondiabetic men (aged 40-59 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were included in the study in which also a number of conventional risk factors were measured at baseline. RESULTS: After 22 years of follow-up, 483 men had died, 53% from cardiovascular diseases. After dividing men into quartiles of fasting blood glucose level, it was found that men in the highest glucose quartile (fasting blood glucose > 85 mg/dl) had a significantly higher mortality rate from cardiovascular diseases compared with those in the three lowest quartiles. Even after adjusting for age, smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s, and physical fitness (Cox model), the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8). Noncardiovascular deaths were unrelated to fasting blood glucose level. CONCLUSIONS: Fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middle-aged men.     

Renal artery stenosis: evaluation with intravenous digital subtraction angiography

The ability of diagnostic intravenous digital subtraction angiography (IVDSA) to demonstrate the degree of renal artery stenosis was compared with that of intraarterial angiography in 45 patients with 92 arteries. Stenotic lesions on both IVDSA and intraarterial studies were classified as normal (0% stenosis), minor (less than 50%), low grade (50%-80%), and high grade (80%-99%). There was agreement about the degree of stenosis in 90% of the cases. IVDSA grading was correct in 94% of atheromatous lesions and in 56% of the fibromuscular dysplastic lesions. In the high-grade atheromatous lesions, the degree of stenosis was slightly overestimated on IVDSA studies in 22.5% of the cases. In fibromuscular dysplasia, stenosis was underestimated in 33% of the cases.     

Telavancin, a multifunctional lipoglycopeptide, disrupts both cell wall synthesis and cell membrane integrity in methicillin-resistant Staphylococcus aureus

The emergence and spread of multidrug-resistant gram-positive bacteria represent a serious clinical problem. Telavancin is a novel lipoglycopeptide antibiotic that possesses rapid in vitro bactericidal activity against a broad spectrum of clinically relevant gram-positive pathogens. Here we demonstrate that telavancin's antibacterial activity derives from at least two mechanisms. As observed with vancomycin, telavancin inhibited late-stage peptidoglycan biosynthesis in a substrate-dependent fashion and bound the cell wall, as it did the lipid II surrogate tripeptide N,N'-diacetyl-L-lysinyl-D-alanyl-D-alanine, with high affinity. Telavancin also perturbed bacterial cell membrane potential and permeability. In methicillin-resistant Staphylococcus aureus, telavancin caused rapid, concentration-dependent depolarization of the plasma membrane, increases in permeability, and leakage of cellular ATP and K(+). The timing of these changes correlated with rapid , concentration-dependent loss of bacterial viability, suggesting that the early bactericidal activity of telavancin results from dissipation of cell membrane potential and an increase in membrane permeability. Binding and cell fractionation studies provided direct evidence for an interaction of telavancin with the bacterial cell membrane; stronger binding interactions were observed with the bacterial cell wall and cell membrane relative to vancomycin. We suggest that this multifunctional mechanism of action confers advantageous antibacterial properties.     

Frailty assessment of older adults,first-time applicants of public home care service in Norway

ObjectiveEarly detection of frailty is essential to prevent or delay disability. The most appropriate screening tool for frailty among home-dwelling older adults is under debate. The present study estimates the prevalence of frailty among older adults, first-time applicants of public home care service in Norway, and investigates the appropriateness of gait speed and Short Physical Performance Battery as screening-tools for frailty.Design and settingWe conducted a cross-sectional study of 116 older adults >65 years applying for public home care service for the first time. Frailty was assessed by an adapted version of the Fried Frailty Phenotype. The test accuracies of gait speed and Short Physical Performance Battery to detect frailty were calculated for a general population >70 years in Norway.Results62.1% of the participants were frail, 29.3% were prefrail, and 8.6% were robust. Mean gait speed and Short Physical Performance Battery-scores were significantly lower in frail compared to prefrail individuals, and significantly lower in prefrail compared to robust individuals. The sensitivity and specificity of gait speed at a cut point of 0.8 m/s to detect physical frailty phenotype was 99% and 68%, respectively.Conclusions The high prevalence of frailty in the present study indicates that screening for frailty should be considered at an earlier time point than when older adults apply for public home care service for the first time. Gait speed may be an appropriate screening tool for frailty in a general population >70 years in Norway.

KEY POINTS

• The prevalence of frailty among older adults, first-time applicants of public home care services in Norway is major.
• Screening for frailty should be considered before older adults apply for public home care service for the first time.
• Gait speed at a cut point at 0.8 m/s may be an appropriate screening tool for frailty in a general population >70 years in Norway.