Non-Hodgkin's lymphoma and residential proximity to toxic industrial waste in southern Israel

Environmental exposure has been linked to non-Hodgkin's lymphoma (NHL). Toxic volatile compounds were found in groundwater downstream of an industrial site in southern Israel. The risk of NHL and clinical characteristics of NHL patients were analyzed in relation to their proximity to the site.     

Matching the evaluation of the clinical efficacy of clopidogrel to platelet function tests relevant to the biological properties of the drug

OBJECTIVES: This study aimed to explore platelet function tests relevant to the biological effects of clopidogrel that could help the clinical monitoring of drug efficacy. BACKGROUND: Clopidogrel selectively inhibits the P2Y12 receptor, the major role of which is stabilization of aggregation, whereas initiation of aggregation depends on activity of both P2Y1 and P2Y12 receptors. METHODS: Tests used were peak aggregation (Agg(max)) and late aggregation (Agg(6min)), and disaggregation, relating to P2Y1 and P2Y12 activity, respectively; and monoclonal antibody binding activated glycoprotein (GP) IIb/IIIa receptors (PAC-1) and P-selectin, measuring activation and secretion. A first study compared hirudin/PPACK (r-hirudin and D-phenylalanyl-prolyl-arginine chloromethyl ketone) with citrate as blood anticoagulant (16 patients), and a second control study compared the effects of clopidogrel, aspirin, or both (20 normal controls). RESULTS: Clopidogrel similarly inhibited adenosine 5'-diphosphate (ADP)-induced Agg(max) with either anticoagulant, but significantly more Agg(6min) (75% vs. 31%), P-selectin (72% vs. 53%), and PAC-1 (62% vs. 24%) in hirudin/PPACK. In the control study, it inhibited Agg(max) by 22%, and Agg(6min), P-selectin, and PAC-1, by 69%, 66%, and 55%, respectively (all p < 0.05). Disaggregation at six min reached 62% with clopidogrel, but was virtually absent with placebo and aspirin. Non-responsiveness as evaluated by inhibition of Agg(max) in citrate was diagnosed in 35% of patients; in half this rate by Agg(6min), P-selectin, and PAC-1; and in 6% to 12% with the latter tests performed in hirudin/PPACK. CONCLUSIONS: The evaluation of clopidogrel responsiveness by platelet function tests is largely influenced by the choice of blood preservative and functional tests. Measures of aggregation stabilization, and of consequent secretion and activation, identified most patients as responders, contrasting with measures of peak aggregation, by likely reflecting better the interactions clopidogrel and the P2Y12 receptor.     

Cor triatriatum--a case report

A case of a 54 year old female with cor tritriatum is described. Diagnostic role of transthoracic and transesophageal echocardiography is discussed.     

Peripartum cardiomyopathy--a case report

Peripartum cardiomyopathy -- a case report. A case of a 32-year old woman, previously healthy, with heart failure symptoms occurring during third pregnancy, is described. In spite of standard pharmacological treatment, her condition worsened and the pregnancy had to be terminated at 28 hbd by cesarean section. The patient's condition improved and three months later normal left ventricular function as well as good exercise tolerance were observed.     

Percutaneous procedures for the repair of iatrogenic occlusion or stenosis of peripheral vessels in children--report of 5 cases

Invasive percutaneous diagnostic or therapeutic procedures are associated with the risk of thrombosis and occlusion of peripheral vessels which are used for vascular access. Data on the transcatheter therapy of vascular complications in children are scarce. We described five children in four of whom percutaneous transluminal balloon angioplasty of occluded peripheral vessels was successfully performed. Technical aspects of this treatment and indications are discussed.     

What primary care physicians know about diagnosis and treatment of chronic heart failure

BACKGROUND: The majority of patients with chronic heart failure (CHF) are treated by primary care physicians. Recent studies have shown that their knowledge about diagnosis and treatment of CHF is not satisfactory. AIM: To evaluate the knowledge of primary care physicians on the diagnosis and treatment of patients with CHF. METHODS: The survey consisting of 23 questions on the diagnosis and treatment of CHF, was filled in by 116 primary care physicians, practising in the city of Poznań. The questions dealt with the most typical characteristics of CHF, including history, physical examination, diagnosis of diastolic CHF and medical treatment, according to the recent guidelines of the European Society of Cardiology. RESULTS: More than 90% of physicians regarded history and physical examination as the most important elements required for establishing the diagnosis of CHF. Ankle oedema, dyspnea and fatigue were listed as the most typical CHF symptoms. Almost 80% of surveyed physicians routinely performed ECG and chest radiogram in order to diagnose CHF. Echocardiography was used by only 20% of physicians, and the term "diastolic CHF" was familiar to only one third of them. Angiotensin converting enzyme inhibitors (ACEI) were used by more than two thirds of doctors, and beta-blockers--by one third. The correct initial recommended dose of enalapril was known to more than half of the physicians, and the target dose--to only one fourth of them. The correct initial recommended dose of carvedilol was known to almost half of the physicians, and the target dose--to only 3% of them. Diuretics were prescribed by 62% of physicians, spironolactone--by half of them, and digitalis--by one third of them. CONCLUSIONS: Primary care physicians practising in the Poznań area diagnose CHF mainly on the basis of history, physical examination, ECG and chest radiogram. Echocardiography is underused which may hamper the accuracy of CHF diagnosis. ACEI and beta-blockers are also underused. These findings demonstrate that knowledge about diagnosis and treatment of CHF is insufficient among primary care physicians and indicate the need for educational and systematic changes, including a wider access to echocardiography.