Is chronic or recurrent idiopathic pericarditis an autonomous inflammatory disease?]

PURPOSE: Chronic pericarditis or recurrent pericarditis is mostly considered to be idiopathic even when up-to-date medical investigations are undertaken. The absence of aetiology and the associated inflammatory process are features of a common disease for internists. As there are only a few published reports on this disease, therapeutic options are not easily envisaged. CURRENT KNOWLEDGE AND KEY POINTS: Idiopathic pericarditis and its evolution, characterized by recurrence or chronicity, has long been diagnosed and studied. Faced with a case of acute pericarditis, no clinical or biological data can preclude evolution towards a chronic or a recurrent form. The two major complications are tamponade and constriction. Classical treatment is aspirin and nonsteroidal anti-inflammatories. Steroids have a spectacular effect but steroid dependence is frequently observed. Colchicine treatment seems to be efficacious and can be used to stop steroid therapy. There are only a few published reports on the importance of immunosuppressive drugs such as azathioprine and cyclophosphamide. FUTURE PROSPECTS AND PROJECTS: Through our own experience and literature review, we propose to consider chronic and/or recurrent pericarditis as an autonomous inflammatory disease of the pericardium. Thus, large-scale studies concerning the treatment should improve the outcome of patients.     

Body composition and physical performance of Spanish adolescents: the AVENA pilot study

In order to validate the physical fitness tests and anthropometric parameters of the AVENA multicenter study, a pilot study was carried out in 101 adolescents (48 girls and 53 boys) aged 15-18 years. Body composition was established by the sum of skinfolds (SS) in millimeters (biceps, triceps, subscapular, suprailiac) and body mass index (BMI, weight/height(2)) in kilograms per meters squared. Physical fitness was measured by means of the Course-Navette test (CNT). Median BMI was 22.5 and 20.3 for boys and girls, respectively, while their median SS was 32.5 and 47.47, respectively. The median CNT score was 8 and 4 for boys and girls, respectively. For both groups, there was a negative correlation between body fat and physical fitness, the correlation being stronger in boys ( r=-0.65) than in girls ( r=-0.43; p<0.01). SS appears to be more suitable than BMI in expressing body composition in this context. The CNT indicates physical fitness in adolescents satisfactorily. This subject will be explored in more depth during the final phase of the multicenter study.     

Is Bilateral Internal Thoracic Artery Use Safe in the Elderly?

Abstract Background: The strategy of bilateral mammary artery grafting is often not considered for elderly patients due to perceived concerns of increased morbidity and mortality. The objective of this study is to explore the safety of bilateral mammary in elderly patients. Methods: Out of 7746 patients who underwent coronary artery bypass grafting using at least one internal thoracic artery (ITA), there were 3940 patients aged 65 years or greater, and of those, 3581 patients had a single ITA (SITA) and 359 patients had bilateral ITAs (BITAs). The primary outcome was the incidence of major adverse cardiac or cerebrovascular events (MACCEs). Secondary outcomes included re‐exploration for bleeding, blood transfusions, sternal wound infections, and intensive care unit and hospital length of stay. Results: The incidence of mortality and MACCE were similar in both groups (mortality BITA 2.6%, SITA 3.6%, p = 0.25, MACCE BITA 8.5%, SITA 6.1%, p = 0.13). Superficial and deep sternal site infections were significantly more prevalent in the BITA group than the SITA group [superficial OR 0.42, 95% CI [0.23 – 0.75] (p = 0.003) and deep OR 0.29, 95% CI [0.14 – 0.58 (p = 0.0005)]. Conclusion: Use of BITA is safe in the elderly with respect to mortality and early cardiovascular outcome. BITA use in the elderly is associated with an increased risk of sternal wound infection. Our experience in this situation suggests that there is a maximum age (approximately 74 years) beyond which the combined risk of MACCE and wound complications supersedes the benefits in terms of sternal infections. (J Card Surg 2012;27:1‐5)     

Family demography in a remote rural community in Zambia

A community survey was conducted in a remote rural area of Zambia by The Kasanka Trust whose aims in running a National Park are to include aid to the community living around its borders. Selected results have been extracted from a general report by the Kasanka Trust, including awareness of HIV infection and tuberculosis. The remarkable population dynamics found in this apparently impoverished, poorly served community is highlighted.     

Clinical outcome after repair of acute type A dissection in patients over 70 years-old.

BACKGROUND: Despite current aging of patients proposed for cardiac surgery, published results of type A dissection repair in the elderly are sparse and controversial though an increased operative risk when compared to younger patients is well-documented. Whether any patient of an advanced aged suffering from acute dissection of the proximal aorta should be referred for surgery deserves specific clinical studies. OBJECTIVE: To define factors of poor outcome after repair of type A dissection in the elderly by focusing on both early and late results. METHOD: A retrospective study including a consecutive series of 83 patients operated on in two neighboring French university centers between 1988 and 1999 with similar outstanding methods. Complete follow-up was achieved in March 2000. Results were compared according to: (i) the presence or the absence of complications at admission; and (ii) the use of hypothermic circulatory arrest (HCA) for completion of the distal suture. RESULTS: Mean age was 75.2+/-3.6 years (70-85). Overall operative mortality (OM) was 37.3%. OM was significantly higher (51.2 versus 23.8%, P=0.01) for patients who presented at admission any one of the following complications: tamponade, shock, endotracheal intubation upon arrival or evidence of brain, myocardial, mesenteric, renal or limb malperfusion. OM was not significantly affected by age or by the use of HCA during repair. Overall Kaplan-Meier survival was 50% at 1 year, 30% at 5 years and 13% at 10 years and was significantly lower (P=0.004) for patients who presented at least one complication at admission. Kaplan-Meier survival (excluding OM) was respectively 81, 48 and 21% and was significantly lower in case of prolonged stay in ICU (P=0.014) and for patients operated on without HCA (P=0.02). CONCLUSIONS: Results of repair of acute type A dissections in the elderly are acceptable for uncomplicated cases at admission. Using HCA in elderly patients whenever required for appropriate repair does not worsen early or late survival.     

Haemorrhagic shock encephalopathy syndrome presenting with myoglobinuria

An infant with haemorrhagic shock encephalopathy syndrome (HSES) who in addition presented with hyperpyrexia and myoglobinuria is reported. As rhabdomyolysis is a feature of heat stroke and malignant hyperthermia, the association of HSES with myoglobinuria supports the hypothesis that HSES may be a form of hypermetabolic state triggered by hyperthermia.     

血小板激活因子对大鼠脑血管通透性的影响及药物的保护作用

颈内动脉注射血小板激活因子(PAF),再给伊文思蓝,可见脑实质染色程度加深,而颈内动脉只注射伊文思蓝,脑实质未见染色。而我们合成的新药SZ-1可剂量依赖性地抑制PAF诱导的脑实质伊文思蓝染色程度的加深。在体外培养的脑微血管平滑肌细胞上,PAF能显著刺激~(14)-花生四烯酸的释放,而SZ-1能剂量依赖性地抑制这种释放,提示PAF在脑内产生的损害除与其他因素相关外,还与其刺激花生四烯酸释放有密切关系,SZ-1对PAF引起的脑部损害有保护作用。