Coronary stent implantation in patients older than 75 years of age: clinical profile and initial and long-term (3 years) outcome

Objective The objective of this study was to compare the initial and long-term outcome of elderly and younger patients after coronary stent implantation. Methods The evolutions of 76 patients aged >75 years and of 860 patients aged ≤75 years who underwent consecutive stenting (from June 1991 to June 1997) were compared in a cohort study. Results The elderly patients had lower left ventricular ejection fractions (0.58 ± 0.14 vs 0.61 ± 0.13; P = .03) and more frequently had unstable angina (78.9% vs 55.3%; P <.0001), previous heart failure (10.5% vs 4.9%; P = .03), and multivessel disease (68.4% vs 58.3%; P = .08). After the procedure, the elderly patients showed a higher inhospital mortality rate (6.6% vs 2.4%; P = .03) and myocardial infarction rate (5.3% vs 1.7%; P = .04). The long-term follow-up period (mean, 3.2 ± 1.4 years; median, 3.0 years) showed in the elderly a higher mortality rate (15.4% vs 5.8%; P = .006), a lower rate of repeat revascularization (9.2% vs 19.7%; P = .04), and a similar incidence rate of major adverse cardiac events (27.7% vs 28.2%; P = .93). Multivariate analysis of the elderly group identified female gender (hazard ratio, 2.19; 95% CI, 1.18 to 4.06; P = .012) and presence of multivessel disease (hazard ratio, 2.35; 95% CI, 1.05 to 5.26; P = .037) as independent predictors of further events. Conclusion Patients aged >75 years have a less favorable baseline profile and higher inhospital and 3-year mortality rates. However, the incidence rate of major adverse cardiac events in the long term is acceptable and similar to that of younger patients. (Am Heart J 2002;143:620-6.)     

Metabolic syndrome in psoriatic arthritis: the interplay with cutaneous involvement. Evidences from literature and a recent cross-sectional study

The aim of this study was to evaluate the prevalence of MetS and its components and the level of serum uric acid in patients with PsA and in those with PsA sine psoriasis. A secondary aim of the study was to investigate on correlations of MetS in all study population. Consecutive PsA patients underwent assessment of disease activity and metabolic parameters. Blood samples were collected after 12 h of overnight fasting and analyzed for glucose, lipid profile, serum uric acid, and acute-phase reactants. The NCEP-ACT III criteria were used to identify subjects with MetS. Forty-two patients (52.5%) were classified as having PsA with clinically evident psoriasis (group 1) and 38 (47.5%) as having PsA sine psoriasis (group 2). Group 1, when compared to group 2, showed a significant increase for the frequency of MetS (p?=?0.006) and for mean values of diastolic blood pressure (p?=?0.0116) and of serum uric acid (p?=?0.04). We then aimed at defining determinants of MetS in the entire study population. In the multivariate analysis, three variables reached statistical significance: presence of psoriasis (OR 0.14; p?=?0.01), increase of one unit of BMI (OR 1.26; p?=?0.001), and smoking habit (OR 5.93; p?=?0.02). In our study, the occurrence of MetS and mean levels of serum uric acid were higher in PsA patients with clinical evident psoriasis compared to sine psoriasis PsA. The results also show the potential role of BMI, psoriasis, and smoking as important determinants in the development of MetS in PsA patients.     

Cineangiography in the diagnosis of aortic dissection

To assess the ability of biplane cineangiography in the diagnostic evaluation of acute dissection of the aorta, 20 patients with acute dissection were studied within 24 hours of surgery or autopsy, or both. Biplane large film aortic angiography was performed in 11 patients (Group I) and biplane aortic cineangiography in 9 (Group II). The morphology of the aortic valve was defined precisely in 5 (50 percent) of 10 patients in Group I and in all 9 patients (100 percent) in Group II (p < 0.02). Aortic regurgitation was diagnosed in all patients in both groups in whom it was present (p = not significant). Intimai tears were localized in 5 (50 percent) of 10 patients in Group I and in 8 (89 percent) of 9 in Group II (p < 0.07). Intimal flaps were not identified angiographically in three patients in Group I and were identified in four patients (100 percent) in Group II (p < 0.01). The presence of retrograde dissection was established in three (38 percent) of eight patients in Group I and in four (100 percent) of four patients in Group II (p < 0.05). There was no difference in the ability to identify a nonclotted false lumen between cine and large film angiography. It is concluded that in addition to improved diagnostic capabilities, technical advantages make cineangiography a good alternative to large film angiography in the diagnostic evaluation of patients with acute dissection of the aorta.     

Non-steroidal anti-inflammatory drugs in Parkinson's disease

Parkinson's disease (PD) is known to be a chronic and progressive neurodegenerative disease caused by a selective degeneration of dopaminergic (DAergic) neurons in the substantia nigra pars compacta (SNc). A large body of experimental evidence indicates that the factors involved in the pathogenesis of this disease are several, occurring inside and outside the DAergic neuron. Recently, the role of the neuron-glia interaction and the inflammatory process, in particular, has been the object of intense study by the research community. It seems to represent a new therapeutic approach opportunity for this neurological disorder. Indeed, it has been demonstrated that the cyclooxygenase type 2 (COX-2) is up-regulated in SNc DAergic neurons in both PD patients and animal models of PD and, furthermore, non-steroidal anti-inflammatory drugs (NSAIDs) pre-treatment protects against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) or 6 hydroxydopamine (6-OHDA)-induced nigro-striatal dopamine degeneration. Moreover, recent epidemiological studies have revealed that the risk of developing PD is reduced in humans who make therapeutical use of NSAIDs. Consequently, it is hypothesized that they might delay or prevent the onset of PD. However, whether or not these common drugs may also be of benefit to those individuals who already have Parkinson's disease has not as yet been shown. In this paper, evidence relating to the protective effects of aspirin or other NSAIDs on DAergic neurons in animal models of Parkinson's disease will be discussed. In addition, the pharmacological mechanisms by which these molecules can exert their neuroprotective effects will be reviewed. Finally, epidemiological data exploring the effectiveness of NSAIDs in the prevention of PD and their possible use as adjuvants in the therapy of this neurodegenerative disease will also be examined.     

Effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy in HIV-1-positive subjects: results from ACTG 384

OBJECTIVE: To assess the effect of baseline- and treatment-related factors on immunologic recovery after initiation of antiretroviral therapy (ART). METHODS: Nine hundred eighty antiretroviral-naive HIV-1+ subjects were randomized to start stavudine/didanosine or zidovudine/lamivudine with nelfinavir, efavirenz, or both nelfinavir and efavirenz. RESULTS: Greater CD4 cell recovery was associated with age of 40 years or younger, female sex, higher baseline naive/memory CD4 cell ratio, higher baseline virus load (VL), and virologic suppression (VS). Most subjects who maintained an undetectable VL had a substantial increase in CD4 cell count, but 13% of the subjects did not, even after 3 years of VS. Persistent T-cell activation was associated with lower CD4 cell recovery, even in subjects who achieved VS. Initial treatment assignment did not affect total CD4 cell recovery, naive/memory CD4 cell reconstitution, or decline in T-cell activation. In addition to CD4 cell recovery, B-cell counts rose substantially after ART initiation. CONCLUSIONS: In this large randomized trial, younger age, female sex, higher naive/memory CD4 cell ratio, higher baseline VL, and VS were associated with greater CD4 cell increase, whereas persistent T-cell activation was associated with impaired CD4 cell recovery after ART initiation. Initial treatment assignment did not affect CD4 cell reconstitution.     

Técnicas oncoplásticas para el manejo de tumores centrales de mama

Central tumors of the breast are in a difficult location for breast conservation that in many occasions had resulted in mastectomy. At the present time, the use of oncoplastic techniques have increased conservative management in this group of women, with an adequate oncological resection and good aesthetic results being achieved. This article describes oncoplastic procedures for the removal of breast central tumors with special interest in conservation and reconstruction of the areola-nipple complex.     

Die Botelhosche Reaktion und die Roffosche Neutralrotreaktion

Ohne Zusammenfassung     

Hypomagnesaemia-hypercalciuria-nephrocalcinosis: a report of nine cases and a review.

BACKGROUND: The cardinal characteristics of primary hypomagnesaemia-hypercalciuria-nephrocalcinosis include renal magnesium wasting, marked hypercalciuria, renal stones, nephrocalcinosis, a tendency towards chronic renal insufficiency and sometimes even ocular abnormalities or hearing impairment. METHODS: As very few patients with this syndrome have been described, we provide information on nine patients on follow-up at our institutions and review the 42 cases reported in the literature (33 females and 18 males). RESULTS: Urinary tract infections, polyuria-polydipsia, renal stones and tetanic convulsions were the main clinical findings at diagnosis. The clinical course was highly variable; renal failure was often reported. The concomitant occurrence of ocular involvement or hearing impairment was reported in a large subset of patients. Parental consanguinity was noted in some families. CONCLUSIONS: The results indicate an autosomal recessive inheritance. The diagnosis of primary hypomagnesaemia-hypercalciuria-nephrocalcinosis deserves consideration in any patient with nephrocalcinosis and hypercalciuria.     

Secretory breast carcinoma in a 63-year-old man

A secretory carcinoma of the breast, associated with axillary node metastasis, occurred in a 63-year-old man. Secretory breast carcinoma is a rare variant of breast carcinoma, but it is the commonest type seen in children, although most of the cases have been described in females. Here, we describe a case in an adult man.