Evidence for increased levels of plasminogen activator inhibitor and tissue plasminogen activator in plasma of patients with angiographically verified coronary artery disease

We studied 234 consecutive patients who underwent coronary angiography because of severe angina pectoris. Tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI), and lipoprotein Lp(a) were measured in citrated plasma samples. The 214 patients showing significant coronary artery stenosis (greater than 50% reduction of luminal area in any of the great coronary arteries) had higher mean levels of tPA (P less than 0.001) and PAI (P less than 0.01) than a random population sample of similar age. PAI and tPA levels were higher in smokers than in either non-smokers or ex-smokers, and in patients with hypertension tPA was increased. Subjects with blood group A had a higher mean Lp(a) level than subjects with blood group O. There were positive correlations of PAI and tPA levels with serum triglycerides and with body mass index; Lp(a) correlated weakly with plasma fibrinogen concentrations. The findings suggest an impairment of the fibrinolytic system in patients with coronary artery disease, which offers a link between established risk factors and a plausible pathophysiological mechanism, namely thrombus turnover.     

Host cell-induced differences in the O-glycosylation of herpes simplex virus gC-1. II. Demonstration of cell-specific galactosyltransferase essential for formation of O-linked oligosaccharides

By using a lectin-based screening method for cell-dependent variations of O-glycosylation of viral glycoprotein, we found that O-linked oligosaccharides of herpes simplex virus type 1 (HSV-1) glycoproteins in virus-infected mouse neuroblastoma (C1300) cells differed from those of HSV glycoproteins produced in other cells. Thus, O-linked oligosaccharides of HSV-1-specified glycoprotein C (gC-1), produced in GMK cells and a number of other cells, occurred mainly as trisaccharides or larger structures. In contrast, gC-1, produced in C1300 cells, contained O-linked monosaccharides and very few, if any, larger oligosaccharides of this class. A structural comparison between O-linked oligosaccharides of gC-1 from HSV-1-infected C1300 cells and from GMK cells showed that biosynthesis was interrupted prior to formation of a core disaccharide with terminal galactose, indicating a major early defect in O-glycosylation of glycoproteins in C1300 cells. A comparison of the content of galactosyltransferases between C1300 and GMK cells showed that C1300 cells lacked galactosyltransferases, including the specific enzyme engaged in formation of the core O-linked disaccharide mentioned, while other glycosyltransferases adding terminal sugars to O-linked oligosaccharides were present in equal amounts in both cell lines. These results indicated that HSV-1 is strictly dependent on host cell-specified factors for biosynthesis of O-linked oligosaccharides associated with viral glycoproteins.     

Survival in patients with abdominal aortic aneurysms. Comparison between operative and nonoperative management

This study evaluates the risk benefit relationship in the surgical treatment of abdominal aortic aneurysm (AAA). Two hundred and thirteen patients with AAA diagnosed by CT were selectively managed depending upon the size of the aneurysm, and were followed with a mean follow-up time of 5 years and 4 months. Aneurysms greater than 5 cm were generally operated on if no serious contraindication existed. Aneurysms less than 5 cm were followed by repeated examinations and operated on if an increase in size occurred. Some small aneurysms were operated on for other reasons. Elective surgical management of 134 patients resulted in a thirty day mortality of 7.5%. Later, seven additional patients died from causes related to the surgery. Survival of electively operated patients by life table analysis was 68% at 5 years. A significantly higher mortality was noted among those who had evidence of coronary heart disease at the time of operation. Forty-two patients with AAA less than 5 cm at the initial examination were not operated on and three ruptured, but all had grown to a size greater than 5 cm at the time of rupture. Patients with AAA less than 5 cm that were not operated on had a slightly but not significantly higher mortality than those who were operated on electively. This difference was mainly attributable to deaths from cardiac causes and not to ruptures. Patients with aneurysms greater than 5 cm who were not operated on had a significantly higher mortality than those that were, only 14% in the former group survived.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diagnosis of prosthetic aortic graft infection by magnetic resonance imaging

The accuracy of magnetic resonance imaging (MRI) in the diagnosis of prosthetic aortic graft infection was evaluated in 18 patients with history and findings suggestive of this complication. The prospective interpretation of MRI was compared with surgical findings. Sixteen patients had a graft infection verified at operation. Fourteen patients had infection of the retroperitoneal portion of the graft; two patients had an infection limited to one of the groins; no graft infection was found at surgical exploration in the remaining two patients. Perigraft infection was correctly diagnosed on the basis of MRI findings in 14 of 16 cases; findings were false negative in one case, questionable in another case, and correctly excluded graft infection in two of two cases. MRI also defined the extent of infection in 14 of 16 cases. MRI findings that supported the clinical suspicion of graft infection were perigraft fluid collections remaining more than 3 months after surgery. Furthermore, local inflammation was suggested by an increased signal intensity of adjacent muscle on T2-weighted images in some cases. CT scans were performed in 12 patients; these enabled a correct diagnosis in five and provided indeterminate or false information in seven. These results indicate that MRI is helpful in the diagnosis of aortic graft infection. Furthermore, MRI provides information about the extent of infection crucial for planning therapy.     

Multiple primary malignancies in patients with Merkel cell carcinoma1

Background Merkel cell carcinoma (MCC) is a rare malignant cutaneous tumour, the incidence of which is increasing. Second malignancies have been reported to occur with high incidence in these patients. Objectives We report the rate and nature of multiple malignancies in patients with MCC treated over a 10 year period in Addenbrooke’s Hospital in Cambridge, United Kingdom, as well as the temporal relationship of these additional malignancies to the diagnosis of MCC. Results The 27 patients had an approximately equal sex incidence with a median age at diagnosis of 79 years. Seventy percent (n=19) of patients had a second primary malignant tumour; and 7 of these patients had two or more tumours in addition to the MCC. Eighteen patients had additional cutaneous malignancies: melanoma, squamous cell carcinoma and basal cell carcinoma, and 8 patients presented non‐cutaneous malignancy including colorectal, haematological and breast tumours. Of the 28 additional tumours in our patients, half were diagnosed prior to presentation of MCC, 32% within 6 months of diagnosis, and 18% between 6 months and 3 years after diagnosis. Possible reasons for the high rate of additional tumours in this population are discussed. Conclusions Our figures reflect a higher incidence of multiple malignancies in those with Merkel cell tumour than has previously been reported. This has important implications for the care and surveillance of these patients.     

Surgery and postoperative radiotherapy a valid treatment for advanced oropharyngeal carcinoma

Since 1992 we have prospectively included all head and neck cancer patients in our health region in a departmental based register. Our hospital takes care of all head and neck cancer patients in our health region consisting of approximately 1 million people. In 1997, we evaluated the results of the treatment of oropharyngeal cancer in the 1992?C1997 period. On the basis of this evaluation, we changed our treatment policy for tonsillar and base of tongue carcinoma. We first changed the treatment for the lesions with worst prognosis, i.e., those with T3?CT4 carcinomas, from radiotherapy only, to radical surgery and postoperative radiotherapy. We have since that time increasingly also operated the smaller oropharyngeal carcinomas. The 2?years?? overall survival and disease-specific survival for all patients diagnosed in the 1992?C1997 period was 56 and 63%, respectively. The results from a similar group of patients in the 6?years?? period from 2000 to 2005, after the change in treatment, have increased to 83 and 88%. When we looked at the subgroup of patients in the 2000?C2005 period treated with surgery and postoperative radiotherapy, 45 out of 69 patients (65%) presenting with an oropharyngeal cancer were fit for operation. With radical surgery and postoperative radiation therapy, the 2?years overall survival is now 91%. The 2-year disease-specific survival is 96% and the locoregional control is 98%. This is a marked improvement as compared to radiotherapy alone and definitely competitive with modern radiochemotherapy.     

Histogram analysis of MR imaging-derived cerebral blood volume maps： combined glioma grading and identification of low-grade oligodendroglial subtypes

BACKGROUND AND PURPOSE： Inclusion of oligodendroglial tumors may confound the utility of MR based glioma grading. Our aim was, first, to assess retrospectively whether a histogram-analysis method of MR peifusion images may both grade gliomas and differentiate between low-grade oligodendroglial tumors with or without loss of heterozygosity （LOH） on 1p/19q and, second, to assess retrospectively whether low-grade oligodendroglial subtypes can be identified in a population of patients with high-grade and low-grade astrocytic and oligodendroglial tumors.     

The relationships between dose and antihypertensive effect of four AT1-receptor blockers. Differences in potency and efficacy

The relationships between dose and antihypertensive effect of the first four available AT 1 -receptor blockers, i.e. losartan, valsartan, irbesartan and candesartan, were assessed based on data obtained from the FDA's evaluation reports of the respective New Drug Application files. All available randomized, double-blind, placebo-controlled, parallel-group studies in adult men and women with mild to moderate primary diastolic hypertension were included, provided that the reduction in trough (24 h post-dose) supine or sitting diastolic blood pressure (DBP) had been assessed using the intention-to-treat approach. All studies had an initial single-blind placebo run-in period followed by at least 4 weeks double-blind treatment. The selected studies were included in a meta-analysis of the dose-response relationship for each drug. The dose-response relationship was estimated by fitting the placebo-adjusted, weighted mean reductions in DBP for each dose of the drug to an E max model. The E max (maximal effect at an infinitely large dose) for the reduction in DBP, with corresponding 95% confidence intervals in brackets, were found to be 5.6 (3.6-7.5) mmHg for losartan, 5.8 (5.0-6.6) mmHg for valsartan, 6.9 (5.9-7.9) mmHg for irbesartan and 7.5 (6.1-8.9) mmHg for candesartan ( p = 0.014, candesartan vs valsartan). In conclusion, this investigation demonstrates that candesartan can reduce DBP significantly more than valsartan, and is supportive of previous head-to-head comparisons, which have proven candesartan to have a greater antihypertensive effect than losartan at recommended doses. Thus, differences in efficacy between different AT 1 -receptor blockers do exist, and should have implications for the choice of AT 1 -receptor blocker when treating patients with hypertension, considering the importance of good blood pressure control.     

Personality traits in head and neck squamous cell carcinoma patients in relation to the disease state,disease extent and prognosis

OBJECTIVE: We aimed to study whether personality scores, as measured using the Eysenck Personality Inventory (EPI), are associated with the risk and prognosis of head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: A total of 78 male patients with newly diagnosed HNSCC and 61 male patients with benign HN disease completed the EPI, which assesses the following: neuroticism, extraversion and lie score. The TNM stage, prognosis, diagnostic delay, level of education and smoking and alcohol consumption histories of the patients were also recorded. Patients with cachexia and those aged > 80 years were excluded. RESULTS: The cancer patients had higher neuroticism scores (10.7 +/- 0.5 vs 8.3 +/- 0.6; p < 0.01) than the control patients. This association was shown to be secondary to the fact that neuroticism is associated with increased alcohol consumption. The personality trait scores were not associated with the length of diagnostic delay. It was also suggested that a low lie score predicted disease-specific death in the HNSCC patients (p = 0.02). Total survival also seemed to be predictable (p < 0.05). CONCLUSION: Neuroticism is probably associated with a risk of HNSCC as a result of increased alcohol consumption. If the prognostic results can be replicated, a potentially important association between this personality trait and the prognosis of HNSCC is suggested.