Deaths from acute pancreatitis: why do we miss the diagnosis so frequently?

Summary Review of acute pancreatitis deaths between 1974 and 1984 revealed 126 patients, 53 (42%) of whom were first diagnosed at autopsy. Pancreatitis was undiagnosed in life in 13 (33%) of the patients with a gallstone aetiology, 8 (40%) of those with an alcohol aetiology, 21 (42%) of those of unknown aetiology and 17 (74%) of those with pancreatitis due to other identified aetiological factors. These patients more commonly died within the first week of their illness, more often had significant underlying medical disease and tended to have less severe degrees of pancreatic parenchymal destruction. Only 7 (13%) of the 53 patients undiagnosed in life had presented with abdominal pain. The majority (68%) presented atypically with known or suspected medical conditions, often to internists, or post-operatively (19%). Failure to diagnose these patients in life was most often due to a lack of consideration of the diagnosis, usually because of the atypical presentation, and consequent omission of an amylase determination—made in only 5 (9%) of the patients. Presented in part at the European Pancreatic Club 18th Meeting, Nijmegen, The Netherlands, September 1986, and at the International Association of Pancreatology, S?o Paolo, Brazil, September 1986.     

3 427例胃癌临床资料分析

目的 通过对16年来胃癌发病情况的动态观察，分析其流行病学变化趋势及可能成因。方法 将我院1986年-2001年胃镜检查资料列为研究对象，人为分成1986—1993和1994—2001前后两组，探讨检出率和性别的差异，并以1989年和1999年为例，比较10年间胃癌平均发病年龄的变化。结果 16年来随着胃镜受检人数的增加，胃癌检出人数亦呈波动上升趋势，但是胃癌检出率却呈波动下降趋势．前后两组检出率分别为11．29％（1102／9760）和7．28％（2325／31945），差异显著（P〈0．001，x^2=132．79）。后组男女性别比（2．9）低于前组（3．5）（P〈0．05，x^2=5．23）。1999年平均发病年龄为1989年的1．08倍（P〈0．001，μ=6．60）。结论 盐城地区胃癌检出率呈波动下降趋势，胃癌患者平均发病年龄上升，男性比例有所下降，可能与环境因素改变有关。     

Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience

BACKGROUND: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). OBJECTIVES: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. METHODS: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. RESULTS: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6). CONCLUSION: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.     

Plasma lipoproteins and apolipoproteins in insulin-dependent and young non-insulin-dependent Arab women

Summary Plasma lipids, lipoproteins and apolipoproteins (apo) were analysed in 30 young Arab IDDM and 50 young insulin-requiring NIDDM women. The mean age of IDDM and NIDDM groups was 20.2 and 34.5 years, and mean duration of diabetes was 5.7 and 4.6 years, respectively. Two groups of 40 and 60 healthy women (matched for age and BMI) provided corresponding control groups. In comparison with control subjects, diabetics showed marked increases in the following parameters: total cholesterol (TC), low density lipoprotein (LDL) cholesterol, total triglycerides (TG), very low density lipoprotein (VLDL) triglycerides, phospholipids, apoB, LDL apoB, glucose and glycosylated hemoglobin (HbA_1c) as well as the ratios of total cholesterol/high density lipoprotein (HDL) cholesterol, LDL-cholesterol/HDL-cholesterol, LDL cholesterol/high density lipoprotein 2 (HDL₂) cholesterol and apoB/apoAI. Plasma LCAT activity, concentrations of HDL₃ apoAI and apoAII in plasma and lipoprotein fractions were normal in both the diabetic groups. Levels of C-peptide, HDL, HDL₂ and HDL₃ cholesterol, plasma apoAI, HDL apoAI and HDL₂ apoAI were markedly decreased in the diabetic groups as compared to their corresponding controls. There was no significant correlation between fasting glucose or HbA_1c and any of the above parameters. Despite insulin therapy in both the diabetic groups studied, abnormalities in lipids, apoB and apoAI still persisted. Our data suggest a possible higher risk of atherosclerosis in these patients.     

¿Se está desacelerando el ritmo de disminución de la mortalidad cardiovascular en España?

Introduction and objectivesTo update the information on mortality from cardiovascular diseases and assess recent trends in Spain.MethodsDeaths from cardiovascular diseases (codes I20-I25, I50, I05-I09, I00-I02, I26-I49, I51, I52, I60-I69, I10-I15, and I70-I79 of the 10th revision of the International Classification of Diseases and Causes of Death) were obtained from the National Statistics Institute. Trends were analyzed using Joinpoint regression models. The results revealed the years (periods) composing each trend, as well as the annual percent change for each of them. The direction and magnitude of recent trends (last available 5-year period) were assessed by using the average annual percent change.ResultsThe decline in mortality rates from cardiovascular diseases slowed from −3.7% and −4.0% in 1999-2013 to −1.7% and −2.2% since 2013 in men and women, respectively. During the study period (1999-2018) all the analyzed causes decreased significantly. Nevertheless, recent trends differed according to age, sex, and the cause analyzed. Truncated rates (35-64 years) slowed (cardiovascular disease and stroke in men and ischemic heart disease in both sexes), stabilized (cardiovascular disease, stroke, and other heart diseases in women, and blood vessel disease in men), or increased (other diseases of the heart in men and diseases of the blood vessels in women).ConclusionsIn Spain, as in other countries, the reduction in mortality rates from cardiovascular diseases slowed (overall rates for both sexes and truncated in men) or stabilized (truncated rates in women) from 2014 to 2018.     

Cluster randomization trial of sequence mass screening for colorectal cancer

PURPOSE: Colorectal cancer is a major cause of death worldwide. To reduce the incidence and mortality from rectal cancer, an individual quantitative risk-assessment model (hereafter referred to as the Attributive Degree Value) and reverse passive hemagglutination fecal occult blood test were used in a randomized, controlled, population-based trial that was conducted in Jiashan County, Peoples Republic of China. METHODS: All residents of Jiashan County aged 30 years or older were enrolled in the study, and 21 townships in the county were randomized to either a screening (n = 10 townships) or control (n = 11 townships) group. Participants in the screened group submitted a one-article-per-slide stool sample and completed a structured risk-assessment questionnaire from which their attributive degree value was computed. According to study protocol, 4,299 participants were defined as high risk and underwent diagnostic evaluation with 60-cm flexible sigmoidoscopy and, in some cases, an additional screening with colonoscopy. RESULTS: From 1989 to 1996, cumulative mortality from colon cancer was 90 (95 percent confidence interval, 83–97) per 100,000 in the screened group and 83 (95 percent confidence interval, 76–90) per 100,000 in the control group (log-rank = 1.49, P = 0.222). Mortality from rectal cancer during this time was 110 (95 percent confidence interval, 102–118) per 100,000 in the screened group, which differed significantly from the control group mortality rate of 161 (95 percent confidence interval, 152–170) per 100,000 (log-rank P = 0.003). CONCLUSION: Mass screening with a reverse passive hemagglutination fecal occult blood test along with an individual attributive degree value score was effective in reducing mortality from rectal cancer but not in reducing mortality from colon cancer or the incidence of colorectal cancer.     

Predictors and Clinical Outcomes of Next-Day Discharge After Minimalist Transfemoral Transcatheter Aortic Valve Replacement

Objectives

This study sought to investigate predictors and safety of next-day discharge (NDD) after transcatheter aortic valve replacement (TAVR).

Patients using statin treatment within 24 h after admission for ST-elevation acute coronary syndromes had lower mortality than non-users: a report from the first Euro Heart Survey on acute coronary syndromes.

AIMS: Statins provide effective secondary prevention in cardiovascular disease. However, it remains uncertain how soon statins should be started after an acute coronary syndrome (ACS). Recently published trials suggest starting before discharge. We hypothesize that statins should be initiated without delay. METHODS AND RESULTS: Data from a large cohort of 10,484 consecutive patients with an ACS were analysed. Of this cohort, 1426 first-time statin receivers and survivors of the first 24 h were compared with 6771 first-day survivors not receiving statin therapy. A propensity score for the likelihood of receiving statin therapy within 24 h was developed and used with other established risk factors in a multivariable analysis. There was a significantly reduced all-cause 7-day mortality in patients receiving early statin therapy [0.4 vs. 2.6%, unadjusted hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.08-0.37, adjusted HR 0.34, 95% CI 0.15-0.79]. Statistical significance was observed in patients presenting with STE-ACS (adjusted HR 0.17, 95% CI 0.04-0.70) and not in NSTE-ACS patients. However, no statistical evidence of heterogeneity in treatment effect was observed between these groups. CONCLUSION: These data suggest that very early statin therapy is associated with reduced mortality in patients presenting with STE-ACS; however, these findings have to be confirmed by prospective, randomized controlled trials before firm treatment recommendations can be given.