Carotid endarterectomy after ischemic stroke--is there a justification for delayed surgery?

PURPOSE: To assess the relationship between outcome of carotid surgery and wait after ischemic stroke. METHODS: We retrospectively analysed data from patients undergoing carotid endarterectomy after ischemic stroke. We investigated the time interval between the event and endarterectomy in relation to surgical results and complications. RESULTS: Between January 2000 and December 2003, 104 patients were scheduled to undergo carotid endarterectomy after a recent stroke. Endarterectomy was performed within 6 h in seven patients (6.7%); within 4 weeks in 29 (27.9%); 4 weeks or more in 62 (59.6%) and six (5.8%) patients received no further therapy. Perioperative complications among patients treated within 4 weeks were 3.4% and were comparable to those treated after 4 weeks (4.8%). However, more than 12% of the patients awaiting operation experienced a new cerebrovascular event (ischemic stroke or carotid occlusion), most of them occurred in the 3rd or 4th week after the initial event. CONCLUSION: Our data indicates, that carotid endarterectomy can be performed with a comparable risk within a short delay after stroke. In addition severe cerebrovascular events occurring within the waiting period may be avoided.     

Post partum rubella vaccination and anti-D prevention]

The effectiveness of a routinely performed puerperal rubella vaccination was tested. Additional a possible adverse influence of simultaneously administered anti-D immunoglobulin on the effectiveness of the rubella vaccination was examined. Rubella antibody titers (HHT) in pregnant women were determined; after delivery puerperal women with titers of less or equal 1:16 were selected for rubella vaccination. 2 1/2 to 3 months later rubella antibody titers were done again. 15% of 130 vaccinated women did not show a conversion of the former negative titer or a low titer of 1:8 remained. Also reductions of the antibody titers were seen. When simultaneously rubella vaccination and anti-D immunoglobulin was administered only in 1 case out of 27 patients a negative titer remained after vaccination. The used anti-D immunoglobulin contained rubella antibodies of a titer 1:256 to 1:512; according to experimental studies, this concentration should not have any influence to the immunologic response of rubella vaccination. Our practic results could not confirm the reservations concerning simultaneous rubella vaccination and anti-D prophylaxis.     

Correction to: Regional differences in baseline disease activity and remission rates following golimumab treatment for RA: results from the GO-MORE trial

Clinical Rheumatology - The original publication contains two areas which require correcting. None of these errors change the results or conclusions of the article, but the authors wish to...     

Effect of Pluronic L-81 on intestinal lipoprotein secretion in the rat

The hydrophobic nonionic detergent Pluronic L-81 has been shown to lower plasma very-low-and low-density lipoprotein cholesterol, thus preventing diet-induced atherogenesis. The major effect of this agent is a pronounced interference with intestinal lipid metabolism. For studying mesenteric lymph lipoproteins during detergent exposure, a combined micromorphological and biochemical assessment of mucosa and lymph during steady-state lipid absorption was performed. Pluronic L-81 was infused intraduodenally at a constant rate in combination with mixed micellar solutions or saline in mesenteric lymph fistula rats. Pluronic L-81 impairs transepithelial lipid flux during fat absorption, trapping export lipids within the enterocytes and leading to a cytosolic and endoplasmic reticulum lipid accumulation sparing the Golgi region. Pluronic L-81 markedly (P<0.001) reduces mesenteric triglyceride, phospholipid, and total cholesterol secretion almost exclusively by a reduction of chylomicron formation. Chylomicron and very-low-density lipoprotein lipid composition was only insignificantly altered, except for somewhat higher phospholipid/triglyceride ratios. The chylomicron apoprotein pattern was almost unaffected. Thus, chylomicron formation decreased dramatically without major compositional alterations. The reduction of lipid and apoprotein secretion without particle augmentation is not in favour of a selective interference of Pluronic L-81 with intestinal apoprotein B-48 secretion.Parts of this work have been presented at the Annual Meeting of the American Gastroenterological Association, Washington, DC, May 1989, and published in abstract form (1).     

Acute Effects of Glucocorticoids on Serum Markers of Osteoclasts, Osteoblasts, and Osteocytes

The aim of this study was to investigate the acute effects of oral glucocorticoids in doses used in clinical practice on biochemical indices of the function of osteoclasts, osteoblasts, and osteocytes. In 17 adult patients suffering from various medical pathologies requiring systemic steroid therapy that were never before treated with glucocorticoids, glucocorticoid treatment was initiated (mean prednisolone equivalent dose of 23.1 ± 12.7 mg/day, range 10–50). Fasting morning serum concentrations of osteocalcin (OC), amino-terminal propeptide of type I procollagen (PINP), type 1 collagen cross-linked C-telopeptide (βCTX), soluble receptor activator of nuclear factor kappaB ligand (sRANKL), osteoprotegerin (OPG), sclerostin, Dickkopf-1 (Dkk-1), and high-sensitivity C-reactive protein (hsCRP) were measured at baseline and on three consecutive days. Significant reductions in serum OC, PINP, OPG, sclerostin, and hsCRP were observed during 96 h of glucocorticoid administration, while serum βCTX showed a significant percentual increase. A significant positive correlation was found between serum concentrations of Dkk-1 and βCTX after 96 h of treatment with glucocorticoids. A significant drop in serum sclerostin, OPG, and OC observed in this study may reflect the rapid glucocorticoid-induced apoptosis of osteocytes.     

Knowledge of osteoporosis correlated with hormone therapy use and health status

OBJECTIVES: The study objectives were: (a) to evaluate knowledge about osteoporosis and to identify its correlates among women > or =40 years of age attending outpatient centers; (b) to compare the level of knowledge between women already receiving treatment for osteoporosis and first-time attendees. METHODS: A cross-sectional survey was conducted with women recruited from nine outpatient centres in the Czech Republic. The women were divided into two subgroups: patients who have already been diagnosed with osteoporosis (osteopenia) and who are receiving treatment for the disease (OS group); first-time attendees who have been referred for the assessment of osteoporosis (comparison group). The patient's knowledge of osteoporosis was assessed using the Osteoporosis Questionnaire (OPQ) developed by Pande et al. [Pande KC, Takats D, Kanis JA, Edwards V, Slade P, McCloskey EV. Development of a questionnaire (OPQ) to assess patient's knowledge about osteoporosis. Maturitas 2000;37:75-81]. RESULTS: A total of 474 women (median age 63 years) were studied (306 in the OS group, 168 in the comparison group). Knowledge scores based on OPQ (median) were 7 and 6 points in the OS and comparison groups, respectively. When adjusted for age, the statistics showed better knowledge patients in the OS group (P=0.019). In both the OS and comparison groups, knowledge was found to be correlated positively with education (P<0.001) and experience of hormone replacement therapy (HRT) (P<0.001) and negatively with age (P<0.001). Knowledge was higher among women with better health status in the OS group. CONCLUSION: Knowledge about osteoporosis among Czech women aged > or =40 years and attending outpatient centers is relatively poor. To improve it, special attention should be paid to elderly women, those who have not used HRT, poorly educated women and those treated with several drugs.     

Erratum to: Efficacy and safety of piascledine 300 versus chondroitin sulfate in a 6 months treatment plus 2 months observation in patients with osteoarthritis of the knee

Clinical Rheumatology -     

Radiographic progression of knee osteoarthritis in a Czech cohort

OBJECTIVE: To determine the 5-year radiographic progression of osteoarthritis (OA) of the knee in a Czech cohort. METHODS: 139 patients with idiopathic OA were followed for 5 years, receiving only physical therapy and non-steroidal antiinflammatory drugs as needed. Weight-bearing radiographs of both knees were performed at the initial and final evaluation by a single technician using the same instrument and a standardized procedure. Radiographs were evaluated using the Kellgren-Lawrence scale (KL). Joint space width (JSW) was determined by 2 independent trained readers, and discrepancies re-reviewed. RESULTS: JSW decreased 0.39 +/- 0.95 mm in 5 years, or 0.078 +/- 0.19 annually. The reduction of JSW was greatest in the KL grade III radiographs (0.099 +/- 0.18 mm). The smallest reduction in JSW was seen in those with KL grade I (0.044 +/- 0.14 mm). However, only 25% of those with KL stage II or stage III demonstrated any change in JSW over the 5-year period. The reduction in JSW was not constant, being most rapid in the first year and then much slower. The coefficient of variation (CV) of the method was good (intra- and inter-observer CV 3.6%). CONCLUSION: This 5-year follow up of Czech patients with OA of the knee demonstrated a low rate of radiographic progression of JSW. The most rapid progression appeared in KL stage III. The progression was most rapid in the first year.