Thirty years of experience with desmoid tumors at Charity Hospital

The experience of the Charity Hospital surgeons in dealing with desmoid tumors is examined retrospectively over a 30-year period. Sixteen cases are presented. A 33 per cent rate of recurrence was noted despite excisions with margins free of tumor in each instance. In accordance with chi-square analysis, unequivocal statistical significance is given to the fact that women who have been pregnant are more likely to have abdominal than extraabdominal desmoid tumors. It was also found to be significant that parous women in whom desmoids develop are more likely to have the tumor within 10 years of their last pregnancy.     

Effect of body weight changes on 24-hour blood pressure and left ventricular mass in hypertension: a 4-year follow-up

BACKGROUND: Few data are available on the long-term effects of weight loss on 24-h blood pressure (BP) and left ventricular mass in overweight hypertensive patients. METHODS: A total of 181 never-treated overweight hypertensive subjects (body mass index, 25 to 39 kg/m(2), office BP 145/94 +/- 12/7 mm Hg) had 24-h BP monitoring and echocardiography twice, at baseline and after 3.8 +/- 2 years (minimum 1 year). None of the subjects received antihypertensive drugs during the follow-up. Main outcome measures were changes in 24-h BP and in left ventricular mass. RESULTS: Percent change in body weight had a direct relationship with 24-h BP changes (r = 0.35 and 0.31 for systolic and diastolic BP, respectively; both P <.001). The associations with office BP changes (r = 0.13, P =.10 for systolic BP; r = 0.15, P =.06 for diastolic BP) were significantly weaker (both P <.01, z test). The patients who lost weight during follow-up (n = 106) had a significantly lower increase in 24-h BP (+0.6 +/- 9/ +0.2 +/- 6 v +4.9 +/- 9/ +2.7 +/- 7 mm Hg for systolic/diastolic BP, both P <.01) and in left ventricular mass (-3 +/- 30 g v +9 +/- 32 g, P <.02) than the remaining subjects. In a multiple linear regression, a 10% weight loss independently predicted a 4.3/3.8 mm Hg decrease in 24-h systolic/diastolic BP. CONCLUSIONS: Long-term weight loss determines a sustained BP reduction during the 24 h and a decrease in left ventricular mass in overweight hypertensive subjects. The relation of weight loss with ambulatory BP changes is closer than that with office BP.     

Prognostic value of low and high ankle-brachial index in hospitalized medical patients

BackgroundPeripheral arterial disease (PAD) is frequently underdiagnosed in the clinical practice, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular (CV) death. The ankle-brachial pressure index (ABI) represents a noninvasive, objective tool to diagnose PAD and to predict adverse outcome.MethodsABI was determined by means of Doppler velocimetry, in 707 patients, aged 50 years or older, consecutively hospitalized in an internal medicine ward, who were followed-up for at least 12 months in order to assess all-cause and CV mortality.ResultsSymptomatic PAD affected 8% of the population while the prevalence of PAD, defined as ABI < 0.90, was 29%; high ABI (> 1.40) was found in 8% of the patients. After a mean follow-up period of 1.6 years, both low and high ABI were independently associated with CV mortality with a hazard ratio of 1.99 (p = 0.016) for low and 2.13 (p = 0.04) for high ABI, compared with normal ABI (0.90–1.40). High ABI also independently predicted all-cause mortality with a hazard ratio of 1.77 (p = 0.04).DiscussionABI measurement reveals a large number of individuals with asymptomatic PAD among those hospitalized in an internal medicine department. An increased mortality was observed in patients with both low and high ABI. Hospital admission for any reason may serve as an opportunity to detect PAD and start appropriate preventive actions.     

A Circuit for Safe Diagnostic Electrical Stimulation of the Human Brain

Abstract

An electronic circuit for controlled electrical stimulation of the human brain has been designed to optimize safety in charge transfer from electrodes to brain and to eliminate the likelihood of unwanted currents from the neurostimulator resulting from component failure. The circuit schematics feature the following designs: (1) a highly accurate and versatile rate generator 0.5 p.p.s. to 99 in increments of 0.5 p.p.s., (2) symmetrically-biphasic lead and lag pulses of 100 μsec duration, (3) photo-isolated driver amplifiers with accurate waveform, reproduction, (4) true biphasic passive-current regulators driven by an isolated battery supply voltage for switch-selectable currents of 0.25 to 5 ma or variable current regulation, (5) accurate current and voltage waveform monitors that isolate the stimulating electrodes from the monitors, and (6) capacity-coupled outputs to guarantee no net D.C. component at the end of each biphasic pulse. Relay-switching circuits are also shown that allow sequential stimulation and recording from one or several electrodes. This neurostimulator has been in use for over two years without evidence of electrolytic damage at identifiable electrode tips. The utility of simultaneous stimulation of several different electrodes at safe charge levels is described.