Beneficial effect of atorvastatin on erythropoietin responsiveness in maintenance haemodialysis patients

Aim: To evaluate the effect of atorvastatin on erythropoietin responsiveness and whether this effect is mediated by C‐reactive protein (CRP) reduction in prevalent dyslipidemic, haemodialysis patients. Methods: We studied prospectively 33 stable, iron‐repleted haemodialysis patients with low‐density lipoprotein cholesterol (LDL) ≥2.58 mmol/L, who received 20 mg atorvastatin aiming to achieve the target of LDL <2.58 mmol/L, over a period of 9 months. Twenty‐five patients completed the study, 15 men, with mean age 66.1 ± 8.2 years. The duration of haemodialysis was 56.6 ± 63.1 months and 5/25 patients were diabetics. Total serum cholesterol, triglycerides, high‐density lipoprotein cholesterol, LDL, haemoglobin, albumin, intact parathyroid hormone, serum iron, ferritin, total iron binding capacity, CRP and weekly dose of erythropoietin/body weight/haemoglobin were analysed. Results: Twenty of the 25 patients (80%) achieved the goal of LDL <2.58 mmol/L. There was a significant decrease in total cholesterol (5.77 ± 0.88 to 4.16 ± 0.96 mmol/L, P < 0.001) and LDL (3.59 ± 0.77 to 1.94 ± 0.77 mmol/L, P < 0.001). Haemoglobin increased from 121 ± 11 to 126 ± 7 g/L (P < 0.05), while weekly dose of erythropoietin/body weight/haemoglobin decreased significantly from 8.34 ± 3.70 to 7.87 ± 3.11 IU/kg per haemoglobin (P < 0.05). CRP decreased not significantly from 7.0 ± 6.1 to 4.5 ± 2.2 mg/L. Conclusion: Dyslipidemia of haemodialysis patients was treated safely and effectively with atorvastatin, but a fifth of the patients failed to achieve the therapeutic target. Statin therapy resulted in a significant increase of haemoglobin levels and improvement of erythropoietin responsiveness without a significant reduction in CRP levels, suggesting that the beneficial effect of statins on erythropoietin responsiveness may be driven by a mechanism other than CRP reduction.     

Influence of Propranolol on the Ventricular Depolarization Gradient

Sensing of the ventricular depolarization gradient (VDG) has recently been used as The basis of a closed-loop rate responsive pacemaker. Factors influencing this aspect of the evoked response have not been fully evaluated although previous reports have suggested that sympathetic stimulation and circulating catecholamines are primarily responsible for the observed changes during stress and exercise. In five patients (Table I), four males and one female (mean age 60.4 ± 20.1 years) implanted with the Prism pacemaker, the pacing response to exercise and tilting was assessed before and after the infusion of propranolol. There was an increase in the pacing rate in all patients during the infusion of the drug (mean 27 ± 12.9 beats/min) suggestive of a direct drug effect on the VDG. The rate control parameter (RCP) of the pacemaker, the numerical equivalent of the VDG, was significantly different after the administration of propranolol (P < 0.01). However, exercise performance and pacing rate behavior were not different after beta blockade. The pacing rate increase observed when tilting patients to the supine position was not altered by propranolol. Out date suggest that factors other than adrenergic stimulation may be of importance in affecting the ventricular evoked response and accordingly the rate adaptation of the Prism pacemaker.     

Precipitous Rise and Fall of SGOT

Three patients are reported whose studies showed a transient but marked elevation of serum transaminase levels with a rapid return toward normal. In two patients this phenomenon was associated with transient episode of hypotension; in the third case this was an incidental finding discovered fortuitously on a routine test. Hepatic ischemia and parenchymal injury may cause transient elevations of serum transaminase levels.     

DETECTION OF AUTOIMMUNITY PARAMETERS IN THE ACQUIRED IMMUNODEFICIENCY SYNDROME (aids)

We have examined various autoimmunity parameters in AIDS with special emphasis on the expression of pemphigus and bullous pemphigoid antibodies. Sera from healthy seropositive individuals without syphilis (CS-, n = 17), seropositive individuals with syphilis (cs+, n = 11), and patients with AIDS (n = 6) were studied and compared with normal controls (n = 30); autoimmunity parameters related to dermatology were evaluated. Indirect immunofluorescence (IIF) for pemphigus and pemphigoid antibodies, antinuclear antibodies (ANA), anti-DNA antibodies, antismooth muscle antibodies (ASMA) antimitochondrial antibodies (AMA), and antithyroid antibodies (ATA) was carried out and findings were graded with a cumulative index (CI) for each patient group. Pemphigus and bullous pemphigoid-like antibodies (IgG, PV + BP) were detected in 33% of the AIDS patients. Statistically increased CI (P less than 0.01) was found in the CS- group compared with the CS+ group and in the AIDS group compared with CS- (P less than 0.01).     

Duplex sonography in detection of renal artery stenosis: A simplified approach using new parameters

A case report illustrating a new investigation for detecting renal artery stenosis (RAS) is reported. Colour Doppler ultrasound evaluation of the readily accessible intrarenal arteries is a fast and accurate technique. Acceleration time and acceleration are the Doppler parameters used for measuring systolic upstroke on the waveforms obtained. Prolonged acceleration time (>0.07s) and diminished acceleration (< 3m/s²) indicate haemodynamically significant stenosis. Intrarenal Doppler ultrasound should provide a safe noninvasive screening examination for the detection of RAS.     

Inducible nitric oxide synthase expression and its prognostic significance in colorectal cancer

Zafirellis K, Zachaki A, Agrogiannis G, Gravani K. Inducible nitric oxide synthase expression and its prognostic significance in colorectal cancer. APMIS 2010; 118: 115–24. Nitric oxide synthases (NOS) are expressed in colorectal cancer. The aim of this study was to examine the inducible NOS (iNOS) expression in colorectal cancer and to investigate its prognostic relevance. Tissue sections of primary tumors from 132 patients undergoing curative resection for colorectal cancer were immunohistochemically examined for iNOS expression. The expression pattern of iNOS was correlated with various clinicopathological characteristics and survival. iNOS immunoreactivity was observed in the cytoplasm of tumor epithelial cells in 60 patients (45.5%) and positively correlated with lymph node involvement (p = 0.019). No significant correlation was found between iNOS expression and various clinicopathological characteristics, including age, gender, tumor location, tumor size, tumor grade, T stage, and Union International Contra la Cancrum (UICC) stage. Survival analysis showed a significant correlation between iNOS‐positive tumors and poor disease‐specific survival (p < 0.0001), with independent prognostic significance in multivariate analysis (HR = 4.42; p < 0.0001). Patients with stage II disease and iNOS‐positive tumors had significantly worse disease‐specific survival than those with iNOS‐negative tumors (p < 0.0001). In addition, patients with stage III disease and iNOS‐positive tumors had significantly worse disease‐specific survival than those with iNOS‐negative tumors (p = 0.001). The ability of iNOS to predict outcome in colorectal cancer patients may be independent of other known prognostic factors, providing a new molecular marker with significant potential for clinical utility.     

Prognostic value of COX‐2 immunohistochemical expression evaluated by quantitative image analysis in colorectal cancer

Epidemiological studies have shown that the inducible form of cyclooxygenase (COX‐2) may be involved in colorectal carcinogenesis, but it is controversial whether its expression is a prognostic factor for colorectal cancer. The aim of the study was to examine the expression of COX‐2 in colorectal cancer and investigate its prognostic relevance. Tissue sections of primary tumors from 132 patients undergoing curative resection for colorectal cancer were immunohistochemically examined for COX‐2 expression. The levels of intensity and extent of COX‐2 staining were quantified by use of a computerized image analysis system and correlated with various clinicopathological characteristics and survival. COX‐2 immunoreactivity was observed in the cytoplasm of tumour epithelial cells of all colorectal cancer tissues examined. No significant correlation was found between levels of intensity and extent of COX‐2 staining and various clinicopathological characteristics, including age, gender, tumor location, tumor size, tumor grade, depth of invasion, lymph node status and TNM stage. There was an inverse correlation between intensity and extent of COX‐2 staining scores (Spearman's rho=?0.414; p<0.001). To analyze the prognostic value of intensity and extent of COX‐2 staining, the patients were divided into four groups with respect to quartiles (≤25; >25 to ≤50; >50 to ≤75; and >75). No significant disease‐specific survival difference among the quartiles was found based on analysis of intensity (p=0.689) and extent (p=0.975) of COX‐2 staining. These results suggest that the expression of COX‐2 protein has no significant impact on the outcome of patients with colorectal cancer.