The presence of insomnia and depression contributes to the acceptance of an initial treatment trial of continuous positive airway pressure therapy in patients with obstructive sleep apnea

Sleep and Breathing - The presence of comorbid insomnia and sleep apnea (COMISA) reduces the initial acceptance of continuous positive airway pressure (CPAP) therapy in 39–58% of patients...     

Chemokine CXCL-1: activity in the vitreous during proliferative vitreoretinopathy

The aim of this study was to investigate CXCL-1 chemokine levels in the vitreous during rhegmatogenous retinal detachment (RRD) with and without proliferative vitreoretinopathy (PVR) and identify possible correlations with clinical parameters (extent and duration or RRD and PVR grade). Vitreous samples from patients with primary RRD with or without PVR were collected and assayed using a double antibody enzyme-linked immunosorbent assay (ELISA). Eleven vitreous samples from organ donors were employed as a control group. CXCL-1 levels were measured in 35 vitreous samples from 35 RRD patients. Mean CXCL-1 levels (64·82 ± 6·47 pg/ml) were significantly higher (P = 0·048) compared to controls. There was a significant positive correlation between CXCL-1 levels and the extent of the detachment (r = 0·794, P = 0·006). Peak CXCL-1 levels coincided with 3+ quadrant RRD, an interim of 29–60 days’ duration and PVR grade B. Increased CXCL-1 levels may be indicative of mild inflammation in the detached retina and the adjacent vitreous. The results of the present study may provide novel insight into the complex interactions taking place during the early and late stages of RRD complicated by PVR.     

Prevalence of Pulmonary Hypertension in Patients with Idiopathic Pulmonary Fibrosis: Correlation with Physiological Parameters

The aim of this study was to prospectively evaluate the prevalence of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF). One hundred thirty-nine patients (101 male, mean age?=?68.6?±?9?years), with confirmed IPF and who were admitted to eight Pulmonary Departments in Greece between November 2005 and December 2006 were included in the study. Pulmonary artery systolic pressure (PASP) was estimated by echocardiography, and PH was defined as PASP?>?36?mmHg. We compared demographics, pulmonary function tests, NYHA functional status, 6-min walk distance (6MWD), B-type natriuretic peptide (BNP), PaO(2), and P(A-a)O(2) at rest data between patients with PH and without PH (PASP?≤?36?mmHg). Increased estimated right ventricular systolic pressure was present in 55% of patients (mean PASP?=?47.1?±?11.2?mmHg vs. 30.3?±?3.8?mmHg, respectively). Patients with PH had a lower but not statistically significant DL(CO) (47.1?±?18.8 vs. 52.5?±?20.1), lower PaO(2) at rest (64.6?±?12.2 vs. 71.1?±?11.3, P?=?0.004), and lower mean 6MWD (282?±?118 vs. 338?±?91, P?=?0.007). Significant differences were also observed in the NYHA functional status between the two groups (P?=?0.02). Statistically significant correlations were observed between PASP and PaO(2) at rest (r?=?-0.331, P?=?0.00), P(A-a)O(2) at rest (r?=?0.494, P?=?0.00)(,) 6MWD (r?=?-0.264, P?=?0.01), SpO(2) at rest (r?=?-0.293, P?=?0.00), SpO(2) at the end of exercise (r?=?-0.364, P?=?0.00), and also BNP values (r?=?0.319, P?=?0.01). Moreover, PaO(2) (P?=?0.02), P(A-a)O(2) (P?=?0.005), and SpO(2) at the end of exercise (P?=?0.023) were independent predictors of the presence of estimated PH. Using Doppler echocardiography as a screening tool for the estimation of PH, we found that PH is common in patients with IPF. Gas exchange parameters at rest and exercise desaturation might indicate underlying PH in IPF.     

A case of a young asymptomatic woman with optic disc drusen and vasculitis

Purpose

We present the case of a young woman with optic disc drusen and peripheral vasculitis.

Methods

Diagnosis was based on fundoscopic, optical coherence tomography as well as fluorescein angiography (FA) findings.

Results

An asymptomatic 34-year-old female patient with no systemic pathology was referred to our hospital from her optician for retinal findings. Fundoscopy revealed mild disc swelling that could be attributed to the presence of optic disc drusen in both eyes. There was fundoscopic evidence of periphlebitis in the periphery confirmed by FA findings.

Conclusions

In our case, the unique feature was the presence of optic disc drusen and retinal periphlebitis. The patient''s disc configuration may have contributed to a predisposition for vasculitis in addition to vessel tortuosity.Key words: Optic disc drusen, Retinal periphlebitis, Optical coherence tomography     

A multicenter evaluation of the appropriate use of single-photon emission tomography myocardial perfusion imaging in Greece

Background

This study evaluates the appropriate use of myocardial perfusion imaging (MPI) and determines patterns and variables associated with inappropriate testing.

Methods

Over a 10-month period data were collected prospectively from consecutive patients referred for MPI in four academic departments and an appropriate use grade was assigned (appropriate, uncertain, inappropriate, and unclassifiable scans) according to established criteria.

Results

Among 3,032 referrals appropriate MPI had 72.8% of patients and 19.2% of studies were inappropriate, the remaining being uncertain (7.2%) or unclassifiable (0.8%). In multivariate analysis the asymptomatic status (odds ratio 10.7, P < .001), good functional capacity (odds ratio 1.9, P < .001), an interpretable resting electrocardiogram (odds ratio 1.8, P = .004), an age <65 years (odds ratio 1.5, P = .001) and the absence of diabetes (odds ratio 1.7, P < .001) or dyslipidemia (odds ratio 1.3, P = .014) were independent predictors of inappropriate scintigraphy. The most common indication for inappropriate testing was the assessment of asymptomatic patients <2 years after percutaneous coronary intervention (PCI) (38.9%).

Conclusions

The appropriate use of MPI is relatively high, but a considerable proportion of inappropriate scans is noted which is associated with markers of lower risk. The most common source of inappropriate testing is the assessment of asymptomatic patients <2 years after PCI.