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PubMed2002

A pilot study of thalidomide for patients with symptomatic mesenteric panniculitis.

BACKGROUND: Mesenteric panniculitis is a rare condition with no standard therapy. AIM: To assess the safety and efficacy of thalidomide for the treatment of patients with symptomatic mesenteric panniculitis using a newly established clinical disease activity index (Mesenteric Panniculitis Subjective Assessment Score). METHODS: In an open-label pilot study, five patients with symptomatic mesenteric panniculitis received oral thalidomide, 200 mg nightly, for 12 weeks. The primary end-point was a reduction in the Mesenteric Panniculitis Subjective Assessment Score by > or = 20% at 12 weeks or complete remission (absence of symptoms). RESULTS: Four (80%) of the five patients responded. The median Mesenteric Panniculitis Subjective Assessment Score at baseline was 39 and at week 12 was 25 (average decrease of 44%). One patient achieved complete remission by week 4, which was sustained. At 12 weeks, three (75%) patients experienced a global response, five (100%) patients had a > or = 20% (range, 29-98%) decrease in erythrocyte sedimentation rate and three (75%) patients had a > or = 20% (range, 61-93%) decrease in C-reactive protein. Abdomino-pelvic computed tomography scans were unchanged in all five patients. There were no serious adverse events. CONCLUSIONS: Thalidomide is safe, well tolerated and efficacious in the treatment of some patients with symptomatic mesenteric panniculitis. Further study is indicated.

Aged↗
PubMed1998

Splenic irradiation for symptomatic splenomegaly associated with myelofibrosis with myeloid metaplasia.

Twenty-three patients who had myelofibrosis with myeloid metaplasia (MMM) were treated at our institution with 50 courses of splenic irradiation (SI) for symptomatic splenomegaly. The median dose of radiation per course was 277.5 cGy, administered in a median of 7.5 fractions. 8/23 patients received multiple courses of SI. Of 49 evaluable courses of SI, 46 (93.9%) resulted in an objective decrease in spleen size. The median duration of response was 6 months (range 1-41). Reduction in spleen size was associated with symptomatic relief in all patients. Overall median survival after SI was 22 months. Significant cytopenia occurred in 10 (43.5%) patients, or 16 (32%) of the 50 courses of SI. Prolonged, life-threatening pancytopenia after a single course of SI occurred in six patients (26%), resulting in fatal sepsis or haemorrhage in three (13%). Nine patients underwent subsequent splenectomy: the perioperative mortality rate was 11%. One third of patients experienced postoperative intra-abdominal haemorrhage necessitating surgical re-exploration. SI can provide symptomatic relief and a reduction in spleen size in most MMM patients. The increased risk of postoperative bleeding in patients requiring subsequent splenectomy dictates against considering SI as an alternative to splenectomy for patients who are otherwise good surgical candidates.

Adult↗
PubMed2003

The relationship between the occlusal interference side and the symptomatic side in temporomandibular disorders.

This study aimed to investigate the relationship between the facial side of pain or clicking symptoms and the side of occlusal interference, and to examine the features of pain and clicking patients in terms of frequencies of occlusal interferences in relation to the symptomatic side. Occlusal conditions in 31 pain patients and 40 clicking patients were investigated just after the relief of pain or clicking solely by means of bite plane therapy. The symptomatic side did not associate with the side of fewer occlusal contacts in intercuspal position, no canine contact on the working side, occlusal contact on the non-working side, or unilateral contact in retruded contact position. The results of this study suggest that pain or clicking does not necessarily tend to appear on the side of these occlusal interferences. Additionally, characteristic inclination for pain and clicking patients in terms of frequencies of occlusal interferences in relation to the symptomatic side was not identified.

Adult↗
PubMed2003

Factors influencing the care-seeking behaviour of chest symptomatics: a community-based study involving rural and urban population in Tamil Nadu, South India.

Our aim was to identify the factors that influence the care-seeking behaviour of chest symptomatics in urban and rural areas in South India. We conducted in-depth interviews with 649 participants: 80% of 310 urban residents and 63% of 339 rural people had sought care (P < 0.01), 93% within 1 month of onset of symptoms. Private health care facilities were the first and preferred point of contact for 57% of urban and 48% of rural participants; the major reasons were proximity to residence and their perception that good-quality care would be available there. Symptomatics who did not seek care attributed their inaction to insufficient severity of symptoms (51%), unaffordability (46%) and lack of time due to work pressures (25%). Socio-economic factors such as literacy and family income significantly influenced care-seeking behaviour. Our results indicate that most chest symptomatics seek care promptly; their initial response is to go to the nearest private health care facility, shifting to another if they are dissatisfied. Fifty per cent of the participants who did not seek care felt that their symptoms were not severe.

Adolescent↗
PubMed2002

Early studies on the safety and efficacy of thalidomide for symptomatic inflammatory bowel disease.

BACKGROUND AND AIM: Thalidomide is clinically effective in the treatment of graft versus host disease in bone marrow transplantation and aphthous ulceration in HIV infection. It appears to exert a selective effect on tumor necrosis factor-alpha (TNF-alpha) production. Tumor necrosis factor-alpha is implicated in the pathogenesis of inflammatory bowel disease (IBD). The aim of this study was to assess the efficacy and safety of thalidomide in symptomatic IBD. METHODS: Eleven patients (nine males, mean age 33 years, range 20-77 years) with chronic inflammatory bowel disease (six Crohn's disease (CD), four ulcerative colitis (UC), one indeterminate colitis (IC)) who were symptomatic despite standard medical therapy were administered a daily dose of thalidomide for 12 weeks in an open-labeled protocol. Their response was assessed by using clinical, colonoscopic, histological, and immunological methods. RESULTS: Two patients withdrew at 3 weeks because of mood disturbances. Of the remaining nine patients, eight (five CD, two UC and one IC) had a marked clinical response, while one patient with CD had no response. The mean stool frequency decreased from 4.3 to 2.3 per day (P = 0.0012), and the stool consistency increased from 2.1 to 1.2 (P = 0.02). The mean Crohn's Disease Activity Index decreased from 117 to 48 (P = 0.0008). Endoscopic inflammatory and histological grade, C-reactive protein and erythrocyte sedimentation rate (ESR) all decreased significantly (P = 0.011, P = 0.03, P = 0.023 and P = 0.044, respectively). However, the serum TNF-alpha levels did not change. Side-effects included mild sedation, xerostomia and skin dryness in all, constipation in three, and minor abnormalities in nerve conduction in one patient. CONCLUSION: These data strongly suggest that thalidomide is an effective short-term treatment for symptomatic IBD.

Adult↗
PubMed2003

Long-term results of multiple minocycline hydrochloride injections for the treatment of symptomatic solitary hepatic cyst.

BACKGROUND: The current study presents the long-term results of multiple minocycline hydrochloride (MINO) injections for the treatment of symptomatic solitary hepatic cyst. METHODS: From 1989 to 1998, nine patients were referred for the treatment of a symptomatic solitary hepatic cyst, comprising two males and seven females aged between 41-72 years (mean 58.2 years). The chief complaint in all cases was upper abdominal discomfort or pain. Mean cyst diameter was 14.1 +/- 2.3 cm. After insertion of an 8 or 9-French catheter into the cyst, 200 mg of MINO in 10 mL saline was injected and the catheter was flushed with 10 mL saline, for a total of 20 mL saline. The catheter was then clamped for 30 min. MINO injection was performed daily for 7-8 days, after which time the catheter was removed. RESULTS: One patient complained of moderate right subscapular pain immediately after the injection, and one patient complained of pain at the site of catheter insertion. Patients were followed for 42-153 months (mean 85 months). Cyst regression without recurrence was documented in all patients. CONCLUSIONS: Multiple injections of MINO are safe, definitive treatments for symptomatic solitary hepatic cyst.

Adult↗
PubMed2003

Birthweight distribution in southern Chinese infants with symptomatic congenital heart disease.

OBJECTIVE: Western infants with congenital heart disease have frequently been reported to have a low birthweight for gestational age. Studies in Asian infants seem to be lacking in this area. This is the first extensive study presenting the birthweight distribution of Chinese newborns with symptomatic congenital heart disease. METHODS: The birth data of 454, mainly southern-Chinese infants with symptomatic cardiovascular defects, born between 1990 and 1995 and admitted to Grantham Hospital, Hong Kong in 1994 and 1995, were analysed retrospectively. Infants with (non)-genetic syndromes or other major extracardiac malformations were excluded. RESULTS: Fifteen per cent of all newborns had a birthweight below the reference mean of - 2 Z-score. After correction for length of gestation, no significant difference could be detected in birthweight between the cyanotic and acyanotic groups, nor between the different haemodynamic disturbances. Infants with atrial or ventricular septal defects, tetralogy of Fallot, pulmonary atresia with ventricular septal defect, heart with univentricular atrio-ventricular connection or double outlet right ventricle showed significant birthweight deficits. Transposition of the great arteries was not related to being small for gestational age. CONCLUSIONS: Similar to Western infants, prenatal growth impairment was a common feature in Chinese infants with symptomatic congenital heart disease. The birthweight distribution in Chinese might be comparable to that in Western populations. Exceptions are possibly the high frequency of low birthweight in Chinese newborns with atrial septal defect or a single-ventricle abnormality. Further studies on fetal anthropometry and haemodynamics are necessary to provide insight into the relation between cardiovascular malformations and being small for gestational age.

Asian People↗
PubMed2000

Comparison of prazosin, terazosin and tamsulosin in the treatment of symptomatic benign prostatic hyperplasia: a short-term open, randomized multicenter study. BPH Medical Therapy Study Group. Benign prostatic hyperplasia.

BACKGROUND: The objective of this open randomized clinical study was to compare the short-term efficacy and safety of three alpha-1 blockers, prazosin, terazosin and tamsulosin, in the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). METHODS: The study comprised 121 patients with symptomatic BPH who were randomized to receive 0.5 mg of prazosin twice daily, 0.5 mg of terazosin twice daily or 0.1 mg of tamsulosin once daily for the initial 2 weeks. The doses were doubled for the next 2 weeks. The primary variables assessed were a symptom score, changes in maximum and average urinary flow rate (Qmax and Qave), postvoid residual urine volume and blood pressure. RESULTS: The percentage changes in the total symptom score from baseline were 38, 39 and 26% at 4 weeks by prazosin, terazosin and tamsulosin, respectively. Terazosin produced significantly higher improvement in four out of nine individual symptoms than tamsulosin (P < 0.05). A significant increase in Qmax or Qave in uroflowmetry was obtained in the prazosin and tamsulosin groups. Blood pressure remained unchanged in normotensive patients, but significantly decreased in hypertensive patients except for the tamsulosin group. Adverse events were minimal in all treatment groups. CONCLUSIONS: The efficacy and safety profiles were different among the alpha-1 blockers at standard doses. Tamsulosin appears to be safer than the others for aged patients or patients with hypertension who have impaired blood pressure regulation, while terazosin is significantly effective in improving symptomatic score when compared with the others examined. It is recommended that the alpha-1 blocking agent and its optimal dose are selected on the basis of the baseline characteristics of the patients with symptomatic BPH.

Adrenergic alpha-Antagonists↗
PubMed2000

Symptomatic intraocular inflammation in multiple sclerosis.

PURPOSE: The aim of this study was to determine the type and outcome of uveitis in patients with multiple sclerosis. METHODS: A retrospective study of 16 patients attending the uveitis clinic who had a clinically definite diagnosis of multiple sclerosis and symptomatic intraocular inflammation. The type of uveitis and complications present as well as the outcome of therapeutic intervention, either medical or surgical, was determined. RESULTS: Chronic, bilateral anterior uveitis was present in six patients. Secondary cataracts requiring surgery occurred in 10 eyes, and trabeculectomy was done on five eyes for secondary glaucoma. Symptomatic vitritis (visual blurring and/or visually significant floaters) occurred in eight patients and was bilateral in four. Occlusive peripheral retinal vasculitis with subsequent areas of ischaemia and neovascularization requiring panretinal laser photocoagulation developed in eight eyes, five of which also required vitrectomy. Other posterior segment complications included macular oedema (four) and epiretinal membrane involving the macula (two). Five patients required systemic steroids for control of posterior uveitis. The median visual improvement following cataract surgery or vitrectomy was 3 Snellen lines to a median visual acuity of 6/18. CONCLUSIONS: A wide range of clinical patterns of uveitis, which may be both symptomatic and sight-threatening, occur in patients with multiple sclerosis. In addition, the complications of uveitis may cause significant visual morbidity, much of which is amenable to appropriate surgical intervention. It is important that these potentially remediable conditions are recognized and treated to ensure that patients with multiple sclerosis retain optimum visual function.

Adult↗
PubMed2002

Ultrasound-guided, high-energy extracorporeal - shock-wave treatment of symptomatic calcareous tendinopathy of the shoulder.

BACKGROUND: The objective of the present study was to test the effectiveness of ultrasound-guided high-energy extracorporeal shock-wave treatment in symptomatic chronic calcareous tendinopathy of the shoulder rotator cuff, and to assess the morphology of the hydroxyapatite deposits before and after this treatment. METHODS: The study involved 80 patients who suffered from calcification of the rotator cuff. These patients were treated with an instrument with electromagnetic induction of shock-waves (Doli-Lithotripter, Dornier, Munich, Germany) under continuous ultrasound location of the treatment focus. The treatments were carried out in one to five sessions at an interval of 4-6 weeks. Each patient received a total of 1800 shock waves in each therapy. The flow density of the energy in the therapy focus was 0.08-0.42 mJ/mm2. RESULTS: Sixty-eight patients (85%) attained complete freedom from symptoms or only had minimal residual symptoms when stressing their shoulder joint. The calcification suffered by 57 (71.2%) patients was completely resorbed after treatment and partially resorbed in 16 patients (20%). Complete resorption of the calcareous deposits led to freedom from symptoms. In all patients with amorphous calcareous deposits, there was complete resorption of the calcification. Mixed calcareous foci were eliminated in 64.7-77% of the cases, depending on the extent of amorphous structures. Complete resorption was achieved in 44.4% of patients where homogeneous calcareous deposits were >1 cm in size. CONCLUSION: Shock-wave treatment in periarthritis of the shoulder is a new and very effective method for symptomatic calcareous tendinopathy. Extracorporeal shock-wave treatment has good prospects of success in any type of calcification. As a non-invasive technique with a high success rate, shock-wave treatment is an alternative to surgical operations in patients who remain symptomatic after exhaustive conservative treatment.

Adult↗
PubMed2003

Paroxysmal atrial fibrillation: ectopic atrial activity and prevalence of severely symptomatic patients.

Catheter ablation is a promising approach in severely symptomatic patients with paroxysmal atrial fibrillation (PAF). Until this time it has only been performed in highly selected patients with weekly episodes and frequent premature atrial contractions (PACs). The aim of the present study was to estimate the prevalence of severely symptomatic patients with PAF and to evaluate the significance of PACs. The files of 7,447 consecutive patients were screened and 1,357 PAF patients identified. Holter recordings were performed in 108 patients with >/=2 spontaneous AF episodes. Despite antiarrhythmic treatment, 6.5% (1.8-11.1%) had a history of weekly PAF episodes. 29.2% of patients and 10% of healthy, age-matched controls had more than 700 PACs. The number of PACs was inversely related to the reported numbers of previous episodes and directly related to age and size of left atrium. We estimate that about 6.5% of patients with PAF are severely symptomatic and might benefit from catheter ablation. Our data suggest that the number of PACs should not be used as a selection criterion for catheter ablation. Frequent PACs are seen in a substantial proportion of elderly healthy individuals.

Adult↗
PubMed2000

A comparative study of terazosin and tamsulosin for symptomatic benign prostatic hyperplasia in Japanese patients.

OBJECTIVE: To compare the efficacy and safety of an incremental-dose regimen of terazosin (1-2 mg daily) and a fixed-dose regimen of tamsulosin (0.2 mg daily), on Japanese patients with symptomatic benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: This multicentre, single-blind, randomized trial compared terazosin and tamsulosin over 4 weeks, in 61 patients with symptomatic BPH randomly assigned to terazosin (n = 31) or tamsulosin (n = 30). Terazosin 0.5 mg twice daily was administered for 2 weeks, followed by 1 mg twice daily for 2 weeks. Tamsulosin (0.2 mg) was administered once daily for 4 weeks. Symptoms were evaluated using the International Prostate Symptom Score (IPSS), and quality of life (QOL) was assessed subjectively before treatment, and again after 2 and 4 weeks of treatment. Objective measurements taken before and after the treatment period were the maximum (Qmax) and average (Qave) urinary flow rates, and the percentage residual urine volume. Improvement was defined as a 25% decrease from baseline in IPSS, > 1 point increase in QOL score, and > 2.5 mL/s increase in Qmax. Adverse reactions potentially related to the study drugs were recorded throughout the treatment period. RESULTS: Both terazosin and tamsulosin produced statistically significant improvements in subjective and objective variables. Neither treatment affected systolic or diastolic blood pressure or pulse rate. Adverse reactions were noted in four patients (three in the terazosin group and one in the tamsulosin group). However, there was no statistically significant difference in the incidence of adverse effects between the groups. CONCLUSIONS: Despite the limitations of small sample size and relatively short treatment periods, terazosin and tamsulosin were equally effective in the treatment of symptomatic BPH in Japanese patients, using relatively lower doses than those used in Western countries.

Adrenergic alpha-Antagonists↗
PubMed2001

A quantitative analysis of purinoceptor expression in the bladders of patients with symptomatic outlet obstruction.

OBJECTIVE: To compare the expression of the seven known P2X receptors in human bladder from male patients with detrusor instability caused by symptomatic bladder outlet obstruction with that from control bladders, using a quantitative reverse transcription-polymerase chain reaction (RT-PCR) method. PATIENTS AND METHODS: Real-time quantitative RT-PCR provides a system for detecting and analysing RNA. Bladder biopsies were obtained from nine patients undergoing prostate surgery and control biopsies were obtained from eight age-matched men undergoing routine bladder endoscopy studies, and who were asymptomatic. Total RNA was extracted from each sample and 10 ng of this used for individual PCR reactions. The expression levels of the seven P2X genes in the total RNA were then determined. RESULTS: In the control bladder, P2X1 was by far the predominant purinergic receptor at the RNA level, the remainder consistently present in the order P2X1 >> P2X4 > P2X2 > P2X7 > P2X5 >> P2X3 = P2X6 = 0. Calponin, a smooth muscle-specific protein, was used as a marker for smooth muscle content. In bladder from symptomatic patients, the P2X1/calponin ratio was greater than that in controls (P = 0.016). There appeared to be no difference in P2X2, but P2X4, P2X5, and P2X7 were all greater in the symptomatic bladder than in the controls, although these differences were not significant. CONCLUSION: P2X1 is the predominant purinoceptor subtype in the human male bladder, consistent with pharmacological evidence. The amount of P2X1 receptor per smooth muscle cell is greater in the obstructed than in control bladder, suggesting an increase in purinergic function in the unstable bladder arising from bladder outlet obstruction.

Aged↗
PubMed2003

A comparison of aspiration and sclerotherapy with laparoscopic de-roofing in the management of symptomatic simple renal cysts.

OBJECTIVES: To present the results of a minimally invasive treatment of symptomatic simple renal cysts, and to propose an algorithm for their management. PATIENTS AND METHODS: Seventeen patients presenting with suspected symptomatic simple renal cysts were referred for trial aspiration; 16 presented with loin pain and one with a flank mass. If the cyst and symptoms recurred after a temporary response, they were managed by re-aspiration with sclerotherapy using 95% ethanol, or by laparoscopic de-roofing of the cyst. RESULTS: Of the 17 patients referred, one failed to respond to aspiration and was excluded from further analysis. Three patients had sustained pain relief from simple aspiration alone, 13 required further treatment for symptom relapse, of whom six had aspiration and sclerotherapy, and seven had laparoscopic de-roofing. After a mean follow-up of 17 months, pain had recurred in all five patients originally presenting with pain and managed by sclerotherapy, and the patient who presented with a painless mass from a large cyst also developed pain after sclerotherapy. In contrast, the subsequent seven patients managed by laparoscopic treatment are pain-free at a mean follow-up of 17.7 months. CONCLUSION: Evaluation including a diagnostic aspiration is essential to diagnose a symptomatic cyst. When treatment is indicated, laparoscopic de-roofing appears to be more effective than sclerotherapy.

Adult↗
PubMed1999

Prevalence of CagA, VacA antibodies in symptomatic and asymptomatic children with Helicobacter pylori infection.

BACKGROUND: Limited data are available on the prevalence of CagA and VacA Helicobacter pylori antibodies in children. The aim of this study was to investigate the antibody prevalence to the H. pylori virulence factors CagA and VacA in symptomatic and asymptomatic children with H. pylori infection and to correlate these antibodies with the severity of gastric inflammation or density of H. pylori organisms in the gastric mucosa. MATERIALS AND METHODS: Twenty-three symptomatic children and 132 asymptomatic children with positive H. pylori serology participated in this study. Anti-H. pylori IgG antibody and CagA or VacA H. pylori antibodies were measured by enzyme immunoassay (HM-CAP; sensitivity and specificity > 90%) and Western immunoblot (Helicoblot 2.0) methods, respectively. Gastric inflammation and H. pylori density were graded histologically using the revised Sydney criteria. RESULTS: The prevalence of CagA and VacA antibodies were 69% and 35% in symptomatic children and 54% and 52% in asymptomatic children, respectively. Multiple regression analysis showed a correlation between CagA antibody and the severity of gastritis but no correlation with other histological features, including the number of neutrophils or lymphoid follicles. Neither antibody correlated with the degree of bacterial density in the gastric mucosa. CONCLUSION: CagA and VacA H. pylori antibodies are common in the pediatric population. The combined CagA/VacA antibodies correlated weakly with the degree of mucosal inflammation.

Adolescent↗
PubMed2001

Comparison of quality and cost-effectiveness in the evaluation of symptomatic cholelithiasis with different approaches to ultrasound availability in the ED.

Ultrasound is the imaging study of choice for the detection of gallstones, but ultrasound through medical imaging departments (MI Sono) is not readily available on an immediate basis in many emergency departments (EDs). Several studies have shown that emergency physicians can perform ultrasound themselves (ED Sono) to rule out gallstones with acceptable accuracy after relatively brief training periods, but there have been no studies to date specifically addressing the effect of ED Sono of the gallbladder on quality and cost-effectiveness in the ED. In this study, we investigated measures of quality and cost-effectiveness in evaluating patients with suspected symptomatic cholelithiasis during three different years with distinctly different approaches to ultrasound availability. The study retrospectively identified a total of 418 patients who were admitted for cholecystectomy or for a complication of cholelithiasis within 6 months of an ED visit for possible biliary colic. The percentage of patients who had gallstones documented at the first ED visit improved from 28% in 1993, when there was limited availability of ultrasound through the Medical Imaging Department (MI Sono), to 56% in 1995, when MI Sono was readily available, to 70% in 1997, when both MI Sono and ED Sono were readily available (P <.001). There were also significant differences over the 3 years in the mean number of days from the first ED visit to documentation of gallstones (19.7 in 1993, 10.7 in 1995, 7.4 in 1997, P <.001); the mean number of return visits for possible biliary colic before documentation of gallstones (1.67 in 1993, 1.24 in 1995, and 1.25 in 1997, P <.001); and the incidence of complications of cholelithiasis in the interval between the first ED visit for possible biliary colic and the date of documentation of cholelithiasis (6.8% in 1993, 5.9% in 1995, 1.5% in 1997, P =.049). The number of MI Sonos ordered by emergency physicians per case of symptomatic cholelithiasis identified increased from 1.7 in 1993 to 2.5 in 1995 and dropped back to 1.7 in 1997, when 4.2 ED Sonos per study case were also done. The cost of ED Sonos was more than offset by savings in avoiding calling in ultrasound technicians after regular Medical Imaging Department hours. The indeterminate rate for ED Sonos was 18%. Excluding indeterminates, the sensitivity of ED Sono for detection of gallstones was 88.6% (95% CI 83.1-92.8%), the specificity 98.2% (95% CI 96.0-99.3%), and the accuracy 94.8% (95% CI 92.5-96.5%). We conclude that greater availability of MI Sono in the ED was associated with improved quality in the evaluation of patients with suspected symptomatic cholelithiasis but also with increased ultrasound costs. The availability of ED Sono in addition to readily available MI Sono was associated with further improved quality and decreased costs. The indeterminate rate for ED Sono was relatively high, but excluding indeterminates, the accuracy of ED Sono was comparable with published reports of MI Sono.

Adolescent↗
PubMed2002

C-reactive protein is elevated in symptomatic compared with asymptomatic patients with carotid artery disease.

OBJECTIVES: to investigate the level of inflammatory markers between symptomatic and asymptomatic carotid stenosis patients. DESIGN: cross-sectional study. MATERIALS AND METHODS: a prospective study of 137 consecutive patients, admitted electively for carotid endarterectomy during 1997-2000, was conducted. 125 patients had cerebrovascular symptoms: either stroke (neurological deficit >24 h), Transient ischaemic attack (neurological deficit<24 h) or amaurosis fugax. Twelve patients were asymptomatic. A medical history and a fasting venous blood sample were taken from each patient around 6 weeks before surgery. The plasma concentrations of cholesterol and of inflammatory markers; (high sensitivity C-reactive protein (hs-CRP), sICAM-1, sVCAM-1, sE-selectin) were determined. RESULTS: the concentration of hs-CRP in the symptomatic group (3.9 mg/L) was significantly higher than in the asymptomatic group (2.1 mg/L; p = 0.04). These concentrations were within normal range (<10 mg/L). sICAM-1, sVCAM-1, sE-selectin and total cholesterol concentrations were not different between the two groups. CONCLUSION: plasma hs-CRP was elevated in symptomatic compared to asymptomatic patients with carotid artery disease. High sensitivity C-reactive protein has been shown to be of prognostic value in a number of cardiovascular conditions and this study suggests it may be of value to identify patient at high risk of developing neurological deficits.

Aged↗
PubMed2003

Emergency treatment of acute symptomatic or ruptured abdominal aortic aneurysm. Outcome of a prospective intent-to-treat by EVAR protocol.

OBJECTIVE: Outcome of treatment of patients with ruptured or symptomatic non-ruptured aneurysm (rAAA and snrAAA), preferentially treated by emergency endovascular repair was assessed. The outcome was compared with a historical group of patients treated by open repair. PATIENTS AND METHODS: Two groups of patients presenting with acute symptomatic AAA were compared. Group I (study group) consisted of 40 consecutive prospectively enrolled patients from May 2001 until June 2002, in whom emergency endovascular abdominal aortic aneurysm repair (e-EVAR) was the preferential management. Short or wide neck or profound hypovolemic shock were exclusion criteria for e-EVAR. Group II (control group) consisted of 28 patients, retrospectively analysed, all treated by conventional surgical repair between January 1999 and May 2001. In group I, 26 patients had rAAA and in group II 22 patients. The other patients had snrAAA. RESULTS: In group I, 14 patients were treated by open repair. Unsuitable anatomy or profound hypovolemia was the cause of open repair in eight patients, while logistic reasons were the reasons for use of open repair in six patients (off-protocol use of open surgery). Thus, in this prospective series the feasibility of EVAR was 80% (32/40). Patient characteristics, proportion rAAA or hemodynamically unstable patients were comparable in group I and II. Volume of blood loss and need for fluid transfusion were significantly less in group I compared to group II. The perioperative mortality in group I was significantly less than in group II (20% vs. 43%, respectively, p = 0.04). If patients with rAAA were considered the mortality was 31% in group I and 50% in group II, which difference did not reach the level of statistical significance. CONCLUSION: e-EVAR was a feasible treatment in the majority of patients with rAAA and snrAAA. Blood loss and the requirements of fluid transfusion were significantly decreased. Most importantly in this institutional series significantly lower first-month mortality was observed in the group with preferential e-EVAR compared to a control group. A multi-center study assessing the outcome of preferential use of e-EVAR in patients with acute symptomatic AAA is required.

Acute Disease↗