Enhanced levels of oxidized low-density lipoprotein prime monocytes to cytokine overproduction via upregulation of CD14 and toll-like receptor 4 in unstable angina.

OBJECTIVES: The purpose of this study was to establish whether oxidized low-density lipoprotein (oxLDL) contributes to cytokine overproduction via upregulation of CD14 and toll-like receptor-4 (TLR-4) expression on circulating monocytes of unstable angina (UA) patients. METHODS AND RESULTS: Expression of CD14 and TLR-4 on circulating monocytes, and the concentration of plasma oxLDL, (interleukin [IL])-6, IL-1 beta, IL-8, tumor necrosis factor (TNF)-alpha, monocyte chemoattractant protein-1 (MCP-1) were measured in 27 control (C) subjects, 29 patients with stable angina (SA), and 27 with UA. CD14 and TLR-4 expression on monocytes and circulating IL-6, IL-1 beta, and oxLDL were higher in UA than in SA and C subjects (P<0.001). In in vitro experiments, oxLDL increased CD14 and TLR-4 expression (P<0.001) in control monocytes as well as IL-6, IL-1 beta, and at a lower extent TNF-alpha and MCP-1 levels in the supernatant (P from <0.05 to <0.001). The preincubation of sera derived from UA patients but with control monocytes also induced a significant increase of CD14 and TLR-4 expression (P<0.001) and of IL-6 and IL-1 beta production (P<0.001) in the supernatant. CONCLUSIONS: In UA patients oxLDL may contribute to monocyte overproduction of some cytokines by upregulating CD14 and TLR-4 expression.

Atherosclerosis and secondary deep vein thrombosis: a difficult correlation.

The aim of this study was to verify the degree of atherosclerosis in a group of subjects affected by secondary deep vein thrombosis and in a matched control group. Sixty-three patients were studied. Of these, 19 were cases (mean age 62.2 +/- 1.2) and 16 were controls (mean age 59.3 +/- 2.7). Twenty-eight were excluded because they were affected by hyperhomocysteinemia. The arterial tree was examined by means of echo color Doppler, and the intima media thickness and the presence of and degree of plaques bilaterally in the carotid and femoral artery and abdominal aorta were measured with a computerized method. No difference was found in the 2 groups as concerns intima media thickness or plaques in the arterial district explored. Secondary deep vein thrombosis is not a greater risk factor for atherosclerosis.

Chronic viral hepatitis: a prospective factor against atherosclerosis. A study with echo-color Doppler of the carotid and femoral arteries and the abdominal aorta.

OBJECTIVE: To evaluate if chronic viral hepatitis may be a protective factor for atherosclerosis. METHODS: Echo-doppler of the carotid and femoral arteries and the abdominal aorta was used to examine 48 patients with a histological diagnosis of chronic viral hepatitis (42 hepatitis C virus-related, 6 hepatitis B virus-related), with a low degree of activity and preserved hepatic function, and 50 controls matched for age, sex and exposure to the main risk factors of atherosclerosis. RESULTS: The prevalence of atherosclerosis in patients was clearly lower than in controls in all investigated sites, although the difference was statistically significant only for the carotid arteries. The percentage of patients with carotid atherosclerosis was 27% in patients with liver disease and 56% in controls (P<0.005). Furthermore, and again at the carotid level, the patients with liver disease had fewer atheromatous lesions (16 plaques vs. 59; P<0.001) than controls as well as a lower degree of vessel stenosis. None of the liver disease patients presented with vessel stenosis above 30% vs. 8% of control subjects. CONCLUSIONS: Chronic viral hepatitis may help prevent from atherosclerosis.

Seasonal variation in the incidence of deep vein thrombosis in patients with deficiency of protein C or protein S.

An attempt was made to identify circaseptanal or seasonal variation of deep vein thrombosis (DVT) in a population with protein C or protein S deficit. Forty-four patients with DVT and protein C or protein S deficit were studied for 1 year. A significant circannual rhythm was found for the total population that peaked during winter. There was also a significant falling circaseptanal rhythm on Fridays. These observations may optimize an adequate and precise anticoagulant therapy in patients with protein C or protein S deficits.

Treatment of heart failure and ascites with ultrafiltration in patients with intractable alcoholic cardiomyopathy.

BACKGROUND: In Western countries the excess of alcohol intake causes, secondary, non ischaemic cardiomyopathy and cirrhosis. Frequently, therapy is not effective so ultrafiltration was tried on patients affected, with positive effects on life quality. We tried to verify utility and tolerance to peritoneal ultrafiltration in a group of subjects affected by heart failure secondary to alcoholic cardiomyopathy, refractory to conventional therapy. METHODS: Sixteen patients (14 males, 2 females) with heart failure and ascites affected by alcoholic cardiomyopathy were studied. All subjects were in IV class NYHA (New York Heart Association); ejection fraction (EF) was evaluated by echocardiogram and ascites by abdominal ultrasound. Patients were submitted to clinical exam, body weight, abdominal circumference, diuresis and routine biohumoral exams, electrocardiogram and chest X-ray. Subsequently they underwent intermittent nocturnal peritoneal dialysis with a changing cycle of 6-12 hours per session. After 5 days, subjects were checked through echocardiogram and abdominal ultrasound. RESULTS: The patients mean age was 56.7 +/- 3.2 years. After ultrafiltration, all subjects showed decreased body weight, abdominal circumference and urea; there was an increase of diuresis and Natriuria. Fifteen subjects entered III NYHA class without variation of EF; all of them showed clinical and echographic reduction of ascites. Mean ultrafiltration quantity was 6.084 ml with mean dialysis hours 20; 7.36% of patients had fever that disappeared within 24 hours with antibiotic therapy. All subjects referred to feel well and the mean hospitalization period was of 7 day in spite of the usual 22 days.

Hemophilia A, von Willebrand disease, and atherosclerosis of abdominal aorta and leg arteries: factor VIII and von Willebrand factor defects appear to protect abdominal aorta and leg arteries from atherosclerosis.

We hypothesized that patients with hemophilia or von Willebrand disease might be protected from atherosclerosis because of their coagulation defect. We studied 40 subjects affected by these two coagulation diseases using echocolor Doppler of the abdominal aorta and leg arteries, and compared the results with those obtained in 40 control patients who were homogenous with study patients in terms of sex, age, and risk factors for atherosclerosis. The probands presented a lower number of plaques than the 40 control subjects in the aorta and in the leg arteries. The most serious hemophilic patients had fewer plaques than controls or than patients with mild hemophilia. Both hemophilia and von Willebrand disease seem to protect against atherosclerosis.

Chronobiology of non fatal pulmonary thromboembolism.

BACKGROUND: It as been demonstrated that acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary embolism show an increased onset rate during certain periods of the day, week, or year. According to some authors, the highest risk appears to occur in the morning, on weekends and during winter. This paper, therefore, intends to examine whether a circadian, weekly, or annual rhythm in the incidence rate of deep vein thrombosis (DVT) and non-fatal pulmonary embolism (PE) in ageing patients does exists. METHODS: A survey was conducted into 212 patients affected by DVT and PE, admitted to the Second Medicine Institute of Padua, Italy, over a period of two solar years. Thromboses were diagnosed via echo-Doppler examination of the legs and pulmonary embolism via perfusive and ventilatory scintiphotographs. RESULTS: In the overall sample, a circadian variation was found, both for deep vein thrombosis (peak at 12:26 hrs, p=0.001), and pulmonary embolism (peak at 10:26 hrs, p=0.001). A weekly, rhythmic recurrence was also found for the two complaints, with a peak on Saturdays, while no significant annual rhythmic recurrence was found. There was, however, a tendency towards an increase during the winter and summer months. CONCLUSIONS: The results may have important clinical applications, both in prevention and in the timing of drug dosage.

Quality evaluation of health care offered by an Internal Medicine Department.

BACKGROUND: The aim of this work is to evaluate the quality and patients satisfaction for given services in an Internal Medicine Department during three months. METHODS: A questionnaire was given to all the patients admitted to our Medicine Department to evaluate our strength and to correct weakness. RESULTS: Our patients assessed doctors and nursing staff for skill and dedication. They gave suggestions about hotel management: bathroom cleaning and number of beds in the same room. They also asked for a pharmacy and a post office inside the hospital. CONCLUSIONS: It appears that our ward gives a satisfactory health care situation. Some of our patients suggestions can be put into practice in a short time, while others require longer, depending on public resources and not on private, such as happens, on the contrary, in the United States.

Moderate-dose intravenous immunoglobulin treatment of Job's syndrome. Case report.

Job's syndrome (or hyperimmunoglobulinemia E syndrome) is a rare genetic disease characterized by skin eczema, pyogenic "cold" abscesses, sinopulmonary recidivous infections and high IgE plasma concentrations. Job's syndrome treatment is not satisfactory and cases studied are still limited. To describe the effects of IVIG therapy in a 37-year-old woman with hyper IgE syndrome and pneumonia. We measured IgE serum by immuno-fluorometric test and neutrophil chemotaxis by migration in a Boyden chamber before and after IVIG therapy. A moderate dose of IVIG resolved the clinical-radiological signs of the S. aureus bronchopneumonia and improved cytologic and biohumoral parameters. Intravenous immunoglobulins represent a useful treatment for acute pneumonia in Job's syndrome.