Severe sleep apnea-hypopnea syndrome is related to left ventricle dysfunction and hypertrophy in acromegalic patients.

OBJECTIVE: To assess whether sleep apnea-hypopnea syndrome (SAHS) is a risk factor for development of acromegalic cardiomyopathy. METHODS: A descriptive, cross-sectional study of 32 patients with acromegaly (15 categorized as non-controlled-NCA and 17 as controlled-CA) compared to 20 matched controls (by sex, age, and BMI) referred to the pulmonology department for suspected SAHS. Polysomnography, echocardiography (M-mode, 2-dimensional, and Doppler), and 12-lead electrocardiography were performed in all participants. Development of cardiac morbidity (ischemia heart disease or heart failure) was evaluated after 7 years. RESULTS: SAHS was diagnosed in 81.3% of patients with acromegaly and 85% of controls. Mild SAHS was more common in CA than in NCA patients (31.3% vs. 0%, p=0.048). There was a trend to greater prevalence of left ventricular diastolic dysfunction (LVDD) in acromegalic patients as compared to controls (58.1% vs. 30%, p=0.05). Presence of severe SAHS in patients with acromegaly was related to greater risk of LVDD (90.9% vs. 40%, p=0.008; OR 2.3 [1.3-4.0]), LV hypertrophy (55.6% vs. 10.5%, p=0.02; OR 5.3 [1.3-22.2]), and cardiac events (87.5% vs. 35.6%; p=0.01; OR 7.53 [1.07-53.24]). CONCLUSION: SAHS is highly prevalent in patients with acromegaly. Only in these patients was severe SAHS associated to hypertrophy, LV diastolic dysfunction, and cardiac events.

Functional sequelae of tuberculous pleurisy in patients correctly treated.

STUDY OBJECTIVES: To assess the functional sequelae (FS) of patients with tuberculous pleurisy (TP), to analyze the influence of different factors in the occurrence of these FS, and, finally, to evaluate the relationship between the FS and roentgenographic sequelae. DESIGN: An observational, retrospective study. SETTING: A community teaching hospital in Alicante, Spain. PATIENTS AND METHODS: From April 1986 to July 2000, all patients with a firmly established diagnosis of TP, who had been functionally studied at the end of follow-up, were included in the study. A diagnosis of TP was considered to be definitive when the presence of granuloma on a pleural biopsy specimen was demonstrated or when a culture was positive for Mycobacterium tuberculosis in pleural fluid (PF) or tissue. The general characteristics of the study population and PF were compared in patients with or without restrictive FS (ie, FVC or TLC < 80%), looking for risk factors for developing this complication. RESULTS: Eighty-one of 150 patients who had been treated for TP were eligible for the study. At the end of follow-up, eight patients (10%) had a restrictive FS. These patients had a lower PF lactate dehydrogenase concentration (p < 0.001), a higher PF concentration of cholesterol (p < 0.03) and triglycerides (p < 0.03), and a higher percentage of lymphocytes (p < 0.04). A weak correlation was found between the FVC and the intensity of radiographic pleural thickening (r = - 0.298; p < 0.01). CONCLUSIONS: The FS in patients with TP is restrictive in type, infrequent, and usually mild. A higher PF lipid content or a more chronic inflammatory pleural reaction at diagnosis appear to be risk factors for developing a FS. The correlation between FS and roentgenographic sequelae is poor.

CEA and CA 549 in serum and pleural fluid of patients with pleural effusion.

BACKGROUND: The determination of the pleural fluid (PF) carcinoembryonic antigen (CEA) concentration has proved helpful in the differentiation between pleural effusions (PE) of malignant and benign origin. The present study was designed to prospectively compare the utility of CEA with that of a recently introduced tumour marker, carbohydrate antigen 549 (CA 549). PATIENTS AND METHODS: In 383 consecutive patients referred for thoracentesis (130 malignant and 253 benign), pleural and serum levels of CEA and CA 549 were, respectively, determined by enzyme immunoassay (EIA) and immunoradiometric assay (IRMA). RESULTS: CEA and CA 549 showed a high specificity for malignancy in serum (97 and 96%, respectively) and PF (98 and 99%). The serum sensitivity was 33% for CEA and 47% for CA 549 while in PF was 49 and 54%, respectively. The area under the curve of CA 549 (0.78) was significantly larger than that of CEA (0.66) in serum (P < 0.005) and in PF (0.83 and 0.75, respectively, P < 0.02) as well. CA 549 showed a higher sensitivity (P < 0.001) than CEA for ovarian tumours. In PF, the accuracy of the combination of both markers was higher than that of any individual marker, although the difference was only significant with respect to CEA (P < 0.02). CONCLUSIONS: The results of the present study show that a new tumour marker CA 549 is at least similar in terms of sensitivity and specificity to CEA in the evaluation of patients with PE of unknown cause.