RESUMO
AIMS: Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is considered a marker for cardiovascular risk. Transcutaneous oxygen pressure (TcPO2), a test associated with microvascular function, has in several studies shown better correlation with diabetic foot ulcer (DFU) healing. Whether a low TcPO2 could be a marker for mortality in the high-risk population of DFU patients has not been evaluated before. The aim of this study was to evaluate the predictive value of TcPO2 in comparison with ABI and toe blood pressure (TBP) on 1-year mortality in type 2 diabetes patients with DFU. METHODS: Type 2 diabetes patients aged ≤ 90 years, with one DFU who attended our multidisciplinary DFU-unit during year 2013-2015 and were screened with TcPO2, ABI and TBP were retrospectively evaluated. One-year mortality was assessed from the national death register in Sweden. RESULTS: A total of 236 patients (30% women) with a median age of 76 (69-82) years were evaluated in this study. Within 1 year, 14.8% of the patients died. TcPO2 < 25 mmHg was associated with a higher 1-year mortality compared with TcPO2 ≥ 25 mmHg (27.7 vs. 11.6%, p = 0.003). TBP and ABI did not significantly influence 1-year mortality. In a Cox regression analysis adjusted for confounders, TcPO2 was independently predicting 1-year mortality with a hazard ratio for TcPO2 < 25 mmHg of 2.8 (95% CI 1.34-5.91, p = 0.006). CONCLUSIONS: This study indicates that a low TcPO2 is an independent prognostic marker for 1-year mortality among patients with type 2 diabetes and DFU.
Assuntos
Índice Tornozelo-Braço , Pressão Sanguínea/fisiologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/mortalidade , Pé Diabético/sangue , Pé Diabético/mortalidade , Idoso , Idoso de 80 Anos ou mais , Monitorização Transcutânea dos Gases Sanguíneos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Pé Diabético/diagnóstico , Feminino , Úlcera do Pé/diagnóstico , Úlcera do Pé/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Dedos do Pé/irrigação sanguínea , Dedos do Pé/fisiopatologia , Cicatrização/fisiologiaRESUMO
AIMS: To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. METHODS: Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. RESULTS: Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (P<0.001). Only 6% in the diabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; P<0.001), but time-to-proliferative diabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. CONCLUSIONS: In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to <10% in our matched control group. More advanced diabetic retinopathy was linked to worse visual acuity.
Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/patologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diabetes Mellitus Tipo 2/complicações , Retinopatia Diabética/complicações , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Índice de Gravidade de Doença , Suécia/epidemiologiaRESUMO
OBJECTIVE: Our objective was to determine whether epidural analgesia and histologic chorioamnionitis were independent predictors of intrapartum fever. STUDY DESIGN: This secondary analysis, retrospective cohort study included term parturients with placental examination during 2005. Logistic regression used fever (⩾38 °C) as the dependent variable. Significance was defined as P⩽0.05. RESULT: There were 488 (76%) of 641 term parturients with placental examination and epidural. Independent predictors of intrapartum fever were epidural odds ratio (OR)=3.4, confidence interval (CI): 1.70, 6.81, histologic chorioamnionitis OR=3.18, 95% CI: 2.04, 4.95, birthweight OR=2.07, 95%CI: 1.38, 3.12, vaginal exams OR=1.15, 95% CI:1.06, 1.24, duration ruptured membranes OR=1.03, 95% CI: 1.01,1.05, parity⩾1 OR=0.44: 0.29, 0.66 and thick meconium OR=0.35: 95%CI: 0.24, 0.85. CONCLUSION: Epidural analgesia and histologic chorioamnionitis were independent predictors of intrapartum fever. Modification of labor management may reduce the incidence of intrapartum fever.
Assuntos
Analgesia Epidural , Corioamnionite/epidemiologia , Febre/etiologia , Complicações do Trabalho de Parto/etiologia , Adulto , Analgesia Epidural/efeitos adversos , Feminino , Febre/epidemiologia , Humanos , Análise Multivariada , Gravidez , Estudos Retrospectivos , Adulto JovemRESUMO
INTRODUCTION: Spontaneous preterm birth (SPTB) is the common endpoint of different underlying etiologies, including chorion-decidual bleeding and inflammation. However, specific histologic findings from a prior pregnancy do not always inform clinical management in subsequent pregnancies secondary to few prior studies having evaluated the relationship between prior pregnancy pathology and subsequent outcomes in patients with SPTB. METHODS: Included subjects had: 1) a SPTB with available placental pathology and 2) a subsequent consecutive delivery at >20 weeks gestational age at our institution. For included subjects archived placenta and membrane paraffin blocks from the index SPTB were cut, stained with Prussian Blue and evaluated by a perinatal pathologist for the presence of hemosiderin. The association between histologic findings and subsequent pregnancy outcomes were evaluated through logistic and linear regression. RESULTS: A total of 131 subjects were included, of whom 39.7% had a recurrent SPTB. Funisitis at the time of preterm delivery significantly increased the risk of early (<34 weeks) recurrent preterm birth (OR 3.38, p = 0.016), though this may have been confounded by gestational age at delivery. Several histologic features were significantly associated with reductions in birth weight in the subsequent pregnancies, even if they did not increase the risk of recurrent preterm birth. DISCUSSION: The presence of chorion-decidual bleeding or inflammation in a prior pregnancy can signal an increased risk in a future pregnancy beyond the recurrent risk of SPTB itself. CONCLUSIONS: Placental histologic findings after SPTB maybe associated with differences in birth weight in a subsequent pregnancy.
Assuntos
Córion/patologia , Decídua/patologia , Hemorragia/complicações , Doenças Placentárias/patologia , Placenta/patologia , Resultado da Gravidez , Adulto , Peso ao Nascer , Corioamnionite/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Inflamação/complicações , Trabalho de Parto Prematuro/patologia , Gravidez , Nascimento Prematuro/patologia , Estudos RetrospectivosRESUMO
OBJECTIVE: Uniform histopathologic guidelines were applied to diagnose chorioamnionitis and estimate the accuracy of clinical signs in term parturients. STUDY DESIGN: A retrospective cohort study utilized slides from term parturient placentas with Amniotic Fluid Infection Nosology Committee guidelines as the gold standard. Sensitivity, specificity and accuracy for fever, maternal tachycardia and fetal tachycardia were calculated. RESULT: Of 641 placentas, 367 (57.3%) had histologic chorioamnionitis and 274 (42.7%) were negative. Fever had a sensitivity of 42%, specificity of 86.5% and accuracy of 61%. Fever, maternal tachycardia and fetal tachycardia had a sensitivity of 18.3%, specificity of 98.2% and accuracy of 52.4%. CONCLUSION: Histologic chorioamnionitis, frequently asymptomatic, is a common finding in placentas examined from term parturients. Clinical signs are not accurate in the diagnosis. Adoption of uniform pathologic guidelines will facilitate research into the clinical significance of these lesions in the future.
Assuntos
Corioamnionite/diagnóstico , Corioamnionite/patologia , Adulto , Corioamnionite/classificação , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Febre de Causa Desconhecida/etiologia , Fidelidade a Diretrizes , Hospitais Universitários , Humanos , Recém-Nascido , New York , Placenta/patologia , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Estudos Retrospectivos , Taquicardia/etiologiaRESUMO
OBJECTIVES: To investigate the accuracy of the biochemical diagnosis of primary hyperparathyroidism (pHPT) in a consecutive series of patients with operatively verified disease. DESIGN AND SUBJECTS: Four hundred thirty-six patients with pHPT, 340 women and 96 men, were reviewed. Biochemical variables, including total calcium (Ca), ionized calcium (Cai) and PTH were analyzed and registered in a prospective database. RESULTS: In the subgroup of patients with more mild hypercalcemia (Ca below 2.70mmol/L) the correlation between Ca and Cai was poor. 19 respectively 18 patients had preoperatively a Ca respectively Cai level within the reference range. Further 35 patients had preoperatively a normal level of PTH. The diagnostic sensitivities, in detecting pHPT, for Ca, Cai and the combination of Ca and Cai were 96%, 96% and 99%. CONCLUSION: If calcium and ionized calcium are not used in the diagnostic workup of pHPT some 4% of the patients will be overlooked. We recommend analyzing both Ca and Cai in the diagnostic workup of pHPT.
Assuntos
Cálcio/sangue , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/diagnóstico , Hormônio Paratireóideo/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Seguimentos , Humanos , Hiperparatireoidismo Primário/fisiopatologia , Hiperparatireoidismo Primário/cirurgia , Íons , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Valores de Referência , Sensibilidade e Especificidade , Adulto JovemRESUMO
AIMS: Adjunctive treatment with hyperbaric oxygen therapy has recently been shown to improve ulcer healing in patients with chronic diabetic foot ulcer. The aim of the present study is to evaluate whether hyperbaric oxygen therapy improves the health related quality of life in these patients. METHODS: Prospective randomized placebo-controlled double-blinded study setting using SF-36. RESULTS: A total of 75 patients were included in the study; 38 were randomized to hyperbaric oxygen therapy and 37 to placebo (hyperbaric air). The overall mean physical and mental summary scores for the entire study population at baseline were 29.6 ± 8.8 and 47.5 ± 12.4, respectively. There was a significant difference between baseline and 1 year follow-up responses to the mental summary score and two of the eight (SF-36) (?) domains in the -hyperbaric oxygen group, whereas no significant improvement of health related quality of life was seen in the placebo group. Comparing quality of life in patients who healed their ulcer (healers) with those who did not (non-healers), post-treatment levels of the mental health summary score, social functioning and role limitations due to physical and emotional health were significantly improved in healers. No differences were seen in any SF-36 (?) domain in non-healers. CONCLUSIONS: Hyperbaric oxygen therapy improves long-term health related quality of life in patients with chronic diabetic foot ulcers, possibly attributable to better ulcer healing.
Assuntos
Diabetes Mellitus Tipo 2/terapia , Pé Diabético/terapia , Oxigenoterapia Hiperbárica/métodos , Cicatrização/fisiologia , Idoso , Doença Crônica , Diabetes Mellitus Tipo 2/fisiopatologia , Diabetes Mellitus Tipo 2/psicologia , Pé Diabético/fisiopatologia , Pé Diabético/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Estudos Prospectivos , Qualidade de Vida/psicologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
AIMS/HYPOTHESIS: The randomised, double-blind, placebo-controlled Hyperbaric Oxygen Therapy (HBOT) in Diabetic Patients with Chronic Foot Ulcers (HODFU) study showed beneficial effect of HBOT. As this treatment is expensive and time-consuming, being able to select patients for therapy would be very useful. The aim of this study was to evaluate whether circulatory variables could help in predicting outcome of HBOT. METHODS: All HODFU study participants who completed therapy, predefined as receiving at least 36 out of 40 scheduled HBOT/placebo sessions, were included in this study (n = 75). Baseline transcutaneous oximetry (TcPO2), toe blood pressure (TBP) and ankle-brachial index (ABI) were measured. Ulcer healing rate was registered at the 9-month follow-up visit. An ulcer was considered healed when it was completely epithelialised and remained so at the 12-month follow-up. RESULTS: In the HBOT group TcPO2 were significantly lower for patients whose ulcer did not heal as compared with those whose ulcers healed. A significantly increased healing frequency was seen with increasing TcPO(2) levels in the HBOT group (TcPO2/healing rate: <25 mmHg/0%; 26-50 mmHg/50%; 51-75 mmHg/73%; and >75 mmHg/100%). No statistically significant relation between the level of TBP or ABI and healing frequency was seen. CONCLUSIONS/INTERPRETATION: Our results indicate that TcPO2 in contrast to ABI and TBP correlates to ulcer healing following HBOT. We suggest HBOT as a feasible adjunctive treatment modality in diabetic patients with chronic non-healing foot ulcers when basal TcPO2 at the dorsum of the foot is above 25 mmHg. TRIAL REGISTRATION: NCT00953186 FUNDING: Mrs Thelma Zoegas Foundation and Faculty of Medicine, Lund University.
Assuntos
Índice Tornozelo-Braço/métodos , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Oxigenoterapia Hiperbárica/métodos , HumanosRESUMO
OBJECTIVE: To evaluate presence and severity of cardiac disease in individuals with chronic diabetic foot ulcers using echocardiography. METHOD: Eighty consecutive patients with chronic foot ulcers attending the multidisciplinary diabetes foot clinic at Helsingborg Hospital underwent clinical examination, toe blood pressure measurement and a standard echocardiographic examination. RESULTS: Sixty-nine percent of the patients had a history of myocardial infarction and/or hypertension and/or heart failure; 78% had signs of left ventricular dysfunction and/or left ventricular hypertrophy and/or diastolic dysfunction; 76% of the patients without a history of cardiovascular disease had signs of cardiac dysfunction on echocardiography. CONCLUSION: Cardiac dysfunction is a common occurrence present in patients with chronic diabetic foot ulcers, even in those without known cardiac disease or hypertension. Echocardiography may be recommended as a screening procedure in the management of diabetic patients with chronic foot ulcers. The present study supports the view that diabetic chronic foot ulcers ought to be seen as a sign of cardiac disease, although further research is needed to elucidate this issue.
Assuntos
Pé Diabético/complicações , Pé Diabético/epidemiologia , Cardiopatias/complicações , Cardiopatias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Pé Diabético/tratamento farmacológico , Pé Diabético/metabolismo , Ecocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/tratamento farmacológico , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/epidemiologia , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Suécia/epidemiologia , Disfunção Ventricular Esquerda/epidemiologiaRESUMO
Cardiovascular risk factors are often ineffectively controlled in hypertensive postmenopausal women, and moreover, some antihypertensive drugs may increase particular risk factors such as insulin resistance. In a multicenter, multinational (Finland, Sweden, Lithuania), double-blind, prospectively randomized study hypertensive obese postmenopausal women without hormone therapy (n = 98) were randomly assigned to receive treatment with either the centrally acting agent moxonidine, 0.6 mg/day, or with the peripherally acting atenolol, 50 mg/day, for 8 weeks. In addition to blood pressure measurements, insulin sensitivity was estimated by the quantitative insulin sensitivity check index (QUICKI) and by the insulin sensitivity index (ISI-Matsuda). Subgroup analysis in insulin-resistant women (fasting P-insulin > or = 10 mU/l) and blood pressure responders (diastolic blood pressure < or = 90 mmHg and/or reduction of blood pressure > or = 10 mmHg) were also carried out. Both atenolol and moxonidine led to a significant reduction in diastolic blood pressure of 9.5 mmHg and 6.2 mmHg, respectively. Among insulin-resistant women, an increase in the insulin sensitivity assessed by ISI was improved with moxonidine treatment (p = 0.025). A decrease in insulin sensitivity assessed by QUICKI was observed with atenolol treatment in women with fasting insulin level < 10 mU/l. In patients, in whom blood pressure was reduced, an improvement in insulin sensitivity (ISI) was associated with moxonidine treatment (p = 0.019), but not with atenolol treatment. The centrally acting sympatholytic agent moxonidine did reduce blood pressure somewhat less than atenolol, but it was associated with an improved metabolic profile in terms of decreased insulin resistance both in insulin-resistant postmenopausal women and in women with a significant blood pressure response.
Assuntos
Anti-Hipertensivos/uso terapêutico , Atenolol/uso terapêutico , Hipertensão/tratamento farmacológico , Imidazóis/uso terapêutico , Insulina/sangue , Simpatolíticos/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Método Duplo-Cego , Feminino , Finlândia , Humanos , Hipertensão/sangue , Receptores de Imidazolinas/agonistas , Resistência à Insulina , Lituânia , Pessoa de Meia-Idade , Obesidade/tratamento farmacológico , Obesidade/metabolismo , Pós-Menopausa , SuéciaRESUMO
INTRODUCTION: There is scant information about the expression of CD44 and E-cadherin, two cell adhesion molecules, and the antimetastatic protein nm23-H1, in complete hydatidiform moles. We measured the expression of these markers to determine their usefulness in predicting the development of invasive disease. MATERIALS AND METHODS: We performed a retrospective study of 27 patients with complete hydatidiform moles, collecting clinical information including the patient's age, pre-evacuation hCG level, pathology, hCG monitoring, and the development of gestational trophoblastic neoplasia. Immunohistochemical staining for CD44, E-cadherin, and nm23-H1 was performed. CD44 expression was classified as positive or negative. For E-cadherin and nm23-H1, the intensity of expression was graded on a 0 to 3 scale. Chi-square or Fisher's exact testing was used to evaluate the relationship between these markers and the development of invasive disease. RESULTS: CD44 was expressed in 26% of cases. E-cadherin expression was 1+, 2+, and 3+in 8%, 33%, and 59% of cases, respectively. Nm23-H1 expression was 1+, 2+, and 3+in 4%, 11%, and 85% of cases. The risk of developing invasive disease did not correlate with the expression of CD44, E-cadherin, or nm23-H1. CONCLUSION: In this preliminary study, there is no relationship between CD44, E-cadherin, and nm23-H1 expression in complete hydatidiform moles and the risk of invasive disease. Other molecular markers predictive of invasive disease should be sought to limit hCG surveillance to those at risk.
Assuntos
Caderinas/biossíntese , Receptores de Hialuronatos/biossíntese , Mola Hidatiforme/metabolismo , Núcleosídeo-Difosfato Quinase/biossíntese , Neoplasias Uterinas/metabolismo , Adolescente , Adulto , Biomarcadores Tumorais/biossíntese , Feminino , Humanos , Mola Hidatiforme/patologia , Nucleosídeo NM23 Difosfato Quinases , Invasividade Neoplásica , Gravidez , Estudos Retrospectivos , Neoplasias Uterinas/patologiaRESUMO
Research suggests that hyperbaric oxygen therapy may have beneficial effects on ulcer healing and amputation rates in diabetic patients. This paper describes the design of a study that is evaluating its effects on chronic diabetic foot ulcers.
Assuntos
Pé Diabético/terapia , Oxigenoterapia Hiperbárica/métodos , Atividades Cotidianas , Amputação Cirúrgica/estatística & dados numéricos , Atitude Frente a Saúde , Doença Crônica , Pé Diabético/diagnóstico , Pé Diabético/psicologia , Método Duplo-Cego , Teste de Esforço , Humanos , Oxigenoterapia Hiperbárica/psicologia , Ambulatório Hospitalar , Equipe de Assistência ao Paciente/organização & administração , Estudos Prospectivos , Qualidade de Vida/psicologia , Projetos de Pesquisa , Índice de Gravidade de Doença , Inquéritos e Questionários , Suécia , Resultado do Tratamento , Caminhada , CicatrizaçãoRESUMO
This study identified cytogenetic abnormalities in a population screened for deletion 22q11.2 syndrome (D22S) by fluorescence in situ hybridization (FISH) and G-banding and correlated these abnormalities to referring specialty and submitted indications. Requests for the D22S FISH assay were retrospectively reviewed over a 29-month period in our institution. Positive test results for D22S FISH and other abnormalities found by other FISH assays and G-banding were correlated to submitting specialist and indication. Thirteen medical services ordered D22S FISH testing on 297 patients over 29 months. The detection rate for all cytogenetic aberrations was 9.4% (28 of 297) including 5.4% (16 of 297) for D22S detection by FISH and 2.7% (8 of 297) for detection of additional cytogenetic anomalies by G-banding cytogenetics. Sixty-six of 297 patients negative by D22S FISH and G-banding were screened using other FISH assays and 3 of 47 (6.4%) patients screened using subtelomeric probes were positive for deletion and 1 of 3 (33%) patients screened for Prader-Willi syndrome was positive for deletion. Pediatric geneticists requested 53.9% (160 of 297) of the tests, yielding 60.7% (17 of 28) of positive test results. Tetralogy of Fallot and developmental delay were the indications associated with the most positive test results. In our institution, pediatric geneticists identify the largest spectrum of indications with D22S and appear most aware of the association of developmental delay with D22S. Performing conventional cytogenetics and other FISH assays, in addition to FISH for D22S, is important because there is considerable overlap between D22S and the phenotype of several other syndromes.
Assuntos
Anormalidades Múltiplas/genética , Bandeamento Cromossômico , Deleção Cromossômica , Cromossomos Humanos Par 22/genética , Técnicas de Laboratório Clínico/estatística & dados numéricos , Testes Genéticos/métodos , Hibridização in Situ Fluorescente/métodos , Anormalidades Múltiplas/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Síndrome de DiGeorge/diagnóstico , Síndrome de DiGeorge/genética , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/genética , Humanos , Lactente , Recém-Nascido , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
OBJECTIVES: Previous studies have shown that patients with diabetes mellitus have an increased mortality after suffering from acute myocardial infarction (AMI). Patients with diabetes have several risk factors for cardiovascular disease. Our objective was to quantify the prevalence of pharmacological cardiovascular prevention at admission and relate such treatment to short and long-term mortality following AMI in patients with and without diabetes. DESIGN AND SUBJECTS: All patients discharged from the Department of Internal Medicine at Helsingborg Hospital in 1996 and 1997 with a principal diagnosis of AMI were included in the study. Patients were divided into two groups according to the presence or absence of diabetes. Cardiovascular risk factors, on-going medication, type of ward following admission, peak creatine kinase MB mass (CKMB) and immediate treatment were registered. Information about death was obtained from the national register. Kaplan-Meier analysis was performed for life-expectancy. RESULTS: A total of 673 patients with AMI were registered, of which 117 (17.4%) had diabetes. No differences in 30 days (17.1% vs. 15.3%) or 1-year (24.8% vs. 27.4%) mortality were seen between the diabetes and control groups, whereas the 2-year mortality was significantly higher in the diabetes group (40.2% vs. 29.1%). Cardiovascular risk factors occurred more often in the diabetes group and the use of aspirin, ACE-inhibitors, statins and diuretics was significantly more frequent. In patients treated with aspirin, in combination with either statin or angiotensin converting enzyme (ACE)-inhibitor, or both, no differences were seen in 30 days, 1 or 2-year mortality between groups. CONCLUSION: In contrast to earlier studies we did not find an increased 30 days and 1-year mortality in patients with diabetes suffering from AMI. This discrepancy was linked to a higher frequency of pharmacological cardiovascular prevention, a finding supporting the hypothesis that survival of a diabetes patient after AMI could be affected by factors operating before the infarction.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Infarto do Miocárdio/prevenção & controle , Idoso , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIM: To assess the adjunct effect of metformin to insulin in type 2 diabetes. METHODS: Obese and overweight type 2 diabetes patients treated with insulin for at least 1 year, and with poor glycaemic control (HbA1c > upper reference level + 2%), were included in a randomised, double-blind, placebo-controlled study. Patients were treated for 12 months with either metformin (850 mg b.i.d.) or placebo added to their usual insulin, which was stabilized during a 3-month placebo run-in period, but thereafter attempted to be unchanged. RESULTS: Thirty-seven patients were included. Two patients dropped out during run-in. There were no differences between the metformin (n = 16) and placebo (n = 19) group at baseline. Most patients received multiple insulin injections. Metabolic control was improved by addition of metformin. Mean change in HbA1c from baseline showed highly significant difference between groups at 3, 6, 9 and 12 months. Mean change (percentage units +/- s.d.) at 12 months was -1.1 +/- 0.7% vs. + 0.3 +/- 0.8% (p < 0.001) for HbA1c and -1.4 +/- 2.1 mmol/l vs. + 0.6 +/- 2.2 mmol/l (p = 0.025) for fasting blood glucose. Mean low density lipoprotein (LDL) cholesterol change differed slightly at 6 months, but not at 12 months. There were no changes in insulin dose, blood pressure, body weight, triglycerides, total- and high density lipoprotein (HDL) cholesterol, fibrinogen, C-peptide and laboratory safety variables, including serum B12. Combination therapy was well-tolerated with the same adverse event rate as insulin alone, but more patients with diarrhoea. CONCLUSION: Addition of metformin to insulin induced and maintained clinically significant and consistent long-term reduction of hyperglycaemia in obese, insulin-treated type 2 diabetes patients.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico , Insulina/uso terapêutico , Metformina/uso terapêutico , Obesidade , Glicemia/metabolismo , Pressão Sanguínea , Índice de Massa Corporal , Peso Corporal , Colesterol/sangue , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos , Triglicerídeos/sangueRESUMO
Spontaneous massive retroperitoneal hemorrhage from an adrenal gland is a rare event. A thoughtful and meticulous approach to such a patient, with appropriate diagnostic studies, ICU and surgical care are essential for patient survival. In patients with active bleeding, angiographic embolization is a valuable adjunct to achieve hemostasis, to allow for further work-up of the adrenal tumor, and an improved subsequent oncologic resection. Hemodynamically unstable patients, however, may require supportive transfusions in the intensive care unit, potential embolization if deemed feasible, or urgent surgical exploration. If possible, however, the acute surgical removal of an adrenal tumor within a large retroperitoneal hematoma should be avoided, as under such conditions a proper oncologic resection may not be possible. The possibility of a pheochromocytoma must always be entertained. Early recognition and treatment of patients with presumed adrenal insufficiency may decrease patient morbidity and mortality.
Assuntos
Neoplasias do Córtex Suprarrenal/complicações , Embolização Terapêutica , Hemorragia/terapia , Neoplasias do Córtex Suprarrenal/diagnóstico , Neoplasias do Córtex Suprarrenal/cirurgia , Adulto , Feminino , Hemorragia/complicações , Hemorragia/patologia , Humanos , Imageamento por Ressonância MagnéticaAssuntos
Anti-Inflamatórios/efeitos adversos , Cortisona/efeitos adversos , Glucocorticoides/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Anti-Inflamatórios/administração & dosagem , Cortisona/administração & dosagem , Prescrições de Medicamentos , Uso de Medicamentos , Glucocorticoides/administração & dosagem , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/prevenção & controleRESUMO
PURPOSE: CD30-positive anaplastic large cell lymphoma (ALCL) has been described in adults with HIV-1 infection but is extremely rare in HIV-1-infected infants and children. PATIENT AND METHODS: A 14-month-old girl with congenitally acquired HIV-1 infection presented with fever and a tender, erythematous, cystic mass on the right labium majorum. The mass was biopsied. Histologic examination and immunohistochemistry were performed. RESULTS: Histologic examination showed Touton-like giant cells resembling histiocytes and focally abundant neutrophils obscuring the lymphoid infiltrate. Immunocytochemistry revealed a CD30-positive ALCL of T-cell lineage. CONCLUSION: Although non-Hodgkin's lymphoma is known to be associated with HIV-1 infection in children, large cell lymphomas of T-cell lineage are extremely rare in this population. Early diagnosis should be aggressively pursued in an HIV-1-infected child who presents with a fever and cutaneous mass.
Assuntos
Síndrome da Imunodeficiência Adquirida/congênito , Antígeno Ki-1/análise , Linfoma Relacionado a AIDS/diagnóstico , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Cutâneo de Células T/diagnóstico , Feminino , HIV-1 , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas , Linfoma Relacionado a AIDS/patologia , Linfoma Anaplásico de Células Grandes/patologia , Linfoma Cutâneo de Células T/patologiaRESUMO
Infection with hepatitis C virus (HCV) is usually established by detection of serum antibodies (anti-HCV). This study was conducted in order to evaluate whether saliva and urine may substitute serum for anti-HCV detection. Serum, saliva, and urine were obtained simultaneously from 141 patients with a variety of liver diseases and from 52 patients with autoimmune diseases (systemic lupus erythematosus n = 27 and rheumatoid arthritis n = 25). The cell free fraction of saliva and urine samples was tested for anti-HCV using a modification of a serum anti-HCV kit. Western blot analysis was used as a confirmation method. Of the patients with liver diseases, 73 were anti-HCV-seropositive. Salivary and urinary anti-HCV could be detected in 66 (90%) and 36 (49%) of the anti-HCV-seropositive patients, respectively. The presence of anti-HCV in saliva or urine was not related to the severity of liver disease. All the anti-HCV-seronegative liver patients were negative for salivary anti-HCV and 22 (32%) had urinary anti-HCV. The patients with autoimmune diseases were all anti-HCV-seronegative. None had detectable salivary anti-HCV while 33 (63%) were positive for urinary anti-HCV. Western Blot analysis confirmed the presence of anti-HCV in all serum and saliva samples tested but only in 2/12 urine samples. The results suggest that saliva, but not urine, may serve as a substitute for serum for the determination of anti-HCV positivity.