Relationship between carotid intima thickness and silent cerebral infarction in patients with type 2 diabetic nephropathy.

AIM: To examine the relationship between carotid intima media thickness (CIMT) and silent cerebral infarction (SCI) in order to determine whether CIMT is a predictor of SCI in patients of type 2 diabetic nephropathy. METHODS: A total of 80 patients of type 2 diabetic nephropathy were selected on the basis of fasting and 2-hour post-prandial blood sugar, 24 hrs albumin estimation in urine, urea and creatinine in the serum. The selected candidates underwent MRI brain and carotid B mode ultrasonography to find out the event of SCI and to evaluate the CIMT respectively. RESULTS: The SCI was found in 30 (37.5%) patients with type 2 diabetic nephropathy. The mean age, BMI, blood pressure (BP), macroalbuminuria, S. lipids, low GFR, duration of diabetes and CIMT were significantly higher in the subject with SCI than in those without it. Multiple logistic analyses indicated that age, BP, and CIMT were found to be significant and independent risk factors of SCI in type 2 diabetic nephropathy subjects. CONCLUSION: CIMT is a surrogate and reliable predictor of higher risk of SCI among type 2 diabetic nephropathy patients.

Aromatase inhibitors and musculoskeletal symptoms.

AIMS: Recent evidence shows aromatase inhibitors (AIs) to be of benefit over tamoxifen in the adjuvant setting. It is also apparent that musculoskeletal symptoms associated with AIs may be a significant problem in the clinical setting. The aim of this article is to review the data on AIs with respect to musculoskeletal symptoms in the adjuvant setting. MATERIAL AND METHODS: A review on the literature relating to AIs in the adjuvant setting and musculoskeletal symptoms. RESULTS: Results of phase III trials show lower incidence of musculoskeletal symptoms than reported in the clinical setting. DISCUSSION: AIs offer a significant advantage over tamoxifen. More research is required to ascertain the cause and to define the spectrum of musculoskeletal symptoms reported in women taking AIs. Decision of appropriate treatment should be made jointly between clinician and patient after full discussion of the risks and benefits.

Clinical trials assessing the optimal management of brain metastases--the state of play.

These three clinical trials offer the opportunity to answer the controversies and uncertainties that exist in managing patients with brain metastases: for patients with solitary brain metastasis there is the EORTC trial, for patients with NSCLC, where there is a certainty that the patient should receive radiotherapy, there is TACTIC, and where there is uncertainty of the benefit of radiotherapy there is QUARTZ. We would encourage all clinical oncologists seeing patients with brain metastases to consider patients for entry into any one of these trials.