Prediction on admission of in-hospital mortality in patients older than 70 years with acute myocardial infarction.

STUDY OBJECTIVE: To identify the differential characteristics regarding risk factors, presentation, and clinical status on hospital admission in patients aged 70 years or older with acute myocardial infarction (MI) of less than 24 h of evolution, compared with patients younger than 70 years, and to analyze possible factors that could affect mortality on admission in the group of patients older than 70 years. STUDY DESIGN: Of 1,289 patients admitted in the coronary care unit with acute MI during the period 1988 to 1991, with a delay from onset of symptoms of less than 24 h, we defined two groups according to age: younger than 70 years (group 1) and 70 years or older (group 2) in order to analyze the possible predictive factors for mortality on hospital admission in patients older than 70 years (n = 322). By means of univariate analysis, we studied clinical variables that were present on admission; age; sex; medical history of diabetes, cerebrovascular accident, stable angina, previous MI, cardiac failure, right bundle branch block, and atrial fibrillation; previous treatment with digoxin, calcium antagonists, angiotensin-converting enzyme inhibitors (ACEI), antiaggregants or beta-blockers; location and extension of the acute MI, and thrombolysis. The association between mortality, as the dependent variable, and all other variables, as independent variables, was evaluated using a stepwise logistical regression procedure. RESULTS: In patients older than 70 years of age, the model included the following as independent predictors of mortality: female sex (odds ratio [OR], 2.59); complete right bundle branch block (CRBBB) (OR, 4.88); Q-wave MI (OR, 0.35 for non-Q-wave MI); and Forrester grade 2 to 3 (OR, 6.36) and 4 (OR, 80.14). CONCLUSIONS: In patients with acute MI and older than 70 years at the time of admission to the coronary care unit, together with the variables indicating the degree of hemodynamic involvement and the extension of the acute MI, factors such as female sex and CRBBB stand out as independent predictors of mortality.

[The female sex and mortality after acute myocardial infarct]. / Sexo femenino y mortalidad tras infarto agudo de miocardio.

INTRODUCTION: To study the possible influence of gender on in-hospital mortality in patients suffering acute myocardial infarction. PATIENTS AND METHODS: We analyzed 1,951 consecutive patients admitted to our Coronary Unit between January 1986 and December 1991 with this diagnosis and with a delay of no more than 24 hours prior to admission. RESULTS: In-hospital mortality was 12.8% in the 1,603 males and 25.6% in the 348 females (p < 0.001). Age, previous history of: not smoking, diabetes, heart failure, stable angina, myocardial infarction, stroke, right branch block, atrial fibrillation, and treatment with digoxin were variables significantly associated with greater mortality (p < 0.05) as well as the localization of the infarction, the Forrester grade and/or presence of atrioventricular block on admission and not treatment with intravenous fibrinolytics and beta-blockers. Multivariate analysis of variables associated with mortality (selection criterion for variable entry p < 0.20) shows that age, gender, previous angina, situation and extension of the infarction determined by ECG and Forrester on admission are independent predictors of in-hospital mortality. CONCLUSIONS: Gender is an independent predictor of in-hospital mortality in acute myocardial infarction (female/male odds ratio = 1.63).

Treatment of cholecystoduodenal fistula in the era of laparoscopy.

INTRODUCTION: At first, laparoscopic cholecystectomy was considered unsuitable for patients presenting biliary tract diseases. This study seeks to demonstrate cholecystoduodenal fistula is not a contraindication for laparoscopic cholecystectomy, and it can be performed without a higher risk for the patient. PATIENTS AND METHODS: A retrospective study has been completed on laparoscopic biliary pathology from 1992 to 1999 (191 urgent and 877 elective choice surgeries). 302 cases (28%) are of complicated biliary pathology. We report on 14 cholecystoduodenal fistulae, 3 cholecystocolonic fistulae, and 2 cholecystogastric fistulae. RESULTS: Only in 5 patients with cholecystoduodenal fistula was the operation successfully completed by laparoscopy. Conversion to open surgery was because of bleeding (5 cases), difficulty for colon suture (2 cases), and inflammation of the gallbladder with the duodenum (7 cases). An endo-GIA 35 was used to transect the fistula. All patients were discharged after 4 or 5 days without wound infection, and they have been evaluated at 3 and 12 months, without problems. CONCLUSION: Cholecystoduodenal fistula can no longer be considered a contraindication for laparoscopic treatment, and it does not increase morbidity risk.

Prodrug design of phenolic drugs.

Phenolic group in therapeutic drugs can be used for a prodrug modification to overcome various undesirable drug properties that may become pharmacological, pharmaceutical or pharmacokinetic barriers for application. Several strategies have been used in order to overcome the limited bioavailability of phenolic drugs. Classical design represents a nonspecific chemical approach to mask undesirable drug properties, limited bioavailability or chemical instability. Targeted prodrug design represents a new strategy for directed and efficient drug delivery. Particularly, targeting the prodrug to specific enzyme or specific membrane transporter has potential as selective drug delivery system mainly in cancer therapy. The article brings examples of ester, sulphate, carbamate, carbonate, phosphate and ether prodrugs as well as the limitations of these prodrug strategies. Some specific enzyme targets are also presented.

[Secretory IgA and infantile respiratory pathology]. / IgA secretora y patología respiratoria infantil.

Secretory component of IgA is the major class of immunoglobulin in secretions and mucous membranes. Many causes have been involved in etiopathogenesis of respiratory tract disease in children, one of them the possible deficit of secretory component of IgA. Authors have studied 191 children with respiratory tract disease secondary to infections and/or allergy and a control group of 35 healthy children. In all of them the secretory IgA non stimulated sputum was measured. In the group with respiratory disease serum IgA, IgG, IgM and IgE were also measured. Levels of secretory IgA were greater in group with respiratory disease than in control; also serum level of IgA was above normal for their ages. Level of secretory IgA was greater in children with "wheezing respiratory disease". These findings do not agree with theory of existence of an IgA secretory deficit as a cause or respiratory tract disease in children.