Functional status and life satisfaction of patients with stable angina pectoris in Austria.

OBJECTIVES: Although substantial progress in the treatment of stable angina pectoris (sAP) has been made, little is known about the functional status and quality of life (QoL) of patients in different healthcare systems. DESIGN AND METHODS: We undertook a survey using the Seattle Angina Questionnaire (SAQ) (five domains scored form 0-worst assessment to 100-best assessment) to assess symptoms, QoL (including limitation of activities), demographics, geographic distribution and individual disease data in patients with stable coronary artery disease in Austrian cardiology practices. RESULTS: A total of 660 patients with sAP with a mean age of 69.2 years were included. SAQ scores were 67.5±24.4 for physical limitation, 65.5±26.6 for angina stability, 79.3±23.2 for angina frequency, 86.3±16.2 for treatment satisfaction and 63.7±24.2 for overall QoL. Multiple regression identified male gender, but also female gender, Eastern Austrian residence and high body mass index as predictive factors for SAQ scoring. A total of 35.6% of the patients reported at least one desirable activity that was limited through AP symptoms. CONCLUSIONS: Activity and QoL assessments are in accordance with published literature: The number and the diversity of desired activities indicate the need to focus on patient's individual activity level to improve symptom management.

Intracranial volume changes in craniosynostotic rabbits: effects of age and surgical correction.

BACKGROUND: The premature fusion of one or more cranial sutures, termed craniosynostosis, alters normal brain growth patterns and results in compensatory changes in the cranial vault. The authors previously reported that bilateral coronal suture fusion resulted in a reduction in intracranial volume in a rabbit model of nonsyndromic, familial coronal suture synostosis. METHODS: The current follow-up study involved collecting cross-sectional three-dimensional computed tomographic head scans from 142 rabbits (70 normal, 44 with uncorrected synostosis, and 28 synostosed rabbits with coronal suturectomy) at 0, 10, 25, 42, 84, and 126 days of age. Intracranial contents were reconstructed, and indirect intracranial volume was calculated. RESULTS: Results revealed a significant (p < 0.05) postsynostotic reduction of intracranial volume (23 percent) by 25 days of age in rabbits with uncorrected craniosynostosis compared with normal controls, which continued through 84 days of age. Also, rabbits with surgically released synostosis, using a simple strip suturectomy, showed significantly (p < 0.05) greater intracranial volume at 25 days of age compared with unoperated synostosed rabbits. However, no changes in intracranial volume were noted between 42 and 84 days of age in rabbits with surgically released synostosis, at which point their intracranial volume was 30 percent less than that in normal control rabbits. CONCLUSIONS: These data suggest that in rabbits with uncorrected craniosynostosis, compensatory changes in the neurocranium were not capable of compensating for the loss of sutures as growth sites. The results also showed that that surgical release of the synostosed suture improved intracranial volume in the short term (25 to 42 days) but failed to change it in the long term (42 to 84 days), possibly because of rapid resynostosis of the suturectomy site. This study suggests that surgical release of the suture fusion site alone may not be adequate to allow for normal intracranial volume growth in synostotic rabbits. For this reason, it may be efficacious to design and develop adjunct protein and gene therapies to prevent resynostosis and improve postoperative intracranial volume in craniosynostotic individuals.

Sequential thoracentesis: minor change of zinc compared to other selected essential trace elements in the serum.

This study first indicates that the serum trace element Zn tends to decrease in the course of sequential thoracenteses. Other selected essential elements such as copper (Cu), manganese (Mn), molybdenum (Mo), and cobalt (Co) do not reveal loss changes in their serum levels. Therefore, Zn should be monitored in patients who undergo repeated thoracentesis. To measure the magnitude of changes in serum trace elements and the clinical relevance of potential imbalances, concentrations of the essential elements are analyzed in 57 serum/effusion pairs obtained from 5 patients (4 male, 1 female; age 28-78 yr) who underwent repeated thoracenteses as a result of recurrent pleural effusion. All patients declined other therapeutic options such as chemical pleurodesis and/or chest tube placement. The total volumes of fluid removed ranged from 2.3 to 19.3 L and the frequency of thoracentesis ranged from 6 to 15 within a period of 102-174 days. Two patients had benign pleural disease and three had malignancies. Three patients suffered from pleural effusions resulting from exudates (total protein content > 3.0 g/dL, LDH > 200 U/L), and two resulting from transudates (total protein < 3.0 g/dL, LDH < 200 U/L). All trace elements were simultaneously determined by inductively coupled argon plasma-mass spectrometry. In addition, the concentrations of the following clinically relevant parameters were analyzed by standard methods: total protein, pH, leukocyte count, lactate dehydrogenase, and glucose.

Cystatin C of pleural effusion as a novel diagnostic aid in pleural diseases of different aetiologies.

There has been considerable recent interest in the potential use of serum cystatin C as a diagnostic tool. Here we examined the hypothesis that the cystatin C level in the pleural effusion can differ from the corresponding serum level. We evacuated pleural effusion fluids from 47 patients by thoracentesis. Cystatin C, beta(2)-microglobulin, inorganic phosphate, creatinine and total protein were quantified in both pleural effusion fluids and corresponding sera. We determined cystatin C levels in pleural effusions and calculated the ratio of cystatin C levels in serum and effusion, to discriminate between effusions caused by severe renal impairment and other types of effusion. Extremely high concentrations of cystatin C in serum/effusion pairs were only measured in patients with renal failure (6.0 +/- 0.8/6.0 +/- 0.8 mg/l, means +/- S.D., n=11). A clearly defined region was found to correspond to pleural effusion caused by renal failure (r=0.954). The quantification of cystatin C in the effusion was justified by the discovery that there were some patients with a high serum cystatin C level but a low effusion concentration, or a low serum cystatin C but a high effusion concentration, indicating causes other than renal failure. In conclusion, the pilot data indicate a relationship between the cystatin C concentration in pleural fluid and the underlying disease. Thus cystatin C levels in pleural effusion and serum may be a valuable criterion for the differential diagnosis of pleural diseases of different aetiologies.