Prognostic impact of peripheral artery disease-related parameters in patients with acute coronary syndrome.

BACKGROUND: Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. METHODS: We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. RESULTS: Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). CONCLUSIONS: LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.

Do We Need Fasting Prior to Coronary Angiography? The CORO-NF Randomized Pragmatic Study.

BACKGROUND: Similar to procedures requiring general anesthesia, current guidelines recommend fasting for 6 hours for solids and for 2 hours for liquids prior to coronary angiography, but without data supporting such recommendation. The CORO-NF study aimed at assessing whether a shorter fasting period prior to elective coronary angiography associates with improved patient satisfaction without more complications compared with the standard fasting approach. METHODS: We conducted a single-center, randomized, prospective, pragmatic study in 2 sequential phases: a "conventional protocol phase," continuing the usual practice (F Group); and an "experimental phase" (NF Group), reducing minimum fasting duration to 2 hours. Patients received a questionnaire to express a satisfaction score ranging from 1 (maximum complain/no approval) to 5 (minimum or no complain/full approval). All patients admitted acutely were enrolled in a control A Group registry. Fasting time and every major complication and periprocedural complications were analyzed. RESULTS: Fasting time was 821 ± 357 minutes in the F Group and 230 ± 146 minutes in the NF Group (P < .001). The satisfaction score was higher in the NF Group (4.2 ± 0.7 vs 2.9 ± 1.2, P < .001), even at multivariable analysis considering fasting time (P < .001). No intraprocedural food ingestion-related adverse events occurred in either of the 2 experimental groups, as well as in the parallel A Group, with no excess of peri- and postprocedural complications in the NF Group. CONCLUSIONS: The significantly higher satisfaction scores among patients undergoing a shorter-than-recommended fasting period prior to coronary angiography, not counterbalanced by decreased safety, underscores the potential benefits of revising the traditional 6-hour fasting protocols.

Short and Long-Term Outcomes of Lesion Index-Guided High-Power Short-Duration Approach for Atrial Fibrillation Ablation.

High-power short-duration (HPSD) ablation is an increasingly used ablation strategy for pulmonary vein isolation (PVI) procedures, but Lesion Index (LSI)-guided HPSD radiofrequency (RF) applications have not been described in this clinical setting. We evaluated the procedural efficiency and safety of an LSI-guided HPSD strategy for atrial fibrillation (AF) ablation. Paroxysmal and persistent AF patients scheduled for AF ablation were prospectively enrolled and divided into two groups, according to the ablation power used (≥45 W for the LSI-HP Group and ≤40 W for the LSI-LP group). All patients underwent only PVI LSI-guided ablation (5.5 to 6 anteriorly; 5 to 5.5 superiorly, 4.5 to 5 posteriorly) with a point-by-point strategy and an inter-lesion distance <6 mm. Forty-six patients with AF (25 in the LSI-HP Group vs 21 in the LSI-LP Group)-59% paroxysmal, 78% male, with low-intermediate CHA2DS2-Vasc scores (2 [1-3]), a preserved ejection fraction (65 ± 6%) and a mean left atrial index volume of 39 ± 13 mL/m2 were prospectively enrolled. Baseline clinical characteristics were comparable between groups. PVI was successful in all patients. The RF time (29 (23-37) vs. 49 (41-53) min, p < 0.001), total procedure time (131 (126-145) vs. 155 (139-203) min, p = 0.007) and fluoroscopy time (12 (10-18) vs. 21 (16-26) min, p = 0.001) were significantly lower in the LSI-HP Group. No complications or steam pops were seen in either group. LSI-HP AF ablation significantly improved procedural efficiency-reducing ablation time, total procedural duration, and fluoroscopy use, while maintaining a comparable safety profile to lower-power procedures.

Treatment of feline herpesvirus-1 associated disease in cats with famciclovir and related drugs.

BACKGROUND: Feline herpesvirus 1 (FHV-1) is a common cause of ocular and upper respiratory disease in cats and kittens, and a potential cause of eosinophilic dermatitis. HYPOTHESIS: The systemic anti-herpes drug, famciclovir (Famvir; Novartis), would be effective in the clinical management of disease attributable to FHV-1, including conjunctivitis, keratitis, corneal sequestra, rhinosinusitis and FHV-1 associated dermatitis. CLINICAL OUTCOME: Oral famciclovir was used to treat signs considered referable to FHV-1 in 10 cats: four had primary ocular disease, two had rhinosinusitis and four had FHV-1 associated dermatitis. Patients treated in Australia (five cats) and Europe (one cat) were given 62.5 mg of famciclovir once or twice daily. Four cats treated in the USA were given 125 mg three times daily. Famciclovir was uniformly well tolerated and, in all cases, had a positive impact on the patient's condition. The apparent improvement in lesions was superior to what had been achieved previously using other therapeutic strategies. One cat with severe destructive rhinosinusitis was significantly improved by a 4-month course of famciclovir in combination with antibacterials. Corneal sequestra detached in two out of three cats treated; cats with ocular signs were qualitatively more comfortable, with reduced clinical signs and an improved appearance of the eyes. Critically, oral famciclovir therapy was considered more convenient than topical ocular therapy. All four cats with FHV-1 associated dermatitis improved substantially, although relapse occurred subsequently in three patients. A further cat with presumptive FHV-1 associated dermatitis responded to topical aciclovir cream before famciclovir could be sourced. CONCLUSIONS: Famciclovir appears to be a promising systemic drug for treating diseases associated with FHV-1 infection. More rigorous clinical trials are required to optimise the dosing regimen for safe and effective specific anti-herpes treatment in feline clinical medicine.

Multiple-center study of reduced-concentration triamcinolone topical solution for the treatment of dogs with known or suspected allergic pruritus.

OBJECTIVE: To determine the efficacy of triamcinolone acetonide topical solution (TTS) in dogs for use in reduction of clinical signs of pruritic inflammatory skin diseases of a known or suspected allergic basis and to evaluate adverse effects associated with TTS administration. ANIMALS: 103 pruritic adult dogs with known or suspected allergic skin disease. PROCEDURE: Dogs were treated for 4 weeks with TTS or with vehicle solution (control dogs) in a multiple-center study. Clinical signs were scored by owners and by examining veterinarians before and after treatment. Blood samples obtained before and after treatment were subjected to routine hematologic and serum biochemical analyses. RESULTS: Treatment success, as defined by an improvement of at least 2 of 6 grades in overall clinical score, was evident in 35 of 52 (67%) TTS-treated dogs (mean improvement, 1.98) and 12 of 51 (24%) control dogs (mean improvement, 0.29). For several criteria, TTS was significantly more effective than vehicle in reducing clinical signs. Minor alterations in hematologic determinations in TTS-treated dogs were limited to slightly lower total leukocyte, lymphocyte, and eosinophil counts after treatment. Minor adverse effects were reported by owners in 6 of 52 (12%) TTS-treated and 9 of 51 (18%) control dogs. CONCLUSIONS AND CLINICAL RELEVANCE: Triamcinolone used as a spray solution at a concentration approximately one-sixth the concentration of triamcinolone topical preparations currently available for veterinary use is effective for short-term alleviation of allergic pruritus in dogs. Adverse effects are few and mild and, thus, do not preclude prolonged treatment with the solution.

Systemic lupus erythematosus in a cat: fulfillment of the American Rheumatism Association criteria with supportive skin histopathology.

Systemic lupus erythematosus (SLE) was diagnosed in a 9-year-old castrated male Persian cat. The cat described is the first to fulfil four of 11 American Rheumatism Association criteria for the diagnosis of SLE in humans (symmetrical facial dermatitis, thrombocytopenia, positive antinuclear antibodies, oral ulceration) with supportive skin histopathology. Haematological abnormalities included a mild anaemia and severe thrombocytopenia. Skin disease consisted of symmetrical multifocal alopecia with crusting, predominantly on the face. Histopathology of the skin revealed interface dermatitis and interface folliculitis with follicular atrophy. Complete remission was obtained with corticosteroid therapy.

Feline urticaria pigmentosa in three related Sphinx cats.

Abstract A pruritic maculopapular eruption with clinical and histological features similar to urticaria pigmentosa of humans is reported in three related Sphinx cats. All cats shared the same grandsire, had a juvenile onset of disease, and demonstrated similar historical, clinical and histological findings. Physical examination revealed widespread bilaterally symmetrical, erythematous, partially coalescing, crusted macules and papules on the trunk, limbs, neck and head. A few macules exhibited a dark brown pigmentation. Dermatographism could not be elicited in any of the cats. Histological examination of papules revealed the présence of a perivascular to diffuse dermal and subcutaneous infiltrate of well-differentiated mast cells. In one cat where systemic involvement was pursued, evidence of internal disease was not found. Resumen Se describe en 3 gatos esfinge emparentados una erupción maculopapular pruritica con caracteristicas clinicas e histológicas similares a la urticaria pigmentosa en la especie humana. Todos los gatos compartian el mismo abuelo, desarrollaron la enfermedad en edad juvenil y mostraron hallazgos históricos, clinicos e histológicos similares. El examen fisico mostró pápulas y máculas costrosas, eritematosas, parcialmente unidas, generalizadas, bilaterales y simétricas localizadas en tronco, extremidades, cuello y cabeza. Algunas máculas mostraban una pigmentación marronácea oscura. No pudo provocarse dermatografismo en ninguno de los gatos. El examen histológico de las pápulas mostró la presencia de un infiltrado dérmico y subcutáneo perivascular a difuso compuesto por mastocitos bien diferenciados. No se encontró enfermedad sistémica en un animal en el que se evaluó esta posibilidad. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats. (Urticaria pigmentosa felina en 3 gatos esfinge emparentados.) Veterinary Dermatology 1996; 7: 227-233.] Résumé Les auteurs décrivent chez 3 chats Sphynx apparentés une eruption maculopapuleuse présentant des similitudes cliniques et histologiques avec l'urticaire pigmentaire humaine. Les 3 chats ont le même grandpère, présentent une apparition précoce des symptômes, et, une anamnèse, une clinique et une histologie similaires. L'examen clinique révèle des macules et des papules croûteuses à large distribution bilatérale et symétrique, érythèmateuses, partiellement coalescentes, sur le tronc, les membres, le cou et la tête. Quelques macules montrent une pigmentation brun foncé. La présence d'un dermographisme n'a pu être démontré chez aucun des chats. L'examen histologique des papules révèle la présence d'un infiltrat dermique et sous cutané périvasculaire à diffus de mastocytes bien différenciés. La recherche d'une atteinte systémique chez un des chats n'a pas montré d'atteinte interne. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats. (Urticaire pigmentaire féline chez 3 chats Sphynx apparentés.) Veterinary Dermatology 1996; 7: 227-233.] Zusammenfassung Es wird über eine juckende makulopapuläre Eruption mit klinischen und histologischen Befunden, die der Urticaria pigmentosa des Menschen ähneln, bei drei verwandten Sphinx-Katzen berichtet. Alle Katzen hatten den selben Großvater, zeigten einen Krankheitsbeginn im Jugendalter und wiesen ähnliche Befunde in der Vorgeschichte, Klinik und Histologie auf. Die klinische Untersuchung zeigte weit verteilte, bilateral symmetrische, erythematöse, teilweise koaleszierende verkrustete Maculae und Papeln am Rumpf, Gliedmaßen, Hais und Kopf. Einige maculae wiesen eine dunkelbraune Pigmentierung auf. Dermatographismus konnte bei keiner der Katzen ausgelöst werden. Die histologische Untersuchung der Papeln zeigte die Anwesenheit eines perivaskulären bis diffusen dermalen und subkutanen Infiltrates von gut differenzierten Mastzellen. Bei einer Katze mit systemischen Erscheinungen konnte die Ursache der inneren Erkrankung nicht gefunden werden. [Vitale, C.B., Ihrke, P.J., Olivry, T., Stannard, A.A. Feline urticaria pigmentosa in three related Sphinx cats (Feline Urticaria pigmentosa bei drei verwandten Sphinx-Katzen). Veterinary Dermatology 1996; 7: 227-233.].

Putative Diethylcarbamazine-induced Urticaria with Eosinophilic Dermatitis in a Dog.

Résumé- Une urtricaire due à la diethylcarbamazine associée à une dermite prurigineuse a été suspectée chez un chien mâle castré croisé Retriever. L'animal présentait des lésions d'urticaire multiples qui avaient tendance à fusionner au niveau des paupières, des lèvres, les conques auriculaires et du prépuce. Les biopsies cutanées ont révélé un infiltrat périvasculaire et périannexiel intense riche en polynucléaires éosinophiles. Parfois les polynuclaires éosinophiles étaient "dégranulés" ou présentaient des formes "en flamme". La suppression de l'administration de diethylcarbamazine a été suivie d'une disparission rapide de toutes les lésions cutanées. L'hypothèse d'une réaction immune à la diethylcarbamazine est proposée. [Vitale, C. B., Ihrke, P. J., Gross, T. L. Putative diethylcarbamazine-induced uticaria with eosinophilic dermatitis in a dog. (Probable urticaire et dermite éosinophilique induites par la diethylcarbamazine chez un chien). Resumen- Se describe el caso de un perro macho castrado, cruzado de retriever que presentaba una dermatitis pruritica con urticaria supuestamente inducida por dietilcarbamacina. El perro mostraba multiples habones, principalmente alrededor de los ojos, la boca, los pabellones auriculares y el prepucio. El estudio histológico mostró un infiltrado perivascular y perianexal, con predominancia de eosinófilos. Ocasionalmente los eosinófilos degranulaban formando "figuras en llama". La retirada de la terapia con dietilcarbamacina fue seguida por una mejoria rápida y espectacular de todas las lesiones cutáneas. Se postula una reacción adversa a la dietilcarbamacina mediada por factores inmunológicos. [Vitale, C. B., Ihrke, P. J. and Gross, T. L. Putative diethylcarbamazine-induced urticaria with eosinophilic dermatitis in a dog (Urticaria con dermatitis eosinofilica supuestamente inducida por dietilcarbamacina en un perro). Zusammenfassung- Es wird über eine vermutlich Diethylcarbamazin-verursachte Urtikaria mit Juckreiz bei einem männlich-kastrierten Retrievermischling berichtet. Der Hund wies generalisiert multifokale Striemen auf, die dazu tendierten um Augen, Mund, Ohrmuscheln und Präputium zusammenzulaufen. Die Hautbiopsie zeigte ein starkes perivaskuläres und periadenxales Infiltrat mit vorwiegend eosinophilen Granulozyten. Gelegentlich degranulierten die Eosinophilen zu "Flammenform". Das Absetzen von Diethylcarbamazin führte zu einer dramatischen und raschen Abheilung aller Hautveranderungen. Es wird eine immunologischvermittelte Arzneimittelreaktion auf Diethylcarbamazin vermutet. [Putative diethylcarbamazine-induced utricaria with eosinophilic dermatitis in dogs (Vermutlich Diethylcarbamazin-verursachte Urtikaria mit eosinophiler Dermatitis beim Hund). Abstract- A suspected diethylcarbamazine-induced urticarial dermatitis with associated pruritus is reported in a castrated male mixed breed retriever. The dog had generalized multifocal wheals that tended to cluster around the eyes, mouth, pinnae, and prepuce. Skin biopsy revealed an intense perivascular and periadnexal infiltrate with eosinophils predominating. On occasion, eosinophils degranulated to form "flame figures". Withdrawal of diethylcarbamazine resulted in dramatic and rapid resolution of all skin lesions. An immunologically mediated adverse drug reaction to diethylcarbamazine is proposed.