[Ulcerative colitis and thrombocytopenia: a clinical case of fortuitous association?]. / Rettocolite ulcerosa e piastrinopenia: un caso clinico di associazione fortuita?

Ulcerative colitis (UC) is an inflammatory bowel disease of unknown etiology, involving primarily the rectum with major intestinal symptoms. Additionally, UC is often associated with extraintestinal manifestations, especially arthropathies, as well as with some autoimmune disorders. Vice versa, UC is rarely described in association with hematologic abnormalities, such as autoimmune hemolytic anemia and immune thrombocytopenic purpura with antiplatelet antibodies positive. Usually UC precedes the onset of thrombocytopenia by days or years or coincides with it. We report a case of UC and thrombocytopenia with negative anti-platelet antibodies in which an immunosuppressive therapy with corticosteroids obtained significant remission of intestinal symptoms along with a rapid increase of platelet count.

Prognostic significance of atrial fibrillation in thrombolysed and non thrombolysed patients.

AIM: Atrial fibrillation (AF) is considered a frequent complication of acute myocardial infarction (AMI). The aim of this study was to examine the incidence and prognostic significance of AF complicating AMI. METHODS: A total of 848 patients with AMI were examined evaluating: age, sex, coronary risk factors, incidence of AF, prior ischemic events, infarct location, electrocardiogram on admission, thrombolytic therapy, in-hospital complications and mortality. RESULTS: AF was recorded in 84 patients (9.9%). They were older (P<0.0001), less frequently smokers (P<0.007), had higher creatinekinase level (P<0.005) and more advanced heart failure (Killip class >or=2). AF was documented in non-thrombolysed more than in thrombolysed patients (11.2% vs 7.5%). Overall mortality resulted significantly higher in patients with AF (P=0.001); nevertheless it did not result as independent predictor of mortality. Instead, independent predictors of mortality have been Killip class >or= II (P<0.0001), age (P<0.0001) and prior infarction (P<0.002 ). CONCLUSIONS: In our experience, AF cannot be considered an independent predictor of mortality. Contrary, advanced heart failure, either in thrombolysed or not-thrombolysed patients, is an independent predictor of AF and mortality. Nevertheless, AF represents an expression of advanced heart failure, that is worsened by the development of arrhythmia with severe consequences on prognosis.

Hypertensive disorders in normal/over-weight and obese type 2 diabetic pregnant women.

BACKGROUND: Hypertension is one of the major complications of pregnancy. Its impact in type 2 diabetic pregnant women could be understimated because it is generally evaluated by retrospective studies and as one of the outcome measures. OBJECTIVE: Our aims were: 1) to evaluate the prevalence of hypertensive disease between type 2 diabetic and normal pregnancies; 2) to relate hypertensive disease to body weight in type 2 diabetic pregnancies; 3) to assess the impact of different types of hypertension on pregnancy outcome in type 2 diabetic women. STUDY DESIGN: Seventy-six type 2 diabetic (23 normal-weight, 26 overweight and 27 obese) and sixty normal (43, 15 and 2 respectively; x (2) 0.0001) pregnancies, matched for age and smoking habit. Hypertension was defined as >/=140/90 mmHg and classified in chronic, gestational and pre-eclampsia. STATISTICAL ANALYSIS: Student's t-test, chi (2), simple, and/or multiple and logistic regression analysis were used when appropriate. Odds ratio was calculated for hypertension. p significant <0.05. RESULTS: The overall prevalence of hypertension was 40.8% (18.4% chronic, 17.1% gestational and 5.3% pre-eclampsia) in type 2 diabetic pregnancies and 10% (8.3% gestational and 1.7% pre-eclampsia) in normal pregnancies (p<0.0001), with an odds ratio of 6.2. All the types of hypertension, significantly chronic, contributed to the higher prevalence. Only in diabetic pregnancies, hypertension was associated with a higher pregestational BMI; whenever BMI increased, chronic and gestational hypertension increased by contrast of pre-eclampsia (chi (2), 0.02). Hypertensive disorders did not affect maternal-fetal outcome. CONCLUSIONS: The prevalence of hypertension was 40.8% in type 2 diabetic pregnant women whilst it was 10.0% in non diabetic controls. All hypertensive disorders, significantly chronic, were more frequent. Increasing BMI was a crucial factor for chronic and gestational but not for pre-eclampsia. Hypertensive diseases did not seem to affect pregnancy outcome.