[Study of a detection strategy for silent ischemia in diabetic patients: 18 month follow-up of the ARCADIA register]. / Etude d'une stratégie de détection de l'ischémie silencieuse chez les patients diabétiques: suivi à 18 mois du registre ARCADIA.

BACKGROUND: The prognostic impact of a myocardial ischemia-based therapeutic program in asymptomatic diabetic patients remains controversial. We prospectively assessed the benefit of a stratification algorithm based upon clinical and myocardial perfusion imaging (MPI) data on cardiovascular events in such patients in a non-randomized register. METHOD: 701 consecutive asymptomatic diabetic patients were classified to be at low or intermediate-to-high cardiac risk according to 13 simple boil-clinical parameters. Intermediate-to-high risk patients were scheduled for MPI and underwent either a conventional (Group 1, n=180) or an intensive multifactorial (Group 2, n=245) therapeutic program. Low risk patients (Group 3, n=276) underwent no specific management. RESULTS: At the end of the survey and as a consequence of intensive management, lipid lowering therapy, antiplatelet drugs, and beta-blockers were more often prescribed in Group 2 than in Group 1 (55, 31 and 17% versus 36, 23, and 8% respectively, p<0.01). Planned coronary angiography in case of severe ischemia on MPI and revascularization were more frequent in Group 2 (16.2 and 8.9%) than in Group 1 (8.0 and 2.8% - p<0.01). At 19-month follow-up (96.7% completed), major event rate in Group 2 was significantly lower than in Group 1 (3.9 versus 9.8%, p<0.01) and similar to that of Group 3 (2.2%, NS). CONCLUSION: Easy-to-perform risk stratification is able to select diabetic patients with good medium-term prognosis. In clinically selected higher risk patients, an intensive medical therapy combined with coronary angiography +/- revascularization in case of large ischemia on MPI is effective to improve prognosis.

[Kidney load in spleen irradiation in lymphogranulomatosis patients]. / Zur Frage der Nierenbelastung bei der Milzbestrahlung von Lymphogranulomatose-Patienten.

Within the period of 1972 to 1982, 35 patients suffering from lymphogranulomatosis had to be treated by para-aortal pendulum therapy and irradiation of the spleen or spleen pedicle. Some of these patients received an additional polychemotherapy. All of these 35 patients were regularly checked-up by clinical and laboratory examinations in oncologic departments. There were no signs of radiogenic lesions of the kidney. In spite of this, the urines of these patients were examined by discelectrophoresis. Eight patients had a pathologic protein spectrum which was a symptom of other diseases in two cases and did not appear again in four cases, when control examinations were performed. One patient refused the control examination, but this one had no pathologic modifications in abdominal CT. Just one female patient showed in three control examinations protein spectra resembling to those of a proliferating glomerular lesion and a tubular lesion. All the other parameters, including a functional scintigraphy of the kidney, were normal. The patient felt well and had no clinical signs of disease. A functional damage of the kidney after irradiation of the spleen cannot be identified by current clinical and laboratory methods.