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BackgroundPrimary angioplasty is going to be the preferred method in the therapy of myocardial infarction. A remaining problem is restenosis rate, which should be improved by implantation of coronary stents. Long-term experience is available for a period of twelve months in only a few studies so far. MethodsIn a prospective study, 717 consecutive patients with acute myocardial infarction were treated either with primary angioplasty alone (n=587) or in combination with stent implantation (n=130) from 1989 to 1999. Restenosis rate and target-vessel revascularization rate were examined by angiography on an average of four months. After a mean time of 30 months, follow-up data were obtained by a written questionnaire or phone interview of the patients or their general practioner or both. ResultsAge 59.6 (SD 11.5) yrs, 74.9% male/25.1% female, 49.8% coronary multi-vessel diseases, 14.6% diabetics, 10.9% cardiogenic shock (CS), time to treatment <6h in 83%.    The residual stenosis measured immediately after intervention was 28.5% in the angioplasty group and 10.8% in the stent group (p<0.001). Reocclusion occurred in 5.1% in just dilated patients, but was absent in the stent group. After 30 days, 5.1% in the angioplasty group had died versus 14.6% in the stent group (p<0.001). These findings can be explained by an increased incidence of cardiogenic shock in the stent group. Analysis of patients with or without cardiogenic shock alone showed no differences in mortality.    During the angiographic follow-up, we found a 40% lower restenosis rate (38.7 vs. 23.6%; p=0.005) for the stent patients, requiring fewer reinterventions (p<0.001). After a mean of 30.7 months, fewer patients in the stent group had dyspnoe or angina. Target-vessel revascularization had to be performed in 27.4% of the angioplasty group vs. 16.5% in the stent group (p=0.03). The mortality rate at long-term follow-up showed no difference, if the two groups were examined separately for patients with or without CS (with CS: 47.8 vs. 58.6%, p=ns; without CS: 9.5 vs. 6.4%, p=ns). A combined end point long-term mortality, reinfarction, reintervention or CABG-OP occurred in fewer patients of the stent group without cardiogenic shock (angioplasty 42.1 vs. stent 26.6%, p=0.008). In patients with CS, we found no difference for the combined end point (56.5% vs. 72.4%, p=ns). ConclusionsIn patients with acute myocardial infarction, implantation of a coronary stent offers clinical benefit due to restenosis and target-vessel revascularization rate, but it did not improve mortality. HintergrundDie primäre PTCA entwickelt sich zum Goldstandard der Myokardinfarkttherapie. Ein Problem ist die Rezidivstenose, welche durch die Implantation von Stents bereits seit einigen Jahren zu umgehen versucht wird. Langzeiterfahrungen liegen jedoch bisher nur in wenigen Studien bis zu 12 Monaten vor. MethodikIn einer prospektiven Studie wurden 717 Patienten von 1989–1999 mit akutem Myokardinfarkt konsekutiv in einer Datenbank erfasst, welche mittels primärer PTCA mit (n=130) oder ohne (n=587) Stent-Implantation behandelt wurden. Rezidivstenose und Re-Interventionsrate wurden nach 4 Monaten im Rahmen einer koronarangiographischen Kontrolle untersucht. Nach im Mittel 30 Monaten erfolgte eine telefonische bzw. schriftliche Nachbefragung. ErgebnisseStichprobe: Alter 59,6 (SD 11,5) Jahre, 74,9% Männer/25,1% Frauen, 49,8% koronare Mehrgefäßerkrankung, 14,6% Diabetiker, 10,9% kardiogener Schock, 83% Ischämiezeit <6h.    Die Residualstenose direkt nach Intervention maß in der PTCA-Gruppe 28,51%, in der Stent-Gruppe 10,75% (p<0,001). Die Rate an Frühverschlüssen war mit 5,1% versus 0% signifikant unterschiedlich. Gestorben nach 30 Tagen waren in der PTCA-Gruppe 5,1%, in der Stent-Gruppe 14,6% (p<0,001). Dies war durch den mit 2,7 vs. 15,4% signifikant höheren Anteil von Schock-Patienten in der Stent-Gruppe erklärbar. Nach Subgruppenanalyse nach kardiogenem Schock finden sich zwischen Nur-PTCA und Stent keine signifikanten Mortalitätsunterschiede mehr. In der koronarangiographischen Kontrolle sahen wir bei den Stent-Patienten 40% weniger Rezidivstenosen (38,7 vs. 23,6%; p=0,005) mit entsprechend deutlich seltenerer Notwendigkeit der Re-Intervention (p<0,001). Nach im Mittel 30,7 Monaten zeigte sich in der Stent-Gruppe bezüglich Angina pectoris und Luftnot ebenfalls ein Profit für das Stent-Kollektiv. Erneute Dilatationen waren in der PTCA-Gruppe mit 27,4 vs. 16,5% deutlich häufiger (p=0,03). Das ursprüngliche Infarktgefäß war hierbei mit 27,2 vs. 12,4% signifikant öfter betroffen. Bezüglich der Langzeitmortalität sahen wir differenziert nach Schock-Patienten zwischen Nur-PTCA und Stent-Patienten keinen signifikanten Unterschied (mit CS: 47,8 vs. 58,6%, p=ns; ohne CS: 9,5 vs. 6,4%, p=ns). Der sekundäre Endpunkt aus Langzeitmortalität, Re-Infarkt, Re-PTCA und ACB-OP wurde bei Patienten ohne kardiogenen Schock jedoch von deutlich weniger Stent-Patienten erreicht (42,1 vs. 26,6%, p=0,008). Bei Patienten mit CS zeigte sich kein signifikanter Unterschied (56,5 vs. 72,4%, p=ns). SchlussfolgerungDie koronare Stent-Implantation im Rahmen der primären PTCA des akuten Infarktes führt auch im Langzeitverlauf zu einer signifikant geringeren Rate an interventionspflichtigen Rezidivstenosen, vermag allerdings keinen Überlebensvorteil zu erbringen.

Our aim was to conduct a survey about urinary symptoms and to find out if questioning patients about symptoms is helpful for the GP to make medical decisions concerning prostate problems among middle-aged men.

The concentrations of mercury (Hg), cadmium (Cd) and lead (Pb) in brain (cerebrum) and kidney during fetal (second trimester terminations or abortions, n=20) and postnatal (infants deceased before three months of age, n=15) development have been studied. Information on possible sources of exposure was obtained from the mothers of the fetuses, but not from those of the infants. The median concentration of Hg in the brain was 4 µg/kg wet weight in both fetuses and infants (total range ≤2­23 µg/kg). The concentrations of Hg in the kidneys were significantly higher than in brain, median of Hg 6 µg/kg (range ≤5­34 µg/kg) in fetuses and 10 µg/kg (≤7­37) in infants. There was a tendency of increasing concentration of Hg in the fetal kidney, but not in the brain, with increasing number of amalgam fillings in the mothers. The concentration of Cd in the brain was less than 1 pg/kg in most cases, both in fetuses and infants. The concentration of Cd in the kidneys was significantly higher, with a median of about 2 µg/kg (1­8µg/kg) in both groups. There was no detectable association between tissue Cd concentrations and the smoking habits of the mothers. The concentration of Pb in brain was below 10 µg/kg in most cases. In the kidneys, the concentrations of Pb were significantly higher, with a median of 12 µg/kg in the fetuses (range ≤6­20 µg/kg) and 15 µg/kg (1­9­36 µg/kg) in the infants. In general, the concentrations of Cd and Pb were lower than in previously reported studies.

The concentrations of copper (Cu), zinc (Zn) and selenium (Se) in the brain and kidneys of second trimester fetuses (abortion cases) and infants (deceased before three months of age) were determined. Concentrations of Cu in brain, 0.31-1.6 mg/kg wet weight,increased with age, and were, on the average, three times higher in the brains of infants than of fetuses. In kidneys, Cu concentrations ranged between 0.34 and 2.9 mg/kg, and increased with age after birth. Concentrations of Zn in the brain decreased significantly with age in the fetuses, from about 7 mg/kg at post-conceptional week 12 to less than 5 mg/kg at week 20, but increased again post-natally. In kidneys, Zn concentrations (12-37 mg/kg) increased in parallel with the increase in tissue density. Concentrations of Se in brain, 0.072-0.14 mg/kg, decreased with age in the fetuses, but increased with age post-natally. Kidney Se concentrations (0.16-0.55 mg/kg) did not change significantly with age during the fetal period, but increased about 2.5 times during the postnatal period. There was a significant association between the concentrations (on molar basis) of Zn and Cu in kidneys, but not in brain. There was no correlation between the concentrations of Cu, Zn or Se and those of mercury, cadmium and lead, previously determined in the same samples, with the exception of mercury and Se in kidneys.

Health-related quality of life was assessed in a diet and exercise intervention study among 157 healthy men aged 35–60 years (mean ± s.d.; 46.2 ± 5.0) with moderately raised cardiovascular risk factors. The men were randomized to four groups, diet (D, n=40), exercise (E, n=39), diet plus exercise (DE, n=39), and no active intervention (controls (C) n=39). Quality of life was measured with two self-administered questionnaires; Subjective Symptoms Assessment Profile and Minor Symptom Evaluation Profile, at baseline and after 1.5, 3 and 6 months. Cardiovascular risk factors were investigated at baseline and after 6 months. As a result of changes in dietary habits and physical exercise in the three intervention groups, several important cardiovascular risk factors were significantly reduced. The quality of life/well-being did not differ between the four groups and did not change significantly in any of the groups during the study. There was, however, a tendency towards fewer gastrointestinal symptoms in group D and fewer cardiac symptoms in group DE. We conclude that advice on lifestyle changes in the form of diet and exercise reduce risk factors in middle-aged men without negative effects on their quality of life.

Acute otitis media is a common disease, particularly among children. The importance of a correct diagnosis is crucial, especially as unjustified prescription of antibiotics has become a major problem in clinical praxis.