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Wir berichten uber 3 Patienten mit entzundlichen Dermatosen im Rahmen einer chronisch entzundlichen Darmerkrankung (CED). Die Diagnosefindung der vorliegenden CED basierte auf der primaren/initialen Bestimmung des fakalen Calprotectin-Wertes. Obwohl die Patienten keine intestinalen Beschwerden angaben, war der erhohte Calprotectin-Wert im Stuhl der Anlass fur eine weitere gastroenterologische Abklarung. Dieser Beitrag weist den Dermatologen auf die Bedeutung der Bestimmung des fakalen Calprotectin-Wertes als einen (weiteren) Parameter in der Diagnostik der entzundlichen Dermatosen hin.

We report on three patients with inflammatory dermatoses as a result of a chronic inflammatory bowel disease (IBD). The diagnosis of IBD was based on the initial determination of the fecal calprotectin value. Although the patients did not report any intestinal complaints, the increased calprotectin value in the stool was the reason for further gastroenterological evaluation. This article highlights the importance of determining the fecal calprotectin value as another parameter in the diagnosis of inflammatory dermatoses.Wir berichten über 3 Patienten mit entzündlichen Dermatosen im Rahmen einer chronisch entzündlichen Darmerkrankung (CED). Die Diagnosefindung der vorliegenden CED basierte auf der primären/initialen Bestimmung des fäkalen Calprotectin-Wertes. Obwohl die Patienten keine intestinalen Beschwerden angaben, war der erhöhte Calprotectin-Wert im Stuhl der Anlass für eine weitere gastroenterologische Abklärung. Dieser Beitrag weist den Dermatologen auf die Bedeutung der Bestimmung des fäkalen Calprotectin-Wertes als einen (weiteren) Parameter in der Diagnostik der entzündlichen Dermatosen hin.

Background/Introduction Although arterial stiffening is related to atherosclerosis progression, its prognostic role in hypertension is not fully elucidated, while augmented left ventricular mass index (LVMI) is linked to adverse outcome. Purpose The aim of the present study was to compare the predictive role of changes in arterial stiffness and LVMI for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. Methods We followed up 1082 essential hypertensives (mean age 55.9 years, 562 males, office blood pressure (BP)=145/91 mmHg) free of cardiovascular disease for a mean period of 8 years. All subjects had at least one annual visit and at baseline and last visit underwent complete echocardiographic study for estimation of LVMI and measurements of arterial stiffness on the basis of carotid to femoral pulse wave velocity (PWV), by means of a computerized method. The distribution of PWV was split by the median (8.2 m/sec) and accordingly subjects were classified into those with high (n=546) and low values (n=536). Moreover, LV hypertrophy (LVH) was defined as LVMI ≥125 g/m2 in males and LVMI ≥110 g/m2 in females, while CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. Results The incidence of CAD over the follow-up period was 3.5%. Hypertensives who developed CAD (n=38) compared to those without CAD at follow-up (n=1044) had at baseline higher waist circumference (101.7±10.1 vs 96.2±11.6 cm, p=0.004), LVMI (123.9±22.1 vs 105.8±21.3 g/m2, p=0.026), prevalence of LVH (46% vs 25%, p=0.018) and prevalence of high PWV levels (67% vs 40%, p=0.021). No difference was observed between hypertensives with CAD and those without CAD with respect to baseline office BP, serum creatinine and lipid levels (p=NS for all). By univariate Cox regression analysis, it was revealed that changes in PWV levels between baseline and last visit predicted CAD (hazard ratio=1.243, p=0.014). However, in multivariate Cox regression model baseline glomerular filtration rate (hazard ratio=1.029, p=0.015) and changes in LVMI (hazard ratio=1.036, p Conclusions In essential hypertensive patients changes in LVMI predict future development of CAD, whereas PWV alterations exhibit no independent prognostic value. These findings support that LVMI constitutes a superior prognosticator of events than PWV and its estimation is essential in order to improve overall risk stratification in hypertension.

Background/Introduction For estimation of overall cardiovascular risk the European Society of Hypertension (ESH) proposes stratification according to blood pressure (BP), prevalence of risk factors, asymptomatic target organ damage, diabetes, kidney and symptomatic cardiovascular disease, while the European Society of Cardiology (ESC) HeartScore constitutes another potent predictive tool of adverse outcome. Purpose The aim of the present study was to compare the predictive role of ESH stratification and ESC HeartScore for the incidence of the composite end-point of coronary artery disease (CAD) and stroke in a cohort of essential hypertensive patients. Methods We followed up 2150 essential hypertensives (mean age 55.7 years, 1085 males, office BP=145/91 mmHg) for a mean period of 8 years. All subjects had at least one annual visit. Patients were divided based on the ESH risk categories as well as according to the ESC HeartScore. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure. Stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings. Results The incidence of CAD, stroke and their composite over the follow-up period were 2.8% (n=60), 1.11% (n=24) and 3.9% (n=84), respectively. By using the ESH stratification, regarding the total population 15.3% (n=329) was of low and moderate risk, 54.4% (n=1170) was of moderate to high and high risk and 30.3% (n=651) was high to very high and very high risk. According to the ESC HeartScore 89.2% (n=1918) was of low to moderate risk, 10% (n=215) of high risk and 0.8% (n=17) of very high risk. Cox-regression analyses revealed that high to very high and very high ESH risk category was related to increased risk for the composite end-point of CAD and stroke (hazard ratio=4.5, p Conclusions In essential hypertensive patients categorization of patients by means of the ESH stratification and the ESC HeartScore are both predictive of future cardiovascular events. Based on our results, the ESH risk stratification constitutes a better prediction model for CAD and stroke than the ESC HeartScore in essential hypertension and its estimation is essential in order to improve overall risk assessment in this setting.

Background/Introduction Renal dysfunction is related with adverse prognosis in hypertension, however there are scarce data on the predictive cardiovascular and renal impact of kidney function variability in this setting. Purpose The aim of the present study was to assess the predictive role of visit-to-visit renal function changes on the incidence of coronary artery disease (CAD), stroke and end-stage renal disease in a cohort of essential hypertensive patients. Methods We followed up 2380 essential hypertensives (mean age 58.9 years, 1240 males, office blood pressure (BP)=144/91 mmHg) free of cardiovascular disease for a mean period of 8 years. All subjects had at least one annual visit and blood sampling was performed in all visits for estimation of glomerular filtration rate (GFR). We calculated standard deviation (SD) of mean GFR from visits from 6 months onward in patients with ≥5 visits during follow-up. CAD was defined as the history of myocardial infarction or significant coronary artery stenosis revealed by angiography or coronary revascularization procedure, while stroke was defined as rapid onset of a new neurological deficit persisting at least 24 hours unless death supervened confirmed by imaging findings. End-stage renal disease was defined as GFR Results The incidence of CAD, stroke and end-stage renal disease over the follow-up period were 2.8% (n=68), 1.09% (n=26) and 0.6% (n=14). Hypertensives who developed CAD compared to those without CAD at follow-up (n=2312) had at baseline higher left ventricular mass index (115.7±24.6 vs 103.7±27.3 g/m2, p Conclusions In essential hypertensive patients GFR variability predicts future development of end-stage renal disease but exhibits no independent prognostic value for CAD and stroke. These results suggest that fluctuations of renal function are related with damage at the kidneys and not at the cardiac and cerebrovascular level.

Background/Introduction Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk. Purpose The aim of the present study was to compare the predictive role of ISH and CH for the incidence of atrial fibrillation (AF) in a cohort of essential hypertensive patients. Methods We followed up 1605 essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 58.1 years, 842 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP Results The incidence of new-onset AF over the follow-up period was 3.4% (n=55). Patients with ISH (n=510) compared to those with CH (n=1095) were older (65±10 vs 55±11 years, p Conclusions In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for AF. These findings support that ISH constitutes a hypertensive phenotype of particularly increased arrhythmia risk needing careful evaluation and treatment.

Background/Introduction Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk, while new-onset diabetes mellitus (NOD) is linked with atherosclerosis progression. Purpose The aim of the present study was to compare the predictive role of ISH and CH for the incidence of NOD in a cohort of essential hypertensive patients. Methods We followed up 1435 non-diabetic essential hypertensives with office systolic blood pressure (BP)≥140 mmHg [mean age 57 years, 730 males, office BP=153/92 mmHg] for a mean period of 8 years. All subjects had at least one annual visit and at baseline underwent echocardiographic study and blood sampling for estimation of metabolic profile. Patients with baseline ISH exhibited office systolic BP ≥140 mmHg and office diastolic BP Results The incidence of NOD over the follow-up period was 4.2% (n=60). Patients with ISH (n=460) compared to those with CH (n=975) were older (65±11 vs 54±10 years, p Conclusions In essential hypertensive patients, ISH but not CH exhibits independent prognostic value for NOD. These findings support that ISH constitutes a hypertensive phenotype of increased metabolic risk needing careful evaluation and treatment.

Isolated systolic hypertension (ISH) and combined systolic-diastolic hypertension (CH) are related with increased cardiovascular risk. The aim of the present study was to compare the predictive role of ISH and CH for the incidence of atrial fibrillation (AF) in a cohort of essential hypertensive

Objective:Salt intake is linked to hypertension but data on its association with incident cardiovascular events, especially among hypertensives, is limited. We examine the prospective association of different salt consumption levels with cardiovascular morbidity in a hypertensive population.Design a

Objective:Blood pressure variability (BPV) has been mainly studied through the prism of congestive heart failure (CHF) and hypertension, but not in the setting of an acute coronary syndrome (ACS). The aim of the present study was to assess blood pressure variability (BPV) in patients hospitalized fo

Objective:Visit-to-visit Blood Pressure Variability (BPV) has been associated with a worse outcome in some but not all studies. Recently, BP Time in Therapeutic Range (TTR) has been introduced as a measure of long-term BP control.We examined the prospective association of TTR versus visit-to-visit B

Objective:The impact of blood pressure variability (BPV) on cardiovascular morbidity and mortality has been examined through the prism of heart failure and hypertension, but not in the setting of myocardial infarction (MI). The aim of this study is to determine the association between in-hospital sh

Hypertension and metabolic syndrome are related to sympathetic overdrive and arterial stiffening, while there are no data whether ivabradine modulates sympathetic activity and vascular abnormalities in this setting. The aim of this study was to assess the effect of ivabradine on muscle sympathetic

Introduction: Resistant hypertension is related to sympathetic overdrive and arterial stiffening, while there are scarce data whether metabolic syndrome further potentiates sympathetic activity and vascular abnormalities in this setting. Hypothesis: The aim of this study was to assess the effect of the metabolic syndrome on muscle sympathetic nerve activity (MSNA) and arterial stiffness in resistant hypertensive patients. Method: We studied 24 patients with resistant hypertension [age: 58±10 years, 15 males, office blood pressure (BP): 178/94±15/12 mmHg, 24-hour BP: 149/84±15/11 mmHg, under 4.2±0.5 drugs] that underwent transthoracic echocardiographic study and blood sampling for assessment of the metabolic profile. Metabolic syndrome was defined according to the Adult Treatment Panel III criteria and arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV). In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Results: Resistant hypertensive patients with metabolic syndrome (n=11) compared to those without (n=13) exhibited higher waist circumference (108.1±5.4 vs 94.6±9.2 cm, p=0.001), fasting glucose (131.8±2.9 vs 94.6±2.1 mg/dl, p Conclusions: In resistant hypertensive patients, metabolic syndrome is associated with high MSNA and PWV levels. These findings support that metabolic syndrome further deteriorates sympathetic activity and arterial stiffening characterizing resistant hypertension.

This study aimed to assess the predictive role of body mass index (BMI), waist circumference (WC) and the waist-to-hip ratio (WHR) for the incidence of coronary artery disease (CAD) in a cohort of essential hypertensive patients. We followed up 2266 essential hypertensive individuals (mean age, 57.8 years; males, 1083; office blood pressure (BP), 143/89 mm Hg) who were free of cardiovascular disease for a mean period of 6 years. All subjects had at least one annual visit and, at baseline, underwent blood sampling and a complete echocardiographic study to determine the left ventricular (LV) mass index. CAD was defined as a history of myocardial infarction or significant coronary artery stenosis that was revealed by angiography or a coronary revascularization procedure. The incidence of CAD throughout the follow-up period was 2.33%. Hypertensive individuals who developed CAD (n=53) had a greater baseline WC (101.1±11.7 vs. 96.4±12 cm, P=0.005), WHR (0.94±0.07 vs. 0.89±0.08 cm, P

Resistant hypertension is related to sympathetic overdrive and arterial stiffening, while there are scarce data whether metabolic syndrome further potentiates sympathetic activity and vascular abnormalities in this setting. The aim of this study was to assess the effect of the metabolic syndrome on

Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p < 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p < 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p < 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p < 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p < 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p < 0.001) and 24-hour HR (r = -0.281, p < 0.05), while it was positively associated with CRP (r = 0.335, p < 0.05), TChol (r = 0.296, p < 0.01), age (r = 0.443, r < 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p < 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p < 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

We evaluated bortezomib induced peripheral neuropathy (BIPN) characteristics in an attempt to better clarify the type, grade, duration and reversibility of neuropathy as well as investigate possible peripheral neuropathy (PN) risk factors and detect the best way to manage it. We calculated the grading of neuropathy using the Total Neuropathy Score reduced version (TNSr) in a series of 51 patients with relapsed/refractory multiple myeloma treated with bortezomib. Seventy percent developed clinical PN. BIPN, although manageable, is frequently underestimated in patients treated with bortezomib intravenously. Continuous follow-up and management of PN are needed to avoid quality of life impairment. © 2014 Informa UK, Ltd.

Introduction Les manifestations neurologiques de l’H.L. surviennent en moyenne 5 ans apres le diagnostic, elles sont peu sensibles aux traitements et sont considerees comme un indice de mauvais prognostic. Observation Nous presentons le cas d’un homme de 21 ans, qui souffrait d’une H.L.depuis l’âge de 1 an, avec localisations osseuse et cutanees. Apres un traitement chimiotherapeutique, on constata une remission complete de la maladie apres 3 ans, et jusqu’a l’âge de 18 ans, il ne presentait aucun symptome. Depuis cet âge, un syndrome cerebelleux progressif apparut. L’IRM cerebrale montra des lesions en hypersignal T2 dans les 2 hemispheres cerebelleux, lesquelles se rehaussaient avec le Gadolinium. Un traitement par Immunoglobulines Intraveineuses (IgIV) (0,8 g/kg sur 2 jours) et par dexamethasone (20 mg/jour pour 4 jours) et par cures mensuelles, fut institue. Discussion Les manifestations neurologiques de l’H.L. sont rares (1-4 p. 100 des histiocytoses), d’apparition tardive, souvent peu sensibles aux traitements et considerees comme un indice de mauvais prognostic. Il n’y a pas de donnees consensuelles sur leur traitement. On trouve dans la litterature, quelques cas avec traitement aux IgIV, sans resultats encourageants. Toutefois, notre cas presente une stabilisation de l’evolution avec le traitement aux IgIV. Conclusion En attendant d’autres etudes, nous pensons qu’un traitement aux IgIV peut etre entrepris dans le cas de l’H.L. avec atteinte du S.N.C.