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Background & Aims: In spite of the high incidence of hepatic encephalopathy (HE) in cirrhosis, there are few observational studies. Methods:We performed an analysis to define the characteristics of HE and associated features using the database of the Canonic Study. Clinical, laboratory and survival data of 1348 consecutive cirrhotic patients admitted with an acute decompensation were compared according to the presence (n = 406) or absence of HE and of acute-on-chronic liver failure (ACLF) (n = 301). Results: HE development was independently associated with previous HE episodes; survival probabilities worsen in relation to the presence and grade of HE. There were marked differences between HE associated (n = 174) and not associated (n = 286) to ACLF. HE not associated with ACLF occurred in older cirrhotics, inactive drinkers, without severe liver failure or systemic inflammatory reaction and in relation to diuretic use. In contrast, HE associated with ACLF occurred in younger cirrhotics, more frequently alcoholics, with severe liver failure and systemic inflammatory reaction, and in relation to bacterial infections, active alcoholism and/or dilutional hyponatremia. Prognosis was relatively preserved in the first and extremely poor in the second group. Independent risk factors of mortality in patients with HE were age, bilirubin, INR, creatinine, sodium, and HE grade. Conclusions: In cirrhosis, previous HE identifies a subgroup of patients that is especially vulnerable for developing new episodes of HE. The course of HE appears to be different according to the presence of ACLF.

BAP1 germline mutations predispose to a cancer predisposition syndrome that includes mesothelioma, cutaneous melanoma, uveal melanoma and other cancers. This co-occurrence suggests that these tumors share a common carcinogenic pathway. To evaluate this hypothesis, we studied 40 Italian families with mesothelioma and/or melanoma. The probands were sequenced for BAP1 and for the most common melanoma predisposition genes (i.e. CDKN2A, CDK4, TERT, MITF and POT1) to investigate if these genes may also confer susceptibility to mesothelioma. In two out of six families with both mesothelioma and melanoma we identified either a germline nonsense mutation (c.1153C > T, p.Arg385*) in BAP1 or a recurrent pathogenic germline mutation (c.301G > T, p.Gly101Trp) in CDKN2A. Our study suggests that CDKN2A, in addition to BAP1, could be involved in the melanoma and mesothelioma susceptibility, leading to the rare familial cancer syndromes. It also suggests that these tumors share key steps that drive carcinogenesis and that other genes may be involved in inherited predisposition to malignant mesothelioma and melanoma.

Background: Secondary hyperparathyroidism remains a serious problem in hemodialysis patients. The therapy of renal osteodystrophy is mainly based on lowering phosphate levels and administering vitamin D3 metabolites and calcimimetic agents. Methods: An observational, prospective, multicenter study was made to evaluate the efficacy of alfacalcidol in 185 chronic hemodialysis patients with secondary hyperparathyroidism (i-PTH >150 pg/ml). Patients with a Ca×P product >70 were excluded. Intermittent therapy with intravenous alfacalcidol was observed for 6 months. Results: The mean dose of alfacalcidol per week was 3.63 ± 1.71 µg. Patients previously treated with vitamin D3 metabolites needed higher doses of alfacalcidol (4.0 ± 1.7 vs. 3.2 ± 1.6; p = 0.01). Only 50.8% of the patients had received vitamin D3 metabolites prior to the start of the study and at baseline they had higher i-PTH levels (600.3 ± 360.5 vs. 489.9 ± 292.6, p = 0.02). i-PTH levels decreased from 546 ± 332.6 to 332.4 ± 274.5 pg/ml (p < 0.001). 60.5% of the patients had i-PTH < 300 pg/ml at the last observation. Serum calcium increased (9.4 ± 0.8 to 9.97 ± 1.0 mg/l, p < 0.001). Conclusion: Alfacalcidol reduced the levels of i-PTH and produced a slight increase in serum calcium and phosphate levels. In mild or moderate hyperparathyroidism the doses needed were lower than in severe hyperparathyroidism.

The growing and curing dependence of structural and optical properties of sol-gel Si- and Zr-based films was studied by using the fast Fourier Transform IR (FTIR) spectroscopy in the 500-5000 cm -1 range. Samples are prepared by means of a spin-coating technique with different ratios between the precursor fraction. The introduction of zirconium in the starting solution confers both rigidity and high refractive index to the films. The IR spectra are characterized by three main absorption regions: from 700 to 1250 cm -1 the ZrO and Si-O-Si stretching modes are dominant, from 1250 to 1800 cm -1 the absorption is strongly dependent on the Zr content and the region from 2750 to 3500 cm -1 is characterized by the CH 2 and CH 3 vibrational peaks and by the OH broad band. The curing process is monitored after isochronal thermal treatments in the range 50-500°C.

Aims: Sixty new cases of human dirofilariasis due to Dirofilaria repens, occurring in Italy between 1990 and 1999, are presented. This is the most extensive case study of this zoonosis reported worldwide by a single study group. The aim is to utilize this large experience to characterize the different histopathological findings in the parasitic lesions in man. Methods and results: Diagnosis was performed on histological sections of the nematode enclosed in the nodules excised at biopsy or surgery. The nematode was located in the subcutaneous tissue (49 cases), the epididymis (two cases), the spermatic cord (two cases), the lung (two cases), the breast (two cases), the omentum (two cases) and under the conjunctival tissue (one case). The majority of cases (46) were from Piedmont; the remainder were from Emilia-Romagna, Sardinia, Sicily, Tuscany, Apulia and Lombardy. The histopathological features of the lesions are described and the clinical and epidemiological aspects of the zoonosis are discussed. The prevalence in Italy in general and in the area of Piedmont in particular, comprising the provinces of Alessandria, Asti, Novara and Vercelli, which is one of the most severely affected areas of the world, is emphasized. The evident increase in the number of cases in the last few years is a clear indication that it is an emergent zoonosis. Conclusions: We recommend that each and every case observed be recorded, to enable the true extent of human dirofilariasis in Italy to be assessed, and that a reference centre be set up in the area to collate the data. The importance of the histopathologist's role in the diagnosis is stressed.

OBJECTIVE: The largest Italian asbestos cement factory had been active in Casale Monferrato until 1986: in previous studies a substantial increase in the incidence of pleural mesothelioma was found among residents without occupational exposure to asbestos. To estimate exposure to asbestos in the population, this study evaluated the presence of histological asbestosis and the lung burden of asbestos fibres (AFs) and asbestos bodies (ABs). METHODS: The study comprises the consecutive series of necropsies performed at the Hospital of Casale Monferrato between 1985 and 1988. A sample of lung parenchima was collected and stored for 48 out of 55 necropsies. The AF concentration was measured with a TEM electron microscope with x ray mineralogical analysis. The ABs were counted and fibrosis evaluated by optical microscopy. The nearest relative of each subject was interviewed on occupational and residential history. Mineralogical and histological analyses and interviews were conducted in 1993-4. RESULTS: Statistical analyses included 41 subjects with AF, AB count, and interview. Subjects without occupational exposure who ever lived in Casale Monferrato had an average concentration of 1500 AB/g dried weight (gdw); Seven of 18 presented with asbestosis or small airway lung disease (SAL). G2 asbestosis was diagnosed in two women with no occupational asbestos exposure. One of them had been teaching at a school close to the factory for 12 years. Ten subjects had experienced occupational asbestos exposure, seven in asbestos cement production: mean concentrations were 1.032 x 10(6) AF/gdw and 96,280 AB/gdw. Eight of the 10 had asbestosis or SAL. CONCLUSION: The high concentration of ABs and the new finding of environmental asbestosis confirm that high asbestos concentration was common in the proximity of the factory. Subjects not occupationally exposed and ever living in Casale Monferrato tended to have higher AB concentration than subjects never living in the town (difference not significant). The concentrations of ABs and AFs were higher than those found in other studies on nonoccupationally exposed subjects.

Crystallographically textured, orthorhombic β-PbO films are deposited on silica substrates by reactive vapor deposition of Pb in an O2 atmosphere of a two-zone oven (1000:1 Ar/O2 ratio at a flow rate of 100 mL/min, 1050800 °C, 25 min).

s / Digestive and Liver Disease 48S (2016) e1–e17 e17 showed that 70% of patients has insufficient intake of calories and 40-60% inadequate water and sodium intake, despite the nutritional indications provided by the hepatologist. The weekly macronutrient intake was insufficient in 70-95% of cases, with the exception of sugar, which was excessive in 87% of cases including diabetic patients. Conclusions: The intake of total calories anddifferentmacronutrients is inadequate in 80-90% of outpatients with cirrhosis, due to both scarce adherence to the indications given by the hepatologist and low knowledge of nutritional facts. Muscle wasting is very often present even in less advanced disease. This highlights the need of a personalized nutritional approach, including educational and motivational aspects. http://dx.doi.org/10.1016/j.dld.2015.12.047

Mohs micrographic surgery is the treatment of choice for basal cell carcinomas (BCCs) at high risk for local recurrence. This procedure is scarcely employed in Italy, even when it appears necessary, for different causes, including high costs, organization problems, or low professional experience with the technique. Aim of this study is to report our experience with the "surgical margin marking", as alternative to standard Mohs micrographic surgery in the management of high-risk BCCs of the head and neck region.A retrospective analysis on 102 (64 males and 38 females; mean age: 66.8 years; median: 68 years; range: 53-87 years) of 208 patients with high-risk basal cell carcinomas of the head and neck region, submitted to surgical margin marking has been made. All cases had completed a 3-year follow-up. Primary tumours were 52 (51%), recurrent tumours were 50 (49%).The mean number of micrographic surgery stages for a complete tumour clearance was 1.65 (range: 1-4 stages). In 47% (N.=49) of cases the tumours were removed by a single stage, while in 42.1% (N.=43) of patients two stages were required. Only 2 patients (2%) showed recurrences during a mean follow-up of 61.2 months (median: 62 months; range: 37-84 months).Our experience supports the effectiveness of the surgical margin marking technique in the treatment of high-risk basal cell carcinomas of the cephalic region. It may represent an alternative approach to Mohs micrographic surgery in dermatologic departments of many hospitals, where standard Mohs micrographic surgery is more difficult to perform.

CZT, show some prerogatives as materials for X and gamma ray detection because of its properties, as high stopping power, good transport properties, and low leakage current even at room temperature. Nevertheless, despite the improvement in the grown techniques, its transport properties are limited, if compared with those of traditional materials for radiation detection. This fact leads to a reduction of spectroscopic properties especially when increases the penetration length of gamma-rays at high energies. Several methods have been proposed to link the interaction depth and the charge losses achieving good improvements in the spectroscopy but, in most cases, they produce only heuristic corrections without any clearly visible relation with some physical models. Bargholtz et al. have improved the spectroscopy digitizing the signals and fitting them with a model, but this method is very expensive in term of computing power because of the high number of fitting paramiters. In this work, we propose an hybrid approach to the problem. Once known the read-out electronic transfer function, the detector signal could be corrected using the photon impact depth (extracted from the discontinuity in the current signal) and the material transport parameters, obtained from two simple fitting procedure with only four free parameters for each fit. This method, based on the Zanio model, is not only useful to correct the charge losses but also to achieve the characteristic properties of CZT, because takes into account also the detrapping contribution. In the last year we have presented the results obtained with a simplified model, now we show those obtained with the complete model, with a more accurate fit that lead to a more precise measure of detrapping time. The transfer function used in the calculations is the one measured in our system; nevertheless the procedure employed and the calculation of the integral terms are immediately extendable to many other transfer function.

Charge collection efficiency and material transport properties in CdTe and CZT planar devices for X and gamma ray detection are commonly determined by means of the Hecht equation, under the limiting approximation of a uniform internal electric field. As an alternative, the Manys theory is helpful when surface recombination velocity of carriers has to be taken into account. Experiments carried out on planar detectors have shown a non constant, linearly decreasing profiles of the internal electric field and, in several cases, the electric field does not decrease down to zero but to a fixed value different and afterwards it result to be constant. A similar non-uniform electric field could be also expected when a high radiation flux hits the surface near the detector contacts. This fact could explains as photoconductivity measurements on these kinds of devices are often not so easy described by means of the Hecht theory. Last of all, the use of the Hecht or Manys equations to fit photoconductivity curves could lead to wrong conclusionsin the determination of ?? product. Starting from the Ramo-Shockley theorem, the authors calculate a new relation between charge collection efficiency and applied bias in the case of an electric field decreasing linearly along the detector thickness, being satisfied all the other Hecht hypotheses. The new functional dependence of charge collection efficiency on applied bias contains the slope of the electric field as a parameter and provides for the Hecht model as the special solution when the electric field is uniform. Moreover this model allows to fit with a very good accuracy experimental results on several our CZT detectors. The authors believe that this shape of field should be widespread in presence of diffused spatial charge and think that this model could be an important instrument for interpreting the data arising from pulsed photocurrent measures not only for CdTe and CZT detectors but also for other materials.

The objective of this study was to compare the accuracy of 2 variables: pulmonary artery occlusion pressure (PAOP) and right ventricular end diastolic volume index (RVEDVI) as predictors of the hemodynamic response to fluid challenge as well as definition of the overall correlation between RVEDVI and change in PAOP, right ventricular ejection fraction (RVEF), central venous pressure (CVP), and determination of the right ventricular function during orthotopic liver transplantation.A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RVEF, allowing calculation of RVEF end-diastolic volume index (EDVI, as the ratio of stroke index [SI] to EF). The above-mentioned hemodynamic measures were taken in 4 phases: T0, after induction of anesthesia; T1, during anhepatic phase; T2, 30' after graft reperfusion; and T3, at the end of surgery.The variation of the REF value was 36 +/- 4% and 39 +/- 6%. Linear regression analysis showed a significant correlation between RVEDVI (range, 133 +/- 33-145 +/- 40 mL/m(2)) and stroke volume index (SVI) in each phase (r(2) = 0.49, P.01; r(2) = 0.57, P.01) at T0 and T1, respectively, and at T2 and T3 (r(2) = 0.51, P.01; r(2) = 0.44, P.01), respectively. No significant variations in the linear regression analysis between RVEDVI, PAOP, CVP, and RVEF were observed. No relationship was found between PAOP (range, 10 +/- 2-6 +/- 2 mm Hg) and SVI.RVEDVI may be the best clinical estimate of right ventricular preload. In fact, minor changes of RVEF have been recorded, confirming that RV function was not altered during uncomplicated orthotopic liver transplantation.

Prototyping suites are products devoted to permit easy customer access to system prototyping methodology. The scope of this keynote is to determine if and when the need to prototype complex systems will create a solid EDA industrial sector, based on System On a Chip. Contemporary and future customer requirements are analyzed, compared with features of current products. SoC market is investigated, to derive the size of the prototyping systems segment, in terms of number of equipment and expected revenues; a market size trend is estimated.

Cardiovascular complications can be divided into 2 big categories involving the cardiovascular system in locoregional anaesthesia: those of local anaesthetics with direct effect on sympathetic fibres, which regulate the cardiovascular activity and those who derives from alteration of the normal cardiac function due to the toxic effect of the drugs. While the first are referred to the extension of a central block, the second considers the overdose caused by accidental intravenous injection. This is more frequent in peripheral blocks then in central blocks. The use of catheters in both central and peripheral blocks introduces another factor of risk due to a prolonged administration of local anaesthetics. The prevention of those complications should foresee through an accurate anamnesis the subjective conditions of risk: so we have to choose the best individual technique and dose of anaesthetics; the use of qualitative correct material, the ENS as a support to identify nerve structures and the application of more recent and safe drugs represented by the compound of S(-) enantiomers, Ropivacaine and Levobupivacaine. Which are described to be less cardiotoxic but with the same characteristics as Bupivacaine. Finally don't forget respect the classical rules of security during locoregional anaesthesia.

The choose of the best anaesthesia for carotid surgery is a very debated item: the locoregional techniques probably offer more hemodynamic stability and a direct neurologic monitoring, while general anaesthesia allows the complete control of airways and ventilation and reduces the global stress for the patient. This review analyzes the data of studies that compare general and locoregional anaesthesia. Among the latter, possibly elective techniques, the one described by Winnie combines an optimal analgesic efficacy with the lowest rate of adverse effects. A single bolus of a local anesthetic injected at a C4 level (apex of scalene muscles triangle) guarantees a complete block of the superficial and deep cervical plexuses.

To determine risk and prognostic factors in patients admitted to the intensive care unit (ICU) in which an episode of bacteremia caused by Pseudomonas aeruginosa has been diagnosed.Cohort, observational, prospective, multicenter study. Patients admitted to 30 ICUs in Spain in whom one or more pathogens were isolated from blood cultures were included.In a total of 16,216 patients admitted to the participating ICUs during the study period, 949 episodes of bacteremia were diagnosed In 77 cases (8.11%), P. aeruginosa was the causative pathogen, with an infection rate of 4.7 episodes per 1000 patients. Independent risk factors associated with P. aeruginosa bacteremia were as follows: respiratory infection focus (OR 3.92; 95% IC 2.33-6.59; p/= 0.0001), previous use of antibiotics (OR 2.13; 95% IC 1.18-3.81; p/= 0.0078), arterial catheter (OR 4.09; 95% IC 2.26-7.38; p/= 0.0001), and previous longer ICU stay (days) (OR 1.02; 95% IC 1.003-1.033; p = 0.0274). Crude mortality rate in patients with bacteremia caused by P. aeruginosa was 50.6% (39/77), whereas mortality rate of bacteremia caused by other pathogens was 38.6% (337/872) (p = 0.039). This difference was also found for attributed mortality (31.2% [24/77] vs. 20.4% [178/872], (p = 0.027). In the multivariate analysis adjusted by respiratory infection focus, previous ICU stay, and age, crude mortality (OR 1.55; 95% CI 0.96-2.51; p = 0.071) and attributed mortality (OR 1.63; 95% CI 0.96-2.78; p = 0.0709) of P. aeruginosa bacteremia were higher than in bacteremia caused by other pathogens. In the multivariate analysis, risk factors significantly associated with crude mortality were respiratory infection focus (OR 4.13; 95% IC 1.15-14.76; p = 0.0293) and severe sepsis or septic shock (OR 4.96; 95% IC 1.23-20.09; p = 0.0248).Bacteremia caused by P. aeruginosa admitted to the ICU have a higher crude and attributed mortality than bacteremias caused by other pathogens. Prognosis is associated with the presence of severe sepsis or septic shock and respiratory infection focus.

25 patients (33.8%) in group I and 39 (55.7%) patients in group II, and in 25 patients (33.8%) versus 31 patients (44.3%) after the second session. 24 patients (32.4%) in group I achieved variceal eradication after the third session. Fever, chest pain and dysphagia were observed more frequently in group II than in group I, fatal bleeding from post sclerotherapy ulcer was seen in three patients in group II which never occurred in group I. Conclusion: Band ligation is a good alternative to cyanoacrylate injection in treatment of actively bleeding junctional varices.

The information included in drug package inserts is often difficult for users to understand. The impact of rephrasing inserts on comprehension was assessed.A community double-blind clinical trial was undertaken with random allocation of subjects to unmodified or modified inserts, in which presentation and structure had been improved and technical content expressed in plain language. A questionnaire on comprehension of the use of four common drugs was administered to all participants. The following aspects were analyzed: indications, interval of administration, administration in relation to meals, contraindications, storage and what to do in cases of missing a dose or improvement in symptoms.1,560 participants were included, among whom 770 randomly received the unmodified inserts. The mean proportion of correct answers was 45.7% in the unmodified insert group and 75.5% among those who received the modified version. In all groups of age, study level and employment status, participants with modified texts achieved a higher correct response rate than the unmodified group. An improvement73% in the correct response rate was observed in interval of administration, administration in relation to meals and what to do in cases of missing a dose. With the modified leaflet the odds ratio of successfully answering more than 70% of questions was 13.5 (95% confidence interval, 10.5-17.5) compared with the unmodified leaflet.The comprehension of drug package inserts may be considerably improved by making simple changes in their content. These changes may contribute to accident prevention or inappropriate use of commonly prescribed drugs.

To compare the effects of sodium fluoride and etidronate in severe postmenopausal osteoporosis, we conducted a 3 year, prospective, trial in 118 postmenopausal osteoporotic women with at least one vertebral fracture, who were randomly assigned to receive sodium fluoride (25 mg twice daily, as enteric-coated tablets) plus calcium (1000 mg/day) or intermittent etidronate (400 mg/day for 14 days) followed by calcium (1000 mg/day for 76 days). Lateral spine X-ray films and dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine and proximal femur were performed at enrollment and yearly. Nonvertebral fractures were recorded every 6 months. Thirty-one women in the fluoride group and 47 in the etidronate group completed the trial. At 36 months, the mean change from baseline of the lumbar bone density in the fluoride group was 8.5 +/- 2.04% (p = 0.001) and in the etidronate group was of 3.6 +/- 0. 84% (p0.001). The changes in the fluoride group were significantly higher than in the etidronate group (p = 0.01). Both groups showed nonsignificant changes in femoral neck bone density. There was no significant difference between groups in the cumulative proportion of women with new vertebral fractures, with an incidence in the fluoride group of 16% vs. 17% in the etidronate group. However, the number of new vertebral fractures was significantly lower in the fluoride group (6 fractures) than in the etidronate group (19 fractures) (p = 0.05). The number of patients with nonvertebral fractures was similar in both groups. A high incidence of side effects, mainly gastrointestinal symptoms and lower extremity pain syndrome, was observed in the fluoride group. Etidronate was well tolerated. We conclude that, in women with severe osteoporosis, although sodium fluoride is more favorable than cyclical etidronate for increasing lumbar bone mass, no differences were observed in the incidence of fractures.

The study assessed whether varying accessibility of patients with unstable angina (UA) to coronary angiography and revascularization determined differing usages and outcomes.The appropriate use rate of coronary angiography and revascularization procedures in UA remains to be established.A total of 791 consecutive patients with UA without previous acute myocardial infarction (AMI) admitted to four reference teaching hospitals (one with tertiary facilities) were followed for six months. End points were six-month mortality and readmission for AMI, UA, heart failure, or severe ventricular arrhythmias.Patients admitted to the tertiary hospital were 3.27 (95% confidence interval [CI] 2.32 to 4.62) times more likely to undergo coronary angiography after adjustment for comorbidity and severity than were those admitted to nontertiary facilities (overall six-month use rates 70.1% and 48.3%, respectively). Revascularization procedures were performed in 36.2% of patients in the tertiary hospital and 24.6% in the others (p = 0.0007); adjusted relative risk (RR) 2.37 (95% CI 1.55 to 3.63). Median delay for urgent coronary angiography was shorter in the tertiary hospital (24 h vs. 4 days, p0.0002). Six-month mortality and readmission rates were similar in tertiary and nontertiary hospitals: 3.9% versus 5.3% and 16.9% versus 21.2%, respectively. Adjusted RR of death or readmission for the nontertiary hospitals was 1.23 (95% CI 0.57 to 2.67).The use of coronary angiography and revascularization procedures in UA patients with no previous AMI is higher in tertiary than in nontertiary hospitals, but the more selective use of these procedures in nontertiary centers does not imply worse outcome.

The aim of this study was to assess the clinical course of unstable angina and the prognostic value of clinical and electrocardiographic variables measured during admission in a prospective, multicenter cohort study with 6-month follow-up. The population corresponds to 4 general teaching hospitals in Catalonia, Spain. The clinical course was analyzed in 839 consecutive patients aged up to 80 years with primary unstable angina, without myocardial infarction or previous coronary bypass. The main outcome measures were cardiac mortality and nonfatal myocardial infarction. Patients involved in the present analysis belonged to the Resources Used in Acute Coronary Syndromes and Delays in Treatment (RESCATE) study. Six-month overall mortality, cardiac mortality, and nonfatal myocardial infarction rates were 4.6%, 4.1%, and 3.9%, respectively. Six-month cardiac mortality or myocardial infarction rate did not differ among clinical forms of presentation. Peripheral artery disease (RR 3.5, 95% confidence interval [CI] 1.88 to 6.50, p = 0.0001), ST-T-wave electrocardiographic changes on admission (RR 2.22, 95% CI 1.13 to 4.36, p = 0.0203), and age65 years (RR 1.74, 95% CI 1.04 to 2.91, p = 0.0356) independently predicted 6-month cardiac mortality or nonfatal myocardial infarction. Their positive predictive values were 21%, 10%, and 11%, respectively, whereas their negative predictive value wasor = 93% in all cases. Prevalences were 9%, 70%, and 41%, respectively. In this prospective study, patients with unstable angina without prior myocardial infarction have a relatively low, although not negligible, 6-month severe complication rate. Stratification risk can easily be established with clinical and electrocardiographic characteristics measured during admission. Their absence almost rules out future adverse events, while their presence does not necessarily imply bad prognosis.

The aim of this study was to analyze 28-day case fatality trends between 1978 and 1993 among hospitalized acute myocardial infarction (AMI) patients in the REGICOR registry, Gerona, Spain, and relate them to thrombolytic and antiplatelet drug use and changes in patient characteristics.A total of 2053 consecutive patients 25 to 74 years of age with a first Q-wave AMI admitted to the reference hospital between 1978 and 1993 were registered. Clinical characteristics and patient management were recorded. Four 4-year periods were considered: 1978 to 1981, 1982 to 1985 (prethrombolytic therapy), 1986 to 1989 (thrombolytic and antiplatelet drugs introduced), and 1990 to 1993 (thrombolytic and antiplatelet drugs used routinely). The end point was death at 28 days. Case fatality at 28 days decreased 6% per year between 1978 and 1993. A logistic model adjusted for comorbidity and severity showed the last 3 periods to present a steep decrease in the OR of death at 28 days: 0.86 (95% CI, 0.52 to 1.41), 0.59 (95% CI, 0.35 to 0.99), and 0.40 (95% CI, 0.24 to 0.69), respectively, compared with the first period. After 1986, 85.7% of the 112 lives saved could be attributed to the use of antiplatelet and thrombolytic drugs. Adjusted relative risk reduction was 56.0% for antiplatelet drugs, 34.1% for thrombolytic drugs, and 77.9% for the 2 combined.Our results strongly suggest that new therapies introduced since 1986 have contributed to the decrease in 28-day case fatality of patients admitted with a first Q-wave AMI. This decrease could be attributable mainly to the use of antiplatelet and thrombolytic drugs. These findings should encourage the routine use of thrombolytic and antiplatelet drugs and particularly their combination in the acute phase of AMI.

Fibrinogen is the major ligand of platelet glycoprotein IIb/IIIa platelet receptor. Genes coding for platelet fibrinogen receptor glycoprotein IIb/IIIa are polymorphic. The PLA alloantigen has two antigenic determinants, PLA1 and PLA2, located in a 17-23 kD fragment of glycoprotein IIIa. We analyzed whether PLA genotype has any effect on plasma fibrinogen concentration and investigated if the effect has different magnitude in myocardial infarction patients compared with subjects free of angina or myocardial infarction. One hundred sixteen consecutive patients who suffered a myocardial infarction and 136 subjects recruited by random sampling from the local census were included in the study. PLA genotype distribution and allele frequencies in patients did not significantly differ from those in the control group. Mean fibrinogen concentration tended to be higher in controls with genotype PLA1PLA1 than in those with genotype PLA1PLA2 or PLA2PLA2, and in patients this difference reached statistical significance (p0.001). We conclude that the PLA polymorphism may be in linkage disequilibrium with another functional mutation in or near the promoter area of the fibrinogen gene or even in another gene, which controls the production or the clearance of fibrinogen.

Mortality after acute myocardial infarction is worse in women than in men, even after adjustment for comorbidity and age dissimilarities between sexes.To assess the influence of sex on survival after acute myocardial infarction.Inception cohort obtained in a prospective registry of patients with acute myocardial infarction from 1992 through 1994.Four teaching hospitals in northeastern Spain.All consecutive patients aged 80 years or younger with first acute myocardial infarction. A total of 331 women and 1129 men were included.Survival at 28 days and mortality or readmission at 6 months.Women were older (mean, 68.6 vs 60.1 years), presented more often with diabetes (52.9% vs 23.3%), hypertension (63.9% vs 42.3%), or previous angina (44.6% vs 37.4%), and developed more severe myocardial infarctions than men (acute pulmonary edema or cardiogenic shock occurred in 24.8% of women and 10.5% of men) (all P.02). Men were more likely than women to receive thrombolytic therapy (41.3% vs 23.9%; P.001), but rates of percutaneous transluminal angioplasty and coronary artery bypass graft surgery at 28 days were similar among men and women. The 28-day mortality rate was significantly higher among women (18.5% for women, 8.3% for men; P.001). Revascularization procedures at 6 months were performed in a similar proportion of women and men. However, women had higher 6-month mortality rates (25.8% in women, 10.8% in men; P.001) and readmission rates (23.3% for women, 12.2% for men; P.001). After adjustment, women had greater risk of death than men at 28 days (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.12-2.65) and at 6 months (OR, 1.73; 95% CI, 1.18-2.52).In this study population, women experienced more lethal and severe first acute myocardial infarction than men, regardless of comorbidity, age, or previous angina.

At present, the most efficacious and used immunostimulant agent in the superficial bladder cancer immunotherapy field, is the BCG, even if its mechanism of action is still partly unknown. The therapeutic effects of BCG don't seem to depend exclusively on local immune response, so that according to this assertion, this immunohistochemical study had been conducted on 14 patients affected by superficial bladder cancer (pTa-pT1) which aimed to value both the apoptosis and proliferation indexes and the expression of the genetic product p53 and EGFR before and after the exposition of the vesical mucosa to the BCG. The BCG treatment can reduce the proliferation index of the normal urothelial cells in a statistically significant way whereas it would exclude a cytostatic effect mediate by negative modulation of EGFR from the cytokinins induced by BCG itself. The index of apoptosis of the urothelium does not increase after BCG and decreased expression of p53 associated after the treatment, although statistically not significant, it would seem to bear, the prophylactic efficacy of BCG according to the follow up of the patients included in the study.

A retrospective study was conducted in 206 renal carcinomas (RC) that underwent surgery between 1983 and 1992, evaluating those that were diagnosed incidentally. Among this series, 74 cases (35.9%) were incidental renal carcinomas (IRC). The complementary examination that allowed to reach a diagnosis was ultrasound in 58 (78.4%) patients, computerized axial tomography (CT) in 23 (17.6%) and intravenous urography (IVU) in 3 (4%). An evaluation is made of the main prognostic factors (nuclear differentiation grade and pathological stage) and the survival in these patients. The results obtained allow to conclude that IRC display an earlier pathological stage and lower nuclear differentiation grade than the other RC, the difference being statistically significant (p0.05). Also, the probability of survival in IRC-diagnosed patients is higher than in those diagnosed with non-incidental RC, the difference being statistically significant (p0.05).

Sixty patients (greater than 16 yrs old) suffering primary or relapse genital herpes simplex viruses (HSV) and relapse labial HSV were appointed for this study. Three or more relapses were experienced per year. Patients (under treatment) were divided into two groups (distribution areas), corresponding to either labial herpes or genital herpes. These groups were sub-divided into 3 groups. The total number of labial or facial HSV patients was 36 (10 in group 1, 12 in group 2, 14 in group 3) and 24 for genital, buttocks, or 'area pudenda' HSV patients (6 in group 1, 8 in group 2, 10 in group 3). The design was a randomized, double- blind study. The setting was hospital and outpatient. The patients diagnosed as having the HVS disease were sent to the dermatology department and were assigned to a group at random. Treatment was begun as follows: During the treatment signs and symptoms were assessed and after the treatment, the relapses were also assessed (biochemical and hematological tests before and after the treatment) and the diagnosis of the HSV type I and II. The statistical evaluation of the results was performed and carried out with the SPSS and BMDP program. The relapses of the herpes infection in the lips and the face were significantly reduced (p less than 0.026) in patients treated with laser He-Ne and laser He-Ne plus Acyclovir. The interim between the relapses also increased significantly (p less than 0.005) in relation with the group treated with Acyclovir. The duration of the herpetic eruptions was clearly reduced in all locations in patients treated with laser He-Ne plus Acyclovir. No differences were noted between patients treated with laser He-Ne only or Acyclovir only. Therefore it is probable that therapeutic synergism took place. In relation with this, laser He-Ne shows the same therapeutic efficacy as Acyclovir taken orally. The association of Acyclovir and laser Ne-Ne could be an alternative method for the treatment of HSV in the face. The number of relapses of the herpes infection in the genital, buttocks or 'area pudenda' and the interim between the relapses were not substantially modified with the treatment of laser He-Ne or laser Ne-Ne plus Acyclovir. Although a little difference exists in comparison with the patients treated with Acyclovir alone, a survey or an increased number of patients should be necessary. © (1996) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.