The prognostic value of blood glucose level on admission in non-diabetic patients with acute myocardial infarction.

UNLABELLED: The diabetic patients represent a population with a high risk of morbidity and mortality because of vascular complications. Out of them, all the patients with acute ST-elevation myocardial infarction have a more reserved prognostic than those without diabetes mellitus. Moreover, the patients with impaired glucose tolerance have a more severe evolution in case of a myocardial infarction. AIM: We wondered about the progress of patients with myocardial infarction and high blood glucose levels in admittance who had not been previously diagnosed with diabetes mellitus. MATERIALS AND METHODS: We took 128 patients (who did not have diabetes) with acute ST-elevation myocardial infarction and divided them into three groups, according to the blood glucose level in admittance (<140 mg/dL, 140-200 mg/dL and > 200 mg/dL); we also analyzed a group of diabetics with acute myocardial infarction who were admitted in the same period in our clinic. We made a prospective analysis over a period of 30 days. We evaluated the mortality at 30 days (as primary objective), as well as the extent of the infarction and the change of the left ventricle systolic function (secondary objectives). RESULTS: Both mortality and the mass of myocardial necrosis grew relative to the blood glucose level in admittance; instead, the ejection fraction varied inversely to the initial blood glucose level. CONCLUSION: The admittance blood glucose level represents a useful and available marker for the initial stratification of risks in patients with acute myocardial infarction, even in those undiagnosed with diabetes mellitus.

[Evidence-based medicine, conceptual challenge or the future of daily practice?]. / Evidence-based medicine, provocare conceptuala sau viitorul cotidian al practicii medicale?

Evidence based medicine is a recent acquisition concept brought up by its promoters as a new way to learn and practice medicine. Having in view that knowledge access is strongly limited and what seems to be true and argued today may become out-of-date tomorrow, EBM expects to become a methodological base in permanent change. The problem is the patient's option to the medical decision. Who has to decide? Based on what logic or arguments? EBM can't replace the demonstration or the "scientific truth", the statistic studies always being an approximation of reality which can never be reflected in its complexity. That is why, perhaps, Sackett reformulated the definition of EBM as a judicious use of the best medical proof for an individual therapeutic conduct of every patient.

[Real-time sonography in deep thrombosis of the pelvic and leg veins. A prospective comparison to phlebography]. / Real-time-Sonographie bei tiefer Becken- und Beinvenenthrombose. Ein prospektiver Vergleich zur Phlebographie.

Real-time B mode ultrasound is a well accepted diagnostic procedure in the non-invasive vascular examination. In a prospective study we examined 101 patients with clinical suspected deep vein thrombosis of the pelvis or leg using ultrasound and contrast venography within 24 hours and we compared the results of both examinations. All veins of the pelvis and lower extremities were scanned in transverse and longitudinal planes. 113 venograms were obtained; they demonstrated the presence of isolated proximal vein thrombosis in seven patients, seven isolated calf vein thromboses and 43 thromboses of both proximal and calf veins. The sensitivity of ultrasonography for detecting deep vein thrombosis in the proximal veins of the lower extremity was 98%, the specificity was also 98%. In the veins of the pelvis the sensitivity was 78%, the specificity 98% and in calf veins 60% and 97% respectively. The sensitivity for the detection of isolated calf vein thrombosis was only 14%. We conclude that ultrasonography has a very good sensitivity for detecting proximal vein thrombosis of the lower extremity and thrombosis of the pelvic veins. Phlebography remains the better method in detecting isolated calf vein thrombosis because of the difficult visualisation of the small calf veins by ultrasonography.