ABSTRACT
B-type natriuretic peptide (BNP) is an important clinical parameter of severity in congestive heart failure (CHF). Recent findings suggest a close relation between lipid and glucose metabolism and the natriuretic peptide axis, even if conflicting data exist on the relationship between natriuretic peptide levels and insulin resistance (IR). Thus, we sought to investigate potential relations between BNP level and IR in 134 patients with severe ischemic myocardial dysfunction [mean+/-SD: age =64.8+/-9.6 yr, male/female =104/30; body mass index (BMI) =25.5+/-4.05 kg/m2, 26.1% diabetics; ejection fraction (EF) = 30.2+/-7.7%]. In univariate analysis, an inverse relationship between BNP levels and EF% was observed (R=-0.43, p=0.0006). Moreover, we found an inverse association between BNP levels and BMI (R=-0.27, p=0.036), and also between BNP and homeostasis model assessment of insulin resistance (HOMA-IR) (R=-0.27, p=0.039). In multivariate analysis, EF% and HOMA-IR were significantly and independently associated with logarithmically transformed BNP levels (beta=-0.40, p=0.019 and beta=-0.26, p=0.042, respectively; R2=0.36). In conclusion, in patients with severe ischemic myocardial dysfunction EF and IR are independently associated with BNP levels explaining about 1/3 of the variability of this parameter. Multiple potential mechanisms may underlie this association, but it seems now clinically important to take into account also metabolic features when interpreting plasma natriuretic peptide concentrations obtained for diagnostic or prognostic purposes.
Subject(s)
Blood Glucose/metabolism , Diabetes Mellitus/metabolism , Insulin Resistance/physiology , Myocardial Ischemia/metabolism , Natriuretic Peptide, Brain/blood , Aged , Analysis of Variance , Body Mass Index , Constriction, Pathologic/metabolism , Coronary Angiography , Diabetes Mellitus/diagnostic imaging , Female , Humans , Immunoassay , Insulin/blood , Male , Middle Aged , Myocardial Ischemia/diagnostic imaging , Patient Selection , UltrasonographyABSTRACT
Carcinoma of the gallbladder is the most frequent neoplasm of the biliary tract. During the period between 1 January 1979 and 31 December 1991 a total of 1016 operations for cholecystectomy were performed by our Division of Surgery and 27 cases of gallbladder carcinoma were diagnosed. The symptoms were generally similar to those of benign hepatobiliary disorders. The diagnostic tests carried out did not allow a preoperative diagnosis of gallbladder carcinoma to be made. In the majority of cases diagnosis was a surprise following the histological analysis of the operated part. The prime therapy for these lesions is surgery. Since it is not possible to make an early diagnosis of this type of neoplasm, which in the majority of cases has a fatal prognosis, the authors consider that the finding of inveterate calculosis, large calculi and echographic thickening of the gallbladder wall represent indications for surgery even in the absence of major symptoms.
Subject(s)
Gallbladder Neoplasms , Adult , Aged , Aged, 80 and over , Cholecystectomy , Diagnosis, Differential , Female , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/surgery , Humans , Laparotomy , Male , Middle AgedABSTRACT
90 patients suffering from Hodgkin's disease, 32 in stages I and II, 42 in stage III and 16 in stage IV have been studied retrospectively. The first were treated with supra and subdiaphragmatic extensive radiotherapy, the second with total nodal or polychemotherapy (MOPP), the third with polychemotherapy. Results were highly satisfactory in stages I and II with a complete remission rate of 100% (duration: 4/100 months) and with survival of 91.8% at 7 years. At the 3rd stage, total nodal therapy led to complete remission in 73.3% of patients (9--46 months) with 5-year survival of 76.1%; at this stage, polychemotherapy induced complete remission in 65.2% of cases (6--34 months) with 4-year survival of 64%. Much worse were the results of polychemotherapy in the IVth stage. The same series has been reconsidered with allowance for explorative laparotomy by splenectomy carried out in 15 patients in I-II stage and treated with extensive radiotherapy, in 7 IIIrd stage patients subjected to total nodal therapy and in 10 in IIIrd stage treated with MOPP. In IIIrd stage splenectomized patients, the incidence of recurrences is lower than in the controls and independent of treatment. The lower incidence of recurrences also observed in I-II stage cannot be evaluated for the moment.
Subject(s)
Antineoplastic Agents/therapeutic use , Hodgkin Disease/therapy , Adult , Antineoplastic Agents/administration & dosage , Drug Therapy, Combination , Evaluation Studies as Topic , Female , Hodgkin Disease/drug therapy , Hodgkin Disease/radiotherapy , Humans , Male , Neoplasm Staging , Remission, Spontaneous , Retrospective Studies , Splenectomy , Time FactorsABSTRACT
The results of 38 cases of laparotomy with splenectomy in Hodgkin's disease are presented. After describing the results obtained, and modifications due to preoperative classification of Hodgkin's disease, the diagnosis and surgical treatment are shortly discussed.
