The association of ventricular tachycardia and endothelial dysfunction in the setting of acute myocardial infarction with ST elevation.

BACKGROUND: Ventricular tachycardia (VT) is frequently seen in ischemic settings like acute myocardial infarction with ST segment elevation (STEMI). Endothelial dysfunction (ED) represents inflammation and the loss of all protective features of the endothelium. We aimed to examine the association between VT and ED in patients with STEMI. MATERIAL/METHODS: The study included 90 subjects (30 with VT and acute STEMI, 30 with STEMI without VT, and 30 controls). Sera of all subjects were tested on ED markers by enzyme immunoassay: sICAM-1 (intracellular adhesive molecule-1), sVCAM-1 (vascular adhesive molecule-1), P- and E-selectins, and VEGF (vascular endothelial growth factor). In addition, CRP (C-reactive protein) was detected. RESULTS: Significantly increased values of low-density lipoprotein, triglycerides, leukocytes, creatinine, and the number of cigarettes smoked were observed among patients with VT+STEMI in comparison to controls. The levels of E-selectin were significantly lower in the VT+STEMI group than in the other groups, while the levels of VCAM-1 were significantly higher in the groups with STEMI and VT+STEMI compared to the controls. Lower levels of VEGF were recorded in STEMI and VT+STEMI groups compared to the control group. A significant correlation between CRP and VCAM-1 in patients with VT +STEMI was demonstrated. CONCLUSIONS: We showed that ED may have a role in the immunopathogenesis of VT in patients with STEMI. The role of sE- selectin and correlation of sVCAM-1 with CRP as possible ED predictive markers in patients with VT+STEMI should be further investigated in a large cohort of patients.

Most common inhalant allergens in atopic dermatitis, atopic dermatitis/allergic rhinitis, and atopic dermatitis/bronchial asthma patients: a five-year retrospective study.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease with a distinctive clinical appearance and distribution. Around 85% of patients have positive immediate skin reaction or specific IgE to different airborne allergens that are in association with respiratory allergy. The aim of this retrospective, open and uncontrolled study was to identify the most common inhalant allergens in AD patients, AD/allergic rhinitis patients, and AD/bronchial asthma patients by skin prick test per year during the 2001-2005 period.

Exfoliative erythroderma.

Exfoliative erythroderma refers to the skin that is diffusely red and inflamed with varying degrees and types of scaling. There are many causes of erythroderma, but the most common are exacerbations of an underlying skin disease, drug reactions and underlying malignancies. Erythroderma is a rare, potentially serious skin condition. Protein loss in the form of desquamation and exudation is significant, resulting in hypoproteinemia. Usually more than one skin biopsy should be done. Biopsy analysis is important to rule out cutaneous T-cell lymphoma. Patients should be carefully evaluated for underlying disease. Erythroderma can represent a serious medical threat to the patient, and may require hospitalization. Various forms of exfoliative erythroderma are presented, considering the etiopathogenesis, physical findings, differential diagnosis and treatment.

Regressing seborrheic keratosis - clinically and dermoscopically mimicking a regressing melanoma.

The diagnosis of seborrheic keratosis is a clinical diagnosis. In a certain percentage of cases, differential diagnosis between seborrheic keratosis and malignant melanoma is difficult. We describe a case of regressing seborrheic keratosis simulating malignant melanoma. Clinical, dermoscopic and histopathologic examinations were performed for the occurrence of an asymmetric, irregularly demarcated, irregularly pigmented lesion measuring 1.3 x 1.5 cm on the right part of the abdomen in a 76-year-old male Caucasian. In order not to miss melanoma, the excision and histopathologic examination of the lesion with peppering is essential.

Normalization in the appearance of severly damaged psoriatic nails using soft x-rays. A case report.

The prevalence of nail psoriasis varies considerably among different studies, ranging from 10% to 55%. In psoriatic arthritis, its prevalence is as high as 85%. In spite of the high prevalence of the disease, considerable functional, psychical and cosmetic discomforts for the affected patients, and recent advances in the management of skin psoriasis, an efficacious and longlasting treatment for psoriatic nails remains elusive. A 51-year-old male patient with skin psoriasis and severe psoriatic lesions of all his finger nails and toe nails is presented. Some nail plates were up to 30 times thicker than normal. The patient received radiotherapy with soft x-rays in a total dose of 13.5 Gy administered in nine fractionated doses of 1.5 Gy (43 kV, 25 mA, 0.6 mm aluminum filter) at one-week and two-week intervals. Upon therapy completion, the appearance of nail plates gradually improved to normalize completely at 12 months of therapy. Almost three years of therapy completion, the patient is free from both disease relapse and radiotherapy sequels. Considering the high therapeutic efficacy and longlasting remission achieved, this type of radiotherapy should be used in the treatment of severe psoriatic nail lesions with massive nail plate thickening, to alleviate psychical and functional difficulties associated with the disease.

[The role of omega-3 fatty acids from fish in prevention of cardiovascular diseases]. / Uloga omega-3 masnih kiselina iz riba u prevenciji kardiovaskularnih bolesti.

Fish and fish oil are rich sources of omega-3 fatty acids--essential polyunsaturated fatty acids. These acids in doses of 1 g per day have been shown to significantly reduce the all-cause mortality in post myocardial infarction (MI) patients and the risk for sudden death caused by cardiac arrhythmias. One of the recently most studied mechanisms that may contribute to this benefits of omega-3 fatty acids is their anti-arrhythmic effect. Namely, these acids influence membrane ion channels, increase ventricular fibrillation threshold and increase heart rate variability. Although the data concerning primary prevention is less straightforward than the data relating secondary prevention, it seems that the use of omega-3 fatty acids in primary prevention might be justified as well. In higher doses (2 to 4 g per day) they are used to treat hypertriglyceridemia. Potential mechanisms by which omega-3 fatty acids may reduce risk for cardiovascular disease include also antithrombotic (they decrease platelet aggregation/reactivity, reduce plasma viscosity, enhance fibrinolysis) and anti-inflammatory effects (e.g. they decrease IL-6, MCP-1, TNF), improving vascular endothelial cell function (e.g. they increase availability of nitric oxide), reducing expression of endothelial cells adhesion molecules, inhibiting smooth muscle cells migration and proliferation, and reducing blood pressure. Based upon clinical studies the use of omega-3 fatty acids should be considered today at least as a part of comprehensive secondary prevention strategy in post-MI patients. It has been also shown that adding highly concentrated omega-3 fatty acids to standard treatment in the secondary prevention of MI is cost effective versus standard treatment alone. Particularly important is that there are no significant drug interactions with omega-3 fatty acids.