[Peripheral arterial occlusive disease as predictor of high atherosclerotic burden]. / Periphere arterielle Verschlusskrankheit als Prädiktor einer hohen Atheroskleroselast.

Atherosclerosis is a disease which affects the whole arterial vascular tree. In particular patients with peripheral arterial occlusive disease (PAOD) often suffer from additional atherosclerotic manifestations in other vascular territories. This has a direct impact on cardiovascular prognosis. Atherosclerosis is an inflammatory disease. A high inflammatory burden is associated with polyvascular atherosclerosis and also with the occurrence of cardiovascular events. Control of cardiovascular risk factors is crucial for the treatment of patients with polyvascular atherosclerosis. In addition, anticoagulation treatment is very important in patients with atherosclerosis. Moreover, exercise training is an important treatment option in PAOD patients not only to improve walking distance but also for multiple additional positive effects. So far the role of anti-inflammatory treatment is not clear and must be further elaborated by future clinical research.

Area at risk and viability after myocardial ischemia and reperfusion can be determined by contrast-enhanced cardiac magnetic resonance imaging.

BACKGROUND/AIMS: Clinical differentiation between infarcted and viable myocardium in the ischemic area at risk is controversial. We investigated the potential of contrast-enhanced cardiac magnetic resonance imaging (ceCMRI) in determining the area at risk 24 h after ischemia. METHODS: Myocardial ischemia was induced by percutaneous coronary intervention of the left anterior descending coronary artery in pigs. Coronary occlusion time was 30 min in group A, which caused little myocardial infarction and 45 min in group B, which led to irreversible damage. 24 h after reperfusion ceCMRI was performed at 2 and 15 min after administration of gadolinium-diethylenetriamine pentaacetic acid. The area at risk was determined by intravenous injection of Evans blue and myocardial viability by triphenyltetrazolium-chloride staining. RESULTS: The signal-intense areas at 2 and 15 min after contrast administration matched the area at risk in groups A and B. Nonviable myocardium in group A was overestimated (14-15%) while good agreement was present in group B. CONCLUSION: The area at risk of reperfused ischemic myocardium can be determined by ceCMRI 24 h after coronary recanalization. This type of information might have relevant clinical implications in the treatment and stratification of patients with acute coronary syndrome in particular after surgical interventions.

Gonorrhea case-finding among asymptomatic men seeking ambulatory care: a cost effectiveness analysis.

Case-finding for gonorrhea in asymptomatic men is generally not performed in primary care settings and often not performed when men are seen for other reasons in clinics for sexually transmitted diseases. We performed a cost-effectiveness analysis of case-finding among asymptomatic men seeking ambulatory care, using culture of the first-voided urine and treatment of culture-positive patients with tetracycline. The analysis demonstrated that care-finding is increasingly cost-effective as the probability of asymptomatic gonorrhea becomes greater. Over a reasonable expected range of the probability of asymptomatic gonorrhea (0.1-15%) in such settings, the additional cost to avert one additional day of morbidity ranged from $47,000 to $260; the additional cost to avert one additional case of residual asymptomatic infection ranged from $26,000 to $140; and the additional cost to avert one additional case of pelvic inflammatory disease in a contact ranged from $250,000 to $1,400. We conclude that the cost-effectiveness of case-finding for gonorrhea among asymptomatic men compares favorably with that of other medical interventions when the probability of infection is relatively high (perhaps greater than or equal to 5%). In order to make use of such information, physicians in ambulatory care settings require better information about the probability of gonorrhea in asymptomatic men who differ in their medical histories and socioeconomic and ethnic backgrounds.