Ankle-Brachial Index Is a Predictor of In-Hospital Functional Status but Not of Complications in Hospitalized Elderly Patients.

INTRODUCTION: Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients. METHODS: This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period. RESULTS: The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (ß = 0.231, p = 0.013 and ß = 0.314, p = 0.001, respectively). CONCLUSIONS: The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.

Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study.

Renal denervation (RD) is an intriguing treatment strategy for resistant hypertension. However, limited data are available about its long time efficacy as well as its effects on intermediate phenotypes like arterial stiffness and carotid IMT. 12 patients (9 males, mean 69 years) with resistant hypertension underwent bilateral RDN (Medtronic System) since April 2012 in Niguarda Ca' Granda Hospital (Milan). Patients were studied before intervention, and at 1, 3, 6 and 12 months after RD. Carotid intima media thickness (Esaote Mylab) and carotid-femoral pulse wave velocity (Complior, Alam medical) were assessed at each step. Compared to baseline, patients showed a marked reduction of office systolic blood pressure at each follow-up step (p < 0.05 versus baseline for all steps) as well as pulse wave velocity (p < 0.01 at 1 year versus baseline). Moreover, reduction in pulse wave velocity was higher than the expected value obtained only considering blood pressure drop. Conversely, no significant effect was observed on diastolic blood pressure as well as carotid intima-media thickness. In our study, renal denervation was a safe and effective procedure. The BP lowering effect was maintained during follow-up and a beneficial effect on arterial stiffness was observed, which implies that this effect can't passively originate from the BP fall but rather from an improvement of arterial mechanical properties, possibly related to a reduced sympathetic arterial drive.

The organ-specific extrapulmonary presentation of sarcoidosis: a frequent occurrence but a challenge to an early diagnosis. A 3-year-long prospective observational study.

BACKGROUND AND AIM: The percentage of organ-specific extrapulmonary presentation of sarcoidosis has usually been estimated on the basis of retrospective studies, with figures varying in the range of 7-22%. We have hypothesized that a prospective study could give a higher figure, and could better outline the variable pattern of extrapulmonary presentation. MATERIAL AND METHODS: A careful examination with particular interest to the possible extrapulmonary signs or symptoms of the disease, even if previously unrecognized, was carried out in 204 consecutive sarcoid patients (mean age 37 +/- 11) seen between 2000 and 2002. Some of them had already visited our clinic in previous years. Their median follow up in our clinic was 34 months, while the median duration of disease was 60 months. RESULTS: An organ-specific extrapulmonary presentation did occur in 73 patients (35.78%). The most frequent extrapulmonary presentation was due to skin lesions (different from erythema nodosum) and to peripheral lymph nodes (8% each). Less frequent were renal stones (4%), uveitis (3%) and others (12%). The extrapulmonary presentation may be a challenge to the diagnosis. In our series an early diagnosis was reached only in 38 of 73 patients. In the other 35 patients, the diagnosis was reached later, after a time interval ranging from 6 months to 20 years. The lung involvement was detected early in 33 patients with extrapulmonary presentation. In 35 other patients the pulmonary involvement appeared after a median time interval of 24 months (range 6-240, interquartiles 15-60). In 5 patients, no pulmonary changes ever appeared after a long term follow up of 20 months, 5 years (2 patients), 10 years and 29 years respectively. CONCLUSION: An organ-specific extrapulmonary presentation is common in sarcoidosis, but may go unrecognized for years.