Long-term rates of cardiovascular events in patients with the metabolic syndrome according to severity of coronary-angiographic alterations.

OBJECTIVES: To assess the long-term risk of mortality and cardiovascular events, related to metabolic syndrome (MetS), in patients with less, or more severe coronary artery disease (CAD). METHODS: One thousand and eighty patients were divided in four groups, according to severity of CAD (1=less than 50% or nonsignificant stenoses; 2=greater or significant stenoses), and according to MetS (A=no; B=yes). Risk was evaluated with the Cox regression analysis. RESULTS: About 18.9% of patients had less and 81.1% more advanced CAD. MetS was present in 45.1% of the first, and in 52.9% of the second group. At baseline, patients with MetS, or significant stenoses, had less favorable medical, biochemical, and angiographic characteristics. During a follow-up of 12.6+/-3.4 years, group 1B had higher incidence (16.3 vs. 7.1%) and hazard ratio [2.36 (1.001-5.57; P=0.0497)] of myocardial infarction than group 1A; group 2B had a higher incidence (19.0 vs. 11.7%) and hazard ratio [1.67 (1.18-2.37; P=0.0041)] of stroke than group 2A. Groups 2A and 2B, as compared with groups 1A and 1B, had a higher incidence of myocardial infarction (39.1 vs. 7.1; 41.8 vs. 16.3%); group 2B had higher incidence of stroke than group 1B (19.0 vs. 9.8%). After adjustment for common risk factors, group 2B retained an elevated risk of stroke. After additional adjustment for diabetes, no event was significantly related to MetS. CONCLUSION: At baseline, coronary patients with MetS, or significant angiographic alterations, had more cardiovascular risk factors. During follow-up, both MetS and significant CAD increased the risk of cardiovascular morbidity but not of mortality.

[A dural fistula as a rare cause for a pulse-synchronized tinnitus aurium]. / Arteriovenöse Durafistel als seltene Ursache für einen pulssynchronen Tinnitus.

Pulse-synchronized tinnitus aurium is commonly caused by vascular processes within the area of the temporal bone. With a microphone or a stethoscope in the external ear or on the mastoid perceptible noises can be heard by the physician. The most important differential diagnoses of an objective tinnitus are paraganglioma of the glomus jugulare or the glomus tympanicum, vascular stenosis, arteriovenouse malformations, aneurysms and atypic findings of the bulbus venae jugularis interna of the temporal bone. In case of a pulse-synchronized tinnitus purposeful use of neuroradiological diagnostic can lead to a correct diagnosis. The indication for invasive intervention of dural fistulas depends on the number and the hemodynamic relevance of these fistulas and on individual suffering of the patient. Even if it does not succeed, all to embolize AV-short-circuits, it is possible to reduce the intensity of the tinnitus in order to continue with conservative therapy.

Metronomic trofosfamide inhibits progression of human lung cancer xenografts by exerting anti-angiogenic effects.

BACKGROUND: Recent studies of conventional chemotherapeutic drugs administered in metronomic therapy schedules showed remarkable inhibitory effects on tumor angiogenesis. Subsequent and prolonged tumor regression was achieved moreover by circumventing acquired drug resistance. In this study, metronomic and conventional trofosfamide were compared on human NSCLC xenograft "LX-1." MATERIALS AND METHODS: In vitro cytotoxicity of trofosfamide on tumor and human umbilical cord endothelial cells was determined under normoxic and hypoxic conditions. Additionally fractions and duration of cell cycles were analyzed by flow cytometry. In vivo LX-1 xenotransplanted nude mice were treated with trofosfamide in conventional and metronomic schedules (i.p./p.o.). Tumor sections were evaluated for microvessel density (MVD), relative growth fraction and apoptosis. RESULTS: In contrast to the rapid growth of conventionally treated lung cancer, long lasting tumor growth retardation over the total treatment period was achieved with metronomic treatment. While growth fraction and apoptotic rate of LX-1 cells remained unchanged, the MVD was significantly reduced (50%). CONCLUSION: Our results show advantages of a metronomic trofosfamide schedule compared to a conventional bolus therapy mainly due to inhibition of angiogenesis. In vitro data show that this mechanism works under normoxic and hypoxic conditions and suggest that this is in part a direct cytotoxic effect on endothelial cells.

Incidence and clinical characteristics of the metabolic syndrome in patients with coronary artery disease.

BACKGROUND AND OBJECTIVES: Several studies suggested that the insulin resistance-associated metabolic syndrome (MS) is a major risk factor for coronary artery disease (CAD), but the criteria to identify MS were only recently standardized by the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III. METHODS: We evaluated the incidence of the newly defined MS in patients with documented CAD and compared the characteristics of patients with and without this syndrome. RESULTS: In a Canadian population with CAD (793 men and 315 women, age 58.1+/-9.8 years) 51% had MS. As compared to patients without the MS syndrome, these patients had significantly higher waist circumference, blood pressure levels and fasting glucose and triglyceride, but lower high-density lipoprotein (HDL)-cholesterol levels. Their homeostatic model assessment (HOMA) insulin resistance index was significantly higher, with indicators of highly atherogenic, small low-density lipoprotein (LDL) and HDL particles. Family history of diabetes and the use of hypoglycemic agents, beta-blockers and thiazides were more frequent, but physical exercise and alcohol consumption were less frequent in MS positive patients. Cumulative coronary stenosis score and the frequency of patients with >50% coronary artery narrowing were higher and there was a strong tendency for higher rates of previous myocardial infarction in MS positive patients. CONCLUSIONS: In a CAD population documented in 1991-1992, 51% of participants had MS and in several respects a more advanced coronary disease than those without the syndrome. These results support the view of NCEP ATP III, that in CAD prevention, beyond lowering LDL-cholesterol levels, interventions concerning the constituents of MS should be important.