Low testosterone and sexual symptoms in men with acute coronary syndrome can be used to predict major adverse cardiovascular events during long-term follow-up.

Low total testosterone (TT) and sexual symptoms are common among men with coronary artery disease, however its impact on major adverse cardiovascular events (MACE) is still debatable. We investigated whether low TT and coexisting sexual symptoms in men with acute coronary syndrome (ACS) can be used to predict the incidence of MACE. In the prospective study 120 consecutive men (mean age 58 ± 9 years; diabetes 27%; current smokers 58%; left ventricular ejection fraction 50 ± 10%) with ACS were included. The group of men with the presence of three sexual symptoms (decreased frequency of morning erections, a lack of sexual thoughts and erectile dysfunction) and with TT serum concentration <3.2 ng/mL was distinguished. All of the patients had their prognosis assessed according to the Global Registry of Acute Coronary Events (GRACE Score 2.0). Primary composite endpoint - MACE (recurrent ischaemia, non-fatal myocardial infarction, stroke and death) and secondary endpoint - in stent restenosis (ISR) were registered during the 18.3 month follow-up period. The mean TT level in the entire group was 3.7 ± 0.5 ng/mL. Low TT was diagnosed in 63 (52.5%) men. Both low TT and sexual symptoms were diagnosed in 57 (47%) participants. During the follow-up, 29 (24.2%) participants experienced MACE, 20 (16.6%) men ISR. In the Cox proportional hazards regression, high risk of death on the GRACE score (HR 3.16; 95% CI: 1.5-6.6; p = 0.002), the presence of low TT and sexual symptoms (HR 2.75; 95% CI: 1.26-6.04; p = 0.02) independently predicted an incidence of a MACE (p = 0.006). For the secondary endpoint only low TT and sexual symptoms (HR 2.68; 95% CI: 1.03-6.94; p = 0.034) were independent covariates which predicted IRS. Low TT which coexists with sexual symptoms in males with ACS can be used to predict MACE, especially IRS independently of classic cardiovascular risk factors.

[A case of primary salpinx cancer--diagnostic difficulties]. / Przypadek pierwotnego raka jajowodu--trudnosci diagnostyczne.

In this paper the authors presents 55-years old female patient with primary carcinoma of salpinx. The special attention is payed to the possibility of clinical misdiagnosis. The low rate of appearance and not very characteristic symptoms of that type of carcinoma makes final clinical diagnosis almost impossible without intra-or postoperative histopathological study. In presented case, in the first acute appendicitis was recognized and patient was treated surgically. During the operation the large cyst near the right uterine appendages was found and after histopathological examination the primary salpinx carcinoma was revealed. In consequences pan hysterectomy was made with cytostatic all treatment just after the operation. Now, five years has gone and the patient, temporary controlled in dispensary, is still in good condition.

An overview of the progression of diabetic retinopathy with treatment recommendations.

The American Academy of Ophthalmology and the National Eye Institute's national eye health care program's goals are to eliminate preventable blindness as a sequala of diabetes by the year 2000. To successfully implement the program, there needs to be a collaborative effort between primary care providers and ophthalmologists. The various primary health care providers treat approximately 80% of the diabetic population and are therefore in an excellent position to screen patients at risk for vision threatening problems and arrange for timely ophthalmic referral. This article provides an overview of the progression of diabetic retinopathy, the latest research findings and the recommendations for treatment and eye care guidelines set forth by the American Academy of Ophthalmology and the American Diabetes Association. Patient education, early recognition of asymptomatic ocular manifestations, and timely referral and treatment are the keys to prevent blindness.