[Rehabilitation program in patients with moderate-to-severe intermittent claudication: immediate results and one year follow-up]. / Riabilitazione del paziente arteriopatico allo stadio IIB: risultati immediati e follow-up a un anno.

BACKGROUND: Physical training is believed the primary treatment of claudication symptoms. Although exercise therapy is self-effective, some drugs improving functional capacity have additive effects. TASC (Trans Atlantic Society Consensus) considers Propionil-L-Carnitine (PLC) and prostaglandin-E1 (PGE1) as poorly studied drugs with potential benefits in improving claudication. This retrospective, observational study was performed to compare the efficacy of PGE1 and PLC, and to evaluate both the immediate results of an intensive, short-course rehabilitation program and the outcome at one year follow-up. METHODS: Twenty-five patients with severe-moderate claudication were selected. All patients were subjected to an intensive, supervised exercise program for 4 weeks in combination with either PGE1 (10 patients) or PLC (15 patients). Drugs were infused i.v. before every exercise session: 60 microg PGE1 within 2 hours and 600 mg PLC within 10 minutes. Patients were trained with the same supervised tread-mill walking-exercise program. At the end of the rehabilitation period, patients were instructed to keep walking (advised home exercise). Initial claudication distance (ICD) and absolute claudication distance (ACD) were evaluated during a constant treadmill test (3 km/hour speed, 10% grade) at entry, after 4 weeks and at one year follow-up. A patient was considered as no-responder if his/her improvement in ACD was <33%. RESULTS: A significant increase of both ICD and ACD was detected after both 4 weeks (+269% and +135%, respectively, in PGE1 group; +245% and +125%, respectively, in PLC group) and one year (+364% and +202%, respectively, in PGE1 group; +279% and +176%, respectively, in PLC group). No-responder patients after the intensive training period (2 in PGE1 group and 4 in PLC group) remained no-responders also at one year follow-up. Both PGE1 and PLC treatments were well tolerated. No serious drug-related side effect requiring interruption of the treatment was observed. CONCLUSIONS: A short-course of intensive exercise treatment plus PLC or PGE1 may enhance walking ability. The result was confirmed at one year follow-up.

Evidence of vascular damage in dengue disease: demonstration of high levels of soluble cell adhesion molecules and circulating endothelial cells.

Clinical evidence suggests that vascular damage plays a key role in the pathophysiology of dengue hemorrhagic fever (DHF). In this study, the authors tested this hypothesis by examining the levels of soluble intercellular adhesion molecule and vascular cell adhesion molecule (sICAM-1 and sVCAM-1), and the presence of circulating endothelial cells (CECs), as evidence of vascular damage, in peripheral blood from DHF patients (n=13). A significant increase in plasma levels of sICAM-1 (n=12) and sVCAM-1 (n=13) was detected by enzyme-linked immunosorbent assay (ELISA) in DHF patients, compared with healthy individuals. Increased numbers of CECs, as detected by the expression of endothelial cell markers (ICAM-1, platelet cell adhesion molecule [PCAM]-1, and CD36) with flow cytometry, were observed in DHF patients (n=4), compared to healthy subjects. The high levels of sICAM-1 and sVCAM-1, together with the presence of CECs in DHF patients, provide further evidence of endothelium damage and activation in DHF patients.

Combination of lisinopril and nifedipine GITS increases blood pressure control compared with single drugs in essential hypertensive patients.

The present study was designed to evaluate the effect of combination therapy using the angiotensin-converting enzyme-inhibitor lisinopril and the dihydropyridine calcium antagonist nifedipine GITS on the degree and homogeneity of 24-hour blood pressure reduction in essential hypertensive patients. After a 4-week placebo run-in period, 51 patients (mean age, 54.4 +/- 9.4 years) with essential hypertension and clinic diastolic blood pressure between 105 and 115 mm Hg were randomized to 4-week treatment with lisinopril (20 mg), nifedipine GITS (30 mg), or their combination according to a multicenter, randomized, double-blind, crossover study. Trough clinic blood pressure and 24-hour ambulatory blood pressure were measured at the end of the run-in period and after 4 weeks of treatment. In addition to clinic and 24-hour average blood pressure reduction, the trough-to-peak ratio and the smoothness index, a new measure for the homogeneity of blood pressure reduction, were also calculated. Although both lisinopril and nifedipine GITS produced a significant reduction in clinic and 24-hour average blood pressure values, the reduction obtained with the combination was significantly (P < 0.001) greater. Moreover, the combination therapy increased (P < 0.01) the smoothness index as compared with each single drug for both systolic (lisinopril, 1.02; nifedipine GITS, 1.1; combination, 1.76) and diastolic (lisinopril, 0.98; nifedipine GITS, 0.87; combination, 1.54) blood pressure values, whereas trough-to-peak ratio values (expressed as median) for systolic (lisinopril, 0.41; nifedipine GITS, 0.52; combination, 0.55) and diastolic (lisinopril, 0.35; nifedipine GITS, 0.40; combination, 0.49) blood pressure values were not significantly increased by the combination therapy. Thus, antihypertensive treatment with the combination of lisinopril and nifedipine GITS is more effective and balanced over the 24 hours than the combination components administered alone, confirming that the smoothness index is superior to the trough-to-peak ratio in assessing homogeneity of pharmacologic blood pressure reduction.

Síndrome hipereosinofilico idiopático: a propósito de un caso / Idiopathic hypereosinophilic syndrome: apropos of a case

Lactante femenina de 4 meses de edad, quien consultó al Servicio de Pediatría del Hospital Militar "Dr. Carlos Arvelo", por letargia, hiporexia y vómitos. El examen físico luce en buenas condiciones generales. Adenopatías cervicales pequeñas. Durante su hospitalización presenta convulsiones tónico-clónicas generalizadas. Se realizan los siguientes exámenes: El hematológico reveló 180.000 leucocitos por mm3 con 91// de eosinófilos. Exámenes de heces, líquido cefalorraquídeo, pruebas hepáticas y renales,, estudios serológicos e inmunológicos, química sanguínea. RX de tórax, electrocardiograma y electroencefalograma, tomografía de cráneo, eco cardíaco y abdominal, fueron normales. La investigación de Médula Osea demostró hiperplasia granulocícitica con 90// de eosinófilos maduros, sin evidencias de formas inmaduras. Diagnósticando de esta manera SHI. Se inicia tratamiento con prednisona sin respuesta, por lo que se asocia cincristina y alopurinol, mejorando respuesta hematológica. A la sexta semana se asocia 6-mercaptopurina, obteniendo franca mejoría (10.000 con 3// de eosinófilos). A diferencia de lo descrito en la literatura y en adultos, donde existe infiltración a otros órganos, nuestro propósito es señalar la importancia de esta entidad poco frecuente en la infancia, con buena evolución y sin infiltración evidente a otros órganos