Lipid-lowering efficacy, safety, and costs of a large-scale therapeutic statin formulary conversion program.

STUDY OBJECTIVE: To assess the lipid-lowering efficacy, safety, and costs of a large-scale statin formulary conversion program. DESIGN: Prospective, observational study. SETTING: Tertiary academic medical center. PATIENTS: A total of 980 patients consented to participate; 942 patients completed the study. INTERVENTION: Patients were converted from their current statin therapy to either cerivastatin 0.4 or 0.8 mg/day, or simvastatin 80 mg/day, using a conversion algorithm. MEASUREMENTS AND MAIN RESULTS: Efficacy and safety were evaluated at baseline and after 6 weeks of therapy; costs were also measured. Overall attainment of the National Cholesterol Education Program (NCEP) goal for low-density lipoprotein cholesterol (LDL) increased from 64.8% to 74.5% of patients (p<0.001); mean LDL decreased from 115+/-30 mg/dl to 106+/-25 mg/dl (p<0.001). Adverse events occurred in 3% of patients, and included myositis (0.6%) and increased hepatic transaminases (0.1%). Overall costs were reduced by $115/patient treatment-year. CONCLUSION: Statin therapeutic interchange can improve lipid control at reduced costs. The possibility of uncommon but potentially serious adverse effects suggests that these programs require appropriate monitoring.

Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia.

BACKGROUND: Long-term therapy with hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) has been shown to reduce levels of C-reactive protein (CRP). However, the generalizability, speed of onset, and dose-response characteristics of this effect are uncertain. METHODS AND RESULTS: We measured CRP, LDL cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels among 785 patients with primary hypercholesterolemia at baseline and after 8 weeks of therapy with either 0.4 or 0.8 mg of cerivastatin. Overall, cerivastatin resulted in a 13.3% reduction in median CRP levels (P:<0.001) and a 24.5% reduction in mean CRP levels (P:<0.001). Although LDL-C promptly decreased in a dose-dependent manner (mean LDL-C reduction, 37.3% for 0.4 mg and 42.2% for 0.8 mg of cerivastatin), no clear dose-response effect of cerivastatin on CRP was observed, nor was there any substantive correlation between the magnitude of change in CRP and the magnitude of change in LDL-C (r=-0.08) or the magnitude of change in HDL-C (r=-0.04). Thus, <2% of the variance in the percent change in CRP over 8 weeks could be attributed to the percent change in either of these lipid parameters. Further, there was no evidence of correlation between baseline CRP levels and baseline lipid levels or between end-of-study CRP levels and end-of-study lipid levels. CONCLUSIONS: Among 785 patients with primary hypercholesterolemia, CRP levels were significantly reduced within 8 weeks of initiating cerivastatin therapy in a lipid-independent manner.

[Laparoscopic selective vagotomy (posterior truncal vagotomy and anterior linear stomach resection) in complicated duodenal ulcer]. / Laparoskopische selektive Vagotomie (hintere trunkuläre Vagotomie und vordere lineare Magenresektion) beim komplizierten Ulcus Duodeni.

32 patients with complicated duodenal ulcer (bleeding, recurrence, perforation) were treated by laparoscopic posterior truncal vagotomy and anterior linear gastric resection in our modification (access to the posterior vagus via the omental bursa) of the method of Gomez-Ferrer/Taylor. Instead of the seromyotomy along the lesser curve we resect a 1 cm broad strip out of the anterior gastric wall. In one patient with additional hiatus hernia the anterior vagal trunc was cut accidentally. Converted to laparotomy this case was completed as truncal vagotomy and pyloroplasty. No disorders of postoperative gastric emptying were found. 17 patients were followed up 6 weeks postoperatively. 14 showed complete healing of the ulcer, 2 patients showed healing in progress. A follow up after 12 months obtained information about 18 patients: 7 were free of symptoms, 11 complained about intermittent pains or fullness. 8 of these 11 patients were controlled by gastroscopy, not any ulcer or gastritis or disorder of gastric emptying could be found. We see advantages of our method over Kathkouda's modification of Taylor's procedure in the simplicity of the method, the primary hemostasis and a short operating time by using the stapler. We consider our procedure a minimal invasive, quick, safe treatment for duodenal ulcer disease with lasting effect at reasonable cost, especially in complicated cases like recurrent ulcer, bleeding or penetrating ulcer and in noncompliant patients that are not suitable for medical treatment.

The photoelectron x-ray microscope, a possible tool for analytical soft x-ray microscopy.

In the soft x-ray region, different techniques have been recently developed which can give images of biological objects at an intermediate resolution between optical and electron microscopes. At these wavelengths, very little sample preparation is required because the image contrast is directly dependent upon the chemical composition of the sample itself and on the x-ray wavelength. X-ray microscopy can be extended to absorption microanalysis with a similar resolution, provided that the basic microscope can work through a large range of wavelengths. The photoelectron x-ray microscope that we are developing at LURE satisfies this condition. Its principle is to make a contact x-ray image of the object on a plane photocathode and then, to magnify the secondary electron image, into which it is converted, by means of an emission electron microscope. In the present state of the art, the expectable detection limit, for element maps of 0.1 micron resolution, would be near 1% in concentration.

Optical Fourier transform: what is the optimal setup?

The two basic optical Fourier transform configurations are examined with respect to component complexity, aberrations, and optical noise. It is shown that the converging-beam illumination setup (CB-FT) is much simpler and works better than the classical parallel beam illumination setup within a restricted range of object size and lens aperture. This range corresponds to many practical cases. Therefore, the CB-FT should be preferred in ordinary cases whereas the classical setup with a special purpose Fourier lens should be used only for a large space-bandwidth product. It is probably never a good solution to use the parallel beam configuration with a general purpose lens as the Fourier lens.

Implementation of an incoherent optical image restoration method: limitations related to optical subtraction.

Incoherent optical information processing is known to be far less sensitive to noise than coherent processing. However, it is restricted to real non-negative quantities. In cases like approximate deconvolution for image restoration, where positive and negative quantities are involved, the use of incoherent illumination is possible only at the expense of some additional sophistication needed to incorporate the negative parts; in particular, the restoration can be achieved by combining two incoherent convolutions and one subtraction. This paper describes an experiment of this type, with special emphasis on the practical implementation and on the difficulties related to the subtraction. Alignment and normalization of the two images to be subtracted are critical issues. If the subtraction is performed optically, the dynamic range of this operation is an additional problem.

Program for cardiac patients: stress testing and training.

Dynamic exercise stress testing had become a widely accepted technique in the diagnosis of cardiac patients. The results of standardized exercise testing may be used to evaluate a patient's functional capacity and to derive an exercise prescription to assist him in improving his state of cardiovascular fitness. Because the physical therapist has special training and skill in exercise-related techniques, a stress testing laboratory and an exercise-based cardiac rehabilitation program may be appropriately established in a hospital's physical therapy department. Results are presented of a diagnostic exercise testing and an exercise-based cardiac rehabilitation program organized and supervised by physical therapists in a 300-bed private hospital.

Visualization of traveling acoustic fields.

The visualization of traveling acoustic waves is achieved by means of acoustic stroboscopy. The limitations of the technique, interpretation of results, frequency range, and optical noise are reviewed. Two methods of noise reduction are studied: spatial filtering and holography. Optical holography of acoustic fields is also shown to offer the best advantages among the various methods of visualization outlined here.

Optical Fourier analysis of acoustic fields.

Optical Fourier analysis of acoustic fields is used for the interpretation of acoustic disturbances. The method is applied to the study of modes propagating in an elastic waveguide. In particular, the mode dispersion curves are determined with an accuracy greater than that with purely acoustic methods.