[Muscle-related adverse effects of statins]. / Statiinien lihashaitat.

Adverse effects on muscles occur in approximately 5 to 10% of patients taking statins. Drug interactions, associated diseases, agedness, low body weight, high statin dose and hereditary factors increase the risk of adverse effects. In most cases the muscle effects are mild and disappear upon discontinuation of the medication. Rhabdomyolysis is a severe though rare complication that can possibly result in renal damage. A totally different muscle-related adverse effect, necrotizing myopathy, has recently been linked to the use of statins. Its characteristic feature is progression of the symptoms in spite of discontinuation of the statin.

[Esophageal varices and dyspnea. A clinicopathological conference report]. / Ruokatorven laskimolaajentumat ja hengenahdistus.

A young man who had moved from India to Finland was extensively examined for abdominal complaints. The findings included large esophageal varices, open portal vein and enlarged lymph nodes. The large spleen was excised. The diagnosis did not become clear from laboratory investigations. After ten years the patient was repeatedly examined to reveal the cause of esophageal varices and abdominal complaints. Autoimmune pancreatitis and cholangitis were suspected after 23 years from the initial symptoms. In the end, the most plausible explanation for the patient's mixed disease was tuberculosis. Sarcoidosis was another disease that came into question.

[Anemization, recurring bouts of fever and cardiac insufficiency in a young woman]. / Nuoren naisen anemisoituminen, kuumeilu ja sydämen vajaatoiminta.

A young woman having undergone surgery for aortic coarctation in childhood developed severe cardiac insufficiency after being ill for a few months. The clinical picture turned out to be compatible with subacute endocarditis. The patient received antibiotic treatment with vague effect on hemodynamics and the aortic valve was replaced. However, after valvular replacement a refractory myocardial insufficiency developed. A heart transplantation was performed. Thereafter the patient has been well.

[Violent endocarditis in a previously healthy woman]. / Aiemmin terveen naisen raju endokardiitti.

A previously healthy woman having recently retired to old-age pension contracted a mild respiratory infection. During a peroral course of antibiotics, the inflammatory values continued to elevate. Admission to hospital was followed by stroke, revealing an underlying endocarditis. The patient succumbed suddenly two days later. In this clinical-pathological meeting case report we review the cause of it all.

Only modest resources are needed to improve treatment of hospitalised patients with chest pain or heart failure: rapid assessment is a safe and efficient strategy.

BACKGROUND: The objective of this study was to evaluate the safety and efficacy of rapid assessment using modest resources in hospitalised chest pain and heart failure patients. METHODS: We evaluated 81 patients hospitalised for chest pain or heart failure in a prospective rapid assessment group and 162 patients in a retrospective usual care group with 6 months' follow-up. Main outcome measures were length of hospital stay at index observation, number of days spent in hospital for all causes, chest pain or heart failure, and number of visits to the doctor. RESULTS: Chest pain patients: Length of hospital stay was significantly shorter in the rapid assessment group (1.3 vs. 3.7 days, P<0.0001). Days spent in hospital over 6 months were fewer in the rapid assessment group (2.9 vs. 8.8 days, P<0.005). Furthermore, the number of days spent in the hospital for chest pain or heart failure decreased (2.5 vs. 8.0 days, P<0.01). Heart failure patients: The length of hospital stay (8.7 vs. 9.7 days, P=ns) or days spent in the hospital over 6 months did not differ (25.7 vs. 23.1 days, P=ns). However, there were fewer days (10.5 vs. 16.7 days, P<0.01) spent in the hospital for chest pain or heart failure in the rapid assessment group. CONCLUSIONS: Rapid assessment of hospitalised chest pain and heart failure patients on the next working day is a safe strategy in a medium-sized hospital. In 6 months, rapid assessment effectively reduces days spent in the hospital in chest pain patients, but not in heart failure patients. It can easily be integrated into standard care using modest resources.