RESUMO
Both brachial blood pressure (BP) level and its variability (BPV) significantly associate with left ventricular (LV) structure and function. Recent studies indicate that aortic BP is superior to brachial BP in the association with LV abnormalities. However, it remains unknown whether aortic BPV better associate with LV structural and functional abnormalities. We therefore aimed to investigate and compare aortic versus brachial BPV, in terms of the identification of LV abnormalities. Two hundred and three participants who underwent echocardiography were included in this study. Twenty-four-hour aortic and brachial ambulatory BP was measured simultaneously by a validated BP monitor (Mobil-O-Graph, Stolberg, Germany) and BPV was calculated with validated formulae. LV mass and LV diastolic dysfunction (LVDD) were evaluated by echocardiography. The prevalence of LV hypertrophy (LVH) and LVDD increased significantly with BPV indices (P⩽0.04) in trend tests. After adjustment to potential confounders, only aortic average real variability (ARV), but not brachial ARV or weighted s.d. (wSD, neither aortic nor brachial) significantly associated with LV mass index (P=0.02). Similar results were observed in logistic regression. After adjustment, only aortic ARV significantly associated with LVH (odds ratio (OR) and 95% confidence interval (CI): 2.28 (1.08, 4.82)). As for LVDD, neither the brachial nor the aortic 24-hour wSD, but the aortic and brachial ARV, associated with LVDD significantly, with OR=2.28 (95% CI: (1.03, 5.02)) and OR=2.36 (95% CI: (1.10, 5.05)), respectively. In summary, aortic BPV, especially aortic ARV, seems to be superior to brachial BPV in the association of LV structural and functional abnormalities.
Assuntos
Aorta/fisiopatologia , Pressão Sanguínea , Artéria Braquial/fisiopatologia , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Ecocardiografia , Feminino , Grécia/epidemiologia , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/epidemiologia , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/epidemiologiaRESUMO
Aortic blood pressure (BP) and 24-h ambulatory BP are both better associated with target organ damage than office brachial BP. However, it remains unclear whether a combination of these two techniques would be the optimal methodology to evaluate patients' BP in terms of left ventricular diastolic dysfunction (LVDD) prevention. In 230 participants, office brachial and aortic BPs were measured by a validated BP monitor and a tonometry-based device, respectively. 24-h ambulatory brachial and aortic BPs were measured by a validated ambulatory BP monitor (Mobil-O-Graph, Germany). Systematic assessment of patients' LVDD was performed. After adjustment for age, gender, hypertension and antihypertensive treatment, septum and lateral E/Ea were significantly associated with office aortic systolic BP (SBP) and pulse pressure (PP) and 24-h brachial and aortic SBP and PP (P ⩽ 0.04), but not with office brachial BP (P ⩾ 0.09). Similarly, 1 standard deviation in SBP was significantly associated with 97.8 ± 20.9, 86.4 ± 22.9, 74.1 ± 23.3 and 51.3 ± 22.6 in septum E/Ea and 68.6 ± 2 0.1, 54.2 ± 21.9, 37.9 ± 22.4 and 23.1 ± 21.4 in lateral E/Ea, for office and 24-h aortic and brachial SBP, respectively. In qualitative analysis, except for office brachial BP, office aortic and 24-h brachial and aortic BPs were all significantly associated with LVDD (P ⩽ 0.03), with the highest odds ratio in 24-h aortic SBP. Furthermore, aortic BP, no matter in the office or 24-h ambulatory setting, showed the largest area under receiver operating characteristic curves (P ⩽ 0.02). In conclusion, 24-h aortic BP is superior to other BPs in the association with LVDD.
Assuntos
Pressão Arterial , Monitorização Ambulatorial da Pressão Arterial , Diástole/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Adulto , Idoso , Calibragem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
A 3-year study assessed the prevalence and causes of severe treatment-related hypoglycaemia in type 2 diabetes mellitus patients admitted to hospital in Piraeus. Out of the 2858 patients admitted, 207 (7.2%) had severe hypoglycaemia: 72 were being managed with insulin, 132 oral hypoglycaemic drugs and 3 combined insulin/oral drugs. Only 28.5% of patients were attending a diabetes clinic. The cause of the hypoglycaemic attack could be determined for 86.1% of cases; 30.8% were due to a missed meal. Interviews showed that education and level of knowledge about diabetes mellitus, and particularly hypoglycaemia symptoms, was inadequate. Logistic regression analysis showed that knowledge about diabetes mellitus correlated with educational status and with follow-up in a diabetes clinic.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Hipoglicemia/epidemiologia , Hipoglicemia/etiologia , Admissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Atitude Frente a Saúde , Causalidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Dieta para Diabéticos , Escolaridade , Exercício Físico , Feminino , Hemoglobinas Glicadas/metabolismo , Grécia/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Hipoglicemia/sangue , Hipoglicemia/prevenção & controle , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico , Modelos Logísticos , Masculino , Planejamento de Cardápio , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prevalência , Autocuidado , Inquéritos e QuestionáriosRESUMO
A 3-year study assessed the prevalence and causes of severe treatment-related hypoglycaemia in type 2 diabetes mellitus patients admitted to hospital in Piraeus. Out of the 2858 patients admitted, 207 [7.2%] had severe hypoglycaemia: 72 were being managed with insulin, 132 oral hypoglycaemic drugs and 3 combined insulin/oral drugs. Only 28.5% of patients were attending a diabetes clinic. The cause of the hypoglycaemic attack could be determined for 86.1% of cases; 30.8% were due to a missed meal. Interviews showed that education and level of knowledge about diabetes mellitus, and particularly hypoglycaemia symptoms, was inadequate. Logistic regression analysis showed that knowledge about diabetes mellitus correlated with educational status and with follow-up in a diabetes clinic
Assuntos
Atitude Frente a Saúde , Causalidade , Dieta para Diabéticos , Escolaridade , Hipoglicemia , Admissão do Paciente , Diabetes Mellitus Tipo 2RESUMO
AIMS: Type 2 diabetes mellitus (DM) and coronary artery disease (CAD) are both associated with endothelial dysfunction and elevated oxidative and inflammatory state. We examined the effect of vitamin C on endothelial function and levels of soluble vascular cell adhesion molecule (sVCAM-1), interleukin-6 (IL-6) and tumour necrosis factor (TNF-alpha), in DM patients with or without CAD and in non-diabetic subjects. METHODS: Thirty-seven patients with DM + CAD, 17 patients with DM without CAD and 21 non-diabetic subjects were divided into groups receiving vitamin C 2 g/day or no anti-oxidant for 4 weeks. Forearm blood flow was determined using venous occlusion gauge-strain plethysmography. Forearm vasodilatory response to reactive hyperemia was considered as index of endothelium-dependent dilation. RESULTS: Baseline levels of IL-6 and TNF-alpha were significantly higher in patients with DM + CAD compared with patients with DM (P < 0.01) or non-diabetic subjects (P < 0.01). IL-6 and TNF-alpha levels were also higher in DM compared with non-diabetic subjects (P < 0.05). sVCAM-1 levels were lower in non-diabetic controls compared with DM + CAD (P < 0.05) or DM (P < 0.05). Reactive hyperaemia was higher in non-diabetic controls compared with DM + CAD (P < 0.001) or DM (P < 0.001). Vitamin C significantly increased reactive hyperaemia only in the DM + CAD group, while it had no effect on serum levels of sVCAM-1, TNF-alpha and IL-6 in any of the groups. CONCLUSIONS: Type 2 diabetes mellitus is associated with impaired endothelial function and increased levels of TNF-alpha, IL-6 and sVCAM-1, especially in patients with DM and CAD. Vitamin C significantly increased forearm vasodilatory response to reactive hyperaemia only in patients with combined DM and CAD.
Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Angiopatias Diabéticas/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/fisiopatologia , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/sangue , Angiopatias Diabéticas/fisiopatologia , Feminino , Antebraço/irrigação sanguínea , Humanos , Hiperemia/sangue , Hiperemia/complicações , Hiperemia/fisiopatologia , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/análise , Molécula 1 de Adesão de Célula Vascular/sangue , Vasodilatação/fisiologiaRESUMO
BACKGROUND: Out of 1705 patients hospitalised for various reasons in the 3rd Internal Medicine Department of the Regional General Hospital of Nikaea, in Piraeus, 146(8,5%) persons were admitted for drug intoxication between November 1999 and November 2000. METHODS: On average, these persons [male 50(34,2%)--female 96(65,8%)] were admitted to the hospital within 3.7 hours after taking the drug. RESULTS: The drugs that were more frequently taken, alone or in combination with other drugs, were sedatives (67.1%), aspirins and analgesics (mainly paracetamol) (43.5%). 38.3% of patients had a mental illness history, 31.5% were in need of psychiatric help and 45.2% had made a previous suicide attempt. No death occurred during the above period and the outcome of the patients' health was normal. After mental state examination, the mental illnesses diagnosed were depression (20.96%), psychosis (15.32%), dysthymic disorder (16,2%), anxiety disorder (22.58%) and personality disorder (8.87%). CONCLUSIONS: Self-poisoning remains a crucial problem. The use of paracetamol and sedatives are particularly important in the population studied. Interpersonal psychiatric therapy may be a valuable treatment after people tried to poison themselves.
Assuntos
Overdose de Drogas/epidemiologia , Hospitalização/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Feminino , Grécia/epidemiologia , Departamentos Hospitalares , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Fatores SexuaisAssuntos
Diabetes Mellitus Experimental/cirurgia , Imunossupressores/uso terapêutico , Transplante das Ilhotas Pancreáticas/imunologia , Alanina Transaminase/sangue , Animais , Aspartato Aminotransferases/sangue , Azatioprina/uso terapêutico , Glicemia/metabolismo , Ciclosporina/uso terapêutico , Diabetes Mellitus Experimental/sangue , Quimioterapia Combinada , Teste de Tolerância a Glucose , Transplante das Ilhotas Pancreáticas/fisiologia , Prednisolona/uso terapêutico , Suínos , Transplante HomólogoRESUMO
The effects of the diuretic furosemide on the sensitivity of glucose disposal to insulin were investigated in rat soleus muscle in vitro. At basal levels of insulin, the rates of 3-O-methylglucose transport, 2-deoxyglucose phosphorylation and lactate formation were not affected significantly by furosemide (0.5 mmol/l). However, furosemide significantly decreased these rates at physiological and maximal levels of insulin. The contents of 2-deoxyglucose and glucose 6-phosphate in the presence of furosemide were not significantly different from those in control muscles at all levels of insulin studied. It is concluded that furosemide decreases the sensitivity of glucose utilization to insulin in skeletal muscle by directly inhibiting the glucose transport process.
Assuntos
Diuréticos/farmacologia , Furosemida/farmacologia , Glucose/metabolismo , Hipoglicemiantes/farmacologia , Insulina/farmacologia , Músculo Esquelético/efeitos dos fármacos , 3-O-Metilglucose/farmacocinética , Animais , Transporte Biológico/efeitos dos fármacos , Desoxiglucose/farmacocinética , Masculino , Ratos , Ratos WistarRESUMO
Median nerve regeneration was studied in 30 adult primates after repair by microsurgical suture or tubulization with a nonwoven, bioabsorbable, polyglycolic acid device. The two methods were compared electrophysiologically and histologically 6 and 12 months after repair. The electrophysiology included recording of electrically evoked compound action potentials and subsequent determination of threshold, conduction velocity, amplitude, and area above the baseline for each component. Measurements were obtained before nerve transection and at the time of biopsy by stimulating both proximal and distal to the transection site. Analysis of all electrophysiological parameters revealed no statistically significant differences (p less than 0.05) between the two repair techniques. Histopathology included examination of cross sections proximal and distal to the repair sites and longitudinal sections through the coaptation site. End organs (Meissner's and Pacinian corpuscles and muscle) were sectioned to determine the degree of reinnervation. No significant differences between the repair techniques were observed by histological analysis of these sections. These evaluations indicated that the tubulization repair technique produced results comparable to that of the suture technique.
Assuntos
Nervo Mediano/fisiologia , Regeneração Nervosa , Próteses e Implantes , Técnicas de Sutura , Eletrofisiologia , Humanos , Macaca fascicularis , Teste de Materiais , Nervo Mediano/cirurgia , Regeneração Nervosa/fisiologia , Ácido Poliglicólico/uso terapêutico , Resultado do TratamentoRESUMO
A 37-year-old white male experienced unexpected postoperative bleeding after fasciotomy and decompression for left pronator and compartment syndromes of the forearm. He was subsequently diagnosed with a mild form of hemophilia A. One year later, surgery was required for right pronator and compartment syndromes. Pre- and postoperative cryoprecipitate infusions controlled bleeding following the second operation until the patient discontinued his infusions, resulting in a wound hematoma. Covert mild hemophilia is implicated in the pathogenesis of his compartment syndromes.
Assuntos
Síndromes Compartimentais/cirurgia , Antebraço/cirurgia , Hemofilia A/complicações , Hemorragia/cirurgia , Síndromes de Compressão Nervosa/cirurgia , Esforço Físico/fisiologia , Complicações Pós-Operatórias/cirurgia , Adulto , Síndromes Compartimentais/sangue , Fator VIII/metabolismo , Antebraço/inervação , Hemofilia A/sangue , Hemorragia/sangue , Humanos , Masculino , Síndromes de Compressão Nervosa/sangue , Tempo de Tromboplastina Parcial , Complicações Pós-Operatórias/sangue , ReoperaçãoRESUMO
Eight hundred twenty-one median nerves were retrospectively and prospectively reviewed for variations during operations to treat carpal tunnel syndrome. Ninety-two cadaver median nerves were also dissected to document the incidence of variations within the carpal canal. The combined incidence of anomalies at operation (Lanz groups 1 to 4) was 9.8% and in the cadaver series 18%. The discrepancy reported by Poisel, 54% in the Lanz group 1 series, versus ours of 1.42% cannot be explained.
Assuntos
Síndrome do Túnel Carpal/cirurgia , Nervo Mediano/anatomia & histologia , Humanos , Nervo Mediano/anormalidades , Estudos Prospectivos , Estudos RetrospectivosAssuntos
Dedos , Mãos/cirurgia , Torniquetes , Dedos/irrigação sanguínea , Dedos/patologia , Humanos , Necrose , Pressão/efeitos adversosAssuntos
Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Masculino , Nervo Mediano/cirurgiaRESUMO
This paper reports four cases of trigger finger that resulted from partial laceration of the flexor tendons. Of the four cases, there were one profundus and three superficialis tendons in three males and one female, ranging from 13 to 36 years of age. They were all treated surgically by excision of the "tag" with full functional recovery.