RESUMEN

Adrenocortical carcinoma (ACC) is a rare cancer with poor prognosis. Pan-genomic analyses identified p53/Rb and WNT/ß-catenin signaling pathways as main contributors to the disease. However, isolated ß-catenin constitutive activation failed to induce malignant progression in mouse adrenocortical tumors. Therefore, there still was a need for a relevant animal model to study ACC pathogenesis and to test new therapeutic approaches. Here, we have developed a transgenic mice model with adrenocortical specific expression of SV40 large T-antigen (AdTAg mice), to test the oncogenic potential of p53/Rb inhibition in the adrenal gland. All AdTAg mice develop large adrenal carcinomas that eventually metastasize to the liver and lungs, resulting in decreased overall survival. Consistent with ACC in patients, adrenal tumors in AdTAg mice autonomously produce large amounts of glucocorticoids and spontaneously activate WNT/ß-catenin signaling pathway during malignant progression. We show that this activation is associated with downregulation of secreted frizzled related proteins (Sfrp) and Znrf3 that act as inhibitors of the WNT signaling. We also show that mTORC1 pathway activation is an early event during neoplasia expansion and further demonstrate that mTORC1 pathway is activated in ACC patients. Preclinical inhibition of mTORC1 activity induces a marked reduction in tumor size, associated with induction of apoptosis and inhibition of proliferation that results in normalization of corticosterone plasma levels in AdTAg mice. Altogether, these data establish AdTAg mice as the first preclinical model for metastatic ACC.

Asunto(s)

Carcinoma Corticosuprarrenal/patología , Antígenos Transformadores de Poliomavirus/genética , Proteína de Retinoblastoma/fisiología , Proteína p53 Supresora de Tumor/fisiología , Animales , Humanos , Diana Mecanicista del Complejo 1 de la Rapamicina , Ratones , Ratones Transgénicos , Complejos Multiproteicos/fisiología , Metástasis de la Neoplasia , Proteína de Retinoblastoma/antagonistas & inhibidores , Sirolimus/farmacología , Serina-Treonina Quinasas TOR/fisiología , Proteína p53 Supresora de Tumor/antagonistas & inhibidores , Vía de Señalización Wnt/fisiología , beta Catenina/fisiología

RESUMEN

Adrenocortical cancer (ACC) is a very aggressive tumor, and genomics studies demonstrate that the most frequent alterations of driver genes in these cancers activate the Wnt/ß-catenin signaling pathway. However, the adrenal-specific targets of oncogenic ß-catenin-mediating tumorigenesis have not being established. A combined transcriptomic analysis from two series of human tumors and the human ACC cell line H295R harboring a spontaneous ß-catenin activating mutation was done to identify the Wnt/ß-catenin targets. Seven genes were consistently identified in the three studies. Among these genes, we found that AFF3 mediates the oncogenic effects of ß-catenin in ACC. The Wnt response element site located at nucleotide position -1408 of the AFF3 transcriptional start sites (TSS) mediates the regulation by the Wnt/ß-catenin signaling pathway. AFF3 silencing decreases cell proliferation and increases apoptosis in the ACC cell line H295R. AFF3 is located in nuclear speckles, which play an important role in RNA splicing. AFF3 overexpression in adrenocortical cells interferes with the organization and/or biogenesis of these nuclear speckles and alters the distribution of CDK9 and cyclin T1 such that they accumulate at the sites of AFF3/speckles. We demonstrate that AFF3 is a new target of Wnt/ß-catenin pathway involved in ACC, acting on transcription and RNA splicing.

RESUMEN

We describe the effect of influenza-like illness (ILI) during the outbreak of pandemic (H1N1) 2009 on health care worker (HCW) absenteeism and compare the effectiveness and cost of 2 sick leave policies for HCWs with suspected influenza. We assessed initial 2-day sick leaves plus reassessment until the HCW was asymptomatic (2-day + reassessment policy), and initial 7-day sick leaves (7-day policy). Sick leaves peaked in August 2009: 3% of the workforce received leave for ILI. Costs during May-October reached R$798,051.87 (≈US $443,362). The 7-day policy led to a higher monthly rate of sick leave days per 100 HCWs than did the 2-day + reassessment policy (8.72 vs. 3.47 days/100 HCWs; p<0.0001) and resulted in higher costs (US $609 vs. US $1,128 per HCW on leave). ILI affected HCW absenteeism. The 7-day policy was more costly and not more effective in preventing transmission to patients than the 2-day + reassessment policy.

Asunto(s)

Personal de Salud , Política de Salud/economía , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/economía , Gripe Humana/epidemiología , Ausencia por Enfermedad/economía , Absentismo , Brasil/epidemiología , Análisis Costo-Beneficio , Brotes de Enfermedades/economía , Hospitales de Enseñanza/economía , Hospitales de Enseñanza/estadística & datos numéricos , Humanos , Gripe Humana/prevención & control , Ausencia por Enfermedad/estadística & datos numéricos

Asunto(s)

Hiperplasia Suprarrenal Congénita/genética , Hiperplasia Suprarrenal Congénita/enzimología , Animales , Subunidad RIalfa de la Proteína Quinasa Dependiente de AMP Cíclico/genética , Modelos Animales de Enfermedad , Lateralidad Funcional , Ratones

RESUMEN

A human case of swine influenza A (H1N1) in a 50-year-old woman from a village near Teruel (Aragon, in the north-east of Spain), with a population of about 200 inhabitants, has been reported in November 2008.

Asunto(s)

Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/diagnóstico , Agricultura , Animales , Femenino , Humanos , Gripe Humana/fisiopatología , Persona de Mediana Edad , España , Porcinos

RESUMEN

We established cell lines from adrenal tumors of transgenic mice harboring the large T-antigen of simian virus 40 under the control of the adrenocortical specific promoter of the scavenger aldose reductase-like akr1b7 gene. Mass spectrometry analyses of serum-supplemented or serum-free culture media showed that ATC1 line secreted only corticosterone. These cells, propagated over 25 passages, were characterized with regard to ACTH and PRL responsiveness, as measured by increased corticosterone production, induction of genes involved in the different steps of steroidogenesis (cholesterol delivery, steroid biosynthesis and detoxification of by-products) and expression of transcriptional regulators (SF-1 and DAX1). Corticosterone secretion (RIA) in serum-free medium was stimulated over 12-fold after 6 h treatment with either 10(-9)M ACTH or PRL and both hormones seemed equivalent in promoting this secretion (149 +/- 14 ng and 145 +/- 18 ng/10(6) cells/6 h, respectively). As expected, Northern blots indicate that ATC1 cells expressed mRNAs for the enzymes of corticosterone metabolism CYP11B1 and CYP21A, as well as those for the proteins SIK, SRB1, StAR, CYP11A1, and AKR1B7. Interestingly, these cells have maintained not only the expression of SF-1 but also that of DAX1. No expression of the zona glomeruloza-specific cyp11b2 gene was detected. With the exception of cyp21a and mc2r genes which were constitutively expressed, most of the genes above mentioned were induced in a time- and dose-dependent fashion in response to ACTH or PRL while DAX1 was repressed. Importantly, hormone-mediated repression of DAX1 gene expression was also observed in vivo in mice adrenals. Altogether these data demonstrate that ATC1 line provided an unique model of well differentiated zona fasciculata immortalized cells suitable for the dissection of molecular events leading to ACTH and PRL regulation of adrenal functions.

Asunto(s)

Neoplasias de la Corteza Suprarrenal/genética , Neoplasias de la Corteza Suprarrenal/metabolismo , Hormona Adrenocorticotrópica/farmacología , Línea Celular Tumoral , Marcación de Gen , Prolactina/farmacología , Neoplasias de la Corteza Suprarrenal/patología , Animales , Antígenos Transformadores de Poliomavirus/genética , Expresión Génica/efectos de los fármacos , Masculino , Ratones , Ratones Transgénicos , Esteroides/metabolismo

Asunto(s)

Aldehído Reductasa , Proteínas de Unión al ADN/fisiología , Regulación de la Expresión Génica/fisiología , Proteínas/genética , Factores de Transcripción/fisiología , Animales , Factores de Transcripción Fushi Tarazu , Proteínas de Homeodominio , Ratones , Receptores Citoplasmáticos y Nucleares , Factor Esteroidogénico 1

RESUMEN

Mvdp/akr1-b7 encodes an aldose-reductase-like enzyme expressed in the zona fasciculata of the adrenal cortex, the function of which is essential for the detoxification of the cholesterol side chain cleavage product, isocaproaldehyde. The -510/+41 akr1-b7 promoter fragment is able to reproduce the endogenous gene zona fasciculata restricted, ACTH-controlled expression, in transgenic mice adrenals. Here, we report that three response elements contained within this promoter (positions -102, -458, -503) are able to bind SF-1, the essential regulator of steroidogenesis, although the low affinity site at -503 retains some other specific proteins present in Y1 nuclear extracts. Mutation of the -102 site results in a lowering of the activity of the -510/+41 promoter in Y1 cells, whereas mutation of the -458 site induces a reduction both in the global activity and forskolin sensitivity of the promoter. Interestingly, differential mutations of the -503 site nucleotides either induce an increase or a decrease in the basal and forskolin-induced activity.

Asunto(s)

Aldehído Reductasa , Proteínas de Unión al ADN/metabolismo , Regulación de la Expresión Génica/fisiología , Proteínas/genética , Factores de Transcripción/metabolismo , Corteza Suprarrenal/citología , Corteza Suprarrenal/metabolismo , Animales , Sitios de Unión/fisiología , Línea Celular , Factores de Transcripción Fushi Tarazu , Proteínas de Homeodominio , Fragmentos de Péptidos/genética , Regiones Promotoras Genéticas/fisiología , Receptores Citoplasmáticos y Nucleares , Elementos de Respuesta/fisiología , Factor Esteroidogénico 1

RESUMEN

The MVDP (mouse vas deferens protein) gene encodes an aldose reductase-like protein (AKR1B7) highly expressed in vas deferens epithelium and zona fasciculata of the adrenal cortex. Recombinant MVDP showed kinetic properties distinct from those of aldose reductase, including its spectrum of substrates, cofactor preference and sensitivity to inhibitors. We demonstrate that in adrenocortical cells, MVDP, rather than aldose reductase, is the principal reductase for isocaproaldehyde (a product of side-chain cleavage of cholesterol) and 4-hydroxynonenal (a lipid peroxidation product). In steroidogenic tissues MVDP expression is regulated by pituitary trophic hormones, namely ACTH in adrenals, FSH in ovaries, and LH in testicular Leydig cells.

Asunto(s)

Aldehído Reductasa/metabolismo , Proteínas/metabolismo , Esteroides/biosíntesis , Conducto Deferente/metabolismo , Corteza Suprarrenal/metabolismo , Aldehído Reductasa/genética , Aldehídos/metabolismo , Animales , Caproatos/metabolismo , Línea Celular , Cloranfenicol O-Acetiltransferasa/genética , AMP Cíclico/farmacología , Femenino , Genes Reporteros , Cobayas , Humanos , Inmunohistoquímica , Masculino , Ratones , Proteínas/genética , ARN sin Sentido/genética , Ratas , Especificidad de la Especie , Conducto Deferente/enzimología

RESUMEN

The MVDP (mouse vas deferens protein) gene encodes an aldose reductase-like protein (AKR1B7) that is responsible for detoxifying isocaproaldehyde generated by steroidogenesis. In adrenocortical cell cultures, hormonal regulation of MVDP gene occurs through the cAMP pathway. We show that in adrenals, the pituitary hormone ACTH regulates MVDP gene expression in a coordinate fashion with steroidogenic genes. Cell transfection and DNA-binding studies were used to investigate the molecular mechanisms underlying MVDP gene regulation in Y1 adrenocortical cells. Progressive deletions of upstream regulatory regions identified a -121/+41 fragment that was sufficient for basal and cAMP-mediated transcriptional activities. Gel shift assays showed that CTF1/nuclear factor 1 (NF1), CCAAT enhancer binding protein-ss (C/EBPss), and selective promoter factor 1 (Sp1) factors bound to cis-acting elements at positions -76, -61, and -52, respectively. We report that the cell-specific steroidogenic factor-1 (SF-1) interacts specifically with a novel regulatory element located in the downstream half-site of the proximal androgen response element (AREp) at position -102. Functional analysis of SF-1 and NF1 sites in the -121/+41 promoter showed that mutation of one of them decreases both constitutive and forskolin-stimulated promoter activity without affecting the fold induction (forskolin stimulated/basal). Individual mutations of C/EBP and Sp1 sites resulted in a loss of more than 50% of the cAMP-dependent induction. When both sites were mutated simultaneously, cAMP responsiveness was nearly abolished. Thus, in adrenocortical cells, both SF-1 and NF1 are required for high expression of the MVDP promoter while Sp1 and C/EBPss functionally interact in an additive manner to mediate cAMP-dependent regulation. Furthermore, we report that MVDP gene regulation is impaired in stably transfected Y1 clones expressing DAX-1. Taken together, our findings suggest that detoxifying enzymes of the aldose reductase family may constitute new potential targets for regulators of adrenal and gonadal differentiation and function, e.g. SF-1 and DAX-1.

Asunto(s)

Corteza Suprarrenal/enzimología , Aldehído Reductasa/genética , Proteínas Potenciadoras de Unión a CCAAT/fisiología , Proteínas de Unión al ADN/fisiología , Proteínas Represoras , Factor de Transcripción Sp1/fisiología , Factores de Transcripción/fisiología , Aldo-Ceto Reductasas , Animales , Secuencia de Bases , Sitios de Unión , Proteínas Potenciadoras de Unión a CCAAT/química , Proteínas Potenciadoras de Unión a CCAAT/genética , Línea Celular , Células Cultivadas , Colforsina/farmacología , AMP Cíclico/farmacología , Receptor Nuclear Huérfano DAX-1 , ADN/química , ADN/metabolismo , Proteínas de Unión al ADN/química , Proteínas de Unión al ADN/genética , Proteínas de Unión al ADN/farmacología , Factores de Transcripción Fushi Tarazu , Regulación Enzimológica de la Expresión Génica/efectos de los fármacos , Proteínas de Homeodominio , Masculino , Ratones , Mutagénesis Sitio-Dirigida , Factores de Transcripción NFI , ARN Mensajero/análisis , Receptores Citoplasmáticos y Nucleares , Receptores de Ácido Retinoico , Secuencias Reguladoras de Ácidos Nucleicos , Factor de Transcripción Sp1/química , Factor de Transcripción Sp1/genética , Factor Esteroidogénico 1 , Relación Estructura-Actividad , Factores de Transcripción/química , Factores de Transcripción/genética , Factores de Transcripción/farmacología

RESUMEN

Sequential angiographic follow-up is needed for interpreting coronary events that occur after successful percutaneous translumial coronary angioplasty (PTCA). One hundred eight consecutive patients who had undergone successful dilatation were followed for 10 years, and quantitative sequential angiograms were recorded at 6 months (n = 101) and 10 years (n = 68). The 10-year event rate was: 5.8 +/- 2.4% for cardiac death, 9.7 +/- 3.3% for Q-wave acute myocardial infarction, 18.3 +/- 4.5% for additional surgery, and 22.4 +/- 4.9% for repeated angioplasty. Using Cox's proportional-hazards regression, multivessel coronary artery disease (CAD) (RR 5.6; 95% confidence intervals [CI] 1.2 to 24.7; p = 0.02), restenosis within 6 months (RR 7.8; 95% CI 3.1 to 20.0; p = 0.0001), and CAD progression over 10 years (RR 10.6; 95% CI 1.3 to 87.1; p = 0.004) were the strongest predictors of all-cause death, repeated PTCA, and additional surgery, respectively, after controlling for age and coronary risk factors. The minimal luminal diameter of 48 narrowings with complete sequential angiographic follow-up and without restenosis remained stable from 6 months (2.13 +/- 0.60 mm) to 10 years (2.18 +/- 0.61 mm). Disease progression was similar in nondilated arteries and dilated arteries (32% vs 30%). The 10-year risk of coronary events was higher in patients with baseline multivessel CAD than in those with 1-vessel CAD because of more frequent progression of CAD (RR 3.8; 95% CI 1.6 to 6.8; p = 0.001). Thus, early cardiac events after successful PTCA were related to restenosis, and late events to CAD progression. Nevertheless, after the restenosis period, the target lesion remained stable for the next 10 years. Coronary disease progression was not related to the angioplasty procedure.

Asunto(s)

Angioplastia Coronaria con Balón , Angiografía Coronaria , Causas de Muerte , Puente de Arteria Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Cardiopatías/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Estudios Prospectivos , Recurrencia , Retratamiento , Factores de Riesgo

RESUMEN

A 54-year-old female presented with dyspnea on exertion and wheezing, with a negative response to inhaled beta-2 stimulating drugs and intravenous glucocorticoids. The major values of basal spirometric study were normal; however, the morphology of the flow-volume curve showed intrathoracic obstruction of large airways, with negative response to beta stimulating drugs. The bronchial provocative test with histamine was normal. Chest radiographs only showed a mild widening of the median mediastinum with left anterior tracheal displacement. Nuclear magnetic resonance showed a right aortic arch with tracheal strangulation.

Asunto(s)

Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Asma/diagnóstico , Diagnóstico Diferencial , Disnea/etiología , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Esfuerzo Físico , Radiografía , Tráquea/diagnóstico por imagen

RESUMEN

We report two cases of eosinophilic cystitis in children of 11 months and 11 and a half year of age respectively. The presenting symptoms were the emision of mucosanguinolent filaments in the urine in one case and with lower urinary tract symptoms and macroscopic hematuria in the other. Physical examination revealed in one of them a round, tough and painful mass in the hypogastric area. In one case we found peripheral blood eosinophilia. They both showed in the Urinalysis albuminuria, pyuria and hematuria, with the presence of eosinophils in one of them. Macroscopic examination presented in the two cases a tumoral, mamelonne mass in the wall of the bladded. The diagnosis was anatomopathologic due to the demonstration of an inflammatory infiltration, primarily of eosinophils. The clinical course was unfavourable in the case an hemicystectomy was practicated and self-limited in the one only symptomatic treatment was used.

Asunto(s)

Cistitis/orina , Eosinofilia/orina , Niño , Cistitis/diagnóstico , Eosinofilia/diagnóstico , Femenino , Humanos , Lactante , Masculino , Orina/análisis , Urografía

RESUMEN

Repeat coronary angiography was performed within 6 months after successful percutaneous transluminal coronary angioplasty (PTCA) in 178 of our first 181 patients (98%). The remaining 3 patients were symptom free, had negative treadmill exercise test results and were considered not to have had restenosis. A second follow-up angiogram was performed in 107 patients (59%), including all patients with persistent or recurrent anginal symptoms, between 7 and 18 months after PTCA. Fifty-one of the 181 patients (28%) had restenosis on 51 of 205 successfully dilated segments (25%). The stenosis was greater than or equal to 70% in 49 of these 51 segments; it was 65% and 55%, respectively, in the 2 remaining patients. Restenosis was documented angiographically at a median time of 4.7 +/- 4 months. However, 47 patients (92%) had restenosis documented within 6 months, 2 between 7 and 12 months and 2 between 13 and 18 months after PTCA. Stepwise logistic regression analysis selected the following factors as independent predictors of restenosis after PTCA: variant angina, multivessel disease, severity of residual stenosis and less reduction in the diameter of the stenosis on the angiogram immediately after PTCA. Of these 4 factors, the degree of residual stenosis immediately after PTCA was by far the most significant. It is concluded that restenosis occurs in approximately 25% of patients, almost always within the first 6 months, after successful PTCA. The degree of residual stenosis after PTCA is the most important predictor of restenosis. Increased experience and improved instrumentation may eventually lead to less residual stenosis and better late results after PTCA.

Asunto(s)

Angioplastia de Balón , Enfermedad Coronaria/terapia , Angiografía Coronaria , Enfermedad Coronaria/diagnóstico por imagen , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Quebec , Recurrencia , Análisis de Regresión , Riesgo , Factores de Tiempo

RESUMEN

Restenosis is the main problem limiting long-term success of percutaneous transluminal coronary angioplasty (PTCA) and is most accurately evaluated by follow-up angiography. We compared the primary and long-term results of angioplasty in 268 consecutive patients (293 segments) with first PTCA (PTCA 1, angiographic follow-up 98%) and in 66 patients (76 segments) with repeat PTCA after restenosis (PTCA 2, angiographic follow-up 92%). Forty clinical, angiographic and procedural factors were assessed in relation to outcome. Primary success rate was higher in PTCA 2 (91% vs 67.5%) and major complications were fewer (4.5% vs 16%). Higher inflation pressure (7.9 +/- 2.3 vs 6.8 +/- 1.8 atm, P less than 0.005) and larger balloons (3.5 +/- 0.5 vs 3.2 +/- 0.5 mm, P less than 0.005) were used for PTCA 2, resulting in lesser residual stenosis (33 +/- 16% vs 40 +/- 18%, P less than 0.05). Restenosis rate (greater than or equal to 70%) after PTCA 1 and after PTCA 2 (27% vs 36%, P = NS) and the mean time to recurrence (4.7 vs 5.3 months, P = NS) were similar. Procedural factors were the main determinants of long-term success in primary PTCA. The restenosis risk was independently related to residual stenosis greater than or equal to 45% (P less than 0.001), variant angina (P less than 0.05) and multivessel disease (P less than 0.05) after PTCA 1 and to male sex (P less than 0.001) and higher inflation pressure (P less than 0.05) after PTCA 2. Mild to moderate intimal tearing was associated with less restenosis after PTCA 1, but not after PTCA 2. Including 9 patients (10 segments) with a third PTCA, 70% of the 66 patients with repeat PTCA had a successful long-term outcome. Repeat angioplasty should therefore be considered as an integral part of PTCA therapy. Restenosis however remains a major concern. An optimal primary result with a minimal residual stenosis is decisive for first PTCA, whereas avoidance of a dissection by using lower inflation pressure on a restenosis might improve the long-term outcome of repeat PTCA.

Asunto(s)

Angioplastia de Balón , Enfermedad Coronaria/terapia , Adulto , Angiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia

RESUMEN

Among 268 patients undergoing percutaneous transluminal coronary angioplasty between February 1980 and January 1983, a total of 21 patients had variant angina, documented before angioplasty in 14 and after angioplasty in 7. Before angioplasty, all 21 patients had rest angina and 17 also had effort angina; single vessel coronary artery disease with 60 to 95% stenosis was present in all patients and the left anterior descending coronary artery was involved in all but 3 patients. Coronary angioplasty was successful in 19 patients (90%). Eight of the 19 patients remained symptom-free without coronary restenosis after successful angioplasty; in the other 11 patients, angina reappeared within 4 months, usually in association with restenosis. Of the nine patients with coronary restenosis, six had repeat angioplasty (five successful procedures and one failure), two received medical therapy and one underwent coronary bypass surgery. Patients in whom calcium channel antagonists were discontinued immediately after angioplasty had an exceedingly high coronary restenosis rate (8 [80%] of 10 successful attempts), but when calcium antagonists were continued for an average of 6 +/- 4 months after angioplasty, the restenosis rate was low (3 [21%] of 14 successful attempts). After a mean (+/- SD) follow-up period of 33 +/- 13 months, 1 patient had died and the 20 others (95%) were symptom-free; among these 20, 15 patients (75%) had been taking no antianginal drugs for more than 1 year, 2 still received calcium channel antagonists and 3 had had coronary bypass surgery. Repeat coronary arteriography performed 14 +/- 7 months after angioplasty in the 17 patients without angioplasty-related infarction or surgery showed 50% or less coronary stenosis in 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

Angina Pectoris Variable/terapia , Angioplastia de Balón , Adulto , Anciano , Angina Pectoris Variable/diagnóstico por imagen , Angina Pectoris Variable/fisiopatología , Bloqueadores de los Canales de Calcio/uso terapéutico , Constricción Patológica , Angiografía Coronaria , Vasoespasmo Coronario/etiología , Vasos Coronarios/patología , Vasos Coronarios/fisiopatología , Electrocardiografía , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia

RESUMEN

This prospective randomized trial was carried out in 92 patients who underwent a successful percutaneous transluminal coronary angioplasty (PTCA) and had no evidence of coronary spasm before PTCA. All patients were premedicated with calcium antagonists and platelet inhibitors and received platelet inhibitors (aspirin and dipyridamole) for 6 months after PTCA. The diltiazem group (46 patients with 50 stenoses successfully dilated) received diltiazem, 90 mg three times a day by mouth for 3 months after PTCA; in the control group (46 patients, 53 stenoses), calcium antagonists were discontinued immediately after PTCA. All patients underwent a control angiogram 5 to 10 months after PTCA unless recurrence of angina dictated its need earlier. Baseline characteristics were similar in both groups, except for the number of diseased vessels greater than or equal to 70%, which was higher in the control group (1.2 +/- 0.55 vs 0.9 +/- 0.39 for the diltiazem group, p less than 0.05). In the diltiazem group, the degree of stenosis increased from 38 +/- 15% immediately after PTCA to 42 +/- 23% at repeat angiography 8.24 +/- 4.79 months after PTCA and there were seven restenoses. In the control group, the degree of stenosis increased from 37 +/- 12% to 44 +/- 23% at repeat angiography 8.26 +/- 4.91 months after PTCA and there were 10 restenoses (NS vs the diltiazem group). In conclusion, in patients without variant angina before PTCA, adjunction of diltiazem to platelet inhibitors does not decrease the incidence of restenosis. These data suggest that coronary spasm is not the major mechanism of restenosis.

Asunto(s)

Angioplastia de Balón , Arteriopatías Oclusivas/prevención & control , Benzazepinas/uso terapéutico , Enfermedad Coronaria/prevención & control , Diltiazem/uso terapéutico , Adulto , Angioplastia de Balón/efectos adversos , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/terapia , Ensayos Clínicos como Asunto , Enfermedad Coronaria/diagnóstico por imagen , Enfermedad Coronaria/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Distribución Aleatoria , Recurrencia , Factores de Tiempo

RESUMEN

The socioeconomic benefits of coronary artery dilatation to the individual and the society in general, were assessed in a review of our first 158 cases in which we studied the length of in-patient treatment, the period off work and the number of patients returning to work after six months and one year. The population included 114 men and 44 women with an average age of 50 +/- 10 years, a history of anginal pain of 18.10 +/- 26.13 months, and of resistant angina of 4.33 +/- 5.72 months. Only one artery was diseased in 130 patients (82%), the remaining patients having multivessel disease. Left ventricular function was normal in 76% of the patients under study. Fifteen patients had already finished working at the time of dilatation and were excluded from the study. One hundred and nineteen (84%) of the 142 patients followed-up were still working before dilatation and 112 (79%) returned to work after 6 months. Of the 94 patients with a good initial result of dilatation, 76 returned to work (81%); 12 initial failures were treated medically, and 6 (50%) returned to work (p less than 0.05); 36 initial failures underwent aorto-coronary bypass surgery and 30.83% are back at work. At one year, 89% of the 103 patients followed-up were working, whilst only 83% of this subgroup were working before dilatation. The 91% of the 69 initial successes have returned to work; 71% of the 7 failures treated medically and 95% of the 27 failures who then underwent bypass surgery, have also returned to work.(ABSTRACT TRUNCATED AT 250 WORDS)

Asunto(s)

Angioplastia de Balón/economía , Enfermedad Coronaria/terapia , Adulto , Puente de Arteria Coronaria , Enfermedad Coronaria/rehabilitación , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Estilo de Vida , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Trabajo

RESUMEN

To evaluate the incidence of perioperative myocardial infarction (PMI), serial determinations of serum creatine kinase isoenzymes (CK-MB), electrocardiograms (ECGs), and pyrophosphate myocardial scans were performed in 112 patients undergoing isolated coronary bypass grafting. An abnormal increase in total CK-MB liberation (Q greater than 9.8 IU ml-1 kg) occurred in 25 patients (22.3%), new Q waves were present at ECG in 10 patients (8.9%), and the pyrophosphate myocardial scan was abnormal in 13 patients (11.6%). All tests were negative in 81 patients (72.3%). A diagnosis of PMI was established if confirmed by at least two of the techniques; this diagnosis was made in 15 patients (13.4%). The pattern of CK-MB liberation in patients with a PMI, characterized by a high peak and a prolonged release, was significantly different from that of patients without a PMI. The most important predictive factor for PMI was the duration of myocardial ischemia during the operation. Patients who had a PMI had more frequent early complications, and their prognosis at 2 years showed a 51% probability of remaining free of new cardiac events as compared to 96% for the group of patients without a PMI (p less than 0.001). PMI is not a benign complication of coronary bypass, and its detection appears improved by a combination of diagnostic tests.

Asunto(s)

Puente de Arteria Coronaria/efectos adversos , Infarto del Miocardio/diagnóstico , Adulto , Anciano , Pruebas Enzimáticas Clínicas , Creatina Quinasa/sangre , Electrocardiografía , Femenino , Corazón/diagnóstico por imagen , Humanos , Complicaciones Intraoperatorias , Isoenzimas , Masculino , Persona de Mediana Edad , Mortalidad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/etiología , Complicaciones Posoperatorias , Pronóstico , Cintigrafía

RESUMEN

One thousand consecutive ECG's from an ambulatory population of patients with suspected or proven cardiac disease were evaluated using two versions of the Telemed computerized ECG system. Only minor differences were found between the two programs. In version 6 vs. version 5, 87% vs. 90% of 287 normal ECG's were correctly classified and 93% vs. 96% of abnormal ECG's were correctly classified; the percent of acceptable diagnostic agreement was 86.2% and 87.4% respectively (NS). The sensitivity for arrhythmia detection, transmural inferior infarction and ST-T wave abnormalities was slightly greater in version 6. The increased sensitivity was not accompanied by decreased specificity. The sensitivity for left ventricular hypertrophy decreased from 95.2% to 91.4% in version 6 with a slight increase in specificity (95.2% to 97.0%). In conclusion, criteria changes in the most recent version of the Telemed program have not resulted in a major change in diagnostic performance. Arrhythmia detection is slightly but not significantly improved.

Asunto(s)

Computadores , Electrocardiografía , Cardiopatías/diagnóstico , Adolescente , Adulto , Anciano , Arritmias Cardíacas/diagnóstico , Cardiomegalia/diagnóstico , Niño , Preescolar , Estudios de Evaluación como Asunto , Femenino , Bloqueo Cardíaco/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico