Prognostic value of blood pressure in patients with high vascular risk in the Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial study.

Background: Hypertension guidelines advise aggressive blood pressure (BP) lowering in patients with diabetes or high cardiovascular risk, but supporting evidence is limited. We analysed the impact of BP on cardiovascular events in well treated high-risk patients enrolled in a large clinical trial (Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial).

Methods: Twenty-five thousand five hundred and eighty-eight patients with atherosclerotic disease or diabetes with organ damage, tolerant to angiotensin-converting enzyme inhibitors, were randomized to ramipril, telmisartan or both.

Complex abdominal aortic pathologies: operative and midterm results after pararenal aortic aneurysm and type IV thoracoabdominal aneurysm repair.

The aim of the study was to describe the clinical outcome of pararenal aortic aneurysm (PAAA) and type IV thoracoabdominal aneurysm (TAAA) repair, with special consideration placed on disease-related complications and midterm follow-up. Data were collected retrospectively between 1997 and 2004 for patients with PAAA or type IV TAAA repair. Comorbidities, operative details, and early and late outcome were analyzed to predict disease-related complications.

Cordial connections: molecular ensembles and structures of adhering junctions connecting interstitial cells of cardiac valves in situ and in cell culture.

Remarkable efforts have recently been made in the tissue engineering of heart valves to improve the results of valve transplantations and replacements, including the design of artificial valves. However, knowledge of the cell and molecular biology of valves and, specifically, of valvular interstitial cells (VICs) remains limited. Therefore, our aim has been to determine and localize the molecules forming the adhering junctions (AJs) that connect VICs in situ and in cell culture.

Effect of telmisartan on renal outcomes: a randomized trial.

Background: Angiotensin-receptor blockers (ARBs) blunt progression of advanced diabetic nephropathy, but their long-term renal effects in other patients are not clear.

Objective: To examine the long-term renal effects of telmisartan versus placebo in adults at high vascular risk.

Design: Randomized trial.

Poor validation of medical record ICD-9 diagnoses of gout in a veterans affairs database.

Objective: Diagnostic codes based on medical records or claims data have been used to identify patient populations with gout for important epidemiologic and clinical studies. We evaluated whether we can document the accuracy of such diagnoses by review of medical records and then on direct interviews with a subset of patients.

Methods: Electronic medical records of 289 patients with 2 visits with ICD-9 codes for gout were extensively reviewed to search for documentation of features that would classify patients as having gout by 3 sets of proposed criteria, the American College of Rheumatology (ACR), New York, or Rome criteria.

Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1-2 hypertension.

The antihypertensive effects of telmisartan 80 mg versus valsartan 160 mg, both combined with hydrochlorothiazide (HCTZ) 25 mg, were assessed in a pooled analysis from two large trials with identical study designs in patients with stage 1-2 hypertension. The trials were double-blind with a 4:4:1 randomization scheme to compare once-daily telmisartan 80 mg and HCTZ 25 mg versus once-daily valsartan 160 mg and HCTZ 25 mg versus once-daily placebo on reductions in clinic blood pressure (BP). The primary end point was changes from baseline in BP at the end of 8 weeks.

Febuxostat treatment for gout: what the clinician needs to know.

Febuxostat is a new non-purine based inhibitor of xanthine oxidase that will be a useful addition to the drugs available to treat gout. This short review covers general principles of the management of gout and then focuses on practical aspects and use of febuxostat.

Toward a valid definition of gout flare: results of consensus exercises using Delphi methodology and cognitive mapping.

Objective: To identify, in people known to have gout, the testable, key components of a standard definition of gout flare for use in clinical research.

Methods: Consensus methodology was used to identify key elements of a gout flare. Two Delphi exercises were conducted among different groups of rheumatologists.

Quality of life and disability in patients with treatment-failure gout.

Objective: The relationship between self-reported quality of life and disability and disease severity was evaluated in subjects with treatment-failure gout (n = 110) in a prospective, 52-week, observational study.

Methods: Subjects had symptomatic crystal-proven gout of at least 2 years' duration and intolerance or refractoriness to conventional urate-lowering therapy. Serum uric acid (sUA) concentration, swollen and tender joint counts, frequency and severity of gout flares, tophus assessments, comorbidities, and patient-reported outcomes data [Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire-Damage Index] were collected.

Clinical efficacy and safety of successful longterm urate lowering with febuxostat or allopurinol in subjects with gout.

Objective: To determine longterm urate-lowering efficacy and clinical benefits and safety of therapy with febuxostat or allopurinol in subjects with gout.

Methods: Subjects (n=1086) in this open-label extension study were assigned to fixed-dose daily urate-lowering treatment (ULT) with febuxostat (80 mg or 120 mg) or allopurinol (300 mg). ULT reassignment was permitted during months 1 to 6 to achieve serum urate (SUA) concentrations between 3.

Telmisartan in migraine prophylaxis: a randomized, placebo-controlled trial.

We evaluated telmisartan 80 mg for migraine prophylaxis. Migraine patients (n = 95) with three to seven migraine attacks in 3 months were randomized, double-blind to telmisartan or placebo. The primary end-point was the reduction in the number of migraine days (i.

Reporting standards for endovascular repair of saccular intracranial cerebral aneurysms.

Background And Purpose: The goal of this article is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting on the radiological evaluation and endovascular treatment of intracranial, cerebral aneurysms. These criteria can be used to design clinical trials, to provide uniformity of definitions for appropriate selection and stratification of patients, and to allow analysis and meta-analysis of reported data.

Methods: This article was written under the auspices of the Joint Writing Group of the Technology Assessment Committee, Society of NeuroInterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebrovascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and Section of Stroke and Interventional Neurology of the American Academy of Neurology.

Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis.

Background And Purpose: Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing.

Intracranial dissection during carotid endarterectomy treated by carotid stenting.

Intracranial dissection of the internal carotid artery after carotid endarterectomy (CEA) is a serious complication with a potentially fatal outcome. We report on a 67 male with a symptomatic high grad stenosis of the internal carotid artery. Intraoperative completion angiography showed a thrombotic occlusion and the internal carotid artery (ICA) was resected with interposition of a Dacron graft.

Antihypertensive efficacy of telmisartan vs ramipril over the 24-h dosing period, including the critical early morning hours: a pooled analysis of the PRISMA I and II randomized trials.

Cardiovascular risk is subject to circadian variation, with peak morning incidence of myocardial infarction and stroke correlating with the early morning blood pressure (BP) surge (EMBPS). Ideally, antihypertensive therapy should maintain control of BP throughout the 24-h dosing cycle. In two sister studies, Prospective, Randomized Investigation of the Safety and efficacy of Micardis vs Ramipril Using ABPM (ambulatory BP monitoring) (PRISMA) I and II, BP control was compared in patients with essential hypertension (24-h mean baseline ambulatory BP approximately 148/93 mm Hg) randomized to the angiotensin receptor blocker, telmisartan (80 mg; n=802), or the angiotensin-converting enzyme inhibitor, ramipril (5 or 10 mg; n=811), both dosed in the morning.

Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes.

Background: Perioperative acute ischemic stroke (AIS) is a recognized complication of noncardiac, nonvascular surgery, but few data are available regarding incidence and effect on outcome. This study examines the epidemiology of perioperative AIS in three common surgeries: hemicolectomy, total hip replacement, and lobectomy/segmental lung resection.

Methods: Discharges for patients aged 18 yr or older who underwent any of the surgical procedures listed above were extracted from the Nationwide Inpatient Sample, an administrative database that contains 20% of all discharges from non-Federal hospitals each year, for years 2000 to 2004.

Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study.

Objectives: This 5-yr study assessed urate-lowering and clinical efficacy and safety of long-term febuxostat therapy in subjects with gout. The primary efficacy end-point was reduction to and maintenance of serum urate (sUA) levels < 6.0 mg/dl.

Clinical diagnostic criteria for gout: comparison with the gold standard of synovial fluid crystal analysis.

Background: Several classification or diagnostic criteria sets for gout have been proposed but none validated.

Objective: This small pilot study considered urate crystal identification as the gold standard for diagnosis and compared the clinical aspects of 3 proposed criteria sets with that standard.

Methods: Eighty-two subjects who had synovial fluid analyses in a VA medical center were studied.

Intravascular ultrasound of symptomatic intracranial stenosis demonstrates atherosclerotic plaque with intraplaque hemorrhage: a case report.

Background: Intracranial artery stenosis is assumed to represent atherosclerotic plaque. Catheter cerebral arteriography shows that intracranial stenosis may progress, regress, or remain unchanged. It is counterintuitive that atherosclerotic plaque should spontaneously regress, raising questions about the composition of intracranial stenoses.

Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial.

Objective: To compare the urate-lowering efficacy and safety of febuxostat, allopurinol, and placebo in a large group of subjects with hyperuricemia and gout, including persons with impaired renal function.

Methods: Subjects (n = 1,072) with hyperuricemia (serum urate level > or = 8.0 mg/dl) and gout with normal or impaired (serum creatinine level >1.