Hemoglobin concentration is an independent determinant of heart failure in acute coronary syndromes: cohort analysis of 2310 patients.

Background: Anemia is an important determinant of heart failure and death after ST elevation myocardial infarction (STEMI). The frequency of anemia and its impact on these outcomes across the range of acute coronary syndromes (ACS), however, have not been defined.

Methods: This is a cohort study of 2310 patients with ACS stratified by quartiles of admission hemoglobin concentration [Hb]): Q1, <12.

A novel fluorescence-based cellular permeability assay.

Vascular permeability is a pathologic process in many disease states ranging from metastatic progression of malignancies to ischemia-reperfusion injury. In order to more precisely study tissue, and more specifically cell layer permeability, our goal was to create a fluorescence-based assay which could quantify permeability without radioactivity or electrical impedance measurements. Human aortic endothelial cells were grown in monolayer culture on Costar-Transwell clear polyester membrane 6-well cell culture inserts.

Prevalence of beta-thalassemia trait in premarital screening in Al-Hassa, Saudi Arabia.

Background: The Al-Hassa area is one of the regions in Saudi Arabia where hemoglobinopathies are prevalent. The Saudi Ministry Of Heath designed a protocol for premarital testing after the royal decree in December 2003. The protocol was implemented in a February 2004 order.

Insulin-induced hypoglycemia suppresses plasma parathyroid hormone levels in patients with adrenal insufficiency.

Hypoglycemia has been reported to cause suppression of parathyroid hormone (PTH) levels in serum in normal subjects. It is possible that increasing cortisol levels in response to hypoglycemia was responsible. To examine this possibility the acute PTH response to insulin administration and resulting hypoglycemia was examined in patients with adrenal insufficiency.

The effect of diabetes on heart rate and other determinants of myocardial oxygen demand in acute coronary syndromes.

Aims: To compare major determinants of myocardial oxygen demand (heart rate, blood pressure and rate pressure product) in patients with and without diabetes admitted with acute coronary syndromes.

Methods: A cross-sectional study of the relation between diabetes and haemodynamic indices of myocardial oxygen demand in 2542 patients with acute coronary syndromes, of whom 1041 (41.0%) had acute myocardial infarction and 1501 (59.

Frequent misdiagnosis and mismanagement of hyperprolactinemic patients before the introduction of macroprolactin screening: application of a new strict laboratory definition of macroprolactinemia.

Background: Macroprolactin (big big prolactin) has reduced bioactivity and is measured by immunoassays for prolactin when it accumulates in the plasma of some individuals. We applied normative data for serum prolactin after treatment of sera to remove macroprolactin to elucidate the contribution of macroprolactin to misleading diagnoses, inappropriate investigations, and unnecessary treatment.

Methods: We reviewed records of women attending a tertiary referral center who had prolactin >1000 mIU/L.

The impact of different glucocorticoid replacement schedules on bone turnover and insulin sensitivity in patients with adrenal insufficiency.

Objective: Optimization of physiological replacement of glucocorticoid in patients with adrenal insufficiency is controversial. The present study was undertaken to compare the relative impact of three different regimes of glucocorticoid replacement in patients with adrenal insufficiency on parameters of bone turnover and insulin sensitivity.

Patients: Six female and three male patients with adrenal insufficiency and 17 female and 14 male control subjects participated.

A single serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes.

Objectives: To analyse the relation between serum glucose concentration and hospital outcome across the whole spectrum of acute coronary syndromes.

Methods: This was a prospective cohort study of 2127 patients presenting with acute coronary syndromes. The patients were stratified into quartile groups (Q1 to Q4) defined by serum glucose concentrations of 5.

Acute thrombosis of abdominal aortic aneurysms--report of two cases and review of the literature.

An acutely thrombosed abdominal aortic aneurysm (AAA) is a rare but devastating complication of aortic aneurysms. Incidence in reported series is approximately 0.7-2.

Effect of diabetes on serum potassium concentrations in acute coronary syndromes.

Objectives: To compare serum potassium concentrations in diabetic and non-diabetic patients in the early phase of acute coronary syndromes.

Background: Acute phase hypokalaemia occurs in response to adrenergic activation, which stimulates membrane bound sodium-potassium-ATPase and drives potassium into the cells. It is not known whether the hypokalaemia is attenuated in patients with diabetes because of the high prevalence of sympathetic nerve dysfunction.

Gross variability in the detection of prolactin in sera containing big big prolactin (macroprolactin) by commercial immunoassays.

A high molecular mass form of prolactin (PRL), macroprolactin, accumulates in the sera of some subjects. Although macroprolactin exhibits limited bioactivity in vivo, it retains immunoreactivity. We examined the frequency of macroprolactinemia in clinical practice and the ability of immunoassay systems to distinguish between macroprolactin and monomeric PRL.

Interaction between arrival time and thrombolytic treatment in determining early outcome of acute myocardial infarction.

Background: Shortening prehospital delay has been identified as an important means of improving responses to reperfusion treatment. If this increases the risk profile of the population delivered to hospital, it may paradoxically cause a deterioration in hospital mortality.

Objective: To examine the interaction between arrival time (time from onset of chest pain to arrival at hospital) and thrombolytic treatment in determining the early outcome of acute myocardial infarction.

The low-dose ACTH test does not provide a useful assessment of the hypothalamic-pituitary-adrenal axis in secondary adrenal insufficiency.

Objective: The 1 microg ACTH stimulation test has been introduced to improve the sensitivity of ACTH as a test of the integrity of hypothalamic-pituitary-adrenal axis (HPAA). This study aims to compare the sensitivity, specificity and diagnostic accuracy of the "low-dose" 1 microg ACTH (LDACTH) test and the "standard dose" 250 microg ACTH (SDACTH) test, with the overnight metyrapone test (OMT) which assesses the entire HPAA.

Design: A prospective evaluation of the performance of SDACTH and LDACTH screening tests in a diverse cohort of patients with possible adrenal insufficiency as routinely encountered in clinical practice using the OMT as the reference method.

Intracellular mechanisms of TRAIL: apoptosis through mitochondrial-dependent and -independent pathways.

Tumor necrosis (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF family of cytokines that promotes apoptosis. TRAIL induces apoptosis via death receptors (DR4 and DR5) in a wide variety of tumor cells but not in normal cells. The objectives of this study are to investigate the intracellular mechanisms by which TRAIL induces apoptosis.

Socioeconomic differentials in recurrent ischaemia and mortality after acute myocardial infarction.

Objective: To examine the influence of socioeconomic deprivation on case fatality following acute myocardial infarction.

Design: Prospective cohort observational study.

Setting: General hospital.

Changing face of acute myocardial infarction in east London: a prospective cohort study of trends in management and outcome in the reperfusion era.

Aims: To define the trends in management and outcome of acute myocardial infarction over the first decade since the widespread adoption of thrombolytic therapy.

Methods: Prospective cohort study of 1737 consecutive patients with acute myocardial infarction admitted for coronary care between January 1988 and December 1997.

Results: Trend analysis with comparison of early (1988-1992) and late (1993-1997) cohorts showed significant increments in median age (interquartile range) from 62 (54-70) to 64 (55-72) years (P < 0.

Failure of Bcl-2 to block mitochondrial dysfunction during TRAIL-induced apoptosis. Tumor necrosis-related apoptosis-inducing ligand.

Tumor necrosis (TNF)-related apoptosis-inducing ligand (TRAIL) is a member of the TNF family of cytokines that promotes apoptosis. TRAIL induces apoptosis in a wide variety of tumor cells but not in normal cells. Oncogene Bcl-2 can protect cells from apoptosis induced by various stress stimuli.

Acute myocardial infarction in women: contribution of treatment variables to adverse outcome.

Background: Women have excessive mortality rates after acute myocardial infarction compared with men. The extent to which this increased risk can be attributed to differences in treatment is not well-understood.

Methods: This was an observational follow-up study of 1737 patients admitted with acute myocardial infarction for coronary care between January 1, 1988, and December 31, 1997.

Hyperprolactinaemia: analysis of presentation, diagnosis and treatment in the endocrine service of a general hospital.

The charts of 184 patients with clinically significant hyperprolactinaemia who presented to a teaching hospital between 1978-1995 were reviewed, 158 (86%) females and 26 (14%) males. Hyperprolactinaemia was due to a microadenoma or was idiopathic in 36.4%, drug induced in 16%, associated with a macroadenoma in 12%, due to epilepsy in 7%, with other causes each contributing 5% or less.

Influence of previous aspirin treatment and smoking on the electrocardiographic manifestations of injury in acute myocardial infarction.

Objective: To examine demographic and clinical characteristics of patients with acute myocardial infarction in order to identify factors affecting the electrocardiographic evolution of injury.

Methods: Prospective cohort study of 1399 consecutive patients with a first myocardial infarction. Baseline clinical data associated with ST elevation and Q wave development were identified and 12 month survival was estimated.

Clinical characteristics determining the mode of presentation in patients with acute coronary syndromes.

Objectives: The purpose of this study was to examine clinical characteristics of patients with acute coronary syndromes to identify factors that influence the mode of presentation.

Background: In acute coronary syndromes, presentation with myocardial infarction or unstable angina has major prognostic implications, yet clinical factors affecting the mode of presentation are not well defined.

Methods: A prospective cohort study was made of 1,111 patients with acute coronary syndromes.

Computer-generated correspondence for patients attending an open-access chest pain clinic.

Aim: To determine whether general practitioners (GPs) prefer structured computer-generated or standard dictated outpatient clinic letters.

Design: Questionnaire survey of all GPs referring patients to an open-access chest pain clinic at a district general hospital in London. The GPs were asked to compare three twinned examples of structured computer-generated and unstructured dictated letters.

The fanconi anemia pathway requires FAA phosphorylation and FAA/FAC nuclear accumulation.

Fanconi anemia (FA) is an autosomal recessive cancer susceptibility syndrome with at least eight complementation groups (A-H). Two FA genes, corresponding to complementation groups A and C, have been cloned, but the function of the FAA and FAC proteins remains unknown. We have recently shown that the FAA and FAC proteins bind and form a nuclear complex.