Insufficient communication about medication use at the interface between hospital and primary care.

Background: Lack of updated and uniform medication lists poses a problem for the continuity in patient care. The aim of this study was to estimate whether hospitals succeed in making accurate medication lists congruent with patients' actual medication use. Subsequently, the authors evaluated where errors were introduced and the possible implications of incongruent medication lists.

Detection of coronary microembolization by Doppler ultrasound in patients with stable angina pectoris undergoing elective percutaneous coronary interventions.

Background: Intracoronary Doppler guidewires can be used for real-time detection and quantification of microembolism during percutaneous coronary interventions (PCIs). We investigated whether the frequency of Doppler-detected microembolism is related to the incidence of myonecrosis during elective PCI.

Methods And Results: The study population included 52 consecutive patients (aged 64+/-10 years; 36 men, 16 women) with coronary artery disease who underwent elective PCI of a single-vessel stenosis.

Involvement of endothelial NO in the dilator effect of VIP on rat isolated pulmonary artery.

The endothelium and its interaction with smooth muscle play a central role in the local control of the pulmonary vasculature, and endothelial dysfunction is thought to contribute to pulmonary hypertension and chronic obstructive pulmonary disease. Vasoactive intestinal peptide (VIP), a 28-amino acid neuropeptide, relaxes the rat pulmonary artery, but there is controversy as to whether or not this action of VIP depends on the endothelium. The aim of this study, therefore, was to investigate the role of the endothelium and nitric oxide (NO), the major endothelium-derived relaxing factor, in the dilator action of VIP on the rat isolated pulmonary artery.

Low incidence of cardiac biomarker elevation following PCI of chronic total coronary occlusions.

Background And Objectives: After a percutaneous coronary intervention (PCI) creatine kinase-MB fraction (CK-MB) elevation is observed in 5 to 30% of the cases. The often long and diffuse lesions of chronic total coronary occlusions (CTO) could represent a high risk group. However, there is no systematic data available on the incidence of elevation of cardiac troponin I (cTNI) after recanalisation of CTOs.

Effect of combined spa-exercise therapy on circulating TGF-beta1 levels in patients with ankylosing spondylitis.

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease of the axial joints with no satisfactory therapy. Reduction of joint pain has been reported after a course of therapy at a spa, Gasteiner Heilstollen, in Badgastein in Austria. The mechanism underlying this beneficial effect is not clearly understood and objective evidence for the biological response to therapy is lacking.

Turbulent flow as a cause for underestimating coronary flow reserve measured by Doppler guide wire.

Background: Doppler-tipped coronary guide-wires (FW) are well-established tools in interventional cardiology to quantitatively analyze coronary blood flow. Doppler wires are used to measure the coronary flow velocity reserve (CFVR). The CFVR remains reduced in some patients despite anatomically successful coronary angioplasty.

Altered autonomic cardiac control predicts restenosis after percutaneous coronary intervention.

Background: Early and late restenosis in up to 30% remains a major problem for long-term success after percutaneous coronary intervention (PCI). Compared to bare metal stents, the use of drug-eluting stents reduces restenosis below 10%, but implant coasts have to be considered. In restenosis noninvasive testing lacks diagnostic power.

Successful high-risk coronary angioplasty in a patient with cardiogenic shock under circulatory assist with a 16F axial flow pump.

We report the case of a 75-year-old patient who suffered from subacute myocardial infarction and severely impaired left ventricular ejection fraction (EF: 17%). Using a novel 16F left ventricular assist device we performed an angioplasty of the right coronary artery, and of the left anterior descending artery. As a result of the circulatory support the patient recovered from cardiogenic shock within 8 hr.

Detection of coronary microembolisation by Doppler ultrasound during percutaneous coronary interventions.

Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals (HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention (PCI).

Methods And Results: In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated (r = 0.

Drug-drug interactions among recently hospitalised patients--frequent but mostly clinically insignificant.

Objective: Patients use and store considerable amounts of drugs. The aim of the present study was to identify potential drug-drug interactions between drugs used by patients recently discharged from the hospital and, subsequently, to estimate the clinical implications of these interactions.

Methods: Patients were visited within 1 week following their discharge from hospital and interviewed about their drug use.

Lack of association between Chlamydia Pneumoniae serology and endothelial dysfunction of coronary arteries.

Background: Recent publications brought up the hypothesis that an infection with Chlamydia Pneumoniae (CP) might be a major cause of coronary artery disease (CAD). Therefore, we investigated whether endothelial dysfunction (ED) as a precursor of atherosclerosis might be detectable in patients with previous infection with CP but without angiographic evidence of CAD.

Methods: We included 16 patients (6 male / 10 female) of 52 consecutive patients with normal coronary angiography who had typical angina pectoris and pathologic findings in the stress test.

In vitro cytotoxic effect of proteasome inhibitor bortezomib in combination with purine nucleoside analogues on chronic lymphocytic leukaemia cells.

Objective: The anti-tumour in vitro activity of proteasome inhibitor bortezomib (PS-341, VELCADE) in combination with purine nucleoside analogues, cladribine (2-CdA) and fludarabine (FA) was tested in lymphocytes derived from 26 patients with B-cell chronic lymphocytic leukaemia (B-CLL).

Methods: Cell viability was assessed by propidium iodide staining, and apoptosis by annexin-V and caspase activation flow cytometry assays. Additionally, expression of the apoptosis-regulating proteins Bax, Bak, Bid, Bcl-w, Bcl-2, XIAP and Mcl-1 was evaluated in B-CLL lymphocytes.

Disregarded use of herbal medical products and dietary supplements among surgical and medical patients as estimated by home inspection and interview.

Purpose: More and more patients use herbal medical products (HMP) and dietary supplements (DS). Due to the possibility of drug interactions and side effects, it is important that physicians are aware of the use. The aim of the present cross sectional survey was to analyse the consumption of HMP and DS among patients recently discharged from two hospital departments.

Transarterial aortic valve replacement with a self expanding stent in pigs.

Objectives: To evaluate the feasibility of percutaneous aortic valve replacement without cardiac arrest in animal experiments.

Methods: A self expanding nitinol stent, containing pulmonary valves from pigs in its proximal part, was implanted in six pigs (94-118 kg) by means of a 25 French catheter through the left subclavian artery under guidance of fluoroscopy and transoesophageal echocardiography. During stent deployment the original aortic valve was pushed against the aortic wall by the self expanding force of the stent while the new valve was expanded.

The use of over-the-counter drugs among surgical and medical patients.

Introduction: An increasing number of drugs are sold directly to the consumers without a prescription from pharmacies and from non-pharmacies such as supermarkets and gas stations.

Aim Of Study: To analyse the consumption of over-the-counter drugs (OTCs) among patients recently discharged from two hospital departments. Furthermore, to describe where the drugs had been bought and to which extent OTCs used prior to admission were recorded in the hospital files.

TGF-beta1 induces bone marrow reticulin fibrosis in hairy cell leukemia.

The mechanisms that lead to reticulin fibrosis of bone marrow (BM) in hairy cell leukemia (HCL) are not fully understood. We therefore investigated the involvement of TGF-beta1, a potent fibrogenic cytokine, in this process. Immunoassays revealed that TGF-beta1 is present at higher concentrations in BM, serum, and plasma of HCL patients in comparison with healthy donors (P < 0.

Pentoxifylline in ischemic, hypertensive and idiopathic-dilated cardiomyopathy: effects on left-ventricular function, inflammatory cytokines and symptoms.

Introduction: Tumor necrosis factor (TNF)-alpha and interleukin-6 (IL-6) are significantly elevated in patients with congestive heart failure (CHF). Pentoxifylline, a xanthin-derived agent, is known to inhibit the production of TNF-alpha and IL-6. Recent studies have shown that pentoxifylline produces an increase in ejection fraction, a decrease in left-ventricular chamber size and an improvement in clinical status in patients with idiopathic-dilated cardiomyopathy.

The role of soluble CD23 in distinguishing stable and progressive forms of B-chronic lymphocytic leukemia.

Soluble CD23 (sCD23) has been recognized as an important prognostic parameter in patients with chronic lymphocytic leukemia (B-CLL) at early clinical stages. There is, however, no clear information on its prognostic significance in advanced stages and on its role as an indicator for aggressive or indolent courses of disease. Therefore, sCD23 was measured in the serum of 145 patients at diagnosis and serial determinations were carried out for 8 years in 38 patients.

Notch2 is involved in the overexpression of CD23 in B-cell chronic lymphocytic leukemia.

Members of the Notch family encode transmembrane receptors that modulate differentiation, proliferation, and apoptotic programs of many precursor cells, including hematopoietic progenitors. Stimulation of Notch causes cleavage followed by translocation of the intracellular domain (NotchIC) to the nucleus, where it activates transcription of CBF1 responsive genes. The aim of this study was to elucidate the mechanisms leading to the overexpression of CD23, a striking feature of B-cell chronic lymphocytic leukemia (B-CLL) cells.

Severe hypoglycemia in an elderly patient treated with metformin.

Unlabelled: The following case of severe hypoglycemia was reported during a systematic evaluation of hospital admissions caused by adverse drug reactions (supported by BfArM).

History And Findings On Admission: A 79-year-old diabetic woman was admitted to hospital in a stuporous and unresponsive state. The initial physical examination revealed no other abnormal findings.

Optimal timing of liver transplantation for patients with primary biliary cirrhosis: use of prognostic modelling.

Background/aims: Liver transplantation remains the only definitive treatment for patients with end-stage primary biliary cirrhosis, although the optimal timing of the procedure remains uncertain. The aim of the study was to use prognostic modelling to determine the optimal timing of transplantation for patients with primary biliary cirrhosis.

Methods: A prognostic model for predicting the survival of patients after transplantation was generated using the Cox regression model with data from 312 patients transplanted for primary biliary cirrhosis at the Queen Elizabeth Hospital, Birmingham.

Classification of dyspepsia. Identification of independent symptom components in 7270 consecutive, unselected dyspepsia patients from general practice.

Background: Several attempts to classify dyspepsia into subgroups have been proposed as a basis for empirical treatment and research. However, subgrouping has proved difficult due to overlap of symptoms between subgroups, and the response to empirical therapy is difficult to predict. We aimed to study whether natural symptom combinations occur in patients seeing general practitioners because of dyspepsia and whether symptom presentation could predict the effect of proton pump inhibitor treatment.

Comparative results of thrombolysis treatment with rt-PA and urokinase: a pilot study.

Background: The aim of the following prospective study was to investigate whether patients benefited from locoregional lysis treatment of recent deep leg vein thrombosis after 1 year.

Patients And Methods: The prospective study included 69 patients aged between 22 and 58 years, in whom recent lower leg vein and popliteal vein thromboses were diagnosed by phlebography. Patients were randomized to one of three treatment groups: one group was treated for a maximum of 7 days with full heparinization and daily dose of 20 mg rt-PA administered locoregionally over a period of 4 hours; a second group received 100,000 IU/h urokinase locoregionally for a maximum of 7 days, in addition to full heparinization; and in the third group (control group), intravenous heparin infusions after PTT constituted the only form of treatment.

In-vitro selection of resistance to vancomycin and teicoplanin in Enterococcus faecium and Enterococcus faecalis compared with Staphylococcus epidermidis.

Clinical isolates of Enterococcus faecium, Enterococcus faecalis and Staphylococcus epidermidis were studied for their ability to develop resistance by two selection methods, one in broth and one on agar. The MICs for enterococci after exposure to vancomycin ranged from 0.5 mg/L to 4 mg/L, and those after exposure to teicoplanin ranged from 0.