Presence Of Arterial Hypertension Research Articles

Maturity-onset diabetes of the young (MODY) in Brazil: Establishment of a national registry and appraisal of available genetic and clinical data.

Maturity-Onset Diabetes of the Young (MODY) comprises a heterogeneous group of monogenic forms of diabetes caused by mutations in at least 14 genes, but mostly by mutations in Glucokinase (GCK) and hepatocyte nuclear factor-1 homeobox A (HNF1A). This study aims to establish a national registry of MODY cases in Brazilian patients, assessing published and unpublished data. 311 patients with clinical characteristics of MODY were analyzed, with unpublished data on 298 individuals described in 12 previous publications and 13 newly described cases in this report. 72 individuals had GCK mutations, 9 described in Brazilian individuals for the first time. One previously unpublished novel GCK mutation, Gly178Ala, was found in one family. 31 individuals had HNF1A mutations, 2 described for the first time in Brazilian individuals. Comparisons of GCK probands vs HNF1A: age 16±11 vs 35±20years; age at diagnosis 11±8 vs 21±7years; BMI 19±6 vs 25±6kg/m2; sulfonylurea users 5 vs 83%; insulin users 5 vs 17%; presence of arterial hypertension 0 vs. 33%, all p<0.05. No differences were observed in lipids and C-peptide. Most MODY cases in Brazil are due to GCK mutations. In agreement with other studied populations, novel mutations are common. Only 14% of patients with familial diabetes carry a HNF1A mutation. Diagnosis of other rare forms of MODY is still a challenge in Brazilian population, as well as adequate strategies to screen individuals for molecular diagnosis.

PP.18.05] EVALUATION OF PLATELET-PLASMA HEMOSTASIS IN PATIENTS WITH UNSTABLE ANGINA AND ARTERIAL HYPERTENSION

Objective: To assess the activity of platelet and plasma hemostasis in patients with unstable angina and arterial hypertension (AH). Design and method: The study involved 126 patients with unstable angina (UA):1 group −48 patients (38%) - without AH (mean age 59.2 + − 7.2 years), 2 group- 78 patients (mean age 57.4 +− 6.4 years) (62%) with hypertension. All patients underwent a complete blood count, determination of cardiac enzymes (troponin I, CKMB, biochemical blood tests, a marker of inflammation CRP, levels of myeloperoxidase (MPO), von Willebrand factor (VWFr), thrombin levels, determining the activity of platelets, D-dimers (DD), Xa factor, aggregatogram with analyzer Multiplate and determination of platelet activation by flow cytometry, determining the activity of platelets, ECG, EchoCG, ABPM,coronary angiography. Results: Patients (pts) in both groups detected the activation of platelet-plasma hemostasis at admission. However, in patients with UA and AH were significantly higher than the following values: platelet volume (MPV) 9,7fl vs 8,9fl; VWF 147% vs 132%; level of MPO 330 pmol/l vs 284 pmol/l; the level of spontaneous aggregation with method of Multiplate (TRAP-test) with an estimate of area under the curve (AUC) 122U vs 106U. The activity of receptors of platelets IIb/IIIa and expression of p-selectin on the platelet surface was confirmed by the number of CD62P positive cells by flow cytometry and was in the 2 group of patients with UA and AH 56% vs 49% in the 1 group (UA without AH). All values in groups 1 and 2 was significantly different. Conclusions: The presence of arterial hypertension in patients with unstable angina increases hyperaggregation of platelets and activates plasma hemostasis. This fact should be considered when the antithrombotic therapy in pts with UA is assign and in the control of hemostasis during treatment.

Work up of incidental adrenal mass: state of the art.

Due to the increasing use of radiological investigations, the detection of incidental adrenal masses has become even more frequent. Therefore, it is crucial to identify the nature of the adrenal mass in order to decide the type of treatment that should be undertaken. Toward this goal, biochemical tests are useful in order to assess catecholamines levels for the presence of a pheochromocytoma or cortisol excess in case of Cushing's syndrome. Furthermore, the dexamethasone suppression test and late-night salivary cortisol may be useful in measuring plasma cortisol, respectively, in the blood and urine. Hyperaldosteronism could be suspected in the presence of arterial hypertension. With regard to imaging modalities, the contrast washout and Hounsfield units estimation might play a role as indicators on computed tomography. In terms of treatment, a surgical approach is most suitable for a hyperfunctioning adrenal mass irrespective of size, and for nonfunctioning masses >4 cm. For indeterminate smaller lesions, with washout >50%, <10 Hounsfield Unit, nonfunctioning, benign-appearing, undergoing a follow-up in regular intervals is more appropriate in order to estimate mass growth. This paper summarizes recent findings on the management of incidental adrenal masses, with a special focus on the use of imaging, surgical management and follow-up modalities in improving patient outcomes.

Metabolic syndrome and new onset diabetes after kidney transplantation

AimsThe metabolic syndrome developed after kidney transplantation is the result of several factors which are identical with the risk factors in normal population, however, also some factors typical for the transplanted patients—especially the effects of immunosuppressive therapy. Material and methodsIn the groupof 268 patients after kidney transplantation, which had no type 1 or type 2 diabetes mellitus before transplantation, we identified patients with metabolic syndrome(based on IDF criteria), 12 months from the kidney transplantation. In all patients, we recorded the following parameters: age at the time of transplantation, type of immunosuppression, waist measure, the value of triacylglycerols, the value of HDL cholesterol, presence of arterial hypertension, andthe value of glycaemia in fasting state (or presence of diabetes mellitus). The groupof patients was divided into the control group and the group of patients with metabolic syndrome. ResultsThe average age of patients was 46.1±11.6years. The control group included 149 patients (55.6%),and we identified the metabolicsyndromein 119patients (44.4%). The patients with metabolicsyndrome were significantly older (P<0.0001), had significantly larger waist (both the entiregroup and the males andfemales) P<0.0001.The femaleswith metabolic syndrome had significantly lower value of HDL—cholesterol (P=0.0013), and significantly higher number of patients with metabolic syndrome had hyperglycaemia in fasting state or diabetes mellitus (P=0.0006). ConclusionBy controlling the weight and waist, we may identify the risk patients for development of metabolic syndrome after kidney transplantation.

The obese child in the Intensive Care Unit. Update.

Given that childhood obesity is an epidemic, the frequency of critically-ill patients who are overweight or obese seen at intensive care units has increased rapidly. Adipose tissue is an endocrine organ that secretes a number of protein hormones, including leptin, which stands out because it regulates adipose tissue mass. The presence of arterial hypertension, metabolic syndrome, diabetes mellitus, respiratory disease and chronic kidney disease may become apparent and complicate the course of obese pediatric patients in the Intensive Care Unit. Obesity management is complex and should involve patients, their families and the medical community. It should be coordinated with comprehensive government health policies and implemented in conjunction with a change in cultural context.

Alterations of soluble TWEAK and CD163 concentrations in patients with chronic heart failure

Inflammatory activation plays a pivotal role in chronic heart failure with reduced ejection fraction (HF-REF). A novel mediator from TNF family: soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) along its soluble decoy receptor CD163 (sCD163) recently has been investigated in other cardiovascular pathologies. We aimed to evaluate sTWEAK and sCD163 concentrations in HF-REF patients.The study enrolled 79 patients with stable HF-REF, EF < 35%. The control population without history of heart failure included two groups: 26 comorbidities matched patients and 27 healthy volunteers. sTWEAK and sCD163 serum concentrations were determined using ELISA kits. Univariate and multivariate analysis was performed to assess variables affecting concentration of sTWEAK and sCD163.HF-REF patients were characterized by higher sTWEAK (median 374 IQR: 321–429 vs 201 IQR: 145–412pg/ml, P=0.005), sCD163 (median 744 IQR: 570–1068 vs 584 IQR: 483–665pg/ml, P=0.03) concentrations and sTWEAK/sCD163 ratio (median 0.53 IQR: 0.32–0.7 vs 0.3 IQR: 0.22–0.37, P=0.001) comparing to healthy volunteers. Comparing to comorbidities matched controls, HF-REF patients had lower sTWEAK levels (median 374 IQR: 321–429 vs 524 IQR: 384–652pg/ml; P=0.002), while sCD163 and sTWEAK/sCD163 ratio didn’t differ. Concentration of sTWEAK in HF-REF was affected by white blood cell count and aspirin intake, while sCD163 by exercise capacity, LV diastolic volume, CRP and presence of arterial hypertension. ConclusionsHF-REF patients present increased sTWEAK and sCD163 levels as well as sTWEAK/sCD163 ratio when compared to healthy subjects, however CHF itself appears to be associated with down-regulation of sTWEAK.

Renal filtration function in patients with gout

Aim. To study circadian blood pressure (BP) profile in patients with gout depending on the presence of arterial hypertension (HT) and their relationship to the renal filtration function. Material and methods. Patients with gout (n=87) were included into the study. All the patients underwent ambulatory BP monitoring (ABPM) with the assessment of circadian BP profile, determination of uric acid serum levels, glomerular filtration rate (GFR) was evaluated by CKD-EPI method. Depending on GFR level, all the patients were divided into 2 groups - with renal dysfunction or without one. Results. ABPM revealed circadian BP dysregulation in 55% of gout patients both with HT and without HT. Chronic kidney disease (CKD) was revealed in 72.4% of male patients, with the prevalence in patients with HT (76.6 vs 61%; p&lt;0.001). Correlations between uric acid levels and some ABPM indicators and GFR were determined. Conclusion. Obtained data suggest the contribution of hyperuricemia in disorders of systemic and renal hemodynamics, leading to the early development of CKD.

Relationship between renal function and renal volume in autosomal dominant polycystic kidney disease: Cross-sectional study

ObjectiveTo determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behavior according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. MethodCross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. ResultsWe evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft–Gault formulas. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. ConclusionThe volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function.

The Risk/Benefit Analysis of Oral Anticoagulant Treatment in Atrial Fibrillation Using HAS-BLED and CHA2DS2-VASc Score

Abstract Introduction. The purpose of this study is to evaluate the risk and the benefit of oral anticoagulant treatment in nonvalvular atrial fibrillation (AF) patients, using the two scores recommended by the guidelines: the CHA2DS2-VASc score and HAS-BLED score. Material and method. We conducted a retrospective observational study on 144 patients with nonvalvular atrial fibrillation, admitted between 1st of July 2013 and 30th September 2013 in the 3rd Medical Clinic of Tîrgu Mureș with a prospectiv follow-up at 6 months. Based on the data collected from the patient charts, the thromboembolic risk was assessed using the CHA2DS2-VASc score and the hemorrhage risk was assessed using the HAS-BLED score. At 6 months, the patients were contacted via telephone and were questioned regarding their state of health, the existence of hospitalizations in the last 6 months, the international normalized ratio (INR) value, the existence of hemorrhagic or thromboembolic events. Results. The group of patients was composed of 70 female and 74 male with the mean age of 70 ±11 years. From the total number of patients 13 (11.7%) had a history of stroke and the CHA2DS2-VASc score revealed that these 13 were in the high risk class. The presence of arterial hypertension and vascular disease were statistically associated with stroke. Hemorrhagic events were encountered in 19 patients (13.19%) and 16 of them had a higher than 3 HAS-BLED score. A history of bleeding, anemia and labile INR were the factors statistically associated with bleeding. Conclusions. The CHA2DS2-VASc score is useful in stratifying patients with AF in risk groups for thromboembolic events while the HAS-BLED score proved to be a useful tool in predicting bleeding events in anticoagulated patients.

MODELING OF THE 10-YEAR SURVIVAL OF MEN 60 YEARS AND OLDER, WITH ISCHEMIC HEART DISEASE

Aim. To invent 10-year survival model of the men &gt;60 y.o. with ischemic heart disease (IHD), including prognostic significance of the traditional risk factors, electric remodeling parameters of myocardium and other factors comorbid with the fatal events and survival depending on the age. Material and methods. Study cohort consisted of 167 men with IHD at the age &gt;60 y.o. (mean age 76,3±0,5). All persons in the cohort underwent complex clinical and functional assessment of cardiovascular system, the parameters of electrical activity of myocardium studied — value of the ventricles activation velocity, repolarization heterogeneity, and stages of electrical remodeling severity. All participants were followed-up during 10 years with the analysis of the disease course and fatal events monitoring. Survival analysis was done on the base of tables of lifetimes completion with the part of died, survived, of cumulative part of survived (survival function), density of the death probability, function of momentary risk. Results. In the cohort of men &gt;60 y.o. with IHD cardiovascular death, mortality coefficients from all cases and from cardiovascular diseases, cumulative part of the survived, density of the probability of heath and the function of momentary risk in different age groups (I group 60-74 years and II group &gt;75 years) сdid not differ significantly. Physical activity and high density cholesterol level &gt;0,6 mmol/L are associated with the increase of survival rate in the 1st age group, as in the 2nd. Presence of arterial hypertension in IHD cohort of men was a predictor of fatal outcomes and increased mortality — odds ratio (OR) 2,469 (p&lt;0,04). In the 2nd age group the main factor increasing mortality was the functional class of the heart failure — OR 3,672 (p&lt;0,009). Electrical remodeling of myocardium in men older than 60 y. with IHD does not significantly associate with prognosis. As the predictors of fatal outcomes among the persons of the 1st age group were the velocity of ventricles activation (VVA) &lt;39 s -1 , OR 2,266 (р&lt;0,044), for the persons of the 2nd age group — value of heterogeneity of VVA — OR 13,632 (p&lt;0,04). Conclusion. 10-year prospective follow-up of the men cohort &gt;60 y.o. with IHD made it possible to create a model of survival, which makes it to predict fatal events, to establish significant for prognosis factors and focus on the specific factors of fatal outcomes for various age groups inside this age cohort.

THE RELATION OF CARDIOVASCULAR HEALTH WITH PROFESSIONAL OCCUPATION (ESSE-RF IN KEMEROVO REGION)

Aim. Analysis of the prevalence of cardiovascular diseases and risk factors depending on occupation. Material and methods. Under the multicenter epidemiological study ESSE-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Russian Federation) the questioning performed and 1627 persons investigated in Kemerovo Region at the age 25-64 y.o. Two comparison groups were created: employed (n=1214), unemployed (n=413). The data obtained on the occupation and cardiovascular risk factors: smoking, alcohol consumption, obesity, cholesterol level, lipoproteids, glucose, anamnesis of cardiovascular diseases and real presence of arterial hypertension, ischemic heart disease (IHD) by Minnesota criteria, and angina pectoris by Rose score. In statistical processing, with the aim to relieve age differences of the groups we standardized by the age via direct method, and in regression analysis there was a parameter age. Results. In employed men there was statistically significant lower prevalence of smoking — among workers 40,2%, unemployed 52,6% (p=0,011). CHD in anamnesis in 5,4% and 11,9%, resp. (p=0,0047), arterial hypertension — 47,9% and 57,1%, resp. (p=0,043), angina by Rose score — 5,3% and 13,6%, resp. (p=0,00001), CHD by Minnesota code — 5,0% and 9,2%, resp. (p=0,048), CHD by 3 epidemiological criteria — 9,4% and 20,4%, resp. (p=0,00020). In women employment was related to lower prevalence of smoking — 15,4% among workers, 22,4% — unemployed (p=0,038) and CHD by Minnesota code —5,4% and 9,6%, resp. (p=0,019). Occupational status for men leads to the decrease of arterial pressure by 3,4 mmHg in average (p=0,051), increase of total cholesterol concentration by 0,231 mmol/L (p=0,041), and in women — increase of HDL by 0,135 mmol/L (p=0,0024). Conclusion. Better cardiovascular health do have employed people comparing to unemployed: tendency is stronger in men. The results reflect common tendency of the higher level of health among employed young inhabitants comparing to unemployed.

ASSOCIATION OF THE METABOLIC SYNDROME CONSTITUENTS WITH MARKERS OF SUBCLINICAL TARGET ORGAN DAMAGE DURING FOLLOW-UP OF INTELLECTUAL LABORERS

Aim. To evaluate the relation of metabolic syndrome (MS) and its constituents with markers of subclinical damage of target organs (TOD) in follow-up of almost healthy intellectual laborers. Material and methods. From the selection of 1600 employees of a bank we randomly selected 383 with at least one component of MS without cardiovascular disorders, of those by the end of 2 years period 331 came to final visit (response 86%). Mean age 46,6±9,0 y., mostly women (214 (64,6%)). All patients underwent anthropometry, blood pressure measurement (BP), lipids investigation, creatinine and fasting glucose, echocardiography with the assessment of the left ventricle hypertrophy (LVH), ultrasound study of carotid arteries (intima-media complex thickness — CIM, and atherosclerotic plaques), vascular rigidity assessment, anklebrachial index, albumin concentration in single portion of urine at both stages of observation. Results. While performing multiple logistic regression, presence of arterial hypertension (AH) associated with increased probability of LVH, thickening of CIM and higher vessel rigidity in standardization by gender and age. Relation of MS with the markers of TOD has not been found. In 2 years of follow-up there was a significant increase of patients with thickening of CIM (from 81 (24,5%) to 146 (44,1%), p<0,001) and decrease of LVH prevalence (from 154 (46,7%) to 109 (32,9%), p=0,003) together with significant decrease of BP and total cholesterol. Conclusion. Presence of AH is associated with higher probability of LVH and increased vessel rigidity, as atherosclerotic changes in carotid arteries. MS was not related with an increased prevalence of TOD, and the main predetermining factors for structural heart abnormalities, the vessels and kidneys, were gender and age. In 2 years of observation there was markedly decreased number of patients with LVH and kidney dysfunction at the background of BP pattern improvement, and increase of the number of patients with thicker CIM, regardless of a decrease of the hypercholesterolemia patients. In MS patients there was more common to use antihypertension treatments, that led to more prominent LVH regression.

Relación entre función y volumen renal en la poliquistosis renal autosómica dominante: estudio transversal

ObjectiveTo determine in patients with autosomal dominant polycystic kidney disease the relationship between total renal volume (the sum of both kidneys, TRV) as measured by magnetic resonance and renal function; and its behaviour according to sex and the presence of arterial hypertension, hypercholesterolaemia and hyperglycemia. MethodCross-sectional study including patients with autosomal dominant polycystic kidney disease who underwent periodic reviews at Nephrology external consultations at Hospital de las Nieves de Granada, and who underwent an magnetic resonance to estimate renal volume between January 2008 and March 2011. ResultsWe evaluated 67 patients (59.7% women, average age of 48±14.4 years) and found a significant positive association between TRV and serum creatinine or urea, which was reversed compared with estimated glomerular filtration by MDRD-4 and Cockcroft-Gault. Women showed an average serum creatinine level and a significantly lower TRV level compared with males. Subgroups affected by arterial hypertension and hyperuricemia presented average values for serum creatinine and urea, higher for TRV and lower for estimated glomerular filtration. The hypercholesterolaemia subgroup showed higher average values for urea and lower for estimated glomerular filtration, without detecting significant differences compared with TRV. ConclusionThe volume of polycystic kidneys measured by magnetic resonance is associated with renal function, and can be useful as a complementary study to monitor disease progression. The presence of arterial hypertension, hyperuricemia or hypercholesterolaemia is associated with a poorer renal function.

Laparoscopic appendectomy: Which factors are predictors of conversion? A high-volume prospective cohort study

Appendicitis represents one of the most frequent condition requiring surgery. In Italy almost 0.2% of the population will be affected by acute appendicitis every year. Laparoscopic appendectomy (LA) has gained acceptance over the past years and despite several meta-analyses, randomized studies and retrospective studies have been conducted, the indications and results are still conflicting especially in cases of complicated appendicitis. The aim of our study is to evaluate which factors are related to conversion to open appendectomy (OA) during laparoscopic appendectomy (LA). Matherials and methodsFrom September 2011 to May 2013, appendectomy for acute appendicitis was performed on 434 patients in our Surgical Unit at S. Orsola-Malpighi Hospital, Bologna, Italy. Of these, 369 patients (85%) underwent LA. The clinical, demographic, surgical and pathological data of these patients were included in a prospective database. To note, only laparoscopic appendectomies were considered to be included in the analysis. The following factors were analyzed in order to identify which were associated with the conversion: age, sex, body mass index (BMI), previous abdominal surgery, comorbidities, clinical and laboratory parameters including Alvarado score, PCR, intraoperative findings such as anatomy and degree of inflammation. During our study period, laparoscopic appendectomies were performed by different surgeons both residents and attending surgeons. The decision to convert the intervention in an open procedure was taken by the individual surgeon. Regarding the postoperative period, were considered the time of hospitalization and related costs, time of oral intake of liquid and solid, time of passage of stool, readmissions and reoperations. ResultsAt univariate analysis, the factors significantly related to the conversion were the presence of comorbidities (p < 0.001) and, among these, the presence of arterial hypertension (p = 0.006) or other cardiovascular diseases (p = 0.031) and the history of previous abdominal surgery (p = 0.023). Patients with higher mean age (33.9 ± 15.4 vs. 46.0 ± 19.3, p = 0.001) and higher body mass index (BMI) (23.5 ± 4.3 vs 25.8 ± 4.9 kg/m2, p = 0.006) had a higher risk of conversion.Multivariate analysis finally showed that factors significantly related to the conversion were the presence of comorbidities (p = 0.029), the presence of an appendiceal perforation (p = 0.003), a retrocecal appendix (p = 0.004), the presence of appendicular abscess (p = 0.023) and the presence of diffuse peritonitis (p = 0.008). ConclusionThe majority of patients with acute appendicitis can be successfully managed with laparoscopy. We found that the only preoperative independent factor related to conversion during laparoscopic appendectomy is the presence of comorbidities. Nevertheless surgeons should take into account that presence of peri-appendicular abscess and diffuse peritonitis are both independently related not only to higher rate of conversion but also to higher risk of postoperative complication.

Current features of clinical picture and diagnostics of pheochromocytoma

Background. Taking into consideration new data on the increased detectability and more exact diagnostic methods, revision of classical ideas of clinical picture and criteria of diagnostics of a pheochromocytoma (Ph) is required. Aim. To study current features of clinic manifestation, results of instrumental methods and factors, which influence on treatment efficiency of patients with confirmed diagnosis of Ph. Matherials and methods. There were studied 9 patients with histologically confirmed diagnosis of P (1 man 56 years old; 8 women who were 37.6 ± 5.5 years old). Next parameters were evaluated: presence of arterial hypertension (AH), specific features of P (sympathetic attack); indications for screening of Ph, the time from the appearance of indications for screening till the laboratory confirmed diagnosis, characteristics of CT (native density, size, contrast washout, specific features (cystic, heterogeneous structure with areas of necrosis and hemorrhage)), features of preoperative preparation, presence of intraoperative complications, efficiency of the surgery. Used descriptive statistics were percentage, mean M, standard deviation SD and 95% confidence interval CI. Results. AH was presented in 6 patients (67%), among whom 4 patients had specific features which indicated symptomatic AH. These 4 patients had the classic triad of Ph (44%). Indications for screening of Ph in 4 patients were specific features of Ph (time from screening indication appearance till laboratory confirmed diagnosis was 41 ± 14 mnths. (95% CI 18;63), in other 5 - adrenal incidentaloma (AI) (time from the detection of AI until the laboratory confirmed diagnosis was 13 ± 9 days (95% CI 2; 24). CT characteristics were the next: native density - 49,9 ± 12,8 HU (95% CI 40; 59,7), lesion size - 5,4 ± 1,8 cm (95% CI 4; 6,7), contrast washout - 30,1 ± 11,1 HU (95% CI 21,6; 38,6). Only 2 patients had so called specific CT features. All patients received adequate preoperative preparation with alpha-blockers. There were no any specific intraoperative complications in all cases. After surgery metanephrine and normetanephrine were within reference range. Conclusions. 1/3 of patients with Ph had not clinical manifestations. Specific CT features presented in a smaller percentage. The success of surgery entirely depends on adequate preoperative prescription of alpha-blockers.

Vitamin D Deficiency and Insufficiency in Hospitalized COPD Patients.

Introduction31–77% of patients with COPD have vitamin D deficiency and insufficiency, with results being highly variable between studies. Vitamin D may also correlate with disease characteristics.AimTo find out the prevalence of vitamin D deficiency and insufficiency in patients with COPD admitted for exacerbation and a risk factors for lower vitamin D levels among comorbidities and COPD characteristics.Methods152 patients were studied for vitamin D serum levels (25(OH)D). All of them were also assessed for diabetes mellitus (DM) and metabolic syndrome (MS). Data were gathered also for smoking status and exacerbations in last year. All patients completed CAT and mMRC questionnaires and underwent spirometry.ResultsA total of 83,6% of patients have reduced levels of vitamin D. 42,8% (65/152) have vitamin D insufficiency (defined as 25–50 nmol/L) and 40,8% (62/152) have vitamin D deficiency (<25 nmol/L). The mean level of 25(OH)D for all patients is 31,97 nmol/L (95%CI 29,12–34,68). Vitamin D deficiency and insufficiency are more prevalent in females vs. males (97,7 vs 77,8%; p = 0.003). The prevalence and severity of vitamin D deficiency and insufficiency in this study is significantly higher when compared to an unselected Bulgarian population (prevalence 75,8%; mean level 38,75 nmol/L). Vitamin D levels correlate with quality of life (measured by the mMRC scale) and lung function (FVC, FEV1, FEV6, FEF2575, FEV3, but not with FEV1/FVC ratio and PEF), it does not correlate with the presence of arterial hypertension, DM, MS and number of moderate, severe and total exacerbations. Vitamin D deficiency is a risk factor for longer hospital stay.ConclusionsThe patients with COPD admitted for exacerbation are a risk group for vitamin D deficiency and insufficiency, which is associated with worse disease characteristics.

Evaluation of the retinal nerve fibre layer and ganglion cell complex thickness in pituitary macroadenomas without optic chiasmal compression.

The aim of this prospective study was to measure the thickness of the circumpapillary retinal nerve fibre layer (cpRNFL) and the ganglion cell complex (GCC) using spectral domain optical coherence tomography (SD-OCT) in a cohort of consecutive de novo patients with pituitary macroadenomas without chiasmal compression. Twenty-two consecutive patients with pituitary macroadenoma without chiasmal compression (16 men, 6 women, aged 45.2±14.6 years, 43 eyes) entered the study between September 2011 and June 2013. Among them, 31.8% harboured a growth hormone-secreting pituitary adenoma, 27.3% a prolactin-secreting pituitary adenoma, 27.3% a corticotrophin-secreting pituitary adenoma, and 13.6% a non-secreting pituitary tumour. Eighteen subjects (nine females, nine males, mean age 36.47±6.37 years; 33 eyes) without pituitary adenoma, with normal ophthalmic examination, served as controls. In both patients and controls, cpRNFL and GCC thicknesses were measured by SD-OCT. Patients were significantly older (P=0.02) than controls. Best corrected visual acuity, intraocular pressure, colour fundus photography, and automatic perimetry test were within the normal range in patients and controls. Conversely, cpRNFL (P=0.009) and GCC (P<0.0001) were significantly thinner in patients than in controls. The average GCC (r=0.306, P=0.046) significantly correlated with the presence of arterial hypertension. OCT parameters did not differ significantly between patients with a tumour volume above the median and those with a tumour volume below the median. Pituitary macroadenomas, even in the absence of chiasmal compression, may induce GCC and retinal nerve fibre layer thinning. SD-OCT may have a role in the early diagnosis and management of patients with pituitary tumours.

Predictors of survival and cause of death in patients with essential thrombocythemia.

Standard risk stratification for overall survival (OS) in patients with essential thrombocythemia (ET) is based on advanced age and history of thrombotic events. Recently, International Prognostic Score for ET (IPSET) incorporated also leukocytosis in prognostic model. The aim of this study was to establish additional risk factors for OS in ET patients. After the median follow-up of 7 yr, in 244 consecutive ET patients, 32 deaths were documented (13.2%). The 5- and 10-yr OS was 95.9% and 79.7%, respectively. Considered additional risk factors at diagnosis of ET were the presence of arterial hypertension, diabetes, hyperlipidemia, and smoking attitude. The main cause of death in 75% of patients was cardiovascular (CV) comorbidity. Patients with CV risk factors had increased risk of death (HR = 2.33). Cox regression model identified age, leukocytosis, presence of CV risk factors, and previous thrombosis as unfavorable predictors of survival. Based on these parameters, four risk groups were defined, with significantly different survivals (P < 0.001). Improved prognostic model displayed a better hazard ratio profile compared to the standard risk stratification and IPSET. The addition of CV risk factors allows better prognostic assessment by delineating the intermediate-risk category and improved identification of the high-risk patients.

Arterial and Venous Thrombosis: Clinical Evidence for Mechanistic Overlap

Venous and arterial thromboembolic disorders are usually considered as two separate pathophysiological entities. Over the last years, some clinical evidence challenged this common view. First of all, a number of studies have reported an increased risk of subsequent symptomatic atherothrombosis in patients with venous thromboembolism (VTE), in particular after unprovoked events. In a substudy of the Warfarin optimal duration Italian pulmonary embolism (WODIT PE) trial, the incidence of arterial cardiovascular events in patients affected by unprovoked pulmonary embolism (PE) was significantly higher than in patients with PE secondary to transient risk factors such as surgery, trauma or immobilization. This finding was subsequently confirmed by the results of a large prospective cohort study comparing the incidence of symptomatic atherosclerotic disease in patients with unprovoked VTE and patients with secondary VTE. In a subsequent population-based cohort study from Denmark, the relative risk of cardiovascular events in the first year after deep vein thrombosis (DVT) and after PE was significantly higher than in a control population and remained increased during the subsequent 20 years of follow-up. The results of these and other studies were summarized in a meta-analysis of the literature that confirmed a significantly higher incidence rate ratio of arterial cardiovascular events in patients with unprovoked VTE than in patients with provoked VTE and in controls. A possible explanation for such association between unprovoked VTE and arterial thrombosis could be represented by shared risk factors between these disease entities. Among traditional cardiovascular risk factors, obesity and age have consistently been demonstrated to be independent risk factors also for VTE. Of interest, obesity was also shown to be associated with a significantly increased risk of recurrent VTE. Obesity, and in particular visceral adiposity (abdominal obesity), predisposes to inflammatory and hypercoagulable states thus resulting in a prothrombotic condition that may cause both venous and arterial thrombotic events. A study from Norway found abdominal obesity defined by the measurement of waist circumference to be a better predictor of the risk of VTE than obesity defined by the body mass index. In addition, abdominal obesity is commonly associated with the presence of arterial hypertension, diabetes mellitus, and dyslipidemia. In a meta-analysis of studies on the association between cardiovascular risk factors and VTE, we found all these major arterial risk factors to be significantly associated with venous thrombosis. In addition, we and others found an association between the metabolic syndrome, which is a cluster of cardiovascular risk factors, and VTE. Finally, a large-population based case-control study reported an increased risk of venous thrombosis in both current and ex-smokers compared to those who had never smoked. Although these associations were not fully confirmed by the results of prospective cohort studies, and although the strength of the association was not comparable to that reported for major traditional risk factors for venous thrombosis, these findings may be clinically relevant because cardiovascular risk factors are common, they frequently co-exist, and their co-existence may result in an additive effect. Moreover, most cardiovascular risk factors are modifiable. These observations also raised the question of whether drugs that are effective in preventing arterial thrombosis, such as aspirin and statins, may be also effective for the prevention of venous thrombosis. Two recent randomized controlled trials compared aspirin with placebo for the secondary prevention of VTE after an initial course of anticoagulant therapy. When the results of these two studies were pooled together, there was a statistically significant 32% reduction in the rate of VTE recurrence with no increased risk of major bleeding. In a meta-analysis, we found that statins reduce the risk of a first VTE event by 20%. Other studies have suggested that statins may also play a role in the secondary prevention of VTE, but no randomized controlled trials are available to support this hypothesis. In conclusion, the presence of cardiovascular risk factors should be carefully assessed in patients with unprovoked VTE and their management may concomitantly prevent subsequent atherothrombotic events and reduce the risk of recurrent VTE. Future studies should assess whether the combination of aspirin and statins may result in a substantial reduction of the risk of recurrent VTE. DisclosuresAgeno:Bayer Healthcare: Honoraria, Membership on an entity’s Board of Directors or advisory committees, Research Funding; Boehringer Ingelheim: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Daiichi Sankyo: Honoraria; Pfizer: Honoraria, Membership on an entity’s Board of Directors or advisory committees; BMS: Honoraria, Membership on an entity’s Board of Directors or advisory committees; STAGO: Honoraria. Off Label Use: I will discuss evidences on the role of aspirin and statins for the prevention of venous thromboembolism.

Immunological aspects of pathogenesis of metabolic syndrome-related arterial hypertension

Aim. To analyze the link between levels of adipocytokines (leptine), non-specific cytokines (interleukin-6, tumor necrosis factor-α) and arterial hypertension. Methods. 123 subjects, including 100 patients with metabolic syndrome (according to 2005 Criteria of International Diabetes Federation) and 23 healthy subjects, were examined. General examination was performed, body weight, height and waist circumference were measured, body mass index was calculated. Following laboratory test were performed: serum leptin, interleukin-6, tumor necrosis factor-α, main classes of immunoglobulin, C-reactive protein levels were measured. Results. In patients with metabolic syndrome, increased body weight was associated with increased risk of arterial hypertension. A 10-fold increase of serum leptin level (44.69±8.96 ng/ml) compared to healthy controls (4.72±1.33 ng/ml, p 0.01), was revealed. Leptin level elevation was strongly associated with increased body mass index (r=0.77; p 0.001). Tumor necrosis factor-α concentration in patients with metabolic syndrome exceeded 2 pg/ml, while in healthy controls it didn’t reach this level. Interleukin-6 level was elevated in patients with metabolic syndrome (7.32 [3.25; 7.17] pg/ml) compared to controls (1.53 [1.19; 2.49] pg/ml, Fisher’s exact test, p 0.001). Examination of immunoglobulin levels in patients with metabolic syndrome revealed decreased serum level of immunoglobulin E (97.12±66.24 IU/ml) compared to controls (60.47±19.04 IU/ml, p=0.01). Concentration of immunoglobulin G in patients with metabolic syndrome was also higher (14.61±3.50 g/l) compared to controls (12.57±2.07 g/l, p=0.009). Increased interleukin-6 and immunoglobulin G levels were associated with presence of arterial hypertension. Conclusion. Increased interleukin-6 and immunoglobulin G might be an important factor for arterial hypertension onset and progression.