Profile of Cardiovascular Disease Patients Who are Diagnosed with COPD in a Smoking-Cessation Unit

INTRODUCTION

Cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD) have similar prevalence rates and risk factors, and both frequently occur in the same patient. The primary objective of the study was to evaluate the rate of COPD patients among subjects with some form of CVD referring to a smoking cessation unit. The secondary objective was to analyze the demographic and clinical profile of these subjects and to identify independent factors potentially associated with COPD.

METHODS

Observational, prospective study involving 132 patients with smoking habits, and some form of CVD, referring to the smoking cessation unit at the Pulmonology Department of the University Hospital of Cáceres, Spain, between October 2015 and March 2017.

RESULTS

A total of 58 patients (43.9%) were diagnosed with COPD. Main CVDs were: ischemic heart disease (76.5%), chronic heart failure (24.8%), peripheral arterial disease (18.5%), and atrial fibrillation (7.6%). Independent factors were: pack-years (> 30 versus < 30; odds ratio, OR 5.3; 95% CI 1.3-21.4); forced expiratory volume in the first second (OR 0.9; 95% CI 0.9-1.0); chronic heart failure (yes versus no; OR 4.7; 95% CI 1.3-16.4); and modified Medical Research Council (mMRC) dyspnea (2-3 versus 0; OR 18.7; 95% CI 1.9-182.0).

CONCLUSIONS

Four of ten patients with some form of CVD also experience COPD. Dyspnea, airflow limitation, smoking habits, and chronic heart failure were significant factors associated with COPD in patients with CVD. Smoking cessation units are useful to improve the diagnosis of COPD in these patients. Further prospective studies with a greater cohort of patients are required to corroborate the present results and to enhance the knowledge of the clinical profile of these patients.

[Meningococcal purpura fulminans: treatment with recombinant protein C activator in 3 cases]

Purpura fulminans is a serious disease associated with high rates of morbidity and mortality. It usually leads to disseminated intravascular coagulation and septic shock related to reduced levels of protein C. Recombinant protein C (rPC) activator has been used successfully to inhibit this process. Intracranial hemorrhages are the most important, life-threatening adverse effects of treatment with rPC activator. We report 3 cases of patients with meningococcal purpura fulminans who developed septic shock and multiorgan dysfunction. They were treated with the protocol for septic shock, antibiotics and rPC activator from the time of admission, and improvement in hemodynamic dysfunction was observed within hours in all patients. All received platelet replacement transfusions. Subarachnoid bleeding complications occurred in 2 patients. One patient died 5 days after admission and 2 were discharged from the intensive recovery care unit 28 days after admission.

Expression of opioid receptors in osteoblast-like MG-63 cells, and effects of different opioid agonists on alkaline phosphatase and osteocalcin secretion by these cells

We have previously shown that several stressful situations associated with tissue injury determine a decrease in serum osteocalcin concentration. Since reduced osteocalcin production is a marker of decreased osteoblastic activity, this finding could be related to the pathogenesis of osteoporosis secondary to some diseases. Endogenous opioids are involved in stress response. Proenkephalin-derived peptides have been shown to inhibit alkaline phosphatase activity, another marker of bone formation, in the murine cell line ROS-17/2.8. On the other hand, serum osteocalcin has been reported as being low in heroin abusers. We have therefore thought it of interest to study the presence of opioid receptors in the human osteoblast-like cell line MG-63, and to evaluate the effects of different opioid agonists on the secretion of alkaline phosphatase and osteocalcin by these cells. The presence of opioid receptors was studied by means of RT-PCR and immunohistochemistry. RT-PCR studies suggested the presence of specific mRNA for the three types of receptors, and immunohistochemistry clearly showed their occurrence. Osteocalcin synthesis was significantly inhibited by high concentrations of the mu agonists morphine and (D-Ala(2), N-MePhe(4),Gly(5)-ol)-enkephalin although no changes were seen with the delta agonist (D-Ala(2),D-leu(5))-enkephalin. Morphine-induced osteocalcin inhibition was abolished when osteoblastic cells were incubated simultaneously with naloxone, whereas it was potentiated when cells were preincubated with naloxone. None of the opioid agonists modified the secretion of alkaline phosphatase. In conclusion, human osteoblast-like cells MG-63 express the three types of opioid receptors. Endogenous opioids may be involved in the reduction of osteocalcin observed in stressful situations associated with tissue injury.

[Occult rupture of the aortic arch caused by a traffic accident]

A patient presented to our emergency department from another hospital diagnosed with pelvic fracture after a motor vehicle accident. In the ensuing 12 hours, chest pain developed, and a widened mediastinum on chest radiography was found. Posterior aortography showed aortic arch rupture. During surgery, we found a complete circumferential disruption of the arch between the brachiocephalic trunk and the carotid artery. Even though thoracic aortic injuries rarely occur in motor vehicle accidents, thoracic arch ruptures are extremely uncommon. This injury should be suspected after high-speed motor vehicle accidents, when accompanied with chest pain or widened mediastinum.

[The prognostic value of common predictive variables in rectal cancer]

BACKGROUND

A study was undertaken to identify common clinical variables, easy to obtain in an out-patient office, that complement the prognostic estimation on survival offered by the staging classification in patients operated on for rectal cancer.

PATIENTS AND METHODS

236 patients were included. Twenty-one variables related to symptoms, examinations, type of operation, tumor stage, pathology and follow-up were evaluated, all of them were collected prospectively. The relative predictive value was analyzed by means of the Cox' proportional hazards progression model.

RESULTS

Age, carcinoembryonic antigen (CEA), alcaline fosfatase (FA), deshidrogenase lactate (LDH), elective surgery, showed independent predictive value. The risk of death raised by 1.026 (CI 95%: 1.005-1.047) for each year of age at the moment of surgery, serum CEA over 5 ng/ml raises the risk by 2.32 (IC 95%: 1.385-3.893), LDH over 190 mU/ml by raises the risk by 1.64 (IC 95%: 1.026-2.639), FA over 250 U/ml raises the risk by 2.16 (IC 95%: 1.027-4.578), elective surgery reduces the risk by 0.32 (IC 95%: 0.106-0.965).

CONCLUSIONS

Age, CEA, LDH, FA and elective surgery, complement the prediction on survival offered by the tumor stage in patients operated on for rectal cancer.

Expression of some hepatocyte-like functional properties of WRL-68 cells in culture

Some morphologic and functional characteristics of an hepatic fetal human epithelial cell line (WRL-68 cells) were determined to validate the use of these cells as an in vitro hepatic model. WRL-68 cells have a morphologic structure similar to hepatocytes and hepatic primary cultures. They secrete alpha-feto protein and albumin and exhibit a cytokeratin pattern similar to other hepatic cultures. WRL-68 cells preserve the activity of some characteristic or specific liver enzymes or both used in clinical chemistry for the diagnosis of hepatic disorders, i.e. alanine amino transferase, aspartate amino transferase, gamma-glutamyl transpeptidase, and alkaline phosphatase.