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ABSTRACT: Accumulating evidence suggests that inflammation plays an important role in the development of acute cerebrovascular disease. The aim of this study is to evaluate the predictive value of a series of candidate serum immuno-inflammatory and thrombotic/fibrinolitic molecules towards diagnosis of acute ischemic stroke.
We enrolled 120 consecutive patients with a diagnosis of acute ischemic stroke and 123 consecutive hospitalized control patients without a diagnosis of acute ischemic stroke. We evaluated plasma levels of IL-1beta, TNF-beta, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1 and sVCAM-1 as markers of immuno-inflammatory activation, vWF plasma levels as a marker of endothelial dysfunction, TPA antigen and PAI-1 plasma levels as a marker of a prothrombotic state.
TNF-alpha, PAI-1 and TPA on bivariate logistic regression were highly correlated to stroke diagnosis. Among the other variables maintained in the final model ILbeta, Selectin E, were significantly associated with acute ischemic stroke diagnosis, whereas IL-6, VICAM-1, ICAM-1 and neutrophil percentage showed only a slight or no association with stroke diagnosis. Furthermore, only the continuous values of TNF-alpha, PAI-1 and TPA showed a significant predictive value and likelihood ratio, with an area under the ROC curve of 98.6%, 97.1% and 99.9%, respectively.
Our findings could suggest the high diagnostic power of these immuno-inflammatory and thrombotic/fibrinolytic variables in patients with acute ischemic stroke. Although our results are encouraging, additional studies are needed to establish the validity of this approach.
Atherosclerosis 08/2008; 203(2):503-8. · 3.79 Impact Factor
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ABSTRACT: Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. We enrolled 102 consecutive patients with type 2 diabetes mellitus with diabetic foot and 123 patients with type 2 diabetes mellitus without limb lesions to compare the prevalence of main cardiovascular risk factors, subclinical cardiovascular disease, previous cardiovascular morbidity, and incidence of new vascular events on a 5-year follow-up. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A1c, and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.
Metabolism 06/2008; 57(5):676-82. · 2.66 Impact Factor
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Internal and Emergency Medicine 05/2008; 3(4):395-9. · 2.06 Impact Factor
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ABSTRACT: Today it may be more useful to use the term acute ischemic cerebrovascular syndrome (AICS) to define a spectrum of disease ranging from TIA to stroke and that share a similar underlying pathophysiology: cerebral ischemia. The aim of this study is to evaluate the prognostic importance of some demographic, laboratory and clinical variables on the outcome in hospitalized patients with a discharge diagnosis suggestive of acute ischemic cerebral syndrome (AICS).
17,377 Subjects were enrolled in the GIFA study, a multicenter survey of hospitalized older patients. 1878 Subjects with a main discharge diagnosis suggestive of acute ischemic cerebrovascular syndrome (AICS) represent the final sample. The primary outcomes of this study were: (1) in-hospital mortality; (2) cognitive impairment at discharge; (3) functional status at discharge.
Age, WBC count, glucose blood level at admission and Charlson index score were directly associated with in-hospital mortality. Age, WBC count, Charlson index score and disability at admission are directly associated with cognitive impairment at discharge. Finally, age, Charlson index score and disability at admission are directly associated with disability at discharge.
Our study evaluated prognosis in the light of the three main aspects of mortality, disability and cognitive impairment that showed substantial sharing for most of the prognostic factors, probably owing to the possible strict association of these outcome indicators with markers of ischemic brain damage extent (WBC) and/or individual response to an ischemic event by neuroplasticity (age, comorbidity) in subjects with AICS.
International journal of cardiology 05/2008; 125(3):391-6. · 7.08 Impact Factor
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ABSTRACT: Diabetes mellitus increases the risk of stroke, and pathophysiological changes of diabetic cerebral vessels may differ in comparison with non-diabetic ones; nonetheless, the clinical and prognostic profile of stroke in diabetic patients is not yet fully understood. On this basis, the aim of our study was to evaluate cerebrovascular risk factor prevalence in diabetic stroke patients in comparison with non-diabetics, to analyze whether diabetics have a different prevalence of stroke subtypes as classified by the TOAST classification, and determine whether diabetics and non-diabetics have a different prognosis.
We enrolled 102 diabetics and 204 non-diabetic subjects with acute ischemic stroke, matched by sex and age (+/-3 years). We used as outcome indicators the Scandinavian Stroke Scale (SSS) score at admission and the modified Rankin disability scale at discharge and at a 6-month follow-up. We classified ischemic stroke according to the TOAST classification. Diabetes was associated with lacunar ischemic stroke subtype, with a record of hypertension, and with a better SSS score at admission. The association of diabetes with lacunar stroke remained significant even after adjustment for hypertension or for large artery atherosclerotic and cardioembolic stroke subtypes.
Our study shows some significant differences in acute ischemic stroke among diabetics in comparison with non-diabetics (higher frequency of hypertension, higher prevalence of lacunar stroke subtype, lower neurological deficit at admission in diabetics).
Nutrition, metabolism, and cardiovascular diseases: NMCD 03/2008; 18(2):152-7. · 3.52 Impact Factor
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ABSTRACT: Elevated blood pressure is an important risk factor for cardiovascular disease and stroke. Several studies have demonstrated that physical exercise reduces blood pressure levels in hypertensive subjects and improves control of several well-known risk factors for atherosclerosis such as diabetes mellitus, blood lipid profile and obesity. Our group attempted to evaluate if an exercise program based on periodic controlled fast walking sessions would reduce blood pressure levels in hypertensive subjects.
We enrolled hypertensive subjects not suffering from obesity (Body Mass Index < 30) already under pharmacological therapy; in these subjects we performed a six-week program of mobility exercise based on fast walking.
Secondary care.
We enrolled 189 subjects; 168 subjects completed the training period. Entry criteria were Stage I WHO hypertension in pharmacological treatment, BMI < 30, and absence of any pathological condition resulting in reduced mobility.
A six-week mobility program centered on fast walking.
Systolic and diastolic blood pressure levels before and after the walking program.
Mean 24 h systolic blood pressure changed from 143.1 to 135.5 mmHg. Mean 24 h diastolic blood pressure changed from 91.1 to 84.8 mmHg.
This reduction, evaluated with Ambulatory Blood Pressure Monitoring (ABPM), confirms that physical exercise should be a part of lifestyle changes for the management of hypertension both in untreated hypertensive patients or high-risk subjects for hypertension, and also for hypertensive patients in association with pharmacological therapy.
Clinical Journal of Sport Medicine 05/2006; 16(3):238-43. · 2.12 Impact Factor
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ABSTRACT: Cerebrovascular risk represents a progressive and evolving concept owing to the particular distribution of risk factors in patients with ischemic stroke and in light of the newest stroke subtype classifications that account for pathophysiological, instrumental, and clinical criteria. Age represents the strongest nonmodifiable risk factor associated with ischemic stroke, while hypertension constitutes the most important modifiable cerebrovascular risk factor, confirmed by a host of epidemiological data and by more recent intervention trials of primary (HOT, Syst-Eur, LIFE) and secondary (PROGRESS) prevention of stroke in hypertensive patients. To be sure, a curious relationship exists between stroke and diabetes. Although the Framingham Study, The Honolulu Heart Program, and a series of Finnish studies reported a linear relationship between improved glucose metabolism and cerebral ischemia, the clinical and prognostic profile of diabetic patients with ischemic stroke remains to be fully understood. Our group, on the basis of TOAST classification--a diagnostic classification of ischemic stroke developed in 1993 that distinguishes five different clinical subtypes of ischemic stroke: large-artery atherosclerosis (LAAS), cardioembolic infarct (CEI), lacunar infarct (LAC), stroke of other determined origin (ODE), and stroke of undetermined origin (UDE), and now extensively used in clinical and scientific context--analysed the prevalence of cerebrovascular risk factors and the distribution of TOAST subtypes in more 300 patients with acute ischemic stroke in two consecutives studies that reported the significant association between diabetes and the lacunar subtype and a better clinical outcome for diabetic patients, most likely related to the higher prevalence of the lacunar subtype. Well-confirmed are the roles of cigarette smoking, atrial fibrillation, and asymptomatic carotid stenosis as cerebrovascular risk factors. Particularly interesting seems to be the function of inflammation markers (CRP, TNF-alpha, IL-1 beta, ISPs) as potential risk factors. Still elusive remains the association between cholesterol serum levels and stroke, on the basis of the epidemiological data regarding this causative relationship, confirmed only by the results of intervention trials (4S, LIPID, CARE, HPS, ASCOT). Ultimately, cerebrovascular risk appears peculiar owing to the unique relationship between some modifiable risk factors (mainly diabetes and cholesterol) and the possible preferential association with stroke subtypes and specific cerebrovascular risks.
Seminars in Vascular Medicine 09/2004; 4(3):287-303.
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ABSTRACT: Midgut malrotation occurs as a result of failure in normal intestinal rotation and fixation during early pregnancy. Pathological conditions reported in the literature involving midgut malrotation predominantly relate to infants and children. In adults malrotation is often revealed as an incidental finding on computed tomography (CT), or the associated altered anatomy can be the cause of atypical clinical symptoms of relatively common intestinal disorders.An unusual presentation of acute appendicitis, with fever and recurrent pain in left iliac fossa is reported. Underlying intestinal malrotation delayed the correct clinical diagnosis of acute appendicitis. It was not until a CT scan was performed that a malrotation was identified. The predominant appearances of malrotation are the siting of the ascending colon, caecum (and appendix) in the left side of the abdomen and the right-sided placement of the duodenojejunal junction.
Radiography.
