P209 THE FOLLOW–UP OF PATIENTS AFTER ACUTE CORONARY SYNDROME: THE APULIAN PONTE–ACS PROJECT

Background

Patients discharged after acute coronary syndrome (ACS) deserve a tight follow–up in order to optimize long–term pharmacological treatments and prevent the occurrence of adverse events. The aim of the PONTE–ACS Project was to evaluate the impact of a dedicated cooperative program between hospital and outpatient structures on the persistance on recommended therapies and long–term outcome occurrence in patients discharged after ACS.

Materials and Methods

This was a prospective, longitudina, cohort study. We enrolled patients who were discharged after ACS and/or after coronary revascularization in the HUB centres of ASL Bari. Patients underwent cardiologic evaluation and laboratory examination at 30 days, 3–, 6–, and 12–months from the index event. The following endpoint were considered: all–cause mortality, ACS recurrence/cardiac ischemia/angina, restenosis/intrastent thrombosis, stroke/transient ischemic attack (TIA), heart failure, any bleeding. Adherence and persistence to therapies were evalauted as well as the percentage of patients who reached the recommended goals.

Results

We enrolled 2476 patients (77.4% male, mean age: 67.2±12.0 yrs). After one–year follow–up, 99.5% (p < 0.05) were on statin–therapy, 16.1% with ezetimibe (p < 0.01) and 9.9% (p < 0.01) with proprotein convertase subtilisin/kexin type 9 inhibitors. The overall mortality at one–year follow–up was 3.1%, while ACS recurrence/cardiac ischemia/angina and restenosis/intrastent thrombosis were 3% e 1.3%, respectively. Any bleeding rate was 2.2%.

Conclusions

The PONTE–ACS Project was able to improve the management of patients after ACS, to manage a structured follow–up protocol for patients discharged after ACS and/or coronary revascularization, thus improving adhesion to recommended therapies and keeping lower the incidence of major cardiovascular and bleeding events.

Bioactive properties of Persea lingue Ness (Lauraceae) fruit and leaf extracts

Persea lingue Ness is a tree species that lives mainly in temperate forests of south-central Chile. Its leaves are used in ethnomedicine, the fruit is a drupe similar to that of the avocado and has not been studied. The aim of this study was to determine the cytotoxicity in leukemia cell and antibacterial activity, along with some chemical content characteristics of P. lingue fruit and leaf extracts. The antibacterial activity was determined by the inhibition of bacterial growth in liquid medium assay against Gram-positive and Gram-negative bacteria. The leukemia cell lines Kasumi-1 and Jurkat were used to evaluate the cytotoxic activity by using propidium iodide and AlamarBlue assays. Total phenolic, flavonoid, condensed tannin, alkaloid and lipid contents were evaluated in the fruit and in the leaf extracts. The antioxidant activity of both extracts were also elavaluated. Leaf extract presented the highest content of total phenols, condensed tannins and flavonoids, and also the highest antioxidant activity. While the fruit extract has a higher amount of lipids and alkaloids and the high antibacterial activity against Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Bacillus megaterium and Micrococcus luteus. The leaf extract only showed activity against M. luteus. Concerning the cytotoxic activity, only the fruit extract showed cytotoxicity against the cell lines Jurkat and Kasumi-1. P. lingue fruit extract is a potential source of biologically active molecules for the development of new drugs to be used in some types of leukemia, as well as antibacterial agent.

Aneurysm of the Internal Jugular Vein — A Case Report

Venous aneurysms unrelated to arteriovenous fistulas are uncom mon. This case report describes clini cal findings and data obtained by echo Doppler examination in a young girl with a venous aneurysm of the right internal jugular vein and a tho racic outlet syndrome. An etiologic correlation between the aneurysm and the thoracic outlet might be sus pected.

A new strategy for treatment of a congenital arteriovenous fistula of the neck. Case report

Congenital arteriovenous fistulas (AVF) without associated vascular malformations are uncommon. Only a very few cases of AVF have been reported in the neck. We describe our findings in a patient with AVF treated by a combined vascular and endovascular approach.

[Endovascular treatment of aneurysms in the elderly]

The constant increase in the median age over 80 requires more and more care from vascular surgeons to obtain better results in the treatment of aortic degenerative diseases. In the last years a remarkable improvement in the procedures of endovascular surgery of abdominal aortic aneurysms has been reached. Actually different prostheses are available for the treatment of aortic aneurysms. The early results of these procedures are similar to the traditional surgical techniques, but at the moment long term results are not yet available. The Authors underline the importance of a long term follow up to allow a correct evaluation of physiopathological modifications in the aortic circulation.

[Management of thoracic and thoraco-abdominal aneurysms in the elderly]

Repair of descending thoracic aneurysm or thoracoabdominal involves transient ischaemia of many organs with high risk of complications. The elderly patient may be more at risk depending on the presence or absence of significant comorbidity factors. Careful preoperative evaluation and patient selection considerably reduce the risk of operative mortality and morbidity. We review the management of thoracic and thoracoabdominal aneurysms in the elderly and briefly describe our surgical approach in order to minimize operative risk and improve surgical results.

[Carotid endarterectomy in the elderly]

The elderly population has the highest risk for developing stroke and the annual death rate is some 394/100,000 population. Moreover, the elderly are the fastest growing segment in our society. In carefully selected patients carotid endarterectomy may provide to prophylaxis against stroke. With a careful selection, acceptable low operative motality and morbidity rates may be achieved, comparable to the 4.3% and the 2.3% of the Veterans Affair and ACAS studies, in which the patients' mean ages were 64.1 and 67 years respectively.

Molecular cloning, expression and characterization of the first three genes in the mevalonate-independent isoprenoid pathway in Streptomyces coelicolor

The mevalonate-independent biosynthetic pathway to isopentenyl diphosphate and dimethylallyl diphosphate, the universal precursors to the isoprenoids, operates in eubacteria, including Escherichia coli, in algae, and in the plastids of higher plants. A search of the Sanger Centre Streptomyces coelicolor genome database revealed open reading frames with ca. 40--50% identity at the deduced amino acid level to the first three E. coli enzymes of this pathway, corresponding to deoxyxylulose phosphate synthase, deoxyxylulose phosphate reductoisomerase and 2-C-methyl erythritol 4-phosphate cytidylyltransferase. The S. coelicolor genes have been cloned and expressed in E. coli, and the recombinant proteins characterized physically and kinetically. The presence of the corresponding enzyme activities in extracts of S. coelicolor CH999 further supports the operation of the mevalonate-independent pathway in this organism.

Premature lesions of the carotid vessels in HIV-1-infected patients treated with protease inhibitors

OBJECTIVES

To evaluate the presence of premature atherosclerotic lesions of epiaortic vessels in HIV-1-infected protease inhibitor-(PI) treated patients compared with PI-naive patients and healthy individuals.

DESIGN

One-hundred and two HIV-1-positive patients, including 55 treated with PI for at least 12 months and 47 either naive or treated with PI-sparing regimens, were subjected to epiaortic vessel ultrasonography. These data were compared with those obtained from 104 healthy individuals.

METHODS

Intima characteristics, pulsation and resistance indexes, and minimal, peak and mean speed were evaluated using a colour power doppler. Atherosclerotic plaques were described. Independent risk factors and values for glycaemia, cholesterolaemia and triglyceridaemia were considered. Statistical analysis included the chi-square test, Mantel-Haenszel test, odds ratio and logistic regression analysis.

RESULTS

Of the PI-treated patients, 29 out of 55 (52.7%) presented acquired lesions of the vascular wall at ultrasonography, whereas similar lesions were found in seven out of 47 (14.9%) PI-naive patients. Of the 104 healthy individuals, seven cases (6.7%) of intimal medial thickness were noted. A slightly significant correlation was found between carotid lesions and age, male sex and hypercholesterolaemia, whereas cigarette smoking, hypertriglyceridaemia and Centers for Disease Control and Prevention stage significantly increased the risk of vascular lesions (P= 0.022, P= 0.017 and P= 0.079 respectively). However, the highest significance regarded use of PI (P= 0.011). These results were confirmed by logistic regression analysis.

CONCLUSIONS

These data demonstrate a higher than expected prevalence of premature carotid lesions in the PI-treated compared with PI-naive patients. If confirmed, a periodic ultrasonographic study of the vascular wall should be included in the follow-up of HIV infected patients.

[Strain-gauge plethysmography in angiopathies caused by vibrant tools]

The authors compare the results obtained from the strain gauge plethysmography on 79 patients affected by vibrating machines angiopathology with a group of 20 others non exposed to vibrations. The results, analyzed according to the microcirculation vision, lead the authors to suppose that the damage caused by vibrating instruments is revealed at the capillary bed trophic exchange level.

Plasma lipids as a risk factor in peripheral vascular disease

Plasma lipids were tested in 59 patients with symptomatic peripheral vascular disease (PVD) (confirmed by angiographic and, in many cases, operative examinations) and compared with the lipid balance in 47 nonarteriopathic subjects constituting the control group. Of all the elements considered, only the hypertriglyceridemia and the fall in the HDL cholesterol/total cholesterol ratio showed a statistically significant difference between the two groups. In particular, there was a significant difference between the two groups. In particular, there was a significant difference in the triglyceridemia present in the arteriopathic patients, as evidenced by the double check afforded by the frequency test (PVD: 25/59; control: 8/47; p less than 0.01) and the averages test (PVD: 201 +/- 131; control: 138 +/- 98; p less than 0.01).