Search

Objectives: Some patients with deep intracerebral hemorrhage (ICH) have a transient hypertensive response and they may be erroneously classified as secondary to hypertension. We investigated frequency, risk factors, and outcomes for patients with deep ICH without hypertension. Materials and methods: We consecutively recruited patients with spontaneous ICH attending two Spanish stroke centers (January 2015-June 2019). Excluded were patients with lobar/infratentorial ICH and patients who died during hospitalization. We defined deep ICH without hypertension when the bleeding was in a deep structure, no requirement for antihypertensive agents during follow-up and no evident chronic hypertension markers evaluated by transthoracic echocardiography, 24 h ambulatory blood pressure monitoring and/or electrocardiography. We compared clinical, radiological, and 3-month functional outcome data for deep-ICH patients with hypertension versus those without hypertension. Results: Of 759 patients with ICH, 219 (mean age 69.6 ± 15.4 years, 54.8% men) met the inclusion criteria and 36 (16.4%) did not have hypertension. Of these 36 patients, 19 (52.7%) had a transient hypertensive response. Independent predictors of deep ICH without hypertension were age (adjusted OR:0.94;95%CI:0.91–0.96) and dyslipidemia (adjusted OR:0.27;95% CI:0.08–0.85). One third of deep ICH without hypertension were secondary to vascular malformations. Favorable outcomes (modified Rankin Scale 0–2) were more frequent in patients with deep ICH without hypertension compared to those with hypertension (70.9% vs 33.8%; p < 0.001). Conclusion: Of patients with deep ICH, 16.4% were unrelated with hypertension, around half showed hypertensive response, and around a third had vascular malformations. We suggest studying hypertension markers and performing a follow-up brain MRI in those patients with deep ICH without prior hypertension. © 2021 Elsevier Inc.

[No abstract available] FINANCIAL/NONFINANCIAL DISCLOSURES: None declared. Scopus

Context: Cardiac tamponade (CT) following cardiac surgery is a potentially fatal complication and the cause of surgical reintervention in 0.1%-6% of cases. There are two types of CT: acute, occurring within the first 48 h postoperatively, and subacute or delayed, which occurs more than 48 h postoperatively. The latter does not show specific clinical signs, which makes it more difficult to diagnose. The factors associated with acute CT (aCT) are related to coagulopathy or surgical bleeding, while the variables associated with subacute tamponade have not been well defined. Aims: The primary objective of this study was to identify the factors associated with the development of subacute CT (sCT). Settings and Design: This report describes a case (n = 80) and control (n = 160) study nested in a historic cohort made up of adult patients who underwent any type of urgent or elective cardiac surgery in a tertiary cardiovascular hospital. Methods: The occurrence of sCT was defined as the presence of a compatible clinical picture, pericardial effusion and confirmation of cardiac tamponade during the required emergency intervention at any point between 48 hours and 30 days after surgery. All factors potentially related to the development of sCT were taken into account. Statistical Analysis Used: For the adjusted analysis, a logistical regression was constructed with 55 variables, including pre-, intra-, and post-operative data. Results: The mortality of patients with sCT was 11% versus 0% in the controls. Five variables were identified as independently and significantly associated with the outcome: pre-or post-operative anticoagulation, reintervention in the first 48 h, surgery other than coronary artery bypass graft, and red blood cell transfusion. Conclusions: Our study identified five variables associated with sCT and established that this complication has a high mortality rate. These findings may allow the implementation of standardized follow-up measures for patients identified as higher risk, leading to either early detection or prevention. © 2018 Annals of Cardiac Anaesthesia

Amaç: Preanalitik hataları azaltmak amacı ile yapılan eğitimin ve Laboratuvar Bilgi Sistemi ile tüp barkotlama sisteminde yapılan teknolojik yeniliklerin etkisini ortaya koymak çalışmamızda amaçlanmıştır.Gereç ve Yöntem: İyileştirmelerin sonuçlarını değerlendirmek için 2013 ve 2014 yıllarına ait preanalitik hatalar Laboratuar Bilgi Sisteminden (LBS) geriye dönük olarak alınmıştır. Preanalitik faz için on kalite indikatörü hesaplanmıştır. İyileştirme yapılmış yıl ile geçmiş yıl karşılaştırılmıştır. Kabul edilemez, minimum, kabul edilebilir ve optimal olmak üzere dört kalite spesifikasyon ölçütü tanımlanmıştır.Bulgular: İyileştirme çalışmalarından sonra tüm preanalitik hata tiplerinde azalma görülmüştür. Kalite indikatörleri spesifikasyon ölçütü olarak değerlendirildiğinde, 2013 yılında QI-14 (taşıma sırasında hasarlanmış örnekler) ve QI-16 (yanlış saklanan örnekler) kabul edilemez, QI-8 (kayıp örnekler) ve QI-12 (yetersiz hacimli örnekler) minimum ve QI-9 (yanlış kaptaki örnekler) kabul edilebilir iken, 2014 yılında tümünün optimal düzeyde olduğu görülmüştür. QI-15 (hatalı etiketlenmiş örnekler) kabul edilebilir iken 2014 yılında kabul edilemez olarak değerlendirilmiştir. QI-10a, b (hemolizli örnekler), 11a (pıhtılı örnekler) ve 13 (yetersiz hacimli örnekler-antikoagülanlı tüplerde) her iki yılda da optimal düzeyde değerlendirilmiştir.Sonuçlar: Preanalitik faz ile ilgili eğitimlerin sürekliliğinin sağlanması ve teknolojik alt yapının güçlendirilmesi bu evrenin kontrolünü sağlayacak temel faktörlerdir Background and objective: We aimed to investigate the effect of “training about the pre-analytical phase” and “technological arrangements in laboratory information systems (LISs) and tube barcoding system”, on decreasing PEs.Materials and methods: PEs in 2013 and 2014 were obtained from the LIS retrospectively in order to evaluate the effect of improvements. Ten quality indicators (QIs) described for pre-analytical phase were calculated. We compared QIs of the “improved year” with the past year. Four quality specification criteria were defined as “ unacceptable”, “minimum”, “desirable” and “optimum” for each quality indicator.Results: There was a reduction in all types of PEs related to the improvement strategies. When QIs were considered as quality specifications (QSs), QI-14 (number of samples damaged in transport) and QI-16 (samples improperly stored) were “unacceptable”, QI-8 (samples lost-not received) and QI-12 (samples with insufficient sample volume) were “minimum” and QI-9 (samples collected ininappropriate container) was “desirable” in 2013; QI-10a, 10b (samples hemolyzed), 11a (samples clotted) and 13 (samples with inadequate sample-anticoagulant) were all “optimum” in 2 years. Conclusion: It was shown that continuous education on pre-analytical phase and improvements of the technological infrastructures are the main factors that will enable the control of this phase.

The aim of this study was to determine the frequency of haemostatic abnormalities in women with menorrhagia and to evaluate their effect on quality of life (QoL). The study population was composed of patients with menorrhagia seen in the outpatient clinic, having a score of >185 with a pictorial blood assessment chart. Structured questionnaires were used in the assessment of demographic characteristics and QoL, and patients were tested for bleeding disorders. Ninety women were recruited for the study. Bleeding disorders were detected in 40% of them: 11.1% had von Willebrand disease, 2.2% had low von Willebrand factor and 26.7% had platelet function disorders (PFD). In 22 (91.6%) cases with PFD the, defect was non-specific and impaired aggregation response to ristocetine (37.5%) was the most commonly detected problem. Bleeding disorders were not associated with any significant reduction in QoL (p >.05). Hereditary bleeding disorders may be the cause of unexplained menorrhagia even in the middle-aged women, but they had no prominent effect on QoL. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Background: In 2010, the EUPHAS 2 collaborative group created a registry with the purpose of recording data from critically ill patients suffering from severe sepsis and septic shock treated with polymyxin-B hemoperfusion (PMX-HP) for endotoxin removal. The aim of the registry was to verify the application of PMX-HP in the daily clinical practice. Methods: The EUPHAS 2 registry involved 57 centers between January 2010 and December 2014, collecting retrospective data of 357 patients (297 in Europe and 60 in Asia) suffering from severe sepsis and septic shock caused by proved or suspected infection related to Gram negative bacteria. All patients received atleast one cycle of extracorporeal endotoxin removal by PMX-HP. Results: Septic shock was diagnosed in 305 (85.4%) patients. The most common source of infection was abdominal (44.0%) followed by pulmonary (17.6%). Gram negative bacteria represented 60.6% of the pathogens responsible of infection. After 72h from the first cycle of PMX-HP, some of the SOFA score components significantly improved with respect to baseline: cardiovascular (2.16±1.77 from 3.32±1.29, p&nbsp

Hemophilia B is a recessive X-linked bleeding disorder characterized by deficiency of the coagulation factor IX (FIX). In hemophilia B patients the severity of the bleeding phenotype is related to the degree of the FIX defect. Hemophilia B treatment has improved greatly in the last 20 years with the introduction first of plasma-derived and then of recombinant FIX concentrates. Replacement therapy may be administered through on-demand or prophylaxis regimens, but the latter treatment modality has been shown to be superior in prevention of hemophilic arthropathy and in improvement of patients' quality of life. The purpose of this narrative review is to summarize the current knowledge on treatment strategies for hemophilia B, focusing on recombinant FIX products either clinically used or in development. There is only one rFIX product that is licensed to treat hemophilia B patients; from the analysis of the literature data presented in this review, the authors conclude that this rFIX product has demonstrated an excellent safety profile and excellent clinical efficacy for halting and preventing bleeds in hemophilia B patients. While prophylaxis has emerged as the best therapeutic strategy for such patients because of its ability to prevent hemophilic arthropathy and to improve patients' quality of life, the pharmacokinetically tailored dosing of rFIX is another key point when planning hemophilia B treatment, as it allows optimization of the factor concentrate usage. Further clinical studies are needed to better assess the safety and efficacy (ie, the incidence of adverse reactions and inhibitor development) of newer rFIX products.

Background: Upper gastrointestinal bleeding is one of the most frequent causes of morbidity and mortality in the course of liver cirrhosis. Patients with liver disease frequently have haemostatic abnormalities like hyperfibrinolysis. Therefore, antifibrinolytic amino acids have been proposed to be used as supplementary interventions alongside any of the primary treatments for upper gastrointestinal bleeding in patients with liver diseases. Objectives: To assess the beneficial and harmful effects of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease. Search methods: We searched the Cochrane Hepato-Biliary Group Controlled Trials Register (11 June 2012), Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2012, Issue 5 of 12), MEDLINE (Ovid SP) (1946 to June 2012), EMBASE (Ovid SP) (1974 to June 2012), Science Citation Index EXPANDED (1900 to June 2012), LILACS (1982 to June 2012), Clinical Trials Search Portal of the WHO (accessed June 18, 2012), and the Metaregister of Controlled Trials (accessed June 18, 2012). We scrutinised the reference lists of the retrieved publications. Selection criteria: Randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. Observational studies for assessment of harms. Data collection and analysis: Data from randomised clinical trials were to be summarised by standard Cochrane Collaboration methodologies. Main results: We could not find any randomised clinical trials assessing antifibrinolytic amino acids for treating upper gastrointestinal bleeding in patients with acute or chronic liver disease. We could not identify quasi-randomised, historically controlled, or observational studies in which we could assess harms. Authors' conclusions: No randomised clinical trials assessing the benefits and harms of antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver disease were identified. The benefits and harms of antifibrinolytic amino acids need to be tested in randomised clinical trials. Unless randomised clinical trials are conducted to assess the trade off between benefits and harms, we cannot recommend nor refute antifibrinolytic amino acids for upper gastrointestinal bleeding in patients with acute or chronic liver diseases. © 2015 The Cochrane Collaboration.

Purpose: To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature. Methods: Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature. Results: Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage. Conclusions: In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.

Currently the treatment mainstay of sepsis is early and appropriate antibiotic therapy, accompanied by aggressive fluid administration, the use of vasopressors when needed and the prompt initiation of measures to support each failing organ. Activated protein C and hydrocortisone, when used accordingly can affect mortality. As the pathophysiologic events that take place during sepsis are being elucidated, new molecules that target each step of those pathways are being tested. However, a lot of those molecules affect various mediators of the sepsis cascade including inflammatory cytokines, cellular receptors, nuclear transcription factors, coagulation activators and apoptosis regulators. Over the last decade, a multitude of clinical trials and animal studies have investigated strategies that aimed to restore immune homeostasis either by reducing inflammation or by stimulating the innate and adaptive immune responses. Antibiotics, statins and other molecules with multipotent immunomodulatory actions have also been studied in the treatment of sepsis. © 2011 Expert Reviews Ltd. 9 11 1013 1033

Gangrene presenting at birth is a rare clinical problem; it results from diminished perfusion of a part of the body, usually the extremities. A variety of aetiological factors may account for this situation. Arterial thrombosis, emboli, trauma, congenital heart disease, sepsis, coagulopathy, polycythaemia, congenital bands, and birth trauma are some of the causes which should be considered. In the majority of cases, an aetiological factor is not identified. The management of neonatal gangrene is usually conservative, preventing infection of the affected part and allowing the gangrenous portion to declare itself in order to optimise future reconstruction and rehabilitation. In this paper, two cases of newborn with gangrene of an upper extremity are reported.

Background: Patients with hemophilia and von Willebrand disease (VWD) may be protected against arterial thrombosis, through a hy-pocoagulable state or atherosclerosis. We performed a systematic review to assess the association between these clotting disorders, arterial thrombosis and the prevalence of asymptomatic atherosclerosis. Methods: Eligible articles were identified by searches of MEDLINE and EMBASE to retrieve studies that evaluated the prevalence of arterial thrombosis and asymptomatic atherosclerotic disease (by intima media thickness of the carotid and femoral arteries, or flow mediated dilation of the brachial artery) in patients with hemophilia or VWD. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Weighted standardized mortality ratios (SMR) and weighted mean differences (WMD) were calculated and pooled using a fixed or random effects model. Statistical heterogeneity was assessed by using X2 en I2 statistics. Results: 15 longitudinal and cross-sectional studies with a total of 19.242 patients met the inclusion criteria. The mean age in the various studies ranged between 35 and 54 years. Mortality due to arterial thrombosis was reduced in patients with hemophilia compared to healthy controls (weighted SMR 0.57, 95% confidence interval (CI) 0.46-0.71), and most consistently so in high quality studies (weighted SMR 0.55, 95% CI 0.48-0.63). No results were available for non- fatal arterial events in hemophilia or for patients with VWD. IMT of the carotid and femoral arteries was similar between VWD and hemophilia patients and healthy controls (WMD 0.01 mm (95% CI - 0.02-0.04) and -0.04 mm (95% CI -0.10-0.02)). The prevalence of atherosclerotic plaques was lower in patients with hemophilia and VWD than in controls. Only two studies assessed FMD and the results were inconsistent. Conclusion: Hemophilia is associated with reduced mortality due to arterial thrombosis, while data on non-fatal arterial events and VWD are lacking. This beneficial effect may be associated with a reduced frequency of atherosclerotic plaques.

A case of mushroom poisoning by false morel, Gyromitra esculenta (Pers.) Fr. (Ascomycetes), in Denizli, Turkey, is reported and documented. A short description of the taxon, case of poisoning, and taxonomic discussions of G. esculenta is presented. © 2009 by Begell House, Inc.

Somatic type of delusional disorder is known monosymptomatic hypochondriacal psychosis. According to DSM-VI, delusional disorder somatic type is defined as a somatic delusion in which a person believes he or she has a physical defect or general medical condition. A 47-year old man who claim had a disorder of coagulation, apply to emergency service with blood in a packet and a piece of meat. The patient has got coetaneous lesions results from self-injury to the skin. He said to that he had a disorder to unknown by medicine. This patient has been presented for the purpose of differential diagnosis and difficulty in treatment.

Nontraumatic primary intraventricular hemorrhage (PIVH) is characterized by direct bleeding into the neuroventricular system. A very rare condition, PIVH accounts for 3% of all spontaneous intracerebral hemorrhages. Hypertension is a major cause of PIVH. Reports about PIVH in the literature are infrequent and it appears to be a relatively benign condition. Between 1998 and 2001, 15 patients with PIVH were evaluated in the Departments of Neurosurgery of Yüzüncü Yil and Pamukkale Universities; their prognosis and results of treatment with external ventricular drainage (EVD) were recorded. The diagnosis was established easily and rapidly with computed tomography. Prognoses of the patients were made by the Glasgow Coma Score (GCS). Hypertension was the most common etiology (n=9, 60%); the prognosis for survivors (73.3%) was good (mortality, 26.6%). Elderly patients, who scored low on the GCS, and patients with coagulopathy had poor prognoses. All patients with PIVH underwent surgery with EVD within 24 hours of their hospital admission. Applying EVD had positive results and influenced the prognosis and early and late complications of PIVH accordingly. ©2005 Health Communications Inc.

S-1 is a new oral fluorinated pyrimidine derivate, in which the oral 5-fluorouracil (5-FU) prodrug, tegafur, was combined with two 5-FU-modulating substances, 5-chloro-2,4-dihydroxypyridine (gimeracil), and potassium oxonate (oteracil), at a molar ratio of 1:0.4:1. The final mechanism of action is exerted by 5-FU. The present study is the first European phase II trial of S-1 in gastric cancer. The primary study objectives were the safety, toxicity and activity of S-1 in non-pretreated patients with gastric cancer. The secondary objective was the duration of response. Patients had to have histologically- or cytologically-verified metastatic or locally advanced, unresectable gastric cancer; S-1 was administered orally twice daily at 40, then 35 mg/m2 for 28 days every 5 weeks. The starting dose of 40 mg/m2 was found to be intolerable due to significant non-haematological toxicity, and this dose was rapidly reduced to 35 mg/m2 twice daily. Of the 7 patients enrolled at the 40 mg/m2 level, only 3 were evaluable. At 35 mg/m2, a response rate of 26.1% (95% Confidence Interval (CI) 12.0-45.1%) in 23 enrolled patients, and 31.6% (C.I. 14.7-53.0%) in 19 evaluable patients according to an independent radiology review, was found. The median duration of response at 35 mg/m2 (6 patients) was 223 days (range, 108-828 days), and of stable disease was 111 days (range 68-411 days). S-1 can be administered with an acceptable safety and toxicity in European patients at a dose of 35 mg/m2 days 1 - 28 every 5 weeks and is associated with a moderate response rate similar to the results achieved with other fluoropyrimidines. © 2003 Elsevier Science Ltd. All rights reserved. 39 9 1264 1270

Background: Patients with hemophilia and von Willebrand disease (VWD) may be protected against arterial thrombosis, through a hy-pocoagulable state or atherosclerosis. We performed a systematic review to assess the association between these clotting disorders, arterial thrombosis and the prevalence of asymptomatic atherosclerosis. Methods: Eligible articles were identified by searches of MEDLINE and EMBASE to retrieve studies that evaluated the prevalence of arterial thrombosis and asymptomatic atherosclerotic disease (by intima media thickness of the carotid and femoral arteries, or flow mediated dilation of the brachial artery) in patients with hemophilia or VWD. Study selection, data extraction, and quality assessment were independently performed by two reviewers. Weighted standardized mortality ratios (SMR) and weighted mean differences (WMD) were calculated and pooled using a fixed or random effects model. Statistical heterogeneity was assessed by using X2 en I2 statistics. Results: 15 longitudinal and cross-sectional studies with a total of 19.242 patients met the inclusion criteria. The mean age in the various studies ranged between 35 and 54 years. Mortality due to arterial thrombosis was reduced in patients with hemophilia compared to healthy controls (weighted SMR 0.57, 95% confidence interval (CI) 0.46-0.71), and most consistently so in high quality studies (weighted SMR 0.55, 95% CI 0.48-0.63). No results were available for non- fatal arterial events in hemophilia or for patients with VWD. IMT of the carotid and femoral arteries was similar between VWD and hemophilia patients and healthy controls (WMD 0.01 mm (95% CI - 0.02-0.04) and -0.04 mm (95% CI -0.10-0.02)). The prevalence of atherosclerotic plaques was lower in patients with hemophilia and VWD than in controls. Only two studies assessed FMD and the results were inconsistent. Conclusion: Hemophilia is associated with reduced mortality due to arterial thrombosis, while data on non-fatal arterial events and VWD are lacking. This beneficial effect may be associated with a reduced frequency of atherosclerotic plaques.

In nine patients with non-malignant diseases undergoing major upper abdominal surgery, the mechanism of the postoperative fibrinolytic shut-down was investigated because of its potential significance for postoperative deep vein thrombosis by employing new and specific methods for assessing and stimulating the fibrinolytic system. The shut-down was found to result from an impairment of the balance between tissue-type plasminogen activator, t-PA, and its recently discovered fast-acting inhibitor. In this balance, the t-PA antigen concentrations both in resting conditions and after stimulation evoked by desamino-D-arginine vasopressin (DDAVP) were found to be unchanged by surgery. However, there was a significant postoperative increase in t-PA inhibitor levels. The release of t-PA under the stimulus of DDAVP infusion overcame the postoperative shut-down of t-PA activity. However, DDAVP infusion was associated with potentially unfavourable increases in the Factor VIII/von Willebrand factor complex. The discovery of increased t-PA inhibitor in the postoperative period opens new possibilities for a rational approach to reduce or abolish the postoperative fibrinolytic shut-down. Chemicals/CAS: blood clotting factor 8, 9001-27-8; desmopressin, 16679-58-6; plasminogen activator inhibitor, 105844-41-5; tissue plasminogen activator, 105913-11-9; Desmopressin, 16679-58-6; Factor VIII, 9001-27-8; Glycoproteins; Plasminogen Inactivators; Tissue Plasminogen Activator, EC 3.4.21.68; von Willebrand Factor

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:21:40Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:44:07Z : No. of bitstreams: 1 2-s2.0-32044458595.pdf: 221452 bytes, checksum: 54605f9a6b725bd2e187a351e5f46fcb (MD5) Made available in DSpace on 2014-05-27T11:21:40Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-01 Natural killer cells constitute a population of lymphocytes able to non-specifically destroy virus-infected and some kinds of tumor cells. Since this lytic activity was shown by non-immunized animals the phenomenon is denominated natural killer (NK) activity and contrasts with specific cytotoxicity performed by cytolytic T lymphocytes (CTLs) because it does not depends on MHC-restricted peptides recognition. In fact, the main feature of most functional receptors of NK cells (NKRs) is their ability to be inhibited by different kinds of class I MHC antigens. In the middle of the 1950's, Burnet & Thomas forged the concept of tumor immunosurveillance and NK cells can be considered one of the main figures in this phenomenon both for effector and regulatory functions. In the present review the early studies on the biology of NK cells were revisited and both their antitumor activity and dependence on the activation by cytokines are discussed. Departamento de Microbiologia e Imunologia Instituto de Biociências UNESP Universidade Estadual Paulista, Botucatu - SP Departamento de Microbiologia e Imunologia Instituto de Biociências UNESP Universidade Estadual Paulista, Camp. de Rubiao Jr. s/n, Cx. p. 510, 18618-000 - Botucatu - SP Departamento de Microbiologia e Imunologia Instituto de Biociências UNESP Universidade Estadual Paulista, Botucatu - SP Departamento de Microbiologia e Imunologia Instituto de Biociências UNESP Universidade Estadual Paulista, Camp. de Rubiao Jr. s/n, Cx. p. 510, 18618-000 - Botucatu - SP

Diabetes represents an independent risk factor for coronary artery disease (CAD), and the prognosis in terms of survival rates is worse for diabetic patients who have CAD with respect to those with CAD but no diabetes. An acute coronary event represents a cause of death in more than 30% of diabetics. Experimental studies suggested that the increased incidence of myocardial infarction in diabetics is due to an increased risk of developing atherosclerotic plaque with subsequent ulceration and intracoronary thrombus formation. Structural abnormalities of the coronary vessel wall were associated with an abnormal pattern of coronary flow and of coagulation abnormalities: all these abnormalities explain the epidemiological evidence of widespread and severe vascular atherosclerotic disease in diabetics. Due to the extreme complexity of ischemic vascular disease in patients with diabetes, an optimal therapeutic strategy is based on the correction of elevated blood glucose and lipid levels, of blood pressure, of platelet and coagulation abnormalities and of any other risk factor. Both percutaneous and surgical myocardial revascularization have been proved equally effective for CAD treatment in diabetes, even though a recent randomized trial has shown a significantly improved outcome after surgical revascularization. More recently the characterization of the advanced glycation end-product receptor opened new perspectives in the treatment of the complications of diabetes, and gave a new impact to the need of further investigations, through new randomized trials, of the best therapeutic options for diabetic patients.