End-stage renal disease (ESRD) is associated with increased cardiovascular morbidity and mortality. Recent studies indicate that atrial fibrillation (AF) is prevalent among ESRD patients while it adversely affects the clinical outcome. Despite these considerations, AF management in this population is problematic. Notably, most ESRD patients with AF are deprived of the benefits of anticoagulation therapy because of the fear of hemorrhagic complications. This article provides a concise and critical overview of the complex pathophysiology, epidemiology, and discusses the clinical issues regarding the emerging association between ESRD and AF.

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Background and Purpose-The available data regarding the association between metabolic syndrome (MS) or MS components and ischemic stroke in type 2 diabetics are limited and inconsistent. This study aimed to investigate these associations. Methods-Five hundred ninety-nine consecutive type 2 diabetic patients (mean age 60.4Ϯ9.6 years, 54% men) were followed-up for 10.1 years (median period). Baseline clinical and laboratory characteristics and the occurrence of a first-ever ischemic stroke during follow-up were recorded. Results-Seventy-eight patients developed a first-ever ischemic stroke. According to Cox proportional hazard model, waist circumference (hazard ratio, HR:1.006, 95% CI:1.002 to 1.010, Pϭ0.003) and age (HR:1.061, 95% CI:1.002 to 1.125, Pϭ0.04) were significant predictors. After incorporating various combinations of MS components in multivariate models, only age and waist circumference remained significant. Conclusions-MS per se at baseline or combinations of its components do not predict the development of ischemic stroke in type 2 diabetic patients. Waist circumference represents an independent prognostic factor and could be used as a clinical tool for stroke prevention in this population.

The skin may exhibit the first clinical evidence of a systemic disease and may provide the first clues to a diagnosis in malignancies. Erythroderma is defined as generalized redness and scaling and it is a clinical manifestation of a variety of underlying diseases including, rarely, solid tumors. Breast cancer is associated with a variety of skin paraneoplastic manifestations like acanthosis nigricans, erythromelalgia, thrombotic thrombocytopenic purpura, acrokeratosis paraneoplastica, dermatomyositis, systemic sclerosis, and scleroderma. However, in the literature, the correlation of erythroderma with breast cancer is quite infrequent. Here, we describe a case of a 76-year-old woman who presented with a paraneoplastic manifestation of erythroderma due to breast cancer.

References 1. Aso Y, Okumura K-I, Takebayashi K, Wakabayashi S, Inukai T: Relationships of plasma interleukin-18 concentrations to hyperhomocysteinemia and carotid intima-media wall thickness in patients with type 2 diabetes.