In stable angina the platelet count is unchanged compared to patients with normal coronary arteries but the platelet size is increased. However, in unstable angina there is a decrease in platelet count and an even larger increase in platelet size. We interpret this as meaning that unstable angina might be associated or preceded by an increase in platelet destruction rate that is not completely compensated for by an increase in platelet production rate. The large, more reactive platelets might be causally related to an ongoing coronary artery obstruction in unstable angina.

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P Pr ro og gn no os st ti ic c aan na al ly ys si is s a an nd d p pr re ed di ic ct ti iv ve e r ru ul le e f fo or r o ou ut tc co om me e o of f h ho os sp pi it ta al l--t tr re ea at te ed d c co om mm mu un ni it ty y--a ac cq qu ui ir re ed d p pn ne eu um mo on ni ia a ABSTRACT: In community-acquired pneumonia (CAP) mortality may be reduced by early identification of patients requiring intensive care treatment. The purpose of this study was to determine prognostic factors of outcome in patients with CAP in order to establish a clinically applicable discriminant rule.Ninety three episodes of CAP in 92 patients were retrospectively reviewed with regard to epidemiological, clinical, laboratory and microbiological data. The prognostic analysis included a univariate as well as a multivariate approach, in order to identify parameters associated with death using the Cox regression hazard function in a backward stepwise selection model. The three parameters found to contribute most to the significance of the model were used in a discriminant rule for classification of outcome.The parameters found to be significantly different between survivors and nonsurvivors were heart rate, systolic and diastolic as well as mean blood pressures, leucocyte count, percentage of lymphocytes, and lactate dehydrogenase (LDH) values. The multivariate analysis revealed that heart rate, systolic arterial pressure, and LDH serum levels were most closely associated with fatal outcome. A prognostic rule composed of the variables heart rate ≥90 beats·min -1 , systolic arterial blood pressure ≤80 mmHg, and LDH ≥260 U·l -1 achieved a sensitivity of 77%, a specificity of 75%, and positive and negative predictive values of 42 and 93%, respectively. It was associated with a six fold increased risk of fatal outcome.In conclusion, heart rate, systolic blood pressure, and LDH values were most closely associated with death in a multivariate analysis. A discriminant rule consisting of these three variables achieved favourable classification results. The rule qualifies for further prospective validation, and may prove useful in the management of hospital-treated CAP.

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Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.

In this report, we present the successful percutaneous ventricular septal defect (VSD) closure, just 1 week post-transcatheter aortic valve implantation (TAVI). Periprocedurally, after implantation of the 31-mm CoreValve in an intentionally "high" position, we balloon postdilated, with an excellent result. A week post-TAVI, the patient started to deteriorate. Echocardiogram revealed a good working prosthesis; however, a perimembranous VSD was evident, causing significant shunt. We proceeded with interventional treatment of the defect, using an Amplatzer multifenestrated--"Cribriform"--septal occluder. Six months after the combined procedure, the patient showed marked improvement in symptoms and no shunt was observed.