An elevated white blood cell (WBC) count and C-reactive protein (CRP) concentration are associated with acute myocardial infarction (AMI) and long-term mortality in patients with coronary artery disease. Their relationship with short-term prognosis following AMI is less clear, however. We investigated the relationship between WBC count and CRP concentration, obtained at the time of admission, and the development of subsequent ischaemic coronary events (SICE) within 30 days of AMI in 177 patients. After adjustment for confounding factors, CRP concentration was found to be a strong independent predictor for SICE within 30 days in patients with AMI. WBC count was not found to be an independent predictor, but there was a strong correlation between high WBC counts and the onset of SICE within 30 days in patients with AMI. We conclude that CRP concentration and WBC count could be used to predict the short-term prognosis of patients with AMI.
Zusammenfassung. Grundlagen: Das Syndrom der toxischen epidermalen Nekrolyse (TEN) ist eine seltene, akute, lebensbedrohliche Erkrankung, bei der es zur Abschilferung der Haut an der Derma-Epidermis-Grenze und Mukositis kommt.Methodik: Wir berichten über eine 71-jährige Frau mit toxischer epidermaler Nekrolyse.Ergebnisse: Unsere Patientin litt unter TEN durch Naproxen Natrium (zwei Dosen, je 550 mg). Nach zwei Tagen wurde sie über die Notfallambulanz unseres Krankenhauses mit Fieber, Juckreiz und makulopapulärem erythematösem Hautausschlag am Stamm aufgenommen. Die Schleimhäute der Augen, des Mundes und der Genitalien waren entzündet; im Genitalbereich bestanden große erosive Veränderungen.Schlussfolgerungen: Bei Früherkennung des TEN kommt es bei entsprechend raschem Management zu einem guten Ergebnis ohne Narbenbildung und Folgeschäden.Schlüsselwörter: toxische epidermiale Nekrolyse, Naproxen Natrium, Lyell-Syndrom.Summary. Background: Toxic epidermal necrolysis (TEN) syndrome is an uncommon, acute, life-threatening disorder that involves sloughing of skin at the dermal-epidermal junction with associated mucositis.Methods: We report a 71-year-old woman suffering from TEN.Result: Our patient suffered from TEN due to naproxen sodium (two doses, 550 mg each). After two days she was admitted to the emergency department of our hospital with a high temperature, irresistible itching, and extended maculopapular erythematous rash over the trunk. The mucous membranes of the eyes, mouth, and genitalia also showed marked inflammation; most prominent were large erosions in the genitalia area.Conclusions: With early recognition of the disease, transfer to a burn center, proper wound management, and infection monitoring, patients with TEN have an excellent chance of survival without scarring and sequelae.
This study aimed to determine the effects of fluvastatin treatment on insulin sensitivity in patients with hyperlipidaemia. Non-obese, normoglycaemic, normotensive patients with hyperlipidaemia (n = 20) and a reference group of healthy subjects of similar age, sex, and body mass index (n = 20) were evaluated. Patients with other causes of peripheral insulin resistance were excluded. All participants underwent a diagnostic protocol, which included measurements of insulin sensitivity index and other metabolic parameters. Insulin sensitivity was assessed by Homeostasis Model Assessment (HOMA). Serum insulin levels were tested by radioimmunoassay. Patients were treated with fluvastatin 40 mg once daily for 3 months. Before fluvastatin treatment, fasting serum insulin levels were significantly raised in patients with hyperlipidaemia compared with subjects from the reference group (19.1 ± 13.4 versus 8.1 ± 3.4 µlU/ml). The fasting serum insulin levels and HOMA-estimated insulin sensitivity were correlated in the whole group. Correlation analysis showed a significant relationship between HOMA-estimated insulin resistance and plasma cholesterol and triglyceride concentrations. Patients with hyperlipidaemia had reduced insulin sensitivity that was reflected by high serum fasting insulin levels. Anti-hyperlipidaemic treatment with fluvastatin increases insulin sensitivity.
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