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Alzheimer's disease (AD) is characterized by profound memory loss sufficient to interfere with social and occupational functioning. It is the most common form of dementia, affecting more than 20 million people worldwide. AD is characterized by an insidious loss of memory, associated functional decline, and behavioral disturbances. Patients may live for more than a decade after they are diagnosed with AD, making it the leading cause of disability in the elderly. The incidence of AD ranges from 1 to 4 percent of the population per year, rising from its lowest level at ages 65 to 70 years to rates that may approach 6 percent for those over the age of 85 years. The first neurotransmitter defect discovered in AD involved acetylcholine (ACh). As cholinergic function is required for short-term memory, the cholinergic deficit in AD was also believed to be responsible for much of the short-term memory deficit. Clinical drug trials in patients with AD have focused on drugs that augment levels of ACh in the brain to compensate for the loss of cholinergic function. These drugs have included ACh precursors, muscarinic agonists, nicotinic agonists, and acetylcholinesterase inhibitors. The most highly developed and successful approaches to date have employed acetylcholinestrase inhibition. Although some Food and Drug Administration-approved drugs are available for the treatment of Alzheimer's disease, the outcomes are often unsatisfactory, and there is a place for alternative medicine, in particular, herbal medicine. This paper reviews the clinical effects of a number of commonly used types of herbal medicines for the treatment of AD.

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Behcet's disease is a multisystem disorder and classified as "vasculitic syndrome with a wide variety of clinical manifestations." Cardiac involvement is very rare but can occur with different presentations including: pericarditis, cardiomyopathy, endocarditis, endomyocardial fibrosis, intracavitary thrombosis, and coronary artery disease. Great vessel involvement is more common. Recurrent Phlebitis, commonly involving large vessels (superior vena cava, inferior vena cava, hepatic veins) and cerebral veins are the sole presentation in this regard. Arterial involvement is expressed by aneurysm or pseudoaneurysmal formation. Due to the wide variety of cardiovascular manifestations and the resulting high mortality, cardiac surgeons should be familiar with this disease. In this paper we review the articles and introduce our four cases presenting with aneurysm of ascending aorta with free aortic insufficiency, aneurysm of descending aorta, pulmonary artery aneurysm, and pseudoaneurysm of aortic arch. doi: 10.1111/j. 1540-8191.2008.00607.x (J Card Surg 200823:765-768) Behcet's disease (BD) was first discovered in 1937 by Hulusi Behcet. It is an autoimmune disease and is classified as a vasculitic syndrome. This disease is a multisystem disorder with a wide variety of clinical manifestations including skin, eye, musculoskeletal, neurologic, and cardiovascular presentations. 1,2 The spectrum of cardiac diseases may include pericarditis, coronary artery stenosis or aneurysm, myocarditis, cardiomyopathy, congestive heart failure, valvular pathology, endocarditis or endocavitary thrombosis, aneurysm of aorta and its branches, pulmonary artery aneurysm, or venous thrombosis. Due to its wide variety of pathologies, disease presentation may vary in each case. CASE REPORT Case 1A 24-year-old man, a known case of BD, under followup by the rheumatology clinic in our center, developed exertional chest pain a few weeks prior to presentation to our ward. His workup, including chest xray (CXR), computed tomography (CT) scan, transthoracic echocardiography, and aortography, showed cardiomegaly, severe aortic insufficiency, and a huge aneurysm of ascending aorta as is shown in (Fig. 1). aortic valve no. 23. The patient had a smooth postoperative course and an uneventful recovery, but 20 days postoperative the patient was operated on once again Address for correspondence: Mehrab Marzban, M.D., Tehran Heart Center, Tehran, Iran. Fax: +98-21-88029256; e-mail: mehrabmarzban2007@yahoo.com due to massive pericardial effusion resulting from subxiphoid drainage. Now, two years postoperative, the patient is on maintenance prednisolone therapy. Case 2A 50-year-old woman, a known case of BD with cutaneous and ocular manifestation on prednisolone and colchicine, presented to our center with a history of upper abdominal pain, mild dysphagia, and weight loss for a few weeks. Her workup, including CXR, echocardiography, CT scan, and aortogram, showed a saccular aneurysm of descending aorta, just above the diaphragm (Fig. 2). The patient...

BackgroundDiverse ethnic groups may differ regarding the risk factors and severity of coronary artery disease (CAD). This study sought to assess the association between ethnicity and CAD risk and severity in six major Iranian ethnic groups.MethodsIn this study, 20,165 documented coronary artery disease patients who underwent coronary angiography at a tertiary referral heart center were recruited. The demographic, laboratory, clinical, and risk factor data of all the patients were retrieved. The Gensini score (an indicator of CAD severity) was calculated for all, and the risk factors and severity of CAD were compared between the ethnical groups, using adjusted standardized residuals, Kruskal–Wallis test, and multivariable regression analysis.ResultsThe mean age of the participants (14,131 [70.1%] men and 6034 [29.9%] women) was 60.7 ± 10.8 years. The Fars (8.7%) and Gilak (8.6%) ethnic groups had the highest prevalence of ≥4 simultaneous risk factors. The mean Gensini score was the highest for the Gilaks (77.1 ± 55.9) and the lowest among the Lors (67.5 ± 52.8). The multivariable regression analysis showed that the Gilaks had the worst severity (β 0.056, 95% CI 0.009 to 0.102; P = 0.018), followed by the Torks (β 0.032, 95% CI 0.005 to 0.059; P = 0.020). Meanwhile, the Lors showed the lowest severity (β −0.087, 95% CI −0.146 to −0.027; P = 0.004).ConclusionsThis study found that there was heterogeneity in CAD severity and a diverse distribution in its well-known traditional risk factors among major Iranian ethnic groups.