-----The authors present a cross-sectional study involving 61 patients with idiopathic Parkinson's disease (PD) who were consecutively examined and compared to a control group with 74 subjects. Only patients who fulfilled the standard diagnostic criteria for PD and whose brain magnetic resonance imaging was normal were included. The objective of the study was to evaluate the prevalence of inferior urinary tract symptoms in PD and to study the possible association between clinical factors to urinary dysfunction. ln the patient group, 39.3% presented urinary symptoms when compared to 10.8% in the control group. All symptomatic patients presented irritative symptoms. The most common irritative symptom PD was nocturia, followed by frequency and urinary incontinence. Around 25% of the patients presented functional obstructive symptoms determined by the disease. The most frequent obstructive symptom was incomplete emptying of the bladder. Only the age of the patients and control group were correlated with urinary dysfunction.KEY WORDS: Parkinson's disease, urinary symptoms, autonomic symptoms.Prevalência e fatores associados aos sintomas urinários na doença de P Prevalência e fatores associados aos sintomas urinários na doença de P Prevalência e fatores associados aos sintomas urinários na doença de P Prevalência e fatores associados aos sintomas urinários na doença de P Prevalência e fatores associados aos sintomas urinários na doença

We report two patients with exertional headaches beginning with vigorous exercise and relieved by rest. Neurologic evaluation and neuroimaging were normal in both. During exercise stress testing, the onset of the patients' typical headaches correlated with ECG changes indicative of myocardial ischemia. In both patients coronary angiography revealed three-vessel disease, and myocardial revascularization procedures were followed by complete resolution of headaches. Based on these patients, and a review of prior similar reports, we conclude that myocardial ischemia is a rare and treatable cause of exertional headache. Accurate diagnosis is critical to controlling headaches and preventing myocardial infarction.

Age, LVEF ≤40% and LA diameter are independent predictors of new-onset AF during ACS. This arrhythmia is associated with higher overall mortality (in-hospital and in follow-up).

Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment. © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. Degenerescência caseosa da calcificação do anel mitral: uma perspectiva multi-imagem Resumo A calcificação do anel mitral é um achado ecocardiográfico comum, particularmente em idosos e doentes com insuficiência renal terminal em diálise. A degenerescêncica caseosa, ou necrose liquefeita, da calcificação do anel mitral é uma forma rara de calcificação do anel mitral. O reconhecimento precoce desta entidade evita procedimentos diagnósticos invasivos na medida em que é uma patologia benigna e, ao contrário de tumores e abcesso cardíacos, tem um bom prognóstico. Os autores apresentam o caso clínico de uma doente de 84 anos de idade com uma massa hiperecogénica ao nível do folheto posterior da válvula mitral, associada * Corresponding author. E-mail address: silviamartinsribeiro@gmail.com (S. Ribeiro). Ressonância magnética cardíaca a insuficiência mitral severa. A ressonância magnética cardíaca demonstrou uma massa hipoperfundida, com realce tardio, após administração de gadolíneo. A tomografia computadorizada cardíaca evidenciou a natureza calcificada da lesão. Uma abordagem multi-imagem permitiu o diagnóstico de calcificação caseosa do anel mitral posterior. A doente recusou cirurgia cardíaca. PALAVRAS-CHAVE

Colon cancer represents the second leading cause of cancer-related deaths. For patients who have undergone curative surgery, adjuvant therapy can reduce the risk of recurrence and death from relapsed or metastatic disease. Postoperative chemotherapy with a 5-fluorouracil-based regimen combined with oxaliplatin is the current standard of care for stage III patients. However, there is still controversy in stage II disease about the real impact of adjuvant monotherapy or combined therapy on survival. Better identification of a subgroup of patients with a higher risk of recurrence can select patients who might benefit from adjuvant therapy. For the elderly population, there is a well-established role for postoperative therapy, although the most appropriate regimen remains to be defined. Targeted agents for combined adjuvant therapy in stage II and III colon cancer is a promising area, but to date, there is no evidence supporting its use in this setting. Results from large prospective trials with targeted therapy have been disappointing and new drugs and strategies are needed to define the role of these types of agents in the adjuvant scenario of colon cancer.

Mitral annulus calcification is a common echocardiographic finding, particularly in the elderly and in end-stage renal disease patients under chronic dialysis. Caseous calcification or liquefaction necrosis of mitral annulus calcification is a rare evolution of mitral annular calcification. Early recognition of this entity avoids an invasive diagnostic approach, since it is benign and, unlike intracardiac tumors and abscesses, has a favorable prognosis. The authors present the case of an 84-year-old woman with a suspicious large, echodense mass at the level of the posterior mitral leaflet with associated severe mitral regurgitation. Cardiac magnetic resonance imaging demonstrated a hypoperfused mass with strong peripheral enhancement 10 minutes after gadolinium administration. Multislice computed tomography showed the calcified nature of the mass. A multi-modality imaging approach confirmed the diagnosis of caseous calcification of the posterior mitral annulus. The patient refused surgical treatment. © 2011 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L. All rights reserved. Degenerescência caseosa da calcificação do anel mitral: uma perspectiva multi-imagem Resumo A calcificação do anel mitral é um achado ecocardiográfico comum, particularmente em idosos e doentes com insuficiência renal terminal em diálise. A degenerescêncica caseosa, ou necrose liquefeita, da calcificação do anel mitral é uma forma rara de calcificação do anel mitral. O reconhecimento precoce desta entidade evita procedimentos diagnósticos invasivos na medida em que é uma patologia benigna e, ao contrário de tumores e abcesso cardíacos, tem um bom prognóstico. Os autores apresentam o caso clínico de uma doente de 84 anos de idade com uma massa hiperecogénica ao nível do folheto posterior da válvula mitral, associada * Corresponding author. E-mail address: silviamartinsribeiro@gmail.com (S. Ribeiro). Ressonância magnética cardíaca a insuficiência mitral severa. A ressonância magnética cardíaca demonstrou uma massa hipoperfundida, com realce tardio, após administração de gadolíneo. A tomografia computadorizada cardíaca evidenciou a natureza calcificada da lesão. Uma abordagem multi-imagem permitiu o diagnóstico de calcificação caseosa do anel mitral posterior. A doente recusou cirurgia cardíaca. PALAVRAS-CHAVE

No abstract

Background: Accurate risk stratification is an important step in the initial management of acute coronary syndrome (ACS), and current guidelines recommend the use of risk scores, such as the Global Registry of Acute Coronary Events risk score (GRACE RS). Recent studies have suggested that abdominal obesity is associated with cardiovascular events in patients with ACS. However, little is known about the additional value of abdominal obesity beyond risk scores. The aim of our study was thus to assess whether waist circumference, a surrogate of abdominal adiposity, adds prognostic information to the GRACE RS. Methods: This was a retrospective cohort study of ACS patients admitted consecutively to a cardiac care unit between June 2009 and July 2010. The composite of all-cause mortality or myocardial reinfarction within six months of index hospitalization was used as the endpoint for the analysis. Results: A total of 285 patients were studied, 96.1% admitted for myocardial infarction (with or without ST elevation) and 3.9% for unstable angina. At the end of the follow-up period, 10 patients had died and the composite endpoint had been reached in 27 patients (9.5%). More than 70% of the study population were obese or overweight, and abdominal obesity was present in 44.6%. The GRACE RS showed poor predictive accuracy (area under the curve 0.60), and most of the GRACE variables did not reach statistical significance in multivariate analysis. The addition of waist circumference to the GRACE RS did not improve its discriminatory performance. Conclusion: Abdominal obesity does not add prognostic information to the GRACE RS to predict six-month mortality or myocardial reinfarction. endpoint foi atingido em 27 (9,5%) dos doentes. Mais de 70% da população era obesa ou apresentava excesso de peso, e 44,6% apresentavam obesidade abdominal. O GRACE-RS apresentou um baixo poder discriminatório (AUC = 0,60), sendo que na análise multivariada a maioria das variáveis GRACE não atingiu a significância estatística. A introdução do perímetro abdominal no GRACE-RS não melhorou o seu poder discriminatório. Conclusão: A medição da obesidade abdominal não acrescenta informação prognóstica ao GRACE-RS preditor da morte ou re-enfarte aos seis meses de seguimento clínico. PALAVRAS-CHAVE