To determine whether women have an unfavorable outcome after coronary interventions compared with men, we evaluated patients undergoing revascularisation within the Arterial Revascularisation Therapies Study (ARTS).We evaluated 1205 patients (23% women) with multivessel disease randomised to percutaneous or surgical coronary revascularisation. The in-hospital results, and clinical outcome at five years were evaluated. Women were older, with a higher prevalence of hypertension, hypercholesterolaemia, family history for coronary artery disease (all p<0.001), diabetes mellitus (p=0.05) and stable angina (p<0.05) than men, but had a lower incidence of history of myocardial infarction or smoking (both p<0.001). More major bleeding complications, even after adjusting for baseline clinical characteristics (OR 29.4, 95% CI: 5.3-500, p<0.005) were observed in women following percutaneous coronary intervention. During clinical follow-up freedom from major adverse cardiac and cerebrovascular events was similar in men and women, regardless of treatment strategy. Men assigned to bypass surgery had a better quality of life, but women reported more frequently angina.The clinical outcome of women with multivessel disease undergoing coronary revascularisation was similar to that in men. However, women presented more bleeding complications before hospital discharge, and had less favourable assessment in specific domain of daily life at follow-up.
1. Direct radioligand—binding techniques have been used to characterize and quantify adrenoreceptors in human peripheral lung tissue removed at thoracotomy from ten patients, nine of whom had evidence of obstructive airways disease. 2. [3H]Dihydroalprenolol was used to characterize β–adrenoreceptor sites and [3H]prazosin to identify α–adrenoreceptor sites. Binding of both ligands showed saturability, high affinity, rapid kinetics, reversibility and stereospecificity. The rank order of agonists and antagonists inhibiting specific binding correlated well with known physiological potencies. Specificity of [3H]dihydroal-prenolol binding suggested that the population of lung β–adrenoreceptors is predominantly of the β2 subtype.
No abstract is provided for this article.
With the high initial success rates that are regularly reported for coronary angioplasty it has become increasingly difficult to demonstrate methods or techniques that are able to provide more beneficial acute results than can be achieved by conventional angioplasty. On the other hand, the incidence of late restenosis has remained much the same over the 10 years that angioplasty has been part of clinical practice [1] and there is still no proven intervention which modifies the restenosis process. The problem of restenosis has therefore assumed increasing relevance in determining the clinical value of coronary angioplasty, and accordingly, studies that address the problem of restenosis have needed to become more exacting. Although there have numerous articles addressing the problem of restenosis in the clinical setting, with many defining certain factors associated with restenosis and possible interventions to reduce the incidence of restenosis, there is surprisingly little consensus. Most of the discrepancies can be attributed to three factors: 1) the selection of patients, 2) the method of analyis, 3) the definition of restenosis employed. The purpose of this review is to show that these three factors influence the outcome and conclusions of restenosis studies.
No abstract is provided for this article.
No abstract is provided for this article.
Recurrence of coronary artery stenosis or "restenosis" is now well established as the main limitation of percutaneous transluminal coronary angioplasty (PTCA), which was first used by Gruentzig in 1977.'However, despite the increasing popularity and application of the percutaneous approach to coronary revascularisation as an attractive alternative to coronary artery bypass graft surgery and the apparent frequency of lesion recurrence there is still no satisfactory universally accepted "definition of restenosis" (table).2"'New devices for percutaneous coronary recanalisation (endoluminal coronary stent implantation; directional, extractional, or rotational atherectomy; laser balloon angioplasty; and excimer laser) have up to now, failed to provide better long term outcome than balloon angioplasty.""'7but they have stimulated the search for universally applicable, objective methods of assessing the new methods and of comparing them with conven- tional balloon angioplasty and with each other Thoraxcenter, in terms of the immediate and long term effects Erasmus University, on treated vessels.'5Rotterdam, Nearly all the early reports on restenosisThe Netherlands after angioplasty relied on visual or user-
Chronic obstructive pulmonary disease (COPD) is an increasing global health problem and cause of death. COPD is a chronic inflammatory disease predominantly affecting small airways and lung parenchyma that leads to progressive airway obstruction. However, current therapies fail to prevent either disease progression or mortality. The mainstay of current drug therapy is long-acting bronchodilators. Several once daily inhaled β2-agonists and muscarinic antagonists (and combinations) are now in development. No treatments effectively suppress chronic inflammation in COPD lungs. With better understanding of the inflammatory and destructive process in the pathophysiology of COPD, several new therapeutic targets have been identified. Several mediator antagonists or inhibitors tested in COPD have so far been disappointing, but CXCR2 antagonists that block pulmonary neutrophil and monocyte recruitment are more promising. Broad spectrum anti-inflammatory drugs may be more effective, and include inhibitors of the proinflammatory enzymes phosphodiesterase-4, p38 mitogen-activated protein kinase, Janus kinases, NF-κB kinase and PI3 kinase-γ and -δ, but side effects after oral administration are a major limitation so that in future inhaled delivery may be necessary. A new promising approach is reversal of corticosteroid resistance through increasing histone deacetylase-2 (HDAC2) activity. This might be achieved by existing treatments such as theophylline, nortriptyline and macrolides, or more selectively by PI3 kinase-δ inhibitors. Thus although there have been major advances in the development of long-acting bronchodilators for COPD, it has proved difficult to find anti-inflammatory treatments that are safe and effective.
