Lipid-lowering for lower limb atherosclerosis

Background: Lipid-lowering therapy is recommended for secondary prevention in people with coronary artery disease. It may also reduce cardiovascular events and/or local disease progression in people with lower limb peripheral arterial disease (PAD). Objectives: To assess the effects of lipid-lowering therapy on all-cause mortality, cardiovascular events and local disease progression in patients with PAD of the lower limb. Search methods: The authors searched The Cochrane Peripheral Vascular Diseases Group's Specialised Register (last searched February 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2007) for publications describing randomised controlled trials of lipid-lowering therapy in peripheral arterial disease of the lower limb. Selection criteria: Randomised controlled trials of lipid-lowering therapy in patients with PAD of the lower limb. Data collection and analysis: Three authors independently assessed trial quality and extracted data. Main results: Eighteen trials were included, involving a total of 10,049 participants. Trials differed considerably in their inclusion criteria, outcomes measured, and type of lipid-lowering therapy used. Only one trial (PQRST) reported a detrimental effect of active treatment on blood lipid/lipoprotein levels. The pooled results from all eligible trials indicated that lipid-lowering therapy had no statistically significant effect on overall mortality (Odds Ratio (OR) 0.86; 95% Confidence Interval (CI) 0.49 to 1.50) or on total cardiovascular events (OR 0.8; 95% CI 0.59 to 1.09). However, subgroup analysis which excluded PQRST showed that lipid-lowering therapy significantly reduced the risk of total cardiovascular events (OR 0.74; CI 0.55 to 0.98). This was primarily due to a positive effect on total coronary events (OR 0.76; 95% CI 0.67 to 0.87). Greatest evidence of effectiveness came from the use of simvastatin in people with a blood cholesterol ≥ 3.5 mmol/litre (HPS). Pooling of the results from several small trials on a range of different lipid-lowering agents indicated an improvement in total walking distance (Mean Difference (MD) 152 m; 95% CI 32.11 to 271.88) and pain-free walking distance (WMD 89.76 m; 95% CI 30.05 to 149.47) but no significant impact on ankle brachial index (WMD 0.04; 95% CI -0.01 to 0.09). Authors' conclusions: Lipid-lowering therapy is effective in reducing cardiovascular mortality and morbidity in people with PAD. It may also improve local symptoms. Until further evidence on the relative effectiveness of different lipid-lowering agents is available, use of a statin in people with PAD and a blood cholesterol level ≥ 3.5 mmol/litre is most indicated.Output Type: Revie

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Commento agli artt. 143-230 bis in Commentario Breve al Codice Civile a cura di Cian e Trabucchi, 8° edizione, Padova 2007

Commento alle norme in materia di rapporti personali e patrimoniali tra i coniugi sia nella fisiologia del rapporto sia in sede di separazione e divorzio

Commento agli artt. da 810 a 821 del cod. civ., nel Codice Civile, Commento Giurisprudenziale Sistematico diretto da G. Cian, da pag. 811 a pag. 839

Commento alle norme civilistiche che disciplinano i beni in generale, fornendo la nozione di bene con la distinzione tra beni mobili e immobili, di energie, di beni mobili iscritti in pubblici registri, di universalit\ue0 di mobili, di pertinenze e di frutti naturali e civili, con il regime giuridico ad essi relativo

Double Blind Placebo Controlled Evaluation of Clinical Activity and Safety of Dation 500 mg in the Treatment of Acute Haemorrhoids

Objective: Efficacy of treatment of acute haemorrhoidal crisis by Daflon 500 mg (D500) in comparison to a placebo (Pl). Design: Prospective, double blind, placebo controlled trial with randomization into two parallel groups. Setting: In- and outpatients at a University Hospital. Patients: One hundred patients with a history of haemorrhoidal disease, suffering from an acute haemorrhoidal attack. Interventions: Administration of Daflon 500 mg or placebo at a dose of three tablets b.i.d. for the first 4 days and two tablets b.i.d. for the following 3 days. Main outcome measures: Improvement of symptoms and signs measured by a score and patient acceptability. Results: Overall improvements of symptoms was greater in the D500 group than in the Pl group, from day 2 up to day 7. The clinical severity of proctorrhagia, anal discomfort, pain and anal discharge diminished in both groups, but to a greater extent in the D500 group ( p &lt;0.001). Inflammation, congestion, oedema and prolapse were more markedly improved in the D500 group than in the Pl group. Duration and severity of the current haemorrhoidal episode, as assessed by patient self-evaluation, were less important in the D500 group compared with previous episodes. Use of analgesics and topical medications diminished in both groups, with a major reduction in the D500 group from day 4 ( p &lt;0.001). Acceptability was good in both groups: no patient experienced major side-effects. Conclusion: Treatment with D500 resulted in a quicker and more pronounced relief of signs and symptoms of acute haemorrhoids than with the placebo. </jats:sec