Abstract Background In up to 80% of patients with pulmonary embolism (PE) no peripheral symptomatic thrombosis can be identified. Whether the heart may represent a source of PE is unknown. Methods We ...conducted a cross-sectional survey of patients who were 60 years or older and were discharged from the hospitals of Veneto region, Italy between 2000 and 2006 with the diagnosis of PE. We compared the prevalence of several acute and chronic heart diseases in patients discharged with the diagnosis of PE alone with that of patients with co-occurring symptomatic peripheral deep venous thrombosis (PE/DVT). Results Out of 11,236 eligible patients, 9079 (81%) were discharged with the diagnosis of PE alone, and 2157 with that of PE/DVT. 3239 of the 9079 (35.7%) patients with isolated PE, and 666 of the 2157 (30.9%) with PE/DVT had at least one heart disease. The adjusted odds ratio (OR) for having at least one heart disease in patients with isolated PE as compared to those with PE/DVT was 1.26 (95% CI, 1.13–1.40). The heart diseases that significantly contributed to the study results were all-cause cardiomyopathies (adjusted OR, 2.31; 95% CI, 1.37–3.89), all-cause heart failure (1.82; 1.45–2.27), coronary heart disease (1.28; 1.08–1.52), and atrial fibrillation or flutter (1.28; 1.08–1.51). Conclusions There is an association between isolated PE and a number of heart diseases. The results of our survey generate the hypothesis that in older patients several heart diseases may directly account for the development of PE. Prospective studies are needed to confirm this hypothesis.
The synthesis of 2-morpholinoethyl mycophenolate was realized by an enzymatic transesterification of simple esters of mycophenolic acid with 2-morpholinoethanol. Best results were achieved by a ...Candida antarctica lipase B (CAL B) catalyzed transesterification of ethyl mycophenolate in toluene. CAL B showed to selectively transform only the ethyl ester function leaving unreacted the other functional groups present on the substrate. By this way 2-morpholinoethyl mycophenolate was obtained in satisfactory yields from mycophenolic acid (84%).
Chronic thromboembolic pulmonary hypertension (CTEPH), a disease associated with considerable morbidity and mortality, is the consequence of unresolved thromboembolic occlusion in pulmonary ...vasculature. CTEPH was considered a rare disease occurring in 0.1-0.5% of patients with pulmonary emboli who survive. Recently, a much higher incidence was reported and some risk factors such as a previous pulmonary embolism (PE), an idiopathic form of PE and the severity of perfusion defect at the time of diagnosis have been identified. Exertional dyspnea is the main symptom at the beginning of the disease while later on patients may suffer from syncope related to low cardiac output or hemoptysis as a consequence of high pulmonary artery pressure. In suspected patients, a confirmation of pulmonary arterial hypertension should be ascertained at transthoracic echocardiography. Then the obstructive nature of the disease may be revealed by ventilation-perfusion lung scan but is better described at pulmonary angiography. Computed tomography scan may be useful to rule out confounding disorders. To prevent recurrences, long-term oral anticoagulants to maintain an INR between 2.5 and 3.5 (target 3.0) are indicated. Treatment of severe CTEPH is essentially surgical (thromboendarterectomy). This procedure may be difficult when distal branches of pulmonary vascular tree are involved. In selected cases, alternative therapies may be the arterial pulmonary vessel angioplasty and lung transplantation.
In vivo platelet reactivity, expressed by plasma concentration of beta-thromboglobulin (beta TG) and platelet factor 4 (PF4), was determined in 57 patients with bioprosthetic heart valves: 35 had ...well-functioning bioprostheses (WFBP), while 22 had documented malfunctioning bioprostheses (MFBP). beta TG and PF4 values in patients with WFBP were not significantly different from controls, even when these determinations were repeated at monthly intervals, whereas beta TG and PF4 concentration was significantly higher in patients with MFBP compared to both groups. There was a strong positive correlation between beta TG and PF4 in all subjects studied. Serum lactic dehydrogenase, indirect bilirubin level and reticulocyte count were significantly higher in patients with MFBP than in those with WFBP, but no correlation was found between platelet reactivity and rate of intravascular hemolysis. Our results suggest that there is an increased platelet release in vivo of the platelet-specific proteins in patients with MFBP not related to mechanical damage, and that bioprostheses, at least in a degenerative state, may represent a potential thrombogenic focus.
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