To explore whether temporal lobe atrophy predicts 3-month functional outcome in a population of patients with anterior circulation acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). We retrospectively selected patients > 65 years from our prospective endovascular stroke registry between June 2013 and August 2018. According to 3-month modified Rankin Scale (mRS), patients were divided in two groups, named good (mRS ≤ 2) and poor (mRS > 2) outcome. Measures of temporal lobe atrophy (i.e., interuncal distance [IUD], medial temporal lobe thickness [mTLT] and radial width of temporal horn [rWTH]) were assessed on pre-treatment CT scan. Cutoff values for good outcome were obtained for IUD, mTLT and rWTH by means of non-parametric ROC curve analysis. Multivariate analysis was performed to identify predictors of outcome. Ordinal shift analysis based on cutoff values was built to evaluate differences in 3-month mRS. Among 340 patients, 130 (38.2

Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0-1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602-1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515-0.990). The rates of modified Rankin Scale score of 0-2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689-1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566-0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644-1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844-1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262-0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337-0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of <1, antiplatelet, and anticoagulant), differences were found also between GA versus CS as regards modified Rankin Scale score of 0-2 (aOR, 0.659 [95% CI, 0.538-0.807]) and GA versus LA as regards death (aOR, 1.413 [95% CI, 1.095-1.823]). Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended.

Fahr’s disease (FD), also known as familial idiopathic basal ganglia calcification, is a neurodegenerative disease affecting cerebral micro vessels, mainly in the basal ganglia. It mostly presents with movement disorders, dementia and behavioral abnormalities. It is considered hereditary with an autosomal dominant transmission. Fahr’s disease is often underestimated and under diagnosed. We reported the clinical differences found in two patients with Fahr’s Disease. In particular, we described a case of Fahr’s disease with behavioral alteration with extrapyramidal movement disorders, and a rare case of Fahr’s disease with cognitive and behavioral alterations in absence of extrapyramidal movement disorders.

Introduction: Aging is associated with a large increase in the prevalence of hypovitaminosis D. 25- Hydroxyvitamin D, 25(OH)D, is the best indicator for vitamin D status. Its possible role in the pathogenesis of Alzheimer’s disease (AD), the leading cause of dementia in the elderly, is particularly important. The aim of the present study was to examine the association between 25-hydroxyvitamin D (25(OH)D) and cognitive functions in a group of Italian elderly patients affected with AD. Methods: We studied the relationship between 25(OH)D and cognitive functions assessed by MMSE (Mini Mental State Examination) in 150 consecutive elderly patients (F 76 %, age 78,66+ 6,05 years old) attending our Geriatric ambulatory for cognitive disorders with diagnosis of AD. Results: In our sample hypovitaminosis D was present in 100% of the screened patients; 111 patients (74%) had 25(OH)D serum levels inferior to 20 ng/ml; 39 (26%) patients had serum levels included between 20 and 30 ng/ml. After adjustment for age, gender, systolic blood pressure, education, cardiovascular diseases and antihypertensive treatment, a significant relationship was observed between 25(OH)D and cognitive status. MMSE appeared significantly higher in subjects with 25(OH)D serum levels ≥ 20 ng/ml than in those with 25(OH)D < 20 ng/ml (18,42+4,33 vs 12,22+4,44; p=0,000). Conclusion: Our results showed a relationship between 25(OH)D and cognitive impairment in patients with AD, suggesting that 25(OH)D could be involved in the onset of dementia.

Introduction. Delirium, defined as an acute mental status with altered level of consciousness, is a common geriatric syndrome and a typical complication in hospitalized elderly patients. We aimed to assess the occurrence of delirium and the possible relationship with renal impairment. Methods. Patients aged over 65 years admitted consecutively to a Geriatric Unit, were screened for a first diagnosis of delirium. Delirium was evaluated using the validated Assessment Test for Delirium and Cognitive Impairment (4AT). Results. Final analysis included 311 patients (182 women,129 men). Mean eGFR was 62.44 ± 28.84 mL/min/1.73 m2. Prevalence of Cognitive impairment or delirium was 5.4, 84.8 e 9.8% for 0, 1-3 and ≥ 4 4AT scores. At univariate analysis, prevalence of clear delirium was increased with the worsening of CKD, being 3.7% in stage IIIb up to 68% in stage IV-V (p < 0.001). At multivariable logistic analysis, adjusted for gender and smoking habit, higher eGFR levels were associated with a reduced risk for the presence of delirium (OR = 0.86 95% CI 0.82-0.91, p < 0.001) and for developing possible cognitive impairment (OR = 0.87 95% CI 0.83- 0.90, p < 0.001). Discussion. Mild to moderate delirium is a pervasive condition among geriatric patients with manifested renal function impairment.

Background and purpose Computed tomography perfusion (CTP) and multiphase CT angiography (mCTA) help selection for endovascular treatment (EVT) in anterior ischemic stroke (AIS). Our aim was to investigate the ability of perfusion maps and collateral score to predict functional outcome after EVT. Patients and methods Patients with M1-middle cerebral artery occlusion, evaluated by mCTA and CTP and treated with EVT within six hours of onset, were enrolled. Perfusion parametric maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and time to maximum of tissue residue function (T-max) were generated; areas of altered perfusion were manually outlined to obtain volumes CBFv, CBVv, Tmax,v 16-25s and Tmax,v 9.5-25s. Diffusion-weighted imaging (DWI) at 24-36 hours was used to manually outline the ischemic core (volume: DWIv). Collateral vessels were assessed on mCTA considering extent and delay of maximal enhancement (six-point scale). Functional outcome was evaluated by modified Rankin Scale score at three months. Volumes in good and poor outcome groups were compared by Wilcoxon rank-sum test t, and their discriminative ability for outcome was determined by receiver operating characteristic analysis. A logistic regression model, including T-max, CBF and collaterals, was used to differentiate good and poor outcome. Results Seventy-one patients (mean age 75 +/- 11 years, range 45-99 years) were included. Tmax,v 16-25s, Tmax,v 9.5-25s, CBVv, CBFv and DWIv were statistically different between the two groups. CBF had the best discriminative value for good and poor outcome (area under the curve (AUC) 0.73; 64.5% sensitivity; 74.4% specificity); the logistic regression model might be promising (AUC 0.79, 64.5% sensitivity, 82.1% specificity). Conclusions In patients with AIS, the combined use of CTP and mCTA predicts functional outcome of EVT and might allow better selection.

OBJECTIVE:This study aimed to evaluate the association between polypharmacy and delirium, the association of specific drug categories with delirium, and the differences in drug-delirium association between medical and surgical units and according to dementia diagnosis.METHODS:Data were collected during 2 waves of Delirium Day, a multicenter delirium prevalence study including patients (aged 65 years or older) admitted to acute and long-term care wards in Italy (2015-2016); in this study, only patients enrolled in acute hospital wards were selected (n = 4,133). Delirium was assessed according to score on the 4 "A's" Test. Prescriptions were classified by main drug categories; polypharmacy was defined as a prescription of drugs from 5 or more classes.RESULTS:Of 4,133 participants, 969 (23.4%) had delirium. The general prevalence of polypharmacy was higher in patients with delirium (67.6% vs 63.0%, P = .009) but varied according to clinical settings. After adjustment for confounders, polypharmacy was associated with delirium only in patients admitted to surgical units (OR = 2.9; 95% CI, 1.4-6.1). Insulin, antibiotics, antiepileptics, antipsychotics, and atypical antidepressants were associated with delirium, whereas statins and angiotensin receptor blockers exhibited an inverse association. A stronger association was seen between typical and atypical antipsychotics and delirium in subjects free from dementia compared to individuals with dementia (typical: OR = 4.31; 95% CI, 2.94-6.31 without dementia vs OR = 1.64; 95% CI, 1.19-2.26 with dementia; atypical: OR = 5.32; 95% CI, 3.44-8.22 without dementia vs OR = 1.74; 95% CI, 1.26-2.40 with dementia). The absence of antipsychotics among the prescribed drugs was inversely associated with delirium in the whole sample and in both of the hospital settings, but only in patients without dementia.CONCLUSIONS:Polypharmacy is significantly associated with delirium only in surgical units, raising the issue of the relevance of medication review in different clinical settings. Specific drug classes are associated with delirium depending on the clinical setting and dementia diagnosis, suggesting the need to further explore this relationship.

Background and purpose: - To compare outcomes of minor stroke patients with intracranial vessel occlusions (IVO) underwent mechanical thrombectomy (MT) versus those treated with intravenous thrombolysis alone (IVT). Methods: - We retrospectively reviewed two large prospective stroke databases from two European centers searching for patients admitted with minor stroke (i.e. NIHSS Score <= 5), baseline mRS = 0 and occlusion of the M1-M2 segment of the middle cerebral artery (MCA). Groups receiving (A) IVT alone and (B) MT+/-IVT were compared. Primary outcome measures were MT safety, successful recanalization rate (mTICI 2b-3) and NIHSS shift (discharge NIHSS minus admission NIHSS); secondary outcomes included discharge rates and excellent outcome (mRS 0-1) at 3 months. Univariate and multivariate analyses were performed. Results: - Thirty-two patients were enrolled in Group B (19 MT alone; 13 MT + IVT) and 24 in Group A. Successful recanalization (mTICI 2b-3) was obtained in 100% of cases in Group B vs 38% in Group A. Symptomatic hemorrhagic transformation rate did not differ between the two groups. Multivariate analysis reported MT as the only predictor of early (< 12h) favorable NIHSS shift and lower NIHSS at discharge. Moreover, discharge at home and excellent outcome at 3-month follow-up were statistically associated with MT. Conclusions: - MT in patients with minor strokes and intracranial vessel occlusion (IVO) is safe and can determine a rapid improvement of NIHSS Score. MT seems also associated with a higher rate of patients discharged at home after hospitalization and better clinical outcome at 3-month follow-up. Larger randomized trials are warranted to confirm these results. (C) 2019 Elsevier Masson SAS. All rights reserved.

Amiodarone is a class III antiarrhythmic drug widely used for treating a number of cardiac arrhythmias such as atrial fibrillation, both in young and elderly people. Its hepatotoxicity is usually mild and occurs with delayed onset. Acute hepatotoxicity is a rare side effect; it is sometimes related to intravenous administration. In that case, acute hepatocellular injury occurs within 24 hours following amiodarone’s intravenous administration. Liver enzymes significantly improve after stopping treatment. Its acute toxicity due to intravenous administration is believed to depend on different mechanisms, such as ischemic liver injury, mithochondrial damage, hypersensitivity reactions. It is sometimes due to the vehicle (polysorbate-80). The present case report describes an unusual condition of acute elevation of serum aminotransaminase concentrations following intravenous amiodarone’s administration. An 88-year-old woman, affected with acute heart failure, developed acute hepatitis after starting intravenous amiodarone for atrial fibrillation with rapid ventricular response. Liver transaminases returned to baseline values within 15 days after discontinuing the drug. The authors hypothesized that this kind of injury might be due to liver ischemia, with possible superimposed direct drug toxicity and worsened by polysorbate 80, the solubilizer of amiodarone infusion. It can also be linked to high dose in an aged person. The CIOMS/RUCAM Scale identified our patient’s acute hepatitis as a highly probable adverse drug reaction.

Toxic epidermal necrolysis (TEN) or Lyell’s syndrome is a rare but serious potentially fatal autoimmune dermatologic disease. It is characterized by cutaneous damage due to apoptosis of the keratinocytes with consequent dermo-epidermal separation for a >30% extension of the body surface, associated with mucosal lesions. It is due to the activation of the immune system, often following the intake of potentially toxic drugs [antibiotics, antiepileptics, non-steroidal antinflammatory drugs (NSAIDs), allopurinol] or after infection with herpetic viruses or mycoplasma. We describe the case of an 82- year-old man starting therapy of Allopurinol for hyperuricemia. After four days the patient shows an extensive erythematous rash localized to the trunk and upper limbs. The following day the rash also involves the face, tending to the confluence and after another two days, the macules turn into de-epithelized areas because of dermo-epidermal separation and the lesions involve the oral and ocular mucosa, causing dysphagia and difficulty in speaking. He was treated with steroid and antihistamine therapy, suspending the previously undertaken therapy with antibiotic and Allopurinol.

Background: Hepatic encephalopathy (HE) is a complication of transjugular intrahepatic portosystemic shunt (TIPS). Aims: Extend the knowledge about the early detection of multiple brain metabolic abnormalities following TIPS; these abnormalities can be detected and managed prior to the clinical manifestation of HE with use of Multiparametric Magnetic Resonance with Spectroscopy. Methods: 12 cirrhotic Patients underwent TIPS; each Patient underwent a 3 T MRI evaluation before and after TIPS. The spectroscopic images were processed measuring the values of the metabolites N-acetylaspartate (NAA) - Glutamine / Glutamate (Glx) - Colina (Cho) - Myinositol (mI) at the level of the nuclei of the base. Results: Spectroscopic examination performed before the TIPS procedure showed low values of Cho and Mi, instead following the procedure: an increase in the Glx value, a mean reduction in the values of Cho and mI, a statistically significant reduction in the Cho / Creatine ratio, in the mI / Creatine ratio and an increase of the Glx / Creatine ratio. Conclusions: Our study demonstrated the efficacy of spectroscopy in Patient subjected to TIPS. MR 3 T with spectroscopy can become a valid tool for monitor the dynamics of changes in brain metabolism after TIPS and to provide an early diagnosis of HE allowing an early treatment.

We read with great interest the work by Kokabi et al ( 1 Kokabi N. Ludwig J.M. Camacho J.C. et al. Baseline and early MR apparent diffusion coefficient quantification as a predictor of response of unresectable hepatocellular carcinoma to doxorubicin drug-eluting bead chemoembolization. J Vasc Interv Radiol. 2015; 26: 1777-1786 Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar ) regarding the role of apparent diffusion coefficient (ADC) as a predictor of response after doxorubicin drug-eluting bead chemoembolization in patients with unresectable hepatocellular carcinoma (HCC). Evaluation of treated HCC is still a clinical challenge for radiologists and clinicians. Baseline and Early MR Apparent Diffusion Coefficient Quantification as a Predictor of Response of Unresectable Hepatocellular Carcinoma to Doxorubicin Drug-Eluting Bead ChemoembolizationJournal of Vascular and Interventional RadiologyVol. 26Issue 12PreviewTo investigate baseline and early apparent diffusion coefficients (ADC) derived from diffusion-weighted imaging (DWI) as a predictor of objective response (OR) and survival in unresectable hepatocellular carcinoma (HCC) treated with doxorubicin drug-eluting bead (DEB) transcatheter arterial chemoembolization. Full-Text PDF

Hepatic encephalopathy (HE) comprises a spectrum of neuropsychiatric manifestations and it is one of the most debilitating complications of chronic liver disease, typically threatening patients’ self-reliance, physical condition, quality of life, and surroundings due to its unpredictable nature [ [1] Ferenci P. Lockwood A. Mullen K. et al. Hepatic encephalopathy definition, nomenclature, diagnosis and quantification: final report of the working party at the 11th world congress of gastroenterology, Vienna, 1998. Hepatology. 2002; 35: 716-721 Crossref PubMed Scopus (1683) Google Scholar ]. We report a case of a 46-year-old man with liver cirrhosis hepatitis-C-virus-related, in a waiting list for liver transplantation (LT) that was admitted to our hospital for the onset of HE. Patient had a MELD-score of 22 and CPT C10. The measurement of serum ammonia level was 132 mol/L. While hospitalized, patient underwent to brain MRI revealing a symmetric high signal intensity in basal ganglia (basal-ganglia hyperintensity, BGH) in T1 weighted images (Fig. 1A and B ). We also carried out quantitative analyses measuring the ratio of globus pallidus (GB) to subcortical frontal white-matter (WM) signal intensity on T1WI with region-of-interest (ROI). Gb/WM ratio was 1.193. 70–80% of patients with chronic liver disease show areas of BGH at T1-weighted imaging, and clinical significance of BGH in patients with HE remains unclear. BGH is considered to be secondary to manganese (Mn) deposition which probably plays a role in HE development. Manganese is known to be neurotoxic, particularly affecting the actions of certain proteins (i.e., receptors) that interact with the neurotransmitter dopamine. In the presence of paramagnetic substances such as Mn, the relaxation times of protons are shortened giving rise to bright T1-weighted images [ [2] Maeda H. Sato M. Yoshikawa A. et al. Brain MR imaging in patients with hepatic cirrhosis: relationship between high intensity signal in basal ganglia on T1-weighted images and elemental concentrations in brain. Neuroradiology. 1997; 39: 546-550 Crossref PubMed Scopus (120) Google Scholar ]. If the deposition of manganese is real reason of BGH, then one could expect partial or complete reversibility after reduction of the manganese level or improvement of liver function [ [3] Watanabe A. Murakami J. Ando T. et al. Reduction of increased signal intensity in the basal ganglia on T1-weighted MR images during treatment of hepatic encephalopathy. Internal Medicine. 1993; 32: 10-14 Crossref PubMed Scopus (24) Google Scholar ]. After 47 days of first MRI evaluation, patient underwent to successful LT. During hospitalization, patient underwent to neurological examination and then we performed a brain MRI, one week after successful LT. We observed a complete disappearance of BGH in T1-weighted images (Fig. 1C and D), already after 7 days from LT, despite it is well accepted that a restitution of normal signal intensity may take as long as 10 to 20 months after successful LT. Moreover the Gb/WM ratio after LT was 1.011. Indeed, Pujol et al. [ [4] Pujol A. Pujol J. Graus F. et al. Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology. 1993; 43: 65-69 Crossref PubMed Google Scholar ] described 21 patients with advanced liver disease who underwent MR imaging before and 10–20 months after liver transplantation, exhibiting a complete resolution of the BGH in all cases. Thomas Naegele et al. [ [5] Naegele T. Grodd W. Viebahn R. et al. MR imaging and (1)H spectroscopy of brain metabolites in hepatic encephalopathy: time-course of renormalization after liver transplantation. Radiology. 2000; 216: 683-691 Crossref PubMed Scopus (110) Google Scholar ] evaluating the reversibility and time-course of BGH changes after liver transplantation with MRI spectroscopy found that BGH renormalization seems to be delayed with respect to spectroscopically detectable metabolite changes. Authors 3 concluded that a complete normalization of BGH on T1-weighted images occurs within 1 year after liver transplantation, except in patients with chronic rejection.

53 Background and Aims: Left ventricular hypertrophy (LVH), is an independent predictor for 54 cardiovascular events. We investigated if chronic hepatitis C virus (HCV) infection and the related 55 insulin resistance (IR)/hyperinsulinemia could influence the increase of left ventricular mass 56 (LVM). 57 Methods: We enrolled 260 outpatients matched for age, body mass index, gender, ethnicity: 52 58 with never-treated uncomplicated chronic HCV infection (HCV), 104 never-treated hypertensives 59 (HT) and 104 healthy subjects (NT). LVM was calculated according to the Devereux formula and 60 indexed for body surface area. The following laboratory parameters were measured: fasting plasma 61 glucose and insulin, total, LDLand HDL-cholesterol, triglyceride, creatinine, e-GFR-EPI, HOMA. 62 Quantitative HCV-RNA was assessed by PCR. 63 Results: HCV + patients with respect to healthy normotensive subjects had an increased LVMI 64 (100+23 vs 83+15 g/m 2 ; P<0.0001), similar to that observed in HT group (103+25 g/m 2 ). Regarding 65 biochemical variables, HCV + patients, in comparison with normotensive healthy subjects, had 66 higher triglyceride, creatinine, fasting insulin and HOMA (3.2+1.3 vs 2.5+1.0; P<0.0001). At linear 67 regression analysis, the correlation between LVMI and HOMA was similar in HT (r= 0.528, 68 P<0,0001) and HCV (r= 0.489, P<0,0001) groups. At multiple regression analysis, HOMA resulted 69 the major determinant of LMVI in all groups, explaining respectively 21.8%, 27.8% and 23.9% of 70 its variation in NT, HT and HCV. At correlational analysis HCV-RNA and HOMA demonstrated a 71 strong and linear relationship between them, explaining the 72.4% of their variation (P=0.022). 72 Conclusions: We demonstrated a significant and direct correlation between HOMA and LVMI in 73 patients with chronic HCV infection, similar to that observed in hypertensives. 74

Left ventricular hypertrophy (LVH), is an independent predictor for cardiovascular events. We investigated if chronic hepatitis C virus (HCV) infection and the related insulin resistance (IR)/hyperinsulinemia could influence the increase of left ventricular mass (LVM).We enrolled 260 outpatients matched for age, body mass index, gender, ethnicity: 52 with never-treated uncomplicated chronic HCV infection (HCV(+)), 104 never-treated hypertensives (HT) and 104 healthy subjects (NT). LVM was calculated according to the Devereux formula and indexed for body surface area. The following laboratory parameters were measured: fasting plasma glucose and insulin, total, LDL- and HDL-cholesterol, triglyceride, creatinine, e-GFR-EPI, HOMA. Quantitative HCV-RNA was assessed by PCR.HCV(+) patients with respect to healthy normotensive subjects had an increased LVMI (100 ± 23 vs. 83 ± 15 g/m(2); p < 0.0001), similar to that observed in HT group (103 ± 25 g/m(2)). Regarding biochemical variables, HCV(+) patients, in comparison with normotensive healthy subjects, had higher triglyceride, creatinine, fasting insulin and HOMA (3.2 ± 1.3 vs. 2.5 ± 1.0; p < 0.0001). At linear regression analysis, the correlation between LVMI and HOMA was similar in HT (r = 0.528, p < 0.0001) and HCV(+) (r = 0.489, p < 0.0001) groups. At multiple regression analysis, HOMA resulted the major determinant of LMVI in all groups, explaining respectively 21.8%, 27.8%, and 23.9% of its variation in NT, HT and HCV(+). At correlational analysis HCV-RNA and HOMA demonstrated a strong and linear relationship between them, explaining the 72.4% of their variation (p = 0.022).We demonstrated a significant and direct correlation between HOMA and LVMI in patients with chronic HCV infection, similar to that observed in hypertensives.

OBJECTIVE To address whether glucose tolerance status, and in particular 1-h postload plasma glucose levels, may affect diastolic function in 161 never-treated hypertensive white subjects. Impaired left ventricular relaxation, an early sign of diastolic dysfunction, represents the first manifestation of myocardial involvement in diabetic cardiomyopathy. A plasma glucose value ≥155 mg/dL for the 1-h postload plasma glucose during an oral glucose tolerance test (OGTT) is able to identify subjects with normal glucose tolerance (NGT) at high risk for type 2 diabetes and with subclinical organ damage. RESEARCH DESIGN AND METHODS Subjects underwent OGTT and standard echocardiography. Diastolic function was assessed by pulsed Doppler transmitral flow velocity and tissue Doppler imaging. Insulin sensitivity was assessed by Matsuda index. RESULTS Among the participants, 120 had NGT, 26 had impaired glucose tolerance (IGT), and 15 had type 2 diabetes. According to the 1-h postload plasma glucose cutoff point of 155 mg/dL, we divided NGT subjects as follows: NGT <155 mg/dL (n = 90) and NGT ≥155 mg/dL (n = 30). Those with NGT ≥155 mg/dL had higher left atrium dimensions (P < 0.0001) and isovolumetric relaxation time (IVRT) (P = 0.037) than those with NGT <155 mg/dL. By contrast, early/late transmitral flow velocity and all tissue Doppler parameters were significantly lower in those with NGT ≥155 mg/dL than in those with NGT<155 mg/dL. At multiple regression analysis, 1-h glucose was the major determinant of left atrium area, IVRT, septal e′, septal e′-to-a′ ratio, lateral e′, and lateral e′-to-a′ ratio. CONCLUSIONS The main finding of this study is that 1-h postload plasma glucose is associated with left ventricular diastolic dysfunction. Subjects with NGT ≥155 mg/dL had significantly worse diastolic function than those with NGT<155 mg/dL.

Gastrointestinal stromal tumors (GISTs) are rare, but represent the most common mesenchymal neoplasms of the gastrointestinal tract. Tumor resection is the treatment of choice for localized disease. Tyrosine kinase inhibitors (imatinib, sunitinib) are the standard therapy for metastatic or unresectable GISTs. GISTs usually metastasize to the liver and peritoneum. Bone metastases are uncommon. We describe three cases of bone metastases in patients with advanced GISTs: two women (82 and 54 years of age), and one man (62 years of age). Bones metastases involved the spine, pelvis and ribs in one patient, multiple vertebral bodies and pelvis in one, and the spine and iliac wings in the third case. The lesions presented a lytic pattern in all cases. Two patients presented with multiple bone metastases at the time of initial diagnosis and one patient after seven years during the follow-up period. This report describes the diagnosis and treatment of the lesions and may help clinicians to manage bones metastases in GIST patients.