Chronic hepatitis E: A brief review

Hepatitis E viral infection has traditionally been considered an acute, self-limited, water borne disease similar to hepatitis A, endemic to developing countries. However, over the past decade, zoonotic transmission and progression to chronicity in human patients has been identified, resulting in persistently elevated transaminase levels, progressive liver injury and cirrhosis. In addition to liver injury, neurological, renal and rheumatological manifestations have also been reported. Chronic hepatitis E occurs mainly in immunosuppressed individuals such as transplant recipients, human immunodeficiency virus patients with low CD4 counts and in patients with hematological malignancies receiving chemotherapy. Diagnosis is established by persistent elevation of hepatitis E virus RNA in the stool or serum. This population often requires treatment with antiviral agents, particularly ribavirin, as spontaneous clearance with reduction in immunosuppression occurs only in about a third of the patients. The purpose of this review, is to further discuss the clinical presentation, and recent advances in diagnosis, treatment and prophylaxis of chronic hepatitis E.     

Cardiac metastasis from colorectal cancer： A case report

The heart is an unusual site of metastasis from any malignancy. We report a case of cardiac metastasis from colorectal cancer. A 70-year-old woman was referred with a presumptive diagnosis of sigmoid colon cancer with cardiac myxoma. Two-dimensional echocardiography showed a 4 cm x 4.5 cm mobile mass on the lateral right atrial wall, and computed tomography revealed a low attenuated Iobulating mass in the right atrium. The patient underwent anterior resection for sigmoid colon cancer （T4N2）. Thereafter, she experienced progressive shortness of breath. Therefore, a cardiac operation was performed 2 wk after the colorectal operation. Histological examination revealed adenocarcinoma, which was identical to the primary lesion. Although two- dimensional echocardiography has become the diagnostic test of choice for detecting cardiac tumors, in patients with colorectal cancer showing a cardiac mass, further diagnostic evaluation such as a magnetic resonance imaging might be necessary.     

Demographic and clinical features of atrial myxomas: A case series analysis

Aim: Cardiac myxomas are uncommon tumors and have a wide clinical spectrum. Their diagnosis can therefore be elusive because symptoms are nonspecific and misleading. Our aim was to characterize and analyze the clinical findings in patients presenting with cardiac myxomas. Methods: We conducted a retrospective, hospital-based case study using the electronic records of a Spanish general hospital, caring for a population of 155,000. Patients’ data were collected for the period between 2000 and 2016. Demographic data and clinical features were analyzed. Results: Our series included 22 patients over a 15-year period (annual incidence of 0.94 patients per 100,000 inhabitants). Men were predominant (68%) and the median age was 69 years. Cardiac (40.9%), systemic (27.3%), and neurological manifestations (13.6%) were the main clinical features. Left atrium (81.8%) was the predominant location. Surgical treatment was performed in all patients and the overall outcome was good in all cases. Conclusions: Cardiac myxomas are uncommon, benign tumors, predominantly located in the left atrium and mainly affecting middle-aged and elderly male patients. Congestive heart failure, stroke, and systemic symptoms, although misleading and nonspecific, are the most frequent forms of clinical presentation.     

Atrial septal hematogenous cyst with calcification mimicking myxoma: A rare case

A 61-year-old female presented with right atrial mass during physical examination. Contrast-enhanced left heart echocardiography revealed a mass with the size of 32*23 mm in the right atrium, attached to the atrial septum; there was a certain degree of activity and deformation. MRI showed a mass of about 35*22 mm in the right atrium adjacent to the atrial septum, which was diagnosed with right atrial myxoma. Intraoperative TEE showed that the mass was located in the atrial septum close to the inferior vena cava and spontaneous echo contrast with hyperechoic images within the mass. The lesion was resected under cardiopulmonary bypass. Pathological examination revealed that the filling defect was an atrial septal hematogenous cyst with calcification.     

犬慢性快速心房起搏心房颤动模型的建立

报道犬慢性快速心房起搏心房颤动 (简称房颤 )模型的建立方法。取杂种犬 13只 ,安置实验用埋藏式高频率心脏起搏器快速起搏 ( 3 70～ 4 0 0次 /分 )心房 8～ 10周。于起搏前及起搏 8～ 10周后行经胸超声心动图、心房程序电刺激和burst刺激。 10只犬完成实验。快速起搏前所有犬均未能用心房程序刺激诱发出持续性房颤 ( >15min) ,2只 ( 2 0 %)可用burst刺激诱发出非持续性房颤。起搏 8～ 10周后 ,3只 ( 3 0 %)犬不需诱发即出现房颤。 8只 ( 80 %)可经程序刺激诱发出持续性房颤 ,其平均持续时间为 5 3± 11min。 10只犬 ( 10 0 %)均可用burst刺激诱发出持续性房颤。超声心动图检查显示快速起搏后犬心房面积显著增大 (左房 :6.4± 1.3cm2 vs 11.1± 1.8cm2 ;右房 :4 .2± 1.1cm2 vs 7.8± 1.3cm2 ,P均 <0 .0 0 1)。结论 :犬慢性快速心房起搏房颤模型具有房颤诱发率高、持续时间长、重复性好等特点。     

Emergency surgery due to haematoma in a case of left atrial myxoma

Atrial myxomas generally do not require urgent surgery. We report on a 78-year-old woman in whom transesophageal echography revealed a large left atrial myxoma. She acutely developed dyspnoea, tachypnoea, and forward failure necessating urgent surgery. The myxoma was surgically removed and showed a haematoma. The most likely reason for the deteriorating condition was acute enlargement of the myxoma due to intramyxomal haemorrhage. This case illustrates that the clinical condition of patients with symptomatic myxoma can deteriorate suddenly and require urgent surgical treatment.     

Transmission of dengue virus from deceased donors to solid organ transplant recipients: case report and literature review

Dengue fever is a vector-transmitted viral infection. Non-vectorial forms of transmission can occur through organ transplantation. We reviewed medical records of donors and recipients with suspected dengue in the first post-transplant week. We used serologic and molecular analysis to confirm the infection. Herein, we describe four cases of dengue virus transmission through solid organ transplantation. The recipients had positive serology and RT-PCR. Infection in donors was detected through serology. All cases presented with fever within the first week after transplantation. There were no fatal cases. After these cases, we implemented dengue screening with NS1 antigen detection in donors during dengue outbreaks, and no new cases were detected. In the literature review, additional cases had been published through August 2017. Transmission of Dengue virus can occur through organ donation. In endemic regions, it is important to suspect and screen for dengue in febrile and thrombocytopenic recipients in the postoperative period.     

Gastrointestinal tuberculosis in renal transplant recipients: case report and review of the literature

O. Jarrett, S.A. Grim, E. Benedetti, N.M. Clark. Gastrointestinal tuberculosis in renal transplant recipients: case report and review of the literature
Transpl Infect Dis 2011: 13: 52–57. All rights reserved Abstract: Mycobacterium tuberculosis is an important opportunistic pathogen following renal transplantation and is often associated with adverse outcomes. Gastrointestinal tuberculosis (GITB) is an infrequent manifestation of TB but a potentially lethal one. We present a case of a renal allograft recipient with GITB 18 months after transplant and review other published cases to identify the typical presenting symptoms, risk factors, and natural history. Treatment of GITB is also discussed.     

Cytomegalovirus myocarditis in solid organ transplant recipients: A case series and review of literature

Cytomegalovirus (CMV) is a DNA virus of the Herpesviridae family and is estimated to affect 15%‐30% of high‐risk solid organ transplant recipients. Typical manifestations of CMV end‐organ disease in this population include colitis, esophagitis, and pneumonitis, and myocarditis is a rarely reported manifestation. We describe two cases of CMV myocarditis in solid organ transplant recipients and review the literature regarding previously published cases of CMV myocarditis.     

Hepatitis E virus infection in the liver transplant recipients:Clinical presentation and management

Hepatitis E virus(HEV) is an emerging pathogen and an increasingly recognized cause of graft hepatitis, especially in the post-orthotopic liver transplantation immunocompromised population. The exact incidence and prevalence of HEV infection in this population remains unclear but is certainly greater than historical estimates. Identifying acute HEV infection in this population is imperative for choosing the right course of management as it is very difficult to distinguish histologically from acute rejection on liver biopsy. Current suggested approach to manage acute HEV involves modifying immunosuppression, especially discontinuing calcineurin inhibitors which are the preferred immunosuppressive agents post-orthotopic liver transplantation. The addition of ribavirin monotherapy has shown promising success rates in clearing HEV infection and is used commonly in reported cases.     

Fatal herpes simplex virus type 2 hepatitis in a heart transplant recipient: a case report and review of the literature

Herpes simplex virus (HSV) hepatitis is often unrecognized clinically with most untreated cases diagnosed postmortem. HSV hepatitis has been reported in solid organ transplant (SOT) recipients, mostly in kidney and liver transplants, and rarely in heart transplant recipients. We describe a fatal case of community‐acquired HSV‐2 hepatitis in a 24‐year‐old heart transplant recipient occurring 3 years after transplant. We also review the literature summarizing HSV hepatitis and the potential role of quantitative HSV polymerase chain reaction monitoring in the SOT population.     

Murine typhus in a liver transplant recipient: report of a first case

Zoonoses, especially rickettsial diseases, are rarely reported in solid organ transplant recipients. We report here a case of murine typhus in a 69‐year‐old liver transplant recipient, who presented with acute febrile illness 5 years post transplantation. Although receiving treatment with broad‐spectrum antibiotics, he was still febrile and developed progressive dyspnea. Laboratory results showed elevated transaminases and his chest radiograph revealed bilateral interstitial infiltration. The diagnosis of murine typhus was made by a 4‐fold rise in specific Rickettsia typhi antibody, using indirect immunofluorescent assay. He dramatically improved after treatment with doxycycline for 7 days. To our knowledge, this is the first case report of murine typhus in a liver transplant recipient.     

Partial atrial standstill: a case report

Twelve-lead electrocardiograms revealed no atrial activity and a wide QRS escape rhythm at 38 beats/min in a 20-year-old man who presented with syncope. Doppler echocardiography documented the absence of A wave both in the tricuspid and mitral valve flow. The only mechanical activity was documented at the left atrial appendage. An electrophysiologic study demonstrated electrical inactivity in the right atrium and an atrial tachycardia in the left atrium. Atrial pacing with maximum output did not capture the atria. Our case represents an advanced stage of partial atrial standstill, with a mechanical and electrical atrial activity confined only to the left trial appendage. The patient remained asymptomatic after receiving a VVIR pacemaker and anticoagulation therapy.     

复律后左心房功能恢复与心房颤动持续时间相关性的临床研究

目的:应用心肌组织多普勒技术结合M型超声、脉冲血流多普勒和心尖搏动图评价心房颤动(房颤)复律后心房功能的变化及其相关因素。方法:正常对照组20例,房颤复律患者34例。根据房颤持续时间分成短期房颤组(n=18)和长期房颤组(n=16),于复律后1小时、1天、1周和1个月行超声检查。采用心肌组织多普勒技术测量二尖瓣环侧壁心房收缩期心肌组织运动峰速(Am)和舒张早期运动峰速(Em)并计算Am/Em比值,M型超声测量瓣环侧壁舒张晚期心肌最大运动幅度(DAD)和舒张早期最大运动幅度(DED)并计算DAD/DED比值,脉冲血流多普勒测量心房收缩期跨瓣血流最大流速(A)和心室舒张早期血流最大流速(E)并计算A/E比值,心尖搏动图记录心房收缩压力波。并筛选出与复律后1小时、1天、1周左心房心肌组织运动速度有关的临床变量。结果:复律后1小时、1天、1周与Am相关的临床变量均为房颤持续时间。左心房功能与房颤持续时间的关系:复律后1小时及1天,Am、Am/Em,A/E,DAD、DAD/DED在两房颤组均低于正常对照组(P<0.05);长期房颤组低于短期房颤组(P<0.05);复律后1周,长期房颤组仍低于正常对照组和短期房颤组(P<0.05);短期房颤组与正常对照组无差异(P>0.05)。复律后1个月,除长期房颤组DAD/DED仍低于正常对照组(P<0.05),其余指标3组间无差异(P>0.05)。复律后左心房顿抑仅发生于长期房颤组,其发生率于1小时为43.8%,1天为25%,1周为12.5%。结论:房颤复律后左心房功能的恢复及左心房顿抑的发生与房颤持续时间有明显相关性。     

Toxoplasmosis in non‐cardiac solid organ transplant recipients: A case series and review of literature

The risk of toxoplasmosis in high‐risk cardiac transplant recipients is well recognized prompting universal donor and candidate screening with administration of targeted post‐transplant chemoprophylaxis in high‐risk (D+/R?) cardiac transplant patients. In contrast, until recently, there have been neither well‐defined recommendations nor consensus regarding toxoplasmosis preventive strategies among non‐cardiac solid organ transplant recipients. We report 3 cases of post‐transplant toxoplasmosis in non‐cardiac transplant recipients (one lung and two liver); all 3 infections presumed to be donor‐derived. Not surprisingly, pre‐transplant Toxoplasma serology was negative in all the patients. None of the patients were on trimethoprim‐sulfamethoxazole (TMP‐SMX) prophylaxis at the time of diagnosis of toxoplasmosis. The median time from transplant to onset of infection was 90 days (range: 30‐120 days). Clinical presentations included cerebral (n = 1) and disseminated infections (n = 2). Two of the 3 patients, both with disseminated infection died (mortality ~ 67%).     

Severe acute Q fever pneumonia complicated by presumed persistent localized Q fever endocarditis in a renal transplant recipient: A case report and review of the literature

Q fever in solid organ transplant (SOT) recipients is rarely described in the medical literature. We present a case of severe acute Q fever pneumonia that evolved into persistent localized Q fever endocarditis in a renal transplant recipient.     

慢性心房颤动对人心房肌细胞内游离钙浓度的影响

用激光共聚焦显微镜技术 ,以Fluo 3作为钙指示剂 ,对急性分离的风湿性心脏病 (RHD)慢性心房颤动 (AF)和RHD窦性心律患者的心房肌细胞内游离Ca2 + 浓度进行比较、测定。观察RHD慢性AF患者心房肌细胞内是否存在钙超载。结果 :RHD慢性AF患者心房肌细胞内游离Ca2 + 浓度明显高于窦性心律患者心房肌细胞内游离Ca2 +浓度 (5 17± 98vs 2 6 2± 6 5nmol/L ,P <0 .0 1)。研究提示RHD慢性AF可以引起患者心房肌细胞内Ca2 + 超载