A man with lung cancer and tuberculosis: a false positive by positron emission tomography and its clinical repercussions

Positron emission tomography (PET) has come to play an increasingly important role in the evaluation of lung cancer patients, both for diagnostic staging and post-treatment follow-up. As is true for other techniques, PET gives false positive and negative results. False positives have been described in the presence of certain active infections and inflammatory lesions, such as tuberculous granulomas, coccidioidomycosis, aspergillosis and histoplasmosis. We report the case of a man whose PET gave a false positive and in whom both lung cancer and tuberculosis were present. A radical change in therapeutic approach was required, making the case interesting.     

Minimally invasive video thoracoscopic correction of pectus excavatum

Pectus excavatum, the most common congenital deformity of the chest wall, has esthetic, psychological and social repercussions as well as a slight impact on pulmonary function. Treatment is surgical and is carried out for esthetic purposes in most cases. The most commonly applied surgical technique is based on the one originally described by Ravitch: sub-perichondrial, bilateral chondrectomy and sternal osteotomy. In 1997, however. Nuss described a minimally invasive approach to correction by means of a support bar. Our objective was to perform minimally invasive correction of pectus excavatum using a substernal extrapleural approach guided by video-assisted thoracoscopy. We treated three patients over 15 years of age without surgical complications. In all three cases, the minimally invasive technique corrected the pectus excavatum with excellent esthetic results. Both the path of insertion and duration were shorter with the described approach than with traditional surgery. Video images facilitated extrapleural insertion of the bar and minimized complications.     

Prevalence,awareness, treatment and control of hypertension in a Canarian population. Relationship with glucose tolerance categories. The Guía Study

OBJECTIVE: To estimate the prevalence, awareness, treatment and control of hypertension in a Canarian population; and their relationship with the glucose tolerance categories. DESIGN: From a population of 6355 subjects over 29 years old, 690 were chosen in a random sampling. Blood pressure measurements, a standard oral glucose tolerance test (excluding known diabetic patients), and a questionnaire on diabetes and hypertension history and medication use was performed. RESULTS: The total prevalence of hypertension was 50.3%; 62.0% of the hypertensive subjects were aware of their condition; 60.6% had their diastolic and 11.0% their systolic blood pressure controlled and 8.6% had both. For diabetic, glucose intolerant and normoglycemic subjects, the respective prevalences of hypertension were 79.4, 60.2 and 43.1% (higher in diabetic subjects, P < 0.001); the awareness of hypertension was 66.7, 61.8 and 59.5% (differences not significant); systolic blood pressure control was 4.8, 14.7 and 13.7% (lower in diabetic subjects, P = 0.017 versus glucose intolerant and P = 0.011 versus normoglycemic subjects); diastolic blood pressure control was 50.4, 72.1 and 63.2% (lower in diabetic subjects, P = 0.004 versus glucose intolerant and P = 0.025 versus normoglycemic subjects). There were no differences in the number and type of antihypertensive drugs among the different glucose tolerance categories. CONCLUSIONS: Blood pressure was comparable in our population and in other European populations. The prevalence of hypertension was higher, the awareness was similar, and control was worse in diabetic than in non-diabetic subjects; the drug treatment pattern was not different.     

Mechanisms involved in the water intake-related pressor response in the rat

OBJECTIVE : In this study we aimed to characterize and clarify the mechanisms involved in the acute blood pressure increase observed concomitantly with water intake in moderately dehydrated rats. DESIGN : Short-term water deprivation was employed as a model to induce controlled water intake to study concomitant cardiovascular responses in the rat. METHODS : Male Wistar rats were deprived of water for 18-24 h before the experiments and were allowed to drink for 20 s periods during the experimental session. During these periods water intake was accompanied by steady arterial pressure increases. This pressor response was unaffected by topical anesthesia of the oral cavity. Direct administration of water into the stomach did not cause pressor responses. The pressor response was not affected by bilateral adrenal demedullation or by pretreatment with diazepam, homatropine methyl bromide, d(CH2)5 Tyr(Me)AVP, losartan or RX821002. The pressor response was significantly reduced by ganglionic blockade with mecamylamine or pretreatment with the alpha1-adrenoceptor antagonist, prazosin. CONCLUSIONS : Our results show that: (1) short-term dehydration can be used as a model to study cardiovascular responses associated with water intake in rats; and (2) the sympathetic nervous system and vascular smooth muscle alpha1-adrenoceptors are involved in the pressor response to water intake by dehydrated rats.     

Chest pain units. Organization and protocol for the diagnosis of acute coronary syndromes

The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary.We present a systematic approach to create and manage a chest pain unit employing specialists headed by a cardiologist. The unit may be functional or located in a separate area of the emergency room. Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.     

Indications for catheter ablation and results in Andalusia,Spain

INTRODUCTION AND OBJECTIVES: We report the results of the first Catheter Ablation Registry of the Arrhythmia Working Group of the Andalusian Society of Cardiology (AWGASC) for 2000. METHODS: The register includes information about the ablation procedures performed in 2000, which was collected retrospectively and submitted voluntarily by four out of six cardiac electrophysiology laboratories of the AWGASC. A total of 424 patients (mean age 45 18 years; 50% men) were included. Twelve patients underwent two different ablation procedures, bringing the total number of procedures to 436. The overall success rate (based on current criteria), success rate by procedure, in-hospital mortality, and major complications are reported. RESULTS: The type and distribution of the ablation procedures were atrioventricular nodal re-entry tachycardia ablation, 34%; accessory pathway ablation, 39%; ventricular tachycardia ablation, 8%; atrial tachycardia ablation, 3%; atrioventricular junctional ablation, 9%, and cavo-tricuspid isthmus ablation, 9%. The overall success rate was 94% (range 97.8% to 87.4% in different laboratories), rate of major complications 1.1% (range 0% to 3.7%), and overall mortality 0.23% (1 patient). CONCLUSIONS: These findings summarize the indications and results of catheter ablation procedures performed in 2000 at four cardiac electrophysiology laboratories in Andalusia. This is the first multicenter registry in Spain.     

Safety and usefulness of transesophageal echocardiography in the acute phase of myocardial infarction

INTRODUCTION AND OBJECTIVES: The usefulness and safety of transesophageal echocardiography have been assessed in other studies but there is no report in which these factors have been evaluated in the acute phase of myocardial infarction.Patients and method. Transesophageal echocardiography was performed 56 times in 55 patients in the first week after a myocardial infarction. RESULTS: The study was completed in 54 of 56 patients. The indications were a transthoracic acoustic window that did not provide an accurate diagnosis in 13 (23.2%), diagnosis of mechanical complications and severity assessment of mitral regurgitation in 35 (62.5%), exclusion of aortic dissection in 4 (7.1%), assessment of the severity of aortic stenosis in 1 (1.8%), exclusion of the presence of atrial thrombus in 1 (1.8%), evaluation of the left ventricular outflow tract gradient in 1 (1.8%), and evaluation of the presence of a left ventricular thrombus in 1 patient (1.8%). Two patients (3.6%) died while the study was being made, the first one 10 minutes after finishing the echocardiogram due to progression of a partial rupture of the papillary muscle and the second due to left ventricle free wall rupture. In both patients, the indication for transesophageal echography was the need for proper evaluation of a post-Acute Myocardial Infarction mechanical complication. CONCLUSIONS: Transesophageal echocardiography is a very useful technique for evaluating patients during the acute phase of myocardial infarction but further studies are needed to establish its safety in these patients.     

The mitochondrial organelle and the heart

The heart is highly dependent for its function on oxidative energy generated in mitochondria, primarily by fatty acid beta-oxidation, respiratory electron chain and oxidative phosphorylation. Defects in mitochondrial structure and function have been found in association with cardiovascular diseases such as dilated and hypertrophy cardiomyopathy, cardiac conduction defects and sudden death, ischemic and alcoholic cardiomyopathy, as well as myocarditis. While a subset of these mitochondrial abnormalities have a defined genetic basis (e.g. mitochondrial DNA changes leading to oxidative phosphorylation dysfunction,fatty acid beta-oxidation defects due to specific nuclear DNA mutations), other abnormalities appear to be due to a more sporadic or environmental cardiotoxic insult or have not yet been characterized.This review focuses on abnormalities in mitochondrial bioenergetic function and mitochondrial DNA defects associated with cardiovascular diseases, their significance in cardiac pathogenesis as well as on the available diagnostic and therapeutic options. A concise background concerning mitochondrial biogenesis and bioenergetic pathways during cardiac growth,development and aging will also be provided.