Successful treatment of extensive muscle calcification in a patient with primary idiopathic polymyositis with diltiazem

A 25‐year‐old female patient with documented diagnosis of polymyositis developed extensive muscle calcification in the left thigh muscles with overlying skin induration one year after her disease onset, despite well controlled myositis. Plain X‐ray of the left femur and hip revealed extensive calcification involving the periarticular soft tissue shadows around the left hip and left upper thigh. The patient received diltiazem 90 mg/day in divided doses and follow‐up plain X‐ray study after 6 months of treatment revealed almost complete resolution of the muscle calcifications.     

Diagnostic accuracy of multi-slice computed tomography in identifying lesion characteristics in coronary total occlusion

We performed this study to compare the sensitivity and specificity of multi-slice computed tomography (MSCT) to coronary angiography (CA) in detecting coronary total occlusion (CTO) lesion characteristics. Moreover, we analyzed the association between these characteristics and the risk of revascularization failure. Fifty patients with confirmed CTO diagnosis were tried for revascularization using the antegrade (all 50) or retrograde (in failed nine antegrade interventions) approaches. Each patient underwent CA and MSCT before the intervention and data from both modalities were compared using the SPSS software. Successful revascularization occurred in 36 (72%) and 6 (66.7%) patients of the antegrade and retrograde groups, respectively. Compared to CA, MSCT exhibited high sensitivity in detecting CTO segment calcification (100%), size of the affected vessel (100%, area under the curve [AUC]?=?0.82), distal filling of the affected segment (97.7%) and side-branching at the CTO segment (93.3%). However, it had lower sensitivity in detecting collaterals (75%) and the length of the affected segment (87.5%, AUC?=?0.77). According to MSCT data, increased occlusion length >?18 mm (p?=?0.01), atherosclerotic vessel wall (p?=?0.02), small distal vessel size?≤?2.75 mm (p?=?0.002), proximal side-branching (p?=?0.01) and calcification of the proximal cap (p?=?0.007) or distal stump (p?=?0.01) were associated with an increased risk of revascularization failure. MSCT exhibited high sensitivity in identifying several CTO lesion characteristics, such as lesional calcification and size of the affected vessel. However, further research is needed to improve the diagnostic accuracy of this modality and define the predictors of revascularization failure in CTO patients.     

Blood pressure and proteinuria effects of multiple quantitative trait loci on rat chromosome 9 that differentiate the spontaneously hypertensive rat from the Dahl salt-sensitive rat

A blood pressure (BP) quantitative trait locus (QTL) was previously located within 117 kb on rat chromosome 9 (RNO9) using hypertensive Dahl salt-sensitive and normotensive Dahl salt-resistant rats. An independent study between two hypertensive rat strains, the Dahl salt-sensitive rat and the spontaneously hypertensive rat (SHR), also detected a QTL encompassing this 117 kb region. Dahl salt-sensitive alleles in both of these studies were associated with increased BP. To map SHR alleles that decrease BP in the Dahl salt-sensitive rat, a panel of eight congenic strains introgressing SHR alleles onto the Dahl salt-sensitive genetic background were constructed and characterized. S.SHR(9)x3B, S.SHR(9)x3A and S.SHR(9)x2B, the congenic regions of which span a portion or all of the 1 logarithm of odds (LOD) interval identified by linkage analysis, did not significantly alter BP. However, S.SHR(9), S.SHR(9)x4A, S.SHR(9)x7A, S.SHR(9)x8A and S.SHR(9)x10A, the introgressed segments of which extend distal to the 1 LOD interval, significantly reduced BP. The shortest genomic segment, BP QTL1, to which this BP-lowering effect can be traced is the differential segment of S.SHR(9)x4A and S.SHR(9)x2B, to which an urinary protein excretion QTL also maps. However, the introgressed segment of S.SHR(9)x10A, located outside of this QTL1 region, represented a second BP QTL (BP QTL2) having no detectable effects on urinary protein excretion. In summary, the data suggest that there are multiple RNO9 alleles of the SHR that lower BP of the Dahl salt-sensitive rat with or without detectable effects on urinary protein excretion and that only one of these BP QTLs, QTL1, overlaps with the 117 kb BP QTL region identified using Dahl salt-sensitive and Dahl salt-resistant rats.     

High tidal volume and positive fluid balance are associated with worse outcome in acute lung injury

STUDY OBJECTIVES: Recent data have suggested that ventilatory strategy could influence outcomes from acute lung injury (ALI) and ARDS. We tested the hypothesis that infection/sepsis and use of higher tidal volumes than those applied in the ARDS Network (ARDSnet) study (> 7.4 mL/kg of predicted body weight) would worsen outcome in patients with ALI/ARDS. DESIGN: International cohort, observational study. SETTING: One hundred ninety-eight European ICUs participating in the Sepsis Occurrence in Acutely Ill Patients study. PATIENTS OR PARTICIPANTS: All 3,147 adult patients admitted to one of the participating ICUs between May 1, 2002, and May 15, 2002. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Patients were followed up until death, hospital discharge, or for 60 days. Of the 3,147 patients, 393 patients (12.5%) had ALI/ARDS. ICU and hospital mortality was higher in patients with ALI/ARDS than those without ALI/ARDS (38.9% vs 15.6% and 45.5% vs 21.0%, respectively; p < 0.001). A multivariable logistic regression analysis with ICU outcome as the dependent factor showed that the independent risks for mortality were as follows: presence of cancer, use of tidal volumes higher than those used by the ARDSnet study, degree of multiorgan dysfunction, and higher mean fluid balance. Sepsis, septic shock, and oxygenation at the onset of ALI/ARDS were not independently associated with higher mortality rates. CONCLUSIONS: In addition to comorbidities and organ dysfunction, high tidal volumes and positive fluid balance are associated with a worse outcome from ALI/ARDS.     

Solitary benign fibrous tumors of the pleura

Solitary benign fibrous tumors of the pleura are very rare. Seven patients (mean age, 52 years) who presented between 1995 and 2005 were studied retrospectively. They had nonspecific chest symptoms and no history of asbestos exposure or smoking. Chest radiography showed a large opacity occupying most of the affected hemithorax, with clear costophrenic angles. Computed tomography of the chest showed a large well-delineated heterogeneous mass directly related to the lateral chest wall. Needle biopsy suggested the benign nature of the lesion. Surgery was performed through a posterolateral thoracotomy. Five tumors arose from visceral pleura, and 2 from parietal pleura. The mean tumor diameter was 7.5 cm (range, 8-14 cm). Complete surgical excision was carried out in all cases. Histopathology and immunohistochemical staining confirmed the benign nature of the tumors. There was no mortality or major complication. The mean follow-up period was 4 years (range, 1-10 years). All patients remained tumor-free during follow-up. Wide local excision, including pulmonary and pleural resection, is recommended as the best therapeutic option.     

Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions

Background

Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis¹Intravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005).

High‐resolution CT pulmonary findings in idiopathic ankylosing spondylitis: correlations with clinical assessment,plain chest X‐ray and pulmonary function tests

Aim: The aim of this study is to evaluate pulmonary manifestations of ankylosing spondylitis on high‐resolution computed tomography (CT) scan and to correlate these findings with clinical assessment, plain chest X‐ray and pulmonary function tests. Methods: The study comprised 32 patients (26 males [81.3%], 6 females [18.8%]) who met the modified New York criteria for diagnosis of idiopathic ankylosing spondylitis; in addition 10 normal subjects not complaining of any respiratory symptoms and matched for age and sex served as a control group. All patients were subjected to full history‐taking, full clinical examination, chest X‐ray, high‐resolution computed tomography (HRCT) chest and pulmonary function tests. Results: The abnormalities on HRCT included evidence of apical lung fibrosis in two patients (6.3%), interstitial lung disease in six (18.8%), minor interstitial abnormalities in eight (25%), bronchiectasis in four (12.5%), lung nodules in three (6.3%) and pleural thickening in five patients (6.3%). Nine patients (28.1%) showed negative findings by chest X‐ray which revealed positive findings on HRCT. Five patients (15.6%) showed positive findings on both HRCT and plain chest X‐ray, and 18 patients (56.3%) showed no findings on both HRCT and chest X‐ray. Four patients (12.5%) showed normal pulmonary function tests, 25 (78.13%) showed restrictive pattern, 17 (53.13%) had obstructive pattern and 26 patients (81.3%) had diffusion defects. Conclsuion: The identification of non‐apical minor basal interstitial lung disease in our study which was previously reported in other studies, raises a possible association to ankylosing spondylitis. High‐resolution CT scan is more sensitive than chest X‐rays in detection of such minor interstitial lung disease (ILD), and other parenchymal lung changes.     

A pilot study of short-term hemodynamic effects of negative pressure ventilation in chronic obstructive pulmonary disease assessed using electrical cardiometry

Background

Pulmonary rehabilitation combined with negative pressure ventilation (NPV) demonstrated benefits in patients with chronic obstructive pulmonary disease (COPD). The effect of NPV remains unknown. This study aims to clarify the short-term response of the hemodynamic outcome of NPV in patients with COPD undergoing pulmonary rehabilitation program by electrical cardiometry.

Methods

This is an observational retrospective study of COPD patients who had been treated in a pulmonary rehabilitation unit with NPV between January 2018 and December 2019 that were enrolled to analyze the hemodynamic outcomes.

Results

Thirty patients with COPD that were undergoing a pulmonary rehabilitation program and were regularly receiving NPV were enrolled. Cardiac output (p < .001) and heart rate (p < .001) showed a significant decrease after NPV. Stroke volume did not demonstrate significant change (p = .15). There was a significant decrease in thoracic fluid content (p = .016) and a significant increase in stroke volume variation (p = .038) systemic vascular resistance (p < .001) and left ventricular ejection time (p < .001). Other hemodynamic parameters were all comparable before and after NPV.

Conclusions

Negative pressure ventilation demonstrated an impact on hemodynamics in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Electrical cardiometry is a feasible method of determining the hemodynamic effects of negative pressure ventilation. Thoracic fluid content significantly decreased immediately after the NPV.

     

Circulating Endothelial Cells and Endothelial Function Predict Major Adverse Cardiac Events and Early Adverse Left Ventricular Remodeling in Patients With ST‐Segment Elevation Myocardial Infarction

Endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) are mobilized from the bone marrow and increase in the early phase after ST‐elevation myocardial infarction (STEMI). The aim of this study was to assess the prognostic significance of CECs and indices of endothelial dysfunction in patients with STEMI. In 78 patients with acute STEMI, characterization of CD34+/VEGFR2+CECs, and indices of endothelial damage/dysfunction such as brachial artery flow mediated dilatation (FMD) were determined. Blood samples for CECs assessment and quantification were obtained within 24 hours of admission and FMD was assessed during the index hospitalization. At 30 days follow up, the primary composite end point of major adverse cardiac events (MACE) consisting of all‐cause mortality, recurrent nonfatal MI, or heart failure and the secondary endpoint of early adverse left ventricular (LV) remodeling were analyzed. The 17 patients (22%) who developed MACE had significantly higher CEC level (P = 0.004), von Willebrand factor (vWF) level (P = 0.028), and significantly lower FMD (P = 0.006) compared to the remaining patients. Logistic regression analysis showed that CECs level and LV ejection fraction were independent predictors of MACE. The areas under the receiver operating characteristic curves (ROC) for CEC level, FMD, and the logistic model with both markers were 0.73, 0.75, and 0.82, respectively, for prediction of the MACE. The 16 patients who developed the secondary endpoint had significantly higher CEC level compared to remaining patients (P = 0.038). In conclusion, increased circulating endothelial cells and endothelial dysfunction predicted the occurrence of major adverse cardiac events and adverse cardiac remodeling in patients with STEMI. (J Interven Cardiol 2016;29:89–98)