Diabetic cardiomyopathy: mechanisms, diagnosis and treatment

Independent of the severity of coronary artery disease, diabetic patients have an increased risk of developing heart failure. This clinical entity has been considered to be a distinct disease process referred to as 'diabetic cardiomyopathy'. Experimental studies suggest that extensive metabolic perturbations may underlie both functional and structural alterations of the diabetic myocardium. Translational studies are, however, limited and only partly explain why diabetic patients are at increased risk of cardiomyopathy and heart failure. Although a range of diagnostic methods may help to characterize alterations in cardiac function in general, none are specific for the alterations in diabetes. Treatment paradigms are very much limited to interpretation and translation from the results of interventions in non-diabetic patients with heart failure. This suggests that there is an urgent need to conduct pathogenetic, diagnostic and therapeutic studies specifically in diabetic patients with cardiomyopathy to better understand the factors which initiate and progress diabetic cardiomyopathy and to develop more effective treatments.     

培养心肌细胞牵张刺激装置的建立及应用

1　方法　牵张刺激装置的制作如模式图 1.制作实验模型采用材料为有机玻璃板、2 4孔培养板、硅胶膜 (厚度 0 .2 2 μｍ) .硅胶膜从平面圆形变为球形时 ,面积扩大的百分比 =(Ｓ球 -Ｓ园 ) /Ｓ园 ,其中Ｓ球 =ＡＤ2 ,Ｓ园 =ｒ2 ,而ＡＤ2 =ｈ2 +ｒ2 ,其中ｒ为孔的半径 ,ｈ为膜升高的高度图 2 .通过控制ｈ的大小 ,可控制膜被牵拉的强度 .本实验采用使膜面积扩大 2 0 %的强度 ,故ｈ =4ｍｍ[1] .参照Ｋａｓｓｉｒｉ等[2 ,3 ] 方法进行心肌细胞的分离培养 .生长有贴壁心肌细胞的 2 4孔板被固定于牵张装置 ,缓慢充气使硅胶膜向上凸起 4ｍｍ ,分别维持…     

Intracranial Dural Sinus Thrombosis: Novel Use of a Mechanical Thrombectomy Catheter and Review of Management Strategies

Management of intracranial dural sinus thrombosis with involvement of multiple sinuses is complex, often involving not only the primary problem (thrombosis) but acute adverse events consequent to the disease. We highlight the novel use of an endovascular device (typically for suction thrombectomy in the peripheral vascular system) used in our patient with a life-threatening multi-sinus thrombosis. As there is no standard treatment yet for cranial sinus thrombosis, our review of the literature highlights some effective management strategies. A 35-year-old woman developed associated complications of cranial sinus thrombosis that included intracranial hypertension caused by an expanding intracranial hematoma, pulmonary embolism treated by placement of filters in superior and inferior vena cava to eliminate intra- and extracranial sources of emboli, and procedure-related retroperitoneal hematoma that necessitated peripheral vascular intervention. After failure of several common devices during mechanical thrombolysis, a thrombectomy catheter (typically for peripheral vascular intervention to aide in the clot removal) was used. Our case highlights the fine balance of anticoagulation and thrombolysis and the proactive, aggressive approach used by our multispecialty team to manage concurrent factors.     

Very late recurrence of childhood acute lymphoblastic leukemia treated with chemoimmunotherapy: a report of three cases occurring 19, 11, and 9 years after discontinuation of chemotherapy

Current therapeutic modalities for childhood acute lymphoblastic leukemia (ALL) are associated with a high cure rate, and recurrences more than 4 years after therapy cessation are very unusual. We report three cases of exceptionally late recurrences of childhood ALL after cessation of chemotherapy (CT) given for respective periods of 8, 7, and 24 months. CT was followed by maintenance immunotherapy (IMT) with Bacillus Calmette-Guérin (BCG) and allogeneic leukemic lymphoblasts pretreated with formaldehyde or irradiated in vitro. Leukemic recurrences were observed 19, 11, and 9 years after cessation of CT and appeared morphologically similar to the original blasts. A second complete remission was easily achieved in all three patients, but two went on to repeated relapse (one has died following the fourth recurrence). We speculate that some residual leukemic cells, remaining after the inadequate, short-term CT, were responsible for these unusual evolutions, and we question a possible delaying role of IMT in prolonging remission. Other possible etiologies are discussed.     

Recurrent chest pain as the presenting manifestation of spinal meningioma

We report the case of a 9-year-old boy with a spinal cord meningioma whose only manifestations were recurrent episodes of chest pain lasting for 2 years. This case shows that spinal cord meningioma should be considered among the possible causative factors of chronic chest pain in childhood. Chest pain, meningioma, spinal tumors     

Can clinical data help to screen patients with lymphoma for MR imaging of bone marrow?

Background: Previous studies have suggested combining magneticresonance (MR) imaging and biopsy in patients with lymphomabut associations between MR results and clinical symptoms havenever been investigated. The purpose of this retrospective studywas to better delineate patients profiles requiring bone marrow(BM) imaging in lymphoma Materials and methods: 50 MR studies and blind biopsies (BB)were reviewed in 40 patients with lymphoma. MR results werecompared to clinical, laboratory-based and BM follow-up datato determine potential associations between MR results and theseparameters Results: 46% of MR studies were abnormal with a normal BB; 2%were normal with an abnormal BB. Abnormal MR results were significantlyassociated with subsequent bone marrow involvement (p<0.01).Abnormal MR studies were significantly associated with constitutionalsymptoms, bone pains (p<0.05) and an elevated alkaline phosphataselevel (p < 0.01). MR imaging excluded malignancy in threepatients and caused therapy to be modified in three Conclusions: Abnormal clinical and laboratory-based data shouldbe used to screen patients with normal BB for MR imaging, especiallyin patients with Hodgkin's disease and high grade non-Hodgkin'slymphoma biopsy, bone marrow, comparative studies, lymphoma, magnetic resonance studies     

Short report: Crimean-Congo hemorrhagic fever outbreak in Rawalpindi, Pakistan, February 2002

A nosocomial outbreak of Crimean-Congo hemorrhagic fever occurred in Rawalpindi, Pakistan in February 2002. The identified index case died shortly after admission to a hospital. Two of the health care workers became secondary cases; one of them died on day 13 after coming in contact with the index case. The other secondary case was successfully treated with oral ribavirin.     

Long-term outcome of congenital intestinal pseudoobstruction

We evaluated 85 children with congenital chronic intestinal pseudoobstruction (CIP) over the past 10 years. Twelve (14%) were born prematurely. One had a family history of CIP. Six had systemic diseases. Thirty-five (41%) had urinary bladder involvement. Manometric features were consistent with myopathy in 32, neuropathy in 48, and mixed disease in 5. Of 48 patients with neuropathy, 6 had urinary bladder involvement (12.5%) (P < 0.0001 vs myopathy), and 10 had malrotation (21%) (P = NS vs myopathy). Upon referral, 53 (62%) were dependent on partial or total parenteral nutrition (PN). At the time of chart review (median 25 months after evaluation), 22 patients had died, 14 of whom were on total PN, 13 of them died because of PN-related complications and 1 died of sepsis. Three others died of sepsis while on partial PN (P = 0.007 vs mortality in patients fed enterally) and five died after small bowel transplantation. In conclusion, in children with congenital CIP, the risk for prematurity is increased twofold, the majority of cases are sporadic, abnormal bladder function is more common in myopathic CIP, and complications related to parenteral nutrition are the main cause of death in children with CIP.