Myocardiopathy and Takayasu's disease. Apropos of a case

The possibility of cardiac involvement in Takayasu's disease is well known, but this involvement generally appears to be secondary to reno-vascular hypertension or to pulmonary arteritis and, exceptionally, as a result of coronary disease. In the case reported here, the inflammatory myocardial lesion localised to the left ventricle was demonstrated while the patient was still alive. It was responsible for an episode of severe heart failure which finally resolved after 2 years. The inflammatory involvement of the myocardium was associated with laboratory signs of inflammation and with inflammatory arterial lesions. Several haemodynamic investigations were performed to follow the course of the disease. The diagnosis was confirmed by myocardial biopsies and by the pulmonary arterial and renal arterial involvement. A review of the literature revealed that this condition was extremely rare and has only been proven in a few autopsy cases.     

Rare complication of extracorporeal circulation: diffuse coronary fibrosis; giant cell myocarditis

A 38 year old woman developed severe coronary stenosis several months after double valve replacement. Aorto-coronary bypass surgery was performed but the patient died of a peroperative myocardial infarction. Histological studies showed not only fibrous thickening of the intima of the whole coronary arterial tree, but also variable medial changes with inflammatory infiltration. In addition, inflammatory granulomata with giant cells were found in the myocardium. These coronary lesions and their association with a giant cell myocarditis cannot be satisfactorily explained by known pathological conditions. The usual mechanisms of coronary disease were not operative in this case. There remains the hypothesis of a primary change of the coronary wall related to either cannulation, anoxic arrest or perfusion fluid, or a combination of these factors. The coronary lesions could have developed by an immunological process which would also explain the giant cell myocarditis.     

Do Hospital Attributes Predict Guideline-Recommended Gastric Cancer Care in the United States?

Background  

Hospital attributes have been shown to impact short- and long-term outcomes after cancer surgery. However, the effect of hospital attributes on processes of cancer care in terms of delivery of guideline recommended care has not been evaluated. We examined the impact of hospital attributes (volume and type) on guideline-recommended care in patients treated for gastric cancer.     

The use of magnetic resonance spectroscopy in the subacute evaluation of athletes recovering from single and multiple mild traumatic brain injury

Abstract Advanced neuroimaging techniques have shown promise in highlighting the subtle changes and nuances in mild traumatic brain injury (MTBI) even though clinical assessment has shown a return to pre-injury levels. Here we use (1)H-magnetic resonance spectroscopy ((1)H-MRS) to evaluate the brain metabolites N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) in the corpus callosum in MTBI. Specifically, we looked at the NAA/Cho, NAA/Cr, and Cho/Cr ratios in the genu and splenium. We recruited 20 normal volunteers (NV) and 28 student athletes recovering from the subacute phase of MTBI. The MTBI group was categorized based upon the number of MTBIs and time from injury to (1)H-MRS evaluation. Significant reductions in NAA/Cho and NAA/Cr ratios were seen in the genu of the corpus callosum, but not in the splenium, for MTBI subjects, regardless of the number of MTBIs. MTBI subjects recovering from their first MTBI showed the greatest alteration in NAA/Cho and NAA/Cr ratios. Time since injury to (1)H-MRS acquisition was based upon symptom resolution and did not turn out to be a significant factor. We observed that as the number of MTBIs increased, so did the length of time for symptom resolution. Unexpected findings from this study are that MTBI subjects showed a trend of increasing NAA/Cho and NAA/Cr ratios that coincided with increasing number of MTBIs.     

Feedback of extended panel sequencing in 1530 patients referred for suspicion of hereditary predisposition to adult cancers

High‐throughput sequencing analysis represented both a medical diagnosis and technological revolution. Gene panel analysis is now routinely performed in the exploration of hereditary predisposition to cancer, which is becoming increasingly heterogeneous, both clinically and molecularly. We present 1530 patients with suspicion of hereditary predisposition to cancer, for which two types of analyses were performed: a) oriented according to the clinical presentation (n = 417), or b) extended to genes involved in hereditary predisposition to adult cancer (n = 1113). Extended panel analysis had a higher detection rate compared to oriented analysis in hereditary predisposition to breast / ovarian cancer (P < .001) and in digestive cancers (P < .094) (respectively 15% vs 5% and 19.3%, vs 12.5%). This higher detection is explained by the inclusion of moderate penetrance genes, as well as the identification of incident mutations and double mutations. Our study underscores the utility of proposing extended gene panel analysis to patients with suspicion of hereditary predisposition to adult cancer.     

Depressive symptoms in acute stroke: A cross-sectional study of their association with sociodemographics and clinical factors

The aim of the study was to estimate the prevalence of post-stroke depression (PSD) in the acute phase following first-ever stroke, and to identify its sociodemographic and clinical correlates. Data were collected in a cross-sectional correlational study from face-to-face interviews using structured questionnaires and patients' medical records. The sample consisted of 109 patients with first-ever stroke. Depressive symptoms after stroke were measured with Beck Depression Inventory II. Mild, moderate or severe depressive symptoms were reported by 27% of the participants. PSD was uniquely associated with post-stroke fatigue, sleep latency and sleep disturbance. Patients with PSD also reported slightly more bodily pain. Stroke type, stroke location, and the sociodemographic characteristics we examined were unrelated to PSD. Further research is needed to assess the role sleep changes, fatigue and bodily pain might have in relation to depression in the acute phase after stroke.     

Physical and Sexual Abuse and Neglect and Eating Disorder Symptoms

Abstract

For eating-disordered patients with a history of post-traumatic stress, childhood abuse and neglect, and dissociative disorder, eating behavior symptoms may function as a rational response to unmetabolized traumatic experiences. This paper will review trauma-based theory, dissociation, abreactive, and ego-states therapy as they apply to eating disorder patients.