Cystic teratoma of the pancreas

The preoperative diagnosis of cystic tumours of the pancreas can be difficult. It is usually based on morphological and biological (i.e., cyst fluid content of tumour markers) data. However, the latter can be misinterpreted in case of exceptional cystic tumours, other that cystadenomas. We report here the case of a 45-year old woman who was operated on for a benign cystic mature teratoma with endocrine component and high concentrations in cyst fluid CEA and CA 72.4 which was evocative of a malignant mucinous cystadenoma.     

Severe thrombopenia as single sign of hemophagocytosis in a patient with cirrhosis and lethal infection of ascitis fluid by Escherichia coli

Hemophagocytosis is defined by a systemic macrophages activation, phagocyting the blood elements. This syndrome can be primary or secondary to multiple causes such as neoplasia or infections. We report here the first case of a hemophagocytosis caused by an Escherichia coli infection of ascitis fluid.     

Metastatic transitional cell carcinoma with high CA 19.9 serum levels

We report the case of a 75-year-old woman with liver metastases of a urothelial carcinoma accompanied by a marked increased in CA 19-9 serum level. The mechanisms leading to this elevation, similar to that observed in biliary tract diseases, are discussed.     

Left ventricular response to exercise in aortic stenosis: an exercise echocardiographic study

BACKGROUND: While normal at rest, left ventricular (LV) systolic function may become abnormal during exercise in patients with aortic stenosis. Once contraindicated in patients with aortic stenosis, exercise testing is now recommended in asymptomatic patients with aortic stenosis to elicit symptoms and thereby ascertain the need for aortic valve replacement. However, the clinical significance of an abnormal LV response to exercise in asymptomatic patients with aortic stenosis remains unknown. OBJECTIVE: The aim of this study was to evaluate the clinical implications of an abnormal LV response during exercise in the setting of aortic stenosis. METHODS: We monitored the LV response to exercise by 2D-Doppler echocardiography during a symptom limited semirecumbent bicycle exercise in 50 patients with tight aortic stenosis (aortic valve area < or = 1.0 cm(2)) and a normal LV systolic function (LV ejection fraction, EF > or = 50%) and followed them for an average of 11 months. RESULTS: Twenty patients had an abnormal LV response to exercise with a mean decrease in LV EF from 64 +/- 10 to 53 +/- 12% while 30 patients had a normal LV response to exercise with a mean increase in LV EF from 62 +/- 7 to 70 +/- 8%. Patients with an abnormal LV response during exercise were more likely to develop symptoms during exercise than patients with a normal LV response: 80% versus 27% (P< 0.0001). The survival free of cardiac events was significantly lower in patients with abnormal LV response to exercise than in patients with a normal response (P = 0.03). CONCLUSION: Exercise echocardiography provides objective data that facilitate interpretation of exercise elicited symptoms in asymptomatic patients with severe aortic stenosis. In addition, an abnormal LV response to exercise may predict a poor outcome.     

Usefulness of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) in differentiating congestive heart failure from noncardiac cause of acute dyspnea in elderly patients with a normal left ventricular ejection fraction and permanent, nonvalvular atrial fibrillation: insights from a prospective, monocenter study

BACKGROUND: The incremental role of bedside tissue Doppler echocardiography and B-type natriuretic peptide (BNP) over the clinical judgment has been recently reported in the emergency diagnosis of congestive heart failure with a normal left ventricular ejection fraction (HFNEF). However, how well does this diagnostic strategy be applicable in the setting of atrial fibrillation is unknown. OBJECTIVE: To investigate the usefulness of bedside tissue Doppler echocardiography and BNP in the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation. METHODS: Forty-one consecutive elderly patients with an ejection fraction > or =50% (mean age 84 years; 22 with HFNEF and 19 with noncardiac cause), hospitalized for acute dyspnea at rest, were prospectively enrolled; bedside septal E/Ea and BNP were obtained at admission. Results: By multivariable logistic regression analysis including the clinical judgment of heart failure, E/Ea and BNP, E/Ea (P = 0.014) and BNP (P = 0.018) provided independent diagnostic information. Optimal cutoffs were 13 for E/Ea (area under the ROC curve of 0.846, P < 0.0001; sensitivity 81.8%, specificity 89.5%) and 253 pg/ml for BNP (area under the ROC curve of 0.928, P < 0.0001; sensitivity 86.4%, specificity 89.5%). The concordance between the clinical judgment and BNP concentration at the cutoff of 253 pg/ml correctly classified 24 of 25 patients; E/Ea at the cutoff of 13 correctly classified 14 of the 16 patients with discrepancy. CONCLUSION: Bedside tissue Doppler echocardiography and BNP provide useful additional diagnostic information over the clinical judgment for the emergency diagnosis of HFNEF in elderly patients with permanent, nonvalvular atrial fibrillation.     

Prevalence and determinants of cognitive impairment in chronic heart failure patients

Cognitive impairment has seldom been investigated in patients with chronic heart failure (CHF). The authors' aim was to assess the prevalence and determinants of cognitive impairment in patients hospitalized for CHF decompensation. The authors prospectively performed the Folstein Mini-Mental State Examination (MMSE) and completed a standardized questionnaire for cerebrovascular accidents (CVA) and transient ischemic attacks (TIA) in patients hospitalized for CHF decompensation during a 3-month period. A total of 83 patients were studied: 15 had a history of CVA or TIA, 51 (61%) had an MMSE score < or = 28 (or < or = 26 if schooling < or = 8 years), and 26 (31%) had an MMSE score <24. Factors associated with an MMSE score <24 were atrial fibrillation/flutter (odds ratio [OR], 8.1; 95% confidence interval [CI], 1.9-34.6), New York Heart Association functional class IV (OR, 4.1; CI, 1.0-16.4), and schooling >8 years (OR, 0.2; CI, 0.0-0.8). Adjusting for history of CVA or TIA or excluding patients with a history of CVA or TIA did not affect the findings. Cognitive impairment is frequent in patients hospitalized for CHF decompensation whether or not they have a past history of CVA or TIA. The severity of cognitive impairment parallels that of CHF. The question of whether this cognitive impairment decreases adherence to treatment and contributes to a worse outcome in CHF patients should be explored.     

Sodium valproate does not augment Prpsc in murine neuroblastoma cells

Sodium valproate (VPA) has been reported to increase the accumulation of the pathologic isoform of prion protein (PrPsc) in scrapie-infected murine neuroblastoma cells. In this study, the effect of VPA on PrPsc accumulation was investigated in murine N2a neuroblastoma cells chronically infected with scrapie strain 22L (N2a-22L). No accumulation of PrPsc was detected after short-term (3 days) or long-term (21 days) treatment of N2a-22L cells with 4.8, 12, 18 or 24 microM VPA. Higher VPA concentrations (240 and 600 microM) also failed to augment PrPsc expression. In conclusion, in our experimental conditions, no deleterious effect was induced by VPA on prions replication.