Sleep disorders in patients with postural tachycardia syndrome

Objective

Patients with postural tachycardia syndrome (POTS) often describe symptoms of fatigue, sleepiness, and lack of refreshing sleep. We aimed to provide further objective measures of sleep in patients with POTS.

Methods

POTS patients (n = 18) were selected based on autonomic testing and evaluation at our center. Controls (n = 16) of similar age, gender, and BMI were selected from new patients referred to the Stanford Sleep Disorders Clinic for any sleep-related complaint. All patients underwent polysomnography and completed several sleep questionnaires and a 2-week sleep diary.

Results

POTS patients and control subjects were of similar age (27 ± 10.2 vs. 29 ± 5.4 years, p = 0.92) and Body Mass Index (21 ± 3.8 vs. 24 ± 4.1, p = 0.14). The majority of subjects in both groups were females (72 % POTS vs. 81 % controls). POTS patients scored higher on subjective fatigue scales but not sleepiness scales. POTS patients scored in the normal range on the BDI and the “evening” category on the MEQ. Their sleep diaries were not different from controls. With the exception of mild OSA, slightly reduced %REM and prolonged REM latency, their PSG data were normal and no different from controls.

Conclusions

It is unlikely that the sleep-related complaints of POTS patients are the result of a primary sleep disorder unique to POTS. We propose that a combination of factors such as body fatigue, chronic pain, and other somatic symptoms common in POTS patients might be the underlying reason for sleep-related symptoms in POTS.

     

Clinical events after transjugular intrahepatic portosystemic shunt: Correlation with hemodynamic findings

Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are increasingly being used, but the relationship between the hemodynamic effects of TIPS and the clinical events on follow-up remains undefined. Hence, we have investigated the hemodynamic correlations of portal hypertension–related events after a TIPS procedure. Methods: Prospective follow-up of 122 cirrhotic patients who had a TIPS procedure performed because of variceal hemorrhage was conducted. Results: The portacaval pressure gradient (PPG) significantly decreased after the TIPS procedure (from 19.7 ± 4.6 to 8.6 ± 2.7 mm Hg; P > 0.001), but increased thereafter and at rebleeding (n = 25) was >12 mm Hg in all patients (18.4 ± 4.6 mm Hg). Twenty-six patients developed ascites; the PPG (measured in 19) was always >12 mm Hg. Increasing the PPG to >12 mm Hg occurred very frequently (83% at 1 year). Within 1 year, 77% of patients underwent balloon angioplasty or restenting. However, 80% had again a PPG of >12 mm Hg 1 year after reintervention. Hepatic encephalopathy developed in 31% of patients at 1 year; 21 of 23 patients had a PPG of <12 mm Hg. Conclusions: Total protection from the risk of recurrent complications of portal hypertension after a TIPS procedure requires that the PPG be decreased and maintained <12 mm Hg. However, reintervention will be required in most patients within 1 year and again the second year. On the other hand, such portal decompression is associated with an increased risk of hepatic encephalopathy.GASTROENTEROLOGY 1998;114:1296-1303     

Rapid growth of cervical cancer metastasis in the brain

Cervical cancer rarely metastasises to the brain, with occurrences of approximately 0.77%. Our patient was referred for treatment of a brain lesion on the background of known metastatic cervical cancer to the lungs and new onset seizure activity. The lesion grew in size from 18 mm to 29 mm in a period of 14 days. The lesion was debulked and the patient returned to the care of her oncology team. The brain is an increasingly common site for metastases of cervical cancer and must be considered when staging these patients.     

Knee and hip radiographic osteoarthritis predict total hip bone loss in older adults: A prospective study

The relationship between osteoarthritis (OA) and osteoporosis remains controversial. This study was designed to determine the association between hip and knee radiographic OA and change in total hip bone mineral density (BMD) over 2.6 years. A total of 867 population‐based randomly selected subjects (mean age 62 years, range 51 to 80 years, and 49% female) were included. Hip and knee joint space narrowing (JSN, 0 to 3) and osteophytes (0 to 3) in both lower limbs was assessed using Altman's atlas. Total hip BMD was measured by dual‐energy X‐ray absorptiometry (DXA). We found that radiographic OA (score of JSN or osteophytes > 0) was common in this sample (hip 45%, knee 68%). In multivariable analyses, percentage change in total hip BMD per year was predicted by right and left hip axial JSN (β = –0.25% and –0.29% per grade, respectively, both p < .05), right hip superior femoral osteophytes (grades 2 and 3 versus 0: β = –1.60, p < .05), combined right and left knee tibiofemoral JSN (β = –0.06 per grade from grades 0 to 12, p < .05), and osteophytes (β = –0.06 per grade from grades 0 to 14, p < .05) independent of each other and joint pain. In conclusion, older subjects with radiographic hip and knee OA have higher total hip bone loss over 2.6 years regardless of symptoms, suggesting that consideration should be given to the monitoring of bone mass in these subjects. © 2010 American Society for Bone and Mineral Research.     

Design, synthesis and cytotoxicity of novel chalcone analogs derived from 1-cyclohexylpyrrolidin-2-one and 2,3-dihydrobenzo[f]chromen-1-one

Two divergent series of novel chalcone analogs, one derived from 1‐cyclohexylpyrrolidin‐2‐one and the other derived from 1‐benzo[f]chromanone, were designed, synthesized and evaluated for cytotoxicity against two murine cancer cell lines. Two 1‐benzo[f]chromanone analogs, 4g and 4j yielded moderate toxicity against both melanoma B16 and lymphoma L1210 cell lines with IC₅₀ values between the range of 5 and 6 µM. With an IC₅₀ value of 3.4 µM, compound 4g was also active against human MDA‐MB‐435 melanoma cells. X‐ray structures of the β‐hydroxy ketone product ( 4a ) and the α,β‐unsaturated ketone ( 4h ) were collected, and confirm the syn‐configuration between the carbonyl moiety and the β‐vinylic proton in 4h . X‐ray structures of two 1‐cyclohexylpyrrolidin‐2‐one derivatives were also obtained, and both showed an E‐configuration for the double bond.     

Clinicoradiological features of tuberculous meningitis in patients over 50 years of age

Background and aim

Tuberculous meningitis (TBM) is a debilitating form of CNS tuberculosis with a high morbidity and mortality in spite of treatment. The diagnosis is based on clinical, radiological and laboratory features. The classical CT features of basal exudates, hydrocephalus, infarcts and granulomas have been mostly reported in younger individuals. Our aim was to study imaging features of TB meningitis in adults over the age of 50 years.

Materials and methods

Clinical, imaging and laboratory features of 53 adult patients over the age of 50 years (sixth to eighth decades) were studied retrospectively. Diagnosis of TBM was based on clinical and laboratory features.

Results

Imaging features were the conspicuous absence of typical features of TBM (ie, basal meningeal enhancement, hydrocephalus, infarcts/granulomas were seen in only a minority of patients).

Conclusions

CT features of TBM in elderly patients were few, atypical and non‐contributory for diagnosis, probably because of age related immune senescence. Strong clinical suspicion and correlation with laboratory findings is necessary for early diagnosis.The elderly population is increasing all over the world, including India, because of increased life expectancy. The incidence of tuberculosis has been estimated to be higher in elderly subjects than in younger populations.¹ Non‐specific clinical symptoms may be masked by illnesses prevalent in old age, such as diabetes mellitus, vascular diseases and malignancies. CT has been used in the evaluation of tuberculous meningitis (TBM) to identify complications and for prognosis. CT features include basal meningeal enhancement, hydrocephalus, infarctions and focal granulomas.² We report a retrospective study of clinical and radiological features of TBM in patients over the age of 50 years (sixth to eighth decades).