Embolization of a Wiktor stent within a stent: Successful nonsurgical management

A case of embolization of an unexpanded Wiktor stent while attempting to traverse an expanded Wiktor stent is reported. The embolized stent was subjected to longitudinal axial traction, using a balloon catheter to cause stretching and partial unraveling. This partially unraveled stent was deployed across the dissection to scaffold it. The patient had no postprocedure complications. © 1996 Wiley-Liss, Inc.     

A Recombinant System and Reporter Viruses for Papiine Alphaherpesvirus 2

Primate simplex viruses, including Herpes simplex viruses 1 and 2, form a group of closely related herpesviruses, which establish latent infections in neurons of their respective host species. While neuropathogenic infections in their natural hosts are rare, zoonotic transmission of Macacine alphaherpesvirus 1 (McHV1) from macaques to humans is associated with severe disease. Human infections with baboon-derived Papiine alphaherpesvirus 2 (PaHV2) have not been reported, although PaHV2 and McHV1 share several biological properties, including neuropathogenicity in mice. The reasons for potential differences in PaHV2 and McHV1 pathogenicity are presently not understood, and answering these questions will require mutagenic analysis. Here, we report the development of a recombinant system, which allows rescue of recombinant PaHV2. In addition, we used recombineering to generate viruses carrying reporter genes (Gaussia luciferase or enhanced green fluorescent protein), which replicate with similar efficiency as wild-type PaHV2. We demonstrate that these viruses can be used to analyze susceptibility of cells to infection and inhibition of infection by neutralizing antibodies and antiviral compounds. In summary, we created a recombinant system for PaHV2, which in the future will be invaluable for molecular analyses of neuropathogenicity of PaHV2.     

Computer versus visual analysis of exercise thallium-201 images: a critical appraisal in 325 patients with chest pain

Although computer-aided analysis of planar thallium images has been previously reported to be superior to visual analysis, a segment-by-segment comparison of all thallium variables (presence of initial defect, presence of redistribution, and presence of abnormal lung:heart thallium ratio) has not been performed with the use of both methods. In the present study, such a comparison was performed to determine which thallium variable(s) are superior, when the computer method is used. In addition, both methods were compared to determine their correlations with the angiographic extent of coronary artery disease (no disease, or one-vessel disease vs multivessel, or left main disease) and the occurrence of future events (cardiac-related death or nonfatal myocardial infarction). Computer-aided analysis was superior to visual analysis (an average of three independent blinded observers) for detection of coronary disease because: (1) it was more specific for detecting initial defects despite having the same sensitivity (89.6% vs 91.0%, p = NS) and (2) it was more sensitive for detecting redistribution in the territory of a stenosed vessel (68% vs 46%, p less than 0.001). However, absolute myocardial clearance of thallium had very poor specificity compared to visually assessed redistribution. Only when segmental clearance was considered abnormal on a relative basis (if it was slower by 98% or more than the fastest clearing segment in the heart) did abnormal clearance achieve the same specificity (99%) and a better sensitivity (60% vs 48%, p less than 0.01) than visual analysis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Is homocysteine a relevant cardiovascular risk factor?

Scientific research is searching constantly for new markers to help stage the progress and prognosis of cardiovascular disease. Over the past few decades, homocysteine has been suggested as a risk factor involved in the promotion of atherosclerosis and thrombotic vascular events. Several large observational studies have indicated a relationship between homocysteine and cardiovascular illness. However, more robust prospective trials reveal a weaker association between the two than do case-control and cross-sectional data. Recently, many randomized controlled trials have evaluated the impact of homocysteine-lowering therapy on vascular risk. The overall evidence suggests a null effect, thereby failing to validate the hypothesis that a reduction in homocysteine levels would result in clinical benefit. This review outlines the latest relevant data and illustrates why the use of homocysteine as a screening tool or a target of cardiovascular treatment cannot be recommended.     

Metformin-Induced Lactic Acidosis (MILA): Review of current diagnostic paradigm

A new diagnostic paradigm has been proposed to better categorize causes of Metformin-Associated Lactic Acidosis (MALA). The diagnostic criteria defines a link between Metformin and lactic acidosis if lactate is >5 mmol/L, Ph < 7.35 and Metformin assay > 5mg/L. Metformin assays are not readily available in emergency departments including nationwide Veteran’s Affairs Hospitals; thereby making this proposed classification tool difficult to use in today’s clinical practice. We describe a case report of a 45-year-old male, who took twice the amount of Metformin prescribed and presented with Metformin-induced lactic acidosis. According to the new criterion, our case would be classified as “Lactic Acidosis in Metformin-Treated Patients (LAMT).” However, the term LAMT does not distinguish between a septic patient taking Metformin with lactic acidosis, and a patient who ingested toxic amounts of Metformin and has lactic acidosis (in absence of Metformin assay). Our case highlights the importance of medication reconciliation done on arrival to emergency department. Timing and dosing of Metformin in patients who present to the emergency department with lactic acidosis may cinch the diagnosis of Metformin-Induced Lactic Acidosis (MILA) in the absence of a Metformin assay but in the right clinical context.     

Folie a deux and delusional disorder by proxy: an atypical presentation

Delusion of parasitosis is a rare condition characterised by an individual harbouring the delusion of being infested with insects or parasites. We report a rare and interesting case of delusion of parasitosis presenting as folie a deux, that is, the delusion is shared by both the parents of an 18‐month‐old child, with proxy projection of parental delusion on the child. The case highlights the rare concomitant occurrence of two psychocutaneous disorders and emphasizes the importance of early recognition and appropriate intervention to safeguard the well‐being of the child.