Cardiovascular magnetic resonance for the diagnosis and management of heart failure with preserved ejection fraction

Heart Failure Reviews - Heart failure with preserved ejection fraction (HFpEF) is characterized by an impaired ventricular filling resulting in the development of dyspnea and other HF symptoms....     

Solitary osteochondroma of the capitate,in a child

Osteochondromas, are the most common tumors of the long bones in children. Osteochondromas are extremely rare in the carpal bones. They are diagnosed in adult life, in almost all cases in the literature. We report a 7?year old boy, who presented with a hard mass on the dorsum of his hand, with decreased wrist movements. Radiological examination showed a calcified tumor of the second row of the carpal bones, with spherical shape and covered with cartilage. He was surgically treated with removal of a cartilaginous mass that was arising from the capitate. Pathology confirmed the diagnosis of an osteochondroma.     

Absence of opiate and histamine H2 receptor-mediated effects of clonidine

The possibility that clonidine might exert some of its effects via opiate or histamine H2 receptors has been suggested from observations in animals and man. We undertook a double-blind, randomized study in six normal subjects, comparing the effects of 0.2 mg intravenous clonidine after pretreatment with 300 mg cimetidine, 0.8 mg naloxone, and saline. There was no attenuation of the hypotension, bradycardia, sedation, inhibition of salivary flow, or reduction in plasma catecholamines after cimetidine and naloxone, but the fall in plasma catecholamines ater clonidine correlated with blood pressure, sedation, and salivary flow, suggesting a central adrenergic mechanism for these effects. It is not known whether cimetidine can cross the blood-brain barrier after short-term dosing. We conclude that in normotensive subjects the short-term effects of intravenous clonidine are probably not mediated by an action at peripheral histamine H2 or central opiate receptors.     

Optimizing Outcomes in the Jehovah’s Witness Following Trauma: Special Management Concerns for a Unique Population

Abstract Background:   The objective of this study was to describe the management of the Jehovah’s Witness (JW) in an intensely active level I trauma center and review the modern therapeutic options available for the trauma care of these patients. Study design:   A retrospective review of injured JWs admitted to a busy trauma center over a 13-year period was conducted. Results:   Over the study period, 143 JWs were identified. Among these, 15.4% (22/143) overall and 32.3% (10/31) requiring surgical intensive care unit (SICU) admission accepted transfusion. Overall, 56.6% of JWs (81/143) required operation and 21.7% (31/143) were admitted to the SICU with a complication rate of 4.2% (6/143) and a mortality of 1.4% (2/143). One patient of the 31 patients that were admitted to the SICU received 10 ml of blood with subsequent discontinuation of the transfusion and was excluded from analysis. Of the 30 JWs admitted to the SICU, 20 (66.7%) did not receive transfusion and demonstrated mean admission and nadir hemoglobin (Hb) levels of 12.7 (±2.5) and 9.1 (±3.0) mg/dl, respectively. Ten patients accepted transfusion. This group had longer mean SICU stays (23.3 vs. 5.5 days) but similar mortality (10%, 1/10 vs. 5%, 1/20) compared to non-transfused counterparts. Only one complication (1/20, 5%) was observed in the JWs who were not transfused, compared to a 40% (4/10) complication rate in those accepting transfusion. Conclusion:   Although our experience was limited, we found no significant difference in the mortality or morbidity between JW patients who received or abstained from transfusion following major trauma. We should keep in mind that the population was small, in order to extract safe conclusions regarding whether we should transfuse or not transfuse trauma patients. We can, however, see interesting insights on the value of trauma resuscitation.     

Plasma B-type natriuretic peptide is related to left ventricular mass in hypertensive patients

Dear Editor, We read with great interest the paper by Cowie et al., on clinicalapplications of B-type natriuretic peptide (BNP) testing.¹ Atrial(ANP) and B-type natriuretic peptide are peptide hormones releasedin response to myocyte stretch. Novel biomarkers have been evaluatedfor four