Evaluation of the Incidence of Chronic Thromboembolic Pulmonary Hypertension 1 Year After First Episode of Acute Pulmonary Embolism: A Cohort Study

Purpose

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important complication after acute pulmonary embolism (PE) with considerable morbidity and mortality. The aim of this study was to estimate the CTEPH incidence in a cohort after the first occurrence of PE.

Methods

We conducted a 1-year follow-up cohort study between 2015 and 2018 to assess the incidence of CTEPH in 474 patients with their first acute episode of PE. For the diagnosis of CTEPH, patients with unexplained persistent dyspnea during follow-up underwent transthoracic echocardiography, right heart catheterization, ventilation-perfusion lung scanning, and CT pulmonary angiography.

Results

Overall, 317 patients were included in the study. The mean age of the patients was 56.5 ± 16 years. One hundred and three patients (32%) had exertional dyspnea at the 1-year follow-up. Patients with evidence of pulmonary hypertension (PH) on echocardiography underwent right heart catheterization. Eleven patients (18%) had no PH (mPAP < 25 mmHg); 47 patients (81%) had mPAP > 25 mmHg. Fifteen patients had PAWP > 15 mmHg, including those with underlying left heart problems or valvular diseases. There were 32 patients with PAH (mPAP > 25 mmHg and PVR > 3 WU) undergoing CTEPH studies; 22 patients (6.9%) had multiple segmental defects suggesting CTEPH on a perfusion scan.

Conclusion

The incidence of CTEPH observed in this study 1 year after the first episode of acute PE was approximately 6.9%. This incidence seems to be high in our population, and diagnostic and therapeutic strategies for the early identification of CTEPH are needed.

     

Studies in meconium. An approach to screening tests to detect cystic fibrosis.

Screening for cystic fibrosis (CF) in newborns is desirable, and efforts should continue in establishing a system of easily available, reliable, simple, and inexpensive tests. In addition to the Boehringer-Mannheim (BM) test for the detection of albumin, we propose the assay for lactase and beta-D-fucosidase in meconium. These latter two enzymes are present in the meconium of babies with CF and absent in meconium of most healthy babies. In a mass screening program for CF involving 20,182 specimens of meconium using only the BM strip, we found 46 positive results. Twenty-nine specimens came from infants with CF, six of whom had meconium ileus. Seventeen specimens yielded false-positive results by the BM test. Eleven of these would have been excluded by the addition of the lactase and beta-D-fucoside assay, thus reducing the false-positive test results by nearly 61%. In a comparative study of the three methods, the lactase and beta-D-fucosidase yielded 1.2% false-positives when examined independently. Performance of these two assays may allow greater specificity in diagnosis when used in addition to the BM test.     

Appendicitis complicating pregnancy.

In this series, nine pregnant patients had appendectomy. Seven patients had acute appendicitis; pyuria and symptoms suggesting urinary tract infection delayed diagnosis in one whose appendix perforated. Abdominal pain and nausea with or without vomiting were presenting symptoms in all of the patients. Tenderness in the right lower quadrant was present in six. Eight patients, including two with a normal appendix, had leukocytosis with a left shift. There was no fetal or maternal loss. In addition, I reviewed more than 900 other cases of appendectomy during pregnancy, as reported in the literature since 1960. Among 713 previously reported cases of confirmed appendicitis, rupture had occurred in 25%. There were five maternal deaths, all in the group of patients with perforation. Perinatal mortality was 4.8% among patients with acute inflammation only and 19.4% in those with perforative appendicitis. The diagnosis rests on clinical acumen, and prompt surgical intervention is the key to good outcome.     

Complex carotid stenting using a coronary technique

PURPOSE: To report the utility of a coronary technique to facilitate carotid stenting in patients with difficult arch anatomies. TECHNIQUE: When confronted with challenging arch anatomy that prevents engaging the common carotid artery (CCA) with the guiding sheath using standard techniques, an 8-F left Amplatz guiding catheter (AL1) is placed at the origin of the innominate artery. A 0.014-inch coronary guidewire is advanced into the external carotid artery (ECA), and a small monorail coronary balloon is inflated in a small branch of the ECA. The balloon/guidewire combination facilitates maneuvering a 0.035-inch Amplatz super-stiff guidewire through the ECA and then advancing the guiding catheter into the CCA. CONCLUSION: This anchoring technique can be a helpful method for cannulating the CCA in patients with a complex arch when the ECA is patent.     

Ursachen der Lungenembolie bei psychisch und neurologisch Kranken

Zusammenfassung Bei psychisch und neurologisch Kranken fanden sich Lungenembolien bei 18,02% der Männer und 29,10% der Frauen während der Jahre 1958–1961 gegenüber sonst 6,78% bzw. 10,14% während der Jahre 1915–1922. Eine Gefährdung durch bestimmte Krankheiten besteht nicht. Sie wird bei alten Menschen durch eine langdauernde Kreislauf- und Herzbehandlung erhöht. Die biologische Lebenserwartung wird dabei überschritten. Zahlreiche psychisch und neurologisch Kranke haben dagegen nach dem vorgelegten Sektionsgut eine relativ geringe Lebenserwartung, so daß sie im allgemeinen wenig emboliegefährdet sind.Die im eigenen Sektionsgut beobachtete Zunahme der Lungenembolien während der letzten Jahre braucht daher kein Ausdruck für eine gesteigerte Thrombosebereitschaft zu sein. Für das Entstehen einer Lungenembolie hatten eine Abmagerung des Körpers, das Vorkommen von Decubitalstellen, cerebrale oder extracerebrale Gewebszerstörungen, eine Dysregulation des Wasserhaushaltes, eine Korrelationsverschiebung der Serumeiweißkörper oder die Gabe von Psychosedativa keine nachweisbare Bedeutung. Als Quelle der Embolie war meistens eine schnell fortschreitende blande Fernthrombose der Oberschenkelvenen nachweisbar.     

Sonohysterography versus transvaginal sonography for screening of patients with abnormal uterine bleeding.

OBJECTIVES: To compare the accuracy of saline infusion sonohysterography (SIS) with transvaginal sonography (TVS) for the screening of causes of abnormal uterine bleeding (AUB) in out-patients. METHODS: 81 patients with AUB were studied. All cases who were examined with TVS, were further investigated with SIS using saline as contrast medium, finally hysteroscopy was used as the gold standard. RESULTS: TVS had sensitivity of 72%, specificity of 92%, positive predictive value of 94% and negative predictive value of 65%, while SIS had sensitivity of 94.1%, specificity of 95%, positive predictive value of 96% and negative predictive value of 90%. TVS had kappa measure of agreement of 0.60 while 0.86 was reported for SIS. CONCLUSIONS: In this study SIS was more sensitive and specific in diagnosing polyp, myoma and adenomyosis with high positive and negative predictive value. Furthermore, results obtained by SIS demonstrate more agreement with that obtained by hysteroscopy than TVS.     

Intramolecular interaction in the tail of Acanthamoeba myosin IC between the SH3 domain and a putative pleckstrin homology domain

The 466-aa tail of the heavy chain of Acanthamoeba myosin IC (AMIC) comprises an N-terminal 220-residue basic region (BR) followed by a 56-residue Gly/Pro/Ala-rich region (GPA1), a 55-residue Src homology 3 (SH3) domain, and a C-terminal 135-residue Gly/Pro/Ala-rich region (GPA2). Cryo-electron microscopy of AMIC had shown previously that the AMIC tail is folded back on itself, suggesting the possibility of interactions between its N- and C-terminal regions. We now show specific differences between the NMR spectrum of bacterially expressed full-length tail and the sum of the spectra of individually expressed BR and GPA1-SH3-GPA2 (GSG) regions. These results are indicative of interactions between the two subdomains in the full-length tail. From the NMR data, we could assign many of the residues in BR and GSG that are involved in these interactions. By combining homology modeling with the NMR data, we identify a putative pleckstrin homology (PH) domain within BR, and show that the PH domain interacts with the SH3 domain.     

Predicting the continuous values of breast cancer relapse time by type-2 fuzzy logic system

Microarray analysis and gene expression profile have been widely used in tumor classification, survival analysis and ER statues of breast cancer. Sample discrimination as well as identification of significant genes have been the focus of most previous studies. The aim of this research is to propose a fuzzy model to predict the relapse time of breast cancer by using breast cancer dataset published by van't Veer. Fuzzy rule mining based on support vector machine has been used in a hybrid method with rule pruning and shown its ability to divide the samples in many subgroups. To handle the existence of uncertainties in linguistic variables and fuzzy sets, the TSK model of Interval type-2 fuzzy logic system has been used and a new simple method is also developed to consider the uncertainties of the rules which have been optimized by genetic algorithm. B632 validation method is applied to estimate the error of the model. The results with 95 % confidence interval show a reasonable accuracy in prediction.