Concurrent occurrence of three primary neoplasms with different hystotype in the same kidney, associated with an adenoma of the omolateral adrenal gland: First case report

We present an unusual case of concurrent occurrence of three synchronous primary tumors in the same kidney (oncocytoma, chromophobe renal cell carcinoma, angiomyolipoma) associated to an adenoma of the omolateral adrenal gland in a patient with no evident clinical symptoms. The immunohistochemistry showed a positivity for KIT in oncocytoma and chromophobe cell carcinoma, and a weak positivity in the angiomyolipoma, only in the cells positive for HMB-45. This is the first report of this kind of presentation.     

Reproducibility of Doppler indices of left ventricular systolic and diastolic function in patients with severe chronic heart failure

Doppler ultrasound has been utilized to evaluate cardiac outputand left ventricular filling pressure in patients with variouscardiac diseases. This method would be particularly useful fornon-invasive haemodynamic monitoring in patients with severechronic heart failure. However, few data exist on the reproducibilityof Doppler indices in this population. To determine the magnitudeof technical and biological variability of Doppler indices,serial Doppler echocardiographic studies were performed in 26patients with severe heart failure in the usual clinical setting.Short-term intra- and inter-observer, mid-term and day-to-dayvariabilities of stroke volume, cardiac output, maximal earlyand late diastolic velocities of mitral flow, rate of decreaseand deceleration time of flow velocity in early diastole andthe colour Doppler area of the mitral regurgitant jet were evaluatedby two cardiologists. For each source of variability, correlationcoefficients with standard errors and mean differences betweenpaired determinations with their standard deviations were calculated.Short-term (intra- and inter-observer) variability was smallfor each considered variable: the mean differences of measurementswere within 10% of the mean value for most parameters and nosystematic error was found. Stroke volume and cardiac outputshowed a significant increase in the afternoon. The standarddeviations of differences between day-to-day measurements were41 ml (9% of the mean value) and 39 ml (11% of the mean value),respectively. Doppler indices assessing diastolic filling andcolour Doppler area of mitral regurgitant jet showed greatervariations on a mid-term and day-to-day basis. ‘Spontaneous’shifts from a predominant early diastolic velocity to a predominantlate diastolic velocity mitral flow pattern were observed infour patients with coronary artery disease and less compromisedleft ventricular ejection fraction. We conclude that, in patients with severe heart failure, Dopplermeasurements have a good short-term intra- and inter-observerreproducibility and, therefore, may be suitable for assessingacute interventions. For systolic indices, day-to-day variabilitywas also fairly small, provided that a rigorous—but practicablyobtainable—methodology is used. The relatively large mid-termand day-to-day variability of diastolic variables, observedin less compromised patients, should be considered when serialDoppler studies are performed.     

Two-dimensional echocardiographic assessment of anticoagulant therapy in left ventricular thrombosis early after acute myocardial infarction

This study was designed to assess, by two-dimensional echocardiography,the effects of anticoagulant therapy on left ventricular thrombosisdetected after acute myocardial infarction. Thirty-eight patientswith left ventricular thrombi detected by two-dimensional echocardiologywithin 5 weeks (mean 4) of the onset of infarction were randomlyassigned to the following groups: group A consisted of 19 patientswho received oral anticoagulants (acenocoumarin 1.6 mg dailyregulated to keep prothrombin time within the range of 25 to35%) and group B which consisted of 19 non-treated control patients.Seventeen patients from both groups were restudied 15 days,3 months and one year later to evaluate the changes in sizeof thrombi. Echocardiographic examinations were read blindly;a significant decrease in ventricular thrombus size was takenas a 5 mm reduction of thickness in the apical views. In Group A, 9 patients showed a complete resolution of thrombusat the 15 day study; at one year, thrombus had resolved in 15and persisted unchanged in size in 2 patients. The mean dimensionof thrombi in patients of group A was 18±6.6 mm at thescreening examination and decreased to 6.6mm, 3.8mm and 2.2mm,respectively, at 15 days, 3 months and one year follow-up studies.Among 17 patients of group B at the 15 day study, two had resolutionof thrombus and 15 were unchanged; at the one year examinationthrombus was resolved in 4, decreased in size in 4 and persistedunchanged in 9 patients. Analysis of variance of the dimensionalchanges of thrombi in the two groups of patients confirmed asignificant efficacy of anticoagulant therapy (P<0.001). On the basis of our results we conclude that full-dose anticoagulanttherapy, started early (within 5 weeks) after acute myocardialinfarction, is effective in the resolution of left ventricularthrombosis.     

Assessment of interferon cardiotoxicity with quantitative radionuclide angiocardiography

Abstract. Three different types of cardiovascular sequelae attributed to interferon therapy have been reported: arrhythmia, ischaemic heart disease and cardiomyopathy. We evaluated the left ventricular ejection fraction (LVEF) during alpha interferon therapy (3 MU administered subcutaneously three times a week for 6 months) in 11 patients with chronic viral hepatitis. LVEF was within the normal range in all patients (mean value ± SD 64.6 ± 10.7%) before interferon was started, but decreased after 1 month of therapy (mean value± SD 59.7 ± 8.3%) ( P = 0.015). An LVEF reduction of more than 10% was observed in five of the 11 patients. Three months after therapy was stopped, nine of the 11 patients showed an LVEF close to the pre-treatment level (mean value ± SD 62.1 ± 8.3%). In our patients with chronic C hepatitis, low subcutaneous doses of interferon alpha often decreased the LVEF. It is not clear whether this finding is due to the direct effect of interferon on cardiac cells, or to the peripheral vascular effects of the drug. As LVEF reduction could be critical in patients with previously reduced myocardial contractility, our results further highlight the need for careful cardiac analysis before starting interferon therapy.