Large left atrial myxoma presented as fever of unknown origin: a challenging diagnosis and a review of the literature

Myxoma is the most common type of primary tumors of the heart in adults. The majority of patients with myxomas may experience symptoms due to central or peripheral embolism or intracardiac obstruction, while in some cases, they may be completely asymptomatic. Rarely, patients develop unusual symptoms that complicate the diagnostic evaluation. Herein, we describe the case of a 70-year-old patient with a long-lasting low-grade fever due to a large left atrial myxoma revealed during a transthoracic echocardiography.     

Inhibition of Amiodarone‐Induced Lung Fibrosis but not Alveolitis by Angiotensin System Antagonists

Abstract: Earlier work in this laboratory showed that amiodarone induces apoptosis in alveolar epithelial cells by a mechanism inhibitable by angiotensin system antagonists. A variety of recent studies suggests a critical role for alveolar epithelial cell apoptosis in the pathogenesis of lung fibrosis. On this basis we hypothesized that amiodarone‐induced alveolar epithelial cell apoptosis and lung fibrosis in vivo might be inhibitable by the angiotensin converting enzyme inhibitor captopril or the angiotensin receptor antagonist losartan. Amiodarone‐induced lung fibrosis was induced in male Wistar rats by oral adminstration over six months. Replicate groups of rats received captopril or losartan in addition to amiodarone. Apoptosis was detected by increased total lung activity of caspase 3 and in situ end labeling (ISEL) of fragmented DNA. Collagen was localized and quantitated by the picrosirius red technique. Alveolar epithelial cell apoptosis was detected in amiodarone‐treated animals as early as three weeks after the start of amiodarone administration; by six months exposure, the incidence of alveolar epithelial cell apoptosis was significantly reduced by coadministration of captopril or losartan. Alveolar wall collagen accumulation also was significantly attenuated by captopril (100%) or losartan (74%), but neither agent blunted the accumulation of alveolar macrophages evoked by amiodarone (5.3‐fold at 6 months). Lung neutrophil content was unchanged by amiodarone treatment for three weeks or six months. These results indicate that amiodarone induces alveolar epithelial cell apoptosis in vivo that is inhibitable by angiotensin antagonists. They also support the hypothesis that blockade of angiotensin formation or function attenuates amiodarone‐induced lung fibrosis irrespective of the severity of alveolitis.     

Predicting confrontation naming item difficulty

Background: Item response theory (IRT; Lord & Novick, 1968) is a psychometric framework that can be used to model the likelihood that an individual will respond correctly to an item. Using archival data (Mirman et al., 2010), Fergadiotis, Kellough, and Hula (2015) estimated difficulty parameters for the Philadelphia Naming Test (PNT; Roach, Schwartz, Martin, Grewal, & Brecher, 1996) using the 1-parameter logistic IRT model. Although the use of IRT in test development is advantageous, its reliance on sample sizes exceeding 200 participants make it difficult to implement in aphasiology. Therefore, alternate means of estimating the item difficulty of confrontation naming test items warrant investigation. In a preliminary study aimed at automatic item calibration, Swiderski, Fergadiotis, and Hula (2016) regressed the difficulty parameters from the PNT on word length, age of acquisition (Kuperman, Stadthagen-Gonzalez, & Brysbaert, 2012), lexical frequency as quantified by the Log10CD index (Brysbaert & New, 2009), and naming latency (Székely et al., 2003). Although the model's predictive utility was high, a substantial proportion (20%) of the response time data were missing. Further, only 39% of the picture stimuli from Székely and colleagues (2003) were identical to those on the PNT. Given that the IRT sample size requirements limit traditional calibration approaches in aphasiology and that the initial attempts in predicting IRT difficulty parameters in our pilot study were based on incomplete response time data this study has two specific aims.

Aims: To estimate naming latencies for the 175 items on the PNT, and assess the utility of psycholinguistic variables and naming latencies for predicting item difficulty.

Methods and Procedures: Using a speeded picture naming task we estimated mean naming latencies for the 175 items of the PNT in 44 cognitively healthy adults. We then re-estimated the model reported by Swiderski et al (2016) with the new naming latency data.

Outcomes and Results: The predictor variables described above accounted for a substantial proportion of the variance in the item difficulty parameters (Adj. R² = .692).

Conclusions: In this study we demonstrated that word length, age of acquisition, lexical frequency, and naming latency from neurotypical young adults usefully predict picture naming item difficulty in people with aphasia. These variables are readily available or easily obtained and the regression model reported may be useful for estimating confrontation naming item difficulty without the need for collection of response data from large samples of people with aphasia.     

Promotion and Prevention in Child,Adolescent and Young People Mental Health: The Greek Experience of Participation in the Mental Health Network Programme of the European Commission

In 1997 the European Commission established the Mental Health Promotion Network to seek out, disseminate and promote best practice in mental health promotion and the prevention of mental disorders. The Network has commissioned a number of projects including two projects addressing the promotion of mental health and prevention of mental disorders in children and adolescents. Anticipated results included the establishment of criteria to identify good practice, development of a European database of good practice and widespread dissemination of good practice that could be implemented throughout the Community. The paper discusses the involvement and experiences of the staff employed in one organisation, from Greece, who have participated in the work Network, and highlights some of the difficulties faced and lessons learnt from participation in a multi-national project.     

Long-term outcome of pneumatic dilation in the treatment of achalasia

OBJECTIVE: Achalasia is a well-defined esophageal motor disorder for which pneumatic dilation is an established therapeutic method. Even though it has been used for several years, there are limited data on the long-term outcomes of patients treated with this procedure. Hence, we aimed to evaluate the long-term efficacy of pneumatic dilation to control the symptoms of achalasia. METHODS: The medical records of all patients treated in our unit for achalasia with pneumatic dilation were reviewed. We identified the long-term result of the initial procedure, the date of the first dilation, and the time interval between dilation and retreatment. RESULTS: Of 260 patients who were treated with pneumatic dilation, 153 (67 men, 86 women) were followed up for more than 5 yr. The mean follow-up period was 11.09 +/- 3.91 yr, and the success rate of the dilation was 75.8%. Among these patients, 35 (19 men, 16 women) had follow-up periods of more than 15 yr. The mean follow-up time of those patients was 16.56 +/- 1.09 yr, and the success rate was 51.4%. Kaplan-Meier survival analysis showed that, overall, 50% of patients develop recurring symptoms after 10.92 yr. CONCLUSIONS: Although 51.4% of patients continued to be in clinical remission more than 15 yr after the initial pneumatic dilation, the long-term success rate of pneumatic dilation seems to drop progressively with time.     

Vasculitis beyond aortitis in IgG4-related disease (IgG4-RD): case report and review of the literature

Clinical Rheumatology - IgG4-related disease (IgG4-RD) can affect almost every tissue/organ. Vascular involvement in the setting of IgG4-RD is increasingly being recognized with most of the cases...     

Effects of endoscopic variceal treatment on oesophageal function: a prospective, randomized study

AIM : Endoscopic methods are currently the most widely used techniques for the treatment of bleeding oesophageal varices (BOV). However, a number of complications may limit their usefulness. We conducted a prospective, randomized comparison of variceal ligation versus sclerotherapy in cirrhotics after the control of variceal haemorrhage to study the relative short-term risks of these two procedures with respect to oesophageal motility and gastro-oesophageal reflux. METHODS : Seventy-three patients with established cirrhosis and an episode of variceal bleeding controlled by one session of endoscopic therapy were randomized to treatment with sclerotherapy or ligation until variceal eradication. In 60 of these patients, oesophageal manometry and 24-h intra-oesophageal pH monitoring were performed at inclusion and 1 month after variceal eradication. RESULTS : After variceal eradication with sclerotherapy, peristaltic wave amplitude decreased from 76.2 +/- 14.7 mmHg to 61.6 +/- 17.7 mmHg (P = 0.0001), simultaneous contractions increased from 0% to 37.9% (P = 0.0008), and the percentage of time with pH < 4 increased from 1.60 +/- 0.25 to 4.91 +/- 1.16% in channel 1 (P = 0.0002) and from 1.82 +/- 0.27 to 5.69 +/- 1.37% in channel 2 (P = 0.0006). In contrast, the above parameters were not disturbed with ligation. CONCLUSION : Our data define the advantages of ligation over sclerotherapy with respect to post-treatment oesophageal dysmotility and associated gastro-oesophageal reflux.     

Postbiopsy intramural hematoma of the duodenum in an adult with Noonan's syndrome

Intramural duodenal hematoma is a rare complication of endoscopic biopsy. It is usually seen in children with growth failure and in patients with bleeding disorders or who are anticoagulated. It is frequently associated with acute pancreatitis. We present a case of an adult patient with Noonan's syndrome who developed postbiopsy intraduodenal hematoma. Abdominal ultrasound and computed tomography scan established the diagnosis. Conservative treatment was successful. According to a brief review of the literature, patients with Noonan's syndrome may develop hematoma after sampling of the duodenum because they present all the main predisposing factors. Additionally, pulmonic valve stenosis may be another predisposing factor, but this may warrant further investigation.