Rapid identification of atypical variant of plasma butyrylcholinesterase by PCR.

Human butyrylcholinesterase is the enzyme responsible of mivacurium and succinylcholine metabolism, which may be significantly impaired when mutation Asp70Gly is found in patients. We describe a simple PCR method for the detection of this variant. Thirteen out of sixteen patients tested after prolonged apnea were positive for the presence of this mutation (50.0% homozygotes and 31.3% heterozygotes), suggesting that this test contributes to the explanation of some clinical events and to their prevention in relatives of these patients.     

Myocarditis and heart failure: need for better diagnostic, predictive, and therapeutic tools.

Viral infection of the heart is increasingly recognized as animportant cause of both acute and chronic heart failure. Enterovirusesand adenoviruses have been considered the most common pathogensof viral cardiomyopathy (CMP), but parvovirus B19 (PVB19) isincreasingly found in endomyocardial biopsies of patients withacute myocarditis or idiopathic dilated cardiomyopathy (ICM).^1,2In addition to direct cytopathic effects of these cardiotropicviruses, there is convincing evidence that autoimmune responsesinduced by viruses contribute to the heart disease in a significantsubset of patients with myocarditis.³ Caforio et al.⁴ present a prospective study in 174 consecutivepatients with myocarditis included between 1992 and 2005.     

Noninvasive tests for arterial structure, function, and compliance: do they identify risk or diagnose disease?

BACKGROUND: Brachial artery reactivity (BAR), carotid intima-media thickness (IMT), and applanation tonometry for evaluation of total arterial compliance may provide information about preclinical vascular disease. We sought to determine whether these tests could be used to identify patients with coronary artery disease (CAD) without being influenced by their ability to identify those at risk for CAD developing. METHODS: We studied 100 patients and compared 3 groups: 35 patients with known CAD; 34 patients with symptoms and risk factors but no CAD identified by stress echocardiography (risk group); and 31 control subjects. BAR and IMT were measured using standard methods, and total arterial compliance was calculated by the pulse-pressure method from simultaneous radial applanation tonometry and pulsed wave Doppler of the left ventricular outflow. Ischemia was identified as a new or worsening wall-motion abnormality induced by stress. RESULTS: In a comparison between the control subjects and patients either at risk for developing CAD or with CAD, the predictors of risk for CAD were: age (P =.01); smoking history (P =.002); hypercholesterolemia (P =.002); and hypertension (P =.004) (model R = 0.82; P =.0001). The independent predictors of CAD were: IMT (P =.001); BAR (P =.04); sex (P =.005); and hypertension (P =.005) (model R = 0.80; P =.0001). CONCLUSION: IMT, BAR, and traditional cardiovascular risk factors appear to identify patients at risk for CAD developing. However, only IMT was significantly different between patients at risk for developing CAD and those with overt CAD.     

High-resolution imaging of progressive articular cartilage degeneration.

The objective of this study was to develop and verify a new technique for monitoring the progression of osteoarthritis (OA) by combining a rat model with the imaging modality optical coherence tomography (OCT). Time-sequential, in vivo, OCT imaging was performed on the left femoral condyles of 12 Wistar rats following sodium-iodoacetic acid-induced OA progression. The right femoral condyles (untreated) were also imaged and served as controls. Imaging was performed on days 0, 10, 20, 30, and 60 with an OCT system capable of acquiring images at four frames per second and an axial resolution of 5 microm. Progressive changes were analyzed using an OA scoring system. OCT successfully identified progressive cartilage degeneration as well as alteration of the cartilage/bone interface. Significant changes to both of these structures were observed in the sodium-iodoacetic acid-injected condyles. Structural changes detected with OCT were confirmed histologically. OCT in combination with a well-known model used in arthritis research represents a powerful tool for following degenerative joint disease progression in a given animal by detecting changes to the cartilage/bone interface and articular cartilage.     

The Intubation Difficulty Scale (IDS): Proposal and Evaluation of a New Score Characterizing the Complexity of Endotracheal Intubation

Background: A quantitative scale of intubation difficulty would be useful for objectively comparing the complexity of endotracheal intubations. The authors have developed a quantitative score that can be used to evaluate intubating conditions and techniques with the aim of determining the relative values predictive factors of intubation difficulty and of the techniques used to decrease such difficulties.

Methods: An Intubation Difficulty Scale (IDS) was developed, based on parameters known to be associated with difficult intubation. It was then evaluated prospectively in a group of 311 consecutive prehospital intubations and 315 intubations in an operating room. In the operating room, the IDS was compared with two other parameters: the time to completion of intubation and the visual analog scale (VAS). Time was measured by an independent observer. Operators in both groups completed a checklist regarding the conditions of intubation.

Results: There is a good correlation between the IDS scale and the VAS assessment of difficulty and time to completion of intubation. VAS and time to completion have a significant but lesser correlation to each other. Comparison of IDS with operator-assessed subjective categorical impression of difficulty by Kruskall-Wallis was statistically significant.     

An unusual case of sundown syndrome subsequent to a traumatic head injury

An unusual case of sundown syndrome is here reported, in which a bilingual patient would involuntarily change languages at sunset. Numerous theories have been advanced in attempting to account for sundowning. Cameron [1] has suggested that nocturnal delirium was based on an inability to maintain a spatial image without the assistance of repeated visualization. Krai [2] and Wolanin and Phillips [3] have argued for a more psychogenic account, by stating that psychosocial stressors may, in concert with impaired cognitive functioning, account for sundowning. The present case concerns a 42-year-old white male who in January 1989 suffered a closed head injury. A thorough personal history as well as a detailed examination of the patient's daily activities allowed us to account for the unusual manner in which the sundowning manifested itself. The uniqueness of this case allows us to underscore both the psychological as well as environmental and neurological factors involved in sundowning. Thus, we have as a consequence been able to synthesize the seemingly disparate accounts of both Cameron and more recent published literature [2, 3].     

Cardiac hemangioma presenting as atypical chest pain.

A 44-year-old man presented with atypical chest pain and dyspnea. Investigation revealed the presence of a 15-mm rounded, well-vascularized left-ventricular mass. The mass was removed surgically and histopathologic evaluation identified a cardiac hemangioma.     

Annexin A5 and the failing heart; lost or found in translation?

Heart failure is the number one reason for hospital admissionin patients above 65 years of age. It is predicted that thenumber of heart failure patients will almost double in the next20 years. Ischaemic and hypertensive heart disease are the majorcauses of this disabling disease. Approximately 22% of womenand 46% of men who have had a myocardial infarction will developheart failure within 6 years.¹ Still, hypertension is a chiefcause of cardiac failure: diastolic dysfunction accounts for>50% of all heart failure patients.² In the world we livein, an increasing number of people become at risk of developinghypertension heart