Fatal hepatic hemorrhage by peliosis hepatis in X-linked myotubular myopathy: a case report

We report a 5-year-old boy with X-linked myotubular myopathy complicated by peliosis hepatis. At birth, he was affected with marked generalized muscle hypotonia and weakness, which required permanent ventilatory support, and was bedridden for life. He died of acute fatal hepatic hemorrhage after using a mechanical in-exsufflator. Peliosis hepatis, defined as multiple, variable-sized, cystic blood-filled spaces through the liver parenchyma, was confirmed by autopsy. To avoid fatal hepatic hemorrhage by peliosis hepatis, routine hepatic function tests and abdominal imaging tests should be performed for patients with X-linked myotubular myopathy, especially at the time of using artificial respiration.

Difference of clinical course after catheter ablation of atrioventricular nodal reentrant tachycardia between younger and older patients: atrial vulnerability predicts new onset of atrial fibrillation

BACKGROUND

The aim of this study was to compare the long-term procedural outcomes, the stability of atrioventricular conduction, and the new onset of atrial fibrillation (AF), after ablation of atrioventricular nodal reentrant tachycardia (AVNRT).

METHODS AND RESULTS

Consecutive patients with AVNRT (n=109), who underwent slow-pathway ablation, were divided into two groups based on the median age of the studied patients: the younger group aged <55 years and the older group aged ≥55 years. During a mean follow-up period of 60.6 months, the rate of change in the PR interval from before ablation to follow-up was significantly greater in older patients compared with younger patients. However, there was no delayed-onset high-degree AV block during follow-up in either group. No patients in the younger group suffered from persistent AF, whereas persistent AF occurred in 5/54 (9.3%) older patients. Multivariate Cox analysis revealed that atrial vulnerability, with induction of AF during the electrophysiological study, was the only predictor of the development of AF (Hazard ratio: 13.9, 95% confidence interval: 1.62-119.2, p<0.01).

CONCLUSION

Slow-pathway ablation of AVNRT is a reliable strategy even in older patients. However, physicians should consider regular long-term follow-up of older patients with atrial vulnerability, in order to assess the subsequent development of AF.

[Prognosis of type A acute aortic dissection treated conservatively]

We examined 58 cases of type A acute aortic dissection treated from 2003 to 2005 in our hospital. Thirty-three patients were treated surgically and 25 patients were treated conservatively. Among the 25 patients treated conservatively, 13 patients had open false lumen, and were eligible for surgical therapy. Surgical therapy was abandoned however, for various reasons (stroke, advanced age, malignancy, renal disease, lung disease, or patient's reject). Thirteen patients (52%) treated conservatively died while only 1 patient (3%) treated surgically died. Patients with thrombosed false lumen had good prognosis while those with open false lumen or ischemic complication had poor prognosis. It is concluded that patients with thrombosed false lumen of type A acute aortic dissection could receive conservative therapy with surgical team's back up and close computed tomography (CT) follow up to detect recanalization and enlargement of the aorta.

Component analysis of HPLC profiles of unique lipoprotein subclass cholesterols for detection of coronary artery disease

BACKGROUND

Patients with coronary artery disease (CAD) are known to have several lipoprotein abnormalities. We examined plasma cholesterol concentrations of major lipoproteins and their subclasses, using a gel permeation HPLC, to establish an association between a lipoprotein subclass pattern and the presence of CAD.

METHODS

We performed a simple and fully automated HPLC, followed by mathematical treatment on chromatograms, for measuring cholesterol concentrations of major lipoproteins and their subclasses in 62 male patients (45 with CAD and 17 controls without CAD) who underwent cardiac catheterization.

RESULTS

For major lipoprotein classes, the patient group had a significantly (P<0.05) higher LDL-cholesterol (LDL-C) and lower HDL-cholesterol (HDL-C), but no difference in VLDL-cholesterol (VLDL-C) concentrations. For lipoprotein subclasses, the patient group had a significantly higher small VLDL-C (mean particle diameter of 31.3 nm, P<0.001), small LDL-C (23.0 nm, P<0.05), and very small LDL-C (16.7-20.7 nm, P<0.001), but a significantly lower large HDL-C (12.1 nm, P<0.001) concentrations. Combined variables of "small VLDL-C+small LDL-C+very small LDL-C-large HDL-C" differentiated the patient from the control group more clearly than single-subclass measurements or calculated traditional lipid markers.

CONCLUSIONS

These results suggest the usefulness of multiple and simultaneous subclass analysis of proatherogenic and antiatherogenic lipoproteins and indicate that HPLC and its component analysis can be used for easy detection and evaluation of abnormal distribution of lipoprotein subclasses associated with CAD.

Cystatin C, a novel measure of renal function, is an independent predictor of cardiac events in patients with heart failure

BACKGROUND

Cystatin C, a novel endogenous marker of glomerular filtration rate, has been reported as more sensitive to detect renal insufficiency than creatinine. The purpose of the present study was to examine the clinical significance of serum cystatin C level in patients with mild to moderate heart failure.

METHODS AND RESULTS

Serum levels of cystatin C were measured by an enzyme immunoassay in 140 patients with heart failure and 64 control subjects without heart failure. Patients were prospectively followed during a median follow-up period of 480 days, with the end points of cardiac death and progressive heart failure requiring rehospitalization. Serum levels of cystatin C were higher in patients with heart failure than in control subjects (1.14 +/- 0.60 ng/mL versus 0.72 +/- 0.14 ng/mL, P < .001). The Cox multivariate proportional hazard analysis revealed that a change of 1 standard deviation (SD) in cystatin C level was the one of independent predictor for cardiac events (hazard ratio, 1.94; 95% confidence interval, 1.29-6.64; P < .01). The cardiac event rate was markedly higher in patients with elevated cystatin C level (> or =1.0 ng/mL) than in those with normal level (< or =1.0 ng/mL) (38.7% versus 10.3%, P < 0.001). Furthermore in patients with normal creatinine levels (n = 91), the cardiac event rate was similarly higher in patients with elevated cystatin C than in those with normal levels (29.2% versus 7.5%, P = .002).

CONCLUSION

Elevation of serum cystatin C, a new marker of renal function, provides promising prognostic information for clinical outcome in patients with mild to moderate heart failure.

Serum heart-type fatty acid binding protein predicts cardiac events in elderly patients with chronic heart failure

BACKGROUND AND OBJECTIVES

Heart-type fatty acid binding protein (H-FABP) is released into the circulation from the damaged myocardium of patients with severe chronic heart failure. Chronic heart failure is the most frequent cause of death and disability in the elderly. However, there are no data for the prognostic value of H-FABP in the elderly population. This study investigated whether H-FABP can effectively predict the prognosis in elderly patients (> or = 70 years) with chronic heart failure.

METHODS

Serum H-FABP levels were measured in 90 chronic heart failure patients > or =70 years old (mean age 77 +/- 4 years, range 70-92 years), and patients were followed-up for 421 +/- 326 days.

RESULTS

There were 35 cardiac events (38.9%) including cardiac deaths and readmissions for worsening chronic heart failure. Multivariate analysis with the Cox proportional hazard model showed that H-FABP was the only independent predictor of cardiac events (chi2 = 6.640, p = 0.0100). Kaplan-Meier analysis revealed that H-FABP effectively risk stratified elderly patients with chronic heart failure for cardiac events.

CONCLUSIONS

These findings suggest that H-FABP is a reliable marker for prognosis in elderly patients with chronic heart failure.

Prognostic value of elevated circulating heart-type fatty acid binding protein in patients with congestive heart failure

BACKGROUND

Heart-type fatty acid binding protein (H-FABP) is released into the circulation when the myocardium is injured and is a novel marker for the diagnosis of acute myocardial infarction. The purpose of the present study was to examine the clinical significance of increased serum H-FABP levels in patients with congestive heart failure.

METHODS AND RESULTS

Serum levels of H-FABP were measured in 179 patients admitted with congestive heart failure and 20 age-matched normal controls by using a sandwich enzyme-linked immunosorbent assay. Patients were prospectively followed during a mean follow-up period of 20 months with the end points of cardiac death and progressive heart failure requiring rehospitalization. Serum levels of H-FABP were higher in patients with congestive heart failure than in control subjects (5.7 +/- 4.8 ng/mL versus 2.7 +/- 0.8 ng/mL, P < .01) and increased with advancing NYHA class (P < .01). The cardiac event rate was markedly higher in patients with elevated H-FABP levels than in those with normal levels (43% versus 7%, P < .0001). Furthermore, the Cox multivariate proportional hazard analysis revealed that the elevated H-FABP level was the only independent predictor for cardiac events (chi2= 7.397, P < .01).

CONCLUSIONS

Elevation of H-FABP indicates latent and ongoing cardiomyocyte damage and identifies patients at high risk for future cardiac events in congestive heart failure.

Changes in circulating blood volume following isoflurane or sevoflurane anesthesia

Changes of circulating blood volume (CB volume) measured by the dual indicator dilution method were observed in 33 chronically instrumented mongrel dogs following either alpha-chloralose-urethane (C group), additive isoflurane (I group) or sevoflurane anesthesia (S group). These anesthetic groups were each divided into two subgroups with regard to respiratory care, namely Cp, Ip and Sp for those with intermittent positive pressure ventilation (six animals per subgroups), and Cs, Is and Ss for those with spontaneous breathing (five animals per subgroups). The CB volume under positive pressure ventilation remained unchanged in the Ip and Sp groups at both 0.5 and 1.0 MAC, and in the Cp group. The CB volume remained essentially unchanged in the Cs and Is groups at both 0.5 or 1.0 MAC, but the plasma volume tended to increase slightly in the Is group at 1.0 MAC. In the Ss group under spontaneous breathing, however, the CB volume increased from 84.4 +/- 7.0 to 91.4 +/- 7.7 at 0.5 MAC, and to 91.4 +/- 10.2 ml.kg(-1) at 1.0 MAC (0.01 < P < 0.05). These increases were caused by an increase in the plasma volume. The above data suggests that a concomitant increase in the venous pressure associated with an increase in the intrathoracic pressure produced by positive pressure ventilation would attenuate changes in the CB volume during sevoflurane anesthesia.