Splenectomy and chronic thromboembolic pulmonary hypertension

BACKGROUND

An increased prevalence of splenectomy has been reported in patients with idiopathic pulmonary arterial hypertension. Examination of small pulmonary arteries from these subjects has revealed multiple thrombotic lesions, suggesting that thrombosis may contribute to this condition. Based on these findings, we hypothesised that splenectomy could be a risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), a condition defined by the absence of thrombus resolution after acute pulmonary embolism that causes sustained obstruction of the pulmonary arteries and subsequent pulmonary hypertension.

METHODS

The medical history, clinical characteristics, thrombotic risk factors and haemodynamics of 257 patients referred for CTEPH between 1989 and 1999 were reviewed. In a case-control study the prevalence of splenectomy in patients with CTEPH was compared with that of patients evaluated during the same period for idiopathic pulmonary hypertension (n=276) or for lung transplantation in other chronic pulmonary conditions (n=180).

RESULTS

In patients with CTEPH, 8.6% (95% CI 5.2 to 12.0) had a history of splenectomy compared with 2.5% (95% CI 0.7 to 4.4) and 0.56% (95% CI 0 to 1.6) in cases of idiopathic pulmonary arterial hypertension and other chronic pulmonary conditions, respectively (p<0.01).

CONCLUSION

Splenectomy may be a risk factor for chronic thromboembolic pulmonary hypertension.

Pulmonary artery distensibility in pulmonary arterial hypertension: an MRI pilot study

Pulmonary arterial hypertension (PAH) is a disease of the small vessels in which there is a substantial increase in pulmonary vascular resistance leading to right ventricle failure and death. Invasive haemodynamic evaluation is mandatory not only for diagnosis confirmation but also to address prognosis and eligibility for the use of calcium-channel blockers through an acute vasodilator challenge. Noninvasive surrogate response markers to the acute vasodilator test have been sought. In the present study, the relationship between pulmonary artery distensibility, assessed using magnetic resonance imaging (MRI), and response to acute vasodilator tests was investigated. In total, 19 patients diagnosed with idiopathic PAH without any specific treatment were evaluated. Within a 48-h window after pulmonary artery catheterisation, patients underwent cardiac MRI. Cardiac index, calculated after the determination (invasively and noninvasively) of cardiac output, showed excellent correlation, as did right atrial pressure and right ventricle ejection fraction. Pulmonary artery distensibility was significantly higher in responders. A receiver operating characteristic curve analysis has shown that 10% distensibility was able to differentiate responders from nonresponders with 100% sensitivity and 56% specificity. The present findings suggest that magnetic resonance imaging and pulmonary artery distensibility may be useful noninvasive tools for the evaluation of patients with pulmonary hypertension.

N-terminal-pro-brain natriuretic peptide as a haemodynamic marker in idiopathic pulmonary arterial hypertension

Patients with idiopathic pulmonary arterial hypertension usually undergo acute vasodilator tests with nitric oxide (NO) for haemodynamic evaluation and therapeutical planning. The aim of this study was to evaluate the link between the variation of N-terminal (NT)-pro-brain natriuretic peptide (BNP) levels and haemodynamic parameters during the acute vasodilator test. A total of 22 idiopathic pulmonary arterial hypertension patients who underwent acute vasodilator tests were studied. Blood samples were collected at baseline and after 30 and 60 min of NO inhalation. NT-pro-BNP levels were measured in each sample. A receiver-operating characteristic curve was used to evaluate the capability of the NT-pro-BNP level variation during NO inhalation in recognising nonresponders. To distinguish responders from nonresponders, the increase of the NT-pro-BNP (0% as cut-off value) determined a 50% specificity and 100% sensitivity (positive predictive value of 38% and a negative predictive value of 100%). These results suggest that N-terminal-pro-brain natriuretic peptide was able to distinguish nonresponder patients with the acute vasodilator test. N-terminal-pro-brain natriuretic peptide may be an interesting additional biological tool in the evaluation of idiopathic pulmonary arterial hypertension patients.

Clinical response to sildenafil in pulmonary hypertension associated with Gaucher disease

There are few reports of pulmonary hypertension in Gaucher disease. We report a patient who showed significant clinical improvement after treatment with sildenafil.

Effect of sitaxsentan treatment on quality of life in pulmonary arterial hypertension

In recent years new therapeutic options have been developed for the management of pulmonary arterial hypertension (PAH). Sitaxsentan is an oral, once daily, highly selective endothelin A receptor antagonist that recently demonstrated a positive effect on functional capacity and haemodynamics of PAH patients. The aim of this study is to evaluate the effect of sitaxsentan in the quality of life (QOL) of PAH patients. Twenty-three patients with idiopathic PAH or PAH associated to collagen vascular diseases were evaluated at baseline and after 16 weeks of treatment with sitaxsentan 100 mg orally, once daily. 6-min walk test distance (6MWD) and QOL questionnaire (QOLQ) (SF-36) were obtained at baseline and at week 16. There was a significant improvement in functional capacity evaluated by 6MWD (472 m vs. 490 m, p = 0.03) and also in the physical component of the QOLQ (p < 0.01). Evaluating each of the domains of the SF-36 QOLQ, those more related to physical capacity presented a significant increase while the domains related to the mental component presented a trend of improvement, without reaching statistical significance. Sitaxsentan improves QOL in patients with PAH mainly through the domains related to functional capacity.

Chronic use of benzodiazepines and cognitive deficit complaints: a risk factor study

Benzodiazepines produce an anterograde amnesia after acute administration but whether their chronic use is hazardous to memory processes remains unclear. The present study analyses the risk of increasing cognitive complaints with chronic benzodiazepine use. Subjects seeking medical assistance at the General Internal Medicine Outpatient Clinic of Hospital de Clinicas de Porto Alegre, were interviewed before seeing physicians. They were asked about use of benzodiazepines, history of neurological and psychiatric diseases, use of alcohol, and deficits in remembering and learning as well as age, sex and level of education. Age (over 51 years), low level of education, a history of neurological and psychiatric diseases and use of benzodiazepines showed significant associations with cognitive complaints. After a conditional logistic regression analysis, benzodiazepine use lost its association with memory complaints. These data support the hypothesis that the chronic use of benzodiazepines does not carry a risk for cognitive deficits complaints.

Biometria e parâmetros hematológicos em tartarugas da Amazônia de um criatório comercial de Rio Branco/AC

RESUMO Com o objetivo de definir os valores biométricos e quantificar parâmetros hematológicos como hematócrito, concentração de proteínas plasmáticas totais e leucócitos totais de tartarugas da espécie Podocnemis expansa, coletou-se um mililitro de sangue da veia femoral de 60 exemplares aparentemente saudáveis. Os animais obtidos do criatório particular, Estância Terra, localizado no estado do Acre, foram classificados em seis grupos de pesos diferentes. Durante a biometria, foram tomadas medidas de peso, comprimento e largura da carapaça e do plastrão, para as análises da correlação dos parâmetros de tamanho e massa corporal entre os indivíduos do mesmo grupo. Os valores observados indicaram que o grupo 06, que inclui os animais com massa acima de 26 kg, apresentou melhor correlação entre as massas individuais de cada animal (r = 0,97) Enquanto que, o grupo 02 (massa entre 21 e 25 kg) apresentou a pior correlação entre as massas (r = 0,34). O resultado da média total de hematócrito de todos os animais deste experimento foi de 10,56%. A concentração das proteínas plasmáticas totais foi de 3,69g dL-1, e a média de leucócitos totais foi de 51466,66µL. Estes parâmetros são considerados fora do padrão quando comparados com os valores encontrados em animais saudáveis da mesma espécie. Assim, este trabalho pode contribuir com informações sobre os dados biométricos e parâmetros hematológicos de P. expansa de cativeiro e demonstra a importância do monitoramento da sanidade dos animais em cativeiro, prevenindo manifestação de enfermidades que poderão pôr em risco a saúde de todo o plantel.

Neoplastic pulmonary lymphangitis: Symptomatic treatment and quality-of-life evaluation in a prospective palliative care series

19536

Background: Neoplastic lymphangitis, or lymphangitis carcinomatosa, is a rare and distressing form of lung metastasis, for which symptom improvement is strongly necessary. Since measuring quality of life is an important step toward improving symptom management in cancer patients, and dyspnea in pulmonary lymphangitis is a complex syndrome in end-of-life care, we focused on evaluating a cohort of those individuals. Methods: 52 consecutive patients with neoplastic pulmonary lymphangitis (NPL) were prospectivelly followed in 3 services, with quality of life (QoL) evaluation also, using Medical Outcomes Study 36-item Short-Form Health Survey (SF- 36) and Saint George's Respiratory Questionnaire (SGRQ). Results: 65% (34) of patients were female; age ranged from 37 to 84 years (median: 60). Primary tumor sites were: 28 lung (54%), 18 breast (35%), 5 digestive (9%) and 1 bone cancer. Histological findings were of adenocarcinoma in most cases (71%). Karnofsky performance scale ranged from 10 to 90% (median: 60%); 52% (27) patients had other comorbidities (Charlson index ranged from 6–10; median 7); 48% (25) were previous smokers; hemoglobin levels ranged from 4.9 to 16.7 g/dL (median: 12). We also evaluated 33 patients with echocardiography, and 13 (43%) of them had signs of associated pulmonary hypertension; ejection fraction ranged from 46 to 83% (median: 69%); diastolic dysfunction was present in 22 and pericardial effusion in 10 patients. At accrual, median QoL scores were of: 32% (range: 0–84%) for SF-36 (scale with 0 worst) and 66% (range: 0–100%) for SGRQ (scale with 100% worst). Treatment is showed in a table below. Median survival was of 4 months (range: 0.2–40+ months); 22 (42%) of the patients had an unusual longer survival of more than 6 months, still showing good QoL scores. Conclusions: Despite the fact that QoL is generally poor and survival is short for patients with NPL, some patients may have longer survival time and some improvement is possible with active palliative care.

[Table: see text]

No significant financial relationships to disclose.

Molecular epidemiology of human T-cell leukemia virus type I (HTLV-1) Brazil: the predominant HTLV-1s in South America differ from HTLV-ls of Japan and Africa, as well as those of Japanese immigrants and their relatives in Brazil

To better understand the origin of human T-cell leukemia virus type l (HTLV-l) in South America, we conducted a phylogenetic study on 27 new HTLV-ls in Brazil. These were obtained from Brazilians of various ethnic origins, such as Japanese immigrants, whites, blacks and mulattos. We amplified and sequenced proviral DNAs of a part of the long terminal repeats. Phylogenetic trees revealed that all but 6 of the new isolates were not only similar to each other but also similar to HTLV-ls of other South American countries, including those from Amerindians. However, the isolates differed from the HTLV-ls of Africa and Japan. The other six isolates were from Japanese immigrants and were phylogenetically almost identical to HTLV-ls in Japan but different from the majority of South American HTLV-ls, including the other new Brazilian HTLV-ls. These findings indicate that the recent introduction of HTLV-1 from Japan is limited to Japanese immigrants. In addition, the results do not support the prevailing hypothesis that HTLV-ls in South America were introduced by blacks who were brought from Africa as slaves. Rather, these results suggest that the majority of HTLV-1s prevailing in South America have spread from Amerindians, some of whom are likely to have possessed this human retrovirus from the beginning of their settlement in South America.