Aggressive Diagnosis Research Articles

Blunt Carotid Artery Injury: The Futility of Aggressive Screening and Diagnosis

Blunt Carotid Artery Injury: The Futility of Aggressive Screening and Diagnosis

Diagnosing pulmonary embolism: Experience with spiral CT pulmonary angiography in gynecologic oncology

Objectives. To review our experience with the diagnosis and prognosis of pulmonary embolism (PE) in gynecologic oncology patients. Methods. Spiral CT pulmonary angiography (CTPA) studies on gynecologic oncology patients were collected from our radiology database from 6/2001 to 6/2003. Patient charts were retrospectively reviewed. Data were abstracted relative to presenting symptoms, demographics and laboratory and diagnostic evaluations. Patient data were compared using chi-square contingency tables and logistic regression analysis. Survival was studied using the Kaplan–Meier method and the log rank test. The effect of PE on survival was adjusted using a proportional hazards regression model. Results. One-hundred and eleven CTPA studies were performed over 2 years and 25 patients were diagnosed with PE. Both PE ( n = 25) and non-PE ( n = 86) groups were similar for age, race, BMI and cancer diagnosis. Tachycardia ( P = 0.02, OR = 3.03 [95% CI 1.16–7.94]) and leukocytosis ( P = 0.04, OR = 2.93[95% CI 1.05–8.18]) were more frequent among PE patients and confirmed as independently prognostic of PE. All other clinical and laboratory findings were similar between patients with and without PE. Overall survival for patients with and without PE was 63% versus 94%, respectively, at 2 years ( P = 0.02). Conclusion. In a gynecologic oncology patient with high clinical suspicion for PE, our clinical pre-test probability was 23.0%. Two-year mortality rates were 6-fold higher for patients diagnosed with PE. The significant overlap in clinical presentations, multiple risk factors and higher mortality rates encourage the aggressive diagnosis and treatment of PE among this population. Further work is needed to reduce the incidence and mortality rate of PE.

Province of Residence and Active Syphilis Infection among Zambian Men and Women: New Evidence from Population-Based Data

This study examined the risk factors for active syphilis infection in a subset of nationally-representative population-based survey of Zambian men and women. Syphilis prevalence was 6.5% for women = 2107) and 7.4% for men (N = 1745). In the multivariate model, province was a strong risk factor for active syphilis infection, with Copperbelt, Eastern, Luapula, Lusaka, North-Western and Western Provinces presenting significantly higher risk for women, and Copperbelt, Eastern and Lusaka Provinces presenting significantly higher risk for men compared to the Northern Province. In addition to province, age, education, age at first intercourse, marital status, history of genital sore or discharge, and having ever paid for sex were independent predictors of syphilis infection. Given the ongoing HIV-1 epidemic in Zambia, more aggressive diagnosis and treatment of active syphilis infections, particularly in high-risk provinces, are important strategies to reduce reproductive morbidity and curb HIV-1 transmission.

Differential diagnosis and management of human-directed aggression in cats

In veterinary behavioral medicine and in veterinary neurology, there is an effort to collaborate with different consultants, as seen both in human psychiatry and in human neurology. This cooperation can lead to a complete assessment of any case, to a more holistic collection of information regarding the development of the case, and to a synergetic vision regarding the therapy. In other words, it is essential to understand how behavioral medicine and neurology are linked together to improve diagnosis and therapy process. This review emphasizes the bond between neurology and behavior starting with the neuroanatomic basis of anomalies in veterinary behavioral medicine such as: limbic system, temporal and frontal lobe, pituitary gland, spinal cord, meninges and peripheral nerves. After that, the review deals with some disorders which overlap between neurology and behavioral medicine, and it will conclude by analyzing the differential diagnoses of the neurological diseases and their relationship with behavioral signs.

Akute mesenteriale Durchblutungsst�rungen

Subsets of acute mesenteric circulation disorders comprise mesenteric artery embolism and thrombosis, mesenterial vein thrombosis and non-occlusive mesenteric ischemia. Clinical presentation is often characterized by a discrepancy between severe subjective pain and relatively unspectacular findings on physical examination; all forms still carry an appallingly high mortalitiy rate. The most important point for better survival rates is early and, if indicated, invasive and aggressive diagnosis and treatment. Unfortunately, there are no non-invasive diagnostic tests of sufficient sensitivity and specificity so far, and mesenterial angiography (or abdominal CT, if mesenterial venous thrombosis is supected) remains the gold standard of diagnosis. With the introduction of new techniques (multidetector row CT), computed tomography may play a more important role in the future. In the obstructive forms of arterial mesenteric ischemia, the main therapeutic step after stabilization of the circulation remains an early laparotomy with embolectomy or revascularization and, if appropriate, resection of infarcted bowel. In patients with nonocclusive mesenteric ischemia, counteraction of mesenteric vasoconstriction is the main therapeutic principle. This review describes the different forms of acute mesenteric circulation disorders and gives an overview of the currently established and recommended forms of diagnosis and treatment.

Expression of apoptosis-related markers and HER-2/neu in thymic epithelial tumours.

To correlate the expression of a series of apoptotic and oncogene markers (including p53, Bcl-2, BAX, Bcl-XL, p21WAF,1/CIP1, cyclin D1, HER-2/neu) in thymic epithelial tumours with histological type, stage and resectability and to determine whether the information on HER-2/neu would be valuable in identifying patients who are eligible for anti-HER-2/neu treatment. Immunohistochemical stains were performed on 16 cases of non-neoplastic thymus, 63 thymomas and 17 thymic carcinomas. Fluorescence in-situ hybridization (FISH) for HER2 was performed to validate the gene amplification. Eighteen thymomas were positive for p53 and 14 of them were low-expressors, with positive cells below 10%. All thymic carcinomas revealed over-expression of p53 with positive cells either between 10% and 50% or >50%. The expression of p53 correlated with histological type and stage in thymoma. In both thymoma and thymic carcinoma, there was a statistically significant correlation between p53 status and resectability, with low expressors having a higher likelihood of being resectable. Thymic carcinomas, regardless of the histological subtypes, uniformly expressed Bcl-2, while thymomas showed no or only weak cytoplasmic immunoreactivity. Most thymomas and thymic carcinomas were negative for Bcl-XL, p21WAF,1/CIP1 and cyclin D1. The expression of BAX was inconsistent among different histological types. Nine thymic carcinomas revealed membranous positivity for HER-2/neu, but no HER2 gene amplification could be demonstrated by FISH in any of the cases. p53 and Bcl-2 are more implicated in the development of thymic carcinoma than thymoma. The higher level of p53 expression and the strong immunopositive pattern of Bcl-2 in thymic carcinomas have potential value in the differential diagnosis and prediction of aggressiveness and resectability. On account of the absence of HER2 amplification, patients would probably not benefit from anti-HER-2/neu treatment.

Aggressive Fibromatosis, Aetiology, Diagnosis and Treatment

*@ Summary Aggressive fibromatosisrepresents (AF) a semimalignant tumour which has a locally destructive and invasive growth tendency but does not metastasize because of its high recurrence rate, the tumour remains a surgical problem. AF is rare group of fibroproletlative tumour started initially as painful masses developing slowly affecting mainly the limbs, neck, trunk, and the abdomen in that order. The disease process of (AF) regardless of the site of presentation, sex, or the age of the patient, endocrine, genetic and physical factors seem to play an important role in the development of the disease. Recent innovation in the field of molucular biology showed the abnormalities in (AF) is at the level of chromosomes in the form of gene mutation and chromosomal anomalies. Other studies showed that the pathogenesis of (AF) is related or modulates by hormone. Physical trauma seemed to have role in the development of the tumour. Whether (AF) is benign or malignant tumour is still in the field of theories. Many investigators put this type of tumour in the category of malignant lesion even in the absence of distal metastasis. The modalities of treatment of (AF) is widely different but surgery makes the major bulk, provided there is a good preoperative demonstration of the lesion by contrast solution and MR imaging, in the recurrent types of (AF) the combination of other modalities of treatment, radiotherapy, chemotherapy, cytotoxic and noncytotocix with and without surgery could be the most appropriate way of management. In this paper the character, pathogenesis, development method of detecting and the different modalities of treatment have been reviewed from literature.

Polysialylated neural cell adhesion molecules expressed in human pituitary tumors and related to extrasellar invasion.

Pituitary adenomas are usually benign tumors; however, some behave aggressively and metastasize. Until now, no specific marker of aggressive behavior or malignancy has been found. The polysialylated neural cell adhesion molecule (NCAM), which is highly expressed in embryonic tissues such as the brain and pituitary, is detected in some and neuroendocrine tumors. Because polysialylation has been implicated in the regulation of cell growth and migration, polysialylated NCAM expression has been considered as a prognostic marker in such tumors. In the present study, the authors analyzed polysialylated NCAM expression in 82 pituitary tumors from humans: 49 secreting adenomas, 32 nonfunctioning adenomas, and one growth hormone and prolactin-secreting carcinoma associated with acromegaly and spinal and liver metastases. Based on immunohistochemical analyses, the tumors were classified as somatotropic (22 tumors), prolactinoma (14 tumors), corticotropic (17 tumors), and gonadotropic or so-called null cell adenomas (28 tumors). Assessment of polysialylated NCAM was performed using three different methods (immunohistochemical analysis, Western blot analysis, and enzyme-linked immunosorbent assay) with a specific mouse monoclonal immunoglobulin M (Men B) that recognizes polysialic acid on NCAM. Tumoral NCAM expression was also evaluated with the aid of immunohistochemical analysis. Using this method, NCAM and polysialylated NCAM were studied in six healthy pituitaries. In addition, correlations were investigated using three statistical methods (chi-square test, nonparametric Mann-Whitney U-test, and principal component analysis) to compare tumoral polysialylated NCAM expression and seven parameters (tumor size and type, intrasphenoidal or cavernous sinus invasion, Ki-67 index, mitoses, and patient age and sex). Neural cell adhesion molecules were expressed in the healthy anterior pituitary and in all tumors. In contrast, polysialylated NCAM was not found in the healthy pituitary gland, but was expressed in 46.3% of typical pituitary tumors and 85% of the tumors selected as highly aggressive, including one carcinoma and three tumors with histological characteristics that raised suspicion of malignancy. There was no significant correlation between polysialylated NCAM expression and tumor size, tumor type, Ki-67 index, mitoses, or patient age and sex. In contrast, the expression of polysialylated NCAM, which was sensitive to endoneuraminidase-N treatment, was strongly correlated with tumor invasion (p < 0.0001). In pituitary tumors in humans, expression of polysialylated NCAM is strongly related to tumor invasion and confirms the clinical diagnosis of aggressiveness.

Cardiovascular Mortality in End-Stage Renal Disease

Cardiovascular disease accounts for more than 50% of end-stage renal disease (ESRD) deaths. The reported cardiovascular death rates in patients receiving dialysis are substantially higher than in the general population. Cardiovascular mortality in ESRD is particularly high after acute myocardial infarction, but it is also elevated in ESRD patients with other forms of atherosclerotic vascular disease (eg, chronic coronary artery disease, strokes, transient ischemic attacks, and peripheral arterial disease). Left ventricular hypertrophy and dilation are associated with increased cardiovascular mortality, as is congestive heart failure. One of the major reasons for such high cardiovascular mortality in ESRD is the large burden of cardiovascular disease present in patients with chronic artery disease before renal replacement therapy. These observations mandate not only aggressive diagnosis and treatment of cardiovascular disease in patients with ESRD, but also active screening, diagnosis, and treatment in those with chronic kidney disease before renal replacement therapy.

Myocardial and Pericardial Disease in HIV.

Cardiovascular complications are frequently encountered in the HIV-infected population. Cardiac care providers should implement appropriate preventive, screening, and therapeutic strategies to maximize survival and quality of life in this increasingly treatable, chronic disease. All HIV-infected individuals should undergo periodic cardiac evaluation, including echocardiography, in order to identify subclinical cardiac dysfunction. Left ventricular (LV) dysfunction can result from, or be exacerbated by, a variety of treatable infectious, endocrine, nutritional, and immunologic disorders. Aggressive diagnosis and treatment of these conditions may lead to improvement or even normalization of myocardial function. Endomyocardial biopsy should be considered to direct etiology-specific therapy. Standard measures for the prevention and treatment of congestive heart failure are recommended for HIV-infected patients. Afterload reduction with angiotensin-converting enzyme inhibitors may be indicated for patients with elevated afterload and preclinical LV dysfunction diagnosed by echocardiogram. However, judicious drug selection and titration are necessary in this cohort of patients with frequent autonomic dysfunction, at risk for a number of potentially lethal drug interactions. Carnitine, selenium, and multivitamin supplementation should be considered, especially in those with wasting or diarrhea syndromes. Monthly intravenous immunoglobulin (IVIG) infusions have been demonstrated to preserve LV parameters in HIV-infected children; ventricular recovery has been documented in some children with recalcitrant HIV-related cardiomyopathy following IVIG infusion. We support the use of immunomodulatory therapy in the pediatric population, and look forward to further study into the efficacy and broader application of this approach. Highly active antiretroviral therapy (HAART) may be associated with dyslipidemia and the metabolic syndrome. This should be treated with dietary and possibly with pharmacologic interventions. Drug interactions need to be considered when instituting pharmacologic therapies. Pericardial effusions are often seen in patients with advanced HIV infection. Asymptomatic effusions are most often nonspecific in nature, related to the proinflammatory milieu found in advanced AIDS. Nonspecific effusions are a marker of advanced disease and do not require exhaustive etiologic evaluation. In contrast, large or symptomatic effusions are often associated with infection or malignancy, and warrant thorough investigation and etiology-specific treatment.

Feasibility and Value of Video-Assisted Thoracoscopic Surgery Wedge Excision of Small Pulmonary Nodules in Patients with Malignancy

Advances in CT scanning have presented physicians with the challenge of diagnosing small (< 10 mm) or deep (> 5 mm) pulmonary nodules (SmPNs) in patients with known malignancies during workup or follow-up. Wedge excision of SmPNs is difficult with video-assisted thoracoscopic surgery (VATS) and often requires the performance of a thoracotomy. The value of the early detection of metastatic disease must be weighed against the morbidity (ie, thoracotomy) that is necessarily involved in obtaining the information. Little is known about the incidence of metastases in this subset of patients. We describe a VATS technique that allows the reliable excisional biopsy of SmPNs and present our findings in this patient population. Using CT scan localization, 150 micro Ci technetium sulfur colloid is injected into the area of the pulmonary nodule. Additional blue dye is injected at the lung surface. During VATS, a sterile gamma probe is used to identify the area of radioactivity and plan placement of staple lines performed by an endostapling instrument. Palpation and the presence of radioactivity in the specimen supported the resection of the correct nodule, and CT scan findings confirmed the procedure. Between March 2000 and January 2001, 17 patients with known malignancies and SmPNs underwent VATS excisional biopsies. Six patients received a new diagnosis of malignancy, and 11 patients were in follow-up of a previously treated malignancy. The malignancies included the following: breast (four patients), head and neck (four patients), pancreas (two patients), lymphoma (two patients), lung (one patient), prostate (one patient), rectal (one patient), seminoma (one patient), and urethral (one patient). All lesions were successfully resected on the first try. Nodules were removed from 10 segments and all lobes. The mean (+/-/SD) nodule size was 9.2 +/- 3.6 mm, and the mean depth was 9.4 +/- 5.2 mm. Fourteen of 17 nodules (82.4%) could be neither seen nor felt using standard VATS techniques. Diagnoses included metastatic (four patients), new primary lung cancer (one patient), acid-fast bacillus (one patient), granuloma (seven patients), carcinoid (two patients), and inflammatory pseudotumor (two patients). Among these lesions, 29.4% were malignant, and 35.3% of patients received a diagnosis that altered their therapy. Five of 12 SmPNs (41.7%) < 10 mm in size were malignant. The median length of hospital stay was 2 days. Patients returned to full activity within 1 week. VATS excision of SmPNs after CT scan localization with radiolabeled technetium is reliable, reproducible, and associated with minimal morbidity. The technique prevented thoracotomies in 82.4% of patients. Despite the small size of these lesions, malignancy was found 29.4% of the time. This technique allows the early diagnosis of SmPNs, with low morbidity, in patients with known malignancies. The reliability of this technique, the high incidence of malignancy, and the reduction in morbidity from undergoing excisional biopsy procedures will encourage the clinician to strive for earlier and more aggressive diagnoses of SmPNs.

Nonalcoholic fatty liver disease

N 'onalcoholic fatty liver disease (NAFLD) includes a spectrum of hepatic pathology that resembles alcohol-induced liver disease but develops in individuals who are not heavy drinkers. NAFLD is likely to be the most common cause of chronic liver disease in many countries and may also potentiate liver damage induced by other agents, such as alcohol, industrial toxins, and hepatotrophic viruses. The lack of specific and sensitive noninvasive tests for NAFLD limit reliable detection of the disease. Often, NAFLD is diagnosed presumptively when imaging studies suggest hepatic steatosis or when liver enzyme elevations are noted in overweight or obese individuals with no other identifiable reason for liver disease. NAFLD is strongly associated with insulin resistance and dyslipidemia; however, whether it is a cause or a consequence of these other conditions in not clear. The natural history of NAFLD is also uncertain. Nevertheless, discrepancies between the apparently high prevalence of NAFLD in the population and the generally low prevalence of clinically significant liver disease, as well as the relatively low representation of NAFLD patients among liver transplant populations, have generated considerable skepticism about the clinical importance of NAFLD. The latter has reduced enthusiasm for aggressive diagnosis, treatment, and follow-up of patients with NAFLD. This review of the clinical literature and selected basic information about NAFLD challenges some of these assumptions.

Strategies to improve adult treatment panel III guideline adherence and patient compliance

The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III report outlines the management of hypercholesterolemia through guidelines. These guidelines call for more aggressive diagnosis and treatment of hypercholesterolemia, which will substantially increase the number of individuals in the United States considered to be at risk for heart disease and will expand the number who will receive dietary and drug treatment. The new features of ATP III add complexity to the guidelines, which will impact adherence as well as add challenges to the management of hypercholesterolemia. Following key recommendations and incorporating essential elements of adherence can improve implementation of the NCEP ATP III guidelines. The use of global risk scoring aids, including the Palm Pilot cholesterol risk calculators, can improve guideline adherence and provide education and motivation to patients to maintain compliance.

Inflammation in lung transplantation for CF. Immunosuppression and modulation of inflammation.

Lung transplantation is an accepted therapy for selected individuals with end-stage lung disease due to cystic fibrosis (CF). Recent data show that CF recipients oflung transplantation have survival as good as those of any other diagnostic group. After transplantation, CF patients confront the major threats to life and health of graft infection and rejection. Inflammation is the common mediator of injury to the lung in both these instances. Graft infection after lung transplantation involves the same micro-organismsas are typical with CF as well as opportunistic agents. Prophylactic strategies and aggressive diagnosis via bronchoscopy are both critical in the effective treatment of post-transplant lung infections. Graft rejection involves the detection and recognition of foreign antigen and the subsequent activation of specific T-lymphocyte clones leading to inflammatory injury to the donor organ. Immunosuppression is used to prevent and/or modulate host response to the donor organ and titrated to serum therapeutic drug monitoring and transbronchial biopsy findings. Precise clinical monitoring and aggressive diagnostic approaches are crucial to minimizing graft injury and aggressive diagnostic approaches are crucial to minimizing graft injury and enhancing life after transplantation. Although most CF lung transplant recipients experience both graft infection and rejection and the 5-yr survival rate remains at approx 50%, improvement in diagnosis and therapy continue over time. With the introduction of new approaches to antimicrobial therapy, new immunosuppressant agents and promising strategies to promote immune tolerance, survival after lung transplantation is likely to improve in the coming decades.

Community issues in gastroesophageal reflux disease: what we know and what we do not know

GERD is one of the most common disorders seen by physicians. Despite its wide prevalence, the impact of this disorder on patients and the community remains unclear. A more precise understanding of the impact of GERD on the community will require vigorous studies to determine if aggressive diagnosis and therapy improve clinical outcomes and decrease the cost of the disease to the community. In addition, the issue of screening and surveillance endoscopy for patients with long-standing GERD or Barrett's esophagus must be evaluated in terms of the ability to decrease esophageal cancer mortality and costs. Comparisons with similar diseases, such as asthma and breast cancer, may provide clues to the answers to these questions but are not a substitute for rigorous clinical trials.

The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder

The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder

Cardiovascular disease and dyslipidemia in women.

Cardiovascular disease, primarily coronary heart disease (CHD), outnumbers the next 16 causes of death in women combined. However, the long-held belief that heart disease in women has a more benign prognosis than in men has resulted in less aggressive diagnosis and management patterns. Appreciation of the differences between men and women in CHD risk factors and presentation can assist in treatment decisions. Although estrogen replacement offers substantial beneficial effects on lipid levels in postmenopausal women, the first 2 randomized trials of estrogen alone and estrogen plus progestin, the Heart and Estrogen/Progestin Replacement Study and Estrogen Replacement and Atherosclerosis Study, observed no benefit in reducing risk of CHD death and nonfatal myocardial infarction and angiographic progression of CHD, respectively, in women with CHD. Available data show that lipid-lowering therapy reduces women's CHD risk and mortality but also indicate that a considerable proportion of women remains untreated or undertreated. Randomized trials of statins for primary and secondary prevention of coronary heart disease suggest that these agents are at least as effective for lowering coronary disease risk in women as in men. Therefore, statin drugs should be the drug of first choice for women with established CHD. Hypercholesterolemic postmenopausal women who require estrogen for menopausal symptoms may derive further reductions in low-density lipoprotein cholesterol and reductions in trigyceride levels with the addition of a statin drug.

Prostate cancer detection, characterization, and clinical outcomes in men aged 70 years and older referred for transrectal ultrasound and prostate biopsies

Objectives. To evaluate the diagnostic findings and treatment options chosen in men aged 70 years and older referred for prostate biopsy. Methods. Age, prostate-specific antigen (PSA), biopsy pathology, clinical stage, treatment pursued, and treatment outcome were analyzed in 210 men age 70 years and older referred for transrectal ultrasound and prostate biopsies. All patients were followed for a mean of 46.9 months (range 28 to 63). Results. Cancer was found in 120 (56.8%) of the patients. The cancer detection rate was significantly higher (81.0%) in patients aged 80 years and older than those younger than 80 years. Cancer patients aged 80 years and older had a higher rate of poorly differentiated cancer (64.7%) compared with the 70 to 74-year-olds (33.3%) and 75 to 79-year-olds (32.1%). The patients aged 80 years and older also had a larger proportion of high-stage cancer. The patients younger than 80 years had a significantly higher incidence of stable/falling PSA with treatment compared with the older patients. Of the 210 patients, 41 (19.4%) died within 5 years of the diagnostic procedure; 3 died of prostate cancer. The death rate was not significantly different among the three age groups evaluated. None of the patients aged 80 years and older died of prostate cancer. Conclusions. Patients aged 80 years and older who are diagnosed with prostate cancer are less likely to respond well to treatment and usually die of unrelated causes. Aggressive diagnosis, staging, and treatment in octogenarians should be guided by the patients’ symptoms, overall health, and personal preferences.

Tuberculosis in renal transplant recipients.

Tuberculosis (TB) has been described in kidney transplant recipients as an infection with predominantly pulmonary involvement. We report the impact of TB in kidney transplantation. Clinical records of adult kidney recipients, transplanted between 1 January 1986 and 31 December 1995 were analyzed for sex, age, graft origin, immunosuppressive therapy, TB sites, diagnostic methods and concomitant infections. Annual incidence, mean time of onset, relation to rejection treatment, tuberculin skin test (PPD) and outcome were analyzed. Patients with a history of TB or graft loss in the first month were excluded. TB was diagnosed in 14 of 384 (3.64%). Mean age at transplantation was 35 years. Twelve of these received the graft from a living donor. All had triple immunosuppression with cyclosporine. Ten had pulmonary TB, three extrapulmonary infection and one disseminated disease. In 13 cases an invasive diagnostic procedure was performed. Mycobacterium tuberculosis cultures were positive in all cases; microscopy revealed acid-fast bacilli (AFB) in 6, and adenosine deaminase was elevated in CSF and pleural effusion in 2. Annual incidence varied from 0% to 3.1%. At the time of TB presentation 8 patients had other concomitant infections (cytomegalovirus, nocardia, Pneumocystis carinii, disseminated herpes simplex virus). Median time of onset was 13 months. Diagnostic results became available post-mortem in 2 cases, and one had TB in a failing allograft. TB was treated with 4 drugs including rifampin in 10 patients. Cyclosporine was discontinued in one, lowered in one and increased in 8. During treatment 5 patients had rejection episodes. At 1 year, graft survival was 72.7% and patient survival 90.9%. TB was more prevalent when recipient and donor were both PPD positive. In summary: although TB is a growing threat in the transplant setting, early and aggressive diagnosis with meticulous monitoring of immunosuppression allows a successful outcome for both patient and graft. Optimal prophylaxis guidelines have yet to be completely defined.

Clinical Significance of Precordial ST Segment Depression in Acute Inferior Myocardial Infarction

Background and Objectives:To evaluate the clinical and prognostic significance of precordial ST segment depression in precordial leads on admission electrocardiogram (ECG) in acute inferior myocardial infarction treated with intravenous thrombolytic therapy. We analysed about clinical and angiographic characters. Materials and Method:ECG findings in 50 patients with acute inferior myocardial infarction were retrospectively studied with results of coronary angiography and clinical informations. We classified all patients in two group according to the admissional ECG. Twenty nine patients (Group A) had no or <1.0 mm ST depression in precordial lead and Twenty one patients (Group B) had ≥1.0 mm ST depression in two or more precordial (V1-V6) leads were included in this group. Results:In precordial ST segment depression in acute inferior myocardial infarction patients had higher plasma peak mean CK levels (1945±1419 vs 3547± 2728 IU/L, p=0.027) and lower LV ejection fraction (62±10% vs 53±11%, p=0.008) and lower left ventricle global chordal shortening (0.89±0.71 vs -1.39±0.94, p=0.046) and inferior wall chordal shortening (-1.68±1.11 vs -2.43±0.74, p=0.014) and higher Killip class (1.3±0.8 vs 2.4±1.4, p=0.002) than without precordial ST segment depression patients. Conclusion:In conclusion acute inferior myocardial infarction with precordial ST depression patients had more extensive myocardial damage with global and inferior left ventricle severe wall motion dysfunction. Therefore, this suggests a worse prognosis in acute inferior myocardial infarction with precordial ST depression than without precordial ST depression patients. We need more aggressive diagnosis and treatment in this patients to prevent extending myocardial damage. (Korean Circulation J 1999;29(3):285-291)