Medical History Of Hyperlipidemia Research Articles

Xanthoma of the Jaw Bones: Cases Series and Review of Literature

BackgroundIntraosseous xanthomas are rare benign lesions sometimes associated with excess lipid production. Xanthoma of the jaw bones (XJB) was first reported in 1964, and fewer than 50 cases have been reported in the English literature to date. The etiopathogenesis of XJB is highly suggestive of a reactive process or a metabolic condition.MethodSeven cases of XJBs were retrieved from the archives of 4 oral and maxillofacial pathology services. Clinical, radiographic and histopathologic features of all these cases were retrospectively analyzed. Immunohistochemical (IHC) stains for S100 and CD68 were performed.ResultsAll seven cases involved the mandible. Patients’ age ranged between 13 and 69 years with an evenly distributed female to male ratio. One patient had a medical history of hyperlipidemia, but the medical and dental histories of the others were unremarkable. For most cases, XJB was an incidental finding discovered during routine radiographic examination. Swelling and cortical expansion were noted in a few cases. Radiographically, cases typically presented as either well-defined multilocular or unilocular lesions, which were either radiolucent or mixed radiolucent/radiopaque. All the lesions were treated with surgical curettage and no recurrence was observed during subsequent follow-ups. Each of the seven cases exhibited sheets of foamy macrophages. The diagnosis is established by exclusion of entities with overlapping microscopic features and involved correlation with the clinical, histological, radiographic and IHC profiles. Immunohistochemically, all the cases expressed diffuse positivity for CD68 and were negative for S100.ConclusionXJB is a rare lesion of unknown etiology, which may mimic other benign or reactive jaw lesions. Due to its rarity and the potential diagnostic challenges it presents, clinicians must remain vigilant and consider CXJ in their differential when assessing radiolucent jaw anomalies.

Could hyperlipidemia be a risk factor for corticobasal syndrome? - a pilot study.

Corticobasal syndrome (CBS) is a specific clinical manifestation shared by multiple pathologies. The exact mechanism of this phenomenon remains unclear. Differential diagnosis of CBS in everyday clinical practice is challenging, as this syndrome can overlap with other entities, especially progressive supranuclear palsy Richardson-Steele phenotype (PSP-RS). Several papers have suggested a possible role of vascular pathology as a linking factor in the pathogenesis of CBS based on different neuropathologies. This paper analyses differences in the occurrence of the most common vascular risk factors such as hypertension and lipid profile with respect to dietary habits among patients who fulfill the diagnostic criteria for probable/possible CBS and PSP-RS. Seventy (70) patients in total were included in the study. Exclusion criteria comprised hydrocephalus, stroke in the past, the presence of marked vascular changes in white matter defined as the presence of vascular change ≥ 1 mm in 3T MRI, medical history of hyperlipidemia or the use of drugs that could impact upon lipid metabolism before the initiation of the neurodegenerative disease, and neoplastic focuses in the central nervous system. Patients with diabetes, or with BMI exceeding 18-25, or who were smokers, or who were affected by chronic stress were also excluded. Data was analysed statistically using the Shapiro-Wilk test, the U Mann-Whitney test for group comparison, and a Bonferroni correction to control the false discovery rate (FDR). Our obtained results indicated a statistically significantly higher level of total cholesterol in the CBS group (p = 0.0039) without a correlation with dietary habits. The results obtained in our study may suggest a possible role of vascular pathology in CBS development. This issue requires further research.

Clinical characteristics and outcomes in young patients with myocardial infarction

Abstract Background Young people hold a stable or increasing percentage of patients with acute myocardial infarction in many countries. However, data on clinical characteristics and outcomes in young patients are lacking. Purpose To compare clinical characteristics and outcomes between patients aged ≤45 years and those aged >45 years with acute myocardial infarction. Methods A total of 24125 patients with acute myocardial infarction between January 2013 and September 2014 from China Acute Myocardial Infarction (CAMI) registry were included in this study. Clinical characteristics, in-hospital and 2-year outcomes were compared between patients aged ≤45 years (young) and those aged >45 years (older). Gender disparity in prognosis of myocardial infarction was analyzed among young patients. Results Of 24125 patients, 2042 (8.5%, 116 female) were aged ≤45 years. Compared with patients aged >45 years, young patients were more often male, current smokers, having medical history of hyperlipidemia and family history of premature coronary artery disease. Young patients were significantly more likely to have clear trigger factor, present with persistent chest pain and suffer ST-segment elevation myocardial infarction. Symptom onset to admission time was shorter in patients aged ≤45 years. For patients undergoing emergency coronary angiography, those aged ≤45 years were more likely to suffer left anterior descending coronary artery related myocardial infarction. Young patients were significantly more likely to receive percutaneous coronary intervention and other medications at discharge, including dual antiplatelet therapy, statins, angiotensin converting enzyme inhibitors or angiotensin II receptor blockers and β blockers. Compared with patients aged >45 years, young patients experienced significantly lower in-hospital and 2-year mortality and major adverse cardiac and cerebrovascular events (MACCE, a composite of death, reinfarction and stroke) rates (Table 1). Among young patients, women experienced higher in-hospital mortality and MACCE rates than men (Table 2). Women who survived at discharge experienced significantly higher 2-year mortality (1.4% vs 3.8%, Log-rank P=0.0412, Table 2). Conclusions Compared with the older patients, young patients were more likely to present with typical symptoms and receive guideline-recommended medications. Clinical outcomes of patients aged ≤45 years were significantly better than older patients. However, our results showed significant gender disparity in both short- and long-term outcomes of young patients. More efforts are needed to improve prognosis in young patients with acute myocardial infarction. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Twelfth Five-Year Planning Project of the Scientific and Technological Department of China

Clinical Characteristics, Prognosis, and Gender Disparities in Young Patients With Acute Myocardial Infarction.

Background: Young people hold a stable or increasing percentage of patients with acute myocardial infarction (AMI) in many countries. However, data on clinical characteristics and outcomes of young AMI patients were insufficient. This study aimed to analyze clinical characteristics, prognosis, and gender disparities in patients aged ≤45 years with AMI.Methods: A total of 24,125 patients from China Acute Myocardial Infarction registry were included in this study. Clinical characteristics, managements, and in-hospital and 2-year outcomes were compared between patients aged ≤45 years and those aged >45 years. Predictors of all-cause death were obtained using multivariate regression models. Gender disparities of AMI were analyzed among young patients.Results: Of 24,125 patients, 2,042 (8.5%, 116 female) were aged ≤45 years. Compared with patients aged >45 years, young patients were more often male, current smokers, and more likely to have medical history of hyperlipidemia. Smoking (72.1%) was the major modifiable risk factor in patients aged ≤45 years. Young patients received more evidence-based medications and had significantly lower risk of both in-hospital and 2-year adverse events than older patients. Education level and left ventricular ejection fraction were independent predictors of 2-year mortality in young patients. Moreover, symptom onset to admission time of young women was significantly longer than that of young men. Young women were less likely to receive percutaneous coronary intervention and suffered higher risk of in-hospital adverse events than young men (adjusted odds ratio for death: 5.767, 95% confidence interval 1.580–21.049, p = 0.0080; adjusted odds ratio for the composite of death, re-infarction, and stroke: 3.981, 95% confidence interval 1.150–13.784, p = 0.0292). Young women who survived at discharge had a higher 2-year cumulative incidence of death (3.8 vs 1.4%, plog−rank = 0.0412).Conclusions: Patients aged ≤45 years constituted a non-negligible proportion of AMI patients, with higher prevalence of smoking and hyperlipidemia but better care and prognosis compared with older patients. There were significant gender disparities of managements and outcomes in young patients. More efforts to improve quality of care in young women are needed.

Stopping Levothyroxine Therapy in Subclinical Hypothyroidism, Perhaps We Could Start a Trend

Introduction: Subclinical hypothyroidism (SCH) is diagnosed based on elevated thyrotropin (TSH) and normal thyroxine (FT4) levels. Previous guidelines recommended treatment of SCH with levothyroxine (LT4) when TSH is > 10 uIU/mL or if TSH <10 uIU/mL with symptoms suggestive of hypothyroidism, positive thyroperoxidase antibodies (TPO Ab) or evidence/risk factors of cardiovascular disease. There has been an increasing practice of LT4 prescription for SCH, which contributes to making LT4 the second most prescribed drug in the US. Case: This case reviews the course of a patient with SCH treated with LT4. A 68 year old woman with medical history of hyperlipidemia, osteoporosis, and non-toxic multinodular goiter was diagnosed with SCH due to Hashimoto’s thyroiditis based on TSH 9.59 uIU/mL (0.34 - 5.60), FT4 0.66 ng/dL (0.58 - 1.64), and +TPO Ab. The patient had similar thyroid function tests (TFT) 1 year ago. She reported symptoms of hair loss, dry skin, and fatigue. She decided to undergo a trial of LT4 50 mcg daily. Two months later, her TSH had normalized and she reported slight improvement of fatigue. After one year on LT4, the patient reported symptoms of anxiety and heat intolerance and decided to stop LT4. Laboratory work up revealed TSH 0.22 uIU/mL and FT4 1.03 ng/dL consistent with exogenous hyperthyroidism. At the time of her follow up, the patient had been off LT4 for about 3 weeks. She continued to have ongoing fatigue, but reported resolution of the hyperthyroid symptoms. She was advised to stay off LT4 and to have yearly TFT. Discussion This case illustrates that not only LT4 treatment for SCH did not result in apparent improvement of hypothyroid-related symptoms, but also caused iatrogenic hyperthyroidism. A recent meta-analysis of 21 randomized clinical trials including 2192 patients with SCH found that LT4 therapy is not significantly associated with improvement in general quality of life or thyroid-related symptoms. Additionally, there is evidence of potential harm associated with LT4 and added burden of lifelong management. In 2019, a new guideline panel issued a strong recommendation against thyroid hormones in adults with SCH. Patients who are already on LT4 therapy for SCH may benefit from LT4 deprescribing. Clinicians need to discuss with their patients if LT4 discontinuation is a reasonable consideration. Studies at low risk of bias assessing patient important outcomes after LT4 discontinuation are required imminently.

MULTIMODAL CARDIAC IMAGING APPROACH IN ATYPICAL CHEST PAIN RESULTING IN PRIMARY RIGHT ATRIAL CARDIAC SPINDLE CELL SARCOMA

Spindle cell sarcomas (SCS) of the heart represent a very rare entity among malignancies. Atypical chest pain is not considered a common presentation. Multimodal cardiac imaging can broaden differential diagnosis in this context. A 54-year-old male with medical history of hyperlipidemia presented

Republished: Direct oral anticoagulant and AKI: apixaban-induced acute interstitial nephritis

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs...

2298 Novel Use of N-Acetylcysteine in the Management of Immunotherapy-Induced Acute Liver Injury

INTRODUCTION: There is limited research regarding the use of N-Acetylcysteine (NAC) to manage non-acetaminophen induced acute liver failure (NAI-ALF). NAC has an anti-inflammatory, antioxidant effect, and improves oxygenation by vasodilating microcirculation. A mortality benefit and association with lower hospitalization length has been seen when using NAC in NAI-ALF. Use of immunotherapy to treat cancer has recently increased, and acute liver injury has been reported with many agents. This case examines using NAC to manage immunotherapy induced acute liver injury (ITI-ALI). CASE DESCRIPTION/METHODS: Patient is a 67-year-old Caucasian female with a medical history of hyperlipidemia and well-differentiated angiosarcoma of the right breast, diagnosed in 2011. She had mastectomy and adjuvant chemo-radiotherapy resulting in remission. Surveillance abdominal CT, in 2017 showed new enhancing hepatic lesions. Abdominal MRI confirmed these concerning lesions. A cervical mass was noted, which was biopsied, and diagnostic of metastatic angiosarcoma. She was started on Pazopanib. Two weeks into therapy, she experienced darkened urine, myalgia, and abdominal pain. Labs just prior to admission showed transamninits, ALT of 522 units/L and AST of 456 units/L. Admission labs showed worsening transaminitis, ALT 1377 units/L and AST 1212 units/L. Exam showed jaundice and diffuse abdominal pain. Acetaminophen levels were undetectable. Abdominal ultrasound showed patent hepatic vasculature, normal liver size, appearance, echogenicity, and no intrahepatic ductal dilation or masses. Additionally, serologies for herpes simplex virus, Ebstein Barr virus, cytomegalovirus, viral hepatitis, anti-nuclear antibody, and anti-smooth muscle antibody were negative. Ultimately, her acute liver injury was suspected to be ITI-ALI. NAC was started and Pazopanib was held. Hepatic function was serially monitored, and her acute liver injury rapidly improved. She was discharged and repeat labs on follow-up continued showing improvement in transaminases (Figure 1). DISCUSSION: The use of NAC in NAI-ALF was described in a prospective study by Mumtaz, Azam, et al, and in a randomized, case-control trial by Nabi, et al. Neither studies had patients who had developed ITI-ALI. Both studies were able to conclude that using NAC in NAI-ALF reduced mortality and hospitalization length. Further prospective studies should be conducted to identify if there is a statistically significant effect on mortality and length of hospitalization by using of NAC in ITI-ALI.

TICAGRELOR-INDUCED TRANSAMINITIS: A RARE AND UNEXPECTED PHENOMENON

Ticagrelor, a new type of P2Y12 receptor antagonist, has been widely used in acute coronary syndrome and become a part of dual anti-platelet therapy after percutaneous coronary intervention (PCI). A 60-year-old man with medical history of hyperlipidemia and coronary artery disease s/p PCI to mid

The CAMI-score: A Novel Tool derived From CAMI Registry to Predict In-hospital Death among Acute Myocardial Infarction Patients

Risk stratification of patients with acute myocardial infarction (AMI) is of clinical significance. Although there are many existing risk scores, periodic update is required to reflect contemporary patient profile and management. The present study aims to develop a risk model to predict in-hospital death among contemporary AMI patients as soon as possible after admission. We included 23417 AMI patients from China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014 and extracted relevant data. Patients were divided chronologically into a derivation cohort (n = 17563) to establish the multivariable logistic regression model and a validation cohort (n = 5854) to validate the risk score. Sixteen variables were identified as independent predictors of in-hospital death and were used to establish CAMI risk model and score: age, gender, body mass index, systolic blood pressure, heart rate, creatinine level, white blood cell count, serum potassium, serum sodium, ST-segment elevation on ECG, anterior wall involvement, cardiac arrest, Killip classification, medical history of hypertension, medical history of hyperlipidemia and smoking status. Area under curve value of CAMI risk model was 0.83 within the derivation cohort and 0.84 within the validation cohort. We developed and validated a risk score to predict in-hospital death risk among contemporary AMI patients.

Impact of cigarette smoking on recurrence of hyperlipidemic acute pancreatitis.

AIMTo investigate the impact of cigarette smoking on the recurrence rate and recurrence-free survival in patients with hyperlipidemic acute pancreatitis (HLAP).METHODSA total of 863 patients were admitted to our hospital for acute pancreatitis (AP) from January 2013 to March 2016, of whom 88 diagnosed with HLAP were enrolled in this retrospective study. Demographic data, medical history, previous episodes of pancreatitis, consumption of alcohol and cigarettes, as well as biochemical and hematological data were carefully recorded for univariate and multivariate analyses. During follow-up, the information on current smoking status and recurrent AP was gathered. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the differences between groups were compared using the log-rank test.RESULTSNo significant differences were observed between the three groups in age or medical history of hyperlipidemia, fatty liver, diabetes mellitus, hypertension, or AP. The current smokers had a remarkably higher recurrence rate and a greater incidence of repeated episodes of AP (50.0% and 77.8%, respectively) than non-smokers (9.8% and 39.0%), and these two percentages were reduced to 9.1% and 36.4% for patients who gave up smoking. The median follow-up time was 13.5 mo and HLAP recurred after hospital discharge in 23 (26.1%) patients. Multivariate analysis identified current smoking (HR = 6.3, P = 0.020) as an independent risk factor contributing to HLAP recurrence. Current smokers had significantly worse RFS than non-smokers (23 mo vs 42 mo), but no significant difference was documented between ex-smokers (34 mo) and non-smokers. The RFS was not significantly different between light and heavy smokers.CONCLUSIONSmoking is associated with worse RFS and an increased rate of HLAP recurrence. Continued smoking correlates with a compromised survival and smoking cessation should be recommended.

Abstract T MP114: Hyperlipidemia and Statin Use: Is There an Effect on Mortality Following an Ischemic Stroke?

Background: Prior treatment with stain use is associated with reduced risk of arterial ischemic stroke (AIS) occurrence and recurrence. Recent studies report elevated lipid levels are associated with improved survival in AIS patients. We investigated the association of hyperlipidemia and statin use on all-cause mortality in AIS patients. Methods: All AIS patients, age ≥ 20 years (n=3898) residing within the Greater Cincinnati/Northern Kentucky region in 2005 and 2010 were included in the analysis. Based on prior medical history of hyperlipidemia or elevated fasting LDL levels during hospitalization (HLD) and statin use at baseline and/or discharge, patients were categorized as follows. Group1: no HLD and no statin use, Group2: HLD and no statin use, Group3: HLD and statin use. Covariates included age, BMI, baseline stroke severity (NIHSS), history of: hypertension, heart disease, diabetes, end-stage renal disease, dementia, prior stroke, and smoking. Multivariable logistic regression was used to estimate the odds of mortality, at 30- and 90-days and 1-, 2- and 3-years post stroke. Results: There were 22%, 21%, and 56% patients in groups 1, 2, and 3 respectively. Those in groups 2 and 3 were significantly younger, heavier, more likely to be male and have hypertension, diabetes, heart disease, and severe stroke, but less likely to have atrial fibrillation, dementia, and prestroke disability compared to patients in group 1. In unadjusted and adjusted analyses, patients in group 3 showed lower odds of mortality at all the time points compared to patients in groups 1 and 2. Patients in group 2 also showed lower odds of mortality at all the time points compared to patients in group 1 (Table). Conclusions: A pre-morbid diagnosis of HLD is associated with lower mortality in AIS patients, irrespective of statin use. Statin use appears to be associated with additional improved survival.

Hypotension associated with menaquinone

A case of mild symptomatic hypotension after treatment with menaquinone (vitamin K(2)) is reported. A 62-year-old white man with a medical history of hyperlipidemia, coronary artery disease, and benign prostatic hyperplasia was started on a regimen of menaquinone 100 μg daily as a supplement to his medications for coronary artery disease. Approximately two hours after taking the first dose of menaquinone, the patient experienced sudden weakness and dizziness. At that time, his blood pressure was 110/55 mm Hg. On day 2 of treatment, his blood pressure was 105/50 mm Hg two hours after taking menaquinone; however the patient was asymptomatic. On day 3, the patient's blood pressure was 100/50 mm Hg two hours after menaquinone ingestion, with symptoms of generalized weakness and dizziness, at which point menaquinone was discontinued. All of the patient's heart rate measurements were within normal limits during this time. The day after discontinuing menaquinone, the patient's blood pressure was 115/65 mm Hg, after which his readings were within normal limits on subsequent days. After a 10-day menaquinone-free period, the patient was rechallenged. On rechallenge day 1, the patient's blood pressure was 115/60 mm Hg two hours after menaquinone ingestion; on rechallenge day 2, his blood pressure was 100/55 mm Hg. The patient was asymptomatic on both days of the rechallenge. The Naranjo et al. adverse drug reaction probability scale score was 7, indicating a probable adverse reaction to menaquinone. The drug interaction probability scale score for this case was 6, indicating that a drug interaction was probable. A 62-year-old white man developed mild symptomatic hypotension while receiving menaquinone therapy.

44 ONGOING KIDNEY IMPAIRMENT IN JAPANESE PATIENTS WITH PRIMARY ALDOSTERONISM: PREDICTORS OF NEW-ONSET CHRONIC KIDNEY DISEASE AFTER ADRENALECTOMY

You have accessJournal of UrologyAdrenal: Surgery + Tumors/Benign and Malignant Disease (Physiology and Pharmacology)1 Apr 201244 ONGOING KIDNEY IMPAIRMENT IN JAPANESE PATIENTS WITH PRIMARY ALDOSTERONISM: PREDICTORS OF NEW-ONSET CHRONIC KIDNEY DISEASE AFTER ADRENALECTOMY Takanobu Utsumi, Atsushi Okato, Takeshi Namekawa, Tomokazu Sazuka, Mitsuru Yanagisawa, Kazuyoshi Nakamura, Takahito Suyama, Shinichi Sakamoto, Koji Kawamura, Naoto Kamiya, Takashi Imamoto, Naoki Nihei, Yukio Naya, Hiroyoshi Suzuki, and Tomohiko Ichikawa Takanobu UtsumiTakanobu Utsumi Chiba, Japan More articles by this author , Atsushi OkatoAtsushi Okato Chiba, Japan More articles by this author , Takeshi NamekawaTakeshi Namekawa Chiba, Japan More articles by this author , Tomokazu SazukaTomokazu Sazuka Chiba, Japan More articles by this author , Mitsuru YanagisawaMitsuru Yanagisawa Chiba, Japan More articles by this author , Kazuyoshi NakamuraKazuyoshi Nakamura Chiba, Japan More articles by this author , Takahito SuyamaTakahito Suyama Chiba, Japan More articles by this author , Shinichi SakamotoShinichi Sakamoto Chiba, Japan More articles by this author , Koji KawamuraKoji Kawamura Chiba, Japan More articles by this author , Naoto KamiyaNaoto Kamiya Sakura, Japan More articles by this author , Takashi ImamotoTakashi Imamoto Chiba, Japan More articles by this author , Naoki NiheiNaoki Nihei Chiba, Japan More articles by this author , Yukio NayaYukio Naya Ichihara, Japan More articles by this author , Hiroyoshi SuzukiHiroyoshi Suzuki Sakura, Japan More articles by this author , and Tomohiko IchikawaTomohiko Ichikawa Chiba, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.088AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Inappropriately high aldosterone levels impair renal function in patients with primary aldosteronism (PA), because hyperaldosteronism is associated with glomerular hyperfiltration and reduced glomerular filtration rate. Aldosterone excess, such as in PA, thus probably contributes to the development of chronic kidney disease (CKD). While CKD develops postoperatively with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, subtle kidney impairment is often masked by hyperfiltration before surgery. Interpreting renal function in patients with PA can therefore be difficult using conventional preoperative eGFR. This study investigated postoperative changes in renal function for all PA patients, to identify predictors of postoperative CKD development in patients without pre-existing CKD. METHODS This retrospective study included 78 Japanese patients with PA who underwent unilateral adrenalectomy between 1990 and 2011. Patients followed for <1 year were excluded. As eGFR is known to be limited by differences in creatinine generation among ethnicities, values were obtained using a new 3-variable Japanese equation that was developed and validated in a Japanese population: eGFR (ml/min/1.73 m2) = 194 × (serum creatinine)−1.094 × (age)−0.287 × 0.739 (if female). Changes in eGFR were compared by 1-way ANOVA, with multiple comparisons using the Bonferroni method. Uni- and multivariate analyses were performed to identify clinical predictors for CKD within 1 year after surgery. RESULTS Patients with preoperative eGFR ≥60 ml/min/1.73 m2 showed a significant decrease in postoperative eGFR, while patients with preoperative eGFR <60 ml/min/1.73 m2 showed no significant postoperative decrease. Of the 66 patients without pre-existing CKD, 24 developed CKD within 1 year postoperatively. In all patients with new-onset CKD, preoperative eGFR was 60-89 ml/min/1.73 m2. Multivariate analysis identified preoperative eGFR as an independent predictor of new-onset CKD. Based on univariate analysis, additional factors associated with new-onset CKD included older age and medical history of hyperlipidemia (P<0.05). CONCLUSIONS Patients with preoperative eGFR of 60-89 ml/min/1.73 m2 showed a higher proportion of new-onset CKD after surgery. Clinicians should be attentive to patients at greater risk of significant declines in renal function after adrenalectomy. These data may offer indications for early intervention to prevent declines in renal function. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e19 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takanobu Utsumi Chiba, Japan More articles by this author Atsushi Okato Chiba, Japan More articles by this author Takeshi Namekawa Chiba, Japan More articles by this author Tomokazu Sazuka Chiba, Japan More articles by this author Mitsuru Yanagisawa Chiba, Japan More articles by this author Kazuyoshi Nakamura Chiba, Japan More articles by this author Takahito Suyama Chiba, Japan More articles by this author Shinichi Sakamoto Chiba, Japan More articles by this author Koji Kawamura Chiba, Japan More articles by this author Naoto Kamiya Sakura, Japan More articles by this author Takashi Imamoto Chiba, Japan More articles by this author Naoki Nihei Chiba, Japan More articles by this author Yukio Naya Ichihara, Japan More articles by this author Hiroyoshi Suzuki Sakura, Japan More articles by this author Tomohiko Ichikawa Chiba, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Paradoxical Thromboembolism: A Trip Better Left Untraveled

Introduction Pulmonary embolism is a common sequela of deep vein thrombosis (DVT). Less well documented is the occurrence of DVT and its relationship to stroke via an intracardiac shunt such as a patent foramen ovale (PFO). We report a case of DVT and stroke in conjunction to the presence of intracardiac thrombus and a moderate-sized PFO. Methods This is a case study report of a 61-year-old woman with a previous medical history of hyperlipidemia only who traveled to Mexico from the Unites States. The trip included three long bus trips of 12, 13, and 14 hours in duration. This patient presented to a hospital in Mexico with severe headache and right-sided weakness. The patient was diagnosed and treated for left hemispheric stroke and eventually transported to our hospital in Houston, Texas, for further stroke evaluation and management. With the use of a Philips IE33 8 MHz linear array probe and multi-plane TEE probe as well as a Siemens Sequoia 4V phased array probe, we were able to safely and accurately diagnose and manage the patient's condition until intervention could be safely performed. Results Multiple diagnostic imaging tests were performed, including a bilateral lower-extremity duplex venous ultrasound, duplex carotid ultrasound, transthoracic and transesophageal echocardiograms, as well as computed tomography scans of the chest and brain. With the patient's current condition and symptoms as well as the collected findings, our test results indicated that a paradoxical thromboembolic event had most likely occurred. There was right lower-extremity DVT, bilateral pulmonary embolisms, and large and highly mobile thrombus within the right-side chambers of the heart that occasionally protruded through a moderate size patent foramen ovale of 0.9 cm. The left distal common carotid artery and internal carotid artery were found to be occluded, and initial computed tomography scan of the brain showed a large left middle cerebral artery distribution infarct. Conclusion Venous thromboembolic disease can cause stroke in the presence of an intracardiac shunt such as a PFO. The use of vascular and cardiac ultrasound examinations is critical in determining the etiology of cerebrovascular events. We document a rare case of combined DVT, pulmonary embolism, intracardiac thrombus, PFO, and extracranial carotid arterial occlusion. Although the prevalence of DVT and intracardiac shunts alone is high, it is unclear from the literature which patients would benefit from PFO closure.

Factors associated with use of ultrasonography screening for hepatocellular carcinoma among hepatitis B or C carriers

Objectives: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are important risk factors for hepatocellular carcinoma (HCC). Yet, there have been few studies on adherence to screening recommendations for groups at high risk for HCC. We assessed whether demographic factors or medical conditions affected screening participation among HBV/HCV carriers. Methods: The study population consisted of 15 565 men and women who visited the National Cancer Center, Korea between August 2002 and July 2009. A self-administered questionnaire was used to collect information on demographic characteristics, medical history, including chronic HBV and HCV infection, and health check-up history. HBV surface antigen and HCV antibody levels were measured in serum. Results: Among 781 HBV carriers, 596 (76.3%) were aware of their infection and 451 (57.8%) had ever been tested by ultrasonography. Among HCV carriers, 49 of 127 (36.6%) were aware of their infection and 61 (48.0%) had ever been tested by ultrasonography. Among HBV carriers, male sex (OR, 1.68; 95% CI, 1.22–2.31), family history of liver disease (OR, 2.04; 95% CI, 1.43–2.90), medical history of hyperlipidemia (OR, 2.70; 95% CI, 1.36–5.33), and awareness of infection status (OR, 4.30; 95% CI, 2.99–6.17) were associated with being tested. Among HCV carriers, awareness of infection (OR, 3.77; 95% CI, 1.72–8.26) was significantly associated with being tested by ultrasonography. Conclusion: Male sex, family history of liver disease, medical history of hyperlipidemia, and awareness of high risk status were associated with being tested by ultrasonography.

Factors Affecting the B-Type Natriuretic Peptide Levels in Stroke Patients

This study aims to evaluate the relationship between increased B-type natriuretic peptide (BNP) levels in stroke patients and clinical parameters such as age, sex, medical history, blood pressure, Glasgow Coma Score (GCS) and National Institutes of Health Stroke Scale (NIHSS). This is a prospective study of 123 stroke patients at the Emergency Department. The patients were divided into 3 groups according to the NIHSS scores. The analysis of the mean difference between continuous variables and plasma BNP levels was assessed using the Mann-Whitney and Kruskal-Wallis. Spearman correlation analysis was performed for BNP and other clinical parameters. The BNP levels of patients who had a medical history of hyperlipidaemia, chronic obstructive pulmonary disease, diabetes mellitus and coronary artery disease were significantly higher than in patients without these diseases. Patients who had atrial fibrillation (AF) in their electrocardiography had significantly higher BNP levels than patients with sinus rhythm. A positive correlation was found between plasma BNP levels with age, blood urea nitrogen (BUN) and NIHSS and a negative correlation was found between plasma BNP levels and GCS. There was a significant difference between the BNP levels of NIHSS groups. We consider that plasma BNP levels could help us in interpreting the general clinical severity, functional capacity and clinical progress of stroke patients at the time of admission in the Emergency Department. In evaluating the high BNP levels in stroke patients, we must keep in mind that age, AF, BUN and medical history can affect the BNP levels.