Incidence of coronary artery disease in patients with rheumatic heart disease undergoing surgery

Background: To know the incidence of significant coronary artery disease in rheumatic valvular heart patients undergoing preoperative valve replacement surgery by coronary angiogram. This very important prognostic indicator after surgery if we miss the cad the morbidity and mortality was high. Aim: To assess the CAD-related RHD in various valve involvement and associated risk factors like systemic hypertension and diabetic mellitus. Materials and methods: In this study, we analyzed 100 patients undergoing preoperative coronary angiogram in our department to know the incidence of significant CAD. This study also detected a correlation between the CAD, various valve involvement, sex, comorbidities like DM, SHT and Dyslipidemia were analyzed and also the incidence of CAD with duration of disease, the age of the patients and associate with post CMC or PTMC. Results: In this study, out of 100 patients undergone preoperative coronary angiogram, 8 had significant CAD. 5 patients were male and 3 were female and involvement of valves LCX was 4, LAD was 2, RCA was 1 and LMCA was 1 (p-value <0.05). In this study, the incidence of CAD was high in patients had comorbidities like DM, SHT, and dyslipidemia. Insignificant CAD group 2 had SHT, 2 had DM, 2 had both DM and SHT remaining 2 had no comorbidities. This study showed 5 patients of Aortic valve disease and 3 patients of Mitral valve disease had significant CAD. Conclusion: From this study, the incidence of CAD in our department is 8% most common in males than females and Aortic valvular RHD patients are mostly affected than other valvular RHD. Incidence increased with Age and associated comorbidities.

A study on the safety and tolerability of mycophenolate mofetil in patients with connective tissue disease

Background: Connective tissue disorders (CTD) are mostly due to inflammatory and fibrotic tissue injury. Glucocorticoids and immunomodulators though useful but are toxic. Mycophenolate mofetil (MMF) is now being used successfully in many autoimmune diseases, but the safety of MMF in CTD patients is yet to be conclusively established.Methods: The study was a retrospective record based observational one in patients of CTD satisfying the predetermined inclusion criteria. Various safety parameters were noted down from the observed records and analysed accordingly.Results: The 120 case records of CTD patients were analysed for a specific set of safety parameters over the preceding one year. Diarrhoeal attacks were the most commonly encountered side effect (38.3%) of long term patients who were on mycophenolate therapy followed by infection.Conclusions: Mycophenolate was found to be generally well tolerated in CTD patients with few reports of adverse events, but larger clinical trials are needed to conclusively establish its safety.

Presencia de patrón esclerodérmico capilaroscópico en pacientes sin conectivopatías: descripción de dos casos clínicos / Scleroderma pattern in patients without connective tissue disorders: cases reports

Videocapillaroscopy (VCP) is a consolidated imaging technique that helps the clinician in the assessment of connective tissue disorders (CTD). Their findings have demonstrated predictive value, and a potential role in the differential diagnosis and treatment monitoring of CTD. To date, the scleroderma pattern has been described mainly in CTD. We describe two cases in which the presence of scleroderma pattern, evidenced by ATP, is not only present in CTD.

La videocapilaroscopia (VCP) es una técnica de imagen fácil, inocua y sencilla que se ha consolidado como ayuda diagnóstica para las enfermedades del tejido conectivo. Los hallazgos de VCP demostraron tener valor predictivo de patología microangiopática, siendo útil para el diagnóstico diferencial, seguimiento y monitoreo de respuesta al tratamiento. La presencia de patrón esclerodérmico hasta ahora ha sido descrita en patologías asociadas al tejido conectivo. Presentamos dos casos clínicos en los cuales la presencia de patrón esclerodérmico evidenciado por medio de la VCP no es exclusiva de las enfermedades del tejido conectivo.

Caso para diagnóstico / Case for diagnosis

A esclerodermia localizada (EL) ou morfeia é uma doença crônica do tecido conjuntivo, de provável etiologia autoimune, que tem como base alterações na síntese e deposição do colágeno, representadas clinicamente por lesões cutâneas escleróticas. Algumas placas podem apresentar coloração amarelada ou xantocrômica, causando confusão diagnóstica. Este artigo relata o caso de uma adolescente, com concomitância de lesões eritematosas e xantocrômicas, ambas manifestações clínicas da doença.

Localized scleroderma or morphea is a chronic disease of the connective tissue. Its etiology may be autoimmune and the condition results from a disturbance in collagen synthesis and deposition, clinically represented by sclerotic skin lesions. Some plaques may be yellowish, which can be misleading at diagnosis. This article reports the case of an adolescent girl who concomitantly presented erythematous lesions and yellowish lesions, both of which constitute clinical manifestations of the disease.

Pulmonary manifestations in connective tissue disorders: Hospital-based study at a Tertiary Care Hospital.

Background. The pleuro-pulmonary manifestations frequently occur in patients with the connective tissue disorders (CTDs), and limited data are available on this topic from India. Methods. Between January 2002 and December 2006, 195 patients with various CTDs having respiratory symptoms were evaluated for respiratory system involvement. Results. Interstitial lung disease (ILD) was the commonest (38.5%) presentation of CTDs. It was observed in nearly threefourth of the cases with scleroderma followed by rheumatoid arthritis (RA) cases (44.5%). Pulmonary arterial hypertension was observed in 53.8% and 60% of cases with scleroderma and mixed connective tissue disorder (MCTD), respectively. In RA and systemic lupus erythematosus (SLE), pulmonary hypertension was a rare presentation. Pulmonary function tests were abnormal in all the patients with MCTD, 89.9% patients with RA, 84.6% patients with scleroderma and nearly one-third patients with SLE. Restrictive defect was the most common abnormality [RA (88.7%), scleroderma (72.7%), SLE (66%)]. High resolution computed tomography revealed reticulonodular lesions (n=78); pleural effusion (n=15, mainly in patients with RA and SLE); honeycomb appearance (n=14; mainly in patients with RA and scleroderma); and bronchiectasis (n=9, mainly in patients with RA). Conclusions. Pulmonary manifestations are common in patients with CTDs, ILD being the most common pulmonary involvement. All patients with CTDs should be systematically evaluated and monitored for pulmonary involvement.

The Clinical and Pathological Characteristics of Polymyositis Using ENMC Diagnostic Criteria / 대한류마티스학회지

OBJECTIVE: Polymyositis (PM) has known to be the most common type of idiopathic inflammatory myopathy (IIM). However, recent immunopathological studies demonstrated that PM was overdiagnosed previously due to suboptimal classification system. Using newly proposed classification system, we investigated the frequency, clinical and pathological characteristics of PM. METHODS: Among the patients diagnosed as IIM during past 6 years, we classified a 'definite' or 'probable PM' using the European Neuromuscular Center (ENMC) diagnostic criteria. The findings of clinical, laboratory and pathological findings were analyzed. Response to treatment was assessed at 6 months after treatment. RESULTS: Of total 97 cases with IIM, twenty-three cases (24%) were satisfactory to the diagnostic criteria for PM (definite=5 and probable=18). Most cases were young adults, and female predominance was found. All cases showed proximal muscle weakness, and about two-thirds of patients showed extramuscular manifestation. One (4%) had breast cancer, and accompanying connective tissue disorders (CTDs) were found in 3 cases (13%), two of which had systemic sclerosis. Interstitial pneumonia was found in one case (4%). All cases showed marked elevation of serum creatine kinase level. On muscle biopsy, there were endomysial mononuclear cell infiltrations in all cases. Three-fourths of patients responded to immunosuppressant therapy (74%). CONCLUSION: Using ENMC criteria, the frequency of PM was lower than that had been reported previously. The results of clinical characteristics, response to therapy and clinical outcome were similar to the previous reports. However, association of malignancy or CTDs was low in PM.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.

Evaluation of Lung Permeability in Patients with Connective Tissue Disease using 99mTc-DTPA Aerosol Scintigraphy / 대한류마티스학회지

OBJECTIVE: The association between the connective tissue diseases and lung diseases is well established. DLCO and 99mTc-DTPA aerosol scintigraphy are used for evaluation of the alvelolar-capillary permeability. This study evaluated the changes in permeability of alveolar-capillary membrane and the utility of the 99mTc-DTPA aerosol clearance to detect lung involvement in patients with connective tissue diseases. METHODS: The patient group consisted of the patients with any proven connective tissue diseases (27 rheumatoid arthritis, 17 systemic lupus erythematosus, 7 other connective tissue diseases) and the control group consisted of healthy 12 persons. The patients and controls were non-smokers and had no concomitant diseases that could affect the result (diabetes, any lung diseases etc). Chest X-ray, spirometric measurements of lung volumes, flow idices, diffusing capacities and 99mTc-DTPA aerosol scintigraphy were performed in the patient group and control group. 99mTc-DTPA aerosol (1110 MBq) was used with the aero-vent jet nebulizer as a lung delivery system. Patients in sitting position inhaled for 5 minutes at normal tidal oral breathing, Scintigraphic data were recorded using the Picker Prism 2000 gamma cammera, 15 frames of the lung were obtained as the area of interest anteriorly and posteriorly (120 msec at each frame, for 30 minutes). 99mTc-DTPA clearance rate was calculated as the time to half clearance (T1/2). RESULTS: The mean clearance rates of 99mTc-DTPA were 64.0+/-24.1 min (RA 70.7+/-26.2 min, SLE 61.6+/-14.0 min, Others 43.9+/-24.7 min), and 47.0+/-10.3 min in the patient group and the control group respectively. Significant correlation was not found between the pulmonary clearance rate of 99mTc-DTPA and other parameters (disease duration, ESR, CRP, DLCO and FEV1/FVC). CONCLUSION: 99mTc-DTPA clearance in the patient group (RA, SLE, others) was significantly decreased than that in control group (p<0.05). In the patient group with normal chest X-ray, 99mTc-DTPA clearance in the connective tissue disorders was significantly decreased than control group (p<0.05). We suggest that 99mTc-DTPA aerosol scintigraphy may be one of useful technique for early detection of the lung involvement in the connective tissue disorders.