Hepatic vascular malformations in hereditary hemorrhagic telangiectasia: imaging findings.

Hereditary hemorrhagic telangiectasia (HHT) or Osler-Weber-Rendu disease is an autosomal dominant disorder characterized by telangiectases and arteriovenous malformations (AVM) of skin, mucosa, and potentially every organ. The reported prevalence of the disorder is 1/100,000-2/100,000; hepatic involvement occurs in 8-31% of cases (almost always defined by clinical criteria). Hepatic involvement is shown by examination of biopsy and necropsy specimens [1] and by angiography [2]. More recently, hepatic vascular malformations have been detected by using sonography [3], Doppler sonography [4, 5], CT [6], and MR imaging [7]. In almost all the cases described, the malformations were detected in a late stage of hepatic vascular derangement. This pictorial essay illustrates the broad spectrum of abnormalities of hepatic vessels and collaterals in HHT that are detectable by imaging techniques even in the early or clinically silent stages of the diseases.

[The high-resolution analysis of the P wave recorded via the esophagus: a new diagnostic approach in patients with paroxysmal atrial fibrillation]. / L'analisi ad alta risoluzione dell'onda P registrata per via transesofagea: nuovo approccio diagnostico in pazienti con fibrillazione atriale parossistica.

BACKGROUND: P-wave signal averaged ECG has recently been proposed in the evaluation of patients with Paroxysmal Atrial Fibrillation (PAF). The aim of this study was to verify the utility of this method in the characterisation of these patients utilizing a transoesophageal signal. METHODS: The study population consisted of two groups of subjects: Group A, 34 consecutive patients (16 males; 57 +/- 9 yrs) with a documented PAF and without any underlying heart disease, and Group B, normal controls (9 males; 44 +/- 6 yrs). A signal-averaged ECG, triggered with the oesophageal P-wave, obtained from an X, Y, Z lead system was recorded in each patient, utilizing the AEROTEL HIPEC 200 system. The three orthogonal averaged ECGs were band-pass filtered (non-recursive filter, 40-250 Hz) and combined into a spatial vector magnitudo. We evaluated the filtered P-wave duration (Ad, msec) and the Root Mean Square (RMS) voltages of the last 10, 20, and 30 msec of the P vector magnitudo (RMS 10, 20, 30; mcV). RESULTS: The patients with PAF presented with a significantly longer Ad duration (A 126.6 +/- 12.4 vs B 96.8 +/- 12.5 msec, < 0.001), and lower amplitudes of RMS 10, 20, 30 (RMS 10 A 4.8 +/- vs B 9 +/- 2.7 p < 0.005; RMS 20 A 6.9 +/- 2.3 vs B 15.7 +/- 7.3 p < 0.005; RMS30 A 12.1 +/- 5.1 vs B 25.3 +/- 11.5 p < 0.005). An Ad > or = 100 msec, a value of RMS 10 < or = 6.5, RMS 20 < or = 9 and RMS 30 < or = 12.5 mcV showed high values of sensitivity, specificity and positive predictive value (Ad 85%, 100%, 100%, RMS10 93%, 80%, 90%, RMS20 84%, 90%, 96%, RMS30 72%, 90%, 72%). The combined duration/voltage criteria (Ad +/- 110 msec and RMS10 < or = 6.5 mcV or RMS20 < or = 9 mcV) showed a sensitivity of 80% and 76% with a specificity and positive predictive value of 100%. CONCLUSIONS: The P-wave triggered transoesophageal atrial signal averaged ECG appears able to identify patients with PAF; however, prospective studies must investigate the possible clinical use of these findings.

[The efficacy of oral treatment with flecainide for paroxysmal atrial fibrillation: correlation with plasma concentration]. / Efficacia del trattamento orale con flecainide nella fibrillazione atriale parossistica: correlazione con le concentrazioni plasmatiche.

In the acute treatment of paroxysmal atrial fibrillation several drugs can be used. The aim of our work was to assess the efficacy of a single oral dose of flecainide in the conversion to sinus rhythm by correlating this data with flecainide plasma concentration. We have considered 37 patients affected by paroxysmal atrial fibrillation (for more than 8 hours) randomly assigned to the following two groups: group A, 19 patients, mean age 44.4 +/- 1.9 years) treated with flecainide (200 mg) and control group B (18 patients, mean age 46.6 +/- 1.8 years). This was done in order to point out any possible overlap between pharmacological and spontaneous conversion to sinus rhythm. In all patients, the following were performed: a Holter recording (524 hours) to evaluate the time of conversion to sinus rhythm (t-conversion to sinus rhythm), a determination of flecainide plasma concentration (after 150 flecainide administration) an Rx, an Echo-2D/Doppler test and an estimation of thyroid function. The Rx, the Echo-2D/Doppler and the endocrinological data in the 2 groups did not show any significant differences. We obtained a conversion to sinus rhythm in all but one of the group A patients (time of conversion to sinus rhythm 162 +/- 83 min) and in just 5 group B patients (time of conversion to sinus rhythm 1118 +/- 125 min) (time of conversion to sinus rhythm A vs B p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)