Echocardiographic and electrocardiographic presentations of patients with endomyocardial biopsy-proven cardiac amyloidosis.

OBJECTIVE: Cardiac amyloidosis is under diagnosed and its prevalence is unknown. This is a retrospective, nonrandomised, single centre study of patients with endomyocardial biopsy-proven cardiac amyloidosis focusing on their echocardiographic and electrocardiogram (ECG) presentations. This is the first case series in Malaysia on this subject. METHODS: We identified all of our endomyocardial biopsyproven cardiac amyloidosis patients from January 2010 to January 2018 and reviewed their medical records. All patients echocardiographic and ECG findings reviewed and analysed comparing to basic mean population value. RESULTS: In total there are 13 biopsy-proven cardiac amyloidosis patients. All of the biopsies shows light chain (AL) amyloid. Majority of the patients (8, 61.5%) is male, and most of our patients (8, 61.5%) is Chinese. All seven patients on whom we performed deformation imaging have apical sparing pattern on longitudinal strain echocardiogram. Mean ejection fraction is 49.3%, (SD=7.9). All patients have concentric left ventricular hypertrophy and right ventricular hypertrophy. Diastolic dysfunction was present in all of our patients with nine out of 13 patients (69.2%) having restrictive filling patterns (E/A ≥2.0 E/e' ≥15). On electrocardiogram, 12 (92%) patients have prolonged PR interval (median 200ms, IQR 76.50ms) and 9 (69.2%) patients have pseudoinfarct pattern. CONCLUSION: Echocardiography plays an important role in diagnosing cardiac amyloidosis. The findings of concentric left ventricular hypertrophy with preserved ejection fraction without increased in loading condition should alert the clinician towards its possibility. This is further supported by right ventricular hypertrophy and particularly longitudinal strain imaging showing apical sparing pattern.

Female sterilization with Hulka clips--initial experience at the University Hospital, Kuala Lumpur.

PIP: The initial experience with the use of Hulka clips for sterilization in 100 patients is reported. In July, 1979, University Hospital physicians in Kuala Lumpur introduced spring-loaded clips, and have found the procedure to be safe and the method acceptable. The 86 patients available for the followup were admitted 1 day prior to the operation for a detailed interview, physical and pelvic examinations, pap smear, and hemoglobin estimation. The laparoscopy was performed under general anesthesia, although others report using local anesthesia, and the patients were discharged the following day. Follow-up was conducted at 3, 6, and 12 months. The women were between 25-40 years old and the majority were para 3-5; 10.5% had only 2 live births. The average age of the patients' youngest child at the time of sterilization was 2.8. Indians comprised the largest ethnic group. The problems encountered at laparoscopy generally occurred in the initial stages of the study and included: difficulty at insertion of trochar, inability to visualize fimbria, tubal transection, and the need for additional clips to ensure occlusion. 2 pregnancies were reported, 1 patient had a luteal phase pregnancy and in the other patient, the left tube was only partially occluded. The actual failure rate in the series was 1.16%, which is acceptable and similar to other reports. A distinct advantage of the clip was the low incidence of tubal transection, .6%, which is a more common occurrence with silastic bands. In addition, the clips offer good prospects for reversibility, compared to other sterilization methods.^ieng