Hematochezia due to Caecal Angiodysplazia led to Diagnosis of a Transverse Colon Cancer in a Young Female Patient: Case Report and Literature Review.

We present an unusual case of a caecal angiodysplasia whose bleeding determined the discovery of a mid-transverse colon cancer in a 26 years old female patient. After the initial successful angiographic treatment of the caecal lesion the patient underwent laparoscopic - assisted transverse colectomy. The postoperative evolution was favorable, without resumption of bleeding episodes and rapid social reintegration. The histopathology revealed mucinous adenocarcinoma that penetrates the visceral serous with 7 lymph nodes invasion of 18 examined. As a result of the advanced stage, pT4aN2bM0 - stage IIIC, the life expectancy at 5 years is between 30 to 50%.

Seronegative hepatitis C virus infection in patients with lymphoproliferative disorders.

It has been reported that hepatitis C virus (HCV) RNA may be present in serum and/or lymphoid cells in the absence of specific circulating antibodies. The current study analysed seronegative HCV infection in patients with lymphoproliferative disorders. We studied 77 anti-HCV-negative patients (45 male and 32 female, mean age 54.8 ± 14.2 years) with various lymphoproliferative disorders. HCV-RNA was detected by RT-PCR in plasma, peripheral blood mononuclear cells (PBMC) and bone marrow. Furthermore, the presence of viral nonstructural protein 3 (NS3) was determined in PBMC and bone marrow by immunostaining. HCV-RNA was detectable in at least one compartment in 27 (35.1%) patients. Viral RNA was found in bone marrow in 22 patients (28.6%), in PBMC in 13 (16.9%) and in plasma in 10 (13%) patients. In nine patients, evidence of infection was confined to the bone marrow compartment. Viral load in HCV-RNA-positive plasma ranged from 15 to 1.17 × 10(3) IU/mL. NS3 was detected in all but two HCV-RNA-positive bone marrow samples and in all but one HCV-RNA-positive PBMC samples. All 27 HCV-RNA-positive patients remained anti-HCV-negative when tested again after 6-12 months, but only four remained HCV-RNA positive. In conclusion, among patients with lymphoproliferative disorders, HCV can be present in plasma, PBMC and bone marrow despite the lack of circulating specific antibodies. Further studies are required to analyse the phenomenon of seronegative infection and to determine whether such patients are infectious.

Feasibility and clinical value of "intelligent" compression and digital storage of transthoracic echocardiograms in day-to-day practice.

BACKGROUND: The aim of this study was to assess the clinical concordance of expert cardiologists' interpretation of echocardiographic studies recorded on Super-VHS videotape or stored in magneto-optical disk, as well as the feasibility and clinical value of intelligent compression and digital storage of echocardiographic data as cine-loops and still-frames for interpretation of transthoracic echocardiographic images in clinical practice. METHODS: All clinical cardiologists experienced in echocardiography in our department (n = 10) reported on a standardized worksheet checklist the echocardiographic data of 7 consecutive patients (140 reports), and recorded them on videotape or magneto-optical disks to compare the interpretation of videotaped studies, acquired in the usual way, with clinically compressed studies stored to magneto-optical disks using a standard (Italian Society of Echocardiography) image acquisition protocol. RESULTS: The time interval between analog and digital study readings was 50 +/- 15 days. Except for tricuspid valve regurgitation grading (k = 0.28) and for left ventricular global hypokinesia (k = 0.32), the intraobserver agreement in the interpretation of the 3290 cardiovascular morphological and functional findings found on analog and digitally stored images was good (k value ranging from 0.66 to 1.00). The wall motion score index was 1.56 +/- 0.53 when interpreting analog studies, and 1.52 +/- 0.54 on digital studies (p = 0.35). Conversely, the interobserver variability of the wall motion score index (Gini index ranging from 0 to 0.80) was significantly lower when interpreting studies stored digitally than when analog ones were examined (0.48 +/- 0.021 and 0.52 +/- 0.023 respectively, p = 0.006). In comparison to videotape recordings, digital storage of echocardiographic studies significantly shortened the time to image access for study review (327 +/- 62 and 30 +/- 4 s, respectively, p < 0.0001) and the reading time (600 +/- 300 and 540 +/- 300 s respectively, p = 0.034), rendered study accessibility easier (difficult or good: 73 vs 43% of observers, fast or optimal: 27 vs 57% of observers respectively, p = 0.0011) and improved the recorded image quality perception (poor: 25 vs 10% of observers, sufficient or good: 75 vs 90% of observers respectively, p = 0.022), without loss of study completeness (insufficient: 18 vs 17% of observers, adequate or complete: 82 vs 83% of observers, respectively; p = NS). Finally, from September 1, 1999, digital storage has become routine practice for patients admitted to our Department. By December 31, 1999, 411 echo studies had been stored: 7 +/- 3 cine-loop/study, 32 +/- 18 frames/cine-loop, and 3 +/- 2 still-frames/study. The average amount of memory needed for storage was 18.6 +/- 11.9 MB/study. CONCLUSIONS: Clinical compression of echocardiographic studies seems to be an accurate summary of the complete examination recorded to videotape for the assessment of patients admitted in the coronary care unit. In addition, digitally stored studies allow a significant improvement in the interobserver reproducibility of wall motion score assessment.

Correlation of ST-segment depression during ambulatory electrocardiographic monitoring with myocardial perfusion and left ventricular function.

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia.

99Tcm-sestamibi tomoscintigraphy at rest and after nitrate administration in predicting wall motion recovery after revascularization.

To evaluate whether nitroglycerin administered before the injection of sestamibi improves the detection of viable but hypoperfused myocardium, 41 post-infarction patients with left ventricular dysfunction underwent echocardiography and SPET at rest and after nitrate administration. In 25 revascularized patients, perfusion at rest and contractility were assessed 3-4 months after coronary artery bypass grafting. Perfusion (PI) and wall motion indices (WMI) were calculated for each revascularized area. There was a strong correlation between contractility and perfusion defect (r = 0.58, P < 0.0001). Nitrates significantly reduced the number of perfusion defects in hypokinetic (delta PI = 0.25 +/- 0.66) and akinetic (delta PI = 0.32 +/- 0.62), but not in dyskinetic (delta PI = 0.08 +/- 0.62), segments. Twenty-five revascularized patients had 110 asynergic segments and 136 segments with a resting perfusion defect. Function improved in 42% and perfusion in 64% of segments after surgery. Viable segments had a lower PI at rest (2.78 +/- 1.38 vs 3.86 +/- 1.29, P < 0.001) and a lower WMI (2.46 +/- 0.50 vs 2.79 +/- 0.59, P = 0.002). Nitrates reduced the number of perfusion defects slightly more in viable than non-viable segments (delta PI = 0.58 +/- 0.89 vs 0.30 +/- 0.46, P = 0.06). Contractility and perfusion at rest were the most important predictors of functional recovery. The sensitivity and specificity in predicting contractile improvement were 74% and 64% for resting SPET respectively, and 80% and 50% for nitrate SPET respectively. Nitrate administration significantly reduces perfusion defects in asynergic regions; however, its usefulness in predicting contractile recovery may be limited owing to its low specificity. Contractility and sestamibi uptake at rest were the strongest predictors of post-operative wall motion improvement.

[Contemporary opinions on the use of aspirin, heparin and thrombolytic therapy in unstable angina pectoris--pathogenetic findings versus results of many clinical tests]. / Wspólczesne poglady na zastosowanie aspiryny, heparyny i trombolizy w dlawicy piersiowej niestabilnej--konfrontacja przeslanek patogenetycznych z wynikami wielu badan klinicznych.

We summed up the results of clinical researches on thrombolysis in unstable angina pectoris (UAP). We also presented results of similar researches on aspirin and-or versus-heparin in UAP. The idea of applying thrombolytic therapy in UAP was based on data of anatomopathologic, coronary angiographic, biochemical and recently intracoronary ultrasonographic findings. These data indicated that the acute coronary syndromes (UAP, non-Q wave and Q-wave myocardial infarction) were very often caused by coronary plaque disruption and thrombosis. Although the efficiency of thrombolytic therapy in UAP was confirmed angiographically, nevertheless thrombolysis did not significantly decrease in-hospital cardiac events. Bleeding complications were significantly higher in patients who had received thrombolytic therapy. Heparin in constant i.v. infusion and aspirin administered orally seemed to improve clinical outcome. Thrombolytic therapy is not recommended in patients diagnosed as having unstable angina pectoris.

[Evaluation of the antihypertensive efficacy of urapidil in the treatment of hypertension emergencies]. / Ocena skutecznosci hipotensyjnej urapidilu w leczeniu przelomu nadcisnieniowego.

Hypertensive crisis is defined as an acute elevation of the blood pressure involving the risk of life. Agents used to the treatment of hypertensive emergencies should lower the blood pressure under control and produce minimal adverse effect. The aim of this study was to evaluate the antihypertensive efficacy of urapidil i.v. in hypertensive emergencies. Twenty three patients (pts) with the hypertensive crisis in association with ischaemic heart disease and/or acute left ventricular failure were studied. Urapidil was given intravenously in the emergent treatment to the group of 23 pts in the mean dose of 50 mg. Systolic (RRs) diastolic blood pressure (RRd) and heart rate were measured within 4 hours after the drug administration. In this group of pts the significant decrease in RRs and RRd after 2 min. of administration of urapidil was observed and the maximum effect (p < 0.05) occurred within 40 min. The heart rate decreased by 8% and was significantly different (p < 0 > 05) at the maximum point of the drug action. Urapidil administered in 25-75 mg i.v. appeared an effective antihypertensive agent in more than 90% of patients with hypertensive emergencies. What was striking, no reflex tachycardia was observed after i.v. administration of urapidil despite its antihypertensive action.