A 40-Year-Old Man With Multiple Pulmonary Nodules and Mediastinal Lymphadenopathy With Positive Anti-Neutrophil Cytoplasmic Antibody Reveals an Unexpected Diagnosis.

CASE PRESENTATION: A 40-year-old man with no significant medical history presented to the ED with a 2-day history of right-sided chest pain accompanied by night sweats and chills. These symptoms were accompanied by a dry, nonproductive cough without hemoptysis. The patient worked as an air traffic controller, with a side business of buying, renovating, and selling houses. He takes part in the remodeling work himself but denies any exposure to animal droppings, bird droppings, or mold. He denied chronic sinus disease, rash, or arthralgias. A resident of Platte City, Missouri, he had recently traveled to Salt Lake City, Utah. At the time of presentation, the patient denied any fever or shortness of breath. He had no history of nicotine, alcohol, or illicit substance use and denied any recent weight loss.

Psychosocial Impact of Congenital Heart Diseases on Patients and Their Families: A Parent's Perspective.

BACKGROUND: Currently, over 90% of children with congenital heart disease (CHD) survive into adulthood. As a consequence the psychosocial impact on children and their families has become an important outcome measure. Therefore, the goal of this study was to assess the psychosocial impact from a parent's perspective and to identify possible predictors. METHODS: We included all parents of children who underwent open-heart surgery in the years 2010 and 2011 at the Department of Cardiothoracic Surgery at University Hospital Heidelberg and invited them to complete standardized questionnaires. Psychosocial outcome was measured via parent self- and proxy reporting of family burden (Family Burden Questionnaire, FaBel), health-related quality of life (KidScreen-10), developmental problems (Five-to-Fifteen, FTF), and mental health problems (Strength and Difficulties Questionnaire, SDQ). RESULTS: In total, 113 families returned the questionnaires completely (71.5%). The Aristotle Basic Complexity score and the STAT 2020 Score overall did not predict the psychosocial impact, whereas the number of surgical operations did significantly predict psychosocial impact across all domains in this study cohort. CONCLUSIONS: These data suggest that the number of surgical operations might be a relevant predictor for the long-term psychosocial impact on families suffering from CHD and a potential connecting factor for specialized psychological support. When setting up screening instruments or support programs the entire family must be considered.

Staged left ventricular recruitment after single-ventricle palliation in patients with borderline left heart hypoplasia.

OBJECTIVES: The goal of this study was to review results of a novel management strategy intended to rehabilitate the left heart (LH) in patients with LH hypoplasia who have undergone single-ventricle palliation (SVP). BACKGROUND: Management of patients with hypoplastic LH syndrome and borderline left ventricle (LV) involves 2 options: SVP or biventricular repair. We hypothesized that staged LV recruitment and biventricular conversion may be achieved after SVP by using a strategy consisting of relief of inflow and outflow tract obstructions, resection of endocardial fibroelastosis, and promotion of flow through the LV. METHODS: Patients with hypoplastic LH and borderline LV who underwent traditional SVP (n = 34) or staged LV recruitment (n = 34) between 1995 and 2010 were retrospectively analyzed and compared with a control SVP group. RESULTS: Mean initial z-scores for LH structures before stage 1 SVP were not significantly different between groups. Mortality occurred in 4 of 34 patients after LV recruitment and in 7 of 34 after traditional SVP. LH dimension z-scores increased significantly over time after LV recruitment, whereas they declined after traditional SVP, with significant interaction between stage of palliation and treatment group. Restriction of the atrial septum (conducted in 19 of 34 patients) was the only predictor of increase in left ventricular end-diastolic volume (p < 0.001). Native biventricular circulation was achieved in 12 patients after staged LV recruitment; all of these patients had restriction at the atrial septum. CONCLUSIONS: In these patients with borderline LH disease who underwent SVP, it is possible to increase LH dimensions by using an LV recruitment strategy. In a subset of patients, this strategy allowed establishment of biventricular circulation.

Anthropometry increases 1 repetition maximum predictive ability of NFL-225 test for Division IA college football players.

The purpose of this study was to compare existing 1 repetition maximum (1RM) bench press prediction equations in National Collegiate Athletic Association (NCAA) Division IA college football players and determine if the error associated with the prediction of 1RM bench press from the National Football League (NFL)-225 test could be reduced through the addition of anthropometric measurements. Anthropometric measures, 1RM bench press, NFL-225 test repetitions to fatigue, and body composition data were collected on 87 Division IA football players (mean+/-SD age 19.9+/-1.3 years; height 182.3+/-7.3 cm; body mass 102.3+/-21.1 kg; % fat 13.9+/-6.7; 1RM bench press 140.5+/-2 6.6 kg; and NFL-225 reps to fatigue 14.1+/-8.0). Hierarchical regression revealed an R=0.87 when predicting 1RM from the NFL-225 test alone, which improved to R=0.90 with the addition of the anthropometric variables: arm circumference and arm length. The following equation was the best performing model to predict 1RM bench press: 1RM (lb)=299.08+2.47 arm circumference (cm)--4.60 arm length (cm)+5.84 reps @ 225; SEE=18.3 lb). This equation predicted 43.7% of subjects' within +/-10 lb of their actual 1RM bench press. Using a crossvalidation group, the equation resulted in estimates of 1RM which were not significantly different than the actual 1RM. Because of the variability that has been shown to be associated with 1RM prediction equations, the use of actual 1RM testing is recommended when this is a critical variable. However, coaches, scouts, and athletes, who choose to estimate 1RM bench press using repetitions to failure from the NFL-225 test, may benefit from the use of the equations developed in this study to estimate 1RM bench press with the inclusion of simple anthropometric measurements.