Malignancy with unknown primary presenting as acute cardiac tamponade: a case report.

A case report of a patient presenting in cardiac tamponade that was subsequently diagnosed as being secondary to malignancy of unknown primary. The patient was treated by urgent pericardiocentesis, followed by subsequent formation of a subxiphoid pericardial window. He was discharged home and given palliative chemotherapy. Malignant pericardial effusions are common, but it is rare for a patient to present in cardiac tamponade as the presenting feature of an unidentified malignancy. The causes, diagnosis and treatment of cardiac tamponade are discussed.

Circulating levels of endothelin-1 in a homogenous Gulf Arab population with untreated essential hypertension.

BACKGROUND: Racial variations are reported in the natural history of hypertension. For example, hypertension is significantly more prevalent in blacks than whites. Endothelial cells are important regulators of vascular tone and homeostasis, in part through secretions of vasoactive substances including endothelin-1 (ET-1), a small peptide with potent vasopressor actions. In black hypertensives, ET-1 levels are higher than in normotensive blacks and in both hypertensive and normotensive whites. Since ET-1 might play a significant role in the development and severity of hypertension in the indigenous Arab population of the United Arab Emirates, we investigated the circulating levels of ET-1 in this homogenous population. PATIENTS AND METHODS: ET-1 levels were measured in plasma samples from 60 untreated hypertensive Arabs and compared with 60 age- and sex-matched normotensive controls. RESULTS: ET-1 levels were significantly higher in hypertensives (mean 10.1 +/- 1 pmol/L) than normotensives (mean 2.2 +/- 0.5 pmol/L). Body mass index (BMI) was slightly higher among the hypertensives. For all subjects these levels significantly (P < 0.001) correlated with systolic blood pressure and less significantly (P < 0.05) with diastolic blood pressure and body weight. The correlation between ET-1 and both systolic and diastolic blood pressure was persistently significant after adjusting for BMI. CONCLUSION: Plasma concentrations of ET-1 are significantly higher in hypertensive Gulf Arabs as compared with reported levels in white hypertensives and ET-1 could be a risk factor for cardiovascular diseases in this population. The endothelial system might be particularly important with respect to hypertension in this racial group and merits further study.

Association between an ANF Gene I/D dimorphism and left ventricular hypertrophy in a Gulf Arab population.

BACKGROUND: An association case-controlled study was carried out on a group of 151 United Arab Emirates nationals--62 normotensives with and without left ventricular hypertrophy (LVH) and 89 hypertensives, also with and without LVH--with a view to evaluating the value of an insertion/deletion (I/D) dimorphism located in the second intron of the human atrial natriuretic factor (ANF) gene in relation to left ventricular hypertrophy. SUBJECTS AND METHODS: Criteria used for LVH inclusion were: demonstration of Sokoloe and Lyon ECG criteria (sum of S wave in V(1), and tallest R wave in lead V5 or V6 > or =35 mm) and echocardiography findings (interventricular septum > or =1.2 cm; posterior LV wall > or =1.3 cm) in the long axis. ANF gene was obtained according to the usual methods by DNA extraction by means of polymerase chain reactions (PCR). The frequencies of this marker were performed according to the Hardy-Weinberg proportions. RESULTS: Our findings show that there was a significant difference in the distribution of the I and D alleles between the two groups (LVH vs non-LVH), with chi(2) = 12.34, 2df, P=0.002, making this a significant association of the D allele with LVH. CONCLUSION: Our results do suggest that variants of the ANF gene might be involved in the determination of left ventricular hypertrophy.