A hand-carried cardiac ultrasound device in the outpatient cardiology clinic reduces the need for standard echocardiography.

OBJECTIVE: To assess the potential value and cost-effectiveness of a hand-carried ultrasound (HCU) device in an outpatient cardiology clinic. METHODS: 222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, electrocardiogram and physical examination, the same cardiologist (level-2 or level-3 trained) immediately performed an HCU examination. The cardiologist then reassessed the clinical situation to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from the two examinations were compared. RESULTS: HCU was performed in 108/222 patients, and a definite diagnosis was established in 34 of them (31%), making SE examination potentially avoidable. In the 74 patients with inconclusive HCU results and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. The overall agreement between HCU and SE for diagnosis of normal/abnormal echocardiograms was 73% (kappa = 0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of euro2142 per 100 patients referred for echocardiography was estimated. CONCLUSIONS: The use of a simple HCU device in the outpatient cardiology clinic allowed reliable diagnosis in one third of the patients referred for echocardiography, which translates into cost and time saving benefits.

Radiofrequency ablation of bony metastatic disease.

Image-guided radiofrequency (RF) ablation is an emerging alternative therapy for treatment of cancer in patients who can not undergo surgical resection. We have performed RF ablation on patients to locally treat and palliate painful osseous metastatic disease for several years. We present an overview of various applications of RF ablation for treating osseous metastatic disease.

Riboflavin treatment of antiretroviral induced lactic acidosis and hepatic steatosis.

BACKGROUND: Antiretroviral induced lactic acidosis and hepatic steatosis is a rare syndrome caused by inhibition of deoxyribonucleic acid (DNA) polymerase gamma by the Nucleoside Reverse Transcriptase Inhibitor (NRTI) class of antiretrovirals. There have been recent reports of NRTI-induced lactic acidosis treated with high-dose riboflavin. INTERVENTION AND RESULTS: We report a case of NRTI lactic acidosis reversed with high-dose riboflavin. Treatment with 50 mg of riboflavin per day was initiated on hospital day 10 after the patient developed respiratory failure. Arterial lactate decreased from 11.9 mmol/dL to 2.1 mmol/dL. Despite lactic acidosis reversal the patient developed acute respiratory distress syndrome (ARDS) and expired. Autopsy confirmed extensive hepatic steatosis with no infectious agents identified. CONCLUSION: Nucleoside Reverse Transcriptase Inhibitor lactic acidosis will likely become more prevalent with the trend toward aggressive antiretroviral treatment. This report provides additional support for the efficacy of riboflavin treatment to reverse this serious complication of antiretroviral therapy. Clinicians should have a high index of suspicion for lactic acidosis in a patient on NRTIs and the medications should be stopped at the earliest sign of toxicity.

Triplet state energy transfer between the primary donor and the carotenoid in Rhodobacter sphaeroides R-26.1 reaction centers exchanged with modified bacteriochlorophyll pigments and reconstituted with spheroidene.

The dynamics of triplet energy transfer between the primary donor and the carotenoid were measured on several photosynthetic bacterial reaction center preparations from Rhodobacter sphaeroides: (a) wild-type strain 2.4.1, (b) strain R-26.1, (c) strain R-26.1 exchanged with 13(2)-hydroxy-[Zn]-bacteriochlorophyll at the accessory bacteriochlorophyll (BChl) sites and reconstituted with spheroidene and (d) strain R-26.1 exchanged with [3-vinyl]-13(2)-hydroxy-bacteriochlorophyll at the accessory BChl sites and reconstituted with spheroidene. The rise and decay times of the primary donor and carotenoid triplet-triplet absorption signals were monitored in the visible wavelength region between 538 and 555 nm as a function of temperature from 4 to 300 K. For the samples containing carotenoids, all of the decay times correspond well to the previously observed times for spheroidene (5 +/- 2 microseconds). The rise times of the carotenoid triplets were found in all cases to be biexponential and comprised of a strongly temperature-dependent component and a temperature-independent component. From a comparison of the behavior of the carotenoid-containing samples with that from the reaction center of the carotenoidless mutant Rb. sphaeroides R-26.1, the temperature-independent component has been assigned to the buildup of the primary donor triplet state resulting from charge recombination in the reaction center. Arrhenius plots of the buildup of the carotenoid triplet states were used to determine the activation energies for triplet energy transfer from the primary donor to the carotenoid. A model for the process of triplet energy transfer that is consistent with the data suggests that the activation barrier is strongly dependent on the triplet state energy of the accessory BChl pigment, BChlB.

Papillon-Lefèvre syndrome.

Papillon-Lefèvre syndrome, also known as hyperkeratosis palmaris et plantaris or hyperkeratosis palmoplantaris, is a devastating dermatological disease characterized by a thickening of the stratum corneum of the skin on the palms of the hands and soles of the feet. In addition, some patients manifest excessive sweating (hyperhidrosis), the growth of fine body hair and the development of dirty-colored skin on the affected parts. Calcification of the falx cerebri of the dura mater, as well as other areas of the brain, have been reported. From a dental standpoint, young patients with Papillon-Lefèvre syndrome have juvenile or precocious periodontosis, with severe destruction of the alveolar bone in both deciduous and permanent dentitions. Bone loss has been observed as early as two years of age, with premature exfoliation of the teeth. There is usually gingival enlargement, gingival ulceration and the formation of deep periodontal pockets; but in some cases, there is no inflammatory reaction and only the periodontium of the secondary teeth is affected. This disease eludes all known forms of therapy and results in edentulousness after only a few years.

Papillon-Lefèvre syndrome.

Papillon-Lefèvre syndrome is a particularly devastating disease that eludes all forms of therapy. It challenges researchers to find a connection between the dermatologic aspects of the disease and the severe periodontosis resulting in an edentulous patient in just a few years.

The diagnostic significance of a prolonged erythrocytic glycerol lysis time (GLT50).

The predictive value of a prolonged glycerol lysis time (GLT50) was assessed by analysis of case records of 100 consecutive subjects with values greater than 73 seconds (normal = 26--73 seconds) reported by the clinical laboratory of The New York Hospital. There were 72 cases of hemoglobinopathy: 65 thalassemia trait, four sickle-thalassemia, and one each of Hb D-thalassemia, sickle-C disease, and sickle-cell anemia. Nine of the remaining subjects had iron-deficiency anemia, three had chronic renal disease, and seven had miscellaneous disorders. Four subjects were apparently normal, and in five cases there was insufficient information for a diagnosis. Of 78 patients who had both a prolonged GLT50 and microcytosis, 67 (86%) had thalassemia trait and seven (9%) had iron-deficiency anemia. In 74 patients with GLT50 greater than 100 seconds, thalassemia trait was found 16 times as often as uncomplicated iron-deficiency anemia. All 31 subjects with GLT50 greater than 180 seconds had hemoglobinopahy. A prolonged GLT50 strongly suggests thalassemia trait, especially when greater than 100 seconds or associated with microcytosis.

Incidental discovery at radical mastectomy of inapparent Hodgkin's disease in long term survivors.

Two long-term survivors with nodular sclerosing Hodgkin's disease were found to have adenocarcinoma of the breast sixteen and twenty years after limited field radiotherapy. Examination of the axillary nodes at radical mastectomy showed both metastatic adenocarcinoma and clinically inapparent Hodgkin's disease. The occurrence of persistent but clinically inactive Hodgkin's disease as well as the development of secondary malignancies in this disease has important clinical ramifications. Skin testing and in vitro lymphocyte transformation studies in these two patients were also done.