ACE Inhibitor Induced Isolated Angioedema of the Small Bowel: A Rare Complication of a Common Medication.

Angioedema is a subcutaneous or submucosal tissue swelling due to capillary leakage and transudation of fluid into the interstitial tissue. It can be localized or generalized as part of a widespread reaction known as anaphylaxis. Millions of people in United States and all over the world receive ACEI antihypertensive therapy. ACEI is known to cause angioedema with an incidence of 0.7 percent. We present a case of 40-year-old female who was started on lisinopril three days prior to presentation for newly diagnosed hypertension. She presented with nonspecific severe abdominal pain, nausea, and vomiting. She denied having difficulty breathing or swelling anywhere in the body. On exam, she did not have facial, lip, tongue, or throat swelling. Her abdomen was tender without guarding or rigidity. Laboratory examination was unrevealing except for mild leukocytosis. Computed tomography scan (CT scan) of the abdomen with oral and IV contrast revealed a moderate amount of ascites with diffuse wall thickening, hyperenhancement, and mucosal edema of the entire small bowel. In the absence of any other pathology, matching history, and imaging findings highly suggestive of angioedema, she was diagnosed with isolated small bowel angioedema as a result of ACEI therapy. She was managed conservatively, and lisinopril was discontinued. A week later on follow-up, all her symptoms had resolved, and repeat CT scan showed resolution of all findings.

Portable acuity screening for any school: validation of patched HOTV with amblyopic patients and Bangerter normals.

BACKGROUND: We needed to validate and calibrate our portable acuity screening tools so amblyopia could be detected quickly and effectively at school entry. METHODS: Spiral-bound flip cards and download pdf surround HOTV acuity test box with critical lines were combined with a matching card. Amblyopic patients performed critical line, then threshold acuity which was then compared to patched E-ETDRS acuity. 5 normal subjects wore Bangerter foil goggles to simulate blur for comparative validation. RESULTS: The 31 treated amblyopic eyes showed: logMAR HOTV = 0.97(logMAR E-ETDRS)-0.04 r2 = 0.88. All but two (6%) fell less than 2 lines difference. The five showed logMAR HOTV = 1.09 ((logMAR E-ETDRS) + .15 r2 = 0.63. The critical-line, test box was 98% efficient at screening within one line of 20/40. CONCLUSION: These tools reliably detected acuity in treated amblyopic patients and Bangerter blurred normal subjects. These free and affordable tools provide sensitive screening for amblyopia in children from public, private and home schools. Changing "pass" criteria to 4 out of 5 would improve sensitivity with somewhat slower testing for all students.

Echocardiographic speckle-tracking based strain imaging for rapid cardiovascular phenotyping in mice.

RATIONALE: High-sensitivity in vivo phenotyping of cardiac function is essential for evaluating genes of interest and novel therapies in small animal models of cardiovascular disease. Transthoracic echocardiography is the principal method currently used for assessing cardiac structure and function; however, standard echocardiographic techniques are relatively insensitive to early or subtle changes in cardiac performance, particularly in mice. OBJECTIVE: To develop and validate an echocardiographic strain imaging methodology for sensitive and rapid cardiac phenotyping in small animal models. METHODS AND RESULTS: Herein, we describe a modified echocardiographic technique that uses speckle-tracking based strain analysis for the noninvasive evaluation of cardiac performance in adult mice. This method is found to be rapid, reproducible, and highly sensitive in assessing both regional and global left ventricular (LV) function. Compared with conventional echocardiographic measures of LV structure and function, peak longitudinal strain and strain rate were able to detect changes in adult mouse hearts at an earlier time point following myocardial infarction and predicted the later development of adverse LV remodeling. Moreover, speckle-tracking based strain analysis was able to clearly identify subtle improvement in LV function that occurred early in response to standard post-myocardial infarction cardiac therapy. CONCLUSIONS: Our results highlight the utility of speckle-tracking based strain imaging for detecting discrete functional alterations in mouse models of cardiovascular disease in an efficient and comprehensive manner. Echocardiography speckle-tracking based strain analysis represents a method for relatively high-throughput and sensitive cardiac phenotyping, particularly in evaluating emerging cardiac agents and therapies in mice.