Wild-Type Transthyretin Amyloidosis: A Prevalent and Underdiagnosed Cause of Heart Failure With Preserved Ejection Fraction.

Cardiac amyloidosis is an infiltrative disease characterized by the extracellular deposition of misfolded protein in the myocardium, leading to increased stiffness and an eventual restrictive cardiomyopathy. The slow onset of symptoms and overlap with other cardiomyopathies make prompt diagnosis a challenge. Clinicians should be alerted and include amyloidosis in their differential diagnosis, particularly in patients with heart failure with preserved ejection fraction, unexplained left ventricle hypertrophy, particularly in those shown intolerance to previous antihypertensive medication, and early orthopedic manifestations of the disease such as carpal tunnel syndrome and spinal stenosis. The workup requires the exclusion of monoclonal gammopathies and technetium-99m pyrophosphate nuclear scintigraphy (99mTc-PYP) studies with single-photon emission computerized tomography (SPECT) imaging. Several therapies are now available and can prolong life with significantly improved quality of life, particularly when the diagnosis of amyloidosis is made early. We present the case of a 77-year-old with a delayed diagnosis by five years to highlight the need for heightened clinical suspicion and an appropriate diagnostic algorithm for cardiac amyloidosis.

Human dermal tissue allograft use in treating chronic pilonidal sinus.

A study was conducted to try to improve upon existing conservative techniques in the treatment of chronic pilonidal sinus by using human dermal tissue allograft. A prospective study of 46 consecutive patients undergoing 47 operations for pilonidal disease was conducted by three surgeons. All patients underwent a conservative surgical technique with injection of human dermal tissue allograft and primary wound closure on an ambulatory basis. Sixty percent of patients required no postoperative narcotic use. Eighty-five percent missed no work or school. Sixty-six percent healed primarily. Thirty-three percent of patients developed minor wound complications that quickly responded to suture removal and drainage. There were no wound failures. The recurrence rate was 11% with a median follow-up of 15 months. This study demonstrates that primary closure is possible when combined with a conservative technique in treating uncomplicated pilonidal disease. This operative approach merits further investigation.