We carried out a retrospective and descriptive study of 4 HIV infected patients with relapsing visceral leishmaniasis (VL) seen at 2 tertiary-care hospitals in Spain during the last 6 y, in whom miltefosine was used as a compassionate use treatment at a dosage of 50 mg b.i.d. Patients had a medium CD4 lymphocyte count of 69 cells/microl and were C stage. All patients received at least 2 different anti-leishmanial drugs and had at least 3 relapses before miltefosine treatment (range 3-7). Three patients were treated with miltefosine at a standard dose of 50 mg b.i.d. for 28 d, and the other during 12 months. Despite an initial symptomatic improvement, miltefosine treatment failed to eradicate the infection in all cases. We conclude that the use of miltefosine alone is not strong enough to cure relapsing VL in HIV-1 controlled infected patients.
Patent foramen ovale (PFO) is a relatively common congenital condition which has been implicated in cryptogenic stroke as a result of paradoxical thromboembolism by right-to-left shunting. Many studies have demonstrated that transcatheter PFO closure significantly reduced the incidence of recurrent strokes in a small group of high-risk patients with PFO and atrial septal aneurysm compared with antithrombotic drugs. Two-dimensional transoesophageal echocardiography (2D TEE) has become the election technique for guiding patent foramen ovale closure. Real-time Three-dimensional transoesophageal echocardiography (3D TEE) may be potentially superior to 2D TEE in the accurate assessment of the morphology and efficacy of transcatheter closure devices because of a better spacial orientation.
Primary cardiac sarcomas are rare. A 63-year-old woman presented with progressive symptoms of fatigue, palpitations, and dyspnea. Transthoracic echocardiography detected a mass in the left atrium, fixed and probably attached to the interatrial septum suggestive of myxoma. Transesophageal echocardiography confirmed the existence of a large lobulated mass in the left atrium measuring 45 mm × 25 mm in diameter. Subsequent cardiac magnetic resonance imaging showed a mass of heterogeneous appearance, with broad base of implantation on the posterior wall of the left atrium. The extension study with multidetector computed tomography showed superficial infiltration of the atrial wall, without involvement of the mitral valve or pulmonary veins and no extension to other extracardiac structures. The patient underwent surgery resecting a bilobed mass, smooth and yellowish, strongly attached to the posterior wall of left atrium. The pathologic study was consistent with the diagnosis of myxofibrosarcoma.
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