Background. While the mitral annular plane systolic excursion (MAPSE) has been suggested as a surrogate measurement of left ventricular ejection fraction, less is known about the relative value of mitral annular ascent (MAa). Methods. Our database was queried for complete transthoracic echocardiograms performed for any clinical indication. Baseline echocardiographic measurements were compared to determine any correlation between MAa and traditional Echo-Doppler echocardiographic measures to characterize left ventricular diastolic dysfunction (LVDD). Results. Patients with normal LV diastolic function were younger (41 ± 13 years) than patients with LVDD (stage 1: 61 ± 13 years; stage 2: 57 ± 14 years; and stage 3: 66 ± 17 years; p = 0.156). LV ejection fraction decreased in patients with stage 2 LVDD (63 ± 17%) and was further reduced in patients with stage 3 LVDD (28 ± 21; p = 0.003). Discussion. While a vigorous MAa excursion was seen in patients with stage 1 LVDD, MAa significantly decreased in stage 2 and stage 3 LVDD patients. Our results highlight the importance of atrioventricular coupling, as MAa motion seems to reflect changes in left atrial pressure. Additional studies are now required to better examine atrioventricular interactions and electromechanical coupling that might improve our assessment of LV diastolic function.
We have shown for the first time that M-mode interrogation of the MA longitudinal motion appears useful to assess atrio-ventricular interactions. Since LV systolic and diastolic functions are so closely related; additional studies are now required to examine how this longitudinal measure correlates with known circumferential rotational data obtained with other imaging modalities.
Presentación de casos clínicos RESUMENLa seudomicroangiopatía trombótica o síndrome de Moschcowitz es una manifestación infrecuente del déficit de vitamina B12. Se caracteriza por anemia hemolítica con características microangiopáticas, reticulocitos e índices hematimétricos normales o con ligera megaloblastosis, asociados a manifestaciones neurológicas. La vitamina B12 está presente en alimentos proteicos de origen animal. La lactancia materna es una fuente adecuada para los niños cuando los niveles maternos son normales. Se presenta a una paciente de 16 meses que se internó por anemia hemolítica con requerimiento transfusional, plaquetopenia, mal progreso pondoestatural y retraso neuromadurativo. Durante su internación se arribó al diagnóstico de seudomicroangiopatía trombótica secundaria a déficit de vitamina B12.
Introduction Clostridium species are gram-positive or gram-variable anaerobic organisms that have been known to cause different kinds of infections of varying scope and severity. Clostridium species have been associated with high in-hospital mortality rates, particularly in immunocompromised patients with malignancies. Despite the potential severity of these infections in the oncologic population, primary literature on the topic is relatively scarce. Methods A retrospective chart review was performed to identify all patients older than 18 years with positive Clostridium species blood cultures at the H. Lee Moffitt Cancer Center and Research Institute from April 10, 2005, to September 30, 2016. Data were analyzed to identify underlying risk factors, clinical presentation, and treatment of Clostridium bacteremia in the cancer population. Results A total of 18 patients had bacteremia with Clostridium species. The patients' ages ranged from 26 to 79 years (median, 62.5 years), and 6 of the patients were female (33%). The predominant Clostridium species in our sample was Clostridium perfringens, which was found in 7 patients (38%), followed by Clostridium septicum found in 4 patients (22%). A gastrointestinal source was identified in 11 patients (66%). Three patients died of the infection (16%). Conclusions The potential severity of Clostridium infections in the oncologic population warrants a thorough evaluation in every patient with positive blood cultures, with focus on the gastrointestinal tract as a potential source of infection. Further studies about susceptibility testing would provide valuable information and may serve to reduce mortality rates among patients with Clostridium bacteremia.
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