This study examined possible selective impairment of endothelial dysfunction in the peripheral vascular bed in patients with chronic heart failure in the absence of confounding factors influencing endothelial function (i.e. hypertension, hypercholesterolaemia and diabetes mellitus). Several recent studies have suggested that endothelium-dependent peripheral vasodilation is impaired but endothelium-independent vasodilation is preserved in patients with chronic heart failure. However, a classical paper has demonstrated that sodium nitrite-mediated calf blood flow is clearly depressed in patients with valvular heart disease and cardiomyopathy. We examined forearm blood flow changes mediated by acetylcholine and nitroprusside in patients with valvular heart disease (n = 55) or congenital heart disease (n = 13), and a comparison was made with healthy volunteers (n = 21). The blood flow changes mediated by acetylcholine and nitroprusside were significantly impaired in both patient groups (P < 0.01). When blood flow responses were collected from all patients, two types of vasodilatory capacity were found to have decreased significantly with increasing clinical severity of heart failure (New York Heart Association functional class; P < 0.01). This suggests that the peripheral vasodilatory responses mediated by endothelium-dependent and endothelium-independent vasodilators are significantly impaired in patients with symptomatic chronic heart failure due to non-ischaemic heart disease.
Transient cortical blindness, an uncommonly recognized complication of cerebral angiography, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insufficiency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.
We investigated the usefulness of Holter monitoring to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients. This is a multi-centre, prospective study in 406 asymptomatic diabetic patients. They were categorized into three groups based on findings of Holter monitoring. A total of 377 met inclusion criteria and were classified as low (n = 172), moderate (n = 136) and high risk (n = 69). In total, 86 in moderate and 53 in high risk receive further evaluation. In total, 29 in moderate and 25 in high risk were diagnosed as cardiac disease and 12 required additional treatment, including coronary intervention. Over 1.8 years of mean follow-up, 11 (16.5 per 1000 person-years) experienced cardiovascular events. The cumulative incidence in moderate and high risk was higher than that in low risk (p = 0.029 and p = 0.014, respectively). Our study suggests that Holter monitoring may be a useful screening tool to detect cardiac disease and predict future cardiovascular risk in asymptomatic diabetic patients.
Myxomas of the mitral valve diagnosed during life are exceedingly rare. We employed transthoracic and transoesophageal echocardiography and magnetic resonance imaging enhanced by gadolinium-diethylene-triamine-pentaacetic acid in a patient with palpitations. After these examinations clearly demonstrated a myxoma on the atrial side of the posterior mitral valve leaflet, urgent surgery was performed. When a small tumour of the mitral valve exists, these examinations are useful not only for detecting and characterizing the tumour, but also for deciding the optimal surgical management.
A 59-year-old woman with nephrotic syndrome was diagnosed as having primary amyloidosis based on the detection of amyloid deposition (AL-protein) in the esophagus and kidneys. Bone marrow aspirate showed plasmocytic proliferation, leading to a diagnosis of multiple myeloma (IgG i,-type). In addition, a very rare translocation t(1; 20) (q21; qil) was seen by chromosomal analysis of both the bone marrow and peripheral blood, multiple myeloma ; amyloidosis ; chromosomal abnormality Then, an azoospermic man with t(1; 20)(q21 ; q13) was reported by Antonelli et al. in 1983. Madan andKleinhout (1987) subsequently showed that the women of a large family that suffered from first trimester abortions had t(1; 20)(p36 ; p11). Most recently, Weh et al. (1990) have reported two patients with multiple myeloma and t(1; 20)(q12.3 ; p13). We here report a woman with multiple myeloma, the nephrotic syndrome and systemic amyloidosis, who also had the chromosomal abnormalities t(1; 20) (q21; q11). CASE REPORTA 59-year-old house-wife was admitted for treatment of the nephrotic syndrome on 26 May, 1989. The hemogram was normal and the Westergren sedimentation rate was increased. Liver and kidney function was normal. Urinary protein excretion ranged between 10 and 15 g/day, with Bence-Jones protein being detected by immunoelectrophoresis. Her serum total protein level was low (4.9 g/100 ml), but there was an increase of y-globulin (16.9%). This M-protein was shown to be an IgG A-type paraprotein by immuno-electrophoresis. The serum IgG level was elevated (1,473 mg/100 ml), while both the IgA (47 mg/100 ml) and IgM (61 mg/100 ml) levels were low. Bone marrow aspiration microscopically showed the proliferation of plasmocytis (18.0%) with scattered plasmocytic packets, leading to a diagnosis of multiple myeloma. Needle biopsy of the kidney indicated amyloidosis ; with Congo Red staining AL-type amyloid deposition along the capillary walls thickened the basement membrane, resulting in the nephrotic syndrome. Chromosomal analysis by G-banding was performed after the culture of the bone marrow
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