Prevalence and haemodynamic profiles of pulmonary hypertension in cardiac amyloidosis.

OBJECTIVES: While cardiac amyloidosis (CA) classically involves the left ventricle (LV), less is known about its impact on the right ventricle (RV) and pulmonary vasculature. We performed a retrospective analysis to identify the prevalence and types of pulmonary hypertension (PH) profiles in CA and to determine haemodynamic and cardiovascular magnetic resonance (CMR) predictors of major adverse cardiovascular events (MACE). METHODS: Patients with CA who underwent CMR and right heart catheterisation (RHC) within 1 year between 2010 and 2019 were included. Patients were assigned the following haemodynamic profiles based on RHC: no PH, precapillary PH, isolated postcapillary PH (IPCPH), or combined precapillary and postcapillary PH (CPCPH). The relationship between PH profile and MACE (death, heart failure hospitalisation) was assessed using survival analysis. CMR and RV parameters were correlated with MACE using Cox-regression analysis. RESULTS: A total of 52 patients were included (age 69±9 years, 85% men). RHC was performed during biopsy in 44 (85%) and for clinical indications in 8 (15%) patients. Rates of no PH, precapillary PH, IPCPH and CPCPH were 5 (10%), 3 (6%), 29 (55%) and 15 (29%), respectively. Haemodynamic PH profile did not correlate with risk of death (p=0.98) or MACE (p=0.67). Transpulmonary gradient (TPG) (HR 0.88, CI 0.80 to 0.97), RV, (HR 0.95, CI 0.92 to 0.98) and LV ejection fraction (HR 0.95, CI 0.92 to 0.98) were significantly associated with MACE. CONCLUSIONS: PH is highly prevalent in CA, even at the time of diagnosis. While IPCPH was most common, CPCPH is not infrequent. TPG and RV ejection fraction (RVEF) are prognostic markers in this population.

Malignant Brenner tumor: Two case reports.

Malignant Brenner tumor (MBT) is a rare ovarian tumor that, given the infrequency of the disease, has not been well documented in the literature. Diagnosing MBT both radiographically and histologically remains a challenge. We report two cases of ovarian MBT, detailing the clinical presentation, radiographic characteristics, and histologic findings with supplementary imaging. Our cases demonstrate the pathologic challenge of histologically diagnosing MBT versus other Brenner tumors and transitional cell carcinoma (TCC) of the ovary.

Economic impact of crisis intervention in emergency psychiatry: a naturalistic study.

OBJECTIVE: This is a naturalistic study comparing the outcomes of all emergency psychiatric interventions in the Hospital Center of Luxembourg during two periods of six months each, before and after the introduction of a crisis intervention program. The aim of the study was to investigate the clinical and economic impact of crisis intervention on psychiatric emergency admissions. METHODS: All subjects admitted to the emergency psychiatric unit during the two study periods were considered for participation. Data were collected retrospectively and comparisons were made between patients before (September 1, 2001 to February 28, 2002) and after (September 1, 2002 to February 28, 2003) crisis intervention programs were established. RESULTS: A comparison between the two patient groups demonstrated a significant decrease in the rate of voluntary hospitalizations after crisis intervention, and a significant increase in the number of patients with subsequent outpatient consultations. The cost increase due to ambulatory follow-ups was widely compensated for by the cost decrease due to hospitalization avoidance. CONCLUSIONS: These preliminary findings suggest that crisis intervention leads to a shift from hospitalization to outpatient psychotherapeutic management in emergency psychiatric services, which has a significant economic impact.

Gender differences in acute mountain bike racing injuries.

OBJECTIVE: To evaluate injury rates and patterns in off-road bicycle racing, and to compare the findings in male and female cyclists. SETTING: The study was conducted from 1994-2001 at a large off-road bicycling competition held for 4 days each summer at Mammoth Mountain, California. DESIGN: Injured cyclists were evaluated at the first aid station or at the local hospital. Registration data were used to estimate the number of male and female competitors in each race. PARTICIPANTS: Cyclists who sustained an injury during a race and were unable to finish the race due to the injury were included in the study. 22 female subjects and 71 male subjects met the inclusion criteria during the 8-year study period. There were a total of 20,769 race participants during the study period. MAIN OUTCOME MEASURES: Injuries were categorized, and injury rates were calculated. RESULTS: The overall injury rate during the study period was 0.77% (22/2,869) for women versus 0.40% (71/17,900) for men (p = 0.01). Fractures were sustained by 45.5% (10/22) of female subjects versus 21.1% (15/71) of male subjects (p = 0.03). Odds ratios indicate that overall, women were 1.94 times more likely than men to sustain an injury and 4.17 times more likely to sustain a fracture. CONCLUSIONS: These data suggest that although participation in this sport is higher among men, the risk of injury is greater for women.