A case of crossing coronary arteries.

We present the case of a patient in whom coronary angiography, performed due to severe calcific aortic stenosis, revealed crossing between the left anterior descending artery and the first diagonal branch. There is only a single report presenting this particular coronary anatomy, whereas this is the eleventh case of crossing coronary arteries ever reported. The clinical implications of this variant coronary anatomy with regard to diagnostic angiography and selection of revascularization procedures are briefly discussed.

An unusual case of acute on chronic renal failure following percutaneous coronary intervention.

Contrast nephrotoxicity is a common and well-documented complication of procedures utilising x ray contrast medium. It should be looked for whenever patients are exposed to contrast medium as it carries a good prognosis if managed appropriately, with only a minority of cases requiring dialysis. It is essential, however, that other causes of renal dysfunction are excluded before making a firm diagnosis of contrast nephropathy. Any delay in administering the appropriate treatment depending on the underlying pathology can result in devastating consequences. The differential diagnosis of acute renal failure is extensive and a systematic diagnostic approach should always be observed.

Primary cardiac undifferentiated sarcoma of the right atrium presenting with cardiac tamponade.

This report illustrates the serial imaging of a primary cardiac undifferentiated sarcoma of the right atrium using echocardiography, chest X-ray, and computed tomography. Transthoracic echocardiography on presentation showed an extensive mass of the right atrial free wall with an impending cardiac tamponade. Symptoms were controlled with pericardiocentesis, pericardial window, and radiotherapy but recurred 8 months later with pleural effusion and tumor spread to the great arteries. Primary cardiac sarcoma (PSC) is a rare and aggressive malignancy that is usually diagnosed late due to its nonspecific symptoms. Cytology and cardiac biopsy may be negative, and suspicion for the tumor is warranted in recurrent pericardial effusion. Analogous to parietal pleural biopsy in lung tumors with pleural effusion, parietal pericardial biopsy may be positive in PSC of the right atrium with pericardial effusion. Echocardiography is the major diagnostic tool and aids pericardiocentesis. Pericardial window may be useful for recurrent pericardial effusion but does not preclude its reaccumulation. There is no proven effective treatment for PSC, and treatments include surgical resection, cardiac transplant, chemotherapy, and radiotherapy. Despite its poor prognosis, symptomatic relief is important and attainable.

The incidence of type 1 diabetes mellitus in Greek-Cypriot children and adolescents in 1990-2000.

OBJECTIVES: To ascertain the exact incidence of type 1 diabetes mellitus (DM1) in Greek-Cypriots under the age of 15 yr, to analyze possible gender differences in the age of onset and to observe any seasonal variation in the manifestation of the disease. RESEARCH DESIGN AND METHODS: All cases of newly diagnosed DM1 patients under the age of 15 yr from 1990 to 2000 were collected and relevant information was obtained. The data were statistically processed in relation to the population data provided by the Department of Statistics and Research of the Ministry of Finance. RESULTS: The mean annual incidence of DM1 in the Greek population of Cyprus under the age of 15 yr for the period 1990-2000 is 11.32/100,000. There is a trend towards increasing incidence during this period. There is a gender influence on the age of onset: more males develop DM1 before the age of 6 yr and after 13 yr. Moreover, there is a gender difference in the group who manifest DM1 in the age range 5-9 yr, with females having a mean age of onset of 8.1 yr, compared with 7.3 yr for males. There is a statistically significant seasonal variation, but not among preschool subjects who manifest DM1 before the age of 4 yr. CONCLUSIONS: DM1 is a common condition in Greek-Cypriots under the age of 15 yr. The gender difference in the age of onset probably reflects the peripubertal period of each gender. The seasonal variation cannot be solely attributed to weather and temperature changes. This survey covers a 10-yr period and deals with an adequate number of reported cases; therefore, it could contribute to the international effort to determine the exact pathogenesis of DM1.