Segmental distribution of nodules on trunk.

A 70-year-old Caucasian man presented with a longstanding history of numerous nontender, fleshy, skin-colored papules on his trunk, ranging from 3 to 8 mm in size. They were noted incidentally during an examination of unrelated nonhealing lesions on the patient's left cheek. He said the lesions on his trunk first appeared when he was 28 years old and had continued to grow in size and number. The patient said his son had at least one similar lesion on his upper back, but otherwise there was no family history of these lesions. A biopsy was performed on one of the nodules. WHAT IS YOUR DIAGNOSIS? HOW WOULD YOU TREAT THIS PATIENT?

Effects of gradual coronary artery occlusion and exercise training on gene expression in swine heart.

Gradual occlusion (O) of the swine left circumflex coronary artery (LCX) with an ameroid occluder results in complete O within 3 weeks, collateral vessel development, and compensatory hypertrophy. The purpose of this investigation was to determine the independent and combined effects of O and exercise training (E) on gene expression in the swine heart. Adult Yucatan miniature swine were assigned to one of the following groups (n=6-9/group): sedentary control (S), exercise-trained (E), sedentary swine subjected to LCX occlusion (SO), and exercise-trained swine with LCX occlusion (EO). Exercise consisted of progressive treadmill running conducted 5 d/wk for 16 weeks. Gene expression was studied in myocardium isolated from the collateral-dependent left ventricle free wall (LV) and the collateral-independent septum (SEP) by RNA blotting. E and O each stimulated cardiac hypertrophy independently (p<0.001) with no interaction. O but not E increased atrial natriuretic factor expression in the LV, but not in the SEP. E decreased the expression of beta-myosin heavy chain in the LV, but not in the SEP. E retarded the expression of collagen III mRNA in SEP; but not in the LV. Exercise training and coronary artery occlusion each stimulate cardiac hypertrophy independently and induce different patterns of gene expression.

The mTOR/p70S6K signal transduction pathway plays a role in cardiac hypertrophy and influences expression of myosin heavy chain genes in vivo.

OBJECTIVE: Rapamycin inhibits p70 S6 kinase (p70(S6K)) activity and hypertrophy of cultured neonatal rat cardiac myocytes. The purpose of the present study was to determine whether rapamycin inhibits left ventricular (LV) hypertrophy in intact rats and whether it alters cardiac gene expression. METHODS: 300 g rats were subjected to aortic constriction (AC) or sham-operation (SH) and studied 2 and 3 days after surgery. Beginning 1 day prior to surgery, rats were injected with rapamycin (1.5 mg/kg, i.p.) or carboxymethylcellulose vehicle (V), yielding 4 groups (SH-V, SH-R, AC-V, AC-R). Total RNA was extracted for determination of mRNA levels by Northern blotting. RESULTS: LV dry weight/body weight ratios were 0.43 +/- 0.04 (mean +/- SE) for SH-V, 0.46 +/- 0.02 for SH-R, 0.56 +/- 0.02 for AC-V, and 0.53 +/- 0.03 for AC-R. R inhibited cardiac hypertrophy induced by pressure overload (ANOVA; p < 0.05). Rapamycin had no effect on the expression of atrial natriuretic factor mRNA, but increased the levels of beta-myosin heavy chain mRNA 6-fold in hearts of SH-R and AC-R compared to SH-V. Rapamycin also increased the expression of alpha-myosin heavy chain mRNA in SH-R by 3-fold compared with SH-V, but had no effect on the AC-R group. CONCLUSION: The data suggest that an intact mTOR signaling pathway is required for rapid hypertrophic growth of the heart in vivo. Moreover, the data suggest a novel link between the mTOR/p70(S6K) signal transduction pathway and pretranslational control of myosin gene expression in the heart.

Three-dimensional echocardiography of intracardiac masses.

We describe two cases in which three-dimensional echocardiography provided unique anatomical data. This information enhanced the diagnostic power of two-dimensional echocardiography by improving confidence in interpretation and by providing distinctive spatial insights.

Myocardial contrast echocardiography in acute myocardial infarction.

PURPOSE OF REVIEW: Myocardial contrast echocardiography (MCE) has evolved into an important clinical tool for imaging coronary microcirculation. It can be used to delineate the spectrum of perfusion derangements that characterize acute myocardial infarction. RECENT FINDINGS: Presently, MCE uses microcirculatory perfusion as the basis to distinguish myocardial necrosis and viability in the post-infarct stage. Its future role may expand to image cellular integrity, inflammation, and angiogenesis, all of which contribute to the pathophysiology of the myocardial infarction. SUMMARY: This review provides an update of the current role and future clinical applications of MCE in acute myocardial infarction.

Delineation of intracardiac shunts using contrast echocardiography.

Contrast echocardiography is useful to visualize the endocardial borders of the left ventricle and improve the signal intensity of spectral Doppler signals. It can also help to define intracardiac flow dynamics in complex situations. We report 2 cases where contrast echocardiography improved the delineation of complex shunts and also provided new information not available by conventional echocardiography.