Common origin of left anterior descending artery and right coronary artery from right aortic sinus: presentation of rare variant.

The authors discuss a case of 55-year-old man admitted to hospital with clinical symptoms and electrocardiac signs of myocardial infarction, who underwent invasive diagnosis and one of most rare coronary arteries anomaly was observed: common origin of right coronary artery and anterior interventricular artery (left anterior descending artery) from right aortic sinus. Anatomical variants of coronary arteries are rare amongst general population, ranging between 0.29% to 1.3% and such anomaly is found in 0.03% of all coronarographies and is responsible for 2.3% of all coronary variations. Knowledge about coronary arteries anomalies is helpful not only in making better diagnosis but also in making better therapeutic decisions.

Noninvasive diagnosis of suspected severe pulmonary embolism: transesophageal echocardiography vs spiral CT.

OBJECTIVE: Patients with pulmonary embolism (PE) and echocardiographic signs of right ventricular overload have worse prognosis and may require aggressive therapy. Unequivocal confirmation of PE is required before thrombolysis or embolectomy. This study compares the value of transesophageal echocardiography (TEE) and spiral CT (sCT) in direct visualization of pulmonary artery thromboemboli in patients with suspected PE and echocardiographic signs of right ventricular overload. MATERIAL AND METHODS: Forty-nine consecutive patients (29 men and 20 women), aged 52.2+/-18.3 years, with clinical suspicion of acute (23) or chronic (26) PE and otherwise unexplained right ventricular overload at transthoracic echocardiography underwent TEE and sCT. Main and lobar (central) pulmonary arteries were searched for emboli with both TEE and sCT, while segmental and subsegmental (distal) pulmonary arteries were searched only with sCT. RESULTS: Of 40 patients with PE confirmed by high-probability lung scan (27) or angiography (13), central pulmonary arterial emboli were found at TEE and sCT in 32 (80%) and 36 (90%) patients, respectively. Neither method reported false central PE (specificity, 100%). When distal pulmonary arteries were analyzed, sensitivity of sCT increased to 97.5%, but three patients with primary pulmonary hypertension according to standard tests were misclassified as having distal PE (specificity, 90.1%). Most patients had bilateral PE according to sCT (34/36) and standard tests (40/40) but not TEE (15/32), probably due to its topographic limitations. CONCLUSIONS: Because of high prevalence of bilateral central pulmonary thromboemboli in patients with hemodynamically significant PE, both sCT and TEE allow its definitive confirmation in most cases. Thrombi reported by sCT distally to lobar arteries should be interpreted with caution.

[Pheochromocytoma with hemorrhagic necrosis and rupture with symptoms of acute abdomen and shock]. / Pheochromocytoma--martwica krwotoczna i przerwanie guza z objawami ostrego brzucha i wstrzasem.

A case of a pheochromocytoma with haemorrhagic necrosis resulting in signs of acute abdomen with shock is reported. Diagnosis of a ruptured adrenal tumor was made by CT scanning. Elevated urine and plasma catecholamines as well as histological examination of the removed tumor confirmed the clinical suspicion of pheochromocytoma. The patient made uneventful recovery and is asymptomatic 2 years after surgery. Ruptured pheochromocytoma as a cause of abdominal emergency is discussed in view of the existing literature.

Plasma neuropeptide Y during dynamic exercise in patients with essential hypertension.

UNLABELLED: The aim or the study was to assess plasma neuropeptide Y immunoreactivity concentration (NPY-ir) during dynamic exercise in pts with different stages of essential hypertension (ESH). We studied 25 males aged 29.4 +/- 6.3 yrs with established ESH (ESH) and 12 healthy males aged 27.3 +/- 5.1 yrs (C). Plasma concentrations of NPY-ir, NA, A, BP were measured before treadmill test, in the last minute of two six-min. work loads corresponding to 60% and 80% of maximal individual load and 30 min. after cessation of exercise. Plasma NPY-ir was evaluated with RIA, NA and A with REA. Gradual exercise resulted in an increase of NPY-ir in ESH (from 14.4 +/- 5.8 to 18.1 +/- 6.4 and 20.7 +/- 8.1 fmol/ml p = 0.036, p = 0.02) and in C (from 11.7 +/- 4.6 to 13.4 +/- 5.0 and 15.2 +/- 5.9 fmol/ml, p < 0.01). Likewise plasma NA and A increased in both groups. Plasma NPY-ir during exercise was significantly higher in ESH than in C (p = 0.041 and p = 0.047) while no such differences were observed in plasma NA and A. According to the left ventricle mass index (LVMI) ESH was divided into two subgroups: with left ventricular hypertrophy (LVH+) n = 10, LVMI = 159.7 +/- 7.7 g/m2 and without the hypertrophy (LVH-) n = 15 LVMI = 112.3 +/- 19.2g/m2. LVH- presented significant increase in plasma NPY-ir during exercise (from 14.7 +/- 5.7 to 18.2 +/- 6.5, 22.8 +/- 8.3 fmol/ml p < 0.01), while no changes in LVH+ were observed (from 14.1 +/- 5.8 to 17.8 +/- 6.0 and 17.8 +/- 6.7 fmol/ml, ns). LVH+ were older than LVH- (33.4 +/- 7.1 yrs vs 26.7 +/- 4.2 p = 0.04), but no correlation between age and plasma NPY-ir was noticed. No differences in plasma NA and A were present between these subgroups. CONCLUSION: Patients at different stages of essential hypertension display various patterns of sympatho-adrenal activation during dynamic exercise.

Transoesophageal echocardiography for definitive diagnosis of haemodynamically significant pulmonary embolism.

Transesophageal echocardiographic evaluation of right and left pulmonary arteries, up to the origin of their lobar branches, was prospectively performed with a single plane probe in 32 consecutive patients (18 M, 14 F, aged 55.5 +/- 14.6, from 32 to 80 years) with clinical or echocardiographic suspicion of pulmonary embolism, who met transthoracic echocardiographic criteria of right ventricular overload. Transoesophageal echocardiography showed unequivocal (20 patients) or suspected (three patients) intraluminar thrombi in 88.5% of 26 patients with haemodynamically significant acute or chronic pulmonary embolism, confirmed with reference methods. The sensitivity of the unequivocal transoesophageal echocardiographic diagnosis was 80% for acute and 73% for chronic haemodynamically significant pulmonary embolism. No false-positive results were found (specificity 100%). Additionally, in three cases, transoesophageal echocardiography disclosed the cause of the right ventricular overload revealing a previously undiagnosed atrial septal defect or Ebstein anomaly. Direct visualization of proximal pulmonary arterial thrombi by transoesophageal echocardiography emerges as a useful new method of prompt and definite diagnosis of haemodynamically important pulmonary embolism.