Persistently elevated serum concentrations of human chorionic gonadotropin (hCG).

OBJECTIVES: We describe a woman with constantly elevated hCG levels in serum. Since assay interference, pregnancy or cancer did not explain the elevated levels, we measured the concentrations of hCG, its ß subunit (hCGß) and its core fragment (hCGßcf) in serum and urine using specific assays, to understand the nature of the elevated hCG levels. METHODS: We used 3 assays for total hCG (these assays also recognize hCGß and to various degrees hCGßcf), 3 for intact hCG heterodimer, 3 for free hCGß and one for hCGßcf. RESULTS: With an hCG assay detecting total hCG the serum concentrations were in the range of 150-260 IU/L for the whole study period of almost 5 years, except for a peak of 1,200 IU/L, coinciding with a spontaneous abortion. Quantitation of different forms of hCG with specific immunoassays showed that the immunoreactivity in serum consisted of hCGß. Urine contained hCGß and hCGßcf. CONCLUSIONS: The laboratory findings are in keeping with familial hCG syndrome. However, so far the condition remains to be determined in any family members. Elevated hCG levels without any explanation are problematic as they cause suspicion of cancer or ectopic pregnancy and may lead to harmful therapy. Specific assays, as used here, will aid in diagnosis of such cases.

Differences in the Clinical Profile and Management of Atrial Fibrillation According to Gender. Results of the REgistro GallEgo Intercéntrico de Fibrilación Auricular (REGUEIFA) Trial.

To analyze the clinical profile and therapeutic strategy in atrial fibrillation (AF) according to gender in a contemporaneous patient cohort a prospective, multicenter observational study was performed on consecutive patients diagnosed with AF and assessed by cardiology units in the region of Galicia (Spain). A total of 1007 patients were included, of which 32.3% were women. The mean age of the women was significantly greater than that of the men (71.6 versus 65.7 years; p < 0.001), with a higher prevalence of hypertension (HTN) and valve disease. Women more often reported symptoms related to arrhythmia (28.2% in EHRA class I versus 36.4% in men), with a poorer level of symptoms (EHRA classes IIb and III). Thromboembolic risk was significantly higher among women (CHA2DS2-VASc 3 ± 1.3 versus 2 ± 1.5), in the same way as bleeding risk (HAS-BLED 0.83 ± 0.78 versus 0.64 ± 0.78) (p < 0.001), and women more often received anticoagulation therapy (94.1% versus 87.6%; p = 0.001). Rhythm control strategies proved significantly less frequent in women (55.8% versus 66.6%; p = 0.001), with a lesser electrical cardioversion (ECV) rate (18.4% versus 27.3%; p = 0.002). Perceived health status was poorer in women. Women were older and presented greater comorbidity than men, with a greater thromboembolic and bleeding risk. Likewise, rhythm control strategies were less frequent than in men, despite the fact that women had poorer perceived quality of life and were more symptomatic.

Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy: An International, Multi-Institutional Study of the MINICOR Group.

BACKGROUND: Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). METHODS: Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. RESULTS: We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. CONCLUSIONS: In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.

Quantitative myocardial perfusion with stress dual-energy CT: iodine concentration differences between normal and ischemic or necrotic myocardium. Initial experience.

OBJECTIVES: To determine whether the quantification of iodine with stress dual-energy computed tomography (DECT-S) allows for the discrimination between a normal and an ischemic or necrotic myocardium using magnetic resonance (MR) as a reference. METHODS: This retrospective study was approved by the institutional review board, with waiver of informed consent. Thirty-six cardiac MR and DECT-S images from patients with suspected coronary artery disease were evaluated. Perfusion defects were visually determined, and myocardial iodine concentration was calculated by two observers using DECT colour-coded iodine maps. Iodine concentration differences were calculated using parametric tests. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the optimal iodine concentration threshold for discriminating pathologic myocardium. RESULTS: In total, 576 cardiac segments were evaluated. There were differences in mean iodine concentration (p < 0.001) between normal (2.56 ± 0.66 mg/mL), ischemic (1.98 ± 0.36 mg/dL) and infarcted segments (1.35 ± 0.57 mg/mL). A myocardium iodine concentration of 2.1 mg/mL represented the optimal threshold to discriminate between normal and pathologic myocardium (sensitivity 75 %, specificity 73.6 %, area under the curve 0.806). Excellent agreement was found in measured myocardium iodine concentration (intraclass correlation coefficient 0.814). CONCLUSION: Cardiac DECT-S with iodine quantification may be useful to differentiate healthy and ischemic or necrotic myocardium. KEY POINTS: • DECT-S allows for determination of myocardial iodine concentration as a quantitative perfusion parameter. • A high interobserver correlation exists in measuring myocardial iodine concentration with DECT-S. • Myocardial iodine concentration may be useful in the assessment of patients with CAD.

Pólipo fibroepitelial vulvar gigante / Giant vulvar fibroepithelial polyp

Los tumores benignos de origen epitelial localizados en la región vulvar tienen baja prevalencia siendo su incidencia real desconocida. El más común de ellos es el pólipo fibroepitelial (AU)

Benign epithelial tumors located in the vulvar region have a low prevalence. The most common of these is fibroepithelial polyp (AU)

Una campaña de información y diagnóstico de la fibrilación auricular: la «Semana del Pulso» / A campaign for information and diagnosis of atrial fibrillation: ¡°Pulse Week¡±

Introducción y objetivos. La fibrilación auricular está presente en un 5-15% de la población anciana y causa una quinta o una cuarta parte de los accidentes cerebrovasculares. No es infrecuente que estos pacientes estén asintomáticos. Realizamos una campaña pública con el objetivo de evaluar la efectividad de un programa de información y diagnóstico de la fibrilación auricular en personas de 65 años o más desde el ámbito de la atención primaria. Métodos. Se envió una carta con un díptico informativo y una invitación para acudir a consulta a todos los individuos de 65 años o mayores sin diagnóstico previo de fibrilación o flutter auricular de tres áreas concretas de la provincia de Pontevedra. Las consultas se efectuaron dentro de un programa especial denominado «Semana del Pulso», durante 5 días laborables, en el que un grupo de enfermeras entrenadas realizaba una breve historia clínica, palpación del pulso durante 15 s y estimación de la presión arterial. Si el pulso era arrítmico, se realizaba un electrocardiograma de 12 derivaciones. Resultados. Se enviaron 8.869 cartas. Durante la semana especificada acudieron 1.532 sujetos (877 mujeres) con una media de edad de 72,5 ± 6,5 años, 833 (54%) con historia de hipertensión arterial, 232 (15%) diabéticos, 61 (4%) con ictus previo y 88 (6%) con infarto de miocardio antiguo. Se realizaron 187 electrocardiogramas por pulso arrítmico. Se detectó fibrilación auricular previamente no conocida en 17 pacientes (1%). Conclusiones. Una campaña dirigida a población anciana, basada en la palpación del pulso durante 5 días de consultas, tiene escasa capacidad para detectar nuevos casos de fibrilación auricular en nuestro medio(AU)

Introduction and objectives. Atrial fibrillation occurs in 5%-15% of elderly patients and causes one-fourth to one-fifth of all cerebrovascular events. These patients are frequently asymptomatic. We conducted a public campaign aiming to evaluate the effectiveness of a program for information on and diagnosis of atrial fibrillation in individuals aged 65 years old or more from the primary care perspective. Methods. We sent letters containing informative materials and an invitation to attend a special nurse appointment to all individuals>=65 years old, without a previous diagnosis of atrial fibrillation or flutter. Patients were from 3 specific areas in Pontevedra province. The procedures were performed according to a specially designed program called ¡°Pulse Week¡± within 5 working days. A group of trained nurses obtained a brief medical history and performed pulse palpation for 15 s and blood pressure measurement. A complete 12-lead electrocardiogram was performed if arrhythmic pulsations were detected. Results. A total of 8869 letters were sent. During the specified week, 1532 individuals were evaluated (877 women); the mean age was 72.5 (6.5) years old, 833 had hypertension (54%), 232 had diabetes (15%), 61 had previous stroke (4%) and 88 had had a myocardial infarction (6%). Electrocardiograms were performed in 187 patients. There were 17 patients with newly diagnosed atrial fibrillation. Conclusions. A public, 5-day campaign based on pulse palpation and targeting elderly individuals had little impact on the detection of new cases of atrial fibrillation in our environment(AU)

A campaign for information and diagnosis of atrial fibrillation: "pulse week".

INTRODUCTION AND OBJECTIVES: Atrial fibrillation occurs in 5%-15% of elderly patients and causes one-fourth to one-fifth of all cerebrovascular events. These patients are frequently asymptomatic. We conducted a public campaign aiming to evaluate the effectiveness of a program for information on and diagnosis of atrial fibrillation in individuals aged 65 years old or more from the primary care perspective. METHODS: We sent letters containing informative materials and an invitation to attend a special nurse appointment to all individuals≥65 years old, without a previous diagnosis of atrial fibrillation or flutter. Patients were from 3 specific areas in Pontevedra province. The procedures were performed according to a specially designed program called "Pulse Week" within 5 working days. A group of trained nurses obtained a brief medical history and performed pulse palpation for 15 s and blood pressure measurement. A complete 12-lead electrocardiogram was performed if arrhythmic pulsations were detected. RESULTS: A total of 8869 letters were sent. During the specified week, 1532 individuals were evaluated (877 women); the mean age was 72.5 (6.5) years old, 833 had hypertension (54%), 232 had diabetes (15%), 61 had previous stroke (4%) and 88 had had a myocardial infarction (6%). Electrocardiograms were performed in 187 patients. There were 17 patients with newly diagnosed atrial fibrillation. CONCLUSIONS: A public, 5-day campaign based on pulse palpation and targeting elderly individuals had little impact on the detection of new cases of atrial fibrillation in our environment.

Embolias silentes tras cardioversión eléctrica de fibrilación auricular: ¿qué aporta la resonancia magnética cerebral? Respuesta / Silent embolism after electrical cardioversion of atrial fibrillation: what does brain magnetic resonance imaging provide? Response

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Resultados perinatales en función de la dosis de betametasona administrada en gestantes / Perinatal outcomes depending on the doses of betamethasone administered in pregnant women

Objetivos: Evaluar los resultados perinatales entre diferentes dosis de corticoides antenatales. Sujetos y métodos: Estudio retrospectivo de61 gestaciones únicas con amenaza de parto prematuro, sin otra patología asociada, y con al menos una dosis estándar de betametasona por vía intramuscular (2 dosis de 12 mg/24 h). Dos grupos de estudio: grupo 1: dosis estándar, y grupo 2: una o más dosis adicionales semanales de 12 mg de betametasona. Variables maternas: semanas de gestación al inicio del tratamiento corticoideo, semanas al parto, tipo de parto, patología puerperal, entre otras; variables neonatales: sexo, índice de Apgar, peso, talla, perímetro cefálico y patología neonatal. Se realizó un estudio descriptivo y comparativo de ambos grupos. Resultados: No hubo diferencias estadísticamente significativas en los grupos. Sin embargo, se registraron más casos de displasia broncopulmonar(p = 0,09) en el grupo 1.Conclusiones: La repetición semanal de las dosis de corticoides no mejora los resultados perinatales ni asocia efectos adversos (AU)

Objectives: To evaluate perinatal outcomes between different doses of antenatal corticosteroids.Subjects and methods: Retrospective study of 61single pregnancies at risk of premature birth, withn o other associated pathology and with at least one standard dose of intramuscular betamethasone (two doses of 12 mg/24h). There were two study groups: Group 1: standard dose, and Group 2: one or more additional weekly doses of 12 mg. Maternal variables: gestational weeks at the beginning of steroid treatment, weeks at delivery, type of birth, puerperal pathology; neonatal variables: sex, Apgar score, weight, height and cephalic perimeter at birth, and neonatal pathology. We performed a descriptive and comparative study on both groups. Results: No statistically significant differences were found between the groups. However, there were more cases of bronchopulmonary dysplasia (P=.09) in group 1.Conclusions: Repeated weekly doses of corticosteroids do not improve perinatal outcomes and are not associated with adverse effects (AU)

Isquemia coronaria producida por seudoxantoma elástico y revascularización miocárdica con doble injerto arterial / Coronary Heart Disease Produced by Pseudoxanthoma Elasticum and Coronary Artery Bypass with Double Internal Mammary Artery

Presentamos el caso de una mujer de 18 años que, tras la biopsia de una lesión cutánea, fue diagnosticada de seudoxantoma elástico. A pesar de estar asintomática se realizaron una serie de estudios para descartar la posible existencia de enfermedad coronaria. La ergometría y los estudios isotópicos demostraron isquemia miocárdica. En la coronariografía se observaron lesiones obstructivas severas en los tres territorios. Después de una arteriografía de ambas mamarias, troncos supraaórticos y arterias mesentéricas que no demostró lesiones, fue revascularizada quirúrgicamente con un resultado satisfactorio (AU)