Symptomatic Partial Congenital Absence of the Pericardium Revealed Using Cardiac Magnetic Resonance.

Congenital absence of the pericardium is a very uncommon finding, and its diagnosis poses a challenge because it is rarely suspected in daily clinical practice. Although in most cases it has a benign course, this congenital defect should be identified because of the associated risk of sudden death. We present a symptomatic case of partial congenital absence of the left pericardium suspected as the result of an abnormal response to exercise stress testing, and confirmed using cardiac magnetic resonance imaging. We review the current diagnostic tools and therapeutic indications of this rare anomaly.

Hepatitis C virus co-infection and sexual risk behaviour are associated with a high homocysteine serum level in HIV-infected patients.

BACKGROUND AND AIMS: A better understanding of the relationship of homocysteine with cardiovascular risk factors is needed. The objectives of this study were to assess the serum level of homocysteine in HIV-infected patients and to analyse the possible association of increased levels of the amino acid with cardiovascular risk factors, demographic and clinical characteristics of participants. METHODS: Cross-sectional study carried out as a supplementary task to the usual controls necessary in HIV-infected patients in the outpatient clinic of the Hospital General of Castellon, Spain. For two consecutive visits the demographic, clinical and HIV-related characteristics and blood analyses results were obtained for each participant. Homocysteine serum level was documented and the possible association of the amino acid with all the other study variables was assessed with a multiple linear regression analysis. RESULTS: A total of 145 patients were included. The mean homocysteine serum level of all participants was 11.9 ± 5.9 µmol/L. A total of 54 patients (37%) presented homocysteine serum levels higher than the upper limit of normal. An association was found between higher homocysteine serum level and the following variables: family history of early coronary disease (P = 0.027), sexual HIV risk behaviour (P = 0.016), hepatitis C virus co-infection (P = 0.002), higher height (P = 0.002), higher diastolic blood pressure (P = 0.049), lower serum level of folic acid (P <0.001), and lower serum level of vitamin B12 (P = <0.001). CONCLUSION: In the HIV population, increased homocysteine serum level is associated with sexual risk behaviour and hepatitis C virus coinfection.

[Value of early exercise stress testing in a chest pain unit protocol]. / Valor de la prueba de esfuerzo precoz en un protocolo de unidad de dolor torácico.

Early exercise testing (first 24 hours) was evaluated in the stratification of patients seen in the emergency room for chest pain. One hundred and forty-two consecutive patients without ischemia in the ECG or troponin I elevation were included. Ninety-two patients were discharged after the exercise testing (group I, 82 negative and 10 inconclusive test results) and 50 patients were hospitalized (group II, 29 positive and 21 inconclusive test results). In group I, cardiac events (unstable angina and non-fatal infarction) occurred in the next 30 days of follow-up in 2 patients with inconclusive test results; no cardiac events occurred in patients with negative test results. In group II, unstable angina was diagnosed in 30 patients and 3 presented recurrent angina. There were no complications during exercise testing. In conclusion, early exercise testing is safe and useful in the stratification of patients seen in the emergency room for chest pain. Only patients with negative test results should be discharged early.

Valor de la prueba de esfuerzo precoz en un protocolo de unidad de dolor torácico / Value of early exercise stress testing in a chest pain unit protocol

Se ha evaluado la prueba de esfuerzo precoz (primeras 24 h) en la estratificación de los pacientes que acuden a urgencias por dolor torácico. Se han incluido a 142 pacientes consecutivos sin isquemia en ECG ni elevación de troponina; 92 pacientes se dieron de alta tras la prueba (grupo I, 82 prueba negativa y 10 no concluyente) y 50 ingresaron (grupo II, 29 prueba positiva y 21 no concluyente). En el grupo I, 2 pacientes con prueba no concluyente presentaron episodios (angina inestable e infarto no mortal) a los 30 días; ninguno con prueba negativa tuvo episodios. En el grupo II se diagnosticó angina inestable en 30 pacientes y tres presentaron angina recurrente. No hubo complicaciones durante la prueba de esfuerzo. Se concluye que la prueba de esfuerzo precoz es útil y segura en la estratificación del paciente que acude a urgencias por dolor torácico. El alta precoz requiere que la prueba sea negativa (AU)

Osteocalcin and myoglobin removal in on-line hemodiafiltration versus low- and high-flux hemodialysis.

BACKGROUND: Removal of medium and large solutes is poor with low-flux (LF-HD) and limited with high-flux hemodialysis (HF-HD) and on-line hemodiafiltration (OL-HDF). In clinical practice, there are few in vivo solute markers. Osteocalcin is a protein with a molecular mass of 5,800 daltons, and myoglobin is a large molecule with a molecular mass of 17,200 daltons. The aim of this study was to evaluate the impact of OL-HDF on in vivo removal of a wide spectrum of solutes (urea, creatinine, osteocalcin, beta2-microglobulin, and myoglobin) in comparison to LF-HD and HF-HD. METHODS: Twenty-three patients (15 men, 8 women) were studied. Every patient underwent three dialysis sessions with routine HD parameters. We compared 1.8-m2 polysulfone LF-HD and 1.8-m2 polysulfone HF-HD versus OL-HDF. Predialysis and postdialysis solute concentrations were measured. The percentage of reduction ratio for each solute was calculated. RESULTS: Mean values for predialysis osteocalcin, beta2-microglobulin, and myoglobin were 16.3 +/- 21 ng/mL, 27.4 +/- 5 mg/L, and 239 +/- 162 ng/mL in LF-HD, respectively. Urea and creatinine reduction ratios were similar in LF-HD and HF-HD and only 1.2% higher in OL-HDF. Osteocalcin, beta2-microglobulin, and myoglobin reduction ratios for LF-HD were negligible. Mean osteocalcin reduction rates were 54.2% +/- 12% for HF-HD versus 63.5% +/- 9% for OL-HDF (reinfusion volume, 26.8 +/- 5 L/session; P < 0.01). Mean beta2-microglobulin reduction rates were 60.1% +/- 9% for HF-HD versus 75.4% +/- 9% for OL-HDF (P < 0.01). Mean myoglobin reduction rates were 24.5% +/- 6% and 62.7% +/- 9% for HF-HD and OL-HDF, respectively (P < 0.01). CONCLUSION: LF-HD does not seem to remove solutes with a molecular weight greater than 5,800 daltons. OL-HDF provides marked enhancement of convection volume and enables a significant increase in osteocalcin and beta2-microglobulin removal. Myoglobin extraction is nil with LF-HD, very low with HF-HD, and only adequate with OL-HDF.