Endoscopic treatment of pancreatic fluid collection in gastric heterotopic pancreas. A case report.

BACKGROUND: Heterotopic pancreas is defined as pancreatic tissue located outside the pancreatic parenchyma that lacks an anatomic or vascular connection to the normal pancreas. Symptomatic gastric heterotopic pancreas is a rare condition that can manifest as acute or chronic pancreatitis. Asymptomatic heterotopic pancreas does not require treatment, while symptomatic lesions should be resected. The modality of final resection of heterotopic pancreas depends on its size and the depth of gastric wall involvement. METHODS AND RESULTS: A 36-year-old woman was admitted for recurrent epigastralgia. Abdominal computed tomography (CT) scan revealed that an abscess had formed in the gastric antrum. After multidisciplinary discussion we decided for conservative treatment with intravenous antibiotics and further detailed endoscopic diagnostic. Esophagogastroduodenoscopy revealed a submucosal mass with a central fistula and intermittent pus secretion in the prepyloric region of the gastric antrum, which was subsequently drained with a double pigtail stent under endoscopic ultrasound (EUS) and fluoroscopy. The possibility of pancreatic fluid collection in the case of heterotopic pancreas was suggested during the EUS examination, and histology subsequently confirmed heterotopic pancreatic tissue. The patient was in good condition and without any abdominal pain. According to a control CT scan after 10 weeks, the fluid collection was completely resolved. Due to the possible recurrence of pancreatitis, resection of heterotopic pancreas was proposed to the patient. Since the lesion involved the muscularis propria of the gastric wall, surgical resection of the mass was indicated. CONCLUSION: Fluid collections after acute pancreatitis in heterotopic pancreas in the gastric antrum can be successfully managed by endoscopy.

The prevalence and clinical outcome of supraventricular tachycardia in different etiologies of pulmonary hypertension.

PURPOSE: Patients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative incidence of SVT in patients with different etiologies of PH. The secondary objective was to analyse the clinical impact of SVT. METHODS: We retrospectively studied the prevalence of SVT and the clinical outcome in 755 patients (41% males; 60 ± 15 years; mean follow-up 3.8 ± 2.8 years) with PH of different etiologies. The prevalence of SVT was analysed separately in isolated pre-capillary PH (Ipc-PH) and in patients with combined post- and pre-capillary PH (Cpc-PH). RESULTS: The prevalence of SVT in the Ipc-PH group (n = 641) was 25% (n = 162). The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients). An excessive prevalence of SVT was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01). Out of the overall study population, Cpc-PH was present in 114 (15%) patients. Patients with Cpc-PH manifested a higher prevalence of SVT than subjects with Ipc-PH (58; 51% vs. 162; 25%; p <0.0001) and were more likely to have persistent or permanent atrial fibrillation (38; 29% vs. 61; 10%; p <0.0001). Parameters significantly associated with mortality in a multivariate analysis included age, male gender, functional exercise capacity and right atrial diameter (p < 0.05). Neither diagnosis of SVT nor type of arrhythmia predicted mortality. CONCLUSIONS: The study detected a significant prevalence of SVT in the population of PH of different origins. Different spectrum and prevalence of arrhythmia might be expected in different etiologies of PH. Patients with an elevated post-capillary pressure showed a higher arrhythmia prevalence, predominantly due to an excessive number of atrial fibrillations. The diagnosis of SVT was not associated with mortality.

Correlation between ADR of screening and all colonoscopies.

BACKGROUND AND AIMS: Colonoscopy with polypectomy are associated with a reduction in the incidence of colorectal cancer (CRC), as well as mortality, secondary to CRC. Because of the variation in physicians' performance and the risk of interval CRC after a colonoscopy, several quality indicators have been established. ADR (adenoma detection rate) is a generally accepted quality indicator. But it is also a target of possible gaming and achieving an adequate number of colonoscopies only from screening may be a problem for some practices. The aim of this study was to compare ADR for colonoscopies done for various indications and to look for correlations between the ADR of screening and all examinations. METHODS: We retrospectively assessed the quality indicators of all colonoscopies performed in a nonuniversity hospital, Frydek-Mistek, from January 2013 to December 2017. We calculated the ADR for all colonoscopies in patients over 50 years of age (subdivided into screening, surveillance, diagnostic) and separately only for screening colonoscopies. Correlations were made using the Pearson's correlation coeficient. RESULTS: The sample was composed of 6925 patients over 50 years of age (3620 men, 3305 women, mean age 66.2 years). The ADRs for screening and surveillance were higher than for diagnostic colonoscopies for all of the endoscopists, and the ADRs for all colonoscopies were lower than for screening, but sufficiently over 25%. There was a positive correlation between the ADR of screening and all colonoscopies (r=0.906, P<0.005). CONCLUSIONS: The calculation of ADR for all colonoscopies was possible in our endoscopic department, and there was a positive correlation with ADR for screening colonoscopies. ADR for all colonoscopies is a good tool for calculating real ADR from large sample sizes without gaming. TRIAL REGISTRATION: ClinicalTrials.gov (NCT03730441).

The impact of riociguat on clinical parameters and quality of life in patients with chronic thromboembolic pulmonary hypertension - results of a retrospective clinical registry.

AIMS: The primary objective of the registry was to assess the impact of riociguat on clinical parameters and quality of life in patients with chronic thromboembolic pulmonary hypertension (CTEPH) that was inoperable or persistent/recurrent after pulmonary endarterectomy (PEA). In contrast to randomized pivotal trials, this non-interventional registry evaluated the effectiveness and safety of riociguat in a real-world setting. METHODS: Retrospective data were collected from patients' charts as recorded in routine clinical practice from the initiation of riociguat therapy up to approximately 5 months and 1 year after this initiation. RESULTS: In total, 51 patients from a single site were enrolled. After 5 months (mean duration) of riociguat treatment, the following improvements from baseline were observed: change of distance in the 6-minute walking distance (6MWD) (P=0.066); change of score from the quality of life questionnaire (EQ5D-5L) (P=0.020), and overall self-assessment of health status (P=0.001). New York Heart Association (NYHA) class improved in 24.3% of patients. After 11.2 months (mean duration) of riociguat treatment, the following improvements from baseline were observed: change of distance in the 6MWD test (P=0.006), and overall self-assessment of health status (P=0.009). NYHA class improved in 46.4% of patients. Riociguat was well tolerated. In total, 4 patients reported side effects, with hospitalization required in one case and 2 patients who had to discontinue the treatment. Annual survival rate was 89.1%. CONCLUSION: Riociguat improves functional NYHA class, distance in the 6MWD test and quality of life in a real-world patient population.

Cardiac involvement in hypereosinophilia.

Cardiac abnormalities associated with hypereosinophilia represent rare diseases and occurs most commonly due to hypersensitivity or allergic reactions, other possible etiologies cover infections, malignancy, vasculitis or hypereosinophilic syndromes. Three stages of cardiac involvement are usually described. Initially, myocardial inflammation occurs, that can continue with a thrombotic stage and eventually progress to the last irreversible stage called endomyocardial fibrosis, which represents one of the acquired forms of restrictive cardiomyopathy. In most patients, increased levels of eosinophils in the blood differential test; however, it may not be present in the initial stages of the disease. Of the imaging methods, magnetic resonance imaging and positron emission tomography combined with CT PET-CT are used in addition to echocardiography. Endomyocardial biopsy may be indicated for definitive evidence of eosinophilic myocarditis. The clarification of the cause of hypereosinophilia is necessary for specific treatment of this disorder.

Atrial fibrillation and atrial tachycardia in patients with chronic thromboembolic pulmonary hypertension treated with pulmonary endarterectomy.

Atrial fibrillation (AF) and atrial tachycardia (AT) are frequently observed in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who were treated with pulmonary endarterectomy (PEA). Their prevalence and impact on prognosis of patients are not known. We analysed the prevalence of AF/AT and the clinical outcome in 197 patients with CTEPH treated with PEA (median age 62; interquartile range 53-68 years; 62% males). The prevalence of AF/AT was 29% (57 patients). Compared to patients without arrhythmia, the subjects with AF/AT were older [60 (50-67) vs. 62 (57-70) years], manifested an increased size of the left atrium [39 (35-44) vs. 45 (40-50) mm], had a reduced 6-min walking distance [411 (321-506) vs. 340 (254-460) m], and higher pulmonary artery systolic pressure after PEA [38 (30-47) vs. 45 (38-71) mmHg], all results with P-value <0.05. During the follow-up with a median 4.2 (1.6-6.3) years, 45 (23%) patients died. In a multivariate Cox regression model only the male gender [hazard ratio (HR) 2.27, 95% confidence interval (CI) 1.15-4.50], a reduced 6-min walking distance (HR 3.67, 95% CI 1.74-7.73), and an increased New York Heart Association class (HR 8.56, 95% CI 4.17-17.60) were associated with mortality (P < 0.05). The prevalence of AF/AT in patients with CTEPH treated with PEA is high. Arrhythmias are associated with reduced functional capacity but not with mortality.

[The benefit of magnetic resonance for diagnosing cardiomyopathy and myocarditis]. / Prínos magnetické rezonance pro diagnostiku kardiomyopatií a myokarditidy (1. cást).

Magnetic resonance is becoming an increasingly used examination in cardiology, since it greatly improves the accuracy of diagnosing of many heart diseases. At present magnetic resonance is the gold standard in assessing the volumes of the heart chambers and the systolic function of both ventricles. The possibility of detecting tissue characteristics to refine the diagnostics of different types of myocardial pathology is of essential importance. The authors summarize in the article the present knowledge about the use of magnetic resonance of the heart in the field of myocardial disease, i.e. cardiomyopathy and myocarditis. The first part of the review gives a general introduction into the topic of magnetic resonance examination of myocardial diseases, which is followed by a detailed descrip-tion of the benefits of this imaging method in dilated cardiomyopathy and myocarditis,in hypertrophic cardio-myopathy, and arrhythmogenic right ventricular cardiomyopathy.Key words: fibrosis - cardiomyopathy - magnetic resonance - myocarditis - late contrast agent saturation.

[The benefit of magnetic resonance for diagnosing cardiomyopathy and myocarditis]. / Prínos magnetické rezonance pro diagnostiku kardiomyopatií a myokarditidy (2. cást).

Magnetic resonance is becoming an increasingly used examination in cardiology, since it greatly improves the accuracy of diagnosing of many heart diseases. At present magnetic resonance is the gold standard in assessing the volumes of the heart chambers and the systolic function of both ventricles. The possibility of detecting tissue characteristics to refine the diagnostics of different types of myocardial pathology is of essential importance. The authors summarize in the article the present knowledge about the use of magnetic resonance of the heart in the field of myocardial disease, i.e. cardiomyopathy and myocarditis. In the first of this article, a general overview of cardiac magnetic resonance examination has been given, followed by detailed description of its usefulness in dilated cardiomyopathy and myocarditis, in hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. The second part of the review summarizes the benefits of cardiac magnetic resonance examination in cardiac amyloidosis and other less common cardiomyopathies.Key words: fibrosis - cardiomyopathy - magnetic resonance - myocarditis - late contrast agent saturation.