Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFRCT.

PURPOSE: To determine the occurrence of physiological significant coronary artery disease (CAD) by coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) in asymptomatic patients with a new diagnosis (<1 year) of type-2 diabetes mellitus (T2DM). METHODS: FFRCT-analysis was performed from standard acquired coronary CTA data sets. The per-patient minimum distal FFRCT-value (d-FFRCT) in coronary vessels (diameter ⩾1.8 mm) was registered. The threshold for categorizing FFRCT-analysis as abnormal was a d-FFRCT ⩽0.75. Total plaque volume and volumes of calcified plaque, non-calcified plaque, and low-density non-calcified plaque (LD-NCP) were assessed by quantitative plaque analysis. RESULTS: Overall, 76 patients; age, mean (SD): 56 (11) years; males, n (%): 49(65), were studied. A total of 57% of patients had plaques. The d-FFRCT was ⩽0.75 in 12 (16%) patients. The d-FFRCT, median (IQR), was 0.84 (0.79-0.87). Median (range) d-FFRCT in patients with d-FFRCT ⩽0.75 was 0.70 (0.6-0.74). Patients with d-FFRCT⩽0.75 versus d-FFRCT >0.75 had numerically higher plaque volumes for all plaques components, although only significant for the LD-NCP component. CONCLUSION: Every sixth asymptomatic patient with a new diagnosis of T2DM has hemodynamic significant CAD as evaluated by FFRCT. Flow impairment by FFRCT was associated with coronary plaque characteristics.

High burden of coronary atherosclerosis in patients with a new diagnosis of type 2 diabetes.

PURPOSE: The purposes of this study were to compare the presence, extent and composition of coronary plaques in asymptomatic patients with newly diagnosed type 2 diabetes to age- and sex-matched controls. METHODS: Patients with newly diagnosed (<1 year) type 2 diabetes ( n = 44) and controls ( n = 44) underwent contrast-enhanced coronary computed tomography angiography. Advanced plaque analysis including total plaque volume and volumes of plaque components (calcified plaque and non-calcified plaque, including low-attenuation [low-density non-calcified plaque]) was performed using validated semi-automated software. RESULTS: Coronary artery calcification was more often seen in patients with type 2 diabetes (66%) versus controls (48%), p < 0.05. Both the absolute volume (median; interquartile range) of low-density non-calcified plaque (7.9 mm3; 0-50.5 mm3 vs 0; 0-34.3 mm3, p < 0.05) and the increase in low-density non-calcified plaque ratio in relation to total plaque volume ( τ = 0.5, p < 0.001) were significantly higher in patients with type 2 diabetes. More patients with type 2 diabetes had spotty calcification (31% vs 0%, p < 0.05). By multivariate analysis, the presence of any low-density non-calcified plaque was higher in males (odds ratio: 4.06, p < 0.05), who also demonstrated a larger low-density non-calcified plaque volume ( p < 0.001). The presence and extent of low-density non-calcified plaque increased with age, smoking, hypertension and hyperglycaemia, all p < 0.05. CONCLUSION: Asymptomatic patients with newly diagnosed type 2 diabetes had plaque features associated with increased vulnerability as compared with age- and sex-matched controls.

[Amyloidosis is a rare cause of heart failure]. / Amyloidose er en sjælden årsag til hjertesvigt.

Light-chain amyloidosis (AL) is the most common form of systemic amyloidosis and is associated with an underlying plasma cell dyscrasia. The disease is often difficult to recognize because of its broad range of manifestations and often vague symptoms. The clinical symptoms include proteinuria, hepatomegaly, heart failure and autonomic or sensory neuropathy. A 70-year-old man with a past medical history of sacroidosis and heart failure was admitted to hospital. He had breathlessness and swelling of his lower extremities. Among other symptoms the combination of transthoracic echo-cardiogram findings and low voltage on the ECG led to the diagnosis AL.

[Liposarcoma in the lung misinterpreted as an infection of Echinococcus multicularis].

Primary liposarcoma of the lung is an extremely rare disease. Only 14 cases have been reported in the literature in English. Liposarcoma is not sensitive to chemotherapy or radiotherapy. Surgical resection is considered the only therapeutic option. We present a case of a giant liposarcoma occupying two thirds of the right thoracic cavity.

Familial hypocalciuric hypercalcemia and calcium sensing receptor.

Familial hypocalciuric hypercalcemia (FHH) is a lifelong, benign autosomal dominant disease characterized by hypercalcemia, normal to increased parathyroid hormone level, and a relatively low renal calcium excretion. Inactivation of the calcium-sensing receptor in heterozygous patients results in FHH, while in homozygous patients as well as in compound heterozygous or dominant negative heterozygous patients, it may result in neonatal severe hyperparathyroidism (NSHPT). Parathyroid surgery is not indicated in FHH and does not lower plasma calcium unless total parathyroidectomy is performed, in which case hypocalcemia ensues. There is currently no definitive medical treatment available, although pamidronate can be used to stabilize these patients before parathyroidectomy. Some NSHPT patients are asymptomatic subsequently in their lives. In this paper, clinical characteristics of this relatively rare disorder are presented.

"Live High-Train High" increases hemoglobin mass in Olympic swimmers.

PURPOSE: This study tested whether 3-4 weeks of classical "Live High-Train High" (LHTH) altitude training increases swim-specific VO2max through increased hemoglobin mass (Hbmass). METHODS: Ten swimmers lived and trained for more than 3 weeks between 2,130 and 3,094 m of altitude, and a control group of ten swimmers followed the same training at sea-level (SL). Body composition was examined using dual X-ray absorptiometry. Hbmass was determined by carbon monoxide rebreathing. Swimming VO2peak was determined and swimming trials of 4 × 50, 200 and 3,000 m were performed before and after the intervention. RESULTS: Hbmass (n = 10) was increased (P < 0.05)after altitude training by 6.2 ± 3.9 % in the LHTH group, whereas no changes were apparent in the SL group (n = 10). Swimming VO2peak was similar before and after training camps in both groups (LHTH: n = 7, SL: n = 6). Performance of 4 × 50 m at race pace was improved to a similar degree in both groups (LHTH: n = 10, SL: n = 10). Maximal speed reached in an incremental swimming step test (P = 0.051), and time to complete 3,000 m tended (P = 0.09) to be more improved after LHTH (n = 10) than SL training (n = 10). CONCLUSION: In conclusion, 3-4 weeks of classical LHTH is sufficient to increase Hbmass but exerts no effect on swimming-specific VO2peak. LHTH may improve performance more than SL training.

Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study.

BACKGROUND: Capillary refill time (CRT) has been advocated as a tool for rapid assessment of circulatory status. The correlation between neither CRT and mortality nor CRT and markers of circulatory status has been assessed. We performed a prospective observational cohort study to assess the relationship between CRT (using two existing definitions and as a continuous variable) and short-term mortality. METHODS: We included all acutely admitted adult patients to a medical admission unit. We measured CRT, blood pressure, pulse, temperature and peripheral oxygen saturation. We presented the data descriptively. Difference between continuous data was analysed using Wilcoxon Rank Sum Test and categorical data using χ(2) test. The primary endpoint was 1-day all-cause mortality. RESULTS: 3046 patients were enrolled and CRT was measured on 1935. In univariate analyses, we found increasing all-cause 1-day mortality with all definitions of CRT. Performing multivariable analysis, controlling for age, sex, mean blood pressure, pulse, temperature and peripheral oxygen saturation, we found increasing CRT as a continuous variable and according to the Schriger and Baraff definition to be associated with increased mortality. Both the Trauma score and Schriger and Baraff definitions had high negative predictive values. The calculations on the Schriger and Baraff definition were based on limited power. CONCLUSIONS: We found a significant association between CRT measured as a continuous variable and short-term mortality. Using the definition of Schriger and Baraff also seems appropriate, but this is based on calculations of limited power.

[Munchausen disease diagnosed ten years after debut]. / Münchausens syndrom blev diagnosticeret to år efter symptomdebut.

Munchausen disease is difficult to diagnose especially because it is often an exclusion diagnosis. We present a case of skin ulcers in a young woman, who was eventually diagnosed with Munchausen disease.

Combined vertebral assessment and bone densitometry increases the prevalence and severity of osteoporosis in patients referred to DXA scanning.

We performed a retrospective study to assess if vertebral fracture assessment (VFA) after routine bone mineral density (BMD) measurement on a dual-energy X-ray absorptiometry (DXA) machine had increased the number of patients diagnosed with osteoporosis and revealed previous unknown incident vertebral fractures. A total of 3275 patients were referred to bone densitometry by DXA to be screened for osteoporosis or evaluation of ongoing antiosteoporotic treatment. All spine X-rays obtained at our hospital from the same patients in the period from 3 mo before to 3 mo after the date of DXA scans were reviewed. Among the 3275 patients, 85% were females and 15% were males. In total, 68% of the patients had normal BMD, and 32% had osteoporosis. Vertebral fractures diagnosed by VFA were seen in 7.9% patients, of which 3.2% had normal BMD and 4.8% had osteoporosis assessed by BMD. The relative number of patients diagnosed with osteoporosis increased 9.79% and in absolute terms from 32.4% to 35.6% of patients referred to DXA. Addition of VFA to routine BMD measurement increased clinically significant the number of patients diagnosed with osteoporosis as well as the number of patients with fractures and thereby altered the severity and prognosis.

[Dapsone-induced methaemoglobinaemia]. / Dapsoninduceret methæmoglobinæmi.

Dapsone is used as an antibiotic for dermatological disorders and may cause methaemoglobinaemia. Specific treatment with intravenous methylene blue is the treatment of choice. We present a case of dapsone-induced methaemoglobinaemia. Arterial blood gas analysis showed that pH was 7.4, PaO2 11.7 kPa, PaCO2 4.5 kPa and bicarbonate concentration 21.9 mmol/l. The methaemoglobin level was found to be 32%. The symptoms were headache and tachycardia. Methylene blue was administered and the methaemoglobin level dropped to 5% within three days.