Persistent PR segment change in malignant pericardial disease.

BACKGROUND: Electrocardiographic changes may manifest in patients with pericardial effusions. PR segment changes are frequently overlooked, but when present, can provide diagnostic significance. The diagnostic value of PR segment changes in determining benign versus malignant pericardial disease in cancer patients with pericardial effusions has not been investigated. We aimed to determine the relationship between PR segment changes and malignant pericardial disease in cancer patients presenting with pericardial effusions. METHODS: Consecutive patients with active malignancy who underwent surgical subxiphoid pericardial window by a single thoracic surgeon between 2011 and 2014 were included in this study. A total of 104 pre- and post-operative ECGs were reviewed, and PR depression or elevation was defined by deviation of at least 0.5 millivolts from the TP segment using a magnifying glass. Pericardial fluid cytology, flow cytometry and tissue biopsy were evaluated. Baseline characteristics and co-morbidities were compared between cancer patients with benign and malignant pericardial effusions. RESULTS: A total of 26 patients with active malignancy and pericardial effusion who underwent pericardial window over the study period were included. Eighteen (69 %) patients had isoelectric PR segments, of whom none (0 %) had evidence of malignant pericardial disease (100 % negative predictive value). Eight (31 %) patients had significant ECG findings (PR segment depression in leads II, III and/or aVF as well as PR elevation in aVR/V1), all 8 (100 %) of whom had pathologically confirmed malignant pericardial disease (100 % positive predictive value). PR segment changes in all 8 patients persisted (up to 11 months) on post-operative serial ECGs. The PR segment changes had no relationship to heart rate or the time of atrial-ventricular conduction. CONCLUSIONS: In patients with active cancer presenting with pericardial effusion, the presence of PR segment changes is highly predictive of active malignant pericardial disease. When present, PR changes typically persist on serial ECGs even after pericardial window.

Cross-sectional comparison of live and interactive voice recognition administration of the SF-12 health status survey.

OBJECTIVE: To compare interactive voice recognition (IVR) and live telephone methods for administering the SF-12 health status survey (SF-12). STUDY DESIGN: Patients with low back pain received either IVR or live interviews in a cross-sectional design with partial randomization. The interviews consisted of the SF-12 and some additional questions specific to low back pain. PATIENTS AND METHODS: Complete findings were obtainable from 229 patients. Summary scales were compared by using multivariate analysis of variance with mean comparisons for continuously scored items. Response frequencies for categorically scored items were compared by using the chi-square test. RESULTS: The 2 methods produced similar results on the Physical Component Summary scale but not the Mental Component Summary scale. Compared with patients who had a live telephone interview, the patients using IVR acknowledged significantly greater overall mental interference, greater general emotional concerns, and poorer mood and overall health. CONCLUSIONS: Because IVR eliminates the demand characteristics of responding to a personal interviewer, it may be a desirable way to evaluate sensitive topics. It also may reduce costs of data entry, labor, and measurement error.

A comparison of medullary thyroid carcinoma and thyroid adenocarcinoma in dogs: a retrospective study of 38 cases.

The medical records of 38 dogs with thyroid neoplasia that were treated by surgical excision of the tumor, or had an incisional biopsy performed as a diagnostic procedure, were reviewed. Of the 38 dogs, 21 (55%) had resectable tumors, whereas 17 (45%) had an incisional biopsy as the tumors were nonresectable. All dogs had an initial diagnosis of thyroid carcinoma. The type of carcinoma was confirmed in 33 dogs by histological and immunohistochemical examination. Twelve dogs (36%) had medullary thyroid carcinoma, and 21 dogs (64%) had thyroid adenocarcinoma. Of the 12 dogs with medullary thyroid carcinoma, 10 (83%) had resectable tumors. Of the 10, three (30%) had at least a 1-year survival. None had radiographic evidence of metastasis at the time of surgery. Of the 21 dogs with thyroid adenocarcinoma, 11 (52%) had resectable tumors. Of the 11 dogs, five (45%) had at least a 1-year survival. Three dogs had radiographic evidence of metastasis at the time of surgery. Of 10 dogs with nonresectable thyroid adenocarcinoma, two dogs (20%) had at least a 1-year survival. In the dogs in this study, medullary thyroid carcinoma was more prevalent than previously reported. Most of the medullary thyroid carcinomas were well circumscribed and resectable. Medullary thyroid carcinoma may possess gross and histological characteristics of a less malignant nature when compared with other thyroid carcinomas.

Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group.

BACKGROUND: Milrinone, a phosphodiesterase inhibitor, enhances cardiac contractility by increasing intracellular levels of cyclic AMP, but the long-term effect of this type of positive inotropic agent on the survival of patients with chronic heart failure has not been determined. METHODS: We randomly assigned 1,088 patients with severe chronic heart failure (New York Heart Association class III or IV) and advanced left ventricular dysfunction to double-blind treatment with (40 mg of oral milrinone daily (561 patients) or placebo (527 patients). In addition, all patients received conventional therapy with digoxin, diuretics, and a converting-enzyme inhibitor throughout the trial. The median period of follow-up was 6.1 months (range, 1 day to 20 months). RESULTS: As compared with placebo, milrinone therapy was associated with a 28 percent increase in mortality from all causes (95 percent confidence interval, 1 to 61 percent; P = 0.038) and a 34 percent increase in cardiovascular mortality (95 percent confidence interval, 6 to 69 percent; P = 0.016). The adverse effect of milrinone was greatest in patients with the most severe symptoms (New York Heart Association class IV), who had a 53 percent increase in mortality (95 percent confidence interval, 13 to 107 percent; P = 0.006). Milrinone did not have a beneficial effect on the survival of any subgroup. Patients treated with milrinone had more hospitalizations (44 vs. 39 percent, P = 0.041), were withdrawn from double-blind therapy more frequently (12.7 vs. 8.7 percent, P = 0.041), and had serious adverse cardiovascular reactions, including hypotension (P = 0.006) and syncope (P = 0.002), more often than the patients given placebo. CONCLUSIONS: Our findings indicate that despite its beneficial hemodynamic actions, long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure. The mechanism by which the drug exerts its deleterious effects is unknown.

Carboxymethyl-cellulose microchromatography for the quantitation of hemoglobin Bart's (gamma 4) and its use in the detection of the alpha-thalassemia conditions.

A modification of an existing (micro) CM-cellulose chromatographic procedure is introduced for the quantitation of hemoglobin Bart's (or gamma 4) in blood samples of newborn babies. Normal newborn with four active alpha chain genes (alpha alpha/alpha alpha) have small amounts (average 0.55%) of this abnormal hemoglobin while increased percentages are present in newborn with an alpha-thalassemia-2 heterozygosity (alpha 0 alpha/alpha alpha; average 1.55%) or an alpha-thalassemia-2 homozygosity (alpha 0 alpha/alpha 0 alpha; average 4.65%). The identification of hemoglobin Bart's in normal newborn was made by high-performance liquid chromatography, and the absence of contaminating non-hemoglobin proteins was confirmed by electrophoresis and additional chromatographic experiments. This rapid procedure is useful for the detection and differentiation at time of birth of the different alpha chain deficiencies which are common among various populations in the world.