Cardiac Imaging and Management of Prosthetic Valve Candida Parapsilosis Endocarditis.

Fungal infective endocarditis is a rare and serious form of endocarditis associated with severe morbidity and mortality. The greatest propensity for infection can be found in patients with implanted prosthetic valves, implanted cardiac devices, and intravenous drug use. We present a case of a 45-year-old male with a prior bioprosthetic mitral valve who was diagnosed with Candida parapsilosis endocarditis. Computed tomography imaging of the abdomen was significant for splenic infarcts, and transesophageal echocardiography demonstrated a 1.23 cm x 0.55 cm lesion and 1.02 cm x 0.545 cm lesion on the bioprosthetic valve. The patient was subsequently treated with Amphotericin B and life-long Fluconazole. This case highlights the imaging findings and treatment of a rare disease process.

Pulmonary Vein Ganglia Are Remodeled in the Diabetic Heart.

Background Cardiac autonomic neuropathy is thought to cause adverse cardiovascular effects in diabetes mellitus. Pulmonary vein ganglia ( PVG ), which have been implicated in normal and abnormal heart rhythm regulation, have not been fully investigated in type 1 diabetes mellitus (T1D). We examined the functional and anatomical effects of T1D on PVG and studied the details of T1D-induced remodeling on the PVG structure and function. Methods and Results We used a mouse model of T1D (Akita mouse), immunofluorescence, isolated Langendorff-perfused hearts, and mathematical simulations to explore the effects of T1D on PVG . Whole-mount atrial immunofluorescence of choline acetyltransferase and tyrosine hydroxylase labeling showed that sympathetic and parasympathetic somas of the PVG neurons were significantly hypotrophied in T1D hearts versus wild type. Stimulation of PVG in isolated Langendorff-perfused hearts caused more pronounced P-P interval prolongation in wild type compared with Akita hearts. Propranolol resulted in a comparable P-P prolongation in both phenotypes, and atropine led to more pronounced P-P interval shortening in wild type compared with Akita hearts. Numerical modeling using network simulations revealed that a decrease in the sympathetic and parasympathetic activities of PVG in T1D could explain the experimental results. Conclusions T1D leads to PVG remodeling with hypotrophy of sympathetic and parasympathetic cell bodies and a concomitant decrease in the PVG sympathetic and parasympathetic activities.

Treatment of Depression With Duloxetine in Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes.

The mitochondrial cytopathies are a heterogeneous group of diseases characterized by heteroplasmic maternal transmission and selective dysfunction of tissues and organs highly dependent on aerobic respiration (eg, skeletal muscle, cardiac muscle, and brain). Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a specific subtype of mitochondrial cytopathy that is commonly associated with mood disturbances in individuals who survive until adulthood. Because of the altered cellular metabolism inherent in MELAS, it is often difficult to determine drug dosing, drug choice, and treatment response in patients with this rare disease. Historically, management of these patients focused on symptomatic relief and supplementation of compounds thought to optimize aerobic respiration (specifically, enzyme Co-Q10). We report a case in which an adult patient with MELAS and comorbid major depressive disorder demonstrated excellent response to the selective serotonin-norepinephrine reuptake inhibitor medication duloxetine.