A unique case of primary effusion lymphoma-like lymphoma showing disappearance and recurrence of the body cavity effusion.

Primary effusion lymphoma-like lymphoma (PEL-LL) is a rare B-cell lymphoma that the etiology remains unclear. We describe a case of PEL-LL with a pleuropericardial effusion. Diagnosis required long period of time as it followed a unique progress of disappearance and recurrence of the body cavity effusion. We finally had a diagnosis of B-cell lymphoma by the immunocytochemistry of effusion using the cell block procedure. Authors consider that it is valuable to actively try the cell block procedure at the time of the first drainage for early diagnosis, if the body cavity effusion due to the malignancy is suspected.

Comparison of the Effects of Carperitide and Tolvaptan on Patients with Left Ventricular Dysfunction: A Two-Center Retrospective Study.

In patients with left ventricular (LV) dysfunction, diuretics can reduce blood pressure and lead to electrolyte abnormalities. The aim of this study was to compare the effects of tolvaptan (T group) and carperitide (C group) in these patients. Sixty-one consecutive patients admitted to the Iwate Prefectural Kuji Hospital or the Emergency Center of the Iwate Medical University between July 2011 and April 2015 were included in this study. These patients had acute heart failure (HF) and were initially treated with furosemide. Patients were excluded from the study if they received combined carperitide and tolvaptan, if they received tolvaptan or cardiotonic drugs prior to the study period, if their LV ejection fraction was ≥40%, and if they had renal dysfunction (serum creatinine > 2.0 mg/dL). There were no differences in the change in serum electrolytes in both groups, and none of the patients in the T group received supplementary dobutamine therapy. Oxygen administration was stopped successfully after a significantly shorter treatment period in the T group. These findings suggest that patients treated with tolvaptan did not require dobutamine as frequently as those treated with carperitide and indicated that tolvaptan may improve respiratory function more rapidly in patients with LV dysfunction.

Possible usefulness of gadolinium-enhanced brain MRI for evaluating risk of perioperative hemorrhage: a case of infective endocarditis.

A 59-year-old woman visited a local hospital for fever and was diagnosed as having infective endocarditis (IE) on the basis of blood cultures and transthoracic echocardiography. Based on clinical episodes of subarachnoid hemorrhage after admission, it was judged that she was not a good candidate for urgent open heart surgery, and it was decided to treat her with conservative medical therapy for the acute phase. We explored the optimum timing for surgery by employing gadolinium (Gd) contrast medium-enhanced magnetic resonance imaging (MRI) T2* weighted image (black dots) due to her high risk of perioperative cerebral hemorrhage. After the disappearance of the contrast media enhancement effect around the black dots, open heart surgery was performed successfully on the 103rd hospitalization day. The patient was discharged 22 days after the surgery with no clinical complications. This case suggests that disappearance of the contrast media enhancement effect around the black dots may be a useful marker for optimal timing of surgery to minimize the risk of perioperative cerebral hemorrhage in patients with IE. Learning Objective. The MRI T2* weighted images including those with Gd contrast medium enhancement effect may be useful for evaluating the risk of perioperative intracranial hemorrhage in IE.

Mild renal dysfunction on admission is an important prognostic predictor in patients with infective endocarditis: a retrospective single-center study.

OBJECTIVE: Infective endocarditis (IE) continues to be associated with high mortality. The aim of the present study was to identify prognostic predictors for short-term mortality in patients with IE. METHODS: We conducted a retrospective study of 119 consecutive patients with IE (mean age 58±17). Prognostic predictors for mortality at the early phase of admission were determined using a multivariate regression analysis, and a receiver operating characteristic (ROC) analysis was carried out to evaluate the predictive ability. RESULTS: Eleven of 119 patients died during hospital admission. In this non-survivor group, the clinical parameters at the time of admission, including serum creatinine (Cr), the estimated glomerular filtration rate (eGFR), the red blood cell count, the white blood cell count, the serum CRP level and heart rate, differed significantly from those observed in the survivors (all; p<0.05). According to a logistic regression analysis, an increase in log-serum Cr per one standard deviation (odds ratio=2.18, 95%CI=1.08-4.41) and a decrease in log-eGFR per one standard deviation (odds ratio=0.51, 95%CI=0.26-0.98) were significantly associated with in-hospital death. The area under the ROC curve for serum Cr to predict the outcome was 0.80, the sensitivity was 64% and the specificity was 85% at a cut-off value of 1.16 mg/dL. For eGFR, the area under the ROC curve was 0.77, the sensitivity was 64% and the specificity was 86% at a cut-off value of 47.5 mL/min./1.73 m(2). CONCLUSION: Mild renal dysfunction at the time of admission is an important predictor of early phase mortality in patients with IE.

Spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma.

We present a case of spontaneous healing of saccular type aneurysm with ventricular septal lacerations after blunt chest trauma. A 50-year-old Japanese man was transferred to our hospital diagnosed with ventricular septal lacerations after blunt chest trauma. Electrocardiogram (ECG) at admission showed ST elevations in I, II, III, aVL, aVF, V2-through to V6 were observed. Laboratory data showed elevated creatine kinase. Echocardiogram revealed normal ventricular contraction and a saccular type ventricular septal laceration with an influx blood flow without septal shunt flow. After admission, serial echocardiogram and cardiac computed enhancement tomography showed disappearance of a saccular type ventricular septal laceration. Gadolinium-enhanced magnetic resonance imaging (MRI) was performed at day 30. MRI showed an enhanced scar of saccular type aneurysm with ventricular septal laceration; this image suggested some residual damage of ventricular septal laceration. At discharge, ECG was resolved with normal ST-T level and no Q wave, but persistent complete right bundle branch block and left axis deviation. After one year, repeat MRI showed a scar of saccular type aneurysm with ventricular septal laceration. .