Normalization of FFRCT after surgical unroofing of a myocardial bridge: a case report.

Background: Cardiac computed tomography angiography derived fractional flow reserve (FFRCT) is a diastolic measurement and has emerged as a valuable non-invasive alternative to FFR in patients with stable coronary artery disease. It has, unlike FFR during coronary angiography, not been validated for the physiological evaluation of an isolated myocardial bridge (MB) so far. Case summary: Our patient, previously known with a long myocardial bridge of the mid-segment of the left anterior descending artery, presented with a non-ST-segment elevation myocardial infarction that was treated by surgical unroofing of the MB. FFRCT after surgery confirms a major amelioration of coronary blood flow. Discussion: Myocardial bridge may rarely present as a non-ST-segment elevation myocardial infarction. FFRCT has thus far been accepted as a useful diagnostic tool in stable coronary artery disease. Our case report suggests that cardiac computed tomography angiography may be considered a useful technique for anatomical and physiological evaluation of MBs.

Glucocorticoid-mediated effects on angiogenesis in solid tumors.

Angiogenesis is essential in tumor development to maintain the oxygen and nutrient supply. Glucocorticoids have shown both direct and indirect angiostatic properties in various types of solid cancers. In most of the reported cases glucocorticoid-mediated actions involved suppression of multiple pro-angiogenic factors expression by cancer cells. The anti-angiogenic properties of glucocorticoids correlated with diminished tumor vasculature and reduced tumor growth in multiple in vivo studies. However, when glucocorticoid treatment is considered, possible adverse events should be taken into account. Additional research is needed to further test the use of these steroidal drugs in cancer therapy.

Single-centre experience on transthyretin familial amyloid polyneuropathy: case series and literature review.

Familial amyloid polyneuropathy (FAP) is a most often length-dependent axonal neuropathy, often part of a multisystem disorder also affecting other organs, such as cardiac, gastrointestinal, genitourinary, renal, meningeal and eye tissue. It is most frequently the result of a mutation in the TTR gene, most commonly a p.Val50Met mutation. TTR-FAP is a rare autosomal dominant heritable disabling, heterogeneous disease in which early diagnosis is of pivotal importance when attempting treatment. This paper discusses the course of four Belgian FAP patients with different TTR mutations (p.Val48Met; p.Val52Ala; p.Ala59Val; p.Val50Met). We also review the diagnosis and differential diagnosis of TTR-FAP, diagnostic studies, follow-up, its current treatment and those in development, prognosis and the importance of genetic counseling. At first, TTR-FAP is often misdiagnosed as a chronic inflammatory demyelinating polyneuropathy or chronic idiopathic axonal polyneuropathy. Genetic testing is obligatory to confirm the diagnosis of TTR-FAP, except in familial cases. Biopsy samples are an asset in diagnosing TTR-FAP but can be falsely negative. At the moment, tafamidis meglumine is considered as first-line treatment in stage I neurological disease. Patients eligible for liver transplantation should be carefully selected when first-line therapy fails.