Primary malignant pericardial sarcomatoid mesothelioma: An autopsy report.

Primary malignant pericardial sarcomatoid mesothelioma (PMPSM) is an extremely rare tumor with poor prognosis. We present an autopsy case in an 80-year-old man admitted for heart failure after one month of treatment at an outpatient clinic. He died three months after symptom onset. A complete autopsy revealed localization of the tumor to the pericardium without other lesions. Histologically, mainly spindle-shaped atypical cells with hyperchromatic nuclei and nucleoli were observed. Immunohistochemical markers for mesothelioma were positive for calretinin, cytokeratin AE1/AE3, and cytokeratin CAM5.2. Thus, we diagnosed primary sarcomatoid malignant mesothelioma of the pericardium. To our knowledge, only four PMPSM cases have been reported in the English literature in the past 30 years. Although PMPSM is rare, clinicians and pathologists should recognize it as a possible diagnosis of pericardial tumors. It is necessary to accumulate clinical and pathological diagnostic findings to establish early detection methods for this extremely rare disease.

Detection of coronary artery stenosis after successful percutaneous coronary intervention by dipyridamole stress portable type signal-averaged electrocardiography: a prospective study.

In our previous studies, using portable type signalaveraged electrocardiography (portable SAECG) with dipyridamole stress we reported that patients with coronary artery disease were identified at the bedside with high sensitivity and specificity. In this study we prospectively investigated whether coronary artery stenosis after successful percutaneous coronary intervention (PCI) could be detected. Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 61 patients 8.0 +/- 9.4 months after successful PCI for myocardial infarction or angina pectoris (46 males and 15 females, mean age 66 +/- 12 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by the multiphasic oscillation method at each lead of the standard 12 leads, and the maximal value of changes in fQRSd (MAX DeltafQRSd) among the 12 leads was determined. The positive test was defined as MAX DeltafQRSd > or =5 ms, and negative as MAX DeltafQRSd <5 ms based on our previous studies. Then selective coronary arteriography was performed. In the positive group (n = 24), 21 patients had stenosis (> or =50%) of the coronary artery and 3 did not. In the negative group (n = 37), 8 patients had stenosis and 29 did not. The sensitivity, specificity, positive predictive accuracy, and negative predictive accuracy for the detection of coronary artery stenosis by SAECG were 72%, 91%, 88%, and 78%, respectively. Dipyridamole stress portable SAECG is useful to detect patients with coronary artery stenosis after successful PCI.

Portable-type signal-averaged electrocardiography with dipyridamole to detect patients with coronary artery disease.

BACKGROUND: In a retrospective study portable-type signal-averaged electrocardiography (SAECG) with dipyridamole stress was found to identify patients with coronary artery disease (CAD) at their bedside with high sensitivity and specificity, so the utility of this method was prospectively investigated in the present study. METHODS AND RESULTS: Standard 12-lead QRS wave SAECG was performed before and after dipyridamole stress at the bedside in 71 patients with chest pain (43 males, mean age 63 +/-9 years). The filtered QRS duration (fQRSd) before and after dipyridamole stress was determined by multiphasic oscillation method for each of the standard 12 leads, and the maximal value of changes in fQRSd (MAX DeltafQRSd) among the 12 leads was determined. The positive test was defined as MAX DeltafQRSd >or=5 ms, and negative as MAX DeltafQRSd <5 ms based on the previous study. Selective coronary arteriography was performed next. In the positive group (n=31), 25 patients had significant stenosis of the coronary artery and 6 did not. In the negative group (n=40), 5 patients had significant stenosis and 35 did not. The sensitivity, specificity, positive predictive accuracy and negative predictive accuracy for CAD detection by SAECG was 83%, 85%, 81% and 88%, respectively. CONCLUSIONS: Dipyridamole-stress portable SAECG is useful for detecting CAD at the patient's bedside with high sensitivity and specificity.