Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical support and heart transplantation.

Giant cell myocarditis (GCM), a rapidly progressive inflammation of the myocardium, is associated with fulminant heart failure, refractory ventricular arrhythmias, and conduction system abnormalities. Few case reports have noted orbital myositis as the initial clinical presentation. Our case demonstrates a unique presentation of GCM with only ocular symptoms, which unlike prior studies, rapidly progressed to heart failure, tachyarrhythmias, and conduction disease. Our case necessitated quick recognition and treatment with mechanical support making this the first known case of GCM with successful placement of biventricular assist devices and ultimately with heart transplantation

A better model for membrane study: Mapping the effects of SOPC in a quaternary phase diagram

Honors Chemistry ThesisIn my study, I attempt to create a unique and more biologically relevant model of the cholesterol-rich exoplasmic leaflet of animal plasma membranes. Using electroswelling to create giant unilamellar vesicles, fluorescence microscopy, and the previously completed ternary mixture of DOPC, DSPC, and cholesterol, DOPC, a rare biological lipid, was gradually replaced with SOPC, an abundant biological lipid in order to create a partially completed quaternary phase diagram consisting of DOPC, SOPC, DSPC, and cholesterol. Focusing on the biological raft region, (Lo+Lα coexistence phase), reduction in the size of the coexistence region was found, thus verifying the notion that SOPC is more miscible with DSPC and cholesterol than is DOPC. DOPC replacements greater than 70% resulted in a disappearance of the coexistence region leading to a suspicion that the phase domains were too small to observe using optical fluorescence microscopy. The creation of a more biological model membrane can be used to further understand the role of lipids and proteins in cellular membranes as well as the size of biological rafts important in cellular function

Recurrent heart failure with preserved ejection fraction associated with carfilzomib administration for multiple myeloma

Abstract Carfilzomib, an epoxyketone proteasome inhibitor, has demonstrated improved progression-free survival in patients when used with standard treatment (lenalidomide and dexamethasone) in patients with relapsed multiple myeloma (MM). However, there are reports of adverse cardiac events with carfilzomib manifested by dyspnea and heart failure. A patient is presented who had recurrent, clinically mild cardiotoxicity, as manifested by recurrent heart failure with preserved ejection fraction, with ongoing maintenance carfilzomib in a patient with resistant MM is presented

Radial haemostasis is facilitated with a potassium ferrate haemostatic patch: the Statseal with TR Band assessment trial (STAT)

Haemostasis is a limiting factor for discharge after uncomplicated transradial procedures. The purpose of this study was to determine whether a potassium ferrate haemostatic patch (PFHP) could serve as an adjunct to the air-bladder TR Band (TRB) to facilitate implementation of a rapid deflation protocol. This was a prospective multicentre randomised controlled trial comparing radial haemostatic protocols. Deflation of the TRB was attempted at 40 minutes with PFHP and at 120 minutes without the PFHP. The primary outcome was time to full deflation of the TRB with haemostasis. At four US sites, 180 patients were enrolled after receiving a minimum of 5,000 units of unfractionated heparin or bivalirudin. Interventions comprised 30% of procedures. Successful TRB deflation occurred at 43±14 minutes with PFHP and 160±43 minutes without PFHP (p<0.001). Minor haematomas occurred in nine (10.3%) of the TRB patients and 16 (17.2%) of the PFHP patients (p=0.20). Radial artery occlusion occurred in 2% of patients in the PFHP group (p=NS). Outpatients randomised to PFHP were discharged 51±83.5 minutes earlier than control. The PFHP haemostatic patch facilitated early deflation of the TRB with a non-significant increase in forearm haematomas. Use of the PFHP may improve patient throughput and allow earlier discharge following transradial procedures