Cardiovascular comorbidity in patients with chronic obstructive pulmonary disease: echocardiography changes and their relation to the level of airflow limitation

Objective. To compare frequency of echocardiographic changes in patients with chronic obstructive pulmonary disease (COPD) and non-COPD controls and to assess their relation to the level of airflow limitation. Methods. Study population included 120 subjects divided in two groups. Group 1 included 60 patients with COPD (52 male and 8 female, aged 40 to 80 years) initially diagnosed according to the actual recommendations. Group 2 included 60 subjects in whom COPD was excluded serving as a control. The study protocol consisted of completion of a questionnaire , pulmonary evaluation (dyspnea severity assessment, baseline and post-bronchodilator spirometry, gas analyses, and chest X-ray) and two dimensional (2D) Doppler echocardiography. Results. We found significantly higher mean right ventricle end-diastolic dimension (RVEDd) in COPD patients as compared to its dimension in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000). Pulmonary hypertension (PH) was more frequent in COPD patients than in controls (28.0 ± 4.8 vs. 24.4 ± 4.3; P = 0.0000) showing linear relationship with severity of airflow limitation. The mean value of left ventricular ejection fraction (LVEF%) was significantly lower in COPD patients than its mean value in controls (57.4 ± 6.9% vs. 64.8 ± 2.7; P = 0.0000) with no correlation with severity of airflow limitation.       Conclusion. Frequency of echocardiographic changes in COPD patients was significantly higher as compared to their frequency in controls in the most cases being significantly associated with severity of airflow limitation. Echocardiography enables early, noninvasive, and accurate diagnosis of cardiac changes in COPD patients giving time for early intervention. Key words: airflow limitation, chronic obstructive pulmonary disease, Doppler echocardiography, pulmonary hypertension, ventricular dysfunction. &nbsp

Heterotopic Ossification in the Abdomen of an Elderly Patient, as an Incidental Finding During Elective Surgery: A Case Report

Introduction. Heterotopic ossification (HO) is a rare diverse pathologic process, with broad spectrum. Case report. This is a case report of a 73 years old patient who had ventral hernia at the medial line on the anterior abdominal wall, and underwent a routine surgery. During the surgery an incidental finding of HO was discovered. Discussion. HO is well documented to occur at increased frequency with certain predisposing conditions, including orthopedic surgery, most commonly hip arthroplasty. Non-genetic HO can occur nearly anywhere in the body, but is often designated by the tissue type it involves, such as myositis ossificans when involving skeletal muscle, or fasciitis ossificans when involving fascia. Key words: heterotopic ossification, abdominal surgery, ventral hernia, osteosarcoma

Combining prostate health index and mpMRI data (MRI Spectroscopy) to manage PI-RADS lesions and reduce excessive biopsy, a single center study

To evaluate the values of PHI and PI-RADS findings in the early detection and prediction of prostate cancer, as well as their application in clinical trials, especially when values of PSA are in the „ grey zone„ with negative DRE. The 100 patients, men aged 50 years or older with prostate-specific antigen 4 to 10 ng/ml („gray zone„) and normal digital rectal examination with suspected prostate cancer were examined, who had undergone biopsy and were divided in two groups. A group with no evidence of PCa (non PCa) and the group with PCa. The performance of PHI and mpMRI PI-RADS score was compared to predict biopsy results and, specifically, the presence of clinically significant prostate cancer (csPCa) using multiple criteria. Among 100 subjects, 21 (21.0%) were diagnosed with PC, including 13 (61.95%) with csPC (Gleason≥7). By the threshold of PHI≥36, the sensitivity, specificity, PPV, and NPV to predict PCa were 100%, 68.35%, 45.65%, and 100%, respectively. The best cut-off (PHI) was 42.8% with sensitivity 85.7% and specificity 86.1%. The area under the receiver operator characteristic curve (AUC) of combining PHI and mpMRI was greater than that of PHI alone (0.993 vs. 0.954, p=0.002) and mpMRI alone (0.993 vs. 0.976, p=0.025). Comparing the performance in the identification of clinically significant prostate cancer (csPCa), we found that PHI ≥ 73.04 and PI-RADS score ≥ 4 were able to identify csPCa (Gleason score ≥ 7 (3 + 4)) both alone and added to a base model including age, PSA, fPSA-to-tPSA ratio and prostate volume. If biopsy was restricted to patients with PI-RADS 5 as well as PI-RADS 3 or 4 and PHI≥36.0, 50% of biopsy could be avoided with one csPCa patient being missed. The analyzed correlation between PHI and PI-RADS score was statistically significant (p<0.0001). According to the value of Spearman's coefficient, R=0.748, the correlation is positive, i.e. direct, and they showed that with an increase in the value of the prostatic health index, (PHI) the PI-RADS score increases, and vice versa. The combination of PHI and mpMRI had higher accuracy for detection of csPC compared with PHI or mpMRI alone. Keywords: Prostate health index, mpMRI PI-RADS, detection of prostate cance

DEEP VEIN THROMBOSIS AND RECURENT PULMONARY EMBOLISM IN A PATIENT WITH THROMBOPHILIC MUTATIONS AND GENERALIZED PSORIASIS: A CASE REPORT

Introduction: Genetic risk factors that increase venous thromboembolism risk are disorders in the synthesis or activity of coagulation factors. Factor V Leiden, prothrombin (20210-A), antithrombin deficiency, protein C and protein S deficiency, and hyperhomocysteinaemia are the most common venous thromboembolism-related gene mutations. When genetic factors are combined with non-provoking risk factors (obesity, psoriasis, smoking and previous venous thromboembolism) the result is increased venous thromboembolism risk for each factor individually. Previous venous thromboembolism is one of the strongest risk factors, even in patients actively treated with anticoagulant. Patients are more likely to have recurrent venous thromboembolism with longer duration. Psoriasis is a complex immune–mediated disease, associated with cardiovascular risk, hypercoagulability markers and elevated homocysteine. Lots of observational reports suggest increased incidence of venous trombembolic events in patient with psoriasis. Case presentation: We present patient with inherited thrombophilia and chronic diffuse plaque psoriasis complicated with deep venous thrombosis and pulmonary embolism. DNA analysis indicates the presence of homozygosis for Factor V Leiden mutation as well as heterozygosis for Factor XIII V34L, PAI -1 5G/4G and MTHFR A1298C polymorphism. Dermatological anamnesis is positive for plaque psoriasis since 12 years ago. Conclusion: The presentation of this case indicates an association between venous thromboembolism and chronic psoriasis. All patients with recurrent thromboembolism, hereditary thrombophilia, and moderate to severe psoriasis should be considered to be at higher risk for venous thromboembolism and appropriately treated

COPD as a risk factor for coronary artery disease (CAD): overview of 10-year atherosclerotic cardiovascular disease (ASCVD) risk assessment

We aimed to investigate the association between COPD and CAD (overview of 10-year risk of fatal cardiovascular event), and the relation to the severity of airflow limitation. Cross-sectional study including 220 patients with stable COPD as investigated group (IG), aged 40 to 75 years and 58 non-COPD subjects, matched by gender, age, BMI, smoking status, as control group (CG). All study subjects underwent pulmonary, cardiological evaluation, lipid and glycemic status. The analysis compared the 10-year established ASCVD risk between COPD stages (according to GOLD classification 1, 2, 3, 4) and between IG vs. CG. ASCVD score was classified as low (score <5%), borderline (5 to <7.5%), moderate (≥7.5 to <20) and high risk (score ≥20%). Results presented statistically significant difference between mean ASCVD value in IG 21,69±13,86% vs. CG 15,83±9,92% (p=0.0028). The median risk of ASCVD for fatal cardiovascular events was high in IG and moderate in CG. The mean and median values of 10-year ASCVD risk in the IG subgroups were: GOLD1 16,79±8,04% (50% of the subjects with risk >15,7%), GOLD2 22,67±16,49% (50% of the subjects with risk >20,6%), GOLD3 26,81±14,15% (50% of the subjects with risk > 27,6%) and GOLD4 20,70±13,52% (50% of the subjects with risk > 18,4%). The average ASCVD risk of fatal cardiovascular event was moderate in GOLD1 and GOLD4, and high in GOLD2 and GOLD3. We found higher risk for fatal cardiovascular outcome in patients with COPD, even in the early COPD stages (GOLD2), compared to non-COPD group. Our findings suggest that an urgent need to develop comprehensive strategies for prevention, screening and early treatment are needed

Heterotopic Ossification in the Abdomen of an Elderly Patient, as an Incidental Finding During Elective Surgery: A Case Report

Introduction.&nbsp;Heterotopic ossification (HO) is a rare diverse pathologic process, with broad spectrum.&nbsp;Case report.&nbsp;This is a case report of a 73&nbsp;years old patient who had ventral hernia at the medial line on the anterior abdominal wall, and underwent a routine surgery. During the surgery an incidental finding of HO was discovered.&nbsp;Discussion.&nbsp;HO is well documented to occur at increased frequency with certain predisposing conditions, including orthopedic surgery, most commonly hip arthroplasty. Non-genetic HO can occur nearly anywhere in the body, but is often designated by the tissue type it involves, such as myositis ossificans when involving skeletal muscle, or fasciitis ossificans when involving fascia

METASTATIC CUTANEUS MELANOMA OF THE GALLBLADDER-CASE REPORT

Melanoma is an aggressive malignant tumor that originates from melanocytes and most commonly occurs on the skin. Dominantly metastasize to regional lymph nodes, in the brain and lungs and rarely in the gastrointestinal (GI) system. The aim of this report is to present a rare case of metastasis of cutaneous malignant melanoma in the gallbladder, discovered 10 months after excision of the primary melanoma of the skin. A 45-year-old patient was hospitalized in our hospital due to abdominal pain in right upper quadrant and nausea lasting for 7 days. An intraluminal substrate was found in the gallbladder with computed tomography and later a CT guied biopsy was performed on it, thus proving a metastatic deposit of primary malignant melanoma.Metastatic deposits in the gallbladder are extremely rare finding, and 238 cases have been described in the literature

COPD and heart rhythm disturbances: Overview of supraventricular and ventricular arrhythmias

We aimed to investigate the association between COPD and heart rhythm disturbances and their relation to the severity of airflow limitation. Cross-sectional study, including 220 patients with stable COPD as investigated group (IG), aged 40-75 years and 58 non-COPD subjects, matched by gender, age, BMI, smoking-status, as control group (CG). All study subjects underwent pulmonary evaluation, resting-ECG, 24-hour-ECG-Holter monitoring. Results presented statistically significant difference between presence of atrial fibrillation (AF) in IG 49(22.3%) vs. CG 2(3.4%) (p<0.05). There was a significant linear positive correlation between AF and GOLD stage (R=0.173;p<0.05). With decrease of FEV1(GOLD1→GOLD4), the frequency of AF increased significantly. Four ventricular rhythm disturbances were processed: bigeminy, couplets, polymorphic ectopic ventricular beats (PEVB) and un-sustained ventricular tachycardia (UVT). There was no significant association between subgroups of IG and bigeminy and IG 18(8.2%) vs. CG 4(6.9%) (p=0.25). With decrease of FEV1(GOLD1→GOLD4), the frequency of couplets increased significantly. Results presented statistically significant difference between presence of PEVB in IG 21(9.5%) vs. CG 0(0.0%) (p=0,01). The presence of UVT was not registered in GOLD1, in GOLD2 2(3.2%), GOLD 3 2(3.8%), GOLD4 2(4.1%). There was no significant association between subgroups of IG and UVT (Fisher-Freeman-Halton test:p=0.9). Results presented statistically significant difference between presence of PEVB in IG 6(2.7%) vs. CG 0(0.0%) (p=0,07). As a conclusion, there is an urgent need to develop strategies for detection and early treatment of life-threatening arrhythmias in COPD patients