Advanced alveolar echinococcosis disease associated with Budd–Chiari syndrome

AbstractIntroductionAlveolar echinococceal disease of the liver is rare. Echinococcus multilocularis is responsible for the development of the related clinical conditions. Advanced disease may result with serious complications such as end stage liver disease and Budd–Chiari syndrome.Presentation of caseIn this presentation, a 28 years-old woman who was a case with advanced alveolar echinococcosis complicated with a Budd–Chiari syndrome and was performed successful living donor liver transplantation, has been demonstrated with clinical and radiological images.DiscussionInitially there may be no clinical evidence of the disease in humans for years. Severity and fatality are the significant characteristics of the natural history. Extension to the surrounding tissues and metastasis of the parasitic mass may be observed. Prevention is essential in disease control. Serologic assay may identify the parasite. However, early diagnosis is rare. Staging is based on radiologic imaging. Some patients with advanced disease may require surgery. Hepatic resection and liver transplantation are accepted procedures in selected patients.ConclusionThe importance of early diagnosis to prevent advanced complications such as development of Budd–Chiari syndrome and metastasis has been underlined

Serum copeptin level can be a helpful biomarker in evaluation of myocardial perfusion scintigraphy results

Background: Myocardial perfusion scintigraphy (MPS) is a well-established diagnostic tool. The sensitivity and specificity of single photon emission computed tomography (SPECT) MPS to detect significant coronary lesion were 86% and 74%, respectively. The aim of this study was to examine the role of serum copeptin in evaluation of MPS. Methods: Sixty-two consecutive patients underwent both SPECT MPS using 99mTc-sestamibi and transthoracic echocardiography were enrolled prospectively. Age, gender, height, weight, presence of cardiovascular risk factors were recorded. Exercise treadmill test (ETT) with modified Bruce protocol was used to induce coronary ischemia during MPS. While performing MPS, blood samples for serum copeptin level were drawn three times at pre-exercise, at the peak of ETT, and 6 h after ETT, respectively. The patients were enrolled into three groups according to MPS results (normal, equivocal and ischemia). Results: The study included 62 patients (23 with normal, 20 with equivocal, 19 with ischemia on MPS). Pre-, peak-, and post-exercise B-type natriuretic peptide and troponin I values were similar across the groups (p > 0.05 for all comparisons). Serum copeptin values for pre- and peak-exercise were similar among all groups (p = 0.883 and p = 0.089). Post-exercise copeptin values of the normal and equivocal groups were similar (p = 0.661, z = –0.438) while that of the ischemia group was significantly higher than both the normal (p < 0.001) and equivocal group (p < 0.001). Conclusions: Serum copeptin was found to be increasing significantly in case of ischemia on MPS. It may be used in differentiation of equivocal results from false positive results.

Epicardial adipose tissue thickness and systemic sclerosis

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Purpose: Microvasculopathy and endothelial damage are prominent features of systemic sclerosis (SSc) and increases risk of cardiovascular disease. Epicardial adipose tissue (EAT) is localized beneath the visceral pericardium and has been shown to be closely related with coronary artery disease (CAD). The goal of this study was to investigate the thickness of EAT in SSc patients who had no previous or current history of cardiac involvement. Methods: Thirty patients with SSc and 30 healthy controls (HC) were included to the study. Measurement of EAT was evaluated using echocardiography and Doppler imaging technique. Results: EAT thickness was significantly higher in SSc group compared to HC (6.2±0.9 mm vs. 5.3±0.6 mm, p=0.01) and it was correlated with disease severity score (r=0.45, p=0.01) in SSc patients.\nConclusion: This is the first study, displaying a significantly higher EAT thickness in patients with SSc. We believe that further studies are needed to clarify the role of adipose tissue in patients with SSc

Can Impaired Elasticity of Aorta Predict the Success of Vardenafil Treatment in Patients with Erectile Dysfunction?

Objective. Vardenafil is used in treatment of erectile dysfunction (ED) but reveals variable clinical outcomes. Here, we aimed to evaluate the role of aortic elasticity in predicting vardenafil success among patients with ED. Methods. Sixty-one consecutive male subjects with primary ED and indication for vardenafil treatment were included. All subjects fulfilled 5-item version of the International Index of Erectile Function (IIEF-5) before the vardenafil treatment. Pretreatment aortic stiffness index (ASI) and aortic distensibility (AD) were obtained echocardiographically. Following two-month vardenafil treatment, the patients were reevaluated with IIEF-5. Pretreatment, posttreatment, and ΔIIEF-5 scores and ASI values were compared. Results. Average age was 54±8 years. Pretreatment and posttreatment IIEF-5 and ΔIIEF-5 scores were 9.1±2.5; 18.5±2.3; and 9.4±3, respectively. Mean ASI and AD values were 3.10±0.54 and 4.13±2.55 1/(103  ×  mmHg) accordingly. ASI value of severe pretreatment ED (n=15) was significantly higher than that of mild-moderate pretreatment ED (n=12) (p<0.001). All pretreatment IIEF-5 scores increased significantly compared to posttreatment IIEF-5 scores (p<0.001). ASI values were significantly correlated to pretreatment IIEF-5 scores (p<0.001) and ΔIIEF-5 value (p<0.001) but not to posttreatment IIEF-5 score. Conclusion. Aortic elasticity was impaired in accordance with degree of ED. The subjects with higher ASI values obtained more benefits from vardenafil

Prädiktiver Wert des PRECISE-DAPT-Scores für die Langzeitmortalität bei Patienten mit akutem Koronarsyndrom und kardiogenem Schock als Komplikation

Background: Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. Methods: The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell’s and Uno’s C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R 2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. Results: All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59–3.68], R 2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. Conclusion: The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS