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Fungal endocarditis, a rare and lethal infection, is aetiologically connected with Candida and Aspergillus species. Among these two agents, Candida is a common nosocomial infection with increasing rates over the last years and mortality up to 40% in cases of systemic candidiasis. In the present paper, we describe the case of a 58 year old woman with metastatic breast cancer under palliative chemotherapy who was hospitalized for recurrent episodes of fever due to fungal endocarditis of the implantable venous access port. Such cases may elude the attention of the physician and need to be taken into account especially in oncologic patients with implantable devices under chemotherapy regimens. The treatment of Candida endocarditis can be difficult because of the formation of biofilms on prosthetic devices. The prognosis of these patients may be ameliorated with the combination of fungal and invasive treatment.

We report three cases of patients with blunt thoracic trauma, who underwent transesophageal echocardiography (TEE) because of high index of clinical suspicion for acute traumatic aortic syndrome. TEE revealed three different locations of aortic injury one of which was not diagnosed with aortography.

Backround: Prolongation of QT dispersion (QTD), defined as the difference between maximum and minimum QT intervals on surface ECG, has been proposed as a noninvasive arrythmogenic marker. The aim of this study was to estimate the value of QTD in identifing patients susceptible to ventricular fibrillation or ventricular tachycardia (VF/VT) after an acute myocardial infarction (AMI) and to evaluate the behavior of QTD in relation to the thrombolytic therapy. Methods: We studied 108 consecutive patients with AMI. All patients had a 12-lead surface ECG recorded upon admission and a second ECG 24 hours later. QT interval was measured from the onset of Q to the end of T in each of 12 standard ECG leads. QTD was the difference between the longest and shortest values of QT. All QTD measurements were corrected for heart rate (QTcD) using QTc values according to Bazzet formula. Results: Fifteen patients (13.8%) developed VF/VT in the first week after AMI (group 1A) and 93 patients (86.2%) did not have VF/NT (group 1B). QTD and QTcD values were significantly greater in group 1A in comparison to group 1B on admission and 24 hours later. Sixty-five patients (60%) received intravenous thrombolysis in the acute phase of AMI (group 2A) and 43 patients (40%) did not (group 2B). No significant difference in QTD and QTcD was observed in the first ECG on admission between the two groups. Conversely, QTD and QTcD were lower in group 2A patients in the second ECG 24 hours after admission. Conclusions: These results provide evidence that increased values of QTD are correlated well with occurrence of malignant ventricular arrhythmias after acute myocardial infarction while lower values associated with the thrombolytic therapy. A.N.E. 1999;4(1):35–38

This study was undertaken to determine whether adaptations to short-term exercise training after myocardial infarction, could affect the response of heart rate, blood pressure and double product at submaximal workload, and the behavior of electrocardiographic ST segment depression. We studied 60 patients (group A) who underwent a modest level exercise training for 3 months and 40 patients (group B) who did not participate in this program. All these subjects were involved in the trial 1 week after discharge from the hospital. Submaximal treadmill stress test was performed after the 3-month period. The stress test duration was longer (p < .01), heart rate (p < .001), systolic blood pressure (p < .01) and double product (p < .01) at submaximal workload were lower and the onset of ST depression of 1 mm was delayed (p < .01) in group A. In conclusion, postinfarction short-term exercise training increases the exercise tolerance, decreases the heart rate, systolic blood pressure, and double product response to exercise and improves the ischemic threshold.

Objective: Plasma cortisol in obese subjects does not differ from that in normoweight subjects. Extra-adrenal cortisol production by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) can result in local hypercortisolemia. The aim of the present study was to examine the role of visceral hypercortisolemia in the development of metabolic syndrome in severe obesity. Methods: Eight lean women during hysterectomy (controls) and 19 severely obese women during bariatric surgery were studied, 8 without metabolic syndrome (OM– group) and 11 with it (OM+ group). Biopsies of omental and subcutaneous fat were performed in the severely obese women during surgery, but only omental biopsies in the controls. Expression of 11β-HSD1, glucocorticoid receptor α (GRα) and glucocorticoid receptor β (GRβ) was evaluated using real-time PCR.Results: Omental 11β-HSD1 expression was different between groups (one-way ANOVA, p < 0.01). Post-hoc analysis revealed that mean omental 11β-HSD1 mRNA levels were higher in the OM– group compared to controls, whereas they were similar when comparing the OM+ group with lean controls. Expression of 11β-HSD1 in subcutaneous fat was not different between OM+ and OM– groups. GRα expression in omental fat did not differ among groups or between omental and subcutaneous fat in severely obese patients. An expression of GRβ was not detected.Conclusion: Contrary to our original hypothesis, omental 11β-HSD1 expression is not increased in the OM+ group.

We report a case of a 40-year-old primipara Caucasian woman with Turner syndrome (TS) and Hashimoto thyroiditis who had underwent a successful IVF-ET cycle with oocyte donation and single embryo transfer. All pregnancies in women with TS are considered as high risk, with cardiovascular complications being the most dangerous. Our case represents a typical case of fetal growth restriction with gradual slowing down of fetal growth after 28 weeks. At 37 + 3 gestational weeks, a healthy male newborn weighing 2240 g, with artery pH of 7.32 was delivered by cesarean section. The neonate was small for gestational age. Women with TS who become pregnant need close surveillance from a multidisciplinary team of cardiologists, obstetricians and endocrinologists. The primary goal is to prevent maternal complications and to improve perinatal outcome. In doing so, a thorough evaluation of fetal growth and uteroplacental and fetal circulation should by no means be omitted, after 26-28 weeks of gestation. The examinations should be at monthly or even shorter intervals to find early signs of growth restriction and act accordingly.

OBJECTIVE—To evaluate changes in left ventricular function and the impact of ventricular hypertrophy and pressure gradient early and late after aortic valve replacement in patients with isolated aortic stenosis. DESIGN—41 patients with isolated aortic stenosis and normal systolic function underwent cross sectional and Doppler echocardiography two months before and two weeks and four years after aortic valve replacement. RESULTS—Early after the operation, left ventricular mass index (mean (SD)) decreased from 187 (44) g/m2 to 179 (46) g/m2, because of a reduction in end diastolic diameter (p 13 mm) (p 30 mm Hg ) (p

We report the case of a patient who was admitted to the hospital with acute pulmonary embolism 2 weeks after a complicated pelvis fracture. Echocardiography revealed a large, long, and mobile thrombus in the right atrium. The patient was scheduled to undergo urgent surgical thrombectomy. Preoperative echocardiography did not detect any thrombi in the right heart and pulmonary artery. The obvious embolism of this large thrombus in the pulmonary circulation was silent as the patient remained asymptomatic and hemodynamically stable. We discuss the contribution of echocardiography to the appropriate therapeutic management of right atrial thrombi and particularly to the cancellation of urgent operative thrombectomy.

This study sought to determine the duration of new or worsening left ventricular regional wall motion abnormalities (RWMAs) after dobutamine stress echocardiography (DSE) and their relation to the extent of coronary artery disease (CAD).Despite extensive reports on DSE, little is known about the duration of new or worsening RWMAs during recovery. We hypothesized that the persistence of RWMAs during recovery may be associated with the extent of CAD and therefore ischemia.Sixty-five consecutive patients with positive results on DSE and angiographically documented CAD were studied. Each patient underwent 12-lead electrocardiography and two-dimensional echocardiography at rest, during dobutamine infusion and continuously during recovery to assess the recovery time of ischemic myocardial regions.All patients had at least one ischemic region during DSE. Complete resolution of RWMAs occurred within 25 min in patients with multivessel CAD, within 20 min in those with two-vessel disease and within 15 min in those with single-vessel disease (p0.001). The greater the wall motion score index at peak stress, the longer the duration of RWMAs into the recovery phase (p0.01). RWMAs persisted long after normalization of each patient's symptoms, electrocardiographic (ECG) changes, heart rate and rate-pressure product during recovery.We demonstrated that normalization of left ventricular RWMAs occurs after resolution of symptoms and ECG changes during recovery. The time to recovery is related to the extent of CAD and myocardial ischemia as well as to the presence or absence of collateral circulation. These findings may represent stunned myocardium after brief period of ischemia.