Poor outcome among patients undergoing myocardial perfusion imaging with intermediate-zone troponin.

Background: Intermediate zone troponin elevation is defined as one to five times the upper limit of normal. Approximately half the patients presenting with chest pain to the emergency department have initial intermediate zone troponin.

Objectives: We aimed to investigate the long-term outcome of patients hospitalized with chest pain and intermediate zone troponin elevation.

Early post-stress decrease in cardiac performance by impedance cardiography and its relationship to the severity and extent of ischemia by myocardial perfusion imaging.

Background: While single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is a well-established noninvasive procedure for the evaluation of patients with coronary artery disease (CAD), it is unable to detect the presence of, or underestimates the extent of CAD in certain patients. We aimed to show that a bio-impedance device can detect early post-stress changes in several hemodynamic parameters, thereby serving as a potential marker for the presence of significant ischemia.

Methods: Prospectively enrolled patients, referred to our Medical Center for clinically-indicated MPI, underwent testing using a Non-Invasive Cardiac System (NICaS) before and immediately after exercise.

Evaluation of Patients with Acute Chest Pain Using SPECT Myocardial Perfusion Imaging: Prognostic Implications of Mildly Abnormal Scans.

Background: While patients presenting to emergency departments (ER) with chest pain are increasingly managed in chest pain units (CPU) that utilize accelerated diagnostic protocols for risk stratification, such as single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI), data are lacking regarding the prognostic implications of mildly abnormal scans in this population.

Objectives: To evaluate the prognostic implications of mildly abnormal SPECT MPI results in patients with acute chest pain.

Methods: Of the 3753 chest pain patients admitted to the CPU at the Leviev Heart Center, Sheba Medical Center 1593 were further evaluated by SPECT MPI.

A novel heart rate variability algorithm for the detection of myocardial ischemia: pilot data from a prospective clinical trial.

Background: Heart rate variability (HRV) analysis has been shown to be a predictor of sudden cardiac death and all-cause mortality in patients with cardiac disease.

Objectives: To examine whether newer HRV analysis algorithms, as used by the HeartTrends device, are superior to exercise stress testing (EST) for the detection of myocardial ischemia in patients without known coronary artery disease (CAD).

Methods: We present pilot data of the first 100 subjects enrolled in a clinical trial designed to evaluate the yield of short-term (1 hour) HRV testing for the detection of myocardial ischemia.

Comparison of the usefulness of heart rate variability versus exercise stress testing for the detection of myocardial ischemia in patients without known coronary artery disease.

Heart rate variability (HRV) has been shown to be attenuated in patients with coronary artery disease (CAD) and may, therefore, be possibly used for the early detection of myocardial ischemia. We aimed to evaluate the diagnostic yield of a novel short-term HRV algorithm for the detection of myocardial ischemia in subjects without known CAD. We prospectively enrolled 450 subjects without known CAD who were referred to tertiary medical centers for exercise stress testing (EST) with single-photon emission computed tomography myocardial perfusion imaging (MPI).

The structural effect of the E148Q MEFV mutation on the pyrin protein: a study using a quantum chemistry model.

Background: Familial Mediterranean fever (FMF) is a recessively inherited disease with a variety of clinical presentations. The disease is associated with mutations in the FMF gene (MEFV), which encodes for the pyrin protein. The role of the E148Q pyrin mutation in the FMF phenotype remains inconclusive, and some authors even view it as a disease-insignificant polymorphism.

[Clostridium difficile-associated diarrhea: causes and relationship to reactive arthritis].

We present a patient treated with methotrexate (MTX] for rheumatoid arthritis, in whom clostridium difficile-associated colitis has developed, without preceding antibiotic treatment. Two weeks later, the patient was admitted with knee arthritis. Reactive arthritis was diagnosed and treated successfully with the naproxen.

[Aortic atheroma and splenic emboli].

The association between atheroma of the thoracic aorta and systemic embolization to the brain and other organs was discovered in the early 1990s in concordance with the improvement in the trans-esophageal echocardiography technique. The optimal treatment for secondary prevention of recurrent emboli is controversial, since the results of several studies differ and even contradict one another. In this article, the authors describe a man with splenic infarct, originating from a mobile descending aortic plaque.

[Ammonia as a cause for hepatic encephalopathy].

In a patient with cirrhosis of the liver, associated with hepatitis B virus, who was admitted for confusion and acute elevation of liver enzymes, a diagnosis of hepatic encephalopathy was made. A serum ammonia level of 54 (normal less than 33) microgram/liter, supported the diagnosis, but puzzled the medical staff regarding the possibility that ammonia may directly induce the confusion. While it is widely accepted that the ammonia level is a marker that usually parallels the amount of toxins and metabolites that bypasses the liver, its role in causing brain dysfunction is debated.

[Neurogenic pulmonary edema].

In a patient, admitted for cerebral stroke with right side hemiparesis, an acute episode of dyspnea has developed 6 hours after admission. Based on a finding of fine rales on auscultation and a chest radiogram showing congestion, a diagnosis of pulmonary edema was made. The electrocardiogram and cardiac enzymes were normal.

[Aspirin and endoscopy].

A patient with stable anginal syndrome, on aspirin, was admitted for colonoscopy, as part of a work-up for weightloss and iron deficiency anemia. Should this patient discontinue aspirin prior to the colonoscopy? A literature review, as well as the current guidelines of the American Association for Gastrointestinal Endoscopy, did not support such an act. An Israeli physician survey, published recently, suggests an interesting attitude for this dilemma, in which the risk imposed on the patient by withdrawal of aspirin will determine whether to continue or stop the drug prior to the procedure.

[Black tongue].

In a patient with Sjogren syndrome, receiving prednisone and methotrexate, treatment with ceftriaxone was prescribed for presumed urinary tract infection. About 20 minutes from initiation of the intravenous drug administration, the patient's lips and tongue color turned black, without swelling or additional visible changes. The drug was discontinued immediately and the black color gradually disappeared within the next 24 hours.