Raltitrexed as a substitute for capecitabine in metastatic gastric cancer: a case report and literature review.

Background: 5-Fluorouracil and its oral prodrug, capecitabine, are frequently used in the treatment of gastrointestinal cancers-including gastric cancer-but carry a cardiotoxicity risk. Raltitrexed (brand name Tomudex), a direct inhibitor of thymidylate synthase, has been successfully used as an alternative to fluoropyrimidines in patients with 5-fluorouracil-induced cardiac events. We report the first case, to our knowledge, of raltitrexed used with trastuzumab and platinum-based chemotherapy as a substitute for fluoropyrimidines following cardiotoxicity in a 78-year-old male patient with metastatic gastric cancer.

Association of Left Ventricular Ejection Fraction with Mortality and Hospitalizations.

Background: Although echocardiography is widely used to measure left ventricular ejection fraction (LVEF), its prognostic value has not been demonstrated in a broad range of patients including those acutely hospitalized for cardiac or noncardiac causes. We determined whether greater degrees of left ventricular systolic dysfunction were associated with progressively increasing risks of death or cardiovascular hospitalizations among patients in hospital or outpatient settings.

Methods: A total of 27,323 patients with LVEF measured and 19,445 matched controls were followed for 223,034 person-years.

Cryptogenic stroke and patent foramen ovale: clinical clues to paradoxical embolism.

Background: Patent foramen ovale (PFO) is an independent risk factor for cerebral infarction. Since ~25% of the population have a PFO, the simple association of PFO with stroke is not enough to establish the diagnosis of paradoxical embolism. We evaluated possible clinical clues to the diagnosis of paradoxical embolism.

Intracardiac echocardiography guided device closure of atrial septal defects.

Objectives: This study was designed to determine the feasibility and accuracy of intracardiac echocardiography (ICE) in guiding percutaneous closure of atrial septal defects (ASD).

Background: Intracardiac echocardiography is a novel imaging technique that might be used to guide interventional procedures. The sensitivity and specificity of ICE, compared to standard imaging techniques, in detecting potentially adverse procedural events and guiding remedial action will be an important consideration in its use.

Determination of left ventricular ejection fraction using intravenous contrast and a semiautomated border detection algorithm.

Manual endocardial tracing using Simpson's method (MANUAL SIMP) provides an accurate assessment of left-ventricular ejection fraction (LVEF). We have previously demonstrated in patients who are difficult to image: (1) the incremental accuracy of contrast-enhanced power harmonic imaging and MANUAL SIMP in the calculation of LVEF; and (2) the use of intravenous contrast-combined MANUAL SIMP was the most accurate method of LVEF determination. However, MANUAL SIMP is time-consuming, requires accurate planimetry of the endocardial borders, and is difficult to apply routinely in the clinical situation.