A randomized pilot study on the effect of niacin on pulmonary arterial pressure.

Background: Niacin induces the release of vasodilating prostaglandins, for which receptors are present within the pulmonary arterial circulation. We hypothesized that immediate-release niacin would reduce right ventricular systolic pressure in patients with pulmonary hypertension in a randomized, double-blinded, single-dose provocation study.

Methods: We recruited inpatient subjects with a Doppler echocardiogram showing a peak tricuspid regurgitation (TR) jet velocity of 2.

An unusual cause of right upper- and mid-zone infiltrates on chest x-ray.

Chest x-ray remains a critical investigation in patients who present with shortness of breath. We report a 60-year-old man who presented with shortness of breath, haemoptysis and respiratory failure, a raised white cell count, and right upper-and mid-zone infiltrates on chest x-ray. He developed progressive multiple organ failure despite aggressive intensive care management with antibiotics, ventilation and inotropes.