Perioperative risk assessment among patients with congestive heart failure: a call for guidelines.

Each year, more than 10 million major noncardiac surgical procedures are performed in the United States. Current perioperative risk assessment focusing on ischemic heart disease and adherence to practice guidelines reduces morbidity and mortality. An estimated 10 million people in the United States suffer from ventricular dysfunction (class B), and half are symptomatic (class C), despite medical therapy.

The challenges associated with current clinical trials for diastolic heart failure.

Purpose Of Review: Diastolic heart failure (DHF) is the culmination of various cardiovascular insults, producing a proportionally greater alteration of diastolic performance, subtle reductions of systolic function and the clinical syndrome of heart failure. Over half of heart failure patients aged 65 years or older have DHF, which carries similar morbidity and mortality to systolic heart failure (SHF). The aging population and increased prevalence of hypertension, diabetes mellitus and obesity will result in disproportionately higher incidence of DHF.

Rituximab therapy for refractory thrombotic thrombocytopenic purpura and autoimmune-mediated thrombocytopenia in systemic lupus erythematosus.

Thrombotic thrombocytopenic purpura (TTP) rarely occurs in the setting of systemic lupus erythematosus (SLE); when it does occur it has a high mortality rate and is refractory to conventional treatment. No clear treatment guidelines exist when refractory TTP occurs in the setting of SLE. A 24-year-old male patient presented with TTP in the setting of SLE that was refractory to conventional treatment but responded to rituximab.

Resolution of MRI findings in central pontine myelinosis associated with hypokalemia.

We report a case of a 20-year-old African-American female, hospitalized and treated for hyperemesis gravidarum and hypokalemia with a normal serum sodium level. Two to 3 days into her hospitalization, she developed urinary incontinence, weakness, and pain in her lower extremities. An MRI brain scan showed central pontine signal alteration, leading to a diagnosis of CPM.