Stress testing for the evaluation of patients with mitral regurgitation.

Purpose Of Review: The emerging role of stress and particularly exercise echocardiography in mitral regurgitation has been recently emphasized. In fact, the evaluation of mitral regurgitation only under resting conditions might underestimate the full impact of the lesion and its clinical effects.

Recent Findings: Exercise echocardiography can identify what otherwise might be considered as a moderate valve disease.

Revisiting cutaneous adverse reactions to pemetrexed.

Pemetrexed (Alimta®) is a multitargeted antifolate drug approved as a single agent or in combination with cisplatin for the treatment of a small number of malignancies including advanced and metastatic non-squamous non-small cell lung cancer (NSCLC), and malignant pleural mesothelioma. This review reports the recent peer-reviewed publications and original findings regarding cutaneous adverse reactions (CARs) to pemetrexed. Pemetrexed-related CARs are frequently reported under the unspecific term 'skin rash'.

Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis.

Background: Recent studies emphasized the usefulness of exercise stress echocardiography in asymptomatic patients with aortic stenosis. Nevertheless, the additive value of exercise pulmonary hypertension (Ex-PHT) in such patients remains unexplored. We therefore aimed to identify the determinants and to test the impact on outcome of Ex-PHT in asymptomatic patients with severe aortic stenosis.

Prognostic importance of exercise brain natriuretic peptide in asymptomatic degenerative mitral regurgitation.

Aim: The exercise Doppler echocardiographic stress test can be of interest in the management of asymptomatic patients with primary mitral regurgitation (MR). The resting brain natriuretic peptide (BNP) level is a good surrogate marker of the consequences of MR and is a powerful predictor of outcome. The incremental prognostic value of BNP response during exercise is unknown.

Sweaty skin, background and assessments.

Overproduction of sweat, sweaty skin, and body malodors are felt unpleasant by many people in diverse social groups. This review summarizes the functional aspects of the eccrine, apocrine, and apoeccrine sweat glands as encountered in health and disease. A series of measuring methods are conveniently used to explore any trouble in sweat production.

The importance of exercise echocardiography for clinical decision making in primary mitral regurgitation.

Primary mitral regurgitation is generally an insidious disease with late onset of symptoms. Current European and American guidelines recommend surgery in severe primary mitral regurgitation when symptoms, overt left ventricular dysfunction, pulmonary hypertension or atrial fibrillation, occur. However, recent large studies reported an improved outcome in asymptomatic patients with severe mitral regurgitation referred for early mitral valve repair despite the risk of operative mortality or mitral valve replacement.

Prognostic importance of brain natriuretic peptide and left ventricular longitudinal function in asymptomatic degenerative mitral regurgitation.

Objectives: To identify the determinants and the impact on outcome of brain natriuretic peptide (BNP) in asymptomatic patients with degenerative mitral regurgitation (MR).

Method: Comprehensive transthoracic echocardiography including two-dimensional speckle tracking quantification was performed in 135 consecutive asymptomatic patients (60±14 years, 56% men) with moderate to severe degenerative MR and preserved left ventricular (LV) function. Blood samples were collected at the time of the echocardiography and plasma BNP levels were measured.

Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification.

Objectives: This study examined the clinical course of patients with asymptomatic severe aortic stenosis (AS) according to the new proposed aortic valve stenosis grading classification.

Background: The management of patients with asymptomatic severe AS remains controversial. Moreover, under the same denomination of severe AS, several entities might be identified according to transvalvular flow rates and pressure gradients, resulting in 4 flow-gradient patterns.

Bioimpact of EGFR antagonists on the pilosebaceous follicles.

Cancer patients under targeted chemotherapy to the epidermal growth factor receptor (EGFR) frequently suffer from unusual skin adverse events. In the past, these changes were globally qualified as a rash. Our aim was to assess objectively by non invasive bioinstrumentation some early structural and functional skin changes associated with EGFR inhibitor treatment.

Molecular dermatopathology in malignant melanoma.

At present, immunohistochemistry is taken for granted in the establishment of malignant melanoma (MM) diagnosis. In recent years, molecular diagnosis in dermatopathology has benefited from a vast array of advances in the fields of genomics and proteomics. Sensitive techniques are available for detecting specific DNA and RNA sequences by molecular hybridization.

Left ventricular dyssynchrony: a dynamic condition.

Left ventricular dyssynchrony (LVD) is common in heart failure patients with LV systolic dysfunction. Contrary to what it could be expected, LVD is not a stable phenomenon. Various conditions (inducible ischemia, exercise, drug administration) may significantly alter the presence and the magnitude of LVD, which could per se modulate response to treatment for heart failure.

Focus on skin cancer association and progression under TNF antagonist therapy.

Introduction: Basal and squamous cell carcinomas are the most common non-melanoma skin cancers (NMSC) in humans. Their prevalence is higher in immunocompromized patients. Results of some animal experiments have indicated that TNF acts both as a tumour promotor and an inductor of apoptosis.

Prediction of exercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation.

Objective: Exercise systolic pulmonary arterial pressure (SPAP) predicts the occurrence of symptoms in patients with degenerative mitral regurgitation (MR). However, this measurement is not always available. The purpose of this study was to identify resting echocardiographic predictors of exercise SPAP and whether predicted exercise SPAP may predict symptom-free survival.

Seasonal variations in vitamin D levels in melanoma patients: a single-centre prospective pilot comparative study.

Background: More than 90% of vitamin D synthesis is dependent on UV exposure. Photosensitive disorders such as lupus erythematosus, protoporphyria and xeroderma require strict sun avoidance, and vitamin D deficiency has been demonstrated in these patients. Melanoma patients are also instructed to avoid sun exposure and may hence be expected to be vitamin D deficient.

Recent trends in specular light reflectance beyond clinical fluorescence diagnosis.

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These properties offer diagnostic clues and disclose some peculiar functions of the skin. A series of superficial infections (erythrasma, some tinea capitis types, tinea/pityriasis versicolor, dermatophytoses, etc.

New approaches in light/laser therapies and photodynamic treatment of acne.

Acne is a domain in which the technology and understanding of light/laser therapeutic procedures have advanced considerably. The aim of the paper was to revisit adjunctive physical treatments of acne, including light/laser treatments and photodynamic therapy. This review summarizes findings about such treatment modalities with particular emphasis on efficacy and safety.

Comparison of the platelet concentrations obtained in platelet-rich plasma (PRP) between the GPS™ II and GPS™ III systems.

Introduction: Platelet growth factors are known for their ability to speed up tissue healing (bone, skin, tendons, muscle). Various techniques make it possible to collect this platelet-rich plasma or PRP.

Methods: This study compares the platelet concentrations obtained from five patients using GPS™ III, which has recently come onto the market, with those obtained using GPS™ II.

Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment.

Ischaemic mitral regurgitation is a frequent complication of left ventricular global or regional pathological remodelling due to chronic coronary artery disease. It is not a valve disease but represents the valvular consequences of increased tethering forces (papillary muscles displacement leading to a more apical position of the leaflets and their coaptation point) and reduced closing forces (reduced contractility, dyssynchrony of the papillary muscles, intra-left ventricular dyssynchrony). Although mitral regurgitation has an unloading effect and reduces impedance, the volume overload begets further left ventricular dilatation, increases ventricular wall stress leading to worsened performance.

Do we need a new carotid artery stenting trial?

Four well-conducted carotid artery trials comparing carotid artery stenting with carotid artery endarterectomy (EVA-3S, SPACE, ICSS and CREST) could not demonstrate the superiority of carotid artery stenting (CAS) over carotid artery endarterectomy (CEA). There is at the moment no level-I evidence to support widespread use of endovascular management of carotid artery disease in routine practice. In order to shead some light on the continuing debate on the role of carotid artery stenting, the authors conducted a search in contemporary published literature concerning carotid artery stenting.

Topical treatment options for drug-induced toxic epidermal necrolysis (TEN).

Importance Of The Field: Drug-induced toxic epidermal necrolysis (TEN) is a dreadful skin condition. The mortality rate of 25 - 30% is mainly due to both metabolic failures and septicemia following loss of epidermal integrity. Topical treatments are important options in these patients.

Facing up to toxic epidermal necrolysis.

Toxic epidermal necrolysis (TEN) is a rare but life-threatening mucocutaneous adverse drug reaction. The disease is characterized by a specific and extensive destruction of the epidermis and mucosal epithelia, particularly of the mouth, genitalia and eyes. The TEN pathomechanism is probably initiated by a toxic drug metabolism inside keratinocytes, leading to a self-activation of apoptosis and necrosis.

Exercise-induced changes in degenerative mitral regurgitation.

Objectives: We sought to quantify exercise-induced changes in patients with degenerative mitral regurgitation (MR), to examine the relationship between exercise-induced changes in MR and in systolic pulmonary artery pressure (PAP), and to identify their potential impact on symptom-free survival.

Background: MR severity can change during exercise in patients with functional MR. Quantified changes in MR severity during exercise remain undetermined in patients with degenerative MR.