Focus on malignant ventricular premature contractions

Premature ventricular contractions (PVCs) are common. Although often benign, they can also be associated with increased morbidity and mortality. The aim of this review was to assess the risk evaluation of PVCs in patients with or without structural heart disease and discuss the management of this arrhythmia. Reports published in English were searched in PubMed with the following search terms: premature ventricular contraction, ectopic ventricular beat, ventricular extrasystole, antiarrhythmic drugs, ablation, ventricular arrhythmia, ventricular tachycardia, ventricular fibrillation and torsade de pointe. This analysis suggests that all patients with frequent PVCs should be assessed for PVC burden, symptom status and the presence of structural heart disease. PVCs in patients with structurally normal hearts was once considered a benign phenomenon. Uncommonly, PVCs may provoke life-threatening arrhythmias. Ventricular fibrillation is the initial mode of malignant rapid ventricular arrhythmias (MRVAs). Patients with malignant PVC and PVC burden >10% are at increased risk of MRVA in case of myocardial infarction and heart failure. MRVA is the primary cause of sudden cardiac death in patients with and without structural heart disease. Therapeutic options include medical therapy and catheter ablation, the latter more effective and potentially curable, particularly in patients with left ventricular dysfunction. The timely recognition and effective treatment of malignant PVCs in symptomatic patients with underling cardiomyopathy are mandatory to initiate early therapies before the occurrence of adverse clinical outcomes and to improve the long-term prognosis.

Impact of cardio-oncology strategies in the management of breast cancer patients

Background

Cardio-oncology has arisen as one of the most rapidly expanding fields of cardiovascular medicine. The accumulated evidence on the possibilities of early diagnosis of cardiotoxicity provided by imaging techniques as well as on the benefits of preventive and therapeutic interventions is also increasing.

Objective

This study reported our echocardiography lab's initial experience of a cardio-oncology follow-up program.

Methods

We prospectively studied the outcomes of 107 patients diagnosed with breast cancer who attended our follow-up program between 2017 and 2020. An echocardiographic monitoring were realised according to the chemotherapy protocol. Cancer therapy-related cardiac dysfunction (CTRCD) is defined, according to the european society of cardiology (ESC) guidelines of 2016, as a drop of left ventricular ejection fraction (LVEF) by >10 percentage points from baseline to a value <50%. A new entity named subclinical systolic dysfunction, is defined by a drop of global longitudinal strain (GLS) by >15% from baseline, however, LVEF remains >50%. The diagnosis should be confirmed by a second echocardiogram after 2–3 weeks.

Results

We enrolled 107 patients diagnosed with breast cancer and receiving anthracycline and/or trastuzumab. 27 patients were excluded for many reasons: 17 patients were lost to follow-up, 10 patients had an inadequate echo-imaging (8 had a follow-up without measurement of GLS and 2 patients were poorly echogenic). Only eighty patients were finally retained. The average age of our patients was 49.9±10.8 years. The mean left ventricular ejection fraction (LVEF) was at 64±4.4%. The incidence of CTRCD was 6%. the mean delay of diagnosis from the onset of chemotherapy was 174 days. It was reversible in 60% of cases after the initiation of a cardioprotective treatment which allowed the anti-cancer treatment pursuit. The incidence of subclinical cardiac dysfunction was 25%. The mean delay between the initiation of anti-cancer treatment and the diagnosis was 314.5 days. A cardioprotective treatment with Bblockers and angiotensin-converting enzyme (ACE) inhibitors was prescribed and all these patients recovered a normal GLS with a mean delay of three months and pursuied their chemotherapy.

Conclusion

We showed that timely cardiovascular evaluation, intervention and close monitoring in the context of a structured service allowed the majority of patients (99%) to pursue their anti-cancer treatment and to avoid the evolution to CTRCD in patients diagnosed with subclinical cardiac dysfunction.

Funding Acknowledgement

Type of funding sources: None. Treated subclinical cardiac dysfunction

[Utility of cardiovascular magnetic resonance in hypertrophic cardiomyopathy: when is it superior to echocardiography?]

The diagnosis of hypertrophic cardiomyopathy is usually established by echocardiography. Recently, there has been greatly increased use of cardiac magnetic resonance (CMR) because of its precise determination of myocardial anatomy and the depiction of myocardial fibrosis. In this review, we describe the role of echocardiography and magnetic resonance in the assessment of this complex disease. In conclusion, there is a complementarity between cardiovascular magnetic resonance imaging and echocardiography for the diagnosis and the management of HCM.

Les uvéites de l'enfant: étude de 18 observations

Childhood uveitis is a rare but serious disease that may causes visual loss. Causes are various and an underlying disease is not always found.

PURPOSE

To analyse clinical features and prognosis of uveitis in children.

PATIENTS AND METHODS

A retrospective, descriptive study of cases observed in a general pediatric unit over a period of 15 years (1990-2005) at Tunis.

RESULTS

We gathered 18 cases of uveitis (girls 55.6% ,boys 44.4%). Mean age at the diagnosis was 8+/-3 years. Diagnosis was made after a decreased of visual acuity in 55.6% of cases. Localization of uveitis was anterior (6 cases), intermediate (1 case), posterior (3 cases) and total (8 cases). An underlying disease was found in only 5 patients: Behçet's disease (3 patients), juvenile chronic arthritis (1 patient), possible dermatopolymyositis (1 patient). The evolution was favorable in 10 cases with local treatment, systemic corticotherapy and/or immunosuppressive agents. Complications occurred in 3 cases.

CONCLUSION

Causes of uveitis in childhood remains most often undiagnosed Our study illustrates the pending risk of severe visual impairment and strict ophtalmology follow-up is mandatory.

[Syphilitic aortic aneurysm. A case report]

The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.

Sodium lauryl sulfate-induced irritation in the human face: regional and age-related differences

The particular sensitivity of the human face to care products prompted us to study irritation induced by sodium lauryl sulfate (SLS) in its various regions. We examined regional and age-related differences, correlating basal transepidermal water loss (TEWL) and capacitance to SLS irritation. SLS (2% aq.) was applied under occlusion for 1 h to the forehead, cheek, nose, nasolabial and perioral areas, chin, neck and forearm to two groups of subjects--one with 10 subjects with an average age of 25.2 +/- 4.7 years and another with 10 subjects with an average age of 73.7 +/- 3.9 years. TEWL was measured before and 1 h and 23 h after patch removal. Baseline stratum corneum hydration was also measured. Irritation was assessed by the changes in TEWL (deltaTEWL = TEWL after patch removal - basal TEWL) after corrections to the control. In the younger group, all areas of the face and the neck reacted to SLS, whereas the forearm did not. In the older group, the nose, perioral area and forearm did not react. In both age groups, some significant differences between the regions of the face were detected. The younger group showed higher changes in TEWL than the older group in all the areas studied, but only in the chin and nasolabial area were the differences statistically significant. Significant correlations were found between basal TEWL and deltaTEWL in 5 of the 7 areas which reacted to SLS. Baseline TEWL is one parameter that correlates with the susceptibility of the face to this irritant.

Identification of Malassezia species from Tunisian patients with pityriasis versicolor and normal subjects

BACKGROUND

The genus Malassezia (Pityrosporum), recognized as a member of microbiological flora of the skin in humans and warm-blooded animals, has been recently revised to include 10 Malassezia species. The aim of the study was the isolation, identification and analysis of Malassezia species distribution in skin of healthy volunteers and lesions of pityriasis versicolor (PV).

MATERIAL AND METHODS

Specimens were taken from 100 patients with PV and 30 healthy volunteers. Cultures were made in modified Dixon agar medium and the isolates were identified by morphological and physiological methods: macroscopy, microscopy, catalase, beta-glucosidase and lipid assimilation tests.

RESULTS

Malassezia globosa was the predominant species in lesional skin of PV (65%). It was isolated alone in 47% of cases and associated in 18% with M. furfur (13%) or M. sympodialis (5%). In healthy skin M. globosa was found alone in 7.77% and associated in 15.54%, respectively, with M. furfur (4.44%), M. sympodialis (4.44%), M. restricta (3.33%) and M. slooffiae (1.11%).

CONCLUSION

From these findings it was suggested that M. globosa presents the main species implicated in the pathogenicity of PV and M. furfur as the second agent of importance.

Kératoplastie transfixante à chaud dans les ulcères cornéens infectieux perforés

PURPOSE

To evaluate anatomical and functional prognosis of urgent penetrating keratoplasty in perforated infectious corneal ulcers.

METHODS

Seven eyes of seven patients had an urgent penetrating keratoplasty for perforated infectious corneal ulcers. Anatomical success was defined by eradication of infection and preservation of eye from enucleation and phthisis bulbi. Corneal graft survival was defined by the presence of a clear graft.

RESULTS

The patients'mean age was 40.5 years. Four eyes had bacterial corneal ulcer and three eyes had herpetic corneal ulcer. Anatomical success was obtained in six eyes. The graft remained clear in two eyes. Graft rejection was noted in four eyes after a mean period of 4.5 months. Postoperative complications were ocular inflammation (one eye), ocular hypertension (three eyes), cataract (one eye), peripheral anterior synechiae (one1 eye), graft ectasia (one eye), bacterial infection (one eye) and recurrent herpetic keratitis (one eye). The mean follow-up period was 22 months, ranging from 9 to 32 months.

CONCLUSION

Urgent penetrating keratoplasty can preserve eye integrity and eradication of the infectious process in a large part of perforated bacterial and herpetic corneal ulcers. Visual rehabilitation is often a secondary objective. Adapted antimicrobial treatment reduces graft reinfection and steroid treatment reduces the frequency of some complications, especially graft rejection.

[Eosinophilic pustular folliculitis in infancy: an unusual case]

INTRODUCTION

Eosinophilic pustular folliculitis in children is a follicular inflammatory dermatosis, usually occurring early in life. The disease progresses in flares of prurigenous plaques studded with papules and sterile pustules of the scalp and other areas of the skin.

OBSERVATION

A 7 year-old boy presented with itching papular vesicular and pustular plaques on the scalp and the face. Pigmented plaques with pustular border, located on the trunk, were associated with pustular and erosive lesions of the side of the lower lip and in the nostrils. A specimen taken from the pustules did not show bacterial or fungal infection. Histologic examination of a biopsy specimen showed subcorneal pustules with eosinophilic and neutrophilic infiltrates of follicles. Clinical improvement was obtained only by the combination of steroids and dapsone, but recurrence followed withdrawal of treatment.

DISCUSSION

Eosinophilic pustular folliculitis in children is rare. Our case report combines features of the infancy form (lesions located on the scalp and face) and the adult form (location on the trunk and limbs with annular distribution), expressing the conceptual confusion that remains between both forms. The mucosal involvement seen in our patient has never been reported in the literature neither in the infancy nor in the adult form.

[Role of lactate dehydrogenase (LDH) level in the aqueous humor in the diagnosis of retinoblastoma (RB)]

In spite of the progress of the imagery in ophthalmology, the retinoblastoma remains in some particular cases, difficult to make. Moreover, the therapy sanction is often heavy. The lactate dehydrogenase (LDH) dosage in aqueous humor is an invasive technique conceivable when there are diagnosis problems particularly in retino-blastoma of old children and in affections simulating retino-blastoma. The purpose of this work is to lay out three observations where the LDH dosage enabled to keep the retinoblastoma diagnosis in one 8-year old child and eliminate it in two children having pseudoglioma with spontaneous evolution allowing to confirm the non-tumoral nature of the affection. Thus, the technique of LDH dosage has been reliable for the 3 cases which we have introduced. The authors compare the reliability of the different cytochemical techniques during the retinoblastoma diagnosis.

[Intraorbital dermoid cyst. Apropos of a case]

Orbital dermoid cyst represents 3 to 4% of all primary orbital tumours. The intraorbital location is relatively rare. We report the case of a 9 year-old male child with an orbital dermoid cyst, who presented with progressive right proptosis, which had developed 3 months earlier. Visual acuity, ocular motility and funduscopic examination were normal. Imaging aspects (ultrasonography and computed tomography) have revealed an extraconical orbital, hypodense, well limited tumor, without bone destruction and no enhancement located at the postero-external side of the orbit. The tumors was extirpated surgically via a superior approach. Histopathology confirmed the diagnosis of dermoid cyst.

[Penetrating keratoplasty in primary congenital glaucoma]

PURPOSE

We present preliminary research on penetrating keratoplasty in corneal dystrophy secondary to congenital glaucoma. The aim was to analyse the functional and anatomic results of this morbid condition where visual prognosis is usually poor.

PATIENTS AND METHODS

Six cases of congenital glaucoma in which the ocular pressure is controlled were studied. Age varied from 10 months to 11 years, the medium age was 47.7 months (SD: 42.8). These patients underwent penetrating keratoplasty. Recession varied from 3 months to 29 months, with a medium recession of 18.4 months (SD: 11.54).

RESULTS

Anatomic results: the graft remained transparent in 5 eyes. Some postoperative complications were noticed: ocular hypertonia medically treated in one case, minor uveitis in one case, total cataract operated by phacophagy with a final outcome of ophthalmomalacia, buphtalmia (31.5 of diameter and ocular tonus at 7 mmHg). Functional results: an amelioration of visual acuity was obtained in 5 of 6 cases.

CONCLUSION

The anatomic and functional results were satisfactory. Ocular pressure must be normalised before keratoplasty. Important buphtalmia constitutes one contra-indication to this intervention. Hypotonia would appear to be a factor of poor prognosis.

Vitamin A and E blood levels in erythrodermic and pustular psoriasis associated with chronic alcoholism

Vitamin A and E blood levels were determined, using a high-performance liquid chromatographic method, in 7 patients with erythrodermic psoriasis or psoriatic acral pustulosis associated or not associated with chronic alcoholism, during and after the acute episode. These vitamins were also studied in 5 patients with psoriasis vulgaris involving more than 80% of the surface body area and associated with chronic alcohol intake and in 17 patients with psoriasis vulgaris involving more than 50% of the skin but without chronic alcoholism. Vitamin A blood levels were reduced in all the patients in the group "erythrodermic psoriasis/psoriatic acral pustulosis", while vitamin E blood levels were below the normal range during the acute psoriatic episode only in the 5 patients having a history of chronic alcohol intake in this group. In the other groups--psoriasis vulgaris with chronic alcoholism and psoriasis vulgaris without heavy alcohol consumption--vitamin A and E blood levels were not reduced. The implication of vitamin E in psoriasis, probably by its antioxidant activity, and its relationship with selenium are discussed. We suggest that attention should be paid to the vitamin A deficiency in erythrodermic or pustular psoriasis and to the vitamin E deficiency when these inflammatory diseases are associated with chronic alcoholism.

What is occupational contact dermatitis? An operational definition

Occupational contact dermatitis remains an important cause of disability. Eight steps in an operational definition of OCD are as follows: 1. Relevant clinical history 2. Relevant morphology 3. Positive diagnostic patch test with appropriate vehicle and concentration 4. Repeat patch test when excited skin syndrome is suspected 5. Positive provocative use test or repeat open application test to refine clinical relevance 6. Serial dilutions, when necessary, of the chemical tested 7. Reviewing controls for nonirritating concentrations when this is not known by the investigator 8. Generally, clearing of the dermatitis when allergen is removed, or exposure significantly decreased The diagnosis is not always easy. Well-conducted clinical investigations are needed, including clinical history, clinical examination, and patch testing with careful follow-up. However, many of the chemicals reported in the literature as sensitizers induce only sporadic allergic reactions. Thus, epidemiologic animal and human studies are necessary to determine the capacity of the chemicals used in industry to induce contact dermatoses. It is necessary to standardize the predictive tests to compare results among laboratories and to predict the potential for sensitization.