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The aim of this article was to determine whether lateral and septal early diastolic mitral annular velocities (LW-e' and IS-e', respectively) accuracy to reflect left ventricular (LV) relaxation is truly compromised by a limitation of mitral annular motion due to mitral annulus calcification (MAC) and to search for e' surrogates to circumvent this limitation.LW-e', IS-e', and peak early diastolic velocities at the basal-lateral and basal-septal LV segments 2 cm distal to the annulus (LW-e'2 and IS-e'2, respectively) were measured using tissue Doppler imaging (TDI) in 206 consecutive patients referred for echocardiography. Significant MAC (assessed by two-dimensional echocardiography) was present in 57 (28%) subjects. There was a significant reduction in LW-Δe' (LW-e' minus LW-e'2) in subjects with posterior MAC (0.15 ± 1.35 vs. 1.30 ± 1.24 cm/s, P0.0001) and a small but not significant reduction in IS-Δe' (IS-e' minus IS-e'2) in subjects with anterior MAC (-0.15 ± 1.04 vs. 0.42 ± 1.56 cm/s, P = 0.07), compared with age-matched no MAC subjects. Potential confusion factors were analysed on multiple regression. The basal segments in which e'2 were measured were free of calcification regardless of MAC. In search for e'2-based surrogates for e', the regression equation [Formula: see text] (R(2) = 0.86, P0.0001) was obtained from the first 100 consecutive subjects and validated in the next 49 no MAC subjects (intraclass correlation coefficient 0.96, P0.0001). In the septal side, no difference was found between IS-e' and IS-e'2 in the 149 subjects with no MAC (8.5 ± 3.1 vs. 8.5 ± 2.9 cm/s, P = 0.55).MAC significantly affected LW-e' (and not significantly IS-e') accuracy to reflect LV relaxation. [Formula: see text] and IS-e'2 as surrogates for LW-e' and IS-e', respectively, may correct this inaccuracy.

This randomized pilot study was designed to determine whether the addition of interferon alpha-2b to standard radiation therapy offered an advantage in loco-regional control and survival over radiation therapy alone in a homogeneous group of patients with stage IIIB carcinoma of the cervix. Thirty-six patients were treated with a combination of interferon alpha-2b plus radiation therapy, and 38 patients were treated with radiation therapy alone. Patients with evidence of ureteral obstruction were excluded from the study. Evaluation of loco-regional response was determined by pelvic examination, cervical cytology, biopsies and CT scans when indicated. Survival time was measured from initiation of treatment to date of death or last follow-up. Patient characteristics were comparable between both study arms. The objective complete response rate was 67% in the combined therapy group and 55% in the radiation alone group (P = 0.454). With a median follow-up of 17 months for all patients and 31 months for live patients, 50% of the combined group survived vs. 39.5% of the radiation alone group (P = 0.424). We conclude that the addition of interferon alpha-2b to standard radiation therapy did not significantly improve loco-regional response or survival, although such a trend was noted. We encourage the design of a larger randomized study with sufficient power to detect meaningful differences to prove whether the tendency observed in the present investigation holds any promise to improve the outcome of these patients.

The aim of our study was to assess the spontaneous outcome of acute myocarditis associated with severe cardiac dysfunction in children, as well as to compare these features with those occurring in adult patients.Fifty patients consecutively diagnosed of acute myocarditis during the last 7 years in our hospital were studied; 15 patients were children younger than 14 years, and 35 were adults. Immunosuppressive therapy was not used in any patient.Mean age was 2 +/- 3 years in children, ranging from 2 months to 12 years. One patient required temporary pacing for a third-degree atrioventricular block, while the remaining 14 children had severe congestive heart failure, with a left ventricular ejection fraction of 30 +/- 12% (16 to 44%). After a mean follow-up of 21 +/- 26 months, only 3 children died, at 1, 4 and 10 months after the initial diagnosis. Death was sudden in all 3 patients. Left ventricular ejection fraction rose to 45 +/- 14% at 1 month after diagnosis, and to 58 +/- 15% at the end of follow-up. Unfavorable evolution (death or evolution to chronic dilated cardiomyopathy, with a left ventricular ejection fraction45%) occurred in 6 children (40%) at 1 month after diagnosis and in only 4 (25%) at the end of follow-up. The 9 children with 1-month favorable outcome were alive and had an ejection fraction45% at long-term, while only 2 of the 6 children with 1-month unfavorable outcome were alive and had an ejection fraction45% at long-term. Only the 3 children who died had an ejection fraction30% at 1-month. Favorable outcome was more frequent in children that in adult patients with acute myocarditis (75% versus 46%).The outcome of acute myocarditis with severe cardiac dysfunction was favorable in a majority of pediatric patients; this favorable evolution was less frequent in adults. Patients in whom left ventricular ejection fraction did not increase at short-term had a higher risk of death, and they should probably be considered for heart transplantation.

Although uncommonly, infective endocarditis in non-addict patients may involve people without predisponente heart disease. The aim of our study was to assess the clinical and prognostic features of this type of endocarditis and to compare them with those of the more common type of endocarditis with underlying lesion.With this aim, we have reviewed 71 consecutive cases of non-addict infective endocarditis diagnosed in our hospital in the last 7 years; there was no preexisting cardiac lesion in 9 patients (13% of all endocarditis and 21% of native valve endocarditis), while underlying heart disease, including mitral valve prolapse, was present in the remaining 62 patients.Mean age was significantly lower in 9 patients without preexistent lesion (28 +/- 18 versus 46 +/- 17 years, p0.01), while there was no differences for gender. Infection involved the aortic valve in 56%, the tricuspid or pulmonary valve in 33% and the mitral valve in only 11% of the patients without underlying cardiopathy (for 44%, 4% and 49%, respectively, in patients with cardiopathy). Staphylococcus aureus caused 67% of cases in patients without cardiopathy and only 9% in those with cardiopathy. Surgery was required in a similar proportion by both groups of patients (55% and 56%), although mortality was more than twice higher in patients with prior cardiac lesions (25% versus 11%).A significant proportion of non-addict infective endocarditis involves patients without predisponente heart disease. These cases have some differential features (younger age, aortic and right heart valves involvement, S. aureus as the main causative agent and lower mortality) in comparison to those of endocarditis in patients with underlying cardiopathy.

We report a case of a patient with an aortic prosthetic valve who had Q fever endocarditis, glomerulonephritis and rapidly progressive renal failure. He was seen in 1987 and successfully treated by heart valve surgery and a one-year course of doxycycline. Five years later, the patient had another episode of Q fever endocarditis, involving the native mitral valve, complicated with acute renal failure and severe mitral regurgitation that required hemodialysis and mitral valve replacement. The outcome was again successful. This case report raises the question of whether Q fever endocarditis can be eradicated, and also the required duration of antibiotic therapy for this disease.