Little is known about the diagnostic significance of coronary artery calcification detected fluoroscopically in apparently healthy young men. This study compared the presence of fluoroscopically detected coronary artery calcification with angiographic coronary artery disease in asymptomatic male military aircrew undergoing noninvasive cardiac screening tests and coronary arteriography for occupational indications. Of 1,466 men screened with coronary fluoroscopy, 613 underwent coronary arteriography because of one or more abnormal noninvasive test results. The mean age (+/- SD) of all subjects screened was 40.2 +/- 5 years (range 26 to 65). Significant coronary artery disease (greater than or equal to 50% diameter stenosis) was found in 104 of the 613 subjects with arteriograms (16.9% disease prevalence). Overall sensitivity and specificity for coronary artery calcification detection of significant disease, based only on those subjects undergoing arteriography, were 66.3% and 77.6%, respectively. For measurable disease (mild plus significant), sensitivity was 60.6% and specificity 85.9%. Positive and negative predictive values were 37.7% and 91.9%, respectively, for significant disease. For measurable disease, positive and negative predictive values were 68.9% and 80.9%, respectively. In these asymptomatic young men, a fluoroscopic examination negative for coronary artery calcification indicated a low risk of significant coronary artery disease, whereas a positive test result (calcification present) substantially increased the likelihood of angiographically significant coronary artery disease.

Introduction:Neuroleptic malignant syndrome (NMS) is a life-threatening condition associated with the use of neuroleptic drugs and is characterized by a clinical syndrome of mental status change, muscle rigidity, fever, and autonomic instability. The incidence of NMS seems to has been decreasing, possibly due to increased awareness, changes in drug prescribing practices, the use of lower doses of dopamine blocking agents and atypical antipsychotics. The risk factors most consistently identified with precipitating NMS are prominent psychomotor agitation and incrementally higher doses of one or more parenterally administered neuroleptics. The use of atypical antipsychotics may be associated with: a decreased risk, decreased mortality, and atypical features of NMS.Objectives:To alert clinicians for atypical presentations of NM.Methods:To report and discuss, based on online pubmed database, a case of a NMS with no muscle rigidity, in spite of an extremely elevated CK level, due to quetiapine.Results:Atypical cases of NMS without muscle rigidity and/or hyperthermia have been reported in database. With the widespread use of atypical antipsychotics, atypical presentations of NMS should be more frequent. While not yet proven, it has been hypothesized that such atypical cases are a prodrome of the disease and represent impending NMS with typical presentation.Discussion/Conclusion:Clinicians must be aware for this atypical presentation of the NSM since adherence to strict diagnostic criteria may lead to alternate and/or delayed diagnosis, with eventually poor outcomes. For this reason, a strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment.