Idiopathic Pulmonary Hypertension (IPAH) is characterized by elevated pulmonary arterial pressure in the absence of an identifiable underlying cause. The condition is usually relentlessly progressive with a short survival in the absence of treatment.(1) We describe a patient of IPAH in whom the pulmonary artery pressures significantly abated with complete disappearance of symptoms, following spontaneous development of a pulmonary arterio-venous malformation (PAVM).

Background: Uretolithiasis is one of the most common cause of urinary tract obstruction which leads to the admission into the emergency ward. The detection of urolithiasis or acute renal colic is by the radiography, conventional ultrasonography (US) and intravenous urography (IVU). A colour Doppler USG measures this change as a resistive index (RI) of the arcuate arteries at the corticomedullary junction or the interlobar arteries.Methods: 84 patients between the ages 15-50 years, who were admitted to the Emergency department of our hospital with unilateral renal colic were included into our study. Detailed demographic data was collected from all the patients and they were all subjected to a thorough physical and clinical examination. Bladder ultrasound was taken along with color Doppler for all the patients at the time of admission for every 6 hours. Thus, an increased RI index signifies an obstruction without a dilatation.Results: Left flank pain was slightly more than the right flank pain, although this was not found to be significant. Most of the patients were presented with vomiting or nausea and dysuria was seen in 48 patients. there were 41 cases of hydronephrosis in total and all of them were positive for mean RI. The specificity with the mean resistive index with color Doppler was 90%, while the sensitivity was 100%.  Around 95% of the prediction was accurate with mean resistive index, with more than 90% efficiency.Conclusions: The mean resistive index is a very good tool for the diagnosis of hydronephrosis, with a very high level of specificity and sensitivity.

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Objective: To measure the distance between the mitral leaflet coaptation point and the mitral annulus (CPMA) and assess the relation of this index to structural and functional characteristics of the failing left ventricle. Design: Echocardiographic indices and CPMA were measured at baseline and again during dobutamine infusion and leg lifting. Left ventricular diastolic and systolic dimensions, left ventricular ejection fraction (LVEF) by Simpson's rule, mitral annulus dimension, and E point septal separation were correlated with CPMA. Setting: Tertiary referral centre. Patients: The total study population of 129 patients included 94 with LVEF < 35% and 35 with LVEF 35%-45%; 76 had coronary artery disease and 53 had dilated cardiomyopathy. Interventions: A dobutamine infusion was given in 18 patients and preload increase by leg lifting in 28. Main outcome measures: Correlations between CPMA and contractility indices at baseline and during interventions. Results: CPMA was correlated with left ventricular diastolic dimension (r = 0.52), left ventricular systolic dimension (r = 0.53), LVEF (r = −0.44), fractional shortening (r = −0.42), E point septal separation (r = 0.48), and mitral annulus dimension (r = 0.44) (all p < 0.001). Dobutamine decreased CPMA from (mean (SD)) 12.04 (3.64) mm to 8.92 (2.56) mm and increased LVEF from 27 (6.2)% at baseline to 33.4 (6.9)% at 10 µg/kg/min (both p < 0.001). These changes were strongly related (r = 0.68, p < 0.007). After leg lifting, CPMA decreased from 13 (4) mm at baseline to 10 (3) mm (p < 0.001), and LVEF increased from 32 (11)% at baseline to 39 (11)% (p < 0.001). Fractional shortening and left ventricular diastolic dimension also increased (p < 0.001) and mitral annulus dimension and E point septal separation decreased (p < 0.002), but left ventricular systolic dimension did not change. Conclusions: The mechanism displacing the mitral coaptation point towards the left ventricular apex is multifactorial. The correlations between CPMA difference (before versus after interventions) and ejection fraction difference (before versus after interventions) shows that this index depends mainly on left ventricular function.

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