Refractory Lyme arthritis commonly is treated successfully with arthroscopic synovectomy. We describe a patient who presented with a concomitant medial meniscal tear; he underwent initial medial meniscal repair and a partial meniscectomy. He required additional surgery before full recovery was achieved.

No abstract

Background: Heart Failure (HF) is a complex cardiovascular (CV) disease with half of patients having preserved ejection fraction (HFpEF). Right heart catheterization (RHC) is often used to prognosticate and guide therapy in decompensated HFpEF while strain echocardiography is increasingly being used as an alternative modality. Purpose: To evaluate the prognostic impact of strain imaging compared to RHC in hospitalized patients with decompensated HFpEF. Methods: This was a retrospective cross-sectional study with patients hospitalized for acute HFpEF exacerbation with echo and RHC data available during index admission. Strain analysis was performed using 2D strain imaging software. Demographic and clinical parameters were obtained with mortality data via National Death Index. The outcomes of interest were 6 month, 1 year and 5 year all cause mortality and a composite of CV death with HF readmissions. Separate models incorporating all variables were done using survival analysis by multivariable Cox regression after adjusting for age, gender and race. Results: A total sample of 178 patients was included in the analysis. The mean age±SD was 69.4±13.5. Majority were African American (50%) and female (62%). Half(53%) had diabetes while 88% had hypertension. The 5 year all cause mortality rate was 45% with CV death at 18% and overall readmission rate was 29%. Only mean pulmonary artery pressure (mPAP) was significantly predictive of 6 month all cause mortality HR 2.01; 95% CI (1.07-3.78) p=0.031 and 5 year all cause mortality 1.91; 95% CI (1.46-2.51) p<0.001. For the composite outcome of combined CV death and HF readmissions, right atrial reservoir strain was significant at the 6 month and 1 year time periods with HR 0.65; 95% CI (0.44-0.96) p=0.03 and HR 0.60; 95% CI (0.41-0.89) p=0.01 respectively. Conclusions: RHC and strain variables may be predictive of different outcomes in decompensated HFpEF.

No abstract