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BackgroundDoubts remain about atherosclerotic disease and risk stratification of asymptomatic type-2 diabetic patients (T2DP). This study aims to evaluate the usefulness of calcium score (CS) and coronary computed tomography (CT) angiography (CTA) to predict fatal and non fatal cardiovascular events (CVEV) in T2DP.MethodsEighty-five consecutive T2DP undergoing CT (Phillips Brilliance, 16-slice) with CS and CTA were prospectively enrolled in a transversal case-control study. Patients were followed for 48 months (range 18 - 68) to assess CVEV: cardiovascular death, acute coronary syndrome, revascularisation and stroke. Potential predictors of CVEV were identified. Predictive models based on clinical features, CTA and CS were created and compared.ResultsPerforming CT impacted T2DP treatment. Cardiovascular risk was lowered during follow-up but metabolic control remained suboptimal. CVEV occurred in 11.8% T2DP (3.1%/year). CS ≥86.6 was predictor of CVEV over time, with a high negative predictive value, an 80% sensitivity and 74.7% specificity. Although its prognostic value was not independent of the presence/absence of obstructive CAD, adding CS and CTA data to clinical parameters improved the prediction of CVEV: the combined model had the highest AUC (0.888, 95%CI 0.789-0.987, p < 0.001) for the prediction of the study endpoints.ConclusionsCS showed great value in T2DP risk stratification and its prognostic value was further enhanced by CTA data. Information provided by CT may help predict CVEV in T2DP and potentially improve their outcome.

We report a 16-month-old girl with varicella complicated by cellulitis, invasive Group A (GAS) infection and deep vein thrombosis. She presented with varicella lesions, fever and a painful firm tumefaction on the right lower leg (RLL). Ultrasound showed a local subcutaneous tissue thickening suggestive of cellulitis and antibiotics were initiated. Further swelling of the RLL motivated a second ultrasound that showed an obstructive thrombus for which she was started on enoxaparin. The blood culture confirmed GAS infection leading to directed antibiotherapy. Additional studies showed positive lupus anticoagulant, decreased protein S and antithrombin. She completed a 2-week course of intravenous antibiotics and anticoagulation therapy with clinical and laboratory markers improvement. However, 3 days later, a recrudescence of symptoms occurred and the ultrasound revealed a local abscess. Further amoxicillin treatment resulted on a complete resolution of symptoms. Doppler ultrasound after 1 month showed markedly increased vein patency.

An electromyographical investigation of 80 patients with chronic Chagas' disease was made. It was found that 79% of the studied patients had EMG manifestations of old and chronic denervation of the upper and lower limbs without clinical features of nervous system involvement.

In the era of Multislice Computed Tomography (MSCT), few studies have been dedicated to the evaluation of coronary anomalies and variants. We aim to present, describe and assess the prevalence of congenital coronary variants and anomalies (CVA) in the MSCT coronary angiographic studies performed in our department. All the MSCT coronary angiographies performed in our department, between April 1, 2007 and May 31, 2012 were reviewed. Coronary anomalies and variants were characterized and grouped according to their type: origin, course (including myocardial bridging) and distal ending. A total of 663 patients underwent a MSCT coronary evaluation during this period. A total of 84 anomalies and variants were identified in 80 individuals: 12.1% of the population (80/663). The most frequent variant was the myocardial bridging of the anterior descending artery. Four (4.7%) of the anomalies were considered malignant, corresponding to a prevalence of 0.6% (4/663) in the population. Congenital coronary anomalies and variants are relatively common. In our study, the prevalence was 12.1%, myocardial bridging being the most common. This fact may explain the higher prevalence compared to some series based on the cardiac catheterization studies. Few of these anomalies were considered malignant, with prevalence rates similar to those found in the cardiac catheterization studies.