Hypertrophic non-obstructive apical cardiomyopathy : a case presentation and review of the literature

CITATION: Przybojewski, J. Z. & Blake, R. S. 1984. Hypertrophic non-obstructive apical cardiomyopathy : a case presentation and review of the literature. South African Medical Journal, 66:492-498.The original publication is available at http://www.samj.org.zaA 20-year-old coloured man gave a history of atypical chest pain, palpitations after strenuous exercise and a single episode of post-exertional presyncope. The diagnosis of hypertrophic non-obstructive apical cardiomyopathy (HNOAC) was established by means of electrocardiography, echocardiography (both M-mode and two-dimensional) and left ventricular cine angiography. This variant of hypertrophic cardiomyopathy is most unusual and has been encountered most frequently in Japan, although a few cases have been diagnosed in the USA. The present case is the second reported from the Republic of South Africa. Important aspects of HNOAC are reviewed.Publisher’s versio

Diagnostic features of tuberculous meningitis: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Tuberculous meningitis (TBM) is a common central nervous system infection in the Philippines; however it is difficult to diagnose as findings are non-specific. Hence we decided to determine if, among patients with chronic meningitis syndrome, the following are associated with the diagnosis: new-onset seizures; focal neurologic deficit; pulmonary tuberculosis (PTB) on chest X-ray; cerebrospinal fluid (CSF) pleocytosis with lymphocytic predominance; decreased CSF glucose; increased CSF protein.</p> <p>Methods</p> <p>Adult patients with suspected TBM were enrolled after informed consent was obtained. Baseline physical examination and diagnostic tests including CT scan of the head with contrast and CSF analysis for acid fast bacilli (AFB) smear, TB culture and cryptococcal antigen detection were done and results collected. Definite TBM was defined as positive AFB smear or positive TB culture or positive basal meningeal enhancement on CT contrast study. Logistic regression was done to determine which were associated with a diagnosis of TBM.</p> <p>Results</p> <p>91 patients were included. Using the gold standard criteria mentioned above, 44 had definite TBM; but if subsequent clinical course and response to anti-Koch's therapy are considered, 68 had a final diagnosis of TBM. After logistic regression was performed, only abnormal CSF (the combination of CSF pleocytosis with lymphocytic predominance, decreased CSF glucose, and increased CSF protein) was associated with the diagnosis of TBM.</p> <p>Conclusion</p> <p>In patients with chronic meningitis syndrome, only abnormal CSF was associated with the diagnosis of TBM.</p

Book Reviews

Basic Neurology. Ed. by J. Gilroy and P. L. Holliday. Pp. vii + 373. Illustrated. R27,90. London: Macmillan. 1982.The Pathology of the Heart. By E. G. J. Olsen. Pp. ix + 402. Illustrated. R91,85. London: Macmillan. 1982.Profile of Disease and Health Care in South Africa. By H. C. J. van Rensburg and A. Mans. Pp. xvii + 319. R29,50. Pretoria: Academica Press. 1982.Principles of Ambulatory Medicine. Ed. by L. R. Barker, J. R. Burton and P. D. Zieve. Pp. xiii + 1127. Illustrated. R78,-. Baltimore, Maryland: Williams &amp; Wilkins. 1982.Topical Reviews in Accident Surgery, vol. 2. Ed. by N. Tubbs and P. S. London. Pp. ix +258. Illustrated. £18,50. London: Wright PSG.1982.Early Care of the Injured Patient. 3rd ed. Ed. by A. J. Wait, L. F. Peltier, B. A. Pruitt jun, D. D. Trunkey and R. F. Wilson. Pp. xv + 413. Illustrated. Philadelphia: W. B. Saunders. 1982.Current Pediatric Therapy. 10th ed. By S. S. Gellis and B. M. Kagan. Pp. xxxviii + 776. R94,25. Philadelphia: W. B. Saunders. 1982.Selected Techniques in Interventional Radiology,vol. 19 (Saunders Monographs in Clinical Radiology). By S. Kadir, S. L. Kaufman, K. H. Barth and R. 1. White jun. Pp. xi +216. Illustrated. R76,75. Philadelphia: W. B. Saunders. 1982.Clinical Topics in Internal Medicine. Ed. by G. M. Tisi and H. M. Ranney. Pp. xii 173. Illustrated. Baltimore, Maryland: Williams &amp; Wilkins. 1982.Recognizable Patterns of Human Malformation: Genetic Embryologic and Clinical Aspects (Major Problems in Clinical Pediatrics, vo!. vii). 3rd ed. By W. David and M. D. Smith. Pp. xvii + 653. Illustrated. R78,55. Philadelphia: W. B. Saunders. 1982.The Patient and the Plastic Surgeon. By R. M. Goldwyn. Pp. xiii + 255. Boston: Little, Brown. 1981.The Aging Lumbar Spine. By S. W. Wiesel, P. Bernini and R. H. Rothman. Pp. 257. Illustrated. R69,55. Philadelphia: W. B. Saunders. 1982.Postoperative Complications of Intracranial Neurological Surgery. By N. H. Horwitz and H. V. Rizzoli. Pp. xi + 472. Illustrated. Baltimore: Williams &amp; Wilkins. 1982.Current Topics in Inflammation and Infection (International Academy of Pathology Monograph). Ed. by G. Majno, R. S. Cotran and . Kaufman. Pp. xi + 242. Illustrated. Baltimore, Maryland: Williams &amp; Wilkins. 1982.Radiology of the Ear, Nose and Throat. By G. E. Valvassori, G. D. Porter, W. N. Hanafee, B. L. Carter and R. A. Buckingham. Pp. viii + 342. Illustrated. RI94,30. Philadelphia: \Y/. B. Saunders. 1982.Neuropathology ofParasitic Infections. By W. J. Brown and M. Voge. Pp. 240. Illustrated. RI5,-. Oxford: Oxford Medical Publishers. 1982.Herzkrankheiten: Pathophysiologie, Diagoostik, Therapie. 2nd ed. By H. Roskamm and H. Reindel!. Pp. xxxiii + 1543. Illustrated. DM 278,-. Berlin: Springer-Verlag. 1982.Review ofSpeech, Language and Hearing, vols I, 2and 3. By N. J. Lass, L. V. McReynolds, J. L. Northern and D. E. Yoder. Illustrated. R36,20 each. Philadelphia: W. B. Saunders. 1982

Reliability and Diagnostic Performance of CT Imaging Criteria in the Diagnosis of Tuberculous Meningitis

The original publication is available at http:// www.plosone.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Introduction: Abnormalities on CT imaging may contribute to the diagnosis of tuberculous meningitis (TBM). Recently, an expert consensus case definition (CCD) and set of imaging criteria for diagnosing basal meningeal enhancement (BME) have been proposed. This study aimed to evaluate the sensitivity, specificity and reliability of these in a prospective cohort of adult meningitis patients. Methods: Initial diagnoses were based on the CCD, classifying patients into: ‘Definite TBM’ (microbiological confirmation), ‘Probable TBM’ (diagnostic score $10), ‘Possible TBM’ (diagnostic score 6–9), ‘Not TBM’ (confirmation of an alternative diagnosis) or ‘Uncertain’ (diagnostic score of ,6). CT images were evaluated independently on two occasions by four experienced reviewers. Intra-rater and inter-rater agreement were calculated using the kappa statistic. Sensitivities and specificities were calculated using both ‘Definite TBM’ and either ‘Definite TBM’ or ‘Probable TBM’ as gold standards. Results: CT scan criteria for BME had good intra-rater agreement (k range 0.35–0.78) and fair to moderate inter-rater agreement (k range 0.20–0.52). Intra- and inter-rater agreement on the CCD components were good to fair (k = ranges 0.47–0.81 and 0.21–0.63). Using ‘Definite TBM’ as a gold standard, the criteria for BME were very specific (61.5%–100%), but insensitive (5.9%–29.4%). Similarly, the imaging components of the CCD were highly specific (69.2–100%) but lacked sensitivity (0–56.7%). Similar values were found when using ‘Definite TBM’ or ‘Probable TBM’ as a gold standard. Discussion: The fair to moderate inter-rater agreement and poor sensitivities of the criteria for BME suggest that little reliance should be placed in these features in isolation. While the presence of the CCD criteria of acute infarction or tuberculoma(s) appears useful as rule-in criteria, their absence is of little help in excluding TBM. The CCD and criteria for BME, as well as any new criteria, need to be standardized and validated in prospective cohort studies.Funding: KB received funding from the Discovery Foundation (Academic Fellowship Award; http://www.discovery.co.za/portal/loggedout-individual/discoverycommunity- about), College of Neurology of South Africa (K.M. Browse Award; http://www.collegemedsa.ac.za/Default.aspx ) and the University of Stellenbosch. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Publisher's versio

Acute myocardial infarction with a non-diagnostic electrocardiogram : case presentation and overview

The original publication is available at http://www.samj.org.zaThe clinical presentation of a young hypertensive White man with acute high lateral non-transmural myocardial infarction (MI) is documented. This diagnosis was established on the grounds of a history of chest pain, elevated serial serum enzyme levels, technetium-99m pyrophosphate ('hot-spot') scintigraphy, exercise thallium-201 ('cold-spot') scanning, left ventricular cine angiography and selective coronary arteriography. Daily resting 12-lead ECGs failed to demonstrate unequivocal features of acute non-transmural subendocardial MI. The diagnostic difficulties facing the clinician in a case of acute MI associated with a non-diagnostic ECG are stressed, and the ECG features of acute subendocardial MI are reviewed.Publishers' versio

Two simple inexpensive photographic methods for viewing ECG-gated radionuclide blood pool images

The original publication is available at http://www.samj.org.zaAlthough the ECG-gated radionuclide blood pool scan (GBPS) has become an established method for studying regional myocardial wall motion, it is usually performed with the aid of an expensive computer system. A simple, inexpensive method was developed to view gated radionuclide blood images by a film loop and a photographic motion detection (PHOMOT) technique. These techniques were compared with left ventricular cine angiography in 15 patients. Segmental wall movement (78 segments) showed identical results in 92% of cases. In all patients the same diagnosis was arrived at by GBPS and cine angiography. The photographic techniques developed offer a simple screening procedure to reduce cardiac catheterization in patients with suspected abnormalities of left ventricular wall contraction.Publishers' versio

Objective CT criteria to determine the presence of abnormal basal enhancement in children with suspected tuberculous meningitis

Background: There are no widely accepted objective criteria to determine the presence of basal enhancement on CT in children with suspected tuberculous meningitis (TBM). Objective: To test nine recently described objective CT criteria for the presence of abnormal basal enhancement in children with suspected TBM against the definite diagnosis as determined by cerebrospinal fluid (CSF) culture. Materials and methods: CT scans of patients with a clinical suspicion of TBM who had undergone lumbar puncture for CSF culture spanning a period of 4 years were reviewed for the presence of nine recently described criteria for the presence of abnormal basal enhancement. The radiologists were blinded to the final diagnosis based on CSF culture against which the criteria were tested. The criteria have been named: the 'Y-sign', 'linear enhancement', 'double lines', Iinfundibular recess of the third', 'ill-defined edge', 'nodular enhancement', 'join the dots', 'contrast filling the cisterns', and 'asymmetry'. Results: A total of 65 patients were included in the study, 34 with culture-proven TBM and 31 with other diagnoses. Four individual criteria had a specificity of 100%, but the sensitivities of these criteria ranged from 15% to 53% only. Three other criteria had specificities of 97% and sensitivities ranging from 62% to 82%. The presence of more than one criterion in the same patient showed a specificity of 97% and sensitivity of 91%. Conclusions: Very high specificity was demonstrated for all nine criteria, including 100% specificity for four individual criteria. Sensitivity was at best 82%, but improved to 91% when more than one criterion was present. These criteria need to be tested for inter- and intraobserver variability to prove their clinical usefulness. © Springer-Verlag 2006.Revie

Endovascular Treatment of Femoral Artery Pseudoaneurysm in a HIV Positive Patient – A Case Report

Arterial pseudoaneurysm formation has been increasingly reported in HIV positive patients and generally surgery is indicated. We paced an endovascular stent in a femoral artery pseudoaneurysm of a 30-year-old HIV-positive male. Early results of this procedure are good. We believe that implantation of an endovascular stent graft can result in a shorter hospital stay and can significantly reduce morbidity for HIV-positive patients with pseudoaneurysms. © 2007 Elsevier Ltd. All rights reserved.Articl