Timothy Ho

Increased augmentation index in patients with cystic fibrosis

Increased large artery stiffness occurs in a range of inflammatory conditions indicating an ageing of the vasculature and additionally being an independent risk factor for cardiovascular events. We determined large artery parameters in adults with cystic fibrosis (CF). 50 clinically stable adult patients with CF (mean±sd age 28.0±8.2 yrs) and 26 controls matched for age, sex and body mass index were studied. Central aortic blood pressure, augmentation index (AIx) and aortic pulse wave velocity (PWV) were determined using applanation tonometry. Lung function, diabetic status and C-reactive protein (CRP) were also determined. Mean±sd AIx was greater in patients than controls, 8.5±11.1% and -1.8±13.1%, respectively (p<0.001), while PWV was similar. Although AIx was greatest in the sub-group with CF-related diabetes (CFRD), it was also increased in the non-CFRD sub-group when compared with controls. In patients, AIx was related to log10 CRP (r = 0.33) and forced vital capacity (r =  -0.34; both p<0.05), and CRP remained predictive in multiple regression. AIx is increased in adults with CF, in the presence of a normal blood pressure and independent of diabetic status. AIx was related to the systemic inflammatory status. These findings have implications for management and require further exploration so that cardiovascular health can be maintained.

An 86-year-old female with lymphangioleiomyomatosis

To the Editors: In the paper by Johnson 1 on lymphangioleiomyomatosis (LAM), he describes the typical patient being female and of child-bearing age. Although patients outside this age range have been described, the oldest recorded in the recently reported National Heart, Lung and Blood Institute registry was aged 76 yrs, the mean age of onset being 38.9 yrs 2. We wish to report a …

Recurrent hydropneumothorax as a presenting feature of malignant mesothelioma

A 73-year-old former smoker with previous occupational exposure to asbestos presented with a pneumothorax that was initially managed by simple aspiration. Despite this, it re-accumulated and a bronchopleural fistula was suspected. A video-assisted thoracoscopic procedure was performed and revealed an abnormally thickened pleura that turned out to be a mesothelioma. All persistent pneumothoraces should be investigated.

Dynamic vascular changes following intravenous antibiotics in patients with cystic fibrosis

BACKGROUND Adults with cystic fibrosis (CF) have altered large artery haemodynamics which is associated with a persisting systemic inflammatory state. We hypothesized that a short-term intervention favorably influencing the inflammatory status may modify their haemodynamic state. METHODS Adult patients with CF were studied immediately preceding and following 2 weeks of intravenous antibiotics. Large artery haemodynamics, principally heart rate-adjusted augmentation index (AIx) were obtained. Blood pressure (BP), spirometry and CRP were also measured. RESULTS Complete data was available for 15 patients; mean (SD) age 28 (6)years. CRP was reduced while FEV1% predicted improved. Following treatment AIx was lower: 10.9 (10.9)% to 8.1 (10.9)% (p<0.05) while BP was similar and a trend toward lower heart rate (p=0.06). Change in AIx was related to baseline FEV1% predicted (r=0.77) and BMI (r=0.71) (both P<0.01). CONCLUSION The abnormal central haemodynamics evident in adults with CF is modulated with a short intervention of intravenous antibiotics.

Further warnings about laser pointers

Ziahosseini and colleagues report a maculopathy after a self administered laser burn from a laser pointer.1 Unfortunately, such injuries are likely to become more common because of the widespread availability of these …