T. Gardecki

C-reactive protein and four other acute phase reactant proteins of non-cardiac, origin (orosomucoid, alpha 1- antitrypsin, heptoglobin, and alpha 2- macroglobulin) were studied serially by laser immunonephelometric assay in sera from 17 patients with myocardial infarction. A similar comparison was made in 57 patients undergoing surgery and 72 patients with acute infection. C-reactive protein was consistently the most sensitive acute phase reactant in all three conditions. After myocardial infarction, a raised serum C-reactive protein level was found on admission in four patients before a rise in creatine kinase MB isoenzyme (CK MB). The peak C-reactive protein level was reached on the third post-infarct day and it then declined over seven days with a half-life similar to myocardial tropomyosin. Serial monitoring of serum C-reactive protein, in parallel with cardiac proteins of short half-life (CK MB) and long half-life (tropomyosin), provides maximal information for diagnosis and for detecting post-infarct complications.

The development of a malignant soft tissue tumour (malignant fibrous histiocytoma) in a surgical wound is reported. Although rare, this occurrence has important diagnostic implications and the management is discussed.

Long term central venous access is associated with many complications such as central venous stenosis which can occur in up to half of long term central lines. Many treatment modalities are employed such as transluminal angioplasty, arthrectomy and stents to improve vascular flow. We report a case of a subclavian vein stent migration to the right atrium causing tricuspid valve regurgitation. The patient was asymptomatic and therefore treated conservatively.