Blood cyst originating from tricuspid septal leaflet

Successful removal of a blood cyst of the tricuspid valve in a 34 years old man is reported. The rarity of this cyst in an adult and diagnostic clues are discussed.     

Time interval from the initiation of the electrocardiographic P wave to the start of left atrial appendage ejection flow: A novel method for predicting atrial fibrillation recurrence

OBJECTIVE: The incidence of paroxysmal and persistent atrial fibrillation (AF) recurrence is high and unpredictable. In this study, a novel noninvasive method that was thought to reflect the interatrial conduction time was investigated to predict AF recurrence. This method was on the basis of the measurement of time interval from initiation of the electrocardiographic P wave to the start of left atrial (LA) appendage (LAA) ejection flow (P-LAA). Methods and Results: Forty-five consecutive patients (age, 61 +/- 11 years; 20 male) with newly diagnosed AF (mean duration, 132 hours; range: 6 hours-3 months) who converted to in sinus rhythm spontaneously or with cardioversion were studied prospectively. Transthoracic and transesophageal echocardiography were performed to measure LA size, mechanical functions, LAA ejection velocity, and P-LAA. Transesophageal echocardiography was performed for the measurement of P-LAA 1 to 2 days after conversion to in sinus rhythm. The patients were followed up for a period of 163 +/- 72 days for the recurrence of AF. AF recurred in 17 (38%) patients after a mean time of 81 +/- 67 days. P-LAA was significantly higher in patients with AF recurrence (123 +/- 36 vs 92 +/- 24 milliseconds, P =.0047) and multiple regression analysis indicated that P-LAA was an independent predictor of AF recurrence. Multiple regression analysis revealed no significant differences in LA size parameters, or in clinical and LA mechanical function parameters recorded after restoration of in sinus rhythm between patients with and without AF recurrence. CONCLUSION: P-LAA may be considered to be an independent predictor of recurrent AF.     

Mesenchymal stem cells and ligand incorporation in biomimetic poly(ethylene glycol) hydrogels significantly improve insulin secretion from pancreatic islets

The main goal of this study was to investigate pancreatic islet function with mesenchymal stem cells (MSCs) in a ligand‐functionalized poly(ethylene glycol) (PEG) hydrogel for the treatment of type 1 diabetes (T1D). Rat bone marrow‐derived MSCs (rBM‐MSCs) were encapsulated within synthetic PEG hydrogel, and cell viability and apoptosis within this 3D environment was examined in detail. ATP content and caspase‐3 activity of encapsulated MSCs showed that fibronectin‐derived RGDS, laminin‐derived IKVAV and/or insulinotropic glucagon‐like peptide (GLP‐1) were required to maintain MSC survival. Incorporation of these peptides into the hydrogel environment also improved pancreatic islet viability, where combinations of peptides had altered effects on islet survival. GLP‐1 alone was the leading stimulator for insulin secretion. Cell adhesion peptides RGDS and IKVAV improved insulin secretion only when they were used in combination, but could not surpass the effect of GLP‐1. Further, when pancreatic islets were co‐encapsulated with MSCs within synthetic PEG hydrogel, a two‐fold increase in the stimulation index was measured. Synergistic effects of MSCs and peptides were observed, with a seven‐fold increase in the stimulation index. The results are promising and suggest that simultaneous incorporation of MSCs and ECM‐derived peptides and/or GLP‐1 can improve pancreatic islet function in response to altered glucose levels in the physiological environment. Copyright © 2014 John Wiley & Sons, Ltd.     

Expression of galectin-3, nm-23, and cyclooxygenase-2 could potentially discriminate between benign and malignant pheochromocytoma

Currently, the only reliable indicator of malignancy in pheochromocytoma is the presence of distant metastasis or extensive local invasion; predicting behavior of pheochromocytoma remains challenging. We aimed to correlate the behavior of pheochromocytoma with its expression of nm-23, cyclooxygenase (COX)-2, and galectin-3 (genes used to predict the course of some neoplastic diseases), evaluated immunohistochemically in 55 paraffin blocks of formalin-fixed pheochromocytoma specimens with confirmed behavior. In 3 (7%) of 44 benign and 7 (64%) of 11 malignant pheochromocytomas, there was negative nm-23 expression (P = .000). COX-2 immunoreactivity was positive in 10 (23%) of benign and 9 (82%) of malignant tumors (P = .000). Galectin-3 was expressed in 5 (11%) of benign and 9 (82%) of malignant pheochromocytomas (P = .000). Negative nm-23, along with positive COX-2 or galectin-3, predicted malignancy with 100% specificity. Dual negativity for galectin-3 and COX-2, along with nm-23 positivity, indicated benign behavior with 100% sensitivity. In early pheochromocytoma, evaluation of nm-23, galectin-3, and COX-2 expression could predict the outcome. Larger studies seem necessary to confirm the potential practical value of our findings.     

Lamotrigine and twin pregnancy,incidental event or possible correlation?

Lamotrigine is frequently used to manage epilepsy during pregnancy. However, some major and minor birth defects are reported with lamotrigine monotherapy. This study is a case series report on 20 epileptic women who were receiving lamotrigine in their pregnancy. Apart from the normal pregnancies and births, in our study three patients gave birth to healthy twins, two vanished twin syndromes occurred and one patient had abortion. Twin pregnancy in association with lamotrigine therapy has not been clearly described before. Our observational study raises the idea that lamotrigine may induce twin pregnancy but larger studies need to investigate the presence or absence of such association more decently.     

Palliative surgery for advanced stage (stage IV) gastric adenocarcinoma

BACKGROUND/AIMS: The factors that effect resectability, major morbidity, early mortality, and survival in advanced stage gastric adenocarcinoma patients are evaluated. METHODOLOGY: Records of 74 patients that underwent surgery for stage IV gastric adenocarcinoma in the Third Surgical Clinic of Izmir Atatürk Training Hospital between January 1997 and January 2004 were reviewed retrospectively. Two groups (the patients with resectable disease and those with unresectable disease) were compared with regard to age, gender, primary complaint, symptoms, site of the tumor, involvement of adjacent organs, lymph node involvement, distant metastases, differentiation of tumor, surgical procedure, perioperative blood transfusions, and postoperative hospital stay. RESULTS: Mean age of the 74 patients was 58.4 years. Forty-five cases (60.8%) were considered as unresectable and 29 (39.2%) patients underwent a palliative resection. There was a significant relation between resectability and site of the tumor, and severity of invasion. As the number of perioperative blood transfusions increased, morbidity and mortality increased significantly. Although early mortality was high in the palliative resection group, survival (mean 10.4 months, longest 25 months) was better compared to that of the unresectable gastric cancer group (mean 3.5 months, longest eight months). CONCLUSIONS: A palliative gastric surgery may be applied to improve prognosis of advanced gastric cancer patients, even at the presence of peritoneal dissemination, hepatic metastases, N3 lymph node involvement, adjacent organ invasion, or poor differentiation of the tumor.     

The Time Interval from the Initiation of the P‐Wave to the Start of Left Atrial Appendage Ejection Flow: Does It Reflect İnteratrial Conduction Time?

Recurrence of atrial fibrillation is more common in patients with atrial conduction delay. In the present study, we evaluated whether findings obtained from transesophageal echocardiography (TEE), a semi-invasive method, correlate with those from an invasive method, electrophysiologic study (EPS), in measuring interatrial conduction time. METHODS AND RESULTS: We compared two methods of calculating interatrial conduction time in a group of 33 patients. The origin of the P-wave on the surface electrocardiogram (ECG) was taken as the onset of atrial activation. The time interval from this point to the commencement of the left atrial appendage ejection flow (P-LAA) was measured by TEE. Meanwhile, simultaneous recordings of the left atrial appendage were obtained with a catheter positioned in the LAA, and an invasive interatrial conduction time was measured from the origin of the surface's earliest P-wave (I-IACT). The mean I-IACT (46.27 +/- 13.25 ms) correlated strongly with the mean P-LAA (49.91 +/- 12.72 ms; r = 0.839, P < 0.0001). CONCLUSION: The interatrial conduction time can be estimated with a relatively noninvasive method using P-LAA measurements. This technique can be applied widely in predicting AF recurrence, and appropriate therapy may be applied.