Pitfalls in the echocardiographic diagnosis of intracardiac and extracardiac masses

Transthoracic and transesophageal two-dimensional (2-D) echocardiography remain the procedures of choice for evaluating cardiac mass lesions. Potential errors in diagnosis can be made, however, if the mass lesion's size, shape, mobility, and attachment to other cardiac structures are not clearly delineated. Usually a left atrial myxoma arises from the interatrial septum at the level of the fossa ovalis. Pitfalls in diagnosis occur when the tumor size is very small, or its attachment site is atypical or ill-defined. Atrial thrombi classically reside in an atrial appendage, but can also form in the body of the left atrium. The presence of atrial fibrillation rhythm, enlarged atrial chamber, prosthetic mitral/tricuspid valves, stenotic mitral/tricuspid valves, low cardiac output state, and spontaneous atrial contrast echoes are all features that favor the mass in question being a thrombus. Ventricular thrombi usually occur with poorly functioning ventricles. The diagnosis of ventricular thrombus should be made with great caution if the systolic function is normal, or if the mass has a band or thread-like appearance. A thorough knowledge of normal anatomical variants that can mimic pathological lesions is also important for reaching a correct diagnosis. Last but not least, as in all testing modalities, the patient's clinical picture should be correlated with the echocardiographic findings.     

Electrochemical oxidation of As(iii) on Pd immobilized Pt surface: kinetics and sensing performance

Pd nanoparticles were electrochemically immobilized on a Pt surface in the presence of sodium dodecyl sulfate (SDS) molecules to study the electrokinetics of arsenite oxidation reactions and the corresponding sensing activities. The X-ray photoelectron spectroscopy (XPS) analysis showed that on the Pt surface, Pd atoms exist as adatoms and the contents of Pd(0) and Pd(ii) were 75.72 and 24.28 at%, respectively, and the particle sizes were in the range of 61–145 nm. The experimental results revealed that the catalytic efficiency as well as the charge transfer resistance (at the redox potential of the Fe(ii)/Fe(iii) couple) increased in the order of Pt < Pt–Pd < Pt–Pd_sds. A Pt–Pd_sds electrode exhibited an open circuit potential (OCP) of 0.65 V in acidic conditions; however, when 50.0 mM NaAsO₂ was present, the OCP value shifted to 0.42 V. It has been projected that the As(iii) oxidation proceeds using a sequential pathway: As(iii) → As(iv) → As(v). After optimization of the square wave voltammetric data, the limits of detection of As(iii) were obtained as 1.3 μg L⁻¹ and 0.2 μg L⁻¹ when the surface modification of the Pt surface was executed with Pd particles in the absence and presence of the SDS surfactant, respectively. Finally, real samples were analyzed with excellent recovery performance.

Amplification of true surface area can be improved when Pd particles are deposited on a substrate in the presence of sodium dodecyl sulfate (SDS) surfactant. In acidic medium, As(iii) undergoes a two-step oxidation process.     

Salbutamol in acute organophosphorus insecticide poisoning – a pilotdose-response phase II study

Background: Treatment of acute organophosphorus (OP) insecticide poisoning is difficult, with many patients dying despite best care. Pre-clinical studies have shown benefit from salbutamol, possibly due speeding alveolar fluid clearance or reducing bronchoconstriction. In this small pilot dose-response study, we aimed to explore whether addition of nebulized salbutamol to standard care might improve resuscitation.

Methods: We performed a single-blind phase II study comparing the effect of two different doses of nebulized salbutamol versus saline placebo, in addition to standard treatment. Primary outcome was oxygen saturations over the first 60?min of resuscitation; secondary outcomes included heart rate, incidence of dysrhythmias, time to ‘atropinization’, atropine dose required, and mortality.

Result: Seventy-five patients were randomized to receive 5?mg (Salb5, n?=?25) or 2.5mg (Salb2.5, n?=?25) of salbutamol, or saline placebo (NoSalb, n?=?25), by nebulizer. Oxygen saturations did not differ between groups over the first 60?min of resuscitation (median AUC NoSalb: 1376 [95% CI 1282 to 1470], Salb2.5: 1395 [1305 to 1486], Salb5: 1233 [1100 to 1367]; p?=?.9898). Heart rate was also similar across the three arms. Median time to full atropinization, and atropine dose required, were the same for all three arms (NoSalb 15.0 [10–16] min and 12.6 [8.0–13.4] mg, Salb2.5 15.0 [10–16] min and 12.6 [9.3–16.8] mg, and Salb5 15.0 [10–20] min and 12.6 [10.7–20.6] mg; p?=?.4805 and p?=?.1871, respectively). Three (12%) patients died in the Salb2.5 and Salb5 groups and two (8%) in the NoSalb group.

Conclusion: This pilot study, within the limitations of its small size and variation between patients, found no apparent evidence that administration of nebulized salbutamol improved resuscitation of patients with acute OP insecticide self-poisoning. The data obtained provides a basis to design further studies to ultimately test the role of salbutamol in OP insecticide poisoning.     

Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort

Techniques in Coloproctology - The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. All adult patients treated with SiLaT in our...     

Failure of fasting to influence the GIP response to oral glucose in non-obese human subjects

The plasma GIP response to an oral 50 g glucose tolerance test has been compared in eight non-obese human subjects after 12 and 36 h of fasting. Basal plasma GIP and basal plasma insulin concentrations were similar after 12 and 36 h of fasting. Basal blood glucose was lower after 36 h fasting than after 12 h fasting (p less than 0.0125). After 36 h fasting the oral glucose tolerance test stimulated higher blood glucose concentrations at 60, 90 and 120 min (p less than 0.0125) and higher plasma insulin concentrations at similar time points (p less than 0.05), but stimulated plasma GIP concentrations were similar after 12 and 36 h fasts. These findings show that the increased insulinotrophic effect of oral glucose after 36 h fasting in non-obese subjects is not due to an associated augmentation of the glucose-induced GIP response.     

Use of nonvolume-reduced (unmanipulated after thawing) umbilical cord blood stem cells for allogeneic transplantation results in safe engraftment

Volume reduction of umbilical cord blood (UCB) units before infusion is standard in most transplant centers. We examined 26 patients who underwent transplantation from May 1997 to December 2001 with unmanipulated (n=18) or volume-reduced (n=8) UCB units for engraftment. Of 18 unmanipulated UCBT patients, 16 achieved ANC >500/mm(3), a median of 26 days (range, 16-104) post-UCBT; two died before engraftment on days +2 and +14. Of 18 unmanipulated UCBT patients, 10 achieved platelet recovery, a median of 60.5 days (range, 41-144) post-UCBT; eight patients died before platelet recovery +2 to +255 days post-UCBT. These results are similar to several reported studies and our series utilizing volume-reduced UCB units for UCBT. At a median follow-up of 29.5 months, the 100-day and 3-year overall survivals of unmanipulated UCBT were 61.1% (95% CI, 38.6-83.6) and 48.6% (95% CI, 24.8-72.4) and of volume-reduced UCBT were 60% (95% CI, 24.4-95.6) and 22.5% (95% CI, 0-58.7). There was no serious toxicity from UCB infusion using unmanipulated UCB units. We conclude that unmanipulated UCB units may be infused safely into UCBT patients with adequate engraftment and survival.     

Two dimensional echocardiographic demonstration of an unusual complication of aortic infective endocarditis

The two dimensional echocardiographic findings of aortic root abscess have been described. The echocardiographic findings in a patient with aortic valve endocarditis complicated by abscess formation, tear in the intima of the ascending aorta, and rupture of abscess cavity into the right ventricle are reported.     

E2 prostaglandins modulate cell proliferation in the small intestinal epithelium of the rat.

Groups of Sprague-Dawley rats were administered 1 mg/kg indomethacin subcutaneously, indomethacin subcutaneously plus 200 micrograms/kg oral 15-R-15 methyl-prostaglandin E2 (MePGE2) or oral MePGE2 twice daily for 10 days. The animals were treated with antibiotics to prevent mortality. Two control groups were used: control 1 was given placebo and control 2 was treated with antibiotics. All rats were killed 4 h after injection of a metaphase blocker, and the proliferative activity of the distal small intestine was examined in histological sections by means of the cumulative mitotic index (MI). A reduction in the number of villous cells was observed in the rats given antibiotics (p < 0.05 vs. control 1). The small intestinal villi of the rats treated with indomethacin had fewer cells than those of both control groups (p < 0.05) whereas the crypts contained more cells (p < 0.05) and had a higher MI than those of the controls (p < 0.05 vs. controls 1 and 2). These changes were reverted by the prostaglandin analogue. The number of cells of the small intestinal crypts and the cumulative MI in the rats who received indomethacin and the prostaglandin analogue were similar to controls, and they were significantly lower than the values observed in the animals treated with indomethacin (p < 0.05). The animals treated with the prostaglandin analogue and placebo developed a marked hyperplasia of the small intestinal villi (p < 0.05 vs. both control groups), but the atrophy of the villi induced by indomethacin was not prevented by simultaneous administration of the analogue.(ABSTRACT TRUNCATED AT 250 WORDS)