Left main coronary artery aneurysm associated with extensive coronary arterial calcification: case report and review

We present a 68-year-old male with left main coronary artery aneurysm and extensive coronary calcification involving the entire coronary arterial tree detected by coronary angiography and electron beam computerized tomography. With this article we also discussed the relationships between the pathogenesis of coronary atherosclerosis, coronary calcification, and coronary aneurysm formation.     

Pathophysiology underlying drooling in Parkinson’s disease: oropharyngeal bradykinesia

We aimed to investigate the association between drooling and possible etiological factors in Parkinson’s disease (PD) and to determine its effect on the quality of life. Demographic data of the 63 patients with idiopathic PD were recorded. Radboud Oral Motor Inventory for Parkinson’s disease (ROMP) test was administered to all patients to evaluate speech, swallowing functions, and saliva control. The freezing of gait questionnaire (FOGQ) was used to evaluate gait and freezing of gait. Dynamic Parkinson gait scale (DYPAGS) was administered for the objective quantification of PD gait features. Disease severity was assessed by UPDRS and modified Hoehn & Yahr Scale. PD specific health-related quality was evaluated by PDQ-39 questionnaire. Drooling was only significantly correlated to UPDRS score; a stronger association was found between drooling and UPDRS 3 motor score; and a more significant association was determined between drooling and the bradykinesia questions of the motor part of UPDRS 3. Interestingly, no significant association was found between sialorrhea score and PDQ-39 score. Based on the results of this study, we concluded that oropharyngeal bradykinesia may be responsible for drooling in PD. In contrast to a general expectation, we did not find any adverse impact of drooling on the quality of life.     

Co-existence of chronic renal failure, renal clear cell carcinoma, and Blau syndrome

Blau syndrome is a rare, multisystem, autosomal-dominant, and granulomatous disorder caused by susceptibility variants in the NOD2 gene. We describe here a 14-year-old girl with Blau syndrome with incidentally diagnosed renal carcinoma. The index case presented with growth retardation and recurrent symmetric arthritis. Her clinical symptoms included bilateral cataract due to recurrent uveitis, camptodactyly, and persistent erythematous rash with ichthyosis. Her two sisters and her mother were affected with combinations of these conditions—symmetric polyarthritis, uveitis, and skin involvement—suggesting an autosomal dominant trait. The index case developed a chronic renal insufficiency, and an abdominal computerized tomography scan revealed a 2.5-cm mass in the left kidney. The histopathological examination showed renal clear cell carcinoma, chronic tubulointerstitial nephritis, and giant cell granulomas in both the tumor and non-neoplastic renal tissue. Granulomatous inflammation was observed in the skin biopsy specimen. The patient was diagnosed with Blau syndrome based on her family history, uveitis, granulomatous inflammation proved by skin biopsy, and polyarthritis. Sequencing of the NOD2 gene showed a heterozygous p.R334Q mutation in all affected family members. To the best of our knowledge, this is the first reported case of a patient with Blau syndrome accompanied by chronic renal failure and renal carcinoma.     

Xanthogranulomatous salpingitis as a rare pathologic aspect of chronic active pelvic inflammatory disease

Xanthogranulomatous salpingitis (XGS) is a rare form of chronic inflammation of the fallopian tubes. A 41-year old woman with a history of secondary infertility for 2 years is presented. The patient underwent bilateral salpingooopherectomy with presumptive diagnosis of adnexal mass with cystic component. Intraoperative pathology consultation was done. The diagnosis of bilateral XGS associated with chronic active follicular salpingitis was made. XGS is reported to be caused by an unsuccesfully treated pelvic inflammatory disease. Its association with chronic active follicular salpingitis has not been previously reported. Chronic active follicular salpingitis with xanthogranulomatous inflammation might give the impression of a cystic adnexal mass with septations on preoperative pelvic computed tomography. Frozen sections are necessary to rule out malignancy as done in our case.     

Rosiglitazone Attenuates Liver Inflammation in a Rat Model of Nonalcoholic Steatohepatitis

Rosiglitazone is an insulin-sensitizing agent. We aimed to assess the effects of rosiglitazone on a methionine- and choline-deficient diet (MCDD) model of nonalcoholic steatohepatitis (NASH) in rats. Wistar rats were fed either MCDD or a control diet in the 4-week induction study; they were given saline or 4 mg/kg/day rosiglitazone. After the induction study period, the rats were divided into four groups and fed MCDD or given a control diet for an additional 8 weeks and received saline or rosiglitazone. Serum and tissue samples were obtained. Rosiglitazone improved inflammation in NASH and improved ALT, alkaline phosphatase, and interleukin-6 levels in the induction study and interleukin-1β, interleukin-6, and tumor necrosis factor-α levels in the treatment study. Our preliminary study is the first to show the anti-inflammatory effects of rosiglitazone in NASH. Rosiglitazone’s effect on cytokines may be a key mechanism of its anti-inflammatory effect in NASH.     

Effects of CPAP on left ventricular structure and myocardial performance index in male patients with obstructive sleep apnoea

BACKGROUND: Obstructive sleep apnoea (OSA) has the potential to cause heart failure. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on left ventricular structure and myocardial performance index (MPI) in severe OSA patients. METHODS: Sixty-seven subjects without any cardiac or pulmonary disease had overnight polysomnography and echocardiography. In 33 males with severe OSA, thickness of interventricular septum (IVS) and posterior wall (LVPW) were measured by M-mode. Left ventricular MPI was calculated as (isovolumic contraction time+isovolumic relaxation time)/aortic ejection time by Doppler. RESULTS: Eight males were non-compliant with CPAP. Mean age was 47.9+/-8.2 years, and 20 of 25 patients (80.0%) were hypertensive. Patients had high body mass index (BMI: 31.0+/-3.9 kg/m(2)), but there was no change in BMI from baseline after 6 months. Thickness of IVS (11.0+/-1.1mm) and LVPW (11.0+/-1.0mm) at baseline were significantly decreased after 6 months of CPAP therapy (10.5+/-0.9 mm, P<0.001 and 10.4+/-0.7 mm, P<0.0001, respectively). Left ventricular MPI (60.1+/-13.8%) significantly decreased (53.0+/-10.7%, P<0.0001) after CPAP usage. CONCLUSIONS: In male patients with severe OSA, CPAP therapy significantly decreases left ventricular wall thickness and improves global function even with 6 months of usage.