Successful closure of a large PDA with an Amplazter septal occluder in a child with heart failure and pulmonary hypertension--a case report

Transcatheter methods for closure of patent ductus arteriosus (PDA) have been known as an effective technique for many years. The devices designed for interventional closure of PDA, coexisting with elevated pulmonary artery pressure are still far from ideal and there is a significant risk of embolisation into the aorta. We present a case of a 14-year-old girl with a large PDA, pulmonary hypertension and congestive heart failure. She underwent successful PDA closure with an Amplatzer atrial septal occluder (ASO), a device originally designed to close an atrial septal defect.     

Surgical treatment of interventricular septum rupture in an 87-year-old female with acute antero-lateral myocardial infarction and 97% risk according to the Euroscore scale

Rupture of the interventricular septum is a serious complication of myocardial infraction (MI). It occurs in 1-3% of all MI cases, usually within 2 weeks after infraction. In 60% of the cases post-MI ventricular septal defects (VSD) are the result of completely occluded coronary artery supplying anterior wall of left ventricle and subsequent transmural MI. 50% of patients die within the first week after the rupture unless they are surgically treated. In this case report we describe an 87-year-old woman with post-MI VSD who was successfully operated (endocardial patch exclusion technique, proposed by David). In spite of a very high predicted risk (97% by Euroscore), calculated high risk should not be considered as the contraindication for life-saving operation.     

Diversin regulates heart formation and gastrulation movements in development

Canonical and noncanonical Wnt signaling regulate crucial events in the development of vertebrates and invertebrates. In this work we show that vertebrate Diversin, a potential orthologue of Drosophila Diego, controls fusion of heart precursors and gastrulation movements in zebrafish embryogenesis. These events are regulated by noncanonical Wnt signaling, which is independent of beta-catenin. We found that Diversin directly interacts with Dishevelled and that this interaction is necessary and sufficient to mediate signals of the noncanonical Wnt pathway to downstream effectors like Rho family GTPases and Jun N-terminal kinase. The ankyrin repeats of Diversin are required for the interaction with Dishevelled, for the activation of noncanonical Wnt signaling, and for the biological responses. The mutation K446M in the DEP domain of vertebrate Dishevelled, which mimics a classical Drosophila loss of function mutation, prevents functional interaction with Diversin's ankyrin repeats. Diversin also affects planar cell polarity in Drosophila, which is controlled by the noncanonical Wnt signaling pathway. Our data thus demonstrate that Diversin and Dishevelled function together in a mutually dependent fashion in zebrafish gastrulation and organ formation.     

The hip joint instability in the course of spastic type of cerebral palsy in adolescents

The appearance of hip subluxation or dislocation in the cerebral palsy children is due to muscular and neurologic factors. In this paper the clinical and instrumental methods of early detection of hip joint instability were presented. Clinical measurements of spasticity around the hip joint should be applied to many times, but they do not provide to objective, reproducible data. The purpose of the paper was to present the etiological concepts of this spasticity complication. The methods is used in the author's clinical practice for establishing the dynamic status of investigated muscle groups. Pharmacological spasticity treatment and the operative methods are the useful methods of prevention of hip dislocation in children with cerebral palsy. For the totally dislocated hips the bony procedures should be advocated to make the reduction of dislocated hip joint. The clinical observations suggest that surgery of dislocated hip is very important factor improving the hip position, sitting balance and quality of life of the involved children.     

Use of densitometric examination after cemented total knee arthroplasty

Background. Dual energy X-ray absorptiometry (DXA, DEXA) is one of many ways of measuring bone mineral density (BMD). Considering the fact that it is possible using DXA analysis to distinguish metal elements from bone, this method seems to be optimal in the assessment of bone mineral density in the area of an inserted implant. The aim of our study was to examine the usefulness of DXA examination of the knee joint area after cement arthroplasty. Material and methods. A BMD analysis of four areas surrounding the knee prosthesis was performed using the author's own method. Results. After a series of densitometry analyses, the coefficient of variation (CV) and the least significant difference (LSD) were determined. Conclusions. DXA analysis of the knee joint after arthroplasty using the method described here shows high repeatability. Periodic DXA analysis of the vicinity of the knee prosthesis may be useful in assessing the dynamics of change occurring around the implant.     

Reasons for diagnostic difficulties in spinal defects and deformations in children and adolescents

Background. The growing spine is vulnerable to pathological processes in the bony, muscular or nervous tissue of the spine, with symptoms that include disturbances of the spinal axis in both planes. The clinical picture often corresponds to idiopathic scoliosis. Radiographic examinations done routinely mostly do not show any pathology in the initial period of disease growth. The aim of our study was to present diagnostic problems in children and adolescents treated "routinely" with the diagnosis of a posture defect or scoliosis. Material and methods. The material included 25 girls and boys mistakenly diagnosed and treated for scoliosis, while the hidden etiology delayed proper treatment. Results. In 12 cases the reason for deformity was osteoid osteoma of the spine, in 2 cases astrocytoma, in 2 others, meningioma, and in the others, hidden congenital defects of the vertebrae. In most cases, scoliosis were diagnosed due to a misleadingly typical clinical picture. All the examined patients needed surgical treatment. In cancer processes, the clinical diagnosis was confirmed by histopathologic examination. Conclusions. These examples of defects and deformities of spine caused by hidden pathological process indicate the necessity of thorough evaluation of every posture deformity in children and adolescents. Early diagnosis and surgical removal of the cause of deformity in all cases led to inhibition of the tumor or reduction of spinal deformity. Our observations indicate the risk of mass screening examinations, after which selected children are referred for treatment without diagnosis. Such therapeutic mistakes can be dangerous and delay proper treatment.     

Multilocus sequence types, serotypes, and variants of the surface antigen PspA in Streptococcus pneumoniae isolates from meningitis patients in Poland

Meningitis caused by Streptococcus pneumoniae represents an important factor of morbidity and mortality in humans. In a significant number of cases, this disease is associated with specific clones of the organism, the so-called invasive pneumococcal clones. The aim of the study was to analyze 156 S. pneumoniae isolates identified as etiological agents of meningitis in Poland in the years 1997 through 2002. The isolates were characterized by multilocus sequence typing (MLST), and the results were compared with those obtained by pulsed-field gel electrophoresis (PFGE) and with the MLST data on invasive pneumococci from other countries. Eighty-nine different sequence types were found in the group of isolates, 50 of which had been known before including 19 of the major invasive clones. However, a significant fraction of the isolates possessed novel combinations of known and new MLST alleles. The majority of penicillin-nonsusceptible isolates belonged to the group of international multiresistant clones (Spain(23F)-1, Spain(6B)-2, Spain(9V)-3, Poland(23F)-16, and Poland(6B)-20), which underlined the importance of these in the dissemination of antimicrobial resistance. The results of the MLST analysis correlated well with the PFGE data, thus again demonstrating good congruence between the two typing methods for S. pneumoniae. The majority of the isolates (95.5%) belonged to families 1 or 2 of the surface protein PspA, confirming its potential usefulness as the vaccine antigen candidate.     

Involvement of Fas and FasL in Ectromelia virus-induced apoptosis in mouse brain

In this study we showed that the virulent Moscow strain of Ectromelia virus (ECTV-MOS) infection leads to induction of apoptosis in the BALB/c mouse central nervous system. ECTV-MOS-infected cells and inflammation sites were found in brain parenchyma between 5 and 15 days after footpad infection with ECTV-MOS. Infected cells consisted of microglia and monocytes, astrocytes and oligodendrocytes and these type of cells underwent apoptosis within 5-15 days post infection (d.p.i.). The highest number of apoptotic cells was found at 5 and 10 d.p.i. and represented mainly microglia (61.4% and 38.6% of apoptotic cells, respectively) and astrocytes (21% and 8.9%, respectively). The number of apoptotic oligodendrocytes was 5.4% and 4.5%, respectively. Fluorometric assays demonstrated involvement of caspase-1, -3 and -8 but not caspase-9 in apoptosis in ECTV-MOS-infected mouse brains. Expression of Fas/FasL was significantly increased on ECTV-MOS-infected cells between 5 and 15 d.p.i., whereas Fas was up-regulated also on the surrounding, non-infected cells. Taking together we may conclude that ECTV-MOS infection of microglia and astrocytes leads to local inflammation resulting in Fas/FasL up-regulation and apoptosis, which limits mouse central nervous system infection with ECTV-MOS.