Increased circulating monocyte count is related to good collateral development in coronary artery disease

Monocytes have been shown to take an important role in collateral growth in animal studies. The aim of the study was to investigate the relation of circulating monocyte count with collateral development in patients with severely stenotic CAD. Patients who had > or =95% stenosis in at least one major coronary artery were included in the study. Coronary angiograms of 210 eligible patients from our database were analyzed again and 103 of them had good and 107 had poor collateral development according to Cohen-Rentrop method. Only the monocyte count was found to be significantly different between two groups (671+/-218 mm(-3) versus 522+/-195 mm(-3), p<0.001) when multivariate analysis was performed and an increased monocyte count was observed in the good collateral group (Odds ration [OR], 2.918; 95% confidence interval [CI], 1.281-6.648, p=0.011). This study in which the relationship between monocyte count in blood and collateral development was disclosed has a potential importance in clinical and basic cardiovascular medicine.     

Targeting danger-associated molecular patterns after myocardial infarction

Introduction: Myocardial infarction (MI) provokes an intense inflammatory response that can lead to left ventricular adverse remodeling and heart failure (HF). The prognosis of HF patients is poor and related to a decreased quality of life and considerable health care costs. Hence, targeting the early inflammatory response after MI provides an interesting target to attenuate left ventricular remodeling and prevent HF.

Areas covered: In the current review, we discuss the theory that our immune system does not distinguish between self and non-self, but rather senses danger. So-called danger-associated molecular patterns (DAMPs) serve as ligands for pattern recognition receptors (PRRs), which act as signal transduction molecules to induce a pro-inflammatory state. Many different DAMPs and PRRs have been identified recently. Here, we provide a concise overview of their interactions as well as their role in the inflammatory response after MI.

Expert opinion: Interference with Toll-like receptor (TLR) 2, TLR4 and NLRP3-inflammasome signaling has consistently shown to reduce infarct size and preserve cardiac function post-MI in experimental animal models. Since clinically applicable inhibitors have been developed for these pathways, the path has been cleared to assess whether these promising results can be translated into the human situation.     

Intradiploic epidermoid cysts of the skull: a report of four cases

Epidermoid cysts are uncommon, benign and slow-growing lesions. They may often reach an enormous size without producing neurological symptoms. Intradiploic epidermoid cysts are nearly 25% of all epidermoids. They are derived from ectodermal remnants that stay within the cranial bones during embryonic development. Intradiploic epidermoid cysts can be located in any part of the skull. Two of our four cases were located in left occipital bone and the others were in the frontal bone. These tumours can occur at any age from the first to the seventh decade of life. Our cases had a mean age of 38.75 years (19-55 years). They may reach great sizes before the initial diagnosis and may produce major neurological signs. For good long-term prognosis, correct radiological assessment and complete removal of the tumour with its capsule are essential. We report four cases of intradiploic epidermoid cysts of the skull and analyse the clinical, radiological features and treatment of these lesions in the light of relevant literature.     

The regional and cellular expression profile of the melatonin receptor MT1 in the central dopaminergic system

The physiological effects of pineal melatonin are primarily mediated by melatonin receptors located in the brain and periphery. Even though there are a number of studies demonstrating the regulatory role of melatonin in the development of dopaminergic behaviors, such as psychostimulant-induced diurnal locomotor sensitization or drug seeking, little is known about the contribution of melatonin receptors (i.e., MT1) to this role. Therefore, as a first step in understanding the functional role of melatonin receptors in dopaminergic behaviors, we focused on determining the expression pattern of MT1 receptors in the dopaminergic system of the human and rodent brain. Regional (e.g., nucleus accumbens shell) and cellular (e.g., tyrosine hydroxylase immunopositive cells) expression of MT1 mRNA was characterized by applying the immuno-laser capture microdissection (immuno-LCM) technique coupled with nested RT-PCR. Moreover, employing quantitative Western immunoblotting and RT-PCR, we found that the mouse MT1 receptor expression presents diurnal variations (i.e., low mRNA and high protein levels at night, ZT21). The dopaminergic system-based presence of MT1 receptor proteins was not limited to rodents; we found these receptors in postmortem human brain as well. Further research is needed to understand the regional/cellular functional role of melatonin receptors in the regulation of dopaminergic behaviors, using models such as melatonin receptor knockout mice.     

Unilateral temporary functional stasis in the upper urinary tract caused by “a filled bladder” on Tc-99m DTPA diuresis renography: A teaching case

A 2-year-old girl with recurrent urinary tract infection having slight left pelvicaliceal dilatation on her renal ultrasound underwent a Tc-99m DTPA diuresis renography. During the excretion phase, a prominent and persisting left pelvicaliceal stasis was noticed even after the diuretic injection. However, it disappeared simultaneously with an uncontrolled micturition. This patient is presented to show the effect of filled bladder on the physiological drainage of urine. Since urine flow in the urinary system is more complicated than simple drainage, a thorough understanding of the physiological basis for diuresis renography and the pitfalls of the technique is required for its appropriate use in the management of patients suspected of urinary tract obstruction.     

Low dose dopamine prevents end organ damage in experimentally induced pancreatitis

BACKGROUND/AIMS: End organ damage due to microcirculatory failure plays an important role in the pathogenesis of acute pancreatitis (AP). The aim of this study was to investigate whether dopamine, a vasoactive agent, is beneficial in the prevention of local and systemic injury in acute pancreatitis. METHODOLOGY: Pancreatitis was induced in rats with 5% Na-taurocolic acid infusion into the pancreatic duct. Rats were resuscitated for four hours with saline in the pancreatitis group (P), lactated ringer's (LR) solution in the LR group and low dose dopamine (5 microg/kg/min) + LR in the D-LR group. The sham group (S) underwent pancreatic duct cannulation only. Rectal temperature (RT) and meanarterial pressure (MAP) were monitored throughout the experiment. Blood samples for amylase, lipase, WBC and blood gas analysis were taken at baseline and at the end of the study. All rats were sacrificed at the 4th hour and pancreatic and lung tissues were removed for histopathological examination and tissue myeloperoxidase (MPO) activity. RESULTS: MAP was lower in the P and LRgroups than the sham and the D-LR groups. RT was higher in P and LR groups than the sham and the D-LR groups. Base deficit was higher in the P group than the sham and the D-LR groups. The lung MPO activity was higher in the P group than all the others. Lung MPO activity that is closest to the sham was that of D-LR group's. The pancreatic MPO activity was found to be increased in the P and decreased in the LR groups. CONCLUSIONS: In this experimental model for AP, low dose dopamine + LR resuscitation attenuates the lung injury but not the local pancreatic injury.     

Pulse contour cardiac output system use in pediatric orthotopic liver transplantation: preliminary report of nine patients

Anesthetic management of orthotopic liver transplantation (OLT) in pediatric patients is challenging in terms of intraoperative bleeding, fluid management, and hemodynamic monitoring. The pulse contour cardiac output (PiCCO) system, a relatively new device based on the single-indicator transaortic thermodilution technique, may be useful for intraoperative hemodynamic monitoring in pediatric patients. This is a preliminary report of PiCCO use in nine children (aged 9.8 +/- 4.7 years) undergoing OLT. Hemodynamic volumetric parameters monitored by the PiCCO system were mean arterial pressure (MAP), cardiac index (CI), intrathoracic blood volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI), and stroke volume variability (SVV). All parameters were recorded at anesthesia induction (T0), at the end of the anhepatic phase (Tanhepatic), and at the end of operation (Tend). The PiCCO system revealed similar MAP, CI, EVLWI, SVV, and SVRI values at all measurement intervals. Despite similar central venous pressure measurements, ITBVI values indicated significantly lower values at Tanhepatic than at T0 (627 +/- 160 mL/m2 and 751 +/- 151 mL/m2, respectively, P = .013). There were no PiCCO catheter-related complications in any patient. These findings demonstrate that the PiCCO system is a safe, continuous, multiparameter invasive monitoring device for use in pediatric patients undergoing OLT. This system may provide valuable data during pediatric OLT and appears to be a promising monitoring tool in these patients.