Hypothalamic lipoma adjacent to mamillary bodies

INTRODUCTION: Intracranial lipomas are rare lesions of developmental origin. They are generally asymptomatic and localized in the midline. However, they may occasionally produce neurological symptoms such as seizures. Surgical treatment is rarely indicated. CASE REPORT: We report a child with a lipoma that is located on the ventral side of the mamillary bodies. The diagnosis was made using computerized tomography (CT) and magnetic resonance imaging (MRI). There have been no previous reports of lipomas in this location.     

The bronze baby syndrome: evidence of increased tissue concentration of copper porphyrins

A case regarding a newborn infant with severe Rh haemolytic disease, who presented with the bronze baby syndrome and eventually died, is reported. The postmortem examination showed marked extramedullary haematopoiesis in the liver and spleen, heavy hepatic haemosiderosis and mild intralobular cholestasis. The porphyrin content, which was assayed in different tissues. was very high in the liver, suggesting that the increased erythropoiesis seen in Rh haemolytic disease leads to an increased synthesis of porphyrins as by-products of haem synthesis. Phototherapy causes photodestruction, sensitized by bilirubin, of porphyrins (mainly copper porphyrins), yielding brown photoproducts.     

Spontaneous echocardiographic microbubbles associated with prosthetic mitral valves: mechanistic insights from thrombolytic treatment results.

The purpose of this study was to determine the prevalence of microbubbles (MBs) in patients with prosthetic mitral valves (PMVs). The clinical and echocardiographic predictors of MB were investigated. We also analyzed the temporal relation between MBs and the thrombolytic treatment of thrombotic PMV dysfunction. The study material comprised 307 transesophageal echocardiography examinations in 279 patients (170 women and 109 men with a mean age of 37.9 +/- 13.3 years) with PMV. The PMV was mechanical in 245 patients (tilting-disk valves in 129, and bileaflet aortic valves in 116) and bioprosthetic mitral valves in 34 patients. Twenty-eight sessions of thrombolytic treatment were performed because of the obstructive (n = 18) and nonobstructive (n = 10) thrombi involving the PMV. No MBs were seen in any of the bioprosthetic valves. The MBs were present in 128 of 227 (56.4%) PMV without obstruction compared with only 1 of 18 (5.5%) valves with thrombotic obstruction (P <.0001). The MB were documented in 75.4% of the normal bileaflet valves compared with 38.5% of the tilting-disk valves (P <.0001). The MB intensity score was also significantly higher in the bileaflet valves (2.0 +/- 0.8 vs 0.7 +/- 0.7, P <.05). The incidence of MBs increased from 5.5% to 68.7% after successful thrombolysis in patients with obstructive PMV thrombi (P <.001). There were no other predictors of MBs in this series. The passage of MBs in the aortic root was not documented in any instances. We conclude that MBs are normal echocardiographic findings depending on the type and function of the mechanical PMVs.     

Pulpal tissue in bilateral talon cusps of primary central incisors: report of a case

Talon cusp is a tooth anomaly that affects both the primary and the permanent dentitions. However, the occurrence of this anomalous cusp is rather infrequent in the primary dentition. Only 7 cases of bilateral talon cusps affecting the primary teeth have been reported in the dental literature. This is a case report of bilateral talon cusps on primary maxillary central incisors whose histologic evaluation revealed the existence of pulpal tissue in the anomalous cusps.     

Reflex occipital lobe epilepsy.

Photosensitivity is a typical feature of photosensitive epilepsy which is usually considered a form of idiopathic generalized epilepsy. Partial seizures featuring visual symptoms are rarely reported in photosensitive epilepsy. In this study, we describe 13 neurologically normal patients in whom daytime seizures were always induced by television and began with elementary visual hallucinations, followed frequently by vomiting, headache and then secondary generalization. Three patients additionally reported nocturnal seizures, which have not been described in previous studies. Two of these latter patients had generalized tonic-clonic seizures, the other always awoke from sleep and could describe typical visual hallucinations at the beginning of the seizure. EEG features included normal background activity and occipital spikes or spike-waves in all but two patients. Eight patients also showed generalized epileptiform activity during intermittent photic stimulation. Seizure frequency was low in all. Apart from two patients, who refused treatment, all patients received antiepileptic drugs. Only one patient continued to have rare seizures after treatment; in the others seizure control was achieved with monotherapy. We conclude that reflex occipital lobe epilepsy is an idiopathic form of the benign partial epilepsies, which may overlap with one another.     

The Risk of Atrial Fibrillation With Ivabradine Treatment: A Meta‐analysis With Trial Sequential Analysis of More Than 40000 Patients

Recent trials reported that risk of atrial fibrillation (AF) is increased in patients using ivabradine compared with controls. We performed this meta‐analysis to investigate the risk of AF association with ivabradine treatment on the basis of data obtained from randomized controlled trials (RCTs). We searched PubMed, EMBASE, Scopus, and the Cochrane Library for RCTs that comprised >100 patients. The incidence of AF was assessed. We obtained data from European Medicines Agency (EMA) scientific reports for the RCTs in which the incidence of AF was not reported. We used trial sequential analysis (TSA) to provide information on when we had reached firm evidence of new AF based on a 15% relative risk increase (RRI) in ivabradine treatment. Three RCTs and 1 EMA overall oral safety set (OOSS) pooled analysis (included 5 RCTs) were included in the meta‐analysis (N = 40 437). The incidence of AF was 5.34% in patients using ivabradine and 4.56% in placebo. There was significantly higher incidence of AF (24% RRI) in the ivabradine group when compared with placebo before (RR: 1.24, 95% confidence interval: 1.08‐1.42, P = 0.003, I 1980 = 53%) and after excluding OOSS (RR: 1.24, 95% confidence interval: 1.06‐1.44, P = 0.008). In the TSA, the cumulative z‐curve crossed both the traditional boundary (P = 0.05) and the trial sequential monitoring boundary, indicating firm evidence for ≥15% increase in ivabradine treatment when compared with placebo. Study results indicate that AF is more common in the ivabradine group (24% RRI) than in controls.     

Serum concentrations of CA 125, CA 15-3, CA 19-9 and CEA in normal pregnancy: a longitudinal study

Purpose  

Although cancer diagnosed during pregnancy is rare, the coexistence of pregnancy and malignancy becomes more common in view of prolongation of reproductive age. Therefore, it is important that the specificity of a tumor marker be evaluated during pregnancy to avoid misinterpretation in the follow-up of a pregnant cancer patient. The present study aims to investigate the serum concentrations of CA-125, CA 15-3, CA 19-9 and CEA in healthy pregnant women through gestation.     

Circulating stromelysin concentration is elevated in hypertensive aortic root dilatation

Accumulating data suggest that activity of matrix metalloproteinases (MMPs) is increased in aortic dissection, and in thoracic and abdominal aneurysms. In the present study we sought to determine circulating stromelysin (MMP-3) concentration and its relationship with hypertension-induced aortic root dilatation. The study population included 42 patients with essential hypertension. The subjects were divided into two groups according to echocardiographically measured aortic diameter as those with aortic dilatation (n = 22) and without aortic root dilatation (n = 20). Plasma concentration of MMP-3 was determined by one-step sandwich enzyme immunoassay (EIA) method and compared in both groups. Baseline demographic properties were similar in both groups. Plasma stromelysin (MMP-3) level was significantly higher in patients with aortic dilatation than those without aortic dilatation (5.2 ± 2.3 vs 3.3 ± 1.9 ng/ml; P = 0.007). In conclusion, we found that circulating stromelysin (MMP-3) concentration was elevated in hypertension-induced aortic root dilatation.