Use of Unique Doppler Flow‐Pattern for the Diagnosis of Left Ventricular Diverticulum

Isolated congenital left ventricular diverticulum (LV) is reportedly a rare finding. It is frequently associated with other congenital defects involving heart, pericardium, sternum, diaphragm, and abdominal wall. It is an outpouching from the ventricle and has all three layers of left ventricular free walls. We present the case of a 53‐year‐old woman who was discovered to have an outpouching of the LV apex on a nongated chest CT scan raising possibility of a pseudoaneurysm. A transesophageal echocardiogram (TEE) showed systolic diminution of this outpouching with unique Doppler flow‐patterns suggesting a diagnosis of a muscular type of LV diverticulum instead of a postinfarct LV pseudoaneurysm. The patient was reassured and treated conservatively.     

Prevalence and Predictors of Left Ventricular Diastolic Dysfunction in a Hispanic Patient Population

Minimal data exist on attributes of diastolic dysfunction in the Hispanic population. The purpose of this study was to evaluate the prevalence and predictors of diastolic dysfunction in a Hispanic patient population. We performed a retrospective review of 166 consecutive echocardiograms in a southwestern Texas Hospital that caters to a large Hispanic patient population. We identified all echocardiograms that met criteria for diastolic dysfunction and assessed baseline demographics and comorbidities in the cohort of Hispanic patients. A multivariate analysis was performed to identify the independent predictors of diastolic dysfunction. A total of 129 out of 166 patients (77.8%) were of Hispanic origin. Out of the 129 patients, 87 (67.4%) had some degree of diastolic dysfunction in this population suggesting a high prevalence in the study cohort. In the diastolic dysfunction group, the mean age was 64.5 ± 13.9, 37% were male and 63% female, 78% had diabetes, 85% had hypertension, and 49% had some degree of renal insufficiency (stages 3–5). A logistic multivariate analysis showed that diabetes was an independent predictor of diastolic dysfunction with odds ratio of 2.69 (95% confidence interval [CI], 1.06–6.28; p = 0.038). Similarly age (per year increase) and chronic kidney disease were independent predictors of diastolic dysfunction. We demonstrated that older age, presence of diabetes, and renal dysfunction are independent predictors of diastolic dysfunction in the Hispanic patient population. Strategies geared toward reducing diabetes and preventing renal dysfunction are likely to decrease prevalence of diastolic dysfunction and heart failure in this community.     

A Quick and Easy Approach to Prepare Ground Bone Slides from Undecalcified Skeleton

Ground bone slides are not only necessary for teaching histology of Haversian system to undergraduate and postgraduate students, but also essential for rapid pathological diagnosis in related diseases as well as to be used in polarizing microscopy and studying bone architectures from fossils. This technique is also applicable for hard tissues like teeth. Present histology manual-cum-practical literatures though prefer bone-slide preparation from decalcified skeleton, but Haversian architectures with osteons are vivid in ground bone slides. Here a technique is briefed; which have practiced well to prepare the ground bone slides with very simple, cheap and easily available equipments in a very short time, which can be adopted by anatomists, odontologists and geologists for quick making of compact bone slides without hampering the bone continuity avoiding hazardous and time consuming methods or costly equipments like freezing microtome.     

Acquired prolactin deficiency indicates severe hypopituitarism in patients with disease of the hypothalamic-pituitary axis

OBJECTIVE: Prolactin deficiency has been the subject of many scientific studies, but there is a paucity of information regarding prolactin deficiency in humans. In this report, adults with disease of the hypothalamic-pituitary axis (HPA) were studied to determine the prevalence of severe acquired prolactin deficiency (APD) and the pathophysiological characteristics associated with it. PATIENTS AND METHODS: APD was defined as a serum prolactin level persistently below the detection limit of the assay, i.e. less than 50 mU/l (normal range: male 85-444, female 85-530). Patients with a diagnosis of acromegaly, prolactinoma or with congenital or drug induced prolactin deficiency were excluded. Three hundred and sixty-nine patients (190 women, age range 17-79 years) with disease of the HPA, meeting the specified criteria were identified. RESULTS: Twenty-two (13 women, age range 29-76 years), showed evidence of APD. Thirteen of the 22 patients with APD had been treated for Cushing's disease. In all, 62 patients treated for Cushing's disease were identified, resulting in a prevalence of APD in treated Cushing's disease of 20.97%. Excluding treated Cushing's disease, the prevalence of APD in the remainder of the cohort was 2.93%. Nineteen patients with APD (86.4%) and 183 without APD (52.7%) underwent surgery in the region of the HPA (P = 0.0042). In contrast, nine patients with APD (40.9%) and 283 without APD (80.4%) had received radiotherapy, with fields which included the HPA (P < 0.001). No patient with isolated APD was identified. All patients with APD had evidence of severe GH deficiency (GHD) with a peak GH response to provocative stimuli of < 1.6 mU/l and a median IGF-I standard deviation score (SDS) of -4.85 (quartiles -9.56 to -2.80). Of the 13 patients with APD and Cushing's disease, all were gonadotrophin and TSH-deficient, six were adrenocorticotropic hormone (ACTH)-deficient and six (46.1%) had cranial diabetes insipidus (CDI). Of the remaining nine patients with APD, total anterior pituitary hormone failure was present in all and CDI was present in two (22.2%). CONCLUSIONS: The presence of APD indicates severe hypopituitarism in adults with HPA disease. It is universally associated with severe GHD. It is more common after surgery to the HP region. It has a low overall prevalence except in patients surgically treated for Cushing's disease.     

An electron microscopic study of lymphatics in the dermal lesions of human leprosy

The dermal lymphatic vessels in lepromatous and tuberculoid leprosy lesions were studied by light- and electron-microscopy. In the lepromatous patient, lymphatic vessels were seen in both intra- and peri-granulomatous areas. The lymphatic lining cells contained lipid droplets, lysosomes, and numerous pinocytotic vesicles. Cells bearing bacilli were only occasionally seen. In the tuberculoid cases, lymphatic vessels were seen only along the edges of the granulomas and the lining cells were less prominent. Inflammatory cells, both lymphocytes and histiocytes, were found traversing the walls of lymphatic vessels in both groups of patients. The results of the study confirm the continued and increased functioning of the lymphatic drainage system in dermal leprosy lesions, and indicates that it may be a major route for the clearance of lipids from the lipid-rich bacilliferous lesions in the lepromatous patient. The lymphatic pathway appears to be a minor pathway for the dissemination of Mycobacterium leprae in comparison with the blood vascular system.     

Immunocytochemical detection of p21ras,Raf-1, ERK1/MAP kinase and PKC isoforms in a 20-methylcholanthrene-induced transformed murine embryonal fibroblast cells in culture

An immunocytochemical study using antibodies against p21ras, Raf-1, MAP kinase/ERK1 and PKCalpha, beta, gamma, delta, epsilon, zeta, isoforms were performed on a 20-methylcholanthrene-induced transformed murine embryonal fibroblast cells in both in vitro and in vivo growth conditions. Altered expression of p21ras, Raf-1, MAP kinase in this particular cell line strongly supported the previous findings of the activation of one component of signal transduction under the influence of the other in the MAP kinase cascade of signal transduction during neoplastic transformation and which also seemed to be involved in CNCI-PM-20 cell line. The altered expression of PKCalpha, beta, and delta was thought to be an epigenetic event occurring under the indirect influence of other changes in these cells. Host physiology and metabolism did not have much impact on the expression of these gene products after biological incubation of these cells in syngenic host.     

Percutaneous coronary intervention versus coronary artery bypass grafting in diabetic patients

Revascularization with CABG or angioplasty in diabetic patients is associated with a less favor-able outcome. The value of early intervention will be assessed in the ongoing BARI 2D trial. It remains to be determined whether the widespread use of GP IIb/IIIa drugs and prolonged dual antiplatelet therapy in diabetic patients who receive stents, and possibly drug-eluting stents, will alter results significantly so that outcomes become comparable or even better than CABG (Fig. 3). It seems prudent to consider CABG with LIMA grafting in diabetic patients who have severe multi-vessel disease and to consider angioplasty in selected patients who have more discrete and less severe disease.