Successful recovery from a massive pulmonary artery tumor embolism occurring during surgery for renal cell carcinoma

We report herein on a case of renal cell carcinoma with retrohepatic inferior vena cava tumor thrombus in which intraoperative cardiac arrest from a massive pulmonary embolism was managed successfully with emergency sternotomy and cardiopulmonary bypass, followed by the removal of the primary site and pulmonary artery embolus.     

A new clustering system for protein sequences and its application to constraints discovery in protein evolution

A conceptual clustering system, CLUSMOL/S, has been developed to classify protein sequences from a user-defined point of view. Given a grouping of amino acids as a viewpoint, the system constructs taxonomic trees of sequences based on minimum information criterion. Every tree node expresses itself as a generic consensus sequence that consists of specific consensus amino acids, insertionideletion points, and generic amino acids with a specified character. The resulting tree and generic sequences show the similarity-based relationships among sequences and their characteristics. Application to vertebrate cytochromes c yields an acceptable cladrogram only when amino acids are grouped by volume and length of sidechains. The result indicates that the steric factor is the most important constraint in the process of protein evolution. © Munksgaard 1995.     

Sarcomatoid renal cell carcinoma with a chromophobe component producing beta-human chorionic gonadotropin

We report a case of sarcomatoid renal cell carcinoma with a chromophobe component showing significant elevation of beta-human chorionic gonadotropin (beta-HCG) in the peripheral blood. A 35-year-old man was hospitalized because of a large tumor of the left kidney and elevated serum levels of beta-HCG. Extended nephrectomy was performed, after which the serum beta-HCG level decreased. However, 3 months later, masses were discovered in the left renal bed and in the lung in association with elevated serum levels of beta-HCG. The patient was rehospitalized and received combination therapy with interferon-alpha and doxorubicin-based multiple chemotherapy (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). The recurrent mass responded extremely well to treatment, and beta-HCG normalized. However, the patient died 14 months after nephrectomy because of eventual resistance to chemotherapy. Sarcomatoid renal cell carcinoma containing beta-HCG positive cells were pathologically diagnosed with immunohistochemical staining in the left kidney. Sarcomatoid renal cell carcinoma is a variant of renal adenocarcinoma which has a poor prognosis. This patient had an extremely rare sarcomatoid renal cell carcinoma associated with serum levels of beta-HCG which were elevated and strongly correlated with morphologic cancer activity. beta-HCG might be a useful serum marker for detecting and monitoring this renal cell carcinoma.     

Maximum Ventricular Dyssynchrony Predicts Clinical Improvement and Reverse Remodeling during Cardiac Resynchronization Therapy

Background: Tissue synchronization imaging (TSI) and tissue tracking imaging (TTI) might facilitate the evaluation of ventricular dyssynchrony.
Methods: In 22 patients, TSI and TTI were performed before and <1 month after onset of cardiac resynchronization therapy (CRT). With TSI guidance, maximum left ventricular (LV) intraventricular conduction delay (IVCDmax) was the greatest difference in time-to-peak velocity between septum and lateral wall. IVCD between the basal septum and lateral wall (IVCDbase) was also measured. Using TTI, the mean peak myocardial displacement of the basal septal and lateral walls (PMDbase), and the temporal coefficient of variation of the PMD in six LV regions (CV-PMDLV) were measured. The patients were divided into responders (whose LV end-systolic volume decreased by ≥15% during a 27 ± 9 months follow-up) and nonresponders.
Results: Before CRT, IVCDbase was similar in both groups, and remained unchanged within the 1st month of CRT in both groups. However, before CRT, IVCDmax was greater in responders than in nonresponders (P < 0.05), and decreased only in the responders during CRT (P < 0.05). No significant difference was observed in PMDbase or CV-PMDLV between the two groups, before or during CRT.
Conclusions: TSI was useful to measure IVCDmax. A greater IVCDmax before CRT that decreased shortly after onset of CRT may predict long-term clinical improvement in CRT recipients.     

Effect of cholestasis induced by organic anion on the lipid composition of hepatic membrane subfractions and bile in rats

Several organic anions inhibit the secretion of cholesterol and phospholipid into bile without affecting total bile acid secretion (uncoupling). The uncoupling induced by sulphobromophthalein (BSP) alters the fatty acid composition of biliary lecithin. The purpose of this study was to investigate the relationship between the lipid composition of bile and of liver subcellular membrane fractions during BSP-induced uncoupling. After depletion of the bile salt pool, rats fitted with a bile duct cannulus were infused with sodium taurocholate given either alone or with BSP. Bile was collected and liver microsomes and canalicular membranes were isolated for analysis of lipid composition. In bile, uncoupling increased the cholesterol/phospholipid ratio (C/P ratio) and the saturated/unsaturated fatty acid ratio (S/U ratio) in phosphatidylcholine. The C/P ratio was increased in the canalicular membrane, but the membrane phosphatidylcholine S/U ratio decreased during uncoupling. In microsomes, the S/U ratio of membrane phosphatidylcholine was slightly increased, but the C/P ratio was unaffected during uncoupling. These results support the hypothesis that an increased secretion of hydrophobic phosphatidylcholine species from the canalicular membrane into bile reduces the proportion of hydrophobic phosphatidylcholine species in the canalicular membrane during uncoupling. The decreased contribution of hydrophobic phosphatidylcholine species may ameliorate the decrease in membrane fluidity resulting from the accumulation of cholesterol in the canalicular membrane and stimulate the synthesis of hydrophobic phosphatidylcholine species in the microsomes.     

Experience with a Novel Retrograde Wiring Technique for Coronary Chronic Total Occlusion

Objectives

We report our evaluation of a novel retrograde wiring technique known as the Rendezvous method.

Background

Different strategies of retrograde approaches can be used to improve the success rate of recanalization of coronary chronic total occlusion (CTO). We previously introduced the Rendezvous technique as an alternative final step for a retrograde CTO procedure.

Methods

From July 2007 to May 2010, 20 CTO patients were treated in two medical centers using the Rendezvous method, which is an alternative to the conventional final externalization method to complete the retrograde CTO procedure. It involves crossing of the guidewire through the CTO segment using 2 microcatheters.

Results

The majority of the CTO sites were in the proximal right coronary artery (50.0%). Most of the lesions had mild to moderate calcification (95.0%) and revealed an abrupt stump with a side branch at the occlusion site. The lesion length of the occlusion was relatively long (median 27.6 mm; range of 7.1–87.3 mm). No adverse cardiac events occurred during hospitalization.

Conclusion

The Rendezvous method used during the retrograde approach can be performed as an alternative to the conventional “externalization method” after the guidewire and microcatheter have crossed the occluded proximal segment into the opposite guiding catheter. (J Interven Cardiol 2013;26:254–258)