Primary systemic amyloidosis with severe cardiac amyloidosis

An autopsy case of primary systemic amyloidosis with severe cardiac amyloidosis in a 75-year-old Japanese man is reported. The initial signs were dyspnea and cough, followed by general fatigue and loss of appetite. Heart failure, pleural effusion, and liver cysts were found on physiological examination. Autopsy findings were primary systemic amyloidosis with severe diffuse cardiac amyloidosis and cardiac hypertrophy (585 g). Focal necrosis by infarction was found in the liver and spleen. The cause of amyloidosis was unknown.     

The Role of Urotensin Receptors in the Paracetamol‐Induced Hepatotoxicity Model in Mice: Ameliorative Potential of Urotensin II Antagonist

We aimed to evaluate the possible protective effect of a UTR antagonist and to determine the effect of the antagonist on ALT and AST levels in serum, the mRNA expression level of UTR, tumour necrosis factor‐alpha (TNF‐α) and IL‐1β and SOD activity, GSH and MDA levels in liver tissues, which are important mediators or markers for the hepatotoxicity animal model in mice. Animals fasted overnight and were divided into seven equal groups (n = 12). The first group was the healthy group (administered 0.1% DMSO intraperitoneally). Group 2 received only paracetamol (PARA) (administered orally at a dosage of 300 mg/kg). Groups 3 and 4 were treated with only AGO (AC7954, UTR agonist) 15 and 30 mg/kg intraperitoneally, respectively. Groups 5 and 6 were treated with only ANTA (SB657510, UTR antagonist) 30 and 60 mg/kg intraperitoneally, respectively. Group 7 was treated with AGO 30 mg/kg and ANTA 60 mg/kg intraperitoneally. One hour after the pre‐treatment drugs were administered, groups 3 through 7 were given PARA. After the experimental period, the mice were killed 6 and 24 hr after PARA was administered. Antagonist administration significantly decreased the ALT and AST levels, while agonist administration did not. In addition, SOD activity and GSH levels increased, and the MDA level decreased with the pre‐treatment of two antagonist doses. The increased UTR gene expression through PARA was significantly lower in both doses of the antagonist groups at 24 hr when compared with the agonist and PARA groups. This study showed that UTR antagonists have hepatoprotective and anti‐inflammatory effects on high‐dose PARA‐induced hepatotoxicity in mice.     

Vagus Nerve Stimulation and Emotional Responses to Food among Depressed Patients

Background

Approved for treatment of treatment-resistant depression and for epilepsy, vagus nerve stimulation (VNS) therapy involves stimulation of the vagus nerve, affecting both mood and appetite regulating systems. VNS is associated with changes in food intake and weight loss in animals. Studies of its impact on food intake and weight with humans are limited. It is not known whether or how VNS influences emotional response to food, but vagus afferents project to regions in the insula involving satiety and taste.

Method

Thirty-three participants were recruited for three groups: depressed patients undergoing VNS therapy, depressed patients not undergoing VNS therapy, and healthy controls. All participants viewed images of foods twice in random order. When applicable, VNS devices were turned on for one viewing and off for the other. Participants were instructed to rate immediately after the viewings how each picture made them feel on a visual analog on three dimensions (unhappy to happy, calm to aroused, and small/submissive to big/domineering).

Results

Controlling for time since last meal, a significant main effect was found for arousal ratings in response to sweet food images. Post-hoc analyses indicated that the VNS group demonstrated significant changes in arousal ratings between paired food image viewings compared to controls. Sixty-four percent of VNS participants demonstrated increases and 36% demonstrated decreases in arousal. Higher body mass indexes and greater levels of self-reported sweet cravings were associated with increased arousal during VNS activation.

Conclusions

This study was the first to examine the effects of acute left cervical VNS on emotional ratings of food in adults with major depression. Results suggest that VNS device activation may be associated with acute alteration in arousal response to sweet foods among depressed patients. Future research is needed to replicate these findings and to assess how activation of the vagus nerve affects eating and weight.     

Successful catheter ablation of a right-sided accessory pathway in a child with interruption of the inferior vena cava and azygos continuation

Azygos continuation is seen in 0.6% of patients with congenital heart disease. The major significance of this anomaly lies in its association with complex cardiac defects and the technical difficulty that can accompany cardiac catheterization. We report our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway in a 6-year-old boy with infrahepatic interruption of the inferior vena cava and azygos continuation.     

The effects of prior use of atorvastatin on coronary blood flow after primary percutaneous coronary intervention in patients presenting with acute myocardial infarction

BACKGROUND: Statins exert a variety of favourable effects on the vascular system not directly related to their lipid lowering function known as pleiotropic effects. There are not enough data regarding the effects of prior statin use on coronary blood flow after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Accordingly, in the present study, we aimed to investigate the effects of prior statin use on coronary blood flow after primary PCI in patients with AMI using the Thrombolysis In Myocardial Infarction (TIMI) frame count method. METHODS: The study population consisted of 200 patients (161 men; mean age=62+/-7 years) referred to cardiology clinics with AMI who subsequently underwent successful primary PCI. The study population was divided into two groups according to statin use before primary PCI. Group 1 consisted of 98 patients (75 men; mean age=63+/-7 years) not taking statin and group 2 consisted of 102 patients (86 men; mean age=61+/-7 years) taking daily dose of at least 40 mg atorvastatin for at least 6 months. Coronary blood flow was determined by TIMI frame count method using the angiographic images obtained just after PCI and stenting. RESULTS: Only mean TIMI frame count was detected to be significantly lower in patients taking at least 40 mg atorvastatin for at least 6 months compared with that of the patients taking no statin (P<0.001). After confounding variables were controlled for, the mean TIMI frame count of patients in group 2 was significantly lower than that of the patients in group 1 (P=0.001). Pain to balloon time and vessel type were detected as important confounding variables of TIMI frame count after analysis of covariances. CONCLUSIONS: Prior statin use may improve coronary blood flow after PCI in patients with AMI, possibly by its beneficial effects on microvascular function.     

Characterizing the Patterns of HIV Disclosure to Clients Among South African Female Sex Workers in Port Elizabeth

Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.     

A comparison of microwave thermosphere versus radiofrequency thermal ablation in the treatment of colorectal liver metastases

Background

Microwave thermosphere ablation (MTA) is a new generation technology. The aim of this study was to compare the efficacy of MTA and radiofrequency ablation (RFA) in achieving local tumor control in patients with colorectal liver metastasis (CRLM).

Long-term effects of octreotide therapy on in-stent restenosis

The purpose of this study was to assess the long-term effects of octreotide therapy on in-stent restenosis at 6-month follow-up coronary angiography and the clinical events after stenting. A randomized, double-blind, placebo-controlled trial was conducted to assess the effects of octreotide on restenosis after stenting. The patients (n = 148) received either subcutaneous octreotide or placebo 1h before the stenting procedure and then every 8h for 3 weeks. Percent diameter stenosis was interpreted before and after stenting, and on a 6-month follow-up coronary angiogram by quantitative coronary angiography. The mean percent diameter stenosis of the octreotide group was significantly lower than that of the placebo group on the 6-month follow-up coronary angiograms (18.8% ± 14.2% vs 35.0% ± 19.2%, respectively; P = 0.001). The restenosis rate of the octreotide group was statistically lower than that of the placebo group (11.8% vs 26.4%, respectively; P 0.05). With regard to major cardiovascular events, there was no significant difference between the octreotide and placebo groups. The administration of octreotide for treatment of in-stent restenosis results in a relatively low long-term angiographic restenosis rate and no significant acute effects on cardiovascular clinical events.     

A permanent junctional reciprocating tachycardia with atypical location,treated with radiofrequency catheter ablation

Permanent junctional reciprocating tachycardia (PJRT) is an incessant or almost incessant supraventricular tachycardia with a long RP interval, usually occurring in children and young adults.The differential diagnosis of PJRT includes an atrial tachycardia and atypical atrioventricular nodal reentrant tachycardia (AVNRT). The accessory pathways in PJRT are typically located in the posteroseptal region.We report a case of successful radiofrequency catheter ablation in a 28-year-old male patient with PJRT due to a left posterolateral accessory pathway.     

Percutaneous Closure of Mitral Paravalvular Leak via Retrograde Approach with Use of the Amplatzer Duct Occluder II and without a Wire Loop

The gold-standard treatment for prosthetic-valve paravalvular leakage is surgery to repair or replace the valve; however, the morbidity and mortality rates cannot be ignored, and some patients are poor surgical candidates. The percutaneous closure of such defects is possible, and different devices are being used for this purpose. In almost all instances, a femorofemoral or femorojugular wire loop is constructed to deliver the closure device. Herein, we present the case of a 61-year-old man in whom a mitral paravalvular leak was successfully closed with use of the Amplatzer® Duct Occluder II, via retrograde approach under 3-dimensional transesophageal echocardiographic guidance, without the use of a wire loop. To the best of our knowledge, this is the 1st report of retrograde device deployment without the construction of an arteriovenous wire loop, and the 1st case in which the Amplatzer Duct Occluder II was used for the percutaneous closure of a mitral paravalvular leak.Key words: Echocardiography, transesophageal; heart catheterization; heart valve prosthesis implantation/adverse effects/instrumentation; mitral valve insufficiency; postoperative hemorrhage/etiology; prosthesis design; prosthesis failure; treatment outcomeParavalvular leakage after mechanical valve implantation is a relatively rare sequela. It occurs in approximately 5% of cases, with an incidence as high as 0.6% per patient-year.¹ Paravalvular leaks develop as a result of suture rupture, and they vary in size. Small leaks can be asymptomatic or cause hemolysis, whereas larger leaks can cause serious hemodynamic changes and heart failure. The surgical treatment of paravalvular leaks is associated with morbidity and death.² Over the past few years, percutaneous closure of these defects has been reported, with the use of different devices and technical approaches.³Herein, we report the percutaneous closure of a mitral paravalvular leak, under the guidance of 3-dimensional (3D) transesophageal echocardiography (TEE), via a retrograde approach and without the need to fashion an arteriovenous wire loop.