Venous variations in the region of the third ventricle: the role of MR venography

In this study, we examined the anatomical variations of the subependymal veins in the region of the foramen of Monro and the third ventricle by MR time of flight (TOF) venography. Fifty healthy subjects, ten patients with third-ventricle tumors, and four patients with lateral-ventricle tumors were included in the study. The courses of the anterior septal vein (ASV), thalamostriate vein (TSV), and internal cerebral vein (ICV) were studied. The proximity of the venous angle, the false venous angle, and the ASV–ICV junction to the posterior margin of the foramen of Monro was measured. In 69 (53.9%) sides, the ASV–ICV junction was located at the venous angle and at the posterior margin of the foramen of Monro. In 59 (46.1%) sides, the ASV–ICV junction was located beyond the foramen of Monro. Our study shows the high incidence of posteriorly located ASV–ICV junctions, which can be crucial in the planning of a better surgical approach. We strongly recommend that MR venography, which is a short radiological examination, be used before one operates on third-ventricle and lateral-ventricle tumors.     

Intrathoracic extravasation of antineoplastic agents: case report and systematic review

A case history is presented of a 34-year-old woman who was treated postoperatively for breast cancer with combination chemotherapy including epirubicin. The catheter of the port penetrated the wall of the superior vena cava, and extravasation in the mediastinum occurred. Severe pain, fever, and bilateral pleural effusion developed that necessitated two drainage procedures. She recovered well without sequelae. A comprehensive search of the medical literature was conducted using MEDLINE including bibliographies of all selected articles. Six additional cases of intrathoracic cytostatic agent extravasation were identified and the etiologic factors, clinical course, treatment strategy, and outcome were reviewed for each case.     

First observation of homozygous hemoglobin hamadan (B 56 (D7) GLY-ARG) and beta thalassemia (-29 G>A)- hemoglobin Hamadan combination in a Turkish family

During screening surveys for beta thalassemia and abnormal hemoglobins in Mugla, a city located in the Aegean Region of Turkey, a hemoglobin variant was detected in two large families residing in two neigboring cities (i.e., Mu?la and Aydin) without any clinical signs. Further analysis of the variant revealed it as Hb Hamadan (B 56 (D7) GLY‐ARG). Family screening revealed the father of the propositus as homozygote Hb Hamadan. The grandfather of the index case was detected as combination of Hb Hamadan with beta thalassemia. The beta thalassemia carrier had a promotor mutation at ?29 G>A, which is also a novel mutation. Furthermore, we described a simple and rapid restriction enzyme digestion protocol (Hha I) for the verification of Hb Hamadan. The clinical and hematologic data of the index case and his father showed that neither homozygous Hb Hamadan nor combination with beta thalassemia has clinical importance. This is also important especially from the prenatal diagnosis point of view. Am. J. Hematol. 74:280–282, 2003. © 2003 Wiley‐Liss, Inc.     

Maternal and umbilical venous adrenomedullin and nitric oxide levels in intrauterine growth restriction.

OBJECTIVE: To verify whether adrenomedullin (AM) and nitric oxide (NO) concentrations are changed in the maternal and fetal circulation in pregnancies complicated by intrauterine growth restriction (IUGR) compared to normal pregnancies, and to determine any relationship between them. METHODS: Forty-six small for gestational age (SGA) and 34 appropriate for gestational age (AGA) infants were included in the study. Umbilical and maternal venous AM and NO concentrations were determined. RESULTS: Umbilical NO concentrations in SGA infants (mean +/- SD; 176.2 +/- 75.8 micromol/L) were significantly greater than in AGA infants (143.4 +/- 39.2 micromol/L) (p = 0.015). However, umbilical AM concentrations were similar in SGA and AGA infants with 14.2 +/- 4.4 pmol/mL and 14.5 +/- 6.2 pmol/mL, respectively (p > 0.05). There was no relationship between NO and AM levels in umbilical blood (r = 0.09, p = 0.40). No difference was found between either AM or NO levels in the maternal plasma of the two groups. CONCLUSIONS: We suggest that NO is increased in the fetoplacental circulation in SGA infants probably as a response to decreased blood flow, whereas AM is not. Additionally, increased NO in the fetoplacental circulation was found to be independent from AM secretion.     

Atrial natriuretic peptide concentrations in children with pulmonary hypertension: Correlation with hemodynamic measurements

Summary To define the relation between atrial natriuretic peptide (ANP) and hemodynamic parameters in children with pulmonary artery hypertension, we measured the ANP concentrations of the femoral vein, right atrium, pulmonary artery, left atrium and left ventricle, or femoral artery in 32 patients during right or left heart catheterization. There is a strong correlation among the ANP levels obtained from different locations (p<0.001), and these ANP levels are positively correlated with pulmonary arterial pressures and pulmonary resistance. Patients were divided into two groups according to their pulmonary arterial pressure. The group with pulmonary arterial systolic pressure higher than 31 mmHg had higher ANP levels than the group with pulmonary arterial systolic pressure lower than 31 mmHg. When patients were grouped according to their pulmonary resistance, ANP levels in the group with pulmonary resistance over 2 U/m² were higher than those in the group with pulmonary resistance lower than 2 U/m². In this study ANP levels showed a correlation with the right ventricular systolic pressure. A correlation was not seen between ANP levels and the flow ratios or the presence of shunt. The results of our study suggest that ANP should be considered an important factor in pulmonary hypertension, independent of other factors.     

Serum leptin levels correlate with obesity parameters but not with hyperinsulinism in women with polycystic ovary syndrome

OBJECTIVE: To examine serum leptin concentrations in obese and lean patients with polycystic ovary syndrome (PCOS) to assess whether the changes in leptin levels are due to obesity or hormonal alterations. DESIGN: Controlled clinical study. SETTING: Academic research environment. PATIENT(S): Obese and lean women with PCOS. INTERVENTION(S): Blood samples were collected before and after food consumption. MAIN OUTCOME MEASURE(S): Serum leptin and insulin levels. RESULT(S): Serum leptin concentrations were significantly correlated with body mass index (r = 0.649) and also with HOMA (r = 0.535). However, after controlling for body mass index in a partial correlation analysis, no significant correlation was found between serum leptin levels and HOMA or hyperinsulinemia. While lean patients with PCOS had a significant correlation between leptin concentrations and obesity parameters, they did not show any significant correlation with insulin resistance parameters. CONCLUSION(S): Although leptin concentrations in women with PCOS correlate with insulin resistance/hyperinsulinemia, this is related only to obesity.     

Trisomy of 8q22.3 approximately q23-qter following an unbalanced 1;8 translocation in a boy with multiple anomalies

An 11-month-old boy was first referred with global developmental delay, pallor and heart defects (ASD, VSD, mitral and tricuspid valve insufficiency). He also had facial abnormalities. Standard karyotyping showed additional material on one chromosome 1p homolog, and fluorescence in situ hybridization (FISH) indicated an unbalanced translocation of 1pter approximately p36.33 and 8q22.3 approximately q23. The breakpoint on p was found to reside very close to the telomere, making this a rare case of "almost pure" trisomy of 8q22.3 approximately q23-qter, without a significant partial 1p36 monosomy by FISH technique. The patient's face resembled the peculiar face in previously reported cases of 8q23-qter duplication. This report supports that critical gene(s) for cardiac septum formation reside on distal chromosome 8q.     

A tubulopapillary adenoma of the gallbladder in a child of 3 years

Adenoma is the most frequent type of gallbladder (GB) neoplasm; however, GB neoplasms are unusual and unsuspected diagnoses in childhood. The average patient age is 50.5±16.3 years. We present a case of tubulopapillary adenoma of the gallbladder in a 3-year-old girl. She was admitted to the hospital with a 6-month history of abdominal pain and nausea and vomiting. Ultrasonography (USG) revealed an echogenic soft tissue lesion in the lumen of the GB. She underwent cholecystectomy. A tubulopapillary adenoma and adenomatous hyperplasia of the GB were diagnosed histologically. According to the literature, this is the youngest patient found to have gallbladder adenoma.     

The influence of nutritional status on complications after major intraabdominal surgery

OBJECTIVE: Currently most nutritional assessment techniques are based on their ability to predict clinical outcomes. However, the validity of any of these techniques to truly measure "nutritional risk" has not been proved. We have therefore prospectively assessed the prognostic value of two nutritional assessment techniques and nonnutritional factors in determining outcome after major abdominal surgery. METHODS: At admission and discharge, 100 patients undergoing major abdominal surgery were assessed on the following items: Subjective Global Assessment, Nutritional Risk Index, anthropometric measurements, serum total protein, serum albumin, lymphocyte count, total serum cholesterol. Patients were monitored for postoperative complications until death or discharge. RESULTS: At admission, 44% of the patients were malnourished according to the Subjective Global Assessment, while 61% of the patients were malnourished according to the Nutritional Risk Index. At discharge, these numbers were 67% and 82%, respectively. Higher death rates were found in the malnourished groups. The risk of complication was increased in malnourished patients with both assessment techniques. The odds ratios for the association between malnutrition and complications varied between 1.926 and 9.854 with both assessments. The presence of cancer in the patient was predictive for complication. CONCLUSIONS: Malnutrition is a marker of bad outcomes. Both Subjective Global Assessment and Nutritional Risk Index nutrition tests are predictive for malnutrition and postoperative complications in patients undergoing major abdominal surgery.