Delineation of an Octopus‐Like Thrombus Attached to the Eustachian Valve

Eustachian valve (EV) is a vestige of the valve of the inferior vena cava which directs the umbilical vein blood through open foramen ovale in fetal life. Following birth it gradually regresses, but it may persist in variable size, shape, and thickness as a functionless and benign structure. However, there are reports suggesting that persistent EV may not be completely innocent. It has been accused of being a predisposing cause of patent foramen ovale and paradoxical embolism and also interfering with transseptal interventional procedures. It may serve as a site of infective vegetations and be mistaken as a tumor or thrombus. In the present case, an octopus‐like thrombus attached to the EV was delineated with the utility of two‐dimensional and real time three‐dimensional transesophageal echocardiography. EV was considered to play an essential role in preventing potential pulmonary embolism.     

Delayed repair of stanford type-A dissection following fulminant cerebral infarction

We report an impressive case in which a complete infarction of the right hemisphere due to an acute occlusion of the right carotid artery had developed. After cerebral decompression and neurological rehabilitation, the persisting dissection of the ascending aorta and both carotid arteries was successfully repaired in one session.     

Does moxifloxacin alter oxidant status in the cornea? An experimental study

Objective: In this experimental study, we investigated the possible effects of intracameral moxifloxacin on oxidative stress parameters and endothelial cell morphology in corneal tissue.

Methods: In total, 30 rats were randomly assigned to three groups of 10 rats: the sham group (Group 1, n?=?10); the control group (Group 2), where balanced salt solution (BSS) was administered at a dose of 0.01?cc (n?=?10); and the treatment group (Group 3), where moxifloxacin was administered at a dose of 0.05?mg/0.01?cc (n?=?10). Total antioxidant status (TAS) and total oxidant status (TOS) in corneal tissue and blood samples were measured and the oxidative stress index (OSI) was calculated. Also, corneal tissue histopathology was evaluated with caspase-3 and caspase-8 staining. Apoptotic activity was also evaluated.

Results: In blood samples, TAS, TOS, and OSI levels were not statistically significantly different (all p?>?0.05). Compared with the sham and control groups, TOS and OSI levels in cornea tissue were significantly different in the moxifloxacin group (all p?p?>?0.05). Compared with the sham and control groups, apoptotic activity was higher in the moxifloxacin group, in both immunohistochemical staining for caspase-3 and caspase-8.

Conclusions: Intracameral moxifloxacin injection seems to be safe systemically, but it may have toxic effects on corneal tissues, as suggested by oxidative stress parameters and a histopathological evaluation.     

Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain

Acute onset abdominal pain constitutes a significant proportion of emergency department visits, but only a small fraction of these cases are attributable to vascular pathologies (Bauersfeld, 1947 [1]). In this case, report, we present an incidental diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection (SISMAD). A 69-year-old man was admitted to the emergency department complaining of fever, loss of appetite, vague epigastric pain, dysuria, and a productive cough for several days. A lower extremity venous Doppler ultrasound was performed, and a deep venous thrombosis (DVT) was identified in the left main femoral vein and in the proximal segment of the superficial vein. The patient also had no blood flow in the distal part of left external iliac vein. A contrast-enhanced computerized tomography angiography of the thorax and abdomen was performed to detect pulmonary embolism and the etiology of the abdominal pain. No pulmonary embolism was found; however, multiple metastatic nodules were identified in both lungs, as well as infiltration on the posterobasal field of the right lung, metastases on the liver, focal dilatation, and an intimal flap on the middle-distal part of the superior mesenteric artery (SMA) at 2?cm, with a segment that was compatible with isolated dissection. There was a contrast passage on the distal part of SMA, and no sign of bowel ischemia.     

Rheumatoid arthritis and anti-thyroid antibodies

The aim of this study was to evaluate the quality of B cell responses in patients with Inflammatory Bowel Disease (IBD) and healthy individuals of different ages, vaccinated with the pandemic (p)2009 influenza vaccine. The in vivo response was measured by the hemagglutination inhibition (HAI) assay, which represents the most established correlate with vaccine protectiveness. The in vitro response was measured by activation-induced cytidine deaminase (AID) in cultures of vaccine-stimulated PBMC. Both responses are somewhat impaired in IBD patients undergoing anti-TNF-α treatment but these are much more decreased in IBD patients undergoing treatment with anti-TNF-α and immunosuppressive (IS) drugs. These latter patients had in vivo and in vitro B cell responses similar to those of elderly individuals. Moreover, as we have previously demonstrated in healthy subjects, the in vitro response to the polyclonal stimulus CpG may be used as a biomarker for subsequent vaccine response and AID activation is correlated with the serum response in IBD patients, as it is in healthy individuals. These results altogether indicate that IBD patients on anti-TNF-α and IS have significantly impaired in vivo and in vitro B cell responses, as compared to those on monotherapy. This is the first report to demonstrate that B cell defects, as measured by the autonomous AID reporter, in IBD patients contribute to reduced humoral responses to the influenza vaccine, as we have previously shown for elderly individuals.     

Low scores on the Benton Facial Recognition Test associated with vertebrobasilar insufficiency

Background

Decreased posterior cerebral circulation has been observed in patients with vertebrobasilar insufficiency (VBI). Reduced cerebral perfusion may have an impact on mental performance as measured by the Benton Facial Recognition Test (BFRT). We evaluated the usefulness of BFRT in identifying cognitive decline in patients with VBI by correlating test performance with total blood flow in the vertebrobasilar system and other variables such as educational level and gender.

Materials and methods

Thirty-three participants without dementia (mini-mental state examination; MMSE >27) and cranial magnetic resonance imaging abnormality, but with atherosclerotic risk factors were involved in the study. Nineteen subjects had a total vertebrobasilar flow volume less than 200 ml/min (Group I), and 14 subjects had a flow volume more than 200 ml/min (Group II).

Results

The groups were similar in regard to gender, age, and educational level. BFRT results were 19.53 ± 3.12 and 22.36 ± 2.73 for Groups I and II, respectively (p = 0.01). The educational level was the main factor affecting the BFRT score in Group I (p = 0.04).

Discussion

BFRT is clearly impaired in VBI as measured by Doppler ultrasound examination. We concluded that the test appears to adequately distinguish cognitive levels between VBI and other patients. Additionally, our results suggest that education is associated with BFRT results, and for normative purposes, gender consideration is unnecessary. Further studies are needed to investigate the association between VBI and memory dysfunction in early dementia.     

Comparison of the Effects of Desflurane and Propofol Anesthesia on the Inflammatory Response and S100β Protein During Coronary Artery Bypass Grafting

Cardiopulmonary bypass (CPB) contributes to the secretion of anti-inflammatory cytokines that mediate the inflammatory response observed during open heart surgery. In addition to many factors, type of anesthesia management affects immune response and central nervous system in cardiac surgery. The aim of this study was to assess the effect of propofol versus desflurane anesthesia on systemic immune modulation and central nervous system on patients undergoing coronary artery bypass grafting. Forty patients undergoing elective coronary artery bypass graft surgery with CPB were included in this prospective randomized study. Patients were allocated to receive propofol (n?=?20) or desflurane (n?=?20) for maintenance of anesthesia. The blood samples for IL-6, IL-8, TNF-α, and S100β were drawn just prior to the operation before the induction of anesthesia, second before cardiopulmonary bypass, third after CPB, fourth 4 h postoperatively at the ICU. Major finding in our study is that S100β levels were lower in propofol group when compared to desflurane anesthesia. And also immune reaction was less in patients exposed to desflurane anesthesia when compared to propofol anesthesia as indicated by lower plasma concentrations of IL-8 and IL-6. Propofol is more preferable in terms of S100β for anesthetic management for CABG.