“Salt mummification” — atypical method of embalming a corpse

International Journal of Legal Medicine - It is extremely rare for table salt to be used to preserve a dead body in criminal cases. In the case presented here, after the death of his 85-year-old...     

Plowing the atrium and growing thrombi: two cases of large atrial thrombi following ablative and surgical procedure for atrial fibrillation.

AIM: We present two patients with a large left atrial (LA) thrombus following invasive treatment for atrial fibrillation and inadequate anticoagulation. METHODS AND RESULTS: Case 1: A 30-year-old woman, with a one-year history of symptomatic paroxysmal atrial fibrillation resistant to medical therapy, underwent catheter ablation for atrial fibrillation. Three days after the procedure the patient presented with dizziness, fatigue, rapid atrial fibrillation with a sub-therapeutic INR. Transesophageal echocardiography (TEE) revealed a large LA thrombus. Case 2: A 59-year-old male, with severe mitral regurgitation and chronic atrial fibrillation, underwent mitral valve repair and Cox-Maze procedure. Three months later, while asymptomatic, a follow-up transthoracic echocardiography a large posterior LA thrombus was imaged. His INR was also sub-therapeutic. Both patients were treated by enhancing anticoagulation and close echocardiographic follow-up. So far both patients have remained asymptomatic two months following discharge. CONCLUSION: Large LA thrombi detected by transthoracic echocardiography are a rare complication of the Cox-Maze procedure and radio-frequency ablation for atrial fibrillation, which may occur even in patients with restored normal sinus rhythm receiving inadequate anticoagulation therapy.     

IgA antibodies to gliadin and coeliac disease in psoriatic arthritis.

OBJECTIVES: To find out whether patients with psoriatic arthritis (PsoA) have an increased prevalence of antibodies to gliadin (AGA) and of coeliac disease. METHODS: One hundred and fourteen PsoA patients with skin disease of 20+/-13 yr and joint disease of 11+/-10 yr duration answered a questionnaire concerning their medical history and underwent clinical examination, including radiology. Serum IgA AGA and IgG AGA, IgA antibodies to endomysium and immunoglobulins, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) concentration were determined. RESULTS: Five of the 114 patients (4.4%) had coeliac disease. After exclusion of these five patients, the mean IgA AGA concentration was significantly higher (P=0.0005) than that in a reference group. None of the patients had IgA antibodies to endomysium. The mean serum IgA concentration was significantly increased and IgM decreased. Patients with a high concentration of IgA AGA had significantly higher ESR and CRP and a longer duration of morning stiffness than those with a low AGA concentration. CONCLUSIONS: Patients with PsoA have an increased prevalence of raised serum IgA AGA and of coeliac disease. Patients with raised IgA AGA seem to have more pronounced inflammation than those with a low IgA AGA concentration.     

Bursting pressure in anastomotic healing in experimentally induced colitis in rats

BACKGROUND: Experimental studies on healing of colonic anastomosis have been thoroughly investigated. However, clinical parameters of the healing process of anastomosis in the inflamed colon has not yet been reported. METHODS: In the present study, healing of anastomosis in trinitrobenzene-sulfonic acid-induced colitis in rats was assessed by measuring the bursting pressure and bursting wall tension. RESULTS: On postoperative day 4, bursting pressure and bursting wall tension were significantly lower (P<0.001) in rats with colitis with or without anastomosis and normal colon with anastomosis, compared with normal colon without anastomosis. On postoperative day 7, bursting pressure and bursting wall tension of normal colon with anastomosis approached that of normal colon without anastomosis. However, bursting pressure and bursting wall tension of rats with colitis with or without anastomosis remained significantly lower (P<0.001) than the latter. Furthermore, unlike rats without colitis in which perforation occurred mostly at the anastomotic line, the bursting site in colitic rats was predominantly away from the anastomotic line. CONCLUSIONS: These results suggest that in surgery for inflammatory bowel disease, it is the adjoining inflamed bowel wall that is vulnerable to be perforated in response to increasing intraluminal pressure rather than the anastomosis that is braced by the sutures.     

Cardiac dimension and function in patients with childhood onset growth hormone deficiency,before and after growth hormone retreatment in adult age

Background Growth hormone (GH) replacement during childhood has been shown to increase stature; however, there is little information on its long-term effect on the heart is not yet clear. The aim of this study was to assess cardiac size and function in patients with childhood-onset GH deficiency in whom GH treatment had been stopped at the achievement of final height and the effect of a second course of GH replacement in adult age. Methods Cardiac dimensions and function, obtained with echocardiography, of 21 patients (5 women and 16 men, mean age 28 ± 8 years), all of whom were treated during childhood, were compared with 21 age- and sex-matched healthy control subjects. Eight of these patients (2 women and 6 men, mean age 28 ± 8 years) were given a second course of GH replacement therapy for 15 ± 3 months. Results The stature and all cardiac dimensions of patients with GH deficiency who were treated during childhood were significantly smaller than those of the control subjects. After the second course of GH in adulthood, the only significant change observed was an increase in left ventricular (LV) mass (93 ± 21 vs 106 ± 24 g, P = .007) and LV mass index (59 ± 12 vs 66 ± 13 g/body surface area, P = .005). Conclusion The stature and cardiac dimensions of patients with childhood-onset GH deficiency measured in adult age were smaller than those of control subjects, despite long-term GH replacement therapy during childhood. A second course of GH treatment during adulthood caused a significant increase in the estimated LV mass index in patients with both isolated and multiple pituitary hormone deficiency. (Am Heart J 2003;145:549-53.)     

New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses

Purpose

Detailed knowledge on the normative growth of the spine is of great relevance in the prenatal diagnosis of its abnormalities. The present study was conducted to compile age-specific reference data for vertebra C4 and its three ossification centers in human fetuses.

Materials and methods

With the use of CT (Biograph mCT), digital image analysis (Osirix 3.9) and statistical analysis (Wilcoxon signed-rank test, Kolmogorov–Smirnov test, Levene’s test, Student’s t test, one-way ANOVA, post hoc RIR Tukey test, linear and nonlinear regression analysis), the normative growth of vertebra C4 and its three ossification centers in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17–30 weeks was examined.

Results

Significant differences in neither sex nor laterality were found. The height and transverse and sagittal diameters of the C4 vertebral body increased logarithmically as: y = ?3.866 + 2.225 × ln(Age) ± 0.238 (R ² = 0.69), y = ?7.077 + 3.547 × ln(Age) ± 0.356 (R ² = 0.72) and y = ?3.886 + 2.272 × ln(Age) ± 0.222 (R ² = 0.73), respectively. The C4 vertebral body grew linearly in cross-sectional area as y = ?7.205 + 0.812 × Age ± 1.668 (R ² = 0.76) and four-degree polynomially in volume as y = 14.108 + 0.00007 × Age⁴ ± 6.289 (R ² = 0.83). The transverse and sagittal diameters, cross-sectional area and volume of the ossification center of the C4 vertebral body generated the following functions: y = ?8.836 + 3.708 × ln(Age) ± 0.334 (R ² = 0.76), y = ?7.748 + 3.240 × ln(Age) ± 0.237 (R ² = 0.83), y = ?4.690 + 0.437 × Age ± 1.172 (R ² = 0.63) and y = ?5.917 + 0.582 × Age ± 1.157 (R ² = 0.77), respectively. The ossification center-to-vertebral body volume ratio gradually declined with age. On the right and left, the neural ossification centers showed the following growth: y = ?19.601 + 8.018 × ln(Age) ± 0.369 (R ² = 0.92) and y = ?15.804 + 6.912 × ln(Age) ± 0.471 (R ² = 0.85) for length, y = ?5.806 + 2.587 × ln(Age) ± 0.146 (R ² = 0.88) and y = ?5.621 + 2.519 × ln(Age) ± 0.146 (R ² = 0.88) for width, y = ?9.188 + 0.856 × Age ± 2.174 (R ² = 0.67) and y = ?7.570 + 0.768 × Age ± 2.200 (R ² = 0.60) for cross-sectional area, and y = ?13.802 + 1.222 × Age ± 1.872 (R ² = 0.84) and y = ?11.038 + 1.061 × Age ± 1.964 (R ² = 0.80) for volume, respectively.

Conclusions

The morphometric parameters of vertebra C4 and its three ossification centers show no sex differences. The C4 vertebral body increases logarithmically in height and both sagittal and transverse diameters, linearly in cross-sectional area, and four-degree polynomially in volume. The three ossification centers of vertebra C4 grow logarithmically in both transverse and sagittal diameters, and linearly in both cross-sectional area and volume. The age-specific reference intervals for evolving vertebra C4 may be useful in the prenatal diagnosis of congenital spinal defects.     

Characterization of the expression of MHC proteins in human embryonic stem cells

Human embryonic stem (ES) cells are pluripotent cells that may be used in transplantation medicine. These cells can be induced to differentiate into cells from the three embryonic germ layers both in vivo and in vitro. To determine whether human ES cells might be rejected after transplantation, we examined cell surface expression of the MHC proteins in these cells. Our results show very low expression levels of MHC class I (MHC-I) proteins on the surface of human ES cells that moderately increase on in vitro or in vivo differentiation. A dramatic induction of MHC-I proteins was observed when the cells were treated with IFN-gamma but not with IFN-alpha or -beta. However, all three IFNs induced expression of MHC-I proteins in differentiated human ES cells. MHC-II proteins and HLA-G were not expressed on the surface of undifferentiated or differentiated cells. Ligands for natural killer cell receptors were either absent or expressed in very low levels in human ES cells and in their differentiated derivatives. In accordance, natural killer cytotoxic assays demonstrated only limited lysis of both undifferentiated and differentiated cells. To initiate a histocompatibility databank of human ES cells, we have isotyped several of the published ES cell lines for their human leukocyte antigens. In conclusion, our results demonstrate that human ES cells can express high levels of MHC-I proteins and thus may be rejected on transplantation.     

Risk of thromboembolic complications in patients with permanent atrial fibrillation undergoing cardioverter-defibrillator implantation

BACKGROUND: Cardioversion of atrial fibrillation (AF) carries the risk of thromboembolic complications and, therefore, anticoagulation therapy is routinely administered before and after this procedure. In patients with permanent AF who undergo implantation of cardioverter-defibrillator (ICD), anticoagulants are usually withdrawn during the perioperative period. However, in some patients sinus rhythm may be restored during defibrillation threshold (DFT) testing which potentially may increase the risk of thromboembolic complications. AIM: To assess the frequency of sinus rhythm restoration during ICD implantation in patients with permanent AF and the rate of both thromboembolic events and local bleeding complications which may occur due to temporary withdrawal of anticoagulation therapy and its re-initiation early after the procedure. METHODS: Permanent AF was present in 23 (12%) of 193 patients selected for ICD implantation. All patients received prolonged oral anticoagulation according to the generally accepted standards. Anticoagulation therapy was stopped few days before the procedure and replaced by low molecular weight heparin which was administered up to 24 hours before ICD implantation and re-initiated 12-24 hours afterwards. RESULTS: During DFT testing sinus rhythm was restored in 5 (21.7%) patients with AF. Clinical and DFT characteristics were similar in those who were converted to sinus rhythm and those who remained in AF. No thromboembolic events were noted in either group. Local haematoma at the site of ICD implantation occurred in two (8%) patients. CONCLUSIONS: Sinus rhythm was restored in 21.7% of patients with permanent AF who underwent ICD implantation. Temporary withdrawal of anticoagulation therapy did not increase the risk of thromboembolic complications, however, its early re-initiation after implantation resulted in an increase in local bleeding complication rate.