Leiomyosarcoma of the Right Atrium Masked by a Covering Thrombus: Conflicting Results of Echocardiography and Transvenous Biopsy—In Favor of Echocardiography

A 62-year-old woman was admitted for the evaluation of pedal edema and ascitis. Echocardiography revealed a right atrial (RA) mass invading the interatrial septum and extending into the inferior vena cava (IVC). Contrast enhanced computerized tomography scan excluded extravascular involvement. An organized thrombus was diagnosed by transvenous endomyocardial biopsy. The patient was treated with continuous intravenous heparin, and died soon after from hepatic failure. Postmortem histologic examination revealed a leiomyosarcoma surrounded by a thrombus involving RA, IVC, and hepatic veins. Endomyocardial biopsy played a misleading role that affected patient's management.     

A Study of the Heating of Plaque During an Intravascular Procedure

In invasive techniques such as laser angioplasty and intravascular ultrasonography, there is a source of heat inside the vascular system that is being released/dissipated by the inserted device. In this article, the transfer of heat from this source to the plaque deposited on the walls of the artery has been studied numerically using two different models. The models consider the transient conduction and the absorption of heat through the plaque. The variation of thermophysical properties is also included in the analysis. It was found that the temperature distribution depends significantly on the type of plaque and the power level.
heat transfer, arterial plaque     

Burn disaster response planning: an urban region's approach.

The objective of this study was to describe a draft response plan for the tiered triage, treatment, or transportation of 400 adult and pediatric victims (50/million population) of a burn disaster for the first 3 to 5 days after injury using regional resources. Review of meeting minutes and the 11 deliverables of the draft response plan was performed. The draft burn disaster response plan developed for NYC recommended: 1) City hospitals or regional burn centers within a 60-mile distance be designated as tiered Burn Disaster Receiving Hospitals (BDRH); 2) these hospitals be divided into a four-tier system, based on clinical resources; and 3) burn care supplies be provided to Tier 3 nonburn centers. Existing burn center referral guidelines were modified into a hierarchical BDRH matrix, which would vector certain patients to local or regional burn centers for initial care until capacity is reached; the remainder would be cared for in nonburn center facilities for up to 3 to 5 days until a city, regional, or national burn bed becomes available. Interfacility triage would be coordinated by a central team. Although recommendations for patient transportation, educational initiatives for prehospital and hospital providers, city-wide, interfacility or interagency communication strategies and coordination at the State or Federal levels were outlined, future initiatives will expound on these issues. An incident resulting in critically injured burn victims exceeding the capacity of local and regional burn center beds may be a reality within any community and warrants a planned response. To address this possibility within New York City, an initial draft of a burn disaster response has been created. A scaleable plan using local, state, regional, or federal health care and governmental institutions was developed.     

Purification and characterization of mammary myoepithelial and secretory cells from the lactating rat

Myoepithelial and secretory cells from the mammary gland of the lactating rat have been isolated, purified, and characterized. Mammary tissue was dissociated with collagenase into basket-like networks of myoepithelial cells and single secretory cells. Because of their larger size, the myoepithelial cell networks could be separated from other mammary and blood cells by differential centrifugation. Isolated secretory cells were purified by isopycnic centrifugation in 25% bovine serum albumin. The purified myoepithelial and secretory cells were viable, as shown by the incorporation of 32P into distinct macromolecules that were separable by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Both myoepithelial and secretory cells retained their characteristic morphology after isolation and purification, as shown by light, transmission, and scanning electron microscopies. The isolated myoepithelial cells were unique and, thus, distinguishable from other mammary cells in a number of respects; they 1) contracted in response to the addition of oxytocin, 2) bound [3H]oxytocin specifically, 3) accounted for the content of alkaline phosphatase and [Na+ + K+]ATPase in mammary tissue, and 4) reacted specifically with antiserum prepared against purified myoepithelial cells. The purified secretory cells were unique in possessing glucose-6-phosphate dehydrogenase activity. The different cell markers not only gave independent estimates of the purity of the cell fractions, but they also may be helpful in identifying mammary cells in stages of differentiation and neoplastic transformation.     

Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

Bifurcation angles play an important role in coronary bifurcation intervention. Bifurcation angles affect the coronary bifurcation intervention from many aspects: (1) impact the atherosclerosis proliferation via affecting the hemodynamic parameters at bifurcation regions; (2) impact side branch compromise after main vessel stenting via hemodynamics, atherosclerosis proliferation, geometric characteristics, and plaque/carina shift; (3) affect the long‐term clinical outcome after coronary bifurcation stenting. Bifurcation angles are key factors to formulate the intervention strategy of stenting procedure and can also be modified by different bifurcation stenting strategies. In the last few years, significant improvements have occurred in understanding the role of bifurcation angles. However, there are still questions remain to be clarified: (1) How to measure the bifurcation angles accurately and comprehensively? (2) How do bifurcation angles impact the immediate and long term outcome of PCI? (3) Why the results of previous studies remain controversial? The exact influence of bifurcation angles on post‐PCI effect like side branch compromise and clinical outcome has not been fully elucidated. In this review, we highlight the current knowledge of bifurcation angles, summarize the questions remained to be clarified, and discuss the implications for clinical practice and future studies. (J Interven Cardiol 2015;28:236–248)