Herniation of the heart into the right pleura following blunt chest trauma--an unusual presentation

A 21-year-old male patient had sustained a blunt chest and abdominal trauma during a traffic accident. All the major injuries were on the left side. On the second day, a massive shift of the mediastinum to the right was noted. Further investigations raised the suspicion of herniation of the heart into the right pleural cavity. However, the patient's hemodynamic stability did not fit into the picture. Echocardiography and CT scan helped reinforce our suspicion. Herniation was confirmed at the operation, which was performed through median sternotomy. The patient recovered well without complications.     

Importance of Contrast Aortography With Lotus Transcatheter Aortic Valve Replacement: A Post Hoc Analysis From the RESPOND Post-Market Study

Objectives

The aim of this post hoc analysis from the RESPOND (Repositionable Lotus Valve System–Post-Market Evaluation of Real World Clinical Outcomes) post-market study was to assess the final implantation depth on the contrast aortogram after Lotus valve (Boston Scientific, Marlborough, Massachusetts) transcatheter aortic valve replacement (TAVR) and to correlate with permanent pacemaker implantation (PPI) and paravalvular leak (PVL).

Cost comparison of predictive genetic testing versus conventional clinical screening for familial adenomatous polyposis

BACKGROUND: Mutations of the APC gene cause familial adenomatous polyposis (FAP), a hereditary colorectal cancer predisposition syndrome. AIMS: To conduct a cost comparison analysis of predictive genetic testing versus conventional clinical screening for individuals at risk of inheriting FAP, using the perspective of a third party payer. METHODS: All direct health care costs for both screening strategies were measured according to time and motion, and the expected costs evaluated using a decision analysis model. RESULTS: The baseline analysis predicted that screening a prototype FAP family would cost $4975/ pound3109 by molecular testing and $8031/ pound5019 by clinical screening strategy, when family members were monitored with the same frequency of clinical surveillance (every two to three years). Sensitivity analyses revealed that the genetic testing approach is cost saving for key variables including the kindred size, the age of screening onset, and the cost of mutation identification in a proband. However, if the APC mutation carriers were monitored at an increased (annual) frequency, the cost of the genetic screening strategy increased to $7483/ pound4677 and was especially sensitive to variability in age of onset of screening, family size, and cost of genetic testing of at risk relatives. CONCLUSIONS: In FAP kindreds, a predictive genetic testing strategy costs less than conventional clinical screening, provided that the frequency of surveillance is identical using either strategy. An additional significant benefit is the elimination of unnecessary colonic examinations for those family members found to be non-carriers.     

Mechanism of hemolysis of G-6-PD deficient red cells: changes in membrane lipids and polypeptides

Summary A study of red cell membrane polypeptide and lipid profiles in G-6-PD deficient subjects has been made. High membrane spectrin and lipid content was demonstrated in the red cells of drug sensitive G-6-PD deficient individuals, while it was normal in non-sensitive G-6-PD deficient subjects. An inverse relationship was observed between GSH level and spectrin content in the former group. Possible mechanism of increased spectrin content in relation to hemolysis is discussed.     

Transfemoral Transcatheter Tricuspid Valve Replacement With the EVOQUE System: A Multicenter,Observational, First-in-Human Experience

ObjectivesThe purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes.BackgroundTranscatheter tricuspid intervention is a promising option for selected patients with severe tricuspid regurgitation (TR). Although transcatheter leaflet repair is an option for some, transcatheter tricuspid valve replacement (TTVR) may be applicable to a broader population.MethodsTwenty-five patients with severe TR underwent EVOQUE TTVR in a compassionate-use experience. The primary outcome was technical success, with NYHA (NYHA) functional class, TR grade, and major adverse cardiac and cerebrovascular events assessed at 30-day follow-up.ResultsAll patients (mean age 76 ± 3 years, 88% women) were at high surgical risk (mean Society of Thoracic Surgeons risk score 9.1 ± 2.3%), with 96% in NYHA functional class III or IV. TR etiology was predominantly functional, with mean tricuspid annular diameter of 44.8 ± 7.8 mm and mean tricuspid annular plane systolic excursion of 16 ± 2 mm. Technical success was 92%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 0%, 76% of patients were in NYHA functional class I or II, and TR grade was ≤2+ in 96%. Major bleeding occurred in 3 patients (12%), 2 patients (8%) required pacemaker implantation, and 1 patient (4%) required dialysis.ConclusionsThis first-in-human experience evaluating EVOQUE TTVR demonstrated high technical success, acceptable safety, and significant clinical improvement. Larger prospective studies are needed to confirm durability and safety and the impact on long-term clinical outcomes.     

Elucidation of the receptors in macrophage and Plasmodium yoelii interactions

Binding of hyperimmune serum opsonized merozoites of Plasmodium Yoelii nigerensis to trypsinized macrophages suggested it to be mediated by FcII receptor. Receptor blocking inhibition with monoclonal antibody 2.4G2 directed against Fc receptor for IgG1/IgG2b provided evidence that Fc delta 2b on macrophage played an important role in the merozoite-macrophage interactions. In addition, a neuraminidase sensitive receptor was noted to mediate the binding of P. yeelii merozoites in the absence of serum. Binding inhibition studies with two monosaccharides, D-mannose and alpha-methyl mannoside, indicated the role of Mannose/Fucose receptor on macrophage in this interaction.     

Preliminary evaluation of extracts of Alstonia scholaris bark for in vivo antimalarial activity in mice

The petroleum either extract and methanol extract of the bark of Alstonia scholaris were found to be devoid of antiamalarial activity in mice infected with Plasmodium berghei. However, a dose-dependent improvement of conditions and delayed mortality amongst animals receiving methanol extract of A. scholaris was noticed. Studies with A. constricta and alstonine shall help resolve the antimalarial status of the bark in question.