A Mysterious Crescent in the Heart: Ruptured Sinus of Valsalva Dissecting Interatrial Septum,Multimodality Imaging,and Full Recovery

A 59‐year‐old man who was admitted to the emergency department with new and spontaneous onset of fatigue, dyspnea, and palpitations. There was neither a history of trauma, chest pain, nor infection. Transthoracic two‐ and three‐dimensional echocardiography and computer tomography demonstrated sinus of Valsalva aneurysm rupture dissecting interatrial septum and leading to a huge thrombus formation in it. The diagnosis with multimodality imaging performed within hours, and urgent surgery saved the patient's life.     

Confetti‐like macular atrophy: A new entity?

Anetoderma, is characterized by herniated atrophic macules clinically and by decreased to absent dermal elastic fibers histopathologically. Atrophoderma is characterized by depressed, atrophic, pigmented patches clinically and by thickened and homogenized dermal collagen bundles with absence of elastolysis histopathologically. Atrophoderma elastolyticum discretum describes lesions that are reminiscent of atrophoderma clinically but they are compatible with anetoderma histopathologically. A 34-year-old female patient presented with diffuse, hypopigmented, atrophic, shiny macules on the upper limbs and upper trunk. Histopathological examination revealed an atrophic epidermis with disorganized, hyalinized and coarse collagen bundles in the middle and lower dermis. Elastic fiber loss and fragmentation were detected in the upper dermis. The other patient was a 42-year-old female patient. She applied with diffuse, hypopigmented, shiny, atrophic macules on the upper limbs and upper trunk. Histopathological examination revealed findings that were similar to those of the first case but there was near complete loss of elastic fibers throughout the whole thickness of dermis. Our cases did not show depressed or herniated atrophic macules clinically but the macules were at the same level with the surrounding healthy skin. Histopathological findings in these cases showed the histopathological features of both atrophoderma and anetoderma. These two cases are interesting because they may represent a clinicopathological entity which has not been described before.     

Sheehan syndrome presented with acute renal failure associated with rhabdomyolysis and hyponatraemia.

Sir, Hyponatraemia is a frequent complication of moderate to severehypothyroidism [1]. Thus, thyroid function should be evaluatedin any patient with an otherwise unexplained reduction in theplasma sodium concentration. There have been several case reportsof rhabdomyolysis, which may lead     

In psychosis, cortical interneurons overexpress DNA-methyltransferase 1

Cortical DNA-methyltransferase 1 (DNMT1) is preferentially expressed in interneurons secreting GABA where it very likely contributes to promoter CpG island hypermethylation, thus causing a down-regulation of promoter functions. To consolidate and expand on previous findings that, in the cortex of schizophrenia (SZ) brains, glutamic acid decarboxylase 67 (GAD67) expression is down-regulated whereas that of DNMT1 is up-regulated, we studied both parameters in Brodmann's area (BA) 9 from the McLean 66 Cohort Collection (Harvard Brain Tissue Resource Center, Belmont, MA). In BA9 of SZ and bipolar disorder patients with psychosis, DNMT1 mRNA and protein expression preferentially increases in layer I, II, and IV interneurons, and this increase is paralleled by a decreased number of GAD67 mRNA-positive neurons. The increase in DNMT1 and the decrease in GAD67-expressing neurons were unrelated to postmortem interval, pH, RNA quality, or to the presence, dose, or duration of antipsychotic (APS) medication, with the exception of a subgroup of SZ patients treated with a combination of valproate and APS in which the expression of DNMT1 failed to change. The DNMT1 increase and the GAD67 decrease in BA9 interneurons are significant features of SZ and bipolar disorder with psychosis. Interestingly, the DNMT1 increase failed to occur when patients with psychosis received a combination of valproate and APS treatment but not APS monotherapy.     

Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: a four-year comparative study

Purpose:

To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus.

Materials and Methods:

Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter.

Results:

Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years.

Conclusions:

As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients.     

The fruit extract of three strawberry cultivars prevents lipid peroxidation and protects the unsaturated fatty acids in the Fenton reagent environment

In this study, we detected the flavonoid ingredients of three different varieties of strawberry (Fragaria ananassa Duch cultivar Camarosa, Selva and Dorit) grown in Elazig, and we researched on their effects on the radicals DPPH√ and OH√. It was detected that in the manipulation of 50-100 μl extract, it was efficient to turn the DPPH√ radical over 85% to DPPH√ OH√ form. In in vitro environment in which hydrogen peroxide and Fenton reagent were used, it was also detected that the capacity of interception of lipid peroxidation is high. When the level of Malondialdehyde (MDA)-2-thiobarbituric acid was compared with that of the Fenton R group, the level was shown to be decreased in the groups in which a quite distinct level of the extract of strawberry fruit was given (p < 0.001). Depending on the decrease in LPO formation, the amounts of oleic acid and linoleic acid that were added to the reaction environment were preserved in in vitro environment in which the extract of strawberry fruit was added (p < 0.01, p < 0.05 and p < 0.01).Consequently, it has been confirmed that the strawberry fruit that has a scavenging effect against the radicals prevents that lipid peroxidation in in vitro environment.     

Addition of rosiglitazone to glimepirid and metformin combination therapy in type 2 diabetes

The study was planned to determine the efficacy and safety of adding rosiglitazone to a combination of glimepiride and metformin therapy with insufficiently controlled type 2 diabetes. This was an open-label study with a follow-up period of 26 weeks. Thirty patients were taking 3 mg glimepiride two times and 850 mg metformin two times per day. Patients were told to take one rosiglitazone 4 mg tablet before breakfast additionally. The primary efficacy measure was the mean change in HbA1c from baseline to the end of the study. Secondary efficacy parameters included the mean changes from baseline to the end of the study in fasting plasma glucose (FPG) and insulin levels, as well as total cholesterol, HDL-C, LDL-C, triglycerides, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Mean HbA1c levels decreased significantly from 7.54 +/- 0.9% to 6.57 +/- 0.7% (p < 0.001) at 26th week. FPG levels fell from 169.39 +/- 37.8 mg/dl to 135.69 +/- 28.0 mg/dl (p < 0.001), respectively. Insulin levels decreased from 19.60 +/- 9.8 U/L to 14.66 +/- 11.6 U/L (p = 0.026) at 26th week. No one experienced elevations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels greater than 2.5 times the upper limit of the reference range. This study confirms that the addition of rosiglitazone (4 mg/day) to sulphonylurea and metformin treatment for patients with type 2 diabetes improves glycemic control, is safe, and generally well tolerated.     

The effect of L-glutamine on mucosal healing in experimental colitis is superior to short-chain fatty acids.

Background/aims: The effects of short-chain fatty acids and glutamine on diseased colonic mucosa, such as in inflammatory bowel disease, are not well described. The aim of this study was to investigate the role of L-glutamine and short-chain fatty acids, both via enema and oral administration, on mucosal healing in experimental colitis. Methods: Colitis was induced with trinitrobenzenesulphonic acid in ethanol enema in rats. Saline enema (Colitis group, n: 12), L-glutamine enema (n: 12), short-chain fatty acids enema (n: 12), oral L-glutamine (n:11) and oral short-chain fatty acids (n.11) were applied twice daily for 10 days after induction of colitis. The sham group (n: 12) received only saline enema. Rats were sacrificed at the tenth day. Crypt depth and DNA content were measured in colonic mucosa. Results: Crypt depth was significantly greater in both glutamine groups and short-chain fatty acids enema group than in sham and colitis groups (p<0.05). The mucosal DNA contents of the colitis and glutamine enema groups were significantly greater than both short-chain fatty acids groups (p<0.05). DNA content in the oral glutamine group was significantly greater than in the short-chain fatty acids enema group (p<0.05). Conclusions: L-glutamine enema can accelerate mucosal healing and regeneration in experimentally induced colitis in rats. When compared to glutamine in this study, shortchain fatty acids showed no beneficial effect on colitis.     

Subclinic arterial and left ventricular systolic impairment in autosomal dominant polycystic kidney disease with preserved renal functions

The International Journal of Cardiovascular Imaging - Subclinical atherosclerosis and cardiovascular events are common even in young normotensive patients with autosomal dominant polycystic kidney...