Congenital left ventricular wall abnormalities in adults detected by gated cardiac multidetector computed tomography: Clefts, aneurysms, diverticula and terminology problems

Objectives

Our aim was to evaluate congenital left ventricular wall abnormalities (clefts, aneurysms and diverticula), describe and illustrate imaging features, discuss terminology problems and determine their prevalence detected by cardiac CT in a single center.

Materials and methods

Coronary CT angiography images of 2093 adult patients were evaluated retrospectively in order to determine congenital left ventricular wall abnormalities.

Results

The incidence of left ventricular clefts (LVC) was 6.7% (141 patients) and statistically signi?cant difference was not detected between the sexes regarding LVC (P = 0.5). LVCs were single in 65.2% and multiple in 34.8% of patients. They were located at the basal to mid inferoseptal segment of the left ventricle in 55.4%, the basal to mid anteroseptal segment in 24.1%, basal to mid inferior segment in 17% and septal–apical septal segment in 3.5% of cases. The cleft length ranged from 5 to 22 mm (mean 10.5 mm) and they had a narrow connection with the left ventricle (mean 2.5 mm). They were contractile with the left ventricle and obliterated during systole. Congenital left ventricular septal aneurysm that was located just under the aortic valve was detected in two patients (0.1%). No case of congenital left ventricular diverticulum was detected.

Conclusion

Cardiac CT allows us to recognize congenital left ventricular wall abnormalities which have been previously overlooked in adults. LVC is a congenital structural variant of the myocardium, is seen more frequently than previously reported and should be differentiated from aneurysm and diverticulum for possible catastrophic complications of the latter two.     

Some Heavy Metals Accumulation in Tissues in <Emphasis Type="Italic">Capoeta umbla</Emphasis> (Heckel, 1843) from Uzuncayir Dam Lake (Tunceli,Turkey)

Concentrations of metals were determined in the gills, liver, kidney, heart and muscle in Capoeta umbla caught from six stations from the Munzur River system. Metal concentrations in the tissues tended to vary significantly among stations (p < 0.05). Liver (Cu, 10.10 ± 0.23–23.03 ± 9.37 ppm; Zn, 14.67 ± 3.01–21.82 ± 2.39 ppm; Cd, 18.04 ± 4.56–52.69 ± 10.65 ppb and Fe, 28.87 ± 6.78–115.11 ± 34.87 ppm) and kidney (Cu, 1.80 ± 0.25–3.70 ± 0.62 ppm; Zn, 20.81 ± 0.37–29.36 ± 0.70 ppm; Cd, 132.06 ± 5.29–639.51 ± 20.14 ppb and Fe, 24.40 ± 1.98–59.39 ± 1.97 ppm) tissues showed higher metal concentrations than other tissues. It seems that metal contamination in the river is too high for the health of fish and the people who eat them. The geographical locations of catch, season, nature of diet, and the size of fish used for analyses might lead to different metal concentration in the same fish species.     

Long-term efficacy and safety of etanercept in children with polyarticular-course juvenile rheumatoid arthritis: interim results from an ongoing multicenter,open-label,extended-treatment trial

OBJECTIVE: To evaluate the long-term efficacy and safety of etanercept in children with juvenile rheumatoid arthritis (JRA) participating in an ongoing multicenter, open-label, extended-treatment trial. All patients had been participants in an initial randomized efficacy and safety trial of etanercept. METHODS: Etanercept was administered at a dosage of 0.4 mg/kg (maximum 25 mg) subcutaneously twice each week. Safety and efficacy evaluations were performed every 3-4 months. The JRA 30% definition of improvement (DOI) was defined as improvement of > or =30% in at least 3 of 6 response variables used to assess disease activity, with no more than 1 variable worsening by more than 30%. RESULTS: At the time of analysis, 48 of the 58 patients (83%) were still enrolled in the study; 43 of them (74%) had completed 2 years of treatment. Of these 43 patients, 81% met the JRA 30% DOI, 79% met the JRA 50% DOI, and 67% met the JRA 70% DOI. Ten children started low-dose methotrexate after year 1. Of the 32 children taking prednisone, the dosage was decreased to <5 mg/day in 26 (81%). Two children had serious infections (varicella with aseptic meningitis in one and complicated sepsis in the other). In general, adverse events were of the types seen in a general pediatric patient population. CONCLUSION: Children with severe, longstanding, methotrexate-resistant polyarticular JRA demonstrated sustained clinical improvement with >2 years of continuous etanercept treatment. Etanercept was generally well-tolerated. There were no increases in the rates of adverse events over time. However, children taking etanercept should be monitored closely for infections.     

Embolization of Patent Foramen Ovale Closure Devices: Incidence,Role of Imaging in Identification,Potential Causes,and Management

Transcatheter patent foramen ovale (PFO) closure is an alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke, and it is associated with a small incidence of periprocedural sequelae. Because embolization of PFO closure devices is a very rare procedural complication, data on its frequency, causes, and management are sparse. We sought to review the medical literature and the cases of PFO closure-device embolization at our institution with the aim of identifying likely problems and reporting potential solutions. Out of 310 adult patients who underwent transcatheter PFO closure from June 2002 through April 2011, there were 2 cases (0.6%) of PFO closure-device embolization. In both patients, hypermobile septum primum and thick septum secundum were present. In one patient, failure to use a sizing balloon might have resulted in an underestimation of the PFO''s size. In both patients, device embolization was identified in a timely fashion, the embolized device was safely retrieved, and the PFO was percutaneously closed with success.The incidence of PFO closure-device embolization is very low. The cases described here underscore the importance of imaging in the identification of morphologic predispositions to closure-device malpositioning, in the recognition of impending embolization, and in the timely management of embolization.Key words: Contrast media/diagnostic use, device removal/methods, echocardiography, transesophageal, fluoroscopy, foramen ovale, patent/radiography/therapy/ultrasonography, foreign body migration, ischemic attack, transient/prevention & control, prosthesis implantation/adverse effects, septal occluder device/adverse effects, stroke/prevention & controlSeveral studies^1–3 have shown the feasibility of transcatheter patent foramen ovale (PFO) closure as an adjunct or alternative to antiplatelet or anticoagulative therapy in patients with cryptogenic stroke. Procedural sequelae are rare. In a meta-analysis of 10 studies consisting of more than 1,350 patients with transcatheter PFO closure,⁴ major sequelae (death, tamponade, hemorrhage requiring blood transfusion, fatal pulmonary embolism, and need for surgical intervention) occurred in 1.5% of patients, and minor sequelae (device embolization with percutaneous retrieval, arrhythmias, device fracture, asymptomatic device thrombosis, symptomatic air embolism, and groin sequelae) occurred in 7.9% of patients. Data exist on the predisposing factors for embolization of atrial-septal-defect closure devices (inadequate rim and undersized device)^5–8; but PFO closure-device embolization is such a rare complication that data on its frequency, causes, and management are sparse.^1,9,10 We sought to review the literature on PFO closure-device embolization and to describe such cases at our institution with the aim of identifying likely problems and reporting potential solutions. Open in a separate window     

Nickel Sensitivity in Asthma Patients

Nickel sulphate frequently causes allergic contact dermatitis; less known effects are nasal inflammation (rhinitis) and bronchial asthma. In this study, we aimed to find if there is a relationship between asthma and nickel sensitivity. Asthmatic patient, non-asthmatic atopic, and healthy control groups were patch tested with nickel sulphate. Nickel sensitivity was more prevalent in the asthmatic patient group compared to the non-asthmatic atopic and healthy control groups.     

Plasma Protein C and Antithrombin III Levels in Polycythemic Newborns

Thromboembolic complications have been reported in association with neonatal polycythemia, the primary cause of hyperviscosity in the newborn. Although there are some studies on coagulation in polycythemic neonates, the situations that predispose these newborns to thrombosis are still not clear.1 One of the causes may be the reduction in blood flow within the microcirculation, which favors coagulation. As protein C (PC) and antithrombin III (AT III) are important coagulation inhibitors, we decided to study them in polycythemic newborns.     

Hemoglobinopathies in the District of Antalya, Turkey

A screening program was conducted to ascertain the incidence of hemoglobinopathies in the district of Antalya, Turkey. The survey sample was selected from the household registration forms of health centers by systematic random sampling. Heparinized blood samples were collected from 1,616 subjects from 884 families.

The prevalence of p thalassemia traits with increased Hb A2 was 10.2%. This is higher than that found in previous studies performed in Antalya. The prevalence of abnormal hemoglobins (Hbs) was found to be 0.8%. Four subjects had Hb AS; five had Hb D-Los Angeles (B 121 [GH4] Glu-Gln); one had Hb Ube-2 (68 [E1] Asn-Asp), one had Hb P-Nilotic (fusion between B 22 and) and two had Hb D-like variants.