Unusual presentation of ulnar artery aneurysm and dissection with associated anomalous radial artery: appearances on multi-detector row CT angiography

We present a case of ulnar artery aneurysm and dissection associated with a congenitally hypoplastic ipsilateral radial artery. We postulate that the aetiology is due to increased blood flow through the ulnar artery as a consequence of the radial artery anomaly, therefore making the ulnar artery more vulnerable to aneurysm formation and traumatic damage. This might represent a variant of the hypothenar hammer syndrome with associated ulnar artery dissection and recurrent distal embolisation manifesting as Raynaud’s phenomenon. Forearm arterial injuries, treatment and the importance of upper limb arterial anatomical variations are also discussed. To our knowledge, this is the first reported case of its type diagnosed by multi-detector row computed tomography angiography.     

Predictors of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation: A Systematic Review

AF Recurrence After RFA: Systematic Review. Introduction: The relationship between success of radiofrequency ablation for atrial fibrillation (AF) and patient characteristics has not been systematically evaluated. Methods and Results: We searched MEDLINE and Cochrane Central Trials Registry databases from 2000 through 2008 for studies reporting preprocedure predictors and AF recurrence after radiofrequency ablation. We extracted multivariable analyses and univariable data on predictors and AF recurrence. Eligible studies were highly heterogeneous, particularly regarding ablation technique and definition of AF recurrence. Among 25 studies with multivariable analyses, two‐thirds to 90% of studies found that AF type, ejection fraction, left atrial diameter, structural heart disease, hypertension, and AF symptom duration did not predict AF recurrence (among patients with ejection fraction above 40% and left atrial diameter below about 55 mm). Studies found that gender and age were not predictors (in patients between 40 and 70 years old). Meta‐analyses of univariable AF recurrence rates by AF type in 31 studies found that studies were statistically heterogeneous, but that nonparoxysmal AF predicted AF recurrence compared to paroxysmal AF (relative risk 1.59; 95% confidence interval 1.38–1.82; P < 0.001); meta‐analyses of persistent or permanent versus paroxysmal AF yielded similar findings. Conclusion: Nonparoxysmal AF may be a clinically useful proxy for a combination of confounded variables, none of which alone is an independent predictor of AF recurrence. Evaluation of predictors was limited by exclusion of patients with severe heart disease or at the age extremes; thus, the evidence may not be as applicable to these populations. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1208‐1216, November 2010)     

Interleukin-3 and granulocyte-monocyte colony-stimulating factor receptors on human acute myelocytic leukemia cells and relationship to the proliferative response

Interleukin-3 (IL-3) and granulocyte-monocyte-colony-stimulating factor (GM-CSF) stimulate proliferation of human acute myeloid leukemia (AML) in vitro, although patterns of response among clinical cases are diverse. Whether regulatory abnormalities related to growth factor responses in human AML may establish the outgrowth of the neoplasm is unclear. We determined receptor numbers and affinity for IL-3 and GM- CSF on human AML cells using human recombinant IL-3 (rIL-3) and GM-CSF (rGM-CSF). In 13 of 15 cases of primary AML high-affinity (kd 26 to 414 pmol/L) receptors for IL-3 were demonstrable on the cells. The average numbers of IL-3 receptors ranged from 21 to 145 receptors per cell. Normal WBCs showed IL-3 receptors on their surface at similar densities. IL-3 receptor positivity often correlated with GM-CSF receptor positivity of AML; GM-CSF receptors were demonstrated on the cells of 11 of 15 cases, although average numbers of GM-CSF receptors were ten times greater. The in vitro response of the cells to exogenous IL-3 or GM-CSF was examined by measuring thymidine uptake. Because IL-3 and GM-CSF were potent inducers of DNA synthesis in vitro, apparently relatively few receptors are required to permit activation of growth. These experiments did not provide evidence for overexpression or increased receptor sensitivity as an explanation for AML growth. In a minority of cases, however, the cells were unable to respond to IL-3 (four of 15 cases) or GM-CSF (four of 15 cases) despite normal receptor availability on the cell surface.     

Kartagener's syndrome: A re-visit with Chinese perspectives

Abstract The objective of this study was to evaluate the clinical, radiological investigation profiles, and ciliary function and ultrastructure in Chinese patients with Kartagener's syndrome (presence of dextrocardia, sinusitis and bronchiectasis). All patients with dextrocardia were assessed for the presence of sinusitis and bronchiectasis in our hospital network. Patients identified with Kartagener's were assessed when they were at steady state for their bronchiectasis. Seven cases (4 males; mean age 34.9 years) were identified and systematically reviewed. The mean 24 h sputum volume was 26.6±32.77 mL/day and the patients suffered from a mean of 2.9 exacerbations/year. Nasal symptoms (anosmia in one, obstruction in six and persistent discharge in three patients) were common. Only two cases (1 M) were married and both had normal fertility. Lung function assessment showed a mean FEV₁/FVC of 83.3±38.78/86.5±36.72 (% predicted) with little reversibility. High resolution computerized tomography (HRCT) revealed bronchiectactic involvement of the lower lobes in seven and middle lobe/lingula in four cases. Assessment of α-1-anti-trypsin, aspergillus precipitins, auto-antibodies and serology for Pseudomonas pseudomallei was normal. Sputum culture yielded Pseudomonas aeruginosa in three, Haemophilus influenzae in three and commensals in one case. Phase contrast microscopy assessment of respiratory cilia, obtained by brushing the inferior turbinate, revealed that most of the mucosa was unciliated. The mean ciliary beat frequency was 5.2 ± 6.76 Hz (range 0–13.7; normal range 12–18 Hz). Four patients had immotile cilia whilst the rest had normal ciliary movement. Transmission electron microscopy showed the absence of dynein arms in four patients. The results of this study show that patients with Kartagener's syndrome may have normal ciliary ultrastructure and the absence of dynein arms is not necessarily associated with ciliary immotility. The presence of ciliary immotility might have prognostic value as these patients appear to have more active bronchiectasis. Our experience on this series should help clinicans in the investigation and management of these patients.     

Signal Averaging of the Surface QRS Complex: Practical Applications

Signal-Averaged ECG. Signal averaging of the surface QRS complex has been used in recent years to detect electrical signals of small amplitude not otherwise evident on the surface ECG. The technique enables detection of low-amplitude signals in the terminal portion of the QRS complex and the ST segment. These low-amplitude signals termed late potentials (LPs) have been correlated with the presence of fragmented electrical activity recorded from endocardial and epicardial sites due to inhomogeneous propagation of conduction in scarred myocardium. Recent studies have supported the value of the signal-averaged ECG for risk stratification postmyocardial infarction, in the management of patients with syncope and patients with sustained ventricular tachycardia (VT), and survivors of cardiac arrest.     

Antimicrobial Effects of the Stem Bark Extracts of Parkia Biglobosa (Jacq.) Benth. on Shigellae

Total and hydroalcoholic extracts of the stem barks of Parkia biglobosa (Jacq) Benth. (Mimosaceae) were tested on strains belonging to three species of Shigellae: S. dysenteriae, S. flexneri and S. boydii collected from hospitals in Ouagadougou, Burkina Faso. The results showed that both extracts were active against Shigellae. The hydroalcoholic extract was more active than the decoction (aqueous one) prescribed by the traditional healer. Both extracts were particularly effective against S. dysenteriae, the most virulent of the three pathogenic species. The effects of the extracts have been compared to that of gentamicin. The phytochemical screening on the extracts revealed the presence of sterols, triterpenes, polyphenolic compounds including tanins, flavonoids, coumarins, anthocyanidins. Other components are saponosides and reducing sugars.     

Apoptosis and proliferation under conditions of deoxynucleotide pool imbalance in liver of folate/methyl deficient rats

Weanling male F344 rats were fed either a semi-purified diet low in methionine and lacking in choline and folic acid (folate/methyl deficient) or a supplemented control diet for periods of 2, 5, 7 days, 3 weeks, and 9 weeks. Two days after initiating the folate/methyl deficient diet in weanling F344 rats, the incidence of apoptotic bodies, identified by in situ end-labeling of 3'-OH DNA strand breaks, was significantly increased in liver sections from the deficient rats. Apoptotic cell death was confirmed biochemically by an increase in nuclear Ca2+/Mg2+-dependent endonuclease activity that paralleled the increase in apoptotic bodies over the 9-week feeding period. There was no morphologic evidence of necrotic foci or necrosis-associated inflammatory response over the 9-week period. Confirming that cell turnover is chronically elevated in this model, the increase in apoptotic rate was accompanied by a sustained increase in the mitotic index (MI). The DNA repair-associated enzyme, poly(ADPribose) polymerase (PARP), was similarly elevated and was associated with significant decreases in the substrate for ADPribose polymer synthesis, nicotinamide adenine dinucleotide (NAD). Because folate metabolites are essential for de novo purine and thymidine biosynthesis, prolonged deficiency in folic acid can induce an imbalance in the deoxynucleotide precursors for DNA replication/repair and negatively affect the fidelity of DNA synthesis. Using an HPLC method, hepatic deoxyuridine triphosphate (dUTP) levels were increased at 3 and 9 weeks after initiation of the deficient diet and levels of thymidine triphosphate (dTTP) were reduced. An increase in dUTP/ dTTP ratio is consistent with a block in folate-dependent de novo thymidylate biosynthesis and may predispose to uracil misincorporation and DNA repair-related DNA strand breaks.      

Determination of the DDE and PCB contents of peregrine Falcon eggs: A comparison of whole egg measurements and estimates derived from eggshell membranes

A method using eggshell membranes to determine egg content levels of DDE and polychlorobiphenyls (PCBs), two of the most ubiquitous environmental contaminants, has been validated. A comparison was made between the residue levels determined from the egg contents of 40 Peregrine Falcon (Falco peregrinus) eggs and from hexanesoluble extracts of the dried eggshell membranes. The results confirm the use of museum eggshells for estimations of DDE and PCB levels of the original egg contents. This method should be valid for other lipophilic compounds. The data generated are of use not only to determine the records of past contamination, but may be expected to provide useful information on patterns of contamination encountered in different geographical areas. The membrane extraction technique allows pollutant levels to be measured without removing viable material from endangered species.