Fatal myocardial infarction in a young man caused by a right megadolicho-coronary artery with thrombosis: a case report

A case of fatal myocardial infarction in a young man, secondary to thrombosis of an isolated ectatic coronary artery, is reported. Histological study of this abnormal artery demonstrated that it was of elastic type in its proximal two centimeters. This abnormal arterial structure supports the hypothesis of a congenital defect.     

Defining the relationship between obesity and total joint arthroplasty

OBJECTIVE: The purpose of this study was to examine the relationship between obesity and patient-administered outcome measures after total joint arthroplasty. RESEARCH METHODS AND PROCEDURES: A voluntary questionnaire-based registry contained 592 primary total hip arthroplasty patients and 1011 primary total knee arthroplasty patients with preoperative and 1-year data. Using logistic regression, the relationships between body mass index and the several outcome measures, including Short Form-36 and Western Ontario and McMaster Universities Osteoarthritis Index, were examined. RESULTS: There was no difference between obese and non-obese patients regarding satisfaction, decision to repeat surgery, and Delta physical component summary, Delta mental component summary, and Delta Western Ontario and McMaster Universities Osteoarthritis Index scores (p > 0.05 for all). Body mass index was associated with an increased risk of having difficulty descending or ascending stairs at 1 year (odds ratio, 1.2 to 1.3). DISCUSSION: Obese patients enjoy as much improvement and satisfaction as other patients from total joint arthroplasty.     

Kell is not restricted to the erythropoietic lineage but is also expressed on myeloid progenitor cells

Anti-Kell antibodies have been shown to suppress fetal erythropoiesis, but little is known about their effect on myelopoiesis. We analysed the effect of Kell-related antibodies on granulocyte-macrophage colony-forming units (CFU-GM) growth in semisolid medium using peripheral blood mononuclear cells (PBMNCs) from haematologically normal individuals. In addition to its inhibitory effect on erythroid burst-forming units (BFU-E) growth, anti-Kell antibodies significantly reduced CFU-GM colony formation from Kell-positive individuals but not from Kell-negative donors. Moreover, anti-cellano and anti-Kpb antibodies also inhibited the growth of CFU-GM from antigen-positive MNCs. These data indicate that Kell is not restricted to erythroid blood cells, but is also expressed on myeloid progenitor cells.     

The transitional zone in the tunica media of renal arteries has a maximal length of 10 millimetres

BACKGROUND: The goal of our study was to demonstrate and to determine the length of the transitional zone in the tunica media in renal arteries. The majority of renal artery atherosclerotic stenotic lesions occurs in this segment. PATIENTS AND METHODS: Anatomical and histological studies were performed on 26 renal arteries from 13 adults at autopsy (mean age 61.6 years, range 33 to 87 years). RESULTS: In the macroscopical examination the right renal arteries (RRA) were longer with a median 53.8 mm (range 38 to 65 mm) than the left renal arteries (LRA) with a median 47.6 mm (range 35 to 63 mm), the circumferences were nearly the same: RRA 10.9 mm (range 5 mm to 15 mm) and LRA 11 mm (range 5 mm to 15 mm). Probes for histological examinations were taken from three different regions of each renal artery (origin, 5 mm and 10 mm distal to the origin). We observed a typical elastic arterial structure at the origin and muscular types at the distal 10 mm region. At the distal 5 mm region variable ratios of elastic tissue (ET) and smooth muscle cells (SMC) were found as follows: 15 arteries presented an equal ratio of EM:SMC, 7 arteries presented ET > SMC and 4 arteries presented ET < SMC ratios. CONCLUSIONS: In this study we confirmed that in renal arteries, a transitional zone (TZ) that is an arterial segment with transition from elastic to muscular type, does exist, involving the maximal length of 10 mm. Further studies on the impact of the biomechanical properties of the transitional zone as a potential localizing factor in renal atherosclerotic disease are justified. In addition, the complex biomechanical behavior of the TZ of the arterial wall should be taken into consideration when interventional procedures are planned.     

Media calcinosis from the viewpoint of the cardiologist

Mediacalcinosis (MC) represents a disease of the muscular type arteries characterized by progredient calcification of the media. MC involves most frequently the arteries of the lower extremities. However, a more extensive disease involving the arteries of the pelvis and the abdominal aorta is common. A systemic extension of MC with the involvement of the coronary arteries has been reported, but is however, according to the present opinion, rather rare. MC occurs isolated (primary MC) as well as associated with other diseases (secondary MC). The secondary forms are most frequently due to diabetes mellitus type II and to chronic renal insufficiency and accompanying secondary hyperparathyroidism. The etiopathogenesis of MC has not yet been clarified. The recent evidence based on molecular-biologic investigations suggests an active pathomechanism of an ectopic arterial wall ossification. Genetic predisposition appears possible. The diagnosis of MC is traditionally established by conventional x-ray radiography of the pelvis-lower extremity-region. Among the newer imaging modalities, the computed tomography and the high resolution B-mode ultrasonography are of special importance. The diagnostics of coronary calcification are in descending order of importance relevant the intracoronary ultrasonography (IVUS), the electron beam computed tomography (EBT), the thorax-fluoroscopy and the thorax-radiography. For the diagnosis of coronary MC necessary arterial wall layer specific calcium detection is currently possible only with the IVUS methodology. The prognosis of the primary MC is quoad vitam good. However, the mechanic and biological effects of MC on cardiacal and vascular function have not yet been determined. The secondary MC in type II diabetics represents an independent cardiovascular risk factor. A causal therapy of MC is not known. For the clinical cardiologists, MC is of primary interest as a differential diagnosis to atherosclerosis. For the scientists, MC offers an excellent in vivo model to study processes associated with arterial wall ossifications and ageing.     

What are a patient's current chances of finding a matched unrelated donor? Twenty years' central search experience in a small country

Between 1988 and 2007, international searches for matched unrelated donors (MUDs) were performed for 1586 Austrian patients. Between 2004 and 2007, a MUD was identified for 76.7% of the patients. Between 1996 and 2003, a donor was identified for 71.3% of the patients, and between 1988 and 1995, only for 53.4% of the patients. Search times of successful searches decreased from 7.7 months in the first period to 1.7 months in the period from 2004 to 2007. However, transplants were not performed in all cases in which a donor was found: only in 61.6% of the patients between 2004 and 2007, in 53.4% between 1996 and 2003 and in 29.6% between 1988 and 1995. Multivariate analysis determined that having a common HLA type was the most important variable impacting on finding a MUD for a patient. Factors that most strongly influence a patient's access to transplant were the patient's European origin and a short time between diagnosis and start of donor search. The strongest factor for both finding a donor and being transplanted was a search being performed during more recent years: patients' chances increased from year to year.     

Is Lymph-node Ratio a Superior Predictor than Lymph Node Status for Recurrence-free and Overall Survival in Patients with Head and Neck Squamous Cell Carcinoma?

Introduction

TNM status is questioned as an exact predictor of survival in different tumour entities. Recently, lymph node ratio (LNR) has been described as a predictor of survival in patients with HNSCC. The purpose of this study was to evaluate to which degree LNR could be used as a more accurate predictor than TNM staging?

Methods

A total of 291 patients, with a follow-up of at least 3 years, were analyzed using log-rank statistic, univariate and multivariate data analyzes, and p values, for prediction of lymph node ratio on overall and recurrence-free survival.

Results

Survival differed significantly if patients were stratified for LNR. Impact of LNR on survival was significantly different even in patients with extracapsular spread. Patients with pN0 had no survival benefit compared with patients with pN1 or higher with a LNR lower than 6 %.

Conclusions

LNR is a prognostic tool in patients with a lymph node status pN0–pN2b. LNR remained significant even in patients with extracapsular spread, contrary to TNM status. With LNR, stratification for high-risk patients (higher than 6 % LNR) can be evaluated easily. We would suggest using LNR in the clinical routine.     

Comparison of different PCR protocols for the detection and diagnosis of Plasmodium falciparum

An assessment of differing PCR protocols for the diagnosis of Plasmodium falciparum infection was performed on samples from an area of holoendemic malaria transmission in western Burkina Faso. The PCR protocols had generally high sensitivities (>92%) and specificities (>69%), but the negative predictive values (NPV) were moderate and differed widely among the PCR protocols tested. These PCR protocols that amplified either the P. falciparum pfcrt gene or the small subunit ribosomal DNA were the most reliable diagnostic tools. However, the moderate NPV imply that more than one PCR protocol should be used for diagnosis in holoendemic areas.N. Oster and I.Z. Abdel-Aziz have contributed equally to this work.