Giant cardiac lipoma: report of a case

Cardiac lipomas are extremely rare benign tumors. We report a case of a 41-year-old man who was admitted because of cardiomegaly and a feeling of discomfort in his chest. Computed tomography and magnetic resonance imaging studies showed a large mass occupying the mediastinum and pericardial space. The patient underwent resection of a lipoma which weighed 1100 g and had a pedicle 6 cm in diameter, connected to the epicardial surface of right ventricle infundibulum.     

Assessment of setup accuracy in patients receiving postmastectomy radiotherapy using electronic portal imaging

Purpose The aim of this study was to investigate the setup accuracy for patients undergoing postmastectomy radiotherapy using electronic portal imaging. Materials and methods Ten patients undergoing radiotherapy via tangent (TG), supraclavicular-axillary (SA), and internal mammary (IM) fields were included. To explore the setup accuracy, distances between chosen landmarks were taken as reference parameters (RPs). The difference between measured RPs on simulation films and electronic portal images (EPIs) was calculated as the setup error. Results A total of 30 simulation films and 120 EPIs were evaluated. In the SA field, calculated RPs were lung length (LL), clavicle-field center perpendicular distance, and clavicle-field center transverse distance. The mean of the standard deviations (SDs) of the random errors (σ) for these parameters were 4.7, 7.3, and 7.6; and the SDs of the systematic errors (Σ) were 6.8, 4.4, and 13.5, respectively. In the TG fields, the calculated RPs were the central lung distance (CLD), maximum lung distance (MLD), and central soft-tissue distance (CSTD). In the medial TG field, the σ values for these parameters were 3.4, 3.6, and 4.1, respectively; and the σ values were 6.6, 2.6, and 3.4, respectively. In the lateral TG field, Σ values for the calculated RPs were 2.4, 3.2, and 3.3l, respectively; and the Σ values were 5.6, 3.6, and 4.8, respectively. Conclusion CLD, MLD, and CSTD in TG fields and LL in SA fields are easily identifiable and are helpful for detecting setup errors using EPIs in patients undergoing postmastectomy radiotherapy.     

Radiological and clinical course of pneumonia in patients with avian influenza H5N1

INTRODUCTION: We evaluated chest X-ray and clinical findings of patients with lower respiratory tract infection due to influenza H5N1 and presented the radiological findings and clinical course of the infection. MATERIALS AND METHODS: Between December 2005 and February 2006, eight hospitalized patients (median age 10, 5-15 years) with avian-flu were evaluated in this study. All patients were evaluated with chest X-ray and four of them with CT scan. Post mortem pathological characterization were also available for three of the patients. RESULTS: A rapidly progressive pneumonia with high mortality rate was observed especially for cases with late admission. The major radiologic abnormalities were extensive pneumonic infiltration with segmental and multifocal distribution, mostly located in lower zones of the lung. No pleural effusion and hilar lymphadenopathy was noted. CONCLUSION: Avian flu may be presented as rapidly progressive pneumonia. The chest radiography has an important role in diagnosis and should be obtained daily because of rapid change of the findings that may necessitate prompt action.     

Protective effects of trimetazidine on testicular ischemia-reperfusion injury in rats

INTRODUCTION: We tried to prove the effectiveness of trimetazidine (TMZ) on testicular torsion-detorsion injury. MATERIALS AND METHODS: 15 male rats were equally divided into three groups: group 1 was the sham-operated control group; group 2 had 2 h of unilateral testicular ischemia followed by 3 days of reperfusion, and group 3 had 2 h of unilateral testicular ischemia followed by 3 days of oral TMZ treatment (5 mg/kg, bid) during reperfusion. In the removed testicles, tissue reduced glutathione (GSH), glutathione reductase (GR), glutathione peroxidase (GPx), malondialdehyde (MDA) levels and pathological modified Johnson scores (MJS) were evaluated. Mann-Whitney U test was used for statistical evaluations. RESULTS: In group 2, on the ipsilateral side, GSH were significantly lower and MDA were higher than in groups 1 and 3, though GSH and MDA were not statistically different between groups 1 and 3. On the other hand, GPx in the control testicles of group 3 was significantly lower compared to those in the counterparts of both groups 1 and 2. Among three groups, GR determined in both testicles were not statistically different. On the ipsilateral side, MJS in group 3 were lower than in the sham group, but significantly higher than in group 2. CONCLUSIONS: According to this study, TMZ has an antioxidant effect on testicular torsion-detorsion injury, though the protective effect of TMZ seems to decrease in control testicles. Consequently it has been considered that TMZ can be only used in torsion patients with a healthy contralateral testicle after further studies have been conducted.     

The effects of blood pressure lowering on P-wave dispersion in patients with hypertensive crisis in emergency setting

Hypertensive emergency refers to a severe hypertension (HT) that is associated with new or progressive end-organ damage. In these clinical situations, blood pressure (BP) should be reduced immediately to prevent or minimize organ dysfunction. The present study evaluated the diagnostic value of two electrocardiographic indices in detecting patients, who are at risk for paroxysmal atrial fibrillation (PAF), in the setting hypertensive crisis. The study population consisted of 30 consecutive patients aged ≥40 years, who were admitted to the emergency room with hypertensive crisis. Electrocardiographic (ECG) recordings of the patients were performed before and after the treatment. The minimum (Pmin) and maximum (Pmax) P wave duration on ECG, and P-wave dispersion (P(d)), which was defined as the difference between Pmin and Pmax, were measured. The mean P(d) was 118.0 ± 32.1 and 94.0 ± 44.3 before and after the treatment, respectively. The decrease observed in the mean P(d) was statistically significant (p = 0.005). The mean Pmax was 214.7 ± 37.1 before the treatment, while it was 194.0 ± 47.3 after the treatment, and the difference was significant (p = 0.021). The mean Pmin was 96.7 ± 26.3 and 100.0 ± 41.0 before and after the treatment, respectively; however, the difference was not significant (p = 0.624). Pmax and P(d) display significant changes with acute treatment of HT. There is a need for larger prospective studies to clearly elucidate the diagnostic value of ECG indices, Pmax and P(d) as indicators of future PAF.     

Comparison of Plateletpheresis on the Fenwal Amicus and Fresenius Com.Tec Cell Separators

Summary

Background

A variety of apheresis devices are now available on the market for plateletapheresis. We compared two apheresis instruments (Fenwal Amicus and Fresenius COM.TEC) with regard to processing time, platelet (PLT) yield and efficiency, and white blood cell (WBC) content.

Material and Methods

Donors undergoing plateletpheresis were randomly separated into two groups (either the Amicus or the COM.TEC cell separator).

Results

In the pre-apheresis setting, 32 plateletpheresis procedures performed with each instrument revealed no significant differences in donors’ sex, age, weight, height and total blood volume between the two groups. However, the pre-apheresis PLT count was higher with the COM.TEC than with the Amicus (198 × 10³/μl vs. 223 × 10³/μl; p = 0.035). The blood volume processed to reach a target PLT yield of ≥3.3 × 10¹¹ was higher in the COM.TEC compared to the Amicus (3,481 vs. 2,850 ml; p < 0.001). The median separation time was also significantly longer in the COM.TEC than in the Amicus (61 vs. 44 min; p < 0.001). 91 and 88% of the PLT products collected with the Amicus and the COM.TEC, respectively, had a PLT count of >3.3 × 10¹¹ (p = 0.325). All products obtained with both instruments had WBC counts lower than 5 ↔ 10⁶, as required. There was no statistical difference with regard to collection efficiency between the devices (55 ± 15 vs. 57 ± 15%; p = 0.477). However, the collection rate was significantly higher with the Amicus compared to the COM.TEC instrument (0.077 ± 0.012 × 10¹¹ vs. 0.057 ± 0.008 × 10¹¹ PLT/min; p < 0.001).

Conclusion

Both instruments collected platelets efficiently. Additionally, consistent leukoreduction was obtained with both instruments; however, compared with the COM.TEC instrument, the Amicus reached the PLT target yield more quickly.Key Words: Plateletpheresis, Apheresis, Amicus, COM.TEC, Cell separator     

The prevalence of carotid artery calcification on the panoramic radiographs of end-stage renal disease patients with peritoneal dialysis: do incidental findings provide life-saving information?

This study investigated the presence of carotid artery calcifications (CACs) on panoramic radiographs (PRs) in end-stage renal disease (ESRD) patients treated with peritoneal dialysis (PD), and analysed the relationship between CAC prevalence and PD duration. A random sample of 110 PRs were collected from ESRD patients (15 with questionable CACs were subsequently excluded). CACs were found in 26 (27.4%) patients; 10 males (23.3% of all males) and 16 females (30.8% of all females). The overall mean PD period was 4.0 +/- 3.2 years. There was a significant difference in PD period between patients with and without CACs (5.3 +/- 3.1 years versus 3.5 +/- 3.1 years, respectively). To our knowledge, this study has the highest CAC prevalence, is the first to be carried out in ESRD patients being treated with PD and has the largest sample of ESRD patients (n = 95). We believe dentists should carefully evaluate patients' PRs for evidence of CACs, enabling these incidental findings to provide life-saving information.     

Esomeprazole in acute and maintenance treatment of reflux oesophagitis: a multicentre prospective study

INTRODUCTION: The aim of this study was to assess the efficacy and safety of esomeprazole 40 mg once daily (q.d.) in healing reflux oesophagitis at 4 and 8 weeks, and the efficacy of esomeprazole 20 mg q.d. for 12 weeks in the maintenance of remission. METHODS: A total of 235 patients with endoscopically proven reflux oesophagitis were enrolled in this study, which consisted of two phases (healing and maintenance therapy). Patients who showed complete endoscopic and symptomatic healing at the end of 4 or 8 weeks were switched to maintenance treatment with esomeprazole 20 mg q.d. for 12 weeks. The primary efficacy endpoint was healing of reflux oesophagitis at week 8. Secondary assessments included the proportion of patients with symptomatic relapse in the maintenance phase. RESULTS: At the end of week 8, 88% (95% life-table confidence intervals [CI]: 84%, 92%) of patients were healed endoscopically and 90.6% of the patients were asymptomatic. Patient age, gender and Helicobacter pylori status had no effect on the efficacy of treatment. During the 12-week maintenance treatment phase, symptomatic relapse ratios were 0.5%, 2.2%, and 0%, for the first, second, and third 4-week periods, respectively. The proportions of patients satisfied with treatment were 95% and 99.4% at the end of acute and maintenance treatment, respectively. The most common adverse effects were headache, upper respiratory tract infection and abdominal pain. CONCLUSIONS: Esomeprazole is effective in the healing of reflux oesophagitis, the resolution of heartburn, and in maintaining symptomatic remission. The effectiveness of esomeprazole in patients with gastroesophageal reflux disease is not affected by the presence of H. pylori.