Paradoxical and pulmonary embolism due to a thrombus entrapped in a patent foramen ovale

A 70-year-old woman, with a history of recent thromboembolic stroke, was admitted to our hospital because of sudden dyspnea due to pulmonary thromboembolism. Transthoracic echocardiography revealed a tubular thrombus entrapped in a patent foramen ovale. Transesophageal echocardiography confirmed this finding and also revealed an atrial septal aneurysm. Because her cerebral status contraindicated surgical intervention, medical therapy with heparin and warfarin was started. Follow-up transthoracic echocardiography, performed 3 weeks after the initiation of therapy, revealed complete resolution of the thrombus. Medical therapy can be an alternative to surgical therapy in high-risk patients who have entrapped thrombi.     

Stent implantation to the stenosed right coronary artery in a patient whose right and left coronary arteries originate from a single ostium in the right sinus of Valsalva

The authors report a rare case of a patient who had anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva. The stenosed right coronary artery was successfully dilated with stent implantation.     

Immunocytochemical detection of milk proteins in tracheal aspirates of ventilated infants: a pilot study

In this study, we evaluated immunocytochemical staining for milk proteins (alpha-lactalbumin and beta-lactoglobulin) in tracheal aspirates of mechanically ventilated infants, and assessed whether this staining technique supported a clinical diagnosis of aspiration in infants receiving orogastric feedings. All newborns requiring mechanical ventilation in the neonatal intensive care unit of a major tertiary care hospital were potential subjects for this study. Tracheal aspirates were obtained prior to the introduction of enteral feeding and at various time points thereafter in newborns requiring mechanical ventilation. Cells were obtained and processed for immunocytochemical staining of alpha-lactalbumin and beta-lactoglobulin. In total, 88 specimens recovered from 34 infants were adequate for staining. Alveolar macrophages recovered from most of the infants who were never fed (true negative controls) did not display immunoreactivity for milk proteins: 4/34 or 12% of infants' aspirates demonstrated presence of milk proteins before enteral feeding was commenced. Tracheal aspirates obtained from 12 infants after introduction of enteral feedings appeared to support clinical and radiological findings suggestive of aspiration events, with positive immunostaining on several occasions. These observations support our work in a murine model and demonstrate that immunocytochemical staining of tracheal aspirates for milk proteins may enhance the ability to diagnose pulmonary aspiration. Further studies are needed to define the clinical significance of our findings and the effects of single and repeated aspiration events on respiratory status.     

Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk type 2 diabetic patients who insist on fasting in Ramadan

Aim of this prospective study is to evaluate the effect of repaglinide t.i.d. (three times a day) plus single-dose insulin glargine regimen in low-risk type 2 diabetic patients during Ramadan fasting. Participants had been taking the regimen for at least 3 months. Patients with a history of diabetic coma, severe hypoglycemic crisis or repeating attacks of hypoglycemia were excluded. Hypoglycemic unawareness, kidney or liver disease or HbA1c over 8% were also accepted as exclusion criteria. Eleven patients who insisted on this worship and eight non-fasting cases were involved. All were told to make home-glucose-monitorisation weekly and report any hypoglycemic event throughout Ramadan. Fasting blood glucose (FBG), post-prandial blood glucose (PBG) and fructosamine levels, body weights and blood pressures were recorded just before and after Ramadan. Seven patients in each group concluded the follow-up. Any significant change was detected in the parameters in either groups (P>0.05). Glucose control remained unchanged; fructosamine 318.14+/-65.38 versus 317.28+/-52.80 mmol/L in fasting group, 290.71+/-38.48 versus 290+/-38.56 mmol/L in non-fasting group. None of them exhibited either a major or a minor hypoglycemic event. The results of this pilot study indicated that repaglinide t.i.d. plus single-dose insulin glargine regimen was safe for low-risk type 2 diabetic patients who insisted on fasting during Ramadan.     

Unusual elongation of the Eustachian valve

We report a patient with a snake-shaped, mobile mass in the right atrium. The mass was determined to be an elongated Eustachian valve which was a persistent part of the embryologic valve of the sinus venosus.     

Modification of Surface and Subsurface Properties of AA1050 Alloy by Shot Peening

AA1050 Al alloy samples were shot-peened using stainless-steel shots at shot peening (SP) pressures of 0.1 and 0.5 MPa and surface cover rates of 100% and 1000% using a custom-designed SP system. The hardness of shot-peened samples was around twice that of unpeened samples. Hardness increased with peening pressure, whereas the higher cover rate did not lead to hardness improvement. Micro-crack formation and embedment of shots occurred by SP, while average surface roughness increased up to 9 µm at the higher peening pressure and cover rate, indicating surface deterioration. The areal coverage of the embedded shots ranged from 1% to 5% depending on the peening parameters, and the number and the mean size of the embedded shots increased at the higher SP pressure and cover rate. As evidenced and discussed through the surface and cross-sectional SEM images, the main deformation mechanisms during SP were schematically described as crater formation, folding, micro-crack formation, and material removal. Overall, shot-peened samples demonstrated improved mechanical properties, whereas sample surface integrity only deteriorated notably during SP at the higher pressure, suggesting that selecting optimal peening parameters is key to the safe use of SP. The implemented methodology can be used to modify similar soft alloys within confined compromises in surface features.     

Increased P wave dispersion: a new finding in patients with syndrome X

The present clinical study was undertaken in patients with syndrome X, namely angina with normal coronary arteries, to investigate the presence of increased P wave dispersion by comparing patients with coronary artery disease (CAD) and healthy control subjects. Three groups were studied - group A, 21 patients (48 6 years) with syndrome X; group B, 16 patients (56 9 years) with CAD; and group C, 16 healthy subjects (49 8 years). Patients with CAD were older than those in groups A and C (P=0.005 and P=0.035, respectively). All groups demonstrated similar PQ, QRS and RR intervals. Group B had a lower minimum P wave duration than group C (P=0.05). P wave dispersion in group A was found to be higher than that in groups B and C (P=0.018 and P=0.0001, respectively). Patients with syndrome X demonstrated increased P wave dispersion compared to patients with CAD and healthy subjects. High sympathetic tone or autonomic imbalance observed in patients with syndrome X may affect intra-atrial and interatrial conduction times, and leave them prone to develop atrial arrhythmias.     

Serum concentrations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 in patients with chronic hepatitis

BACKGROUND: Insulin-like growth factor-I is a liver-derived humoral factor, which has important anabolic and metabolic actions and is predominantly bound by insulin-like growth factor binding protein-3. Low serum concentrations of both insulin-like growth factor-I and insulin-like growth factor binding protein-3 have been reported in patients with chronic liver disease, especially cirrhosis, but their conditions in chronic hepatitis are uncertain. The aim of this study was to evaluate the effect of chronic hepatitis on serum concentrations of insulin-like growth factor-I and insulin-like growth factor binding protein-3 and their association with hepatic inflammation activity and fibrosis. METHODS: Serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 were measured by RIA (ng/ml) in 17 patients with mild to severe chronic viral hepatitis (12 chronic hepatitis C, 5 chronic hepatitis B) and 16 healthy subjects. The hepatic inflammation activity and the severity of fibrosis were evaluated using Desmet classification. RESULTS: Both insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels did not correlate with inflammation activity, fibrosis or transaminase levels. In the chronic hepatitis group, insulin-like growth factor-I levels were significantly higher than the control group (mean, 263.8 +/- 27.33 versus 127.14 +/- 10.83 ng/ml, P < 0.001, respectively), whereas insulin-like growth factor binding protein-3 levels were significantly lower when compared with the controls (1643.47 +/- 60.68 versus 2728.87 +/- 284.61 ng/ml, P < 0.05, respectively). CONCLUSIONS: These results suggest that the concomitant states of serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels in patients with chronic hepatitis may be different from cirrhotic patients and high serum IGF-I levels may be a specific finding of the stage of chronic hepatitis before developing cirrhosis.     

Distribution of sexual and asexual Ostracoda (Crustacea) from different altitudinal ranges in the Ordu region of Turkey: testing the Rapoport Rule

We evaluated Rapoport's rule which states a negative correlation between species richness and altitude. To understand the relationship between altitude and reproductive modes (a/sexual) of non-marine ostracods, 166 aquatic bodies in Ordu region, Turkey were randomly sampled from July 11 to July 16, 2010. A total of 26 species of ostracods were found from 133 out of 166 sites. Except for one species (Heterocypris incongruens), the other 25 species were new reports for the region. Candona improvisa was also a new report for Turkish ostracod fauna. Three species (Psychrodromus olivaceus, H. incongruens, and C. neglecta) occurred most frequently as 43, 46, and 76 times, respectively. Canonical correspondence analyses exhibited two variables [Habitat type (p=0.014; F=2.171) and water temperature (p=0.018; F=2.248)] as having the most effect on species. Correlation of species' reproductive modes to those of environmental variables measured was not significant. UPGMA dendrogram displayed 15 most frequently occurring species into four clusters where most species (11) were asexual. Although a small group (asexual species without swimming setae) showed a tendency to habitat type and electrical conductivity, such variables are believed to play secondary role on species distribution. Highest species diversity (13 species) was observed at the range of 1200 and 1400?m (a.s.l.), where numbers of stations sampled was not the highest (22). Numbers of asexual species (19) were higher than the sexual (11) but there were no significant differences (p>0.05) between the frequencies of their occurrences at different altitudinal ranges. Accordingly, our findings do not support the Rapoport Rule. Results yield that reproductive modes of species (sexual and asexual) was not directly correlated to altitude or any environmental variables measured during this study. A better explanation of ostracod diversity appears to be suitability of habitats.