Aortic dissection - a rare complication of primary aldosteronism - a case report

Primary aldosteronism is common cause of secondary hypertension. As a result of high blood pressure it can lead to severe complications, including aortic dissection. We would like to present a case of 40 year-old patient who had resistant hypertension despite administration of multiple drugs. During diagnosis primary aldosteronism was found, complicated by aortic dissection. After introducing the appropriate treatment we managed to significantly reduce the cardiovascular risk.     

Thrombosis within the area of muscle bridge as a cause of myocardial infarction

Muscle bridge with concomitant sclerotic lesions may cause myocardial infarction (MI). We present a case of 70 year-old woman, who suffered from MI due to sclerotic lesion located within the anterior descending artery, right above the muscle bridge. Implanting two drug eluting stents resulted in restoration of proper flow through the vessel, widening the sclerotic lesion and the area of muscle bridge.     

Complex profile of the reflex diving response

Breath-holding coupled with face cooling triggers a set of the reflex cardiovascular responses, defined as a diving reflex. The major reflex responses include a decrease in heart rate and peripheral vasoconstriction with an increase of arterial pressure to evoke central blood pooling with preferential provision of the brain and heart perfusion. Due to high individual variability and situational dependence the individual course of the reflex response is hardly predictable. Heart rhythm disturbances are the major, sometimes fatal complications of the response. This review is an outline of causing factors, circumstances, mechanisms and the effects of the diving reflex and their practical implications, including risk factors of the critical arrhythmias occurred in diving.     

Optimizing analysis, visualization, and navigation of large image data sets: one 5000-section CT scan can ruin your whole day

The technology revolution in image acquisition, instrumentation, and methods has resulted in vast data sets that far outstrip the human observers' ability to view, digest, and interpret modern medical images by using traditional methods. This may require a paradigm shift in the radiologic interpretation process. As human observers, radiologists must search for, detect, and interpret targets. Potential interventions should be based on an understanding of human perceptual and attentional abilities and limitations. New technologies and tools already in use in other fields can be adapted to the health care environment to improve medical image analysis, visualization, and navigation through large data sets. This historical psychophysical and technical review touches on a broad range of disciplines but focuses mainly on the analysis, visualization, and navigation of image data performed during the interpretive process. Advanced postprocessing, including three-dimensional image display, multimodality image fusion, quantitative measures, and incorporation of innovative human-machine interfaces, will likely be the future. Successful new paradigms will integrate image and nonimage data, incorporate workflow considerations, and be informed by evidence-based practices. This overview is meant to heighten the awareness of the complexities and limitations of how radiologists interact with images, particularly the large image sets generated today. Also addressed is how human-machine interface and informatics technologies could combine to transform the interpretation process in the future to achieve safer and better quality care for patients and a more efficient and effective work environment for radiologists. Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11091276/-/DC1.     

Comparison of the effectiveness of compression stockings and layer compression systems in venous ulceration treatment

Introduction

The aim of the research was to compare the dynamics of venous ulcer healing when treated with the use of compression stockings as well as original two- and four-layer bandage systems.

Material and methods

A group of 46 patients suffering from venous ulcers was studied. This group consisted of 36 (78.3%) women and 10 (21.70%) men aged between 41 and 88 years (the average age was 66.6 years and the median was 67). Patients were randomized into three groups, for treatment with the ProGuide two-layer system, Profore four-layer compression, and with the use of compression stockings class II. In the case of multi-layer compression, compression ensuring 40 mmHg blood pressure at ankle level was used.

Results

In all patients, independently of the type of compression therapy, a few significant statistical changes of ulceration area in time were observed (Student’s t test for matched pairs, p < 0.05). The largest loss of ulceration area in each of the successive measurements was observed in patients treated with the four-layer system – on average 0.63 cm2/per week. The smallest loss of ulceration area was observed in patients using compression stockings – on average 0.44 cm²/per week. However, the observed differences were not statistically significant (Kruskal-Wallis test H = 4.45, p > 0.05).

Conclusions

A systematic compression therapy, applied with preliminary blood pressure of 40 mmHg, is an effective method of conservative treatment of venous ulcers. Compression stockings and prepared systems of multi-layer compression were characterized by similar clinical effectiveness.     

Are accessory breasts a potential cause of diagnostic mistakes? Discussion based on case report

The patient was admitted to the oncology clinic due to the presence of a 3 x 4 cm large tumor in the right axillary region. As the lesion resembled a lipoma, it was surgically excised under general anaesthesia. Histopathologic examination described only physiological breast adenomatous tissue. Accessory breasts usually occur along the 'milk line' which develops in the 6th week of intrauterine life and it extends on the anterior aspect of the body, from the axillary fossa to the groin. Accessory breasts achieve different sizes. They are relatively common in human population (2-6%). In most cases accessory breasts are asymptomatic and cause nothing more than a visible distention which may resemble a tumor. Surgical excision is the treatment of choice due to the risk of development of the same pathological changes as in the normal breast. Histopathologic examination is ubiquitous to ascertain the definite diagnosis.     

Disseminated peritoneal leiomyomatosis coexisting with leiomyoma of the uterine body

The authors present an extremely rare case of disseminated peritoneal leiomyomatosis (DPL) coexisting with leiomyoma of the uterine body in a 32-year-old woman. The patient had undergone a caesarean section 12 years ago and used oral contraceptives since then. Before the present surgery leiomyoma of the left corner of the uterine body was diagnosed. DPL was found on the uterine serous membrane, Douglas’s cavity, vesicouterine recess, the great omentum and abdominal peritoneum. There were no DPL nodules on the surface of the liver, kidneys and bowels. Saving operation was performed and only leiomyoma and the great omentum were resected. Immunohistochemical analysis using smooth muscle actin and HHF-35 antibodies showed the same reactivity of leiomyoma and DPL cells and proved the intra-operative diagnosis. Our case corroborates that DPL may occur in women of reproductive age and in patients who use oral contraceptives over a long span of time. That both leiomyoma and DPL are hormonally dependent could also be proved.     

Ethylenediaminetetraacetic acid affects subcellular expression of clusterin protein in human colon adenocarcinoma COLO 205 cell line

The aim of our study was to determine the expression of various isoforms of clusterin and to evaluate how etoposide or calcium chelators [ethylenediaminetetraacetic acid and (2-aminoethoxyethane)-N,N,N',N'-tetraacetic acid] affect the subcellular expressions of the 50-kDa isoform of clusterin protein in colon adenocarcinoma COLO 205 cells. We then determined how the cytoplasmic vs. nuclear expression of the 50-kDa isoform of clusterin correlates with the viability of COLO 205 cells. To identify the clusterin isoforms, and its nuclear and cytoplasmic expression in COLO 205 cells, Western bloting was used. Cell viability was determined by the 3-(4,5-dimethylthiazol-2-yl)-2-5-diphenyltetrazolium bromide assay. Etoposide decreased the viability of COLO 205 cells with a concomitant increase in the 50-kDa clusterin concentration in the cell nucleus. Chelation of the extracellular calcium ions by (2-aminoethoxyethane)-N,N,N',N'-tetraacetic acid did not modulate the subcellular distribution of clusterin. The use of ethylenediaminetetraacetic acid, which reduces the intracellular and extracellular calcium levels, stimulated nuclear expression of clusterin protein and was accompanied by extensive cell death. Intracellular calcium determines cytoplasmic expression and antiapoptotic activity of the intracellular protein clusterin. The depletion of intracellular calcium leads to increased nuclear expression of the 50-kDa clusterin protein, which is accompanied by cell death. We concluded that there is at least one cell death-promoting pathway in COLO 205 cells that is dependent on intracellular calcium and nuclear localization of 50-kDa clusterin.