Transthoracic Doppler echocardiographic coronary flow imaging in identification of left anterior descending coronary artery stenosis in patients with left bundle branch block

Background: Conventional noninvasive methods have well‐known limitations for the detection of coronary artery disease (CAD) in patients with left bundle branch block (LBBB). However, advancements in Doppler echocardiography permit transthoracic imaging of coronary flow velocities (CFV) and measurement of coronary flow reserve (CFR). Our aim was to evaluate the diagnostic value of transthoracic CFR measurements for detection of significant left anterior descending (LAD) stenosis in patients with LBBB and compare it to that of myocardial perfusion scintigraphy (MPS). Methods: Simultaneous transthoracic CFR measurements and MPS were analyzed in 44 consecutive patients with suspected CAD and permanent LBBB. Typical diastolic predominant phasic CFV Doppler spectra of distal LAD were obtained at rest and during a two‐step (0.56–0.84 mg/kg) dipyridamole infusion protocol. CFR was defined as the ratio of peak hyperemic velocities to the baseline values. A reversible perfusion defect at LAD territory was accepted as a positive scintigraphy finding for significant LAD stenosis. A coronary angiography was performed within 5 days of the CFR studies. Results: The hyperemic diastolic peak velocity (44 ± 9 cm/sec vs 62 ± 2 cm/sec; P=0.01) and diastolic CFR (1.38 ± 0.17 vs 1.93 ± 0.3; P=0.001) were significantly lower in patients with LAD stenosis compared to those without LAD stenosis. The diastolic CFR values of <1.6 yielded a sensitivity of 100% and a specificity of 94% in the identification of significant LAD stenosis. In comparison, MPS detected LAD stenosis with a sensitivity of 100% and a specificity of 29%. Conclusions: CFR measurement by transthoracic Doppler echocardiography is an accurate method that may improve noninvasive identification of LAD stenosis in patients with LBBB.     

Spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis.

BACKGROUND: Autoimmune pancreatitis is an evolving entity. METHODS: A patient who had spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis is presented. RESULTS: A 58-year-old diabetic woman with jaundice was referred for pancreatic head carcinoma diagnosed by magnetic resonance imaging (MRI). At laparotomy, a pancreatic head mass (4 x 3 cm) that involved the transverse mesocolon and two other hard masses (1 cm) in the pancreatic body and tail were found. The gallbladder was palpated as a hard tumor mass. Frozen section examination of the gallbladder and pancreatic biopsies revealed cholecystitis and pancreatitis with lymphoplasmacytic infiltration. The common bile duct was brittle and unsuitable for anastomosis. Starting 1 month after the operation, drainage from the biliary catheter decreased gradually and stopped. There was no parenchymal lesion on MRI examination in the 2nd postoperative month. Cholangiography from the percutaneous catheter showed flow of contrast agent into the duodenum. Serum immunoglobulin G, G4 and E levels were increased. CONCLUSION: To the best of our knowledge, this is the first report of spontaneous regression of a pancreatic head mass and biliary obstruction due to autoimmune pancreatitis.     

Simultaneous carotid endarterectomy and myocardial revascularization by using cardiopulmonary bypass for both procedures

OBJECTIVE: The optimal treatment of patients with co-existing occlusive coronary and carotid arterial disease is controversial. This study reports our experience with simultaneous carotid endarterectomy and coronary bypass in conjunction with cardiopulmonary bypass with mild hypothermia. METHODS AND RESULTS: From March 2001 to June 2004, 72 patients underwent simultaneous coronary bypass and carotid endarterectomy. Their mean age was 68.9 years and there were 56 men and 16 women. The indication for carotid endarterectomy was a lumen diameter reduction of more than 75% and/or the presence of ulcerated/unstable plaque. Carotid endarterectomy was done during cardiopulmonary bypass under mild hypothermia, haemodilution, systemic heparinization and controlled haemodynamics under pulsatile perfusion for additional cerebral protection. The mean cardiopulmonary bypass time was 64.7 minutes and aortic cross-clamp time 32.4 minutes, and the mean number of grafts per patient was 2.7. Four patients had perioperative neurological complications (5.5%) and two had permanent deficits (2.7%). The procedure-related mortality was 3 (4.1%). CONCLUSIONS: We suggest that combining coronary revascularization and carotid endarterectomy and performing both under cardiopulmonary bypass is safe, offering acceptable morbidity and mortality rates.     

Wet-spun graphene filaments: effect of temperature of coagulation bath and type of reducing agents on mechanical & electrical properties

Although many factors are considered to improve the properties of graphene filaments, there is no report in the existing literature on the effect of the temperature of the coagulation bath to the mechanical properties of graphene oxide filaments obtained in the wet-spinning process and also to the mechanical and electrical properties of the resulting graphene filaments after reduction. In this study, the effect of the temperature of the isopropanol coagulation bath during wet-spinning of graphene filaments on their final properties after formation was investigated and it was found that the decrease of the coagulation bath temperature resulted in more compact filaments having better mechanical properties for both graphene oxide and corresponding reduced graphene filaments. The best tensile strength and Young''s modulus values were obtained in isopropanol coagulation bath which was kept at 15 °C. On the other hand, the types of the chemical reduction agents which can provide better electrical conductivity to graphene filaments after reduction were also investigated and it was determined that the use of hydriodic acid/acetic acid mixture resulted in graphene filaments having the best electrical conductivity (1.28 × 10⁴ S m⁻¹) and also tensile strength (234 ± 26 MPa) values. The addition of acetic acid into hydriodic acid increased the tensile strength 26% when compared with the plain HI treatment. Both electrical conductivity and tensile strength results were higher than most of the previously reported values of the wet-spun neat graphene filaments in the literature.

Cold isopropanol coagulation bath and use of acetic acid/hydriodic acid reduction resulted in better tensile strength for wet-spun graphene filaments.     

Predictors of false negative diffusion-weighted MRI in clinically suspected central cause of vertigo

Introduction

Vertigo is classified as peripheral and central. Differentiation of stroke mimics is the most important diagnostic challenge. There is no clinical guidance for the indications of neuroimaging in isolated vertigo patients. The primary aim of this study is to test the diagnostic value of a DWI-MRI protocol to rule-out a central cause in patients with acute isolated vertigo in the ED.

Adhesive capsulitis: contrast-enhanced shoulder MRI findings

Purpose: Evaluation of contrast‐enhanced magnetic resonance imaging (CE‐MRI) findings in cases clinically diagnosed as adhesive capsulitis (AC). Methods: CE‐MRI images of 12 cases diagnosed as AC (13 shoulder joints) and nine control cases were retrospectively evaluated. AC diagnosis was established based on the history and clinical symptoms. MR signal intensity changes in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules were analysed with regard to the presence of abnormal soft tissue and contrast enhancement. Capsular and synovial thickening were measured in the axillary recess and rotator interval on coronal oblique CE T1‐weighted images. Patient and control groups were compared by Fisher's exact and McNemar tests in terms of signal intensity changes and contrast enhancement in the described areas. Results: Comparison of the group with AC and the control group regarding intensity changes showed a statistically significant difference in the axillary pouch (P < 0.001). No significant difference was found in the rotator interval, biceps anchor and anterior–posterior capsules (P > 0.05). Comparison of AC and control groups in terms of contrast enhancement revealed statistically significant differences in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules (P < 0.001). A significant difference was determined between the AC and control groups with regard to thickening in axillary pouch and rotator interval (P < 0.001). Conclusion: CE studies are useful for diagnosis of AC as it demonstrates thickening of specific soft‐tissue areas like joint capsule and synovium.     

AA type renal amyloidosis secondary to FMF: a long-term follow-up in two patients

Renal amyloidosis, which leads to renal failure, is the most important long-term complication of familial Mediterranean fever (FMF). Resolution of nephrotic syndrome secondary to amyloidosis in FMF following colchicine treatment has rarely been reported. We describe two patients with FMF and nephrotic syndrome. These patients were treated with colchicine 1.5 mg/day and had a complete remission of nephrotic syndrome with a stable clinical course over 30 years. To our knowledge, our patients have the longest follow-up time without proteinuria.     

Soluble cytokeratin 18 biomarkers may provide information on the type of cell death during early ischemia and reperfusion periods of liver transplantation

Ulukaya S, Ulukaya E, Alper I, Yilmaztepe‐Oral A, Kilic M. Soluble cytokeratin 18 biomarkers may provide information of the type of cell death during early ischemia and reperfusion periods of liver transplantation.
Clin Transplant 2010: 24: 848–854. © 2009 John Wiley & Sons A/S. Abstract: Hepatocellular damage takes place as a result of ischemia and reperfusion during liver transplantation (LT). To discriminate the type of cell death and quantitate its severity may provide new insights into the mechanisms of hepatocellular damage. Therefore, we investigated the type of cell death by ELISA‐based assays in patient sera. Apoptosis was specifically assessed by measuring a novel soluble biomarker, the caspase‐cleaved cytokeratin 18, while total cell death (apoptosis and necrosis) by cytokeratin 18 released from dead (necrotic and apoptotic) cells. Twenty‐seven live (LDLT) and 14 deceased (DDLT) donor liver transplantations were analyzed before the operation, at the anhepatic stage, first, sixth and 24th hour after the reperfusion. Both apoptosis and total cell death have successfully been demonstrated although they have not been confirmed by the liver biopsy that is impossible to perform in this setting. Apoptosis was not induced in LDLT. Total cell death (primarily necrosis) only transiently appeared the first hour after the reperfusion in LDLT, while it sharply increased the first hour after the reperfusion and maintained its level in DDLT. Soluble cytokeratin 18 biomarkers seem to be useful to discriminate and quantitate the type of cell death during early ischemia and reperfusion periods of LT.     

A Case Report of Thrombocytopenia-associated Multiple Organ Failure Secondary to Salmonella enterica Serotype Typhi Infection in a Pediatric Patient: Successful Treatment With Plasma Exchange

A high proportion of the patients with Salmonella enterica serotype Typhi infection develop severe sepsis. The mortality rate is high despite aggressive antimicrobial therapy in these patients. The case of a 10-year-old boy who developed thrombocytopenia-associated multiple organ failure (TAMOF) secondary to S. typhi infection is reported. The patient did not respond to antimicrobial treatment, including ciprofloxacin, in addition to conventional supportive measures, so plasma exchange was performed. The thrombocytopenia and organ failure had resolved after 3 days of plasma exchange therapy. Plasma exchange is suggested to be a life-saving intervention in a child with TAMOF secondary to S. typhi infection.