Intramyocardial hydatid cyst: a mistaken identity and its successful removal on a beating heart

Hydatid cyst of the heart is a rare but potentially fatal disease. There have been reports of the occurrence of such cysts, but we present here a unique experience of mistaken identity of a right ventricular intramyocardial hydatid cyst for a mediastinal hydatid cyst, leading to a dangerous intraoperative procedure.     

Evaluation of troponin T criteria for periprocedural myocardial infarction in patients with acute coronary syndromes

In patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI), the diagnosis of periprocedural myocardial infarction is often problematic when the pre-PCI levels of cardiac troponin T (TnT) are elevated. Thus, we examined different TnT criteria for periprocedural myocardial infarction when the pre-PCI TnT levels were elevated and also the associations between the post-PCI cardiac marker levels and outcomes. We established the relation between the post-PCI creatine kinase-MB (CKMB) and TnT levels in 582 patients (315 with acute coronary syndromes and 272 with stable coronary heart disease). A post-PCI increase in the CKMB levels to 14.7 μg/L (3 × the upper reference limit [URL] in men) corresponded to a TnT of 0.23 μg/L. In the 85 patients with acute coronary syndromes and normal CKMB, but elevated post peak TnT levels before PCI (performed at a median of 5 days, interquartile range 3 to 7), the post-PCI cardiac marker increases were as follows: 21 (24.7%) with a ≥ 20% increase in TnT, 10 (11.8%) with an CKMB level >3 × URL, and 12 (14%) with an absolute TnT increase of >0.09 μg/L (p <0.005 for both). In the patients with stable coronary heart disease and post-PCI cardiac markers > 3× URL compared to those without markers elevations, the rate of freedom from death or nonfatal myocardial infarction was 88% for those with TnT elevations versus 99% (p <0.001, log-rank) and 84% for those with CKMB elevations versus 98% (p <0.001, log-rank). Of the patients with acute coronary syndromes, the post-PCI marker levels did not influence the outcomes. In conclusion, in patients with acute coronary syndromes and elevated TnT levels undergoing PCI several days later, ≥20% increases in TnT were more common than absolute increments in the TnT or CKMB levels of >3× URL. Also, periprocedural cardiac marker elevations in patients with acute coronary syndromes did not have prognostic significance.     

Case report: Expansion of visceral leishmaniasis to the western hilly part of Nepal

We report the first case of visceral leishmaniasis (VL) from the non-endemic western hilly region of Nepal. The patient presented with a history of high-grade fever, abdominal distension, anemia, and weight loss. The case was confirmed as VL by microscopical detection of the Leishmania species amastigote in bone marrow aspiration and by a positive result for the rK39 test. The patient was treated with 0.5-1.0 mg/kg of Amphotericin B for 14 days (total of 405 mg), and amastigotes were negative on discharge. Five months later, this patient again developed fever, abdominal distension, and anemia. Clinical and hematological examinations suggested a relapse of VL. The patient was treated with 1 mg/kg of Amphotericin B for 18 days (total of 515 mg) and was clinically improved on discharge.     

Fas-FasL system in molar pregnancy

Citation Soni S, Rath G, Prasad CP, Salhan S, Jain AK, Saxena S. Fas–FasL system in molar pregnancy. Am J Reprod Immunol 2011; 65: 512–520 Problem Hydatidiform mole (molar pregnancy) is the commonest form of Gestational Trophoblastic Disease, with the risk of undergoing malignant transformation. The molecular pathway leading to pathogenesis and progression of molar pregnancy is barely understood. The study focuses on Fas/FasL system which represents one of the main apoptotic pathways controlling placental morphogenesis. Method of study Placental tissues from 52 patients with complete hydatidiform moles (CHMs) and 55 age‐matched controls were examined for Fas and FasL expression using immunohistochemistry, immunofluorescence and Western blotting. The protein expression was also correlated with trophoblast apoptosis (assessed by M30 Cyto DEATH), clinico‐pathological parameters and disease progression. Results Immunohistochemistry and immunofluorescence revealed both cytoplasmic and membranous expression of Fas in villous syncytiotrophoblast as well as cytotrophoblast but FasL was confined merely to the cytoplasm of syncytiotrophoblast. Both Fas (cytoplasm and membrane) and FasL were significantly upregulated in syncytiotrophoblast of CHMs (P = 0.004, P < 0.0001 and P < 0.0002 respectively) and showed a positive association between them (P = 0.019). However, none of the proteins reveal any correlation with M30 index. The results were revalidated using Western blotting. Conclusion This study demonstrated differential expression of Fas and FasL in CHMs and its implications in the pathogenesis of molar pregnancy has been discussed.     

In vitro evaluation of 45S5 Bioglass®-derived glass-ceramic scaffolds coated with carbon nanotubes

Highly porous (> 90% porosity) 45S5 Bioglass?-derived glass-ceramic scaffolds were fabricated by foam replication method, and coated with carbon nanotubes (CNT) (coating thickness: 1 μm) using electrophoretic deposition (EPD). In vitro cell culture using mesenchymal stem cells (MSCs) was carried out on both scaffold systems (with and without CNT coating) over a 4-week period. By using AlamarBlue?, BSA and alkaline phosphatase assays; the cell viability and differentiation were measured quantitatively measured and compared between the two scaffold types. The results showed that both scaffold systems are biocompatible with MSCs and they can support the cellular activity. No cytotoxic effects of CNT were observed under the conditions of the present experiments. Although a lower initial cell viability on the CNT-coated scaffolds was observed, no significant differences were found after 4 weeks of culture compared with the uncoated scaffolds. This work therefore shows that there is in principle no significant improvement of cellular responses by creating a CNT-coating on this type of highly bioactive scaffolds. However, the electrical conductivity introduced by the coating might have the potential to increase cell viability and differentiation when cell culture is carried out under the effect of electrical stimulation.     

The puzzle of choline and lipid peak on spectroscopy

Choline and lipid lactate peaks elevated in a number of intracranial space occupying lesions, in endemic area tuberculosis should be considered. Choline peak along with lipid lactate elevation is non-specific and can be seen in a number of other conditions like high-grade gliomas, Metastases, lymphomas and demyelinating disorders. We present a case of 45 year old gentle man known case chest tuberculosis on treatment default presenting with multiple intracranial lesions showing lipid–choline elevation.