Calcified atrial thrombus: complication of central venous hyperalimentation

Two years and eight months after having had hyperalimentation during an infection, a 4-year-old boy was readmitted to the hospital with a viral syndrome. A chest X-ray film showed calcification over the right heart. After treatment of the viral problem, the boy was readmitted for evaluation of the calcifications. Percutaneous angiography demonstrated right atrial filling defects in the areas of calcification. The inferior vena caval pressures were normal. An echocardiogram showed a normal left atrium and mitral valve but did not reveal the masses within the right atrium. An electrocardiogram showed mild right ventricular hypertrophy. The patient subsequently underwent resection of 75% of the right atrial wall, which was involved with the growth, and this was reconstructed by using pericardium. The final pathological report described marked endocardial fibrosis infiltrated by chronic inflammatory cells consistent with organized mural thrombus. This case represents a complication of central venous catheterization secondary to traumatization of the endocardium by constant action of the heart against an indwelling catheter.     

Effects of bacterial vaginosis and other genital infections on the natural history of human papillomavirus infection in HIV-1-infected and high-risk HIV-1-uninfected women

BACKGROUND: Whether the natural history of human papillomavirus (HPV) infection is affected by bacterial vaginosis (BV) or Trichomonas vaginalis (TV) infection has not been adequately investigated in prospective studies. METHODS: Human immunodeficiency virus 1 (HIV-1)-infected (n=1763) and high-risk HIV-1-uninfected (n=493) women were assessed semiannually for BV (by Nugent's criteria), TV infection (by wet mount), type-specific HPV (by polymerase chain reaction with MY09/MY11/HMB01 HPV primers), and squamous intraepithelial lesions (SIL) (by cytological examination). Sexual history was obtained from patient report at each visit. Risk factors for prevalent and incident HPV infection and SIL were evaluated by use of multivariate models. RESULTS: BV was associated with both prevalent and incident HPV infection but not with duration of HPV infection or incidence of SIL. TV infection was associated with incident HPV infection and with decreased duration and lower prevalence of HPV infection. TV infection had no association with development of SIL. Effects of BV and TV infection were similar in HIV-1-infected and high-risk HIV-1-uninfected women. HIV-1 infection and low CD4(+) lymphocyte count were strongly associated with HPV infection and development of SIL. CONCLUSIONS: BV and TV infection may increase the risk of acquisition (or reactivation) of HPV infection, as is consistent with hypotheses that the local cervicovaginal milieu plays a role in susceptibility to HPV infection. The finding that BV did not affect persistence of HPV infection and that TV infection may shorten the duration of HPV infection helps explain the lack of effect that BV and TV infection have on development of SIL.     

Non-photoperiodic regulation of reproductive physiology in the flexibly breeding pine siskin (Spinus pinus)

Salivary cortisol has been recently used to assess welfare of captive and free-ranging animals. However, rhythms of cortisol secretion may vary annually and thus, it is necessary to take into account these rhythms when evaluating the physiological significance of fluctuations of this hormone throughout the year as stress indicator in animals. Here, we analyze monthly differences in cortisol secretion in Asian elephants (Elephas maximus) during a year. Saliva samples of eight adult female Asian elephants were collected and analyzed using Radioimmunoassay. Results revealed an overall seasonal pattern of salivary cortisol secretion and significant differences in cortisol concentration among months were found. Overall, the highest cortisol levels were recorded in October, and then decreased until reaching the lowest concentration in April. However, some individual variations were found respect this annual overall trend. The occurrence of this annual pattern of cortisol secretion should be taken into account when using cortisol as a tool to assess animal welfare in captive animal at zoological parks, as well as it opens new questions to further analyze this pattern and its variations, as well as the endogenous mechanisms controlling it.     

Postprandial lipoprotein metabolism in familial hypercholesterolemia: thinking outside the box

Familial hypercholesterolemia (FH) is a dominantly inherited disorder principally due to mutations in the low-density lipoprotein (LDL) receptor that classically cause markedly elevated plasma LDL cholesterol concentrations and premature coronary heart disease (CHD). However, elevated plasma LDL cholesterol alone does not fully account for the increase or variation in risk of CHD. We propose a hypothetical model for the role of postprandial dyslipoproteinemia based on the overproduction and decreased catabolism of triglyceride-rich lipoproteins, which may be a consequence of LDL receptor deficiency. Expression of postprandial dyslipoproteinemia in FH may also depend on the type of pathogenic gene variants and on coexistent conditions, particularly obesity and insulin resistance. Further research is required to investigate our model proposed and to test whether treating postprandial dyslipoproteinemia decreases CHD risk in FH incremental to standard therapy.     

One-Month Serotonin Infusion Results in a Prolonged Fall in Blood Pressure in the Deoxycorticosterone Acetate (DOCA) Salt Hypertensive Rat

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A cost savings approach to SPRED1 mutational analysis in individuals at risk for neurofibromatosis type 1

Neurofibromatosis type 1 (NF1) is a clinically diagnosed autosomal dominant disorder requiring routine clinical management, particularly during the pediatric years. An overlapping disorder, Legius syndrome, at times is clinically indistinguishable from NF1 and results in a small percentage of individuals being mischaracterized. Distinguishing these two entities is increasingly important for prognosis, reproductive planning, and clinical management. The goal of our study was to evaluate the cost impact of genetic testing for patients with solely pigmentary findings. The costs of genetic testing in patients aged 1.5–18 years were modeled using a simulated population, assuming the clinical management approach of a single NF1 clinic. Two genetic testing algorithms (SPRED1 testing alone, and NF1 mutation analysis with reflex to SPRED1) were compared against a baseline of no genetic testing. The cost for SPRED1 mutation analysis for each individual meeting NF1 diagnostic criteria without neoplastic or boney manifestation, when compared to the no‐testing approach with routine follow‐up mutations between the ages of 10 and 14 years, was minimal (range of $4–$16). Based on the clinical practice of one NF1 clinic, we found that the cost difference to perform SPRED1 mutation analysis on individuals who meet diagnostic criteria for NF1 without neoplastic or boney manifestation were minimal. Therefore it is important that “when to test decisions” remain a physician/patient discussion, as individual benefits may be greatest at a different age than when it is most cost efficient. © 2013 Wiley Periodicals, Inc.