Diagnostic value of two-dimensional echocardiography in cardiac hydatid disease

Echinococcal infection of the heart is rare. The preoperativefindings, with special attention to two-dimensional echocardiography(2DE), of six patients with cardiac echinococcosis and theirsurgical and pathological correlations are reported. Cardiachydatid cysts (HCs) were located in the cardiac apex in threepatients, in the upper part of the interventricular septum extendingtowards the anterior aspect of the heart in one and in the postero-superiorright atrial wall in another patient. The remaining patienthad multiple intrapericardial cysts. In three patients the cystspresented as well defined, rounded, echolucent masses withinthe myocardial wall bulging into the cardiac chambers. In twopatients, the cysts had ruptured into a cardiac chamber withloss of the characteristic ‘cystic’ appearance;these cysts presented as an echogenic or solid mass protrudinginto a cardiac chamber. Finally, another patient had one HCwith echolucent appearance and another HC in a different locationwith echogenic appearance; this last cyst corresponded to adegenerated HC. In two cases the cyst showed a loculated internalaspect. In one patient the myocardial segment involved by thecyst had a dyskinetic movement. In all six patients, 2DE accuratelydemonstrated the location and morphological details of the cardiaccysts, permitted recognition of the ruptured and/or degeneratedcysts and was superior to thoracic computed tomography and angiographyin the preoperative assessment of these patients. Nuclear magneticresonance imaging (one patient) gave no further informationto that obtained by 2DE. We conclude that 2DE is the techniqueof choice for an early diagnosis of this rare entity.     

Characterization of a Precocious New Lesion Distal to a Stent Site by Atherectomy

A 58-year-old woman presented with a new rapidly progressive lesion distal to a stent. This lesion was treated with atherectomy through the stem in order to characterize it pathologically. The aggressive proliferative response discovered suggested that this unusually distal lesion was produced by the trauma of her previous angioplasty .     

Transesophageal Doppler Analysis of Coronary Sinus Flow A New Method to Assess the Severity of Tricuspid Regurgitation

Background: Severe mitral regurgitation induces reversal of flow in the pulmonary veins. We hypothesized that severe tricuspid regurgitation may disrupt normal coronary sinus flow. The purpose of this study was to analyze the Doppler flow pattern of the coronary sinus and to determine its value in the assessment of the severity of tricuspid regurgitation. Methods: The coronary sinus flow was analyzed in 70 consecutive patients with some degree of tricuspid regurgitation (27 mild, 14 moderate, and 29 severe) and in 35 patients without tricuspid regurgitation. The coronary sinus flow was obtained by pulsed-Doppler transesophageal echocardiography in a transverse plane, which showed its drainage into the right atrium. Results: The number of patients with adequate studies of the coronary sinus tended to increase with the severity of the tricuspid regurgitation. In patients without or with only mild tricuspid regurgitation the coronary sinus Doppler flow pattern was formed by two negative waves, a late systolic wave and another diastolic one with higher velocity and longer duration. The systolic wave became reversed in 21 (96%) of the patients with severe tricuspid regurgitation. The sensitivity, specificity, and diagnostic accuracy of the presence of a reversed systolic wave in the coronary sinus for the diagnosis of severe tricuspid regurgitation was 95%, 82%, and 80%, respectively. Conclusions: Significant tricuspid regurgitation modifies the coronary sinus flow pattern as assessed by transesophageal echocardiography. The presence of a reversed systolic flow in the coronary sinus appears to be a reliable new sign with good sensitivity, specificity, and diagnostic accuracy for the diagnosis of severe tricuspid regurgitation .     

Biochemical and Cytologic Alterations in the Respiratory Tract of Rats Exposed for 4 Hours to Hydrogen Sulfide

Fischer-344 rats were killed by exsanguination 1, 20, and 44hr after a single 4-hr exposure to an atmosphere of 0, 10, 200,and 400 ppm of hydrogen sulfide (H₂S) Alterations in the activitiesof lactate dehydrogenase and alkaline phosphatase, and cytomorphologyof epithelial cells in fluids obtained by nasal and bronchoalveolarlavage were used as indicators of cell injury. Changes in thenumber of leukocytes were used as indicators of inflammatoryresponse, and changes in the concentration of protein were usedas indicators of altered vascular permeability. Inhalation ofH₂S resulted in 139, 483, and 817% increased cellularity inthe nasal cavity of rats exposed to 10, 200, and 400 ppm, respectively.This was due to marked exfoliation of degenerated epithelialcells and exudation of neutrophils. The high dose of H₂S resultedin a moderate increase in lactate dehydrogenase and proteinin nasal passages; values returned to baseline levels 20 hrlater. Bronchoalveolar cell counts were decreased in rats exposedto 400 ppm and unchanged in those exposed to 10 and 200 ppm.Enzymatic activities in lung lavage fluid were moderately elevated(up to 90%), yet protein concentrations were increased by morethan 3000% and remained significantly elevated up to 44 hr afterexposure to 400 ppm. It was concluded that inhalation of H₂Shas a severe cytotoxic effect on the nasal epithelium and asevere edematogenic effect on lung parenchyma. These resultsare in agreement with autopsy findings of individuals killedby accidental exposure to H₂S-containing sour gas.     

Conformation of linear homo-oligoprolines

A conformational analysis of Piv-l-Pro-d-Pro-OMe was performed in the solid state using i.r. absorption and X-ray diffraction. The tertiary amide bond is in the trans conformation, whereas the tertiary peptide bond is in the cis conformation. The sequence of the, ø angles is F, F*. The preferred conformations of the pivaloylamino group, the pyrrolidine rings, and the ester moiety are also discussed.     

Cryoplasty for the Treatment of Coronary Bifurcation Stenoses Following Main Vessel Stenting

Objectives

This retrospective study sought to assess the safety and clinical efficacy of cryoplasty for treatment of side‐branch stenoses following main vessel stenting in coronary bifurcation lesions.

Background

Cryoplasty prevents restenosis by reducing smooth muscle proliferation and extracellular matrix synthesis. Clinical effectiveness has been demonstrated in the peripheral circulation. Treatment of coronary bifurcation lesions remains a challenge. We used a novel strategy of main vessel stenting combined with side‐branch cryoplasty to treat high‐grade stenoses following main vessel stenting.

Methods

Eighteen patients with bifurcation lesions had significant plaque shift into a side branch after main vessel intervention. Drug‐eluting stents were placed in the main vessel and cryoplasty was performed on the side‐branch vessel. Quantitative coronary analysis was performed on all side‐branch vessels both pre– and post–main vessel stenting. All patients had clinical follow‐up 3 months or more after cryoplasty including either nuclear stress testing or diagnostic coronary angiogram.

Results

Mean percent stenosis decreased from 80.6% post main vessel stenting to 24.8% following cryoplasty (P < 0.0001). Of the 17 patients who had pre‐cryoplasty nuclear stress testing 1 patient had ischemia identified in the distribution of the treated vessel at follow‐up. Five patients had follow up angiography. One patient had restenosis, the other 2 were unchanged. There was a low incidence of MACE.

Conclusions

In this first report of its use in the coronary circulation, cryoplasty for bifurcation side‐branch disease was safe and associated with a low rate of clinical recurrence in carefully selected patients. (J Interven Cardiol 2013;26:239–244)

     

Randomized clinical trial on acute effects of i.v. iron sucrose during haemodialysis

Aim: Haemodialysis induces endothelial dysfunction by oxidation and inflammation. Intravenous iron administration during haemodialysis could worsen endothelial dysfunction. The aim of this study was to ascertain if iron produces endothelial dysfunction and the possible neutralizing effect of N‐acetylcysteine when infused before iron. The oxidative and inflammatory effects of iron during haemodialysis were also assessed. Methods: Forty patients undergoing haemodialysis were studied in a randomized and cross‐over design with and without N‐acetylcysteine infused before iron sucrose (50 or 100 mg). Plasma Von Willebrand factor (vWF), soluble intercellular adhesion molecule‐1 (sICAM‐1) levels, malondialdehyde, total antioxidant capacity, CD11b/CD18 expression in monocytes, interleukin (IL)‐8 in monocytes and plasma IL‐8 were studied at baseline and during haemodialysis. Results: Haemodialysis produced significant (P < 0.001) increase in plasma vWF, sICAM‐1, malondialdehyde, IL‐8 and CD11b/CD18 expression in monocytes, as well as decrease in total antioxidant capacity. Iron induced significant increase in plasma malondialdehyde and IL‐8 in monocytes, but had no effect on total antioxidant capacity, CD11b/CD18 expression, plasma IL‐8, vWF and sICAM‐1. The addition of N‐acetylcysteine to 50 mg of iron produced a significant (P = 0.040) decrease in malondialdehyde. Conclusion: Standard (100 mg) and low (50 mg) doses of iron during haemodialysis had no effects on endothelium. Iron only had minor effects on inflammation and produced an increase in oxidative stress, which was neutralized by N‐acetylcysteine at low iron dose. Haemodialysis caused a significant increase in oxidative stress, inflammation and endothelial dysfunction markers.     

Pre-natal care and prevention of low birth weight: A case-control study in southern Spain

A national policy for improving pre-natal care was applied throughoutAndalusia (southern Spain) in 1984. We report the results ofan evaluation of this health care programme as regards the preventionof low birth weight. Two case-control studies in a hospitalsetting were performed: one before the programme was implemented(1981–1982) and the second one 6 years after the programme(1990–1993). A total of 179 cases and 395 controls forthe period 1981–1982 and 251 cases and 381 controls for1990–1993 were selected. Pre-natal care was assessed onthe basis of the number of pre-natal care visits, the date ofthe first visit and an American composite index to adjust forgestational age. Multiple-factor adjusted odds ratios (OR) andtheir 95% confidence intervals (CI) were estimated using logisticregression analysis. The use of pre-natal care significantlyimproved overtime: the proportion of women receiving no pre-natalcare decreased from over 30% to less than 5% and the proportionof women starting pre-natal care in the first trimester for1990–1993 was 3 times the figure for 1981–1982.In the 1981–1982 case-control study, pre-natal care wasnot related to low birth weight risk. In the 1990–1993case-control study, a clear and significant trend was observedbetween the number of pre-natal care visits and the adequacyof care according to the composite index and the risk of lowbirth weight. When these relationships were analysed stratifyingby gestational age, a significant trend was found between pre-natalcare and pre-term low birth weight. The results suggest thatthe present Andalusian programme helps prevent pre-term lowbirth weight.