Duplication of the inferior vena cava: anatomy,embryology and classification proposal

A case of a duplicated inferior vena cava (IVC) along with other anatomical vessel variations in a 72-year-old male cadaver is presented. The anomalous vessels involved, besides the IVC, were the left testicular vein and artery, the left suprarenal artery and a superior accessory left renal artery. Based on the gross appearance of the preaortic anastomotic trunk between the left and right IVC as well as on the underlying embryological features, a classification is proposed: incomplete bilateral duplication of the IVC and complete bilateral duplication of the IVC. The latter can be further divided into three types: major, minor and asymmetric.     

R2 relaxometry with MRI for the quantification of tissue iron overload in beta-thalassemic patients

PURPOSE: To evaluate the usefulness of a time-efficient MRI method for the quantitative determination of tissue iron in the liver and heart of beta-thalassemic patients using spin-spin relaxation rate, R2, measurements. MATERIALS AND METHODS: Images were obtained at 1.5 T from aqueous Gd-DTPA solutions (0.106-8 mM) and from the liver and heart of 46 beta-thalassemic patients and 10 controls. The imaging sequence used was a respiratory-triggered 16-echo Carr-Purcell-Meiboom-Gill (CPMG) spin-echo (SE) pulse sequence (TR = 2000 msec, TE(min) = 5 msec, echo spacing (ES) = 5 msec, matrix = 192 x 256, slice thickness = 10 mm). Liver iron concentration (LIC) measurements were obtained for 22 patients through biopsy specimens excised from the relevant liver segment. Biopsy specimens were also evaluated regarding iron grade and fibrosis. Serum ferritin (SF) measurements were obtained in all patients. RESULTS: A statistically significant difference was found between patients and healthy controls in mean liver (P < 0.004) and myocardium (P < 0.004) R2 values. The R2 values correlated well with Gd DTPA concentration (r = 0.996, P < 0.0001) and LIC (r = 0.874, P < 0.0001). A less significant relationship (r = 0.791, P < 0.0001) was found between LIC measurements and SF levels. R2 measurements appear to be significantly affected (P = 0.04) by different degrees of hepatic fibrosis. The patients' liver R2 values did not correlate with myocardial R2 values (r = 0.038, P < 0.21). CONCLUSION: Tissue iron deposition in beta-thalassemic patients may be adequately quantified using R2 measurements obtained with a 16-echo MRI sequence with short ES (5 msec), even in patients with a relatively increased iron burden.     

Vismodegib persistence and discontinuation patterns in Greek patients from a real world setting

Hedghehog pathway inhibitors have been successfully used for patients with locally advanced basal cell carcinomas. However, these treatments have been associated with various adverse events that may limit patient compliance. In this study, an association of patient and disease characteristics with drug compliance in a real clinical setting was made. 18 patients were included in the study. The average patient age was 78.39 years. The time that patients remained to treatment was, on average, 8.73 months. 72.2% of patients experienced at least one adverse event. At study cut‐off, 11 out of 18 patients had discontinued treatment. The most common reason for discontinuation was reported “fatigue” from the treatment due to the type of AEs experienced (37.4%) and patient's choice after complete response achievement (30.8%). Factors that were associated with treatment discontinuation was: number of previous treatments, severity of AEs and patient age.     

Phylogenetic analysis of viridans group streptococci causing endocarditis

Identification of viridans group streptococci (VGS) to the species level is difficult because VGS exchange genetic material. We performed multilocus DNA target sequencing to assess phylogenetic concordance of VGS for a well-defined clinical syndrome. The hierarchy of sequence data was often discordant, underscoring the importance of establishing biological relevance for finer phylogenetic distinctions.     

The risk of using the Internet as reference resource: a comparative study

OBJECTIVE: We sought to examine the frequency and the specific problems encountered in accessing Internet references in two leading medical journals during the last 3 years. METHODS: Two investigators independently reviewed all publications in the issues of the New England Journal of Medicine and The Lancet during October 2005 to March 2006, November 2004 to January 2005, and November 2003 to January 2004. We calculated the total number of references and the subset referred to an Internet source of each article. Then, we visited the electronic sources to identify the Internet references and noted the problems of accessibility, if any. When we failed to directly access the reference in the electronic address provided by the authors, we visited the referred website; if this was also inadequate, we performed Google searches to retrieve the missing reference(s). RESULTS: 465/18,850 (2.5%) and 952/24,630 (3.9%) of the reviewed references in the New England Journal of Medicine and The Lancet, respectively, referred to Internet sources; from these we could not access 68/465 (14.6%) and 170/952 (17.9%) in the two journals, respectively. There were increasing proportions of lost Internet references as they age. Searching into the website referred by the authors of the reviewed articles could not provide the missing information in a considerable proportion (62.2%). However, the use of an Internet search engine (Google) helped us to identify references in other websites, reducing the proportion of missing Internet references to 17/465 (3.7%) and 17/952 (1.8%) for the two journals, respectively. CONCLUSIONS: The response "page not found" was commonly encountered when we tried to access Internet references in publications of leading medical journals during the last 3 years. A considerable proportion of missing references was identified with the use of Google search engine. Authors of scientific articles should be aware of the problem of missing Internet references and until well-established Internet archiving solutions are in use, they should choose carefully their Internet references from reliable websites whenever it is impossible to avoid using them.     

Two successfully treated cases of Staphylococcus lugdunensis endocarditis

Prosthetic valve and pacemaker lead endocarditis by Staphylococcus lugdunensis remain very rare, while the former is associated with an ominous prognosis. Two cases involving a prosthetic aortic valve and a pacemaker lead, respectively, are reported. Despite disease severity and delayed diagnosis, patients recovered fully with combined antimicrobial and surgical treatment.     

An analysis of patient house calls in the area of Attica, Greece

Background  

Physicians house calls to patients have been declining in many countries of the world. The objective of this study was to describe the patterns of utilization of house call services provided by SOS doctors in the area of Attica, Greece.     

Proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor use in the management of resistant hypercholesterolemia induced by mitotane treatment for adrenocortical cancer

We report the case of a patient with probable heterozygous familial hypercholesterolemia and mitotane-induced resistant hypercholesterolemia, despite combination therapy with rosuvastatin and ezetimibe. The patient was managed with the addition of evolocumab. Use of a proprotein convertase subtilisin-kexin type 9 inhibitor, should be considered in patients who develop mitotane-related hypercholesterolemia that cannot be managed with conventional lipid-lowering treatment.     

Cartilaginous and osseous metaplasia with bone marrow formation in the aortic valve of a patient with giant cell aortitis

We describe the case of a 40-year-old man who presented with an ascending aortic aneurysm and aortic valve regurgitation. The patient underwent a Bentall surgical procedure. Pathologic findings were consistent with giant cell aortitis with synchronous cartilaginous and osseous metaplasia with bone marrow formation in the degenerated aortic valve. The coexistence of these findings has not been previously reported in the English language literature.