Concomitant cardiac and hepatic hemangiomas

Primary tumors of the heart are rare with a reported incidence of about 0.002% to 0.3% at autopsy. A cardiac hemangioma is a form of benign primary cardiac tumor that often presents with atypical clinical symptoms. Hemangiomas are generally isolated lesions. Here, we report a patient with previous hepatic hemangioma who later was found to have a large coexistent cardiac hemangioma presenting with cardiac compressive symptoms.     

Carotid artery stenting in the presence of contralateral carotid occlusion: mind the hyperperfusion syndrome!

Stroke is the third cause of death in western countries and its complications lead to significant socio-economic problems related to the prolonged hospitalization and rehabilitation of patients with neurological lesions. Severe atherosclerotic lesions of the carotid artery are the main cause of stroke and transient ischemic attacks. Their incidence may reach 5-7% per year in patients with carotid artery stenosis > 70% with or without symptoms. Time-honored carotid endarterectomy is still regarded as the gold standard therapy for primary and secondary prevention of stroke. However, surgery is not free of complications and the rate of perioperative stroke ranges from 5.1 to 14.3%. A group of patients at a particularly high risk of stroke during surgical endarterectomy is represented by patients with significant carotid stenosis in the presence of an occluded contralateral artery. Indeed, carotid cross-clamping during operative surgery in the absence of an adequate collateral flow may result in a critical flow reduction during the operation and therefore increases the risk of periprocedural strokes. In the North American Symptomatic Carotid Endarterectomy (NASCET) trial, the overall risk of stroke was 5.1%, whereas it increased up to 14.3% in patients with an occluded contralateral carotid artery. Recently, carotid stenting has been increasingly used as an endovascular technique for carotid revascularization, especially after the introduction of neuroprotection devices which improved the safety of the procedure. Therefore, it may be an attractive alternative to carotid endarterectomy, especially when the surgical risk is too high. We describe the immediate and late outcomes of 3 patients treated with carotid artery stenting in the presence of contralateral carotid occlusion.     

Transcutaneous Electrical Nerve Stimulation Reduces Acute Low Back Pain during Emergency Transport

Background: Patients with acute low back pain may require emergency transport because of pain and immobilization. Transcutaneous electrical nerve stimulation (TENS) is a nonpharmaceutical therapy for patients with low back pain. Objective: To evaluate the efficacy of paramedic‐administered TENS in patients with acute low back pain during emergency transport. Methods: This was a prospective, randomized study involving 74 patients transported to hospital. The patients were randomly assigned to two groups: group 1 (n= 36) was treated with true TENS, while group 2 (n= 36) was treated with sham TENS. The authors recorded pain and anxiety as the main outcome variables using a visual analog scale (VAS). Results: The authors recorded a significant (p < 0.01) pain reduction (mean ± standard deviation) during transport in group 1 (79.2 ± 6.5 mm VAS to 48.9 ± 8.2 mm VAS), whereas pain scores remained unchanged in group 2 (75.9 ± 16.4 mm VAS and 77.1 ± 11.2 mm VAS). Similarly, the scores for anxiety were significantly reduced (p < 0.01) in group 1 (81.7 ± 7.9 mm VAS to 69.2 ± 12.1 mm VAS) after treatment. No significant change was noted (84.5 ± 5.8 mm VAS and 83.5 ± 8.9 mm VAS, respectively) in group 2. Conclusions: TENS was found to be effective and rapid in reducing pain during emergency transport of patients with acute low back pain and should be considered due to its ease of use and lack of side effects in the study population.     

In vitro activity of green tea extract against Leishmania major promastigotes

Background: Systemic and topical treatment options against Leishmaniasis are limited to a few drugs with inconsistent efficacy and unacceptable side effects and none of them is suitable for all forms of the disease. Objective: The aim of this study was to search the in vitro activity of green tea extract against L. major promastigotes and compare it with glucantime. Methods: Extract was prepared by percolation method. The extract was dried and dissolved in DMSO 1% solvent. Leishmania major promastigotes treated with 6 concentrations (3, 6, 12, 24, 48, 96 mg/ml) of the extract. As control positive group glucantime 85 mg/ml and additional untreated control group were included in this study. All cultures were performed in triplicate. The promastigotes were also counted and their flagellate's motilities were assessed microscopically. Results: Ethanolic extract of green tea showed significant leishmanicidal activity against L. major promastigotes in different concentrations. Notably there was a concordance in anti-leishmanial effect of the ethanol extract with the increasing of the dosage (3, 6, 12, 24, 48, 96 mg/ml). In comparison with glucantime the mean alive promastigotes in 12 mg/ml concentration of green tea was almost as same as 85 mg/ml glucantime and higher green tea extract concentrations were higher effective than glucantime. Conclusion: Our study revealed a novel pharmacological activity against promastigotes of L. major and suggests that green tea extract has the potential of being used in leishmaniasis but more studies are needed to find out its activity against amastigote and appropriate route of application.     

Mortality and morbidity after aortic root replacement: 10-year experience

Aortic root reconstruction remains a challenging surgical procedure. This retrospective study was carried out to evaluate the early and long-term outcomes of aortic root replacement over a 10-year period. There were 83 patients with a mean age of 43.2 +/- 14 years (range, 10 to 78 years). Type A aortic dissection and Marfan syndrome were found in 28% and 24%, respectively. The most common technique used for repair of this condition was the Bentall operation. The mean duration of follow-up was 29.6 +/- 28 months, ranging from 1 to 120 months. Hospital (30-day) mortality was 13.3% (11 patients). Two patients died during the late follow-up. The mortality was significantly higher in patients presenting with cardiogenic shock, those with long cardiopulmonary bypass and crossclamp times, and the group who had concomitant coronary artery bypass grafting. Emergency operation was not a significant risk factor for early death in our patients. The most common complications were bleeding and neurological sequelae. Aortic root replacement can be achieved with acceptable mortality and morbidity in a high-risk group of patients. Improvements in the outcome may be achieved by faster transport of patients in cardiogenic shock, and by reducing the cardiopulmonary bypass and crossclamp times.     

Heart transplantation in 7 patients from a single family with limb-girdle muscular dystrophy caused by lamin A/C mutation

We describe 7 transplanted heart recipients from a single family with limb-girdle muscular dystrophy type 1B linked to a mutation of the LMNA gene in the splice donor site of the exon 9 (IVS 9 + 1:g > a). These patients did not display higher early postoperative or late complications than other heart transplant recipients at a mean follow-up of 8 years (range 1–17 years). Noticeably, there was no case of rhabdomyolysis and skeletal muscle symptoms were not markedly impaired.     

Unusual histopathological findings in a young Pekingese dog with intrathoracic malignant peripheral nerve sheath tumour

This report describes intrathoracic malignant peripheral nerve sheath tumour in a Pekingese dog with unusual histopathologic findings. A 2-year-old male Pekingese dog presented with a history of pain and chronic hind limb lameness. Thoracic radiographs revealed soft-tissue opacity ventral to the thoracic vertebrae and dorsal to the aorta and base of the heart. The echo texture of the mass ultrasonographically was heterogenic, including hypo- and hyper-echoic areas within the mass, which had a well-defined echogenic wall. The owner refused further diagnostic tests, and due to a poor prognosis, the dog was euthanized. On histopathological examination, ovoid structures, known as Verocay bodies in human schwannomas, together with the pseudo-rosette-like structures in which neoplastic cells were arranged around blood vessels, were found as the most pronounced histological feature. Immuno-histochemical examination revealed that neoplastic cells were extensively positive for both neuron-specific enolase and vimentin. To the authors' knowledge, such histopathological findings associated with malignant peripheral nerve sheath tumour in dogs have not been previously reported.