Gastro-intestinal stromal tumor (GIST) complicating a colonic interposition: a novel case report

Background: Gastrointestinal stromal tumor (GIST) is a rare tumor comprising 0.1-0.3% of all gastrointestinal (GI) malignancies. Stomach followed by small intestine is the most common sites of involvement, implicated in 95% of the cases. We present a case of GIST complicating a colonic interposition. To the best of the author's knowledge, this is the first reported case of GIST complicating a colonic interposition. Case presentation: A 47 year old African American male presented to the emergency department with intermittent, severe chest pain. Past medical history was significant for alkali (NaOH) ingestion during 1980 for which esophageal resection and a colonic pull-through was performed. A CXR revealed a widened mediastinum and CT scan chest revealed showed a large (11.4 ˟ 8.3 ˟ 12.1 cm) vascular mediastinal mass. At endoscopy, a large, ulcerated, cratered and friable mass was found at 29cm extending to 36cm at which point the lower anastomosis of the colonic pull through was present. Multiple endoscopic biopsies were obtained which showed that the tumor was immunoreactive with CD117, CD34 and DOG1 while markers of carcinoma, melanoma and lymphoma were negative. In light of the pathology report, the immunohistochemistry and the CT scans, the tumor was classified as a stage 4 GIST of colonic interposition. Conclusions: GIST can complicate unusual locations such as colonic interposition and should be kept in the differential diagnosis of such unusual presentations

Rare cause of infranodal block

The patient exhibits multiple features suggestive of Timothy syndrome, which is a multisystem autosomal-dominant condition with findings that include prolonged QT interval, hand and foot abnormalities, dysmorphic facial features, and mental retardation. A 2:1 infranodal atrioventricular block may occasionally be seen in the setting of severely prolonged QT interval. Functional nature of atrioventricular block is demonstrated by resumption of 1:1 conduction with changes in heart rate

MYXOBACTERIAL INTERACTION WITH PHIZOBIA

The predation of four soil myxobacteria - Myxococcus fulvus, “yxococcus virescens, Myxococcus stipitatus and Polyangium fuscum on several susceptible Rhizobium spp. was investiqated. No significant difference in the course of attack on living and heat killed rhizobial cells was seen in plate assays, but viable cells were resistant to the myxobacterial culture filtrate in tube assays. Some partially lysis-resistant rhizobia were rendered more susceptible when separated from their polysaccharide. On hydrolysis, the purified gum gave glucose, galactose, mannose and glucuronic acid; aminosugars were absent. This qum had no effect on the synthesis and activity of lytive. The partially purified lytic enzyme complex showed an N-acetyl hexosaminidase activity on purified Rhizobium leguminosarum cell walls. Viable cells, polysaccharide gum, purified cell walls and lipids ofR. leguminosarum did not induce any chemotactic response in any of the myxobacters tested, while autoclaved cells and cell proteins attracted the migrating cells. These myxobacters were also found in the rhizosphere of several local legumes. When introduced in sterilized soil with added rhizobia, M. fulvus and P. fuscum suppresses root nodulation

Cardiac resynchronization therapy in patients with challenging anatomy due to venous anomalies or adult congenital heart disease

BACKGROUND: Cardiac resynchronization therapy (CRT) has proven salutary effects in patients with congestive heart failure, systolic dysfunction, and electromechanical dyssynchrony in the setting of ischemic, nonischemic, and congenital cardiomyopathy. While CRT device implants have become routine in the adult ischemic or nonischemic cardiomyopathy populations, patients with congenital heart disease offer special challenges due to unusual anatomic variations. METHODS: A comprehensive assessment of anatomic abnormalities is essential prior to implant. In addition, implant techniques and equipment must be tailored to the expected anatomy. A flexible approach is necessary-implant may require equipment and techniques adapted from vascular intervention. CONCLUSION: This article describes our approach to CRT implant in patients with congenital heart disease, and is illustrated by reports of several cases

Presence of obesity is associated with lower mortality in elderly patients with implantable cardioverter defibrillator

BACKGROUND: Higher body mass index (BMI) is associated with greater prevalence of cardiovascular risk factors, yet an inverse relationship between obesity and survival after cardiovascular events has been described. It is unclear whether a similar relationship exists for patients with implantable cardioverter defibrillators (ICDs) at high risk for mortality. We aimed to assess the impact of BMI on mortality and cardiovascular hospitalization in patients with ICD. METHODS: Patients who underwent ICD implantation in 2010-2011 were divided into normal (m RESULTS: Of 904 patients (mean age 67±13 years), 26% had normal BMI, 32% were overweight and 42% were obese. No significant baseline differences in ventricular ejection fraction, ICD for primary or secondary prevention, history of heart failure, syncope or cardiac arrest existed. Despite a greater prevalence of diabetes, hypertension and prior myocardial infarction, the obese and overweight groups had lower mortality (10.1% and 7.9%, respectively) than the normal group (22.9%, P CONCLUSIONS: A paradoxical relationship between BMI and mortality risk is present in elderly patients with ICD at high risk of sudden death with a lower mortality in obese or overweight patients than in those with normal BMI