Prophylactic use of carvedilol to prevent ventricular dysfunction in patients with cancer treated with doxorubicin

Objective: Deterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related. Methods: A prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months. Results: LVEF decreased from 62 ± 5% at baseline to 58 ± 7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF < 50% compared to four of the 38 assigned to placebo (11%), (p = 0.013). No significant differences were noted between carvedilol and placebo in terms of the development of diastolic dysfunction, clinically overt heart failure or death. Conclusions: Carvedilol might prevent deterioration in LVEF in cancer patients treated with doxorubicin. This effect may not be dose related within the studied range

Cavitation phenomenon in mechanical prosthetic valves: Not only microbubbles

Introduction: Microbubbles (MBs) or cavitation is high-velocity, echo-bright findings present during the closing or opening of a mechanical valve (MVP). Cavitation bubble growth or gas emboli are less frequently described. We evaluated the hemodynamic parameters involved in the formation of gas emboli and the impact of gas emboli on requests for additional investigations. Methods and Results: Transthoracic echocardiographic studies (TTE) of 57 patients (31 males, mean age 46.8\ua0\ub1\ua013.8\ua0years) with gas emboli were evaluated after heart valve replacement surgery. The majority (72%, n\ua0=\ua042) had a mitral or combined mitral/aortic MVP, with 28% (n\ua0=\ua016) an aortic MVP. The last TTE with and without gas emboli were considered for the same patient and the no emboli group was the control group (42 patients). The patient's blood pressure (BP) and heart rate (HR) were available for each TTE. Comparing the two TTEs, the systolic and diastolic BP, transmitral and aortic gradients, and left ventricular ejection fraction were similar but the HR (80.9\ua0\ub1\ua018.7 vs 72.5\ua0\ub1\ua013.9\ua0bpm, P\ua0=.02) was significantly higher in the group with gas emboli. A TEE was performed 52 times in 27 patients, due to gas emboli, with one case positive for thrombus/vegetation. For 19 patients, a brain CT was requested. In two patients, the indication for the brain CT was gas emboli but the result was negative. Conclusion: Gas emboli are frequently present and associated to an increased HR. They can cause the misdiagnosis of endocarditis or thrombus formation with significant additional requests for diagnostic examinations

نمو وانتاج قلويد ات التروبان بواسطة مزارع المعلق الخلوي لنبات السكوان الأبيض

Cell suspension of Hyoscyamus albus L. were investigated for growth and production of tropane alkaloids in three different media. The effects of sucrose concentration and initial pH were also studied. 2,4- Dichlorophenoxyacetic acid and 1% sucrose enhanced the production of tropane alkaloids. The percent of alkaloids (0.75%) was higher than in the cultivated plant (0.352 %).أجرى قحص لنمو وانتاج قلويدات التروبان لمزارع المعلق الخلوي في ثلاث بيئات مختلفة لنبات السكران الأبيض ، وقد درس أيضا تأثير تركيز السكروز ورقم الأس الهيدروجيني في بداية التجارب كما تم التوصل إلى زيادة انتاج قلويدات التروبان بإشخد ام هرمون 2 ، 4 -ثنائي كلوروفينوكللي حامض الخليك و 1 % سكروز ، حيث بلغت نسبة تكوين قلويد ات التروبان ( 75،%) وهي أص منها في النبات المنزرع ( 352 ،% ) .أجرى فحص لنمو وانتاج قلويدات التروبان لمزارع المعلق الخلوي في ثلاث بيئات مختلفة لنبات السكران الأبيض ، وقد درس أيضا تأثير تركيز السكروز ورقم الأس الهيدروجيني في بداية التجارب كما تم التوصل إلى زيادة انتاج قلويدات التروبان باستخدام هرمون 2 ، 4 -ثنائي كلوروفينوكسي حامض الخليك و 1 % سكروز ، حيث بلغت نسبة تكوين قلويدات التروبان ( 75.%) وهي أص منها في النبات المنزرع (352.%

Infected pseudoaneurysm of ascending aorta

We are presenting a rare complication post Bioprosthetic aortic valve replacement. A middle age man presented with the clinical features of Pyrexia of unknown etiology and found out that he had endovascular infection, with septic emboli to the spleen. We are presenting two interesting images as a quiz and discuss in brief the clinical data of the infected pseudo aneurysm of the aortic root and ascending aorta