A Case of Carcinoid Heart Disease and Echocardiographic Findings

Abstract: Carcinoid heart disease occurs in approximately 50% of patients with carcinoid syndrome. Right heart involvement resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis is most common. We report a case of tricuspid heart disease resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis

Thoracoscopic Left Atrial Appendage Ligation Complicated by Persistent Left Superior Vena Cava

We herein report a 64 year-old male who had an incidental finding of a persistent left superior vena cava (SVC) revealed by intraoperative transesophageal echocardiography (TEE) during a Maze procedure with left atrial appendage ligation. During the intraoperative TEE, an incidental dilated coronary sinus \u3e 1.1 cm was noted which prompted further evaluation and aided in our ultimate diagnosis. Consequently, significant additional surgical dissection and manipulation were required to isolate the left upper pulmonary vein. This case report reviews the anatomy and embryology of a persistent left SVC, discusses its clinical implications, and identifies surgical considerations for treatment

Endotracheal Tube Dislodgment in a High Risk Pulmonary Hypertensive Patient due to Undiagnosed Tracheomegaly: A Case Report

Introduction Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.1 Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.2 Case This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O2 who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, but he was considered medically optimized for surgery and had undergone a prior uncomplicated general anesthetic. An intraoperative endotracheal tube dislodgement necessitated emergency airway rescue with difficulty in re-establishing adequate ventilation resulting in the patient being brought to the ICU post-operatively. After a second endotracheal dislodgement shortly later, retrospective radiographic airway analysis revealed tracheal dimensions of 32 x 26mm, suggesting a previously undiagnosed tracheomegaly. Written consent and HIPAA authorization was obtained from the patient for the publication of this case report. Conclusion This case highlights the clinical importance for anesthesiologists to be aware of tracheobronchomegaly (TBM) despite limited provider experience with these patients and sparse reporting on the condition. It is underdiagnosed radiographically and may first present in the OR. TBM can manifest in many ways with potentially fatal complications thus it is vital for anesthesiologists to be able to recognize, troubleshoot, and potentially treat issues related to the disease

Common Hypercyclic Vectors for the Conjugate Class of a Hypercyclic Operator

Given a separable, infinite dimensional Hilbert space, it was recently shown by the authors that there is a path of chaotic operators, which is dense in the operator algebra with the strong operator topology, and along which every operator has the exact same dense Gδ set of hypercyclic vectors. In the present work, we show that the conjugate set of any hypercyclic operator on a separable, infinite dimensional Banach space always contains a path of operators which is dense with the strong operator topology, and yet the set of common hypercyclic vectors for the entire path is a dense Gδ set. As a corollary, the hypercyclic operators on such a Banach space form a connected subset of the operator algebra with the strong operator topology

Fast Attitude Maneuvers for the Lunar Reconnaissance Orbiter

This paper describes a new operational capability for fast attitude maneuvering that is being developed for the Lunar Reconnaissance Orbiter (LRO). The LRO hosts seven scientific instruments. For some instruments, it is necessary to per-form large off-nadir slews to collect scientific data. The accessibility of off-nadir science targets has been limited by slew rates and/or occultation, thermal and power constraints along the standard slew path. The new fast maneuver (FastMan) algorithm employs a slew path that autonomously avoids constraint violations while simultaneously minimizing the slew time. The FastMan algo-rithm will open regions of observation that were not previously feasible and improve the overall science return for LRO's extended mission. The design of an example fast maneuver for LRO's Lunar Orbiter Laser Altimeter that reduc-es the slew time by nearly 40% is presented. Pre-flight, ground-test, end-to-end tests are also presented to demonstrate the readiness of FastMan. This pioneer-ing work is extensible and has potential to improve the science data collection return of other NASA spacecraft, especially those observatories in extended mission phases where new applications are proposed to expand their utility

Hsp70 and Hsp40 Functionally Interact with Soluble Mutant Huntingtin Oligomers in a Classic ATP-Dependent Reaction Cycle

Inclusion bodies of aggregated mutant huntingtin (htt) fragments are a neuropathological hallmark of Huntington disease (HD). The molecular chaperones Hsp70 and Hsp40 colocalize to inclusion bodies and are neuroprotective in HD animal models. How these chaperones suppress mutant htt toxicity is unclear but might involve direct effects on mutant htt misfolding and aggregation. Using size exclusion chromatography and atomic force microscopy, we found that mutant htt fragments assemble into soluble oligomeric species with a broad size distribution, some of which reacted with the conformation-specific antibody A11. Hsp70 associated with A11-reactive oligomers in an Hsp40- and ATP-dependent manner and inhibited their formation coincident with suppression of caspase 3 activity in PC12 cells. Thus, Hsp70 and Hsp40 (DNAJB1) dynamically target specific subsets of soluble oligomers in a classic ATP-dependent reaction cycle, supporting a pathogenic role for these structures in HD

Better data for teachers, better data for learners, better patient care: college-wide assessment at Michigan State University's College of Human Medicine

When our school organized the curriculum around a core set of medical student competencies in 2004, it was clear that more numerous and more varied student assessments were needed. To oversee a systematic approach to the assessment of medical student competencies, the Office of College-wide Assessment was established, led by the Associate Dean of College-wide Assessment. The mission of the Office is to ‘facilitate the development of a seamless assessment system that drives a nimble, competency-based curriculum across the spectrum of our educational enterprise.’ The Associate Dean coordinates educational initiatives, developing partnerships to solve common problems, and enhancing synergy within the College. The Office also works to establish data collection and feedback loops to guide rational intervention and continuous curricular improvement. Aside from feedback, implementing a systems approach to assessment provides a means for identifying performance gaps, promotes continuity from undergraduate medical education to practice, and offers a rationale for some assessments to be located outside of courses and clerkships. Assessment system design, data analysis, and feedback require leadership, a cooperative faculty team with medical education expertise, and institutional support. The guiding principle is ‘Better Data for Teachers, Better Data for Learners, Better Patient Care.’ Better data empowers faculty to become change agents, learners to create evidence-based improvement plans and increases accountability to our most important stakeholders, our patients