Fatal cardiac perforation and pulmonary embolism of leaked cement after percutaneous vertebroplasty

Percutaneous vertebroplasty consists of percutaneous injection of polymethylmethacrylate (PMMA) via a transpedicular approach for the treatment of collapsed osteoporotic or metastatic vertebrae. Even if percutaneous vertebroplasty is considered to be minimally invasive, threatening complications can occur. Cement leakage is the most common complication of percutaneous vertebroplasty. Rigorous patient selection and individual therapeutic strategy may reduce the occurrence of leakage, in particular the risk of cement entry into the venous system and the spinal canal is the potent major hazard of this technique. Cement pulmonary and cardiac embolism are reported in literature as a cause of unexpected death after percutaneous vertebroplasty. Authors report a fatal case of pulmonary cement embolization occurred after vertebroplasty with haemopericardium, due to the perforation of the right atrium wall from a cement solidified fragment. A complete post mortem examination documented the presence of multiple cement fragments in the pulmonary arteries and transmural perforation of the wall of the right atrium by a whitish needle-like foreign body. Pulmonary microembolization was observed under polarized ligh

Hospital autopsy for prevention of sudden cardiac death

In the past 20 years, cardiovascular mortality has decreased in highincome countries in response to the adoption of preventive measures to reduce the burden of coronary artery disease and heart failure. Despite these encouraging results, cardiovascular diseases are responsible for approximately 17 million deaths every year in the world, approximately 25% of which are sudden cardiac death. The risk of sudden cardiac death is higher in men than in women, and it increases with age due to the higher prevalence of coronary artery disease in older age. Accordingly, the sudden cardiac death rate is estimated to range from 1.40 per 100 000 person-years in women to 6.68 per 100 000 person-years in men. Sudden cardiac death in younger individuals has an estimated incidence of 0.46\u20133.7 events per 100 000 person-years, corresponding to a rough estimate of 1100\u20139000 deaths in Europe and 800\u20136200 deaths in the USA every year. Cardiac diseases associated with sudden cardiac death differ in young vs. older individuals. In the young there is a predominance of channelopathies and cardiomyopathies, myocarditis and substance abuse, while in older populations, chronic degenerative diseases predominate. In younger persons, the cause of sudden cardiac death may be elusive even after autopsy, because conditions such as inherited channelopathies or drug-induced arrhythmias that are devoid of structural abnormalities are epidemiologically relevant in this age group. Identification of the cause of an unexpected death provides the family with partial understanding and rationalization of the unexpected tragedy, which facilitates the coping process and allows an understanding of whether the risk of sudden death may extend to family members. Accordingly, author present their experience with autopsies of unexplained sudden death young victims in which a cardiac origin was suspected and the relevance of a standardized protocol for heart examination and histological sampling, as well as for toxicology and molecular investigation

Physicochemical properties of mixed micellar aggregates containing CCK peptides and Gd complexes designed as tumor specific contrast agents in MRI

New amphiphilic molecules containing a bioactive peptide or a claw moiety have been prepared in order to obtain mixed micelles as target-specific contrast agents in magnetic resonance imaging. The first molecule, C18H37CONH(AdOO)2-G-CCK8 (C18CCK8), contains a C18 hydrophobic moiety bound to the C-terminal cholecystokinin octapeptide amide (CCK 26-33 or CCK8). The second amphiphilic compound, C18H37CONHLys(DTPAGlu)CONH2 (C18DTPAGlu) or its gadolinium complex, (C18DTPAGlu- (Gd)), contains the same C18 hydrophobic moiety bound, through a lysine residue, to the DTPAGlu chelating agent. The mixed aggregates as well as the pure C18DTPAGlu aggregate, in the presence and absence of Gd, have been fully characterized by surface tension measurements, FT-PGSE-NMR, fluorescence quenching, and small-angle neutron scattering measurements. The structural characterization of the mixed aggregates C18DTPAGlu(Gd)-C18CCK8 indicates a spherical arrangement of the micelles with an external shell of 21 Å and an inner core of 20 Å. Both the DTPAGlu(Gd) complexes and the CCK8 peptides point toward the external surface. The measured values for relaxivity in saline medium at 20 MHz proton Larmor frequency and 25 °C are 18.7 mM-1 s-1. These values show a large enhancement in comparison with the isolated DTPAGlu(Gd) complex

Toward the Identification of Novel Antimicrobial Agents: One-Pot Synthesis of Lipophilic Conjugates of N-Alkyl d- and l-Iminosugars

In the effort to improve the antimicrobial activity of iminosugars, we report the synthesis of lipophilic iminosugars 10a-b and 11a-b based on the one-pot conjugation of both enantiomeric forms of N-butyldeoxynojirimycin (NBDNJ) and N-nonyloxypentyldeoxynojirimycin (NPDNJ) with cholesterol and a succinic acid model linker. The conjugation reaction was tuned using the established PS-TPP/I2/ImH activating system, which provided the desired compounds in high yields (94-96%) by a one-pot procedure. The substantial increase in the lipophilicity of 10a-b and 11a-b is supposed to improve internalization within the bacterial cell, thereby potentially leading to enhanced antimicrobial properties. However, assays are currently hampered by solubility problems; therefore, alternative administration strategies will need to be devised

Correlation between ion composition of oligomineral water and calcium oxalate crystal formation

The ion content of drinking water might be associated with urinary stone formation, representing a keystone of conservative nephrolithiasis management. However, the effects of specific ions on calcium oxalate crystal formation and their mechanism of action are still highly controversial. We report an investigation of the effects of oligomineral waters with similar total salt amount but different ion composition on calcium oxalate (CaOx) precipitation in vitro, combining gravimetric and microscopic assays. The results suggest that the “collective” physicochemical properties of the aqueous medium, deriving from the ion combination rather than from a single ionic species, are of importance. Particularly, the ability of ions to strengthen/weaken the aqueous medium structure determines an increase/decrease in the interfacial energy, modulating the formation and growth of CaOx crystals

Coarse-Graining the Lin-Maldacena Geometries

The Lin-Maldacena geometries are nonsingular gravity duals to degenerate vacuum states of a family of field theories with SU(2|4) supersymmetry. In this note, we show that at large N, where the number of vacuum states is large, there is a natural `macroscopic' description of typical states, giving rise to a set of coarse-grained geometries. For a given coarse-grained state, we can associate an entropy related to the number of underlying microstates. We find a simple formula for this entropy in terms of the data that specify the geometry. We see that this entropy function is zero for the original microstate geometries and maximized for a certain ``typical state'' geometry, which we argue is the gravity dual to the zero-temperature limit of the thermal state of the corresponding field theory. Finally, we note that the coarse-grained geometries are singular if and only if the entropy function is non-zero.Comment: 29 pages, LaTeX, 3 figures; v2 references adde

On the order of BEC transition in weakly interacting gases predicted by mean-field theory

Predictions from Hartree-Fock (HF), Popov (P), Yukalov-Yukalova (YY) and $t$-matrix approximations regarding the thermodynamics from the normal to the BEC phase in weakly interacting Bose gases are considered. By analyzing the dependence of the chemical potential $\mu$ on temperature $T$ and particle density $\rho$ we show that none of them predicts a second-order phase transition as required by symmetry-breaking general considerations. In this work we find that the isothermal compressibility $\kappa_{T}$ predicted by these theories does not diverge at criticality as expected in a true second-order phase transition. Moreover the isotherms $\mu=\mu(\rho,T)$ typically exhibit a non-singled valued behavior in the vicinity of the BEC transition, a feature forbidden by general thermodynamic principles. This behavior can be avoided if a first order phase transition is appealed. The facts described above show that although these mean field approximations give correct results near zero temperature they are endowed with thermodynamic anomalies in the vicinity of the BEC transition. We address the implications of these results in the interpretation of current experiments with ultracold trapped alkali gases.Comment: 16 pages, 5 figure