Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical). This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively

Jet-regulated cooling catastrophe

We present the first implementation of Active Galactic Nuclei (AGN) feedback in the form of momentum driven jets in an Adaptive Mesh Refinement (AMR) cosmological resimulation of a galaxy cluster. The jets are powered by gas accretion onto Super Massive Black Holes (SMBHs) which also grow by mergers. Throughout its formation, the cluster experiences different dynamical states: both a morphologically perturbed epoch at early times and a relaxed state at late times allowing us to study the different modes of BH growth and associated AGN jet feedback. BHs accrete gas efficiently at high redshift (z>2), significantly pre-heating proto-cluster halos. Gas-rich mergers at high redshift also fuel strong, episodic jet activity, which transports gas from the proto-cluster core to its outer regions. At later times, while the cluster relaxes, the supply of cold gas onto the BHs is reduced leading to lower jet activity. Although the cluster is still heated by this activity as sound waves propagate from the core to the virial radius, the jets inefficiently redistribute gas outwards and a small cooling flow develops, along with low-pressure cavities similar to those detected in X-ray observations. Overall, our jet implementation of AGN feedback quenches star formation quite efficiently, reducing the stellar content of the central cluster galaxy by a factor 3 compared to the no AGN case. It also dramatically alters the shape of the gas density profile, bringing it in close agreement with the beta model favoured by observations, producing quite an isothermal galaxy cluster for gigayears in the process. However, it still falls short in matching the lower than Universal baryon fractions which seem to be commonplace in observed galaxy clusters.Comment: 18 pages, 17 figures, 1 table, Accepted for publication in MNRA

Mass Distribution in Galaxy Clusters: the Role of AGN Feedback

We use 1 kpc resolution cosmological AMR simulations of a Virgo-like galaxy cluster to investigate the effect of feedback from supermassive black holes (SMBH) on the mass distribution of dark matter, gas and stars. We compared three different models: (i) a standard galaxy formation model featuring gas cooling, star formation and supernovae feedback, (ii) a "quenching" model for which star formation is artificially suppressed in massive halos and finally (iii) the recently proposed AGN feedback model of Booth & Schaye (2009). Without AGN feedback (even in the quenching case), our simulated cluster suffers from a strong overcooling problem, with a stellar mass fraction significantly above observed values in M87. The baryon distribution is highly concentrated, resulting in a strong adiabatic contraction (AC) of dark matter. With AGN feedback, on the contrary, the stellar mass in the bright central galaxy (BCG) lies below observational estimates and the overcooling problem disappears. The stellar mass of the BCG is seen to increase with increasing mass resolution, suggesting that our stellar masses converges to the correct value from below. The gas and total mass distributions are in striking agreement with observations. We also find a slight deficit (~10%) of baryons at the virial radius, due to the effect of AGN-driven shock waves pushing gas to Mpc scales and beyond. This baryon deficit results in a slight adiabatic expansion of the dark matter distribution, that can be explained quantitatively by AC theory.Comment: 17 pages, 12 figures, submitted to MNRAS, new version after referee report

The MUSIC of Galaxy Clusters I: Baryon properties and Scaling Relations of the thermal Sunyaev-Zel'dovich Effect

We introduce the Marenostrum-MultiDark SImulations of galaxy Clusters (MUSIC) Dataset, one of the largest sample of hydrodynamically simulated galaxy clusters with more than 500 clusters and 2000 groups. The objects have been selected from two large N-body simulations and have been resimulated at high resolution using SPH together with relevant physical processes (cooling, UV photoionization, star formation and different feedback processes). We focus on the analysis of the baryon content (gas and star) of clusters in the MUSIC dataset both as a function of aperture radius and redshift. The results from our simulations are compared with the most recent observational estimates of the gas fraction in galaxy clusters at different overdensity radii. When the effects of cooling and stellar feedbacks are included, the MUSIC clusters show a good agreement with the most recent observed gas fractions quoted in the literature. A clear dependence of the gas fractions with the total cluster mass is also evident. The impact of the aperture radius choice, when comparing integrated quantities at different redshifts, is tested: the standard definition of radius at a fixed overdensity with respect to critical density is compared with a definition based on the redshift dependent overdensity with respect to background density. We also present a detailed analysis of the scaling relations of the thermal SZ (Sunyaev Zel'dovich) Effect derived from MUSIC clusters. The integrated SZ brightness, Y, is related to the cluster total mass, M, as well as, the M-Y counterpart, more suitable for observational applications. Both laws are consistent with predictions from the self-similar model, showing a very low scatter. The effects of the gas fraction on the Y-M scaling and the presence of a possible redshift dependence on the Y-M scaling relation are also explored.Comment: 22 pages, 25 figures, accepted for pubblication by MNRA

Parosteal Lipoma

Teaching Point: Recognizing the distinct imaging features of parosteal lipoma

Van-e esély az intervertebralis discusok regenerációjára? Elozetes tanulmány

Introduction: Segmental instability of the spine caused by the decreased height of intervertebral discs is one of the major causes of chronic low back pain affecting 70-80% of the adult population. The decrease in height is due to degenerative lesions induced by vertical compression overload of the disc. Objective: A preliminary study was performed to determine if disc degeneration due to overload could be stopped. We hypothesized that disc distraction during fusion surgery from posterior approach could reduce the pressure on the discs, degeneration could be stopped, and perhaps the function could be restored. Methods: To characterize the condition of the discus, we used the determination glycosaminoglycan content, which is responsible for the disc-bound water content and thus for ensuring its elasticity. The use of gadolinium contrast agent in MRI (dGEMRIC) is an accepted method for determining the glycosaminoglycan content of the intervertebral disc, as the concentration of absorbed contrast agent is inversely proportional to the number of glycosaminoglycans in the intervertebral discs. In addition to pre- and postoperative dGEMRIC data, we examined disc height, lumbar lordosis, visual analog pain scale, and the Oswestry Disability Index. Results: All patients underwent monosegmental fusion following posterior distraction of the affected segment due to segmental instability. During the surgeries, lumbar lordosis did not decrease despite posterior distraction. The heights of the discus increased by an average of 3 mm, the pain decreased, and the Oswestry Disability Index improved. In the dGEMRIC studies, an average of 309.18 units/cm2 of gadolinium accumulated in the discs before surgery, which decreased postoperatively to 174.43 units/cm2. All changes were significant at the p = 0.05 significance level. Conclusion: The trend of our preliminary results suggests that increasing the height of the discs can reduce the hydrostatic pressure in the discs, resulting in an increase in the amount of glycosaminoglycans, which can stop the degeneration of the discs and also initiate regeneration processes.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Cervicalgies irradiant dans le membre supérieur gauche

A 31 years old male, HIV negative, with past history of sarcoidosis with articular and pulmonary involvement ,without immunosuppressive therapy, presents two years later with cervical pain radiating to the upper limb. Cervical imaging shows several para vertebral collections and lytic bone lesions. A diagnosis of tuberculous osteo-arthritis is established based on imaging and mycobacterial data.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Oesophageal lesions as first manifestation of necrotising sarcoid granulomatosis

Necrotising sarcoid granulomatosis is a rare disease associating sarcoid-like granulomas, vasculitis and necrosis in the lungs and seldom in extrapulmonary locations. We report the case of a 23-year-old woman with an initial symptom consisting of epigastric pain. Oesophagoscopy demonstrated oesophagitis. Evolution was marked by fever, dyspnoea and pulmonary lesions. The first presumptive diagnosis was Wegener disease but biopsies (of the lungs and the oesophagus) demonstrated the diagnosis of necrotising sarcoid granulomatosis. Evolution was favourable under corticoid therapy. Necrotising sarcoid granulomatosis may present as an extrapulmonary disease and is an important differential diagnosis of other disease such as Wegener disease.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Thrombolysis associated with LUCAS (Lund University Cardiopulmonary Assist System) as treatment of valve thrombosis resulting in cardiac arrest.

Thromboembolic complications remain a frequent cause of morbidity and mortality in patients with a mechanical prosthetic heart valve. We report the case of a 57-year-old female patient admitted for acute respiratory distress. A thrombosis of the St Jude mitral valve was confirmed by transesophageal echocardiography. Surgery was planed, but brutal deterioration of her hemodynamic parameters and cardiac arrest prompted emergency thrombolysis. A LUCAS (Lund University Cardiopulmonary Assist System) chest compression device was used. Rapid recovery of valve mobility was obtained. Hypothesis of this rapid recovery and safety of LUCAS in this setting are discussed. © 2010 Elsevier Inc. All rights reserved.Case ReportsJournal ArticleSCOPUS: ar.jinfo:eu-repo/semantics/publishe

A rare case of primary hyperoxaluria type 1 co-existing with autosomal-dominant polycystic kidney disease in a newborn

We describe the first reported case to our knowledge of an infant presenting with the extremely rare association of primary hyperoxaluria type 1 (PH-1) and autosomal-dominant polycystic kidney disease (ADPKD). This diagnosis was suspected on the basis of the renal US findings and confirmed by complementary examinations. It led to severe oxalosis with very rapid onset of end-stage renal failure (ESRF) and required combined liver-kidney transplantation at the age of 18 months. The boy died 13 days after transplantation. © 2010 Springer-Verlag.SCOPUS: ar.jinfo:eu-repo/semantics/publishe