Pathophysiology of Resistant Hypertension: The Role of Sympathetic Nervous System

Resistant hypertension (RH) is a powerful risk factor for cardiovascular morbidity and mortality. Among the characteristics of patients with RH, obesity, obstructive sleep apnea, and aldosterone excess are covering a great area of the mosaic of RH phenotype. Increased sympathetic nervous system (SNS) activity is present in all these underlying conditions, supporting its crucial role in the pathophysiology of antihypertensive treatment resistance. Current clinical and experimental knowledge points towards an impact of several factors on SNS activation, namely, insulin resistance, adipokines, endothelial dysfunction, cyclic intermittent hypoxaemia, aldosterone effects on central nervous system, chemoreceptors, and baroreceptors dysregulation. The further investigation and understanding of the mechanisms leading to SNS activation could reveal novel therapeutic targets and expand our treatment options in the challenging management of RH

An unusual pattern of three major components of the cardiovascular system: multimodality imaging and review of the literature

INTRODUCTION: Coronary artery anomalies are found in 0.4% to 1.4% of patients who undergo coronary angiography. Anomalous origin of left coronary artery from the right sinus of Valsava is the rarest, with a reported prevalence of 0.02 –0.03% according to angiographic studies. CASE PRESENTATION: We present the rare case of a 42-year-old-man suffering from stable angina with unusual development of 3 major components of the cardiovascular system Coronary angiography revealed an anomalous origin of the left coronary artery from the ostium of the right coronary artery. Magnetic resonance angiography depicted an anomalous origin of the left common carotid artery from the innominate artery and an aneurysm of descending thoracic aorta. Coronary computed tomography angiography revealed the course of left coronary artery between aortic root and conus arteriosus at the level of the right ventricular outflow tract. In this report we attempt to highlight the rarity of this vascular anatomy. CONCLUSION: Anomalous origins of the coronary arteries are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is a matter of paramount importance possibly evaluating the effects of therapeutic intervention. Newer imaging modalities improve the illumination of vascular system anatomy, shedding light to diagnostic dilemmas that come up in daily medical practice

Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation

<p>Abstract</p> <p>Background</p> <p>To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB) is associated with hematoma formation and progression, patient's age and histology of the lesion.</p> <p>Findings</p> <p>177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 ± 44.7 cc vs. 17.2 ± 32.9 cc; p < 0.001, Mann-Whitney-Wilcoxon test for independent samples, MWW); the likelihood of hematoma formation was increasing till a volume equal to 82.6 cc, at which the second-order approach predicts a maximum. The volume of blood suctioned was positively associated with the duration of the procedure (Spearman's rho = 0.417, p < 0.001); accordingly, hematoma formation was also positively associated with the latter (p = 0.004, MWW). The volume of blood suctioned was not associated with patients' age, menopausal status and histopathological diagnosis.</p> <p>Conclusion</p> <p>The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.</p

Vacuum-assisted breast biopsy in close proximity to the skin: a case report

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Effects of lazaroid U-74389G on intestinal ischemia and reperfusion injury

Backround: Mesenteric ischemia occurs in a number of clinically relevant pathophysiologic processes, including sepsis, hemorrhage, intestinal transplantation, severe burns, and mesenteric thrombosis. The readmission of molecular oxygen into an ischemic tissue promotes the oxidation of resuscitated tissue with certain pathophysiologic mechanisms. Materials and methods: Twenty four swine ( male or female) were used in this study. The animals were allocated to four groups with an equal number (n 6) in each group: 1) control group-ischemia for 30 minutes (min) and reperfusion for 60 min (60 rep). 2) control group-ischemia for 30 minutes (min) and reperfusion for 120 min (120rep). 3) ischemia for 30 minutes (min) and immediate iv injection of lazaroid U-74389G in inferior vena cava and reperfusion for 60 min (60rep +drug). 4) ischemia for 30 minutes (min) and immediate iv injection of lazaroid U-74389G and reperfusion for 120 min (120rep +drug). The dose that the lazaroid was administered was 10mg/kgr. Results: We investigated further the role of a powerful antioxidant molecule such as U-74389G and we concluded that there is statistically significant relation in MDA(malondialdeyde), TNF (tumor necrosis factor) measurement in tissue, while the histological score in the groups that the lazaroid was administered was improved.Conclusions: In many emergency clinical situations, such as reperfusion of the intestine, the role of U-74389G could be protective, as well as in solutions that preserve solid organs for transplantation or during reperfusion of them, after the completion of the vessels anastomosis.ΕΙΣΑΓΩΓΗ: H ισχαιμία του μεσεντερίου πραγματοποιείται σε έναν αριθμό ποικίλων παθοφυσιολογικών καταστάσεων, που περιλαμβάνει τη σήψη, την αιμορραγία, την μεταμόσχευση εντέρου, τα σοβαρά εγκαύματα και τη θρόμβωση μεσεντερίου. ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΙ: Τα πειραματόζωα χωριστήκαν σε 4 πειραματικές ομάδες με ίσο αριθμό πειραματοζώων σε κάθε πειραματική ομάδα ( n=6). Η ομάδα του μάρτυρος-ισχαιμίας για 30 λεπτά και επαναιμάτωση για 60 λεπτά (60 rep). Η ομάδα του μάρτυρος-ισχαιμίας για 30 λεπτά και επαναιμάτωση για 120 λεπτά (120 rep). Η ομάδα της-ισχαιμίας για 30 λεπτά και άμεση χορηγηση του λαζαροιδους U-74389G στην κάτω κοίλη φλεβα και επαναιμάτωση για 60 λεπτά (60 rep+drugs). Η ομάδα της-ισχαιμίας για 30 λεπτά και άμεση χορηγηση του λαζαροιδους U-74389G στην κάτω κοίλη φλεβα και επαναιμάτωση για 120 λεπτά (120 rep+drugs). Η δόση με την οποία χορηγήθηκε το μόριο ήταν ισχυρά αντιοξειδωτική με 10mg/kgr. ΑΠΟΤΕΛΕΣΜΑΤΑ: Διερευνήσαμε περαιτέρω το ρόλο ενός ισχυρού αντιοξειδωτικού μορίου, όπως το U-74389G και καταλήξαμε στο συμπέρασμα ότι υπάρχει στατιστικά σημαντική σχέση με το MDA, TNF (μέτρηση στον ιστό), ενώ η παθολογοανατομικη βαθμονόμηση των ομάδων του λαζαροειδούς παρουσίασε βελτιώση. ΣΥΜΠΕΡΑΣΜΑΤΑ: Σε πολλές επείγουσες κλινικές καταστάσεις, όπως είναι επαναιμάτωση του εντέρου, ο ρόλος του U-74389G θα μπορούσε να είναι προστατευτικός, καθώς και σε διαλύματα που διατηρούν σταθερά τα οργάνα για μεταμόσχευση ή κατά τη διάρκεια της επαναιμάτωσης αυτών, μετά την ολοκλήρωση της αναστόμωσης των αγγείων. Τέλος, η χορήγηση των λαζαροίδων θα μπορούσε να χρησιμοποιηθεί για την προστασία των ιστών μετά την αναπτυξη του αιμορραγικού σοκ

Congenital peritoneal encapsulation of the small intestine: A rare case report

Introduction: Peritoneal Encapsulation (PE) is a scarce congenital malformation, characterized by a supplementary peritoneal membrane that covers all or a part of the small intestine. Presentation of case: PE was unexpectantly discovered in a young woman during laparotomy for bowel obstruction. There were no specific pre-operative indications of this malformation. The operation was uneventful. Discussion: PE is a very rare congenital anatomical anomaly that is difficultly identified pre-operatively. PE is mainly asymptomatic, but in some cases, like in the presented one, PE presents with small bowel obstruction. Surgeons should be aware of this malformation and suspect it when encountering a patient with small bowel obstruction without other etiological factors. Conclusion: Knowledge of this peculiar congenital anomaly is pivotal, so that accurate diagnosis and appropriate management of it are direct and efficient

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies

Circulating levels of matrix metalloproteinase-9 (MMP-9), neutrophil gelatinase-associated lipocalin (NGAL) and their complex MMP-9/NGAL in breast cancer disease

<p>Abstract</p> <p>Background</p> <p>Recent evidence suggests that neutrophil gelatinase-associated lipocalin (NGAL) expression is induced in many types of human cancer, while detection of its complex with matrix metalloproteinase-9 (MMP-9) is correlated with cancer disease status. We aim to evaluate the serum expression of MMP-9, NGAL and their complex (MMP-9/NGAL) during the diagnostic work-up of women with breast abnormalities and investigate their correlation with disease severity.</p> <p>Methods</p> <p>The study included 113 women with non-palpable breast lesions undergoing vacuum-assisted breast biopsy for histological diagnosis, and 30 healthy women, which served as controls. Expression levels of MMP-9, NGAL and their complex MMP-9/NGAL were determined in peripheral blood samples with immunoenzymatic assays.</p> <p>Results</p> <p>Women with invasive ductal carcinoma exhibited significantly increased levels of MMP-9, NGAL and MMP-9/NGAL compared to healthy controls (MMP-9: p < 0.003, NGAL: p < 0.008 MMP-9/NGAL: p < 0.01). Significant correlations were observed between MMP-9 and NGAL serum levels and breast disease severity score (r = 0.229, p < 0.006 and r = 0.206, p < 0.01, respectively), whereas a non-significant correlation was found for their complex. MMP-9, NGAL and their complex MMP-9/NGAL levels were not correlated with either Body Mass Index (BMI) or age of patients.</p> <p>Conclusion</p> <p>These findings suggest that the serum measurement of MMP-9 and NGAL may be useful in non-invasively monitoring breast cancer progression, while supporting their potential role as early biomarkers of breast disease status.</p