Successful Vaginal Delivery of a Pregnant Woman with Cantrell's Pentalogy

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution

Takayasu's Arteritis Treated by Percutaneous Transluminal Angioplasty with Stenting in the Descending Aorta

A 17-yr-old young woman was referred to our hospital with a 2-yr history of claudication of the lower extremities and severe arterial hypertension. Physical examination revealed significantly different blood pressures between both arms (160/92 and 180/95 mmHg) and legs (92/61 and 82/57 mmHg). The hematological and biochemical values were within their normal ranges, except for the increased erythrocyte sedimentation rate (83 mm/hr) and C-reactive protein (6.19 mg/L). On 3-dimensional computed tomographic angiography, the ascending aorta, the aortic arch and its branches, and the thoracic and, descending aorta, but not the renal artery, were shown to be stenotic. The diagnosis of type IIb Takayasu's arteritis was made according to the new angiographic classification of Takayasu's arteritis, Takyasu conference 1994. Percutaneous transluminal angioplasty with stenting was performed on the thoracic and abdominal aorta. After the interventional procedures, the upper extremity blood pressure improved from 162/101 mmHg to 132/85 mmHg, respectively. She has been free of claudication and there have been no cardiac events during 2-yr of clinical follow-up

Unimolecular reactions of gaseous picoline radical cations. A new experimental and computational study

Letzel M, Barth D, Kuck D, et al. Unimolecular reactions of gaseous picoline radical cations. A new experimental and computational study. International Journal Of Mass Spectrometry. 2013;336:1-16.The fragmentation reactions of the molecular ion of the three isomeric methylpyridines (2-picoline 1, 3-picoline 2, and 4-picoline 3) were studied using methods of tandem mass spectrometry and quantum chemical calculations with Gaussian-3 (G3) theory using the B3LYP density functional method (G3//B3LYP). Additionally RRKM calculations of the microcanonical rate constants of selected reaction pathways were performed. Derivatives of 2- and 4-picoline which bear an isotopically labeled methyl substituent (CD3: 1-d(3) and 3-d(3), (CH3)-C-13: 1-C-13 and 3-C-13) were also analyzed. Of the four primary dissociation reactions of the picoline radical cations 1(center dot+)-3(center dot+), the loss of a hydrogen atom, the elimination of an ethyne molecule and the elimination of a hydrogen cyanide molecule are observed in the MIKE spectra, while the loss of a methyl radical is only found in the collisional activation (CA) mass spectra of the molecular ions. The CA mass spectra of the labeled picoline radical ions reveal that some positional hydrogen exchange and carbon exchange takes place before the loss of the methyl radical. According to the G3 and RRKM calculations, the direct cleavage of the methyl substituent competes effectively with increasing internal energy of the ion with the loss of a methyl radical after rearrangements. The other three pathways found for metastable molecular ions are accompanied by efficient or complete hydrogen scrambling. The theoretical calculations prove that this scrambling occurs mainly by initial H-transfer from the methyl group to the pyridine ring and a subsequent H-ring walk. The calculations show further, that loss of H-center dot may occur from many of the intermediate ions after the rearrangements but that the direct loss of H-center dot from the methyl substituent competes successfully even at low energies, contrary to the behavior of the toluene radical ion. The elimination of an ethyne molecule gives rise to a broad flat-topped signal in the mass-analyzed ion kinetic energy (MIKE) spectra, and the MIKE spectra of 1-C-13 and 3-C-13 exhibit a 1:1 sharing of the C-13-label between ionic and neutral products. These particular features are explained by the theoretical calculations by a first rearrangement of the picoline radical cations to a seven-membered aza-cycloheptatriene radical cation 4(center dot+) followed by a rearrangement to a more rigid bicyclo-[3.2.0] isomer before the elimination of ethyne. Finally, the elimination of a hydrogen cyanide molecule exhibits only minor loss of C-13-label in the case of 1-C-13 and 3-C-13. This observation does not agree with any mechanism including a rearrangement to 4(center dot+). The theoretical calculations suggest that instead the loss of the hydrogen cyanide molecule proceeds by a cleavage of the pyridine ring after the initial H-transfer from the methyl substituent Although this pathway needs more energy than a rearrangement to 4(center dot+), its rate coefficients are superior owing to its loose transition states. (C) 2012 Elsevier B.V. All rights reserved