Retroperitoneal bronchogenic cyst originating from diaphragmatic crura

Bronchogenic cyst is a benign lesion which is commonly seen in the posterior mediastinum. Diaphragmatic origin in retroperitoneum is an unusual location for a bronchogenic cyst. Cross-sectional imaging modalities describe the origin and content of the cyst evidently. Magnetic resonance (MR) images of a 42-year-old male patient who attended ER with back pain revealed a huge retroperitoneal complicated bronchogenic cyst arising from the diaphragm and surrounding the abdominal aorta anteriorly. Bronchogenic cysts in the retroperitoneum rarely originate from the diaphragm and should be kept in mind in the differential diagnoses of abdominal cystic lesions. MR imaging (MRI) is superior to other imaging techniques such as computerized tomography (CT) in detecting the origin and content of these cystic lesions. © 2014, Association of Surgeons of India

Upgrades from Previous Cardiac Implantable Electronic Devices Compared to De Novo Cardiac Resynchronization Therapy Implantations: Results from CRT Survey-II in the Turkish Population

Objective: Cardiac resynchronization therapy is the guideline-directed treatment option in selected heart failure with reduced left ventricular ejection fraction patients. Data regarding the contemporary clinical practice of cardiac resynchronization therapy in Turkey have been published recently. This sub-study aims to compare clinical and periprocedural characteristics between cardiac resynchronization therapy upgrade and de novo implantations. Methods: Turkish arm of the Cardiac Resynchronization Therapy Survey-II was conducted between October 1, 2015, and December 31, 2016, at 16 centers. All consecutive patients who underwent an upgrade to cardiac resynchronization therapy system (n=60) or de novo cardiac resynchronization therapy implantation (n=335) were eligible. Results: Distribution of age, gender, and heart failure etiology were similar in the 2 groups. Atrial fibrillation, valvular heart disease, and chronic kidney disease were more common in cardiac resynchronization therapy upgrade patients. Narrow intrinsic QRS duration and left ventricular ejection fraction being 75% in both groups, and only beta-blockers were prescribed at rates of >90% in both groups. Conclusion: Cardiac resynchronization therapy upgrades are performed with high procedural success rates and without excess periprocedural complication risk. Feared complications of cardiac resynchronization therapy upgrades due to the pre-existing device should not delay the procedure if indicated.publishedVersio

The roles of pre–P-wave versus peri–P-wave fractionated electrograms for atrial substrate beyond entrainment response

Atrial tachycardia (AT) with alternating cycle lengths is sparsely reported, and, hence, the ideal mapping strategy has not been firmly established. Beyond the entrainment during tachycardia, some fragmentation characteristics might also give important clues for its possible participation in the macro–re-entrant circuit. We discuss a patient with prior atrial septal defect surgical closures who presented with dual macro–re-entrant ATs related to a fragmented area on the right atrial free wall (240 ms) and the cavotricuspid isthmus (260 ms), respectively. After ablation of the fastest AT on the lateral right atrial free wall, the cycle of the first AT changed to the second AT that was interrupted on cavotricuspid isthmus, proving the dual tachycardia mechanism. This case report addresses the utilization of electroanatomic mapping information as well as fractionated electrogram timing with respect to the surface P-wave as guides for ablation location

Paradoxical para-hisian pacing response

Para-Hisian pacing (PHP) is among the most useful maneuvers in cardiac electrophysiology during sinus rhythm and identifies whether retrograde conduction is dependent on the atrioventricular (AV) node. In this maneuver, the retrograde activation time and pattern are compared during capture and loss of capture of the His bundle while pacing from a paraHisian position. A common misconception about PHP is that it is useful only for septal accessory pathways (APs). However, even with left or right lateral pathways, as long as pacing from the para-Hisian region conducts to the atrium with the activation sequence being analyzed, it can be used to determine whether that activation is AV node–dependent or AP-dependent

The initial part of polymorphic ventricular tachycardia as a clue for the sustainability of tachycardia and ablation success: A varying degree of purkinje–Myocardial complicity?

The cardiac Purkinje system is capable of very rapid burst activity suggestive of its potential role in being a driver of polymorphic ventricular tachycardia (VT) (PMVT) or ventricular fibrillation (VF). It plays a pivotal role, however, not only in the triggering of but also the perpetuation of ventricular arrhythmias. A varying degree of Purkinje–myocardial complicity has been blamed in determining not only the sustained or non-sustained nature of PMVT but also the pleomorphism of the non-sustained runs. The initial part of PMVT before cascading to the whole ventricle to establish disorganized VF can give important clues for ablation of PMVT and VF. We present a case of an electrical storm after acute myocardial infarction that was successfully ablated after identifying Purkinje potentials that triggered polymorphic, monomorphic, and pleiomorphic VTs and VF

Kalsifik Aort Darlığı Patogenezinde Barsak Mikrobiyotasının Rolünün Araştırılması

Calcific aortic valve disease (CAVD) is the most prevalent valvular heart disease. However, its pathogenesis has not been elucidated clearly. Gut microbiota has recently shown to be associated with atherosclerosis and several degenerative diseases. In this study, we aimed to investigate the role of gut microbiota in the pathogenesis of CAVD. We recruited eligible subjects with calcific aortic stenosis (CAS) (n= 60), aortic sclerosis (ASc) (n= 49) and age- and gender- matched control subjects (n= 48). Besides routine cardiovascular (CV) examination; arterial stiffness and 2D speckle tracking echocardiography were performed. Coronary artery, aortic valve and mitral annular calcium scores from computed tomographic (CT) scans were recorded. Besides routine laboratory tests, plasma levels of gut microbiota metabolites, namely choline, betaine and trimethylamine N- oxide (TMAO), and serum levels of biomarkers related to calcification (osteopontin [OPN]) and tissue remodeling (tissue inhibitor of matrix metalloproteinase- 1 [TIMP- 1], matrix metalloproteinase- 9 [MMP- 9]) were measured. Histopathological examinations were performed in aortic valves excised during aortic valve surgery due to either severe CAS or any other non- stenotic disease of the aortic valve. Prevalence of traditional CV risk factors, co- morbidities or medications did not differ among groups. The study population had normal levels of calcium- phosphorus product, alkaline phosphatase, parathyroid hormone and 25- hydroxyvitamin D. Reflective of systemic inflammation, C- reactive protein levels were also similar among patient groups. Patients with moderate- severe CAS had significantly higher plasma levels of choline, a marker of gut microbiota metabolism, when compared to both ASc (p=0.006) and control (p<0.001) groups. Plasma betaine/ choline ratio, which is another marker of gut microbiota metabolism, was significantly lower in patients with moderate- severe CAS compared to both ASc (p= 0.009) and control (p= 0.002) groups. Plasma TMAO levels did not statistically differ between groups (p=0.509). Plasma choline levels were significantly correlated with determinants of CAS severity, namely aortic peak flow velocity (p< 0.001) and aortic valve calcium score (p< 0.001). Plasma choline levels were also independently associated with aortic peak flow velocity (p= 0.009). There was a significant negative correlation between betaine/ choline ratio and aortic peak flow velocity (p< 0.001). In histopathological examinations, plasma choline levels were significantly elevated in patients who had aortic valves with denser lymphocyte infiltration (p< 0.001), more severe tissue remodeling (p= 0.002) and calcification (p= 0.002), neovascularization (p= 0.011), and osteoid metaplasia (p=0.004). These valves also demonstrated significantly higher CD11c+ dendritic cell and plasma cell infiltration, reflecting the chronic inflammatory nature of the disease. Our study hereby demonstrates a significant association between gut microbiota metabolites and CAVD presence and severity evaluated with echocardiography, computed tomography and histopathological examinations for the first time in the literature.Bu çalışma, Türk Kardiyoloji Derneği (Proje No: 2016/ 3) tarafından desteklenmiştir.Kalsifik aort kapak hastalığı (KAKH), en sık görülen kalp kapak hastalığıdır; ancak patogenezi halen net olarak bilinmemektedir. Son zamanlarda barsak mikrobiyotasının ateroskleroz ve bazı dejeneratif hastalıklar ile ilişkisi olduğu bildirilmiştir. Bu çalışmada, KAKH patogenezinde barsak mikrobiyotasının rolünün incelenmesi hedeflenmiştir. Bu amaçla kalsifik aort darlığı (KAD) (n= 60), aort sklerozu (ASc) (n= 49) olan hastalar ile yaş ve cinsiyet eşlenik kontroller (n= 48) çalışmaya dahil edilmiştir. Rutin kardiyovasküler (KV) değerlendirmenin yanısıra arteriyel sertlik ve 2D speckle tracking ekokardiyografi (STE) gerçekleştirilmiştir. Kardiyak bilgisayarlı tomografi (BT) taramalarından koroner arter, aort kapak ve mitral annüler kalsifikasyon skorları kaydedilmiştir. Rutin laboratuvar testlerine ek olarak; kolin, betain, trimetilamin N- oksit (TMAO) adlı barsak mikrobiyota metabolitlerinin plazma düzeyleri ile ossifikasyon (osteopontin [OPN]) ve doku yeniden biçimlenmesi (matriks metalloproteinaz doku inhibitörü- 1 [TIMP- 1], matriks metalloproteinaz- 9 [MMP- 9]) ile ilişkili biyobelirteçlerin serum düzeyleri ölçülmüştür. Ciddi KAD veya aort kapağın darlık dışı herhangi bir hastalığı nedeniyle yapılan aort kapak cerrahisi esnasında çıkarılan aort kapaklarında histopatolojik incelemeler gerçekleştirilmiştir. Gruplar arasında geleneksel KV risk faktörleri, komorbiditeler ve ilaç tedavileri bakımından farklılık izlenmemiştir. Tüm çalışma grubunda kalsiyum- fosfor çarpımı, alkalen fosfataz, paratiroid hormon ve 25- hidroksivitamin D düzeyleri normal aralıkta saptanmıştır. Gruplar arasında sistemik inflamasyonun belirteci olan C- reaktif protein düzeylerinin de benzer olduğu görülmüştür. Orta- ciddi KAD hastalarında barsak mikrobiyota metabolizmasının göstergesi olan plazma kolin düzeyleri, ASc (p= 0.006) ve kontrol (p= 0.001) gruplarıyla kıyaslandığında anlamlı biçimde daha yüksek bulunmuştur. Orta- ciddi KAD hastalarında barsak mikrobiyota metabolizmasının bir diğer göstergesi olan plazma betain/kolin oranı ise, ASc (p= 0.009) ve kontrol (p= 0.002) gruplarıyla kıyaslandığında anlamlı biçimde daha düşük saptanmıştır. Plazma TMAO düzeyleri bakımından gruplar arasında farklılık gözlenmemiştir (p= 0.509). Plazma kolin düzeylerinin, KAD ciddiyetini belirlemede kullanılan aort kapağın zirve akım hızı (p< 0.001) ve aort kapak kalsiyum skoru (p< 0.001) ile anlamlı pozitif korelasyon gösterdiği, aort kapağın zirve akım hızının bağımsız öngörücüsü olduğu belirlenmiştir (p= 0.009). Betain/ kolin oranının ise KAD ciddiyetini yansıtan aort kapağın zirve akım hızı ile anlamlı negatif korelasyon gösterdiği izlenmiştir (p< 0.001). Histopatolojik incelemelerde daha yoğun lenfosit infiltrasyonu (p< 0.001), daha ciddi doku yeniden biçimlenmesi (p= 0.002) ile kalsifikasyon (p= 0.002), neovaskülarizasyon (p= 0.011) ve osteoid metaplazi (p= 0.004) gözlenen kapaklarda plazma kolin düzeylerinin anlamlı biçimde daha yüksek olduğu saptanmıştır. Bu kapaklarda CD11c+ dendritik hücre ve plazma hücre infiltrasyonunun da, hastalığın kronik inflamatuvar seyrini yansıtan biçimde, anlamlı olarak daha yoğun olduğu gözlenmiştir. Çalışmamız sonucunda barsak mikrobiyota metabolitleri ile ekokardiyografik, BT ve histopatolojik incelemelerle değerlendirilen KAKH varlığı ve ciddiyeti arasındaki ilişki; literatürde ilk defa ortaya konmuştur

Total right ovarian vein thrombosis after cesarean section

Abstract Not Availabl

New Fe3+ specific "turn-on" fluorescent sensor based on H-2 saldien-substituted phenanthroimidazole: Fabrication and practical applications

WOS:000681039600099Precise recognition of Fe3+ in a biological system and ecological environment is of great importance. Therefore, a new phenanthroimidazole based chemosensor SP (H-2 saldien-substituted phenanthroimidazole) was designed, fabricated and evaluated as a facile fluorogenic "OFF-ON" type chemosensor toward Fe3+ in aqueous solution. The SP could sensitively and selectively recognize Fe3+ with a limit of detection of 0.36 mu M. The sensing mechanism for the SP-Fe3+ system was successfully proven on FT-IR spectroscopy, TOF-MS and the calculations of DFT (density functional theory). It is found that the SP could be basically recycled through treating with EDTA. Moreover, Fe3+ can be visualized by prepared SP in the test kit and low-cost smartphone sensor applications. Evidently, the experiments manifested that the prepared SP was capable of recognizing of Fe3+ in aqueous media. (C) 2021 Elsevier B.V. All rights reserved

Association of real-time sonoelastography findings with clinical parameters in lateral epicondylitis

The objective of this study was to investigate the role of real-time sonoelastography (RTSE) in patients with lateral epicondylitis (LE) and whether it is associated with clinical parameters. Seventeen patients with unilateral LE were enrolled in the study. The healthy elbows of the participants constituted the control group. Using B-mode ultrasound, color Doppler ultrasound, and RTSE, we prospectively examined 34 common extensor tendon elbows of 17 patients. Both color scales and strain ratio were used for evaluating RTSE images. Two radiologists evaluated the RTSE images separately. Elbow pain was scored on a 100-mm visual analog scale (VAS). Symptom duration and the presence of nocturnal pain were questioned. Quick disabilities of arm shoulder and hand (DASH) Questionnaire was applied to assess the pain, function, and disability. Nottingham health profile (NHP) was used to determine and quantify perceived health problems. Both color scales and strain ratios of the affected tendon portions were significantly different from that of healthy tendons (p < 0.001). There was no significant association between NHP, VAS, Quick DASH scores, and color scales and strain ratio. Strain ratio of the medial portion of the affected tendon was significantly correlated with symptom duration (rho = −0.61 p = 0.010) and nocturnal pain (rho = 0.522 p = 0.031). Interobserver agreement was substantial for color scales (κ = 0.74, p = 0.001) and strain ratio (ICC = 0.61, p = 0.031). RTSE may facilitate differentiation between healthy and affected elbows as a feasible and practical supplementary method with substantial interobserver agreement. RTSE was superior to B-mode ultrasound and color Doppler ultrasound in discriminating tendons with LE. Strain ratio of the medial portion of the tendon is associated moderately with nocturnal pain and symptom duration. No other associations were present between RTSE findings and clinical or functional parameters. © 2015, Springer-Verlag Berlin Heidelberg