Intrapericardial Bronchogenic Cyst: An Unusual Clinical Entity

Mediastinal cysts are extremely rare clinical disorders. They usually have a pericardial origin. In this report, we present a 27-year-old male patient with a mediastinal bronchogenic cyst together with clinical presentation and management of the pathology

Impact of Altered Mineral Metabolism on Pathological Cardiac Remodeling in Elevated Fibroblast Growth Factor 23

Clinical and experimental studies indicate a possible link between high serum levels of fibroblast growth factor 23 (FGF23), phosphate, and parathyroid hormone (PTH), deficiency of active vitamin D (1,25D) and klotho with the development of pathological cardiac remodeling, i.e., left ventricular hypertrophy and myocardial fibrosis, but a causal link has not been established so far. Here, we investigated the cardiac phenotype in klotho hypomorphic (kl/kl) mice and Hyp mice, two mouse models of elevated FGF23 levels and klotho deficiency, but differing in parameters of mineral metabolism, by using histology, quantitative real-time PCR, immunoblot analysis, and serum and urine biochemistry. Additionally, the specific impact of calcium, phosphate, PTH, and 1,25D on hypertrophic growth of isolated neonatal rat cardiac myocytes was investigated in vitro. Kl/kl mice displayed high serum Fgf23 levels, increased relative heart weight, enhanced cross-sectional area of individual cardiac myocytes, activated cardiac Fgf23/Fgf receptor (Fgfr) 4/calcineurin/nuclear factor of activated T cell (NFAT) signaling, and induction of pro-hypertrophic NFAT target genes including Rcan1, bMHC, brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) as compared to corresponding wild-type (WT) mice. Investigation of fibrosis-related molecules characteristic for pathological cardiac remodeling processes demonstrated ERK1/2 activation and enhanced expression of Tgf-β1, collagen I, and Mmp2 in kl/kl mice than in WT mice. In contrast, despite significantly elevation of serum and cardiac Fgf23, and reduced renal klotho expression, Hyp mice showed no signs of pathological cardiac remodeling. Kl/kl mice showed enhanced serum calcium and phosphate levels, while Hyp mice showed unchanged serum calcium levels, lower serum phosphate, and elevated serum iPTH concentrations compared to corresponding WT mice. In cultured cardiac myocytes, treatment with both calcium or phosphate significantly upregulated endogenous Fgf23 mRNA expression and stimulated hypertrophic cell growth and expression of pro-hypertrophic genes. The treatment with PTH induced hypertrophic cell growth only, and stimulation with 1,25D had no significant effects. In conclusion, our data indicate that Hyp mice, in contrast to kl/kl mice appear to be protected from pathological cardiac remodeling during conditions of high FGF23 levels and klotho deficiency, which may be due, at least in part, to differences in mineral metabolism alterations, i.e., hypophosphatemia and lack of hypercalcemia

Ascending aortobifemoral bypass surgery simultaneously with coronary revascularization

Ateroskleroz sistemik bir hastalık olup, koroner arter hastalığı ile aortoiliyak tıkayıcı hastalık sıklıkla birlikte seyredebilir. 2004-2014 yılları arasında Anabilim dalımıza koroner arter hastalığı ve Leriche sendromu olan üç hasta başvurdu. Hastalara koroner arter baypas cerrahisi ile eş zamanlı çıkan aortobifemoral baypas uygulandı. Bir hastaya ek olarak karotis endarterektomi yapıldı. Hastalar altı ay süresince takip edildi. Ameliyat sonrası üçüncü ayda tekrarlanan bilgisayarlı tomografi anjiyografilerinde koroner ve periferik greftler açıktı ve yeni lezyon yoktu. Sonuç olarak, asendan aortobifemoral baypas, koroner revaskülarizasyon uygulanacak hastalarda umut verici başarılı erken ve orta dönem sonuçlar ile eş zamanlı uygulanabilir bir yöntemdir.Atherosclerosis is a systemic disorder and coronary artery disease may frequently coexist with aortoiliac occlusive disease. Between 2004-2014, three patients were admitted to our institution with coronary artery disease and Leriche syndrome. The patients underwent coronary artery bypass surgery and ascending aortobifemoral bypass simultaneously. One patient underwent additional carotid endarterectomy. The patients were followed over six months. Repeated postoperative computed tomography angiography at three months showed patent coronary and peripheral grafts and no additional lesions were present. In conclusion, simultaneous ascending aortobifemoral bypass appears to be an applicable procedure with promising short and mid-term results in patients receiving coronary revascularization