Ectopic pancreas tissue appearing in a mediastinal cyst

Heterotopia of pancreatic tissue is a common developmental anomaly. Although ectopic pancreatic tissue is mostly found in the gastrointestinal tract, localization in the mediastinum is extremely rare. We report a 32-year-old male patient who had an urgent thoracotomy two years ago due to a thoracic surgery. During the thoracotomy fragments of a partly necrotic cystic mass in the right thorax were removed and decortication was performed. Two years later the patient was hospitalized again because of haemoptoe and atypical chest pain. A residual cystic mass was detected between the right hilum and the ascending aorta connecting to the pericardium, the superior vena cava and the aorta on the chest CT. After the operation a mediastinal cyst was diagnosed, with a pancreatic tissue by histology

Elevated Levels of Asymmetric Dimethylarginine (ADMA) in the Pericardial Fluid of Cardiac Patients Correlate with Cardiac Hypertrophy.

Pericardial fluid (PF) contains several biologically active substances, which may provide information regarding the cardiac conditions. Nitric oxide (NO) has been implicated in cardiac remodeling. We hypothesized that L-arginine (L-Arg) precursor of NO-synthase (NOS) and asymmetric dimethylarginine (ADMA), an inhibitor of NOS, are present in PF of cardiac patients and their altered levels may contribute to altered cardiac morphology.L-Arg and ADMA concentrations in plasma and PF, and echocardiographic parameters of patients undergoing coronary artery bypass graft (CABG, n = 28) or valve replacement (VR, n = 25) were determined.We have found LV hypertrophy in 35.7% of CABG, and 80% of VR patients. In all groups, plasma and PF L-Arg levels were higher than that of ADMA. Plasma L-Arg level was higher in CABG than VR (75.7 ± 4.6 μmol/L vs. 58.1 ± 4.9 μmol/L, p = 0.011), whereas PF ADMA level was higher in VR than CABG (0.9 ± 0.0 μmol/L vs. 0.7 ± 0.0 μmol/L, p = 0.009). L-Arg/ADMA ratio was lower in the VR than CABG (VRplasma: 76.1 ± 6.6 vs. CABGplasma: 125.4 ± 10.7, p = 0.004; VRPF: 81.7 ± 4.8 vs. CABGPF: 110.4 ± 7.2, p = 0.009). There was a positive correlation between plasma L-Arg and ADMA in CABG (r = 0.539, p = 0.015); and plasma and PF L-Arg in CABG (r = 0.357, p = 0.031); and plasma and PF ADMA in VR (r = 0.529, p = 0.003); and PF L-Arg and ADMA in both CABG and VR (CABG: r = 0.468, p = 0.006; VR: r = 0.371, p = 0.034). The following echocardiographic parameters were higher in VR compared to CABG: interventricular septum (14.7 ± 0.5 mm vs. 11.9 ± 0.4 mm, p = 0.000); posterior wall thickness (12.6 ± 0.3 mm vs. 11.5 ± 0.2 mm, p = 0.000); left ventricular (LV) mass (318.6 ± 23.5 g vs. 234.6 ± 12.3 g, p = 0.007); right ventricular (RV) (33.9 ± 0.9 cm2 vs. 29.7 ± 0.7 cm2, p = 0.004); right atrial (18.6 ± 1.0 cm2 vs. 15.4 ± 0.6 cm2, p = 0.020); left atrial (19.8 ± 1.0 cm2 vs. 16.9 ± 0.6 cm2, p = 0.033) areas. There was a positive correlation between plasma ADMA and RV area (r = 0.453, p = 0.011); PF ADMA and end-diastolic (r = 0.434, p = 0.015) and systolic diameter of LV (r = 0.487, p = 0.007); and negative correlation between PF ADMA and LV ejection fraction (r = -0.445, p = 0.013) in VR.We suggest that elevated levels of ADMA in the PF of patients indicate upregulated RAS and reduced bioavailability of NO, which can contribute to the development of cardiac hypertrophy and remodeling

Correlations between ADMA levels and echocardiographic parameters of patients undergoing VR surgery.

<p>ADMA: asymmetric dimethylarginine; PF: pericardial fluid; VR: valve replacement; RV: area of right ventricle; IVS: thickness of interventricular septum; PW: thickness of posterior wall; Ds of LV: end-systolic diameter of left ventricle; Dd of LV: end-diastolic diameter of left ventricle; RA: area of right atria; LA: area of left atria; LVM: left ventricular mass; LVEF: left ventricular ejection fraction; R: Pearson’s correlation coefficient; R²: R-squared value.</p><p>Correlations between ADMA levels and echocardiographic parameters of patients undergoing VR surgery.</p

Proposed mechanisms by which elevated level of ADMA in pericardial fluid elicits hypertrophy/remodeling of cardiac muscle: accordingly, reduced NO bioavailability and increased level of Ang II together leads to development of cardiac hypertrophy/remodeling.

<p>ADMA–asymmetric dimethylarginine, NO–nitric oxide, NOS–endothelial NO synthase, RAS–renin-angiotensin-system, Ang II–angiotensin II, ROS–reactive oxygen species.</p

Characteristics of the patients and medications.

<p>Data are mean <b>±</b> SEM.</p><p>*indicating blood pressure of 140/90 was considered normal in both cardiac groups [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0135498#pone.0135498.ref063" target="_blank">63</a>].</p><p>^#indicating medications in monotherapy for CABG (using beta-blocker or ACE inhibitor) and VR (using diuretic or ACE inhibitor).</p><p>CABG: coronary artery bypass graft; VR: valve replacement; AMI: acute myocardial infarction, Estimated GFR: estimated GFR calculated by the Modification of Diet in Renal Disease (MDRD) GFR, sCr: serum creatitine, NCP–non-cardiac patients; CABG–coronary artery bypass graft; VR–valve replacement.</p><p>Characteristics of the patients and medications.</p

Correlations between the levels of asymmetric dimethylarginine (ADMA) and echocardiographic parameters of patients undergoing valve replacement (VR) surgery.

<p>(A) plasma ADMA vs. area of right ventricle (<i>y</i> = 10.438<i>x</i> + 25.49, <i>r</i> = 0.453, <i>p</i> = 0.011); (B) PF ADMA vs. left ventricular (LV) end-systolic diameter (<i>y</i> = 23.689<i>x</i> + 13.53, <i>r</i> = 0.487, <i>p</i> = 0.007); (C) PF ADMA vs. LV end-diastolic diameter (<i>y</i> = 20.531<i>x</i> + 34.72, r = 0.434, p = 0.015); D: PF ADMA vs. LV ejection fraction (<i>y</i> = -16.779<i>x</i> + 73.55, r = -0.445, p = 0.013).</p

Morphological parameters of ventricles and atria of patients undergoing coronary artery bypass graft (CABG, n = 28) or valve replacement (VR, n = 25) surgery.

<p>(A) The thickness of interventricular septum (IVS) and posterior wall (PW), (B) the right ventricular (RV), the right atrial (RA) and the left atrial (LA) areas and (C) the left ventricular mass significantly higher in VR compared to CABG. Mean±SEM. p<0.05.</p

Correlations between the levels of L-Arg and asymmetric dimethylarginine (ADMA) in plasma and pericardial fluid (PF) of patients undergoing coronary artery bypass graft or valve replacement surgery.

<p>(A) plasma L-Arg vs. ADMA of CABG patients (<i>y</i> = 0.006<i>x</i> + 0.21, <i>r</i> = 0.539, <i>p</i> = 0.002); (B) PF L-Arg vs. ADMA of CABG and VR patients (CABG: <i>y</i> = 0.005<i>x</i> + 0.39, <i>r</i> = 0.468, <i>p</i> = 0.006; VR: <i>y</i> = 0.003<i>x</i> + 0.67, <i>r</i> = 0.371, <i>p</i> = 0.034); (C) plasma vs. PF L-Arg of CABG patients (<i>y</i> = 0.347<i>x</i> + 50.69, r = 0.357, p = 0.031); (D) plasma vs. PF ADMA of VR patients (<i>y</i> = 0.498<i>x</i> + 0.50, r = 0.529, p = 0.003).</p

Association between Obesity and Overweight and Cardiorespiratory and Muscle Performance in Adolescents

The high prevalence of obesity in childhood and adolescence has major public health consequences, since it is associated with various chronic diseases in the short- and long-term. The goal of our study was to examine the possible association between obesity and overweight and cardiorespiratory and muscle performance during a 4-year follow up period in adolescents. The body mass index (BMI) and physical performance of adolescents (360 girls and 348 boys) between 14&ndash;18 years of age was measured twice a year, and the possible correlation between overweight and obesity and cardiorespiratory and muscle performances were investigated. Our results revealed that cardiorespiratory performance increased significantly in boys during the 4 years (p &lt; 0.001), but the aerobic performance of girls only showed seasonal fluctuation. Muscle performance significantly increased both in boys and girls (p &lt; 0.001). Inverse association between obesity and cardiorespiratory and muscle performance was proved. Overweight was also inversely correlated with cardiorespiratory performance, but it demonstrated no correlation with muscle strength. Avoiding increased BMI and decreased physical fitness is essential for adolescents&rsquo; health to prevent short- and long-term adverse effects