Rupture of a pacemaker lead during the course of infective endocarditis

A 23-year-old male who had a VDDR pacemaker implanted seven years ago due to sick sinus syndrome and recurrent syncope episodes was admitted with symptoms of dyspnea, fever, and tachycardia, which were present for a few days. He was suspected to be suffering from pneumonia and underwent computed tomography scanning of the thorax, which revealed widespread infiltration in the lung parenchyma and pulmonary emboli. Transthoracic echocardiography revealed an extremely mobile echogenic structure in the right atrium, which was determined to be the free portion of a ruptured pacemaker lead. There was an overlying thrombus and/or vegetation-like organized soft tissue within the right ventricle around the lead component. In this article, the rupture of a permanent pacemaker lead, which complicated the course of infective endocarditis associated with pulmonary embolism and pneumonia is reported. We hypothesize that the underlying mechanism for the rupture is soft tissue entrapment within the right ventricle. Unfortunately, this rare and life-threatening situation led to the death of our patient after the surgical removal of the device and its components. © 2013 Turkish Society of Cardiology

The role of visceral adiposity index levels in predicting the presence of metabolic syndrome and insulin resistance in overweight and obese patients

PubMed ID: 30932744Background: To investigate visceral adiposity index (VAI) levels in obese patients with and without metabolic syndrome (MetS) and its relationship with insulin resistance (IR), and define cutoff value of VAI in the determination of patients with MetS and IR. Methods: Aged between 18 and 65, 92 patients with obesity were included. Levels of homeostasis model assessment of IR (HOMA-IR) and VAI were calculated. Results: Of 92 patients, HOMA-IR and VAI levels (P < 0.001 and P < 0.001, respectively) were found to be higher in 41 (44.6%) with MetS. The cutoff value of VAI in predicting MetS was found to be 2.205. The frequency of MetS was seen as 22.2% when VAI was below this value, but if over, was found to be 66%. There was a positive correlation between VAI and HOMA-IR levels. In 36 cases (39.1%) with HOMA-IR (?2.5), VAI was detected to be higher than those without IR, and high-density lipoprotein-cholesterol levels were lower. The cutoff value of VAI in predicting IR was found to be 2.31. While the prevalence of IR was 23.4% in those with VAI of 2.31, IR frequency in patients with equal to or greater than 2.31 was determined as 55%. Conclusion: We found that MetS was present in almost half of overweight and obese individuals, and the cutoff values of VAI in predicting the presence of MetS and IR were 2.205 and 2.31, respectively. Our study was carried out in overweight and obese Turkish individuals, and we consider that further studies including normal weight individuals and larger population are required. © Copyright 2019, Mary Ann Liebert, Inc., publishers 2019

Whipple's disease: A Case Report

Whipple's disease is an infectious disorder caused by Tropheryma whipplei (TW). Patients present with abdominal pain, diarrhoea and weight loss. The disease is commonly diagnosed by histological examination of small bowel biopsies, especially after staining with periodic acid-Schiff (PAS). Because of the rarity of the disease, its diagnosis is not often considered. Therefore, necessary investigations might be omitted. This case report might serve as a reminder for internists or general surgery or gastroenterologists to consider Whipple&#146;s disease in patients with abdominal or other symptoms after having excluded common differentials. Whipple disease is a chronic, relapsing, and multisystem disease. Long-term antibiotic therapy is required. Without treatment, Whipple&#146;s disease may be fatal. We also review the current literature on Whipple&#146;s disease. [Cukurova Med J 2012; 37(4.000): 223-228

Arterial Stiffness in Breast Cancer Patients Treated with Anthracycline and Trastuzumab-Based Regimens

Aims. Cardiovascular diseases are the primary cause of premature morbidity and mortality in early breast cancer patients after treatment with cardiotoxic chemotherapeutic agents. Arterial stiffness is an independent risk factor for future cardiovascular diseases and can be used as a predictive marker of subclinical cardiac damage. The aim of this study is to analyze the arterial stiffness in breast cancer patients who are in the follow-up period after receiving anthracycline-based chemotherapy regimens with trastuzumab. Methods and Material. We enrolled 45 HER2-positive breast cancer patients who are on follow-up at least for six months after completion of adjuvant chemotherapy with trastuzumab, and cardiovascular risk matched 30 control volunteers. The measurements were done with pulse wave analyzing machine. Results. Mean pulse wave velocity was higher in breast cancer patients compared to controls. The pulse wave velocity was significantly higher in patients receiving aromatase inhibitors compared to patients under tamoxifen. It was also significantly higher in postmenopausal breast cancer patients than postmenopausal controls. Conclusions. Arterial stiffness measurements may predict the breast cancer survivors with higher risk for cardiovascular events earlier in the follow-up period, and necessary preventive approaches and/or treatments can be applied

S100A1 as a Potential Diagnostic Biomarker for Assessing Cardiotoxicity and Implications for the Chemotherapy of Certain Cancers.

This study examined the value of blood marker S100A1 in detecting cardiotoxicity induced by chemotherapy agents; trastuzumab and lapatinib, in normal rat heart. The rats were divided into three groups: control (n = 8, no treatment), T (n = 8, one time ip treatment with 10 mg/kg trastuzumab) and L (n = 8, oral treatment with 100 mg/kg/day lapatinib for 7 days). The activities of oxidative stress parameters Malondialdehyde (MDA), Superoxide dismutase (SOD), Catalase (CAT) and Glutathione (GSH) were measured from the extracted cardiac tissues. The levels of troponinI and S100A1 expressions were measured from blood samples. All biomarkers responded to the treatments as they exhibited alterations from their normative values, validating the chemically induced cardiotoxicity. S100A1 expression attenuated significantly (75%), which made the sensitive detection of cardiotoxicity feasible. Assessment of cardiotoxicity with S100A1 may be a valuable alternative in clinical oncology of cancers in some organs such as breast and prostate, as they do not overexpress it to compete against

Levels of cardiac injury parameters as measured from the bloods collected from all experimental groups (each with n = 8).

<p>Panels show graphs for the markers TroponinI and S100A1. Multi group Kruskal Wallis test yielded <i>P</i> = 0.0280 and 0.0354, respectively. * indicates statistically significant difference against the control group C (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145418#pone.0145418.t001" target="_blank">Table 1</a>).</p

Oxidative stress parameters as measured from the cardiac tissues extracted from the animals in all experimental groups (each with n = 8).

<p>Panels show graphs for the biochemical markers Malonyldialdehyde (MDA); Superoxide dismutase (SOD); Catalase (CAT); Glutathione (GSH). Multi group Kruskal Wallis test yielded <i>P</i> = 0.0003, 0.0003, 0.0002 and 0.0005, respectively. * indicates statistically significant difference against the control group C (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0145418#pone.0145418.t001" target="_blank">Table 1</a>).</p