Uncommon presentation of a rare tumour - incidental finding in an asymptomatic patient: case report and comprehensive review of the literature on intrapericardial solitary fibrous tumours

BACKGROUND: A solitary fibrous tumour is a rare, mainly benign spindle cell mesenchymal tumour most commonly originating from the pleura. An intrapericardial location of a solitary fibrous tumour is extremely unusual. We present a case of an asymptomatic patient with a slow-growing massive benign cardiac solitary fibrous tumour. CASE PRESENTATION: A 37-year-old asymptomatic female patient was referred to our hospital with an enlarged cardiac silhouette found on her screening chest X-ray. The echocardiographic examination revealed pericardial effusion and an inhomogeneous mobile mass located in the pericardial sac around the left ventricle. Cardiac magnetic resonance (MRI) examination showed an intrapericardial, semilunar-shaped mass attached to the pulmonary trunk with an intermediate signal intensity on proton density-weighted images and high signal intensity on T2-weighted spectral fat saturation inversion recovery images. First-pass perfusion and early and late gadolinium-enhanced images showed a vascularized mass with septated, patchy, inhomogeneous late enhancement. Coronary computed tomography angiography revealed no invasion of the coronaries. Based on the retrospectively analysed screening chest X-rays, the mass had started to form at least 7 years earlier. Complete resection of the tumour with partial resection of the pulmonary trunk was performed. Histological evaluation of the septated, cystic mass revealed tumour cells forming an irregular patternless pattern; immunohistochemically, the cells tested positive for vimentin, CD34, CD99 and STAT6 but negative for keratin (AE1-AE3), CD31 and S100. Thus, the diagnosis of an intrapericardial solitary fibrous tumour was established. There has been no recurrence for 3 years based on the regular MRI follow-up. CONCLUSION: Intrapericardial SFTs, showing slow growth dynamics, can present with massive extent even in completely asymptomatic patients. MRI is exceedingly useful for characterizing intrapericardial masses, allowing precise surgical planning, and is reliable for long-term follow up

In vivo MRI and ex vivo histological assessment of the cardioprotection induced by ischemic preconditioning, postconditioning and remote conditioning in a closed-chest porcine model of reperfused acute myocardial infarction: importance of microvasculature

BACKGROUND: Cardioprotective value of ischemic post- (IPostC), remote (RIC) conditioning in acute myocardial infarction (AMI) is unclear in clinical trials. To evaluate cardioprotection, most translational animal studies and clinical trials utilize necrotic tissue referred to the area at risk (AAR) by magnetic resonance imaging (MRI). However, determination of AAR by MRI' may not be accurate, since MRI-indices of microvascular damage, i.e., myocardial edema and microvascular obstruction (MVO), may be affected by cardioprotection independently from myocardial necrosis. Therefore, we assessed the effect of IPostC, RIC conditioning and ischemic preconditioning (IPreC; positive control) on myocardial necrosis, edema and MVO in a clinically relevant, closed-chest pig model of AMI. METHODS AND RESULTS: Acute myocardial infarction was induced by a 90-min balloon occlusion of the left anterior descending coronary artery (LAD) in domestic juvenile female pigs. IPostC (6 x 30 s ischemia/reperfusion after 90-min occlusion) and RIC (4 x 5 min hind limb ischemia/reperfusion during 90-min LAD occlusion) did not reduce myocardial necrosis as assessed by late gadolinium enhancement 3 days after reperfusion and by ex vivo triphenyltetrazolium chloride staining 3 h after reperfusion, however, the positive control, IPreC (3 x 5 min ischemia/reperfusion before 90-min LAD occlusion) did. IPostC and RIC attenuated myocardial edema as measured by cardiac T2-weighted MRI 3 days after reperfusion, however, AAR measured by Evans blue staining was not different among groups, which confirms that myocardial edema is not a measure of AAR, IPostC and IPreC but not RIC decreased MVO. CONCLUSION: We conclude that IPostC and RIC interventions may protect the coronary microvasculature even without reducing myocardial necrosis

Writing for a cause: building a national identity through literature : the case of W.B. Yeats and the Irish National Revival

The aim of the thesis is to explore the potential that literature can have in studying mechanisms of identity building and identity shaping on the national level. National identity being defined as a cultural construct, my approach to the analysis will be from a cultural perspective, through literature. For this reason I intend to study a period from the many troubled ones in Ireland through the works of the Nobel Laureate in literature, William Butler Yeats. The aim is to try out a more or less unconventional approach to the studies of national identity and nationalism and set up a model through which other nationalisms could be analyzed through literature. The thesis builds on the assumption that literature, through themes specific elements, can have a significant influence on the way in which national identity is constructed and represented and in this respect, can be used as a tool in nation-building processes. It can be used as a tool in nation-building as a form of cultural revival for a nation through imagining a common past and a common future. It can be used as a tool also in a more imaginative way, in trying to create common identities where there has never been one as William Butler Yeats did. To what degree literature was and is part of this evolution of the Irish events remains, I must emphasize, an open question due to the highly subjective nature of both literature and nationalism. Nevertheless, the potential influence that literature can have is worth exploring on a larger scale

Abortált hirtelen szívhalál egy 39 éves biztonsági őrnél = Aborted sudden cardiac death in a 39-year-old security guard

A nonobstruktív koronáriákkal járó szívinfarktus, azaz MINOCA, az infarktusok megközelítőleg 6-8%-át teszi ki. Esetismertetésünkben egy 39 éves biztonsági őr történetét mutatjuk be, aki éjszakai szórakozást követően érkezett a háziorvosi ügyeletre epigasztriális fájdalom, verejtékezés, fáradtság- és gyengeségérzés miatt. A megkezdett vizsgálat közben keringésmegállás jelentkezett, azonnali reanimaciót kezdtek automata külső defibrillátor segítségével, amely sokkolandó ritmust detektált. Öt DC-sokk után a spontán keringés visszatért. Heteroanamnézis alapján néhány órával korábban a beteg designer drogot fogyasztott. Az ügyeletes PCI-centrumban elvégzett akut koronarográfia során ép epikardiális koszorúereket találtak. A szívultrahang-vizsgálat megtartott szisztolés balkamra-funkciót igazolt. A keringésleállás hátterében több etiológiai tényező is felmerült, azonban a valódi ok tisztázatlan maradt. Betegünk posztreszuszcitációs ellátást követően érkezett a Városmajori Szív- és Érgyógyászati Klinikára további kardiológiai kivizsgálás, esetleges ICD-implantáció elbírálása céljából. Érkezésekor készített 12-elvezetéses EKG-felvételen jobb Tawara-szár-blokk, és a mellkasi V1- és V2-elvezetésben ST-szakasz-eleváció, valamint Q-hullám volt látható. Az etiológia tisztázása céljából szív mágneses rezonanciás (CMR) vizsgálatot végeztünk, amely a típusos eltérések alapján akut szeptális szívinfarktust igazolt. Esetünk hangsúlyozza, hogy a negatív koronarográfiás vizsgálat nem zárja ki az akut szívinfarktus lehetőségét, és a rutinszerűen elvégzett diagnosztikus vizsgálatok ellenére is fennálló differenciáldiagnosztikai nehézség esetén a CMR-vizsgálat segíthet a diagnózis tisztázásában. = Myocardial infarction with non-obstructive coronary arteries, the so called MINOCA is responsible for up to 6-8% of the infarctions. In our case presentation we aim to describe the story of a 39-year-old security guard who after a night of going out visited his GP doctor with the symptoms of acute epigastric pain, sweating, fatigue and general weakness. During physical examination, the patient had a cardiac arrest and resuscitation was performed immediately with an automatic external defibrillator. After five DC shocks the patient was successfully resuscitated. According to heteroanamnestic information he has taken designer drugs a few hours prior to the incident. The patient was taken to the PCI centre on duty and during the acute coronary angiography normal coronary arteries were observed. Transthoracic echocardiography showed preserved left ventricular systolic function. Several etiologic factors have arisen in the background of circulatory arrest, but the real cause remained unclear. Our patient arrived at the Heart and Vascular Centre after post-resuscitation therapy for further cardiac evaluation and consideration of an ICD device implantation. Upon his admission his resting 12-lead ECG showed that there was a right bundle branch block, ST-segment elevation and Q-wave in precordial V1 and V2 leads. For the etiological clarification we performed a cardiac magnetic resonance (CMR) examination, which showed typical signs of acute septal myocardial infarction. Our case highlights that normal coronary angiography does not exclude acute myocardial infarction. In case of differential diagnostic difficulties despite of the routinely preformed diagnostic tests, CMR can help to clarify the diagnosis