A rare case: mosaic trisomy 22

A 9-year-old female child of healthy parents (mother: 43 years, father: 44 years) was referred to our center because of severe mental retardation. While pedigree analysis was not contributory, two older sibs were normal and healthy. Physical examination revealed facial dysmorphism, microcephaly and hyperflexibility of all joints. Her chromosome constitution showed a mosaic pattern; mos 46,XX[98]/47,XX,+22[2]. So skin biopsy was performed and mosaic trisomy 22 was confirmed with FISH analysis (46,XX[73]/47,XX,+22[27]). Physical features of this case seemed consistent with her mosaic constitution. This report would be a demonstrative example to show the significant contribution of FISH in states of mosaicism.

Adjunctive therapies in the cath lab. Intracoronary tirofiban infusion in a case with massive intracoronary thrombus

By inhibiting platelet aggregation, glycoprotein IIb/IIIa inhibitors prevent arterial occlusion and reduce ischemic complications in the setting of acute ischemic coronary syndromes associated with intracoronary thrombus. There are also accumulating data in the literature regarding the local use of these agents for thrombus dissolution. We report a case with massive right coronary artery thrombus in which the thrombus was successfully dissolved with intracoronary tirofiban infusion. To the best of our knowledge, this is the first case of this kind.

Coronary artery to left ventricular fistula: case report and review of the literature

In this report, an unusual case with a multiple plexiform type of coronary artery-to-left ventricular fistula and coexisting atherosclerotic involvement of the contralateral coronary artery is described and the pertinent literature is reviewed briefly.

Primary angioplasty and stenting in a patient with primary antiphospholipid syndrome and thrombocytopenia

Antiphospholipid syndrome is characterized by venous and arterial thrombosis, thrombocytopenia, stroke and, rarely, acute coronary syndromes. However, there are no data available regarding the management of acute myocardial infarction in primary antiphospholipid syndrome with accompanying severe thrombocytopenia and cardiogenic shock. We describe such a case, which was managed by successful primary percutaneous transluminal coronary angioplasty and stent implantation with accompanying immunosuppression therapy.

Familial erythromelanosis follicularis and chromosomal instability

We report a 17-year-old male patient with erythromelanosis follicularis faciei et colli (EFFC), oral leucokeratosis and diabetes mellitus without islet cell antibody. His sister also had minimal findings of EFFC and minimal follicular papules on her shoulders and extensor surfaces of the arms. The father had only fine follicular papules, but no erythromelanosis. Skin and mucous membrane lesions of the proband were investigated histopathologically. Interestingly, in peripheral lymphocyte cultures of the family members, chromosomal breakage was not observed spontaneously, but it was seen with nitrogen mustard, although this disease may be of autosomal recessive inheritance. Thus, we suggest that EFFC may be a polyaetiological disorder (i.e. familial and environmental) and might be considered one of the chromosomal instability syndromes.

A review on grain and nut deterioration and design of the dryers for safe storage with special reference to Turkish hazelnuts

Turkey produces about 80% of the total hazelnut crop of the world. About 75% of the production are exported. In Turkey hazelnuts are traditionally sun dried, and may be subject to mold growth and subsequent mycotoxin formation due to prolonged drying time under humid and rainy weather conditions. Drying hazelnuts in a reasonable time after harvest is necessary for mycotoxin-free, high-quality products. In general, nuts and cereals contaminated by the toxins pose a potential hazard not only to the people of the producer countries, but also to people of the importing countries, if they should be regarded as safe by inefficient sampling plans, therefore preventing toxin formation actually benefits very large populations. Deterioration and health hazards associated with toxin contaminated hazelnuts and other nuts and cereals have similar causes and consequences; therefore, deterioration of the nuts and cereals in storage has been reviewed by considering as many grains and nuts as possible, then special reference was made to hazelnuts. Proper preharvest practices followed by proper drying and safe storage reduces the hazards associated with contamination by the toxins. This article reviews the pre- and post-harvest practices, and the grain- and nut-drying systems required for toxin-free products. Because drying is the major unit operation involving this process, the drying systems and the mathematical models required for their design is also discussed.

Increased basic fibroblast growth factor levels in serum and blister fluid from patients with vitiligo

Basic fibroblast growth factor (bFGF) is a pleiotropic growth factor which has a high capacity for stimulating normal melanocyte proliferation and suppressing melanogenesis. The close and complicated relationship between bFGF, melanocyte proliferation and melanogenesis raises the theoretical possibility that bFGF may also be involved in the pathomechanism leading to vitiligo. The aim of this study was to compare the serum and suction blister fluid bFGF levels of vitiligo patients (9 females, 11 males) with those of healthy controls (3 females, 8 males). Vitiliginous skin-blister fluid bFGF levels and serum levels were significantly higher in vitiligo patients compared with healthy normal controls. Our data indicate that bFGF might be involved in the pathogenetic chain of events leading to vitiligo. Further studies are needed to define the exact role of bFGF and various other melanocytic mitogens in this disease.

Comparison of low-dose dobutamine echocardiography and thallium-201 reinjection for the determination of myocardial viability in the early post myocardial infarction period

OBJECTIVE

Determination of viability in the infarction zone in the early post Ml period is an important parameter in clinical decision making.

METHODS

In an attempt to compare the places of low-dose dobutamine echocardiography (LDDE) and thallium-201 reinjection SPECT (TI-SPECT) in the determination of viability in dyssynergic myocardial segments, 17 patients (mean age: 54.6 +/- 12.8 years, 16 male, 1 female) with a recent myocardial infarction and an uneventful early clinical course underwent both tests within 5-13 days of infarction. The 16-segment model was utilised to evaluate the left ventricular wall motion and each segment was graded as 1) normokinetic, 2) hypokinetic, 3) akinetic and 4) dyskinetic or aneurysmal on a 4-scale basis. A dyssynergic segment of myocardium was considered to be viable by LDDE if it showed an improvement in wall motion of at least one grade with low-dose dobutamine infusion (10 microg/kg/min). On the other hand, mild to moderate (< 50%) fixed perfusion defects and reversible (at least a 10% improvement in perfusion on either redistribution or reinjection images) severe (50% or more) perfusion defects were considered positive for viability by TI-SPECT.

RESULTS

Of the 76 segments with resting dyssynergy (10 dyskinetic/aneurysmal, 33 akinetic, 33 hypokinetic), 51 (67%) were shown to be viable by LDDE and 61 (80%) by TI-SPECT. There was an agreement of 76% (p = 0.03, K = 0.63) between the two methods.

CONCLUSION

This study disclosed a moderate degree of agreement between LDDE and TI-SPECT for the determination of viability in dyssynergic myocardial segments in the early post-myocardial infarction period.

Corrosive injuries of the esophagus in newborns

To evaluate the morbidity and mortality of corrosive esophageal injuries (CEI) in the neonatal period, the records of 184 children hospitalized following caustic ingestion over a 10-year period from January 1987 to November 1997 were reviewed. Eight (4.3%) were newborns (5 boys and 3 girls). The mean age of the newborns was 12 days (range 1-28). The ingested caustic materials were benzalkonium chloride in six patients and trichloroacetic acid in two. Oropharyngeal examination and esophagoscopy were performed for diagnosis. Hyperemia and fibrin plaques were present in the oropharynx in all patients. The management consisted of endotracheal intubation, antibiotics, corticosteroids, and total parenteral nutrition. Pneumonia and sepsis developed in three patients and one died of sepsis. Stenosis developed in two patients, who were treated three times with antegrade dilatations. The morbidity was 62.5% (five patients) and the mortality was 12.5% (one) in newborns with CEI. These results indicate that ingestion of a caustic substance results in high morbidity and mortality in newborns. Parents and nurses should be warned about this risk.

Physical polymer surface modification methods and applications in food packaging polymers

Continued innovations in the polymer industry have made polymer surface modification methods a subject of intense research. The importance and necessity of surface modification of plastics are explained, and the advantages of physical surface treatments over the less-sophisticated chemical methods are outlined. Currently available physical surface modification methods for food packaging polymers are reviewed from the food packaging perspective. These physical surface modification methods include flame, corona discharge, UV, gamma-ray, electron beam, ion beam, plasma, and laser treatments. The principle of operation of each method is briefly described, and the advantages and disadvantages of each technique are cited. The extent to which each of these methods can produce the specific modifications desired is discussed. Furthermore, the effects of each treatment on barrier, mechanical, and adhesion properties of food packaging polymers are also examined. Finally, an overview of economic aspects of sophisticated surface modification techniques, including ion beam, plasma, and laser treatments, is presented.

FISH analysis with locus-specific probes in sperm from two translocation carrier men

Meiotic segregation of normal and derivative chromosomes was analysed in sperm samples from two balanced reciprocal translocation carrier men by use of dual-colour fluorescence in situ hybridisation (FISH) technique. The translocations were t(4;8)(p15;p12) and t(15;22)(q(23:q13.2), and the digoxigenin-labelled FISH probes were specific to either the translocated or centric segments of the chromosomes involved in the translocations. A total of 1000 spermatozoa for each probe were analysed and the modes of segregation were described on the basis of signals in each sperm cell. The mean frequency of alternate and/or adjacent-1 (adj-1) segregation types was 69.47%, whereas they were 30.51 and 78.70% for the adjacent-2 (adj-2) and alternate/adj-2 segregation types, respectively. This study illustrated that FISH is a valuable technique for analysing the meiotic segregation products of the heterozygotes in respect to aneuploidy risk.

Stabilization of the Chevron procedure for hallux valgus deformity with a capsuloperiostal flap

This article reports on the use of a Chevron procedure in the treatment of hallux valgus for better stabilization of the osteotomy. This procedure was performed on 31 feet of 24 patients, Twenty-two of the patients were female and two were male. The average age was 41 and average follow-up time was 14 months. The average correction of the 1-2 intermetatarsal angle was 3.8 degrees and average correction of the hallux valgus angle was 15.3 degrees. On the follow-up, 93.5% of the feet were pain free and 81% did not have any discomfort with shoewear. There were two cases of superficial infection, and two patients complained of dysesthesia or hypoesthesia after the operation. Results revealed less correction loss, shorter union time, less metatarsophalangeal stiffness, and more postoperative patient tolerance. The authors attached the distally based "V"-shaped medial capsuloperiostal flap to the metatarsal shaft and, because of obtained stability, used no internal fixation or postoperative cast but only night splint, allowed weightbearing on the heel as soon as the patient tolerated it, and encountered no displacement of fragments, malunion, or recurrence of the deformity.

Dispersion of repolarization in paroxysmal atrial fibrillation

Widened dispersion of refractoriness has been considered to lead to an increase in atrial vulnerability. In this study, we obtained simultaneous monophasic action potential recordings by 2 special catheters from 2 different loci in the right atrium in 9 normal subjects (Group 1) and in 7 patients with paroxysmal atrial fibrillation (Group 2). We measured action potential duration at 50% (APD50) and 90% (APD90) repolarization from both loci in the right atrium during steady-state through one of the two catheters. The differences between APD50 and APD90 recorded by the two catheters were designated as dispersion of APD50 and dispersion of APD90, respectively. While, the mean APD50 and APD90 were 149.7+/-16.9 and 228.3+/-44.7 ms respectively in Group 1, the corresponding values for Group 2 were 145.7+/-33.5 and 213.5+/-53.1 ms. The difference between the 2 groups was not statistically significant. However, the dispersion of APD50 and APD90 were 13.8+/-13.8 and 10.0+/-9.7 ms in Group 1 and 42.8+/-19.6 and 57.1+/-32.4 in Group 2, respectively and the difference between the 2 groups for both measurements was statistically significant (P<0.01). Another finding was a high correlation between age and dispersion of APD90 in the whole population studied (r=0.82, P<0.001). With these findings, although one can not derive the conclusion that patients with paroxysmal atrial fibrillation have a greater dispersion of repolarization, our finding of increasing dispersion of repolarization with age could be an explanatory factor for the increased prevalence of atrial fibrillation with advanced age.

Adenosine sensitive left ventricular tachycardia

Presented here is a 39-year-old male patient with no structural heart disease but a ventricular tachycardia with right bundle branch block morphology and right axis deviation, which is responsive to adenosine. The ventricular tachycardia was initiated by ventricular pacing, shown to originate from the mid-anterior free wall region of the left ventricle and terminated by adenosine. Radiofrequency current application at a site where presumed P potentials were recorded eliminated the tachycardia, a finding that suggests that the origin of the tachycardia may be closely related to the anterior fascicle.

Interaction between grapefruit juice and diazepam in humans

Grapefruit juice has been reported to markedly improve the bioavailability of triazolam, midazolam, terfenadine, cyclosporine and several dihydropyridine calcium channel blockers including felodipine, nifedipine, nitrendipine and nisoldipine. Because these drugs are metabolized by the hepatic cytochrome P450 isozyme (CYP) 3A4, the inhibitory effect of grapefruit juice is thought to results from inhibition of CYP3A4. In this study, our aim was to investigate the effects of grapefruit juice on plasma concentrations of diazepam. Eight healthy male and female subjects participated in this study. Oral (5 mg) diazepam was administered with either 250 ml water and grapefruit juice. Blood samples were collected for a 24 h period, and whole blood concentrations of diazepam were measured enzyme immunoassay. The mean AUC(0-24) of diazepam was increased 3.2-fold (P < 0.001) and Cmax was increased 1.5-fold (P < 0.05) by the grapefruit juice. Grapefruit juice postponed the tmax of diazepam from 1.50 h to 2.06 h (P < 0.01).

QRS polarity on 12-lead surface ECG. A criterion for the differentiation of right and left posteroseptal accessory atrioventricular pathways

In this study, we tried to disclose certain electrocardiogram (ECG) criteria that might be useful in the classification of posteroseptal accessory atrioventricular pathways as right and left in patients with pre-excitation in whom the accessory pathway localization was verified by subsequent successful ablation. Twenty such patients with posteroseptal accessory pathways (mean age 34.9 +/- 9.8; 11 male, 9 female) were included in the study. Localization of the accessory pathway was right posteroseptal in 13 (65%) and left posteroseptal in 7 (35%). Common to all these 20 patients with posteroseptal accessory pathways was a QRS polarity positive in lead L1 and negative in leads D3, aVL. In patients with right posteroseptal accessory pathways, QRS polarity was negative in lead V1 in all and positive in lead V2 in 90%. On the other hand, none of the patients with left posteroseptal accessory pathways showed negative QRS polarity in lead V1. In conclusion, these findings strongly suggest that in patients with pre-excitation, a QRS polarity negative in lead V1 and positive in lead V2 is an important surface ECG finding that signifies right-sided localization of a posteroseptal accessory pathway. In cases with left posteroseptal accessory pathways, QRS polarity in leads V1 and V2 has been found to be either biphasic or positive.

Radiofrequency catheter ablation treatment of a child with dilated cardiomyopathy secondary to chronic ectopic atrial tachycardia

Ectopic atrial tachycardia (EAT) is a rare but reversible cause of dilated cardiomyopathy (DCMP). The diagnosis and the definite control of the arrhythmia are essential for the regression of DCMP. Unfortunately, conventional antiarrhythmic drugs usually fail to control the arrhythmia, and the results of surgery or direct current ablation are suboptimal. Recently, radiofrequency (RF) catheter ablation has been evolving as a safe and effective therapy for EAT. This report describes the RF ablation treatment of a 14-year-old boy with DCMP secondary to chronic EAT. Activation mapping was used for the purpose of identifying the focus origin located just anterior to the coronary sinus os. RF energy applied at this focus successfully terminated the tachycardia. No complications related to the procedure were observed. RF ablation not only caused elimination of the EAT but also led to improvement in left ventricular function as early as two weeks after the procedure, and complete resolution of DCMP in three months.

Complete heart block caused by cardiac echinococcosis and successfully treated with albendazole

Images

Can isolated, symptomatic, frequent ventricular premature depolarizations be a predictor of an inducible ventricular tachycardia? Treatment by radiofrequency catheter ablation

In this report, we describe a case of sustained ventricular tachycardia of right ventricular outflow tract origin, induced by dobutamine infusion in a patient with symptomatic, frequent ventricular premature depolarizations but no documented clinical ventricular tachycardia. Radiofrequency catheter ablation abolished not only the ventricular tachycardia itself, but also the frequent ventricular premature depolarizations responsible for all the symptomatology. In conclusion, provocation by catecholamine infusion may have a place in the search for an alternative to antiarrhythmic therapy in patients with isolated, frequent and symptomatic ventricular premature depolarizations.

Comparative study on cardiomyoplasty patients with the cardiomyostimulator on versus off

BACKGROUND

A major concern in evaluating dynamic cardiomyoplasty has been whether the synchronous stimulation of latissimus dorsi muscle is essential for benefit or not. We studied 10 patients to determine the efficacy of the systolic augmentation generated by the synchronous electrical stimulation of the latissimus dorsi muscle.

METHODS

Left ventricular ejection fraction, end-systolic and end-diastolic volume indexes, and stroke volume index obtained during resting, peak exercise, and recovery periods ("on" values) were compared with those obtained 1 week after cessation of electrical stimulus ("off" values). Double product and estimated total body oxygen consumption at peak exercise were also calculated and compared.

RESULTS

Higher ejection fractions (0.36 +/- 0.07 versus 0.33 +/- 0.06 at rest, 0.40 +/- 0.07 versus 0.33 +/- 0.07 at peak exercise, and 0.37 +/- 0.06 versus 0.31 +/- 0.06 at recovery).(ABSTRACT TRUNCATED)

Fistulous connection between the left pulmonary artery and the innominate vein

A 66-yr-old woman was admitted to our clinic with signs and symptoms suggesting either pulmonary embolism or pneumonia. Subsequently she was diagnosed as having pneumonia, but since pulmonary artery pressure was high on echocardiography, pulmonary angiography was performed to exclude the possibility of pulmonary embolism. No findings suggestive of pulmonary embolism were evident on pulmonary angiogram, but there was a fistulous connection between the left pulmonary artery and the innominate vein. To our knowledge, this report represents the first case of a fistula between the pulmonary artery and a systemic vein.

Prevalence and predictors of atrial fibrillation in rheumatic valvular heart disease

The highest frequency of AF in RHD occurs in those with mitral stenosis, mitral regurgitation, and tricuspid regurgitation in combination. AF, while occurring in 29% of patients with isolated mitral stenosis and in 16% with isolated mitral regurgitation, is an infrequent finding (1%) in patients with aortic valvular disease. Left atrial diameter by univariate analysis, and age and left atrial diameter by multivariate analysis have been shown to be the most important parameters to determine the occurrence of AF in patients with RHD.