Morphological and clinical findings in 247 surgically excised native aortic valves

Aortic valve disease is an increasingly common medical problem in the 20th century; however, its pathogenesis is poorly understood. The present paper reviews 247 cases of aortic valves surgically excised over a one-year period, with special attention to the morphological and histological changes observed in surgically excised aortic valves, and to how those changes relate to the mechanisms of valve failure. Patient age ranged from 17 to 86 years, with a mean of 64.1 +/-13.4 years, and there were 156 men (63.2%) and 91 women (36.8%). A total of 172 valves (69.6%) were tricuspid and 75 valves (30.4%) were congenitally abnormal, of which 67 valves (27.1%) were congenitally bicuspid, six valves (2.4%) were congenitally unicommissural and one valve (0.4%) was quadricuspid; the status of one valve could not be determined. Almost 70% of patients had features of aortic stenosis. Calcification was seen in the large majority of cases, with almost 70% of the valves showing either grade 3 or grade 4 calcification. Ulceration of calcific nodules was present in 42.0% of cases and in the majority of the valves with grade 4 calcification. A total of 15% of the valves showed evidence of postinflammatory changes consistent with rheumatic disease. Neovascularization was present in two-thirds of all valves, while one-half showed inflammatory cell infiltrates. Inflammatory cells were composed mainly of lymphocytes and macrophages, and were located primarily near areas of neovascularization. There was no significant difference in the pathological findings between men and women.

DeBakey Surgitool mechanical heart valve prosthesis, explanted at 32 years

Contemporary mechanical heart value prostheses are expected to last "just about forever" or the patient's lifeline. They do however still suffer complications, some of which necessitate premature explantation. Complications today are mainly related to patient compliance with anticoagulant medication, infection and hemorrhage. The DeBakey Surgitool mechanical heart valve was the first such device to have Pyrolyte components. We present a DeBakey surgitool mechanical heart valve that was in place for 32 years! It was explanted for dysfunction related to tissue overgrowth and not to its related components. With good patient compliance, this mechanical heart valve prosthesis is an example of good prosthetic valve durability.

Constrictive pericarditis: case presentation and a review of the literature

Constrictive pericarditis (CP) is a relatively rare entity, the result of a thickened, scarred and often calcified pericardium, adherent to the heart and limiting diastolic ventricular filling. Some reported etiologies for CP include pericardial involvement from cardiac trauma (including surgery), mediastinal irradiation, tuberculosis and other infectious diseases, neoplasms and myocardial infarction. However, the majority of CP cases are idiopathic. This report presents three cases of postoperative, tuberculous and idiopathic CP, highlighting the clinical and pathological changes seen in CP, and a review of the literature.

Hypersensitivity myocarditis complicating hypertrophic cardiomyopathy heart

The present report describes a case of eosinophilic myocarditis complicating hypertrophic cardiomyopathy. The 47-year-old female patient, known to have hypertrophic cardiomyopathy, was admitted with biventricular failure and managed aggressively with dobutamine infusion and other drugs while being assessed for heart transplantation. On transthoracic echocardiogram, she had moderate left ventricular dysfunction with regional variability and moderate mitral regurgitation. The recipient's heart showed the features of apical hypertrophic cardiomyopathy and myocarditis with abundant eosinophils. Myocarditis is rare and eosinophilic myocarditis is rarer. It is likely that the hypersensitivity (eosinophilic) myocarditis was related to dobutamine infusion therapy. Eosinophilic myocarditis has been reported with an incidence of 2.4% to 7.2% in explanted hearts and may be related to multidrug therapy.

Papillary Fibroelastoma of the Interatrial Septum:. A Case Report

Primary cardiac tumors are rare, with benign lesions outnumbering malignant ones by a margin of over four to one. Amongst the benign cardiac neoplasms, papillary fibroelastomas are reported second only to myxomas. Papillary fibroelastomas commonly rise from heart valves and their size ranges from a few millimeters to well over 2.0 cm in diameter. While myxomas commonly arise from the interatrial septum, we present the rare example of a large papillary fibroelastoma arising from the left side of the interatrial septum.

Successful control of Marek's disease by vaccination

Marek's disease (MD) is a neoplastic disease of poultry caused by the highly contagious Marek's disease virus (MDV). Vaccination with live attenuated vaccines forms the cornerstone of the current MD control programmes. The widespread use of the vaccines in the last 30 years has significantly reduced the losses from MD. Despite the huge success of the vaccination policy, the continuing trend in virulence increase of field strains of MDV has forced the introduction of new generations of vaccines to keep up with the creeping virulence increase of MDV. In these circumstances, it is very important to undertake research to develop more sustainable strategies of control. Development of new recombinant DNA technologies such as the use of bacterial artificial chromosomes (BAC) offers the possibility of developing molecularly-defined vaccines. In addition, the availability of the whole chicken genome sequence allows the opportunity of exploiting genetic resistance against MD as another sustainable strategy.

Gangliogliomas: A report of five cases

Gangliogliomas are rare tumors of the Central Nervous System. Five gangliogliomas were diagnosed out of 1560 brain tumours surgically resected out in a period of 5 years accounting for 0. 32%. We have tried to discuss in detail the pathological features of these tumours and have mentioned the clinical and radiological features associated with them. All the slides, tissue blocks and pathology reports of the surgical specimens of gangliglioma were reviewed and the clinical and radiological data reviewed. The ages of the patients ranged from 7-65 years with 4 males and 1 female. The tumors were located in the lateral ventricle (a rare site), temporal, parietal and the frontal lobes with duration of seizures varying from 1-9 years. The tumors were diagnosed by the presence of a dual population of neoplastic ganglionic and glial components. The glial components consisted of pilocytic astrocytes (l case), fibrillary astrocytes (2 cases), oligodendrocytes (1 case) and anaplastic astrocytes and oligodendrocytes (1 case). There was one-grade I GG, three-Grade II GGs and one-grade III GG. Astrocytes were the commonest glial component of GGs, either pilocytic or fibrillary. Oligodendrocytes as the glial component of GGs was seen in 2 cases one of which was anaplastic and this is a rare finding.

Cord blood stem cell banking and transplantation

Stem cells have the ability to divide for indefinite periods in culture and to give rise to specialized cells. Cord blood as a source of hematopoietic stem cells (HSC) has several advantages as it is easily available, involves non-invasive collection procedure and is better tolerated across the HLA barrier. Since the first cord blood transplant in 1988, over 2500 cord blood HSC transplants have been done world wide. Since then, the advantages of cord blood as a source of hematopietic stem cells for transplantation have become clear. Firstly, the proliferative capacity of HSC in cord blood is superior to that of cells in bone marrow or blood from adults. A 100 ml unit of cord blood contains 1/10th the number of nucleated cells and progenitor cells (CD34+ cells) present in 1000 ml of bone marrow, but because they proliferate rapidly, the stem cell in a single unit of cord blood can reconstitute the entire haematopoietic system. Secondly, the use of cord blood reduces the risk of graft vs host disease. Cord Blood Stem Cell banks have been established in Europe and United States to supply HSC for related and unrelated donors. Currently, more than 65,000 units are available and more than 2500 patients have received transplants of cord blood. Results in children have clearly shown that the number of nucleated cells in the infused cord blood influences the speed of recovery of neutrophils and platelets after myeloablative chemotherapy. The optimal dose is about 2 x 10(7) nucleated cells/kg of body weight. The present study was carried out for collection, separation, enumeration and cryopreservation of cord blood HSC and establishing a Cord Blood HSC Bank. 172 samples of cord blood HSC were collected after delivery of infant prior to expulsion of placenta. The average cord blood volume collected was 101.20 ml. Mononuclear cell count ranged from 7.36 to 25.6 x 10(7)/ml. Viability count of mononuclear cells was 98.1%. After 1 year of cryopreservation, the viability count on revival was over 82.1%. Related cord blood stem cell transplantation was carried out in three cases at Army Hospital (R&R), Delhi Cantt.

Novel pyridine-catalyzed reaction of dimethyl acetylenedicarboxylate with aldehydes: formal [2 + 2] cycloaddition leading to 2-oxo-3-benzylidinesuccinates

[reaction: see text]. The 1,4-zwitterionic intermediate generated from pyridine and DMAD adds to aldehydes in a formal [2 + 2] manner, resulting in the facile synthesis of 2-oxo-3-benzylidinesuccinates.

Oxidative cyclisation of cinnamyl ethers mediated by CAN: a stereoselective synthesis of 3,4-trans disubstituted tetrahydrofuran derivatives

The oxidative cyclisation of cinnamyl ethers mediated by cerium(IV) ammonium nitrate results in the stereospecific formation of 3,4-trans disubstituted tetrahydrofuran derivatives in moderate to good yields.