Mobile atheromatous plaque of the aortic arch diagnosed by transthoracic echocardiography prior to coronary artery bypass surgery. Which one would you choose: scepticism or wishful thinking?

A routine pre-operative chest X-ray of a patient admitted to our institution for an elective coronary artery bypass operation revealed a mildly dilated mediastinal silhouette, which led the cardiovascular surgery resident to schedule emergency transthoracic echocardiography (TTE), with a special note asking for detailed evaluation of the ascending aorta and aortic arch. TTE revealed a mobile atheroma at the aortic arch, which obliged the cardiac surgery team to modify their strategy to combined hemi-arcus aortae replacement and coronary artery bypass grafting (CABG). Although with transoesophageal echocardiography (TEE) a small portion of the ascending aorta may be obscured by the trachea, TEE provides higher resolution images than TTE. Therefore one can conclude that TEE is the imaging modality of choice for detecting aortic atheromatous plaques but in patients with low risk for stroke and aortic atheromas, a detailed TTE may be sufficient for the pre-operative assessment.

Autonomic functions in acrocyanosis assessed by heart rate variability

OBJECTIVE

To evaluate the autonomic activity of patients with acrocyanosis by using heart rate variability indices.

MATERIAL AND METHODS

The study group consisted of 24 patients with acrocyanosis and the control group contained 22 sex- and age-matched healthy subjects. All subjects underwent 24-hour Holter monitoring. Among the heart rate variability (HRV) parameters, time-domain and frequency-domain indices were analysed.

RESULTS

The time-domain indices of HRV indicating global autonomic functions were found to be increased, and indices indicating parasympathetic activity showed a significant decrease in the patient group. Power-spectral analysis of HRV revealed that the low frequency and high frequency power were higher in the patient group than in controls. However, the ratio of Low Frequency/High Frequency was found to be lower in the patient group than in controls.

CONCLUSION

In acrocyanosis, both sympathetic and parasympathetic systems seem to be disrupted. Therefore, we may conclude that acrocyanosis may be resulted of systemic autonomic imbalance rather than pure sympathetic over-activation. Also, these results suggest that acrocyanosis is not a localised disorder; on the contrary, it is associated with various abnormalities of the systemic autonomic nervous system.

[Molecular diagnostics of lung cancer]

Development of the target therapies of lung cancer was a rapid process which fundamentally changed the pathological diagnosis as well. Furthermore, molecular pathology became essential part of the routine diagnostics of lung cancer. These changes generated several practical problems and in underdeveloped countries or in those with reimbursement problems have been combined with further challenges. The central and eastern region of Europe are characterized by similar problems in this respect which promoted the foundation of NSCLC Working Group to provide up to date protocols or guidelines. This present paper is a summary of the molecular pathology and target therapy guidelines written with the notion that it has to be upgraded continuously according to the development of the field.

Evaluation of the effects of rosmarinic acid on red blood cell deformability, morphology, and nitric oxide in rat lower limb skeletal muscle ischemia-reperfusion injury

BACKGROUND

Erythrocyte deformability, the ability of red blood cells to bend and twist as they pass through capillaries, is es-sential for tissue perfusion. This study investigates the effects and underlying mechanisms of rosmarinic acid treatment on erythrocyte deformability in rats subjected to lower limb ischemia-reperfusion injury.

METHODS

The study was conducted on Wistar albino rats weighing 400-450 g. The rats were randomly divided into five groups: the control group with no treatment (C), the group receiving only the solvent dimethyl sulfoxide (DMSO), the ischemia-reperfusion group (IR) subjected to 90 minutes of ischemia followed by 90 minutes of reperfusion in the femoral artery of the lower limb, the rosmarinic acid control group (RA-C) to assess the effects of rosmarinic acid alone, and the group (IR+RA) in which rosmarinic acid was administered intraperitoneally one hour before the ischemia-reperfusion procedure. At the end of the experiment, intracardiac blood samples were collected. Analyses included May-Grünwald-Giemsa (MGG) staining, measurement of endothelial nitric oxide synthase (eNOS), erythrocyte deformability indexes, malondialdehyde (MDA), and superoxide dismutase (SOD) levels.

RESULTS

Significant findings were observed in the study. Erythrocyte deformability was statistically significantly improved in the group that received rosmarinic acid prior to ischemia-reperfusion compared to the group that underwent ischemia-reperfusion alone. Morphological changes of erythrocytes were also significantly better in the IR+RA group than in the IR group. Immunohistochemical analysis of eNOS staining revealed that eNOS activity was higher in the IR group compared to the IR+RA group. Malondialdehyde (MDA) levels were significantly elevated in the IR group compared to all other groups. Analysis of superoxide dismutase levels showed that the SOD levels in the IR+RA group were significantly higher than those in the other groups.

CONCLUSION

Our findings indicate that rosmarinic acid treatment administered prior to ischemia provides protective effects against erythrocyte deformation and morphological deterioration. It is suggested that the improvement in deformability may be mediated by increased SOD activity, which reduces reactive oxygen anions, by-products of nitric oxide (NO) production, thereby exerting an antioxidant effect and enhancing the beneficial actions of NO.

Influence of Lactation on Internal Mammary Artery Size and Flow

This prospective study compared internal mammary artery blood flow and diameter and hospital mortality after coronary artery bypass grafting in 3 groups of patients: group 1, 32 women who had breast fed; group 2, 21 women who had not breast fed; and group 3, 30 average-sized males. Mean internal mammary artery flow was significantly lower in group 2 (94 mL·min−1 in group 1, 65 mL·min−1 in group 2, 105 mL·min−1 in group 3). Mean distal internal mammary artery diameter was also less in group 2 (1.35 mm in group 1, 1 mm in group 2, 1.5 mm in group 3). Postoperative myocardial infarction occurred in 1 patient in group 1, 4 in group 2, and 1 in group 3. Anterior myocardial infarction in the 4 patients in group 2 was caused by internal mammary artery spasm. Hospital mortality was 3.13% in group 1, 9.52% in group 2, and 3.33% in group 3. The angina-free period in group 1 was significantly longer than in group 2 (4.5 versus 1.7 years). It was concluded that in women who had not breast fed, the internal mammary artery diameter was inadequate to supply myocardial demand and the graft was prone to lifethreatening spasm.