Cardiac papillary fibroelastoma excision combined with reconstructive surgery

1. The effect of the aqueous extract of Cissus sicyoides (CS) on isolated guinea pig aortic rings was studied. CS contracts the smooth muscle of the aorta in a dose-response relation. 2. The extract of CS increases the norepinephrine contraction in normal calcium and in solutions without calcium. 3. Lanthanum inhibits the contraction induced by CS. 4. The vasoconstrictor effect of CS was increased in solutions without calcium or with low calcium, which is an inverse calcium-dependent contraction. 5. Prolonged exposure to calcium-free solution did not abolish CS contraction. These contractions can be elicited repeatedly even after 6 hr of continuous exposure to calcium-free solutions. 6. Caffeine reduces contractile response induced by CS in normal calcium, as well as in solutions without calcium. 7. Our results support the idea that the aqueous extract of CS acts at the membrane level, increasing the calcium entry through the membrane as well as acting on the internal calcium deposits, possibly on the sarcoplasmic reticulum.     

Aortic valve papillary fibroelastoma. A diagnosis by transthoracic echocardiography

Cardiac papillary fibroelastomas are unusual, frond-like growths typically found on cardiac valves, diagnosed incidentally on autopsy or cardiac surgery, but rarely during life. We report a rare case of an aortic valve papillary fibroelastoma detected by transthoracic echocardiography and confirmed by histologic study.     

A case report of mitral valve papillary fibroelastoma leading to embolic stroke

A 39-year-old man presented with acute onset of left arm and left side face weakness, and mild expressive aphasia. He was referred for two-dimensional echocardiography, which demonstrated a 13 mm diameter pedunculated, mobile, echodense mass attached to the anterior leaflet of the mitral valve. At operation, the tumor was a 10 x 10 x 15 mm, rounded, and yellow-whitish mass with a short stalk arising from rough zone of the anterior leaflet of the mitral valve. The surface appeared to be sean anemone. The mitral valve with this tumor was excised and replaced with a 29 mm St Jude Medical mechanical valve. The pathological findings are typical of a papillary fibroelastoma.     

Transesophageal echocardiography in the detection and surgical management of a papillary fibroelastoma of the mitral valve causing partial mitral valve obstruction

Duchenne muscular dystrophy (DMD) is an X-chromosome-linked myopathy caused by a defect in the DMD gene. Intragenic deletions appear to be the most common gene defect leading to DMD, and the deletion frequency has been estimated to be 66%. Results of this study using a group of 24 DMD patients of Sri Lankan origin employing the technique of multiplex DNA amplification using the polymerase chain reaction indicated a deletion frequency of 62.5%. Eighty per cent of these deletions were localized in a region of the DMD gene regarded as a 'hot spot' for DMD deletions. Our results are in agreement with the results of other studies carried out on Caucasian populations.     

Transesophageal echocardiographic localization of an aortic valve papillary fibroelastoma during routine coronary artery bypass surgery

Papillary fibroelastomas are rare, primary cardiac tumors most often diagnosed incidentally at autopsy. These tumors have been associated with embolism, neurologic injury, coronary ischemia and sudden death. We report a case of clinical detection of an asymptomatic aortic valve papillary fibroelastoma by transesophageal echocardiography. The mass was an incidental finding during routine coronary artery bypass surgery. This finding dictated a change in the operative approach to include resection of the aortic valve mass in addition to coronary revascularization.     

Surgical treatment of right atrial papillary fibroelastoma, originated from the eustachian valve--a case report

Papillary fibroelastoma is one of the most common benign primary cardiac tumor after myxoma. However, it is rare to originate from Eustachian valve. A 44-year-old woman was pointed out the right atrial tumor during admission for vasospastic angina. On two-dimensional echocardiogram, the tumor was found in the right atrium, and easily moved to the right ventricle. At operation, the tumor originated from Eustachian valve, and was resected together with the valve by means of extracorporeal circulation. The size of tumor was 57 mm in length, and the histological diagnosis was papillary fibroleastoma. The post-operative course was uneventful.     

Extraovarian peritoneal serous papillary carcinoma: studies of clinical and pathological features

OBJECTIVE: To study the clinicopathological features of extraovarian peritoneal serous papillary carcinoma (EPSPC). METHODS: The clinical pictures and pathological characteristics of 10 cases of EPSPC admitted to our hospital from 1980 through 1994 were studied retrospectively. Meanwhile, control studies were performed for 5 cases of ovarian serous papillary carcinoma and 4 cases of malignant peritoneal methothelioma. RESULTS: The ages of the 10 patients were between 44 and 77. The bilateral overies and fallopian tubes were all normal. The histomorphology as examined by photomicroscope and ultrastructural electromicroscope, the histochemistry determined by periodic acid-schiff (PAS) and Alcian blue stain and the immuno-histochemistry detected by carcinoembryonic antigen (CEA), AE1 and AE3 monoclonal antibody assays all revealed no difference between EPSPC and ovarian serous papillary carcinoma. The same is true for those between EPSPC and malignant methothelioma of peritonium except that the Alcian blue stain result would turned to be negative from positive after digesting with hyaluronidase and the micro-villi are longer for malignant peritoneal methothelioma as compared with EPSPC. CONCLUSIONS: The pathohistogenicity of EPSPC is not from ovaries but the methothelium of peritoneum, so called the secondary Müllarian system.     

Acute acoustic trauma--its features and management

A patient with normocytic anemia and marked and persistent reticulocytosis is presented. Causes responsible for blood loss and hemolytic diseases were excluded and, after bone marrow examination, myelodysplastic syndrome (refractory anemia) was diagnosed. In vitro reticulocyte survival studies suggested that reticulocytosis was a consequence of delayed maturation of the reticulocytes. Pseudoreticulocytosis may be an unusual presentation of myelodysplastic syndromes, because only 4 patients with such a finding have previously been reported.     

Colostomies and their management

This article describes the common types of colostomy and outlines the basic principles of management. It relates to UKCC professional development category: Care enhancement.     

The five mysteries of the mind, and their consequences

OBJECTIVE: Using the European Community (EC) criteria for classification Vitali et al. Arthritis Rheum 1993;36:340 7, we report the prevalence estimates of Sjogren's syndrome (SS) from a general population and present the first population data to assess the impact of the syndrome. METHODS: A cross-sectional population-based survey performed on 1000 adults, aged 18-75 yr, randomly selected from a population register. Responders to the initial postal phase were invited for an interview. The five criteria measured at interview were: (1) the reporting of subjective oral symptoms lasting for > 3 months; (2) the reporting of subjective ocular symptoms lasting for >3 months; (3) Schirmer-I test; (4) unstimulated salivary flow; (5) autoantibodies [Ro (SS-A), La (SS-B), rheumatoid factor (RF), antinuclear antibodies (ANA)]. SS was diagnosed if at least four of these five criteria were positive. The MOS Short-form 36 (SF-36), General Health Questionnaire (GHQ) and the Health and Fatigue Questionnaire (HFQ) were completed by subjects after the interview, and scores were compared between those with and without a diagnosis of SS. RESULTS: A total of 341 subjects completed both the postal questionnaire and home visit. A diagnosis of SS could be given to 13 subjects. After adjusting for the presence of possible bias due to non-response, our best estimate of the prevalence of SS in the study population was 33 per 1000 subjects (95% CI 22 44). The prevalence of the disorder was higher in females (38; 95% CI 27-52) and for those subjects aged > or = 55 yr (46; 95% CI 34-61). Those subjects diagnosed positively were more impaired for each of the eight dimensions of the SF-36 than those without a diagnosis, and also suffered from higher levels of depression and fatigue. CONCLUSIONS: SS affects approximately 3-4% of adults and in the general population appears to be associated with a clinically significant impairment of a subject's health and well-being.     

Hospital infections and their consequences in patients of advanced age

On the basis of a representative survey of more than 66,000 patients in German acute hospitals from 1978 to 1989 the incidence and consequences of nosocomial infections on length of hospital stay and mortality for patients above age 60 are discussed. Infection rates are higher for female patients and increase with age for both sexes. Surprisingly the length of stay differences due to nosocomial infections are smaller in absolute and relative terms for older patients. The consequences on mortality, however, strongly concentrate on older patients. Using realistic assumptions on incidence and mortality and on possible degrees of infection the number of "preventable deaths" due to nosocomial infections are calculated. For 1990 the results sum up to more than 6000 deaths at ages above 60 alone for the Federal Republic of Germany within its former borders.     

Linear accelerator output variations and their consequences for megavoltage imaging

An experimental study of radiation output intensity fluctuations of a Philips SL25 linear accelerator is presented. Measurements are obtained using an electronic portal imaging device, and the consequences of the measured fluctuations for various different applications of megavoltage imaging including portal imaging, transit dosimetry and megavoltage computed tomography (MVCT) are discussed with examples. Fluctuations in output of +/- 0.7% (1 SD) are seen on every radiation pulse after photon noise and uncertainties caused by the detection system have been accounted for. Large fluctuations are also seen during the initial beam stabilization period (15%), during normal accelerator operation after the beam has been on for more than 1 min (4.5%) and during are therapy as a repeatable function of gantry angle (9%). Such output intensity fluctuations are shown to produce image artifacts in portal imaging devices with scanned detector readout and can also produce systematic errors in detector calibration that would lead to uncertainty in transit dose calculations. The propagation of these intensity fluctuations through MVCT image reconstruction is shown to produce ring artifacts in the reconstructed image. Sample portal and MVCT images are presented. All observed fluctuations in accelerator output are well within the manufacturer's specifications and do not affect the total dose delivered during normal treatment. Finally, megavoltage imaging is shown to be a powerful tool for accelerator quality assurance and treatment verification.     

Misdiagnosis and labeling in psychiatry and their consequences: Part II

The complexity of arriving at a correct psychiatric diagnosis in cases in which physical and mental disorders are interrelated is discussed. A case is presented in which a psychiatric diagnosis had been made and malingering suspected, although the patient actually had a severe neurological disorder. The psychiatric diagnosis had not been changed despite recurrent medical and psychological examinations which clearly indicated a physical disorder. The difficulties that follow misdiagnosing organic disorders as psychiatric disorders are illustrated. Various aspects of the effects of psychiatric misdiagnosis on functional, legal and civil aspects of life are discussed. Emphasis is given to the problems facing those discharged from military service for medical reasons, especially mental disorders. Important measures are currently being applied to overcome some of these problems. It is strongly emphasized that there is need for greater openness and tolerance among psychiatrists when making psychiatric diagnoses.     

Determiners and consequences of verbal behaviors of young children and their mothers.

Explored the dynamic aspects of maternal language instruction and first language learning. 10 boys and 10 girls between 1 and 5 yrs of age were observed with their mothers in their middle-class homes. 11 types of motivating techniques and 5 types of instructional activities could be reliably differentiated. The frequencies of motivating techniques remained unchanged with the child's increasing age and language level, whereas the frequencies of the mother's instructional activities declined significantly. Meaningful intercorrelations of the motivating techniques attested to the mutual adaptation of mothers and children. Significant intercorrelations of the types of contents taught suggested maternal teaching styles. Motivating techniques and contents of instructions were only weakly related, indicating that instructional strategies can be combined rather flexibly. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical features and management of carcinoma of the pancreas

Carcinoma of the pancreas remains a disease of uncertain aetiology, late presentation and appalling prognosis. This article reviews the clinical presentation of the disease and the role of surgical and non-surgical methods of management.     

Results of psychotherapeutic quality control and their consequences for the general practitioner

The evaluation of psychotherapeutic procedures has been rendered possible by comparing treated and untreated randomized groups. An analysis of expected and unexpected results shows that precisely those elements of psychotherapy which can be applied by practitioners are successful.     

Differential diagnosis mistakes in carpal tunnel syndrome and their therapeutical consequences]

Analysis of some diagnostic mistakes in carpal tunnel syndrome has been discussed in relation to similar symptoms.     

Results of hygienic investigations in hospitals and their consequences (author's transl)

In all parts of the hospitals examined results were found, which demonstrated, in part considerable, gaps in the hygienic systems. Therefore the enforcement of the following measures must be emphatically postulated: - Development of hospital hygiene plans by competent experts in cooperation with the doctors and nurses in charge. - Foundation of commissions for hygiene, who are responsible for preventive measures and for the establishment of a survey of hospital infections. - Delegation of the internal control of hospital hygiene to a person experienced in that field without other functions. - Renovation of supplementation of the technical hygienical facilities especially in old hospitals.