Endovascular repair of supra-celiac and abdominal aortic pseudo aneurysms concomitant with a right atrial mass in a patient with behcet's disease: a case report

Behcet's disease is a rare immune mediated systemic vasculitis which besides it's more frequent involvement of eyes and skin, sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses. A 51-year-old patient with Behcet's Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography [CT] revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behcet's disease. Endovascular repair can be a good treatment option for the pseudoaneurysms

Acceleration of skin wound healing with tragacanth [Astragalus] preparation: an experimental pilot study in rats

Gum tragacanth is a natural complex mixture of polysaccharides and alkaline minerals extracted from species of Astragalus plant, which is found widely in arid regions of the Middle East. In a pilot experimental study we examined the effects of its topical application on wound healing in ten albino adult male rats. Two similar parasagittal elliptical full-thickness wounds [control vs. test samples] were created on the dorsum of each animal. Test group samples were fully covered by a thin layer of gum tragacanth daily. The extent of wound healing was evaluated by planimetric analysis on multiple occasions during the 10-day study period. On the 7[th] day of the study, the percent of wound closure was significantly higher in gum tragacanth-treated specimens compared to the control samples [87% +/- 2% vs. 70% +/- 4%, P<0.001]. The majority of wounds in the test group were completely closed by the 10[th] day of the study. The difference in wound healing index measured by histological examination on day 10 of the study was also statistically meaningful between the two groups [0.624 +/- 0.097 vs. 0.255 +/- 0.063, P<0.05]. The results of this study clearly showed the useful effects of topical application of gum tragacanth in acceleration of skin wound contraction and healing. More studies are encouraged to identify the implicating agents and precisely understand the mechanism by which they exert their wound healing effects

Incidentally detected tricuspid papillary fibroelastoma

A 56-year-old man was admitted to our hospital for coronary artery bypass graft surgery. Preoperative transthoracic echocardiography revealed thickening of the anterior leaflet of the tricuspid valve, and transesophageal echocardiography showed oval and irregular-shaped masses, featuring well-demarcated borders and a homogenous texture, attached to the atrial side of the anterior leaflet of the tricuspid valve with a small, tiny, mobile stalk. In the operating room, this mass was resected and gross anatomical examination showed multiple finger-like fronds attached to the stalk. When it was placed in saline, the mass revealed typical Sea anemone','suggestive of papillary fibroelastoma. Although echocardiography had been previously conducted for routine preoperative evaluation, this incidental finding significantly changed the surgical plan

Angiotensin- converting enzyme insertion/deletion polymorphism and its association with coronary artery disease in an Iranian population

The study of the association between genotype and phenotype is of great importance for the prediction of many diseases and pathophysiological conditions. The relationship between angiotensin-converting enzyme [ACE] gene insertion/ deletion [I/D] polymorphism and pathological processes such as coronary artery disease [CAD] has been investigated previously with discordant results. This study was designed to determine the association between ACE gene I/D polymorphism and CAD in an Iranian population. A total of 1050 individuals who were referred to Tehran Heart Center for coronary angiography were recruited. Six hundred seventy-six CAD-positive patients [documented by coronary angiography and Gensini scores higher than 6] and 374 CAD-negative patients were evaluated for ACE gene I/D polymorphism via the Polymerase Chain Reaction Amplification method. The patients' age, sex, smoking status and its duration as well as familial history of CAD, hypertension, and diabetes mellitus were recorded. Five hundred four [74.6%] of the CAD-positive patients were male, and the mean age of this group was 60 [60 +/- 10]. In the CAD-negative individuals, the mean age was 56 [56 +/- 10] and 196 of them were male [52.4%]. After the analysis of all the groups and gender subgroups, neither genotype nor allele frequency was significantly different between the CAD-positive and CAD-negative groups [p values for genotypes and allele frequencies were 0.494 and 0.397, respectively]. ACE gene I/D polymorphism was not associated with an increased risk of CAD in an Iranian population

comparative study of recombinant human basic fibroblast growth factor [bFGF] and erythropoietin [EPO] in prevention of skin flap ischemic necrosis in rats

Impaired wound healing in ischemic tissues such as skin flaps resulting from inefficient perfusion is one major cause of complications in plastic surgery. In present experimental study, we investigated the effects of fibroblast growth factor-2 [FGF-2 or bFGF] and erythropoietin [EPO] in prevention of skin flap necrosis in rats. 30 adult albino rats were randomized into 3 groups: in control group, normal saline solution; in EPO group, erythropoietin [100U/ kg/day]: and in FGF-2 group, fibroblast growth factor-2 [2,5 microg/day] were injected subcutaneously in 3 daily consecutive doses in the designated flap areas before creating 4:1 random pattern skin flaps on the dorsum of animals. Areas of ischemic [S] and necrotic [S[N]] zones were measured and compared in all groups one week after the flap creations. The necrotic zone [S[N]], as well as the ratio of the necrotic zone to the total discolored zone [S[N]/[S[I]+S[N]]] were substantially larger in the control group [41% +/- 7%, 90% +/- 6%] compared to the EPO [20% +/- 2%,42% +/- 4%] and the FGF-2 [8% +/- 2%,19% +/- 3%] groups [p < 0.001]. The differences in these values were also meaningful between the EPO and FGF-2 groups [p < 0.001].Vascular density in ischemic area of the control group was less than those in the EPO and the FGF-2 groups; however, the differences were not statistically significant between any of the groups [p > 0.05]. Local administration of erythropoietin or fibroblast growth factor-2 in skin flaps could remarkably increase tissue viability and accelerate the wound healing process. However, the therapeutic effect of fibroblast growth factor-2 in preventing the necrotic event in, ischemic zones of skin flaps is much more considerable than that of erythropoietin

Detection of vim- and ipm-type metallo-beta-lactamases in Pseu-domonas aeruginosa clinical isolates

Pseudomonas aeruginosa is the most important bacterium isolated from burn wounds, and its resistance to imipenem due to metallo-beta-lactamases is increasing. This study was designed to detect vim1, vim2, Ipm1 and ipm2 metallo-beta-lactamases genes between Pseudomonas aeruginosa isolates isolated from Shahid Motahari Burns Hospital, Iran. To that end, we isolated 483 nonduplicate consecutive isolates of P aeruginosa from burn infections; and after biochemical confirmation, we examined the imipenem susceptibility via the Kirby-Bauer method. All the imipenem-resistant and imipenem-intermediate isolates were screened for vim1, vim2, ipm1 and ipm2 genes through the FOR method. From the 483 isolates, 272 [56%] and 63 [13%] isolates had resistant and intermediate zones in their imipenem antibiogram pattern, respectively. Fifty-four [16.1%], 7[2.1%], 22[6.6%], and 11[3.3%] of the resistant and intermediate isolates had vim1, vim2, ipm1 and ipm2 genes in their PCR results, respectively. MBL-mediated imipenem resistance in P aeruginosa is a cause for concern in the treatment of infective burn patients. The rate of imipenem resistance due to MBL was increased dramatically and newer versions of MBL families were detected for the first time. These results suggest that an effective method should be provided to fight MBL production in clinical isolates

Association between androgenic hormone levels and left ventricular ejection fraction

Androgens have been shown to have diverse effects on the cardiovascular system. The aim of this study was to compare androgenic hormone levels in patients with different left ventricular ejection fractions [EF]. The study population consisted of 515 consecutive men who were referred for angiographic studies and whose results of echocardiography and coronary angiography were available. The patients were classified into four groups: EF < 35%, EF=35-45%, EF=45-54%, and EF >/= 55% to evaluate the trends of baseline characteristics and serum androgens, including free testosterone [fT], total testosterone [tT], and dehydroepiandrosterone sulfate [DHEAS]. To better elucidate the difference in the patients with severe heart failure, the patients were divided into two groups according to their EF level, and comparisons were repeated between those with EF < 35% and the ones with EF >/= 35%. There were statistically significant trends in some characteristics in the patients with different levels of EF. The subjects with higher EF levels were less likely to have diabetes [p value < 0.001], coronary artery lesion [p value < 0.001], or high levels of C-reactive protein [CRP] [p value < 0.001]. As regards the patients with severe heart failure, our regression analysis revealed that the fT level was significantly lower in those with EF < 35% than in the ones with EF >/= 35% [5.82 +/- 2.73 pg/mL vs. 6.88 +/- 3.34 pg/mL, p value < 0.05]. A significant association was found between the level of fT and EF < 35%. There is a need for further controlled prospective studies to delineate any possible causal relationship accurately

Ultrasonographic screening of the carotid artery in coronary artery bypass surgery

The incidence of stroke after coronary artery bypass grafting [CABG] is between 0.9% and 6.7%, which significantly increases in-hospital and out-hospital costs. This study was designed to evaluate the prevalence of significant carotid stenosis and its risk factors in CABG. In total, 2044 consecutive patients undergoing elective CABG were investigated through a pre-operative duplex scanning of the carotid arteries. The relation of age, sex, smoking, hypertension diabetes, dyslipidemia, and coronary disease with carotid stenosis was evaluated. The prevalence of carotid stenosis was 7.6%. The multivariate analysis showed that age over 55 and left main coronary disease were significant independent risk factors for carotid stenosis. Female gender, smoking hypertension, and diabetes were the risk factors in the univariate logistic regression model. Carotid stenosis is prevalent in CABG candidates. It seems that age >/= 55 years and left main coronary disease are the independent risk factors for carotid stenosis in CABG patients

Left-sided endocarditis associated with multi-drug resistance acinetobacter Lwofii

Acinetobacter lwoffii, and important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia

Do C-reactive protein and lipoprotein [a] have different impacts on the severity of coronary artery disease in diabetic and non-diabetic patients?

The potential role of lipoprotein [a] changes and also inflammation in coronary artery disease [CAD] have rendered these processes one of the most interesting objects of study in patients affected by type 2 diabetes mellitus. The aim of the current study was to evaluate lipoprotein [a] and other lipid profiles and also C-reactive protein [CRP] as the predictors of cardiovascular disease severity in non-insulin dependent diabetic subjects in comparison with non-diabetic CAD patients. Between June and September 2004, 372 patients with CAD were enrolled at Tehran Heart Center. Non-insulin dependent diabetics accounted for 102 of the cases, and the remaining 270 were non-diabetics. The severity of CAD was evaluated using the Gensini score, and the effect of patient variables such as serum lipid concentrations and CRP on CAD severity in the diabetics was investigated and compared with that of the non-diabetics. The mean of the Gensini score, CRP, and serum concentrations of all the lipid profiles were similar between the diabetic and non-diabetic patients. In the diabetic group, a high CRP concentration [?=0.200, Rs= 0.040; P=0.046] was effective on the Gensini score, whereas lipoprotein [a] and lipid profiles did not influence CAD severity. In the non-diabetics, no significant relationships were found between the Gensini score and all the studied laboratory indices. A high CRP level is an important predictor of the severity of CAD in diabetic patients with CAD