Limb ischemia after heart transplantation: an unusual case of tissue embolism

Major complications of heart transplantation include graft rejection, infection, graft arteriosclerosis, malignancy, and drug toxicity. Among these complications, infections and thrombophilic disorders are of particular interest owing to their major contribution to morbidity and mortality among heart transplantation patients. Thrombophilic disorders are caused by imbalance between hypercoagulation and fibrinolytic states. In this report, we describe a 43-year-old man who had unusual complications of heart transplantation. We presume that the unusual postoperative complications of the patient might have been caused by a faulty surgical procedure, improper use of anticoagulant agents, and incomplete prophylaxis for infections. During the postoperative period, the patient suffered arterial obstruction three times, for which he underwent clot removal via embolectomy. In addition to arterial obstruction, the patient had a mobile mass in the left atrium that was removed by open cardiac surgery. The frozen sample of the cardiac mass was positive for Acinetobacter baumannii. After 7 days of observation in the hospital and proper antibiotic regimen, the patient was sent home with no additional complaints and normal physical examination. We conclude that in heart transplantation patients, the precise performance of the surgical procedure, postoperative care, and early removal of the embolus might reduce morbidities and mortality due to thrombophilic disorders

Refractory vasoplegic syndrome in an adult patient with infective endocarditis: a case report and literature review

Postoperative vasoplegic syndrome [VS] is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence ofVS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS. The patient s blood pressure did not increase after the administration of a high dose of epinephrine and norepinephrine. Therefore, he was commenced on a low dose ofvasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose ofvasopressors, this patient was refractory to a combination of epinephrine and norepinephrine; only a vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily

Thereafter, the patient passed the recovery period in the cardiac intensive care unit and was discharged. It seems that vasopressin is an excellent option in refractory vasoplegia with minimal response to other vasopressors

Impact of FLT-3 mutations on clinical features and response to the therapy in acute promyelocytic leukemia patients

FLT3 mutations are associated with poor outcome in acute myeloblastic leukemia [AML] patients. Only limited information is available about effects of FLT3 mutation on Acute Promyelocytic Leukemia [APL]. We investigated the prevalence and impact of FLT3 mutations on the clinical characteristics and the response to treatment in APL patients treated with arsenic trioxide [As[2]O[3]]. Blood samples were collected from 115 untreated APL patients and genomic DNA was extracted by the salting-out method. FLT3-ITD and FLT3-D835 mutations were investigated by PCR-RFLP. Mann-Whitney U test and Chi-square were used for data analysis. FLT3-ITD and FLT3-D835 mutations were detected in 16 [14%] and 13 [11%] of the patients, respectively. Both mutations were identified in two patients, so overall frequency of FLT3 mutations was estimated to be 23.5%. Patients positive for FLT3-ITD mutation had a higher rate of white cell counts [p= 0.005] and more frequent bcr3 type of PML/RARA fusion [p=0.04]. We have not found any significant association between FLT3-D835 mutation and the clinical characteristics of patients. Between the group with FLT3 Mutations and the group without, there was no significant difference in response to therapy. Complete remission induction with As[2]O[3] may be independent of FLT3 mutation status, so As[2]O[3] may be the first choice of APL especially in patients with FLT3 mutations. However, further studies on a large group of patients are necessary to confirm our findings

[Detection of viability and metabolic activity of NB4 cell line treated with AZT]

APL is a Prevalent leukemia that Approximately included 5-10% of patients with acute myeloblastic leukemia. ATRA and recently arsenic is used for treatment. ATRA leads to resistance to treatment and arsenic is toxic in high doses. AZT induce cell death in different ways. The purpose of this study was Assessment of effect of AZT, a telomerase inhibitor, on NB4 cell line [APL cell line] to reduce toxic effect of high dose arsenic. In this study, viability and metabolic activity of NB4 cells, treated by different concentrations of AZT[50,100,200 micro M], was assessed by trypan blue dye method and MTT assay respectively. Treated cells with AZT=50,100,200 micro M showed decreased viability, both in dose-dependent and time-dependent through trypan blue dye method and decreased cell metabolic activity by MTT assay. Considering that AZT is able to induce apoptosis and decrease cell activity, it seems AZT is a suitable drug for inhibiting the growth of tumor cells