Surgical Repair for Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare congenital heart defect. Herein, we describe three cases of ARCAPA in an 8 months old, 18 months old, and 4 year old child. Two cases were incidentally diagnosed using a computed tomographic angiograph, and the other was incidentally diagnosed using a coronary angiograph. These cases underwent a reimplantation technique on diagnosis and resulting in positive clinical outcomes during the follow-up period which was a mean of 1.5 years.

White Blood Cell Count to Mean Platelet Volume Ratio Is a Prognostic Factor in Patients with Non-ST Elevation Acute Coronary Syndrome with or without Metabolic Syndrome

BACKGROUND AND OBJECTIVES: Leukocyte and platelet have been found to be associated with metabolic syndrome (MetS). We aimed to determine the usefulness of a novel marker named white blood cell count to mean platelet volume ratio (WMR) for predicting outcomes of non-ST elevation acute coronary syndrome (NSTE-ACS) with or without MetS. SUBJECTS AND METHODS: A total of 331 NSTE-ACS individuals (60±12.5 years, 57.4% male) were enrolled and followed for a median of 24 months. MetS was identified using the National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: Patients were divided into two groups: high WMR (WMR≥720) and low WMR (WMR<720). Major adverse cardiovascular events (MACE) and MetS rates were significantly greater in the higher WMR group compared to those in the low WMR group (MACE: 14.3% vs. 25%, p=0.014; MetS: 50.9% vs. 75%, p<0.001). MetS was diagnosed in 62.2% of patients. MACE incidence in patients with or without MetS was comparable (p=0.737). Among MetS individuals, patients in the high WMR group had more MACE than the low WMR group (11.2% vs. 26.5%, p=0.007). However, MACE was comparable among non-MetS individuals (p=0.681). In multivariable Cox regression analysis, hazard ratios (HR) of MACE incidence for high-WMR in MetS individuals was 2.616 (95% confidence interval: 1.282–5.339, p=0.008). However, HR of MACE incidence for high WMR in non-MetS individuals was not significant. CONCLUSION: Among NSTE-ACS patients without revascularization therapy, elevated admission WMR was associated with an increased risk of developing composite MACE in MetS individuals but not in non-MetS patients.

Molecular and hormonal regulation of angiogenesis in proliferative endometrium.

Angiogenesis is a hallmark of wound healing, the menstrual cycle, cancer, and various ischemic and inflammatory diseases. A rich variety of pro and anti-angiogenic molecules have already been identified. Vascular endothelial growth factor (VEGF) is an interesting inducer of angiogenesis and lymphangiogenesis, because it is a highly specific mitogen for endothelial cells. Signal transduction involves binding to tyrosine kinase receptors and results in endothelial cell proliferation, migration, and new vessel formation. In this article, the role of VEGF and other growth factors in the pathology of dysfunctional uterine bleeding is reviewed. We also discuss the role of VEGF expression and interaction with extracellular matrix that lead to possible inhibition or stimulation of Angiogenic factor on endometrium of dysfunctional uterine bleeding patients.

Concurrent mobile and in situ types of right heart thrombi

Right-sided heart thrombus is a life-threatening condition that necessitates immediate therapy. Detection of right-sided heart thrombus is usually via transthoracic echocardiography. Generally, thrombolysis is considered a treatment of choice, but there is currently no consensus about the optimal therapeutic choice. We present a case of multiple right atrial thrombi with concurrent mobile and broad-based in situ thrombi in a patient with a history of chronic obstructive pulmonary disease, which was completely resolved by thrombolysis following a failed Heparin infusion. The patient was sent home in good clinical condition and was stable at 3 months' follow-up

Effects of hydrochlorothiazide on kidney stone therapy with extracorporeal shock wave lithotripsy

The aim of this investigation was to assess the efficacy of hydrochlorothiazide as a hypocalciuric diuretic on stone-free rate of renal pelvic calculi after extracorporeal shock wave lithotripsy [ESWL]. A double-blind, placebo-controlled randomized clinical trial was conducted and 52 patients with renal pelvic calculi [diameter

Slow Coronary Flow Phenomenon and Increased Platelet Volume Indices

BACKGROUND AND OBJECTIVES: We sought to determine the relationship between mean platelet volume (MPV), platelet distribution width (PDW), and platelet larger cell ratio (P-LCR) with slow coronary flow (SCF). SUBJECTS AND METHODS: Eighty participants who underwent coronary angiography were divided into two groups, 50 participants with SCF as case group, and 30 with normal coronary flow (NCF) as control group. Baseline characteristics and laboratory data were collected before angiography. RESULTS: Platelet volume indices MPV (10.8+/-1.2 fL), PDW (14.5+/-2.2 fL), and P-LCR (30.5+/-8.1%) in the SCF group were significantly (p<0.05) higher than those (10.1+/-0.9 fL, 13.2+/-1.8 fL, and 26.8+/-6.8%, respectively) in the NCF group. The patients with three SCF arteries had significantly higher platelet volume indices compared to those with NCF arteries; however, the patients with one SCF artery did not. Based on linear regression model, MPV, PDW, and P-LCR were independent predictors of mean infarction frame counting (TFC). In multivariate analysis, MPV {odds ratio (OR)=32.393, 95% confidence interval (CI)=1.189-882.606, p=0.039} and P-LCR (OR=0.566, 95% CI=0.330-0.937, p=0.028) were independent predictors of SCF. CONCLUSION: Platelet volume indices MPV, PDW, and P-LCR were associated with both the presence and extent of SCF.

Tolterodine to Relieve Urinary Symptoms Following Transurethral Resection of the Prostate: A Double-Blind Placebo-Controlled Randomized Clinical Trial

PURPOSE: To evaluate the effect of tolterodine on early storage symptoms following transurethral resection of the prostate. MATERIALS AND METHODS: Seventy patients over 55 years of age who underwent transurethral resection of the prostate owing to benign prostatic hyperplasia were randomly assigned to receive either 2 mg of tolterodine twice daily (treatment group) or matched placebo during a 1-month study period. Before and 1 month after the procedure, they were asked to complete the International Prostate Symptom Score (IPSS) questionnaire and quality of life subscale to assess their symptoms. Also, analgesic use and adverse drug events were determined at follow-up. RESULTS: Of 70 allocated patients, 64 patients (91.4%), including 33 in the treatment group and 31 in the placebo group, completed the study. The mean age of the patients was 67 years. None of the patients' basic clinical characteristics were significantly different. At the end of the follow-up period, the total IPSS and quality of life score had significantly improved in the patients receiving tolterodine compared with those receiving placebo (p=0.001 and p=0.036, respectively). The treatment group compared with placebo demonstrated significant improvements in frequency and urgency but not in nocturia. The amount of consumed painkiller was also significantly lower in the tolterodine group than in the placebo group (p=0.0001). The rate of side effects was not significantly different between the groups. CONCLUSIONS: Administering 2 mg of tolterodine twice daily is an effective and well-tolerated regimen to relieve early storage symptoms, quality of life, and the amount of analgesic consumption following transurethral resection of the prostate.

Significance of salivary phosphodiesterase level in oral squamous cell carcinoma patients.

Oral cancer, more specifically oral squamous cell carcinoma (OSCC) consider as common cancer that 300,000 people diagnosed per year worldwide. The only effective treatment for OSCC is surgical intervention. Over the past two decades, overall disease condition has not improved although advancement of treatment has considerably increased. The phosphodiesterase (PDEs) are responsible for the hydrolysis of the second messengers with a fundamental role in the transduction of the intracellular signals. In numerous pathological conditions such as cellular differentiation, apoptosis, and tumor invasivity the different PDF activity has been observed that shown role in pathophysiological mechanism. The role of PDEs as an intervention factor for activation of angiogenesis by influencing a tumor growth has been shown. The objective of this study was to estimate and compare salivary PDEs levels in healthy controls and biopsy-proven oral cancer patients before definitive therapy. Study was done in patients age between 25-65 years biopsy proven oral cancer patients and control group. After obtaining prior consent from biopsy-proven oral cancer patients (n=26) (before onset of any definitive treatment) and age- and sex-matched healthy controls (n=29), salivary sample was collected for estimation of the activity of phosphodiesterases (PDEs).

Evaluation of oxidative protein damage in patients with hypercholesterolemia.

Background: Hypercholesterolemia is highly prevalent in Indian population and known to contribute towards increased mortality and morbidity related to cardiovascular and cerebrovascular disorders. An antioxidant defence system consisting of enzymatic and non-enzymatic compounds prevents oxidative damage of lipoproteins in the plasma. When the activity of this system decreases or the reactive oxygen species (ROS) production increases, oxidative stress may occur.The –SH group (reduced thiols) bound to proteins (protein thiols) play a major role in maintaining the antioxidant status of the body. Protein thiols acts as major extracellular antioxidant, they react with reactive oxygen species (ROS) and prevent LDL oxidation. Such thiols have been studied in different disease conditions and found to be decreased compared to healthy control samples. Reduced concentration of protein thiol found to have positive correlation with increase serum level of LDL cholesterol. In the current work we have measured the level of serum protein thiols along with lipid profile in newly diagnosed hyperlipidemic patients and we tried to establish the relationship between serum protein thiols and lipid profile parameters. Objective: To study the level of protein thiols as a potent antioxidant in patient with an increased level of cholesterol. Materials: After obtaining prior consent, blood (2 ml) was taken using aseptic precautions from hypercholesterolemic patients (n = 25) and age and sex matched healthy controls (n = 25) in plain vacutainers. Serum protein thiols were measured by spectrophotometric method using 5, 5′ dithio-bis (2-nitrobenzoic acid) (DTNB). Triglyceride levels were measured by Cobas 6000 using a GPO Trinder method and HDL levels by Cobas 6000 using a direct- homogenous method. LDL levels were calculated. Results: There was a significant decrease in the levels of protein thiols p< 0.001 in hypercholesterolemic patients when compared to healthy controls and a corresponding correlatable increase in the level of LDL cholesterol due to oxidative damage. Conclusion: There may be a role for protein thiols as a biomarker in pathophysiology of cardiovascular and cerebrovascular disorders in patients with hyperlipidemia.