Renal angiomyolipoma with inferior vena cava and right atrial embolism: A case report and literature review / 中南大学学报(医学版)

Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.

Coronary Microembolization with Normal Epicardial Coronary Arteries and No Visible Infarcts on Nitrobluetetrazolium Chloride-Stained Specimens: Evaluation with Cardiac Magnetic Resonance Imaging in a Swine Model

OBJECTIVE: To assess magnetic resonance imaging (MRI) features of coronary microembolization in a swine model induced by small-sized microemboli, which may cause microinfarcts invisible to the naked eye. MATERIALS AND METHODS: Eleven pigs underwent intracoronary injection of small-sized microspheres (42 microm) and catheter coronary angiography was obtained before and after microembolization. Cardiac MRI and measurement of cardiac troponin T (cTnT) were performed at baseline, 6 hours, and 1 week after microembolization. Postmortem evaluation was performed after completion of the imaging studies. RESULTS: Coronary angiography pre- and post-microembolization revealed normal epicardial coronary arteries. Systolic wall thickening of the microembolized regions decreased significantly from 42.6 +/- 2.0% at baseline to 20.3 +/- 2.3% at 6 hours and 31.5 +/- 2.1% at 1 week after coronary microembolization (p < 0.001 for both). First-pass perfusion defect was visualized at 6 hours but the extent was largely decreased at 1 week. Delayed contrast enhancement MRI (DE-MRI) demonstrated hyperenhancement within the target area at 6 hours but not at 1 week. The microinfarcts on gross specimen stained with nitrobluetetrazolium chloride were invisible to the naked eye and only detectable microscopically. Increased cTnT was observed at 6 hours and 1 week after microembolization. CONCLUSION: Coronary microembolization induced by a certain load of small-sized microemboli may result in microinfarcts invisible to the naked eye with normal epicardial coronary arteries. MRI features of myocardial impairment secondary to such microembolization include the decline in left ventricular function and myocardial perfusion at cine and first-pass perfusion imaging, and transient hyperenhancement at DE-MRI.

Pathology of Endoscopic Submucosal Dissection; How Do We Interpret? / 대한소화기학회지

It is widely accepted that endoscopic submucosal dissection (ESD) is an important treatment option for cases of early gastric carcinoma where the probability of lymph node metastasis is very low. The resected ESD specimens are carefully examined by serial sections at 2 mm intervals, and if pathology reveals submucosal invasion more than 500microm and/or lymphovascular invasion, or if the resection margin is involved by the tumor, surgery is recommended. In this point of view, thorough pathologic examination and reporting the accurate pathologic diagnosis of ESD specimen is very important. The diagnostic approach and pitfalls in the diagnosis of ESD specimen are reviewed.

Avaliação da captura de fragmentos por meio da filtração intra-aórtica em pacientes submetidos à troca valvar aórtica / Particulate emboli capture by an intra-aortic filter device during aortic valve replacement

OBJETIVO: O objetivo deste estudo foi avaliar a atividade embólica de pacientes portadores de estenose aórtica calcificada submetidos a troca valvar aórtica por meio da filtração intra-aórtica com dispositivo EMBOL-X® System (Edwards Lifesciences Inc., Mountain View, CA, USA). MÉTODOS: De janeiro de 2007 a julho de 2007, foi utilizado o filtro intra-aórtico EMBOL-X após o despinçamento aórtico em 13 portadores de estenose aórtica calcificada submetidos a troca valvar aórtica consecutivamente. A média de idade dos pacientes foi 63,7 anos (34-79) e 61,5% eram do sexo feminino. A média do tempo de CEC foi 60,2±7,5 (45-72) minutos e a média do tempo despinçamento aórtico foi 50±7,5 (35-63) minutos. Após a retirada dos filtros, eles foram fixados em formalina, analisados macroscopicamente e quantificados os fragmentos capturados. Foi realizado exame histológico do material capturado. RESULTADOS Não foi observado nenhum caso de complicação neurológica. Nenhum paciente apresentou insuficiência renal pós-operatória. Não houve óbitos hospitalares. Partículas embólicas foram encontradas em cinco (38,5%) dos filtros. Das partículas embólicas capturadas, em dois (40%) filtros havia fibrina, dois (40%) apresentavam tecido conjuntivo, um (20%) continha hemácias e em um não foi possível determinar a natureza. CONCLUSÃO: O dispositivo EMBOL-X® System foi efetivo na captação de fragmentos intra-aórticos na substituição da valva aórtica em pacientes com estenose aórtica calcificada.

OBJECTIVE: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA). METHODS: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. RESULTS: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in one it was not possible to determine the nature of the particulates captured. CONCLUSION: The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.

Vasoocclusion by sickled RBCs in 5 autopsy cases of sudden death.

Mortality in sickle cell disease is high at young age group. So it is necessary to find out the cause of death in young patients with sickle cell disease. We are presenting 5 cases of sudden death in young adults with undiagnosed sickle cell disease. The provocative factors for those terminal events were vasoocclusive crisis. In our patients crisis was secondary to fever (infection), conductive arrhythmia, cardiovascular collapse, post partum shock and hemorrhage. On microscopic examination of viscera, not a single patient showed signs of chronic organ damage, sequestration crisis or acute chest syndrome, which are the common causes of death in sickle cell disease.

Utilidad de la ecocardiografía transtorácica en la embolia sistémica / Usefulness of transthoracic echocardiography in systemic embolism

Se presenta la experiencia del Departamento de Cardiología del Hospital de Especialidades "Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, y se revisa la literatura internacional con respecto a la utilidad del estudio ecocardiográfico transtorácico en la embolia sistémica. Se analizan en forma suscinta los resultados obtenidos mediante el uso de este método diagnóstico en 38 pacientes y los obtenidos en diferentes centros ecocardiográficos internacionales y del oaís. Se concluye que el método ecocardiográfico transtorácio es el primer paso obligado en el estudio de pacientes en quienes se sospecha embolia arterial de origen central, a pesar de que actualmente se cuenta con la ecocardiografía transesofágica; este último método debe ser usado en caso de que el estudio transtorácico sea negativo, dudoso de calidad inadecuada para el diagnóstico, o bien, que no pueda llevarse a cabo por condiciones desfavorables del paciente

Embolization of an intramedullary arteriovenous malformation of the spinal cord

Embolization therapy is increasingly recognized to be the treatment of choice for patients with intramedullary spinal arteriovenous malformations [AVMs] even though in the majority of cases only partial or temporary occlusion of the AVM is achieved. The authors report a case of an 8-year-old boy who had a lower thoracic intramedullary AVM which had bled at least twice in the past. The lesion was totally obliterated by embolization over two sessions. The clinical improvement in his condition is still apparent at 6-months follow-up

Acute electrocardiographic lead II changes following experimental pulmonary air embolization

The effect of venous air embolization on the heart's electrical activity is not well demonstrated in the literature. This is a study of the acute electrocardiographic [ECG] lead II changes following experimental injection of 40 ml of air in two groups of dogs [7 dogs in each group]. In group I [GI], air was injected peripherally in the femoral vein and in group II [GII], air was injected directly into the central pulmonary artery. Six dogs were used as control. All dogs were subjected to general endotracheal anesthesia and sternotomy to expose the heart. ECG changes were recorded using lead II. Cardiac dysrhythmia was the most frequently encountered ECG change. It occurred in 85.7% of dogs of GI and in 100% of dogs of GII. Sinus tachycardia was the commonest in GI [85.7%]. Sinus tachycardia and premature ventricular contractions were commonest in GII [42.8% each]. The incidence of T wave inversion was greater in GI [42.8%], while ST segment changes were greater in GII. The only significant difference between the two groups was the presence of P-pulmonale in GI only [57.1%]. Venous air embolism should be thought of in patients with any access to their systemic venous circulation and whose monitoring reveals unexplained ECG changes

Trombose cardíaca e embolia em pacientes falecidos de cardiopatia chagásica crônica / Cardiac thrombosis and embolism in patients who had died with chronic chagasic cardiopathy

Foram estudados, de forma retrospectiva, 111 pacientes falecidos no Instituto do Coraçäo entre 1978 e 1984, 72 dos quais eram do sexo masculino, com idade média de 47,5 anos (10-85), todos portadores da moléstia de Chagas. Encontraram-se 81 casos (73%) com trombose cardíaca, em 53% dos quais nas cavidades direitas e em 46% nas cavidades esquerdas. Os episódios embólicos foram observados em 67 casos (60%), sendo em 65% pulmonares e em 38% sistêmicos. Os órgäos-alvo foram: rins 21 vezes, baço em quatro, cérebro em duas aorta abdominal, artéria mesentérica e artéria ilíaca externa uma vez, respectivamente. Do total de casos com trombose em cavidades direitas (35/65) 53% tinham embolia pulmonar, enquanto que dos casos com embolia pulmonar (6/41) 14% näo tinham trombose em cavidades direitas. Dos casos com trombose em cavidades esquerdas (24/56) 42% apresentaram embolia sistêmica, enquanto que dos casos com embolia (2/26) em 7% näo havia trombose em cavidades esquerdas. Conclui-se que a incidência de trombose e embolia é alta nos enfermos com disfunçäo miocárdica grave, existindo uma relaçäo entre ambas, embora näo absoluta