Cholesterol crystal embolization in a Saudi patient after cardiac surgery-a case report

An eroded atheromatous aorta may be a source of cholesterol crystal embolism[CCE]. Embolization of atheromatous material accounts for obstruction of distal arterioles around which a foreign-body giant cell granuloma inflammatory reaction develops. The diagnosis is often delayed or un recognized because of varying or misleading clinical signs, such as renal insufficiency, digestive or neurological symptoms, or both or unexplained multiple-system disease. Although CCE can occur spontaneously, it has been increasingly recognized as an iatrogenic complication from an invasive vascular procedure, such as manipulation of the aorta during angiography or vascular surgery. It has also been reported to occur following anticoagulant therapy or thrombolysis. Patients undergoing coronary artery bypass grafting [CABG] often experience a combination of these factors: anticoagulation, intra-arterial angiographic procedures and intraoperative aortic cross-clamping. These multiple factors could account for the acute and severe postoperative clinical and biological findings observed in the case reported here. A 65-year-old Saudi man was admitted to our hospital on July 9, 2008 due to chest pain at rest. He had suffered from type 2 diabetes mellitus on Oral hypoglycemics, hypertension on treatment, impaired renal functions and hypercholesterolemia, he was an ex-smoker with history of diagnosed pulmonary interstitial fibrosis. He had Coronary angiography in another hospital on May 2008 showing a left main lesion 60%, Left anterior descending lesion 90%, circumflex lesion 80% and Right coronary lesion 70%, three weeks later an acute on top of chronic deterioration in renal chemistry was observed for which conservative treatment was chosen

interplay between c-Myconcogene expression and circulating vascular endothelial growth factor, its antagonist receptor, funs-like tyrosine kinase 1 in diffuse large b cell lymphoma: relationship to patient outcome

Aim: is to assess the relation between c-Myc oncogene expression and angiogenic factors namely vascular endothelial growth factor [VEGF], funs-like tyrosine kinase 1[Flt-1] in patients with diffuse large B cell lymphoma [DLBCL] and their impact on the patient outcome

Methods: Forty Five DLBCL patients beside 10 normal controls were included. c-Myc oncoprotein was assessed by immunohistochemistry and sVEGF, and sFlt-1 were assessed by immunosorbent assay

Results: c-Myc over-expression was detected in 66.6% of DLBCL. The DLBCL patient group with positive c-Myc overexpression showed significantly higher sVEGF and significantly decreased sFlt-1 as compared to group with negative c-Myc over-expression [P=0.000, 0.009 respectively]. sVEGF was positively correlated to sLDH and .v./32 microglobulin [r =0.6, p;0.000, r =0.69, P= 0.000] respectively. The non-survived DLBCL group showed significantly higher expression of c-Myc, high concentration of sVEGF and lower concentration in sFlt-1 as compared to the living group [P=0.000 for all]

Conclusion: These findings confirm the in vitro based suggestion that c-Myc over-expression orchestrate the angiogenic mritch necessary for tumor progression. c-Myc over-expression, elevated sVEGF, and normal sFlt-1 at diagnosis are poor prognostic markers· in DLBCL patients