Subclinical chronic left ventricular systolic dysfunction resulting from phosphine poisoning.

We present a case of a 32-year-old male crew member of a cargo ship, accidentally exposed to phosphine, a fumigating substance. He and other crew members developed increasing fatigue and digestive disorders 24 h later; two died from acute pulmonary oedema. The patient was admitted to hospital, where bilateral pneumonia, acute nephritis, hepatopathy, electrolyte imbalance and leucopenia were diagnosed. He was discharged from hospital 3 weeks later. He was examined 4 months later for possible chronic consequences of acute phosphine poisoning, which included echocardiography showing normal heart size and cardiac function. However, on advanced quantitative analysis, using two-dimensional speckle tracking echocardiography, depressed global longitudinal strain was found. Our report extends previously published findings of phosphine-induced left ventricular (LV) dysfunction by demonstrating that subclinical myocardial dysfunction resulting from acute phosphine exposure may persist several months after the exposure in an otherwise asymptomatic patient, and potentially may not be entirely reversible. The persistence of subclinical abnormalities of LV longitudinal function can be diagnosed using the advanced quantitative echocardiographic analysis we describe.

In vitro and in vivo characteristics of connexin 43-modified human skeletal myoblasts as candidates for prospective stem cell therapy for the failing heart.

BACKGROUND: Previously, connexin 43-modified skeletal myoblasts (MbCx) were shown to reduce the pro-arrhythmic effect during the regeneration of heart tissue in an animal model of infarction. To increase the relevance to clinical implementation, in this study, we introduced connexin 43 into human myoblasts using a highly safe non-viral vector and demonstrated that their transplantation had a positive effect on the function of the injured heart. METHODS AND RESULTS: Myoblasts were efficiently transfected with a pCiNeo-GJA1 plasmid (65.72%). qPCR analysis revealed over 32-fold higher expression of the connexin 43 gene in the MbCx cell population compared to 'native' controls. The susceptibility of the myoblasts to oxidative stress conditions (p<0.001) and the fusion index (p<0.01) were increased in the MbCx cells. Additionally, we observed changes in the MYOG and MYH2 gene expression levels in the GJA1-modified myoblasts. Finally, we observed a significant improvement in the post-infarction echocardiographic parameters after intervention using MbCx cells compared with non-transfected myoblasts (MbWt) and the control (0.9% NaCl), wherein a significant decrease in the left ventricular area change in the short axis (SAX AC%) was observed at the two-month follow-up (p<0.05 and p<0.01, respectively). CONCLUSIONS: We demonstrated the positive effect of connexin 43 overexpression on the biology and function of human skeletal myoblasts in the context of their potential clinical applications. Our preclinical studies using a mouse infarction model indicated the positive effect of MbCx implantation on the function of the injured heart.

Prevalence of congenital coronary artery anomalies and variants in 726 consecutive patients based on 64-slice coronary computed tomography angiography.

BACKGROUND: Coronary computed tomography angiography (CCTA) is helpful in making a precise noninvasive evaluation of coronary anatomy, allowing concomitant evaluation of other cardiac structures. The aim of this study was to determine the prevalence of coronary artery variations detected by 64-slice multi detector CT. MATERIALS AND METHODS: The results of ECG-gated CCTA in 726 consecutive patients (mean age 58 years) were analysed retrospectively. The main indications for CCTA were a typical chest pain, angina pectoris, screening for coronary artery disease and determination of the patency of bypass grafts or stents. Acquisition was performed with a 64-detector CT scanner with retrospective ECG gating. Imaging results were assessed by experienced cardiovascular radiologist. RESULTS: The overall incidence of coronary artery anomalies was 1.1% (8 out of 726 participants). The most common anomaly was an anomalous origin of the circumflex artery from the right coronary sinus with a retroaortic course (4 patients,0.6%), followed by origin of right coronary artery from the left coronary sinus (2 patients, 0.3%). One patient with abnormal origin of the left main artery from the right coronary sinus (0.1%) and 1 patient with a circumflex artery origin from the proximal segment of the right coronary artery (0.1%) were observed, both with retroartic course. CONCLUSIONS: CCTA is a noninvasive imaging technique useful for the precise evaluation of variations of the coronary arteries. This study shows similar results to other reports on this subject.

Persistent left superior vena cava with an absent right superior vena cava in a 72-year-old male with multivessel coronary artery disease.

Congenital anomalies of systemic veins are usually asymptomatic and found incidentally during ultrasonography, computed tomography (CT) or magnetic resonance examinations performed for other clinical indications. Persistent left superior vena cava (PLSVC) with absent right superior vena cava (RSVC) is the congenital aberration in the thoracic venous system which occurs in only 0.09%to 0.13% of patients who have congenital heart defects. In this paper, we present the extremely rare case of a 72-year-old male with PLSVC associated with an absence of RSVC, referred for coronary CT angiography. Multidetector CT angiography is a powerful tool for the detection of venous anomalies, which is essential before invasive procedures such as the implantation of pacemakers.

[Difficulties in the diagnosis of primary malignant histiocytoma of the lung]. / Trudnosci w rozpoznaniu pierwotnego histiocytoma malignum pluca.

A case is presented of a round coin shadow seen on a routine chest radiogram producing grave diagnostic problems. During hospitalization the patient presented neurological and bone and joint involvement symptoms. Transthoracic needle biopsy of the lesion allowed to diagnose large cell cancer, but autopsy changed this diagnosis to malignant histiocytoma.

[Wegener's granulomatosis with tracheoesophageal fistula]. / Ziarniniakowatosc Wegenera z przetoka tchawiczo-przelykowa.

A case of Wegener's granulomatosis in a 54 year old female is presented. The disease course was fulminating, the necrotic process involving lungs, gingiva, skin, trachea, producing finally a tracheo-esophageal fistula. Therapy with cyclophosphamide and prednisone produced resolution of all organ involvement except for the tracheo-esophageal fistula.