Topographical anatomy of the left ventricular summit: implications for invasive procedures.

BACKGROUND: Recent clinical reports have emphasized the clinical significance of the left ventricular summit (LVS), a specific triangular epicardial area, as the source of ventricular arrhythmias where radiofrequency ablation is of great difficulty. MATERIALS AND METHODS: The macroscopic morphology of the LVS has been assessed in 80 autopsied and 48 angio-computed tomography (CT) human hearts. According to Yamada's equation, the size was calculated based on the distance to the first, most prominent septal perforator. RESULTS: The size of the LVS varies from 33.69 to 792.2 mm2, is highly variable, and does not correlate with body mass index, sex, or age in general. The mean size of the LVS was 287.38 ± 144.95 mm2 in autopsied and angio-CT (p = 0.44). LVS is mostly disproportionately bisected by cardiac coronary veins to superior-inaccessible and inferior-accessible areas. The superior aspect dominates over the inferior in both groups (p = 0.04). The relation between superior and inferior groups determines three possible arrangements: the most common type is superior domination (50.2%), then inferior domination (26.6%), and finally, equal distribution (17.2%). In 10.9%, the inferior aspect is absent. Only 16.4% of the LVS were empty, without additional trespassing coronary arteries. CONCLUSIONS: The difference in size and content of the LVS is significant, with no correlation to any variable. The size depends on the anatomy of the most prominent septal perforator artery. The superior, inaccessible aspect dominates, and the LVS is seldom free from additional coronary vessels, thus making this region hazardous for electrophysiological procedures.

Applicability of computed tomography preoperative assessment of the LAA in LV summit ablations.

PURPOSE: Ventricular arrhythmias originating from the left ventricular summit (LVS) may present with challenges for catheter ablation. Recently, the left atrial appendage (LAA) became a new vantage point for mapping and ablating arrhythmias from that region, but data of possible usefulness is limited. METHODS: From September to December 2019, we retrospectively analyzed 48 consecutive patient hearts (20 male; mean age 57.9y ± 11.56) undergoing diagnostic coronary vessel imaging in 64 dual-source computer tomography angiography (CTA). Distances from the LAA to the LVS, LAA shape type, and coronary arteries in the LVS region were measured. Also, we compared the true LVS area from CTA with a calculated formula derived from LVS definition. RESULTS: The mean LVS area calculated from the formula was 291.58 mm2 (± 115.5) while the true area calculated from CT was 263.33 mm2 (± 99.49) (p = 0.44). The mean inaccessible area was 133.42 mm2 (± 72.89), accessible 95.67 mm2 (± 72.77). The mean LAA coverage over LVS was 196.08 mm2-which is approximately 75% of LVS size in general. The most common LAA shape was chicken wing (50%); windsock has the highest accessible area coverage on average (80.23%), followed by chicken wing (59.88%), broccoli (47.72%), and cactus (46.98%). The mean distance from LAA to the surface was 5.14 mm (1.5 to 10 mm) and was not correlated with BMI. LAA has a 98% coverage over the point of transition between the great cardiac vein and anterior interventricular vein. CONCLUSION: Angio-CT assessment of the LAA over the LVS structures may be helpful in decision making before an ablation procedure. LAA appears to be a promising mapping approach in LVS arrhythmias.

Detailed radiological study of the patent ductus arteriosus: a computed tomography study in the Polish population.

BACKGROUND: The aim of the study was to perform qualitative and quantitative computed tomography (CT) angiography-based evaluation of patent ductus arteriosus (PDA) morphology and its influence on morphology of the great vessels. MATERIALS AND METHODS: Two-thousand twenty-two patients underwent 64-slice or dual-source CT and were retrospectively screened for the presence of PDA. Those who had presence of PDA underwent evaluation of its anatomy and morphology. RESULTS: Thirty-two adult patients with PDA were evaluated (mean age 41.4 ± 17.4 years). Subjects with PDA had a higher value of aortic isthmus (p = 0.0148), main pulmonary artery (p < 0.0001), right (p =0.0007) and left (p = 0.0074) pulmonary arteries diameters than individuals from control group (16 adults, median age 43.3 ± 12.4 years). Types A, B, C, D, and E of PDA morphology occurred in 16 (50%), 3 (9%), 9 (28%), 2 (6%), and 2 (6%) patients, respectively. Subjects with the type A configuration of PDA tended to have a larger diameter at the aortic orifice (10.2 ± 5.2 mm vs. 6.4 ± 4.9 mm, p = 0.09) and a larger maximal diameter (10.3 ± 5.3 mm vs. 7.1 ± 4.7 mm, p = 0.14) compared to subjects with the type C configuration. The values of minimal, mean, and maximal diameters of PDA were 4.7 ± 1.9 mm, 7.0 ± 3.2 mm, and 9.4 ± 5.0 mm, respectively. The Spearman correlation coefficient between the main pulmonary artery and PDA diameters demonstrated a good correlation for minimal (r = 0.70, p < 0.001), mean (r = 0.62, p = 001), and maximal (r = 0.60, p = 0.0003) PDA diameters. CONCLUSIONS: Computed tomography enables quantitative and qualitative evaluation of PDA, including its type of morphology, length, and diameters. In the evaluated adult population with PDA, the majority of patients had dilation of the aortic isthmus and pulmonary arteries. PDA diameters correlate with diameters of the pulmonary arteries and this correlation is strongest between PDA diameter at the narrowest site and main pulmonary artery.

Computed tomography in the evaluation of the anomalous origin of the coronary artery: coexistence with other congenital heart disease in an adult population.

BACKGROUND: The aim of the study is to assess the prevalence of anomalous origin of the coronary artery in cardiac computed tomography (CT) and to evaluate its coexistence with other congenital heart disease. MATERIALS AND METHODS: 7,115 patients, who underwent 64-slice or dual source cardiac CT in the years 2005-2011 were screened for the presence of anomalous origin of the coronary artery. RESULTS: Anomalous origin of coronary artery was found in 62 (0.87%) patients (34 males, mean age 57.4 ± 15.1 years). Anomalous aortic and pulmonary origin of coronary artery concerned 59 (0.83%) and 3 (0.04%) cases, respectively. Concomitant heart defects were observed in 5 (0.07%) patients, all with anomalous aortic origin of coronary artery. Malformations included transposition of great arteries (4 patients) and single ventricle in (1 patient). CONCLUSIONS: The incidence of anomalous origin of a coronary artery in cardiac CT is similar to invasive coronary angiography. In an adult population the vast majority of those anomalies are isolated abnormalities without concomitant other congenital heart defects.

Are there differences between macrocyclic gadolinium contrast agents for brain tumor imaging? Results of a multicenter intraindividual crossover comparison of gadobutrol with gadoteridol (the TRUTH study).

BACKGROUND AND PURPOSE: Gadobutrol (Gadavist) and gadoteridol (ProHance) have similar macrocyclic molecular structures, but gadobutrol is formulated at a 2-fold higher (1 mol/L versus 0.5 mol/L) concentration. We sought to determine whether this difference impacts morphologic contrast-enhanced MR imaging. MATERIALS AND METHODS: Two hundred twenty-nine adult patients with suspected or known brain tumors underwent two 1.5T MR imaging examinations with gadoteridol or gadobutrol administered in randomized order at a dose of 0.1 mmol/kg of body weight. Imaging sequences and T1 postinjection timing were identical for both examinations. Three blinded readers evaluated images qualitatively and quantitatively for lesion detection and for accuracy in characterization of histologically confirmed brain tumors. Data were analyzed by using the Wilcoxon signed rank test, the McNemar test, and a mixed model. RESULTS: Two hundred nine patients successfully completed both examinations. No reader noted a significant qualitative or quantitative difference in lesion enhancement, extent, delineation, or internal morphology (P values = .69-1.00). One hundred thirty-nine patients had at least 1 histologically confirmed brain lesion. Two readers found no difference in the detection of patients with lesions (133/139 versus 135/139, P = .317; 137/139 versus 136/139, P = .564), while 1 reader found minimal differences in favor of gadoteridol (136/139 versus 132/139, P = .046). Similar findings were noted for the number of lesions detected and characterization of tumors (malignant/benign). Three-reader agreement for characterization was similar for gadobutrol (66.4% [κ = 0.43]) versus gadoteridol (70.3% [κ = 0.45]). There were no significant differences in the incidence of adverse events (P = .199). CONCLUSIONS: Gadoteridol and gadobutrol at 0.1 mmol/kg of body weight provide similar information for visualization and diagnosis of brain lesions. The 2-fold higher gadolinium concentration of gadobutrol provides no benefit for routine morphologic imaging.

Morphological characteristics of potentially malignant pulmonary nodules in high-risk male smokers detected in lung cancer screening trial in Cracow, Poland.

The purpose of this paper was to present morphological characteristics of potentially malignant nodules revealed in a group of male smokers aged 50-74 with a very high risk for developing lung cancer estimated in the study for lung cancer screening in Cracow (Poland). Nine hundred male smokers aged 50 to 74 years were invited to the study and were asked in questionnaires about e.g. smoking exposure history. Exclusion criteria included e.g. positive cancer history and chest computed tomography (CT) examination in the previous year. Based on CT results and characteristics of pulmonary nodules subjects were classified to group A (low risk), group B (indeterminate) and group C (high-risk individuals - required work-up). Final diagnosis was based on pathological results of postoperative material. Thirty-nine males of mean age 63.4 (standard deviation (SD): 6.69 years) revealed 41 potentially malignant pulmonary nodules in baseline screening. In 14 subjects 16 type C pulmonary nodules were histologically proved. Nine nodules were found to be benign lesions, while 7 nodules revealed malignant lung cancer: 5 cases of adenocarcinoma and 2 cases of adenosquamous carcinoma. We determined morphological characteristics of potentially malignant pulmonary nodules in 39 high-risk male smokers and proved lung cancer in 7 subjects.

A EuroPrevall review of factors affecting incidence of peanut allergy: priorities for research and policy.

Peanuts are extensively cultivated around the world, providing a foodstuff that is both cheap to produce and nutritious. However, allergy to peanuts is of growing global concern, particularly given the severity of peanut-allergic reactions, which can include anaphylaxis and death. Consequently, it is important to understand the factors related to the prevalence of peanut allergy in order to inform efforts to ameliorate or pre-empt the condition. In this article we review evidence for the relevance of factors hypothesized to have some association with allergy prevalence, including both genetic and environmental factors. Although our analysis does indicate some empirical support for the importance of a number of factors, the key finding is that there are significant data gaps in the literature that undermine our ability to provide firm conclusions. We highlight these gaps, indicating questions that need to be addressed by future research.

[Promoting remyelination in multiple sclerosis by endogenous adult neural stem/precursor cells]. / Promouvoir la remyélinisation dans le cadre de la sclérose en plaque à l'aide des cellules neurales/précurseurs et/ou souches endogènes adultes.

Although the treatment of multiple sclerosis has made significant strides in the last decade, successful translation from laboratory to clinical medicine of neuronal repair remains a therapeutic challenge. Nevertheless, advances in the biology of stem and precursor cells, particularly in relation to myelin damage, make this a realistic proposition during the next decade. Replacing lost myelin (remyelination) is currently thought to be an important clinical objective because of the role it might play in slowing or preventing axonal degeneration. Stem/precursor cell-based strategies for enhancing remyelination can be divided into those in which cell are transplanted into a patients (exogenous or cell therapies) and those in which the patients own stem/precursor cells are mobilised to more efficiently engage in healing areas of demyelination (endogenous or pharmacological therapies). While the two approaches tend to be regarded separately they are not mutually exclusive. This article focuses on the endogenous approach and reviews the nature and nomenclature of the stem and precursor cells present within the adult CNS that engage in remyelination and that are therefore potential targets for pharmacological manipulation.

Changes of the total antioxidative status of blood cells in the progression of stomach and large bowel cancers in patients subjected to primary radical treatment.

The analysis included 53 patients (32 men and 21 women) aged 43 to 66 years, who were subjected to radical treatment (surgical or combined) because of stomach (22 patients) or large bowel (31 patients) cancer. All the patients were included in the same model of control examinations, which considered evaluation of the erythrocytes TAS and of the Ca19-9, CEA and AFP concentrations in serum. It was confirmed that in all the patients in whom the recurrence and/or the dissemination occurred of the cancer, the average erythrocytes TAS value increased 5.5 times by comparison with the period before progression and 7 times in comparison with the patients without recurrence and/or dissemination of the cancer. Moreover it was shown that statistically significantly higher TAS values were associated with the progression of the large bowel cancer in comparison with the stomach cancer and that the blood cells TAS positively correlated with the changes of the Ca19-9, CEA and AFP concentrations in patients with progression of the cancer after radical treatment.

The influence of antineoplastic chemotherapy on the glutathione enzymes activity in the blood.

The analysis included 78 patients (42 men and 36 women) aged 48 to 67 years treated with cytostatics because of a neoplastic disease. In all the patients examined was evaluated the influence of the chemotherapy carried out on the glutathione peroxidase (GPx) and glutathione reductase (GR) activities. It was confirmed that the effect of the action on the glutathione enzymes (GE) activity of the antineoplastic chemotherapy changes depending on the duration of the treatment with cytostatics. In the end this activity settles at a high level, statistically significantly higher than that registered before the beginning of the antineoplastic treatment. The increase of the GE activity is mainly favoured by the chemotherapy following the schemes FAC (5-fluorouracyl + doxorubicin + endoxan) and PAC (cisplatin + cyclofosfamide + pharmorubicin).

Exposure to cadmium, lead and mercury in the adult population from Eastern Poland, 1990--2002.

The aim was to estimate the adult exposure to cadmium, lead and mercury from daily household diets in Eastern Poland (Lublin city and province). A duplicate diet approach was used to top collect diet samples in 1990, 1993, 1998 and 2002. Cadmium and lead contents were measured by flame atomic absorption and the mercury content was measured by cold vapour atomic absorption spectrometry. The intake of the three elements was calculated using FOOD computer software. The exposure to cadmium taken with daily diets was from 16.4-34.5 microg/person/day (27-58% PTWI). The lead exposure was 66.5-106 microg/person/day (31-49% PTWI), which posed a smaller risk, and the exposure risk to mercury of 4.08-6.65 microg/person/day (10-16% PTWI) was even lower.

Comparative analysis of zinc status, food products' frequency intake and food habits of 11-year-old healthy children.

Children are particularly vulnerable to zinc (Zn) deficiency during periods of rapid growth and development such as infancy and adolescence. The aim was to find the relationship between food frequency, intake, food habits and zinc status in 11-year-old healthy children from southern Poland. The study group comprised children (n = 157) in the age range 11.0 +/- 0.4 years. The level of Zn in serum, erythrocytes and hair samples was measured using atomic absorption spectrophotometry. The parents of children examined completed a special food frequency questionnaire. The Zn concentration in hair (boys 182.98 +/- 65.63 microg x g(-1), n = 78; girls 203.82 +/- 39.80 microg x g(-1), n = 79; p = 0.0171), erythrocytes (8.60 +/- 2.76 mg x l(-1), n = 50) and blood serum (0.79 +/- 0.15 mg x l(-1)) correlated significantly (p < 0.05) with frequency intake of different products (hair: meat, rolls, fruit juices without additives, brawn, pate, barley, black pudding, fish canned, chips, margarine used for cooking, bacon; erythrocytes: fruits, matured cheese, dishes of meal, white cottage cheese, fruit juices without additives, cakes and cakes with cream, margarine used for bread spread; blood serum: bread, fruits, milk, kefir, yoghurt). The relationship of the Zn amount in food products, food frequency intake and the concentration in different healthy children tissues is influenced by many internal and external factors.

[Zinc homeostasis and glutamatergic system in the pathogenesis and treatment of depression]. / Homeostaza cynku i uklad glutamatergiczny w patogenezie i terapii depresji.

This article presents a review of the interactions between zinc and glutamate system in the pathophysiology and treatment of depression.

The influence of lead and cadmium environmental pollution on anthropometric health factors in children.

THE AIM: The aim of the study was to examine the relationship between environment pollution (lead and cadmium) and selected anthropological factors. MATERIAL AND METHODS: The study group comprised 267 children, aged 11 +/- 0.4. Blood sampling and anthropological measurements were carried out in Kraków (polluted area) and in the Krosno region (low polluted area) in 1995. The lead and cadmium concentrations in the whole blood were determined using atomic absorption spectrometry with a graphite furnace and automatic dosage. The anthropometric measurements were made at the same time as the blood collection. RESULTS: The blood lead content in boys and girls was: 5.89 +/- 2.54, 5.01 +/- 1.62 micrograms/dl respectively, and the cadmium blood content was: 0.65 +/- 0.30, 0.68 +/- 0.47 microgram/l. Body mass and height did not correlate with lead and cadmium concentrations in the children's blood. Smaller head circumferences, independently of gender, were associated with a higher cadmium level. The values of four skin-folds (on the arm: biceps, triceps, under scapular bone and above iliac crest), as well as the percentage of fat content in the organism (PFDWB) calculated by the Slaughter-Lohman equation was higher in girls than in boys. CONCLUSIONS: 1. The relationships between cadmium and lead blood levels in children on the one hand and the degree of environmental pollution with these metals, and the gender of the children on the other were observed. The boys accumulated more lead, whereas the girls absorbed more cadmium. 2. Anthropometric analysis did not show a significant influence exerted by the polluted environment on the basic auxological parameters. In the group of children examined, the only differences observed were related to gender, head circumferences and indicators of obesity.

The bacterial flora and the changes of the N-nitrosamine concentration in the operated stomach.

The studies included 170 patients (103 men and 67 women) aged 23 to 66 years, operated on because of an ulcerous disease. Depending on the method of surgical treatment patients were divided into 5 groups (those after gastric resection with Rydygier's method, after resection with the Billroth II method, after trunk vagotomy with pyloroplasty, after highly selective vagotomy, and after gastro-enterostomy). In all patients a qualitative estimation of the nitrate-reducing bacteria was carried out, as well as a chromatographic test of the selected N-nitrosamine concentration in the gastric juice. It was shown that the changes in the quantity of the nitrate-reducing bacteria and in the N-nitrosamine concentration depended on the type of surgical intervention conducted. The largest mean content of nitrate-reducing bacteria and the highest average N-nitrosamine concentration were confirmed in the gastric juice of patients after gastroenterostomy and after gastric resection with the Billroth II method, and the lowest values--in patients after highly selective vagotomy.

Endogenous diazepam concentrations in the serum of patients with liver neoplasms.

The study included 61 patients (35 men and 26 women) ages 47 to 74 in whom a primary liver cancer was diagnosed or neoplastic metastases to the liver were confirmed in the course of a cancer of the stomach or the large bowel. In each patient the endogenous serum diazepam concentration (ESDC) was estimated chromatographically and the results obtained were compared to selected clinical traits such as the magnitude and number of neoplastic changes and their location in the liver parenchyma, the histological form of the tumor and the primary location of the cancer in the case of neoplasms of the alimentary canal. The determination of the ESDC was also carried out in a control group made up of voluntary blood donors. Neither group examined received any medication belonging to the benzodiazepine group. From the results of the tests conducted it was confirmed that the average ESDC of patients with liver neoplasms was 65 times higher than that of the control group. Simultaneously, however, in patients with a primary liver cancer the average endogenous concentration was higher than in patients with neoplastic metastases to that organ and this was statistically significant. The location in the hepatic parenchyma of the neoplastic change as well as the primary location of the cancer remained without a statistically significant influence in the changes of ESDC. It was moreover shown that significantly high ESDC were associated in the liver mainly with increased neoplastic growth (above 3 cm in diameter) and with multiple spread (5 focuses and more).

The clinical value of the determinations in the serum of zinc concentration in women with breast cancer.

The clinical usefulness of the determinations of the zinc serum concentration at different stages of the breast cancer diagnostic process was evaluated in the present work. On the basis of the analysis of 182 women surgically treated because of this neoplasm, a statistically significant dependence was shown between the frequency of occurrence of hypozincemia and the progression of the cancer, its histological form, and the microscopic state of the axillary lymph nodes. The clinical usefulness was also shown by the determinations of the zincemia in the post-operative monitoring of patients with breast cancer. The critical value was also determined for the microelement concentration below which a statistically significantly high risk of occurrence of distant metastases appears.

Alterations in serum and brain trace element levels after antidepressant treatment. Part II. Copper.

We have studied the effect of chronic treatment with imipramine, citalopram, and electroconvulsive shock (ECS) on serum and brain copper levels in rats. Chronic treatment with citalopram and imipramine (but not ECS) significantly (approx 14%) decreased the serum copper level. Chronic treatment with both drugs did not alter the brain copper level. However, chronic ECS induced a significant increase (by 36%) in the copper level in the hippocampus and also in the cerebellum (by 16%). In contrast to the zinc, where both pharmacologic and ECS treatment increased its hippocampal concentration, these two antidepressant therapy (drugs versus ECS) differ in their effect on brain copper level. These findings suggest that the mechanism by which copper is involved in ECS differs from that of any involvement in the action of the drugs studied.

Alterations in serum and brain trace element levels after antidepressant treatment: part I. Zinc.

We have studied the effect of chronic treatment with imipramine, citalopram and electroconvulsive shock (ECS) on serum and brain zinc levels in rats. Chronic treatment with citalopram (but not with imipramine or ECS) significantly (approx 20%) increased the serum zinc level. Chronic treatment with both drugs slightly (by approx 10%) increase the zinc level in the hippocampus and slightly decreased it in the cortex, cerebellum and basal forebrain. Calculation of the ratio hippocampus/brain region within each group demonstrated a significantly (approx 20%) higher value after treatment with either imipramine or citalopram. Moreover, chronic ECS induced a significant increase (by 30%) in the zinc level in the hippocampus and also a slight increase (by 11-15%) in the other brain regions. Thus, these different antidepressant therapies induced an elevation of the hippocampal zinc concentration, which indicates a significant role of zinc in the mechanism of antidepressant therapy.