A chiari network mimicking a cystic structure.

The Chiari network is a net-like mobile structure, occasionally encountered near the entrance of the inferior vena cava in the right atrium. Due to its fenestration, the Chiari network does not cause flow obstruction of the blood. The Chiari network is usually an incidental finding with no further clinical consequences. We report an unusual presentation of a Chiari network, mimicking a right atrial oscillating cystic mass attached to the interatrial septum by a thin stalk.

Left atrial compression caused by hiatus hernia: a rare cause of syncope.

Symptomatic left atrial compression is a rare clinical condition presenting with heart failure, syncope or shock. A Med-line search with the term "left atrial compression" showed only 271 hits. Only 17 cases, of which 11 with hiatus hernia, of left atrial compression due to structures of the gastrointestinal tract were found. We describe a 86-year-old man suffering from repeating syncope due to left atrial compression by a hiatus hernia. This prompted us to review the few cases of atrial compression caused by gastro-intestinal structures.

Transesophageal echocardiography in patients with cryptogenic stroke: does it alter their management? A 3-year retrospective study in a single non-referral centre.

BACKGROUND: Cardiac embolism is estimated to be the aetiology of ischemic cerebral-vascular insults (CVI) in 25% of cases. Transesophageal echocardiography (TEE) is a reliable and widely used examination in the diagnosticwork-up of stroke. TEE is superior to transthoracic echocardiography (TTE) in the search of minor sources of cardiac embolism but it is time consuming and has its inherent risks. AIM: The aim of this study was to determine whether in patients younger than 65 years of age with CVI our TEE-findings would alter their management. Only patients in whom nor the medical record, nor TTE, nor Carotid Ultrasonography could establish an aetiology, were included. METHODS: A 3-year retrospective study was done in patients admitted to the stroke unit of a regional medical centre covering 110,000 inhabitants. The TEE-database was reviewed and all TEE's performed in eligible patients were selected. Minor and major sources of cardiac embolism were listed. The impact of TEE-findings on the management of CVI was evaluated. RESULTS: Fifty-four patients fulfilled the criteria for this study. The mean age was 52 years (range 18 - 65). A major source of cardiac embolism was seen in 6 cases (11.1%). Four patients (7.4%) had infective endocarditis (IE) with vegetations. A small apical thrombosis in a patient with isolated left ventricular non-compaction was noted and in 1 patient dysfunction of a mechanical prosthetic valve was documented. The most frequently encountered minor source of cardiac embolism was a patent foramen ovale (PFO) or small atrial septal defect (ASD) with documented right-to-left shunt during Valsalva manoeuvre (15 patients, 27.8%). Of these 15 patients, an atrial septum aneurysm(ASA) was seen in 7 patients (13%). Our TEE-findings altered the management of CVI substantially in 21 cases (38.9%). The 4 patients with IE and the patient with mechanical valve dysfunction had cardiac surgery. Twelve patients (22.2%) were referred for percutaneous closure of the PFO/ASD. Three patients with PFO/ASD and the patient with IVNC were treated with maintenance therapy of oral anticoagulation. CONCLUSION: In 1 out of 3 patients, younger than 65 years, suffering from CVI in whom nor medical history, nor TTE, nor Carotid Ultrasound could reveal the cause of the CVI our TEE-findings altered their management.

Embolic events in infective endocarditis: a review and report of 4 cases.

Infective endocarditis (IE) remains a dangerous disease in terms of morbidity and mortality. Valve damage with or without congestive heart failure, paravalvular extension, embolization of vegetation, damage due to immunological involvement and septic shock are the main complications of IE. Embolic events are frequent and life-threatening complications of IE. In previous series, the reported figures of embolic complication vary from 10 to 50%. We describe four cases of patients with IE and peripheral embolization. In this paper, we will briefly discuss the role of echocardiography, infective microorganisms and clinical aspects in the prediction of an embolic event. Therapeutic strategies are discussed.

International comparison of odor threshold values of several odorants in Japan and in The Netherlands.

The purpose of this paper is to compare the published odor threshold values of six odorants. In Japan, all of the odor threshold values used in the Offensive Odor Control Law (enacted in 1972) were determined in an odor-free room (4 m3) by a trained panel (20 men, ages 30-45 years who were perfumers) who sniffed the odors directly and made absolute judgments of odor quality and intensity. In The Netherlands, sensorial odor concentration measurements were made with an olfactometer in a mobile sniffing car with eight panelists, four men and four women, ages 18-40 years. Such presentations are repeated with different dilution ratios. Comparison of the threshold data for the six different compounds given as the barely perceptible concentration level revealed striking similarities for hydrogen sulfide (in Japan 0.0005 ppm/in The Netherlands 0.0003 ppm), phenol (0.012/0.010), styrene (0.033/0.016), toluene (0.92/0.99), and tetrachloroethylene (1.8/1.2) but not for m-xylene (0.012/0.12). Such a similarity was not found with any other literature sources.