Infrared Spectroscopic Study and Mathematical Simulations of Carotid Atherosclerosis.

BACKGROUND/AIM: The pathogenesis, treatment and prevention of atherosclerosis continue to be the subject of intensive research and study by the scientific community. Based on Fourier-transform infrared spectra and 3D-Doppler echogram, we attempted to develop a computational simulation model for predicting the association of atherosclerotic risk factors with pathogenic molecular structural changes. MATERIALS AND METHODS: Atheromatic carotid arteries from 56 patients (60-85 years old) were used as samples. Color 3D-Doppler echogram screening was performed on all patients preoperatively. Each infrared spectrum consisted of 120 co-added spectra at a spectral resolution of 4 cm-1 Results: The infrared spectral analysis reveals 'marker bands', such as the 1,744 cm-1 band assigned to aldehyde formation and to the 'fingerprint' digital spectral region of 1,050-1,169 cm-1, characteristic of the presence of advanced glycation end products (C-O-C). The accumulation of calcium phosphate salts increases the formation rate of stenosis. The critical point of stenosis risk starts at about 45%, while when stenosis is over 60-70%, the risk of ischemic stroke or other major adverse cardiovascular events increases dramatically. CONCLUSION: Fourier-transform infrared spectroscopy and mathematical simulation models showed that carotid artery stenosis over 45% reduces the blood flow rate, while stenosis over 65% dramatically increases the hemodynamic disturbance, with a parallel increase the rate of ischemic stroke or other major adverse cardiovascular events.

Diagnostic dilemma in spontaneous innominate artery pathology: a case report.

We report the case of a 71-year-old female who presented with sudden onset of right cervical pain and ipsilateral arm hypoaesthesia. The diagnostic evaluation revealed a pathology of the origin of the innominate artery (IA). The differential diagnosis was among a spontaneous acute dissection and a ruptured pseudoaneurysm. The dilemma of the proper treatment emerged. Surgical or medical treatment? Open or endovascular approach? The patient was offered an open treatment under cardiopulmonary bypass and sort circulatory arrest. As less than ten cases of isolated IA dissection have been previously reported in the literature, we discuss the differential diagnosis difficulties and the treatment options.

Massive pulmonary embolism due to hydatid cysts: A rare postoperative complication of liver echinococcosis.

Pulmonary embolism due to hydatid cysts is a very rare pathology. A 55-year-old male was transferred to our hospital due to respiratory failure, as a result of left pulmonary artery obstruction by cystic lesions. His medical history included multiple operations for abdominal echinococcosis. He was urgently operated for the extraction of the proximal hydatid cysts with the use of cardiopulmonary bypass with an excellent outcome and six months later through a right thoracotomy for the distal right pulmonary artery, the cysts were extracted. Meanwhile, he followed additional medication treatment with albendazole, preoperatively as well as postoperatively. Today, 5 years later, he has no evidence of hydatidosis recurrence.

Common swelling of the dorsal thoracic wall brings an unexpected finding: elastofibroma dorsi.

Elastofibroma is a rare benign, soft-tissue slow-growing tumor seen predominantly in elderly females. We present such a case in a 46-year-old female. She presented with gradually increasing soft tissue swelling of 8×6 cm in the right inferior subscapular region. MRI showed a large intramuscular lesion with atypia. She underwent excisional biopsy and the histopathology and immunochemistry showed elastofibroma. We present this rare case to emphasize the important role of the diagnostic tools. A definitive diagnosis helps to avoid unnecessary wide and radical resection.

Successful treatment of postoperative massive pulmonary embolism with paradoxal arterial embolism through extracorporeal life support and thrombolysis.

Pulmonary embolism is a common clinical entity related to high mortality. About 200,000 to 300,000 patients die every year due to pulmonary embolism. The purpose of this article is to describe a case of a patient who on the second postoperative day after undergoing thromboembolectomy of the left femoral artery, manifested a massive pulmonary embolism. Due to cardiorespiratory collapse a combined treatment via extracorporeal life support (ECLS) and parallel catheter thrombolysis was decided and performed. By cardiorespiratory improvement and final stabilization the patient was successfully weaned from ECLS and the system was successfully removed. After a reasonable postoperative time the patient was dismissed in good overall condition.

Solitary fibrous tumor: A center's experience and an overview of the symptomatology, the diagnostic and therapeutic procedures of this rare tumor.

Solitary Fibrous Tumor of the Pleura (SFTP) is a rare tumor of the pleura. Worldwide about 800 patients diagnosed with this oncological entity have been described in the existing literature. We report our center's 13 year experience. During this time three patients suffering from this rare disease have been treated in our department. All patients were asymptomatic and their diagnosis was initially triggered by a random finding in a routine chest x-ray. The diagnosis was set preoperatively through a needle biopsy under computer tomography (CT) guidance. The tumors were resected surgically though video-assisted thoracoscopic surgery (VATS) or thoracotomy. Because of the lack of specific guidelines due to the rarity of the disease a long-term, systematic follow-up was recommended and performed. Parallel an overview of the diagnostic and therapeutic procedures of the rare tumor is made.

Inappropriate antidiuretic hormone secretion due to squamous cell lung cancer.

The syndrome of inappropriate secretion of antidiuretic hormone is a disorder of impaired water excretion caused by the inability to suppress secretion of antidiuretic hormone. It has been commonly associated with small cell carcinoma. The association of this syndrome with squamous cell lung carcinoma has rarely been reported, with only 4 cases over the past two decades in the English literature. We describe the case of a 75-year-old Caucasian male who developed the syndrome after a right pneumonectomy for down-staged squamous cell lung cancer previously treated with neoadjuvant platinum-based chemotherapy and radiotherapy.

Experimental studies in the bronchial circulation. Which is the ideal animal model?

BACKGROUND: The importance of the role of bronchial arteries is notable in modern days thoracic surgery. The significance of their anastomoses with adjusted structures has not yet been sufficiently rated, especially in cases of haemoptysis, heart-lung transplantations and treatment of aneurysms of the thoracic aorta. The need of a thorough study is more relevant than ever and appropriate laboratory animals are required. METHODS: We review the literature in order to highlight the ideal experimental animal for the implementation of pilot programs relative to the bronchial circulation. A comparative analysis of the anatomy of the bronchial arterial system in humans along with these of pigs, dogs, rats, and birds, as being the most commonly used laboratory animals, is presented in details. RESULTS: The pig has the advantage that the broncho-oesophageal artery usually originates from the aorta as a single vessel, which makes the recognition and dissection of the artery easy to perform. In dogs, there is significant anatomical variation of the origin of the bronchial arteries. In rats, bronchial artery coming from the aorta is a rare event while in birds the pattern of the bronchial artery tree is clearly different from the human analog. CONCLUSIONS: The pig is anatomically and physiologically suited for experimental studies on the bronchial circulation. The suitable bronchial anatomy and physiology along with the undeniable usefulness of the pig in experimental research and the low maintenance cost make the pig the ideal model for experiments in bronchial circulation.

Late atrial appendage perforation from a pacemaker lead pacemaker complication.

Lead perforation is a rare complication of device implantation, varying between 0.3% and 1%, although the prevalence may be higher. Late lead perforations (>1 month after implantation) are believed to be very rare. We describe the successful treatment of a 65-year-old man with late cardiac perforation due to the pacemaker active fixation lead after an uneventful implantation.

An unusual pattern of three major components of the cardiovascular system: multimodality imaging and review of the literature.

INTRODUCTION: Coronary artery anomalies are found in 0.4% to 1.4% of patients who undergo coronary angiography. Anomalous origin of left coronary artery from the right sinus of Valsava is the rarest, with a reported prevalence of 0.02 -0.03% according to angiographic studies. CASE PRESENTATION: We present the rare case of a 42-year-old-man suffering from stable angina with unusual development of 3 major components of the cardiovascular system Coronary angiography revealed an anomalous origin of the left coronary artery from the ostium of the right coronary artery. Magnetic resonance angiography depicted an anomalous origin of the left common carotid artery from the innominate artery and an aneurysm of descending thoracic aorta. Coronary computed tomography angiography revealed the course of left coronary artery between aortic root and conus arteriosus at the level of the right ventricular outflow tract. In this report we attempt to highlight the rarity of this vascular anatomy. CONCLUSION: Anomalous origins of the coronary arteries are rare, but may cause myocardial ischemia and sudden death. Thus, their reliable identification is a matter of paramount importance possibly evaluating the effects of therapeutic intervention. Newer imaging modalities improve the illumination of vascular system anatomy, shedding light to diagnostic dilemmas that come up in daily medical practice.

Hepatoid pancoast tumor. A case report and review of the literature.

A 48-year-old male patient presented with a Pancoast tumor of the right lung and a serum alpha-fetoprotein (αFP) at 39,000 ng/ml. Alpha-fetoprotein is a tumor marker found elevated in patients with hepatocellular carcinoma (HCC), germ cell or stromal tumors of the ovary and nonseminomatous testicular cancer. Occasionally, this tumor marker may rise in non-neoplastic conditions such as cirrhosis and hepatitis and only exceptionally in rare cancers with hepatoid differentiation. We present our case report and review the English literature for αFP-producing lung carcinomas. To the best of our knowledge this is the first report in the literature of an αFP producing Pancoast tumor.

Alveolar adenoma: an extremely rare innocent coin lesion.

Alveolar adenoma is an extremely rare benign tumour of the lung. Less than 30 cases have been reported in the English literature. A 42-year-old asymptomatic female who presented with a solitary peripheral pulmonary nodule on chest roentgenogram underwent thoracoscopic wedge resection and was diagnosed with this rare tumour. The indolent clinical progression and the absence of recurrence and metastasis after complete resection are the most important characteristics of this tumour. The classical solitary pulmonary nodule is a common and vexing problem. Nodules are extremely common in clinical practice and challenging to manage. Solitary pulmonary nodules can represent different specific lung diseases, focal non-specific inflammations, and primary and secondary malignant tumours. Identification of malignant nodules is important because they represent a potentially curable form of lung cancer.

Endovascular management of a late saccular aortic aneurysm after end-to-end repair of coarctation.

Post-coarctation surgical repair aneurysm formation is observed rarely with end-to-end anastomosis technique. The redo surgery is associated with high mortality and morbidity rate. Although the minimal invasive method with stented grafts has been reported in only small number of patients, this could represent a valid alternative treatment. We present a case of successful endovascular treatment of a patient with a late post-coarctation repair saccular aneurysm.