Myocardial bridges of the coronary arteries in the human fetal heart.

During the last century, many investigators reported on myocardial bridges in the adult human heart. In the present study, 39 human fetal hearts (the mean gestastional age was 30 weeks) were studied for myocardial bridging, and the results were correlated with adult data. Among the 39 (27 male and 12 female) fetal hearts studied, 26 bridges were observed on 18 fetal hearts (46.2%). Ten of the bridges had one myocardial bridge, whereas double myocardial bridges were observed in eight fetal hearts. The most frequent myocardial bridges were observed on the left anterior descending artery (LAD), which had 13 bridges (50%). Eight (30.7%) myocardial bridges were on the diagonal artery, and on the posterior descending artery there were five (19.3%). Myocardial bridges were not observed on the circumflex artery. The data presented in this study may provide potentially useful information for the preoperative evaluation of the newborn and may have a clinical implication for sudden fetal death.

Role of the nitric oxide pathway in ischemia-reperfusion injury in isolated perfused guinea pig lungs.

We examined the role of the nitric oxide (NO) pathway on ischemia-reperfusion injury via the use of isolated perfused guinea pig lungs. We administered both L-Arginine and N-nitro-L-arginine methyl ester (L-NAME) to the lungs in or after 3 h of ischemia. We observed pulmonary artery pressures as well as tissue and perfusate malondialdehyde (MDA) and glutathione (GSH) levels. We observed that L-NAME significantly increased both tissue and perfusate GSH levels and pulmonary artery pressures, but it decreased both tissue and perfusate MDA levels. On the other hand, L-arginine significantly decreased pulmonary artery pressure and both tissue and perfusate glutathione levels, but it increased both tissue and perfusate MDA levels. Electron microscopic evaluation supported our findings by indicating the preservation of lamellar bodies of type II pneumocytes. We concluded that L-NAME administration during reperfusion improves lung recovery from ischemic injury.

Acinar cell ultrastructure after taurine treatment in rat acute necrotizing pancreatitis.

OBJECTIVE: To evaluate the organelle-based changes in acinar cells in experimental acute necrotizing pancreatitis (ANP) after taurine treatment and the association of electron microscopic findings with histopathological changes and oxidative stress markers. METHODS: The study was performed in February 2005 at Gulhane School of Medicine and Hecettepe University, Turkey. Forty-five rats were divided into 3 groups. Acute necrotizing pancreatitis was induced in groups II and III. Groups I and II were treated with saline and Group III with taurine 1000 mg/kg/day, i.p, for 48 hours. Histopathological and ultrastructural examinations were determined using one-way analysis of variance and Kruskal-Wallis tests. RESULTS: Histopathologic findings improved significantly after taurine treatment. Degree of injury in rough and smooth endoplasmic reticulums, Golgi apparatus, mitochondria and nucleus of acinar cells also decreased with taurine in correlation with biochemical and histological results. CONCLUSION: Taurine improves acinar cell organelle structure, and ultrastructural recovery in ANP reflects histological improvement.

Autoimmune myasthenia gravis after coronary artery bypass surgery.

Myasthenia gravis is the most common disorder of neuromuscular transmission and is a heterogeneous disorder that is generally autoimmune, which is caused by an auto-antibody to the nicotinic acetylcholine receptor. We present a rare case of myasthenia gravis that occurred 8 weeks after a coronary artery bypass grafting operation. A 64-year-old man with multivessel coronary artery disease underwent myocardial revascularization. Severe myasthenic symptoms began 8 weeks after the operation and emergent mechanical ventilation was needed because of myasthenic crises. The serum anti-acetylcholine receptor antibody level was high. The details of this unusual patient are discussed.

Hyperbaric oxygen-induced changes in bacterial translocation and acinar ultrastructure in rat acute necrotizing pancreatitis.

BACKGROUND: We aimed to investigate the effects of hyperbaric oxygen therapy on bacterial translocation and acinar cell ultrastructure in a rat model of acute necrotizing pancreatitis. METHODS: Forty-eight male Sprague-Dawley rats were randomly divided into three groups. Acute pancreatitis was induced in groups II and III. Groups I and II did not receive any treatment, and group III was treated with hyperbaric oxygen. All surviving animals were killed 48 h after the induction of pancreatitis. Bacterial translocation and histological and ultrastructural changes were determined. RESULTS: The incidence of bacterial translocation in group III was significantly lower in comparison with group II (P<0.001). Histopathological and ultrastructural injury scores were also significantly lower in group III (P<0.001 and P<0.04, respectively). CONCLUSIONS: Hyperbaric oxygen therapy displayed beneficial effects on pancreatic superinfection and or histopathological and ultrastructural changes in experimental necrotizing pancreatitis.

Double right coronary artery; fistula and atherosclerosis: rare combination.

Combination of the primary congenital coronary artery anomalies, fistula and atherosclerosis rarely occur. We report a 50-year-old male who presented with severe chest pain, for which he underwent a coronary angiography. Injection into the right coronary artery (RCA) demonstrated a double RCA running very closely together in the atrioventricular groove. The superior one gave rise to a coronary fistula leading to the right ventricle and the inferior one was atherosclerotic. Both of them terminated as a posterior descending artery. The left system showed occlusion of the left anterior descending and major obtuse marginal. Both were corrected surgically.

Quadricuspid aortic valve: a chance for repair.

Quadricuspid aortic valve is an uncommon congenital anomaly that often causes aortic regurgitation in adulthood, necessitating valve replacement. A 54-year-old woman presented with symptoms and signs of aortic regurgitation, but during surgery a quadricuspid aortic valve was identified. The abnormal cusp was fibrotic, short, thick, and fenestrated. Excision of the fourth cusp was performed and valve repair carried out successfully, with only minimal regurgitation.

Magnesium decreases cardiac injury in patients undergoing coronary artery bypass surgery.

BACKGROUND: The calcium-channel blocking effect of magnesium might have protective effects in patients undergoing cardiopulmonary bypass surgery. We assessed the effects of magnesium on hearts undergoing coronary artery bypass surgery with intermittent warm blood hyperkalemic cardioplegia in the antegrade fashion. PATIENTS AND METHODS: Twenty patients undergoing coronary bypass surgery were randomly divided into two groups, a control group who received intermittent antegrade warm blood hyperkalemic cardioplegia for myocardial protection, and a study group who received the same solution with the addition of magnesium to the cardioplegia. Extracellular substrates (creatinine phosphokinase, creatinine phosphokinase-MB group, lactate dehydrogenase, c-reactive protein, and cardiac troponin I were measured preoperatively and postoperatively. RESULTS: There were significant differences in the post-operative concentrations of creatinine phosphokinase, creatinine phosphokinase-MB group, c-reactive protein, and lactate dehydrogenase after cardiopulmonary bypass (P<0.001) in the study group compared with the control subjects. Cardiac troponin I levels were also significantly lower in the study group after cardiopulmonary bypass (P<0.005). CONCLUSIONS: Our study indicates that if magnesium is added to intermittent antegrade warm blood hyperkalemic cardioplegia, blood levels of many markers of cardiac myocardial injury after cardiopulmonary bypass are lowered. This finding may have implications for myocardial protection.

The effect of taurine treatment on oxidative stress in experimental liver fibrosis.

Oxidative stress is important in pathogenesis of liver fibrosis, which is the result of deposition of excessive ECM proteins produced by activated hepatic stellate cells (HSCs). Reducing reactive oxygen species (ROS) production decreases collagen accumulation in liver. We investigated the benefits of antioxidant therapy in liver fibrosis and its association with HSC apoptosis. Forty-five male Spraque-Dawley rats were subdivided into three groups. Group I was treated with CCl(4) plus taurine, Group II with CCl(4) plus saline, and Group III with saline for 12 weeks. Erythrocyte and liver malondialdehyde (MDA) levels, superoxide dismutase (SOD) activities, Glutathione peroxidase (GSHpx) activities, and serum and liver TIMP-1 and MMP-13 levels were measured. Histopathological examinations were performed. Activated and total HSCs were quantified immunohistochemically. Apoptotic HSCs were detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) staining. Taurine decreased histopathological injury scores and oxidative stress parameters significantly. The number of activated HSCs was significantly higher in taurine untreated group ( [Formula: see text] ). Serum and tissue MMP-13 levels were significantly higher and TIMP-1 levels were significantly lower in taurine-treated group ( [Formula: see text] and [Formula: see text], respectively). The number of apoptotic activated hepatic stellate cells was significantly higher with taurine treatment ( [Formula: see text] ). Preventing the production of reactive oxygen species is effective in inhibiting fibrogenesis in experimental rat model. Inhibitory activity of this agent on HSCs' activation, apoptosis, and further fibrogenic events should be clearly identified.

Is late antibiotic prophylaxis effective in the prevention of secondary pancreatic infection?

BACKGROUND: Secondary infection of the inflamed pancreas is the principal cause of death after severe acute pancreatitis (AP). Although patients are not always managed early in the course of AP in clinical practice, prophylactic antibiotics that were used in experimental studies in rats were always initiated early after induction of pancreatitis. The effectiveness of antibiotics initiated later is unknown. AIM: The aim of this study was to compare the effectiveness of ciprofloxacin and meropenem initiated early versus later in the course of acute necrotizing pancreatitis (ANP) in rats. METHODS: 100 Sprague-Dawley rats were studied. ANP was induced in rats by intraductal injection of 3% taurocholate. Rats were divided randomly into five groups: group I rats received normal saline as a placebo, group II and IV rats received three times daily meropenem 60 mg/kg i.p. at 2 and 24 h, respectively and group III and V rats received twice daily ciprofloxacin 50 mg/kg i.p. at 2 and 24 h, respectively, after induction. At 96 h, all rats were killed for quantitative bacteriologic study. A point-scoring system of histological features was used to evaluate the severity of pancreatitis. RESULTS: Meropenem and ciprofloxacin initiated 2 h after induction of pancreatitis significantly reduced the prevalence of pancreatic infection (p < 0.001 and p < 0.04, respectively) as compared to controls. Neither of the antibiotics initiated later during the course of AP caused a significant decrease in pancreatic infection in rats (p > 0.05). Although the rats treated early infected less frequently than the rats treated later, the comparison reached statistical significance only in the meropenem group (p < 0.02). CONCLUSION: Early antibiotic treatment reduces pancreatic infection more efficiently than late antibiotic treatment in ANP in rats.

The effect of antibiotic and probiotic combination therapy on secondary pancreatic infections and oxidative stress parameters in experimental acute necrotizing pancreatitis.

INTRODUCTION: Ciprofloxacin and meropenem have effects on intestinal bacteria that are responsible for pancreatic infection, and on the basis of recent data it has been argued that probiotics, especially those used in the food industry, could improve efforts to prevent and treat secondary pancreatic infections by inhibiting bacterial translocation. AIMS: To evaluate the effects of probiotic treatment alone or in combination with early administration of two different antibiotics on serum amylase, pancreatic histopathology, bacterial translocation, and oxidative markers. METHODOLOGY: Acute pancreatitis was induced in rats with 3% sodium taurocholate (1 mL/kg intraductally), except in group VI (sham group). After the stabilization period, the rats were divided into seven groups (n = 20) randomly. At hour 6 after injection, group I rats received probiotic Saccharomyces boulardii (25 mg/d orally q.d.), group II received meropenem (60 mg/kg intraperitoneally b.i.d.), group III received ciprofloxacin (40 mg/kg intraperitoneally b.i.d.), group IV received the same dose of probiotic plus meropenem, and group V received probiotic plus ciprofloxacin. Treatment was not given to group VI (sham group) and group VII (pancreatitis group). At hour 48 after induction, specimens were collected. RESULTS AND CONCLUSION: Although histopathologic scores in treatment groups were found to be lower than in group VII, the difference was statistically significant only in group V (p < 0.001). In evaluation of oxidative stress, we found that MDA levels decreased and SOD levels increased in treatment groups in comparison with levels in group VII. Probiotic treatment alone reduced bacterial translocation. Probiotic-antibiotic combination therapy was shown to improve histopathologic scores and oxidative parameters.

Bicuspid aortic valve.

The bicuspid aortic valve is a common congenital cardiac anomaly, having an incidence in the general population of 0.9% to 2.0% and a frequency of 54% in all patients aged >15 years with valvular aortic stenosis. In most cases it remains undetected until infective endocarditis or calcification supervenes. The bicuspid aortic valve may function normally throughout life, may develop progressive calcification and stenosis or may develop regurgitation with or without infection. The association of the bicuspid aortic valve with dissection of the aorta is also common. The recognition of the bicuspid valve in patients with aortic valve disease remains an important challenge to the clinician, whereas preoperative knowledge of valve morphology would be helpful in planning the surgery. Antibiotic prophylaxis is also recommended in such patients, since these valves are likely to become the most important intrinsic cardiac predisposition for infective endocarditis with the virtual disappearance of rheumatic fever in developed countries.

MR imaging determination of the normal level of conus medullaris.

The location of conus medullaris according to age and sex was retrospectively evaluated with a 0.5-T magnetic resonance (MR) imaging system. A total of 639 subjects without any conspicuous spinal canal pathology on the lumbar MR imaging examination were selected. The level of conus medullaris was most commonly located at the T(12)-L(1) intervertebral disc level in the whole population. Our results do not correlate with the previous studies. No significant difference in the conus level was found with increasing age.

Serous fluid leakage without seroma after aortobifemora bypass operation.

Perigraft seroma and serous fluid leakage is an uncommon clinicopathologic entity. Serous leaks and/or seroma formation from dacron grafts have been reported in peripheral arterial anastomoses. We present a case of serous fluid leakage without seroma which developed after aorto-bifemoral and femoro-popliteal bypass.

Examination of the variations of lateral femoral cutaneous nerves: report of two cases.

The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.