Myxoma developing after open heart surgery: is radiofrequency ablation responsible for the formation of the tumor?

34-year-old male with history of recurrent atrial fibrillation (AF) and mitral stenosis, status post radiofrequency ablation (RFA) and prosthetic mitral valve replacement two years earlier was admitted with prosthetic valve thrombosis for redo mitral valve surgery. During the surgery, a 2 x 1.5 x 1 cm mass was identified on the interatrial septum, attached to the edge of tricuspid valve's septal leaflet by a stalk. The mass was excised and histological evaluation revealed myxoma. It is accepted that myxomas can develop after cardiac trauma. It is known that RFA for AF increases the risk of thrombus or endocarditis in the atrium. Herein, we report a myxoma case where we think the heat energy caused by RFA might have triggered the development of the tumor.

Segment 10 based molecular epidemiology of bluetongue virus (BTV) isolates from Turkey: 1999-2001.

Bluetongue is a significant arbovirus infection that has a negative impact on ruminant productivity in Turkey. Twenty-one Turkish BTV isolates were analyzed phylogenetically, based on genome segment 10 (Seg-10) nucleotide sequences. These analyses were used to explore the epidemiological background of individual isolates from both a regional and global perspective. In the regional analysis, the different BTV strains fell into two groups (Group 1 and Group 2). The Turkish virus isolates were localized in Group 1 which contains two sub-groups. The neighbor-joining analysis revealed that Seg-10 of majority of the Turkish viruses was closely related to certain other virus strains allocated in the eastern lineage. The Seg-10's of two viruses (TR25 and TR26) were more closely related to strains isolated in the Asia-Australia region. These strains belong to the 'eastern' topotype identified by [Maan, S., Maan, N.S., Ross-Smith, N., Batten, C.A., Shaw, A.E., Anthony, S.J., Samuel, A.R., Darpel, K.E., Veronesi, E., Oura, C.A.L., Singh,K.P., Nomikou, K., Potgieter, A.C., Attoui, H., van Rooij, E., van Rijn, P., De Clercq, K., Vandenbussche, F., Zientara, S., Bréard, E., Sailleau, C., Beer, M., Hoffman, B., Mellor, P.S., Mertens, P.P.C., 2008. Sequence analysis of bluetongue virus serotype 8 from the Netherlands 2006 and comparison to other European strains. Virology 377, 308-318]. Comparisons of amino acid sequences deduced from the Seg-10 genes showed a high level of conservation in the NS3/3A proteins from the Turkish viruses. The more frequent amino acid substitutions were identified by multiple alignment analysis, and one of the isolates (TR23) was remarkably found to be genetically quite distinct from the other isolates.

Hemolysis after mitral valve repair: a report of five cases and literature review.

BACKGROUND AND AIM OF THE STUDY: Hemolytic anemia is known to be a rare complication after the prosthetic replacement of the mitral valve, especially in the presence of perivalvular leaks, and even more rarely after mitral valve repair. Following repair, certain distinct patterns of the regurgitant flow disturbances associated with high shear stress are responsible for the hemolysis. Early echocardiographic recognition of these flow patterns may be important to diagnose the condition and may lead to re-repair or replacement of the valve. METHODS: During the past eight years, mitral valve repair was performed by the present authors in 159 patients, with a prosthetic ring being placed in 130 cases. In five of the patients receiving rings (3.8%) however, intractable hemolytic anemia quickly developed, due to recurrent or residual mitral regurgitation, and this necessitated reoperation. RESULTS: The valve was replaced in all five patients. One patient died from respiratory and renal failure leading to multiorgan failure. The other four patients were followed up and are currently in good health, with no evidence of hemolysis. CONCLUSION: Hemolysis frequently occurs immediately or soon after mitral valve repair, and may even appear in mild regurgitation. Thus, following repair with a prosthetic ring it is essential to clearly visualize the dynamic flow patterns postoperatively with transesophageal echocardiography, focusing especially on probable fragmentation, collision and rapid acceleration jets. These findings may lead the surgeon to revise the repair, or to replace the valve.

Attenuation of acute lung injury following lower limb ischemia/reperfusion: the pharmacological approach.

AIM: The purpose of this study was to examine the effects of N-acetylcysteine (NAC), calcium dobesilate (DOBE) and aprotinin on the amelioration of lung damage following ischemia/reperfusion injury in a rat hind limb model. A well known antioxidant dimethyl-sulfoxide (DMSO) was also tested for comparison. METHODS: Ischemia was induced in the lower limb for 4 h by vascular clamping and followed by 1 h of reperfusion. Lung injury was evaluated in 5 groups as a saline (control), DMSO, NAC, DOBE and aprotinin group. Plasma creatine kinase, lactate dehydrogenase, thiobarbituric acid reactive substances (TBARS) as well as lung tissue TBARS levels were measured. Lung tissue samples were taken for histological examination. P<0.005 was considered statistically significant. RESULTS: Plasma TBARS values were found to be significantly lower in the DMSO (P<0.005), NAC (P<0.005) and aprotinin (P<0.005) groups compared to the control group. Lung TBARS values were significantly lower in the DMSO, NAC, DOBE and aprotinin groups compared to the control group (P<0.001, P<0.001, P<0.001). Also in the aprotinin group lung TBARS values were found to be significantly lower compared to DMSO (P<0.001), NAC (P<0.001) and DOBE (P<0.001) groups. Histological examination showed less prominent peribronchial leukostasis (P<0.005) and interstitial leukostasis (P<0.005) in all drug groups compared to the control group. CONCLUSION: These observations indicate that DOBE and NAC, which are known to have antioxidant properties and aprotinin, a serine proteinase inhibitor, acted effectively on the prevention of lung injury in a rat hind limb ischemia/reperfusion model. The reason why aprotinin exerts a more protective effect than the other drugs is not clear, however, its clinical use may have the dual advantage of hemostasis and lung protection in surgical practice.

An extraanatomic bypass method alternative to the obturator bypass.

Obturator bypass is the preferred method when infectious groin problems are challenging. However, this method can not be applied either in some special settings including the dissemination of the infection towards retroperitoneum and some technical difficulties in handling obturator bypass area (like fibrosis and inability to expose the obturator foramen). We present an alternative bypass method in two cases.