Congenital coronary artery anomalies in adult population detected using dual source ECG-gated CTA in a single institution.

BACKGROUND: Congenital anomalies of the coronary arteries (CAs) are rare and are often diagnosed incidentally during a conventional coronary angiography. Recently, the incidence of these congenital defects is on the rise particularly after the introduction of the electrocardiography (ECG) gated coronary computed tomographic angiography (CCTA). This innovative radiological screening modality has led to the most precise mapping of the course of the CAs on computed tomographic scan. The aim of the study is to determine the prevalence and describe the CAs congenital anomalies and their variations in Kuwaiti population at a single institution experience. MATERIALS AND METHODS: We analysed the CCTA data obtained consecutively from 842 patients (2013-2014), retrospectively. The inclusion criteria for patients' selection were: atypical chest pain, equivocal ECG, assessment of patency of coronary stents or grafts and pre-operative screening. Information was acquiesced using a dual-source CT scanner with ECG gating. RESULTS: Data analysis revealed that 22 (2.61%) patients were found to have CA anomalies out of the 842 patients who underwent CCTA. Out of these CA anomalies, 13 cases showed more than two ostia, 7 cases showed the ectopic origin of a CA from opposite sinus or non-aortic sinus, 2 cases showed single coronary ostium and 1 case showed coronary artery with pulmonary fistula. Also, myocardial bridging was identified in 78 (9.26%) patients whereas ramus intermedius branch was identified in 160 (19%) patients. CONCLUSIONS: The prevalence of CA anomalies in Kuwait was 2.6%, which is relatively higher than previously reported studies from different countries.

AK2 deficiency compromises the mitochondrial energy metabolism required for differentiation of human neutrophil and lymphoid lineages.

Reticular dysgenesis is a human severe combined immunodeficiency that is primarily characterized by profound neutropenia and lymphopenia. The condition is caused by mutations in the adenylate kinase 2 (AK2) gene, resulting in the loss of mitochondrial AK2 protein expression. AK2 regulates the homeostasis of mitochondrial adenine nucleotides (ADP, ATP and AMP) by catalyzing the transfer of high-energy phosphate. Our present results demonstrate that AK2-knocked-down progenitor cells have poor proliferative and survival capacities and are blocked in their differentiation toward lymphoid and granulocyte lineages. We also observed that AK2 deficiency impaired mitochondrial function in general and oxidative phosphorylation in particular - showing that AK2 is critical in the control of energy metabolism. Loss of AK2 disrupts this regulation and leads to a profound block in lymphoid and myeloid cell differentiation.

[Catheter fracture and pulmonary embolization of the distal fragment: a rare complication of the totally implantable venous access port]. / Rupture du cathéter et migration du fragment distal vers les artères pulmonaires : une complication rare des chambres à cathéter implantables.

INTRODUCTION: Totally implantable venous access port plays a crucial role in the treatment of patients in oncology. However, its use can result sporadically in catheter fracture with catheter tip embolization into pulmonary arteries. CASE REPORTS: We report this unusual but potentially serious complication in four patients. In these patients, the port had been inserted percutaneously into the subclavian vein using the infra-clavicular approach. This side effect occurred late in three patients. In all patients, the catheter fracture was asymptomatic or pauci-symptomatic and was caused by the pinch-off syndrome. The retrieval of the embolized fragments was successfully performed by transcatheter procedure in the cardiac catheterisation laboratory. CONCLUSION: We reviewed the literature and the newest guidelines and recommendations to detail the clinico-radiological features, the possible causes of this complication and discussed means to recognize, manage and prevent it.

Nano Mg(1-x)Ni(x)Al2O4 spinel pigments for advanced applications.

Nano Mg(1-x)Ni(x)Al2O4 spinel pigments were synthesized via polymeric combustion technique upon heat treatment at 210 °C. Citric acid in the presence of ethylene glycol polymer, with mass ratio of 60:40, was successfully used as a host network for the synthesis process. The obtained spinel was calcined at different temperatures; 300-1200°C and investigated by thermal analysis (TG-DTG/DTA), X-ray powder diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), transmission electron microscopy (TEM), and scanning electron microscopy (SEM). UV-Vis and diffuse reflectance spectroscopy (DRS) using CIE-Lab/parameters methods have been used for color measurements. The addition of colored pigment on different types of glazes was studied. The results revealed that NiMgAl2O4 spinel beside MgNiO phases were crystallized with particle sizes of 9-21 nm at 600 °C and 52-180 nm at 1200 °C. All prepared samples exhibited green to pale green colors due to the inclusion of Ni(2+) inside the spinel structure. The pale green color intensity increased with increasing calcination temperature. The prepared pigment was suitable to convert commercial and opaque glazes to color product to be used in different applications.

Age-standardized mortality rates by cause in Basra, Iraq: 1978 and 2007.

Mortality data are essential to identify the public health importance of different diseases and allocate resources appropriately. This descriptive study was carried out to assess the pattern of mortality in Basra governorate in southern Iraq using the death records from the civil registry system for 2 years (1978 and 2007). The overall age-standardized mortality rate was lower in 2007 than 1978 (7.95 versus 8.70 per 1000), so too were the age-specific mortality rates, with the exception of that for young adults, which was 22% higher. The leading cause of death in both years was cardiovascular diseases, while cancer was the third leading cause in 1978 and the second in 2007. Mortality rates were 45.5% lower for infectious diseases in 2007 compared with 1978, 39.5% lower for respiratory diseases, 50.0% lower for digestive system diseases, 66.7% higherfor congenital malformations and 4-fold higher for endocrine and nutritional diseases.

Age-standardized mortality rates by cause in Basra, Iraq: 1978 and 2007

Mortality data are essential to identify the public health importance of different diseases and allocate resources appropriately. This descriptive study was carried out to assess the pattern of mortality in Basra governorate in southern Iraq using the death records from the civil registry system for 2 years [1978 and 2007]. The overall age-standardized mortality rate was lower in 2007 than 1978 [7.95 versus 8.70 per 1000], so too were the age-specific mortality rates, with the exception of that for young adults, which was 22% higher. The leading cause of death in both years was cardiovascular diseases, while cancer was the third leading cause in 1978 and the second in 2007. Mortality rates were 45.5% lower for infectious diseases in 2007 compared with 1978, 39.5% lower for respiratory diseases, 50.0% lower for digestive system diseases, 66.7% higher for congenital malformations and 4-fold higher for endocrine and nutritional diseases

[Repair of nose, lips and chin mutilations. The customary repairs versus allografts]. / Réparation des mutilations du triangle nasolabio-mentonnier. Plasties conventionnelles versus allogreffes.

Central-facial mutilations, located within the nose lips and chin triangle, require great quality repairs regarding morphology and function. Plastic surgery history affords the ideas evolution in this field crossing over nose and lips reconstructions, which were the subject of successive reports within our society, in 1994 (nose reconstruction) and 2002 (lips reconstruction). Now a day, following this progress, the plastic surgeon has a large choice of reliable techniques. His choice is dictated by a precise evaluation of the limits of the substance loss to repair, according to a (mapping) classification of the nose-lip and chin triangle. This classification defines three units (nose-labial, bilabial and chin-labial) as reflexion bases to the therapeutic indications. This anatomical and surgical approach was built starting from a retrospective study of 195 central-facial mutilations caused by ballistic damage and dog bites. The results evaluation makes possible to carry out a reflexion on the potential indications regarding allograft as a therapeutic alternative to the traditional reconstructions of this territory.

Psychological aspects of orthognathic surgery and its effect on quality of life in Egyptian patients.

A study was made of 120 patients aged 11-33 years who underwent various types of orthognathic surgery in a Cairo hospital between 1998 and 2004. Patients answered a standardized questionnaire to identify motives for seeking surgery, the degree of satisfaction with the outcome and its effect on quality of life. Preoperatively, aesthetic reasons were the primary motive for seeking surgery in 95% of patients. Postoperatively, 85% of the patients were positive about the outcome of surgery as well as its effect on their quality of life. Postoperative improvement of facial aesthetics of the patients was associated with improvement of their quality of life in all aspects tested.

Rheumatic manifestations of psoriasis.

Psoriatic arthritis was described as a distinct rheumatic disease in the 1960s, and subsequently grouped among the spondyloarthropathies. Recently, other rheumatic manifestations of psoriasis, such as enthesopathy and osteoperiostitis, were recognized. This study attempts to examine the rheumatological and radiological manifestations of Psoriasis and their association with skin and nail disease. Eighty-one psoriatic outpatients were interviewed consecutively during 6 months. Questionnaires and indices were carried out to assess the extent and severity of skin and nail involvement, as well as the activity and severity of peripheral and axial rheumatic manifestations. Radiological examination of the hands, feet, spine and pelvis was also done for all patients. Fifty-nine psoriatic outpatients (73%) had rheumatic manifestations clinically and/or radiologically (Psoriatic arthropathy "PsA"). Clinical peripheral arthritis was found in 14 (23.7%) of the patients with PsA, being oligoarticular in 11, polyarticular in two, and exclusively of the distal interphalangeal (DIP) joints in one patient. Sacroiliitis and/or spondylitis were found in 38 (64.4%), enthesopathy in 36 (61%), dactylitis in two (3.3%), radiological DIP involvement in 24 (40.6%), and radiological osteoperiostitis in 49 (83%) of patients with PsA. Most PsA patients had more than one rheumatic manifestation, while four patients (6.7%) had isolated enthesopathy without any other rheumatic manifestations. Subungual hyperkeratosis of the nails was significantly correlated with PsA (p<0.05), as well as with clinical arthritis, enthesopathy, and DIP involvement (p<0.01), while other types of skin and nail lesions were correlated with selected rheumatic manifestations. The performance of existing criteria for PsA was poor, as individual sets favored either sensitivity or specificity. Psoriatic arthropathy (PsA), occurring in about three-quarters of hospital outpatients with psoriasis, is more common than previously thought. More sensitive and specific criteria for the diagnosis and classification of PsA need to be developed, taking into account the recently described clinical and radiological manifestations.

Psychological aspects of orthognathic surgery and its effect on quality of life in Egyptian patients

A study was made of 120 patients aged 11-33 years who underwent various types of orthognathic surgery in a Cairo hospital between 1998 and 2004. Patients answered a standardized questionnaire to identify motives for seeking surgery, the degree of satisfaction with the outcome and its effect on quality of life. Preoperatively, aesthetic reasons were the primary motive for seeking surgery in 95% of patients. Postoperatively, 85% of the patients were positive about the outcome of surgery as well as its effect on their quality of life. Postoperative improvement of facial aesthetics of the patients was associated with improvement of their quality of life in all aspects tested

[Facial injuries treated in the Grenoble University Hospital. Epidemiological analysis of 961 patients managed in one year]. / Traumatismes faciaux au CHU de Grenoble. Etude épidémiologique de 961 dossiers sur une période de 365 jours.

INTRODUCTION: The purpose of this study was to determine the types of facial injuries treated in a one-year in a maxillo-facial unit operating in a mountainous region. METHODS: All patients admitted to the Grenoble University Hospital maxillo-facial unit for a one year period were studied. We noted cause of trauma, age, sex, type and location of fracture, type of soft tissue injury, time between trauma and surgery. RESULTS: A total of 994 patients presenting maxillo-facial trauma underwent surgery over one year; 30% of the unit's maxillo-facial surgical activity. On average, 80 patients were treated for maxillo-facial trauma per month, with a peak of 97 facial injuries in July; 65.6% were hospitalized in the maxillo-facial unit; 25,4% of the injured were aged between 21 and 30 years. Sex-ratio was 2.7M/1F. The most frequent cause was sports injuries (25.8%) followed, in decreasing order, by traffic injuries (23.1%), home injuries (17.6%), fight injuries (3.4%), work injuries (3.4%) and dog bites (3.2%). 10.5% of the injuries occurred in a mountainous setting and 40.7% were sports injuries, 95% of which during practice of winter's sports. Injuries included facial fractures (65.5%) with or without soft tissue damage, and soft tissue injuries only (34.5%); 33.6% of the patients had other lesions of the body. 67.2% underwent surgery within the first 24 hours and 86.9% before the fifth day. DISCUSSION: Sports accidents are the leading cause of facial trauma in the mountainous regions. Most facial injuries result from ski, surf and other winter sports accidents. Most of the victims were given surgical care within the first 24 hours following the accident.

[Replantation of traumatic amputated ears by Mladick procedure: 6 cases]. / Réimplantation du pavillon de l'oreille selon la technique de Mladick: à propos de six cas.

UNLABELLED: Traumatic ear amputations are relatively rare. Whenever possible, ear reimplantation should be attempted, however the choice of the surgical procedure must be judicious. PATIENTS AND METHODS: We present 6 cases of partial ear amputation treated by the pocket technique described by Mladick. The series comprises 5 partial amputations severing less than half of the auricule and 1 subtotal amputation preserving the ear lobule. RESULTS: Necrosis of the avulsed fragment occurred in the only case of subtotal amputation. In the 5 other cases the revascularisation of the severed part was successful. Morphological results are often very good when the ear is freed from the pocket before 4 weeks. Beyond this delay skin grafting is necessary and inaesthetic scar retraction occurs. CONCLUSION: The success rate depends on the size and the degree of contusion of the amputated ear. We recommend the Mladick's procedure for reimplantation of fragments less than 1/2 of the auricle with favorable tissue condition. We believe that other procedures described in the literature could offer a good alternative for amputations exceeding half of the ear pavilion.

[Fractures of the mandibular angle: factors predictive of infectious complications]. / Fractures de l'angle mandibulaire: facteurs prédictifs des complications infectieuses.

INTRODUCTION: Fractures of the mandible angle raise the risk of infectious complications. We searched for factors predictive of these complications. MATERIAL AND METHODS: We reviewed retrospective all cases of mandibular angle fracture treated during a 26-month period. We compared two groups: fractures with wisdom teeth and fractures without wisdom tooth. For each group we noted clinical and radiological characteristics of the fractures and infectious complications. RESULTS: The series included 72 mandibular angle fractures, 30 with a wisdom tooth against 42 without. Most of the patients were treated within 2 days, generally using mini-plate screw fixation. In the wisdom tooth group, 16.6% of patients developed infectious complications versus 9.5% in the without wisdom tooth group. All patients of the wisdom tooth group presented a potentially infectious focus on the preoperative x-rays. For without wisdom tooth group, irregular follow-up was found to be the only risk factor. DISCUSSION: The angular localization increases the risk of infectious complications especially if the wisdom tooth is in the fracture. We propose a decision tree to determine when to preserve or not the wisdom tooth.

[Beyond the lips. Reconstructive techniques and indications]. / Les lèvres dépassées. Techniques de reconstruction et indications.

Labial tissue defects that extend beyond the anatomic boundary of the labial region confront us with two distinct reconstructive problems. When the extension is centrifugal towards the periphery, the tissue loss is essentially tegumentary. The reconstructive aim in this case is not only to restore tissues of the perilabial areas with the best possible morphologic and functional harmony but also to place the reconstructed lip harmoniously and in good relation to these structures. In the case of posterior extension of tissue losses towards the jaws, it is mandatory to reconstruct the underlying bony and eventually alveolo-dental architecture prior to the lip reconstruction. The reconstruction strategy is emphasised by two cases of complex ballistic injury.

Genome-wide scans of three independent sets of 90 Irish multiplex schizophrenia families and follow-up of selected regions in all families provides evidence for multiple susceptibility genes.

From our linkage study of Irish families with a high density of schizophrenia, we have previously reported evidence for susceptibility genes in regions 5q21-31, 6p24-21, 8p22-21, and 10p15-p11. In this report, we describe the cumulative results from independent genome scans of three a priori random subsets of 90 families each, and from multipoint analysis of all 270 families in ten regions. Of these ten regions, three (13q32, 18p11-q11, and 18q22-23) did not generate scores above the empirical baseline pairwise scan results, and one (6q13-26) generated a weak signal. Six other regions produced more positive pairwise and multipoint results. They showed the following maximum multipoint H-LOD (heterogeneity LOD) and NPL scores: 2p14-13: 0.89 (P = 0.06) and 2.08 (P = 0.02), 4q24-32: 1.84 (P = 0.007) and 1.67 (P = 0.03), 5q21-31: 2.88 (P= 0.0007), and 2.65 (P = 0.002), 6p25-24: 2.13 (P = 0.005) and 3.59 (P = 0.0005), 6p23: 2.42 (P = 0.001) and 3.07 (P = 0.001), 8p22-21: 1.57 (P = 0.01) and 2.56 (P = 0.005), 10p15-11: 2.04 (P = 0.005) and 1.78 (P = 0.03). The degree of 'internal replication' across subsets differed, with 5q, 6p, and 8p being most consistent and 2p and 10p being least consistent. On 6p, the data suggested the presence of two susceptibility genes, in 6p25-24 and 6p23-22. Very few families were positive on more than one region, and little correlation between regions was evident, suggesting substantial locus heterogeneity. The levels of statistical significance were modest, as expected from loci contributing to complex traits. However, our internal replications, when considered along with the positive results obtained in multiple other samples, suggests that most of these six regions are likely to contain genes that influence liability to schizophrenia.

Oxidative modification and inactivation of the proteasome during coronary occlusion/reperfusion.

Restoration of blood flow to ischemic myocardial tissue results in an increase in the production of oxygen radicals. Highly reactive, free radical species have the potential to damage cellular components. Clearly, maintenance of cellular viability is dependent, in part, on the removal of altered protein. The proteasome is a major intracellular proteolytic system which degrades oxidized and ubiquitinated forms of protein. Utilizing an in vivo rat model, we demonstrate that coronary occlusion/reperfusion resulted in declines in chymotrypsin-like, peptidylglutamyl-peptide hydrolase, and trypsin-like activities of the proteasome as assayed in cytosolic extracts. Analysis of purified 20 S proteasome revealed that declines in peptidase activities were accompanied by oxidative modification of the protein. We provide conclusive evidence that, upon coronary occlusion/reperfusion, the lipid peroxidation product 4-hydroxy-2-nonenal selectively modifies 20 S proteasome alpha-like subunits iota, C3, and an isoform of XAPC7. Occlusion/reperfusion-induced declines in trypsin-like activity were largely preserved upon proteasome purification. In contrast, loss in chymotrypsin-like and peptidylglutamyl-peptide hydrolase activities observed in cytosolic extracts were not evident upon purification. Thus, decreases in proteasome activity are likely due to both direct oxidative modification of the enzyme and inhibition of fluorogenic peptide hydrolysis by endogenous cytosolic inhibitory protein(s) and/or substrate(s). Along with inhibition of the proteasome, increases in cytosolic levels of oxidized and ubiquitinated protein(s) were observed. Taken together, our findings provide insight into potential mechanisms of coronary occlusion/reperfusion-induced proteasome inactivation and cellular consequences of these events.