Admission monocyte to high density lipoprotein cholesterol ratio predicts amputation in patients undergoing embolectomy for acute lower extremity ischemia.

OBJECTIVE: Acute limb ischemia is a common clinical manifestation of embolism or thrombosis, which can lead to amputation. Increasing evidence suggests that various biomarkers can predict amputation at the time of admission. Identifying an easily obtainable and inexpensive indicator has always been a major objective. The aim of this study was to determine the predictive value of the admission monocyte count to the HDL-C ratio for a lower extremity amputation in patients undergoing embolectomy for acute limb ischemia. PATIENTS AND METHODS: This retrospective, single-center study included 269 patients who underwent an emergent embolectomy. The study population was divided into two groups according to early amputation: the non-amputation group (n = 220) and the amputation group (n = 49). Two groups were compared based on various data. RESULTS: According to the multivariate regression analysis, patients with a higher CRP and MHR have a significantly higher amputation rate (HR: 1.148; CI: 1.075-1.225; p < 0.001 and HR: 1.547; CI: 1.003-2.387; p = 0.04, respectively). Patients with arterial back bleeding have a significantly lower amputation rate (HR: 0.106; CI: 0.02-0.558; p = 0.008). CONCLUSIONS: Our study demonstrated that preoperative CRP, MHR, and no arterial back bleeding after surgery were found to be independent predictors of amputation as a poor prognostic factor within 30 days after an embolectomy.

Primary cardiac myxomas: report of 28 cases and review the literature.

PURPOSE: Although primary cardiac tumors are rare, cardiac myxoma is the most common seen intracardiac tumor. This study summarizes our surgical experience with cardiac myxomas. METHODS: Twenty-eight cases of cardiac myxoma that were surgically treated in our center between January 1990 and March 2010 were retrospectively reviewed. In all patients the New York Heart Association (NYHA) functional classification was used to assess the functional status, and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were measured before and after surgery. RESULTS: Nineteen patients were female and 9 male. The mean age was 53.3 ± 12.7 years (range 4-73). The most common symptom was dyspnea (86%). Two patients presented with peripheral embolism. In preoperative assessment of functional status, 24 of the patients were in NYHA Class II, 2 of them were in Class I and the other 2 patients were in Class III. All patients were in NYHA class I in the early postoperative period up to long-term follow up. The mean preoperative CRP and ESR levels were 47.3 ± 14.6 mg/l (range 30-79) and 52.8 ± 21.4 mm/h (range 28-82), respectively. One month after surgery, CRP and ESR levels returned back to normal values. Postoperative CRP and ESR levels were 8.4 ± 2.6 mg/l (range 1-12) and 7.9 ± 4.8 mm/h (range 3-18), respectively. CONCLUSION: Myxomas should be considered in all patients with embolism. After surgical resection of cardiac myxomas, the functional status of patients improve and CRP and ESR levels become normal.

Successful surgical treatment of Nicolau's syndrome combined with intravenous iloprost.

A 4 year-old boy was admitted to our clinic with symptoms of pain and ecchymosis in his right leg and foot after injection of benzathine penicilline. There was a localized gangrenous area at the femoral injection site. Doppler ultrasonography showed no arterial flow in the femoral artery and clear evidence of acute thrombosis of the superficial femoral and popliteal veins. Femoral arterial and venous thrombectomy and fasciotomy were performed immediately. After surgery the boy was treated by Iloprost infusion and enoxaparine. One week later necrotic changes had regressed, fasciotomies were closed and only the distal phalanx of the third toe needed amputation. Early surgical intervention and standard management combined with Iloprost infusion may help in healing the lesions by increasing extremity perfusion and may prevent extremity loss.

Simulating the propagation of spreading cortical depression (SCD) wavefront on human brain surface.

Spreading cortical depression (SCD) is a slowly spreading supression of electroencephalogram (EEG) activity that was first observed in anaesthetized rabbits in 1944. Since then, the spatial properties of propagation have been investigated on numerous animal experiments. In the folded and complex human cortex, both the occurrence of SCD and the relationship between SCD and migraine have been discussed controversially. This study proposes a software tool to simulate the possible wavefront motion on the surface of human brain. The SCD wavefront motion has been simulated up to an affected surface region of roughly 150 cm(2) and validated by clinical experts.

An internal iliac artery aneurysm causing a colonic obstruction: report of a case.

An 80-year-old male patient presented with the chief complaints of a sudden onset of pain in the right lower quadrant and constipation of 3 days' duration. In computerized tomographic examination an aneurysm of right internal iliac artery and an abnormally enlarged descending colon were seen. During an emergency operation a small rupture in the subserosa of the rectosigmoid junction was found.

Ruptured cardiac hydatid cyst masquerading as acute coronary syndrome: report of a case.

The case of a 40-year-old man hospitalized for investigation of a doubtful diagnosis of acute coronary syndrome is reported herein. Two-dimensional echocardiography and angiography showed a cardiac cyst localized in the left ventricular apex in close proximity to the left anterior descending coronary artery. Surgery performed with the aid of cardiopulmonary bypass revealed that the cyst had ruptured partially into the left ventricle and filled with thrombus. This case is of particular interest because of the rarity of cardiac localization of a hydatid cyst, and the conflict between the severity of the complications that occurred and the absence of correlated symptoms.