Gender-based comparison of takotsubo syndrome versus myocardial infarction.

BACKGROUND: Takotsubo Syndrome (TTS) is an acute reversible left ventricular dysfunction. Recently published studies have highlighted a similar mortality rate as acute coronary syndrome (ACS). We compared the impact of gender differences on the outcome of TTS patients as compared to ACS patient. DESIGN AND METHODS: We included a collective of 138 patients TTS between 2003 and 2016 at our institution. Patients were divided according to their gender into two groups (Males n=21, 15% and females, n=117, 85%). They were compared with a cohort of 300 patients with a diagnosis of ACS. RESULTS: On the acute phase, in male patients with TTS, a treatment with inotropic was more often required (33.3 vs. 11.5%, P<0.01), were more susceptible to cardiogenic shock (28.6 vs. 12.5%, P<0.04). Concerning the long-term prognosis after the acute event, male patients had higher all-cause mortality over long-term follow-up. A Kaplan-Meier analysis indicated that the mortality of male patients with TTS was significantly higher compared to male patients with ACS (log-rank <0.01), while there was no significant difference between female patients with TTS and ACS (log-rank =0.60, P=0.45). In a multivariate cox regression analysis, male gender (HR 2.7, 95% CI: 1.1-6.5, P=0.02) GFR <60 ml/min (HR 2.8, 95% CI: 1.2-6.0, P=0.01) and history of cancer (HR 3.6, 95% CI 1.4-9.3, P<0.01) were independent predictors of 5-year mortality. CONCLUSIONS: Considerable evidence suggests that TTS compared to ACS implicates more significant clinical short-term events on male patients and it may be associated with poorer long-term prognosis.

[Bedside implantation of a new temporary vena cava inferior filter : German results from the European ANGEL registry]. / Bettseitige Implantation eines neuen passageren V.-cava-inferior-Filters : Deutsche Daten aus dem europäischen ANGEL-Register.

BACKGROUND: Pulmonary embolism (PE) is a frequently occurring complication in critically ill patients, and the simultaneous occurrence of PE and life-threatening bleeding is a therapeutic dilemma. Inferior vena cava filters (IVCF) may represent an important therapeutic alternative in these cases. The Angel® catheter (Bio2 Medical Inc., San Antonio, TX, USA) is a novel IVCF that provides temporary protection from PE and is implanted at bedside without fluoroscopy. MATERIAL AND METHODS: The European Angel® Catheter Registry is an observational, multicenter study. In our German substudy, we investigated patients from three German hospitals and four intensive care units, who underwent Angel® catheter implantation between February 2016 and December 2016. RESULTS: A total of 23 critically ill patients (68 ± 9 years, 43% male) were included. The main indication for implantation was a high risk for or an established PE, combined with contraindications for prophylactic or therapeutic anticoagulation due to either an increased risk of bleeding (81%) or active bleeding (13%). The Angel® catheter was successfully inserted in all patients at bedside. No PE occurred in patients with an indwelling Angel® catheter. Clots with a diameter larger the 20 mm, indicating clot migration, were detected in 5% of the patients by cavography before filter retrieval. Filter retrieval was uneventful in all of our cases, while filter dislocation occurred in 3% of the patients. CONCLUSION: The German data from the multicenter European Angel® Catheter Registry show that the Angel® catheter is a safe and effective approach for critically ill patients with a high risk for the development of PE or an established PE, when an anticoagulation therapy is contraindicated.

[Acute pulmonary embolism and contraindication of anticoagulation : Bedside implantation of a new temporary vena cava inferior filter]. / Akute Lungenembolie und Kontraindikation für eine Antikoagulation : Bettseitige Implantation eines neuen passageren V.-cava-inferior-Filters.

Pulmonary embolism (PE), mostly caused by deep vein thrombosis, is a life-threatening complication in critically ill patients in the intensive care unit. A potential strategy to prevent PE in patients with contraindication for anticoagulant therapy is the implantation of a vena cava filter (VCF), to provide fast and safe PE protection against ascending thrombi. We report the case of a 56-year-old woman with an intracranial hemorrhage, who developed a PE. Because of acute contraindications for anticoagulant therapy, bedside implantation of a new VCF was performed to overcome the period of absolute contraindications for anticoagulation. After explanation, several thrombi were found on the filter.

Infective endocarditis - A word of caution on non-typical bacteria.

A previously healthy 52-year-old man presented to our department with remitting and relapsing fever for more than 6 weeks. During complex staged work-up, we revealed that he suffered from an Abiotrophia defectiva endocarditis of the mitral valve with mitral regurgitation and vegetation requiring mitral valve replacement. He recovered well postoperatively and is currently being followed at our Outpatient Cardiology Clinic.

High strain sensitivity controlled by the surface density of platinum nanoparticles.

We report a controllable strain gauge factor obtained using a two-dimensional nanoparticle layer formed from platinum nanoparticles. A vacuum technique is used for room temperature nanoparticle deposition that allows control of the electrical resistance of the film, exhibiting semiconducting-like behavior when nanoparticle arrays cover the surface below a threshold value while above it a metallic behavior is prevalent. The highest sensitivity is obtained for intermediate density values of the nanoparticle assemblies, which could be explained using a tunneling and hopping current expression. The device, which exhibits more than one order of magnitude higher strain sensitivity than continuous metallic films, is fabricated at room temperature through standard lithographic processing allowing for miniaturization and easy integration in silicon technology or flexible substrates.

Endometriosis-associated ovarian cancer. Presentation of a case report and review of the literature.

Endometriosis is a frequent benign disease presenting in more than 10% of women in reproductive age. Although its course is usually benign, it has characteristics of malignant disease, such as progressive course, implantation at distant sites, creation of a microenvironment that renders its course independent and mobilization of the immune system in order to prevent its destruction. Endometriosis-associated ovarian cancer (EAOC) is encountered in 0.3-1.0% of cases of endometriosis. We present in the current article a case of EAOC, reviewing the literature for epidemiological data and data of genetics, and other possible associated factors that lead to the pathogenesis of the disease.

Pure vulvar Langerhans cell histiocytosis: a case report and literature review.

Langerhans cell histiocytosis (LCH) of the female genital tract is a very rare disease. Only 16 cases of primary vulvar LCH without subsequent systemic spread of disease have previously been published in the literature. We describe an additional case of LCH in which the lesion was confined to the vulva. A 52-year-old Caucasian woman presented for further investigation with a 6-month history of vulvar pruritus. Physical examination revealed multiple fine red papules on both labia minor. A metastatic workup did not reveal any evidence of disease beyond the vulva. The lesion was biopsied, and histological findings were characteristic of LCH. The patient was treated by local extirpation of both labia minor. Ten months after surgery, the patient has no signs of local recurrence or systemic spread. It is necessary to perform a biopsy of the lesions when a woman presents atypical chronic lesions on the vulva. Although different treatment has been proposed, complete surgical excision is fundamental in "pure" genital Langerhans cell histiocytosis as initial therapy.

Engineering of FePt nanoparticles by e-beam co-evaporation.

Fe(50)Pt(50) nanoparticles were deposited on thermally oxidized Si substrates by electron-beam co-evaporation of Fe and Pt, at substrate temperatures T(s) between 300 and 700 degrees C. The co-deposition led to the formation of drop-like, coalesced nanoparticles, chain-like structures or continuous films, the morphology being dependent on T(s) or the nominal thickness of the layer, f. The nanoparticles have a mean diameter D(p) between 3 and 45 nm, which increases with increasing f. The degree of crystallization in the ordered face centred tetragonal (fct) phase of the samples depends strongly on the growth conditions and increases with increasing T(s) and f. Nanoparticles with a higher proportion of the fct phase exhibit higher coercivity, with a maximum value of approximately 10.3 kOe (for the specimens prepared at 600 degrees C with f = 8.5 nm). Conversely, samples with a high proportion of the cubic phase are either superparamagnetic or ferromagnetically soft. The thermal annealing performed on selected samples resulted in structural transformation as well as magnetic hardening that depended on f and D(p).

FePt and CoPt nanoparticles co-deposited on silicon dioxide-a comparative study.

We compare CoPt and FePt nanoparticles grown under identical conditions on oxidized Si substrates by electron beam co-evaporation. Growth was performed under high vacuum conditions at substrate temperatures of 1023 K and was immediately followed by an annealing step. This process forms CoPt and FePt nanoparticles with mean diameters between ∼17 and ∼22 nm. In particular, the annealing step results in grain size enlargement for all samples and in a progressive magnetic hardening of the nanoparticles which reach maximum perpendicular coercivities of ∼6.6 kOe (for the CoPt) and ∼10.2 kOe (for the FePt nanoparticles). We show that, during this annealing step, a progressive transition towards the hard magnetic L1(0) ordered phase takes place in both materials. In contrast to FePt, CoPt nanoparticles must be annealed in order to crystallize in this phase.

Fabrication of nanorods by metal evaporation inside the pores of ultra-thin porous alumina templates.

Porous alumina has attracted a great deal of attention as a template material for the growth of nanowires and nanodots. Typically, the pores have a high aspect ratio, which forbid the use of evaporation techniques for filling them, due to a pore closure effect. For this reason electrochemical methods are mainly used. However, there are materials, such as Al, which are very difficult to deposit electrochemically. In this work, the fabrication of Al nanorods by electron gun evaporation into low aspect-ratio pores of ultra-thin porous alumina templates is described. The thicknesses of the templates are in the range from 50 to 70 nm, while their pores have diameters from 20 to 40 nm, i.e. their diameter:height aspect ratios are very low, from 1:1.5 to 1:3. These properties make it possible to completely fill the pores with evaporation techniques. This method can be generalized to any target and substrate material.

Structural study of very thin anodic alumina films on silicon by anodization in citric acid aqueous solution.

The formation of thin alumina films on a silicon substrate by anodization in a mild acid, specifically in 1% wt citric acid aqueous solution, is investigated by transmission electron microscopy (TEM). We present a comparative study between two cases of starting material: pure aluminum and an alloy of aluminum with 1% silicon. In both cases the thickness of the Al layer was less than 50 nm. It was observed that under exactly the same conditions, in the first case the anodization was stopping before anodizing the whole film and a remaining non-anodized Al layer was always present, while in the second case, the Al layer was fully anodized, resulting in an alumina matrix with a very high density of silicon nanocrystals of uniform sizes embedded in it. In both cases the alumina film was compact and amorphous.

Effective ways of restoring muscular imbalances of the rotator cuff muscle group: a comparative study of various training methods.

BACKGROUND: Many studies have compared different training methods for improving muscular performance, but more investigations need to be directed to the restoration of muscular imbalances. OBJECTIVE: To determine the most effective training for altering strength ratios in the shoulder rotator cuff. METHODS: Forty eight physical education students were randomly assigned to four groups (12 per group): (a) experimental group who carried out multijoint dynamic resistance training for shoulder internal and external rotation movement (pull ups or lat pull downs, overhead press, reverse pull ups, push ups) (MJDR group); (b) experimental group who exercised the same muscle group using dumbbells weighing 2 kg (isolated group); (c) experimental group who followed an isokinetic strengthening programme for the rotator cuff muscle group (isokinetic group); (d) control group who had no strength training. Testing was performed in the supine position with the glenohumeral joint in 90 degrees of abduction in the coronal plane, with a range of motion of 0-90 degrees of external rotation and 0-65 degrees of internal rotation at angular velocities of 60, 120, and 180 degrees /s. The test procedure was performed before and after the exercise period of six weeks. RESULTS: One way analysis of variance found no differences between the groups for the initial tests. Analysis of variance with repeated measures showed that the strength ratios in all the experimental groups had altered after the exercise period, with the isokinetic group showing the most significant improvement. CONCLUSIONS: Isokinetic strengthening is the most effective method of altering strength ratios of the rotator cuff muscle.

Occurrence of acute lower limb injuries in artistic gymnasts in relation to event and exercise phase.

OBJECTIVES: To record the incidence of lower limb injuries (acute and overuse syndromes) in Greek artistic gymnasts in relation to the event and exercise phase. METHODS: A total of 162 gymnasts (83 male and 79 female athletes) participating in the Greek artistic gymnastic championships were observed weekly for the 1999-2000 season. RESULTS: Ninety three (61.6%) acute injuries and 58 (38.4%) overuse syndromes were recorded. The most common anatomical location was the ankle (69 cases, 45.7%), followed by the knee (40 cases, 26.5%). The rate of mild injuries was 26.6% (25 cases), that of moderate injuries was 44% (41 cases), and that of major injuries was 29% (27 cases). The incidence of injury to the ankle and knee was significantly higher in the floor exercise, especially during the landing phase, than in the other events. CONCLUSIONS: By its nature, gymnastics predisposes to acute injuries, but up to 75% are mild or moderate. Special attention should be paid to the floor exercise, especially the landing phase.

Infantile myofibromatosis: a case study and review of literature.

Infantile myofibromatosis is an unusual condition generally presenting in the newborn period. The case being reported is that of a female newborn who had multiple lesions that involved skin, subcutaneous tissue, skeletal muscles, bone, and lungs. The disease was diagnosed because of the easily palpable skin tumors and subcutaneous nodules that were obvious immediately after birth. The diagnosis was established by histopathological examination of one nodule that showed a spindle-celled mesenchymatogenic lesion demonstrating the morphological and immuno-phenotype characteristics of myofibroblastic differentiation. The histologic picture, combined with the clinical manifestations and the imaging findings, are consistent with infantile myofibromatosis. The physical condition of the newborn was excellent and remains so six months later. The tumors of the skin and the subcutaneous nodules have gradually regressed without therapy. At the age of six months, four (4) nodules are palpable; the infant is under continuous observation.

A comparative study of intraperitoneal carboplatin versus intravenous carboplatin with intravenous cyclophosphamide in both arms as initial chemotherapy for stage III ovarian cancer.

Cisplatin (C) or carboplatin (CBP) plus cyclophosphamide (CTX) was until recently considered standard chemotherapy for advanced ovarian cancer (OC). Attempts to maximize platinum and its analog activity against OC include its administration directly into the peritoneal cavity. In the past we have shown that intraperitoneal (IP) CBP administration is a safe and effective treatment for OC [Polyzos et al: Proc Am Assoc Cancer Res 1990;31: 1120]. In the present study we aimed to compare the effectiveness and toxicity of CBP administration either intravenously (IV) or IP plus CTX IV. Since 1990, 90 evaluable patients with stage III OC were prospectively randomized to receive CBP 350 mg/m2 IV or IP plus CTX 600 mg/m2 IV (in both groups) every 3-4 weeks for six courses. The randomization incorporated stratification according to performance status and the amount of residual tumor (maximum diameter 2 cm). Clinical assessment was performed with abdominal CT and serum CA-125. Responses were observed in 33/46 = 72% (95/CI 56.5-84.0) of the IV group and in 33/44 = 75% (95/CI 59.7-86.8) of the IP group with 48 and 45% clinical complete responses, respectively. Times to progression were 19 months (8-62+) for the IV group and 18 (6-72+) for the IP group. Median survivals were: 25 months (6-80+) and 26 months (6-72+), respectively. Significantly more patients in the IV group than in the IP group had grade 3 or higher leukopenia (p < 0. 01) and grade 3 thrombocytopenia (p < 0.09). Morbidity due to infectious complications in the IP group was minimal. It seems that IP CBP is equally effective to IV administration in terms of response and survival with less myelotoxicity. The favorable results on survival demonstrated in studies with IP C administration in patients with small volume disease [Alberts et al: N Engl J Med 1996;335:1950-1965] could not be repeated in the present study applying CBP in patients with variable tumor size and a relatively small number of patients. The likelihood that patients with large volume disease would benefit from a regional approach compared to systemic administration is small and this explains the inability to detect a difference between the two arms.

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.

Congenital infection by human parvovirus B19 ascites-anaemia.

A case of intrauterine infection by human parvovirus B19 (HPV B19) manifested as ascites during pregnancy is presented. Ascites was diagnosed by ultrasound at 27 weeks' gestation. A caesarean section was performed at 37 weeks'. owing to affected mobility of the fetus. A pale, female infant with low haemoglobin and bradycardia was delivered. Polymerace Chain Reaction (PCR) lab tests revealed that the mother and the fetus were infected by HPV B19. The neonate was born with low haemoglobin (Hb = 10 g/dl) and with ascites; it was discharged in good general condition 50 days after delivery.