[The effect of type II diabetes and the metabolic syndrome on cardiac second window preconditioning]. / Het effect van type ii diabetes en het metabool syndroom op cardiale tweede venster preconditionering.

Preconditioning is the most powerful endogenous mechanism, to protect the heart against ischemic damage. Conflicting data are published whether preconditioning can be induced in case of diabetes and the metabolic syndrome, which are clinically very relevant conditions. If preconditioning could be induced consistently and chronically in this population, an important reduction of surgical morbidity and mortality could be reached. In this project we induced hypoxic preconditioning in mice and used cardiac pressure-conductance catheterisation and infarct size as outcome parameters. In the first part, we found that hypoxic preconditioning was capable to reduce infarct size with 40% and preserve the load-independent parameters with 33% after coronary occlusion. A DKO (double knock-out: ob/ob; LDLR-/-) model for the metabolic syndrome developed a larger infarct size and had a reduced contractility. No preconditioning could be induced in this model. To detect the determing factor of the resistance to preconditioning, we used single knock-out models. A comparable preconditioning effect of wild type mice could be induced in the lipoprotein receptor deficient (LDLR-/-) model for dyslipidemia. The leptin deficient (ob/ob) model, characterized by insulin resistance and abdominal obesity had, identically to the DKO model, a larger infarct size. A second window of preconditioning could be induced, although it was less pronounced than the wild type and LDLR-/- model. Insulin resistance and abdominal obesity could be identified as the major factor in the resistance to preconditioning.

Left atrial myxoma: presentation with acute aortic occlusion and 'resolution' of the primary tumor.

We report a case of an acute infrarenal aortic occlusion caused by embolization of a left atrial myxoma. The aortoiliac embolus was removed by an emergency embolectomy with a Fogarty catheter. Patient refused initially the resection of the small remaining part of his cardiac tumor. Two months later, he agreed and a surgical resection was performed. Peroperatively and histopathologically, no residual tumor could be detected. This is the first report of embolization of a left atrial myxoma with subsequent asymptomatic complete embolization or regression.

The case for urgent carotid endarterectomy.

The high mortality rate previously reported and the absence of proven advantage of urgent carotid endarterectomy over natural history, has discouraged consideration of this operation. We want to report on two patients with stroke in evolution and fluctuating stroke, who underwent immediate surgery with excellent results. With these cases we aim to demonstrate that selected patients with stroke in evolution or fluctuating stroke due to recent carotid thrombosis have a good prognosis after emergency surgery. We think that in these selected cases endovascular therapy is at this moment a waste of time.

Transmesosigmoid hernia: report of a case and review of the literature.

We report a case of a transmesosigmoid hernia in a 6 weeks postpartum woman. We found 14 previous reports of this rare type of internal hernia. Our patient presented with acute abdominal pain and developed a small intestinal obstruction. History, clinical and radiographic examination were not diagnostic. An early laparoscopy was performed and a herniation of a small intestine loop through a hole in the sigmoid mesocolon was seen. The hernia was reduced and the defect in the sigmoid mesocolon was closed laparoscopically. The small intestine was viable and enterectomy could be avoided. The role of laparoscopy and potential causes of this type of hernia are discussed.