Incidental finding of a giant intracardiac angioma infiltrating both ventricles in a 35-year-old woman: a case report.

BACKGROUND: Primary cardiac tumors are rare and often asymptomatic or present with unspecific symptoms. Benign cardiac tumors of vascular origin are especially rare, with only few existing data in the literature. CASE PRESENTATION: A 35-year-old Caucasian female patient presented to our department with an asymptomatic giant intracardiac angioma infiltrating both ventricles. Evaluation of this tumor involved electrocardiography, echocardiography, cardiac magnetic resonance imaging, coronary angiography, an open myocardial biopsy, and histological examination of the resected specimen. Because our patient was asymptomatic, she was managed conservatively with regular follow-up. We discuss the treatment options available in comparison with similar cases. CONCLUSION: Diagnosis and therapy of benign cardiac tumors, especially of asymptomatic lesions, can be a challenge. There is no evidence available to help in the management of such patients. An extensive evaluation is needed with different imaging modalities, and case-specific decisions should be made that involve experts in cardiology, cardio-oncology, and heart surgery.

Constrictive Pericarditis in the Presence of Remaining Remnants of a Left Ventricular Assist Device in a Heart Transplanted Patient.

Constrictive pericarditis (CP) is a severe subform of pericarditis with various causes and clinical findings. Here, we present the unique case of CP in the presence of remaining remnants of a left ventricular assist device (LVAD) in a heart transplanted patient. A 63-year-old man presented at the Heidelberg Heart Center outpatient clinic with progressive dyspnea, fatigue, and loss of physical capacity. Heart transplantation (HTX) was performed at another heart center four years ago and postoperative clinical course was unremarkable so far. Pharmacological cardiac magnetic resonance imaging (MRI) stress test was performed to exclude coronary ischemia. The test was negative but, accidentally, a foreign body located in the epicardial adipose tissue was found. The foreign body was identified as the inflow pump connection of an LVAD which was left behind after HTX. Echocardiography and cardiac catheterization confirmed the diagnosis of CP. Surgical removal was performed and the epicardial tubular structure with a diameter of 30 mm was carefully removed accompanied by pericardiectomy. No postoperative complications occurred and the patient recovered uneventfully with a rapid improvement of symptoms. On follow-up 3 and 6 months later, the patient reported about a stable clinical course with improved physical capacity and absence of dyspnea.

Preoperative patient preparation: psychological and educational aspects.

Effective preoperative preparation can be a major investment in the determination of positive patient outcomes. Psychological preparation and patient education are important aspects of the patient's surgical experience. The trend toward ambulatory surgery decreases the time nurses spend with preoperative patients and challenges the perioperative nurse to provide effective comprehensive support in a limited amount of time.

Safety in intraoperative trauma care.

Care of patients with penetrating trauma is risky because of increased prevalence of blood borne disease. Perioperative nurses have constant exposure to body fluids so they are at an increased risk of exposure. Personal safety has emerged as one of the primary workplace concerns of nurses. This report reviews intraoperative safety, Association of Operating Room Nurses and Occupational Safety and Health Administration standards, and universal precautions in practice.

Flow-cytometric characterization of cardiac allograft-infiltrating cells following MHC class I antigen pretreatment in the mouse.

Changes in the graft-infiltrating cell population (GIC) induced by Class I MHC pretreatment were characterized using flow cytometric analysis. C3H mice received 10(7) EL4 cells intravenously 14 days prior to transplant with C57BL/10 (H-2b) hearts. Transplanted hearts were removed from six recipients in both groups at 4, 6, 9, 12, 15, and 21 days after transplantation. GICs were harvested and incubated with FITC-conjugated Lyt-1 and Lyt-2 and phycoerythrin-conjugated L3T4 monoclonal antibodies. The proportion of GICs which were Lyt-1, L3T4, or Lyt-2 positive was similar in both control and pretreated groups at all times posttransplant, and all three cell populations exhibited similar changes over the course of the study in both groups. At Post-transplant Day (PTD) 9, there were significantly more double-staining cells (L3T4+, Lyt2+) in the pretreated group than in the control group (8.58 +/- 2.49% vs 4.36 +/- 1.32%, P < 0.05). By PTD 15, the double-staining cells had increased in pretreated mice to 17.46 +/- 4.36% of the total GICs (P < 0.05). The percentage of GICs in EL4-pretreated mice which were Lyt-1- was significantly higher at all time points than the percentage of L3T4- or Lyt-2- cells, whereas in the control, these cell populations were equivalent, implying that in pretreated mice, cells are present which are L3T4+ or Lyt2+ but Lyt-1-.(ABSTRACT TRUNCATED AT 250 WORDS)

Human basophil degranulation triggered by very dilute antiserum against IgE.

When human polymorphonuclear basophils, a type of white blood cell with antibodies of the immunoglobulin E (IgE) type on its surface, are exposed to anti-IgE antibodies, they release histamine from their intracellular granules and change their staining properties. The latter can be demonstrated at dilutions of anti-IgE that range from 1 x 10(2) to 1 x 10(120); over that range, there are successive peaks of degranulation from 40 to 60% of the basophils, despite the calculated absence of any anti-IgE molecules at the highest dilutions. Since dilutions need to be accompanied by vigorous shaking for the effects to be observed, transmission of the biological information could be related to the molecular organization of water.

Application of weak electric field to the hindpaw enhances sciatic motor nerve regeneration in the adult rat.

Direct current (DC) electrical stimulation of the hindpaw is shown to enhance sciatic motor nerve regeneration in the adult rat. Cathodal stimulation, using weak currents (10 microA/cm2; field strength approximately 100 mV/cm) increased the reinnervation of the hindpaw muscles as measured by evoked electromyograms. This enhanced regeneration only occurred after cut-and-suture lesions, but not after crushing injury of the sciatic nerve. This enhancement of motor nerve regeneration by weak DC fields had been previously described in amphibians but we are the first to describe this phenomenon in mammals.

Orthotopic bone transplantation in mice. III. Methods of reducing the immune response and their effect on healing.

Various methods of reducing the immune response to allogeneic bone grafts, either by pretreating the graft or by immunosuppressing the recipient, were compared. Tibial grafts from B10.D2 mice, either untreated or pretreated in various ways, were transplanted into B10 recipients. The antibody response was followed and the extent of bone healing at 4 months was assessed. Pretreatment of the graft by X-irradiation, freezing, or by incubation in alloantisera (either anti-H-2 or anti-Ia) reduced or abolished the immunogenicity of the graft. Immunosuppression of the recipient with methotrexate or antilymphocyte serum (ALS) also greatly depressed the antibody response. But when healing was assessed, none of these treatments except ALS improved the delayed healing of the bone allografts. The reason for this failure was probably that X-irradiation, freezing, alloantiserum pretreatment, and methotrexate all interfered with bone healing directly, whereas ALS did not. We conclude that many methods will reduce the immune response to allogeneic bone, but that only ALS will improve the healing of the allogeneic bone. Furthermore, as a corollary to the observation that pretreatment with anti-Ia serum markedly reduced the immunogenicity of bone allografts, we conclude that much of the immunogenicity of bone allografts is attributable to a population of Ia-positive cells.