Fatty acid status and antioxidant defense system in mothers and their newborns after salmon intake during late pregnancy.

OBJECTIVE: The aim of the present study was to assess the maternal and newborn status of erythrocyte fatty acids and the antioxidant defense system after the intake of two portions of salmon per week during late pregnancy. METHODS: Pregnant women (N = 123) were randomly assigned to continue their habitual diet, which was low in oily fish (control group, n = 61) or to consume two 150-g salmon portions per week (salmon group, n = 62) beginning at 20 wk of gestation and lasting until delivery. Fatty acids, selenium, and glutathione concentrations and antioxidant defense enzyme activities were measured in maternal erythrocytes at 20, 34, and 38 wk of pregnancy, and in cord erythrocytes collected at birth. Plasma concentrations of antioxidant molecules were measured. RESULTS: Compared with the control group, consuming salmon had little effect on erythrocyte fatty acids in either mothers or newborns. Components of the antioxidant defense system did not differ between groups. Glutathione peroxidase activity and the concentrations of tocopherols, retinol, and coenzyme Q10 were significantly lower in cord blood compared with maternal blood at week 38 in both groups. CONCLUSION: Maternal and newborn erythrocyte fatty acids are not strongly affected by the intake of two portions of salmon per week during the second half of pregnancy, although erythrocyte docosahexaenoic acid might be increased in newborns. Maternal and newborn antioxidant defense systems are not impaired by intake of salmon from 20 wk gestation.

Plasma inflammatory and vascular homeostasis biomarkers increase during human pregnancy but are not affected by oily fish intake.

The Salmon in Pregnancy Study investigated whether the increased consumption of (n-3) long-chain PUFA (LC-PUFA) from farmed Atlantic salmon affects immune function during pregnancy and atopic disease in neonates compared with a habitual diet low in oily fish. In this context, because the ingestion of (n-3) LC-PUFA may lower the concentrations of inflammatory biomarkers, we investigated whether the consumption of oily fish affects the levels of inflammatory cytokines and vascular adhesion factors during pregnancy. Pregnant women (n = 123) were randomly assigned to continue their habitual diet (control group, n = 61), which was low in oily fish, or to consume two 150-g salmon portions/wk (salmon group, n = 62; providing 3.45 g EPA plus DHA) from 20 wk of gestation until delivery. Plasma inflammatory cytokines and vascular adhesion factors were measured in maternal plasma samples. Inflammatory biomarkers, including IL-8, hepatocyte growth factor, and monocyte chemotactic protein, increased over the course of pregnancy (P < 0.001), whereas plasma matrix metalloproteinase 9, IL-6, TNFα, and nerve growth factor concentrations were not affected. Vascular homeostasis biomarkers soluble E-selectin, soluble vascular adhesion molecule-1, soluble intercellular adhesion molecule (sICAM)-1, and total plasminogen activator inhibitor-1 increased as pregnancy progressed (P < 0.001). The plasma sICAM-1 concentration was greater in the control group than in the salmon group at wk 20 (baseline) and 38 (P = 0.007) but there was no group x time interaction, and when baseline concentration was used as a covariate, the groups did not differ (P = 0.69). The remaining biomarkers analyzed were similar in both groups. Therefore, although some inflammatory and vascular homeostasis biomarkers change during pregnancy, they are not affected by the increased intake of farmed salmon.

Does consumption of two portions of salmon per week enhance the antioxidant defense system in pregnant women?

Salmon is a rich source of marine n-3 fatty acids, which may increase oxidative stress and, in turn, could affect the antioxidant defense system in blood plasma and erythrocytes of pregnant women. The Salmon in Pregnancy Study provided two meals of salmon per week to pregnant women from week 20 of gestation; the control group maintained their habitual diet low in oily fish. Higher selenium and retinol plasma concentrations were observed after dietary salmon supplementation. Besides, a concomitant increase in selenium and glutathione concentration as well as glutathione peroxidase and reductase activities were detected as pregnancy progressed. However, tocopherols, retinol, ß-carotene, and coenzyme Q(10) decreased in late pregnancy. Collectively, our findings lead to the hypothesis that increased farmed salmon intake may increase antioxidant defenses during pregnancy. Clinical trials identifier NCT00801502.

Does increased intake of salmon increase markers of oxidative stress in pregnant women? The salmon in pregnancy study.

The Salmon in Pregnancy Study provided two meals of salmon per week to pregnant women from week 20 of gestation; the control group maintained their habitual diet low in oily fish. Salmon is a rich source of marine n-3 fatty acids. Since marine n-3 fatty acids may increase oxidative stress, we investigated whether increased salmon consumption could affect markers of oxidative stress in mid and late pregnancy. Urinary 8-iso-prostaglandin F(2α), urinary 8-hydroxy-2'-deoxyguanosine, and plasma lipid peroxide concentrations did not change from week 20 to 38 of pregnancy and were not altered by increased consumption of salmon. Thus, increased intake of salmon during pregnancy does not increase oxidative stress, as judged by the markers of oxidative damage to lipids and DNA measured herein.

Long term patency of the ductus arteriosus after stent placement: report of two cases and review of the literature

Stent placement in the patent ductus arteriosus (PDA) is becoming an alternative treatment to improve cardiac function and quality of life in patients with ductal dependent cardiac conditions. Although, today most of these cardiac defects can be surgically corrected without the need of maintaining PDA patency for a long period of time, some countries lack the resources, and in other cases, surgical intervention is preferably delayed due to medical reasons. This report presents 2 cases where stents were placed in the PDA.

Biventricular pacing as alternative therapy for dilated cardiomyopathy associated with congenital heart disease.

Biventricular, alternative, and multisite pacing are currently being explored to improve cardiac function among patients with medically refractory, end-stage dilated cardiomyopathies. Although, due to inherent myocardial abnormalities, patients with repaired congenital heart defects may be at a greater risk than others to develop heart failure, often requiring cardiac transplantation. The efficacy of biventricular pacing among these patients is unknown. This report presents a patient with successfully repaired congenital heart disease in infancy who developed a symptomatic dilated cardiomyopathy at 22 years of age. Following biventricular pacing, systemic ventricular function showed a 14% improvement in ventricular dP/dt. One month later, subjective symptoms improved and cardiac ultrasound illustrated a 125% increase in fractional area of change. Exercise stress testing showed a 17% improvement in aerobic work capacity.

Initial experience using the Palmaz Corinthian stent for right ventricular outflow obstruction in infants and small children.

The original Palmaz balloon expandable stent has been used extensively for the treatment of vascular stenoses in older children and young adults. Placement of the Palmaz stent in infants and small children, however, is limited by stent inflexibility, large delivery sheath size, and concerns about creating fixed obstructions after the placement of small diameter stents in growing patients. New Palmaz Corinthian stents were placed through 6 French sheaths in four high-risk patients with postoperative right ventricular outflow obstruction. Patients were not considered candidates for surgical repair. Median patient age and weight were 17 months (range 5-32 months) and 7.7 kg (range 4.6-11.1 kg), respectively. Median fluoroscopy time was 58.2 min (range 55.2-172 min). No complications were encountered. In each case, successful stent placement was achieved, and surgery with cardiopulmonary bypass was avoided. Palmaz Corinthian stents are more flexible, require a smaller delivery sheath, have equal or increased radial strength, and can be maximally expanded to a greater cross sectional area when compared to the original Palmaz stent. These characteristics make the Palmaz Corinthian stent a reasonable alternative for use in a select group of infants and small children who are not candidates for surgical repair of postoperative right ventricular outflow obstruction.

Treatment of primary cardiac malignancies with orthotopic heart transplantation

OBJECTIVE: Heart transplantation has become available as a possible treatment for patients with malignancies. Primary cardiac malignant tumors are extremely rare but several patients have been treated with this modality. Whether survival is improved over the direct removal of tumor or heart transplantation is not known. We compiled data regarding malignant primary heart tumors that have been treated at various transplant centers in order to determine if early diagnosis and treatment with cardiac transplantation has resulted in an improved mortality. METHODS: A total of 173 questionnaires were sent to the heart transplant centers across the United States and Canada inquiring about those patients who were found to have a primary cardiac malignant tumor and who underwent heart transplantation. Cases reported in the literature, which had undergone transplantation, were also reviewed by a search in MEDLINE. RESULTS: Twenty-four cases were collected. The overall survival time was from 1 month to 66 months. The actuarial survival was 54% at 12 months, 45% at 24 months and 35% at 36, 48 and 60 months respectively. Metastases were present in 10 out of the 14 deceased patients, possibly being one of the major factors affecting survival. Only 1 living patient developed metastases. CONCLUSION: Survival rates of patients with primary cardiac malignancies treated with resection, radiation, chemotherapy, or a combination of them (conventional therapy) versus heart transplantation are similar. Early diagnosis and resection are the most important factors for a better outcome, however these factors will not guarantee success since the presence or development of metastasis is a major contributor to death in both groups of patients

Treatment of primary cardiac malignancies with orthotopic heart transplantation.

OBJECTIVE: Heart transplantation has become available as a possible treatment for patients with malignancies. Primary cardiac malignant tumors are extremely rare but several patients have been treated with this modality. Whether survival is improved over the direct removal of tumor or heart transplantation is not known. We compiled data regarding malignant primary heart tumors that have been treated at various transplant centers in order to determine if early diagnosis and treatment with cardiac transplantation has resulted in an improved mortality. METHODS: A total of 173 questionnaires were sent to the heart transplant centers across the United States and Canada inquiring about those patients who were found to have a primary cardiac malignant tumor and who underwent heart transplantation. Cases reported in the literature, which had undergone transplantation, were also reviewed by a search in MEDLINE. RESULTS: Twenty-four cases were collected. The overall survival time was from 1 month to 66 months. The actuarial survival was 54% at 12 months, 45% at 24 months and 35% at 36, 48 and 60 months respectively. Metastases were present in 10 out of the 14 deceased patients, possibly being one of the major factors affecting survival. Only 1 living patient developed metastases. CONCLUSION: Survival rates of patients with primary cardiac malignancies treated with resection, radiation, chemotherapy, or a combination of them (conventional therapy) versus heart transplantation are similar. Early diagnosis and resection are the most important factors for a better outcome, however these factors will not guarantee success since the presence or development of metastasis is a major contributor to death in both groups of patients.

Primary cardiac osteogenic sarcoma treated with heart transplantation

Primary cardiac osteogenic sarcomas are rare malignancies. Less than 30 cases have been reported in the literature. Most of them have been found in the left side of the heart. We report a case of a primary osteogenic sarcoma of the left atrium in a 28 year old female. She underwent resection of the tumor and subsequently heart transplantation. To our knowledge this is the second patient with a primary cardiac osteosarcoma who underwent heart transplantation

Primary cardiac osteogenic sarcoma treated with heart transplantation.

Primary cardiac osteogenic sarcomas are rare malignancies. Less than 30 cases have been reported in the literature. Most of them have been found in the left side of the heart. We report a case of a primary osteogenic sarcoma of the left atrium in a 28 year old female. She underwent resection of the tumor and subsequently heart transplantation. To our knowledge this is the second patient with a primary cardiac osteosarcoma who underwent heart transplantation.

Primary cardiac myofibroblastic sarcoma, case report and review of diagnosis and treatment of cardiac tumors

Primary cardiac tumors are rare entities with a frequency between 0.0017 to 0.28. We report a 53 year old male with a primary cardiac myofibroblastic sarcoma that presented with a hemorrhagic pericardial effusion. A review of the literature is presented with a brief discussion of the clinical presentation diagnosis and treatment of benign and malignant primary cardiac tumors

Primary cardiac myofibroblastic sarcoma, case report and review of diagnosis and treatment of cardiac tumors.

Primary cardiac tumors are rare entities with a frequency between 0.0017% to 0.28%. We report a 53 year old male with a primary cardiac myofibroblastic sarcoma that presented with a hemorrhagic pericardial effusion. A review of the literature is presented with a brief discussion of the clinical presentation diagnosis and treatment of benign and malignant primary cardiac tumors.

Botulinum toxin A for the treatment of achalasia

Pneumatic balloon dilatation of the esophagus is one of the current recommended treatment for achalasia. This procedure is associated with risks such as esophageal rupture. Surgery and percutaneous gastrostomy tube placement has been performed in severely affected individuals. The Botulinum Toxin A (BoTxA) is widely used to treat neuromuscular conditions in which spasticity is of concern. We present four cases in which BoTxA was used as an alternative of treatment and in which less invasive modalities were unsuccessful. The patients received a total of 80 units of BoTxA, applied to the submucosa in doses of 20 units in each predetermined quadrants to the lower esophageal sphincter. All patients demonstrated improvement of their symptoms without side effects in this study

Botulinum toxin A for the treatment of achalasia.

Pneumatic balloon dilatation of the esophagus is one of the current recommended treatment for achalasia. This procedure is associated with risks such as esophageal rupture. Surgery and percutaneous gastrostomy tube placement has been performed in severely affected individuals. The Botulinum Toxin A (BoTxA) is widely used to treat neuromuscular conditions in which spasticity is of concern. We present four cases in which BoTxA was used as an alternative of treatment and in which less invasive modalities were unsuccessful. The patients received a total of 80 units of BoTxA, applied to the submucosa in doses of 20 units in each predetermined quadrants to the lower esophageal sphincter. All patients demonstrated improvement of their symptoms without side effects in this study.