Incremental benefit of three-dimensional transthoracic echocardiography in the assessment of left atrial appendage aneurysm leading to severe extrinsic compression of a coronary artery.

Left atrial appendage aneurysm (LAA AN) is a rare disease entity, which can be congenital or acquired in nature. We report an adult patient with LAA AN presenting with anginal chest pain in whom live/real time three-dimensional transthoracic echocardiography (3DTTE) provided incremental value over the two-dimensional (2D) technique in providing a more comprehensive assessment of the lesion. A literature review of the salient features of LAA AN is also provided in a tabular form.

Prosthetic mitral inflow mimicking severe aortic regurgitation (revisited). An echocardiographic challenge.

Assessing aortic regurgitation (AR) severity in patients with mitral valve prosthesis may pose an echocardiographic challenge. We present a case of mild AR in whom difficulty occurred in judging its severity due to eccentric mitral prosthetic inflow signals filling practically completely the proximal left ventricular outflow tract in diastole mimicking severe AR. Frame-by-frame analysis of two-dimensional transthoracic echocardiographic images using a small sector depth and width was helpful in clarifying the true severity of AR.

CD98 expression is decreased in papillary carcinoma of the thyroid and Hashimoto's thyroiditis.

AIMS: CD98 is a component of the large neutral amino acid transporter (LAT), which is a cell surface amino acid transporter. CD98 also binds to and activates beta(1)-integrin, promoting anchorage-independent growth. CD98 expression is increased in a variety of carcinomas but its distribution in the normal and neoplastic thyroid gland has not been reported. The aim was to examine the immunohistochemical expression of CD98 in normal and diseased thyroid tissue. METHODS AND RESULTS: One hundred and forty thyroid cases were selected from the archives of the Department of Pathology, including normal controls, neoplasms (follicular adenoma, follicular carcinoma and papillary carcinoma) and non-neoplastic conditions (multinodular goitre, Graves' disease and Hashimoto's thyroiditis). Immunohistochemistry for CD98 was performed and each case was scored for proportion of cells and intensity of immunoreactivity. In normal thyroid, there was moderately strong expression of CD98 in the lateral cell membranes of follicular cells. A similar pattern of expression was seen in follicular adenoma, minimally invasive follicular carcinoma, multinodular goitre and Graves' disease. In most cases of papillary carcinoma and in the inflamed areas of Hashimoto's thyroiditis, expression of CD98 was decreased. CONCLUSIONS: CD98 expression is down-regulated in thyroid papillary carcinoma; this may relate to the better prognosis associated with many of these tumours.

Intraventricular hemorrhage in ICSI twin pregnant woman with thrombasthenia: A rare case report.

Intraventricular hemorrhage is bleeding into the fluid-filled areas (ventricles) inside the brain. The condition occurs most often in babies that are born premature, growth restricted and twins pregnancies. Abnormal platelets number or functions are responsible greatly for this condition. We presented here a pregnant woman had thrombasthenia at 28 weeks of gestation with ultrasound findings of intraventricular haemorrhage in her both ICSI twin's fetuses.

Repair of very severe tricuspid regurgitation following detachment of the tricuspid valve.

We report on the case of 5-year-old girl with severe tricuspid regurgitation following previous repair of double outlet right ventricle with subaortic ventricular septal defect, performed through trans-atrial approach using detachment of tricuspid valve leaflet. The severe tricuspid regurgitation was found to be due to dehiscence at the site of the previous detachment and was repaired using a pericardial patch. In this report, we discuss the relative merits and risks of using this technique.

Trends and Challenges in Pathology Practice: Choices and necessities.

The way we provide healthcare is influenced by ongoing experiences, increased knowledge, new discoveries and scientific as well as technological advances. The rapid pace of important developments that have taken place in recent years have significantly influenced our choices of the ways we provide our health service. Like other medical specialties, pathology and its practice have had to respond to the rising needs and challenges within the health service in general and those facing the speciality in particular. This article addresses some of the challenges, particularly those which are unique to pathology. It discusses the choices that are available to different pathology departments depending on their individual circumstances.

Characterization of respiratory manifestations of chronic hepatitis C virus infected patients

Background: chronic hepatitis C virus [HCV] infection has been reported in association with several extrahepatic manifestations. Chronic HCV infection is also associated with both direct and indirect effects on pulmonary tissue

Purpose: to evaluate phenotypes of respiratory manifestations of chronic hepatitis C virus

Patients and Methods: 1-this study was conducted on 150 Egyptian patients with chronic hepatitis C. Patients were selected from those attending the in patients and out patients clinic of the Tropical Medicine and Chest Departments, Al-Azhar University Hospital-Damietta from September 2016 to Septamber 2018. 2-also ,50 healthy subjects matched for age and sex were included as volunteer.3-consent was informed by all patients and volunteer shared in this study

Results: C.O.P.D: documented in 32 patients [21.3%].Asthma: documented in 15 patients [10%] of all patients. Air way hyperreactivity: documented in 15patients [10%] of all patients. Idiopathic pulmonary fibrosis [IPF]: is presented in 37 patients [24.6%]. Pneumonia: documented in 10 patients [6%] of all patients. Transudative pleural effusion: documented in 10 patients [6%] of all patients. Adenocarcinoma: documented in 5 patients [3.3%] of all patients. Pseudolymphoma: documented in 1 patient [0.006%] of all patients. Lung abscess: documented in 10 patient [6%] of all patients. Pulmonary embolism: documented in 5 patients [3.3%] of all patients. Hepatopulmonary syndrome: documented in 10 patients [6%] of all patients

Conclusion: Chronic hepatitis C virus infection is related to the development of several pulmonary abnormalities. These pulmonary manifestations of HCV infection are frequently underdiagnosed

Recommendations: Any patient with chronic HCV infection should be evaluated with HRCT chest and pulmonary function tests for early diagnosis of pulmonary abnormalities to prevent further complications

Significance of persistent left ventricular dysfunction during recovery after dobutamine stress echocardiography

This study was designed to assess the duration of new or worsening left ventricular regional wall motion abnormalities [RWMA] after dobutamine stress echocardiography [DSE] and their relation to the extent of coronary artery disease [CAD]. This study included 34 patients with positive results on DSE and angiographically documented CAD. Patients were classified into groups I, II and III according to the presence of one, two or three-vessel disease on coronary angiography, respectively. All patients had at least one ischemic region during DSE. The disappearance of ECG changes after DSE was faster than the disappearance of RWMAs and all ECG changes disappeared within 20 minutes, while RWMAs disappeared after 25 minutes. Patients with three-vessel disease had a longer time for ECG and RWMAs disappear than patients with one or two-vessel disease. The mean recovery time of RWMA was 7.1 +/- 2.6, 11.5 +/- 4.6 and 13.1 +/- 3.9 minutes in groups I, II and III, respectively. Normalization of RWMA after DSE occurred after the resolution of symptoms and ECG changes during recovery. The time to recovery was related to the extent of CAD and myocardial ischemia

Usefulness of transoesophageal echocardiography in selection of low risk patients with atrial fibriliation for immediate cardioversion

Despite exclusion of left atrial thrombi by transoesophageal echocardiography [TEE], cardioversion related thromboembolism has been reported in atrial fibrillation [A.F.]. The aim of this work is to define low risk group of patients with A.F. for cardioversion without previous anticoagulation. Patients were selected for immediate cardioversion if there were no thrombi, no spontaneous echo contrast, and the outflow velocity of left atrial appendage [LAA] was >/= 0.25 cm/sec. on TEE. Sixty patients with A.F. lasting more than 2 days without previous anticoagulation were examined with TEE and included in this study. Patients who are eligible for immediate cardioversion after TEE were anticoagulated with I.V. heparin together with warfarin prior to cardioversion. Heparin was continued until the patient has reached the therapeutic prothrombin value then D.C. shock was given to convert A.F. into sinus rhythm. Based on TEE findings, the patients were divided into two groups:- Immediate cardioversion, group A with mean age of 36.6 +/- 8.3 years [n=42]: and conventional warfarin treatment before cardioversion, group B with mean age of 65.4 +/- 6.8 years [n=18].We found non significant difference between two groups regarding the aetiology of A.F. except hypertension which was more common in group B [p<0.05]. Echocardiography revealed thrombi in 5 patients in group B representing 8.3% of all TEE examined patients. Left atrial dimension [LAD] was significantly larger, fractional shortening was lower, impaired L.V. function was more common and LAA outflow and inflow velocities were lower in group B compared to group A [p<0.001]. Age, duration of A.F. and impaired L.V. function were independent negative predictors for immediate cardioversion. No thromboembolic events occurred at or after cardioversion in any of the patients. One-month follow-up maintenance of sinus rhythm was found in 3 1/42 [73.6%] patients in group A compared to 5/18 [27.8%] patients in group B [p<0.01]. After using these TEE exclusion criteria [No thrombi, No spontaneous echo contrast and LAA outflow velocity >/= 25 cm/sec.] immediate cardioversion can safely be performed in about 88% of patients with A.F. lasting more than 48 hours without incrased risk of thromboembolism. These patients maintained sinus rhythm significantly better after one month compared to patients with conventional warfarin therapy before cardioversion

Cardiac involvement in primary sjogren's syndrome patients detected with echocardiography

To determine a pattern of cardiac involvement in primary Sjogren's syndrome patients and to evaluate these cardiac abnormalities in asymptomatic patients. The study was carried out on 20 primary Sjogren's syndrome patients [PSS] as well as 10 healthy controls matched in age and sex. None of the patients had evidence of cardiac symptoms. All subjects had complete history, clinical examination, laboratory tests [Rh F, ANA and anti Ro and anti La], chest X-ray, ECG and echocardiography. Cardiac abnormalities were detected in 7 [35%] primary Sjogren's syndrome patients out of 20 [PSS] patients examined with echocardiography. Seven [35%] presented with left ventricle diastolic dysfunction and 6 [30%] presented with pulmonary hypertension but only [15%] showed left ventricle hypertrophy, there were 2 patients with mitral regurge and only 1 patient with mitral stenosis and prolapse and also, 1 [5%] presented with aortic regurge and 1 [5%] patient by tricuspid regurge. There was significant difference between PSS patients and control subjects as regards to diastolic functions [E peak, A peak, E/A and DFT] and there was no correlation between the occurrence of these silent cardiac abnormalities and the clinical and laboratory findings. Cardiac involvement is common in PSS but clinically with silent manifestations. Thus, echocardiography should be done for all patients with PSS to detect any cardiac abnormalities