TULAA is the best approach in uncomplicated appendicitis. It is less invasive and traumatic, permits a complete evaluation of the peritoneal cavity with superior cosmetic results, especially in obese patients and in cases of ectopic appendicitis.
BRBNS belongs to the group of vascular venous malformations. Most of the time it occurs sporadically, but it can be inherited as an autosomal dominant trait. Recent analysis identified a locus on chromosome 9 responsible for venous malformations. BRBNS patients present typical skin lesions, with some lesions having a rubber-like nipple appearance; the number of skin and GI lesions and the severity of anaemia are correlated. Treatment is dependent on the extent of gut involvement and the severity of the clinical picture. In the absence of massive bleeding, a conservative treatment will be sufficient; otherwise resections are mandatory, but additional lesions may subsequently develop. Management with electrocautery or laser photocoagulation are usually not effective even if some reports recommend them. Pharmacological treatment is useless. Prognosis of BRBNS is unknown.
A 70-year-old diabetic, hypertensive woman underwent transesophageal echocardiography to evaluate a recent cerebrovascular accident. She was found to have mild mitral valve insufficiency with severe mitral annular calcification and a small patent foramen ovale. Because of complaints of chest pain, 64-detector-row computed tomographic coronary angiography was performed (Figures 1 and 2). A 2ϫ1.8-cm heterogeneous mass consistent with caseous calcification of the mitral annulus was noted, without significant coronary artery disease. The patient was managed conservatively.Unlike mitral annular calcification, caseous calcification of the mitral annulus is rare, occurring in fewer than 0.07% of patients undergoing echocardiography, and it is without known clinical significance. 1 It is characterized echocardiographically as large, round, tumorlike calcifications, usually on the posterior mitral annulus. Histological analysis reveals a pasty, acellular substance that is culture-negative and free of cancerous or inflammatory cells. 2 This is the first reported case of accidentally discovered caseous calcification of the mitral annulus by computed tomographic coronary angiography. Caseous calcification of the mitral annulus should be included in the differential diagnosis of intracardiac masses on computed tomographic imaging.
DisclosuresNone.
Cystatin C proved to be a superior marker rate over serum creatinine in estimating glomerular filtration in children younger than 3 years with UTMs and mild renal impairment, thus, offering a more specific and practical measure for monitoring GFR.
Twenty-three closed-chest, alpha-chloralose-anesthetized, volume-expanded, alpha- and beta-adrenergic-blockaded dogs with rate fixed by atrial pacing had 30-90 ml of saline at 37 degrees C infused into the pericardial sac a) with vagus intact, b) after vagotomy, and c) with vagus intact but with systolic pressure augmented with a balloon. A significant reduction in left ventricular (LV) systolic pressure (SP), and cardiac output (CO) occurred at a pericardial volume of 30-60 ml, when LV end-diastolic (ED) and right atrial (RA) pressures were not increased. Whereas the percentage decline of CO, LVSP, maximum negative and maximum positive dP/dt was greater in group A (vagus intact) than in group B (vagus cut), significant residual depressed performance was demonstrated only in group B. In four paced, atropinized, beta-blockaded dogs, response to tamponade was similar to that in intact dogs; vagotomy at 90 ml in these dogs resulted in a fall in CO, a rise of LVSP and a significant elevation in LVED and RA pressures. Thus, in the early phases of cardiac tamponade a sympathetic neurohumoral response supports cardiac performance while the vagus nerve exerts a myocardial protective effect. Vagal afferents appear to modulate this response.
We present an adult patient who had an acute myocardial infarction complicated by a ventricular septal defect and had it repaired percutaneously. Real-time three-dimensional echocardiography (RT3D) before and during the closure procedure were performed. RT3D provided anatomical and functional information of the defect as well as real-time guidance during the procedure. This case highlights the utility of three-dimensional echocardiography in guiding transcatheter procedures.
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