Moderate Hypertrophy Research Articles

A Step-by-Step Approach to a Successful Cosmetic Breast Reduction.

Evolution of breast reduction techniques has been a result of combining different skin marking patterns with a wide variety of pedicles. Despite the many differences that may exist among these procedures, they all rely on a few key principles. To make surgery more expeditious and minimize technical challenges, these principles can be incorporated into simple surgical strategies. The authors present a step-by-step approach to help to achieve a successful cosmetic breast reduction for patients with small to moderate breast hypertrophy. Special emphasis is given to intraoperative clues that make this procedure more reproducible and straightforward.

Does treatment with sub-lingual allergen-specific immunotherapy reduce adenoid size and improve quality of life among Egyptian children?

IntroductionAdenoidal hypertrophy is a paediatric problem. Adenoidectomy contributes to post-operative complications. Allergic rhinitis is a major health problem. Its prevalence in Egypt and the Middle East is up to 9%. The aim of the present study was to evaluate the effect of sub-lingual immunotherapy on adenoid size and/or quality of life among children suffering from adenoid hypertrophy with allergic rhinitis in Suez Canal University Hospital.Material and methodsForty-six children suffering from adenoid hypertrophy and allergic rhinitis were recruited for this purpose. Skin prick test was administered to identify the causative allergen. All patients received sub-lingual immunotherapy. Lateral X-ray, serum total immunoglobulin E, symptoms, and sign score were recorded for all patients before and after the treatment.ResultsThe nasal symptoms and adenoidal size of the examined patients were significantly decreased after immunotherapy was applied, and thus there was an improvement in the quality of life among those patients.ConclusionsIt was concluded that sub-lingual immunotherapy was an alternative treatment of adenoidectomy in children with moderate adenoid hypertrophy with allergic rhinitis. Surgical treatment for children who suffer from severe adenoid hypertrophy with allergic rhinitis could not be considered as obligatory because medical treatment has no effect on the size of adenoids nor on quality of life.

Hypertrophic cardiomyopathy. Cardiomyocyte ultrastructure, the specific or stereotypic signs

To study cardiomyocyte (CMC) ultrastructural changes in the interventricular septum (IVS) of patients with HCM and evaluate their specificity for this pathology. IVS myocardial samples taken from 44 HCM patients aged 18-59 years at IVS myoectomy underwent an electron microscopic study. The diameter of CMCs and their nuclei was measured in semithin sections. A morphometric examination of the IVS myocardium in HCM patients revealed moderate hypertrophy of CMCs and their nuclei, the diameters of which averaged 23.7±4.4 and 5.2±0.9 μm, respectively. The IVS CMCs were characterized by the ultrastructural signs of hypertrophy: the larger size and number of structures ensuring contractile and synthetic functions; the myocytes contained higher amounts of myofibrils, intermyofibrillar mitochondria, granular endoplasmic reticulum cisterns, and free ribosomes. On the contrary, some CMCs had fewer myofibrils in the perinuclear region, which is an adaptive change under hemodynamic overload conditions. In addition, a number of myocytes displayed signs of dystrophic changes: the appearance of lipofuscin granules, myelin figures, phagosomes, lipid droplets, and vacuoles, which can fill all free sarcoplasmic zones. Ultrastructural changes characteristic of hypertrophy were found in IVS CMCs in HCM patients. In addition, there was partial myofibrillar loss and dystrophic changes in a number of myocytes, which are stereotypic compensatory-adaptive changes under hemodynamic overload conditions. All the above-mentioned changes in the CMC ultrastructure are characteristic of myocardial hypertrophy, but not specific for hypertrophic cardiomyopathy.

Surgical management of left ventricular outflow tract obstruction in a specialized hypertrophic obstructive cardiomyopathy center

ObjectivesThis study evaluates operative approach and contemporary surgical outcomes in the management of left ventricular outflow tract obstruction by a single surgeon at a high-volume, specialized hypertrophic cardiomyopathy center. MethodsThis is a retrospective review of 1559 consecutive operations for left ventricular outflow tract obstruction from 2005 to 2015. Demographic profiles, echocardiogram-derived ventricular morphology and hemodynamics, operative data, and in-hospital outcomes were analyzed. ResultsOf the 1559 operations, 586 were isolated septal myectomies, 522 were myectomies with mitral valve or subvalvular apparatus intervention, 422 were myectomies with another concomitant procedure, and 29 were isolated mitral valve interventions without myectomy. Common mitral valve interventions included anterior leaflet shortening (16%), chordae tendineae resection (9.8%), papillary muscle resection (7.2%), and papillary muscle reorientation (7.5%). Ninety-two patients underwent mitral valve replacement, 42 for left ventricular outflow tract obstruction and 50 for intrinsic mitral valve pathology. Patients undergoing mitral interventions had thinner septums (18 ± 0.4 mm vs 22 ± 0.5 mm, P < .001) and less myocardium removed (6.2 ± 3.5 g vs 8.8 ± 3.8 g, P < .001) than patients without a mitral intervention. Prevalence of in-hospital permanent pacemaker insertion was 4.2% (n = 1334) for complete heart block and 1.1% (n = 464) for isolated septal myectomy with normal preoperative conduction. Overall, there were 2 postoperative ventricular septal defects (0.13%) and none for isolated myectomies. Operative mortality was 0.38%. ConclusionsSeptal myectomy can be performed safely with excellent outcomes when the procedure is performed by a highly experienced surgeon in a high-volume, specialized center. A mitral valve intervention is a useful adjunct in patients with moderate hypertrophy.

Morphological peculiarities of pneumonia in the use of antibiotics and antioxidants

The study of pneumonia and its treatment have been going on for decades, but complex therapy is still not effective enough, which makes it relevant in our time. The purpose of the work is to reveal the morphogenesis of pneumonia in conditions of application of antioxidants. In this work a comparative description of the results of lung necropolis and analyzes of patients' protocols in the treatment of antibiotics with antioxidants and without their using was made, morphological features were compared with different types of pneumonia. Data were obtained from the Vinnytsia Oblast Department of Pathology and Anatomy (OSPAB). 16 patients were divided into 4 groups of 4 people in each (A - died of lobar pneumonia, B - died of gangrenous pneumonia, B - died of segmental pneumonia, G - died of focal pneumonia). Patients are divided into 2 subgroups, depending on the method of treatment (I subgroup - therapy with antibiotics and antioxidants, II subgroup - antibiotics without the use of antioxidants). This allowed us to detect the direct role of antioxidants in the treatment of various types of pneumonia. When we compared morphological differences, depending on the type of treatment, a number of criteria were taken into account, namely: the degree of filling of the alveoli with air, the number of erythrocytes, leukocytes and neutrophils in the field of view. As a result, we have found indisputable evidence that antioxidants are an important element in the treatment of pneumonia. Based on the research, it was found that antioxidant therapy positively affects the course of pneumonia. The histological picture of cranial, gangrenous and segmental pneumonia is characterized by a decrease in segmental neutrophils in the alveoli, and with focal pneumonia in bronchioles. With clover and gangrenous pneumonia, an increase in air in the alveoli and moderate hypertrophy in the vasculature was observed. Morphological changes in pulmonary tissue with the use of antioxidants were to reduce the number of neutrophils and erythrocytes in the exsudate, the presence of small amounts of air in the alveoli, whereas in the other therapy, the alveoli were irritable. Flexibility of interalveolar membranes in the application of antioxidant therapy was more moderate than without its application.&#x0D;

Histopathology in HCM.

[first paragraph of article]Histopathology in patients with HCM is characterized by disarray of the overall architecture of the hypertrophied myocytes, which appear branched and may be intermingled with a variable amount of interstitial fibrosis. These changes may be patched and must be distinguished from the non-specific physiological disarrangement of the junctional area of the septum and the apex. The myocardial cell diameter is another important indicator of hypertrophy. Under normal conditions it ranges from 5–12 μm in diameter. Anything up to 20 μm may be indicative of mild hypertrophy. In moderate hypertrophy cardiocyte diameter is up to 25 μm and moderate to severe hypertrophy is usually between 25-30 μm. For diameters greater than 30 μm severe hypertrophy must be suspected.

Sudden unexpected death with primary adrenal lymphoma

An 82-year-old man was found dead on the road near his home with unwitnessed interval of 3 h from final witness. He had been diagnosed with hypertension and mild aortic stenosis (AS) 13 years before death, and was continuously followed up with medication. Although a recent medical check-up related to cardiac function was stable and consistent with moderate AS, he sometimes complained of general fatigue, anorexia associated with intermittent mild fever and rare vomiting in the weeks before death. At autopsy, no lethal injury or drug intoxication was found, but congenital bicuspid aortic valve (BAV) with central rache was found. Although calcification was found in a restricted area of one cusp, valvular structural deformity was clearly milder than in typical severe AS cases. Moderate left ventricular hypertrophy without coronary disease was found. A brownish-red, soft nodular lesion was found in both adrenal glands, but no other tumorous focus was evident in any other organs. Immunohistochemical examination showed that B-lymphocyte-derived markers (CD20, melanoma associated antigen (mutated) 1, and CD79a) were exclusively positive. Therefore, we diagnosed primary adrenal lymphoma (PAL), diffuse large B-cell lymphoma phenotype. We concluded that the cause of sudden unexpected death (SUD) was adrenal insufficiency associated with PAL, with a background of moderate AS related to BAV.

Prostate Cancer Radiotherapy: An Evolving Paradigm.

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A urologist referred a 69-year-old man for a radiotherapy opinion regarding a recently diagnosed adenocarcinoma of the prostate. Annual serum prostate-specific antigen (PSA) testing over 7 years demonstrated a rise in PSA from 1.36 ng/mL to 5.8 ng/mL, prompting a transrectal ultrasound that revealed a heterogeneous 37-mL gland containing no visualized hypoechoic nodules. Biopsy disclosed a Gleason score 3+4 (grade group 2) adenocarcinoma of the prostate. The synoptic report stated that six of 14 cores and 17% of the tissue were involved, with the greatest core involvement being 80% at the right apex. Perineural invasion was present without lymphovascular invasion. Disease was present bilaterally at the base, midgland, and apex.His medical history was significant only for treated peptic ulcer disease and he was taking no medication. His International Prostate Symptom Score was six of 35, and he reported being sexually active with good erectile function. There was no family history of prostate cancer. He is retired. Digital rectal examination revealed moderate benign prostatic hypertrophy with no suspicious nodules. A staging computerized tomography (CT) scan of the abdomen and pelvis and a whole-body bone scan ordered by his referring urologist reported no evidence of metastatic disease. The patient had discussed surgical options with his urologist and now wished to consider radiotherapy approaches.

ПРЕДИКТОРИ ЗРОСТАННЯ РИЗИКУ СМЕРТІ ВІД УСІХ ПРИЧИН У ПАЦІЄНТІВ ІЗ ПОСТІЙНОЮ ФОРМОЮ ФІБРИЛЯЦІЇ ПЕРЕДСЕРДЬ НЕКЛАПАННОЇ ЕТІОЛОГІЇ

Atrial fibrillation (AF) is one of the most common arrhythmias in the heart, and it is a potent risk factor for the development of cardiovascular disease (CVD) and death from all causes.The aim of the study – to identify predictors of the risk of death from all causes in patients with a persistent form of atrial fibrillation (PFTF) of non-valvular etiology.Materials and Methods. We performed a retrospective analysis of 146 histories of diseases of patients with non-valvular PA F with inpatient treatment, 16 patients died at the time of the study, which were subject to further analysis. For heart rate controll, the therapy of BB (bisoprolol and carvedilol) was performed. The endpoint of the study was death from all causes. An assessment of heart rate control on ECG data and echocardiographic parameters were performed at the time of discharge.Results and Discussion. In the group of patients undergoing analysis, strict heart rate control was prevalent. There was an increase in the size of both atriums, the volume of LV , its moderate hypertrophy, moderate regurgitation on the mitral and tricuspidal valve according to the echocardiography data. At the time of discharge, the dosage for heart rate controll was: bisoprolol – (5.6±2) mg, carvedilol – (20±2.3) mg, digoxin – (0.19±0.07) mg. Then we determined the predictors risk increasing of death from all causes. Onefactor regression analysis revealed that the risk of death from all causes among patients with PA F significantly increased with a history of COPD in patient anamnesis (p = 0.01), as well as increase in the NYHA functional class of HF on the scale for each unit (p = 0.046). In multivariate regression analysis, where indicators were selected using stepwise method, the risk of death from all causes in patients with PA F in the presence of COPD in patient anamnesis increased significantly when standardized by other risk factors (p=0.01).Conclusions. Independent risk increasing predictors of the death from all causes in patients with PA F non-valvular etiology are the presence of COPD in patient anamnesis and the increasing of NYHA functional class HF. The death risk from all causes in these patients significantly increases with the presence of COPD in patient anamnesis when standardized by other factors. The study complements the existing data on the importance of heart rate controll in patients with PA F and the correctness of the treatment concomitant HF. The obtained results are new and important for revealing the reasons of high mortality of this category of patients and ways of correction of their treatment.

Biomarkers associated with low, moderate, and high vastus lateralis muscle hypertrophy following 12 weeks of resistance training.

We sought to identify biomarkers which delineated individual hypertrophic responses to resistance training. Untrained, college-aged males engaged in full-body resistance training (3 d/wk) for 12 weeks. Body composition via dual x-ray absorptiometry (DXA), vastus lateralis (VL) thickness via ultrasound, blood, VL muscle biopsies, and three-repetition maximum (3-RM) squat strength were obtained prior to (PRE) and following (POST) 12 weeks of training. K-means cluster analysis based on VL thickness changes identified LOW [n = 17; change (mean±SD) = +0.11±0.14 cm], modest (MOD; n = 29, +0.40±0.06 cm), and high (HI; n = 21, +0.69±0.14 cm) responders. Biomarkers related to histology, ribosome biogenesis, proteolysis, inflammation, and androgen signaling were analyzed between clusters. There were main effects of time (POST>PRE, p<0.05) but no cluster×time interactions for increases in DXA lean body mass, type I and II muscle fiber cross sectional area and myonuclear number, satellite cell number, and macronutrients consumed. Interestingly, PRE VL thickness was ~12% greater in LOW versus HI (p = 0.021), despite POST values being ~12% greater in HI versus LOW (p = 0.006). However there was only a weak correlation between PRE VL thickness scores and change in VL thickness (r2 = 0.114, p = 0.005). Forced post hoc analysis indicated that muscle total RNA levels (i.e., ribosome density) did not significantly increase in the LOW cluster (351±70 ng/mg to 380±62, p = 0.253), but increased in the MOD (369±115 to 429±92, p = 0.009) and HI clusters (356±77 to 470±134, p<0.001; POST HI>POST LOW, p = 0.013). Nonetheless, there was only a weak association between change in muscle total RNA and VL thickness (r2 = 0.079, p = 0.026). IL-1β mRNA levels decreased in the MOD and HI clusters following training (p<0.05), although associations between this marker and VL thickness changes were not significant (r2 = 0.0002, p = 0.919). In conclusion, individuals with lower pre-training VL thickness values and greater increases muscle total RNA levels following 12 weeks of resistance training experienced greater VL muscle growth, although these biomarkers individually explained only ~8–11% of the variance in hypertrophy.

Maternal High-Fat and High-Salt Diets Have Differential Programming Effects on Metabolism in Adult Male Rat Offspring.

Maternal high-fat or high-salt diets can independently program adverse cardiometabolic outcomes in offspring. However, there is a paucity of evidence examining their effects in combination on metabolic function in adult offspring. Female Sprague Dawley rats were randomly assigned to either: control (CD; 10% kcal from fat, 1% NaCl), high-salt (SD; 10% kcal from fat, 4% NaCl), high-fat (HF; 45% kcal from fat, 1% NaCl) or high-fat and salt (HFSD; 45% kcal from fat, 4% NaCl) diets 21 days prior to mating and throughout pregnancy and lactation. Male offspring were weaned onto a standard chow diet and were culled on postnatal day 130 for plasma and tissue collection. Adipocyte histology and adipose tissue, liver, and gut gene expression were examined in adult male offspring. HF offspring had significantly greater body weight, impaired insulin sensitivity and hyperleptinemia compared to CD offspring, but these increases were blunted in HFSD offspring. HF offspring had moderate adipocyte hypertrophy and increased expression of the pre-adipocyte marker Dlk1. There was a significant effect of maternal salt with increased hepatic expression of Dgat1 and Igfb2. Gut expression of inflammatory (Il1r1, Tnfα, Il6, and Il6r) and renin–angiotensin system (Agtr1a, Agtr1b) markers was significantly reduced in HFSD offspring compared to HF offspring. Therefore, salt mitigates some adverse offspring outcomes associated with a maternal HF diet, which may be mediated by altered adipose tissue morphology and gut inflammatory and renin–angiotensin regulation.

Diagnostic values of DAS28 and DAS28-squeeze in evaluating Rheumatoid Arthritis disease

Background : In recent years, rheumatoid arthritis (RA) uses a “treat to target” treatment strategy. This strategy requires a valid and accurate tool for assessing disease activity. The most widely used tool is DAS28, which was developed from DAS with the omission of ankle and foot joints. There has been many critization aboutthe accuracy of DAS28 in classifying the state of RA disease. Most importantly, when an active disease state was misclassified as an inactive state (false negative)which lead to under treat and subsequently to disability. The difference between DAS28 and DAS lies mainly in the exclusion of ankle and foot joints, thus DAS28-squeeze, a new and simple tool has been proposed. It comprises the same 28 joints in DAS28 added with a sqeeze test on both metatarsophalangeal joints. However, this new tool has never been validated with any imaging techniques.Objective : To assess the diagnostic values of DAS28 and DAS28-squeeze.Methods : This study comprised a cross-sectional diagnostic study, using Power Doppler sonography as a standard reference in evaluating the diagnostic value ofDAS28 and DAS28-squeeze. This study uses the most sringent sonography criteria of active disease which is an active Doppler signal with a moderate synovial hypertrophy on B-mode. Results : Over the study period, 56 subjects underwent diagnostic tests using DAS28, DAS28-squeeze and Power Doppler sonography. There were 4 false negativecases in DAS28 and 1 case in DAS28-squeeze. The sensitivities of DAS28 and DAS28-squeeze to identify active disease using Power Doppler sonography as reference standard were 73.3% (95%CI ± 11.59) and 93.3% (95%CI ± 6.55), respectively. While the specificities of DAS28 and DAS28-squeeze were 36.6% (95%CI ± 12.62) and 34.1% (95%CI ± 12.42), respectively. Furthermore the negative likelihood ratioof DAS28 and DAS28-squeeze were 0.73 and 0.19, respectively.Conclusion : This study is the first to validate DAS28- squeeze using imaging techniques. From this study the false negative rate of DAS28-squeeze is lower thanDAS28. DAS28-squeeze has a better sensitivity and negative likelihood ratio than DAS28 in identifying RA disease state.Keywords : Rheumatoid Arthritis, DAS28, DAS28-squeeze, treat to target, Power Doppler, squeeze test

A novel CT finding in cardiac amyloid

A 68-year-old woman presented with dyspnoea, having recently been diagnosed with multiple myeloma. She was reviewed in the cardiology clinic and an echocardiogram performed, revealing moderate concentric pseudo hypertrophy with sub endocardial signal hyperechogenicity consistent with infiltration.

Early Recovery of Left Ventricular Systolic Function after Transcatheter Aortic Valve Implantation.

Background:A lot of studies have shown a positive effect of transcatheter aortic valve implantation (TAVI) on left ventricular ejection fraction (LVEF).Objectives:We aimed to investigate the effect of TAVI on left ventricular function and correlate this phenomenon with hypertrophy degree in an early follow-up.Materials and Methods:Between August 2015 and July 2016, 250 consecutive patients with symptomatic severe aortic stenosis (AS) underwent TAVI in our institution. Given the aim of this analysis, only patients with an LVEF <50%, no more than moderate mitral valve regurgitation, successful valve implantation, and 1-month follow-up available were included in the study (n = 46). Patients were enrolled in a prospective database, with clinical and echocardiographic evaluations at 1 month after TAVI.Results:All patients had severe symptomatic AS (mean transaortic pressure gradients: 44.1 ± 13.8 mmHg and mean aortic valve area: 0.66 ± 0.19 cm2). Mean baseline LVEF was 39.3 ± 8.8%. Significant hemodynamic improvement was observed after TAVI. Mean transvalvular aortic gradient decreased significantly from 44.1 ± 13.8 mmHg to 8.9 ± 4.2 mmHg (P < 0.005). A statistically significant improvement in LVEF compared to baseline was observed in the 1st month of follow-up (39.3 ± 8.8% vs. 44.1 ± 10.1%, P < 0.019). Overall, 52.2% of patients showed an increase in LVEF, 32.6% had no change, while only 2.2% had a decrease in LVEF. Interestingly, we found a significant reverse correlation between LVEF improvement and ventricular hypertrophy measured as diastolic interventricular septum thickness (Pearson index r = −0.42). Patients showing greater improvement in LVEF were those with less than moderate hypertrophy.Conclusions:Patients with depressed systolic function show a consistent and early LVEF recovery after TAVI. An impaired LVEF recovery is most likely among patients with more than moderate hypertrophy, probably responsible of left ventricular fibrosis that irremediably compromises systolic function.

Understanding Minoxidil-Induced Pericardial Effusion

Minoxidil is a powerful antihypertensive medication that has been used extensively to control blood pressure in patients with renal failure. Its mechanism of action is through a cyclic AMP-mediated effect on arteriolar smooth muscle, with little effect on veins causing a direct vasodilatation of peripheral blood vessels. Minoxidil use has been associated with cause and/or exacerbation of pericardial effusions both in dialysis patients and those with normal kidney function. We report a 58-year-old African American female with history of severe resistant hypertension that has been controlled by Minoxidil 5 mg po BID, and stage 3 chronic kidney disease who presented with shortness of breath, and headache. Blood pressure 240/124 mmHg. Her CT Brain revealed no intracranial bleed. Electrocardiogram showed normal sinus rhythm, with no ST/T wave changes. Cardiac biomarkers were normal. However, 2D Echocardiogram showed Estimated ejection fraction EF of 65%, moderate pericardial effusion, with no evidence of pericardial tamponade, and moderate Left ventricular hypertrophy. This case reviews and explains the association between Minoxidil use and pericardial effusion, which may need appropriate treatment/monitoring, and extensive work ups to rule out other pathologies.

EFFECT OF DEFFERENT LEVELS OF TURMERIC SUPPLEMENTATION WITH DIET ON HUMORAL IMMUNE RESPONSE TO NEWCASTLE AND INFECTIOUS BURSAL DISEASE VIRUS AND HISTOPATHOLOGICAL CHANGES OF SOME INTERNAL ORGAN OF BROILER CHICKENS

In this study, evaluated the effect of turmeric dietary addition on immune response against the Newcastle disease virus (NDV) and Infectious bursal disease (IBDV). and histopathological changes in some internal organs was evaluated in 42 day old broiler chicks. ninety-six Ross broiler chicks were reared from 1 to 42 days old and divided randomly into four groups, Feed and drinking water were offered ad libitum. Group1 (G1) received turmeric (0.2%), while group2 (G2) received turmeric (0.4%), Group3 (G3) received turmeric (0.6 %) and group4 (G4) was the control positive received basal diet . At the end of the trial five birds from each treatment were slaughtered for assessment of histological section, take same of organ (liver , spleen , and bursa of Fabricius) at 42 day. Results of ELISA test titer revealed differences among various treatment groups at the end of the experiment. mean ELISA test values of G2 revealed a higher significant at (P&lt; 0.05) in antibody titers in comparsion with other groups and control. specimen from liver ,spleen and bursa of fabricius were dissected out for histopathological examination and results of microscopic section showed increase in immune response of G2 chicken : of microscopic sections of G2 histopathological changes in the liver tissue revaled mamefisted by focal mononuclear cells aggregation and proliferation of kupffers cells and slight congestion of blood sinusoids and congestion of portal bloob vessels with few infiltration of inflammatory cells .The intrahepatic bile ductless exhibited dilation and hyperplasia of their epithelial linings with slight per portal fibrosis compared with G1,G3 which showed no clear histopathological changes. The microscopic examination of the spleen revaled range from mild (G1 and G3) to moderate hyperplasia of lymphoid follicles in (G2) . histopathological changes in the bursa of fabricius were characterized by moderate follicular hypertrophy especially in G2 as compared with other treated group's and control .

Central round block repair of large breast resection defects: oncologic and aesthetic outcomes.

The central round block repair is a volume displacement technique to reconstruct large wide local excision (WLE) defects in breasts with moderate ptosis or hypertrophy. There are limited published data on the outcomes of this technique. Data were collected prospectively for 57 consecutive patients and follow up information obtained from patient records. The volume of breast resection was estimated geometrically from mammography. Aesthetic outcomes were assessed from clinical measurements and panel review of patient photographs. The median age was 51 [22-86] years and follow-up 5 (1.9-8.4) years. The median specimen resection weight was 50 [25-361] g and tumour size 25 [10-75] mm. Estimated volume of breast excised was 17.8% (6-31%). In total, 12/57 patients had incomplete margins: five patients had re-excision to achieve clear margins and seven required mastectomy. Two patients had local recurrence during the follow-up period, five developed distant metastases. Aesthetic data were completed for 35/50 patients. Twelve (34%) had no measurable asymmetry and 31 (89%) had a nipple position within 2 cm of the original height. Only two patients requested symmetrising surgery. Central round block reconstruction of large defects after WLE is a safe technique with good aesthetic outcomes. Contralateral symmetrising surgery is not usually required.

Should Adrenal Glands be Spared in Radiotherapy? Evidence from Preliminary Clinical Observation and Translational Research

Fatigue is a complicated syndrome associated with multiple factors. Development of fatigue after incidental radiotherapy (RT) to adrenal gland was observed in clinical practice. This study aimed to investigate the effect of adrenal RT on fatigue and related physiological impact. Three patients with inevitable RT to adrenal gland after standard optimization for intensity modulated RT were prospectively enrolled. Serum levels of cortisol, aldosterone, dehydroepiandrosterone sulfate (DHEA-S) and adrenocorticotropic hormone (ACTH) were measured before, during and after RT. Fatigue was scored according to validated Fatigue Severity Scale (FSS). Dosimetric parameters were collected by using RT planning systems. Balb/c mice were surgically explored for identification of left adrenal gland with sham operation as controls. Intra-operative RT was delivered by linear accelerator (IX, Varian, Palo Alto, CA) with electron beam (2-Gy single fraction, 6 MeV, 90%, dose rate: 400 MU/min). Exhausted swimming test was applied for endurance assessment to represent fatigue. Plasma levels of stress hormones and histopathological features were examined. In the enrolled patients, the RT dose to unilateral adrenal gland was 33.5 ± 11.8 Gy. The serum baseline (afternoon) cortisol levels declined from 10.4 ± 3.9 (pre-RT) to 5.8 ± 3.9 (interim RT) and 4.6 ± 2.1 (post-RT 1 week) μg/dL. Alterations in levels of morning cortisol and aldosterone showed a similar trend to baseline cortisol whereas the ACTH levels slightly increased, indicating a possible compensatory feedback from hypothalamic-pituitary-adrenal axis. In experimental mice model, the RT to unilateral adrenal gland decreased the time of maximal endurance swimming from 19.91 ± 0.09 to 14.8 ± 2.96 min. In histopathological assessment, the irradiated adrenal glands showed characteristic RT injury features in adrenal cortex including moderate hypertrophy, disorganization, cellular aggregates, increased vasculogenesis, condensed chromatin in nucleus and cytoplasmic swelling which were more prominent in zona fasciculata and medulla. The preliminary clinical observation with fatigue development and characteristic hormone alterations indicated that adrenal glands could be regarded as an organ at risk in RT. This observation was supported by experimental animal model with functional and histopathological evidence.

Myocardial hypertrophy and intracardial hemodynamics in children with bicuspid aortic valve

Bicuspid aortic valve is one of the most common congenital heart diseases with low manifestation in childhood and severe consequences in adults that determines the importance in early diagnostics of myocardial changes in this anomaly. According to the literature the polymorphisms in the genes of NFATC family could result both in impaired embriogenetic valves formation and development of postnatal myocardial hypertrophy. The aim of the study was to detect the early changes of intracardial hemodynamics at aortic valve in children with bicuspid aortic valve (BAV) and establish their interrelations to the signs of myocardial hypertrophy in these children. Materials and methods: Dopplerograhphic study of basic intracardiac hemodynamics parameters in 38 children with BAV and in 28 children of control group was conducted. The results were processed statistically by Student’s t-test, correlation analysis and multiple regression. Results: In the result of study the moderate concentric left ventricle myocardial hypertrophy development was detected in 62 % of children with BAV which is accompanying to significant increasing of blood flow velocity and pressure gradient at aortic valve. There were not established significant correlations between the parameters of hemodynamics at valve and left ventricle’s posterior wall depth and septum depth whereas the highest inputs of these values were obtained in the left ventricle systolic dimension and volume and less in the hypertrophic signs. Conclusions: In children with BAV the moderate concentric myocardial hypertrophy with significant changes of intracardial hemodynamics at aortic valve takes place with the highest inputs in left ventricle volumetric values The obtained data serves as a substantiation for the treatment and prevention of it further development.

Cardiomyocyte dimethylarginine dimethylaminohydrolase-1 (DDAH1) plays an important role in attenuating ventricular hypertrophy and dysfunction.

Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthases that limits nitric oxide bioavailability. Dimethylarginine dimethylaminohydrolase-1 (DDAH1) exerts a critical role for ADMA degradation and plays an important role in NO signaling. In the heart, DDAH1 is observed in endothelial cells and in the sarcolemma of cardiomyocytes. While NO signaling is important for cardiac adaptation to stress, DDAH1 impact on cardiomyocyte homeostasis is not clear. Here we used the MerCreMer-LoxP model to specifically disrupt cardiomyocyte DDAH1 expression in adult mice to determine the physiological impact of cardiomyocyte DDAH1 under basal conditions and during hypertrophic stress imposed by transverse aortic constriction (TAC). Under control conditions, cardiomyocyte-specific DDAH1 knockout (cDDAH KO) had no detectable effect on plasma ADMA and left ventricular (LV) hypertrophy or function in adult or aging mice. In response to TAC, DDAH1 levels were elevated 2.5-fold in WT mice, which exhibited no change in LV or plasma ADMA content and moderate LV hypertrophy and LV dysfunction. In contrast, cDDAH1 KO mice exposed to TAC showed no increase in LV DDAH1 expression, slightly increased LV tissue ADMA levels, no increase in plasma ADMA, but significantly exacerbated LV hypertrophy, fibrosis, nitrotyrosine production, and LV dysfunction. These findings indicate cardiomyocyte DDAH1 activity is dispensable for cardiac function under basal conditions, but plays an important role in attenuating cardiac hypertrophy and ventricular remodeling under stress conditions, possibly through locally confined regulation of subcellular ADMA and NO signaling.