Articles: function.
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Cardiovascular CasesSESSION TYPE: Case ReportsPRESENTED ON: Saturday, March 22, 2014 at 04:15 PM - 05:15 PMINTRODUCTION: Primary cardiac tumors are extremely rare with a prevalence of 0.02% in pooled autopsy studies. Lymphomas involving the heart have a prevalence between 1% to 2% of primary cardiac tumors. Diagnosis usually requires tissue biopsy either by open surgical tissue resection or image-guided biopsy. We report a case of a patient who found to have a primary cardiac T-cell lymphoma (PCTCL) of the right atrium (RA) diagnosed by biopsy guided by intracardiac echocardiography (ICE). (1, 2)CASE PRESENTATION: A 66-year-old woman who presented with a 2 month history of progressive shortness of breath and orthopnea. Her ejection fraction decreased from 65% to 35% over a 4 year period. Coronary computed tomography angiography (CTA) revealed normal coronary arteries and a RA mass vs thrombus (Fig 1). A cardiac MRI with contrast was performed and the characteristic of the mass was suggestive of a lymphoma (Fig 2). Patient subsequently underwent percutaneous transcatheter biopsy of the RA mass using fluoroscopic and ICE guidance. Pathologic specimens demonstrated a T-cell lymphoma. ⋯ Patients with PCTCL typically remain asymptomatic until the mass leads to either obstruction of circulation, embolization, interference with valve function, decreased myocardial contractility or conduction disturbances. Histological diagnosis is made by biopsy and typically requires an open-chest procedure under general anesthesia. Transcatheter biopsy with transesophageal echocardiography guidance also requires general anesthesia. However, ICE imaging allows transcatheter biopsy of an intracardiac mass, especially of the right atrium. This can be made under direct visualization with conscious sedation, minimizing the risk for perforation. (3)CONCLUSIONS: Intracardiac mass biopsy using ICE is an attractive modality which provides precise localization of cardiac structures under conscious sedation. This case illustrates successful use of imaging to minimize risk in the assessment of a cardiac mass.Reference #1: Reynen K. Frequency of primary tumors of the heart. Am J Cardiol 1996;77:107-10.Reference #2: Lam KY, Dickens P, Chan AC. Tumors of the heart. A 20-year experience with a review of12,485 consecutive autopsies. Arch Pathol Lab Med 1993;117:1027-31.Reference #3: Kuppahally S.,Litwin S. Endomyocardial Biopsy of Right Atrial Angiosarcoma Guided by Intracardiac Echocardiography. Cardiology Research and Practice Volume 2010, Article ID 681726DISCLOSURE: The following authors have nothing to disclose: Ahmed Al-Badri, Sean Wilson, Chad Klinger, Carlos RuizNo Product/Research Disclosure Information.
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Stress can play an important role in etiology of fibromyalgia syndrome (FMS) by activating the hypothalamic-pituitary-adrenal (HPA) axis, the sympathetic nervous system (SNS), and altering the immune system. The current study examined the influence of catechol-O-methyltransferase (COMT) Val158Met genotypes on salivary markers of HPA axis (cortisol), SNS (α-amylase), and immune (IgA) systems in women with FMS. ⋯ The results suggest that women with FMS with the Met/Met genotype exhibit greater disturbed activity of the SNS and humoral immune system. These results provide initial evidence of a link between Val158Met polymorphism and dysfunctions in the SNS and humoral immune system in women with FMS.
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Brain imaging studies suggest that loss of consciousness induced by general anesthetics is associated with impairment of thalamic function. There is, however, limited information on the time course of these changes. We recently obtained intracranial electroencephalogram (EEG) recordings from the ventroposterolateral (VPL) nucleus of the thalamus and from the motor cortex during induction of anesthesia in three patients to study the time course of the alterations of cortical and thalamic function. ⋯ We conclude that induction of anesthesia with propofol in these patients was associated with concurrent alterations of cortical and sensory thalamic activity.
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Although dezocine is a partial μ-opioid receptor agonist, it is not a controlled substance. Thus, the characterization of the molecular targets of dezocine is critical for scientific and clinical implications. The goal of this study is to characterize molecular targets for dezocine and determine their implications. ⋯ The unique molecular pharmacological profile of dezocine as a partial μ-receptor agonist, a κ-receptor antagonist, and a norepinephrine and serotonin reuptake inhibitor (via norepinephrine transporter and serotonin transporter) was revealed. These discoveries reveal potentially important novel clinical implications and drug interactions of dezocine.
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Reg Anesth Pain Med · Mar 2014
Randomized Controlled Trial Comparative StudyA Randomized Comparison of the Efficacy of 2 Techniques for Piriformis Muscle Injection: Ultrasound-Guided Versus Nerve Stimulator With Fluoroscopic Guidance.
Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques. ⋯ Ultrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.