Intralobar Pulmonary Sequestration – Clinical Case In A Three-Year-Old Child

Pulmonary sequestration is a rare congenital lung anomaly, which presents with a solid or cystic primitive tissue that has no function. Commonly, this formation does not communicate with the tracheobronchial tree and has an anomalous blood supply, most often from the systemic circulation. There are two types of pulmonary sequestration – intralobar (intrapulmonary) and extralobar (extrapulmonary).We present a 3-year-old boy from normal pregnancy and delivery through Cesarean section with intralobar pulmonary sequestration. The child is with normal physical and neuropsychological development, has had all the necessary vaccinations, and suffers from frequent respiratory infections with recurrent cough. The anomaly was discovered accidentally during another hospitalization due to cough, but without a fever, and with suspected inflammatory changes in the radiography, with a wider mediastinal shadow. The performed chest CT with contrast revealed a cystic formation in the posterior-basal left lung with an anomalous supply from the thoracic aorta. Despite the controversial behavior in sequestration, without or with mild symptoms, the child was referred for consultation with a pediatric surgeon and for possible surgical treatment.Pulmonary sequestration is a rare congenital anomaly with the intralobar type being more frequent. A distinctive feature for the latter is the absence of clinical symptoms, especially in childhood. However, it has to be suspected in cases of a chronic cough and recurrent pneumonias. Non-invasive imaging techniques, such as CT angiography, MRI, echography, including fetal one, are the preferred diagnostic tool

Therapeutic approach to idiopathic hypertrophic cardiomyopathy

Идиопатичната хипертрофична кардиомиопатия е рядко срещана в детска възраст с висок потенциален риск от фатален край. Отличителен белег е миокардната хипертрофия при липса на хемодинамична причина. От първия описан случай на експериментално лечение на кърмаче през 1971 г. бета-блокерите имат водеща роля в медикаментозното лечение с вариации в дозовите режими. По последни литературни данни и клинични проучвания употребата на високи дози бета-блокер неоспоримо показва значим процент на преживяемост в дългосрочен план.Представяме клиничен случай на 11-месечно кърмаче, което постъпва в нашата клиника с данни за сърдечна недостатъчност. От проведените образни изследвания - рентгенография на гръден кош и ехокардиография, се установи изразена симетрична хипертрофична необструктивна кардиомиопатия. Започна се медикаментозно лечение с пропранолол в постепенно покачваща се доза до 5 мг / кг / 24 часа. Няколко седмици по-късно при контролно ехокардиографско изследване се установи значително подобрение в диастолната функция на лява камера с известна регресия в хипертрофията на миокарда. Контролираното прилагане на високи дози бета-блокери би могло съществено да подобри прогнозата и дългосрочната преживяемост при пациентите с идиопатична хипертрофична кардиомиопатия.Idiopathic hypertrophic cardiomyopathy is a rare disease in childhood with a high potential of a lethal outcome. The hallmark of the disorder is myocardial hypertrophy that occurs in the absence of an obvious hemodynamic stimulus. Since the first case of an experimental treatment of an infant described in 1971, beta blockers have become one of the leading medication options with variations of the dose regimens. According to the current literature data and clinical trials the use of beta blockers in high doses is consistent with a high percentage of survival.We`re presenting a clinical case of an 11-month old infant, who was admitted to our clinic with symptoms of congestive cardiac failure. The chest radiography and echocardiography results showed a severe symmetric hypertrophic cardiomyopathy without an obstruction in the left ventricular outflow tract. The treatment was started with Propranolol in a titrating dose until reaching the dose of 5mg/kg/24hours. Several weeks later, echocardiography examination showed a significant improvement in the left ventricle diastolic function with some degree of regression of myocardial hypertrophy.The use of high doses of beta blockers together with the monitoring of the clinical state could improve the prognosis and survival in patients with idiopathic hypertrophic cardiomyopathy

Mycophenolate mofetil versus azathioprine for prevention of acute rejection in renal transplantation (MYSS): a randomised trial.

BACKGROUND: Mycophenolate mofetil has replaced azathioprine in immunosuppression regimens worldwide to prevent graft rejection. However, evidence that its antirejection activity is better than that of azathioprine has been provided only by registration trials with an old formulation of ciclosporin and steroid. We aimed to compare the antirejection activity of these two drugs with a new formulation of ciclosporin. METHODS: The mycophenolate steroids sparing multicentre, prospective, randomised, parallel-group trial compared acute rejections and adverse events in recipients of cadaver-kidney transplants over 6-month treatment with mycophenolate mofetil or azathioprine along with ciclosporin microemulsion (Neoral) and steroids (phase A), and over 15 more months without steroids (phase B). The primary endpoint was occurrence of acute rejection episodes. Analysis was by intention to treat. FINDINGS: 168 patients per group entered phase A. 56 (34%) assigned mycophenolate mofetil and 58 (35%) assigned azathioprine had clinical rejections (risk reduction [RR] on mycophenolate mofetil compared with azathioprine 13.7% [95% CI -25.7% to 40.7%], p=0.44). 88 patients in the mycophenolate mofetil group and 89 in the azathioprine group entered phase B. 14 (16%) taking mycophenolate mofetil and 11 (12%) taking azathioprine had clinical rejections (RR -16.2%, [-157.5% to 47.5%], p=0.71). Average per-patient costs of mycophenolate mofetil treatment greatly exceeded those of azathioprine (phase A 2665 Euros [SD 586] vs Euros 184 [62]; phase B 5095 Euros [2658] vs 322 Euros [170], p<0.0001 for both). INTERPRETATION: In recipients of cadaver kidney-transplants given ciclosporin microemulsion, mycophenolate mofetil offers no advantages over azathioprine in preventing acute rejections and is about 15 times more expensive. Standard immunosuppression regimens for transplantation should perhaps include azathioprine rather than mycophenolate mofetil, at least for kidney graft

Therapeutic approach to idiopathic hypertrophic cardiomyopathy

Идиопатичната хипертрофична кардиомиопатия е рядко срещана в детска възраст с висок потенциален риск от фатален край. Основен отличителен белег е миокардната хипертрофия при липса на хемодинамична причина. От първия описан случай на експериментално лечение на кърмаче през 1971 г., бета-блокерите имат водеща роля в медикаментозното лечение с вариации в дозовите режими. По последни литературни данни и клинични проучвания употребата на високи дози бета-блокер неоспоримо показва значим процент на преживяемост в дългосрочен план.Представяме клиничен случай на 11-месечно кърмаче, което постъпва в нашата клиника с данни за сърдечна недостатъчност. От проведените образни изследвания - рентгенография на гръден кош и ехокардиография, се установи изразена симетрична хипертрофична необструктивна кардиомиопатия. Започна се медикаментозно лечение с пропранолол в постепенно покачваща се доза до 5мг/кг / 24часа. Няколко седмици по-късно при контролно ехокардиографско изследване се установи значително подобрение в диастолната функция на лява камера с известна регресия в хипертрофията на миокарда.Контролираното прилагане на високи дози бета-блокери би могло съществено да подобри прогнозата и дългосрочната преживяемост при пациентите с идиопатична хипертрофична кардиомиопатия.We`re presenting a clinical case of an 11-month old infant, who was admitted to our clinic with symptoms of congestive cardiac failure. The chest radiography and echocardiography results showed a severe symmetric hypertrophic cardiomyopathy without an obstruction in the left ventricular outflow tract. The treatment was started with Propranolol in a titrating dose until reaching the dose of 5mg/kg/24h. Several weeks later, echocardiography examination showed a significant improvement in the left ventricular diastolic function with a certain degree of regression of the myocardial hypertrophy.The use of high doses of beta blockers together with the monitoring of the clinical state could improve the prognosis and survival in patients with idiopathic hypertrophic cardiomyopathy.Idiopathic hypertrophic cardiomyopathy is a rare disease in childhood with a high probability of a lethal outcome. The hallmark of the disorder is myocardial hypertrophy that occurs in the absence of an obvious hemodynamic stimulus. Since the first case of an experimental treatment of an infant described in 1971, beta blockers have become one of the leading medication options with variations of the dose regimes. According to the current literature data and clinical trials, the use of beta blockers in high doses is consistent with a high percentage of survival

A novel, low-volume method for organ culture of embryonic kidneys that allows development of cortico-medullary anatomical organization

Here, we present a novel method for culturing kidneys in low volumes of medium that offers more organotypic development compared to conventional methods. Organ culture is a powerful technique for studying renal development. It recapitulates many aspects of early development very well, but the established techniques have some disadvantages: in particular, they require relatively large volumes (1-3 mls) of culture medium, which can make high-throughput screens expensive, they require porous (filter) substrates which are difficult to modify chemically, and the organs produced do not achieve good cortico-medullary zonation. Here, we present a technique of growing kidney rudiments in very low volumes of medium-around 85 microliters-using silicone chambers. In this system, kidneys grow directly on glass, grow larger than in conventional culture and develop a clear anatomical cortico-medullary zonation with extended loops of Henle. © 2010 Sebinger et al

FLORA, MYCOTA AND VEGETATION OF KUPENA RESERVE (RODOPI MOUNTAINS, BULGARIA)

The paper represents results from recent complex studies of flora, mycota and vegetation within the Kupena Reserve (Rodopi Mts, Bulgaria). Twenty three species, referred to 2 divisions, 4 classes and 16 families are recorded for the bryoflora. The vascular flora is presented by 368 species from 57 families, 121 of which are considered as medicinal plants. Eighty seven species of larger ascomycetes and basidiomycetes are found and reported for first time in the reserve. Four of them are of a high conservation value. The vegetation cover is consisted of mixed and monodominant deciduous and coniferous forests, as well as of mire, riverbank and mesic grasslands. Thirteen types of habitats according to the Habitats Directive classification have been recorded within the reserve

Identification of tomato accessions as source of new genes for improving heat tolerance: from controlled experiments to field

Background: Due to global warming, the search for new sources for heat tolerance and the identification of genes involved in this process has become an important challenge as of today. The main objective of the current research was to verify whether the heat tolerance determined in controlled greenhouse experiments could be a good predictor of the agronomic performance in field cultivation under climatic high temperature stress. Results: Tomato accessions were grown in greenhouse under three temperature regimes: control (T1), moderate (T2) and extreme heat stress (T3). Reproductive traits (flower and fruit number and fruit set) were used to define heat tolerance. In a first screening, heat tolerance was evaluated in 219 tomato accessions. A total of 51 accessions were identified as being potentially heat tolerant. Among those, 28 accessions, together with 10 accessions from Italy (7) and Bulgaria (3), selected for their heat tolerance in the field in parallel experiments, were re-evaluated at three temperature treatments. Sixteen tomato accessions showed a significant heat tolerance at T3, including five wild species, two traditional cultivars and four commercial varieties, one accession from Bulgaria and four from Italy. The 15 most promising accessions for heat tolerance were assayed in field trials in Italy and Bulgaria, confirming the good performance of most of them at high temperatures. Finally, a differential gene expression analysis in pre-anthesis (ovary) and post-anthesis (developing fruit) under heat stress among pairs of contrasting genotypes (tolerant and sensitive from traditional and modern groups) showed that the major differential responses were produced in post-anthesis fruit. The response of the sensitive genotypes included the induction of HSP genes, whereas the tolerant genotype response included the induction of genes involved in the regulation of hormones or enzymes such as abscisic acid and transferases. Conclusions: The high temperature tolerance of fifteen tomato accessions observed in controlled greenhouse experiments were confirmed in agronomic field experiments providing new sources of heat tolerance that could be incorporated into breeding programs. A DEG analysis showed the complex response of tomato to heat and deciphered the different mechanisms activated in sensitive and tolerant tomato accessions under heat stress