Incidental finding of a giant intracardiac angioma infiltrating both ventricles in a 35-year-old woman: a case report

Background: Primary cardiac tumors are rare and often asymptomatic or present with unspecific symptoms. Benign cardiac tumors of vascular origin are especially rare, with only few existing data in the literature. Case presentation: A 35-year-old Caucasian female patient presented to our department with an asymptomatic giant intracardiac angioma infiltrating both ventricles. Evaluation of this tumor involved electrocardiography, echocardiography, cardiac magnetic resonance imaging, coronary angiography, an open myocardial biopsy, and histological examination of the resected specimen. Because our patient was asymptomatic, she was managed conservatively with regular follow-up. We discuss the treatment options available in comparison with similar cases. Conclusion: Diagnosis and therapy of benign cardiac tumors, especially of asymptomatic lesions, can be a challenge. There is no evidence available to help in the management of such patients. An extensive evaluation is needed with different imaging modalities, and case-specific decisions should be made that involve experts in cardiology, cardio-oncology, and heart surgery

Fronteiras urbanas, mercados em disputa: jogos de poder na produção de espaços

In this article, we view the expansion fronts of urban borders as privileged spaces to understand practical agencies, the network of actors, and the power games involved in the production of urban land and housing markets in São Paulo. An unavoidable presence in those places today, the men of Primeiro Comando da Capital (PCC – First Capital Command), in interaction with this intricate network of actors, act as operators of these markets and the internal management of popular territories. The fact is that the PCC's businesses expand as occupations and precarious settlements expand. In the ambivalent game of protection and extortion, between acceptance and coercion, they mobilize power resources in agreements, disputes, conflicts, and accommodations that constitute the production and management of informal land and housing markets. DOI: https://doi.org/10.1590/2236-9996.2024-6164684-pt https://doi.org/10.1590/2236-9996.2024-6164684-enNeste artigo, tomamos as frentes de expansão das fronteiras urbanas como espaços privilegiados para apreender os agenciamentos práticos, trama de atores e jogos de poder na produção dos mercados urbanos de terra e moradia em São Paulo. Presença hoje incontornável nesses lugares, os homens do PCC, em interação com essa trama intrincada de atores, atuam como operadores desses mercados e da gestão interna de territórios populares. O fato é que os negócios do PCC se expandem conforme também se expandem ocupações e assentamentos populares. No jogo ambivalente de proteção e extorsão, entre aceitação e coerção, mobilizam recursos de poder nos acordos e disputas, conflitos e acomodações que são constitutivos da produção e gestão dos mercados informais de terra e moradia. DOI: https://doi.org/10.1590/2236-9996.2024-6164684-pt https://doi.org/10.1590/2236-9996.2024-6164684-e

Operative Behandlung der akuten und chronischen Osteomyelitis- eine Fallanalyse der Jahre 2008-2018

Die Inzidenzen der Osteomyelitis wurden bisher in Deutschland nicht erfasst. Da die Osteomyelitis jedoch medizinisch und sozioökonomisch große Bedeutung hat, war es Ziel der Arbeit die Häufigkeit, die Geschlechterverteilung, die Lokalisation und die operative Versorgung der Fälle der Jahre 2008-2018 zu analysieren. Die Inzidenzen stiegen an, Männer waren häufiger betroffen als Frauen. Die untere Extremität war häufiger Manifestationsort und mit zunehmendem Patientenalter stieg auch die Zahl der Osteomyelitisfälle. Prädisponierende Erkrankungen und Komorbiditäten sind bei zunehmendem Patientenalter entsprechend der demographischen Entwicklung stärker zu beleuchten, um die große sozioökonomische Belastung durch dieses Krankheitsbild zu minimieren

Der Einfluss des Phosphodiesterase-III-Inhibitors Milrinon auf die rechtsventrikuläre Pumpfunktion des ischämischen, isolierten Rattenherzens

Das akute Versagen des rechten Ventrikels ist eine schwerwiegende postoperative Komplikation, die gehäuft nach herzchirurgischen Eingriffen unter Einsatz der Herz-Lungen-Maschine auftritt. Diese akute Rechtsherzinsuffizienz wird in der klinischen Praxis mittels medikamentöser Optimierung der Vor- und Nachlastsituation therapiert, eine weitere Therapieoption stellen die Katecholamine dar, die aufgrund ihres Wirkungsmechanismus aber zu einer drastischen Erhöhung des Sauerstoffverbrauchs im Organismus führen, was sich nachteilig auf die Prognose der Patienten auswirkt. In der vorliegenden Arbeit evaluierten wir den therapeutischen Wert des PDE-III-Inhibitors Milrinon hinsichtlich der inotropen Wirkung an isolierten, postischämisch reperfundierten Rattenherzen. Verglichen wurden das rechtsventrikuläre Schlagvolumen, die Herzfrequenz sowie der myocardiale cAMP-Gehalt nach Applikation von Milrinon, Adrenalin und deren Kombination. Die von uns erhaltenen Ergebnisse lassen den Schluss zu, das durch die Anwendung von Milrinon die Menge der notwendigen Katecholamine im Tiermodell herabgesetzt werden kann, was für den Patienten eine Verbesserung der Prognose bedeuten könnte

Fronteiras urbanas, mercados em disputa: jogos de poder na produção de espaços

Resumo Neste artigo, tomamos as frentes de expansão das fronteiras urbanas como espaços privilegiados para apreender os agenciamentos práticos, trama de atores e jogos de poder na produção dos mercados urbanos de terra e moradia em São Paulo. Presença hoje incontornável nesses lugares, os homens do PCC, em interação com essa trama intrincada de atores, atuam como operadores desses mercados e da gestão interna de territórios populares. O fato é que os negócios do PCC se expandem conforme também se expandem ocupações e assentamentos populares. No jogo ambivalente de proteção e extorsão, entre aceitação e coerção, mobilizam recursos de poder nos acordos e disputas, conflitos e acomodações que são constitutivos da produção e gestão dos mercados informais de terra e moradia

Despossessão, violências e a potência transformadora: um olhar interseccional sobre as remoções

The present article takes the following question as its starting point: What does it mean to think about eviction and its consequences based on the narratives of women who have faced these processes? By examining the narratives and thoughts of women who have either undergone eviction or are living under its threat, it is possible to highlight dimensions of the process that may otherwise go unnoticed by analyses that focus on other dimensions, and which do not appraise the characteristics of those being evicted and what this represents in terms of the totality of the phenomenon. By shedding light on the multiplicity of impacts resulting from the eviction processes, it is possible to return to the conceptual notion itself, so that it may be formulated from the bottom up, i.e., from the various experiences that comprise it. Ultimately, what is eviction? What does it mean to live under the threat of losing your home?O presente artigo parte da seguinte questão: o que significa pensar a remoção e suas consequências com base na narrativa de mulheres que enfrentam esses processos? Ao recuperar as narrativas e as reflexões de mulheres que sofreram remoção ou se encontram em situação de ameaça, é possível iluminar dimensões do processo que podem passar despercebidas ou ser encobertas por análises cujo enfoque recai sobre outras dimensões, que não passam por uma reflexão sobre as características de quem está sendo removido, e sobre o significado disso diante da totalidade do fenômeno. Ao lançar luz sobre a multiplicidade dos impactos decorrentes dos processos de remoção, pode-se retomar a própria noção conceitual para, então, formulá-la desde baixo, quer dizer, a partir das várias experiências que a compõem. Afinal, o que é remoção? O que significa viver sob a ameaça de perder o lugar onde se vive

Cardiac involvement in patients with Becker muscular dystrophy: new diagnostic and pathophysiological insights by a CMR approach

<p>Abstract</p> <p>Background </p> <p>Becker-Kiener muscular dystrophy (BMD) represents an X-linked genetic disease associated with myocardial involvement potentially resulting in dilated cardiomyopathy (DCM). Early diagnosis of cardiac involvement may permit earlier institution of heart failure treatment and extend life span in these patients. Both echocardiography and nuclear imaging methods are capable of detecting later stages of cardiac involvement characterised by wall motion abnormalities. Cardiovascular magnetic resonance (CMR) has the potential to detect cardiac involvement by depicting early scar formation that may appear before onset of wall motion abnormalities.</p> <p>Methods </p> <p>In a prospective two-center-study, 15 male patients with BMD (median age 37 years; range 11 years to 56 years) underwent comprehensive neurological and cardiac evaluations including physical examination, echocardiography and CMR. A 16-segment model was applied for evaluation of regional wall motion abnormalities (rWMA). The CMR study included late gadolinium enhancement (LGE) imaging with quantification of myocardial damage.</p> <p>Results </p> <p>Abnormal echocardiographic results were found in eight of 15 (53.3%) patients with all of them demonstrating reduced left ventricular ejection fraction (LVEF) and rWMA. CMR revealed abnormal findings in 12 of 15 (80.0%) patients (p = 0.04) with 10 (66.6%) having reduced LVEF (p = 0.16) and 9 (64.3%) demonstrating rWMA (p = 0.38). Myocardial damage as assessed by LGE-imaging was detected in 11 of 15 (73.3%) patients with a median myocardial damage extent of 13.0% (range 0 to 38.0%), an age-related increase and a typical subepicardial distribution pattern in the inferolateral wall. Ten patients (66.7%) were in need of medical heart failure therapy based on CMR results. However, only 4 patients (26.7%) were already taking medication based on clinical criteria (p = 0.009).</p> <p>Conclusion </p> <p>Cardiac involvement in patients with BMD is underdiagnosed by echocardiographic methods resulting in undertreatment of heart failure. The degree and severity of cardiac involvement in this population is best characterised when state-of-the-art CMR methods are applied. Further studies need to demonstrate whether earlier diagnosis and institution of heart failure therapy will extend the life span of these patients.</p

Toll-like receptor 4 on islet β cells senses expression changes in high-mobility group box 1 and contributes to the initiation of type 1 diabetes

Type 1 diabetes mellitus is caused by the autoimmune destruction of β cells within the islets. In recent years, innate immunity has been proposed to play a key role in this process. High-mobility group box 1 (HMGB1), an inflammatory trigger in a number of autoimmune diseases, activates proinflammatory responses following its release from necrotic cells. Our aim was to determine the significance of HMGB1 in the natural history of diabetes in non-obese diabetic (NOD) mice. We observed that the rate of HMGB1 expression in the cytoplasm of islets was much greater in diabetic mice compared with non-diabetic mice. The majority of cells positively stained for toll-like receptor 4 (TLR4) were β cells; few α cells were stained for TLR4. Thus, we examined the effects of anti-TLR4 antibodies on HMGB1 cell surface binding, which confirmed that HMGB1 interacts with TLR4 in isolated islets. Expression changes in HMGB1 and TLR4 were detected throughout the course of diabetes. Our findings indicate that TLR4 is the main receptor on β cells and that HMGB1 may signal via TLR4 to selectively damage β cells rather than α cells during the development of type 1 diabetes mellitus

Comparing Pandemic to Seasonal Influenza Mortality: Moderate Impact Overall but High Mortality in Young Children

Background: We assessed the severity of the 2009 influenza pandemic by comparing pandemic mortality to seasonal influenza mortality. However, reported pandemic deaths were laboratory-confirmed - and thus an underestimation - whereas seasonal influenza mortality is often more inclusively estimated. For a valid comparison, our study used the same statistical methodology and data types to estimate pandemic and seasonal influenza mortality. Methods and Findings: We used data on all-cause mortality (1999-2010, 100% coverage, 16.5 million Dutch population) and influenza-like-illness (ILI) incidence (0.8% coverage). Data was aggregated by week and age category. Using generalized estimating equation regression models, we attributed mortality to influenza by associating mortality with ILI-incidence, while adjusting for annual shifts in association. We also adjusted for respiratory syncytial virus, hot/cold weather, other seasonal factors and autocorrelation. For the 2009 pandemic season, we estimated 612 (range 266-958) influenza-attributed deaths; for seasonal influen