Vasiliki Katsi

Temperature differences are associated with malignancy on lung lesions: a clinical study

BackgroundAlthough new endoscopic techniques can enhance the ability to detect a suspicious lung lesion, the primary diagnosis still depends on subjective visual assessment. We evaluated whether thermal heterogeneity of solid tumors, in bronchial epithelium, constitutes an additional marker for the diagnosis of benign and malignant lesions.MethodsA new method, developed in our institute, is introduced in order to detect temperature in human pulmonary epithelium, in vivo. This method is based on a thermography catheter, which passes the biopsy channel of the fiber optic bronchoscope. We calculated the temperature differences (ΔT) between the lesion and a normal bronchial epithelium area on 22 lesions of 20 subjects, 50 – 65 years old.ResultsEleven lesions were benign and 11 were malignant, according to the biopsy histology followed the thermography procedure. We found significant differences of ÄT between patients with benign and malignant tumor (0.71 ± 0.6 vs. 1.23 ± 0.4°C, p < 0.05). Logistic regression analysis showed that 1-Celsius degree differences between normal tissue and suspicious lesion six-fold the probability of malignancy (odds ratio = 6.18, 95% CI 0.89 – 42.7). Also, ΔT values greater than 1.05°C, constitutes a crucial point for the discrimination of malignancy, in bronchial epithelium, with sensitivity (64%) and specificity (91%).ConclusionThese findings suggest that the calculated ΔT between normal tissue and a neoplastic area could be a useful criterion for the diagnosis of malignancy in tumors of lung lesions.

Epigenetics, the missing link in hypertension

Epigenetics refers to functional alterations in gene expression or phenotype without any change of the underlying DNA sequence. It is the study of the potential of a cell or organism to express different traits through functional regulation of its gene transcription. Though it is met as a necessary process in biology, epigenetics may often play a crucial part in the development of specific pathologic conditions, including cardiovascular diseases and hypertension.

Early initiation of low-dose atorvastatin treatment after an acute ST-elevated myocardial infarction, decreases inflammatory process and prevents endothelial injury and activation

BACKGROUND High-dose statin treatment improves clinical outcome of ST-elevated myocardial infarction (STEMI). However, the effect of low-dose atorvastatin treatment on inflammatory and pro-thrombotic molecules during the post-STEMI period is unclear. We investigated the effect of low-dose atorvastatin treatment on the kinetics of cytokine IL-6, vascular cell adhesion molecule (sVCAM-1) and endothelium-derived markers of thrombosis/fibrinolysis such as von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA), post STEMI. METHODS Twenty-four normocholesterolemic patients with STEMI were randomised to receive atorvastatin 10mg/day or no statin treatment for 6 weeks after the event. Blood samples were obtained by their admission to the hospital as well as at weeks 1 and 6. Circulating levels of IL-6, sVCAM-1, vWF, PAI-1 and tPA were determined by ELISA. RESULTS Atorvastatin induced a decrease of IL-6 at 1 week, an effect which reached significance compared to baseline at 6 weeks post STEMI (p<0.05 vs baseline). Serum sVCAM-1 was increased in controls both at 1 and 6 weeks post-STEMI (p<0.05 vs baseline), an effect prevented by atorvastatin. Plasma vWF was increased 1 week post-STEMI in controls (p<0.05 vs baseline) and returned to baseline at 6 weeks, an effect prevented by atorvastatin. Plasma PAI-1, tPA and the PAI-1/tPA ratio remained unchanged in both groups. CONCLUSION Early initiation of low-dose atorvastatin treatment decreases the expression of IL-6 and sVCAM-1 and the release of vWF in patients with STEMI. Therefore, low-dose atorvastatin, modulates inflammatory response and decreases endothelial injury and activation in patients with recent STEMI.

Visual loss due to cardiac calcified amorphous tumor: A case report and brief review of the literature

Cardiac calcified amorphous tumor (CAT) is a recently described non-neoplastic endocardially based intracavitary cardiac mass. It is composed of nodules of calcium on a background of amorphous fibrinous material [1]. It was first described in 1997 and since then very few cases have been reported in the available English literature [1–5]. In the present manuscript we describe a case of a middle aged woman with a cardiac CAT causing retinal arterial emboli and transient visual field defects. This 65-year-old woman with a history of diabetes mellitus and hypertension referred to the local physician complaining of visual disturbances. She suffered an episode of transient visual field defect leading to a partial loss of vision in her left eye 40 days ago. The findings from the physical examination were otherwise unremarkable. Left central retinal arterial occlusion was detected and special investigation was performed in order to identify the source of emboli. Blood tests, including thrombotic and autoimmunological parameters, were normal. Resting electrocardiogram demonstrated bifascicular block. On the chest x-ray the cardiac size was normal. The carotid and vertebral duplex ultrasound was unremarkable. Brain magnetic resonance imaging also revealed no significant findings. Transthoracic echocardiography revealed a calcified mass measuring 2.6×1.7×0.5 cm adherent to the mitral posterior leaflet on the ventricular side of the mitral valve causing mild mitral valve obstruction (Fig. 1). The three-dimensional echocardiography was

Omentin, Fat and Heart: Classical Music with New Instruments

Obesity is a new pandemic and its cardiovascular and metabolic complications will be more evident in the near future. The need to elucidate the structure and function of adipose tissue is becoming more prominent. Body fat mass has long become not just a matter of quantification, but an area of great interest due to the paracrine, endocrine and autocrine properties of its elements. The novel adipokines are under intense investigation and omentin has come into the centre of interest due to its favourable effects on inflammation and glucose homeostasis. Not all aspects of omentin have been clarified. This review tries to focus on the current knowledge of these aspects and the future perspectives of this novel adipokine.

Cardiovascular repercussions of the pseudoexfoliation syndrome

Pseudoexfoliation syndrome is a primarily ophthalmological disorder caused by deposition of whitish-gray protein on the lens, iris, and multiple other eye tissues. There is increasing evidence over the previous years that pseudoexfoliation syndrome is a systemic disorder with various extraocular manifestations and has recently been linked to several cardiovascular disorders. The present article aims to summarize the current knowledge on cardiovascular implications of this well-described clinical entity.

Association between retinal microcirculation and aortic stiffness in hypertensive patients.

BACKGROUND The fundoscopic examination of hypertensive patients, an established hypertension-related target organ damage, tends to be underutilized in clinical practice. We sought to investigate the relationship between retinal alterations and aortic stiffness, an independent predictor of cardiovascular morbidity and mortality. METHODS Our population consisted of 197 consecutive essential hypertensive patients (age 60 ± 13 years, 115 females) without overt cardiovascular disease. All subjects underwent fundoscopy examination and were distributed to four groups according to Scheies grading system. Aortic stiffness was evaluated by carotid-femoral pulse wave velocity with a validated device (Complior). RESULTS The four groups (Scheies grades 0-3: including 24, 75, 74, 24 patients respectively) did not differ with regard to age, gender and their metabolic profile. Patients with higher Scheies category had higher values of pulse wave velocity (8.2 ± 1.5, 8.9 ± 1.7, 9.3 ± 1.8, 9.8 ± 2.1m/s respectively, p=0.001). Multivariable regression analysis showed that age, fundus classification and systolic arterial pressure were independent determinants of pulse wave velocity. CONCLUSION Hypertensive subjects exhibit a progressive stiffening of the aorta in parallel with the progression of retinal alterations according to Scheies scale. Further studies are needed to clarify involved pathophysiological mechanisms and explore possible causal relationships.

Impact of Arterial Hypertension on the Eye

Systemic hypertension has been linked to a wide range of major eye diseases. High arterial blood pressure (BP) decreases choroidal circulatory flow, increases intraocular pressure, and is associated with retinal microvascular abnormalities and prevalence of retinal vein occlusion (RVO) and retinopathy. This review offers a comprehensive overview of ocular diseases associated with hypertension and emphasizes their importance as predictors to future cardiovascular events. It also gives evidence-based clinical data for the therapeutic approach of eye disease in hypertensive patients.

Tricuspid regurgitation after successful mitral valve surgery

The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified.

The association of Restless Legs Syndrome with hypertension and cardiovascular disease.

Restless Legs Syndrome (RLS) is a sensory-motor neurological disorder that appears to be surprisingly common in the community. Periodic limb movements in sleep are typically encountered in more than 80% of RLS patients and comprise involuntary muscular jerks in the lower limbs, such as flexion of the knees or ankles. Iron deficiency and dopaminergic neuronal dysfunction in the central nervous system are currently thought to be the likely pathophysiological culprits. There is evidence linking RLS to hypertension and cardiovascular disease. This short review will first present a synopsis of epidemiological, clinical, and pathophysiological data concerning the syndrome, and then information on the possible links between RLS and cardiovascular disorders