Abstract
Objective: Congenital absence of the pericardium (CAP) is a rare heart disorder, frequently misdiagnosed due to an
unspecific clinical picture and leading to diagnostic challenges. The purpose of this case presentation is to show how
cardiac imaging methods can aid in accurate diagnosis of CAP.
Case presentation: A case of the complete congenital absence of the pericardium in a 40-year-old man with
complaints on dyspnea and fatigue is presented. Echocardiography revealed a dilated right ventricle with good
contractility; normal dimensions and function of the left ventricle, and normal heart valve function. Pulmonary
hypertension and atrial septal defect were excluded during echocardiography. Computed tomography revealed
abnormal heart axis rotation leftward and posteriorly, raising suspicion of CAP. The diagnosis was confirmed by
cardiac magnetic resonance imaging . The diagnostic flowchart for the CAP is discussed.
Conclusion: Multimodality cardiac imaging provides clues to the diagnosis of CAP.
Objective. The study aims to evaluate the severity of endogenous intoxication and characterize morpho-functional liver changes during experimental acute generalized peritonitis (AGP) in diabetic rats.
Methods. Fifty-six adult male Wistar rats were used, including 8 controls and 48 males with experimental pathology. Diabetes mellitus was induced by an intraperitoneal (i.p.) injection of streptozotocin (60 mg/kg). On day 14, AGP was induced by i.p. injection of a 10% filtered fecal suspension. Endogenous intoxication was assessed by measuring hydrophilic and hydrophobic molecular products in the blood. Liver function was evaluated by serum aminotransferase activity, total protein, and protein fractions. Histological analysis of liver tissue was performed using standard hematoxylin-eosin staining.
Results. A progressive increase in endogenous intoxication was observed peaking on day 7. This was marked by a significant elevation in middle molecular weight molecule (MMWM) concentrations at wavelengths of 254 nm and 280 nm by 103.0% (p<0.001) and 340.0% (p<0.001), respectively. The erythrocyte intoxication index (EII) increased by 148.8% (p<0.001) compared to controls. Concurrently, aminotransferase activity increased, while serum total protein and albumin levels decreased. Histologically, inflammatory infiltration and vascular congestion were evident on day 1 progressing to hepatocellular dystrophy and necrosis by day 3. By day 7, signs of hepatic failure were present including disruption of trabecular architecture, hydropic degeneration, intracellular cholestasis, and portal tract expansion due to vascular hyperemia.
Conclusions. Experimental acute generalized peritonitis in diabetic rats resulted in a pronounced endogenous intoxication accompanied by progressive morpho-functional liver damage culminating in hepatic insufficiency by day 7.
ABSTRACT
Aim: To investigate hepcidin as a marker of iron status in chronic kidney disease (CKD) patients (stage 5 vs. stage 3), and to assess its association with iron injection status within the maintenance hemodialysis group.
Materials and Methods: This cross-sectional study compared 69 hemodialysis (stage 5 CKD [G1]) and 19 non-dialysis (stage 3 CKD [G2]) patients, assessing hepcidin, ferritin and hemoglobin. As a part of their standard anemia management, patients requiring iron administration received scheduled injections of ferric carboxymaltose.
Results: Hemodialysis patients (G1) had significantly lower hemoglobin and higher anemia prevalence than non-dialysis patients (G2), while baseline hepcidin and ferritin levels were comparable. Importantly, hepcidin levels were above the normal range in 85,5% and 84,2% of G1 and G2 patients, respectively. Hepcidin
correlated positively with ferritin in both groups (G1: ρ=0,66, p<0,001; G2: ρ=0,87, p<0,001). Within G1, recent iron injections, administered in 24 patients, were significantly associated with higher hepcidin and ferritin, but not hemoglobin, as compared to patients without additional ferric therapy (n=45) (effect size: r=0,09 [by hemoglobin], r=0,80 [by hepcidin] and r=0,58 [by ferritin]).
Conclusions: Significant iron metabolism impairment, marked by high hepcidin and ferritin prevalence, exists in both CKD stages studied. Although hemodialysis patients had lower hemoglobin, baseline hepcidin/ferritin levels were similar between groups. Within the hemodialysis group, recent iron injections were associated with increased hepcidin/ferritin but not hemoglobin. Findings suggest hepcidin may be a crucial indicator of functional iron availability in CKD, potentially offering more insight than ferritin, particularly reflecting acute changes following iron administration in hemodialysis patients.
KEY WORD S: hepcidin, ferritin, chronic kidney disease, hemodialysis
ABSTRACT
Aim: To investigate the relationships of kidney function with clinical and laboratory parameters in multiple myeloma (MM) patients.
Materials and Methods: A cross-sectional study involved 105 MM patients. Data included clinical manifestations and standard laboratory parameters.
Kidney function was assessed via estimated glomerular filtration rate (eGFR), serum creatinine, urea, uric acid (UA), calcium (Ca), and albumin-to-creatinine
ratio (ACR). The markers of MM activity and burden included M-protein, beta-2 microglobulin (β2m), albumin, hemoglobin (Hb), lactate dehydrogenase (LDH)
and platelets (PLT). Rank biserial correlation assessed associations between symptoms and laboratory parameters. Rank-based canonical correlation analysis
(RCCA) explored the multivariate relationship between six kidney function indicators and six MM-related markers.
Results: Common laboratory abnormalities included elevated β2m (90,5 %) and anemia (indicated by low Hb in 52,4 % of patients). Frequent symptoms
included bone pain (71,4 %) and weakness (68,6 %). Symptoms like weakness/breathlessness correlated significantly with (β2m, M-protein) and renal impairment (creatinine, ACR, eGFR). RCCA identified one significant canonical correlation (R1=0,497; p=0,013), linking impaired renal function (characterized by low
eGFR, high ACR, creatinine and urea) with a myeloma profile indicative of disease activity and burden (high β2m, low Hb, low albumin, and high M-protein).
Conclusions: The study confirms a significant multivariate association between a profile of impaired renal function and markers reflecting MM activity, hematopoietic suppression and systemic burden. These findings underscore the multifactorial nature of MM-related kidney injury and highlight the clinical utility
of monitoring key laboratory markers (including eGFR, ACR, creatinine, β2m, Hb and albumin) alongside clinical evaluation for comprehensive assessment
and management of MM patients.
KEY WORDS: multiple myeloma, chronic kidney disease, anemia
Tumors of the right uterine appendages cannot always be distinguished from mucous neoplasms of the appendix (MA) at the preoperative stage. According to the literature, MA is traditionally considered more common in women than in men at the age of 50 years, with a ratio of 4:1. We have identified 2 cases of surgical treatment of MA in gynecological practice, one of mucinous cystadenoma and the other of mucinous cystadenocarcinoma. We present the visual intraoperative assessment of the appendix condition in cystadenoma and cystadenocarcinoma, clinical manifestations, diagnostic discrepancies, and operative tactics. The literature on the detection of appendicular mu-cocele that mimics ovarian tumor formations in women has been reviewed. The features of diagnostics and possible diagnostic errors were summarized. Diagnostic laparoscopy, visual and operative clinical experience of the surgeon, and cytological and histological examinations of intra- and postoperative results allow for an adequate treatment. It is advisable that the stages and course of appendectomy be reviewed by operating gynecologists and, if necessary, general surgeons.
Keywords: right uterine appendage, mucocele, appendix, appendicular mucinous cystadenoma, cystadenocarcinoma.CASE REPORT