Notes

Brain-wide useful connection patterns assistance standard mental ability and mediate connection between socioeconomic position within youth.
. © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.General physicians of experience suspected variant angina as gastroesophageal reflux disease (GERD) due to heart burn in two patients. Proton pump inhibitors were administered in these patients, although spontaneous ST segment elevations were recognized and total or subtotal coronary spasm was provoked by the pharmacological spasm provocation tests. Under the vasodilators but not proton pump inhibitors, two patients complained of neither heart burn nor chest symptoms. General internists and cardiologists should bear in mind coronary spasm when they suspect GERD due to heart burn. Guidelines for GERD may note the necessity of differential diagnosis of coronary artery spasm as one of etiology of GERD-related chest symptoms. . © 2019 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.A 31-year-old female with a history of polycystic ovary syndrome and two recent miscarriages presented with symptoms of a transient ischemic attack. Echocardiography to assess for possible embolic source identified a 4.8 cm left atrial mass, presumed to be an atrial myxoma. At surgery the tumor was suspicious of malignancy. Histopathology revealed a heterogeneous hyper- and hypo-cellular spindle cell tumor showing mild atypia. Atrial myxoma markers were negative. The Ki67 proliferation factor was 30% and fluorescence in situ hybridization (FISH) analysis showed MDM2 amplification. Expert review confirmed the morphological, immunohistochemical, and FISH features to be of a cardiac intimal sarcoma. Recent improvements in imaging, surgery, and molecular testing have increased diagnoses of primary cardiac intimal sarcomas. Here we discuss the pathological and clinical implications of these rare atrial myxoma mimics. . Crown A 60-year-old man with history of exertional angina pectoris was referred for treatment of an ostial left circumflex (LCX) coronary artery stenosis. The branch angle between left anterior descending artery (LAD) and LCX was shallow, therefore stent implantation seemed at risk of "carina shift" of plaque to the LAD ostium as well as higher in-stent restenosis. Therefore, directional coronary atherectomy (DCA, Atherocut™, L-size, NIPRO, Osaka, Japan) was performed at the ostium of the LCX lesion. After evaluating plaque accumulation using intravascular ultrasound (IVUS), DCA was circumferentially performed 16 times, from 2 atm to 3 atm, using an 8 fr guide system. Although angiogram and IVUS showed excellent results, adjunctive balloon dilatation with 3.5 mm paclitaxel-coated balloon was performed to prevent restenosis. At 8 months, the patient reported being angina-free, and subsequent follow-up angiogram showed no restenosis of LCX. Paclitaxel-coated balloon following DCA for LCX ostial stenosis seems to be safe and effective for both acute and chronic results, suggesting a potential stentless therapeutic option. https://www.selleckchem.com/products/MLN8237.html . © 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Evisceration of small bowel through the rectum is extremely uncommon, chronic long standing prolapse and/or increased intra-abdominal pressure being the most frequent association. Management is in line of any acute abdomen with resuscitation beginning as soon as patient arrives with covering the bowel with moist hot packs. The management of such patients depends on the general state of each individual patient. In extremely frail patients, palliative care should be instituted. Laparotomy and Hartmann's procedure is the safest option. Here we report a case of an elderly female with full-thickness chronic rectal prolapse who presented acutely at the Emergency Department with small bowel eviscerating through the anus following it herniating through the rectum.Giant intracranial aneurysms (ICGA) represent 3 to 5% of all intracranial aneurysms in adults. They are defined as arterial dilatations, with more than 25 mm in diameter. Despite important advances in the research of endovascular techniques of treating giant intracranial aneurysms, the management of these vascular malformations still poses great difficulties for neurologists and interventional radiologists. In particular, these challenges arise from the difficult and modified cerebral anatomy of patients with ICGA. Choosing the best treatment for patients with ICGA involves not only finding the perfect balance between the potential risks and benefits of endovascular treatment, but also taking into consideration the patient's biological condition and associated diseases. The aim of this paper is to describe the decisional algorithm of treating patients with giant intracranial aneurysms and factors which could influence the choice of endovascular technique. We report a clinical case of a 63-year-old female withthods leads to a significant increase in life expectancy, a severe decline in quality of life might be experienced by these patients.In brachial plexus injuries, external rotation in patients with a moderate to severe glenohumeral dysplasia is corrected with derotational humeral osteotomy surgery. The most frequent complications described for this procedure include keloid scar, loss of external rotation secondary to bone remodelling, loss of internal rotation, prominence of osteosynthesis, fracture distal to the plate transient ulnar paraesthesia and radial nerve palsy (1), and delayed union and non-union. Rarely, treating complications associated with derotational humeral osteotomy may require revision of osteosynthesis (2). The literature that investigates the effectiveness of derotational humeral osteotomy as a procedure to rescue dorsal infraspinatus tendon transfer is limited. This article is the first communication of a pediatric patient with an obstetric brachial plexus injury receiving a derotational osteotomy as a procedure to salvage a failed rescue Latissimus dorsi tendon transfer with a complication. This case report was performed according to the principles of the Declaration of Helsinki. Written informed consent for participation in this case report was obtained from the patient's parents.
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