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We report an unusual case of extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) in the setting of metastatic uterine leiomyosarcoma. Recognition of the associated sequelae of this condition may improve short- and long-term outcomes. A 56-year-old black female with a history of uterine leiomyosarcoma diagnosed incidentally after total abdominal hysterectomy for fibroid uterus without initiation of chemoradiation treatment presented to the emergency department complaining of generalized weakness and progressively worsening stridor for 2 weeks. The patient was experiencing shortness of breath, dysphagia, and hoarseness. Physical exam was remarkable for rhonchi but was otherwise normal. Diagnostic imaging via CT of the abdomen, pelvis, and chest revealed DVTs of the left common and external iliac veins, the superior mesenteric artery, multiple pulmonary emboli of the right pulmonary artery, several nodular lesions within the lungs, and scattered peritoneal necrotic lesions, which were suspicious for metastatic disease. Additionally, CT of the neck showed an exophytic mass protruding into the airway from the subglottic region and thyromegaly with bilateral thyroid lobe nodules. The patient was subsequently started on Eliquis and chemotherapy. The rarity of this case is rooted in the extent of the patient's DVTs and PEs secondary to hypercoagulability in metastatic cancer. This presentation should be further evaluated to exclude thrombophilias or underlying malignancies. Drawing from the lessons of this case will help guide future clinical management regarding the care of metastatic uterine leiomyosarcoma.

Background: To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. Methods: Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates. Results: Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36–0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31–0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07–0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups. Conclusion: In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions. [ABSTRACT FROM AUTHOR]

Background: Left ventricular thrombus (LVT) is a serious complication after myocardial infarction. However, due to its asymptomatic nature, early detection is challenging. We aimed to explore the differences in clinical correlates of LVT found in acute to subacute and chronic phases of myocardial infarction. Methods: We collected data from 153 patients who were diagnosed with LVT after myocardial infarction at the Affiliated Hospital of Qingdao University from January 2013 to December 2022. Baseline information, inflammatory markers, transthoracic echocardiograph (TTE) data and other clinical correlates were collected. Patients were categorized into acute to subacute phase group (< 30 days) and chronic phase group (30 days and after) according to the time at which echocardiograph was performed. The resolution of thrombus within 90 days is regarded as the primary endpoint event. We fitted logistic regression models to relating clinical correlates with phase-specific thrombus resolution. Results: For acute to subacute phase thrombus patients: C-reactive protein levels (OR: 0.95, 95% CI: 0.918–0.983, p = 0.003) were significantly associated with thrombus resolution. For chronic phase thrombus patients: anticoagulant treatment was associated with 5.717-fold odds of thrombus resolution (OR: 5.717, 95% CI: 1.543–21.18, p = 0.009). Conclusions: Higher levels of CRP were associated with lower likelihood of LVT resolution in acute phase myocardial infarction; Anticoagulant therapy is still needed for thrombus in the chronic stage of myocardial infarction. [ABSTRACT FROM AUTHOR]

(1) Background: A rare and unexpected consequence of childbirth, labor, or the immediate postpartum period is amniotic fluid embolism (AFE). This study aims to identify AFE cases during or immediately after birth from anesthetic management perspectives. Secondary goals include assessing patient clinical features, obstetric care techniques, birth outcomes, and case survival. (2) Methods: A retrospective observational study assessed AFE patients hospitalized in three Romanian clinical institutions from October 2007 to April 2023. Based on the Society of Maternal-Fetal Medicine (SMFM) criteria, we diagnosed 11 AFE patients. (3) Results: AFE occurred in eight cases (73%) during peripartum, two (18%) within 30 min after placental delivery, and 1 (9%) during a scheduled cesarean surgery. Only one of six cardiorespiratory arrest patients responded to external cardiac massage, while the other five (83%) needed defibrillation. The patients received, on average, five units of red blood cells, six of fresh frozen plasma, and two of activated platelets. Six patients (55%) received factor VIIa infusions. Maternal mortality was 36.3%. Six neonates (75%) needed neonatal resuscitation, and two (25%) died on the second and third days. (4) Conclusions: AFE management necessitates a multidisciplinary approach and the incorporation of advanced life support techniques to optimize outcomes for both the mother and newborn. [ABSTRACT FROM AUTHOR]

The vulnerability of plant xylem to embolism can be described as the water potential at which xylem conductivity is lost by 50% (P50). According to the traditional hypothesis of hydraulic vulnerability segmentation, the difference in vulnerability to embolism between branches and roots is positive (P50 root−branch > 0). It is not clear whether this occurs broadly across species or how segmentation might vary across aridity gradients. We compiled hydraulic and anatomical datasets from branches and roots across 104 woody species (including new measurements from 10 species) in four biomes to investigate the relationships between P50 root–branch and environmental factors associated with aridity. We found a positive P50 root–branch relationship across species, and evidence that P50 root–branch increases with aridity. Branch xylem hydraulic conductivity transitioned from more efficient (e.g., wider conduit, higher hydraulic conductivity) to safer (e.g., narrower conduit, more negative P50) in response to the increase of aridity, while root xylem hydraulic conductivity remained unchanged across aridity gradients. Our results demonstrate that the hydraulic vulnerability difference between branches and roots is more positive in species from arid regions, largely driven by modifications to branch traits. [ABSTRACT FROM AUTHOR]

The properties of bark and xylem contribute to tree growth and survival under drought and other types of stress conditions. However, little is known about the functional coordination of the xylem and bark despite the influence of selection on both structures in response to drought. To this end, we examined relationships between proportions of bark components (i.e. thicknesses of tissues outside the vascular cambium) and xylem transport properties in juvenile branches of five Cupressaceae species, focusing on transport efficiency and safety from hydraulic failure via drought‐induced embolism. Both xylem efficiency and safety were correlated with multiple bark traits, suggesting that xylem transport and bark properties are coordinated. Specifically, xylem transport efficiency was greater in species with thicker secondary phloem, greater phloem‐to‐xylem thickness ratio and phloem‐to‐xylem cell number ratio. In contrast, species with thicker bark, living cortex and dead bark tissues were more resistant to embolism. Thicker phellem layers were associated with lower embolism resistance. Results of this study point to an important connection between xylem transport efficiency and phloem characteristics, which are shaped by the activity of vascular cambium. The link between bark and embolism resistance affirms the importance of both tissues to drought tolerance. Summary statement: The study highlights the functional coordination between xylem transport properties and bark structure of Cupressaceae. We found xylem transport efficiency strongly related to phloem characteristics, while xylem safety is associated with both dead and living cell content. [ABSTRACT FROM AUTHOR]

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls (P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18–34.5) and severe periodontitis with an OR of 7.48 (1.24–44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87–23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01–6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72–40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed. [ABSTRACT FROM AUTHOR]

While tumor emboli are a rare cause of stroke in cancer patients, they highlight the importance of gross observations and pathological assessments in the evaluation of clots. In this case report, a 70-year-old male with type 2 diabetes mellitus and coronary artery disease presented with acute left-sided weakness. He was clinically diagnosed with stroke and given alteplase at 1.5 h from last known normal. He then underwent CT angiography that showed right internal carotid artery occlusion and immediate thrombectomy. The recovered clot was white and lipid-like; due to its atypical appearance, it was sent for pathological assessment, where it was shown to bear features of malignancy. Subsequent imaging identified masses indicating malignancy in the left gluteus, right pleural hilum, and spine. Tumor embolic stroke is a rare pathology. Embolic diseases such as strokes and pulmonary embolisms are common in patients with cancer. Embolic stroke of undetermined source (ESUS) represents a significant portion of cancer strokes. Tumor emboli, though rare, may be an underappreciated source of ESUS in cancer patients. We intend for this case to demonstrate the value of pathological assessment for atypical thrombi as well as highlight the etiology of tumor embolic strokes. [ABSTRACT FROM AUTHOR]

Objectives: To assess the clinical outcomes of surgical revascularization in patients diagnosed with acute lower limb ischemia (ALI). The primary outcome was defined as the limb salvage rate within 30 days after surgery. Methods: This is a retrospective single-center study. The target population was recruited from the Prapokklao Hospital database between January 2019 – December 2023. Patients who were diagnosed with acute occlusion of the artery according to the International Classification of Disease 10th Revision (ICD-10) code I74.0, I74.3, and I74.5 were identified. Medical records were analyzed for demography, clinical presentation, etiology, Rutherford severity classification, revascularization procedures, major amputation, mortality within 30 days after revascularization, and data during follow-up. Results: This study enrolled a total of 70 patients, 46 men (65.71%) and 77 affected limbs. The mean age was 65.67 years (SD 13.69 years), and the median was 65 years, ranging from 19 to 94 years. Co-morbidities: 42 (60%) hypertension, 28 (40%) peripheral arterial disease, 26 (37.14%) atrial fibrillation. Etiologies: 36 (51.43%) thrombosis (34.29% in-situ thrombosis of the native vessel) and 34 (48.57%) embolism. Rutherford classification of severity categories I, IIa, and IIb was 1 (1.42%), 21 (30.0%), and 48 (68.58%), respectively. The modalities of revascularization included 70 (100 %) thromboembolectomy with a Fogarty catheter, 30 (42.86%) intra-arterial angioplasty with balloon or stent, 8 (11.43%) bypass procedure, 6 (8.57%) endarterectomy and 8 (11.42%) fasciotomy. Technical success was 98.57 %. The mean operative time was 195.07 minutes (SD 95.51 minutes). The median hospital stay was 8 days. Post-operative complications were 8 (11.43%) bleeding, 7 (10%) compartment syndrome, 5 (7.14%) reperfusion injury, 5 (7.14%) acute kidney injury, 2 (2.86%) pneumonia and 1 (1.43%) acute myocardial infarction. The 30-day major amputation rate and mortality were 10.0% and 5.71%, respectively. At 30 days, sixty-three patients (90%) had limb salvage, and Four (5.71%) patients had died. Conclusion: Clinical outcomes following surgical revascularization for acute lower limb ischemia in our hospital showed high technical success and limb salvage rates. The limb salvage rate was 90.0%, and the mortality rate was 5.71%. [ABSTRACT FROM AUTHOR]

Tumor embolization is a well-described cause of unexpected death in human oncologic patients; however, it is poorly explored in veterinary medicine. We report a case of pulmonary tumor embolization in a dog with sudden death. During necropsy, a neoplastic mass was observed replacing the left adrenal gland and forming an intravascular thrombus within the central adrenal vein. A large embolus occluded the left pulmonary artery. The adrenal mass was histologically confirmed as a pheochromocytoma, and the embolus was constituted of neoplastic cells. Multiple smaller neoplastic emboli were observed within the pulmonary artery branches. Tumor embolization should be considered as a possible cause of sudden death in dogs, particularly in oncologic patients [ABSTRACT FROM AUTHOR]

Quercus pyrenaica Willd thrives in the intermediate zone between the Mediterranean sclerophyllous and the temperate deciduous forest. In December 2022, the presence of the bacteria Xylella fastidiosa (Xf) was confirmed in samples collected from a Quercus pyrenaica located in Sabrosa, Vila Real, Portugal. Following Xf infection, the transport of water and nutrients is hindered due to the occlusion of xylem vessels. This loss of hydraulic conductivity may lead to vessel blockage and subsequent embolism formation. The objective of this study was to investigate the interaction between Xf and Quercus pyrenaica tissues, as well as the mechanism by which the bacteria can spread through the plant's xylem vessels, ultimately resulting in the formation of vascular plugs. At the time of the sample collection (10 months post-detection), symptoms of Bacterial Leaf Scorch (BLS) began to appear. Examination of xylem vessels using both light and scanning electron microscopy (SEM) revealed the presence of various types of occlusions, predominantly tyloses. Additionally, fibrillar networks, gums, starch grains, and crystals were observed. The stem vessels exhibited significantly more occlusions compared to the leaves. Furthermore, individual bacterial cells were observed to be attached to the vessel wall. This implies that occlusions were primarily induced by tyloses and gums as a defensive response to the invasion of vascular pathogens, in addition to the pathogen itself. This study highlights the presence of starch grains in stems, which may function as a refilling mechanism, thereby preventing the loss of hydraulic conductivity in plants and potentially acting as a means to entrap the bacteria. These mechanisms exemplify the constitutive defense systems of the plant against Xf. Understanding the interaction between Xylella fastidiosa and Quercus pyrenaica is crucial, given that the latter species occupies nearly 95% of the natural distribution area of Portugal. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This prospective cohort study aimed to assess the pulmonary embolism (PE) rate and clot burden in patients with chronic obstructive pulmonary disease (COPD) exacerbation. MATERIAL AND METHODS: A total of 248 patients entered the study, and their clinical probability of PE was assessed using the Geneva score. Patients with high clinical probability underwent computed tomographic pulmonary angiography, while those with low or intermediate probability underwent a d-dimer test. RESULTS: Among the patients analyzed, 14 individuals (5.6%) were confirmed to have PE using computed tomographic pulmonary angiography. A 3-month follow-up revealed 3 cases of PE out of 232 patients initially deemed PE-free. Mortality rates were higher among patients with venous thromboembolism at admission than those diagnosed with PE during follow-up. Pulmonary embolism (PE) prevalence among patients with COPD exacerbation was 5.6%. CONCLUSION: The results of this study show the importance of screening for PE in patients with COPD presenting with dyspnea. Not all of them are due to COPD exacerbation; a small minority of them can be due to PE, which needs prompt screening, confirmation, and therapy. However, further research with larger cohorts is required to understand better the potential benefits and implications of systematic screening for pulmonary embolism in this specific patient population. [ABSTRACT FROM AUTHOR]

Fire-induced heating of stems can impair plant water transport by deforming xylem and increasing vulnerability to cavitation, but it is not clear whether these effects can result in tree death, or how quickly this may occur. In field experiments, we heated stems of Symplocos tinctoria (L.) L'Hér saplings to 90 °C using a thin-film resistive heater, and we monitored stomatal conductance, leaf water potential, sap flow and hydraulic conductivity until stem death. Sap flow and stomatal conductance declined quickly after heating, while whole-plant hydraulic conductance and leaf water potential remained high for the first week. In fact, leaf water potential increased during the first days after heating, indicating that stomatal closure was not initially caused by leaf water deficit induced by impaired water transport. After 1 week, leaf water potential and whole-plant conductance declined below unheated controls, while stomatal conductance and sap flow continued declining, approaching zero after 2 weeks. To better understand the cause of these declines, we directly measured hydraulic conductivity of heated stems. Stems underwent a progressive decline in conductivity after heating, and by the time that samples were severely wilted or desiccated, the heated portion of stems had little or no conductivity. Importantly, conductivity of heated stems was not recovered by flushing stems to remove embolisms, suggesting the existence of physical occlusions. Scanning electron micrographs did not reveal deformed cell walls, nor did it identify alternative causes of blockages. These results reveal that stem heating can result in xylem dysfunction and mortality, but neither response is immediate. Dysfunction was likely caused by wound responses rather than embolism, but improved understanding of the mechanisms of heat-induced hydraulic failure is needed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To characterize patients with methylmethacrylate embolism. METHODOLOGY: Systematic literature search of clinical cases according to the PRISMA 20 statement and the Cochrane Handbook of Systematic Reviews of Interventions (version 5.1.022). The population with a diagnosis of embolism or vascular complications due to bone cement (methyl methacrylate) reported in publications from 1992 to 2019 was included, with analysis of sociodemographic, clinical, and paraclinical characteristics. RESULTS: The most common procedure was vertebroplasty (77%), mostly in women (74.3%); 63.5% were symptomatic patients and the pulmonary artery was the most common site (89.2%). All patients received anticoagulants and the mortality rate was 9%. CONCLUSIONS: Women have a higher risk of methylmethacrylate embolism after interventions such as vertebroplasty, with a higher prevalence of pulmonary clinical presentation due to embolus at this level and detected postoperatively; however, unlike what is described in the literature, there was a higher incidence of symptomatic patients. In the reported cases, medical treatment consisted of the administration of anticoagulants, mainly heparin, so that the reported mortality figures were low. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although retroperitoneal bleeding and massive hematuria are potential complications of angiomyolipoma (AML), the pulmonary embolism as a presenting symptom is extremely rare. It is important to be aware that benign AMLs can present with pulmonary fat embolism. [ABSTRACT FROM AUTHOR]

The objective of the study was to assess the short- and long-term mortality of infective endocarditis (IE) among people who inject drugs (PWID). Using prospectively collected data on hospitalized patients (years 2000 through 2021) with IE, PWID were identified and included in this study. Survival analysis was performed to analyze short- and long-term mortality and study their risk factors among PWID and a matched group of non-intravenous drug users (N-IDU). In a study of 485 patients admitted for IE, 55 (11%) of them were PWID. These PWID patients were 1:1 age- and sex- matched to an N-IDU group (N = 55 per group). Both groups had similar baseline comorbid conditions, including congestive heart failure, type 2 diabetes, and neoplastic diseases. However, PWID were more likely to have HCV co-infection (62% vs 16%, respectively, p < 0.001) and advanced liver disease/cirrhosis (52% vs 7.9%, respectively, p < 0.001). IE in PWID more often affected the tricuspid valve (42% vs 22%, respectively, p = 0.024) and presented with more embolic events (66% vs 35%, respectively, p < 0.01). S. aureus was the primary cause of IE in PWID (44% vs 21%, respectively, p = 0.01). After adjusting for other variables, PWID (HR = 2.99, 95% CI [1.06, 8.43], p = 0.038) and valve bioprosthetic replacement (HR = 5.37, 95% CI [1.3, 22.1], p = 0.02) were independently associated with increased mortality risk, whereas IE caused by tricuspid valve infection was associated with reduced mortality risk (HR = 0.25, 95% CI [0.06, 0.97], p = 0.046). In this cohort, PWID had increased risk of long-term mortality after hospital discharge for IE, when compared to matched N-IDU with similar baseline characteristics. The reasons behind the significant increase in mortality warrant further investigation. [ABSTRACT FROM AUTHOR]

Abstract Resource allocation theory posits that organisms distribute limited resources across functions to maximize their overall fitness. In plants, the allocation of resources among maintenance, reproduction, and growth influences short‐term economics and long‐term evolutionary processes, especially during resource scarcity. The evolution of specialized structures to divide labor between reproduction and growth can create a feedback loop where selection can act on individual organs, further increasing specializaton and resource allocation. Ferns exhibit diverse reproductive strategies, including dimorphism, where leaves can either be sterile (only for photosynthesis) or fertile (for spore dispersal). This dimorphism is similar to processes in seed plants (e.g., the production of fertile flowers and sterile leaves), and presents an opportunity to investigate divergent resource allocation between reproductive and vegetative functions in specialized organs. Here, we conducted anatomical and hydraulic analyses on Onoclea sensibilis L., a widespread dimorphic fern species, to reveal significant structural and hydraulic divergences between fertile and sterile leaves. Fertile fronds invest less in hydraulic architecture, with nearly 1.5 times fewer water‐conducting cells and a nearly 0.5 times less drought‐resistant xylem compared to sterile fronds. This comes at the increased relative investment in structural support, which may help facilitate spore dispersal. These findings suggest that specialization in ferns—in the form of reproductive dimorphism—can enable independent selection pressures on each leaf type, potentially optimizing spore dispersal in fertile fronds and photosynthetic efficiency in sterile fronds. Overall, our study sheds light on the evolutionary implications of functional specialization and highlights the importance of reproductive strategies in shaping plant fitness and evolution.

Abstract Recent studies elucidate that coronavirus disease 2019 (COVID‐19) patients may face a higher risk of cardiovascular complications. This study aimed to evaluate association of COVID‐19 with the risk of pulmonary embolism (PE) or deep vein thrombosis (DVT). This nationwide population‐based retrospective cohort study included Korean adult citizens between January 2021 and March 2022 from the Korea Disease Control and Prevention Agency COVID‐19 National Health Insurance Service cohort. The Fine and Gray's regression with all‐cause death as a competing event was adopted to evaluate PE and DVT risks after COVID‐19. This study included a total of 1,601,835 COVID‐19 patients and 14,011,285 matched individuals without COVID‐19. The risk of PE (adjusted hazard ratio [aHR], 6.25; 95% confidence interval [CI], 3.67–10.66; p

Objectives: Infective endocarditis (IE) caused by Abiotrophia spp. and Granulicatella spp. share an increased risk of extracardiac vascular complications (EVC). The current work aims to assess the prevalence of EVC in IE due to these microorganisms. Methods: This was a study with mixed design, consisting in a single center experience combined with a systematic review of multiple databases. We included studies enrolling adults >18 years old with a diagnosis of Abiotrophia spp. and Granulicatella spp. IE. We collected data regarding the presence and the description of EVC in IE along with clinical and microbiological details. Risk of bias assessment was performed using the Newcastle-Ottawa Scale for comparative observational studies, and a dedicated tool for single-arm non-comparative studies. The review was registered in PROSPERO (CRD42023433130). Results: The cohort study identified 2 patients. The systematic review included 83 studies, involving 228 cases of Abiotrophia spp. (n = 103), Granulicatella spp. (n = 94), and unspecified nutritionally variant streptococci (n = 31) IE. EVC occurred in 101/230 (44 %) patients, central nervous system involvement occurred in 66/101 (66 % of total embolisms), and pseudoaneurysm or peripheral vascular embolization occurred in 11/101 (11 %). Conclusions: Considering the observed prevalence of EVC a proactive approach in the diagnosis of such a complication is warranted.

Of all benign neoplasms of the heart, cardiac myxomas (CM) are found in 50-90% of cases. National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine has experience in surgical treatment of 968 heart tumors. Of these, CM was observed in 868 cases. The aim. To conduct an analysis of the frequency of detection of complicated forms of CM, to present the causes and methods of diagnosis and surgical treatment of these complications. Material and methods. Pathology of the valvular apparatus combined with CM occurred in 70 (8.1%) patients: an isolated lesion of the mitral valve (MV) was observed in 27 (38.6%) patients, concomitant relative insufficiency of the tricuspid valve (TV) was found in 10 (14.3%) cases. Results. During the surgical treatment of valvular pathology, we performed valve replacement in 15 (21.4%) patients (MV in 12, TV in 1, aortic valve [AV] in 1, AV + MV in 1 patient), reconstructive operations with a positive functional effect in 50 (71.4%) patients, and isolated tumor removal from the valve apparatus in 5 (7.1%) cases. Relapses after surgical treatment of CM in our cohort of patients occurred in 1.8% cases. Among patients with sporadic myxomas of the heart, recurrence was observed in 13 cases (1.5%). If the principle of radical removal of CM followed, relapses occurred in 1.3% (10 cases out of 772). In 7 cases of myxoma syndrome, the recurrence rate was 42.5%. Embolic complications of the course of CM were determined in 58 (6.7%) cases. Damage to cerebral vessels was found in 46 (77.9%), embolisms of peripheral vessels in 10 (16.9%), and embolisms of coronary arteries in 2 (5.1%) patients. In 41 patients with CM (4.2%), a significant lesion of the coronary arteries was found, which required surgical intervention. To correct the pathology of the coronary vessels, the following was performed: stenting in 3 cases (7.3%), coronary bypass surgery in 35 (85.4%), dissection of the muscle bridge that narrowed left anterior descending artery in 2 (4.9%), left ventricular aneurysm plastic surgery in 1 case (2.4%). Conclusions. Calcium changes in left atrial myxoma were most often accompanied by mechanical damage to the leaflets and chordal apparatus of the mitral valve. Hyperthermia was a frequent manifestation of CM (56.8%). In isolated cases, the temperature reaction may be associated with the tumor infection process.

Paradoxical embolism through the foramen ovale is a rare and devastating event requiring urgent treatment. Herein, we present the case of a 23-year-old male who presented with a pulmonary embolism complicated by a left renal artery paradoxical embolism. Urgent vacuum-assisted thrombo-aspiration restored normal perfusion of the left kidney within 5 hours. The patient had a patent foramen ovale and heterozygous thrombophilia. However, a radioisotopic scan performed 2 years later revealed an unexpected decrease in left renal perfusion. Therefore, despite the angiographic success, functional evaluation using a renal scan should be performed to assess renal function.

IntroductionDrought-induced embolism formation in conifers is associated with several tracheid and pit traits, which vary in parallel from stem apex to base. We tested whether this axial anatomical variability is associated with a progressive variation in embolism vulnerability along the stem from apex to base.MethodsWe assessed the tracheid hydraulic diameter (Dh), mean pit membrane area (PMA) and the xylem pressure at 50% loss of conductivity (P50) on longitudinal stem segments extracted at different distances from the stem apex (DFA) in a Picea abies and an Abies alba tree.ResultsIn both trees, Dh and PMA scaled with DFA0.2. P50 varied for more than 3 MPa from the treetop to the stem base, according to a scaling of -P50 with DFA-0.2. The largest Dh, PMA and P50 variation occurred for DFA