Segmental Duodenal Resections: Toward Defining Indications, Complexity, and Coding.

Background: Segmental resections of the duodenum are uncommonly performed and are technically challenging due to intimate relationships with the biliary tree, pancreas, and superior mesenteric vessels. The objective of this study was to assess indications, operative strategy, and outcomes of duodenal resections and to advocate that this form of resection deserves its own unique Current Procedural Terminology (CPT) and Relative Value Unit (RVU) structure.

Methods: Patients undergoing isolated and partial duodenal resection from 2008-2023 at University of Tennessee Health Science Center affiliated hospitals were retrospectively reviewed.

Peri-Ampullary Metastasis From Endometrial Adenocarcinoma: A Rare Etiology of Obstructive Jaundice.

Endometrial cancer is the commonest gynecologic malignancy, of which adenocarcinoma is the most common histologic type. While most women who relapse present with local symptoms within 3 years of the initial diagnosis, metastatic disease usually involves the abdominal cavity and liver. Herein we present a rare case of a patient with a remote history of endometrial adenocarcinoma status-post curative surgical resection and adjuvant therapy who presented with obstructive jaundice proved to be secondary to peri-ampullary metastasis of uterine adenocarcinoma.

Blocking the urotensin II receptor pathway ameliorates the metabolic syndrome and improves cardiac function in obese mice.

The metabolic syndrome is defined by the presence of hyperlipidemia, obesity, hypertension, and diabetes. The syndrome is associated with significant cardiovascular morbidity and mortality. The aim of the present study was to determine the role of the vasoactive peptide urotensin II (UII) in the pathogenesis of the metabolic syndrome.

Deregulation of Hippo kinase signalling in human hepatic malignancies.

Background/aims: Hepatocellular carcinoma (HCC), cholangiocarcinoma (CC) and hepatoblastoma (HB) are the main hepatic malignancies with limited treatment options and high mortality. Recent studies have implicated Hippo kinase pathway in cancer development, but detailed analysis of Hippo kinase signalling in human hepatic malignancies, especially CC and HB, is lacking.

Methods: We investigated Hippo kinase signalling in HCC, CC and HB using cells and patient samples.

Celiac disease autoantibodies in severe autoimmune liver disease and the effect of liver transplantation.

Background/aims: Celiac disease (CD) is associated with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis. We investigated the following: (i) the prevalence of tissue transglutaminase antibodies (tTGAs) and endomysial antibodies (EMAs) in end-stage autoimmune liver disease (ESALD), (ii) the correlation among auto-antibodies and the human leucocyte antigen (HLA) haplotype, and (iii) the effect of liver transplantation on antibody kinetics.

Methods: Pretransplantation sera from 488 patients (310 with ESALD, and 178 with non-autoimmune disease) were tested for tTGAs.

Metabotropic glutamate receptors as drug targets.

L-glutamate (Glu), the main excitatory amino acid neurotransmitter in the mammalian central nervous system, is involved in many physiological functions, including learning and memory, but also in toxic phenomena occurring in numerous degenerative or neurological diseases. These functions mainly result from its interaction with Glu receptors (GluRs). The broad spectrum of roles played by glutamate derived from the large number of membrane receptors, which are currently classified in two main categories, ionotropic (iGluRs) and metabotropic (mGluRs) receptors.

The role of swab and tissue culture in the diagnosis of implantable cardiac device infection.

Background: The isolation of a pathogen is vital in the diagnosis and treatment of a device infection. A swab culture, despite poor sensitivity, is the most common method used in specimen collection.

Objective: To determine the relative value of swab and tissue specimen cultures in patients with implantable cardiac pacemakers and defibrillators.

Successful endoscopic treatment of mediastinal pseudocysts.

Mediastinal pseudocysts can pose a diagnostic and therapeutic challenge to the clinician and surgeon. Recognizing their presence and instituting appropriate therapy can reduce morbidity and mortality. This report describes unusual clinical features in a patient presenting with multiple mediastinal pseudocysts due to pancreatic duct leak secondary to pancreatic duct stenosis and an entrapment of a pancreatic duct stone.

Relationship between successful ablation sites and the scar border zone defined by substrate mapping for ventricular tachycardia post-myocardial infarction.

Introduction: It is unknown if identification of scar border zones by electroanatomical mapping correlates with successful ablation sites determined from mapping during ventricular tachycardia (VT) post-myocardial infarction (MI). We sought to assess the relationship between successful ablation sites of hemodynamically stable post-MI VTs determined by mapping during VT with the scar border zone defined in sinus rhythm.

Methods And Results: Forty-six patients presenting with hemodynamically stable, mappable monomorphic VT post-MI and who had at least one such VT successfully ablated were prospectively included in the study.

The need for atrial flutter ablation following pulmonary vein antrum isolation in patients with and without previous cardiac surgery.

Objectives: The aim of this study was to assess the incidence of atrial flutter (AFL) after pulmonary vein antrum isolation (PVAI) in patients with previous cardiac surgery (PCS) in comparison to patients without PCS and to assess the need for AFL ablation in both groups.

Background: Atrial fibrillation (AF) and AFL often co-exist. Pulmonary vein antrum isolation may be sufficient to control both arrhythmias.

Response to pharmacological challenge of dissociated pulmonary vein rhythm.

Unlabelled: Dissociated pulmonary vein rhythm.

Introduction: Characterization of the electrophysiologic behavior of the pulmonary vein (PV) triggers initiating atrial fibrillation (AF) is still lacking. We conducted the current study to evaluate the behavior of the dissociated PV rhythm (PVD) observed after electrical disconnection from the left atrium of the PV responsible for initiation of AF.

Pre-existent left atrial scarring in patients undergoing pulmonary vein antrum isolation: an independent predictor of procedural failure.

Objectives: The goal of this study was to assess the impact of left atrial scarring (LAS) on the outcome of patients undergoing pulmonary vein antrum isolation (PVAI) for atrial fibrillation (AF).

Background: Left atrial scarring may be responsible for both the perpetuation and genesis of AF.

Methods: A total of 700 consecutive patients undergoing first-time PVAI were studied.

Prevalence, predictors, and mortality significance of the causative arrhythmia in patients with electrical storm.

Introduction: Electrical storm (ES) is characterized by either refractory ventricular tachycardia (VT) or ventricular fibrillation (VF). However, little is known about the prevalence, predictors, and mortality implications of the causative arrhythmia in ES. We sought to assess the prevalence, predictors, and survival significance of VT and VF as the causative arrhythmia of ES in implantable cardioverter defibrillator (ICD) patients.

Primary biliary cirrhosis: an infectious disease caused by Chlamydia pneumoniae?

Background/aims: The etiology and pathogenesis of primary biliary cirrhosis (PBC) remain elusive. Both an infectious etiology and molecular mimicry have been implicated. The aim is to study the prevalence of Chlamydial antigens and RNA in the liver tissue of patients with PBC.

Pulmonary vein isolation for the treatment of atrial fibrillation in patients with impaired systolic function.

Objectives: We aimed to determine the safety and efficacy of pulmonary vein isolation (PVI) in atrial fibrillation (AF) patients with impaired left ventricular (LV) systolic function.

Background: To date, PVI has been performed primarily in patients with normal LV function. Yet, many AF patients have impaired LV systolic function.

Randomized study comparing combined pulmonary vein-left atrial junction disconnection and cavotricuspid isthmus ablation versus pulmonary vein-left atrial junction disconnection alone in patients presenting with typical atrial flutter and atrial fibrillation.

Background: Atrial flutter (AFL) and atrial fibrillation (AF) frequently coexist in the same patient. Recently it has been demonstrated that the triggers for both AF and AFL may originate in the pulmonary veins (PVs). We hypothesized that in patients with both AF and typical AFL, pulmonary vein-left atrial junction (PV-LAJ) disconnection may eliminate both arrhythmias.

Nonthoracotomy implantable defibrillator lead extraction: results and comparison with extraction of pacemaker leads.

Extraction of pacemaker leads has been demonstrated to be successful and safe in experienced hands using current tools. Whether application of such techniques and tools yield similar results among patients undergoing extraction of nonthoracotomy implantable defibrillator leads is unknown. This report describes a retrospective analysis of indications, techniques used, and outcome of patients who had a single ventricular nonthoracotomy implantable defibrillator lead extracted at The Cleveland Clinic Foundation.

Hepatitis B virus enhances tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) cytotoxicity by increasing TRAIL-R1/death receptor 4 expression.

Background/aims: Apoptosis by death receptors, such as Fas and tumor necrosis factor (TNF)-alpha receptor-1, play a significant role in the pathogenesis of hepatitis B virus (HBV)-infections. Although liver also expresses death receptors for TNF-related apoptosis-inducing ligand (TRAIL), information is lacking regarding the effects of HBV on apoptosis by TRAIL. Thus, the aims of this study were to examine the effects of HBV replication on TRAIL cytotoxicity.

Phased-array intracardiac echocardiography monitoring during pulmonary vein isolation in patients with atrial fibrillation: impact on outcome and complications.

Background: The objective of this study was to assess the impact of intracardiac echocardiography (ICE) on the long-term success and complications in patients undergoing pulmonary vein isolation (PVI) for treatment of atrial fibrillation (AF).

Methods And Results: Three hundred fifteen patients underwent PVI for treatment of AF. Each patient underwent ostial isolation of all PVs using a cooled-tip ablation catheter.

The large GTPase dynamin is required for hepatitis B virus protein secretion from hepatocytes.

Background/aims: The hepatocellular transport pathways and cellular proteins utilized during the packaging and secretion of hepatitis B virus are poorly understood. In this study, we tested if the large GTPase dynamin, a protein involved in vesicle formation and secretion at the trans-Golgi network in hepatocytes, is also used by hepatitis B virus (HBV) in secreting viral proteins.

Methods: Using HepG2.

Etiology of nonresponsive celiac disease: results of a systematic approach.

Objectives: Nonresponse or relapse of symptoms is common in patients with celiac disease treated with gluten free diet. Refractory sprue (RS) is defined as initial or subsequent failure of a strict gluten-free diet to restore normal intestinal architecture and function in patients who have celiac-like enteropathy. The aims of this study were: 1) to identify causes of persistent symptoms in patients referred with presumed diagnosis of nonresponsive celiac disease (NCD); and 2) to characterize patients with true RS.

Nonexcitatory stimulus delivery improves left ventricular function in hearts with left bundle branch block.

Introduction: Preliminary data in a heart failure animal model and isolated muscle preparation have suggested that nonexcitatory stimulation (NES) improves left ventricular (LV) function.

Methods And Results: We compared biventricular (BV) pacing with NES in an animal model with left bundle branch block (LBBB). The left bundle branch (LBB) was ablated in eight normal heart pigs and led to >50% increase in QRS duration (mean 100 +/- 15 msec).