Double-chambered right ventricle in an adult patient diagnosed by transthoracic echocardiography

Abstract Background Double-chambered right ventricle is a rare congenital disease frequently misdiagnosed in the adult patient. An anomalous muscle band divides the right ventricle in two cavities causing variable degree of obstruction. Although echocardiography is considered a useful method for the diagnosis of this pathology in children, it has been recognized the transthoracic scanning limitation in adults. Case presentation A 29 year-old patient with double-chambered right ventricle presenting mild exercise intolerance referred for follow up of a known ventricular septal defect in whom a complete diagnosis was obtained based only on transthoracic two dimensional echocardiography without the needing of cardiac catheterization. Conclusion Based on non invasive echocardiographic diagnosis, patient was referred to surgical correction, which was completely successful.

Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC), right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA) flow pattern and flow reserve (CFR) are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire) data was obtained in RCA and left anterior descendent coronary artery (LAD) before and after adenosine. Resting RCA phasic pattern (diastolic/systolic) was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV) dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress) more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS) either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS); RCA vs. LAD was 1.35 vs. 2.85 (p < 0.001). It had no significant correlation among any cardiac mechanical or hemodynamic parameter with RCA-CFR or RCA flow pattern. RCA-CFR had no difference compared with LAD (3.38 vs. 3.34, p = NS), as well as in pulmonary hypertension (3.09 vs. 3.10, p = NS) either in RV dysfunction (3.06 vs. 3.22, p = NS) subgroups. Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or hemodynamic parameter with RCA-CFR or RCA phasic flow pattern. RCA flow reserve is still similar to LAD, independently of those right-sided cardiac disturbances.

Isolated right atrial appendage (RAA) rupture in blunt trauma – a case report and an anatomic study comparing RAA and right atrium (RA) wall thickness

Abstract Background Heart chambers rupture in blunt trauma is uncommon and is associated with a high mortality. The determinant factors, and the incidence of isolated heart chambers rupture remains undetermined. Isolated rupture of the right atrium appendage (RAA) is very rare, with 8 cases reported in the reviewed literature. The thin wall of the RAA has been presumed to render this chamber more prone to rupture in blunt trauma. Objective To report a case of isolated RAA rupture in blunt trauma, and to compare right atrium (RA) and RAA wall thickness in a necropsy study. Methods The thickness of RA and RAA wall of hearts from cadavers of fatal penetrating head trauma victims was measured. Our case of isolated RAA rupture is presented. The main findings of the 8 cases reported in the literature, and the findings of our case, were organized in a table. Result The comparison of the data showed that wall thickness of the RAA (0.53 ± 0.33 mm) was significantly thinner than that of RA (1.11 ± 0.42 mm) (p < 0.05). Comments In all these 9 cases of isolated RAA rupture, cardiac tamponade occurred, RAA rupture was diagnosed intraoperatively and sutured, and the patients survived. Main mechanisms hypothesized for heart chamber rupture include mechanical compression coincident with phases of cardiac cycle, leading to high hydrostatic pressure inside the chamber. Published series include numerous cases of RA rupture, and only a few cases of RAA rupture. Conclusion Thus, our data suggests that wall thickness is not a determinant factor for RA or RAA rupture in blunt trauma.

Infective endocarditis with left to right intracardiac fistula due to Streptococcus anginosus - a rare complication caused by an even rarer bacterium

Although infective endocarditis (IE) has been described in reports dating from the Renaissance, the diagnosis still challenges and the outcome often surprises. In the course of time, diagnostic criteria have been updated and validated to reduce misdiagnosis. Some risk factors and epidemiology have shown dynamic changes since degenerative valvular disease became more predominant in developed countries, and the mean age of the affected population increased. Despite streptococci have been being well known as etiologic agents, some groups, although rare, have been increasingly reported (e.g., Streptococcus milleri.) Intracardiac complications of IE are common and have a worse prognosis, frequently requiring surgical treatment. We report a case of a middle-aged diabetic man who presented with prolonged fever, weight loss, and ultimately severe dyspnea. IE was diagnosed based on a new valvular regurgitation murmur, a positive blood culture for Streptococcus anginosus, an echocardiographic finding of an aortic valve vegetation, fever, and pulmonary thromboembolism. Despite an appropriate antibiotic regimen, the patient died. Autopsy findings showed vegetation attached to a bicuspid aortic valve with an associated septal abscess and left ventricle and aortic root fistula connecting with the pulmonary artery. A large thrombus was adherent to the pulmonary artery trunk and a pulmonary septic thromboemboli were also identified.

The notion of equivalence and lexical cohesion in the translation of political speeches

Abstract This dissertation investigates the notion of equivalence with particular reference to lexical cohesion in the translation of political speeches. Lexical cohesion poses a particular challenge to the translators of political speeches and thus preserving lexical cohesion elements as one of the major elements of cohesion is undoubtedly crucial to their translation equivalence. We rely on Halliday’s (1994) classification of lexical cohesion which comprises: repetition, synonymy, antonymy, meronymy and hyponymy. Other traditional models of lexical cohesion are examined. We include Grammatical Parallelism for its role in creating textual semantic unity which is what cohesion is all about. The study shed light on the function of lexical cohesion elements as rhetorical device. The study also deals with lexical problems resulting from the transfer of lexical cohesion elements from the SL into the TL, which is often beset by many problems that most often result from the differences between languages. Three key issues are identified as being fundamental to equivalence and lexical cohesion in the translation of political speeches: sociosemiotic approach, register analysis, rhetoric, and poetic function. The study also investigates the lexical cohesion elements in the translation of political speeches from English into Arabic, Italian and French in relation to ideology, and its control, through bias and distortion. The findings are discussed, implications examined and topics for further research suggested.

The problems of equivalence in advertising translation: examples from English and Russian

Abstract The academic environment has recently recognized the importance and benefits that an extensive research on the translation of advertising can have for translation studies. Despite the growing interest and increasing research activity in the field it is still difficult to speak about a theory of advertising translation in general. There is a need for further study encompassing different languages and both heterogeneous and homogenous cultures that will give the possibility to receive a more complete map of what the translation of advertising is and should be. Previous studies have been concentrated, for the most part, on Western European language pairs. This study is a research into perfume and cosmetics print advertisements translated from English into Russian where both visual and verbal elements are considered. Three broad translation approaches have been identified in what concerns the verbal message: Translated message, parallel translation, recreated adverts, and three approaches in dealing with the image: similar images, modified images, completely different images. The thesis shows that where Russian advertisements for perfume products tend to have a message, or create one, this is often lacking in the English copy. The article ends by suggesting that perfume advertisements favor the standardization approach when entering Russian market. The attempts to localize the advert have also been noticed although they are obviously less numerous in perfume adverts and are rather instances of adaptation - a mix between the localization and standardization approaches since they keep drawing on the same globally accepted universals about female beauty and concern for ‘woman’s identity’ (we focused our analysis on products designed for female consumers). This study, complementing previous studies, aims to be a contribution to the description of laws and strategies that guide the translation of advertising texts into Russian.

Non invasive assessment of right ventricle in patients with operated tetralogy of Fallot

The objective of this study was to evaluate right ventricular function in patients with right ventricular volume overload in patients with (tetralogy of Fallot, and pulmonary atresia + VSD ) underwent corrective surgery; with echocardiography measure that can be easily applied; and to study the relationship between ProBNP and the contractile function of the right ventricle, dilated right atrium, and the consequences of pulmonary insufficiency . Methods: The study included 50 patients (50% males, mean age 30.64 ± 13.30 years) with prior cardiac surgical intervention of TDF (90%) or pulmonary atresia + VSD (10%). (49 pz) have performed a cardiac MRI and clinical evaluation, (47 pz) echocardiogram, (48 pz) ECG, (34 pz) a cardiopulmonary exercise testing, (29 pz) a dosage of ProBNP. Results: The S-wave velocity (p <0.0001), the TAPSE (p <0.0001) correlated significantly with RVEF estimated by cardiac MRI. The VO2 max was 27.93 ± 12.91 ml / kg / min, 15% of patients had VE/VCO2 The peak> 35. ProBNP correlated positively and significantly with the area of the right atrium (p = 0.0001), and negative and significant with VO2 max (p = 0.04). Those who have increased pulmonary insufficiency (PVR fraction> 30%) have a significantly increased RVED volume (p = 0.01), reduced VO2 max (p = 0.04), and lower ejection fraction of LV (p = 0.02) than the group of patients with PVR ≤ 30. Conclusion: The TAPSE and S-wave velocity are fundamental and may become the technique of choice for routine assessment of RV systolic function in adult patients with TOF. The monitoring of the Pro BNP is probably a choice, given the simplicity and their information that correlate with the test cardiopulmonary. In view of the ventricular-ventricular interaction, so measures to maintain or restore the functioning of the pulmonary valve could preserve biventricular function.

The Right to Voice: Its Realization by Estonian and American Parents in Public Schools

Investigating parents’ formal engagement opportunities in public schools serves well to characterize the relationship between states and societies. While the relationship between parental involvement and students’ academic success has been thoroughly investigated, rarely has it been seen to indicate countries’ governing regimes. The researcher was curious to see whether and how does parents’ voice differ in different democracies. The hypothesis was that in mature regimes, institutional opportunities for formal parental engagement are plenty and parents are actively involved; while in young democracies there are less opportunities and the engagement is lower. The assumption was also that parental deliberation in expressing their dissatisfaction with schools differs across democracies: where it is more intense, there it translates to higher engagement. Parents’ informedness on relevant regulations and agendas was assumed to be equally average, and their demographic background to have similar effects on engagement. The comparative, most different systems design was employed where public middle schools last graders’ parents in Tartu, Estonia and in Huntsville, Alabama the United States served as a sample. The multidimensional study includes the theoretical review, country and community analyses, institutional analysis in terms of formal parental involvement, and parents’ survey. The findings revealed sizeable differences between parents’ engagement levels in Huntsville and Tartu. The results indicate passivity in both communities, while in Tartu the engagement seems to be alarmingly low. Furthermore, Tartu parents have much less institutional opportunities to engage. In the United States, multilevel efforts to engage parents are visible from local to federal level, in Estonia similar intentions seem to be missing and meaningful parental organizations do not exist. In terms of civic education there is much room for development in both countries. The road will be longer for a young democracy Estonia in transforming its institutional systems from formally democratic to inherently inclusive.

„Let ´em have it – right on the chin.“ – Die Haltung der britischen Öffentlichkeit zum RAF-Flächenbombardement 1939-1945

In „’Let ‘em have it – right on the chin.’ – Die Haltung der britischen Öffentlich-keit zum RAF-Flächenbombardement 1939-1945“ wird durch die Untersuchung der vier Tageszeitungen Times, Manchester Guardian, Daily Express und Daily Mirror sowie der wöchentlichen Berichte des britischen Informationsministeriums nachgewiesen, dass 1942 ein Konsens in der britischen Öffentlichkeit für Flächenbombardements eintrat. Diese Einigkeit entstand aufgrund der Kriegssituation, sozialpsychologischer Mechanismen und realpolitischer Erwägungen und verfestigte sich 1943 und zum Teil auch 1944 deutlich. Die öffentliche Meinung kehrte sich in den drei Jahren zwischen 1940 und 1943 vollständig um und wandelte sich 1944 erneut: Während 1940 die Mehrheit gegen die Bombardierung der deutschen Zivilbevölkerung eingestellt war, fand in den folgenden drei Jahren eine Entwicklung statt, die 1943 in den Konsens, 1944 aber in die Tabuisierung des Themas mündete. Dabei verstärkten insbesondere zwei Argumente den Prozess der Konsensbildung: Nachdem bis Anfang 1941 die Bedeutung der Begrifflichkeiten so weit vereinheitlicht worden war, dass beispielsweise die Mehrheit der Briten etwas mit dem Ausdruck „Flächenbombardement“ anfangen konnte, setzte sich im Laufe des Jahres 1940 – in Presse und Bevölkerung parallel – ein Feindbild durch, das das gesamte deutsche Volk in Haftung nahm und es insofern auch für die deutschen Luftangriffe auf Großbritannien verantwortlich machte. Erst daraus erwuchs die Rechtfertigung für die Forderung nach Vergeltung, die durch diese Begründung von bloßen Rachegelüsten losgelöst werden konnte. Seit dem deutschen Angriff auf die Sowjetunion im Juni 1941 galten Flächenbombardements – hier folgten Bevölkerung und Presse der britischen Regierung – außerdem als Vorbereitung für die Westoffensive. Eine Mehrheit sprach sich schon 1941 für Flächenbombardements aus, mit den großen Angriffen 1942 und vor allem 1943 war der Konsens dann so vollständig erreicht, dass kritische Stimmen fast gänzlich verstummten. Als mit der alliierten Landung in der Normandie 1944 ein wichtiges Argument für die Notwendigkeit von Flächenbombardements wegfiel, setzte eine Tabuisierung des Themas ein, die sich 1945 verfestigte. Insgesamt beleuchtet die Arbeit, durch welche Faktoren in einer Kontroverse eine gesellschaftliche Einigkeit im Großbritannien der frühen vierziger Jahre erzeugt wurde. Dieser Zusammenhalt war notwendig, um die Handlungsfähigkeit der Gesellschaft zu gewährleisten, so dass sich der Konsens in der Kriegssituation als wichtige Überlebensstrategie erwies. Erreicht wurde er aber auf Kosten des für eine demokratische Gesellschaft auch charakteristischen Pluralismus von Meinungen und Einstellungen.

[Right-sided lower abdominal pain and diarrhea of a young diabetic woman]

We report the case of a 24-years old diabetic women hospitalised because of right-sided lower abdominal pain and diarrhea. She fulminantly developed shock before appendectomy could be performed and was transferred to intensive care unit. Hypotension remained and laparoscopy revealed primary peritonitis and toxic shock syndrome by Group A Streptococcus which was cultivated in blood and ascites. Therapy with penicilline and clindamycine resolved symptoms. During hospitalisation Clostridium difficile colitis occurred. This complication leaded to prolonged hospitalisation.

Right ventricular systolic function and cardiac resynchronization therapy

AIMS: The effect of cardiac resynchronization therapy (CRT) on right ventricular ejection fraction (RVEF) has not been well studied. Furthermore, it is unclear whether baseline RVEF influences response to CRT. To evaluate the acute and chronic effects of CRT on right ventricular systolic function, and to investigate whether baseline RVEF impacts response to CRT. METHODS AND RESULTS: Forty-four patients with a standard indication for CRT underwent radionuclide angiography at baseline and after at least 6 months' follow-up for measuring RVEF, right ventricular synchrony (using phase analysis), and left ventricular ejection fraction (LVEF). In addition, NYHA functional class and 6-min walking distance (6MWD) were evaluated. There were no significant acute changes in RVEF with CRT. After a mean follow-up of 9 +/- 5 months, RVEF was slightly improved (by 1.9 +/- 5.0% in absolute terms, P = 0.016), and to a lesser extent than LVEF (5.1 +/- 9.0%, P = 0.009 compared with RVEF). Right ventricular dyssynchrony was significantly improved at follow-up (P = 0.016). Patients with a baseline RVEF < or = 0.35 (n = 19) were less likely to improve in NYHA class (P = 0.016), and also tended to improve less in 6MWD and LVEF (P < 0.06). CONCLUSION: Cardiac resynchronization therapy has no acute effect on RVEF, and only slightly improves RVEF at follow-up. Patients with reduced RVEF at baseline were less likely to respond to CRT, indicating that right ventricular systolic dysfunction may play a role in patient selection.