We studied the effects of L-carnitine on left ventricular systolic function and the erythrocyte superoxide dismutase activity in 51 patients with ischemic cardiomyopathy. They all previously were under the treatment of angiotensin-converting enzyme Ž . inhibitor, digitalis and diuretics. Patients were randomized into two groups. In group I n s 31 , 2 grday L-carnitine was added Ž . Ž . to therapy. L-Carnitine was not given to the other 20 patients Group II . In group I mean age 64.3" 7.8 years , 27 of the Ž . patients were men, and four were women. In group II mean age 66.2" 8.7 years , 17 of the patients were men, and three were Ž . women. Twenty age-matched healthy subjects mean age: 60.1" 5.3 years constituted the control group. In each group, left Ž . ventricular ejection fraction LVEF by echocardiography and red cell superoxide dismutase activity by spectrophotometric Ž . method were measured initially and after 1 month of randomisation. Compared with normal healthy subjects n s 20 , patients Ž . Ž . ns51 had significantly higher red cell SOD activity 5633" 1225 vs. 3202 " 373 Urg Hb, P -0.001 . At the end of 1 month Ž . of L-carnitine therapy, red cell SOD activity showed an increase in group I 5918 " 1448 to 7218 " 1917 Urg Hb, P-0.05 . In Ž group II, red cell SOD activity showed no significant change after 1 month of randomisation 5190" 545 to 5234 " 487 Urg . Ž Hb, P s 0.256 . One month after randomisation there was a significant increase in LVEF in both groups I and II 37.8᎐42.3%, . P-0.001 in group I; 41.5᎐43.8%, P -0.001 in group II . The improvement in LVEF was more significant in the L-carnitine Ž . group 4.5% vs. 2.3%, P-0.01 . We conclude that, as a sign of increased free radical production, superoxide dismutase activity was further increased in patients with L-carnitine treatment. L-Carnitine treatment in combination with other traditional pharmacological therapy might have an additive effect for the improvement of left ventricular function in ischemic cardiomyopathy. ᮊ

SUMMARYTo determine whether the presence of anticardiolipin (aCL) antibodies in patients with acute coronary syndome is predictive of recurrent cardiac events in hospital stay and follow-up.The study population consisted of 80 patients with acute coronary syndrome. IgM and IgG aCL levels were determined before hospital discharge. We divided the patients into those with an aCL IgG ≥ 40 IgG phospholipid units (group I, n = 30) and those with an aCL IgG < 40 IgG phospholipid units (group II, n = 50). All patients underwent coronary angiography. Follow-up coronary angiography was performed 12 months after percutaneous coronary intervention (PCI). Infectious and autoimmune diseases were exclusion criteria. Patients were observed to determine overall mortality, reinfarction, and restenosis.There were no differences between the groups with respect to the prevalence of hypertension, diabetes mellitus, and cigarette smoking, sex, or ejection fraction. The prevalence of left ventricular thrombus was similar between the groups (group I: 16% versus group II: 16.7%, P > 0.05). Although the presence of left atrial thrombus was much more frequent in cardiolipin positive patients (13% versus 4%, respectively), the difference was not statistically significant (P = 0.19). Restenosis was observed in 40% of the cardiolipin positive patients and 14% of the cardiolipin negative patients (P < 0.01). There was no significant association between reinfarction and anticardiolipin positivity during followup (26% versus 10%, P > 0.05). In group I patients, in-hospital mortality was somewhat more frequent compared to group II patients (4% versus 10%), but the difference was not statistically significant (P = 0.27). One year mortality was similar between the groups.These results suggest that 1) restenosis occurs more frequently in anticardiolipin positive patients and 2) no association is evident between positive aCL and mortality, reinfarction, and intracardiac thrombus. (Int Heart J 2005; 46: 631-638)

Bronchial inflammatory polyps are defined as tumor-like lesions. They are usually related to chronic inflammatory processes in the adult. Because they may cause complications, they should be surgically removed. A 55-year-old male patient had been followed for recurrent pulmonary infections for 40 years. His main symptoms were orthopnea and hemoptysis upon admission to our hospital. A chest computerized tomography (CT) revealed bronchiectasis located at the right middle lobe and lower lobe and obstruction of the main bronchus at the level of carina. In bronchoscopy a mobile polypoid pinkish lesion protruding to the trachea was observed. We performed an inferior bilobectomy. The pathological examination revealed an endobronchial fibroepithelial polyp. The presence of a giant endobronchial polyp with chronic respiratory symptoms over an extended period of time and the rarity of information pertaining to these lesions in the literature provoked intrigue and constituted a worthy presentation.

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Mediastinal lymph node dissection, an important part of surgery for non-small cell lung cancer, is associated with a risk of chylothorax. Although mortality has significantly decreased in recent years, it still worries thoracic surgeons. In this report we reviewed our experience on chylothorax with 26 cases and assessed the outcomes after conservative and surgical approaches. Between January 2000 and June 2010, twenty-six patients developed chylothorax after pulmonary resection performed for non-small cell lung cancer. Initially, all cases were treated conservatively with cessation of oral intake and the application of talc poudrage. If the conservative method failed, a surgical approach was used, which consisted either of suturing the leak or of mass ligation. The mean age of patients was 56 ± 9.05 years, and 3 were female. Chylothorax was more common on the right side, in lobectomy cases, in cases with adenocarcinoma, and in patients with advanced stage lung cancer, but the difference did not reach statistical significance. Conservative treatment was successful in 19 of 26 (73 %) patients, four of whom had undergone pneumonectomy. Seven out of 26 cases (27%) required thoracotomy to control the chylous leak. Though thoracotomy was required mostly for the right side (6 right vs. 1 left, p = 0.15), and in patients who had had pneumonectomy as their first operation (4 patients vs. 3, p = 0.18), this did not reach statistical significance. No patient died as a result of surgical intervention. In conclusion, chylothorax is not rare after pulmonary resection performed for lung cancer. But it is not as dangerous as it used to be. Talc pleurodesis has increased the success of conservative management and minimized the need for surgical intervention. In cases of high output leak the surgeon should not hesitate to perform surgery. VATS can be performed instead of open surgery in suitable cases.