An 82-year-old man was found dead on the road near his home with unwitnessed interval of 3 h from final witness. He had been diagnosed with hypertension and mild aortic stenosis (AS) 13 years before death, and was continuously followed up with medication. Although a recent medical check-up related to cardiac function was stable and consistent with moderate AS, he sometimes complained of general fatigue, anorexia associated with intermittent mild fever and rare vomiting in the weeks before death. At autopsy, no lethal injury or drug intoxication was found, but congenital bicuspid aortic valve (BAV) with central rache was found. Although calcification was found in a restricted area of one cusp, valvular structural deformity was clearly milder than in typical severe AS cases. Moderate left ventricular hypertrophy without coronary disease was found. A brownish-red, soft nodular lesion was found in both adrenal glands, but no other tumorous focus was evident in any other organs. Immunohistochemical examination showed that B-lymphocyte-derived markers (CD20, melanoma associated antigen (mutated) 1, and CD79a) were exclusively positive. Therefore, we diagnosed primary adrenal lymphoma (PAL), diffuse large B-cell lymphoma phenotype. We concluded that the cause of sudden unexpected death (SUD) was adrenal insufficiency associated with PAL, with a background of moderate AS related to BAV.

In this study, a simple and efficient diagnostic system, which adopts a novel methodology consisting of principal component analysis (PCA)-based feature generation and ellipse models-based classification criterion, is proposed for the diagnosis of a ventricular septal defect (VSD). The three stages corresponding to the diagnostic system implementation are summarized as follows. In stage 1, the heart sound is collected by 3M-3200 electronic stethoscope and is preprocessed using the wavelet decomposition. In stage 2, the PCA-based diagnostic features, [[Formula: see text]], are generated from time-frequency feature matrix ([Formula: see text]). In the matrix TFFM, the time domain features [Formula: see text] are firstly extracted from the time domain envelope [Formula: see text] for the filtered heart sound signal [Formula: see text], and frequency domain features, [Formula: see text], are subsequently extracted from a frequency domain envelope ([Formula: see text]) for each heart sound cycle automatically segmented via the short time modified Hilbert transform (STMHT). In stage 3, support vector machines-based classification boundary curves for the dataset [Formula: see text] are first generated, and least-squares-based ellipse models are subsequently built for the classification boundary curve. Finally, based on the ellipse models, the classification criterion is defined for the diagnosis of VSD sounds. The proposed diagnostic system is validated by sounds from the internet and by sounds from clinical heart diseases. Moreover, comparative analysis to validate the usefulness of the proposed diagnostic system, mitral regurgitation and aortic stenosis sounds are used as examples for detection. As a result, the higher classification accuracy, which is achieved by this study compared to the other methods, is [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text] for diagnosing small VSD, moderate VSD, large VSD and normal sounds, respectively.

The patient population in desperate need for an airway substitute are individuals with long segment tracheal defects that are considered, technically, inoperable. Regardless of the underlying etiology, benign or malignant growing processes, this patient category enters a palliative setting or require tracheal transplantation. Different airway substitutes have been categorized by Grillo as follows; tracheal transplantation, autogenous tissue, non-viable tissue, tissue-engineering and foreign materials. These fields have been explored in the past in animal models and in clinical patients. Research on airway replacement has been exposed to a level of controversies in the past years. The field has been turbulent and apocryphal. In particular, the area of tissue-engineering using stem cells has suffered from a major set-back leaving scientists, clinicians and ethical committees skeptical. Recently, a hopeful study emerged using aortic allografts as tracheal substitutes in patients with airway defects. The initial results seem promising and reliable. The developments of the field at this point seem striking and hopeful. The focus of this review is to shed light on developments in the field of aortic allografts as substitute for tracheal replacement.