A 78-year-old woman complaining of suddenly developed numbness and coldness of the left hand was referred to our hospital on the suspicion of embolism. A 2×1cm mass was revealed in the fossa ovalis of the interatrial septum by echocardiography. She underwent operation under a preoperative diagnosis of thrombus in the left atrium or tumor of the interatrial septum. In the operation, the mass was excised including the interatrial septum and the defect of the interatrial septum was closed with a PTFE patch. A sagittal section of the mass showed that it was a fresh thrombus covered with normal endocardium of the fossa ovalis except for a small protrusion to the left atrial cavity. These findings yielded diagnosis of thrombus trapped in a patent foramen ovale. She was discharged after an uneventful postoperative course, although temporary pacing was needed for transient bradycardia in the early postoperative days. In this case, we hypothesize that an unidentified venous thrombus trapped in a patent foramen ovale had partly passed through the interatrial septum and caused paradoxical embolism in the left hand. Paradoxical embolism is a well-known phenomenon described in a number of reports. There are some reports of a trapped thrombus in a patent foramen ovale detected by echocardiography or in autopsy. We describe a rare case of surgical demonstration of a trapped thrombus in a patent foramen ovale, and recommend that examinations for venous thrombus with a suspicion of paradoxical embolism are necessary for patients of thromboembolism.

Protamine has been widely used as a pharmaceutical product and natural food preservative. However, few studies have been conducted to assess the beneficial function of dietary protamine. This study examined the effects of dietary salmon protamine on serum and liver lipid levels and the expression levels of genes encoding proteins involved in lipid homeostasis in the liver of rats. Groups of male Wistar rats were fed AIN93G diet containing 2% or 5% protamine. After 4 weeks of feeding these diets, markedly decreased serum and liver cholesterol (CHOL) and triacylglycerol levels were noted. Increased activity of liver carnitine palmitoyltransferase-2 and acyl-CoA oxidase, which are key enzymes of fatty acid beta-oxidation in the mitochondria and peroxisomes, was found in rats fed on protamine. Furthermore, rats fed protamine showed enhanced fecal excretion of CHOL and bile acid and increased liver mRNA expression levels of ATP-binding cassette (ABC) G5 and ABCG8, which form heterodimers and play a major role in the secretion of CHOL into bile. The decrease in triacylglycerol levels in protamine-fed rats was due to the enhancement of liver beta-oxidation. Furthermore, rats fed protamine exhibited decreased CHOL levels through the suppression of CHOL and bile acid absorption and the enhancement of CHOL secretion into bile. These results suggest that dietary protamine has beneficial effects that may aid in the prevention of lifestyle-related diseases such as hyperlipidemia and atherosclerosis.
Absorption ; Acyl-CoA Oxidase ; Animals ; Atherosclerosis ; Bile ; Carnitine ; Cholesterol ; Diet ; Homeostasis ; Humans ; Hyperlipidemias ; Lipid Metabolism ; Liver ; Male ; Mitochondria ; Peroxisomes ; Proteins ; Rats ; Rats, Wistar ; RNA, Messenger ; Salmon ; Triglycerides