Aortic Elastic Properties of Patients with Neurocardiogenic Syncope

Objective: Neurocardiogenic syncope (NCS) is a common clinical problem; however, hemodynamic mechanism is not clearly understood. Aim of the present study was to investigate aortic elastic parameters of patients with NCS provoked by head‐up tilt test. Material and Method: We conducted a prospective study of 40 cases referred to our institution for head‐up tilt testing. Group I constituted as 22 patients who developed mixed response and were enrolled for analysis. Hemodynamic data were compared with subjects of negative head‐up tilt test (Group II). Aorta‐diastolic and aorta‐systolic diameters, aortic strain, aortic distensibility, aortic elastic modulus, and aortic stiffness index were calculated from transthoracic echocardiographically derived diameters of thoracic aorta. Results: Aortic distensibility (mean ± SD; 2.7 ± 1.2 cm²× dyn^?1× 10^?6 vs 4.0 ± 1.2 cm²× dyn^?1× 10^?6, P = 0,003) and aortic strain index (mean ± SD; 7.0 ± 1.8% vs 8.7 ± 2.9%, P = 0.042) were lower, and aortic stiffness index (mean ± SD; 27.6 ± 10.9 vs 20.9 ± 6.18, P = 0.035) and aortic elastic modulus (mean ± SD; 0.94 ± 0.7 cm²× dyn^?1× 10^?6 vs 0.49 ± 0.1 cm²× dyn^?1× 10^?6, P = 0.009) were higher in patients in Group I compared with those in Group II. There was no difference between two groups for following clinical variables: aorta‐diastolic and aorta‐systolic diameters, systolic and diastolic blood pressure, pulse pressure, E/A, weight, height, and body mass index. Conclusions: Findings of this study have shown that elastic properties of aorta are impaired in patients with NCS. The data suggest that increase in aortic stiffness might be one of the determinants responsible for NCS. This proposal of novel link should be confirmed in further studies.     

New concept parameters of RigiScan in differentiation of vascular erectile dysfunction: Is it a useful test?

BACKGROUND: The aim of this study is to investigate the value of new nocturnal penile tumescence recording parameters, such as tumescence activity unit and rigidity activity unit values, total erection number and erection times, in differentiating between psychogenic erectile dysfunction and organic erectile dysfunction. We also aimed to determine the role of these parameters in differentiating arterial erectile dysfunction from veno-occlusive dysfunction. METHODS: Eighty-seven consecutive patients were allocated into three groups as psychogenic, arterial and venous erectile dysfunction after investigations. Nocturnal penile tumescence recording parameters between psychogenic and vascular erectile dysfunction and arterial and veno-occlusive dysfunction were compared. Mann-Whitney U-test, Pearson's chi2 test and correlation coefficient tests were used for statistical analysis. RESULTS: Depending on intracavernous injection, penile Doppler ultrasonography and cavernosometry tests, 37 patients (43%) had psychogenic impotence while 50 (57%) had organic pathologies. Of the 50 patients diagnosed with vascular impotence, 29 (48%) had arterial failure and 21 (42%) had veno-occlusive dysfunction. Nocturnal penile tumescence recording revealed psychogenic erectile dysfunction in 34 patients (39%) and vascular erectile dysfunction in 53 patients (61%). Nocturnal penile tumescence recording has been regarded as the gold standard and, in our series, it showed 90.6% sensitivity and 88.2% specificity in differentiating the cause of erectile dysfunction. Values of rigidity activity unit and tumescence activity unit were significantly higher in patients with psychogenic impotence (P < 0.001), when compared with vascular impotence. In patients with a vascular cause, no difference was found between arterial failure and veno-occlusive dysfunction with regard to tip tumescence activity unit, base tumescence activity unit, tip rigidity activity unit, base rigidity activity unit and erection time (P > 0.001). However, patients with arterial failure had less erection than patients with veno-occlusive dysfunction (P < 0.001). CONCLUSION: New recording parameters of nocturnal penile tumescence can differentiate organic and psychogenic erectile dysfunction more precisely. However, these recording parameters cannot distinguish subgroups with a vascular cause of erectile dysfunction.     

小儿上尿路结石286例临床分析

目的:进一步探讨新疆地区小儿泌尿系结石的临床特征.方法:对收治的286例小儿上尿路结石患儿的临床资料进行分析.其有明显的区域、族群分布和结石成分特征;均经影像学确诊;239例行开放手术取石治疗.结果:开放手术取石239例,一次取尽结石率89.0%,术后2～12年复发41(14.3%)例,术中术后未发现严重并发症.结论:影像学检查是诊断小儿泌尿系结石的主要手段,磁共振尿路成像对小儿尿路结石形态诊断,具有较好的实用性和优越性;开放手术适应证广、技术成熟,仍是目前小儿泌尿系结石的主要治疗方法.     

Fibroepithelial polyp originating from the glans penis in a child

A fibroepithelial polyp is a benign neoplasm that occurs throughout the urinary tract. In this article, we report a pediatric case of a fibroepithelial polyp originating from the glans penis. To our knowledge, this is a previously unreported lesion arising from the glans penis.     

Urinary tract involvement in a child with epidermolysis bullosa simplex

Epidermolysis bullosa is a rare disorder which may present various systemic involvement. We present a 15-month-old boy with epidermolysis bullosa simplex who was admitted with symptoms of hematuria and dysuria and discuss the pathology from a urological standpoint.     

Comparison of Atrial Leads: Importance of Polarity and Fixation Mechanism

To compare the influence of polarity and fixation mechanism on atrial leads, we evaluated acute implantation and 12-month follow-up results in 211 patients, 138 male and 73 female, aged 63 ± 14 years, implanted with DDD (210) and AAI (1) pacemakers. Eighty patients had bipolar (B) active fixation (AF) leads (CPI-4266), 71 had unipolar (U) AF (Medtronic-6957J), 36 had B passive fixation (PF) (Medtronic-4512), and 26 had U PF (Medtronic-4511) leads. Acutely, capture thresholds were higher in the AF than the PF group (BAF: 1.0 ± 0.5 V; UAF: 0.9 ± 0.4 V; BPF: 0.6 ± 0.2 V; UPF: 0.5 ± 0.1V - P < 0.001). The BPF lead acute sensing threshold was superior to the AF leads (P wave sensing for BPF: 3.2 ± 1.5 mV; BAF: 2.2 ± 1.2 mV; UAF: 2.2 ± 1.1 mV - P < 0.003). In both AF and PF groups, lead polarity did not affect pacing and sensing thresholds. The difference in acute capture thresholds between AF and PF leads was abolished prior to discharge, and at subsequent follow-up over 12 months, no difference in chronic thresholds was observed. During the follow-up period, the chronic sensing thresholds of BAF leads were superior to the others. There was no significant difference in the complication rates of the four leads. Thus, all four leads proved satisfactory in clinical practice. No major impact of polarity and fixation mechanism was detected.