Validation study to determine the accuracy of central blood pressure measurement using the SphygmoCor XCEL cuff device in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Central aortic blood pressure could be helpful in the evaluation of patients with aortic stenosis (AS). The SphygmoCor XCEL device estimates central blood pressure (BP) measurement with its easy‐to‐use, operator‐independent procedure. However, this device has not been properly validated against invasive measurement in patients with severe AS. We evaluated the relationship between cuff‐brachial BP, transfer function‐estimated and invasively measured central aortic pressure in patients with severe AS before and after transcatheter aortic valve replacement (TAVR). Agreement between techniques was analyzed and, according to the ARTERY Society recommendations, the minimum acceptable error was a mean difference ± SD ≤5 ± ≤8 mm Hg. A total of 94 patients with AS undergoing TAVR had simultaneous non‐invasive and invasive measurements of central BP before and after the procedure. Before TAVR central systolic BP was in average slightly underestimated, though with wide variability, when using the default calibration of brachial‐cuff SBP (mean difference ± SD, −3 ± 15 mm Hg), and after TAVR the degree of underestimation increased (mean difference ± SD, −9 ± 13 mm Hg). The agreement tended to improve for those patients with low aortic gradient stenosis compared to those with high gradient at baseline (mean difference ± SD, −2 ± 11 mm Hg vs. −4 ± 17, respectively, p = .3). The cuff‐brachial systolic BP yielded numerically lower degree of agreement and weaker correlation with invasive measurements than SphygmoCor XCEL. In patients with severe AS the SphygmoCor XCEL cuff device, despite showing strong correlation, does not meet the ARTERY Society accuracy criteria for non‐invasive measurement of central SBP.     

Medical waiver for flying after microvascular decompression for hemifacial spasm

BACKGROUND: Microvascular decompression has become the treatment of choice for hemifacial spasm. Post-surgical symptoms of vestibular dysfunction may appear, but are mostly transient. The unique occupational demands of military aviators necessitate complete otoneurological evaluation after vestibular insults to allow safe return to flying duties. CASE REPORT: We present a case of a military jet-fighter pilot who developed transient vertigo and disequilibrium after microvascular decompression for hemifacial spasm. Resolution of symptoms and complete recovery as documented by vestibular bedside and laboratory tests allowed us to grant the pilot full solo flying privileges.     

Determinants and prognostic significance of an intra-dialysis rise of cardiac troponin I measured by sensitive assay in hemodialysis patients

Background

Previous studies using conventional cTnI assays reported conflicting results on the evolution of cTnI levels during hemodialysis. The determinants and prognostic significance of changes in cTnI during hemodialysis are presently unknown. The aim of this prospective study was to characterize the determinants and prognostic significance of intra-dialysis changes in cTnI using a sensitive assay.

Methods

cTnI was measured before and after hemodialysis with a sensitive assay in 90 chronic patients without acute cardiac symptoms. Multivariable regression analyses were used to identify factors that were associated with intra-dialysis rise in cTnI. The prognostic effect of an intra-dialysis rise in cTnI during a 52-month follow-up was evaluated using Cox regression models. The primary and secondary endpoint was the incidence of major adverse cardiovascular events and all-cause mortality, respectively.

Results

Pre-dialysis cTnI was elevated in 31 patients (34 %). cTnI increased significantly during dialysis and this had a trend to be associated with longer dialysis vintage. A greater intra-dialysis rise in cTnI was associated with a significantly higher incidence of cardiovascular events, also after correction for age, gender, dialysis vintage, residual diuresis, previous cardiovascular events, and pre-dialysis cTnI levels (HR per 10 ng/L rise in cTnI: 1.21; CI 1.06–1.38; p 0.005).

Conclusion

TnI levels rise significantly during hemodialysis and a greater intra-dialysis rise in cTnI is associated with an increased incidence of cardiovascular events. These findings suggest that hemodialysis has an acute deleterious effect on the heart. An intra-dialysis rise in cTnI may help identify patients who are susceptible to the hemodynamic stress of hemodialysis.     

Doppler flowmeter in the differential diagnosis of the acute scrotum in children.

A Doppler flowmeter was used to evaluate an acute scrotum in 23 children. A diminished or absent flow was noted in cases of torsion of the testis. Orchitis, epididymitis and torsion of the testicular appendix were accompanied with an increased blood flow. Inflammatory and ischemic lesions could be detected and in all operated cases the diagnosis proved to be correct. Unnecessary operations in cases of torsion of the testicular appendix can be avoided with this accurate non-invasive method.     

Differences in the serum lipid constituents of hyperlipidemic men and women

A thousand cases of hyperlipidemia were studied and significant differences were found in the levels of cholesterol and triglycerides between the two sexes. Hyperlipidemic men had higher triglycerides levels and hyperlipidemic women higher cholesterol levels. When divided into different hyperlipidemia groups, women were equally distributed among them, while the men were grouped essentially in the group characterised by normal cholesterol level and elevated triglycerides level. Within this same group men had more accentuated triglycerides values than women. From the fact that most hyperlipidemic men belong to Type IV, hyperlipidemia may constitute a strong “risk” factor in the development of coronary diseases in men.     

Differential patterns of vasculature to liver tumours

An angiographic study of the vasculature of Vx2 tumour deposits in the rabbit''s liver is described.     

Cryopreserved allografts in orthognathic surgery

After more than two years' use of cryo-preserved allografts in orthognathic surgery, the authors show the value of the use in a General Hospital of material from a cryo-preserved bone bank supplied with femoral heads by the Orthopedic Traumatology Dept.