Quantitative evaluation of right ventricle function by transthoracic echocardiography in childhood congenital heart disease patients with pulmonary hypertension

Introduction and Objective: The present study aims to quantitatively evaluate the right ventricle (RV) function by means of transthoracic echocardiography in normal children and childhood congenital heart disease patients with pulmonary hypertension. Patients and Methods: This study was conducted in a cohort including 40 healthy children and 30 pediatric patients with pulmonary hypertension who were diagnosed under close surveillance at the study center between October 2009 and November 2010. Results: Statistically significant differences were found between the patient and control groups for the right ventricle myocardial performance index (RVMPI), the left ventricle myocardial performance index (LVMPI), the tricuspid valve systolic flow velocity (Ts), the ratio of systolic pulmonary artery pressure to the right ventricle outflow tract systolic flow velocity time integral (sPAP/RVOT VTI), and the ratio of systolic pulmonary artery pressure to right ventricle outflow tract systolic flow velocity time integral × heart rate (sPAP/[RVOT VTI×HR]). When the children were divided into three groups based on their pulmonary vascular resistance significant differences emerged that predicted an increasing severity of RV dysfunction. Significant differences were also observed for the RVMPI, the LVMPI, and the Ts as well as for echocardiographic pulmonary flow (Qp) and systemic flow (Qs). Discussion: The present study demonstrates that echocardiographic parameters can be used for the quantitative detection of RV dysfunction in childhood congenital heart disease patients with high pulmonary artery pressure (systolic, diastolic, and mean) or pulmonary vascular resistance.     

Chronic inflammatory demyelinating polyradiculoneuropathy associated intracranial hypertension

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired immune-mediated demyelinating neuropathy. In this report, we detail the course of a 58-year-old male patient who had headache and double vision followed by progressive paresthesia and difficulty in walking. The patient had bilateral papilledema and mild leg weakness, absent ankle jerks and loss of sensation in distal parts of his lower and upper extremities. His electromyography (EMG) was concordant with CIDP and lumbar puncture revealed high opening pressure. The polyradiculoneuropathy as well as the papilledema and elevated cerebrospinal fluid (CSF) pressure improved under steroids. The improvement in intracranial hypertension (IHT) and papilledema under steroid treatment suggests that the IHT in this patient might be associated with CIDP.     

Surgery for bronchiectasis

The incidence of bronchiectasis has declined significantly in industrialized countries and its management has also changed because of the progress of antibiotic therapy. However, for some patients, medical treatment is not sufficient to control the disease and the quality of life is affected. Surgical treatment is then a very good alternative, when a gesture of complete resection of the affected areas is feasible in terms of lung function and it allows, with a low morbidity and mortality, for very satisfactory long-term results and slows down the progression of the disease. In cases of diffuse and inhomogeneous bronchiectasis, a gesture of incomplete resection of cystic, non-perfused and suppurative areas improves symptoms and reduces recurrent infections. When the bronchiectasis is diffuse, but homogeneous, associated with severe respiratory failure, lung transplantation should be considered. Therefore, surgery remains important in the management of bronchiectasis. Its indications and the lung resection gesture to achieve should be discussed based on the symptoms, imaging examinations and the lung function of the patient.     

Can dynamic and static pupillary responses be used as an indicator of autonomic dysfunction in patients with obstructive sleep apnea syndrome?

Purpose

We aimed to reveal whether static and dynamic pupillary responses can be used for the detection of autonomic nervous system (ANS) dysfunction in patients with obstructive sleep apnea syndrome (OSAS).

Methods

We included in this study patients with OSAS, who were divided into three groups according to the apnea–hypopnea index (AHI) (group 1, mild [n?=?20]; group 2, moderate [n?=?20]; and group 3, severe [n?=?20]), and healthy controls (group 4, n?=?20). Pupillary responses were measured using a pupillometry system.

Results

Static (mesopic PD, P?=?0.0019; low photopic PD, P?=?0.001) and dynamic pupil responses (resting diameter, P?=?0.004; amplitude of pupil contraction, P?<?0.001; duration of pupil contraction, P?=?0.022; velocity of pupil contraction, P?=?0.001; and velocity of pupil dilation, P?=?0.012) were affected in patients with different OSAS severities. Also, AHI was negatively correlated with mesopic PD (P?=?0.008), low photopic PD (P?=?0.003), resting diameter (P?=?0.001), amplitude of pupil contraction (P?<?0.001), duration of pupil contraction (P?=?0.011), velocity of pupil contraction (P?<?0.001), and velocity of pupil dilation (P?=?0.001).

Conclusion

We detected pupil responses innervated by the ANS were affected in the OSAS patients. This effect was more significant in the severe OSAS patients. Therefore, the pupillometry system can be an easily applicable, noninvasive method to detect ANS dysfunction in the OSA patients.

     

Autonomic dysfunction detection by an automatic pupillometer as a non-invasive test in patients recovered from COVID-19

Graefe's Archive for Clinical and Experimental Ophthalmology - To recognize dysfunctions in the autonomic nervous system (ANS) with changes in dynamic and static pupillary responses in patients...