No pituitary gland volume change in medication-free depressed patients

Increased serum cortisol levels and a hyperactive hypothalamo-pituitary-adrenal (HPA) axis have been proposed to play an important role in the pathophysiology of Major Depressive Disorder (MDD). However, there are inconsistent results regarding pituitary gland volume (PGV), which is one of the key elements of the HPA axis evaluated by MRI in depressed patients. In this study, we analyzed the PGV of medication-free moderately depressed MDD patients (N=34) and age and sex matched healthy controls (N=39). PGV did not differ between MDD patients and healthy controls [mean volume+/-S.D.; 0.76+/-0.17 cm3 and 0.75+/-0.14 cm3; ANCOVA, F1,69=1.25 p>0.05; respectively]. Our results confirm that volumetric PGV changes are not crucial for depression pathophysiology among unmedicated, moderately depressed adults.     

Naproxen treatment prevents periprocedural inflammatory response but not myocardial injury after percutaneous coronary intervention

BACKGROUND AND AIM: Recent studies have documented that elevation of C-reactive protein (CRP) levels after percutaneous coronary intervention (PCI) have been predictive of adverse outcome. This study was performed to test the hypothesis that preprocedural use of naproxen sodium is associated with a reduction in the extent of inflammatory response and myocardial injury after PCI. METHODS: Ninety-seven patients who were scheduled for elective PCI were randomized either for naproxen sodium (500 mg bid) (n:39, 75% male, 59+/-10 years) or control (n:58, 76% male, 60+/-10 years). All patients were troponin negative before the procedure. Blood samples for CRP, Troponin I and CK-MB were collected at baseline and after the procedure. RESULTS: The characteristics were similar between the two groups. After coronary stenting, the rise in CRP levels was significantly higher in controls than those treated with naproxen (DeltaCRP=6.4 mg/L in the controls and 0.43 mg/L in the naproxen group, p<0.0001). The incidence of any troponin I elevation or CK-MB elevation above upper limit of normal was not statistically different between groups. During follow up (12+/-2 months), major cardiac adverse events (death, myocardial infarction, and revascularization of target lesion) was similar between groups. CONCLUSION: Our data show that naproxen pretreatment leads to significant suppression in PCI related CRP elevation. However this improvement in CRP levels was not associated with any significant reduction in post-PCI myonecrosis.     

Stress-induced (Takotsubo) cardiomyopathy: a transient disorder

Once the diagnosis of Takotsubo cardiomyopathy has been made, treatment should be based upon the patient's overall clinical condition. Up to now, there has been no controlled data to guide the optimal medical regimen, but it is reasonable to treat these patients with standard medications for left ventricular systolic dysfunction during acute phase. This includes aspirin, beta-blockers, ACE-inhibitors, and diuretics as necessary for volume overload. Since this type of cardiomyopathy is a transient disorder, the appropriate duration of therapy is not known. Although the current study demonstrates that the use of beta-blockers, aspirin, ACE inhibitors and calcium channel blockers does not seem to be indicated for chronic treatment of Takotsubo cardiomyopathy, we strongly believe that we need to achieve the data which will be obtained from large scale prospective studies in the near future to assess the clinical significance of chronic medical treatment.     

Modified McIndoe procedure for vaginal agenesis.

Between 1982 and 1997, 29 patients with congenital absence of the vagina underwent modified McIndoe vaginoplasty at the Division of Plastic and Reconstructive Surgery, Ege University Medical School, Izmir, Turkey. As a modification, an X incision was utilized instead of a straight-line horizontal or sagittal incision. During the first postoperative week, a perforated Pyrex rigid mold was used. This was replaced with an unperforated mold at the end of the first week. These patients' medical records were reviewed retrospectively. Complications encountered included infection, total lack of skin graft take, stress urinary incontinence, partial graft loss, and vaginal stricture. All complications were treated except the stress urinary incontinence, and the final results were satisfactory.     

Two‐Dimensional Longitudinal Strain and Strain Rate Imaging for Assessing the Right Ventricular Function in Patients with Mitral Stenosis

Background: Longitudinal two‐dimensional strain (L2DS) deformation is a novel technique that evaluates global and regional right ventricular (RV) function. The aim of the study was to investigate the systolic function of RV by using this method in patients with pure mitral stenosis (MS). Methods: Conventional echocardiography and L2DS analysis were performed in 45 MS patients and 21 healthy controls. For strain analysis apical four‐chamber views were obtained and by using a software system, peak systolic strain and strain rates were calculated off‐line in each segment. Results: The mean global longitudinal strain (GLS) of the whole RV (?20 ± 7 vs. ?24 ± 6%, P= 0.02) and mean GLS of the septum (?19 ± 7 vs. ?23 ± 5%, P = 0.03) were significantly reduced in the MS patients. Compared with the control group no significant change was determined in the mean GLS of the RV free wall (RVFW). While the mean global longitudinal strain rates (GLSR) of the entire RV and RVFW were similar between the groups, a significant difference in the mean GLSR of the septum (?1.2 ± 0.4 vs. ?1.5 ± 0.3 s^?1, P= 0.005) was determined in the patients with MS. A regional analysis demonstrated that MS patients had significantly reduced strain and strain rates in the basal and mid‐segments of the septum, whereas only lower strain values in the basal RVFW. Conclusions: RV systolic function evaluated by L2DS analysis in patients with MS has shown decreased global and segmental systolic functions. (ECHOCARDIOGRAPHY 2010;27:525‐533)     

Optimal design of simply supported columns subject to distributed axial load and stress constraint

The optimum designs are given for columns, which are simply supported and under distributed and concentrated axial loads. The objective is to maximize the buckling load subject to volume and maximum stress constraints. The area of the minimum cross‐section under a stress constraint is not known a priori as it depends on the maximum buckling load which in turn depends on the optimum shape. This minimum cross‐sectional area is computed as part of an iterative procedure. An iterative solution method is developed based on finite elements and the results are obtained for n=1, 2, 3, defined as I =α_nAⁿ with I being the moment of inertia, and A the cross‐sectional area. Numerical results show that the optimal areas become larger in the direction of the distributed load. Results are given for uniformly and triangular distributed loads, which are shown to have distinct effects on the optimal column shape. Copyright © 2009 John Wiley & Sons, Ltd.     

Prenatal sonographic findings in a fetus with splenogonadal fusion limb defect syndrome

Splenogonadal fusion limb defect syndrome (SGFLD) is a very rare abnormality. We report on a case with prenatal sonographic findings of a fetus with postnatally diagnosed SGFLD syndrome. This is also the second case of prenatal ultrasonographic diagnosis of gastrointestinal malrotation associated with SGFLD. A 26‐year‐old primigravid woman was referred to our clinic because of nonvisualization of both fetal femoral bones at 20 weeks of gestation. A detailed sonographic examination showed complete bilateral absence of lower limbs, micrognathia, single umbilical artery and a right‐sided stomach. Autopsy confirmed prenatal sonographic findings and additionally showed that the spleen was abnormally connected to the left gonad by a fibrous band. In conclusion, although all limbs and both sides were equally affected in most of the reported cases, SGFLD syndrome should be considered in cases with terminal limb defects of lower limbs. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009