Why aortic elasticity differs among classical and non-classical mitral valve prolapsed?

Background: Mitral valve prolapse (MVP) is the most common valvular heart disease and characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are two types of MVP, broadly classified as classic (thickness ≥5?mm) and non-classic (thickness <5?mm) according to the morphology of the leaflets. We aimed to investigate elastic properties of the aorta in young male patients with classical and non-classical MVP.

Material/Methods: In the present study, 63 young adult males (mean age: 22.7?±?4.2) were included. Patients were divided into classic MVP (n?=?27) and non-classic MVP (n?=?36) groups. Aortic strain, aortic distensibility and aortic stiffness index were calculated by using aortic diameters obtained by echocardiography and blood pressures measured by sphygmomanometer.

Results: There was no significant difference between the groups in terms of age, body mass index, left ventricular mass and ejection fraction. When comparing the MVP group it was found that aortic strain and aortic distensibility were increased (p?=?0.0027, p?=?0.016, respectively) whereas the aortic stiffness index was decreased (p?=?0.06) in the classical MVP group.

Conclusion: We concluded that the elastic properties of the aorta is increased in patients with classic MVP. Further large scale studies should be performed to understand of morphological and physiological properties of the aorta in patients with MVP.     

Vacuum-assisted closure of wounds and anxiety

The aim of this study was to investigate the degree of anxiety in patients in whom the vacuum-assisted closure (VAC) of wounds was used. Psychological evaluations were made on the day before VAC was applied and at the 10(th) day of treatment in 20 patients with traumatic wounds of the lower extremity. Anxiety was measured with the Hamilton Rating Scale for Anxiety and with the State Anxiety Inventory test. The same measurements were also made in 20 further patients with similar wounds but managed with classic treatment as controls. Both groups showed a significant increase in anxiety during the 10 days. The mean (SD) differences in the anxiety scores measured during the 10-day period were significantly higher in the group treated by VAC than in the control group, State Anxiety Inventory test (14.0 (2.3) compared with 2.6 (1.2), p<0.001) and Hamilton Rating Scale for Anxiety test (4.4 (0.6) compared with 1.3 (0.6), p<0.001). Although we think that VAC is an effective tool for treating lower extremity wounds, we have concerns about possible accompanying psychological effects.     

Compartmentalization of inoperable high-flow vascular malformation

A high-flow vascular malformation of the face is a rare entity, and it can cause severe disfigurement and can even be potentially fatal as a result of massive hemorrhage. The authors describe a high-flow vascular malformation case that was successfully treated by compartmentalization and sclerotherapy with polidocanol. Two weeks later, the necrotic tissues were debrided and the resulting defect was covered with a skin graft. The resulting aesthetic outcome was more than anticipated by the patient. With this technique, it was possible to treat what was considered an untreatable vascular malformation using a standard technique.     

Pulmonary arteriovenous fistula and brain abscess

Patients with pulmonary arteriovenous fistulas (PAVFs) are at risk for the development of brain abscesses. The history of a 26-year-old man with PAVF, which has remained unrecognized for many years, is reported. Within four years, the patient presented life threatening cerebral abscesses twice at different sites. Treatment consisted of parenteral antibiotics. Finally, the pulmonary arteriovenous fistula has been treated by embolization. This case emphasizes the importance of early diagnosis and treatment of PAVF in preventing central nervous system infections.     

Surgical synovectomy combined with yttrium 90 in patients with recurrent joint synovitis

Radiation synovectomy (RS) is one of many therapeutic options used for recurrent joint synovitis. Our aim was to analyze the effect of the surgical synovectomy combined with yttrium 90 (⁹⁰Y) in the treatment for recurrent joint synovitis. A surgical combined RS procedure was used on 32 knees of 30 patients. They were divided into two groups. Group 1 consisted of 7 knees of 7 patients (5 women and 2 men) with a mean age of 40.7 years in whom RS was combined with the open synovectomy. Group 2 consisted of 25 knees of 23 patients (21 men and 2 women) with a mean age of 45.5 years in whom RS was combined with the arthroscopic synovectomy. Arthroscopic synovectomy or open surgery biopsy was carried out for all cases who diagnosed of having synovitis. A scintigraphic examination was conducted within 24 h after the RS procedure to investigate the systemic leakage of ⁹⁰Y in all patients. The outcome of treatment was assessed based on self-reporting using the visual analogue scale (VAS) of night pain, rest pain, activity pain, effusion, and satisfactory scores. The average follow-up period was 4.15 years. There was a significant difference between before and after treatment in terms of outcome parameters’ VAS scores in both groups (p < 0.05). But there was no statistically significant difference between open and arthroscopic synovectomy groups in terms of outcome parameters (p > 0.05). Satisfactory outcome was excellent in 3 patients (42.8 %) in group 1 and 8 patients (32 %) in group 2. Surgical synovectomy with combined ⁹⁰Y could treat recurrent joint synovitis successfully. There was no statistically significant difference between open and arthroscopic synovectomy techniques combined with RS procedure.     

Enlargement of the aorta: An occupational disease?

BACKGROUND:

Aortic dilation may critically precede progression to thoracic aortic aneurysm (TAA). Prolonged or repetitive isometric-type heavier strenuous activities resulting from the nature of some professions may be an important causative factor for TAA.

METHOD:

The echocardiographic measurement data of middle-age subjects who were isometric-type daily strenuous activity trainers or ordinary activity trainers were retrospectively analyzed. Clinical features and echocardiographic parameters of the left ventricle and left atrium (LA), aortic root (AR) and ascending aorta (AA) were compared between the groups.

RESULTS:

AR (35.6±3.0 mm versus 33.5±1.9 mm), AA (36.8±3.0 mm versus 34.4±1.9 mm) and LA (37.4±2.2 mm versus 36.2±2.2 mm) diameters were significantly enlarged in the strenuous activity trainer group versus the ordinary activity group. Diastolic blood pressure was significantly lower (73.8±5.9 mmHg versus 78.3±6.0 mmHg) in this group. AR diameter was correlated with height (β=0.460; P=0.004) and LA diameter (β=0.280; P=0.008) while AA diameter was correlated with type of profession (β=0.309; P=0.003), left ventricular systolic diameter (β=0.500; P=0.001) and LA diameter (β=0.272; P=0.005) in regression analysis.

CONCLUSION:

Aortic dilation and, subsequently, TAA may be an occupational disease due to nature of some professions (eg, the military, security, weight lifters, athletes, heavy workers, etc). Echocardiography is a convenient method of imaging that could be easily applied either during preparticipation screening or during periodical examination of these subjects. Earlier detection of TAA and limitation of such strenuous activities in these individuals may be initial lifesaving measures for the prevention of future cases of aortic aneurysm and dissection.     

Isolated biventricular noncompaction: a case report

Myocardial noncompaction （MN） is defined as an .unclassified congenital cardiomyopathy which is characterized by the presence of prominent ventricular trabeculations and deep intertrabecular recesses. It is assumed to occur as an arrest in normal endomyocardial morphogenesis and is mostly associated with other congenital cardiac malformations The left ventricle is usually involved; but, both ventricules can be affected.     

Independent prediction of metabolic syndrome by plasma fibrinogen in men, and predictors of elevated levels

The role of plasma fibrinogen levels in predicting metabolic syndrome (MetS) and assessment of determinants of these levels were investigated. A total of 2234 men and women, aged 49+/-12 years, representative of Turkish adults who had plasma fibrinogen determinations, were prospectively evaluated and followed for a mean of 6.6 years. The modified Clauss method was used for assays. MetS was defined by ATPIII criteria modified for male abdominal obesity. MetS cases at baseline were excluded in prospective analyses. Median (interquartile range) fibrinogen values were 2.87 (2.29; 3.56) g/L. Fibrinogen levels predicted significantly newly developing MetS in men (RR 1.40 [95%CI 1.07; 1.83] for a 2-fold increment), after adjustment for age and smoking status, and (RR 1.32 [95%CI 0.95; 1.83] again for doubling), after additional adjustment for all 5 components of MetS. MetS was not significantly predicted by fibrinogen levels in women in either multivariable model. By regression analysis of eight covariates, not waist circumference, but systolic blood pressure, current smoking and C-reactive protein (CRP) in men, and age in women were predictors of elevated (>3.0 g/L) fibrinogen at follow-up (p<0.05 in all). CONCLUSIONS: Plasma fibrinogen predicts MetS independently of its components in men, in contradistinction to women, and, hence, is likely one of its components. Hyperfibrinogenemia representing an inflammatory state is postulated as the underlying mechanism. Central obesity is linked to elevation in fibrinogen mainly through the mediation of blood pressure, CRP, and via being affected by cigarette smoking.