Giant left atrial appendage aneurysm: The third ventricle!

The giant congenital intrapericardial aneurysmal dilatation of the left atrial appendage without mitral valve disease is a very rare condition that is generally diagnosed in older patients. The problem is usually accompanied with supraventricular rhythm disorders and life-threatening systemic thromboembolism. Complete surgical correction is possible, and it should be performed immediately after the diagnosis. We are going to describe a patient with a history of cerebral thromboembolism and palpitation who was diagnosed with congenital intrapericardial aneurysmal dilatation of the left atrial appendage. The condition was identified by means of echocardiography and was surgically treated by resection of the appendage containing the aneurysm.This case report was presented in the DICE session of The Turkish Society of Echocardiography at 6th European Congress of Echocardiography (EUROECHO 6) which was held in Munich, Germany (December 4–7, 2002).     

A comparison of three-dimensional finite element stress analysis with in vitro strain gauge measurements on dental implants

PURPOSE: The purpose of this study was to evaluate the compatibility of three-dimensional finite element stress analysis and in vitro strain gauge analysis in the measurement of strains on a dental implant. MATERIALS AND METHODS: Two vertically placed implants embedded in a poly(methyl methacrylate) model were used. Strain gauges were bonded to the cervical parts of the implants, and seven cement-retained fixed partial dentures were fabricated. A three-dimensional model of the strain gauge analysis model was constructed, and an additional model in which human bone simulation was provided was also constructed. A static vertical load of 50 N was applied at certain locations to simulate centrally positioned axial and laterally positioned axial loading for strain gauge analysis and three-dimensional finite element stress analysis. RESULTS: Statistically significant increases in strain levels were recorded between loading types in the strain gauge analysis (P < .05). Strains obtained from strain gauge analysis were higher than for three-dimensional finite element stress analysis. There was a remarkable difference between the two finite element models under the conditions of laterally positioned axial loading. CONCLUSION: There are differences regarding the quantification of strains between strain gauge analysis and three-dimensional finite element stress analysis. However, there is a mutual agreement and compatibility between three-dimensional finite element stress analysis and in vitro strain gauge analysis on the determination of the quality of induced strains under applied load.     

The effects of hormone replacement therapy on echocardiographic basic cardiac functions in postmenopausal women

This prospective study was designed to investigate the effects of hormone replacement therapy (HRT) on systolic and diastolic functions. Twenty-eight non-smoking, healthy postmenopausal women who had not received any kind of HRT for at least three years within the onset of menopause were included in the study. All patients received 0.625 mg conjugated oestrogens and 2.5 mg medroxyprogesterone acetate as daily HRT regimen. Their basic systolic and diastolic functions were investigated echocardiographically using standard positions and windows before and 6 months after initiation of HRT. The means of age, weight and length of postmenopausal period were 49.3 +/- 5.8 years, 63.5 +/- 8.7 kg and 46.3 +/- 7.1 months, respectively. Heart rate and systolic and diastolic pressures were similar during the pre- and post-treatment periods. After 6 months of HRT, the mean left ventricular end-systolic and end-diastolic volumes were decreased significantly (71.3 +/- 16.4 versus 56.3 +/- 22.8 ml, 144.5 +/- 26.1 versus 111.7 +/- 24.0 ml, respectively, P < 0.05). Left ventricular ejection fraction was increased (45.1 +/- 6.2% versus 54.8 +/- 4.1%, P < 0.05). Improvement in diastolic function was significant compared with the pretreatment period (E/A 0.90 +/- 0.2 versus 1.10 +/- 0.4, deceleration time 238 +/- 36.8 versus 201 +/- 24.2 ms, respectively, P < 0.05). Based on our preliminary results, we conclude that besides the known favourable effects on women's lives, HRT may also improve cardiac performance and age-related dysfunctions. The present results further suggest that oestrogens exert many direct effects on the cardiovascular system, other than the metabolic changes related to lipoproteins.      

Prevalence and predictors of arrhythmia in end stage renal disease patients on hemodialysis

BACKGROUND: Sudden death is common in end-stage renal disease (ESRD). Cardiac arrhythmia is observed frequently in patients with ESRD and is thought to be responsible for this high rate of sudden death. This study investigated the prevalence and the predictors of arrhythmia in patients on maintenance dialysis. METHODS: Ninety-four patients on hemodialysis program were enrolled in the study. Routine laboratory results were noted. Arrhythmia, periods of silent ischemia, and heart-rate variability analyses were obtained from 24-hour Holter monitor recordings. Corrected QT (QTc) dispersion was calculated from 12-lead surface EKG. Echocardiographic and tissue Doppler examinations were performed on interdialytic days as well. Ventricular arrhythmia was classified according to Lown classification; classes 3 and above were accepted as complex ventricular arrhythmia (CVA). RESULTS: The mean age was 52.5+/-13.2 years; 44 (46.8%) were women. Ventricular premature contractions were detected in 80 (85.1%) patients, of whom 35 (37.2%) were classified as complex ventricular arrhythmia (CVA). Coronary artery disease, hypertension, and QTc dispersion appeared as independent factors predictive of CVA development. Atrial premature contractions (APC) were detected in 53 patients (56.4%) and supraventricular arrhythmia in 15 (16%) patients; all were identified as atrial fibrillation. Duration of dialysis therapy was found as an independent predictor of APC. CONCLUSION: Arrhythmia is frequently observed in ESRD patients receiving hemodialysis and may be responsible for the high rate of sudden mortality. Hypertension, CAD, and QTc dispersion are independent predictors of CVA, and duration of dialysis therapy is an independent factor affecting APC development in these patients.     

Prevalence of Asthma and Related Symptoms in Sivas, Central Anatolia

Background. In our clinical experience, asthma is an important health problem in our region, but we did not know its prevalence. Objective. The main objective of our study was to assess the prevalence of asthma in Sivas, a city in Central Anatolia. Methods. A cross-sectional study was performed using a screening questionnaire adopted from European Community Respiratory Health Survey (ECRHS). A total of 5448 adults of both genders between 20 and 107 yr of age living in Sivas, a city in the central region of Anatolia in Turkey, participated in the survey. Of the cohort, 2691 were men (49.4%) and 2757 (50.6%) were women. Results. The mean age was 38.2 yr (SD = 12.7 yr), almost half of the study population was at or younger than 40 yr of age. The prevalence of wheezing in the last 12 months, diagnosis of asthma, asthma attack in the last 12 months, and use of asthma medicine were 20.9%, 4.5%, 4.9%, and 3.4%, respectively. Awakening with chest tightness, with shortness of breath, or with cough were reported as 14.2%, 14.8%, and 22.7%, respectively. The prevalence of respiratory symptoms related to asthma was statistically higher in women than that of men (p = 0.000, OR 1.346, 95% CI: 1.228-1.475). Those who had asthma/allergic symptoms in their family members were significantly younger than others (p : 0.001). Conclusions. The results of this study demonstrate that symptoms suggestive of asthma are quite common and constitute a major health problem in Sivas, Turkey. This study also showed that, despite a high rate of reported symptoms exists, the rate of diagnosis and treatment of asthma is low among the adult population in Sivas.     

Laparoscopic ultrasonography in the management of ovarian cysts

BACKGROUND: The aim of the study was to determine the role of laparoscopic ultrasonography in the management of ovarian cysts extirpated by means of endoscopic surgery. METHODS: Laparoscopic ultrasonography was used during endoscopic surgery in 14 consecutive patients with an adnexal mass. The diagnostic accuracies of transvaginal and laparoscopic ultrasonography were compared according to the final pathological diagnosis. Estimations of the exact location of the ovarian mass by means of laparoscopic visualization and laparoscopic ultrasonography were compared. The presence of residual tumor tissue after cyst extirpation was monitored with laparoscopic ultrasonography. RESULTS: Using laparoscopic ultrasound and transvaginal ultrasound the correct diagnosis was made in 12 of 14 (85.7%) and 9 of 14 (64.3%) patients, respectively (not significantly different). With laparoscopic visualization, the exact location of the ovarian tumor could be demonstrated in 57.1% (8/14) of the cases, while with laparoscopic ultrasonography precise visualization of the ovarian mass was achieved in all cases (not significantly different). Two patients were found to have residual tumor tissue in the ovary when laparoscopic ultrasonography was performed again after tumor extirpation. CONCLUSION: Laparoscopic ultrasonography seems to be useful in patients with an adnexal mass managed by endoscopic surgery, in terms of evaluating the internal characteristics and predicting the histological diagnosis of the ovarian cyst, deciding on the correct placement of the incision to prevent unnecessary trauma to the ovary, and evaluation of the ovary after cyst extirpation to expose any residual tumor tissue.