An unusual variation of deltoid muscle

An unusual anatomic variation of the deltoid muscle was found in a 45-year-old female cadaver during dissection of the right upper extremity. The posterior fibers of the right deltoid muscle were enclosed in a distinct fascial sheet and the deltoid muscle was seen to arise from the middle 1/3 of the medial border of the scapula. There was no accompanying vascular or neural anomaly of the deltoid muscle. To the best of our knowledge, unilateral posterior separation of the deltoid muscle with a distinct fascia has not been described previously. While dissecting deltoid, posterior deltoid, or scapular flaps, the surgeon needs to look out for this variation because it may cause confusion.     

Serum levels of cardiac enzymes before and after renal transplantation

BACKGROUND: Cardiac troponins are very sensitive and specific indicators of myocardial damage; however, they are sometimes found to be increased in patients with end-stage renal disease (ESRD). HYPOTHESIS: The aim of this study was to determine cardiac troponin I (cTpI) and creatine kinase myocardial isoform (CK-MB) levels and to assess their diagnostic and prognostic importance before and after renal transplantation. METHODS: Thirty-four patients with ESRD (mean age 31.8 +/- 8.6 years, 11 women) were enrolled. Serum levels of cTpI and CK-MB were measured pre- and postoperatively on Days 1, 7, and 30. Patients were followed up for cardiac events, and possible myocardial damage was investigated by exercise thallium-201-labeled myocardial perfusion scintigraphy. Mean cTpI levels were 0.24 +/- 0.11 ng/ml (preoperative), and 0.34 +/- 0.27 ng/ml (Day 1), 0.26 +/- 0.11 ng/ml (Day 7), and 0.28 +/- 0.30 ng/ml (Day 30). RESULTS: Compared with preoperative levels, cTpI was increased in 16 (47%), decreased in 6 (17.6%), and did not change in 12 (35.4%) patients. However, the increase did not exceed the myocardial infarction reference level of 2.3 ng/ml in any patient. Mean CK-MB levels were 12.6 (8.7U/l (preoperative), and 16.8 +/- 9.2U/l (Day 1), 16.3 +/- 8.1U/l (Day 7), and 13.3 +/- 6.6U/l (Day 30). Creatine kinase-MB was increased to above normal levels of 24 U/l in 13 (38.2%) patients on postoperative Days 1 or 7, and decreased to normal at the end of Month 1. No cardiac events occurred, and there was no abnormality in any patient on thallium scintigraphy. CONCLUSION: There was no significant difference in the levels of cTpI in patients with ESRD without cardiac events before and after renal transplantation (p > 0.05). Our findings show that cTpI has very high sensitivity and specificity for detecting cardiac damage in patients with ESRD after renal transplantation.     

Cardiovascular prognostic value of vascular involvement in Behcet's disease

We measured carotid artery intima-media thickness (IMT), brachial artery flow mediated dilation (FMD), and coronary flow reserve (CFR) in 38 Behcet's disease (BD) patients without vascular involvement, 15 BD patients with vascular involvement, and 35 control subjects. BD patients with and without vascular involvement were similar regarding carotid IMT (0.52+/-0.14; 0.51+/-0.09; 0.46+/-0.09; P=0.051), and brachial FMD (16.3+/-6.8; 16.5+/-9.1). CFR values were significantly impaired in BD patients compared to the controls; however the BD patients with and without vascular involvement were similar regarding CFR (2.66+/-0.45; 2.62+/-0.48; 2.91+/-0.53, P=0.007 with and without vascular involvement and the controls, respectively). Endothelial and coronary microvascular functions are compromised in BD patients without vascular involvement as remarkably as that in patients with vascular involvement.     

Effect of Trimetazidine on Late Potentials After Acute Myocardial Infarction

Summary. The purpose of this study was to evaluate the effect of trimetazidine on late potentials in patients with acute myocardial infarction. A total of 60 patients (52 males, mean age 55 ± 2 years, and 8 females, mean age 54 ± 1.8 years) with the diagnosis of acute myocardial infarction were included in this study. The study was designed as a randomized, double-blinded, and placebo-controlled trial. Signal-averaged electrocardiography and echocardiography were performed during the first 2 days of acute myocardial infarction and were repeated between days of 8 and 15 (mean 11). Patients were treated with trimetazidine (n = 30) or placebo (n = 30). In the placebo group, the total filtered QRS duration and low-amplitude terminal signal duration increased (from 102.7 ± 1.8 ms to 113.3 ± 1.8 ms, and from 32.2 ± 0.9 ms to 38.3 ± 1.1 ms; P < 0.001), the root mean square voltage of the terminal 40 ms of the QRS decreased (from 28.6 ± 2.1 µV to 21.4 ± 1.3 µV; P < 0.001), and the incidence of late potentials increased (from 30% to 46%; P < 0.01) significantly. In the trimetazidine group, these measurements were a decrease from 102.9 ± 1.9 ms to 100 ± 2.0 ms (NS), an increase from 31.6 ± 0.9 ms to 32.5 ± 0.9 ms (NS), a decrease 29.3 ± 2.0 µV to 27.3 ± 1.8 µV (P < 0.01), and a decrease from 33% to 30% (NS), respectively. The ejection fraction was 47.1 ± 1.3% to 50.8 ± 1.2% in the placebo group (P = 0.05), and 48.1 ± 1.1% to 53.4 ± 1.2% (P < 0.01) in the trimetazidine group. It is concluded that trimetazidine reduces late potentials after acute myocardial infarction without changing blood pressure and heart rate.