Force-frequency relationship in the echocardiography laboratory: a noninvasive assessment of Bowditch treppe?

BACKGROUND: Estimation of contractility of the left ventricle is an important, and as yet elusive, goal with noninvasive techniques. OBJECTIVE: We sought to assess the feasibility of a totally noninvasive estimation of force-frequency relation (FFR) during exercise stress in the echocardiography laboratory. METHODS: We enrolled 13 healthy control patients (12 men, age 38 +/- 15 years) as group I, and 50 patients (38 men, age 64 +/- 11 years) referred for exercise echocardiography as group II. To build the FFR, the force was determined at each step as the ratio of the systolic pressure (cuff sphygmomanometer)/end-systolic volume index (biplane Simpson's rule/body surface area). The slope of the relationship was calculated with the linear best fit of the FFR. RESULTS: Noninvasive systolic pressure/end-systolic volume ratio was obtained in all patients. The slope of the linear best fit of the force-frequency curve was lower in group II compared with group I (group II = 10.1 +/- 9.3 x 10(-2) vs group I = 14.9 +/- 9.9 x 10(-2) group I, P =.04). By regional wall-motion analysis, 2 subgroups were identified in group II: group IIA (n = 8) had a positive echocardiogram; and group IIB (n = 42) had a negative echocardiogram. The slope of the force-frequency curve was lower in patients with ischemia compared with those without (group IIA = 3.5 +/- 4.2 x 10(-2) vs group IIB = 11.4 +/- 9.5 x 10(-2); P =.012). Heart rate-systolic pressure/end-systolic volume index relation was biphasic, with an initial positive slope and a subsequent negative slope in 1 patient of group I, 4 patients of group IIA, and 15 patients of group IIB (P <.05 vs group I). CONCLUSION: A noninvasive estimation of FFR can be easily determined during exercise echocardiography. This index of global contractility is theoretically appealing for identification of limited contractile reserve and latent global left ventricular dysfunction.     

Laparoscopic sacropexy and obstructed defecation syndrome: an anatomoclinical study

Introduction and hypothesis

Laparoscopic sacropexy (LSP) is associated with obstructed defecation syndrome (ODS) in 10–50 % of cases. An anatomoclinical study was carried out to investigate whether there is any correlation between iatrogenic denervation during LSP and ODS.

Methods

Five female cadavers were dissected to identify possible sites of nerve injury during LSP. Subsequently, the videos of 18 LSP were blindly reviewed to assess the location of sacral dissection and tacks, the position and depth of the peritoneal tunnel, and another 4 variables. An anatomical triangle was defined on the right lumbosacral spine so as to clearly describe the sites of the surgical variables, which were then statistically correlated with the patients’ postoperative outcome.

Results

The only variable associated with postsurgical ODS was dissection in the 90° angle of the anatomical triangle, where the superior hypogastric plexus was observed in all cadavers.

Conclusions

Medial and midline dissection over the sacral promontory might be associated with postoperative ODS.     

Vasectomy-related changes on sonographic examination of the scrotum

PURPOSE: The goal of this study was to evaluate the sonographic changes in the epididymis and testis after vasectomy using state-of-the-art high-resolution equipment. METHODS: We performed a retrospective study of 30 patients with a history of vasectomy and 30 patients without who were referred for scrotal sonography for various indications over a 1-year period. After excluding findings related to acute pathology, sonographic findings for the epididymis and testis in the 2 groups were tabulated and compared. RESULTS: The following findings had a statistically higher incidence in the vasectomy group than in the controls: thickened epididymides (53% versus 17%, p < 0.05); epididymal tubular ectasia (43% versus 7%, p < 0.001); and both of the previous 2 findings simultaneously (37% versus 7%, p < 0.01). Sperm granulomas were found in 3 patients in the vasectomy group, and none was seen in the control group. Other findings (eg, epididymal cysts) showed no statistical difference in incidence. CONCLUSIONS: We found a significantly higher incidence of thickened epididymides, epididymal tubular ectasia, a combination of both these findings, and sperm granuloma in the vasectomy group than in the controls. These findings are most likely attributable to postvasectomy obstructive changes and increased intraluminal pressure in the efferent ducts, epididymis, and vas deferens.