Echocardiographic findings in patients with Behçet's disease

Case-controlled studies have shown that the prevalence of left ventricular (LV) diastolic dysfunction is higher in patients with Beh?et's disease. However, there are no data evaluating the value of Doppler tissue imaging (DTI) in Beh?et's disease. The aim of this study was to evaluate the cardiac involvement and the LV function at rest and at the end of isometric exercise by pulse-wave Doppler and DTI methods in patients with Beh?et's disease. Fifty-four patients with Behcet's disease and 50 control subjects were studied. Dimensions of cardiac chambers, aortic root dimension, valvular abnormalities, and systolic function were similar in both groups. The mean E/A ratio was significantly lower in patients than controls (1.22 +/- .09 vs 1.36 +/- 0.30, p = 0.01). The E/A ratio was <1 in 12 patients (22%) and in 3 controls (6%) (p = 0.02). By DTI, no difference was found in the mean S-, e-, and a-wave velocities, and e/a ratio between the 2 groups. The e/a ratio was <1 in 13 patients (24.1%) and in 7 controls (14%) (p = 0.2) by DTI. There were no differences in the mitral pulse-wave Doppler and DTI parameters in patient and control groups at the end of exercise. The prevalence of cardiac pathology in Beh?et's disease did not differ appreciably from the controls. In conclusion, the LV systolic and diastolic functions in the patients with Beh?et's disease and controls were similar not only at rest but also at the end of exercise.     

The effects of pulmonary vein isolation on the dominant frequency and organization of coronary sinus electrical activity during permanent atrial fibrillation

BACKGROUND: Pulmonary vein isolation (PVI) has been shown to suppress atrial fibrillation (AF). We examined the effects of PVI on disorganization and dominant frequencies (DF) in patients with permanent AF. METHODS AND RESULTS: Twenty-eight patients with permanent AF (>6 months) who failed > or =1 antiarrhythmic drugs (AAD) and > or =2 cardioversions (CV) with AF reversion <30 minutes after CV were included. PVI and isolation of DFs in pulmonary veins (PVs) was performed during AF. Fast Fourier transformations of atrial electrograms were performed. Disorganization index (DI) was defined as the percentage of time spent in type III AF during 1-minute continuous recordings. The temporal stability and reproducibility of DIs from the same sites were verified over time prior to ablation. Highly disorganized AF activity concentrated in the posterior left atrium (PLA) including sites at the left atrial (PV-LA) junction (55.7% of sites in PLA, 32.9% in septum, and 11.4% in other sites). DF and DI from the coronary sinus (CS) before and after PVI were analyzed. PVI reduced the DI (14.3 +/- 25.0% before PVI vs 4.6 +/- 8.6% after PVI; P < 0.02). There was significant reduction of DI in 26 of 28 patients. The DF remained unchanged (5.6 +/- 1.3 Hz before PVI vs 5.9 +/- 0.9 Hz after PVI; P = 0.31). After a follow-up of 30 +/- 11 months, 15 (54%) of patients are free of symptomatic AF, 3 (10%) in sinus rhythm on AAD, 5 (18%) with paroxysmal AF, 4 (14%) in chronic AF, and 1 (4%) with atypical flutter. CONCLUSIONS: In the vast majority of patients with chronic AF, PVI reduces AF disorganization without affecting the DF as measured in the CS.     

Agreement of the clinician's choice of archwire selection on conventional and virtual models

Objectives:To compare archwire selection on dental casts with archwire selection using a three-dimensional (3D) software program (OrthoAid) and assess agreement between clinicians.Materials and Methods:The best-fitting archwires were selected for dental casts of 100 patients with malocclusion using two approaches by three orthodontists. The first method was to visually determine the fitness of five preformed nickel titanium archwires to the arch form on a dental cast (subjective method). The second method was archwire selection on a virtual image of the same cast by means of 3D software (objective method). Agreement between selections performed by the orthodontists was calculated using Kappa statistics. The accuracy of fit of the archwires to the curves fitted to the arch form was also calculated or reversely assessed by means of the root mean square (RMS) for both methods using the Dahlberg formula.Results:The mean RMS of the distances between the patient arch forms and the archwires for the subjective method was 1.163–1.366 mm. The agreement of selections between orthodontists was 42%–58% (Kappa ranged from .074 to .382). Using the 3D software (objective method), the mean RMS decreased to 0.966–1.171 mm, and agreement increased to 47% to 84% (Kappa ranged from .444 to .747).Conclusions:The use of 3D computer software for archwire selection in patients with malocclusion provided better adaptation and interexaminer reliability.     

Cricothyrotomy in emergency context: assessment of a cannot intubate cannot ventilate scenario

Objective

The aim of this study was to assess airway management by emergency physicians in case of a simulated situation where intubation and ventilation were both impossible.

Study design

Observational manikin study.

Methods

A manikin (Airman^®; Laerdal) allowing simulating difficult airway situations was used. The scenario assessed concerned a patient needing tracheal intubation for severe traumatic brain injury. The manikin was settled to make tracheal intubation under direct laryngoscopy impossible at the first attempt and to make facemask ventilation impossible after the second attempt. Manikin could initially be ventilated through the intubating laryngeal mask Airway (ILMA) but became impossible few seconds after its insertion. With impossible ventilation through the ILMA, arterial oxygen saturation decreased during 2 minutes before an hypoxic cardiac arrest occurred. Physicians could use classic laryngoscope with Macinthosh blade, a Gum Elastic Bougie, an ILMA and a cricothyrotomy set. Adhesion to the national airway management algorithm was assessed. Time to cricothyroidotomy decision after ventilation through ILMA became impossible was measured.

Results

Twenty-five emergency physicians were assessed. For 14 of them, national expert conference algorithm was perfectly followed. For ten physicians, cricothyroidotomy decision was taken after hypoxic cardiac arrest occurred.

Conclusion

Simulation with a manikin is useful to assess the adhesion rate to difficult intubation algorithms. Our study shows that the decision making process for cricothyrotomy is too often delayed as soon as ventilation became impossible and oxygenation compromized.     

Single‐session double valve replacement: TAVI+tricuspid valve‐in‐valve procedures

We describe a 70‐year‐old lady with rheumatic heart disease and a history of the mitral valve and tricuspid valve replacement, who underwent transcatheter aortic valve implantation and the tricuspid valve‐in‐valve procedure in a single session.     

A novel technique for experimental stellate ganglion block in rats

A stellate ganglion block (SGB) is routinely performed in a clinical setting for the treatment of sympathetically maintained pain syndromes. However, the cardiovascular effects of SGB have not been well defined. The purpose of the present study was to develop a new technique of SGB in a rat model. Our new technique of SGB is a posterior percutaneous approach and uses the cartilaginous process of the C7 spinous process as a landmark. Twenty-six Sprague-Dawley female rats were divided into six groups. Group I (n = 4) underwent right sided SGB, Group II (n = 5) underwent left-sided SGB, and Group III (n = 5) underwent bilateral SGB using bupivacaine 0.25%. Three additional sham groups (n = 4 in each group) served as controls to each of the three treatment groups. Ipsilateral eyelid droop (ptosis) was observed in all animals that underwent SGB with bupivacaine. Heart rate decreased significantly for up to 45 min after bilateral SGB compared with control groups. However, this value did not change in rats after unilateral SGB. In 9 additional rats, we evaluated the accuracy of SGB by injecting methylene blue to stain the right (n = 3), left (n = 3), and bilateral SGB (n = 3). At autopsy, 11 of 12 SG were stained post-methylene blue injection. We conclude from our study that our new approach, posterior percutaneous SGB is a reliable technique that can be used for further studies. IMPLICATIONS: We describe a new technique for stellate ganglion block in rats that may be used in future studies to investigate the role of cervical sympathetic nervous system (especially the stellate ganglion) in regulating sympathetically maintained pain and myocardial function.     

A novel biallelic LMNB2 variant in a patient with progressive myoclonus epilepsy and ataxia: A case of laminopathy

The report of LMNB2‐related progressive myoclonus epilepsy and ataxia due to missense homozygous c.473G>T variant.     

Sonographically diagnosed and conservatively managed case of polyorchidism: A case report

Polyorchidism is a congenital abnormality with distinct sonographic characteristics. In most cases, sonography is sufficient for diagnosis. In instances of complicated polyorchidism, an MRI may provide further information. Conservative treatment with sonographic follow-up is the best management option in uncomplicated cases. We present a rare case of polyorchidism with no associated complications that were managed conservatively with periodic follow-up imaging.