Cyanoacrylate for septal ablation in hypertrophic cardiomyopathy

Objective: Alcohol septal ablation (ASA) has been shown to be an effective treatment in patients with hypertrophic obstructive cardiomyopathy (HOCM) who are refractory to medical treatment. We describe an alternative approach for septal ablation with glue (cyanoacrylate), which is particularly useful in patients with the collateral formation to the right coronary artery in whom ASA is contraindicated. Methods: In our method left coronary ostium was cannulated with 6–8F guiding catheter. Septal branch was cannulated with a 4F catheter and a microcatheter then cyanoacrylate mixture was instilled into the septal artery. Immediate polymerization prevents the leak into the left anterior descending coronary artery, and also into the right coronary artery (RCA) via septal collaterals. Results: Glue septal ablation (GSA) was performed in 18 patients (6 patients had collateral branches to RCA). Immediately after the procedure peak left ventricular outflow (LVOT) gradient reduced significantly both in cardiac catheterization (65.0 ± 13.8 vs. 14.2 ± 5.7 mmHg, P < 0.001) and Doppler echocardiographic measurements (75.8 ± 19.9 vs. 18.0 ± 9.1 mmHg, P < 0.001). LVOT tract gradient reduction persisted after 6 months follow‐up. Septal wall thickness (20.2 ± 3.7 mm vs. 16.5 ± 3.2 mm, P = 0.003) reduced and NYHA functional class (3.1 ± 0.4 vs. 2.2 ± 0.3, P < 0.001) improved. There was no significant complication during the procedure and within 6 months follow‐up period. Conclusions: GSA seems to be an efficient and safe approach to HOCM, especially in patients with the collateral formation. Further experience is needed in order to assess the long‐term efficacy and safety of this technique. (J Interven Cardiol 2011;24:77–84)     

The Turkish Version of the Eating Disorder Examination Questionnaire: Reliability and Validity in Adolescents

The Eating Disorder Examination Questionnaire (EDE‐Q) is the self‐report questionnaire version of the Eating Disorder Examination Interview. The aim of the current study was to validate a Turkish version of the EDE‐Q in a sample of Turkish primary and high school students (626 girls and 299 boys) in Istanbul. Subjects also completed the Eating Attitudes Test, the General Health Questionnaire and the Body Image Satisfaction Questionnaire, and they were weighed. Girls had higher scores on all EDE‐Q subtests. EDE‐Q scores increased as body mass ?ndex increased. EDE‐Q total score and subscales were highly correlated with the Eating Attitudes Test and the Body Image Satisfaction Questionnaire, supporting its validity. A small test–retest reliability study provided satisfactory results. The present study suggests that the Turkish version of EDE‐Q is an acceptable, reliable and valid measure in nonclinical adolescent samples. More psychometric studies are needed concerning wider age ranges and various clinical samples. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

A novel fuzzy-logic inference system for predicting trauma-related mortality: emphasis on the impact of response to resuscitation

Introduction  

Trauma scoring aims for quantification and uniform reporting of trauma-related outcomes. Despite significant advances in trauma scoring, the exact time period at which relevant calculations should be made is not clear. Considering the importance of response to resuscitation, calculation of trauma scores after a period of resuscitation can allow better discrimination of patients who will survive.     

Review of Pathological Hallmarks of Schizophrenia: Comparison of Genetic Models With Patients and Nongenetic Models

Schizophrenia is a condition that impairs higher brain functions, some of which are specific to humans. After identification of susceptibility genes for schizophrenia, many efforts have been made to generate genetics-based models for the disease. It is under debate whether behavioral deficits observed in rodents are sufficient to characterize these models. Alternatively, anatomical and neuropathological changes identified in brains of patients with schizophrenia may be utilized as translatable characteristics between humans and rodents, which are important for validation of the models. Here, we overview such anatomical and neuropathological changes in humans: enlarged ventricles, dendritic changes in the pyramidal neurons, and alteration of specific subtypes of interneurons. In this review, we will overview such morphological changes in brains from patients with schizophrenia. Then, we will describe that some of these alterations are already recapitulated even in classic nongenetic models for schizophrenia. Finally, in comparison with the changes in patients and nongenetic models, we will discuss the anatomical and neuropathological manifestation in genetic models for schizophrenia.     

Development and validation of an Arabic version of the International Prostate Symptom Score

OBJECTIVE

To develop and validate an Arabic version of the International Prostate Symptom Score (IPSS).

PATIENTS, SUBJECTS AND METHODS

An Arabic version of the IPSS (IPSS‐Arb) was developed through a series of translations and modifications which involved the authors, urology and non‐urology medical and nursing staff. The validity and reliability were assessed in 76 patients with urinary symptoms due to benign prostatic hyperplasia (BPH) and in 63 control subjects without BPH; 25 patients had transurethral resection of prostate (TURP) whereas the remaining 51 patients were treated with terazosin. The reliability of the IPSS‐Arb was assessed by determining the internal consistency (Cronbach’s α coefficient) and by assessing the test‐retest reliability (intraclass correlation coefficient, ICC). Construct validity was assessed by determining the correlation between the IPSS‐Arb scores and the quality‐of‐life question (QoL‐Arb), and by determining the ability of the IPSS‐Arb to discriminate between the patients and controls by calculating the area under the receiver operating characteristic (ROC) curve.

RESULTS

The Cronbach’s α coefficient (internal consistency) for the IPSS‐Arb was 0.85, and 0.78–0.88 for the individual items. The test‐retest reliability (ICC) was 0.88 (P < 0.001). In addition, the IPSS‐Arb had a high correlation with the QoL‐Arb (Spearman rank correlation coefficient 0.82, P = 0.01). The mean (sem , 95% confidence interval) area under the ROC curve for the IPSS‐Arb was 0.93 (0.09, 0.89–0.97), whereas the area for its individual questions was 0.79–0.90. The IPSS‐Arb also showed a high sensitivity to change. The mean (sd ) IPSS‐Arb scores before and after TURP were 23.1 (6.4) and 6.9 (1.8), respectively (P < 0.001); in the terazosin group, the scores were 12.6 (7.4) and 8.2 (4.0), respectively (P < 0.001).

CONCLUSIONS

The IPSS‐Arb was shown to be a reliable and valid instrument for patients with BPH. We recommend using it for patient assessment and follow‐up, and as a research tool in Arabic‐speaking patients both in the Middle East and worldwide. In addition, this study provided another proof of the wide suitability of the IPSS among various nations worldwide.     

Induction of anesthesia in coronary artery bypass graft surgery: the hemodynamic and analgesic effects of ketamine

OBJECTIVE

The aim of this prospective, randomized study was to evaluate the hemodynamic and analgesic effects of ketamine by comparing it with propofol starting at the induction of anesthesia until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.

INTRODUCTION

Anesthetic induction and maintenance may induce myocardial ischemia in patients with coronary artery disease. A primary goal in the anesthesia of patients undergoing coronary artery bypass grafting surgery is both the attenuation of sympathetic responses to noxious stimuli and the prevention of hypotension.

METHODS

Thirty patients undergoing coronary artery bypass grafting surgery were randomized to receive either ketamine 2 mg.kg⁻¹ (Group K) or propofol 0.5 mg.kg⁻¹ (Group P) during induction of anesthesia. Patients also received standardized doses of midazolam, fentanyl, and rocuronium in the induction sequence. The duration of anesthesia from induction to skin incision and sternotomy, as well as the supplemental doses of fentanyl and sevoflurane, were recorded. Heart rate, mean arterial pressure, central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, cardiac index, systemic and pulmonary vascular resistance indices, stroke work index, and left and right ventricular stroke work indices were obtained before induction of anesthesia; one minute after induction; one, three, five, and ten minutes after intubation; one minute after skin incision; and at one minute after sternotomy.

RESULTS

There were significant changes in the measured and calculated hemodynamic variables when compared to their values before induction. One minute after induction, mean arterial pressure and the systemic vascular resistance index decreased significantly in group P (p<0.01).

CONCLUSION

There were no differences between groups in the consumption of sevoflurane or in the use of additional fentanyl. The combination of ketamine, midazolam, and fentanyl for the induction of anesthesia provided better hemodynamic stability during induction and until the end of sternotomy in patients undergoing coronary artery bypass grafting surgery.