Left ventricular function by 'conventional' and 'tissue Doppler' echocardiography in paediatric dialysis patients

Aim:   Cardiovascular abnormalities are common in children with chronic kidney disease (CKD). Left ventricular (LV) structure and functions have been extensively studied by conventional pulse-wave Doppler echocardiography (cPWD), however, tissue Doppler imaging (TDI) is a relatively new echocardiography method. The aims of this study were to evaluate LV diastolic function in paediatric dialysis patients using cPWD and TDI methods, and to compare the findings obtained with two modalities.
Methods:   This study included 38 children and adolescents on dialysis (14 haemodialysis and 24 peritoneal dialysis, duration of dialysis 58.0 ± 32.8 months) and 16 age- and sex-matched healthy subjects.
Results:   The mean left ventricular mass index (LVMI) was significantly higher in the patient group ( P  < 0.001) and the most common cardiac geometry was concentric LV hypertrophy (55%). There was no significant difference in LV systolic function between patient and control groups. However, dialysis patients had worse LV diastolic function both according to cPWD (lower E/A ratio) and TDI (lower Em/Am ratio) than the healthy subjects ( P  < 0.001 and P  = 0.001, respectively). Also, the index of LV filling pressure (E/Em ratio) obtained by the combination of cPWD and TDI was significantly higher in the patients ( P  < 0.001). Cumulative dose of calcium-based phosphate binder (CBPB), diastolic blood pressure and LVMI were the independent predictors of E/Em ratio.
Conclusion:   Our study shows that LV diastolic dysfunction is common in paediatric dialysis patients and TDI findings correlate well with cPWD findings. Similarly, higher dose intake of CBPB, hypertension and LV hypertrophy have a negative effect on LV filling pressure suggesting diastolic function.     

Lev氏病1例

随着社会人口的老龄化,Lev氏病的发病率逐渐增高,Lev氏病是一种退化性疾病,目前尚无有效的治疗方法阻止本病的进程,因此Lev氏病的治疗目前仍是对症治疗。应该积极有效地控制各种可能加速心脏纤维支架硬化症的因素,已经发生晕厥或阿斯综合征患者的患者,应积极考虑人工心脏起搏器的植入,预防猝死的发生。     

Relapse of brucellosis simulating testis tumor

We report on a case of a 32-year-old man referred for evaluation of a painless left testicular mass suggesting a testicular tumor. Previous history was uneventful except for a 3-year history of systemic brucellosis without epididymo-orchitis. Radical inguinal orchidectomy was performed. Clinical and histopathological findings indicated a brucellar abscess of the left testis. Even in the absence of systemic symptoms, the possible relapse of brucellosis as an abscess formation in the testis should be considered as a rare cause of testicular mass in patients who live in endemic regions.