Influence of body height on aortic systolic pressure augmentation and wave reflection in childhood.

The enhanced wave reflection in small children is a well-known phenomenon. It is explained on the basis of differences in the body height and the timing of wave reflection. This hypothesis still has not been proved directly. The aim of our study was to determine the reference values of aortic augmentation index (Aix(ao)) and the simultaneously measured return time of the systolic pulse wave (RT) in relation to the body height to test this hypothesis. Aix(ao) and RT were measured by Arteriograph in a healthy population aged 3-18 years (n = 4619, 2489 males). The Aix(ao) decreased with increasing age in boys from 18.6 ± 8.4% to 4.7 ± 4.3% and in girls from 22.3 ± 9.2% to 8.1 ± 5.1%, whereas the RT increased from 115.5 ± 16.3 ms to 166.7 ± 20.8 ms in boys and from 106.7 ± 21.9 ms to 158.1 ± 15.5 ms in girls. These changes were constant during childhood, but they slowed down after the onset of puberty. Because aortic pulse wave velocity (PWV(ao)) measured in the same population was unchanged during childhood, the increase of RT can only be explained by the increase of aortic length due to growth. In the puberty PWV(ao) starts increasing indicating that RT (Aix(ao)) does not follow the increase (decrease) of aortic length proportionally.

Comparison of arterial stiffness parameters in patients with coronary artery disease and diabetes mellitus using Arteriograph.

Recently an expert consensus document advised to standardize user procedures and a new cut-off value for carotid-femoral pulse wave velocity in daily practice. Our aim was to observe aortic pulse wave velocity (PWVao) and augmentation index (AIXao) in two high cardiovascular risk groups: patients with verified coronary artery disease (CAD) or with type 2 diabetes mellitus (T2DM). We also aimed to determine the cut-off values for PWVao, AIXao in CAD and T2DM patients using oscillometric device (Arteriograph). We investigated 186 CAD and 152 T2DM patients. PWVao and AIXao increased significantly in the CAD group compared to the age-, gender-, blood pressure-, and heart rate-matched control group (10.2+/-2.3 vs. 9.3+/-1.5 m/s; p<0.001 and 34.9+/-14.6 vs. 31.9+/-12.8 %; p<0.05, respectively). When compared to the apparently healthy control subjects, T2DM patients had significantly elevated PWVao (9.7+/-1.7 vs. 9.3+/-1.5 m/s; p<0.05, respectively), however the AIXao did not differ significantly. The ROC-curves of CAD and healthy control subjects explored cut-off values of 10.2 m/s for PWVao and 33.23 % for AIXao. Our data provide supporting evidence about impaired arterial stiffness parameters in CAD and T2DM. Our findings encourage the implementation of arterial stiffness measurements by oscillometric method in daily clinical routine.

[Partial replacement of the trachea with jejunal autograft in the dog]. / Légcsópótlás vékonybél szabadlebennyel állatkísérletes modellben (Elókísérlet).

Extensive lesions of the cervical trachea can occur as a result of malformation, inflammation, tumor disease or trauma. If a short segment of the trachea is resected primary anastomosis may be possible. The problem of how to treat lesions longer than 50% of total tracheal length is still unresolved. The aim of our study was to clarify the possible use and limitations of small bowel interposition for tracheal replacement in veterinary model. We resected 6 cm of the cervical trachea of 5 adult mongrel dogs. Autolog jejunum free flap was used for replacement. The wall of the implant was supported with 5 polytetrafluoroethylene rings placed on the outer surface of the bowel perpendicular to its axis. We performed the surgery in two stages. Intraoperative tracheostomy was necessary in every case. The tracheal tube extended through the whole length of the implant. The survivals, the viability of the graft and complications were examined. The length of survival ranged between 18 h and 72 h. In one case obstruction of the tracheal tube occurred, in 3 cases the micro vessel anastomosis of the graft thrombosed, in one case both complications developed. In our experience use of the small bowel flap was complicated with fatal technical difficulties. The micro vessel anastomosis proved to be highly risky. Further investigations are needed to improve the results with this method.

[Repeated resection of hepatocellular carcinoma and its recurrences and removal of pulmonary metastases]. / Hepatocellularis carcinoma és recidíváinak ismételt resectiója tüdömetastasisok eltávolításával.

A case of a 67 year old male successfully treated local recurrence of previously radically resected hepatocellular carcinoma with distant metastases of the lung is reported. Two years after a complete removal of the primary liver malignoma a local recurrence was resected which was followed by selective intraarterial cytostatic treatment and chemoembolisation. A three-year disease-free interval was achieved, then recurrence in the liver and lung metastases were detected at the regular check-up. All of the malignant focuses were eliminated by parenchyma sparing surgical resections, then a postoperative adjuvant chemotherapy (FAM scheme) has been followed. After eight months the patient remained symptom-free. The long-term survival seems to justify the aggressive approach of this kind of malignancies.