2D speckle tracking: a diagnostic and prognostic tool of paramount importance.

OBJECTIVE: We aimed to conduct a review of the literature relevant to cardiac imaging techniques and summarize the use of different non-invasive imaging modalities in the assessment of ventricular size, function, and mechanics. The current review emphasizes the benefits of speckle tracking imaging (STI), highlighting its use in demonstrating myocardial strain. This robust technique is a recent addition to the existing imaging techniques that are used to assess the myocardium. In terms of effectively determining the left ventricle ejection fraction, it is a comparable technique to cardiac magnetic resonance. The use of STI method for image acquisition relies on semiautomatic identification of the border and deformation of the region of interest, and is also independent of the angle of insonation, thus it increases the inter-and intra-observer reproducibility in contrast to the conventional tissue doppler imaging. MATERIALS AND METHODS: The databases of PubMed, Scopus, and Embase were thoroughly searched for the following keywords: 2- dimensional/ two-dimensional/ 2-D, speckle/strain tracking, systolic dysfunction, and heart failure. The studies selected described image acquisition techniques and the application of this imaging modality in various clinical settings. The selected journal articles were perused to provide the best possible analysis of STI. RESULTS: Our comparative analysis demonstrated that the STI, when compared with the conventional echocardiography, is a more sensitive image acquiring technique for detecting subclinical myocardial dysfunction. Based on the analysis it can be stated that the STI can provide valuable information on both regional and global myocardial function, and it can also quantify cardiac synchronicity and rotation. Additionally, it serves as a better prognostic indicator. CONCLUSIONS: The change in longitudinal strain can serve as an early marker of the left ventricular systolic dysfunction, and therefore, monitoring via STI has both diagnostic and prognostic value in heart failure, ischemic heart disease, valvulopathies, chemotherapy-induced cardiotoxicity, and cardiac resynchronization therapy. Despite the lack of standardization, the method is also effective in assessing the right ventricle and left atrial function and arterial rigidity.

From swing to cane: Sex differences of EEG resting-state temporal patterns during maturation and aging.

While many insights on brain development and aging have been gained by studying resting-state networks with fMRI, relating these changes to cognitive functions is limited by the temporal resolution of fMRI. In order to better grasp short-lasting and dynamically changing mental activities, an increasing number of studies utilize EEG to define resting-state networks, thereby often using the concept of EEG microstates. These are brief (around 100 ms) periods of stable scalp potential fields that are influenced by cognitive states and are sensitive to neuropsychiatric diseases. Despite the rising popularity of the EEG microstate approach, information about age changes is sparse and nothing is known about sex differences. Here we investigated age and sex related changes of the temporal dynamics of EEG microstates in 179 healthy individuals (6-87 years old, 90 females, 204-channel EEG). We show strong sex-specific changes in microstate dynamics during adolescence as well as at older age. In addition, males and females differ in the duration and occurrence of specific microstates. These results are of relevance for the comparison of studies in populations of different age and sex and for the understanding of the changes in neuropsychiatric diseases.

The effect of candesartan on pentraxin-3 plasma levels as marker of endothelial dysfunction in patients with essential arterial hypertension.

BACKGROUND: In the last decades, the studies performed on the field of endothelial dysfunction confirmed the fact that the starting point of this pathology is the inflammation. Several inflammatory biomarkers had been discovered and studied, ones showing systemic inflammation, and others being more specific biomarkers and showing the local inflammation. Pentraxin-3 (PTX3) is a new inflammatory biomarker, from the same family as high-selectivity C-reactive protein (hs-CRP), but it is a more specific biomarker, due to its local production: the endothelial cells and not the liver like in the case of hs-CRP. AIMS: Several antihypertensive classes of drugs seem to have a positive impact on reducing the local endothelial inflammation, beyond their effect of lowering the blood pressure, so this study aims to analyze the effect of candesartan on the two inflammatory biomarkers: PTX3 and CRP, compared with other antihypertensive drugs, in hypertensive patients with endothelial dysfunction. METHODS: A total of 365 patients were included in the study: 127 hypertensive patients were under treatment with candesartan, 134 patients were under treatment with other hypotensive medication (beta blockers, calcium channel blockers, and diuretics), both groups with controlled values of blood pressure, and 104 were normotensive persons. Classical methods of assessing the endothelial function were correlated with these biochemical markers. RESULTS: The patients treated with candesartan had a significant lower value of PTX3 and hs-CRP, compared with those under treatment with other antihypertensive medication as follows: PTX3: 0.61 ± 0.49 vs 0.95 ± 1.04 ng/ml, P = 0.006 and hs-CRP: 0.19 ± 0.20 vs 0.20 ± 0.22 mg/dl, P = 0.54. CONCLUSIONS: Candesartan decreases PTX3 and hs-CRP plasma levels more powerful than other classes of antihypertensive drugs (beta blockers, calcium channel blockers, and diuretics), so we may assume that candesartan has a more potent action in reversing endothelial dysfunction and that it offers a higher vascular protection than other classes of antihypertensive drugs. We are suggesting that this new biochemical marker, PTX3, might be better and more specific marker for endothelial dysfunction, than hs-CRP.

Evaluation of patients diagnosed with essential arterial hypertension through network analysis.

BACKGROUND: Essential hypertension is a chronic pathology that causes long-term complications due to late diagnosis of patients, the inability to control the disease through medication, or due to the complexity of associated risk factors. AIMS: Our study sets out to identify specific patterns of response to arterial hypertension treatment, by taking into consideration the multiple connections between risk factors in a relevant population of hypertensive patients. METHODS: Network science is an emerging paradigm, branching over multiple aspects of physical, biological and social phenomena. One such branch, which has brought significant contributions to medical science, is the field of network medicine. To apply this methodology, we create a complex network of hypertensive patients based on their common medical conditions. Consequently, we obtain a community-based representation which pinpoints specific-and previously uncharted-patterns of hypertension development. This approach creates incentives for evaluating patient's treatment efficacy, by considering its network topological position. RESULTS: Distinct clusters of patients with common properties have emerged for each study group (group A-treated with nebivolol, group B-treated with perindopril and group C-treated with candesartan cilexetil). Therefore, our network-based clustering allows for a better treatment assessment.

Colon capsule endoscopy leading to gastrointestinal stromal tumor (GIST) diagnosis after colonoscopy failure.

BACKGROUND: Gastrointestinal stromal tumors are a subtype of mesenchymal tumors. In recent years a significant progress was made in their diagnosis and treatment which led to significant improvement of their prognosis. Endoscopy remains one of the main diagnostic methods. In the rare instance of colonoscopy failure, different approaches are available: different endoscope, computed tomography colonography, capsule endoscopy, use of an enteroscope. CASE PRESENTATION: We present the case of a 75-year-old Caucasian man admitted for abdominal pain, diarrhea and weight loss. Two colonoscopy attempts failed in a different center and a decision to use colon capsule endoscopy was made. This exam revealed a submucosal mass located in the sigmoid colon. Surgery was performed and a local invading gastrointestinal stromal tumor was removed. This is the first image of a colonic gastrointestinal stromal tumor seen on capsule endoscopy. CONCLUSION: Colon capsule is a useful diagnostic tool in selected patients after colonoscopy failure or contraindication.

[Short bowel syndrome due to a severe complication related to Meckel's diverticulum]. / Sindromul de intestin scurt chirurgical--consecinta a unei complicatii grave generate de diverticulul Meckel.

A 17 years old patient, admitted and operated in emergency with acute diffuse peritonitis which had been had the onset four days before. During surgery, a huge volvulus of the small intestine is revealed due to an adherence between Meckel's diverticulum and mesentery, with large intestinal necrosis. Extended enterectomy is performed with jejunostomy. The postoperative outcome is difficult due to severe metabolic insufficiencies which are managed by intensive therapy measures. The patient is readmitted to surgery and an anastomosis between 30 cm jejunum and 20 cm ileum is performed. Then the outcome is good, with digestive function recovery and weight gain. Unfortunately, the patient died one year after surgery, due to severe haematological and neurological disorders caused by the mal-absorbtion syndrome.

[Malignancy of familial adenomatous polyposis. Diagnosis and treatment]. / Polipoza adenomatoasa familiala degenerata malign. Particularitati diagnostice si terapeutice.

Familial adenomatous polyposis with features of malignancy find in a 23 years old patient, whose diagnosis has been established on endoscopical basis. Total proctocolectomy is performed with terminal ileostomy. Histopathologically, the diagnosis is revealed, with establishing of multiple areas of malignancy in rectum and sigmoid colon. In the postoperative period, the patient is treated by pelvic radiotherapy and polychemotherapy. After one year, the clinical outcome is good, with weight gain 13 Kg and finishing high school. After two years, peritoneal carcinomatosis and one lung metastasis.

[Gall bladder carcinoma]. / Carcinomul inaparent al veziculei biliare.

The study comprises a lot of 989 cholecystectomies for gall bladder lithiasis performed in the First Surgery Clinic of the University Emergency Hospital of Bucharest throughout three years and a half (2000-June 2003). Half out of them--493 cases (50%)--were laparoscopic interventions. All of the organ material was submitted to pathological examination. In 4 cases (0.4%), all females, the pathologist surprisingly unveiled the diagnosis of gall bladder carcinoma in the 3rd stage of evolution for all of them. None of the observations presented beforehand or per operative hints suggestive for a malignant affliction. Three patients associated multiple pathology such as acute pancreatitis (obs No2), common bile duct lithiasis (obs No3) and cholecysto-duodenal fistula (obs No4). The postoperative evolution of gall bladder neoplasia of the 4 cases studied was extremely fast, the patients soon being readmitted in our clinic for jaundice, subhepatic tumoral mass and liver metastasis, on average after 31 days after cholecystectomy. That was why the reinterventions were confined to limit at exploratory laparotomies only.

[Ascites--a complication of chronic alcoholic pancreatitis]. / Ascita--complicatie a pancreatitei cronice etanolice.

We present the case a 44 year old patient previously diagnosed with chronic alcoholic pancreatitis with pancreatic ascites during hospitalization in the Gastro-Enterology department. As the conservative therapy performed for 21 days was not effective in diminishing the ascites, the patient was admitted in our Surgical Department and scheduled for surgical intervention. He was operated and we discovered a small dimension cyst (7/4 cm) developed in the body and tail of the pancreas, fistulized in the peritoneal cavity through an outlet positioned below the insertion of the mesocolonum transversum, fairly close to the duodeno-jejunal angle. We executed a cysto-jejunal anastomosis by using the first loop of the jejunum, secured with a politer drainage positioned as in WITZEL technique and drive out in the left upper quadrant. The postoperative evolution of the patient was difficult, but constantly positive. The patient left the hospital 32 days after the intervention. The clinical and ultrasound follow-up after three months were normal.

[Acute necrotizing pancreatitis following abdominal trauma]. / Pancreatita acuta necrotica posttraumatica.

We present 11 cases of acute necrotizing pancreatitis following abdominal trauma operated in our clinic during the last five years. All patients except one were male. All of them had obvious symptoms of acute diffuse peritonitis when they came to hospital. The diagnosis was established by CT scan in four observations. All operations were performed during 12-36 hours after they came. During surgery, there was complete pancreatic necrosis in seven cases and incomplete in the other four cases. Associated injuries following trauma were represented by: hemothorax--two cases, spleen injury--one case, lesion of mesentery--one case, intestinal lesion--one case. In all cases we performed a wide opening of the lesser sac, pancreatic capsulectomy, necrosectomy and multiple drainage of the pancreatic side (behind the peritoneum) and peritoneal cavity. The postoperative outcome was difficult in all cases. Postoperative morbidity recorded pancreatic leakage (three cases), pseudocysts (two cases) and a perforation of gastric wall. There were 10 cases cured and one patient died.

[Surgical treatment of great median upper and/or lower abdominal incisional hernias with mesh placed in the rectus sheath(behind the muscle)]. / Cura chirurgicala a eventratiilor mari, mediane supra si/sau subombilicale prin plastie cu plasa sintetica introdusa în teaca muschilor drepti abdominali (retromuscular).

We present our experience concerning surgical treatment of great upper and/or lower abdominal incisional hernias, by the technique using a mesh placed in the rectus sheath. Durind 5 years, we operated 42 cases. The features of our trial were: average age--56 years; female prevalence--40 cases (95%); great obesity rate (15 observations--35%). The early postoperative morbidity was represented by (number of cases): thrombophlebitis (2), prolonged postoperative ileus (3), seromas (7), prolongs hemorrhagic drainage (3), hematomas (2). We recorded no death. The late postoperative morbidity (number of observations) recorded granulomas (3) and recurrency (2). We obtained good and very good results in 37 cases (88%).

The value of echocardiography in the early diagnosis of myocardial impairment due to connective tissue diseases.

The study comprised 14 patients with systemic lupus erythematosus (SLE) and 12 patients with diffuse scleroderma. Echocardiography ascertained 5 cases of congestive and 1 case of restrictive cardiomyopathy among the patients with SLE, as well as 6 cases with restrictive cardiomyopathy among those with scleroderma. The authors specify two important echocardiographic variables: the E-septum distance and the septal and wall motion after amyl-nitrite test, which reveal the intrinsic contractile properties of the myocardium, allowing an early diagnosis of myocardial impairment, as well as the selection of patients for an efficient treatment with vasodilator drugs.