Impact of triple pelvic osteotomy on contact stress pressure distribution in the hip joint.

PURPOSE: We studied changes of contact stress distribution in the hip joint after Tonnis triple pelvic osteotomy applied in the treatment of dysplasia and hip joint incongruence in adolescents. METHODS: In a group of 75 patients, 54 (72 %) female, who underwent surgery by triple pelvic osteotomy in adolescence for developmental disorder of the hip and avascular necrosis of the femoral head, a three-dimensional hip joint model was used based on the radiography of the pelvis with hips. The following biomechanical parameters were calculated: resultant hip force normalised to body weight (R/Wb), inclination of the resultant hip force (θ-R), the position of the stress pole (θ), peak contact hip stress (Pmax), and peak contact hip stress normalised to body weight (Pmax/Wb). Gait quality was also assessed. RESULTS: After surgery the Wiberg CE angle was increased by 17.85° (114 %), resultant hip force normalised to body weight (R/Wb) was decreased by 0.107 (3.3 %), the position of the stress pole was shifted medially by 27.59° (63.5 %), and peak contact hip stress normalised to body weight (Pmax/Wb) was decreased by 2249.74 (55.9 %). Waddling gait was reduced from 17 (23.9 %) to four cases (5.6 %). All changes were statistically highly significant (p<0.01). CONCLUSIONS: The effect of Tonnis triple pelvic osteotomy lies in the improvement of stress distribution across the acetabular cartilage of the hip joint, thus slowing down the degenerative damage of the hip joint.

Ultrasonography of major salivary glands could be an alternative tool to sialoscintigraphy in the American-European classification criteria for primary Sjogren's syndrome.

OBJECTIVE: To test the diagnostic accuracy of modified American-European classification criteria (AEC) for primary SS (pSS) by replacing sialoscintigraphy (sSC) with ultrasonography of the major salivary glands. METHODS: One hundred and ninety subjects were evaluated for the diagnosis of pSS, including US of the salivary glands. We tested the diagnostic accuracy of the three different sets of five diagnostic criteria for pSS. Each set combined these four criteria (ocular symptoms, oral symptoms, Schirmer-I test and auto-SS-A antibody) and one of the following: US (US set), sSC (sSC set) or biopsy (Biopsy set). The area under the receiver operating characteristics curve (AUC-ROC) was used to evaluate the diagnostic accuracy of each set of criteria. RESULTS: Out of 190 subjects examined, 140 subjects fulfilled the AEC for the diagnosis of pSS, whereas 50 subjects were classified as non-pSS subjects. US score was positive in 129 (92%), sSC in 123 (88%) and biopsy in 93 (66%) of 140 pSS patients. Among 140 patients with pSS, 88 (63%) patients fulfilled the criteria of the US set, 85 (61%) patients of the sSC set and 71 (51%) patients of the Biopsy set. None of the subjects from the non-pSS group fulfilled any of the sets of criteria. Diagnostic accuracy of each of the three sets of criteria was high and similar [AUC-ROC (s.e.) for the US set was 0.99 (0.00), followed by the sSC set at 0.98 (0.00) and the Biopsy set at 0.97 (0.00)]. CONCLUSION: US finding of major salivary gland involvement could replace sSC in AEC for the diagnosis of pSS.

Advantages and limitations of the autofluorescent diagnostics of the laryngeal cancer and precancerosis.

Any endoscopic diagnostic procedure that is capable of giving exact information on laryngeal lesions without damaging the tissue has essential advantages over standard biopsy. Tissue autofluorescence is defined as a natural ability of tissue to fluoresce when exposed to a certain light wavelength. This feature is a consequence of the presence of fluorophores in the tissues, which are activated by a narrow wavelength range. However, due to their biochemical and biophysical characteristics, laryngeal precancerosis and cancer do not fluoresce when exposed to blue light. In the present study, we used Pentax's System of Autofluorescent Endoscopy (SAFE 1000) to detect autofluorescence disturbances from laryngeal mucosa. Diagnostic parameters (sensitivity and specificity) of the microlaryngoscopy (MLS) and SAFE 1000 in the diagnosis of laryngeal precancerosis and carcinoma were compared and discussed. We have found that SAFE had a better sensitivity with regard to mentioned laryngeal pathology, but MLS had better specificity than SAFE. The overall diagnostic sensitivity in the diagnostics of laryngeal atypical hyperplasia and cancer with SAFE was 89%, as opposed to 73% with MLS. Diagnostic specificity of SAFE for all cases of laryngeal carcinomas and atypical hyperplasia was 78%. The specificity of MLS in diagnostics of laryngeal carcinomas cases was 98%, while that for cases of atypical hyperplasia was 100%. Many other conditions that have impact on autofluorescent features of laryngeal mucosa were also discussed.

Personality, depression and anxiety in primary Sjogren's syndrome - Association with sociodemographic factors and comorbidity.

OBJECTIVE: Patients with primary Sjögren's Syndrome (pSS) have diminished health quality and fatigue, arthralgia along with dryness of the mouth and eyes have major impact on their psychological and social aspects of life. The purpose of this study was to determine psychological features of patients with pSS. We analyzed personality, depression and anxiety of patients with primary Sjögren's Syndrome (pSS) in comparison with patients with rheumatoid arthritis (RA) and healthy controls (HC) and assessed their association with sociodemographic factors and comorbidity. METHODS: In 105 pSS patients (mean age 51.34 years, mean disease duration 5.98 years), 52 RA patients (mean age 51.37 years, mean disease duration 8.10 years) and 54 HC (mean age 51.35 years) clinical and sociodemographic characteristics were determined and results analyzed. At enrollment patients and controls completed the Revisited NEO Personality Inventory Five-Factor model (NEO-PI-R), the Zung Self-Rating Depression Scale and the Zung Self-Rating Anxiety Scale. Statistical analyses were performed using SPSS [Version 16.0]. The relative size of the effect was assessed based on standardized estimates of effect size (d). RESULTS: Patients with pSS, similarly to RA patients had higher scores of Neuroticism (d = 0.46, p = 0.007) and lower scores of Extraversion (d = 0.51, p = 0.001) and Openness for experience (d = 0.65, p = 0.013) compared to HC. There was no significant differences between pSS group and HC in the depression (d = 0.171, p>0.05). However, patients with pSS had higher anxiety in comparison to HC (p<0.0001). In multivariate models, education and satisfaction with family relationships were significant predictors for psychological characteristics of patients, independently of clinical diagnosis. CONCLUSIONS: Our study is the first to show that patients with pSS scored high on neuroticism and anxiety and low on sociability. Education and satisfaction with family relationships predisposed to their psychological profile. Psychological assessment of patients with pSS may improve understanding and treatment of this clinical condition.

Correlation of structural defects in the ascending aortic wall to ultrasound parameters: benefits for decision-making process in aortic valve surgery.

BACKGROUND: Histopathological changes in the ascending aorta wall in patients with severe tricuspid aortic valve (TAV) stenosis were graded and correlated to echocardiographic parameters. Objective was to associate threshold echocardiographic values with structural defects in the ascending aorta providing a tool to improve decision-making process in cases when simultaneous aortic valve replacement (AVR) and ascending aorta replacement is considered. METHODS: Biopsies from 108 TAV stenosis patients subjected to AVR were graded into three grades according to severity of aortic wall changes. Echocardiographic parameters obtained preoperatively and correlated to grade, age, gender and risk factors, were diameters of ventriculo-aortic junction (AA), sinus Valsalva (SV), sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA) as well as indexes: sinus Valsalva (SVI), sinotubular junction (STJI), AscA/AA and STJ/AA. RESULTS: Two echocardiographic parameters portrayed grades with statistical significance: STJ (F = 5.417; p = 0.006 (p < 0.05)) and AscA (F = 3.924; p = 0.023 (p < 0.05)). By using multiple predictors in the setting of Regression analysis, statistically significant differences among grades were reached for AA, SV, STJ, AscA and SVI. With further ROC curves analysis, threshold values for different grades were recognized. Grade 2 is identified in patients with AscA > 3.3 cm, while Grade 3 is identified in patients with values of AscA > 3.5 cm, STJ > 2.9 cm and STJI > 1. CONCLUSIONS: Hemodynamic stress induced by TAV stenosis leads to elastic lamellae disruption in the aortic wall. Those changes could be graded and correlated with echocardiographic parameters of the aortic root and ascending aorta, providing a tool for decision to replace ascending aorta concomitantly with AVR.

Multiobserver Reliability of Ultrasound Assessment of Salivary Glands in Patients with Established Primary Sjögren Syndrome.

OBJECTIVE: To evaluate the multiobserver reliability of salivary gland ultrasonography (SGUS) for scoring greyscale (GS) parenchymal inhomogeneity and parenchymal color Doppler (CD) signal in patients with established primary Sjögren syndrome (pSS). METHODS: The study comprised 2 multiobserver reliability assessments in patients with pSS in 2 European centers. The first reliability exercise was performed on 24 patients with pSS and 8 controls who were independently evaluated with GS and CD US by 5 observers at the Institute of Rheumatology, Belgrade, Serbia. The second reliability exercise was carried out on 10 patients with pSS who were independently assessed with GS and CD US by 8 observers at the Hospital G.U. Gregorio Marañón, Madrid, Spain. SGUS parenchymal inhomogeneity and parenchymal CD signal were semiquantitatively scored using a 4-grade scoring system. The multiobserver agreement was calculated by the overall agreement and Light's κ statistics. RESULTS: A total of 640 SGUS examinations were performed in the first reliability exercise and a total of 320 examinations in the second reliability exercise. Multiobserver reliability was good (κ = 0.71-0.79) to excellent (κ = 0.81-0.82) for GS parenchymal inhomogeneity in both exercises. There was a moderate (κ = 0.53-0.58) to good (κ = 0.70) multiobserver reliability for parenchymal CD signal in the first exercise. However, there was no agreement or only a fair agreement (κ = 0.03-0.29) for parenchymal CD signal in the second exercise. CONCLUSION: US may be a reliable technique in the multiobserver scoring of GS parenchymal inhomogeneity of major SG in patients with established pSS. CD scoring of SG needs further standardization to be used in multicenter studies.

A comprehensive morphometric analysis of the internal thoracic artery with emphasis on age, gender and left-to-right specific differences.

AIMS OF THE STUDY: The aim of this analysis was the morphometric description of the internal thoracic artery (ITA) with an emphasis on age, gender and left-to-right specific differences, as well as on age and atherosclerosis related changes of the elastic skeleton. METHODS: Forty eight arteries were obtained during forensic autopsies from 32 persons who had died of non-vascular causes. The following morphometric parameters were analyzed: thickness of the intima, the medial layer and the wall, the intima-to media-ratio and the elastic skeleton parameters. RESULTS: The intima thickness increases significantly with aging (ANOVA F=34.061, p⟨0.001), as does the intima-to-media ratio (ANOVA F=10.831, p⟨0.001). With aging, there is a significant increase in the thickness of the media (F=56.519; p⟨0.001) and of the wall (F=34.094; p⟨0,001). There is a significant increase in the media thickness during the development of atherosclerosis in the ITA (ANOVA F=11.848, p⟨0.001). No significant difference was found when these data were analyzed based on the left-to-right principle or depending on gender of the patients. However, the analysis of the elastic skeleton parameters indicated that the combined effects of aging, atherosclerosis and male gender lead to the degeneration of the elastic skeleton of the ITA. CONCLUSION: The grade of atherosclerosis gradually increases with aging as shown by morphometric analysis. The increase in the medial layer thickness suggests the potential for positive remodeling of the ITA during aging and atherosclerosis. The left/right position has no influence on morphometric parameters of the ITA, while male gender affects parameters of the elastic skeleton.

Diagnostic value of salivary gland ultrasonographic scoring system in primary Sjogren's syndrome: a comparison with scintigraphy and biopsy.

OBJECTIVE: To compare an ultrasonographic (US) scoring system of salivary glands with scintigraphy and salivary gland biopsy, in order to evaluate its diagnostic value in primary Sjögren's syndrome (SS). METHODS: In 135 patients with suspected SS, the grades of 5 US measures of both parotid and submandibular salivary glands were scored (0-48 scale). Diagnosis of primary SS was established following the American-European Consensus Group criteria of 2002. The patients' total scintigraphic score (0-12 scale) was determined and the histopathological changes of minor salivary glands graded. Area under the receiver-operating characteristic (ROC) curve was employed to evaluate the diagnostic value of the US scoring system. RESULTS: Primary SS was diagnosed in 107 (79.2%) patients and the remaining 28 subjects (20.8%) constituted the control group. US changes of salivary glands were established in 98/107 patients with SS and in 14/28 controls. Mean US score was 26 in SS patients and 6 in controls. Through ROC curves, US arose as the best performer (0.95 +/- 0.01), followed by scintigraphy (0.86 +/- 0.31). Setting the cutoff score for US at 19 resulted in the best ratio of specificity (90.8%) to sensitivity (87.1%), while setting the cutoff scintigraphic score at 6 resulted in specificity of 86.1% and sensitivity of 67.1%. Among 70 patients with US score >or= 19, a scintigraphic score > 6 was recorded in 54/70 (77.1%) and positive biopsy findings in 62/70 (88.5%) patients. CONCLUSION: We show high diagnostic accuracy of a novel US scoring system of salivary glands (0-48) in patients with primary SS comparable to invasive methods, i.e., scintigraphy and salivary gland biopsy.

Blood pressure in non-critically ill preterm and full-term neonates.

The neonatal period is a time of extensive hemodynamic changes. It is expected that these changes are most prominent in premature infants during the first week of life. The aim of this study was to examine arterial blood pressure (BP) measured by an oscillometric device in the first month of life in a stable premature population admitted to our neonatal intensive care unit (NICU), and to evaluate the influence of gestational age, postnatal age, birth weight, gender, and sleep state on BP. This prospective study was conducted over 27 months. The study population consisted of 373 hemodynamically stable infants (292 preterm and 81 full-term infants). Overall 12,552 BP measurements were carried out using a non-invasive oscillometric blood pressure monitor. Both systolic and diastolic blood pressure progressively increased during the first month of life. BP increased more rapidly in preterm infants than in full-term infants, and was higher in groups with higher birth weight. Multiple regression analysis showed that mean BP during the first week and on the 30th day increased with gestational age, and also that it was higher in the awake than in the sleep state.

[Effect of diabetes mellitus in recovery and maintenance of sinus rhythm in patients with persistent atrial fibrillation]. / Uticaj dijabetesa melitusa na uspostavljanje i odrzavanje sinusnog ritma kod bolesnika s perzistentnom fibrilacijom pretkomora.

INTRODUCTION: Diabetes mellitus is frequently accompanied by cardiac rhythm disorders. On the other hand, atrial fibrillation is the most frequent cardiac arrhythmia in adult population [1, 2]. According to some of the large epidemiological studies diabetes mellitus is among independent risk factors for development and persistence of atrial fibrillation [3]. Both diabetes mellitus and atrial fibrillation independently increase the risk of thromboembolism, especially of stroke [3-5]. It is obvious that rhythm control, i.e. restoration and maintenance of sinus rhythm, may be essential for prevention of thromboembolism in these patients. THE AIM OF THE STUDY: The aim of this study is to analyse the impact of diabetes mellitus on rhythm control in patients with persistent atrial fibrillation. METHODS: We analysed the impact of diabetes mellitus and other clinical and echocardiographic parameters (age, gender, current arrhythmia duration, presence of previous episodes of persistent atrial fibrillation, cardiac and/or noncardiac diseases, left atrial diameter and left ventricular ejection fraction) on outcome of attempted cardioversion in patients with persistent atrial fibrillation admitted to Cardiologic Department of the Institute of Cardiovascular Diseases, Clinical Centre of Serbia, between January 1992 and December 1999. We also analysed retrospectively the impact of diabetes mellitus and other parameters listed above on the presence of previous episodes of atrial fibrillation in our patients, that at our opinion reflected the possibilities of sinus rhythm maintenance in these patients. All continuous parameters were expressed as mean value and standard deviation. Statistical significance of differences between variables was examined using Chi-square test. For identification of independent predictors of examined outcomes we used multiple logistic regression model with 95% of confidence interval. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) programme. RESULTS: Of 378 patients with currently persistent atrial fibrillation, aged mean 53.98 +/- 11.69 years, there were 266 (70.4%) men. Diabetes mellitus was previously diagnosed in 27 (7.1%) patients, cardiac diseases in 223 (59.0%), noncardiac diseases in 47 (12.4%) and 140 (37.0%) patients had "lone" atrial fibrillation. Left atrial enlargement was noted in 224 (59.3%) patients, and reduced left ventricular ejection fraction in 82 (21.7%). Atrial fibrillation lasted 48 hours to 9 years, mean 8.5 +/- 18.14 months before cardioversion. While 43 patients had previous episodes of persistent AF for last 1-30 years, mean 10.5 +/- 7.3,335 patients never experienced AF before. There was a statistically significant difference in percent of diabetic patients (18.6%/43 vs. 5.7%/335, value of Chi-square test = 7.759, p < 0.01) in these two groups. We analysed the impact of diabetes mellitus on outcome of attempted cardioversion and on presence of previous episodes of AF reflecting the success in maintaining sinus rhythm. Multiple logistic regression models for all of 378 patients, with dependent variable being present in previous recurrent atrial fibrillations and independent variables of clinical and echocardiographic parameters as listed, identified diabetes mellitus to be an independent predictor of repeated atrial fibrillations with relative risk of 4.6 (CI 95%). When dependent variable in the same model was outcome of cardioversion (sinus rhythm is restored in 281/378 patients--74%) diabetes mellitus was not among independent predictors of successful cardioversion. DISCUSSION: The relationship between atrial fibrillation and diabetes mellitus is not completely understood, including the impact of known complications of diabetes mellitus on electrophysiological properties of atrial myocardium and development of atrial fibrillation [6]. Besides being the independent risk factor for occurrence of atrial fibrillation, diabetes mellitus, according to our results, appears to influence the possibilities of maintaining sinus rhythm after cardioversion of permanent atrial fibrillation in diabetic patients. We found that patients with diabetes mellitus and persistent atrial fibrillation may be successfully converted to sinus rhythm like any other group of patients, but the presence of diabetes mellitus increases the risk of arrhythmia recurrence for 4.6 times compared to patients without diabetes mellitus. Obviously, diabetic patients need to be treated with more efficacious antiarrhythmics from the very beginning, including amiodarone, which successfully prevents recurrent atrial fibrillation in the majority of patients [7, 8]. CONCLUSION: We concluded that diabetes mellitus independently predicts the presence of recurrent atrial fibrillation but does not influence the possibility of sinus rhythm restoration. The relationship between atrial fibrillation and diabetes mellitus needs further investigation.