Clinical benefits of aspirin desensitization in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease are not related to urinary eicosanoid release and are accompanied with decreased urine creatinine.

BACKGROUND: Treatment with acetylsalicylic acid (ASA) after desensitization may be a therapeutic option in patients with nonsteroidal anti-inflammatory drug exacerbated respiratory disease (NERD). The mechanisms that lead to improvement in rhinosinusitis and asthma symptoms remain unknown. AIM: To attribute the documented clinical effects of ASA treatment of chronic rhinosinusitis and/or asthma to the release of eicosanoid metabolites in urine. METHODS: Fourteen patients with NERD were successfully desensitized, and, eventually, eight patients were treated with 650 mg of ASA daily for 3 months. In addition to clinical assessments, nuclear magnetic resonance imaging and smell test were performed before and after treatment with ASA. Venous blood and urine were collected before desensitization and after 1 and 3 months of treatment. The levels of urinary leukotrienes (LT) (cysteinyl LT and LTE4) and tetranor PGDM (metabolite of prostaglandin D2) were measured by enzyme-linked immunosorbent assay. RESULTS: Treatment with ASA after desensitization alleviated symptoms of rhinosinusitis, improved nasal patency (mean, 50% decrease in peak nasal inspiratory flow) and sense of smell (fourfold increase in smell test score) in as early as 4 weeks. Clinical improvements were not accompanied by any change in sinonasal mucosa thickness as assessed with nuclear magnetic resonance. Urinary cysteinyl LTs, LTE4, and prostaglandin D2 metabolite remained relatively stable during ASA treatment and did not correlate with clinical improvements. Desensitization was associated with a progressive decrease of urinary creatinine. CONCLUSION: Clinical improvement in rhinosinusitis and/or asthma after ASA desensitization was not related to concentrations of urinary eicosanoid metabolites. A decrease of urinary creatinine requires further study to determine the renal safety of long-term treatment with ASA after desensitization.

2D speckle tracking echocardiography for the assessment of regional contractile reserve after myocardial infarction.

AIMS: To assess whether quantitative resting assessment of local myocardial function by 2D speckle tracking echocardiography may be helpful for the evaluation of myocardial viability in patients after ST-elevation myocardial infarction (STEMI) and for the prediction of left ventricular function recovery after 12-month follow-up. METHODS: The study group comprised 96 patients with first STEMI treated with successful primary percutaneous coronary intervention. Seven to 12 days after STEMI, all patients underwent resting echocardiography and low-dose dobutamine stress echocardiography (LDDSE) with visual assessment of contractile reserve which was the reference method for the evaluation of myocardial viability. After 12 months resting echocardiography with visual assessment of functional recovery was performed. Subsequently, acquired images were analyzed off-line using 2D speckle tracking echocardiography algorithm. Measurements included peak systolic longitudinal and transverse strain (SLS/STS), peak longitudinal and transverse strain (PLS/PTS), systolic longitudinal and transverse strain rate (SLSR/STSR) at baseline and after 12 months. RESULTS: All analyzed longitudinal parameters of strain had a very good diagnostic value, while transverse parameters had only good diagnostic value for predicting myocardial viability defined on the basis of LDDSE. Moreover, SLS and PLS had good, whereas SLSR only satisfactory diagnostic value for predicting function recovery after 12-month follow-up. CONCLUSIONS: 2D speckle tracking analysis applied during resting echocardiography can be helpful for the prediction of myocardial viability and functional recovery in patients after STEMI. Longitudinal strain parameters allow the prediction of local contractile reserve with SLS showing best correlation with DSE results functional recovery after 12-month follow-up.

Echocardiographic quantitative analysis of resting myocardial function for the assessment of viability after myocardial infarction--comparison with magnetic resonance imaging.

BACKGROUND AND AIM: The study was set out to assess feasibility and diagnostic value of the echocardiographic quantitative analysis of the resting regional systolic function (i.e. strain and strain rate) with use of the speckle tracking (2D strain) for myocardial viability assessment in patients with acute myocardial infarction (MI) treated with primary angioplasty. The reference method was the late enhancement magnetic resonance imaging (LE MRI). METHODS: The study group consisted of 40 patients (29 men, mean age 61 ± 9 years) in whom resting echocardiographic examination was performed 7-10 days after MI with peak systolic longitudinal strain (STS) and systolic longitudinal strain rate (SLSR) measurement by 2D strain technique on external workstation (EchoPac 6.1.0., GE Vingmed Ultrasound). Within 72 h LE MRI was performed in all patients, with visual assessment of late enhancement in all segments of the left ventricle. Viability of a segment was assessed based on two distinct, frequently adopted criteria: LE extent ≤ 50% or ≤ 75% of the wall thickness. RESULTS: Due to suboptimal image quality 70 (10.9%) of the segments were excluded from 2D strain analysis. In the analysis of akinetic and dyskinetic segments, SLS and SLSR measurements with 2D strain technique had good discrimination value for viability defined as LE extent of ≤ 75% by MRI (area under the ROC curve 0.715 and 0.705, respectively; diagnostic accuracy of the criterion SLS ≤ -7.61% was 72.8%; diagnostic accuracy of the criterion SLSR ≤ -0.79/s was 64.9%). However, when the ≤ 50% viability criterion by LE MRI was used, only SLS measurement could be used for viability assessment, with sufficient diagnostic value (area under the ROC curve 0.620; diagnostic accuracy of the criterion SLS ≤ -9.77% was 57%). In the analysis of all segments, including hypokinetic and normokinetic segments, SLS and SLSR measurements did not provide additional information, beyond that of the visual viability analysis. CONCLUSIONS: Resting quantitative echocardiographic analysis of myocardial function seems to be a promising tool for myocardial viability assessment. There is a trend towards greater diagnostic value of SLS than SLSR measurements.

Secondary gleno-humeral joint dysplasia in children with persistent obstetric brachial plexus palsy.

The study aimed to evaluate the degree of gleno-humeral joint deformation in children with persistent obstetric brachial plexus palsy and its effect on limb function. Computer tomography was performed in 24 children in the mean age of 6.1 years. There were eight boys and 16 girls. Gleno-scapular angle, congruency of gleno-humeral joint and joint deformity according to Waters at all. criteria were measured. The mean functional score according to the Mallet classification system was 12.3 points. The joint was stabile in nine, subluxed in seven and dislocated in nine cases. Gleno-scapular angle in affected joints was 23.3 degrees and in non-affected 4.5 degrees. The glenoid was statistically more retroverted in older children. With more severe posterior incongruence there was statistically greater limitation of passive external rotation, active internal rotation and a poorer functional result according to Mallet. Abnormalities were found also in the humeral head, being deformed and smaller compared to the non-affected side in all cases. Glenoid retroversion, posterior subluxation/dislocation of humeral head and smaller humeral head size are the abnormalities, most often identified in CT examinations. Shoulder function and in particular, passive, external rotation are closely associated with the degree of deformity of the glenoid, as well as with the extent of posterior humeral head dislocation.

Comparison of thermography and Doppler sonography in the evaluation of the cold immersion test in women with excessive vasospastic reaction.

BACKGROUND: Determining the predisposition to vasospastic reactions in a function test is important at the earliest possible stage of diagnosis. Thermography is an acknowledged procedure for monitoring function tests; however, its availability is limited. The aim of this study was to compare the progression of the cold immersion test in a thermal picture and an US-CD examination with the flow assessment of the small blood vessels of the hand. MATERIAL/METHODS: A group of 16 women declaring high cold tolerance of their hands was compared with a group of 24 women reporting hand complaints when exposed to the cold. The subjects underwent a test in which they immersed their right hand in ice-cold water (0 degrees C). Then images of the temperature distribution in the hand were recorded with a thermovisory camera. At the same time, spectral waveforms were registered in the proper palmar digital artery and in the radial artery at specified time intervals. RESULTS: Data analysis comprised temperature measurements at the level of the nail plate of the middle finger and at the wrist. There were differences between the groups at all the stages of the immersion test (efficient return of temperature to initial values in the reference group, delayed return in subjects with low tolerance to thermal stimuli). Flow resistance analysis using the Doppler method in the studied arteries revealed similar differences between the groups (swift flow normalization and efficient reperfusion in the reference group, higher flow resistance and low reperfusion in subjects with low tolerance to thermal stimuli). CONCLUSIONS: Changes in the parameters of hand warmth during the immersion test assessed by thermography and changes in the flow parameters observed by Doppler sonography demonstrated similar progression, which suggests the equivalence of both methods. Doppler sonography may thus serve as a method of monitoring function tests to establish a predisposition to vasospasm.