Negativity of the electromechanical window: relation to frequent premature ventricular complexes.

OBJECTIVE: The electromechanical window (EMW) was investigated as a new predictor of arrhythmia in the presence of long QT. However, the use of EMW to predict idiopathic frequent ventricular premature complexes (PVCs) in those with normal QT intervals has not been clarified. PATIENTS AND METHODS: This single-center study included consecutive patients who presented to the Cardiology Clinic with palpitations and were found to have idiopathic PVC on 24-hour Holter monitoring. Those with a PVC/24-hour frequency of < 1% were defined as group 1, 1-10% as group 2, and > 10% as group 3. The EMW was defined as the time difference (in ms) between the aortic valve closure and the end of the QT interval, measured from an ECG on the concurrent echocardiogram. RESULTS: A total of 148 patients were included in the study, 64% (n = 94) of which were female. The patients' mean age was 50.11 ± 14.7. The groups were similar in terms of the patients' age, BMI, and comorbidities. There was a statistically significant difference between the three groups in terms of the EMW measurements (group 1: 3.78 ± 19.6, group 2: -7 ± 30.9, group 3: -34.83 ± 55.2 ms: p < 0.001). In the multivariate regression analysis, the EMW (OR 0.971, p = 0.007) and every 10-ms decrease in the EMW (OR 1.254, p = 0.011) were thus determined to be independent predictors of PVC > 10%. An EMW value of ≤ -15 ms was associated with the frequency of 24-h PVC > 10%, with a sensitivity of 70% and a specificity of 70% (AUC 0.716, 95% CI: 0.636-0.787 p < 0.001). CONCLUSIONS: The results showed that a negative increase in the EMW may be associated with frequent idiopathic PVCs.

Sleep quality and its associations with disease activity and quality of life in older patients with rheumatoid arthritis.

PURPOSE: Sleep disturbance is among the most important geriatric syndromes, and its evaluation is part of the routine comprehensive geriatric assessment (CGA). Previous studies have demonstrated that older patients with rheumatoid arthritis (RA) have poorer sleep quality than younger control patients. However, there needs to be more data on the sleep quality of older patients with RA with age-matched controls. METHODS: Totally 100 participants, 50 older RA patients classified according to the ACR criteria, and 50 age- and gender-matched control patients without RA were included in the study. All patients underwent CGA, including assessing their functionality, depressive, cognitive, and nutritional status. In addition, sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI), and RA disease activity by a rheumatologist using the Disease Activity Score 28 (DAS28-CRP), and quality of life with the RA QoL questionnaire (RAQoL). RESULTS: The median age was 70 years (min-max: 65-86), and 62.5% were female. Co-morbidities and comprehensive geriatric assessment parameters were similar between the two groups. Median PSQI global score was higher in patients with RA than controls [9 (min-max: 1-20) vs. 5 (min-max: 1-13), p = 0.029). When the patients were categorized with respect to being 'poor sleepers' (PSQI score > 5), 62% of patients with RA and 38% of controls were poor sleepers (p = 0.016). The patients classified as poor sleepers were more likely to have a diagnosis of RA, higher DAS28-CRP and RAQoL scores, lower grip strength, and be a woman. PSQI global scores were significantly positively correlated with DAS28-CRP scores (r = 0.514, p < 0.001), RAQoL scores (r = 0.689, p < 0.001), number of medications used (r = 0.292, p = 0.003), and YDS scores (r = 0.407, p < 0.001), and significantly negatively correlated with handgrip strength (r = - 0.351, p = 0.001). CONCLUSION: The results suggest that older patients with RA might have poorer sleep quality compared to age- and gender-matched controls. Moreover, sleep quality correlated with RA disease activity and QoL in old age.

Effect of the route of administration of methylprednisolone on oedema and trismus in impacted lower third molar surgery.

Due to their anatomical position, the surgical removal of impacted third molars results in oedema, pain, and trismus. The purpose of this study was to evaluate the efficacy of supraperiosteal injection of methylprednisolone compared with an oral tablet form and intravenous (i.v.) injection in the prevention of postoperative pain and oedema associated with inflammation. This randomized, prospective, and controlled study included 44 patients. The patients were randomly divided into four groups: group 1 (control; no steroids), group 2 (local injection), group 3 (oral tablets), and group 4 (i.v. injection). On days 2 and 7 following surgery, linear oedema was determined using facial landmarks, and maximal mouth opening was measured. Postoperative mouth opening and swelling were evaluated for each route of methylprednisolone administration and compared. The female (59%) to male (41%) ratio was 1.44; the mean age of the patients was 29.6 years. The level of significance was set at P<0.01 for mouth opening and P<0.05 for oedema. With regard to trismus, all three routes of administration demonstrated better efficacy in comparison to the control. While oral administration and i.v. injection of methylprednisolone achieved similar results, masseter injection provided better results in reducing oedema and trismus when compared to the control following lower third molar surgery.

Nitric oxide metabolism in cancerous and non-cancerous oral gingivomucosal tissues: possible implications of nitric oxide in cancer process.

PURPOSE: Nitric oxide (NO) is a molecule that plays various roles in the body tissues. NO plays important roles in vasodilatation, platelet aggregation, cytokine stimulation, neurotransmission, immune function, etc. NO also exerts dual functions as an oxidant and antioxidant substance depending on its concentrations and environmental conditions. In this study, we aimed to examine possible correlation between NO levels and NO synthase (NOS) activity in the patients with oral cancer. MATERIALS AND METHODS: The study included 19 tissues from human subjects (11 malign and eight benign lesions). RESULTS: NO level and NOS activity were found decreased in the malign lesions compared with those of the benign ones. CONCLUSIONS: In conclusion, two suggestions can be made; first, decreased NO synthesis may be an attempt to suppress angiogenesis, which is known to provide more essential nutrients to malign lesions and/or second, malign lesions may suppress NO production to be capable of creating more rapid proliferation as it has been known that NO is also a powerful free radical inducing apoptosis.

Is there a relation between duration of cyclosporine usage and right and left ventricular function in renal transplant patients? Tissue Doppler Echocardiography study.

BACKGROUND: Our aim was to investigate the effect of cyclosporine (CsA), which is commonly used in renal transplant patients and causes myocardial fibrosis and elevated arterial tension, on cardiac function. METHODS: Sixty-six renal transplant patients (RTPs) and 25 healthy controls were included in the study. Renal transplantation patients were divided according to time of CsA exposure: group 1 (0 to 36 months); group 2 (36 to 72 months) and group 3 (> 72 months). Systolic peak velocity (Sm, mitral; St, tricuspid) and mitral early (e)/late (a) (Me/a) and tricuspid e/a (Te/a) waves of the right and the left ventricles were measured by pulse-wave (PW) Doppler used for tissue Doppler imaging of both ventricles as well as the ventricle free wall near to the lateral tricuspid and the posterior mitral leaflets. The measurements included conventional diastolic early (E) and late (A) waves and deceleration time (DT) of the E wave, isovolumetric relaxation time (IVRT) of both ventricles, as well as left ventricular systolic ejection fraction (EF). RESULTS: There were no statistically significant differences between the groups with regard to demographic, clinical, and most biochemical characteristics. Left ventricular EF was normal in all groups; there were no statistically significant differences. IVRT and DT of left ventricle and right ventricle DT values were similar among RTPs. On the other hand, values were found to be increased in RTP groups compared with the control group. E/A ratio, Me/a Te/a of both ventricles were similar among RTPs. However, these values were found to be decreased in RTP groups compared with the control group. CONCLUSIONS: Although left ventricular systolic functions were normal in all groups, there were statistically significant impairments of biventricular diastolic function parameters among renal transplant recipients compared with the control group.

Predominant tricuspid stenosis secondary to bacterial endocarditis in a patient with permanent pacemaker and balloon dilatation of the stenosis.

In a 49-year-old woman with sick sinus syndrome and a permanent VVI pacemaker, severe tricuspid stenosis and its clinical consequences developed 4 years after the attack of endocarditis. Besides the quite unusual occurrence of lead related tricuspid stenosis, successful treatment with balloon dilatation is the unique feature of this case.

Coronary artery aneurysm development after successful primary stent implantation.

This case report describes a patient who developed an aneurysmatic dilation of a coronary artery 6 months after successful primary stent implantatIon. The dilation occurred within the stented segment of the artery. To our knowledge, this is the first report of the development of an aneurysm, in the absence of angiographically visible dissection or other possible causative factors.

Evaluation of signal-averaged electrocardiogram in healthy obese women: effects of subcutaneous adipose tissue.

OBJECTIVE: To determine the correlations between signal-averaged electrocardiography (SAECG) indices and various anthropometric parameters in obese women. SUBJECTS: Twenty-seven healthy obese women (mean age 29.7 +/- 9.6 y, mean body mass index 35.2 +/- 6.0 kg/m2). MEASUREMENTS: SAECG was performed using a Marquette, MAC 12/15 system. Bidirectional filtering, low-pass filtering 250 Hz and 25, 40 and 80 Hz high-pass filter settings were employed on the same averaged beats. At least 200 beats were averaged to achieve a noise level <1 microV. Body mass index, waist to hip circumference ratio, neck circumference, arm circumference and conicity index were determined for all subjects. Skinfold thicknesses were measured in triceps, biceps, subscapular, supra-iliac and para-umbilical regions. RESULTS: Significant correlations were observed between the root mean square (RMS) voltage of the terminal 40 ms of the filtered ORS complex at 25 and 40 Hz and skinfold thicknesses measured at different sites. Significant correlations were obtained between the noise level at 25 and 40 Hz and skinfold thicknesses measured at subscapular, biceps and triceps regions also. The only SAECG parameter correlated significantly with the noise level was the RMS voltage at 25 and 40 Hz high-pass filter settings. CONCLUSIONS: In obese women SAECG must be performed with 80 Hz high-pass filter setting which eliminates the random noise originating from the subcutaneous adipose tissue. In addition RMS voltage which shows positive linear correlations with the noise level of 25 and 40 Hz high-pass filter settings might be inappropriate for the definition of abnormal SAECG criteria in obese women.

Acromegalic cardiomyopathy: evaluation of the left ventricular diastolic function in the subclinical stage.

It is recently shown that the majority of acromegalic patients without concomitant heart disease have diastolic dysfunction at rest. The aim of this study is to evaluate left ventricular diastolic function in normotensive acromegalic patients without any evidence of heart disease. Eleven acromegalic patients and 16 normal subjects of comparable age and sex distribution were studied by echocardiography. Left ventricular end-diastolic diameter, interventricular septal thickness, left ventricular posterior wall thickness, left ventricular end-diastolic volume and stroke volume were found to be significantly higher in acromegalic patients. Left ventricular mass and left ventricular mass index increased significantly in acromegalics in comparison with controls (229.16 +/- 46.11 g versus 167.17 +/- 24.57 g and 124.99 +/- 26.91 g/m2 versus 95.09 +/- 13.29 g/m2 respectively, p < 0.001). Mitral A wave desceleration rate and isovolumetric relaxation time (IVRT)-two of the studied parameters of left ventricular diastolic filling- were significantly prolonged in patients as compared with controls (p = 0.03 and p < 0.001 respectively). Four (36%) of the acromegalic patients had peak early/late diastolic mitral velocity ratio lower than 1, indicating diastolic dysfunction. All of the patients had IVRT longer than 90 ms (mean + 2 standart deviations of normals). It is concluded that in acromegalic patients without any other evidence of heart disease left ventricular diastolic function is impaired. This indicates a specific cardiomyopathy exists in the subclinical stage. IVRT is found to be more sensitive than other studied parameters for detecting diastolic dysfunction at this stage.

Influence of global system of mobile telephones on permanent pacemakers

To investigate the influence of Global System of Mobile (GSM) telephones on permanent pacemakers, four brands of GSM telephones: Panasonic, Motorola, Nokia, Ericsson, and 24 permanent pacemaker, 17 models of five major brands, were tested in their original sterile packages. Pacemaker brands tested were Pacessetter, Cardiac Pacemakers Inc. (CPI), Vitatron, Medtronic and Intermedics. The effects of switching on and off, ringing and transmission were tested and marker channel recordings were made connuously. Tests were carried out for each model of GSM telephone wile the telephone was immediately on or up to 15 cm above the pacemaker box. No program chagne was noted in any of the pacemakers. All CPI models tested, Synchrony II of Pacesetter, Unity of Intermedics, and Thera SR of Medtronic were unaffected. However all remaining models showed intermittent and/or continuous inhibition of 2-13 seconds and inappropriate triggering of impulse when the telephones were placed on the package. Interference dsppeared beyond 15 cm in all pacemaker models. O ne pacemaker, AFP of Pacesetter implanted 8 years ago, induced VT as long as the patient tried to keep the telephone active over either ear. In conclusion, patients with permanent pacemakers shoud be advised not to use GSM telephones until further tests prove their safety.

The short-term effects of cilazapril on left ventricular diastolic function.

To investigate the short-term effects of cilazapril on left ventricular diastolic functions in patients with essential hypertension, 20 patients with mild-to-moderate essential hypertension were evaluated. Following 2 weeks of placebo washout, all patients underwent blood pressure determination and echo-Doppler ultrasonography recordings. Cilazapril, 2.5 mg, was given to all patients, and blood pressure was determined. Echo Doppler ultrasonography recordings were repeated 3 h after drug therapy. The investigated diastolic function parameters were peak and mean velocities of mitral E and A waves, ratio of peak E to peak A, and acceleration and deceleration rates of E and A waves. Both systolic and diastolic blood pressure changes were insignificant. The E wave peak and mean velocities were significantly increased (p = 0.006 and 0.02, respectively), and the A wave peak and mean velocities were significantly reduced (p = 0.006 and 0.02, respectively) after cilazapril therapy. The ratio of peak E to peak A velocity was also found to be increased following cilazapril therapy (p = 0.006). It is to be concluded that the immediate improvement of left ventricular diastolic functions after cilazapril therapy despite the lack of blood pressure decrease is probably a result of the inhibition of tissue angiotensin-converting enzyme and/or other local humoral factors, but this needs to be further investigated.