Correlation between systolic deformation and dyssynchrony indices and the grade of left ventricular hypertrophy in hypertensive patients with a preserved systolic ejection fraction undergoing coronary angiography, based on tissue Doppler imaging.

OBJECTIVES: The purpose of this study was to investigate whether systolic mechanical dyssynchrony occurs in hypertensive patients with a normal coronary artery and a normal ejection fraction and its relationship with different degrees of left ventricular (LV) hypertrophy. METHODS: A total of 125 angiographically normal coronary patients (42.4% male; mean age ± SD, 57.16 ± 8.26 years) with an ejection fraction greater than 50% were included, of which 84 were hypertensive and 41 normotensive. The hypertensive patients were categorized into 3 groups: no, mild, and moderate LV hypertrophy. Tissue Doppler and deformation imaging parameters were measured in the 6 LV basal segments at peak systole. RESULTS: The frequency of dyssynchrony was 40.5% in the hypertensive patients compared to 19.5% in the control patients (P = .020). Among the hypertensive patients, LV dyssynchrony was found in 5 patients (20%) with no hypertrophy, 20 (42.6%) with mild hypertrophy, and 9 (75%) with moderate hypertrophy. There was a moderate correlation between the grade of hypertrophy and septal-lateral wall delay (r = 0.497), 6-basal segment delay (r = 0.454), overall strain (r = 0.453), overall peak systolic velocity (r = -0.430), and standard deviation of the time to peak systolic velocity in the basal segments (r = 0.429). After adjustment for the LV end-systolic diameter and body surface area, overall strain was the best correlate of the hypertrophy grade (odds ratio, 7.043; 95% confidence interval, 1.839-26.980; P = .0044). CONCLUSIONS: Among tissue Doppler and deformation indices, overall peak systolic strain was the strongest correlate of the LV hypertrophy grade. Therefore, in hypertensive patients with normal cardiac systolic function, a reduction in overall strain in the 6 basal LV segments may be a good indicator of progression of the LV hypertrophy grade and systolic dysfunction.

Evaluation of subclinical left ventricular dysfunction in diabetic patients: longitudinal strain velocities and left ventricular dyssynchrony by two-dimensional speckle tracking echocardiography study.

BACKGROUND: We evaluated left ventricular (LV) subclinical systolic dysfunction in diabetes mellitus patients using two-dimensional speckle tracking echocardiography (STE) for early detection of changes in LV longitudinal strain (ST) or synchronized contraction. METHODS: To determine ST and LV dyssynchrony, 37 normal coronary and normotensive diabetes mellitus patients with LV ejection fraction >50% were enrolled and compared to 39 nondiabetic normal coronary and LV function subjects. The cases underwent standard conventional transthoracic echocardiography and tissue Doppler imaging (TDI) and STE. End-systolic ST and time-to-peak systolic strain (Ts) were measured in 18 LV segments. RESULTS: Conventional parameters were similar between diabetic and nondiabetic subjects. In diabetic patients, significant reduction in global and segmental ST adjusted for age and body mass index, independently correlated with early diastolic velocity at the septal mitral valve annulus by TDI (P = 0.001), ratio of transmitral early and late diastolic velocities (P < 0.001), relative wall thickness (P = 0.014), glycosylated hemoglobin (P < 0.001), and fasting blood sugar (P < 0.001). These correlations were not found in the nondiabetic patients. After adjustment, presence of diabetes mellitus remained an independent correlate of reduced LV global longitudinal ST (R = 0.688, P = 0.003). Delay of Ts between the anteroseptal and posterior walls and all the LV segments was markedly higher in the diabetic group regardless of diastolic dysfunction. CONCLUSION: In diabetic patients with normal coronary and ejection fraction, segmental and global end-systolic longitudinal ST decreased and differences between Ts among LV segments increased irrespective of diastolic dysfunction at early stage. These results suggest that there might be early detectable changes in systolic function in the natural course of diabetes mellitus by STE study.

Using inverted autogenous veins to substitute arteries in a canine model.

AIMS: Rapid harvesting of autogenous graft over a wire is an optional way in trauma surgery and it places the inverted conduit so that its adventitial layer is within the lumen of the graft. Our aim of this study was to compare the patency of inverted autogenous graft vs noninverted graft in dogs. SETTINGS AND DESIGN: Experimental animal models. MATERIALS AND METHODS: In this experimental study, 12 dogs were anesthetized and 10 cm of the external jugular vein was excised. The vein was equally divided into two 5-cm sections. One section was inverted and the other was left intact. Afterward, 5 cm of both the femoral arteries were removed and the right (inverted) and the left (not inverted) arteries were grafted, respectively. The patency of the arteries was evaluated by Color Doppler ultrasonography immediately postoperation and up to 6 months thereafter. STATISTICAL ANALYSIS: Data were analyzed with Fisher's exact test using SPSS version 15. P value below 0.05 was significant. RESULTS: None of the 12 inverted vein grafts were patent at 3(rd) to 14(th) days follow-up with Doppler ultrasonography. All of them were completely obstructed by thrombosis. However, 11 (92%) of the noninverted vein grafts were patent both at 3 and 6 months follow-up. One of the noninverted grafts was almost completely obstructed with thrombosis (90%) and the other 2 were incompletely obstructed with intimal thickening. CONCLUSIONS: Despite many favorable results in the previous studies with regard to excellent patency of inverted vein graft, our results were disappointing and we recommend using the graft in the right direction and taking care to preserve the intima intact.

Bowel perforation by crumpled paper in a patient presenting with acute abdominal pain.

Many of the abdominal foreign bodies are due to accidental ingestion. Our objective in this case report is to emphasize the importance of the enquiry about the foreign body in the differential diagnosis of acute abdominal pain. According to our knowledge, this is the first report of bowel perforation caused by paper ingestion. A 14-year-old boy with abdominal pain underwent exploratory laparotomy and was found to have abdominal pus and ileal perforation. A crumpled paper was found at the site of perforation. Postoperative enquiry revealed that the patient had ingested 10 crumpled papers. We highlight that recording the history is an important aspect in the management of patients with acute abdominal pain and that foreign bodies should be included in its differential diagnosis.

Wind sock deformity in rectal atresia.

Rectal atresia is a rare anorectal deformity. It usually presents with neonatal obstruction and it is often a complete membrane or severe stenosis. Windsock deformity has not been reported in rectal atresia especially, having been missed for 2 years. A 2-year-old girl reported only a severe constipation despite having a 1.5-cm anal canal in rectal examination with scanty discharge. She underwent loop colostomy and loopogram, which showed a wind sock deformity of rectum with mega colon. The patient underwent abdominoperineal pull-through with good result and follow-up. This is the first case of the wind sock deformity in rectal atresia being reported after 2 years of age.

Role of rectal biopsy in predicting response to intrasphincteric botulinum toxin injection for obstructive symptoms after a pullthrough operation.

OBJECTIVE: Our aim was to correlate the pathological results and clinical response in patients who underwent botulinum toxin (BT) injection for obstructive symptoms (OS) after a pullthrough operation for Hirschsprung's disease (HD). METHODS: Between August 2002 and February 2006, 16 of 107 HD patients (15%) were referred with persistent OS after pull-through (PT) operation in this center. They underwent rectal biopsy and BT injection in the internal sphincter. Their responses to BT injection were evaluated by the constipation score before, and at 1, 3 and 8 months after the injection, and anorectal manometry (ARM) before and at 2 weeks, and 1 and 8 months after the injection. The association between response to BT and acetylcholinesterase (AChE) staining of rectal biopsy was also assessed. RESULTS: Fourteen of 16 patients (87%) had improvement in bowel function after 2 weeks, and two patients did not respond at all. Six of the 14 patients with early response had recurrence of symptoms after 2-3 months. Eight patients with normal ganglia and negative AChE had good response with no recurrence on follow-up. However, 4 of 6 recurrences were neurogenic dysfunctions and 2 were intestinal neuronal dysplasia (2-4+AChE). Two patients with no response had an aganglionic segment (4+AChE). Four of 6 patients with recurrence showed improvement with BT re-injection and only 2 did not improve. CONCLUSION: A higher degree of AChE staining is associated with lack of response to BT injection. This is also a test for predicting the severity of neurogenic dysfunction in the intestinal wall.

Esophageal Atresia: Migration of the gastrostomy tube into the bronchus.

A 2-day-old baby boy, 38 weeks gestation, weight 2000 g was brought due to hypersalivation and imperforate anus with gasless abdomen on plain X-ray. He underwent a gastrostomy tube insertion and colostomy. In contrast study of the stomach, on the 5th postoperative day, the dye spilled into the tracheo bronchial tree and the catheter was seen, entering the right main bronchus. The patient underwent right thoracotomy and the presence of fistula and catheter were confirmed. The fistula and distal esophagus were closed and fixed to the prevertebral fascia because of a long gap. He is under follow-up and recieving home care for a later delayed primary anastomosis.