Biomechanical evaluation of caudally and buccally screwed customised reconstruction plates for lateral segmental defects of mandible.

The aim of this study was to compare locking reconstruction plates with caudobuccally screwed custom mandibular reconstruction plates in bridging lateral mandibular segmental defects. The in vitro study was conducted on 13 polyurethane mandibles. A total of 7 mandibles with lateral segmental defects were bridged with locking reconstruction plates in group I, 6 mandibles with the same standard defect were bridged with caudobuccally screwed customised reconstruction plates in group II. Mean yield displacement, yield load, and displacement at 80 N (Newtons), 100 N, 200 N, 300 N loading were compared among the 2 groups. The mean (SD) displacement for Group I was 11.27 (3.6) mm, Group II was 21.08 (2.5) mm. Group II had significantly greater (p=0.0001) displacement when compared with Group I. The mean (SD) force before failure for Group I was 638.4 N (127.2), Group II was 1398. 3 N (162.7). Group II withstood significantly greater force than Group I (p=0.0001). The study reveals that the caudobuccally screwed custom reconstruction plates can significantly enhance yield load as preserving the preoperative shape of the face and mandible.

Left ventricular twist in hypertrophic cardiomyopathy : Predictor of nonsustained ventricular tachycardia.

BACKGROUND: We investigated the efficacy of clinical and classic echocardiographic parameters in predicting the occurrence of nonsustained ventricular tachycardia (NsVT) in patients with hypertrophic cardiomyopathy (HCM). METHODS: The study comprised 59 patients with HCM (47 male, [80%]; mean age, 48.48 ± 14.16 years). Clinical, electrocardiographic, as well as classic two-dimensional and speckle-tracking echocardiography (STE) data were collected. All patients had Holter monitoring within 24-72 h of the echocardiographic examination. NsVT was defined as three or more consecutive premature wide QRS complexes with a heart rate of > 100 bpm. The patient population was categorized into groups based on the occurrence or absence of NsVT on the 24-h Holter recordings. RESULTS: NsVT was observed in 17 patients (29%). In these patients, higher twist (14.4 ± 3.8 vs.18 ± 7.9; p = 0.02), higher apical rotation (8.7 ± 4.2 vs. 12.2 ± 7; p = 0.02), higher sudden cardiac death risk score (4.4 ± 2.2 vs. 7 ± 3.3; p = 0.007), and decreased global longitudinal peak strain (GLPS; -12.8 ± 3.1 vs. -10.6 ± 2.8; p = 0.014) were observed. In the multivariate logistic regression analysis, including GLPS and twist, GLPS (Odds Ratio [OR]: 1.406; 95% CI: 1.087-1.818; p = 0.009) and twist (OR: 1.236; 95% CI: 1.056-1.446; p = 0.008) were found to be independent predictors of NsVT. In the receiver operating characteristic curve analysis, GLPS < -11.9% predicted NsVT with 82% sensitivity and 60% specificity (area under the curve [AUC]: 0.70; p = 0.014) and twist > 15.2° predicted NsVT with 70% sensitivity and 58% specificity (AUC: 0.69; p = 0.027). CONCLUSION: Decreased GLPS and increased twist were predictive of NsVT in HCM patients. Parameters that can easily be measured with STE can help detect patients who may develop arrhythmia.

Cytopathology of pericardial effusions : Experience from a tertiary center of cardiology.

BACKGROUND: Pericardial effusion (PE) is a common clinical condition that can develop as a result of systemic or cardiac diseases. Here, we report the results of cytology for patients who underwent pericardiocentesis for PE. METHODS: The study comprised 283 patients who underwent primary percutaneous pericardiocentesis between 2007 and 2016. The mean age of the patients was 60.0 ± 16.6 years; 162 (57.2%) were male and 121 (42.8%) were female. The presence of reactive mesothelial cells, acute and chronic inflammatory cells, and/or blood without evidence of malignant cells was considered as benign. The presence of malignant cells with/without reactive mesothelial cells, inflammatory cells, and/or blood was considered as malignant. RESULTS: The vast majority of PE specimens (219 cases; 77.4%) were classified as benign. Only 20 cases (7.1%) were classified as atypical, and malignant cells were present in the PE specimens of 44 cases (15.5%). The most common diagnosis was benign PE. The most commonly encountered malignancy was lung cancer. The rate of malignancy was 1.9% in the serous group and 24% in the hemorrhagic group, which was statistically significant. CONCLUSION: Benign PE was the most frequent cytological diagnosis in our study. Chronic nonspecific pericarditis was the most frequent type of pericarditis in the benign PE group, while lung adenocarcinoma was the most frequent malignancy in the malignant PE group. The rate of malignancy was significantly higher in the hemorrhagic group than in the serous group.

Outcomes of direct stenting in patients with ST-elevated myocardial infarction.

BACKGROUND: We compared direct stenting (DS) with conventional stenting (CS) - i.e., stenting after predilation - during primary percutaneous coronary intervention (P-PCI) in terms of procedural results and long-term mortality in patients with ST-elevated myocardial infarction (STEMI). METHODS: We retrospectively analyzed 2306 patients (mean age 59 years, 22% female) who underwent P­PCI within 12 h of symptom onset. Patients were then followed up prospectively for clinical events. Patients were divided into a DS group (n = 597) and a CS group (n = 1709). The CS group was further divided into a CS-1 group (baseline thrombolysis in myocardial infarction [TIMI] flow grade ≥ 1) and a CS-2 group (baseline TIMI flow grade 0). Main outcome measures were postprocedural myocardial reperfusion and all-cause mortality in long-term follow-up. RESULTS: Patients in the DS group had a higher percentage of final TIMI-3 flow, myocardial blush grade 3 and complete ST-segment resolution, better left ventricular ejection fraction, and a lower incidence of distal embolization compared with CS patients. In-hospital (1.5 vs. 4.6%, respectively, p = 0.001) and long-term all-cause mortality (8.8 vs. 17.0%, respectively, p < 0.001) were significantly lower in the DS group than in the CS group. Kaplan-Meier survival analysis showed similar survival rates in the DS and CS-1 groups (log-rank p = 0.40), but significantly worse survival in the CS-2 group than in the other groups (log-rank p < 0.001). After adjusting for risk factors, DS was not found to be a predictor of long-term mortality. CONCLUSION: DS in P­PCI was associated with better postprocedural angiographic results and long-term survival. However, the DS group had similar in-hospital and long-term mortality to matched patients in the CS group.

Cardiac masses : Experience from a Turkish tertiary center of cardiology.

OBJECTIVE: Cardiac masses comprise a category that includes benign, malignant, and nontumoral mass lesions. The present study aims to share the findings relating to cardiac masses observed at our tertiary cardiology hospital in Turkey. METHODS: The records of patients who presented with cardiac masses and underwent surgery at our institute between 2006 and 2015, and whose tissue samples were sent to a pathology laboratory, were retrospectively reviewed in a consecutive manner. RESULTS: The study included 228 patients with an average age of 52.5 ± 17.3 years. Of the study's subjects, 95 (41.7%) were male and 133 (58.3%) female. The most commonly observed mass was myxoma in 68 patients (29.8%), of whom 20 (29.4%) were male and 48 (70.6%) female. The second most frequently detected mass was pannus, with 38 cases (16.7%) - 10 (26.3%) in males and 28 (73.7%) in females. The third most common cardiac mass was thrombus (16.2%), with 18 cases of thrombi in men (48.6%) and 19 (51.4%) in women. CONCLUSION: The most commonly observed cardiac mass was myxoma and most were localized in the left atrium. The second most frequently detected mass was pannus, which was mostly found on mitral mechanical prosthetic valves. Thrombi were the third most prevalent mass and were commonly localized in the right atrium.

Biventricular mass in a patient with mucinous breast cancer.

We present a case of a 73-year-old woman patient diagnosed with mucinous breast cancer and biventricular homogenous mass image findings by transthoracic echocardiography and her fatal prognosis.

"Rescue administration" of intracoronary thrombolytic therapy for drug-eluting stent thrombosis.

Stent thrombosis is an example of device-induced, platelet-mediated arterial thrombosis with a potentially fatal adverse event that often leads to myocardial infarction and/or death. The optimal treatment of patients with drug-eluting stent thrombosis in whom mechanical thrombectomy has failed is not established. This case demonstrates the usefulness of intracoronary thrombolysis after failed mechanical thrombectomy in patients with stent thrombosis. To our knowledge, this is the first report on using intracoronary thrombolysis in this specific situation.

Contrast-induced neurotoxicity after coronary angiography.

BACKGROUND: Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication. PATIENTS AND METHODS: This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6 ± 7.8 years; range, 47-72 years) and coronary artery disease who were administered iopromide contrast agent. RESULTS: In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89 %) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177 ± 58 ml. The mean time between contrast agent administration and clinical symptoms was 100 ± 71 min (range, 30-240 min). While in 5 of the patients (56 %) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89 %), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2 ± 6.7 h (range, 8-30 h). CONCLUSION: CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.

A successful septal ablation of the first septal perforator artery arising from the circumflex artery.

Congenital coronary anomalies are usually incidental, uncommon and asymptomatic. We present a case of a successful septal ablation of the first septal perforator artery arising from the circumflex artery in a patient with symptomatic hypertrophic cardiomyopathy.

Noncompaction cardiomyopathy. Is it more than noncompaction?

Noncompaction cardiomyopathy, a rare congenital cardiomyopathy, is characterized by increased trabeculation in one or more segments of the ventricle. The coexistence of other cardiac anomalies such as coronary-cameral fistula, bicuspid aortic valve, ventricular septal defect, patent ductus arteriosus and bradyarrhythmias make noncompaction cardiomyopathy resemble the reptile heart. The defect in myocardial compaction and the frequently seen accompanying anomalies may share a common causative factor during embryogenesis.

Spontaneous coronary artery dissection associated with Leriche syndrome.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. SCAD has been observed in three groups of patients; those with coronary atherosclerosis, women in the peripartum period, and those with an idiopathic cause. SCAD may also be associated with other conditions. Herein, we present a 44-year-old man who developed SCAD concomitant with Leriche syndrome.

A successful percutaneous closure of ventricular septal defect following septal myectomy in patients with hypertrophic obstructive cardiomyopathy.

Postoperative ventricular septal defect (post-op VSD) after septal myectomy in patients with hypertrophic obstructive cardiomyopathy is a rare and unexpected complication. We report a case of successful percutaneous closure of VSD following septal myectomy and mitral valve replacement in a patient with intrinsic mitral valve disease and severe mitral valve regurgitation together with hypertrophic obstructive cardiomyopathy.

A mysterious case of fatal embolism after the repair of tetralogy of Fallot: secondary to arrhythmia?

Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. The most important late complications observed after repair of TOF are atrio-ventricular arrhythmias and sudden cardiac death. We present a rare case of fatal embolism and sudden cardiac death in a 36-year-old patient, 30 years after the operation for TOF.

Coronary muscular bridge mimicking acute stent thrombosis.

A patient who develops hypotension or angina pectoris after intravenous inotropic agents should be assessed for dynamic left ventricular outflow obstruction or the presence of a muscular bridge. In this case report, we present a patient with low ejection fraction who developed hypotension and angina pectoris with inotropic therapy after coronary intervention. We performed a coronary angiogram to exclude stent thrombosis but a muscular bridge was found in the segment distal to the stent.

Is 5-fluorouracil-induced vasospasm a Kounis syndrome? A diagnostic challenge.

Cardiovascular hypersensitivity is a rare and well-documented side-effect of 5-FU (5-fluorouracil). Besides the common complications such as angina pectoris and myocardial infarction, it can also cause cardiogenic shock, and supraventricular and ventricular arrhythmias. Studies have reported that FU-induced angina most commonly occurred due to vasospasm. In our case, 9 hours after stopping the infusion of 5-FU, the patients developed symptoms and electrocardiographic (ECG) findings consistent with acute myocardial infarction. We intend to share this rare case and discuss whether this late complication after 5-FU infusion is an FU-induced vasospasm or rather an allergic reaction leading to Kounis syndrome.

Cardiogenic shock due to dynamic left ventricular outflow tract obstruction of acute myocardial infarction: an under-diagnosed complication.

We report on a patient who developed cardiogenic shock caused by dynamic left ventricular outflow tract (LVOT) obstruction following percutaneous coronary intervention for anteroseptal acute myocardial infarction.

Snake-like thrombus in the right atrium causing pulmonary embolism.

In this report, we present a case of an 84-year-old woman treated with a low-dose prolonged infusion of tissue plasminogen activator (tPA) for a free-floating thrombus in the right atrium.