Comparison of two and three dimensional transthoracic versus transesophageal echocardiography in evaluation of anatomy and pathology of left atrial apendage.

OBJECTIVE: Our objective was the comparison of combined utility of two-dimensional (2D) transthoracic echocardiography (TTE) and three-dimensional (3D) TTE versus 2D and 3D transesophageal echocardiography (TEE) in evaluation of anatomy of the left atrium appendage (LAA) and for clot formation in LAA. BACKGROUND: 2DTEE as semi-invasive method has been for a long time used to visualize the LAA. Improved echocardiography technology has increasingly improved visualization of LAA by 2DTTE and 3DTTE in many patients and decreased the need for TEE performance. METHODS: We compared combined 2DTTE and 3DTTE with 2DTEE and 3DTEE in evaluating the LAA for anatomical features and thrombus. Eighty-six patients underwent 2DTTE, 3DTTE, 2DTEE and 3DTEE. RESULTS: LAA could be visualized in all patients. 31 % of patients had one lobe, 43% had 2 lobes and 26% had > 2 lobes. Of 86 patients studied, 79 had no thrombus and 7 had thrombus in the LAA by all modalities. Six patients, 3 with atrial fibrillation (AF), and 4 in sinus rhythm (SR) had a suspected thrombus by 2DTEE. Only in one patient 3DTEE cropping has been needed to clearly show thrombus which was suspected in short axis view on 2DTEE as rounded echo dense mass. CONCLUSIONS: Our preliminary study suggests that combined 2DTTE and 3DTTE has comparable accuracy to TEE in evaluating the LAA anatomy and pathology in terms of thrombus. Only in inappropriate (obese) patients 2TTE, but not 3DTTE, may misdiagnose pectinate musculature as thrombus.

Hemodialysis Parameters and Pulse Wave Velocity.

Aim: The study aimed to evaluate the acute effect of ultrafiltration on the mechanical properties of the aorta using brachial-ankle pulse wave velocity (PWV) before and after hemodialysis (HD). Patients and Methods: This study included 80 patients who were on a long-term HD program. The input variables were anamnestic data, body composition monitor (BCM) parameters, and echocardiography findings. The assessment of hydration status was determined by BCM, whose work is based on the principle of multifrequency bioimpedance spectroscopy. Another diagnostic procedure was the use of an arteriograph apparatus to assess PWV and Augmentation Index (AIx). All measurements were performed before and after dialysis on the middle dialysis day of the week. Results: The participants were divided into two groups based on hydration status: the experimental group consisted of 40 overhydrated participants and the control group consisted of 40 normovolemic participants. Statistically, the following BCM parameters correlated significantly positively with PWV: total body fat (r = 0.222; P < 0.05), overhydration (r = 0.290; P < 0.001), and relative overhydration (r = 0.290; P < 0.001). From echocardiography findings, only left atrial diameter correlated statistically significantly positively with PWV (r = 0.359; P < 0.001). Comparison of the mean PWV values within the experimental group before and after HD showed a statistically significant decrease from 14.32 ± 2.34 m/s to 8.72 ± 1.52 m/s (Z = 3.254; P = 0.0001). Mean PWV values within the control group did not decrease significantly from 13.39 ± 1.32 m/s to 10.39 ± 1.18 m/s (Z = 0.524; P = 0.742). If we compare the mean values of PWV between groups, then before HD treatment, there was no statistically significant difference between groups with PWV values in the experimental group of 14.32 ± 2.34 m/s and the control group of 13.39 ± 1.32 m/s (Z = 0.762; P = 0.852). According to the results of univariate regression analysis before and after HD treatment, only overhydration showed an absolute effect on PWV before and after HD. Conclusion: Overhydration showed an effect on brachial-ankle PWV before and after HD, and brachial-ankle PWV should be followed in HD patients.

Causes of an Increased Rate of Caesarean Section.

INTRODUCTION: The increase in the percentage of the Cesarean sections has got an important place in determination of modern obstetrics. The evaluation of that needs actual, modern opinion for obstetrics and transformation actual obstetric science than investigating the best situation for the mother and child in the actual moment. All medical, organizational, economic and ethical capacities with support of modern diagnostic and therapeutic procedures present a reason for the access in modern obstetrics. It takes the descriptive and analytic method at work. In our country the percentage of the Caesarean section is 15% (according to WHO data), with large variations in frequency depending on the writer and the investigated time. AIM: To investigate the prevalence of Cesarean section in Bosnia and Herzegovina until 2017. PATIENTS AND METHODS: In our investigation made prospective and target analysis is investigated at 2017 as a target year. Sources are: patient charts, notes and charts of new born. Group A presents number investigated patients with made Cesarean section in time at one year (2017) in General hospital "Prim.dr A.Nakas". Group B presents control group with identical number of deliveries with Cesarean section in 2007 in General hospital "Prim.dr A. Nakas" with all variables who detected in investigation group. RESULTS: Analysis the number of deliveries finished Cesarean section in time from 2007 to 2017 in General hospital "Prim.dr Abdulah Nakas "Sarajevo presents augmentation frequency from 15,5 % in 2007 year to 21,7 % in 2011; smaller number in 2012 to 20,3% and finally 22.9% in 2017 for all deliveries. CONCLUSION: Our investigation shows an important number of Cesarean section and is still working because of clearer obstetric indication but they make a vital indication for the mother and baby. It worries percent of poorly described indications, that are something important for the comfort of doctor and any patients that wants natural delivery. It worries the public because the more important short term and long-term unwanted effects; Cesarean delivery in correlation with augmentation of this operation.

Echocardiographic Assessment of Ischaemic Mitral Regurgitation, Mechanism, Severity, Impact on Treatment Strategy and Long Term Outcome.

INTRODUCTION: The commonest mitral regurgitation etiologies are degenerative (60%), rheumatic post-inflammatory, 12%) and functional (25%). Due to the large number of patients with acute MI, the incidence of ischaemic MR is also high. Ischaemic mitral regurgitation is a complex multifactorial disease that involves left ventricular geometry, the mitral annulus, and the valvular/subvalvular apparatus. Ischaemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. RESEARCH OBJECTIVES: The objective of this study is to determine the role of echocardiography in detecting and assessment of mitral regurgitation mechanism, severity, impact on treatment strategy and long term outcome in patients with myocardial infarction during the follow up period of 5 years. Also one of objectives to determine if the absence or presence of ischaemic MR is associated with increased morbidity and mortality in patients with myocardial infarction. PATIENTS AND METHODS: The study covered 138 adult patients. All patients were subjected to echocardiography evaluation after acute myocardial infarction during the period of follow up for 5 years. The patients were examined on an ultrasound machine Philips iE 33 xMatrix, Philips HD 11 XE, and GE Vivid 7 equipped with all cardiologic probes for adults and multi-plan TEE probes. We evaluated mechanisms and severity of mitral regurgitation which includes the regurgitant volume (RV), effective regurgitant orifice area (EROA), the regurgitant fraction (RF), Jet/LA area, also we measured the of vena contracta width (VC width cm) for assessment of IMR severity, papillary muscles anatomy and displacement, LV systolic function ± dilation, LV regional wall motion abnormality WMA, LV WMI, Left ventricle LV remodeling, impact on treatment strategy and long term mortality. RESULTS: We analyzed and follow up 138 patients with previous (>16 days) Q-wave myocardial infarction by ECG who underwent TTE and TEE echocardiography for detection and assessment of ischaemic mitral regurgitation (IMR) with baseline age (62 ± 9), ejection fraction (EF 41±12%), the regurgitant volume (RV) were 42±21 mL/beat, and effective regurgitant orifice area (EROA) 20±16 mm(2), the regurgitant fraction (RF) were 48±10%, Jet/LA area 47±12%. Also we measured the of vena contracta width (VC width cm) 0,4±0,6 for assessment of IMR severity. During 5 years follow up, total mortality for patients with moderate/severe IMR-grade II-IV (54.2±1.8%) were higher than for those with mild IMR-grade I (30.4±2.9%) (P<0.05), the total mortality for patients with EROA ≥20 mm(2)(54±1.9%) were higher than for those with EROA <20 mm(2)(27.2±2.7%) (P<0.05), and the total mortality for patients with RVol ≥30 mL (56.8±1.7%) were higher than for those with RVol<30ml (29.4±2.9%) (P<0.05). After assessment of IMR and during follow up period 64 patients (46%) underwent CABG alone or combined CABG with mitral valve repair or replacement. In this study, the procedure of concomitant down-sized ring annuloplasty at the time if CABG surgery has a failure rate around 24% in terms of high late recurrence rate of IMR during the follow period especially after 18-42 months. CONCLUSION: The presence of ischaemic MR is associated with increased morbidity and mortality. Chronic IMR, an independent predictor of mortality with a reported survival of 40-60% at 5 years. Ischaemic mitral regurgitation has important prognosis implications in patients with coronary heart disease. Recognizing the mechanism of valve incompetence is an essential point for the surgical planning and for a good result of the mitral repair. It is important that echocardiographers understand the complex nature of the condition. Despite remarkable progress in reparative surgery, further investigation is still necessary to find the best approach to treat ischaemic mitral regurgitation.

Dental treatment of patients with kidney diseases-review.

In their practice every dentist is brought into a situation to treat patients with grossly impaired kidney function. Kidney diseases, whether acute or acquired, imply a number of body dysfunctions such as prolonged bleeding, high blood pressure, infection tendency etc. which, in turn, pose a threat involving serious complications in cases of dental interventions in these patients. The aim of this article is to provide a review of current dental practice in patients with kidney disease. This implies dental intervention and preparations of patients with chronic renal disease, nephritic syndrome, patients on dialysis, and patients with kidney transplants. Certainly, cooperation between the dentist and nephrologist is an imperative for the appropriate dental treatment of patients with grossly impaired renal function.

Congenital anomalies of the uterus, and ultrasound diagnostics.

Sonographic detection and evaluation of congenital anomalies of the uterus represent an important segment in the additional therapeutic procedure, that is, treatment of patients with congenital anomalies of the uterus. Besides the primary reason that is manifested in the total cure of the patients, the secondary reason represents the decrease of costs of treatment of congenital anomalies of the uterus. Both descriptive and analytical methods were used in this paper. In 1997 Kurjak and Kupesic compared the sensitivity and specificity of transvaginal ultra sound, color Doppler, hysterosonography and three-dimensional ultrasound during diagnosis of the uterus septum. Representation of pathological findings in our paper in comparison to the examined group is: uterus subseptus = 15.38%, double horned uterus = 10.25%. The examined group includes intrauterine abnormalities of the uterus, analyzing, in that process, individual, pathological entities of intrauterine abnormalities. The research is a prospective, target, clinical study. In the examined group, due to the clinical suspicion of intrauterine abnormalities, 78 patients were examined in the following manner: two-dimensional transabdominal and transvaginal black-and-white and color Doppler ultrasound examinations were made and then three-dimensional transabdominal black-and-white and color Doppler ultrasound examinations. This means that in the detection of congenital anomalies of the uterus, the same sonographic techniques were first applied on the conventional and then also on the multidimensional base. Our research showed that three-dimensional technique is a more reliable diagnostic tool than two-dimensional technique. Sensitivity and specificity rate as well as positive predictive value show that this technique is an extraordinary one for assessing the volume, and position of congenital abnormalities.

[Central venous catheters for haemodialysis and optimal blood flow]. / Centralni venski kateteri za hemodijalizu i optimalni protok krvi.

INTRODUCTION: Central venous catheters (CVC) have become and indispensable form of haemodialysis access and represent, in our centre, about 8,58 % of the permanent vascular access with a total number of more than 957 venous catheters in the past 8 years. We used double-lumen catheters. METHODS: The aim of this study was to identify the factors of the catheter dysfunction. We studied prospectively 23 chronic haemodialysed patients with CVC, 14 men and 9 women 63 +/- 14 (51-83), treated with haemodialysis for 3.7 +/- 4 (1-9) years. Catheters were inserted by percutaneous Seldinger techniques in right internal jugular vein. We studied the localization of the catheter tip: superior vena cava, right atrium, the blood pressure before and after haemodialysis, the interdialytic weight gain, and number of symptomatic episodes during 13 last dialysis (one month). The patients were divided into two groups: group I with usual adequate catheter function (n=17) and group II with frequent dysfunction (n=6). RESULTS: In group I the catheters tip was in the right atrium, and in group II in the vena cava superior. Blood pressure was not different between the two groups. We found no correlation between central venous pressure, blood pressure, interdialytic weight gain and symptomatic hypotension, but there was a higher frequency of hypotension in the hypovolemic patients. CONCLUSIONS: Optimal hemodynamic conditions will be provided by a catheters tip in the rights atrium and a central venous pressure over 5 mmHg, which can be provided with vascular filling or dry body weight.

[Prevention of hepatitis C at Center for Haemodialisys of Clinical Centre of University of Sarajevo]. / Prevencija hepatitisa C u Centru za hemodijalizu K.C.U. Sarajevo.

GOAL: The patients with the chronical programm for haemodialisys have the higher risk from getting ill virus hepatitis C in the realtion to the rest population. AIM OF THE WORK: Was the evaluation of the prevalence and incidence of hepatitis C at the Center for Haemodialisys CCU Sarajevo and the effect of the prevalentive measures on the incidence of the serum conversion of hepatitis C, in the period from 2002 till 2004 year. MATERIAL AND METHOD: By the examening is comprehended 155 patients aged 54,58 +/- 14,797 years, with the aproximative length of the haemodialisys 58,9 +/- 53,9 months. Patients at the chronic programm of the bicarbonite haemodialisys taree times per week, and antibodies on the hepatitis C were determined III generation. Also was determined PCR. RESULTS: During the periiod of examination the dialized population was increased also 2002 year the prevalence of hepatitis C was 23,87% (37/155), in 2003 year 29,29% (46/157) and 2004 year the pregalence amounted 26,28% (46/175). Incidence of hepatitis C was significantly decreased in the course of the period of followup and in 2002 year was 16,21%, in 2003 year 13,04%, that in 2004 year would amount 4,34%, that is only in two patients occurred the serum conversion on hepatitis C. CONCLUSION: By applying of the corresponding protocoles and their strict realization (desinfection of the hands, wearing of gloves, apparatus desinfection) and separation of the dialyzed monitors for anti HCV positive and anti HCV negative patients dicreased significantly the hepatitis C incidence in our dialyzed population. The strict application of the preventive measures can completely prevent the speading occurrence of hepatitis C on haemodialisys.