Prognostic Value of the Residual SYNTAX Score on In-Hospital and Follow-Up Clinical Outcomes in ST Elevation Myocardial Infarction Patients Undergoing Percutaneous Coronary Interventions

Aims. We investigated the prognostic significance of residual SYNTAX score (RSS) in patients undergoing PCI due to STEMI and relationship between RSS and in-hospital and long-term ischemic cardiac events. Methods. Between June 2015 and December 2018, 538 patients who underwent primary PCI were evaluated for in-hospital events and 478 patients were evaluated for clinical events during follow-up. Primary and secondary endpoints for both in-hospital and follow-up periods were cardiac death and major adverse cardiac events (MACE). Results. 538 patients were included the study. RSS values of 131 patients were 0, and RSS values of 407 patients were >0. The median value of the RSS > 0 group was 7. According to this value, the RSS > 0 group was divided into 2 groups as R-ICR (RSS < 7, N = 188) and ICR (RSS ≥ 7, n = 219). In the RSS ≥ 7 group, during in-hospital and follow-up period, both mortality and MACE rates were higher than the other two groups. Area under the curve (AUC) for RSS for in-hospital death was found to be higher than SS (p=0.035) but similar to Grace Score (GS) (p=0.651). For MACE, RSS was higher than SS (p=0.025) and higher than the GS (p=0.041). For follow-up cardiac mortality, the AUC of the RSS was found to be higher than SS (0.870/0.763, p=0.02) and GS (0.870/0.733, p=0.001). For MACE, the AUC of RSS was higher than SS (p=0.03) and GS (p=0.004). Conclusions. High RSS values in STEMI patients are associated with increased risk of ischemic cardiac events. RSS may help determine revascularization and level of additional PCI to improve prognosis by reducing the risk of ischemic cardiac events after P-PCI

A variant course of the superficial palmar branch of the radial artery

WOS: 000310226000012PubMed: 22179903The objective of this report was to present a case of superficial palmar branch of the radial artery (SPBRA) with a variant course, which to the best of our knowledge, has not been reported in the literature. During anatomical dissections that were carried out in the Department of Anatomy of Suleyman Demirel University School of Medicine to demonstrate the superficial palmar arch, a variation in the course of the SPBRA was noted in the right hand of an adult cadaver. This variant branch ran superficial to, and in contact with, the flexor retinaculum, and ran transversely to join the ulnar artery

Assessment of ultrasonographic sizes of median and ulnar nerves and association with anthropometric measurements

Objective: The aim of this clinical trial was to obtain the association of cross-sectional area (CSA)`s of median and ulnar nerve with the anthropometric measurements in healthy individuals. Methods: 200 healthy volunteers were measured bilaterally. Age, sex, body mass index, and dominant extremity were recorded. Also, shoulder width, forearm, and upper arm length and forearm circumference were recorded. CSA of the nerves were defined with the ultrasonographical (USG) examination. The median nerve CSA measured at the level of scaphoid bone and the mid-point of the forearm. The ulnar nerve CSA was measured at the level of the hook of hamate and the mid-point of the forearm. Results: The results of the 118 women and 82 men was recorded. The average median nerve CSA at the level of scaphoid bone was 8.7±1.8, and at the mid-point of the forearm was 8.7±1.8. The average ulnar nerve CSA at the level of the hook of hamate was 6.3±1.4, and at the mid-point of the forearm was 7.5±1.9. There was no statistical difference in CSA between dominant and non-dominant arms. Men did have larger nerves than women. Of all the anthropometric measurements recorded, CSA correlated most closely with forearm circumference with a correlation coefficient of .721. Other than this bifid and trifid median nerve consecutively was seen in 9% and 3% of the healthy individuals. The CSA of the bifid and trifid median nerve was relatively higher than that of the non-bifid median nerve. Conclusions: The ulnar nerve was easily visualized and measured along its entire course, and the CSA of the nerve was consistent at multiple sites. The reference values obtained in this study will facilitate the analysis of abnormal nerve conditions, and the information on side-to-side variation and sex-specific differences should be particularly helpful

Relationship between White Blood Count to Mean Platelet Volume Ratio and Clinical Outcomes and Severity of Coronary Artery Disease in Patients Undergoing Primary Percutaneous Coronary Intervention

Background. The white blood cell count to mean platelet volume ratio (WMR) is an indicator of inflammation in patients with atherosclerotic disease. Residual SYNTAX Score (RSS) is an objective measure of degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). We investigated the relationship between WMR and clinical prognosis and RSS in patients undergoing primary percutaneous coronary intervention (P-PCI). Method. Between June 2015 and December 2018, 537 patients who underwent primary PCI were evaluated for in-hospital events, and 477 patients were evaluated for clinical events during follow-up after discharge. The endpoint of our study is major adverse cardiac events (MACEs) seen in the in-hospital and follow-up periods. Results. In our study, 537 patients were stratified into two groups according to admission median WMR. There were 268 patients in the low WMR group (WMR1064 (sensitivity: 83.12%, and specificity: 36.29%) and >1130 (sensitivity: 69.15%, and specificity: 44.91%), respectively. The Kaplan-Meier analysis showed that the high WMR group had the significantly lowest MACE-free survival rate (log-rank test, p=0.006). A moderate correlation was observed between WMR and RSS (r: 456, p=0.002). Conclusion. A higher WMR value on admission was associated with worse outcomes in patients with P-PCI and independently predicted for follow-up MACEs. The WMR provides both a rapid and an easily obtainable parameter to identify reliably high-risk patients who underwent primary percutaneous coronary intervention due to STEMI

Ultrasonographical assessment of absence of palmaris longus muscle: a cross-sectional study in the Turkish population

Introduction: The palmaris longus is one of the most variable muscles of the human body. The decision of existence of palmaris longus in individuals is often made by clinical tests, but detection of agenesis of this muscle trough ultrasound is rare in literature.Aim: The aim of this study is to evaluate the frequency of the palmaris longus and variations when available in healthy volunteers by ultrasonography.Materials and Methods: In this cross-sectional descriptive study, forearms of 220 healthy volunteers examined by ultrasonography. A physiatrist and a radiologist, both trained in musculoskeletal ultrasound performed all ultrasound evaluations by using a linear probe (7-12 MHz). Volunteers between 18-35 years old, having any acute or chronic disease and having normal sensory examination results, are included to this study.Results: The results of 125 women and 95 men were recorded. The prevalence of bilaterally absence of palmaris longus muscle was 38.9% in our study population. The unilateral presence of palmaris longus mostly on the left side and percentage of unilaterality was 5.55%. The absence of the muscle was found statistically more common in women. No significant difference in palmaris longus agenesis was found for laterality. In addition to these results, we define four different types of palmaris longus muscle shape. Conclusion: In discordance with the literature, the prevalence of the absence of palmaris longus muscle was significantly higher than the previous studies` results. But ultrasound in experienced hands is the gold standard method for detecting the absence of palmaris longus muscle. Also, further studies will be needed in bigger population to define the absence, size, shape and other variations of the palmaris longus muscle.  

The effect of the palmaris longus muscle on wrist flexion and extension strength

BACKGROUND: The palmaris longus (PLM) is a fusiform-shaped muscle that appears in the superficial flexor compartment of the forearm. It has been suggested that PLM is a phylogenetically degenerate metacarpophalangeal joint flexor. OBJECTIVE: The aim of this study was to compare the strength of wrist flexion and extension in healthy volunteers with and without the PLM. METHODS: Sixty-four healthy subjects, 30 men and 34 women, 18-22 years old were enrolled in this study. The database consisted of 128 wrist tests. The inclusion criteria were as follows: Sedentary lifestyle, unknown musculoskeletal disorders and right-handedness. Musculoskeletal ultrasound imaging was used for assessing the presence of PLM. A hand-held digital dynamometer was used to assess the peak force of wrist extension and flexion. Data were analyzed separately for women and men RESULTS: The existence of right-sided PLM was 73.3% in male subjects and 55.9% in female subjects. For men, the strength of wrist flexion was 36.03 ± 13.92 N and 34.24 ± 12.23 N for the right and left side, respectively. For women, the respective strengths were 16.20 ± 7.29 N and 15.26 ± 6.79 N. For both sexes, there was no statistically significant difference between those with and without a PLM (p> 0.05). There was also no significant difference in the agonist/antagonist (flexion/extension) ratio of the wrist between those with and without a PLM in both sexes and sides. CONCLUSIONS: The existence or absence of PLM plays no role in the strength of either the flexors or extensors of the wrist. © 2017 - IOS Press and the authors