Morphological analysis and clinical significance of the opening of the third coronary artery

Introduction: The human heart is in most cases vascularized by two coronary arteries, the right coronary artery (RCA) and the left coronary artery. The supernumerary coronary artery, which arises independently from the right aortic sinus and passes through sub-epicardial adipose tissue of the pulmonary conus and anterior side of the right ventricle is called the third coronary artery (TCA). Methods: This study consisted of 28 formalin-fixed adult human cadaveric hearts. The presence of the TCA was determined. The position of the orifice of the right and excess arteries in relation to the sinotubular junction was determined, and then also the position of the orifice of the excess arteries “on the o’clock level” in relation to the orifice of the RCA. The radius of these orifices and their distance from the orifice of the RCA were measured. The angle between the aorta and TCA, as well as RCA and conus branch, was measured. Results: A total 11 of specimens had supernumerary arteries. A supernumerary artery was found in two hearts. The angle formed by the aorta with the TCA was 60.09 ± 17.57, while the angle between the aorta and the conus branch had an average value of 89.88 ± 15.92. The orifices of all supernumerary arteries were located below the level of the sinotubular junction. The average diameter of the TCA was 1.49 mm ± 0.41. The average distance between the TCA orifice and the RCA orifice was 2.21 mm ± 1.03. In 45.45% cases, the orifice of TCA was located at the 10 o’clock level. Conclusion: The present study highlights the presence of the TCA. It may constitute a significant collateral circulation contributing to apical and septal perfusion. Interpretation of signs and symptoms of coronary occlusion should therefore include possible contribution of this vascular channel

ELEVATED SERUM C-REACTIVE PROTEIN LEVEL IS NOT ASSOCIATED WITH SERUM NITRIC OXIDE IN PATIENTS WITH POSTTRAUMATIC STRESS DISORDER

Background: The aim of the present study was to evaluate serum nitric oxide (NO) and C reactive protein (CRP) concentration in veterans with and without PTSD. Furthermore, we aimed to assess whether there is a correlation between serum NO and CRP concentrations in tested groups. Subjects and methods: Cross-sectional study included 90 male individuals, with and without experience of direct war combat, divided into three equal groups (n=30): group 1- included war veterans with PTSD, group 2 - included war veterans without PTSD, and control group - 30 apparently healthy volunteers, without experience of direct war combat. The diagnosis of PTSD was assessed according to the guidelines in the 10th revision of the International Classification of Diseases (ICD-10). High-sensitivity CRP was determined by immunonephelometry. The serum NO level was determined by classic colorimetrical Griess reaction. Results: Serum CRP concentration in veterans with (3.54±1.19 mg/L) and without PTSD (3.24±2.04 mg/L), was significantly higher (p<0.05) compared to control group (1.26±1.06 mg/L). Serum NO concentration in veterans with (7.64±4.43 μmol/L) and without PTSD (7.12±2.60 μmol/L) was significantly lower (p<0.05) compared to control group (11.26±7.01 μmol/L). Statistically significant correlation between serum NO and CRP concentration was determined in veterans without PTSD (r=-0.473; p<0.01). No correlation was observed between serum NO and CRP concentration in veterans with PTSD (r=0.118; p=0.534) and in control group (r=-0.067; p=0.727). Conclusion: The present study has showed significant increase of serum CRP and significant decrease of serum NO concentrations in veterans with and without PTSD. Furthermore, statistically significant negative correlation between serum NO and CRP concentration was determined only in veterans without PTSD. Obtained results indicate that the complex mechanism of the pathogenesis of PTSD requires further research

Vrijednosti serumskog kreatinina, Cockcroft-Gault i Modification of Diet in Renal Diseases jednadžbi u bolesnika s arterijskom hipertenzijom

To determine whether there are differences between serum creatinine levels, estimated glomerular filtration rate (GFR) according to the Modification of Diet in Renal Disease Study (MDRD) equation, creatinine clearance, and estimated GFR obtained by the Cockcroft-Gault method related to age, stage, and duration of arterial hypertension. The study included 124 patients with arterial hypertension who were examined at the Clinic for Heart, Rheumatism and Blood Vessels, Clinical Center University of Sarajevo. All patients were examined, and data about the duration and stage of hypertension were taken. Kidney function was assessed using serum creatinine, estimated GFR according to the MDRD equation, creatinine clearance estimated by the Cockcroft-Gault method (eCrClCG) and its corrections for body surface area (eCrClCG1.73), body mass index (eCrClCGBMI), both body surface area and body mass index (eCrClCGBMI1.73), and estimated GFR using the Cockcroft-Gault method (eGFRCGBMI1.73). There was a significant difference in values in MDRD equation estimated GFR, eCrClCGBMI, eCrClCGBMI1.73, and eGFRCGBMI1.73 in patients with different stages and durations of hypertension, which was not found by analysis of serum creatinine values. Estimated GFR and eCrCl are more sensitive markers of kidney impairment than serum creatinine values, and their assessment should be introduced as a routine screening in the detection of early stages of chronic kidney disease in primary care settings, especially in patients with arterial hypertension.Cilj: utvrditi postoje li razlike između vrijednosti kreatinina u serumu, procijenjene stope glomerularne filtracije (eGFR) prema jednadžbi Modification of Diet in Renal Disease (MDRD), klirensa kreatinina i eGFR-a dobivenih Cockcroft- Gault metodom s obzirom na dob, stupanj i trajanje arterijske hipertenzije (AH). Bolesnici i metode: istraživanje je obuhvatilo 124 ambulantna bolesnika s AH-om pregledana na Klinici za bolesti srca, krvnih žila i reumatizam Kliničkog centra Univerziteta u Sarajevu. Pregledani su svi bolesnici te su uzeti podatci o trajanju i stupnju AH-a. Bubrežna je funkcija ocijenjena na osnovi serumskog kreatina, procijenjene su stope glomerularne filtracije prema MDRD jednadžbi, klirensom kreatinina procijenjenim Cockcroft-Gault jednadžbom (eCrClCG) i njegovim korekcijama za površinu tijela (eCrClCG1,73), za indeks tjelesne mase (eCrClCGBMI), indeks tjelesne mase i površinu tijela (eCrClCGBMI1,73) i procijenjeni GFR primjenom Cockcroft-Gault metode (eGFRCGBMI1,73). Rezultati: nađena je značajna razlika u vrijednostima procijenjenog GFR-a MDRD jednadžbom, eCrClCGBMI, eCrClCGBMI1,73 i eGFRCGBMI1,73 u bolesnika s različitim stupnjevima i trajanjem AH-a, što nije dobiveno analizom vrijednosti serumskog kreatinina. Zaključak: procijenjeni GFR i eCrCl osjetljiviji su biljezi oštećenja bubrega od vrijednosti kreatinina u serumu i njihovo određivanje treba biti uvedeno kao rutinski probir u otkrivanju ranih stadija kronične bubrežne bolesti u primarnoj zdravstvenoj zaštiti, posebno u bolesnika s AH-om