Predictors of exercise-induced pulmonary hypertension in patients with asymptomatic degenerative mitral regurgitation: mechanistic insights from 2D speckle-tracking echocardiography

Presence of exercise-induced pulmonary hypertension (EIPH) in asymptomatic degenerative mitral regurgitation (DMR) determines prognosis. This study aimed to elucidate the mechanism and predictors of EIPH in asymptomatic DMR. Ninety-one consecutive asymptomatic patients with DMR who underwent exercise stress echocardiography were prospectively included. We obtained various conventional echocardiographic parameters at rest and during peak exercise, as well as left atrial (LA) function at rest using 2-dimensional speckle-tracking analysis. The 25 patients (33.3%) with EIPH were significantly older and had a greater ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity during peak exercise than those without EIPH. LA strain (LAS)-s and LAS-e, indices of LA reservoir and conduit function, respectively, were significantly lower in those with EIPH than in those without EIPH. Multivariate analysis indicated that LAS-s was the only resting echocardiographic parameter that independently predicted EIPH, with a cut-off value of 26.9%. Furthermore, Kaplan-Meier curve analysis showed that symptom-free survival was markedly lower among those with reduced LAS-s. In conclusion, decreased LA reservoir function contributes to EIPH, and LAS-s at rest is a useful indicator for predicting EIPH in asymptomatic patients with DMR

Size and Morphology of Sella Turcica in Malay populations: A 3D CT Study

The purpose of this study was to analyse the linear and area dimensions and morphological shape of sella turcica to determine if differences exist due to gender or age and compared with available global data. A total of 183 (113 men and 70 women) Malay subjects who had their computed tomography (CT) scan at the Radiology Department, Hospital University Sains Malaysia (HUSM) for ordinary diagnosis not related to craniofacial deformities. The selected age groups were divided into four groups as children (0-6 years), preadolescents (7-12 years), adolescents (13-20 years) and adults (21-35 years). The images were processed using Mimics V17.0 software. Conventional measurements included three different heights of the sella turcica (anterior, posterior, median), its length, diameter, area and width, measured in relation to the Frankfort reference line (FH). Morphometric methods were used to assess shape. No significant differences in size of the sella were found except at sella height anterior between genders. When age was evaluated, significant differences were found among all age groups. The study found that sella turcica presented with a three different shapes: in a U shape (57.9 %), in a J shape (24.5 %) and shallow (17.5 %). Sella shape and dimensions reported in the current study can be used for discovering Pathological enlargement of the pituitary fossa and may also be helpful in providing reference data in the assessment of racial, gender and age specific variation in Malay populatio

Histochemical Characteristics of Tertiary Dentin Due to Calcium Hydroxide Paste in Rats

Calcium hydroxide is mainly used for dental pulp capping and it is thought that it induces hard tissue formation far better than other materials. Experimentally verifying this fact, Nishikawa et al revealed that bone-like dentin corresponding to tertiary dentin is rapidly formed when calcium hydroxide is applied directly to the pulp. Utilizing the same experimental system, histochemical study of the newly formed hard tissue (reparative dentin) was carried out and the results thereof were reported. Thick and irregular reparative dentin was formed in the pulp cavity and partial narrowing of the root canal was observed in m-CT. Histopathologically, the irregular reparative dentin increased its thickness obliterating the root canal having a diff erent Azan staining of aniline blue compared to primary dentin. Numerous cellular inclusion bodies were also trapped inside the thick dentin. Furthermore, with Schmorl’s thionine picric acid staining,thick reparative dentin was noted around the pulp cavity and dentin. The dentin was densely stained with picric acid with diff erent staining ability from the surrounding dentin. In addition, it was clearly confi rmed that many cells were trapped in reparative dentin. The results of the experiment suggest that the characteristics of the newly formed reparative dentin is comparable to tertiary dentin

Vascular Patterns of Villous Tumors of the Colorectum

In order to more fully understand the morphological characteristics of villous tumors of the colorectum, the vascular patterns of six colorectal resection specimens were microangiographically studied. Grossly, villous adenomas were of two main types: pedunculated polyps and carpet-like lesions. Pedunculated villous adenomas had many large stalk vessels in a broad short pedicle, representing a large blood supply to the tumor. The carpet-like lesions were composed of continuous clusters of polyps with stalk vessels and the flat elevated lesions among polyps and at the periphery showed similar vascular patterns to the mucosa of normal colon. In lesions with cancer invasive to the proper muscle layer, scattered ulcerations due to the destruction of polyps were also observed, corresponding to at least a Dukes B lesion. The above findings could represent very important additional information for endoscopic treatment or local excision for the prevention of hemorrhagic complicatios or incomplete removal of tumor

Surgery for Ulcerative Colitis - A Comparative Retrospective Study -

The records of patients with ulcerative colitis (UC) who underwent operation at our hospitals between 1973 and 1995 were reviewed. The clinical course of the disease was the chronic relapsing-remitting type in seven, chronic continuous type in four, acute attack of the relapsing-remitting type in six, and fulminant colitis (toxic megacolon) in two patients. The most common indication for surgery was a condition refractory to conservative therapy. Four patients with massive bleeding, perforation and toxic megacolon underwent emergency operation. The surgical procedures performed were ileoanal anastomosis (IAA) in four, ileoanal canal anastomosis (IACA) in one, ileorectal anastomosis (IRA) in five, proctocolectomy and permanent ileostomy (PCI) in four, and colectomy in five patients. The mortality rate was 5.2%. During follow-up, drug therapy with sulfasalazine (salazosulfapyridine) in colectomy or IRA patients was necessary to control inflammation in the remaining rectal mucosa. One patient with segmental colectomy for severe colitis required removal of the remaining colon 1 year later. Three out of four patients undergoing total proctocolectomy and IAA had a good postoperative course with an average of six bowel movements in 24 hours, but one patient with a long rectal cuff was returned to a PCI because of a cuff abscess. The PCEEA instrument was sufficient to perform IAA and IACA. Carcinoma in the remnant rectum occurred in one patient 20 years after Hartmann\u27s procedure. In conclusion, total proctocolectomy, which has the advantage of removing all diseased mucosa with its potential for inflammation, dysplasia, and carcinoma, may be preferable for extensive long-standing UC

A case of impacted supernumerary teeth occurring in the bilateral mandibular premolar area

In this study, a 1₇–year–old patient, who had regularly visited us from childhood, complained of discomfort in the andibular molar area, and impacted supernumerary teeth was confirmed by radiography. Its position was closely investigated using 3–dimensional CT, excision was performed, and a favorable course has been achieved. Thus, the importance of screening using panoramic radiography was reconfirmed