Pathogenesis, diagnosis and management of pneumorrhachis

Pneumorrhachis (PR), the presence of intraspinal air, is an exceptional but eminent radiographic finding, accompanied by different aetiologies and possible pathways of air entry into the spinal canal. By reviewing the literature and analysing a personal case of traumatic cervical PR after head injury, we present current data regarding the pathoanatomy, clinical and radiological presentation, diagnosis and differential diagnosis and treatment modalities of patients with PR and associated pathologies to highlight this uncommon phenomenon and outline aetiology-based guidelines for the practical management of PR. Air within the spinal canal can be divided into primary and secondary PR, descriptively classified into extra- or intradural PR and aetiologically subsumed into iatrogenic, traumatic and nontraumatic PR. Intraspinal air is usually found isolated not only in the cervical, thoracic and, less frequently, the lumbosacral regions but can also be located in the entire spinal canal. PR is almost exceptional associated with further air distributions in the body. The pathogenesis and aetiologies of PR are multifold and can be a diagnostic challenge. The diagnostic procedure should include spinal CT, the imaging tool of choice. PR has to be differentiated from free intraspinal gas collections and the coexistence of air and gas within the spinal canal has to be considered differential diagnostically. PR usually represents an asymptomatic epiphenomenon but can also be symptomatic by itself as well as by its underlying pathology. The latter, although often severe, might be concealed and has to be examined carefully to enable adequate patient treatment. The management of PR has to be individualized and frequently requires a multidisciplinary regime

Two cases with suspected permanent pacemaker allergy [Kalici Pacemaker Alerjisi Düşünülen ?ke Olgu]

PubMedID: 15355832[No abstract available

Pericarditis: Review [Perikardit]

Pericarditis is rather frequent disease in the inflammation pathologies of the heart. Firstly, infection agents and other patogens may cause pericarditis by inflammation. There are two clinical titles as acute and chronic pericarditis. Typical chest pain is the most marked clinical findings of acute pericarditis. Enfection pathogens, especially viral agents are the most important etiological reason in acute pericarditis. Right heart failure findings such as pretibial edema, ascites and hepatomegali are seen in chronic pericarditis. Cardiac surgery, malignancy, chronic kidney disease and tuberculosis are the main cause of chronic pericarditis. Nowadays, while classical clinical findings are useful for diagnosis of acute pericarditis, tissue Doppler imaging and magnetic resonans imaging are becoming the important techniques for diagnosis of chronic pericarditis. In this paper, we reviewed clinical features, diagnosis and treatment of the pericarditis. Copyright © 2005 by Türkiye Klinikleri

Annular systolic velocity predicts the presence of spontaneous echo contrast in mitral stenosis patients with sinus rhythm

PubMedID: 17803227Ojectives: Thromboembolism is the major cause of morbidity and mortality in mitral stenosis (MS), even in sinus rhythm (SR). Spontaneous echo contrast (SEC) is the strongest predictor of thromboembolism. The aim of the study was to investigate if the annular velocities obtained with tissue Doppler imaging can predict the presence of SEC in MS patients with SR. Methods: One hundred and five MS patients and 100 controls were included. Annular velocities were recorded. All patients underwent transesophageal echocardiography. Subjects were divided into three groups as controls (Group I), the patients without SEC (Group II) and the patients with SEC (Group III). Results: Group III patients had lower ejection fraction, annular systolic velocity, smaller mitral valve area, higher transmitral gradient and larger left atrial size. The annular systolic velocity was the only independent predictor for SEC. The cutoff values of annular systolic velocity for prediction of the presence of any SEC and dense SEC were 13.5 and 11.8 cm/s, respectively. Conclusion: The annular systolic velocity is an independent predictor for SEC in MS patients with SR. © 2007 Wiley Periodicals, Inc

Systolic tissue velocity is a useful echocardiographic parameter in assessment of left atrial appendage function in patients with mitral stenosis

PubMedID: 17767531Background: The incidence of thromboembolism remains high in patients with mitral stenosis (MS). The left atrial appendage (LAA) is a potential site for development of thrombus and LAA dysfunction is an independent predictor of thromboembolism. The LAA dysfunction is represented by reduced LAA late emptying velocity. But the magnitude of LAA flow velocities is dependent on acute changes in loading conditions. Aim: To investigate the value of the LAA tissue velocities obtained by tissue Doppler imaging (TDI) in assessment of LAA function in MS patients with and without thromboembolic events. Methods: The study population consisted of 98 isolated MS patients of 32 age and sex-matched healthy controls. All subjects underwent transesophageal echocardiography (TEE). LAA late peak emptying (LAAEV) and filling (LAAFV) flow velocities were recorded. LAA peak late tissue systolic (LSV) and diastolic (LDV) tissue velocities by TDI were measured. The patients were divided into three groups as Group I (n = 38, sinus rhythm and LAAEV ? 25 cm/s), Group II (n = 26, sinus rhythm and LAAEV < 25 cm/s), and Group III (n = 34, atrial fibrillation). Results: Twenty-one patients had thromboembolic events. LAAEV, LAAFV, LSV, and LDV were significantly reduced in patients with embolic events. Spontaneous echo contrast (SEC) density was strongly negative correlated with LSV, whereas weakly negative correlated with LAAEV. Multivariate regression analysis showed that LSV and the presence of SEC were independently associated with embolic events. Conclusion: LSV seems more reliable and useful parameter in evaluating LAA function. LAA function is more depressed among patients with embolic events. © 2007, the Authors

Successful occlusion of reentry ring like coronary artery fistula with glue injection [Yeniden giriş (reentry) halkasi şeklinde koroner arter fistülünün yapiştirici enjeksiyonu ile kapatilmasi]

PubMedID: 19666421[No abstract available

Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease

PubMedID: 14565631Mitral annular calcification (MAC) and aortic valve calcification (AVC) are manifestations of atherosclerosis. To determine whether mitral annular calcification and aortic valve calcification detected by transthoracic echocardiography (TTE) might help in predicting significant coronary artery disease (CAD), 123 patients with significant CAD and 93 patients without CAD detected by coronary angiography were investigated. MAC and AVC identified CAD with a sensitivity and specificity of 60.2%, 55.9% and 74.8%, 52.7%, respectively, and with a negative and a positive predictive values of 51.5%, 64.3% and 61.3% and 67.6%, respectively. The positive predictive value of MAC was greater than gender, hypertension, and hypercholesterolemia. AVC showed a positive predictive value greater than gender, hypertension, family history, and hypercholesterolemia. The negative predictive values of MAC and AVC for CAD were greater than those of all risk factors except diabetes mellitus. In conclusion, presence of MAC and AVC on TTE may help in predicting CAD and should be added to conventional risk factors. Absence of MVC and AVC is a stronger predictor for absence of CAD than all conventional risk factors, except diabetes mellitus. Patients with MAC and AVC should be taken into consideration for the presence of significant CAD and thereby for diagnostic and therapeutic interventions in order to improve the prognosis

Diastolic function predicts outcome after aortic valve replacement in patients with chronic severe aortic regurgitation

PubMedID: 19455677Background: Due to eccentric hypertrophy and fibrosis, patients with severe aortic regurgitation (AR) have diastolic dysfunction. Increased fibrosis correlates with increased myocardial stiffness and worsening of diastolic function. Patients with irreversible left ventricular (LV) dysfunction have severe myocardial fibrosis and myocyte apoptosis and do not benefit from aortic valve replacement (AVR). Hypothesis: To investigate whether diastolic properties of LV predicts outcome after AVR in patients with chronic severe AR and LV systolic dysfunction. Methods: The study population consisted of 41 patients with chronic severe AR and LV systolic dysfunction. Preoperative echocardiographic examinations were repeated at the postoperative 6th month. Left ventricular ejection fraction (LVEF) was calculated. Diastolic function was evaluated with Doppler echocardiography. Patients were classified as Group 1 (impaired relaxation), Group 2 (pseudonormalization), and Group 3 (restrictive pattern). Results: Postoperative LVEF was significantly increased in Group 1, whereas it tended to decrease in Group 3. Left ventricular size was significantly decreased in Group 1 and 2 during the postoperative period. Multivariate linear regression analysis showed that deceleration time and early/late ratio were independent predictors of postoperative changes in LVEF. Conclusions: Assessment of diastolic function is a reliable parameter in predicting outcome of AVR in patients with chronic AR and systolic dysfunction. © 2009 Wiley Periodicals, Inc

Evaluation of cardiovascular and inflammatory factors in age-related macular degeneration [Yaa Baglí Maküla Dejeneresansínda Kardiyovasküler ve Enflamatuvar Risk Faktörlerinin Degerlendirilmesi]

Purpose: To evaluate cardiovascular and inflammatory risk factors in Age-Related Macular Degeneration (AMD). Materials and Methods: Thirty-nine patient with dry-type AMD and 37 control were included in the study. Smoking history, body mass index (BMI), serum fibrinogen CRP, IL-6, Tumour necrosis factor alpha (TNF-alpha), Apolipoprotein B, Lipoprotein A, HDL, LDL and total cholesterol values were analyzed. Cardiologic examination was performed to all participants. Results: In dry-type AMD patients, the mean BMI (33.1±5.13) were statistically significantly higher than in the control group (24.9±5.63), (p=0.045). The mean TNF-alfa levels for dry-type AMD and controls were 15.6±52.29 pg/ml and 15.5±41.37 pg/ml, respectively and statistical significant difference was observed (p=0.035). There was statistical significant difference in terms of mean IL-6 levels which were 31.9±114.6 and 1.2±1.5 pg/ml, (p<0.05), respectively. There were no significiant differences between cases and controls in terms of serum fibrinogen, HDL, LDL, total cholesterol, trigliserid, CRP, Lip (a), Apo-B, smoking. Conclusion: In the study there was no relationship between serum cardiac risk factors and AMD. In addition, there was high rate of obesity in the patient group. In the patient group, TNF alpha and IL-6 levels were higher than the control group. These results suggest that inflammatory factors may have a role in the pathogenesis of AMD

Relationship between left ventricular geometry and left ventricular systolic and diastolic functions in patients with chronic severe aortic regurgitation

PubMedID: 18422665Background: Chronic aortic regurgitation (AR) is a form of volume overload inducing left ventricle (LV) dilatation. Myocardial fibrosis, apoptosis, progressive LV dilatation, and eventually LV dysfunction are seen with the progression of disease. The aim of the study was to assess the relation between LV geometry and LV systolic and diastolic functions in patients with chronic severe AR. Methods: The study population consisted of 88 patients with chronic severe AR and 42 healthy controls. The LV ejection fraction (LVEF) was calculated. Subjects were divided as Group I (controls, n = 42), Group II (LVEF > 50%, n = 47), and Group III (LVEF < 50%, n = 41). Transmitral early and late diastolic velocities and deceleration time were measured. The annular systolic (Sa) and diastolic (Ea and Aa) velocities were recorded. Diastolic function was classified as normal, impaired relaxation (IR), pseudonormalization (PN), and restrictive pattern (RP). Results: The LVEF was similar in Group I and II, while significantly lower in Group III. Sa velocity was progressively decreasing, but LV long- and short-axis diameters were increasing from Group I to Group III. Forty-six, 31 and 11 patients had IR, PN, and RP, respectively. LV long-axis systolic and diastolic diameters were significantly increasing, while LVEF and Sa velocity were significantly decreasing from patients with IR to patients with RP. The LV long-axis diastolic diameter is independently associated with LV systolic and diastolic functions. Conclusions: The LV long-axis diastolic diameter is closely related with LV systolic and diastolic functions in patients with chronic severe AR. © 2008, the Authors