Cardiac autonomic imbalance in children with allergic rhinitis

The involvement of autonomic imbalance has been reported in the pathogenesis of hypersensitivity reactions. Allergic diseases are more frequent in children and some of predisposing factors may be changed according to the increasing age, but the involvement of autonomic imbalance has not been investigated in pediatric population. In this cross-sectional, case-control study, we evaluated the autonomic system by measuring heart rate variability (HRV) in pediatric patients with allergic rhinitis. Thirty-five pediatric patients with allergic rhinitis and 36 healthy children (mean age 11 +/- 2.7, and 12 +/- 3 years, respectively) were enrolled in the study. Age and gender were not different between the groups. The diagnosis of allergic rhinitis was based on the history, symptoms, and skin prick tests. Participants with acute infection, nasal polyposis, bronchial asthma, and any other medical problems, assessed by history, physical examination and routine laboratory tests, were excluded. Twenty-four hour ambulatory electrocardiographic recordings were obtained, and the time domain and frequency domain indices of HRV were analyzed. We found significant increase in calculated HRV variables in children with allergic rhinitis compared to controls, which reflect parasympathetic tones, such as number of R-R intervals exceeding 50 ms, root mean square of successive differences between normal sinus R-R intervals, the percentage of difference between adjacent normal R-R intervals, and high frequency. These results indicate that HRV is increased, which implies sympathetic withdrawal and parasympathetic predominance. We propose that autonomic imbalance may be involved in the pathophysiology of allergic rhinitis in pediatric patients.

The effects of perindopril on aortic elasticity and inflammatory markers in hypertensive patients

BACKGROUND

Inflammation plays an important role in hypertension and in atherosclerosis. Inflammatory changes induced even in prehypertensive subjects can lead to increased arterial stiffness. The effects of perindopril on both inflammatory and aortic elasticity markers were tested in hypertensive patients.

MATERIAL/METHODS

One hundred nine hypertensive patients not taking any antihypertensive therapy were included in the study. Aortic strain, aortic distensibility, aortic stiffness index, and inflammatory markers, including CRP, IL-1alpha IL-1beta, and TNF-alpha, were measured in all patients before and after twenty weeks of perindopril therapy.

RESULTS

While aortic strain and distensibility showed statistically significant increases with perindopril therapy, the aortic stiffness index and inflammatory markers were found to decrease.

CONCLUSIONS

Perindopril therapy resulted in an improvement in aortic elastic properties. There was also an attenuation of inflammatory status of the patients as reflected by lower inflammatory marker levels compared with pretreatment values.

Importance of urinary measurement of glutathione S-transferase in renal dysfunction patients after on- and off-pump coronary artery bypass surgery

BACKGROUND

Acute renal failure (ARF) occurring after on-pump and off-pump cardiac surgery was assessed by urinary alpha glutathione S-transferase measurement (alpha-GST) in patients who already had renal dysfunction.

METHODS

Fifty-one patients with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were included in the study. On-pump coronary artery bypass was performed in 25 of them, and off-pump surgery in the other 25 patients. Urinary alpha-GST levels, plasma creatinine levels, creatinine clearance and fractional excretion of sodium were measured.

RESULTS

Urinary alpha-GST levels were found to be significantly increased at 24 hours postoperatively. A weak correlation was detected between alpha-GST levels and plasma creatinine, creatinine clearance and fractional excretion of sodium. Preoperative and postoperative 24 hour levels showed a positive predictive value for the occurrence of acute renal failure.

CONCLUSIONS

Tubular damage produced by cardiopulmonary bypass is not the only factor associated with postoperative ARF. Because factors independent of pump usage can adversely affect renal function, excluding pump usage alone is not sufficient to prevent postoperative ARF in patients who have preoperative renal dysfunction.

Is low adiponectin levels more sensitive predictor of in-stent restenosis: new questions and challenges

Predicting in-stent restenosis has been subject of many investigations. Several candidates have also been proposed such as CRP. However, recent findings suggested that adiponectin may be a more sensitive marker for in-stent restenosis. These initial results should be confirmed by other large scale prospective trials.

Giant Chiari network mimics intracardiac tumor in a case of neurofibramatosis

Neurocutaneos syndromes are associated with cardiac or heart related extracardiac tumors, as well as atrial or ventricular septal defect, pulmonary stenosis, coarctation of aorta. Here we describe a case of neurofibromatosis with valvular pulmonary stenosis and giant Chiari network, which mimics a right atrial tumor originating from interatrial septum.

Conventional and non-conventional coronary risk factors in male premature coronary artery disease patients already having a low Framingham risk score

BACKGROUND

Individual risk factors and, more importantly, global risk assessment tools such as the Framingham risk score have been used successfully for risk prediction especially in older patients. However, there is paucity of data about the coronary heart disease prediction in premature coronary artery disease patients with a low Framingham risk score.

METHODS AND RESULTS

We recruited 102 consecutive young patients without hypertension and diabetes mellitus in the study. All subjects had had chest pain and underwent coronary angiography since non-invasive diagnostic test results suggested ischaemia. Forty-five patients having at least one coronary lesion independent of severity were included in the study group.The remaining fifty-seven subjects without any coronary lesion were used as control group. Conventional and non-conventional risk factors were evaluated both in patients and control subjects. Framingham risk score and absolute 10-year hard CHD events risk were also calculated for each individual. The coronary heart disease group had a significantly higher smoking frequency as compared to the control group.They also had higher plasma levels of triglycerides, apolipoprotein B and apo B/AI ratio but a smaller LDL particle size.We failed to find any independent CHD predictor after logistic regression analysis. However, individual ROC curve analysis of risk factors revealed that apolipoprotein B, triglycerides and apo B/AI ratio have the highest area under the curve for coronary artery disease prediction.

CONCLUSIONS

The Framingham risk score may underestimate the true risk of an individual. Incorporating non-conventional risk factors such as apolipoprotein B and apo B/apo AI ratio may provide valuable information in these patients.

Perindopril, atenolol, and amlodipine prevent aortic ultrastructural changes in rats exposed to ethanol

BACKGROUND

The effects of perindopril, an angiotensin-converting enzyme inhibitor, atenolol, a beta adrenergic receptor blocker, and amlodipine, a calcium channel blocker, were investigated in chronic alcohol administered rats.

MATERIAL/METHODS

Adult male Wistar rats (240-320 g) were used in the present study. Alcohol was given to rats on a modified liquid diet for 21 days. Perindopril (2.5 and 5 mg/kg), atenolol (5 and 10 mg/kg), and amlodipine (5 and 10 mg/kg) were injected into rats in different groups intraperitoneally for 21 days. Control rats were pair fed an isocaloric liquid diet containing sucrose as a caloric substitute for alcohol. Saline was injected into the control rats for 21 days. The hearts were removed after the rats were anesthetized by ether, and 1-mm3 samples from the ascending aortas were fixed. Five fields per aorta were examined and photographed with a transmission electron microscope. Blood alcohol levels were also measured spectrophotometrically.

RESULTS

Daily alcohol consumption of the rats was in the range of 12.09-15.50 g/kg. Blood alcohol concentrations were 145.63 mg/dl on the 21st day of alcohol consumption. Chronic alcohol consumption caused some marked aortic wall injuries. Perindopril, atenolol, and amlodipine at high doses, but not low doses, produced some significant beneficial effects on alcohol-induced aortic wall damage.

CONCLUSIONS

These results imply that perindopril, atenolol, and amlodipine may have protective effects on heavy chronic alcohol consumption-induced aortic wall injury in rats only in high doses.

State and trait anxiety levels before coronary angiography

AIM

To investigate the factors that are related to increased anxiety before elective coronary angiography.

BACKGROUND

Anxiety before coronary angiography is an important factor for complications. To know the factors for increased anxiety, it is important for nurse to prevent complications.

DESIGN

A cross-sectional study design was used. The study included 88 consecutive patients waiting for coronary angiography. Methods. A data-collecting form, which included questions about demographic features, health history and angiography, was completed by the participants on the day of coronary angiography. The level of state and trait anxiety was measured by Spielberger's State-Trait Anxiety Inventory. Multivariate Analysis was performed to disclose the independency of the relation between state anxiety and factors.

RESULTS

Both trait and state anxiety levels were found to be moderate (age = 46, SD = 9, 24-67 years and age = 40, SD = 10, 21-65 years, respectively). There was a significant relation between state and trait anxiety levels (r = 0.56, p < 0.001). Among the investigated factors, only the trait anxiety (p < 0.001) and time on waiting list (p = 0.020) were found to be independent. For predicting high level of state anxiety, the cut-off value of trait anxiety was found to be 48 with a sensitivity of 67% and specificity of 67% and cut-off value of time on waiting list was found to be seven days with a sensitivity of 83% and specificity of 52%.

CONCLUSIONS

The time on waiting list and trait anxiety levels are the most important factors for state anxiety level. To prevent high level of coronary angiography-related anxiety, those patients with trait anxiety level >48 and time on waiting list >7 days should be managed specifically. The preventive measures should be specifically focused on the connection between state and trait anxiety.

RELEVANCE TO CLINICAL PRACTICE

Nursing planning should be focused on patients especially those on a long-time waiting list and on patients with high trait anxiety level prior to coronary intervention.

Left atrial appendage can still cause clinical events after ligation

We present a 71-year-old female patient with transient ischaemic attack. A thrombus located at the stump of previously ligated left atrial appendage was suspected as the cause of event.

A nomogram for measurement of mitral valve area by proximal isovelocity surface area method

INTRODUCTION

Although its accuracy has been documented in many studies, the proximal isovelocity surface area (PISA) method is not used widely for mitral valve area (MVA) measurement. In this study, we prepared a new nomogram and tested its use in MVA assessment.

MATERIAL AND METHODS

The study included 23 patients (age: 27 +/- 5 years) with mitral stenosis, of whom 7 were in atrial fibrillation. The MVA was measured by four methods: planimetry (PL) (reference method), pressure-half time (PHT), conventional PISA (CP), and nomogram (Nomo) methods. The nomogram included two unknowns: (1) r; the radius of the first PISA section; (2) a; the length of the border opposite to the PISA angle in the triangle with both adjacent borders of 1 cm. The nomogram was also tested for its popularity potential by eight echocardiographers, none of whom were included in the author list.

RESULTS

Mean MVA(PL) was 1.85 +/- 0.53 cm(2) (range: 0.72-2.99), mean MVA(PHT) was 1.72 +/- 0.56 cm(2) (range: 0.91-3.30), mean MVA(CP) was 1.69 +/- 0.45 cm(2) (range: 0.97-2.54), and MVA(Nomo) was 1.70 +/- 0.44 cm(2) (0.96-2.49). The nomogram correlated with planimetry (r = 0.87; P < 0.001), pressure half-time (r = 0.71; P < 0.001) and conventional PISA (r = 0.99; P = 0.000) methods. The nomogram method also correlated with planimetry in patients with atrial fibrillation (r = 0.81; P = 0.026). The echocardiographers found that the nomogram is superior to the planimetry and conventional PISA methods but inferior to the pressure half-time method in terms of simplicity.

CONCLUSION

The new nomogram is potentially helpful in measurement of MVA. It may be used as an additional method in assessing severity of mitral stenosis.

The altered autonomic nervous system activity in iron deficiency anemia

Autonomic function is impaired in anemic patients with various etiologies such as vitamin B12 deficiency, sickle cell trait, and thalassemia major. However, there are insufficient data about autonomic functions in patients with iron deficiency anemia, the leading cause for anemia in the general population. In the present study we aimed to investigate the autonomic status in iron deficiency anemia by analyzing the heart rate variability (HRV). Age- and gender-matched 43 patients with iron deficiency anemia and 39 healthy subjects were undertaken into 24-hr Holter monitoring for assessing the HRV. We used serum levels of iron, iron binding capacity, C-reactive protein, vitamin B12, and folate to exclude other causes of anemia. While age, gender, vitamin B12 and folate levels were not different between the groups, HRV values were lower in patients with iron deficiency anemia compared to control group, which reflects parasympathetic withdrawal. Blood hemorheological factors such as decreased viscosity and/or altered red cell deformability may be responsible for this decreased parasympathetic activity. However, these components do not display remarkable contribution in iron deficiency anemia. Therefore, we speculated a probable link between anemia and the accentuated sympathetic activity that may be triggered by hypoxia sensed through carotid bodies. Despite lacking adequate convincing evidence concerning exact mechanism of carotid body activation, it is assumed as due either to hypoxia-related mitochondrial respiratory chain inhibition or potassium channel suppression that leads to intracellular calcium accumulation. In conclusion, the present study demonstrates an altered autonomic balance in patients with true iron deficiency anemia.

Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting: clinical research

BACKGROUND

Use of the radial artery (RA) as a conduit in coronary artery bypass grafting (CABG) has become increasingly popular in recent years. The aim of this study was to compare the results of two different RA harvesting techniques. Use of the harmonic scalpel is suggested to be safe and additionally reduces spasm rates.

MATERIAL AND METHODS

From January 2000, the first 200 consecutive patients who underwent RA harvesting for CABG were enrolled in this study. Patients were divided into two groups. RA was harvested by means of electrocautery + hemoclips in Group I and by harmonic scalpel + hemoclips in Group II. 30 patients (30 %) in Group I and 25 patients (25 %) in Group II were female. Mean age was 53.9 +/- 9.3 and 53.5 +/- 8.4 years in Group I and Group II, respectively. Hand circulation and ulnar collateral flow was assured with a modified Allen test in all patients preoperatively. During the operation perfusion of the hand was monitored by oximetric plethysmography. The distal end of RA was also explored and clamped with a soft vascular clamp to evaluate the saturation values in the groups. During the clamping period, oxygen saturation values did not decrease so we harvested RAs in all patients.

RESULTS

There were no statistically significant differences between the groups with the exception of the RA harvesting times, the postoperative analgesia requirements, the rate of vasospasm and the need for hemostatic clips.

CONCLUSION

Harmonic scalpel usage in RA harvesting causes less trauma to adjacent tissues; the analgesia requirements, the rate of vasospasm, the RA harvesting time and the need of hemostatic clips decreases. We conclude that the use of a harmonic scalpel for radial artery harvesting is safer and faster than the routine technique.

A New Echocardiographic Index for Assessing Left Ventricular Function and Mechanism of Mitral Regurgitation and Its Relation to Other Echocardiographic Indices

OBJECTIVE

Mitral regurgitation (MR) is a progressive disease of the mitral valve, which can be primary or functional. The assessment of left ventricular function in MR is still troublesome. In this study, we evaluated the validity of a new parameter, total dt, in patients with MR.

METHODS

Forty patients with severe MR constituted the study group. According to the transesophageal echocardiographic evaluation, the patients were dichotomized into two groups: (1) Primary MR; n = 21, (2) Functional MR; n = 19. The total dt was defined as the sum of time intervals from 1 msto 3 ms (positive dt) and from 3 ms to 1 ms (negative dt) on the CW Doppler recording of MR jet. It was compared to other indices of left ventricular function and left ventricular geometry, including ejection fraction, fractional shortening, myocardial performance index, coaptation distance, left ventricular volume and diameter, sphericity index, and parameters of diastolic function.

RESULT

The total dt correlated with myocardial performance index, coaptation distance, and sphericity index. It could differentiate between primary and functional MR with an area under curve of 0.878, followed by myocardial performance index with 0.860. The total dt > 104 ms was 79% sensitive and 81% specific for discrimination.

CONCLUSION

The total dt is useful for assessing left ventricular function and also for differentiating primary MR from functional MR.

Evaluation of plasma adiponectin levels in young men with coronary artery disease

OBJECTIVE

In this study, we investigated the relation between plasma adiponectin levels and other risk factors in a young patient population.

MATERIAL AND RESULTS

We enrolled consecutively 69 young patients (< 45 years) with coronary artery disease in the study group. he patient enrollment period was between February 2003 and November 2004. The control group consisted of 42 age- and sex-matched healthy subjects. Anthropometric, lipid and other variables including adiponectin, fasting glucose and plasma insulin levels were measured in all subjects. Appropriate statistical analyses were performed to determine the differences between the groups, the relation between adiponectin and other parameters and independent factors that predict CAD. There was a statistically significant difference between the groups in terms of lipid parameters (triglycerides, total cholesterol, HDL and LDL cholesterol). Mean plasma adiponectin levels were significantly lower in the patients (P < 0.05). Among the risk factors adiponectin had a significant negative association with the plasma triglyceride level (P < 0.01). Logistic regression analysis revealed triglycerides and adiponectin as independent predictors of CAD. The areas under the ROC curves of adiponectin and triglycerides were not different (P > 0.05).

CONCLUSION

We found a decreased plasma adiponectin level in young male patients with coronary artery disease. It may be a novel marker of atherosclerosis in young men.

A complication of coronary angiography: fractured and retained intraaortic catheter

The complications linked directly to coronary artery catheter itself are very rare. We presented a case in which the broken right coronary artery catheter was successfully removed from the ascending aorta. The removal of catheter was accomplished via an aortic incision, which was created for saphenous vein graft in the site of anastomosis during an emergency coronary artery bypass graft surgery. We believe that a broken catheter in the aorta is a catastrophic event, which could be removed safely in the operating room even with concomitant bypass surgery.