Lack of effects of transdermal estradiol on diastolic function: a randomized placebo-controlled double-blind short-term trial

OBJECTIVE

Limited information is available on the effects of transdermal estradiol on diastole. The present study was a randomized double-blind placebo-controlled trial designed to investigate the short-term effects of transdermal estradiol on left ventricular diastolic function in postmenopausal women.

METHODS

The study included 45 women aged 50.8 +/- 3.6 years (25 randomized to the study group and 20 to placebo), who underwent Doppler echocardiography and determination of the plasma estradiol level after 4 and 8 weeks of transdermal estradiol administration in a dose of 50 micrograms per 24 h.

RESULTS

There were no modifications in heart rate. Systolic blood pressure dropped in the study patients after 8 weeks (p < 0.03); diastolic blood pressure remained unchanged. Estradiol levels were 67 +/- 36 pg/ml at 4 weeks and 70 +/- 49 pg/ml at 8 weeks in the study group. Basal values of peak early and peak atrial velocities, acceleration time and rate, deceleration time and rate, early/atrial velocity ratio and pressure half-time were not significantly different between the estradiol and placebo groups. Doppler values remained unchanged after both 4 and 8 weeks in women receiving estradiol. Women with relatively high serum 17 beta-estradiol levels (> 100 pg/ml) at 4 or 8 weeks of treatment did not present more pronounced changes in the Doppler-derived parameters compared with patients with low hormone levels.

CONCLUSION

The results showed a lack of short-term effects of transdermal estradiol on left ventricular diastolic function in postmenopausal women, irrespective of serum estradiol levels.

Retrograde embolism and atherosclerosis development in the human thoracic aorta: are the fluid dynamics explanations valid?

The mechanisms of atherosclerosis development in the thoracic aorta is miscellaneous and still only partially understood. The marked variability of the sites of deposition of atherosclerotic plaques in the aorta could not be clarified based solely on the risk-factors theory of atherosclerosis. The sites of deposition of atherosclerotic plaques are considered to be affected by blood-flow patterns that cause areas of altered shear stress on the aortic wall. Close relations between protruding aortic plaques (PAP), stroke and peripheral emboli were established. The analysis of PAP distribution and motion to characterize atherogenesis in the human thoracic aorta and the pathogeneses of embolic events was performed. We concluded that protruding aortic plaques and markers of relative aortic flow instability (occurrences of vortices) are predominantly noticed in the human arch and in the descending aorta, whereas the ascending aorta showed lesser prevalence of atheromatosis. Reversal and rotational blood-flow in the thoracic aorta most likely exist in all patients with systemic emboli and mobile protruding aortic atheromas. Therefore, retrograde cerebral embolism from distal aortic plaques is conceivable.

Vertical growth in mono-and dizygotic twins: A longitudinal cephalometric cohort study

OBJECTIVE

The aims of this longitudinal analysis of untreated monozygotic and dizygotic twins were to investigate vertical changes of the craniofacial structures during growth, to determine the concordance between genetically twins and to assess the genetic component for the various aspects of vertical growth.

SETTINGS AND SAMPLE POPULATION

The sample consisted of 34 pairs of untreated monozygotic twins (23 male, 11 female) and 30 untreated dizygotic siblings of multiple birth (8 male, 8 female and 14 mixed) from the Forsyth Moorrees Twin Study (1959-1975); lateral cephalograms taken from 6 to 18 years of age were analysed at 3-year intervals.

MATERIALS AND METHODS

Cephalograms were traced, and longitudinal changes between twins in six angular and proportional vertical cephalometric variables (SN-NL, ML-NL, SN-ML, y-axis, PFH/AFH and LAFH/AFH) were analysed with intraclass correlation coefficients and linear regression modelling.

RESULTS

The concordance between monozygotic/dizygotic twins at 18 years of age was moderate to high with intraclass correlation coefficient values between 0.51 and 0.66. Additionally, sex differences in concordance at 18 years of age were found for three variables. High heritability (66%-79%) was observed for 5 of the 6 variables (LAFH/AFH, ML-NL, y-axis, SN-ML, PFH/AFH), while SN-NL showed limited heritability (34%).

CONCLUSIONS

Although monozygotic/dizygotic twins share at least part of their genetic material, differences in the vertical dimension were found. This supports the complex developmental mechanism of the human face and the varying influence of genetic and environmental factors.

Does rapid maxillary expansion enlarge the nasal cavity and pharyngeal airway? A three-dimensional assessment based on validated analyses

OBJECTIVES

To evaluate the three-dimensional changes following rapid maxillary expansion (RME) of the nasal cavity (NC) and pharyngeal airway (PA) in growing patients, using innovative and validated evaluation methods and to investigate whether a correlation between skeletal expansion and increase in airway volume exists.

SETTINGS AND SAMPLE POPULATION

Records of patients who had cone beam computed tomography taken before and after orthodontic treatment with or without RME were retrospectively collected and divided into two groups: (a) RME, 39 patients (mean age 10.40 ± 1.74 years); and (b) control, 29 patients, matched for age (mean age 11.07 ± 1.45 years) and follow-up period.

MATERIAL AND METHODS

Total and partial volumes of the NC and the PA were calculated. The PA centerline was determined to assess the minimal cross-sectional area and hydraulic diameter. Paired and unpaired t test were applied to compare the difference between time points and between groups. One-way ANOVA and post hoc Tukey's tests were used to compare subgroups with respect to changes in palatal width and lacrimal ducts distance.

RESULTS

All of the NC, PA and skeletal parameters were significantly enlarged after RME. The NC volume and inter-molar distance in the RME were significantly larger compared to the control group. The initially lower mean values of minimal cross-sectional area and hydraulic diameter in the RME group when compared to the control group normalized after RME treatment.

CONCLUSIONS

Based on validated analyses, the NC volume increase was evident after RME in the long term after controlling for growth.

Left ventricular thrombectomy in the early postinfarction period

Emergency left ventricular thrombectomy was performed on four patients soon after infarction. In three patients surgery was carried out after embolisation had occurred and when a large, residual, protruding, mobile thrombus remained in the left ventricle. Surgery was performed in the fourth patient after a high risk thrombus was detected and initial attempts to lyse it had failed. All four patients had an uneventful recovery and were discharged within two weeks of surgery. These cases indicate that the therapeutic option of left ventricular thrombectomy is feasible for patients with acute infarcts and problematic left ventricular thrombi.

Blunted responses of doppler-derived aortic flow parameters during whole-body heavy isometric exercise in heart transplant recipients

BACKGROUND

Relatively light isometric exercise (handgrip) in heart transplant recipients induces attenuated increments in heart rate, blood pressure, and systemic vascular resistance, but hemodynamic response to whole-body, heavy isometric exercise is unknown. The aim of our study was to investigate the influences of whole-body, heavy, isometric exercise on Doppler-derived parameters in these patients.

METHODS

We investigated 18 patients, aged 54.0 +/- 2 years, 1.6 +/- 1.0 years after cardiac transplantation and 18 sedentary healthy volunteers, aged 51.8 +/- 4 years (p = not significant). Patients performed supine, isometric exercise by stretching a whole-body isometric device at 50% of maximal voluntary contraction for 3 minutes.

RESULTS

Resting heart rate, blood pressure, and rate-pressure product were higher in transplanted patients when compared with the healthy volunteers (p < 0.001 for all). However, during isometric exercise, these parameters increased to a lesser extent in the transplanted compared with the healthy subjects-heart rate, 12% vs 40% (p < 0.001); mean arterial pressure, 20% vs 27% (p < 0.05); and rate-pressure product, 39% vs 85% (p < 0.001). In the healthy volunteers, peak-flow velocity, mean acceleration, flow-velocity integral, and stroke volume decreased by 30% to 40% with isometric exercise (p < 0.001 for all), whereas systemic vascular resistance increased by 36% (p < 0.001) and cardiac output did not change. In the transplanted patients, all above parameters remained unchanged. Heavy, whole-body isometric exercise was well tolerated in heart transplant recipients in this study, without hemodynamic deterioration or other complications.

CONCLUSIONS

With whole-body, heavy isometric exercise, Doppler-derived aortic flow parameters demonstrate blunted responses or remain unchanged among heart transplant recipients. The observed phenomenon may have implications for studies of exercise physiology in transplant recipients.

Right-to-left shunt through a patent foramen ovale caused by severe tricuspid regurgitation detected with color Doppler echocardiography

We describe a 65-year-old patient with moderate combined mitral disease and severe tricuspid regurgitation, in whom the tricuspid regurgitant jet was oriented toward the interatrial septum. Color flow and pulsed Doppler demonstrated a late-systolic to mid-diastolic, right-to-left shunting of the tricuspid regurgitant jet through the foramen ovale. This finding was subsequently confirmed with transesophageal echocardiography.

Rapid-maxillary-expansion induced rhinological effects: a retrospective multicenter study

Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal-dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm(3); P < 0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P < 0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P > 0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P > 0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient's age.

Correlation between echocardiography and cardiac catheterization in assessing the severity of aortic stenosis

The severity of aortic stenosis was assessed by echocardiography in 81 consecutive adult patients, 40 of whom underwent cardiac catheterization. The patients' mean age was 54 +/- 16.4 years. A good correlation was found between the severity of aortic stenosis assessed by cross-sectional echocardiography and cardiac catheterization. Aortic valve separation of 7 mm or less occurred only in severe aortic stenosis whereas a separation of 12 mm ruled out any significant aortic stenosis. A separation of 8-11 mm constituted a 'grey' area between mild and severe aortic stenosis. Cross-sectional echocardiography provides a reliable method for crude evaluation of aortic stenosis.

Usefulness of spiral computed tomography (dual-slice mode) for the detection of coronary artery calcium in patients with chronic atypical chest pain, in typical angina pectoris, and in asymptomatic subjects with prominent atherosclerotic risk factors

The prevalence and extent of coronary calcium were retrospectively assessed by spiral computed tomography in 541 patients (mean age 62 +/- 9 years), of whom 101 had typical angina pectoris, 307 had atypical chest pain, and 133 were asymptomatic subjects with prominent atherosclerotic risk factors. The highest prevalence of coronary calcium was in men with angina pectoris (89%), whereas it was not detected in 48% of men and 56% of women with atypical chest pain.

Correlation between cardiac catheterization and echocardiography in assessing the severity of mitral stenosis

During a 12-mth period 162 consecutive patients with mitral stenosis underwent examination by M-mode as well as cross-sectional echocardiography. The mitral valve area was measured by cross-sectional echocardiography ad the severity of mitral stenosis by M-mode echocardiography. Out of the total, 69 patients underwent left and right heart catheterization and in 53 of these the mitral valve area was calculated. A correlation of r=0.92 for the mitral valve area was found between sector scan echocardiography and cardiac catheterization, whereas the correlation between M-mode echocardiography and catheterization yielded a result of only r=0.38. Thus the assessment of the severity of mitral stenosis by cross-sectional echocardiography is a reliable alternative to cardiac catheterization.

Prevalence and characteristics of non-syndromic hypodontia among Turkish orthodontic patient population

Background:

Hypodontia is often used as a collective term for congenital absence of primary or secondary teeth, although specifically it describes the absence of one to six teeth excluding third molars. The prevalence of hypodontia varies from 0.03 to 10.1% in various populations.

Materials and Methods:

In this retrospective study, we reviewed the records of Turkish orthodontic patients treated between 1994 and 2003. A total of 1236 orthodontic patients (507 girls, 729 boys) were included in this study. The age of the patients ranged from 11 to 20 years. Data were collected and entered into the SPSS 20 program for statistical analysis. The Chi-square test was used to analyze differences in the distribution of hypodontia, sex, and malocclusion type.

Results:

In the total sample of 1236 patients who were orthodontically treated, hypodontia was found in 82 children, including 45 girls and 37 boys. The prevalence of hypodontia was 7%. Patients with more severe hypodontia showed a tendency to exhibit a class II relationship. The mandibular second premolar were the most commonly missing teeth in 48 girls and 26 boys.

Conclusion:

Hypodontia may lead to some clinical problems including malocclusions, esthetic and functional complaints, and also psychological problems. All cases should be evaluated by an interdisciplinary approach for appropriate treatment choice. Our data emphasize the importance of detailed and careful radiographic examination. This helps in long-term and effective treatment planning according to a child's individual requirements.

Genetic and environmental components of vertical growth in mono- and dizygotic twins up to 15-18 years of age

OBJECTIVES

To determine the additive genetic and environmental contributions to the vertical growth of craniofacial structures.

MATERIALS AND METHODS

The sample consisted of 64 untreated monozygotic (44 male, 20 female) and 61 untreated dizygotic twins (32 male, 29 female). Lateral cephalograms taken at 15 and 18 years of age were traced to analyze the sella-nasion-nasal line angle (SN-NL), nasal line-mandibular line angle (ML-NL), sella-nasion-mandibular line angle (SN-ML), sella-nasion-sella-gnathion angle (Y-axis), posterior face height/anterior face height (PFH/AFH), and lower anterior face height/anterior face height (LAFH/AFH). The genetic and environmental components of variance were analyzed with structural equation modeling for multilevel mixed effects.

RESULTS

At 15 years of age, strong dominant genetic control was seen for NL-ML (81%), LAFH/AFH (73%), and Y-axis (57%), whereas strong additive genetic components were found for PFH/AFH (78%), SN-NL (58%), and SN-ML (57%). Unique environmental factors accounted for 18-42% of observed variance, with SN-NL being affected the most (42%). At 18 years of age, only LAFH/AFH (86%) was under strong dominant genetic control, whereas the remainder were under additive genetic influence. The sole exception was SN-NL, which changed from additive to unique environmental influence.

CONCLUSIONS

Either additive or dominant genetic components were found at 15 or 18 years of age for most vertical variables. Environmental factors accounted for about 10-40%, with SN-NL being mostly affected.

Quantitative myocardial ultrasonic integrated backscatter measurements during contrast injections

We and others have shown that normal myocardium exhibits 4 to 5 dB diastolic-to-systolic cyclic variation (CV) of integrated backscatter. To investigate the effect of intramyocardial contrast on integrated backscatter, we injected 5% sonicated albumin, containing microbubbles in the range of 5 microns in diameter, into the left atrium in nine open-chest dogs. The dogs were anesthetized and placed in the right lateral decubitus position on a specially designed table with a cutout allowing ultrasound imaging from below. Ultrasonic data was obtained from the right precordium by use of a prototype M-mode integrated backscatter system implemented in a commercially available two-dimensional system. Usable data were obtained in eight of nine dogs. Integrated backscatter increased up to 13 dB after contrast injections. There was a significantly decreased CV of integrated backscatter during myocardial contrast in all eight dogs. The mean level of CV of integrated backscatter for the eight dogs decreased from 4.7 dB (530 beats analyzed) without contrast to 2.8 dB during contrast (436 beats analyzed). There was a trend to greater CV at higher levels of contrast. Septal excursion, as measured by M-mode echocardiography simultaneously with integrated backscatter by the same ultrasound beam, was similar with and without contrast (mean 8.2 vs 8.3 mm). Thus left atrium contrast injection produces quantitatively measurable integrated backscatter effects. Cyclic variation of integrated backscatter decreases with contrast. However, at higher contrast levels the decrease tends to be smaller. These effects should be considered during quantitative tissue characterization and myocardial contrast studies.

Cerebral arteriovenous malformation diagnosis by two-dimensional color-coded Doppler ultrasonography of the head

Two-dimensional color-coded Doppler examination revealed a cranial arteriovenous (AV) malformation in a critically ill newborn with intractable congestive heart failure. This case emphasizes the value of color-coded Doppler in the diagnosis of this rare malformation.

Heritability of facial soft tissue growth in mono- and dizygotic twins at 12 and 17 years of age: A retrospective cohort study

OBJECTIVE

The purpose of this investigation of untreated monozygotic and dizygotic twins was to identify the genetic and environmental components to the facial soft tissue growth.

SETTINGS AND SAMPLE POPULATION

The sample consisted of 52 untreated monozygotic twins (36 male and 16 female) and 46 untreated dizygotic twins (23 male and 23 female) from the Forsyth Moorrees Twin Study (1959-1975).

MATERIALS AND METHODS

Lateral cephalograms were taken at 12 and 17 years of age and traced to analyse facial convexity, nasolabial angle, upper and lower lip thickness, upper and lower lip profile and nose prominence. The genetic and environmental components of variance were analysed with structural equation modelling for multilevel mixed-effects model.

RESULTS

At 12 years of age, strong additive genetic influence was seen for facial convexity (70%), upper lip profile (66%) and nose prominence (65%), whereas strong dominant genetic components were found for upper lip thickness (56%). Nevertheless, under unique environment influence were nasolabial angle (58%), lower lip profile (51%) and lower lip thickness (64%). At 17 years of age, only upper lip thickness (55%) and nose prominence (84%) were under strong additive genetic control, while the rest of the variables were under strong dominant genetic control. The only exception was lower lip thickness (61%), which is still influenced by the unique environment.

CONCLUSION

Although monozygotic/dizygotic twins share at least part of their genome, at both times either additive, dominant or environmental components were found. Nevertheless, at 17 years of age most of the variables are either under additive or dominant genetic influence.

Left ventricular dynamics during strenuous isometric exercise in marathon runners, weight lifters and healthy sedentary men: comparative echocardiographic study

Global and segmental left ventricular dynamics during strenuous large-muscle isometric exercise were compared between endurance and static type professional athletes and sedentary men. Using a trunk dynamometer and supine echocardiography, only the weight lifters manifested increased (p < 0.01) wall thickness during both diastole and systole, resulting in decreased left ventricular volume at end systole. These group-related differences would suggest a causal relationship between chronic intensive weight-lifting training and efficient myocardial dynamics at the time of strenuous isometric exercise.

Attenuated responses of Doppler-derived hemodynamic parameters during supine bicycle exercise in heart transplant recipients

The aim of this study was to characterize Doppler-derived hemodynamic parameters in heart transplant recipients at rest and during symptom-limited supine bicycle exercise. Eighteen sedentary patients aged 54.0 +/- 2 years, 1.6 +/- 1.0 years following cardiac transplantation, and 18 sedentary healthy volunteers aged 51.8 +/- 4 years were investigated. Basic hemodynamic parameters and Doppler-derived parameters were recorded at rest and at peak dynamic exercise. Resting heart rate, blood pressure and rate-pressure product were higher in the transplanted patients (p < 0.001). However, in comparison with the resting state, the increase in these parameters at exercise was lower in heart transplant recipients. In the healthy, dynamic exercise induced an increase in peak flow velocity, mean acceleration, flow velocity integral, stroke volume, cardiac output and cardiac index (p < 0.001 for all) while systemic vascular resistance, ejection time and acceleration time decreased (p < 0.001 for all). The following parameters increased in the transplanted patients at dynamic exercise: peak flow velocity, cardiac output and cardiac index (p < 0.001), mean acceleration (p < 0.01) and flow velocity integral (p < 0.05). Ejection time decreased (p < 0.05) and acceleration time and systemic vascular resistance remained unchanged. In conclusion, at rest peak flow velocity, mean acceleration, flow velocity integral and stroke volume are lower in the transplanted than in the healthy controls, while cardiac output, cardiac index and systemic vascular resistance are equal. Our study demonstrates attenuated responses of basic hemodynamic parameters and Doppler-derived cardiovascular indices at symptom-limited supine bicycle exercise in heart transplant recipients compared to healthy volunteers.

Postoperative Positional and Dimensional Changes of Mandibular Canal after Bilateral Sagittal Split Set-Back Osteotomy

Objective

This preliminary study was planned to provide information about preoperative mandibular canal (MC) position and the postoperative positional changes of MC and length in three dimensions, with the purpose of providing some assistance in reducing inferior alveolar neurosensory disturbance (IAND).

Methods

MC was examined on CBCT data using SimPlant Pro Standalone 13.0. MC locations were measured in all dimensions, with respect to mandibular bony borders.

Results

The results showed that MC is frequently located in the midthird of the ramus anteroposteriorly and superoinferiorly and in the midthird of the corpus superoinferiorly. Postoperatively, ramus width was increased, ramus length was decreased significantly, and MC was repositioned laterally and inferiorly. MC length was decreased on both sides, non-correlated with the set-back amounts.

Conclusion

Preoperative results may be beneficial for the prediction of MC position for surgeons, and postoperative results will be used for the following studies to correlate postoperative positional changes with IAND.

Genetic and environmental impact on mandibular growth in mono- and dizygotic twins during adolescence: A retrospective cohort study

INTRODUCTION

This study aimed to discover the genetic and environmental factors that contribute to the mandibular development of untreated monozygotic and dizygotic twins.

MATERIAL AND METHODS

The sample, taken from the Forsyth Moorrees Twin Study, included 52 untreated monozygotic twins (36 male, 16 female) and 46 untreated dizygotic twins (23 male, 23 female). At the ages of 12 and 17, lateral cephalograms were collected and traced to assess total mandibular length, mandibular ramus length, mandibular corpus length, gonial angle, SNB, and bony chin prominence. The genetic and environmental components of variation were assessed using multilevel mixed-effects structural equation modelling.

RESULTS

At 12 years of age, high additive genetic influences were observed for total mandibular length (74%), gonial angle (76%), SNB (41%), and bony chin prominence (64%), whereas strong dominant genetic components were observed for corpus length (72%), and mandibular ramus length was under unique environment influence (54%). At 17 years of age, only total mandibular length (45%), ramus length (53%), gonial angle (76%), and bony chin prominence (68%) were under strong additive genetic control, while the remainder were under strong dominant genetic control.

CONCLUSIONS

Although monozygotic and dizygotic twins share at least a portion of their DNA, additive, dominant, or environmental components were discovered during adolescence. Nonetheless, by the age of 17, the majority of the mandibular traits are under either additive or dominant genetic impact.

Echocardiography in diagnostic assessment of peripheral arterial embolization

In an attempt to identify a cardiac source of emboli, two-dimensional echocardiography was performed postoperatively in 42 consecutive patients with acute peripheral arterial embolism requiring urgent embolectomy. The patients were divided into four groups. Group 1 included 14 patients with chronic atrial fibrillation, among whom four cases of intracavitary thrombi were detected. Group 2 included 13 patients with acute or previous myocardial infarction, and left ventricular thrombi were detected in three. Group 3 included one patient with a prosthetic mechanical aortic valve and one with mitral valve prolapse; thrombi were not detected in either. Group 4 comprised 13 patients with no clinical evidence of a cardiac source of embolism; in one of them a large left ventricular thrombus was detected. Altogether eight intracavitary thrombi were detected (19%), and only in three (7.1%) were the results of echocardiographic examinations defined as entirely normal. A number of clinically undetected cardiac lesions, such as mitral annular calcification and aortic valve calcification, possibly associated with peripheral arterial embolism, were also detected by postoperative echocardiography. Because of the high percentage of intracavitary thrombi detected and the therapeutic implications thereof, especially if embolism recurred, it is concluded that two-dimensional echocardiographic examination should be recommended for patients with acute peripheral embolism.

Simultaneous alveolar cleft closure and dental midline correction with curvilinear intraoral distraction

This article describes a new method that enables vector control during alveolar distraction osteogenesis in the treatment of a cleft palate patient. The patient presented with unilateral complete cleft lip and palate, and the alveolar part of the defect was covered by a mobile buccal flap. The distraction was performed by sliding the surgically released tooth segment with the help of an intraoral distractor over 1.5-mm stainless steel archwires held by metal crowns. This vector-controlled method enabled new bone and attached gingiva formation in harmony with the proper alveolar shape.