Left ventricular global longitudinal strain may foresee prolonged postoperative pericardial effusion

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pericardial effusion (PE) is a frequent finding in patients that undergo coronary artery bypass grafting (GABG). Postoperative PE may be found in as many as 85% of patients. Although postoperative PE is a frequent finding following CABG, fortunately its course is usually benign and they randomly disappear within 7-10 days. However, in some instances PE may persist for longer and cause complications. There are currently limited data in the medical literature providing information regarding the factors that may contribute to postoperative pericarditis. We aimed to analyze the main echocardiographic characteristics that may influence the presence of PE 6 to 8 weeks following CABG.  

Material and methods: This was a prospective cross-sectional study that included 90 consecutive patients that underwent CABG procedure in the Cardio Surgery Department of our tertiary medical center.  We excluded patients that underwent other cardiac surgery interventions, patients with CABG that had postoperative bleeding which required reoperation and patients that had PE prior to intervention.  Patients in whom PE was registered formed the first group (32 patients), whereas those without PE formed the second group (58 patients). Echocardiography data obtained before the surgery were compared between the two groups.

Results

The average amount of PE was 5.11 ± 1.62 mm. The groups did not differ in regard to gender (males 65.62% vs 63.79%, p = 0.86), age (59.59 ± 9.29 vs 61.69 ± 10.71, p = 0.35), body mass index (27.13 ± 4.05 vs 28.62 ± 4.11, p = 0.1). Comparison between groups in respect to echocardiographic features are presented in table 1. As seen in this table, left ventricular global longitudinal strain (LV GLS) was the only echocardiographic feature analyzed with statistical significance (-14.64 ± 6.86 vs -16.96 ± 4.1, p = 0.04). Both groups had mean values outside reference range, which can be explained by coronary artery disease in both groups.  

Conclusions

Postoperative PE in small amount may be found in a considerable number of patients, as long as two months following CABG. More severe LV GLS alterations may be associated with occurrence of PE in patients following CABG. Abstract Figure. Comparison of echocardiographic features

Defining the Modalities of Intravenous Contrast Application During the Diagnostics of Hepatic Metastases with Computerized Tomography

Introduction:

The liver is the biggest human abdominal parenchymal organ; it weights approximately 1500 grams and is located in the right hypochondrium, under the diaphragm. Liver is able to perform multiple functions also by means of the rich dual vascularization: hepatic arterial system and the portal vein system, between which exists a short circuit (shunt) and free mixture inside the sinusoid, whilst the two flows drain in the same vein system. The discovery of CT and its application in practice fundamentally changes the importance of diagnostic methods for hepatobiliary lesions.

Patients and methods:

During a 4-year period, 984 patients suspected with liver or biliary tract disease were explored with CT. 117 of these patients were analyzed with liver metastases. Examinations of the liver was performed in dorsal decubitus and in absolute apnea with spiral movement of the table and in denominations of 1and 5 mm. Siemens MSCT 64 and 6 tier apparatuses enable short scanning time with almost immediate reconstruction, which offers all the necessary elements required for carrying out certain protocols.

Results:

The average density of metastatic lesions is about 20 HU smaller than normal liver parenchyma. Metastasis with necrosis are more hypodense (30-50 HU smaller than normal liver parenchyma), whilst necrotic metastases with smaller dimensions are almost isodense with normal parenchyma. However, metastases with diameter between 4 to 6 cm are completely isodense and will remain so even after the application of I.V. contrast. The average more frequent size according to most authors, as well as according to our material (148 patients or 90%) was 2-3 cm in transversal diameter.

Correlation between blood lead level and hemoglobin level in mitrovica children

Introduction:

Lead toxicity is a serious health threat, especially in developing countries due to environmental pollution. It was thus aimed to investigate correlation between blood lead level and concentration level of hemoglobin in the blood of children involved in research.

Material and methods:

The research included 250 children of which 31(12.4%) kindergarten children, 166 (66.4%) of primary school pupils in Mitrovica and 53(21.2%) of primary school pupils in Shtime as control group. From the 250 children included in the survey 129 or 51.6% were female children and 48.4% male children. Children were selected randomly, while tests for concentration of Pb and blood hemoglobin were done at the National Institute of Public Health.

Results:

The average value of blood lead level of Mitrovica pupils was 2.4 µg/dL (SD±1.9µg/dL), range 0.5 to 16.3µg/dL. The average value of blood lead level of Shtime pupils was 2.3µg/dL (SD±0.7µg/dL), range 1.2 to 5.2 µg/dL with no statistical difference (P = 0.191). The average value of blood lead level in kindergarten children of Mitrovica was 3.8µg/dL (SD±1.3µg/dL), range 2.2 to 7.7µg/dL with significant difference between the average values of blood lead levels of pupils and kindergarten children of Mitrovica (P <0.0001). The average value of hemoglobin in the pupils of Mitrovica was 14.0g/dL(SD± 3.7g/dL), range 9.4 to 25.6 g/dL. The average value of hemoglobin to pupils of Shtime was 11.4g/dl(SD±0.8 g/dl), range 9.2 to 13.0 g/dl with significant difference between mean values of hemoglobin pupils of Mitrovica and Shtime (U ‘= 6440.0, P <0.0001). With Spearman correlation is found significant correlation of a medium scale (r = -0.305, df = 248, p <0.0001) between blood lead levels and hemoglobin level in the blood.

Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density

Breast cancer is the most common cancer and the second most common cause of death from cancer in women.The aim of this studywas to determine which is more accurate imaging test mammography or ultrasound for diagnosis of breast cancer based on the women's age and breast density. We examined 546 patients with breast symptoms, by clinical breast examination, mammography and ultrasound. A total of 546 breast lesions were examined by histopathology analyses. Histopathology results revealed the presence of 259 invasive cancers, and 287 benign lesions. Sensitivity varied significantly with age and breast density. In the 259 women who had both tests, ultrasound had a higher sensitivity than mammography in women younger than 45 years, whereas mammography had a higher sensitivity than ultrasound in women older than 60 years. The sensitivity according to age was 52,1% for mammography and 72,6% for ultrasound. The specificity according to age was 88, 5% for ultrasound and 73, 9% for mammography. Comparing the sensitivity of mammography and ultrasound according to the breast density indicates that mammographic sensitivity was 82,2% among women with predominantly fatty breast, but 23.7% in women with heterogeneous dense breasts, with the increase of fibro glandular density the level of sensitivity with mammography decreases, while ultrasonographic sensitivity was 71,1% among women with predominantly fatty breast and 57,0% for heterogeneous dense breasts. Our data indicate that sensitivity and specificity of ultrasound was statistically significantly greater than mammography in patients with breast symptoms for the detection of breast cancer and benign lesions particularly in dense breast and in young women.