Sinus Diameter Research Articles

Construction of risk prediction model for acute type A aortic dissection

Objective To analyze the risk factors associated with acute type A aortic dissection, and to establish an effective predictive scoring model for early clinical intervention. Methods A retrospective review of 200 patients diagnosed as acute type A aortic dissection in the Department of Emergency, Guangdong Provincial People's Hospital between April 1, 2012 and March 31, 2017 was conducted as a modeling group. There were 160 males and 40 females with age of (53.30 ±13.19) years. According to the criteria of dissection rupture within 72 h after CTA examination, patients were divided into a rupture group (100 cases) and an unruptured group (100 cases). A prediction model of rupture risk was established based on the multivariate Logistic regression analysis of the risk factors of acute A-type aortic dissection in the early stage. After the establishment of the model, a prospective review of 80 patients diagnosed as acute type A aortic dissection in our hospital between April 1, 2017 and May 31, 2018 was conducted as a validation group. There were 57 males and 23 females with age of (54.00 ±13.68) years. In the validation group, there were 53 patients with rupture and 27 patients without rupture. Furthermore, this model was verified in the validation group. The scores were divided into low-risk rupture and high-risk rupture according to the best cut-off value of the receiver operating model curve of the modeling group. Results Logistic regression analysis showed that 10 factors were finally established the rupture risk prediction score model. The factors were as following: age >63 years (2 points), women (2 points), ventilator assisted ventilation (3 points), AST >80 U/L (2 points), no distortion of the inner membrane (2 points), diameter of the aortic sinus >41 mm (1 point), maximum diameter of the ascending aorta >48 mm (1 point), ratio of false lumen area to true lumen area >2.12 (2 points), Lac >1.9 mmol/L (3 points), and WBC >14.2×109 /L (1 point). The results of validation showed that the scoring model had a high predictive value (AUC = 0.928, 95% CI: 0.872-0.984, P < 0.001) and goodness of fit (Hosmer-Lemeshow χ2 = 8.331, P = 0.402). Moreover, the scoring model was further divided into low-risk (0-6 points) and high-risk (7-19 points), with sensitivity of 83.0% and specificity of 86.0%. Conclusions The predictive model of dissection risk in the acute type A aortic dissection constructed within 72 h after CTA is helpful for the evaluation of the disease and early intervention, and has certain clinical application value. Key words: aortic dissection; rupture; risk factors; risk score; model

Decreased left atrial global longitudinal strain predicts the risk of atrial fibrillation recurrence after cryoablation in paroxysmal atrial fibrillation.

We aimed to investigate the association of atrial fibrillation (AF) recurrence with left atrial (LA) strain in nonvalvular paroxysmal AF patients after cryoablation. We included 190 patients who underwent successful cryoablation due to paroxysmal AF. In addition to classical echocardiographic data, LA apical 2-chamber (A2C) strain, LA apical 4-chamber (A4C) strain, and LA global longitudinal strain (LA-GLS) values were calculated by speckle tracking echocardiography. Forty-eight-hour Holter monitoring was performed to all patients no later than 6months after ablation. AF recurrence was detected in 42 patients (22.1%). End-systolic diameter, LA end-systolic diameter, LA-volume, LA-volume index, interatrial septum thickness, coronary sinus diameter, epicardial fat thickness (EFT), and septal E/E` ratio were significantly higher, LV-EF, IVRT, septal S and A` wave, lateral S wave, LA-A2C strain, LA-A4C strain, and LA-GLS were significantly lower in patients with AF recurrence. LA-GLS, LA-volume index, and EFT were found to be independent parameters for predicting AF recurrence. LA-GLS and LAVI should be included in routine evaluations to determine long-term AF recurrence preoperatively.

Ameliorative effects of curcumin on microvascular complicationin streptozotocin-induced diabetic rat penis

Background: Vascular diseases from diabetes typically result in conditions that interfere with the microvascular functions, such as erectile dysfunction (ED) of the penis. It is unrevealed which morphological changes the microvasculature of the penis may result from the treatment and supplementation of curcumin.Objective: This study aims to determine the effects of curcumin, the active compound of turmeric, on penile microvasculature in experimentally induced diabetic rats.Methods: Rat were divided into three groups, control © and diabetic (DM). Diabetic rats supplemented with curcumin (DMC) (200 mg/kg BW). For induction of a diabetic condition, rats were injected with a single intraperitoneal injection of streptozotocin (60 mg/kg BW). A histological study and vascular corrosion casting along with scanning electron microscopy (SEM) were used to determine a morphological change of microvessels in the penis of rats after 8 weeks of experiments.Results: The histological investigations of penile tissue of DM group revealed thickly lined venous sinuses with smooth but sparse muscle layers. Dorsal arteries (DA) and deep dorsal veins (DV) of the penis were present of narrow lumen and showed thickening of collagen fibers at their wall of tunica media. An increasing thickness of collagen fibers was observed. Vascular corrosion casting revealed critically decreased diameters of DM venous sinus in the penis’ glans, which were observed as shrunken and partially lacking in the distal area of the glans. The diameter of venous sinuses in corpus cavernosum (CC) of DM rats were dilated and the density of venous sinuses was decreased. Interestingly, the signs of vessel restoration and improvement were presented by increasing diameters and recovering with healthy and nourished DA, DV, venous sinus at the area of the glans, and CC of the penis in DMC groups. Conclusion: The results have shown that the effects of curcumin could improve the destruction of the penile microvasculature in induced diabetic rats by STZ. Keywords: Diabetes mellitus, streptozotocin, curcumin, penis, Microvasculature, vascular corrosion cast

Radiological study of the myriad variations in frontal sinus anatomy: an institutional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The frontal sinus is a challenging area for endoscopic surgeons. The variations in the frontal sinus differs so much among individuals that there are forensic applications. A detailed radiological study of the sinus is important for understanding the pathophysiology of sinusitis and as a prerequisite for frontal sinus drainage procedures. Aims and objectives were to document the anatomical variations of the frontal sinus (radiological) and to correlate the variations with the signs and symptoms of sinusitis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Coronal and axial CT paranasal sinuses scans of 30 consecutive patients who attended the Otolaryngology clinic OPD in St. John’s medical college and hospital, Bangalore, India with signs/symptoms of chronic sinusitis were evaluated between January to July 2018. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The average frontal sinus diameter in patients with sinusitis was 6.65 mm. The prevalence of frontal cells in our study was 48%. Agger nasi cells were the most common cells seen. Frontal sinus disease was found in 72% of the studied sides in the scans.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Frontal sinus anatomy varies with different ethnicities. It is very important to study the frontal sinus anatomy before exploring the sinus for disease clearance and avoid surgical complications.&lt;/p&gt;

Abstract TP579: Ratio of Arteriovenous Malformation Draining Vein to Adjacent Venous Sinus Diameter is Associated With Increased Risks of Vein Stenosis

Introduction: Venous outflow stenosis in cerebral arteriovenous malformation (AVM) remains the main risk factor associated with AVM rupture. The hemodynamic process underlying the development of venous outflow stenosis is poorly understood. Here, we compared the location of stenosis within the draining vein of the AVM in relation to the adjacent venous sinus and explored the hypothesis that the ratio of draining vein to adjacent sinus diameter might predict the development of venous stenosis. Methods: Patient demographic parameters, and cerebral angiograms of 290 patients with supratentorial AVMs seen at our institution between 1997 and 2018 were reviewed. AVM draining vein and adjacent venous sinus diameters, degree of draining vein stenosis, and distance (mm) from the stenotic point of the draining vein to the junction of the adjacent draining sinus were recorded. The correlation between percentage of AVM draining vein stenosis and the ratio of venous sinus to AVM draining vein diameters was analyzed. Results: 247 AVMs in 242 patients with complete angiographic data were included, and a total of 361 draining veins were measured. Venous stenosis was present in 131 draining veins (36.3%). Venous stenosis was observed within 20 mm of the junction to the adjacent major draining sinus in 85% of our sample (Fig 1A). The ratio of draining vein to adjacent sinus diameter correlated positively with the percentage of venous stenosis (P=0.0001, r=0.21; Fig 1B). Conclusion: AVM venous outflow stenosis is observed closer to the adjacent venous sinus junction. The degree of venous stenosis is greater when the ratio of AVM draining vein/adjacent venous sinus diameter approaches or is larger than 1. This may be related to more turbulent flow at the junction of the draining vein and venous sinus, especially in larger draining veins, thus leading to venous stenosis with time. Further studies are needed to explore the pathophysiology of venous stenosis.

The Effect of Sinus Diameter on the Opening and Closing Performance of Aortic Valve Under the Expansion of Aortic Root

In order to explore the effect of aortic sinus diameter on aortic valve opening and closing performance in the case that aortic valve itself has no obvious disease and aortic root expands continuously. In this study, 20 groups of aortic root models with different aortic sinus and root diameters were constructed according to the size of clinical surgical guidance to simulate the possible expansion of aortic root at the later stage of operation. The valve sinus diameter DS were set to 32, 36, 40 and 44 mm, the aortic root diameter DA values were set to 26, 27, 28, 29 and 30 mm. Time-dependent pressure loads were applied to the valve and the vessel wall of the aortic and the ventricle side. Structural mechanics calculation by finite element software. The maximum stress, orifice area and contact force of the valve were analyzed to evaluate the valve opening and closing performance in dilated state. The orifice area of the valve was small when the DS=32 mm，DA=26, 27 mm and DS=36 mm,DA=26 mm. The valve was incompletely closed when the DS=32, 36 and 40 mm，DA =30 mm and DS =44 mm,DA = 29, 30 mm. The calculated values of the rest of the 12 models were within the normal range and the valve motion was normal. The results showed that the size of the aortic sinus affects the open and closed performance of the aortic valve. The smaller sinus diameter is adapted to the larger root diameter and the larger sinus diameter is adapted to the smaller root diameter. When the sinus diameter is 40 mm, it can well adapt to the relatively large range of root expansion.

Morphometric Relationship of the Transverse Sinus with Sigmoid Sinus Groove and Jugular Foramen

Cranial venous sinus anatomy is fundamental in neurosurgery and radiology, especially in surgical planning and treatment of neurological diseases. In this study, we aimed to study the morphometric relationship of the transverse sinus with sigmoid sinus groove and jugular foramen and imply if this relationship could aid in diagnosing the transverse sinus thrombosis. This is a retrospective analytical study conducted in our center among 30 patients who underwent Computed Tomography (CT) venogram during a period of 1 year. Diameter of transverse sinus and sigmoid groove at midpoint, and diameter of jugular foramen as it enters the skull base were collected. Relation of transverse sinus with sigmoid sinus groove and jugular foramen was analyzed. There were 60 transverse sinuses in the study with left and right being 50% (30 each). Mean age of patients collected was 53.20 years. There were 43.3% male and 56.7% female patients. Diameter of the Transverse sinus has statistically significantly linear relationship with the diameter of the sigmoid sinus groove and jugular foramen (p&lt;0.001) and was positively correlated (r= 0.651 and 0.624 respectively). Diameter of the transverse sinus has significant positive linear correlation with the sigmoid sinus groove and jugular foramen.

Valve-sparing aortic root replacement in children: Outcomes from 100 consecutive cases

ObjectiveValve-sparing root replacement is an attractive alternative to composite mechanical or biologic prostheses for aortic root aneurysms in children. Data on outcomes in pediatric patients are limited. We present our institutional experience with 100 consecutive pediatric valve-sparing aortic root procedures. MethodsAll children who underwent valve-sparing root replacement at our institution from May 1997 to August 2017 were identified, and echocardiographic and clinical data were reviewed. The primary end point was mortality, and secondary end points included complications, further interventions, and subsequent valvular dysfunction. ResultsMedian age at operation was 13.6 years (interquartile range, 9.42-15.9); 51 patients (51%) had Marfan syndrome, and 39 patients (39%) had Loeys–Dietz syndrome. Mean preoperative maximum sinus diameter was 4.4 ± 0.71 cm (z score 7.3 [5.7-9.3]). Most patients (n = 80, 80%) underwent reimplantation procedures with a Valsalva graft. Four patients (4%) underwent David I reimplantation with a straight-tube graft, 13 patients (13%) underwent a Yacoub remodeling procedure, and 3 patients (3%) underwent a Florida sleeve procedure. Perioperative valve-sparing root replacement mortality was 2% (n = 2). Six patients required late reintervention for development of pseudoaneurysms. Eight patients underwent additional aortic surgery. Average time to reoperation was 7.23 ± 4.56 years. Of the 84 patients undergoing a reimplantation procedure, 5 (5.9%) underwent late valve replacement versus 5 (33.3%) of the 15 patients who received a remodeling procedure (P = .001). ConclusionsValve-sparing root replacement is a safe and effective option for children with aortic root aneurysms in children. The reimplantation procedure is preferred. Late aortic insufficiency and pseudoaneurysm formation remain late concerns.

Transsphenoidal surgery for pituitary adenomas: early results from a single center.

To evaluate early results of transsphenoidal surgery for pituitary adenomas. Retrospective evaluation of 90 consecutive patients undergoing endoscopic pituitary adenoma surgery (2007-2016) at "Maggiore della Carità" Hospital in Novara, Italy. Age at diagnosis, sex, symptoms at presentation, hormonal and radiological data, complications of surgery, and short-term follow-up information were collected. The majority of patients were male (M/F: 1.5/1, mean age at diagnosis 62.1 ± 1.5years mean ± SEM). Most patients (91.1%) presented with a macroadenoma (27.4mm ± 1.1mm mean ± SEM), while 77.8% were non-functioning pituitary adenomas. Clinical presentations related to mass effect were visual impairment (74.0%) and/or hypopituitarism (55.1%). The main surgery complication was insipidus diabetes (12.2%), followed by cerebral hemorrhage (4.4%), cerebrospinal fluid (CSF) leaks (4.4%), syndrome of inappropriate antidiuresis (SIAD) (2.2%), and epistaxis (2.2%); only one patient died because of stroke. Risk of complications was not associated with tumor size (OR = 0.588, 95% CI 0.967-1.081, p = 0.443). Visual function improved in 70.6% of patients, while recovery of normal pituitary function occurred in 48.1%. Early neuroimaging studies demonstrated no residual tumor in 27.6% of patients. Invasion of cavernous sinus (OR = 3.293, 95% CI 0.897-16.738, p = 0.05) and maximum tumor diameter (OR = 6.857, 95% CI 1.039-1.309, p < 0.01) were associated with an unfavorable surgical outcome. Transsphenoidal endoscopic surgery for pituitary adenomas is safe and is frequently followed by improvement in visual symptoms, whereas recovery of pituitary function is less common. In our patients, complete surgical removal of adenomas is comparable to that of other series, but further investigations will be necessary to clarify the long-term risk of tumor recurrence.

Prediction of SGA at Birth by Using the Right Portal Vein Diameter Measurement at the 30–35-Week Scan

ObjectiveThis study sought to test the hypothesis that the measurement of the right portal vein (RPV) diameter on the transverse abdominal view at the 32-week ultrasound scan is small in fetuses with growth retardation and to validate the use of this measurement as a tool for detecting small for gestational age (SGA) at birth. MethodsThis was a retrospective cohort study at a single centre. The study population comprised 326 consecutive pregnancies, including 29 SGA at delivery and 297 unaffected cases. Stored images of the transverse view of the abdomen, obtained at the routine third trimester scan, were used to assess the diameters of the umbilical vein, the portal sinus, and the RPV. ResultsThe portal sinus and RPV diameter were smaller compared with the reference group (P = 0.021 and P < 0.001, respectively). Using a 10th percentile cut-off, the detection rate for SGA at birth was 38% for the RPV diameter versus 45% for the estimated fetal weight. The false-positive rates were 9% versus 8%, respectively. Multiple regression analysis revealed that RPV below the 10th percentile remained an independent four-fold risk factor for SGA (odds ratio [OR] 5.05; 95% confidence interval [CI] 1.94–13.14). Further analysis revealed a higher prevalence of induction of labour for non-reassuring fetal well-being (P = 0.005), fetal acidemia (P = 0.028), and admission to a neonatal intensive care unit (NICU, P = 0.029) in the RPV ≤10th percentile group. ConclusionRPV below the 10th percentile could be a reliable third trimester ultrasound marker of a subnormal fetal environment. This study proposed a new and accessible approach for prediction of SGA.

Comparison of the Dacron ring and suture annuloplasty for aortic root repair: an in vitro evaluation.

Increasing evidence shows that annular stabilization is essential in most aortic valve repair procedures. However, a standardized comparison of the 2 commonly used annuloplasty procedures is lacking. We hypothesized that the Dacron ring is more rigid than the polytetrafluoroethylene suture, whereas both procedures decrease annular dimensions. The aim of this study was to compare the biomechanical properties of the ring and suture techniques with native aortic roots in vitro. Eighteen aortic roots explanted from 80-kg pigs were randomized into a Dacron ring group, a suture annuloplasty group and a native control group. Each sample was tested in a pulsatile in vitro model with a force transducer attached to the aortic annulus to obtain radial force measurements, and annular dynamics was evaluated using 2-dimensional echography. Among the 2 annuloplasty procedures, only the Dacron ring group provided a significant reduction in the annular diameter compared with the native group (P < 0.006). Both annuloplasty procedures significantly reduced the geometric orifice area, tenting area and sinus diameter while increasing the coaptation length compared with the native group. Systolic annular distension was retained between groups, although the total radial forces were significantly reduced in the procedure groups compared with the native group (ring 1.07 ± 0.45 N, suture 1.13 ± 0.39 N and native 3.55 ± 1.34 N, P < 0.001). Although both annuloplasty procedures increase coaptation length and decrease geometric orifice area, a significant downsizing of the annulus was achieved using the Dacron ring only. The systolic annular distension was similar to the native aortic root, whereas the radial annular forces were evenly decreased by both annuloplasty procedures. Long-term studies are needed to disclose any difference in long-term effect of the annuloplasty procedures.

Association of Difference in Coronary Sinus Diameter by Computed Tomographic Angiography Between Patients in and Not in Stable Atherosclerotic Plaque(S).

BackgroundPathological finding fail to describe the morphology of coronary arterial plaques. Retrograde cardiac arteriography is a complicated procedure and does not detect all left posterior and marginal veins of the heart. Magnetic resonance angiography has long scan time and low spatial resolution. The objective of the present study was to assess the possible utility of the difference in coronary sinus diameter to quantify stable atherosclerotic plaque(s) using 256-slice coronary computed tomographic angiography.Material/MethodsA total of 336 patients were divided into 2 groups with 168 patients each. Patients who had heart failure were included in the study group and those who did not were included in the non-study group. Patients were subjected to cross-sectional study. Cardiovascular images were performed with 256-slice coronary computed tomographic angiography with a prospective electrocardiogram and clinical manifestation. Two-tailed paired t test following Dunnett’s multiple comparison tests was performed for the quantitative measurement of coronary computed tomographic angiography and clinical manifestation at 99% confidence level.ResultsThe clinical manifestation did not clearly show cardiac abnormality. The diameters of the superoinferior coronary sinus ostium was than that of the anteroposterior coronary sinus ostium, (p<0.0001, q=26.325). There was the difference in size of the coronary sinus ostium between patients in and not in heart failure (p<0.0001). The study group patients had longer coronary sinuses than patients in the non-study group (p<0.0001).Conclusions256-slice computed tomographic angiography is a feasible and is non-invasive bio-tool for evaluation of coronary artery anatomy.

Bicuspid aortic valve morphology and its impact on aortic diameters-A systematic review with meta-analysis and meta-regression.

To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects. The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis. A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD-mean difference (MD): 0.06mm/m2 (95% CI: -0.65 to 0.77mm/m2 , P=.87) and -0.06mm (95% CI: 1.10-0.97mm, P=.91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype-MD: 1.66mm/m2 (95% CI: 0.83-2.49mm/m2 , P<.001) and 2.03mm (95% CI: 0.97-3.09mm, P<.001). Age, gender, AS, and AR had no influence on observed differences. RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.

Influence of the Sievers type and valvular functional impairment in bicuspid associated aortopathy in a prospective series

Bicuspid aortic valve (BAV) is associated with high incidence of ascending aortic aneurysm. In BAV sporadic form, changes in outflow's hemodynamic secondary to the valvular morphotype are said to play a prominent role in the aortic dilatation. We aimed at comparing the different ascending aorta segment diameters according to the morphotype and the function of the BAV. We evaluated 174 patients with sporadic BAV by transthoracic echocardiography. The valvular function was defined as either Aortic Insufficiency (AI) if Grade ≥ 2 and aortic Stenosis (AS) if mean gradient > 20 mmHg. Aortic diameters were measured at the Valsalva sinus, tubular ascending aorta and at the aortic arch. Kruskal-Wallis, Mann–Whitney and Spearman tests were used for comparisons. Among the non-operated patients, Sievers’ morphotype was type 1LR for 63%, type 1NR for 18%, and other types counted for 19%. The Valsalva sinus diameter did not differ according to the Sievers’ type ( P = 0.78). The type 1LR type compared to the type1NR appeared to have a wider tubular aorta, but not significantly (42.3 ± 8.5 vs. 36.4 ± 7.3 mm; P = 0.06). Aortic valve function was distributed as follows: AI: 39%, AS: 20%, Both: 9%, Normal: 32%. Comparison of the different valve dysfunctions revealed a difference at the Valsalva ( P < 10–4) and the tubular aorta ( P = 0.001) but not at the aortic arch level ( P = 0.62). AI was highly associated with an increase of the aortic diameters of any segment, excepting for the arch. In addition, aortic diameters increased with age in case of AI (Valsalva: r = 0.28; P = 0.02; Tubular aorta: r = 0.27; P = 0.02) and not in case of AS ( r = –0.06; P = 0.73 and r = –0.03; P = 0.84). Our results showed the tremendous role of AI in the aortic dilation of all segments except the arch. However no influence of BAV morphotype was noticed on aortic diameters. Our results give rise to the relatively limited influence of the valvular morphology in the development of aortic dilation.

Development and Application of a System Based on Artificial Intelligence for Transcatheter Aortic Prosthesis Selection.

IntroductionThe interest in Expert systems has increased in the medical area. Some of them are employed even for diagnosis. With the variability of transcatheter prostheses, the most appropriate choice can be complex. This scenario reveals an enabling environment for the use of an Expert system. The goal of the study was to develop an Expert system based on artificial intelligence for supporting the transcatheter aortic prosthesis selection.MethodsThe system was developed on Expert SINTA. The rules were created according to anatomical parameters indicated by the manufacturing company. Annular aortic diameter, aortic area, aortic perimeter, ascending aorta diameter and Valsalva sinus diameter were considered. After performing system accuracy tests, it was applied in a retrospective cohort of 22 patients with submitted to the CoreValve prosthesis implantation. Then, the system indications were compared to the real heart team decisions.ResultsFor 10 (45.4%) of the 22 patients there was no concordance between the Expert system and the heart team. In all cases with discordance, the software was right in the indication. Then, the patients were stratified in two groups (same indication vs. divergent indication). The baseline characteristics did not show any significant difference. Mortality, stroke, acute myocardial infarction, atrial fibrillation, atrioventricular block, aortic regurgitation and prosthesis leak did not present differences. Therefore, the maximum aortic gradient in the post-procedure period was higher in the Divergent Indication group (23.9 mmHg vs. 11.9 mmHg, P=0.03), and the mean aortic gradient showed a similar trend.ConclusionThe utilization of the Expert system was accurate, showing good potential in the support of medical decision. Patients with divergent indication presented high post-procedure aortic gradients and, even without clinical repercussion, these parameters, when elevated, can lead to early prosthesis dysfunction and the necessity of reoperation.

Preliminary investigation of orally administered benazepril in horses with left‐sided valvular regurgitation

Despite the paucity of data available, orally administered angiotensin-converting enzyme (ACE) inhibitors are empirically used in horses with valvular regurgitation. Evaluate the echocardiographic and hormonal changes in response to oral benazepril in horses with left-sided valvular regurgitation. Prospective, randomised double-blind, placebo-controlled trial. Horses with mitral valve (MR) and/or aortic valve regurgitation (AR) received oral benazepril (n = 6) at a dosage of 1 mg/kg q 12 h or a placebo (n = 5) for 28 days. Echocardiography was performed before drug administration and after 28 days of treatment. Plasma renin activity, serum ACE activity, angiotensin II concentration, aldosterone concentration and biochemical variables were measured before drug administration and after 7 and 28 days of treatment. Relative to baseline, horses treated with benazepril had statistically significant reduction in left ventricular internal diameter in systole (mean difference between groups = -0.97 cm; 95% CI = -1.5 to -0.43 cm), aortic sinus diameter (-0.31 cm; -0.54 to -0.07 cm), and percentage of the aortic annulus diameter occupied by the base of the AR jet (-17.05%; -31.17 to -2.93%) compared with horses receiving a placebo. In addition, horses treated with benazepril had a significantly greater increase in cardiac output (11.95 L/min; 1.17-22.73 L/min) and fractional shortening (7.59%; 3.3-11.88%) compared with horses receiving a placebo. Despite profound serum ACE inhibition, renin activity and concentrations of angiotensin II and aldosterone were not significantly different between treatment groups or among time points. Very small sample size and short treatment period. Treatment with oral benazepril resulted in statistically significant echocardiographic changes that might indicate reduced cardiac afterload in horses with left-sided valvular regurgitation. Additional studies with a larger sample size will be necessary to determine if administration of benazepril is beneficial in horses with valvular regurgitation. The Summary is available in Spanish - see Supporting Information.

Temporal Bone Hyperpneumatization and Tinnitus: Clinico-Radiological Evaluation Using CT Scan

Purpose: We propose that there is increased incidence of subjective tinnitus (ST) in patients with temporal bone hyperpneumatization (TBHP). The secondary goal of this project is to assess the degrees of association of TBHP with paranasal sinus hyperpneumatization (PNSHP), chronic sinusitis (CS), otomastoiditis (OM) and concha bullosa (CB). Methods and Materials: A total of 196 patients, who had computed tomography (CT) of the head for various clinical indications, were included in this study. CT head scans of patients with TBHP (n=96) were correlated with control patients (n=100). These patients had no apparent TBHP, history of ST, PNSHP, CS, OM or CB. The TBHP was graded based upon the extent of pneumatization. Size of the maxillary and sphenoid sinuses were also measured, providing pneumatization grade. Results: Subjective tinnitus (ST) was present in 31 cases of TBHP and in 8 patients in the control group, which was statistically significant. Mean volume of maxillary sinus and the largest axial sphenoid sinus diameter were significantly larger in the cases of TBHP than in that of controls. Otomastoiditis was found in only 4 cases of TBHP (4%) and none of the controls; however, the difference was not statistically significant. Chronic sinusitis was present in 8 cases of TBHP and 5 of controls, and was also not statistically significant. Concha bullosa was significantly more frequent among cases of TBHP than controls. Conclusion: There is a significant (p < 0.001) association between subjective tinnitus and increasing grade of temporal bone hyperpneumatization. There is a positive correlation between paranasal sinus hyperpneumatization and occurrence of concha bullosa, mimicking symptoms of sinusitis, with TBHP.

Comparison of coronary sinus diameter Z-scores in normal fetuses and fetuses with persistent left superior vena cava (PLSVC)

To establish Z-score reference ranges for coronary sinus (CS) diameter in normal fetuses and explore the diagnostic value of CS Z-score in fetuses with persistent left superior vena cava (PLSVC). Study of 235 normal fetuses and 30 fetuses with PLSVC was involved. Noncardiac biometrical parameters included biparietal diameter (BPD), femoral length (FL), heart area (HA), gestation age (GA). The coronary sinus systolic and diastolic diameter (CSDs and CSDd ) were measured at the end of systole and diastole. CSDs and CSDd Z-score models were constructed by using linear regression analysis with Non-cardiac biometrical parameters as independent variables. Z-scores between normal fetuses and fetuses with PLSVC were compared. A simple, linear regression model was the best description and correlations between fetal CSDs and CSDd and four independent variables were excellent. Reference ranges for predicting means and SDs of the fetal CS were established. Equations for Z-score calculation were provided, CSDs and CSDd Z-scores were statistically different between normal fetuses and those with PLSVC. Development of CSDs and CSDd Z-score reference ranges in normal fetuses was realized. The CSDs and CSDd Z-scores can provide quantitative evidence in prenatal diagnosis of PLSVC.

Endonasal Operative Corridor Expansion by Sphenoidal Pneumosinus Dilatans in Tuberculum Sellae Meningiomas.

A retrospective cohort study of patients with tuberculum sellae meningioma (TSM)-associated sphenoidal pneumosinus dilatans (PSD) over a recent epoch was evaluated using a propensity-matched morphometric analysis. A total of 38 patients with TSM and sphenoidal PSD were identified and matched by age and sex to 32 patients without tumors (controls). Overall, no significant difference between test and control groups was noted in sphenoid sinus size or other parameters; however, significantly greater mean distances from the posterior margin of the planum sphenoidale to the diaphragma sella (0.76 ± 0.23 vs. 1.03 ± 0.27, respectively; P= 0.0001) and angle between the planum sphenoidale to anterior face of sella turcica (113.41 ± 10.58 vs. 123.21 ± 12.55, respectively; P= 0.001) were seen in patients with TSM and PSD, suggestive of a selective expansion of the tuberculum sellae region. TSM/sphenoid sinus morphologies were divided into 3 types (A, B, and C) based on the extent of tumor and sinus morphology. There was progressive increase in tumor volume and anteroposterior sinus diameter from sphenoidal PSD types A-C, which influenced selection of surgical approach. This study suggests that TSM-associated sphenoidal PSD leads to more selective splaying of the tuberculum sellae region rather than cumulative increase in sinus volume. This may lead to operative corridor expansion for endonasal access to TSMassociated with sphenoidal PSD. A radiologic classification scheme for sphenoidal PSD associated withTSM is suggested that may aid surgical decision-making.

The diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults: A cross-sectional study

BackgroundThe identification of human remains is an essential part of forensic science. Studying paranasal sinuses is very useful in identification of mutilated or burnt bodies from accidents such as plane crashes. We aimed to assess the diagnostic value of anthropometric indices of maxillary sinuses for sex determination using CT-scan images in Iranian adults. MethodsCT-scan slices of 228 maxillary sinuses (from 144 men and 144 women) were studied. The maximum height, maximum anterior-posterior diameter, maximum width, and maximum distance between the sinuses were measured in both sexes. Our participants were divided into three age groups of 20–34, 35–49, and over 50 to compare the recorded measurements in different age groups. ResultsWe found a significant difference between men and women regarding the maximum height, maximum width, maximum A-P diameter of sinuses and the maximum distance between the right and left maxillary sinuses in all of our participants. We also found that the highest accuracy for sex determination was related to the maximum distance between the sinuses (65.6%) and the lowest to the maximum width of the right sinus (56.2%). The most accurate identification resulted from assessing the maximum distance between the sinuses in the 20–34 age group (74.3%), the maximum anterior-posterior diameter of the sinuses in the 35–49 age group (62.8%) and the maximum height of the left sinus in the over 50 age group (65.7%). ConclusionRegardless of age, according to our study the parameters of height, width, anterior-posterior diameter of sinuses and the maximum distance between the right and left maxillary sinuses are partially valuable for sex determination. The most accurate sex identification was examined in the 20–34 age group from studying the maximum distance between the sinuses. Especially in the over 50 age group, it is not enough to consider the sinus parameter for sex identification.