effects of 21 and 23 milimeter aortic valve prosthesis on hemodynamic performance and functional capacity in young adults

Early and medium-term improvement of functional capacity and regression of left ventricular hypertrophy was evaluated in the young adult patient group following application of 21 mm or 23 mm bileaflet aortic mechanical valve prosthesis due to aortic stenosis. Twenty two patients [10 male, 12 female; mean age 27 +/- 8.2 [19-43]] who underwent isolated aortic valve replacement due to rheumatic aortic stenosis, were included in the study. 21 mm and 23 mm bileaflet mechanical prosthesis was used respectively in eight and fourteen patients. The mean body surface area was 1.86 m[2] and 1.68 m[2] respectively in 23 mm and 21 mm prosthesis while 1.73 +/- 0.25 m[2] for the whole group. Functional capacity was New York Heart Association [NYHA] class II in 9 patients and class III in thirteen patients. Implantation was performed without enlarging the aortic root in all except four patients. In all patients transvalvular gradients, effective orifice area and the diameter of left ventricle were measured with transthoracic echocardiography during rest and after maximal exercise. Mean follow-up was 34 +/- 12 months [range 11-57 months]. There were no postoperative complications or deaths. All the patients were assessed as NYHA class I with regards to functional capacity [p=0.01]. Significant improvements were determined in postoperative mean transvalvular gradient [p=0.005] and left ventricular mass index [p=0.01] when compared with preoperative values. Our findings show that replacement with 21 mm and 23 mm mechanical prosthesis provides a significant improvement in regression of symptoms and increase of functional capacity in young adults in early and mid-period without increasing mortality and morbidity

Iliopsoas haematoma: a rare complication of warfarin therapy

Iliopsoas haematoma is a rare complication that occurs in patients receiving anticoagulant therapy. The clinical manifestation of iliopsoas haematoma is non-specific. It can mimic orthopaedic or neurological disorders, including paraesthesia or paresis of the thigh and leg due to compression of the nerve plexus. Among the many available diagnostic modalities, computed tomography is the most useful radiological method for diagnosis. Treatment approaches for iliopsoas haematoma include conservative therapy, surgical intervention, or transcatheter arterial embolisation. Conservative therapy consists of bed rest, restoration of circulating volume, and drug discontinuation for correcting underlying coagulopathy. Although a conservative approach is the first choice, transcatheter arterial embolisation and surgical intervention may be required in patients with hemodynamically unstable and active bleeding. The report described a case of iliopsoas haematoma due to anticoagulant therapy with paraesthesia in the left leg who was successfully treated by conservative approach

Gastric duplication cyst in an adult

Gastric duplication cyst which is a rare anomaly can also be observed in adulthood. Abdominal pain is the cost common complaint in adults and most cases are discovered incidentally by radiological examination or gastric endoscopy. Re-operative diagnosis of gastric duplication is difficult and definitive diagnosis requires findings on laparatomy together with histopathological examination of the lesion. Gastric duplication cyst is primarily managed by complete excision. Gastric duplication cyst was suspected on gastric endoscopy and magnetic resonance imaging [MRI] of the abdomen in a 52-year-old woman presented with abdominal pain. She was treated by complete excision of the cyst and the diagnosis was confirmed with the operative findings and histopathological examination of the removed specimen