Assessment of the role of speckle tracking echocardiography in targeting the left ventricular lead position in patients undergoing cardiac resynchronization therapy

Background: Cardiac Resynchronization Therapy [CRT] is now a well-established treatment for patients with advanced heart failure through biventricular pacing. Optimizing the left ventricular [LV] lead position via echocardiographic speckle tracking guidance could reduce the rate of non-responders to CRT

Objectives: to assess the role of speckle tracking echocardiography in determining the proper position of the left ventricular lead in patients undergoing CRT

Methods: the study population comprised 50 patients who were indicated for CRT according to the ESC 2012 guidelines. Speckle tracking echocardiography was done to all patients before CRT implantation or shortly after implantation while switching off pacing to determine the latest activated myocardial wall of the LV. The patients were classified after CRT implantation into two groups; the first group [group A] included 20 patients and represented those with concordance between the most mechanically delayed myocardial wall derived from speckle tracking echocardiography and the coronary sinus lead position, and the second group [group B] included 30 patients that showed discordance between them. Both groups were recruited for follow-up after a period of 6 months to assess clinical response, echocardiographic response and mortality

Results: Significant correlation was observed between echocardiographic response and the LV lead concordance [p value=0.041], and between combined clinical and echocardiographic response and LV lead concordance. There was a nearly significant difference between clinical response and the LV lead concordance [p value=0.057], and there was a trend towards less mortality in the group with concordant LV lead [10.5% in the concordant group versus 24.1% in the discordant group] with no statistical significance [p value=0.286]

Conclusions: we demonstrated an increased benefit with an echocardiographically optimized LV lead position targeting the most delayed myocardial wall by 2D speckle tracking echocardiography

role of multi-detector computed tomography in the assessment of cystic and cavitary pulmonary lesions

Lung cysts and cavities are well defined lesions with definable walls containing air or fluid. The differential diagnosis is broad including congenital, idiopathic, infective or neoplastic lesions. Multidetector row CT is primary non-invasive evaluation of cystic and cavitary lesions. To assess the role of multi-detector computed tomography [MDCT] in evaluation of cystic and cavitary lesions in the lung. The study was conducted on 63 patients with cystic or cavitary pulmonary lesions and subjected to MDCT. The study included 33 patients with infective lesions, 13 patients with idiopathic lesions, eight patients with congenital lesions, seven patients with neoplastic lesions and two patients with pseudocystic lesions proved to be due to diaphragmatic hernias. MDCT is an accurate safe diagnostic modality in assessing cystic and cavitary lung lesions; it can assess wall thickness, size, contents and surrounding parenchyma

Surgery for cervical spondylotic myelopathy: anterior versus posterior approaches

Surgical treatment of cervical spondylotic myelopathy [CSM] remains controversial. Several approaches have been advocated to treat cervical spondylotic myelopathy including anterior, posterior and combined approaches. The aim of this study was to review the clinical and imaging varieties of cervical spondylotic myelopathy and their influence on choosing the appropriate surgical approach. Fifty five cases with cervical spondylotic myelopathy operated upon at the neurosurgery department, Alexandria University were reviewed. The different clinical and imaging features were analyzed, and parameters for choice of surgical approach were addressed. Among all patients with CSM, neck pain was present in 49%, brachialgia in 67%, mild myelopathy in 44% and moderate myelopathy in 56%. Following cervical laminectomy, neck pain improved in 50% and remained stationary in 50%; brachialgia recovered in 33%, improved in 50% and remained stationary in 17%; mild myelopathy showed good outcome in 80% and fair outcome in 20%; whereas moderate myelopathy showed good outcome in 20%, fair outcome in 60% and poor outcome in 20%. Following anterior discectomy with fusion, neck pain recovered in 28.5%, improved in 38% and remained stationary in 28.5%; brachialgia recovered in 58.5%, improved in 31% and remained stationary in 10.5%; mild myelopathy showed excellent outcome in 17%, good outcome in 58% and fair outcome in 25%; whereas moderate myelopathy showed good outcome in 35%, fair outcome in 30% and poor outcome in 35%. Following cervical laminoplasty, neck pain improved in 100%; brachialgia remained stationary in 100%; mild myelopathy showed good outcome in 100%; whereas moderate myelopathy showed fair outcome in 50% and poor outcome in 50%. Early surgical intervention for CSM is associated with higher recovery rate. Selection of surgical approach depends on age, cord morphology, and spine geometry mostly spinal curve and canal diameter. The presense of cervical spine instability necessitates complementation of spine decompression with spine fixation

Acute spinal epidural abscess: clinical presentations and surgical management

Spinal epidural abscess is a serious condition affecting males more than females causing spinal cord compression. Risk factors include imunocomprimise, septic lumbar puncture, or haematogenous spread of remote infections. The aim of this study was to highlight the common risk factors for epidural abscess and its management based on eliminating these factors. All patients in the present study underwent plain x-ray, CT scan of affected spine, MRI of the affected area of the spine, and bone scanning when needed. Once neurological symptoms appeared urgent decompression and evacuation of the pus with subsequent culture and sensitivity was done. Liver diseases and Diabetes Mellitus. Were the most risk factors among our patients. The lumbar spine was commonly affected than other areas of the vertebral column. Posterior laminectomy and decompression were done for 24 cases. Fluid puss collection was found in 21 patients whereas 3 patients had a fibrous granulation tissue. Discectomy and partial corpectomy were done when affection of the anterior column was found. Staph. Aurues was found in about 60% of the culture obtained from the abscess. Epidural abscess is best treated by urgent decompression and giving the appropriate antibiotic

Conservative versus surgical management of hypertensive putaminal hemorrhage

Hypertensive putaminal hemorrhage is the most common type of intraparenchymal cerebral hemorrhage, yet the therapeutic policy is still controversial. The aim of this work was to analyze clinical and imaging data of patients with hypertensive putaminal hemorrhage and identify selection criteria for appropriate treatment. Thirty cases with hypertensive putaminal hemorrhage admitted to the neurosurgical emergency unit, Alexandria University were included in the study. All patients were evaluated clinically and using imaging studies. Analysis of data was conducted and parameters suggestive of therapeutic modality were identified. Patients with hypertensive putaminal hemorrhage had acute onset in 86.7% and subacute onset in 13.3%. The clinical course was progressive in 33.3%, regressive in 20%, and stationary in 46.7%. Putaminal hematomas were focal in 6.7%, insular in 13.3%, ruptured in 26.7%, dissecting in 26.7%, and massive in 26.7%. The ipsilateral lateral ventricle was patent in 6.7%, effaced in 40%, obliterated in 26.7%, obstructed in 6.7%, and occluded in 20%. Midline structures were central in 33.3%, mild shift in 33.3%, moderate shift in 13.3%, and severe shift in 20%. Associated brain stem hemorrhage was present in 13.3%. Hypertensive putaminal hematomas have different clinical and imaging presentations. Indications for surgical evacuation include; progressive clinical course, moderate [5-10 mm] and severe [>10 mm] midline shift, as well as dissecting and massive hematomas. Predictors for bad outcome include; old age, major brain attack, massive hematoma, occluded ipsilateral lateral venticle, severe midline shift [>10 mm] and associated brain stem hemorrhage