RESUMEN
The nutcracker syndrome [NCS] depends on mesoaortic compression of the left renal vein. It has different clinical entities. This study aimed to examine different clinical aspects of NCS. This was a retrospective and descriptively designed study. The patients with abdominal pain, flank pain, or scrotal pain admitted to the Urology and General Surgery outpatient clinic between January 2014 and May 2016 were reviewed. All data were examined descriptively. Urologic and general surgical examinations were performed individually by a urologist and a general surgeon. The abdominal ultrasonography and computed tomography findings, blood pressure, white blood cell count, bilirubin tests, and urine tests were recorded. Patients with inconsistent diagnostic data or missing outcomes were excluded. Five patients were diagnosed with NCS on scanning 134 patients. The mean age was 24 years [20-33 years]. The first patient had left lower quadrant pain. The second patient also had left lower quadrant pain with microscopic hematuria and a mild increase in the total bilirubin level [1.84 mg/dL]. The third patient presented left testicular pain and hypertension [160/100 mm Hg]. Consequently, left side varicocele was found on physical examination and Doppler ultrasound. The fourth patient had leukocytosis [11,900], a mild increase in total bilirubin level [1.73 mg/dL], and left and right lower quadrant pain. The radiological and laboratory entities must be taken into consideration with clinical findings for correct diagnosis because NCS may have different symptoms
RESUMEN
BACKGROUND AND OBJECTIVES: QRS complex fragmentations are frequently seen on routine electrocardiograms with narrow or wide QRS complex. Fragmented QRS complex (fQRS) is associated with increased morbidity and mortality, sudden cardiac death and recurrent cardiovascular events. In this study, we aimed to interrogate the relationship of systemic inflammation with the presence of fQRS in patients with acute coronary syndromes (ACS). SUBJECTS AND METHODS: Two-hundred and twenty eligible patients with ACS that underwent coronary angiography were enrolled consecutively in this study. Patients with significant organic valve disease and those with any QRS morphology that had a QRS duration > or =120 ms as well as patients with permanent pacemakers were excluded from this study. RESULTS: Patients with fQRS were of a higher age (p=0.02), had increased C-reactive protein (CRP) levels (p<0.001), prolonged QRS time (p<0.001), extent of coronary artery disease (CAD) (p<0.001), creatine kinase-MB (CK-MB) levels (p=0.006) and Q wave on admission electrocardiography (p<0.001) in comparison to patients with non-fragmented QRS. When we performed multiple logistic regression analysis, fQRS was found to be related to increased CRP levels {odds ratio (OR): 1.2, 95% confidence interval (CI): 1.045-1.316, p=0.007}, QRS duration (OR: 1.1, 95% CI: 1.033-1.098, p<0.001), extent of CAD (OR: 1.5, 95% CI: 1.023-2.144, p=0.037), Q wave (OR: 2.2, 95% CI: 1.084-4.598, p=0.03) and CK-MB levels (OR: 1.0, 95% CI: 1.001-1.037, p=0.04) independently. CONCLUSION: In our study, we found that fQRS was independently related to increased CRP. Fragmented QRS that may result as an end effect of inflammation at cellular level can represent increased cardiac risk by different causative mechanisms in patients with ACS.