Effect of radiation on endothelial functions in workers exposed to radiation

SUMMARY OBJECTIVE Our aim is to determine whether radiation affects the endothelial function of hospital staff working in the radiation unit for diagnostic and therapeutic purposes. We have evaluated endothelial function with vascular imaging parameters such as flow-mediated dilatation (FMD) and aortic stiffness index (ASI). METHODS A total of 75 employees, 35 of whom are exposed to radiation due to their profession and 40 as the control group, were included in our single-centered study. Demographic data, FMD, aortic stiffness, and echocardiographic findings of the two groups were compared. RESULTS There were no significant differences in demographic data. Median FMD values tended to be lower in the radiation exposure group [7.89 (2.17-21.88) vs. 11.69 (5.13-27.27) p=0.09]. The FMD value was significantly lower in the catheter laboratory group than in the radiation-exposed (p=0.034) and control (p=0.012) groups. However, there was no statistically significant difference between the non-catheter lab radiation exposed group and the control group (p=0.804). In addition, there was no statistically significant difference in the ASI value between the groups (p=0.201). CONCLUSION We have found that FMD is decreased among hospital staff working in radiation-associated areas. This may be an early marker for radiation-induced endothelial dysfunction.

RESUMO OBJETIVO O nosso objetivo é determinar se a radiação afeta a função endotelial de funcionários do hospital que trabalham em unidades com exposição à radiação para fins diagnósticos e terapêuticos. Avaliamos a função endotelial com parâmetros de imagens vasculares, tais como dilatação fluxo-mediada (FMD) e o índice de rigidez aórtica (ASI). METODOLOGIA Um total de 75 funcionários, 35 expostos à radiação devido à sua ocupação e 40 como grupo de controle, foram incluídos em nosso estudo monocêntrico. Os dados demográficos, de FMD, rigidez aórtica e ecocardiográficos dos dois grupos foram comparados. RESULTADOS Não houve diferenças significativas nos dados demográficos. Os valores médios de FMD, em geral, foram mais baixos no grupo de exposição à radiação [7,89 (2,17-21,88) e 11,69 (5,13-27,27) p=0,09]. O valor de FMD foi significativamente menor no grupo laboratorial com cateter do que no exposto à radiação (p=0,034) e no de controle (p=0,012). No entanto, não houve diferença estatisticamente significativa entre o grupo laboratorial sem cateter e exposto à radiação e o grupo de controle (p=0,804). Além disso, não houve diferença estatisticamente significativa quanto ao valor de ASI entre os grupos (p=0,201). CONCLUSÃO Observamos que a FMD é menor entre funcionários que trabalham em setores hospitalares associados à radiação. Isso pode ser um marcador inicial de disfunção endotelial induzida por radiação.

Emergent surgical retrieval of an embolized septal occluder from the main pulmonary artery

Surgical closure of ASD has been used for over 50 years and appears to be a safe and effective operation. However, over the past decade, transcatheter closure techniques have been increasingly practiced. We present a case of 51 -year old woman with atrial septal defect [ASD]. She presented with progressive decrease in exercise tolerance. Echocardiographic examination-showed the ASD and a 26mm septal occluder device [Cardio-fix septal occluder] was successfully deployed under fluoroscopic and echocardiographic guidance. However, the patient suddenly complained of palpitation and sustained ventricular tachycardia thirty minutes after the procedure. A repeat echocardiographic examination confirmed embolization of the device into main pulmonary artery. Due to failure of capture of the device via multisnare, the patient was immediately taken to the operating room for removal of the device and surgical closure of the defect. The embolized device was grasped and retrieved from proximal pulmonary artery between index and middle fingers inserted into the main pulmonary artery via the tricuspid and pulmonary valves. The ASD was closed by running nonabsorbable polypropylene suture. Postoperative recovery was uneventful. The patient was discharged home after a total of six days of hospitalization

Spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy

Apical hypertrophic cardiomyopathy [HCM] is a relatively uncommon inherited disease. Spontaneous coronary artery dissection [SCAD] is also uncommonly observed, which often occurs in pregnant or post partum women but is rare in men. This report describes a 38 years old man with apical hypertrophic cardiomyopathy who developed SCAD leading to acute inferior myocardial infarction. After emergent appendectomy operation at another hospital, he was immediately transferred to the Cardiology Department of our hospital due to acute myocardial infarction. He emergently underwent coronary angiography which showed a long dissection involving the right coronary. He underwent an emergent CABG with cardiopulmonary bypass. Postoperative recovery was uneventful and he was discharged. According to our knowledge, no case of spontaneous coronary artery dissection associated with apical hypertrophic cardiomyopathy unrelated to postpartum period or oral contraceptive use has been reported so far