Characterization of left atrial geometry and function in patients with hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study.

OBJECTIVE: Left atrial (LA) remodelling is an interesting pathological aspect in hypertrophic cardiomyopathy (HCM) which has not been yet fully understood. Also, a comprehensive evaluation of LA alterations in HCM is still lacking. Cardiac magnetic resonance imaging (cMRI) can precisely characterize LA function and structure. We sought to thoroughly assess LA remodelling using cMRI in patients with HCM. PATIENTS AND METHODS: We enrolled 105 patients with HCM and 105 healthy controls. LA parameters determined by cMRI comprise LA volume (LAV), total ejection fraction (LATF), total strain LA- εt, passive ejection fraction (LAPF), passive strain LA-εe, active ejection fraction (LAAF), active strain LA-εa. LA sphericity index (LASI) and LA strain were also determined. Parameters of LV systolic and diastolic functions were also assessed. RESULTS: LAV and LASI were significantly increased, while LA phasic functions were decreased in patients with HCM (p<.001). LATF was inversely correlated with LV long-axis strain (r= -0.466, p<.0001) and mass (r= -0.515, p<.0001), and as well with filling pressures, described by E/E' (r= -0.424, p<.0001). LA volumes, phasic functions and geometry were negatively associated with LV measurements, whereas a positive correlation between the LATF and LA strain (r = 0.496, p<.0001) was found. In addition, LAV was closely related to diastolic dysfunction severity (p<.0001). CONCLUSIONS: In patients with HCM, all three LA phasic functions were impaired, being directly related to LA enlargement. LASI and LA strain predicted LA reservoir function impairment.

[Early contrast-enhanced MR imaging assessment of femoral head viability after femoral neck fracture]. / Evaluarea precoce a viabilitatii capului femural in fractura de col femural prin RMN cu substanta de contrast.

AIMS: To evaluate the use of MR imaging, before and after i.v. administration of Magnevist, for assessing the femoral head perfusion after femoral neck fracture. Evaluation of femoral head viability is important because the outcome of internal fixation is adversely affected by the development of capital osteonecrosis. METHODS: We performed MRI of the femoral head in 48 hours of injury, on 10 patients with femoral neck fracture. Five patients underwent MR imaging of the hip utilizing fat-suppressed (STIR) sequences and the others, T1-weighted spin-echo sequences before and after i.v. contrast administration. MR findings were correlated with radiographic follow-up for at least 12 months. RESULTS: Radiographic follow-up showed femoral head osteonecrosis in two patients. On contrast-enhanced MR images of these patients, the femoral head did not enhance and was lower in signal intensity than were the enhancing femoral shaft and neck distal to the fracture and the enhancing femoral head on the unaffected side. In the patients with persistent perfusion, contrast-enhanced MR images showed a uniform increase in signal intensity in the femoral shaft and neck as well as the femoral head; the femoral head on the fractured side showed contrast enhancement similar to that on the healthy side. CONCLUSIONS: These preliminary results indicate that contrast-enhanced MR imaging may be useful for noninvasive evaluation of femoral head perfusion after femoral neck fracture. MR findings also may aid the clinician in deciding between joint-preserving therapy and hip arthroplasty.

[Hansson Twin Hook--a new implant technique in trochanteric fractures]. / Osteosinteza cu Hansson Twin Hook--o noua tehnica de osteosinteza în fracturile trohanteriene.

Hansson Hook is an implant developed in Scandinavian countries for femoral neck fractures. Due to the good results given by this technique the implant was developed in order to use it in trochanteric fractures. The hook was doubled and the implant adapted to a plate with barrel, similar with those used in compression screw technique. The new implant is named Omega 2 Hansson Twin Hook and is produced by Stryker Osteonics. In the authors' department five patients with trochanteric fractures were treated using Hansson Twin Hook. According to Evans classification, three fractures were stable and two unstable. The surgical technique is somewhat different than a common compression screw implantation: the incision is smaller, the plate is the first to be implanted, the expanding of the hooks requires special instrumentation. Patients were allowed to walk with full weight the day after the surgery. The postoperative results were very good, both immediately and three months after operation. In conclusion, the authors believe that Hansson Twin Hook is a useful implant in trochanteric fractures and offers a good rotational stability.

[Osteomyelitis, a cause of prolonged fever in adults]. / Osteomielita, cauza de sindrom febril prelungit la adult.

A 35 years old male patient with an unexplained prolonged fever, after serial unsuccessful investigations in 3 different services, suffers a fracture of the lower third of the right femur produced by a minor trauma. This raises the suspicion of a pathological fracture. The surgical intervention and the microbiological exam confirms the existence of an osseous infection with Gram-negative germs, and the clinical course is uneventful after stabilization with an external fixator and appropriate antibiotic therapy. Osteomyelitis, although rare in adults, should be included in the differential diagnosis of any prolonged fever of unknown origin in adults.