Left ventricular hypertrophy and arterial stiffness in essential hypertension.

AIM: The aim of this study was to evaluate the association between an increase in arterial stiffness and the development of left ventricular hypertrophy in essential hypertension patients. MATERIALS AND METHODS: One hundred forty essential hypertension patients were included in the study. Patients were divided into two groups based on echocardiographic measurements; with left ventricular hypertrophy (n=70) and without left ventricular hypertrophy (n=70). The criterion for hypertrophy was accepted as an intraventricular septum and posterior wall thickness in diastole of 11 mm or above. Aortic stiffness values of the patients groups were measured noninvasively by arteriography through the brachial artery. Pulse wave velocity (PWV) measurements were used as indicators of arterial stiffness. RESULTS: When compared to the group without left ventricular hypertrophy, elevated systolic blood pressure, mean blood pressure, and pulse pressure were located in the left ventricular hypertrophy group at a significant level (p > 0.01). A statistically significant difference was not observed in the diastolic blood pressure and pulse measurements of the groups. Pulse wave velocity, the indicator of arterial stiffness, was elevated to a significant degree in the left ventricular hypertrophy group (p > 0.01). While a positive correlation was found between pulse wave velocity and left ventricle mass index, microalbuminuria, high sensitive C-reactive protein (Hs-CRP), and left ventricle end-diastolic volume, a negative correlation was found between pulse wave propagation velocity and left ventricle E/A. CONCLUSIONS: In conclusion, pulse wave analysis is a valuable method for predicting cardiac hypertrophy in essential hypertension (Tab. 6, Ref. 25).

Influence of body height on aortic systolic pressure augmentation and wave reflection in childhood.

The enhanced wave reflection in small children is a well-known phenomenon. It is explained on the basis of differences in the body height and the timing of wave reflection. This hypothesis still has not been proved directly. The aim of our study was to determine the reference values of aortic augmentation index (Aix(ao)) and the simultaneously measured return time of the systolic pulse wave (RT) in relation to the body height to test this hypothesis. Aix(ao) and RT were measured by Arteriograph in a healthy population aged 3-18 years (n = 4619, 2489 males). The Aix(ao) decreased with increasing age in boys from 18.6 ± 8.4% to 4.7 ± 4.3% and in girls from 22.3 ± 9.2% to 8.1 ± 5.1%, whereas the RT increased from 115.5 ± 16.3 ms to 166.7 ± 20.8 ms in boys and from 106.7 ± 21.9 ms to 158.1 ± 15.5 ms in girls. These changes were constant during childhood, but they slowed down after the onset of puberty. Because aortic pulse wave velocity (PWV(ao)) measured in the same population was unchanged during childhood, the increase of RT can only be explained by the increase of aortic length due to growth. In the puberty PWV(ao) starts increasing indicating that RT (Aix(ao)) does not follow the increase (decrease) of aortic length proportionally.

Comparison of arterial stiffness parameters in patients with coronary artery disease and diabetes mellitus using Arteriograph.

Recently an expert consensus document advised to standardize user procedures and a new cut-off value for carotid-femoral pulse wave velocity in daily practice. Our aim was to observe aortic pulse wave velocity (PWVao) and augmentation index (AIXao) in two high cardiovascular risk groups: patients with verified coronary artery disease (CAD) or with type 2 diabetes mellitus (T2DM). We also aimed to determine the cut-off values for PWVao, AIXao in CAD and T2DM patients using oscillometric device (Arteriograph). We investigated 186 CAD and 152 T2DM patients. PWVao and AIXao increased significantly in the CAD group compared to the age-, gender-, blood pressure-, and heart rate-matched control group (10.2+/-2.3 vs. 9.3+/-1.5 m/s; p<0.001 and 34.9+/-14.6 vs. 31.9+/-12.8 %; p<0.05, respectively). When compared to the apparently healthy control subjects, T2DM patients had significantly elevated PWVao (9.7+/-1.7 vs. 9.3+/-1.5 m/s; p<0.05, respectively), however the AIXao did not differ significantly. The ROC-curves of CAD and healthy control subjects explored cut-off values of 10.2 m/s for PWVao and 33.23 % for AIXao. Our data provide supporting evidence about impaired arterial stiffness parameters in CAD and T2DM. Our findings encourage the implementation of arterial stiffness measurements by oscillometric method in daily clinical routine.

[Gastric and duodenal intramural hematoma: report of two cases]. / A gyomor és duodenum intramuralis haematomája: két eset ismertetése.

Two cases of intramural hematoma arising in the duodenum and the stomach are reported. Both patients were male, aged 40 and 58 years, and suffered from chronic pancreatitis. Hematoma of the duodenal wall may have resulted from the acute exacerbation of the chronic pancreatitis in the first patient. As to the second case, continuous administration of Colfarit following myocardial infarction may have been causal to the gastric lesion. The initially suspected diagnosis in the first case, was pancreatic pseudocyst with obstruction of the duodenum while in the second case the gastric hematoma imitated a submucosus neoplastic process. The authors review clinical symptoms and therapeutic approaches of intramural hematomas of the proximal gastrointestinal tract. Literature data regarding etiology and therapy are presented.

[Changes in approach to the delivery of dysmature infants following the introduction of Doppler flowmetry]. / A Doppler-flowmetria bevezetését követö szemléletváltozás a dysmaturus magzatok szülésvezetésében.

The authors studied the clinical history dysmature newborns delivered between 1982-1988. Since the middle of 1985 the fetal circulation in each case has routinely been followed by Doppler flowmetry. With this direct assessment of fetal circulation it is possible to diagnose intrauterine growth retardation and pathologic deviations of fetal circulation at earliest. As a result of this the authors have found an increase in the frequency of terminated pregnancies and caesarean sections. The ratio has been shifted towards pre and dysmature newborns. But on the other hand the frequency of intrauterine deaths has decreased. In all those cases where the dysmature newborn died during the perinatal period there were pathologic flow parameters, as well as malformations in some cases. Further prospective clinical studies of neurological development and disorders of dysmature newborns and children are necessary to decide whether our new point of view has been right or wrong.

Reverse flow in the human fetal descending aorta as a sign of severe fetal asphyxia preceding intrauterine death.

Flow velocity waveforms (FVW) in the descending part of the human fetal aorta were monitored in 35 cases of severe intrauterine growth retardation (IUGR) showing pathological intrauterine circulation (end-diastolic block). In 5 of the 35 fetuses, reversed aortic flow was observable during diastole and the simultaneously recorded CTG findings were pathological. All 5 fetuses having this circulatory sign died in utero within the next day. Controls were 260 healthy fetuses with normal growth curves; no end-diastolic block or reverse flow was found in this group. Diastolic reverse flow in the fetal descending aorta appears to reflect severely altered circulation preceding imminent fetal death.

Childhood rhabdomyosarcoma in otorhinolaryngology.

Two cases of childhood rhabdomyosarcoma with otorhinolaryngological localization are reported and the literature of this rare malignancy is reviewed. The prognostic importance of localization, early diagnosis and combined surgical, irradiation and cytostatic treatment are emphasized.